THE INITIAL CLINICAL SURVEY AND HOW TO IDENTIFY THE … · the patient has pernicious anemia, and...

MODULE twO tRANSCRIPt: DAY 2 QUEStIONS | COPYRIght © 2016 FUNCtIONAL NEUROLOgY SEMINARS LP | PAgE 1

THE INITIAL CLINICAL SURVEY AND HOW TO IDENTIFY THE LESION BEFORE EXAMINATION (MODULE TWO)

Transcript – Day 2 Questions

Presentation by Drs. Datis Kharrazian and Brandon Brock

Dr. Kharrazian

Okay, ready for… So, we’re going to get into questions people have sent in for Sunday. So here’s the first question.

“Dr. Brock, did you keep the big toe as a souvenir?”

Dr. Brock

For legal reasons I cannot say. No, no man. It was put in a biohazard box.

Dr. Kharrazian

Okay.

“What’s your vitamin B dosage and route recommendation for a very elevated homocysteine as in the case yesterday?”

Dr. Brock

Go first. I mean, for me, it depends on how high it is. And it also depends on what the cause is. I mean, if the patient has pernicious anemia, and they have intrinsic factor antibodies, or parietal cell antibodies, or I know they’re not absorbing it, then I will give it injectable, and I usually give it subcu. And I usually will make a mentholated version of cyanocobalamin with folinic acid with P5P, and that’s our formulation. And then six point two-five across. And we’ll give that shot, you know, once every three days or two days, and it resolves it really well.

Now, there’s obviously sublingual versions that work great, if you can tolerate that. There’s obviously some oral versions that work great if you can tolerate that. I also need to know if you have COMT issues, because if you don’t, and we give over-methylation, then sometimes there’ll be a problem. Sometimes you need to


give them methionine with it, and you don’t. I mean, it’s not just a straight “what is your B formulation.” I think we’ll probably go through methylation at some point in pretty good detail, but for me it’s all about how high it is, and then what are my blocks… what is the blockade for me getting it oral? And if I have a bunch of blockades, then I’m going to go a different route.

Dr. Kharrazian

So, let me… how I do it. So, if I see high homocysteine, my first question is, well first, let’s just back to it. Homocysteine’s very inflammatory, destroys neurons. So research shows past seven, homocysteine above seven, has an inflammatory response to neurons. The literature shows homocysteine past double digits have an impact on blood vessels. So the homocysteine at even levels of seven or eight or nine are very inflammatory to the brain. Most people are really only focused on the vascular issues with it, but we’re not.

Here’s the other thing with homocysteine. When homocysteine’s high, it’s not just that this is an inflam-matory chemical in the body; it means they’re not methylating. Right? So homocysteine becomes cysteine through a transfer of methyl groups. So, you know, you have a complete methylation defect throughout their body. It includes their brain. So all the pathways that require methylation, like dopamine, serotonin, acetylchol… all these pathways are now not as efficient. So it’s a really big deal when you see high homocysteine unrelated to cardiovascular issues and neurodegenerative issues, but just the fact that neurochemically that’s off, right?

So, if I see homocysteine that’s elevated, it depends on what’s going on with the patient. If they’re already taking B12, it makes you more suspicious, or folic acid, or something like that. But if they’re already taking B12 and folate, my first question is: Are they absorbing it? So one of the reasons they can’t absorb it is, do they have hypochlorhydria? So if they can’t tolerate protein and feel like they can’t digest meat, we know that they have some hypochlorhydria, they have some reflux, we know they’re not digesting their protein. The next thing I immediately do is, with the way I run my office is, I do routine blood work that includes homocysteine, but also always includes a CVC. So if I see high homocysteine, I immediately look to see if they have megaloblastic anemia. And if they have megaloblastic anemia, the next immediate step, like Dr. Brock was saying is, is it an autoimmunity causing intrinsic factor antibodies? So I run intrinsic factor blocking antibody. If they have intrinsic factor blocking antibody, you’ve got to go with intramuscular or IV B12 to have the best effect. You can get away with some of them if you calm down the autoimmunity and use something like sublingual B12. Okay?

Now, there are some people, one-third of the population has a catechol-O-methyltransferase polymor-phism, where they can’t process methyl groups more efficiently. So some people need a methyl folate type of substance to lower it. So you can try methyl folate types of derivatives that bypass that common polymorphism, see if that lowers homocysteine. And for the most part, the most common reasons why people have high homocysteine that I’ve seen isn’t just the fact that COMT polymorphism, it’s the fact they have hypochlorhydria or underlying anemia, or, you know, pernicious factor autoimmunity that causes it to be an ongoing problem.

Now, as soon as you see high homocysteine, you wan to put them on whatever cocktail of methyl folate or B12 and see if it comes down, and the question, honestly, is how much do you use? You don’t know. You’re going to have to just come up with a number. And really, how do you know it? Because there isn’t any good research on it. And then see if the levels come down. If the levels are coming down, great. If the


levels aren’t coming down, then you give more, and if they’re still not coming down, you’ve got to find the cause and the mechanism that’s causing it if you haven’t already. So that’s… sometimes it takes months to figure out how to lower someone’s homocysteine, and sometimes it’s immediate. As soon as you give them some support, it comes down. So it’s definitely one of those things that you want to monitor over time when you’re looking at it. So that’s, I guess, the…

Dr. Brock

And one other thing I’ll say is, if you have an MTHFR SNP, fine. You’re going to have a methylation issue. If you have a COMT SNP, you’re not going to break down catecholamine. There’s a good chance you’re going to get sympathetically dominant, and super anxious. Some people that can’t deal with methylation, you give hydroxylation. When you hydroxylate things, you get hydroxyestrone. It goes and it actually blocks or it breaks down catecholamines, where COMT doesn’t break it down. So there’s different types of folate that we might give, depending on what the issue is. It’s not always just as simple as saying, “Hey, let’s give some methyl donors.” I mean… And it’s just like what Dr. Kharrazian said. I treat a lot of people with mental illness with methylation, because you have to have BH4 as a co-factor for all of these major neurotransmitters, and if you don’t have it, they tank. And so it’s actually a really big concept. We probably need to address it a little bit more than just with this one question. But anyway, there you go.

Dr. Kharrazian

And also, it’s not just catechol-O-methyltransferase polymorphism presenting itself, so 5-methylenetetra-hydrofolate reductase polymorphism. So there’s two main polymorphisms to B12. Just as a… Okay.

“What dosage of nitric oxide do you use prior to therapy? Length of time taken prior to therapy and during therapy?”

Do you mind if I go?

Dr. Brock

No, please. Just… I…

Dr. Kharrazian

So, I mean, there… We don’t actually use nitric oxide. We use substances that increase endothelial nitric oxide. And the most profound one is vinpocetine, I think. I prefer it in emulsified liquid form. I think that has the best effect. And we know that the endothelial nitric oxide synthase with vinpocetine has agonists with things that drive cholinergic pathways. So acetylcholine works in conjunction with endothelial nitric oxide, so when we use things like vinpocetine in combination with things that increase sensitization of acetylcholine receptors and slow down acetylcholine esterase reductase pathways, we have more acetylcholine in the pathway, like huperzine, we have a great effect. I personally like to use an emulsified vinpocetine huperzine L-acetyl-carnitine mix to get a nitric oxide effect.

I feel the best response with patients is if they take a dose of substance and then raise their heart rate just for a few minutes. So if they take some nitric oxide support, and then just run in place for as long as they… for like two minutes, three minutes, that has this profound effect. Because when you do it the other way you raise nitric oxide levels as you increase your heart rate. So as your heart rate beats faster, you get more


circulation to your blood vessels. That actually signals your vascular endothelium to release nitric oxide. And the vascular endothelium is now considered an endocrine gland, because it releases hormones and messenger pathways. That’s not just these pipes. So if you take substances that start to activate endothelial nitric oxide, like vinpocetine, and then take things like huperzine and acetyl-carnitine all at the same time, and then raise the heart rate with that, you have this profound nitric oxide effect.

Now, how long do they take it for is another question. So I’ll have some of my patients – just look at their circulation and how cold their hands and feet are, and how their nail beds are, will then determine the dosage and how much they take. But what I find is, those that have really compromised pathways, they can do it with exercise, and sometimes they can do it with exercise in the morning and in the afternoon. And again, it’s not exercise; it’s getting the heart rate up. It’s not like they have to go and put on gym clothes and, you know, do all that and go run and whatever. But if they already are doing a workout, I really prefer they take their support before the workout to get the best effect. Okay?

Now, the best way to actually raise nitric oxide is just working out.

Dr. Brock

Viagra and nitro.

Dr. Kharrazian

Yeah. And then the best way to raise dopamine is also to exercise for all these pathways too. So, just a little bit of activity has a big difference on the brain. So that’s how I use the nitric oxide support.

Dr. Brock

Yeah, I mean, and dosages… Like, I’ll do things like, you saw the temperature gun that Dr. Kharrazian was using. If I have somebody that truly has vasoconstriction, and it’s not small vessel disease but it’s the fact that their nitric oxides kind of suck, then we’ll dose them until their temperature changes.

Dr. Kharrazian

You can have them – family members – feel their hands and their feet, and then look at their nail beds. And they’re really white if they have poor circulation. And then they exercise, if they look at their nail beds or take a picture, and then feel their extremities, that’s what’s normal. So you want to teach them like, “That’s normal, and what you have without that is not normal.” So you want to try to stay in that normal state as often as you can throughout the day. And that’s… especially like the case I showed you guys, that gentleman, he has some severe circulation issues, and his brain’s not activating and developing because he’s hypoxic in his frontal areas for various reasons. So, we know he’s got a nasal septum block, but we also know his circulation’s poor. The combination of both of those are terrible. Right? So at least we can improve his circulation throughout the day.

Okay. What’s next?


Dr. Brock

That there?

Dr. Kharrazian

“Is there a minimal or maximum length of time recommended for detox? I have conflicting information.

Dr. Brock

Me too.

Dr. Kharrazian

Me too. We’re confused too.

Dr. Brock

It depends, man. Are you on heroin? Yeah, it’s different than somebody if it’s… It really… Some people are definitely more toxic; some people have more genetic biotransformational issues, some people are on other substances. This is… The reason why there’s conflicting information is because there’s conflicting situations.

Dr. Kharrazian

Physiology, yeah.

Dr. Brock

I mean…

Dr. Kharrazian

It’s actually twenty-one days and four hours and six minutes.

Dr. Brock

And thirty-seven seconds. I’ve got to throw that on there. It’s new research.

Dr. Kharrazian

Yeah, yeah. It’s new research. We don’t know. No one knows. Everyone’s uniquely different. So we can’t answer that.

Dr. Brock

So, whoever’s question that was, it’s…

Dr. Kharrazian

We’re sorry.


Dr. Brock

We’re sorry, yeah. We suck.

Dr. Kharrazian

“Does the same time line for denervation and nerve death given for peripheral neuropathy from earlier today also apply to autoimmune-driven neuropathy? Or can autoimmune peripheral neuropathy improve with a longer time frame post-development?”

Dr. Brock

Okay, well let me… These are great, really some interesting questions. So look. Remember, you’re only going to denervate if there’s… if you demyelinate a significant segment, or if there’s actually axonal damage. Now, the only reason why you would denervate with myelin damage is because if you get enough demyelination, it actually makes the axon die. You only get denervation when axons die. With certain types of CIDP, you don’t even denervate, you just demyelinate. So there’s no motor conduction at all, so you just sit there and you’re frozen, okay? And then the myelin kind of has to start to grow back, and there may be some denervation and stuff like that. But my thing is this: There may be no denervation from autoimmune disease. There’s just neuropathic symptoms that don’t lead to straight-up lower motor pathology. So if somebody walks up with a hatchet, and goes whoosh, and cuts a nerve, well then, you know the time frame. But if you have a slow, systemic illness chewing on something or eating on something, it may never create denervation, but it may create neuropathic disease that never leads to denervation. So that is as variable as anything. Do you have myelin basic protein antibodies? Do you have… I mean, there’s more than myelin basic protein antibodies for peripheral nerves. You know, so…

Dr. Kharrazian

Beta-tubulin, or filaments…

Dr. Brock

Yeah, there’s… Look, Cyrex does some of it, Athena Labs does a lot of it…

Dr. Kharrazian

There’s a lot more of them, yeah.

Dr. Brock

I mean, there’s… I’m going to tell you this: When you start getting high up into those genetic tests, and some of these autoimmune tests, it’s not cheap. Like, you’re going to break five, six, seven, eight thousand dollars just about every time when you do a complete peripheral polyneuropathic profile that looks at all the genetic components, and the autoimmune components, and you’re starting to classify what it is that’s there. So, the answer to this is, it’s very variable, and it may not create any denervation, and it may not create any axonopathy. It just depends on what the disease process is.


Dr. Kharrazian

But if there is an auto… a true autoimmune component destroying the nerve, here’s the bottom line: No one has figured out how to cure autoimmunity. It’s an actually incurable condition. You’re just trying to modify the expression of it. So if it is a true autoimmune neuropathy, you would expect to have ongoing inflammatory reactions, because that’s the nature of an incurable disease. You’re just trying to manage it as best you can.

Dr. Brock

That’s the name of the game. Autoimmunity is this: What can I do to make you have more good days than bad?

Dr. Kharrazian

“Earlier yesterday Dr. Kharrazian referred to a lady with temporal lobe seizures who heard voices telling her to kill her child. What about a person who experiences consistent nightmares of killing people, or witnessing people get gilled while tensing, sweating, and breathing heavily, all without walking?”

Dr. Brock

Waking.

Dr. Kharrazian

Did you… All without waking.

“Is this seizure-type activity or something else?”

Did you have a question?

Dr. Brock

No, but I will tell you this. Let me just give you a little quick tip on this. Some people that have PTSD will actually perseverate over certain activities in their sleep. And you see this with orbital frontal lesions, basal ganglionic escape. Don’t give them dopamine. I made this huge mistake of giving some people Phenibut, because they couldn’t sleep, and so a lot of people with PTSD, they’re like, “I’ve gotta sleep, I’ve gotta sleep, I’ve gotta sleep.” So Phenibut is really a nice way of carrying GABA into the central nervous system, but what you need to also understand is, it drives up dopamine at the same time. So I was actually enhancing the ability to stay asleep and have more vivid nightmares. Woo hoo! Not a good idea. These are… Some of these things with dreams and post-traumatic stress, it’s not the same thing as a seizure. It’s a totally different pathway.

Dr. Kharrazian

I have no idea. I don’t know.

Dr. Brock

That’s my answer, and I’m sticking to it. So, next.


Dr. Kharrazian

Time is short. I don’t know.

“What is the functional neurology approach to anorexia and bulimia? What is the issue in the brain, etcetera?”

Dr. Brock

Well, I can tell you this much: There’s a large involvement with cortisol and right parietal lobe with anorexia, because of the internal reality of understanding what you look like, versus the external reality of what you really do look like. And some people get what’s called body dysmorphism, which really lives in the right cortex. Now, does that mean that everybody needs functional neurology that has anorexia? The answer is no. Some people need to be hospitalized, they need to be force fed, they need psychiatric help, they need a lot of things. Bulimics look different. You know, one of the ways you can tell a bulimic is, you look at their teeth, and they’ve been throwing up a lot and stuff like that, or they abuse laxatives, which is really a bad deal, because coming off those is not cool. These are very serious conditions. And when I say “very serious conditions,” here’s what I want to tell you: Be careful with very serious conditions. Don’t pretend like what you’re doing is going to fix everything. That is my responsible parting shot disclaimer for the weekend.

Dr. Kharrazian

I would tell you personally, there’s some patients that I just don’t take any more, and if these are their main chief complaints, I just… it’s a failing model for me, so I’d rather work with patients I know I can help. There’s only so many new patients I can take per month. So I don’t know what to do with them.

Dr. Brock

I would say this: I agree with Dr. Kharrazian. I’ve learned to say no. I said yes, you know, to some patients where it’s like, “You’re… huh?” You know, and it’s just tough. Some patients are just sick. They… Some people need to be put into an inpatient facility. And it doesn’t mean that at some point in time you’re not going to administer care to them to make their brain better. I don’t want to, like, say that there is no use, but I want to say that I’m not so sure that I’m the primary source of treatment for everything. We just can’t pretend like we’re that kind of practitioner.

Dr. Kharrazian

Especially working with chronic people. If you keep taking every single case that you have a hunch that’s not going to work for you, you will completely burn out. So, that’s… Okay. Next question.

“What is the clinical significance of learning a language using Broca versus learning it using Wernicke? What are the advantages and disadvantages of one versus the other?”

Dr. Brock

Well, you’re going to get your primary language with Broca. If you do a secondary language, or learn something later in life, you’re usually going to learn the posterior part of your brain. And I would say this: Hey man, if you are having problems with parietal stuff, you need to go through word-finding exercises. If you are going through expressive types of Broca’s stuff, then you need to go through sentence generation


and difficulty sentence structures. And then we do vestibular therapy, with verbal therapy, with fixation therapy, with somatosensory therapy, to all integrate together. I’m giving you treatment strategies right now, when I really shouldn’t. But if I have a posterior brain that I need to activate… Because you’ve got to understand. When you… Let’s say you grew up in a Hispanic household, but you started speaking English, and as a child you spoke Spanish, but you quit doing that. There’s certain layers in your cortex that are going to atrophy. But if you learn that language later on, and you heard it as a child, you’ll be able to reuse Broca’s again to learn it. If you never heard that, you’re going to have to learn the posterior aspect of your brain, so if you need posterior rehabilitation, go learn something you never heard. Okay? Otherwise, try to make your native tongue a little bit better. Just come to Texas. All aphasias fit in there. It’s fine.

Dr. Kharrazian

“When a child is lying prone on a table and is asked to rotate their head to one side, and has difficulty figuring out right versus left, does this indicate brain imbalance? Why is this phenomenon seem to be more apparent in boys who love their video games?”

Dr. Brock

Well, you know, boys are right-brain axis, and a lot of times some of the violence in video games are… really drive up right brain. So you may get a little bit of asymmetry just for the sheer fact of sex. But if you then, on top of that, create some… You know, if they’re doing something repetitively, that creates more asymmetry, then you can get an asymmetric brain. Okay? It’s just a fact. And what this is looking at here is different types of primitive reflexes. And I’ll show all the primitive reflexes as we go through the program. They’re really quick and easy to do, and some people need to do them to rehabilitate. It doesn’t always indicate an asymmetric brain, but it can indicate the fact that a primitive reflex has not been inhibited, which is not always due to asymmetry, it’s just due to the fact that there’s not any inhibition. So the answer is yes and no.

Dr. Kharrazian

“Can you discuss peripheral neuropathy metabolic support and nutritional strategies options post chemo?”

Dr. Brock

No. Not yet.

Dr. Kharrazian

“When providing paperwork history and questionnaires, do you give them all the forms to fill out? Or do you have them fill out a general health questionnaire, then after your initial assessment, have them fill out more specific forms based on your findings?”

Dr. Brock

I do. Like, I don’t give everybody a vestibular evaluation. Like, if you come in and you’ve got… had a stroke, you may or may not get vestibular. It depends on if you have symptoms. You train your staff to learn which forms to give, and then after you interview them, if you feel like they need more, then you give them additional forms. I mean, that’s what we do. I don’t know how you guys run it. You know, we do try to get the stuff filled out before people get there, because it just takes too much time. It throws off the whole schedule if it takes an hour to fill out forms. They should have that stuff filled out before they get in.


Dr. Kharrazian

So, the way I do it is, I do a case review. Because I don’t take every patient that calls the office. So we have patients come in, I have questions and forms, and the questionnaire forms are in there. And we send it out to them, we let them know if it’s not detailed enough, they don’t put a lot of effort into it, we just don’t even go any further. And then once they send that back, I review the case, and if I don’t think it’s like I can help them, like anorexia patient or something, I will just tell my office staff, “Don’t worry about charging them or anything, we’re just not going to take the case.” Or she’ll just know right away, some red flags, that we don’t take certain cases. Like, I don’t work with cancer patients or things like that. And then, if I go through the case review, and I have… and I feel comfortable with them, then I’ll usually call them on the phone and go, “Here’s what’s realistic; here’s not what’s realistic.” That’s where ninety percent or more of my patients fly in, so it’s important for me to have all the paperwork and everything for them. And the type of practice I have is a diagnostic practice. So I’m just there; people are flying in for me to figure out what’s going on with them, get them some strategy, then do some followups or refer them back to their referring practitioner or something.

So I like to have everything in front of me ahead of time before they actually make a trip down to the office, and I like to discuss what I’m potentially thinking with them before they make the commitment to spend money and time and energy to come out, and I want to let them know what I think is realistic. So that’s how I do it. And then when I do followups, things… the forms that… So, I kind of give them all the forms in the beginning, because I’m just trying to dig and look for everything. And I have all their medical records sent to me before they come in, so I can already screen stuff before they come in, and then when they come in, I’m already ready to go with what I need to do. And then the followup, I might use forms if I’m using it to see if their assessment is better.

Dr. Brock

We have a panel, too, that now looks at cases and says, “We’re not going to do this.” Because again, otherwise you just end up feeling like a total failure. I mean… and it’s… look, this stuff’s hard enough even if it’s a case that you know you can treat, much less getting somebody that comes in and, you know… We could sit here and tell stories all day about some of the crazy stuff we’ve had come in, but we’ll do that some other time.

Dr. Kharrazian

“How is the brain region localization form different from the brain function assessment form and brain health nutrition assessment form?”

Those are forms I’ve used for nutritional seminars, but the brain function assessment form is not as detailed as the new form that we have, the brain region localization form. Then the BHNAF form, if you’re using that form, is just a nutritional form for the brain. I still use that in my practice. Okay.

“Once receiving the paperwork prior to the exam, do the answers allow you to carve out the direction of the exam? In other words, do you focus the exam on the areas that stand out most?”


Dr. Brock

You’re still going to do a comprehensive exam, but in the back of your mind you’re going to be thinking, “What am I looking for and where am I going?” So I’m going to tell you this: Exam is exam. You’ve got to cover all areas. But you need to be thinking, “The imaging showed this. The diagnostics showed this. Their labs showed this. Their intake forms showed this. What they told me showed that.” So you’re walking in… Everybody walks into an exam with a little bit of, sort of preconception of what they’re going to, you know, find. But it doesn’t mean that you ignore the other areas. Now listen, I just want to say this, and I don’t care really whose feelings this hurts. I’ve seen a lot of people do these exams where they walk up, they go to just one area, do a couple of things, they say, “Hey, this is it,” and they neglect the entire rest of the body, and they make a treatment plan, and then walk away. And I’m like, “That’s just not good.” So…

Dr. Kharrazian

Part of the reason we’re here is because we really think the focus-limited exam is just a bad model to continue to teach.

Dr. Brock

I need you to get the assessment and say, “I think this is what’s going on, but I’ve got to look at everything on the body,” because there’s a lot of stuff that people don’t report, that you won’t find inadvertently or in the middle of the exam, and they’ll say, “Oh yeah, yeah, yeah, I…” You know.

Dr. Kharrazian

So, here’s how I do it. I have them in exam, I have an exam form that has all the areas of the brain I want to cover, all the things I want to do, and all the basic eyes, ears, throat, lung, heart, abdomen types of evalu-ation, so I can make sure I don’t miss anything. Right? Now, the order I do them will depend upon what I pick up from the questionnaire forms and initial survey. So meaning, I know if I… If I know they have some vestibular tendencies, if I go in and start testing that pathway, they may be so dizzy I won’t get a chance to test everything else, because they’re already… it’s already a problem. If they have fatigue issues in certain regions of the brain, I may wait to do this at the end, or maybe I do them in the beginning. It all depends on… So I’m trying to look at their initial workup from the forms and their history, and then decide, “Do I wait to test this area first, or do I wait to test this at the end, or do I do it first?” And then that’s the call I make. Usually if I know it’s going to cause symptoms and make them crash, I’ll be… I’ll probably wait until I check some of the baselines stuff, get that out of the way, and then start stressing out the areas of the brain that are involved, so I can still screen for all the other factors without making them crash during the exam.

Dr. Brock

Yeah, you will learn that when you walk in, you’re like, “I’ve got to start here versus here.” I try to do everything the same every time, if I can, but sometimes you just walk in, you start talking to them, and you’re like, “Look, I at least have to get this part looked at in the time frame that I’ve got, because this person’s got about this much before they start crashing.” I mean, I’ve had people seize in the office because they can’t handle the exam.


Dr. Kharrazian

I haven’t done the exact same exam – I mean, the same sequence exam findings – with any patient. I always vary it based on where I need to go. But I do eventually get to it all. So when you’re working with a lot of fatigued, chronic people, brain-injured people, autoimmune people, you have to be very conscious of what’s going to fatigue them and exhaust them, and you have to consider that when you examine them.

Dr. Brock

And you’re going to have to go through this program and organize your thoughts as you go. Like, “Let me take this stuff out of this module and organize it, and then start utilizing it.” The people who don’t do that, it’s harder for them to integrate this into their practice, okay?

Dr. Kharrazian

“On the topics of autonomics and conditions with very expensive genetic testing, have you treated patients with suspected Ehlers-Danlos empirically once observing autonomic dysfunctions and other notable presentations? If so, have you seen this misdiagnosed?”

Dr. Brock

There’s a few Ehlers-Danlos patients out there, yeah. Most of them know it because their joints dislocate, yeah. Do people have autonomic problems that are misdiagnosed? Yeah. Is it misdiagnosed and it’s really a cardiac condition? Absolutely. Is there cardiac conditions that are really neurological conditions? Yes. I only ever have had one Ehlers-Danlos patient ever.

Dr. Kharrazian

I’ve never had one.

Dr. Brock

The one I had was like, he was cool. And they were there like, “Watch this.” k-k-k-k. I don’t… But it’s really a sad condition. I mean, it’s a genetic disorder of connective tissue. There’s not a ton that you’re going to do with it. You’re going to have to stabilize them, activate them, and make sure they have enough feedback to where they don’t get hypotensive, because they’re not activated. So there can be some problems and issues there. I’m not sure I’m answering the question, but anyway.

Dr. Kharrazian

“What kind of plastic change and/or gait abnormalities do you see in women who wear heels a lot? Any footwear you recommend for minimizing gait changes?”

Dr. Brock

This is a loaded… This is going to get us in trouble, right here.


Dr. Kharrazian

Let’s kick this one.

Dr. Brock

No, you know what? I really don’t… All I see is this: I see possible distal entrapments and sore feet and calluses sometimes, but a lot of times I see this: good style.

Dr. Kharrazian

I just don’t get it. Okay.

“For patients with a history of head trauma from sports injuries, like repeated minor trauma from playing football, who are currently asymptomatic or very mildly symptomatic, are there any screening or prophy-lactic therapeutic recommendations to avoid future deterioration?”

Dr. Brock

Well, I will say this: Your apoenzymes, if you’re E1, E1-E2, E2-E3, E3, you’re okay. If you’re E4, I wouldn’t play football. Personally. That can be screened. But other than that, it’s like this: Look, do a neurological exam. If your brain ain’t that great, and you’ve already had a couple of head injuries, don’t play contact sports. If your kid has had, or you have had a head injury, and you’re not recovering well, stop playing contact sports. If you need to wear something on your head to keep you from killing yourself, you might want to consider not playing that sport. I’m just saying: You’re at risk.

Dr. Kharrazian

Okay, last question.

“How do we assess mirror neurons prior to using mirror work to make sure we can use that pathway? Is it just mimicking movement for assessment? I can’t recall the assessment.”

Dr. Brock

This is actually a great question. We’re going to use mirror neurons a lot for speech, and we’re going to lose… Lose, we’ve already lost some mirror neuron’s I think. We’re going to use evaluation for mirror neurons. And mirror neurons are things that help people mimic, and help people do things, in order to reproduce function. So, I’ve used mirror neurons to get people the ability to speak that have lost Broca’s areas or have lost other speech-producing areas, or they’ve lost certain types of movements. So we may give them different types of exercises where they video themselves, and then watch themselves, and then visualize themselves, and then they can start to execute movement again. So I think that in all fairness, to not dilute this, we’ll give a pretty good breakdown when we start talking about treatment strategies, but it is pretty cool to use mirror neuron therapy for certain types of recreation of function, because they can help augment an area that just doesn’t do so well. And there’s a lot of different conditions where mirror neurons are dysfunctional or not there or not present or not working, and now the person doesn’t have the ability to emulate things or do things. They’ve even implicated this partially with autism and stuff like that.


Dr. Kharrazian

Okay. Well, thank you everyone for joining us for this session. We really appreciate you being here. Thank you for all those questions.

Dr. Brock

See you next time.

Dr. Kharrazian

Thank you.

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