I was recently interviewed by Dr. Kevin Pho on his podcast, ThePodcast by KevinMD.com, based on my Chest Pain blog article. Watch (or read) as I describe my unexpected evolution from practicing conventional family medicine to pioneering a functional medicine style based on body mechanics and nutrition.
Hi and welcome to the show, where we share the stories of the many who intersect with our healthcare system but are rarely heard from. My name is Kevin Pho, Founder and Editor of KevinMD.
Today on the show we have Cathy Kim, she’s a family physician and she wrote the KevinMD article “Fascia in primary care: When chest pain is not in your chest”. Cathy, welcome to the show.
Thanks so much for having me.
So we’ll get into your article a little bit, but first off can you share your story and your journey to where you are today?
Several years ago I had an injury that had a lot of consequences after — a lot of pain, and things that weren’t explained by my original injury, which was a fracture. So I used that as an opportunity to explore alternative ways of treating it — because after 20 plus years in primary care, I already knew all the options; and I wasn’t really excited about them to be honest. So I saw sports chiropractic care, acupuncture, and including, myofascial physical therapy. I was just amazed at how fast the function could return when you targeted the correct mechanical problem.
Since I was really much more symptomatic than most patients — as I was doing my primary care well-woman exam . . . any kind of visit . . . people would bring up these things, these complaints, and I would say “well let’s try this because I know it worked; I understand how it works — so how about we try this.” It’s an amazing point to have this option of offering that to patients, instead of writing prescriptions and having them walk out still in as much pain as they came in with.
I was always a big listener to my patients, so they might come out less burdened or more validated — but to actually have them walk out feeling better physically — that was a great gift I could give, a great reward in practice that I had never had before. So it just grew to be more complex kinds of interactions with patients. So this article, the chest pain article, was the beginning of my blog article series to show how you could use this — how it applies to primary care — and that it’s not always just for athletes or people with mechanical injuries like knee pain . . . you know, things that you would tend to think are more in the realm of straight kind of “specialty medicine”.
That’s how I came to this area — and then experiencing what fascia was and kind of understanding that it’s new — it’s like a new frontier. I looked into how many books were written about fascia from 2000 to 2010: it’s only about 7, and it’s about 30 since 2010. So it’s exploding as an area and especially since 2018, when some work was published about it possibly being an organ in and of itself . . . which then really affects every specialty: because if it’s an organ of itself, in the whole body, then it could restructure how you’re thinking about anything, any disease process.
What exactly is the type of medicine that you’re practicing as it relates to the fascia? And can you tell me in a little more detail exactly what you do?
Learning about working with people, and with these problems that I would find, among them being that chest pain case that I wrote about, I learned — and I went to a functional medicine conference and I thought, “oh well this is true — this root cause and going to what that is; and when we give people Prilosec™, is that really helping their root cause of why they have this symptom, right? That always actually had bothered me, even in medical school — that I didn’t understand how that was helping the root cause.
So probably philosophically, I was much more aligned with that from the beginning. And I was very mechanically-minded, even when I did prenatal care — like when the woman would complain about something — I would think about the mechanics of the pregnancy, where it sat and what symptoms she was having.
So functional medicine was a good match for my inherent philosophy. It relies a lot on nutrition and the biochemistry aspect — and so I feel that what’s slightly different about what I’m doing as the root cause — is I look at the root cause mechanics, structural mechanics, of why someone would have something.
For instance if someone has their torso way in front of their hips, then you can have them pursue an anti-inflammatory diet and lifestyle. — there will be a limit to how much you are going to help impact the impact of gravity on the off-balance that they have. So that’s how I’m slightly different because I balance both of those.
So let’s transition into your KevinMD article and I think it’s going to give my audience a fuller picture of what you do in the exam room. So you wrote this case “Fascia in Primary Care when Chest Pain is not in your Chest”.
Now for those who haven’t read that article, can you just walk my audience through it and explain why you decided to share this particular case?
I thought this case was a good illustration. It kind of encapsulates the trepidation and the thought process of what happens when you are conventionally trained, traditionally trained, as an allopathic physician medical doctor, which is not very experiential. You know everything as rote, through sitting in lectures; and so you don’t really do a lot of hands-on, except, you know, maybe when you do venipuncture on your classmates.
I thought that this was momentous in terms of chest pain — chest pain where: it’s the heart; it’s the lungs; we take it very seriously. So to take this approach that I had, and look at all his data by numbers, this man should have really nothing really seriously wrong with his heart and his lungs; yet, he could not walk a block or around the block.
It’s basically what I go through with the different kinds of patients — because they might come to me and then they have nowhere else to go. So a lot of people who are doing fascia work, a lot of these books — these people are anatomists or body workers and maybe orthopedists, but because I’ve been a primary care doctor all the way from prenatal care all the way to the elderly population.
You know how when you’re in a lecture and you’re at a conference and you learn something new and then all of a sudden you think of three patients and how that matches that? — So imagine all the light bulbs that go off for me when I figure out something or I see it in a patient and it reminds me of the pregnant woman and at the same time an adult and all of those.
So I have light bulbs like that going off all the time. So the synthesis of all of that, while I put together the mechanics . . . to see how if I release the right places, could this man’s chest pain be improved? Because I did not have — based on my experience — I did not think that referring him once again somewhere else was going to give him a lot — especially when he had to stop working. So there’s a lot riding on that for him.
Now what kind of modalities did you do in this particular case to help him with his fascial pain?
I didn’t know it was fascial pain, but I was trying to understand based on a careful history, because you know they always teach us in medicine that the patient details are in the history. So if you’re skilled at listening, you can pick out the parts that make a difference.
So when I listened to his story and how that bothered him and details of what was happening. I thought, “okay it seems really it’s movement and how can I help him with that?” So I would have to say that in a kind of a “scrappy engineer” way — you know how someone could just make something out of things at home and use little sticks — and I just made it up (from) how it worked on me.
Because I realized when I was worked on: pvc pipe was used, elbows were used, hand pressure was used. So it depended on the area — what was useful, what I could do there. So if it was around his rib cage, I used my elbow mostly. But, at that time I was just starting out, so I really didn’t use anything more than just my hands and pressure and my elbows, in the attempt to loosen these fascial layers that had become adherent to each other. So that is what I did. And because it was new, I didn’t want to go all-in and hurt him a lot. So I did it as a little light test everywhere; and as long as he was okay with it, we kept going — because he also knew that he couldn’t work; and he was willing to try.
I cannot tell you how meaningful that patient visit was on a busy primary care day where you’re scheduled every 20 minutes; and you see this person — and they have so much riding on the fact that they can’t work and they’re looking for help. So you’re doing this on-the-spot-experiment by the seat of your pants and trying to make sure that you’re also riding the line of their best interest; and you’re not hurting them and checking in.
It’s uncharted territory, which, in this age of, like, GPS and satellite technology, you almost never are in uncharted territory. This was truly uncharted, because it’s not like I have a mentor for that or anything in this work. That was amazing to have him explain to me, when you’re just suspensefully waiting, and hearing him say that he’s crying because he’s so happy — from months of having this disability really with no hope. So it was like I’m an explorer and scientist and all that at the same time, working on someone trying to figure it out.
And for clinicians who are interested in exploring more about what you do, is there a fellowship or a training course or any books or online resources you can recommend?
I have read a lot of books. You can see the stack I have read, to look for the understanding of it more; and it’s done at such a mechanical level, direct, in terms of anatomy. I’m interested in the clinical application of it, for a primary care problem that you would not really think is straightforward.
So I’m working on developing — that’s why I have blog articles and my series — when I first wrote this — it was the first one to introduce how I came into using it for primary care.
It doesn’t say it’s for pain and injury. It’s for things that you encounter that are unsolvable in primary care. I would say I’m interested in that. There are other workshops. I have found them more geared towards body workers: people who are in sports who are going to help people with hip pain and those kinds of things.
My root cause approach is in functional medicine: It’s not just that I guide about anti-inflammatory diet and anti-inflammatory lifestyle — my perspective is that the two biggest problems that we are having in our modern society is: we’re having inflammation from the chronic exposure to all these newer pesticides and non-diverse diet; and we’re having inflexibility. Because in our modern lifestyle, we move less; and so I’m looking at what are the key things that we are losing in this modern way of living — no squat toilets, all modern chairs. You see how that restricts the hip so much and that’s like a perpetual motion engine that’s driving the rest of the stiffness.
So I’d say, that’s how I do both: it’s structural inflexibility and lifestyle inflammation. I offer that and I’m developing that for helping other interested primary care people who think that way, to work on these things.
We’re talking to Cathy Kim, she’s a family physician and she wrote the KevinMD article “Fascia in primary care when chest pain is not in your chest”.
Cathy you mentioned several times about an anti-inflammatory lifestyle. Can you explain what that is and what are some changes patients can do to reduce inflammation?
Sure, so I’ve given some lectures on this and actually I was prepared to give one at the beginning of the pandemic which we had to cancel. I explain that inflammation is basically an event that disrupts the body’s normal routine of doing things; and if you want to understand it analogously to the world, it’d be like a hurricane coming through.
A hurricane comes through, disrupts everything, floods everything and we go to kind of like a survival mode until we can get everything back. But what people misunderstand about when they get exposed to these kinds of things that make us inflamed — like pesticides for instance that is on everything, or even glyphosate (which is RoundUp™) used on a lot of grain crops that’s all being fed to the animals, and then we ingest that through there.
There’s all these sources through the processing and industrialization of agriculture and preparation of our food — and never mind in our medicines (because they add the colors and those are artificial petroleum-based often) — all of these things disrupt us and even if they’re natural.
For instance in my lecture, I mention how you can have a seaweed extract added that’s “natural” — except if you ate the seaweed like we would eat it, you’re getting a tiny smidgen of that; but when you kind of extract it and then add it “to texture,” then you’re getting an amount that’s inflammatory. So that’s disruptive to your body.
My point to people is to try to help them understand inflammation, which — stress causes inflammation, all these chemicals, foreign things are causing inflammation — that these are so disruptive that you need time to recover, so you can get more of your regular routine restored.
Inflammation is like mud; and if you look at inflammatory things that you take into your body, as like creating this hurricane, and then mud, which needs to dry out — then you would really understand how you need to tilt everything towards having a lot more sunshine and less often the hurricane thing. That’s how I help people understand what they need to do.
That ties into diversity of eating; because when you diversify your food, then your diversity of your microbiome in your gut; and your immune system is better. Then, when that’s more stable and healthy, the rest of your body will follow (as long as I can help you also be more structurally sound — so that you are not trying to hoist your head up the direction that it’s actually pitching), so that’s how that matters.
And my final question Cathy. What is your take home message that you want to leave with the KevinMD audience?
Diversity is probably the key word that ties the problem of inflammation and inflexibility. We’re losing diversity in our food intake for the natural healing powers of all the diversity of what we could have taken in — that contributes to inflammation. And we’re losing diversity in our movements as we specialize in these jobs — and even not even looking up, for instance, for the weather anymore, because people look down at their phone or their Apple watch instead of up at the sky.
We are losing this diversity of diet and movement and this results in inflammation and inflexibility, which I feel is the root cause for many of the illnesses and ailments that we’re taking care of. If you can improve that in a meaningful way, a lasting way, then you improve your well-being.
Cathy thank you so much for sharing your time and insight and thanks again for being on the show.