Hello my fellow sniffers my name is Marlene McCohen and this is Cody my African Gray and we would like to welcome you to Parent Tip Tuesday. Now today I think it's an African Gray kind of day so we're gonna do something different today and eventually I'll do this for all birds and all different kind of birds but today we're going to talk about what it's like to own an African Gray. I thought this would be a great video because Cody thinks it's really funny so funny he just wants to jump on my head. I thought this would be a great video today because although there's a lot to be educated on when you are looking into buying a parrot sometimes you just need to know what it's like to own a certain type of bird and of course since it's the anniversary of George this week well kind of past but for me it's still the anniversary of George I thought we would talk about African Grays and also yeah do you like that? I have my African Gray nail polish if you guys noticed this is basically George because he was all gray with one red feather and then of course I have a red pedicure for his red tail so every year I do something like that. Cody likes it right Cody? Yeah he always likes the red one which finger do you like the red one? Yeah do you want a toy? All right I'm just gonna talk to you guys and tell you from my experience what it's like to own both the African Grays that I have owned. The first thing you need to know about owning an African Gray is that of course it's a lot of work they need constant attention. You guys have heard that so often about so many parrots but of course the bigger the parrot the more attention they're going to need in different kinds of ways so of course even the littlest bird needs all of the attention you can give in the world but bigger birds need like a more focused attention because they're more capable of destroying stuff getting rambunctious they have the ability to destroy things that little birds kind of aren't able to destroy that's why some people call certain birds starter birds because experienced bird owners know that no matter what if you get a larger parrot they're gonna be after everything you own to destroy and it's not that you can train them not to do it you can try but most of the time you just gotta be more aware you know hey I can't put my purse on the table hey I can't leave my laptop open all these things become a whole new world when you own a parrot. Let's talk about African Grays.  Cody is not a two year old in that way and African Grey feels a little bit different while Jersey feels like the cute little kid on the block that everyone wants to play with. Cody and my African Grey George felt more like the posh little kid on the block that would answer you rather than chase you isn't really interested in you engaging with him 100% physically but intellectually needs to be stimulated so they're very different some people want a bird that they can cuddle all the time like Jersey you see how cute she is and some people need a bird that can be with them observing but not necessarily needing to be fondled like all birds they insist on being in your presence they want to see you they want to know that you're there if you're not in the same room they're going to scream just like any other bird would with African Grey's I always felt like George could be near by me but not necessarily on me he was able to be kind of like a sidekick he also didn't want me petting him and cuddling him all the time because that's not really something that African Grey's are into can you give them head scratches sure have you seen me cuddle Cody yes but that's not something you should expect out of your African Grey if you get one believe me not all of them are cuddly in fact it's pretty rare they just have different feathers than cockatoos and cockatoos really want you to engage with them with that physical love and African Grey's don't for me personally that works great because sometimes it's hard for me to be cuddling a bird all day we will discuss how to prevent your bird from wanting to cuddle all day because it's very important that you're able to keep your bird active and engaged with toys and foraging as you can see Cody's on my shoulder he's what I call a shoulder bird meaning that he enjoys being on my shoulder my African Grey George did not like being on my shoulder he would have much rather been right here on the stands of this chair just sitting next to me and I really like that so in this way Cody is a really different bird Cody gets a lot of anxiety if he's not right here on me I think that has something to do with the true story of Cody if you guys watch that video even if I am in Cody's site he flies to me every second I can put him down then I walk two steps he flies to me I walk somewhere else he flies to me Cody lands on me all day probably about 70 times a day does Cody fly to me in such a panic as if I'm going to leave and go somewhere in fact I'll tell you something funny about that in light of the recent hurricane my sister told me that my brother is probably going to go work for FEMA which is the disaster relief and then she mentioned that his girlfriend CEO may have signed up for it and I said to myself oh maybe I should do it and my sister said um yeah I don't know and I thought she was thinking like cuz you know there might be any kind of like physical labor or something to do she goes you can do it but you're gonna have to take Cody African grays are extremely sensitive they're very sensitive emotionally because they're so intellectual African grays are one of the most emotional parrot companions that you can have so you always have to be aware before getting a parrot or an African gray that there is a lot of emotions to deal with so if you're not someone that enjoys dealing with emotions of human beings on a regular basis it's even harder to deal with a parrots emotions because they can't just say to you what is bothering them so what is it like living with a bird that can talk to you it's amazing for me this is one of my favorite things about African grays but I must tell you not all African grays talk you may get a bird that doesn't talk that's why you can never ever get a bird for its talking abilities or expected to talk because you're doing a huge disservice to the parrots and you have to make sure that just like your dog doesn't talk to you but he communicates that you're well aware that you may get a parrot that communicates but does not talk so that's very important but as far as how much noise a bird makes like an African gray all day you're looking at a lot of talk chatter beeping noises alarms somebody commented on one of my videos that the video was great but the alarm in the background was a little stressful there was no alarm that was the bird that was my bird pretending to be kind of like a smoke detector maybe the comment was a joke but either way that's what it was so you have to be well prepared for the fact that you will be hearing noise all day long different kinds of noises are they entertaining yes but are they always entertaining what if you need some peace and quiet what do you do that's when you have to have your bird next to you because that's probably the only guaranteed way to keep him quiet or give him such great foraging toys and keep him as busy as you possibly can engaged and entertained all of the time so it can be a lot of work here are some examples of what you might hear during the day with an African gray microwaves beeping phone messages coming in computers turning on phones ringing phone conversations with the bird the dogs barking any beeping that the bird may have heard outside the door opening the door creaking an alarm ringing any single process that you go through that the bird has seen so George was able to do my morning routine for example I would put on my makeup and every click of every bottle or spray or any single thing that I used on my face he knew the exact sound of closing the top opening the other bottle pouring it and he would go through it exactly at the same time as I did there's so many noises that a human could never ever create that just sounds so real and they are real that your African gray will be able to imitate it may trip you out a lot you may think somebody is beeping or turning on a button or the oven just went on or I don't know if ovens make noises honestly that's my own fault the microwave every single noise you can think of the bird can make you spraying you watering things the noise of water the noise of waterfalls these are just things that the bird hears anything on TV I told you guys about the time my bird did the exorcism in my house that was unpleasant when it was dark at night so any little thing that they have heard if they're interested in it they can absolutely recreate so those are some of the noises you will be hearing all day long when you own in African gray do they have quiet time yes there's many moments when the bird doesn't say talk or do anything but there's a lot of moments when it's kind of sporadic so things may be quiet and then suddenly your bird makes some beeping noise and sometimes it's a really good warning African grays can be great to let you know what it is you're missing from your routine maybe that's more specific to me because I tend to be really obsessive compulsive so the bird learns quickly what it is that I should be doing I have gotten signs from my bird that it's time to clean the glass table because the bird is making the spray bottle noise these are the things the birds do and they identify when it's going to happen so the birds like we put a lot of crumbs on this table looks like it's time to hear that noise so yeah I'm telling you a lot of the fun stuff about owning an African gray because I want you guys to know what it really is like in daily life they're also very routine I've talked about routine before but grays are prone to plucking just like cockatoos are so you want to make sure that you're giving them a really good routine that they're comfortable with and not changing things up too much it can happen that your bird can start plucking and you have to solve the mystery so if you're not generally good at solving mysteries without someone flat out telling you what's wrong maybe these aren't the birds for you your bird could start plucking and it could be because you're waking him up an hour later or an hour earlier or putting him to bed at the wrong time you have to be able to analyze what is different in your household now there could be a new piece of furniture that you put near his cage and he doesn't like it these are all things that you have to consider before getting a bird do you really want a bird to be able to rule your house because that's really what it feels like you know we become slaves to our birds in a way not to say that I don't have some sort of control come here baby come here not to say that I don't have some control over the birds of course you know I'm able to make a schedule for myself and for the birds but a lot of my time goes into keeping the birds happy I can't get out of the house on a decent time it takes me a while I want to make sure that they've had their breakfast that they've had their lunch or that they're put to sleep or woken up or had some good time with me before I leave when I come back my priority can't be to go to anything else except the birds they take things personally we can't take things personally we're not allowed to take our birds personally and behave differently towards them that's the one thing I noticed about African grays African grays can be difficult when you're in a relationship because they often are one-person birds of course through socialization you can train your African gray to be more cordial with people but you cannot force your African gray to like somebody that person has to want to win over the African gray and has to really take the time and have the patience to do it so sometimes I hear about people who take their gray personally meaning that the bird is their girlfriend's bird or boyfriend's bird and the bird pushes them away and says don't come to me or don't talk to me or all sorts of things and those things sound so real you feel like a human is telling you so you're like fine okay the bird doesn't like me so I don't like the bird that's what happens guys these birds feel so human that sometimes people take them personally okay baby you can't do that you have got to treat the bird like this is a little soul that you are determined to convince that you mean no harm and you want to be its friend so that's something I would say to any of you who have a significant other with an African gray or any other parrot that doesn't like you it's your job to put all of that effort in and when I say that it could take a day or it could take a year I mean it I've had some comments on one of my videos where I say don't take it personally I was trying to explain that it could take a year or so so be patient someone commented my gray only took a day or my parrot only took a day and I'm like yeah that's possible too but what's more important is to let the people know that even if it doesn't take a week or two weeks or a month it's always still possible you just need a lot of patience and you're gonna have to put in that effort right baby one of my favorite things that Cody does and also George did is laugh at appropriate jokes it's so amazing it's almost like maybe we give off a vibe before that they know that we're going to laugh and sometimes it's just like their geniuses they understand everything that's going on and that can be a real argument breaker in the house if there's an argument going on you can tell that the birds will take one side or start getting excited to cockatoos will do that a lot another thing you should probably know about owning an African gray back on the subject of cuddling let me show you see he's kind of nippy we know that he loves me and he's obsessed with me you have to be prepared for that be prepared to get bit not all birds bite but a lot of birds bite every once in a while and it'll come out of nowhere and usually you could figure out what you did wrong but you have to be prepared to have a bird bite so that's another reason people talk about starter birds starting with small birds you go out and you get a macaw and it's the sweetest thing and then it goes through its hormonal stages and that big beak bites you what happens there that's why there's research and that's why yeah baby and that's why we have to get used to things Cody doesn't want to step up right now he's afraid of where I was gonna put him so he attempts to bite right Cody this actually doesn't hurt he's not really biting but he could and that's something you need to be prepared for you also need to be very intuitive when you own a parrot you have to know just like they know about you what they're going to do next like is he going to bite right now is he going to push me away I know but for the purpose of showing you guys I'm not afraid to let you see what it's like so for example step up Cody he's doing a good job of stepping up if I do it wrong oh you're a good bird if I do it wrong he might try to bite my finger right I know that so these are little things that you always have to know about owning an African gray now this is very hard for me to convey but when I talk about African grays passionately and how intelligent they are you all know no matter what bird you have they're super super intelligent they're more intelligent than probably you even expected them to be but owning a gray is like having a bird that's intuitive with your mind and what you're going to say and that's what's very fascinating having a bird that knows when I'm going to laugh knows when I'm going to cry knows when I'm going to move a certain way I used to breathe and go and George used to go all right because he knew that's what I was going to say and that kind of stimulation is very interesting and entertaining to me personally I love that they're observing every single thing that I do now all parents especially African grays need foraging toys why are we talking about foraging toys well they have to keep busy it's a really great idea to create forging toys to hide your bird's food so they have to work to get it remember in the wild birds are busy all day long they're looking for mates they're digging for food they're bringing food back they're regurgitating for the babies they're sitting on eggs there's so many things that birds are busy doing all day long in the wild so when we take a bird and cage it they get really bored as you can imagine we're talking about birds that have learned to speak any language that you want my African grays have learned to speak all of my other birds languages including English which is pretty fascinating right so it's very important that we do not bore our birds when you leave your bird in a cage he has to be left with a lot of things to do and in fact when you feed your bird it's a good idea to give him some work to do to feed him that is what a foraging toy is a foraging toy is a toy that has a mechanism of some sort maybe there's a dial that the bird has to turn and when he turns it his nut comes out things that the bird has to figure out before he gets his food but the toys don't have to have those kind of mechanisms you can make foraging toys at home you can actually take tubes and paper and things that the bird needs to chew and then suddenly he finds his nut and those things keep birds really busy and really entertained because that's what they would do in the wild is go through branches and all sorts of different things to get their food so we have to kind of figure out the best way to recreate the wild for them why are we talking about foraging toys because it's important to know that when you have an African gray you have to put a lot of work into keeping them busy you make one foraging toy for a few nuts do you know how quickly your bird can destroy it so you also have the job of creating these things all the time for your birds your bird could eat a toy in two to three days so how often do you have to replenish toys or if you enjoy making your own toys for your birds as I do I have a drawer just for beads and wood and all sorts of things that I can put together to make the bird toys if you enjoy doing that think about the time that goes into that versus the time it takes for them to destroy it you're gonna be pretty busy so these are some things you need to know before getting an African gray a lot about time how much time do you have to spend with your bird every day well for me personally it's every moment that I can I don't really sit at home and leave them caged I can't do it I have to find ways for them all to be engaged now you may just have one bird so that could be a lot easier and that's probably the best idea but even with just Cody Cody keeps me very busy if I take Cody into the bathroom with me to put my makeup on and get ready for the day most of the time I'm chasing him around oh no no no don't chew that don't get that I've moved everything that I can but Cody can fly so you have to be prepared for every single thing that you do regular daily routines to become a lot more difficult now although African grays tend to be okay with being just next to you for a little while maybe you can give them a toy Cody he gets himself into things he really does for example you guys have seen on my story time on my Instagram how Cody behaves he likes to go into the drawers he likes to play with things he likes to get at all my makeup brushes pull them out so a lot of my time is spent saying no don't do that put that back let me get this you know he doesn't care he wants to get the next thing that he can get that adds a lot of time but I'm not going to cage him up I'm gonna do my best to put him in an entertaining spot and give him an entertaining toy or something to play with I have boxes everywhere that I keep them with little things that I can give them to keep them entertained and Cody really enjoys that but still they get bored so every five minutes I have to give him something new so I just wanted to give you the real deal on what it's like they can be chill for a little while but they can also be very rambunctious like this bird climbs on my head about 40 times a day when I'm walking when I'm going to get some food when I'm making myself tea when I'm doing any normal task Cody flies lands on my head would you be able to deal with that when I'm telling you it sounds so cute and fun and oh my god imagine a bird landing on my head but what if you're just trying to get something done and you put him back and then he flies again and lands on your head what if he has like attachment issues like Cody does Cody's 100% an attached bird and a lot of birds get like that so that's something to consider George was a little more confident about our relationship he knew he was number one bird he was happy sitting next to me but not on me and I really liked that about him but as I said if that story is true this makes 100% sense and you could get an African gray or any bird like this I prefer African graze over cockatoos I love cockatoos because they're so cute and so cuddly and I love cuddling Jersey but you got to be really careful with cockatoos and not getting them used to too much cuddling because they need to be engaged so that is my perspective on owning an African gray all in all it's a lot of fun I love that bond intellectually that I have with Cody and the one I had with George do you see how he just went for my necklace you know your bird is going to beat the boss so that's something to be well prepared for but I really wanted to take you through a day with an African gray and just let you know things that you could expect things that are so much fun but also have their downfalls and also things that you may not have ever thought of and also put a light on them where you realize that things that sound fun may not be it's a lot of commitment to own a bird it's a lot of commitment to own an African gray just to keep them entertained just to keep them happy just to be the detective that figures out the mysteries of what is their problem that's something that you're going to have to do for a lot of years and again you cannot get a bird and get bored of it you cannot get a bird and assume that when it bites you it just doesn't like you and that's it that's wrong it takes a lot of training and on that note I should tell you guys if you know somebody that is an expert with birds or has a bird maybe you should ask them to go with you to get a bird before you get yours because it's important that you bond with your bird and not just get one because you thought this was the one that you like the look of or you want to own it's really important when you bring your bird into your home that you know this a lot of people ask me for advice before getting a bird and I tell everyone the same thing love him like he's your family member include him in everything like he's your best friend and respect him like he is your teacher and then you and your bird will be very very happy thank you guys so much for watching cody do you want to say bye let's say bye cody bye we really enjoyed this parrot tip Tuesday let me know if there's any specific birds you guys want to know about of course i'll go through all of mine first but if you have a favorite of my birds i'll do that video soon for you guys thank you guys so much for watching please come join parrot station on facebook that's our members group and the community I have for me to see your birds so come on and share them and follow me on instagram at marlene mcconan for the daily life of these babies you can watch them through my story time thank you so much bye


Hey, this is Brett with Summit Auto in Fond du Lac, Wisconsin. You're new and used heavy-duty truck and RAM headquarters, and today we are checking out this brand new 2021 RAM 3500 Crew Cab Long Box single rear wheel. This truck has the 6.7 liter high output Cummins diesel, which pumps out 400 horsepower and 1,075 foot-pounds of torque. It is hooked up to the 6-speed heavy-duty ISEN transmission. It is a big horn level 2 with the Sport Appearance Crew, and the color is Diamond Black Metallic. We shoot all of our videos in 1080p, 60 frames per second. So if you have HD capabilities on your computer tablet or smartphone device, turn them on right now, because it is definitely your best way to check out the looks, styling, and options of the truck before seeing it in person. And if you'd like to check out all the photos on this truck, in the upper right-hand part of your screen is a link to our website. Click that and check us out there. So this one's going to come with the special 20-inch polished aluminum rims. These are an option on this truck that have been added to it. Firestone TransForce LT28560R20 tires with an all-terrain tread pattern to it. You get the spring and shock in the front for suspension. Diamond Black's got just a little bit of metal flake to it. If you have your HD capabilities on, you can kind of see it there if we get it focused in right. So really a good-looking color. Halogen headlamps, factory fog lights, front bumper parking sensors on here. The Sport Appearance Group gives you those painted bumpers, as well as the gloss black grille and the hood or color matching. Clearance lights up top on the cab. We'll check out the original window sticker here. Feel free to pause this at any second. I'm not going to go through everything, but the main points and the optional equipment, I will. This is a 2021 Ram 3500 Bighorn Crew Cab Long Box 4x4. Diamond Black's the color. 6.7 Cummins Diesel, high output engine, six-speed automatic ice and transmission. Everything on the left here is your standard equipment. Your optional equipment starts right there, with the Diamond Black Crystal Pearl is $100. Premium cloth bucket seats are $295. You get the towing technology group, which gives you the mirror mounted auxiliary reverse lamps, the center stop lamp with cargo view cam, the power heated trailer mirrors with power foldway, and the surround view camera system, as well as the trailer reverse guidance. Sport appearance group is $895, gives you the sport decal, the gloss black grille, and the painted front and rear bumpers, which is $895. Fifth wheel and gooseneck towing prep group is $530. And the level two equipment group is $4,890. Now you get the power outlets, the Uconnect 8.4C radio.  And you also get a 400-watt inverter. 220 amp alternator is $100, and that high output Cummins diesel is a $12,195 option. Those clearance lamps are $95, LED bed linings $165, and the rear wheelhouse liners are $195. You get the Alpine premium sound system with the subwoofer, which is $595. The automatic level rear air suspension, which is $1,705, which is a pretty cool system. We'll check out in just a second. Those rims are a $1695 option, and the spraying bed liner is $565. Total MSRP is $74,765. If you want to get your summit price in the upper right-hand-party screen, there's a link to our website, where you can check out the incentives and rebates on this truck right now. Three-year 36 bumper to bumper, five-year 100,000-mile powertrain warranty, all the diesel trucks from Ram and Jeep get 100,000 powertrain. So they do have environmental performance now, and you can see that this one's rated for a B minus on greenhouse gas, and a C plus on small grating, so kind of right in the middle. They don't rate these for crash test on the heavy-duty trucks. Factory subwoofer, part of that Alpine premium sound system, and we'll continue our walk around here. First thing I want to show you on the back is that rear auto-leveling air suspension. So you do get this arm right here, and when the load goes down and this gets pushed up, it'll actually send a signal to the airbags here, and it'll pump those up, or the pump to pump those airbags up, and that's a pretty cool system. So if you have a heavy load, it'll level everything out. You get the plastic wheel well liners back here. You get those sport decals on the bed. Now you can remove those if you want, they're just stickers. You get the painted rear bumper, backup parking sensors, full towing package, which includes that receiver hitch, four pin and seven pin wiring. You get all the chrome badges on the back here. Shocked down assist tailgate. Spray and bed liner, you do get LED bed lighting back here. Box tie-downs, the fifth wheel and Gooseneck prep package, seven pin, four pin wiring, and then a 115 volt, 400 watt plug-in. You also get the LED bed lighting back here, and that lights up the cargo lamps as well, which is really nice. And that spray and bed liner is just about as nice as you can get out of any bed liner manufacturer. The factory ones are always really nice.  I think it's a good look. You also have the LED side lights. You have the surround view camera right there, blind spot monitoring, built-in directional signals. These mirrors power-fold in as well. The Bighorn level two group gives you the dark charcoal and black cloth interior. Both these front seats are heated. You get the power driver seat with lumbar, factory floor mats, auto headlamps, power pedals, audio controls on the back of the steering wheel, power windows, power locks, power mirrors, you get the dark wood grain trim on the doors as well as the cloth bolsters. And then these mirrors do fold in like so. Both sides work nice. And then you can control that blind spot mirror by pressing this button, and then which side you, I'm sorry, this button, and then which side you wanna adjust. And if you watch that mirror on the left there, it can actually up and down, in and out. So that's pretty cool on these mirrors as well. We'll hop inside and we'll check out the ignition here, instrument cluster. You get the seven inch LCD display, digital speedometer, compass, menu. You have your range to empty, battery life, oil temperature, and you can change those corners to read whatever you want, miles per gallon, miles to empty, all that stuff there. You also get the heated leather wrap steering wheel, cruise controls on the right with the gear selector controls, Bluetooth and information center controls on the left. And the ice and transmission just gives you that knob there or handle. And then you get the shifters right there if you wanna do a manual shift. This one comes with the 8.4C radio which gives you AM, FM and Sirius XM radio capabilities. You also have your climate controls that you can do here. And you do get dual climate controls as well as where it's blowing. You also have your heated seats and heated steering wheel controls here. And you can check out your backup camera. Now with this backup camera, you can see just how nice in HD they made everything. And then you can also zoom in right on that receiver hitch so you can get hooked up to your boat camper or trailer the first time every time. Speaking of that, if you wanted to hook up your fifth wheel or goose neck, boom, now you can check out the bed as well. And if you're parking your goose neck or fifth wheel or just your normal trailer, you can use these side mirrors or side cameras I should say in the mirrors to adjust to which side you wanna look down. So you can see we can look down the left side or we can look down just the right side. Or if you wanna be right in the middle, you can do that too. So really cool system there. Then you also have the surround view camera, which is also a really nice system to have, especially with a long box. And then you can do a wide view on the rear camera, a wide view on the front camera or a narrow view on both of those. And then you can switch back to the cargo cam. So it's really nice. It's really easy to use. It's really intuitive and everything's in very nice crisp HD quality. So lots of stuff you can do with this radio including the Android Auto Apple CarPlay where you can project your cell phone to the screen. So while this system doesn't have navigation on it, you can project your cell phone to the screen and get navigation on there. So you got Waze or Google Maps projected right to the screen and it's like you have the navigation right on your screen. They went to a push button four wheel drive in the heavy duty trucks on RAM, dual climate controls, heated seats, heated steering wheel controls, more tactile. If you like the buttons and knobs including the volume and tune. Factory Brake Controller, this is for your alternate trailer brake height or I'm sorry, alternate trailer height. So say you have a trailer that's higher up or heavier than the other one, you can set this up so that the rear auto level air suspension can adjust to which trailer you have and have a preset. Factory exhaust brake, tow hall, front rear parking sensors. Down here you get two USBs, two USB C's and an AUG stack. And you get the keyless entry with your start. Cell phone holder.  You also get sliding center console with cup holders and coin slots. And then you get more storage underneath here as well. Get the big horn badge on the dash over there. Do you like that design on the seats? I always thought that looked pretty good. And you do get map lights up here, power sliding rear window buttons and home link buttons for your garage door security systems and lane systems. This is also an auto dimming mirror. You do get that wood grain trim up there and the Alpine letters right there. It'll let you know that you do have the Alpine sound system. And we'll take a quick look at the back seats.  These seats do fold up.  If you got muddy boots or tools, put them on there, you're not gonna get your seats dirty. Or if you got pets, you can put both sides down. They got a nice flat place to lay and that's a pretty nice feature as well. And then you have storage underneath there. You also get in-floor storage on each side with removable containers for easy cleaning. You could put ice in there.  These floor mats snap in so they don't move on you. You also get another 115 volt 400 watt plug-in. Two USBs, two USB C's back here as well. Side current airbags. Get that same trim on those back doors and child safety locks on the back doors as well. I did wanna show you these LED tail lamps because they are part of that big horn level two group. Or maybe they're part of the, can't remember if they're part of the big horn level two or if they're part of the trailer tow group. Anyways, they're there. Get the truck all lit up here. Now I'd personally like to thank you for checking out the video today and hopefully from this HD video, you will have been able to tell just how good looking this truck is. Check out some of the options. Check out the Diamond Black Pearl Coat. And to see more pictures of this truck, you're one of our other 450 new and used cars, trucks, SUVs, minivans, wranglers, halftones, three quarter tons, one tons. You name it, we got it. Go to our website right there, www.summitauto.com. Full pictures and descriptions of every single vehicle from two locations all at summitauto.com. And if you'd like to check out more HD videos, you can go to youtube.com slash summitauto. Remember to like, subscribe, and share on this video and all the videos that you see there. In fact, in a second you will see a link to subscribe to our YouTube channel on your left. It links more Ram 3500 truck videos like this one on right. If you have not been to our website on the bottom link to this vehicle on our website, click those check us out. And we really look forward to helping you with this extremely good looking 2021 Ram 3500 crew cab long box, single rear wheel, big horn level two sport and diamond black clear coat. Thanks again for checking out the video.


Let's dive right in and examine the top 15 herbs for anxiety today, on eccentric nature. Now these anxiety-elping herbs are in no particular order, as each herb may very well affect you differently from the others. So to say one is truly THE BEST is truly subjective in this category. But let's start our list off from a well-known powerhouse herb from India, Ashwagandha. I just hear that name and I shudder. Ashwagandha. Found primarily in Northern Africa and India, this herb is one of the most powerful adaptogens, which affect your body's systems and hormones, allowing you to regulate stress. A 2019 study showed how taking Ashwagandha can reduce the stress hormone cortisol. This was backed up by a 2012 study that showed up to 28% lower cortisol levels when taking Ashwagandha. The studies show that Ashwagandha is actually much better at long-term anxiety relief. Now the only real knock that I found against Ashwagandha is that studies have shown mixed results at a lower dose of the herb. The good news is that long-term studies have shown that those who took it for three months showed an upturn in mood, energy, and better anxiety levels. Number 2. Chamomile Yep, saw that one coming. Perhaps one of the best-known herbs for anxiety stress relief and sleep. Chamomile is great for the long-term treatment of generalized anxiety disorder, and this according to multiple studies. One study even showed that it is better at reducing relapses of GAD as well. Research shows that the compounds in chamomile can bind to the same brain receptors as drugs like valium. Most studies tend to focus on how chamomile can help lesser forms of anxiety. But a 2016 study showed chamomile to be also effective against medium to severe anxiety symptoms. Though it is one of the safer herbs you can take, chamomile can affect blood-thinning drugs like whereferin and the anti-rejection drug, cyclosporine. So of course it's best to consult with your doctor if you're taking other medications. Number 3. Valerian Let's not confuse this awesome herb with the movie Valerian in the City of a Thousand Planets. Though both might be equally sleep-inducing. While research does support how Valerian can help with anxiety and depression, there just aren't a lot of studies available yet on Valerian. Studies suggest that Valerian is generally safe, but overuse can lead to headaches and dizziness. The biggest problem with Valerian is that while it's okay with helping with anxiety, is that it's actually more helpful as a sleep aid and people often report symptoms of drowsiness when taking Valerian.  Literally. Number 4. Lavender This sexy beast has been shown to help anxiety symptoms as much as the drug, Lorazepam. And it's considered to be one of the most effective herbs for short-term anxiety relief. Long-term, it's very still out. There is research that says lavender loses effectiveness when taken for a long period of time. But there isn't enough research yet to confirm this theory. So we really don't know how helpful it can be in the long term. Also if you're taking lavender essential oil in capsule form, this has been known to cause constipation and headaches. Lavender can lower your blood pressure. And if this is something you don't want, you'll want to be careful about taking lavender as well. Number 5. Passionflower While this lovely flower is quite effective at treating anxiety, it unfortunately has some downsides as well. A 2010 review showed that passionflower is comparable to a class of prescribed anxiety drugs known as benzodiazepines. Though another study said it didn't work as quickly as oxapam. Another of the benzodiazepines. However, people did do better throughout their day when on passionflower than when on the drugs. Oddly, its biggest strength is also its biggest weakness. Passionflower is considered to be the best herb for anxiety-related insomnia. But it is also an incredible sedative and can cause some serious drowsiness, even more than valerium. So taking it for regular anxiety use can be a bit tricky. Number 6. Hey, my name is Kava Kava or you can just call me Kava for short. This amazing shrub from the Pacific Islands is the number one go-to herb if you're having an acute anxiety attack. A 2013 study showed that people who took Kava Kava extract showed a significant reduction in anxiety compared to those who received the placebo. Oh gosh, sounds like a miracle herb, doesn't it? Unfortunately, there have been some conflicting reports on the potential long-term effects on the liver when taken in excess. So if you have liver problems at all, please consult your doctor. Number 7. Lemon balm. One of the best benefits of lemon balm is that, unlike some other herbs on this list, is that it can relax the body without people losing their clarity of thinking. In a 2011 study, 300 milligrams of lemon balm extract taken twice daily lowered anxiety by 15-18%. But even more awesome, it lowered anxiety-related insomnia by 42%. Like most herbs, lemon balm is considered safe, just in moderation, as overdoing it can cause nausea and abdominal pain. Number 8. Rodiola. Rodiola? If you don't know this herb, it's time you did. Also known as Golden Root, Arctic Root, or Rose Root, this massive adaptogen is actually one of the most highly used in traditional medicine. However, according to research, it may be better for stress than anxiety. Research shows that it can help with mild to medium anxiety problems, but the results were pretty inconclusive. One study showed it to be not as effective as Zoloft or Sertrally, though people did show far fewer side effects when they used Rodiola rather than the drug. Number 9. Vitex Agnus Castus, or Chasteberry. If your biggest problem is PMS-related anxiety, then Chasteberry is probably going to be the best herb for you. And this is still an herb as it comes from the Chaste Tree, which grows in many warm temperature climates. Studies have shown it to be particularly effective at reducing anxiety and depression during PMS. Plus it can help overall PMS symptoms as well. Guess who's back, back again. Tumeric, tell your friends. That's right, is there nothing Tumeric can't do! Thanks to its active agent Curcumin, this colossal anti-inflammatory also has research showing how it is particularly good at reducing anxiety associated with chronically activating your stress response. For best results, you want to take an extract for this, but Tumeric is when you might want to avoid if you have an iron deficiency problem. Number 11. Bromi. One of the lesser known herbs, Bromi can increase your levels of serotonin, increase your peace of mind, and soothe restlessness. It also has the unique ability to improve cognitive function as well as help the body to cope with stress. And while it serves as a mild sedative, it can also enhance mental clarity and focus. Say what? Yeah, it sounds weird, but this is the big problem with conflicting research. As there's studies that say it's good for clarity, and there's studies that say it's a sedative. Let's just hope you're more on that clarity side. Number 12. Tulsi Basil. Also known as Holy Basil. According to the Journal of Aerovita and Integrative Medicine, Holy Basil has antidepressant and anti-anxiety properties comparable to diazepam and other antidepressant drugs. One study found that people took 500 milligrams of Tulsi Basil extract each day felt less anxious, stressed, and depressed. And they even felt more social. Ooh, party bonus! Number 13. CBD Oil. Chock up another big positive for cannabis oil. As a 2019 study found that of 72 adults, 57 experienced decreased anxiety within the first month of taking CBD. And they sustained these results for the whole three month study period. Yes, more research is still needed. But CBD is definitely the biggest up-and-coming herb for anxiety. Number 14. Gelfemia Glauca. Gelfemia Glauca is a plant species native to Mexico. And people there have traditionally used it for anxiety. A 2012 study showed that a daily dose of 0.175 milligrams of Gelfemia Glauca showed a greater reduction in GAD symptoms compared to those who took lorazepam. Not the only problem with this plant is that it's a little bit more rare. And it might be a little bit more expensive depending on where you're at. And finally, number 15. Hopps. Beer lovers everywhere, rejoice! Actually, don't. Because hops is only good for you medicinally without the alcohol. And you're gonna want to take pure hops in pill or powder form. There are various studies showing how hops can help improve cortisol levels and help with sleep, depression and anxiety. Though, like several other herbs on this list, it can cause tiredness. Also, if you're allergic to hops, you may experience a mild rash or congestion if taking it. So that's the top 15 herbs for anxiety. Which of the herbs on this list have you tried for anxiety before? Have any of them helped you? Please let me know in the comment section down below. If you're loving learning about the benefits of herbs, then you should watch the benefits of lavender tea next, or all the benefits of peppermint next. Please, be kind, take care of each other. And may all of these anxiety-helping herbs help you.


We'll be starting in just a moment. Okay, my name is Jason Moore and it is my pleasure to introduce Matt Smith from Central Florida and Matt, since we're starting a moment late, I'll let you just jump right into it. Okay. You guys hear me alright? So my name is Matt Smith. I am a physiatrist for those of you who don't know what that is. I'm a, it's kind of a combination between sports medicine and neurology a little bit and I did a little extra training in sports and spine. I do a lot of procedures for the spine. My clinic is called the Spine Health Institute. It's in Altamont Springs, Florida, which is just north of Orlando. I hear there's an Altamont around California, but that's not that one. Alright, so the title of my talk is called More Than Bones and the reason it's called that is because as a spine doc, most of my training and focus is on the bony part of the spine. My premise or thesis is that we're missing a lot of the spine when that's all that we concentrate on. So we're going to start off actually with a quote or a couple quotes. So this is one of my favorite authors in the Semtelep. I heard there's a rumor he might be here tomorrow. I don't know if that's true or not. Anyway, he's famously known for saying that you shouldn't quote people, but I'm quoting him and it's from his book of aphorisms, The Bed of Procrustis. Modernity is a double punishment. It's both make us age prematurely and to live longer.  So one of my contrarian viewpoints is the way we look at spine as a medical profession maybe if not wrong and complete. So I'm going to pretend that we're all clinicians here and I'm going to give you a patient presentation. So history of present illness. We had a typical gentleman that I might see in clinic, 45-year-old guy. He's coming in with low back pain around his right butt. Past medical history. He's got insulin-resistant diabetes, melanitis, a little bit of sleep apnea, reflux. He's got some arthritis in other areas, little psoriasis, maybe a little hypercholesterolemic. The social history, fairly clean living guy. He likes to eat the standard American diet. Functional history more or less the same, doesn't exercise quite as much as he should. Review of systems, nothing too scary. When I say scary, I'm thinking infection and cancer, right? So I'm thinking pain that awakens you at night, unintentional weight loss, things like that, nothing too scary.  He's not a weight lifter. This is not because he can squat 500 pounds, he's just a little fat. It's a physical exam, kind of an average build, what you would kind of expect from your everyday guy. So, gets it x-rays, nothing too scary. We think this might be a little bit of sacroiliac joint problem, which we think probably happens maybe up to 15% of the time. How do you treat him? I get him into physical therapy, give him a little bit of ibuprofen, maybe a sacroiliac joint belt, maybe do an injection if he's refracted to all this stuff, you know, your kind of standard stuff. So I've done that, but have I fixed the problem? Let's look at another patient.  He's got some red, kind of painful nodules on his finger. He's got a history of mitral valve prolapse, tooth decay, he's diabetic too. He's got all those same kind of standard things that we see in almost everybody. This is a picture of his hand. So he's got, I think I'm, I decided not to shave, so this little sticker's not sticking on me. Anyway, so tell me if you can't hear me. So he's got these little nodules. Now these are actually, right here, these are not painful, but he's got ones on his fingertips at R. So what do we say? Well you've got little painful things on your hands, having pains bad, let's give you some things to fix that pain, just don't use your hands so much, right? Fix the problem. Well no, we haven't, because those are, at least these things here are called Janeway lesions, the things on his fingertips are called ozernose. These are septic emboli from what's called bacterial endocarditis, which is where you get an infection in your heart valve, shoots out little bits of bacteria that get lodged in little capillaries in your fingers and you're basically on the, you know, you're on your way to dying really fast. And so if I just treated this guy, I've missed this whole underlying pathophysiology of what's really going on, I've only treated the symptoms. My contention is that treating that guy's sacroiliac pain is very similar to treating this guy's endocarditis with just a little bit of insets. I'm only treating the symptoms of a much deeper pathology. And so for those of you who don't know the lingo supertentorial is your cortex and that's kind of medical lingo for saying if your problem's super tentorial, it's all in your brain. So there's a reason probably a lot of our back pain patients come to us and it's not just because they're crazy, right? There's more than just a psychological reason they come with a whole constellation of pain symptoms and other problems. And then a doc I know quoted Bill Davis and he said, just fixing these, these symptoms is like fixing a leaky faucet when your whole house is on fire. So how did I get started? This is actually a picture of me when I was 19. This is Adrian and I said, I'm a cancer survivor at a football size Ewing sarcoma in my belly. And they always say you don't know what you have until you don't have it. I was a mediocre athlete. I was pretty active and whatnot. But I, it wasn't until this happened that I said, you know, I'm gonna start working out. I'm gonna really get into that lifestyle that really values everything that I can do. Of course, this is like late 90s, paleo wasn't around then. This whole kind of thing wasn't around then. But I discovered actually all that when I was in residency. But this is kind of what got me going. So I'm gonna talk about two things in this talk. The first is kind of stuff you guys already know or at least already suspect, at least in regards to low back pain. It's not just due to mechanical pathology but also a manifestation of the metabolic syndrome. And if you don't know what that is, I'll talk about it. The second part is the best way to fix the bulk of low back pain or at least address it, that this chronic low back pain, which is the main thing I'm gonna focus on, is to address the metabolic syndrome in addition to the mechanics, such as what Esther speaks about. And I'm gonna talk about this with seven parts and I'll just get going it now. So some perspective, we all know this is a gigantic problem. And how big of a problem is this? Well, in the world, there's a prevalence of about 70% low back pain. Anywhere, the incidence is thought to be about 5%, probably more. In the United States, we lose about 150 million work days a year because of low back pain. The direct cost is about $70 billion a year, indirect about $130 billion. This is old. So James Steele, I don't know if you guys have seen any of his talks. He goes into this much better than I do. But as far as how this has been prevalent, probably since the beginning of time, we know Otsi, the caveman. He has spondylosis. Spondylosis is arthritis of the spine. But this is also new. There's tons of evidence coming out now that says it's getting worse, and it's getting worse faster than it used to. When studying Sweden in the 80s, saw a four-fold increase. Now there's probably confounding variables such as insurance reimbursement and stuff like that for having low back pain. But it looks like more people are getting it. So it's a big, big bad thing. As a spine doc, some of the common things that I see and that I think about from a bony perspective, at least, are some of these. This is just a schematic of what your bones look like. This is where your belly would be. And this is when you feel those ridges, you're feeling, these are called spinous processes.  We call that the kaudi kwana. Here's your disc, the inner jelly part called the nucleus pulposus. Consistency of toothpaste in the outer part is a tough, fibrous ring. And then each bone individually looks like a tripod where the big front leg is right here is where the disc and the bone is. And then you have these little two back legs called the facets at the end. So the relatively straightforward bony parts. So this is a cross-sectional or axial view of an MRI. And so you can see there's a disc bulge right here, okay? Here's that kaudi kwana or that horse's tail. Here's those facets, and here's the disc bulge. Now, this typically presents with chronic low back pain. If it's pinching on your nerve, you might find it going down your leg. But this can be chronic. I mean, usually it's acute, but it can be chronic, and it can cause focal low back pain in addition to shooting pain. Here's it from a sagittal or a side view. You see that disc coming out. Here's that kaudi kwana right here. Compression fractures usually also present with acute pain. But you can have chronic pain with it. Here's one of my patients, L1 compression fracture. We number our spine bones, yet the low back bones, you typically have five. We start counting below the lowest rib of where the low back bones. And so this is the first one, you see how that's smushed. This is a 3D reconstruction of this CAT scan. You can see how it's smushed a little bit. So this is crazy. Talk about red flags. This is a gentleman I saw probably only about a month and a half ago. This right here is an abscess. He was parking cars and noted about three months of low back pain. He was parking cars the day before he came into the hospital. Started having low back pain, then he lost control of his bowel and bladder. When it ended up having to do what's called laminectomy, where you take the back part of the bone. My partner did this. I'm not a surgeon, I'm a physiatrist. But my partner took out the back part of his bone here and up top and ran a catheter and had to wash that whole thing out. So those are some of the more straightforward things. You see that MRI, you kind of know what you've got, all right? These are the trickier things. And now we have mechanical low back pain, which is what almost everybody has most of the time, which is your sinews, your tendons, your muscle strains. It's a lot harder to put your finger on what is exactly causing the pain. Now, we talked about a disc herniation causing pain. There's something called interpretable disc disruption. A guy that I actually met last week, Nikolai Bogduk, describes this as not just disc degeneration. You talk about those rings of fibers, you can get tears in those. This is a real hard thing to diagnose. You can put dye inside the disc and then get a CAT scan later and it has a certain characteristic pattern that is suggestive of this. When you look at MRI, it looks real bright on a particular type of way you can look at it.  This is what the facet joint looks like on Axial View. Here's a CAT scan, you can see it a little bit better. See how there's a little arthritis there? I see this all the time. That can definitely be a source of chronic low back pain. I want to touch on idea though, which is, and we'll go into this in a lot more detail in just a second, but there's this idea that there's a progression that goes from a little bit of degeneration to instability to stability and all of these parts of the low back pain kind of complex, the disc and the facets and all these other things might play into that, but then we might eventually at some point come to stability. So let's go and look about how MRIs can be a little misleading. So there's something called spondylosis deformans. Spondylosis means back not looking quite as perfect as it should. That's all it means. Spondylosis means spondy means backbone. Losis means something's up with it. So spondylosis, you get it as you age. Like I said, Otzi the caveman had it, but it seems that something else is going on more than just the normal wear and tear as we age. This is a patient and if you're not used to looking at MRIs, you might not pick this up, but you should even if you're not used to looking at this is not a normal looking back. This is one of my favorite patients. He's a great guy. He only has a little bit of pain. Rating down his leg. He's been oystering. He's been doing all this stuff. Here's his caudy quanta bunched up here. He's got numerous discs that are just getting worn out. This one's almost completely fused on its own. This one, too, looks horrible. His back looks awful, but he doesn't have that much pain. Here's a study that was done in 2013. They looked at about 170 guys in Sweden and they looked at their their two lowest disc levels and they looked at all these different changes. You don't have to know what these mean. But basically, there are a variety of things we might see on MRI. You have to have at least two of these. All right, here's a couple of examples. This is called a modic change. This is at your lowest disc. This is swelling. We see it bright on this kind of MRI, dark on here. Here is that little high intensity zone right here that might indicate a little bit of a tear within the disc. Here's what we call a type two modic change. That's where the bones around the disc get a little fattier. And here's a disc bulge. So I looked at all these all these problems on the MRI. All these things, you know, patients come to me. Oh, my God, I have degenerative disc disease.  You know, this is degenerative disc disease. This is spondylosis. This is all this. They looked at all this. They put it in this complicated algorithm and they compared it to what's called in a westerly disability, an X, as a measure of function in your visual analog scale, which is a measure of pain. And what did they find as the correlation? Yeah, as my old attending user say, nothing much. So despite a progressive worsening of the people's back, there's not a good correlation with pain. Here's another study. It looked at younger people.  There was really no correlation with how bad their MRI looked and how bad their pain was. Furthermore, 13 of those guys, one year later, developed back pain in that interval on their MRI follow-up, there was no change. So something's going on that we're not seeing on MRI. Here's another study. This is even weirder. So we thought about maybe there's not a one-to-one correlation. There might be a negative correlation. In this study, it showed that with older individuals that the least degenerated disc had the most correlation with low back pain and the most degenerated disc had the least correlation with low back pain. So this brings us to then back to the Krakalli Willis Cascade. Krakalli Willis was actually one guy, William Krakalli Willis. He came up with this in the 70s. So is maybe something going on? Are these guys stabilizing now? They're degenerating even more into where their pain's improving? Maybe. Or are we maybe not looking at all the same stuff or all the right stuff that we should? So we talked about that one study that looked at all these variables. When we look at everything, are we missing the one important thing that we should be looking at, such as, for instance, high-intensity zones? If I look at the setarthropathy and disc degeneration and all this other stuff, and I missed that point that there's a little bit of a T2, a hyperintensity on your disc, am I, by looking at everything else, am I clouding the signal? Or are we not looking at something? Because after all, this talk is called More Than Bones, and I've only talked about bones so far, so I might be alluding to something I'll talk about later. So let's talk real quick about what we tend to do for most low back pain. There's four treatments. Surgery, you can give injections. I'm sure you guys have heard of epidurals and things like that. You can give drugs, and then what we, I'm kind of clumping everything else that we do as far as a physical modality and the physical therapy. This is called dynamic spinal locus thesis. This needs surgery. If you're bending forward and leaning back and your bones are actually shifting a good bit, you really probably need to get that fused. That's not much of a controversy. And there's a variety of things you can do for an injection. This actually comes with a lot of controversy too. A lot of times these are better for acute back pain, like an acute disc herniation, but sometimes you can do a few percutaneous image guided procedures that get people up and going and that can have a useful place, but certainly some of these things, including surgery, might be overdone. And then of course there's drugs. Strangely, the way we dose drugs and the way we choose what to give are based on the World Health Organization's prescription for how we should dose drugs for cancer patients, essentially. But we use that same thing for people with low back pain and one of the results is that we get a lot of people who are taken to lauded and a lot of high dose opioids for low back pain. And there's physical therapy, which is one of those things that can sometimes mean anything to everyone. Could be something like what Esther is prescribing. It could also be you go to the physical therapist and they get you doing an arm cycle or a gometer for low back pain and no one ever gets better. But we're gonna talk more about this later. So I'm gonna have a little bit of a segue now. I'm gonna talk about one of my patients and he, I'm not violating HIPAA because he let me use his, he said I could use his name and his name's Tony. 71 year old guy, he's about 73 now, but he has a pacemaker. He's got a little bit of intermittent low back pain, but no red flags, no neurologic deficit. And this is a picture of him. And he comes to me, I never had anybody say this to him. And he goes, I want you to help me out. I got a little bit of low back pain and I'm going to Ecuador to train my Sherpa because I'm then going to go to Everest. All right, so he's 71 years old. He takes off a shirt for the physical exam. He looks like he's about 35 and a really healthy 35. He's neurologically intact. There's no red flags, a little social history. He's a businessman. He doesn't have any real bad habits. He's completed the Boston Marathon and he's the oldest guy to complete the Antarctic ice marathon with a pacemaker. His CT, I'm not going to read you all this, but basically it's not great. And so here's a picture of it. Here's a disbolge, gigantic disbolge, disbolge, disbolge, disbolge, worn out disc. This is called the vacuum phenomenon. It means the disc is worn out. He's got facet or throat. His back is not good. At least the bony parts aren't. But look at this. These are some muscles around the back. Those are really good. Here's the psoas muscles. These are your muscles that make you do that. Really good. So we ended up doing a little bit of conservative treatment. He hiked for 20 days on Everest. He said he was going over a crevasse. As he was crossing it, he felt a little twinge. He felt that he could probably go to the top, but he got a little paranoid and so he stopped. But here's a guy with a pacemaker with a really jacked up looking spine climbing Everest. How is that even possible? Is it his genes? Is it his anatomy? Or is there something else going on? And so let's revisit anatomy and physiology a little bit. And this brings us to the perennial question. Why do pigs have less back pain than humans? Well, here's an axial picture of an MRI of around the lumbosacral junction. I flipped it over for comparison purposes. Here's your extensor muscles right here. Here's your psoas muscles. This is one of my patients. And here's a pork chop that I cooked not too long ago and curry and coconut. This is a protein waffle that we made and this is a plantain right here. And so this is gluten-free. Just, I don't want to get crucified. Anyway, so I actually don't know if pigs have less back pain than humans. I'm not a veterinarian, but look at this. One, the anatomy is totally different, but look at the spinous process. It's way unfair. Pigs are also quadruped. There's a lot going on here, but look how big and these muscles are big and delicious.  And we know from some research in the past that strengthening of certain muscles looks like it can probably help low back pain. So, I talked about the psoas muscles as your hip flexor muscles. It starts kind of like in the front part of your low back and then attaches right over here to your hip. We know that strengthening those tends to help chronic low back pain. Strengthening the multifidus muscles, which are some of the muscles that help the spine extend, also seems to help. And then, of course, having weak ones is then correlated with back pain. But it's a little more subtle than that. So, it looks like muscle asymmetry, almost more than anything, is associated with back pain on that side. And that's what this study showed in 2004 in the journal, Spine. This is a study that was done in Australian football players, which I guess is soccer, where there's this muscle called the transversus abdominisis, one of your corset muscles.  And they show that the guys who had low back pain, so even if you have big muscles, you can still get low back pain, but they had a little bit more difficulty activating their corset muscles. And they looked at this on MRI, having them relax and try to activate it. And the guys who didn't have low back pain seemed to do a lot better job. So we know if you're missing muscle or not having the right kind of muscle that could be associated with low back pain. So there's a problem, a deficit, but it looks like there might be a problem of having too much of something too. I don't know if this is a real word, it might be. But this, to me, means having too much fat.  And I'm gonna go into a little bit why later. There's a orthopedic law called Wolf's Law, which states that if you stress any kind of orthopedic structure in a certain way, it's gonna get stronger in that same way. And I mean, that makes sense, right? You stress your bones a certain way, they get stronger in that certain way. So it was always thought that, hey, obesity is not great, but at least it keeps you from being osteoporotic because of that reason. And even though it makes you osteoporotic, though, one of the downsides, it makes your weight-bearing joints worse. And you look at this from a mechanical perspective, it kind of makes sense. However, what Lou at all showed is that that's not true. Yeah, compared to frail people who are malnourished, people with obesity have better bone density, but compared to people who are just normal, obese people are more likely to have osteoporosis than osteopenia. Well, then maybe the reason is, okay, well, they're obese, they're probably not exercising as much as they should, that's why they're osteopenic, but then why are they getting degenerative joints? If it's from a mechanical perspective, their joints should then be preserved if they're not using them so much. And what these guys showed is it's not just they're weight-bearing joints that are bad, but they're wrist bones, they're hand bones, a whole bunch of non-weight-bearing joints. And it's unlikely that they're doing handstands. So what's going on? And it looks like it's not so much just a mechanical problem, but it's a physiological problem. So this is kind of old news to a lot of you guys, but if that is not just a safe haven for triglycerol, it's also an active endocrine organ. Some of the main cytokines we look at for inflammation, TNF alpha, interleukin-6, go up. Leptin goes up, that can lead to some things too. Leptin resistance goes up.  It's not all fat. As you get more bad fat, it goes up from 20% to 40%, and it's not just increase in quantity, it's a change of kind. So these white blood cells are making more pro-inflammatory cytokines. So if you think about it, if you've got 100 pounds of fat, that's 40 pounds of white blood cells that are pumping out bad cytokines. And this goes down adiponectin, which is a very curious cytokine. And so it makes this vicious feedback loop, and like any kind of cancer, it's self-propagating, right? So you get increased visceral adipose tissue that makes inflammation go up. That inflammation inhibits your body's ability to break down fat, which makes you fatter. You can talk about adiponectin. This makes you more insulin sensitive. It does all the things that protect you from diabetes.  And so that makes an even more complicated positive feedback loop.  Now you're hurting more, you're depressed. We know depression is linked with inflammation. That makes you get fatter. We know inflammation in itself directly causes you to get fatter. And this is being seen in a variety of ways. So we know that knee arthritis is associated with decreased adiponectin. We already talked about the white blood cells and the fat, but we're seeing that even more fat around orthopedic areas. Todd Becker posted this article, I thought this was awesome. If you give so many epidural steroid injection for acute or herniated disc, corticosteroids work by inhibiting an enzyme called phospholipase A2. Phospholipase A2 cleaves arachidonic acid from your cell membrane. That then goes and creates all those prostaglandins that cause inflammation.  Fat is like the anti-epidural steroid injection. Now, could this all affect the spine? I've been talking about other joints. Well, we know that the thing that more than arthritis, the thing that causes most back pain is smoking. The second most common thing that is associated with low back pain is obesity. The more obese you are, the more likely you'll have low back pain. And now, we know that osteoarthritis in general deserves a seat at what's called the metabolic syndrome. Now, metabolic syndrome is this pathology that has many faces. Some of the things we think that are causes or manifestations of the metabolic syndrome include hypertension, hyperlipidemia. Obesity is one of them, but not everybody gets obese. Multiple others, increased risk for cancer, numerous others. But what about pain in general? So we know arthritis goes up, pain tends to go up with the metabolic syndrome. And then the spine in particular, this study was just given to me by a friend of mine who's a professor at UCF. And the more manifestations of the metabolic syndrome you have, the more likely you are to have spine arthritis. Now, this is complicated if you haven't already realized. And the devil is in the details. So, we've looked at MRIs. We looked at the level of pain associated with them. There's not a great correlation, right? But you look at muscle mass, you look at these metabolic parameters, and there is a good correlation. And some interesting findings. So, the more pain you have and the more catastrophizing you have, meaning the more you think you're in pain, the less endurance your muscles have when you're trying to do all those good posture things that you're supposed to do to maintain your spine health. Strangely, when you look at how atrophied your muscles are, it's out of proportion to the actual denervation that occurs, meaning you should be stronger than you are. There's not a neurological reason that a lot of people are as weak as they should be. They could be stronger, but they're not. And that then goes to another vicious feedback, Luke. Low back pain, you get depressed, you get inactive. Sarcopenia means, it's like osteopenia, osteopenia is bone thinning. Sarcopenia is muscle wasting. That then leads to the metabolic syndrome, which means more back pain, but it also works the other way, too. So, fortunately, we know that if you work out, if you have more strength, that tends to ameliorate chronic pain of all sorts. And this goes back to Wolf's Law, but again, not just because of the mechanics, but because of the physiology. And fortunately, it's never too late to break the cycle. I used to say, and this is what I was taught, that after 30, no matter what you do, you're gonna lose 10% of your capacity every decade. And then I heard it was about three to 5%. But now, research is showing that we really don't even know what your potential is. And it looks like we've maintained the physiologic machinery to get good muscle mass till basically we die, almost. And there's been studies that show that high-intensity training helps pain of all sorts in elderly people. And like I said, this is really complicated. The mechanisms are so varied, and we don't even understand how all of them work yet, but this just shows, this is a variety of combinations of the physiology and the mechanics that all work to make your bones denser at least, and similar things with muscle.  Once Alzheimer's hits, once you get a stroke, you can't get them back. Now Todd Backer talks about this. When I was at UAB, we did a lot of research on constrain-induced therapy for stroke, and we showed that you can actually regrow the gray matter in your brain. Well, looks like you can also regrow your disc. And this is done in mice. The conjure sites, these are the cells that make that annulus that we were talking about, are regrowing with exercise. Now unfortunately, or maybe fortunately, we can't make humans exercise and slice up their disc and see how it helps, but we can do it in mice, and it does help. And we have this model. So, and this is the whole hermetic model, right? Stress causes a whole bunch of reactions, causes damage, and then because of those reactions, with adequate rest, we get supercompensation. This is the whole progressive overload type model, right? And we know this forever. Frederick Nietzsche, what does not destroy me makes me stronger. And if you guys don't recognize this, you can move out of America. They never get involved in a land war in Asia. Why did Visini die? Because he didn't have that hermetic response to Iocane powder, and Wesley did, and the Princess Bride. And so that in a way is what we need to be always maintaining in our spine. But again, the devil's in the details. So while we can have stress and then rest and then supercompensation, if we don't stress ourselves, we don't maintain we atrophy. And if we give ourselves too much, then we get tissue degradation. And the parameters of what cause all these things are different for everybody. And going back to the necessity of stress, if we do things that take away that stress response, we don't get adaptation. So colleague, Mark Bamman at UAB, he showed that if you take anti-inflammatories after you exercise, you don't get that adaptive response. One of the ways our muscles grows, the satellite cells around them donate nuclei and that lets our muscle cells grow. They don't do that if we cut off that inflammatory response. Now, just to give you an idea how complicated this is. If we want to make mice lose their disc and get degenerative disc disease, we give them a certain amount of stress.  And we know how to do this. So not all stress is good stress. And one of the really cool things that we're doing from an interventional perspective is figuring out how to put stem cells in the disc. But we know that every stem cell and every scaffolding that we use has different parameters. What helps one stem cell grow by putting a little bit of stress on it kills another type. So this is very, very varied. And that, I think, is why we get this mediocre meta-analysis from the Cochrane collaboration and from the European Spine Journal and others. When they look at exercise in general and they say, hey, listen, it's kind of a mediocre response. It's because we're looking at everything. You can't look at everything and say what's right for this individual. And here's just two examples. This is a six-month study looking at lumbar extension exercises and some other study and other exercises. And they showed pretty good results. Here's another one. They actually showed good results better than the tonal one indicate, but it's a two-month study. And they did a totally different protocol. But here's another study done in cricketers and they looked with ultrasound at different sizes of their multifit eye, focused on making the multifit eye the same size and they showed statistically significant decreases in pain. And this is just my shameless deadlift plug. Deadlifts, some people love them, some people hate them. Some people think you should do isolated lumbar extension exercises, but in healthy people, deadlifts, when you're looking at EMGs, actually activate the muscles the most, the focused lumbar extensors the most. Now, would I get grandma doing deadlifts on day one when she's never done deadlift before? Probably not. Not if I want to keep my medical license, but it's a good exercise for particular people. Some people though should be doing this. Some people shouldn't even be doing that. They should be doing something totally different. And that then makes us ask, is good enough, good enough? My job as a back doctor is to try to make your pain go away.   Now, this is a treatment or a program that in 1995 where they did a strength training program in minors, and look, per month, they were giving $14,430 for like a work cop and it went to 380 after they did this strength training program. My specialty journal just published this, which showed that if you make obese people strength trained, they can walk better. If I give you an epidural and you never walk and you never get stronger, you've gotten no better. So, the question is then, how is this ancestral? Well, my feeling is we only have to go back to Otsi the caveman. We can just go back to 1994. So this was the obesity rate, look, 80 to 21% is the worst. This is 2010. That would be the best per state. The way we've gone in treating low back pain, as physicians, has been mainly through passive modalities. You come in, I give you a treatment, you're better, good luck. That's not how it used to be. 50 years ago, it was to get you stronger.  So, in conclusion, Einstein says, make things as simple as possible, but not any simpler. This is really complicated. There's a false dichotomy between posture and strength. That's one of the big things. You see people say, hey, listen, you need to have certain posture, and you see people who say, no, you have to be strong. If you're doing a back squat, you have to have good form, but if you don't have the muscles there, no matter how good your form is, you're not gonna be able to do it right. It's not just the mechanics and the muscle, and it's not just anatomy or physiology. And there's subtleties to everything. Dysdegeneration is normal. Introvertibular dysdegeneration is not normal. And there's variations between how much muscle you have in total and focal loss. Physiology is very complicated. Adiponectin, I talked about how great it is when it goes up. Well, we don't really know exactly what adiponectin does, and with rheumatoid arthritis, it goes up too, and so we're not really sure what it does, so physiology is very complicated. And we also have to be really careful with cause and effect. I talked a lot about correlations, and when future research is done, we need to be really careful with the transversus abdominis thing, it's a big thing. We try to strengthen transversus abdominis a lot, but is that a consequence of back pain or a cause? And lastly, there's no procedure, there's no exercise, there's no one thing that is right for everybody, and this is why, again, those physical therapy studies fail, and most studies fail that try to look at one treatment for everybody. We need to take a multimodal approach and be open to what treatment's the best for the individual. So two quotes, and I'm done. I'm a big Seneca fan, and this is one of my favorite quotes, to live under constraint is misfortune, but there's no constraint to live under constraint.  The weak man is not as happy as that same man would be if he were strong. This reality is offensive to some people who would like the intellectual or spiritual to take precedence. It is instructive to see what happens to these very people as their squat strength goes up. So that's it for me, here's a couple of the studies I quoted, and that's it. So I don't even know if we have any time for, okay, any questions? If there's any questions we have time for one, and then we have about 10 minutes to get over for the closing remarks. Have you're dealt with someone who has a leaky gut and trying to strengthen, like what's the protocol, when to start strength training after their inflammation has calmed down? Yeah, well, that is such a complicated question. So, leaky gut is, I don't have the setup to really test for leaky gut, and from my understanding, leaky gut is such a, the way it presents is so varied as well. I probably have leaky gut for all I know. I mean, I had radiation, so I still do squats and deadlifts and everything like that, and it really depends on, I would say the way I would treat the patient is not so much do you have leaky gut or not, but what can you do when you start out? And of course I'd also have to fully work you up as a patient too, so it's not something that if this, then that, you have to look at the whole picture. I feel like I'm kind of circumventing your question, but it's a really complicated, why you asked is really complicated, yeah. All right guys, Matt Smith. Thank you. We have about 10 minutes until the closing remarks in the Wheeler Hall.