# What a Yale Neurologist Has Patients Do for Chronic Symptoms | Dr. Dario Zagar **Channel:** Raelan Agle **Source:** https://www.youtube.com/watch?v=XRkRGq0fEjo **Transcript page:** https://www.withtranscript.ai/video/XRkRGq0fEjo ## Chapters - 0:00 — Introducing Neuroplastic Symptoms and Guest - 3:46 — How Normal Tests Lead to Neuroplasticity - 9:15 — Explaining Brain-Based Symptoms Clearly - 16:47 — Why Behavior Changes the Brain - 25:06 — Personal Back Pain and Recovery Path - 31:23 — Different Perspectives and Recovery Paths - 44:36 — Three Common Questions About Recovery - 54:52 — Resources and Final Recommendations ## Transcript **[0:00] Speaker A:** They may have migraine and fibromyalgia and IBS and POTS and insomnia and other things. But what does that actually mean, and why do they have these problems? We can explain a lot about what you're dealing with, but it's in a way that's completely different than what you've probably learned about before. And we'll give an approach to treatment that's completely different than what you've heard before that hopefully will be more effective. **[0:23] Speaker B:** All your tests are normal. **[0:26] Speaker B:** If you've been handed that sentence and nothing else, like I was for so many years, this conversation's for you because my guest is a neurologist who knows what those normal tests are missing. Dr. Dario Zagar is an associate professor of clinical neurology at Yale, newly appointed chief of Yale's General Neurology Division, and a founding member of the Functional Neurological Disorders Society. He knows his stuff. He's been in practice for over 20 years, seeing patients with long Covid fibromyalgia, functional neurological disorder, chronic Lyme disease, and chronic pain, with so many of these people dealing with chronic fatigue that no treatment has helped. His path here didn't actually start at Yale. **[1:17] Speaker B:** It started with his own back pain in his 20s and a book by, you guessed it, Dr. John Sarno. Today he's walking us through three things. What he actually looks for when every test comes back normal, why what you do matters just as much, if not more, than what you believe. And the very first thing that he tells patients who've tried everything and are still not better. Before we get into Dr. Zagar's insights, I want to share something that's been giving me back my peace of mind lately. **[1:54] Speaker B:** I had no idea how easy it was for someone to find things like your home address, your phone number, even the names of your relatives online. There are entire sites collecting this stuff and selling access to it. And as someone who has a pretty public life online, I found that unsettling. 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And yes, seeing those being removed was very satisfying. **[3:17] Speaker B:** If you'd like to protect your piece just like I did, get 20% off DeleteMe consumer plans. When you go to JoinDeleteMe.com Raylan and use promo code Raelyn at checkout or use the QR code on the screen, that's joindeleteme.com Raelyn Code Raelyn. This is all also linked in this video's description. Dr. Zagar, it is so incredible to have you here. Thanks for speaking with us today. **[3:43] Speaker A:** Of course. Thank you for having me. **[3:46] Speaker B:** So you have so much incredible experience and insight on this. Let's just dive right in. So when you have a patient that comes in and their tests are normal, their MRI is normal, their blood tests are normal, Maybe they've seen four or five specialists already, what happens in that first 10 minutes that they meet with you? **[4:08] Speaker A:** Well, the first thing before I even see the patient, I'm looking through their prior history and looking for exactly the kind of things that you mentioned. What kinds of things have they been dealing with? Is it one problem or is it a lot of different problems? So I see a lot of people with migraine, for example, and if they're coming to see me and they're having frequent migraines, they probably also have things like neck and back pain, ibs, sleep problems, maybe palpitations or dizziness, maybe fatigue, maybe problems like anxiety. And they probably see five or six different doctors. **[4:41] Speaker A:** So obviously when I see them, I'm going to examine them, I'm going to get a thorough history, make sure there's not something else that's going on. And then if we've gone through all that, I'm going to start talking to them about neuroplasticity. **[4:53] Speaker B:** Yeah. When you said patients come in with a lot of different problems, that's relatable. And I think most of us come in thinking we have five or six different separate things going in our body that probably require five or six separate specialists. **[5:07] Speaker B:** So how do you handle that? **[5:09] Speaker A:** In a lot of ways, that's one of the first things that I'm just introducing to them. I want to tell them about the possibility that rather than five or six different problems, they really have five or six different symptoms that are really all related to one problem, particularly if they're young and healthy, let's say they're in their 20s. You know, I'll sometimes ask, are you surprised that you have so many problems? Does it make sense what you've understood so far about what you're dealing with? And a lot of times the answer is no. I mean, they may have names for things. They may have migraine and fibromyalgia and IBS and POTS and insomnia and other things. But what does that actually mean? And why do they have these problems? **[5:48] Speaker A:** And why do they either not get better or why do they move and change? And why do they remain so frustrating despite the fact that they're seeing so many different people? So really, what the. In a way, the. The hook is we can explain a lot about what you're dealing with, but it's in a way that's completely different than what you've probably learned about before, but in a way that hopefully makes more sense, maybe hopefully will explain your experience better than what you've heard before and. **[6:17] Speaker A:** And will give an approach to treatment that's completely different than what you've heard before that hopefully will be more effective. **[6:22] Speaker B:** So I hear this time and time again when I interview people that even who. People who eventually fully got past all of their chronic fatigue, their chronic pain, their migraines, whatever it might be, using neuroplastic recovery approaches. When they first heard about it, when someone first introduced it to them, they completely were rejected it. They were even insulted, they felt invalidated, like they were making it all up. So how do you say to someone that your brain is involved, to someone who's been told that it's all in your head so that they feel like, understood in that moment and not like they're just being dismissed. **[7:00] Speaker A:** So in a lot of ways, that's the $64,000 question, right? To explain to people that, yes, your symptoms are real, but no, they may not be related to structural damage in your body, but they're still real. The brain is incredibly powerful. It controls all of our experiences. **[7:18] Speaker A:** And so because the brain senses and controls everything in our body, it can really cause just about any symptom. If someone has something like migraines, they'll sometimes use that as a way in. I'll say when you have a migraine, the pain is real. You're in bed, you're maybe on the floor vomiting, you're dizzy, you can't stand the light and sound. But if you get an mri, there's nothing wrong with your head, there's nothing wrong with your brain. **[7:43] Speaker A:** There's nothing structurally there that's causing this, but the symptoms are incredibly real and visible to all. These are related to activations of certain pathways in the brain, overreactivity of our nervous system. And in the same way that the brain can do that, it can cause a number of other symptoms that are all just as real. So it's just a different way of looking at these things. Now, how you talk about it is very key because as you said, people can feel that they have been not taken seriously by people in their lives, by their employer, by their, their spouse, by their physicians. They've seen. So it's really crucial to validate what people have gone through, to validate their experiences. To say, look, what you've been through is terrible. This has obviously affected your life in an incredibly impactful way. But it's also really important for you and for us to figure out what's causing this problem so that we can actually treat it. **[8:39] Speaker A:** And when I talk to people about this, I'll often again focus more on the what is going on. Say this is what's going on. We're learning more about what's going on in the brain, what's going on in the nervous system, why these issues occur, and really just help them to understand what this is about, that this is a real problem, but it's an issue with, in a sense, with the nervous system. So that no matter where the problem is in their body, the problem is in the brain. It's not in their imagination, it's not in some way a psychological problem. **[9:10] Speaker A:** These are real physical issues that they have, but from a completely different mechanism. **[9:15] Speaker B:** So how do you explain to people when you say your MRI is normal? These are the reasons I think this is coming from your brain. I wish I would have ended up in your office at any point of my 10 year journey with chronic fatigue syndrome. But I think one of my first questions would have been why is my brain doing this? **[9:34] Speaker A:** That's a very good question. Yes. And so first I talk about the idea of nervous system overreactivity, because I think that's something that kind of makes sense to people when I explain that it's almost like the volume not knob in your brain is turned up too high, that something flipped this switch, turned it all the way up and it's just stuck there. And when the volume knob is turned up too high, your brain experiences what's going on in your body in this heightened abnormal way. That's kind of a starter. And then you can talk more about the idea of the Brain being stuck in this sort of a threat state that something got it stuck in this like a protective mode. And this can be related to a physical injury, it can be related to an illness. And some people, it can be triggered by stress, it can be triggered by a number of different things for different people. **[10:19] Speaker A:** Sometimes we don't really know exactly what triggers it, but for whatever the reason, the brain gets stuck in this protective mode that causes this heightened experience. The second thing that I'll explain to people that often resonates to them is that no matter what initially triggered it, in most cases the symptoms themselves become stressful and anxiety provoking. **[10:38] Speaker A:** Particularly when people don't know what they're from, right? When people have all these symptoms and they don't know why, that's even worse than, you know, you know, people would rather hear something bad in a way than say, people hearing, I don't know what it's from, right? Because if they can't figure it out, that must mean it's something really bad, right? Something I am a mystery, I am mysterious. What is this? **[11:00] Speaker A:** And so the physical symptoms, what people are experiencing, plus this uncertainty about what's causing them, causes this heightened, even more heightened reaction, right? If we weren't, and if our brain wasn't in a danger mode before, it is after they're having pain and numbness and tingling and fatigue and all of these things, right? And the brain just gets stuck in this loop of symptoms, stress and anxiety about symptoms, more symptoms, around and around. And people will often kind of say, that makes sense, this is how I feel, right? And that often gives us the kind of a foothold of how to start in terms of saying, really the first thing is helping you to better understand what's going on. So that instead of having this uncertainty, mystery about it, it's being able to say, look, I don't like what's going on, but this is what's causing it. **[11:51] Speaker A:** It's not dangerous. We know what it is. And changing how people respond when they have the symptoms to, you know, you can say, okay, you still don't like it. I'm not asking you to like it, but at least we can help you to not, you know, to, to, to not get us thrown off, to not have to freak out as much about it. Because that's really what happens when, you know, when people are going through this. And so oftentimes that's the very first thing. Just being able to, for people to kind of take a breath regardless of what's going on inside them instead of Being constricted and. And tense and tight because of how they're feeling. **[12:26] Speaker B:** Yeah, there's something very hopeful there and something that immediately brings a sense of. **[12:31] Speaker B:** You're like, I just feel my shoulders dropping. Even thinking about someone saying that to me was going through this because it felt like my whole body was shutting down and I was going to need so many different things to get past how I was feeling. **[12:44] Speaker A:** Yeah. So I saw someone just today and we went through this together and I could see like she had this kind of like, you know, I could tell the. I don't know if I like what I'm hearing right now as I first started, and then as I go along and I was really explaining what's going on. **[13:01] Speaker A:** And she asked me, how did you get interested in this? And I started saying, because of personal experience, I've had a lot of these things. This is what I went through. And by the time she left, she had a smile on her face and she said, I feel hopeful. You can't ask for more than that in a first, first visit, you know, with someone and that at least says, look, you know, I may not really be sure about what you're telling me, but at least there's enough there that, you know, I'm going to look into this and maybe I have a little bit of hope of what's going on. **[13:30] Speaker B:** Yeah. So I have to admit I'm on the edge of my seat a little bit to ask you a question. I'm so excited with all of your experience in this, what you're finding. Because there's a lot of agreement I find in the people that I interview in what's going on with these neuroplastic conditions, mind body conditions, lots of different names for them, and the explanation makes sense, but where it breaks down or where I see some, like, people having different insights on this is. So our brain is stuck in protection mode. **[14:03] Speaker B:** It's communicating to us through symptoms. And I would say without Dr. Degar in front of me, I never would have put that together. Like, how am I supposed to know that back pain means that my job isn't the right fit for me or that chronic fatigue means that I have a stress from my childhood? It feels like a really faulty system that no one could ever piece together on their own and could ever fix on their own. So in your experience, what is happening there? Why are we getting symptoms that seem. Seem not at all related to the cause? **[14:30] Speaker A:** That is also a good question and one that I don't really have a good answer for except to say that it'd be nice if our brain could just tell us what's going on. But our brain has a limited repertoire of communicating with us what's going on in our body. One way that it communicates with our body is through emotions. For example, we think of emotions as being things like, I'm just angry, or I'm sad or I'm anxious. But really what emotions are, are physical expressions of what's going on in our body. There are a way for us to know what's going on in our system. Are we tired? Are we hungry? **[15:06] Speaker A:** Do we feel threatened about something? And we get this physical reaction actually before we get a conscious idea of what it's from. And those physical reactions can be palpitations, tightness in the chest, sweating, tingling. And when you piece apart different emotions, they are kind of a mixture of the same. They're a combination of different kinds of sensations in the body. **[15:30] Speaker A:** And in a way, it's up to us to kind of figure out what they mean. And most of the time, it's obvious, right? When there's a dog that's in front of you barking at you, you know, why you're sweating and have palpitations and all of this. But in many cases, unfortunately, there are things going on in our unconscious, which is what most of the brain activity is really doing. We are not aware of it, and it's trying to communicate us to us through these different sorts of messages. **[15:59] Speaker A:** And unfortunately, we don't always speak the same language. And so part of it is our trying to figure out what our brain is telling us. And when it comes for pain, most of the time it's because there's some sort of structural damage, right? You twisted your ankle, you cut yourself, you touch the hot stove. So again, it doesn't take a lot for us to know what that means. **[16:21] Speaker A:** But with these neuroplastic symptoms, these same mechanisms that have often a more clear message to us, it's just murkier. We don't know what's going on. So. But why? Sometimes it's pain, or sometimes it's dizziness, or sometimes it's something else. **[16:37] Speaker A:** I mean, I think sometimes the symptoms may mean something. You know, they'll. You'll hear about the kind of metaphorical language like tight shoulders, you're holding the weight of the world on your shoulders. **[16:47] Speaker A:** Or, you know, But I think a lot of the times there may or may not be any sort of meaning, and I don't know why it is. **[16:56] Speaker B:** Yeah, okay, so we talk a lot here on the Channel. And, you know, lots of people in this space talk about what people believe is very important and learning about what's going on. But I know that you've said that what patients do matters as much as what they believe. **[17:13] Speaker A:** Correct. **[17:14] Speaker B:** What does that look like on any given day for someone who's at home, mostly housebound? **[17:20] Speaker A:** Yeah. So it's important for us for people to start to understand what's going on, for this treatment to work. If you are stuck with your sensations and believing that they are all indicative of something that's serious, dangerous and threatening, it's going to be hard to get better. So part of it is really changing your thought processes, changing how you frame the symptoms you're experiencing, feeling like you understand what's causing it, kind of getting your brain to calm down about that. But at the same time, I'm sure you've seen this. We see people who fully believe everything we're telling them, everything they've read, and they do not improve one bit. **[17:58] Speaker A:** And part of that is because the understanding part of the brain, the rational part of the brain is up here and the part of the brain that's causing the symptoms is down here. And there are a couple of ways that we can get to this part down here, but just understanding is not enough, unfortunately. And so a couple of the ways that we can get to the part down here. One is through repetition. One is through going through these, you know, these techniques and these strategies, self talk going through. And when we have a symptom, reminding ourselves it's dangerous, again, people sometimes say, well, I've done that already, like, no, you gotta keep doing it. You know, we're trying to get to the part down here, but actually a really powerful way to get down here more quickly is actually with our behavior, our physical, our actions, what we do, how we behave. **[18:44] Speaker A:** And I think sometimes people are working up here and not with this sort of physical way. Perhaps ironic, part of how these neuroplastic symptoms work are that our brain is causing our symptoms, but it's also reacting to the symptoms that are there and reacting to our response to the symptoms. So if we have pain and we freeze and we don't move and we tense up and we stay stuck, our brain goes, oh crap, what is going on? **[19:09] Speaker A:** Even though it's what caused the symptoms in the first place, it's so bizarre and annoying and then that keeps things stuck in a loop. But if our brain gives us that signal and instead of doing the freezing and the tensing and restricting and staying at home, we actually Start to move, increase our activity that sends our brain a different signal than just thinking does. And that can make a huge difference. Let me tell you a quick personal story about this that I only kind of oddly, recently figured out what it meant. So, like a lot of people, I used to be afraid of flying. I was not a good flyer, right? When there was turbulence, I'd be sweating, I'd be anxious, I'd be gripping the armrest, and I would do what I think most people do have this. I would talk to myself. No one ever died from turbulence. **[20:00] Speaker A:** You know, this is just air moving the plane. **[20:03] Speaker A:** You know, you're more likely to get killed on the way to the airport than. And I would never feel any better, right? I'm talking to myself, but I'm still sitting here like this, right? And so one time I was on a pretty bumpy flight, and I'm doing that usual thing. I'm gripping, I'm holding, I'm, like, tensing. **[20:18] Speaker A:** And I would look around, and the flight attendant's walking through the aisle, she's giving out the drinks. People are sitting there chatting, and I'm like, why am I reacting like this? And they are reacting like that. Like, what is wrong with me? I said, what if I. **[20:35] Speaker A:** Instead of behaving like a nut job, I behaved like these people who are there reading their book and having their drink in a conversation. And so I started to just do that. I started to pretend like I was them. So I pulled out my book, I started reading, I stopped gripping the seats, I pulled out a drink, and I was acting like I was not scared. And I did this for a couple of minutes, two, three minutes. **[20:59] Speaker A:** And I'm, like, forcing myself to do this, right, Because I'm still sweating and anxious and all that. After about five minutes, I felt this complete relief wash over my entire body, and the anxiety was completely gone. It was not like I was thinking about anything. Nothing had changed about my thought process about what was going on. It was purely how I was behaving in the moment. **[21:27] Speaker A:** And it was. I just was. My mind was completely blown, and I'm sitting there, and I literally had no sense of anxiety, mentally or physically. And it was like, what the hell just happened? You know, this does not make sense. **[21:42] Speaker A:** And so the things kind of smoothed out. I'm like, I. I wish the turbulence would come back again so I could see. Was I just imagining this? Was this some sort of weird thing? And so it got turbulent again. And I'm sitting there and I felt totally fine. And for the rest of the flight, I felt completely fine, even though it was bumping around just as much as it was before, you know, when I was freaking out. And after that time, I just. It's. Everything's been totally different. That totally changed my experience and realized that anxiety is not just what we're thinking about, and it's something we can choose to change. No one wants to be anxious, but I think we don't understand how our behaviors and other things either make us better or make us worse completely unconsciously. And so that really taught me a lot. **[22:31] Speaker A:** And now I understand, understand that what happened, what I was doing, I was sending my brain a signal of safety, right? Every time I was tensing up and freaking out, I was telling my brain, you write, I am dangerous. I better, like, stay gripping to the seats or something's going to happen. And so when that happened, I just told my brain, you're fine, don't worry about it. And then everything changed. **[22:56] Speaker B:** I love this example so much. And it sounds like what I hear some people talk about, referred to as top down and bottom up, approaches to nervous system regulation. **[23:05] Speaker B:** So you can think your way through a little bit. You can have those reassuring messages, remind yourself you're okay. But then there's almost like the physical hacks. Like, if I'm smiling, my nervous system thinks everything's okay. If I'm breathing slowly, slow, gentle exhales, the body's like, okay, we must not be in danger. **[23:22] Speaker B:** You know, if I'm using my peripheral vision, everything must be okay. If I'm humming, if I'm singing. **[23:28] Speaker A:** And it sounds. It sounds stupid because it sounds. It makes people feel like that they're pretending or like acting there, you know, but it's. It goes way beyond that. And so those are minor things that can help, but bigger things that can help are getting out of bed, getting out of a chair, leaving the house, taking a few steps. These are things that, while small, can make a huge difference in what our brain is perceiving about our experience and whether in fact, we are in danger or not at the time. And I think for some people, how they feel really changes when they start to change their behavior. Now, none of this is easy. **[24:09] Speaker A:** When we make these changes, we are rebelling against what our brain is telling us, which is not easy to do. And so part of recovering from all this and through this neuroplastic plastic work is recognizing that what our brain is telling us is not always an accurate reflection of what's going on in our body, in our system, in the world around Us. And so it's like all of this at first. It's kind of a hard sell to say, don't listen to what your brain is telling you. When you listen, you're reinforcing this kind of this. This incorrect message. And being able to not listen little by little, again, lets the brain learn a new kind of way and maybe recognize that it's being too protective, that, okay, maybe I was wrong, maybe this wasn't as bad as I thought it was going to be. And then just doing that and building that up little by little, making these small steps can make a huge difference. **[25:06] Speaker B:** So I'm sure people listening would love to hear. Just like your patient this morning really appreciated hearing about your personal experience. **[25:13] Speaker B:** What was your journey and how did you respond, or how did you get onto this path of understanding what was at the root cause of what was going on? **[25:21] Speaker A:** Yeah, so the main issue that kind of led to this was back pain. And I started having back pain after college. I tried rollerblading for the first time and had a bit of a spill. Initially felt okay. But then that night, I go home and feeling a little tight. And by the time I woke up the next day, I was completely bedbound because I was in such excruciating pain. I couldn't even move. I mean, I was in tears. I was in so much pain. **[25:50] Speaker A:** And so I called out from work, and, you know, this lasted a couple of days. And it's like, again, what was that? And so I would start throwing out my back periodically, sometimes from something, you know, lifting something heavy, sometimes for something minor, sometimes for no particular reason. And I found myself constantly thinking about this pain. Even when I wasn't in pain, I was thinking about the pain and what if it happens? What if this. I got to sit in this chair, I got to have this pillow. I got to do this. I got to do that. And this lasted a couple of years. I went for some physical therapy. I did the usual and was still dealing with it. And it was really frustrating. And then actually I was in medical school at the time, and I was in the bookstore and happened to find. **[26:36] Speaker A:** I was looking in the health section, sort of trying to find something that might help. And I found the book Healing Back Pain by John Sarno. And so I read the first kind of chapter intro and immediately knew that was the problem that I had. So this wasn't a hard, you know, something that. I mean, I read it and it just made much more sense than what I had heard before, you know, that sometimes I could do squats at the gym and I'd be fine. And then another time I'd pick up a bag that weighed about 2 ounces and I would be bed bound, like. And I'm 22 years old. Right. It just didn't make any sense. And so what he talked about in his book, and this is the idea that, that physical symptoms can sometimes not be related to structural injury. And his book, he talked mainly about the role of stress, conscious stresses, unconscious stresses. **[27:21] Speaker A:** And then when I look back, you know, when it first started, I just finished college, I felt sort of adrift. I felt kind of lonely. And when I looked what was going on in my life had more to do with them than what happened in the moment. And so that made a lot of sense to me. And working with those strategies really helped. **[27:41] Speaker A:** And then through my life since that time, I've had a number of other things and migraines and digestive issues and muscle tension and you name it. And when I looked back, actually prior to that, I had had other symptoms that were. That were probably similar. So it's something that, as you mentioned, I really enjoyed your five. The recent video was about the five. **[28:02] Speaker B:** Oh, five phases. **[28:03] Speaker A:** Five phases, right. And I really liked phase five. You know, like, this is often a lifetime thing. Like, you're not fixed. **[28:10] Speaker A:** You know, your goal is to learn how to know what to do and to know how you feel and what that means to you so you can get better. And so that's what my experience has been since that time. And so really this has. My career as a neurologist for the last 22 years has been in large part trying to learn more about why people get these problems. And fortunately, we've learned a lot more that it's not just stress. There are a number of other things that play a role. Why does this happen? From this neurologically, how can we tell people about this? Strategies to help people. And it's been just revolutionary since that time, which has been amazing. And then we have people like you with, you know, with. With channels that, that give information and hope to people. **[28:52] Speaker B:** Yeah, I. It took me a while. I'd had this channel for a while before I realized that I would still get neuroplastic symptoms. And it wasn't that I wasn't fixed. I was never broken. And I've heard many experts now on the channel say, like, every human on the planet gets neuroplastic symptoms. Like everyone has symptoms that come from the brain and from the nervous system. So it's going to keep happening for the rest of Your life. The difference is, is that you understand what' and you have tools to deal with it so you don't get stuck there anymore. So you're not living with chronic symptoms, but they're gonna. I still get them. I got neuroplastic rosacea. I had crippling neuroplastic back pain a few months ago. **[29:30] Speaker B:** Like, just all sorts of things. And you see the signs. You're like, ah, I know what's happening here. Something's fishy here. Yeah. **[29:40] Speaker B:** So I love your example about the Rollerblading, and I'd love you to elaborate a little bit more on what you say to people listening who say, this isn't coming from my brain. I had a rollerblading accident. I had an injury. I was hit by a car. I had Covid. **[29:57] Speaker B:** I had mold exposure. I had Lyme disease, whatever it might be. So I am the exception, and this does not apply to me. Here are my tests. I have something structural. **[30:07] Speaker A:** So what I would say is that typically, injuries heal. Our bodies were designed to heal. And most of the time, things work very well. But when it comes to neuroplastic symptoms, it starts with an injury that may be the initial. There may be a structural injury that starts. **[30:24] Speaker A:** But it can be helpful to look at the pattern that happens that's different. Instead of things healing and improving over time, people may often gradually get worse over time, or new symptoms may develop, or things may move around. And the way I look at it, it starts with a physical injury of some sort. And either that's. That pain may stimulate the brain in a way that. That kind of starts this overreactivity cycle from. Starts that happening. In some cases, the brain uses it as an excuse, you know, as its way to start talking to us. This is its way to, you know, to tell us something. But I tell them it started out as one thing, and now it's a different thing that needs to be treated in a different way. This is no longer an injury that just needs to heal. We've seen that is not the case now. **[31:17] Speaker A:** This has become a separate problem and with a different cause and a different treatment that's required for it. **[31:23] Speaker B:** Are there things that you're seeing in podcasts, books, YouTube channels, coaches, whatever it might be? Because generally speaking, this information is still not common knowledge. **[31:35] Speaker B:** That said, once you tap into it, there is a ton of information that is out there. And we're all. Many of us, I think many of the doctors I interview included, are figuring some of this out as we go. So are there things misconceptions out there, thinking patients are getting wrong, people are getting wrong, or things that are holding them back because they're not fully seeing or understanding what's happening and what they should do about it. **[32:01] Speaker A:** What I would say is I think it's very useful to have different people's perspectives because even though, you know, this is different for everyone, there is no single best treatment for everyone. **[32:12] Speaker A:** I think. So I think people will often say, you know, I heard this before, but I was watching something and that clicked. So I think some of it is to your point. We are figuring this out as we go along. I mean, Alan Gordon coming up with Somatic Tracking a few years ago, and the idea that, as opposed to the old Sarno idea that there was always some sort of stress, emotional stress, and you have to work on that first, you know, this approach of that's not always the case, number one. **[32:43] Speaker A:** And number two, you know, there's an approach of this sort of this bottom up approach and working on the symptoms first in a way and how we're reacting to the symptoms and these new techniques. So, I mean, we're learning new strategies and things that are, number one about why these happen, what is the mechanism and how can we treat them, because what works for one person is not going to work for another person. And what resonates for one person in terms of why it's happening. Again, same thing. Some people, they'll see one thing in here and it just doesn't click. **[33:17] Speaker A:** So I wouldn't say, you know, I wouldn't say that there are specific misconceptions. I think there are different ways of looking at things. And part of this is finding what clicks for you and seeing what makes sense to you and trying different strategies. Because again, this is different from person to person. **[33:36] Speaker B:** Yeah, I'm wondering, and I know I can't put a number on it, but just how much you see that people can generally see, speaking, get past these conditions on their own or with YouTube videos or like when I got that really bad back pain that I mentioned a few years ago, I had just started using the Curable app just to learn more about this. **[33:57] Speaker B:** And then I realized what my back pain was because the doctor said I was fine. And I'm like, okay, so I used the Curable app and very quickly I got past my really excruciating back pain. So. And I know you were on the Curable podcast, so is that a reasonable place, like for someone to start on their own or do they need professional guidance? **[34:17] Speaker A:** So I would say, again, this is different from person to person. There are some people where they will read some of the materials, they'll work with a workbook or a. An app or a podcast, and they will do very well. I think when I. One of the challenges in my practice is that I don't have a big network of people to do the work in terms of, you know, working with people on pain reprocessing, therapy on eaet, working on these strategies, unfortunately. So I feel like I can introduce it to people, I can get them to a certain level, but I really wish I had more people to get them to the next, you know, to really take them through it, because I think a good number of people really would benefit from working with someone who can really teach them, who can give them the skills, who can see them weekly and really help to treat them. **[35:13] Speaker A:** And so I think a number of people are not getting better that I see because they don't have that support. And that's the hard part. And it's very frustrating. So I think. But it's growing and there are more people who are doing this, and we, you know, introducing it to other counselors, therapists, physical therapists, is huge in terms of building up that. **[35:34] Speaker A:** That network. But I would encourage anyone who is working with this on their own, if they're not seeing the results that they want, but they think that this is relevant for them, it's definitely worth seeing someone, a practitioner, either locally or online, because I think that can make a big difference. **[35:52] Speaker B:** Yeah, it's a challenging and frustrating part of this journey is that there isn't like, here's the formula that works for everyone, and we know this is specifically what you need. Some people will have a lot of support in their life. Guidance, a lot of education on this topic, existing tools because of past experience, you know, so everyone's coming at this from a different place, and we don't have the exact same thing that we know that is causing this nervous system that's on high alert. So we can't say it's this. This is what you need to do, Correct? Yeah. But it's also great to have different things out there that can maybe work alongside with a coach or a doctor. **[36:28] Speaker A:** Totally. **[36:28] Speaker A:** Yes. There are so many more resources, which is really great because again, they can learn more, they can get support, they can feel like they have some guidance along the way, even if they're not able to work with someone one on one. **[36:42] Speaker B:** Yeah. And the great thing is that a lot of this is for free and for people listening, I can drop a link for you that you get six weeks free of curable. That was all I needed to get past my back pain. So I think a lot of this used to be, like, behind paywalls, and it used to be very expensive, and you had to take costly programs. But there's so many free resources out there, which is incredible. So I know you've had some incredible success stories. You know, is there one that stands out to you? **[37:09] Speaker A:** Yeah. So I saw someone actually, not long ago who. And she gave me permission to talk about her story. And so she's someone I who was dealing initially with symptoms related to what was billed as chronic Lyme and chronic Epstein Barr virus. She had a lyme infection about 10 years ago, including rash and other typical Lyme symptoms, arthritis. She was treated with antibiotics for several months, but she really didn't improve. **[37:39] Speaker A:** And in fact, she continued to get worse. She had symptoms like this, chronic hip pain and leg pain, back pain, fatigue, cognitive symptoms. She would get these episodic symptoms that were billed as Epstein Barr, reactivations of horrible gastrointestinal symptoms and fatigue. And her activities were very curtailed. She was able to kind of improve to a degree that she could function, but not to the level that she wanted. And then she got Covid. This was, you know, you know, 2021ish. And after that, she declined further, you know, post exertional malaise, horrible fatigue, worsening pain. It's one of the situations where it's probably easier to say what she wasn't dealing with than what she was dealing with with all these symptoms. And, you know, she had a number of different treatments. **[38:32] Speaker A:** She was being seen at a long Covid clinic. And then I saw her, and this was just a few months ago, and told her about the idea of neuroplasticity. And when I see people with issues like this, I'm honest with them when I explain it, I say, you know, there are different theories about why people have symptoms like this that don't improve after an infection. Some people think there may be some persistent infection. Some people think that it's related to dysregulation of the immune system. **[39:00] Speaker A:** But another theory says that it may be related to overreactivity of the nervous system, a heightened nervous system response that's triggered by the infection, by the whole experience of what you've been through, by the symptoms that you've been dealing with, and then talk more about that. So we went through this. I referred her. Fortunately, she was able to see a therapist I work with who does pain reprocessing. Therapy and other treatments. **[39:20] Speaker A:** And so I messaged her a couple months later just, oh, I want to check in and see how you're doing. And she sent me the best message. So I'm going to post this on my Instagram because she said I can post it just talking about how her life had changed 100% just in that two or three month period. Her pain was completely gone. This is 10 years of pain. **[39:41] Speaker A:** She spent every summer with her grandkids, but usually she was the one sitting there while they were kayaking and doing all these other things. And she said this was the first time in a year she was able to, to go kayaking, to go hiking, to do these other things. So she said the pain was gone. She was working on the nausea and the GI symptoms. Those were almost gone. And then she had been getting going on the fatigue, which was improving. And this wasn't like minor symptoms for a few weeks. This was 10 years and lots of different treatments. And it was really just through working on this. But what I love is that she said to me that when, when I first started explaining what was what I thought was going on, she said she sat under her breath. I don't remember hearing it. **[40:22] Speaker A:** She said she remembers saying, yup, he doesn't know what I've got either. And she, she felt herself feeling kind of resisting. Resisting what? What I was telling her. But, but she said that as she kept listening, she felt more open to it. She said by the time she left the office, her hip pain was completely gone. And that kind of like gave her evidence that maybe this is what was going on. And I'm not going to say that everyone has this kind of a dramatic response, but I'm sure you hear this. Some people do. **[40:52] Speaker A:** And so this kind of gave her the hope and the idea that, well, wait, maybe this crazy idea that's completely different than what everyone has been telling me for 10 years might be what I'm dealing with. **[41:03] Speaker B:** Yeah. **[41:04] Speaker A:** And she was, you know, started working on that and, and her, she's, this is where she is such an important, **[41:10] Speaker B:** very hopeful, such an incredible story. I know a lot of people can relate to that journey. And also just an important thing that I try and emphasize a lot is that it's okay if this doesn't make sense to you right away. If you're hearing this, I'm like, I'm skeptical, I'm not sure this fits what's going on. But just stay open minded, stay curious, like, what have you got to lose? Yeah. **[41:33] Speaker A:** And interestingly, she's someone who said, you know, she really hadn't had a lot of symptoms prior to that. She didn't have a significant amount of stress, stress going on for her. The way she, she conceptualized it as really it being the illness, the symptoms from the illness, the stress of the illness. She said she felt almost, she, like she had PTSD from what she initially went through because she felt so sick, that got her brain stuck in this protective mode that, that made sense to her and really that was the stressor, the trigger and the stressor. And then the symptoms got stuck in a loop. And what she said that she found is that once she understood kind of the mechanism and was able to kind of observe things, she said she would feel her brain telling her that symptoms were going to happen, that if she thought about doing something, her brain would say, you know, you're going to have fatigue if you do that, or you're going to have pain if you do that. **[42:25] Speaker A:** But she recognized that she didn't really have to listen to that and that she, she felt that she was almost talking herself into the symptoms when they were occurring. And when she saw the pattern of how things were occurring and it wasn't how it initially seemed to be, she was really able to use these strategies to get better. **[42:44] Speaker B:** In your experience, is there any correlation between severity of symptoms, how long people have been feeling unwell, and their ability to recover or not recover from these symptoms and conditions? **[42:59] Speaker A:** I would say she is an example of why. That's why there really isn't a correlation. **[43:04] Speaker A:** I think, you know, I've seen people like her with 10 years of symptoms, 30 years of symptoms that get better. Really the, the bigger thing is if this resonates with someone, how much they're willing to consider these ideas, how much they, they think they're plausible, and how motivated they are to improve. And I don't mean motivated like as a judgment. Again, this is, this is not easy. I think because we're in it, it makes a lot of sense to us. But for people where for their whole life they've heard completely different things and then they're hearing something totally different, it's very difficult really to, you know, to expect someone to just say, oh yeah, you're right, this is what I'm going to do. And you know, it's not, it's not that easy. You know, it takes being open minded. It takes being willing to think of things in a new way and being almost a rebel, right, because you have to be willing to say everything everyone else said is wrong. **[44:01] Speaker B:** Yes. **[44:02] Speaker A:** And this is. Right. It's a challenge. And this is why I wish there were a test. Right. **[44:07] Speaker A:** There's an. You can do the MRI that shows the abnormalities that are like, you know, like they say, gray hair of the spine. Right. That people can point to. But I don't have a test that I can pull up and say, here's what's going on in your brain that's doing this. And this is why I know this is what you have. That's hard. Right? So we're. This is really counterintuitive in a lot of ways. **[44:29] Speaker A:** And so it really. Whether people improve a lot improve or not has most to do. **[44:36] Speaker A:** If. Does this make sense to you? Does this fit with your experience? **[44:40] Speaker A:** Are you willing to try something that's different and not the standard treatment to these things? **[44:46] Speaker B:** Are you willing to be a rebel? **[44:48] Speaker A:** Are you willing to be a rebel? **[44:50] Speaker B:** That would have landed for me. You had me at rebel. Okay, let's do this. Okay. So I would love to ask you the three most common questions that I get asked in video comments, in emails, in my own Brain Retraining 101 program, and the support calls. It's like daily these questions come up and everyone explains them slightly different, and it just helps it land for people. Okay, are you ready? **[45:16] Speaker A:** Yes. **[45:17] Speaker B:** Hot seat, question one. So you talked about it's important to do things right. You have to get up, you have to walk, you have to leave your house. And people have built up all these rules for themselves. Like, it's, no, I can't stand for too long. I can't be around certain smells, bright lights, sit in that kind of chair, whatever it might be, and it feels very dangerous. So how do you tell people how to safely expand activity? What does that look like? **[45:45] Speaker A:** So I think the first thing is before doing that, you have to have some level of confidence. **[45:51] Speaker A:** Because I tell people, you know, it's not doing it and having your symptoms not get worse. And so you keep doing it, your symptoms will probably get worse when you do this. Right. Because this is the pattern that your brain is stuck in. And so part of it is being able to say, okay, I know that if I do this thing that I can't do, my symptoms may increase. **[46:14] Speaker A:** So you have to be able to know what to do ahead of time. How am I going to deal with this when that happens? What am I going to tell my brain when my symptoms increase? Okay. Because if it was as easy as you just get up out of that chair and walk, and you're going to be Pain free. **[46:32] Speaker A:** It would be easy, right? But you have to be able to say to yourself, okay, my pain may increase, but I know this doesn't mean that I'm actually hurting myself. So I think again, part of it is cultivating enough confidence that someone is willing to start to do that. And again, sometimes it goes the other way, that doing things can build the confidence. But I think there has to be some basic level of someone being willing to do that or they're just gonna. It's just gonna fulfill their prophecy. Right? It's my pain increased. See, I knew that was gonna happen. So part of it is being able to say, okay, when this happens, you literally just talk to yourself, tell, this is what I'm gonna tell myself, it's okay. **[47:11] Speaker A:** And go through these strategies, calming strategies, grounding strategies, self talk about safety. I just do a little bit. The goal is to do things little by little. And some people, when you teach them, when they get enthusiastic, they say, can I just go and do it? You know, And I'll say, yes, you can. **[47:28] Speaker A:** But, you know, it's possible that that may throw things off. But I think some people want to just dive in. I think for most people, it's probably better just to go little by little. And I think this is different than pacing, as it's traditionally being told, like, you can only do so much or you're going to create damage and hurt yourself. It's, we're going to do this in a way that helps you to feel comfortable. **[47:53] Speaker A:** My goal is not to make you uncomfortable. It's to help you to feel confident and comfortable and able to do these things. **[47:59] Speaker B:** Yeah, it sounds like what Ellen Gordon refers to as creating corrective experiences. So you're doing those same things again, but you're giving your brain new data like, okay, this is not dangerous. Symptoms come up. Doesn't mean that I'm going backwards. Everything is actually okay. **[48:14] Speaker A:** Yeah. Because if people are able to start and do that and do that self talk and use those strategies, they may find that, okay, wait a second, that maybe it increased, but then maybe it calmed back down again. Or maybe they can say, maybe it increased, but I just don't care as much. **[48:30] Speaker A:** You know, I was okay with that. And that's a start too. **[48:34] Speaker B:** Okay, so the second question that comes up a lot is because a lot of my viewers are people facing chronic fatigue syndrome, ME. And one of the biggest symptoms they have is fatigue and post exertional malaise. So it seems to be a lot of people understanding, okay, if pain comes up, that's okay, but post exertional malaise feels like a category of its own for many people going through this. And I can relate because you do the activity, the next day you're laid out. So is that a reason to act differently or what is happening in that case? **[49:08] Speaker A:** Yeah, so I, I definitely understand why that feels different. I think, you know, in a way, pain is almost like a positive symptom. It's something that's there that shouldn't be there. **[49:19] Speaker A:** In a way, this, the, the kind of malaise and fatigue is the absence of something, the absence of energy, the absence of life force. And so I think in a way, mentally that feels different for people. And so. But I don't think it really is different in a way. It's just a different symptom of the same problem. **[49:40] Speaker A:** So I think the goal would be the same part of it again is going through the same process as before you get to that, you know, when you're doing the activity or before you do the activity so that it's less likely to happen. But I think people may find that first, either maybe it's less likely or maybe it's a little less afterwards, or maybe it's shorter lived once they start working on this. But part of it is also then being able to use the same strategies. You know, if normally you would stay in bed all day, try getting out of bed, try, you know, small challenges to how you're feeling. So it's using similar strategies but being very gentle about it. **[50:17] Speaker B:** Yeah, that was a great explanation. And I know in my own experience, and I hear this from many others, like it doesn't feel like a symptom. It feels like your battery is drained. It's not something that showed up, it's just that everything was drained. Clearly something wrong. **[50:32] Speaker B:** And it was fascinating for me to learn that your brain creates that feeling. Just like it creates the pain, just like it creates the nausea, everything else, it's also created that fatigue. **[50:42] Speaker A:** Yeah, I think, and I'm sure you've heard this, and you know, I like the idea of marathon runners and the idea of hitting the wall. You know that when people run a marathon, very often at a certain point, mile 20 or something, they get this complete lack of energy, like completely drained. Every instinct would be to stop, like, you better stop. **[51:05] Speaker A:** But they know that if they keep going despite feeling that, that then they're going to get this second wind in a period of time where they get a new burst of energy and keep going and they can't complete the race. And so that really is the brain. That's this prediction model at work, right. Your brain is, is giving you a signal in anticipation of what it's worried might happen if you keep going. Okay. **[51:30] Speaker A:** But it's not real. And so I think that's a useful way of looking at it. This is something that can happen to anyone and this is how they respond and this is what happens. This is like someone's hitting the wall all day. **[51:46] Speaker A:** But I think it's helpful to just kind of have these ideas. **[51:51] Speaker B:** Yeah. All right, question number three. This one comes up a ton as well. I hear from lots of people that say they're getting better. **[51:59] Speaker B:** Generally the trajectory is going the right direction, you know, kind of not linear, but looping the right way. They're feeling like they're going to be through this soon. And then all of a sudden all of these symptoms come on. They get what they call a crash or a flare. And they're not now they're just really feeling lost. **[52:17] Speaker B:** Like, is this a setback? Am I actually not getting better? What does this mean? Was doing something wrong? Does this mean that this is not even the cause of what's like just so many doubts come in and people understandably feel very lost in what to do and hopeless. **[52:33] Speaker A:** And I'm smiling not because it's funny, but just because I knew this was coming. And it's very common question and it's a very common situation. I think it's important for people to understand that improvement is not in a straight line with this, that that's not the exception to get these flare up of symptoms. That's really the rule, that as people get better, this is how it goes, right? It's up and down. And the goal is to keep this, the general trajectory in this direction. But in one way, when people start getting new symptoms, that's a sign that what you're, that you are doing the right thing. That is more of a sign that this is what's going on. And I tell people sometimes that can be really useful to see if you're working on this and your back pain went away and then wait a second, your headaches start getting worse again or you're getting this new symptom. **[53:22] Speaker A:** Notice that, right? **[53:24] Speaker A:** Look at these patterns. This is a way to help us actually to know that this is a neuroplastic brain based problem. So while it's annoying and frustrating, it is not something that should be a cause for despair. Although it can be really frustrating because people start to feel positive and then. And so you really have to be There to kind of hold their hand and say, you will be okay. This is all right. This is frustrating. Not the end of the world. And part of it is, you know, when people go through these things, I think they get used to saying this is the. That this is never going to work because they get so frustrated because they've tried so many things. **[54:03] Speaker A:** And so when, you know, I think that's sometimes why people may be afraid to be hopeful when they learn about something like this, because they've been told they've been hopeful before and things haven't worked. So I think this is sort of an extension of that. And there may be kind of may get frustrated maybe more easily or more deeply because of what they've been through before. So it's important to be able to give support and say, this is normal, and that's okay. Just keep going. **[54:32] Speaker B:** Yeah, I think it's important for people to know that. I don't think I've come across anyone, virtually anyone, that didn't experience that. Like, it's just an infuriating, not fun part of the journey. But just letting people know that it's normal, like, we've all been there. It doesn't mean you're not getting past this. It's just a part of the process, and it sucks. **[54:52] Speaker B:** And whatever little messages of safety you can feel and internalize in those moments, like, I'm okay. I don't love this. It is really horrible to go through, but I'm gonna be okay. **[55:02] Speaker A:** Yes. **[55:03] Speaker A:** And part of it is it's also okay to be upset and sad about it and be sad about you went through what you went through before, and then, okay, we'll do this. **[55:11] Speaker B:** All right, so this is all incredibly helpful. I'm thinking about people listening, and they're thinking, wow, this is phenomenal. I probably can't land myself in your office. So what would someone listen? Like, what could someone listening do today, this week to either find a doctor that can help them or what resources do you have that they can access even if they can't get an appointment to see you? **[55:36] Speaker A:** Well, so first, I'm a general neurologist. I work at Yale, and I'm in Connecticut. So I can see patients who are in Connecticut either in person or by telehealth, but unfortunately not out of state. I wish I could in terms of resources. So I have. I've started doing some videos on Instagram and YouTube. It's Dario ZagarMD just kind of getting started. But, you know, to your point, before I find every person I'm telling this to in my office is hearing this for the first time. Right. **[56:02] Speaker A:** And so it's like, how can we tell more people about this? Because this is something more people really need to know about. So I think that's why this sort of outreach is important. But other resources. Most people leave my office with a curable handout because they have a couple of great kind of explanations that are really good. **[56:20] Speaker A:** I have there are some videos. I usually try to give a smorgasbord of different videos, depending on what I think people will like maybe a video of Alan Gordon or one of your interviews or something else. There's the Lynn Health Program. That's another good one. So there are lots of good resources. **[56:38] Speaker A:** Howard's book, Howard Schubiner's book, unlearn your Pain that came out not long ago is great. So fortunately we have really good resources. And then in terms of looking for practitioners, I think it's the best is probably through the ATNS website, Association for Treatment of Neuroplastic Symptoms. You can find people in your area, either physicians or practitioners of other sorts. So please look them up. **[57:00] Speaker B:** Amazing as always. All of this is linked in the video description. I'm thinking of another amazing conversation I had with a woman named Devin Carter who does great work in this space. So I'm going to link that here. I'll be greeting you in that video if you're looking to learn more about recovery. **[57:15] Speaker B:** But Dr. Zagar, this is so phenomenal. I'm so thrilled to meet you. It has been. I've been on the edge of my seat. Every word of this is gold. **[57:22] Speaker B:** I'm so helpful, so grateful to you and the work that you're doing and for taking some time here to talk to people in my audience here. Thank you. **[57:30] Speaker A:** Well, thank you again for having me and again, thank you for what you're doing.