Beyond the Pain with Dr. Gary Kaplan: A Journey into Integrative Medicine

Are you tired of enduring chronic pain, battling with unyielding fatigue, or wrestling with relentless depression? I know I was, but there is hope, my friends. I invite you to join me and our guest, the renowned Dr. Gary Kaplan, as we navigate the perplexing world of chronic illnesses. Dr. Kaplan brings his groundbreaking insights on chronic conditions and a unique neuroinflammatory approach to treatment that might just change the way we understand and manage these persistent foes.

We discuss the pitfalls of our medical system, including the unscrupulous dealings of pharmaceutical and insurance companies, and the lack of resources available to emergency doctors. These realities are frustrating, but we face them head-on, sharing personal experiences like Dr. Kaplan's journey with his father's medical challenges. The riveting conversation also unveils the psychological and environmental factors that play a crucial role in diagnosing and treating chronic illnesses.

We wrap up by delving into the latest advancements in immune dysfunction research and the role of cross-disciplinary collaboration in propelling this field forward. We explore promising treatments for long COVID, the importance of early testing, and the potential implications of different COVID variants. Brace yourselves as we reveal the secrets of supercharging your immune system and effective anti-aging methods. So, buckle up and join us on this enlightening journey that dares to challenge traditional perspectives on chronic illness, shining a light on the power of integrative medicine.

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Transcript

Speaker 1: 1:07

Hello everybody and welcome to the Off White Code podcast. I'm your host, jordan Amney, and today I'm joined by the founder and medical director at Kaplan Center for Integrated Medicine. He's a clinical associate professor at Georgetown University, the author of why Are you Still Sick, how Infections Can Break your Immune System and how you Can Recover, and he also specializes in finding solutions for chronic illnesses such as long COVID, chronic fatigue, fibromyalgia and many more. He is one of only 19 physicians in the whole country to be board certified in family medicine and pain medicine. So, everybody, it is my pleasure to introduce you all to Dr Gary Kaplan. Hello, dr Kaplan, it's nice to meet you.

Speaker 2: 1:50

Jordan, pleasure to meet you and thank you for having me on the show.

Speaker 1: 1:53

Of course, and so for everybody that doesn't know you or the things that you're working on, could you please like give us a little breakdown of your medical journey and what led you to where you are now?

Speaker 2: 2:05

So the medical journey is a bit long, but basically the shorthand version of it is my boards of family medicine and pain medicine and there's not a lot of me that will board it that way. I focus on people with chronic pain and chronic illness and I see a lot of people this whole tower of babble right of letters that are of people that I see. So I see people with PAN, pan, pediatric autoimmune acute onset, the neuropsychiatric syndrome of origin of strep and other infections. I see people with post-treatment Lyme syndrome. I see people with post-COVID syndrome. I see people with chronic depressive syndromes that are non-responsive to treatment. I see people with chronic pain. So the interesting thing was, years ago we were looking at this stuff as chronic fatigue syndrome. These are all things that we've come to name by the description of what it is, not the pathophysiology. So we're calling things name, as in you have a bloody nose, well, that's good, but what's the origin of that bloody nose? You're bleeding from somewhere. Where's it coming? Antirably, posteriorly, right? We need to be specific about that because of fractures. So we need to look at that.

Speaker 2: 3:18

One thing that I do with a lot of my students is we talk about congestive heart failure. Congestive heart failure. Is pump failure right? So what do you do to treat congestive heart failure? Well, the first thing they start doing is diuretics. They'll do something to that Iron or trope in order to increase the beating of the heart. However, maybe the first thing you want to do is how come? Why did the pump fail? Is it because they had an heart attack, coronary artery disease? Is it because they got cardiomyopathy? Is it because, you know, fell in the blank? And so, as you back up and you want to talk more about cause and not the symptoms, and too many times we get focused on the symptoms, and so one of the things that happened was we were focused on all of these symptoms going on, and in particular, by Academy, the Academy of Pain Medicine, thought it would be very spiffy to start giving opioids to people who had chronic pain.

Speaker 2: 4:11

As a white paper back in the late nineties, and it sounded like a good idea. With the help Extrapolation of research from terminal cancer patients spiffily changed the name of things from addiction to dependent on opioids. So it would sound more polite, and off we went. Well, the consequences of that are brutally apparent today. Right, one in twenty thousand people dying a year from opioid overdoses, a horrible behavior on the part of some of the drug companies, not horrible behavior of the part of a large number of physicians as well. You know, at one point there were more scripts being written in the state of West Virginia than there was a population in West Virginia, and you know it's just the amount of damage we did. Our first thing we take in the Hippocratic Oath is first, do no harm. And here we were, not a large number of physicians but nevertheless a group of physicians. So we're just exploiting the system to the end degree and it was absolutely horrific and continues to be so. So we've done a huge amount of damage by doing that.

Speaker 2: 5:14

But we had backed up in the early 2000s and we were looking at.

Speaker 2: 5:18

The fact is, we started using the oil because we watched our patients see side back and forth between depression and chronic pain and stop back up and what's that going on about?

Speaker 2: 5:30

So I was fortunate to be able to convince a group of colleagues to sit down and start exploring what was going on with chronic pain and what was going on with depression. And who's a pood from NIMH was one of our people at, mike Lumpkin, who's from Georgetown in neurophysiology, and so we had. They had a really excellent group of people some other psychiatrists, some other physiologists and we had an excellent group of people who sat down and looked at the literature, and we'd meet once a month, every other month, to talk about this. And what happened is, over time, we began to understand that what we were looking at was symptoms of inflammation in the brain, and so that began our understanding of chronic pain, of chronic fatigue and a number of other disease conditions being a result of an inflamed brain on fire. And that led to my first book, which was Total Recovery, talking about specifically the innate side of this, looking at microglia's activity in the central nervous system and because that's really the main microglia astrocytes and I can talk shop here. This is lovely.

Speaker 2: 6:39

Microglia astrocytes and mast cells are the innate side of the immune system in the central nervous system. So we started looking more deeply into that as to what that was about, and as I developed a neuroinflammatory model of thinking about these conditions, a couple of really astonishing things happened. So I had one patient come in suicidally depressed a 17-year-old kid and he'd been non-responsive to any of a number of treatment programs. He'd been hospitalized. They sent him to me because what the hell Kaplan's thinking about this neuroinflammatory stuff? See what he thinks. Well, I examined him, ran a bunch of tests on him, and one of the things we found was he had celiac disease.

Speaker 1: 7:22

Okay.

Speaker 2: 7:22

About 5% of celiacs will present with no gastrointestinal symptoms and only neurologic symptoms. Okay, so he indeed had no gastrointestinal symptoms. So, but blatantly celiac, no debates about it. We took him off gluten, we did some other stuff to clean up his gut and a year later he is off all antidepressants. He is 100%, and he's been now that way for the last five years that I followed him.

Speaker 2: 7:53

So you know, if you think differently, if you think about what's going on here, you end up with a different answer. I want to give you another example of a young woman that I saw. This is a young lady who, when she's 10 years old, she develops obsessive compulsive disorder. Okay, out of the blue Develops obsessive compulsive disorder, and the next thing that happens is she starts getting depressed, she starts developing cutting behavior and she ends up hospitalized for suicidal ideation, self harm, medicated, released, again, goes through this process of doing better for a little while, but again regresses another psychiatric hospitalization for attempted suicide. We're back and forth, and now I'm saying when she's 16 years old. So what do you think the harm that's been done to this poor young woman since she's 10 years old? She's been told she's broken. She's been told she's crazy.

Speaker 1: 8:46

Right.

Speaker 2: 8:48

And the psychiatric guys who are looking at her got an aga is a treatment-resistant issue. So I take a look at her from a neuroinflammatory standpoint. What we found on her where she had Lyme disease she had CDC positive Lyme disease, no debates about it, and she had autoimmune antibodies to the limbic system and central nervous system. So this poor young lady has been sick now for six years, has been told she's crazy. And who was crazy is us. We missed the diagnosis. We told her that she was crazy because we didn't think about looking at this differently. The end result of which is I've now got a kid who is not just struggling with a brain that's all lit up, but who's also been traumatized by the medical profession, the self-esteem that's been done, harm that's been done to her by virtue of psychiatric hospitalizations. She is not broken, she is sick.

Speaker 2: 9:46

And we screwed up the diagnosis. And when I went to tell her psychiatrist about this, her psychiatrist read me the Ryan Act. She said no, you're wrong. She doesn't have Lyme disease, she doesn't have PANS. This is completely you know, you're completely wrong in your diagnosis and just went off the rails on me. Now this is the resistance that I run into in the profession from time to time when we suggest to them that maybe we need to think about differently. And so this is the work that we've been doing is trying to educate the profession, trying to educate our medical students to think differently about this stuff and understand that when we're not listening to patients, when we're not because if you went back and, by the way, got the history on her, there was a tick bite, there was an erythema, migraine's rash, I got it yeah.

Speaker 2: 10:35

Okay, got treated for two weeks, which is an adequate treatment time, and then all this other stuff evolved out. So the reality of the matter is we have to think differently about these people, because as long as we keep focused on their symptoms and not on the cause, we're not going to get anybody better. We're just going to leave them stuck in a loop and do a lot of damage in the process of it.

Speaker 1: 11:01

Yeah, it's very interesting because the body works kind of as a whole and these inflammatory diseases we really when you see psychiatric disorders it almost feels like you know they say with medical school and everything, like you're drinking from a fossil but drinking from a hose and there's just so much going on and there's so many things to consider. But it's very interesting because there's been a lot of conditions, like even Alzheimer's and other things, that they're linking now to just inflammation in the brain and then we're finding out that if we can reduce that inflammation we can really treat things. And, to your point, if anybody doesn't really understand Lyme disease as well, like the, you have this migratory arthritis and all this inflammation building up throughout the whole body. And I guess one of my questions is how did, how were you able to determine? Were you just determining from the history or were there like some kind of titers that were positive, that allowed you to suspect that it would be Lyme disease in her case?

Speaker 2: 12:05

So all of the above. So there is. I know I know we do this abbreviated, but the reality of the matter is history, history, history. My intake histories are an hour and a half Okay. Before I touch a patient, do anything with them, I sit and I'm listening to them and I'm trying to understand the evolution of the disease in their body. Because the other thing, and then the other answer to your question, is yes, there's absolutely a laboratory analysis that gets done, testing that gets done in order for us to be able to arrive at the diagnosis. So it's a combination of history. The history helps guide the testing that we do and that we put all that together and come up with a treatment plan for them. The other thing we do which is different is because, again, why do people go on a long COVID? 20% of people go on a long COVID, the other 80% don't. What's different about that 20%? And so the question is what's the setup? Clearly, genetics is a piece of this, no question, and we have much to understand in that area. There's also epigenetics, and integrated medicine is about paying attention to the epigenetic profile as well. So epigenetic profile is a number of things we're looking at.

Speaker 2: 13:25

Have you been poisoned Right? Do you have heavy metals in your system, lead out of the water supply, mercury out of eating too much fish, especially the high-end fish? I had a young woman who, 12-year-old, who severe problems again, with kind of a pandas presentation, except that her problem is mercury toxicity. She was eating tuna fish every single day. The FDA says maybe we shouldn't do that. The FDA says if you're pregnant, don't eat that more than twice a week. Well, what about the rest of us? So we got rid of the mercury in her and she became fixed, all done. So it takes a standing back and going. What else is going on? So, looking at toxins being exposed to mold-ridden buildings, where you're getting mold toxins, all the plasticized that we get exposed to in other environmental toxins.

Speaker 2: 14:20

Looking at adverse events of childhood. Now, if you're coming in and somebody comes into the emergency room and they've got a heart attack, I actually don't care what their family background is. I do care about getting litigated and getting the proper lines into them and bringing them back to life. First things first. If they're dead, the rest is irrelevant. So first thing you do is you do what you need to do to address the emergent needs, but then you need to step back and go. Okay, how do we get here and what can we do? And I have a chronic illness problem. So we want to look at what was it like growing up? Was it a safe environment or wasn't a safe environment?

Speaker 2: 15:08

Adverse events of childhood, which is an incredibly benign way of saying child abuse. If you've had grown up in an environment which was particularly difficult, painful, traumatic, your odds of developing an autoimmune disease are about 15% higher than the rest of the population. Your odds of developing heart disease, obesity, diabetes is 25% higher than the rest of the population. These events have long lasting physiologic effects on the individual and they manifest in a way that can shorten their lives, and so we want to make sure we understand the totality of the individual who's come in to see us so that we can get the best possible treatment out for them. And if it's acute appendicitis, I don't care. What I care about is getting that appendix out and getting the infection under control. But if I've got chronic fatigue syndrome, if I got chronic depression and I've got chronic anything that's going on chronic fibromyalgia and, by the way, in most of my patients it's a little bit of all of the above, so we're not so much a little bit. I have patients who have chronic pain, chronic fatigue, chronic daily headaches, sleep disturbances, so it's a little bit of all of the stuff that we're looking at and thus we need a very comprehensive history in the process of understanding all of the areas that are under siege, if you will, that have been disrupted. So we want to get a very comprehensive history. We want to think in terms of the epigenetic issues. That's part of our history as we're taking these, asking these questions and we're then we're looking for infections that may have come into play.

Speaker 2: 16:48

Do you have problems with any of the tick-borne disease? Are there problems with chronic strep? Are there problems with toxoplasmosis? I just had a kid who came into see me history of hallucinations, visual and auditory. He was at a very good school, overseas, very smart guy. Suddenly in the last two years he's got severe depression and he's got problems with hallucinations. He's medicated. The things were marginally under control. I worked him up. He had toxoplasmosis and he had Bartonella. We've been treating those and for the last two months he said no further hallucinations of any kind.

Speaker 2: 17:23

He's gone away to send a to him or pack off him with the medications in order to do that, because I'm treating the underlying cause. So that's the kind of stuff we want to work on.

Speaker 1: 17:33

I think that is one of the most interesting things too is and you kind of spoke on it is that you, when you see, let's say, just a regular psychiatric patient, they usually especially if they're young or there's something on it there's usually not just one thing going on, there's multiple things, and you're trying to treat all of these things going on and if you don't hit the basis of it then you're just, you're essentially just shooting from the hip, just doing whatever. I'm interested in the fact that because when you were talking about how autoimmune disorders or if you have like a rough childhood, you can have an increase in the chances of getting an autoimmune disorder Do you think that that and you may not have, we might not have insight on any of this yet but do you think it's due to the drastic increase in like cortisol, which typically can lower your immune system to begin with, and then that sticks with you, or do we even have an I think, unquestionably, that's a piece of the problem.

Speaker 2: 18:39

Okay, we know that the endocrine soup that your brain is now coming up and is distorted by virtue of being in a very high stress, threatening environment. The specifics we still have work to do on, but one of the things we have, one of the things that will be at this conference we have a conference on chronic disease in November and one of the speakers is going to be talking specifically about that of what happens with all of these psychological stressors that set us up for damage to the immune system and so we're trying to create a holistic conference to educate our colleagues about the full range, inclusive of the gut microbiome, inclusive of the psychological issues, inclusive of the other epidemic issues, so that we have, we give them a roadmap, if you will, in order to be able to have to think about these problems and how to fix them. If somebody comes into you with chronic fatigue syndrome right, and your model is, I don't know we, we first of all, does it exist? Do we believe them?

Speaker 2: 19:42

I was on the advisory committee for health and human services on MACSF for four years and the stories I heard were absolutely horrific People who were dismissed, people were told they were malignant people who were called that they were lying. And these are people who are frequently really crippled. I mean they're homebound, some of them bedbound, and being totally dismissed by the profession on top of everything else they have to deal with is actually horrendous. So the first thing I would encourage all my students to do, and all my colleagues do, is believe your patient, listen to them, try and understand what's going on with them and then don't just write them off.

Speaker 2: 20:24

I will also encourage all of you to read a book by a friend of mine, sarah Remi, r-a-m-e. Why the Book is Women a Mysterious Illness. This is a book that talks about the journey Sarah's, in particular, going through the medical profession being dismissed. It's a particular problem to women, more so than men, because women's complaints are frequently, more frequently dismissed than taken seriously, especially when they're soft symptoms, soft being tired. Well, you have four kids, you got whatever. So we write you off as opposed to going now. Wait a minute. What do you mean by you're tired? What does it mean to be tired and trying to understand what that experience is like for somebody? Is it different than it was a year ago? Is it different than it will be two months from now? So what's changed? What's happened in there that has caused what's going on with you? I'll give the example of my father. This is the upper end of the spectrum. My father is 94. My father is a vigorous, healthy 94. Six couple of miles a day. I was doing great.

Speaker 2: 21:37

In November he had some kind of an episode that they didn't quite figure out. What happened? Okay, hospitalized, worked him up, nothing. He's now down in Florida and he's telling me he's good. So I go down. He just saw the cardiologist, so I go down there to see him and we go off for a walk. He gets maybe 100 feet, he's out of breath and his heart's pounding and I said let us discuss the meaning of the word okay. So no, you're not. Okay, I'm going to call the cardiologist. So I call the cardiologist and the cardiologist's first statement to me is well, he's 94. Okay, I call bullshit.

Speaker 1: 22:19

Yeah.

Speaker 2: 22:20

All right, and I'm a doc, I'm an academic doc, and so I can carry a little more heft and get a little more deference when I say let's start this conversation over, and I'll have you know, by the way, I make sure if I have to go to the hospital for me or I'm with my family, people know I'm a physician, okay, and people know I'm an academic physician. And it's not because of being an asshole, it's because as soon as somebody, our colleagues, hear that stuff, we get treated differently. We are treated completely differently than anybody else who walks in that ear or walks in that hospital. It shouldn't be, but it is.

Speaker 1: 23:02

Yes sir, that's very accurate. I'm saying it myself.

Speaker 2: 23:06

So now we're having a different conversation. He says, well, okay, let me, let me put a, send him home for a loop. Okay, so that we're, we'll monitor him for a couple of weeks. Well, they put the loop on him and the next thing you know, they're calling off saying how'd you like to come in the hospital Cause he's got third degree heart block? Fine, so they put the pacemaker in him. My sister's down there and he's not doing well. After the pacemaker, still same problem. And I said, okay, first off, why does he have third degree heart block? Didn't have it before. Now he has it Right circumflex.

Speaker 2: 23:44

Perhaps we've had another cardiac event, but it doesn't show up on the KG. So there, as far as their concern didn't happen, I'm going this is new. But what changed? What's new? So I said to Lynn, stress them, tell cardiologists, I want them stressed. So they go to stress test them a couple of weeks after putting the pacemaker in, he's on the treadmill, maybe about a minute, and done heart rates about 120. Okay. So then they say, okay, well, we'll do cardiac cath. But they're really reluctant to do so because it's 94 years old. I know he's got coronary artery disease because we've already put a stent in his LAD. So I go down there to see the calf and I get a call when they put him in the hospital and they've done the blood work on him, saying your dad's a little anemic and we're going to have to give him a transfusion. I said really how anemic. They said, well, the hemoglobin's about 7.9, 6.9, 6.9. That's half a tank.

Speaker 2: 24:46

You run a car and half a tank, you can't run a person. So I said okay, and they said, well, we're going to transfuse the unit. And I said why don't you do two while we're at it? And so they fought me on it, but I finally prevailed and we gave him two units and meanwhile I'm flying down there. I get down there in the morning and the cardiologist has pulled him down to the cath lab and they got ready to do the cath and I go in and the cardiologist says, oh, we're going to have to cancel the cath. I said, okay, what's going on? He said well, the hematologist didn't clear for me, really Okay. I said any idea why he's anemic? He says no Interesting. I said can we get a gastroenterologist to look at him? He says well, if you want a GI to look at him, we'll do that. He said fine. So we sent him back up to the floor.

Speaker 2: 25:39

The hematologist comes in and the hematologist looks at dad and says, oh, it's probably avian malformations. If the hematologist was in the room for four minutes, he was in the room for a very long time. I mean, he was out and I would have a chance to say bless the thing. So, okay, fine. So he takes off the gastroenterologist much nicer guy comes in and he says I'll scope him tomorrow. So he scopes dad in the morning and dad's got two tumors in his colon. He's got a four-sonometer and a six-sonometer tumor. Might be a reason for the blood loss. Yes, yeah, so okay. And, as luck would have it, old people get old tumors and so he's got one node, nothing else going on on scans, and so went in and did partial collect me and now he's back up to walk in a couple of miles a day and doing well. Thank you very much.

Speaker 2: 26:35

Now are we going to do chemo and other stuff on him? No, we're not going to do that. Not the conversation. That's his decision and I respect that. But the reality of the matter is they were perfectly ready to simply write him off because he's 94. And there was no reason to write him off. He's got a bunch of quality years ahead of him.

Speaker 2: 26:55

The other part of the problem is that everybody's so freaking, subspecialized, no one looking at the whole picture. So the cardiologist is completely focused on the pump. Meanwhile there's a series of blood tests they've done where he's clearly getting anemic. But fluids aren't his thing, pumps are his thing, so he doesn't pay any attention to the fluids, even though they're documenting a progressive anemia on him. So we got to step back and pay attention to our patients at the most basic level and make sure that we're doing good medicine. That's bottom line and it's been very frustrating. My father is just, from my standpoint, run-of-the-mill stuff that you should be doing right. No magic to it. My patients much more complicated and require a lot more thinking outside the box in order to be able to address their concerns.

Speaker 1: 27:49

But if we can't do the basics.

Speaker 2: 27:52

How are we going to take care of these far more complex people?

Speaker 1: 27:55

Exactly yes, and so first, when they corrected the tumor and the anemia, did the AV malformation and all the did all that clear up with?

Speaker 2: 28:07

There are no AV malformations. Okay, that was just the assumption of the part of the hematologist.

Speaker 1: 28:12

There are no AV malformations, okay.

Speaker 2: 28:15

So the AV malformation, the AV malformation is going to be an affirmation. We demonstrate that, as opposed to just assume that.

Speaker 1: 28:20

Yeah, yeah. I think that some of the issues and you were kind of harping on it is that when people come in and they say, oh, I'm 94, they're like, oh, okay, there's really nothing I can do, and it actually really displays itself like in emergency medicine, which I'm going into when people come in for chronic pain, frequently the same person comes in over and over and over again. Let's say, they have fibromyalgia, which is a condition where you have a lot of pain consistently. It's a chronic condition that you have a lot of specialty in. But coming from like I've definitely seen it happen where it can be very frustrating because whether they don't have the time because you know in an emergency room you don't have time to take a full long history and really give a lot of thought to some things, but instead of figuring out maybe a better plan, like it can be very quick or very easy to get very frustrated at the fact that the person keeps showing up and then they get worse treatment and worse treatment. And then it's like, oh my gosh, why this person's here again for their pain? That doesn't exist, because you sent them to some specialist and then that specialist didn't actually specialize in whatever actually was going on, and then they get written off and then you see them again, and so then it's very frustrating on one end of the spectrum because you're the gatekeeper and you don't have the time. But you realize that it's not.

Speaker 1: 29:52

I think that instead of getting frustrated, I think the key is to kind of maybe because obviously as an ER your scope can't be everything, but if they can get them to somebody like you or something where they can actually get it, the whole picture, looked at, it would be way better than because essentially, you admit them or you don't admit, you give them the, you refer them to some specialist, you don't know who, some pain person, and if they don't see, or they give them drugs and then nothing's solved and then they just come back and then they just come back and then it's frustrating because you can't help them.

Speaker 1: 30:29

So it's just a human response to be frustrated at something that you can't help, and so it's almost like a dual led short or a constant circle of not getting the right things done. So I really actually applaud for one you're thinking, but the fact that you were able to start this medical center that really looks at chronic pain and like the full scope because it's almost it feels impossible, because the rule of medicine is everything gets more specialized every year. It's like you're saying so if you with more specialties, nobody's looking at the full scope and you really you have to trust your family physician to do that. But it can be very, very difficult to if they're not seeing the family physician regularly or whatever. And so it's a really a great thing that you've built and the like, the concept behind it all and trying to get down to the nitty gritty of why everything is happening. So for one, I'm glad that your father is healthier and everything, but now I'm actually glad for all the other patients that you see as well.

Speaker 2: 32:22

Thank you. I think you know we have a real problem in medicine. We're in a real crisis in medicine. One of the problems is, you know, ers are treat in street right.

Speaker 1: 32:32

Yeah, you can't do that, that's your job, but that's your job, that's fine.

Speaker 2: 32:37

So, and the problem becomes increasingly, people are using the ERs as their primary care physician. So either we're going to change the model of the ER, and maybe we need to do that. But the other part of the problem is we've got, we're dictated to by insurance which says your time is not worth any money. Okay, so you've got six to eight minutes to see a patient, because if you see him for nine minutes you're losing money. And so you end up on this treadmill where you're constantly being dictated to what amount of care you can provide to a patient by what the insurance has decided your time is worth. The other part of the problem is EMR, because EMR now a good chunk of your visit is spent filling out the EMR to be able to get the insurance to reimburse you for what it is you've done Right. So I'm assuming you guys still have Scribes.

Speaker 1: 33:35

Yeah, I mean for the most part, like most ERs do. I don't believe that my place. But you know, with residents and everything, you've got to be used to making the charts to begin with. But for most ERs they have adopted that haven't helped the ones that don't, because it can be very chaotic without one.

Speaker 2: 33:53

Right, so but. But there's another cost.

Speaker 1: 33:58

Yes, yeah, you got to pay the Scribes.

Speaker 2: 34:00

You got to pay the Scribes. So EMR added another cost, the insurance added another cost. In our office which is happening increasingly around the country I write a script, send it off to the pharmacy. The pharmacist says to the patient that'll be $1,200. Patient calls me back and says, excuse me, I can't afford this. And then we begin with getting pre-authorization and I have one person one entire person in my office devoted to doing nothing more than getting pre-authorizations for prescriptions and imagines that we order. Now the amount of money I make on a prescription and an order for an MRI or a CT scan or whatever is zero. So the insurance companies are now adding to the cost of our clinic by one full-time individual in order to be able to get the patients the prescriptions that they're entitled to be getting. All right, this is happening throughout the system.

Speaker 2: 35:00

Several years ago, cleveland Clinic put out a study that showed they were spending $10 million a year on pre-authorization. So we have to pay attention to the damage that the insurance companies and the pharmaceutical companies are doing to us in terms of being able to get our patients access to care, and that has horribly corrupted the profession and we're going to have to fight back against it. I mean, unfortunately, the way we fight back against it. We're fee-for-service practice. We do not accept insurance because I can't spend the time and do what I do with my patients. If I were on an insurance basis, I would be bankrupt.

Speaker 1: 35:43

Yeah, lord, help the lady or whoever is having to speak to insurance people all day. I mean even just to dedicate one person that has to do that, like I know. I've worked with many because I was a scribe at once and I remember working with cardiologists and he would prescribe some medication and then he would get a call from the insurance company and they'd be like, oh, you can't prescribe this medication to this person. And he's like, well, yes, I can. This is literally what this person needs. And you have to have this full five to 10 minute discussion while you have patients waiting and then for one you're now 10 minutes late, patients upset. You're upset because you just had to talk to somebody about you know it's like getting a prank call or something. You're like what is going on? And then you go in there. So now you've got two people frustrated and now you're supposed to get to the bottom of their cardiac disease. It's not helpful in the slightest towards the actual goal, which is treating people.

Speaker 2: 36:42

It's a very broken system and unfortunately it's going to get worse before it gets better, if you ever tried to access the system which you find. First off, trying to get a physician's office to call you back is almost impossible. Secondly, frequently you can't get to the dock. You get to the PA or you get to the nurse practitioner.

Speaker 2: 37:01

And being able to actually see a physician becomes an increasingly rare event, and in fact there was a study looking in Mississippi where they had nurse practitioners instead of family physicians and what they found was the cost actually went up to the insurance companies to have the nurse practitioners doing it because they were ordering more tests. But there's a reason we spend four years in medical school and then another fill on the blank number of years in our residency and our fellowship training, right.

Speaker 2: 37:36

And we are not going to get the same product in a four-year program. That's four years. That may be a nursing program, maybe a year or two after that if you're doing nurse practitioner, but you're not getting the same product. What doesn't mean there's not a good place in the necessity for nurse practitioners and PAs there absolutely is, but we haven't figured out the proper mix at this point in time. And what's more, responding to instead is the insurance company saying, okay, we're only paying for this. So somebody has administrators decided well, that their nurse practitioner is doing this because we can't afford to have a full doc doing this and the doc will only do this. And you know there was a debate a little bit ago in one of the states how many nurse practitioners could a physician supervise? Specifically, it was regarding to CVS, and CVS was arguing that you should have one physician, one physician, supervising 100 nurse practitioners, that they're many clinics.

Speaker 1: 38:35

I don't even know if you could manage a hundred employees at a gas station or something.

Speaker 2: 38:44

So it's a massive problem and so we have. You know, we've wanted to the weeds, the politics, a bit of medicine, but I'm very discouraged by what I'm seeing. There are areas where we're really excelling, we do some really spectacular work, and there are areas in terms of day-to-day care of patients. Well, we're getting really poor care because patients can't get access to the time that they need in order to be heard, to be seen, in order to be listened to, and especially my chronic patients.

Speaker 2: 39:16

The other thing I would tell your audience, and very important in working with chronic patients, it's extremely important that you constantly reassess, whether or not you're, what's happening to you, what's happening to them in terms of their treatment program. Are they getting better? Are they responding to it? Because what happens is they end up with an accumulation of drugs that aren't necessarily still working. They may end up missing a more significant issue that comes up medically, because you were assuming was just more the same. So, if you're going to pay attention to your other care for a chronically ill population, it's a constant reassessment and making sure that you didn't miss anything and making sure that things haven't devolved in a direction that suggests some other illness or diagnosis that you originally missed.

Speaker 1: 40:04

That's good advice. I'm very interested in now how I'm going to structure you know, not only my thought process but what I can do to help in any way. And I guess I'm curious too, because the like we were just talking about, like nurse practitioners, and the one unfortunate thing about being a physician, is the consistent test and the continuing your medical education that you have to. Just, I mean, you don't just become a doctor and then they let you go and do whatever you want. You know you have to. You're constantly having to study and educate yourself, and that's too. And that leads me to like I think it's in November, whatever you're actually doing An international conference on, like the developing of or the developments in like this chronic illnesses.

Speaker 1: 40:56

I guess you know that's the extra thing. Like you're saying, like you're gonna get a little bit more because you're constantly. You have these people that were so programmed to continually keep learning more and more and more. And I'm glad for one that you're actually going to be speaking at this conference. And I guess I'm just interested, like where is it going to be held at?

Speaker 2: 41:19

Conference will be physically held in Washington DC at the Marriott. It's co-sponsored by Georgetown and Foundation for Total Recovery, which is a foundation I created after I wrote my first book, so I took some of the proceeds from that book to see that foundation. It's an education and research foundation and so this will have some of the top people around the country. We've got people from NIH Dr Nath, who'll be speaking on ME-CSF, and Pans Pandas. We have Frankovic from Stanford talking about Pans Pandas. We have people from Cornell and Columbia and from the UK talking about autoimmune disease and chronic pain, autoimmune disease and post treatment Lyme syndrome. We have some very interesting Mustafa Maglevio, coming out of Wayne State, is doing some really fascinating work with stem cells and autoimmunity and so looking at how he's been able to actually reverse a couple of cases this has got ends of one, we have more work to do on this but where he's been able to actually put people who have rheumatoid arthritis, scleroderma, in remission. Okay, okay, ain't nobody doing that.

Speaker 1: 42:31

No.

Speaker 2: 42:33

So we've got a lot of cutting edge stuff. We're going to be talking about IVIG treatments for this stuff. So we've got a really top faculty all cleared for CME. So you can attend it, either in person and there are reduced rates for the students, obviously or you can attend it virtually because we want as many people. Last year's conference we had over 900 people, so in the room only physicians and in the room researchers, and in the room were limited to about 300 people, so otherwise everybody can attend virtually. So that's November 8, 9, 10. And we've gotten good reviews from the programs we've run. So really would encourage your audience to attend and anybody who has loved ones who are struggling with any of these conditions. What's the latest research? Where are we going? What are we doing? Because there's a lot of stuff breaking very fast in these fields and a lot of exciting things happening. So November 8, 9, 10, washington DC and they can go through. I have to look at the website medstarhealthorg. Forward slash N-D-U-C-I-2023.

Speaker 1: 43:39

Okay, and what's?

Speaker 2: 43:40

the name of the conference Like the full developments in understanding chronic illness, the role of immune dysfunction and infections. Okay, perfect, yeah, 8, 9, 10.

Speaker 1: 43:51

That's exciting. I love that they allow the virtual ones as well, because it's better to be in person, because you just retain a lot more. But for some people they just can't do it. You live in California and your shift is the day before and you can't get over there to be at the conference. The ability of allowing the virtual ones allow and even just people that aren't physicians, like you were just saying, that would be interested in like the newest research and everything. That's how we learn as physicians. What's the newest thing and the funny thing about medicine is it's more of a practice than just a science, so you have to continually keep learning and some things change, and so I think that's also a great thing. How is it co-hosting these conferences? Is it very stressful or they're certainly challenging.

Speaker 2: 44:45

I mean, basically the first thing is what do you want to cover right and who do you want to be your faculty? So that requires a fairly deep dive into the literature in terms of what you want to be looking at and who you want to invite. And then we've been very fortunate because of the reputation we have. Pretty much all of our A-list crew says yes to us, so that part makes it easier. And then once we've got that set up, we have lots of other people have a research assistant who's doing the groundwork here.

Speaker 2: 45:14

But we've got organizations that we work with that put on the conference. They're very expensive to put on. They're a great big deal to put on it runs almost $400,000, rustible as conference off, not so cheap. But we also want to keep the price to a level where people can find it accessible. And there's also a difference, by the way, of being in the room during the conference and being virtual. When you're in the room there's a lot of sidebar conversations that can be had with a lot of people and a lot is a lot of chemistry that occurs just by virtue of this is a very diverse group of people.

Speaker 2: 45:51

A lot of conferences. It's the same people over and over and over again, okay, and they all know each other. This is a group of people where we've got neurologist and pediatricians and gastroenterologist and nutritionist and stem cell specialist, rheumatologist, family physicians, pain specialists, so there's a whole diversity of people that normally are not in the same room with each other. And now there's a lot of cross fertilization occur. Lime specialist is psychiatrist, so we've got a lot of opportunity for cross fertilization to occur amongst all of these different practitioners and so it gets quite exciting and there's a lot of interesting follow up, research and opportunities to collaborate that come out of these meetings and that's perhaps even more important than the meeting itself.

Speaker 1: 46:41

I love that.

Speaker 1: 46:42

Yeah, that's the beautiful thing about having, like the most, like all the brilliant minds in the subject coming together is that for one.

Speaker 1: 46:50

You know one, if you hear a presentation, most of it's, all you know, preplanned and you're hoping to get your message out, but once you can actually sit down and start speaking to people like that's where you're getting this education from too, because other people have different ways of looking at things, and I'm sure you know like we were even just talking about with the Lyme disease and stuff like that, like pure psychiatrists that see similar symptoms.

Speaker 1: 47:15

After that, you may be more inclined to think, oh well, yeah, you know, I wonder if it is the Lyme, you know, instead of rejecting immediately, you'd be like oh, I bet it is something similar, because I've heard about this before, and so, yeah, I think that's. The conferences are great, you know you can learn so much, and so I think when you, when you're co hosting it though do you have to are you coming up with the guest list and like are they putting all that expenditures and everything on your plate, or is it more of like it's kind of all figured out and then you just have to come up with the guest list?

Speaker 2: 47:56

No. So we so myself and my co chair, craig Shibasaki sit down and decide who we want to invite and we create the faculty. So we create the faculty, we invite the faculty and that's the conference. And after that there's all kinds of people who put everything else together and then during the conference itself, we're hosting right. So I've got my own lecture to present, but I also spend a day where I'm introducing people and facilitating panel discussions and that kind of stuff.

Speaker 1: 48:28

So there's a lot of work that goes on.

Speaker 2: 48:30

And then I got lots of people that I get to meet face to face that I've only ever talked to over over zoom and that's kind of fun also.

Speaker 1: 48:39

Yeah, well, hopefully I'll be able to attend. Well, maybe not with the schedule I'm about to get, but if not this one, maybe the next one. Then we'll get to meet face to face, I'll be there.

Speaker 2: 48:49

That would be great.

Speaker 1: 48:50

Yeah, of course, and so that I mean that's great, that's how people are going to get their education. I know that you're a busy man and everything, and so I want to get to kind of the the nitty gritty, because I know we've been kind of talking shop. But since you are a specialist in chronic conditions and everything, I really am very interested for one on like what condition you find like the most interesting to treat and maybe like what is the condition that you find the like most difficult to treat?

Speaker 2: 49:24

So hands down. The most difficult to treat is complex regional pain syndrome.

Speaker 1: 49:28

Okay.

Speaker 2: 49:28

That is hands down. It's a complex regional pain syndrome. It's fortunately a relatively rare bird. You'll have people who have pain on denting pain things that shouldn't cause pain cause pain. Just brushing against the skin it will cause excruciating pain for these people, and so those are some of the toughest pain conditions to treat.

Speaker 2: 49:50

As far as the other things are concerned, if you know, again, it's having a lot of tools in your box. So I'm originally trained as an osteopath, so I do manual therapy. I'm also trained as an acupuncturist. I was trained at UCLA efficient training program, and so we've got lots of tools to be able to do things. We do things like prolotherapy and there are various injection techniques that we can use in order to treat some of the pain problems, and so it's combining all this stuff and I have a team around me. So I have a team, a psychologist, I have a nutritionist, I've got an acupuncturist, herbalist, I've got physical therapist, and so and nurses, and it's this team approach that allows us to really be able to accomplish things that we would never be able to accomplish as a solo practitioner.

Speaker 2: 50:38

And I have other colleagues. I have not going to leave the long field. That's one of my colleagues here we have a nurse practitioner, herpete, who is also working in our team, and another doc who just joined us recently. So it's about having this team approach. The synergy of this actually allows us to accomplish a great deal more. Also, I think, having reimagined all of these things not as separate diseases so much, but as different phenotypic expressions of an underlying neuroinflammatory disease, and when I look at it like that, there's a unity to all of these things that allows us, okay, came out expressed differently in this individual for this, but the underlying problems the same. So now we're looking at the pathophysiology of it and by virtue of the more I understand the pathophysiology, the better I'm able to be in terms of diagnosing and treating these individuals. So that's the key Get away from the symptoms, get down the pathophysiology.

Speaker 1: 51:31

Just saying pathophysiology, I'm sure all the medical students just love being there as the, because that was like one of the toughest parts, but that is that's essentially medical school, where you're breaking all of that down and trying to get to why certain things happen. And I definitely find that the most interesting is also one of the most difficult aspects is trying to figure out what everything is going on, especially like in a situation you were talking about, like with complex regional pain syndrome. I can imagine that it may even be difficult getting labs, depending on where they have pain. You can't just stick them anywhere if they're having this excruciating pain just a touch. And so I mean I think it's very, it's very like, interesting, but I could see where it could be just super difficult because, yeah, it's neuroinflammatory pain, but people are going to present very differently each time. Yeah, it's definitely a tough task that you've taken upon yourself, but I know that a lot of people can really benefit from it.

Speaker 2: 52:36

We can do better, we have to do better. You keep asking questions and you get better.

Speaker 1: 52:40

Yep, yeah, I think it's awesome. I'm curious too, because you had mentioned, like long COVID and that 20% of people get it. Have you figured out or, more, discovered any way of maybe trying to prevent it?

Speaker 2: 52:57

Yeah.

Speaker 2: 52:58

I mean, it looks like if you get the vaccinations, the number of people going into the long COVID is significantly decreased, probably about 15%. If you treat it. Paxilovid also looks like it'll reduce the number of long COVID. Treating also with metformin originally kind of sideline than gain back. We know that early on we were seeing that diabetics who were being treated with metformin had a much higher survival rate than those that did not, and so metformin dampens the it's an mTOR, so when it does is it dampens the over-response of the immune system with cytokine storms, and so that which is what was killing people.

Speaker 2: 53:42

So, that also seems to be beneficial. And then past that, using low-dose naltraxon, which modulates the microglial activity, the central nervous system. Low-dose naltraxon high dose obviously is used for treatment of drug overdoses, also used in terms of alcoholics to prevent recidivism, but in low dose, anywhere from about 1.25 to 4.25, it actually down-regulates the microglia and so it doesn't stop it from reacting, it just stops it from over-reacting, and so those things can be very useful. Cytokine profiles Bruce Patterson will be speaking at the conference has identified some cytokine profiles that are consistent with long-haul COVID, and we have a treatment protocol in order to be able to address that High percentage of those people, respond to it and get better.

Speaker 2: 54:31

And then the other thing about long-haul COVID is sometimes what's happened is it's just the end result of a longer process. So these people again you have to go back. What's the nutrition status, what's their status of whether or not they've had environmental toxins, what other things that potentially set them up in order for them to go on to this? And then you're going to go back and treat that. Well, we do all of that. We've got a pretty good success rate in treating this individual linoleum back.

Speaker 1: 54:55

That's awesome. So Metformin still continues to be the wonder drug that everybody has always chalked it up to be, but I definitely did not know about naltrexone which, like you just mentioned, is I've only seen it really, and even in the medical school and everything really just mentioned as a way of preventing alcohol, more like alcohol abuse and everything like that, and so it's more naltrexone, metformin and the vaccinations that are our best defense against it.

Speaker 2: 55:32

Yeah, and Paxilovid, if you happen to get it. Paxilovid also cuts down the incidence of long-haul COVID. So we have tools now, which we had done before. The other thing is the bug has evolved. Delta, unquestionably, was the worst of the worst. The Omicrons seem to be a bit more benign and COVID is not a benign disease to begin with because of these long-haul problems. But now things are looking and by the way you can get these, flu can set off a chronic illness, chronic fatigue syndrome, chronic pain symptoms, because all of these bacteria and viruses are capable of doing this, depending upon the immune system's predisposition. So we see the same thing in long-haul COVID with COVID, but we're seeing. It looks like it were. Data were not there yet, but the data is suggesting that the Omicron variants don't tend to produce long-haul issues as much as the earlier variants did. We'll see. That remains to be seen.

Speaker 1: 56:30

Yeah, yeah, hopefully not, at least until more research happens. But is there a prime treatment window?

Speaker 2: 56:38

Because I mean not so big Paxilovid you want to be treating within the first 72 hours.

Speaker 1: 56:43

Okay.

Speaker 2: 56:44

In order to get that to work, metformin likewise the earlier started the better. So same thing with Lottoestotraxin. Now Lottoestotraxin has to be compounded. It's not available off the shelf, so you have to prescribe it, and it's a dose-dependent response, right? So low dose under 4.25 or under milligrams. That helps modulate the microglial system, as metformin helps modulate the acquired, the B-cell system.

Speaker 2: 57:10

So you want to get in as fast as you can in order to address these things, and I want to emphasize this over and over and over again. I just I talked to a patient of mine who's a New York young woman. She has an internship and she got sick. She gets a cold right. Basically, all upper respiratory infections should be assumed to be covered until proven otherwise. So she gets a cold and she's still going to work and she's young, she's healthy, otherwise she's getting through all this stuff.

Speaker 2: 57:41

And I'm talking to her and I'm going now we're a week into this and I said did you test for COVID? She said I don't know if COVID. I said did you test for COVID? And so I said you have to test for COVID. So she tested for it. She in fact has COVID Now. It's lovely that she's got a mild case of it, okay, but she's now out infecting everybody else. We need to be responsible for each other. We need to do this testing and determine whether or not we have the disease so that we don't spread it to everybody else.

Speaker 1: 58:14

Exactly. I think that it is maybe the media and how everything was spun. Whenever it happened, I will say that there was some weird kind of we were not as informed going in. So it kind of set up this thing where we everybody doesn't want to admit that they have it. And I remember specifically that if you had the vaccine you weren't supposed to get it or you weren't supposed to be able to pass it on. And then if you had COVID once, you weren't going to get it again.

Speaker 1: 58:42

And I remember in my situation I had COVID, and two weeks after that, because I was a student, they had to make us wait to get the vaccine. I get COVID right before. And then I was like I was trying to tell them you know, essentially, but as a student you'll do whatever. And so I get the vaccine two weeks after I get COVID. And then you know, fast forward three to four months, my wife she has, and she had COVID too. She had COVID, had the vaccine, everything Fast forward three or four months. And then she had a cold and I was like, did you get tested? And because I work, you know, in the hospital, we had to. We essentially just got her tested anyway, and but she for like a week was like there's no way I can have COVID. There's just not, it's not possible. We've already had it and we've been vaccinated, it's just not.

Speaker 1: 59:37

Every all the media is telling us one thing, then, lo and behold, she has it.

Speaker 1: 59:42

And then right after that we start to find out that it can be, you know, caught again. And so that one was more of a weird spin on the fact that, like you, if you're primed to think that you can't get it again, you're just going to assume that you can't, it can't be that, yeah. So it started off more of as a taboo, and then that led to people being more skeptical and being like, oh, I don't want to have to lose my job just because of COVID checks, and I think that's really good, especially as students too, because they get we get so nervous that we're going to have to miss time and do certain things, and so that's definitely a smart thing to just go get tested, because you were also talking about long COVID and some of that and the quicker you get in there to treat it, the better. Well, a lot of people, if it's long COVID and all it is is fatigue and your smell is gone.

Speaker 1: 1:00:39

You could say that it was just the cold for almost a month, before you start to actually start to think that there's something going on. And then you've already. You're missing your time. You're missing your 72 hours.

Speaker 2: 1:00:51

You missed a diagnosis because at that point in time, unless we're doing blood testing, the testing won't, the nasal swabs won't tell you anything at all. Exactly, Exactly.

Speaker 2: 1:01:01

So COVID there's a lot about COVID. I mean, COVID, from my opinion, was the greatest national security failure in the history of this country, but it was a novel virus. We had no idea what the hell we were dealing with. Originally we were using the ventilators all wrong because we had assumed it was one presentation when it was in fact another, and the government was doing doing us no good in terms of getting a legitimate piece of information out to us on a regular basis, and so we had our back channels where we're communicating in order to be able to share information with each other to get the proper data out, and it created nothing but chaos with the public's mind. And it was a terrifying bug. To begin with, I mean, we had no idea what was going on. It was killing people, lots of them. We lost over a million people in this country to that bug. So very bad bug and no legitimate government coordination of what was going on and not enough lead time, which we should have had in terms of what was going on. So we could have prepped better, we could have held our estimates. Sorry, there's certainly a quarter million less people that could have should have died if we had done this properly. So really a massive failure. We're in a different situation now. You know everybody got upset about those vaccines. The messenger RNA vaccines didn't just materialize on a magic. Those vaccines were originally developed looking at Ebola and so they had been on the shelf for 10 years because nobody wanted the vaccine for a walla, because it just wasn't a market for it. But the development had already been done on those vaccines 10 years earlier. That's where they pulled them from. That eventually they did the research and found there to be useful here and we have now a whole new technology for doing vaccinations.

Speaker 2: 1:02:48

Are there side effects of the vaccines? Yes, there are. There are side effects for the flu vaccine. We see a number. We see any of a number of things. But if you look at the potential side effects of the vaccine versus the consequences of the bug, no contest, no contest. Do you see cardiomyopathy in a percentage of people because of the vaccine? Yes, you do. The stats, I think, are something in the order of one per 100,000 versus 200 per 100,000 if you get the bug. So you know if you put it side. Yes, there are side effects of the vaccine. There are risks always, but the bug is so much more deadly and damaging than the vaccine? I don't think it's a contest. Vaccines do not guarantee you will not get the bug, but they mitigate the severity of the disease when you get it.

Speaker 1: 1:03:38

I agree with you and I think that that kind of transparency is. I'm glad you even said all of that, because I think that kind of transparency is what we would have made the country and everybody community way more accepting of everything. And I think that, like you said, it was just a mishandling of we want people to take this. Even if it's good for your health, we're gonna act like there's nothing that can ever happen and there's a consequence to every single thing, that every action has an opposite reaction, like it's just a you can't hope, you can't do anything without there being a side effect, and so I mean just, but it's the risks and everything that you have to weigh. And then I knew that I was going to be in the hospital. I wanted to help people or protect people as much as I could, and that's the reason I did it.

Speaker 1: 1:04:32

And I don't know, I mean it's yeah, I think the transparency is exactly and I'm glad that you said I mean, even if there is a chance of cardiomyopathy, like the last thing you want is for it to be, I mean, there's still a chance of cardiomyopathy with the other, with the actual bucks. So Much higher, yeah, much higher. So yeah, it's really about the transparency and we've I mean, unfortunately, in medicine. Anybody that worked in a hospital during COVID time knew the severity of it, but everybody on the outside was, you know, there was quarantine. So you, you, that just breeds skepticism to begin with, and I mean we could probably go on for hours about the misuse or even the benefits and the good things that were done during that time. One good thing I will say is the student loans. I hate that they're gonna have to bring those back.

Speaker 2: 1:05:29

Yeah, I can certainly understand that. I was like bring in another round.

Speaker 1: 1:05:32

Now, I'm just kidding.

Speaker 2: 1:05:33

I'm kidding, but the other thing that's come out of this is the people who have chronic fatigue syndrome suddenly got believed. Yes, two million people which were being dismissed and written off. All of a sudden, covid comes along and people are developing long-term fatigue as a result of COVID and you're going. Ha, maybe this is a real thing and indeed now these people are getting the attention that they deserve and the research dollars that they deserve.

Speaker 2: 1:06:00

When I first got involved with ME-CSF and HHS, our NIH budget for ME-CSF was five million a year. Now five million is a good amount of money to you and I. However, in a research arena, it's a joke, it's a tip. It's the fastest way to end your career because there's not enough funding to support ongoing research. So five million a year was not a useful number for them to be spending on long-haul COVID.

Speaker 2: 1:06:26

And if you made a comparison between the money being spent on ME-CSF, we had about two million people struggling with the disease versus people who were struggling with multiple sclerosis, where about three quarters of a million people have multiple sclerosis in this country. That budget was $140 million. Ok, but it was about not believing the disease existed and so you couldn't get a group of people behind it to do the funding that was appropriate in order to treat the research that we needed. That's now happening and because that's happening, this whole business of neuroinflammatory disease is getting a lot more funding and a lot more attention, so we'll end up with better answers for people in the relatively near future.

Speaker 1: 1:07:12

I did want to ask you one more question if you have time, because we've been talking about the immune system and I heard that you have like three hidden secrets that could supercharge your immune system and I was very interested to hear that going on our discussion.

Speaker 2: 1:07:28

So the not so hidden secrets are sleep, exercise and nutrition. Ok, pure and simple. Those things are essential for a normal. The best anti-inflammatory essential nervous system is exercise, both weights and cardiovascular. Ok, sleep, getting eight hours to sleep at night, seven hours to sleep at night, is absolutely essential. Sleep is when we detoxify our brains. Right. Lymphatic system is most active during slow-wired sleep.

Speaker 2: 1:07:56

But otherwise, the other thing you want to look at is low-dose naltrexone. So low-dose naltrexone is probably going to turn out to be one of the better anti-aging drugs. And again metformin, which will also be another one of the anti-aging drugs and in fact, is being investigated now as an anti-aging drug. So those are the two big ones. The third one that looks very promising, well, let me back it up. So the other one that's much more accessible and easier is NMN. Ok, nmn is the precursor to NAD and precursor, ultimately, to creation in the mitochondrial cycle, for creation of ADPs, so NMADH. So supplementing with NAD, nmm, rather, I think, does a lot in terms of maintaining your energy, especially your age, and going forward, and so we want to make sure that we're doing those things. So those would be the three big things. The other thing sitting off in the background is rapamycin low-dose, so rapamycin, another M-tor, but using one to six milligrams a week. There are some studies suggesting that it may actually be very effective slowing the aging process.

Speaker 2: 1:09:05

But the easily accessible ones. Nmm Signal is the brand we use. No economic connection with Isarium, which is the company that produces it, but I think it's the highest grade NMM on the market at the moment. Davidson-claris doing some research on it that they're going to be producing a pharmaceutical grade NMM. And then low-dose naltrexone has to be by a script, so you can do that as this metformin. But I think those three are probably all anti-aging and actually lead to. The other thing I would actually make sure is make sure your vitamin D levels are good Vitamin.

Speaker 2: 1:09:43

D levels norm is listed at 30 nanogram per deciliter. It should be 50 to 80. D is a hormone. D is necessary for a healthy functioning in the end system. We know that the people who suffer worse in COVID had low vitamin D levels and higher probability of developing a low-haul again with low vitamin D levels. So vitamin D somewhere between I'll supplement myself 3,000 to 5,000, international units a day. But you can also get lots of vitamin D going out in the sun. 20 minutes arms, legs, chest a day will do that for you. But checking vitamin D should be part of a normal physical Checking vitamin D levels, see what they are and treat a cordial end.

Speaker 1: 1:10:25

I agree, the problem with today's society, with it being very technologically advanced, is the fact that we don't get this whole vitamin D that we used to. I mean, that's one of the main things is you would be outside I mean, if you're looking at it from an evolutionary standpoint, that's the whole reason for melanin and the different skin tones, to begin with, is just your absorption of vitamin D and where you exist in the environment, and I know a lot of people. I was doing my rotations and everything in New Jersey and New York and a lot of people suffer from vitamin D exposure because also vitamin D deficiency, because the clouds and the exposure to the direct sunlight is drastically decreased. So, especially if you live in a major city and things like that and hemperbidur inside, you're not going to get what your ancestors or what your body is programmed to regularly receive, and it's so cheap. As far as the cycle, there's a lot of other things out there that people will tell you to take, and vitamin D is a gods and I think that's one of the benefits from COVID.

Speaker 1: 1:11:44

I hate to say that there's benefits from a virus, but people were actually concerned about their vitamin D levels and then realizing that there was, I think, and I would butcher the statistics but there was a drastic amount of people in New York all had very severely low vitamin D levels, and nobody would have even thought to check that. If people go, oh, I've stepped outside every now and then I've mowed the grass before wearing long sleeves, and they don't realize that you need direct sun exposure to those areas. And now, right now, it's almost impossible to walk outside in Mississippi with your shirt off without getting a sunburn or getting destroyed by mosquitoes. So you've got to find some way to supplement it, and so I'm glad that you brought that up.

Speaker 2: 1:12:33

The other thing that you want to keep in mind is use of sunscreen. I know we're psychotic about getting sun exposure because of basal cells and melanomas or whatever, but the reality of the matter is sunscreen blocks vitamin D production 100%.

Speaker 1: 1:12:46

I've heard that.

Speaker 2: 1:12:47

We need direct sun exposure on our skins, but dosing 15, 20 minutes a day, not more than that. Then you can put it all in sunscreen you want.

Speaker 1: 1:12:55

I agree and actually I like what you, just because I looked up. The other day I went into the pharmacy I think there's 25, 50, milli equivalents or whatever vitamin D for the pills, and then there was the 200 or whatever, and I remember looking and I was like, oh, I wonder what I should get. And I looked up the daily dosage and I think it was 30, like you had said, and I just felt like it was so low of full supplementation and I had heard during COVID times about some people taking like 500. And I didn't know specifically what. And so I agree to what you were saying is that it probably should be a little bit higher. Especially if you are a person listening to this now and you don't get a lot of sun exposure, you need to consider that. On top of it, if you've got darker skin complexion, anything like that, like you're going to need more vitamin D than the regular, then just what the average.

Speaker 2: 1:13:54

Get your blood levels checked.

Speaker 1: 1:13:56

Yes, don't guess.

Speaker 2: 1:13:57

Get your blood levels checked. It's easy.

Speaker 1: 1:14:00

And I also. I was looking up the signal for your in-and-in supplement and because those can actually be relatively pricey I don't know if you can find them at a pharmacy or like a vitamin store cheaper, but the signal one is relatively the cheapest one that I've seen so far. And do you have a recommended dosage? For how much somebody?

Speaker 2: 1:14:20

should be 5,000 to 1,000 milligrams a day, so two to four pills of the signal a day.

Speaker 1: 1:14:27

Yeah.

Speaker 1: 1:14:28

I think that is because I know the importance from medical school. You know the whole NAD pathway and where the hydrogens and the pluses are going, but you don't ever think about having to supplement it because it's all just known in this obscure pathway that you're just having to only think about when you're getting tested. And so I think that that's at least something that I'm going to look into getting for one, because getting around 30, you know I'm like whew, the age is starting to kick in, so I need as much anti-aging as possible.

Speaker 2: 1:15:03

The reality of the matter is as you age that's the other thing, right as you age, by the time you're 50, 60, your NMN stores are pretty depleted, and so we want to build them now so that we have good store houses that continue on throughout life. So now is the time for you to be planning to live, to be 100, 120, right, we want you vital, we want you strong. And you know, the longevity data says we should easily be able to get to 120 to 160 in good vitality. It's not just a matter of numbers, it's a matter of having quality years. And basically the demographic data says look, everybody born after 1995, average lifespan will be 100.

Speaker 1: 1:15:48

We can only hope.

Speaker 2: 1:15:50

Well, there's no reason not to as long as we take proper care of ourselves. We know we can do this. We know the body's capable of living that long, but we have to take care of it. So I have had a pleasure being here with you today.

Speaker 1: 1:16:06

I was about to say yeah, I don't want to keep you too long, but I have drastically enjoyed speaking to you. I've learned a lot even myself. So you do a lot of great work, and it was a pleasure to speak to you. And I would just like for you I don't know if you had said it before, but please let anybody know where they can reach out to you, or so.

Speaker 2: 1:16:27

CatholicCliniccom. K-a-p-l-e-n cliniccom is our website and we can be contacted through that. And the book is why You're Still Sick, how infections break our immune system and how you can recover. That's available on Amazon, as is total recovery, so I would encourage you to look at it. And again, Sarah Remy's book I'll put it in a plug for Women of Mysterious Illness, I think should be required reading by every medical student, Brian, book that you wrote.

Speaker 1: 1:16:55

OK, yeah, Everybody, go check them out and go sign up for your conference the new developments and understanding chronic illnesses. And Sarah, it was so great. I'm going to check out the book.

Speaker 2: 1:17:06

Great, all right Jordan. Thank you very, very much. A complete pleasure. Thank you very much for the show.

Speaker 1: 1:17:11

Of course, thank you, and thank you very much for listening.