WEBVTT 00:00.460 --> 00:02.860 At this time, 00:08.400 --> 00:11.260 I would like to thank 00:11.260 --> 00:06.700 our Claude and 00:06.700 --> 00:11.540 Vaughniltis outstandingly 00:11.540 --> 00:37.780 Dr. Nathan offered to come to lecture on a few different topics that I think are really 00:37.780 --> 00:42.420 important and this is the first lecture of three that he's going to be presenting here at the 00:42.420 --> 00:47.900 hospital. This one is on chronic pain. There's also going to be one on autism and then there's 00:47.900 --> 00:53.940 also going to be one on neurodegenerative diseases, multiple cirrhosis, Parkinson's and these are 00:53.940 --> 01:00.660 there's one in January, one in February, one in March. Before Dr. Nathan begins I just wanted 01:00.660 --> 01:08.220 to point out that we do have a new calendar. I have a large calendar for well there are brochures 01:08.220 --> 01:12.780 available. There are brochures available here at the hospital in different places around town, 01:12.780 --> 01:19.660 hopefully the Chamber of Commerce, that lists the ongoing education here. There are fitness classes 01:19.660 --> 01:25.260 and then there are also lectures and support groups and they're all intended to be free or 01:25.260 --> 01:31.860 low-cost. So all the lectures here at the hospital are free and if you don't want to come and pick 01:31.860 --> 01:42.220 up a paper copy you can go online to ncdh.org slash calendar. So it's there also and without 01:42.220 --> 01:52.140 much further information I'd like to say please welcome Dr. Nathan. Thank you. Well good evening 01:52.140 --> 02:07.460 everybody. I'm Neil Nathan. I've much before being called Neil to Dr. Neil or Dr. Nathan or most anything else. I am working these days at 02:07.460 --> 02:15.860 Gordon Medical Associates which is an alternative health clinic in Santa Rosa and I go down there on 02:15.860 --> 02:23.140 Mondays and Tuesdays. I stay overnight in Santa Rosa because I live here in Fort Bragg and I have we 02:23.140 --> 02:29.900 have opened a branch at Gordon Medical at the Women's Health Center and it's Dr. Abramson and 02:29.900 --> 02:37.820 got an ex-opist here and I do work there on Thursdays. We are getting busy so we will probably 02:37.820 --> 02:47.620 expand that very soon. And so let me give you a little background about who I am and what I do. I was told I needed to tell you about the wellness 02:47.620 --> 02:58.820 series. So this is the first of three lectures that I'll be giving. On February 11th I'm going to be giving a talk on autism and that will also include 02:58.820 --> 03:09.500 information on ADD and ADHD. Basically it's all in a spectrum and we're going to talk about how to look at it from a whole different 03:09.500 --> 03:20.420 perspective. Not the Rilland perspective but in terms of the biochemical imbalances that cause that and what we can do to treat that because it's really 03:20.420 --> 03:32.780 treatable and it's important I think that the public know that. The third lecture will be March 18th and we're going to talk about what is called neurodegenerative diseases. 03:32.780 --> 03:43.860 That's a horribly complicated word and really it means multiple sclerosis, Parkinson's disease and almost anything that causes some deterioration of the nervous system 03:43.860 --> 03:58.260 and what we can do about it. Now my perspective will be alternative. It's to expand your awareness of things that are not in conventional medicine and that's what I'm 03:58.260 --> 04:09.660 going to do to a certain extent today. Today's lecture will be a tad more conventional than others but my hope is to simply expand your knowledge of what it is we think we know. 04:09.660 --> 04:26.460 As we, I name the medical profession. That's kind of what I'm hoping to do. A brief discussion of who I am. I came to the Medecino Coast back in 1974. 04:26.460 --> 04:37.060 I'm an intern at San Francisco General Hospital and I worked here from 74 to 79 here at the hospital. I delivered babies, I did surgery, I worked in the emergency room. 04:37.060 --> 04:45.660 I was even Chief of Staff for a year during that period of time. So the fact that I'm back on the coast, people go, how did you find Medecino? 04:45.660 --> 04:57.060 I'm not sure my heart ever left Medecino. I kind of always knew I'd come back and here I am. I'm back with my wife, three dogs and a cat. 04:57.060 --> 05:10.660 My kids are all grown up and they love coming back also. So it's really a joy to be back here. A brief discussion of why do I think I'm knowledgeable enough about pain to give this talk. 05:10.660 --> 05:24.660 After my work as a family physician, and I am board certified in family medicine, I'm board certified in pain management and I'm also board certified in holistic medicine. 05:24.660 --> 05:34.660 After my start in conventional medicine, I became really interested in helping people at a deeper level. 05:34.660 --> 05:44.660 And back in the 70s when I was here, I used probably every cent I made, I went running around the country to study with anybody who had something to teach. 05:44.660 --> 05:58.660 And I studied a whole lot of things that I didn't think were very valuable, and I studied a whole lot of things that were. And I'm trying to distill through my studies what works and what doesn't work. 05:58.660 --> 06:08.660 I'm very practical, which is the only truth that matters to me, is whether my patient is getting better. If they are, then I have something valuable to offer them. 06:08.660 --> 06:18.660 If they're not, it's simply verbal conjecture and hypothesis guessing. And I don't think that's very helpful. 06:18.660 --> 06:28.660 So the truth of anything that I say is always in how my patients do. And I'm pretty hard nosed about my results. 06:28.660 --> 06:40.660 So that when people are not getting better, I'm often the first in our relationship to go, you know, what I'm doing is not working. We need to take another tack. We need to look at it differently. 06:40.660 --> 06:48.660 And that's the approach that I take to what I'm doing. So over the years, I got really interested in a whole lot of alternatives. 06:48.660 --> 06:59.660 And I studied acupuncture, osteopathic manipulation, and although I am an MD, I have 35 years of osteopathic training under my belt. 06:59.660 --> 07:08.660 Homeopathy, a whole lot of biochemical evaluations, prolotherapy, which we'll talk about today. 07:08.660 --> 07:23.660 And over a period of time, my practice evolved into, it became more and more obvious that the best use of my time was to work with people that other people didn't know what to do anything for. 07:23.660 --> 07:41.660 My bag of tricks or tools became big enough that I began to treat people that the word I used for it, fall through the medical cracks, where they'd seen specialists, they'd seen other people, did not know what to do next. 07:41.660 --> 07:54.660 And I sort of was the next step. Some people even started calling me the last resort, but I said, no, that's Vegas, Meno, Barbados. That's not who I am. 07:54.660 --> 08:08.660 And then it evolved into even more of that. So it got to the point that my last leg of my journey, I was in Missouri where I had run Dr. Norm Shealy's pain clinic for a number of years. 08:08.660 --> 08:14.660 It got to the point that really all I did was treat people that other people didn't quite know what to do. 08:14.660 --> 08:24.660 And so it wasn't really the best use of my time to treat sore throats and bladder infections and things like that, you know, any of my colleagues could do that. 08:24.660 --> 08:35.660 When it came to pain, I got involved with Norm Shealy, who some of you may have heard of, and most of you may not, who was a neurosurgeon who developed some of the first pain clinics in the country. 08:35.660 --> 08:43.660 And I worked with Norm when he was in La Crosse, Wisconsin. And then later on he invited me to come work with him in St. Philip, Missouri. 08:43.660 --> 08:51.660 Before that, I had run a regional pain clinic inpatient in Duluth, Minnesota for eight years. 08:51.660 --> 09:01.660 And that means that we have patients with chronic pain problems who stayed with us in the hospital for four weeks at a time while we figured out what they had and what to do about it. 09:01.660 --> 09:15.660 And we use a process that is what in general is right now where you have a team of people, which include psychologists, physical therapists, massage therapists, occupational therapists. 09:15.660 --> 09:24.660 It's a whole team of people that analyze the patient from every way possible to figure out what is this individual need and how can we give that to them. 09:24.660 --> 09:32.660 And that's the model that has evolved over the years into how to treat chronic pain when you don't quite know what to do next. 09:32.660 --> 09:44.660 So over the years I have treated thousands of people with chronic pain and have evolved my own understanding of what that means and how to do it. 09:44.660 --> 09:53.660 So tonight what I'd like to share with you is my perspective on pain, which includes acute pain, which we'll talk about for a while. 09:53.660 --> 10:07.660 Chronic pain. And that means both an understanding of the principles of treating it and then I'd like to talk about specific things that you may or may not have heard of, of newer things that we have available that can help to treat pain. 10:07.660 --> 10:16.660 So my perspective is if we have to, you may have to learn to live with your pain. 10:16.660 --> 10:25.660 But most of the time we can not only make it better or fix it. And unfortunately that is not the basic attitude in medicine today. 10:25.660 --> 10:35.660 The basic attitude of my colleagues is I don't have time to evaluate it and they usually don't have the skills to evaluate it. 10:35.660 --> 10:40.660 So I'm going to give you some medication and then you'll go away for at least a while and then you can come back. 10:40.660 --> 10:48.660 The problem with that concept is it doesn't work. At best medication will take the edge off pain. 10:48.660 --> 11:03.660 It is not a cure because it does not address cause. And so the big issue if you leave tonight with only one understanding, it's, and this is true not just for pain but anything, is you have to have a really clear diagnosis. 11:03.660 --> 11:13.660 That means what is causing this pain? And by that the current term in pain clinics is you have to find the pain generator. 11:13.660 --> 11:22.660 Fancy word for what's causing this pain. Where's it coming from? And by that I mean what tissue or tissues is causing the pain? 11:22.660 --> 11:34.660 Is it joint, bone, ligament, tendon, nerve or combinations of the above? You really have to be precise about it. 11:34.660 --> 11:45.660 And one of my biases that made me kind of a maverick or renegade in the field is that many, many conventional specialists don't believe that you can make that diagnosis. 11:45.660 --> 11:55.660 And so I'm going to start out with a very brief discussion of the basic concept of how my profession use acute low back pain. 11:55.660 --> 11:59.660 And we're going to go from that to the evolution of product pain and how that works. 11:59.660 --> 12:14.660 And I'm going to toss in a study that we did when I was in Springfield, Missouri, which I hope will prove my point. Not that the study is preventing it, but whatever. 12:14.660 --> 12:27.660 Okay. Pain is really important now. In the last two years it is now considered in hospitals the fifth vital sign along with temperature, blood pressure, pulse and respiration. 12:27.660 --> 12:35.660 Now hospitals are required to document and log the amount of pain that people experience. And here's the problem. 12:35.660 --> 12:49.660 Pain is absolutely totally subjective. So we can't define it. You have to define it. And we do it by simply having people have a 0 to 10 scale. 12:49.660 --> 12:58.660 And you either draw a number or give a number of how much your pain is, with 10 being the worst pain you could imagine and 0 is not. 12:58.660 --> 13:05.660 And then we log that in throughout someone's hospital stay and we determine therefore how we do it. 13:05.660 --> 13:15.660 Simple and important. Again, pain is completely subjective. It is always real. 13:15.660 --> 13:23.660 Malamering is rare, but embellishment happens sometimes. That's just human nature. 13:23.660 --> 13:36.660 But I really want to emphasize that. One of the things that plagues my profession is an obsession with not wanting to give medications or drugs or treatment to people who are malingering. 13:36.660 --> 13:43.660 And many people who are not in the pain field are not aware that malingering is really rare. 13:43.660 --> 13:53.660 In the eight years that I ran an inpatient pain clinic, I found three malingers total. And my whole...it's just rare. 13:53.660 --> 14:03.660 And many physicians are obsessed with the fear that someone will put something over on them and get medication that's not truly warranted. 14:03.660 --> 14:13.660 And I can tell you that by statistics in every other way possible, pain is real. Whatever someone tells me they're experiencing, I have no reason to doubt it. 14:13.660 --> 14:21.660 And if it eventually shows that that's not the case, so be it. They have no reason to doubt the reality of someone's pain. 14:21.660 --> 14:29.660 And that's just really important. I hope you all understand and accept that. That all pain is real. It's not in people's heads. 14:29.660 --> 14:35.660 It's real. Does the head process it? Yes. 14:35.660 --> 14:42.660 There are three kinds of pain. Acute, chronic, and relapsing or recurring pain. 14:42.660 --> 14:52.660 And often we really work to distinguish them because there's a big difference in the treatment between acute pain and chronic pain. 14:52.660 --> 15:00.660 We'll talk about that in more detail later. But they're carried on different nerve fibers, they're experienced by the body differently, and they're treated differently. 15:00.660 --> 15:05.660 It is much, much, much easier to treat acute pain than much harder to treat chronic pain. 15:05.660 --> 15:15.660 Once it becomes chronic, the nerves move into a series of cycles, which we will go over in more detail, and the cycles are harder to break. 15:15.660 --> 15:25.660 However, a lot of people get immediately lumped as having chronic pain, what they really have is acute relapsing pain, 15:25.660 --> 15:29.660 and that behaves like acute pain that needs to be treated more aggressively. 15:29.660 --> 15:38.660 And the reason this is important is that often if someone, if a physician hears that you have had pain for 10 years, 15:38.660 --> 15:48.660 they're likely to assume that you have chronic pain and not treat it effectively and may not therefore make the right choices in terms of what's really going on. 15:48.660 --> 15:54.660 So taking the time to really get a good history from a patient is always important. 15:54.660 --> 16:04.660 And it's not true so much here on the coast, but in HMO clinics where I have work in communities where HMOs have the majority of health care, 16:04.660 --> 16:18.660 Kaiser for example, which some of you may belong to, the physician usually doesn't have time a lot to actually do the kind of job you have to do to listen and get the information that we need. 16:18.660 --> 16:22.660 And that's really unfortunate, and it leads to unfortunate things. 16:22.660 --> 16:28.660 So again to emphasize it, treatment begins with a clear diagnosis. 16:28.660 --> 16:35.660 Without that, we are sitting in the dark, and although I am a good guesser, I am way better at what I do when I know what I do. 16:35.660 --> 16:38.660 It seems like that would be. 16:38.660 --> 16:40.660 Simple and reasonably obvious. 16:40.660 --> 16:50.660 So the interesting question is, you may not even know it's a question, is that can a diagnosis, a clear diagnosis of where the pain is coming from be made? 16:50.660 --> 16:59.660 And you may be surprised to discover that the position of the medical establishment is that it can't. 16:59.660 --> 17:07.660 Deo, who is a well-known writer on the subject of low back pain, has written the position paper of the medical establishment. 17:07.660 --> 17:15.660 It says that 85% of people with low back pain cannot be given a diagnosis of where it's coming from. 17:15.660 --> 17:20.660 Wow, they're pretty prominent. Well, we do, if that's the case. 17:20.660 --> 17:26.660 And in fact, this is taken from Essentials of Orthopedic Medicine. It is the orthopedic textbook. 17:26.660 --> 17:33.660 This is mechanical low back pain, and this is how it is diagnosed. 17:33.660 --> 17:40.660 So if you have pain in that area, you have, by orthopedic standards, mechanical low back pain. 17:40.660 --> 17:48.660 And the numbers of tissues in that area are, there are dozens of different tissues that cause that pain. 17:48.660 --> 17:56.660 And if you believe that you can't make a diagnosis, that's as good as you can do, localizing pain, then you probably shouldn't be treated. 17:56.660 --> 18:05.660 If I didn't say it before, you'll discover I'm quite an opinionator, so I'll be firing those off this week. 18:05.660 --> 18:17.660 The Agency for Healthcare Research and Quality, which is nicknamed AHRQ, is the federal agency that determines guidelines by which physicians should practice. 18:17.660 --> 18:24.660 So this is what most physicians are looking at as their guideline about what they should and should not do. 18:24.660 --> 18:28.660 Now, leave it around, I'm not making this up. 18:28.660 --> 18:41.660 The focus is on detecting red flags. Now, red flags means we don't want to miss really serious things that could reflect itself as low back pain. 18:41.660 --> 18:57.660 And those red flags are metastatic disease, meaning metastatic cancer, disc protrusion, where the nerve is being pinched and we are losing function of a leg or another body part because the nerve is being pinched. 18:57.660 --> 19:05.660 Spinal stenosis, where the actual cord is being pinched or compressed so the nerve, again, nerve function is being cut off. 19:05.660 --> 19:10.660 Loss of bowel or bladder and a loss of sensation or strength. 19:10.660 --> 19:24.660 Those are big deals and by all my guideline criteria, do those matter? Absolutely not. Does it happen very often? No. Right? 19:24.660 --> 19:38.660 So by those criteria, if a patient does not have red flags, and I assure you that the vast, vast, vast majority of patients, talking 98 plus percent, if they have low back pain, do not have a red flag. 19:38.660 --> 19:44.660 So if you don't have a red flag, this is the standard of care that is espoused by conventional medicine. 19:44.660 --> 19:53.660 It is imaging studies, meaning x-rays or MRIs or CT scans are not recommended for at least four weeks. 19:53.660 --> 20:00.660 The treatment recommended are NSAIDs, which basically mean mesononesteroidal endoclavities. 20:00.660 --> 20:09.660 That means aspirin, botrin, aloe. Their spinal manipulation have been shown to be useful. 20:09.660 --> 20:14.660 Other medications are not recommended or warranted by their assessment. 20:14.660 --> 20:23.660 So stronger pain medications, muscle relaxants, those are not on the list of what is the accepted way of treating acute low back pain. 20:23.660 --> 20:28.660 Bed rest for more than four days is not helpful. I agree with that. 20:28.660 --> 20:33.660 And the sooner you can get someone active, the better it is for them. And I agree with that too. 20:33.660 --> 20:43.660 We do know that the sooner you get around and start moving, if you have an acute back injury, the better it is for you. Those are true. 20:43.660 --> 20:50.660 And I want to call attention to this, and I only put one of these slides on. I have a whole bunch more of them. 20:50.660 --> 20:58.660 I didn't want to get too carried away with it. But the important thing to take away is if you have acute low back pain, 20:58.660 --> 21:07.660 there is 10% of patients will not get better in four to six weeks and will ultimately go on to get chronic pain. 21:07.660 --> 21:17.660 In addition, over 50% of people who have an acute episode of back pain, within six months to a year, will have another episode, 21:17.660 --> 21:21.660 and most of those will go on to get chronic pain. 21:21.660 --> 21:27.660 What I mean by that, and these are not my statistics, this is well documented in the medical field, 21:27.660 --> 21:40.660 is that if you don't treat acute pain quickly, properly, and well, there is a really good chance it will become chronic and it will keep coming back. 21:40.660 --> 21:48.660 However, according to the experts, you can't make a diagnosis of what's causing it 85% of the time, 21:48.660 --> 21:57.660 and the treatment is take some aspirin or Aleve or see a chiropractor or osteopath and don't come back for four weeks, and then we'll talk about it. 21:57.660 --> 22:05.660 So we know that if you don't do anything, it's likely to become chronic, but there's not much you can do. 22:05.660 --> 22:14.660 That's the medical model we're working with, and part of my message tonight is I don't believe that that's true at all. 22:14.660 --> 22:18.660 So let me talk for just a few minutes about pain generators. 22:18.660 --> 22:21.660 Where does pain come from? 22:21.660 --> 22:28.660 Well, it comes from the joints between the vertebrae. 22:28.660 --> 22:33.660 It comes over here as well, through the sacroiliac joints. 22:33.660 --> 22:41.660 It comes from the ligaments, and I'll go into these in a bit more detail, the ligaments through here. 22:41.660 --> 22:47.660 It comes from tendons, muscles, and anything that's there can generate pain. 22:47.660 --> 22:56.660 So our job is what does the being who is in front of us have? 22:56.660 --> 22:59.660 Why do they hurt? 22:59.660 --> 23:08.660 And I would submit to you that it is possible to determine that with accuracy and do something about it, and thereby prevent chronic pain. 23:08.660 --> 23:18.660 So the first step of preventing chronic pain is to treat acute pain as properly as we possibly know how. 23:18.660 --> 23:28.660 This was a theory of mine for many years, and I decided eventually to get off my tail and prove it. 23:28.660 --> 23:37.660 So one of the things I did when I worked in Springfield, Missouri is I took a job, another job, I didn't already have a day job, 23:37.660 --> 23:50.660 but I went to work with an occupational health clinic who had a captive audience that they took care of the majority of people who worked for the largest corporations in Springfield, Missouri. 23:50.660 --> 23:55.660 Those patients had to come to this clinic for health care if they got injured on the job. 23:55.660 --> 24:01.660 So if they had back pain, they had to see the clinic. If it came back, they had to see the clinic. 24:01.660 --> 24:14.660 And so this was to me a great way to be able to follow people for several years to see if treatment that we gave actually resulted in not getting injured again, 24:14.660 --> 24:20.660 not having pain again, and not becoming chronic, because it was a captive audience. They weren't going anywhere else. 24:20.660 --> 24:29.660 And my job at the clinic was to treat the people that weren't getting better by the other practitioners who worked in the occupational health clinic. 24:29.660 --> 24:35.660 So it was, understand that the people that are in this study were not your ordinary back problems. 24:35.660 --> 24:44.660 These were the problem back problems, the ones that weren't responding to the simpler measures that were provided by my colleagues at the occupational health clinic. 24:44.660 --> 24:53.660 So these numbers are a bit skewed. And by a bit skewed, I mean these are the worst patients that I've got here, because that was my job. That's what I did. 24:53.660 --> 25:10.660 And it is my contention that you can diagnose where pain is coming from. And what we discovered was that in people who had 243 consecutive low back injuries, 25:10.660 --> 25:18.660 and no one was eliminated from the study. One of my pet peeves with doing research studies is a lot of people doctor the numbers so they get better numbers. 25:18.660 --> 25:28.660 There's no doctoring. Every single person who I saw was included in the study. Whether I like the outcome or not, you know, that's the nature of what I call decent research. 25:28.660 --> 25:38.660 Interestingly, the vast majority came from the sacroiliac joint. In a few moments I'll tell you how did I determine that with precision. We'll talk about that. 25:38.660 --> 25:52.660 And the second most common is the piriformis muscle. We'll talk about that muscle and why it's important. The quadratus muscle, pain coming from a rib head where a rib joins the spine. 25:52.660 --> 26:01.660 Other muscles. And you'll notice that there's a lot more than 100% here. And that's because some people have more than one of those components. It's not all one. 26:01.660 --> 26:15.660 So that's where most of the pain comes from. Rarer, herniated discs, which is what a lot of people focus on in evaluating a low back, is an obsession with the disc. 26:15.660 --> 26:25.660 And this study, by the way, my study echoes every other study that's ever been done on this. So that a 3% incidence of herniated disc is standard in the medical field. 26:25.660 --> 26:38.660 So despite the obsession that we have with ruling out a disc, it's not common. 97% of the time it's not a disc. A facet joint is a possibility. 26:38.660 --> 26:51.660 Ileo rotation, which means the hips are rotated. Some of you may hear that phrase from chiropractors who tell you that someone is out of place. 26:51.660 --> 27:01.660 That means that when you examine them, one leg is shorter than the other, but that's because the hip is rotated. And the technical term for that is just ileo rotation. 27:01.660 --> 27:10.660 Then we have several types of bursitis, which I'll talk about. Sacro coccidial injury, which just means tailbone injury. Sorry for the medical terms. 27:10.660 --> 27:17.660 I used these slides in some medical presentations some time back. The ileo lumbar ligament, which we'll show you. 27:17.660 --> 27:26.660 And spinal stenosis is really rare. In all of those patients, only 0.5% of people have that, either. 27:26.660 --> 27:35.660 So really what we're talking about is the vast, vast, vast majority of our patients had a strain injury to the sacroiliac joint and the muscle surrounding it. 27:35.660 --> 27:38.660 That's really the simple part of it. 27:38.660 --> 27:47.660 So let me just give you a better visual picture of what I'm talking about when I throw these words around. 27:47.660 --> 27:54.660 So this is the quadratus lumborum muscle right here. It's a big, thick muscle sitting back here. 27:54.660 --> 28:02.660 It's what a lot of people think of as their back muscle. But we don't have a back muscle. We have lots and lots of names for stuff. 28:02.660 --> 28:11.660 So this is our name for it. And what I'm going to show you in these drawings here is that each muscle in the body has what are called trigger points. 28:11.660 --> 28:16.660 Trigger points are the place where the artery and the nerve enter the muscle. 28:16.660 --> 28:26.660 And when a muscle has been tight for a long time, the trigger point acts up and becomes a tender nodule, which you can palpate and feel. 28:26.660 --> 28:29.660 It is not mystical. It is easily palpated. 28:29.660 --> 28:33.660 The deep trigger points radiate pain to this area. 28:33.660 --> 28:42.660 So if you have sacroiliac pain, you don't know is it coming from the sacroiliac joint? Is it coming from something around it? 28:42.660 --> 28:51.660 Pain in these spots shoots to these areas. So that means you actually have to examine somebody to find out where pain is coming from. 28:51.660 --> 29:01.660 Another pet peeve. The majority of people that I have seen as a pain specialist have never been examined, even by the specialist that they've seen. 29:01.660 --> 29:08.660 And never is a strong term. I cannot count the number of people that when I do my initial evaluation on it, they'll say, you know, 29:08.660 --> 29:14.660 I've seen orthopedic surgeons. I've seen neurosurgeons. I've seen physiatrists. I've seen rheumatologists. 29:14.660 --> 29:23.660 Nobody actually touched it. They put the MRI scan up. They put up the x-rays. They would look at the studies, the water and EMG. 29:23.660 --> 29:31.660 Nobody examined it. I do not understand that. This is the only way you can tell where things are coming from. 29:31.660 --> 29:38.660 So if someone hurts here and they hurt here, these may be connected events. But by no means is this impossible to diagnose. 29:38.660 --> 29:45.660 I think this is... I'm sorry. Okay. I'm going to get off my pen right again. 29:45.660 --> 29:51.660 Now the superficial trigger points here radiate pain to these areas. 29:51.660 --> 29:59.660 Now what that... I'm talking about radiation patterns. That means where you hurt may not be where the problem is. 29:59.660 --> 30:09.660 It could be a little bit away from that and you need to know the anatomy and the structure in order to know where we're looking at. 30:09.660 --> 30:19.660 Now, high on my list of diagnostic importance was this muscle here called the piriformis. 30:19.660 --> 30:27.660 It goes from the sacrum, which is the stick-wad of bone that attaches to the glute and attaches to the hip right at the top. 30:27.660 --> 30:39.660 And the piriformis muscle is one of the most uniquely important muscles because the sciatic nerve runs through it. 30:39.660 --> 30:47.660 And what that means is that 80% of the time when people complain of sciatica or pain shooting down their leg, 30:47.660 --> 30:54.660 it is not coming from the disc, which is where everybody looks. It's coming from the back. 30:54.660 --> 30:59.660 Because that's where the piriformis is. It runs smack across the body. 30:59.660 --> 31:09.660 So if that muscle has tightened up to protect the sacroiliac joint or to protect anything around it because that's what muscles do, 31:09.660 --> 31:12.660 they try to protect us. They tighten up to try to protect us. 31:12.660 --> 31:17.660 If it tightens up to protect us, it may pinch the sciatic nerve called sciatica. 31:17.660 --> 31:24.660 So when we see sciatic pain, actually this is the most common cause by far. 31:24.660 --> 31:34.660 Nothing else comes close and is often overlooked and missed and not discovered by my profession. 31:34.660 --> 31:39.660 So it's really important to...not that you need to know this anatomy. 31:39.660 --> 31:43.660 This is not going to be a pop quiz or anything after this. 31:43.660 --> 31:48.660 It's just so you get a better feel. What I'm going to be covering here is a whole system. 31:48.660 --> 31:54.660 And I want to sort of flush out this system so you get the idea of all the muscles and nerves and ligaments 31:54.660 --> 32:00.660 and the kinds of things that we want to look at in order to make a good diagnosis and treat it properly. 32:00.660 --> 32:07.660 So this is just an example because low back pain is probably one of the most common things that anyone ever goes to the doctor for. 32:07.660 --> 32:14.660 Another muscle in place here is called the iliopsoas muscle. Now that's made up of two muscles. 32:14.660 --> 32:20.660 The psoas, which starts oddly enough way in the back on the spine. 32:20.660 --> 32:24.660 It's the only muscle in the body that starts in the back and comes out in front. 32:24.660 --> 32:28.660 And it comes out into the front right into the groin here. 32:28.660 --> 32:38.660 So that's the psoas. And the fibers connect with the iliacus muscle which is in the pelvic brim here. 32:38.660 --> 32:44.660 So that contains a muscle. Important here is the piriformis, which I just told you about. 32:44.660 --> 32:49.660 And the psoas are antagonists and they work together. 32:49.660 --> 32:53.660 So as a general rule, if one goes out, the other goes out. 32:53.660 --> 33:02.660 And that's why you kind of have to look at both to know what you're looking at because it is extremely common for both to be out of whack because they work together. 33:02.660 --> 33:07.660 It's not, again, it's not a hard thing to figure out. 33:07.660 --> 33:17.660 There's another muscle that starts up at the top of the hip and comes all the way down to the side of the knee. 33:17.660 --> 33:24.660 And these are the radiation point areas for some of these muscles. So these are the trigger points. 33:24.660 --> 33:30.660 And again, you can see, you can get pain in your thigh and you can go, well, what's causing that? 33:30.660 --> 33:35.660 But it's simply a muscle which is not too far away. 33:35.660 --> 33:42.660 I'm going to just, again, these are other muscle groups that we look at. 33:42.660 --> 33:46.660 I'm going to move on into other areas. 33:46.660 --> 33:52.660 What I want to call your attention to is this thick ligament in here, which is the thickest ligament in the body. 33:52.660 --> 33:55.660 It's the posterior sacroiliac ligament. 33:55.660 --> 33:57.660 Again, no problem quiz. 33:57.660 --> 34:02.660 This is what holds the stability of the back together. 34:02.660 --> 34:08.660 What many people don't know is that all joints in the body are basically held together by ligaments. 34:08.660 --> 34:10.660 That's where the strength is. 34:10.660 --> 34:11.660 All right? 34:11.660 --> 34:15.660 So that's true for your knee and it's true for your low back. 34:15.660 --> 34:22.660 And so where the body needs to have tremendous stability, like in the low back area, it builds a thick one. 34:22.660 --> 34:23.660 All right? 34:23.660 --> 34:28.660 The angelic engineering crew figured this out long, long ago and that's how they designed it. 34:28.660 --> 34:29.660 That's how it works. 34:29.660 --> 34:33.660 So this particular ligament is the thickest and strongest one in the body. 34:33.660 --> 34:38.660 And there's a couple of others here, and I'm pointing them out just so you understand a little better. 34:38.660 --> 34:44.660 These are called the ilio lumbar ligaments, which attach to the lower vertebrae and they attach in here. 34:44.660 --> 34:49.660 So you can imagine that this holds this whole joint here together. 34:49.660 --> 34:59.660 The other thing that I will just point out because we'll see it again is these joints in here are called facet joints. 34:59.660 --> 35:03.660 And oddly enough, in the spine we give a different name to joints. 35:03.660 --> 35:10.660 It's almost like, because the word facet just means joint, so it's a little bit like the Department of Redundancy Department. 35:10.660 --> 35:12.660 It's called a joint joint. 35:12.660 --> 35:15.660 It's a different word so most people don't realize it. 35:15.660 --> 35:18.660 Those are the joints that give the spine its mobility. 35:24.660 --> 35:26.660 Okay. 35:26.660 --> 35:34.660 So the reason I've given you this anatomy lesson is to help you understand how we go about to make the diagnosis. 35:34.660 --> 35:40.660 I've said that it is my belief that we can precisely identify where pain is coming from. 35:40.660 --> 35:44.660 First of all, we can if we actually touch in the mix. 35:44.660 --> 35:50.660 When you actually touch a body, you can tell that there's pain in the sacroiliac joint. 35:50.660 --> 35:54.660 You can tell if the ligaments hurt. You can tell if the spine is painful. 35:54.660 --> 35:57.660 You can feel the muscles. You can feel trigger points. 35:57.660 --> 36:02.660 It's all available to us by just putting our hands on an individual who's in pain. 36:02.660 --> 36:08.660 But second of all, if we want to know where it's coming from, let's take the sacroiliac joint, 36:08.660 --> 36:10.660 which is this big, long joint right in here. 36:10.660 --> 36:13.660 It's a very long, complicated joint. 36:13.660 --> 36:25.660 So many other tissues are near it that it really helps to know is the pain coming from that or from the tissues around it. 36:25.660 --> 36:31.660 For example, if you hurt here, is that pain coming from the sacroiliac joint? 36:31.660 --> 36:35.660 Is it coming from the ilioelumbar ligament, which is just above it? 36:35.660 --> 36:38.660 Is it coming from the facet joint, which is right over here? 36:38.660 --> 36:44.660 Is it coming from that quadratus lumborum muscle, which is just above it that I showed you a few minutes ago? 36:44.660 --> 36:49.660 So it's not as, I'm not trying to say it's simple, but we have to at least ask the questions. 36:49.660 --> 36:54.660 Okay, I can tell that you hurt right here and that's over your sacroiliac joint. 36:54.660 --> 36:57.660 But where is the pain generated? 36:57.660 --> 36:59.660 That first question keeps coming back. 36:59.660 --> 37:07.660 And so the method that we have used for years is we inject into that area to see if that takes the pain away. 37:07.660 --> 37:09.660 Here's the supposition. 37:09.660 --> 37:15.660 If I inject this spot and only that spot, then someone's pain goes away immediately. 37:15.660 --> 37:17.660 And I mean pretty much completely. 37:17.660 --> 37:20.660 I know with absolute precision the death's where it's coming from. 37:20.660 --> 37:23.660 It's not coming from the muscle because I ain't going to hear the muscle. 37:23.660 --> 37:25.660 It's not coming from the facet. 37:25.660 --> 37:28.660 It's not coming from the ilioelumbar joint because I'm not there. 37:28.660 --> 37:36.660 If I can get the pain to go away and I know where it's coming from, then I know exactly what I need to do to treat that. 37:36.660 --> 37:42.660 So that's the basic process by which I generated all of those numbers on that research study. 37:42.660 --> 37:43.660 Yes? 37:43.660 --> 37:45.660 Inject what? 37:45.660 --> 37:56.660 Usually, the answer varies actually, but usually it is either a penicillin, which is marquise, or cortisol, or both. 37:56.660 --> 38:01.660 It depends on what I'm trying to achieve and what I think is going on. 38:01.660 --> 38:05.660 Diagnostically, all I need is the marking, which is a local anesthetic. 38:05.660 --> 38:08.660 And if it works, it works immediately. 38:08.660 --> 38:16.660 And by immediately, I mean the patient gets off the table and within five minutes they will say, whoa, where's my pain? 38:16.660 --> 38:22.660 So it is a very clear diagnostic tool as to what's going on. 38:22.660 --> 38:34.660 Now, if I'm really sure that it's a sacroiliac joint, I may put some cortisol in there also because especially for acute injuries, that will take 70% of, that will cure 70%. 38:34.660 --> 38:37.660 A second one will take care of almost the rest. 38:37.660 --> 38:40.660 So it's a very wonderful tool. 38:40.660 --> 38:44.660 I know cortisol is, you know, in the 30-word category. 38:44.660 --> 38:46.660 It's an alcohol-hungerable, terrible substance. 38:46.660 --> 38:47.660 Everyone needs it. 38:47.660 --> 38:52.660 As a holistic physician, here I am saying, I use cortisol. 38:52.660 --> 38:53.660 Whoa. 38:53.660 --> 38:57.660 Am I a renegade or what? 38:57.660 --> 39:01.660 Used occasionally, it is absolutely safe. 39:01.660 --> 39:03.660 And we use a form of it that's called depo-medro. 39:03.660 --> 39:05.660 Depo meaning depo. 39:05.660 --> 39:07.660 And it pretty much stays where I put it. 39:07.660 --> 39:10.660 Very little of it gets into the circulation. 39:10.660 --> 39:16.660 And so if I use it sparingly and only occasionally, it's a very safe thing to do. 39:16.660 --> 39:22.660 And in fact, in the study we've done, I think we can prove it when you look and see how the numbers came out. 39:22.660 --> 39:25.660 People did not go on to develop problems with it. 39:25.660 --> 39:38.660 The reason cortisol has a really bad rep is because if you take it constantly, regularly, for a variety of medical conditions, rheumatoid arthritis, 39:38.660 --> 39:48.660 chronic obstructive lung disease, or asthma on a long-term basis, if you are taking it long-term, it has every side effect in the universe. 39:48.660 --> 39:52.660 It will weaken the bones, it will weaken the immune system, it will weaken the tissues. 39:52.660 --> 39:54.660 You don't want to do that. 39:54.660 --> 40:00.660 So I am not advocating widespread, one-ton, and irresponsible use of it. 40:00.660 --> 40:03.660 I am saying it is also not the worst thing in the world. 40:03.660 --> 40:15.660 An example is one of my partners has had some surgery two years ago and had some sacroiliac joint pain since, 40:15.660 --> 40:24.660 but absolutely refused because of his concerns with cortisol to let anybody, and everybody in my clinic goes out to do this, by the way, 40:24.660 --> 40:27.660 but he wouldn't let anybody inject it. 40:27.660 --> 40:35.660 He finally was so tired of being in pain that he came to me a few weeks ago and said, treat it. 40:35.660 --> 40:41.660 And I did a variety of things that helped him, and I finally said, try an injection. 40:41.660 --> 40:44.660 It is simple, it is not bad, it is not horrible. 40:44.660 --> 40:53.660 I finally screwed up his courage, and he had the shot, and he walked off the table and said, what did you do? 40:53.660 --> 40:58.660 I said, I did what everyone else here has wanted to do for two years. 40:58.660 --> 41:04.660 Actually, I injected him two months ago, and he has been pain free ever since, and he had it for two years. 41:04.660 --> 41:10.660 So he just keeps shaking his head, and I am like, why didn't I get the shot? 41:10.660 --> 41:16.660 So I don't want to trivialize this, but I can't count the number of people where that has actually happened. 41:16.660 --> 41:18.660 It is really not a bad treatment. 41:18.660 --> 41:28.660 Okay, so the last, that is where the needle would go for a sacroiliac joint injection. 41:28.660 --> 41:32.660 This is a needle pointed over the facets. 41:32.660 --> 41:35.660 This is a facet joint in here. 41:35.660 --> 41:44.660 Just giving you a kind of little visual image of the kinds of things I am going to be talking about. 41:44.660 --> 41:50.660 That is a needle touching the tip of the, it is called the transverse process that comes off of the vertebrae, 41:50.660 --> 41:55.660 and that is what the iliolumbar ligament attaches to. 41:55.660 --> 42:05.660 This is a needle that is literally a pain in the butt because it is sitting on the sitting bone. 42:05.660 --> 42:10.660 This is where you sit, it is called the ischial tuberosity, that is the fancy word for it, 42:10.660 --> 42:14.660 and people can get, believe it or not, an ischial tuberosity versus sinus, 42:14.660 --> 42:18.660 because there is a little bursa where you sit that lubricates that area, 42:18.660 --> 42:21.660 and a lot of medical professions have never heard of it. 42:21.660 --> 42:25.660 But sometimes people will say, this is where I hurt. 42:25.660 --> 42:33.660 And one story for example is I had a well-known radiologist from Kansas City who heard about me 42:33.660 --> 42:36.660 and came down to see me in Springfield. 42:36.660 --> 42:41.660 He had seen several neurosurgeons, several orthopedic surgeons. 42:41.660 --> 42:44.660 They had convinced him that his pain was from his disc. 42:44.660 --> 42:49.660 They resected his disc, and they were offering him more and more surgery. 42:49.660 --> 42:53.660 And he had been going on in pain for five years. 42:53.660 --> 42:58.660 When I examined him, he had no pain over his lower back area. 42:58.660 --> 43:01.660 In other words, this upper area here, no pain whatsoever. 43:01.660 --> 43:04.660 I am not pressing on it, I am not pushing on it, nothing. 43:04.660 --> 43:07.660 But when I got to his, I don't have a better word for it, 43:07.660 --> 43:10.660 derriere, but that's a reasonable medical term, 43:10.660 --> 43:14.660 right there over his sitting bone, exquisitely tense. 43:14.660 --> 43:19.660 And I said, and when that happens, the piriformis muscle tends up to protect it. 43:19.660 --> 43:21.660 Remember our friend the piriformis? 43:21.660 --> 43:26.660 So he had sciatic pain that came from that spot. 43:26.660 --> 43:31.660 And so what I did was I injected cortisone and marcain into this spot. 43:31.660 --> 43:36.660 I injected his piriformis muscle just with marcain, 43:36.660 --> 43:39.660 and I stretched it out, I treated the muscle, 43:39.660 --> 43:44.660 and he got off the table and said, where's my pain? 43:44.660 --> 43:47.660 So I've been wrestling with this for five years. 43:47.660 --> 43:49.660 He said, it can't be that simple. 43:49.660 --> 43:51.660 Because you can do this, I'm going to do this in my office. 43:51.660 --> 43:54.660 This literally takes two minutes, this is not complicated. 43:54.660 --> 43:56.660 I don't need a fluoroscope, I don't need to do this. 43:56.660 --> 43:58.660 An x-ray department, this is easy. 43:58.660 --> 44:01.660 He said, that's not possible. 44:01.660 --> 44:02.660 Okay? 44:02.660 --> 44:06.660 So you keep noticing whether what is not possible is, 44:06.660 --> 44:10.660 and you know, come back and see me in three weeks. 44:10.660 --> 44:11.660 We came back in three weeks. 44:11.660 --> 44:13.660 He had had a slight recurrence of his pain. 44:13.660 --> 44:15.660 He had been 90% better. 44:15.660 --> 44:19.660 I treated him one more time, same way, 44:19.660 --> 44:23.660 and he was completely cured of his disc problem 44:23.660 --> 44:25.660 and low back problem, which he never had. 44:25.660 --> 44:30.660 Again, this is a plea for actually touching people, 44:30.660 --> 44:31.660 putting your hands on their body. 44:31.660 --> 44:34.660 I really believe it is possible to make a clear diagnosis 44:34.660 --> 44:36.660 of where pain is coming from, 44:36.660 --> 44:38.660 and I really believe it's possible to treat it. 44:38.660 --> 44:42.660 Understand that these are not the only ways that you can treat these. 44:42.660 --> 44:45.660 You can treat sacroiliac joints in many, many, many other ways. 44:45.660 --> 44:46.660 This does it. 44:46.660 --> 44:49.660 This is just the one that, in my experience, 44:49.660 --> 44:54.660 works the fastest and the easiest. 44:54.660 --> 44:57.660 That's the bursa that sits over the hip. 44:57.660 --> 44:59.660 People get pain over in this area. 44:59.660 --> 45:02.660 It's often a hip bursa problem. 45:02.660 --> 45:10.660 I mentioned the fact that you could get rib injuries, 45:10.660 --> 45:14.660 and one of the most underdiagnosed problems in the back, 45:14.660 --> 45:19.660 and this goes all the way up the whole back, is a jammed rib. 45:19.660 --> 45:24.660 A jammed rib is not a term that most physicians use. 45:24.660 --> 45:26.660 It's an osteopathic term, actually. 45:26.660 --> 45:30.660 What it means is that actually the rib is jammed, 45:30.660 --> 45:34.660 and there are joints in a rib that enable them to be jammed. 45:34.660 --> 45:36.660 This is a close-up picture showing the joints, 45:36.660 --> 45:39.660 but there are several actual joints in a rib, 45:39.660 --> 45:42.660 and if there is a blow to the rib, 45:42.660 --> 45:45.660 if someone catches their arm and falls on it, 45:45.660 --> 45:48.660 if you reach up into a position that is not physiological, 45:48.660 --> 45:52.660 a rib can jam in a position where it's not supposed to be. 45:52.660 --> 45:56.660 If that happens, you get pain, especially in the shoulder area. 45:56.660 --> 45:59.660 Let me use you as an example. 45:59.660 --> 46:04.660 Some of the pain that people have in this area is a jammed rib. 46:04.660 --> 46:06.660 Everyone treats muscles that are going out of style, 46:06.660 --> 46:08.660 but often it's these ribs that get jammed. 46:08.660 --> 46:10.660 The first thing that most people say is, 46:10.660 --> 46:12.660 you have ribs up here? 46:12.660 --> 46:13.660 Actually, yes. 46:13.660 --> 46:15.660 The first rib starts here, second, third, 46:15.660 --> 46:18.660 so we've got lots of ribs over here, and we'll start now. 46:18.660 --> 46:22.660 In the lower back area, we have ribs as well. 46:22.660 --> 46:27.660 Now, again, looking at the bigger picture, 46:27.660 --> 46:30.660 I showed you a picture of this muscle that goes up the back, 46:30.660 --> 46:34.660 the quadratus lumborum, it attaches to the ribs. 46:34.660 --> 46:36.660 If it goes into spasm and gets tight, 46:36.660 --> 46:39.660 it will pull on the ribs and jam them, 46:39.660 --> 46:44.660 and then it becomes hard to treat that muscle if you don't free up the ribs also. 46:44.660 --> 46:51.660 So you have to look at this whole system here to really do this appropriately. 46:51.660 --> 46:57.660 This is simply a picture of a simple osteopathic technique that we use 46:57.660 --> 46:59.660 to free up the ribs. 46:59.660 --> 47:02.660 This shows the ribs up here, and what we're going to be doing 47:02.660 --> 47:06.660 is putting traction on the ribs in the direction that the rib goes. 47:06.660 --> 47:09.660 It's gentle traction. It's not a pumping technique. 47:09.660 --> 47:12.660 You simply put traction on the rib until it lets go, 47:12.660 --> 47:16.660 and it's not hard or difficult to do, but if you don't do it, 47:16.660 --> 47:21.660 the muscle has trouble letting go because it keeps trying to protect the jammed rib. 47:21.660 --> 47:23.660 So what I hope I'm keep conveying, 47:23.660 --> 47:27.660 I'm trying to slowly build a model of complexity up, 47:27.660 --> 47:32.660 but also to tell you that that model of complexity is what we are working with, 47:32.660 --> 47:40.660 and it's very possible to tease out these pieces so that we can work with them. 47:40.660 --> 47:47.660 Okay, so in my model, which was, I believe that you can make a diagnosis 47:47.660 --> 47:49.660 with precision of where pain is coming from, 47:49.660 --> 47:54.660 and then you can apply the appropriate treatment to it. 47:54.660 --> 47:58.660 So in the low back area, what are our options? 47:58.660 --> 48:03.660 And these are the ones that I used in the study that I'm discussing, 48:03.660 --> 48:06.660 which is you can treat the sacroiliac joints, the iliolumbar ligaments, 48:06.660 --> 48:13.660 the bursa, trigger points, the ribs, the vertebrae can be out of alignment, 48:13.660 --> 48:16.660 which is what osteopaths call somatic dysfunction. 48:16.660 --> 48:21.660 Sorry about the fancy term, but that is what it's called. 48:21.660 --> 48:25.660 You can block the facet nerves to see if they're jammed in the facets, 48:25.660 --> 48:30.660 and what I mean by that is I show you the joints in the spine. 48:30.660 --> 48:34.660 There is a teeny, teeny nerve called a facet nerve 48:34.660 --> 48:38.660 that comes from the main nerve and just wraps around into the joint. 48:38.660 --> 48:43.660 If someone is injured, you can actually compress 48:43.660 --> 48:47.660 or pinch the facet nerve in the joint. 48:47.660 --> 48:52.660 And, for example, one of the common ways that happens is when patients 48:52.660 --> 48:56.660 have compression fractures, and the whole spine gets compressed 48:56.660 --> 49:01.660 because there's a 95% of the time that feels fine, no problem. 49:01.660 --> 49:05.660 But that percent of the time, people will experience a constant aching, 49:05.660 --> 49:09.660 very annoying pain that goes on and on and on forever. 49:09.660 --> 49:12.660 And what's usually happening is the facet nerve is being pinched 49:12.660 --> 49:14.660 in the area that got compressed. 49:14.660 --> 49:19.660 How can you tell? You can inject it with fluoroscopy, 49:19.660 --> 49:21.660 knowing exactly where you're putting a needle. 49:21.660 --> 49:26.660 And if you exactly know what you're doing, and again, this is not cortisol. 49:26.660 --> 49:29.660 This is simply marquette, which is like light of day. 49:29.660 --> 49:32.660 And you can hear those words. 49:32.660 --> 49:35.660 If someone has a facet nerve that's being pinched, 49:35.660 --> 49:39.660 they will get off the x-ray table and say, my pain is gone. 49:39.660 --> 49:41.660 So we have our diagnosis. 49:41.660 --> 49:42.660 And here's the good news. 49:42.660 --> 49:44.660 This sounds horrible, but I'm going to give it to you anyway. 49:44.660 --> 49:46.660 Then you can kill the nerve. 49:46.660 --> 49:50.660 And when I start saying words like kill the nerve, I get that thing again. 49:50.660 --> 49:52.660 Keep in mind I worked in Missouri for a long time, 49:52.660 --> 49:55.660 which is the buckle of the Bible belt, and this was done a lot. 49:55.660 --> 50:02.660 But when I say kill the nerve, the nerve that causes the scent pain 50:02.660 --> 50:05.660 is a teeny filamentous branch. 50:05.660 --> 50:08.660 It does not go to any muscle. 50:08.660 --> 50:10.660 It does not have any other sensation. 50:10.660 --> 50:16.660 All it is is a nerve that's being pinched and is saying, out, out, out, out, out, out, out, out, out, out, out. 50:16.660 --> 50:18.660 And it just doesn't shut out. 50:18.660 --> 50:19.660 It goes on and on. 50:19.660 --> 50:21.660 It'll go on forever if you don't play it. 50:21.660 --> 50:25.660 So if you kill that nerve, it is a very safe procedure. 50:25.660 --> 50:29.660 You're at no risk, zero, at damaging anything else. 50:29.660 --> 50:32.660 We're not talking about cutting a nerve and losing function. 50:32.660 --> 50:34.660 The nerve couldn't do that, can't do it. 50:34.660 --> 50:36.660 So we can simply inject a little phenol. 50:36.660 --> 50:39.660 Again, by injection, it does not require surgery. 50:39.660 --> 50:44.660 You can inject phenol into the same place you put the lammortain. 50:44.660 --> 50:48.660 And within a couple of days, pain is permanently relieved. 50:48.660 --> 50:52.660 It is a very, very wonderful technique for people who've had pain for years 50:52.660 --> 50:56.660 who don't know that their pain is coming from the facets. 50:56.660 --> 50:59.660 A lot of physicians, even some pain specialists, 50:59.660 --> 51:02.660 who pop facets and say it doesn't matter. 51:02.660 --> 51:06.660 I have helped hundreds and hundreds and hundreds of people with severe pain 51:06.660 --> 51:11.660 to be completely pain-free by knocking out their facets, nerves. 51:11.660 --> 51:14.660 Very simple, very safe, and very underutilized. 51:14.660 --> 51:19.660 But it's a procedure that really needs to be looked at more. 51:19.660 --> 51:24.660 So back to my little study. 51:24.660 --> 51:28.660 We treated not just low back pain, but since I was working, 51:28.660 --> 51:30.660 I was like, let's do the whole thing. 51:30.660 --> 51:35.660 So basically I looked at every type of pain that people came in with acutely. 51:35.660 --> 51:36.660 And I took consecutive patients. 51:36.660 --> 51:38.660 Every single patient that I saw. 51:38.660 --> 51:41.660 And remember, these were the ones who were the worst, 51:41.660 --> 51:43.660 not the simple ones that got better and relieved. 51:43.660 --> 51:47.660 These are the ones that my colleagues after a week or two said, 51:47.660 --> 51:48.660 you're not responding to what I'm doing. 51:48.660 --> 51:50.660 Why don't you take a look? 51:50.660 --> 51:57.660 So for these patients, we treated 364, 243 were in the back, 51:57.660 --> 52:03.660 71 in the back and shoulder, 39 in the ribs, and 11 in the head. 52:03.660 --> 52:08.660 Now, remember that statistics show that re-injury occurs 52:08.660 --> 52:14.660 in over 50% of people within six months to a year. 52:14.660 --> 52:18.660 I can maintain that if we really treat it properly, 52:18.660 --> 52:22.660 people don't get re-injured because they don't have weak tissues. 52:22.660 --> 52:23.660 They're healed. 52:23.660 --> 52:25.660 They don't tend to re-injure. 52:25.660 --> 52:32.660 So the number of re-injuries was 7.4%, which is way lower than greater than 50%. 52:32.660 --> 52:35.660 And we followed these patients for over three years. 52:35.660 --> 52:38.660 So we're not talking six months or a year. 52:38.660 --> 52:39.660 It's over three years. 52:39.660 --> 52:42.660 Captive population, there was no place else to go. 52:42.660 --> 52:44.660 They had to come and see us. 52:44.660 --> 52:49.660 So we think that actually means something. 52:49.660 --> 52:51.660 Which of those went on to become chronic? 52:51.660 --> 52:54.660 A whopping 3.2%. 52:54.660 --> 53:01.660 And in the standard medical treatment, if pain becomes, 53:01.660 --> 53:08.660 50% of these people would become chronic if they recurred and didn't get better. 53:08.660 --> 53:14.660 So 3.2% versus 50% is, from our perspective, fairly significant. 53:14.660 --> 53:20.660 So I can get up in front of you and say that I actually have some data and research that shows that. 53:20.660 --> 53:26.660 If we treat chronic pain properly and aggressively, 53:26.660 --> 53:32.660 we actually can do a good job of helping people to heal and heal more permanently. 53:32.660 --> 53:35.660 So that's my take on the message. 53:35.660 --> 53:39.660 The number one thing with chronic pain is can it be prevented? 53:39.660 --> 53:45.660 And I think, not in every case, but often it can if we really take the pain seriously. 53:45.660 --> 53:46.660 Okay? 53:46.660 --> 53:51.660 Pain Mike, here. 53:51.660 --> 53:59.660 That's just the back pain alone, the re-injury and the chronic and the back pain is basically the same. 53:59.660 --> 54:10.660 So now that I've broad beaten you about the importance of precise diagnosis, 54:10.660 --> 54:16.660 I want to do two main more things tonight. 54:16.660 --> 54:24.660 You know, I'm available to you all as long as you want. I'm happy to talk about any number of subjects later on in the year if you want. 54:24.660 --> 54:29.660 Someone asked, what about fibromyalgia? That's a whole two-hour lecture. I'm happy to do that. 54:29.660 --> 54:38.660 But what I want to do tonight is I want to now explain the differences in treating chronic pain from acute pain, 54:38.660 --> 54:40.660 and then I want to talk about alternatives. 54:40.660 --> 54:50.660 And I want to go over some of the newer stuff that we're working with that we're excited about that's been very helpful. 54:50.660 --> 55:01.660 So again, being a little technical, but I really want to emphasize acute pain is neurologically completely different than chronic pain, 55:01.660 --> 55:04.660 and that's why we have to treat it differently. 55:04.660 --> 55:13.660 Acute pain is carried on neurologically what we call A delta fibers, again, no test, and chronic pain is carried on C fibers. 55:13.660 --> 55:21.660 They have a different feel to them. Acute pain is when you reach out, you know, and get a pin stuck in your finger, 55:21.660 --> 55:24.660 and you get this immediate withdrawal reaction. 55:24.660 --> 55:32.660 That is a different pain than the chronic nagging ache of a low back when it's been operating for a long period of time. 55:32.660 --> 55:42.660 So, but one thing to understand is that we have recently realized that over time, if pain continues, if it doesn't get treated, 55:42.660 --> 55:49.660 the nerve actually gets irritated, and you develop an additional type of pain called neuropathic pain, 55:49.660 --> 55:57.660 which means that the nerve itself is irritated, and that has to be treated separately also, and they're all different. 55:57.660 --> 56:03.660 Meaning, acute pain responds very well to a variety of medications. 56:03.660 --> 56:10.660 That's not a bad thing. Once again, we don't have to do this, you know, when they say medication, again, 56:10.660 --> 56:15.660 what's a holistic boy like you talking about? Pain medication, boy. 56:15.660 --> 56:23.660 When you're in acute pain, the muscles around that tighten up to protect the body, 56:23.660 --> 56:29.660 and it is very helpful to make them relax by tricking them into thinking there's no pain. 56:29.660 --> 56:33.660 It's not evil, it's not wrong, and it's not bad, and that speeds up the healing, 56:33.660 --> 56:39.660 because if those muscles relax, you get a better blood supply, and the tissues will heal faster. 56:39.660 --> 56:46.660 So there's nothing wrong about using pain medication for acute pain. It's a useful tool. 56:46.660 --> 56:54.660 In chronic pain, medication has a limited role. Not only is it prone to getting people addicted, 56:54.660 --> 56:59.660 but it barely takes the edge off most of the time, and that varies from person to person. 56:59.660 --> 57:03.660 But the vast majority of our patients on chronic pain will say, 57:03.660 --> 57:07.660 I need it to live with, but it's just taking the edge off. 57:07.660 --> 57:14.660 Keeping in mind that neither, medication in either case doesn't address cost. 57:14.660 --> 57:18.660 So going back to that. Now if we have neuropathic pain, 57:18.660 --> 57:24.660 we have a variety of medications that treat the pain coming from nerves, and that's different. 57:24.660 --> 57:33.660 So we have a whole family of medications like Neurontin, Tegretol, the newer ones, Lyrica, 57:33.660 --> 57:40.660 are all based on numbing nerves, and they're useful and quite valuable, 57:40.660 --> 57:45.660 but we have to be precise about which nerves are causing the pain, 57:45.660 --> 57:56.660 because even our choice of medication may be in the wrong arena if we're not working on the right tissues. 57:56.660 --> 58:06.660 So let me talk for a minute about something that is one of the understandings of chronic pain called reverberating loops, 58:06.660 --> 58:15.660 which is why does the pain become chronic? Why is it the body doesn't figure out what to do with it and deal with it? 58:15.660 --> 58:22.660 And one of the concepts that has been best proven and has been around for a long time is that when you are in pain, 58:22.660 --> 58:28.660 let's say here's a muscle or the skin over here, you damage the muscle, you bang it, you hurt it, 58:28.660 --> 58:33.660 there's a contusion of the muscle, the nerves are affected, the nerves come from the skin, 58:33.660 --> 58:48.660 from the muscle into the spinal cord, and then up to the brain, where you go out. 58:48.660 --> 58:54.660 The basic process, it's simply a wiring diagram, an electrician would be fine with it, 58:54.660 --> 59:00.660 from the muscle into the spinal cord to the brain. 59:00.660 --> 59:08.660 I want to focus on this area in here for just a second. 59:08.660 --> 59:19.660 I'm going to blow it up. So we have the nerve coming in here, it synapses with another nerve that goes up to the brain. 59:19.660 --> 59:29.660 Simple straightforward thing. However, in this area here, there are millions and millions and millions of nerve endings right there. 59:29.660 --> 59:37.660 And what happens sometimes is that these are so close to each other that you get one that loops on itself, 59:37.660 --> 59:41.660 which is where the word reverberating loop comes from. 59:41.660 --> 59:52.660 What happens is, even when the muscle is healed, the original injury pattern stimulates itself. 59:52.660 --> 01:00:01.660 It means the body, this is done, but on a neurological basis, it's like a short in the system electrically, 01:00:01.660 --> 01:00:04.660 it just keeps telling the brain that you hurt. 01:00:04.660 --> 01:00:11.660 And that's why identifying this as chronic pain is an important way to change the reverberating loop. 01:00:11.660 --> 01:00:14.660 Now you can change reverberating loops in a number of known ways, 01:00:14.660 --> 01:00:18.660 and we'll talk about that in more detail when we get to treatments, 01:00:18.660 --> 01:00:24.660 but things like hypnosis, acupuncture, various types of nerve blocks, 01:00:24.660 --> 01:00:32.660 anything that shuts this system down briefly has the capacity to break the habit and to change this. 01:00:32.660 --> 01:00:40.660 My current favorite way of doing it is with an electrical device that's recently been released called a frequency-specific microcard. 01:00:40.660 --> 01:00:50.660 And it is my new favorite toy because over the years, helping nerves to heal has been the hardest thing that I've ever had to work with. 01:00:50.660 --> 01:00:59.660 And I have found frequency-specific microcard to be the best tool to get inflammation out of nerves and to literally reboot the system. 01:00:59.660 --> 01:01:01.660 Because that's what we're talking about here, is rebooting it. 01:01:01.660 --> 01:01:03.660 It's like, it's confused. 01:01:03.660 --> 01:01:10.660 It's just like a little computer system that's just simulating itself. If you can break this, you can break the cycle. 01:01:10.660 --> 01:01:13.660 So I hope I'm making sense out of that. Is that clear? 01:01:13.660 --> 01:01:14.660 Yes. 01:01:17.660 --> 01:01:23.660 The other things I want to at least talk about for a bit are what I call the vicious cycles of pain. 01:01:23.660 --> 01:01:27.660 Because there are certain things in chronic pain where pain begins more pain. 01:01:27.660 --> 01:01:31.660 And if you don't break the cycle, you can't fix it. 01:01:31.660 --> 01:01:34.660 These are all very basic to any chronic pain problem. 01:01:34.660 --> 01:01:37.660 So we have the muscle spasm contraction cycle. 01:01:37.660 --> 01:01:40.660 We have the muscle weakness deconditioning cycle. 01:01:40.660 --> 01:01:46.660 The depression, fatigue, insomnia cycle, and the disability compensation part of the cycle. 01:01:46.660 --> 01:01:50.660 The muscle spasm contraction cycle is a very simple one. 01:01:50.660 --> 01:01:52.660 We kind of alluded to it. 01:01:52.660 --> 01:01:57.660 When you're in pain, the muscles tighten up to protect you. 01:01:57.660 --> 01:02:02.660 When they do so, they are actually compressing their own blood supply. 01:02:02.660 --> 01:02:06.660 It's not physiologically. It's designed for short-term use. 01:02:06.660 --> 01:02:10.660 It's as if the body has gotten confused and it doesn't think no one is doing properly. 01:02:10.660 --> 01:02:15.660 So the artery goes into the muscle. 01:02:15.660 --> 01:02:20.660 But if that muscle is tightening up, it literally shuts off its own blood supply. 01:02:20.660 --> 01:02:28.660 And not to the point that it dies or atrophies, but enough that the waste products are not getting out of the muscle properly. 01:02:28.660 --> 01:02:31.660 And there's a buildup of lactic acid in the muscle. 01:02:31.660 --> 01:02:35.660 And inflammatory irritants build up in the muscle. 01:02:35.660 --> 01:02:40.660 What does the muscle do when that happens? 01:02:40.660 --> 01:02:42.660 It gets tighter. 01:02:42.660 --> 01:02:45.660 So it tightens a little bit more. 01:02:45.660 --> 01:02:47.660 It shuts off its blood supply a little bit more. 01:02:47.660 --> 01:02:50.660 It gets a little bit more of the irritants in there. 01:02:50.660 --> 01:02:52.660 And how does it respond to that? 01:02:52.660 --> 01:02:54.660 It tightens up a little bit more. 01:02:54.660 --> 01:02:59.660 And so you get, I call it a vicious cycle, or it's actually a vicious spiral. 01:02:59.660 --> 01:03:04.660 If you don't deal with that, it's really hard to treat chronic pain. 01:03:04.660 --> 01:03:09.660 You have to get a better blood supply to the muscle, and you have to get it to relax. 01:03:09.660 --> 01:03:18.660 So that muscle relaxation strategies, of which there's a small trillion, are all useful and valuable when treating chronic pain. 01:03:18.660 --> 01:03:20.660 And that can be heat. 01:03:20.660 --> 01:03:34.660 It can be massage, a variety of electrical stimulation devices, ultrasound, acupuncture. 01:03:34.660 --> 01:03:35.660 Ice. 01:03:35.660 --> 01:03:36.660 Massage. 01:03:36.660 --> 01:03:39.660 Ice, no, because ice actually makes it tighten up. 01:03:39.660 --> 01:03:45.660 Keep in mind that ice and heat are not opposites, which you would think they are, but they do different things to the body. 01:03:45.660 --> 01:03:47.660 Ice works in a different way. 01:03:47.660 --> 01:03:51.660 It doesn't work, but it's not. 01:03:51.660 --> 01:03:58.660 But what it does do, now some people do feel better when they use ice, because it overloads the mechanical receptors, 01:03:58.660 --> 01:04:01.660 it sort of shuts down the riverbane loop for a little while. 01:04:01.660 --> 01:04:04.660 Usually not long enough to be permanent, but it can do that. 01:04:04.660 --> 01:04:08.660 On the other hand, it does tighten up the muscles and make them contract. 01:04:08.660 --> 01:04:12.660 So generally, for chronic pain, I'm a big fan of heat. 01:04:12.660 --> 01:04:14.660 Not for everybody. 01:04:14.660 --> 01:04:20.660 There are some patients who will say to me, Neil, the ice feels better than the heat, and I go, great, they use the ice. 01:04:20.660 --> 01:04:23.660 Whatever feels better is your body's way of telling you what works better. 01:04:23.660 --> 01:04:32.660 But as a general rule, philosophically, the heat is more likely to stimulate better blood flow and to get the muscle to relax. 01:04:32.660 --> 01:04:43.660 Biofeedback, meditation, yoga, stretching, all of these things are ways that we can get the muscles to relax in our mind, 01:04:43.660 --> 01:04:48.660 and that's critical in reversing this cycle. 01:04:48.660 --> 01:04:58.660 The second one is the muscle weakness deconditioning part of the cycle, where when you're in pain, you do less. 01:04:58.660 --> 01:05:02.660 The less you do, the more deconditioned you get. 01:05:02.660 --> 01:05:14.660 And as an exclamation point way of describing that, a study's been done that shows that hospitalized patients can lose up to 18% of their muscle mass 01:05:14.660 --> 01:05:18.660 in the first week of hospitalization when they're very old. 01:05:18.660 --> 01:05:24.660 Now, the good news is it doesn't keep happening, because that would be five weeks and you're wasting your time. 01:05:24.660 --> 01:05:26.660 It drops off after a while. 01:05:26.660 --> 01:05:35.660 But that's an extraordinary amount of muscle weakness in a very short period of time. 01:05:35.660 --> 01:05:41.660 For some hospitalized patients, it's not an option to get up and exercise, depending on what you're there for. 01:05:41.660 --> 01:05:49.660 So what that means is that people become deconditioned much faster and to a much more profound degree 01:05:49.660 --> 01:05:52.660 when they realize when they've been in pain for a while. 01:05:52.660 --> 01:05:56.660 And that cycle is the same kind of a vicious cycle. 01:05:56.660 --> 01:05:58.660 The more you hurt, the less you do. 01:05:58.660 --> 01:06:02.660 The less you do, the weaker you get, the less you can do. 01:06:02.660 --> 01:06:07.660 And what happens to most human beings is they finally get to the point is that I can't stand it anymore. 01:06:07.660 --> 01:06:11.660 I'm getting out of this house and I'm doing blah, blah, blah, whatever that happens to be. 01:06:11.660 --> 01:06:19.660 And that's fine, but often that exceeds the body's ability to do that, and they get into more pain, 01:06:19.660 --> 01:06:25.660 and then they have to rest more, and then they get more deconditioned, and you can see how the cycle goes. 01:06:25.660 --> 01:06:35.660 So part of the second part of treating chronic pain is it has to have built into it some degree of physical activity. 01:06:35.660 --> 01:06:37.660 And here's the tricky part. 01:06:37.660 --> 01:06:45.660 It has to be gentle enough that you don't overdo, and not so bad that you make yourself worse so you'd set yourself back. 01:06:45.660 --> 01:06:49.660 And that place isn't the set place. 01:06:49.660 --> 01:06:52.660 You kind of have to keep finding that place. 01:06:52.660 --> 01:06:54.660 That is not a simple thing to do. 01:06:54.660 --> 01:07:02.660 However, that's critical in whatever program you're going to put together, however you're going to think about it, 01:07:02.660 --> 01:07:06.660 that becomes important that you reverse the decondition. 01:07:06.660 --> 01:07:10.660 It has to be built into it. 01:07:10.660 --> 01:07:14.660 Then we get the depression and salmoneth, the peak part of the cycle. 01:07:14.660 --> 01:07:19.660 25% of patients with chronic low back pain become depressed. 01:07:19.660 --> 01:07:26.660 The vast majority of them also have difficulties with sexual function, which they don't always talk about, 01:07:26.660 --> 01:07:31.660 but that also bothers and disturbs people to understand the weak-brain degree. 01:07:31.660 --> 01:07:37.660 So when they become depressed, that becomes part of the problem. 01:07:37.660 --> 01:07:49.660 So the more depressed you are, the less you do, the more pain you're in, it changes the chemicals in your body. 01:07:49.660 --> 01:07:53.660 Depression is a deficiency to a certain extent in serotonin. 01:07:53.660 --> 01:07:58.660 Serotonin is critical in sleep and in pain relief. 01:07:58.660 --> 01:08:05.660 So the same chemicals that get depleted by one affect the other, and we're off to the races. 01:08:05.660 --> 01:08:13.660 So again, ignoring depression and saying, oh, it just comes with the territory, I'm depressed because I'm in pain. 01:08:13.660 --> 01:08:18.660 True, but that doesn't mean that we should be ignoring that, 01:08:18.660 --> 01:08:22.660 because that's another piece that we can work on and fix in a variety of ways. 01:08:22.660 --> 01:08:36.660 And then there's the disability compensation part of it, where it gets hard to treat it when you're disabled, 01:08:36.660 --> 01:08:39.660 when you're getting disability payments for your pain. 01:08:39.660 --> 01:08:48.660 It adds to the difficulty, because the natural tendency of human beings is, 01:08:48.660 --> 01:08:53.660 if I'm going to accept money for this, I guess I have to suffer. 01:08:53.660 --> 01:08:55.660 And that adds another whole piece to it. 01:08:55.660 --> 01:09:02.660 So our whole disability system is not designed for optimal improvement. 01:09:02.660 --> 01:09:09.660 I'm leading with that, but I'm going to give a lot of political comments about it, but I won't. 01:09:09.660 --> 01:09:15.660 A couple of other things that I've been stressed that are important is we talk about perpetuating factors. 01:09:15.660 --> 01:09:20.660 The chemistry changes when you've been in pain for a while, and a lot of my colleagues are not aware of this, 01:09:20.660 --> 01:09:23.660 so I want to emphasize this. 01:09:23.660 --> 01:09:29.660 First of all, magnesium deficiency is present in 90 to 95 percent of people with chronic pain. 01:09:29.660 --> 01:09:36.660 And magnesium is a critical mineral in all muscle and nerve function. 01:09:36.660 --> 01:09:41.660 So replacing magnesium needs becomes biochemically important, 01:09:41.660 --> 01:09:46.660 because if you don't have the raw materials in your body to deal with, it's hard to heal. 01:09:46.660 --> 01:09:49.660 And ignoring that does not help at all. 01:09:49.660 --> 01:09:53.660 So let me emphasize the magnesium part of that story. 01:09:53.660 --> 01:09:58.660 DHEA is the main hormone made by the adrenal gland. 01:09:58.660 --> 01:10:03.660 And when you have been in pain for a long period of time, you will also get stressed. 01:10:03.660 --> 01:10:06.660 Stress is what depletes DHEA. 01:10:06.660 --> 01:10:09.660 Now what does DHEA do from a feeling point of view? 01:10:09.660 --> 01:10:15.660 When your DHEA is low, and it is in 95 plus percent of people with chronic pain. 01:10:15.660 --> 01:10:21.660 Fatigue, fatigue, fatigue, fatigue, to emphasize that. 01:10:21.660 --> 01:10:27.660 And problems with focus, memory, concentration, sex drive. 01:10:27.660 --> 01:10:36.660 These are almost universal in chronic pain patients, and therefore I submit that measuring magnesium and DHEA levels 01:10:36.660 --> 01:10:41.660 is an integral part of that, and if it's low, treating that is really important. 01:10:41.660 --> 01:10:48.660 And so I want to emphasize, we also have to look at the biochemistry of someone who has been in pain for a long time, 01:10:48.660 --> 01:10:50.660 because that can be treated. 01:10:50.660 --> 01:10:53.660 Again, these are treatable pieces. 01:10:53.660 --> 01:10:59.660 And then we have the obvious things of really looking at people's movement, posture, things like that, 01:10:59.660 --> 01:11:07.660 which is, is someone sitting or standing in such a way that they are not allowing those muscles to relax, 01:11:07.660 --> 01:11:11.660 or the ribs to take the back up on them. 01:11:11.660 --> 01:11:17.660 What do you consider treatment amounts of magnesium DHEA? 01:11:17.660 --> 01:11:19.660 What type of... 01:11:19.660 --> 01:11:23.660 Well, first of all, I usually measure it so that I have a better idea of what you need to take. 01:11:23.660 --> 01:11:26.660 Magnesium can be tricky. 01:11:26.660 --> 01:11:30.660 First of all, the kind of magnesium you use matters greatly. 01:11:30.660 --> 01:11:34.660 The commonest magnesium available in most stores is magnesium oxide. 01:11:34.660 --> 01:11:37.660 Only 10% of that is absorbed. 01:11:37.660 --> 01:11:41.660 So you want to use chelated forms of magnesium. 01:11:41.660 --> 01:11:44.660 My favorite is one that's called magnesium tarant. 01:11:44.660 --> 01:11:48.660 T-A-V-R-A-T-E. 01:11:48.660 --> 01:11:54.660 And typically I recommend taking at least two capsules at bedtime. 01:11:54.660 --> 01:11:56.660 That may not be sufficient. 01:11:56.660 --> 01:12:04.660 Some people with really low magnesiums need to actually take it intravenously to go look back up if it's really low. 01:12:04.660 --> 01:12:10.660 Concerning finding out what the levels are in your body, if you go and you request your physician, 01:12:10.660 --> 01:12:12.660 can they do a blood test for you? 01:12:12.660 --> 01:12:14.660 They can, and it's not a good test. 01:12:14.660 --> 01:12:18.660 Okay. So what is a good test? Or is there one? 01:12:18.660 --> 01:12:20.660 There is, but you're... 01:12:20.660 --> 01:12:24.660 We should try to keep it simple, but we'll make it complicated. 01:12:24.660 --> 01:12:29.660 Magnesium is primarily in the body an intracellular mineral, 01:12:29.660 --> 01:12:31.660 meaning that it's inside cells. 01:12:31.660 --> 01:12:33.660 It doesn't flutter around in the bloodstream much. 01:12:33.660 --> 01:12:39.660 So if you get a blood test for magnesium, that may not reflect a deficiency. 01:12:39.660 --> 01:12:44.660 The body will pull magnesium out of bones and anywhere it needs to to keep your blood level low. 01:12:44.660 --> 01:12:50.660 By the time you have an abnormal blood level, your magnesium is really, really deficient. 01:12:50.660 --> 01:12:57.660 My sister-in-law has multiple myeloma, and magnesium is pulling it from the bottom. 01:12:57.660 --> 01:13:03.660 So the way you measure it accurately is you can get what's called an intracellular magnesium, 01:13:03.660 --> 01:13:07.660 and the way it's done is you take a scraping under the tongue. 01:13:07.660 --> 01:13:09.660 My patients call it a pap smear under the tongue. 01:13:09.660 --> 01:13:11.660 It's not painful like a pap smear, I thought. 01:13:11.660 --> 01:13:16.660 You just take a rub of a wooden blade, scrape the tongue, you smear on the slide, 01:13:16.660 --> 01:13:21.660 and then it is analyzed by spectrophotometric methods in one lab where they do it. 01:13:21.660 --> 01:13:28.660 And that tells us what the intracellular levels are, and it's really the only accurate way to do it. 01:13:28.660 --> 01:13:31.660 This particular lab, does it take insurance? 01:13:31.660 --> 01:13:32.660 Does it? 01:13:32.660 --> 01:13:33.660 Take insurance, or is it not? 01:13:33.660 --> 01:13:36.660 It does, and actually it takes Medicare. 01:13:36.660 --> 01:13:37.660 Okay, that's... 01:13:37.660 --> 01:13:41.660 And it's called intracellular diagnostics. 01:13:41.660 --> 01:13:42.660 That's the name of the lab. 01:13:42.660 --> 01:13:47.660 They will send, if you don't mind, they can send your doctor a kit. 01:13:47.660 --> 01:13:52.660 It consists of a little glass slide, and you put the stuff on it, spray it, and send it back to them. 01:13:52.660 --> 01:13:55.660 It's not hard at all. 01:13:55.660 --> 01:13:58.660 DHEA can be measured by a simple blood test. 01:13:58.660 --> 01:14:00.660 It is available anywhere. 01:14:00.660 --> 01:14:04.660 The best lab to do it in this area is Quest. 01:14:04.660 --> 01:14:08.660 And Quest, except here on the coast, they're readily available. 01:14:08.660 --> 01:14:13.660 And if you get a DHEA from Quest, you can get your level and know what you need. 01:14:13.660 --> 01:14:18.660 And again, with DHEA, I do like, with any hormone, you really want to know that someone needs it, 01:14:18.660 --> 01:14:21.660 not just to take it for another. 01:14:21.660 --> 01:14:26.660 So if a patient comes to you concerning this chronic pain thing, 01:14:26.660 --> 01:14:29.660 is this one of the things that you do have checked? 01:14:29.660 --> 01:14:30.660 Fairly routinely. 01:14:30.660 --> 01:14:38.660 So you do a root kidney, and then, due to the factor, you can then be able to send it to their labs in terms of, okay. 01:14:38.660 --> 01:14:39.660 Absolutely. 01:14:39.660 --> 01:14:41.660 These are two of the commonest tests that I run. 01:14:41.660 --> 01:14:47.660 And two of the most useful tests that I run, because the results really help me to help people. 01:14:47.660 --> 01:14:56.660 You build up magnesium in DHEA, often people discover that that horrible fatigue that they've had for years is the biggest. 01:14:56.660 --> 01:15:00.660 When you wrestle with pain all the time, it is exhausting. 01:15:00.660 --> 01:15:04.660 And it's exhausting to the adrenal gland, and the adrenal gland needs some attention. 01:15:04.660 --> 01:15:05.660 Right? 01:15:05.660 --> 01:15:16.660 Okay. 01:15:16.660 --> 01:15:23.660 I think I've kind of talked about this. 01:15:23.660 --> 01:15:29.660 Leave the subject without talking about spiritual or emotional parts of pain. 01:15:29.660 --> 01:15:31.660 That's a whole two-hour lecture. 01:15:31.660 --> 01:15:36.660 But pain, the body is a unity. 01:15:36.660 --> 01:15:39.660 Mind, body, spirit. 01:15:39.660 --> 01:15:44.660 And you can't affect any aspect of it without affecting any other aspect of it. 01:15:44.660 --> 01:15:53.660 So part of pain is understanding the meaning that the pain has for an individual, 01:15:53.660 --> 01:16:01.660 and helping people perhaps to focus on other things in their life that will give their life more meaning. 01:16:01.660 --> 01:16:04.660 What happens to a number of patients is the strength. 01:16:04.660 --> 01:16:05.660 Pain takes over. 01:16:05.660 --> 01:16:06.660 It becomes their whole life. 01:16:06.660 --> 01:16:08.660 And that is not healthy. 01:16:08.660 --> 01:16:16.660 At that point, people are living in pain where it becomes the whole part of their life. 01:16:16.660 --> 01:16:19.660 And that isn't going to help them to heal. 01:16:19.660 --> 01:16:25.660 So it's really, really important to help people rediscover the natural parts of themselves. 01:16:25.660 --> 01:16:28.660 Not to create something that's not there, but to have someone go, 01:16:28.660 --> 01:16:35.660 well, I used to play the piano and I really used to love doing that, but I don't do it anymore. 01:16:35.660 --> 01:16:36.660 And it's like, well, okay. 01:16:36.660 --> 01:16:37.660 That's a starting point. 01:16:37.660 --> 01:16:39.660 That's part of what we need to do. 01:16:39.660 --> 01:16:46.660 So bringing meaning back into someone's life is really important in this process. 01:16:46.660 --> 01:16:49.660 I'm going to pass this up and go elsewhere. 01:16:49.660 --> 01:16:54.660 Let me talk about some other stuff. 01:16:54.660 --> 01:16:57.660 There's a whole lot, and this is a partial list, 01:16:57.660 --> 01:17:03.660 there's a whole lot of alternatives that are available to treat chronic pain. 01:17:03.660 --> 01:17:10.660 I'm going to focus on a few tonight you may not have heard of or don't know much about. 01:17:10.660 --> 01:17:13.660 Let me talk about prolotherapy maybe first. 01:17:13.660 --> 01:17:16.660 How many of you here know about prolotherapy? 01:17:16.660 --> 01:17:19.660 Better than most. 01:17:19.660 --> 01:17:24.660 Prolotherapy is a technique, it's an injection technique, 01:17:24.660 --> 01:17:34.660 which has to do with strengthening ligaments and tendon attachments that are weak. 01:17:34.660 --> 01:17:37.660 The way it's done, sorry, it's by injection, 01:17:37.660 --> 01:17:43.660 is we inject an intentionally irritating material into the ligaments and tendons 01:17:43.660 --> 01:17:48.660 to stimulate the body's fibroblast, which is the cell that we have 01:17:48.660 --> 01:17:52.660 that makes up the tendons and ligaments, to grow. 01:17:52.660 --> 01:17:57.660 It's the only technique I know that will actually strengthen a ligament or a tendon. 01:17:57.660 --> 01:18:01.660 Even surgery, when you reattach it, it weakens it, it doesn't make it any stronger. 01:18:01.660 --> 01:18:05.660 And so it is a fabulous way to strengthen it. 01:18:05.660 --> 01:18:09.660 It is superb for joint pain of almost every type. 01:18:09.660 --> 01:18:15.660 Let me explain the rationale for that. 01:18:15.660 --> 01:18:20.660 Okay, that's not going to work. 01:18:20.660 --> 01:18:24.660 Because it's a little bit counterintuitive. 01:18:24.660 --> 01:18:30.660 This is the structure of a knee, for example. 01:18:30.660 --> 01:18:32.660 We have a joint space in here. 01:18:32.660 --> 01:18:37.660 What holds the integrity of the joint together are the ligaments along the side 01:18:37.660 --> 01:18:41.660 and the ones that crisscross in the inter, the cruciate ligaments. 01:18:41.660 --> 01:18:47.660 So these ligaments are what hold the integrity of that joint together. 01:18:47.660 --> 01:18:54.660 If these ligaments get injured, then what happens is, literally, 01:18:54.660 --> 01:18:58.660 the joint is being held apart with the fluid, with the joint fluid in it. 01:18:58.660 --> 01:19:03.660 It's being held apart by the tightness of these ligaments. 01:19:03.660 --> 01:19:10.660 If these ligaments get weak, or torn to any way, not even a complete tear, 01:19:10.660 --> 01:19:20.660 if the ligaments get weak, what you get is a collapse of the joint on itself. 01:19:20.660 --> 01:19:23.660 So picture it tight, it holds it apart. 01:19:23.660 --> 01:19:26.660 If it collapses, the joint collapses on itself. 01:19:26.660 --> 01:19:32.660 So all of arthritis is about the wearing away of the cartilage, 01:19:32.660 --> 01:19:36.660 which is at the end of the joint space. 01:19:36.660 --> 01:19:40.660 This is what we call in a knee bone on bone. 01:19:40.660 --> 01:19:44.660 So if you have bone rubbing on bone, you're just going to rub the cartilage away. 01:19:44.660 --> 01:19:49.660 Ultimately, that will mean an orthopedist is going to have to do a total knee. 01:19:49.660 --> 01:19:52.660 Can this be treated in another way? 01:19:52.660 --> 01:19:54.660 Yes, prolotherapy can do that. 01:19:54.660 --> 01:19:57.660 Now, usually we hope people aren't in this state, 01:19:57.660 --> 01:20:00.660 because at this state it's much harder to turn it around. 01:20:00.660 --> 01:20:05.660 I have, but it's much harder to use prolotherapy to strengthen a joint. 01:20:05.660 --> 01:20:07.660 And you can do that in any joint. 01:20:07.660 --> 01:20:13.660 Shoulder, knee, ankle, you name the joint, you can use prolotherapy for it. 01:20:13.660 --> 01:20:20.660 But it is a very underused treatment that I believe will become a lot more used very soon. 01:20:20.660 --> 01:20:24.660 The reason for that is that in the last two years we have discovered 01:20:24.660 --> 01:20:28.660 that what we used to call tendonitis is not. 01:20:28.660 --> 01:20:31.660 It is now tendinosis. 01:20:31.660 --> 01:20:34.660 What's the difference other than the change in language? 01:20:34.660 --> 01:20:40.660 Tendinitis implies that there is an inflammation of the tendon. 01:20:40.660 --> 01:20:44.660 The biopsies of the tendon don't show inflammation. 01:20:44.660 --> 01:20:50.660 It shows damage to the insertion of the tendons and ligaments, not inflammation. 01:20:50.660 --> 01:20:54.660 So for years we have treated it with anti-inflammatories, 01:20:54.660 --> 01:20:57.660 which are pain relievers, so they will help it to feel better. 01:20:57.660 --> 01:21:01.660 They're not helping the pathology of the joint or the tendon. 01:21:01.660 --> 01:21:04.660 They don't do anything for it. 01:21:04.660 --> 01:21:09.660 And in fact, if you put cortisone into it, you're not helping it at all, you're going to weaken it. 01:21:09.660 --> 01:21:12.660 So do we have a treatment for it? 01:21:12.660 --> 01:21:17.660 Yes, prolotherapy, because it addresses the issue. 01:21:17.660 --> 01:21:23.660 It takes those damaged tendon fibers and allows the fiberglass to grow, and it tightens them up. 01:21:23.660 --> 01:21:25.660 It's a beautiful technique. 01:21:25.660 --> 01:21:32.660 It is being used more, although the vast majority of orthopedists would rather do a total knee 01:21:32.660 --> 01:21:41.660 than spend, you know, for $40,000 to spend, you know, $500 to $1000 to do prolotherapy. 01:21:41.660 --> 01:21:43.660 That's how it works. 01:21:43.660 --> 01:21:44.660 Sorry. 01:21:44.660 --> 01:21:50.660 Is it usually just one treatment with the prolotherapy or more than one? 01:21:50.660 --> 01:21:56.660 The number of treatments depends on the size of the ligaments in the joint we're going to be treating. 01:21:56.660 --> 01:22:00.660 So in a shoulder, usually you can fix it with three treatments. 01:22:00.660 --> 01:22:05.660 In the ankle, wrist, two or three. 01:22:05.660 --> 01:22:10.660 But in knees and low backs, which are much, much bigger ligamentous structures, 01:22:10.660 --> 01:22:14.660 with more ligamentous damage, it usually takes six treatments or more to treat. 01:22:14.660 --> 01:22:16.660 How about hips? 01:22:16.660 --> 01:22:19.660 Three. 01:22:19.660 --> 01:22:22.660 Sorry, I'm kind of late. 01:22:22.660 --> 01:22:23.660 But it works. 01:22:23.660 --> 01:22:24.660 It's superb. 01:22:24.660 --> 01:22:28.660 I can't tell you how many people I've helped with prolotherapy. 01:22:28.660 --> 01:22:30.660 And I've had it done on myself as well. 01:22:30.660 --> 01:22:32.660 Both of my shoulders have been done. 01:22:32.660 --> 01:22:33.660 My low back's been done. 01:22:33.660 --> 01:22:37.660 And I'm a great believer that it is a fabulous way. 01:22:37.660 --> 01:22:38.660 I had my shoulders done. 01:22:38.660 --> 01:22:43.660 When I had my right shoulder done, I couldn't raise it above here. 01:22:43.660 --> 01:22:47.660 That was eight, nine years ago. 01:22:47.660 --> 01:22:52.660 And what really motivated me to do it was that I couldn't put my arm around my wife when we watched television. 01:22:52.660 --> 01:22:56.660 That was unacceptable. 01:22:56.660 --> 01:23:01.660 Keep in mind that no sane human being does prolotherapy unless you can put up with some pain. 01:23:01.660 --> 01:23:04.660 It is not a comfortable thing. 01:23:04.660 --> 01:23:07.660 It is not for the weak of spirit or will. 01:23:07.660 --> 01:23:08.660 It's not horrible. 01:23:08.660 --> 01:23:10.660 It's just a bit painful. 01:23:10.660 --> 01:23:14.660 And you've got to put up with a little pain if you're going to be doing it. 01:23:14.660 --> 01:23:16.660 But within three treatments, my shoulder was normal. 01:23:16.660 --> 01:23:20.660 I haven't had a twinge in it for eight, nine years. 01:23:20.660 --> 01:23:23.660 So there's no question about it in my mind. 01:23:23.660 --> 01:23:26.660 It's a superb tool used properly. 01:23:26.660 --> 01:23:35.660 On that particular thing, the important thing with Prolo is to get going on it when you first start doing things instead of looking at, you know, go home and take the pain pills. 01:23:35.660 --> 01:23:36.660 Right? 01:23:36.660 --> 01:23:38.660 The sooner we work on it, the better it is. 01:23:38.660 --> 01:23:41.660 If I catch it early, one or two treatments may do wonders. 01:23:41.660 --> 01:23:46.660 If I catch it when we're bone on bone, I may not even be able to fix it adequately. 01:23:46.660 --> 01:23:47.660 It helps with the pain. 01:23:47.660 --> 01:23:48.660 What? 01:23:48.660 --> 01:23:49.660 It helps with the pain. 01:23:49.660 --> 01:23:50.660 It can. 01:23:50.660 --> 01:23:55.660 I'm just saying that there's no tool that I have as a cure-all. 01:23:55.660 --> 01:24:00.660 It helps some people some of the time, select it properly. 01:24:00.660 --> 01:24:03.660 But it's not a matter that everyone with pain gets prolotherapy. 01:24:03.660 --> 01:24:04.660 I don't work that way. 01:24:04.660 --> 01:24:08.660 I have to, by exam, they have to have a loose ligament. 01:24:08.660 --> 01:24:11.660 Or else there'd be no point in my doing that. 01:24:11.660 --> 01:24:14.660 Okay? 01:24:14.660 --> 01:24:19.660 Most of these are probably reasonably well known to most of you. 01:24:19.660 --> 01:24:21.660 Let me just go through some of them quickly. 01:24:21.660 --> 01:24:23.660 I know she hasn't talked about chiropractic. 01:24:23.660 --> 01:24:27.660 Is that a reason for it or just isn't it? 01:24:27.660 --> 01:24:28.660 No. 01:24:28.660 --> 01:24:32.660 It's, no, I don't have any reason at all. 01:24:32.660 --> 01:24:35.660 My first partner here on the coast was a chiropractor. 01:24:35.660 --> 01:24:39.660 I didn't know it at the time, but it was probably illegal for me to be in, 01:24:39.660 --> 01:24:41.660 to share the office with him. 01:24:41.660 --> 01:24:43.660 I didn't know it at the time. 01:24:43.660 --> 01:24:45.660 It is dead warm. 01:24:45.660 --> 01:24:48.660 My profession would have thrown me out if I had known that it was happening. 01:24:48.660 --> 01:24:50.660 He had superpians. 01:24:50.660 --> 01:24:52.660 For those of you who've been around the coastal walls, 01:24:52.660 --> 01:24:54.660 his name is Dan Weisenberg. 01:24:54.660 --> 01:24:57.660 I don't know if you understand or a fabulous chiropractor. 01:24:57.660 --> 01:25:00.660 No, I do a ton of oscic types of manipulation. 01:25:00.660 --> 01:25:04.660 It's just, it's whatever. 01:25:04.660 --> 01:25:07.660 It's the hands of the person doing it. 01:25:07.660 --> 01:25:09.660 It's not the field. 01:25:09.660 --> 01:25:11.660 There are fabulous chiropractors. 01:25:11.660 --> 01:25:13.660 There are lousy chiropractors. 01:25:13.660 --> 01:25:14.660 There are fabulous physicians. 01:25:14.660 --> 01:25:16.660 There are lousy physicians. 01:25:16.660 --> 01:25:20.660 It's the person and their skill, not the field person. 01:25:20.660 --> 01:25:22.660 Do I believe in it? Absolutely. 01:25:22.660 --> 01:25:26.660 Have chiropractors treated me? Absolutely. 01:25:26.660 --> 01:25:28.660 It's whatever. 01:25:28.660 --> 01:25:33.660 For me, it's whoever in my community has the skills that I need. 01:25:33.660 --> 01:25:38.660 And that's kind of what I work with. 01:25:38.660 --> 01:25:42.660 You all know about TENS? 01:25:42.660 --> 01:25:44.660 TENS is an electrical device. 01:25:44.660 --> 01:25:48.660 There are three kinds of TENS that you may not know so much about. 01:25:48.660 --> 01:25:55.660 The original TENS unit was invented by my partner, 01:25:55.660 --> 01:25:57.660 Norm Shealy, many years ago. 01:25:57.660 --> 01:26:02.660 We used a small ton of TENS, so I'm very, very familiar with it. 01:26:02.660 --> 01:26:08.660 That TENS unit operates at a frequency of 2 to 4 hertz or 200 hertz 01:26:08.660 --> 01:26:11.660 and sometimes flips back and forth depending on the unit. 01:26:11.660 --> 01:26:14.660 Now, the 2 to 4 hertz stimulates serotonin, 01:26:14.660 --> 01:26:17.660 and the 200 hertz stimulates dopamine. 01:26:17.660 --> 01:26:22.660 So you can get different neurotransmitters stimulated by the type of TENS you use 01:26:22.660 --> 01:26:24.660 and the frequency you use it. 01:26:24.660 --> 01:26:27.660 Basically, it works a lot like acupuncture. 01:26:27.660 --> 01:26:30.660 The concept in Chinese medicine would be 01:26:30.660 --> 01:26:35.660 if there is a blockage in energy flow, that is where pain comes from. 01:26:35.660 --> 01:26:39.660 So the idea is to get energy or a chain moving through the area of blockage. 01:26:39.660 --> 01:26:45.660 TENS does it by putting energy above, through, and out the other side 01:26:45.660 --> 01:26:48.660 of a very light electrical dose. 01:26:48.660 --> 01:26:51.660 And if you can get the energy moving through there, 01:26:51.660 --> 01:26:55.660 then often it will be very helpful in treating pain. 01:26:55.660 --> 01:26:58.660 Now, there are other types of TENS as well. 01:26:58.660 --> 01:27:01.660 One is called the cranial electrical stimulation, 01:27:01.660 --> 01:27:03.660 originally developed by Saul Liss, 01:27:03.660 --> 01:27:06.660 which operates at a very different frequency. 01:27:06.660 --> 01:27:09.660 It works at 15,000 hertz, and it uses a carrier wave, 01:27:09.660 --> 01:27:13.660 which means it's another frequency that goes with it. 01:27:13.660 --> 01:27:17.660 So it tricks the body into letting electrical stimulation enter it. 01:27:17.660 --> 01:27:22.660 It works, it can work on the head in ways that TENS does not. 01:27:22.660 --> 01:27:27.660 TENS is not supposed to be used on the head because of the rain wave stimulation, 01:27:27.660 --> 01:27:29.660 but Liss can't. 01:27:29.660 --> 01:27:34.660 And it can improve depression, migraines, headaches. 01:27:34.660 --> 01:27:40.660 It can stimulate epinephrine, norepinephrine, dopamine, and serotonin profoundly 01:27:40.660 --> 01:27:45.660 by using a little bit of electrical stimulation for short periods of time. 01:27:45.660 --> 01:27:48.660 The last major type of TENS is the giga-TENS, 01:27:48.660 --> 01:27:52.660 which uses TENS at the 15 to 70 billion hertz, 01:27:52.660 --> 01:27:57.660 and that has been used again by my mentor and friend, Norm Shealy, 01:27:57.660 --> 01:28:01.660 to treat a variety of illnesses, particularly autoimmune diseases 01:28:01.660 --> 01:28:03.660 like rheumatoid arthritis. 01:28:03.660 --> 01:28:07.660 You can do some amazing things with the right type of electrical stimulation. 01:28:07.660 --> 01:28:15.660 I'm going to talk about microcurrent in just a few minutes. 01:28:15.660 --> 01:28:20.660 Yeah, we did enough on polo. 01:28:20.660 --> 01:28:22.660 I'm going to go zipping through there. 01:28:22.660 --> 01:28:26.660 Another type of treatment that you may not have heard of is mesotherapy. 01:28:26.660 --> 01:28:29.660 It's used a lot more for cosmetic purposes than paint, 01:28:29.660 --> 01:28:31.660 but it works really well for paint. 01:28:31.660 --> 01:28:36.660 And what it consists of is teeny, teeny amounts of materials, 01:28:36.660 --> 01:28:40.660 and the materials are often in the form of a little bit of magnesium, 01:28:40.660 --> 01:28:45.660 a little bit of procaine ejected just under the skin, 01:28:45.660 --> 01:28:47.660 a teeny blob under the skin. 01:28:47.660 --> 01:28:51.660 And you do a series of them over the area of paint. 01:28:51.660 --> 01:28:54.660 And for reasons that are not clear to us yet, 01:28:54.660 --> 01:28:59.660 those materials stay in the body longer and produces prolonged relief of pain 01:28:59.660 --> 01:29:01.660 by doing that. 01:29:01.660 --> 01:29:04.660 And so I've had some patients where nothing has helped them, 01:29:04.660 --> 01:29:06.660 but if I've done that particular technique, 01:29:06.660 --> 01:29:09.660 I've sometimes had some really nice success with that. 01:29:09.660 --> 01:29:12.660 And these are some of the little ingredients. 01:29:12.660 --> 01:29:15.660 This is similar in concept to neuro-therapy. 01:29:15.660 --> 01:29:17.660 Is that something people have heard of? 01:29:17.660 --> 01:29:19.660 Some yeses, most unknowns. 01:29:19.660 --> 01:29:23.660 Neuro-therapy is a German concept that... 01:29:27.660 --> 01:29:31.660 If the body has a scar in it, 01:29:31.660 --> 01:29:37.660 often peripheral nerves get trapped in the scar as the scar heals, 01:29:37.660 --> 01:29:42.660 and it stimulates and irritates the nerve on a profound continuing level. 01:29:42.660 --> 01:29:46.660 Often we'll see it with people who have had a cholecystectomy, 01:29:46.660 --> 01:29:49.660 a laparotomy, any number of surgical procedures. 01:29:49.660 --> 01:29:53.660 And what they say is, the pain has never left my scar, not ever. 01:29:53.660 --> 01:29:57.660 Or the pain can radiate from that area to somewhere near it. 01:29:57.660 --> 01:29:59.660 And when someone says, I have this pain here, 01:29:59.660 --> 01:30:01.660 and I had an abdominal surgery, 01:30:01.660 --> 01:30:05.660 and it came on within a month of that and it's never gone away, 01:30:05.660 --> 01:30:10.660 the concept is that there may be a pinatina nerve that is trapped in there 01:30:10.660 --> 01:30:15.660 that is sending this rubber-banging loop message, as I heard, I heard, I heard, I heard. 01:30:15.660 --> 01:30:20.660 You can shut it down by injecting a little bit of anesthetic, 01:30:20.660 --> 01:30:25.660 like cocaine, marcane, directly into the scar. 01:30:25.660 --> 01:30:28.660 Not particularly painful, it's very simple, 01:30:28.660 --> 01:30:31.660 and you can find out the diagnosis with one injection. 01:30:31.660 --> 01:30:34.660 If that takes the pain away, then people go, 01:30:34.660 --> 01:30:37.660 oh, okay, I think I know where the pain is coming from. 01:30:37.660 --> 01:30:42.660 If you continue the injection on a regular basis, it breaks the loop. 01:30:42.660 --> 01:30:46.660 Once the loop is broken, we're done, and the story of the pain is gone. 01:30:46.660 --> 01:30:53.660 So it's another pain thing that we can look at that you all might want to be aware of. 01:30:53.660 --> 01:30:55.660 Are you going to touch your herbal or? 01:30:55.660 --> 01:30:56.660 What? 01:30:56.660 --> 01:30:57.660 Herbal or? 01:30:57.660 --> 01:30:58.660 No. 01:30:58.660 --> 01:30:59.660 Okay. 01:30:59.660 --> 01:31:00.660 Want me to go back? 01:31:00.660 --> 01:31:01.660 On the screen. 01:31:01.660 --> 01:31:02.660 Oh, okay. 01:31:02.660 --> 01:31:04.660 Just a couple of really basic things. 01:31:04.660 --> 01:31:06.660 You're a pretty sophisticated audience. 01:31:06.660 --> 01:31:08.660 I'm not going to go into the stuff. 01:31:08.660 --> 01:31:10.660 Nothing really brand new. 01:31:10.660 --> 01:31:12.660 That is, $300 herbs. 01:31:12.660 --> 01:31:15.660 Oh, I know. 01:31:15.660 --> 01:31:19.660 Okay, my newest, latest, favoritest toy, 01:31:19.660 --> 01:31:22.660 frequency-specific microcurrent. 01:31:22.660 --> 01:31:26.660 It uses two different frequencies. 01:31:26.660 --> 01:31:29.660 Microcurrent means we're talking a thousandth of an amp. 01:31:29.660 --> 01:31:33.660 So no electricity is felt in the body. 01:31:33.660 --> 01:31:37.660 If you use a tens unit, if you crank unit up, you will feel electricity. 01:31:37.660 --> 01:31:39.660 You're not going to feel microcurrent. 01:31:39.660 --> 01:31:42.660 It's at a level that you will not perceive it. 01:31:42.660 --> 01:31:46.660 My most sensitive patient cannot tell that they're receiving it. 01:31:46.660 --> 01:31:51.660 However, it has the capacity to reboot the nervous system. 01:31:51.660 --> 01:31:52.660 Okay? 01:31:52.660 --> 01:31:58.660 I'm not quite sure how it does it, but I'm amazingly impressed with its ability to do that. 01:31:58.660 --> 01:32:02.660 So things that we haven't been able to treat before around, we can now. 01:32:02.660 --> 01:32:10.660 Peripheral neuropathies, all sorts of nerve problems where there is a type of fibromyalgia 01:32:10.660 --> 01:32:14.660 called cervical trauma mediated fibromyalgia, 01:32:14.660 --> 01:32:22.660 which is different than other fibromyalgia and is set off by injury to the cervical spine, to the neck. 01:32:22.660 --> 01:32:27.660 And one of the ways you can tell that that's going on is, A, by history, people will say, 01:32:27.660 --> 01:32:29.660 you know, I was in a minor fender bender. 01:32:29.660 --> 01:32:31.660 I didn't think it was that big a deal. 01:32:31.660 --> 01:32:37.660 Within two months, I had fibromyalgia, and now I'm where I am. 01:32:37.660 --> 01:32:42.660 The tip-off is on physical examination, again, something that people don't do much. 01:32:42.660 --> 01:32:48.660 If you check the reflexes, the reflexes of the knees are hyperactive. 01:32:48.660 --> 01:32:49.660 They jump out. 01:32:49.660 --> 01:32:57.660 And that is indicative that there is irritation of the spinal cord. 01:32:57.660 --> 01:33:04.660 Basically, cord irritation, which causes nerve segment facilitation and irritation of the nervous system. 01:33:04.660 --> 01:33:07.660 Now, here's the beauty. 01:33:07.660 --> 01:33:12.660 The woman who put frequency-specific microcurrent on the map, 01:33:12.660 --> 01:33:17.660 her first study was to take 80 people with cervical mediated fibromyalgia, 01:33:17.660 --> 01:33:24.660 which as you know, the medical profession does not allow that treatment. 01:33:24.660 --> 01:33:27.660 And treated them with FSM. 01:33:27.660 --> 01:33:29.660 All of them got better. 01:33:29.660 --> 01:33:34.660 You know, 60% were cured in three or four months, and I mean flat-out cured. 01:33:34.660 --> 01:33:43.660 So it is clear that this type of electrical stimulation can literally reboot the nervous system. 01:33:43.660 --> 01:33:50.660 It can shut down irritating stimuli that people have not figured out what to do with for a long period of time. 01:33:50.660 --> 01:33:55.660 I'm very impressed with it. I've been using it now for about six months. 01:33:55.660 --> 01:34:00.660 I use it a lot at the clinic and it's a beautiful tool. 01:34:00.660 --> 01:34:03.660 It also can be used for other things as well. 01:34:03.660 --> 01:34:06.660 You say it helps with peripheral neuropathy? 01:34:06.660 --> 01:34:07.660 Yes. 01:34:07.660 --> 01:34:09.660 Feet burning, etc., etc. 01:34:09.660 --> 01:34:12.660 It depends on what causes the peripheral neuropathy. 01:34:12.660 --> 01:34:14.660 It depends on whether it's barnella or... 01:34:14.660 --> 01:34:15.660 Yes. 01:34:15.660 --> 01:34:20.660 There are other causes. Once again, I go back to you have to treat the cause. 01:34:20.660 --> 01:34:22.660 If it's merely nerve irritation, yes. 01:34:22.660 --> 01:34:27.660 It can help even barnella-induced peripheral neuropathy, 01:34:27.660 --> 01:34:31.660 but you still have to get the barnella out of the system, though we're not doing it anyway. 01:34:31.660 --> 01:34:35.660 Can you get some relief while you're trying to get the barnella out? 01:34:35.660 --> 01:34:36.660 Yeah. 01:34:36.660 --> 01:34:43.660 In fact, there's a whole FSM protocol for Lyme disease now that we are starting to work with, 01:34:43.660 --> 01:34:47.660 and we're going to be doing some research on that very soon. 01:34:47.660 --> 01:34:55.660 Because there are frequencies you can use to affect parasites, bacteria, toxins in the body. 01:34:55.660 --> 01:34:59.660 It's a whole bunch of amazing things this little device can do. 01:34:59.660 --> 01:35:02.660 It's my new favorite toy. 01:35:02.660 --> 01:35:10.660 You guys don't know me that well, but my whole professional life I have fallen in love and am in love 01:35:10.660 --> 01:35:18.660 with a wide, wide, wide variety of treatments, and this is my current favorite. 01:35:18.660 --> 01:35:22.660 How exactly is that applied? 01:35:22.660 --> 01:35:24.660 There's a number of ways you can... 01:35:24.660 --> 01:35:28.660 The way we like to do it the most is with... 01:35:28.660 --> 01:35:33.660 We wrap electrodes in wet towels, and we'll put one at the top of the body, 01:35:33.660 --> 01:35:35.660 and then at the bottom of the part we want to treat. 01:35:35.660 --> 01:35:40.660 So if the part I want to treat is an arm, I'll put one at the neck and one on the hand. 01:35:40.660 --> 01:35:44.660 If it's the whole body or the peripheral neuropathy goes down to the feet, 01:35:44.660 --> 01:35:47.660 we'll put a towel here, we'll put a towel at the bottom of the feet, 01:35:47.660 --> 01:35:53.660 then lie it flat on the table, and then we'll adjust the frequencies to a variety of frequencies. 01:35:53.660 --> 01:36:01.660 There's two frequencies, left and right, and the one on the left deals with what we call physiology, 01:36:01.660 --> 01:36:03.660 and then one on the right deals with tissues. 01:36:03.660 --> 01:36:07.660 So these won't mean anything to you because it's a numerically based system, 01:36:07.660 --> 01:36:13.660 but we would start in a cervical trauma fibromyalgia with a 40 on the left and a 10 on the right. 01:36:13.660 --> 01:36:16.660 10 is spinal cord, 40 is inflammation. 01:36:16.660 --> 01:36:20.660 We then might leave it on the anti-inflammation frequency 01:36:20.660 --> 01:36:26.660 and then put it on nerves, muscles, ligaments, tendons, and we would just keep changing the frequency. 01:36:26.660 --> 01:36:31.660 You can monitor the body with your hand and see when the body is loosening up and softening. 01:36:31.660 --> 01:36:34.660 You know you've given it enough and then you change the frequency. 01:36:34.660 --> 01:36:39.660 So we're taught to use our hands to monitor that. 01:36:39.660 --> 01:36:43.660 Why do you put the towel at the base of the neck? 01:36:43.660 --> 01:36:47.660 Just that's the starting point for all therapies? 01:36:47.660 --> 01:36:49.660 Well, I'm running it through the body. 01:36:49.660 --> 01:36:52.660 I can use it on top of the head, I can use it anywhere I want. 01:36:52.660 --> 01:36:57.660 I recently had a patient with acute belt palsy 01:36:57.660 --> 01:37:02.660 where both sides were all affected. 01:37:02.660 --> 01:37:09.660 We could use a towel behind the head and I can actually, there's a glove that's attached to it, 01:37:09.660 --> 01:37:14.660 I can put a glove on the mouth and I can literally run the frequency right along the facial nerve. 01:37:14.660 --> 01:37:20.660 And within a week of treatment she was 50% better from an acute event. 01:37:20.660 --> 01:37:24.660 And that's almost unheard of neurologically. 01:37:24.660 --> 01:37:28.660 So do you use this only when it's cervical trauma 01:37:28.660 --> 01:37:32.660 or you're using in general fibromyalgia on certain areas to relieve pain? 01:37:32.660 --> 01:37:35.660 I can use it on any body tissue whatsoever. 01:37:35.660 --> 01:37:41.660 It's best use is for acute pain and pain that people don't know what to do with. 01:37:41.660 --> 01:37:46.660 But its beauty is nerve pain because nothing else touches nerve pain very well. 01:37:46.660 --> 01:37:52.660 It's the only device I've ever found that allows me to actually take the inflammation out of the nerve. 01:37:52.660 --> 01:37:56.660 There are multiple, you can use it for the skin, you can use it for the respiratory tract. 01:37:56.660 --> 01:37:59.660 There are frequencies for the intestines to make them work better. 01:37:59.660 --> 01:38:05.660 It's a very, very comprehensive device in terms of what it can do. 01:38:05.660 --> 01:38:09.660 So it's like an electrical stimulation? 01:38:09.660 --> 01:38:12.660 It is, the amount of electricity is minimal. 01:38:12.660 --> 01:38:18.660 It's really taking two waves, two electrical waves and putting it into the body 01:38:18.660 --> 01:38:23.660 and at the interfaces of those waves it resets nervous systems. 01:38:23.660 --> 01:38:26.660 I don't know how it does it. I just have seen it work and I... 01:38:26.660 --> 01:38:29.660 It's like turning off the electrical switch. 01:38:29.660 --> 01:38:32.660 It's kind of like throwing a breaker switch and throwing it back on again later. 01:38:32.660 --> 01:38:35.660 Yeah, a little bit like that. 01:38:35.660 --> 01:38:39.660 So it has multiple uses. I'm emphasizing the ones that I think make it unique. 01:38:39.660 --> 01:38:42.660 But there's a lot more that it can do. 01:38:42.660 --> 01:38:47.660 Is there, have there been studies that show which frequencies work? 01:38:47.660 --> 01:38:48.660 Yes. 01:38:48.660 --> 01:38:49.660 On which body parts? 01:38:49.660 --> 01:38:50.660 Yes. 01:38:50.660 --> 01:38:55.660 There are, there's been amazing studies done. 01:38:55.660 --> 01:39:01.660 The lab work was done at the NIH where in people who have the cervical trauma fibromyalgia 01:39:01.660 --> 01:39:05.660 they measured the inflammatory chemicals in the body before a treatment 01:39:05.660 --> 01:39:09.660 and then an hour into the treatment, two hours into the treatment 01:39:09.660 --> 01:39:13.660 and there was a final drop of the inflammatory chemicals. 01:39:13.660 --> 01:39:17.660 I don't know anything else that could make those chemicals drop that fast. 01:39:17.660 --> 01:39:18.660 Never heard of it. 01:39:18.660 --> 01:39:22.660 No drug that I've ever heard of could make the chemicals drop that fast. 01:39:22.660 --> 01:39:30.660 So it clearly is doing something to the body that works at a profound level. 01:39:30.660 --> 01:39:34.660 So it sounds homeopathic? 01:39:34.660 --> 01:39:37.660 Or is it going to trigger your body? 01:39:37.660 --> 01:39:38.660 Conceptually, sort of. 01:39:38.660 --> 01:39:40.660 I mean homeopathics are energy remedies 01:39:40.660 --> 01:39:45.660 and it's like getting the energy to vibrate at the right frequency. 01:39:45.660 --> 01:39:51.660 What happens with the inflammatory chemicals? 01:39:51.660 --> 01:39:53.660 The body gets rid of them. 01:39:53.660 --> 01:39:57.660 So there's a detoxification thing that happens? 01:39:57.660 --> 01:39:59.660 Yeah. 01:39:59.660 --> 01:40:03.660 The essence of fibromyalgia, for example, as well as a whole bunch of other things 01:40:03.660 --> 01:40:08.660 is that the body has, again it's one of these loops 01:40:08.660 --> 01:40:12.660 where the body is making inflammatory chemicals called cytokines 01:40:12.660 --> 01:40:14.660 and it doesn't know how to turn them off. 01:40:14.660 --> 01:40:22.660 If you can suddenly turn them off, that is a major shift in body chemistry. 01:40:22.660 --> 01:40:25.660 Mold toxin, for those of you who lived up here, is like that. 01:40:25.660 --> 01:40:30.660 Mold toxin sets off these inflammatory cytokines. 01:40:30.660 --> 01:40:35.660 For those people who are mold sensitive, not allergy, but mold toxin sensitive, 01:40:35.660 --> 01:40:39.660 of course no one up here has ever seen a mold. 01:40:39.660 --> 01:40:42.660 For those who are sensitive, and it's a genetic issue, 01:40:42.660 --> 01:40:47.660 75% of people won't be bothered by it and 25% of people will. 01:40:47.660 --> 01:40:52.660 Once that gets set off, if you keep going back into a moldy environment, 01:40:52.660 --> 01:41:00.660 you cannot turn off these chemicals and it can really make people sick. 01:41:00.660 --> 01:41:06.660 Are you going to talk about laser, which you see advertised in pulp page ads now from Santa Rosa? 01:41:06.660 --> 01:41:09.660 Well, there's always what laser? 01:41:09.660 --> 01:41:12.660 Well, it's like in connection with chronic pain. 01:41:12.660 --> 01:41:18.660 Usually they're talking about using laser primarily as an acupuncture adjunct. 01:41:18.660 --> 01:41:29.660 They're usually using laser over acupuncture points, and it is effective and works that way. 01:41:29.660 --> 01:41:32.660 Any more questions? 01:41:32.660 --> 01:41:36.660 I'm pretty much done from a sub-adjust, so if you have questions for her, I'll respond. 01:41:36.660 --> 01:41:39.660 You did say that you were up here one day a week? 01:41:39.660 --> 01:41:44.660 I live here, but we're working Thursday mornings over at the Women's Health Center, 01:41:44.660 --> 01:41:50.660 and we're going to be expanding because I'm getting busy enough that I need to do it. 01:41:50.660 --> 01:41:56.660 So is it in the best interest to go to your Santa Rosa office out where you are to start with, or here? 01:41:56.660 --> 01:41:58.660 It depends on the issue. 01:41:58.660 --> 01:42:04.660 If you need anything elaborate like IVs or things like that, Santa Rosa. 01:42:04.660 --> 01:42:09.660 But I am bringing the frequency-specific microcard with me. 01:42:09.660 --> 01:42:11.660 I do prolo here. 01:42:11.660 --> 01:42:14.660 Much of what I do, I can do up here. 01:42:14.660 --> 01:42:17.660 So it just depends on the issue. 01:42:17.660 --> 01:42:21.660 If you want to reach us, if you're interested in doing that, call. 01:42:21.660 --> 01:42:24.660 I have some cards here, and you can call the number on the card. 01:42:24.660 --> 01:42:29.660 You schedule it through the Santa Rosa office, not through the Women's Health Center. 01:42:29.660 --> 01:42:39.660 And my medical assistant who is Karen or anyone else at the clinic can go over with you your needs and where would be best. 01:42:39.660 --> 01:42:40.660 And what records? 01:42:40.660 --> 01:42:45.660 I mean, when you're getting a son or a daughter on a bad or anything, do you need all the records brought to you? 01:42:45.660 --> 01:42:48.660 I like records. I like to look at what's been done. 01:42:48.660 --> 01:42:50.660 I don't want to reinvent the wheel. 01:42:50.660 --> 01:42:54.660 Only because some of them are. 01:42:54.660 --> 01:42:59.660 Do you have any suggestions for someone who is on Medicare? 01:42:59.660 --> 01:43:01.660 How they would pursue treating their pain? 01:43:01.660 --> 01:43:08.660 What would you do if you were? 01:43:08.660 --> 01:43:12.660 You know, I don't know that it's possible for me to put myself in someone else's. 01:43:12.660 --> 01:43:18.660 With my personality, I would move heaven and earth to get my pain helped anyway I could. 01:43:18.660 --> 01:43:21.660 And if I had to spend some money out of pocket, I probably would. 01:43:21.660 --> 01:43:24.660 What if you don't have a pocket anymore? 01:43:24.660 --> 01:43:30.660 I mean, after being this way for 16 years, you know, you run out of money. 01:43:30.660 --> 01:43:36.660 I understand. What we do is alternative and not covered by Medicare. 01:43:36.660 --> 01:43:40.660 And we have had to sign off from Medicare at this point. 01:43:40.660 --> 01:43:43.660 Everyone in my office has done that. 01:43:43.660 --> 01:43:48.660 The problem with that, you may not understand it, is that if Medicare audits a chart 01:43:48.660 --> 01:43:52.660 and finds that we have provided a treatment that they do not authorize, 01:43:52.660 --> 01:43:55.660 and believe me, they don't authorize most of what we do, 01:43:55.660 --> 01:44:00.660 they can fine us $10,000 per procedure in the chart. 01:44:00.660 --> 01:44:04.660 So I try to do five things in that one chart. 01:44:04.660 --> 01:44:06.660 That's a $50,000 fine. 01:44:06.660 --> 01:44:10.660 No, you're misunderstanding me. I'm not talking to you for not taking Medicare at all. 01:44:10.660 --> 01:44:18.660 I'm asking you, do you know of any way that people who are on the low end of the economic spectrum 01:44:18.660 --> 01:44:23.660 can get treatment other than robbing a bank? 01:44:23.660 --> 01:44:27.660 Because the longer you've been in pain, the poorer you get. 01:44:27.660 --> 01:44:34.660 I totally understand. I've been doing this for a long, long time. 01:44:34.660 --> 01:44:37.660 I don't have a good answer for you. 01:44:37.660 --> 01:44:42.660 It's a sociological problem that needs to be solved. 01:44:42.660 --> 01:44:51.660 I hoped that Obama might address that at some point in the health legislation. 01:44:51.660 --> 01:44:54.660 I am less hopeful than I was. 01:44:54.660 --> 01:44:59.660 When he was running, I was on his alternative health committee. 01:44:59.660 --> 01:45:04.660 And that committee isn't around anymore. 01:45:04.660 --> 01:45:09.660 So I think he's up to his eyeballs and alligators right now in that. 01:45:09.660 --> 01:45:12.660 I hope that things can change. 01:45:12.660 --> 01:45:17.660 Because what I do, although it's called alternative, there's nothing alternative about it. 01:45:17.660 --> 01:45:21.660 It's just a medicine. And it should be available to everybody. 01:45:21.660 --> 01:45:24.660 I have a question for you. 01:45:24.660 --> 01:45:29.660 If you come in for one of these treatments, what does it cost you to have one? 01:45:29.660 --> 01:45:31.660 It's an office visit. It's $175. 01:45:31.660 --> 01:45:32.660 Okay. 01:45:32.660 --> 01:45:36.660 If the treatment works, and if you're thrilled with it, 01:45:36.660 --> 01:45:41.660 we have home units where you can take it home and use it every day or three times a week. 01:45:41.660 --> 01:45:45.660 And move your treatment along much faster. 01:45:45.660 --> 01:45:52.660 So the purpose of the first treatment or two is to give a precise treatment to know whether it's going to work or not. 01:45:52.660 --> 01:45:57.660 And if it does, then we recommend that you don't come in and spend a lot of money. 01:45:57.660 --> 01:46:02.660 If you're doing injections, though, for people, Medicare would cover it. 01:46:02.660 --> 01:46:04.660 It's just if you get into the... 01:46:04.660 --> 01:46:05.660 We're not accepting without... 01:46:05.660 --> 01:46:06.660 I see. 01:46:06.660 --> 01:46:08.660 So that you don't have a conflict. 01:46:08.660 --> 01:46:10.660 I've had to sign off for Medicare. 01:46:10.660 --> 01:46:11.660 Okay. 01:46:11.660 --> 01:46:13.660 For 38 years, I took Medicare. 01:46:13.660 --> 01:46:14.660 No, I understand. 01:46:14.660 --> 01:46:15.660 I'm just expecting. 01:46:15.660 --> 01:46:17.660 It's complex for people to understand. 01:46:17.660 --> 01:46:18.660 So, yeah, sorry. 01:46:18.660 --> 01:46:19.660 Billion aspect. 01:46:19.660 --> 01:46:21.660 Do you think you could... 01:46:21.660 --> 01:46:26.660 Just a little bit off topic, but something that you said. 01:46:26.660 --> 01:46:29.660 You mentioned mold allergies or mold... 01:46:29.660 --> 01:46:30.660 Mold toxicity. 01:46:30.660 --> 01:46:31.660 Thank you. 01:46:31.660 --> 01:46:32.660 I just moved up here. 01:46:32.660 --> 01:46:33.660 I've never heard of that before. 01:46:33.660 --> 01:46:37.660 What are the symptoms for the people who are sensitive? 01:46:37.660 --> 01:46:48.660 Problems with focus, memory, concentration, thinking, joint pain, chest tightness, odd neurological sensations, 01:46:48.660 --> 01:46:55.660 numbness and pain in different parts of the body, electrical sensations in places that you shouldn't have electrical sensations, 01:46:55.660 --> 01:47:01.660 eye symptoms, eye irritation, redness, there's a wide, wide spectrum. 01:47:01.660 --> 01:47:04.660 And coughing and sneezing. 01:47:04.660 --> 01:47:08.660 Coughing and sneezing are more traditional mold allergies. 01:47:08.660 --> 01:47:11.660 These are toxin symptoms and it's treated very differently. 01:47:11.660 --> 01:47:12.660 It's not an allergy. 01:47:12.660 --> 01:47:14.660 It's a toxin buildup in the body. 01:47:14.660 --> 01:47:18.660 You've done it with the toxin for people to get that. 01:47:18.660 --> 01:47:19.660 Yes, ma'am. 01:47:19.660 --> 01:47:29.660 Is numbness in joints treated with these electrical variations? 01:47:29.660 --> 01:47:30.660 Could be. 01:47:30.660 --> 01:47:31.660 Could be. 01:47:31.660 --> 01:47:32.660 Yes. 01:47:32.660 --> 01:47:37.660 How important is a good mattress to keep away aches and pains? 01:47:37.660 --> 01:47:39.660 Depends on the being. 01:47:39.660 --> 01:47:44.660 There's no right pillow or mattress. 01:47:44.660 --> 01:47:47.660 Only the right one for you. 01:47:47.660 --> 01:47:50.660 I get that question a lot. 01:47:50.660 --> 01:47:52.660 What's the best pillow? 01:47:52.660 --> 01:47:55.660 It depends on your neck structure and what makes you comfortable. 01:47:55.660 --> 01:48:01.660 So I tell people to experiment and find what makes you most comfortable. 01:48:01.660 --> 01:48:02.660 It's not a right or a wrong. 01:48:02.660 --> 01:48:04.660 Years ago we always talked about hard mattresses. 01:48:04.660 --> 01:48:06.660 Those are out of favor now. 01:48:06.660 --> 01:48:09.660 Now people are doing soft mattresses again. 01:48:09.660 --> 01:48:11.660 So there are fans to that. 01:48:11.660 --> 01:48:13.660 You don't want to get caught up in the fed. 01:48:13.660 --> 01:48:16.660 It's what does my body like? 01:48:16.660 --> 01:48:18.660 So if you call for the appointment, 01:48:18.660 --> 01:48:21.660 and did they send out a questionnaire and stuff to you 01:48:21.660 --> 01:48:23.660 so you have that ready for the week, you'd be okay. 01:48:23.660 --> 01:48:24.660 Great. 01:48:24.660 --> 01:48:27.660 Yes, ma'am. 01:48:27.660 --> 01:48:28.660 I have one last question. 01:48:28.660 --> 01:48:29.660 Yes. 01:48:29.660 --> 01:48:31.660 This hasn't been covered. 01:48:31.660 --> 01:48:34.660 Have you, over your years, in your practice, 01:48:34.660 --> 01:48:40.660 ever worked with anyone who has been completely fused from scoliosis 01:48:40.660 --> 01:48:44.660 with metal rods and nuts and bolts and screws? 01:48:44.660 --> 01:48:45.660 Yes, several. 01:48:45.660 --> 01:48:46.660 Have you? 01:48:46.660 --> 01:48:47.660 Yes. 01:48:47.660 --> 01:48:50.660 With any success? 01:48:50.660 --> 01:48:52.660 It depends on the individual. 01:48:52.660 --> 01:49:00.660 I have several that I've worked with for a long time who got a lot better. 01:49:00.660 --> 01:49:04.660 I would almost use the word almost here, 01:49:04.660 --> 01:49:06.660 meaning they needed treatment every two, three months, 01:49:06.660 --> 01:49:08.660 but basically were pain free in between, 01:49:08.660 --> 01:49:11.660 and I got a lot of all pain medication. 01:49:11.660 --> 01:49:14.660 So again, it depends, but I've had people fused. 01:49:14.660 --> 01:49:18.660 Rods and cages and everything. 01:49:18.660 --> 01:49:20.660 Yes, ma'am. 01:49:20.660 --> 01:49:22.660 Thank you. 01:49:22.660 --> 01:49:25.660 Thank you all for your attention and time. 01:49:25.660 --> 01:49:28.660 Thank you for braving the elements and coming out in this weather. 01:49:28.660 --> 01:49:30.660 And I hope this is helpful. 01:49:30.660 --> 01:49:31.660 Thank you. 01:49:31.660 --> 01:49:56.660 Thank you. 01:50:01.660 --> 01:50:03.660 Thank you. 01:50:31.660 --> 01:50:33.660 Thank you.