Phillip Snell
Good morning everyone.

We have a few moments for people to join us here today.

Good morning over here on Facebook Live.

Those of you that are members or have my Zoom link are welcome to come over onto Zoom and join us here and we can take part in question answer kind of stuff there. It's a little bit unwieldy to do it over here. Let's see. To start with a little bit of commerce, this is a regular meeting for members of the neuro centric Approach Online academy.

Those are the folks that have opted in to take advantage of the neuro centric approach Online courses that are available, you can go to learn more about that@neurocentricapproach.com.

We've got both monthly and annual memberships available there. You get 35 hours of continuing education online and you also with the membership get a discount on the in-person courses that I teach in this material, those in-person courses are weekend courses that are 12 hours in length, currently an upper quarter and a lower quarter course.

Our next scheduled course is in July in St. Louis and that, and you can find that there over here on Facebook. There should be a link there for the events page, but if you don't see that, just go to neuro centric approach and look for the tab for events and you can find the event schedule there.

We also just penciled in a date in mid-December Mark. You might be interested in this mid-December in Phoenix.

The 14th and 15th is a penciled in right now. So yeah, we want to try to, those of us in the Pacific Northwest certainly so today like, like to try to lean on our friends in the southerly, sunny climbs in the wintertime to give us a, a continuing education opportunity down there so we can go dry out for at least a weekend. We can. Let's see what else we got in my personal life. Some changes in my practice locations and such. Some of you have come and done coursework with me and know that I'm affiliated with the athletes at Kabuki Strength Lab, a power lifting facility here in Portland that I think probably has more world record holders per square foot than any other gym in the world.

Kabuki's doing some restructuring.

Technically the way that we, things were organized at Kabuki, my office and the clinical aspect represented there within the kabuki framework.

My office fell under the heading of coaching and the gym and kabuki's gonna double down for a while on their equipment manufacturing and fulfillment.

So those of us that are involved in coaching clinical and gem are peeling out a formation and we're opening up a spot in Lent the Lent neighborhood in Portland for those of you that are familiar with that.

And that'll open up in, if all goes well in June, I'll start seeing patients there in July when I get back from my vacation walk in Italy and a little jaunt across the water to Morocco for the month of June. And during that month in June, I won't be here playing with you guys.

Ask that you take care of yourselves for a month so that I can go spend some good quality time with my son and my wife.

Yeah, that's what I got. What are we gonna talk about today?

I have, I am open to suggestions from the group here.

I had some interesting cases this past weekend and I've been continuing the exploration of this intersection between the aging literature and the pain literature. More specifically to how certain changes in aging and or the accelerated aging associated with increased oxidative stress might factor into the the observed fail failed healing response that we see in the pathogenesis of tendinopathy. And I'll share paper with you guys that I found very interesting this week and that was recently released into Journal of Nature, very reputable journal and we can talk about that if anyone is interested.

Patient cases this week, one a one of our athletes at Kabuki, masters level female powerlifter presented with right lateral elbow pain of one week, no two weeks duration, which occurred after the last meet that she took part in.

She set world records in every event that she was in. So all three lifts cumulative total and once again got best lifter at the meet for female category.

You know that, that is an amazing accomplishment, but it's the kind of stuff that at kabuki we've gotten quite used to. We are disappointed when our athletes go to a go to a meet and don't sweep every single one of the medals in their events.

But she complained of this after her third and last poll, her deadlift and she set a record on it, but she had had persistent right lateral elbow pain since then. It's a little bit different.

She is, her poll strategy is conventional with a mixed grip in that particular hand is the overhand grip evaluation in the clinic looking upstream

at, at best, I saw minimal read less than 30% change in her pain with her index movement. When I explored interventions to create some opening around a putative irritable nerve root in the cervical spine and the, those changes I then worked downstream did not find much palpatory tenderness along the peripheral neurology affecting that area, which you guys know to be primarily the radial nerve.

She didn't have any sensory changes downstream from that point to suggest the sensory component of that nerve was affected.

And when I got around the elbow and palpated along the course of the radial nerve at the extensor carpi radialis longus above the elbow, not a whole lot of tenderness, she's complaining of anything that looks like a bench press now is her index and her goal. She wants to get over 300 pounds on bench.

She's been chasing that rabbit for several years, steadily progressing up. And we've got four pounds to gain. We need four pounds to get an all time world record. And I think she may be the first woman to bench over 300. I'm not sure about that though.

So when I go, went in around the elbow along the expected track of the,

along the expected track of the radial nerve and palpated, especially taking particular interest in the course of the radial nerve as it enters and exits the radial tunnel around the supinator and testing with, with supinator resisted and passive stretching of the supinator itself. I really wasn't able to reproduce symptoms there. And that kind of surprised me as you guys know, my bias on this nerve thing.

So I continued my palpation over the other elements of the elbow

in the posterior aspect of the elbow at the renon, no tenderness when I went to the lateral epicondyle of the humerus, there's a jump sign there. I'm like, oh boy, jump sign. Wow, we had anything that looks like a fracture. I ask her, you know, if she'd taken any, any falls to an outstretch arm. I know that she had recently taken up shooting and had been, you know, absorbing some recoil into that right shoulder and elbow perhaps, but nothing that seemed to either aggravate her elbow with her shooting practice.

This would be rifle by the way.

And nothing to suggest that there was any kind of possible radial head pathology associated with impact. But when I palpated directly over the radial radio Capella joint marked reproduction of pain, that was like, man, the like, yeah, that's it, kind of thing.

And as I stayed on that, my thumb and rotated her wrist back and forth to my hands, felt like there might be a bit of a malposition. And that particular joint, this particular patient is aversive to manipulation.

She's been stung by some chiros in the past and it set her back. So we use it sparingly.

In this particular case, I tried mobilizations thinking about the possibility with the mechanism of injury, of attraction injury that resembles what we learn in school. The board exams as a nursemaids elbow where where a kid goes limp crossing a street with a a care provider holding onto their hand and a traction injury there injures the, the either the anal ligament or the radial ligament there or, and, and from what we think might be occurring there sometimes cause a bit of an entrapment issue right there, or malposition of that radial Capella joint.

And I did some traction, we got some improvements, sort of the mills track traction kind of thing that you guys have seen. Warren Hammer talks about it in his book where you put the patient in a position like with a post or solid object here at the elbow and then you take like a towel and wrap around the wrist for comfort and then you get a good tight grip on the wrist and you provide a distraction on the wrist while you supinate and, and pronate and I did that, it seemed to be a little bit better and yet it was still really, really tender right there over the joint.

So I had a little discussion with her, a part if you will, about manipulation of that radio Capella joint shared with her that I've seen it be remarkably helpful. And what I thought was going on there with that potential malposition, listen to me talking like a proper chiropractor here guys.

And she gave me a thumbs up with a lot of consternation and I set her up in a posterior radial head manipulation and leaned into it, gave it a good solid sw and we got a booming cavitation and she gave me that wide-eyed look and that scary thing in those places that we all go to and practice when you know that a patient is afraid and that they have verbally and at a gut level given you their trust and you don't want to violate that.

Especially when I've got a world record holder that is in training process and nationals are eight weeks out, I don't wanna screw something up there.

So palpatory tenderness over the radial head was probably 50% less directly after that. She explored the bench type of movement that was probably 50% improved.

Two days later she texted me to say that her symptoms were 75 to 80% improved. Yesterday she texted to say that she was 95% improved. Cool. So I don't know, maybe we, we keep manipulation as a, a potential strategy for addressing meat-based tissues.

Yeah, I think so.

I'm, I'm not averse to manipulating a joint guys, so hope you aren't either in the right circumstances.

Mark, you dropped something into the chat regarding elbows. What do you say? I have a short medial elbow case I'd like to share. Turn out to be cervical spine related. All right. Mike Shores my friend, take it.

Marc Heller
So I Heather and he's a carpenter. He's in his early fifties. He's robust and he came in with medial elbow pain and what I first did was, oh, trigger point work on the medial, just la just distal to the medial epicondyle and gave him strengthening exercises, you know, curls and, and what would you call that? Nar deviation type of Carl.

Yeah, I Connected, yeah. And, and he came back a week later, it was no better. And I, so I said, well this is not the whole story.

And we did various, I'm trying, this is all by memory and it's, you know, if, if you hadn't had an elbow case go on, I probably wouldn't have done this 'cause it's off the top of my head. But he, he had some obvious problems at C five six.

And what I tend to do for that area is, I call it an anterior cervical subluxation, if you don't mind the term, meaning there's a lack of flexion and lateral bending of that segment. So we, we did our, and I don't like manip, I don't like high velocity manipulation of the front of the neck, but I, I did a mobile muscle energy type thing for that area and released it and showed him what I call chin to collarbone, which is an exercise that attempts to release the scalings by strengthening the deep neck flexors unilaterally. I i, I sent you the blurb on that one a couple weeks ago, Philip. Yeah. And anyway, that, and he came back the next week and said, oh, I'm much, much, much better.

So it, it, it wasn't primarily the elbow, the elbows where the symptoms were and the neck was where it was apparently seemed to be where it all was coming from. So, and I, I'm not as sophisticated as you fill up, especially off the top of my head with this area, but, you know, it's like I, I'm good at what I do and I did it and I helped him. So I'm a happy camper. He's a happy camper.

Phillip Snell
There you go. There you go. And you know that, again, I, I think we all have to be intellectually honest here that there's a lot that both I and you and the rest of us that are listening here, we, we work a, a model that has a narrative that seems to make sense, but we're still on the edge of some of that research. It's nice for us to have a good story to help explain why we're doing what we're doing. And, and it's also nice to be able to change that story as the evidence changes and matures. And I'm willing to do that and try to do that with this particular model, the neuro centric approach thing that we are playing with here.

Alex, you're on here today. Do you have any comments or anything to share about that or shall I just go right on to talking about bacterial flagella?

Alexe Bellingham
Oh my goodness, how fun that sounds. I do actually have an interesting case that happened this week and I'm kind of debating back and forth on this one. This was a patient that had completed our six week impact program probably around Thanksgiving last year. And so once they're discharged they typically don't come back. But she'd had a follow up with a doc that got her into the program and decided to stop by the front desk and they were feeling kindly towards her 'cause she was one of our, one of our favorites. She'd done really well. But she's a high anxiety patient. She's probably mid thirties, she's approaching retirement age, but she is in a job where they won't let her go because they don't have enough people in her line of duty in order to allow her to retire. And

Phillip Snell
Remind, remind folks that are listening here, Alex, of where you are and what you do and where you work.

Alexe Bellingham
Oh yeah, I am, I'm the chiropractor at Madigan, which is at Fort Lewis up here in Washington serving Army Air Force, some Navy and some Marine Corps.

This is happens to be an army reservist and she's an activated reservist and because she's needed in her MOS they have her in active duty status. So she suffered some

Marc Heller
Alex. Yeah, the average mayor doesn't get to retire in their forties. These are people who put in 20 years in the military and

Alexe Bellingham
Exactly. Retire. Exactly. And and that's something to consider once you've done 20 years in the military, it's basically your half-life. You, you change into another career and, and, and can sometimes work for the military in a, a civilian status or work for some government contractor and still get a pretty decent salary and as well as your retirement, which is well deserved because of some of the things that they do in the military. It's pretty rough on them. Anyway, she is, she came in and she has this new rash body plaing rash just about everywhere.

Kind of looks like ringworm but different sparing her face. But it is on pretty much everywhere else.

Her hands, her arm and back pretty much anywhere.

And at the same time though, her main complaint was neck pain and we'd helped her with her neck pain before. So I, I was taking a look at it.

She has a, a five two centimeter lymph node in the left supraclavicular fossa in the anterior cervical chain with two that are smaller adjacent to it. It's been examined on ct, they're beginning to work it up, but she's coming to me with neck pain and her body's probably doing something to try and shut down that lymph drainage process for whatever reason, for whatever's going on. And, and the debate that goes in my mind are, are we, are we benefiting by helping them move better or do we wanna help the body reinforce the non-movement pattern because obviously her lymph nodes don't wanna drain whatever's going on and they're working really hard locally.

What are you guys' feeling on that?

Phillip Snell
The first thing that comes to mind and, and was this a recent case, Alex? You said that

Alexe Bellingham
Yeah, this was last, last week. She came into the clinic and, and it's still being worked up. She goes in for her biopsy next week

Phillip Snell
And the lymph nodes in the past with any of your work with or around the neck, did you note any lymphadenopathy?

Alexe Bellingham
Never. This is a big fast spring up.

Phillip Snell
So the, I I will say that just in the last two weeks I've seen two different patients with neck pain that had anterior cervical chain lymphadenopathy.

And the working theory that we've got on that with this new lymphadenopathy that's non-painful, they were both being quite affected by the very high pollen titers that we've been having recently. Oh

Alexe Bellingham
Yeah. Yeah. And

Phillip Snell
Certainly with the, the blessings of this kind of weather that we're having here in Portland today with it just pissing rain all day long. Yeah. It that the air is clear but yeah, poplar, older birch

Alexe Bellingham
Are, yeah it's all really high. And that could help explain her plaing rash too, if she's just having a systemic response.

Phillip Snell
Yeah. And yeah, so you know, usually what we'll see there is that if they're not, you know, that that issue is up in my grill a little bit more as a man of a certain age.

Alexe Bellingham
Sure. Having, Having some BPH, the availability of antihistamines to me is long gone now the amount of discomfort from urinary retention associated with taking an antihistamine makes that very Oh

Wow. Yeah,

Phillip Snell
Consider so the places that I've leaned into with that have been turmeric, I've tripled and even quadrupled my stack of turmeric and a now product that combines quercetin and brolin. Yeah. And I've been able to get through, you know, it, it very clearly improves my symptoms and I've had these patients with this kind of stuff to improve a bit as well because if that mucosal, you know, bing in the, in the sinuses occurs to the point that we get a sequestration in the sinus, then at very least you're gonna develop some, some CS buildup and pressure and tension there, but the possibility of secondary infection then goes way up.

Sure. And that could, that could be kicking the, the lymph nodes into high gear there as well.

Alexe Bellingham
Yeah. So That's the first thing that comes to mind.

Okay. I, I guess my main question was you have a patient with su suspicion and possibility she has burn pit exposure and all this other stuff. So I'm thinking there's a possibility of lymphoma and with that as a possibility, how do you feel about manipulation and massage et cetera?

Phillip Snell
You know, I would, I would be careful of it. Like Mark, I'm, I'm judicious about my cervical manipulation and given the evidence that suggests that we can get damn near the same improvement by doing lower force manipulate or mobilization kind of techniques without the attendant. Same admittedly incredibly small risks associated with cervical manipulation.

But you know, my, my opinion here I think doesn't really matter. I, I think an exploration of the evidence on that would probably be worthwhile.

I'm not conversant with with that in this particular episode. But what I would suggest is that probably some of the things in terms of cervical lymphadenopathy that we've seen that I can recall from papers past that centered around chiros touting the purported benefits of cervical manipulation for these kinds of cases probably have more to do with just moving limp and helping to facilitate lymph drainage. And probably those could be just as easily attained or very least tested and maybe variables controlled by doing very low impact lymphatic drainage type of massage through that area and see if they get better now.

Alexe Bellingham
Yeah, I think I, I lean more towards not encouraging the distribution of whatever's going on at this time. 'cause the body's definitely trying to lock it up.

We did work on her, on her headache so we took care of trigger points for the headache 'cause the neck pain was referring upward and, and then I did do a rib adjustment because her shoulder was pretty locked up with it. So we took care of that too. But I went very conservative with her until we get our results next week. Yeah, yeah. I'll keep you guys posted on what happens. She is gonna come back. I'm, I'm having her come back to see me next week after her. She's gonna need the emotional support if nothing else. So.

Phillip Snell
Yeah. Yeah. I wanna wanna be there for Yeah, good

Call. Well imagine all of that, you know, that's straight up doctoring right there.

Alexe Bellingham
Yeah, yeah. We gotta take care of them

Phillip Snell
Not just very quickly throwing a hammer at the nail. Right,

Alexe Bellingham
Right. Exactly. Yeah.

Yeah, her, the doc that had referred her back to me didn't, wasn't even aware that she was being worked up for this 'cause when he saw her was probably about three weeks ago. So we were just in her forefront of her mind. So she came back to us for the chiropractic care.

Phillip Snell
Copy that. Yeah.

Alright, let's see. James Gordon, welcome in. You're welcome to chime in if you have anything to contribute or want to say, Hey, if not, I am going to take off on a little bit of a tangent.

I, some of you know that I've been talking for some time about that. I've got this neuro centric approach tendinopathy force on my desktop that has literally been in process for six months now as I continue to explore the pros and cons, merits and demerits, the idea of neuro centric approach bringing something to the table in regards to the pathogenesis of tendinopathy And my working theory is that the failed healing response that's observed in the pathogenesis of tendinopathy that the, the neural ingrowth we know is important. Very similar to the neural ingrowth that we see after acute injury and a disc that the neural ingrowth is a typically self-regulated limited process that occurs over a a period of weeks wherein we have neurovascular ingrowth into the portions of the deep tendon that are typically avascular and aural that have sustained a mechanical overload.

And then you have an ingrowth of the neurovascular elements from the 10 synovial sheath.

And that in the acute phase we would would refer to as the tenus an most correctly and we would treat that differently than a tendinopathy, right? That would be a let's peel back your activity and your loading strategies on the tendon and let nature take its course and try to support that with other things like you know, gentle movements, appropriate loading, hot cold contrast, topicals, things of that sort.

But for reasons that we've been dancing around discovery of for the better part of 20 years now the pathogenesis in some people of tendinopathy occurs after that acute healing response. That acute healing response typically is limited to somewhere between two and four weeks maybe. And then there's a cell signaling process that is expected wherein the nerves and blood vessels are, you might say, given the signal to retract and outgrow from the deep tendon and those are your tendon injuries that heal and you know, after a period of time the patient's fine and they get up and get back to life in those cases that it doesn't happen that way.

We have an increase of granulation tissue sometimes that increase in granulation tissue. The changes of the morphology of the tendon can actually be painless over time.

But my, and then but it does statistically increase the risk of outright tendon pain in that tendon and mechanical failure of that tendon to some degree down the road. So finding those morphological changes is, even if they're painless, is a worthwhile thing for us to do. And then start a loading strategy on that tendon with heavy slow load to try to reduce the injury likelihood going forward.

The place that my recent interest in this was tickled once again was a paper that came out.

I'll share screen here paper that came out last week from a bunch of researchers I believe in South Korea and here is the paper from Nature Communications, the mucosal TL R five activation controls, health span and longevity.

So you guys know that I am in that odd spectrum of people out there that are receiving some justifiable, humorous nudges and and effacement by known as biohackers.

So I feel like I got a lot of stuff I want to do before I check out of this plane. And I feel like I got started kind of late since I'm mostly retired in my twenties.

So I am doing what I can to try to live a longer and healthier life.

Part of that's motivated by some desires to avoid cognitive problems that I am genetically predisposed to.

And among the things that I am doing, I've been a ke on a ketogenic diet to help with those, the systemic neural challenges for six years.

I also am taking rapamycin six milligrams weekly.

Started relatively recently again 'cause mainly it's been hard to get a source that's not god awful expensive. And what I found for those of you that are interested there is cost plus drugs. Mark Cubans cost plus drugs. All the drugs on there in their dispensary are 13% over cost.

So everything is fair, transparent. And they put sirolimus AKA rapamycin on their formulary not too long ago.

And I managed here in Oregon to get a prescription for that from my naturopath.

So I'm on the rapamycin, I'm also on a carbo, which is an old school diabetes drug that doesn't even affect liver. It just takes its effects are entirely in small intestine where it interferes with the digestion of polysaccharides and results in a improvement in the profile of short chain fatty acids that are known to have health-promoting effects further down in the bowel and the polysaccharides deeper down or further down in the intestinal tract. Then cause gas early on flatulence, which is the big thing that most people see as a side effect and they stop taking it because of, but if you stick with it for a bit, you start to grow the critters in your gut that metabolize those polysaccharides and that gives you the observe short chain fatty profile improvement in the gut.

That short chain fatty acid profile change improves gut integrity and that can help with leaky gut and food sensitivity and food allergies. And that can change the microbiota over towards something that resembles what we observe when a patient has a very high fiber diet.

The ITP protocols or ITP studies that some of you may have seen the podcasts with Rich Hall and Peter Atia. There's been a couple of those that I'm aware of. And these are studies where the three different research facilities using a non cloned mouse model this, these facilities are funded by the nat National Institute of Aging.

Those facilities will receive recommendations from a variety of different researchers to explore their intervention of choice intervention here being drug or nutraceutical, something the mouse can be given and the combination of rapamycin plus a carbo. And that mouse model has now shown in three different research area centers around the the country to confer a 30 to 34% improve improvement in lifespan and health span.

So that's pretty compelling. It's also in a mouse so we don't know how it trends over to humans, but the cool part about those two drugs, a carbo and in this case sirolimus, both of those have been used in humans for a long, long period of time and they are known to be safe to humans. So consider it an off-label use for both of those for the potential benefits of improving health span and longevity. And I'm willing to pay the price for those to try to get that.

And that leads us to this particular paper that I've got on the desktop and this particular paper and this I think some of you will find interesting since all of us became, at least temporarily early on in the pandemic armchair immunologists, as we struggled to learn and relearn the things that we once upon a time were exposed to in our pathology and cell biology classes regarding the innate and acquired immune systems.

But many of you, either directly as we age or in working with your aging patients and around the pandemic, know that as we age, our immune system changes in its ability to be able to manage various exposures to things. And that innate immune system is that first arm of the immune system. Hats off to my cell bio actually I believe at this point in time he was teaching physiology teacher at Western states Mark Kaminsky. And I remember his to this day, 21 years actually would've been 25 years later, his explanation to explain the handshake between the innate and acquired immune system where in the T cells and the neutrophils and the macrophages and the innate immunity first exposed to some sort of pathogenic challenge.

He likened it to a battlefield where these particular nights, if you will, rushed in and they fought bravely against the invaders and when they would slay the invader, they would literally rip its head off and stick it on a pike and parade paraded around the battlefield so that the acquired immune system, your B cells could see elements of the invader and remember the elements of the invaders of those invaders so they could remember that face so that if they see that critter out there on the battlefield, then those B cells would know that they were not friendly and they're the ones that need to be attacked.

I always loved that. Thank you Mark Kaminski.

He was the first person that told us about Google.

How about that? So

the, this particular aspect of the handshake between acquired and or innate and acquired immunity is something that we all learned a bit about in Covid because a lot of those RNA vaccines were about taking, ripping the head off, if you will, of of the covid critter. And the particular aspect that was being utilized were the spike proteins that that critter uses to assault the various cells in the human body.

And that's kind of where we lean into this particular paper here. They used an interesting compo compound that was a fusion protein that contained fla jelly from particular strains of bacteria. Now these flag jelly are non-pathogenic in and of themselves, but they belong to particularly pathogenic critters like Vibrio and such.

And they're able to isolate that and then pair it with a pneumococcal virus proteins from a pneumococcal virus and made it into a nasal delivery and gave it to a bunch of mouths mice.

And when they had noticed previously when they were using that for other reasons in the mice, they noticed that one of the things that occurred with the mice is they tended to live longer and they tended to OB demonstrate a bit more social sociability, they exercise more, they move more, et cetera, et cetera. So that's what caused 'em to lean in on this study and explore it from the aging perspective.

And fascinating thing is they gave this stuff to these mice every two weeks, starting at 600 days of age now in a mouse that correlates to, you know, around about a 60-year-old human.

And they gave that to those mice in the treatment group. They also did a control, they did that in that treatment group until the mice expired of a natural depth. And then they examined a variety of different aspects associated with lifespan and health span in those particular mice. And those things included stuff like bone mineral density, the activity that the mice demonstrated in their enclosures and such.

And lo and behold they got a improvement in lifespan and health span. That's important because no one wants to live a long life if you are in really poor health.

So the health span is probably more important. We'd all like to live a healthy life and then croak on a, you know, while we're doing something fun, but they noted a, an improvement in lifespan and healthspan that rivals that of rapamycin around about 30%. That's pretty cool. So the thing that they were manipulating here is one of these things called toll-like receptors, TLR. And this particular one is tolike receptor five. And now these receptors live on various cell strata in the body.

Some of those are immune cells like macrophages.

And we express some of these toll-like receptors, upregulate immune response in certain areas due to exposure to certain pathogens.

And the TLRs are kind of specific to certain pathogens as well. So groups of pathogens and maybe even groups of portions of pathogens in this case the FLA jelly of a variety of different bacteria that humans have been exposed to since we crawled out of the, the, the muck and mire so to speak.

But the TLR five activation, they found to be the particular interesting one and they found changes in the intestinal VII structures, an improvement of gut integrity in these animals that were receiving the nasal application of these compounds, which tickle, think vaccination, almost tickle the innate re immune response.

So that's fascinating stuff, a full body response to that kind of stuff. And as I started to explore this TLR five trigger, lo and behold, what I found was that there's a body of research out there regarding that and tendinopathy. So the upstream things in the development of tendinopathy, pathogenisis, pathogenesis of tendinopathy that have been noted, some of those upstream things, we see an association or an increased prevalence of tendinopathy in patients that have diabetes, hypercholesterolemia, obesity.

And these items are things that cause increased oxidative stress on the organism that oxidative stress can alter the TLR profile in an individual reducing or changing their immune response to certain things. And that axis between immune response, mechano, transduction and pain is a fascinating area that I am very, very, very interested in. And that's what I'm trying to see if we can lean into a bit with this sort of neuro centric approach model by looking at the systemic effects as we talk about in the coursework, looking at the, the, the past health history, the family health history and that individual to look for these issues that are associated with mechanical sensitization of peripheral neurology and how it might be associated and or related to these kinds of clinical phenomenon.

So that's what I got there. They, that was my geeky stuff for the week.

I'll stop sharing over here.

All right. Mark says that was a vivid image that, that Mark Kaminsky gave us there. Yeah, it's stuck. It's always fun to have those, those, those memory cues that are delivered in such a way that we remember things like that for many, many years. Something to keep in mind when we provide explanations to patients there.

Marc Heller
Hey Philip, one question. The, the papers that you feature in these Saturday morning things, I don't always grab them 'cause I may be walking or whatever. Is there a way to for you to put something out on neuro centric where we could at least look at the abstracts of those papers?

Phillip Snell
Absolutely. I've done that as well. Mark the, as a member, you should be a, I can check on the back end here, I'll do it later once I'm off here. But you should be also a member of the neuro centric approach community and that community on the site, the academy dot neuro centric approach.com, the neuro centric online community.

I put a link to the recordings every week when we do these and if I cite any papers and folks are interested in 'em, I'll pull the at, I'll pull the full citation and park the full citation right there as a PDF. So I'll put that on there later today or tomorrow when I am able to get to that.

Marc Heller
Cool. Perfect. Thank you.

Phillip Snell
Cool. And that's one more benefit that those of you over there on Facebook could get if you were over here on Zoom because you're a member at the neuro centric approach online academy.

So thank you for those of you over here on neuro centric approach over here on Facebook.

And those of you over here on the Zoom call, you guys share the love, tell your friends and colleagues about what we're doing over here and see what we can get in terms of growing the community over time to try to help improve patient outcomes and patient care.

Worth noting something on my radar as recently as yesterday,

some possible locations for a neuro centric approach clinic.

Wouldn't that be cool? I wonder branding the neuro centric approach name as a clinical model and developing that brand over time.

That could be something that would be of interest to folks out there. But something has come onto my radar is one possibility there to be able to walk into a scenario within a health club and move it, move an existing clinic over to that NCA model. So more on that if it develops in the future. Okey doke. Here we are. It's been an hour. You guys be well.

Stay curious, stay compassionate. Take what you've learned. Go help some people. I'll see y'all next week. Cheers.