Episode Eighty-Four.mp4: Audio automatically transcribed by Sonix

Episode Eighty-Four.mp4: this mp4 audio file was automatically transcribed by Sonix with the best speech-to-text algorithms. This transcript may contain errors.

Dr. Carol:
Hello.

Kim Pittis:
Hello.

Dr. Carol:
How are ya?

Kim Pittis:
I’m fantastic.

Dr. Carol:
Me too.

Kim Pittis:
Great.

Dr. Carol:
I just went to the orthopedic surgeon with Susan. She stepped off the curb and splintered her fibular head, her lateral malleolus. The gentleman that put it back together missed the fact that the tallis was lateral and it was the dislocation of the tallis that shattered the fibular So there’s another surgery on Friday. And the Rebound, it’s big orthopedic group, Rebound surgeon was so professional Did not throw the first surgeon under the bus. The first surgeon just pulled the splinters together and didn’t look beyond the incision. So what he said was the fibula is too short. He didn’t say, the first surgeon put it back together wrong. So proud. He was so diplomatic. I was taking lessons. Taking notes. Be diplomatic. Got it.

Kim Pittis:
It’s not always easy because you see so many of the broken missteps. Right? I remember when we were recording one of the pain and injury modules during COVID, and we had a patient that came in who had a horrific motorcycle accident.

Dr. Carol:
Oh, that one.

Kim Pittis:
And it was like super complex. And there was pain. And he was talking about getting a spinal stimulator. And you were just like, right away. And like, they were like, What? And you’re like, I shouldn’t have said that because it does work. But I just see all the ones that fail. Right. So that’s just the perception. Those are just the demographics. That’s just what you’re in the weeds with all the time.

Dr. Carol:
It’s got to work on somebody. I just never see the ones that work.

Kim Pittis:
Why would you? Because if it worked they’re out of pain and they’re doing their thing.

Dr. Carol:
Yeah. And then when you talk to the guys that put them in. The guys that put them in say they don’t work. X percent of the time. They don’t work at all. Most of the time, spinal chord stimulators work for about 12 to 24 months and then the nervous system escapes them. Yeah, it just figures out a way around it. Yeah. And then you still have leads and wires inserted into your spinal cord and no way to get rid of them. I don’t really have just a white turtleneck on. I have my Snoopy sweatshirt on. You love my Snoopy sweatshirt.

Kim Pittis:
I love Snoopy.

Speaker3:
I have a very big topic today.

Dr. Carol:
I’m so excited. I was so waiting for your topic.

Kim Pittis:
It’s one word. But it’s got many little facets all around it in different interpretations. So the word today or the theme today is instability. Well.

Dr. Carol:
Talk to me about that.

Kim Pittis:
Okay. I’m going to. So we throw the word instability around all the time. And we actually had a practitioner or a patient, somebody had written into us to postulate the question for the podcast, which I’m going to address first, but then I would like us to use this opportunity to talk about the different types of instability that there are both physical and when we get an emotional component. Told you. I’m like, just. Very ambitious today. You are. I’m full of stories about this topic, so part of me is needing to, like, talk and debrief and ask you some things and the rest of everybody.

Dr. Carol:
It sure makes me wonder what your week has been like.

Kim Pittis:
My week has actually been fantastic. Like I’ve had. The universe is throwing me so many of the patients that I dream about coming in and success stories of them coming in. But there’s a couple other things that we need to talk about. So I’m going to read part of the question that we were asked and. I’m going to paraphrase it because it’s very long. So the first part of the question was talking about cranial cervical instabilities. So let’s start with that, because this is part of the Core.

Dr. Carol:
We both got that email. I remember that. Yes. Yeah. And yeah.

Kim Pittis:
And it went into different areas. But let’s just start with some of the reasons why somebody could present with cervical spine instability.

Dr. Carol:
There’s another way of phrasing that which is, some of the ways that people are diagnosed with craniocervical instability without any imaging done to prove it.

Kim Pittis:
And this is why when I was thinking reading the question and thinking about the answer and patients, this is exactly what I wanted to touch on because people are throwing around the term without, you’re right, any imaging to back up Why do you think it’s unstable?

Dr. Carol:
And there is such a thing as CCI, Cranial Cervical Instability which means that the ligaments that hold the occiput, C1 and C2 together are loose or have been injured. But you have to have proof. There’s a set of symptoms that indicate, yeah, that’s probably what’s going on. But then you do imaging. At least AP one side bending for sure. A thin slice MRI is best from just above the occiput down to C2 with a 3 tesla. So you’re getting one-millimeter slices which are really tiny and it’s in a very small area. So if there’s a tear in one of the ligaments that holds the occiput C1 and C2 together, you can see it on a thin slice CT. You don’t just casually tell somebody, Oh by the way, you have CI, That’s a big deal. That’s surgical. Go.

Kim Pittis:
Yeah. No. So part of that, I’ve seen so many patients that have come in that have said that they have it with, like you said, zero proof. So then you’re asking, who diagnosed this? Oh, my chiropractor, my PT. But they don’t have imaging. No. Okay. Or it’s I Googled it because I was in this motor vehicle accident and my symptoms seemed to fit this. Okay. I can’t imagine what medical doctors go through with Dr. Google being out there and people being able to throw together symptoms like that.

Kim Pittis:
So, let’s keep going on that, because the person that had written into the question was asking about treating the ligaments, the facet joints. What do we do? So if somebody does have true diagnosed, backed up with imaging, cervical spine instability. Go. That wants to avoid surgery.

Dr. Carol:
Oh, from a malpractice and medical responsibility standpoint. I know you don’t want surgery and the first person you’re going to talk to is the best neurosurgeon for CI within 200 miles. I don’t want surgery. You don’t have to want it but it may be the only way that you keep your brain stem intact Your brain stem is in charge of breathing and all sorts of important things. Do the worst first. If the surgeon looks at your imaging, looks at your symptoms, does a physical exam, and the surgeon says it is safe to treat this conservatively. I want you to go to PT. I want you to do exercises. Do not get yourself adjusted ever in your neck by a chiropractor. If the surgeon says it’s okay to treat it conservatively, then I’ll touch it.I’ll order the imaging. And if there’s no instability, then if the patient insists that she has craniocervical instability.

Dr. Carol:
Because we operate on the thin edge with such difficult patients doing a medical referral. As if it was the worst it could be. Is just common sense to me.

Kim Pittis:
I agree. And I’m sure the Bay Area surgeon that sees all my patients for not just his opinion, but I will send him second and third and fourth opinions. I think people should get as many opinions as possible. And I think I think you need to be an advocate for your own health. And yeah, I think just adding to that, seeing one surgeon, that is great because the surgeon that I refer to. My first go to for a surgeon doesn’t like to operate all that much. That’s why I like him.

Dr. Carol:
No neurosurgeon in his right mind likes doing a CI surgery. They’re terrible. It’s an awful and it’s a dangerous surgery. But it’s also a dangerous injury.

So the risk and the reward are this.

Dr. Carol:
Usually, there is surgeon, number one and surgeon number two. And if all three agree, then it’s up to the patient. Are you willing to take the risk? And then you document the consent and you start using 124/101, 24/77

Kim Pittis:
Right. Have you had any success?

Dr. Carol:
I’ve treated one patient who had. I think she was a Chiari patient because they sometimes go together.

Kim Pittis:
And do you want to explain to patients who are listening maybe what Carrie is.

Dr. Carol:
This is my understanding and I admit that I haven’t googled it lately, so I might be wrong, but a Chiari malformation is where I think. It’s where the foramen magnum is too big and the cerebellum gets pulled down into the foramen magnum. So the cerebellum gets squished. The patient has certain long track symptoms that are specific. Sometimes it’s seen on an MRI of the neck that goes up low, and they see the cerebellum, what they call the tonsils, the little bottom part of the cerebellum hanging down. And the Chiari Malformation is the foramen magnum is too big. So basically they take the back of the occiput off. That’s a short version. And the trouble with that is the occipital nerves, if you look at the back of the skull, everything that’s over the occiput.

Dr. Carol:
It’s a very difficult surgery and I didn’t have very good luck with this one that I tried. So I’m not a fan. But if you’re reading the same case that I think you’re reading. The patient said they treated her Ehlers-danlos. Is that the one? Oh, different one. Okay. Different question. Okay. Louise, please mention the condition tissue name and the frequency. As you mentioned, 124 is torn and broken. And if you look at craniocervical instability, C1 is sloppy, right? And it moves too much because the ligaments that hold it in place are too loose and so torn and broken and the ligaments. But also there’s some really dense. So 100 is ligaments. There’s some really dense connective tissue there. So it’s 77. Oh, remind me to tell you about the miracle for the week that happens when C1 and C2 move too much during an auto accident. Just remind me. So don’t forget.

Kim Pittis:
So I want to postulate another question here, and this is when I think of instability with extremity joints, because I see that a ton with athletes that have had injuries to areas that were not surgical but got extremely stretched out and consequently that joint doesn’t function properly, It works. But it doesn’t work as efficiently as it could if the ligature and everything were intact and quote unquote, normal.

Kim Pittis:
Here is what I see in my head. I’m going to go to the knee because we typically or the shoulder because this is typically two areas where we see a lot of. Let’s go to the shoulder. When and we talk about this in the Core all the time when you make somebody worse. So somebody comes into you with shoulder pain and it’s not frozen shoulder, but you do see some discrepancies with some things restricted, something is inhibited.

Kim Pittis:
Blah, blah, blah.

Kim Pittis:
And you treat scarring and the tissue goes smush, and the patient is euphoric and everybody is happy. And then you get the angry call. The next day, they’re worse. Two things happened. One of two things have happened. One is your treatment was amazing. You’re amazing. The patient felt amazing, maybe too amazing and completely overdid their activity. Or the other side of the equation, in my opinion, is that there was some instability in the joint and the muscles, in the rotator cuff especially, had created a vacuum seal to try to keep the shoulder stable. Hypertonic, created adhesions. And you release those adhesions because you’re amazing and it became quote unquote loose, “The joint is in a different position”, and that increases the nociceptive feedback, saying this is wrong.

Dr. Carol:
And you’ve got if you think about the shoulders and impossible joint to begin with. It’s held together by two ligaments. There’s not a single stable surface in the whole thing. And it’s all held together by muscle balance. There’s 9 burses, which means there’s at least 12 tendons. Round ones, flat If you take the scar tissue out of, let’s say the subscap and you still have partial thickness tears, once the shoulder starts moving properly, those muscles are going to try to fire. The Infraspinatus and the Teres, which and maybe the supraspinatus muscle are the ones that are usually torn door partial thickness They have an opinion about; What do you mean you want me to work now? I’m broken. And you didn’t know I was broken before because everything was glued down and your armpit was scar tissue for a very good reason. So that I could…

Kim Pittis:
I want to go further.

Dr. Carol:
Of course.

Kim Pittis:
When you have a joint that is malaligned. So let’s go back to the knee or towards the knee. And we talk about things like Patellofemoral syndrome, where the kneecap is tracking. You’re rolling your eyes, but it’s like a real thing where kids…

Dr. Carol:
It has nothing to do with the patella or the femur. Let’s just clarify that.

Kim Pittis:
Yes. So for whatever reason, the patella is not tracking as it should.

Speaker3:
I call this an instability because it is not. See, this is why I want to use the word today because or an imbalance. There is an instability. Because when I do a strength assessment or a squad assessment or a lunge assessment or I look at video of the athlete doing sports I can see that the patella is not tracking properly, there’s an instability somewhere. Something is inhibited, causing the patella to not track as it should, or there’s a tightness somewhere causing the patella to not track as it should.

Dr. Carol:
If I get to vote, I go with your second word, which was imbalance because the patella isn’t unstable. It is doing exactly. It doesn’t get to go anywhere. Its doing exactly what the muscles tell it to do. And the muscles are imbalanced. Why?

Kim Pittis:
For sure. You could also say, and some of the strength coaches would say, because of that imbalance, it’s creating instability in the chain. If you’re making. And I’m not saying you’re wrong, I’m just trying to.

Dr. Carol:
No, it just outside my skill set. Don’t look at it that way. But that doesn’t mean they’re wrong.

Kim Pittis:
No, we’re seeing the same thing, but we’re using different words, right? If I’m playing, what’s that game? Jenga. Right. That tower of blocks, right? Yeah. Pull one out and put it on the top. If I’m creating a lot of strength on one side. And then building things up on the left. But I’m always pulling from the right. I’m creating an instability in the chain. There’s a weakness somewhere, and I think that’s just you and I are saying the same thing. But that’s the reason why I wanted to use this word instability today, because it means a lot of different things to a lot of different people.

Dr. Carol:
I’m just really careful with that word because it has a very specific meaning. So your ankle is unstable when the ligaments that hold it where it’s supposed to be. So if you’ve had previous ankle sprains, inversion sprains, for example, you’re a lot more likely to have Tarsal tunnel, because the talus and the tibia and the ankle is unstable. That has a particular meaning. The ligaments that hold the bones together don’t hold the bones together. They’re too long. And the joint is sloppy to me. That’s what instability means. You’re using it in a completely different way. Imbalance, I’m with you. 100%. Unstable has a very specific meaning that I’m not sure I’m willing to let go of.

Kim Pittis:
So, no, I’m not disagreeing with you. I’m just pulling verbiage that I have heard throughout the years.

Dr. Carol:
You’re allowed to disagree with me. Speaking of emotional instability are chronic pain patients that have identifiable pain generators that make sense. That have been told by a fairly unconventional, let’s say, physical therapist or massage therapist that such and so. Your. Whatever. C1 and C2 is unstable or your pelvis is unstable. There is absolutely no evidence except for this intuitive psychic therapists opinion. Her hands tell her that you’re unstable and she doesn’t back it up with imaging because she can’t order imaging. And then the patient who is fearful already because the pain is so high and that turns the vagus nerve down. The patient is fearful, already becomes terrified because now she’s unstable. Yeah. Her body is something she can’t trust. And that. I’m just I’m really careful with the word because I see people come in that are just terrified because of what they’ve been told.

Kim Pittis:
Yes. And this is another point that I want to talk about. What you were just saying is when I’m talking to the practitioners out there right now, and I have been guilty of this in the past until it bit me, is when you get excited about undoing scar tissue. It’s super exciting. Smush And having tissue melt under your hands is what gets me up in the morning. However, it comes at a price. So like you were saying, I’m going to go back to the shoulder is when you are undoing all the adhesions that have kept that shoulder. Quote unquote, “functional”. It is important that you don’t use that word to your patients. So when if you make it worse and they come in, you’re not going to say, Oh, I’ve created some instability now because scar tissue is the only thing that was holding your shoulder together. That’s not accurate. That’s not helpful.

Dr. Carol:
Yeah. And the thing I’m more likely to say is. Oh, good. Now we know now we get to look at what was under. We relieved the adhesions between that nerve and the muscle. And we treated that nerve and we treated those muscles. And that gave you. You notice that your pain pattern is different? Oh, yeah. Yeah, it is. Okay, now we get to go over that. Compensation. So people ask me how many visits does it take? You never work on the same thing twice. So you work on the first thing first, and then you may work on a piece of that first thing. But the second session is almost always to address the compensations that the body put in place to protect the joint muscle, that was injured or adhered or scarred down So you work on somebody’s shoulder and two days later when you see them, their low back hurts. What connects the shoulder on the low back, the latissimus. It attaches to the inside of the arm and it goes to the low back fascia. I am not entirely sure what evolutionary paradigm decided that we needed to have our shoulder and our low back connected, but that’s the reality of it. So you work on somebody’s shoulder and the next time you see them, you work on their shoulder again. But now they have low back issues.

Kim Pittis:
I try to tell that to patients, too. I try to say there’s a four-letter word in my vocabulary that starts with S and it is SAME. I never want to have somebody the same as when they came in a pain scale and a range of motion. That doesn’t change from the moment they walked into the moment they walked out. That never happens. But I’m just saying that would be a complete and utter failure. There’s always change, right? You never want a patient to come in to say, How is it today? It’s the same. No, make it better, Make it worse. Make it do something.

Dr. Carol:
If it’s exactly the same, it means you’ve done the wrong thing.

Speaker3:
Totally.

Kim Pittis:
And to patients listening like I don’t want to say that make it worse. Sometimes the pain does go up. And that is to your point, it’s a good thing. It means muscles that have been turned off or turned on now and they’re working. And sometimes there’s a bit of a sticky area where things that have been offline and now are online, they it takes them a while to to normalize. There’s a process involved.

Dr. Carol:
But it’s your shoulder, your hip, your knee, your ankle. Most body parts are run by a committee. You have your shoulder, shoulders run by a committee of muscles and nerves. Your knee is run by a committee that includes a bunch of muscles, ligaments, bursa. Everything on the hip and everything in the ankle and the foot. So it’s a very large committee that runs your knee and they all have to learn how to communicate together. So it’s fun.

Kim Pittis:
It is fun and it is frustrating for patients sometimes. And a lot of the exercises that clients do with me are super boring, frustrating, tedious, little muscle setting or muscle activation exercises that nobody wants to put on TikTok or Instagram because you could barely see anything firing. But that is an important component in my opinion. And somebody had just written in joint instability versus instability in the kinetic chain. Yes, I like that.

Dr. Carol:
Balance in the kinetic chain. Yeah.

Kim Pittis:
Yes.

Dr. Carol:
So that’s a good distinction, Diana.

Kim Pittis:
Yes. And like I said, depending on who you talk to, like trainers will say there’s an instability in the lower chain. Okay, you like the word imbalance better. We can agree to disagree on that.

Speaker4:
No, But.

Dr. Carol:
Tell me, what do they mean when they say instability in the lower chain? What does that mean?

Kim Pittis:
A lot of times when I hear that verbiage, it means that something is not firing, causing a weakness, causing a movement pattern to be suboptimal, and the potential for injury to occur is greater.

Speaker3:
Like the opposite.

Kim Pittis:
Of instability would be stable. Something is stable. It is reliable.

Speaker3:
It is strong.

Dr. Carol:
And then you have certain sports, certain weightlifters. Football players are the ones that I’ve seen, but they work on their pecs to the point that their shoulders are forward. Yes, they’re pecs are huge. They look great. They’ve got a six pack, they’ve got big packs and their shoulder is a disaster waiting to happen because they can’t stabilize posteriorly. And it’s fine if they’re in a profession that the only thing they have to do is this. But if they ever have to do this, they’re stable. But it’s wrong. Dangerous. There’s nothing unstable about having a posterior chain in your shoulder that doesn’t fire at all. In a normal activity? Yes. So it’s stable, but it’s. See what I mean?

Kim Pittis:
I do see what you’re saying. I’m just I’m forward thinking to my daughter who dislocated her shoulder and. A little while ago. It’s fine. It’s fine.

Dr. Carol:
Fine.

Kim Pittis:
Because we had FSM on the way to the emergency room. Because. Because we couldn’t. Long story. Endless. Nobody wanted to order an MRI. Because why? Shoulders dislocate all the time. What do you need to see the soft tissue for?

Dr. Carol:
Why would you check the labrum in a shoulder that just dislocated? Okay.

Kim Pittis:
So took two weeks to get an MRI. At that point, they’re like, oh, it’s it tore, but man, is it ever healed. But it’s incredible how much healing has gone on by now. I’m like, Duh! Because I just assumed everything was torn in there. So we just. She lived with the CustomCare running 24-7. So the point was, what do we do? Do we operate? Do we inject it? Do we leave it? Do we rehab it? What do we do? The odds of her dislocating her shoulder. Are up to about 70 to 80% for a second dislocation. But it also doesn’t have to be 80%. That statistic is from what? What was the sample size I am the worst mother that a doctor could ever. I ask way too many big questions. And so when I get that statistic, I’ll say, what does that sample size based on? What is 80%? Who is surveyed? Where did that number come from?

Dr. Carol:
And what was their rehab after the first dislocation?

Kim Pittis:
This is it. Let’s say it again for the folks in the back. What was the rehab like? Because a lot of times, and this is what I argued, the fact that they just reset the shoulder and set her on her way without looking at any of the soft tissue and with any instructions tells me, there’s a reason why 80% of these kids are dislocating again, because there has been zero follow up.

Dr. Carol:
And the rehab wasn’t aimed at preventing the next dislocation. If you have an anterior dislocation, there’s an 80% chance you’re going to have another anterior dislocation unless your rehab has been aimed at preventing the next anterior dislocation.

Kim Pittis:
Exactly. Yay. Thank you. And so let’s talk about that. This shoulder was deemed unstable, right? And absolutely. Torn and broken was running around the clock I also ran trama. I also ran bleeding. Right There are events that led up to the torn and broken. I’m going to ask you another question later. We talk about how much our practices have always changed with FSM. My question to you is, what is always stayed true to you? What have you not wavered from?

Dr. Carol:
Wow.

Kim Pittis:
And I’ll give you the rest of the podcast to marinate with that. But what’s been true for me is always trying to figure out the cause of something. And I think that’s why I do well with FSM. Thinking is I was never satisfied with this is tight, this is weak. But why? What is the neighbor? What’s going on above and below? But why?

Kim Pittis:
And I don’t always have all the answers or ask the right questions. But I think always thinking about but why is helpful. So with the shoulder there was it didn’t just tear and break from outer space. There was an event that happened to it. So in the motor vehicle accident, in a sporting accident, there’s an event that takes place. So I never used to use trauma as much as I like to insert it now, there’s a reason why it’s in the beginning. I don’t question why it’s in the beginning, but now I know now why. It’s in the beginning, because the trauma happened before the pathology happened. There was something that started the whole thing. Right. This wheel in motion.

Dr. Carol:
I’m so proud.

Kim Pittis:
Thanks. When there is an instability, like I said, we tend to just go to 124 and I do think that’s a great place to start because it will take the pain down right away. You do get the smush Everything that was around the unstable or instability that was protecting it will start to just be like, Oh, thanks. But there’s always more, right? I think especially in the case of a motor vehicle accident or an athletic type of incident, the bleeding, the trauma, Everything that we run in the basics is is really important to run too.

Kim Pittis:
There is a question that just popped up.

Dr. Carol:
I saw it. But I have never wavered from is 40/10 because every nerve signal comes up through the spine. She’s saying from the spine, but it goes up to the brain and 124/77, because that’s torn and broken in the connective tissue because something’s torn and broken.

Kim Pittis:
Yeah, that’s a that’s a good point. With the population that I work with athletes like the DOMS protocol and I’ve made quite a few workout recovery protocols for my athletes. It’s 124/77, 124/46. It’s the muscle like the sarcomere or something is torn. And it doesn’t have to be a big tear, like microtrauma happens all the time. So going back to the shoulder for a second, if I hear one more person come in that tells me they have tight rhomboids, I might just. I don’t know. Nobody has tight rhomboids. Just for everybody that listens to this podcast. I have not in 24 years of practice seen anybody with bilaterally tight rhomboids.

Dr. Carol:
If you think your rhomboids are tight, you have a cervical disc bulge. That’s just how that works.

Kim Pittis:
Okay, but on a functional level and people who are listening to the podcast, you’re just going to have to watch me on YouTube for a minute. Tight rhomboids would be. You’d have somebody retracted when they came in the rhomboids retract the shoulder blades. So no, what we have as a global epidemic are chronically elongated, stretched out, weak, inhibited, rhomboids because everything we do is in front of us.

Dr. Carol:
So they’re concentrically contracting all the time. They’re elongated.

Kim Pittis:
Yes. So patients, if you want to tell me you have tight rhomboids, you could say you have micro slips of eccentrically contracted rhomboids that I will accept because the rhomboids will try to retract you. Our body is smart. We never want to be hunched over. It will try to retract, but there’s only so much those little baby rhomboids can do. They’re so cute. They try so hard. I just want to give them a little hug. You get slips of these muscles that are working so hard to try to retract. But what ends up happening is they get adhered. And this happens over a length of time. And there you go.

Dr. Carol:
And the rhomboids are. If you look at the action, they don’t work independently, right? You can’t even think about the rhomboids working without the lower traps.

Speaker4:
No. And that’s another muscle that people have a very hard time activating. When our upper traps are hyper-activated and you get reciprocal inhibition with the same muscle. So when our upper traps are activated, which we always are, the lower traps are inhibited because they have to. So we could walk around all stressed out with our shoulders in our ears. One of my favorite exercises to do is getting low trap activation People want to use that big lat muscle. But when you get them to engage their lower trap, the upper trap gets inhibited. So people are like, Oh, I’m doing those lower trap exercises and my neck feels so good. Yeah, because your upper trap can finally just turn off for a little while, have a break, take a breath.

Okay. We have a question that came in on the chat really quick. It is a little bit off topic, but not really because does treating Ehlers-Danlos with the protocols we know? Does POTS respond or is it best to also address it separately with specific protocols?

Dr. Carol:
Ehlers-Danlos is what do we decide four maybe five machines. You treat 124/77 to shorten the connective tissue and you treat 40/10 to take care of the body pain. So we think of the pain with Ehlers-Danlos because it appears in the joints. They think of it as being in the joints. If you look at the pain diagram, it’s a 40/10 because disc annulus is made of connective tissue, which isn’t very good. The other thing with Ehlers-Danlos is you treat the Vagus because the Vagus is turned off or down by infection, stress and trauma. When an Ehlers-Danlos patient stands up. They’ve got a pound of food in their stomach, let’s say, and it pulls on the vagus nerve, creating basically a vagus nerve traction injury. And because their connective tissue is always tearing, there’s always trauma and little bits of connective tissue that keep the vagus turned off and that gives them POTS. So you run. Vagal tone and you either run 81 increase secretions in the Vagus for a longer period of time or vitality in the Vagus for a longer period of time.

Dr. Carol:
And we’re talking 60 Minutes here. And at least everybody I’ve taken care of with Ehlers-Danlos who had POTS when they laid down on the table. They don’t have POTS when they get off the table. And that leads us to the patients with tethered cord. If you think about the connective tissue getting tighter, pulling on the spinal cord gets worse. So if they have a chiari, which is not uncommon in EDS patients. You pull on the spinal cord that’s going to pull the cerebellum down into the hole a little bit worse, and they’re going to end up with pain down the spine. And their spine hurts because now the connective tissue in the spine is shorter or the dura is shorter. So you treat scarring in the dura, scarring in the cord after you’ve treated the Ehlers-Danlos. So There’s a fairly predictable sequence that means Ehlers-Danlos patients are treated almost unattended for 60 minutes. So you can go see somebody else and then come back and do the tethered cord and make sure the Vagus is okay. So. I just love Ehlers-Danlos is so much fun.

Speaker3:
And yeah, I haven’t even really heard.

Kim Pittis:
I haven’t had any patients in the last five years with it. I don’t know why that condition has become. I don’t want to say more popular, but it just seems like everybody’s talking about it right now. There’s maybe it’s just our community, I don’t know.

But it could be our community because why would anybody talk about it when they can’t? They don’t look for it because they can’t treat it. Yeah, our community talks about it because we have a way of treating it. Yeah. So these days, anybody that comes in with chronic pain, first thing they do is put their hand on my desk and lift their little finger. I have their history in front of me. And before I do the physical exam, do me a favor. Put your hand there and lift your little finger. And the little finger goes to a hundred degrees and you go, okay, so how about your elbows? How about your knees? All right, now we know what you have. And what else is going on We look for it because we have a way of treating it, which.

Kim Pittis:
It’s your miracle. Comment now, right? Yeah.

Dr. Carol:
It’s like, impossible, I’d say when you ask me, what is it I’ve never wavered from? And that is, always look for the cause. That’s what drives me. Look for the cause.

Dr. Carol:
This patient had an auto accident. And those of you that know anatomy, there’s this one slide in the Core now where the vertebral arteries run up all the way down the spine, actually. But up at C3, C2, C1 into the brain. The vertebral arteries run through these holes in C1 and C2 and C3 out on the transverse processes. There’s a hole for them and it’s big. And this lady had an accident with her head turned to the left. And because of the way her head moved back and rotated it dissected. It tore the vertebral artery. So she came to San Francisco, which I didn’t remember. She came to San Francisco December of 21, and her symptoms were thalamic pain from her head to her waist and her right arm. It was just in that one quadrant, right? We treated her with 81/10 40/89, quiet the midbrain. And things got better. She took the course, she bought a device, she started treating herself. And this is the cool thing.

Dr. Carol:
She does 81/10. Therefore she does 81/94. Therefore she does 81/89. And it works. It takes down the spasticity, it takes down the pain. And I can hear myself say, don’t get attached to your ideas. You got to be kidding me. Then you look at her face and this side, she has cheekbones like yours. You know, you have cheekbones and you have smile. And there’s this little round thing. She smiles, and the right side of her face is flat. And her right eyelid. Droops. That’s 7/5. That’s not 94. The fifth and seventh nerve come out of the PONS. And I’m treating her. And the day before, we treated the vertebral artery for vitality. And it doesn’t like torn and broken. She’s really sensitive to the frequencies, so she knows right away it really doesn’t like scarring, doesn’t mind bruising. That’s all. Fine. Vitality in the artery. It’s a good. But thought of 81, I wonder. So I ran increased secretions in the PONS. And the right side of her face, started filling up and her right eyelid started resuming normal position.

Dr. Carol:
And I thought if you tear the vertebral artery. What do you get? You get hypoxia. That’s a that’s an AB pair. That doesn’t do anything. What is the lack of circulation and the lack of oxygen due to the brain? Trauma. It kills certain of the cells. Necrosis. And she just said, Oh, that feels really good. So, Necrosis. Have you ever in your life run necrosis in the PONS?

Kim Pittis:
Yeah.

Dr. Carol:
No. Necrosis in the thalamus and the midbrain. But it makes sense if you back to what caused it. So not only did it work, it held overnight. You look at her face and it’s symmetrical now. And then. As an aside, at the end of all the miracle stuff. She had a facial reconstructive surgeon inject her own body fat around her lips to make them look a little fuller when she was early 40s It didn’t go well. It scarred and made lumps and all that stuff. So we land sclerosis in the adipose, inflammation in the adipose and sclerosis in the adipose and the 58s. And we’ve got one little place here that hasn’t resumed its normal tone. Yeah, it’s be realistic, expect a miracle. And none of those things are anything I’ve ever done before.

Kim Pittis:
No, but when you reverse engineer it and you talk about it, it makes complete sense. And that was my whole thing with hypoxia and frozen shoulder to get at an area. But now I want to go back and try necrosis in there for the ones that it didn’t work If you’re thinking about hypoxia, then you’re thinking about necrosis.

Dr. Carol:
And necrosis and what? It would be necrosis in the sarcomere. Yeah. Necrosis in the tendon. Yeah. And then there’s 58, which as an A is degeneration. And it’s an Advanced sequence. I put it together in the Advanced and it’s quite fun. That was what I was all excited about today, was to be able to do that.

Dr. Carol:
And there’s another thing that needs to be one of Carol’s rules. When it doesn’t make sense, you’re missing something. Patient had a lumbar MRI, so she had an auto accident. Messed her up for about 18 months. She was getting better, so she lifted her dad. That made her worse for a couple of days. And then she lifted a boat or did something. And it’s been five years She comes in limping and I do a sensory exam. She won’t tolerate any low back orthopedic exams, and she has an MRI that shows no disc bulges. And I said, I don’t believe it. It’s like there’s no way to have everything from L1 to S2 lit up like a Christmas tree. Hypothetic numb, painful, terribly. Pain doesn’t make any sense. 30 minutes after she left. SI joint. She has the worst joint tear I have ever seen. And she has a well-meaning, very kind, very good naturopath who injects with prolo and steroids, but all aimed at her low back. And she lays in a way, the only way she can lay is on her stomach with her leg out. So it approximates the SI joints.I keep forgetting. What is it? 3 slides in the Core. And so. That might give you something to do next year for three hours. Let’s talk about SI joint tears because it’s so complicated and getting them to heal. Yesterday I taped her.. When you tape an SI joint I’ve torn both of mine one of them twice. One of them once. They put the white tape on, they put rock tape on and an X to hold it together. This one I had to put two layers side by side of white tape, skin tape, and then grab the ilium and drag it over to the sacrum because she’s torn the upper and the lower joint. It’s amazing. o get her out of pain, I had to treat. I had to remember the slides. Yeah. SI joint is a facet joint with lots of ligaments. And you treat nerve pain. That was it. So she came in at a seven and she left at a two.

Kim Pittis:
Nice. So want to get to Debbie’s comment here quick before we wrap. Debbie says, I treat Hypermobility and use the thumb to wrist point. Tell patients that this has made such an effect on your inability to touch your wrist. Because after my 49/100, you can’t. It must make a difference to all the ligaments in your body. Am I right? Because I can tighten up ligaments in the wrist. It must affect the rest of the ligaments in the body, shouldn’t it?

Dr. Carol:
It might affect the rest of the ligaments in the body because sometimes in order to actually. It’s a good question, Debbie, and it’s a good strategy. Sometimes you have to concentrate the current at the local site to have a maximum effect because you increase the ATP.

Kim Pittis:
This is very specific to specific people. Some people, you’re right, you’ll be working on their shoulder for instability and they have an old injury in their ankle and they’re like, I don’t know what you did to my shoulder, but man, my ankle felt fantastic also. And then you’re right, some people you literally different machine or move the contacts and sandwich the area in the extremity that you’re working on. That’s interesting. Okay again like we got through a good part of my list, but not all of it.

Dr. Carol:
I just looked at the clock. It’s 4:00!

Kim Pittis:
The fastest hour of the week.

Dr. Carol:
Amazing. It’s so fun.

Kim Pittis:
So my housekeeping note here is for the sports course. We have room to make it bigger if we need to in Troutdale. So that’s super exciting. So if you are interested in hanging out with us May 20th and 21st, let me know, sign up. I’m going to send an email with some lodging things I have to talk to. Kevin People are asking about hotels and stuff, so I’m going to get that information out to my people. I have a quote we didn’t really talk about like emotional instability. Let’s touch on that next week because that’s a bit of a process. But you okay, being the everlasting optimist and cheerleader that I am, when I see patients that have these self-limiting beliefs and I’m sure you see that too, people who have had pain for so long, this is never going to get better. I’m never going to get faster. When they have that, that can be as big of a barrier as any piece of scar tissue can be. So I found this quote and I think I do want to put it in the clinic somewhere is “There are no prison walls stronger than the ones you cannot see.”

Dr. Carol:
Oh, that’s a good one. I like that. Yeah.

Kim Pittis:
So we can be like the prisoner of our own thoughts and prisoner of our own beliefs and everything else. Yeah, I thought that was a very powerful statement.

Dr. Carol:
It’s like asking a fish if it’s wet. It’s of course I’m wet? You know. And patients who have been raised in an abusive, emotionally traumatic, constant negative environment. And then they become a pain patient. They, almost from birth, childhood, have been taught to expect the worst. They don’t deserve to be happy. And it’s unconscious because it’s just. It’s asking a fish if it’s wet. So then getting that patient to recovery. The first thing I did with this patient, we become what we think. Thank you very much, Tom. Yeah, but you have to have a language for it. When you have a patient whose life experience is. No one has ever cared for them. Yeah. No one has ever loved them. Mom was and addict. Dad was an addict. Six kids, two of them are addicts. This one is the responsible breadwinner, adult child of alcoholics. And she takes care of everybody else but herself. And it’s getting her used to the idea that somebody cares. That getting the pain down is possible, that recovery is possible. And then looking her straight in the eye and say, you deserve to be happy. And helps break down the prison walls.

Kim Pittis:
Yes. Yes, ma’am.

Kim Pittis:
I love your quotes.

Kim Pittis:
Thank you.

Dr. Carol:
Yeah.

Kim Pittis:
Yes, that’s it. That’s it for this week. Aww.

Dr. Carol:
Aww. It went too fast. It always does.

Kim Pittis:
I know. It’s a true story. All right, everybody, thanks for joining us. Keep the questions coming.

Speaker3:
Have a good one.

Kim Pittis:
Keep listening and we’ll see everybody next week.

Dr. Carol:
Bye

Kim Pittis:
Bye.

Kevin:
The Frequency Specific Microcurrent podcast has been produced by Frequency Specific Seminars for entertainment, educational and informational purposes only. The information and opinions provided in the podcast are not medical advice. Do not create any type of doctor-patient relationship and unless expressly stated, do not reflect the opinions of its affiliates, subsidiaries or sponsors or the host or any of the podcast guests or affiliated professional organizations. No person should act or refrain from acting on the basis of the content provided in any podcast without first seeking appropriate medical advice and counseling. No information provided in any podcast should be used as a substitute for personalized medical advice and counseling. FSS expressly disclaims any and all liability relating to any actions taken or not taken based on any contents of this podcast.

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