The Power of Listening: Compassion in Clinical Practice

[00:01:34] Mark Kargela: Welcome to the podcast, Keith,

[00:01:36] Keith Meldrum: Great, Mark. Thanks. It's good to see you again. Thanks for having me.

[00:01:39] Mark Kargela: we were talking this, you were one of the initial guests of the podcast. And I'd like to say since our first recording, our, the production value probably has bumped up a little bit. Technology's done it. And I've, I think that was again, single digits. And I think we're at visit or, uh, episode like one 58 or 59, somewhere in there with this.

So it's come a long way.

[00:01:57] Keith Meldrum: That's awesome.

[00:01:58] Mark Kargela: Thank you for, for joining us for episode two. And I've mentioned as I've kind of watched you online and I love to keep connected with patients because I think it's It's one thing that keeps us grounded as clinicians is the folks that have kind of are walking the walk and dealing with persistent pain and hearing their perspectives, um, and things like that, that really keeps us kind of focused because I, you and I think both agree that conferences often are woefully short on the patient perspective and really making sure that stays intact.

Before we get into more of that discussions, if you could just introduce yourself for maybe folks who haven't listened to that wonderful first episode that we had together, we'll, we'll [00:02:34] link it in the show notes so folks can go back and hear, hear your, your perspective that time. But if you can introduce yourself, I'd appreciate it for the audience.

[00:02:41] Keith Meldrum: Great. Yeah. Well, I appreciate it. Mark. And it's really great to be here again. And like I said, it's really cool to see how far things have come in and like you have been watching you as you, you've grown modern pain in the podcast. And so it's, it's really an honor to be here. So, um, I said, my name is Keith Meldrum.

I, uh, 1 of the many 40 plus million crazy Canadians. Uh, I live in, uh, in British Columbia in the southern part of the province, only about an hour and a half from the border with our friends to the South, the Okanagan Valley. So, um, so by day, I am, uh, I'm an engineer technologist, a vice president of a civil construction company, and that's what sort of keeps me busy throughout the day.

But like one of, uh, many people in Canada under the 8 million, I'm a person that lives with persistent pain. And that's from a. Really poor decision I made at 16. Get behind the wheel of a car after, uh, A little too much alcohol and not enough sleep, and I rolled my car down a [00:03:34] bank and caused myself lots of abdominal trauma, which led to many, many surgeries.

And then just, uh, since then a life with persistent pain and, um. After a number of years of not dealing with it well, and going through a medical system in the late 80s and the 90s that, um, we think it's challenging now for people that live with pain back then. It was pretty, um, pretty archaic. After a lot of challenges and having some opportunities presented to me to be able to.

See pain differently in my life with it. That's what kicked off my advocacy and, uh, in the last 13 or 14 years, I've decided that my job is to stand on a soapbox and beat a drum wherever I can for whoever will listen. So here's a perfect opportunity to be on that soapbox. I appreciate it.

[00:04:23] Mark Kargela: happy to do so. I, cause folks can listen to our first episode, which again, we'll, we'll link in the show notes, but I want to just reflect back to, to kind of that big epiphany moment, [00:04:34] I think, or that big kind of turning point for you in your kind of journey with it.

Cause you had, as you mentioned, really dealt with a healthcare system that was very poorly managing pain. If, if you even say that we're managing it well at all, um, where there was just a lot of skepticism, folks challenging people's moral integrity. I know if our friend Gillette has went through some of the similar stuff with her work compensation journey. Can you kind of talk a little bit about that encounter? Kind of how you were going into it as far as, you know, what had kind of built up to where you were, I think you had mentioned being kind of an angry, really frustrated under which a lot of folks who've gone through that type of journey would be, um, and how that kind of interaction and, and kind of encounter really maybe shifted your kind of approach going forward from that.

[00:05:17] Keith Meldrum: Yeah, no, I appreciate that. Um, but, yeah, so from 86 to 2004, where I kind of had that, that moment, um, it, it really was a struggle. And part of that, I mean, you're, you're young, you know, it was 16, so you're not even, you're still a developing person, [00:05:34] but I had this terrible car accident, just about killed me.

Um, and, you know, that's a lot to deal with at that age and knowing that, you know, I did it to myself and there's all this psychology that goes with it, but nobody ever. Dealt with any of the psychological side. It was all very mechanical. I had damage. They took things out, put things in. I had lots of surgeries, but I still had this pain.

And in early on, I was about 19. I had my family doctor tell me, um, and I mean, I'm getting old 54 now, but I remember I was 18 or 19 and I was in his office and he just looked at me and he said, everything that can be fixed has been fixed. And this is all in your head. So this starts this path of like, what is wrong with me and how crazy must I be?

And why am I making this up? And that didn't add to the challenges in health, my healthcare, then interface with the healthcare system where you're like, geez, I got pain and you're told. What do you want me to do about it? There's nothing I can do. It can't be that bad. Um, you're just [00:06:34] drug seeking, you know, you have all these painful visits because when you're at this crisis moment, you got nothing left in your tank because you don't know how to deal with it.

And all, you know, is I'm hurt, so I have to go to a doctor. So you go to an E. R. which are just like terribly dismissive dehumanizing experiences. And, I mean, I did receive treatments in that. I mean, I tried every needle intervention or anything they could do to me, but it was often just very mechanical from the clinicians.

They're like, yeah, I can stick a needle in you. Oh, it didn't work. So there's nothing. And they would say, there's nothing more I can do for you. And then they just, that's it. So, You're fighting through all of that. And then in the back of my head is my family doctor telling me it's all in my head. And I'm like, Oh, like, I'm really screwed up.

Um, and after another set of needle interventions, they're doing, um, pair of vertebral nerve blocks. And one of them went a little deep and gave me a partial pneumothorax and that doctor is like, okay, like this, you know, there's the risk and it happened. So we should probably stop. He was the 1st 1 who [00:07:34] said. It wasn't without compassion, but he was like, you might wanna try and look at this thing called spinal cord, um, stimulation. It may or may not work. And I was, at this point, I would've taken anything like I was gonna jump at whatever they offered. Long story short, the referral happens. I get sent to the clinic and it's not in my hometown, it's in a, in a major center in British Columbia.

So down I go and I'm doing the intake and I'm sitting there in the doctor's office or in the clinic's office and they're taking your history and I'm reciting it for literally. The third year 40th time, because every time you talk to a doctor or something, you got to recite your history and I'm just, I'm not even looking at him.

I am like, yeah, I'm looking this way and he's sitting off here and he's asking this and asking that. And he's writing away and out of the corner of my eye. I see that he stopped writing. He's put his pen down and I'm like, oh, you know, here we go again. He's going to tell me it's not that bad. And like, whatever.

In that moment, I had just all [00:08:34] of these thoughts of. Here they're going to go and they're just going to throw me out again. So I looked at him, just resigned. I'm like, okay. And he just looked at me. Uh, his name is Dr. David Hunt. And he just looked at me with absolute clear compassion and empathy. And he just said, it's okay.

We believe you. And I was just, I was stunned because up to that point I had doctors say, yeah, I can stick a needle in you, but nobody ever actually said anything. It's real. Or it's that bad. Um, and in that, it's okay. We believe you moment. That was the most important things that any health care provider can provide to a person that lives with pain is validation. Because most people, when you live with this, you do think. Maybe I am crazy, what's wrong with me? What's wrong with my body? It's a really challenging thing and so when somebody who's in this position of authority. Called the doctor says, we believe you. Hey. It can change your [00:09:34] path and that's what it did for me.

It didn't happen overnight. I didn't jump up and go and better, uh, but I was going down a path of anger and fighting and not living my, I was living an okay life because thankfully I had support. But not a great life, and that gave me the opportunity to shift that perspective.

[00:09:53] Mark Kargela: Yeah, just a huge amount of invalidation and finally reaching a healthcare professional who kind of. Could just, like you said, step back, validate what you've gone through and how powerful that can be for patients. You've now done a lot with interfacing with healthcare professionals in a lot of your advocacy work and in what you're doing, which I think is amazing.

You've probably had some great conversations I can imagine, and I'd love to hear your perspective on where you think that invalidation comes from. As far as like, I don't think. People wake up trying to be invalidating or under, or really consider the, what, how those words land with people and how [00:10:34] their behaviors and how their actions land with somebody who's gone on a journey like yourself.

I'm wondering based on your experience with all these different healthcare professionals and being able to come full circle with everything, where do you think that challenge for the validation comes from when it comes to healthcare professionals?

[00:10:50] Keith Meldrum: I love that question, Mark, because I agree with you. I don't think most. People who get into the healthcare profession get into it to to be invalidating. They do it every whether you're a doctor. Nurse, physical therapist, occupational there, whatever you do it, because, um, there's a, I believe this underlying.

Feeling of wanting to help people and and and get people better and I think. A lot of it comes from, we have a system of healthcare that's both the systemic. Healthcare system and then the education system that feeds people into health care. Which is still, still too focused on a healer mentality. And, and don't get me wrong.

I mean, when I'm [00:11:34] sick and I have an illness, I want to be healed. But unfortunately, these bodies are terribly complex. And sometimes, uh, there is no panacea and there's no way to, to actually fix it. But, but healthcare is still founded in, in that fix it mentality. And I think a lot of people get into healthcare.

And they're like, I am here to help people and I'm going to make them better. And then over the years, I think it can be a bit of a grind. It can beat people down. And then when you see people that live with a long term illness, like pain, I can only imagine how difficult that is as a health care provider, because you often get.

a lot from these people because you're not, you're not just getting the pain that they live with. You're getting their life and their social issues and their psychological issues that are emotional and it's a big dump on them. And I think part of it is just this self protection of like, I can't get into all of that.

And if I can't fix you, then, then I can't fix you in any way. And I think that it's some of it as a little bit of self preservation. Otherwise, you'll [00:12:34] wear every single person's illness. And, um, I don't know how you go to work the next day. So, I, I don't, I agree with you. I don't think most people would wake up and go to their medical school and their PT school and say, I'm going to dismiss people for their illness.

They go into it because they want to help people and then they get into it, realize this is complex and these people have so many issues and I don't. Know how to address it because I've been taught how to fix it biomechanically and while, you know, biomechanically and all pain is biomedical, there's so much more to it.

And if we allow those that are in these professions to better understand that and address those issues is equally, if not more sometimes, and just the biomedical, um, I think that would be less frustrating and challenging for them.

[00:13:24] Mark Kargela: Agreed. It's, it's tough when, and it's, it's in a university setting. I'm always trying to dance a line because as an educator and [00:13:34] somebody who works with, you know, students in the physical therapy professions trying to come up, it's, it's, we're, we're trying to train these students to pass a board exam. So it's hard to, Quantify emotions and

[00:13:46] Keith Meldrum: Yes.

[00:13:46] Mark Kargela: pyschosocial components into a nice ABC or D on a scantron sheet.

So I can just can put a rubber stamp on you as a clinician that you are safe to go out there and navigate the clinical world, which again, I think comes back to mentorship and find connecting with clinicians early in your career that can help guide you as you're, cause it's a tough thing. You mentioned a lot of this fix it mentality and healer mentality.

It is a tough thing when you come into the clinic with that, and it depends on your setting, you know, especially if you're going to see, if it's an average community setting where you're seeing the gamut of things, you're definitely going to see. Folks that are navigating the health care system and struggling to navigate it were because of the issues that you discuss as you face some of this, those challenges in your, in your journey.

I'm, I'm wondering, you [00:14:34] mentioned having clinicians not wear it, uh, cause I totally agree. There is something to compassion, fatigue and burnout and these different things in your discussions with folks and in your experience. What do you think is kind of the key to kind of that balance of like. Being able to show empathy and validate these experiences and often, again, coming, having patients come to you with very difficult stories that have some things that, you know, pull at your heartstrings as a clinician where we're trying to kind of, you know, just hold it together as we're hearing just, you know, some horrible situations that people have gone through.

Is there anything you would recommend or maybe anything, advice you've heard along the way to kind of balance that for, for clinicians?

[00:15:16] Keith Meldrum: Unfortunately, not really. Cause that is such a real problem. And I mean, in a perfect world, we would, uh, sort of tear down the healthcare systems that we have in North America and we would rebuild them so that they are truly interdisciplinary and that every clinician has the, the, um, supports that they need so [00:15:34] that, you know, as a PT, when you're dealing with somebody who is carrying not only their, their Their physical pain, but all of the emotions psychology goes with it.

You actually have the ability to connect them quickly and efficiently with the right people. That unfortunately doesn't happen very often. Um, I think the best that I can offer is I do. I do believe that as clinicians. I mean, we're all human beings. You need to find that bit of protection. Um, so you can't go all in.

You can't go all in and be there. You can't be their emotional savior and their physical savior, but, you know, just, just listening and, and hearing people and saying, you know, I think even things like, you know, I'm sorry that happened or that must really be hard. I don't sometimes people are looking for somebody to solve all their problems.

I get it. I was, but often people are just looking to actually be heard. And in that setting, if that's the one time that, you know, you mark as a clinician, you actually. Hear somebody say, and that's a lot to [00:16:34] hear, but if you don't hold it is like, I need to fix it. But if I can just say, I hear you, and that must be really hard.

And I'm sorry, it happened that sometimes can be so important to people. They're like, it's the David hunt for me. It's like, somebody actually heard me, like, they actually heard what I said. And sometimes I can give them a little more space and time to find things that they can do for themselves as well.

Because as people that live with these long term conditions, we. We do need to get to a place where we can start to help ourselves as well, because if we keep looking outwardly, that's not going to be a, a long term solution.

[00:17:09] Mark Kargela: Yeah, the system doesn't really equip our clinicians with the ability to have that support, um, to, to either have that multisystem support, but I'd argue too, like, clinicians need to be able to chat and talk about what they're hearing and experiencing with somebody from a mental health perspective. I mean, I've had my periods where, Some of the stories weighed quite heavily upon me and I felt like it was just a lot to bear and just, you know, [00:17:34] I'm fortunate we have a kind of interdisciplinary setting at our university and just kind of being able to bounce thoughts and ideas and some of these struggles off of some of our psychology colleagues has been huge for me just to be able to not feel like you have to shoulder all that, that challenge and burden of like some of these very challenging and, and, you know, some of my heartbreaking stories that some of our patients bring to us each time.

[00:17:56] Keith Meldrum: Mm hmm.

[00:17:56] Mark Kargela: Um, I'm wondering with, uh, you know, some of the patient perspective, you obviously bring an amazing perspective having gone through it and some of the significant challenges that folks navigate with it. If we're having some patients listening to us right now, which we often do some patients who tune in and podcast.

What would you say are some of the key things, because everybody's at different parts in their journey and I, I'd love to, there was a period of like pain neuroscience education, man, I am going to teach people about pain and they're going to make a complete 180 and man, it's going to be, and granted there are those epiphany moments where, [00:18:34] where people just make a massive shift and like this aha of like, oh my gosh, there is a different way to kind of go about it.

What do you think are some of the key parts of somebody's journey that as a patient who's kind of maybe navigating this struggle? Um, you know, key steps are key parts of the journey for, for someone who's trying to get to the other side and start doing things like you are, where you're living well with pain versus this constant struggle of like, I need to eradicate it, fix it, remove it from my life so I can then move on with life.

What are, what have you found or what would you recommend to some people who are listening?

[00:19:05] Keith Meldrum: I think there is, there is one, there is an absolute building block to that and it's tough to get there sometimes. So as we talked about, you know, sort of my experience, and I've heard this from so many others, this lead up to To that point, and not everybody gets to this point. So, I mean, everybody has different issues and supports in their lives.

But as you go through that fighting and, you know, we talk about fix it mentality from healthcare, well, there's also the person who lives with pain. Like they [00:19:34] just haven't tried hard enough. I haven't had the right surgery. I haven't had the right needle intervention. So you continue to look for that. Um, the, the, the turning point that building block is when we come to this point of, and I'm not going to use the word acceptance because that can be such a challenging word.

But willingness, and I use that term because I got that from my lovely friend, uh, Bronnie Lennox Thompson there at a New Zealand when we're talking about this years ago, she said, acceptance can be just such a harsh and word, and it can feel like. People are being told there's nothing more we can do, and it's all on you.

And that's true. So willingness and by willingness, we mean. You have this, I'm going to really simplify this, but you have this moment where you sort of take a step back, you sit down and you go. And this is kind of, in a way, what I did everything that I've been doing up to this point, thinking I was doing it the right way, which was by fighting it and pushing it and making terrible decisions like life decisions, taking on careers to show the world how tough I was and just creating more pain as much as I thought that was the right thing.

It was the wrong [00:20:34] thing. So I needed that space. David Hunt gave me that to take a step back and say, I think I'm doing it wrong. So what am I willing to do? And what am I able to do to look at this a little differently? To try and live better with this because I had to come to the point and say this pain might actually be with me for the rest of my life because I was stuck.

I used to have this thought a lot. I broke my collar. I broke a lot of bones when I was a kid because I was stupid. I broke my collarbone when I was 12 on a really dumb bike accident. I broke my collarbone. I was fine until I walked my bike home until I saw my mom. My mom looked at me. She said, Oh, my God, what happened?

Then I cried. Let's talk about the psychology behind that. Right. It didn't hurt until I saw my mom, but I broke my collarbone. The whole, uh, I had pain, the collarbone healed and the pain went away. So for my car accident, I'm like, why isn't it going away? Like it did when I broke my collarbone. Sometimes it doesn't.

And I struggled with the fact that it would never go away. And when I was willing to understand that it [00:21:34] might not, that gave me an opportunity to say, okay, what am I able to do to try and help myself live better with it? That turning point is founded on having a moment of validation from somebody it's, I don't, can some people get there without that validation moment?

I haven't met him yet. Um, so the 2 kind of go hand in hand. So if somebody can validate somebody's pain that can give them that opportunity to say, maybe there is something I can do to look at this differently and start to help myself because we do. We do have a role to play in this. And that's why I'm a big fan of the term supported self management, because it's between healthcare and the person to come together and say, let's do the best we can to help you learn to live with this.

[00:22:23] Mark Kargela: You have had also some great experiences with brawny, uh, Lennox Thompson. She's a mentor of mine as well. And that acceptance piece is key, like the, the, this willingness. And I like the way [00:22:34] she's kind of rephrased the willingness. Cause I think acceptance gets unfortunately portrayed as like, you just got to suck it up and deal with it.

This is you going forward versus. Hey, are we willing to maybe have pain with us the rest of the life, but yet still pursue things that give us meaning that give us joy, that give us happiness versus I can't do any of that stuff until somebody removes this pain from my life. Do you think that there's a degree of a struggle that we all have to get through before we're ready to kind of face that?

Cause I do think culturally, and especially with our healthcare systems, We position it of like, what's your 10, zero to 10. We bombard you with that dang number where like your measure of success is where that dang zero to 10 is at all times with people yet, I think shelf in that worry about that number is, is probably the, the key to, to moving forward for a lot of people. Uh, I'm wondering, do you feel like it's possible with the right, maybe clinician early on where you might've been able to make that shift earlier in your [00:23:34] journey, or do you think there was a degree where you had to kind of see that This fight and eradication pursuit of getting to that zero to 10 before I can be successful and move on.

Did you feel like you needed to go through that struggle? Or do you think that if a well armed clinician who understands this stuff and maybe can recognize that, Hey, maybe Keith's got something that's probably going to be a lifelong thing that we need to help him manage and live well with versus don't live until it's gone.

What do you think about that?

[00:24:03] Keith Meldrum: Yeah, I, again, it's a great questions Mark. So, uh, I, it's a bit of a cop out, but, uh, it's, you know, it's, it's person dependent. Um, in, in, and I offer that because in my case, I think there was a little bit of me that did have to go through that. I think part of that was, I was just, I was young when it happened and I carried so much emotional baggage.

I didn't realize it till I was older. I didn't realize how much of this emotional baggage I carried that I did this to myself. Therefore, it's my responsibility to fight through it. Um, because accepting it to me [00:24:34] was like, giving up and I, I had a lot of sort of baggage that I carry with me because when I had my car accident, I did nearly die and I was lying on the ground outside my car. I don't remember a whole lot, but I do remember giving up, like, I was just like, I'm done. Like, I'm ready to die. I just, it hurts so much. I'm done. And then after I got out of the ICU and I got home, I'm like, you big wimp, you gave up. Like, these are these thoughts that go into your head and then frame how you look at things going on.

So I had this fight mentality and I had one of the surgeons, the surgeon who put me back together initially, about five years later, after I was in his office going, it still hurts. He's like, I can't do surgery on it anymore. I'm probably going to make it worse, which I was like, you can't make it worse.

Like, you know, you're going to cut me open. I'll be fine. Well, we know how wrong that is. And he said to me, you're probably going to live this with this pain for the rest of your life. And I'm like, that's just not possible. Like you just make pain go away. So for me, because a lot of the other things going on in my life, I think I [00:25:34] needed to fight through that.

I think that fight could have been lessened, uh, because after my car accident, 16 years old, nearly died. I got lots of good trauma care. I mean, the ambulance showed up, they kept me alive. I went to the hospital. I had surgery that lasted seven or eight hours. They placed me back together. I was in the ICU for two weeks.

Not once did anybody ever come along and say, I was pretty traumatic. How are you feeling? Mentally? It was all like, I mean, I had colostomies put in and taken out mesh, put it like very medical, but nobody ever said, Jesus, you almost died. How does that make you feel? I think if we can catch some of that kind of trauma earlier, people can get to that place of willingness a little sooner.

I do believe that you don't have to go through a long road of fighting it, but it does require an earlier intervention into that.

[00:26:25] Mark Kargela: It seems healthcare is just so full of people that are ready to step next in line to be that person to, to, to join the battle with this patient. We're going to fight. We're going to, [00:26:34] we're going to get rid of it. And again, I think it's motivated, as we've mentioned, through good things. It's, we want to help and we want to help.

But I think it's, hard when we're not trained to recognize when it's time to live well with versus fight till we're living without it. Um, and it's, I think we got to do better as, as healthcare educators to help clinicians. And one of my mentors and, and folks that I really look up to, Jason Silver, really Pushed this, like we have to put the pressure of the elk, take the pressure of this outcome off of us.

Like, you know, there's things in our patients worlds that despite our best efforts and investing as much of our energy as we can possibly into the situation, there's sometimes things that just influence. encounter that we can't control and that if we put that pressure on us, that's going to be a very quick path to, to burnout.

And I think I've mentioned on this podcast a few times where I've kind of nearly said, I just can't do this anymore. Partly probably due to some of the compassion fatigue. Partly due to just, I just feel like I had no way to help do this [00:27:34] fixing that I was, you know, feeling that I had to just do something.

I had to learn something more to be able to handle a Keith there. There's something that I'm missing that, that I, if I found it, I would be able to fix Keith and, and feel like one I'm adequate as a clinician because it kind of gives us this, this burnout and this feeling of like, I'm an imposter in my profession because I got these people that are coming through my doors that, that just aren't responding.

And, um, And I just see patients, you know, day after day who are lining up with clinicians. I had a patient recently, uh, where she was on her 14th pain physician and asking me, did I know any more of pain physicians? And it's, it's tough. And we tried to have a very compassion, empathetic discussion of like, man, you've tried that 14 times and how has it worked?

Has it got you closer to life? You want to live? Do you feel like 15 is going to be the answer? Or maybe would you be willing to try a different approach with it? And that. you know, it was a, I would, I'd love to say it was an epiphany moment. She has moved since [00:28:34] to a little bit more recognition of that, but that's, that's a tough journey for folks to make, especially when, you know, healthcare keeps punting the football around to the next ologist and specialists who, to, to keep them on that pursuit.

And I think it's, it's lovely when we have pain docs, like the gentleman that you encountered that really. Um, you know, understood that, Hey, it's time to maybe look a little bit differently at it and one validate what you've gone through and then, and put you on a different path. Um, what are your thoughts on, we've already talked a little bit about some of these mechanisms and protection, uh, for clinicians, but

[00:29:11] Keith Meldrum: Mm-Hmm.

[00:29:12] Mark Kargela: what, and I love what you talked about too, with the, if we could interject and just understand a person's psychosocial existence around an acute injury.

You nearly died. This had to be a heck of a lot traumatic for you. How you, how you handling that? Do you feel like there's resources out there to help clinicians? Are there any resources you're aware of with some of the amazing [00:29:34] advocacy work you do to help clinicians? Um, kind of better be able to integrate these type of, um, you know, thought processes earlier in their career.

What, what have you seen out there that's been something that you feel like, hey, that's, that's something I think if clinicians could engage in might help them get into this ability to help somebody on their journey versus help them in their battle that unfortunately may not be one if it's just about getting rid of pain.

Uh, what, what have you seen?

[00:30:01] Keith Meldrum: Unfortunately, I see a huge gap there, and I can only speak from the Canadian medical system. And, um, I, I, and I, you know, I don't live in the clinician side, so I don't know what, um, sort of supports and resources they have, but, uh, from the outside looking in, I constantly see the same thing over and over again.

There's that big gap. Um, clinicians are still going through the similar types of of training and education in their system and many like yourself go through this sort of this growth and they get to this point where, like, maybe not [00:30:34] everything I was taught in my school was really the right thing.

Because what I'm seeing in the real world doesn't align with this, but I'm not aware. Not aware of anything they have available to them. Now, they, like you say, you know, you're fortunate you have colleagues that you can go to, but I think it's most, I see it as mostly ad hoc, or they have to sort of go out on their own and find it. I think that's 1 of our biggest gaps. And 1 of the things that I'm fortunate to just starting to be working on, and we'll see if it goes anywhere is here in British Columbia, working with a provincial organization. It's part of our provincial health care system to get in there and understand what health care education is in their curricula.

So it's medical school, nursing, PT, all of that, and, and, and talk to those universities and start to say, that's great. Here's all because they do teach like a medical school. They do teach pain. But it's very, um, disease specific. They talk about people who have cancer pain and people who have these other types of pain, which is really important, [00:31:34] but there is no education about people who just live with long term pain.

And here are the things that you can do. If we teach you these things, you can bring those to your practice immediately. And I'm kind of stuck right now on this. If we get in early. And so to integrate that education into healthcare provider education, they'll have that knowledge and understanding. And I'm hoping that can start to be a bit of a building block on how we change because I think it has to be really, really tough to get into this profession, realize that it isn't everything that you were taught in school.

It doesn't go in. This person open and put this in or do, you know, 10 sets of this 3 time and somebody will be better. Like, Jesus, that doesn't really work all the time. Sometimes it does. And I'm, I'm absolutely not anti, um, interventions or manual therapy 100 percent time in a place. But when it's not the answer, I think too often clinicians are stuck with.

Well, I, I just don't know what to do. [00:32:34] And, uh, I think if we gave them the right tools, which is education and understanding early on. I'm hoping that could help change that trajectory, both for the clinician, so that they feel like they're doing something and for the person.

[00:32:47] Mark Kargela: Agreed. There's a woeful lack of preparation in the graduate, you know, as people are kind of coming up in their professional education to, I just, for me, I felt like it was just like, I had these expectations of what I was going to experience when I went on. I think to a degree, I think we see this in our clinical rotations, but oftentimes I witnessed clinicians, again, great people who are trying to battle that, that feeling of inadequacy and not being a help.

And oftentimes it was casting the blame and pushing it back on the patient of. The malingerer, the symptom modifier, magnifier, or the whatever, when it was an us issue and it was us, that's our defense mechanism, like you said, to kind of just, I don't know what to do. I don't feel adequate. I feel like an imposter.

So it's gotta be a you issue. I can't face the fact that I'm not prepared for it. So, uh, [00:33:34] love your thoughts on that. I want to make sure we touch upon a topic that I think is one that's better understood, being better understood. I won't say, I mean, obviously science continues to, to roll forward and we, month, it feels like I'm having to update my thoughts on various topics, but, uh, mitochondrial disease.

It's something that obviously you have a personal experience with, and one that I think is an important one for us as clinicians to, to recognize, because it brings some unique variables to the equation and has been, I think something as we've understood it, something that's kind of, you know, opened up a better understanding of why maybe some people are predisposed.

To developing chronic pain. Cause I know that can tend to be something, somebody who has mitochondrial disease, could you kind of discuss a little bit, obviously you have the firsthand experience with it, but I'd love if you could kind of unpack, you don't have to give me a PhD, you know, dissertation level thing.

Cause I wouldn't be able to give

[00:34:25] Keith Meldrum: Thank God, because I don't have it. Yeah.

[00:34:27] Mark Kargela: but I think honestly, I think hearing it from somebody who's got that more patient language, patient view, uh, things would be [00:34:34] helpful for the audience. I'm wondering if you could kind of go a little bit into, you know, Mitochondrial disease and then we'll definitely talk about some of your work on it.

[00:34:41] Keith Meldrum: Yeah. Although I appreciate that. And, uh, uh, it's, uh, you know, I appreciate the opportunity to talk about it. I, I, I wish I didn't have the opportunity to talk about it because it's, uh, didn't see this one on my bingo card. But, um, so I, I was definitively diagnosed in the summer of 2021 after, uh, what turns out to be a very, very short diagnostic odyssey of 2 years, because it's typically, um, anywhere from 5 to 7 years to figure it out.

Cause it's this very strange thing and it's not well understood. Um, so I was diagnosed in what led up to the diagnosis, I was starting, I was having these different symptoms and challenges, but because I live with chronic or persistent pain, I kept rationalizing a bunch of stuff away to that, um, and balance issues and just more pain in my body.

And, um, anyway, so we get to a diagnosis because they start to realize, no, there's something [00:35:34] going on and they say. And I have the, the gold standard, um, diagnosis that they do a large muscle biopsy and they go, yep, you have meldrum, you have large scale mitochondrial DNA deletion. And I went, what the hell is mitochondria?

So I look it up and I read it and I go to the science papers and I read all that. And I'm like, Oh, interesting. The mitochondria is this terribly important organelle that converts the simple in the simplest terms. It takes the food that we eat. And it converts it to the energy our body need ATP, um, for a muscle health and for and mitochondrial disease.

It's actually mitochondrial myopathy. It's considered a number of different type of diseases that fall into this. I have a specific 1, um, but what happens and in my cases, because they don't have enough of my mitochondria, um, it causes. Basically muscle atrophy breakdown. Um, the muscle protein sort of goes away.[00:36:34]

Um, and with it, so that leads to weakness. And in my case, balance issues, vision issues, swallowing issues, eating issues, walking, lifting, like, it's just, um, but all of it, you know, on top of all of it is like, oh, my God, I have pain in my arms and my legs and throughout my body. And that's, they think that's just part of, um, and it's, it's one of the top three reported symptoms with mitochondria diseases, pain.

Um, 60 percent of people reported, and they think it's just because of the muscle breaking down. Um, so a lot of this pain that I was having in my body and my balance issues that I thought was from my pain turns out that it was, um, due due to this mitochondrial disease, but it's, it's not, um, it's, they call it a rare disease, but they don't really know.

Um, they're starting to learn and they think that it affects, uh, more people than they realize because the mitochondria is so terribly important, um, to your health. Um, [00:37:34] but the biggest thing for me was to realize that it, it presents these other, um, really strange, bizarre symptoms that I have trouble swallowing.

I balance issues. I fell in my driveway 1 to crack my head on the concrete driveway, gave myself a concussion. Like, oh, this is going to be a fun life. Um, just, uh, you know, walking issues. Movement, all of that, um, but it's the pain and I'm like. Uh, now that I kind of understand what it is, and there's no cure, there's no cure and there's no medication.

There's not, you, there's, they put it right out there. There's not a needle they can stick in, or a pill you can take. They just don't know. So it's all about having to learn how to live with it and manage it the best way you can. So I'm fortunate, after a life of learning, of living with persistent pain, I just shifted my focus and said, well, I need to do the same thing now with mitochondrion disease.

Because I, I'm not going to fight it like I did the first time, because that sure didn't work. So I'm going to learn it. I'm going to own it and I'm going to do the best I can to live with it. But, um, I think there's people [00:38:34] walking around in this world that, that live with a mitochondrial myopathy and just don't know it.

Cause it's so hard to pin down and understand. I think it

[00:38:44] Mark Kargela: mentioned some of your early thoughts with this to be just chalking it up to your chronic pain situation. I'm wondering with that experience in mind, do you feel like it's harder for somebody who's dealt with that going into healthcare system? where they're a chronic pain sufferer, or a person with chronic pain, I shouldn't say suffering because that's not, people aren't necessarily suffering if they're living well, they can be having a fruitful, fruitful life with.

Um, but with that said, do you feel like it's a challenge sometimes for, Folks who are dealing with a persistent pain condition to get a diagnostic, you know, kind of consultation with a healthcare system without them immediately wanting to pin it towards, well, this is just your persistent pain. This is just your chronic pain issue.

Did you get any sense of that? You, it seemed like you got a sense of it with yourself. It's like, that was just the [00:39:34] understandable Well, I deal with this. This must just be part of the gig of my persistent pain thing. Do you feel like there's any of that that you've, maybe that you experienced or maybe that you see out there with, with healthcare?

[00:39:43] Keith Meldrum: um, in, in my case, I was. Fortunate in that I didn't experience that because the lead up to it was just me and I realized going back, um, so the first symptoms that really, um, struck me occurred in 2019, but the lead up to that, I realized I just kept pushing it off. It's going like, oh, it's just your pain.

I'm like, you're not, you're, you know, you got to manage your stress and you got to up your self management and all of this. Um, but because I had such a, um, dramatic symptom that happened and it was the very first system that I had was double vision while driving. I was coming back. I had my parents in the car were coming back from an uncle's, um, memorial service and mom's asleep in the back and dad's sitting there and I'm driving and all of a sudden the highway just doubled on me.

Just I didn't know what lane I was in. I, and I closed [00:40:34] one eye and everything came back into perspective, opened my eyes, everything doubled. And I'm like, well, that's not good. That's not good. So, um, so that was the 1st thing that led me to go and talk to my optometrist and that's there to hold the diagnostic odyssey.

I was very fortunate throughout that. And nobody, they're like, oh, you have chronic pain, whatever. That's that doesn't affect us having said that, I think often that can happen because people who live, especially with, you know. Nonspecific pain, you know, my chronic pain is neuropathic left abdominal pain due to the trauma from a car accident.

So you can always say that's what caused it. The majority of people who live with things like lower back pain, they're like, you know, we, you know, you can talk about imaging. It shows something. It doesn't matter. It doesn't matter. People have pain. So, in the absence of something pathological to pin it on.

I healthcare can often say, oh, you have another pain. That's just your body because they just don't know.

[00:41:32] Mark Kargela: Yeah, having experienced, you [00:41:34] know, I deal with some anxiety that I have to work on myself. My wife does as well, and she had a health care where thankfully she had a mild stroke. You know, was able to recuperate fully, thankfully, from it. I remember sitting bedside with her, you know, we're very worried, distressed.

She's, you know, weak on one side of her body and it was just a scary time as it would be for anybody. And I, I was so mad and so frustrated because the first things that were kind of portrayed to her when she was in, well, this could just be your anxiety going on when she, when she's getting worked up and diagnosed with this thing, I get the, the maybe mentioning and passing or with a validating narrative on the front end and then say, Hey, but we need to be mindful that maybe.

This could be and she wasn't going through any major stressors at the time. So it, it just strikes me as like, sometimes I think folks see like depression, anxiety, or maybe a persistent pain thing on there. And it's so easy for people to be kind of invalidated and pushed off into, well, that's just that.

And thankfully, and we had to advocate quite a [00:42:34] bit to get her to get the. workup. I mean, they ended up giving the workup, but it was all done with this is probably your anxiety. And then finally like, Oh boy, yeah, this isn't your anxiety. When it just, it just doesn't seem like it needs to be that way. It just like, can we just validate each person who's coming and maybe it is their anxiety, but gosh, that's not what you should be portraying on the front end.

Validate, man, I'm so sorry. Your experience is, this must be very hard for you. I can imagine this is a scary for you. And how that was absolutely not what we experienced. So I, that's the kind of point behind that question was just seeing it myself as a, as a husband, as you on the patient side of thing, um, just how frustrating it can be when folks tend to get invalidated, that it's just, and kind of brushed aside that, Hey, these serious symptoms that you're freaked out about, and there's completely put your life into like a distressing, you know, stressful situation.

It's just probably your anxiety. So I think. Good lessons for us to learn in healthcare that we need to kind of validate and give people, you know, a validating empathetic narrative. [00:43:34] And then you can still have that as your differential, but gosh, how you, the language that just gets used. And again, I don't think any of these folks were, Out there like, ooh, let me just see if I can invalidate and piss these people off.

It just I think it just because it was literally it just was part of their like, you know their their vernacular and how they were just going to have lingo and I just Just a lack of awareness of it was just kind of mind boggling and and this was at one of the preeminent healthcare systems in the world Um that we were in thankfully we were fortunate.

We live close to It's the one here in Phoenix that, that I'm not going to name names. And they're great people. I used to work there too. So it was, I have no doubt that there was no, I have zero doubt there was malice behind it or anything like that. But it just, the, the, just the basic operations of healthcare seem to be so lacking in that kind of compassionate curiosity.

Validation narrative and we've spoke to it a bit, but Keith, I want to respect your time and I, we could talk for, for hours and I always enjoy my conversation with you. I want to make sure we talk and let folks know where they can [00:44:34] find you online. I know you got to. Uh, Facebook page and you're active, uh, kind of talking about some of these topics.

Um, and those who are listening, I think the Keith Meldrums, the Pete Moores, the Joletta Beltons, the Tina Prices. And I know I'm probably missing some people that are patients that went through this, that are now letting their voice be heard and advocating for patients. They need to be on your social media feeds and they should be in our conferences.

That's for, for darn sure. For, so we cannot lose sight of what the, what it's all about. And it's the people we were privileged to serve. So where can folks find you online, Keith?

[00:45:05] Keith Meldrum: Well, and then on a few, so they say I'm on Facebook, I've got a, I write a Facebook blog, um, and these thoughts usually come in the middle of the night and I have to write them down, but it's a, it's just a Facebook blog called the path forward. And that is really a tie back to my, my experience with Dr.

David Hunt. And over the years, I realized he gave me a new path forward. So, and I think for many of us. Um, those paths can change. So on Facebook, it's called the path forward. I got my own personal just keep most of the time. You'll just see [00:45:34] Parker and the dog pictures of her. Um, but a path forward is my, my advocacy.

I'm on X, um, as crazy as that social media platform has become, I still, I'm still there, um, because there's still some great, brilliant minds on it and I will be there until it, uh, it's not. So I'm on X, um, uh, Instagram under, uh, Keith Meldrum and, um, finding LinkedIn using more, you know, that's really a business tool, but I'm seeing more and more health being moved there.

So, uh, those are my four main platforms that I use for my social media.

[00:46:06] Mark Kargela: And we'll make sure we link Keith's profiles in the show notes so y'all can, can check him out and make sure you, you add him into your feed because it's, it's definitely, like I said, some, some great pearls of wisdom. And I think the, the viewpoints of people who are living it and dealing with it and helping us as healthcare proficient professionals better manage, um, patients who are in their shoes is, is so valuable.

So, can't thank you enough for the work you're doing, Keith, and thank you so much for your time today.

[00:46:30] Keith Meldrum: Appreciate it was great to see you again. And I really appreciate having the opportunity to do [00:46:34] this with you. Thank you.

[00:46:35] Mark Kargela: Yep. Now we'll wait maybe for a year or two before we get our third recording together for the, for the podcast. So again, thank you so much. And for those of you listening, we'd love to have you subscribe to the podcast, wherever you're listening. If you're watching on YouTube, subscribe, like, and if you can share this, especially if you have a patient in your world, who's kind of navigating some situations who might benefit from hearing Keith's journey and some of the things that he found helpful to move himself forward, make sure you share it to the folks out there.

But we're going to leave it there this week. We will talk to you all next week.

[00:47:03] Keith Meldrum: Great. Thanks, Mark.