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Welcome to Live Well with UCI Health.

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I'm Ryan Manno from KOST 103.5

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and iHeartRadio.

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Very pleased to be joined today

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by Doctor Shalini Shah.

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I want to get your title Vice chair

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of the Department of Anesthesiology

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and Director of Pain Services

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at UCI Health Center

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for Pain and Wellness.

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Doctor Shah, thank you for being here.

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My pleasure.

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So let's talk about pain

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and not the kind that comes

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with waking up every day.

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Like the, you know, physical pain.

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And I think it's probably safe to say

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that most people, as we age,

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deal with pain pretty regularly,

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if not constantly.

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Yeah.

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You know,

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the way we think about pain in

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right now in the country is episodic.

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It happens for a small time.

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I hurt my knee; I sprained my ankle.

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But there's a whole segment of people

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who are living with pain chronically.

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It's a part of their everyday life.

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It's going to be a part of who

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we are as we age, and that's a fact.

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And so how do we get ahead of it

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is really what

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we're focusing on here at UCI.

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First, let's talk about the difference.

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There was a question,

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there was some terms on here

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that I wanted to bring up to you

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the difference between lifespan

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and health span.

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What is that? Yeah.

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So we hear a lot of these buzzwords.

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We hear the word

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lifespan, that's just

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how long we're going to live.

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And then we talk more about health span.

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Is those lives that matter

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or those years

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that matter, the quality years.

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And I'll tell you,

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you know,

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just yesterday in clinic,

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I saw probably seven

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out of my entire panel

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for the day were patients

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who are 90 plus,

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and those patients are

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going to easily touch 100

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without any difficulty.

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So people are living longer. Right.

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And they're healthy, to be honest.

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They're living longer, healthier lives.

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And so how do you get to be

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that one

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of those special types of people,

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you know,

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where you're able to manage,

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you have a little bit of pain

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and you keep that pain episodic

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and not chronic. So how do you.

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Here we go.

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Yeah.

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So typically so as I'm understanding it

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your, your health span will almost always

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be shorter than your lifespan.

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Yeah. Right.

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For most people. Really well said. Yes.

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Is that right. Yes. Okay.

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So how then do we.

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Maybe you don't have exactly the answer.

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Because if you did, you know

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then everyone would be wanting to know

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what can we do preventatively

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to give ourselves a good shot

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at a nice health span?

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If we look at it,

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I like to say it in 360 view,

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and I don't want to get too nerdy on.

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This topic. No, no. Nerd out. Let’s go.

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There's some metabolic factors, just,

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you know,

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insulin resistance, visceral fat,

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things like that. Muscle.

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And we'll talk about muscle in a second.

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The second is some biological markers

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that most people don't know, that

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they're going to the gym every day.

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And they don't

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know that these are the markers

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that predict a long life.

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And that's grip strength.

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So if you do

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grip strength at the gym

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and you measure that, you can even buy

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a tool off of Amazon

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to measure that

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and to see if you can improve that

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and hanging

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if you can hang even for five seconds,

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that will.

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That's a great marker

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to tell you how long you will live

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and how the quality of life would be.

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Hanging. Hanging. And gripping.

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That is so interesting.

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Yeah, and that's apart

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from all the metabolic factors,

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you know,

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what we put in our system

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and how our metabolic rate runs.

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But yeah. Wow.

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Let's talk

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about some of that metabolic stuff.

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Like what

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what do you

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what do you mean when you say that.

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Can you go a little further on that? Yeah.

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So if you're in pain

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you're probably not moving

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because it hurts to move.

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So you're putting on weight

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and that's visceral fat.

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So that deep layer of fat

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and that is a huge marker

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for why we age so fast. Okay.

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Because that fat leads to inflammation.

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And so inflammation, visceral fat,

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these are all the metabolic

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things that limit

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how fast we can process either

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foods or metabolism, things like that.

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And then so for you

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and what you specialize in

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then these things are related to pain.

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100%. Okay. Yeah.

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That's our goal. It's yes you have pain.

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We will all have pain.

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But how do you work past that to keep

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those metabolic markers strong?

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You know you mentioned chronic pain.

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What separates a pain?

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Just like a nagging pain versus

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like when does a pain become chronic?

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My definition is anything longer

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than six weeks to three months, right?

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Okay.

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Most commonly, the number one reason

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why people go and seek a doctor

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for pain is typically low back pain.

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And that's about 70 to 80%

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of what we do and treat is low back pain.

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And to be honest, that's the space.

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If people want promise in the world,

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that's the one space

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that's really improving.

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A lot of new technologies coming out,

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a lot of noninvasive.

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We used to think we need spine surgery.

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There's a lot of things

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that you may not need now.

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So that space is really improving.

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And so you're going to see

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a lot more treatments available

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to take care of that.

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The part

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that is harder to treat is frailty.

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So as we age we get frail.

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And that means we're losing muscle mass.

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And as we lose muscle

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mass, we're not moving as much.

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We can't support our skeleton.

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It's painful.

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And then you see the hip fractures.

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And then once you get

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in the hip fracture,

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then you go to the hospital,

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and then you need a convalescent home

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and all that entire cascade... Yes.

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that we see with our parents

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and our grandparents. You know. Yeah.

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And that's what we're trying to break.

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And so a lot of what

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we're trying to teach our patients

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is about building that muscle mass.

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So after the age of 30, we lose

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about 3 to 5% of our muscle mass

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every decade. Just that's normal.

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We will all do that.

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But after 60, we start to lose about

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15 to 20% of our muscle every year.

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And I've seen those patients

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who've lived that to that 90

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year mark or 85, 90, 95 year mark,

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they still have preserved muscle.

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They're still going to gym every day

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as much as they can to

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to keep gaining that muscle

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so they don't become frail. Yeah.

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And would you say that if, if you had to

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just, you know, your own,

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not your own research, but your own

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the things you've observed,

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your own observations,

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is that

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is that a commonality in those people

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that have not only the long lifespan,

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but the long health span

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is that muscle mass, is going to the gym?

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It is.

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Yeah, almost.

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One of the things that can correlate

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so truly is that muscle mass.

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I wish we did a better job in nutrition

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or teaching medical students

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about nutrition,

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teaching our physicians

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about nutrition

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to educate our patients

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and about these things

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because they're simple.

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They're not complicated,

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simple things that we could do.

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And if you if you do them,

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my dad always preaches this.

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I mean, he's 78 and he still goes.

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He swims every morning.

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He's at the gym every morning.

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And he's always telling me,

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get ahead of it now

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or make it part of your life now.

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Because then when you

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when you get older

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and you just try to

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play catch up with your health

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and it's like,

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but you could have been doing that

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a long time ago.

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Yeah, you could have

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done the preventative stuff.

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Yes, yes. Right.

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And so starting it

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now, even,

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you know,

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no matter how old you are,

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it's, it's never too late to start.

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Yeah.

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And it's never too early to incorporate

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a lot more protein into your diet,

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you know, for a healthy 40 to 50 year

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old female,

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taking about 100g of protein

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a day is very easy.

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It's a very good thing to do. Yeah.

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To build that muscle mass.

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And it's interesting too,

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because I think when

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when you're not thinking about it,

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you're just going through your day.

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You're not thinking about

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how those things correlate

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and then lead to pain.

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And they're coming to see you going,

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well,

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you know,

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my lower back is messed up, by the way.

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Why is it like

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why can't.

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Like if I think about sleeping on like,

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we had sleepovers as kids

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and we would all just, like,

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sleep on the floor

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and like nothing happened, right?

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We, we have a sleep

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number bed at home,

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and my side has a leak in it, and,

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like, it'll sag a little.

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And I swear those mornings when it

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when I'm, I'm like,

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what did I get in a fight?

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My whole body is like,

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you know, and I'm 45. Yeah.

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But we hit a point

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where even the smallest little difference

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in our day to day can cause pain,

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and it can ruin your day.

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It can. You tweak that muscle wrong.

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Usually it's muscle, thank God.

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But yeah, you're absolutely right.

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You feel it. You're feeling it. Yes.

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Right.

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You're feeling it

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where the discs are

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not as supportive as they are

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or they once were.

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So you need more support from

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from a firm mattress.

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Yeah. We feel it. Yeah.

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And it really does.

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It inhibits your enjoyment of life.

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You know,

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when something's

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nagging at you or worse than nagging.

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What are some of the ways

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pain is treated today.

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So you're probably going to hear

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the word often multimodal.

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And what that means is

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many ways at the same time.

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So it's not just prescription painkillers

00:08:05:11 - 00:08:06:10
or medications.

00:08:06:10 - 00:08:07:21
It's not just physical therapy,

00:08:07:21 - 00:08:09:08
but it's everything together.

00:08:09:08 - 00:08:10:23
So that's what we call multimodal.

00:08:10:23 - 00:08:11:22
We try to treat it

00:08:11:22 - 00:08:13:06
aggressively through

00:08:13:06 - 00:08:14:22
many means as fast as we can,

00:08:14:22 - 00:08:16:01
because we need you to get back

00:08:16:01 - 00:08:17:16
moving and building that muscle mass.

00:08:17:16 - 00:08:18:08
Yep. Right.

00:08:18:08 - 00:08:20:04
So it's medications,

00:08:20:04 - 00:08:21:04
injections sometimes.

00:08:21:04 - 00:08:22:10
And people think, well,

00:08:22:10 - 00:08:24:02
do I get these forever?

00:08:24:02 - 00:08:25:01
And the answer is no.

00:08:25:01 - 00:08:27:13
You should not be getting them forever.

00:08:27:13 - 00:08:28:13
Usually it's a series

00:08:28:13 - 00:08:29:13
of a couple injections.

00:08:29:13 - 00:08:31:12
And then you should be better

00:08:31:12 - 00:08:31:23
provided

00:08:31:23 - 00:08:32:22
you're doing all the right things

00:08:32:22 - 00:08:34:17
physical therapy, rehabilitating.

00:08:34:17 - 00:08:37:13
So some of that sometimes we

00:08:37:13 - 00:08:38:11
you need surgery

00:08:38:11 - 00:08:40:02
and we've got great surgeons here

00:08:40:02 - 00:08:41:12
at UCI that we partner with

00:08:41:12 - 00:08:42:20
and they're minimally invasive.

00:08:42:20 - 00:08:44:19
I'm talking about an inch of an incision

00:08:44:19 - 00:08:46:00
and you take care of the problem.

00:08:46:00 - 00:08:46:16
But the point is

00:08:46:16 - 00:08:48:04
we take care of that problem.

00:08:48:04 - 00:08:49:01
Don't let it linger.

00:08:49:01 - 00:08:50:22
You mentioned prescription painkillers.

00:08:50:22 - 00:08:52:15
Where are you as a doctor?

00:08:52:15 - 00:08:54:22
You know this is your life.

00:08:54:22 - 00:08:56:19
Where are you at on, on opioids?

00:08:56:19 - 00:08:57:10
That's a good thing.

00:08:57:10 - 00:08:58:21
It's one tool in the toolbox.

00:08:58:21 - 00:09:01:07
I always say they have a role.

00:09:01:07 - 00:09:02:16
The patients are in pain,

00:09:02:16 - 00:09:03:20
especially after surgery.

00:09:03:20 - 00:09:04:14
They're going to need them

00:09:04:14 - 00:09:06:02
and we need to have them

00:09:06:02 - 00:09:07:17
so patients can move and function.

00:09:07:17 - 00:09:10:17
But the longevity of using them forever

00:09:10:17 - 00:09:11:23
and ever and ever as medications

00:09:11:23 - 00:09:13:19
probably not the best idea.

00:09:13:19 - 00:09:14:18
Yeah, we've got better

00:09:14:18 - 00:09:15:15
things

00:09:15:15 - 00:09:16:21
that are much more

00:09:16:21 - 00:09:17:22
safer and less harmful.

00:09:17:22 - 00:09:19:16
How do you tackle

00:09:19:16 - 00:09:19:20
you know,

00:09:19:20 - 00:09:21:17
you mentioned you've got the toolbox.

00:09:21:17 - 00:09:23:08
I love that term, that phrase.

00:09:23:08 - 00:09:24:23
How do you tackle

00:09:24:23 - 00:09:26:02
if someone's dealing with pain

00:09:26:02 - 00:09:27:20
with other comorbidities?

00:09:27:20 - 00:09:29:08
It's a great phrase that

00:09:29:08 - 00:09:30:18
you use comorbidities.

00:09:31:18 - 00:09:32:00
You know,

00:09:32:00 - 00:09:33:13
when you're dealing with pain

00:09:33:13 - 00:09:34:02
and then you've got

00:09:34:02 - 00:09:35:04
all sorts of other problems.

00:09:35:04 - 00:09:36:14
You've got heart disease.

00:09:36:14 - 00:09:37:13
You've got,

00:09:37:13 - 00:09:38:20
you know, maybe COPD

00:09:38:20 - 00:09:41:00
from smoking cigarettes or you know,

00:09:41:00 - 00:09:42:19
what we're seeing more

00:09:42:19 - 00:09:45:03
than diabetes or heart disease

00:09:45:03 - 00:09:46:02
or lung disease

00:09:46:02 - 00:09:49:01
now is anxiety and depression. Really?

00:09:49:01 - 00:09:50:06
Seeing a lot more mental health.

00:09:50:06 - 00:09:52:04
And that's one of the biggest barriers

00:09:52:04 - 00:09:52:23
to overcome

00:09:52:23 - 00:09:54:16
when we're trying to treat pain.

00:09:54:16 - 00:09:55:18
Talk about that. Why?

00:09:55:18 - 00:09:56:18
How? What do you mean?

00:09:56:18 - 00:09:57:01
You know,

00:09:57:01 - 00:10:00:01
I don't know if it's generational or not,

00:10:00:02 - 00:10:02:01
but we're seeing younger folks

00:10:02:01 - 00:10:03:14
and I mean 20s, 30s, 40s

00:10:03:14 - 00:10:05:19
who are coming into us as patients

00:10:05:19 - 00:10:06:19
with pain,

00:10:06:19 - 00:10:07:23
who also have

00:10:07:23 - 00:10:09:11
considerable amount of anxiety

00:10:09:11 - 00:10:10:15
that they're dealing with,

00:10:10:15 - 00:10:13:01
whether it's workplace stress,

00:10:13:01 - 00:10:14:02
coping skills,

00:10:14:02 - 00:10:15:10
and I don't know if it's a generation

00:10:15:10 - 00:10:17:05
where they were the cell phone generation

00:10:17:05 - 00:10:18:05
where they to cope,

00:10:18:05 - 00:10:19:20
they went to the cell phone or,

00:10:19:20 - 00:10:21:06
you know, sometimes we

00:10:22:05 - 00:10:23:12
just scroll and that's the

00:10:23:12 - 00:10:25:10
way we deal with our stress.

00:10:25:10 - 00:10:26:18
So but how does that then...

00:10:26:18 - 00:10:28:07
I’m fascinated by this.

00:10:28:07 - 00:10:29:18
How does that then

00:10:29:18 - 00:10:31:05
get in the way of what it is

00:10:31:05 - 00:10:32:06
you're trying to treat?

00:10:32:06 - 00:10:33:04
Oh great question.

00:10:33:04 - 00:10:34:12
So what most people don't know

00:10:34:12 - 00:10:37:10
is that pain, anxiety and depression

00:10:37:10 - 00:10:39:00
travel together. Really.

00:10:39:00 - 00:10:40:14
And they synapse at the same places

00:10:40:14 - 00:10:42:16
in the brain together.

00:10:42:16 - 00:10:44:21
So if you have pain, likely

00:10:44:21 - 00:10:45:17
you will develop

00:10:45:17 - 00:10:46:08
chronic pain,

00:10:46:08 - 00:10:46:19
I mean,

00:10:46:19 - 00:10:48:06
and some element of anxiety

00:10:48:06 - 00:10:50:00
and depression and vice versa.

00:10:50:00 - 00:10:51:21
So if you have anxiety and depression,

00:10:51:21 - 00:10:54:08
you will also at some point develop pain.

00:10:54:08 - 00:10:56:17
And so there's what we call comorbid.

00:10:56:17 - 00:10:58:03
They exist together.

00:10:58:03 - 00:10:59:10
So if I'm trying to treat pain

00:10:59:10 - 00:11:00:19
in someone who's anxious

00:11:00:19 - 00:11:02:12
or who's severely depressed,

00:11:02:12 - 00:11:03:12
it's very difficult.

00:11:03:12 - 00:11:04:00
I got

00:11:04:00 - 00:11:05:06
I have to treat that anxiety

00:11:05:06 - 00:11:06:23
and depression component first

00:11:06:23 - 00:11:08:18
because they travel together.

00:11:08:18 - 00:11:10:15
Yeah. Most people don't realize that.

00:11:10:15 - 00:11:11:15
No, I never would have thought

00:11:11:15 - 00:11:12:19
that that would have been on your plate

00:11:12:19 - 00:11:14:16
to also handle that other part of it.

00:11:14:16 - 00:11:15:02
Yeah.

00:11:15:02 - 00:11:16:17
We try to have a psychologist

00:11:16:17 - 00:11:17:01
with us,

00:11:17:01 - 00:11:18:18
a pain psychologist,

00:11:18:18 - 00:11:20:19
and they're a wonderful resource for us.

00:11:20:19 - 00:11:21:19
Do all places do that

00:11:21:19 - 00:11:22:22
or is that just like something

00:11:22:22 - 00:11:24:01
that you guys offer here

00:11:24:01 - 00:11:24:17
at UCI Health?

00:11:24:17 - 00:11:25:06
We're probably

00:11:25:06 - 00:11:27:11
one of the only places here in Orange County

00:11:27:11 - 00:11:29:15
that really has an inbuilt pediatric

00:11:29:15 - 00:11:31:20
and adult psychology program

00:11:31:20 - 00:11:34:23
in addition to pain physicians.

00:11:35:00 - 00:11:35:06
Yeah.

00:11:35:06 - 00:11:38:05
This could be a completely dumb question.

00:11:38:05 - 00:11:40:06
Most are that I ask on this series.

00:11:41:20 - 00:11:42:13
Do you think

00:11:42:13 - 00:11:43:07
that there's something

00:11:43:07 - 00:11:43:21
to this idea

00:11:43:21 - 00:11:44:19
of like once,

00:11:44:19 - 00:11:46:07
once you convince yourself

00:11:46:07 - 00:11:49:07
you're in pain or you are like,

00:11:49:13 - 00:11:50:12
does thinking about pain

00:11:50:12 - 00:11:51:08
and focusing on pain

00:11:51:08 - 00:11:52:17
make pain more painful?

00:11:52:17 - 00:11:54:10
Oh. Do you know what I'm saying?

00:11:54:10 - 00:11:54:16
Like,

00:11:54:16 - 00:11:55:23
can you almost work yourself

00:11:55:23 - 00:11:56:18
into more pain

00:11:56:18 - 00:11:59:09
by focusing on the initial pain?

00:11:59:09 - 00:12:00:11
Yeah, and we have a word for it.

00:12:00:11 - 00:12:02:08
What is. It's called perseverating.

00:12:02:08 - 00:12:03:10
Perseverating.

00:12:03:10 - 00:12:05:00
You learned it here.

00:12:05:00 - 00:12:06:10
See, I knew there was something to that.

00:12:06:10 - 00:12:08:07
Okay, let's talk about perseverating.

00:12:08:07 - 00:12:09:15
So perseverating on the pain

00:12:09:15 - 00:12:10:16
Absolutely can make it worse.

00:12:10:16 - 00:12:10:23
You know,

00:12:10:23 - 00:12:12:13
you're constantly focused on it.

00:12:12:13 - 00:12:13:16
You're micromanaging it.

00:12:13:16 - 00:12:14:19
It's always in the forefront

00:12:14:19 - 00:12:16:06
of your head space.

00:12:16:06 - 00:12:17:14
And yeah, there's a term for it.

00:12:17:14 - 00:12:18:22
It can actually make your pain worse.

00:12:18:22 - 00:12:20:01
And we see this a lot

00:12:20:01 - 00:12:21:13
in migraine patients.

00:12:21:13 - 00:12:21:19
You know

00:12:21:19 - 00:12:23:02
sometimes migraine patients

00:12:23:02 - 00:12:24:08
they keep migraine diaries

00:12:24:08 - 00:12:25:21
I had a migraine at 6 a.m.

00:12:25:21 - 00:12:27:08
It went down at 8:45.

00:12:27:08 - 00:12:28:17
And it came back up at 1,

00:12:28:17 - 00:12:29:13
you know, 1:10.

00:12:29:13 - 00:12:31:08
And they're constantly keeping diaries.

00:12:31:08 - 00:12:32:12
And we try to tell our patients,

00:12:32:12 - 00:12:33:12
don't do that

00:12:33:12 - 00:12:34:23
because you're constantly focusing

00:12:34:23 - 00:12:36:18
and thinking of pain. Yes. That's right.

00:12:36:18 - 00:12:37:02
Yeah.

00:12:37:02 - 00:12:40:02
Do you find or have you encountered

00:12:40:07 - 00:12:41:15
that some people

00:12:43:14 - 00:12:44:06
this might sound

00:12:44:06 - 00:12:44:22
come out the wrong way,

00:12:44:22 - 00:12:45:14
but like

00:12:45:14 - 00:12:47:08
they don't want the pain to go away

00:12:47:08 - 00:12:48:15
because the pain,

00:12:48:15 - 00:12:50:10
the attention of the pain

00:12:50:10 - 00:12:51:06
or is that a thing?

00:12:51:06 - 00:12:51:18
Do people

00:12:51:18 - 00:12:53:07
say they don't want to be in pain,

00:12:53:07 - 00:12:53:19
but they kind of.

00:12:53:19 - 00:12:54:17
It's like, that's my thing.

00:12:54:17 - 00:12:55:15
I'm always in pain.

00:12:55:15 - 00:12:56:23
I see that time to time.

00:12:56:23 - 00:12:59:04
Not as often as you would think,

00:12:59:04 - 00:13:01:05
but I know what you're talking about.

00:13:01:05 - 00:13:03:23
Yeah. Some people live in pain.

00:13:03:23 - 00:13:06:21
Yeah. That’s their life. Right.

00:13:06:21 - 00:13:08:21
Oh, that's the hardest type to treat.

00:13:08:21 - 00:13:09:19
You know.

00:13:09:19 - 00:13:11:08
The ones that are always in pain.

00:13:11:08 - 00:13:11:15
Yeah,

00:13:11:15 - 00:13:13:04
because probably one pain leads

00:13:13:04 - 00:13:14:06
to another pain, too.

00:13:14:06 - 00:13:14:19
You know, it's funny.

00:13:14:19 - 00:13:16:18
There's an actor, Walton Goggins.

00:13:16:18 - 00:13:19:02
The White Lotus. Boom. Yes.

00:13:19:02 - 00:13:20:09
Look at you, doctor.

00:13:20:09 - 00:13:23:00
So he has, like, he was on set, and he...

00:13:23:00 - 00:13:24:04
He put out this video on Instagram

00:13:24:04 - 00:13:25:19
the other day where he was saying he

00:13:25:19 - 00:13:27:11
he did something he, like,

00:13:27:11 - 00:13:28:22
tore something in his,

00:13:28:22 - 00:13:30:03
his quad or something.

00:13:30:03 - 00:13:31:05
He's going to physical therapy

00:13:31:05 - 00:13:32:10
throughout his back

00:13:32:10 - 00:13:33:18
led to an ankle sprain.

00:13:33:18 - 00:13:35:06
Like it was boom, boom, boom.

00:13:35:06 - 00:13:37:02
And he said, as I've gotten older,

00:13:37:02 - 00:13:38:08
I have learned that

00:13:38:08 - 00:13:40:09
if you want to live right,

00:13:40:09 - 00:13:41:19
you got to keep your glutes tight.

00:13:41:19 - 00:13:43:02
And so he's like, when I walk,

00:13:43:02 - 00:13:44:09
I squeeze my ass.

00:13:44:09 - 00:13:46:21
And it's helped me prevent

00:13:46:21 - 00:13:48:09
so many other things.

00:13:48:09 - 00:13:49:00
So he was just like,

00:13:49:00 - 00:13:49:17
when you walk, squeeze

00:13:49:17 - 00:13:50:07
your butt cheeks,

00:13:50:07 - 00:13:52:14
just clench your butt and build up that

00:13:52:14 - 00:13:53:17
that muscle mass. Right?

00:13:53:17 - 00:13:54:00
Yeah.

00:13:54:00 - 00:13:55:08
And it's preventing him

00:13:55:08 - 00:13:56:12
from having further injuries

00:13:56:12 - 00:13:57:16
because of these other things.

00:13:57:16 - 00:13:59:20
I wish I could comment on that one, but.

00:14:01:11 - 00:14:02:11
Anyway, that was what he said.

00:14:02:11 - 00:14:02:22
I don't know,

00:14:02:22 - 00:14:05:05
but it goes back to your muscle mass.

00:14:05:05 - 00:14:06:03
Work on your muscles.

00:14:06:03 - 00:14:07:15
Constantly keeping. Yourself strong.

00:14:07:15 - 00:14:09:17
Under attention. Yeah. Yes.

00:14:09:17 - 00:14:10:11
The other part

00:14:10:11 - 00:14:12:09
that we don't talk about and it's,

00:14:12:09 - 00:14:12:17
you know,

00:14:12:17 - 00:14:14:05
I don't want to make it sound

00:14:14:05 - 00:14:15:09
that it's not scientific,

00:14:15:09 - 00:14:18:17
but it is scientific is your headspace.

00:14:18:17 - 00:14:20:16
It's meditation and things like that.

00:14:20:16 - 00:14:22:23
And what I mean by that is

00:14:22:23 - 00:14:24:06
if you look at those patients

00:14:24:06 - 00:14:25:07
who have also lived

00:14:25:07 - 00:14:27:06
to their mid 80s in their 90s,

00:14:27:06 - 00:14:28:18
about to touch 100. Yeah.

00:14:28:18 - 00:14:30:16
One of the

00:14:30:16 - 00:14:32:18
strongest thread points that we see.

00:14:32:18 - 00:14:34:00
And this is not just my patients,

00:14:34:00 - 00:14:35:20
I'm saying from data sets

00:14:35:20 - 00:14:37:03
is that they have

00:14:37:03 - 00:14:39:07
some element of meditation

00:14:39:07 - 00:14:42:07
or some element of non-reactivity.

00:14:42:07 - 00:14:44:10
They're not reactive in life.

00:14:44:10 - 00:14:45:09
They're not letting things

00:14:45:09 - 00:14:47:03
get to them on a daily basis,

00:14:47:03 - 00:14:48:17
an hourly basis.

00:14:48:17 - 00:14:50:11
They've got that mental.

00:14:50:11 - 00:14:53:08
I don't know the strength to maintain

00:14:53:08 - 00:14:54:16
a non-reactive environment.

00:14:54:16 - 00:14:56:16
And that's also really important

00:14:56:16 - 00:14:57:18
for a health span.

00:14:57:18 - 00:14:59:20
Sure, it can be hard to do,

00:14:59:20 - 00:15:00:15
especially with everything

00:15:00:15 - 00:15:02:02
coming at us at all times, you know,

00:15:02:02 - 00:15:02:21
and you can try

00:15:02:21 - 00:15:03:22
and you can make it a point

00:15:03:22 - 00:15:06:00
to not engage a reactive mind,

00:15:06:00 - 00:15:07:22
but sometimes it'll it'll hit. Yeah.

00:15:07:22 - 00:15:09:07
What do we see on the horizon

00:15:09:07 - 00:15:10:14
for pain management

00:15:10:14 - 00:15:11:06
with what you're doing?

00:15:11:06 - 00:15:11:20
What are some things

00:15:11:20 - 00:15:12:19
you're looking at that you're like,

00:15:12:19 - 00:15:14:00
I like this. This is good.

00:15:14:00 - 00:15:15:03
Oh, it's it's

00:15:15:03 - 00:15:16:18
like I said, it's a great space to be in

00:15:16:18 - 00:15:18:05
because of all the spaces

00:15:18:05 - 00:15:19:04
of all the diseases

00:15:19:04 - 00:15:20:07
that we're treating in the United States

00:15:20:07 - 00:15:20:18
right now.

00:15:20:18 - 00:15:22:06
Pain is the number three disease,

00:15:22:06 - 00:15:23:19
apart from heart disease and diabetes

00:15:23:19 - 00:15:24:20
and that space

00:15:24:20 - 00:15:27:06
from a technological standpoint,

00:15:27:06 - 00:15:28:06
it's booming.

00:15:28:06 - 00:15:30:09
It's booming with new devices,

00:15:30:09 - 00:15:31:15
new therapies coming out

00:15:31:15 - 00:15:32:19
that are nonsteroidal.

00:15:32:19 - 00:15:33:23
So you don't need to have

00:15:33:23 - 00:15:36:06
steroid injections all the time.

00:15:36:06 - 00:15:37:06
They're nonpermanent.

00:15:37:06 - 00:15:38:08
So you don't need a surgery.

00:15:38:08 - 00:15:39:17
It doesn't have to be invasive.

00:15:39:17 - 00:15:43:00
And they can retrain the brain of how

00:15:43:00 - 00:15:43:18
to think about pain

00:15:43:18 - 00:15:45:12
or how to train those pain signals

00:15:45:12 - 00:15:46:22
from stop firing.

00:15:46:22 - 00:15:47:23
Yeah. It's amazing.

00:15:47:23 - 00:15:49:15
It's an amazing space to be.

00:15:49:15 - 00:15:51:19
And I think in the next 1 to 5 years,

00:15:51:19 - 00:15:53:22
we're really going to make a big headway

00:15:53:22 - 00:15:55:15
in the way we treat pain in this country. That soon?

00:15:55:15 - 00:15:56:19
Yeah, really.

00:15:56:19 - 00:15:58:17
So, wait, talk more about that.

00:15:58:17 - 00:15:59:21
It retrained what now?

00:15:59:21 - 00:16:00:11
It does what?

00:16:00:11 - 00:16:00:19
Yeah.

00:16:00:19 - 00:16:02:21
It retrains the brain so that, you know

00:16:02:21 - 00:16:03:14
the longer you have pain.

00:16:03:14 - 00:16:04:07
You mentioned it.

00:16:04:07 - 00:16:05:01
You know there are some people

00:16:05:01 - 00:16:06:12
who live in pain constantly.

00:16:06:12 - 00:16:10:02
And those cells then change over time

00:16:10:05 - 00:16:11:09
to allow more pain.

00:16:11:09 - 00:16:12:22
They need to feel pain in order

00:16:12:22 - 00:16:14:17
to survive, the brain cells.

00:16:14:17 - 00:16:16:13
So the new therapies

00:16:16:13 - 00:16:17:09
that are coming around

00:16:17:09 - 00:16:19:10
are working on what we call plasticity,

00:16:19:10 - 00:16:21:06
so it doesn't become permanent.

00:16:21:06 - 00:16:23:05
You can actually change the way

00:16:23:05 - 00:16:25:08
the brain thinks about pain... Whoa.

00:16:25:08 - 00:16:26:13
and the brain adapts to pain signals

00:16:26:13 - 00:16:27:23
that are coming from the spinal cord.

00:16:27:23 - 00:16:30:04
That's crazy in the coolest way. Yeah.

00:16:30:04 - 00:16:30:14
Oh my gosh,

00:16:30:14 - 00:16:31:18
how exciting for you too

00:16:31:18 - 00:16:34:03
to be in that in that space.

00:16:34:03 - 00:16:36:00
One of my favorite things as we've done

00:16:36:00 - 00:16:39:01
this series is to talk with doctors

00:16:39:01 - 00:16:42:11
about how technology advancements, be it,

00:16:42:12 - 00:16:44:07
you know, AI,

00:16:44:07 - 00:16:45:12
or I've talked to some doctors

00:16:45:12 - 00:16:47:13
who do surgeries with like the

00:16:47:13 - 00:16:48:20
the Apple Goggles on,

00:16:48:20 - 00:16:49:22
you know, like the headsets.

00:16:49:22 - 00:16:51:22
What how is this stuff,

00:16:51:22 - 00:16:52:20
you know, coming into play

00:16:52:20 - 00:16:54:11
with what you specialize in.

00:16:54:11 - 00:16:55:07
A lot of ways.

00:16:55:07 - 00:16:56:19
A lot of out of the box ways

00:16:56:19 - 00:16:58:21
that you wouldn't imagine.

00:16:58:21 - 00:17:00:17
For example, we use virtual reality

00:17:00:17 - 00:17:02:05
goggles to help treat pain.

00:17:02:05 - 00:17:04:01
Or when you come in for a pain procedure

00:17:04:01 - 00:17:05:14
so we can distract patients

00:17:05:14 - 00:17:06:22
from the painfulness

00:17:06:22 - 00:17:09:14
of the procedure itself. That's cool.

00:17:09:14 - 00:17:10:09
Kids love it too. So give me

00:17:10:09 - 00:17:11:17
give me an example of like what?

00:17:11:17 - 00:17:11:21
Like,

00:17:11:21 - 00:17:12:20
am I swimming with dolphins

00:17:12:20 - 00:17:13:19
while you're treating my pain?

00:17:13:19 - 00:17:14:11
Whatever you like.

00:17:14:11 - 00:17:15:19
Actually, to could put on iHeartRadio

00:17:15:19 - 00:17:18:04
if you wanted to. This is phenomenal.

00:17:18:04 - 00:17:19:14
That's so cool, I love that.

00:17:19:14 - 00:17:20:05
And like you were saying,

00:17:20:05 - 00:17:21:15
kids love that too. I'm sure.

00:17:21:15 - 00:17:22:18
They love it.

00:17:22:18 - 00:17:23:21
We use it in the hospital.

00:17:23:21 - 00:17:25:03
You come in for an infusion.

00:17:25:03 - 00:17:27:02
It could be painful. Wear the goggles

00:17:27:02 - 00:17:28:21
and you know you don't experience pain.

00:17:28:21 - 00:17:30:04
You're totally distracted by it.

00:17:30:04 - 00:17:33:02
Patients have a great experience with it.

00:17:33:02 - 00:17:34:10
That's some of the things we do,

00:17:34:10 - 00:17:35:14
some of the new technologies

00:17:35:14 - 00:17:36:13
that are coming out

00:17:36:13 - 00:17:37:17
where you don't need surgery.

00:17:37:17 - 00:17:38:18
We can burn the nerve

00:17:38:18 - 00:17:41:10
that causes the pain. Destroy it.

00:17:41:10 - 00:17:42:09
Minimally invasive,

00:17:42:09 - 00:17:45:07
no needles, no, no sutures, nothing.

00:17:45:07 - 00:17:46:06
And so that's that's

00:17:46:06 - 00:17:47:19
giving a lot of promise to people.

00:17:47:19 - 00:17:48:11
That's cool.

00:17:48:11 - 00:17:50:16
What excites you most about

00:17:50:16 - 00:17:51:22
what's happening at UCI Health

00:17:51:22 - 00:17:52:14
and your team

00:17:52:14 - 00:17:53:13
and what you're seeing,

00:17:53:13 - 00:17:55:02
like specific to UCI Health

00:17:55:02 - 00:17:56:08
and the way you guys handle this?

00:17:56:08 - 00:17:57:22
I think we're very unique.

00:17:57:22 - 00:17:59:02
You're not going to find

00:17:59:02 - 00:18:00:14
many pain centers

00:18:00:14 - 00:18:01:13
a locally,

00:18:01:13 - 00:18:03:06
but definitely not in the country

00:18:03:06 - 00:18:04:05
that do what we do.

00:18:04:05 - 00:18:05:11
And I'll tell you why.

00:18:05:11 - 00:18:05:18
You know,

00:18:05:18 - 00:18:07:18
part of pain is treating the pain.

00:18:07:18 - 00:18:10:12
But sometimes you do need surgery, right?

00:18:10:12 - 00:18:11:14
We're very unique

00:18:11:14 - 00:18:12:09
in that our pain

00:18:12:09 - 00:18:14:18
physicians are also in the operating room

00:18:14:18 - 00:18:15:11
with the surgeons.

00:18:15:11 - 00:18:16:18
And we know who's good,

00:18:16:18 - 00:18:18:16
who's not, what they excel at,

00:18:18:16 - 00:18:18:22
you know,

00:18:18:22 - 00:18:19:18
and we can talk to you

00:18:19:18 - 00:18:21:10
about very specific things

00:18:21:10 - 00:18:22:23
and send you to the right person.

00:18:22:23 - 00:18:24:01
Oftentimes you get a referral.

00:18:24:01 - 00:18:24:08
You're like,

00:18:24:08 - 00:18:25:17
you go see the person, you’re like

00:18:25:17 - 00:18:26:21
This is not the right guy for me

00:18:26:21 - 00:18:28:07
or this is not the right, you know,

00:18:28:07 - 00:18:30:00
how does the referral system work

00:18:30:00 - 00:18:30:20
in the United States?

00:18:30:20 - 00:18:32:03
It's broken,

00:18:32:03 - 00:18:34:07
but that's what we do really well here.

00:18:34:07 - 00:18:36:07
We have a really consolidated system

00:18:36:07 - 00:18:37:15
where we know everybody,

00:18:37:15 - 00:18:39:15
they know us, we work down the hall.

00:18:39:15 - 00:18:41:09
We have somebody who says, look,

00:18:41:09 - 00:18:41:20
we say,

00:18:41:20 - 00:18:43:08
you really need to go talk to a surgeon.

00:18:43:08 - 00:18:44:13
We walk down the hall with you,

00:18:44:13 - 00:18:45:16
introduce you to the surgeon,

00:18:45:16 - 00:18:46:20
and they see you right away,

00:18:46:20 - 00:18:47:23
and we help you

00:18:47:23 - 00:18:49:04
handpick the right referral.

00:18:49:04 - 00:18:51:02
So it's like team, team healthcare.

00:18:51:02 - 00:18:52:00
It is team healthcare,

00:18:52:00 - 00:18:53:14
but it's very personalized

00:18:53:14 - 00:18:55:22
in the right way. You know. Yeah.

00:18:55:22 - 00:18:56:21
How do you find a doctor?

00:18:56:21 - 00:18:58:00
You know, your kid needs a doctor.

00:18:58:00 - 00:18:58:20
How do you find a doctor?

00:18:58:20 - 00:19:00:01
I don’t know, go online or something.

00:19:00:01 - 00:19:00:12
Yeah.

00:19:00:12 - 00:19:02:21
You find, you know, random HealthGrades.

00:19:02:21 - 00:19:05:00
Or Yelp.

00:19:05:00 - 00:19:05:18
For sure.

00:19:05:18 - 00:19:06:10
Yeah. Yelp.

00:19:06:10 - 00:19:07:05
For a dinner a reservation.

00:19:07:05 - 00:19:09:05
But not for a doctor, right? Totally.

00:19:09:05 - 00:19:09:22
Yeah, yeah.

00:19:09:22 - 00:19:10:19
So that's awesome.

00:19:10:19 - 00:19:12:09
I love hearing that and knowing that.

00:19:12:09 - 00:19:13:07
That's a great thing.

00:19:13:07 - 00:19:15:10
Anything else that we should touch on?

00:19:16:14 - 00:19:17:13
You know that maybe

00:19:17:13 - 00:19:18:16
we haven't talked about that.

00:19:18:16 - 00:19:19:12
You think it's important

00:19:19:12 - 00:19:21:00
for people to know that maybe

00:19:21:00 - 00:19:21:22
watching this or hearing this,

00:19:21:22 - 00:19:23:00
that are living in pain?

00:19:23:00 - 00:19:23:21
I think there's hope.

00:19:23:21 - 00:19:24:16
There's definitely

00:19:24:16 - 00:19:25:13
hope on the horizon

00:19:25:13 - 00:19:27:09
for whoever's listening out there

00:19:27:09 - 00:19:29:01
who has pain, whether it's knee

00:19:29:01 - 00:19:30:18
pain as we age, arthritis,

00:19:30:18 - 00:19:31:09
my God,

00:19:31:09 - 00:19:33:10
we're all going to get arthritis, right?

00:19:33:10 - 00:19:35:09
Do we all need hip replacement surgery?

00:19:35:09 - 00:19:36:13
No. What else is out there?

00:19:36:13 - 00:19:39:13
So we've got a lot of new therapies

00:19:39:16 - 00:19:40:10
that we're bringing out

00:19:40:10 - 00:19:41:15
and rolling out at UCI

00:19:41:15 - 00:19:44:15
almost every few months, really.

00:19:44:15 - 00:19:46:18
And so I think there's a lot of promise

00:19:46:18 - 00:19:48:20
to people who are living in pain. Yeah.

00:19:48:20 - 00:19:52:01
And then also, also good pain care.

00:19:52:02 - 00:19:55:02
You know, sometimes

00:19:55:05 - 00:19:57:02
you may not gel with the right doctor

00:19:57:02 - 00:19:58:21
or you may get sent to a quack or,

00:19:58:21 - 00:19:59:02
you know,

00:19:59:02 - 00:20:00:16
I hate to use those kind of words.

00:20:00:16 - 00:20:01:19
But, but it's true.

00:20:01:19 - 00:20:02:23
You don't know who is who.

00:20:02:23 - 00:20:06:01
And but we select our physicians very,

00:20:06:01 - 00:20:06:16
very carefully.

00:20:06:16 - 00:20:07:11
We bring in doctors

00:20:07:11 - 00:20:08:10
from all over the world

00:20:08:10 - 00:20:09:23
Harvard, Stanford, Cleveland Clinic,

00:20:09:23 - 00:20:11:23
and they're all here at UC Irvine.

00:20:11:23 - 00:20:13:02
And so we really try

00:20:13:02 - 00:20:14:20
to create a team of pain physicians

00:20:14:20 - 00:20:15:22
where you don't need to go

00:20:15:22 - 00:20:17:02
to the Cleveland Clinic.

00:20:17:02 - 00:20:18:03
You don't need to go to Harvard

00:20:18:03 - 00:20:19:17
because they're here. That's amazing.

00:20:19:17 - 00:20:21:02
That really is. All right.

00:20:21:02 - 00:20:22:07
Just a side personal question.

00:20:22:07 - 00:20:23:10
If you get a headache, doctor,

00:20:23:10 - 00:20:25:10
what do you take? What do you do?

00:20:25:10 - 00:20:26:23
What do you do specifically?

00:20:26:23 - 00:20:28:15
Caffeine. Really? Okay.

00:20:28:15 - 00:20:30:05
Caffeine is the best thing you can do.

00:20:30:05 - 00:20:30:22
Yeah, yeah.

00:20:30:22 - 00:20:31:17
What about, like,

00:20:31:17 - 00:20:33:10
if you're, like,

00:20:33:10 - 00:20:35:12
if your knee hurts, your knee’s sore,

00:20:35:12 - 00:20:36:14
you know, then what are you reaching for?

00:20:36:14 - 00:20:37:06
Not caffeine.

00:20:37:06 - 00:20:37:20
Not caffeine.

00:20:37:20 - 00:20:39:07
Usually it's an anti-inflammatory.

00:20:39:07 - 00:20:41:07
Oftentimes 8 to 10 out of ten times

00:20:41:07 - 00:20:42:00
it's going to be

00:20:42:00 - 00:20:43:14
an inflammation process. Okay.

00:20:43:14 - 00:20:46:14
So your ibuprofen, your anti-inflammatory

00:20:46:15 - 00:20:47:14
and those types. Okay. Good.

00:20:47:14 - 00:20:48:10
Those are just personal

00:20:48:10 - 00:20:49:10
selfish questions.

00:20:50:14 - 00:20:52:07
My playlist says it's the 90s.

00:20:52:07 - 00:20:54:20
My lower back says it's not.

00:20:54:20 - 00:20:56:03
Doctor, thank you so very much.

00:20:56:03 - 00:20:56:22
We appreciate you.

00:20:56:22 - 00:20:58:19
Oh it's my pleasure. Awesome. Thank you.