Where Physical Therapy and Functional Medicine Meet, with Dr. Bri Thornton

Welcome back to the Beyond Rehab Podcast, and I'm super excited because today I'm with Dr. Chris Ellis, who is the owner of Dynamic Naples, which is such a small world. His clinic is so close to mine, and when I started this journey to interview other physical therapists trained in functional medicine, I never thought there would be another one in my backyard. So welcome to the podcast, Chris, and tell us a little bit about yourself.

Sure. Okay. So I'm Dr. Chris. I've been a PT since 2013. I've been an outpatient the whole time. I did the typical PT grind in the middle for years and then finally decided to break out of the insurance world and open my practice about 8 years ago. And since then, probably about 3 years ago, I started a functional medicine practice on top of that. So that's, that's the big overview. There's more, a whole lot more to it. I do have a 2 employees that are actually OTs that do lymphatic drainage because I think that's such a good complement to functional medicine. So yeah, that's the gist.

And I feel like there's always a really good story to what leads people into functional medicine. So what was it for you that initially caught your attention and made you think, I really want to get trained in this and bring it into my practice?

Yeah, so personal experience. So, well, I'll tell you, I had like sort of 2 what I'd call like life crises in, you know, my first one would be what got me into physical therapy. It was in my early 20s. I was working on a job site as a carpenter. I managed to fall down an elevator shaft and fell 4 floors, broke through some wood on the way down, which basically saved my life. And when I landed, I broke my pelvis, my back, and my hand. I went through intense physical therapy for about 8 months. And, you know, I went into PT like overweight. I was on painkillers. I was depressed. Only time in my life I've been depressed. And it was PT that brought me back and just gave me my life back. And it was so incredible. I was like, that's what I want to do. So that's what got me into PT. And then maybe about 7 years ago, I had developed this like wheeze and cough out of nowhere. And it was just so persistent.

Hmm.

And it was to the point, I mean, you know, as a PT, like, so much of our job is education. I couldn't even barely talk because I was coughing so much. I would be afraid to laugh because I would cough so much. And at one point, my brother and I were playing a game with one of his friends, playing Settlers of Catan, if you know that. And his friend is really funny. So, and this is kind of just post-COVID, so people really, like, nervous about coughing. So he made a joke, and I knew I was about to cough. So I stood up from the table really fast, and then turned and coughed. And I fell down and had a seizure. That's never happened to me. I think my blood pressure just dropped so fast that I went down for— it was just like a couple seconds. And I was like, okay, I need to do something. And then I think I heard a podcast with Chris Kresser. I think it was on Kelly Starrett's podcast. Yeah, it was talking about, you know, root cause medicine, you know, and I totally understand the ethos. That's the same ethos as PT. And I was like, I gotta dig deeper into this. So I started off, I took his blood work course, I loved it, the information was just unbelievable. And then I signed up for the full course. And then, you know, through years of going through that stuff, I sort of figured out what was going on with this, this wheeze and cough, and it's, it is like 95% gone.

And so you kind of found yourself as your first real-life patient that you could apply some of these principles to.

Yeah, I'm kind of a DIY guy. I have to figure it out myself.

Well, I tell people all the time that a lot of times when you take these courses, you start to learn about it, usually you and family members become like your first practice patients to really like get the hang of it. So once you got trained in some of this, how did you see that transform your practice?

Well, it's still transforming it. I'm still figuring out exactly how it fits in.

I—

so I definitely Um, have just a functional medicine course. It's like a package that I offer patients. Um, and then I have, of course, the physical therapy side. So it's kind of— I had these— I was kind of wearing 2 hats. But as time goes on, they're kind of melding together. Um, and so usually people will find me mostly because of physical therapy. And then in my evaluation, I'm asking about their medical history questionnaire. I'm finding out they got reflux, they're having trouble sleeping, they're having all these other issues. And then that, you know, then I'm like, okay, we also should do a functional medicine consult because there's other contributors here. You know, we have this expression in PT, it's like, we can't fix everybody, right? And that always bothered me 'cause there are some people, it's like they've got joint pain. And, you know, as a PT, you think very mechanical. Okay, you're loading it too much, your foot's doing something funny that's loading your knee weird. But sometimes it's not that. Sometimes it's coming from a gut. That was one of the big revelations for me when I got into functional medicine. It's like, oh, your gut can cause joint pain. So it certainly can be just mechanical. It certainly can be just, you know, gut-related. And it can definitely be both. And that's what I find most often.

Yeah, I agree with that for sure. And, you know, when you got trained in this, did you find that it was really challenging to implement as a rehab practitioner? Like, do you feel like your training was geared more towards like physicians and prescribing practitioners?

Yeah, I would say so. I feel like it's a better fit problem. Well, I think it's a natural fit for MDs, PAs, you know, people that can prescribe. So, you know, obviously we can't prescribe, which is fine by me. But I also think in some ways we're perfectly poised to be functional medicine practitioners because we got time. And again, like that ethos is the same, get down to the root cause. So I feel like PT and functional medicine just harmonize so well together.

Yeah, I agree. And honestly, the more practitioners that I meet that do have that prescribing ability, they're doing mostly prescribing and ordering and things like that. But their patients aren't coming in as frequently. And they're looking for people to fill that role of, of being the lifestyle people and helping be with these patients more frequently. So where do you feel that physical therapists can fit the best In this world of functional medicine?

Uh, DLE— diet, lifestyle, and environment. You know, that's what it is. I mean, because we're already asking— I mean, if you're, you know, if you have the time as a PT— some PTs are just having to grind so much, but like you and I, we're seeing people one-on-one, we've got the time to ask, how are you sleeping? What does your diet look like? Are you drinking water? The amount of people don't even drink water is unbelievable.

So I think that's where we have the best opportunity to really go after like And do you, in your practice, do you go over any lab testing and things like that? Do you order any lab testing? What does that look like for you?

So I use Fullscript. So there's a physician that can sign off online for that. And so almost everybody, if they're going down that functional medicine track at all, is going to get a comprehensive blood panel and most likely a GI map test because everybody's got a gut issue. I usually will start off with, do you have any tests? Do you have blood work? And also I'll take what they have and interpret what I can from it. But, you know, I find that your traditional blood panel is way too basic and misses so much information. So I created a more comprehensive panel that casts the biggest net I can for the, you know, the best bang for the buck, essentially. I mean, there's so many markers I can talk about. They're just not on the comprehensive or the regular panel. So yeah, so blood work, GI map tests, stool tests, those are almost everybody's going to get that. Unless I hear something different, there may be a SIBO breath test. I do tell people about CGMs all the time. Blood sugar issues are just crazy. I think anybody would benefit from a CGM. I usually do one twice a year, just, you know, check and get a baseline.

Yeah, I've got one in my bathroom right now.

If you—

now, this may be a challenging question. If you were to pick one blood marker that you think more rehab providers need to understand, what do you think that one marker would be?

Oh, that is a challenging one. There's so many I want to say. Um, I guess I'm a little biased. I'm very blood sugar oriented. Um, so I would say insulin. I don't know why insulin is not on every panel. That should be automatic. The amount of people I catch that are becoming diabetic or pre-diabetic They're told their sugars are fine. Their glucose looks normal. Glucose is a very finicky marker. First of all, A1C can look good, but maybe trending in the wrong way. It's the first shoe to drop usually is insulin. So, in other words, insulin will keep elevating and your A1C can still look good. But once that insulin starts elevating too much, then you're going into prediabetic territory. So, and blood sugar issues are probably the, you know, the backbone of so many chronic diseases. So that if we just did that one thing, I feel like we would be so much more proactive in healthcare.

And I actually, I was thinking in my head of what marker I would pick, and I was between insulin and high sensitivity CRP. But then I'm like, well, half the time it's insulin that's driving that CRP up.

Right.

So I think I would pick insulin as well. And for the people on, on this podcast who maybe this is the first time they've really heard about that, can you describe Why you would want to look at insulin over those other markers we're used to hearing about and how you think that we as physical therapists, occupational therapists can play a pivotal role in improving that.

Yeah. So, okay. So a little blood sugar lesson here. So as you eat food or if you're stressed, your blood sugar elevates, then the pancreas realizes that and, you know, you can't have too much or too little sugar in the blood. It's deadly. So it secretes insulin, which ushers the sugar out of the blood into the liver and muscle tissue, right? And so over time, over decades, if you're eating a diet high in processed carbs, you're living a very stressed life, your pancreas has to work harder because the cells stop responding to insulin as well, and it'll just keep pumping out more and more, right? That's what we do with diabetics. We just give them insulin. So Yeah, what was I saying? Oh, so the other thing too is that just about every cell of the body has an insulin receptor. So when you become insulin resistant, it can affect like any tissue of the body, essentially. Even dementia, now they're calling type 3 diabetes. So it can attack any part of the body.

Yeah, and it really drives up inflammation as well. And for you, what is the optimal number that you're usually looking for, that optimal range you're looking for for insulin?

Oh, I think below 7. I don't really have the numbers memorized, but usually below 7. And I think conventional markers are way too forgiving, by the way. So your conventional labs, the windows are— well, besides cholesterol, that window is too tight. All the other windows are too big and you miss things. So the conventional markers are really there to catch disease when it's already present, whereas functional medicine tightens the windows. for the most part, to catch things before they become problematic so you can make a diet or lifestyle intervention and not have to rely on medicine.

Yeah, and I think insulin, if I remember correctly, I'm pretty sure like they, they will let that run into the 20s, 30s and still be considered like normal. And I know I'm kind of like you, I usually like to see insulin between like 5 and 7. And so that's just a good example of the difference between normal and optimal. And this is kind of a unique question, but what do you think is something in healthcare that is considered normal, but you don't necessarily consider optimal?

Everything. Everything. I— that immediately makes me think of back when I was in the insurance world, we have— because PT is a good example of that. We have this abbreviation WNL, within normal limits, right? Which I hate that.

Yeah.

So, in other words, I was taught as a PT just starting out, what our job is to get the patient about 75% of the way there, and they do the rest on their own, then they are WNL, within normal limits. So you're telling me that they just had a rotator cuff repair, and they're missing flexion, they're missing rotation. And your goal is not to get them back to where they were before, or even better, ideally, your goal is so they can reach their cabinets. So maybe they got 135 degrees of flexion, and then you're good to go. So PT, traditional PT at least, is a perfect example of that. And then I would also just say kind of what I was just talking about, where conventional ranges are there to catch disease when it's there. So we have a very reactive system, not a proactive system. So I— all of it, it's all not ideal, let's put it that way.

Which I would say that's kind of like the, the world of physical therapy and occupational therapy itself, is a lot of us feel like so many patients are coming in only when they're injured. And we're all kind of screaming, we need to play more of a role in prevention. But I would say here with functional medicine, like, that's kind of where it shines, is we are all about trying to optimize and trying to prevent disease. So I think this can be a cool way for rehab providers to kind of start driving that process.

Yeah.

What do you feel like is the biggest barriers for rehab providers In learning functional medicine or getting into this world?

I think a lot of providers don't really know what it is. I think a lot of providers think— PTs, we'll say— probably think that you have to be a prescribing provider. Those are probably the first 2 that stand out to me. Or just being time poor and poor. We all know PTs, the debt-to-income ratio is not great. Um, so, you know, a lot— like, I think back when I was a director at Select, I was seeing like 27 patients a day. I was essentially working 8 to 8. You know, my schedule was 9 to 5, but I go at 8 to catch up on notes, see patients 9 to 5, oftentimes sacrifice my lunch, which you don't even get paid for, by the way, and then stay until 8 o'clock at night just to catch up on all my documentation. So it's like, how can you layer that in if you're, you know, working in a mill like that? I was fortunate that I'd started my own practice. So, you know, now I see on average, let's say about 5 patients a day. So I've got the time, I've got the energy, I've got, you know, my life back essentially. So that's probably the biggest barrier, time.

So you had already started your practice. So once you started your practice, you were like, I, I think I can make this better. I'm going to now add this level of education. What, for the program that you did, what did that look like from a structure standpoint? Like how often Were you, you know, going to— was it in-person class? Was it online?

It was all online. There was online meetings too, but it was mostly recorded webinars, which was, you know, my commute is like, well, out of season, 25 minutes, and in season, sometimes an hour and a half. So I learned in my car. I know it's— I mean, if you don't live in this area, the season here is crazy, the traffic. So That kept me sane because I just, I loved learning all that information. I was having like lightbulb moments like every day on my commute. So it was majority like learning from webinars and then, you know, in person, not in person, like over Zoom meetings with Tracy O'Shea, who runs the Crestor Institute now.

And you brought up the financial barriers with the rehab space. Did you feel like that was a bit of a barrier for you to do this training?

Yes. But I decided I wanted to do it because every time I invest in myself, it always pays off. Yeah, I was in a business mastermind. It was expensive. But I mean, you know, if you spend a little bit of money and you make it back with like one patient, then it's worth it, right? So I was kind of sold on— this is kind of a funny story, actually. So I brought it up to my wife, because, you know, as a husband, it's not a good idea to make big financial decisions without the approval of your wife. So I presented to her, okay, I want to do this. It's a year-long course. It's, you know, X amount of dollars. It is pricey, but I think it can dramatically change my practice. And she's like, I just don't think we can afford it. No, let's not do it. So I was like, okay, kind of laid that to rest for a few weeks. Then our wedding anniversary came up. And I just want to do something different. So I took her to a Reiki appointment. I've never done Reiki before. I don't really know what it's all about. It was just for fun, something different. So she does a Reiki appointment, I end up getting a massage at the same time. And then after the appointment, she comes out and she goes, yes. Like, what? She's like, yes, do the course. I'm like, what happened in there? So the Reiki practitioner was saying something to her like, your husband has something big he wants to do, you have to say yes to it, it's going to change your life. So that's, that's how I got the approval.

Funny enough, it was enlightened.

Yeah. And it's been amazing.

Yeah, I think that's great. And do you feel that Because you took that course that it has also opened up more alternative options for revenue and things like that to build your practice in a different way?

Yeah. So, one of the things that I do a lot is blood work interpretation. So, I built that comprehensive panel and I charge a little extra for my time to interpret it. So, that's just one avenue. Another avenue is just the pure functional medicine pathway that I have combination packages for people that want to do PT and functional medicine altogether. And now I've built this, this blueprint, the Resilient Blueprint, which is a digital program, which kind of combines all these things we're talking about. And I'm just about to launch that. So I think that's gonna be another revenue stream. Yeah.

And it's so interesting, because we're, we're both kind of using it in different ways. But I think for both of us that we have both in-person options, but we also have more virtual options, social media options, things like that. So I think that's what I love about being able to interview different people is I think that the price of these trainings can be a big holdup for people. I know mine was, I think, $3,000 or something like that. And now I think it's up to $6,000, which is a big barrier for a profession that already comes out of school with a big amount of debt.

Mm-hmm.

And then from there, I think people struggle with, well, what do I do with it? And I think it's important to interview and talk to people like yourself where people can see the potential and, and how they can add another source of revenue where they can make that money back. So now that you're trained in functional medicine, what do you think rehab providers are going to be doing differently? Like 10 years from now, where do you think we're going to be as a profession?

Well, I have this like vision of most PTs becoming certified in functional medicine. And then we're just kind of like this healthcare ninja, because you can solve a whole lot of problems. like 90% of problems you can solve before it comes to medicine, right? So I think that's the path because it's— they just, like I said before, they harmonize together, the same exact ethos. We're all about root cause. If you're a provider, like a PT, that gets frustrated that some people just don't respond, that's, that's the whole, right? That's that functional medicine side. That's the diet, lifestyle, environment stuff that is preventing them from getting better. So yeah, I see that as a really good fusion.

And I have a specific question people ask me all the time. And basically the number one question I get— well, not the number one, but one of them— is people will ask me all the time, do I have to be certified in functional medicine? And I normally say no, not necessarily, because certification doesn't expand your scope in any way. You're still held to your scope. However, I do tell people, but you have to understand it and you need to know enough. Like, you can't just order labs because you can, but then not know how to appropriately interpret that. So what are your thoughts on that and whether we need to be certified in functional medicine or not to begin to start to implement some of these things?

100% agree with you. I think just get certified is the way to go because there's such a big chunk of information that if you're just passionate together, bit by bit, you're going to be all over the place. So you have to be organized. And yeah, like, I think back to when I used to look at people's blood work, as you know, before any of this stuff, and I would just be like, oh, your B12 is low, so I guess take B12. You know, there's way more to it, right? It's just like PT where it's like recognizing patterns, right? So you have to have an in-depth understanding to, to really be able to help people the way you want to. And I just can't see you learning that on your own. I mean, all the YouTube videos in the world will not be enough. You have to, I would say, just get certified. It's so worth it.

Yeah. And you brought up Fullscript, which is also what I use. And I would say for me, that is another source of revenue for me where I probably make about probably $1,000 a month just from Fullscript alone. And I've, I've talked to people and said, yes, like it allows you to recommend supplements and things like that. But It's just like a medication. You have to understand interactions and side effects and things like that. So just because you can get on there and get an account doesn't mean that you should.

Right.

And like, you gave a good example with like B12. Most of us think of, oh, we need to do a methylated form, but like methylcobalamin can cause a lot of anxiety and things in certain patients. So you have to learn like, well, where do I pivot with this person? Is it the best one. And I think that's a really, you know, great example that you brought up is, you know, even in the world of supplements, and how much would you say that, and how do you use supplements in your practice?

So I use it mostly, well, there's a couple different things. So I recommend collagen a lot, because everyone's so collagen deficient. That's one thing. But then I, you know, when I do a GI map test and look at someone's microbiome, if I see dysbiosis, or Parasites, or for me, H. pylori, by the way, which is one of the drivers of my wheeze and cough. I will educate them. I don't prescribe necessarily. I'll educate them on like a supplement protocol to help for me, like reduce the H. pylori population. So that's, that's probably the biggest way that I use it. But you said something that made me think of a second marker, going back to your original question of when we were talking about insulin CRP. I would say another secondary, um, Uh, one I would opt for would be ferritin. So, like, iron to me is a big deal. Um, and you usually only see iron as a marker. I'm saying this because people will see low iron, take iron. Well, iron is not a benign supplement. You can have too much iron, which is actually a condition I have. Um, and if you just look at iron on a panel, only 1% of your iron is in the serum. So it's not really the— it's literally the worst marker for iron is iron. So you have to look at ferritin because that's where iron is stored. Because it's, it's not a good thing to just say, okay, you have iron deficiency, take iron, right? Because iron in high quantities can cause iron overload, which basically rusts your organs and can be deadly at, you know, at the end stage. So.

Yeah. And, you know, on that topic, what I see a lot of is I work with a lot of women and iron deficiency is really common in women because we bleed every single month. And especially some of us have conditions where we bleed a A lot. And what happens is a lot of my female patients just assume that their male partner has an iron deficiency. And I just don't find that a lot clinically. You know, I run the panel and I very rarely find that men have that problem, where then they're supplementing with iron and creating more of an overload problem for their male partners.

Mm-hmm.

Because they just assume that they have the same problem. And can you speak a little bit more about what you see clinically in your practice when you have someone who comes in with iron deficiency? And why you think rehab providers need to understand iron deficiency a little bit more.

Well, anemia is super common in women. So first of all, so like you said, menstruation will deplete your iron, and then women will tend to go on iron, and then no one tells them, hey, when you go on menopause, you might have to recheck because you might not be low in iron anymore. So that's a really important thing to understand. Um, you also have to understand the relationship between ferritin and inflammation, right? Because your body— so organisms like pathogenic organisms use iron to replicate. So if you are in an inflamed state, your body will sort of wisely, protectively lock up the iron in ferritin so that that bacteria can't replicate. So you have to understand, is the ferritin high because you have too much iron, or is there an inflammatory state going on? So that's an important thing. And also diet. I mean, a lot of people are not eating red meat anymore. Not eating— I mean, liver is a really good source of iron, and how many Americans actually eat liver? So you have to look at their diet too. Are they getting, you know, inadequate iron? So, and another thing, what's your digestion? Or maybe you are eating red meat and maybe you have low stomach acid. You're not absorbing enough iron. Now, for men, yeah, they tend to be in an iron overload state, um, unless they're vegetarian or vegan, then they tend to go low, low iron. So those are all just a couple examples.

Yeah. And I know for men, when I see a man that's got pretty low iron, I'm like, okay, where is this blood loss coming from? And I think that the important thing to kind of highlight is we're not trying to take over the job of physicians, but I'm sure, and you can share on this, I know personally I have a lot of patients that come in that have seen physicians, they've seen GI specialists, they've seen Countless doctors and they don't have answers. And then when we actually do more comprehensive blood work and we really look at it, that's where we actually see some things that we can optimize. And I honestly think that's where we kind of shine is we're not treating a disease at that point because the doctors ruled those out. We're just trying to optimize this person's function. Do you find that's a common thing that you see in your practice?

Absolutely. And I just recorded a podcast on this, what I call the Core 4. There's Again, this idea of casting the biggest net. So there's 4 things that I would say like everybody would benefit from. So comprehensive blood panel, blood sugar, so a CGM, HRV, and a GI map test. So those 4 things, you get a lot of data. So HRV, in case you don't know what that is, not you, but our audience, that's a measure of your recovery. So it's really a measure of how much time are you spending in a sympathetic state versus a parasympathetic state. effect state. So things like Oura Ring, Apple Watch, Garmin, uh, Morpheus, they all track your HRV. And to me, it's like, especially as a PT, because we get this question all the time, how much is too much? When do I know, you know, should I exercise again? You look at how recovered you are. That's the answer. So those 4 pieces of information can be just— give you probably all the information you need to really get somebody on the right path.

And I think that's what I like about Oura Ring is it kind of almost gives that same sentiment where it's like, what is my readiness score? Like, as soon as I open up my eyes, like, what's my readiness score for the day? Did I recover well? Did I not? And I can use that information to decide what I'm gonna do that day. Now, I use CGMs as well. What are some of the companies that you really like for CGM?

So I have an affiliate account with Nutrisense. They're great if you want something really comprehensive. Because you have someone you're speaking to, like a nurse practitioner, that are guiding you. They're a little bit pricier. If you want something a little bit cheaper, Stelo, stelo.com, S-T-E-L-O. I think it's like $100 for a month's supply.

Yeah.

And then you get an app. So you get data in real time, you can see what your blood sugar is doing in response to what you just ate or whatever stressful situation. I always tell my wife that she's— when we argue, she's making me diabetic. So you can see in real time what's going on with your blood sugar. So those are kind of the 2 I usually recommend. I haven't tried— is it Circles? I think it is.

I haven't used that one. I've used Lingo. Lingo is actually really affordable. I think that it was only like $40-something for a sensor or something like that. So really affordable. I know Stello now integrates with Oura Ring, which is kind of cool. But yeah, There's, there's just so many now, and I think they've made them a lot more affordable. I remember years ago when I first started to practice in functional medicine, they made it so much harder for patients to get direct access to that.

Mm-hmm.

And I think that brings up a good point, which you kind of mentioned already, is that a lot of times when you start a functional medicine session, you're, you're asking for what they've already had tested because most people have some kind of data. And now in the age where people can order their own testing and pay cash for it, you've got patients with even more data who are coming in. So what are some little clinical pearls that you see sometimes in like a CBC or a CMP that helps guide you with further testing? Because those are usually the 2 that most people already have.

Mm-hmm. I'm first looking at their blood sugars and hoping they get something good out, you know, usually get an A1C, which is Sort of good enough as a start, at least. I'll look at their lipid panel and usually talk people off the ledge because everyone freaks out about cholesterol. That's a, that's a huge topic that we could probably spend hours on. But that to me is the beginnings. When your lipid panel goes off is a sign that you're having a metabolic dysfunction. So that's where I'm going to investigate more into the blood sugars. Um, and then, you know, with the— I look at white blood cells and is there an inflammatory thing going on? Is there evidence of autoimmune? Right? That's another thing I talk about a lot is autoimmune. So, and then CRP, luckily CRP is usually routinely ordered. So I'll look at that as well. Um, those are, those are the ones that jump out.

Yeah, I don't actually usually see CRPs, like with the patients that come in for me. I don't usually see that one routinely ordered, which I wish it was. But yeah, I think the cool thing is what is different between— and you can correct me if I'm wrong— but the difference between someone coming in to see like you or I compared to a physical therapist who isn't trained in functional medicine is when they look at that blood panel, they're looking for the things that are flagged as high or low.

Mm-hmm.

And for us, like, we can kind of look at it with more of that narrow lens. And even if there's nothing flagged at all, we can look at it and say, oh, well, you know, your platelets are Greater than 250, that could indicate inflammation, so we may want to dive into that more. And your fasting blood sugar is greater than, you know, 86, so it may be trending in that direction. So let's go ahead and check insulin. So I think that's what's cool is that because of the extra training we've done, we can look at the same piece of paper as someone else and be able to provide very actionable steps.

Right.

Compared to someone who hasn't had this training. And so for you, do you see where functional medicine can fit into different practice settings and things like that? I know you and I are both in the, you know, the cash clinic setting, but do you see where it can fit into other settings?

In the PT world, like in like a SNF or home health or something like that? Yeah, probably. I haven't really given that much thought. Um, you know, probably a whole lot more things are going to be flagged in those settings. Because they're, you know, a lot of people probably already in a disease state. So my initial thought was, you know, if you catch things before they become, you know, medication worthy, you can kind of keep them in our world of, you know, exercise and diet and lifestyle. Maybe in those settings, like a home health setting where disease states are already in progress, maybe some medications are still needed, but maybe we can get them going in the other direction and eventually get them to get off medications. So that— Yeah, that's what I would say.

Yeah, I think in our world of outpatient therapy, it's a— we can play a huge role in prevention and optimization. But yeah, in those other settings, I feel like we can really be pioneers in just lifestyle medicine and educating patients on, hey, we're not just gonna, you know, get you better from this, we're going to transform your life and make you want to live to 85 or 100. And I know, you know, that's something I say all the time, nobody cares if they're 100 if they can't do anything, and they're really, really ill. So for you, are there any final thoughts that you have that you want to talk about? I know we could probably go on and on about so many different topics.

A couple things. So first of all, patients are educated these days, there's so much information out there. So, you know, I mean, I remember the first patient was like, yeah, I just got an Oura Ring. And I was like, what? You know, before I knew anything about it. So I think it's like It behooves you as a PT to really understand as much as you can, because there's so many things that are becoming available, which is great to, to patients. You know, like, you can essentially order your own blood work these days. Uh, yeah, Whoop and Oura have a pretty decent blood panel you can order directly through them now. So, as these things become more available to the public, I think it's important to understand those things. And then different topic. Can we talk about GERD for a second? This to me, like, blew my mind when I, like, learned about hypochlorhydria, which just means low stomach acid. And this is something that I correct in people all the time because reflux is GERD, right? So reflux is usually blamed on too much acid in the diet. Okay, maybe that's part of it. But more often than not, I'm finding that people have too little stomach acid, which sounds counterintuitive, I know. But what happens is if you don't have stomach acid, or you've been on omeprazole because you've been prescribed that—I mean, I know people have been on like a PPI for like thirty years. It's crazy. That was supposed to be cleared for two weeks, not thirty years. So you basically suppress your stomach acid to zero. Well, that acid's there for a reason. It's there to protect you from pathogens, to help you break down your food so you can absorb your food. And then if you don't, if you have very little stomach acid, it goes into your small intestine. And then the bacteria population that is there, they gobble up your food instead of you. So they get your B12 instead of you. So if your B12 is low, that's usually a sign right there. And then what happens is they produce gases, which creates bloating, and that abdominal pressure causes the valve, the LES, to inappropriately open, and then you get regurgitation. So it doesn't matter if there's a lot or little acid, any acid can do that if it regurgitates. And so what do you do? You take digestive enzymes. So it's like completely opposite of what we've been taught. And it's just, it It's crazy. And it's, it's a— that's a hard conversation to have with people because they're so bought into, I have too much acid.

Yeah. And I usually like to describe it to patients where I'm like, well, you have this sphincter, and if the— basically having enough acid is like what tells it to close. And so if there's not enough of it, then it's going to stay open and you're going to have more of those reflux symptoms. But yeah, I feel it because I do GI Map as well. And I feel like time and time again, I am finding so much just poor digestion. It's just, you're just not breaking down anything. And then you ask that person, well, did your doctor tell you how long you need to stay on this omeprazole? Like, no, I just kind of thought I'd be on it for life. And it's like, oh my gosh.

I know.

You know, even if you look at research, it's not meant to be taken for that long.

No. It was originally, literally originally cleared for just 2 weeks of use. It's actually kind of dangerous going out long term. There's associations with certain cancers and long-term omeprazole use.

And I am seeing a lot more chronic bloating coming into the clinic. And I know for the population that I treat, so many women are like, oh, it's just menopause. Like, this is just what happens. And I'm feeling their abdomen. I'm like, no, this, this feels like a bacterial overgrowth issue. And are you typically ordering the SIBO breath test through Fullscript? Are you referring out to physicians to do that?

Through Fullscript? Yep. Yeah, there's also something called the FoodMarble, which is about like $300. It's this thing that you get to keep instead of a test, and you blow into it and you can do it daily. I have one. So you can look at your, your, your gases and see if you have SIBO. So that's a nice little tool. One thing I do just as a kind of a general screening is the baking soda test. Are you familiar with that one? You know, it's not the most reliable test in the world, but it's just— it gives you some idea. So that is, you take a teaspoon of baking soda, you put in a cup of water, stir it up, drink it, set a timer. Should take you about 2 minutes or less to burp, right? Because it's like that old middle school experiment with the volcano, you know, sodium bicarbonate and vinegar, and creates an eruption. If it takes you like 10 minutes to burp, okay, you probably have low stomach acid. So that's just a good little— Quick screen tool you can use.

Well, it's so easy too. It's like, is it the most reliable thing in the world? No, but it gives us a clue. And you didn't have to spend any money to do that because we all have that in our house.

Yep. So I love that little test. It's kind of fun anyways.

Yeah, it's a fun science experiment.

Yeah. Or you could do something to stir up your digestive enzymes. So like a little bit of apple cider vinegar before a meal, diluted a little bit because it's too harsh. And if that helps your digestion, your bloating, that may also be a clue because you're basically giving yourself a little bit of acid.

Yeah. And also super beneficial for blood sugar as well. So yeah, there's a lot of little tips and things that are far within our scope that we can actually recommend for patients. It's just like, PTs have to understand the overall picture and like, well, why, why are we giving those recommendations and things like that? Are there any other burning topics that you're like, oh, we need to talk about this?

Well, cholesterol is always in the back of my mind.

I know, that's like a whole episode. I feel like—

I know, I don't think we should go down that road. I'll just say, just look at your ratio triglycerides to HDL. Take your triglycerides, divide by HDL. If that's 2 or below, you're probably good. If you're concerned with your cholesterol being high, your LDL, right, the bad one— okay, that's a whole other topic. I don't really think it's that bad. Um, then you can always get a CAC study to see if you actually have any calcium buildup. So if you're concerned about LDL, go get a CAC study.

Yeah, and there are just more in-depth cholesterol panels that can be done. And I know now we have things like Function Health where that's Part of that annual testing is looking more in depth to those markers, which is great. But to your point, I think you're right. Patients have access to this. And I think if we want to level up our profession and get the population to think more highly of rehab providers, I do think we need to be able to help answer these questions. And, you know, be more of a healthcare provider for these patients. Like if they come in with questions about this stuff, we're like, I don't know. Go to your doctor. Like, it doesn't look very good on us. So I think the more that we can help support patients through like health and wellness, the better it's going to make our profession look. And hopefully that's what's going to cause a big change in our profession in a positive way.

Yes. So, you know, I think, you know, PTs, we're kind of taught whole body stuff, right? You know, we're always looking for, is that knee problem just a knee? Or is it really hip? Or is it really your ankle? Is it both? Right? We tend to look at whole body. And that's what functional medicine does. And that's why it's the future of healthcare, because people are sick of this. Like, you know, everything is in their own silo, right? You got a knee guy, you got a lung guy, you got a heart guy. And it's like that— the body doesn't work in isolation. So this complement of functional medicine and PT is— I hate the word holistic because it sounds kind of woo-woo, but it is holistic, right? That's what it is. We're looking at the whole picture, the 30,000-foot view.

Yeah, when I built my practice, and I called it holistic health, a lot of rehab providers were like, oh, yeah, because you, you look at the hip when someone comes in with like a knee problem. And I'm like, no, that's not what I mean. Like, I know that's what rehab providers typically think is looking at the entire musculoskeletal system. But no, I mean, looking at all of the systems and looking at that person inside and out, not just looking at their hip because they have knee pain. So I think that's a really important point to make because that's not how we think when we think of the word holistic.

Yeah, unfortunately, it's got this negative connotation. I don't know where that came from. But I mean, what is wrong with looking at the whole picture?

Yeah, yeah, I agree. And I think that, you know, for me, how I got into this is I started off having like gallbladder issues. And I was in PT school learning that unit. I had just gone over it. And I still was like, okay, all I learned was how to identify that it was a gallbladder problem and refer out. And I went to those doctors and I got no useful information where I wished I knew what I did now, where I could have done, you know, lifestyle changes and a GI map and really just kind of dove into it. And I probably would still have a gallbladder today if I had the knowledge that I have today.

Isn't it crazy that we just cut things out? We're in this weird paradigm right now where it's just like something bad, just cut it out. Meniscus, you don't need that, cut it out. Gallbladder, you probably don't need that, cut it out. You know, I just think we're gonna get away from that eventually. Hopefully.

Hopefully. Yeah. Asking more like, well, why did it happen in the first place instead of, yeah, just remove it and then you'll be fine.

Yep, exactly.

So I have one more question for today. And it's the question that I ask everybody at the end of the podcast. And that question is, What does going beyond rehab mean to you?

Ooh, that's a loaded question. Hmm. I would say caring, being able to take time with patients, especially now with the advent of AI. I think things are going to feel more robotic and stand in line, get your medicine and out the door you go. You know, we as PTs, most of us at least, have the advantage of time with people. So we can ask digger— I'm sorry, deeper questions and really dive into their sleep and everything, their lifestyle, their stress. That to me goes beyond rehab, taking the extra time with a patient. Like, I've gone to patients' gyms before and just showed them how to use their equipment and put them on a program, you know, things like that. Going to an appointment with a patient, that can be really powerful. Like, they're about to get a knee replacement and you go to that appointment with that patient. Things like that mean a ton to patients. So that's what I'd say, caring.

Yeah. And I would say, like, on top of that, even if you do find yourself to be a rehab provider, physical therapist in a setting where maybe you are seeing 20+ patients a day, you're typically still seeing them 2 to 3 times a week. So when you have that time together, you usually are the provider that is seeing them the most. So you do still have the ability to make a big change.

Absolutely.

Awesome. Well, thank you. Oh, go ahead.

No, I was gonna say we're lucky that we get to make so many positive changes with people. It's a, it's an incredible career. And unfortunately, it's in a tough spot right now. A lot of people are getting burnt out if they're staying in the insurance world. We're losing PTs, people are leaving the career. So I see like this, you know, this cash-based transition is probably good. Adding functional medicine will give you opportunities to get out of that crazy environment of 20, 30 patients a day. So I'm optimistic that functional medicine can really provide a good spot for PT.

Yeah. And I'm sure you can agree that it has made your career more rewarding.

More rewarding, more fun. I'm solving more problems, more lucrative too, on top of all that. Yeah, it's great.

Well, thank you so much for joining me. I'm so excited to have found someone in my own backyard to interview who is kind of doing similar things to me. So thank you so much, Chris, for being on the podcast.

You got it. Thanks for having me. This was fun.