Episode 46 – Neural Retraining with Dr. Kevin Lasko Neural-Retraining-with-Dr.-Kevin-Lasko (1).mp3

00:01 Announcer: Welcome to the Standing Up to POTS podcast, otherwise known as the POTScast. This podcast is dedicated to educating and empowering the community about postural orthostatic tachycardia syndrome, commonly referred to as POTS. This invisible illness impacts millions and we are committed to explaining the basics, raising awareness, exploring the research, and empowering patients to not only survive, but thrive. This is the Standing Up to POTS podcast.

00:29 Jill (Host): Hello fellow POTS patients and nice people who care about POTS patients. I'm Jill Brook and today we have an episode of The POTS practitioners. I am so excited to speak with today's guest, Dr. Kevin Lasko, who is a chiropractic neurologist. We here at Standing Up to POTS have been hearing his name from several POTS patients and experts because he is getting known for having helped some very complex patients, patients with not just POTS but also Ehlers Danlos syndrome or joint hypermobility syndromes, mast cell activation syndrome, etc. - people who had already failed more conventional approaches. In fact, one of our medical advisors has been telling me for months that I absolutely had to get him on the POTScast. So, I'm happy to report he's here with us today. Dr. Kevin J. Lasko received his Doctor of Chiropractic in 1992, and then went on to earn quite a number of post graduate certifications. He is a board-certified chiropractic neurologist, a fellow of the International Academy of Chiropractic Neurology. He has postgraduate certification in childhood neurodevelopmental disorders, and also post graduate certification in movement disorders. He is a regular presenter to the National and International Ehlers Danlos Societies, the Chiari Foundation, and others. He has a private practice in Quarryville PA and he's one of the very few doctors whose websites actually specifically says that they specialize in treating dysautonomia, EDS, MCAS, Chiari, POTS, and such. So we don't see that too often. Dr. Lasko, thank you so much for speaking with us today.

02:32 Dr. Lasko (Guest): Oh, you’re more than welcome. This is great. Thank you for asking me.

02:37 Jill (Host): So you have a really interesting background. You are licensed as a chiropractor, but you do more neurological stuff – neurological retraining, right? Can you talk about that?

02:42 Dr. Lasko (Guest): Yes, that's probably almost 100% of my practice now. I was a regular - what most people would think of is just a regular - chiropractor for years. But then with my neurologic background, I really started to look at how the neurology affects a lot of the things that I do, and I found out that, boy it's a lot. So I just got really interested in it, took a lot of postgraduate classes. I actually just got done with one this past weekend, and I've been taking these postgraduate classes for probably 25 years.

03:16 Jill (Host): What types of patients do you typically see then, 'cause it sounds like you see the tough ones. [Laughs]

03:22 Dr. Lasko (Guest): Yeah, that's kind of where my practice kind of has gravitated to. I do see a lot of the ones that have, Oh, I want to say not necessarily failed, but maybe they didn't get the results that they wanted with conventional medical approaches. We do see patients that are just recently diagnosed with dysautonomia POTS, but probably half of the patients walk into my office and the other half are either carried, wheeled, or helped. Yeah, we see a wide variety of very sick patients.

03:56 Jill (Host): So why do you think the conventional medical approach or conventional treatments has often failed this type of patient?

04:05 Dr. Lasko (Guest): I mean, I don't think it's a complete fail, obviously, because some of the patients that go through some of the protocols work. You know, they get really good results. I think when we start looking at protocols, a lot of that works for some of the patients, but the ones that that it doesn't work for usually are the ones that I see, and I think it's because they don't fit into that keyhole of the protocol. And I think the individuality of each of the patients is where the protocols kind of fail, because if you start to get where maybe some of the protocols, like I'm with the dysautonomic patient, the normal protocol is basically midodrine, florinef, beta blocker, water, salt, go exercise. Maybe some compression socks. And that works for some. I mean, it does, there's no question about it. When it fails, the individuality of that patient starts to come out and I don't think it's the patient's fault that they failed the protocol, I think the protocol failed the patient. And that's where you kind of have to get outside the box a little bit and say where is the patient failing? Like, there's a big push right now, for like vagal nerve stem, like everybody should get vagal nerve stem. That's not true. It should be individualized care and vagal nerve works for some, and it's not appropriate for others, and that's where you kind of have to tease out which patient is it for and which one isn't. With a lot of the protocols - and again nothing wrong with them, they work, but I think you have to look at the patient and really see how they're functioning. And the last thing you want to do with a dysautonomic patient is exceed what their metabolic limit is to the tissues. I hope the listeners are OK with this, but I use some really weird examples, but they're basic and everybody kind of gets them, so I hope they kind of hold on here. It would be like if there's a significant other, somebody would ask you, “Hey, can you go to the store for me?” And you're like, “Sure I'll go to the store.” And they just start rattling off stuff, “Get bread, eggs, milk, steak, chicken breasts, get a salad, get strawberries, get bananas, get manwich. I need pickles.” And you’re looking at him, you're saying, “OK, I'm going to go to the store for you.” You drive there and you're looking around and you're like everything I was asked to get, I have no idea what to get. You come home and you get yelled at. Nobody wants that and that's exceeding the metabolic limit, and I think that's where a lot of the patients in these protocol type of treatments, especially if they don't respond, a lot of times you have to look at the exceeding of the metabolic limit because when you ask the body to do a task, like if you're pedaling on a recumbent bike or if you're walking on a treadmill, if your tissues aren't being perfused by blood, those tissues are going to fatigue pretty quick. And if you got to meet your 20-minute time frame that you're supposed to be doing it, you start to go into what they call anaerobic metabolism where you actually start to breakdown some of the muscle tissue to get more fuel. And you will only be able to do that for so long, because you'll begin to hurt when you increase that pain fiber firing. Most pain fibers fire with either type C - this is some of the nerdy stuff here with medical stuff - but they fire with two different fiber types. They either fire with type C fibers or what they called type A-Delta. So if you increase pain in this scenario, generally would be a type C fiber. Well, I'll give you one guess what fiber types these sympathetics use: Type C. So, if you increase pain because you're pushing that muscle too much, you increase pain. But when you increase, pain will increase sympathetic firing. If you increase sympathetic firing, you'll start to sensitize those pain nerves to fire easier. I'm sure some of the listeners are like this very unfortunate, but for them to get up out of their chair or their bed, walk to the bathroom, walk to get a cup of water or whatever, by the time they get back, that's like a workout for them. You know, they're done for a day. And that is exceeding the metabolic limit. You've pushed that system too much and it just says, “I'm done,” and I think that's where some of the individuality of the care can be better utilized with some of these treatments that may not have got the results that the patients wanted.

09:12 Jill (Host): Yeah, that makes a lot of sense, and I think probably everybody can relate to that metaphor pretty well. So, that's really interesting. So, these probably are some of the patients that take more time. I guess my next question is why do you like working with these super challenging patients? Like, we're so glad that you do, [laughs] but very few people specialize in that, I think. What makes you attracted to this challenge?

09:43 Dr. Lasko (Guest): I think it's just that - it's kind of a challenge. There's a lot of patients out there that are very, very sick and they just need help, and I think I can offer them maybe a better quality of life, maybe a better chance to be able to go do things that they want to do. I like the challenge of trying to figure out where the system's broken and kind of what type of treatment I can come up with to try to help.

10:11 Jill (Host): That's great! In the POTS community, we commonly hear the definition that dysautonomia is when the automatic functions of the body are not all working properly. Is that how you think about dysautonomia?

10:27 Dr. Lasko (Guest): Yeah, probably a little bit different. I mean, I think that's a general statement that's correct, but there's this - I guess idea - out there with some that it's either like you're all sympathetically driven or your parasympathetically just not working. And that's not really how the system works. They're not like antagonistic to each other all of the time. They have to work in kind of concert with each other. I think that's why I kind of look at that a little bit different because I think with like a dysautonomic problem, I know we're seeing all of these peripheral problems with the heart and, you know, the gut and not delivering blood to your hands and feet, you know, hands and feet are cold, difficulty with temperature regulation. You're real sensitive to sounds or light or things like that. You have brain fog. And if a system is broke, and we know this is the autonomic system that kind of kisses all those areas that I just mentioned, there's a central problem going on here because in most of the patients that I've seen with, say they’re tachycardic, they have GI paresis, poor blood delivery - all the things we kind of just went over - they can easily have 8, 10, 12 different docs that they're going to because they're treating the end organ. And that's fine - it's always good to rule out any pathologies and all of that, I'm not saying that. But the central control mechanism has to at least be looked at, and that's kind of where I come at the dysautonomic dysfunction side of this. If the control of the autonomics is really a central integration problem - and it can be at the brainstem, it could be at the lower brainstem, the upper brainstem, the cerebellum, it can have influences from the vestibular system, the midbrain, the basal ganglia, the cortex - the way I look at it, where is it broke in that overall scheme of your central nervous system? I mean, that's the best way I can kind of explain it. It's - I don't think this is an end organ failure or an end organ problem, I think it's more of a central integration problem, and that's where it gets fun for me because that's neurology and that's kind of where I dance at.

13:00 Jill (Host): So I'm excited to hear more about that. That is an interesting way of looking at it. And so maybe the best way for us to learn more is maybe you can tell us a bit how things work at your practice, 'cause I think you have a pretty unique practice. I think you spend quite a bit of time with each patient. In fact, I think you only see a couple of patients per day. What's your initial evaluation like? What are you looking for once you have evaluated a patient, what happens? Like, how do things run at your office?

13:33 Dr. Lasko (Guest): Sure. You would have to come here, and we try to give you some ideas of where to stay, but once you're here, you know, we do a regular examination or regular neurologic exam. But I think I see patients and they'll come with their books of medical records and say, “Do you want to see all of this?” And like, you know, it makes War and Peace look like reading the, you know, cartoons...

14:00 Jill (Host): [Laughs]

14:03 Dr. Lasko (Guest): ...but all of that's really good. But I kind of do my own exam and it's not a different exam than what any of the other docs do, I think it's in the interpretation of the examination. And I think that's where I kind of tease some of these central neurologic integrative areas that may not be working right out, so I could formulate some sort of treatment plan. So, I mean the big thing is to figure out where is the system kind of broke? When does it break down? And then, how does it break down? Like, what's the effect of that system not working or that part of the brain not working right? And then you kind of have to look at does it respond to some of the therapies that I come up with for the patient to to try? How many of those things can I come up with to help what we're trying to help the patient with? And then, more importantly, can we activate that system enough to get a permanent change? A lot of people hear the word neuroplasticity or long-term potentiation - can we teach that system to work again in a correct manner? If anybody has ever played that telephone game where like, I would tell a story to you. You would tell it to Cathy. Cathy would tell it to Stephanie. Stephanie would tell it to another person and it's eight or ten people down the road. This story should be the same from the start to the finish, and if it's not, I have to figure out who messed the story up. You know, who didn't listen to the person before it? And that's what kind of the initial examination looks like - I have to figure out was it Jill that messed the story up when I told it to her? Or was she OK and Cathy was the one that messed it up because you told the story correctly?

16:11 Jill (Host): Fascinating! OK, so can you describe a few of your tools or treatment approaches that you use to try to get this system communicating properly again?

16:25 Dr. Lasko (Guest): Sure, yeah. I mean, my treatments based on the neurologic exam findings that I get, and I think going back to the interpretation of the exam is most thought to do uh, a neurologic exam or some form of neurologic exam and I think the interpretation is where I kind of differ with some of the notes that I may get, or some of the comments I get back from the patients. I’ll give you an example: like, if you're doing a balance test, one of the bounds tests is called Romberg's. You stand with your feet together, close your eyes, you put your arms up by your side. Some people tip their head up. I don't like doing it that way because when you put your arms out you activate different muscles. When you put your head up, you might activate some of the canals in the vestibular system. So I just have them stand, look straight ahead, hands by their side. Can you maintain balance? Technically, a positive Romberg’s test is when you lose your balance and you take a step, OK? So that would be a positive Romberg's. But what happens if you see a person that always sways from the midline always going to the right and they come back to midline, always going to the right and come back to midline, always going right and come back to midline? Technically, it's not a positive test, but why are they only going to the right? That tells me something about that central integrative state of how they're processing things when they close their eyes. Same things happens with like different eye patterns. They've gone to different people and they said, “Nope, my eyes track fine. It's not a problem.” Ad I do it and I'm like, “Why is it every time you kind of move your eyes to the right you have to move your head with your eyes going to the right but going to the left you can't?” Again, that tells me how that central nervous system is kind of working and we literally just go, like we said before, down that telephone chain in the central nervous system to look at - and I think I said this before, but is it the receptor? Is it the peripheral nerve? Brainstem, cerebellum, vestibular midbrain, all the way up to the brain. And that's how I look at the exam to see if I could formulate some sort of treatment. Because we're so integrated with all this sensory input that we have coming in, the treatment is important - don't get me wrong with that, but if you understand some of these integrative areas, the treatment really isn't that important. It's will that treatment kiss or touch those integrative areas to get the output that you want, and if it's with a dysautonomic person, can you get heart rate to get under control? Can they stand up without their heart rate going up to 170 beats? And if you could maintain it better, again, can you fire those sensory systems or can you do different therapies to help with that so the system functions more normal?

19:42 Jill (Host): Do you have different exercises you have people do depending on which part of their system seems to be off?

19:52 Dr. Lasko (Guest): Oh absolutely. I mean, this is not a protocol by any stretch because not everybody does balance exercises. Not everybody that I see gets eye exercises. Not everybody does vestibular type of things. Some of them do, but it's dependent upon the exam, and does the breakdown correlate to what the person is experiencing, whether it's, you know, tachycardia, gut stuff, or whatever it is, and I think I would look at things a little bit differently, try to get some different input into the system to make it work as good as it can, because I think this might help. We are sensory driven. Our brain develops by what we see, smell, touch, taste, hear, what we're exposed to. And the most constant or one of the most constant inputs we get is from gravity, which this group doesn't do a really good job with [laughs] and movement. And, again, this is another group that doesn't do really well with moving when they're upright [laughs]. So those are two big systems with this population that don't function well, and that's a big input coming in, and again, here comes one of those little metaphors or things, but you can have a blonde haired, blue-eyed mom and a blonde haired, blue eyed dad give birth to a blonde haired blue-eyed child in the middle of like Nebraska. But if all that child is exposed to is Mandarin Chinese, guess what they're going to speak? Mandarin Chinese. They're not going to magically start to speak English. So these different sensory inputs that you have can affect cortical or what they call suprasegmental areas to control what's coming out of there. And if 1 + 1 is, you know, 9 to the system, you're not going to get 2 coming out.

21:57 Jill (Host): So, that is so fascinating to me because I'm accustomed to thinking about orthostatic intolerance as a problem of blood volume or a failure of my blood vessels to vasoconstrict and maybe my brain not getting enough blood, and it sounds like, if I'm understanding correctly, you're saying, sure those things happen. But that's not like the first thing that happens, there's other sensory stuff that might be happening first and making all those other things happen. So, when I take medicines or treatments to do those things, I'm kind of treating the downstream symptom. I'm not getting to the root of the problem. Is that accurate?

22:49 Dr. Lasko (Guest): That's the way I look at it. There could be peripheral problems, small fiber neuropathies, and stuff like that can be causing this. You can have, I mean, you can have a tumor. All those bad things, all the pathologies do have to be ruled out, obviously. But if this group of patients, they've been poked, probed, prodded, imaged, reimaged, re-poked, re-probed, re-proded. And like, no goobers kind of show up anywhere really with, you know, a lot of them. So, if there's no true hard pathologic thing going on, you kind of have to start looking at the physiologic side of it, or the neurologic side of it. And a lot of the docs that are out there that treat them, they look at that - there is no question about it. Their treatments are more peripheral or with meds. And that works for some, you know, there's no question about it. There's also a pretty big population that those don't work for. And, you know, I'm on some groups that we do case studies and things like that and, I mean, we see 18-year-old girls, 24-year-old females, on 25 different meds, 30 different meds. I know everybody is concerned about Poly Pharma and all that. There's other avenues that I think can be explored to see if these type of somatosensory type of therapies, if you know how to target where these integration sites are and how to activate them or inhibit them, you can get some pretty good results, because we've had a lot of patients that I treat that we get them off of beta blockers and things like that. Pretty successful. You know, it's not a light switch for this because that's one of the other things that kind of come into play. There's always a couple of those great cases where in a week they're like a new person and all that, but most of the patients, you know, you have to put in some time. You know, most of them have been sick for a while, and if you think about it, you know, if you've been sick for five years, that's 1500, 1700 days straight that you're getting this 1 + 1 is 9, 1 + 1 is chair – you know, it’s not even a number coming in...

25:14 Jill (Host): [Laughs]

25:16 Dr. Lasko (Guest): ...it's going to take a little bit of time to reprogram the central nervous system to say, “Hey listen, it's 2, and it should only be 2.” And that's where my treatment kind of comes into play. We don't want to overload them because we talked about that metabolic limit going forward and we try to give them as much as what I think they can handle. But it's really important if a patient does decide to come and treat that, we do have a support person there to kind of understand to kind of sit in the background while I'm doing these things to understand how to do some of the exercises, more importantly, when to stop doing some of the exercises. You know you don't want to say you went and practiced golf and you come back home, and you're significant other says “So how'd it go?” “Oh, I hit the ball a couple times.” You know, the way I look at it, so you practiced swinging and missing for an hour. You don't - you don't want to do that. You know, that “practice makes perfect” - I don't necessarily agree with that, perfect practice makes perfect. So you want to make sure you're doing these exercises. There's a lot of people that treat this dysautonomic POTS, EDS - that kind of umbrella at times, and they get good results as well, but I think we can do better if we understood some of the metabolic things that go on behind the scenes while somebody is doing TheraBand® exercises or balance exercises. Like, are you evaluating different autonomic signs when you're doing the somatic motor type of things? Wobble board exercise - great exercise if the person can handle it. [Transcriber’s note: wobble boards are round balance boards that allow the user to tilt the board in any direction]. If they're sitting there and they're trying to maintain balance on a wobble board, but they're just sweating beyond belief because probably exceeding the metabolic limit, that's probably asking that system to do too much. If you're asking somebody to do, like, eye exercises, we'll say, at least in my office, if you're doing different eye exercises and we're asking you to follow my thumb, you want those eyes to be locked on that thumb the entire time. If you start to see these little psychotic or little jumpy eyes going on while you're trying to focus in on my thumb, that's too much. You're exceeding the limit of what that system can do. And again, if you exceed that limit, you kind of go into anaerobic metabolism, maybe increasing some C fiber firing, and that's with pain and the sympathetics. So you get that loop going again.

28:03 Jill (Host): I can see how this becomes really specific to the individual, and that's so interesting. You had mentioned some case studies. Do you mind sharing an example or two of somebody who came to you with our band of problems and what they did and how long it took, and then what their outcome was just to get a feel for like what someone could expect if they did your program?

28:32 Dr. Lasko (Guest): Sure, yeah. And just to touch on something you said, the treatment at my office is very individualized to that person. It's based on your central nervous system and how it works, and that's yours, you know, that's not mine, that's not Cathy’s, that's not my wife’s, that's the person that comes in, and the treatment has to be based on that function and how they work. We have seen a lot of crossovers from the EDS world with dysautonomia and POTS as well. The EDS group has a really rough time. We've seen a lot of them that their spine is completely fused from skull all the way down to S1. And we've had a couple that had severe dysautonomic problems, severe dystonias with movement disorders. There was one - kind of tough to talk about, but she was carried in on a flat board. She was like that for 2 1/2 years. Catheters, PICC lines, feeding tubes. Her thighs were probably the size of my forearms. Anytime she would go from laying flat, maybe up 10 degrees, her system would just crash and her heart rate would spike. She would have dystonias that were just incredible. I mean, there's a lot of places that wouldn't see her, like NIH did not want to see her. A lot of the movement to sort of clinics just didn't want to see her. So, we took her on. Long story short, we actually figured out that the only system that really worked on her at that point was her eyes. And we developed some different eye exercises for her, semi therapies, and we slowly got her up and up and up, and it was in February when we were treating her and we finally got her up so she could look outside, and it was snowing and she just said that was most beautiful things she ever saw, because she's been flat on her back for 2 1/2 years. Long story short, one of her goals was to be a teacher in the summer - this just this past summer. We actually got a picture of her on a beach standing in the ocean in Brazil because she's a missionary and she's over there teaching kids. So that's what she wants to do.

31:02 Jill (Host): Oh wow! That gives me chills. Wow!

31:08 Dr. Lasko (Guest): Yeah, it was kind of tough talking about it. We see a lot of dysautonomic patients that, they get off of their beta blockers and they - they're able to join their family doing things. You know, are you ever going to run a marathon? I don't know. I don't know if you ever wanted to, you know. But these patients should - they should be able to have a quality of life, to be able to enjoy their family, their friends, you know at least be with them when they're getting ice cream, they should be able to eat some ice cream 'cause ice cream is a great food group, but... [laughs] You know, they should be able to do those those things. You know, I think, improving the quality of life is what I always try to tell them. I don't know if we're going to get you back to 100% because I don't know if anybody is 100%, but you should see improvements in your quality of life if we can figure out where in that central nervous system are things kind of broke.

32:09 Jill (Host): Wow! So what kinds of patients tend to do well with your program? Like, is there anything you can tell people that they would know if they were a good candidate or not?

32:22 Dr. Lasko (Guest): In a perfect world, it would be easier on me, but that's OK. [Laughs] Your typical dysautonomic patient - nothing is ever easy - but that's an easier patient for me than somebody that has had 20 spinal surgeries, that have had - that has had all of that. Not that we don't see them because, you know, we do, but, you know, if your autonomic nervous system isn't working right - and it's I mean, obviously it would be great to get you before you got on to the 15, 20 different meds to try to correct this, but yeah, I mean, if you're having things like tachycardia, GI stuff going on, where you’re maybe a little slow motility, your typical dysautonomic patient, they respond pretty well to this. They have to do work - this isn't flipping a light switch on, but we see pretty good improvements if the person is willing to put a little bit of time in and understands, like I say, when to go and when, more importantly, to [inaudible] with some of the exercises, they do pretty well. Truly, truly do.

33:33 Jill (Host): Do you find that mast cell activation syndrome responds to some of this stuff, or is that not really in the category of things that would do well with the neural retraining?

33:46 Dr. Lasko (Guest): Oh no. I'm going to pick on you a little bit here, Jill, but you're looking at the end organ again. [Laughs] What controls or what has a big influence on how your immune system works? It’s your autonomics, it's your sympathetics. But we had one of my first patients, again, spinal fusions, bad dystonias, dysautonomic. But whenever the dystonias would start to kind of ramp up, she would get these mast cell things like on her chest and on her face. What we did was once we got her autonomics under control, where we could kind of attenuate that mast cell activation where she would start getting some of the red blotchiness on her face and on her chest, everything kind of started to turn around. Her dysautonomia started to get a little better, her movement disorders were able to be controlled. And that was one of the first things that we actually saw that we knew the system was starting to get cranked up, and if we could get ahead of it and knock it down, we had a better chance of decreasing the tachycardia, the movement disorder, and today - and this is going well over three years - she doesn't have any more of the mast cell activation, her dysautonomia is good, and she hasn't had a movement disorder in over three years.

35:15 Jill (Host): That's great. Wow.

35:18 Dr. Lasko (Guest): I always kind of go back to, even though the end organ might be something going on there, is there a central control mechanism that could be causing that? Because if we keep treating just the end organ, you're kind of playing whack a mole. I mean, you really are, and you're trying to bounce around - not that you can't affect it that way, but just a quick example, like if somebody is a little tachycardic - say their heart rates 120 beats a minute, 110 - then a beta blocker will decrease that heart rate. There's no question about it. But are the signals still being sent down to say “beat 120”? Did you change that central integrative state to say, “Hey, we don't need to beat at 120”? You really didn't. You really didn't. You put a bandage on an artery bleed, basically, and hope it you know stays until the next time you could take the beta blocker to keep your heart - your heart rate down.

36:19 Jill (Host): This is all such a fascinating take on all of this, and I wish we could keep you forever and talk for hours. If people are interested in this approach or more of what you do, is there anywhere that they can go to learn more?

36:37 Dr. Lasko (Guest): Oh, sure. My website - it's a pretty basic website – just drkevinlasko.com, and then my email is Lasko L-A-S-K-O dot hemispheres – like two sides of the brain - at gmail.com [lasko.hemispheres@gmail.com] But as far as like, you know, reading and research and things like that, I just go on and I Google “Autonomics” and see what comes up. Autonomics and blood delivery. There's not like a specific article, book, or anything like that. I mean, there's a bunch of different neurologic stuff you can Google or, you know, buy books to read. But even in some of the articles, you almost have to read kind of between the lines with some of these things. That's how I kind of formulate some of the treatment protocols that I come up with, maybe others come up with. Do they work, do they make sense? If A can excite B, and B fires to C, if D can excite B, hey, can D excite B to help C? And that's kind of how I look at it, especially if I know how to activate D, I want to see if it can help B talk to C.

37:51 Jill (Host): Interesting, yeah.

37:53 Dr. Lasko (Guest): A lot of people I have been told in the past that there's no medical evidence that this works. There's no literature out there that it works, and I can look you straight in the eye 'cause I can see you here, everything I do is something I could pull up, show somebody to say just that's that scenario I just went over - A to B to C, D affects B. Let's see if I can go from D to B to affect C. It's out there, it's just not looked at, I guess, the way I look at it.

38:27 Jill (Host): So I can relate to that because I'm a nutritionist and I do the same thing, I'm sure not to the degree that you do, but you can go on PubMed, piece together where people have found make up at least harmless theories you can test, based on what's known, that's really interesting. Is there anything you wish more doctors or researchers knew about dysautonomia? Like, do you wish the research was kind of - I don't know - looking at different things or opening its minds to different approaches?

38:58 Dr. Lasko (Guest): Oh my, yes! I mean, in a perfect world that would be great, and I think it's getting there. I really do. I think they're trying to get into looking at different causes of this or looking at different ways to affect it. I truly do feel bad for this patient population because I see a lot of patients that come in that are sick, and you hear some stories out there that - no patient should have to go through what some of these patients go through - and I, I mean from maybe different treating physicians or people like that, saying that maybe because the protocol didn't work, that hey, are you trying enough? Are you pushing through it? Are you trying or are you med seeking? Do you want to get better? Is it Munchausen’s? [Transcriber’s note: Munchausen is a mental disorder where patients falsify or exaggerate a symptom or illness to get attention.] Is it - and I mean we've all heard that, and I really do think I could count on one hand, and you could probably cut a couple of fingers off, the amount of patients that I'm saying, “You know what? Maybe something's going on there.” I think generally patients want to get better. They don't want to stay in bed 27 hours a day, you know. They don't want to do that. They want to be able to go hang out with their friends, pizza shop, go out to a football game or whatever. They want to go do that, but the system doesn't allow that. I don't think you could jump to - because the protocols or the treatment that Doctor X did didn't work, well, it has to be the patient’s problem or it's the patient’s fault, because that's not necessarily true. But we've all heard some of the horror stories that some of the patients go through. And if you don't appreciate some of these central control mechanisms, and if they haven't been tried on some of these patients to see are they going to respond to that and maybe not treatment X, you have to try that. And if you don't give them the benefit of the doubt and if you don't see if that's something that could be beneficial to them, I don't think you can throw up the red flag and say, “Hey it's your fault, not mine. You know, you're not trying hard enough. You're not doing what you're supposed to do,” because there's a lot of patients - those guys, like I said at one of my discussions - I'd go to war with these patients, 'cause you guys just fight. I mean you don't quit. You guys will go through brick walls to try to get better.

41:36 Jill (Host): [Laughs]

41:37 Dr. Lasko (Guest): I'll stand shoulder to shoulder with you any day of the week. But I mean, so that's one - that's one side. One of the other things that I think is going to be coming out - and I don't even know if this has been addressed anywhere, I'll be very honest - is that a lot of these dysautonomic patients, might be you yourself, you might be able to be in this category, but they've had things going on before they're diagnosed at age 12, 14, 18, 22. And I've seen this with my patients just a bunch is that if you kind of start peeling the onion layers back a little bit on them and you start asking if their mom is there or, you know, somebody that was there when they were little, did Jill nurse OK or she’d eat? “Oh my gosh, she didn't eat anything, she was really colicky. So hard to get her to sleep. She had her days and nights mixed up. She would scream because her tummy would hurt. She would always come home from school because, you know, kindergarten because she had a tummy ache. Her face would always flush.” Those are autonomic things going on. And that could be from birth all the way up until puberty stage, when your system, when your autonomics really have to kick in. If that system has already been kind of cranked up for 12, 13, 14 years, and then you ask it to do more, you're going to have an autonomic storm going on there. If you could improve that sensory integration when they're younger, how much better chance will they have when puberty hits? If they're in a little accident, you're playing with a better - a stronger – system, than if it's just let to run without anybody changing it. So, I think those are the two big things because I'm really - Stephanie and I, my wife, we're really trying to look at the more children with my neurodevelopmental background and how can we turn that clock back a little bit and not let the time get wrong or not let that 1 + 1 is 9 get in that hard drive and it's hard to get out.

43:54 Jill (Host): Yeah, that makes a lot of sense. You had mentioned maybe a super generous offer that you would let patients talk for a few minutes - is that - I don't want to put you on the spot.

44:09 Dr. Lasko (Guest): Absolutely. My wife and I just want to try to help. I mean, we really do. And what we offer is if any patients have questions or something like that, we'll do a 10, 15, 20 minute phone call for free. I don't charge anything for it. If they're interested in care, I just want to make sure it's a good fit, even if it's just to answer some of the questions, that's fine. I may not have all of the answers, but try to help in any way that we can.

44:38 Jill (Host): OK, so they could just go to your website, get the phone number. What was your website again?

44:44 Dr. Lasko (Guest): DrKevinLasko.com. The phone number is area code 717–723-1099.

44:54 Jill (Host): That's very generous of you. Dr. Kevin Lasko, thank you so very much for all your information and perspectives. We need more people like you who are thinking outside the box and who are willing to work with us tough patients who don't slot into the normal healthcare system very well. I'm just so grateful to have your brainpower and your creativity and compassion working to help our community. Thank you very much. And, hey listeners, as always, this is not medical advice. Consult your medical team about what's right for you. Please consider subscribing because it helps us get found by more great people like you. But thank you for listening. Remember that you're not alone. And please join us again soon.

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