1 00:00:00,280 --> 00:00:02,800 Hello everyone, I'm Diane Grissell. 2 00:00:02,800 --> 00:00:04,960 I'm also known as Silver Despedience, and this is the 3 00:00:04,960 --> 00:00:07,600 Silver Despedience Perception Dynamics podcast. 4 00:00:07,840 --> 00:00:11,280 And we're recording in iconic Manhattan center. 5 00:00:12,160 --> 00:00:16,280 We have a very interesting guest that we're going to learn about 6 00:00:16,280 --> 00:00:23,000 today and we're really going to learn more about is it in your 7 00:00:23,000 --> 00:00:26,880 head or is it real? And what we're talking about is 8 00:00:26,880 --> 00:00:32,280 pain. There are times when we feel 9 00:00:32,280 --> 00:00:36,880 pain, we can't get it diagnosed, or worse, it gets misdiagnosed 10 00:00:36,920 --> 00:00:40,760 and we get further and further away from finding the answer 11 00:00:40,760 --> 00:00:44,160 that we might need. Well, my guest today is Doctor 12 00:00:44,160 --> 00:00:48,560 Erin Nance, and she is a specialist in helping people 13 00:00:49,040 --> 00:00:53,280 understand pain that might have been misdiagnosed or uncovering 14 00:00:53,600 --> 00:00:56,560 what that pain is and where it's coming from and why. 15 00:00:56,960 --> 00:00:59,760 So welcome. Thank you so much for being 16 00:00:59,760 --> 00:01:01,560 here. Oh, thank you so much, Diane. 17 00:01:01,560 --> 00:01:04,200 It's a pleasure to talk with you and your audience. 18 00:01:05,800 --> 00:01:11,560 OK, let's start with just plain the idea of it's not all in your 19 00:01:11,560 --> 00:01:14,120 head. How many times do you think 20 00:01:14,120 --> 00:01:20,160 people hear that, and what's the impact of hearing you know this 21 00:01:20,160 --> 00:01:25,120 is in your head? So for I would say the vast 22 00:01:25,120 --> 00:01:30,320 majority of people when they start experiencing symptoms, you 23 00:01:30,440 --> 00:01:31,880 you kind of dismiss it yourself, right? 24 00:01:31,880 --> 00:01:35,120 Like that'll go away. It's nothing. 25 00:01:35,360 --> 00:01:38,480 I must have slept on it funny. And that's a universal 26 00:01:38,480 --> 00:01:41,640 experience, but when something. And often that's the case. 27 00:01:41,640 --> 00:01:44,360 Correct. And often that is the case, but 28 00:01:44,360 --> 00:01:50,480 when something is lingering for days, weeks, months, that you 29 00:01:50,480 --> 00:01:53,280 know, is a sign or a red flag that this is something that we 30 00:01:53,280 --> 00:01:56,720 really should be addressing with a healthcare professional. 31 00:01:57,360 --> 00:02:03,880 And if pain is just kind of the only symptom, it is very 32 00:02:03,880 --> 00:02:08,080 difficult to determine where that pain is coming from or what 33 00:02:08,080 --> 00:02:10,440 happened, right? Sometimes you're talking about 34 00:02:10,440 --> 00:02:14,000 your son who's a skateboarder. He fell, he hurt his wrist. 35 00:02:14,160 --> 00:02:17,520 He probably has a fracture. But for most people, there's not 36 00:02:17,520 --> 00:02:21,160 that immediate connection. And that pain comes on what we 37 00:02:21,160 --> 00:02:23,640 call insidious and gradual, right? 38 00:02:23,640 --> 00:02:29,160 There was no one time event that caused this to happen, just 39 00:02:29,160 --> 00:02:32,600 those one time events that are pretty easy actually to 40 00:02:32,600 --> 00:02:35,680 diagnose, right? I, I was sitting down, I heard a 41 00:02:35,680 --> 00:02:38,520 pop in my back. Probably have a herniated disc, 42 00:02:38,560 --> 00:02:40,200 right? You know, I, I was, I was 43 00:02:40,200 --> 00:02:43,720 walking down the street walking my dog and I rolled my ankle and 44 00:02:43,720 --> 00:02:46,480 now my ankle is swollen, probably have a sprained ankle. 45 00:02:47,200 --> 00:02:52,520 But for a lot of conditions that are more what we call systemic 46 00:02:52,720 --> 00:02:57,520 or part of like your bloodstream or autoimmune, rheumatological, 47 00:02:58,200 --> 00:03:02,200 there's no one one like smoking gun, right, as to what is 48 00:03:02,200 --> 00:03:05,280 causing this. And I think that's probably one 49 00:03:05,280 --> 00:03:08,920 of those difficult areas people find themselves when they go 50 00:03:08,920 --> 00:03:14,160 seek out help and they don't have that one diagnose, you know 51 00:03:14,160 --> 00:03:17,280 that that one symptom that a doctor knows immediately. 52 00:03:17,280 --> 00:03:20,480 OK, I know exactly what this is. And people are finding 53 00:03:20,480 --> 00:03:23,440 themselves in this position more and more often. 54 00:03:23,800 --> 00:03:28,360 You know, that is so interesting for for many years you used to 55 00:03:28,360 --> 00:03:31,840 hear the term fibromyalgia and people used to say, Oh my God, 56 00:03:31,840 --> 00:03:34,480 that's what doctors call it when it's all in their head. 57 00:03:34,480 --> 00:03:37,560 You can't identify it. There's really no reason for it. 58 00:03:37,560 --> 00:03:39,360 So they were just going to give it a name. 59 00:03:39,880 --> 00:03:45,560 Now you see no see plastic pain and which seems to be the new 60 00:03:45,800 --> 00:03:53,520 way that that cluster that not necessarily identifiable or as 61 00:03:53,520 --> 00:03:56,720 you said root cause necessarily being clear. 62 00:03:57,560 --> 00:03:59,600 What can you tell us about that? Where? 63 00:03:59,600 --> 00:04:01,920 Where does that all go and where did it come from? 64 00:04:03,200 --> 00:04:08,600 So I think First off is we have to build systems that are rooted 65 00:04:08,600 --> 00:04:13,000 in believing patients and believing that they have a 66 00:04:13,000 --> 00:04:15,640 problem, that there is something wrong. 67 00:04:15,880 --> 00:04:19,560 Because what you asked earlier about what does it do when a 68 00:04:19,560 --> 00:04:21,519 physician tells someone it's all in your head? 69 00:04:21,880 --> 00:04:25,640 Well, it shakes the confidence, right, that we have in our own 70 00:04:25,640 --> 00:04:29,200 ability to trust our gut that something is wrong. 71 00:04:30,120 --> 00:04:33,680 And what I have found is that in the vast majority of cases, when 72 00:04:33,680 --> 00:04:36,840 someone tells you it's all in your head, it's just because 73 00:04:36,880 --> 00:04:38,680 they have not figured it out yet. 74 00:04:39,800 --> 00:04:42,840 And it's, it's a way of kind of pushing, you know someone. 75 00:04:42,840 --> 00:04:44,760 Pushing the boulder way, correct? 76 00:04:45,840 --> 00:04:50,720 And as I said, there are like established diagnostic pathways. 77 00:04:51,120 --> 00:04:53,840 You got a whole lab panel. I have great news. 78 00:04:54,120 --> 00:04:57,760 Your labs are normal. Well, that doesn't help me, 79 00:04:57,800 --> 00:04:59,400 right? I have great news. 80 00:04:59,720 --> 00:05:01,520 We didn't find anything on your MRI. 81 00:05:03,440 --> 00:05:05,840 All right now, yes, that is. It's funny. 82 00:05:06,640 --> 00:05:10,760 You're reminding me of when my mother was in her 90s and dying 83 00:05:11,120 --> 00:05:14,240 and we were going to a super fit woman. 84 00:05:14,240 --> 00:05:17,680 We went to the oncologist, the rheumatologist, the 85 00:05:17,680 --> 00:05:21,480 pulmonologist, the this, that. And they're all like, you know, 86 00:05:23,600 --> 00:05:26,640 I have no idea what's going on. Nothing wrong with you. 87 00:05:27,040 --> 00:05:29,520 And the day she said the oncologist said, well, I just 88 00:05:29,520 --> 00:05:31,280 want to let you know you don't have cancer. 89 00:05:31,560 --> 00:05:36,720 And she goes, oh, crap. I, I just looked at the 90 00:05:36,760 --> 00:05:38,720 oncologist and laughed. I said, you're going to have a 91 00:05:38,720 --> 00:05:41,360 funny dinner conversation. I'm sure you don't have many of 92 00:05:41,360 --> 00:05:43,480 those. You know the patient who said oh 93 00:05:43,480 --> 00:05:45,680 crap. I can tell you. 94 00:05:45,760 --> 00:05:48,520 I bet you see this and you've heard this kind of thing. 95 00:05:48,520 --> 00:05:52,200 Correct from interviewing so many people who have a 96 00:05:52,200 --> 00:05:57,200 misdiagnosis or an autoimmune condition when and multiple 97 00:05:57,200 --> 00:05:59,760 people have actually had a diagnosis of cancer in addition 98 00:05:59,760 --> 00:06:03,120 to these other diagnosis, when they hear they have cancer they 99 00:06:03,120 --> 00:06:04,320 go. Yes. 100 00:06:05,400 --> 00:06:08,000 OK. Because they know this is 101 00:06:08,000 --> 00:06:12,160 something that has a name, it has a treatment and I know what 102 00:06:12,160 --> 00:06:15,920 the prognosis is. And that to them is a better 103 00:06:15,920 --> 00:06:21,040 prospect of just not knowing or trying to chase something you 104 00:06:21,040 --> 00:06:24,200 don't even know what it is. So to get back to your original 105 00:06:24,200 --> 00:06:29,280 question about the fibromyalgia, you know, there, fibromyalgia is 106 00:06:29,280 --> 00:06:34,360 a disease or condition that we call a diagnosis of exclusion, 107 00:06:34,920 --> 00:06:37,600 OK. And what that means is we have 108 00:06:38,240 --> 00:06:40,280 tried to find cancer and we didn't find any. 109 00:06:40,400 --> 00:06:43,200 We have tried to find rheumatoid arthritis and we didn't find 110 00:06:43,200 --> 00:06:45,520 any. We tried to find Lyme disease 111 00:06:45,520 --> 00:06:47,800 and we didn't find any. But you still have these 112 00:06:47,800 --> 00:06:49,200 symptoms. We believe you. 113 00:06:49,200 --> 00:06:51,640 We we, we understand that they're real, that they're 114 00:06:51,640 --> 00:06:54,760 affecting you and they're in a similar pattern to what a lot of 115 00:06:54,760 --> 00:06:57,800 other people are experiencing. But they also don't have 116 00:06:57,800 --> 00:07:00,520 positive labs and they don't have positive CT scans. 117 00:07:00,760 --> 00:07:03,240 And so we're going to diagnose you with fibromyalgia. 118 00:07:03,960 --> 00:07:07,600 Now in giving that diagnosis, and I say this all the time, 119 00:07:08,440 --> 00:07:13,880 diagnosis is power, OK? When you have a diagnosis, that 120 00:07:13,880 --> 00:07:19,720 then opens up a whole variety of potential treatment options of 121 00:07:19,720 --> 00:07:23,960 new specialists of new medications, right? 122 00:07:23,960 --> 00:07:28,440 Because you have a diagnosis, you have to think about what's 123 00:07:28,440 --> 00:07:31,680 going on behind the scenes when you get a diagnosis, that 124 00:07:31,680 --> 00:07:34,720 diagnosis carries an ICD 10 code with it. 125 00:07:35,240 --> 00:07:39,200 And for anyone who's ever seen an EOB or a bill that you get 126 00:07:39,200 --> 00:07:42,040 from your insurance company, OK, correct. 127 00:07:42,360 --> 00:07:48,200 But you need that ICD 10 code in order to get that that treatment 128 00:07:48,200 --> 00:07:51,640 in order to get that IVIG in order to get that new 129 00:07:51,640 --> 00:07:55,480 medication, right? So having a diagnosis is power 130 00:07:55,760 --> 00:07:59,400 not just for your own emotional state, but also from a very 131 00:07:59,480 --> 00:08:02,800 practical standpoint in terms of how insurance works. 132 00:08:03,560 --> 00:08:08,720 So I am glad that people are getting some diagnosis right. 133 00:08:09,040 --> 00:08:13,480 But in my opinion, for the vast majority of people, they have a 134 00:08:13,480 --> 00:08:17,200 root cause that just has not been discovered yet. 135 00:08:17,600 --> 00:08:19,200 And. In some cases then a 136 00:08:19,240 --> 00:08:23,360 misdiagnosis, which is potentially even worse because 137 00:08:23,400 --> 00:08:28,440 you're going down a pathway. It's not, it's not even that 138 00:08:28,440 --> 00:08:30,520 you're you're the pathway is stopping. 139 00:08:31,480 --> 00:08:35,960 You've just stopped because they say, OK, we've figured out your 140 00:08:35,960 --> 00:08:38,840 diagnosis. But for a lot of these 141 00:08:39,559 --> 00:08:45,000 fibromyalgia POTS MCAS, the treatments are drink more water. 142 00:08:45,280 --> 00:08:51,160 Yeah. Exercise more and when you're. 143 00:08:51,440 --> 00:08:53,600 Well, those two factors do help a lot. 144 00:08:53,880 --> 00:08:56,360 Of course. Of course, pretty much anything. 145 00:08:56,560 --> 00:09:00,600 Of course, but it's not specific to your particular problem. 146 00:09:01,600 --> 00:09:05,680 So that's where I feel sometimes when people are given these 147 00:09:05,680 --> 00:09:10,120 diagnosis of exclusion, it prevents them from doing the 148 00:09:10,120 --> 00:09:13,760 further investigation to something that might actually be 149 00:09:14,160 --> 00:09:16,760 treatable. What do you find if someone's, 150 00:09:16,760 --> 00:09:19,880 let's say, been diagnosed with fibromyalgia? 151 00:09:20,120 --> 00:09:24,240 What are underlying things that are often missed once that 152 00:09:24,240 --> 00:09:29,160 diagnosis is given? So for fibromyalgia, right 153 00:09:29,320 --> 00:09:32,760 patients are usually complaining of pain in multiple areas of 154 00:09:32,760 --> 00:09:36,240 their bodies at different times. Sometimes it can. 155 00:09:36,960 --> 00:09:42,120 People can have brain fog or extreme fatigue and there are 156 00:09:42,120 --> 00:09:47,880 many different either infections, EBV or mono, you 157 00:09:47,880 --> 00:09:51,720 know the kissing disease. I find that a lot of people have 158 00:09:51,720 --> 00:09:57,200 had undiagnosed chronic EBV that have been diagnosed with 159 00:09:57,280 --> 00:10:00,040 fibromyalgia. EBV as in Epstein Barr. 160 00:10:00,040 --> 00:10:02,680 Correct. Epstein Barr virus, same thing. 161 00:10:02,680 --> 00:10:04,920 Lyme disease, right? You might have been diagnosed 162 00:10:04,920 --> 00:10:08,280 with fibromyalgia, but your underlying cause was untreated 163 00:10:08,400 --> 00:10:11,680 Lyme disease. Or sometimes there's a, a, a 164 00:10:12,640 --> 00:10:16,880 huge, well, I'll talk about two large categories of disease. 1 165 00:10:16,880 --> 00:10:20,440 is called dysautonomia. And that is when your nervous 166 00:10:20,440 --> 00:10:25,640 system is just kind of off the, the, the, you know, off the 167 00:10:25,640 --> 00:10:28,680 walls and firing in ways that it shouldn't be. 168 00:10:29,040 --> 00:10:32,360 And then a connective tissue disorder called Ehlers Danlos 169 00:10:32,360 --> 00:10:37,760 syndrome, which I find more and more women are being diagnosed 170 00:10:37,800 --> 00:10:41,480 or trying to be diagnosed. And that is that is the root 171 00:10:41,480 --> 00:10:44,000 cause, right? That is your connective tissue, 172 00:10:44,160 --> 00:10:47,360 which is your skin. Everything that holds your 173 00:10:47,360 --> 00:10:50,240 organs together in place, everything that's deep inside of 174 00:10:50,240 --> 00:10:54,440 you, it's not at the right can. Think of it like tension. 175 00:10:54,520 --> 00:10:57,840 Is that tied to lupus? No, Lupus is an autoimmune 176 00:10:57,840 --> 00:11:00,600 disorder that is your body kind of attacking itself. 177 00:11:01,760 --> 00:11:05,920 Eller's download is a. There can be associations. 178 00:11:06,000 --> 00:11:09,000 And comorbidities, because I've heard of associations between 179 00:11:09,000 --> 00:11:11,160 those, right? So people who have Ellers 180 00:11:11,160 --> 00:11:15,040 Danlos, it's actually called the unholy Trinity, they are often 181 00:11:15,040 --> 00:11:19,360 diagnosed with POTS, which is a form of dysautonomia, Ellers 182 00:11:19,360 --> 00:11:24,240 Danlos and MCAS or mast cell activation syndrome. 183 00:11:24,760 --> 00:11:31,080 And they probably what's going on is there is one overarching 184 00:11:31,080 --> 00:11:34,160 problem and it's displaying in these different ways. 185 00:11:34,280 --> 00:11:40,280 So people with MCAS get hives, get food allergies, get allergic 186 00:11:40,280 --> 00:11:43,080 reactions out of the blue. You've been eating strawberries 187 00:11:43,080 --> 00:11:45,520 your whole life and then one day you eat a strawberry and now you 188 00:11:45,520 --> 00:11:46,960 can't breathe. OK. 189 00:11:47,800 --> 00:11:51,120 You have hives and rashes all over your body. 190 00:11:51,440 --> 00:11:53,880 It's not I didn't try a new body wash. 191 00:11:53,880 --> 00:11:56,440 I didn't do any new, you know, detergent. 192 00:11:57,000 --> 00:12:00,000 And all of a sudden you're having these hypersensitive kind 193 00:12:00,000 --> 00:12:04,120 of histamine reaction. And then POTS is a case where 194 00:12:04,120 --> 00:12:08,240 your blood pressure, when you go from sitting to standing, drops 195 00:12:08,400 --> 00:12:09,920 like that. And you, you faint. 196 00:12:11,000 --> 00:12:15,360 And this is now being connected to post viral syndromes. 197 00:12:15,760 --> 00:12:19,960 So when this exploded was post COVID because people had COVID. 198 00:12:20,200 --> 00:12:24,200 And then later on, basically the virus caused this 199 00:12:24,200 --> 00:12:28,480 disorganization of your, your, you know, autonomic system, 200 00:12:28,840 --> 00:12:33,640 which manifested itself as POTS. But post virus syndrome has been 201 00:12:33,640 --> 00:12:36,640 going on for as long as viruses have been along. 202 00:12:36,920 --> 00:12:40,680 There just has been added attention because of COVID and 203 00:12:40,680 --> 00:12:45,040 the effects. That's very interesting. 204 00:12:48,040 --> 00:12:50,520 And it's interesting too since you mentioned COVID, because so 205 00:12:50,520 --> 00:12:54,480 many different things are coming out post vaccination of all 206 00:12:54,480 --> 00:12:57,560 different problems people are having. 207 00:12:58,400 --> 00:13:00,840 Correct. And I think one thing that, you 208 00:13:00,840 --> 00:13:04,000 know, as part of the medical community and one of the, you 209 00:13:04,720 --> 00:13:07,560 know, physicians who I was one of the first people to get the 210 00:13:07,560 --> 00:13:10,680 COVID vaccine. I got the COVID vaccine in 211 00:13:10,680 --> 00:13:14,360 December 2020, you know, had all the boosters. 212 00:13:14,640 --> 00:13:19,320 And I myself had a reaction where I developed very heavy 213 00:13:19,600 --> 00:13:24,160 bleeding during my periods. And I, I have a large social 214 00:13:24,160 --> 00:13:31,080 media page and I told my story and the beginning I said, I am 215 00:13:31,080 --> 00:13:33,480 one of the first people to get the vaccine. 216 00:13:33,520 --> 00:13:37,560 I have had all the boosters. This is not some type of anti 217 00:13:37,560 --> 00:13:42,720 vaccine post or commentary but I want to share my story about a 218 00:13:42,720 --> 00:13:48,120 side effect that I had and that post was taken down for 219 00:13:48,240 --> 00:13:50,800 community guidelines violation. I believe it all right. 220 00:13:51,240 --> 00:13:56,760 So here I am a, you know, credentialed, verified physician 221 00:13:57,840 --> 00:14:02,000 just talking about, again, the effects of a vaccine that I had. 222 00:14:02,640 --> 00:14:05,080 This is not a post about passing judgment up. 223 00:14:05,080 --> 00:14:07,840 People got vaccines or didn't get vaccines. 224 00:14:08,120 --> 00:14:12,800 But I think if we withhold the information, that's what breeds 225 00:14:12,800 --> 00:14:15,800 the mistrust. Well, I'm a I'm a big believer. 226 00:14:16,080 --> 00:14:20,960 Popular or not, I really don't care that science went out the 227 00:14:20,960 --> 00:14:23,240 freaking window for the past five years. 228 00:14:23,240 --> 00:14:25,920 I mean, as I said to you right before we started, I worked with 229 00:14:25,920 --> 00:14:30,160 biotechnology, medical device, pharmaceutical companies for 29, 230 00:14:30,280 --> 00:14:35,160 well, since 1996. So that's a long time. 231 00:14:35,400 --> 00:14:38,320 You know, you know, that's a solid 30 years. 232 00:14:38,840 --> 00:14:42,800 And so much of what I saw and the lack of debate, I mean, if 233 00:14:42,800 --> 00:14:46,480 that, if I had ever propagated that and pushed that out, I'd 234 00:14:46,480 --> 00:14:50,240 have been in jail any number of times or censored or barred from 235 00:14:50,240 --> 00:14:53,520 the industry. And the fact that the discussion 236 00:14:53,520 --> 00:14:57,960 got removed, I mean, I don't care what anybody thinks about 237 00:14:57,960 --> 00:15:00,240 this either. I'm a big fan of X now because 238 00:15:00,240 --> 00:15:03,080 you can actually post things and it can get debated. 239 00:15:03,360 --> 00:15:05,880 I mean, you don't have to like it, but at least it can get 240 00:15:05,880 --> 00:15:08,360 debated. And that's to me what science 241 00:15:08,360 --> 00:15:10,600 always was. And it took a nasty, a really 242 00:15:10,600 --> 00:15:12,160 nasty turn. And I think it's going to take a 243 00:15:12,160 --> 00:15:14,560 long time for that trust to come back. 244 00:15:14,560 --> 00:15:18,880 And maybe it maybe an evaluation is important because there's, 245 00:15:19,400 --> 00:15:22,160 there's a lot of people that are expressing what you're, you're 246 00:15:22,160 --> 00:15:27,080 saying right now. And I think that again, as 247 00:15:27,080 --> 00:15:31,000 scientists, we do the best with the information that we have at 248 00:15:31,000 --> 00:15:33,720 the time. And I, I say this all the time 249 00:15:33,720 --> 00:15:36,000 in my podcast where we go through people stories of 250 00:15:36,000 --> 00:15:39,600 misdiagnosis that it is very easy to to Monday morning 251 00:15:39,600 --> 00:15:43,080 quarterback the situation. Now we have, you know, more 252 00:15:43,080 --> 00:15:48,080 information and data. And what I do hope is that what 253 00:15:48,080 --> 00:15:54,880 is preserved is the discourse, is the transparency, because as 254 00:15:54,880 --> 00:15:58,240 an institution, right, as I'm part of the healthcare 255 00:15:58,240 --> 00:16:02,920 institution, I think what we've learned is that trust is no 256 00:16:02,920 --> 00:16:07,400 longer blindly given, right? It has to be earned. 257 00:16:07,800 --> 00:16:11,440 And I see this with the younger generation of. 258 00:16:11,800 --> 00:16:15,360 Google doctors. People using Google, but what I 259 00:16:15,360 --> 00:16:20,400 will say is that, you know, to to the physicians who get, I 260 00:16:20,400 --> 00:16:24,000 would say miffed or kind of upset when people are bringing 261 00:16:24,000 --> 00:16:27,600 to them things that they read on Google or something they saw on 262 00:16:27,600 --> 00:16:31,600 TikTok or whatnot, they're going to those sources because they're 263 00:16:31,600 --> 00:16:36,160 not getting the answers that they need from the traditional 264 00:16:36,160 --> 00:16:39,440 pathways. And I think it was a real eye 265 00:16:39,440 --> 00:16:44,560 opener to physicians to understand that, you know, if 266 00:16:44,560 --> 00:16:48,320 you ask someone how, if I said I'm going to give you a referral 267 00:16:48,320 --> 00:16:52,560 to a neurologist, how long do you think it would take them to 268 00:16:52,560 --> 00:16:56,200 get that appointment? Well, I can tell you first hand 269 00:16:57,920 --> 00:17:02,520 because I woke up with no hearing two years ago with 270 00:17:02,520 --> 00:17:04,839 sudden sensorial neural hearing loss. 271 00:17:05,240 --> 00:17:09,240 And I will say my probably my biggest shock is when I actually 272 00:17:09,240 --> 00:17:11,920 went to a doctor and told him I had had three confirmed 273 00:17:11,920 --> 00:17:15,119 concussions within the pet prior three months. 274 00:17:15,119 --> 00:17:19,240 He told me it was unrelated. And I remember thinking I'm 275 00:17:19,240 --> 00:17:23,440 where this is what hospital? I mean, I might as well be in La 276 00:17:23,440 --> 00:17:26,079 La land that somebody actually just said that to me. 277 00:17:26,480 --> 00:17:30,160 Not that I thought it was going to resolve the issue, but I was 278 00:17:30,160 --> 00:17:31,760 pretty sure they were concussion. 279 00:17:31,960 --> 00:17:37,040 It was concussion related. So for some people, they're 280 00:17:37,040 --> 00:17:40,320 waiting upwards of six months to see a specialist, right? 281 00:17:40,320 --> 00:17:43,640 And then you may see a specialist and just not be 282 00:17:43,640 --> 00:17:45,680 aligned with what they're saying. 283 00:17:45,880 --> 00:17:50,360 And we have to remember when you go to see a physician, you are 284 00:17:50,360 --> 00:17:54,440 asking for their opinion. And I say this all the time. 285 00:17:54,560 --> 00:17:58,520 I'm a hand surgeon, right? And a patient may see me in my 286 00:17:58,520 --> 00:18:00,280 office. They may see my colleague down 287 00:18:00,280 --> 00:18:02,680 the street, they may see another colleague, you know, in New 288 00:18:02,680 --> 00:18:06,080 Jersey, and we may diagnose them with the same problem, which is 289 00:18:06,080 --> 00:18:09,360 carpal tunnel syndrome. And I may recommend you do a 290 00:18:09,360 --> 00:18:11,680 cortisone shot. Someone may recommend wear a 291 00:18:11,680 --> 00:18:14,040 night brace at night. And the other surgeon may 292 00:18:14,040 --> 00:18:17,600 recommend surgery tomorrow. And it's not necessarily that 293 00:18:17,720 --> 00:18:19,440 any of. Us are wrong, right? 294 00:18:19,440 --> 00:18:20,360 Correct. I agree. 295 00:18:20,360 --> 00:18:22,640 That they are different opinions. 296 00:18:23,600 --> 00:18:28,000 And you know, I tell people if you are in the position to get a 297 00:18:28,000 --> 00:18:31,280 second opinion or multiple opinions, please do. 298 00:18:31,560 --> 00:18:35,600 And no surgeon should ever feel threatened if someone says I'm 299 00:18:35,680 --> 00:18:38,640 seeking another opinion. Because in the end it is. 300 00:18:38,640 --> 00:18:43,320 It's an opinion based off of our experience, off of what we see 301 00:18:43,320 --> 00:18:46,480 our own patients go through. And I may have a very different 302 00:18:46,480 --> 00:18:50,080 reason for recommending A cortisone injection to you as 303 00:18:50,080 --> 00:18:52,440 opposed to the surgeon who's recommending surgery. 304 00:18:52,880 --> 00:18:57,000 You know, that, that perspective alone, I bet the more that 305 00:18:57,000 --> 00:19:00,040 people become aware of your, you having that perspective, I bet 306 00:19:00,040 --> 00:19:02,600 it could have people lined up outside their, your door if 307 00:19:02,600 --> 00:19:06,760 they're not already, because, because it's, it's, it's great 308 00:19:06,760 --> 00:19:09,840 to hear. And you know, one of the, I'm 309 00:19:09,840 --> 00:19:13,000 sure I drive my, our children crazy because I'll, I'll say, 310 00:19:13,200 --> 00:19:14,680 well, let's go get a second opinion. 311 00:19:14,800 --> 00:19:17,800 You know, I, I think that's, I love and oh, you don't trust 312 00:19:17,800 --> 00:19:19,400 that doctor. I said I didn't trust him. 313 00:19:19,760 --> 00:19:23,520 I said, this is the practice of medicine and you know your body 314 00:19:23,600 --> 00:19:27,680 better than anyone else does. And you're not 100% in 315 00:19:27,680 --> 00:19:29,520 agreement. You know, there's a doubt you 316 00:19:29,520 --> 00:19:31,920 have in your head. I'm not the one who's facing 317 00:19:31,920 --> 00:19:33,240 surgery. You are. 318 00:19:33,440 --> 00:19:37,880 So why not look at another and see as you said, it might be a 319 00:19:37,880 --> 00:19:41,040 cortisone shot that helps and alleviates that inflammation 320 00:19:41,040 --> 00:19:44,440 before you need that scraping of your ankle or whatever it is. 321 00:19:44,680 --> 00:19:46,920 Correct. And you know, I use this line 322 00:19:46,920 --> 00:19:50,600 all the time, which is a line from one of my mentors at at 323 00:19:50,600 --> 00:19:52,400 Lenox Hill. Actually the father was named 324 00:19:52,400 --> 00:19:56,200 Chit Roundelwatt, but he always said the eyes only see what the 325 00:19:56,200 --> 00:19:58,880 mind knows. That's such a good line if. 326 00:19:58,880 --> 00:20:04,400 You see a doctor and you just don't think that they have come 327 00:20:04,400 --> 00:20:07,560 to the right conclusion or you're uneasy with the treatment 328 00:20:07,560 --> 00:20:12,640 protocol that they're suggesting see someone else because you 329 00:20:12,640 --> 00:20:14,960 don't know what they don't know. Yeah. 330 00:20:15,440 --> 00:20:18,040 And sometimes they don't even know what they don't know. 331 00:20:19,440 --> 00:20:22,920 Now, that is to say, we are in a Really. 332 00:20:23,280 --> 00:20:26,440 Privileged position where we are in New York City where there is 333 00:20:26,480 --> 00:20:30,040 an abundance of physicians to go to and there are probably some 334 00:20:30,040 --> 00:20:31,600 people listening to this podcast. 335 00:20:31,600 --> 00:20:35,240 So they're like, there's only one rheumatologist in town, 336 00:20:35,600 --> 00:20:39,360 right? And that's that's who I got and 337 00:20:39,360 --> 00:20:43,120 that's when I also feel like listening to other people's 338 00:20:43,120 --> 00:20:48,280 stories online, researching for yourself, using pub Med as a 339 00:20:48,280 --> 00:20:52,440 great if nobody here knows what pub Med is, it is, you know, for 340 00:20:52,560 --> 00:20:55,320 physicians, it is our gold standard. 341 00:20:55,320 --> 00:20:59,680 What is the actual peer reviewed literature being published? 342 00:21:00,680 --> 00:21:04,440 And I often tell people, because I get thousands of messages a 343 00:21:04,440 --> 00:21:06,360 week, people asking me, could you help me? 344 00:21:06,360 --> 00:21:08,560 Could you? And I tell them the same thing I 345 00:21:08,560 --> 00:21:13,400 say #1 put your symptoms into ChatGPT and ask for the top five 346 00:21:13,400 --> 00:21:17,240 differential diagnosis so that you just have an idea of what it 347 00:21:17,240 --> 00:21:20,520 could be. Then go into pub Med and look 348 00:21:20,520 --> 00:21:25,000 who are the people actively researching this topic. 349 00:21:25,000 --> 00:21:30,400 What great advice. Well, you know, pub Med is it's, 350 00:21:30,680 --> 00:21:33,960 it's behind a firewall for most articles, but for most people 351 00:21:33,960 --> 00:21:36,040 you can get the gist from the abstracts. 352 00:21:36,080 --> 00:21:40,000 And again, it's not your job to have a PhD in these subjects. 353 00:21:40,880 --> 00:21:44,680 But I do think being able to connect with someone who is up 354 00:21:44,680 --> 00:21:48,240 to date in the area that you are looking for help. 355 00:21:48,560 --> 00:21:52,120 If anything, they may tell you you don't have this. 356 00:21:52,760 --> 00:21:55,360 And that is also valuable. Getting back to the, your labs 357 00:21:55,360 --> 00:21:59,680 look normal and everything that's also valuable pieces of 358 00:21:59,760 --> 00:22:03,520 of data, right? And sometimes it's collecting 359 00:22:03,560 --> 00:22:05,080 all of the different pieces of data. 360 00:22:05,080 --> 00:22:09,120 But the real question is who is going to piece that together. 361 00:22:09,800 --> 00:22:14,160 And that I find is what is really lacking in our 362 00:22:14,160 --> 00:22:17,800 interactions with doctors is that we no longer have that 363 00:22:18,280 --> 00:22:24,080 quarterback for our care. And that used to be your primary 364 00:22:24,080 --> 00:22:27,000 care doctor, but nowadays you ask someone who's your primary 365 00:22:27,000 --> 00:22:29,640 care doctor. It's whoever I saw at City, MD. 366 00:22:29,960 --> 00:22:35,880 You know, they're they're such truth in that medicine has 367 00:22:35,880 --> 00:22:38,080 changed so, so much. I wish we could go back to the 368 00:22:38,080 --> 00:22:41,200 days of this really dating me, but there was Blue Cross and 369 00:22:41,200 --> 00:22:43,640 Blue Shield. You know, you knew you had your 370 00:22:43,640 --> 00:22:47,560 primary care doctor and they would help you find, you know, 371 00:22:47,560 --> 00:22:50,440 other people if you needed it. And now things have become so 372 00:22:50,440 --> 00:22:59,720 specialized and so diffractioned and divided in ways that and, 373 00:22:59,720 --> 00:23:02,600 and I really see it when I talk with older people. 374 00:23:02,600 --> 00:23:06,120 And I say, does your cardiologist know what the 375 00:23:06,120 --> 00:23:10,640 rheumatologist or the whoever has prescribed you? 376 00:23:10,640 --> 00:23:14,120 Because like I said, I work with clinical trials for over 30 377 00:23:14,120 --> 00:23:16,480 years. I can count on one hand the ones 378 00:23:16,480 --> 00:23:20,840 that would do cocktails. Usually it was only with cancer 379 00:23:20,840 --> 00:23:24,200 drugs where you had somebody test this drug and this drug at 380 00:23:24,200 --> 00:23:27,080 the same trial to find out what were the interactions that might 381 00:23:27,080 --> 00:23:29,880 be causing. And I bet you could even narrow 382 00:23:29,880 --> 00:23:32,840 down a lot of that when you're talking with people with 383 00:23:32,840 --> 00:23:36,320 misdiagnosis, that sometimes you may have two medicines just 384 00:23:36,320 --> 00:23:41,640 plain interacting poorly and causing that fainting or those 385 00:23:42,080 --> 00:23:45,320 drops or spikes in blood pressure or any other things. 386 00:23:45,520 --> 00:23:48,720 Absolutely. I just I have a podcast called 387 00:23:48,720 --> 00:23:51,640 the Medical Detectives and we interviewed. 388 00:23:51,880 --> 00:23:55,960 That's a good one, the medical. Detectives, detectives and we 389 00:23:55,960 --> 00:23:57,600 interviewed. Actually, it was the patient's 390 00:23:58,200 --> 00:24:03,000 wife, but it was a fascinating story because he had a history 391 00:24:03,000 --> 00:24:07,560 of substance abuse and he started having the symptoms that 392 00:24:08,040 --> 00:24:11,840 mimicked and looked very similar to alcohol withdrawal. 393 00:24:11,840 --> 00:24:15,280 But he had been sober, had been passing every drug test, but 394 00:24:15,560 --> 00:24:18,200 people just categorized him. You know, this is who you are, 395 00:24:18,200 --> 00:24:22,160 this is what your problem is. And all along for two years, it 396 00:24:22,160 --> 00:24:25,680 was a side effect from a medication that was prescribed 397 00:24:25,680 --> 00:24:32,120 from his primary care doctor. And again, this is where I feel 398 00:24:32,120 --> 00:24:38,400 like the integration of AI into our, you know, think of yourself 399 00:24:38,400 --> 00:24:40,440 as the CEO of your own healthcare. 400 00:24:40,960 --> 00:24:45,840 You can use AI as a tool, all right, to help you really 401 00:24:45,840 --> 00:24:48,680 proactively take care of your health. 402 00:24:48,680 --> 00:24:51,840 Because to be honest, I don't think the physicians are taking 403 00:24:51,840 --> 00:24:53,960 the time to really go through all. 404 00:24:53,960 --> 00:24:56,200 Of that, and I'm not even sure they have the time anymore. 405 00:24:56,200 --> 00:24:58,240 No, they don't. With the, with the, you know, 406 00:24:58,240 --> 00:25:02,080 the, all the things that have happened in medicine where 407 00:25:02,200 --> 00:25:06,080 you've got my mind's blinking on the word, but you know, 408 00:25:06,120 --> 00:25:10,080 everybody's in the silos and you've got the insurance 409 00:25:10,080 --> 00:25:11,520 companies. And we're not going to go into 410 00:25:11,520 --> 00:25:13,360 the whole insurance company issue, but we've got the 411 00:25:13,360 --> 00:25:16,280 insurance companies And then the doctors have to see X number of 412 00:25:16,280 --> 00:25:18,960 patients a day. And if you have to get, you 413 00:25:18,960 --> 00:25:21,840 know, you've been assigned that many patients within your 414 00:25:21,840 --> 00:25:23,920 insurance company or your responsibilities. 415 00:25:24,320 --> 00:25:26,200 I mean, how can you talk to someone? 416 00:25:26,880 --> 00:25:29,960 So I feel for the doctors, too. It's like things have really 417 00:25:29,960 --> 00:25:31,560 gone awry there. Yes. 418 00:25:31,600 --> 00:25:34,800 And I feel that the vast majority of patients have that 419 00:25:34,800 --> 00:25:39,160 perspective that a doctor is not intentionally trying to blow you 420 00:25:39,160 --> 00:25:41,040 off. They're not intentionally only 421 00:25:41,040 --> 00:25:43,040 wanted to see you for for 5 minutes. 422 00:25:43,600 --> 00:25:47,880 They are put in a system where there are time constraints and 423 00:25:47,880 --> 00:25:50,960 resource constraints, right? Not everyone can just get an MRI 424 00:25:50,960 --> 00:25:53,640 for every headache every, every time you have 1. 425 00:25:54,520 --> 00:25:57,600 So they are, you know, balancing that as well. 426 00:25:57,840 --> 00:26:02,000 But for a patient, you're like, well, I think I need the MRI for 427 00:26:02,000 --> 00:26:06,040 my headache, right? And that's when, if you have, I 428 00:26:06,040 --> 00:26:08,920 would say either a longer standing relationship with 429 00:26:09,120 --> 00:26:12,560 someone like a primary care doctor, they're able to see 430 00:26:12,600 --> 00:26:14,760 like, you know what, you are really off. 431 00:26:15,240 --> 00:26:18,760 And I, I think we need to, you know, do something about it. 432 00:26:18,960 --> 00:26:21,560 Whereas if you're just unfortunately showing up to the 433 00:26:21,560 --> 00:26:26,040 ER because probably you weren't even able to get to see someone, 434 00:26:27,400 --> 00:26:29,800 they don't know your background, they don't know what your normal 435 00:26:29,800 --> 00:26:31,400 is. But the irony is you're more 436 00:26:31,400 --> 00:26:34,040 likely to get that MRI right then and there or. 437 00:26:34,560 --> 00:26:38,240 Not not in the ERMRIS are actually very, very difficult to 438 00:26:38,240 --> 00:26:41,600 get to the ER again, depends on what it's for. 439 00:26:41,920 --> 00:26:48,720 So for example, if you hit your head and you could possibly have 440 00:26:48,720 --> 00:26:51,560 a brain bleed, right, that could kill you. 441 00:26:51,800 --> 00:26:54,080 I mean, eminently and so, so you're going to have either CT 442 00:26:54,080 --> 00:26:55,240 scan of your head or an MRI of your head. 443 00:26:55,600 --> 00:26:59,440 If you go skiing and you injure your knee, you're going to be 444 00:26:59,440 --> 00:27:02,440 checked out to make sure your knee is still, you know, stable, 445 00:27:02,600 --> 00:27:05,120 but you're going to get the MRI. Out weeks later. 446 00:27:05,120 --> 00:27:06,800 Correct. Because that's not an emergency. 447 00:27:06,880 --> 00:27:09,480 So that's what we're talking about, the rationing of these 448 00:27:09,480 --> 00:27:12,040 resources. It's not that you don't need it, 449 00:27:12,040 --> 00:27:15,720 probably eventually, but in this moment like what needs to that's 450 00:27:16,040 --> 00:27:18,080 in the ER setting, it really is about triage. 451 00:27:20,480 --> 00:27:24,920 You've got a book coming out. What's your book about? 452 00:27:25,800 --> 00:27:30,360 South my book is called Little Misdiagnosed, which is the same 453 00:27:30,360 --> 00:27:35,760 name as my TikTok channel and I actually started that Channel 454 00:27:36,080 --> 00:27:40,680 when I diagnosed a woman's 10 year medical mystery in three 455 00:27:40,680 --> 00:27:43,400 seconds. Not in my office but over TikTok 456 00:27:44,200 --> 00:27:50,040 and I thought why should it take this woman 10 years to get 457 00:27:50,040 --> 00:27:52,800 diagnosed with something that I knew immediately? 458 00:27:53,320 --> 00:27:55,920 And so I started to tell. Can I ask what that was? 459 00:27:56,120 --> 00:28:00,480 It was a glomus tumor, so probably very few people 460 00:28:00,480 --> 00:28:03,880 listening may know what that is, but this woman sent me a direct 461 00:28:03,880 --> 00:28:06,120 message, she said. I don't normally talk to 462 00:28:06,120 --> 00:28:08,960 strangers on the Internet, but I'm desperate. 463 00:28:09,360 --> 00:28:14,360 I have had 10 years of severe fingernail pain, and nobody can 464 00:28:14,360 --> 00:28:16,520 tell me what's wrong. I've seen five doctors. 465 00:28:16,640 --> 00:28:18,040 They tell me nothing's wrong with me. 466 00:28:18,200 --> 00:28:19,760 They make me feel like I'm crazy. 467 00:28:19,960 --> 00:28:23,960 But I swear if I just rush my fingernail against something, 468 00:28:23,960 --> 00:28:27,400 I'll jump to the ceiling. And so I messaged her back. 469 00:28:27,400 --> 00:28:30,680 I said I also don't normally talk to strangers on the 470 00:28:30,680 --> 00:28:34,720 Internet, but out of curiosity, do you have a little blue dot 471 00:28:34,800 --> 00:28:36,400 under your fingernail? She said. 472 00:28:36,400 --> 00:28:38,320 I do have a little blue dot under my fingernail. 473 00:28:38,520 --> 00:28:41,560 So I said you're going to ask your doctor to get an MRI of 474 00:28:41,560 --> 00:28:43,080 your finger. It's going to show that you have 475 00:28:43,080 --> 00:28:46,000 a mask called a glomus tumor. Hand surgeon is going to take it 476 00:28:46,000 --> 00:28:48,200 out and you're going to be cured immediately. 477 00:28:48,800 --> 00:28:50,560 So you messaged me back six weeks later. 478 00:28:50,960 --> 00:28:53,800 Oh my God, I got the MRI. It showed I had a mask. 479 00:28:53,800 --> 00:28:55,120 They took it out. It was a glomus tumor. 480 00:28:55,120 --> 00:29:00,160 I'm I'm completely healed now. What that woman didn't know is 481 00:29:00,160 --> 00:29:05,560 that if you go on to Google and type in pub Med glomus tumor, my 482 00:29:05,560 --> 00:29:07,840 name pops up. Or my maiden name, Erin 483 00:29:07,840 --> 00:29:10,680 McDermott, because I'm one of the world's experts on glomus 484 00:29:10,680 --> 00:29:13,920 tumors. OK, but she didn't know that 485 00:29:14,040 --> 00:29:16,200 when she reached out to me, right? 486 00:29:16,560 --> 00:29:20,560 She was just looking for someone who would believe her, because 487 00:29:20,560 --> 00:29:24,520 if someone believed her, then someone could help her. 488 00:29:25,200 --> 00:29:29,880 So I then started telling stories about my time in 489 00:29:29,880 --> 00:29:33,600 residency when I had kind of these interesting cases or, you 490 00:29:33,600 --> 00:29:36,280 know, examples of what would happen when someone would come 491 00:29:36,280 --> 00:29:38,240 in and they didn't have insurance, right? 492 00:29:38,240 --> 00:29:40,440 And they had to have surgery. And what, what did that feel 493 00:29:40,440 --> 00:29:44,680 like? Or, you know, someone was 494 00:29:45,240 --> 00:29:50,440 actually here illegally, didn't have papers and they had to have 495 00:29:50,440 --> 00:29:53,160 major surgery, but they, they, they didn't want their name, you 496 00:29:53,160 --> 00:29:55,080 know, published anywhere else. They thought they could be 497 00:29:55,080 --> 00:29:58,560 picked up. So it was really about stories 498 00:29:58,560 --> 00:30:02,760 of what it was like, you know, as a as a female orthopedic 499 00:30:02,760 --> 00:30:07,480 surgeon also. And those stories went viral on 500 00:30:07,480 --> 00:30:10,400 TikTok. And yeah, so that's the this 501 00:30:10,400 --> 00:30:13,840 book is about those. It's a memoir from my time in 502 00:30:13,840 --> 00:30:18,200 residency talking about these cases and how they those cases, 503 00:30:18,200 --> 00:30:20,880 how they impacted me and how I practice medicine today. 504 00:30:21,920 --> 00:30:25,480 Oh, that's very interesting. So if you've watched The Pit, I 505 00:30:25,480 --> 00:30:29,360 would say it's very similar to The Pit or like a Grey's Anatomy 506 00:30:29,360 --> 00:30:32,800 behind the curtain scene. What? 507 00:30:33,080 --> 00:30:35,840 What are what are some standout stories somebody might find? 508 00:30:36,400 --> 00:30:40,120 What's another one? Well, I think the story that 509 00:30:40,360 --> 00:30:44,480 kind of jump started it all was actually a story that I had to 510 00:30:44,480 --> 00:30:48,360 ask my brother permission to tell because it involves him as 511 00:30:48,360 --> 00:30:51,440 well. But it was my first day at work 512 00:30:51,600 --> 00:30:55,560 as an orthopedic surgeon, as the general surgery intern, right? 513 00:30:55,560 --> 00:30:58,600 It's July 4th weekend. Everything is crazy. 514 00:30:58,600 --> 00:31:00,920 People are, you know, running with, they're like, you know, 515 00:31:01,120 --> 00:31:03,840 all over the place. And I had started on night 516 00:31:03,840 --> 00:31:06,840 float. So I came in at 7:00 ready to, 517 00:31:06,840 --> 00:31:09,400 you know, take care of all the patients at night. 518 00:31:09,400 --> 00:31:11,560 It's kind of scary because there's no attendings with you. 519 00:31:11,560 --> 00:31:16,200 You're doing it on your own. And I was about to admit my 520 00:31:16,200 --> 00:31:19,720 first patient and work them up for a pre op and I kept getting 521 00:31:19,720 --> 00:31:23,800 calls from my mom. I was like why is my mom calling 522 00:31:23,800 --> 00:31:25,840 me? You know I told everyone I'm at 523 00:31:25,840 --> 00:31:29,360 work please don't call me. You know I need to focus. 524 00:31:29,720 --> 00:31:31,000 But she wouldn't stop calling me. 525 00:31:31,400 --> 00:31:33,800 And I finally answered. I said mom. 526 00:31:33,800 --> 00:31:35,520 I said what what's going on? I'm at work. 527 00:31:36,160 --> 00:31:38,160 And she said it's your it's your brother. 528 00:31:38,160 --> 00:31:42,320 He, he was in an accident. And So what kind of accident? 529 00:31:42,360 --> 00:31:47,840 He said, well, he was in the Hamptons and he dove into a pool 530 00:31:47,840 --> 00:31:51,920 and his friends, they, they had to bring him out of the pool 531 00:31:51,920 --> 00:31:54,240 and, and the reception was really bad. 532 00:31:54,240 --> 00:31:56,560 So I couldn't, I couldn't hear them Well, but they're taking 533 00:31:56,560 --> 00:32:00,000 him to the hospital and I said, OK, well, you know, it's, it's 534 00:32:00,000 --> 00:32:01,560 the first weekend of July, right? 535 00:32:01,560 --> 00:32:04,680 Make sure in attending, make sure he looks over his scans and 536 00:32:04,680 --> 00:32:06,560 make sure he's, he's going to be OK. 537 00:32:06,560 --> 00:32:10,520 And then I went back to the pre op and then I got a call from my 538 00:32:10,520 --> 00:32:13,760 younger brother a couple minutes later and I said I know, I know. 539 00:32:13,760 --> 00:32:16,120 Kev hit his head and he said no, I don't. 540 00:32:16,120 --> 00:32:19,200 I don't think you understand. He he can't walk. 541 00:32:19,880 --> 00:32:21,480 Oh my gosh. He can't move. 542 00:32:21,680 --> 00:32:24,280 He's being airlifted to Stony Brook. 543 00:32:26,040 --> 00:32:32,440 And so at that moment I realized he's a quadriplegic, all right. 544 00:32:33,440 --> 00:32:38,400 And I kind of walked back in shock to the, the surgery room 545 00:32:38,400 --> 00:32:40,000 or all the residents were getting ready to go home. 546 00:32:40,000 --> 00:32:43,360 And I just, I said, I can't, I can't do this pre op. 547 00:32:43,560 --> 00:32:45,160 Like, what's, what's the matter? What's going on? 548 00:32:45,560 --> 00:32:50,920 I said, I think my brother's paralyzed and I just dropped to 549 00:32:50,920 --> 00:32:56,080 the ground and went into shock. And so that was kind of the 550 00:32:56,080 --> 00:32:59,240 first, you know, that's I always wanted to tell that first day of 551 00:32:59,240 --> 00:33:02,000 work story from my perspective back. 552 00:33:02,040 --> 00:33:06,120 Of a first day, Oh my. As an orthopedic surgeon, but 553 00:33:06,920 --> 00:33:11,560 being on the other side right as the family member and watching 554 00:33:11,560 --> 00:33:15,200 him go through waiting, waiting for his name to be called for 555 00:33:15,200 --> 00:33:18,080 the add on surgery. Going through, you know, being 556 00:33:18,080 --> 00:33:22,640 in the ICU, not being able to move a muscle, going to rehab 557 00:33:22,640 --> 00:33:28,000 when you're 21 year old NCAA, Team USA All American with 80 558 00:33:28,000 --> 00:33:30,280 year old people who've got in their hips and knees replaced, 559 00:33:31,520 --> 00:33:34,320 you know, and then just the resilience of what it's like to 560 00:33:34,320 --> 00:33:36,480 recover from a spinal cord injury. 561 00:33:37,040 --> 00:33:42,080 And that really set the stage for how I approach the next five 562 00:33:42,080 --> 00:33:45,640 years of my training. It doesn't surprise. 563 00:33:46,360 --> 00:33:48,640 Well, the story certainly surprises me. 564 00:33:48,640 --> 00:33:52,720 I didn't expect you to tell me that story, and I feel like I 565 00:33:52,720 --> 00:33:54,440 still need to catch my breath from it. 566 00:33:55,640 --> 00:34:02,920 But having listened to you for the first bit of this podcast, 567 00:34:03,880 --> 00:34:07,360 there was something in my gut saying something happened that 568 00:34:09,040 --> 00:34:14,880 impacted you in an interesting way because you're, you've got a 569 00:34:14,880 --> 00:34:19,880 high level of compassion in how you speak. 570 00:34:20,080 --> 00:34:22,840 And, and we never met before this podcast. 571 00:34:23,199 --> 00:34:25,800 And I didn't know you till I read a little bit about you and 572 00:34:25,800 --> 00:34:27,880 thought, wow, this is going to be a really interesting 573 00:34:27,920 --> 00:34:33,040 interview. But you, your compassion is 574 00:34:33,040 --> 00:34:38,760 extremely high, which makes you exceptional in a medical in the 575 00:34:38,760 --> 00:34:42,320 medical world, well. I really appreciate you saying 576 00:34:42,320 --> 00:34:46,239 that it is always the the highest compliment when someone 577 00:34:46,719 --> 00:34:50,719 compliments me for my empathy or my, you know, compassion towards 578 00:34:50,719 --> 00:34:53,560 others. And I find that there are other 579 00:34:53,560 --> 00:34:56,679 physicians who are quite popular on social media. 580 00:34:56,679 --> 00:34:59,720 And what I have realized the common denominator is that we 581 00:34:59,720 --> 00:35:04,560 have all had some personal, you know, family event that has 582 00:35:04,640 --> 00:35:07,720 affected how we, you know, our doctors ourselves. 583 00:35:08,520 --> 00:35:11,840 You know, one of my close friends, her name is lady spine 584 00:35:11,840 --> 00:35:15,120 doc Doctor Betsy Grunch. Her mother was an officer who in 585 00:35:15,120 --> 00:35:18,280 the line of duty was in a car accident and became paralyzed, 586 00:35:18,960 --> 00:35:24,800 another neurosurgeon whose son was killed in a drunk driving 587 00:35:24,800 --> 00:35:28,320 accident. And so, you know, we carry these 588 00:35:28,320 --> 00:35:32,400 stories that then, you know, come out in our interactions 589 00:35:32,400 --> 00:35:36,680 with our patients. And I, I know that I am a better 590 00:35:36,680 --> 00:35:41,600 physician because of Kevin's accident and what happened to 591 00:35:41,600 --> 00:35:45,640 our family. And I feel that now what I do on 592 00:35:45,640 --> 00:35:49,760 social media is really, I'm spreading that compassion at 593 00:35:49,760 --> 00:35:54,200 scale because it seems that there is a large, I would guess 594 00:35:55,040 --> 00:35:59,400 or call it a compassion gap between doctors and their 595 00:35:59,400 --> 00:36:02,760 patients now. I think it's, it's very 596 00:36:02,760 --> 00:36:06,960 interesting because that you say the community that is drawn to 597 00:36:06,960 --> 00:36:12,480 you by the Internet because in some places people describe the 598 00:36:12,480 --> 00:36:18,320 Internet as super cold, because people flip off comments and 599 00:36:18,320 --> 00:36:21,280 physical comments and everything else that they would never do 600 00:36:21,280 --> 00:36:24,000 anywhere else. You know, they just say things 601 00:36:24,000 --> 00:36:25,880 and do things that they would never do. 602 00:36:26,280 --> 00:36:29,280 And so I think there's then there's that side of finding 603 00:36:29,280 --> 00:36:33,440 compassion and finding someone that someone, I think people 604 00:36:33,440 --> 00:36:36,720 just want to be heard. And it sounds to me like you're 605 00:36:36,720 --> 00:36:41,760 an excellent listener and that you're sometimes I think the 606 00:36:41,760 --> 00:36:43,760 biggest part of healing starts with you, when you feel 607 00:36:43,760 --> 00:36:46,120 someone's hearing you. Absolutely. 608 00:36:46,240 --> 00:36:49,480 I you know, we were talking earlier that I had given this 609 00:36:49,720 --> 00:36:52,480 Ted talk about the stages of misdiagnosis and. 610 00:36:52,480 --> 00:36:56,200 Oh yes, let's get into that. Well, I'll, I'll, I'll start at 611 00:36:56,200 --> 00:37:02,080 the end, but to, to get to your point, but really, I find one of 612 00:37:02,120 --> 00:37:06,160 the most important pieces to someone who's going through a 613 00:37:06,160 --> 00:37:10,440 misdiagnosis is having a North Star believer, right? 614 00:37:10,440 --> 00:37:16,600 Whether that is a family member or a friend or a doctor or 615 00:37:16,600 --> 00:37:19,960 someone online who you've never actually met in person. 616 00:37:20,440 --> 00:37:24,760 But these are people who make you feel seen, who make you feel 617 00:37:24,760 --> 00:37:30,120 heard, who make you feel like your story matters, right? 618 00:37:30,120 --> 00:37:34,640 And that you are worth fighting for getting that diagnosis. 619 00:37:35,600 --> 00:37:38,760 So I hear it all the time on my podcast. 620 00:37:38,760 --> 00:37:41,640 Everyone that I have interviewed, they all have a 621 00:37:41,640 --> 00:37:45,080 North Star believer. And going back to the original 622 00:37:45,080 --> 00:37:48,720 conversation we had about saying it's all in your head or making 623 00:37:48,720 --> 00:37:52,560 you feel like you're crazy. If you hear that enough, you 624 00:37:52,560 --> 00:37:55,720 start to internalize that and you believe it. 625 00:37:56,040 --> 00:37:59,720 And it's those North Star believer people who say, no, 626 00:38:00,880 --> 00:38:04,000 that's not right, you know, trust yourself. 627 00:38:04,360 --> 00:38:08,800 I believe you and they they give you the courage to re enter this 628 00:38:08,800 --> 00:38:12,360 cycle. One that's very heart warming, 629 00:38:12,360 --> 00:38:16,520 one of the things you mentioned was when we were talking just 630 00:38:16,520 --> 00:38:21,240 before we went on air, was your Ted talk about the stages of 631 00:38:21,240 --> 00:38:25,600 grief with misdiagnosis. Can you tell us about that? 632 00:38:25,960 --> 00:38:29,080 Of course. So, you know, this is based off 633 00:38:29,080 --> 00:38:32,000 of Doctor Kubler Ross. She had a book called On Death 634 00:38:32,000 --> 00:38:36,200 and Dying and she outlined the the five stages of grief. 635 00:38:36,960 --> 00:38:40,040 And this has been a framework in use for over 50 years. 636 00:38:40,280 --> 00:38:44,880 And it has been really helpful for people to process these 637 00:38:44,880 --> 00:38:47,560 emotions. And what I saw was that there 638 00:38:47,560 --> 00:38:52,760 was a very similar pattern of stages going on in people who 639 00:38:52,760 --> 00:38:56,680 had been misdiagnosed. And I thought it would be 640 00:38:56,680 --> 00:39:01,800 helpful to give them a framework to be able to process these 641 00:39:01,800 --> 00:39:06,840 complex emotions, to start the conversation about the the pain 642 00:39:06,840 --> 00:39:12,160 and the trauma that happened from being misdiagnosed, which a 643 00:39:12,160 --> 00:39:14,840 lot of doctors don't talk about or understand that they can be 644 00:39:14,840 --> 00:39:18,800 part of the problem. And, and then also just give 645 00:39:18,800 --> 00:39:23,560 people that ability to finally someone see them and hear them 646 00:39:23,560 --> 00:39:26,240 for, you know, this journey that they've been on. 647 00:39:26,640 --> 00:39:30,120 So as I mentioned earlier, the first stage and many of the 648 00:39:30,120 --> 00:39:32,320 stages are very similar to the stages of grief. 649 00:39:32,320 --> 00:39:35,640 And, and they can people cannot go through stages. 650 00:39:35,640 --> 00:39:38,480 They can skip stages or do stages in different orders, but 651 00:39:38,480 --> 00:39:41,960 typically they are, you know, denial, right? 652 00:39:41,960 --> 00:39:43,400 That's what we talked about earlier. 653 00:39:43,720 --> 00:39:46,200 I just slept on it Funny. It'll go away. 654 00:39:47,520 --> 00:39:49,800 But then when those symptoms, they linger, right? 655 00:39:49,800 --> 00:39:53,400 They don't go away. Then the next stage is gathering 656 00:39:53,400 --> 00:39:56,680 the research, right? Gathering the like, OK, now I'm 657 00:39:56,680 --> 00:39:59,240 going to go to Google. I'm going to, you know, see a 658 00:39:59,240 --> 00:40:02,600 bunch of doctors. I'm going to join a Facebook 659 00:40:02,600 --> 00:40:05,440 group. I'm, you know, going to look on, 660 00:40:05,440 --> 00:40:10,160 use AI. And then it turns into anxious 661 00:40:10,160 --> 00:40:14,240 optimism, right? OK, I saw a specialist and they, 662 00:40:14,360 --> 00:40:17,920 they want me to do this test and they're positive that this is 663 00:40:17,920 --> 00:40:19,720 going to give me the answer, right? 664 00:40:19,920 --> 00:40:23,600 And you put all your energy and all your hopes into getting this 665 00:40:23,600 --> 00:40:27,320 CT scan. And then the next stage is self 666 00:40:27,320 --> 00:40:31,520 doubt when that CT scan comes back as normal, didn't find 667 00:40:31,520 --> 00:40:34,280 anything. You think are they? 668 00:40:34,680 --> 00:40:35,720 How could they not find anything? 669 00:40:38,800 --> 00:40:40,960 Maybe I am wrong, maybe I am going crazy. 670 00:40:42,320 --> 00:40:45,720 And then when you realize again the symptoms are not going away, 671 00:40:46,360 --> 00:40:50,000 that fades into anger. Like no, I'm not crazy. 672 00:40:50,440 --> 00:40:54,280 I do have pain. I do have symptoms and you're 673 00:40:54,440 --> 00:40:58,240 you're mad at the system and you're mad at your doctors and 674 00:40:58,560 --> 00:41:02,320 you're mad at your family and friends who maybe don't think 675 00:41:02,320 --> 00:41:06,880 this is a serious problem or you know, you're mad at someone 676 00:41:06,880 --> 00:41:09,920 suggesting maybe you should, maybe you should talk to you 677 00:41:09,920 --> 00:41:13,200 know, someone, a psychologist or a psychiatrist. 678 00:41:14,880 --> 00:41:20,400 And then once all that angry energy fades, you are in 679 00:41:20,480 --> 00:41:23,320 depression, right? You're tired. 680 00:41:24,360 --> 00:41:26,680 You're tired of seeing all the doctors. 681 00:41:27,720 --> 00:41:32,840 You are grieving the life that you had before you got sick, 682 00:41:33,520 --> 00:41:35,760 right? And you're grieving the life you 683 00:41:35,760 --> 00:41:39,280 thought you were going to have before this happened to you. 684 00:41:39,960 --> 00:41:43,240 And it's incredibly isolating. And you're really, and you're 685 00:41:43,240 --> 00:41:47,680 really sad. And then in the end, you're just 686 00:41:48,000 --> 00:41:52,160 in the stage of apathy. You've just given up. 687 00:41:53,040 --> 00:41:56,200 There's nothing more you can do. Like I've been to all the 688 00:41:56,200 --> 00:41:58,880 doctors. I've told everyone my story. 689 00:41:59,480 --> 00:42:03,520 There's nothing left. Now that I said, I don't want 690 00:42:03,520 --> 00:42:06,840 everyone to leave this podcast being sad, you know, and 691 00:42:06,840 --> 00:42:08,840 depressed. That's I don't want to cause 692 00:42:08,840 --> 00:42:10,680 millions of people crying on the Internet today. 693 00:42:11,960 --> 00:42:16,600 But I tell these stages because I think it's helpful to 694 00:42:16,600 --> 00:42:20,640 normalize that these are the possible emotions you could be 695 00:42:20,640 --> 00:42:23,120 going through. Well, what I find fascinating 696 00:42:23,120 --> 00:42:30,560 that she said that is I've, I've always been very complementary 697 00:42:30,560 --> 00:42:37,800 medicine oriented and worked in very traditional medicine for 30 698 00:42:37,800 --> 00:42:39,440 years. So I always look at everything 699 00:42:39,440 --> 00:42:45,200 as a blend, but I believe in the whole body connection in a big 700 00:42:45,200 --> 00:42:47,400 way. And when I have people come in 701 00:42:47,400 --> 00:42:51,520 to me that are, are a lot of different doctors groups have 702 00:42:51,520 --> 00:42:55,320 always referred their patients to me to work with them with 703 00:42:55,320 --> 00:42:58,520 hypnosis. So I have a very and I always 704 00:42:58,520 --> 00:43:00,680 start with, when was the last time you had a full physical? 705 00:43:01,520 --> 00:43:04,160 And so often they'll say to me, why are you asking that? 706 00:43:04,640 --> 00:43:09,240 I'm like, because whatever's going on in your mind is somehow 707 00:43:09,240 --> 00:43:11,920 impacted by your body. Now, I don't know what that is. 708 00:43:12,000 --> 00:43:15,480 I'm not the MD here, but I think we need to start you with a good 709 00:43:15,480 --> 00:43:20,680 physical with someone so we can just see if there's a reason 710 00:43:20,680 --> 00:43:23,240 you're feeling constantly stressed or why that, you know, 711 00:43:23,240 --> 00:43:25,320 you you can't. Maybe it is just because you're 712 00:43:25,320 --> 00:43:27,280 hunched over your computer or because you can't. 713 00:43:27,280 --> 00:43:29,640 You feel like you're walking in egg shells in your home. 714 00:43:29,960 --> 00:43:31,400 You know, those are all very possible. 715 00:43:31,400 --> 00:43:33,840 And we can look at those with hypnosis all day long and we 716 00:43:33,840 --> 00:43:36,600 can, you know, come up with ways we can move you through things. 717 00:43:36,920 --> 00:43:38,840 But there might be something physical here. 718 00:43:39,560 --> 00:43:42,280 So absolutely what you're talking about, and you'd 719 00:43:42,280 --> 00:43:46,720 mentioned it before, but having the silos, right, of expertise, 720 00:43:46,920 --> 00:43:52,400 but there is also a silo of physical health and mental 721 00:43:52,400 --> 00:43:56,080 health. And what we have to understand 722 00:43:56,080 --> 00:44:01,280 is that it is a continuous spectrum and that one affects 723 00:44:01,280 --> 00:44:05,120 the other. And where I see the major issues 724 00:44:05,120 --> 00:44:09,320 are, is that on the physical side, if they can't figure out 725 00:44:09,320 --> 00:44:12,200 what's going on physically, they're going to punt it to 726 00:44:12,200 --> 00:44:14,720 mental health, right? If you are a woman, well, you 727 00:44:14,720 --> 00:44:17,920 have anxiety, right? Well, you have depression, 728 00:44:18,840 --> 00:44:21,920 You're having a panic attack. No, actually, you're having a 729 00:44:21,920 --> 00:44:23,720 heart attack. Yeah, actually you're having a 730 00:44:23,720 --> 00:44:25,120 stroke. OK. 731 00:44:25,720 --> 00:44:29,160 But these are some of my most popular videos are just even 732 00:44:29,320 --> 00:44:34,840 talking about this, right. And so there's there's that. 733 00:44:34,840 --> 00:44:39,560 Then there's also when you are going through a physical 734 00:44:39,560 --> 00:44:45,720 condition, the help you can have from working with a mental 735 00:44:45,720 --> 00:44:49,480 health counselor can be the main difference. 736 00:44:50,240 --> 00:44:54,160 And I find that people who have been diagnosed, whether it's 737 00:44:54,160 --> 00:45:00,280 cancer, whether it's a, you know, autoimmune disorder, they 738 00:45:00,280 --> 00:45:05,080 are so helped by either talking with a therapist, finding a 739 00:45:05,240 --> 00:45:08,040 group, A community group with the same problems. 740 00:45:08,480 --> 00:45:13,360 OK, because that your mental fortitude is what's going to 741 00:45:13,360 --> 00:45:18,400 help you with your, your physical ailments and getting 742 00:45:18,400 --> 00:45:22,200 back to those stages of, of misdiagnosis, I would say, you 743 00:45:22,320 --> 00:45:27,080 know, the three things that I can recommend how to shortcut or 744 00:45:27,080 --> 00:45:32,720 divert from those final stages of misdiagnosis are #1 finding 745 00:45:32,720 --> 00:45:36,040 your North Star believers. OK, That may mean going to 746 00:45:36,040 --> 00:45:39,080 multiple different doctors. That may mean opening up to 747 00:45:39,080 --> 00:45:46,560 family who you wouldn't normally talk to about medical issues #2 748 00:45:46,560 --> 00:45:50,960 is having the courage to re enter the cycle right? 749 00:45:51,080 --> 00:45:56,040 It's really hard to find another doctor just to be told the. 750 00:45:56,080 --> 00:45:57,560 Same thing. Right. 751 00:45:57,880 --> 00:46:01,040 That is physically and emotionally draining. 752 00:46:01,440 --> 00:46:04,720 So it takes different I call this the will to fight. 753 00:46:05,120 --> 00:46:10,200 It takes courage to have the will to fight and re enter that 754 00:46:10,200 --> 00:46:14,080 that cycle. And then finally, we are living 755 00:46:14,200 --> 00:46:17,800 in a day and age where we have access to tools that were not 756 00:46:17,800 --> 00:46:21,440 available even six months ago, right? 757 00:46:21,640 --> 00:46:25,200 I mean, there there's an AI facial recognition app where you 758 00:46:25,200 --> 00:46:29,720 can upload your picture and you can diagnose you with a rare 759 00:46:30,240 --> 00:46:32,080 genetic disease in three seconds. 760 00:46:32,680 --> 00:46:34,480 OK. I remember years ago working 761 00:46:34,480 --> 00:46:36,560 with a company that was doing that with the Irish that 762 00:46:36,560 --> 00:46:39,880 ultimately became part of Clear, correct, correct. 763 00:46:40,320 --> 00:46:43,560 But it was to diagnose mental imbalances. 764 00:46:43,560 --> 00:46:46,440 It was psychiatric originally. Correct. 765 00:46:46,440 --> 00:46:50,560 So, you know, the putting together all of these, you know, 766 00:46:50,560 --> 00:46:54,640 my social media channel and my podcast and all things has been 767 00:46:54,640 --> 00:46:58,120 building towards what I am actually building, which is a 768 00:46:58,120 --> 00:47:02,520 social media platform called Feel Better, where you have 769 00:47:02,640 --> 00:47:07,480 access to credible health information from health experts, 770 00:47:07,840 --> 00:47:11,280 but then also be able to find a community of people who are 771 00:47:11,280 --> 00:47:12,760 going through the same problem as you. 772 00:47:12,760 --> 00:47:15,960 That's fantastic. What, what I, you know, one of 773 00:47:15,960 --> 00:47:19,440 my thesis is that it's an, if you're a woman with 774 00:47:19,760 --> 00:47:23,040 endometriosis, there's no one you trust more than another 775 00:47:23,040 --> 00:47:26,360 woman with endometriosis. And I really believe in the 776 00:47:26,360 --> 00:47:31,720 power of combining the medical expertise with the community 777 00:47:31,720 --> 00:47:34,760 support. Again, attacking it from the 778 00:47:34,760 --> 00:47:39,120 physical health and the mental health is how we're all going to 779 00:47:39,120 --> 00:47:41,200 be able to help take care of each other. 780 00:47:42,680 --> 00:47:46,840 Oh my gosh, I could keep talking to you, Doctor Aaron Nance, for 781 00:47:46,840 --> 00:47:50,400 another hour, but our time is up and I wish it wasn't because, 782 00:47:50,880 --> 00:47:52,720 well, first of all, that was one heck of an ending. 783 00:47:53,000 --> 00:47:54,680 And I. And what was the name of this 784 00:47:54,680 --> 00:47:57,640 community you're creating? So it's called feel better, feel 785 00:47:57,640 --> 00:48:01,760 better BETR it will be an app launching in June. 786 00:48:01,760 --> 00:48:06,400 Not sure when the podcast is airing, but yeah, we are, you 787 00:48:06,480 --> 00:48:10,720 know, as I said, taking the best from medical social media and 788 00:48:10,720 --> 00:48:15,240 then working with health foundations and really trusted 789 00:48:15,240 --> 00:48:18,880 communities that are rooted, you know, in in health and and 790 00:48:18,960 --> 00:48:21,520 community support. And that's, we just want to make 791 00:48:21,520 --> 00:48:25,240 it as easy as possible for you to, they say, help us, help 792 00:48:25,240 --> 00:48:28,360 ourselves. And that's the ultimate goal. 793 00:48:29,800 --> 00:48:31,960 Well, this has been an absolute pleasure. 794 00:48:32,080 --> 00:48:34,440 Thank you for your time. Well, thank you, Diana. 795 00:48:34,600 --> 00:48:37,720 It's a pleasure. And thank you for inviting me on 796 00:48:37,720 --> 00:48:41,560 and getting these types of stories on because as I said, I 797 00:48:41,560 --> 00:48:46,560 think so many people are feeling isolated and lonely going 798 00:48:46,560 --> 00:48:49,920 through these health challenges. And I just want them to know 799 00:48:49,920 --> 00:48:54,880 that you're not alone, you do matter, and that your stories 800 00:48:54,880 --> 00:48:59,560 are worth listening to. That comes across loud and clear 801 00:48:59,720 --> 00:49:03,080 and it's heart warming. Thank you. 802 00:49:03,240 --> 00:49:06,320 Thank you so much. That's Doctor Aaron Nance and 803 00:49:06,320 --> 00:49:08,600 I'm Diane Griselle. I'm also known as silver 804 00:49:08,600 --> 00:49:10,520 disbedience. This the silver disbedience 805 00:49:10,520 --> 00:49:14,560 perception dynamics podcast. There will be all kinds of 806 00:49:14,560 --> 00:49:18,800 information below this podcast where you can follow doctor 807 00:49:19,240 --> 00:49:21,800 Aaron Nance and I highly recommend you do because she's a 808 00:49:21,800 --> 00:49:27,760 heartworm warming, fresh breath of air so and also happens to be 809 00:49:27,760 --> 00:49:31,000 very intelligent and smart and accomplished too. 810 00:49:31,000 --> 00:49:35,360 So what a combo. So please hit subscribe, share 811 00:49:35,360 --> 00:49:39,120 this with your friends. Follow Doctor Nancy's 812 00:49:39,120 --> 00:49:42,120 information below. Thanks again everybody and thank 813 00:49:42,120 --> 00:49:43,280 you. Thank you.