Best of: How Adopting a Child with Special Needs Led to a Medical Revolution | E184

And last but not least, this week's number 6, bringing back top episodes that you all have enjoyed, that people have asked about, is actually where it all started. This is how I started my field of medicine with my daughter, Anna. This week's episode, we talk about how adopting a kid with special needs changed my personal life, my career. It's the reason why Richmond Integrative and Functional Medicine exists. Literally adopting my daughter has changed tens of thousands of patients' lives. So, um, this is where it all began. So if you're wondering why we do what we do, this episode will tell you exactly why we do what we do. Um, it's why, you know, family members, those you love really change things. And this has changed everything about me and my practice of medicine. So I really hope you enjoy this week's episode. For me, it was more of an awakening. It was like, whoa, this is the thing. This is the thing that the experts are wrong. And this is the thing that a well-meaning person doing the right thing, adopting a child that literally no one else wants, can be investigated.

Right.

This is Crazy. And actually in the special needs world for kids with special needs with rare diseases, this actually happens a bunch.

Hey there. My name is Dr. Christian Genske and I am one of the clinicians at Richmond Integrative and Functional Medicine. And I am here with the infamous Dr. Aaron Hartman. Dr. Hartman is the founder and co-CEO of Richmond Integrative and Functional Medicine. And we have been colleagues and friends for a while now. And he wears many hats. He's a family practitioner, Also has a research group, also was in the military, has done some mission work, has done many, many things. And the goal of today is to kind of learn a little bit about him and what he's done in his life. And so, we're going to start by talking about your journey in medicine and ultimately kind of how you found your way to medicine. And then, secondary question to that would be how you found your way to functional medicine specifically. So, let's start there.

Yeah, my journey, it's kind of the typical atypical journey. I remember being, I think maybe in 2nd or 3rd grade, walking through the park with my parents saying I was going to be a doctor when I grew up. And I mean, the usual kind of things that kids like, you know, want to be astronaut or whatever. Yeah. And I think my parents just kind of like, oh, that's nice, dear. My dad was like the first person in my family to graduate from actually high school and college. So it's kind of like, you know, yeah, sure, I'll be a doctor kind of thing. Right. And did the usual pathway, got into medical school. I liked learning. After I finished my residency, I did the typical thing, which I thought was typical, was like trying to learn a new procedure, a new thing every year. So just over the first 10 years out of practice, just started developing a deeper clinical skillset, worked in a lot of different places. I was kind of counting up a while ago, I've practiced medicine in 7 different countries and I think 5 different continents. So, or 4 different continents. So I've had a lot of clinical experience, which is very much what a standard academic doctor kind of does. You just learn and you grow and you practice, like for you, Chicago and all these different places you've been, and you just build up your clinical armamentarium. But that got me to a point. And you get to a point after 12 years in practice where you feel pretty, like, I feel, took me about 12 years in practice to feel confident. Like, okay, I'm, I can handle a hospitalized patient. I can take care of someone in the ICU. I can admit someone to the ER after the ER guys have made sure they're not, you know, dying. Right. But then that inflection point came with my daughter, with the medical world. And one of the things that happened with our oldest daughter, Anna, is that the process of adopting her, while we had her as a foster kid, one of the GI doctors that was taking care of her recommended her putting a PEG tube in for feeding because she has Cerebral palsy. And one of the things with kids with CP is they're just really small. And so this, and you've seen this happens with lots of kids, they're small, they got special needs. And so the typical thing is give them formula, give them lots of food, fatten them up, because that's kind of all you can do for them. And we just felt like, my wife and I felt like that wasn't, it didn't feel right. My wife and I had conversations about feeding and talking and crawling. And even though my daughter was never supposed to walk and she was never supposed to talk and she was never supposed to crawl, we just had higher expectations for her. Again, at that point in time, she's fostering. She's not our daughter technically yet. And so we opted out. We said, no, we're not gonna put a PEG tube in. We're not gonna put a feeding tube in. We're gonna do this the hard way. Yeah.

The right way.

The right way. Yeah. The first inflection point was the response of the healthcare system. The GI doctor reported us to Child Protective Services. Gosh. I didn't hear that. Yeah. For child neglect. Yeah. We refused the doctor's orders. And so we got investigated for child abuse via neglect because we refused to do what the doctor told us to do. Oh my gosh. Even though my wife is an expert with kids with special needs and OT. I'm a medical doctor. The funniest thing is the nurse that came out to investigate us actually was one of my wife's colleagues because my wife worked in the system. So it's literally the person comes out and investigates us for being bad people. It's like, hey, how you doing? It's a nice conversation. Yeah. Oh, Nate, Nate talked about the GI doctor. Yeah, they put tubes in everybody.

Yeah.

It's one of those conversations you have in hindsight. You're like, they do put tubes in every single kid who has feeding issues. Like, that's not right. So that was our first kind of like bump up to the system, what the system thinks when you don't go with the flow. The second aha moment, which was like the really like question experts, right? Was 6 months later, she was doing research and found a growth chart for kids with cerebral palsy. My daughter was right in the middle. So, the GI, the expert, was looking at a typical developmental child growth chart, which my child, my daughter was like less than the second percentile.

Right.

But, for a typical CP kid, she was in the middle. She didn't need the feeding tube. She didn't need that, but the GI doctor didn't know that.

Wrong frame of reference.

Wrong frame of reference. And so, all of a sudden, it was like, can you trust the experts? Because sometimes they don't know. And so, that was our second aha moment, not just does the system not like you bucking it and they might report you to authorities, but they're wrong sometimes. And so, those were like, I like to say it, it's the ancient Cape Canaveral, that's the mile at the moon, right? A little deviation off course, When you add a year or 2 or 3 and another deviation, another deviation was like the path we started down. But now, I mean, this is, that was 2006. So this is, it was 18 years later.

And you hadn't had any experience similar while practicing medicine. I mean, clearly there are moments when you're practicing as a clinician where you're questioning things and maybe you don't agree with a, a colleague or a specialist that you're referring patients to, but nothing of this magnitude. And, and then there's the emotionality that's attached to it too, because this is your daughter or future daughter, someone that you're already falling in love with. So this was a really big turning point for you and your wife at this time, right?

For me, I will say it was a process of falling in love with my daughter, and that's another story altogether.

Yeah.

You know, my wife says a Tin Man got a heart, you know, kind of thing. And for me, it was more of awakening. It was like, whoa, this is the thing. This is the thing that the experts are wrong. And this is the thing that a well-meaning person doing the right thing, adopting a child that literally no one else wants, can be investigated, right? This is Crazy. And actually in the special needs world for kids with special needs with rare diseases, this actually happens a bunch. We've— my life side colleagues who they've gone, they've been locally here for like GI issues, been said, hey, we can't help you, go up to Harvard. So they go up to Mass General, get up there, say, hey, I'm here for Dr. XYZ. And the intern admitting them is like, you're crazy. And they lose their kid for 3 months and have to fight over this whole— like that actually happens way more than it should happen. It shouldn't happen at all. in the world of kids with special needs. So it was our first aha. It can happen to us too. This is supposed to happen to those people, not us.

Yeah.

And then you realize that this happens a lot more than you think. And then being that now both of us being in healthcare for a while, how many people get, um, the term for it now is gaslit. They didn't have a term for it back then. Now it's like, oh, you got, you know, I'm getting gaslit. It happens. And for me, it was more of like a recognition like, oh, I need to start questioning these people that say they know They're all-knowing. So that happened when, like a year later, like it wasn't actually, it was within the same year because we're still in Florida at that point in time where the eye doctor, my daughter also has this issue with strabismus. Her eyes kind of wander and wobble and looks kind of weird, but it wasn't, it was discordant. So basically they wouldn't go together and come and go. So it was a processing thing. It was a midbrain. I kind of later learned into functional neurology. It was actually from one of her strokes she had. It's a midbrain damage issue. And the ophthalmologist was like, let's cut her eyeballs and make her look normal. I'm like, well, at this stage, I don't care. I want functional. I want her to be able to see and read. I want a kid who's never seen.

This isn't about aesthetics.

Yeah, no. And so we're like, thank you for that opinion. Yeah. Got a consult with an older ophthalmologist, was like, you know, you can do it when they're 6, just there's no rush. Just patch the eye, make her use her hands, try to hit her, lift her head up so she can, which she couldn't do at that point in time either. And then that kept on going from later on, they recommend because of some of her spinal issues doing a surgical procedure called a dorsal rhizotomy, which is where they cut nerves in your back so that you lose tone in your legs. But the problem is you lose strength so you can't ever walk. And you look good in a wheelchair, but your legs become nonfunctional. And then when you're 14, you have contractures, so you get surgeries. So we're like, hmm, I don't know about that. And so we ended up going up to DuPont in Jersey to actually the guy who actually wrote the textbook on cerebral palsy. And he was like, no, I wouldn't do that. I wouldn't do this surgery instead. So we were kind of like, okay, well, surgery. And he was like, well, give it a year and see what happens. So we had this happen so many times where we get to a point in her journey and someone would be like, we cannot offer your daughter anything else. Here's the surgical procedure to do. And we would just—

And that was good enough, right? You just accepted it.

No, of course. We said, well, after a while I was like, hey, no. After a while I was like, come on, then you like hack up my daughter.

One instance going all the way back to the feeding tube became a series of instances where it was like, this is the norm in every issue that we find wrong with our child and we see a specialist for, they're suggesting something that we ultimately disagree with and they're not giving us an alternative. And that's kind of crazy.

I mean, it was 2006 to 2008-ish, '09-ish was when we were kind of going through that process. So that was before, at least in my understanding, before the internet was like, before it was what it is today where you can just find stuff. I mean, it was a respectable doctor. I never went to the internet for anything, right? You know, now it's like I can go to PubMed and pull stuff up. I read textbooks, but I just, you know, But, it just was one of those things where it was like to be in that situation personally and then to walk through that and then throughout all these different pathways through doing gene testing and finding out her nutritional epigenetic expression and changing certain nutrients and then doing advanced gut testing and doing lipid analysis on her, then realizing that in Germany they have this thing called the Galileo, which is an alternating vibration device they use with people with spinal cord injuries that can actually make her brain think she's walking and actually activate her leg muscles. And then started studying functional neurology and realizing actually you can actually do exercises to activate the brain. So went to Atlanta to a clinic, was associated with the Curry Clinic, where they do this rotational stuff to learn how to stimulate her inner ear for muscle stuff. And then realized, wait a second, they were doing like these oral stimulation devices there, which I thought was the weirdest thing I've ever seen. And then 4 years later, I'm going to Canada to get this thing called PONS, which is now FDA approved in the United States to treat balance issues and multiple sclerosis. Well, in Russia, Well, they use them to treat kids with CP. So, I have to go to Canada to get that. So, it's just they kept on building and building and building. And so, today, she's 17, getting ready to turn 18, and she's never had a surgical procedure. She's on no medications and drugs. She's had Anabox once since we've got her.

And she walks?

She walks with forearm crutches. Yeah. Well, actually, that's really interesting. So, she started doing puzzles. Well, she started being able to read like 2 years ago. Now she can actually read her text, read her phone, read texts. Now she can actually like text grandma and grandparents, and she can actually read the texts they send back to her now, which is kind of cool. And she started doing puzzles and she actually did a 60— Chad will help with this one, but 60-piece puzzle a couple weeks ago. And this is a kid who we were told would never see, never read, who would be a vegetable. Every fall the schedule tightens and most of our attention goes to getting the kids ready. Almost none of it goes to the person holding the whole thing together. So I put together these 3 things just for that: a daily multivitamin in the active forms your body can actually use, quercetin and nettles to support your immune and respiratory health without the drowsiness, and NAC and acetylcysteine to help your body rebuild its own antioxidant reserve. This is what I take every fall. That's aaronhartmanmd.com/backtoschool. And this is one of the things my wife makes a big deal about. In the therapy world, kids with CP usually peak out between 4 to 6 years of age. And after that, you start doing surgeries and they just don't because of, they're sitting in a chair and not moving. I'm at 17. She's never peaked out. She gets better every year. She learns to do something new every year. She's a rock star, you know? And so basically she's got this go-to-it attitude. She'll do anything, give it. She complains, I'm tired, Dad. I don't want to take these pills. I don't want to do that. You know? But she's like, I don't want to do that as she's putting them down. She's like, Dad, I don't want to do that device. We started a new thing with her recently, transcranial direct current stimulation, because I was reading some stuff about using that with people with ADHD and focusing. And my thinking was we could actually, if she's doing these puzzles and reading, could I through transcranial direct current stimulation actually reinforce those pathways? So we started doing that and she's like, I hate this, Dad, I don't want to do it. But now she's like, Dad, are we going to do it now? And then she's complaining about it, but she does it. So she is just, oh, A rock star.

Yeah. I've met her. It's true. One of my favorite Anna stories is when I came over to your house and she literally, with assistance, but mostly her, was walk— walked down the stairs, walked all the way across the room. And when she got to me, Becky said, hey, you remember Dr. Jansky? Do you wanna say hi? She's like, can I sit down first? And she was like sweating. She sat down and then she was like, hi, Dr. Jansky. And I just started laughing like I am now because That was a lot of work and, and work that she wasn't expected to ever be able to do.

Yeah.

I was just like, that kind of speaks volumes about the commitment of you and your wife and what you guys, that kind of no quit, never give up attitude. And that clearly was an inflection point for you that kind of transformed your trajectory as a clinician, as a medical scientist, as a provider. And really, I think kind of opened your eyes to many things and pushed you towards the realm of functional medicine and integrative medicine. And so that was a massive inflection point. You also have other children as well. And so how have they influenced you and how have you been influenced by them in this whole functional journey? And how has it kind of in totality affected your family?

Well, me and Anna was where we started, but our second daughter, Rita, and I don't talk as much about her because she's 16 and she has her own story to say, but she had her own health issues that we've worked through that very, very, very significant. Our son was interesting when we got him. Because he almost 6 months old when we got him and he had horrible, horrible eczema. His skin was awful. 2 of our kids are African American. And when we got Khalil, he had all the typical— you see like these brown and dark-skinned individuals when they get bad eczema, like it just makes their skin blotchy and it just looks— it can be kind of bad, especially with young kids that scratch. And he had the blotchiness on his face. It was just really, really, really bad. The first night we had him, my wife actually slept with him on her chest all night long because she was scared he'd stop breathing. Because he was wheezing horribly. And so, fast forward 6 months later, actually not 6 months because we end up losing him for 3 or 4 months and then getting him back. So, it's a trauma story. That's a trauma story.

That's the story for your wife to tell because she's the pit bull that got him back.

Yeah, she is. That's very true. But, I'm trying to think how— it was probably maybe it was more like 6 months later, 9 months later, asthma's mostly gone. A year later, asthma's gone, eczema's gone, At this stage in his life, if he watches what he eats, which is hard because he's 13 now, you know, he doesn't— the only time he like wheezes a little bit is when he gets a gastrointestinal tract infection, which happens. You know, kids get a little head cold a couple times a year, no big deal. He has never had antibiotics since we got him at 6 months. Our daughter Abigail, we got her at 2 years of age. She's never had antibiotics. So, I have 3 kids, no antibiotics. Like, how often does that happen? And the answer is never.

Never.

Between the 3 of them, I used to be able to say that none of them had cavities until Khalil decided to start making homemade lemon juice and then sucking it through a straw. And he went to the dentist and had cavities right here. And you've been in the ER, seen typically, for those who don't know, when people do crystal meth and drugs and street drugs.

Meth mouth.

And meth mouth, they'll get cavities right here. And I was looking at him like, how is he getting this? It wasn't like the typical kid cavities in the back. Right. And come to find out, it was him drinking, making homemade lemon juice. So we told him that and he got the fillings. He stopped doing that. So besides that, A number of our kids have had cavities when they didn't come from amazing places. I kind of joked that with Cleo, once we took away the donut holes, got them out of a moldy smoking environment, took away the donut holes and gave them real food.

Everything's better. The sky's the limit. Yeah. And it's like none of this was done with a bunch of medications and seeing a bunch of specialists. It was lifestyle, right? It's the kind of epitome in the core of what we do in functional medicine. And granted, we use those things when necessary. And sometimes we have to use those, especially in the adult population that has decades of disease that we're trying to prevent from getting worse and reverse. With a child, it tends to be a little bit easier depending on the situation. Clearly not an easy situation with Anna and potentially with either of them as well. But, but all of their lives have been transformed by you and Becky and your lives by them. And, and I think that is really the foundation of, of the impetus behind why you're currently doing what you're doing and continue to do it. So let's talk a little bit about that. How the heck do you go from, I am a family practice doctor and I'm learning these things and this makes sense and this is an aha moment for me, but maybe I'm just gonna provide my family this type of care, to, I want to give this to whomever wants it. I'm gonna practice functional medicine. I'm gonna learn functional medicine. I'm gonna open up shop and put up my shingle. Was it that I gradually started to kind of experiment with patients as I was learning, or like, you know, hands tied behind your back, blindfold on, you dove straight in? Like, how did you kind of approach this situation?

From a business perspective, very conservative. You know, I got to pay the bills and take care of the family. We've had conversations about that kind of stuff. And so, it was like, well, how do I do this? After moving back to Richmond, being here, moved back here in 2007. In 2010, opened up Virginia Research Center, which is a research company. And so, focusing on that and really learning really some really cool things about— one of the things when you do a research study is you get these investigator brochures called IBEs. And basically has all, it's like usually 80, 100 pages of all the research going into like why this drug might work.

Wow.

So, I started just enjoying reading those because it's like, oh, wow, like this drug coming to market, the research that will result in this coming to market in 5 years has 20 years of research behind it. And you're like, whoa, like I thought this new fancy drug. Yeah, the new fancy drug, the stuff on it is decades old. Now, I started thinking, huh, what if I could go back 10 years ago and use that data? Is there other way to recreate what that drug is doing? Like with other stuff, right? And that's kind of, we do that all the time now.

I heard repurposing it.

Yeah. Yeah. So, so starting that, those seeds dropped in my mind reading The Consultant, Michael Thorway journals that I was one of the few people that actually read those things. And then I kept on getting these things from like different AHIM at that point in time, which I think is now the ABIHM, American Board of Integrative Medicine, and then IFM, Institute for Functional Medicine. So eventually in 2000, 2011, I believe. I went to one of the annual conferences in Tampa for the American Board of— it was the AHI at that point in time, or the ABL. I get these initials. I forget. There's a lot of them. I know I am. And so, there's a conference in those 3 days of me going, what is going on? Like, people are saying words, indole-3-carbamol. I'm like, what is that? You know, quercetin. I'm like, what is this? Berberine. Like, what are these things you're talking about?

Gibberish.

Gibberish, small nucleotide polymorphisms.

Yeah.

And, I'm like, so I would leave that. I'm like, this is— I talked to some older guys. They're like, how do you do this? Because I have no idea how to do this. That planted the seeds, but I was already doing this with my daughter. And, I'd stumbled across Amy Asker's work who's a PhD who had a child with autism. And so, she used her scientific background to research SNPs and has a whole protocol on kids with autism doing gene analysis. And based on their SNPs, these are the nutrients that are right for your genes. So I started that with my daughter, then started training with AIHM, then came across the IFM and then just started doing that. And then there's all of a sudden, okay, well let me do a NutraEval, which is this organic acid test that they do in kids. I started at translational medicine because in IFM now and A4M now, there is no track for kids with CP. There's no track for kids who have massive drug exposures and strokes before birth. When's the last time you saw a conference about that?

Never.

So, if I was at the get-go like, okay, like my daughter's here, what kind of has biologic plausibility? So, I started with autism because there was just a lot more things with that and started learning about different things. I stumbled across functional neurology, which is Dr. Dee Scarazi and Dr. Brock, if you've heard, like that kind of stuff. I'm like, wait a second, I can watch how someone walks and tell what's going on with their brain? Right? It was kind of interesting for me because I have an issue like In loud rooms, I can't understand speech very well because I can't decode your words very well with this background noise. I have horrible handwriting, as you know.

Yeah.

Everybody who's ever worked with me knows, right?

Yes.

That actually can be a parietal lobe issue. And then I'm like, wait a second, I had this bad concussion when I was in 2nd grade.

Huh.

Maybe there's a link between my inability to understand speech in loud areas and my poor handwriting. And so I kind of started, let's do some of these things with Anna. And so it was just this process of— Root causality, right? Yeah. Tracking it back. Tracking it back to— well, again, how many lectures do we have in IFM training on functional neurology?

Not many.

Yeah, 1 or 2 maybe.

It's gut.

It's gut.

Yeah, hormones.

Yeah, exactly. And so, there's actually a fellowship you can do, a 2-year fellowship you can do on this. I did that. I did it in about 6 months. So, I did that and just got that information. So then, all of a sudden, it's like, okay, how can I use energy, e-stim, NMS? Then even, it's going to be a pretty big world now. And then you realize, wait a second, in Germany, they've been doing this stuff Since the '50s.

Yeah.

And then, you know, you go to a conference and you realize PEMF is actually used in professional, like million-dollar horses, like these high-end athletes that are horses. They actually use hyperbaric, like a hor— like bigger than this room, the horses go in and PEMF to help them heal quicker for injuries. So, how come this world they're using it on these million-dollar athletes and in my world it's hooey? Yeah. But there's a book I can read on it that goes over the last 50 years of research on it. So started doing that. And then, you know, you see people come in your office and you're just kind of like, you've got chronic fatigue, you've got fibro, you've got post-concussive syndrome. You've got this, whatever chronic Lyme disease thing is. Your gut's a mess. Your hormones are off. You've got this weird skin disease they call psychogenic parasitosis, right? Morgellons. Well, actually, maybe it's a chronic skin Lyme disease. So the traditional world says that's basically all in your head. And then there's ways that it actually could be, there's a parasite that messes with you.

You all started seeing patterns and you started realizing clinically that there are disease states that you were maybe missing, or at least overlooking because of, I mean, you went to medical school, you went to residency, you had the best training, you graduated at the top of your class, you had experience. And now all of a sudden you're learning these things and your whole world opens up to the actual world that we live in and where things are being utilized for decades in other countries. And now you're learning about it. And, you go into your clinic and you're seeing patients and you're like, maybe they got this and maybe they got this. And, you're starting to kind of draw those connections. So, how does that translate into the next step?

Well, I start to cherry-pick because I'm seeing 26 to 28 people a day. A lot of people. And so, 12-minute time slots, 10-minute time slots.

Fast food.

Fast food, yeah. Come in. Big Mac is a Big Mac no matter where you go in the country, right? Diet Coke's a Diet Coke no matter where you go in the country, right? Chronic fatigue is chronic fatigue no matter where you go in the country. And, the reality is that is not the case. If you got diabetes, Because you're in the Gulf War, because you're in Vietnam, or because you have silver fillings in your mouth. You treat all those differently. So, I started like—

We do.

We, yeah, we do. Yeah. We, sorry, should I— We do.

Correct.

Correct. Yeah.

Yeah.

I stand corrected though.

Yeah.

Thank you, Dr. Jansky.

You're welcome.

So, I started saying, okay, these people come in, I'm like, hey, you know, would you consider doing this? Side Order and NutrEval, GI Effects.

Were people receptive?

I was picking the people I thought would be open to it.

Yeah.

Because, Again, you don't have time to convince someone that you might have to pay $200 from some labs.

Yeah.

I got to figure out what to do with them.

Yeah.

So, I don't have the time. So, you just kind of start playing with it a little bit. I started doing that probably 2013-ish.

Family's helpful for that, by the way.

They are. Well, I was already with family. You were. You were. Yeah.

That's where in-laws come in.

That's where in-laws, brothers, and dads, if they're amenable to it. The key is that. If they're amenable, yes. So, I started doing that and started playing with it and just Experimenting. I mean, the practice of medicine is the practice. After all these years, I think we're in the same place where after all these years, I feel like I know less now than I did when I finished my residency. Let me rephrase that. I feel like I have less of a grasp.

Yeah.

I know way more, but it's like back then, I remember talking with my cousin. I was at the end of my residency program and I read all the textbooks you get. You know, I read my OB-GYN textbook, my surgical textbook, my pediatric textbook. I mastered those, took my boards, scored the top 10 percentile. I could literally ignore stuff that was in the books. I remember having a conversation with my cousin. Trevor may or may not remember this conversation, but I've mastered medicine. I've mastered it. I know it. I've got it. I vocally expressed these words outside.

You said that?

I said that, yes. And, he countered me, Marc, well, you're just a young kid. The good news is I grew out of that.

Yeah.

The good news is I grew out of that.

Yeah.

But, that's how the system trains you.

Yeah.

They train you, You know it all, buddy.

Yeah, you know it all. And then you can go even beyond that and subspecialize and get to the point where you feel like you know it even better and know it even more and know it even deeper. And the reality is the deeper you go, sometimes the less you know, and you have to take that step back and take more of a 50,000-foot view. Sometimes the step back, the questioning what you're doing, and that kind of segues into my next question, which is self-doubt. Right? Like, this is a nice segue where you're learning these things and we'll get back to how you kind of developed this functional practice. But along the way, there's no way you can't have doubt, especially when you're going from a system where I'm learning X, Y, and Z. Everybody else is learning it the same way. You graduate, you pick what you wanna do, right? I wanna be a pediatrician. I wanna be family practice. I wanna be ER. I wanna be a surgeon. You hopefully match, you get a residency, you hone your skills in that subspecialty. Maybe you go onto a fellowship to do even more of a honing, and then you practice and you think you know everything you need to know, and you go on to practice what you've learned during that timeframe for the rest of your career. And years down the road, you're maybe practicing antiquated medicine. In our case, we're constantly learning and learning and learning. But now you're in a situation where you're learning all new stuff, completely rethinking things. How does doubt play a role in all of this? How do you get to the point where it's like, is this hooey? Am I doing what I'm supposed to be doing? This does Does this make sense to me? Am I barking up the wrong tree, or is this true?

Every fall, the schedule tightens, and most of our attention goes to getting the kids ready. Almost none of it goes to the person holding the whole thing together. So I put together these 3 things just for that: a daily multivitamin in the active forms your body can actually use, quercetin and nettles to support your immune and respiratory health without the drowsiness, And NAC and acetylcysteine to help your body rebuild its own antioxidant reserve. This is what I take every fall. That's Aaron Hartman MD dot com slash back to school. I think I had doubts early on because well then no, I guess it was intriguing early on as I was studying and learning it. I think the big inflection point for that was probably when I started coming across patients with mold mold issues with with SIRS. Yeah. And because it was so different than all the different of the different I've already been doing. Yeah. It's like. Did we learn about that in our functional medicine training? No, no. Like, we had to do a separate certification that's like 70 credit hours through George Washington. And I also did the Shoemaker stuff, which is like a— it was over a year of stuff, you know. It's just so difficult.

It's more known now, but it's still fringe. I mean, and this was then. I mean, this was it when it was like, this is like, you're crazy. You're crazy to say that.

You say it's mold. Yeah, exactly. So what happened was I came across that, and then you're like, We start testing patients for it. These labs come back and they're positive and you see it over and over again. And I'm like, how can everybody be mold? How can it be? How can every gut patient also be a mold patient? How can— not every, I'm thinking like probably a third, a quarter to third.

Yeah.

But it's like a lot.

Quarter, fifth.

To sixth. We'll talk about that when we do Ryan Hiltz. We will talk about that. That'll be our next big series. Yes, it does fit the genetics. That was very bright, Dr. Justin.

Thank you.

It's a very great insight. You're right. Yeah. But it's like, how was it like this many people? And you're like, wait a second, am I misdiagnosing a whole bunch of people? So I was like 6 months where I'm like, what's going on? And you have to realize like after a while, and that's where we're kind of practicing in a bubble. It's not like I can walk down the hall and talk with my partners I'm practicing with, or I can go online and consult with someone, or you call the local specialist up and say, hey, how many How many mold patients are you seeing and how many MARCoNs are positive? And what do your C4As look like in the Richmond area? You can't, there's no one referring. So you have such a good point because how often did you do that in the hospital? You had a question, you basically, who's your favorite cardiologist? Who's your favorite neurologist? Who's your, the guy coming onto the day shift or night shift that you respect as an ER doc?

It was so much easier to get answers to questions from somebody who'd been doing it longer than you.

Yeah. And we didn't have that, right? This is the first practice in Richmond doing this. And at that point in time, there were, even now there aren't mentoring resources where we can reach out, which has been great for us to be working together.

Right.

Because it's like we, we're both quick uptakes and we're, we're both quick studies and we tend to have good memories about things.

But it's nice to have that sounding board, right? Isn't it nice to be able to talk? I find it, and I know you probably feel the same way, I personally find it rewarding to be able to bounce something off of you and get that feedback because otherwise, what are you doing? You're going back to lectures you listen to, or you're trying to find some textbook that doesn't exist and maybe a webinar buried somewhere or some notes that you scribbled down that you probably can't even read if it's in your writing.

Yeah.

And the reality is like, you have to just have grit and desire to want to learn and continue to learn. And if there's a question and you don't know the answer, where do you get that answer? How do you figure it out? Like, how do you get to that point? So clearly doubt has to play a role. So keep going.

So it did. About 6 months after that, I kind of realized this is a thing that I need to commit to learning this. So how do you do that? And then part of my journey, you start the IFM with A4M training and you go on the pathway, then you kind of Go off the pathway for 3 to 6 months and go down this pathway. And that mold was one of those pathways I went down for about a year and then came back and went back to my regular path and went down the pathway again and came back, then went down the mast cell pathway, right? Then the hypermobile pathway. Then you realize the hypermobile pathway kind of connects with the SIRS pathway and the breast implant.

And the mast cell.

And here's how to know. And then all of a sudden you're like, no one's talking about hypermobility. Then you talk with our colleagues who are pediatricians or psychiatrists, and they're like, "Oh yeah, you're right. A lot of my autistic kids are hypermobile. Oh, you're right. Like, a lot of my long COVID patients are hypermobile." And so it's just this learning thing, and you get to the point where you're like, "You know what? It's like the Wild West. You know, first time you got to the Wild West, you're kind of uncomfortable. Everybody's got a gun, and you don't have a shoe. You're kind of scared. After a while, you're like, 'You know what? Where else are you?' Now it's like." Where else am I going to be?

Right.

Yeah. I could be the joke we talk about between the two of us. You know, there's people talk about the tip of the spear. We're like the compressed air at the tip of the spear.

Yeah.

That's like, we're kind of, of course we're practicing seeing patients and we're seeing stuff before it comes to the consciousness of even with our functional world, our institutions.

Right.

And so whether it's A4M, IFM, or ABIHM, or University of Arizona, University of Maryland, or whoever, it's like we're kind of seeing stuff and then doing our own search and seeing it and being like, whoa. And then we're implementing our practices. And all of a sudden, a year or two later, we hear, oh yeah, Dr. XYZ is talking about this now. It's like, okay, cool. It's kind of a cool place to be.

It is. It's nice. And it's rewarding in the sense that you have the foundation, which I think IFM has become that, where it's the foundation of functional medicine so that you can understand kind of what it means to most people. And that's really where the impetus towards the mainstream push is coming from. So they're careful and I get it. They're careful about some of the fringe stuff. and putting it out there. It's not that they don't believe it. It's not that some of 'em don't practice it, but they're careful about teaching it. And I get that. That's probably more of a business decision. But then there's A4M who's kind of has that like, I don't give a bleep attitude. And it's like, we're gonna put out whatever. And we've trained through both of those. And then we have board certification, or at least for IFM, it's not board, but it's a certification through both. And I think that's the beauty of it is like one wasn't enough for us.

Yeah.

We wanted foundation and then some, cuz I'm seeing things that weren't explained by one, so I need to get 'em explained by something else. And so you just search out where you're gonna get that. So that's awesome. So how did you then go from these patients that were amenable to this extra testing and you kind of figuring out what it meant? And I guess quickly talk about how that translated to improvement in their health and then this aha moment or another inflection point of maybe I need to open up shop, maybe I need to start a practice.

Well, it was just more like you do that, Again, I did that for a couple years, and eventually you're like, people want this, and I need more to do this the right way. Not to do it haphazardly, not to do it kind of gunslinging, you know, to do this the right way. I need 2 hours with this person. I need time. So talking with my wife, who has been along there with me this whole process, she was like, you should just build it and they will come. Man, literally, she said, she said, you have the dreams. Yeah, she was like, you put up just— I was like, ah, I guess I'll put up a shingle and see what happens, right? Now, for me saying I was going to publish a single, see what happens, I say it haphazardly. I got to publish a single, see what happens. And within 6 months, I was like a quarter to half booked. And this is with me not looking for anybody. Now, it sounds haphazard, but I spent a year creating a website, like creating verbiage, trying to figure out what resonated with people, putting little articles together, getting the frame for the website. Then I got my brother-in-law to put the graphics together for the website. So it was like an hour of preparation.

Yeah.

So on January 1st, 2017 popped up and the website went live. It wasn't like I put like an Aaron Hartman, MD, you know, whatever, but it was some thought into it, but I didn't work for anybody. I just put the shingle up and let's see what happens. Right. And people started coming in and I had my schedule start filling up. And by 2020, before the pandemic hit, I was probably 50/50 functional medicine, primary care, but I was kind of primed as well for when the pandemic hit as far as about to happen.

And never expecting this, never expecting that kind of response, maybe hoping for it, but not expecting it. And then also never expecting to probably need or want a colleague. And then I know come 2018, you're like, when are you done? I need some help because you were filling up. I was nervous. When you were like, when is your fellowship done? I need help now. And do you want to join? And it was amazing to see. And I go back to when I was saying, how did you kind of get in? Did you put your arms behind your back, blindfold and dive in? Anyone that knows you knows that's not how you do anything.

Yeah, I know.

Which is why it was a joke. And the reality is everything you do is incredibly well thought out and almost methodical in the way that you've kind of weighed all the pros and cons of every potential situation and then move in a way that although it may seem as a risk, you're also cautious and protected in the same way. And I think that's the beauty behind a lot of what you do. And so you were set up for success, in my opinion. I know in the moment you probably didn't feel that way, but in hindsight, I don't see how any other way it could have gone. So you continue to grow and you continue to grow. And then recently you moved the practice.

Yeah.

And so that's another inflection point. Let's talk about that. So when did the practice move and what has that meant for you, your family, and the practice as a whole?

Well, it's the practice physically we have now. We're 100% functional here, you know, across the street. We did that November of 2022. And so what it was, was basically my practice had become so much so I had a full-time family medicine practice, a full-time clinical research company. And a full-time functional medicine practice.

And so— And a family.

And then kids, a family, and a farm, you know. Yeah, farm as well.

And maybe a couple of hobbies.

Yeah, those are kind of my hobbies. Yeah, a couple hobbies. Yeah. Hobbies, what are those? Yeah, exactly. Do you have hobbies? I used to. You watch sports, don't you?

I do.

You thought soccer?

I do.

Yeah, I like soccer. You know, things like that.

I do.

Yeah. So I wish— sometimes I hear people, you say sports things, I'm like, huh, I grew up playing this. Yeah.

And so just, it's kind of embedded and ingrained in my life now. Beautifully. My children are taking to it. It's kind of nice. I've been patiently waiting to see if they would like sports and they both do and they're both starting to play soccer. Nice. As of last night, first soccer practice, first game is this weekend if they don't get rained out. But that's exciting.

Yeah. Cool. Cool. Yeah.

Makes me happy.

So it was one of those things where it was just kind of building and it came to a point where I was like, again, being very thoughtful and careful. Like when you came on board, it was like, this thing is growing too fast. People are scheduling out 6 months, 9 months. What am I going to do with them? And you came on, it was like we kind of melded together because you were like still in the ER. You didn't quite like, you realized the ER was not where you want to be forever. You were actually trying to get out, you know?

And I'm more of a hands behind the back, blindfold diving headfirst kind of guy.

Well, it was a little thing. It was one of those things where it's like, hey, you want to come here part-time? And again, you have to, we both have to support our families. We have to put in the savings. We have to like, we can't just not get paid for a year or 2. A typical practice, you don't actually break even for 2 or 3 years. And the functional practice is probably 3 to 5 years. Could either one of us go on without getting paid for 2 to 4 years? And the answer is no. So it was kind of like that meld where, okay, cool, let's start. You come on board, cool. I start building and building, and then I get to this inflection point where it's like, I'm kind of drowning. What's next? And so my wife, it's funny, we had been to one of our, we go to these business strategy kind of meetings, like how do you build your practice and kind of in the world, just very, meet a lot of high-level people who think at a different level than I'm used to thinking. And one of those meetings the year prior, my wife, like her moonshot goal, she didn't tell me, was I want to move the practice. And Aaron does full— and she wrote that down, shared it there, didn't tell me about it.

Awesome.

And I've been looking for spaces, but March of 2022, found what appeared to be the perfect place and started the process. Because my thing is, I kind of, in my life, I go through doors. Like my daughter, she shows up to us and I say, I believe certain things because of our personal faith. And it's like, Okay, if I say, you know, taking care of widows and orphans is supposed to be something part of my DNA as a person of faith, and now there's a kid without a home, do I actually believe what I say I believe? And so I'm very methodical, very robotic, and like, well, if I say I believe what I say I believe, then I should be willing to bring this child into my home. We do that, and I, hence after, fall in love with her, you know. The race begins, then the struggle begins.

Yeah.

The struggle's real, you know? And that's where it was. So let's Door opened. I'm like, well, I'm gonna walk through the door and also start negotiating the building. And that was like 6 months of like back and forth. It was kind of painful. Back and forth. Yeah. 100-some page contract. Kind of crazy.

Thank God for you and Becky.

Yeah. Well, I could just see patience. So did that process and then finished that. Actually, that was more like a film. So that was 3 months. That was 3 months. And then it's like, crud, I'm just signing this massive contract. And then when you sign a contract, you're saying, I'm gonna pay this for 7 years. So I'm putting my name down saying I'm personally guaranteeing over $1 million to this third party over the next 7 years. Like, oh my gosh, what did I just do? You know? Well, we need furniture. And so all of a sudden, like, so just that door opens up and the door opens up and all of a sudden November 1st comes and we're here. You know, I'm just walking through doing this. It just, in hindsight, it's like, what was I thinking? Like, how did I get here? But in the walking and the journey was just— Literally, I'm looking down my toes going, "There's one toe. There's another foot. There's another foot." I see a little pathway there. I wasn't getting stuck in the weeds, but it's in hindsight, you know, how did I get here? How did you get here? And in hindsight, like, where else would I want to be? Well, nowhere. Like, I can't imagine myself being anywhere else, and I have no idea how I got here. Yeah, like very much for me was like a faith journey. The shingle up again, open the doors up, and at this stage, our practices like I am in a maintenance phase. You're about the same phase now. We brought on a new nurse practitioner that we're training. She's learning a lot. Actually, most of her I am training now. I'm like excited for the next thing. We've started IV room.

What is next? Keep going.

Well, the next things, I want to take things to the next level because like functional medicine is cool. Integrative medicine is really cool. Energy medicine is really cool. Bio-photomodulation is really cool. Lipotherapy is really cool. I mean, there's all these things that are really cool. Like, create a space where people could come in, we can evaluate them. They got the basic, what we call basic, which is pretty advanced stuff. Then, when the physiology gets stuck doing IV nutritionals to bump over those hurdles, instead of a drug, let's do high-dose vitamin C, let's do IV glutathione. They get stuck then. Can we use pulsed electromagnetic field therapy to reregulate their autonomic nervous system, which you've experienced that before?

Yeah.

I mean, using that at home with— I can cherry-pick some patients with that. Can we add in photobiomodulation? There's so many cool things you can have.

Expanding the arsenal, right? So the tools, more tools we've got to use to treat patients and therefore expanding the ability to get people well, but also the expansive depth of pathology that we're then able to treat, but all under one roof, which is kind of crazy and beautiful and awesome all at the same time. So that, I guess, is the next step. And where are you in that process? Where are we now? Just to kind of speak, when he said maintenance, it means that he and I are basically right now, as we're making this, capped from a patient volume standpoint and kind of on maintenance. And as we're building, the goal is to kind of maintain a certain number, continue to treat patients. We have some IV stuff. What would be the next thing that you'd really want to consider bringing in?

Well, the next thing is that we've— I've looked at, I don't know, I'm just putting one foot in front of another. I've looked at, and we haven't talked about this yet, but I've looked at things like having the idea of personalized doctor, having that being available to patients, which is something we're probably looking at doing once we finish what we're doing right now. I'm filling up our procedure room doing IVs, potentially doing ozone, doing EBOO. You know, there's some really interesting research out there with plasmapheresis, maybe filling with— or doing IV albumin and how it modulates the immune system. Well, maybe you can do that with dialysis and then taking the dialyzed blood and exposing it to Ozone and UV light.

And putting it back in.

Putting it back in.

Yeah.

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