69. Dysautonomia and the complexity of clients with Stuart McDonald

Hello and welcome back to the show today. We have a very exciting guest. He is returning for his second appearance on her education. We have Stuart McDonald. Hello. How are you? Hi there. That's me. I'm Stuart. Welcome. Welcome. Welcome. I'm glad you can be here. It's so great to have you on again. If you haven't already seen or heard or read the emails that you would have received, Stuart is running his second program on her education. He has already done the working with trauma and women's health course, which was last year. I see. That we did almost a while ago. Let's see, here we go. We're almost right on it. Wow. Okay. That's scary. And this time we are running a course on dysautonomia. And I'm really excited to share about this one, because I feel like this came about when we had some conversation about some things that I was seeing in clinic. And it was like Stuart, you can help me with this and he goes, do you know what? I actually have so much to share about this topic. And we're going to hear all about it. So Stuart, anyone who's new to the show and hasn't heard Stuart speak yet. Tell us, give us a little recap on who you are, where you're from, what you're doing. And then I want to dive into a little bit about where this program has come from, because the story behind this, I think, is really, really relevant. And so many other clinicians will feel like the same way. Yeah, right. Yeah, yeah, sure. Well, me, I'll do a real brief one, because if anyone wants to know more, they can go to the other podcast. We've spoken a bit more about me. Yes, yeah. Briefly, I'm an AP. I've been doing work in as an exercise professional, like late 90s, and I had a keen interest in anatomy and physiology. My original degree was in human biology, and I taught anatomy and physiology in different arenas. And for like a long time, 20 years this year, actually, and I, well, we'll dive into me a bit more, but I do lots of complex work with clients, very passionate about that. So trauma, obviously, and dysautonomia, those two kind of, in my book, the way I see things, they're really connected, and then emotion. And again, they're all connected. It's all of our feelings and experience and stuff. And then there's musculoskeletal in there. I've done plenty of musk work in the past as well. So, yeah, and here we are. I wrote my own business, Interception Health, and I contract out to another mob. I'll give a shout out to them. I do a bit of work with bio, and they do some good stuff in this field. And I have had a bit to, like active health clinic, Nathan Butler helped me out lots when I was learning about how to manage this for myself. So there's been a couple of different domains that I've had kind of connections with. But a lot of it is just through my own journey that I've had to learn how to manage this stuff because no one really understood how to do the complexity of it. So I want other people to have that. Which will dive into that in a little bit in a second, but I really want to highlight, if you haven't had anything to do with any of Stu's content or discussions, I think he's a great example of the complexity that we deal with as clinicians or we can have the scope of practice to do, which a lot of people feel quite nervous and scared about. Something that I'm really pushing at the moment in my own teachings to people is we are physiologists and we should understand all the complexity around systems, how they work, and all the cellular interactions with that in order to then prescribe or treat or provide an intervention. And Stu's work is an excellent example of all this. Your stuff is so complex. Your little rap then was just no any even death and what it deserves because it's really, I think I think you were actually quite inspiring when I first met you all like, wow, there's got actually no so much stuff about many things that didn't even know about. And I was like, hopefully that's just because I'm not, I haven't been in the industry as long and I'll get there, but it was really, it was really nice to hear a clinician in EP that has very extensive physiology knowledge and then applies the exercise side based on that, which I think is what you push a lot in the things that you do too, and I want to talk about that because our industry doesn't, I don't feel like that enough. And I know and I know here that that that I think is also really helpful to people is I've always loved biology and human biology in particular that's ever since I was a young pump. But I've always loved it and then I did my degree and for various reasons I really struggled with a lot of the subjects. I loved it, but I struggled with them. I had diagnosed ADHD and a bunch of other stuff, so it was unmanaged and I really struggled with the learning of anatomy and physiology even though I loved it. It was a bizarre paradox. So then I got into the industry through personal training work and I thought I wanted to become a psychologist, that's where I was heading, I did a human anatomy and physiology and psychology. And I thought well I need to pay my way through psychology, but I became like a PT because I thought I've got all this knowledge of anatomy and physiology and I can apply that and not lose what I've learned while following my real passion at that point, which was a psych. And that's when I started learning it was that I had to apply this stuff, although I wanted to apply this stuff, I think that's probably a better way of saying. And so I working with clients, they come in and I'd have my textbooks out and I'd start flipping through, you know, I have my anatomy texts and I'm going through it and I had my physiology texts out and I'm trying to work out what's going on here, what's actually happening. And that's actually how I started to learn this stuff and then I went into teaching it to figure three up to advanced diploma level to other fitness instructors, personal trainers and massage people and my therapist and, and, and then sports and rec students and, and that that was the stuff that I started to apply with these people who were scared of learning. And that of in physiology, I realized, no, you know what, this can become real to you because you've got application here, that's what I think EPs, we should excel at this complexity, I think, and it can be complexity in one field or another, it doesn't have to be in my field, but the complexity of the human body, we're programming physiology all the time, we're manipulating physiology all the time, you know, whether it's the body building stuff that I was passionate about 20 years ago, or it's the corrective exercise stuff, or it's the clinical neurological cardiac stuff that we're talking about with this, this particular course, it's all about the anatomy and the physiology, we've got to understand that, and, and, and more than that, we're going to become passionate about how that applies to our practice, because, because that's how we create excellence for our clients. So, you know, really be on that, the field needs to understand that we are exercise physiologists, that's what we are first, it's a physiologist, and we need to reclaim that, we need to reclaim that, like, I could not agree, we are very much on the same page with this topic, which I love. We're on the top, we're on the same page for a lot of things with our careers, because we're also about giving our clients or patients, if you refer to them as patients, like, exceptional service, with this little set, and that's all we're trying to deliver also with this course, exceptional learning experience, where you actually walk away with some really solid skills. So, I want to talk a little bit about where this course came from, because you've got, like, quite a lived experience with disorder domain, and I feel like that maybe where this program started. Yeah, right. So, yeah, I do. Years ago, I, I was running my own movement in Polaris Studio, and it was my second one, and the first one I hadn't done the business stuff too well, and my account said you've got to, you've got to, you've got to close this down, you've got bankrupt in three years, and, and so we shut that down. The landlord wouldn't let us release the lease, we had six months left on it, so we had a mortgage, and then we had a shop front lease, which was the equivalent payment of our mortgage, so we were paying out the equivalent of two mortgages at the same time. At this time, we had a kid who had been born, a little baby who had been born, and then, 40 months later, he had a little sister being born, so we had two kids under two, then we got a third kid under under three. Whoops, how did that happen? And, and they're all adorable, we love them, but I had these three kids. This point, I'd gone back to do my masters as well, so I was trying to run a business, we had three kids under three, and I was trying to complete my master's while doing all of this, insane, and at the same time, I'd been freshly diagnosed with some stuff, put on some medications, and my body reacted to the medications really poorly, like really bad, no one listened to me, this comes into the story later. And really bad reactions to the medication. and then I just started getting tired and I thought I know what's wrong, I've got, I'm stressed out and I know how to deal with stress, I'm an exercise guy who specializes with anxiety and stress, that was kind of my psychosocial passion at that point and chronic pain. And so I thought the key to that is exercise, so I mapped out an exercise program, it was one of the best celebrities I've ever written, I reckon. This was in the ways when obviously outdoor obstacle courses reign supreme, tough mother and all that stuff. So it was my first one of those and I gave myself five weeks to get ready for it, I started training and I got worse and blew out of knee, I knew that was going to happen, I could feel it getting worse, did that on the program. And then a week later I couldn't hold my eyes, I was just fatigued, knocked out, I couldn't, I couldn't drive anywhere, I couldn't run clients, chronic fatigue, it's setting, it had actually been setting in for a while, I didn't realize it. Because of the stress mostly and because of the reactivity to the drugs, which turns out there's a mass selectivation syndrome and my body was reacting to the medications. I had mast incase and mast selectivation syndrome triggers a lot of the disorder, right, so we get all of this strange connections happening. So all of that was happening in my body, I got the chronic fatigue syndrome and then I started like fainting, I'd sit up from a chair, I'd just black out, I'd never had this before. I had the chronic fatigue syndrome but I was getting all of this dysautonomia with it and you get all your light and your sound sensitivity which is the CFS but I had all of the weird dysautonomia stuff. And so it took many years for me to recover from that and I had to find out ways to do it, I had some really great guidance from two professionals in particular. And they were really, really strong mentors and EP, so Nathan Butler was one of those and then another guy Peter Thornecroft who was a psychologist. And they guided me heavily through a lot of it. The third one that helped me was when I started to get out of it was Dr. Stephen Barlow with these change fitness protocols. Because what they did was they showed me that I had massive belief in a person's capacity to change in the assessment you do with the change fitness coaching. But I had terrible belief in my ability to succeed myself and what had happened was the chronic fatigue and the dysautonomia had just wiped that out of me. I didn't have any belief in it. Anyway, I progressed to go back into my physical training. I got myself better but I had to live differently, I had a new way of being. Because the dysautonomia would keep creeping up on me and then some other stuff happened in later years, we'd track forward. Lots of things happen, more medications that I went on that just cause a right in my body, several of them. Toxicity to one of them, massive, worried about kidneys, massive neurological concerns. And then another one was blood pressure and heart stuff. And then another one I got a heart attack and had a left bundle branch block. And so then I spent like nine months recovering from that. And I had symptoms of dysautonomia with that. It really triggered something bad in my body. And so I managed to recover from that using different protocols and exercise physiology stuff. That was really mindfulness work, restorative work and exercise. They're the ways I did that with nutritional and sleep. They're the kind of the things. Then I started working again and then I got a concussion, massive concussions from my own silliness. And I had this massive concussion to the point where like, I'd go to, I'd go to like stab the food on my plate. And the food would be here. I'd go to stab it and the fork would end up over there. And I'd be looking at the food and the fork. And I'm like, I just didn't have any motor control. And it was quite a significant concussion. And so then I got long, COVID. And I've wiped out for like six weeks of mine. It really just knocked me for six. I was dysfunctional. And all of my dysautonomia, my breathlessness, all of the fatigue, the tachycardia, all of that stuff kicked in, the dizziness, vertigo when I'm fatigued, heavy limbs, all of those things kicked in the gear. I recovered from those, but I had to get more of my electrolytes in. And then what happened was it somehow shifted it. And my dysautonomia went from being like this normal pot's kind of thing to being, I get dysautonomia in my legs. And it's just my lower body. My cardiologist says it's just, it's an atypical presentation, but it's clearly a dysautonomia. I don't get to necessarily get, unless I'm really bad, I'll get the precinct appeal, the blacking out stuff. But my legs just suddenly go, they feel like they're weak, the legs are not weak. But I get up out of the car and I just have to lean against something. It's like they'll collapse under me, but I don't get any of the other stuff happening. And it's very weird and very odd and it's not consistent. But it generally is to do with going from sitting to standing. I've been driving for a long time and then I get up out of the car. And I get all of that happening. And all of these things have been happening in my body, the chronic fatigue, the dysautonomia, the mass-selectivation. All of those things have been contributing to a bunch of shifts and changes. And I've had to really work out how do I create change myself? Because I've had, I've been ghastly, I've been, I've been not believed by so many doctors and specialists and, and, and I've had to really fight through through that process, but at the same time, I haven't been able to get anyone to help me out with stuff. And, and I noticed that all of the things that people would were saying you need to do to balance out the parasympathetic nervous system, get fabled tone up, weren't always working. And, and I, I'm like, what's going on there? I'm doing all the right. Even I might drop my heart right down, but I've still got the thumping of the heart. I've still got all these other symptoms concurrent. I've got blood pressure changes and whole, whole bunch of stuff going on. And so, so I have to try and deep dive into some of that. So that's where I've come from is this long and varied and very colorful journey with dysautonomia. Kind of creeping up on me and then not letting go and then changing its face and then having multiple things that will impact and cause the dysautonomia or exacerbate it or focus it in a different area. So it's pretty crazy stuff. So that's my journey, but it's really important to note that people who've helped me along that journey, the key people in particular haven't had lived experience with it. So they were able to help me and give inside and really helped me even though they didn't have at that time lived experience with these concerns. And I think that's really key that I can have a unique perspective and a unique empathy for people. And yet at the same time, I can coach others up and hopefully educate others to help people in the way that those key people helped me at a time when I really needed to. Yeah, and sometimes that's really okay for people to not have the lived experience. I think this is a conversation we've had before about. You feel like you need to have had some sort of dysregulated systems or you've got dysautonomia yourself. And that's how you can be the best clinician to help those people, but a great example is myself. I do a ton of work in endometriosis space. I don't have endometriosis, but the fact that I can understand it quite in depth. I understand the physiology. I've done lots of extensive research in it. I've seen multiple presentations across clients. Now where the exposure to other people's experience has helped shape how I can address other people's problems, I guess, or symptoms or how they live. So if you're listening to this thinking like I'd love to get into this, but I don't have a lived experience and I just feel a bit like an imposter trying to help these people, you it's okay. You can do so much because there's a lot of people who I want to say helping these people that aren't actually really helping them in the right way because they don't have the knowledge. So it's important to understand that you do not need to have lived experience to still be a really excellent clinician to support. Stu has a great example of those people that have helped you didn't have lived experience. Yeah, yeah. And that's a real turning point. I think for a lot of people is realizing that I don't have to have lived experience, but lived experience is an important thing for me to have in some cases. It opens doors for me with clients that perhaps that doesn't open for other people. There is empathy I can have in ways that someone who hasn't gone through that can't have. However, just because I've experienced it doesn't mean that my experience is the same as that person's and that that's really that puts me on the same ground as any other person, right? Because it's my body in my experience having this experience, I can't say that my experience is the same as yours. I just can't say that because I'm not you. I'm not in your context. I'm not embedded in your environment, living your life. I don't have your history. And so I can't say, I know how it feels. I can describe how it feels to me. And that's the same for any clinician. If the haven't had lived experience, they can't sit there and say, I know how it feels because you don't. Just like I can't say I know how it feels for that person. And you imagine what it might feel like and show empathy that way, or you can say, I've heard plenty of stories and I've read a bunch of stuff. And it sounds like this might be happening in your body, does that make sense? And I think that's that's the lesson I've learned is It can be surprising what happens in the body, and people have experiences that I don't have. Plenty of people get nausea and vomiting, you know, occasionally I'll get nausea when I'm really fatigued, but it's not a, it's not a, it's not a main marker of mine, and vomiting never, I've never vomited from my symptoms ever. And yet people, people frequently see me who have this persistent hyperamesis thing, vomiting all the time, and no one can manage it, and we've got to work out all the parameters that are going on there. How do you get electrolytes and fluids into someone when they're just vomiting it up all the time, and you know, all this stuff, and nothing works, and I'm dance trying to don't worry. Well, of course it doesn't, because there's a different mechanism that's causing it. You know, all of that stuff, well, if I had to rely on lived experience, then I wouldn't be able to help them. But what I've learned is I can be curious, what I've learned is there's such a multiplicity of things that can be contributing and anything can be happening, like it doesn't have to be written in the medication list that you get with the medication to tell you that this could be a symptom of the medication. If I understand physiology, I can go back and research that and say, this could be happening. That's an interesting thought, and that's why I'm so passionate about bringing people back to the physiology first principles, you know. In fact, when you do the course, when you sign up, you'll get a primer on physiology that I wrote up, just a real simple primer on three fundamental aspects of physiology that we need to recap and review if we're going to do good stuff in this field. And the reason for that is because that's our groundwork. It's all bounces off there, and my journey is one of trying to seek out in my body and then in my client's body's answers to the questions. Other people will have different journeys, but what it comes down to the end of the day is curiosity. You know, that's why you're so good with your work because you're curious about what's going on. You're asking questions about these women and why, why isn't it working, what can work? That's what makes a good practitioner is having that empathy combined with that curiosity in that wonder. Yeah. I am also excited to have the pre-learning material you mentioned. That's something we haven't done in any of the education programs until yours. And there's nothing worse than signing up to a course that you're going to do that's in a couple of months. And you're just excited and you want to start learning, but you've got to wait. So we've put together a couple of weeding like stews on the work and that are popped in the learning manual. Well, you said that badly. Yeah. Well, we did discuss it as a team, yes. But I think I said, well, we need some really good stuff to like visit before the program so you can start learning some things and like picking up on things because you're going to start seeing all these clients where you're like, oh, this is actually presenting like this. And maybe this is our disordinomial, which I'm excited about. So if you are joining the course, there's pre-learning, not requirements because you don't have to have been able to actually understand anything in the course, but it's really interesting stuff. I've had a little breeze through it and it's exciting. So there is a little like kind of like welcome lesson pre-learning lesson that's already open. But touching on, you will start noticing things in your clients. I would love to talk about the difference maybe if that's the right term to use between disordinomial and pots because I think I feel like when we were talking about this, I was just ladling around as pots. I was like pots, pots, pots, pots, pots, pots, but like this person doesn't and this person does. And then you highlighted to me that it was actually a type, like a type of disordinomial or it was not really-- [INAUDIBLE] What's the consequence of disordinomial? Yes, OK. Disordinomial. So that's a fuzzy line. And even medical professionals, it's a fuzzy line for a lot of them, the things they say, that pots-- it's a symptom or a series of symptoms that is a syndrome, which is a consequence of having disordinomial and it can come from multiple different reasons. So we often find people looking for an answer and the doctor says, well, it must be-- looks like it could be pots. We'll do a tilt table test and then it comes back negative. It comes back one beep per minute below the threshold. Oh, you don't have pots for-- so now my heart rate is sitting on an average of 89 beats per minute. I'm an otherwise really, really fit person, but every time I'm just sitting there in my chair, my heart rate is pumping 89 beats per minute, even though I'm training four times a week and I'm only 25 years old and you're telling me that it's normal for my heart rate to be sitting at 89 beats per minute when I just because I'm sitting around and talking and listening to stuff, and I'm feeling a bit out of breath, but I don't have pots. Well, the reason for that is because pots is just a designation. It's a category that we've given for changes that occur in the body as a result of the nervous system, not quite working the way that we want it to, given the circumstances. And even though it might be working the way we would expect it to, given the circumstances. So dysautonomia is a dysfunction of the autonomic nervous system when it's not functioning the way we want it to or when it's not regulating the body in the way we want it to. And pots is one way, postural orthostatic tachycardia syndrome is one way it can present where when you change posture from down to up, your heart rate goes up. That's it. As postural orthostatic tachycardia syndrome, and then we talk about, you know, it goes up and we don't have a drop in blood pressure, blood pressure stays the same, or your heart rate goes up and your blood pressure rises. Well, in that case, we've got a different kind of pots now, we're talking about hyperadrenergic pots. So we've got pots that's related to, we might call it hypofolimic pots, we've got pots, which is, you know, blood volume, but what causes the hypofolimia is because you've got stretchy vessels and connected tissue concerns, or is it because you're just not eating and drinking enough, or is it because you've lost so much weight that your body is now dysregulated and it can't manage the stuff. And so now we've got dysfunctional disorder to eat in that's going on there that's causing these concerns, or is it because you had a concussion and that impacted blood flow and caused some damage to the regions that control blood supply and activity, or is it because you've suffered from some kind of trauma, really complex trauma of a long period of time, this caused the disjoint in how your body manages and protects you in spaces. So there's all these other things it could be going on, is it mass-selectivation, inflammatory responses causing your pots, a whole bunch of things could be causing it. So pots is not disordered or autonomia, it's just one aspect of this autonomia. What we cover in this course for this autonomia is certain types of dys autonomia which are exacerbated by misaligned regulation systems in the body when you've got the static load and your body can't regulate stuff properly. So I don't cover all aspects of this autonomia, only ones that we're most likely to come across as it is in this world. I feel like, as you speak about all this stuff, there are so many clients that pop into my head that like some random symptoms and I'm like that's really odd, that's happening and it feels like something's telling you it's not working properly, it's kind of a bit potsy, like I kind of just think those people are like potsy people, but with weird different symptoms. I've actually spoken to you about one in particular who didn't meet the criteria for pots at all with the tilt test, she gets a bit fainting, but the weird fainting doesn't come with changes in heart rate or blood pressure really, doesn't have a sort of predictable pattern other than like maybe it happens that she's extremely fatigued. She has a history of endo, she's got a history of chronic fatigues in Rome apparently too, but the fainting thing was the concern because she said all I want to exercise, but I have to be wary about this weird fainting thing that I have and I was like yeah, I feel this is ringing a lot about me that it's ringing, yeah, but I'm like she's like I don't have hearts, everyone's doing all these like stuff but she's actually also had, she's got something, she just recently saw a cardiologist about a heart issue that she just like they've spoken before stories that come up six sessions anyway, like I'm like she's referred for pelvic pain, but I'm like I feel like we're not really working on that right now because all this stuff is like the barrier I've heard actually exercise to deal with this, so she's just like one person in mind, but like I feel like it's going to be a great case study, I'm going to bring her up, bring her up, bring her up, have a lot of this, I've never thought about this until just now, but I have a client who has extremely heavy painful fatiguing arms, hello, yeah, she's had a diagnosed chronic fatigue syndrome history as well and has no idea what this is except she has a lot of trouble when she carries her baby, she's postnatal, she's got a pro-lapse, like we're dealing with all that, and that's the barrier, she's like I can't do all these, every time I do these arms strengthening exercises like I can't do anything, is it a pro-lapse like vaginal pro-lapse or it's yeah like a pelvic organ pro-lapse yeah, yeah, so I'm instantly going hypermobility and pulse, yeah, right, that's where my brain's going with what you described there and they hit me arms, you know, we're looking at compression. Do you ever have any like blood pressure issues or like the pot, like no, like I didn't go pots initially. I was just like, oh, this is like, like a bit chronic fatigue or like something's going on. Yeah, yeah, yeah, yeah. Only in your arms. Yeah. Yeah, right. What are you saying about your legs? I was like, oh, my God. Yeah, yeah. This is like this. I don't know. So a funny story about myself when when I had my heart thing where I got my left bundle branch locked for the medications I was on, I went back to training and at the time it happened, I was actually lifting quite heavy and and I was doing much more hypertrophic and real functional training and and then I went back to training when I could and for about a couple of years every time I did only when I did biceps curls, say an easy bar biceps curls, preacher curls or standing dumbbell curls or a flat bench press, I would get an extreme heaviness intentionally in my chest and I'd feel like I was having a heart attack again and I thought going on my and my lips would go blue. That's so random. That's bizarre, right? And so I'd regulate myself. I do my horizontal body breaks and and I and I thought what's coming off and I reckon that what it happened was that two things probably was one was that I was doing those kind of lifts whenever what it was that happened to my heart happened and so my body learned that they were bad and it was generating these symptoms in me. And the second one was that I was tidying everything up and breathing and doing all these efforts. Right? In quantum curls effectively giving myself like like crazy, crazy dis autonomia symptoms. So I started to soften and relax when I do it and it all started to go away. No more chest pain, no more shortness of breath, no more blue lips, all of that stuff disappeared. And I was like like I look back on it now and I go well that's obviously what it was like if I had someone come to me today and talk about that I'd go well it probably sounds like there's some issues with regulatory stuff in your heart and your circulatory system we need to we need to look at how we're regulating that and yeah so that's I just thought of that when you were talking about that. I'm like so keen to reach I haven't seen this client fridge because she's like I need to go get some health checks on and like deal with a few other things I'm going to work on my lifestyle. I'm just not in a place to continue exercising right now. I was like yeah they were he's like that's why at the point I was like I don't know what's wrong with your arms like it. Not yet. I can't help you. And now I'm like I actually want to call it and be like hey just I'm actually speaking to you about it. Because she was like I can't carry my child at all like horrible right. I'm in like two seconds and that just gets this heavy pain. Anyway so essentially though what I think is really really important to notice is like there is this the type of things that client clinicians will start to go when they're hearing their clients say these things that are like they're going to start recognizing okay this is a regulatory issue it doesn't really matter what you have you don't need a solid diagnosis of pots to come and do these to use these strategies or whatever it might be. No, no, no, no. Yeah sorry okay. But yeah, yeah. No, no, but you mean like like I'm just thinking oh this if you're if you're getting clients and patients like this that you get this weed stuff like this will help us problem solve. Yes totally. And that's the intention of the course is it's to help you problem solve to realise that this autonomia is a multi-system event. So it's the autonomic nervous system is all over the body and it's regulating everything and and that it helps you the model that I'm putting forth is one that helps you realise that you can workshop solutions for most complex problems using these principles because the body is all about prediction and regulation and that's it the body predicts and it regulates based on the information it receives and when it can't regulate properly then we need to just teach it to regulate properly and that's what we're doing we're just teaching the nervous system to regulate itself. And so so that's going to be applying to so many clients across the board I mean in your context here a lot of women's health stuff there's so much overlap with this autonomia because it's to do with blood supply but it's also to do with inflammatory markers in the body which means that we're going to get excessive bleeding connected with it all we're going to have muscle activation associated with so we're getting weed vibes and we might have gone on fog maps diets trying to manage stuff and they didn't quite work and they worked for a bit but they didn't really and well that's related to this kind of dis autonomia as well it's also related to how our immune system is responding because the two are so closely that you can't set the body as you know I take an inactive approach we don't cover it in as much detail in this one as I do in the trauma course but but in activism is if you know anything about it when you do the course you'd be like oh my gosh it's like all through there because the idea we're talking about here is allostasis and and the body's reactivity to life which is just the body bringing itself back to kind of regulation levels to the status of thriving to homeostatic levels allostasis is the energy and effort that we need to do that and and it's using what we call active inference Carl Friston's work in the active inference modeling he's developed another people along the way and Bruce McCue and a few others and so we're looking into to how the body's regulating and updating itself all the time all the time all the time all the time that means that it's any client this could be affecting an impact to them right so the principles that we teach here can be applied across the board to anyone and really effectively and I would argue I might be biased I would argue that all the people should be training this stuff as it's just a base this should just be people should be going on board with this course I don't want to do it because I've already done it before like it should be such bread and butter but it's not and there's legitimately good reasons for that but I think we can change that and so you know I want to see practitioners going oh wow yeah this client this explains that weird thing that's happening to them maybe this would help yeah and it sounds like maybe I'm correct me if I'm completely off here but it sounds like a lot of chronic conditions can also be a beginning point for someone to go down that pathway and become very much so I hate like it's like you dealing with all this load from a chronic condition like it kind of intense a layer on and get worse and worse and then we end up with a sort of nomea types presentation yes definitely definitely whether that is complex trauma chronic trauma chronic pain whether it's just burnt out chronic injury and flammic conditions oh main flammatory to do conditions or you know the reason dys autonomia is such a big buzz word now is because of COVID we had long COVID happened and people realized that post viral fatigue is a thing and so now what we see is people get the dys autonomia then they have a viral infection could just be a common cold and then their symptoms get worse and they flare up and some people have them stacked one on another on another they just keep stacking and so they just keep getting worse no one's put the thread together but when you go through the history it's like oh there's a pattern here is infection symptoms flare up infections symptoms flare up so so that's inflammatory right what about exposure to environmental toxins it might be heavy metals or it might be molds that's that's what an infection is it's an exposure to an environmental toxin effectively a pathogen and and so we're finding that that becomes an inflammatory response in the body so so much of the work that we cover here is based around reducing inflammation and exercise is fantastic for that like it's fantastic the problem is the problem is that people dive into too much too soon but I think regulator and and my work sits in the gap between oh my gosh nothing's working and everything's working now I can start exercising so this work sits in the gap there getting people from here to here not always easy very often you're banging your head against the brick wall going what on earth am I supposed to do and always you come back to first principles and when you do that's when you get the results yeah yes and I think this leads perfectly into the ideas that exercise prescription can also do harm for some of these people if it's not done correctly which you experienced yourself in a sense of not getting the results you thought you were getting and things might have got worse and this is where I think exercise physiology really stands out because we're using exercise to manipulate physiology or improve it but it can also be a bad thing at the wrong time and we can it can do the opposite it's not always helpful exercise isn't always helped you straight away no I think that's important to know for this program yeah so and that's really important because the program is not teaching you exercise programming for particular conditions you'll we'll talk about exercise programming but we talk about it at a conceptual level and you'll be given practical tools but it's not always about the exercise prescription it's about it's about whether you need exercise or you don't and and one of the barriers I come up against in my practices people go oh yes an exercise guy I want to get back into exercise or the doctor says you're deconditioned you need to do it more exercise the fatigue is making you deconditioned so you need to do strength work and you need to do running and blah blah blah and that's wonderful the problem is that exercise Flares things up, right? It causes a sympathetic increase. An increased sympathetic drive leads to further dysregulation if it's not bound for parasympathetic stuff. And so I unpack a whole bunch of that. We look at the actual systems involved across this autonomia functioning. So what are a whole bunch of different networks that are involved parallel distributed networks that are making everything happen? We look at the anatomy of those, and then we look at the practical application of that, working with an exercise context. If I give a person exercise, what a few changes might make them get worse? How do I get them to the place where they can do enough exercise that they have chronic changes that are adaptive and positive rather than chronic changes that are maladaptive? So often they come to you wanting exercise and one of two mind sets will be behind them. The first one will be, I just want to get back to exercise. I used to do CrossFit. I used to run, do marathons. I love my growing. I love all the things I love. I just want to get back to doing it and how many days a week you're doing it. Oh, I'm still doing four days a week. And okay, and how does your fatigue level? It's terrible, I can't think. I'm sleeping all the time. I feel like I'm going to vomit for like three days of time and I'm fatigued and quiet. My heart rates to the roof. I'm always out of breath. I get dizzy every time I move, okay? But I've got to exercise because I'm going to, I've got to exercise because I'm going to, you know, those clients are the ones who've typically come to me from other practitioners who have gotten worse and they say this person said they know this autonomia. But I don't think they did. They were a lovely person and they, they meant well, but I keep getting worse. Or well-meaning psychologist, psychiatrist, doctors and physios are prescribing exercise, occupational therapists, prescribing exercise, but it's way too much. And they don't understand the principles behind exercise prescription, the recovery principles. This is where we come in. We have the tools to understand that. We just have to zoom out a little bit and realize that what we use over here, we can use over there. And that's what I want to do with this course is teach people that there are times when doing cardio is okay. Times when doing a graduated progression of exercises okay, and times when it's really not. And, and there are times when we have to progress it very differently to how we would for someone else. And those are the thoughts we have to understand. The problem is, thinking is a behavior from my book. A lot of people don't think that, but I think that thinking is a behavior. We think, and out of our thinking we act. So what I believe leads to my action. And so we have to get into our thinking in order to understand that it not does a clinician. And that's what this course hopefully does, yeah. There's a lot of thought behind all of the content in this program and how to live it. So it's definitely something that's very in-depth, complex. I feel unique in the way that we're learning and teaching. I'm excited, I'm excited. I feel like at this would be a good point in time to cover what we're actually covering inside the session. So I mean, it's hard to sort of know, yeah. But it's how it's structured. If you haven't already read any information about it, it's three live sessions. We're doing Saturday, two weeks later, another Saturday, two weeks later, another Saturday. And it's quite a longer session. So we're doing like a nine to 12.30 for like some really good getting into it and getting the juicy meat. And it's not after work when you're tired during the week. But I talk a little bit about maybe what you're covering in each of those sessions. Because you know, there's people that like to know, what are we actually like going to be covering? Yeah. Yeah. I'm actually going to pick out here. I'm getting grabbed out and we don't trust my memory. So that's not regulated. Regulated. Regulated. Even when it is regulated. I know. I know someone who can help you. We definitely don't trust it when it's not regulated. That's pretty easy. So yeah, so we've we've we've mapped out over three Saturdays, a fortnight apart, starting at the end of August, I think 26th of August. I think it is. And it is correct. Or 29th of August. 29th of August. I'm currently here on my overview that I've done for months. Oh, look at that. I've even got the dates on my beta pay page. No. So yeah, we've got three sessions. And they're about three and a half hours each. So it's a decent block of time. And there's a lot of stuff we go through. And session one, we talk about re-framing this autonomia through an allostasis lens. This is really cool. So we talk about, basically, understanding how the brain works, how the nervous system works. We talk about why that changes everything about how we approach this autonomia in clinic. We don't think of it in terms of, oh, the person's got a disease or a pathology. We think what if this autonomia is simply something to do with how the body is regulating itself? What if it's actually a normal response given everything? And if we understand the mechanisms of that response, we can maybe treat it differently and more successfully. So that's the first one we look at the autonomic nervous system as a predictive control system, basically. So a Bayesian kind of brain, talk about allostatic load. And we talk about maybe dysoromia. I was kind of saying it's a failure of predictive protocols in the body. But it's not really a failure of predictive regulation. It's more an amplification of regulation out of whack because something is unbalanced. So we talk about that. And then we do a brief introduction of the central autonomic network, so the hubs that are involved in that, the cortical hubs, the hypothalamus, the brainstem, all that. Then session two is the anatomy of dysoronomia. So there's a bias here. So in my work with people with trauma and then dysoronomia, I come across a lot of talk about vagal nerve stuff. And I was doing lots of apparent vagal nerve stuff. And lots of my clients are doing vagal stuff and it's not working. And they're actually-- We're humming. Oh, the humming. Humid's actually one of the most entry-level ones we can do for someone. But even that can be too much. If you're short of breath all the time, how are you going to help? And if you've got vocal issues-- oh, let's not go there. If you've got vocal issues, then we have to rehabilitate all of that. That's for another day. There's a whole bunch of patient stuff we can do around the mouth and throat that I do as well, which is really cool, but that's not for this cause. I love it. So I started-- this is where it kind of came from. I was working with clients and I got to be in my bonnet. And I went, I don't think what everyone's saying about this stuff is what's actually happening. I think there's some things missing. So I started exploring that. And sure enough, there was some things missing. So anatomically, we have some big gaps. And so this is central and peripheral neuroanatomy we look at. So we look at, again, peripheral distributed networks. It's not comprehensive. I've had to pick and choose. And by no means an expert neurologist in this stuff. I'm passionate about it. And maybe I know more than other people by virtue of my studying of it at this level, but there are so many people who know more than me, because that's what they focus on. The goal here is not to know more. The goal is to understand what we know differently. That's the key. So we look at the anatomy of what we look at. The central autonomic network pathways and their reflexes, like your borough reflex to chemo reflex. We look at respiratory autonomic coupling, which is a cool one, because a lot of people are talking about that. And I've got some cool drills that we do with that stuff, orthostatic control, as a whole body kind of problem. So I'm looking at the neurological stuff that's going on there. Then we look at the vabel pathways, vestibular pathways, them are regulatory stuff. There's a whole bunch of pathways. We unpack what's going on with the central autonomic nervous system that can disregulation. And really what I'm trying to do with this stuff is get away from the idea that this autonomia is because you are only in sympathetic drive and your vagus nervous system is suppressed. That's probably a true thing for you if you have dys autonomia. But that is not the answer to it all. It is a powerful part of the answer, a massive part of the answer. Well, what happens if you're working with pelvic stuff? The pelvic stuff is not controlled by the vagus node. That doesn't get vagal supply of parasympathetically. It gets spinal phallemic and spinal supply. So we need to think about, well, how do I regulate that stuff? How do I work with that side of things? Well, anatomically, how do we do that? And that's where I think the women's health stuff comes in just beautifully. And then we're looking at physical stuff. Then we have to look at the neurovascular supply, right? So I think people don't talk about is nerves are supplied by blood. If we have dys autonomia that affects blood supply, then of course, we're going to get problems with nervous stuff. Receptive signals are not going to return to the brain. We're going to have emotions that are different or blunted or we're not going to feel that we're hungry as well and understand those signals. Even though more of those signals are occurring from hormonal stuff than your neurological, this is going to be traveling back to the race. Oh, bunch of cool things. We don't cover all that detail, but we look at the anatomy that could be impacted on why certain interventions are important. That sets us up to use particular interventions that I will provide certain exercises we can do, are certain. ways of thinking about applying those exercises. And then the third day is phenotops and their physiology. - Yes. I feel like that one makes me feel excited. Like I feel excited by the whole thing, but I'm like, I love when you learn about the different variations of things that you've never knew existed. You're like, oh, this is a type that I didn't know. It was like, actually, class of, like, kind of. - All right. - This makes sense now, right? This makes sense. - Yeah. - This is where I feel like, when we spoke first, you were like, the phenotops are like, there's phenotops. - Yeah, totally, totally. And here's the cool thing, right? So with pots, we mentioned pots earlier, there's phenotypes of pots. But this one is about phenotypes of dysautonomia. So this is really cool. We've got like neurovascular dysregulation and your orthostatic physiology, or you've got your, you've got your, small five in your upper teeth, your blood flow and all distribution things. But there's also gastrointestinal phenotypes and splank-next stuff. Then we've got things like mass-selectivation, immunology, have had effects that there's a whole bunch of different phenotypes that we can be looking at there. So exploring what they are, neurovascular gastrointestinal, you think about your structural phenotypes, maybe more related to your hypermobility and your EDS, hypermobility spectrum disorder and EDS stuff, so that comes into play as well. So yes, there's a bunch of phenotypes and that one becomes really, really practical. So we unpack the phenotypes. We relate it back to the anatomy. We relate it back to the central autonomic network stuff that we talked about because it's multi-system. Stortonomia definitionally is multi-system because the autonomic nervous system is throughout your whole entire body and as involved with regulating all the stuff in your body. And so phenotypes is where it becomes really super practical. That's an exciting session that last day. It's really exciting because it just brings it home. It brings everything together. And we really unpack some case studies around it. We unpack how to prescribe, how to problem solve. Because if you can problem solve well, then you can exercise, prescribe well. So, or treat well. Yeah. - All right. - That's a good question. - It's not very normal. - It's going to be very exciting. So it's about, so it's about 10 1/2 hours of face time. Learning, plus there's a lot of other resources that are coming in the inside of the portal. We've got the pre-learning. Everything comes with a learning manual. So we've got like the theory stuff. - Massive learning manual. Like, it's huge. - It's massive. 100, almost 200 pages at this moment. - I was going to read it and they're like, ah, I might have to just break this up. - Yeah, yeah. The manual has a lot of this. It's just not just an overview. It's not just a heading with blank spaces. I've written content. So it's like it's my textbook. - It's awesome. - So yeah, yeah. And the sessions will be more overview based. And then if you want to go back for detail, you go back to the manual. And it's referenced. So it's not just me making stuff up. Although I can do that if you want, but. - You would be very convincing. (laughing) - Sometimes I think people do make them up, but anyway. - That's a whole lot of conversation. But no, the learning manual is something that we're passionate about here. The education platform because I hate slides that you just get the picture of the slide and then you have to write your own notes and you're frantically writing everything down from the session and you can't pay attention. And it's just not as great. I want like a book that goes with everything that I can listen and watch and then revisit the book and learn more about the stuff that you don't cover as much in depth in the live stuff because we can't get through everything. So yeah, there's all of that in there. We have the private discord group for the actual program that's running live. So that you come into the disordered Nomea group and we can ask questions in there to stew throughout the whole in-between sessions as well. Learning happens outside the session. We know that as well. So that's also part of the program when you jump in. But it's going to be delivered live. So the registrations are open. And they will close off the day before, which is the 28th of August. And it will be delivered live. You will get all the recordings. You will have access for a year. There's quite a lot of content in there. So we have the learning portal open for a year to revisit and re-watch things. But otherwise, if there's anything else that you think you might want to tell people about the programs to you or if people are on the fence thinking about whether or not this is something that is actually relevant for them or if they're worried maybe they don't have enough background information in this, because it can feel like this program feels quite complex for people. And I think they might think they don't know enough about it to even come into the program. So that's something that I do think is also a bit of an issue within the industry of like, I don't know enough about this. We'll see this many people yet. Is this actually valuable? And it's everyone's welcome, really, in my books. But is there anything you'd like to say? There is, yeah, there is, I'd like to say that. I wrote this as an educator, where I've taught stuff from a year 10 level in anatomy and physiology and sports and recreation, doing vet teaching, and then certificate two, certificate three, certificate four diploma and advanced diploma and then tutored at a university tertiary level as well and developed programs in concert with universities. And so my understanding of education is across a massive spectrum of education. This is written, is designed from the ground up, not as a clinician coming in to share all of his knowledge or assume that people know where he's coming from. This is written as an educator, a constant educator, a professional educator, 20 years. I've written this from the ground up as an educational course. It starts, it's complicated information and it assumes knowledge because you've all got at least a master's degree in anatomy and physiology. So there's assumed knowledge, but it's written to introduce you to the information and to walk alongside and grow you as you go. So if you're scared that you don't know us enough, well you're the perfect person to come into these course. That is you. Like come on in, please. Because we're gonna learn together. I'll still be learning stuff. I have to be renewing it all the time. You're gonna have questions that I don't have answers to or questions that I do have answers to that I didn't know I had the answers to because I have to think on the spot. There's other people who are gonna learn from you, other people who are scared. And together we're gonna go on this journey. That's just the way this thing works. And this is the inaugural, you know, this is the first time we're running it. It's at a cheaper price. This is part of a larger program I've got, but Courtney and I were like, we just wanna get this out there. And I wanna get your listeners and I wanna get your people looking at it because it's so important and it can apply to what they're doing in so many ways that we can really create change in people's lives that maybe didn't realize we could. And so yeah, if you are scared of helping on body, it seems overwhelming then come because we've got stuff to teach you. I've developed all of the anatomy diagrammy stuff like all the networks. That's my own work. I'm like, it's designed for this course. It's time to teach you in the clearest way I can possibly think so that you become equipped because I want clinicians to be better. I want humans to get better at the hands of great clinicians 'cause I believe so fervently in what our profession can do. And I think that we're not doing it well enough and I hope that this can be just one more piece of the puzzle to lift us all up. - Well said, well said. And I think that's what our industry needs is like some really solid clinical programs just like this to really help people level up their knowledge, their skills and their confidence. And I think something that we are also trying to strive for, I know I am especially in all my programs is a really safe learning space for people where you're not feeling judged by asking questions or if you have no idea what someone is explaining. You can say, can you please explain that in a different way because I don't get it. There's so many times I've been in rooms where I'm like, I'm too scared to even ask for them to change the way they've described that because I feel like I'm being judged. So I just think that's not a nice place to be learning. So we've got really safe space to ask questions and learn and be curious and maybe even present some of your own clients that you're struggling with and get some help on them. Like it's a really safe space. So we welcome anyone. We'd love to have you inside the program. If you have any questions, you're welcome to shoot myself over an email or hit me up on social media. Stu, I'm sure you'll answer them too. I'll put our contact details in the show notes for this and all the links appropriate for the course. If you want to learn more about it, hopefully this is all given you so much insight into what we're launching for the program and what to expect. 'Cause I think if you're investing in your education, it's really important that you know what you're signing up to and what to expect and that you're getting what you want out of it, essentially. - Exactly, yeah, yeah. - Anyway, I think that's probably all that we need to cover. Thank you so much for jumping on the shows to it. Once again, I'm really excited to get stuck into this program and learn, I'm going to be learning a lot. know that. So I'll be asking all the dumb questions. I'll tell you that. And yeah, thanks again for coming, it was so great to have you on the show. I love being here. It's great. You're doing great things, so thank you. And I look forward to seeing whoever we end up seeing. Yeah, yeah, we hope you join that join the program. But if we do really appreciate you, even just listening to this and being here to support what we're doing. So thank you. And we will see you in the next one. Bye.