Nutrition, Vitamin D and Classification in Persistent Back Pain

And she's got a bag of supplements, and she puts them on my desk. Literally, there were probably like 30 or 40 bottles worth of things on my desk. And I just looked at her, and I'm like, so do any of these actually help you? And she picked out like four or five. And I'm like, I just kind of like put my arm across the five good ones, and I slid them all across. I love that. To the other side, and I was just like, I just looked at her. I was like, so I don't know how much this stuff costs. I know it's not true. Please, before you go buying anything else, please just call me or come in the office and make my appointment.

You're listening to the Restoring Human Movement podcast, where movement experts discuss the latest evidence-based practices to help you and your clients move with mastery. And now, your host, Dr. Sebastian Gonzales. Hey, guys. It's Dr. Sebastian Gonzales, again, your host for the Restoring Human Movement podcast. This is the third part of a five-part series on where I'm interviewing the people who were the contributing presenters or the content creators for the Pro Chiropractic Online platform. That is the Pro Chiropractic Online CE platform. By the way, you can start to buy it now. If your birthday's coming up and you need continuing education, you can get 12 online, at least in California, and this covers ethics as well as documentation history, the needed hours.

And California's one of the hardest, so we tried to hit California and Florida as kind of our metrics. Everything else will fall under that umbrella, typically, but you need to check with your state first. So I'm really excited to put this program out, honestly. And I can't tell you enough that if I were to take this module, this exact module, within my first year of practice, or probably my first five years of practice, it would literally change the way I practice today. And I practice this way today, and it's amazing. It's amazing to see how you can reduce a lot of people's symptoms with flexion intolerant back cases by proctoring in this mannerism.

And so, although you guys might have things that work for you, my hope for this platform was to expose everyone to the things they might not know yet. And as I would say, open Pandora's box, so you start to figure out, huh, there's something else out there. Because we all get very buried in our clinical practice, and it's hard to find new things that might work better than what we're already doing. And I've been fortunate enough to run into a lot of these people through podcasting, and I know I've done a podcast recently where I talked about how podcasting improved my clinical practice. This is basically how.

And so, I kind of want you guys to have that same experience and just dabble in these people's contents because it might just blow your mind. And so, James Valkersel is going to be the one on today, and he's going to cover nutritional-based aspects to the flexion-tolerant back. And true story, I did have a patient recently that they had some neurological-based complaints, and they said, well, what natural stuff should I be taking? What can I be eating to improve this or accelerate it? And I thought, huh, there was a slide on this in James's portion. I need to go back to it, and I will email you back.

And so, I did. And so, again, I'm still learning as I go. I'm not intending to know everything, and all the presenters don't know everything either. We're just presenting things that work extremely well for us. Philip Snell is on there. He talks about, he goes over examination as well as other considerations with the back, epigenetics as well, as well as figuring out why disc injuries might be more prevalent than we think, and why we need to start being really good at addressing them based upon a, is that a socioeconomic with how much money is dumped into addressing flexion-tolerant backs that we just need to be damn good at.

We have Greg Lehman on here. We have Cody DMACC, who goes over some loading, which I know a lot of you have been emailing me about that loading one that I did with him. I think it was back in 122 or 123. Maybe it was 123. We do tend on recapping on that again, and I'm going to have him on again to talk about his portion of the CE platform because he goes over strength conditioning aspects of it where you can, I mean, there's a great case in there. We covered it in 123 a little bit where it was a real patient that came in there, and we got to load him. I was the cameraman at the time, so I guess I didn't do it.

He did it, but it was really cool to see that you can get someone very quickly back into acquiring load, and it's therapeutic. But we will cover a little scaled-down version of loading very soon here for those of you who requested it. So it seems like it's a big need, and that was a very interactive video. I didn't know I'd be watching Grip so damn long. I was very intrigued by the thing. And so we're going to have on James today to talk about the nutritional aspects of it, and quite honestly, went through some of that, and I started realizing that you guys are probably going to be thinking the same thing I am.

How does James have like a 95% cash practice? And so we went down that route a little bit, and sorry, I tangented in a little bit, but honestly, I think it comes down to you got to know that the presenters in this platform are going to be useful to you, and trust me on that. And I guess the content really doesn't matter yet, because you're going to get into the nitty-gritty of it when you get into the course. So I asked James to share a little bit about practice management with us as well as we went through this. So I hope you guys enjoy it, and it will be live. By the time this podcast is live, the platform will be live.

Check with our website to see if your stake qualifies for it, and I'm hoping that it just blows your damn mind. Here we go with the story first, then we'll get on to James. Now, one story I don't think I shared, or at least the topic fact I don't think I shared, was that I got a thing about sheet tension. And you know how you go into a Westin or a nice hotel, and like all the sheets are nicely pressed, and they're pushed into the sides and the bottom, and you get in there, and it feels like the bed is hugging you? That's good sheet tension. That's good stuff. And I don't know if it comes back to, like, the babies like being swaddled and stuff like that, and dogs having their thunder jackets and whatnot, but I really dig good sheet tension.

So another thing that drives me more insane is when actually all the sheets are pulled out of the bottom. And maybe it's when I've been flipping around a lot, but either way, I've got to set that thing under there. And I'm not saying I've got to make my bed, per se, but I've got to have adequate sheet tension to actually sleep well. Other than white noise, I think sheet tension is one of the things that helps me sleep the best. All right, cool. Everyone, welcome on Dr. James Valgersell. Say hey, James. What up? What's up? Thanks so much for—this is, by the way, this is the first podcast I've ever been late to.

There was children one time, a baseball team, actually, that I was coaching, and it was an 8 o'clock thing. And I showed up 30 minutes early, and the kids started showing up at 8, and I said, you guys are late because you don't have your shoes on yet. So I'm going to offend her today. It's all good, man. So I thought I would have you on to—so this is actually the third part of a multiple-part series where I'm interviewing all the presenters that are on the Pro Chiropractic platform, the online thing that we had all your notes go on, or your presentation go on. So I thought of having you on to be really insightful for people who are listening to kind of figure out how nutrition can really play a good role in management of low back conditions and so on.

Sure. Cool. Tell everyone about yourself. Who doesn't know you? I live in practice in Florida. Finished at Palmer, Florida in 2014. I've been in private practice pretty much since I got out. 95% cash. Very little insurance in here. You know, my patients that have PPO will offer them a super bill, but that's about it. I'm a certified functional medicine practitioner as well as in D.C. I'm trained in the McKinsey Method. What else? Familiar with the Titleist Performance Institute stuff. I'm a level one. I'm trained with D.N.S., with Fred Weidenson, or Dr. Weidenson, and a bunch of people through D.N.S., dynamic neuromuscular sterilization, was involved in Motion Calpation Institute all the way through school.

I should have taken my nutrition diplomate exam, and I'm pretty sure I should have taken my rehabilitation diplomate exam. That you should have taken it? Yeah, I haven't gotten around it yet. I've been all that busy. And I just finished a PSP for UPIT, the primary spine practitioner of certification training that they started in, I think it was 2007. I think it was, yeah, it started in December, 2017. That's a lot of stuff. Yeah, it's a lot of stuff. Quick thing before we continue, because I hear fluctuations in audio. At some point it feels muffled, but I can't see if you're getting close or not.

Oh, sorry. Yeah, so whatever you said, when you said sorry right there, it sounds great. So whatever you did there, keep it. It sounds great, too. All right. Cool. That's a lot of stuff. So as you went through that, just as I'm going through like the presenters, I'm kind of asking them their educational background. And why did, so you've gone through a lot of stuff already. Were there any pivotal points in there where you're like, I think I'm going to start focusing on this as being a predominant thing, because a lot of your presentation was nutritional-based. Well, in my opinion, you can't really have one without the other when it comes to musculoskeletal issues, especially the persistent ones.

And more often than not, there is some kind of underlying biochemical or nutritional component that, in my opinion, oftentimes needs to be addressed. And given the way I set my office up, 95% self-pay, I try to be able to offer all of the people that walk through my door some form of help. So I don't want to turn people away if I really don't have to. That said, if we're not getting home runs with somebody within three or four visits over about two weeks, I've missed something or they need to be somewhere else. And I'm okay with admitting that. And I tell my patients, listen, we can't get improvement with you in a reasonably short period of time.

You know, something happened. I might have messed up. You didn't do your homework. Or we need to do some further diagnostics of some kind, blood tests or imaging or something like that. Yeah, I like that. It seems like, like, so I'm mainly cash paid, too. I kind of feel the same way with, like, you don't really have a lot of time to not get a result. It has to be very, very quick. Yeah, yeah. Especially, you know, I feel like the N-range loading exam or the McKenzie method for musculoskeletal and classifying these things appropriately is really, really critical. And through their training, they like to tell you, you know, you've got three visits to figure out and classify it appropriately.

Well, and the type of model that you and I seem to have, we don't get three. Yeah. We're not getting the referral from EMD, you know, and getting 12 visits paid on insurance. No, we've got to hit a home run as soon as possible or else the patient won't come back, you know. So, yeah, we've got to do better. I think everybody needs to do better. But in the type of model we have, we certainly have to try and do better than us. So, then the type of home run you're talking about, what type of results from the styles that you're practicing, what type of results would you expect within the first day, at least?

Well, for example, last Friday, I had a patient with two years of dizziness with pretty much any and all head and eye movement, which was awful for the guy. He's getting anxiety over it and he's getting medication for it and everything. And before he left, his mechanical sensitivities were extension, left rotation, and like a left cardinal field of gaze type thing. And he would get immediate sympathy. By the time he left, left cardinal field of gaze was not problematic, left rotation was not problematic, extension were all not problematic. And it had been two years prior to that? Yeah, two years prior to that.

And during that visit, I actually had a student from Palmer, Florida, who's studying the clinical neurology stuff with Dr. Chet Carrick. And we were talking to the office after the guy left and he was like, I'm really kind of surprised you didn't hit harder on the gaze stability type exercises and the eye movement stuff. And I'm like, well, the patient clearly had a cervical spine issue. So I think that the nystagmus and the eye related stuff and the migraines associated with that will probably secondary to cervical spine dysfunction and they'll likely go away after you clear that up. And he was like, oh, that makes a lot of sense.

I was like, well, yeah, I think so. You know, we can make these things really, really complex, I think, or we can kind of simplify them. But in cases like the guy just mentioned, can we find something that is useful for them, hopefully within an hour, hour and 15, 20 minutes or so, it's a new patient time for me. And if we can, send them home with it, load it, and come in, you know, in three or four or five days or a week or something like that. Yeah. So I'm just thinking for your – when you're explaining that to that student that was coming through, when you're looking at classifying these types of cases, is there a certain ordered process that you tend to use before you start – because like you said, we can make these things really complicated for people or we can kind of take this like the low-hanging fruit type of thing, you know?

Right, right. The question, is there – is there like an ordered process that you'd kind of take? Like the – when you look at a patient come in the first time, what's going through your head when they're going through the history and everything and then as you go into the – through the physical? Like what are you looking for to be the first things to address? Well, it depends on the chief complaint. You know, if it's a musculoskeletal case, then we're going to be focused on musculoskeletal. And I think the amaranth oil exam is paramount in that, you know? Typically, this straight-up McKenzie stuff, derangement, dysfunction, posture, adherent nerve root or other being – are they having any red flags?

If they're red flagging, get them out or refer for imaging or whatever you need to do, but they don't belong in the office more than likely. And then classify it accordingly, you know? If it's derangement, you know, cervical spine, thoracic, lumbar, shoulder, whatever, you'll be able to make it really, really terrible or you can make it better, you know? And it's a rapid thing. But it really depends on how well you follow that type of method. And I think that's kind of similar to, like, the SFMA type of workup where they, you know, stability motor control or – I forgot the other ones. I don't really use the SFMA too much.

I know a lot of them in and rolling. Everyone's on the ground rolling every damn time. Everyone's rolling, yeah. But I think an accurate classification is really important. The pathoanatomical model is useful, I believe, in the acute setting. You know, like someone just got hurt. They had a fall or something. They're in the office two days later. But someone that had an injury, you know, six years ago or something, okay, there's more stuff going on. Yeah. And I think that's a lot of what I see. Like, I honestly don't want a trauma case in my office unless it's like a disc, really. It's – I really don't want the other ones.

It's there – there's that acute healing phase, I think, that needs to occur. And it's not as easy to kind of unmuddy the water. There's a lot of responses going on. Yeah. And, I mean, if you treat any type of trauma stuff, you know, if you treat, like, an acute whiplash thing. You know, I read this on a forum the other day. There was a clinician that was starting manual therapy with a patient after acute whiplash. The person was rear-ended or something. And in my head, I'm like, what are you doing? You've got to modulate the chemical inflammation. This person has chemical pain. You know, and there's a classification right there.

Is it mechanical or is it chemical? Doc, it hurts all the time, 100% of the day. Sorry about that. It hurts 100% of the day. Really? Does it get worse with movement? Yeah, but it's worse 100% of the day versus, no, it only hurts my shoulder when I go like this. Well, it hurts all the time. It's clearly chemical, rather. What are you going to do about it? Okay, you know, here's ibuprofen, 800, three times a day. After 1,600 milligrams, you'll start getting the anti-inflammatory benefits. Come back in a day and a half, two days. See if it's better with that. If that doesn't do what you need it to do, just refer them out.

You know, do some short-term pain management. Yeah. They have a chemical inflammatory issue. We can do stuff with that, you know, lasers and electrotherapy and stuff like that. But oftentimes, those patients who are at a high-level discomfort post-trauma, they likely need medical attention. Yeah. You know? I'm glad we went through this analogy, actually, because now we've got the two boxes, at least. We have the mechanical, and then we have those clear chemical ones. I know that this is very sad. I think that, you know, McKenzie stuff is very, it is very wow factor. And some, a lot of people, some people don't use it.

And so, before we continue on into other stuff, tell me, tell me your experience with some of the McKenzie-based stuff. What, what extremities it helps with, or what twins do you find it doesn't work with, with spinal conditions, just so the listeners can get a feel of, hmm, maybe I should learn a little bit of that. Well, at the end of the day, you know, I think, you know, and this is, this is a Dr. Craig Liebenson thing, too. N equals one. So, you know, no matter what you learn, in my opinion, you have to use what's appropriate for the patient in front of you. You know what I mean? If, for some reason, you, you, you're pretty sure you've got an acute disc issue with some ridiculous symptoms.

If you can't establish a directional preference with a patient, you know, the end-range loading exam is inconclusive for you. Well, did you actually follow through with the protocol? You know, how experienced are you with it? If you're someone that just took part A, you know, the lumbar spine one, and you're trying to work on a cervical in the same way, the cervical spine's different. It's not going to be exactly the same. But in my opinion, the end-range loading exam, when done appropriately for spinal-related disorders, is paramount. Unless it's not. You know what I'm saying? Like, if you can't establish a directional preference with a acute disc or subacute disc, okay, that's fine.

The evidence does not support things like traction, really. There's not a whole lot of support for it. But I will tell you from experience, I've had patients. I can't establish a directional preference, and we've put them in traction for a couple visits, and then we come back to it, then we can find one. So maybe, you know, quote-unquote, creating a little bit more space was helpful for that person. Yeah. I don't know. But when it works, and the McKenzie, you know, I guess the McKenzoids, they would hate for me to say this, because they'll say that McKenzie always works. Because if you accurately classify the patient, yes, it does.

Mm-hmm. But when you can quickly establish a directional preference, load it appropriately with the right force and direction, you can see some really, really, really, really profound improvements in the results of the patients. And they love it, because they can self-treat half the time, but not more. Right. I think that's the big part. And I know that with – I take people into loading, weight loading, resistance training and loading pretty quickly. And there's some people who are afraid. And at least I tell them that we have the safety net that we've established a clear directional preference, and we can reset you whenever we want.

So at least if it starts to trigger, then they start to understand a little bit of a biomechanics of why they're triggering and what different types of things, you know? Yeah. I agree with that, because, you know, I tell patients the same thing. We do – you know, I do some pretty low-level, low-tech rehab. I don't have, you know, barbells, pedal bells and stuff. But I tell people, listen, you know, if they're nervous and they've got some high-level fear avoidance, well, one, that psychosocial aspect, or psychological aspect, rather, that needs to be addressed. Right? It's huge. But I tell them, listen, we're going to do this.

Well, I can't do that. That was painful. That's what hurt me before. We're going to do it. And if you get hurt, you're in the best place you could possibly get injured. You know, you've got someone that's pretty decently trained here to help you out. You know, and you can just slowly do the graded exposure stuff or the resistance. You know, however you want to approach it. And you start at the bottom, and you end up wherever the person needs to end up. You're not going to get somebody that's benched 300 pounds just for their shoulder and pieces of peck there. They're not going to be benched in 300 pounds within six months.

And that's a long injury rehab. You know, start them off with 30, you know, or less. And if they make it up to, you know, 100 in that first day of your rehab, that's fantastic. Great job. You mean just not doing it ever again? It's not the answer. In my opinion, it is not the answer. It's the easy way. It's funny. Like, so some patients come in, I give them the option of, like, I demonstrate a nerve traction model. And I'm like, nerves like about 8% tension. And beyond that, they start to get a little bit irritated. And I'm like, so I'll show them on the little stretchy band. I say, look, you got two choices.

We can help nerve slide to make it so you can actually move to that range freely and it doesn't hurt. Or we can just not move. So it's your choice, really. Either way, you're going to feel okay. It's frozen there. Yeah. And, you know, if you choose not to move, that's fine. You'll never hurt again until, God forbid, you have to run out of your house that's now on fire. And now you're going to hurt the entire, or you're going to hurt worse once you get out of the house. Or you won't make it out of the house because you can't make it out because you can't move. Right. Well, if they got the McKinsey loaded in there, then they can just rep it out after they get out of the house.

And then they're going to be okay. That's right. Yeah. I'm glad to finally talk to you, by the way, after all the email correspondence on. I liked your presentation. It was really good. Oh, thanks, man. You're so easy to work with the non-moving artwork that was on my side because I was opening it in the wrong format. Yeah. You sent me that email back, and you're like, nothing's working over here. And I'm like, working on my machine. I have PowerPoint. What are you using, man? I know. I don't remember what happened. I felt like such an idiot because I know it takes a lot of time. I get it. I've created a lot of content.

And then if it's a stupid tech user error, I'm like, I'm going to spend hours on this until I actually talk to him about it. Yeah. When Ben called me up about this and we talked, and he was like, yeah, we want you to put together a two-hour presentation. You have three weeks to do it. I'm like, what? I was like, dude, I got a business to run. I got patients to treat. I got to go to Pittsburgh again. Yeah. I need some more time. And then I don't have patient hours on Thursdays and the weekends, too. So I'd catch up on my paperwork on Thursdays, and I'd spend three or four hours with both the laptops in front of me.

The laptop that I use for work primarily, it's got another monitor attached to it. At one point, I found myself with like four Firefox windows open. Each one had like eight or nine research data and NCBI articles in it. And on the part with B12 and the presentation and peripheral nerve injury and endoneurial hypoxia, I was up to my neck. And I think the Journal of Neuroendocrinophysiology or Endocrinophysiology or something. I forget which one it was. I can barely pronounce it, and I still can't. And I was reading it, and I was like, oh, my goodness. At that point, I finished the slide. I closed all the laptops.

I worked five minutes from the beach. I went to the beach for a couple minutes. I found a bar, had a beer. I'm like, all right, you got to stop. That's so funny. I'm working on a little course right now, actually, for a workshop for a person. So some of my classmates, like we don't see each other all the time. Probably like you guys don't either. And so some of them, like they'll call me about some questions about their cases. And they're like, hey, why don't you just put on a CE thing? We'll just hang out at a bar. And we never see each other. I'm like, well, that sounds great. And then we started persisting with this idea.

And so finally I said, yeah, I'll put it on. Let's just do it. Come to my office. We're not going to go to a bar. We'll just hang out. Everyone just meet. And like it's a whole class party thing. And I just started to make it, I started realizing that, oh my God, this is more than I want to do. Because you start digging through stuff. It's hard. Yeah. So I feel you. Yeah. Especially, you know, we've got information at our fingertips, man. And I said that to a patient the other day. She was a functional med case, you know, thyroid, weight gain, all nine yards. And she's just got a bag of supplements she throws on my desk.

And I'm like, the problem here is that you, and then I like, and me too, when I pulled out my smartphone, I was like, we have access to anything we want. And we're going to read information from anyone and everyone. Some of it's probably terrible. Right. To start self-treating issues like yours, you could see the goiter internet too. Oh. You could see the growth. I've never actually seen a goiter before. Oh, man. It's not like super duper often when we catch them, but, you know, when you can see it sitting across the table from somebody, it's like, oh, okay, yeah, we need some blood count. You know what I mean?

Yeah. We've got to get some objective markers. And I told her that. She was like, I agree 100%. I don't want to keep guessing. I'm like, yeah, you can't guess, man. Don't guess. Yeah. Don't guess. If there was a good way to maybe screen out all of the information that you can information that is just not good anymore. Because I know no one ever takes their webpages down. And I don't know. I've been definitely guilty of searching things too. But I had a patient recently that they came in and they had a lot of questions and I answered them. And I think to the best of my ability and to get them in the right place to accept what was supposed to be happening.

And I told them, I said, look, we've already got all this question. Do not, do not go online and search this, please. Because it was a hamstring strain, she said, right? No bruising. And it was, it was decreased with, uh, it was decreased with, uh, uh, plantar flexion as well as a cervical extension. And I'm like, please. So she's got neural tension. Yeah. I'm like, please do not look up hamstring tears. Don't look up anything. Don't. Yeah. Because there's nothing there, right? You're not going to find anything. Yeah. So, yeah, don't. Yeah. I can only imagine what you deal with if you deal with nutritional stuff.

Oh my, dude, I had a guy, uh, no, I'm sorry. I had a woman come in two weeks ago. Super nice lady. Um, she's like 80 pounds right now. You know, at her healthiest, she was like 100, 510. She's like, dude, I've been consistently losing weight since like 2015. I'm looking at her medical history. I have 80 pages of stuff I could sift through prior to her even coming in. Oh my goodness, this is crazy. And, uh, she's got a bag of supplements and she puts them all on my desk. Literally, there were probably like 30 or 40 bottles worth of things on my desk. And I just looked at her and I'm like, so do any of these actually help you?

And she picked out like four or five. And I'm like, I just, I just kind of like put my arm across the five good ones and the other, and I slid them all across. I love that. To the other side. And I was just like, I just looked at her. I was like, so I don't know how much this stuff costs. I know it's not cheap. Please, uh, before you go buying anything else, please just, just call me or come in the office and make an appointment. Stop wasting your money because all this stuff's not, there's no regulation behind that nutritional support supplementation. Mm-hmm. You know, it's a multi-billion dollar industry.

Um, and the, the evidence for, you know, nutritional therapy is very, very lacking. But, you know, then we've got a question who's performing the research, what's the duration, you know, et cetera, et cetera, et cetera. You know, whose, uh, whose interests are primary there. You know what I mean? Mm-hmm. Yeah. But, you know, yeah, it's, it's crazy, man. Sometimes I play basketball, you know, with the trash cans and my patients and push myself. You just, you just toss them in. Do you have a little, do you have a little hoop over there too? I don't, I don't have a hoop. I have a small trash can.

And I'm like, you know what? Show me that. And I look at it and it's, it's, you know, uh, it's just, maybe it's magnesium oxide or something, the equivalent chalk essentially. And I'm like, this is crap. Throw it in the trash. Oh, but yours is expensive. I'm like, mine's expensive because it's, it works. You get the same effect of mine. You would need to take 30 of these that you bought and save yourself half price to get the same effect as two of the ones that you got for me. You, congratulations, you threw money in the trash. And like, I just want to like, I'm not going to do it. Do you, do you ever do, um, so I, actually the main, the one main, the main reason why I started this podcast a year, uh, two years ago is because at first it was like, I didn't want to have the same conversation with patients over and over again.

Like I thought we can get beyond it and just record it. And that's, and then they, they can, then we can ask more questions, you know, and like, and, uh, so you were thinking about just doing an example of all of the, like just label comparison or like to all the common ones they come in with so that you don't have to talk about all the time. Um, it seems like a common conversation. I actually, I haven't thought about, maybe I should, but on the the same token, um, I don't, I don't really advertise. I try and keep things kind of private. You can make a private video. Yeah. Just stop. I'm just trying to make it easy.

I think I talked about, uh, push, pull, hinge, uh, carry, et cetera, about four times this week for, for over 30 minutes each. And then I searched Dan John stuff on, um, on Draper's site and I'm, I'm like, I'm going to find something. I'm going to refer to this or I could just make one. I don't want to do this ever again. Cause it's always like, it gets, it gets further away. It's like, okay, do these five things and break them into single arm, single leg. And they're like, but what else? It's yeah. It's always, it's always more. It gets, it gets drugged in a little bit more. So, but yeah, the listeners can, uh, that, that podcast will come soon.

Cause I do plan on doing that one. Um, I had a guy, I had a colleague tell me, he's like, you should start a private Facebook group with your patients or something like that. Yeah, I probably should. I probably should, but then I know my phone will go off all the time. I don't know. I don't, I don't know. Because of their messages or because of phone calls? Uh, not phone, not just calls, but like, you know, I just, I, I, I try and leave work at work. Right. We know, um, that's a good point. I think, uh, I actually, I, I enjoy some of the side projects, but I think of it as duplications of myself.

So I don't have to like, so I never make business calls when I'm not working. Um, but I think that like, I'm, I'm, I don't really love. Social media in that respect. Cause I don't want to answer back, but I want them to actually read the thing that's there or listen to the thing that's there. So, um, maybe a Slack page is something. Ooh, hello. I got that video. Yeah. Is that a Yocum behind you? Is that two Yocums? Yeah, that's two Yocums. Oh man. It's been forever since I've seen a Yocum. I hate to say it, but for a little while I used them as a step stool for single leg stance stuff. I mean, I put a towel on them too, but yeah, it was bad.

I mean, I still use them. But yeah, I probably shouldn't have said that. Well, I mean, those are the oldest, like, I don't know. I don't, is there, has there been a new radiology book that came out since, uh, not, not to my knowledge. I mean, I, I, I don't know. Yeah. I don't know me personally. I'll, uh, I'll, I'll, I'll second that. I don't look at, I don't take x-rays, nor do I really look at them. I mean, I'll send them out cause I'm looking for something else. And I think the radiologist should read it. That's, I have the same exact train of thought. Um, if you're, if you're in my opinion, if you have a x-ray in office, you're playing with fire.

Um, my, uh, one of the radiologists at Palmer, Florida, Dr. Richardson, brilliant guy, super smart guy. Um, we had a discussion one time and he was like, man, you know, this is why you've got to always double check all your stuff. And he sent me a paper, a chiro, uh, collimated in a thoracic spine or cervical spine. It was thoracic spine and, uh, did not comment on a artifact. It was like super small and he didn't comment on it. Three or four or five years of jumping later, the patient came, uh, came down with a lung cancer, squamous cell lung cancer or something and came back to the chiro for not being more thorough and commenting on it and sending out for, um, an overread about the little speck of whatever it was.

And, uh, he got sued and lost his license and it was a whole big thing. Um, and the patient had, you know, at that point, non-operable lung cancer, wound up passing away if I remember, right? And this guy's whole life is, you know, so like when I send out, I have an imaging facility literally around the corner from the house. I could walk there in five minutes. Um, I send patients there for any of my spine stuff, x-rays, MRIs. They have a neuro radiologist, uh, CAQ certified, who's awesome. And he reads every single one and they know, cause I've requested, yeah, if you get a referral from me, this is what I want to read it.

Uh, like three months ago, I got a read back from one of his colleagues, no offense to his colleague. It was just a generic garbage read. Uh, I mean, I'm not great with radiology, but even I knew there was stuff. Yeah. It was just template. It was a template. So I sent it back and he said, read what I put in the bottom right of the requisition sleeve. Uh, please have Dr. So-and-so, you know, read the report, you know, read the imaging. And I was like, and who read it? Whoever I was talking to at the imaging facility, Dr. So-and-so. And I was like, which is not the person requested. And I was like, and I had lunch with my rep and we discussed with every single one of my spine films should be read by him, please.

So it got sent right back and he calls me up and he says, yeah, you were right. There was something there. Blah, blah, blah, blah. It was cool. Yeah. It's, uh, I, I, I, I know we spent a lot of time in, in imaging in school, but I mean, they even, I remember someone saying like, you, you gotta be on drugs to really see everything, you know, it's, it's a lot going on. And, and, uh, we, I don't, I don't spend the time that I don't, I don't keep up with it and I shouldn't be reading it. I, you, listen, you don't want me reading your, reading your, reading your reports or reading your images. I mean, I tell my patients, listen, if you're coming back in tomorrow or whatever, if they're a freaking person for a short period of time and they want a wet read, but yeah, I'll tell you, you know, but it's not, I'm going to miss stuff more than likely.

Yeah. I'll hit the big stuff. We got an enterolosis or spondylo or something like that, or a large discrimination, we'll find it. Um, so you always wait for the guy in the closet, you know, with no windows in his office that reads stuff hundreds of times a day and talking to him like it's gone, spitting out a report or the girl rather, female man, whatever, uh, let the experts do it. Yeah. Are you wearing French cuffs by the way? Do I see a, I'm looking at the collar. I'm going to guess. No, I don't think so. French cuffs is like, I don't know, they have, there has to be different than the actual shirt, right?

I have no idea. I got this shirt at a not expensive store. If you have a chance to look at French cuffs, I have this one shirt and it's the only reason I have cufflinks at all. And, uh, cause I didn't realize when I bought the shirt that it needed cufflinks and it's, it's got supposedly French cuffs and, uh, I'd already hemmed it and shit and it's great though. I only wear it to the best weddings. Yeah. I got it. I kept, I kept getting invited to weddings for the last year and a half. And I didn't even ask for two to a half. Like people stopped. Well, that's not, is it your time of life where, uh, I think it's every, every time around 35 people tend to get like five weddings a year.

I'm going to be 33, uh, in a month and a half. Oh my goodness. Yeah. I'll be 33. Um, my girlfriend's cool. Our, our dog is cool. Her birds are cool. We're, we're, we're okay. Um, side, side conversation. Cause I know that, uh, probably some of the listeners are thinking, uh, there were probably peak your, you probably piqued their interest with the 95% cash practice. Can you tell everybody about, uh, if just, just maybe some tips of how that can be done if they're looking to do something like that? Uh, well, you mentioned before, man, it sounds like you've done a whole lot of stuff, right? Yeah.

Well, again, you know, I don't want to be able to not be able to offer something to everybody who walks through the door. Um, I know there's stuff I hate treating, young children, female health, not for me, period. Just, um, I have zero tolerance for young kids that are screaming and crying and not answering questions. Um, and female health is just, it's too, it's too complex to me. I don't get it. I don't have any interest in it. Um, so I'm not going to be good at it. My, my, my, I don't, I feel like if I was, had female health issues, I'd want to go to someone else who understood, honestly. Me too.

I can, I can, we, I get males in here and, you know, we'll discuss things like low testosterone, which is discussing the presentation I put together. That's very, very important to talk about. A lot of people don't want to talk about it. It needs to be discussed. Oftentimes, especially persistent pain presentation involving men. That have been on opioids. And we talk about it in the presentation. It's, it's there. There's a link between low T and, you know, persistent opioid use. And there is a link to low T and persistent pain. Well, what happens with people that are having persistent pain? What do they get put on?

Survey says opioid. What does, what can that lead to over time? Hypogonadism. All right. So we're going to have less test. Oh, well, there's the cycle right there. So we found that, you know, we supplement with some kind of testosterone, whether it's synthetic or bioidentical. I prefer using bioidentical because then we don't get, we shut down. We get improvements in pain profile. Yeah. So since you've been on T, you know, how's your neck been? Man, it was like, it's like a two out of 10, man. It used to be a chronic five. This is really good. Oh, cool. You working out more too? Yeah. You're running around.

You're doing better. You have things at home. Great. Oh. Do you, you fist bump them after that? I, I, y'all give my patients a hug. We'll fist bump. I think I fist bump like a 50-something-year-old woman today. I just, I just didn't know if, if higher T meant more fist bump, less hand hug. Uh, I'll, I'll, I'll do, I'll do both depending on the person, depending on the person. You kind of got to, like Tom Lotus says, Dr. Lotus actually, you got to chameleon, be a chameleon when you're in practice, kind of, you know, match the energy of your patient. Yeah. You know, mirror people. That's all the psychological.

We, we're actually, uh, I'll actually, I'm going to come back to the T in a second here. We were talking over the last couple of ones I had, uh, I had, uh, Ben on and then I had Phil on, um, and we're talking about, uh, just overall patient communication and, um, uh, Ben, since he had shadowed or he had, uh, interned over at Phil's for a long time, he said that he's the ultimate chameleon coming in, sounding like a good old boy to one guy and then sounding, uh, well, a different way to a different person. So I think I'm finding the, the people that are, that are succeeding in their business ventures are good at communicating.

Yeah. I, I will definitely, um, agree with that. Um, I am not going to talk the same way I will to a 25 year old, uh, construction worker male that I won't speak. I won't talk to him the same way I'm going to talk to a 62 year old female who's having her first ever doubt of that. It's a completely different conversation. So how does, how would, how would someone develop that? Is there any steps you took or just happens? I don't know. Maybe be a sociopath that might help. Right. No, no, no. I've, uh, I've read a lot of, a lot of books, uh, like how to, how to make, uh, anybody like you in 90 seconds.

It's a good one. Um, instantly connecting with people in 60 seconds or less are all really good. Um, but a lot of it is, is psychological stuff and psychological, you know, tricks and manipulative tricks that you can do and not doing it in a way that's going to make somebody feel like they're getting manipulated or used, but just to, to help, help try and kind of connect with somebody on that level to help them feel just that much more comfortable. Um, because people do business with those that they know, like, and trust. So if somebody knows you or how do they know you, they've seen your picture on your website or something like that.

Right. Well, next up, they've got to like you. They're going to do business with you. And in our case, yeah, we're, I don't want to say we're salesmen because I'm not a salesman. I'll take what, uh, what, uh, Don Murphy says. We sell clinical excellence. You know, we're trying to be the best. We're offering solutions to the problem. And that's something I tell my patients. You're here because you need help. You need advice. And you need someone to give it to you straight. Right. I totally agree with that. There's, that's it. There was a phone call I had the other day that, um, it was someone calling about a groin issue and he was too far away for me, or I mean, he could have come, but he was closer to Ben.

And so this guy's talking, this guy's talking to me for five to 10 minutes on the phone and he kept asking questions like more technical ones. And, and, uh, he, he said, Oh, is Ben really good? Is he gonna, and I'm like, look, I'm like, correct me if I'm wrong, but I think you're looking to feel that someone is competent, they're listening to your concerns and you're, that everything's going to be okay. Does that sound right? And he's like, yeah. I said, good. Ben, I'll do that. Call him. You know, and that was it. And I hope he goes. Yeah. I mean, I've, uh, looking for my water here. Um, yeah, I have a patient that moved to, he's in San Diego, isn't he?

Uh, he is. Yeah. Dr. Ramos, what up? Uh, yeah, I had a patient move from here out there last year. And I referred her over to him to continue care. And, um, she went and saw him once and apparently he's too expensive. Well, we all are, right? Everybody's too expensive. So she, she's called, she emails me, um, cause we had stayed kind of in contact just here and there. And she emails me and tells me she saw someone else who offered her, uh, 128 visit care plan over 54 weeks. Oh my God. I couldn't imagine seeing someone that many times just talking to them. I don't want to see that. I don't want to see somebody at all.

Yeah. Oh, geez. And, uh, she was like, what do you think about this? I, I called her out and you know, this was through email and I read the patient bullshit. And I was like, don't ever go back. Call Ben. Yeah. He's more expensive. He will take care of you. I promise. Called, called Ben. We talked for a little bit. He remembered her. I was like, she's going to call you. He can. Um, she never went to the other do 125 visits a year or whatever it was. Actually, I called, uh, called the California board on that guy and his office and let him know. Um, but it's crazy out there in California. Had she, had she in it feeling with Ben?

Um, she's doing great. She's doing great. Good. She's doing great. You know, he did his thing. Um, he's working out in the gym that's going to his office and she, her overall function has gone up. Nice. Yeah, I, I think that is something that's, um, I, I, I'm curious, I'm curious about it. You know, like the, I, I, I don't really tend to like the analogy that I, that I give people about the whole, like, I don't like talking about costs really with them too much, but they're like, well, you know, my insurance is this and it's 20 bucks here. And then we're just going to go blah, blah, blah, blah, blah.

Right. And I'm like, look, if I put myself on my side, if you don't feel significant, the better I would, I actually hope for 75% plus within the 46, but just because I don't know, I'm going to say 50, you know, or less under promise over delivered. Right. And, but I, I, I don't see why they don't see the relevance all the time of it'll cost probably about the same. It'll take you less time to get where you're trying to go and you won't go through much mental suffering for this thing. Um, yeah, yeah. I mean, sometimes I'll, I have a four by six whiteboard in my main treatment today. Um, if I ever have anybody asked me about that, I'd say, okay, well you can go to PT, you know, cause you were referred there.

That's fine. Probably double. I think I might've lost you. You still there? I'm still here. Can you hear me? Yeah, I hear you now. Okay. Video stopped for whatever you're trying to say. We're cool. Um, uh, you know, I'll do the math out for people and I'll say, yeah, you can go do your PT, 12 visits at 40 bucks a pop, uh, for your co-pay and you get what? Is it one-on-one? Are you going to get, you know, people focusing on you? Are you going to get this, this, this, and this that we have to offer you in the office? You can go try it. Come back and let me know. Yeah, I went, it was like 45 bucks and we did a hot pack and the electro thing and they put me in the corner and I did a bunch of exercises.

Yeah. And I'm not saying that that happens for, for everyone because it absolutely doesn't. Um, but that's what I've heard before. And I'm not saying physical therapy is bad because it's absolutely not a bad thing to any means, but to do something like that. Right. Yeah. There's always, this is funny, this side, side story was, it was, uh, I met some, there was two older PTs I met at a course one time and they're about 50, 55, something like that. They've been around, been around for a long time. And it was a DNS course and, uh, we were, uh, so I was mainly one of the only carers there at that time for whatever reason.

So I sat with him at lunch. We were talking stuff and they're like, so let me ask you, how do you, how are you going to use this? Like, what do you mean? They're like, well, don't you just get like three minutes with each person? And, and I'm like, no, I spent, I'm like, and I explained how I practiced and so on. And, uh, after a conversation for a while, they understood that. I'm like, wait a minute, how are you guys going to use this? Don't you guys just do hot packs and STEM? And they're like, oh no, no, no, that that's our, that's our other stereotype too. And I'm like, oh, got it. We all have that.

All professions have this. We all have that. Yeah. Talking to Christian today, um, and he said the same thing. I'm like, man, there's bad pyrus, bad PT's, there's bad plumbers, there's bad mechanics. Like, yeah, yeah, just go to people that, you know, I can trust. That's right. The, uh, I know we'll, we'll start to close this up here. Um, I was actually thinking we go over more nutritional stuff, but at the same time, no, it's, no, it's okay. Cause like he said, I think it's, do they know, like, and trust you now? Cause I want people to hear the course. Um, and we're not going to get through, I mean, you, you got a bunch of diagrams and explanations and studies in there and like, we're not going to get through it all.

There's no point in doing it. Um, but, um, just on that same nutritional note, uh, just for the nutritional novice, such as myself, what are maybe two or three things that I should, uh, maybe be asking the patient to figure out if, if that is going to be their, uh, if the nutritional part is going to be a large aspect of their recovery or not? What do you eat? Do you eat crap? You know, if you eat crap, you're going to feel like crap. You're going to be just semically inflamed. You can, you can throw a bunch of good quality supplements at them. They'll probably feel better. Um, everybody's nutritionally deficient in something.

Um, I forgot who did that, that work and share that information. I'm looking it up right now, real quick. Dr. Scott Shannon, uh, from ICAMP, the Miller School of Medicine, Miami 2014 shared with us. And I have this in the presentation slide number four, the percentage of the U.S. population not meeting the daily recommended intake for specific nutrients. Um, so everybody's deficient for the most part. So what do you eat? If you eat crap, you're, you're deficient in something. Second, for musculoskeletal issues, there is definitely an association between vitamin D deficiency and persistent musculoskeletal pain, especially back then.

Um, so for someone new to doing this type of stuff and incorporating it in clinical practice, those are the two questions I would ask right off the bat. Um, I test almost every single one of my patients, uh, for vitamin D. And not just for the benefit it will likely have, it's not always going to be that way. You know what I mean? Nothing 100%. We're not building cars here. Um, but for the benefits that you may see with musculoskeletal pain, for the anti-cancer properties, for the improvements in blood sugar metabolism, uh, for improving sleep potentially for the, um, um, the inflammatory, the inflammation modulatory effects, um, and for how cheap it is when needed, I think you're doing your patients a disservice by not doing so.

No offense. Um, but I think it's that important. Um, and, um, Alice Vasquez, who said some questionable things and written some questionable things, regardless, you can't deny the guy is very, very, very smart. He will say, uh, in one of his papers, he will say, uh, in one of his papers, I'll quote, um, subtherapeutic dosing of vitamin D is subtherapeutic. Mm-hmm, I like it. I like it. So, the adult human male uses between 3,000 and 5,000 IUs of vitamin D daily. I think the RDA is like 1,000 or 800. Maybe it's 800 in kids and like 1,000 adult human. So, if you, as an adult human male, um, are using 3,000 to 5,000 IUs a day and you're mostly covered up, it looks like you're wearing a T-shirt, uh, shorts or pants.

What are you wearing? Mm-hmm, pants. You caught me on a rare day. It's just, this is, uh, once, uh, this is probably 10, 10 days a year. Yeah. So, uh, approximately maybe 30% skin exposure on you right now. Right, right. And if we use, uh, the sun to synthesize vitamin D via the skin, if we don't have adequate skin exposure and adequate UV from the sun, do you think you're ever going to hit that 5,000 IUs daily just to replenish what you potentially lost or that 4,000? Yeah. I, I think, uh, so maybe I need to use my, use my skin a little bit more often. Kind of like we're trying to, to build the energy of a self-sustaining house.

I need, I need the sun's rays. Um, you know, I would suggest getting a Speedo, uh, running around the block for a half a month. This would be amazing. I like how you don't have the first two buttons done. So, I know you're trying to expose a little bit more. Um, no, it's just comfortable. And, and I'm done with patience today, man. I'm done. I'm done with new people. Like, I have shorts on underneath this thing. I didn't know if my video chat was going to work or not. Oh, yeah. No, no, no. Oh, yeah. No. Well, I, I should just go pantless. Actually, to, to be fair, to be fair, I do have my pant, uh, legs pulled up into clam diggers.

I don't know why this happened, but it happened probably because I ran in here. Yeah, you got me too. So, you got the flops on. Um, yeah. Um, but yeah. So, we had about five minutes of nutritional stuff with this, uh, with this. It's perfect. I think, I think, um, I mean, as I, as I've always talked to the other guys about it and I'm sure that the listeners is the third time we're going around, I'll, I'll say it after I have you off the air, but I, I really do think it's going to be a very, very, very useful platform for everybody. Um, so I don't think throwing a couple spoilers in here and there is, uh, necessarily needed, but, um, I need, I want everyone to be familiar with the presenters.

Sure. Yeah. Um, the first, I want to say, cause I have a presentation on the, I think like the first 30 or so slides are basically running through, uh, the inflammatory cascade, I believe. And, um, it's confusing, uh, no offense, but especially for a lot of chiropractors, we get like what, six or eight weeks of biochemistry. Um, but this is stuff we need to know about because the inflammatory cascade inflammation is what drives pain. It's also what drives depression and anxiety. So if you are treating people with persistent pain presentation, I mean, you see people with persistent issues, right?

Right, right. How many would you say percentage wise approximately might have an element of depression? Oh gosh, I think a lot, you know, um, they don't always talk about it either. Right. And are they not talking about it? Maybe because you're not asking about it. I think that's fair. The, uh, surprisingly, I think, so I wrote a book, uh, where I revealed recovery from a back injury and I shared the depressing parts in there. And after they read that, they also mirrored back their depression. So I think it was the not being naked alone thing. Yeah. And, you know, I personally, I can empathize with all of my persistent, you know, low back disorder patients.

I have a, I suffered a traumatic spondylolisthesis. I had chronic lower back pain of bilateral sciatic or dick for like 10 years and no one took an X-ray. No one ever found it. My extension was about 10 degrees and standing before I hung out with Dustin Dean at this cap course. Oh, he cleared it up in like 20 minutes. It was crazy. You know, you'll like this. I just can't, who I got stuck. I got stuck in traffic cause I just came from his place. Oh yeah. Yeah. How's he doing? He's good. He, we ate pad Thai today. Oh, cool. And I said, Hey, next time you hang out with me. Okay. But yeah, you know, and, and I can fully empathize with these patients that are usually pissed off and usually depressed about it, especially when it's been longstanding.

I was an asshole for like 10 years, lost a lot of my friends cause I was cranky cause I hurt all the time and I couldn't do the stuff I wanted to do. You know, I was a pretty high level soccer player in high school. I had to stop. I was a cap on my high school team since I was in like eighth grade. I stopped playing my senior year and I couldn't run. Yeah. Like that's soft. You know, I don't, I'm not going to get those 10 years fast. Yeah. I couldn't do anything. Yeah. It's, it's, it's soft. Yeah. I think it's, it's really, there's a lot of things that are depressing and there's paranoia with it.

There's, um, isolation. There's, um, I know I shared in my book that, that my girlfriend wanted to go to Italy. I wanted to go cause I wanted to go with her, but I didn't want to go, you know? And it's like all, it's like, do you want to be for, at least for me, it's like, I don't want to talk about this damn back thing anymore. I don't want to be the center of retention. I just, just, I don't want to go, you know, that type of thing. And so it, I think affects other people and it's, you don't, you don't want to, or I didn't want to be the, the, the one that takes someone else's fun away. So I think there's a lot of factors in it, you know?

It's, it's, it's huge. And, you know, and this comes back to the assessment and treatment of patients. Like when I was putting this presentation together about nutrition and back pain and nutrition I got to a point and I was like, there are so many things I need to talk about. I ran out of time. And at first I'm like, I got to do a two hour lecture on nutrition and back pain. How am I going to get all the, what am I going to talk about for two hours? And I started doing it. And there's so much more to it. When you take into account the biopsychosocial model that we all need to become experts in if we're not already or become more educated in if we're ignorant to the topic.

And with that, what nutrition can do for those aspects as well. I think these persistent presentations, there's so much more to it than, than just McKenzie. There's so much more to it than any exercise. There's so much more to it than nutrition. You know, we've got to, we've got to try if you feel comfortable kind of getting into the person's head and seeing where they're at, you know? And sometimes these, these patients, they need referral for site and we need to be aware of that or they need, you know, cognitive behavioral therapy or, you know, action and commitment therapy. We need to be aware of which patients fall where.

And this kind of comes back to how are we going to classify this person? Right. And this is something that Tom Lotus hits on really, really hard, really hard. And this is why I cited World of Hurt in the book from Annie O'Connor. And most call seed. Because if you can't figure out the dominating pain mechanism in your, in your case, those are the, those are the patients that are your number 10 on their list. They've been to nine other providers. They've tried everything and they haven't gotten better. Why? Well, the PT did exercise. Exercise wasn't helpful. The chiro manipulated. It wasn't helpful.

They tried nutrition. It wasn't helpful. Why wasn't it? Why wasn't it helpful? Nothing's going to help me. I'm never going to get better. Boom. There's a problem right there. Yeah, that's a big one. What do you do for fun? Nothing. My life sucks. Oh, wow. Wow. Why is your life suck? Because I can't do anything because my neck hurts. Does it hurt all the time? Yeah. 100% of the day. And, you know, you start digging, start digging, start digging, start digging. And some of these people, you know, I've had a few of them. One of them, one of them was like this. When did, when do you not hurt? When I'm riding my bike.

When do you hurt the worst? When I'm doing chores. Oh, you hurt the worst when you're doing stuff you don't want to do. Right. What a concept. Or when you're laying on the couch and all you can do is perseverate about how bad you feel. Right. I had an interesting lady recently that she would drive a lot. She drove to LA area and it's a long drive over here depending upon the day, just like why I got back. And she gets her shoulder and neck really hurt when she's in the car and she gets so bent up and frustrated. Yeah. And so I told her to put on something that it makes her sing. Put on your favorite album.

Yeah. And that actually helps. Yeah. I think, yeah, I think you're right. I think there's a lot of parts to this and I think we as clinicians just need to be able to navigate it well for the patient. I think we're guides. And we're not going to do everything for them. We're just, we're just guides. Right. So. Right. You know, and a lot of it's, sometimes it's, it's changing, changing the thought process, sometimes about managing stress. Sometimes it's about, you know, movement therapy, manipulation, all the stuff that we're really well trained in. But in my opinion, if you don't figure out the dominating payment, you're, you're not going to, you're not going to help.

You're just not going to help. Uh, and it's tough, it's tough to navigate that. Um, but to, to become well-versed and more educated on these types of topics, I think are really, really, really important for all of us as clinicians, especially with the patients that we tend to see oftentimes persistence, final issue. Nice. I think you cleaned up this, uh, interview very well. Learn, learn more and know where to plug them in. Yeah. Well, you know, don't, don't stop learning. As soon as you stop learning, there's, there's going to be a problem. Yeah. Stop learning. If you're stopped, if you don't, if you don't keep learning, you're going backwards.

So you're going to get those yoke-ums out tomorrow, right? Is that what I mean? Like through to, like end to end, yoke-um. Uh, I, I've got like five cups of coffee I got to clean up first out of my desk. No, I'm absolutely not going to, I'll probably hide those now. I'm really glad on, on like wherever I'm at here. Like no one can tell anything recognizable really behind me. If, if anyone picks this one, can you pick that one thing out? Behind you? No one's, no one's, no one's identified the single thing. It looks like a quiz, quiz photo. You're close. It's a, uh, it's a musculoskeletal ultrasound of the femur, or the, I'm sorry, the acid, the, uh, the, uh, femoral acetabular joint.

So we're right on right now. What's that? I'm at the office right now. Yeah. But yeah, man, Hey, it was great to talk to you. Um, thanks for having us. Uh, thanks for having me. Um, hopefully some people find some use for this thing that took me like six weeks. I put together and many hours, um, but it's, it's, it's going to be brutal to listen to for some of it. Um, for sure. I'm sorry about that. There is good information. I saw it twice. I only, I only zoned out twice. Um, uh, how can everyone reach you? Um, yeah, you can just email me at, uh, drjames at aihcenter.net, uh, websites, www. aihcenter.net.

That would be the best way to get in contact with me. Perfect. Only on business hours though. I will not respond. I don't want to. That's, that's perfectly valid. Yeah. All right. So, um, uh, I'll, I'll pause this right here and I'll come right back. All right. Thanks so much, James, for being on that. That was great. Um, I know we've spoken a lot on email and I've heard your voice over and over again on that, um, presentation that you gave me, but, um, yeah, I like talking to you. You're, you're a good guy. So, cool. Thanks so much. Um, and thanks so much for referring, uh, Ben, Ben was the one who contacted, uh, James to be on this.

So I didn't personally know James at the time. Um, but love his stuff. And, uh, we have friends in common. So, uh, that, that qualifies you as an okay person. Now, again, if you guys are looking for this, uh, CE platform, go on to pro that is P-R-O Cairo, uh, online CE. So that is pro Cairo online CD, CE. There will be a link in the show notes for it. Um, currently the platform is on teachable or sorry, it's on Thinkific. Sorry. Um, we might change that at one point, uh, coming up in the future, but for the most part is an all video based program. You have to go through it, um, and it will rack all your hours in there.

And if you're looking for CEs, it'll present you with a CE, uh, credentialing at the very end. But for the most part, like I told Ben and Phillip, I'm like, I, I don't think we should position this thing as, as mainly a CE thing. The CE is a bonus, honestly, because for, for the cost and being able to watch this in the comfort of my own home and be able to actually learn this quality amount of ship, I think we're selling gold nuggets is what we're selling. We're selling gold nuggets and, and opening Pandora's box for people. So our hope is that if you like those presenters, then you'll, you'll go.

Some of them have, uh, courses like Cody doesn't have a course. I don't, I don't know why he doesn't, but, but Phillip does, um, and Greg does. And into our next module, there's going to be people who have courses as well. And it's kind of snapshots into stuff that you'll be learning in there. So we can't possibly cover it since they're multi-day courses, but I thought we'd take some of the gold nuggets and the pearls of wisdom that, uh, you can definitely learn through that. So, um, I'll talk to you guys next week and leave people, but how you found them. And if you're dating, dating Eagle Scout, talk to you soon.