Brain, Hope, Reality: PTSI not PTSD | Hosted by Dr. Eugene Lipov

Dr. Eugene Lipov (00:02.24)
Well, welcome. We have a special guest today. Thank you so much for having me. Thanks for having me. Can you tell us who you are first? This is Eugene Lipa, of course. Yeah, of course. Brain hope reality is my attempt at podcasting. So we have a real podcaster with us today. doing a great job. I like this setup. It's cool. Simple, right? But to the point. Exactly. It does what it's supposed to. Thank you. Yeah. So my name is Stephanie Cohen.

I am, I wear a lot of hats actually, so I feel, I'm 32 years old, but I feel like I've lived like seven lives. I'm a physical therapist by trait. I'm an athlete, been an athlete my whole life. I'm considered pound for pound the strongest woman in the world. Felt it, felt the power? My shoulder almost fell off, it was close. I'm a PT, a pity. We'll put it back in. Yeah, so.

Pretty involved in sports. have a career in entrepreneurship as well. I started a business when I was in physical therapy school within the software as a service industry. So we pretty much got into the influencer app space before everybody else did and were able to kind of like almost monopolize that particular niche, which gave me the head start into more like entertainment, public speaking, lecturing and that kind of stuff. I'm a firm believer that

in order to be successful or the most successful people, I guess not the most successful people, but people who do this tend to experience success, is gathering a lot of skills and then combining them in creative ways. So a novel application of skills. Exactly. Makes sense. So that's kind of like what I've been up to. So what's your latest project currently?

So right now I'm working on a course. So I've spent like the last four years basically writing everything that I know about strength training. So it's kind of a principles of strength course. Basically when I was in school, I was studying exercise physiology. And then even after graduating from PT school, I realized that a lot of the formal curriculum, while it gives you a really great understanding of fundamental principles, it doesn't really give you much practical application.

Dr. Eugene Lipov (02:21.688)
So it's more kind of like theoretical and baseline stuff, which is so important for you to develop your critical thinking skills. You you can't, you can't bypass the basics and the fundamentals if you want to be great at something. That's a hundred percent. The problem is that there seemed to be no bridge between evidence and practice. Like that's kind of like how I felt. I prepared theoretically, but very unprepared.

for the, for real life. it like in medical space. I mean, you're in medical space. In medicine, they call it translational medicine, meaning you can have great ideas, but what do you do about it? Exactly. But you guys have residency where you kind of are appointed a mentor and you have a program to develop your skills and you're being tested and evaluated. But personal trainers don't have that. And while I understand that we're not, you know, responsible to the same degree as a medical doctor for someone's health.

You're still dealing with individuals. You're still dealing with real people. I would disagree with that because I know a number, like I used to be, I've been a pain physician for 40 years. I've seen a number of people get seriously injured by physical therapy. I would fix them by doing various procedures and then come in and it's like totally injured. It's like, respect the range of motion. Don't break anything I fixed. Don't overstretch sciatic nerve. mean, it's not too much to ask.

Yeah, no, and things can get more complicated. mean, you're a pain specialist, chronic pain and the effects it has on your plasticity of the brain. And if you're a physical therapist, that is more mechanistic in your approach and you completely deny the existence of pain modulation in the brain. And you just try to attack the source of pain in a structure. You're also going to be doing a disservice to your, to your patients. Well, I think that's one of the things that's changed in many ways.

perspective is very similar to my perspective. So what I mean by that is like I had formal training. I finished medical school in 84. Like nutrition wasn't doing like I had 30 minutes on that. I mean after four years you think they could little more kind of useful. combining old principle with new applications I think that's what makes it interesting. I think in that sense we're very similar like Steli Ganglian blog's been around since 1926.

Dr. Eugene Lipov (04:46.328)
first time it was done. It was done for asthma. It was like what? It was in France. So if you think about it, so then we go forth and the way I learned how to do it was blind. So no ultrasound, no x -ray. you know, just hope you get the right spot. It was for CRPS, complex original pain syndrome. It's a burning of the hand or whatever. And then my brother actually conceived like burning of the hand and sweating.

It's kind of the same as hot flashes. I was like, I don't think that's right. He said, I just tried it. So I tried it and it worked, but I knew it wouldn't work because I had no idea. know, formally trained, you like formally trained. can't, not only you're not thinking the box, you didn't even know you're in the box. Right. And then people gave me all type of grief that I was an idiot. was an old fourth and called me needle plunger and got pretty ugly. I still, I'll show you the paper article in Chicago Tribune.

Anyway, so I across the article from Finland where they did T2 clipping, which is you have to move the lung out of the way, know, it's aggressive for hand sweats. And they found out PTSD went away. I was like, what? is that? So there was a great paper. Some neuroscientists did the retro -rhebius virus injection in the neck and they found there is a direct connection from the neck to the brain, which nobody thought there was a connection like

People like me, we were trained, still it doesn't go to the brain. Well, it's been shown for years. There is a direct connection from the brain. And now people like, it's only been about 25 years. CRPS actually is a central phenomenon in the brain, not peripheral. It was like, what? Wow. Yeah, that's interesting. So, you know, it's like medicine, least Western medicine, strength of it is segmentation.

heart, lung, kidney, great. Western medicine, Eastern medicine integration. So you're talking about the same thing, physical therapy, like muscles. like there was a, Dr. Abkarian wrote a very interesting article, showed if you have back pain for over 10 years, you lose 10 % of the cortex. Did you see that article? Isn't that crazy? So interesting. You have to send it to me. I wrote a book about back pain. Perfect. I'll send it to you. But the whole point is it is such a feedback.

Dr. Eugene Lipov (07:09.806)
loop to the brain and people come back for example from a military action. No TBI, nothing, right? Just PTSD, pure PTSD. The brain looks like was cheese. They have significant loss of brain, like up to 20 % of weight. Turns out glutamate is increased by PTSD and glutamate is neurotoxic.

Right? Isn't that nuts? That's crazy. That is crazy. So the whole integration of all this is where it's really interesting. So how is the research, how is the research bridged to physicians and how long does that process take? How do physicians bridge it? How do they accept it? You're saying? How do they accept the new information? Well, that's a tremendous question. So where my head is...

is going is it takes guts to change the narrative, know, especially in the world how we're living it right now with digital media and the high level scrutiny that you get if you don't repeat the same thing everybody else is saying. So no, I actually have three answers for you. That's a massive pain in the patootie. You need to be pretty resilient and you need to have good support.

Like my wife is an amazing support. yeah, yeah, absolutely. Well, it's interesting, every problem is an opportunity, right? And it sounds like a cliche, but let me tell you how it worked out in my life. That's my favorite quote. Each fresh crisis is an opportunity in disguise. Well, let me tell you that opportunity. So I started doing hot flashes and it was working well. So the Chicago Tribune came by and they said, how are you doing?

You know, it's like, whatever, hear it's working well. And I said, yes, I had to read patients. Patients changed my life. I feel great. I can sleep through the night. First time as a breast cancer survivor, I couldn't have sex. couldn't function. After the block, I feel great. So I think it'd be a good article. no, no, So this is 2005, right? So that they go, Bianca Kennedy, the beautiful breast cancer survivor, 32 years old, had severe heart fleshes.

Dr. Eugene Lipov (09:31.928)
She tried everything, nothing worked. After that, was so desperate, she found Dr. Lipov and she let him plunge a three inch needle into her neck. That was the beginning, right? So that's why a lot of my friends call me needle plunger now. And then they went to Northwestern when I went to medical school, chief of OB, whatever. He goes, no, no, that's just absolutely wrong.

He doesn't understand why it works, we shouldn't be doing it. No, no, this is very terrible, dangerous. They went to Raj, where I did my fellowship. And they go, what do you think? They go, we didn't train him. I'm like, this is just terrible. This is terrible. He's a heretic, basically. I was quite annoyed. And that's what led me to read about 3 ,000 articles. That's where I found the finished article. Or we wouldn't be sitting here today without it. So the interesting historical caveat, you know how doctors wash their hands? You ever hear that story where they came from?

Beautiful story. Cautionary tale. Makes me very happy actually that I did better than he did. So Dr. Schmalzer, whatever, a very long name. He went to Vienna Medical School, 1856, something like that. So he goes there and he finds that women who delivered in hospitals had three times chance of dying compared to at home. So the difference was, and he followed them around, so at home it wasn't nurse practitioners.

and then in hospital with doctors and doctors would go dissect dead bodies, run across and deliver a child. So at that time, the thought was if there was bad smell, it would transmit disease. They didn't know anything about germ tape. So he published on that and he gave lectures and said, wash your hands. You'd think they'd be embraced, but no, no, no, no, So they kicked him out of medicine. He had a nervous breakdown.

They put him in psych institution and he was beaten to death one month after admission. But the story is not over. 20 years later, when Lister figured out germ theory, he was hailed as savior of babies, but he was dead 20 years. But they didn't send him mechanistics, right? So then, so that was a very educational for me. So I spent years trying to understand why it worked for half -dushes and PTSD.

Dr. Eugene Lipov (11:53.87)
So I talked to my wife about it I said, it works for half -lives, it works for PTSD. She goes, that's for pain. She says, that's complete bullshit. One thing cannot work for everything. And she has a biochemistry education, smart lady. So I said, all right, fine. So I wrote a paper, primarily for her, but you know, I published it. And then I called it Unified Theory of Stalagangal Blocks. I love how she was challenging you. yeah, absolutely. She's great. She's like a true alpha.

She's a very strong woman. I'm a good beta, but I'm not in her class really. She's outside my class for sure. But the point is that gave me an impetus and I get curious today. And the other part of those quote that actually keeps me going is Linus Plank, you he got Nobel Prize for playing constant businesses, 1925. He said, science move ahead at funerals. So you have to wait for the old guard to die.

So I have very resistant skin. and I've had a lot of trauma and I think people who've had trauma are the super achievers in our space. If you had no trauma and nobody would have you, you're like, okay, everything's fine. Why am I overacting? Like, and if you look to your right, there's a lot of special forces, challenge coins. Every one of them. Yeah.

Every one of them had some kind of trauma pretty much as a young child. Yeah. Cause it makes you want to seek whatever it is to overcome your previous condition. You I'll tell one of my other kind of funny story that I mean, it's like, know, you're old, we have a story for everything. So I just finished my training. So as you said, I did five years in training. So whatever this and this, my mother died by suicide when I was an intern. I mean, I've got trauma.

So I was giving a lecture at Rush and there was a thousand doctors like me who finished all the trainings like whatever. So there's six people that sitting at the table and I gave my speech about something unusual about this muscle accident. So the guy sitting next to me, the chairman goes, I don't think you're right. So he asked the audience to vote if I'm right or wrong. So everybody said I was wrong, like a thousand hands go up that I'm wrong. I got up and I said, know, with all the respect.

Dr. Eugene Lipov (14:19.534)
Medicine is not democracy. It's facts of facts. If you have any problems, come and I'll give you a paper. Not a one came to me. Not a one. So my chairman of my department goes, that was arrogant. I said, you know, if I tell you it is, is. He said, yes, I know you always have a paper about something. So fine. But nobody gave me shit. So that prepared me. Like when I was in Congress, I gave testimony about stellate. This was 2010.

So the chairman, Mr. Filner, you know, like keeping in mind there's like 20 people for various institutions, right? This is Congress, U .S. Congress. He goes, how do I know you're not a crackpot? I was like, get you right there, doesn't it? Get you right there. So that's why I think that's why people like ourselves, I think makes us resilient. And you're willing to try different things out of the box.

It's what I was going to say. It's really easy to kind of like sit on your throne of privilege of not having trauma and not having mental illness or not struggling with that and be super skeptical and want to deny the evolution of treatments just because you don't have the necessity to have hope and faith for a new treatment. All they have is skepticism, which is great. think it's... Well, I think that I have a particular perspective on that.

Part of it is because my mother was on care of psychiatrists, right? For a couple of months. Then she saw him a day before she killed herself. She saw her patients like three hours before she died. So, you can't tell. And there's also, I think the mental health or lack of it is much higher than we think because everybody's in denial land. Because if you have pain...

and it's always with you, you think has to be like that. And the other thing is if you think about it, unfortunately, my psychiatric colleagues, there are some amazing people, but there is a lot of people who are mediocre, we say. So they have set up success, what is considered success, two, 3 % over the years. Like if you look at Freud,

Dr. Eugene Lipov (16:46.798)
Typical psychoanalysis technique is years. It's a lifestyle. PTSD, post -traumatic stress disorder, if you look at here, PTSD, post -traumatic stress injury, try and change the name. In fact, I'm going to try to recruit you to help you with that. PTSD is a term that was started in DSM -3 in 1980. It has not changed.

PTSD has done some really DSM committee, has come up with terms, comes up with various terms and a lot of them has changed. But again, so the point is PTSD to me, psychiatric condition does not to be a lifestyle. You can move on because most people, there's people still arguing with, well, does it really exist? Are you sure it exists? Well, let's see.

If it's a biological condition, let's look at the broken bone. I have a great PSA I can send you. Broken bone, you should be able to identify it, diagnose number one, and treat it successfully. That's basic. So if you have somebody who has a broken bone, you take an x -ray, you see the broken bone. You put a cast on it, you're good. If it looks like a broken bone, you don't tell the people to run up and down the mountain, right? Typically. mean, if you're an idiot, you would, but sure, you would.

So when people say PTSD is invisible, right? So my answer typically is it's invisible to have the wrong scanner. If you have a PET scan or a MEXT scan, you can see it. Do they say the same about other medical illness or mental illness? What do mean? The scans? Yeah, or do they say the same about the mechanism? Like, do they not understand it to the same degree that they didn't understand PTSD? Or can they see it more clearly? Because

I thought that most mental illnesses are invisible. maybe. So first of all, I am not a neuroscientist. Like I'm not a real, I'm self -taught. So I know PTSD very well. thing about PTSD, you can invoke it. If somebody has PTSD and I showed them horrible pictures, I make the lights up. It's overactive. it's instead of this size, let's say it's not as big. And if I show a picture of.

Dr. Eugene Lipov (19:07.288)
For military personnel, show them a picture of trauma. gives them more so. Schizophrenia, I don't know how to clip it. I don't know how to activate it. I don't know. I do know the PTSD piece. And PET scans is another way to diagnose it. So there was a study done in Long Beach, for example. They had the most severe Long Beach VA. They found the sickest PTSD people they could find. They did PET scans. They did stellates. The stuff we're talking about.

and that amygdala activation was reduced. So can actually see a brain change, right? So there is a physiologic change. The other thing is if you look at biological condition, broken leg, on a dog, like your friend of mine, let's say they break a leg, God forbid.

Take an x -ray, you see the break. What do do? You put a cast on, Human, same thing. Well, let's look at the same thing in dogs. In fact, I was the first one in the globe to treat PTSD of the dog using stellate.

So I'll give you one example which kind of tells you where everything is because sympathetic nervous system, that's one of the most basic systems. I'm sure with your education you know that. But there was a study done in South Korea that they induced experimental PTSD in rats. The way you do it, you drop them in the water and they start to sink. You got PTSD from it. You flush them out, whatever. They took half of them and did stellates on them. And the other ones didn't have it.

So they put them back in the water. The ones that sell it, swim out. It shows you, because there's no placebo. People say, well, PTSD, is it real? Doesn't exist. It exists, you can see in the scanner. But just a mere fact those rats swim out means they learned helplessness by the way. Isn't that interesting? That is interesting. Because limbic system in all mammals is the same. So you can do that. And the other part is interesting. If you cut out amygdala in the rat or...

Dr. Eugene Lipov (21:11.286)
A human has amygdala stroke. You cannot give him PTSD. can't get PTSD for it. It's gone. You need amygdala to have PTSD circuits. Do you think PTSD... It's bizarre. It's crazy. But now I'm thinking about anxiety, panic disorders as a symptom of PTSD. Because you kind of get the same effect, you know, when you get traumatized or something really bad happens to you. What's the question? The question is, do you think that...

anxiety panic disorders could be kind of a symptom of PTSD? I may. So back to the diagnosis, right? So my psychiatric colleagues use this term. It's not a biologic term. It's, know, PTSD is basically in order to diagnose you need multiple symptoms. So if you look at DSM, I, DSM people know me very well because I've been trying to change the name. So I'm a thorn in my side.

Well, I mean, is because the only reason, by the way, I want to change that is because a four -star journal, Sherely, in 2013 said if you can change the name to this, people won't kill as many, they won't kill themselves as much. Why wouldn't you do that? That's not. That alone. Right. That should be easy. Anyway, so the point is I think it's artificial.

PTSD, anxiety, depression. If you have PTSD, you're to have anxiety, you're going have depression. So if you look at the backwards, like in pain arena, somebody comes in CRPS, which is burning pain, and I do the block on them, two things can happen. One, pain goes away, or it doesn't. Simple. If it goes away, it's called SMP, Sympathetic Demedicated Pain. If it doesn't go away, it's called SIP, Sympathetic Independent Pain. Right?

To me, all psychiatric disease is sympathetic -immediated psychiatric disease or sympathetic -independent disease. Why do I say that? Let's review the articles. 1942 Cleveland Clinic wrote an article about stellate for depression, Duquois depression. Weird, right? 2023, Dr. Mulvaney and Lynch wrote an article that it works on anxiety.

Dr. Eugene Lipov (23:31.758)
Now you can, like, if you look at our patients, we evaluate for PTSD, depression, because those are comorbid. You can't really separate them, right? But here's a weird one. So there was an article written in 2003 in Canadian journal of anesthesia. So the patient was from Japan. He was a schizophrenic. He gets kicked off the horse, fractures his left shoulder. He gets a stellate done. After the first one, his voices, which were nasty, became...

calm and collected after second went away. Why would that happen? Amygdala controls schizophrenia in many ways. So to me, and since I've tried schizoaffective disorders, type of schizophrenia, the point is it's sympathetically mediated psychiatric condition. It doesn't matter and you can split them. They're all the same. So we have depression with psychosis, right? When you see hallucinations.

I would bet a lot of those guys will respond to sell it. That is interesting. Yeah. So the whole, the whole DSM to me is a very,

highly outdated, first of all, plus we need physiological measures.

FMR is $5 ,000 per skin, very expensive. They have others like EEG, I think is not very effective, in my opinion. But there are other things coming like DNA testing, epigenetic change, all of that. But I think people don't understand this. PTSD causes physiologic problems, such as somebody who has PTSD, the chance of developing heart attacks is twice as high. That's not good. 85 % of men have sexual dysfunction, which is fixable by doing cellulite. I wrote a chapter on that.

Dr. Eugene Lipov (25:21.358)
So part of, since my mother had PTSD from my father who got it from World War II, so we call it secondary PTSD. Like I have it too, but I had treatment and I'm fine. So what we're trying to do, especially with special forces, we treat the guys, the women and the kids. Right? Because you can look at PTSD as STD. Wow. Because if you heal the guy, but the woman is still there, it should trigger him and then keep going back and forth. So if you stop it,

Yeah I said my god, we can have sex we can sit around not fight. We're not arguing about anything. We're enjoying our lives What what is that? That's what it should be. That's what to me that's Treatment that's successful treatment not talking about we had a breakthrough today. Maybe another one tomorrow. No, it's such a bad what because you're asking someone's broken leg to keep running Fix the leg and then make it run

So what we find, a lot of people can do a really good job being participating in psychological care. So then it's really effective. then two, three months and you're done. You can reduce the meds. You know how many drugs, average amount of medications, men or whatever, women, in the VA take for PTSD? 15. 15 different kinds? 15 drugs, different kinds. For one person. One person. That's not good.

No, because well, what happens you can give this drug. no, it side effects. have to give this drug. no, this drug. No, no, can't sleep. Okay, we need to be awake. So, but for example, one of my favorite drugs, the least favorite drugs is atypical on psychotics like resorbital and sarco. Those drugs one per year use. So if it's two years, it's two out of a thousand, the heart stops and they die because diabetes, impotence, nothing important.

Right? It's like diabetes, impotence, heart attacks, water, my car decks still. And we still use it. It's one of the most common. People don't buy the knife for the side effects that that has. Not a problem. We have no problem with that. Yeah. It's a tiny warning. A lot of women toast that. I mean, they make their guys throw that particular drug in garbage. That's expensive. So the fishes are now.

Dr. Eugene Lipov (27:46.194)
are anti -psychotics. Is that scary? It really is because they are contaminating the water. Exactly. least the fish are chill, diabetes and heart attacks. More fits. I don't know. I don't know what does to the fish, but I wouldn't want to find out. I don't want to that fish. But you know what? That's been one of the most frustrating parts about growing up with panic attacks and generalized anxiety disorder is

I've always felt like it had a physiologic cause. I remember the first time I experienced a panic attack, I was 11 or 12 years old at one of the summer camps. And I experienced the physical symptoms of the anxiety. And in my mind, they didn't come about because of any particular reason. They just happened. My heart rate increased, my hands started sweating. Did I feel like your chest was squeezing? Yeah. Heart, take a deep breath.

heart ticket, deep breath, dizziness, dissociation. I had a lot of physical symptoms and the solution from my counselor at that time, I didn't even know a psychologist, was to talk it out, to talk through it. yeah. Great plan. What are you afraid of? And I remember at 12, I was afraid of being afraid. I was afraid of the sensation that I was experiencing. It feels uncomfortable. It feels scary, really uncomfortable. You don't understand it. You don't know how to get out of it. Sometimes you can't and the only thing you can do is go to sleep. I don't know.

Sometimes it's out of your control. Sometimes it goes away when it wants to. Let me give you a weird concept. Do you know what it feels like to feel doom, like that thing is going to happen? Do you feel it now? Let me tell you a funny story. So there is a disease called theochromocytoma from Neurodorothy. It's exotic. It's one of those zebras. One in 10 ,000 people have it. The way it presents a lot of times is strokes, heart attacks, very high blood pressure. It's adrenal gland producing norepinephrine.

too much norepinephrine. Right? So you can see why it'd be a problem. Number three symptom is doom, feeling of doom. If you take it out, feeling of doom is gone. Why? Too much norepinephrine. What do you think stellate produces? Norepinephrine. It's biologic. That's my whole, it's biologic. If you look at it biologically and then you can do psychological intervention, that's the effective method. So then, I mean, they do prescribe for banalol to lower your heart rate.

Dr. Eugene Lipov (30:13.314)
You know the problem with Propranolol? It's a beta blocker. Norepinephrine is alpha blocker. need alpha blocker. Yeah, that's all the problem. That just decreases one of the symptoms. But my point is beta blocker won't even touch it. No, exactly. So the only thing that's effective for sleep for PTSD is prazicin, which is alpha one blocking agent. It's not as good as Steli, but it works in the same principle. It's all norepinephrine. So Propranololol, it won't do anything.

It is, but anyway, I understand the skepticism from the medical industry as far as accepting a new treatment. But I think like it's really rare to find practitioners like you that are genuinely interested and passionate about what they do. I'll give you an example. I've been looking for something like this for quite some time, maybe two or three years. You know, I've been looking into ketamine treatments, alternative treatments. I don't want to be taking meds. I don't want to take more meds. You know, I want to figure out.

a way that I can truly have my condition under control and it's not constantly surprising me at random times in my life. But I never, the appointments, meetings that I had with these people felt like such a sales pitch. It is. It is. Well, the model, well, part of the good Because they're not passionate about it. They don't understand it. They haven't done the research. don't, and that doesn't, as a patient, it doesn't make you feel like you can trust the person. Well, know, the reason I'm passionate is because my mother.

Yeah. Right. I mean, it's pretty clear. So that's part of the reason. mean, for me, it's an amazing plus to see people do well and thrive, especially women, obviously men and women and children. Like I did it my kid. So I appreciate it. Anyway, I think we should summarize and maybe we'll maybe we'll do something more later. For sure. But let me finish my comment. I'm sorry. you're so nice. Thank you. No, you guys are so awesome.

When I first made my appointment and got connected with a nurse practitioner, Haley, what's her name? Heather. Heather. Not Haley. Hannah. Yes, I got started with an age. And I had the consultation with her. Just that alone, for example, I didn't know about your passion for this when I came in. But the entire process kind of exudes that confidence and real focus on patient care.

Dr. Eugene Lipov (32:36.122)
Well, it's really rare really is so I appreciate you know what my father used to say fish stings from the head Fish what? fish stings from the head Anybody who is not that caring I'm not gonna work here. I work them all we had a couple people like that Because it can be my family right? It could be my friends. It could be I mean, why would you treat? Patients like your family if now if you don't then either you hate your family

Or do some other problems. Or you need a block. Something like that. Well, hopefully you feel good. Do feel any different than compared to when you came? Yeah, I do. The perfect way that I can describe it is serenity. That's kind of the word that I felt like. It's probably as good as possible. Yeah. So coming into the treatment yesterday for the right side, I felt upregulated. just felt like on a revved up, which is how I usually feel. Right.

And, literally I got the block and immediately after I felt kind of like as if the noise of the world shut up. You know, it's interesting. One of the people who treated, as a sci -fi writer from Portland and he said, the block stopped the chudging monkeys in my brain. Like you description. It's hard to describe the sensation, right? But that's something like that. Well, I hope it's.

goes great and I hope maybe we can work on change the name. I think we could save a lot of lives with that. I agree. Thank you. Thanks for coming. Really appreciate it.

Okie dokie before my patient