Episode One-Hundred-Fifteen.mp4: Audio automatically transcribed by Sonix
Episode One-Hundred-Fifteen.mp4: this mp4 audio file was automatically transcribed by Sonix with the best speech-to-text algorithms. This transcript may contain errors.
Kevin:
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Kim Pittis:
Hi.
Dr. Carol:
Hi.
Kim Pittis:
So you’re back. I’m back. We’re back. You’re back from San Francisco?
Dr. Carol:
Oh, San Francisco.
Kim Pittis:
And I didn’t see you this time. It was so weird. I wasn’t here, though.
Dr. Carol:
I know, and San Francisco was fascinating. We had two acupuncturists from Hong Kong.
Kim Pittis:
Wow.
Dr. Carol:
We had a physical therapist from Chile. We had a physical therapist from Louisiana, and we had a physical therapist from Arkansas. She is our first practitioner in Arkansas.
Kim Pittis:
Wow.
Dr. Carol:
We had a couple from California, but they were like from all over the country.
Kim Pittis:
And San Francisco is such a cool hub to fly into.
Dr. Carol:
Yeah.
Kim Pittis:
It’s just like that, right? Like it’s a good location.
Dr. Carol:
It is. And then you come early or stay late and go hang out.
Kim Pittis:
Yes.
Dr. Carol:
And I’m hoping everybody feels the same way about Troutdale.
Kim Pittis:
Troutdale almost reminds me of where I’m living in Livermore right now. It’s like this awesome, right? It has the same vibe where you have a big city, but there’s like this town where time is just a little slower. People are super nice. There’s great restaurants.
Dr. Carol:
Pretty village.
Kim Pittis:
Yeah.
Dr. Carol:
Exactly.
Kim Pittis:
And I found that I think the clinic location and the environment is so important with what we do.
Dr. Carol:
Yeah.
Kim Pittis:
I just feel like that in my practice right now because I have the ability to take more time than I ever used to. Like, don’t get me wrong, like having four treatment patients in rooms on the go and whatever. And I love treating athletes that way. But there’s something really nice about having multiple machines and a quiet room and the ability to just take your time and listen. That’s where I’m at right now.
Dr. Carol:
And during the practicum, we did something that I’ve never done in 30 years.
Kim Pittis:
Oh, sure.
Dr. Carol:
Yeah, yeah. So the patient is fairly straightforward. He had a laminectomy. I don’t know 17 years ago. And it got infected. And so they drain the pus out, give him antibiotics. Then they actually left a bunch of disk nucleus fragments. So they redid the laminectomy. I guess this is back in the days when they did laminectomy for this. So maybe it was like 19 years ago and L5, S1, a little bit of L4, S2 were all numb, hypothetic or, well, numb actually. So we did 40/396 and it went from numb to hyperesthesia. And then so inflammation in the nerve and then scarring in the nerve. And the patient was talking while we were treating.
Kim Pittis:
Yeah.
Dr. Carol:
And he said it’s like I have neurovascular claudication. Excuse me. He said, I can walk and it’s only in my right leg, so it’s not true vascular claudication. Vascular claudication is when you can walk a specific distance before the blood supply to your muscles is just insufficient, and you end up with spasticity and pain in the muscles because they get ischemic. So you can walk the exact same distance from your front door to the corner. And then you get claudication and then you have to come back. And he said neurovascular claudication. So after we couldn’t get him back to normal in the hour that it should take because that’s like easy right.
Kim Pittis:
Could be.
Dr. Carol:
Yeah. And he said neurovascular claudication. So we pulled up essential anatomy, and there’s the blood supply to the nerve. And I said, what if the blood vessels to the nerve only on the right got scarred down, shut, or diminished because of the infection? What if? So we switched to scarring in the artery. And I swear, 20, 30s, it went from hyperesthesia to normal.
Kim Pittis:
Wow.
Dr. Carol:
That fast. And then it was, okay, we’ll see if it lasts till tomorrow. Next day, still normal. Scarring in the blood supply to the nerve, and I’ve never treated that ever.
Kim Pittis:
So here’s the thing. Every time you say I tried this, it makes total sense, though. Like the hypothesis Yeah of course. Absolutely. With how you broke it down that makes total sense.
Dr. Carol:
Yeah. And Pseudomonas infection They drained a cup of green pus out of the. Yeah, that’s a good face. Yuck. And it was like 21 years ago. And he said pain in his leg and numbness in his leg ever since.
Kim Pittis:
So patient coming in next week with a very similar Pseudomonas-type history. And so I can’t wait to. I would have never thought about it, but like I said it’s like anything else that you have these crazy ideas about. It makes sense.
Dr. Carol:
Especially when you see Candace. We figured out how to hook up essential anatomy to the projector, and Candace is so good at working it. So she showed the skeleton at the lumbar spine, added the nerves and then she added the blood vessels. And there’s the blood vessel running right next to the nerve. And there’s always a part of me that says it couldn’t be that simple.
Kim Pittis:
No, I know.
Dr. Carol:
Yeah.
Kim Pittis:
And the thing is, when it comes to the blood supply, of course, we all took this in school. We all know. But you don’t think about it in that forefront of your thoughts because we don’t treat it until now.
Dr. Carol:
Yeah.
Kim Pittis:
And that’s why you have the software like Essential Anatomy or Netters or all those other things. And I’ll say it like it’s the patient’s benefit. I just want to show you a little bit about what we’re working on. No, that’s a total lie. I need to refresh my thoughts on what I’m looking at. It has nothing to do with the patient, but you just need some. I don’t want to call it inspiration, but it’s almost just like that, and it jumps out at you.
Dr. Carol:
Visual aids.
Kim Pittis:
Yeah.
Dr. Carol:
When he said claudication, I knew just from being around this business for like 50 years now, that’s a scary thing to say. Anyway. You know what claudication is? It’s occlusion in the arteries.
Kim Pittis:
Yeah.
Dr. Carol:
And he said neurovascular claudication. We had another one too.
Kim Pittis:
Before you go there. I want to go back. So this patient was obviously a health care practitioner and can use these terms that are very helpful to you to think about, okay, we use claudication. What is that?
Dr. Carol:
Yeah.
Kim Pittis:
A lot of patients aren’t going to come in with that terminology or they’ve been diagnosed with something and it just goes way back because they don’t know what it is. So, they’ll give you their interpretation of the diagnosis or it’s up to you to resurrect an old diagnosis. But sometimes the patient will give you the clues. Without the medical terminology, they’ll walk you through it, they’ll say things. So that’s what I mean about slowing down and listening. Even if you have four patients on the go, which is a lot of fun, you have to just be super present and listen. Even if you think you know where you want to go, you have to listen
Dr. Carol:
And the thing that the patient would say is I can walk exactly the same distance. That’s the key with vascular claudication, for those of you that aren’t familiar with it. I can walk exactly the same distance and my leg gets numb and painful. And only my right leg. That sounds like claudication.
Kim Pittis:
Yeah.
Dr. Carol:
Did you have a starting quote that I ran over?
Kim Pittis:
Yeah. Let me pull it up because it’s I had the inspiration over the past two weeks of what to talk about today, and I’ll tell you the quote first, okay?
Get the fundamentals down and the level of everything you do will rise.
Dr. Carol:
Yeah.
Kim Pittis:
So this is more tailored towards the practitioners that are listening as opposed to the patients. But sometimes we can overcomplicate everything. Right? And again that’s the paradox of using FSM. There’s so many avenues that you can take and you can make it as complicated as you want it to be. But to borrow one of Carol’s rules, right? Be a student of easy. So the fundamentals, whatever branch of medicine that you’re practicing in, start with those fundamentals and then you can grow from there. But if you start with your head in the clouds and all these things that are swimming, you’re just chasing your tail. And I have a couple of stories to go around, but that’s where I wanted to go is again, like strip it right down to the basics.
Dr. Carol:
And explain it in a way I love parsing, the human body.
Kim Pittis:
Yeah.
Dr. Carol:
So your knee hurts and your cerebellum, without talking to you about it, without notifying or negotiating, rearranges the way all of the muscles on the left side of your body, from the base of your skull, down to your knee and your toes. Change the order, the strength that everything.
Kim Pittis:
Yeah.
Dr. Carol:
To minimize the trauma and the pain that comes out of that left knee.
Kim Pittis:
Yeah.
Dr. Carol:
Doesn’t talk to you about it, and it actually doesn’t negotiate. You can have somebody strength and stuff. You can have somebody stretch stuff. And the cerebellum will nod and hum and completely ignore it.
Kim Pittis:
Yeah.
Dr. Carol:
And then once we fix the knee, everything goes through the midbrain.
Kim Pittis:
Yeah.
Dr. Carol:
And the midbrain says, no, wait, I remember that left knee. It hurts.
Kim Pittis:
Yes.
Dr. Carol:
So I don’t care what the cerebellum is telling me about the knee. I know that knee hurts. And so I’m going to tell the cerebellum that it should walk a particular way to protect the knee, even though the knee is now just fine.
Kim Pittis:
Yes.
Dr. Carol:
So that’s when, as you say, we tell the midbrain or the limbic system to just take a nap.
Kim Pittis:
Yep.
Dr. Carol:
And then the sensory and motor cortex, the portion of the sensory-motor cortex dedicated to the knee, it’s pretty small.
Kim Pittis:
Yeah.
Dr. Carol:
On the whole homunculus. So the next step is to quiet down the sensory and motor cortex and get that representation for the knee back down to normal.
Kim Pittis:
Right.
Dr. Carol:
Then you go back down to the midbrain, and say, remember, the knee’s fine now. And then you go to the cerebellum and you tell the cerebellum, okay, now coordinate movement since the knee doesn’t hurt anymore. And it’s if you can turn it into a puppet show or a conversation between a committee.
Kim Pittis:
Yeah, it is a committee. And it’s funny that you’re going there because I wanted to tell a bit of a story about 40/89. But let’s talk about the second story that you had with.
Dr. Carol:
This one was frustrating.
Kim Pittis:
Ooh, the frustrating ones are always the good ones.
Dr. Carol:
It was one of those. The practitioner was physical therapist from Louisiana. Hi, Jeff. And he had the coolest t-shirt. He had a black t-shirt with a bright green dinosaur on it and it said daddy saurus. He said, tell me if we have a way to help with loin pain syndrome with hematuria. Excuse me. And I said, what happened? The patient has this terrible flank pain and blood in her urine. What happened immediately preceding it? Oh, she had Covid. Okay. So let’s talk about Covid. Those six virus frequencies. The thing with those viruses, the kidney is this lace of capillaries. So the viruses in the capillaries and the kidneys have Ace2 receptors. Those viruses match with the Ace2 receptors. Go into the blood vessels, reproduce, come boiling out, tear up the capillaries on their way out, form a bunch of blood clots, which then dissolve and hurt like crazy in your low back and you end up with blood in your urine. Rather, I said the number one, the diagnosis that you just described doesn’t exist. He said, yes, it’s very rare. I said, yeah, because it doesn’t exist. What she has is long Covid in the kidneys.So she has the effect of the virus in the kidneys. This was followed by a bunch of other things that ended up being long Covid and the Vagus, long Covid in the small bowel, inflammation in the brain but it all started in the kidneys. So I actually added a slide for how to think about long Covid. I couldn’t help myself.
Kim Pittis:
No, It’s necessary. Yeah.
Dr. Carol:
Yeah, because it’s so easy to treat it. I keep expecting to get hit by lightning when I say things like that. So far, either the house is really well grounded or I got lucky, but that was the other one. So the other rule that we have as FSM practitioners is you take the diagnosis that the patient walks in with and you ignore it. I swear to God, one of the practitioners that came in said she had been diagnosed with plantar fasciitis, injected the bottom of her foot with steroids. Nobody ever did a sensory exam. She has hypersensitivity at L4 or L5, S1, and she has a disc replacement at L4-L5. Therefore, that’s maybe four years old. Therefore, she has a disc bulge at L5-S1. So we put a towel behind her back and put a towel around her foot and ran 40/396 and her plantar fasciitis was gone in 40 minutes. Then I taught her lumbar x-rays, had her lay on her stomach. Foot pain went completely away. We taught the lumbar exercises and there we go. So the Kevin we have to redo the differential diagnosis webinar or presentation or whatever. And the first rule is start over. They walk in with a diagnosis, and if that diagnosis was correct, the patient would be better. And they wouldn’t need to come see you. So when the patient walks in the door, you have to ignore the diagnosis and start from the beginning. What happened just before it started? What are your symptoms? What makes it better? What makes it worse? Do a sensory exam. Do reflexes. Take a history.
Kim Pittis:
Yep. And yeah, I feel like I’ve just been the biggest hypocrite because I said, you have to sit and you have to listen to the patient and you do. And then you have to use your own critical thinking and dismiss the garbage can diagnoses that drive me crazy. Frozen shoulder, jumpers or runner’s knee plantar fasciitis, jumper and runners. That is an absolute thing. You have runner’s knee. Really? Can you break that down and explain what that is? No. Any human that runs as runners you are a runner and you have knees. Oh, yeah. You’d be surprised at the stuff that come that I get signed by physicians.
Dr. Carol:
Oh, and one of my other favorites. I got diagnosed with chondromalacia patella, which means absolutely nothing.
Kim Pittis:
Yes, that’s another funny one for the knees. But you’re right. You have to take all of it. It will give you a clue as to what body part to look at. Maybe or maybe not. But so often with any kind of physical exam that you’re looking at, it’s coming from the other side. It’s coming from up above, it’s coming from down below. And that’s what I wanted to circle back to with the fundamentals of things, don’t get cut off in the wacky diagnoses that somebody is coming in with or their own, because they googled something and had a cousin’s friend’s, dogs, buddy in Australia who knew a guy that like…it comes so often it I’ll just be like, thank you for all of this. I’m just going to do my exam and I’m going to cross-reference it and we’re just going to get an even bigger picture. And so you’re not dismissing what they’re saying because it’s very important to them and it is important to the story. But so often we just get caught up with labels with everything and we don’t have to label everything. And I feel like that’s what happens to a lot of chronic pain patients is that they just need this label and then they get caught up in it. And I think that probably happens a lot with things like fibromyalgia.
Dr. Carol:
And this lady actually still thought she had plantar fasciitis. And it’s like, you never have plantar fasciitis. You had pain in your left foot. It’s not like you’re running had nerve pain. And when you laid on your stomach, the pain went away.
Kim Pittis:
And because like true plantar fasciitis, that would not happen. And I’ll be honest, I don’t like treating feet. It’s just one of those things that give me an armpit over a foot, like any day of the week. But true, like plantar fasciitis is not going to go away that quickly with positioning and with running 40/396 like, it takes a lot of work with the fat pad and mobilizing the tissues and.
Dr. Carol:
Getting the joints to move. And when you look at those four pictures from Netter, there’s four layers in the foot. And I’ve never seen two cases of plantar fasciitis that were the same.
Kim Pittis:
Agreed.
Dr. Carol:
If the tarsals lock up and the arch of the foot doesn’t decelerate and the arch stays locked, and the superficial fascia, which is 77, takes a hit, it’s the arch stays and this gets stretched. So what happens? Well, that’s just 124/77. But you still have to put them in an arch support tape the bottom of the foot. Treat him three times a week.
Kim Pittis:
Do exercises.
Dr. Carol:
Do exercises. Do the little scrunchy toe things to get the muscles to work and keep the bones mobile. And in maybe two weeks it’ll be better.
Kim Pittis:
Yeah.
Dr. Carol:
Give or take.
Kim Pittis:
Give or take. Yeah, it’s a process. But positioning to me that was the one that like changing the positioning is not going to change plantar fasciitis pain.
Dr. Carol:
Thank you very much. But I didn’t find out she was committed to that diagnosis until she started to leave Sunday. And so I still have plantar fasciitis. No you don’t. You never did. You had you have an L5-S1 disc. Yeah. You have L4, L5, S1 and S2 Radiculopathy that give you pain at the bottom of your foot.
Kim Pittis:
Yeah.
Dr. Carol:
Okay.
Kim Pittis:
Yeah. It’s amazing. And sometimes the corrective exercise part, not just with plantar fasciitis, but with any condition, is a process. Like you’re never just done with something. And I think that’s another like part to explain to patients like as you’re restructuring the joint and rebuilding it and reeducating it and however you want to phrase it, there’s a lot of work to always be done. But you want that. You want change. You want to be continuously moving and adapting. So when patients are like, how long do I have do these exercises for? I’m like, you’re not going to have to do these specific exercises very long. But the goal should always to be staying active. And as this gets fixed, there might be something else that happens. So it’s always a journey. It’s always a process.
Dr. Carol:
Then you have to stabilize it. So when you have a lumbar disc, we have the patient lift their leg with their legs straight. More or less. It’s thinking about lifting their leg because the goal is to lift a straight leg. With the patient prone about one millimeter off the table, the muscles should fire hamstrings, glute, ipsilateral lumbar muscles, contralateral muscles.
Kim Pittis:
Yeah.
Dr. Carol:
That’s the order. So you put your hand on their back, have them lift their leg. If they lift it too far you get hamstring glute contralateral because this side where the disc is inhibited is no do less. Nope. Do. That’s it. That’s it. Yeah. That’s it.
Kim Pittis:
Yeah.
Dr. Carol:
And you do it three times and then the muscle gets fatigued. So you wait two minutes, then you do it another three times. And I said that’s all you do that one time in the morning. One time at night. And then what do I do? So then you explain about, keep your low back in extension. Don’t flex forward. If it hurts in your leg, look at your posture and what you’re doing and all of the first part of fixing anything is to not break it again.
Kim Pittis:
Yeah, if it were only that simple. It’s a foreign concept though, and that’s what we do. We tear down and that’s the premise of hypertrophy, right? That’s how a muscle grows. You tear it, you repair it. And as long as you have tools and you have the ability to watch those comp, the biggest thing for me is compensations, because I am a biomechanics freak and that’s my sweet spot. That’s what I can see. I can see the small missteps and firing. And patients can feel it. They know, like I’ll have them stand and I’ll say, how do you feel that you’re standing right now? I feel like my shoulders up and this hip is up. And I said, aha, that’s what it looks like. How does your knee feel and how does your ankle feel though? As long as you bring awareness to it, they know exactly what’s going on. So I think that is so fascinating. Okay. Why are you doing that? Why are you standing like this? I don’t know. I just want to. Does it hurt if you stand a different way? I don’t know, I don’t want to, though. And so fascinating. There’s no pain there, but it’s just the programing, it’s just the pattern and it’s just.
Dr. Carol:
It’s the cerebellum. It does not notify, doesn’t tell you why you’re standing like that. And it also does not negotiate. I’m sorry you’re not allowed to stand any different way because there’s the hippocampus up there that remembers whatever it is that’s hurting. And it’s not going to let me let you stand any other way. Right. And I’m not going to let you stand any other way. And I’m not going to tell you why.
Kim Pittis:
But the patient doesn’t know that part.
Dr. Carol:
No, they don’t.
Kim Pittis:
So it’s just funny when I said you just bring awareness to it and they’re like, that is a great question. I don’t know why I find this comfortable. And so just again, going back to safety, it’s so interesting. I had four new patients in the last two weeks. Three out of the four listened to the podcast.
Dr. Carol:
What’s up with that?
Kim Pittis:
It was super interesting. So I had two of the patients I had brought up, how their amygdala needs to go to time out and they and this one gentleman, you need to put it in time out. No blanket, no pillow. It’s been a very bad amygdala. I’ve just got it. We are punishing the amygdala okay. It’s great because it is like saying like this puppet show that we do, it really is great patient education and all them we’re talking about, they just have this like bigger understanding of their injury. So they think. So again, going back to fundamental things that I wanted to touch on, one of the biggest questions I think we get when we’re teaching is how long do you run this. And I think those questions are getting lesser and lesser because of the way it’s being taught now, because it’s not just a recipe, because I know when I was taking the class, it would be asked probably every two hours, how long would you run that for or. Right? And you’re just like, dear God, till it’s done or until it works.
Dr. Carol:
And the two sides, one side is really soft and smushy and the other side isn’t. So you keep running it until both sides are as smushy as they’re going to get, and then you go on to the next thing.
Kim Pittis:
Right.
Dr. Carol:
So to use 40/89, I will run it almost always on its own machine, almost the duration of a treatment, especially for some patients.
Dr. Carol:
Yeah.
Kim Pittis:
And I don’t want to throw this out because I just don’t like it. But I have a patient who’s very nervous and nervous is the most, like, organic word I can use. So everybody listening can explain it. And it takes about 45 minutes for that patient to come off the ceiling and get back in their body so we can have a conversation about what’s happening.
Dr. Carol:
That’s like the whole visit is over before she.
Dr. Carol:
Yes. Okay.
Kim Pittis:
But when we get there, the magic happens.
Dr. Carol:
Yeah.
Kim Pittis:
And I haven’t found anything that can expedite it or that I can run in congruent with it to help that 40. It’s almost you could almost set your watch. It’s 45 minutes.
Dr. Carol:
Yep. Well and you’re running 40/89 the whole 45 minutes.
Kim Pittis:
Yeah. That’s what I need. And I can’t speed it up. And time is time. And it’s like watching paint dry and you just you’re just like, come on and hurry. Yeah, right.
Dr. Carol:
Well. Turn the fan on.
Kim Pittis:
Right. But I’ve tried to run multiple machines. I’m like maybe three machines. 40/89 will help. No, it is what it is. And I’m hoping that in time it’ll be less and less. But again patient has a pretty extensive history, has a lot of and I don’t want to say trust issues but has seen some practitioners that have made it worse and not better. So I get that it is it takes a while for and I know again, it’s not nervousness, but it’s just the anticipation of the treatment working and the treatment holding and the treatment not making it worse.
Dr. Carol:
On the treatment not working and making it worse. That’s where the midbrain is whispering in the background. I told you this was going to happen. just watch this. 45 minutes later, the midbrain is going, ah, what was I saying? I’ll take a nap now.
Kim Pittis:
Right. And in that moment I can do so much. But it’s only that moment. And I just have to be patient and do everything that I can because. And we know this even without FSM, when there is muscle guarding or muscle splinting, you are not going to have an effective treatment. And just recently I’ve heard some horror stories and I’ll preface the story by saying I took ART in the 90s. I love ART, a very good ART practitioner can do amazing things when they have patience and the right palpatory and treatment hats.
Dr. Carol:
Yes.
Kim Pittis:
I have also seen horrific treatment’s gone awry from practitioners that muscled their way through and tore healthy tissue.
Dr. Carol:
Sotraction nerve.
Kim Pittis:
Yes. And it’s been around for 25, 30 years probably. It’s been around there’s a lot of practitioners out there. So like I said, I don’t want to poo the whole treatment because I use it, I love it. There’s a lot of great practitioners.
Dr. Carol:
ART plus 13 and 396 is a really good combination.
Kim Pittis:
Yes.
Dr. Carol:
That’s perfect.
Kim Pittis:
Yes. Amazing. Like I said, will I use ART without FSM? No.
Dr. Carol:
No. Why would you do that?
Kim Pittis:
Why? I don’t know, I almost always have an FSM machine and I always have my hands, so in my opinion, it just works that much better. But after treatment, when you’ve created extra range of motion and you’ve taken the pain down and you’ve taken that patient who was so apprehensive and nervous into that safe place where you can create change. That is also when I start making sure we’re using the right verbiage by saying how to how much better does that feel now?
Dr. Carol:
Right. Or even how does that feel?
Kim Pittis:
Sure.
Dr. Carol:
We have one she has Ehlers-Danlos but doesn’t know it. And when she laid down on the table to get treated, her quads, pectineus, brevis, trunk muscles, arm muscles were all really tight. And so I ran 81/10. And everything got smushy. Well, then she set up. And she started moving her arms and said, wow, this is so weird. My brain doesn’t know where my arms are.
Kim Pittis:
Yeah.
Dr. Carol:
Wait, she just told me what to run.
Kim Pittis:
Yes.
Dr. Carol:
So we put up warm towel around her neck, had her hold a cloth in both hands, and we ran increased secretions in the sensory and motor cortex and had her move her arms and she said, oh, that’s really weird. That feels. Oh, and then you could watch the change in quality of movement when the sensory and motor cortex is connected.
Kim Pittis:
Yeah.
Dr. Carol:
Then we ran 81/84 increased secretions in the cerebellum, which has a different function, the sensory and motor cortex. Its job is where are my arms and what do I want them to do?
Kim Pittis:
Yeah.
Dr. Carol:
Her arms are completely different. So the sensory and motor cortex had never heard from her arms the way they were now. Then when we shifted to increase secretions in the cerebellum, the muscle tone was different and you could watch the difference in quality of movement.
Kim Pittis:
I have the silly grin on because that’s what we do in the sports course. So when you can do a whole practicum and just watch, like you said, it’s the quality of the range. And I think that is like the beautiful part of doing exercise rehabilitation with patients. It’s not blowing through the stop sign and just getting an arm up here. It’s how does the arm get up there? Because that connection is ultimately what’s going to give you the long lasting effects. It’s not just going to be a party trick that you do in the clinic and then the next morning when they wake up, they’re back to how they were before.
Dr. Carol:
Yeah. And the nice thing, the way the court is now, we started long before we ever get to the central nervous system. We start introducing the concepts that the peripheral musculoskeletal system is once you treat shoulder, elbow, neck, low back, whatever the final step is integrating it with the central nervous system.
Kim Pittis:
Yes.
Dr. Carol:
And that gets started like the first second day, whereas before it didn’t come in till the end.
Kim Pittis:
I think that concept is really important to have as you’re learning it, because that is what creates that critical thinking as opposed to just the recipe.
Dr. Carol:
Yeah, Same thing with the diagnosis part of it. What happened just before? Why does the back of your shoulder hurt?
Kim Pittis:
Yeah.
Dr. Carol:
External rotation is painful and weak. How does your armpit. Aaoo. Okay. I’d love to fix the partial thickness tears in the infraspinatus and the teres, but there’s no way to do that without getting rid of this thing. And the subscap first, right? Really? They’ve been working on my shoulder for a year and a half. Yeah,
Kim Pittis:
And that’s when you say and you still have pain, right? Like, how’s that been working for you? It does blow me away how little subscap is treated and how the glenohumeral joint is treated as if it were an ankle. The scapulothoracic joint and the glenohumeral joint have to work together. That’s not just my opinion, that’s mechanical science.
Dr. Carol:
As long as the subscapular nerve is glued to the subscapularis muscle, cerebellum is not going to let any the motion, it can’t happen. Know think the reason nobody works on the subscap is because it hurts so much. And you run 40/396. So you put your finger in somebodys axilla and they go aaoo. And then you run 40/396 until their upper lip relaxes. Then you start running 13 remove the scarring. Start moving it. When the upper lip contracts again, you go back to 40. Quiet down the nerve, buy yourself some space, then start moving it. And then once the hand is up here. Then you can go to work on the muscles in the back that have partial thickness tears.
Kim Pittis:
Sure.
Dr. Carol:
And then for us, it’s so simple. And I’ve gotten to the point where I really feel sorry for people that don’t do FSM because.
Kim Pittis:
I don’t feel sorry for them. We have enough courses all over the planet now you can get to a course. it’s the patients that I guess I feel sorry for because like I said, I couldn’t imagine being on the receiving end of a subscap treatment anymore without it.
Dr. Carol:
Yeah, I don’t know. True story. It’s just. It’s so much fun.
Kim Pittis:
Yeah.
Kim Pittis:
So fundamentals like we always talk about 40/396. And we talk about that one for a reason because fundamentally as a practitioner, your goal is to get that patient out of pain. Like you don’t have to fix it in one treatment, but you should get that patient out of pain first. And 40/396, 13/396 inflammation and scarring in the nerve is your fastest way to make a dent in the pain.
Dr. Carol:
And sometimes 81/396, depending on if they’re numb or hypersensitive.
Kim Pittis:
Correct
Dr. Carol:
But hypersensitive to normal is a sequence.
Kim Pittis:
Right. And a patient coming in with numbness is a different sense of urgency than a patient coming in with pain.
Dr. Carol:
Yeah.
Kim Pittis:
Like pain patients. It’s like urgent. Get them out of pain. Numb. I’m not saying it’s not urgent, but it’s the annoyance of the numbness. It’s not like when somebody has a nerve pain. But I agree, numbness is 81, for sure.
Dr. Carol:
And speaking of listening. Somebody says my hand is numb. And you check the sensation and they can feel sharp just fine. Yeah, but my hand feels numb. And I said, but you can feel sharp, so how about it feels as if it should be numb, but it’s not. Oh yeah, that’s what it is. That’s called paresthesias and that’s probably coming from the muscle. What you say. I don’t feel sorry for those that don’t use FSM. They get paid for six sessions. I’m done in three. Way to go, Debbie. And then what I have to explain to people that are taking the course for the first time is, yes, you’re done in three and you lose your frequent fliers, but each patient that’s better in three sessions knows six people just like them and start telling patients. So you have to figure out a way to manage new patients.
Dr. Carol:
Yes.
Dr. Carol:
And I don’t have time to see somebody twice a week for 4 to 6 weeks. And that’s actually once you get rid of the people that actually can be fixed, then you have all these holes in your schedule where they used to be.
Kim Pittis:
Right.
Dr. Carol:
You have room for one new patient a day who gets to be seen twice a week for 4 to 6 weeks.
Kim Pittis:
Right.
Dr. Carol:
And then you’re done in three weeks instead of six. But if you tell them six weeks and you’re done in three, then they’re really happy.
Kim Pittis:
Yes, that’s right.
Dr. Carol:
I like that part.
Kim Pittis:
I try to make patients come and check in even when they’re feeling totally fine, because I see a lot of athletes and we do like a biomechanical screen every four months, whether they like it or not, they get a little reminder it’s time to come in. And sometimes it’s just 20 minutes where I’m just going through mechanics just to make sure everything looks right, It’s like getting your teeth cleaned, right? You go to get your teeth cleaned every six months and fingers crossed you don’t have a cavity and there’s nothing. But sometimes there’s something really small that you obviously wouldn’t notice, but your dentist sees, and they can advise you to what route to take before it turns into anything.
Dr. Carol:
Thank you for the reminder. It’s time to get my teeth cleaned. There you go.
Kim Pittis:
No, but. You know what I’m saying. So, like, I try to, especially with that athletic population or even somebody that’s been in chronic pain for a long time, and we’ve had to undo so many things. You have to put the little graduation hat, and they leave the clinic and they’re all fixed. But having them come back in just for a quick look through, I think is really important. So Debbie says something about preventative too.
Dr. Carol:
She said exactly I’m very busy now and I have a few patients coming in monthly now. Prevention better than cure. So, I used to tell patients to come in once every six weeks for a lube oil and filter.
Kim Pittis:
Yeah.
Dr. Carol:
Just your 65 years old used to play basketball, ski, ride hunters and jumpers, whatever. And this is you just come in for a lube oil and filter. Just.
Kim Pittis:
Yeah.
Dr. Carol:
Preventative maintenance.
Kim Pittis:
That’s right. We all need it. I don’t care how old the car is.
Dr. Carol:
Exactly.
Kim Pittis:
Or how many miles it’s put on. So I think it’s important. So our future courses that are coming up, somebody had emailed me about it. Do we have all the Europe stuff on the website yet?
Kevin:
No.
Kim Pittis:
Okay.
Dr. Carol:
Not exactly.
Kevin:
We don’t have venues yet.
Dr. Carol:
We have dates. We don’t have venues. I have to get back in touch with the Royal Medical Association and figure out if we can do the course in the space that they have available, and if they still have the space available, the one in Ireland, the three day and then your you’re doing two days or three days?
Kim Pittis:
I have to go back with them. I might have to put it on the other end. I forgot I have to be in Canada on some of those days, so I just want to make sure that it.
Dr. Carol:
Okay, so NCC is set. I just need a venue for London. One of the practitioners volunteered a place, it’s an hour train ride from London. I’m not sure that’s going to work, so I’d rather do the RMS. And then Eduardo has a place in Rome. I have to work with Slowik to arrange, a space. So we have dates. We don’t have venues yet, so when the need shows up, so I’m assuming the right venue will show up.
Kim Pittis:
Yeah.
Dr. Carol:
Yeah.
Kim Pittis:
So, I had two people reach out recently about your course and asking they heard on the podcast that there was going to be Europe and they’d like to tie in, a vacation with, the courses.
Dr. Carol:
Can we put the dates on the website and have the location TBA?
Kevin:
Yeah. So they’re all up there. So, can go to the events.
Dr. Carol:
Events menu.
Kevin:
And then see 24 and 25 calendar.
Dr. Carol:
24 and 25 calendar. I’m the only person that knows where we’re going to be having.
Kim Pittis:
Courses in the next.
Dr. Carol:
A year from now. We actually do. What I can’t believe is I’m not going to Cleveland this January for the first time in 6 or 7 or 8 years. Burke said. Are you coming? And it’s does the hospital have space for us? No. You have to get a hotel. And what has happened with hotels, just so everybody knows why we’re doing the course. And the training center in Troutdale is that the hotels were charging us was at $132 a gallon for water.
Kevin:
Some of them, yes.
Dr. Carol:
Yeah, $132 for one gallon of hot tea water. And we go through a lot of Tea, $60 for lunch.
Kevin:
$62 a person.
Dr. Carol:
Yeah, $62 a person for lunch. We used to be able to do a seminar in a hotel for five days, including lunch for right around $15,000 including food and beverage. When we were in Denver, it came out to be $29,000 for five days, and that was in a DoubleTree. I haven’t even seen the total for the bill at the Weston. I just sent it to my bookkeeper and I said, don’t worry, next year it’ll be better. So we will do Troutdale and Portland is nice. The Portland seminar is in May. I’m not sure what we’re doing in April. So we might do something in April then. Yeah, it’s. And then we go to.
Kevin:
A five day.
Dr. Carol:
We have a five day.
Kevin:
In the next month, we have a two-day practicum.
Dr. Carol:
Vice versa. April, we have a two-day practicum for people that have taken it on video, or people who’ve taken the course in the past and just want a practicum refresher.
Kim Pittis:
I think practicums are, just to interrupt quickly, are integral for learning. So I get it. We had to teach a ton online during Covid, and I’m glad we were able to do that. I saw especially like a huge gap in the learning for especially for the sports course. So I said no more online because. It’s just you need to be there. You need and whether it’s you treating or getting treated or observing the treatment, it is. And I don’t care what kind of learning style you have. Some people are like, oh, I’m just an auditory learner. No, you have to experience it and see it and touch it and feel it and all that stuff. So that is my firm comment on that one. So if you have not been able to go to a live Core, these practicum weekends are essential.
Dr. Carol:
And that’s two days you fly into Portland on Friday. we’re not done until 6:00 Sunday or sometimes later. We were finished at 6:40 on Sunday night like we were our normal amount behind, plus a little. And the everybody stayed. Yeah, we had two people working on each other after I left at 7:30, it was wild.
Kim Pittis:
But I get it, though, because you’re when you’re learning and you’re there and you finally experience the change, smush, floof, however you want to call it, how on earth do you just walk away from that?
Dr. Carol:
Oh and these days, they totally get it. When we were in Taiwan, there was a GP that said, I don’t do physical medicine. Why am I working on somebody’s neck and shoulder? As a GP, you’re going to be using these frequencies, but in the first three days, your hands will convince your brain that 40 does this and 13 does that. So when we get around to using frequencies in visceral conditions, which is where you’re going to use them.
Kim Pittis:
Yeah.
Dr. Carol:
You have a reason to believe me,
Kim Pittis:
Right.
Dr. Carol:
Because otherwise why would anybody believe it? Then it’s blah blah blah blah blah, numbers, blah blah blah. And it’s no. Yeah, this does this. Speaking of which, Karen Perry and Candace Elliott, their paper was just published in the Journal of Women’s Health. It’s an online journal and it is an pre and post mammograms on a woman with class C dense breast tissue.
Kim Pittis:
Yes,
Dr. Carol:
It’s 217 ankylosis and oxalates. And it’s a total of three hours treatment spread over 18 months. The patient went from class C, which has a 50% increase in the incidence of breast cancer, to a class B, which does not.
Kim Pittis:
Wow.
Dr. Carol:
And that paper just got published. So it started out as a case report. It’s an online journal. So everybody that subscribes to paper or digital content journals know that they charge you $200 a year or $400 a year to subscribe to the New England Journal of Medicine. The smaller online journals charge the author for publishing the paper, and we say that we’ll pay the author $2,000 to write the paper. The cost for $2,000 to get the paper published.
Kim Pittis:
Wow.
Dr. Carol:
So we’ll reimburse her for that and pay her and Candace for having published the paper, because it’s an important paper.
Kim Pittis:
Yeah. Amazing. Congratulations. That’s so exciting.
Dr. Carol:
Isn’t that? It’s coming. And we have a paper about to be published on a. It’s not a paper, it’s a letter to the editor of a journal in gastroenterology, I think, on scar tissue caused by abdominal radiation.
Kim Pittis:
Wow.
Dr. Carol:
And once again, patient went from being seen for obstructions once or twice a month to two treatments to no obstructions at all in the last 18 months.
Kim Pittis:
Wow.
Kim Pittis:
It’s happening. I’m pretty excited.
Kim Pittis:
Oh, yeah.
Dr. Carol:
Arachnoiditis. That’s coming too.
Kim Pittis:
Wow.
Dr. Carol:
Yeah.
Kim Pittis:
Let’s go.
Dr. Carol:
Pre and post MRIs.
Kim Pittis:
Yep. There it is.
Dr. Carol:
The radiologist said scar tissue. Not scar tissue.
Kim Pittis:
I like that objective finding.
Dr. Carol:
Yeah.
Kim Pittis:
It is our objective finding that it is 4:00.
Dr. Carol:
It’s 4:00.
Kim Pittis:
I know. It’s crazy. All the alarms are going off here. Yes, I see it. So…
Dr. Carol:
Where’s my Snoopy watch? See the Snoopy watch.
Kim Pittis:
I can’t see it but.
Dr. Carol:
There it is. So there’s Snoopy.
Kim Pittis:
Ah! Ah!
Dr. Carol:
I was never going to. JJ gave me an Apple Watch for a present. So it’s the funniest part is having this Snoopy screensaver.
Kim Pittis:
I love it.
Dr. Carol:
Look at the time. It’s a different fun thing.
Kim Pittis:
And it makes you smile.
Dr. Carol:
Yeah. Me too.
Kim Pittis:
All right, I will see you next week.
Dr. Carol:
See you next week.
Kim Pittis:
Thanks, everybody for coming. See you again.
Dr. Carol:
We’ll see you next week.
Kim Pittis:
Bye.
Dr. Carol:
Bye.
Kevin:
The Frequency Specific Microcurrent podcast has been produced by Frequency Specific Seminars for entertainment, educational, and information purposes only. The information and opinion provided in the podcast are not medical advice. Do not create any type of doctor-patient relationship and, unless expressly stated, do not reflect the opinions of its affiliates, subsidiaries or sponsors or the hosts or any of the podcast guests or affiliated professional organizations. No person should act or refrain from acting on the basis of the content provided in any podcast, without first seeking appropriate medical advice and counseling. Know information provided in any podcast should be used as a substitute for personalized medical advice and counseling. FSS expressly disclaims any and all liability relating to any actions taken or not taken based on, or any contents of this podcast.
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