Franziska Haydanek: ninety percent of people in some point in their life will have back pain. So almost every single person will have back pain. Most people resolve. And so you don't really need advanced imaging because MRIs are overly utilized. And so the real pet peep of mine is when, you know, someone will be like, ⁓ your back is shut. You you're you're gonna need surgery. And then they wait three months to see me, whole three months are freaking out. And then it kind of like snowballs the symptoms. And so really understanding that back pain is super common, pathology in the spine is super common. The spine ages. We'll all have changes in our spine. And really it's only an issue if it's an issue for the patient. Welcome back to I Did My Own Research. I'm Dr. Fran and today I'm joined in person with Dr. Betsy Grunch. Dr. Grunch is a board certified neurosurgeon and posts online at Lady Spine Doc. Dr. Grunch earned her bachelor's degree in biology from the University of Georgia. She then attended medical school at the Medical College of Georgia at Augusta University. She completed her neurosurgery residency as Duke, as well as her fellowship in spine. She now works as a spine surgeon in Georgia. You likely know her as Lady Spine Doc, as she's known to her millions of followers online, where she posts about all things related to the spine, head, and neck. I was fortunate enough to sit down with Doctor Grunch recently as we both attended the Pinnacle Conference in Austin. Doctor Grunch, welcome to I Did My Own Research. I'm super heavy. We're here together in Austin for the Pinnacle Conference and we took advantage to get together. Yes. I'd love for you to first just tell us about your education history. Yeah. Why you became the type of doctor that you became, really like a little bit of the Medical lore for you. The medical lore. So I briefly grew up in a small town in North Georgia and I my mom was in a car accident when I was thirteen. I always thought I wanted to be a police officer because she was a police officer. And unfortunately, she was injured in the line of duty when I was fourteen years old and suffered a spinal cord injury. And that really just changed our whole life. And to the point where I decided that I wanted to care for learn more about neuroscience and spinal cord injury and wanted to learn why this happened to her and why she could never walk again. And so I became really interested in in the spine and I shadowed her neurosurgeon and I really wanted to be a spine surgeon. And so I went to the University of Georgia. I was the Ma my mom was an injured police officer, so we didn't have any money. So went to local school, got scholarships and did public, you know, undergrad at medical college, Georgia for medical school. Wanted also just stay close to home and be accessible to her. And then in residency, I matched at Duke, which is kind of close to Georgia. So the only time I really went out of state was then. I was there for six years, did my enfolded fellowship there in Spine and then came back. right back to where it all started. Yeah. We've been practicing since. How long was your fellowship for? So at the time, neurosurgery now is seven to eight years. But at the time there were a few six year programs that still were in in existence before this is before the eighty hour work week. So I Eduke was a six hour a six year program. We'll just leave it at that. Yeah. And ⁓ during I see through the lines. I see through those lines, yeah. Nine years and six. Yeah. ⁓ huh. So During my research here I did an enfolded spine fellowship. So they that's pretty common in neurosurgery to do subspecialty. There's not some sub specialties within neuro don't r necessarily require like more terrification. So like peeds and indivascular are typically different, but like spine and functional and some of those other ones you can do kind of enfolded. So so yeah, I did that inside and And there you are. What is the difference? Because you can also go into spine from ortho, correct? ⁓ huh. Is it this exact same medicine, just two different pathways? Kind of. So I actually thought about doing ortho because I knew I wanted to do spine. So for me I was deciding like do I want to do ortho or do I want to do neuro? And I going into medical school, I mean I had shadowed neurosurgeons. I actually took a one year deferment during between undergrad and medical school, ⁓ because my mom was really sick at the time. I knew I wanted to do I thought neuro. So I was worried that it would impede my performance in medical school. So I took a one year deferment. And at the time I had worked for another neurosurgeon during that year that was close to home. So I really felt like I was wanting to do neuro. I really liked the brain too, but I was open to ortho. So in medical school I saw one posterior hip dislocation that was reduced in the emergency room and that was it. I was like, absolutely not. Absolutely not. That's disgusting. So but no, to answer your question, I mean, you can do so orthopedics is five years ortho. with a one year fellowship depends on the program because a lot of people are asking like who's better, ortho or neuro? Well, you can go to like, you know, neuro programs, for example, and get six like I at Duke, I did six years of spine because spine and peas for that matter, like every day we run it on every service. And so I was integrated into spine every single day. Whereas there are some neuro programs where you're in rotations and only spine at one hospital. So you may go to a program where you get six months of spine. And same thing with ortho. You might go to an ortho program where you get less spine and then you have a one year fellowship. I will say in general, more orthopedic trained spine surgeons have less experience in spine coming out of training than a neurosurgeon. But that's a general blanket statement. But you'll get, you know, ⁓ you can do it either way. And it really just it just depends on your program and and what you're exposed to. Yeah. Especially if in medical school so you only see one or the other that you're kind of like, ⁓ I only know ortho because this is the way that you have to go. And so I think that's kind of like a downfall sometimes in medical school is that you don't get exposed to everything along the way. Like I've never seen any neurosurgeries in my entire life. You need to see one. I do. I would love to see some spine surgery. I just like the brain. I I would love to see some brain surgery. I think that would be very interesting. But I also never saw like cardiothoracic surgery. Yeah. I th I would love to see like a beating heart. I think that would be really cool. Yeah. So I think it's just like is hard because we have our basic things that we're exposed to in medical school, but unless you know like I want to be a neurosurgeon, yeah, you're probably not gonna see it. Right. And like it's not a required elective. Yeah. And so unless you seek it out, you're not necessarily gonna see it. And yeah, I agree. Some of these sub specialties are very much like that. And so unless you're exposed to it and somehow at some point in your life and and have an interest it it can be un untapped. Sub art. Yeah. I think that's like how ophthalmology is. Yeah. I think like no one do goes into ophthalmology and Less you knew you wanted to do ophthalmology because you're just not gonna get exposed and that and the eyes are crazy. The eyes are gross. Yes, the eyes are. I agree. And I'm a gynecologist. I hey operate right near the eyeball and it still grosses me out. So Okay, so that's the medical lore, but how did we get into Lady Spine Doc? Like the history there. So, well, I actually so Lady Spine Doc, the name actually came out of my Peloton username. Well, I got a Peloton in two thousand eighteen, like everybody. and started riding my ass off. And I was trying to find a name that like, I don't know, somehow doc, but somehow incorporated spine. And anyway, I one of my friends helped me develop it but like Lady Spine Doc, but with a spin, like the S P I N being capital. So it's actually Lady Spinny Doc, I guess. ⁓ okay. And anyway, so whenever I went on socials during the pandemic I was trying to find a like a unique name. I like, Well shit, I already picked Flaty that one. Maybe I'll just stick with that. So stick with that. Yeah, yeah. So I picked that on TikTok and then actually on Instagram I was still like I had formed an Instagram for professional use as Dr. Grunch, like, you know, back when I started my practice. But as like, you know, kind of in social media world, I wanted a name that was like no one can remember like, you know, your your first and last name. And so I I picked that one because I thought it was it was if someone was trying to think of who I was, they're like, you know, that lady that's the the spine doc. So yeah, the lady spine doc guy. I do agree with you that people who I understand for professional reasons why people use their full name, but I do remember people better when it's not their real name. Yes. And I think sometimes that helps me because people and I've shared this before, people don't call me Dr. Fran. They me paging Dr. Fran. Yes. Like that's how I'm known to be like when I see them in the out in the world, like at the airport, at the restaurant, they're like, ⁓ you're paging Dr. Fran. I'm like, yeah. My name is just a brand is in there. Yes. So it's just in there. So I do agree that Lady Spinedock is very memorable, even if people don't know your actual like legal name. ⁓ yeah, no, people think my legal name is Lady Spine Doc. You should change it. Maybe. ⁓ fields of medicine that kind of overstep at times in the back that people promise fixes for chronic vaccine that don't exist. Yeah, I would say there's a lot of some overlap, you know, chiropractic medicine, pain medicine, interventional pain medicine, there's a lot of overlap and ortho neuro. So the problem with spine is that it's really complex and pain is complex. So it can be coming from a multitude of things, pathological or not, like unrelated to an issue can cause back pain. You can have problems in the abdomen that can cause back pain. You can have referred pain. And so it's a very complicated subject to try to really know where people's pain's coming from. And I think that's why there's so much failed back syndrome and failed back surgery is because in order to really figure out where someone's pain is coming from, it's not just on the MRI. It's gonna be Misleading. You have to really understand the anatomy, understand, talk to the patient, you know, understand diagnostic tools you can help to figure the problem out. And, you know, and the muscoskeletal anatomy, which chiropractors understand the latter, pain doctors understand the diagnostic tests, but the anatomy, we're in inside of people's backs. We know what things look like. We know what anatomical variants look like. But not a lot of us that do that are good listeners. So you have to have this combination of the right kind of of doctor knowledge and understanding of trying to listen to people to really find the right source of pain and and and we still get wrong and it's difficult. Yeah. Is that where like multidisciplinary care comes in? Like do more people work with like You have to go to PT to see if this is like a more functional problem and if you can fix it with physical therapy. And if not, you start doing imaging. Cause my so my husband's family medicine, right? So a lot of back pain actually starts in primary care. Right. And so it an insurance requirement, and please correct me if I'm wrong because this is from an OBGYN's point of view, right? It's a lot of you have to start with physical therapy to see if it gets better. Correct. And then you get imaging after if it doesn't. Yeah. I mean, so like going back to the issue and I I wanna talk definitely on like women's health and kind of where back pain and how you and I overlap a lot. But to answer your question, like 90% of people in some point in their life will have back pain. So almost every single person will have back pain. Yeah. And so, you know, obviously not every person needs to come to a spine surgeon and they often go to their PCP, which they should when it first starts. And so the process behind how we work up and treat back pain, we usually start conservatively unless there's something worrisome like numbness, weakness. you know, bowel bladder problem, something where this we know it's a clear, like more concerning thing. We try conservative treatment to see if it'll go away on its own. Now, why would something go away with physical therapy? It's not like physical therapy is a type of of curative medicine, but it's because most back injuries are self-healing. Like most of the time you injure your back, you have acute pain, and then your body will heal as the inflammation goes down. And so just coaching people through it, working on the pain alleviating maneuvers, working on strengthening, working on stretches. Tens, unit, all those types of needling and all those things that kind of help them through the process while their body is also doing the work. Most people resolve. And so you don't really need advanced imaging. And then if the conservative treatment fails, then that's when we'll get imaging, try to figure it out. And this is kind of, you know, kind of a point that I don't think a lot of people understand, even like physicians ordering the MRIs. MRIs are overly utilized. And so they're not gonna like be this mind. like landmine of like of wealth of knowledge that you're gonna gain. Everyone's gonna have pathology. You're gonna read your MRI report, my MRI report. I literally had a CT this week and they're like, you have some like T twelve problem. I'm like, okay, like good to know I suppose. Yeah. You're always gonna find something. It's like incidental ovarian cysts. Yes. Right? Everyone who has abdominal pain they get an ultrasound, you have a cyst I'm like, everyone has a cyst. Yes. Right. I assume it's similar Everyone has back issues. Yeah, everyone's gonna find something on a back scan. And so the real pet peep of mine is when, you know, someone will be like, ⁓ your back is shut. You, you're, you're gonna need surgery. And then they wait three months to see me, whole three months are freaking out, you know, maybe and maybe not doing the things they need to because now they're worried. And then it kind of like snowballs the symptoms. And so really understanding that back pain is super common, pathology in the spine is super common, the spine ages, we'll all have changes in our spine. And so when does that become an issue is really where we have to kind of troubleshoot things. And and really it's only an issue if it's an issue for the patient. So if it's, you know, something to deal with, deal with it. Like if it's something that is really inhibiting their quality of life, then we'll work it up a little more. We'll try diagnostic injections. If if they failed, you know, physical therapy, medications, you know, and then it's really the role of do we consider intervention or not? It's a journey for sure, but all of those things require a multitude of steps. And so I think, you know Part of the reason why spine care can get so expensive is because s tests are overutilized. Then they have scrutiny by insurance companies. Yeah. And then because it's overutilized and they they try to to hone down on it and then it's a struggle for everybody. Yeah. Well, it's also hard probably for the patient who has pain and then finally gets this scan and they're like, ⁓ I think I know the reason for my pain. Yes. And then someone says like, Well, yeah it shows this on the scan, but it's not the thing that's causing your pain. Yeah. And now they still don't have an answer. Yeah. Answers are key. Yeah. Yeah. Yeah. And I think it's also hard for people to understand that a lot of times that the back pain solution isn't quick. Yes. First of all, so like s even if you get to surgery, that's a huge intervention. Right. Right. And that's gonna revol that's gonna involve risk of surgery, but then also the recovery of surgery, and you're still gonna have to go to PT afterwards to make everything like work the way it's supposed to. Yeah. But it's hard when you're living with pain that I think sometimes people because the process is supposed to be well thought out and supposed to be like mindful of like your body can heal itself at times, but people don't like that because they're in pain. Yeah. People want instant gratification. Yeah. We reward it every day in society. We reward it on social media by scrolling behavior. Like it injuries to any part of our body is not always an instant fix. And it requires time, but also requires change. So like if you're doing something that's injuring injuring your body, you need to think on how I can modify what I'm doing or change what I'm doing to improve my health. Yeah. Is that weight loss? Is that not smoking? Is that you know, your job, is it the way you're picking up something, so many different things that go into that. So it it's definitely a challenge. Yeah. What are some things that you would say for people who are either in the beginning parts of back pain or like, My dad had back pain and I don't want back pain? Like what are some of the best things that we could be doing for ourselves? So prevention of spine problems in my mind, like if you want to have a good spine is like a hardcore flex. So like You know, you yeah. And and people that have back pain understand this. Like if if I could go back and change that one time that I, you know, squatted that weight, like would my life be different? It's true, because a injury to your back can really be life changing. And so I deal with that with p people all the time. And so to answer your question, like the three things I would recommend to improve your spine health and prevent injury. Number one, no nicotine. So like any nicotine. Any nicotine. Zen, dipping, cigarettes, cigars, gum. patches, whatever the case is, any form of nicotine, stop because it is contributes to degenerative dyst disease and acceleration of of degeneration of your spine. And your spine is like a self-healing organ. And so if you're impeding the way blood and nutrients get to your back and your neck, then you're impeding your body's ability to heal itself. And so that will, you know, that will be detrimental to your long term health. And then Second thing I would say is lifting. So your spine is a bony structure with ligaments, joints, discs. So all of those structures are the intrinsic nature of your spine. But if you think of particularly like the lumbar spine, from our, you know, thoracic area, ribs, but bridging that to your pelvis, there is no bone in our body except our spine. And so the way that like that? Yeah, nothing. That's so interesting. So our spine bears all the weight. Yeah. So what else supports it? Your muscles, your core. So that means your perispinal muscles, that means your abdominal muscles, that means your latissimus and all your oblique muscles, that means your diaphragm, that means your pelvic floor. All of those function and support to be adjuvant as strength supporters to your spine. And so if those aren't trained well, aren't built well, you know, Have babies, you you, you lose your pelvic floor strength, you lose your abdominal diastasis and core strength, you are setting yourself up for back pain. And so doing those things to work on retraining your body after pregnancy, to, you know, just like maintaining a healthy weight to doing core strengthening exercise every single day to do your pelvic floor exercises are all important to keep that core strong to support your spine. And the third thing I will say is on that same line is. the building blocks of your muscles. So eating, you know, protein. So your muscles are only as strong as their building block structures, which are amino acids. And so if you're not consuming enough protein, you're only going to break down protein to get it. And so women are v the biggest victims. You need 0.8 grams of protein per pound of body weight per day. So if you're a hundred And fifty pound woman, you need a hundred and twenty grams of protein. That's a lot of protein. A lot of protein. That's a lot of protein. I can tell you most women do not consume. ⁓ I'm sure not. And if you don't, then you're just gonna lose muscle mass over time. Yeah. And then that losing the muscle mass will be detrimental to your spine. Yeah. And then you get to be fifty five and you go for your you have back pain. Scoliosis. Scoliosis, osteopenia. Yeah. Yes. And all these problems. Yes. Yeah. And strength training in there, you know, that will help work building your muscles, but also to your point, the bone health. Yeah. And and weight bearing loads to increase your bone density. Yeah. I think that's been a big discussion, at least in like the perimenopause, menopause parts of social media, is that there's been a lot of emphasis on like longevity and like real longevity, not like fake, fake online longevity, but true longevity. But yeah, like actually like you need to work your muscles, you need to stay strong because it's going to help your bone health. And I think people don't always make that connection that it's not just like your muscles, but it's your bone health and those things are good. Yeah. Impacting like I mean, we're in the era of like social media and influence where like bros go to the gym, but women run on the treadmill and it's changing. And so now like we're understanding that women need to lift too. And it's not about becoming big, you know, bulky muscular people. It's about building our bones and and str strengthening our muscles. Yeah. And I've stopped almost completely doing cardio and just purely do strength and Since I've made that change, I'm the healthiest I've ever been in my entire life and I feel good and I feel strong and you know, it just makes you feel like not so, I don't know, tired during the day and and that you can do things. Yeah. And you've shared and I always command any content creator who shares their own medical journey and you've shared multiple parts of it. You shared your weight loss in the past and you've shared your back pain story in the past that you had a back injury and that kind of it was like a wake up call for you. Yeah. That you were like, I need to make some lifestyle changes. Yep, yep. So I was postpartum for weeks with my son. And like little boys do, you open the diaper, the penis goes out, the pee goes everywhere. Yeah. So my son dodgings. Yeah. My son peed all inside of the bassinet. I had him in one of those, like, I don't know why, I just didn't have a regular diaper changer, but I was one of those like bassinets that set inside of the pack and play or whatever. As a newborn, why? I don't know, but a dead. So the pack and play was soaked. So I'm bending inside the pack and play. To wipe it v of urine and immediate pop in my back down on my You like felt it? ⁓ immediate. It's like a knife. Yeah. Straight through my spine. And what's like like actually happening in your back when that happens? So your annulus, which is like so I tell my patients the disc in your back is like a jelly donut. So those are the that's the squishy thing between the bones in our spine. So it's got a hard outer coating called the annulus, and that's made of collagen fibers interweaving of like really, really tough tissue, highly innervated. So Lots of nerves run through there. And then the inside is a juicy stuff. So that's like the jelly of the donut. That's the nucleus. And that is the part that's like got a lot of water in it. So if you bend over and one of those like fibers tears, it's highly innervated and it will literally bring you to your knees. And so that's when most people say feel pop in their back or something like that. They felt something. That's what they feel is the tear. Now it can be there's multiple layers of collagen and annulus that's there. So you can tear a little bit, but like, or some people can have a full thickness tear and just really rip it and then then cycle link out and get a discarniation. But yeah, so that that pain was like the worst instant pain besides a broken bone that I've had in my entire life. And I couldn't move like my it was in my lumbar L5S1 and I was down to my knees. I didn't know it was there at the time, but and I was I thought I was dying. So anyway, that was kind of the the wake up call for me is like, okay. I mean, obviously I was postpartum, so it's heavy, but I was heavy going into pregnancy and like I like, you know what, like this is yeah, this is if I am not taking care of myself, I'm gonna become the patient that I'm talking to every day. Yeah. Yeah. So that's when I started my yeah journey. And you've been very open too about the phases of that and now focusing on the strength training. I think it's a great example of people practicing what they preach. Yeah. Right. It's hard. It's hard to do these lifestyle interventions. It's hard to change your diet. It's hard to work out every day. But showing up and showing people that you can be a very busy person and still focus on your own health because long like long term, that's the most important thing is your health for you. Yeah. So I just appreciate you sharing that with people because it's hard. I think it's always hard to share your own medical journey. It feels very vulnerable to be like I was in this part this part of my health wasn't good or I didn't feel good here because of the choices I made. Yeah. And I think it's hard to share that. It like feels very like like vulnerable. I think in order to really have people relate to you and for you to understand people, like you have to be real. Like I've been on social media throughout my whole journey. So when I first started it was like earlier before I like really lost a lot of weight. And so people have seen it change over time. So I've kind of like went through this journey with my followers if that makes sense. And so most of it, I mean, I started before on social media, the some of it, but it's just something like there's nothing to hide. There's nothing to be ashamed of. We all go through phases of our life that require it. I've been open and honest about like everything. Like I did keto for a while. I d I thought that was the best thing. I, you know, did the whole 30. I did the cardio, the Peloton, the fasting, intermittent fasting. And there's all like key parts that that I think are useful. Just but understanding like what's sustainable for you. And so even, you know, twenty twenty three, I started using GLP ones and like still controversial to this day, but I'm open about it because it is real. We should not be ashamed of taking medicines that we need to help our health. Yeah. And whatever way we can do that is important. Yeah. And taking advantage of the things that we have. Science. Science science, you know, or like that you bought a Peloton and you fell in love with with Robin and like doing her class, you know, it's like it's gonna change and all those things are gonna benefit benefit you long term. Yeah. Exactly. Okay. You talked about you mentioned women's health and the spine. And I think for me as an OBG ran, I see a lot of patients who come in throughout pregnancy and are having low back pain. Like this is like the most common thing I hear in my practice every single day, right? And then so I'm like, Okay, well your son of gravity is off, right? Like you're now using muscles that you didn't use before. But like you said, really going through like childbirth and like postpartum, I think is when we see even more back pain. Do you agree? Yes, a hundred percent. And that is like one of my passions is really kind of like education around that time. And I mean, I told you that's when I sustained my back injury and I'm a whole believer of the reasons why is because I was postpartum. So like if you think about what happens during pregnancy, you have such a massive expansion of growth. So many changes in your body. But one of the biggest is for our musculoskeletal health is our di diastasis of our abdominal muscles, erectus muscles that are this core strength, part of our core strength, pelvic floor being strained during pregnancy and delivery, as well as like the shaping and changes to our pelvis. And so that includes like laxity of our ligaments of the, you know, pubic symphysis of the SI joints to allow for delivery and safe birth. And all of those changes happen in such a short period of time that's a little overwhelming to the body. And so after delivery, It's so important to like we don't pro talk about this too much in education of these postpartum pa of any postpartum patient about how important it is to make sure you're focusing on retraining your your pelvic floor, retraining your not just so you don't pee on yourself when you jump on the trampoline, but so it's for that's important. It's important. Definitely important. ⁓ happy to me. ⁓ but just so I do appreciate you so sharing that. Yeah, yeah. But so we can really like provide appropriate support to our spine. Yeah. Yeah, it's super important. I think probably that's one thing I mean, obviously I actually know that. That my field is not that great about that. And even myself, I'll ask my patients like, do you have any public floor problems? Yeah. If they say, like, no, I'm good, I'm not peeing myself when I jump in the champ lane. I'm like, Okay, great. That sounds good. I'm so happy that you're not having pain and you're not peeing on yourself. But probably the greater story in that and like This is where like United States and our healthcare system is really working against our patients is because it's like a universal part of postpartum care. So my sister gave birth in Germany and part of her postpartum care package was going to pelvic floor physical therapy. Like everyone went. Everybody needs to go. I I feel, I feel. I mean, it's such I've been recently six years postpartum and it benefited me. And, you know, I think part of it is there's not a lot of specialty trained pelvic floor therapists. I mean The one in our area is extremely good, which doesn't take insurance. So it's cash pay only. So it's it's difficult for access of of good of good public floor therapists. And so I think also there's a little bit of like I mean, let's be honest, it's a little sometimes some women feel that's weird. I ⁓ it's very invasive. I mean, I've gone to public floor physical therapy after I gave birth to my third child. And I mean their hands are in there and it's not just a quick pap smear. No. They're in there. Yeah, you're right. Exactly. And so I mean, ⁓ my physical therapist was like wonderful and made me feel as comfortable as you ever could. Yes. But in the end, it's still a very vulnerable position to. And if you don't understand the reason why Yeah. And it's not instant benefit either. Again, talking about instant gratification and health care. You don't really understand like what you like what what's happening to your body. So it's education. So important. And like and that, you know, comes from even like OBGYN training too. Like, you know, you guys don't see what I see. Nope. You don't see the women that come in in their in their thirties, five years, postpartum with back pain because they never were appropriately retrain their pelvic floor or the woman at 70 years old with severe scoliosis because of 40 years of this to her spine. And it is, you know, it's it's eye-opening for me when I see it every day. And then I, you know, I've been in practice for 13 years now. And so seeing it now and learning more about like kind of the process, it's become like a really passion of mine that to like somehow advocate for women's health and spine health and like somehow integrate it into like it should be normal that we should do this. Yeah, but you're right, no one's talking about it. I mean that's like, you know, when we talk about po I why, because there's no women's spine surgeons. Yeah, what is the number? How many of you are there? Like a hundred? Not many. Yeah, probably a hundred or two if you count neurosurgeons, not many if you add an ortho, there'll be a little bit more, but women's spine surgeons are two percent. Two percent. That's crazy. Yeah. Mm-hmm. Most one of the most underrepresented specialties, a sub specialties. Yeah. I mean I will say what bothers me about that is that we're saying we basically have t that only women should be caring about women. Those that the other ninety eight percent should actually be caring about the fifty percent of the population and know the things that make us different, right? Like as long as they don't care. Okay, okay, you're right. You're right. ⁓ Well, I I'll I will give them the benefit of the doubt and say that it's not the They don't care. I think that this they don't know. And unless you personally experience it, it's hard to understand. Yeah. You're right. And that's why we need more women in underrepresented specialties. Because even look at this. How many women of those two percent of women spine surgeons, how many of those women has have had kids? And then out of those women who have kids, how many of those have had back problems? Yeah. Not right. Not a lot right now. No, no. Maybe in thirty years. Right, right. Well I do think at least one. Yeah. There's one. And like the thing here though is that like, you know, coming back to social media is that there's so few people and there's so little access to people and it's by the time you get to a spine surgeon, it's too late. Yep. Right. And so that's where social media is gonna be a benefit to people, where people are gonna see your videos and hear you talking about like these are the patients I'm seeing because no one's exposed to that. No otherwise, right? No one sees what you see. No one sees the long term consequences that I don't see either. Right. Right. And so Having social media as a way to educate the public for women in their thirties to be like, Okay, so pelvic floor physics physical therapy isn't just it is is isn't just about peeing myself. It's about my abdominal muscles, which impact my back, which long term is gonna impact how I like live. Right. Right. And how many women do you see that come to see you that are like, My back hurts because of the epidural? ⁓ every I mean all the time. So I need you to clarify that for us. It's not the epidural. I mean, like, so like, do you have pain when you have an IV? Like, how many IVs have you had in your life and does your arm hurt? The answer is no, it doesn't. It's not that single soft tissue trauma that causes chronic pain. They associate an invasion to a part of their body, i.e., an epidural, with chronic pain and think A causes B and not that the pregnancy or the delivery and And the the failure of rehabilitation appropriately caused the chronic pain, it's back must be associated with the epidural. Yeah. So I mean that's interesting 'cause I feel that that association that happens so much for patients. Like I I see this with like tubules, right? Yes. They were on a form of birth control, then they get their tube side, they remove the birth control 'cause now they are sterilized and then like now they have painful periods of like, Well, my tube will cause my painful periods. It's like, no. your birth control was managing your pain periods and you stopped the birth control and you're associating that moment with like a different thing. And I that's hard. It's hard because like there is a cue. Like I felt sore at my epidural site for like a week. Yeah. Right. But I wasn't like my long term chronic back pain is for my soreness and then just associating with yeah yeah. And it's hard. And I think that's where it goes back to your point of the story and the listening. Yeah. And the hearing them and being like, okay. And education in that point to be like I hear that you're associating your pain with your epidural placement. Let's talk about why that like anatomically doesn't make sense and talk about like the next steps with that. And you have to do it carefully because you can't say, Well, that's dumb. Yes. Or no, it's not because of that. You're you're wrong. Yes. You have to do it in in a softer explanation way that makes them feel heard, but also explains what's happening. Yeah. I think that's really hard. It's hard. It's really hard to do. And if someone's already formed their deep hearted stone cold beliefs Yes. And they got a C T scan that shows they have a problem there. Right. Now how do you get yourself out of that? It's hard. And it's hard because again, the patients they've hurt and they want to feel better. But like we can't blame it on something that it's not, because then you're not gonna get fixed you're not gonna fix it. Right. Right. Yeah. I wanna go on to just a little rapid fire with you. Okay. Hi. Do you have a favorite vaccine? ⁓ god. Okay. So I will say it's gonna be the meningo cockle vaccine. Okay, tell us more. That's the first time that that's been an answer, so tell us more. Because meningitis can kill you in twenty four hours and I think in in college age students it's underused. Not that meningitis is a is a huge problem, but I think it could save a lot of young lives. Okay. Yes. Meningitis is scary. It's scary. It is really scary. No, I agree with you. Okay. What is your favorite type of surgery to perform? Like that's like technically enjoyable for you. Not because like all the other things, but like what are you like, okay, I like performing this surgery. Anterior lumbar fusion. Okay. What does that mean? So and then OBGYN? So it actually is a phenotencyal incision. ⁓ do OBGYANs come doom for you? N ⁓ vascular. ⁓ okay. Okay. Yeah. Or general surgery approach surgeons. So yeah, so like for those that don't know, phanocyal is like a C section incision along the lower abdomen and we get to go trans through the retroperitoneum, retroperitoneal approach to spine. Then we remove the disc and and do a fusion or like put in a device that immobilizes spine. And I just love the anatomy. It's beautiful and I don't need like a microscope 'cause it's big enough to like see with loops. Yeah. And it's quick. And I have exposure and a closure surgeon. So I literally like it's I come in, it's ready, I do my stuff, and then I leave and someone closes. It's wonderful. That's amazing. And what is like the benefit of going that way instead of going the other side? Great question. So A lot of patients get freaked out that I'm coming through the abdomen to get to their spine. But if you you've been in the abdomen, it is not a long distance to the spine. No, and it's right there, you can feel it. It's actually kinda weird actually. I I don't like it. And it's really skinny patients. I mean you can feel your spine through your belly. Yes, you can. And so yeah, so I the coming separating the muscles and the rectus, you split. So you don't cut. Yeah. And whereas if you come posterior and we're coming, unless we're doing it minimally invasive, you usually have to cut and pull the muscle off the bone and then close it. And so intrinsically the anatomy is not going to be normal. Whereas if we're coming anterior, we do the fusion that way, we're not really dis we just close we pull the muscles back together and and sew them back together. But I think the anatomical preservation is much more natural. Yeah. And I think it minimizes their postoperative recovery. And long term like, you know, just kind of ad advanced like adjacent segment disease and stuff like that. Yeah. Patients do really great. That's amazing. I like always wonder how people figure this stuff out. Yeah, I know. Probably would you answer their hand ⁓ that's bone. You're like, you know what? Someone should come in here and pick that up. We should do the spine that way. Yeah. Yeah. It's pretty crazy how people come up with that kind of stuff. Yeah. Okay. Who are your three favorite people to follow right now and they don't have to be medical? Like online? Ooh, let's see. Okay. So gosh, put me on the spot. Cause there's so many great people. Yeah, I will say, like so many people that I love watching. I I mean, I love Dr. Beach Jem. ⁓ I think she's just very like authentic and herself and and her audience embraces her for that, but she's highly educational and very useful information. Yeah. I will say number two. This is so much. I know. So much. I'm trying to think of someone non medical because I mostly just indulge in in medical, but I like creators who dance. Like I'm very ⁓ you do? I do, yeah, I do. Like good dance? Yeah, good dance. So like there's like I'm trying to think of the name of the account, but there's a group of sisters. They're Asian. They're really popular, like something something triplets. Okay. ⁓ yeah, there's three of them, right? Yeah. Do they do like slidey studios? Yeah, yeah. But I've seen them. I haven't seen them in a while, but like I I just like just to indulge myself in like something completely just mindless. Yeah. I also love that they're like doing it together. I know. I think that's really fun. I think it's fun, but also I it's something that I cannot do, like a skill that I do not have. A skill a sliding dance? Like I mean like I like to envision myself, fancy myself as a talented dancer, but I know I'm just embarrassing myself and that's okay. Yeah, that's fun. And we're gonna do a dance later. It was my first dancing video. All right, let's do it. Even though I took fifteen years of dance class. See you are way more experienced in dance than me. I just embarrassed myself in a dancing competition online and yeah, so and then let's see, lastly number three. I don't know, there's this so the there's this nurse creator, her name is the legal NP. ⁓ I love her. Or besties. Yeah. I not Jamie. I she's Jamie. Yeah, no, I love her. ⁓ she's your bestie? No, I'm just c okay. We can all be besties. I love her. My virtual bestie. But yeah, no, she speaks a lot on, you know, just legal stuff and healthcare and I f I find it very interesting and always learn. Yes. Yeah. I agree. I I really enjoy her content because most of us at some point will be in a medical malpractice situation. And not just us as physicians, but nurses healthcare providers. Anyone who's in there is going to be involved. And so I think Hearing it from that side makes it a little less scary. Yeah. And you learn from other people. And then not that people were doing things wrong, but maybe you could learn how to do it better. Yeah. I think that's very interest I think it's a very interesting niche that more people need to like listen to. Yeah. I think it's very interesting. Yeah. I love her. Yeah. I I think she's I'm glad you all of her. Yeah. So she's so great. No, I love her. She's like really wonderful. I think she has a book coming out. Yeah. Which is exciting. So all great I mean, again, another great example of social media really helping people like in ways that you wouldn't even think about. Yeah. Right? Like Whether it's like how do I prevent back injury, how do I prevent ma medical malpractice? How do I get an IUD and so how do I chart battery? You know, there's so many every single healthcare professional has something that that they are good at. Yes. Or enjoy talking about. And I think that's your opportunity to bring that online because someone else is going to benefit from that. Yep. I agree. Yeah. I agree. All right. So for the two people listening who don't follow you, where can everyone find you online? At Lady Spine Doc on pretty much any social media platform. All right. Thank you for being here. Thank you for having me. Yes.