S2E2: Shocking Link Between Parasites & Severe, Painful Degeneration
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00:00I welcome everybody to our next session here. I hope I have a delightful surprise for all of you.
00:07I have got my close associate who runs our research study and our foundation,
00:14Dr. Jay Persilli, and I'm going to be conversing with him and interviewing him in a few minutes.
00:20But first, I want to talk for about two or three minutes on an issue that continues to stay with
00:28us. Some of you will recall that in the last year or two, that the Epstein-Barr virus was found to
00:36be a major factor in causing multiple sclerosis, as well as a lot of some other neurodegenerating
00:43diseases. We started testing people with adhesive arachnoiditis, and almost to a person, they had
00:51very high antibody levels to the Epstein-Barr virus. Now, since that time, we've been collecting
00:58data, we've been interviewing people, we've been retesting people, and we've been hearing from
01:03people all over North America about this issue. It has not gone away, and in fact, more and more
01:12people are writing about it. There's some recent articles about neurodegeneration with viruses,
01:18and so it's a here and now major issue. And I wanted to start this session by introducing
01:27everybody, and I think you can see this. There is a physician by the name of Bill Rawls. Now,
01:35Dr. Rawls, when he was about 45 years of age, got Lyme disease and Epstein-Barr, and has suffered
01:42the same conditions that a lot of people watching this happen to have. What I find very interesting
01:50is this. I don't know Dr. Rawls, I've only read his material, but he has come to the very same
01:56conclusions that we have come to. And what those fundamentally are, is that these viruses are a
02:04parasite, and that they activate, and that they cause an autoimmune disease. Now, autoimmune is
02:12defined here as some element in the body that starts eating away at your tissues. And Dr.
02:19Persaud and I are going to talk about that in a few minutes, because I think the favorite tissue
02:24of autoimmunity these days happens to be the intervertebral discs. So we're going to talk
02:30about that in a few minutes. But anyway, Dr. Rawls, in reading his material, has the very same
02:37beliefs about what's happening with these viruses that I happen to have.
02:41And I highly recommend that you look him up. His last name is R-A-W-L-S. He's published some books.
02:49He's got a website. He recommends a lot of the same supplements and things that I do.
02:55And so I highly recommend that you take a look at him, and I'll try to bring to you other people,
03:01because what I don't want anyone to think about is this is something that just Forrest Tennant
03:05dreamed up, or the Tennant Foundation dreamed up. This is something that is major, major.
03:11Now, what Dr. Rawls has had the temerity to write about, and I've almost hesitated to write about it,
03:19and that is almost everybody that has these high Epstein-Barr titers also has other viral
03:26titers that are high. And he's been doing the same studies we are, and he's found that the
03:32cytomegalovirus, the herpes-6, a Lyme is in there a lot of times. And now we know that COVID,
03:40and maybe even the COVID vaccine is also contributing to what we see
03:46as a, it seems to be a growing autoimmune diathesis throughout the population.
03:53And this Epstein-Barr virus, it's got a whole list of things that it seems to either cause or
04:00accelerate. People that have Ehlers-Danlos syndrome tend to really be susceptible to the Epstein-Barr
04:08virus. Now, these things are kind of theoretical right now. They're not proven. We don't have a lot
04:14of papers, but it just so happens that it's in everybody. We just don't see anyone anymore
04:24in our studies, if they've got multiple herniated discs, they've all got high Epstein-Barr titers.
04:32And so, we're going to talk about that in a few minutes, but I've got to bring you something about
04:36Epstein-Barr, as well as the peptides almost regularly here on the program. So, that's the
04:41situation. Again, Dr. Bill Rawls, take a look at what he has to say, and anybody else we think has
04:47got some credible message, we want to get it out there, because it just seems to be a here and now
04:53issue that we need to jump on. Anyway, sitting next to me is my great friend and associate,
05:01Dr. Jay Persily. I'm pleased to say that he is the medical director of our research studies that
05:10we sponsor in the Tenet Foundation, and I've known Dr. Persily for gosh, 40 years, long, long time.
05:17We had our offices next to each other, and I've got to get into his background here for a little
05:22bit, but I just want to thank you, Jay, not only for being here tonight, but joining our foundation,
05:27carrying on the studies that I started some time ago. And so, I think you're going to find
05:34what his message is, is going to be a good one for you. Now, let me say why I don't want to
05:41use the word I wrote him in, or I trapped him in any way, but I do want to tell you that I
05:50approached Dr. Persily a couple of years ago and said, you know, we have an issue out here, and that
05:57is people throughout the country can no longer get their opioids. They're being cut back from
06:041,000 milligrams or 500 milligrams of morphine a day down to 80 or 90, and we don't agree with
06:12any of that. We think people should have access to what they need, but from a practical point of view,
06:20our foundation wanted to start sponsoring and advocating some studies and some experience
06:29to help people figure out what they're going to do in this climate of opioid restriction.
06:35Now, I know that there's a lot of people watching this that are out there advocating. They're
06:39trying to get medical boards, state legislatures, the federal government to back off and allow
06:46people to get what opioids they want. From what we can see, it's having a mixed response.
06:53Some states in the country now are backing off and passing some laws. Colorado just passed one
06:59in which people supposedly, if they have intractable pain, they should be able to get
07:04their opioids. Now, we support that fully, but we also want to be practical about this.
07:10There are some states you can hardly get an opioid. In the state of California where we
07:16reside, at one time we had intractable pain laws, and California decided they weren't going to
07:20follow them, which are kind of coming back a little bit now, but we've now got a situation
07:26where it's not just the government whose hand is in this, and this is a message that I really want
07:32to get out to you. First off, it may have been the government that was cracking down on patients and
07:38on doctors, but it's now health plans don't want to pay for opioids. Malpractice carriers don't
07:45want to insure doctors who prescribe opioids. Hospitals and local medical societies may not
07:51want doctors to prescribe opioids. In other words, it's a real problem. In other words,
07:57a doctor in a given community, and it's different throughout the country, may be forced to almost
08:05not prescribe opioids, or if he is or she is, it's got to be a low dose. The other problem that
08:12we're facing now is supplies. In other words, you may have some communities in the country right now
08:19that the doctor's willing to prescribe you a fentanyl patch, he or she's willing to prescribe
08:24you oxycodone or valium, that's a benzodiazepine, but are willing to prescribe these medications,
08:31but the pharmacist either can't get the supplies or the pharmacist or the pharmacy will not
08:38prescribe them or issue them to you. The bottom line comes out like this.
08:44Let's advocate against all of this that we don't agree with, but from a practical point of view,
08:49what do we do? That's why Dr. Persilli is with us. He has been heading a study that's been
08:56sponsored and advocated by the Tenet Foundation for the last couple of years,
09:01on what kind of practical measures can we come up with to allow people to get their dosage down
09:08to 80 or 90 milligrams a day so they can get some relief. Now, let me just say this in summary so
09:16nobody misconstrues, this doesn't work for everybody, okay? There are some people that
09:23my guys are going to need a thousand or two thousand milligrams a day for the rest of their
09:26life and we hope they get it. However, we are coming up with some things that have allowed
09:36people to still stay comfortable, still live a normal life, still function and get that dosage
09:42down to 80 or 90. Dr. Persilli has had some success, that's why he's here. Now, to get us
09:48started, the reason why we wanted Dr. Persilli on our team and why we thought he was the ideal guy
09:56to do this is that first off, he's a general practitioner, but secondly, he's also an
10:02osteopath. He's had a PhD and a few other sheepskins, but we won't talk about that.
10:07But we wanted somebody who is a generalist doctor and an osteopath to do this study. Why?
10:15I'm going to have him tell you a little about, but just summarize it. He may quite, I'm going to
10:21ask him first, my first question is what's an osteopath? But I can tell you this, if it wasn't
10:25for the osteopathic schools budding in this country, I don't know what we'd do for doctors.
10:31But anyway, Jay, again, thanks for being here. You're going to run out of time today,
10:37but we're going to get started. Again, from my personal point of view and from I know my
10:43foundation's board, they want to say thank you for what you've done and we have come up with
10:49some things. Now, first off, Jay, I think it's appropriate. What is an osteopath and what
10:57attracted you to become one? And also clarify if there is a difference between MDs and DOs today,
11:04I'd like to know what it is, but what is an osteopath? Just real quick, it's my pleasure
11:09to be here. Thanks for the invite. Especially just coming from Pomona to Covina, it's always
11:15a problem down the freeway, but we got here, the forest knows God, so we got here quickly.
11:22The whole premise of osteopathic physicians, they're very tender about osteopathic physicians,
11:29but osteopath describes what Dr. Tennant did four years and four years of medical school at
11:36Kansas, I did Chicago because they had good pizza. My love went all the way back to being
11:44a GP when I was very young, my mother's a physical therapist, she was chief at Newark
11:50State Hospital, Metropolitan Hospital, met Bela Lugosi and met Bogart there, they had a little
11:57craziness involved also, but since a very young age, I wanted to do that. But not a lot of
12:04difference because we do those, the same training, I think that Dr. Tennant did, but we do more of
12:11the physical medicine, hands-on, we love working on necks and backs and legs, we like stretching,
12:20we like putting things in position, much like a chiropractor, although we think ours is a little
12:26more specific in cervical, thoracic, lumbar, and then luckily we're able to use medicine if
12:32appropriate and indicated. In other words, you have the same authorizations to prescribe
12:39controlled drugs, uncontrolled drugs, or do surgery, anything that an MD can do.
12:44That's right. Now, osteopathic schools are springing up all over the country.
12:51Now, why is that? And secondly, is there anybody watching this or hears about it should hesitate
12:57to go to an osteopath? I don't think so. My allopathic brother, we call them allopaths
13:04because we're osteopaths, can use each other, refer to each other like we have and done in the
13:11past. I don't think there's any hesitation for you to use a DO versus MD. Wherever you start,
13:20wherever you decide to get your health care, even PAs and RNPs are great people, but I think
13:27we have a little more in our doctor bag to offer after a few years of training.
13:34Now, Jay, you were in family practice for many years and then I know that at some point along
13:40the line, you got very interested in treating chronic pain patients. How did that come about?
13:47The major reasons people come in are for pain. It's the only one that you know you have,
13:54high blood pressure, diabetes, thyroid disorders. Most of them don't have signs and symptoms or it's
14:00too late by the time you have it. So people come in with pain. But in training, I did training in
14:07Arizona because they had good burritos. But right across the street at U of A was a West Center.
14:13And these were individuals at Montham Air Force Base, military individuals from the Vietnam War.
14:21And many of them had horrible pain and tropical pain from agents they used to defoliate the
14:26shrubbery there. Also, they ended up drinking more than they should have or using more drugs than
14:32they should or illegal drugs. So I was very interested, I think, from the beginning on pain
14:37and treatment. At this time, you've switched over to where as a general practitioner, you keep a
14:45general medical practice and then you keep some of your practice for pain patients. How do you
14:52split your time there? And what do you recommend to doctors who have some interest in pain who are
14:57generalists? I try to split them up. I do two and a half days general medicine, two and a half
15:05strictly pain. Most of our boards want us to stay focused if you're just doing general medicine on
15:12that particular topic. And then they want us to be involved in pain on a different day. So
15:19we line individuals up as they need to be seen. But there's so much mixing up. Diabetics with
15:26neuropathy and motor accidents, MVAs that have oral pain, traumatic brain injuries, these
15:33organic diseases and autoimmune disorders. There's such a mix. I mean, human beings are all
15:39wonderful and very different. The next question I want to ask, you know, you're a generalist
15:46and your office is next to a big hospital in Pomona. Tell me about your relationship with
15:53the so-called pain specialists in the area. And let me say this first off, the pain specialists
15:59in our area where we live like Dr. Priscilla. But I wanted you to explain a little bit
16:08exactly the relationship between a generalist doctor and a pain specialist. One of the kind
16:16of reason I'm asking this question is that we get so many complaints about pain specialists.
16:21And I get the feeling that whether it's, I don't know who's faulted it, but somehow or another,
16:28the pain specialists and people with intractable pain have a lot of differences on what should
16:34be done or how it should be done. Tell me how you relate with the doctor, sir, and the difference
16:40between you as a generalist who's interested in pain and a so-called pain specialist.
16:47I really think we get along quite well. I think we're synergistic. Most of the pain specialists,
16:52it's hard to get into. There's very few of them, not nearly enough for the number of pain patients
16:59we have. So many of them are sent to me. They said they've already tried epidurals. They've
17:04already tried implantable pumps. They've already tried electrotherapy and nerve ablation. And they
17:13said, we've kind of done all the diagnostic or hands-on treatment interventions. So why don't
17:21you see what you could do? So I get a lot of referrals from Casaclina and then the anesthesia
17:27individuals at Pomona Valley. They are more specialized than I, the anesthesiologist,
17:33more training. The joke is they put people out, but they only charge to wake them up.
17:42But most of them have some apparatuses, a lot of needles they use. And Dr. Tennant and I have
17:48some discussions on too many epidurals also. So I think we get along with them pretty well.
17:54The complaint we hear is that the pain specialist won't prescribe enough opioids, or if it's a
18:02complex case like an RSV or a arachnoiditis or a head trauma, they don't want to take these kinds
18:10of patients. How do you respond to that? And what's your experience with that?
18:17I think you're right in that they, again, are procedure-oriented. They're trained that way,
18:21and I don't blame them for that. They have all their goodies in their black bag or pink
18:27bag if they're a lady doctor. And then we have extra stuff that we try a little bit out of the
18:32box. We have this box and my finger sticks out with neuropathic agents and ease agents, natural
18:40agents, manipulative agents, tens, magnets, red lights. It's certainly not voodoo because it
18:48works. Many people do that. And the typical allopath or MD, I don't know any DO anesthesia
18:54doctors, just want something different. They've had that treatment and it hasn't worked or
19:01they still have eight and nines on the visual-analog scale.
19:05So, how did you get interested in the issue of restricting when patients started being restricted
19:19when the federal guidelines came out that you had to stay at 80 or 90 milligrams of morphine
19:24and California falling right up behind that like a lot of states? And
19:29what was your reaction to that and what did you do about it?
19:33Well, I was upset certainly and disappointed. I understand why. I understand there's 10,000
19:41deaths a month. But if opioids are used and they have a heart attack, it's obviously the opioid
19:47that did it. If they have uncontrolled diabetes or an opioid, it's always the opioid that's first
19:53on the certificate. But truly, we have all these wonderful agents in our pockets, non-opioid,
20:01all neuropathic treatments, the gabapentins, of course, the neuroleptic agents that we have,
20:09the natural agents that you've done much research on more than I am using in my practice.
20:17When the government came out and then insurance companies adopted all these guidelines and all
20:25these levels, what did you tell your patients that were above the 80 or 90 milligram level?
20:35Well, I said I have bad news. I have DEA and FDA and state medical boards that
20:42review everything we do. The chart is an open book these days. I don't know about HIPAA,
20:46but nothing's very private in medicine anymore. And there's not a day that goes by I don't get
20:52three or four letters. Did you know they're on a schedule two and a three and a tranquilizer?
20:59And some of that is very helpful. A lot of it is garbage, I think. I just flip it over and use it
21:04in the fax machine, actually. But it is good. And we have this cure system in California. So
21:12some patients aren't on us and they don't end up staying with us. They're getting something
21:16of a benzodiazepine or sleeper. And then I'm adding an opioid that I strictly forbid in my
21:22practice. But to get back to the question, which I'm good at deviating, 80 and 90 is max. Mrs.
21:30Smith, I'm glad you want 120 hydrocodone 10. That's at least 40 milligrams that I have to
21:36put down on paper. And if I'm going to do an oxycodone, you know, I can't go more than 40
21:41milligrams, 220s for breakthrough. So I'm sorry, but that's what I have to have. But I do have
21:47legacy patients. We all do. And I try to work with them. The max that I have now is about 300
21:54milligrams equal. MME, we call morphine medical equal. Could you give us a little description of
22:04the patients that you've taken and go back a little bit in time, Jay.
22:14The use of diagnoses like adhesive arachnoiditis and CRPS and traumatic brain injury, these are
22:20kind of new diagnoses that we've really only used in the last year or two. But go back over the last
22:28five or 10 years. Can you give us general ideas on the kind of patients that you either found in
22:36your practice or came to you? Can you describe a few of the patients? What was the common complaints?
22:45How did you diagnose them or what did you say about them?
22:49Most all of them come in with some level of pain and we have to have a good diagnosis.
22:55Pain is very subjective, as you all know out there. It ranges culturally, male, female,
23:03ethnic background. We need to find a good diagnosis. So Dr. Tennant and I have worked on
23:11the traumatic brain injuries as a good diagnosis for at least what we do.
23:17Rupture discs above six millimeters. Everybody has two or three millimeters. Malabsorption,
23:23not everybody breaks down the medicines appropriately. We do enzyme studies to check
23:28for those areas in the liver that break down drugs rapidly or not rapidly. We do genetic testing.
23:36We find many of these people are in families that have chronic pain. There's also the collagen
23:43vascular ones that some of you might have out there, the Ehlers-Danlos syndrome. We're seeing
23:49a lot of that. And then the recurrent back surgeries, the failed back surgeries end up
23:54with scar tissue. And he's writing a paper now on that. He's so arachnoiditis that
24:00should be out soon. That is a big one for us.
24:07When you first started, when we first got the message, the patients have to be cut back.
24:15What was the, other than telling them they got to reduce their dose, what was the first one or two
24:22things you tried to do with these people before we started into kind of structuring a program?
24:30Can you give me some idea? Because I remember some of our discussions of like, well, God,
24:34what do we do now? And we're at dinner trying to figure out, oh, we're not sure what we do now.
24:40We got to do something. So what was your first idea or two? Here, let's take a comment. You've
24:47got somebody who's got back problems, neck problems, diabetes, can't work, in terrible
24:55pain, on fiber, 800 milligrams of morphine. What kind of things did you try at first?
25:03Well, with the family practice, we controlled the diabetes because we know that
25:08it's a major factor with neuropathy and neuropathic pain. Many other things we tried
25:14too. I went back to using tramadol or Ultraset or Ultram. I used that with the first dose of
25:22the opioid. It seemed to have good effects because it acts in different areas of the
25:27pain receptors. Tranquilizers, ketamine, used to be the elephant tranquilizer,
25:34but the low-dose ketamine, either oral or atrophy, seems to work well. We also go back
25:40to butalbitol. I've used Fiorinol for a long time, but butalbitol works also. Used to have
25:47the Darvocet propoxyphene, but cardiac arrhythmia with that. Also, low-dose steroids, real low dose.
25:55It doesn't affect the sugar or blood pressure. The one that crosses blood-brain barriers
26:00is Medrol, and we use a methylprednisolone dose. Injectables, if need be. We have compounding
26:09areas. Any place it can get in the body, through a nose or under a tongue or swallow or suppository.
26:16Topicals work, and we're a big proponent of topical creams. The lidocaine bases, the Harnica
26:23bases, the Voltaren bases are all over the counter, and all those particular drugs.
26:31Let me go a little further with that,
26:37because I'm not quite sure how to start it. Basically, over time, you've evolved into,
26:46first off, trying to make a diagnosis on these cases.
26:53Could you give us, what do you see among your pain patients now, diagnosis-wise? What do you
26:59think? They've got a lot of problems, but as far as a pain diagnosis for their intractable pain,
27:05what would you say is the common things you see? I still believe when you have pain for chronic pain
27:12of six months, a year or two, that we definitely turn on the receptors in the brain. I still
27:19believe in this glial cell inflammation. I know it's hard to prove, and it doesn't show up on an
27:24MRI or CT, but many people obviously do get the MRIs if we see the clumping of nerves, and
27:32that's a diagnosis. Many of us are doing the cytokines, looking for different numbers of
27:38cytokines, the leukotrienes, especially two and nine. We find that associated with inflammation.
27:45We're doing a lot of the viral studies now, Epstein-Barr, the IgA and IgM, to see if they're
27:52very high, and out of the box, there are antivirals that we've been trying out. I've just started that
27:58about six months now to see if that would be of some benefit, but I think the big diagnoses are
28:05the abnormal scans, the inflammatory, pro-inflammatory diseases, the autoimmune diseases,
28:16and then the Ehlers-Danlos disease we mentioned, a lot of the connective tissue
28:20diseases are very interesting, and they're in horrible pain, these people.
28:28Let me just, let's, I know that each patient is different. That's what it's made. It's made
28:36it a little difficult to have a hardcore protocol, and I wish we did, so for those of you listening,
28:43when you can't get the opioids you need, exactly what you do next, I'll be honest about it,
28:51a doctor really doesn't know what to do next. At this time, we don't have a cookbook,
28:57and that's one of the reasons why we're doing this interview, is to make it clear
29:01that when people can't get enough pain relief from their doctors, they can't get enough opioids.
29:08What you do next is really so individualized, it's a little hard to say where we start,
29:18so rather than try to come up with the cookbook here, maybe we can talk about,
29:25not in order of importance now, but I do want to ask you some things that come up all the time.
29:32Let's talk about, for a minute, the benzodiazepines. Okay, now a little history on
29:42benzodiazepine. The first one that came on the market, I believe, was 1963 or 4, and that was
29:47Librium. Valium came the next year or two, and so those drugs have been around for years,
29:55okay, and they have a certain amount of pain relief, and of course, today, I know you've
30:02spoken and done some studies even on agamapentin. Where do you see the benzodiazepines
30:10fitting in to your success in bringing some people's dosages down?
30:18Well, I wish I could use more of those. They came out with a black box about two years ago,
30:23and benzos and opioids, so most of us FPs are a little scared of using those together. There are
30:31some problems with it, but most of the folks listening have done very well with their medicines
30:37over years. I only have about three, three of the 70 that I carry right now on a benzodiazepine,
30:44diazepam, so I try to get a muscle relaxant, something that'll help soften the tissue,
30:51soften the muscles. You know, the big ones we all do are the stretchings and the walking,
30:57and I learned from him the trampolinings, and the rocking chairs, the JFK book was great.
31:06Keeps the body moving, fluid moving, blood, lymphatic, all the things that keep the body
31:12in normal alignment, so I am anti-benzos. I know they're used. I would not criticize
31:18another doctor for using it, although I've been criticized. It's fine. I'm a big boy. It'll bounce
31:24off. What about for sleep? Benzos, like, I guess you hardly see a halcyon or a temazepam used
31:34anymore, but they were a good drug. Do you still use some of those? I'm still not opposed to those,
31:42but I've still been doing the Ambien's low-dose 5 or 10 milligrams of bedtime. Of course,
31:49I have to fail melatonin, valerian root, and naltreptophan, and Benadryl first,
31:55and then I can use that. There's another one, a redic simulator, Belsomra, B-E-L-S-O-R-M-I-N-A,
32:05and that's not been poo-pooed along with opioids, so I'm using quite a bit of that now also.
32:11What's the trade name on that? Belsomra, B-E-L-S-O-M-R-A, so it must be good sleep, Belsomra.
32:19Okay, let's go from here. From a practical point of view, and I bring this up because
32:28to get your doses down and get pain relief, you got to have some sleep, right? You got to have
32:32some sleep. Okay, what's your one, two, or three? You have a pain patient that comes in and they
32:41say, Doc, I'm not sleeping. What would be your top three choices of a sleeping medication?
32:48For that patient, I'm not against a benzodiazepine. Restoril's been my favorite through
32:56the years, Tamazepam. It comes in a 7.5 for seniors, 15 or 30, but then I switch over quite
33:04rapidly to Zolepidem or Ambien or the Belsomra. I tell them, you know, please get asleep,
33:12schedule, get in bed after the bad news at 10 or 10.30, get to sleep, take your pill about an hour
33:18before. No booze with it because it breaks down your other pain pills too quick. Maintain good
33:25habits, nothing, no caffeine after six, some sort of exercise program in the morning for
33:33walking and stretching and maintaining that fluid flow. So I think just a regimen because so many
33:40are up late, they can't sleep, it's midnight, it's one or two, your clock starts thinking,
33:45you get ideas about what you have to do that day or the next day. So just some sort of good
33:52training for sleep. All right, let's move on to the next thing.
34:01I think all the pain patients listening to this certainly can vouch for this.
34:05If you've got a painful pain, whether it's your neck or your pancreas or your bladder or your
34:10brain or whatever it is that's generating the pain, it's also going to generate muscle spasm,
34:16leg twitches, restless legs, can't sleep. We like to say to it is that's muscle spasm and
34:23that's part of it, but anxiety is a big part of it. The bottom line is we need that class of drugs,
34:31something that deals with what they call the gamma-aminobutyric acid receptor and that's
34:38what Valium and these drugs work on. For example, over the years, we've had Soma,
34:44which works quite well for a lot of people, and again, pejorativized these days.
34:49Gabapentin has been used a lot, some of the anti-seizure drugs, the benzodiazepines,
34:55and maybe another muscle relaxant or two. What drugs in those classes have helped you
35:03help these people that can't get opioids and get some pain relief?
35:07What drugs in those classes do you like and what seems to have helped?
35:11Well, the benzos are centrally acting and if I think it's going to be more of a
35:17muscular disease, as you're calling clonus or muscular spasm, many of the good drugs for that
35:24have been Flexeril or cyclobenzaprine, Roboxin. You've mentioned Mepribamid also
35:32working both central and peripherally. GABA, I certainly throw in there too. A new one that I'm
35:38trying for at least three months has been Xanaflex or Tenazidine. Xanaflex, Z-A-N, is the
35:46trade name for it and that works quite well. I'm not totally against benzos. I have two on benzos.
35:54Not happy with it, but nothing else works.
35:59Let's key off of this, nothing else works for just a moment.
36:03What is your recommendation, not only to patients and families out here that might be listening,
36:08but to physicians? What kind of record keeping do you do when you know you're going to use
36:15a Valium or you've got to use something that's controlled that is out of favor these days? I mean,
36:23I hate to say it, just like politicians, drugs are politically incorrect these days. Some are
36:29correct and some aren't correct. This class of drugs is not very correct. What do you put in
36:36your chart or what do you tell the family or patient about these clinically incorrect drugs
36:41like Soma or Valium, for example? Like you, the best way is keep it clean. You soap it. You
36:49put down the subjective, what hurts, what doesn't hurt, what they've tried,
36:53what they haven't tried. Then objectively, you put everything down that you've done
36:58so far, the labs or x-rays or old records, and then you come up with a good solid diagnosis
37:05and then a plan. And I think the big thing is the step ladder that you developed with the
37:11Tenet Foundation, what they've tried before and what's worked and what hasn't, and you keep moving
37:17up the ladder. And the benzos are pretty much at the top of the ladder. They've tried the spa,
37:22they've tried the stretching, they've tried the shots, they've had epidurals, they've had
37:28trigger point injections, they've tried manipulation, they've tried a DC, they've
37:33tried acupuncture. Pretty much at the end of the rope, if you were the last not to hold on to,
37:40I needed this drug. Now, let's say you're, let's take a patient and a lot of people are in this
37:45mess. They can't get enough opioids, but they find that wonderful, politically incorrect drug
37:51called Xanax works, or Valium works, or Ativan works. What do they tell their doctors?
38:00And what do they tell their doctors? So the doctor doesn't say, oh, you're just a drug addict,
38:06and you're abusing these things, and I can't prescribe them, and there's the door. I mean,
38:10what do you, what is the, how does a patient and family deal with this issue of, they needed a
38:19politically incorrect drug, and they know the doctor is going to be put on the spot
38:24if he or she prescribes them. How does, what can the patient and the family do?
38:30I think, I think the best is you approach it appropriately with your physician and say,
38:37you know, I've tried these, this is the only thing that works. I think having your significant
38:41other there is important. Family, we always have someone accompanying our patients so that we're
38:47all on the same page, speaking the same language. And sure, bring the bottles in that you have.
38:54I'm certainly not a drug-seeking doctor, but I'd sure like to live. I'd like to have some
38:58activities, daily living, and go to church, synagogue, the temple. I'd like to go out and
39:03shop. I'd like to walk around the block and get the mail myself, and be a productive citizen.
39:09Functionality is real important, and we want our patients to be functional.
39:13I just sit on the couch and pop pills.
39:17Now, we've talked about this politically incorrect group of drugs related, either the
39:24benzodiazepines or related to them. Now let's shift over to a really politically incorrect group,
39:31the so-called dopamine drugs, better known as stimulants.
39:36And I know you and I have had a lot of conversations about this, but the Brompton
39:43Hospital back in 1895 found out back then, if you had severe and surgical pain, you took your
39:48morphine or your opioids, but you had to take a stimulant drug, something that stimulated the
39:55dopamine receptor in order to get good pain relief. Now, and we've had this unfortunate
40:03situation here recently that Adderall works so well that it's now become something where there's
40:11fraud, and there's counterfeits, and one thing or another. What have you done, or what do you think
40:21should be done if you're in general practice? If people have intractable pain, and we know darn
40:27good and well that those dopamine drugs work, that's why they put caffeine and Percocet and
40:36what have you for years. So what's your thoughts about this, and what can be done, what is being
40:43done? Well, as Dr. Tennant says, we're getting shortages on the market in many ways. The
40:49cancer drugs, there is a shortage. Many of the diabetic agents were getting a shortage for
40:56various reasons, but if they're on Adderall, if they're on a stimulant for its GABA G-A-B-A
41:03activity, and they're on 30, I try to find the 20, or the 10, or even the 75, and I adjust the dose.
41:11I can add, so I can just mix and match that way. Other things that work too are the diet drugs,
41:18the Adipaxes, the Phentermine, that might be another option for those. Anything that can
41:26stimulate GABA. I've even used Pseudopheds and Actipheds, some pathoemetic drugs that
41:33help with those fibers. Do most of your 70 or so patients that you follow,
41:42are a lot of them on a stimulant-type drug? About 25% are on some sort of stimulation drug,
41:49yeah. What about Ritalin? Is that a drug you use much of? Ritalin, I don't use as much,
41:58but it's certainly an option. It would be good to have that available, yeah.
42:04Yeah. One thing about it that a lot of people don't underestimate, I know over the years I've
42:11had people say, oh no, you can't give a pain patient Ritalin, or Dexedrine, or Adderall,
42:19or something like that, because that's only for ADHD, Attention Deficit Disorder. Well,
42:25there's no intractable pain patient who has good attention span.
42:28Yeah. So, that goes hand-in-hand right along with the pain. You can't have a good attention
42:35span with pain, can you? That's true. Yeah. Methylphenidate too, I forgot that one,
42:40an older drug, but certainly can be used in these situations.
42:46What about caffeine? Do you recommend a drink, a lot of coffee or teas too?
42:50I still do, although it couldn't be. It's like you've seen with the receptors that we have,
42:57but amphibians are good, and I tell you that Fiorino and Fioricet, I think they have the
43:03right combination of a phenacetin, and butylbutol, and aspirin, and a caffeine base, especially for
43:10tension headaches, even migraine headaches. I started with that. It's still good. I'm delighted
43:15you brought this up, because now I want to shift to something else. I'm a little mystified as to
43:22why no one seems to understand an old pharmacologic term called potentiation.
43:32Now, you and I are old enough to know that that was the first 10 words you learned in pharmacology,
43:38potentiation, and what that meant was you needed to take, one drug would give you an effect. It
43:48may not be a very good one. You needed to take something that made the drug more potent,
43:53and that's where the term came from, potentiation. Now, today,
43:59drugs like Dorco, or Vicodin, or Percocet are actually frowned on, because they had acetaminophen
44:09to be as part of that drug to get more potentiation. Back in my days, back years ago,
44:20when pain wasn't controversial, I mean, the pie line was, don't ever give anybody an opiate,
44:25don't ever give anybody an opiate, even a shot, unless you gave a potentiator with it,
44:30you know, an aspirin, or acetaminophen, or caffeine, or some of the, you know, even some of
44:37the antihistamines were given with it, and so that's kind of been lost. I think we need to
44:47have a little discussion here about the potentiator with opioids. I mean, if they're
44:52going to get their dosage down, they almost have to do something to potentiate that opioid,
44:58don't they? Do you have some of your favorite thoughts on, you just mentioned a good one,
45:03Fiora said, or if you're all right with the opioid? You know, I'm an older guy now. I use
45:09some of the older drugs, and a lot of this developed after combination drugs, and then
45:15FDA said, oh, that's bad, and you can't put two drugs together, but I certainly think it's good,
45:21and you and I went to a couple years of school, and I think adding and subtracting are wonderful.
45:28My favorite is an opioid, and another one would be an anti-opioid, a low dose of something,
45:36low dose naltrexone we've been using, too, a real low dose, a 0.5 or 1 milligram
45:42use, as long as there's no reversal of the opioid, and then I've been doing the older
45:47one, a tramadol, the first dose of an opioid, I do an Ultram, a 50 milligram Ultram, just once,
45:55so I give 30 of those. I do the Adderall, if I could get it, or the fentramine, I like that
46:02synergistic effect or combination effect that you've talked about, and I think the acetaminophen
46:08thing came about with too much hydrocodone acetaminophen. MAC used to be four grams of
46:14acetaminophen Tylenol, and now it's down to 3,000 because of 325 and the hydrocodone, so you can't
46:21do more than 10, and I think that came about because of some liver failures and how much
46:27damage can be caused by some of these drugs. I want to shift over now and talk about
46:34some of the newer things that I know you're working with, and if we run out of time, we'll
46:39just do it next time, okay, but this is so terribly important because we do have a half a dozen
46:46new drugs, new measures that are making it possible for a lot of people to get down to 80 or 90,
46:53and you mentioned one, low-dose naltrexone. What is your thoughts on who should take
47:00low-dose naltrexone, who's it for, and what does it do? Well, it's a reversal, as you all know,
47:06it's Narcan-based and reverses the adhesion of the opioid to the receptors. There's three
47:13major ones out there. I use a very low dose because it can reverse some of the opioids, so
47:20I can't use it for those that are at higher levels, 100, 120 MMEs, the morphine medical
47:27equivalents, because it does reverse, and we do have some withdrawal, but those that are 50 or 60
47:33MME, about a 0.5 I use. Another one are the anabolic steroids, which we haven't touched on.
47:40I'm doing about 25 people on a nandrolone base, an anabolic steroid to help build up
47:48that tissue and collagen muscle and sinew and tendons. In the interest of time,
47:55we'll come back and talk about that, but you just mentioned nandrolone,
47:59and one of the basic things that you and I came up with some time ago was that it's
48:09old-fashioned. We didn't invent it, we just drug it up again, and that is treating
48:17severe chronic pain. It was a three-step process. Number one, you had to suppress the inflammation
48:23and now autoimmunity. Number two, you had to regenerate some tissues, and number three,
48:28you had to have some pain relief. Those three components, we call them a protocol today, but
48:33you can call them a regimen or a program or call it what you want or a treatment plan.
48:38It's only been around since Methuselah, so these three things are not new.
48:43Here, some people talk about it. We dreamt this thing up like it was something out of the blue,
48:50but let's talk about what we mentioned, that is regeneration of tissue.
48:58One of the real breakthroughs with intractable pain treatment is that we have found that we've
49:06got some measures to try to boost the body's natural healing ability. Anyway, you have found
49:18a—could you tell everybody a little bit of what Nandrolone is? You said it was an
49:23anabolic steroid. That's kind of a term that a lot of people find is negative because athletes
49:29use those to get an unfair advantage, but on the other hand, why did they get an unfair advantage,
49:35and what do the anabolic steroids do, and how do they fit into all of it?
49:41I have not had trouble with the doses we've found. There's a 25, a 50 milligram.
49:48Local compoundings can make it for you. We have one in Covina that's very nice in
49:55preparing that for us, and opioids over time can decrease the immune system, and my anabolic
50:02steroids can build it back up. Opioids over time can decrease tissue strength and durability,
50:09and my anabolic steroids bring that up—anabolism to build up and catabolism to break down.
50:17Many of the people that have chronic pain are very inactive, and we want them more active to
50:22maintain good tissue texture strength and muscle strength and get out there and be alive and have
50:29some fun. If we run out of time, let's focus on this for a little bit. What things have you found
50:38that helps tissue heal? In other words, you've got RSD. You've got traumatic brain injury.
50:45You've got arachnoiditis. You've got turn-off cysts. You've got EDS. You've got to rebuild
50:51some tissues, and osteopaths have been champions of this for a long time. That's been one of the
50:57fundamental differences between MDs and DOs. DOs have always been much more interested in
51:02regrowing tissue, if you will, than were MDs. MDs have been slow, but we've caught on now.
51:09What other things now? Nandrolone has been a wonderful thing in our head.
51:16Tell us a little more about what else might go along with efforts to try to rebuild a tissue,
51:25and also, isn't this kind of getting at trying to cure the underlying disease rather than just
51:31treat it symptomatically? Yeah, and we're supposed to do that. That's why we need a good
51:34diagnosis to treat the underlying disease, not just treat the symptoms. We're treating people,
51:40not just a disease process. To build up with some protein, some good chicken, some fish
51:48on a regular basis. Protein drinks are appropriate also. There's good products at GNC.
51:56Maritine or carnitine is a good builder also. As we said, the anabolic steroid zone
52:03help. I think vitamin D mostly for bones, but it's good for tissue. Along with vitamin C,
52:09skin doesn't heal well without good vitamin C, and the underlying tissues also need it,
52:14the fat and the muscle. I think the stretching, I think draining certain areas like you do on the
52:20trampoline or the rocking chair to maintain fluid interaction, bring the oxygen in, bring
52:27the nutrients in, help build up that torn down muscular skeletal system. Now, I want to make it
52:38clear. We're not talking about, we used the word steroid a while ago. We're not talking about
52:42cortical steroids. That's a different class. We're talking about a different class of hormones made
52:49by the body. Nandrolone is actually made inside the body, is it not? It's a natural. Nandrolone,
52:56for everybody's information out here, is a hormone made by the spinal cord to heal spinal
53:04tissues. The other one that we like to use, I mean, are we able to even get human chorionic
53:11gonadotropin anymore? Yeah, there's a few locations. Florida has some and Nevada now.
53:18So, that's been our old standby, but we switched to Nandrolone because we couldn't get it,
53:22isn't that correct? Right. And again, let me put it this way. If you've got a severe
53:29and critical pain condition, is it your opinion at this time that you believe either Nandrolone or
53:36chorionic gonadotropin or these measures are essential? I think they are and I think we can
53:42get the body to make its own base. I think that's very helpful too. And I think these
53:47TROCHI products are very good in that realm. We're about out of time and we're going to,
53:55I want to ask you this question. You've been a generalist who has chosen to do this.
54:04Frankly, Jay, we need about 3,000 of you around in every community. We really do. We need to have
54:12generalist doctors, primary care doctors, nurse practitioners, PAs, do what you do.
54:19How do we bring this about? Because we don't have enough pain specialists. So, we're going to have
54:25to rely on primary care like you. You stepped over the line a little bit and sort of sub-specialized,
54:31if you will. How do we get other doctors to do this throughout the country?
54:37Well, we're developing more and more schools that are going to train generalists.
54:44MDs, we have about 160 schools. That's my last count. Our schools, the DO schools,
54:51we have 54 now. And we're very much into primary care, FPs or OB-GYNs, Peds,
54:59generalists. And I think they're seeing the light in pain management. So, I think we're
55:04going to do that and help train more and more individuals. Do you feel that they're catching on?
55:13I mean, they no longer are afraid of some of these concepts? Are they going to join us?
55:20If they go to more and more of your lectures or mine, they will. We're hoping they will. But
55:27many of them are joining groups, the Kaisers and Blue Crosses and large groups. And
55:34you know, I'm solo. I don't like people.
55:37The bureaucracy.
55:39Yeah, absolutely. Well, Jay, this is great. We'll have you back. We didn't get to the
55:46autoimmunity and the anti-inflammatories and some things. But we did touch upon the
55:54the anabolic steroids and the tissue growth. Now, anybody who's interested in these things,
56:02Jamie will come on and tell you how to write her and what have you. I saw a couple of things pop
56:08up on the screen for just a bit of a question. And one of them, I just got to answer real quick.
56:14Somebody said that they asked their doctors to test them for the Epstein-Barr virus.
56:18That came back was just positive or negative. That's not going to do it. It's got to be
56:23quantitative. And it's a certain profile they've got to order. The old positive,
56:28negative will not help. It's got to be quantitative. It's got to be very specific.
56:32And certainly, we've got information that we can send to people or the doctors on that merit.
56:38And then lastly, one last sentence, Jay. We can't wait for your students to graduate now.
56:47Okay. A lot of patients are out watching this. They need help right today.
56:54Based on what you're thinking, what can they do right today in their community with their doctors,
57:02nurse practitioners, PA's, naturopaths? What can they do to help get them interested,
57:09get them cooperative, get them to give them better treatment? Have any advice for all the
57:13people watching this out there on what they can do right now?
57:16Well, advice is cheap on the web, but here I go. Never give up hope and never stop trying for sure.
57:23And I applaud all of you for being here. It shows what's fun and a lot of backbone.
57:30And I know everyone's in pain, I assume, looking at this. I'm in pain getting so close to Dr.
57:37But I think if you can get this out and promulgate it and get this information to the
57:44local folks, probably not public health, but I think the private practitioners
57:49may be a benefit. And I know I'm on one of the national convention committees and
57:55they always want to do something on blood pressure and dermatology and resonance shots.
58:00And I said, what about pain? Can we talk about pain? So I always try to get him to come talk to
58:05us. So we'll get there, guys. Never give up hope because it floats.
58:10Well said, Jay, well said. And Jimmy, we're going to turn it back to you.
58:15Anybody who's out there who wants any information that we've heard about today,
58:19we'll try to get it to them. Anything we cover is open and here to try to get better help for
58:26everybody who's out there as well as bring doctors in and get them on board with us.
58:31Again, thanks for being here. We'll see you in a few days. Jay, again, thanks so much,
58:37not for only today, but all you've done the last couple of years.
58:40Yes. Thank you. Thank you. Thank you. Thank you.