Latest / Pharmacy Podcast Network / Function Junction: Functional Medicine in Pain Management with Dr. Lauren Castle | Pain Pod

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Function Junction: Functional Medicine in Pain Management with Dr. Lauren Castle | Pain Pod · Pharmacy Podcast Network

• 0:05
  Speaker 1: You are listening to the global network of podcasters dedicated
• 0:09
  Speaker 1: to the pharmacy profession. Welcome to the Pharmacy podcast Network.
• 0:21
  Speaker 2: This is the Pain Pod.
• 0:24
  Speaker 1: You want to see pain, look at me?
• 0:33
  Speaker 2: Welcome to the Pain Pod, the podcast for all things
• 0:38
  Speaker 2: pain management, hosted by the pain Guy.
• 0:42
  Speaker 3: Doctor Mark Grow.
• 0:47
  Speaker 2: We'll be collaborating with numerous pain management experts talking about
• 0:51
  Speaker 2: substance usage disorders, the latest treatment modalities and the most
• 0:56
  Speaker 2: important important focusing on the pain of our page and says.
• 1:00
  Speaker 1: Leading providers of pain care.
• 1:04
  Speaker 2: And now here's our host, a man wanted in all
• 1:08
  Speaker 2: fifty states, a suburban city like Mountain man without the beard,
• 1:15
  Speaker 2: from the hills of West Virginia and certified in weapons
• 1:20
  Speaker 2: of mass destruction response.
• 1:23
  Speaker 1: Yes, doctor Mark sorboy, all right, welcome back pain pod Nation.
• 1:32
  Speaker 1: Here today we have well hopefully another riveting episode for
• 1:36
  Speaker 1: all y'all to listen in to. But here at the
• 1:39
  Speaker 1: Pain Pod, we try and cover well everything when it
• 1:42
  Speaker 1: comes to pain management, and he even diving into a
• 1:45
  Speaker 1: couple other sectors you know, naturally, things like substance use disorder, addiction,
• 1:49
  Speaker 1: drug diversion prevention, and you know, whatever else is hitting
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  Speaker 1: the headlines these days. As far as casually or directly
• 1:57
  Speaker 1: related to pain management. So anyways, here today, this is
• 2:02
  Speaker 1: another one of the episodes where we actually have a guest,
• 2:04
  Speaker 1: so you're not stuck listening to pain Guy the whole time. Okay, rejoice, rejoice,
• 2:09
  Speaker 1: all right, and yes, proceed to the edge of your
• 2:11
  Speaker 1: seat if you're in a seat, No need for the
• 2:13
  Speaker 1: back of the seat here today. So today, okay, I
• 2:17
  Speaker 1: like to do the thing where we listen to people
• 2:20
  Speaker 1: active listening, right, and a lot of folks have been
• 2:24
  Speaker 1: asking questions, whether it's online, you know, social media, you know, connections, professionally,
• 2:29
  Speaker 1: you name it. A lot of folks want to know
• 2:32
  Speaker 1: more or at least an intro to functional medicine. So
• 2:38
  Speaker 1: today we're going to give you that source. Okay, turns
• 2:41
  Speaker 1: out there's a pretty decent aka a lot of pharmacists
• 2:44
  Speaker 1: that are involved in functional medicine these days. But you know,
• 2:48
  Speaker 1: where where do we get our sources from? Where can
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  Speaker 1: Pain pod Nation trust people? So we've got that for
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  Speaker 1: you here today. Okay, We've got doctor Lauren Cassele joining us.
• 2:58
  Speaker 1: She's actually a founder of the Functional Medicine Pharmacist Alliance
• 3:02
  Speaker 1: and a founder of the Psychedelic Pharmacist Association. So yes,
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  Speaker 1: she doesn't get bored either, and very grateful for your
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  Speaker 1: time here today Lauren as well. So welcome to the
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  Speaker 1: Pain Pod, Yankee.
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  Speaker 3: Market's an honor to be here.
• 3:17
  Speaker 1: Oh well, pleasures ours, pleasures are so whether you know
• 3:20
  Speaker 1: on the mic here or everyone listening, either way, the
• 3:23
  Speaker 1: pleasure is ours. So you know, before we dive into
• 3:26
  Speaker 1: this topic of functional medicine, and you know, the overlaps
• 3:30
  Speaker 1: with pharmacy and US pharmacists and quite frankly everyone in
• 3:34
  Speaker 1: healthcare and patients alike. By the way I'm hearing you, folks,
• 3:37
  Speaker 1: I know that a lot of patients and lay public
• 3:40
  Speaker 1: are listening to the Pain Pod these days. Quite frankly,
• 3:43
  Speaker 1: it makes a little bit tricky on the mic because
• 3:45
  Speaker 1: you know, we want to have our tricky medical terms,
• 3:48
  Speaker 1: but then we also want everyone listening in. So don't worry.
• 3:52
  Speaker 1: We'll keep that in mind in the background. But here today, Lauren,
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  Speaker 1: what I usually like to ask some guests is like, hey,
• 3:57
  Speaker 1: what's your story? Like what you know? Perhaps the professional side,
• 4:01
  Speaker 1: personal side as well too, but what's your story overall?
• 4:04
  Speaker 1: What does our audience need to know about you?
• 4:07
  Speaker 3: My story really started after I graduated from pharmacy school.
• 4:12
  Speaker 3: So I went to Ohio Northern University, Go Polar Bears,
• 4:15
  Speaker 3: graduated in twenty thirteen and decided to go work for
• 4:20
  Speaker 3: Walmart pharmacy. So when I first went to pharmacy school,
• 4:23
  Speaker 3: I actually thought I was going to open my own pharmacy,
• 4:26
  Speaker 3: but fell in love during pharmacy school, ended up moving
• 4:30
  Speaker 3: and had to get a new internship, and that is
• 4:32
  Speaker 3: how I found Walmart. So I then really enjoyed working
• 4:37
  Speaker 3: at Walmart and had gotten a job right after school
• 4:40
  Speaker 3: and kind of just thought I was going to be
• 4:42
  Speaker 3: working there until I you know, retired, climbing the corporate
• 4:47
  Speaker 3: ladder and earning my gold badge. But very quickly I
• 4:53
  Speaker 3: actually found myself in a new paths. So my husband
• 4:55
  Speaker 3: and I had moved back to Michigan, where I was
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  Speaker 3: originally from, and he was working in a big corporate
• 5:02
  Speaker 3: job as well, and just was having a lot of
• 5:04
  Speaker 3: health issues, you know, and we're in our like early
• 5:06
  Speaker 3: mid twenties at this point really should be like thriving
• 5:12
  Speaker 3: at you know, the peak of our lives. And I
• 5:16
  Speaker 3: couldn't quite put my finger on what was going on.
• 5:18
  Speaker 3: And I feel like a lot of listeners, might you know,
• 5:21
  Speaker 3: kind of resonate with this and maybe this might be
• 5:23
  Speaker 3: where some of their interest and functional medicine happens too.
• 5:25
  Speaker 3: But it was all these kind of non specific constellation
• 5:29
  Speaker 3: of symptoms, right, like brain fog and anxiety and trouble sleeping,
• 5:34
  Speaker 3: but then a lot of like sinus issues and congestion,
• 5:39
  Speaker 3: but then also gut issues, Like one day it's more
• 5:44
  Speaker 3: constipation related, other days it's like, oh man, what did
• 5:47
  Speaker 3: I eat and just not quite being able to figure
• 5:50
  Speaker 3: out a core, you know, single cause and from a
• 5:56
  Speaker 3: pharmacy lens, you know, I'm sort of working this up
• 5:59
  Speaker 3: in my mind. And of course we're starting with all
• 6:02
  Speaker 3: of the traditional non pharmacologic options right of any disease
• 6:07
  Speaker 3: state or any condition. Right, it's like, well, what's your
• 6:10
  Speaker 3: lifestyle like? And for the most part, we thought we
• 6:12
  Speaker 3: were eating and working out and doing all the right things. Right.
• 6:15
  Speaker 3: We were eating the whole wheat bread and the skim milk, right,
• 6:20
  Speaker 3: those are what the food pyramids said at the time,
• 6:23
  Speaker 3: which we also were trying to manage our stress, although
• 6:28
  Speaker 3: that's a little tricky when you're in a high pressure
• 6:31
  Speaker 3: corporate job. But outside of that, we were going to
• 6:34
  Speaker 3: the gym and yeah, it just seemed strange. So I
• 6:41
  Speaker 3: was like, okay, well, pharmacologically, then what are our options?
• 6:44
  Speaker 3: And that's when things started to seem not so great. Right, Sure,
• 6:47
  Speaker 3: we could treat some of the allergy things and maybe
• 6:51
  Speaker 3: do some flonaise and nasal spray or some saline rinses,
• 6:55
  Speaker 3: and of course there's all kinds of OTC things we
• 6:58
  Speaker 3: can use for g system, but we're kind of just
• 7:03
  Speaker 3: trying things and not really understanding what's the cause, what's
• 7:08
  Speaker 3: really going on under the surface. And then when it
• 7:12
  Speaker 3: comes to you know, some of the more anxiety and
• 7:15
  Speaker 3: sleep related things, Yeah, we've got things like melatonin or
• 7:19
  Speaker 3: you know, a little diifhenhydromene here and there. But when
• 7:23
  Speaker 3: you go into a doctor's office a lot of the
• 7:26
  Speaker 3: symptoms that he had, I was like, more likely than
• 7:28
  Speaker 3: that they might end up putting you on an antidepressant
• 7:32
  Speaker 3: or an SSRI, maybe even some xanax or ventormine. He
• 7:37
  Speaker 3: also was struggling with weight loss at the time, and yeah,
• 7:41
  Speaker 3: I was in Metro Detroit, so that was pretty standard
• 7:43
  Speaker 3: to have the xanax entering combination. But we got a
• 7:48
  Speaker 3: flyer in the mail one day and it was from
• 7:51
  Speaker 3: this Integrative Wellness center and it had all these symptoms
• 7:54
  Speaker 3: listed on it, and he had almost everyone. So I said, Okay,
• 7:58
  Speaker 3: I think it's a sign. I think maybe you should
• 8:01
  Speaker 3: go check this out and see what it's all about.
• 8:03
  Speaker 3: So he went to a seminar and in that seminar
• 8:07
  Speaker 3: they talked about this thing called functional medicine. So he
• 8:11
  Speaker 3: came home and was like, I think I'm gonna do this.
• 8:13
  Speaker 3: Like the doctor, who actually was a chiropractor, seemed really knowledgeable,
• 8:18
  Speaker 3: and you know, they have a whole twelve week program
• 8:21
  Speaker 3: you go through and they look at your diet and
• 8:24
  Speaker 3: all of these different blood tests, and they work with
• 8:27
  Speaker 3: these professional quality supplements. But I really just feel like
• 8:32
  Speaker 3: they actually treat you as a person. They really take
• 8:35
  Speaker 3: the time to get to know you, and they give
• 8:37
  Speaker 3: you a health coach and a nutritionist and they kind
• 8:39
  Speaker 3: of have this whole team approach to figure out what's
• 8:41
  Speaker 3: going on. And they don't just treat your symptoms. They
• 8:45
  Speaker 3: look at everything together to figure out what's happening underneath.
• 8:50
  Speaker 3: So we said, okay, let's try it. And at the time,
• 8:52
  Speaker 3: Cleveland Clinic was actually starting a center for functional medicine.
• 8:57
  Speaker 3: So me, being a pharmacist from a school in Ohio.
• 9:00
  Speaker 3: It's kind of like, all right, if Cleveland Clinic is
• 9:01
  Speaker 3: doing something, it's kind of a big deal. So we
• 9:06
  Speaker 3: begin this program and ultimately discover through these blood tests
• 9:13
  Speaker 3: that he has food sensitivities to things like gluten and dairy, which,
• 9:19
  Speaker 3: mind you, favorite snack was a PBNJ and a glass
• 9:22
  Speaker 3: of milk. So the very thing that he had been
• 9:26
  Speaker 3: consuming for his entire life as this sort of you know,
• 9:30
  Speaker 3: what we would think of as a decent snack was
• 9:34
  Speaker 3: actually the thing probably driving the most of the inflammatory process.
• 9:40
  Speaker 3: The other thing we discovered was he had something called
• 9:43
  Speaker 3: candida overgrowth in his gut microbiome. Now again as a pharmacist,
• 9:49
  Speaker 3: the only thing we really learned about candida and pharmacy
• 9:52
  Speaker 3: school and our idea or infectious disease module was that's
• 9:55
  Speaker 3: something that might happen. And what we say is an
• 9:58
  Speaker 3: immunocompromised patient someone who has a weekend immune system, maybe
• 10:02
  Speaker 3: due to a condition like HIV or AIDS, or due
• 10:06
  Speaker 3: to being on drugs that would suppress your immune system right,
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  Speaker 3: things like cancer, chemotherapy. I had never heard of a regular,
• 10:16
  Speaker 3: you know, normal person with no other main medical conditions
• 10:19
  Speaker 3: having something like candida causing outward symptoms. But the more
• 10:26
  Speaker 3: that I started to learn about the microbiome and the gut,
• 10:31
  Speaker 3: I started to realize, oh, there's a lot we didn't
• 10:34
  Speaker 3: learn in pharmacy school about this topic, at least not
• 10:37
  Speaker 3: in twenty thirteen when I graduated. So at that point
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  Speaker 3: I really just said, you know what, I think I
• 10:45
  Speaker 3: need to go back to school and learn how to
• 10:47
  Speaker 3: do this for myself because there's so much information here
• 10:51
  Speaker 3: that I just wasn't quite taught in how to think
• 10:55
  Speaker 3: this way. But also this works. Within just a few weeks,
• 11:00
  Speaker 3: all of the symptoms that he was struggling with completely
• 11:04
  Speaker 3: went away, and over the course of the twelve weeks,
• 11:07
  Speaker 3: he actually lost nearly twenty pounds. So what we really
• 11:11
  Speaker 3: discovered was driving a lot of these symptoms was inflammation.
• 11:16
  Speaker 3: So there's different markers you can look at for inflammation,
• 11:18
  Speaker 3: things like homocysteine and HSDRP, which sometimes you know, we'll
• 11:24
  Speaker 3: run those things in conventional medicine too, But we also
• 11:28
  Speaker 3: looked at genetics and figuring out if there were issues
• 11:31
  Speaker 3: with methylation. We looked at, you know, other just tests
• 11:37
  Speaker 3: in terms of hormone levels and kind of realizing that
• 11:40
  Speaker 3: some of his hormones were a little bit off too.
• 11:43
  Speaker 3: We looked at things like vitamin D, which, again we'll
• 11:45
  Speaker 3: run vitamin D, but oftentimes, you know, the question is, well,
• 11:49
  Speaker 3: what's truly an optimal level? Right? If someone's at thirty five, okay,
• 11:54
  Speaker 3: well maybe they're not technically deficient, but is that really optimized?
• 11:58
  Speaker 3: Is that really given our body enough to work with
• 12:02
  Speaker 3: to operate the highest level. So it just starts to
• 12:05
  Speaker 3: ask deeper questions and look at, you know, how can
• 12:08
  Speaker 3: we go from just being okay to really having the
• 12:13
  Speaker 3: best health that we can, you know, and looking at
• 12:16
  Speaker 3: the full picture. So that was the start of my
• 12:19
  Speaker 3: story and from there, you know, I went back to school,
• 12:23
  Speaker 3: did a master's degree in nutrition and functional medicine through
• 12:27
  Speaker 3: the University of Western States. I had some really cool
• 12:30
  Speaker 3: opportunities at Walmart to actually implement functional medicine with our
• 12:34
  Speaker 3: Walmart Health clinics. And when that project ended, it was
• 12:39
  Speaker 3: right when COVID happened. So you look back and sometimes
• 12:44
  Speaker 3: there's a silver lining to things and why the universe
• 12:47
  Speaker 3: maybe something didn't work out the way you thought it would.
• 12:51
  Speaker 3: But that moment was the time when I just decided that,
• 12:54
  Speaker 3: you know what, there's something really here, and I think
• 12:57
  Speaker 3: that more pharmacists are getting really excited about this field
• 13:00
  Speaker 3: and this possibility. Like you said, more patients, they're starting
• 13:03
  Speaker 3: to ask questions about it, and we don't really have
• 13:06
  Speaker 3: any good resources, particularly for pharmacists in the field of
• 13:10
  Speaker 3: functional medicine. Sure there are, you know, some other organizations
• 13:15
  Speaker 3: that are out there, groups like the Institute for Functional
• 13:17
  Speaker 3: Medicine or the American Academy of Anti Aging Medicine, and
• 13:21
  Speaker 3: lots of other ones that are online, but they're not
• 13:24
  Speaker 3: geared towards pharmacists. And you know, I had gone to
• 13:27
  Speaker 3: some of these conferences to kind of check it out,
• 13:29
  Speaker 3: and there weren't very many pharmacists who were there. Maybe
• 13:32
  Speaker 3: a couple compounding pharmacies that were, you know, trying to
• 13:35
  Speaker 3: generate some new business and offered services that were kind
• 13:39
  Speaker 3: of adjacent to or complementary to functional medicine, things like
• 13:42
  Speaker 3: hormone replacement therapy or compounding you know, certain medications. But
• 13:48
  Speaker 3: outside of that, most of these functional medicine practitioners kind
• 13:53
  Speaker 3: of turn their head sideways whenever you said you're a pharmacist,
• 13:56
  Speaker 3: because they're like, well, aren't you the people that put
• 13:58
  Speaker 3: people on drugs? So that really became the moment that
• 14:03
  Speaker 3: I said, Ah, we have our work cut out for
• 14:05
  Speaker 3: us here, and it's not going to be just me,
• 14:08
  Speaker 3: one person coming into this and kind of changing, you know,
• 14:12
  Speaker 3: the perception that people have of pharmacists. But it's going
• 14:16
  Speaker 3: to take all of us coming together and kind of
• 14:19
  Speaker 3: building this bridge between these two worlds, because at the
• 14:22
  Speaker 3: end of the day, you know a lot of people
• 14:24
  Speaker 3: kind of ask, well, what even is functional medicine? How
• 14:27
  Speaker 3: do you define it?
• 14:28
  Speaker 1: Right?
• 14:29
  Speaker 3: And I think that's an important question to ask. It's
• 14:31
  Speaker 3: really what we call looking for the root cause of
• 14:34
  Speaker 3: chronic disease and not just treating a symptom with a medication,
• 14:41
  Speaker 3: but actually digging deeper and understanding the things that led
• 14:45
  Speaker 3: up to that patient presenting with whatever constellation of symptoms
• 14:50
  Speaker 3: and you know, diagnosis and disease states that they have,
• 14:55
  Speaker 3: and looking at it through a more holistic lens, through
• 14:58
  Speaker 3: the physical and not just basic physiology, but really the
• 15:04
  Speaker 3: biochemical imbalances that happen, you know, how all of these
• 15:08
  Speaker 3: different organ systems talk to each other and overlap. But
• 15:12
  Speaker 3: then we also look at the mental health, the emotional health,
• 15:17
  Speaker 3: and even the spiritual health, and so it's truly a
• 15:22
  Speaker 3: complete system and something that I think complements the role
• 15:26
  Speaker 3: of the pharmacist really nicely, because it's very similar to
• 15:31
  Speaker 3: the pharmacist patient care process. If you actually look at
• 15:33
  Speaker 3: the you know, fancy little diagrams for each one, there's
• 15:37
  Speaker 3: a lot of overlap there. So I think that's encouraging
• 15:40
  Speaker 3: for us as pharmacists. You know, we're starting to enter
• 15:43
  Speaker 3: into more roles that aren't just putting pills in a bottle.
• 15:47
  Speaker 3: That's never what we were designed to do. And when
• 15:51
  Speaker 3: we start to get pharmacists out from just being behind
• 15:54
  Speaker 3: the counter and really integrated into the care team, into
• 15:57
  Speaker 3: the clinics, or even working to directly with patients as
• 16:01
  Speaker 3: a consultant on their healthcare team, we can start to
• 16:05
  Speaker 3: see these patterns. We can start to see, you know,
• 16:09
  Speaker 3: particularly you know, the area of our expertise, which is
• 16:13
  Speaker 3: things like polypharmacy or drug interactions, maybe even drug nutrient depletions,
• 16:20
  Speaker 3: some of which we learn in pharmacy school, but often
• 16:23
  Speaker 3: do we actually do anything about them, or do we
• 16:25
  Speaker 3: just say that's just theoretical. But when you start to
• 16:29
  Speaker 3: put all the pieces together and you really look at
• 16:31
  Speaker 3: it in context, you could see how maybe one small
• 16:36
  Speaker 3: drug interaction or drug nutrient depletion really could make a
• 16:39
  Speaker 3: big difference and potentially be that straw that breaks the
• 16:43
  Speaker 3: camel's back, so to speak.
• 16:45
  Speaker 1: It escalates quickly, right, and it's one little thing. So
• 16:50
  Speaker 1: one of the I think the nuggets or pearls you
• 16:52
  Speaker 1: added in there, Laura, was the I think the million
• 16:55
  Speaker 1: dollar question that so many people ask pharmacists, healthcare professionals, anyone,
• 17:01
  Speaker 1: you know, is like, what is functional medicine? I think,
• 17:04
  Speaker 1: you know, perhaps you articulated that very well, of that
• 17:07
  Speaker 1: bigger picture root cause analysis. I even heard maybe a
• 17:12
  Speaker 1: sprinkling worded differently of the biopsychosocial model of health. A
• 17:17
  Speaker 1: lot of times I can concentrate within the pain management realm,
• 17:19
  Speaker 1: of course, but looking at the big picture, you know,
• 17:24
  Speaker 1: we really it's very patient centered, as you mentioned, like
• 17:27
  Speaker 1: the patient care FARMS's patient care process, but you know,
• 17:32
  Speaker 1: it's really that root cause while looking at the larger
• 17:35
  Speaker 1: picture overall, and that's very important for people to understand,
• 17:40
  Speaker 1: of course and wrap their heads around. So you know,
• 17:44
  Speaker 1: when we're talking about functional medicine, yourself and many others
• 17:49
  Speaker 1: I alluded to earlier, many pharmacists have really you know,
• 17:53
  Speaker 1: taken the dive headfirst into the realm of functional medicine.
• 17:55
  Speaker 1: So having been there, what would you say makes it
• 18:01
  Speaker 1: so provocative? Like what is it that's driving the forest?
• 18:05
  Speaker 1: I think you had a couple sprinkles of the idea earlier,
• 18:08
  Speaker 1: But what would you say there?
• 18:11
  Speaker 3: You know, I think for pharmacists, we're getting tired, to
• 18:14
  Speaker 3: be honest, we're tired of being in the same practice
• 18:18
  Speaker 3: settings that we just feel limited by what we're truly
• 18:21
  Speaker 3: able to do in order to help our patients. You know,
• 18:25
  Speaker 3: for me, when I was working in the pharmacy, I'd
• 18:28
  Speaker 3: have patients coming up to me, you know, getting the
• 18:31
  Speaker 3: same medications month after month, and of course we were
• 18:35
  Speaker 3: instructed to well try to switch them to a ninety
• 18:38
  Speaker 3: day supply. Right. We were doing things like working on
• 18:40
  Speaker 3: outcomes MTM, which I was very excited about, right Like
• 18:43
  Speaker 3: I had done the APHA certificate in MTM, and I
• 18:46
  Speaker 3: felt like this was a way to have a more
• 18:48
  Speaker 3: clinical impact on our patients. But once I really got
• 18:53
  Speaker 3: into the functional medicine space, you know, you start looking
• 18:56
  Speaker 3: at some of these programs that feel very clinical on
• 19:01
  Speaker 3: the surface, like you're really making a difference, But then
• 19:04
  Speaker 3: you start to look at the individual patient, and I
• 19:08
  Speaker 3: felt like, really it was just trying to submit these
• 19:11
  Speaker 3: claims in a sense of like, oh, yeah, we'll just
• 19:13
  Speaker 3: switch them to a ninety day supply and just make
• 19:16
  Speaker 3: sure they're on all of these extra medications, you know,
• 19:19
  Speaker 3: and some of them are indicated, right, maybe it's a
• 19:21
  Speaker 3: statin and a patient with diabetes, or you're looking for
• 19:24
  Speaker 3: any inhibitor. But at the same time, there's no question of, well,
• 19:29
  Speaker 3: for how long and at what point a patient actually
• 19:34
  Speaker 3: gets better and we could reverse their diabetes, could we
• 19:39
  Speaker 3: take them off these medications, could we actually use less medication?
• 19:45
  Speaker 3: That's never the question that comes up in these sort
• 19:49
  Speaker 3: of MTM models, at least in the way that they're
• 19:54
  Speaker 3: done in most community of pharmacies. There's no incentive to
• 19:59
  Speaker 3: reverse someone's chronic disease state in the pharmaceutical model because
• 20:03
  Speaker 3: we don't get paid for that, and that, whether we
• 20:08
  Speaker 3: recognize it and we verbalize that or not, is actually
• 20:12
  Speaker 3: creating a sort of fracture in what we actually came
• 20:17
  Speaker 3: to be pharmacists for and how we're actually being incentivized
• 20:21
  Speaker 3: to operate and work. So that was what got me
• 20:26
  Speaker 3: like really fired up about this, is like we need
• 20:28
  Speaker 3: a new model to practice at the top of our
• 20:31
  Speaker 3: license and to actually help patients get better. Right, I
• 20:36
  Speaker 3: could sit there and tell someone like, hey, I can
• 20:39
  Speaker 3: see inside your grocery cart, just you know, just in
• 20:41
  Speaker 3: case you didn't know, and you're picking up your medication
• 20:46
  Speaker 3: for you know, your diabetes and your cholesterol medication, and
• 20:51
  Speaker 3: we need to have a conversation here because this medication
• 20:55
  Speaker 3: can only do so much. But the things in your
• 20:58
  Speaker 3: cart that you're bringing home to feed your family and
• 21:01
  Speaker 3: to feed yourself, they're fueling the disease state. And so
• 21:07
  Speaker 3: we're just covering up a symptom with this medication rather
• 21:13
  Speaker 3: than really looking at treating the root cause, which in
• 21:16
  Speaker 3: this case might be someone's diet, it might be their genetics,
• 21:22
  Speaker 3: it might be you know, other lack of activities. But
• 21:28
  Speaker 3: oftentimes as well, that doesn't go very far to tell someone, oh,
• 21:33
  Speaker 3: well you just need to eat less and exercise more. Right,
• 21:37
  Speaker 3: every patient has heard that. And if it were easy. Yeah,
• 21:41
  Speaker 3: if it were that simple, we'd all look like supermodels,
• 21:44
  Speaker 3: wouldn't we. But that is, you know, to your point,
• 21:48
  Speaker 3: the biopsychosocial model, it's understanding someone's motivations. I'm a big
• 21:52
  Speaker 3: fan of motivational interviewing, and I think that that complements
• 21:58
  Speaker 3: the functional medicine approach really well and understanding like what
• 22:02
  Speaker 3: is someone's motivation to live a healthier lifestyle, you know.
• 22:06
  Speaker 3: And I think a great example, it's like we're on
• 22:09
  Speaker 3: the pain pod, right. Pain pain actually can be one
• 22:14
  Speaker 3: of the biggest motivators, whether it's physical pain, you know,
• 22:19
  Speaker 3: we see this a lot with people who have you know,
• 22:22
  Speaker 3: whether it's something like IBS and they're getting these sort
• 22:24
  Speaker 3: of like debilitating you know, cramps and gas and bloating
• 22:29
  Speaker 3: and you know, all of these sort of like gut pain,
• 22:34
  Speaker 3: or it could be inflammatory pain, something like arthritis or
• 22:39
  Speaker 3: you know, rheumatoid arthritis. And we know that there is
• 22:44
  Speaker 3: a link there with all of these types of autoimmune diseases.
• 22:49
  Speaker 3: There's a link to your gut health. And so what
• 22:53
  Speaker 3: you eat actually does matter and it plays a difference.
• 22:56
  Speaker 3: And what if what you eat could actually lower your
• 23:00
  Speaker 3: pain levels, would that be enough of a motivator to say, hmm,
• 23:05
  Speaker 3: maybe I should put down the sugar, Maybe I should
• 23:08
  Speaker 3: put down you know, the inflammatory oils, and maybe I
• 23:12
  Speaker 3: should actually start picking up some fresh food and healthy
• 23:15
  Speaker 3: food and olive oil and polyphenols and things that we
• 23:19
  Speaker 3: have data on to support that this anti inflammatory way
• 23:25
  Speaker 3: of eating can actually lower your symptoms of pain.
• 23:31
  Speaker 1: I can't even count the amount of times of patient
• 23:33
  Speaker 1: it's not one hundred percent, but the very high persige
• 23:37
  Speaker 1: that people would say, sign me up. It's I feel
• 23:41
  Speaker 1: like disclosing any bias here. The growth leat vineyard over
• 23:44
  Speaker 1: in Italy actually also makes olive oil. I find it delightful.
• 23:48
  Speaker 1: The only way that I know of to get my
• 23:50
  Speaker 1: hands on it is to call cousin g and Luca
• 23:52
  Speaker 1: or actually email and have that sent to me. But
• 23:55
  Speaker 1: that's not what everyone has to do, right there are
• 23:58
  Speaker 1: relatively easier solutions that are out there, you know, part
• 24:01
  Speaker 1: of the grander scope, you know, to your point one
• 24:05
  Speaker 1: thing you mentioned Laura, there was you know, kind of
• 24:08
  Speaker 1: the specific things with you know, the patient perspective. Any
• 24:11
  Speaker 1: you know, can you think of any like particular patient
• 24:14
  Speaker 1: scenarios that come to mind that you know really would
• 24:18
  Speaker 1: be good examples of illustrating how functional medicine could help patients,
• 24:22
  Speaker 1: particularly patients and pain. But you know, really, any anything
• 24:25
  Speaker 1: come to mind?
• 24:27
  Speaker 3: Yeah, I had a patient that had sory artic soriatic arthritis,
• 24:33
  Speaker 3: and you know, she came to our pharmacy and she
• 24:36
  Speaker 3: was getting started on I think it was methatrexiate at
• 24:38
  Speaker 3: the time, and she was like, I'm really nervous about this,
• 24:43
  Speaker 3: you know, like, yeah, my my whole body hurts. I'm
• 24:47
  Speaker 3: constantly in pain, and I just feel so helpless and hopeless,
• 24:51
  Speaker 3: you know that, Like now I have to start this medication,
• 24:54
  Speaker 3: and you know, I'm really worried about side effects. I'm
• 24:58
  Speaker 3: worried about what it's going to do to my other tissues.
• 25:03
  Speaker 3: You know. It's like I've read all the scary warnings
• 25:05
  Speaker 3: on it and all the things, and I just I
• 25:09
  Speaker 3: don't know what else to do. I guess I just
• 25:11
  Speaker 3: trust the doctors, right, and I just take this medicine
• 25:14
  Speaker 3: and hope that it works. And you know, for me,
• 25:17
  Speaker 3: when I was in that practice setting, I really like
• 25:20
  Speaker 3: to recommend books. I think books are a great way
• 25:23
  Speaker 3: that I can give a patient a lot of information
• 25:26
  Speaker 3: and go way more in depth than what I might
• 25:28
  Speaker 3: have time to do in that five to fifteen minute consultation.
• 25:31
  Speaker 3: And so there's actually a book that I had read
• 25:34
  Speaker 3: specifically on, you know, an anti inflammatory diet approach to
• 25:38
  Speaker 3: soiatic arthritis. It's called The keystone approach, and it sort
• 25:41
  Speaker 3: of dives more into the physiology of autoimmune diseases and
• 25:45
  Speaker 3: that sort of gut component to these conditions, and you know,
• 25:51
  Speaker 3: the environmental factors that can also make a difference as
• 25:55
  Speaker 3: well as some of the genetic things. And I think
• 25:57
  Speaker 3: when we say genetics, a lot of times patients feel discouraged, right,
• 26:01
  Speaker 3: because that feels like something that we can't change, that
• 26:03
  Speaker 3: we're just born with it. We're going to have to
• 26:05
  Speaker 3: live with it, and if it killed our grandparents, our grandparents,
• 26:08
  Speaker 3: it's probably going to kill us too. And that's actually
• 26:11
  Speaker 3: not the case. So there's a lot more information and
• 26:14
  Speaker 3: research coming out about the field of epigenetics, which is
• 26:18
  Speaker 3: how our genes are influenced by the food that we
• 26:23
  Speaker 3: eat and the environment that we live in and our
• 26:25
  Speaker 3: stress levels. Right, it's sort of like this little on
• 26:28
  Speaker 3: off switch on our genes that change how they are expressed.
• 26:33
  Speaker 3: So certainly we might be born with our genetics as
• 26:36
  Speaker 3: they are, but the way they're expressed can be influenced
• 26:40
  Speaker 3: by our own choices, and that to me is empowering.
• 26:44
  Speaker 1: Right.
• 26:44
  Speaker 3: If there's something I can do, tell me, I want
• 26:47
  Speaker 3: to know, I want to be involved. I don't want
• 26:50
  Speaker 3: to just accept my fate or my destiny. I want
• 26:53
  Speaker 3: to help myself, you know, I want to live the
• 26:56
  Speaker 3: best life that I can. So I gave her that
• 26:58
  Speaker 3: recommendation to check out that book, and she came back
• 27:02
  Speaker 3: to me a week later with the book in hand
• 27:04
  Speaker 3: and a whole bunch of supplements that she, you know,
• 27:08
  Speaker 3: had had read about in the book. Things like probiotics,
• 27:12
  Speaker 3: things like magnesium, things like omega threes. Right, all of
• 27:16
  Speaker 3: these these nutrients that can actually support our physiology that
• 27:22
  Speaker 3: if we're not getting them from food alone, that it
• 27:26
  Speaker 3: may be helpful to supplement with. And so this is
• 27:30
  Speaker 3: a key place that pharmacists can really start to help
• 27:34
  Speaker 3: guide our patients, you know, making sure that they're actually
• 27:38
  Speaker 3: getting good quality supplements, not necessarily just something they found
• 27:41
  Speaker 3: on Amazon that might have been sitting in a warehouse
• 27:44
  Speaker 3: cooking at one hundred degrees, you know, or coming from
• 27:48
  Speaker 3: you know, a country, or from a company that doesn't
• 27:53
  Speaker 3: have any third party testing. There's unfortunately, I use tumoric
• 27:57
  Speaker 3: as a great example, that's often seen as an anti
• 28:00
  Speaker 3: inflammatory herb, but there were studies done that a very
• 28:04
  Speaker 3: large portion of the tumoric supplements out there in the
• 28:06
  Speaker 3: world were actually contaminated with lead. So third party testing
• 28:12
  Speaker 3: of supplements is very important in something that pharmacists have
• 28:15
  Speaker 3: an opportunity to really talk to their patients about. So
• 28:19
  Speaker 3: we had that discussion. You know, we looked at the
• 28:21
  Speaker 3: things that she brought in, if they made sense for her,
• 28:23
  Speaker 3: if there are any interactions with her medications, and we
• 28:26
  Speaker 3: talked about you know, sources of food that could also
• 28:30
  Speaker 3: help to bring some of these extra nutrients into her diet.
• 28:34
  Speaker 1: Wonderful and it's you know, it's really just getting to
• 28:38
  Speaker 1: that bigger picture overall. And on the flip side, of course,
• 28:41
  Speaker 1: the root cause analysis. Are there any you know, in
• 28:45
  Speaker 1: your experience, you know, working through functional medicine with patients,
• 28:49
  Speaker 1: particularly in the pain management sector, are there any you
• 28:53
  Speaker 1: know root causes the things that come up, any consistencies
• 28:57
  Speaker 1: that you see in you know, for our patients and pain,
• 29:00
  Speaker 1: anything strike you there.
• 29:02
  Speaker 3: Yeah. I think inflammation is probably the biggest driver. And
• 29:06
  Speaker 3: inflammation can have a lot of different causes. Right, A
• 29:09
  Speaker 3: lot of times we just think about, you know, inflammation
• 29:12
  Speaker 3: in the acute setting, right, if someone breaks a bone,
• 29:16
  Speaker 3: then yes, it's going to get red, it's going to
• 29:18
  Speaker 3: get swollen, it's going to be throbbing, it's going to
• 29:22
  Speaker 3: have you know, all of these you know, cido kinds
• 29:26
  Speaker 3: and things that are being recruited to help heal. Right,
• 29:30
  Speaker 3: So our inflammation can actually be a healing process in
• 29:34
  Speaker 3: the short term in the acute setting. That's what our
• 29:38
  Speaker 3: bodies are designed to do. They're actually very smart in
• 29:41
  Speaker 3: this way. But on the flip side, what we find
• 29:45
  Speaker 3: in the functional medicine lens is what we call chronic inflammation.
• 29:49
  Speaker 3: And a lot of times it's you know, often described
• 29:52
  Speaker 3: as being low grade inflammation. You're not going to notice it.
• 29:56
  Speaker 3: It's actually very insidious, meaning that it's sort of hidden.
• 30:01
  Speaker 3: You're not necessarily going to see it in the way
• 30:03
  Speaker 3: that you would see acute inflammation. You might not even
• 30:07
  Speaker 3: really feel it per se because it's chronic, right, and
• 30:12
  Speaker 3: in a sense, you kind of get used to it.
• 30:15
  Speaker 3: So a lot of times people will come in seeking
• 30:18
  Speaker 3: a functional medicine approach and it's like, well, how do
• 30:21
  Speaker 3: you feel, you know, what's your energy level like? And
• 30:23
  Speaker 3: they're like, oh, I'm tired all the time, right, and
• 30:27
  Speaker 3: I'm a little achy, and you know, I guess I
• 30:31
  Speaker 3: feel fine though, And it's like, wait a second, if
• 30:36
  Speaker 3: you feel tired and achy. That to you is fine,
• 30:41
  Speaker 3: So we almost we lose sight of like, well, hey,
• 30:44
  Speaker 3: when was the last time you actually felt really well?
• 30:48
  Speaker 3: When was the last time that you felt amazing? When
• 30:52
  Speaker 3: was the last time you felt healthy and strong? And
• 30:56
  Speaker 3: then people start to kind of put this timeline together.
• 30:59
  Speaker 3: And that's what our goal is with the functional medicine
• 31:02
  Speaker 3: approach is kind of mapping out this timeline to illustrate
• 31:06
  Speaker 3: for people where things started to kind of go off
• 31:10
  Speaker 3: the tracks a little bit, and how do we get
• 31:13
  Speaker 3: back on track, right? How do we get back to
• 31:16
  Speaker 3: what we think of as health as a positive vitality,
• 31:22
  Speaker 3: not just the absence of disease, but actually feeling healthy.
• 31:29
  Speaker 3: So we look at things like inflammation, both acute and chronic,
• 31:33
  Speaker 3: you know, and that can come from things like metabolic
• 31:37
  Speaker 3: dysfunction that can come from you know, diet or insulin resistance.
• 31:42
  Speaker 3: Sleep is a huge one. If we're not getting enough sleep,
• 31:45
  Speaker 3: our body physically can't repair our tissues properly. If we
• 31:50
  Speaker 3: have environmental exposures. Right, I mentioned things like lead, But
• 31:57
  Speaker 3: at the end of the day, you know, there's all
• 32:00
  Speaker 3: these different lifestyle factors that play into it, and the
• 32:03
  Speaker 3: food that plays into it, but we really have to
• 32:07
  Speaker 3: look even deeper sometimes, so we look at things like
• 32:11
  Speaker 3: their gut health and the microbiome. So our microbiome is
• 32:17
  Speaker 3: really a big player in our immune system and in
• 32:21
  Speaker 3: that inflammatory process. So this was really the case for
• 32:24
  Speaker 3: my husband that I mentioned, right. What we didn't know
• 32:28
  Speaker 3: is that what was going on his microbiome was actually
• 32:31
  Speaker 3: causing a lot of these other symptoms that he was
• 32:34
  Speaker 3: having with this sort of inflammation. And there's a big
• 32:39
  Speaker 3: link right now between the gut and the brain, right,
• 32:42
  Speaker 3: we call it the gut brain connection or the gut
• 32:44
  Speaker 3: brain axis, and how that actually can have an effect
• 32:51
  Speaker 3: on your mood and how you feel, but that can
• 32:54
  Speaker 3: also really have an effect on your pain. Right, Things
• 32:58
  Speaker 3: like food sensitivity could amplify someone's pain perception, Things like
• 33:04
  Speaker 3: dysbiosis could actually cause neuroinflammation, right. And so I like
• 33:10
  Speaker 3: to think about conditions where this is very prominent, Things
• 33:13
  Speaker 3: like fibromyalgia, that is a huge one. Things like migraines.
• 33:19
  Speaker 3: Migraines often have food triggers, autoimmune pain we've talked about
• 33:25
  Speaker 3: that one, IBS or you know, other digestive disorders, and
• 33:30
  Speaker 3: even arthritis, like all of these can have a gut
• 33:34
  Speaker 3: related component to them.
• 33:38
  Speaker 1: And that's you know, it becomes so incredibly impactful for
• 33:42
  Speaker 1: our patients. It's you know, it starts with that listening
• 33:45
  Speaker 1: and getting to those root causes along the way, and
• 33:48
  Speaker 1: then just knowing, you know, if all of us pharmacists
• 33:51
  Speaker 1: are not knee deep and expertise when it comes to
• 33:54
  Speaker 1: functional medics in the big picture, it's you know, knowing
• 33:57
  Speaker 1: who to reach out to and hey, now everyone has
• 33:59
  Speaker 1: a connection, right, But you know, kind of more on
• 34:03
  Speaker 1: the fly though. I appreciate you, you know, diving deeper
• 34:07
  Speaker 1: there into the roles within nutrition, inflammation, you name it,
• 34:11
  Speaker 1: particularly for our patients and pain. You also mentioned the
• 34:15
  Speaker 1: idea there of you know, supplements come into play, so
• 34:19
  Speaker 1: you know, bigger picture, there's supplements, there's wellness trends, health advice,
• 34:24
  Speaker 1: you know, opinions or my one sister in law calls
• 34:26
  Speaker 1: the personal facts. There are a dime a dozen and
• 34:29
  Speaker 1: you know, by twelve get twenty five free. But how
• 34:33
  Speaker 1: would you recommend that our our you know, our pain
• 34:35
  Speaker 1: pod listeners distinguish evidence based, your evidence informed functional medicine
• 34:40
  Speaker 1: approaches from any of the potential and obvious misinformation that's
• 34:46
  Speaker 1: out there, Like how do you recommend going about that?
• 34:49
  Speaker 3: I think that's a great question and something that you know,
• 34:53
  Speaker 3: whenever I started out in this, I was super skeptical, right,
• 34:56
  Speaker 3: I was like, how do I know that these tests
• 34:59
  Speaker 3: are validated? You know that this makes sense? And a
• 35:04
  Speaker 3: lot of times in the functional medicine space, you know,
• 35:07
  Speaker 3: we don't have huge randomized, double blind plus de boat
• 35:11
  Speaker 3: controlled studies on the effectiveness of every single supplement you
• 35:17
  Speaker 3: know on the market. But what we do have is
• 35:21
  Speaker 3: the stories from our patients of does this work? And
• 35:25
  Speaker 3: I think that honestly has to be looked at first
• 35:30
  Speaker 3: and foremost, right, whenever a patient is telling us that
• 35:33
  Speaker 3: something is working for them, just because we don't have
• 35:36
  Speaker 3: a study that says, you know, this works for everyone,
• 35:40
  Speaker 3: it doesn't mean that we should just say, well, there's
• 35:41
  Speaker 3: not enough evidence for you to continue taking that. Like
• 35:45
  Speaker 3: the power of the patient is really the key focus here.
• 35:50
  Speaker 3: But I think from a proactive standpoint, right, we can
• 35:53
  Speaker 3: look at different interventions that are evidence based, right, things
• 35:59
  Speaker 3: that mechanistically makes sense. I think that's where we really shine. Right.
• 36:05
  Speaker 3: We have this knowledge of biochemistry and physiology and we
• 36:10
  Speaker 3: can really look at something and say, well, why would
• 36:14
  Speaker 3: this make sense that it would work for this patient
• 36:17
  Speaker 3: and look at it through that lens. And more and
• 36:21
  Speaker 3: more there are studies that are starting to come out
• 36:25
  Speaker 3: right to sort of prove and validate the effect that
• 36:29
  Speaker 3: functional medicine has. I mentioned Cleveland Clinic. They've done several
• 36:32
  Speaker 3: studies comparing the functional medicine approach to just what was
• 36:36
  Speaker 3: sort of the standard of care and finding that, hey,
• 36:39
  Speaker 3: you know what, we're actually having better outcomes in terms
• 36:42
  Speaker 3: of like their promise ten, which is sort of like
• 36:44
  Speaker 3: a global rating scale of symptoms. We're seeing more patient satisfaction. Right.
• 36:52
  Speaker 3: These quality of life measures, I think are where we're
• 36:56
  Speaker 3: really having the best sort of evidence for how these
• 36:59
  Speaker 3: things work. But also, you know, again it's it's very
• 37:04
  Speaker 3: individualized as well, and so what works for one patient
• 37:08
  Speaker 3: might not work for another patient. I think that's another
• 37:10
  Speaker 3: area that from a conversation standpoint, we can really talk
• 37:14
  Speaker 3: about with our patients, you know, and making sure that
• 37:18
  Speaker 3: we want to look at this as sort of that
• 37:21
  Speaker 3: bridge between the pharmacy side, the medical side, what we
• 37:26
  Speaker 3: understand the evidence base for it, and then what we're
• 37:30
  Speaker 3: learning about things like the microbiome or mitochondrial dysfunction. This
• 37:35
  Speaker 3: is like a huge one that I think we can
• 37:37
  Speaker 3: all really nerd out on, right, because sure we learned
• 37:40
  Speaker 3: the crub cycle back in the day, but did we
• 37:42
  Speaker 3: ever think we would really have to use it. Probably not. Well,
• 37:46
  Speaker 3: now we're actually starting to learn just how much mitochondria
• 37:50
  Speaker 3: actually drive not just our energy levels but our overall health.
• 37:56
  Speaker 3: Things like the cell danger response. You know, these these
• 37:59
  Speaker 3: are the types of conversations that we're having in the
• 38:01
  Speaker 3: functional medicine realm that might not be showing up in
• 38:04
  Speaker 3: your everyday, average pharmacy conference, but trust me, in five
• 38:09
  Speaker 3: or ten years they will be. That oftentimes is sort
• 38:12
  Speaker 3: of the trajectory that we see from the functional medicine lenses.
• 38:15
  Speaker 3: We're looking at some of the early research in things
• 38:18
  Speaker 3: and figuring out how it's going to apply in patient care.
• 38:22
  Speaker 3: So this is very relevant for you know, things like
• 38:26
  Speaker 3: long COVID patients who were really struggling with these sort
• 38:30
  Speaker 3: of chronic fatigue or inflammatory conditions. And we're finding now
• 38:36
  Speaker 3: that you know, if our cells physically don't have enough
• 38:40
  Speaker 3: energy to actually work optimally, then that is where we
• 38:45
  Speaker 3: struggle to have repair in our tissues or to regulate information.
• 38:49
  Speaker 3: And how do our mitochondria work, Like what are the
• 38:53
  Speaker 3: things that drive them, right, And it is the nutrient
• 38:56
  Speaker 3: status right, it's the magnesium, it's COQ ten threes, things
• 39:01
  Speaker 3: like creating, right, and actually creating is one of the
• 39:03
  Speaker 3: most studied substances in the entire world. And actually was
• 39:07
  Speaker 3: just listening to Brandon Welch's podcast with you just before this,
• 39:11
  Speaker 3: and you know, I think that's like a great example
• 39:13
  Speaker 3: of you know, another crossover into a space or a
• 39:17
  Speaker 3: field where we're kind of doing the research as we're
• 39:23
  Speaker 3: working with patients. It's it's this sort of end of
• 39:25
  Speaker 3: one experiment to figure out, well, what things are going
• 39:29
  Speaker 3: to be appropriate for the patient that is right in
• 39:31
  Speaker 3: front of us.
• 39:34
  Speaker 1: Wonderful to hear that. It's you know, there's that delicate
• 39:37
  Speaker 1: balance of the safety and the efficacy. Of course, we
• 39:40
  Speaker 1: want more, we always all healthcare professionals. We want more
• 39:43
  Speaker 1: and more and more when it comes to randomized control trials,
• 39:46
  Speaker 1: we also have to work with what we have, right.
• 39:49
  Speaker 1: You know, we all live through times not that long
• 39:51
  Speaker 1: ago really, of you know, not having data but having
• 39:54
  Speaker 1: to proceed, and it springs up a lot for folks. Right. Also,
• 39:59
  Speaker 1: by the way, I kind of feel scene when you're
• 40:00
  Speaker 1: talking about the old minochondria there and energy and I'm
• 40:03
  Speaker 1: like sitting here with the coffee in my hand, and
• 40:06
  Speaker 1: luckily there's not a mirror. I'd be looking into it
• 40:08
  Speaker 1: into my pupil, searching my soul of who am I
• 40:10
  Speaker 1: doing this right? Because you know what it comes down
• 40:13
  Speaker 1: to it we got to check ourselves here too, So
• 40:17
  Speaker 1: and you know what on that note, so you know,
• 40:20
  Speaker 1: as we've talked about, and you emphasize, really, you know,
• 40:22
  Speaker 1: functionial medicine goes into a lot of different factors, the
• 40:25
  Speaker 1: nutrition and the inflammation, sleep, stress, movement, gut health. I
• 40:29
  Speaker 1: appreciate you mentioned the old axis there by the way
• 40:32
  Speaker 1: those of us listening, and that includes me right now.
• 40:34
  Speaker 1: You know, if we could just make one or two
• 40:37
  Speaker 1: practical changes today to improve our overall wellness in the
• 40:41
  Speaker 1: big picture, perhaps that of our patients as well too,
• 40:44
  Speaker 1: what would you recommend first?
• 40:46
  Speaker 3: You had to pick one, honestly, sleep. I think sleep
• 40:50
  Speaker 3: is a foundation and I know for me personally. You know,
• 40:53
  Speaker 3: I mentioned my husband as the sort of genesis for
• 40:56
  Speaker 3: my journey into functional medicine, but I went through my
• 40:59
  Speaker 3: own healing jurney as well, and it was during COVID
• 41:03
  Speaker 3: whenever I was completely burnout, burning the candle at every end. Right,
• 41:07
  Speaker 3: I was working in a market director job. I was
• 41:12
  Speaker 3: overseeing twelve stores. I was driving all over the state
• 41:15
  Speaker 3: of Ohio, hauling COVID vaccines all over the place. But
• 41:19
  Speaker 3: on the flip side, I was still running my organization
• 41:21
  Speaker 3: at night and trying to build you know, this this
• 41:24
  Speaker 3: whole movement of functional medicine pharmacists. And I was caregiving
• 41:29
  Speaker 3: for my mom, who you know, we didn't get into
• 41:31
  Speaker 3: talking about addiction in this particular episode today, but my
• 41:35
  Speaker 3: mom struggled with alcohol addiction her whole life and ultimately
• 41:38
  Speaker 3: ended up passing away from cirrhosis. And you know, trying
• 41:43
  Speaker 3: to balance all of that plus just take care of
• 41:46
  Speaker 3: my own health, something had to give. And so, you know,
• 41:51
  Speaker 3: after my mom passed away, I sort of took a
• 41:54
  Speaker 3: step back, and thankfully, you know, I recommend every pharmacist
• 41:57
  Speaker 3: if you're employed by you know, a company or a
• 42:00
  Speaker 3: or a university, you have resources available to you. They're
• 42:04
  Speaker 3: called benefits for a reason. You should use them. And
• 42:09
  Speaker 3: I always give so much credit to my boss because
• 42:12
  Speaker 3: she saw me as a person, not just an employee,
• 42:15
  Speaker 3: and she recognized that I was struggling, and I was
• 42:17
  Speaker 3: burning out and I needed a break. So I took
• 42:21
  Speaker 3: ten weeks of FMLA and I actually went into an
• 42:24
  Speaker 3: intensive outpatient program myself for depression and anxiety. And you know,
• 42:31
  Speaker 3: in those ten weeks, I started to really evaluate my
• 42:34
  Speaker 3: own life. Like, sure, I was trying to live as
• 42:38
  Speaker 3: healthy of a life as I could, but I was
• 42:40
  Speaker 3: definitely sacrificing my sleep. You know, I was having to
• 42:44
  Speaker 3: wake up super early, and I would stay up super late,
• 42:47
  Speaker 3: especially when I was finishing my master's treat I mean,
• 42:50
  Speaker 3: our assignments were due at midnight Pacific time, so of
• 42:54
  Speaker 3: course I waited until three am Eastern time to turn
• 42:57
  Speaker 3: them in.
• 42:57
  Speaker 1: Oh you're not alone, yes, So I really.
• 43:02
  Speaker 3: Just I started looking at the areas of my own
• 43:05
  Speaker 3: life that it's like, okay, I have to take my
• 43:07
  Speaker 3: own advice here, and I really have to prioritize my sleep,
• 43:12
  Speaker 3: you know, I really have to make sure I'm eating
• 43:14
  Speaker 3: enough protein, eating enough complex carbohydrates, eating enough healthy fats,
• 43:20
  Speaker 3: you know, balancing that diet, but then also finding the
• 43:25
  Speaker 3: things that bring me joy again. Right, I think sometimes
• 43:29
  Speaker 3: we get so overwhelmed with work and it feels so important,
• 43:33
  Speaker 3: like our passion and our calling. But yet I had
• 43:36
  Speaker 3: gotten away from some of the activities that I really enjoyed, right,
• 43:39
  Speaker 3: things like doing yoga, which, yeah, there's movement benefits to it,
• 43:44
  Speaker 3: but there's also stress management things like just going for
• 43:49
  Speaker 3: walks outside, you know, like spending time in nature. I
• 43:52
  Speaker 3: think that's so underrated, especially again for those of us
• 43:55
  Speaker 3: who spend most of our time in front of a
• 43:57
  Speaker 3: computer in blue light and you know, stuck inside of
• 44:01
  Speaker 3: a box, and you get outside and you have that
• 44:05
  Speaker 3: fresh air in that connection with nature. There's literally something
• 44:08
  Speaker 3: called nature prescriptions that have studies behind them that show
• 44:14
  Speaker 3: how they can help with so many different conditions, and
• 44:16
  Speaker 3: you know, even with things like pain. Right.
• 44:19
  Speaker 1: Yeah, it's some of the answers are staring at us.
• 44:23
  Speaker 1: They're right out there beyond the window, right, I know.
• 44:27
  Speaker 1: You know, frequent getting out into nature is incredibly important.
• 44:31
  Speaker 1: My oldest son and I always it's like a ritual.
• 44:33
  Speaker 1: Every year we go camping for at least a couple
• 44:35
  Speaker 1: of days just to get out there. It's free serotonin.
• 44:38
  Speaker 1: Kind of a weird way of looking at it, I guess.
• 44:40
  Speaker 1: But and you mentioned that prescription thing for different things.
• 44:43
  Speaker 1: I think of there's one example here in a while
• 44:46
  Speaker 1: to wonderful West Virginia doctor Matt Raife, wonderful, amazing pharmacist
• 44:52
  Speaker 1: of course in person. For that matter, he worked with
• 44:54
  Speaker 1: a local farmers market and ended up getting programs where
• 44:57
  Speaker 1: patients bringing prescriptions for vege these fruits that they picked
• 45:02
  Speaker 1: up at the farmer's market. It's not replacing a pharmacy.
• 45:05
  Speaker 1: It's certainly compliments along the way. But you know, just
• 45:08
  Speaker 1: these examples of you know, taking a step back, and
• 45:12
  Speaker 1: I appreciate you going there for us, you know, not
• 45:15
  Speaker 1: only for our patients, but for all of us as
• 45:17
  Speaker 1: healthcare professionals as well. Now, one or two things here.
• 45:21
  Speaker 1: I can't let you off the hook here, Lauren. I
• 45:23
  Speaker 1: always ask our pain podcasts one or two questions here.
• 45:27
  Speaker 1: So the first one is how do you define pain?
• 45:33
  Speaker 3: You know, I really think about pain as being information.
• 45:38
  Speaker 3: It is our body's way of trying to communicate with
• 45:42
  Speaker 3: us and to tell us something. And I learned a
• 45:46
  Speaker 3: lot about pain through my friend Veronica RIrA Gilly, who
• 45:51
  Speaker 3: is our executive director for FMPHI. She's also a consultant
• 45:55
  Speaker 3: pharmacist herself, and she works in a lot of pain management,
• 46:01
  Speaker 3: particularly with physical therapists, and sort of in this collaborative
• 46:06
  Speaker 3: role with a lot of them in looking at the
• 46:09
  Speaker 3: functional medicine side of their patient's pain. But then also
• 46:14
  Speaker 3: you know, working with doctor Adrian Lowe who's the creator
• 46:18
  Speaker 3: of something called Pain Neuroscience Education or PNE, and we
• 46:24
  Speaker 3: did a four hour workshop at ASCP a couple of
• 46:28
  Speaker 3: years ago, and it really shifted the way that I
• 46:32
  Speaker 3: look at pain, because it's not just a symptom. It
• 46:37
  Speaker 3: is really again our bodies we have communicating with us.
• 46:40
  Speaker 3: And sometimes I think we can misframe pain as something
• 46:45
  Speaker 3: that it's like, oh, well, you're just gonna have to
• 46:46
  Speaker 3: live with it, or you know, we're just going to
• 46:49
  Speaker 3: try and make it go away, but you can actually
• 46:53
  Speaker 3: use it as a sort of measure to try and
• 46:57
  Speaker 3: help improve your health. And so I think the Pain
• 47:00
  Speaker 3: Neuroscience Education piece is really interesting because they look at
• 47:05
  Speaker 3: it through the lens of how can it inform our
• 47:09
  Speaker 3: treatment plan for a patient? Right, Sometimes we have to
• 47:13
  Speaker 3: actually get moving, like the movement is actually going to
• 47:17
  Speaker 3: be the medicine for overcoming certain types of pain. But
• 47:21
  Speaker 3: that can feel very scary to a patient, right because
• 47:24
  Speaker 3: it sort of becomes ingrained in our brain that we
• 47:29
  Speaker 3: end up in this protective or guarded sort of stance
• 47:32
  Speaker 3: rather than being able or willing to move through the pain,
• 47:37
  Speaker 3: to move with the pain. And so that was a
• 47:41
  Speaker 3: big takeaway that I learned from that training. And I
• 47:44
  Speaker 3: think this is also where another overlapping interest of mind
• 47:49
  Speaker 3: we mentioned. I'm involved with the Psychedelic Pharmacist Association as
• 47:52
  Speaker 3: a board member, and we're actually looking at studying psychedelics
• 47:58
  Speaker 3: for pain, and not just in a physical sense of
• 48:02
  Speaker 3: you know, how could psychedelics actually work on the inflammatory pathways,
• 48:06
  Speaker 3: but the memory of pain, right, even things like phantom
• 48:10
  Speaker 3: limb pain. We're looking at how psychedelics could potentially help
• 48:14
  Speaker 3: process the trauma of pain and how the trauma itself
• 48:20
  Speaker 3: from an emotional standpoint, can perpetuate the pain. And so
• 48:25
  Speaker 3: we see this a lot actually, and I'm sure you
• 48:27
  Speaker 3: do too, that pain is more than just physical. There
• 48:31
  Speaker 3: is a very deep emotional piece to it, a lot
• 48:34
  Speaker 3: of fear that can really hold patients back. And also
• 48:40
  Speaker 3: you know that emotional piece, like the trauma of what
• 48:43
  Speaker 3: they experienced, and unless you work through that, it can
• 48:47
  Speaker 3: be very difficult to heal. And the last piece, I'll
• 48:51
  Speaker 3: mention you even is spiritual pain. You know, I mentioned
• 48:54
  Speaker 3: that I went through a period of true clinical depression.
• 48:59
  Speaker 3: And I'll never forget the day that I actually understood
• 49:05
  Speaker 3: that diagnosis. And you know, i'd sort of I knew,
• 49:11
  Speaker 3: I knew people who had depression, I knew people who
• 49:14
  Speaker 3: were antidepressants. And the moment that I actually felt depression
• 49:20
  Speaker 3: for the first time, it physically felt like a knife
• 49:24
  Speaker 3: in my heart and I cried because I said, oh
• 49:29
  Speaker 3: my God, like, is this truly what people walk around
• 49:34
  Speaker 3: every day for years of their life feeling this level
• 49:38
  Speaker 3: of despair? And it gave me so much empathy for
• 49:44
  Speaker 3: my patients and for people that you know they say
• 49:46
  Speaker 3: every day, right, be kind because you never know what
• 49:49
  Speaker 3: battle someone is facing. And in that moment, I finally understood, like, wow,
• 49:56
  Speaker 3: you know, life is so beautiful. There's so many incredible moments.
• 50:00
  Speaker 3: And on the flip side, man, it is hard, you know,
• 50:04
  Speaker 3: Losing someone is so hard. Being in traumatic experiences is
• 50:09
  Speaker 3: so hard, and yet that is part of life. And
• 50:13
  Speaker 3: so how do we learn how to not just overcome pain,
• 50:19
  Speaker 3: but to find the lessons that are somehow part of
• 50:24
  Speaker 3: that experience. And you know, I'm so grateful for the
• 50:28
  Speaker 3: functional medicine approach because there is such a focus on
• 50:31
  Speaker 3: that right of actually not just getting by and managing
• 50:36
  Speaker 3: the symptoms, but true healing from it. And so I
• 50:40
  Speaker 3: look back now, you know, and this is five years ago,
• 50:43
  Speaker 3: and in my own journey, it's like I can truly
• 50:46
  Speaker 3: say wow, like I've overcome all of that, you know,
• 50:51
  Speaker 3: and it feels like a distant memory at this point.
• 50:54
  Speaker 3: And I just think that hope is so important for
• 50:58
  Speaker 3: people to know, is like, you can get through this.
• 51:02
  Speaker 3: You know, you can do this. And there's so many
• 51:05
  Speaker 3: amazing tools now that we have at our disposal, and
• 51:09
  Speaker 3: I think that's what functional medicine really provides.
• 51:13
  Speaker 1: Incredible and also, by the way, one of the most
• 51:17
  Speaker 1: succinct and spot on answers to defining pain of information.
• 51:23
  Speaker 1: It's you know, I mentioned I always ask our pain
• 51:26
  Speaker 1: podcast this. I actually had an interesting opportunity recently to
• 51:31
  Speaker 1: get in front of our oldest son's third grade class.
• 51:34
  Speaker 1: You know. It was like, parents, come in, talk about
• 51:37
  Speaker 1: your career a day, good galley. When you're given a
• 51:39
  Speaker 1: couple of minutes to explain what pharmacists do to nine
• 51:42
  Speaker 1: year olds, it's quite incredible. But I also went into
• 51:44
  Speaker 1: the pain realm and I just I asked them all.
• 51:46
  Speaker 1: I said, how do you ouch? That was my nine
• 51:49
  Speaker 1: year old version of what is pain? So I don't
• 51:51
  Speaker 1: know if it was the best way to ask it,
• 51:53
  Speaker 1: but I said, how do you ouch? Man? I got
• 51:56
  Speaker 1: everything from I cry to I just don't pay attention
• 52:00
  Speaker 1: to it, I ignore, and everything in between two. And
• 52:03
  Speaker 1: I was like, wow, you know, think about that. If
• 52:06
  Speaker 1: we ask adults, you're gonna get a lot of variety
• 52:08
  Speaker 1: as well too. But perhaps we need to hone that
• 52:11
  Speaker 1: in there and the whole teaching as you were articulating
• 52:14
  Speaker 1: throughout this conversation of you know, healing from and with pain,
• 52:19
  Speaker 1: listening to that information from our bodies quite incredible what
• 52:22
  Speaker 1: you were saying there. It's a I'm not comparing to
• 52:26
  Speaker 1: nine year olds here, just adding on a little bit too.
• 52:29
  Speaker 1: So all right, So my other question that I ask
• 52:31
  Speaker 1: every pain podcast is a little funky here, I think
• 52:34
  Speaker 1: in this realm, but I canna ask it anyway. So
• 52:37
  Speaker 1: what is your favorite pain medication? And of course why?
• 52:43
  Speaker 3: You know, in the functional medicine space, we definitely do
• 52:48
  Speaker 3: leverage a lot of our more botanical option, so things
• 52:52
  Speaker 3: like tumic bosuelia. There's actually something called sbms, or we
• 52:56
  Speaker 3: call them pro resolving mediators, you know, their compounds that
• 53:02
  Speaker 3: can be derived from some of our Omega three fatty acids.
• 53:07
  Speaker 3: There's sort of this synergy that can happen sometimes whenever
• 53:10
  Speaker 3: we work with these these different botanicals that have their
• 53:14
  Speaker 3: own unique mechanisms, but when you kind of bring them
• 53:18
  Speaker 3: all together, you're getting this multi modal approach. So it's
• 53:22
  Speaker 3: it's kind of cool because you know, in pain management,
• 53:25
  Speaker 3: yes we might need multiple medications, right because they have
• 53:29
  Speaker 3: different mechanisms. And I think that's very similar in the
• 53:33
  Speaker 3: functional medicine space when we're looking at supplements, is we
• 53:36
  Speaker 3: don't always use just one agent. We use a combination
• 53:40
  Speaker 3: of things based on the mechanisms that they have and
• 53:43
  Speaker 3: how they can work. I will say also, I am
• 53:46
  Speaker 3: a big fan of using cannabis. I think that that
• 53:49
  Speaker 3: can actually be very beneficial for patients when used appropriately
• 53:55
  Speaker 3: and you know, at the right dosage. So that would
• 53:59
  Speaker 3: be another sort of interesting medication that I personally am
• 54:03
  Speaker 3: starting to study more and more as well.
• 54:05
  Speaker 1: Oh and we need to as pharmacists, you know. Here
• 54:08
  Speaker 1: in the pain Pod, we've of course had some episodes
• 54:09
  Speaker 1: and there'll be more coming because regulatory changes are abundance
• 54:13
  Speaker 1: these days. But you know, incredible what you were mentioning
• 54:17
  Speaker 1: there about that diversify. It almost sounds like we're all
• 54:20
  Speaker 1: a bunch of financial advisors saying it diversify your portfolio.
• 54:24
  Speaker 1: And if there's any student pharmacists listening, I know, portfolio
• 54:27
  Speaker 1: is kind of like journal club. It's those words that
• 54:29
  Speaker 1: it just provoked thoughts and emotions in all schools of pharmacy.
• 54:33
  Speaker 1: But diversified, diversified, diversify. It's the same thing to a
• 54:37
  Speaker 1: real estate agent saying location, location, location, but diversifying the
• 54:42
  Speaker 1: actual pain management treatment plan is incredibly beneficial for a
• 54:46
  Speaker 1: lot of patients, right, all right, So we went over
• 54:50
  Speaker 1: a lot here, doctor Louren, and I certainly want to
• 54:52
  Speaker 1: thank you for your time here today and expertise along
• 54:55
  Speaker 1: the way. And I'm sure if a couple folks will
• 54:58
  Speaker 1: be reaching out to you here and there of course
• 55:00
  Speaker 1: in the way, so feel free folks to connect with
• 55:03
  Speaker 1: via LinkedIn and beyond of course as well too. But
• 55:06
  Speaker 1: thank you, thank you, thank you, and certainly hope you
• 55:09
  Speaker 1: had a good time here in the pain pod.
• 55:12
  Speaker 3: Absolutely, thank you.
• 55:13
  Speaker 1: You're very welcome and pain Podnation hopefully this was worth
• 55:17
  Speaker 1: your time overall. As always, So with that I certainly
• 55:21
  Speaker 1: thank you for your time pain pod Nation, and I
• 55:23
  Speaker 1: wish you a great day every day.
• 55:28
  Speaker 2: If you'd like to join Mark on the Pain pod
• 55:31
  Speaker 2: send us an email to publish You're at Pharmacy podcast
• 55:34
  Speaker 2: dot com, and make sure to share the show and
• 55:38
  Speaker 2: subscribe on your favorite podcast directory.
• 55:41
  Speaker 1: Thanks for listening.