[00:00:01] Nick: On this episode of “In The RACK” podcast, if you feel like you're getting screwed, then you just need to do something about it or you feel like you're not getting the right answers, you need to do somebody, like if you're getting physical therapy somewhere and you feel like you're getting screwed, you got to find somebody else. You know what I mean? Don't give up on therapy, don't give up on the profession, give up on that provider, go find somebody else and that's what I did.
[00:00:30] PODCAST INTRO: Welcome to “In The RACK” podcast, where we provide you with the practical framework for breaking PRs in all facets of health and wellness. We are just a couple of bros giving you the simple house in a world of complex wants. No filters, no scripts, no rules, just straight talk, talk tune. Now, let's get into the rack with your hosts, Dr. Chad and Dr. Nick.
[00:00:55] Chad: Alright, everyone. Welcome to another episode of “In The RACK” podcast. I'm your host, Chad and with me is my co-host and fellow physical therapist, Nick. Yes, he is with me today. I've been on a little podcast kick on my own doing my own thing. And Nick's just like taking vacations and having babies and everything.
[00:01:18] Nick: I'm taking vacation next week. But I've been busy in here. My schedule has been pretty busy. But nonetheless, you have been on your podcast, I respect it.
[00:01:28] Chad: We did miss a few. But we also have been pretty good with doing our “Reckless: In The RACK” series. And we missed the last episode, which would have been episode 40. And this would be now episode, I believe it's 45. So that puts us right back into the next “Reckless: In The RACK” series. So for all of you that have not heard what this is, it's where Nick and I get a little “Reckless: In The RACK”. So basically, how it goes is, Nick and I, we share stories from our patients, and we like to share these stories r ourselves. I'm gonna throw a little twist in there today. So we'll see how that goes. Basically, we share these stories, and we like to share these stories not only because they're reckless, but some of these stories may actually sound very familiar could sound like your story. So you might be able to relate to some of these stories and that's the whole purpose of this. So we'll chime in, we'll give our two cents on the story. And it gives you a little information too, because if you sound like this story could be relatable to you then there could be other ways to go about your journey, whether it's wellness, health, fitness, rehab, whatever. We're gonna hit all the all the points. So let's start it off, Nick. What do you got for your first story?
[00:02:58] Nick: So I got a story. And if any new listeners out there, we give alias names, just so we respect all out there. So this individual, we're gonna go by beauty rest, because this individual really like to sleep, take big time sleeper. So beauty rest came with actually pain in both calves. And felt pretty stiff, pretty tight, but went to actually urgent care early on, because they were concerned that there might be something going on down there. And they ruled out blood clots and things like that. So they did all the appropriate red flag, tests negative for blood clot, negative for any cardiopulmonary issues that may have been influencing, like any kind of fluid retention or anything like that in the legs. And then went on to see orthopedic specialist because they rolled out the red flags, which would be typical. And, unfortunately, this individual beauty rest was told;
“Well, we're not quite sure what it is, but we think it might be compartment syndrome”.
Compartment syndrome is a real thing for sure. But you also with any radiating pain down into the calves, you should probably check the back. But compartment syndrome would be very specific to the lower legs, there's too much pressure within the soft tissues of the lower leg. So sometimes it is a very urgent situation and that it needs to be treated surgically. But the provider proceeded to tell the beauty rest, I think, it's compartment syndrome. But why don't you go try physical therapy for a little bit and we'll just kind of see what happens. Now, I'm glad they provide us a common physical therapy because that meant beauty rest came to us. But unfortunately, there's other people out there that may have seen this provider with similar symptoms and just been told to go home, but rested off, and beauty rest kept dealing with the symptoms and finally did come in. And we got to talk in a little bit, and I just did a simple test where I had beauty rest go through just some repeated extension on his stomach, and the calves just gradually started and pain started going away from the calves. So it was a kind of classic spine low back lumbar thing going on, where there was some radiating symptoms, nerve compression at the level of spine, and we went and did some extension and offloaded the nerves a little bit and the symptoms went away. So it was the conversation of, this is more stemming from the back, as opposed to. Beauty rest was very concerned about things going on the calves. Like, is it my ankles? Is it my feet things like that? So it was just a lot of education and saying, while your systems coming down, we really need to drive home this extension thing but then, at a certain point get into the flexion. And unfortunately, through the Western medical system, they didn't even go through any tests like that, and I asked and there was no even assessment of his movement, it was really just poke around touch feel. And we've said on the podcast time and time again, that a lot of times the side of the pain is not the side of the issue, so he's having issues in calves. But that stemming from his low back from the back, so we got to look higher up. So as a provider out there, if you're just looking at the source, or the side of the pain, you're gonna miss the source of it. So we got to look around, we got to assess movement, we have to assess the individual as a whole, ask more questions, be more thorough. And I know a lot of people going through the insurance model, do not have the time to go through all of those tests. But you can give an extra minute or two and maybe check some movements and be like, something's a little fishy, maybe we need to see and then direct towards the provider. Luckily, this provider did say go to physical therapy. So beauty rest was directed the right way. But unfortunately, other people out there might sent home, maybe with some medications, and anyone who's had any kind of low back issues or spinal issues, nerve related ridiculous pain shooting down the leg. Meds don't work too well for the vast majority of people.
[00:07:30] Chad: What's the number one medication that is prescribed for patients that have some sort of radiculopathy whether it's sciatic related or in the arms? Well, I don't Well, I don't know, by research, but by experience, I can say, look, the number one drug that most patients get prescribed is Gabapentin. I mean, I'm not a medical professional and a medical doctor. But I honestly have not seen one patient that has had a relief of symptoms with the use of Gabapentin, actually, and this is one of the only bring this up, because this comes up so often, with almost every single conversation that I have a patient that is on this medication, because the only side effect or the only symptom that patients usually report is brain fog, or they're feeling like lethargic, tired not themselves. And what does the doctor say?
[00:08:34] Nick: Just increase the dose.
[00:08:35] Chad: Well, that's a good idea. So it's, I just want to bring that up, just because if you are feeling that way, and that just happens to be a medication that you're on, you might want to talk to your doctor and see if that's okay for you to continue to take because we can't say, stop taking it. But I just want to let that if that's the way you're feeling, you're not the only one that feels that way.
[00:08:59] Nick: Advocate for yourself, ask that question. Because if you're feeling a lot of side effects, chances are unfortunately because this is the way a lot of these healthcare providers are taught. If you see a side effect from a med, you give another med, because they're taught from like a, through a pharmaceutical lens, pharmaceutical bias. So ask questions about your side effects if you are experiencing them and figure out if you really need to be on that med. Or, if there's another way you can go about it?
[00:09:30] Chad: I remember who you're talking about right now, because we were working right next to each other, and we were having this conversation. And while we were having that conversation, the patient that I was working on proceeded to talk about the bilateral carpal tunnel surgery that he had as I was working on his neck. It's funny because I had worked with this guy for probably four or five visits and not wants to even bring up the fact that even a carpal tunnel surgery. It's kind of funny how that works. But again that that that is very much the same situation that that Nick was talking about in terms of, is it really the side of pain? Did we just do a carpal tunnel release? Because I had pain in both of my hands. Was that really the source or the root cause of the problem? I can’t say, but I would say probably.
[00:10:21] Nick: I tell people all the time too. Even though I'm telling you the source or it's stemming from the back, there's probably multiple sites of nerve compression. So you have nerve compression at the level of the spine. Well, you may also have a protective muscular response somewhere along that nerve pathway that's also pressing on the nerves. So we need to address that too. And as much as we need to hone in a lot of attention on the source of it, we can absolutely spend a little bit of time going to the other areas. And that's an area where I think a lot of other physical therapists are like,
“No, I know, this is the source. So I'm only going to focus on here, it'd be silly for me to do the other stuff”.
But if this individual beauty rest, is having calf tightness as a result of some stuff going on at the back, is it wrong to give him some calf specific exercises? Absolutely not. It's going to make him feel better. But some would argue that, “No, it's not being caused by his cast, it's by his back. So I'm only going to give him back exercises”. Now, we're just getting myopic the other way. So you have too many extremists out there trying to say this not that or this is good, this is bad. It’s very, very rarely is anything that you can do from an exercise, rehab perspective, that it's getting them moving, it's getting their body moving. So don't look at it that way. Context is everything.
[00:11:50] Chad: Exactly. And don't do something because somebody said. Don't waste your time here. Because there's nothing wrong with treating symptoms, as long as you're treating the root cause of the problem at the same time. I wish I could come up with an alias for this person, but I'm just going to be straight up and just say it's me talking about. So I've been on this health journey for the last probably year and a half or so maybe closer to two years. I was your typical person that never went to the doctor, never went to the PCP, felt like I had this huge clean bill of health and never had to worry about it. Quite honestly, I was just like the typical person that was just not even waste my time. So a couple years ago, I'm going to take a stand, I'm going to go to my doctor for once, I'm going to try to advocate for my health. And this was kinda towards the end of the pandemic. So we were kind of still doing some zoom stuff, which was fine. And finally got an in office visit. And pretty much was told everything that I didn't want to hear which was, you got to change your diet, the doctor pretty much thought I was obese, just from talking to him on the phone because he's looking at my BMI, and he's looking at my age and everything else. I was kind of really just disappointed with the whole visit overall. I mean, he was a super nice guy, he was a younger guy. And that was kind of the reason why I picked him. But I just felt like he wasn't answering the questions that I was asking. He kind of kept on going around some of the questions I was asking, like my big thing. And just to give you all a little brief history is I got a family history of prostate cancer. And that was the main reason why I went in there. I'm like, Dude, I want to know that I'm good here. And everything that I brought up to him, he's like,
“Yep, you don't have to worry about that. You're not there's typical Doctor Response that most people get”.
So I said, can I just get labs done anyways? He's like, we can do them. It was kind of like if you want to do them fine, so I ended up getting them. And he didn't order any of the labs that were first of all specific to prostate, but second of all, specific to metabolic panels or anything like that. I didn't know anything that was going on. I just basically got to CBC and just pretty much got the runaround, so I didn't know what I was getting. And then I went to get my Zoom call visit with him. And nobody showed up on the other line, and I rescheduled again. So I said,
“Wow, this is great! This healthcare system is amazing. I got no answers”.
The doctor pretty much told me that everything that I didn't want to hear and it's kind of funny, because, Nick and I were pretty big advocates, we kind of stay on top of our research as much as we can. And I know what can make, the prevalence of prostate cancer better or worse based on your nutrition, based on your routine exercise wise and all that other stuff. So, I already knew that, I was I'm taking pretty good care of myself. And I knew that a lot of the skepticism in terms of what people think actually increases your risk for prostate cancer is actually wrong. And it was funny because the doctor actually told me,
“Hey, just do me a favor, don't do anything that's going to increase your natural testosterone”.
That was like the one of the last things he told me after he told me to go on a Mediterranean diet. And I said, “What for?” And he goes, “Well, because that can increase your likelihood of getting prostate cancer”. And I was like, “Okay, sure”. So I left and I knew that that wasn't true. And of all the research that I've done. So I kind of just let it go. And I'm like, what, screw it. It is what it is. The system sucks, whatever. So Nick and I actually attended a conference in Florida. It was the conference called “COACHED”. And it was in awesome facility called biofit performance in there out of Orlando. It was right around outside Orlando. And there were a bunch of great speakers there. And one of the speakers their name was Ally Gilbert. So, first of all, she had this presence. First of all, she's yoked out of her mind. And she was came in this hot pink, like jacked up jeep. Her talk was on testosterone, the testosterone epidemic in men and this is gonna be interesting. So pretty much everything that she had talked about, was pretty much everything that went against what the doctor told me, which I had known was true. So I'm listening to this. I was like, “Man, I got to talk to her”. So I went up to her after she did her presentation and I told her about my situation. She goes, Chad, you wouldn't understand how many times I hear that. I was like, Dude, it's so messed up. So I said, I want you to coach me. So she goes, “Great”. So she's been my coach since so probably five, six months. And about two and a half to three months in, I said, I'm gonna reach out to her and see if she recommends any PCPs up in my area that I could talk to you that give a shit. So she gave me a name of a guy that's actually in Tennessee, and of course, my insurance sucks, my insurance is covered anyways and that's totally fine. Like, I get the model. Like, we have the same model here. I'm fine with that. I've been talking to this guy, his name is Justin. And he's out of clinic in Tennessee called the restore clinic. And he does a lot of men's health stuff. And he pretty much was like, we need to order you this panel, this panel, this panel, and the whole time, I had ally, my coach on the line. So like, I felt like I had this good network that was kind of helping and coaching me through this process. And so we did all the tests. So he got the results of some of the tests. He goes,
“Hey, Chad, based on these tests, we get to order these tests”.
And I said, that makes sense. Again, it's was like $200, in total lab fees, big deal based on your health. I have to pay more than that actually, when I use my insurance, do my doctor's office which doesn't make any sense. So, got those labs, don't you know when I comes out, I have a thyroid issue. And I'm like, that's interesting. Nobody ever told me that my prostate looked amazing though. So I go in thinking, hey, I want to just take care of my prostate come out that I've got a thyroid issue. Again, it's not life threatening or anything like that. And it can totally be dealt with, but instead of just taking the approach of let's just pump you full of these meds, I'm now on supplementation to help improve that and take the stress off my thyroid. So that's kind of like where I'm at now. And I would have never been able to get there if it wasn't for somebody to kind of push me in that direction. And that's part of being an advocate for your health in general. So I know this doesn't have anything to do with rehab or physical therapy, but you wouldn't. You'd be surprised about how many people actually talk about their overall health and wellness in here. Like, they don't always just talk about like, their knee or their shoulder, there's always other things going on. And when they can hear your story and be like, “Wow, it's not just me, it's everybody, what I mean?” And how important it is to advocate for yourself, it really does make a difference. And I've said this before on other podcasts, but I used to blame the provider. But I've now just straight up blame the system. The system sucks. It doesn't set up anybody for success. And this is coming from experience from me because I'm going through it currently. And if you feel like you're getting screwed, then you just need to do something about it, or you feel you're not getting the right answers, you need to do something. If you're getting physical therapy somewhere and you feel you're getting screwed, you got to find somebody else. Don't give up on therapy, don't give up on the profession, give up on that provider, go find somebody else and that's what I did. And it's been great ever since. So my take home there is just you'd like you say, Nick, “You got to be your own medical provider. You got to be your own PCP and take matters into your own hands”. Because at the end of the day, these doctors are so busy, they're trying to meet quotas they're seeing. On the average, I bet you medical doctors, and I know this only because my cousin is a podiatrist. He sees 30 to 40 patients a day. How can you see that many patients day, and be able to provide the necessary information to every single one of them?
[00:20:50] Nick: For most people out there who don't work a job there requires you to be interacting with people all the time. Just imagine that going and basically introducing yourself to 40 new people. Maybe you've known the people before, maybe you're seeing them, maybe it’s co incidence, but just imagine that introducing yourself to 40 new people, and then having a conversation with them about something important and then to answer the next one. Like, that's exhausting. Again, I think, Chad used to give me a really hard time about this, but I think he's on board now that we need to give these providers the benefit of the doubt, because number one, they're not being trained in it through schooling to look at things the way that we're talking about and number two, they're just straight up overworked. So you need to ask the questions. So now the doctor is almost forced to have the conversation with you. And at the end of the day, it'll be refreshing for them, because it won't be the same mundane over and over and over, they're just going through the motions of 40 people in a row knees, shoulders, whatever kind of provider they are, but they're struggling themselves. So you can help them out by you asking some questions. So they don't have to feel they have five minutes to dig and trying to find go searching for treasure with you and your situation. So if you ask the questions that helps guide them in the direction as well. So it's gonna benefit both parties.
[00:22:16] Chad: I agree. Again, Nick, I was always on the other line where I was like, “Man, it's providers”. So I bet on the other side, I know. And I should know better, and some of the onus has to be on the provider, but how busy everybody is nowadays being able to like you said, ask the questions is super important and you gotta go in there, you gotta be ready. Because, again, the doctor is not going to know the answers to all the questions and that's why you're there. And if you don't feel you're getting what you need, you don't need a medical doctor to get a lot of these tests done, and you can do this on your own. It's pretty amazing how much you can do on your own that I did not even knew until about the last six months. We're trying to get affiliated with this. I don't know if it would be called a supplement company. It's a nutrition company. And they do like a lot of oral medication.
[00:23:18] Nick: It's natural stuff a pattern for a specific, it's called liposomal. Basically, most of their supplements are liposomal. So it would be typically sublingual, and it gets in your bloodstream that way. And the particular technology that they use allows it to be get to certain parts of the body without before it's broken down.
[00:23:41] Chad: You would think that you'd have to have some sort of medical license to do that, but we can do that as physical therapists. It's great. And it opens up the door for us to help more people. And it's amazing how much more time we have with our patients, and these questions come up. So even if you're a PT, listening to this, it's good to know the other stuff because you'd be surprised how much these patients open up to you and how much you can actually help them. Like, we have that one patient that you worked with her a little bit on her gut issues and everything else. And she's just doing so good, now and if she didn't have the network and the support here, then she probably would still just be dealing with it. So it's just amazing how much impact you actually have on somebody by being able to relate to them as well.
[00:24:33] Nick: I would say, for people wondering how do I do that? How do I prepare? How to ask the right questions? The beauty of the internet and do some research, you do research on your own. Even you're not researching the right stuff, it gives you ammo for questions to ask things like that. And if you go to your provider, your PCP, whoever even if it's your physical therapist, and they get defensive because you're asking health related questions, probably not the provider for you don't want your provider to get defensive once you start to infringe on their territory. It should be an open discussion. If you come in with say, “Hey, I found this article”. And they say, “That's really interesting. I haven't seen that. Can I see it?” And then next time, or even that time, they get back to you with a phone call or email and be like, “Hey, I looked through that article. Fantastic stuff, or they say, it was really a poorly done study”. Now you're like, “Okay, that makes sense.” So you want it to be this openness, this two way road, rather than you bring it up and they just get defensive? Oh, that's not the research I've seen. Because I've had that happen in the past with me too. I brought research on that guy that'll actually print it out and bring the papers, that's me. And they'll be like, “Oh, no, that's not what I've seen”. So I have it right here in my head. You can see it. So do some research on your own? It's out there. You just have to find it. And it takes time and practice and a little bit of that education to be able to sift through it, but you don't necessarily have to do that. That's why you bring that even if it's bad research, it's okay. You brought it to the table. And now that provider has a place to start with you, as opposed to just being, how do you feel just the general questions? Now, they try to narrow down in a five minute span. The clock's ticking. I only got three and a half minutes left. We haven't really narrowed down very far. Everything looks good. You're within normal limits on all the general stuff. See you later.
[00:26:33] Chad: I agree. And if they're getting defensive, it's usually for reason. And whether they're just having a bad day maybe, but it's most likely because they feel they don't know the answer and it's their way around it. So if you feel like that that's happening to you, then you need to find somebody else for sure. Anything else?
[00:26:55] Nick: I think that's it. That’s a lot of good information in a short period of time.
[00:27:00] Chad: Hopefully, it influences somebody. Because I wrote an article not too long ago on that whole thing that we had just talked about, and it really impacted one of our patients. So he's making some changes right now. So it doesn't take much. And even if it helps one person, it was totally worth the conversation. So we know that the healthcare system, it'll never be perfect. And we do hear these stories a little too often. And it's unfortunate, hopefully, that gets better. The best thing we can do is bring awareness, like what we're doing today and that's the full intention of the podcast. So we've said it many times, but you've got to be your own healthcare advocate, whether it's for physical therapy, whether it's for your own health and wellness fitness journey, any of those, you've got to be an advocate for yourself. So all we say is listen, if you're the health care provider, we just ask that you don't be reckless with other people's health. And for all patients that are listening, you shouldn't put up with those providers that are being reckless with yours.
[00:28:05] PODCAST OUTRO: Thank you for joining us “In The RACK” this week. Make sure to subscribe so you don't miss out on any future episodes. You can also find us online at proformptma.com, or on social media at ProForm PTMA. And remember;
“If you train inside the rack, you better be thinking outside the rack”.