After undergoing multiple spine surgeries himself, Joel Proskewitz founded the SpineXchange to offer educational materials for others who are dealing with back surgery or general back pain. 

On this episode of Back Talk Doc, Dr. Lakhia sits in the hot seat as he is interviewed by expert guest Joel for the SpineXchange. Joel and Dr. Lakhia cover advice on many different aspects of back care. 

Both Joel and Dr. Lakhia found a passion for spinal care and education through personal experiences. For Dr. Lakhia, it was his exposure to osteopathic medicine that included over 300 hours of hands-on training in osteopathic manipulation that sparked his interest in lightening the burden patients feel when suffering from spine issues. Joel shares Dr. Lakhia’s interest in spine care and knows first-hand how important spine health is after having to undergo multiple surgeries to repair a fracture in his spine. 

Combining standard medical interventions with additional elements like addressing stress levels, prescribing breathing exercises, discussing research-based supplementation, and incorporating acupuncture is core to Dr. Lakhia’s approach. He emphasizes the need for evidence-based alternative treatments as part of a comprehensive approach for patients. 

“What I've observed in my career is patients are moving away from a pill for every ill, and they want to be able to take more control of their health and use natural interventions,” Dr. Lakhia says when describing the increased interest in integrative medicine for spine health. 

If you’re interested in learning more about the SpineXchange and becoming a subscriber you can check out their website here: https://thespinexchange.com/. 

💡 Featured Expert 💡

Name: Joel Proskewitz

What he does: For over two decades Joel Proskewitz has specialized in spinal rehabilitation for people that have undergone or are facing spinal surgery. He has built up a wealth of experience, both as a long-term spine patient himself and working with doctors and physicians from across the medical world. His specific focus is on spinal pathologies, their associated intervention surgeries, and subsequent patient rehabilitation.

Company: The SpineXchange

Words of wisdom: “The owner of the spine has emotions. They have certain stressors that can systematically create a whole bunch of problems, and you really need to understand the individual who's sitting in front of you.”

Connect: Website |  LinkedIn 

⚓ Anchor Points ⚓

Top takeaways from this Back Talk Doc episode 

• Having a healthy functioning spine is critical to having a healthy functioning life. Dr. Lakhia’s passion for anatomy led him to osteopathic medicine. He wanted to dive deeper into spine care and understand the science behind a healthy spine so he could contribute to treating dysfunction. In addition, his osteopath older brother inspired him to pursue physical medicine. 
• The modern lifestyle is impacting our health. Dr. Lakhia stresses the importance of reviewing your diaphragm’s ability to expand correctly. The connection between good diaphragmatic movement, posture, and overall health is paramount. Those who disregard the influence of posture on pain are overlooking a crucial component of their health.
• You have to meet people where they are. When meeting patients, Dr. Lakhia establishes a rapport through open-ended questions and understanding their personal story. Understanding the patient’s goals and motivations for treatment helps align the treatment plan with the individual. Armed with that knowledge, he can suggest appropriate treatment options, such as physical therapy, spinal injections, and collaboration with neurosurgical colleagues when necessary. 

⚕️ Episode Insights ⚕️

[02:55] A history of physiatry: Dr. Lakhia provides an overview of his speciality and how it came to be. Physiatrists focus on restoring function and reducing pain and operate as a hybrid between neurology and orthopedics. 

[07:10] Across the ages: As people are living longer, Dr. Lakhia explains why he is seeing more patients in the 70-plus age range. At the same time, he’s also seeing more patients from younger generations, potentially driven by the work from home movement. 

[10:04] The spine impacts your overall health: Joel shares his personal experience in how restoring the natural curvature of his spine through surgery improved his quality of life, supporting Dr. Lakhia’s comments on the importance of spinal health. 

[12:12] No longer a pill for every ill: Dr. Lakhia reviews how he uses integrative medicine in his practice and how he sees the approach benefit his patients. 

[15:20] Sprinkle in a little extra: Standard medical interventions absolutely have their place in treatment, however adding interventions, like breathing exercises, can go a long way in improving patient quality of life. 

[18:27] The patient journey: Dr. Lakhia walks listeners through the journey of a patient in his office, starting with building a rapport and learning the patient’s backstory. 

[22:12] Everything offered in-house: Dr. Lakhia reviews the different types of treatments available at the Carolina Neurosurgery and Spine Associates. 

Subscribe & Contact

👉 If you enjoyed this episode of Back Talk Doc, check out our recent episode We Feel Your Back Pain with Dr. Joe Cheatle.

👉Apply for an Integrative Medicine consult with Dr. Lakhia (NC/SC residents only). 

🔎 For more information on Dr. Sanjiv Lakhia and the podcast visit BackTalkDoc.com

👀Check us out on the 15 Best Back Pain Podcasts list!

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Back Talk Doc is brought to you by Carolina Neurosurgery & Spine Associates, with offices in North and South Carolina. To learn more about Dr. Lakhia and treatment options for back and spine issues, go to backtalkdoc.com. To schedule an appointment with Carolina Neurosurgery & Spine Associates, you can call us at 1-800-344-6716 or visit our website at CNSA.com.

Welcome. You're listening to Back Talk Doc, where you'll find answers to some of the most common questions about back pain and spine health. Brought to you by Carolina Neurosurgery & Spine Associates, where cutting-edge nationally recognized care is delivered through a compassionate approach. This podcast is for informational purposes only and not intended to be used as personalized medical advice. And now it's time to understand the cause of back pain and learn about options to get you back on track. Here's your Back Talk Doc, Dr. Sanjiv Lakhia.

I recently had the privilege of being interviewed by Joel Proskowitz from The SpineXchange. Joel is a colleague of Dr. Stuart McGill, and he has gone through himself numerous spine surgeries and came through the other side and has founded The SpineXchange at thespinexchange.com, which is a platform to provide educational materials to people who have gone through back surgery or have back pain in general.

He reached out to me and I was really excited. We had a great interview. We talked a lot about different aspects of back care. I'm going to present that to you for today's episode on the podcast, and I hope you enjoy. And I would encourage everyone to check out The SpineXchange and really consider becoming a subscriber. I think it's a great service and it will definitely benefit you on your own journey.

Sanjiv Lakhia, thank you very much for being here on Interview the Expert at The SpineXchange. I'm very, very honored and very excited to speak with you this evening. So thanks for being here.

Thank you for the invite. This is going to be fun. Looking forward to it.

Sanjiv, just for our viewers, would you be able just to give an introduction of who you are, what you do, and where you work, please?

Yeah. Great. So I am currently a practicing physiatrist, specialty in physical medicine and rehabilitation. I am a doctor of osteopathic medicine at DO, and I graduated out of Ohio University in Athens, Ohio. I currently work in a very large private practice neurosurgical group, and I'm one of the physiatrists here who helps with non-surgical care. My day-to-day work is I work up people with back pain, orthopedic conditions, probably two-thirds of my practice is spinal related, if not more, and try and guide patients down the non-surgical pathways and help them return back to function.

Okay. And from a perspective of the term physiatrist, I've obviously been exposed to that term, but here in the UK and maybe around the world outside of the United States, physiatrist is not a very common term. Would you be able to just expand upon that so that the viewer understands just a little bit more?

Yeah, good question. There's some lack of familiarity even here in the US with the term physiatrist, and depends on what part of the country, sometimes we're called physiatrists. We essentially combine orthopedics, neurology, spine care into a... It's like a hybrid specialty where we really focus on helping pain and restoring function. We're very functionally-driven, looking at quality of life outcomes and restoring function. So historically, physiatrists really came to prominence during the early world wars, where veterans were coming back with catastrophic injuries, brain injuries, strokes, amputations. And even now in today's world, there's a lot of physiatrists at like Walter Reed Hospital and other military institutions, helping these individuals try and get their life back.

It's kind of evolved over time in the United States into different pathways. There's hospital-based physiatry, which is really focused more on those individuals who have those catastrophic injuries and they need inpatient rehabilitation. And then there's the outpatient world where we deal with bread and butter day-to-day aches and pains, a lot of musculoskeletal medicine, orthopedic medicine. Really, it's a great profession. I get to help people try and get their life back on track. And as you and I both know, a lot of people can improve their situation without surgery. Certainly, there are those who need them, given your story, but that's in a nutshell... I like to tell people it's kind of a hybrid of neurology and orthopedics with a focus on restoring function and reducing pain.

That's fantastic, and I think it's very pertinent to many of the viewers here at The SpineXchange because a lot of them have not had surgery and are looking for individuals that have a potential solution from a conservative intervention, possibly with the help of some element of medicine behind that-

Correct.

... whether it be in pharmaceuticals or something to that degree just to help reduce pain. But staying with the topic of being a physiatrist, how come that's the path you chose, Sanjiv, and more specifically the spine? I'm interested about your passion about the spine.

As a DO, and it's interesting, DOs, Doctor of Osteopathic Medicine, they have different licensure capabilities across the world. In the United States, DOs are fully licensed to practice medicine in surgeries. We have full prescriptive rights. But in osteopathic medical school I received about 300 hours of training in hands-on osteopathic manipulation, somewhat similar to chiropractic techniques but somewhat different. But I always found a love for anatomy. That was probably my favorite course in medical school. And I really marvel at how the human body has been designed. It's just perfect in its own way.

So that naturally led towards... I really enjoyed early in my career doing osteopathic manipulation. And of course, you're doing a lot of care of the spine. And then I felt like becoming a physiatrist was next level, where I really got to dive deep into that. I really believe that spine care, having a healthy functioning spine is critical to having a healthy functioning life. There's such a disease burden in this country and across the world that I think we need more practitioners who understand the science behind how to have a healthy spine and how to treat dysfunction. My brother, two years older than me, is an osteopath, so he kind of got me directed along the path of osteopathic medicine. And then I met some mentors during medical school that really opened my eyes to this whole field of physical medicine and rehab or physiatry.

That's fantastic. And you said something now that just struck a chord within me, talking about the burden of spine problems and pathologies. Are you getting to see patient that is younger these days? Are you getting to see people who potentially are outliving their spine on the other side of the spectrum? So who do you get to see? Who are your patients?

The answer to that is yes, it's across all spectrums. I would say the general trend, and we might touch on this a little bit later in terms of difficult cases, but the general trend is people are living longer, more medical advances, cardiovascular care, cancer care, but their body parts are still aging. So we are seeing a huge influx of individuals in their seventies, eighties, nineties who are healthy, but they're kind of breaking down orthopedically and from a spine perspective.

And then the flip side of the coin, particularly I think since COVID, I've seen a lot more people, younger generation, with back problems. I have my theories. I think there was a lot of movement towards work from home and doing what you and I are doing right now, sitting and staring at a computer, and I think it's set people up to have dysfunctional posture, weak muscles, and increased episodes of back injuries.

It's funny you say that, Sanjiv, and there's so many people out there, therapists of many different persuasions, that are saying that posture is not important or it doesn't matter or having a kid slouch for hours over a phone doesn't have any correlation with any type of neck pain. And I'm not a believer in that. Generally, if I look back, we were kids and playing outside and being far more physical. Yes, we would stare down and look at our workbooks, but not to the same degree that the kids are today, the duration and time that they are spending sitting and looking at all the technology and doing less movement. There has to be a downside, a negative to that.

I think one of the key areas to consider when you're talking about what our modern lifestyle has done to our health is just to ask the question, what is the effect of your current activity on your diaphragm's ability to expand correctly? The diaphragm is so key in terms of the ability to take deep inhalations. It's like a piston. It pushes blood everywhere. It moves the lymph, and you cannot have good diaphragmatic movement with poor posture.

As you know, I run a podcast, and one of the great things I've been able to do is interview people who are much smarter than me. Stuart McGill, awesome. I got into learn more about foundation training. I've been able to interview Esther Gokhale, who's authored the Gokhale Method. And every single one of these thought experts really, really emphasizes restoring diaphragmatic movement and its correlation with proper posture as a key to health and reduced pain. I just think if someone doesn't believe that there's an influence or connection between posture, function and pain, they're just not looking in the proper places.

I agree on every level there. And quite interestingly, if I may use myself as an example, you know and most of the viewers know that I've had a significant amount of spine surgeries to repair a fracture in my spine. And the interesting thing is post the surgery, once the spine had actually been realigned and rectified and the natural curvature of the spine restored, it's made a huge positive impact on my overall health and wellbeing, the way that I stand, the way that my muscles function. It literally was a day and night situation. So how I was functioning prior to the surgery, forget about the pain and dysfunction, but just generally from a performance perspective in the gym and just in daily life to what is happening now is completely different, and I owe that specifically to the restoration of the alignment of my spine.

Yeah, exactly. The extreme end of this question are those patients who have pronounced spinal deformities, scoliosis, kyphosis. When those curvatures get to a certain point, what happens? It affects their visceral organs.

Sure.

They cannot breathe properly. Their digestion gets impaired. And oftentimes when that happens is when a complex spine surgeon will get involved. But in my opinion, you don't have to have a 40 degree curvature in your spine for there to be correlations between your posture and your organ function and your overall physiology. So yeah, no, I think it's worth discussing and looking at and something that I talk about with my patients as part of a global discussion.

Fantastic points. Sanjiv, you've spoken on your public forums and in your podcasts about integrative medicine.

Yes.

Could you expand on that a little bit and just explain to us from your perspective, what does that mean for a patient?

Integrative medicine is a form of medicine that really honors a lot of the evidence-based treatments that exist outside of mainstream medicine and across different cultures. It looks at combining the best of modern medicine with Eastern and ancient medicine, and we look at patients from a more holistic lens. We're not just focusing on someone's spine, per se, but we're looking at how is their diet influencing their health? What about their stress? How about their relationships, their spiritual connection, their movement patterns? Because we know when you look at someone from that lens, number one, there's more levers that you can pull to influence positively someone's health, but we know the outcomes are better, they're more complete.

I grew up in a family. My parents immigrated from India, so culturally they adopted a lot of Ayurvedic medicine practices, and we talked a lot about meditation and its benefits. Years ago, my colleagues in the doctor's lounge would say, "Vitamins are expensive urine." But now there's so much literature in PubMed supporting some very basic things that our grandmothers have known all along that are helpful for our health. So you don't have to go very far. You could simply put in acupuncture and back pain in PubMed, and you're going to get a explosive amount of research articles supporting its use. If you just type in meditation and chronic pain, I mean, you'll be up all night reading randomized controlled trials demonstrating the effectiveness of that intervention.

So I think what I've observed in my career is patients are moving away from a pill for every ill, and they want to be able to take more control of their health and use natural interventions. And it no longer has to be about snake oil. I mean, there are so many research-based interventions now, and I learned about this during my two-year fellowship. As you know, I did a two-year Integrative Medicine Fellowship through Andrew Weil's program in Arizona, and then I am double board certified now in Physiatry and Integrative Medicine. So for me, at some point, I'm hopeful, and we talked about this in my fellowship, that integrative medicine will kind of go away and it just becomes good medicine, like doctors just practice good medicine where they consider the whole person.

Exactly. On that note, how do your colleagues, your surgical colleagues, your medical colleagues, how do they look at it now, especially you practicing in a very top-end neurosurgical and spinal practice?

Yeah, I am blessed. I'm in a really amazing practice. The neurosurgeons here are best in the world. The physiatrists, many of them I've known for a long time. And my approach to taking care of patients really fits our model and it's well-respected. I still offer standard medical interventions and I do a number of spinal injections for patients. I practice and do a lot of EMGs. I prescribe a lot of drugs. But I always sprinkle in something a little extra, and sometimes that can just be I take another minute or two and ask my patient about their stress level. It's amazing what you can hear and learn when you just listen. And then I might prescribe a breathing exercise, demonstrate it.

We talk a lot about the 4-7-8 breath in our fellowship. It's a technique that uses ratios of inhalation and exhalation to really calm you down. It doesn't take long to do that with a patient, four seconds, plus seven seconds, plus eight seconds. It's 19 seconds, so it doesn't really put me behind in the clinic, and it adds a lot of value to the interaction. And the tips are helpful. A lot of times we'll talk about research-based supplementation or if there's any herbs that could be tried. So it works well. I've been very well-received. I do a lot of acupuncture. The thing of it is, Joel, is that back pain, particularly in the US, and chronic pain in general, we are still lacking in good, effective interventions in many cases, particularly with the opioid epidemic and all the problems that's happened with that. We are really looking for alternative treatments that have evidence behind it. And I think right now it's kind of a renaissance in the space of spine care and medicine in general, and I'm really happy to be a part of that.

Sanjiv, that's a wonderful thought process and sentiment to have, because I agree with you. I think a lot of people don't look at the person as a whole, and they need to understand that the owner of the spine has emotions. They have certain stressors that can systemically create a whole bunch of problems, and you really need to understand the individual who's sitting in front of you. So it's wonderful to hear that what you're doing is taking that holistic approach. I think it's definitely the route to go for the future.

That's absolutely true. In fact, I almost feel like everyone who comes in with back pain has a background story and they want to be heard about it. There's something going on in their life. And you could, and oftentimes, look, I still do it because very, very busy, don't have time to deep dive every time, you could just focus on the MRI, do the shot, order the PT, get them on their way.

But if you have the opportunity to find out what was going on in their life just before then you'd be really surprised about some of the stress that people are living under. And if you can help them heal that part of the equation, the totality of the healing of the back injury is much better. That's just my experience. And I think that's something I strive for. I don't always hit that mark. You do have to build rapport with patients. But there's always a story to tell, and it's much more than, "I just bent over and tied my shoe and my back got hurt." There's always something else that led up to that. Sometimes you get to it, sometimes you don't.

So with that in mind, Sanjiv, could you take us through a patient's journey? So someone books in to come and see you, how does it evolve? How do you start off? How do you get to know the individual whom you're about to work with?

Wow. That approach has evolved over time. I get better and better at it. We work in these 15-minute intervals in medicine, which are kind of insane.

Sure.

But one of the things I like to do when I walk into a room and I meet someone for the first time is I don't initially like to jump into their chief complaint. I might do something like look at their intake and ask them about their work. "I see you're an engineer. I got an engineer degree too." It opens the door. "How did you hear about our practice? What are some of the things you enjoy to do when you're healthy?" So open-ended questions are key. I think you have to establish some rapport with someone before you're going to recommend treatment, or at least I feel that way.

So once I've established a bit of a connection, I like to really try and have the patient tell their story. So I'll often say to someone, "I looked at your intake form, I read the referring provider's notes, but I really want to hear it in your words." They always tell me something that wasn't on the paper or wasn't what the nurse told me. Oftentimes, the reason they're here is not even... They won't honestly share that until the physician is in the room. So the history gathering is key. Most of the time after I listen to the history, I almost always know what's wrong. I mean, the imaging just confirms things if we do that.

And then I always want to know, "What would success look like for you?" And then the obvious answer is, "Well, get me out of pain." And then I push them a little further because I want to know their why. If I know their why, I can help them really gear their lifestyle towards that goal. So for example, if someone comes in with an acute back pain and it's going down their leg, I want to understand where are they in their life right now? Because I'm probably going to address them differently depending on their circumstance.

So for example, I mean, if they're a professional athlete and they've got extensive pressure, we're going to put our foot on the gas to try and knock out this pain ASAP, and we might do some things a little more aggressively. If they're someone who's retired and they don't have a ton of professional obligations, then I'll definitely dive deep more into conservative care pathways, and I'll get a sense for where they are. I always ask, and I want to know, "Where are you with this?" I'll say that a lot. "Where are you with this on a scale of one to 10, 10 being, 'I can't live another second like this,' one meaning, 'Ah, it's like a pebble in my shoe. It's a little annoying, but it's not that bad'?" Then I can really meet them where they are and get them going on the right pathway. We do have treatment algorithms, right? There's evidence-based medicine.

Of course.

But the person in front of you is an N-of-1. They don't read our books. They don't care about our guidelines. So you have to meet people where they are and get them going. And then of course, traditionally, we'll use a lot of physical therapy. We have a wonderful physical therapy team in our practice. Many of them are trained with Dr. McGill's methods, as you are, and that can be extremely helpful. We might walk them down and do a spinal injection if it's an acute inflammatory issue. And then, of course, I always have tremendous neurosurgical colleagues I get a consult with if I need to.

That's fantastic. And this all takes place at the Carolina Neurosurgery & Spine?

Absolutely, yeah. So we're based out of Charlotte, North Carolina. The office I work in is in Rock Hill, South Carolina, which is just a few miles over the border between North and South Carolina. This is our home base. We love it.

And from a perspective of what you do there, so will you do everything from surgical procedures or at least your surgical colleagues will?

Yes.

But surgical procedures to everything like facet joint injections or medial branch blocks and-

Yes.

... cortical epidurals? So everything takes place at this particular practice?

That's correct. My personal skill set, I do a lot of lumbar transforaminal injections, epidural steroid injections for radiating leg pain or radiculopathy, medial branch blocks. And then we have a team of docs that do RFA. Again, that's a technique to help with spinal arthritis. We do a lot of sacroiliac joint injections. I also do a lot of orthopedic injections under ultrasound, hips, knees, shoulders. Many times their back pain actually was a hip issue.

And then I have that integrative skill set. I do a lot of acupuncture including battlefield acupuncture, which is a form of auricular or ear treatments for acute pain, PRP, stem cell injections. These are regenerative techniques that are evolving and becoming more prominent. So that's an offering through our practice. We offer a lot of different things and try and help people get back on their feet.

Sanjiv, I'm going to ask some technical questions now just to go off the beaten track just slightly.

All right.

People generally will turn around and say, "Steroid injections for the spine, like a nerve root block or a caudal epidural, are they not just ways of masking pain?" I have an opinion. I work with surgical colleagues. I'm in a very, very similar situation to you. But I'd love to know your viewpoint. If a patient presents with a question like that to say, "Are you not just masking my pain? Are you not giving me the ability to just go off and actually create more damage in my spine?" how would you respond to something like that?

I get that every day.

Good.

I mean, it's a reasonable question. And the answer to that is it kind of is, but you have to understand what we're doing. For me, a epidural steroid shot has a couple different goals. What we're doing is we're delivering corticosteroid into an environment where we believe is an acute inflammatory reaction. It's really the inflammatory reaction that's driving the individual's pain. Because as you and I both know, you can have a bulging disc. Even a bulging disc causing stenosis or nearing around a nerve root and have no pain.

Absolutely.

So the first thing I'm trying to do, and I'll tell people, is, "I'm using the injection as a tool to minimize or turn off that inflammatory switch and buy your body time to heal the root injury." Okay? So that the injection buys us time. It also allows us to rapidly restore function, because that's a huge part of recovering from back injuries.

Absolutely.

Every day you hole up in bed, it's going to take one, two, three more days to recover the atrophy that's developing. So I tell people, "I have no plan for having you get an injection every three to four months the rest of your life. That's not our goal. We're going to use a few. We're going to look at this as a three to six month window of rehab of which an injection is a component. It'll liberate you to do the proper rehab to restore your function so that when the injections wear off, the pain is still quite minimal and you're able to move without fear. So it's just a tool. It's a part of the equation. If that's all you want to do, your results are going to be far less than if you do it as a part of a comprehensive program."

Correct.

Does that make sense?

Exactly my narrative to my patients, right? Because it's part of the pack. It's the opportunity to allow you, as you say, to get moving, to be able to actually explore some element of rehabilitation with a little bit more intensity.

That's right.

So it's nice to hear that that is your thought process. Because I think where people go wrong, and please correct me, they think a steroid injection is the cure all for their back pain, and they then don't need to actually explore any further rehabilitation because they're hoping that this will just eradicate the pain forever, which it doesn't do.

It doesn't do. No. You didn't get in the situation because you have a deficiency of steroid in your spine, and then by replacing it, it goes away.

Right.

It's an enabler for active rehab. It has to be viewed in that context. Otherwise, you're just going to be spinning your wheels with it and get frustrated.

Exactly. You said something earlier on the lines of injections and regenerative medicine. People now are really starting to ask the question about PRP and stem cells, specifically stem cells. Again, we understand the use of stem cells within a knee or potentially in a shoulder, but when it comes to the spine, what's happening there? What's going on in that world? Is it progressing to something where it's a valid intervention or are we still very much in the early stages, Sanjiv?

Well, full disclosure, I don't do intradiscal stem cells or I don't do stem cell injections of any type. I do offer PRP in my practice for orthopedic issues. I think the answer to your question, though, in general, is regenerative medicine field is still evolving in the world of spine care. The clinical trials that are out there are very small-scale. I think it's promising, but from my perspective, I want to see a little bit more data to justify the cost, because there's a big disconnect between... To me at least, there's a disconnect between the level of evidence and the level of cost for the intervention.

Right.

If you want to find a vulnerable patient, all you have to do is find someone whose back has been hurting them forever and they're not getting better. That person will sign up for anything, anywhere, anytime. I do see some of that going on across the country. I'm hopeful that over time more literature will evolve. I do think it's a promising area, and I'm hopeful in the next five years or less, we're going to have a more definitive answer to that question.

Sure. Now, the thing for me that I'm trying to get my head around, and I'm explaining this to patients, is that the disc itself is just naturally such a hostile environment. The internals don't like to be exposed to any external elements. And we know that when that happens, you get a whole host of chemical changes within the disc, et cetera. So I'm trying to get my head around how the stem cell itself, intradiscally, right, or intradiscal, how can [inaudible 00:28:40]?

So I think that's critical education. I think getting in a relationship with a knowledgeable bodywork expert, whether it's a physical therapist, a chiropractor, even a good massage therapist, let them be your copilot through your journey on your life about maintaining a healthy spine.

And then lastly, I think it's understand that even if you do everything right, your back can still hurt. It's common. And most of the time, not all the time, I mean, your situation obviously is quite dramatic, and you went through an incredible journey, but most of the time, for most of us, it gets better.

Sure.

So I don't know if I'm dropping any wisdom there, some of that's common sense, but those are some words that I would share.

Sanjiv, that's exactly what I want to hear. Those are very wise words. We don't have to complicate things and pull the wool over people's eyes for them to think it's wisdom. It's actually the basics, it's the fundamentals that are done each and every day that build up that foundation of optimal health, good movement. So those are very wise words. Thank you very much.

Oh, you're very welcome. Yeah.

Sanjiv, we get viewers and members to The SpineXchange from all over the world. So if someone wants to reach out and contact you, how do they get hold of you? What's the easiest way?

Yeah, a couple of different ways. There are contact forms through our group website, and that's at carolinaneurosurgery.com. It's easy to search under physicians, and there'll be links there. I also have my own website at drlakhia.com, D-R-L-A-K-H-I-A, and there's a form there to connect with me. And if you have an inquiry, I'm happy to take a look at it.

Fantastic.

So we're available.

Good. And I'll put all those in our notes. Sanjiv, I could sit here for another two hours talking to you, and I would probably request very kindly that part two happens at a future date because I've got so much more to ask you and a lot more to expand upon. But thank you very much for your time. Thank you very much for your wisdom and sharing your experiences and your knowledge with us here at The SpineXchange. We are greatly appreciative.

Well, you're very welcome. Thank you for your efforts and taking your life circumstance and using it to make the lives of other people better. So we need more of that in the world, and I'm happy to be a part of it.

Appreciate you. Thank you, sir.

Thank you for listening to this episode of Back Talk Doc, brought to you by Carolina Neurosurgery & Spine Associates, with offices in North and South Carolina. If you'd like to learn more about Dr. Lakhia and treatment options for back issues, go to backtalkdoc.com. We look forward to having you join us for more insights about back pain and spine health on the next episode of Back Talk Doc. Additional information is also available at carolinaneurosurgery.com.