1. Simone Maybin, MD: Redefining Our Approach to Pain and Musculoskeletal Medicine

Hello everyone, I'm Dr. Darsha Shah, and I'm Dr. Altamash Raja, and welcome to Medicine Redefined, a podcast where we will explore the often overlooked but necessary components of health, what we consider to be the fundamentals. We will investigate topics and practices that can give you and your patients the best chance to optimize a healthy lifestyle. It's time to move the needle forward and put the health back in healthcare. Our guest today is Dr. Simone Maibin. Simone is a graduate of the Air Force Academy who completed her residency training in Physical Medicine or Rehab at Vanderbilt University. She went on to pursue fellowship training in interventional spine and musculoskeletal medicine at the Johns Hopkins University. On a personal level, Simone has a background as an athlete, a professional athlete, in physique competitions, shows she had certainly walked the walk. As if her academic training wasn't enough, she pursued additional training simultaneously during residency in health coaching and is now a board certified health coach. In this episode, we talk a lot about how she is finding her approach to musculoskeletal care and the integral role of a physician as a coach for not only our patients but our athletes and for the society at large. So without further ado, Dr. Simone Maibin, all right, Simone, welcome. Hey, thanks guys, I appreciate you guys having me. Now we're super excited to have you here on our inaugural podcast of Medicine Redefined. We're going to have some great conversations, hopefully we'll learn something. So Dr. Simone Maibin is our first get in guest and I've worked with you. I've known you for a little while, but why don't you tell us a little bit about yourself and what you want our guest to know about you? Yeah, first of all, thank you so much for having me. This is super exciting just to chat with people like mine did, but a little bit different background. I hope I'm going to bring something interesting to the group here. My background started in the military actually. I was in the military for a little bit after graduating from the Air Force Academy and then made a career change coming into medicine and started off always interested doing something with my hands kind of in the muscle skeletal system, movement, functionality, mobility. And that really came from my experience as an athlete, you know, when I was in medical school, I continued to do sports and did a lot of bodybuilding competitions and, you know, kind of went to the top and that with my professional status and doing background competitions. And it's like, why not pick a field where I can combine my passion for mobility, function, bones, joints, muscles, nerves, things I can see around with the body. We all kind of have that in common, I think, labs are our nemesis. But hey, we can find things wrong with the body in a world of Peminar, which is the residency I did. Physical medicine rehabilitation is a field where I really get to combine my passion for movement, mobility, function, and really connect that with physical ailments, disability, and medical diagnoses that patients have been hit with that are really keeping them from living their optimal life. And I love being able to combine my personal interest with my field. And, you know, I knew early on going into Peminar, I was either going to specialize in sports medicine or pain medicine for me. And so what it really came down to was what did I feel like my strengths and my residency were compared to where I wanted to be at. And my fellowship training focused more on interventional spine and musculoskeletal medicine because I felt like, to be honest, my sports training was very strong in my residency. I did a lot of signline medicine, I did a lot of athlete management. And I knew I was going to be confident using those skills in my clinical practice. You go to fellowship to really hone in on things you can't do. And guess what I couldn't do as a resident, put needles on people's spine safely, you know, without advanced training. I was like, that's what I'm going to do. That's what I'm going to do. It's so now, here I am finishing my fellowship at Johns Hopkins, just this past of summer. And this is my first job here. I'm down in Murdle Beach, South Carolina, working in a hospital-based practice. And I'm bringing pain management and interventional spine for the first time to this hospital system in this area. And I'm super excited to kind of set that pathway for what does pain management look like in our hospital system to heavy weight in the shoulders. But, you know, from my past history, it's not, you know, just a challenge isn't something I went away from. So this seemed like something that was perfect for me. So here I am, my first job. Absolutely. Yeah, I love it, you know, and that's crazy because, you know, I felt like we got to know each other a little bit. Obviously, you know, we met when I'm still training in my residency, like you said in PM&R as well, and you were doing fellowship last year. And you know, we talked quite a bit, but I didn't know that part about you, like your whole journey and not until I listened to one of your podcasts as well. And you know, that really stood out to me. I thought it was cool, you know, that you had, like you mentioned, you had such a strong foundation from your own personal background being an athlete and then the sideline coverage in sports. And I think as often we as individuals, we tend to gravitate towards what we know, what we like, right? I mean, that's the case for me, right? I'm doing sports because I've always wanted to sports like, nah, this is what I like. And I think that's, that's a very natural thing to do. And you were like, no, I'm going to, I'm going to go out because I want to be extremely comprehensive. So I can do everything and I can truly help the individual. But the one thing that really stood out to me is like your unique journey of going from ACGME pain, kind of like diving into head first and then ending up a Hopkins, which I believe you mentioned that when you were a 12 year old girl, you kind of wanted to be affiliated with it. Could you talk about that like, like, you know, coming in whole, like full circle for you? Yeah. Yeah. Man, that's such a really personal story and I did, I highlighted that in my most recent podcast because it really became a really kind of came full circle for me when I ended up coming into, coming to Hopkins in 2019 and what happened with that story is my dad used to have us read these, these books about excellent people growing up. Yeah, I grew up in a strict family, you know, and so I read all these autobiographies. And one of them I read was Bing Carson gifted hands and it was all about how do you become a surgeon from essentially nothing. And I was really inspired by that story. And I said, man, I am going to be a neurosurgeon and I'm going to go to Johns Hopkins and I'm going to do that, you know, it's kind of insane. And so I had to set my sights high for this Johns Hopkins or equivalent environment throughout my training. And so yeah, I definitely had a few setbacks here and there, but I think I had some excellent opportunities to train, to train excellent institutions and, you know, I went to my med school here in Charleston, South Carolina, a medical medical university, a South Carolina and then Vanderbilt for my residency, which is fantastic. And I applied to do ACGME pain thinking, all right, this next step is going to be something that opens me up to be this board certified pain physician because that's what everybody told me made me excellent. You know, I have, I need to have these labels and I needed to have these credentials. Well, you know, you start to meet mentors along the way for your training that open your eyes up to what perspective is in terms of credentialing for training. And I'm not here to put down one program or another. I'm just here to highlight what other people have told me. And, you know, what we do know is that different training environments highlight strengths of certain physicians. And if you do ACGME pain, you're going to be very good at a certain set of skills. If you do different, very strong spine programs, you're going to be strong at a different set of skills. I would argue if you did internal medicine at different hospitals, you're going to have weaker and, you know, weak weaknesses and strengths anywhere you go. Well, you know, the ACGME application process, as you know, is so long and extensive, you're really forced to apply for things earlier than you're really prepared for and for people that are still making decisions between one thing or another. If you're like you, ultimately, you come in, you're like, I'm doing sports, there's no question. Obviously I'm doing ACGME sports, there's nothing else. There's not really a lot of like decision making to be made, but I think there's a lot of trainings that come in, whether it be the medical school level, the residency level, the fellowship level, where we're really being asked a year after year to make decisions sooner than we're exposed to those areas of practice. And that's a lot of pressure on students. And I'm not sure how, you know, maybe it's a bigger discussion than what we're ready for tonight. I don't think it's really relevant. But, you know, we maybe need to restructure kind of the way that we're looking at training and for forcing people to kind of make decisions before they're ready, but essentially that's what happened to me. You know, I was forced to make a decision to look at ACGME pain essentially before I'd actually been rotated into my pain rotations, before I had done some really critical elements of training. So I hear I am applied for pain in the back of my head, wishing I had applied for spine, you know, six months into the process. And the long story short, because it's a whole freaking podcast, is that essentially, essentially, I ended up not matching into my pain program, and I'm in the middle of doing an EMG, I get calls, they're like, hey, by the way, do you want to come to the University of Michigan? I'm like, did I even apply to the University of Michigan? What is happening right now? Well, you know, I've never not matched before, so you don't know that that's what happens essentially, these schools are calling people that didn't get a slot. Well, that was somebody offering me a job. So I dumbly, man, I don't know what you're talking about, I'm in the middle of EMG, like I'll call you back, like, so anyway, I accidentally turned down a job, that job was probably gone within 30 seconds of me hanging up. And then, gosh, I call my mentor, I start gathering a plan and I meet with my chairman at Vanderbilt, we come up with a plan, and essentially, I mean, within 48 hours, I had reached out to Johns Hopkins, a program that I loved, when I was doing the, I believe who was in a P conference, in Atlanta, and I met them there, and I was like, man, this was really, so I go in my folder, and I see it's a good program, I send an email out, the program director gets back to me, oh, yeah, fantastic, do you want to do an interview and the next couple don't, sure, well, hey, do you want the position, I'm like, what, what, am I going to freaking Johns Hopkins? Like after, you know, after like freaking thought I failed, you can imagine, like I was, you know, pretty shocked after this non-match situation, and then it turned around completely, and here I am, back where I envisioned myself, I'll be at, not at neurosurgeon, with the way better lifestyle, no fits, neurosurgeons listening, but doing what I love, after the journey, doing what I love, and at Johns Hopkins, and you know, practicing, you know, what I, I thought I'd love to go through eventually, and so it's amazing, you know, we all have these stories where we failed to just end up in a better place, and I truly believe that's happened many times in my life, and this is just one example. Absolutely, Simone, and I, I love that story because it shows so much grit that you had, right? Something that you're not expecting, and something that you have to go through, and then still making the best outcome out of it, right? And I kind of want to go down that path, actually, and, you know, for, for me, actually, I relate because I wanted to be a brain surgeon at the age of five, only because I could spell neurosurgery properly. I knew that, I knew that he came before the U, and I was like, yes, I got into it, and it's funny, because you talk about having, you know, not enough exposure to fields, right? And I actually wanted, wanted to do GI before I got into PM&R, and I got lucky into PM&R because an OB-GYN resident said, oh, you're into like alternative medicine stuff. Why haven't you thought of PM&R? And I said, why haven't I thought of PM&R, right? And it's something that a lot of med schools, you know, don't teach, and we don't have much exposure to. So what was the conversation your head as you kind of chose PM&R residency, and then even that after that when you're thinking about fellowship? Gosh, that's such a big open question. I mean, I have so many answers for it, I've tried not just not to be so, I mean, narrowed it a little bit. I think really, I went into med school, you know, first thinking neurosurgery, and then I quickly thought orthopedic surgery after the neurosurgeons I were exposed to just weren't very happy. I know that that's just location dependent. And so I was like, okay, orthopedic surgery just makes sense, like everybody says that makes sense based on my background. Well, within orthopedic surgery, you end up meeting physiatrist, and I started doing rotations where I met PM&R doctors. So I did, you know, how between your first and second year, you do that research thing or whatever, to boost your application. So I'm at hospital for special surgery in New York, there to do orthopedic surgery with the best women sports medicine doctors in the world. And they introduce me to the physiatrist there. She's like, oh, this is Jen Solomon, you know, she does, you know, our PM&R, our back pain stuff. I'm like, what? Like, all right, all of a sudden, interesting, but I mean, anyways, back to the surgery, back to the OR. And so I kind of pooped it at the time, but then as I got exposed to it more and more that summer, I started to realize how she really added to the team in that women sports medicine clinic. You know, it was one of those fantastic clinics. We all dream of where you have your surgeons, your women sports family doctors, nutritionist, your psychologist, physiatrist, it was fantastic. And what I really saw in that environment was this opportunity to combine different people from all backgrounds that all cared about athletes performance and functionality. And we had people that are very high level, some of the top athletes, you know, and professional athletes are covered by them, the American Ballet, New York Giants. And then we had people that just live in Upper East Side, New York that just need to see physicians. And they got such great comprehensive treatment. So I walked away from that opportunity realizing that there was more than one way to treat people with, first of all, back to the thing we all like, us the three of us, problems we can see, problems that are physically wrong with the patient. It's not a lab. And I was like, look, in physiatry, you can see all these problems with these patients. And as time went, I did more way rotations. I got exposed to more physiatry after that first summer. And I started to realize there was this ability to combine a little bit more balanced lifestyle with a selected field of medicine. So I think there are orthopedic surgeons that have a decent, a decent balance lifestyle. I think there are more physiatrists that have balanced lifestyles. And I said, when there's a way that I can do some hands-on medicine and still engage in these other things that I really like to do in my spare time. And I do have a lot of things I like to do that are kind of all about wellness and health. And I thought, TM and R allowed me to continue to do a lot of my own interest. But then actually use those skills I'm learning and like implement it more in that team in our clinical environment. I think orthopedic surgeons definitely have a very important role in our healthcare system and when they're seeing injury patients. But I don't know that it would be accepted in their setting to, you know, you're seeing 40 to 45 patients a day, some of them, sometimes even more. I don't think they really are set up to allow them to go there. Like I do sometimes as a physiatrist when I'm implementing some behavior modification suggestions and things like that, it just feels more natural. And so I gravitated to that more and more and more. And I think now, man, I'm so happy. I mean, I work next orthopedic surgeons every day. And we see a lot of the same things. It's just the way I'm approaching that same severe degenerative osteone or that degenerative spine. It's just different than the way they look at it. I mean, our jobs are just a little bit different. There's nothing good or bad about it. It's just different. And it just happens that my field, I get to talk about some of the other things I just happened already in joy and love about function return to returning to their sport. If it's a sport returning to the level of function that they were at previous to injury or debilitation, you know, absolutely. Yeah, that's awesome. Yeah, that's so freaking cool. I mean, you know, I think it wouldn't be an understatement to say that your journey from professional athlete to to trainer to physician, you know, being a physiatrist and interventional spine and musculoskeletal specialist. And now a health coach, I mean, it's pretty remarkable, right? And I know you feel pretty strongly about getting that credibility and getting the certifications. I know you recently, like you were studying for the the health coaching boards. You talked about this course that you took at at Vanderbilt, a great opportunity that came up, but yeah, you know, you can get physician because this is this is a struggle that I personally had to, right? I think both of us have a certification and our parent academy is NSCA. And we've kept up with that. But I remember a lot of my thinking, Hey, do I need every year? Actually, my, my CSCS is ending next month. And I'm debating again, do I need to keep it? I'm going to keep it because it's so easy. But I appreciate value of it. You appreciate the value, but at the same time, being a physician, technically, you know, by all legalities, you're able to do the nutritional counseling, you're able to do all those things, the exercise coaching and all that stuff. Now, whether whether you're actually truly qualified, is it is a thing that you and I know, but for our listeners, like, yeah, why did you continue pursuing this health coaching thing? Now, what value does it add to your practice? And why are you so passionate about that? Yeah. Yeah, it's really interesting, actually. So I started off with the NSCA CPT, certified personal training certification. I got that in 2006 thinking, well, I'm already really interested in creating my own meal plans and creating exercise plans. And I do it a few for other people similar to probably how a lot of us start. And then you go and decided to become legit, if you will. And so I did that. And for a couple of years, I started doing, oh, I worked at Golden Gym. So I worked for a big box. And that went semi-okay because I realized then you had to be a salesperson and sale personal training. I was like, oh, dude, I'm so not a convincing. I'm just, it's not my personality. I would suck at sales if that was something that made a living for me. I'm just like a, you need to want it. And then I'll work with, yeah, you have to meet me halfway kind of thing, especially when it comes to health. I'm so anti. Let me convince you why now you suddenly want to lose weight. Like, we all know that's not real. Well, so even back then, I think I had keyed in to what I know now on a more practical level, which is you will never convince a person to want to fix something more than they want to fix it themselves. And I really had conflict with the fact of having a personal training certification that focused a lot of on the what I consider the basic fundamental foundational skills. You definitely have to have to help people safely in there within their different confines and contracts, whether it be medical limitations, physical limitations, and whether they have sport-specific goals. However, as I analyzed the way my clients did over the years, I looked at the dropout rates and the follow-through rates and why they did or did not achieve their goals. And a lot of it had to do with because the reason I was treating personal training was I was prescribing. I was prescribing personal training just like you prescribe a hypertension medication or anti-inflammatory medication. Here, take this one time a day. Here, take this twice a day. Here, follow this workout regimen. Follow this diet. Come see me in four to six weeks and let's see how you're doing. What happens? I mean, you guys all know the answer. People fall off. They fall off if you're just prescribing without following through. And when I heard about this health coaching concept, I realized health coaching, which I hate that term, I've brainstormed nine million other terms we can use so people actually know what the heck it is because it's not a life coach. It's nothing. So, health coaching what it is is it's helping people reach their health-specific goals by guiding them using their own values and their own strengths and the client guides the progress and guides the action steps. There's literally no direction. So, doctors need the most training to become a good health coach because it's not prescribing. You're working within the confines, the construct and limitations of the client. And it's all behavior driven. So, the goals that you create are not I want to lose 20 pounds. It's I want to be active 150 minutes per week consistently throughout the year. I want to be meal prepping, you know, for three meals consistently blah, blah, blah. Like it's they're focused on behavioral modifications because when you do the research, we have found that patients, our clients tend to have long-term results when their goals are behavior focused rather than just outcome focused. And so, what I realized is that the way that I was targeting my clients all these years wasn't wrong. I was doing what my skillset allowed me to and I believe we all grow over time. I'm sure in 20 years I'll be thinking something I'm doing right now was horrible, you know? And I think what I realized is that I just needed I was interested in doing more. I was interested in figuring out the why for my clients and hoping to get down to what is it? Like why is it that you don't want to change it? Or maybe you're trying to do what Simone or Altamash do every day, but maybe you haven't figured out that your real issue is something completely different. What you do is a health coach is you help them discover what their true barriers are. So sometimes working out three times a week consistently isn't that they don't have the motivation to work out consistently. When you really peel back the onion, which takes a long time, and by the way, all the tools we use are evidence-based science. Everything we implement is evidence-based. Nothing is too, too weird stuff. So when we're we peel back the onion and we realize what is the holding kitchens back. I mean, it is mind-blowing sometimes to see that they're like, oh, I didn't realize it. It really goes back to the fact that I don't have confidence in blah, blah, blah. I don't have my support. My environment isn't comfortable and supportive or my sleep cycle actually is so off. There's no way I'm ever going to get up. So what we do is we work on what the real issues are. Half the time, most clients don't know what their issue is. And so they start working with the health coach. They just know they're not where they want to be. And so now my desire is to work more within the construct of helping people realize what is it that's keeping them from being where they want to be and that how do I safely help them without directing them because I know that that's not going to work long term. Right. So Samo, you are the only health coach that I know, right? That is a physician, which means 99% of physicians don't have this kind of certification. Obviously, all three of us going through medical training. Yeah. We don't we don't learn this in medical, right? So what is the role of the primary care physician when it comes to this health coaching kind of stuff, right? Like how does a patient go about it? Do they ask their primary care doctor? And if so, what does the PCP do or should they be sending them to somebody else, right? Yeah. It's a really it's a real challenge. You know, there's a lot of papers. I was you know, as I went through my course where we're learning, you know, what is the best way to connect people with these health coaches? Number one is it kind of like, I'm trying to think of God, PM and R. It's a great example. PMR, what we do. Nobody knows what the heck we do in some environments. That true. I mean, especially if you're talking what major academic centers, they kind of know, but even the people that consult us, you guys have seen this consults, it's like, all right, guys, come on. You know, so anyway, half of its education and marketing. So half of it is, I was a majority of it for health coaching since, you know, nobody even knows what that term is, is there, if there's a health coach in that environment, we need to make sure that they know about it. PCP needs to be just like they marketed me when I arrived. Hey, there's this new pain physician. By the way, this is what she does. And I think the same thing exists for health coaches is as when they arrive, their needs of this mark, be this marketing to primary cares. And a quick educational form that says, hey, this is what the health coach can do for you. This is how you contact me. This is how my referral process works. And then, you know, reach out to me any questions, concerns that are at us. So it's a lot of groundwork, but that will exist as most people will find in private practice for any field that you're in. I mean, people that we know what they do, what's the panic surgery, you got to do some legwork to get out there. Once PCPs know what exists and what they do, I don't know. It's at that, it's super important that they know the intricacies, but knowing what problems they treat obesity, smoking cessation, for our surgeons, it's getting the patients, you know, off-ready, because to the all these limiting factors like elevated BMI, diabetes management, medication, compliance, you know, there's some deeper stuff you can get into with more elevated clients that are kind of have a good baseline health, but I think once you have that awareness available, then what the PCP does is I, you know, some papers I've read about something I'm trying to do here is you really run parallel clinics. So what it looks like is Altamash comes in for his PCPs visit, hey, Altamash, your diabetes continues to remain out of control. How dare you? A1C is, you know, a 10. Even the Altamash would never have a A1C that was controlled. We're not going to, we're not going to use any other patient's names here. So let's say that's the issue. Well, you know what, hey, you know, I do have a sweet tooth. You know, we can't deny that. But you know, that in that moment, you'd say, Altamash, you know, this is got, we've kind of struggled with this, you know, your sweet tooth is getting a little out of control here. We're going to need you to go talk to Becky. She's our health coach. She's, you know, working down the hallway. How do you feel about just talking to her real quick, just doing a quick, you know, introduction, quick intake? He's like, I don't know about this, but I mean, I'll give it try. You walk in, Becky does all the work. Becky does the introduction. This is what health coaching is. This is what I can do for you. This is what the, the construct would look like. This is what a contract is like. What do you, oh, man, I didn't realize it. But everything you're telling me, I think would really be beneficial. Maybe that, maybe we should try this. Let me, maybe I should come back and visit you a couple times and just see how things go. That, um, health coach then can provide as long as obviously there's, um, patient approval, provide reports and feedback to the PCP. Hey, I saw Altamash for 12 sessions for the last three months. This is the progress we made with his behavior modifications. And then there's a medical way that's probably too much detail for this. There's a medical way that we can build for that, um, which, as you know, these days with special services like this, it's all about how do we build for it? How do we get paid for it? If you can't get paid for these things, that is what's making it difficult for physicians and other providers to offer them in the clinic. And so that's what I've spent a lot of time doing here. And this setting is figuring out, because you know, I'm going to bring a health coach in. How am I going to bring, because I can't do it, I got to see all these complicated spine patients, which I'm very excited to do. But I need to have a health coach here. And I need to figure out how my hospital can get compensated for. Except at the end of the day, we all want to take care of patients, but at the end of the day, it's a business. And so you got to figure out how do you get the hospital reimbursed for this. And so there's, there's ways to do it. And it's not a big deal. But it's going to be easier than some of the things all of us kind of talk about, which is like, hey, can you just sit in the clinic and talk about nutrition for 30 minutes? Uh, if you refer to registered dietitian and the insurance covers it, right? It's, so it's, it's, it's, it's, it's limiting. There's barriers, but we're finding workarounds because we're finding more data, which is what always comes down to you, finding more data and positive outcomes with health coaching and present that. And then that's when we're having the ability to get compensated for in a hospital or clinical setting. I see. Yeah, that's like, that's right up my alley, right? So like, I was looking into getting like functional medicine certified, but unfortunately you have to wait till after residency, you know, to have a license and go through it. So how does someone get into health coaching? Do you have to have a residency? Like do you have to complete residency? Or is it something that me as an intern can get into? Yeah, that's a good question. So it's nice because they do require some medical background. So unlike my personal training certification, anyone can go read and apply for your personal training certification. To be a health coach, you do have to have some exposure to medical training. And so typically these people will have an RN degree or therapy degree or MD or DO degree. Every once in a while, you'll have people that meet qualifications due to a ton of hands-on patient time without having a degree. There's set special exceptions I've seen for certain programs. But for the most part, you just have to have an advanced degree in being some type of provider. And the reason being is that if doctors are sending you those patients, you need to be familiar like, oh, elevated cholesterol could have this impact on the patient. Or oh, the A1C means XYZ. That's a long term number, not a short term number. So that you do need to have some background, but the variety that you bring to the table is actually very good because what I found even in my training group is that each health coach brings to the table whatever their background is to that relationship with the client. And it tends to evolve in a way that's just so special depending on the person. So all three of us may have a different experience depending on the coach and their background. So they're qualified. But like I trained with some people that had a little bit more one girl had a master's of holistic medicine and astrology and believed in a lot of things. And I'm like, I don't know anything about that. But I got this nutrition stuff downpacked. I got this exercise stuff downpacked. And so maybe I was pushing more forward with when it was appropriate answering those very technical health related questions, whereas maybe she wouldn't be as in detail with the exercise details and the nutrition details. Again, you need to know some, but you're really just trying to keep the patient safe since a lot of the patient goals are self-directed. And so after you have this baseline training level, what they look for really is going through this comprehensive program where you're doing a lot of not only understanding of the basic principles and the evidence behind the techniques that we use to communicate with the patients, there's a lot of positive psychology listening and reflection skills, all these things that probably psychologists kind of learn about. And then techniques to look for when you're hearing patients go a certain direction, what tools to use to guide or realign things, how to keep us on track when they're maybe off of where they need to. There's a lot. So learning the techniques are important, but then what happens is you start to integrate a lot of one-on-one time and practicing skills. After you finish that formal education, then comes the time that you actually need to at Vanderbilt, it's 70 sessions, not 70 hours, but 70 sessions. It's important because sometimes the sessions can be longer than hours, so it feels like a million hours. So 70 sessions and you document those, you submit all of this now, you submit your graduate certificate. Okay, wait, let's pause. So if you see all those patients and you complete all your sessions, you complete it all the academia, all this stuff probably takes two years. It should really just be a master's degree. After you complete all that, you submit it and Vanderbilt says, okay, you have your health coaching certificate. Are you kidding me? I'm a doctor. I don't want a certificate. I was like, I'm not just going to certificate. I was like, no, there's boards. And I was like, yes, boards mean something to doctors. I was like, if there's a board I can sit for, that's legit. So you take all that certificate, you take the hours, you take all this documentation, you submit that to the national health and wellness consortium. I'm screwed about, but you submit all this documentation to them. They allow you to sit for the board similar to finishing your ACGME residency stuff. And then you can sit for that and become board certified. So you have, you, that's a choice. Most doctors that took the course with me, which by the way, they both of them happen to be pain physicians. That's, I don't think that's a coincidence. But and so it's interesting. You can really go as far as you want to with it. You know, there's a lot of people that do the program and just get the certificate. And they're full-time health coaches. Are there's people at Vanderbilt right now that health coach for a living in the integrative health center? That's super legit. Yeah. That's freaking awesome. I mean, you know, like you said, I think for me being involved in this is such an early on. Obviously, and, and Darshan is the same way. All three of us, we have a lot of passion. And it's so easy when you're so passionate about this to kind of be sitting in how our medical cultures define now and have those barriers where you're just kind of, again, feel like, you know, you're, it's hopeless. And you're not going to be able to do the things you want to do, whether it's, because the patients aren't buying into it. The system's not created that way to practice. But what I've noticed is that change is coming. It's happening. And the ones who are, are, you know, not ready for it, they're taking matters into their own hand and kind of setting their own standard for excellence. Clearly, you've done that with the, with the coaching, you know, health coaching boards they've taken. I remember reading about pretty recently, the NSCA actually announced, I don't know if you know this, that at least for the CSCS, before it was, you needed to have a bachelor's degree. But now, one not now, excuse me, 10 years from now, because change is slow. 20, 30, you need to have a strength and condition related field, but also the college needs to be like approved by the NSCA. So that's, I think these things are, I mean, unfortunately, this takes time, but, but let's shift gears a little bit, right? Obviously, the most important thing I think we've talked about, it's the whole behavioral change, because if people aren't going to buy into it, it doesn't matter what we do. But, but I want to, because I know you're passionate about a functional training, right? At least a concept of functional training. And it's super popular now, right? Particularly with, we've had issue, like, you know, where since CrossFit came on big and you've had orange through, you've got all these different places and they've got good, they've got bad. So I want you to tell us, like, and maybe some of the listeners, first of all, like what is functional training? Why is it important? And then, you know, like, yeah, I really, could you define it for us and tell us, because like the other day I was watching some, something maybe on Instagram or something, and I saw a person doing curls on a bosu ball in the gym. Is that functional training? Is that, is that what, what that is? If they're a tight rope walker, I would say possibly, I mean, if you work in the circus, which I think actually helps us kind of go into the definition. And I mean, I ask for your inputs, too, because I don't know that I'm an expert on the definition, but I'll say you my interpretation, which is I think functional training is that you're doing specific actions or movements that are actually helping you to employ something specific within your daily routine or daily function or daily sport. And so if the movement you're doing is supportive of something specific, I think that tends to be more functional. I think if you can take the, if your body is learning something from those movements or gaining something from a strength perspective, flexibility, whatever, all the aspects of your fitness and health, I think that's when we could say, okay, that specifically is translating into an activity that that person wants to do. I think a lot of times what we see, like you're talking about is people are picking activities to do, that I don't know that it specifically is helping them reach a specific goal. And I mean, maybe that's not their fault for not knowing that, I mean, we all know half the time, it isn't their fault that they just don't know that that is not helpful. But I would argue, this is kind of why, I mean, I don't know how much, you guys know how much I have, I don't know if it's clear how much I hate CrossFit. So we'll just make that clear. So I'm not a big fan CrossFit. And so like I talk about that on my podcast, and so I think I, you know, when I hear about things that I don't like, I always step back for a second and say, recognize the situation and where people don't move enough. You know, and I said, just recognize where we are right now that I'd rather that person be standing on a boss ball and doing whatever they think is going to help, because hey, they're working on some stability, they're not sitting on the couch. So in one, on one hand, I want to knock them, you know, because I'm like, man, it's so unspecific and helpful, and not helpful. But I think I should really only be doing that for people that are a little bit more fitness savvy, you know, like maybe, ultimately, I should be like, so what, what the heck is that for? Well, you're going to work out almost every day. So like me, you got two people here. I feel like I know you better. Because I'm legit. Yeah, yeah, this guy does nothing wrong. I feel like, I feel like since I know you, I'm like, I'm like, it's like it is personal. You can pick on me too. Okay, okay. So back to all the functional stuff you do run in the gym, you know, but I really think it's a fine line, right? Like we want people to do more and just get out there. And if they're following that random workout on Instagram, because they're, you know, they're a little idle posted it. I don't know. There's a balance. I mean, there's a balance. Like maybe go for it, rather than not do it at all. But for the year more advanced athletes, or let's say, moderate to advanced athletes, that's when maybe I might start getting a little picky and pushing on them to kind of question why are you doing what you're doing? So I'm 100% with you on that, right? Like I think movement is better than no movement. But you know, you being a pain doctor at what point are you going to say, hey, maybe this isn't the best thing you should start out with, right? Like you like not to start out with CrossFit. Like at what threshold have you seen with your patients where you're like, you should not be doing this because this is painful. First of all, the question is at what point have I met a patient doing too much exercise? Well, it's like step back. That is almost never the situation. It's always like, so when's the last time you walked? Well, I walked to the fridge. Okay, come on. Like I, you know, it's so I just not seeing that that that very often in my clinical settings, whether it be here or up in Baltimore, I wasn't seeing the issue of having people do incorrect exercise. Maybe my sports counterparts are maybe other clinics are, but the most common issue I have is lack of inactivity. And maybe a handful times a year, I'll see a guy, a girl, that's maybe trying to push it and do a bunch of weird stuff that I think they're causing more damage than not. And usually in those situations, almost always, it's a guy that used to be a really great athlete in high school college and then gained some weight and kind of has a grasp of the fact that he's not as athletic as he used to be. And now he's in the gym doing a bunch of stuff when his basic agility, endurance, foundational stuff isn't even playing anymore. He's like, oh, I'm going to go do all these things. I'm like, you can't even touch your knees much less like you're trying to squat right now. Bro, like let's take a couple of steps back. It's usually that kind of situation. It's not usually a chronic pain patient. Usually it's just a guy I'm seeing that has kind of a focal injury, kind of a more, some more sports injuries when I'm seeing, because that's how you hurt yourself, right? Yeah. People out of shape doing stuff, they're just not supposed to do. Yeah. And you know, speaking on on those injuries, and another like issue that I have, obviously something that plays the whole country is musculoskeletal-related pathology, right? In fact, that's now the number one reason why people go to the doctor, right? It historically used to be up respiratory infections, but now it's back pain, probably pretty closely followed by shoulder pain and then maybe URIs. But, you know, so obviously like acute classic fractures terrors, like we know that, you know, they need to be treated appropriately and pain in that regard as you can take care of that, you fix the issue, go for it. But we know that pain is really complicated. But for so many doctors, I come across so many physicians who are still stuck on this pathoanatomic model. I'm seeing more and more people talk about this biosocial model for pain. When I'm talking more like chronic dysfunction, a lot of the folks that you see who aren't moving because of inactivity, that kind of stuff. But there's still so many people who just, they want to get the image, they want to get the MRI, they want to see what's wrong over there. Let me give you a quick example, right? Last week I did an interview and I was talking to the chair of orthopedics at a large academic institution in the Northeast. And he had, he was talking about his posterior shoulder pain. And he's had a diagnostic ultrasound scan and he knows he has a significant rotator cuff tear. He's got a super spinatus tear, which is, you know, super spinatus for my med folks. I mean, we know that it's the kind of the muscle above the spine of the scapula, it kind of helps the arm lift up, right? And stabilizes the humerus or, you know, arm bone. Now, his pain was more so on the posterior aspect or the back of the shoulder, not typically where the super spinatus is. And that's not, sometimes it can present like that. But he was convinced, he was convinced that he needed an MRI. Mind you, he's still benching, right? He's still benching. And he's like, yeah, when I bench, it's fine, but after I bench, it hurts. And I want to sleep at night, it hurts. He's like, but I think the pain's back here, and it's not classically super spinatus. So I need an MRI. I was like, bro, like, so I was like, hey, maybe just do some direct cuff, you know, it was fine. It was an interview, like whatever, it was 15 minutes. But this was a surgeon. Yeah, the share of orthopedics. And so, but otherwise, a great guy hit me, you know, he did read some longevity stuff, David Sinclair. So we talked about that. That was cool. But, but what I want to ask you is, I think, why do you think there's such a strong emphasis on the pathoanatomic model still? Like, why are we so hung up on, you know, if this hurts, then we got to get the imaging, we got to figure out like, what's wrong? Like, you know, when we know that it's much more complicated than that. Gosh, that's such a great question. I don't know that I have the direct answer to that. I think I, as I'm reflecting, I'm thinking about the patients, one after another, I've said that, is like, yeah, but why does it hurt? Yeah, but why does it hurt? And so, I know the answer, I know how I manage it, like he managed that expectation, but in terms of why they want to see that I think, I think patients don't know what they don't know. I can't speak for educated people that have, you know, degrees and, you know, enjoying, but, you know, for patients that do that education, they do something hurts. And we describe the x-ray, and you're like, well, you know, all I can see on the x-ray is the bones. You know, if I really want to evaluate the spinal cord and the spinal nerves and the muscles, I'm going to have to get it MRI. Why did you just say that? You just told patients something that it tells us is so simple. We know you can't see anything but bones on the x-ray, but you just said that because you obviously don't think the patient can see that stuff on, you don't think they know that. So if the patient doesn't know they can't see on that on the x-ray, then how in the world are they going to know that you can't see pain? There's no way, or you can't, you can't get an MRI and just see that nerve. When you say that, the sciatic nerves, nerve is painful because of the inflammation. You know, you know, I might use the word like inflammation cascade. We've got to shut down the cascade, right? There's kind of some of the things I use. Well, can we just see the inflammation with MRI? Dang it. No, we can't. But I can tell you ways that the body can feel inflammation. I can tell you the ways that the body senses inflammation. But I think, honestly, I think it's, my opinion is that in the majority of situations, it's the lack of understanding and education that they just feel that if there's pain there, you must be able to see it. You must be able to see it. Like it must be physically visible why there's scaccular dyskinesis, which is a perfect example of something you absolutely cannot find on any imaging, right? But everybody has it. And so it's like, I don't know how to, I don't know how to change that expectation before they get to my clinic. I think the best thing you can do from there, and honestly, probably the best people that do it is probably, I can't imagine anyone does it better than PM and R, is you start describing biomechanics, you start describing the stabilizers and, you know, oh, well, you know, you've been walking this way for so long and now you have the ITBN rubbing off the verses and now that's inflamed. And so because you've been doing that, now this is weak and now going down to this knee, that's turning. Oh, okay. If you get models out and you start showing them, people do understand, you know, it's a matter of talking about biomechanics and using words like walking funny and using words like, well, now that's all irritated. When you start using simple jargon and showing them examples with models, I think that connects for them, that the pain that they're having is more of a sensation and a symptom of their function more so than it is a physiological focal point that we can identify in MRI. And so we can't change that people want to see that, but we can change the way that we manage that expectation and make them feel more comfortable with our ability to kind of target their symptoms. I love it. Yeah, absolutely. Education. Yeah. Absolutely. And speaking of education, right, and us as peeping in our doctors, talking about pain teaching our patients, but not only teaching, but also preaching, living a healthy lifestyle, right? And I think I was listening to one of your podcasts where you said, correct me if I'm wrong, 23% of physicians are obese, is that correct? Oh, yeah, I'm sure it's higher now, right? So what is your solution to that if you do have one, right? Like how do we as physicians walk the walk as you would say in your podcast, right? Yeah, I, you know, I struggle with that answer because one of the things I always humble myself to my patients is always say, hey, I'm just like a cut of society, you know, like physicians are, this is a job, you know, just like the banker has a job, just like your car, the mechanic has a job, like this is just our job. We still have all of our own individual habits we grew up with. A lot of us may have not come from the say, you know, socioeconomic socioeconomic issues that exist for a lot of the people affected by a obesity epidemic, that exists for doctors as well. Access, you know, we had going through training like you are now is one of the most stressful times in our life. We probably take worse care of ourselves than those people that, you know, we're, they're sitting in our clinics, you know, and we're like, you need to do this. You need to drink water. It was last time we drink water 16 hours ago, you know, and so I don't know that, you know, my main point when bringing up that statistic isn't so much that doctors need to do better, so much better than everyone else. I think we need to do better just like everyone else needs to do better. You know, so just like the mechanic needs to do better, just like everyone else in our society needs to kind of rise to the occasion, I feel like we also tend to have more of the resources that are fingertip. So it's a little less, less of an excuse, but given that the percentages are so low too compared to what is it 60 percent, you know, all, all comers, so you know, 23 versus 60 percent, you know, we're doing, we're doing better. And so I'm, you know, I just wish that I think what it speaks to is just how, in fact, many physicians are really not physically displaying that physique that just looks healthy, if you will, you know, to solve perceptions. That's all we're talking about. It's all perceptions. Then, you know, that that self-confidence is down, that ability to speak on a health and nutrition is going to be down. And so it's kind of more of just an explanation of why it might be an issue in some clinical settings is if that, you know, we're having 25 percent of physicians not have, yeah, look like they're walking the talk. I think we can almost guarantee a lot of those people are not going to either address it because they feel insecure, given that they're maybe not displaying what they're talking and going to speak about, or maybe they just don't have the skills either. And so it's unfortunate that we, you know, have not as physicians been able to make sure we're equipping everyone with the same resources, but, you know, hopefully, we'll get to a place in the education system, I would hope, where we kind of even the playing fields, you know, just given the resources we have going through such, you know, expensive medical training. That's awesome. Yeah, no, I love that. As you know, as I'm wrapping up my training and kind of starting fellowship soon, I've been putting a lot of thought into how I want my future practice to be, right? And especially as, as I'm evaluating different fellowship programs, and you talked a little bit about, you know, what some of the barriers are and what you think the optimal type of model will be. And so that kind of gives me a sense of what your vision is. And in you, again, you and I have talked about this offline, but I'd be, I'd be curious. I think some of the people, like I said, it can be challenging. So, so why don't you, how are you practicing like this now? Like what are you incorporating for your patients to kind of help them with that healthy lifestyle, especially some of those challenging ones? Is there anything that you're doing, quote unquote, unconventional right now? Yeah, that's a great question. So I think, you know, we have to set, make it clear what setting I'm in first to kind of describe what options I have and what barriers I have, because every clinical setting will have those things, whether you're in an academic institution, a private institution, or a medium sized group, you're going to have to work with the good and the bad there. And so my setting right now, I would consider a small independent hospital, it's important to identify that word. Because of that, there's going to be a lot of freedoms and some limited resources. So in my setting, I don't have a psychologist in my clinic, which would be ideal, that's what I consider comprehensive pain management, comprehensive well-being management in my practice. I don't have a psychologist in house or in my hospital, so that's a referral out. That's one more opportunity for my patient to fall through the cracks, through that referral pattern. I do have an excellent set of therapists and we could get into a slew of the techniques that they offer, but they offer all the things that I'm looking for in terms of the interventions, some of the more gentle, some of the more advanced and towards the athletic level, which is important to have a breadth. And so I can implement that comprehensive aspect of things. We don't have an nutritionist on hand, so that's not something that I can refer to in house. Again, another opportunity for that to be lost. And so what you can do, and this is kind of something they teach kind of in health coaching, they teach how even family, family physicians can implement a quick like three-minute behavior modification. That's kind of the direction we need to be going, because even me, some of the patients I see, I mean, I'm a spine specialist, so some of the patients I'm seeing might have three or four complicated spine problems that if you're trying to do that in a new patient's visit, and I'm reading records because I'm their fourth, you know, opinion, and they've had four surgeries and all this stuff. I mean, and they're overweight, some own, even I love this stuff, there's no way I can even add in a little dabble of, oh, tell me a little bit about what your vision of optoma health looks like to you, you know, like we can't even go there. So what I tend to do is I am flexible and willing to go there when other patient is a little bit more simple and not a complex spine patient, and oh, oh, came up, okay, came up, it's so funny, I think this is okay to bring up, because there's nothing specific about the patient today, the patient's talking me through the things that make their pain worse, and I'm thinking that they likely have, it's a classic good spine case where somebody's calling it, you know, cervical ridiculous apathy, you know, if you're peeing in our person, you quickly identify that people can have shoulder impingement and carpal tunnel syndrome, and people that don't talk to them long enough realize that they actually have no cervical ridiculous apathy. So that's kind of what's happening here is the problem is isolated to two different locations. Oh, well, it makes it worse. Well, when I'm lifting up and I'm holding my phone, when I'm driving wheel, when I'm driving at the wheel, when I, you know, pick up my cigarette, when you pick up your cigarette, what did you say? No, so we kind of go there for a second, you know, and, you know, the guy laughs and he's like, oh, and I was like, no, hey, you brought it up, you clearly want to talk about your smoking today, and that's fantastic. And that's fantastic. So tell me a little bit about that. And, you know, even for the people they teach you, you know, for people that are in their pre-contemplation phase, which is they're not ready to quit at all. And, you know, what they teach you in health coaching is you still always address, this is why it's medically, you know, wrong, or these are the thing, these are the bad things it's doing for you. You always, even a pre-contemplation phase, you make sure it's your job to highlight, this is what's wrong. In my field, I don't, I mean, I care about their lungs, but I talk about the fact that we know that people that smoke have way worse pain scores and disabilities, disability scores, and those that don't. I mean, on all the studies, they always, they always take out confounding for smoking because it's astronomical how horrible those people do with pain management. And so that's the angle I come from and said, man, you're going on and on about your pain. And I said, but you haven't really changed the one thing that we know makes pain worse than all my patients as it gets the smoking thing. And I said, I know, I know you know, and it sounds like you've talked about this with your PCP, but I'm going to just tell you one more thing. If there's something you want to do about your pain, I'm telling you, there's one more thing you're not working on at all. And I just got to let you know, just factual, because that's my job. Factually, your pain is going to be worse as long as you continue to smoke. And that's all I'm going to say about that. You know, you kind of continue to hear out where the patient sat and what they want to do with that. But I think that that's a great example of that patient had had, I wouldn't call him the simplest patient because I think I ended up giving him three or four problems by the end of the visit. But in terms of his history and there wasn't an image in your review, there was no history of surgeries, there was an opportunity to spend five minutes on one thing I know that's going to improve this guy's quality of life. And I don't mind doing that. I think you have to have, first of all, I, you know, when you work in a field of pain, people tend to be, you got to have a certain personality. You know, I know how to deal with a lot of situations. So you got to be willing to just kind of go there. You can't be a timid person and kind of confront people on these unhealthy behaviors. I think sometimes people are scared to confront them and say, hey, do you know that your weight is affecting X? Oh, I didn't know that. I mean, I've had several people say they didn't know blah, blah. All right. My physician never told me that the weight would actually help with this problem or I never knew that about the smoking problem. That's one thing we know is that patients aren't being told enough. They might be documented in the note so they can build a certain way. But you, you actually have to vocalize your what you know factually about the patient in some way because that is what gets the patient to at least switch to the contemplation phase at some point. It's going to be their own accord, but if physicians aren't bringing up an opportunity for change in a way that objectively helps their health and isn't attacking them as a person, then I don't think that we're ever going to really not, you know, we're going to have a less of a chance of that person kind of seeing that as an opportunity for change for themselves. Yeah, that's so amazing. There's so much to unpack there. And you know, some of what I got is obviously there's a couple of layers to the limitations. And I think you started off talking about how with the staffing that there's some limitations, you know, the appropriate personnel, the appropriate team members, right? I'm a sports guy. So I'll talk about you got to have the right teammates to be able to, you know, success, right? But then, you know, more the focus that all three of us are doing, I think a lot of us can do is, again, having those difficult conversations with the patient, educating ourselves and the patients. Do you think that like if today you were a czar of that hospital, you're the leader of the hospital and you're like, I've got all the money and I need to make that all the money, but you've got some money and you can make one change, either you can make the change for the person now, right? Or you can, or you can keep providing that education and attack it the way you're attacking. Like which one do you think would pay more dividends? Because to me, it seems like you're doing the latter. And I think I do the same thing because I, you know, I'm in the sense, you control the, you control what you can control. And then, you know, the other things kind of hope like, you know, that people smarter than you will figure it out. Is that what, is that the way you're approaching it or? Yeah, you always work when you're confines. I mean, I'm even doing things, you know, I think there's a little things like the patient telling me to do it. You got to listen. I mean, you got to listen. And when people tell you, especially with pain medications, I think this happens a ton. Um, okay. So how are you taking that one? I mean, you see it? No, no, no, I said, no offense. I just always ask my patients how they're taking, I know how it's written. You write, I can't read the computer. I'm asking how you're taking the medication. Oh, well, you know, I might take it once that's information. Your patient's not getting better because they're not taking the medication. You don't need to increase it. You don't need to change the medicine. You don't need to get MRI. You need to figure out a way for compliance. Are you need to figure out what are the barriers to that? So a good example today, you listen to the patient. Oh, well, whatever. Let's send it into details. There's issues with compliance due to his schedule. Well, the medications are on or something that easily can be converted. I can do the GABA Pinter nor the neuropathic pain agent, you know, once at night, you know, it's ideal to split it. But this guy is getting half the dose because I just can't take it twice a day. All right, man, we're just going to do it all at night, right? It's not the best, but we're getting closer and anti-inflammatory. You can put them on the longer acting line versus that. That's simple stuff. I'm not talking about anything that, you know, this high education taught me. This is just common sense, right? And so I think that's working within your system at the very simple level. You're just listening to what the patient's issues are. Almost always, the reason the patient is not progressing almost always has nothing to do with the system. There's a, there's a few times that the system is really holding in what we do. There's a few times of the system. So, you know, I can't get this advanced study, you know, we got insurance issues and things like that. But in terms of, you know, a lot of the barriers, I think a lot of them have to do with listening to why your patient's not progressing and seeing what is in your realm of control, like you're talking about, I think there's a lot of times that you have so much work you can do on the behavior level, that even if you never get that MRI, that person's still probably going to get better, man. I mean, like outside of, you know, catastrophic neuro-logical deficits, right? But yeah, I agree with you wholeheartedly. Like, we got to work at our level. There's so much you can do unless you're bizarre. Yeah, I think, I think you honestly nailed this moment. I mean, there is so much that we can do, but I think oftentimes as physicians, we actually just place limitations on ourselves, right? But you're really big into listening, you're really big into growing. And I think, you know, throughout this podcast right here, this episode, the one thing I've learned, I think all two is how much you're on a quest for knowledge, right? With certifications, not only to help your patients, but also that so that you can grow. So my question here is, what are your next steps? Are there any more certificates you have in mind, any more training? So much pressure. I just finished the last test. Oh my god. I know. No, I think that's a great question. So right now, what I'm going to do is focus on really implementing the skill sets. I took a lot of work to finally get to this place where these things are going to be in a place where the credibility is there. You know, we all know knowledge is one thing, but credibility is huge. And so I'm going to pause on, you know, continuing to get more certifications and work on the implementation phase. And so what I'm focusing on now is really reading, you know, about how do you build for this? How do you structure this? You know, what are best practices of places that are implementing practices that I envision? Where is the health coaching construct? You know, there's things out there that can help me implement things on a functional level. And I think that's where really at this point, I think I'm definitely not definitely not the smartest person at what I do. But there's enough knowledge to get us rolling here. Where now it's about implementing the information and bringing the skills to the patients, you know, bringing the resources to them. And I think that's where I want to spend most of my time at this point is is growing in that aspect of things. Absolutely. I love that, right? We can read as much as we want. But if we don't implement it, then what exact impact are we making, right? We can be on a quest for knowledge as much as we want. But that comes out of action. Love it. So, yeah, so as we come to the near near end now of this episode, I just I just want to ask a fun question. So there's only one supplement you could take. What would it be and why? This is all have nothing to do with this. Because I think I have nothing to do with this. I'm throwing them out of the bus. This is all this. This is funny. So I think it's no I think it's no quite no no hesitation in my part to say that I'm not a big fan of a lot of supplements out there. A lot of supplement companies. There's a few that I think that are, you know, reliable glutamine in particular stands out as something that has been found to be, you know, beneficial in more respects, even than just muscle recovery. And I know I guess if I had to hang on to some crappy supplement, I guess it would be glutamine. But I don't know. I mean, beta-alanine research. I think has been pretty decent as well. And I'm excited to see what else comes out about beta-alanine. But I would say really glutamine and it's just because if I had to pick it, there's a little crossover I think with some cardiac stuff as well as with the muscular, muscular function and recovery. And so I think if we're kind of going bang for buck and cost wise and the fact that people don't really just try to caught, you know, huge, hugely ginseng these compounds. It's just nice. I mean, it's just a simple it's a simple supplement. And I think you can't go wrong with something like glutamine. It's funny. I was kind of hoping you would take the easy answer on say caffeine, technically caffeine supplement. Oh yeah, I do love caffeine. I've seen you drink your coffee. Yeah, I do, I do love caffeine and I can't remember if I listed that in my podcast, but I'd tell clients about it or people will talk to me about their free workout. And I'm like, man, thought away, it'll bring yourself some coffee on the way to the gym. And so I agree with you. I think you I think you're you pick the best one, actually. Yeah, I mean, probably the most researched supplement out there. I mean, I know, creating that you think talk you've talked about a little bit about that as well, but yeah, some of the ones that you mentioned. But that's that's like a whole another world we could be here for hours. But Simone, this has been this has been so much fun. It's been absolutely incredible. You're literally weathering the storm right now. Not in just difficult patients, but coming to us in the middle of a hurricane. So we definitely appreciate that. And I think we kind of lost you there for a second somewhere in the middle. But but we appreciate that. And I know how to find you. But but what's going to happen is people are going to listen to this. And they're going to be like, man, I heard these two clowns, but they were talking to somebody really cool. And they're going to want some more. So how do they find you? How do people find you? Yeah. Well, thanks so much, guys. Again, thanks so much for having me and your kind words and compliments. I you know, I definitely don't see myself above or better than anyone. I'm just doing my little part and you guys are bringing something amazing here to the podcast world. And I appreciate you guys, you know, just honor and little owe me to come and join you guys tonight. If anyone does want to reach out to me and just, you know, ask questions or bash some of my ideas, you can do that. I think that's fun. You know, just you can email me if you want. Simone dot maven at gmail.com. Simone Maven's easiest way to find me on IG Simone Maven. E my website that we've been revamping with all this cool stuff. That's going to be dropping here in the next few weeks as well. And so that'll be Simone Maven.com. Really can't go wrong with the Simone Maven. And so by podcast, healthy 365 on all platforms, including Anchor and Apple podcasts, really anywhere you can find it. So tune in and let me know what you guys think. Absolutely. And we're going to make sure we link to your podcast and our show notes as well. Again, Simone, thank you so much. Awesome. Thank you. Yeah, thank you guys. Thank you so much. You guys have a good night and thanks for hosting. Absolutely. Well, guys, that's a wrap. We hope you enjoyed this episode of Medicine Redefined. But just as a reminder, everything in this podcast is for general information only. It does not constitute the practice of medicine and we are not providing any medical advice. No physician patient relationship is formed and anything discussed in this podcast does not represent the views of our employers. So if you liked it, please make sure to subscribe and share it with all your loved ones or anybody you know who might benefit from this. Until next time.