In this episode of CITV, we release volume 1 of Ted and Fred’s Excellent Adventure!
We received many great questions from our scholars, so many that we will be doing a series in the future to get them all answered.
In this episode, Prof. Carrick discusses:
– (1:00) The current pandemic and what it means for our scope of practice as clinicians.
– (11:54) The use of SNAG’s in clinic- what are they and why and when do we utilize them?
– (13:44)Prof. Carrick’s best advice to new practitioners.
– (48:05) Prof. Carrick’s background and history, including what inspired him to start studying neurology.
– (57:44)Functional Neurology” as a term – Do we like it? Should we keep using it?
These are discussions you truly do not want to miss!
Thank you to everyone who has submitted their questions so far. If you would like to submit a question to Prof. Carrick, please fill out the form using the link below.
– Hello my name is Dr. Freddy Garcia and we’re joined by the honorable Professor Carrick, Dr. Carrick, how are you doing today?
– Marvelous, Freddy, it’s good to see you as always.
– You know, I sent an email out and I posted on social media saying, hey listen, I have an opportunity to connect with Dr. Carrick and I get to ask him their questions to you. Normally I bother you all the time and I get to ask you my questions ’cause I’m selfish like that, but I said, hey, let’s hear from them, let’s hear what they want to ask you. So I’ve got a list of questions, a rather large list actually, and I want to go through the some of them if we can do that today, is that okay?
– Yeah, I think that sounds fun and, you know, you know how to do it but certainly we’ve got a lot of questions and you and I just usually have our chat so we can make this just easy as we always do it and hopefully give some good information to people.
– And we’re gonna have some coffee together, be happy. There it is. All right, so let’s go through some questions here. This one is actually specific to the pandemic and scope of practice. So, it says, Dr. Carrick, do you feel that the recent pandemic makes scopes of practice either more specific or enlarges the scope given a potential new perception by the public about wellness.
– Well, that’s a heavy question. I don’t think that anything is going to really affect our scope of practice but certainly the perception of what we do will definitely change. Not only from a patient’s perspective but from the doctor’s perspective and I think that we’re learning how to do telemedicine markedly better. I had made a post just the other day which was really amazing for me because it’s something that I normally wouldn’t have done with a patient that was very afraid that he had COVID-19. Just in bed feeling terrible, sick to his stomach, couldn’t move and knew he was going to die. And a very high profile, very, very high profile person in our society. So make a long in the short, I was able to do a Skype and with his wife I was able to look and I was very comfortable that I had an impression he had BPPV. I talked to the wife and him, I did a sim with her with a little soccer ball as a head and she could follow what I was going to say. Told him and her that they’re not gonna like this, as you know, it’s terrifying when you have that, just putting them into a Spurling’s position or so is, they don’t like it. And I say, you gotta trust me, you’re gonna feel just terrible, you’re gonna be afraid, just trust me, it’s gonna go away if we do it right, and we did. And so it was like for them a miracle, you know, and you seen them before. But normally they come into the office and I really, it sort of hit me in my soul this thing, well maybe that’s the way we should be treating people, is, you know, at a distance, because the drive in is terrible. A lot of them jump on airplanes.
– You know, one of the things that I think this pandemic does bring to light is the capability and the effectiveness of clinicians just like you experienced through telemedicine. I think what people are realizing is what would have taken six years for people to be comfortable by operating with their clinicians through a computer, they’re now gonna be comfortable with it in six months due to the need of what’s currently going on. A lot of my peers are already online still seeing their patients, still serving them. And just like you, helping them get better. At a time they wouldn’t been able to see them otherwise. Yeah, it’s neat. Early this morning I had a colleague who’s on the front lines of this, he’s a surgeon, and he couldn’t hold his instruments and he had a history of radiculopathy so he had a big panic. Anyways to make a long story short, I was able to intervene and I gave him some home snags to do that sustained natural apophyseal glides and another sort of a miracle. And people are not comfortable to do it on their own because the direction that they put their eyes in and their head is markedly different so especially with our scholars being trained in Neurology and being, I mean, that’s the thing you can do. So, and I know that you’re on the phone every day with people, but I know that many of our colleagues have found that the number of patients that they’re able to see has dropped but not that much when they’re doing this telemedicine using the skills that they have. So I’m very comfortable and confident that our people do have skills. So anyways,, back to your question, scope of practice, I don’t think that’s gonna change but I do think that we’ve got an opportunity to change in, you know, public image. There are many people that are our clinical scholars that are working and seeing patients and the question is what is essential? Well, if I can’t hold an instrument and I’ve got to operate on somebody, that I can go to somebody and have a manipulation or something, that’s pretty darn essential. And I know talking to people, we’ve got people like Sergio Azzolino out in the Bay Area who’s in there in the trenches and he’s seeing all of these people that are working in the front lines and really helping them with their life. And I think that if you’ve ever had one of these emergencies especially for those that are chiropractors that have had that intervention you know what I’m talking about, whether it’s a, how essential is it to be able to move your legs if you can’t with a low back problem or so? I mean, I know myself being on the other end of that. And then with our people that are CBI fellows and that, they know so, so much, they can use a variety of instruments very fluently, and especially with eye movements and things like this and head activities, there’s a lot of things they can do. So, public perception, I think, yeah, definitely we’ve got the opportunity to become engaged with people and that is really good. But engaged to help them, not engage for profit. And of course people pay you for the things that you do but this is nothing to generate income, although income shouldn’t really be interrupted so much if you can do things properly. But having that safe head canon. So Freddy, did you see that Brain EQ has come out with a virtual app?
– Yeah, I saw that, they did some big update, it seems like a big deal, do you have the scoop on it?
– Yeah I do! Now, you know I have a disclosure because I am a non-paid member of the medical advisory board and all of the people basically that have experience with with concussions and things like that, I’m one of them so that’s a disclosure. There’s nothing in it for me other than that. But what they’ve come out with, and again, San Sharma, he was on the front lines with this SARS, they understand and they’ve got all of these teams that are working in Toronto that have this experience at a distance. So what they did is they integrated the app so that now you can see your patient and talked to them. They can call and talk to you, you can interact with them. They also got a 24/7 where they can see some physician if not you, but they’re not pawned off and anybody that they don’t want to have happen and then away you go, but the neurocognitive testing, and I’ve looked at them, I mean, they’re as exact as exact can can be. We used it in our recent NHL study and we compared it to Cambridge and other things. It’s different though, I mean, Cambridge is the best, you know, the best of the best of the best, but this is something that gets you in, but now the interaction, it’s phenomenal. The other thing is, you know, dollars and cents, they have a new price structure mainly because of the people in medicine that are using this, many more than our people. But they bill for these things and there’s CPT codes that they can give you. But they haven’t now a clinical price that I think they, and I don’t even know what it is, $800 or so, but it allows you to see as many as you want. You have 10,000 people you can do it. So it’s it’s really cheap, there’s no expense to it that can be done in, so I really love those guys, it’s really great. I think everyone should have the Brain EQ. I’m dealing now with looking at people with Alzheimer’s and Parkinson’s and it’s phenomenal advice, especially with the balance app, throwing that thing through the tire.
– Well now I’m seeing how you can go from the app and before it used to be like, hey, come on in. I’m starting to see these results turning in for Brain EQ and now, Brain EQ is building the next connection which is saying, hey, I’m seeing these things, let’s connect right away through the application. So it’s just, which is kind of like where this question started off, right, you’re right, I don’t think the scope of practice is gonna change but the public’s perceptions to the clinicians and the public perception to the tools that they use to connect with them is going to change very quickly. That’s what’s gonna change.
– Yeah, and the other thing is is that doctors are there to serve patients and to do their best job so all of these things when you’re looking at diagnostics and those are billable aspects and the one thing with the EQ is its FDA approved and it’s licensed and it’s accredited, it’s HIPAA compliant so you can use it for telemedicine. Whereas, I mean, I’m using like Skype and FaceTime which is not secure but I’m doing it, I’m sort of breaking you know the chance to help people so it makes me a lot more comfortable when you have a secure, medical grade application. So, scope and practice, Freddy, I don’t think so, however stranger things have happened. I know for instance in California the nature pass, or natural pass, however we say it, have been given full prescription rights for everything so their scope has been upped because of this demand. And I know that there are many chiropractors for instance that do funk medicine and other things, you know, well care perhaps that’s on in regards to this, I don’t really know but I can tell you that being front and central and active in your community as I know you are, as I know I am. I’m with my group every day from Mass General Hospital Institute, talking with people in Cambridge and at our medical school here at University of Central Florida I’m a full professor of neurology. We’re talking all of the time and seeing not only how we can help our colleagues but also how we help humankind. The world is changing and our perception is changing so I think you have to be active, you have to be actively involved in your community. And that active involvement doesn’t mean talking about things that you’re not qualified and who is, there’s only a few people that can really talk about what we’re seeing in regards to this virus from CDC or something else and it’s really important to defer to them. So I don’t know if you and I addressed that question but that’s about the best I can think of it.
– Professor Carrick, I’m gonna, you mentioned something, you mentioned the snags. Now rumor has it, I call it a rumor because I think I know the answer, rumor has it they when you were doing some of these vestibular repositioning maneuvers that some people have not noticed that you’re also using snags while doing them. Is that rumor true?
– Well, it’s not a rumor, it’s the truth but if you’ve ever been with me how can you miss it? I do them differently and for the last 41 years so when I do a positioning maneuver, but I’d go further in the snags, I manipulate their necks when I’m doing repositioning maneuvers. But you’ll see, I’ll do different things that other people do so people will do these barbecue rolls or they’ll see me do, they say, what the heck is he doing there? But if you’ve been on rounds with me then you’ve seen it and if you’ve been in the room with me then usually you hear it. Because there’s some audible consequence but I’ve been doing them for years, I’ve never published on this but the physical therapy people from Australia have done a marvelous job with some good RCTs and if you use snags in the upper cervical spine you’re gonna have a greater ability to defeat dizziness than you are with vestibular rehab and things like that. So they’re really good, knowing when to use them and how to use them is another deal but I’ve used them, boy, I mean I can’t even remember as long as I’ve used them, they just makes sense and they’re good.
– It’s one of those things that once I realized what you were doing suddenly it opened my eyes and into my own technique so I figured I’d mention that ’cause I think some people are still reviewing some of your old videos and not seeing everything that’s actually going or taking place when you’re working with those patients. Let’s do another question here. Professor Carrick, what would be your best advice to a young practitioner, say one that’s three years just out of school.
– Get old, fast. In other words, it’s experience and, you know, young heads, old heads, there’s a little bit of a learning curve. I think that you need to be humble and the reality is is that our jobs are difficult and you’re not going to be as good today as you are in 10 years. And if you’ve been out for 30 years you should be better in 31 years. So respect for other people with experiences is really good. Be reasonable. The one good thing for young practitioners is to realize in other disciplines there’s long residency programs of trainings. For a surgical residency is five years and they get paid really crap for 80 hour weeks after they go and sometimes, we see it all the time where you’ll see a new graduate and they’ll get out and they want to make big bucks and you have to look at reasonable aspects. If you want to make big bucks probably real estate’s a good deal or selling business deals. Healthcare practitioners can become very well rewarded financially for what they’re doing but it takes some time. I do think in order to get there that you need to study and you need to involve yourselves with lifelong learning. So, and again, we have a different view on our educational sharing, we’re the people that do it. There’s a lot of courses that are available, some are good, some are not so good. And I think that you need to be judicious when you take a course, for instance, if you’re taking a course from a clinician go and see that clinician in their actual office. Sometimes you’ll be very surprised at what you see. There’s people that really do it and do it well so if you’re going to learn a surgical technique for a knee you want to talk to somebody who’s done a few thousand of them, not somebody who has been taught by the guy that’s done 2,000 of them. So I think that’s really important but there’s a lot of free stuff available that you can learn and read but you can’t learn about patients from a textbook, you have to see patients and you need to have that bit of exposure. We’ve got some marvelously trained clinicians that we’ve trained that are all around the world and they usually welcome people in the shadow. I think it’s really super, super important to pick these best people and go out and see what they’re doing and really get inspired by it and you’ll find that they’re humble with what they do and you’ll also find out if you’re new you go, boy, I’ll never be as smart as those guys. But I can tell you you will and probably be be smarter just from time, it just takes some time. Join your national association that’s responsible, join for instance the Council of Neurology. And again, like Kennedy, don’t ask what my council can do for me but what I can do for my council and things like that. And then contribute, go to meetings, whether it be a neurological meeting at your hospital or a community or whatever, go and see things and surround yourself with good people that aren’t selling you something. I think that although there’s some good courses from product developers, I think Micro Medical has got some good courses, whereas of course they sell things. But in general you really want to be sort of independent of something that would have a sales–
– ‘Cause you want to remove remove any bias.
– You really want to, I think it’s appropriate. And there’s some good people that are involved with some good products but they’re gonna tell you, like, you know, I make money off of this product, this is my product I’m gonna tell you what I do to use it and it could be the best thing ever but at least know what you’re doing and if they tell you that, it’s like shopping for a car. You know, when you go to the one dealership if the guy is banging the other sort of cars you know that you probably don’t want to buy his. If it’s good he doesn’t have to say anything about ’em, that’s the way I always bought my cars. So again, be humble, surround yourself with good people and realize that there’s a lot to learn and you’re not gonna do it in a day. You’re gonna make a lot of errors, if you don’t make errors then you’re really not pushing the envelope. You’re in a little bit of a comfort zone. If you stand really close to the dartboard you’re always going to get it in the bull’s eye so you’ve got to get and play with the team and then be accountable for it. Like a lot of us, if you listen to some people some doctors, they never have any bad outcomes. Well, I can tell you, I’ve had terrible outcomes in my life because I’m aggressive and I do all I can for people and then I try not to have bad outcomes for the next one but the more people you see of a greater difficulty, you’re not going to have an outcome that you might expect. So, you know, being reasonable. And, I can tell you, we’ve got a very good staff at Carrick Institute. If you’re starting out it doesn’t cost you anything to call and speak to us and we can give you names of good people within our discipline now that can talk to you. Let me just tie it, I had a wonderful letter from a new doctor in the NHS in England. And she’s just graduated, she’s been out for two years and she’s thinking neurology, psychiatry, where should she go, this and that. And so she knows me from Cambridge, she called me like, what can I do? and I was able to connect her with a psychiatrist who is just like the top top top person, I think, at Johns Hopkins, and I know her from my group at Harvard, and they developed a mentor-mentee relationship that just clicked. So I think it’s important we pride ourselves that we might not be able to give all of the answers but we can certainly connect you with people that can and we have people that take advantage of that, it’s beautiful. But we’ve got some really talented people that are in our sphere that can help and it doesn’t have to be us. And I can tell you, we’re humble enough to know the things that we do. I talk about things that I do really well and I don’t talk about things that I don’t do really well. I don’t really think that you can do everything really well unless you’re like some super superhuman, I’ve never met one. But there are some things that we can do super, super well. So you’ll find that some guy will just operate on shoulders, the other guy just on knees. Why not do the whole thing? So, when I had my knee done, I don’t like to go to somebody who does a hip and then followed by a knee, followed by a shoulder, follow by, I want a guy that’s just doin’ knees, that’s what I want to do, you know. And anyways, and I’m sort of rambling here but I think, you know, advice to young practitioner is don’t chase the money and these management schemes and that, you’re not gonna be making a lot of money at first and my own thing when I started out, I did really well really fast but I did it because I didn’t have any expectation of making, I just wanted to help people as best I could so. There you have it.
– I love this question, if I can add to it. I was actually on the phone this morning with somebody from England as well and they were asking me, it’s a question I get very often, where to go, what do I do? And we’re kind of laughing because we’re both admitting that when you leave school at first when first get out you think, wow, I have all the tools to be really successful and do all the things that I wanna accomplish. And you quickly realize once you start getting more complicated cases that you don’t, that’s actually the beginning of your learning. I think what’s, that effect where you at the beginning when you come out of school and you think you know more than you know?
– Yeah, well, it’s the deal, we study it all the time, the curve is you come out you’re smarter than everybody and the more you do it it starts going way way way down, then it comes up a little bit. Now, Neva Howard had a great presentation, you know Neva, she’s just like super genius, you know, started with a PhD in physics, concert violinist, world famous in regards of that. She does emergency medicine but she had shown a study that showed the competency level of people listening to heart sounds. And that if you look at a first-year medical student with heart sounds and somebody that’s been out for 10 years they’re about the same and after 10 years the medical student with no experience is better than this guy here unless they were people that were residencies or academic medicine that keep on increasing. So you need to have time and rank but you need to constantly be a lifelong learner. So, and I can give you you know something that we do that we take very seriously, we use different cue streams and interactions so that when people take a course with us after that course they still get bombarded with questions that are designed to promote this lifelong learning and I know that we give people lifelong access for instance to anything that they’ve done at no extra charge. Now that may be dated, but at least it is there and hopefully we give them the skills to be able to think, we’ve developed a problem-based learning model that teaches people how not only to read and interpret the literature but to look at a patient experience and then say, how can I do this better? And let me tell you, when I listen to, again, new people, right out of school, say three years or so, that are in our programs, I am so proud because they’re a blank canvas and they learn so quickly and they just sponge it in and then contribute. So it takes them you, know two, or three modules but in our problem-based activities they catch it. You know, they’ve got better brains, they’re younger and they can just do marvelous things so I think guidance, structured learning, learning with a pedagogy that is going to develop a mastery of skills and entrustable practitioner activities is way to to go but we’re certainly proud of them.
– At one point you mentioned shadowing people. When I was talking about scholar this morning I said, I start admiring and respecting these experienced clinicians when I asked him a question and their answer, is it depends. I think in my younger years I wanted somebody who would very proudly have that definitive answer because that’s what the expectation was. But I think the more you learn you suddenly realize that the answer most of the time, is it depends. It depends on these variables that the young practitioner isn’t even aware of yet, because they haven’t been practicing long enough. And what makes it confusing when people are choosing their education is that people want to buy, people want to purchase their education based off of the assurance that they’re always gonna be given the right answer, like it’s a definitive thing, like there’s an algorithm that spits it out. And it’s really not that simple. You need to teach people how to think so you take that real answer which is, it depends, and you teach them how to think about the problem so they can come closer to an answer. And they still need to test that out.
– Yeah, for sure. You know, it’s interesting Freddy, I remember just like yesterday, you know that when I would do rounds in my clinic we would see just large numbers of patients sent from around the world and we’d have hundreds, literally hundreds of people that would assist and watch and because of the volume that I would see in a track they become very popular. But I remember one question from from Christa Hubbard, one of our colleagues who is sort of a right-hand person, and she goes, that was just absolutely amazing, like a miracle, why why did you do that? And I looked and I said, why don’t you ask me why I would never do that again? Because I can make it better next time. And here’s the reality, that when you get these outstanding outcomes, that doesn’t mean that that would be the limit of that outcome. So every time when I see a patient and rather than say, boy, how good was I? I was always like, how could I have done that better? And I can tell you without equivocation that I probably would never do the same thing again on a patient because when I see a good outcome I think, boy, I could have done this, this, or this, so it really changes. I’m not satisfied with my own assessment of superior mediocrity, if you would. That’s the reality of it.
– Excellent. Hey, Dr. Carrick, let’s do one more. Let’s see here. All right, there were a lot of questions actually about history, historical stuff, where you came from, how you came to be so good at what you did so let’s do this one here. Can you tell us a little bit about the first thing that got you involved or interested in the nervous system and its function when you were a student? Was it an experience at college that pushed you in that direction, was it your love for neurology that was established earlier on? They were very interested in your path and where your curiosity came from. Which, you know what, I gotta tell you, I wanna hear about this. Where’d this all come from?
– Boy, that’s a long one. Well, I can tell you, I don’t think I’ve ever had a love for neurology ever but I have had a love for humankind and the two started go hand in hand and I realized very early in my life, you know, with the variety of things that I’ve done, that some people had different abilities to march or to shoot a gun or to throw a bayonet or to do a variety of things or to think of a plan than other people did. So I realized that there was different abilities of people and I realized that those abilities were, a lot of them were like, you know, being a jock or when you’re boxing that maybe you can be better than somebody else and the whole thing was based upon the brain and nervous system, that’s it. So I fell in love with human function as a very young man before I understood the basis of what that function was but I can measure it, I can know if somebody was gonna be faster than me with their right hand and I would develop a strategy that that would never happen because I could find a weakness and go in there. I became you know pretty good at those sorts of things. In clinical practice–
– You keep talking about striking, you boxed, didn’t you?
– I can tell, yeah.
– And the, you know, the karate thing and everything and everyone’s got black belts but when I, it took me a lot longer than these people do nowadays. But that’s the, you know, that’s the way of things. Anyways, when we look at clinical activities I was thrust into clinical practice starting from nothing and I was really lucky because I had good powers of observation. And I saw things that other people didn’t see and that’s a skill that I learned when, you know, walking to the hockey rink and looking at the constellations and being able to see different things in them, so I learned to observe and I learned how to drive down the road and remember every license plate of every car that passed by or, you know, looking at different things, how many matches in a matchbox. So I learned those things and I learned them pretty well. I learned things almost like if you look at Giordano Bruno who’s probably influential to me in the 16th century people. He got burned at the stake for Copernican sort of neo Aristotlian beliefs but he would take mindful things and put them in silos and be able to retrieve them. So I learned to do that very early, I didn’t have TV, the TV that we did have eventually is only black and white and we only get Ed Sullivan and Hockey Night in Canada so there’s no distractions but I took things and learn to put them in my mind silo so that I could recite something and I remember like yesterday, I don’t know, I was eight or nine, I was reading about Giordano Bruno and he went did a demonstration in front of the Pope where he memorized and actually talked about this song word for word, and it was a complicated song. And everyone was wow, that’s amazing that he memorized that. And then he just sort of like said, well, let me show you something more amazing and then he recited the entire song backwards. And for me as a young kid I thought, isn’t that great. So I learned to do that and so I would sort of impress myself because there wasn’t too many other people to talk about where I would read a book and I’d put it in a silo and then I would say pick whatever page, I’d do it and I’d do it but then I could see that page and I would read it backwards and I thought, wow, that’s pretty cool, my mentor got burned at the stake. It didn’t do too well for him, so that’s an interesting little bit of a story of putting things into perspective. Now in regards to the neurology or brain, I didn’t know what a brain was, I mean, we’ve got one, but when I saw patients and I saw them losing memories and I saw different different aspects I started to understand that function and then I started to realize that when I would do different things and I was very observant of joint movements and gait and kind of stuff that these kind of things, speed of movement, I loved this idea when you play judo and you can you know take someone and do some mat stuff, I loved that sort of thing and that’s basically manipulation or adjustments. So when I found that when joints weren’t moving I would do things and I would look and I’d see different functional things, I’d see, you know, the blink responses would increase or I’d get a smile on the face when they were flat before. They could walk a little bit faster, and it really excited me and I felt very comfortable to realize that I could understand this gait was better but I didn’t have the skills to quantify it so then I would read about gait. And then I would put that information in different silos and away we go. So I remember myself and my good friend who was the forensic odontologist, that’s a guy that solves crimes by looking at your teeth. And we would do some crazy things together, I would go to the prison with him with somebody who’d murdered someone and had bitten somebody and taking you know bites to see, and I’m looking at this guy and he’s doing the bite and I’m looking at his eyes and looking at these cons and before I knew what it was I go, I never seen that sort of look on anybody before. I get excited with that, and the same guy, goes over and says, hey, Ted, get me this panel, we’ve got some guys head in it and he put it in acid to dissolve all the meat to look at these teeth. Anyways, we went down to Harvard together in the very late 70s, early 80s, and started studying with the people, Monroe Keyserling and Stover Snook in regards to isometric lifting capacities. And then my clinical experience just boomed, I was getting people sent in, this was before Facebook and advertising and all of this sort of thing, from around the country. And then I started getting people from China, from the Soviet Union when the wall was up, it was really nuts. And I was comfortable making observations but then I would take those observations and try to learn about the individual components associated with those observations. And learned from a lot of people and a lot of the people that were pivotal in my learning were dead people because I read stuff from centuries ago and I would look at ar, it always did me very well. I look at these people of suffering and I say, boy, I’ve seen that sort of a face on someone who’s been shot or stabbed, I seen that before and I’d look at this and the religiosity of that and then take it into more conceptual terms. As a consequence of that my clinical outcomes started to get better and better and better but were not focused on a thing of this test means that I’ll do this, I’ve never been like that, I still am not. And then as a consequence of it I became pretty well known and I flew airplanes so I’d fly out, I was invited by Dr. Jansey, who was again, I never went to national but he sort of gave me a charge, he said, your kind of responsibility to teach what you know the the biggest problem was, I didn’t know what I knew. And then Ernest Napolitano at NYCC, he said the same thing, you gotta do that. So I said, okay, so I built a school, a great big classroom next to my clinic and in my clinic, I mean, I had, I built a swimming pool because I did aqua, I did all of these things for telemetry, anyways. And then all of a sudden I had to quantify and say, okay, well what do I know? I didn’t know what I knew, I mean, I knew I did observation so that’s how we developed this idea to try to teach people what I knew with the reality that I didn’t know how to teach and I didn’t know what I knew but I could share a clinical experience. So people would see videos and it was like miracles and it was it was so miraculous that we had some people saying, well Carrick just hires actors because how could this ever possibly happen? And of course those are old stories, people know it, know what happens. And then to try to explain it led me to the nervous system and led me to to try to understand it. So one of the people at Harvard introduced me to someone from USC, that’s Paul Rowland, and I knew I needed more education and I wanted to do a PhD to understand mind and brain and how these things went. So I was going to do a program at Harvard, then at USC with these guys, and this one had turned me on to Walden, I was gonna do plain neurophysiology and he said, you don’t want to do that because you’re looking at test tubes and things, you wanna deal with people so. He steered me onto this Walden program, they gave me the opportunity to understand education or a mind/body experience and then I did many stages where I learned to work with rats and animals and looking at conditioning and looking at inside of the site of architectonic areas and that really helped me understand how to explain what we’re doing in the nervous system and explain what I was seeing. And it was pretty humblingly wonderful, took me a lot of time, I used to be in the clinic at 7:00 in the morning till 11:00 at night and people used to camp out and try to get in, I could not see the number of patients. They used to be really, people would be crying and then I would jump in my airplane and I’d fly down in New York or to California and I did a lecture and fly back and it was a little bit exhausting and a lot of sacrifice because I had to miss time from my kids and things growing up, missing their proms and things because I worked seven days a week, I never took a vacation because I had people to serve and that was important to me and when we talk about service to others above self I’ve always held that really as a prime aspect. So no regrets with that but I think that for other people who sacrifice a lot more than me living in there in the jungle and helping people and no families and things like that, there is sacrifice with what we’re doing. So that is basically my journey into the nervous system, observing things that I didn’t know what it was and then to learn about the little things in the silos of my mind that I have it. And interestingly I still have those same silos, I have all those old filing cabinets so you can ask me about something or a person or, you know, I did some translations, you know, you learn different languages but I did some translations of Clement of Alexandria, one of the first Nicene Pope to understand Homer and understand the role of the church in regards to human suffering and journeys of Odysseus and Christ figures and I can tell you verbatim the exhortation of the heathens that was written in the first century and I had that and it’s not effortful for me, and I think those are teachable moments that you can, they’re not innate gifts, maybe some of it, but you can be taught to be an observer and you can be taught how to learn. You can’t memorize it but you can snapshot and you can file and learn from your experiences. So that is the deal and then to, Dr. Jansey was really pivotal even though both him and Ernest Napolitano died shortly after they gave you their charge, they left me. And so there I was, you know, I think that things could have been a lot smoother if I had their guidance and, but we became really big, you know. Clinically I was seeing people and then teaching or learning to teach and sharing and people were very assisting with me and appreciative of my inabilities to probably do a great job as an educator at those times. And realized that I had something to share and that I was trying to do it as best and then other people would look at a patient and say, well, how did this happen? And I would look and say, you know, I don’t really know. But let me think of how I can explain it based upon things that we know today and in order to do that I had to study and learn the things that were known that maybe give us a better picture. So my explanations of how we do things has also changed, I could give you a wonderful dissertation of how stimulation mechanoreceptors explained everything that I do today, but I don’t believe that that’s true anymore. But I did believe it and that’s what I knew and the more I know, the more explanation that I have. But the one thing that I can share with clinicians about the nervous system is that if you can make an observation then you’re gonna have the skills to know if that observation changes as a consequence of something that you do. And that is really cool, and we do all these sorts of little party games where people will put someone in a BNG and I’ll just look at the person without it but I can tell you exactly what’s happening with those eyes that you can see in the BNG, for sure, without a doubt. That’s a skill, other people have it, it’s not limited to me then you say, well why would you even use the BNG? And the answer is, well, because patients like to see it. In other words, I can tell you that you’ve got psychotic intrusions but what is it? When they see it, so that’s a really good educational tool. And we can change some. Again, we’re doing it, so right now what we’re doing with Carrick Institute, we’ve got two books, one book with our editors, On an Anchor, if you look inside the cover it’s from Harvard, Stanford, and Carrick Institute. This is incredible, right? Where we have a book on Islamophobia, how does that affect what we do? Well, it’s mental health and stigma. It’s incredibly great and now we’ve got another textbook on the anti-Semitism. We have a big, big major publication that has just been accepted, I’ll probably be a PubMed near the end of the week on diabetes and and type-2 diabetes. That is not my wheelhouse but I’m the primary guy, I’m the last person on the team on the paper and what we found was using the brain we can make things better or if we teach people about the disorder we can change it independent of the medicines that we’re giving them, it’s really phenomenal. That’s a big high tiered journal. We also have another high tier publication last year in endocrinology that we looked at in regards to depression and diabetes and we found that if you’re depressed statistically you may develop type-2 diabetes. If you have that you’ll be depressed, this cycle. Well, we had published a very interesting study in head eye vestibular motion and show that we can change depressive states and patients doing the things that we do in what people call functional neurology or what we call clinical neuroscience or by using vestibular rehabilitation which has a lot of evidence and by using eye movements, a lot of evidence, by using manipulation which doesn’t have so much evidence, by using aerobic exercise which has got a lot of evidence. And we were able to take and change the person’s outcome in so many different batteries of validated tests that had to do with anxiety, depression, insecurity, irritability, so it’s a really, really good fit. And I was talking to Ron Oberstein today from Life and really interesting, I get invited to present Grand Rounds at at Yale University Medical School Transplant Surgery. Say, what the hell is he doing there doing this? I’m not a liver transplant surgeon, I don’t know how to take out kidneys. But I do know that those people that have got bad organs have encephalopathy and I do know how to take care of that. Now, is my mechanism of taking care of it different than other people’s? I can tell you unequivocally yes. And without a randomized controlled study because I deal with patients, that’s my primary expertise, and you’ve got an ethical aspect when someone comes to see you and their mind isn’t working or they can’t think and they can’t walk and the world is going down, I can’t ethically put them in a group that doesn’t get the treatment that I know is gonna make a difference. So the things that I publish, and I don’t have a lot, I’ve got like 60 papers in PubMed, and they’re good papers, some of them better than others, some of them older that probably I wouldn’t do again today, but no case studies, I’ve not published one case study in my life but a lot of before after intervention. And they’re good, they’re contributory. And as a consequence people at these different institutions want to hear from me and our colleagues that do the things that that we all do so wonderfully. And I’ve never been able to do a wellness care practice because I see acute patients or patients that are with chronic disability. So once I see them they’re done, I don’t follow, and I do follow them I don’t have–
– If I could interrupt you. If I could interrupt you, talking about your practice, every once a while I’ll hear scholars that’s been with us for years and years and years and they’ll talk about your practice that used to be, was it in New Hampshire?
– Can you tell us about that practice ’cause some of these these older doctors tell me about this and it sounded amazing but I’ve never really asked you about it. What was going on there? What type of facilities did you have? what types of patients were you treating? I mean, I used to hear rumors or stories of lines literally like, I think you said it, like you would get there and there’d be a line forming of people. And they’d be like, you know, doctors would be in that line waiting to get treated by you. Is that all true, like what was going on? can you tell us about that?
– Yeah, it was pretty robust. It was a crazy big busy practice with patients sent from around the world, similar to what you’ve seen us do in Atlanta. But it was a little bit different, people now what will talk about, I’m gonna do intensives. Well, intensives is you’re doing the Carrick paradigm because that’s what I’ve always done. People will come in, they’d be there for the day. So I knew for instance that aqua therapy was really amazing, especially people who couldn’t walk or had brain injuries. So I would rent the YMCA pool and hire a kinesio therapist to work with them and we saw so many people work really well. I said, well, I have to do it better, so I built a great big pool in my clinic. I would send people for variable resistant isotonic exercises and plyometric exercises and isokinetic activity and then I said, the hell with it, so I built that in my clinical facility. so I had a super super huge clinical facility and people would go to rehab, they go into the pool, they go to the gym, they go into therapy and they see me. We’re really pretty heavy on manipulation in those days and the successes that we have, and you can say anecdotal or whatever, but it sure made us the place to be and as a consequence of that I had, I’ll give you an example, like if you talk about sign backs, everyone knows what sign backs is, and they have the isokinetics, we had the teth machine which is a trunk extension, flexion, and torso lift. Well, I had that before anybody had that and all of the other centers, I’m talking about people from Spalding, from Mass General, at Harvard, Uconn, everyone in New England would come up to me to my facility every three weeks and we would have rounds at my facility and I would talk about patient experiences. I made some great friends from that. I remember orthopedic surgeons, my good friend Barry Lange would be there and he was also a pilot, he had push pull Cessna. He’d fly in, he and his buddies and they’d come in with people radiculopathy, no reflexes, they do operate on it, they’re spine surgeons. I turn around, bang, the reflex would come back and they would go holy shh, I’ve never seen this! And, you know, I know chiropractors, they don’t do that. Well, but I did. And that was cool, again, no RCT. We’re not gonna get into it because these are people that are going. We would see almost all of these OBGYN patients, people’s labor would stop, I can’t tell you how many times labor and delivery, they stop, I come in, boom, manipulations and kids would be popping out like ping-pong balls. It was really great but it’s very dynamic. There’s nothing mystical about it but it was, if you’ve never seen it, and you know ’cause you’ve seen good quality practice under your own hands with other people who do it really well. It was amazing and the patients were real patients, not from my local area, I had all of them, but from all over the world would come to to see us. It was it was pretty fulfilling but it was exhausting and I never have been tired with it, I can still, you know, work the 12, 13 hour patient days. How can you get exhausted when you’re giving people their life back? It was real, but it was, you’ve never really seen anything like it, it was amazing. I remember, and I would do these calls, the fire department would call in, I had this one patient, I can’t give you, I could give you her name but I think she’s dead. Anyways, she was a big woman and she was, her back popped out and she was on the toilet and screaming, couldn’t move, the fire department came, they couldn’t get her off ;cause of this, better call Dr. Carrick. I went in there and it was, it’s sort of a funny story now but I can manipulate you know really well, that’s one of my skill sets. This woman I guess was 400 pounds if she was an ounce and I said, okay, just relax and I do finger tip things so I did a sitting lumbar, it was like bang. You hear this like, almost like a creepy tree just breaking, you hear this big crack, and then all of a sudden you hear this boom into the toilet. And this turd came out, she was like on this toilet for like seven hours, boom. That went down, they went, holy moly! And she’s passed the toilet paper book, got up. These people are like, another miracle. I mean, stories like this become legend and it’s sort of like, talked to John Merrick or some of these people that did residencies, they’ll tell you, the people coming in with like, I mean, like funny things. And I’m not going to do it here but a lot of them are just like, just wow, and it just really sort of fulfilling and then galloping on and on that institutional practices and the ICU and it just, boom, boom, boom.
– I’m sure some people going to hear that story and say, that cannot be true. But at the same time I’ll say listen, I have been going rounds with professor Carrick treating patients with Parkinsons and he’ll ask them, what is the one thing that you want? And they’ll be like, I want to be able to have normal and close to normal bowel movements. And within a day they’re having those bowel movements again because that decreases in some of those patients. So it’s like, it’s a funny story now but I’ve seen that.
– Yeah, it’s all true and we got video tapes so I mean. We have that, but it’s not like, you know, believe it, it’s not like we’re selling something, it’s the deal. And so what happens is is that when you have someone that you love is ill you want to take them to somebody who’s going to give them their life back or so and the so many people that I know do that on a regular basis, some of them through surgery, some of them through some sophisticated nutritional aspect. I do what I do in my wheelhouse and there’s a lot of stories and legends for the people that have been there. I just have one little story and I think I was talking to Dan Lane, I saw him in Washington and we went to a hockey game. I take care of these these players, you’re not gonna see me on Facebook though with a picture, like a me with, you know what, I don’t do that. But we were looking and we’re talking about one time in Atlanta where they had this big, we call it Snowmageddon. And we had you know hundreds of patients coming from all over the globe and hundreds of doctors from all over the globe to assist me and Atlanta shut down, it was snow, it was ice, cars were off the road, you couldn’t get anywhere. Every patient made those appointments, some people took 24 hours to get from the airport to see us and doctors were staying in rooms and hotels with patients and we had bunks up there. People were making it, I remember looking out the window and seeing patients pushing wheelchairs of other patients and these guys can hardly walk and they all made it. Now if you tell that story, and it was a beautiful story, and there’s no exaggeration of this, that the love and care of people that are serving is one thing, that’s beautiful. But the love and care and then the skill to make a difference in these patients lives is something that you can really see and not one person that was there was boasting about how great they were, not one person. And that’s the sort of people that we train hopefully because we want to do it better. But we’ve got oodles of stories like that, we could sit down and just say hey, let’s tell the story of this person or this person. Sometimes they get changed depending on who’s telling them but the facts are the facts, and they’re are their beautiful stories but if you’ve been on rounds then you’ve seen it. Now a lot of it, let’s face it, you know, I’m touching 70. You’re not going to be around for a long period of time but there’s other people much better than me that you can see and that’s a little bit, but you want to see people! You know, if somebody’s telling you something, you want to go and say, let me see this magic. Maybe you’re gonna be disappointed, maybe the magic was in their mind. But there are some great people out there that actually do it and you want to hunt them down and see it and then do it better than they did, you know, that’s the deal. Give them credit to if they help you.
– Professor Carrick, earlier in our conversation you mentioned the term functional neurology and you said, you know, what they call it. You know, what we, and then your next line was, what we call clinical neuroscience. So let’s talk about that term functional neurology, where did that come from and why does it keep being used?
– It’s a good term, it’s one I don’t use that much, it simply means that we’re increasing function, it’s a paradigm. Traditionally functional neurological lesions are lesions that have no organicity. In other words it’s in your head. Hysteria, things that Charcot would look at, those are functional neurological lesions. People that would write about it, from Babinski to Jorge Jill de la Tourette, and all of these you know wonderful people. So that it was realized that people could have tremors and shakes and things like that that didn’t have a focal lesion and that they would have what we call a functional aspect. Well now it’s known that they weren’t nuts or crazy or hysterical, that there are physiological lesions or if the brain isn’t working right that you may have motor manifestations or other things. So the term is a pretty good one but it’s been morphed largely by the press and you get all sorts of people claim credit to it. Doesn’t really matter but I know years ago they did a PBS special on my work and they talked about–
– Waking Up the Brain, that one?
– It won an Emmy Award and a Freddy’s Award. And they had filmed so many patients and they picked one patient that had had brain surgeries, another one that had you know, you can watch it, and they’re pretty miraculous activities but they had filmed ones that were even much more miraculous. I said, why didn’t you use those? They go, ’cause that’s too miraculous. Levels of miraculous like, you know, this one here people aren’t gonna believe it because it’s so great and they talk about it, it’s amazing. And they saw it, and they did another one with 20/20 where they filmed people and looked at ’em for six months. It was like, how many people are you going to look at? You’re gonna film your patients, follow ’em for six months, and if they weren’t all cured then they would report that, hey, maybe this doesn’t work for a long time. They were all fine, so they reported on on that. So we’ve had a lot of those sort of things. So functional neurology, I get a lot of credit for it. I sort of wish that I wouldn’t because with that then you have to deal with every wack nut that comes down the street that’s talking about functional this and functional that and the other sort of thing. I’m just a plain old clinician. At Carrick Institute we talk about clinical neurosciences, we talk about increasing human function, but people who love the term functional neurology. I’ll give you an example, I get a call from California yesterday for someone who’s got a real high high-end athlete who wants to know who’s a Carrick trained functional neurologist. Now, they use the term. Now I’m not gonna go and say, well, we don’t like that term. Man, I can deal with that and boom, I can give them someone in their area that I know is gonna be great, whether it’s gonna be like it’s Chicago or San Francisco or Minneapolis or L.A., we’ve got great people. Or whether it’s going to be an Amsterdam or Paris, we’ve got great people. But the world talks about functional neurology, there’s been a recent aspect where somebody’s been writing some papers searching for, what’s the evidence of functional neurology? It’s a paradigm. So what do you use? So if I use vestibular rehabilitation in a functional neurological paradigm you’re not going to find a functional neurological aspect of gaze stabilization, it doesn’t exist, but you’ll find gaze stabilization as that type of activity. And there’s all sorts of RCTs in regards to that.
– I think part of the confusion is that people, they’ll say the term functional neurologist and they think that’s a profession. But it’s really a paradigm utilized by many professions. We have medical doctors, we have physical therapists, physiotherapists, chiropractic physicians, acupuncturist, athletic trainers, neuro optometrists, all leveraging that paradigm but they’re still their professions, they’re still a physical therapist. They’re not all of a suddenly, I am now a functional neurologist. They’re still a physical therapist that leverages that paradigm.
– Let me tell you, yesterday, call from a University of Montreal colleague wanting a recommendation for a functional neurologist. Call from MGH looking for who I consider to be the best functional neurologist. Call from L.A. looking for the best functional neurologist. That’s their terms, I know what they mean. And you’re right, because we have people that are amazing physical therapists that practice the paradigm of functional neurology that I would go to with the healthcare. We’ve got some people in medicine or chiropractic. You don’t own something. It’s a common term and it comes with it. A lot of people are so worried about delineating who they are in individual scopes. I’m proud of what I am, my credentials are there, there it is, but I will have people describe me, had one person described me as a cardiac transplant surgeon in one big thing, I’ve been introduced as everything from you know a soup maker to the rainmakers, it’s gonna happen. And when you give interviews what you say may not be what comes out and if you do a video interview they can film you for four hours and put in a 20-second deal of you picking your nose. So you don’t know, that’s not your authoritative type of thing. And you know we get calls from the press every day, every day at Carrick Institute. Majority of people I don’t give an interview to, I’ll give them to some people if they have somebody else has recommended them. But I don’t need to into this aspect of a weird sort of a deal or whatever. Our press has been generally pretty damn good when you look at it compared to anything to anybody else, and we don’t look for it. We try to take away from that and coverage. But we have good people in that functional neurological paradigm but that term is here to stay, society likes it.
– I have some hopes for it though and if I could share with you my hopes. So back before I even went to school I used to be a trainer and then there was this whole phase where there was your trainers and there was your functional trainers. And what that meant was that your trainer didn’t do traditional exercise which was up and down playing in a sagittal plane, it was they do things that are more realistic. More rotation like you’re picking up a box off the ground or reaching up for a soup can. Then it became the thing to become a functional trainer, more realistic health to life. But then you fast forward a couple years and then that trip that term went away because all training became functional training, that paradigm became so part of the fabric of training people for athletic development and fitness and injury prevention that it became the norm, that that term went away. My hope is that people look at what they think is function neurology in that paradigm and it becomes so part of what is physical therapy, chiropractic and medicine, and all that means is that we’re gonna have all those profession taking to account the individual neurophysiology of the patients in front of them and I think that’s something that every single profession can get behind and support.
– I agree with you. You know, it brings out all the characters. The one thing that we see is people praise the things that we do, which is really great. There always is people who will denigrate other people, whether it’s denigrating a different profession or an individual within that profession. We don’t do that, if we had any of our faculty or peers that talked ill of somebody else, we don’t tolerate that, it’s just not even reasonable. So you’ll have a lot of old things where people might say, Oh, Mother Teresa, how great could she have been? You know, she was a chiropractor. There it is. Whereas if she was something else then it would be great. So that sort of thing of denigration is not good, we have it from some people within our own professions where you know they don’t like this guy’s technique so they’ll bad mouth that person. Well, that’s not good, right. The activator guy bad-mouthing the gonstead or the gonstead bad-mouthing the SOT. Our profession has been rife with all of those things and when you look at the characters that do it, if your stuff is really good you don’t have to tell anybody why the other guy is no good. I mean, you don’t have to tell them, it’s really evident. And in regards to functional neurology, it’s a paradigm, it’s multidisciplinary. When somebody does a surgery, you’ve seen me with a patient, I’ve seen say, you gotta do this. With this this lesion, I know you were there and I’m not gonna say the name of the person ’cause he’s very famous, but I said, you know, I’ve got a friend in Japan who does this surgery and the globus pallidus and that’s what you’re gonna need to be able to do your job, he’s the best in the world. Go and see him, so he did. Because I wasn’t, what I could do wouldn’t be the best thing to do and it’s an amazing outcome. But going to Japan. But now this guy who, this Japanese guy, if Ted Kerr calls up that patient’s in that same day. Other people can’t do that because he’s in that functional paradigm. You see, it’s a beautiful, you know who I’m talking about, right? And, you know, it’s a beautiful outcome. So that it’s multidisciplinary and it comes back to us, gives me goosebumps because people refer to us, you get the calls every day at Carrick Institute, who can we go to? We send, I only give numbers, everyone says, what? I mean, I’ve heard people say, I see 1,000 cases of scholars, that’s more than I’ve ever seen. You know, a lot of people see thousands. But we refer a large number of people because we’ve got trained people that can do it and they’re all marvelous. But we do have we do have some characters that they’re the best and everybody else pales in front of them. I don’t like that, it’s not even reasonable. You know, some people are better than we are, we can just do the best that we can do and hopefully not do harm and do it better next day and so far that’s been my life’s history, I guess getting back to your topic that we just went all the way around. But love of neurology and systems, boy, we could, Freddy, that’s a lifetime talk. If you ever read Marcel Proust and you look at his literature, when you look at a dying man and he sees everything coming in front of his life that he’s had and you relive it, you see all of these little segments. I mean, those questions are like that with me, you know, hopefully not on the deathbed but when you look at the reality and reflection there’s so much that we can talk about so I’m glad you invited me just to share as we do and this is long, I don’t even know if anyone’s gonna be able to watch it.
– You know, I guarantee you people will. ‘Cause we put things up on our YouTube and we get emails so I go, I can’t believe they watch the whole video. Professor, I have a long list of questions, we’re gonna stop here today. Maybe for the next one ’cause I know we have a schedule, we’ll do some more clinical questions and give people a mix. But I appreciate your time. Hey, by the way, I am gonna call this show Ted and Fred’s Excellent Adventure, just so you know, so I hope you’re okay with that title. I’m gonna take your your no answer as that being okay and then and then away we go with that name.
– Of course okay, Ted’s first, now if you called it Fred and Ted I might.
– No, Ted and Fred’s Excellent Adventure I understand, you got, you got it. And I’m a Frederick too so.
– It could be Fred and Fred’s Excellent Adventure technically.
– It could be F squared, whatever you do is fine with me.
– All right professor, I will catch you tomorrow, thank you very much for your time today, I enjoyed my time with you as always.
– You’re gracious, thank you, Freddy, bye bye.