The Missing Link in Integrative Medicine’s Approach to Brain Health

Sergio Azzolino DC, DACNB VeDA

Well, thank you Dr. Cook. It’s certainly a pleasure and I wanna give you a heartfelt thank you for all that you’re doing not only clinically, but to bring this information out there because I’ve been at this for nearly 28 years, and we’ve been fortunate to not have any shortage of patients, but from a clinical perspective, it was quite lonely back then dealing with these types of things, because there was few practitioners and we’re so fortunate to have so many people like yourself and all the other brilliant minds in medicine, step over the line and get into integrative medicine because we need you all. And so thank you once again.

Matthew Cook, M.D.

Thank you so much. We had engaging conversation for the last half hour of that, I wish I would’ve recorded because it was so good, but I’m excited to sort of engage into this direction of thinking about the brain. Tell me and tell us what functional neurology is and how you put the central nervous system together, conceptually, and how you think about it.

Sergio Azzolino DC, DACNB VeDA

Sure so classically, most of us learned about the brain as a very hardwired structure, many decades ago. And people had a stroke, we looked for the area of the brain that was damaged. We’d see deficits in the body. If they had a tumor, we knew that would provide deficits and whatnot. And so most were classically trained that lesions had to arise from a tumor or a stroke or some insult to the brain itself. As you know, over the years, over the decades, we all started to understand the wonders aspects of the plasticity of the brain and how dynamic it is. And you may even have those deficits, but many brain lesions, if you would, are not secondary to a true, hard lesion, they’re more soft lesions. We look at depression as a perfect example. We look at vertigo, we look at brain fog, all these things that unfortunately we’re seeing more and more of nowadays, we’re realizing that you could do a scan. You could do an MRI. You could do a pet scan and everything may look perfectly normal, but you have decreased function. So I’ve been very fortunate to be in this space of functional neurology for several decades, where we’ve looked at just overall function in the nervous system looking at, and we’ll talk about specific measurements that we look at, but looking at what areas of the brain are working well and which ones are not. And then we can base very therapeutic efforts towards rectifying that problem. 

So every neurologic exam will start off the same. It should with any neurologist, regardless of whether they’re coming from a functional neurologic perspective or an allopathic perspective, we all should be looking at history from, as you know, in our world of integrative medicine, we look at histories starting early on from utero all the way through, not just from an energetic perspective, but there are things that take place in utero. There are things that take place in early childhood that will wind up the limbic system will wind up certain parts of the brain. And we all are, you know, who we are today because of all that’s happened to us over the decades in life. And so when we see certain people that their coordination is much better, you know, if you look back in history, you may have realized that they had some better development in one aspect or another, or some deficits in aspect over another. So functional neurology and certainly in my practice, we’re blessed to be able to deal with a lot of neurodevelopmental disorders from early on all the way through many professional athletes, to the healthy individual, wanting to maximize their function to people with neurodegenerative diseases. And what we’re always doing is assessing these individuals to see from a very objective perspective, with very quantifiable measurements, what areas of the brain are working well, and which ones are not.

Matthew Cook, M.D.

What would be, give me a couple of the top assessments, your top three assessments you’d like.

Sergio Azzolino DC, DACNB VeDA

You know, every exam starts off with looking at sensory nerves, motor nerves, balancing coordination. Balancing coordination when we get into that, there are simple things that all of us have been trained to look at such as a Romberg’s test and a finger to nose and whatnot. We look beyond that and we put people on force for lights, and we can measure what’s called their center of gravity, very specifically, how they’re maintaining their center of gravity, where they feel normal and stationary is with their eyes open, with their eyes closed, with their eyes open and closed on a hard surface, on a foam surface. We also look at their limit of stability, meaning how far they move before they can lose balance. And although these things don’t sound to be that important. There’s some of the most important things that we could assess on an individual, cause we know balance does decline in all of us where we are in space comes down to our brain function. There’s a map inside our brain of where we are in the world and of the world and following head injuries, following many of the conditions that we all treat from line to mycotoxins to these various infections, people can lose their spatial awareness and have different movement patterns. The limited stability for instance, if you look at the limited stability of a healthy individual, they can move quite a bit before they lose their balance. 

We look at an athlete, they can move a tremendous amount before they lose their balance. But as we age or as we have these different conditions that affect our brain function, we could start to lose our limit of stability or narrow it if you would. And meaning, if we move too far, we’ll not only lose our balance, but we can injure joints. We could sprain things. And the difference between a healthy individual being able to move far and an elderly individual moving to a point to where they fall and have to outstretch their arm and have a humeral fracture or worse yet an elderly individual that doesn’t even get their arm out and falls over and smacks their head and bleeds out is purely a speed of reflexes. And when we check somebody’s limited stability, that’s what we’re doing. We’re checking your reaction time, your speed of movement and your accuracy of movement. And that along with all these other neurologic parameters that we’ll get into are extremely important to have a good baseline of so that we know despite how you’re feeling, we all like to think we’re looking better with age and feeling better, but we have a good baseline of where we’re at so that we know if our brains are moving in the right direction or not.

Matthew Cook, M.D.

Yeah, I like that idea a lot. And I also like our interaction because we, you know, we’re treating a really, a lot of the same patients and doing similar things, but coming from a different place. And that’s my favorite thing in my life because people that are coming from a different place than me, there’s 95 things that you do that I’m just gonna ultimately do because it’s gonna make us better. But interestingly, when I think of balance and all that stuff, one of the things that happens when you get pain in a nerve is you immediately stop paying attention to mechana reception or appropriate reception or where you are in space because the body thinks, oh, I gotta pay attention to pain. And then as we age, almost everybody starts to have more pain and then less good spatial awareness and less stability. And then, so then with, you know, my experience, interestingly with professional athletes, you know, when I fur started, we were doing nerve hydro dissection with 5% dextros. You do that for a really good pro athlete. And then immediately their performance goes up because if you just tweak there that system a little bit, they were already so good, a super helpful you do that also with a profound, the ill person they’ll do well, but the better pro, you really need to do better product for them, for it to last a pro athlete might get six months a benefit from 5% dextrose. Whereas somebody with complex illness will maybe get two or three days. But so then as a concept, if you can, this is why I love so much your testing and your algorithms of thinking about it, because if you can then train and then work on those patterns, I think that that bio biomechanically may have more to do with antiaging or as much to do with antiaging as everything that we do biochemically.

Sergio Azzolino DC, DACNB VeDA

Sure, absolutely. I mean, and the it’s not so much that the brain, when they’re in pain is focusing on the pain. It’s just those pain receptors are going to alter input into your bridal cortex and as result, your spatial awareness starts to change. And so, you know, the nice thing is we can measure that it now. And you know, I came from 30 years ago as a chiropractor, we would manipulate people and see an instant change in their balance and coordination just by improving their joint motion by increasing stimulation of their mechanical receptors. But you know, the beauty of this here as you said, is so exciting because we share so many of the same patient and coming from these different perspectives is, you know, is a dream come true for me because it gives patients the best. And it’s really what they deserve is the best of both worlds.

Matthew Cook, M.D.

I like to say there’s that Moore’s law is an effect in integrative medicine because I feel like, the quality of what we do has more than doubled every two years. And primarily it’s be, I would say half of it comes just from my products, get better every couple years. And then the other half as I meet people like you, who say things that kind of blow my mind and I walk around for a couple weeks and think about it and then start to incorporate that, you were talking about pupillary testing. And I do think that that’s really interesting because it goes into some of the things we were talking about. How do you like to do that?

Sergio Azzolino DC, DACNB VeDA

Well, certainly we always look at pupillary testing just with a light response, but as I was speaking to you, you know, earlier we published a paper just recently with my mentor, Dr. Ted Carrick, who put most of this stuff together, you know, several decades ago. And we’re looking at the pupillary light reflex. The name of the paper is the pupillary light reflex as a biomarker of concussion. And so now there are some wonderful little apps that we have just on an iPad and on a cell phone that my staff will just take a simple snapshot of one’s pupil. And we get very specifically a host of different measurements on the pupil, from the speed of the pupillary constriction to the maximum, you know, resting tone to the maximum or the minimum dilation and diameter of the pupil to the constriction velocity, to redilation of the pupil. One thing that we need to be looking at is about the 75% of maximum diameter. So once the pupil constricts, how long does it take to get back to that 75%? And so, you know, the beauty of this is the one simple thing that we all used do with just a flashlight, and even 30 years ago, we were looking at not only how quickly it responds, but how quickly it fatigues given us a good window is it too much sympathetic activity? Is it too little sympathetic activity? Is it too much firing engine Westfall nucleus that causes a constriction or is it too little? Well, now we have objective measurements that can look very specifically at the multitude of these different pathways and give us a wealth of information on what’s taking place. And, you know, it’s the one thing that we found in the paper. First of all, let me just touch on that very briefly is when you look at people and their resting tone of their pupil, first of all, the pupillary response is not just a product of ambient light. 

It’s a product of the resting state of multitude of different pathways in the brain, from the sympathetics, as we know, the super optic nucleus, the dorsal medial hypothalamus, the, you know, locus coeruleus, the intermediate lateral cell column and the sympathetics to the angio Westfall nucleus that controls the parasympathetics, the ciliary ganglion and whatnot. So there’s all a magnitude of these different pathways that are all integrating specifically to give us that simple pupillary light response. And what we now know is that following a concussion, people can feel completely fine. They could say, I feel great. I’m back to a hundred percent. We’re all celebrating, but we statistically, and we found very statistical significance that there is still a change in that pupil, following the concussion. There’s a change in the response of the pupil, which is significant because that tells us that there is some permanency taking place in that individual’s brain or some permanency of function that’s taking place. Now we know in treating people, we could see a spectacular difference in their function, but are we changing things structurally? We don’t know. Are we just maximizing some pathways that are still working well? So that’s like all these things, the minute we start talking, and then I start talking to you, we have hundreds of studies that we need to employ. And like we were talking about your spectacular work with a stellate blocks. I mean, would be great to just measure their pupillary responses with an app like this and get some objective data before and after, and let’s follow ’em for a year and see what we get.

Matthew Cook, M.D.

Yeah, so then I’m gonna commit that I’m gonna do that with you. So then this would be a good sort of starting point of, and then we’ll move past this how we’re think, how I would think about this. The Sean Berman did this study where they did an animal model. This was with the people that saw surgical network, where they took mice and then took air gun and then gave them a concussion. And so then they would sacrifice those animals and look, and you would basically see a hematoma there in the brain. And then what they did was they did half of ’em, where they gave them a hematoma, and then they gave them all kinds of tests. And basically as soon as they gave them the hematoma in the brain, a concussion, all of their ability to do rollover and be an amazed and do everything they do went down and then they took another group and they gave ’em the hematoma, and then they gave them stem cells. And so then sure enough, their ability to roll over and stuff like that is better than if they did, hadn’t gotten the stem cells. And then when they got the stem cells, when they set, they did the look at them afterwards, their brains looked mostly normal. If they’d gotten stem cells and you could see this hematoma. Now with concussions, then if you imagine that there’s a hematoma, you may have start to feel better. But if that hematoma is affecting any of those 14 pathways that you just mentioned, you may actually still have signs and symptoms of neurological dysfunction. 

And that means you do have neurological dysfunction. What we do when we do the cell is that it blocks the sympathetic nerves around the carotid. And what I’ve been doing is like one CC of, kind of close to the carotid and by the vagus nerve. And I get a fairly profound quick vasodilation that lasts for about two hours. And then you’ll get increased blood flow to the head, that may be part of the mechanism of Weiss. I thinks cell are helpful for patients with concussions. And we see that, you know, we, you, that window, when there’s an increased blood flow is a great time to give peptides or something on the regenerative front stem cells and exosomes. And then also in parallel to that, anything that you do that starts to help by a chemical pathways is gonna help by a chemical pathways, wherever that lesion is, and that lesion could be anywhere. And I love what’s happening in this conversation, ’cause you’re kind of figuring out at a granular level where that is and then starting to attract the before and after. And then we’ve really been focused on therapeutically, is that this gonna work better? Is that gonna work better? But ultimately, I think the trajectory of how we double how good we are in two years from now is that we figure that out in detail.

Sergio Azzolino DC, DACNB VeDA

No, it’s exciting because you know, we deal with concussion day in and day out. And I have never, you know, even contemplated sending somebody for a still block for that very reason. And you know, you blow my mind there cause we just opened up this whole new world and it’s like, wow. I mean, unfortunately there’s not enough hours in the day for us to just put all these things to the test and really see what works best. But I mean, you know, the exciting thing is that every everything has its place and I could just see the improvement. I’d be interested to see if the stellate blocks are working better with post-concussive syndrome versus an acute concussion. Have you had much experience with that?

Matthew Cook, M.D.

I would say they’re probably better for post-concussive syndrome. So I’m not treating generally a concussion like right immediately because they generally don’t find me immediately. I would probably think of something more regenerative immediately and by a chemical immediately, but then when they come in, you know, weeks later and they’re really struggling. And so then that managing and thinking about that conversation is, you know, you think about football players and stuff like that, who we also see a lot. I think that we will be able to mitigate a lot of that damage. The more interventional that we are in the coming years.

Sergio Azzolino DC, DACNB VeDA

Absolutely, you know, certainly in a perfect world for us, we would have baseline testing on everybody and we do a lot of that. And so we would have the not only the balance testing, I was telling you about, but we do a variety of different baseline tests from something that we utilize called right eye to visit video iconography or video nystagmography to also some standard, you know, neuropsychological assessments and whatnot. So we will generally have the speed of people saccades down to the millisecond, their reaction time.

Matthew Cook, M.D.

How people and what saccades are?

Sergio Azzolino DC, DACNB VeDA

Saccades are quick eye movements. We all have ’em and their quick eye movements. And we could get the speed of your eye movements, the latency, which is the reaction time down to the millisecond and also the accuracy of the movement right down to the degree. So we could assess all that in people’s visual fields. So we see if your accuracy is better in one hemisphere or another one area or another, or if you’re faster in one area or another, certainly for a professional athlete, that’s, you know, makes a world of difference if you’re standing at the plate or whatnot, but for every individual it does because some people just are a little slower looking in one direction or another. You know, we also get the accuracy of your movements with our, what are called smooth pursuits. And we could look at smooth pursuits from a circular pattern to left and right, up and down, we could get your vestibular reaction time, how quickly your brain is responding and how quickly your eyes move when you turn your head. Because some simple little turn of the head activates the vestibular system which is the, in the inner ear and that sensing into your brain to cause your eyes to move. So long story short, with that and with a lot of cognitive testing that we’re doing, if we had baseline testing on everybody and many people we do and they get a concussion, we repeat the testing and we can see, as you said, very granularly where their deficit is. And then much of our world in functional neurology is rehabbing that and rehabbing it very specifically. Certainly we use hyperbaric oxygen. We use many different modalities that you are well aware of because they all provide a better neurochemical environment stem cells I’ve found to be, you know, exosomes to be very beneficial and helping to maximize people’s function, whether it’s following, you know, with post concussive syndrome or with later stage neurodegenerative diseases and whatnot, but you know, all exciting stuff and I just, you know, as I said, very exciting to hear you come from your perspective because it’s a whole new world for me.

Matthew Cook, M.D.

And, but despite that coming from, I guess my perspective, despite that the first, when I was an anesthesiologist and I realized I wanted to do this. And the first thing that I did, one of the first things that I did was I went and studied with Andy Barlow and I studied, I did the American functional neurology institute and did functional neuro the certification. And honestly, I loved it. And when I got there, I realized, oh, this is what I’m gonna do the rest of my life. And I’m gonna extricate myself from anesthesia. You know, it was a profoundly important. And as soon as I got there, people started saying your name. And so I’ve been waiting to, I was waiting to connect with you and honored. So then interestingly, a topic that it, we started to talk about that is near and dear to my heart. That then when you talk about, we talk about the stellates and stuff like that is dysautonomia. And so then this is a category of symptoms that’s a term that you may not have heard. There’s another term you might have heard called pots. And we’re a postural orthostatic hypertension, and that may not even be a term you’ve heard. But then when we start to tell you some of the symptoms of what it is, you may know somebody that has these symptoms. Tell us what this auto dysautonomia is. Cause this one is gonna be something is coming to a theater near you soon.

Sergio Azzolino DC, DACNB VeDA

Well, to simplify it from our perspective, and I’m gonna make it very simple because it’s when we lose the regulation over our autonomic nervous system, when we lose the regulation over our control of blood vessels and heart rate and whatnot. And, you know, as you mentioned there, Dr. Cook, many people haven’t heard about it, and a day doesn’t go by that we don’t see many cases as I’m sure you’re in the same situation. And, you know, for all the horrible things that happened with COVID, I think the blessing is COVID showed much of the world, how infections can affect the brain and how there can be lasting effects on the brain and on the autoimmune or on the immune system, leading to auto immunity and whatnot. So I believe it’s given a lot of credence and a lot of validity to what so many of us have been seeing for so long. And so with many of these infections, whether it’s COVID, whether it’s as you know, the world’s finally opened up their eyes to Epstein-Barr, and many of us in integrated medicine, been looking at Epstein-Barr and its effects on neurologic illness for a long time, whether it’s Lyme disease, these things can trigger some dysregulation of the immune system as we see with head injuries, and then people are no longer controlling their blood vessel appropriately. And so they may have severe exertional issues where they fatigue very quickly. They may have orthostatic issues where you get out of a chair too quickly, and you feel like you’re gonna pass out, or even if you’re thinking, we see a lot of people following head injuries, they just, even them starting to think, or try these poor teenagers in school, trying to keep up with their studies. They get severe headaches, they get nausea, they feel like they’re gonna pass out vomiting. They get dysregulation and their bladder and all the rest, because they’ve lost the integrity of the areas of the brain that regulate the autonomic nervous system, which is what regulates all the organs. That’s for the laypeople out there, not for you, you know that.

Matthew Cook, M.D.

Right so then I’m gonna say that in a same way. And again, just, this is so important for people to hear. And then I wanna talk about how you think about treating it. So imagine that when you stand up, you don’t even have to think about it, your blood vessels just perfectly constrict to maintain an even blood flow to your brain. And then you sit down and you relax, but your blood vessels are constantly modulating. And so everything the body does, there is a constant modulation that’s managing and balancing and harmoniously making it so that blood flow and physiology is basically super steady. As my old job, as an anesthesiologist was to stand next somebody and look at a bunch of monitors and then watch the surgery and make sure that that was kind of happening, you know, at a macro level. And fundamentally, a host of these infections will kind of basically throw a monkey wrench into that situation and then it’s choppy. And so when they stand up, the blood pressure can’t manage and the heart rate can’t manage and say get lightheaded, down. I think that this is going to be one of the defining things that will impact healthcare in the next 20 or 30 years. You know, and I remember somebody told me three or four years ago, Eric Gordon actually told me, and he said, pots is Lyme disease until proven otherwise this was at, you know, at that time. Now a lot of times it’s long COVID, but a lot of times long COVID is actually a Lyme disease that nobody knew about once you kind of dig into it. Has that been your experience as well?

Sergio Azzolino DC, DACNB VeDA

Well, interesting. You should ask because I think it’s not only Lyme. I see a tremendous amount with mycotoxins. I started in the late nineties, Vincent Morovich was in the bay area here looking at mycotoxins and mold toxins and everything in his mind. Brilliant guy was mold toxins. So, you know, we looked at that very closely and I came from that perspective prior to the lime world, and we saw a tremendous amount of pots and dysautonomia secondary to mold. We certainly see it with lime. I could just tell you, in general, I tell my patients and certainly other practitioners that if you have the dysautonomia, if you have the pots, we need to fix that before we’re ever gonna get any traction anywhere with, you know, with getting their nervous system more stable, you may be aware. I’m not sure if you are, that we published a paper years ago. It was my capstone project going through the global clinical scholar research program there at Harvard Medical School on the prevalence of Lyme disease and co-infections and people with post-concussive syndrome. And so what we started finding is all the typical things that all of us see with Lyme what’s happening with post-concussive syndrome also. And that’s when we started taking a close look at most of our patients, and we found many of them that were not healing from their concussions with certainly dysautonomia and whatnot, but many of them that were not healing certainly had a very high prevalence. So over 38% had Lyme disease, so.

Matthew Cook, M.D.

But now would you, my theory about that is if you go back to our conversation about that thing where they gave the concussion gun to the arm holes and you create a hematoma. My theory on that is that if you have some kind of vector borne illness could be viral, could be bacterial, could be bark or lime, but most commonly mold, I would say, I totally agree with you that is that concussion and hematoma gives an opportunity for that infection to get into the brain, or at least into the blood vessels where that bruise was. And then normally the brain is privileged and is not exposed to infections, but that’s a way for them to get in.

Sergio Azzolino DC, DACNB VeDA

Absolutely, I couldn’t agree more. I do think, you know, some of these things are sitting at a subclinical level and it’s not until you have an insult and it doesn’t need to be a concussion, it could be a death, a divorce. It could be, you know, a trauma and many people have emotional traumas and that can cause a cytokine storm that opens up the blood brain barrier and these things take off. You know, there’s also, we’ve also seen as, you know, plenty of people that are not converting with their line. They’re not, you know, converting from an IGG to an IGM or vice versa. I’m sorry. And suddenly they have this immunological shift in their body and things take off. So, you know, that’s certainly requires more study, but I would agree with you that I think it’s probably a blood brain barrier issue where they lose the immuno privilege aspect of the brain.

Matthew Cook, M.D.

Now it, so then if we went down the pots conversation and we are 100% getting phone calls around, I had been healthy kind of basically everything had been fine, got COVID and then developing pots, symptomatology and low blood pressure when standing up and passing out. And, so then the question, and we’ve seen in this after COVID and COVID vaccines. And so then the question is from a diagnostic functional neurology perspective, when you see that person, what are you, what do you see?

Sergio Azzolino DC, DACNB VeDA

Sure, let me first preface by saying I started off in the functional neurology world. My brain opened up to all these different infections and all these different things right away, because we’d see the lesions neurologically, but we said, well, what’s causing them. We could rehab ’em successfully, but then some of them may come back. So what’s causing it? So I don’t think one has greater importance than the other. I think we really need to look at all these things. And we certainly do and my hope hopes is that these two worlds, as you said, are beautifully starting to come together at a high level. So we diagnostically will assess these people just as we do. I mean, you know, we always look at orthostatic issues, whether somebody has symptoms of pots or not, but the reason from a functional neurological perspective, why one may have pots, it can be multifold. I mean, I’ve seen pots from secondary, you know, to ipsilateral vestibular lesions, I’ve seen it secondary to certain areas of the brain firing too much. And as a result, they’re, you know, not inhibiting some of these aspects, I’ve seen it from vagal lesions. I’ve seen it from a whole load of things. And so from our perspective, we’re once again, examining the individual, identifying what is happening in their regulatory system, there’s aspects of the limbic system, there’s aspects of the frontal load. 

That’s gonna regulate that there’s aspects in the brain stem from the locus coeruleus to the nucleus tract, to solitarius all these different pathways that we need to assess very closely to see what the lesion is. When one person is lying down and they get up, we know they have to have a change in their barrel receptors. We know the change in position is coming from the vestibular system. We also know that their visual awareness of where they are, has an effect. And so our drive is to figure out what is not working neurologically and then give them some rehab oftentimes, and we have great success with pots, but you can’t just do a generalized, you know, stimulation to the brain. One person may benefit from rotating in one direction versus another, one person may benefit from doing near far gazes to fire the, you know, pupillary ciliary muscles and fire their descending pathways to their parasympathetics. Another person may do well doing some isometrics and some kegel exercises to fire some descending pathways, you know, dealing with parasympathetic control. And it, you know, it’s, as, you know, the list goes on not to be elusive, but just like, you know, you can do things in your office from an injection perspective, a biochemical perspective. You’re not gonna take somebody with pots and not assess what, you know, the underlying source is.

Matthew Cook, M.D.

Right.

Sergio Azzolino DC, DACNB VeDA

And we would do that from a neurologic perspective.

Matthew Cook, M.D.

Right, and we are certainly also kind of working on that as well, but just as to think from kind of a peptide perspective, since we’re sort of talking about this and a biochemical perspective, I would correlate a lot of that symptomatology to infections. And so then, like you were thinking about what’s going on in terms of mycotoxins and infections in the sort of treating that. And then that’s like a whole nother conversation beyond this. The, when we do the stellate, we’re right below, basically the bifurcation of the carotid, but you can do high stellates that are at that bifurcation. And I will feel that sometimes just the stellate by itself will be a little bit of a reboot of that baroreceptor. And so then that sometimes that will help the immune peptides can be quite helpful in terms of relieving that symptomatology thymus beta four. I like the fragments of thymus beta four, much than thymus and beta four. So the fragment one to four is the anti-inflammatory one. And then 17 to 23 is the more of the connective tissue one. And I’ll combine both of those with thymus and alpha one. If they’re some of these are just autoimmune and there’s not an a, there’s like an autoimmune action. This go going on related to an infection that may have been present in the past.

Sergio Azzolino DC, DACNB VeDA

Sure.

Matthew Cook, M.D.

And maybe that’s all that’s needed if there’s an actual active infection. Sometimes we’ll use LL 37, which is an antimicrobial, along with other antimicrobial strategies, the you know, we will do a vagus nerve hydro dissection up basically in the front of the C1 transfers process. And so you can see the vagus there and that can be interesting. And so there’s a variety of sort of products you can begin to use, but then using those as biochemical ways to sort of work on pathways. And I think it’s interesting to frame that as a synergy to what you’re doing, because you’re actually, and that was my first, when I first found out about this, I was like, okay, I have to understand that and incorporate that into our world, because what Dr. Azzolino is doing is actually figuring out which tract is having a problem and training that track. And then if you kind of imagine that you could, the best thing always is to combine four or five modalities, because you always have to do that for super complex problems. And so then I think that there’s gonna be this moment when you start to train a path way, and then you’re doing something that will boost metabolic activity or mitochondrial activity. So mitochondrial peptides. So then imagine someone’s taking SS 31, or imagine that they’re taking human and while they’re training, that vulnerable neurological pathway, I think what’s gonna happen is then suddenly that part of the brain comes on. And that’s our perspective.

Sergio Azzolino DC, DACNB VeDA

Yeah, and that’s exciting. It’s certainly been, we’re not doing peptides at the level that you are there, but it’s certainly been my understanding and my reality of when we combine these things, we just get people will better on a whole different level, you know, as you know many patients say or many practitioners unfortunately say, well, I don’t wanna do too much ’cause then I don’t know what got you well, I say, I mean, who cares? Let’s get you well quickly. We don’t wanna do too much. If you’re reacting, we wanna find out what you’re reacting to. But my reality is combining these things at a high level like you’re doing and combining rehab to target those areas gets people better, much more quickly, and certainly, I think we all need to work towards that because as you know, we’re just seeing an explosion of these.

Matthew Cook, M.D.

Yeah. It’s interesting. What has been your experience in taking care of the neurological sequela of COVID and COVID vaccines?

Sergio Azzolino DC, DACNB VeDA

Well, you know, as we discussed before, the people that I am seeing adversely responding to the vaccination, and this is not a vaccine or an anti-vax conversation in any way, shape or form, it’s done wonders for, you know, millions of people, but the people that we’re seeing adversely respond, and we’re certainly seeing a load of those as I’m sure you are because of just the patient population that we deal with. Most of these people have underlying either these infections that are at a subclinical level or, you know, underlying immune dysregulation. And so, you know, they’re just popping right after the vaccine. It’s just pushing them a little too far. So we’re certainly doing things, as you’ve mentioned to calm down the immune response, and we’re certain getting down to assessing their underlying lesions. We’ve seen people that have dizziness, and if they have dizziness, they’re usually having a cerebellar manifestation or a vestibular manifestation. And we do things to activate those pathways. You know, the vestigial nucleus and the cerebellum is gonna dampen a lot of the vestibular input. We do a tremendous amount of vestibular therapy. We utilize a gyro stem provide very specific stimulation into the vestibular system. We could program that machine. However, we want as fast as slow with down to the degree of movement. And we could be very exacting on just providing information or stimulation into one canal or another. So, you know, once again, and you know, it frustrates, I think a lot of physicians that want the simple answer, and you’re not one of those guys, but you see a long COVID case. Well, you gotta examine ’em and see what the hell’s going on. You can’t just assume it’s all the same thing, because they’re all for different reasons.

Matthew Cook, M.D.

Exactly, and just like that concussion could be up here or could be down here or could be in the ear. And so then you’re trying to figure that out. And then the, my experience has been figuring it out has been a bridge for me between Western medicine, which in neuro from the neurology perspective, I felt like traditionally was a little bit of diagnosis and adios to the chiropractic community that actually had a lot of stuff to do. And then the naturopathic community that really had a lot of interesting stuff to do also, and then kind of bridging and harmonizing between all of those things, which fundamentally is really what we both do in our practice.

Sergio Azzolino DC, DACNB VeDA

Yeah, and I think if we, hopefully we get there in our lifetime, I think it’s happening. Like you said, hopefully all specialties are really just focused on a very patient centric model of let’s examine these people and determine what’s best for them. You know, I examine people all the time and say, hey, they’re gonna be better treated by you, or they need X, Y, or Z, or we do a combination of things. And hopefully if we’re honest in that regard, rather than people just practicing their modality, I mean, what I love about your practice and my practice, and we’re doing multiple different things. So we’re not tied to doing in one thing.

Matthew Cook, M.D.

Well, and that, you know, what I sort of feel like what happened is we were in a little bit of a missionary appeal of helping people, which was fun five years ago, but now the level of immune and kind of neurological problems has come to such a crescendo that there’s more work than it anyone can do. And, you know, we were talking about the value of diagnostic testing, especially the diagnostic testing that you do. These are such big problems. And then they have a fairly substantial economic impact. And because if you have mold, then that may have some significant financial ramifications of what are you gonna do about the high house. How are we gonna detox it, if you answer then, you know, we love energetic testing. And because I think a lot of us grew up doing some of that when we were young, but if you’re gonna make significant decisions about what to do with your life, it would be valuable, I think. And I think you probably agree with me to do some real testing and probably you’re the best that I’ve come across so far in my life in that top category.

Sergio Azzolino DC, DACNB VeDA

Well, thank you. We’re so lucky because science has caught up to what we’re all been doing, right? I mean, if you look, I look back at what was happening in the integrated medical world 30 years ago. I mean, like I said, it was quite lonely from the a physician and a practitioner perspective. And now everybody’s talking about this stuff and we don’t need to theorize about stuff anymore. There’s testing, there’s blood work that shows us what’s happening. I mean, can you imagine if weren’t looking at D-dimer with, you know, long COVID, right? If we just said, we think this is happening. I mean, we can measure these things now. And certainly we know with these infections, we can measure ’em we can measure with mycotoxins, we can measure antibodies. And so we can measure the same neurologically. And we’re so fortunate in that regard, because with the explosion of objective data, I don’t think we need to rely on subjective things anymore. I test muscles and every single patient I see, I’ve probably tested millions of muscles without any exaggeration over the years. I don’t rely. And this is no disrespect to anybody that’s utilizing that because there’s some spectacular practitioners out there, but I don’t rely on muscle testing to make decisions on these things anymore. Not because I don’t want to, ’cause I don’t need to because there’s objective parameters that we could look and find out most things. And as you know, if I don’t know about, how do I test this? I could call up Dr. Cook. And he’s probably gonna say, well, this is how you test it and vice versa. And so we don’t need to rely on the energetic stuff so much anymore and that’s not to dismiss it. It’s just, we’re in a war world now that science is providing us a lot of quantitative measures that we could only dreamed have dreamed of 30 years ago.

Matthew Cook, M.D.

One thing we were talking about in terms of that neurological piece, I was telling you that we got a phone call last night of a friend of ours that I had dinner with, like the week before COVID who got a COVID vaccine. And then like two days later or COVID booster. And then two days later she had a stroke two days ago, and then I mentioned that to you and you said, I saw three of those this week. What do you think is going on with.

Sergio Azzolino DC, DACNB VeDA

So not all of ’em had strokes, let me preface that one was hospitalized with four emboli and yeah, another one was an ICU nurse that unfortunately had a vascular reaction. And as a result has severe pots now, so they weren’t strokes, but they were, you know, right there. So what do I think’s happening? I mean, I think in digging with all these three people, and this is not just one week, we’re seeing this stuff regularly, as I said, I think most of ’em have some things taken place. I mean, I think most of them have some underlying health issues that were not addressed. And as a result, they’re right there, who knows it, it would be so nice to have all the neurologic markers that we have all the autonomic markers looking at their coagulate factors and whatnot, and have all that before, right? And measure it after, but we don’t have that fortune.

Matthew Cook, M.D.

Although we had dinner and then we had dinner and then this probably my favorite thing about you and probably my favorite thing in general about my life is I remember we were talking and we were talking about COVID and you said, this is our war. This is our World War II as doctors.

Sergio Azzolino DC, DACNB VeDA

That was before Ukraine. No.

Matthew Cook, M.D.

But this is when it, and I felt, I profoundly felt like, okay, there’s a burning building. And I’m probably a fireman. I would love to run into that building because that’s just who I would be. And this was in a way, a moment for us to seize the day and then take everything that we learned. And if I died, I would basically be fine because I would feel like my life, I did what I wanted to do. This is what I wanted to do. But interestingly, if I was thinking about it, if I went back to when I was an anesthesiologist, I basically had nothing that I could do to fix myself on the other side of things. Because the only things that anesthesiologists have So really get into trouble with. But you know, as in regenerative medicine, it’s, I think that for doctors out there suddenly you run, yeah. You hear about an ICU nurse that has trouble. You get into a situation where you go and you get exposed to somebody and then you take thymus and alpha one and LL 37 afterwards. And it’s you begin to have. And that would be just be the beginning of a host of things. And the peptides are kind of an interesting category because they’re relatively low cost. And there’s some there tools that practitioners can begin to kind of have to help take care of themselves as they’re doing this stuff. ‘Cause I think there’s gonna be a whole generation of people that anytime you go to war there’s trauma, you know, PTSDs probably one of my favorite thing that I do, ’cause I’m so passionate about it. Primarily because I’m so hopeful. Like when I talk to somebody that’s traumatized, I basically, I talk to them and tell, I come to the conclusion and I kind of do this thing. I call the mathematical proof where I come to a conclusion that they’re gonna be okay. And then we navigate to a narrative that is some kind of hero’s journey story they’re gonna be okay. And in a way I’m just kind of trying to arm them with tools and skills and things that that will help them on that journey, but.

Sergio Azzolino DC, DACNB VeDA

And you know, it was exciting for me to hear how you were so passionate about this is what we gotta do now because I do think it is, you know, our generation has been extremely privileged in not having to fight a real battle and here we are. And I think it’s, I still remember that moment when things were shutting down in San Francisco, I mean, it was eerie, but I remember having a staff meeting was like, okay, what are we gonna, what’s our role here? And our role is not to say, oh my God, you know, things are dangerous. We’re staying home. That’s not, no. How can we step in and make our difference in our own little way? And I do think it brought together a lot of the healthcare communities certainly, you know, praised to the physicians and all the nurses on the front lines, but being in our world too is really exciting because we knew and here we have it, right? The long COVID is something that needs to be treated and needs our expertise at the highest level. So it’s absolutely a calling of us stepping up and saying, what can we do to make this difference? You know, back to what we’re talking about with the reaction. I think hopefully in a short period of time, we’ll be able to, us as a healthcare community really analyze better understand why some of these people are reacting rather than just extrapolating and saying, it’s safe for unsafe for whatnot. And it’s just gonna challenge us all to take a look at things on a deeper level. I mean, something like pans and pandas, man, I was, you know, reported to the medical board 20 years ago for diagnosing pandas, you know.

Matthew Cook, M.D.

Because I tell people what so of a shockingly important thing for parents to be aware of is are those two terms. So tell people what those are.

Sergio Azzolino DC, DACNB VeDA

Pediatric autoimmune neuropsychiatric disorders, secondary to strep, or just pediatric autoimmune neuropsychiatric syndrome. And these are unfortunate psychiatric conditions. Meaning one may have OCD, they may have tics tremors tourettes. They may have obsessive compulsive issues. And unfortunately we commonly see the worst of the worst with these things. And what happens is people, individuals, and it doesn’t need to be a child. It happens in adults also, but most of us that have more mature immune systems have a little better regulation over this, but we can get an infection. Kids commonly get infections, they may get a simple strep infection. And then after that develop severe anxiety or severe OCD or something of the sort, and what’s happening is a simple case of what’s called molecular mimicry. The strep looks very similar to different parts of the brain. Also, just as one can develop, you know, a cardiac condition, you know, a rheumatic fever or so one may also develop antibodies to attack certain parts of the brain. And in attacking those parts of the brain, they develop these psychiatric syndromes. The reason why this is so critical is if we recognize that this is happening as a result of auto immunity, then we treat the auto immunity and there’s a host of things that can be done that Dr. Cook will be able to ramble at what we can do from an autoimmune perspective to treat that rather than putting these kids on drugs, to treat their psychiatric condition.

Matthew Cook, M.D.

Hang on, thank you.

Sergio Azzolino DC, DACNB VeDA

And you know, it is one of the most heartbreaking things dealing with the athletes and all the high level people that you and I deal with this sexy, it’s fun, it’s gratifying, but dealing with these kids is really, you know, and in my opinion, God’s work because unfortunately they’re so bad in their lives are just put on hold and it destroys families. It just rips parents apart because these kids can worsen and worsen and no psychiatric medication in the world’s gonna solve the issue. That’s not to say they’re not necessary. That’s not to say they don’t provide a lot of benefit, but it’s not hitting the mark because we have an autoimmune condition taking place. And we really need to focus our efforts on number one, address in the autoimmune. And once again, from a functional neurologic perspective, we have tremendous success with treating those areas of the brain and getting them more stable.

Matthew Cook, M.D.

Have you seen those patients with, that have had tics for 20 years, 30 years? Will you see those get better with neurological training?

Sergio Azzolino DC, DACNB VeDA

Absolutely, remember if somebody’s having tics or tremors, it’s not a symptom of strep. It’s not a symptom of live or mycoplasm pneumoniae or any of these other things that can cause pans or pandas. It’s a symptom of some deficits in largely in oversimplification. Once again, I welcome any of the neurologists in the group to a higher level conversation or even better yet, you could come in and do some rounds, but it’s an oversimplification of, we commonly see these secondary to some dysfunction, to basal ganglia, little nuclei in the brain, little areas of the brain that turn on and turn off motor activity. And quite often those circuits get a little tripped and we lose a lot of the inhibitory aspects. So when the brain is stimulated, we just get spontaneous activity. And so, yes, we absolutely train these things. We train them, we fire the inhibitory pathways, the beauty of what we can do from a neurologic perspective, if it’s being practiced at a high level is we could fire specifically the inhibitor pathways, not just give something that’s stimulatory to the brain and hope that the inhibitory pathways fire, not just putting a chemical in their, you know, an SSRI or something of the sort or some GABA and hoping that we’re going to activate these inhibitory pathways, but we could fire them very specifically and train them. 

You know, you could do things like antipsychotics, where you have to look the opposite direction. You, we get people in front of light boards where they have to not react. Kids not react to certain targets, but react to others. And we can just train these pathways over and over and make a world of difference. We get great success with pans and pandas. And once again, it’s not to overreach, no matter what causes these things that we all see, you can kill off the line. You can clear the mold toxins, you can kill off the strap, the infections, whatever it may be, but you, the brain just doesn’t jump back to normal. You have to rehab it. And you know, it’d be ludicrous to think, you know, somebody blows out their knee, we repair their knee, we get rid of their pain, but suddenly their knee is gonna be back to normal. It’s not, we need to rehab it. And we also know that the longer you, these things here, the greater probability of permanency.

Matthew Cook, M.D.

And then I wanna echo this idea because then this has been a great theme for this conversation. And I think it’s in a theme that people may not have heard of. And I feel this conversation been a good sort of 101 introduction to the idea that someone could be in a water damage building and get exposed to mycotoxins, that disregulates the immune system. And then all of a sudden they get a concussion and then that causes a problem, or they get bit by a tic and that infection has this immune thing. And then they’re more susceptible to COVID or they get COVID or they’re a little kid and they get strep. And then that causes something that affects their brain and then their basal ganglia can’t regulate. And so then they’re having these problems. Now, these are basically all examples of how the immune system and the nervous system are so intertwined. And so influencing each other that the only way to basically fix these problems is to pay attention to both sides of the equation, the synergy, to try to diagnose to the greatest ability possible. And then we have a lot to do from a therapeutic perspective, both of your training in a peptide side. And even though we didn’t talk in great detail about peptides, I feel that this is a value. This was so valuable for people to hear. A, where you’re coming from. And B that really we’re the future is that we’re gonna be guiding what we do based on these principles and that and then that’s gonna help us get more data and directionally, I think this is the direction that medicine’s going in because we’re being led there because these are the problems of the day.

Sergio Azzolino DC, DACNB VeDA

Absolutely I mean, we did not speak about peptides in our use of ’em, but you know, they are integral to creating a healthy biochemical environment. And, you know, I can’t understate that they’re spectacular. I love them. I love ’em personally and patients love them and get great success with them. And you, and to me, it’s, you know, there’s so many sick people in the world that we’re all so busy dealing with all of the ill ones that you discuss. But, you know, hopefully in our lifetime, we could focus on just 100% maximizing wellness and function, and they certainly play a big part in that.

Matthew Cook, M.D.

I agree. Well, it’s an honor. And to talk to you, I’m grateful. And I look forward to what the future brings for us. And I look forward to continuing to learn from you because your wealth of knowledge and insight.

Sergio Azzolino DC, DACNB VeDA

Well, you took those words outta my outta my mouth, Matt, because it’s truly my honor and pleasure. And I can’t thank you enough for all that you’re doing. Like I said, clinically, and of bringing this information to the world. So thank you. And God bless you for that.

Matthew Cook, M.D.

Thank you so much.