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Common Misconceptions About Pain · Meaningful Medicine with Novant Health

• 0:03
  Carl Maronich (Host): Meaningful Medicine is a Novant Health Podcast, bringing
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  you access to leading doctors who answer questions they wish you would ask.
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  From routine care to rare conditions, our physicians offer tips to navigate medical
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  decisions and build a healthier future.
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  I'm Carl Maronich and with me today is Dr.
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  Kent Cochran, an anesthesiologist and pain medicine specialist from Novant Health.
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  And today, we're going to be talking about pain.
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  Doctor, welcome to the podcast.
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  Dr. Kent Cochran:
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  Thank you, Carl.
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  Appreciate it.
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  Host: Maybe we could start by having you talk about what are some of
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  the biggest misconceptions you hear from patients when it comes to pain?
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  Dr. Kent Cochran:
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  Absolutely.
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  So, the first thing that I see often is when people come and see me, they
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  want me to tell them about their pain.
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  And pain is a subjective.
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  It is nothing that I can tell them.
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  It is something that comes from them to me.
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  And I think the misconception starts with how we even talk
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  about pain in this country.
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  So, the way that we describe pain within the medical field is a number from
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  zero to 10, and that doesn't suffice.
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  There are many things that go into understanding pain, but it
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  has to come from the patient.
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  And that's a departure from virtually any other field of medicine.
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  So, I spend a lot of my time trying to get that out of patients where they tell
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  me where their pain's located, what makes their pain worse, where the location
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  of their pain is, how it radiates, certain positions or activities or times
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  of day where they feel it the most.
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  Those things help me more than any imaging study.
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  They tell me more than most physical exam findings as well.
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  So, the key really is talking to the patient.
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  And I think in a lot of fields of medicine, it's obviously very important,
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  but definitely within our field.
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  That's the crux of all of this, is how are you feeling and then trying
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  to figure out why are you feeling that way and where's that coming from?
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  Host: A lot of elements to it, obviously.
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  And, Doctor, is pain always a sign that something's damaged or can you have pain
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  without actually having had an injury?
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  Dr. Kent Cochran:
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  Yeah.
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  So, again, pain is a subjective finding.
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  It is something that you feel and no one can tell you otherwise.
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  And pain is a sign of nerve injury.
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  And the other signs of nerve injury would be
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  weakness, numbness, tingling, and also pain.
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  So, those are the things that we're looking for to where there's some
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  type of injury happening in a nerve that's going from a peripheral nerve
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  or to the spinal cord, and then acting on the brain to where you feel that.
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  And so, the question is, where is that happening?
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  How is that happening?
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  And we want to stop that before it becomes more of an issue, and more of a problem
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  for the patient in their everyday life.
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  Host: A lot of people think of pain as something just happens when you get older.
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  Is that a reality or is there something else to that?
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  Dr. Kent Cochran:
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  I would say that we see pain more as we age, but pain is abnormal.
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  Pain is a pathology of the central nervous system and the peripheral
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  nervous system, and it's abnormal and it warrants a response from
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  the person where it's happening to.
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  So, I think a lot of people just expect that to happen.
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  And I hear a lot of people say, "Well, I'm getting older,
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  so these things just happen."
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  And that's how things were felt to be the case and how it
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  should be for a long, long time.
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  But pain is abnormal.
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  And If you have numbness in your leg or you have pain in your back,
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  those things should be addressed.
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  And there's a certain period of time—and I'll get into this somewhat,
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  but there's certain period of time where we can let things go and see
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  how things go because the body has an amazing ability to heal itself.
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  But if there's been anywhere from 12 weeks or three months where that
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  pain has been plaguing you every day and that pain hasn't gotten better,
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  then it's time to look at that.
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  But pain and age aren't the same thing, and pain with age
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  should certainly be addressed
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  Host: Doctor, maybe we could go into what you were talking a little bit
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  about and that's if you delay seeking help for some pain you may have.
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  Like many things, waiting doesn't usually help it.
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  So, maybe you could speak a little bit to that.
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  If someone first has a pain, when do they really need to start getting help?
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  Dr. Kent Cochran:
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  Yeah.
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  And Carl, this can be confusing because again, the body has an
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  amazing ability to heal itself.
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  And for greater than 90% of all episodes of pain, it's going to heal itself.
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  Whether you come see me, whether you take over-the-counter medicines,
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  whether you see other types of providers like a chiropractor or a physical
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  therapist or a massage therapist, those pains are going to heal themselves.
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  And I would never tell anyone to not pursue medical care to try to get better.
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  That's definitely a key and that's going to help you to respond to some type
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  of injury or some type of pain sooner.
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  Yet it can be confusing with that statement.
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  So, the crux of this is we want to address pain as it presents.
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  So if it's been two, three weeks of something nagging you, bothering
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  you, then I would definitely try something over-the-counter, medicine
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  that you're able to take, exercise, stretching, movement, walking.
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  Because that's key to get those muscles active, get those nerves that
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  are inflamed causing pain recentered.
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  If it has been a longer period of time, then I would seek care because
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  we want to avoid episode of acute pain from transitioning into chronic pain,
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  because acute pain can allow for healing.
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  It can allow for you to return to your baseline to avoid this episode, this
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  feeling from becoming something that's chronic, something that you'll live with
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  and something that we'll have to manage.
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  Host: Maybe you could speak a little bit more to the difference of those
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  acute pain versus chronic pain, how they may present and what long-term
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  implication could be of those.
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  Dr. Kent Cochran:
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  Absolutely.
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  So, acute pain is defined as a single episode of pain that has
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  occurred for less than three months.
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  So, the nervous system hasn't produced memory.
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  So, within our nervous system, there's the development of nerve fibers that
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  are associated with chronic pain.
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  And that's a burgeoning area of research.
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  There's a lot of things that we don't understand about that.
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  And everyone's a little different with the timing of that.
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  There's some time between six months and 18 months where
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  those nerve fibers will develop.
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  And then, your nerves will have memory of that pain.
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  And then, that pain can be something that you deal with.
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  So, there are basically three phases of pain that I'm trying to
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  figure out whenever I talk to my patients as they're describing this.
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  And is this acute pain?
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  That would be pain—that particular episode, that event
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  being newer than three months.
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  And I have lots of patients where they've had a certain bout of back
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  pain come up for the last 10 years, maybe about every six months, where
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  it comes up every three, four weeks.
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  And that's okay.
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  That's something that we definitely need to watch and make sure that that's
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  not becoming recurrent to where it's going to become chronic pain, that
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  would still be classified as acute pain.
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  But as a certain bout of pain that you felt every day is getting into
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  three, four, five, six months, then we transition from acute pain to
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  something called subacute pain, and that's a very important distinction.
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  Because during that phase is really important to seek care because we
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  want to treat those symptoms of nerve injury and treat that nerve injury to
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  where that doesn't develop into chronic pain, to where that nerve is going
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  to be constantly firing inflammatory signals to where your body feels that.
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  And kind of getting back to your question about injury and damage, there's
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  a lot of conversations about this.
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  And just to give you kind of a caveat as we're starting here, I am talking
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  about non-surgical chronic pain.
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  So, surgeons would classify this differently.
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  I think other fields might classify this differently.
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  So, I'm talking about lesions, I'm talking about injuries.
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  I'm talking about symptoms that haven't warranted surgical correction,
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  and trying to manage those things, either through conservative
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  remedies or medication remedies or interventional pain procedures.
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  So, that subacute phase is really key because we don't want that true
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  transition to chronic pain because the expectation when we reach chronic
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  pain is that we can't cure this, we can't fix this, but we can manage it.
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  My field is chronic pain management.
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  And I tell my patients all three of those words are very important whenever
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  chronic pain has reached that phase.
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  Host: Doctor, somebody if there's trauma that causes
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  pain, they need to go to the ER.
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  That path is pretty clear.
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  Someone has some other type of pain, they may go to their
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  primary care provider first.
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  Maybe you could speak a little bit to the journey somebody who
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  has some pain might go on as they try to navigate their pain issue.
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  Dr. Kent Cochran:
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  Absolutely.
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  So, I would say oftentimes when they see their primary care doctor,
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  they're going to get some baseline imaging, which is important.
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  There's a lot of things we rule out with imaging rather than rule in.
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  So oftentimes, it's showing us what we expect.
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  There isn't a lot out of the ordinary with simple X-ray.
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  Then, probably some medicine, some adjuvant medicine that might help relax
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  muscles or treat inflammatory conditions.
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  Maybe a steroid that could quiet some of that inflammatory reaction.
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  And then, possibly some conservative therapy like seeing a chiropractor, doing
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  physical therapy, seeking massage therapy.
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  Using a TENS unit, using a back brace, all those things would
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  be helpful in that acute phase.
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  Now, at some point, we would hope that the body would be healing this injury to where
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  you would see either this pain resolve or lessen and lessen and the lessen over
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  time to where you notice it much less.
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  And hopefully, by that time, you don't need to see me.
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  Whereas if we are not seeing benefit from those things, then
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  it's probably time to see me.
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  Something else that I see a lot along the journey with pain is people try
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  these therapies and maybe they try one and it doesn't work, so they're
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  not going to use that anymore.
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  They're going to try another one and that doesn't work, so we're
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  not going to use that again.
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  And then, we're going to try another one and that's not working.
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  So, we've taken three good therapies, and they haven't worked and they
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  have not restored baseline function.
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  They haven't taken away pain.
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  Pain is typically a threshold that we need to clear.
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  And oftentimes when I'm seeing patients, it's a collaboration of therapies,
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  maybe medicines from different classes, because pain isn't just one thing.
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  And oftentimes when I hear the word pain medicine, we're talking
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  about the class that's opiates.
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  So, opiate medicines.
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  But pain medicines come in many different forms because pain is affecting a
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  lot of different areas of our body.
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  So again, pain being this threshold that we need to clear.
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  Maybe physical therapy helps this much.
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  Well, we didn't see that benefit yet.
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  Maybe NSAIDs help you this much and we're still not clearing that.
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  And then, maybe come see me.
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  And I'd give you an injection that actually treats that area that
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  hasn't been kind of non-invasively and invasively treated, where we're
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  actually going after the nerve that's inflamed and we clear that threshold.
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  My injection itself probably didn't make it.
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  But alongside those other therapies is allowing you to feel better and also
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  will allow you to return to function.
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  So, I think that that's where people can get frustrated with chronic
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  pain management treatment plans, is that are hoping for the one thing
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  that's going to treat everything.
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  And the spine is an amazing part of our body.
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  It can take on loads of stress and oftentimes whenever we look
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  at imaging, we're seeing our spine degenerate at age 30, 35, 40.
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  And people hear that and they think, "Oh my gosh.
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  This is going to be terrible and I'm not going to be able to make it and
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  I'm going to have this terrible life."
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  Well, our spine is able to take on loads of stress.
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  To be a mammal that's upright, it is our spine that is a huge part of our
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  ability to take on these actions.
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  And so, oftentimes we can see degeneration and degenerative disc
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  disease is a very common diagnosis given after imaging, but that doesn't
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  mean that the prognosis that you have for your life is going to be terrible.
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  Treating those individual nerves, making sure that we're clearing
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  that threshold to where that pain is treated, to where the body can
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  recover, to where that inflammatory response that caused that initial
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  nerve injury is finally quieted down.
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  Host: Doctor, you mentioned imaging.
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  And is it possible or you hear sometimes stories of folks that
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  will have X-ray, an MRI that appears normal, yet they're still in pain.
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  How can that happen and how would you address that?
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  Dr. Kent Cochran:
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  Well, a lot of my professors from medical school would take
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  issue with the word normal.
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  So whenever were taught to read imaging or to have a physical exam,
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  people don't come to us to hear the word normal, because that's not
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  a part of what we're looking at.
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  So, I think maybe unremarkable might be the better word.
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  And again, pain is a subjective.
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  Pain is not something that is seen.
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  Pain is not something that I can tell from a CAT scan or an MRI or an X-ray.
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  That is something that you feel.
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  And I even want to equate what imaging is.
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  Imaging is a picture of your anatomy.
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  That is what imaging is.
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  So, saying that an X-ray is normal really isn't complete, maybe it's unremarkable.
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  You don't see anything
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  that's necessarily standing out or abnormal, yet the patient
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  is feeling something abnormal.
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  There are a ways to test nerves, but we still don't know a test that
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  really tells how someone feels.
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  And so, the way that I mention this to my patients is I treat
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  patients I don't treat pictures.
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  And while imaging is a part of the story, it isn't the story.
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  And there is a puzzle that we're trying to figure out, and imaging is the piece.
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  And I think people have kind of made it this key that unlocks everything.
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  But again, the vast majority of what I hear from my patients with non-surgical,
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  chronic pain management is going to come from them and trying to find these
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  trigger points, trying to find these joint spaces, trying to find these
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  nerves, trying to find these muscles that are constantly given this feedback
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  of pain, and finding ways to treat them and ways to optimize that treatment.
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  Host: Yeah.
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  Well, you kind of started by saying pain is a very subjective thing.
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  Not everyone handles the amount of pain in the same way.
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  So, that makes it additionally challenge, I'm sure, for physicians to treat
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  when everybody's a bit different.
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  Dr. Kent Cochran:
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  It certainly is.
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  And I think a big challenge of what we have within my field is insurance
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  coverage and making sure that we're doing the right thing for the right patient,
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  because everyone needs to have guardrails and ways to make sure that we're doing
• 16:29
  things correctly within our fields.
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  But I think the challenge with that is trying to quantify things.
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  Again, pain has always been a number, and we focus on that number.
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  And then, we focus on the relief of that number.
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  What I would love to see in my career, in my time in pain is
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  talking about the significance of pain within someone's life.
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  And on the other hand of that, the significance of the treatment of that
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  pain and what that means for them.
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  Oftentimes I have patients focus on time.
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  And I can talk about this a little bit with my procedures.
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  But whenever I'm doing procedures, there are two components to my procedures.
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  And those components are a diagnostic one and a treatment side.
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  And on that diagnostic portion, what I want to know is how much
• 17:25
  this is affecting their pain, okay?
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  This has nothing to do with the number, this has nothing to do with a percentage,
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  but what difference are you noticing?
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  And if I ask someone, "How much did this help your pain?
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  And they say, "Well, it helped 90%."
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  I think you'd feel good about that, Carl, wouldn't you?
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  Host: Yeah, I think so.
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  Maybe.
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  Dr. Kent Cochran:
• 17:47
  Yeah.
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  And I've had certain patients say, "Well, I still have 10% left,
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  and that 10% is killing me."
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  And then, I have patients who will say, "Well, I'm about 30% better."
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  And when I was early in my practice, I was somewhat deflated hearing that.
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  I was like, "Argh only 30%."
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  He was like, "No, no, no.
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  Dr.
• 18:04
  Cochran I can do 30% more than I was doing.
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  I can go to the mailbox and I can go pick up my grandchildren
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  and I can walk for a mile today.
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  And I feel so much better.
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  I still have pain, but I'm so much better."
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  And so, that's where I think that our focus needs to be is significant.
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  What does this mean for you?
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  And again, putting words to pain rather than putting numbers to pain.
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  Because I can understand what insurance companies need and I want
• 18:33
  to give them those things to make sure that we're doing things correctly.
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  But one of the challenges with back pain is oftentimes it isn't just one
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  area of the back that's causing issues.
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  So, earlier, I had talked about one part of the treatment plan.
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  So, people trying physical therapy and that not helping and they
• 18:53
  kind of get rid of that, or trying NSAIDs and that didn't really help.
• 18:57
  But they're not doing both those things at the same time.
• 19:00
  So oftentimes, back pain is coming from multiple places and people
• 19:04
  are looking for that one procedure that's going to take away everything.
• 19:08
  And oftentimes, I'm having to layer injections alongside multiple medicines
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  from multiple classes, and then trying to keep people as active as we can by
• 19:18
  getting them to go to physical therapy and continuing a home exercise regimen.
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  Because going through physical therapy, that's not anything
• 19:26
  that you can ever graduate.
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  I have patients come to me and say, 'Well, I graduated physical therapy."
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  Well, in order to maintain that function, to avoid this becoming a recurrent
• 19:37
  problem, it's really key to keep those gains that you got at therapy.
• 19:42
  Because the natural reaction for injury to nerve is for
• 19:49
  a nerve to affect a muscle.
• 19:51
  And whenever a muscle is affected, it's natural reaction is to clamp up.
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  It's called hypertrophy, where everything guards itself.
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  And it's our body's way of guarding you from further injury.
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  The problem is that that muscle over time can be calcified and rigid.
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  It needs to be long and strong and flexible to where you can
• 20:16
  maintain that range of motion.
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  So while everyone's different, everyone's response to
• 20:22
  injury's going to be different.
• 20:24
  Host: Doctor, you started talking a little bit about different
• 20:26
  interventional treatments.
• 20:27
  Maybe you could expand on that a little bit and talk about the
• 20:30
  variety of those that you do and how they benefit different patients.
• 20:33
  Dr. Kent Cochran:
• 20:33
  Absolutely.
• 20:34
  So, there are numerous, and that's grown a lot since I've been in my practice.
• 20:38
  But the point of these procedures are to get people feeling the best
• 20:43
  they can for the longest that they can and get them moving better.
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  Because oftentimes what I'm doing with these procedures are very pinpoint.
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  So, I'm going to go down to one spot, one spot only.
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  And I oftentimes tell patients, well, this injection.
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  Part of it's for you and part of it is for me.
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  And the part of it for you is to obviously feel better.
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  I wouldn't be putting a needle in you if I didn't think that you'd be better.
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  But the part for me is to understand what that means for you.
• 21:13
  So, there are many joints, many nerves, many muscles, many spaces within our
• 21:19
  body where we can see significant change that can correlate with pain.
• 21:25
  So whether that's epidural steroid injections or nerve blocks, radiofrequency
• 21:30
  ablations that are all done in the office, all done on an outpatient basis,
• 21:35
  they take about five, 10 minutes to do, they give us a lot of data about what
• 21:41
  we think the problem is for a patient.
• 21:44
  There's also a burgeoning growing area of our field where there's a
• 21:50
  lot of non-invasive procedures that do the exact same thing that treats
• 21:55
  specific areas, specific nerves.
• 21:58
  And that's something that really drew me to the field because it used to be do
• 22:05
  an epidural, kind of see what happens.
• 22:07
  Whereas now, we're getting to pinpoint a lot more areas and understand a lot
• 22:13
  more, and that can even set people up well for surgery to where oftentimes
• 22:19
  surgeons will send me patients in preparation for surgery for them to
• 22:24
  better understand where a patients pain might be coming from, because I
• 22:28
  want to give patients the right tools.
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  And oftentimes, my injections are what patients need to manage their pain
• 22:36
  or to cure their pain or to improve their pain or to resolve the issue.
• 22:41
  But if that's not the case, then I'm going to do everything I can
• 22:44
  to get them in the right hand.
• 22:45
  So oftentimes, surgeons will send me patients where they're trying to pinpoint
• 22:50
  okay, what, level of the vertebra, what nerve root is most affected?
• 22:56
  And we can pinpoint that and see the response that someone has.
• 23:00
  And while it might be short-lived, if it takes away the vast majority
• 23:03
  or all of their symptoms, then a surgeon's able to say, "All right,
• 23:07
  I'm going to go after this area and we're going to do this procedure."
• 23:11
  Host: How much would you say of pain physical versus neurological
• 23:15
  or even emotional, which is a big aspect when someone's in pain,
• 23:19
  really plays on the emotions?
• 23:21
  Dr. Kent Cochran:
• 23:21
  Absolutely.
• 23:21
  So, we are physical beings.
• 23:24
  We're definitely affected by pathology of our body that causes these symptoms.
• 23:29
  Yet I think taking them in the US because we have so much information,
• 23:35
  we can figure things out so much, that we downplay the fact that while
• 23:40
  we're physical beings, we're also mental, emotional and spiritual beings.
• 23:46
  And we take on a lot of these things within our body and a lot of these
• 23:50
  things are happening in our lives.
• 23:53
  And when that comes out, oftentimes it can come out as pain or it can worsen.
• 23:57
  And living with chronic pain is a big challenge.
• 24:02
  I always equate it to other medical conditions.
• 24:06
  And oftentimes, when we're treating certain conditions, we're
• 24:12
  focused on the result and we're focused on how things will go.
• 24:16
  Well, there's a lot that you're living chronic pain that you
• 24:19
  don't with other conditions.
• 24:20
  And the condition that I always use is high blood pressure.
• 24:24
  It's pervasive and it's very common.
• 24:26
  It's also called the silent killer.
• 24:29
  Well, chronic pain is not silent.
• 24:30
  Chronic pain is making you respond to everything in your day, every movement
• 24:37
  that you have, every position that you have, every task that you need to
• 24:40
  complete can be affected by chronic pain.
• 24:43
  It is the non-silent non-killer.
• 24:47
  It is affecting you and it is affecting your ability to do things.
• 24:51
  And not only from a physical standpoint, but living with it.
• 24:55
  And I think that that's the biggest challenge that we have.
• 24:59
  Fifteen to twenty percent of the adult population has chronic pain.
• 25:04
  And we focus so much on the diagnostic criteria and on the treatment of
• 25:09
  these things and understanding and recognizing the size of these
• 25:12
  things to where oftentimes we miss these things you're talking about.
• 25:18
  And that's a big focus that I have.
• 25:21
  And I think that we can definitely fall short.
• 25:23
  But I definitely want to spend time with our patients have these
• 25:27
  relationships with our patients where we can talk to them about it.
• 25:31
  Because there's been a ton of research that shows the outlook that you have as a
• 25:38
  patient dictates a lot of how you will do.
• 25:42
  And a big part of that is having a clinician address these things.
• 25:47
  And so, it is our job to treat the patient, to treat the pathology, to treat
• 25:54
  the problem, to treat the nerve injury, but also to see the patient a whole,
• 25:58
  especially when it comes to chronic pain.
• 26:01
  Host: Doctor, to wind down, let me ask, what would you tell someone
• 26:04
  who's trying to decide whether or not to see a pain specialist?
• 26:07
  Dr. Kent Cochran:
• 26:07
  I would say the important thing is to really take inventory
• 26:12
  of what's going on with you.
• 26:15
  And have a good understanding as to what's going on with your body and
• 26:20
  finding someone who's going to hear you.
• 26:23
  Someone who's going to listen to you, but also has a plan, someone
• 26:27
  that has a treatment plan to address all of these symptoms.
• 26:31
  I think someone that's going to be honest with you.
• 26:33
  Something that got me into this field was whenever I was in anesthesia, I really
• 26:39
  enjoyed the procedural aspect of medicine, but missed that connection to the patient.
• 26:46
  And chronic pain allowed me to see that.
• 26:49
  But there was this article written whenever I was going through my training
• 26:54
  that showed that most chronic pain patients saw nine physicians from
• 26:59
  different specialties before they made it to a chronic pain physician.
• 27:02
  Now, that's gotten much better.
• 27:04
  That has improved vastly.
• 27:06
  Yet what I saw as I was going through my training is that chronic pain
• 27:11
  medicine was not something that everyone was well-versed at it.
• 27:14
  It was a language that many people didn't speak.
• 27:16
  And I feel like that pushed patients to the margins.
• 27:20
  And whenever I saw that and I rounded on chronic pain medicine, I saw these
• 27:25
  patients were very happy in their care because they found someone that took
• 27:29
  care of them, someone that spoke their language, someone who understood what
• 27:34
  the problem was and could address it.
• 27:37
  And I think also someone that was honest with them.
• 27:39
  I think if you're seeking a chronic pain physician, you want to have someone who's
• 27:44
  going to tell you what they think and is going to come up with a plan to where
• 27:47
  you can improve and also what to expect.
• 27:51
  Because whenever I see a patient, there's two things that I hold in
• 27:54
  my hand and I don't ever want to lessen one or lessen the other.
• 27:58
  I think they're both important, and I think they can counterbalance one another.
• 28:02
  But I think in the fullness of what they can be, we want
• 28:05
  to get the most out of them.
• 28:06
  One is hope.
• 28:08
  I don't ever want to lose hope with anything.
• 28:10
  Because I've mentioned living with chronic pain, oftentimes you aren't
• 28:14
  curing things, you aren't fixing things, you're managing things.
• 28:17
  Well, I always hope I'm wrong.
• 28:19
  There was an attending that I had during training who was an expert in ALS and
• 28:25
  he would tell patients, "I think you have ALS, but I hope that I'm wrong."
• 28:29
  And hearing someone who was a nationally renowned physician say
• 28:34
  that, that stuck with me because that meant a lot to the patients.
• 28:37
  That's how I feel, is that I hope that I'm wrong.
• 28:40
  I don't think I can take this away, but sometimes we hit a home run.
• 28:44
  The other thing that I hold my hand is expectations.
• 28:47
  These tools that I have, these intervention, these procedures
• 28:49
  that we've talked about.
• 28:51
  They are tools and they serve a certain function.
• 28:56
  We can't have them be more than they are.
• 28:59
  But I want you to have expectations that are real to where you can build
• 29:04
  your life around them, and that you have goals to where you can
• 29:08
  have a life that brings you joy.
• 29:10
  And that you can meet the daily goals that, you want for your life that meets
• 29:15
  your family and your hobbies and your job.
• 29:17
  I want to be the one to take you there.
• 29:19
  And I think anyone seeking a pain management physician should want someone
• 29:25
  and hopefully find someone like that.
• 29:27
  Host: Well, Dr.
• 29:27
  Kent Cochran, you speak very passionately about pain and pain management.
• 29:32
  We appreciate all the insights and information you provided today.
• 29:36
  Dr. Kent Cochran:
• 29:36
  Thank you, Carl.
• 29:37
  Host: To find a physician, visit novanthealth.org.
• 29:40
  For more health and wellness information from our experts,
• 29:42
  visit healthyheadlines.org
• 29:44
  If you found this podcast valuable, please share it on your social channels and
• 29:48
  explore our complete library of podcasts.
• 29:51
  Carl Maronich (Host): I'm Carl Maronich.
• 29:52
  Host: This is Meaningful Medicine from Novant Health.
• 29:55
  Thanks for listening.