Ep 58: Beyond the Injury: How Integrative Sports Medicine Transforms Recovery with Dr. Srikanth Nithyanandam

In this episode, integrative sports medicine physician Dr. Srikanth Nithyanandam reminds us that injuries don’t just happen to a body part — they happen to a whole person. He shares how healing accelerates when we address mindset, sleep, nutrition, and the fears that hold us back.   We also dig into integrative modalities, including the theory behind energy medicine and acupuncture and how it compares to dry needling.   Most importantly, he shows how staying connected to the movement we love is the key to getting back to ourselves. 
 
 This is a powerful, practical episode for anyone recovering from injury or supporting someone on that journey. 

Learn more from Dr. Sri here and see the videos he has created to help patients.

Follow on instagram @drsrikanth_sportsmedmd

You tube: Dr. Srikanth Nithyanandam (Family & Sports MD)

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The content in this podcast is for general reference and educational purposes only. It is not meant to be complete or exhaustive, or to be applicable to any
specific individual’s medical condition. No information provided in this podcast constitutes medical advice and is not an attempt to practice medicine or to provide specific medical advice, diagnosis or treatment. This podcast does not create a physician- patient relationship and is not a substitute for professional medical advice, diagnosis or treatment. Please do not rely on this podcast for emergency medical treatment. Remember that everyone is different so make sure you consult your own healthcare professional before seeking any new treatment and before you alter, suspend, or initiate a new change in your routine.

Transcript

Ep 58: Beyond the Injury: How Integrative Sports Medicine Transforms Recovery with Dr. Srikanth Nithyanandam

[00:00:00] Before we start today's episode, I would like to quickly read you our podcast disclaimer. The content in this podcast is for general reference and educational purposes only. It is not meant to be complete or exhaustive or to be applicable to any specific individual's medical condition. No information provided in this podcast constitutes medical advice and is not an attempt to practice medicine or to provide specific medical advice, diagnosis, or treatment.

This podcast does not create a physician patient relationship, and it's not a substitute for professional medical advice, diagnosis, or treatment. Please do not rely on this podcast for emergency medical treatment. Remember that everyone is different, so make sure you consult your own healthcare professional before seeking any new treatment, and before you alter, suspend, or initiate a new change in your routine.

Welcome to the starting day. We're your host, Dr. Kitty Dotson and Dr. Sarah Schuetz. Two internal medicine doctors who spent years practicing traditional primary care. Over time, we realized something was missing from modern healthcare, a [00:01:00] real understanding of how everyday lifestyle choices impact overall health.

We'll help you cut through the noise of the countless health influencers and their conflicting opinions because no matter who you follow, the basics of lifestyle medicine are at the heart of it all.

Welcome to the starting gate. We're your host, Dr. Kitty Dotson and Dr. Sarah Schuetz. Last week we spent a lot of time talking about chronic pain and how your brain can become sensitized to that, and we're gonna continue talking about pain today because it really is such a frustrating thing, especially when it feels like surgery or pills are your only option.

 But there are other ways that we can help our body to recover naturally, including lifestyle changes and a lot of other things through movement and nutrition that can help. We're excited to have an expert in this today, Dr. Srikanth Nithyanandam, a board certified physician in Sports integrative medicine who practices in Georgetown, Kentucky, and he really [00:02:00] focuses his work on non-operative orthopedics and looks at the patient from a more holistic standpoint.

We're so happy to have you with us today. 

Hey, thank you so much for having me in this podcast. I'm really looking forward to having this conversation. 

We just wanna let our listeners know that things that we talk about today is not just from athletes. And I think that's something that a lot of times people hear sports medicine and they immediately tune out and they're like, oh, this isn't for me.

I'm not an athlete anymore. What is a sports medicine doctor going to actually do to help me? But I'm gonna have you all pause, stay on for this show because we wanna prove that thought wrong and really provide information on how to keep you active throughout your life and how you can use the different approaches of integrative medicine as well as seeing a sports medicine doctor in order to keep you doing all the things that you love to be active.

 Let's just start here and give our listeners a definition about what is both, and [00:03:00] we'll do both of them. Sports medicine, and what is integrative medicine. 

Okay. So let me talk about sports medicine first. Sports medicine basically means that it's caring for active individuals. And sometimes when you think about sports medicine, we are thinking about just athletes. But to me, anybody who wants to stay active. can be benefited from seeing a sports medicine physician.

For example, in my clinical practice take care of high level athletes in my Georgetown college. And at the same time, there are times when during my family medicine clinic where I try to encourage a lot of patients to start exercising because it can help with their chronic health problems and stuff.

So I serve in both roles, so one as more as a motivator. And the other role is trying to sometimes be more like a de- escalator in my athletic population where they might be doing too much of exercise that might be causing trouble.

In the field of sports medicine, we have two specialties. So one, we have the orthopedic sports medicine and the other one is the primary care [00:04:00] sports medicine, orthopedic sports medicine. That predominant focus is honing the surgical skills that may be needed for the athletes to get back into sport.

Whereas when you think about primary care, sports medicine, our expertise, again, focusing on diagnosing, evaluating, but also focusing on non-surgical interventions to help the athletes get back into sport again. , It doesn't always have to be athletes. It could be even an any individual who wants to get back playing with their grandkids, or it could be an individual trying to get back into high level sport.

All those things, they all come in the same umbrella of being. An athlete. So integrative medicine is an extra fellowship that I did after my sports medicine training. So I had a background exercise physiology, then I did a family medicine residency, then academic medicine fellowship in sports medicine.

And then even after all that training, I felt that something was missing. I really hated the paternalistic view on medicine where we as doctors think that we are the experts and the patient [00:05:00] is broken in front of us, and then we have a rigid treatment plan. And let's say the patient doesn't like the treatment plan we cannot offer anything else.

 I personally felt that the system was pushing more towards becoming more like technicians. And I didn't like this type of an approach. When I see a patient in front of me, the moment the patient starts talking, I'm trying to label this patient. I'm trying to say, okay.

Which. Which box can I put this patient in? Should I put this patient in the injection box or the rehabilitation box or the surgery box? But when you think about from an integrative medicine standpoint, that is more of an healer approach because one thing that we have forgotten when it comes to chronic care or day-to-day complaints is that there is an immense capacity for the body to heal on its own.

Sometimes when you think about surgery, you can have a good surgeon, but if the body doesn't heal from the surgery, that whole surgery was a waste of a procedure. . So when you think about integrative medicine, you're thinking about whole health approach rather [00:06:00] than just focusing on the problem that the patient presents to me. 

 I love that it really is, hearing your story is really trying to bring back the art of medicine. And I know that's something that we've talked about on this show before. also what leaves many doctors feeling burnout is when they feel like they've lost their autonomy in the fact that they're there with the patient coming up with personalized plans that help meet them where they are.

And so I think that's why so many physicians are looking at some of these other ways of training, like lifestyle medicine or integrative medicine in order to feel like you're treating the whole patient again. 

That's very true. And I feel like it's also when you think about, so let us say, have a rigid treatment plan, and let us say, if you're equipping yourself with knowledge that goes beyond the pharmaceutical treatments that one can offer.

There is a moral injury to these physicians because you know , this may not be the right treatment, but this is, this probably might be the treatment that you could provide to that patient at that time because there is not enough time [00:07:00] or that system doesn't incentivize that type of treatment.

Yeah. 

 Going a little bit more into the integrative medicine bucket, what falls under that umbrella? Because our listeners hear us talk about lifestyle medicine a lot, and they've gotten used to hearing about our six pillars, which cross over with a lot of integrative medicine. But what are some things that people should connect with that style of medicine?

So let's say a patient comes to me they probably would've come for an yearly visit and I would've done labs on them. And let's say the labs all looks perfectly fine. We just classify them as pretty healthy in spite of things that there might be going on their life and stuff.

, When we think about from a traditional medicine, we are more based on numbers, like objective numbers that we look for and think about more like from a pain as well. Because pain is one of the common symptom that I see in my practice. When I think about pain we scale their pain.

We say, how bad is a pain? Like in a one from one to 10, [00:08:00] but we forget that there are so many other things that possibly sensitize the pain as well. We are just more focused on trying to bring the pain scale down and we have done that before. Which is why we are also facing this opioid crisis as well, because we were focused on one thing.

That was the number, when we think about integrative medicine, it goes back to the roots of medicine in the past because medicine in the past was predominantly focused on healing. It's like, how do I create an environment for the body to heal itself? 

For example, one could be seeing an veic practitioner, one could be seeing a traditional Chinese medicine practitioner. One could be seeing an western medicine lifestyle medicine practitioner. But at the end of the day, everybody focuses on one thing is that the body can heal itself, and integrative medicine is more like trying to bridge the gaps.

So for example, let us say I've got a patient with. Uncontrolled diabetes, that patient's culture may not be willing to go on pharmaceutical treatment. So [00:09:00] how do we bridge the gap where we also value the patient's culture beliefs and at the same time, make sure that the patient can stay healthy as well.

If this patient comes to a traditional medicine model, most physicians might say, , this patient is non compliant. , I've even , had sometimes where I've had physicians asking, can we just fire them from their practice? But the integrative medicine is more like listening to the patient's culture beliefs, listening to the barriers for their care and trying to find a plan that works for them.

It's more personalized rather than putting them in this box of this rigid treatment approach. 

I love that. Yes. So let's say someone is dealing with a joint issue like knee pain. Let's say they've had knee pain for several years, now it's getting worse. How would they know if they should go see an orthopedist or if they should see a sports medicine doctor?

So I would say that we work together as a team and we actually do well working together as a team. But I still would recommend seeing a primary care sports medicine doctor [00:10:00] first and the reason for that is, number one, with my background training in musculoskeletal, but , I also have pretty deep training in medical aspects as well.

And sometimes we look beyond the joint. For example, let's say this patient goes to. An orthopedic specialist, and I'm not finding fault with any particular specialty here, but most of the time, given that time barrier, that orthopedic specialist is trying to find a reason for their pain and once they find the reason for the pain, they just focus only on the pain.

For somebody to go through a chronic pain for so many years, from an integrative medicine standpoint or even from an holistic standpoint, , there are other things that might be actually sensitizing the pain as well which an orthopedic specialist where their core focus is to figure out whether this patient would benefit from a surgery or whether this patient from benefit from rehabilitation.

I feel like the sports medicine doctors can see beyond the joint and help them better by focusing on the other medical conditions that could be [00:11:00] contributing to the pain as well. The other thing is that from a sports medicine standpoint, especially if an athlete. One has to understand the demands of the sport.

So for example, I saw a patient with knee pain two days ago, and this particular patient doesn't have knee pain at rest, doesn't have knee pain with activities of daily living, but he's a marathoner and he wants to get back into marathon. So his demands are different, but as if this patient is only doing activities of daily living, that knee pain is not going to bother them.

So I think the sports medicine doctor understands the demands of the sport and then caters the treatment or individualizes the treatment for that particular thing, which an orthopedic specialist, if they don't have a sports medicine hat, they may not know what the demands of the sport might be. In addition to that, for me, is accessibility as well.

Most of the patients who have pain go to a general practitioner, so you don't have to wait for a long referral. You can quickly see a sports medicine doctor right then and When one sees a sports medicine doctor, it doesn't mean that this person. Will not need a surgery. They may need a surgery depending on my [00:12:00] evaluation, but I also would know who the right surgeon might be for this patient to get benefited from.

So I think these are some of the main reasons why I think , it might be beneficial to see a sports medicine doctor first, but again, as I said, we work as a team. It's not one or the other. It's who do you see first and who can help you make sure that you get the best care possible?

And so someone might see you and then you might say, oh, I really think what benefits you the most is the surgery and you should see this correct orthopedist. Yeah. 

Because unfortunately like the surgeries are becoming more complex. So there are some surgeons who would've perfected one technique but may not have perfected the other technique.

So it might be good to know what the patient might be dealing with. So this way we can make sure that this person goes to this right surgeon who can do that particular surgery. 

I think in the world of orthopedics it's strange for people to understand that. 'cause you think of just an orthopedic as one that does surgeries, but even our specialties have become so specialized.

Yes. [00:13:00] And so you have a specialty of orthopedic surgery, but really usually within a group, there's one surgeon that, that does most of the shoulders. Yeah. And one surgeon that does the knees and one that does the feet. And then probably ones within that do different types of knee 

Yeah.

Revisions and things For sure. So it would be very helpful to have someone guide you through. Yeah. 

So for example, like when, even when we think about knee, you can have a cartilage issue for which one surgeon might be better than the other. And then there could be a meniscal issue or a complex ligament issue for which, and another surgeon might be better.

But again, these surgeons have. They have spent years together honing that particular skill. And they may not be good at another complex surgery that might involve a shoulder, but still can do a simple surgery, but not a complex surgery in a shoulder. But they will be a good surgeon in a complex surgery to do in a knee.

So differs. 

I wanna go back to your marathon runner. Yeah. Because so many times, and I'm just curious how you approach this. So many times as people [00:14:00] age and have been active their whole life and then they start to have injuries they may come across someone in healthcare that just tells them, stop doing this.

Yeah. 

It was been really easy for someone to tell this marathoner to say, stop running. You can do your normal activities. And they actually take that advice. For any of our listeners that may have come across that, what is a better way to. Advocate for yourself, if that is something that you truly love and want to continue doing as you age to get appropriate care?

That's a great question because that's sometimes, that's one of the core problems that I see in my patient population as well is like what provides the meaning to the life? What's their aspiration and what's their purpose?

Because the treatment becomes more personalized depending on what they do. For example, we talked about the marathon runner. Who might have knee pain and let us assume that this patient has severe knee arthritis that he didn't even know. And one might say that [00:15:00] you might have to stop running. But let's say if being a runner is their primary identity, that advice is not going to go well.

And this can cause more depression. And then from that standpoint onwards, there is a high chance that they, their overall health might get affected as well. So this is where in my clinical practice. Never do I say any patients that they should not exercise, everybody should exercise.

There are times when during certain injuries we might have to modify exercise. That's where. Physical therapists come into play, other interventions like injections, those things come into play to help them keep moving. But exercise is one of the cornerstone for longevity and I would not recommend against it.

Now the question is let's say for runner who facing the reality where I've got knee arthritis and I'm, I cannot keep doing this like I did 10 years ago. And that's where I would say it's trying to understand where they're coming from and trying to navigate some of, because this is a huge change.

And again, as we get [00:16:00] older, there is always this new change where we may not be same like 10 years before, like how we were an athlete, but trying to figure out how they can still enjoy an activity and maybe help them navigate. Changing their goals for future can be helpful because at the end of the day, , the moment the patient changes their goals and if it aligns with their core value, things will be better.

Until then, there's gonna be a lot of resistance from that standpoint. 

Yeah. when it comes to integrative medicine, what are some other modalities that maybe people aren't used to hearing about that can help with some pain that they're experiencing or even healing from an injury that you use? 

I've talked about the technician mindset, and then we talked about the healer mindset.

So I wanna use this analogy. It's a tree branch analogy. So basically, let's assume that an individual is a tree with branches, and assuming that branches might be the limbs or any part of the body when they [00:17:00] come to my clinic, they are probably complaining about their branch. And the branch could be anything, could be a knee pain, could be shoulder pain, could be could be an elbow pain, whatever in a traditional or the technician mindset, the focus is only on fixing the branch.

but we completely forget about the health of the tree because for us, the health of the tree is so important for the healing to happen. The health of the tree is sick, which is why we try to avoid surgeries in patients with uncontrolled diabetes because we know that the health of the tree is not in a good state at this point.

We try to improve the health of the tree before we do surgery. So the health of the tree is very important. So from an itegrated medicine standpoint, the health of the tree includes physical health, mental health, the mindset, everything plays a role. I'll give you one more example. I started playing tennis like two years ago and things were going really well, and then suddenly one day my heel started hurting.

And then after I kind of self-diagnose since I'm a sports medicine physician, so I self-diagnose and I know that I've got [00:18:00] plantar fascitis. So now my pain scale overall is probably around two of 10. Completely manageable, doesn't affect ities of daily living. Still can go for a jog and things like that.

But there are so many other things that is happening. Behind the scenes, my identity as an being an athlete is being shattered. I hate the fact that if my kid wants to play with me, I have to think about my heel all the time. So when we think about, from an integrative medicine standpoint, one of the good analogy that I learned from my fellowship is that suffering is equal to pain, into resistance.

So the more we resist, the more the suffering is, and we all resist at some level. So for example, my pain scale is one to two, but I'm, I resist because I don't want this pain to be there because I'm not able to play tennis and I don't like that fact. So my suffering worsens, so when I go to the clinic, even though my pain scale is one to two which in that sense, I probably would've gone to the clinic.

But because I'm suffering, I go to the clinic and now the physician in front of me. [00:19:00] It's probably gonna think about aggressive interventions because they look at me and say, oh this person has a significantly high pain scale. Although it is all because of the suffering. And then in a person who is like seeing a clinician, they may not be in a good state of mind to make the decision because they want to get better.

And this might result in unnecessary procedures, which I see all the time. I've seen a lot of patients who get these injections in their plantar fascia or like knee injections multiple times, hoping that they'll find a fix. But their entire health has not been given importance that they don't get better.

when I think from an integrative medicine model right here, assuming that I'm the patient, I'll be focusing on. More to address why at the end of the day you're suffering even though your pain scale is one to two. So that would include a lot of techniques. For example, in my case, it would've been more mindfulness approaches trying to alleviate anxiety from the fact

And who knows there. The more I talk, the more I listen to the more I hear from the patient what their anxiety could be due to. [00:20:00] And sometimes it could be the other way, like that could be the physical health may not be going well. So I've seen a lot of patients with knee arthritis, but then instead of focusing on knee arthritis, I'll be focusing on their weight.

That would ultimately translate to improved outcome from the knee arthritis. There was a patient where I was seeing probably every three months he was seeing somebody and then we focused on weight. And now he sees me once a year because his pain is better. And sometimes when you think about, when you look at an image and you say, how come this pain got better even though this patient is bone on bone arthritis?

And that's where the importance of whole health comes into play. So from an integrative medicine standpoint, we are focused not just on the branch, we focus on the health of the tree more so that the branch can heal itself. 

That was a great analogy. It was. Yes. Yes. Thanks for that. And just, 

yeah. Maybe we can go into how do we heal the tree?

Yeah.

That's why I was like, now we're gonna talk about some of our favorite aspects. Yeah. So how does nutrition play a part in your role [00:21:00] as a sports medicine integrative doctor? 

We talked about the healing environment. And for the body to heal itself, you need to provide a good environment.

And one of the biggest things that one could one, could help heal is by what we consume every day. when it comes to nutrition, there are foods that actually hurt and there are actually foods that heal. Everybody can have different stance on what diet they wanna follow, but I think everybody can come into consensus that, that high sugar, ultra processed food, fried foods are probably going to be more pro-inflammatory basically means that they're going to cost more information.

We also can agree with the same fact that vegetables, fiber, fruits protein like Omega-3 latent rich foods such as like fatty fish and things like that. They also provide anti-inflammatory benefits as well. So when you think about healing, for the healing to happen, you need to have some anti-inflammatory, you need to increase the blood flow.

And there are certain foods that actually can improve the endothelial, which is basically the blood vessel function. [00:22:00] Thereby the healing factors can reach the injured tissue and that can, by health healing. Then we talk about oxidative stress. So we want antioxidants to help with cleaning up the tissues and stuff.

And all those things all come from what we consume on a daily basis. , Obviously I'm not the captain of the ship, my patient is the captain. I'm just trying to be advocate for what they do. But let us say, if somebody follows, I wanna follow a particular diet, I wanna follow a keto diet, or follow a vegan diet, or whatever it is.

At the end of the day, we're just trying to find the core principles of healthy nutrition that can help each individual to help heal from inside. 

I love that. That is something I don't ever remember hearing in my medical school lectures of talking about helping patients heal, even from an orthopedic standpoint or an injury of the focus of, we need to not be just prescribing a surgery or prescribing pt, but we need to be prescribing a diet that's gonna help them heal as well.

And that, that [00:23:00] it's just as important as all the other aspects 

for sure. I think and that's where you had mentioned before where the art of medicine is slowly dying and we are becoming more rigid on a technician mindset. I think evidence-based medicine is great, but I feel like once, as the evidence-based medicine comes into light, sometimes the art of medicine is being lost as well.

And when you think about from a traditional practices, and even though one may not believe in some traditional medicine practices, but when you look from a traditional medicine like Ayurveda or traditional Chinese medicine, nutrition has been a big part of their strategy in helping patients to heal.

It may be personalized to what foods that they need to one need to consume, to heal but when you look from a broader level, everything will have a lot of healing components of foods that are part of the treatment plan. 

another aspect of healing is sleep. And that's something that a lot of times patients aren't.

[00:24:00] Prescribed sleep like you need to, if you're trying to heal, you should really focus on sleep because most of the time they're, if they had an injury and they were hospitalized, they got horrible sleep right after their surgery or whatnot. How can sleep have a big impact for your patients?

We all know that the repair happens during sleep. So our growth hormone goes out and anytime we think about tissue repair, we need the growth hormone release to happen. We don't want to we don't want to circumvent that. So sleep is very important. , One thing that I can control definitely is behavior that can help promote quality sleep.

Even though I'm not able to control the quantity of sleep one might get, you can definitely control the behaviors that can help promote quality of sleep, like thinking about what one is doing before they go to sleep. So are they spending time in front of the TV or spending time in front of the phone?

What's that sleep environment like and what type of activities do they do before they go to sleep? And I usually tell my patients to create a sleep routine , and that could involve [00:25:00] multiple things. It's very hard to figure out which one might help them to promote good sleep, but it's the whole sleep routine that plays a huge role, making sure that there's a cool environment.

Some people like to have a warm shower before they want to go to bed. Some people like to use fragrances like lavender. Fragrances can be helpful to help alleviate anxiety before they go to sleep. Sometimes some patients have a lot of anxiety before they go to sleep, so mindfulness techniques can help promote good quality sleep.

So once we change the sleep behaviors, , we could reassure them that they, when they might have a good quality sleep, which can help with healing process as well. 

 Sarah loves a good wind down routine. I know I am always how to bring that promoting one.

Yeah. Yeah. I love the healing power of sleep and really thinking about it in the terms of, growth hormone. 

Yeah. 

Being released at that time, particularly for musculoskeletal issues would be 

important. And one thing I would probably say is that there, there are some patients that, that I've seen in my practice are very much so again, when we talk about sleep, [00:26:00] that helped to promote healing.

Most people might be so much fixed into the quantity of sleep. Like they could see their watch and say, I'm trying hard, but I'm not having a good quality sleep. But that also can cause issues as well, because now that's going to cause more anxiety. And how many times have I seen patients where they come and tell me I feel well rested, but I still didn't get this much amount of sleep, which is what most people prescribe too.

And that can create like anytime in a patient tries to go to sleep, even though we say go to sleep, what they're trying to do is that they're going away from wakefulness. They're just like, if I go hit my bed, I'm not saying, okay, I have to go to sleep. I just, it just happens. But the moment when people start to think about sleep as some chore that they have to do things don't go well as well.

So that's why the most important thing in my practice, instead of like just advising about sleep, it's about promoting healthy behaviors to ensure that they can get a good quality sleep rather than just focusing [00:27:00] on advising that you need to sleep better because sleeping better. How do I make someone to sleep better?

Just by saying that maybe trying to cultivate behaviors that can help to promote quality sleep. 

And you mentioned wanting to do things that improve blood flow to the area of concern. Yeah. So eating healthy diets that help your blood vessels is helpful. I tend to think of exercise as a way to increase blood flow.

How does someone do that when they're having an issue with movement? 

Yeah, for sure. And I think that's my bulk of our practice. There are two types of patients that I see. So one is my active athletes who their whole identity is movement. And when they have sidelined by an injury, what do I do?

Because sometimes the movement is what keeps them going. As we know, like people who exercise regularly know that. Even though we talk about more physiological benefits, there are a lot of mental benefits. You get this dopamine rush, you feel better. And for some people getting sidelined by an [00:28:00] injury.

 And if they're not able to exercise, that's a big problem. So I think as a sports medicine, background I'm in a good position to understand, okay what movements can cause trouble during this time? And what are some of the modifying activities? For example I kinda take my, me as an example.

So I've got plantar fasciitis right now. Does that mean that I cannot run? And the answer is no. If I have patients run and they say, I feel fine, I let them run. But can they play tennis? And if tennis bothers them, yes. Which means that no tennis for now until we rehab and get you back into tennis, if running itself is bothering you right now, we'll find a different type of an activity.

It could be swimming or biking or something like that. Let us say, if your pain is all predominantly coming from the front of the knee, then my biking may not be a good option. We will try to find something else. Sometimes we provide a generalist advice on what movements are safe and what movements are not.

In reality, that's not true in reality. Everybody's different. One may actually tolerate biking fine, may not tolerate walking fine, and [00:29:00] then the vice versa is all also true, even though the diagnosis might be the same. And that's where our physical therapist might come into play, where they may help to do a trial run or trial, certain moment at the therapy place to see what their feedback might be the next day.

Or I could do the same as well, that I would probably give a prescription and then see how they do and then change the prescription depending on , how their feedback was. But at the end of the day, exercise, I never tell patients not exercise. , We have to modify that way.

We keep moving. 

it just breaks my heart when people go down downhill just because they stop doing the one thing that they love. And then just the whole description that you gave earlier. So really trying to keep people active as much as possible. And, you've touched on this pillar, for stress, you've mentioned mindfulness.

What is something when you're, have people working on healing their body, do you feel like mindfulness is. Doing for that process? [00:30:00] 'cause I know that's something that a lot of people struggle with. You're like, oh, you're telling me to just sit still, be quiet and try to calm my thoughts. How in the world is that helping my healing?

Can you give our listeners a little bit of an explanation of how that plays in? 

, So let me define mindfulness. So mindfulness is basically means that it is being aware of everything that is happening, your thoughts, your feelings, your sensations, without any judgment.

So let us say somebody comes with a low back pain. And the pain skin might be one to two, but now immediately. So that's a sensation that goes to your brain and you feel the sensation. But immediately we want to label it. What could it be?

Could it be my disc? Could it be my joint? Whatever it is. At least in the past they couldn't do more than that. They would come and see a physician, the physician were able to diagnose, but now all they have to do is ask Google. And now with chat GPT, they can ask chat GPT and chat GPT. It's not going to give you a particular diagnosis.

It's going to give you at least five or [00:31:00] six differential diagnosis. So now you convince your brain a signal, A a feeling as a threat depending on what you saw. So now the patient's pain scale from one to two and just, climbed up to five or six because the brain thinks it's a threat. So it has to put more focus into that particular body pad, body part.

So now they come and see me and I do my evaluation and I tell them, you're gonna get better. All you have to do is this, do this exercise, and then do some related rest, and you'll get better. They're not going to believe that because their mind is convinced there's something else going on. So you can see how a person could have had a good trajectory of getting better, but because of their thoughts and their judgment and everything, the trajectory is changing now.

Now this patient might say, you know what I want to see the root cause of the problem so that I want to get an MRI. What the MRI will do is that the MRI, it's not gonna tell what's causing your pain. The M MRI is going to write you a checklist [00:32:00] of what and all things that is wrong in the back.

So now you have an MRI that shows a disc herniation or a disc bulge in all the levels. Like how do you convince yourself now that you're going to heal when you have an objective paper that tells you these are all the problems. when we talk about mindfulness, so basically mindfulness is okay I felt the sensation.

But I don't have a judgment. I trust my doctor, so I'm going to go see my doctor. And then the doctor, after years of training, knows how to make sure that the pain might be from a particular diagnosis. And then I tell them a treatment plan, there is a therapeutic relation between the physician and the patient saying that, you do this, you're gonna get better.

So the mindset has changed from saying that, oh, thank God I'm gonna get better. So when I say I'm going to get better, I'm, I feel calm. There's not much stress going on inside the body because we know that stress goes on, fight and flight response increases. A cortisol can impair healing.

But now , I'm in a calm state because I know I'm going to heal because [00:33:00] my doctor said I'm going to heal. And then I would say to a patient if this new sensation comes, you just come and see me right away. So then the patient also knows that, okay, if I, this sensation, I know who to contact.

So I'll come and see this doctor. you can see how. A mindset can change the entire trajectory of whether this patient is going to get better or the patient's not gonna get better. And this patient might come and say, they may get an imaging and they say, okay, these are my problems, so I want a surgeon to fix all these things.

And the surgeon may fix it , but again, when we say fix it, it's not like you're suturing and putting back together. Most of the time when you say fix it, you're actually trying to stabilize, which means that you're going to lose something and gain something. But the truth is that did you have to lose something to gain something?

It's very hard to know. So that's how I'd say like the mind plays a huge role in healing. And you talked about a patient might think about like how does meditation can help me? Meditation helps you to understand what is pain and what is suffering. So sometimes we [00:34:00] confuse about pain and suffering.

So okay, my pain scale is one to two. Yes, because of all these things, all my judgements, all my thoughts, I'm suffering. But if I may, if I could eliminate that thoughts, then when I look from a sensation standpoint, it's not bad. So that's how one can get better. We talked about, I think you talked about like the central sensitization that does happen where the brain, once the brain perceives as threat, the brain is going to dial up the volume of pain that affects the quality of life, that affects your movement and all those things.

 That's really solid in my brain now. Yeah, it does. 

Thank 

you. 

Can't someone just take a supplement to help all of this? 

I think you, you mentioned the word supplement, so it is a supplement to something that they have to do. A supplement can never be a complete healing medicine.

, So let me give you an example of let's say knee arthritis. So one might come and tell me like, I hear this all the time. Can this glucosomine supplement or a [00:35:00] turmeric supplement can help with my knee? Yes, they can. , But provided we also do the other things as well and you can add the supplement on top of it.

The problem with the supplement, again, that goes with the problems with any integrative medicine modalities that did the supplement help you or did the lifestyle help you? And at the end of the day, it's very hard to say which one does help you, but it might be a combination of everything that could be helpful as well.

But there is no one supplement that I would say can replace a proper lifestyle that is required to feeling better. 

 Do you wanna just repeat that? 

I think that was a very powerful statement and something that I'm not sure is told to patients enough is when you truly are wanting to improve many chronic conditions, like many across the board, not just pain from the musculoskeletal pain that we're talking about today, [00:36:00] without addressing the foundation of lifestyle, you're never going to get the optimal results.

And there's not a pill, there's not a supplement or anything that can take the place of that hard work. 

That's very true. 

I wish there was. I wish there was. Me too. Yeah. But it, I think it's just one of those hard realities that we struggle with. And sometimes in healthcare, we're not giving that message well enough to our patients, and so they end up very frustrated in healthcare because they're doing what their provider told them.

And they still aren't feeling well, but it may be because of these missing pieces that is required to truly heal your body. I, I really like that analogy that you have. Created early in the show of talking about if you want to heal from an injury or chronic condition, et cetera, you really have to focus on healing [00:37:00] the entire 

body.

Yeah. And that focus has to be part of, no matter what the plan is, if the plan is doing an injection, if the plan is physical therapy, if the plan is surgery, this is still part of it. And I think it's something that we don't bring up enough when we're doing something else, especially if we're doing something to a joint.

Yes, 

for sure. Putting a 

needle in there then I think this part gets lost, but can you maybe elaborate on how doing these things to improve your lifestyle and your overall health might benefit you even if you are doing surgery or injections or something else? 

Yeah so when we, when you talk about injections from a sports medicine standpoint, there are two types of injections.

one is a symptom suppression injection. And when you think about that, we all have heard about cortisone injections, so steroid injections, which can help pretty much for a lot of conditions in sports. So steroids are a very strong anti-inflammatory. And assuming that fire as inflammation, I think about steroids as [00:38:00] water.

They can put out the fire. But the problem is that we also know that water is also can be a problem as well. It wets the area. So the way , the steroids do harm, is by weakening the tissues. So for example, if I inject a steroid on a skin, I'm going to see a trophy within few injections.

Similarly. One could theoretically argue saying that if I put a steroid injection into a joint multiple times, it can weaken the tissues and the tissues that's gonna weak on the cartilage. Now the question is that can weakening the cartilage, can that change the long-term outcome of the knee joint?

Theoretically possible. We don't have consistent evidence to show that it's true, but it is theoretically possible. So then we were stuck from this stand, from a sports medicine standpoint. We were stuck with that, that we had cortisone injections, that we didn't have any other options, like what else can we do to help with healing?

And now there's this regenerative medicine treatment options platelet a rich plasma injection is one of the good example for this one, [00:39:00] where we harvest patient's own blood and we centrifuge, we concentrate the growth factors in the blood and then we inject into this particular joint.

So now when you think about steroid as water, that can. Put out the fire. The region in medicine injections are not like water, but they create a barrier to make sure that the fire doesn't happen. So sometimes I might have to put a steroid to stop the fire and then have to consider doing some sort of intervention to make sure that the fire doesn't come in the first place.

let's say I see a patient with severe knee pain, knee arthritis, not able to move, not able to walk. , I know that in order for us to make sure that the fire doesn't happen, we have to focus on the whole lifestyle. But there is an ongoing fire right now that is preventing them from focusing on a lifestyle.

So in this scenario, we might consider a steroid injection to pour out the fire, maybe like one time injection and get some time so that we can focus on the other aspects of lifestyle. So this way. [00:40:00] We never let the fire come in the first place. Sometimes we might focus on the lifestyle and then , in addition, we might have to focus on some sort of like a region and medicine option, like PRP to make sure that the fire never comes back as an added thing.

you can see here that even though I do provide an injection or something like that, without the proper lifestyle, the fire is gonna keep happening and I'm gonna chasing the fire. And we know it's always better not to chase it. It's better to prevent the fire from happening in the first place.

Similarly, one may need a surgery. For example, a patient could have fallen, and they have an acute rotator cuff tear, and the body's the body can heal. But unfortunately, the tear is so bad that. You need to approximate that tear in order to have a proper healing. But again, a surgeon knows this because a surgeon would not do a surgery when they know that the body cannot heal.

We use the body's innate capacity to heal when we do a surgery. So some conditions a surgery might provide them a better outcome. But still your lifestyle plays a huge role as [00:41:00] well. There are many patients that I've seen have regretted why they did a particular surgery because their healing was not in an optimal environment.

So they did a surgery when the healing environment was not optimal. That resulted in complications from the surgery where the person could have postponed the surgery and let the environment be in a better place. So one of the common example that you can think about is. Uncontrolled diabetes, getting a surgery resulting in an infectious complication and changes the complete course, like the patient could have been well off not doing the surgery, but at that time it was a shared decision making that the surgery was necessary, but the complication was unpredictable in that case.

 one modality that I know that you are more familiar with than many healthcare providers are not is acupuncture.

Can you explain to our listeners how that can help with healing? 

 So acupuncturist is a type of an energy medicine. And sometimes for western medicine, energy medicine might look foreign. But when you think [00:42:00] about energy medicine, we use that all the time. Like EK G, we use energy to to diagnose things.

We use energy. Electromyograph is one, electroencephalograph is one. But even when we go beyond , let's say for example, when I'm doing an exercise. I like creating a bending in the collagen that creates this electricity that causes the healing and strengthening of the tissues as well.

So when you look from that lens standpoint, the acupuncturist belief is that we all have a life force called as chi And , when you think about it, like how does a single cell can become a complex human being, that's where the traditional Chinese medicine beliefs, that there is an life force called chi and an iWay that's called prana.

And this force, the electrical force is. Traveling in fascial planes. And these fascial planes have the low resistance where the electric energy is transmitting. So by using an acupuncture needle, one can change the electricity at a target [00:43:00] organ where the healing has to happen. So let's say, for example, I have a tennis elbow, so one could think about as tennis elbow as more of a deficient electrical energy that is required for healing.

So if I know the right points to deliver that electrical energy to that particular spot, the healing can happen. , 

 when we think about from an acupuncture standpoint, even though we talk about energy medicine. If you go see in a sports medicine clinic or even an orthopedic clinic, there are many pains that one cannot understand why a person has particular type of pain and stuff and invest In medicine, we call as like a myofascial pain, so assuming that it's coming from the fascia.

So one could look at acupuncture as more as a traditional medicine in the past who understood the importance of fascia and its role in healing. Maybe we are just starting to look at the surface , and possibly the traditional Chinese medicine and already figure out how the fascia helps with healing and that's basically how I view acupuncture and that could [00:44:00] bridge between eastern and in western medicine.

Now, also for our listeners, what's the difference between dry needling and acupuncture? 

So dry needling would be a more of a myofascial technique, a myofascial release technique where you are putting a needle into a muscle that might be tightened, and that irritation tells the muscle to relax.

In acupuncture, we call this like an ashi points. An ASHI points, almost like trigger points. But in acupuncture, the goal is not to just focus on the ashi points or the trigger points, but also to make sure that we also send an electrical energy to heal as well. So when you think about myofascial pain, that could be many reasons for it.

 , The problem with the acupuncture's research is that you cannot compare an acupuncture with a dry needling. So dry needling is one set of a procedure that doesn't have any other variables, that plays a role. But when you think about acupuncture, like for example, let's say I'm focusing on a.

A pain in the back. I'm not just focusing a pain in the back, like a dry needling [00:45:00] person might do, I might be focusing on other things as well. So can be helping to alleviate anxiety, can be helping to alleviate things that could be causing muscle tension and stuff. Whereas when you think about dry needling is just focusing on just on the muscle per se.

So that's why it's very hard to compare acupuncture dry needing, because acupuncture is a, it's a healing type of a traditional medicine that can, that just not only focus on muscle it focus on overall health. 

So really , we could think of dry needling as being very focal.

Acupuncture is more of taking the whole body 

Correct. 

Into 

play. Okay. That's helpful for me. Yeah. I had some dry needling this year and it was interesting. I'd never had any drying before. Yeah. Or acupuncture before. And it was like, I could feel the needle, get into the area of muscular pain and then you could feel it.

Relax. Yeah. When you're doing acupuncture, since I've never done that before, do you get that immediate feedback even with acupuncture? [00:46:00] That's a great question. 

I think when you think about, so let us assume that, so let us assume that somebody has got chronic shoulder pain and because of chronic shoulder pain, they also have myofascial pain in the back.

They have like tightness in the trapezius musculature and things like that. So when I'm treating from an acupuncture standpoint, even though my target couldn't be the trigger points in the trapezius, but also to make sure that we provide the healing energy to the shoulder to get better. When you think about from a dry needling standpoint, you're just focusing on the muscle tension to help relax the muscle.

But the therapist who might be doing the dry needling is also focusing on the health of the shoulder through exercise. The exercise also is healing as well. We talked about how when you exercise, you create this piece of electric electricity there, thereby help to tell the body, to bring the healing materials there to help heal that.

The shoulder and the dry needling is actually an adjunct to the exercise on top of it. Acupuncture is more [00:47:00] of like my target is not the trigger point. I would still treat the trigger point through an acupuncture needle, but my core reason why I'm doing acupuncture is to help heal that shoulder. Which means that I would find the meridian that the problem that might be arising, I think it's a little bit hard to understand from western medicine standpoint, but, or you can think as more like trying to find the fascial plane that I could send the energy to that particular shoulder and not to heal and I still would he help with the trigger point.

So you could find immediate relief from an acupuncture needle and a dry needling. Right away on the trigger points. But you will, it'll take some time for you to start to feel relief from your shoulder pain because as I said, it's more of a healing rather than acute pain relief, 

relaxation or, yeah.

Some people you might have, like when we, when one does an acupuncture, there is this endorphin release that happens as well that can provide them a pain relief right away. So if one could think that as the theory, how the acupuncture works, but [00:48:00] the problem is that if that theory is the only thing that is true, then the patient's pain relief is gonna be for three, four hours or so.

But how come a patient is going to come and tell you that it helped me for months together? So there is something more that is happening beyond the end, often release that is happening as well, which can help you feel pain relief right away. But the long-term effect could be coming from something else.

I have experienced acupuncture once I did it and I didn't have a specific pain that I was targeting, but. I would wear an aura ring and it just absolutely blew my mind. 'cause I love watching the stress level on that. And I would've thought that I've been so stressed having all these little needles from acupuncture on me and I hit the state of relaxation that I have never hit any other way before other than sleep.

It was incredible. I have not gone again, but I definitely will pursue it again in the future because it was something that I had really had a negative thought about and [00:49:00] it was like, how in the world can this do anything? And then I experienced it and I was like, wow, that was pretty remarkable.

And I think this is exactly like, when you talk about acupuncture and you talked about some clinicians don't believe it, but when you hear patients that had acupuncture and have had benefits. How can you negate that, the benefit that they got from Yeah. Yeah.

So there's a high chance that we still don't understand , how that works. And we are trying to come with theories how it might work. But at the end of the day, it works. And for my patients, it's all about that's what they care. , I'm not trying to make anything better in a, in an x-ray picture or anything like that.

All I care about is can my patients keep moving? For the rest of their life. Yeah. That's where all that matters. 

And I think the one principle as physicians we always have to remember is, we're trying to do no harm and there's a very low risk with acupuncture. Yeah. Yeah. And so I always tell people when they're trying al alternative options for managing chronic conditions or pain or any of these things, first let's assess.

Is it, can it harm you if it [00:50:00] can't harm you? And you get benefit? I don't really care if there was a study to tell you that you're supposed to benefit from it. I just know that it's not harming you, and I'm just glad you feel better. Yeah. And that's great. 

Yeah, for sure. 

Are there any things out there that you do see people using or doing that, that could cause harm?

Especially from social media. 

Yeah from a social media. I haven't come across a lot, I would say. And the good thing is that most patients are pretty honest about what they're using. And I think when , when they see my integrative medicine background they sometimes have a false belief that I believe in certain things that, that they also believe in as well.

But at the end of the day , when they share these things, if it is truly harmful, I would let them know if it is not harmful,, if it's something that they wanna try and we have no idea whether it's gonna help or not. And if it helps them, that's totally fine. One of the biggest things , that some of my patients have followed , is basically the carnivore diet, which is basically a diet that is involved only meat and stuff like that.

 That's one thing. Again, we don't know what the long-term [00:51:00] consequences can be. Can be helpful. But for certain patients, for example, if they have hypercholesterolemia , I would try to help them out to make a decision that can be better for the long term rather than for short term.

But more than that, haven't seen much. Yeah, 

We went to the mall this weekend as a family and there was a kiosk in the middle with these vibration plates. I'm so glad this is, that was 

the question I had 

in my head and we all got on 'em. That's the first time I've ever stood on one, and that is quite a vibration, but we all enjoyed it, including my kids.

We were standing there in the mall. Any thoughts on those? 'cause I know that's a big trend right now, these vibration plates. 

I've not come across that, so maybe I have to do some research on that one. What are the benefits they're saying?

I think they're saying probably because it's improving blood flow. It says it improves lymphatic drainage. Yeah. It can get rid of your cellulite. 

Uhhuh. 

I will tell you, it didn't get rid of mine from my one time on Sunday. But yeah, that it can [00:52:00] promote healing and improve lymphatic drainage and improve bone.

And 

same thing here, structure. Like when I think about, when I think about that particular vibration modality, it's not gonna cause any harm to it. If a patient has severe knee pain, I probably would not let them to stand on that one. But if otherwise, totally fine. But if a patient comes and tells me that's a one only thing that they do to help with healing, I probably try to educate them as well.

And this could be, again, same thing. It's one one tool that can help with overall healing. 

 cold plunging. Is that something that you see as beneficial from a healing standpoint that you've seen? 

The research is very scant from that standpoint that a cold plunging alone can help with healing.

But again, this will come to the same process where when a person is doing cold plunging, they're not doing that one thing alone. They might be doing the other things as well, and , at the end of the day, it's very hard to say that one particular thing that helps them. But if a patient comes and tells me like, [00:53:00] I can do everything else, but I cannot do the cold plunge.

I'll be totally okay with that. If they wanna do it cold plunge as well, that's totally fine as well. There are some studies on improving heart rate variability from a standpoint and heart rate variability could translate to a better longevity profile in the future. But there are also other things that one can do instead of doing a cold plunge that can improve heart rate variability as well.

So again, like if a patient enjoys that to increase their fight and flight for a certain time, and then so that they get an enhanced relaxation response after that, totally fine. But they can also do other things as well that can provide this similar benefits as well. 

And that brings me to my last one.

What about saunas? 

Saunas? I have not looked into it primarily for saunas, but I suspect that might be similar as well. Yeah. Yeah. '

cause I feel like. Some people like to do both. Some, yeah. And do the contrast of them, but others lean more into one modality [00:54:00] or the other. But I feel like I hear more people talk about the mental health benefits of some of these practices more than anything.

Yeah. And it's that's helping that, let's go for it. 

And I think it's, at the end of the day, it's also mindset as well. So you might, you have convinced yourself that it may help and it, and definitely it could be helping from a more physiological level, but it's very hard to emphasize saying that's the magic solution for a certain condition.

Probably not. Yeah. 

It's more of let's just put that tool in our toolbox, but we might need a lot more tools to actually solve the problem. 

Yeah. I think of those types of things as. A supplement almost because it's still, it's just maybe that's gets you your last one or 2%, but it's the other things that you're doing the other minutes of the day you're awake that are really making the bigger for sure.

Impact. So you still need to do the other things and then if you have time and resources to add that and it benefits you. Yeah. Great. 

For [00:55:00] sure. 

You have created a great resource for people with a lot of free education. What has motivated you to do that? And can you tell people what it is and what's available?

Sure. We talked about from a technician mindset , where the patient is coming with a problem and sometimes we know that. Without fixing the underlying health of the tree, I cannot fix the branch alone. But you need time to do that as well.

And one of the biggest limitations is that we don't have time to do those things, and then I could have complained for many years that I don't have time and that probably wouldn't have helped me nor my patients, which is what motivated me at the time. , The videos were like trending.

People were sharing videos. So then I thought to myself, why not make my own videos and share with the patients so that it the clinic visit doesn't end at the 20 minute mark or 10 minute mark. The clinic visit extends beyond that, and that's how [00:56:00] I got started. Actually, initially, I started with COVID-19 when there was a lot of misinformation, patients are not getting good enough information, but then eventually translated to more of an exercise videos.

There were times where even now when you go to an orthopedic clinic or some other clinic, they give you options. So you can go to physical therapy and if the, let's say the patient says, I wish I can go to physical therapy, but I have a high deductible insurance. I cannot afford physical therapy.

Then the physician might give you a piece of paper that has some images of exercise and stuff. And every time I see that paper I felt it was un unethical to give that paper that how in the world would patient understand what to do with that? So then I designed myself like, why not do an exercise video and share with the patients?

And then slowly then it became more okay, what are their lifestyle things that we can talk about beyond things that we talk about in the clinic? For example, when I see patients with knee arthritis, just talking about injections alone might take 20, 30 minutes. So when do I focus time on talking about nutrition, lifestyle supplements and things like that?

So usually I might talk about injection and I might give [00:57:00] them. A QR code of a particular video and say, just watch this video. So you ask me what kind of videos that I put in my channel. So most of these videos are basically exercise videos that I try to put understanding pros and cons of certain interventions things like that.

And predominantly focusing on exercise and how to get people started on exercise. It's easier said one kid say just do one few minutes of exercise per week, but what does that mean? What's the intensity and other the other details that one would like to know?

And that's why I started making those videos. 

I love 

that. That's why we have this podcast. We'll definitely put a link to that in our show notes so people can access that. What do you want? People to take away from this as far as thinking about if they do have a pain or they wanna prevent injury in the future, what should they take away as far as how can they help themselves heal?

, When you talk about the principles that everybody should follow, [00:58:00] even if they have pain, if they don't have pain, is to make sure that they eat healthy exercise regularly, manage their stress levels better. And then let us say, when one has pain, the biggest advice that I'll give would be not to Google it, go see a physician.

 So the problem here is that sometimes the patients may have had a bad experience with a physician, which is why they might be trying to circumvent that process. But I think once you find a good, trustworthy physician. It might be better to go see a physician and get a proper evaluation because as I mentioned in this conversation, your mindset can actually change the trajectory, whether you're going to heal or whether you, or whether things are going to go the other way.

That's one. And I think, and from a standpoint of pain, sometimes we want to focus just purely on pain, but it's also important to understand, okay, yes, I have pain, but is that something else that is going in my life that is exacerbating the pain? And sometimes having a [00:59:00] reflection of that can be helpful as well.

Sometimes we talk about, okay, what am I doing something different that could have actually made this pain worse. For example I saw a patient recently who had foot pain, which was completely under control and suddenly with changes in her lifestyle and have gained some weight because of the changes in her lifestyle, the pain has gone worse.

So now I'm not gonna focus just on the pain. I'm gonna focus on what led to that change in a lifestyle that resulted in this ongoing pain as well. So the biggest thing here is to try trying to find a good physician who can just treat holistically rather than just focusing on the branch like we talked about.

That's great. I'm gonna be thinking of this tree and branch a lot now. No, it's a very great analogy. And if our listeners want to come see you, how could they schedule a visit with you? 

Sure. So I, I practice at UK Healthcare in Georgetown Clinic., I think we can put a number on how to make an appointment. And then I have walk-in [01:00:00] availabilities for injuries for any pain. So most of the time, and it's like a chronic pain that has been going on for a long time. I have a lot of availabilities. You can just call the clinic and they can make an appointment.

But if someone has an acute injury and they need to be seen right away because that can make a difference there are some injuries that may need surgery right away. There are some injuries that can be managed non-surgically, but until I evaluate, it's very hard to know. So for that, I have walk-ins on every day from Monday to Friday between seven 30 to eight in my clinic.

That's great. 

 Thank you so much. You have given us a lot of good information. It really help us on our journeys of trying to stay active. 'cause really that is the whole goal, is to be able to be active and enjoy life as we get through it. 

. See you next time.