Peptides and Sports Injury

Neil Paulvin, DO

Oh, pleasure. Thanks for having me.

Matthew Cook, M.D.

Well, so we’re gonna talk a little bit about sports medicine and we’re gonna talk about anti-aging and we’re gonna talk about complex illness. I thought we might jump in on some of the things that people are doing in complex illness and we got a chance to chat and we’re having a great conversation just about biology and strategies, so doing things. And so then, I was real interested in, you were telling me, we were talking about how to deal with patients with pain, muscle pain, Lyme disease, and you were telling me about a strategy of using a peptide GHK and combining that with frequency specific microcurrent. And I think that might be something people are gonna find interesting and unique. Tell me about that a little bit.

Neil Paulvin, DO

Yeah, sure. No, I mean, it actually started somebody, a patient had tried so many other things without really any great improvement and they linked up with one of the big doctors in FSM or frequency specific microcurrent, and they tried several peptide and they found the ones that were given in the most generally for the most common problems with Lyme was combining GHK with TB4, Thymosin Beta 4, TB 500, which is more rarely a available now, as well as some patients are actually using some combination of Calan for some of the brain symptoms or anxiety related to it. And what they’re doing is they’re doing the treatments anywhere from three to five times a week, the FSM treatments, and then they are either some patients are doing injections very close to the area of their irritation. Some patients who have very systemic symptoms are doing the typical subcu abdominal injections, patients who are in near a doctor’s office are getting injections much more invasively depending on what their complaints are in terms of in joint or into the fascia. They’re getting neurotherapy if it’s a nerve issue. Some combination of that as well. Again, unfortunately, patients of Lyme have complaints all over the spectrum. So you kind of start with that core protocol, especially with the GHK and the FSM. And then you kind of build out depending on what their specific the problem set is.

Matthew Cook, M.D.

I was really interested in hearing that, we’re not doing a lot of FSM, but we have a lot of other electrical strategies that we use in the office. And one of my sort of defining ideas I think is that if you can put something in a tissue, then what’s gonna happen is that’s gonna work its way through the lymphatics, and through the connective tissue, back to the central circulation. And we know that GHK is really a great peptide for connective tissue. And so then when I heard that, when you said that I go, oh, that makes all the sense in the world. And then if you can, and I’ve been working on this myself, quite a bit of putting GHK and TB4, also good for connective tissue into a fascial plane. And sometimes we do that with hydro section. A lot of times we do insulin needles, but then using electrical strategies to help move that through connective tissue makes a lot of sense, particularly for complex immune problems like Lyme and mold. I know you take care of patients with Lyme disease. Tell me a little bit about your philosophy on Lyme disease and how you think about it.

Neil Paulvin, DO

I mean, there’s two pieces to that. I mean, Lyme is such a complex illness if patients especially have had it for a long period of time, it just affects every hormone and hormone system. Everything from joint complaint, immune complaints, they get CBO, they get, I mean, they just run the gamut. So it’s really trying to initially, trying to addressing all those in as simple ways you can. That’s why peptides are great, because a lot of them will check, will check off multiple boxes for the patient as opposed to giving us something for each specific issue. The thing I’ve learned and other practitioner really realize is you really need to go low and slow. Everybody thinks more is better, with Lyme patients, I’ve usually seen in the opposite where, the higher dose that you give, somebody like that di Hexa, they will have a mass cell reaction or combination of both, or they may, and they’re like, what did just happen? I feel worse. And it takes them another month to six weeks before you can start over. I mean, I really start usually regulating their immune system, Thymosin alpha 1, some other type of supplementation initially to get things regulated. And I may give them Thymosin Beta 4 if they have severe pain. 

And I may address their brain fog either with , di Hexa, I’ve had really good success with my Lyme and mold patients with di Hexa, which is a cream, as opposed to giving them another injection or IB they have to deal with. And that’s my starting point. And then we’ll kind of march through the individual steps, will raise their dosages as much as they can tolerate. And then I tend, the ones I will add in later on would be LL37, which I really like, I’ve added in KPV in some cases, either injection or orally, depending on what their gut health is. And then I may even add in GHK, which you mentioned or Melanotan-II, if the brain fog’s not, I love Cerebrolysin in the sense again, ’cause it can help with neuropathy. It can help with some muscle pain. It helps their brain fog. Again, it checks off multiple boxes. It’s just a more complex treatment regimen for patients that you’re not treated locally, that some patients aren’t gonna give themselves a shot every day. For that 20 day, I usually do like a 20 day protocol with them. I’ll probably space out a little more again to see how they respond to it initially. So really, I love adding things in, like red light and LDN and things like that, kind of mixed match depending on where they’re at.

Matthew Cook, M.D.

Okay. So that was entire integrative approach to Lyme disease. And in two minutes, that’s a good one, but then, I like all of that. And so then that’s interesting for people to hear about and think about because within, someone comes in with Lyme disease, that’s such an interesting one because, it runs such a spectrum from debilitated. Can’t get outta bed with overwhelmingly intense symptomatology to a relatively mild fatigue, low energy pain and mild brain fog state. And so then I also have seen that it’s important to start to put small inputs in and see how people do so that you don’t do anything too overwhelming. And I like how you’re covering a lot of the bases working on the brain fog with di Hexa, working with the immune peptides kind of low dosing, trying to develop some strategies to help with pain and musculoskeletal stuff. If you could only do one thing for somebody with Lyme disease, what’s been the most profound impact that you’ve had for those patients?

Neil Paulvin, DO

It’s one, it’s still the immune peptides initially, because if you don’t fix, that’s kind of the big ping pong ball or whatever analogy you want to use there. So if you don’t fix that, you’re gonna have a hard time fixing everything else. A gut would probably be, I see so much, a gut’s involved in so many different systems that that would probably be second, but immune system is just, is the big ping pong ball.

Matthew Cook, M.D.

And so then, a lot of people will say, and I found this, that one trigger for triggering problems with Lyme disease is often gut problems. And so then we’re always looking for strategies to improve and heal the gut. And so one of the things, and you mentioned was this peptide KPV, which is one of the few peptides is actually available in an oral form. What’s been your experience with that, both kind of it as an injectable, and as an oral, both kind of in Lyme disease and in general.

Neil Paulvin, DO

I love it as, I like it as orally better than injectable, unless I’m doing it as an add-on. In terms of somebody’s arthritis is not my number one go-to, but in terms of Lyme patients and patients who also have that autoimmune component like psoriasis, I love it. And now they make it in a cream as well. So again, you can mix match, but in terms of orally, I’ve seen some really great success in, again, Lyme CIBO, which tend to, it’s an overlap syndrome where I kind of call like Venn diagram syndrome, everything just kind of merges into one thing, and ’cause it hits so many different things, it’s gonna hit mass. So it’s gonna hit any type of, if there’s a CIBO issue, it’ll hit mold, it does everything in one thing. So I’m really success with that. So I like it more orally. I tend to push a dose a little bit, but that again, that’s something you need. I’ll put the caveat out there and make sure you discuss that with your doctor. I tend to push a dose when I see that it’s working with people ’cause I haven’t seen really major side effect with them.

Matthew Cook, M.D.

What sort of dosing will you do orally?

Neil Paulvin, DO

I mean, depending on the patient, I’m either going to maybe even three times a day as opposed to twice a day, or I’ll even go to a couple milligrams higher than the recommended dosing. Depends again, depends on the patient, their weight and what’s going on and I go baby steps with it, but I tend to be more graphic ’cause I’ve found it works well. And again, I don’t love using BPC in line multi patients as my first go-to and TB4 has been harder to get. So KPV’s kind of really filled that niche.

Matthew Cook, M.D.

And there are some formulations of KPV that come with BPC. Have you liked those or do you tend to just do KPV by itself?

Neil Paulvin, DO

When I do with any combos, especially with that type of, dependS. If it’s somebody who just has arthritis, I’ll use it if I can find it, it depends on peptides, it’ll come on every conversation, it’s such a state by state issue now, ’cause certain forms, every form only ships to certain states and the rules are all different, where I can get it. I love it for joint. I don’t, in terms of some of your chronic illness, I try it everything separately. And then if they work, we figure out what their happy dose is, then I’ll do it that way.

Matthew Cook, M.D.

Yeah, that’s a good one. We were talking about a little bit in our pre-talk about BPCs and it is what a lot of people would really love it and has been probably one of the more famous peptides. But interestingly, some patients who are immune patients will have some mass cell symptoms with BPC. Sounds like you’ve seen that as well.

Neil Paulvin, DO

Yeah, as I mentioned, I see probably in a quarter to a third, I mean, it’s hard to tell exactly what it is, but they have that either brain fog or they get gut or bloating issues or even some neuropathy symptoms. And I just take, I say, look, I tell them, now I’ve tell them ahead of time. If you get it to stop the medication, let me know what’s going on and we do something else. I’ll proactively give them something, everything from either , if they’re more prescription person. So we go kind of one or the other, it’s kind of protect both of us. And that sometimes works, I mean, I’ll even go use Chromelin if I have to, but again, it depends on the patient.

Matthew Cook, M.D.

Now when we talk, if the next, every time you talk about Lyme, you probably gotta talk about mold, and what’s been your experience of patients who are struggling with mold. And how do you think about it, and how do you think about peptides for patients with mold and how it impacts them.

Neil Paulvin, DO

Mold, it’s kind of, I still view it as kind of the second or third part of the spectrum in terms of treatment of mold patients initially. I mean, mold, especially as you gotta get out of the space, you definitely gotta do the whatever binder happens to work, get the testing done. So that’s always that first part. I tend to, and also it depends what the lab work is showing me, if there’s, I can between their symptomatology and how good or bad their lab work is, especially like their alpha MSH, their C3, C4A. If those are through the roof or their inflammatory marker are through the roof, then tend to be more aggressive with the peptides initially, again, using something like a KPV or TB4, again, as opposed to doing the BPC, the brain, the part that I probably will jump in first with is again, if they have a brain fog issue, which a lot of them do, unfortunately, some very severely, I use it. And I also, again, I see more and more now that have a lot of bloating and weight gain, and these are sometimes the patients say, look, I’ve tried everything under the sun for weight gain, I’m gaining 20 pounds I don’t know. And I say, have you been supposed to leaky or moldy building? Oh yeah, I did. That happened to me a year ago and I did some bond, I thought it was done. 

And then, so I’ll, again, we have to address the gut and again, KPV kind of jumps right back in there and I’ve had again, minimal side effects and it’s worked pretty well. And again, it addresses MSH and stimulating hormone. So it does a lot of things there. And then on the back end again, once they’ve been cleared, the more condition’s been addressed or is being addressed, then you can, VIP is I kind of call Ferrari in the sense that, it works incredibly well and patients heal really quickly. I have also used in some Lyme patients, or unfortunately it’s kind of like a Ferrari out of control and some patients have actually regressed. So you gotta be, some people wanna do mega dose VIP, that’s what’s out there in some groups and stuff. I tend to be, that’s one of the ones where I kind of go much more controlled with on the back end, just because I’ve seen either great effects or I’ve seen some people go back, take a major regression with it. So I tend to be a little more careful the most with it.

Matthew Cook, M.D.

How do you like the dose, the VIP?

Neil Paulvin, DO

I tend to, I mean, I know some people do it up to four times a day. I’ll tend to do it up to, I’ll set patients either once or twice a day, depending on where they are in their whole spectrum of where they are in terms, and also how many symptoms they have, and I’ll tend to do low again, low dose progress on every, I tend to go biweekly and see where they are. And I tend to either me or my health coach will check in with them and I know where they are, because I’d rather, again, with my antiaging patients, I’m very aggressive, it’s very weird dichotomy, antiaging patients, I’m very aggressive, Lyme, mold, Foxy patients. I’m very conservative initially. And then I push and push and push.

Matthew Cook, M.D.

Yeah, that’s kind of a similar strategy that we have. And then, and I think that goes along a little bit with the Shoemaker idea of working on getting people through those initial hurdles. And then once they’ve stabilized and kind of started to improve then, layering in kind of the VIP near the end of the therapy. But now you mentioned what I personally consider to be potentially one of the most challenging things that I’ve actually faced in my career is taking care of patients. And I’m super interested in this topic, the FLOX patients, patients who’ve been damaged by taking an antibiotic, the Floxacin antibiotics, Cipro would be kind of a classic one. Tell me a little bit about that one ’cause I loved hearing that you’re doing that and like to kind of hear your thoughts about it.

Neil Paulvin, DO

Yeah, I mean it’s become bigger and bigger population. I think more and more people are becoming aware of it, which is good. It just, unfortunately, a lot of doctors say, I know I’ve had literally 10 patients in the last month come to me and they’re like, my doctor now knows what it is, but he’s like, I have no idea what to do. You need to find somebody who knows what they’re doing about it. So that’s been addressed over the last year. So when doctors even know it existed, really didn’t believe it. In terms of treatment, like I said, that’s something where I see a complex of usually six parts of it. There’s the anxiety component of it. There’s the muscle joint pain component of it. There’s the severe tendinopathy fear of rupture, which is unfortunately a lot of patients, that’s what they’re most concerned. That’s their most fearful. They see stories about people just spontaneously rupturing their Achilles or the ACL or that’s what they’re afraid to even leave their house, which is part of the issue with it a little bit. So that’s you have those issues, you have mitochondria issues, a lot of severe neuropathy issues. Then you have the fatigue issues. So the main thing I try to do initially again, is definitely try to detox as much as I can. Again, the basic things obviously need to be aware, no NSAIDs, no NSAID, no steroids and no PPIs or proton pumpings like protons or Nexium or things like that. ‘Cause those can set you right back in some fluorinated inhalers that you gotta get them on that baseline first. 

And then like I mentioned, I definitely will address the inflammation is usually is gonna be one of the big issues because that almost everybody has in the tendinopathy. The tendinopathy is an interesting component because if it’s somebody I can see in the office, I can usually either do an IV combined with doing what I call either Paranal injections or you probably do hydro dissection, or I can go in there right with either doing what they call sugar water or the old school dextrose injections. Or you can mix match that with either do protein or with some of the peptides, either GHK, which we talked about before TB4, cerebrolysin, even that, or low dose BPC and you can mix batch there. And then, like I said, the mitochondria, I’ve had decent success by combining the nutrients, I need things like with Vero carnitine and things like that with the mitochondrial peptide, such as or NSS31. And then if I can find, and I’ve seen some decent success with too, but again, so it’s really that one, there’s just so many components. And that’s one where I compare it to a safety deposit box where you kind of have to turn all the keys at one time to certain degree. Otherwise, if you just treat the tendinopathy, you don’t treat the mitochondrial issue or you don’t treat the muscle issue, you kind of are just chasing your tail in some regards. So you gotta be cautiously aggressive there.

Matthew Cook, M.D.

Okay, good. You gave me a bunch of questions that I can ask. So then humanin, and I love humanin. Have you seen good? You’ve had a positive experience with humanin and the patients?

Neil Paulvin, DO

Yes, the right time. Yeah, it’s not my first go to, but it’s definitely second or third tier.

Matthew Cook, M.D.

So then that’s mitochondria. So that’s a good one. I am friends with John Liftoff who developed perioral injection therapy, used to be known as neuro prolotherapy and had him to my office. And we had a bunch of fun doing hydro dissection and talking about sort of that whole concept, the idea being that you could do injections with 5% dextros that would go close to a nerve. And that being an approach to putting something by a nerve that would be therapeutic. The idea being that if a lot of patients have impingement, they may get decreased blood flow and then decreased glucose. So he would call it glucopenia around nerves. And so then he would be putting dextrose there. How’s your experience been with that in the FLOX patients? Have you seen that to be helpful?

Neil Paulvin, DO

PIT?

Matthew Cook, M.D.

Yeah.

Neil Paulvin, DO

Yes, I’ve definitely seen for patient of localized issues, I’ve seen, especially around the Achilles, like peritonitis or pertendonitis, I’ve seen really great improvement pretty quickly. Or the typical I call it, it looks like a hand on the knee, with all the different nerves that go around the knee, it works incredibly well around in the legs. I’ve seen great improvement, so yeah, overall I’ve seen really, it’s very simple. It doesn’t hurt the patients really at all. If you’re doing good injection skills, it’s pretty simple to give them some pretty dramatic improvement somewhat quickly. I like combining with, again, things like red light hyperbaric to kind of augment it as they go on or even, but it works really well.

Matthew Cook, M.D.

Okay, yeah, it’s interesting ’cause we do a lot of hydro dissection around nerves and the first thing that people were really using and including myself was 5% dextrose. And so then, one and interestingly, I think one, so many people are doing peptide injections now with insulin syringes. And so then I have some people who are doing sort of their own injections kind of with a peptide injection, but with 5% dextrous. But I found that those patients respond quite well to . I found that they can respond to peptides as well. And so you’re using GHK and TB4 for them. And I think that those make a lot of sense because TB4 has some peripheral neuropathy benefits and GHK is great for connective tissue. How often will you treat somebody? How often or how do you think when you treat with the peptides for the FLOX patients?

Neil Paulvin, DO

A perfect world, when I can get them into the office, it’s I try do once a week, at least the first month, I also tried doing the IV, not the IV, doing cerebrolysin as well, sometimes with the patients as well, starting to dabble into the and things like that too. But I usually try to do it like once a week, at least for the first four to six weeks, and then reassess where I am and then go from there.

Matthew Cook, M.D.

And for the FLOX patients with the anxiety, because that’s interesting, I’ve really seen what a profound anxiety those patients get. What’s your approach to that?

Neil Paulvin, DO

It’s a combination. I mean, I check their lab work, we check their again, see if they’ll have a mass cell issue. So you gotta control histamine, I check their B6. And then a lot of times it be either will work on their GABA. I love thine and phosphine and now chew kava, any type of kava product I found really good. , some people either work or they just don’t do anything, one or the other. And now I’ve had, and then same thing with C lines type of combination. It either works really well or it doesn’t move the needle. So it’s kind of hit and miss, I just, I know, unfortunately I’ve had a couple patients that go on and 80% of the time they get worse ’cause they have a reaction to it. That’s kind of the rub to it, at least initially, I’d want. So it’s kind of a balanced sake there.

Matthew Cook, M.D.

So I wanna echo those sentiments. I like your thinking there, because for, I think for Lyme and mold and the FLOX patients, these complex patients compared to antiaging, healthy people for that, for the health people, with almost no problems, everything works, and for the people with a lot of problems, often you may have to work your way through a few things in the protocol and what works for one person may not work quite as well for the other. And so finding that the diversity of products and then finding what works for the actual, for each specific person is I think the challenge, but also holds the secret to probably success, would you say?

Neil Paulvin, DO

Oh yeah, everybody, like you said, the antiaging patients is kind of more cookie cutter, but this is you have to have a whole shopping cart for them, otherwise, and you have to let the patient know that ahead of time too. I’ve learned that now you say, look, first thing may not work, don’t get disappointed. We have five other things in the toolbox that are there for you and just let me know. I think with the patient to understand how the process is gonna go, that also makes things work a lot more smoothly. Otherwise, they get really frustrated and they tend to go down the rabbit hole a little bit too much.

Matthew Cook, M.D.

Okay, so then let’s say I’m an anti-aging patient, actually, so I wanna come see you. What would you tell me? What’s your thoughts? What do you think we should do and how do you like to put that together for me?

Neil Paulvin, DO

Okay. Let’s flip the brain here. Okay, so antiaging patients, again, that’s totally different spectrum, I mean, again, a lot of times we’re working, I mean, no matter what, we’re still working on inflammation, but that’s again where we’re going more. I mean, I love again, BPCs gotta be part of your, ’cause it does so many different things between, it has an effect on growth hormone. It helps heal the gut. It helps the brain. So it does so many different things. BPC is definitely a component. I love, again, I’ll use TA1, to use high dose TA1 in the patients who can tolerate as more of an antiaging. Again, mitochondrial health is so important now for every component, both for general health and longevity, as well as preventing neurodegenerative issues. So I will pumble them with mitochondrial peptides, I’ll have them do some combination of cycle, either a mod C with humanin or patients who are really aggressive will do SS31. SS31, again, I don’t think is as fine tune as ready for prime time as some of the other mitochondrial peptide yet. And then, I’m a server licensed junkie, I’ve mentioned it several times already. I think it just has so many brain benefits to it. That’s my core and the last one, if they’re ready for it is a Pilon, which is a, in terms of there’s some studies. So it may affect Teleme length which may or may not have relationship aging. That’s kind of still from everybody I talked to, still disputed where the direct relationship is, but also works on circadian rhythm. It helps regulate the Pino gland, does all those different things for you. So I like doing usually a 15 day round of the patients with the Pilon, but again, I always ask the patient, how many needles do you wanna keep yourself at one time? And then we kind of cycle things. I always start with the MOS and the BPC are usually always a great place to start and then kind of go from there.

Matthew Cook, M.D.

Yeah, I like epitalon as a bioregulator. And I also have found that it works nicely for circadian rhythms. A lot of people will tell me that they will sleep really well with that. And so then that one’s an interesting one because there’s some protocols where you do a lower dose and then you can do a lower dose over time as part of taking with other bio regulators. And then there’s also some strategies where you do high dose, maybe a couple times a year.

Neil Paulvin, DO

Yeah, like the 10 milligrams.

Matthew Cook, M.D.

And so then you could do a low dose might be a milligram a day, a higher dose 10 milligrams a day. And so then, but I think that that’s one that I’m gonna keep my eye on in the years to come. ’cause I think that that is something that people really feel good when they’re taking. Now in addition to antiaging stuff, you’re working in sports medicine and using peptides. Tell me your experience there.

Neil Paulvin, DO

I love them. I mean, again, I think we are early conversation, unfortunately, a lot of them I’ve for my hiring athletes, they’re pretty much banned. I think they just took BPC off a lot that I think that was the last one that was left in terms of being legal. But if you’re not, an elite athlete we’re being tested, I just I’ve had such incredible results with them. And I’ve had patients who would torn lab rooms. I’ve had who six weeks later are back to their PR and they bench press their weight. And now they’re back to a PR. I’ve seen it with arthritis patients. I mean, again for patients who have a trigger point where I combine . So I do a lot of hands on osteopathic manipulation with doing is either a trigger point or a joint injection and it works wonderfully. It does. So you can use it in any part of sports medicine protocol, like a trigger or a joint, or just that how I’m doing is an abdominal. I mean, anybody who’s watching this has probably heard the Wolverine protocol, which kind of is the one that everybody kind of quotes back to in terms of healing and recovery.

Matthew Cook, M.D.

Tell us about the Wolverine protocol.

Neil Paulvin, DO

I mean, the Wolverine protocol, based on the whichever comic strip it is, but it’s BPC TB4 and some type of growth hormone booster. Usually the one that’s quoted as CJC. And I mean, again, when I’ve used something similar to that, I mean, again, in terms of patients who have a lot of tendonitis or a partial tear, rotator cuff, or just a chronic inflammation all over or anything, even from somebody who just has horrible posture and the range of motions limited, it just works incredibly well. They’ve done at max two cycles of it. And I see just again, the improvement is usually pretty profound. Again, you have to mix it in with other things ’cause they can’t be on IM perpetuity. So I tell them that again, things like red light hyperbaric mobility work, all that stuff’s gotta be thrown in there, again, working with a chiropractor, osteopath, all that goes together, the pep you can’t just beat your body up, but say, I’ll just do some peptides with Dr. Paul and I’ll be fine. They have to understand it’s kind of like you do it cyclo and all peptides, I’m a cyclic person that again, you cycled on and off, you mix and match your stacks. You can’t be on these things for 2, 3, 4 years straight, it doesn’t work as well. And for certain things are gonna get just resistance and things like that.

Matthew Cook, M.D.

It was interesting to hear you talk about the whole trigger point concept. I remember first learned about trigger point injections back in medical school in 1993. And it seems like a hundred years ago, but how I think about trigger points now is that often it’s nerve inflammation, it creates muscle spasm. And so then we started to look at that under all ultrasound and then our approach to trigger points has been to try to put something good for nerves close to where the nerve is that’s causing the trigger point or potentially even within that trigger point. And BPC, I think is one of the best, one of the best things for nerves. And I also have been kind of relatively profoundly impressed by how helpful that can be. And we like to empower patients and with trigger points, particularly when you’re injecting with insulin needles, superficially to them, it’s amazing when you empower patients to be able to start to do things that can really help with pain. And so it’s awesome to hear you talk about that, when you do trigger point injections, will you use the insulin needle superficially, or will you go with a needle right into the middle of the trigger point muscle spasm?

Neil Paulvin, DO

I do both. I have training, again, I have, excuse me, my traditional training. I acupuncture is almost like a dry kneeling procedure sometimes depending on how taught the muscle is, I do neurotherapy. So all them kind of, you kind after a while, you kind of like a Jedi sensation of a Jedi feeling of, okay, I need to do this with this patient. So you mix match all of them. So I tend to go more. I will either do one of the, I will either go very, I tag this, I think, but I probably go deeper initially to kind of get the muscle to relax and more of a dry kneeling type mechanism first. And then I tend, I’ve always been taught to come in and out and I’ll do more superficial nerves on the back end because I find it more relaxed if I get the muscle to relax. That’s one thing, I guess it’s muscle depend. That’s that way, if it’s inflammation, I’d probably go more superficial. It’s probably the way I would break it down when I think about it, depends on what I’m dealing with.

Matthew Cook, M.D.

It’s amazing. I think probably every pro sports team that I deal with has people doing dry needling, that’s been such a evolution of how we think about things. And so they’re always taking these needles and sticking them in. Interestingly, that’s probably good strategy of also treating that nerve, my friends over in Hong Kong, who’s a great ultrasound instructor and just human being will do dry needle where he’ll stick a needle under ultrasound, right into the area and try to get a twitch, trying to be close to the nerve, kind of like what we do when we put a needle in and we’re going close to the nerve and then we’ll leave those needles in as kind of part of his modality, which is I think just intellectually super interesting.

Neil Paulvin, DO

No, yeah, it makes perfect sense. I mean, now they make, again, you have cupping, so you got, now there’s cups that you can do attraction type thing. And then you put the needle, I’ll put the stem attached to the needle through the cup. So you like multiple different modalities going one time and then you inject the area and it just, again, there’s so many, you could overlap all these modalities at one time. It’s just how things have is incredible.

Matthew Cook, M.D.

Yeah, I also, it’s interesting for me to hear you talk about the lights, the photo biomodulation, we’re big fans of that and I think it’s the synergy of one plus one plus one sometimes is six. How do you use light therapy in combination with peptide therapy.

Neil Paulvin, DO

In terms, I mean, if I’m doing it for pain, I mean, I usually will, I like, if it’s a localized pain, I mean, I love the light wraps. There’s two or three companies now have really good light wraps and I’ll have them do, in a perfect world, I’ll have them do the red light first to kind of open things up and decrease the inflammation ’cause you get some blood flow improvement there. If it’s somebody who’s chronic pain all over, I’ll have them do the panel, that I think is probably more bang for the buck in a perfect world. Again, a lot of people can’t afford the panels on full when they’re coming down in price, but that’s sometimes they have to come here and do that. And now, so many new cool red light things that are coming out, those are foam rollers coming out, the red light. I think you may do the red light IV, which has people don’t know if the data’s there yet completely. So the photo, body modulation and knowing which even now which wavelength that’s gonna work for them, infrared red, you wanna make sure that’s even getting much more specific now, depending if it’s deep or superficial, I mean, that’s gonna be the next two or three years gonna be really cool how that kind of is going to morph and combine with everything else that we’re doing. But I love doing it peptides. I find it augments it really well. It’s something they can do at home. They can do it four or five times a week. And it just, again, it just I’ve seen much better. I’ve seen definitely improvement than just doing the peptides by themselves.

Matthew Cook, M.D.

Well, you have people inject the peptides and then shine the light on right afterwards?

Neil Paulvin, DO

Yes.

Matthew Cook, M.D.

Yeah. So then that’s a good one and yeah, I love standing in front of those. When I go to bang for Greenfield’s house, he’s got the setup that I’m gonna copy, which is, is that he has red lights behind him. That’s the full panel that goes over the head and then he is got one that comes to right here. And so then you basically get full immersion from the front and from the back. And so then you it’s like a, you go through all of these stations and then he can sit at the computer. And so I’m in the process of creating that because it’s kind of a cool strategy to do and so then for people out there interested in trying it, then one great strategy would be to inject peptides and then go stand in front of the light. Speaking of peptides and pain, you were mentioning how you like to combine peptides with low dose naltrexone. Tell us a little bit about that.

Neil Paulvin, DO

Yeah, I mean, again, I think at this point, I think low dose naltrexone should just be in the water supply at this point because it just has so many benefits, but no, I mean, I love low naltrexone in terms of pain. It just works on so many different facets in terms of, it helps with, if somebody has chronic pain and they have essential sensitization, it disappears the inflammation with the microglia and so on. It also helps regulate the immune. If it’s immune pain, it also helps to heal the gut. So you’re treating so many different modalities and some people think it may have some improvement with the neuropathic component of pain too. So you can do it so many different ways. You can now do it orally, you can do a nose spray and so on. So it has so many different facets. It really doesn’t interact with any of the peptides. What I’ll tend to do is I love BPC157 with doing the LDN and I’ll cycle them through pretty aggressively, depending on what their pain levels are.

Matthew Cook, M.D.

What dosing would you do?

Neil Paulvin, DO

I start, as long as they’re not having a, if there are severe, if there are no autoimmune issues, I start one five and I progress them, at least I want to get them to at least four and a half. I’d go higher than that in some patients, but at least want to give them to four and a half pretty quickly. If there’s an autoimmune component, I usually go either I start a .5 or one. I mean, some is like we have to micro dose ’cause they can’t proceed any further. So it depends, that’s kind of where I go with the caveat, if you’re on any narcotics, it just, unfortunately that’s the one that you can’t work through.

Matthew Cook, M.D.

Yeah. So that’s that medication sort of an agonist antagonist. And so we can impact if you’re on pain medicine, however, I would say what we were, for some reason this morning, we were all talking. I had some friends at the house and we were talking about people dying from fentanyl overdosing, there’s the opioid epidemic has become such an overwhelmingly big problem in America. And my friend was talking about, this good friend of ours, who we just saw and talking to her kids about how to manage your life and how important it is to stay off of opioids. And it reminded me, it’s like the same conversation that I had when I was a teenager with my parents. And I am so overwhelmed with what a big problem that is. Have you used peptides at all for addiction and helping people get off of opioids and pain medication?

Neil Paulvin, DO

I’m starting to dabble in that. That’s kind of my next, I was actually supposed to do training. I’m unfortunate right before the pandemic started now. I mean, between that , what we’re seeing with the psychedelic phenomenon, that’s kind of really what I’m looking to help patients with now. I’ve done very little bit with it. It’s not really my expertise at this point, but I do a little bit, but if it’s kind of an overlapping with everything else.

Matthew Cook, M.D.

My thought process is, is that the peptides can be quite helpful for pain. And so if you can substitute out peptides to some extent, as an alternative to the opioids, that’s helpful. I also have found that, because they make you feel better, people are less dependent on the opioid as a coping mechanism. The immune peptides I found are fairly helpful for the opioid problems. Also mitochondrial peptides also sort of Cmax Clan is just such a interesting topic. Tell me about your sports medicine experience and peptides.

Neil Paulvin, DO

Again, it is great. I mean, in terms of, I mean, besides what we were previously discussed, I mean, it just, it’s always changing. I mean, there’s so many different new things that come out all the time. I mean, again, the one thing in terms of, I mean, patients who have back issues, it’s progressing, I mean, it’s worked really well. I like it in terms of just patients, it’s good, ’cause you can use this part of just a patient’s recovery process along with whatever else you’re doing, everything from four rolling to hyperbaric, or if somebody has a chronic injury, it works as well. I’ve done some “Prolo procedures” doing the peptides instead of doing with the sugar water, doing it, like either a lumbar ligament or around near or close to a facade, it works. I’m not an interventionist. So I don’t go any deeper than that, but I’ve seen really good success with that type of thing. And like I said, I mean, I love it for again, for tendinopathy, somebody with again, I love it for rotator cuff tears, but again, and it’s something that, again, it’s usually a two or three month protocol with me. I found that that tends to be the sweet spot usually by six to eight weeks, most patients are gonna get or are improving. And then the patients who aren’t improving, they got usually have to go obviously a little bit deeper down the road, deep down in terms of more advanced treatments. But it, again, it’s something that’s so simple, an injection once, it just works really well. And again, once they find that right dose, they could go on the BPC and the TB4 and one injection and they just run with it. So patients are very receptive to it. It’s become pretty mainstream, like I said, it’s become part of a lot of protocols now.

Matthew Cook, M.D.

I like that you’re talking a little bit about back pain. When I first started learning about nerve treatments, I’d been doing hydro dissection since 2002 with and local anesthetics. And then we found about using dextrose, it kind of in parallel to that, but starting much way before for that, people started using dextrose or sugar water at a kind, but nerves, like dextrose at 5% and the Prolo community was using dextrose that kind of 15 to 17%. So more concentrated to create some scarring and fix hyper mobility. And now I think that the concept of using peptides to treat basically ligaments and tendons and facets is exponentially better than Prolo therapy. And if somebody came to us, that we might treat their facet joints and we might do a hydro section of the thoracolumbar fascia, however, I love the idea that you can, if you have, you can do superficial with insulin syringes injections in the back, and you’re treating that fascia relatively locally, and I’m amazed how helpful that can be. And with the pandemic, one of the, my silver lining of the pandemic was, I had all these people call me and say, “I wanna come see you, and I’m gonna come see you and when this pandemic is over in a couple years,” and so then I got people doing peptide injections and teaching them on Zoom, just kinda like this, how to do an injections all over the world. And it really sort of cheered me up and gave me hope for the practice of medicine, because it was so much more effective than anything that really I had ever seen. It sounds like you’ve had a similar experience.

Neil Paulvin, DO

Yeah, no, it’s great. And I think, like I said, what I’ll find is it is not doctors refer, like traditionally, it’s other doctors referring to us for pain. It’s the patients now being proactive, trying to find things that are gonna work better and also don’t have the side effects of steroids or narcotics, and they want to do it. And three years ago, if you suggested a patient to do at home injections on their own, it’d be like, besides diabetic, it’d be like five, 10% of people are into it. Now I’d say 75% of my patients are insanely open to just, A, learning online about it, and then not having to be seen in the office. And B, they’re like, yeah, I’ll do two, three injections on my own, that’s fine. It’s like nothing to them anymore. And I think that’s the way medicine going, it’s going between the telemedicine component and patients are becoming their own health advocate as opposed to waiting for their doctor. So then mainstream docs still, at least, I mean, I’m in Manhattan. I would say 50% of the docs have maybe besides BPC, I have no idea what peptides are or what they do and how they should be involved, same with LDN. And it’s a shame, but so I think what you’re doing in this summit is gonna get that word out there even more in terms of patients who are being proactive with their help.

Matthew Cook, M.D.

Well, great. Well, when we did our pre-call, I realized we’re treating a lot of the same conditions. So I said, I should introduce you as my brother from another mother, but instead, I’m gonna close with that. It’s delightful to talk to you. We appreciate everything that you’re doing and grateful to have you on the podcast. Any final thoughts you wanna add for us?

Neil Paulvin, DO

My final thoughts? The one thing, my only final thought would be that, more is not always better in terms of peptides. And the other thing would be, make sure, at least please work with a provider who knows what, who the better quality peptides are and how to dose them. I see so many online groups where they’re just doing dosing wrong and it’s just kind of, and then we have to kind of fix things. So that’s the only concerning part, ’cause peptides have so much great potential. Just use them the right way and make sure you’re working with somebody who has that background of knowing how to dose them and which ones are appropriate for you that aren’t gonna set you back.

Matthew Cook, M.D.

All right. Hey, thanks for taking the time. I really appreciate it. I hope you have a wonderful day.

Neil Paulvin, DO

Thanks. Thanks for having me.