Matt Connarton Unleashed: Dr. Anh Ngo

0:00 Speaker 1: Good morning, sunshine.

0:02 Speaker 2: Jenny is here at the news tablet for and uh. It's especially good that you're here today because, as you can probably hear, my voice is already failing from my recent fight with asthma sounds apparently I'm not fully recovered from that, as I'm as I'm cracking on this uh, Saturday morning.

0:22 Speaker 3: January fourth, our first show of twenty twenty five.

0:24 Speaker 1: Well, at least you didn't end up on the grassy knoll this.

0:27 Speaker 2: Time, that's right, Yes I did. I did have to go to the emergency room again. Yes, but but I can breathe. I can breathe again.

0:33 Speaker 1: A couple of treatments later, and he's speaking yes.

0:35 Speaker 3: Yes.

0:36 Speaker 2: So so here we are and for our first show of the new year. Happy new year, everybody. Let me get get that make up there. Someone who has not been with us in a long time. Doctor noahs here, welcome doctor now. Oh I cannot hear you. Let me figure out why. I think I know why to change the mind.

0:57 Speaker 1: Oh boy, I know you're gonna get the cobwebs out of you.

1:01 Speaker 3: Oh I think I can hear you now, doctor, Now are you there?

1:04 Speaker 4: I'm here, Good morning man, everybody, mind Jen.

1:07 Speaker 3: I apologize. So, yeah, so welcome. It's been well.

1:12 Speaker 2: Obviously this is your first time in the new studio, so it's certainly been well over a year. I know that probably been probably been a year and a half maybe since you've been with us.

1:19 Speaker 4: It's been a little while. I can tell you that the studio is very impressive.

1:23 Speaker 3: Isn't it nice? We love it.

1:25 Speaker 4: It was it was like a grand entrance walking in, going wow, look at this lobby, Yeah, look at this large you know. I had I had to stop by the facilities, you know, because I drank a bit of too much coffee this morning. But I was like, wow, this is very grand.

1:37 Speaker 3: Yeah, I'm very impressed, Thank you, thank you. No, we love it.

1:40 Speaker 1: It's the new digs are styling.

1:42 Speaker 3: And you can tell from the outside that it's a that there's a radio station in here, you know, because as you know, at the old place, like looking at it from the outside, you would never even know that there was a radio station in the building.

1:51 Speaker 4: The signage is impeccable.

1:53 Speaker 3: Thank you.

1:53 Speaker 4: Even without driving without glasses this morning, although I don't need to drive with glasses, I saw it from afar.

1:59 Speaker 3: And that is good to know. That is good to know. Yes.

2:04 Speaker 4: Wow, Well I just want to say one thing before we get started. Yes, is that that song twenty three that you played this morning?

2:13 Speaker 3: Yes.

2:13 Speaker 4: If there was a rating scale out of twenty four, I would rename it twenty four.

2:17 Speaker 3: Wow.

2:18 Speaker 4: I very much enjoyed it.

2:20 Speaker 3: I really like that.

2:20 Speaker 4: I did, especially when it caught my attension when it said the bus is moving leaving in ten minutes.

2:28 Speaker 3: So this is a little inside for people who don't know.

2:30 Speaker 2: So the building that we're in, of course, this used to be a bus station here in Manchester. This amazing building which was remodeled and refitted is that a term for that turn turned into this amazing facility that it is today. But yeah, we were so we were talking off air because we tell everybody especially it always comes up when when someone says, you know, can I use the restroom, and it's like, yes, enjoy our enjoy our enormous bus station bathroom. But so we were talking about that off air, this used to be a bus station and then I play that song and sure enough there's, uh, there's that bus station announcement.

3:04 Speaker 5: I really like that new song. Yeah, yeah, absolutely nice.

3:07 Speaker 3: Yeah.

3:08 Speaker 2: Absolutely. So Again, if you're if you're looking for that online. The song is called twenty three, the band is Tuesday Night Whites, and just to be very clear for everyone, it's it's named after a football team.

3:16 Speaker 3: There's no racial component to that.

3:18 Speaker 1: I don't want, uh, I don't want well being what we call soccer.

3:21 Speaker 3: I don't want anyone to think, what what is that like? Uh? Are they you know, bad people or something?

3:27 Speaker 1: No talking to you about sports and this is not a good thing.

3:30 Speaker 3: Right right.

3:31 Speaker 2: I'm not a I'm not a fan of the of the sports ball as we say, so.

3:39 Speaker 3: Doctor no, uh tell us about uh.

3:42 Speaker 2: For those who don't know, who haven't heard your previous interviews, you've been on with us two or three times before.

3:47 Speaker 3: I think at the old at the old studio, I.

3:49 Speaker 4: Think we've been on, yeah, about two or three times span of last what was it maybe four years?

3:55 Speaker 5: Oh yeah, four or five years now. Yes, he's on his way to the five timers.

4:00 Speaker 4: Yeah. I feel like I'm an aged entity here, you know. But every time it's it's you know, it's it's been an honor to come on because I you know, there's a lot of changes that have occurred, and it feels like it's a it's a fresh start, and especially with this new station too. It's just it's very, very very refreshing.

4:18 Speaker 3: Yes, yes, thank you. Yeah, well of course we met you because.

4:21 Speaker 5: Of Jenny, right, and I'm excited to have you on and share something that's important in my life. I am a pain patient, as you guys know, and you hear the stories all the time. I have CRPS, complex visional pain syndrome, and small fibron aeropathy.

4:35 Speaker 1: And thanks to doctor No, I.

4:37 Speaker 5: Have quality of life because the hardest thing about having CRPS, because it is the most painful disease known to modern medicine, is that it's very difficult to control that pain and have a quality of life. And doctor No from the Pain Specialty group is who makes my life quality wise because of the treatments that I get, which is a combination of different treatments you do. In my case, I have oblasions or different injections or say you sometime a different medication to keep things in check. And I want to share that with people because so many people out there are suffering and pain and you don't have to suffer.

5:15 Speaker 5: That's the biggest thing. You don't have to be the one suffering about it. So just just because I want to be as open as possible. A doctor no is my doctor, and I am happy to be here with him and openly talk about pain care because I do want people to know that there are solutions.

5:33 Speaker 1: You don't have to suffer and you can have a quality life.

5:36 Speaker 4: Yeah, and Jenny, I just want to say, you know, it's an honor to help you, you know, do the things you want to do in life. And I'm touched to hear all of this, and I will also, I know we're on air, but I will also protect your privacy and whatever you know, let you disclose. But if you want me to comment on something, I mean, just let me know. I'm happy to but again, you know, also protect your privacy. But I'm touch to hear all this and it makes me makes me happy to know that I've at least been able to help you, you know, get along your path in life and do the things that you want to do in the way you want to do it.

6:13 Speaker 4: And that means a lot to me.

6:14 Speaker 1: Thank you, Thank you.

6:15 Speaker 2: Well, I can I can tell you, you know, as someone's who's uh you know, had a front row seat for this journey that Jenny's been on. I mean, you've You've made an enormous difference in her life. I mean this, you know, no denying it, huge, huge difference.

6:27 Speaker 5: I'm a lot bedbound for over two years, and even when I started getting treatments, I was still using wheelchair and having a hard time. And at one point I started to get better and I was with a practice that all of a sudden closed their doors, no warning, no notice, just closed its doors. And I was in a pretty bad situation at the time and doctor No actually was coming into a practice here in New Campshire at the time and I was lucky enough to meet this practice because I was literally left with I don't know what to do.

6:58 Speaker 5: I have no provider, and you did come in and you ended up taking over my care.

7:02 Speaker 1: And it's been.

7:03 Speaker 5: Well over three years, probably four. I'm not even sure how many years I've been a patient of yours.

7:08 Speaker 4: Now, Yeah, it's been a while. Uh. I do want to say that, you know, Jenny again, I'm very happy and grateful and touch that you know we were able to help you, because we do hear the story a lot with you know, the shifting of providers, shifting of practices that that patients are left in kind of a no person's land. I don't want to say no man's land, but no person's land, and and and it's unfortunate and it's a very hard place to be. So again, very very touched, very honored to be able to help you along the way.

7:39 Speaker 4: And look at you now, you're you're you're doing great things for not just the New Hampshire, Manchester, the people of the Northeast, but you know, even the nation. So you know, very impressed.

7:50 Speaker 1: Yeah, and it is a huge part of that.

7:52 Speaker 5: And that's one of that's why I want to share this aspect is there is so much stuffering out there that doesn't have to happen.

7:58 Speaker 1: So, like.

8:00 Speaker 5: You offer a lot of different treatments for a lot of different things. And I have significant lower back pain. I have like three deaths that are bulging and they have to be controlled or I'm in awful pain. So some of the things that you do aren't about medication as much as a treatment. One of the things you do for me is called an ablation, and that has a great effect. And I know that you do other things types of injections and stuff, but you know, just talking about like the lower back issue, what are the kind of things that you do for.

8:30 Speaker 1: Other people to help with their their back issues, because we're not all the same.

8:33 Speaker 4: Yeah, so it's a great question. Let me let me just kind of reorganize and kind of preface the thinking of how we approach pain management. But at both of our our locations, know, in new Market, which is the newer one, and also in Newington, our philosophy has always been, look, you're you're we're all going through life. You know, we all go through life as a as a as a child, a youth, a young adult, you know, a midlife adult, an older adult, and as an elderly person. And during that journey our body changes, not just you know our life situation, you know, our economics, our social engagements, but our body changes and with those changes come how we experience those changes.

9:24 Speaker 4: And pain is a very very prevalent aspect of those changes. So what we do in our philosophy is that we can't really care or change those changes or reverse those changes. What we can do is help you adapt, deal with, accommodate with how we perceive or experience those changes. And if you take that perspective of pain management, that's where we come in. And and and Jenny, you mentioned about. You know, so how do we deal with What tools do we have to deal with pain?

10:03 Speaker 2: Right?

10:05 Speaker 4: I can count them off of probably both hands and toes, but I'm gonna try to generalize it into two boxes. We have conservative therapies, right, which include you know, you know, activities like physical therapy, pool therapy, chiropractic care, uh, you know, you know, psychosocial therapy, cognitive behavioral therapy. We have medication therapy, lots of different classes of medications. Yeah, you know, we always hear about one certain class of medication which has always been the easiest to go to, but it's also caused a lot of headaches personally for not for me, for for individuals, socially, economically, and even legally.

10:49 Speaker 4: And that's what I'm talking about opiates and controlled substances. We have lots of different other classes that help mitigate pain, and and those kind of leak into other are disciplines of medicine, and that's why pain management is so broad. We have interventional therapies like you mentioned. Some of those therapies, as you mentioned, include radio frequency elations, you know, steroid injection, nerve injections. When people hear the term injection or oblasion. They think it's just one area, one type of treatment, but there's so many different caveats and ways to how.

11:28 Speaker 1: Do you say it.

11:31 Speaker 4: Approach those classifications. For example, when they say I get a steroid injection or cortisone injection, we hear that a lot. One is there's different classifications of steroids. Two is there's different areas that we inject. Three is there's different reasons to why we approach an injection, and there's different potential outcomes. Some of those are therapeutic, which what you experience. Some of those are diagnostic, which tell us, okay, this work, but it's not gonna last, but we could do something else that lasts longer.

12:02 Speaker 4: And some of those are therapeutic and diagnostic. And there are even some injections that some of those may be potentially longer lasting, are terminally therapeutic, such as you know injectables that cause nerve destruction. Some of those injections are are lubricating. So there's lots of different types. Yeah, and then the next classification, of course, is advance interventions, where we do a lot of minimally invasive implantables or removal of tissue under X ray or fluoroscopy and imaging. Those again, you know, tend to be the cutting edge of pain management.

12:45 Speaker 4: Those those tend to be those that are a little more innovative, spend the time to get trained and learned, trained by multiple disciplines, not just pain management physicians. But you know, we end up having spine surgery involved, orthopedics involved, neurology involved, psychiatry involved, there's indiventional psychiatry. So a lot of the little you know, interventional advanced therapy, some of those where we put in plants and some of those where we don't. And then and then of course to the classical sense, now we go to open cavity, open spine, open area surgery and those can treat.

13:23 Speaker 4: So pay management is actually very wide. The whole concept is, again, how do we help you along your journey given that you've you've hit this this bump, this road bump along the road, or this pothole, and how do we get you to go above that and go beyond that? And that's and that's where our job is. Okay, So I hope that kind of helps, oh, per.

13:44 Speaker 1: And it's fine.

13:44 Speaker 5: And that's what's what's a thing about pay management is it's individualized. No, the medication that works for me might not work for somebody else. But we found a combination of medications and treatments that have worked for me.

13:57 Speaker 1: And it's all and sometimes it's trial and error. Sometimes you try one thing and see if that works.

14:02 Speaker 5: You know, there are medications I did well on medications I haven't done right. And as life changes and time changes, maybe something needs an adjustment or a tweak. And you know, as long as the end result is to have a quality life that's worth living. To be able to participate with things with family members or friends, to be able to enjoy an outing, you know, and not have to sit there and be like, oh, I can't go to that. I'll be intowitch agony, I won't be able to sit there. But to be able to go, yeah, I can go to that.

14:31 Speaker 5: I can go to that show for a few hours, you know. And and that is what makes life work living right is to have those experiences with one another.

14:41 Speaker 4: Absolutely, I mean, just me showing up this morning and have this experience with you and Matt has been phenomenal. Already, Oh thank you, Well, we're glad you're here. Usually around this time already spending it taking the kids and driving them on shopping you off to So I got my alibi this morning.

14:56 Speaker 1: You got a alibi.

14:58 Speaker 3: Yeah, no, so.

14:59 Speaker 4: Thank you, But no, I just wanted to add to your comment about individualization of care ideally, right, ideally, and and if you think about it in terms of efficiency, Ideally, if pain management was a one one type of treatment for all, like a Nike shoe factory, just keep on stamping out all those Nike airs one by one by one. We could do ten an hour, we do twenty an hour, you do five one hundred an hour because factory capacity, right, I would be at a different place. I would be sitting in a very tall, high rise building, you know, in Manhattan somewhere, or downtown Manchester somewhere.

15:41 Speaker 4: But no, it's very individualized because what works for for Matt, what works for Mike, what works for Steve, may not work for Gen and what works for Gen, you know, and it's and it's unfortunate that we have to try on different shoes and we have to you know, the shoe pairs with this pair of sock or this pair of cushion, and and oh the only worked for for you know, three months and now the shoes aren't good anymore, and we have to change up the shoe because because the padding has shifted because you have a bone spur now and your foot, you know.

16:18 Speaker 4: So so yeah, it's very individualized. And that's the unfortunate part is that, you know, we're all we're all such individualized entities that we have to kind of tweak things. And your body's constantly changing, so we always have to change change how we algorithmically or think about and approach how can we make you a little more comfortable so you can do things you want to do.

16:37 Speaker 2: I would imagine that's that's the biggest challenge with new patients, right It's just figuring out what the best solution is for them, And then.

16:45 Speaker 3: There's probably a lot of well, we're going to try this.

16:47 Speaker 2: And then if this doesn't work, well then we're going to try this, and you know, and then you know, hopefully they can hang in there, you know, and and and you know they have to trust you that you know you're on this journey with them and that you're going to help them find the solution.

17:00 Speaker 4: But yeah, so so I'm glad you brought that up because because now now you're trying to get into the mind of like how I'm thinking during the day.

17:07 Speaker 1: Yeah, and and.

17:08 Speaker 4: This is gonna be good. So that gives some insight to patients. So every patient comes with a unique situation. And when you when when you when a provider walks into an encounter with the patient, not only have we relied on the experience and knowledge of what we know about the patient, we also rely on the additional information that we've gathered during the interim between the visits. And you know, we we go on what the patient's communicating to us based on prior visits versus this visit. And so we're calculating all these things and thinking all these things and trying to go down algorithmically and even just non algorithmy or but creatively, what's the status of that patient and how can we tweak it to make it a little better.

17:53 Speaker 4: So so you can imagine that with this new healthcare environment where where it's difficult to survive as a healthcare provider if you don't you know, become efficient. So you know, like time slots are probably fifteen twenty minute time slots, thirty minute time slots. So we're sitting there thinking of how do we accommodate these patients based on the information that we have, and how do we tweak it and make it better for them, and then you know, follow up afterwards. So you can see that everyone's very individualized.

18:27 Speaker 4: There's a lot of different factors that you have to think about, including side effects, right, and risks, and how do we follow that up and to make sure that you know decision making is appropriate and effective.

18:39 Speaker 3: Yeah, yeah, that makes sense.

18:41 Speaker 4: Yeah, so yeah, but I think I think what we've figured out as a team in our practice is that you know, there's certain certain approaches that we have to help mitigate pain for patients, and a lot of those is let's figure out what's causing you the pain. And for a lot of patients, when you come in in your experience O pain, you're like, I'm just in so much pain. It's everywhere. I don't know where it is, but it's also here and here, you know, algorithm Lee or in our thinking, it's it's like, okay, so where are those areas that we can identify and how can we approach each of those areas in a safe and appropriate manner that would minimize the risks and side effects but maximize the benefits.

19:31 Speaker 1: Yeah, so that's a huge thing too.

19:34 Speaker 5: I mean, years ago, before I was the patient of yours, I had a different pain care situation where I was getting injections and it was scary, but it was also super painful. Matt would be in the waiting room listening to me scream like and I've talked about that on air many times. We've talked about, you know, the experience and having somebody going, oh, no, nobody heard you. And then I go out there and Matt's like, oh, okay, I can hear you screaming. And that's not what pain care is be. And that's one of the things that I very much love about you and your office and your practice and the way that you do things is that I have never ever, ever suffered through a treatment.

20:11 Speaker 5: You always make sure that the patient is comfortable, that I'm comfortable. You use numbing agents. You don't go just okay, sucking up, but a coffee we go and in checked away, which is what I had previously experienced. And I know that we were kind of talking about it before the show, but you were talking about how your approach is uniquely different when it comes to doing those kinds of injections, and I'd really like people to know about that, because I know it sounds scary, but it's actually been one of the best things that I get done is to have them done, and I'm never afraid because of the way you do it.

20:50 Speaker 1: So I wonder if you could talk about that a bit.

20:52 Speaker 4: Sure, thank you, Jenny. But before I kind of expand on this, I just want to say that it's not just me, it's the entire team. And let me explain that the entire team here at Paints Best Regroup. We we've adopted this philosophy and so I have to give credit to my staff. We want the patient to experience a pleasant journey right when they step into our centers, and that includes, you know, coming into a calming environment. And that's why we have music and we try to have you know, light, pleasant engaging music.

21:30 Speaker 4: You know, we try to make it a kind of a soothing visual experience, even with you know, dimmer lights, but you know, not not too dim that you fall trip and fall. You know, you know, we want to make sure you feel safe. It's clean. Staff is you know, impeccably friendly and caring. I get a lot of those comments and I'm grateful because the staff is really really adopted this this approach to making patients feel welcome and safe when they come in. So again, it starts not just with the injections, but it's it's a whole thoughtful process of what the patient is going to experience as they come through the door, from the beginning throughout.

22:10 Speaker 4: And that's why we have a little piano there.

22:12 Speaker 3: Right.

22:13 Speaker 4: Some patients come in and they they they tinker around the baby grand piano.

22:16 Speaker 3: Yeah, I was curious about that. If anyone ever actually plays it.

22:19 Speaker 4: Oh, it's amazing. We have concert pianists that come in and just start jamming. We have people that play at restaurants that come in and jam. Oh it's people have their own recordings, and we have some of those artists that that come in with their own recordings and they and they jam. Every want to meet with them for your show.

22:36 Speaker 5: We're happy to make the musicians any day.

22:39 Speaker 4: But it's amazing and and and they come in and they make it a pleasant environment for the patients. You know. I I try to come out sometimes and play, but my piano skills are very limited now that I'm aged, and I haven't played a lot through years. But you know, I I tinker, but my kids play a lot better.

22:55 Speaker 1: Than I do. I was gonna say to your kids.

22:57 Speaker 4: Play, Yeah, they do. But it's for the patients, right, So we put that out there for the patients. We uh talk about instruments. We also have a pain gong, by the way, I just wanted to make Oh yes.

23:08 Speaker 2: Yes, does that Does that get used much? I've never witnessed the gong.

23:12 Speaker 4: It does, actually, So I think we're the only pain practice in the nation that has a pain gong. And we actually have a sign right by the exit that says, please share if your pain is gong. And I did that on purpose because I always tell patients like I can kind of get away.

23:30 Speaker 5: With that, yeah, because yeah, yeah, I think I know it is, and I think you are.

23:35 Speaker 1: I've seen bells. Everybody has a bell, but nobody has a gong.

23:38 Speaker 3: Yeah.

23:39 Speaker 4: Well, I'll tell you the origin of that, by the way, but let me explain the gong first. I'll tell the origin of that, Okay. So the gong is basically for patients to celebrate if they've had a really good experience, and they want everyone who's inside the center to know they can whack the gong and if they whack the gong, yes, yeah, and what happened.

23:58 Speaker 1: You came around the corner, poked your head out.

24:00 Speaker 5: It was the door of all all of a sudden, there's tart to know going, hey, look at that.

24:04 Speaker 4: Yes, And so we've trained the staff to celebrate and clap and cheer patients when we hear the gong, and it's because it's a celebration for the patient to to to know that that you know, they've been happy with the care, they've received some type of relief. It's possibly helped them on their journey to change their life and doing the things they want to do again. And that's and that's why we have it there. Yeah, yeah, fun yeah. So so again some of the different things the staff, it's the team approach on making the experience for patients a little more comfortable as you're going through this journey of trying to mitigate your experiences of pain so that you can do the things you want to do.

24:44 Speaker 4: Now, going back to your question, what different things we do to help patients kind of go through the journey of like these experiences of injections or procedures. One is in this whole day and age just so much paperwork, and we've tried to streamline it as much as possible and and it's it's been hard, but we've we've you know, we've all these regulatory requirements that we have to go through, so we we we help we have the staff help streamline that. So that's been another thing that we've done.

25:11 Speaker 4: We uh, you know, just even the thinking of getting an injection. You know, patients come in anxious, they don't want to feel the poke, and that's where a lot of the thinking of physiology and chemistry and pharmacology becomes involved. And that's why you know, we we we we advise patients to get certain types of medications beforehand to help mitigate some of your experience with pain. And that's including you know, the the anziolytic, the the you know, like the tile and all to help with you know, mitigating you know, your experience with that first poke.

25:48 Speaker 4: It's also with uh creams. You know, we call in creams to help you mitigate that sensation.

25:55 Speaker 5: Because we want to make it so comfortable for you as much as we can.

25:59 Speaker 1: With that's so unique.

26:01 Speaker 4: Yeah, yeah, and then you know, we we we have you know, and then once you're in the room, we have conversations, right, we have lots of you know, funny conversations. We play music the staff in there, Aiden and uh uh, Julia back there, you know, Bobby back there. You know, they tend to pick the music unless it's a special requests by the patient. And sometimes patient special requests are are phenomenal.

26:26 Speaker 1: Right.

26:26 Speaker 4: We've had, you know, hard rock, We've had gospel music. You know, a couple of the patients of request gospel and sometimes yeah, you can request your music. I mean we try to make it as comfortable as possible. Some patients want it blasting. We do that, and and we crack jokes, you know, we try to make you forget. And as you're giggling, you know, the needle gets poked in and then you know, I use a little diff a you know, I even modify the needle technique where I call the slows the slow squeeze technique.

26:56 Speaker 4: Where again it's it's all physiological, it's neurological. You do it in a way where you know, it's it's quick introduction, slow slow. How do you say it, uh, slow medication introduction. But what it does is it numbs and nerves. So as as the needles getting withdrawn. It's not ass as impactful. And then and then we go in and you know, we use you know, we try to use much more comfortable needling so that patients aren't aren't as impacted. And it's not perfect, but it works on the most part.

27:31 Speaker 1: I can attest to that.

27:33 Speaker 5: I can attest to that for Sartin, and there's a lot of other different I mean, it's it's cool because in pain care it's it's not just okay, here's a we're gonna plug you in here. It's that combination of finding out, you know, whether maybe we're doing this treatment along with this medication or this type of therapy.

27:50 Speaker 1: Like I do pool. I I am in the pool every week.

27:55 Speaker 4: And and I commend you on that because it's funny. But one of the basic elements that we have in this world is water, and water is such a great thing for muscle tone and stress on joints, yep. And for you to engage in pool to at least do the movements that would be hard to do on land, but you can.

28:17 Speaker 5: I can't do what I can do in the pool. I can do jumping jacks in the pool. I do an arthritis class at the why at the local why everybody you know? You got Why's around this classes everywhere and it's great. I get in the water, I'm in there for about fifty minutes. I'm moving every one of my joints. And yeah, it's it's not just about medication. It's a combination of things. You have to Like, I watch my diet. I try to stick to an anti inflammatory diet because I don't want to cause more inflammation because my body just basically could glow in the dark if possible when it comes to inflammation.

28:50 Speaker 4: Jenny, you're such an ideal, ideal model patient. I mean, I don't know about that, no, but you really do embrace the multi modal, you know, approach that we have to encourage patients because there's only so much injections and medications can do, and a lot of it is just to help buy you time so you can engage your body to heal a certain way and adjust a certain way so that you can do the things you want to do. So I really really do commend you on that pool therapy stuff.

29:18 Speaker 1: It's huge.

29:19 Speaker 5: And that's the thing about taking care of yourself. It's you got to take care of yourself in totality. I have a therapist, I get in the pool every week, I watch my diet, I take my medications regularly. I take my treatments regularly most of the time. Sometimes I might try and stretch it out a little bit, and then I get a little vet.

29:37 Speaker 3: You can stretch it and.

29:39 Speaker 1: Then I come in sooner. But there's so much you can do.

29:42 Speaker 5: You don't have to the biggest thing I want people to take away I want you to hear today is you don't have to suffer.

29:49 Speaker 1: You don't have to.

29:50 Speaker 5: There are so many things I missed out on because I was suffering and I couldn't go. But I get regular treatment, and I get to go to the Mosaic Art Gallery.

30:00 Speaker 1: Which we picked up my paintings yesterday.

30:02 Speaker 5: I actually sold one for the first time out of the gallery, which was amazing.

30:07 Speaker 4: An artist, I remember that happens.

30:09 Speaker 5: Yesterday, right, So I would have never gotten to take place, take part in that, go to the opening, stand next to my painting on the wall, and fail pride because I wasn't too much pain right, So you can have It's worth it. It's worth it to get the treatment because you get so much in your life.

30:25 Speaker 4: Back and can I just add to what you're saying, Jenny, And again this also falls within our philosophy is that if we make we help you feel good from say whatever base level to higher level, intermediate level, that mental health aspect that you have from feeling just a little better to be able to go and embrace and do the things you want to do, such as going to the art galleries, you know, going and taking those walks. That is neurochemically gonna reinfor force your feeling of of of reward and feeling better, and that in itself will will basically take you on the path on recovery from pain.

31:12 Speaker 4: So it's not just physic physiological pain, but it's also psychological emotional pain kind of about that we try to help really achieve relief for.

31:22 Speaker 2: Yeah, I'm curious, doctor jo If over the course of your career, have you seen a lot of advancements in terms of techniques or technologies that you know that have that have really kind of helped to enhance what you do?

31:36 Speaker 1: Oh?

31:36 Speaker 4: Oh, phenomenally phenomenally. Uh. I can tell you one thing is that the field of medicine in itself has evolved so tremendously it tends to move a little slower because, like, if you look at the example of telephones, right, the iPhone, I mean, what was it maybe two decades ago? We had the flip phone, right, yeah, So wait what two decades ago? Was two thousands? Right? We had like flip phones back in the two thousands, and I mean I still remember that Motorola, that motoro flipt phone net that, yes, And then there's the BlackBerry with the little keyboard.

32:21 Speaker 4: So if you think of the evolution of the cell phone from you know, or telecommunications from pagers to flip phones to BlackBerry and now to these mini computers that live in your hand and you can talk to it and it talks back, tell it what to do, and it does it for you to throws the map up. Like, that's the evolution of medicine as well, because those technologies do migrate over to medicine. However, medicine tends to adopt it a little slower because providers tend to be a little more cautious because of you know, too aggressive a treatment or too aggressive advancements of adoption without studying the adverse effects of it as as closely could be detrimental for people.

33:12 Speaker 4: And that's why you know, the FDA has been very involved with those things. But in terms of pain management, it is extremely evolutionary, and it's evolutionary not just in medication management, not just in you know, the multidisciplinary approach and thinking about pain and suffering not just from you know, a mechanical but also you know, in emotional, psychological, but also in like techniques. So I say that because they have, for example, needles out there right that you put it into the patient for radio frequency evlations, you push a little lever and all of a sudden, boom, it comes out like a trident, so it covers the larger area.

33:55 Speaker 4: But the problem is those needles are extremely expensive. That it doesn't mean it makes it very difficult to cost cover the cost of treatment they have. You know, they have implants and procedures that the pain doctor does that comes very close to what the spine surgeons somewhat do, but not as good as spine sorts. I would never never detract from what the spine surgeons do because they do excellent work and it's so phenomenal to see the results of what they do. But there's been you know, techniques and devices developed where spine surgeons are are doing it, and they're teaching pain physicians to do an under X ray two and the costs are phenomenally less, really phenomenally less.

34:39 Speaker 4: But you know, what are the results. I don't know, right, They're still being studied. They're probably not as as effective as the current standard, and some maybe even more effective, but we just don't know fully yet. Yeah, I mean, preliminary studies have come out enough to get them approved, but long term studies are not fully there yet to clarify what the advantages and disadvantages are. But again, you know, in this American you know, westernized market environment that we have in America, sometimes those those therapies take precedent because they're cheaper to the insurers and the payers and and and there's you know, better margins to be made by the healthcare systems because of that, right.

35:22 Speaker 3: Right, That's always.

35:25 Speaker 1: One thing that people get a lot.

35:26 Speaker 5: And I was curious to ask you the question on air for every for other people as well, is what do you do to help people with like really bad headaches migrains?

35:37 Speaker 4: Great question. So we we deal with a lot of migraines, and we you know, we deal with a lot of headaches. We have a lot of approaches that you know, are specifically pain management related, and a lot of approaches that you know, we've worked with, uh that are fall within neurology, but neurology also leaks over to pain management. And some of the challenges are some of those therapies we've we've adopted and employed because there's such a shortage of neurologists here in New Hampshire. There's a huge shortage of neurologists.

36:11 Speaker 4: I mean, we get comments all the time that, uh, you know, I can't see my neurologists for another six months.

36:18 Speaker 5: Oh, it took me over a year to get into my neurologist's office on a wait list.

36:23 Speaker 4: And it's insane. And we're like, well, you know, we try to accommodate you. We'll we'll figure it out. We'll we'll try to adopt some of those measures to help with pain management, with migrain and headache management. But again, you know, the the experts on those are the neurologists. But you know, we we've been able to accommodate some of those and some of those include, of course, you know, therapeutics, right like medications. There's been a pardon me, burgeoning class of therapeutics that are pretty effective on migrain management, but again they're more expensive and they're on patents, so there's they don't fall within the insurance algorithms as as readily accessible.

37:03 Speaker 4: And those tend to be the calcitonin gene receptor peptide antagonists to see g RP receptor antagonists, and those include some medications that you can take orally once a month, injections injectables. Those help. We also leak over to just in eventual pay manage itself, is that a lot of the headaches are not just migraines, but they could be related to the cervical spine, and we call those cervicogenic headaches.

37:35 Speaker 4: You know, where where the headaches are are from irritation of the nerves that cut off the cervical spine, that cause spasms of the muscles in the back of the neck upper lower part of the head and then you know, through collateral innervation end up being experienced as a headache. You know, we have occipital nerves, you know, greater and lesser eximpble nerves that tend to be irritated from you know, irritation of some type, whether it's spasm them or just fibers tissue irritation. So so there's a lot of ways that we can deal with headache that kind of overlap somewhat with some of the neurologists.

38:10 Speaker 4: Again, they're the experts, you know. I always love my neurology colleagues. Wish I was able to spend more time with them. Sometimes we do get a special guest that comes to our office to interact with us about neurology. Sometimes we we've touched base with some of the neurologists in in the UH Northeast area that we've got today. Yeah, but again they're they're they're far and few between because somehow there's such a shortage of them. And I know that there's been you know, some dynamics that have occurred with health systems that have uh made some shifts in neurology access as well in the in the New Hampshire area.

38:49 Speaker 4: So it's been interesting. But yes, yes, we have lots of little things we could do for migraines as well.

38:54 Speaker 3: Yeah, headaches, it's pretty common migraines.

38:56 Speaker 4: Migraines and heaches. So one thing I just want to say is that people but when they have a headache. They call it a migraine, but it's not always a migraine. There's there's a specific criteria for migraine. There's specific criteria for different types of headaches, like cluster headaches. Yeah.

39:09 Speaker 2: Oh, I know someone who's who's had to deal with cluster headaches, right, yeah, just.

39:13 Speaker 4: Yeah, they have a whole cervicrogenic headaches. So again, you know, we're there to discern between those things. It's not just you know, one label and it falls within that. We tend to try to tease apart. What's the real root cause of it?

39:26 Speaker 3: Yeah?

39:27 Speaker 2: Yeah, what's the most common back pain? I would assume, right, is the most common back pain.

39:31 Speaker 4: Neck pain, injury related pain is very common. Yeah, just a lot of arthritic pain. Degenerative joint pain is very very common. And and just remember that anytime anyone's in mechanical physiological pain, it evolves into the psychological pain.

39:54 Speaker 3: And we have.

39:55 Speaker 4: That that you know, combinatory source of pain, and it becomes very difficult to break. And so that's that's the art of pain management. How do we break one to help decrease the other, Then how do we break the other.

40:09 Speaker 5: One of the aspects of of pain that I call it is paying gry when I'm in so much pain that it's not it's not about anybody else. But everything is short fused, everything is tight. I'm hurting so much that I might come off like I'm really angry, but it's it's really painger. It's it's it's not it's not a normal sense of anger, if that makes sense. But yeah, that's that's kind of a term that we use.

40:34 Speaker 4: Is paining gree real term because it's not. We should quit it.

40:37 Speaker 5: It isn't It isn't our world. It isn't our world because I've seen it before, I've used it in some of my writings. I don't know where the original coin is come from.

40:47 Speaker 3: I know, I don't take credit for that market.

40:49 Speaker 4: Yeah, I don't know straight on the show.

40:52 Speaker 1: Yeah, it's a real phenomenon.

40:55 Speaker 5: And your your loved ones don't necessarily really oh they're in a bad mood.

40:59 Speaker 1: It's like, oh god, I'm not in a bad mood. I'm really suffering.

41:02 Speaker 5: Yeah you know, but yeah you don't. That's the thing. That's the real thing.

41:05 Speaker 4: And this is why I want to give a positive stroke and a very very you know, highlighted comment to my staff is that they are the front line of dealing with, you know, patients, and a lot of these patients call in and come in with angry syndrome. Yeah, yeah, very angry.

41:25 Speaker 5: Yeah, and it's not them and they're wonderful and they're sitting there taking it and you're like.

41:29 Speaker 1: But I need the appointment.

41:30 Speaker 4: Yes, yes, and so and so I just want to say that, yes, it's it's a very notable occurrence. I can only say that, you know, I'm very grateful for the staff to be able to to, you know, oh humbly and craftily handle those situations without without being too affected by it. But does affect all of us.

41:49 Speaker 1: Of course, Oh yeah.

41:50 Speaker 5: I mean you call up like I've called up and been crying like oh this went wrong and I'm really hurting, and they're just all right, we got you.

41:58 Speaker 1: Yeah, where are we going to let's get a you know.

42:01 Speaker 4: So, So one of my most common words that I use during the day is oo. So you know how you take a breath back and you catch yourself. So, so that's that's one thing I think that could help patients when they go through a paining gree episode or pain paying gry episode is take a step back and just kind of take a deep breath and let it out.

42:24 Speaker 5: You know, like like like you know, like, yes, yes, I do a lot of Yeah.

42:32 Speaker 3: I don't know if you I think you know this about me.

42:33 Speaker 2: I'm a hypnotherapist and I do a lot of what I'm bringing a client in a hypnosis. We do a lot of breathing, ironic given my recent asthma issue, but but we do a lot of you know, deep breathing, and I try to I do a little bit of pain management with that too.

42:49 Speaker 3: Sometimes sometimes with clients just to kind of help.

42:50 Speaker 2: Them, I try to get them to do a visualization where they imagine the pain not as a feeling or a sensation, but as an object that's in them that they can remove, that they can actually push out. And sometimes it's helpful for people. But but we do a lot of breathing stuff, you know. I get them to you know, breathe out any negative energy that they're carrying around and breathing positive energy and all that kind of thing.

43:11 Speaker 4: That's phenomenal. Matt, you should maybe become a hypno therapist for pain. We well, I do.

43:17 Speaker 1: I have to do it with somebody asked about it.

43:19 Speaker 3: Oh, yeah, yeah, really, yeah, I meant most of my clients.

43:22 Speaker 2: It's not something I get approached about much because most of my clients the number one thing is quitting smoking, of course, which is true for any epnotherapist. And I do a lot of you know, stress management and all that kind of thing, weight loss of phobias. So it's not actually very common that anyone that a client approaches me for for help with pain management.

43:41 Speaker 3: But I do it, and I actually have a certification in it.

43:43 Speaker 1: It's really And you also have hypno birthing.

43:46 Speaker 4: I do, yes, hypno birthing, yes, yeah, wow.

43:50 Speaker 1: You can use hypnosis in childbirth.

43:52 Speaker 4: Yep to not feel like the labor pains.

43:54 Speaker 3: Right to be able to.

44:00 Speaker 5: Maybe an Epidurals are amazing. Let me tell you I didn't get one when I gave birth to my son. Unfortunately, by the time I was smart enough to ask, they said.

44:09 Speaker 1: The window was closed.

44:12 Speaker 4: So, just so you know, my latter my prior life before I went into pain management was that I was an upstetric antithesiologist. Oh so, so I know the epidural very well, and I just want to make a comment that that it's always good if there's no major contraindications to get the epidural early, because that epidural not only helps you experience for women that are going through labor, that only helps you experience the birthing process in a much more pleasant manner, especially if it's working well.

44:43 Speaker 4: It's a very from a medical standpoint, it's it's probably one of the best life saving tools that the antiseesiologist and the medical team has to deal with any emergencies that may arise that are so fast paced when you're going through the process. So so I've always been an advocate get it early, Let's make sure it works. And if even if you don't want to receive the the the the relief from it, that's okay. We can shut it off. But as long as it's working and it's there and if something some badness occurs, it's it's one of our best If it's one of our best tools to get you through the whole process safely.

45:24 Speaker 3: Okay.

45:25 Speaker 1: Now you have two.

45:26 Speaker 5: Offices, so you can see people in two different locations. Now, yes, I want to make sure listeners know where you are.

45:32 Speaker 4: Yes, yes, So so we we have our main location in Newington, New Hampshire, and that was the well the original one was actually an Exeter and we started with doctor Sanchez, Manuel Sanchez, and and God bless his soul, he's such as I still love that man so much.

45:53 Speaker 1: He was so nice, he is such.

45:55 Speaker 4: He is such that Spanish European classy flair that that, and and and his teachings. I mean, I can only tell you his teachings still come with me today till today. He he he really really uh impressed on me how to really take care of patients here in New Hampshire. Just so you know, but our original office was actually an Exeter and then when I joined in shortly after we went to Newington and then recently just opened up a new office in new Market.

46:29 Speaker 3: Yeah, congratulations, well, thank you, thank you.

46:31 Speaker 4: It's been a little slow of opening. I'm not there often just because I'm pretty tied down in the Newington location, but my staff is there a lot and and we do a lot of uh we're starting to roll out, you know, a lot more clinical time there. The building is still under development, you know, the section for the paint for the clinic is is already ready to go. But it's beautiful. I mean, I'm sure you've been there right there yet should we should come here.

47:00 Speaker 1: Sometimes we go on to the new one now.

47:02 Speaker 4: Oh yeah, yeah, it's really nice. It's uh.

47:04 Speaker 1: I usually go into the r Yeah.

47:06 Speaker 5: So I'm always at the at the Newington office.

47:10 Speaker 4: Honestly, if my wife let me live up in the new market of them, I have like place where I live at home. Yeah, it's it's new, you know, it's new. It's fresh. You know, we we put new flooring in. It's just pretty. I just think it's really pretty.

47:25 Speaker 3: Yeah, oh very good.

47:26 Speaker 4: Yeah good.

47:27 Speaker 2: Yeah what uh now, did you have any other plans for expansion beyond that in the future.

47:34 Speaker 4: You know, it's a great question. I mean, you know, I'd love to be like Doctor Evil out of uh what's that movie? Uh it's a little world domination. But no, realistically it's slow and steady. Yeah we uh, you know, it's it's basically a staffing and and a patient you know, accommodation issue. It's just we go slow and steady. I think as long as you know, we're able to accommodate patients and we're able to figure out areas that that there is need right like you know, up here near the Manchester area, I think there's more need because I know there's been some shifting in the pain management atmosphere out here in New Hampshire.

48:19 Speaker 4: We would definitely think about expanding more. But again, it's just it's I'm very slow and steady. I've I've always been very conservative, and I know, you know, my administrative staff is always asked, why don't we do this? Why don't we do that? We get vendors all the time coming in and going hey, let's do this and do that. Yeah, and I'm just very slow and steady.

48:39 Speaker 3: I just yeah, I just I think that's probably wise.

48:43 Speaker 4: Well, it's it's only because we have something that works right now, and you know, we we have a lot of positive feedback from the community and from patients, and so to to to add another element into something that works has to take a lot of thought and h and consideration, because you know, we want to make sure that we're still doing the best that we can for people and for patients in the community without without changing it too much. That's why, again, the slow and steady approach has always been my my, my, my mindset.

49:15 Speaker 3: Yeah, no, I think that makes I think that makes sense. Doctor. No. This has been wonderful.

49:20 Speaker 2: We're already approaching the top of the hour that the time, the time goes so quickly.

49:25 Speaker 3: Anything we didn't mention that we should make sure that we Uh.

49:28 Speaker 4: I just want to say, you know, happy new Year to everyone, for both of you, to everyone out there in New Hampshire, to the uh, you know, the general public. I want to say that, uh, you know, we hope from Paint Specialty Group a fruitful and very successful year and we're here to help if there's anything that you need. I want to be thankful to my staff. They've done a wonderful job take helping.

49:58 Speaker 3: You know.

49:59 Speaker 4: The providers take care of the community, and we have lots more exciting things to come.

50:04 Speaker 3: Yeah.

50:04 Speaker 1: Absolutely.

50:05 Speaker 5: You can find out more information at Painspecialtygroup dot com. Pain Specialtygroup dot com will show you all the information about the different treatments they offer, different types of problems that they treat and all the providers. Beautiful pictures are on there so you can see more information about the providers. I am a happy patient and I invite you to have a pain free day.

50:26 Speaker 3: And it's a very nice website.

50:27 Speaker 2: By the way, I'm a web design nerd, so I judge these things and it's a very nice website.

50:32 Speaker 4: Well, thank you, thank you. I don't take any credit for you.

50:36 Speaker 2: You don't have time to design your own website, that's for sure, I know, but no, but it's a great site. And yes, Painspecialtygroup dot com and doctor No, thank you.

50:44 Speaker 4: So much, thank you for having me on.

50:46 Speaker 2: Absolutely we got to do this more often. Okay, like we were talking about earlier, we definitely will