Dr. Joe Tatta: Dr. Tyna Moore is a board-certified naturopathic and chiropractic physician. She brings a unique perspective and expertise to the diagnosis and treatment of orthopedic conditions and specializes in the application of natural pain solutions and regenerative injection therapies to treat all varieties of musculoskeletal pain. Throughout her professional career. She has focused on pain and muscle-skeletal conditions and is uniquely qualified to diagnose and treat ailments using a variety of naturopathic, chiropractic, and nonsurgical treatments. Dr. Moore’s regenerative injection patients in her clinic in Portland, Oregon, as well as provides online health consulting to help people achieve their optimal level of wellness and strength, not to exceed a more. Welcome to the Healing Pain Summit. It’s great to have you on as the expert guest this year.
Dr. Moore: Thank you so much. I’m so excited to be here and to talk about a topic that I’m passionate about. So thank you for having me.
Dr. Joe Tatta: So when we, when people think of pain, the first thing I think of as inflammation, and they’re not necessarily wrong to think of that, but there are pros and cons, inflammation. So we want to give people a really good idea exactly what inflammation is and how it affects the body and how to treat it appropriately or naturally and, and you know, really to tackle it so they don’t live a life from pain. Um, let’s start with what is inflammation and why is it important for healing?
Dr. Moore: Okay, so inflammation is critical. I’m a big fan because I’m a regenerative injection therapist. So that’s sort of the premise of my work. Um, inflammation is basically the body’s way of responding to an insult. So let’s take an injury since we’re talking, let’s, let’s, let’s put this in terms of musculoskeletal. Somebody gets injured, they have an inflammatory cascade that ignites, that cascade lasts anywhere from 10 to 14 days. You know, the science is a little bit all over the place there, but 10 to 14 days, the inflammatory cascade occurs. You have about 300 plus days of healing when it comes to collagen healing. So say you sprained an ankle, you’re going to have almost a full year’s worth of that of your body going through a process to get that collagen nice and strong and healthy. Again, get those ligaments and tendons stabilized. The inflammatory cascade is the first part of that. If that’s cut off, each phase of inflammation and healing will not go to fruition. So it will get, the first thing we do is put ensades and ice on people and it cuts the healing cascade off and then the rest of the process doesn’t get to go as robustly as it should. So we need inflammation because it’s in a modulated fashion. It’s what heals us.
Dr. Joe Tatta: Right? So just, you know, really basic. If someone has inflammation in the joint, what types of things would they see, you know, in their body, in their joint?
Dr. Moore: So pain is pretty, um, you know, first and foremost, people may or may not have pain, but generally pain, swelling, Ruber or redness. So say erythema, you know, redness, swelling. Heat is another classic one. So when I assess a joint, like say a bad knee, I will assess the, the contralateral good joint to see what kind of shape the symptomatic one is in. So those, those are classically it and people will notice the pain. They may or may not notice the mild swelling, they may have robust swelling, kind of depends. But just like if you sprain an ankle, that first 24 hours of what happens, that is a robust inflammatory cascade.
Dr. Joe Tatta: And some people have those similar symptoms that they have an autoimmune flare up or they have an autoimmune disease that’s very similar. Correct.
Dr. Moore: Correct. And line. Right. So you can, you can ebb and flow. And I think as people become chronic, they will walk around with chronic low grade inflammation. And so that’s where we have a problem is when acute inflammation, meaning short term and initially is critical and wonderful. When that turns into a chronic situation, we basically have a fire in the body. And so I tell people, you’re, you’re sort of on fire and you’re like sitting in a crockpot basically on low heat all the time.
Dr. Joe Tatta: So I think the, you know, pharmaceutical world, if you will, has done a pretty good job at educating people as to what inflammation is. Uh, you know, when I think of my environments here in New York city, there’s, there’s a CVS or Rite aid or Duane read almost on every single corner. So we have a lot of over the counter drugs that are very accessible to people. Where, where, where and why should someone use a, you know, anti-inflammatory agent? What are they, you know, should I run to the store right away and take them if I have pain and inflammation?
Dr. Moore: That’s a great question. And I think that’s when people, I noticed for myself and everyone else that I’ve treated, when people have pain initially, their first reaction is fear and they want that pain to go away. So they run out to take something to make that pain stop. Um, there’s a couple of different types of over the counter medications. Do you mind if I just quickly breeze through what they are? My patients don’t tend to understand the differences and so I just want to make that clear. So first and foremost, the, so white Willow bark is where it all started, which is a wonderful herb. And white Willow bark was basically transformed an aspirin. Aspirin is an antiinflammatory medication. It works by inhibiting inflammatory pathways in the body, irreversibly cuts them off. So that’s one mechanism. The then was the advent in the 70s of a nonsteroidal anti inflammatory drugs, which we call ensades or insets, and that would be ibuprofen.
Dr. Moore: Um, you know, Aleve, those types of drugs. So those actually work by inhibiting the inflammatory cascades. And so they work in an anti inflammatory fashion as well. They inhibit the cascades, they’re not irreversible like aspirin. And then we’ve got Tylenol and people often confuse Tylenol with ibuprofen. So ibuprofen is a classic end state. Anti-inflammatory Tylenol is actually an analgesic, meaning it cuts pain. It has no anti-inflammatory mechanisms. It has its own set of risks, but it doesn’t actually function as an anti-inflammatory, just pain reliever. So those are the big differences. And so depending on a type of person’s pain, they might need something different, you know? So really having really understanding how they work helps people make a better choice, I think.
Dr. Joe Tatta: Yeah. So as a physician, when would you recommend, let’s say it over the counter and Sade, uh, versus a prescription? Or where’d you, and maybe we can talk a little bit about it.
Dr. Moore: I don’t, I tell people to take Tylenol if they need to. The real concern with Tylenol, I’ll just briefly go over it. Um, it’s pretty, it’s a pretty dangerous drug you’re actually finding in the last few years they’ve, they’ve lowered the dosage recommendation because it can cause spontaneous liver necrosis, which is basically your liver dissolves. And this is really exacerbated with um, using alcohol concurrently. So just so people really understand that 325 milligrams is the upper end dose of safety for IB or I’m sorry, Tylenol, acetaminophen and that is hard to find. Most of the time over the counter Tylenol is in 500 milligrams. So right there we have a problem. Um, anyway, I will tell them to take Tylenol if they need it. I usually give them some kind of herbal concoction involving white Willow bark, curcumin, a bio, a bioavailable form of curcumin. I’ve got a couple other tricks up my sleeve and I actually tell them to heat it and suck it up, keep it moving.
Dr. Moore: Honestly, at the end, if you ask my patients, I say those words, I’m like, you just got to suck it up and keep it moving. And I give them, I’m alternating hot and cold hydrotherapy. I’ll give them some options to keep the pain modulated. But it’s a last ditch effort. If we have to go to a nonsteroidal antiinflammatory, I never use a prescription strength ever. Um, I may use an over the counter and I’ll try to dose it low. But what I’ll do is I’ll use the herbs to my advantage and then I might add in a tiny little bit of ibuprofen. But if I’ve got a good arsenal over here, I just need a touch of it. Versus most people are taking hundreds and hundreds of milligrams several times a day and you know, are chronically in this Seesaw action with their inflammation. So,
Dr. Joe Tatta: so you have a lot of good, um, little things in there that I want to start to kind of pull apart a little bit. Okay. Um, the first is I guess, um, let’s start with just the heat and ice. Cause like eat an ice is always a big thing. Like, you know, when should you put heat on once you, when should you put ice on? Everyone thinks, well if you have inflammation, if it’s hot, let’s put ice on it,
Dr. Moore: right? Not be the best thing. Right? So there’s controversy for sure. And I think that, um, excuse me, my computer’s being a little funny. I think there’s good reason to have controversy. So ice when applied to an acute injury, meaning of a recent injury pretty much does the same thing as I do profane. It cuts off the healing cascade and I want the healing cascade for reasons I explained earlier. So ice in tiny doses might be applicable, but it’s really kind of, um, it’s kind of negating the efforts. I mean, you’re, you’re not going to get a good healing, robust response and good collagen deposition if you chronically ice something. And so what’s the first thing that young athletes do when they come off the field? They get wrapped in ice and ibuprofen are thrown down their throat and we wonder why they have chronic degenerative issues as adults.
Dr. Moore: You know, it’s, it’s like candy and they sugar or they enterically coat these uh, ensades with a nice, it’s red and it’s sweet. It has a sweet taste to it. So the brilliant drugs when you need them, but they really are reserved for, in my opinion, emergency only. Very rare use. I grew up on them, I grew up having them shoved down my throat, so I’m anyway, um, yeah, so heat on the other hand brings in an inflammatory cascade. You can use hot and cold. That’s what I like. I don’t necessarily like ice. I like three minutes hot, 30 seconds cold. I have a blog post about this that people can refer to. It’s very simple. We do that three rounds and what that does is it pumps nutrients in and it pumps the inflammatory chemicals out. It’s brilliant. It works really well. It’s an old school remedy and people really like it. It’s gentle. Feels good.
Dr. Joe Tatta: Yeah. It’s designed to basically designed to increase circulation to get the bad metabolites out and breathe some nice healing nutrients to the diarrhea.
Dr. Moore: Yup. And then you always end with cold. And what that does is it bays, Oh, constricts everything and shuts it out. So now you’ve just got a nice healthy region that’s had a good little pump basically of nutrients in exchange. And you’re good to go. You do that several times a day. It’s very effective.
Dr. Joe Tatta: So I think your stance of not using ensades is really interesting and people are gonna want to know, well, why can I not use an end state or an anti inflammatory Asian?
Dr. Moore: Why should I not use it? So for reasons I spoke of, which is you’re really, you know, biting yourself in the butt when you’re with your ultimate goal is to heal, right. And to have a nice healthy joint or region when you’re done. So you’ve completely nip that in the bud. But the other thing, not to get too biochemical, but there’s three inflammatory pathways, and I’m going to talk about Cox. What Cox is, is an enzyme. Cox basically is shut down by taking either aspirin or insights. And so while that seems great, because that pathway is leading to an inflammatory response, which ultimately leads to this pain and rubber and swelling and all of that jazz, it also has some good benefits. And so we need the Cox enzyme. The Cox enzyme, for instance, um, is integral in the mucosa of the lining of the stomach and the intestines.
Dr. Moore: So without that, we don’t have a healthy lining of our mucosa in our intestines. Um, it’s also critical and cardiovascular health and in blood vessel health. And, um, in kidney, I mean there’s all kinds of things that we need Cox force. So shutting it down, not a great idea. Certain substances that are helpful like fish oil, curcumin, those things, those actually modulate it. They don’t shut it off. There’s a third pathway that when, when these two are shut down, all of your record, Onic acid is shunted down the third pathway. And when that happens, guess what that does? That pathway leads to increased acid secretion in the stomach. So with Cox inhibition, we’ve just desegregated the lining of the stomach and now we increased acid secretion. So that leads to ulcers and tons of gastrointestinal issues. Gastrointestinal bleeding, they just put a black box warning on over the counter and say it’s last year the FDA did.
Dr. Moore: Nobody is talking about it, but it because of this gastrointestinal bleed risk and cardiovascular risk. The other thing that happens is you get more robust, um, um, responses in your cardiovascular system that aren’t entirely healthy if they’re not modulated. So by having everything go down this third pathway, cause these two have been shut off you, at least to a lot of real problems systemically in the body. And so we’re seeing massive deaths. I mean massive. I think it’s something like the last time I looked there was, I mean there’s tens and tens of thousands of deaths every year because of insane use that’s happened, that’s walking into the ER and nobody’s talking about it. Vioxx, that big whole fiasco and the early two thousands, they killed something like 38,000 people, I think. And they knew that it had cardiovascular risks and nobody wanted to talk about it. You know, we get all up in arms over terrorist attacks, killing hands of thousands, but like we’re talking a lot of deaths that were unnecessary and in the name of a pain relief. So
Dr. Joe Tatta: I think they really missed the ball as far as bikes goes because it’s a client, you know when you’re talking about ensades it’s a class of medication, their mechanism, they all work the same basically. So if one particular drug Vioxx is causing cardiovascular issues, which are heart attacks and strokes, then you have to start to say, okay, then the rest of them must have a similar effect. Let’s try to want people, let’s try to really figure this out as far as dosage goes for timing of it or actually take them off the market. Totally. But obviously they’re, you know, they sell very well for companies. Um, one of the kinds, you mentioned GI, you mentioned stomach, one of the kind of, you know, gut issues. Might you come across or GI, you know, stomach issues might’ve come across with the anti-inflammatory NSAIDs.
Dr. Moore: So stomach aches and bleeding and ulcers are the big ones, but something that you and I appreciate when it comes to pain as leaky gut. And so they’ve been shown to actually cause the same kind of damage in the small intestine, which leads to leaky gut, which is basically intestinal permeability, leaky gut, when, when it happens, it’s sort of the beginning of the end for people when it comes to autoimmune disease and chronic pain and chronic illness. So really doing everything we can in our power, not to have people go down that path of leaky gut, which is a, you know, personally I’m a naturepath, we focus on the gut. This is kind of a chronic issue for life for people. I have it many people I know how that most of my patients have it who have pain. So really trying to, um, not have that occur by chronic NCD use in early life would be an ideal thing.
Dr. Moore: And certainly people don’t need to walk into autoimmune disease. Um, I think something like 30 billion tablets are taken a year in the U S so we really do pop this stuff like candy and then you’ve got the cardiovascular risk. The thing with the Vioxx was that their whole selling the whole spiel was that it was less damaging on the gut so that their whole like, Oh, it’s great. It’s so much less damaging on the gut. There’s these GI bleeds in the, you know, it’s not as much of a concern. Oh, but by the way, there’s this huge cardiovascular risk and people are dropping dead of heart attacks and strokes. So that’s the other risk, right? Heart attacks and strokes. That’s also the black box warning. A black box warning on these over the counter and say it’s that people are popping like candy. I had a, my friends, my daughter’s friend told me that his, he knew of somebody, I think it was his aunt or something. She takes a full bottle, like Costco size bottle a week or chronic ankle pain.
Dr. Joe Tatta: Well, you see them at Costco, they’re big huge bottles that are sold in there. They’re quite cheap actually. They’re kind of a generic name, you know, Costco and seeds, whatever you’d like. You said they colored with a little bit of sugar. So it kind of gives you the sensation and the memory that this is, this is a good thing for me to take.
Dr. Moore: Right, right. And I think the big thing to think about with musculoskeletal pain, since that’s what we’re talking about, is that, so ice came across the study in the 90s that showed they took rabbits and they picked their knee cartilage, and then they gave the control group nothing. And then they gave the other group ensades and the N Sade group had significant and further degeneration of their cartilage, of the articular cartilage. So once it’s, and I don’t know if the ensades actually contribute to degeneration of healthy cartilage, but certainly damaged cartilage, which so many people are walking around with. So we know, we know it’s been shown in the studies. We know that it damages cartilage orthopedic docs won’t give it post fracture. We know it inhibits fracture healing. So we know it’s doing something to the osseous bony structures. But it certainly is. It inhibits proteoglycan synthesis, which is what you need to have cartilage regeneration and um, robustness. So basically your soft tissues don’t do well with it. It’s cytotoxic, it’s condor, toxic. We have studies to show this, so people are taking it for their arthritis when it is in fact making their arthritis worse. That’s the bottom line. Without getting too technical on it, it absolutely in equivocally is making their arthritis worse when they’re using it on the longterm for chronic issues.
Dr. Joe Tatta: W which is very important as our baby boomers age and there’s, you know, arthritis is going to start to get worse if they’re not taking care of themselves. So it’s a really important, important point. Um, regarding the liver toxicity, people think they’re safe if they’re not taking high doses of ibuprofen or, I’m sorry, high dose is a Tylenol, but as, as people know it, but what about ensades?
Dr. Moore: Well, I think just the whole fact of the matter. I mean I specifically to liver, I’m not entirely sure, but I know that it has such an effect on cardiovascular and on your um, endothelium and just how your blood vessels work and the liver is such a vascular area. So maybe you know, more specifically, I haven’t looked at any specific studies on it, but I know that it’s not, it’s not good news. And I heard of, you know, the thing about that too, that I always think about nature pathic Lee is the gallbladder, the pancreas and the intestines are all in the liver, all kinds of sisters. It’s like a sisterhood up in there, you know? And when, for instance, when somebody starts having gallbladder issues, we’ll treat their liver and their gut and their gallbladder issues will generally resolve. So I think of that as a sisterhood. When you start screwing around with one aspect, you’re kind of screwing around with the whole kitten caboodle. So even if we don’t have a direct correlation or literature to support it, not a good idea if you want that viscera to function correctly when you’re looking at how damaging it is to one part of that system. For sure.
Dr. Joe Tatta: I know in your practice you do some really interesting and innovative things around regeneration of, of joints and cartilage. Can you talk about that a little bit?
Dr. Moore: Sure. So I do prolotherapy and platelet rich plasma and then adipose derived STEM cell transplants. And so basically what I’m trying to do is take the ligament and tendon area, which has a poor vascular supply again, and sites are not great when we’re talking about screwing with vascular supply, poor vascular supply. Most of these ligaments and tendons have been compromised due to trauma or injury and subsequently people icing and inciting themselves initially. And so I inject substances in there that are natural and regenerative and so they actually bring the body back online to that area, create a modulated inflammatory response. So that’s where I like inflammation. I like it controlled, but I like it there and regenerates the tissue so it regenerates the, the collagen, the cartilage, the ligaments, the tendons. It just stabilizes the joint down and really takes care of that degenerative process.
Dr. Moore: It seems like with cartilage, once it starts going, it just keeps going. It’s almost like this downward spiral. It doesn’t hydrate as well. It doesn’t respond as well. And so once that path begins, it’s kind of a slippery slope down. Getting something nutritive and regenerative in there is awesome. However, doing everything in your power to not allow that slippery slope to occur in the first place is ideal. So not taking ensades, um, you know, lack of exercise, cartilage likes the chondracytes, the cells that your cartilage is made out of. It enjoys a certain load to thrive. It doesn’t enjoy too much of a load because that will crush them and kill them. And so when you think about our population at large, no pun intended, we’ve got an obesity epidemic on our hands. And so we’ve got people literally completely sedentary all day doing nothing to challenge that cartilage and to really stimulate it to do something. But we’ve also, when they do finally stand up and amble around, they’re crushing it and killing it. So anything that we can do in our power as entities, you know, just, we all are responsible for ourselves, you know, so exercise is anti-inflammatory, eating a clean diet. Some of these herbs I mentioned are actually nutritive and regenerative in their own rights. So not only are they modulating your inflammation, but they’re actually helping regenerate your joints. So for me, what I do in practice really is just kind of a whole regenerative medicine process.
Dr. Joe Tatta: Yeah. Which is great cause you’re a naturopath, so you have that, that kind of really integrated approach. Um, as far as the injections go, which joints have you had success or we know, what should people look for as far as, you know, should I have my spine checked out or does it work for my knee? Arthritis?
Dr. Moore: It works for pretty much every joint. Some joints are a little persnickety and they take a little bit more robust treatment or um, we gotta hit them more often, but wonderful. I think my favorite joints to treat better than most responsive are knees. And I’m not entirely sure why. Maybe they have a robust endogenous supply of STEM cells in there, but they do great shoulders do great. I mean these chronic shoulders that are taking people out of action and really ruining their lives, ankles, spines. Um, you can have a herniated disc on MRI. You also can have a lot of ligamentous laxity in the region that’s contributing or causing actually being the chief pain generator. So I always think it’s worth a try. If you can find someone in your area who’s good at this, it’s worth a try. Absolutely. Over surgery, any day. And nine times out of 10 people get some degree if not a significant degree of relief. So,
Dr. Joe Tatta: and would it be one injection or is it a series of injections?
Dr. Moore: It’s a series generally. So there’s different treatments. The weaker treatments require more prolotherapy is a little bit weaker obviously than play the rich plasma. That’s more often. So that’s about once a month for several rounds. But then we have platelet rich plasma now, which is great. I mean, I think since the early two thousands people have been using it in orthopedic medicine and it’s just, if you’re healthy, it’s only as good as yourself. So if you’re healthy and your micro environments healthy and you take that blood and concentrate it out, we can put that anywhere and we’ll get good results. So that’s usually, you know, two maybe three treatments max. I think if you’ve got a good practitioner, if anyone tells you you need five rounds and then they’ll reevaluate, I’d fire him. Personally, I think that a good practice, it’s my job to get my patient 90% better veteran two visits. That’s my, that’s my motto. So,
Dr. Joe Tatta: well, you mentioned the cells have to be healthy. So if someone is, let’s say obese and has, you know, very bad diabetes, is it as beneficial for them or do they need to maybe work on themselves a little bit first and then come back for the injection?
Dr. Moore: Absolutely. So those patients I generally tend to get on, you know, dietary lifestyle changes. I get them working with a PT to start moving and that alone just starts regenerative process is, you know, you know. So, um, yeah, ideally blood sugar is a, having elevated blood sugar is a big problem with inflammation and pain. You’re absolutely shooting yourself in the foot. If you’re walking around with high with, you know, um, erratic blood sugars I should say, and it wreaks havoc on your hormones. That’s just a train wreck. So know those patients don’t respond as well. Obese patients, I tend to, I actually closed my practice so I’m really only treating athletes at this point. So I tend to, I get in that maybe is one of the reasons I get good results. I don’t mean to, you know, I, I’m, I’m picking great patients that I know will respond well cause I certainly don’t want to waste somebody’s time.
Dr. Moore: However, I do think that there is a place for it. If somebody is just so in so much pain, they cannot get moving at all. They’ve got the obesity problem, they’re very sedentary because of it. I think maybe one or two rounds of these treatments is helpful, get them started, but then they really need to focus on doing the work themselves. Then we can come back and get a little more aggressive. So it really still comes down to a lot of personal responsibility. And I know pain is horrible. I’ve lived with it for 15 years. I’ve had chronic pain, but uh, and it gets worse before it gets better when you start, as you know, when you start moving a patient, they certainly will flare generally before they get better and they’ll start to lose hope. But it’s absolutely worth it to get with somebody who’s skilled and stay the course. Living with chronic pain is no way to live.
Dr. Joe Tatta: Excellent. So, you know what I really love about dr Tina Moore is that she’s got a great integrated approach between the regenerative injection therapies. If you want to check out more about that hard, and I did a great podcast so I can go to my podcast page and check out, um, some information about that. She talks about it really in depth for about 40 minutes, but if people want to learn more about your contact, you, how can they find you?
Dr. Moore: So my website’s easy. It’s dr tyna.com, D R T Y N A, and if you go there and sign up, there’s a great ebook and I’ll make that available. It’s just five reasons people aren’t losing weight. And I really tie it to pain. Honestly. It’s kind of the same thing to me. It’s all inflammation, right? Uh, there’s also a place just to sign up. I produce about two newsletters a week with just really, they’re not. So you make such great newsletters that are within space and I love it. You know, I tried to just, I’m throwing out like little nature pathic tips that I’ve learned along the way from my elders and so great stuff there. It’s fun. And the my, my group seems to enjoy it, so if they want to sign up there, they can do that as well. So D R T Y N a. I am on Instagram at that. I am on Facebook and I am on, um, I’m trying to get on Snapchat, but that’s just too confusing for me. I think that’s for the young people.
Dr. Joe Tatta: Well, everyone on the summit is going to help you out because they have an opportunity to share your video. So down below there are a couple of links. One is for Facebook, one is for Twitter, and I think there’s another one for Google plus. So please, if you like the video, and I’m sure you did because there’s some great information here, please share it out on Facebook, Twitter so we can help Dr. Tyna Moore spread her message, check her out on her website. I want to thank her for being on the Healing Pain Summit 2.0 this year and we’ll see you on the next video.