The Hidden Power of the Brain: The Impact of Pain On Healing

Boots Knighton [: 00:00:02

So today is an important episode because we learn about pain and how we experience pain in the body. What if I had a whole new way for you to look at pain and to experience pain and to treat it as a friend instead of a foe? I am bringing to you today my physical therapist and just wonder woman in my life, Ann Alton. I met Ann at physical therapy after I broke my leg five and a half months ago. And upon working with her, I just knew I had to bring her on the podcast. So without further ado, I give you an Ann Alton. Welcome. Ann, I am so glad that you said yes today. Thank you for coming on the program.

Boots Knighton [: 00:01:02

You are so busy helping so many various patients at the physical therapy place that I see you at. And today is your day off. And darn if you aren't meeting me. And on behalf of all my listeners and helping us understand how pain works in our bodies after open heart surgery, it's my pleasure.

Ann Alton [: 00:01:25

It's a passion. So I'm happy to talk about it anytime.

Boots Knighton [: 00:01:29

Well, it shows. And you are new to. We live in Teton Valley, Idaho, and you just recently came to us.

Ann Alton [: 00:01:38

Yes.

Boots Knighton [: 00:01:38

And I just keep thinking about how all of us who break ourselves here and the Tetons are so lucky that you have chosen to move here, and you have just such a unique approach to healing than I've ever seen. And you really balance out the clinic that I see you at and tell us listeners, like, how did you get to where you are in your life with working with the body?

Ann Alton [: 00:02:06

So partly I started off, I have a chronic pain and chronic illness myself. And so some of it was me rehabbing myself and then realizing that I needed a big change, a big shift in my own life, and went back to PT school. So I went back to school to become a physical therapist and got my doctorate in 2011. And while I was there, listened to a guy named Lorimer Moseley. He's a physical therapist out of Australia. I listened to him speak and was absolutely enthralled by the work that he's been doing in regards to pain and how it works. And some of the new pain neuroscience that really is a paradigm shift from what we all grew up with, which is essentially you have damage, there's pain. Fix the damage and the pain goes away.

Ann Alton [: 00:02:57

That's not how it works at all. And because, you know, people experience that, it doesn't work that way. But still, we think that's how it's supposed to work in our minds. So I went on this journey, a lot of classes and did a lot of, like, working on my own understanding of how this works so that I can explain it to my patients and to myself that it's not quite as scary as pain seems to be. Okay. Because, you know, you have pain. You're like, oh, my goodness, what is going on? It doesn't have to be that way. It doesn't have to set off all the alarm bells in our heads.

Ann Alton [: 00:03:34

It's one alarm bell, but it doesn't have to set them all up. And I've been talking about it for 13 years now and getting better at explaining it every single time.

Boots Knighton [: 00:03:43

So the typical human. And this is what I have experienced, like, oh, no, I have pain. Oh, no, the world is ending. Like, what is a better way to approach pain when you experience it?

Ann Alton [: 00:03:58

So, pain is basically, well, pain is an alarm system. You ignore it at your own peril. It's like the engine light on your car. Okay? It could be that you just didn't put your gas cap on well enough the last time you got gas, but it also could be something major. Okay, so pain is something that is a tool. It alerts us that there's something wrong, that there's something going on that we need to pay attention to. But it is not a very good barometer as to how much damage there actually is. And you know that because there are times when you take your pants at night and you're like, where did that bruise on my thigh come from? Right? What happened was, is the.

Ann Alton [: 00:04:42

The information came from your body up to your brain, and your brain said, spinal cord. I know way more than you do. She hits that coffee table all the time. It is not a big deal. We don't have to pay attention to that. Right? On the other hand, the paper cut, that hurts like the dickens. There's not very much tissue damage there, but it sure hurts like the dickens, especially when you use hand sanitizer or, you know, try to cook or something like that. Right? So it's not a very barometer.

Ann Alton [: 00:05:11

It's just a, hey, there's something going on that you need to pay attention to. Okay.

Boots Knighton [: 00:05:16

Okay.

Ann Alton [: 00:05:17

And the other thing to keep in mind is that it. It involves the entire body. Pain does it. It's kind of like a medical office that doesn't have a receptionist that day. It affects everybody because you have the billing person that's trying to answer phones and trying to check in person, and patients. You've got, you know, the nurses that aren't doing their jobs because they're trying to collect payments and, you know, take whatever, like everybody's trying to fill in. And so it affects the whole body. So it's going to.

Ann Alton [: 00:05:53

It's going to affect how you think. It's going to affect how you walk. It's going to affect everything. It's going to affect how you digest things. It's going to. It affects the whole body. So it's just kind of a massive alarm system that goes off that. The way that I tend to try to get my patients to look at it is this is a guide for you that was placed there in your system to give you an idea of, hey, this is something important that you need to pay attention to.

Ann Alton [: 00:06:25

Once you've done that, you can reassure yourself that things are okay. Things are the way they're supposed to be. So an example of this would be if you have just gone through surgery and you reach down and you grab something and like, oh. Oh, my gosh. There's this massive, like, spike of pain. Right. That's your body's way of telling you, not too much too soon. Okay.

Ann Alton [: 00:06:56

That was too much. The way that you can reassure yourself is a stop doing that movement. Right. Listen to your body. But if it goes down in intensity fairly quickly, you can be pretty assured that you just hit your protect by pain line. Okay? So we have this protect by pain line and then we have this tissue damage line that's way up here. Okay? And so almost everybody's hit that protect by pain line. When they say have been a child and they're running across a field and they twist their ankle and they fall down and they go, they're grabbing their ankle and they're going, oh, my gosh.

Ann Alton [: 00:07:34

Ow, ow, ow. And they get up and they walk it off and all their friends are laughing at them because they made such a big deal about their ankle, which is fine, but that's your protect by pain line. And that's way below tissue damage. Tissue damage is way up here. Okay? Does that make sense?

Boots Knighton [: 00:07:50

Yeah. Yeah. Since, because we met because of my leg, and then we'll talk about the pain of open heart surgery and all that in a second. But because we met via my leg, how nice is my leg to bring us together? There's so many interesting things you have said to me, but one thing I want to just ask you about again is when I felt both my tibia and fibula breaking, and they were more like splintering. It wasn't painful.

Ann Alton [: 00:08:21

Right.

Boots Knighton [: 00:08:21

But then it hurt a few minutes later. Right. And so will you re explain why that happened, why that didn't hurt at first.

Ann Alton [: 00:08:32

Yeah. So there's a. There's a couple of things that happen. Number one is that there are the nociceptors, which are the things that, the nerve endings that detect noxious stimulus. Okay, stimulus that's potentially dangerous to us. Those move a whole lot slower than just your touch receptors. So again, I'm going to reference Lauren Burmoslie. He's got this really great TEDx talk that he did.

Ann Alton [: 00:09:00

It's about why things hurt. And it's like 15 minutes.

Boots Knighton [: 00:09:03

Yeah, it's so good.

Ann Alton [: 00:09:04

And it's so good. But basically those, those fast myelinated fibers that just detect touch, they run up to your brain and, like, something just happened on your leg. And the. Then the slower they take, longer. It's kind of part of the reason why, you know, that you stubbed your toe before it starts to hurt. You're like, oh, crap, I stubbed my. Ow. You know, it takes a second for it to reach that.

Ann Alton [: 00:09:30

But the other thing is, is that pain is all about context. So your brain, at the time that you. That you broke your leg probably said, well, she falls all the time. It's probably not a big deal until you looked at it and got more information about what was happening. And then your brain makes this assessment of how dangerous is this really? Okay, so it's all about. It's all about context. And so if you were to fall in similar way, in a similar situation, again, even if you did nothing to your leg, it would probably hurt like the Dickens because your brain's going to go, oh, we did this before. And it was really bad.

Ann Alton [: 00:10:10

So I can say the brain takes into account all kinds of things that take. Takes into account what it feels from the body. Have we been here before? Have we done this before? Do we know other people who have done this before? What was their story like? What have they told us? What have doctors told us about whatever is going on? You know, all of these things. Can I get up? Can I walk? All of these things kind of combined determine how dangerous is this situation, really? According to that, then it turns up the volume on the pain.

Boots Knighton [: 00:10:44

Beautifully said. And that's what happened. Like, I fell, I felt the bones breaking, but I've never broken a bone, so I didn't quite like I knew. I just was a sensation I had never felt before. And then I tried to get up and nothing. Nothing was happening in that leg. Right? It was just like dangling there. And then I realize I'm on the top of a mountain in the backcountry by myself.

Boots Knighton [: 00:11:11

And it's five degrees, and that's when the pain hit.

Ann Alton [: 00:11:15

Yeah. And this is very dangerous. And your brain went, yeah. Holy cow. Mobilize everything.

Boots Knighton [: 00:11:21

Yeah.

Ann Alton [: 00:11:22

This is. This is a very dangerous situation. We need fight or flight to kick in. We need. We need the whole body to mobilize to get us out of this situation. It's pretty cool.

Boots Knighton [: 00:11:33

Yeah, it is. I mean, it wasn't at that moment, but.

Ann Alton [: 00:11:36

Yeah, no, no, not cool at all. But it's cool. It's. It. And it's not cool if there's something going on in your body that's pretty chronic, and your body keeps saying, oh, my gosh, we're gonna die when we're not, you know? And so that's the tricky part. But the cool thing is, is there's so many things that go into the brain's assessment of how dangerous is this, really, that there are so many places that we can intervene, not just with pills, not just with surgery, not just, you know, there's so many different ways that we can intervene because there are so many things that go into this assessment, so we can take it down notch by notch by notch, because there's so many different.

Boots Knighton [: 00:12:18

Right. Which you and I've been doing with my leg. And it's. It's been really incredible, and I'm having such a fast recovery because of it. So let's take a trip to a broken sternum. So, we heart patients that have had open heart surgery go through such an epic ordeal. I mean, just to get to the heart is such an ordeal. And I still believe that my breaking my leg was infinitely more painful than my open heart surgery, and open heart surgery was pretty painful.

Boots Knighton [: 00:12:55

But can we unpack that surgery? And then I also want to make sure we talk about all the pain centers in the body. So can you educate us on that?

Ann Alton [: 00:13:06

Yeah. So, initially, a lot of times, people who go through a surgical procedure that they know is going to happen ahead of time, they had a little bit of time to prepare themselves for it. They typically. Usually they'll have a problem in their body that desperately needs attention. So therefore, the brain is assessing this surgical procedure as less dangerous than, say, an accident where you hit your sternum on, like, bike handles or something, because your brain has decided this is necessary. Okay. It's not going to feel good, but it's necessary. And so that will turn down the volume on the pain a little bit.

Ann Alton [: 00:13:52

So it might be as painful not to say that it doesn't hurt, because pain is always real, and you can never determine how much pain somebody's going to be in at all. It's all individual. It's all based on your own personal, you know, and it could be that this person has been told, this is going to be really painful, and so that's what their expectations are. Or they've seen their mother or father or close relative go through similar thing and they had difficulties or they had infections or they had something else go on. So there are all kinds of factors that can go into it, but one of the reasons why it might not be quite so painful is because the brain has decided this is necessary. Okay.

Boots Knighton [: 00:14:40

I'm hearing you say it's a story we tell ourselves that matters.

Ann Alton [: 00:14:44

Yeah. Yeah. And the story that we tell ourselves isn't necessarily something that we have complete conscious control over. I want people to understand this. So if you think about your typical optical illusion, and there are lots of them that you can look up online, your brain makes a snap judgment about what's happening in this picture. And it may be that, no, those circles aren't moving or those blocks are the same color, but your brain makes a snap decision about whether or not this is what's happening in this picture that's based on survival. The story that we tell ourselves is based on survival and is a snap judgment. Okay? We can intervene later by starting to tell ourselves a different story.

Ann Alton [: 00:15:37

But don't hate on yourself because your brain said, oh, this is super dangerous, right? Because all pain is real. All pain is as intense as the person is telling you. It is. It's just, it's like you said, it's a story we tell ourselves, but it's a. It's our lizard brain in the back of our minds that's just, that's job is to keep us upright and moving. And it's not our frontal cortex that that makes the story.

Boots Knighton [: 00:16:02

Okay, the lizard brain, you've been talking to me about that some with my leg. How does that play a role in open heart surgery?

Ann Alton [: 00:16:12

So recovering from it. So that has a lot to do. Again, with this snap judgment of how dangerous is this? Okay. It can vary based on a person's experience with their doctor. It can be what your physical therapist told you. It can be what your doctor told you. It can be what, some offhand comment the nurse made. It can be experience from forums and people telling their stories.

Ann Alton [: 00:16:40

It can be, any of these can turn the volume up or down, and these are just logged away in our minds, kind of in that lizard brain going, okay, how you know this? This is an experience or this is a memory or some sort of knowledge that we have that goes into this assessment of how dangerous is it. It's really kind of that simple. And it's. It's the snap judgment. It's not something that, you know, if you can think your way out of it. None of us would have pain. So I wanted to go into like the initial healing process of any kind of injury or surgery, and that the body will actually put in extra nerve endings. So it's not all in the brain.

Ann Alton [: 00:17:25

Some of it is in the body as well. So the reason that the body puts in extra nerve endings is because it really, really wants to know all the excruciatingly minute details of what's happening in that zone. Okay? And ideally those, as we stop needing them and as we heal, those nerve endings will start to get taken down. But if somebody is out there that has had a hip pain is like, it still hurts as bad as the day I left, you know, left the. Or that may be because for whatever reason, those extra nerve endings weren't taken down. Um, and there are ways to deal with that. And I can get into that a little bit later if we have time. Or we could do a second 2nd run podcast on how that goes, run out.

Ann Alton [: 00:18:10

But basically you have those extra nerve endings and then you also have inflammation. And inflammation is your body's, I consider them to be your repair crews. So it has all of the good new materials that your body needs to repair and all the old bad materials that it's taking down and trying to get rid of. And so you have this huge inflammatory soup that has all these chemicals in it, and that in and of itself can be irritating to the nerves in the area. Okay? So all of that sends information up to the brain saying, hey, we have an issue here, we're in danger. Right? And so the other, the other thing that can happen is that if that these nerve endings don't go down, the nerve, the inflammation doesn't go down as quickly as we anticipate. Sometimes some of the neighboring areas can get irritated and like, concerned. And I think of it like your neighborhood, you know, somebody broke into your, into your house, and so the neighbors are all kind of like, do we need to be worried about this? Like, is there, is this going to be a crime spree? You know, we've been having issues with this area for a really long time now.

Ann Alton [: 00:19:22

You have this really big issue with this area. Do we need to be concerned? So they start putting in extra alarm systems and being, becoming extra sensitive as well. So that can spread as things. As things go on. But one way that you can return to function is through pacing. And people just kind of naturally do this anyway. But if pain happens to persist for a longer period of time, we get to be more cautious about returning to function. So what I encourage people to do is say, okay, what is comfortable right now on a good day? Doable, but difficult on a bad day.

Ann Alton [: 00:20:02

Okay. And so that's kind of your baseline. And then every day, or every week, you try to do just a tad bit more. And so the, hold on.

Boots Knighton [: 00:20:12

What is, what is comfortable on a good day and what is challenging on a bad day?

Ann Alton [: 00:20:19

Yeah, yeah. Do challenging and not to where you're pay for it for two to three days afterwards. Okay. That is challenging in the moment on that day, but it's easy to, you know, good on a good day. And so that's kind of your baseline, and then you kind of, I say touch it, tease it, nudge it. So we just kind of take that baseline and we just kind of try to push it upwards a little bit, day by day or week by week, whatever is your comfort zone. So ideally, you don't move into an increased amount of activity until what was challenging and hard on a bad day becomes easier on a bad day. Okay.

Ann Alton [: 00:21:06

Does that make sense?

Boots Knighton [: 00:21:07

Yeah. Yeah. It's just such a different way of. It's different than how it was all presented to me in the hospital. And what I heard a lot of sternal patients, sternal heart patients say, you know, it's, we're given the driving restrictions and the lifting restrictions, but that's it. And more times than not, women like myself are not referred for cardiac rehab. I wasn't.

Ann Alton [: 00:21:35

Wow.

Boots Knighton [: 00:21:35

But all the male, all the male heart buddies that I've interviewed, every single one of them were referred to cardiac rehab. And I think out of all the women I've interviewed now, only one or two were referred to cardiac rehab. And so I just wasn't given the proper, like, plan to return to my life, and I had to figure it out on my own. I mean, I just started going to the gym and seeing what I could do.

Ann Alton [: 00:22:03

Wow.

Boots Knighton [: 00:22:04

And then I developed, and there's been several other people that I've interviewed or at least spoken with in, like, communities about. I developed complications with the sternal wires, and I was getting, like, electrocuted down my arm.

Ann Alton [: 00:22:17

Yeah.

Boots Knighton [: 00:22:18

And so I ended up having to have the sternal wires removed.

Ann Alton [: 00:22:22

Yeah, that's. That's. Unfortunately, that is. That is a. I've seen that happen before. And interestingly enough, it was the two times that I've seen it happen with women. And I wonder if it's because you've been left to try to figure out how to pace yourself back into normal, everyday function instead of going to rehab. That's a huge problem.

Ann Alton [: 00:22:44

You know, we know, we know that the, we know that our medical system is run by people, and people have internal biases. So oftentimes, you know, if you're a person of color, if you're a woman, you're going to not get the type of care that a white male would get. And everything's based on off of white men, too. So, like, all of the research that's been done is based on white men. And so we're not just tiny men. We're built differently. And we have different considerations, including the fact that our soft tissues and our connective tissues are different, and they're different based on our, you know, where we are in our cycle, if we still have one.

Boots Knighton [: 00:23:31

Really?

Ann Alton [: 00:23:32

Hormones can change how your soft tissues work and how all of that stuff works so that that can change how you rehab as well.

Boots Knighton [: 00:23:43

Okay, so that's news. You know, by the time this episode airs, another recording I just did yesterday will have aired before it. And I was speaking with Doctor Amy Nuzle about the MTHFR mutation. And leading up to that, she was saying how we as a society can no longer depend on one single provider, healthcare provider, to hold all the knowledge of the human body because there's just so much more that we know now than even, gosh, five years ago. Right? And, yeah, so she said, you know, cause I was like, how is this? Cause I just found out I have the mutation, which explains a lot.

Ann Alton [: 00:24:32

I do, too.

Boots Knighton [: 00:24:33

Oh, no. No wonder we've connected. Anyway, so anyway, I was. Because I was getting really exasperated, because I was like, how is this not being shouted out from the mountaintops? Like, it's such an important mutation that society needs to be talking more about. It's so impactful. And that's what she said. Well, you know, if we, if we were to require even you, Ann, as talented and gifted as you are as a physical therapist, it's not fair to even ask you to keep all of how to rehab in mind because there's just so much new research coming out and things like that. And so we need to kind of change our expectations and shift how we approach healthcare providers and get into, like, a better mindset of, like, we are teaming up.

Boots Knighton [: 00:25:28

And that I'm not going to, like, put you on this pedestal and expect you to rehab all my aches and pains. And, you know, like, there's, that's why there's so many different types of providers, but still, there should be this, like, minimal level of, like, expectation of the patient, of the provider to at least get us on the right track. And I know that I will say that as a woman, here's yet another example of why wasn't I told that my hormones can affect how I heal? Like, that just seems incredibly important.

Ann Alton [: 00:26:11

You know, sometimes, though, because some of this is such new information, it takes about 20 years for things to trickle down to your average general practitioner. Wow. Takes about.

Boots Knighton [: 00:26:23

That's too long.

Ann Alton [: 00:26:24

It's way too long. But there's so much that comes out, you know, that the average practitioner does not have time to read all the new stuff. And so there are ways that we can try to keep up with a lot of this information. But you're right. Like, you know, a lot of what I know is, just because I've been through it, I had to learn it for myself. And so people are like, how do you know all this stuff that has nothing to do with PT, like the THFR mutation, all of that stuff, you know, comt mutations, all of those things. Like, how do you know all of that stuff? And it's because, well, it's cause I had to go through it myself. I had to learn it myself and then advocate for myself with my doctors.

Ann Alton [: 00:27:10

But it definitely is. We need to have another paradigm shift where we are teams and we're teaming with the patient. And I always tell my patients, you live there. I don't, you know way more about your body than I do. So I, you know, there's no such thing as too much information for me because you may say something. I mean, be like, I don't know what to do with that. But two, two, three weeks later, I may go, that's why, that's why she's not getting better. You know, I've had that happen numerous times where somebody has said, like, I had a shoulder patient, for example, one time who was not getting any better, and she at one time mentioned that she couldn't even sing in her choir anymore.

Ann Alton [: 00:27:58

And I realized it's her lungs. They come right up. They come right up into the shoulder. It's her lungs. So I taught her how to breathe, and she got better.

Boots Knighton [: 00:28:07

Oh, wow. Wow.

Ann Alton [: 00:28:09

So to me, there's just not, and unfortunately, a lot of doctors, they have, like, eight minutes to be with me. I'm lucky, and I chose my profession for the purpose of the fact that I get to spend 45 minutes with you one on one. They're trying to even change that now. To where? Yeah. You know, I have to see two more than one person, not where I'm working, but in a lot of places, they want you to see two or three people at a time, and I have always just refused, I think. I can't practice that way.

Boots Knighton [: 00:28:40

Yeah, that doesn't seem responsible or fair to you or the patient, because I know the work that you do with me. I can't imagine you starting, then leaving me, then coming back like that.

Ann Alton [: 00:28:50

Just.

Boots Knighton [: 00:28:50

That wouldn't work.

Ann Alton [: 00:28:51

No, no.

Boots Knighton [: 00:28:53

The eleven centers in the brain.

Ann Alton [: 00:28:56

Yes. You're gonna make me rest them up. I tried to. I tried to find them all. There are at least eleven, and I'm not sure. I'm not sure. So we have the sensory cortex, which is basically the part of our brain that collects sensory information from the body. We have somatosensory cortex, which is.

Ann Alton [: 00:29:17

Well, I guess the sensory cortex also integrates what we hear, see, feel, taste, touch, all of that stuff. We have somatosensory cortex, which is what we feel from within our body. We have the anterior cingulate cortex, which is emotion and cognition. A lot of these things are very emotionally charged. Anytime we're in pain, there's usually an emotional charge to it. We have the insular cortex, which combines sensory and emotional. What we're feeling while or. And or smelling while we're experiencing this emotion.

Ann Alton [: 00:29:57

It's part of the reason why smells bring back emotion and memory so well. We have a prefrontal cortex, which is cognitive and evaluative. So it helps us to evaluate how dangerous something is. It helps us to evaluate situation we're in to make sure that we take the appropriate action to get out of whatever situation it is. We have visualized visual areas. So I always tell people, if they've had, like, a back surgery, take a mirror, look at your back, because it's very important for your brain to be able to visualize what's happening back there. And so this is another area where we can kind of intervene in a person's recovery, and that is to give them as much information as possible about what the. Their situation is, what happened during their surgery, what happened to their body, what's happening now to their body, so that they can understand, so their brain can kind of visualize.

Ann Alton [: 00:30:58

Like, okay, I understand what's happening. Right. When we don't understand something, it's more dangerous. It's more. It's more it's more fear provoking. It's, you know, it's why we're afraid of the dark. We don't know it's there. Right?

Boots Knighton [: 00:31:11

Yep.

Ann Alton [: 00:31:12

So the thalamus, which is their, you, your relay system. So it's, it'll, it'll relay. And so all of these areas. CrosStAlk so the thalamus is really important because it helps relay all of this information to all these different areas. You have your cereal bone, which helps to regulate how you move based on what's happening. You have your, your motor cortex and your premotor cortex, which helps you plan and execute motor activities, which is obviously going to change. If you've had surgery, you're not going to be moving in the same way that you did before. And then the cerebellum helps to make that nice and smooth.

Ann Alton [: 00:31:51

Right. And so I think that's eleven.

Boots Knighton [: 00:31:54

But what happened, I wasn't like counting on my fingers or anything, but.

Ann Alton [: 00:31:58

Yeah. So very thorough. Yeah. What happens is those areas, they all cross talk and they all fire together. And those things that fire together have a tendency to wire together. So if you've heard of Pavlov's dog, he's the guy that taught his dog how to come to the dinner bell. One thing that he notices, not only would the dog come to the bell, but the dog would start to drool, which to me just indicates that our automatic systems, our autonomic nervous system, the stuff that we have absolutely no control over, is also activated when some of these things are activated as well. So you ring that bell and, you know, your autonomic nervous system kicks in as well.

Boots Knighton [: 00:32:42

Right. Two questions for you.

Ann Alton [: 00:32:44

Sure.

Boots Knighton [: 00:32:45

Or maybe even more of a comment. This one's a comment. So it was a while before I had it in me to like, really look at my hospital bill because it just listed off, like, all the things I went through in the five days I was there. And that was just so intense to read through. But then the other thing that I did was I read the surgical report.

Ann Alton [: 00:33:15

Yes.

Boots Knighton [: 00:33:16

And it was really, really awful at first. And then I also watched an open heart surgery. This is probably like two years after my open heart surgery. I watched one online, just like the beginnings parts of it, and then I had to turn it off. But I noticed that it actually, I think it was more helpful than not because I just felt a resolution, like, obviously I had survived.

Ann Alton [: 00:33:47

So your, so your chances are really good that you're, you're in that situation. What likely happened is that your brain went, oh, that's what we've been imagining. Okay, now that makes more sense.

Boots Knighton [: 00:34:00

Okay.

Ann Alton [: 00:34:01

And then is to kind of put that to bed. Right? Like we don't have to worry about what happened anymore because now what we've seen now makes sense and was able to kind of connect the dots. It's kind of like what a lot of people go through is they've been given a puzzle, like a jigsaw puzzle, but they haven't been given the box with the picture on it. Okay. So they're trying to put together this, this jigsaw puzzle based upon somebody's usually not very good explanation of what's happening and no familiarity at all with the terrain. So if somebody has never seen a picture of mountains, never seen mountains before, and they have this picture of mountains to put together and you're like, well, it's kind of hilly, but bigger than. Until, you know, bigger than that. And like.

Ann Alton [: 00:34:50

And they're using all these words that you've never heard of, like, you know, whatever, I don't, you know, ridges and canyons and whatever else. Maybe you've never heard these words before. And so you're trying to put together this puzzle, but you don't have the box that it comes in with the picture to compare where these pieces go. So once your brain has that, it goes, oh, that's where those go. Okay, no problem. All right. I've got that. That makes sense.

Ann Alton [: 00:35:19

So that can help to take down a lot of the anxiety and a lot of the stress that goes along with that. If you find yourself in a position where you just can't handle blood or you can't handle a lot of those, you know, the words or whatever, try to find somebody who can explain it to you, you know? And I always tell people, I have to tell my doctor. Tell me like I'm four. Explain it to me like I'm four years old because that's the level that I'm at right now with this. With this. Just explain it to me like I'm four. And yeah, I understand you're going to be glossing over some of the details and you're not going to be giving me a lot of this, this other stuff. And that's fine.

Ann Alton [: 00:36:01

I just need to know. You went in, there was this doorway in the heart that was not working correctly. And so you hung up a new doorway and now it works better. And I sewed me back up and. Okay, okay. That makes sense to me. Napple. And so, yeah, again, that goes back to us being afraid of what we're not, what we're not familiar with.

Ann Alton [: 00:36:24

And that increased anxiety, increasing the pain, you know, how dangerous is this, really? Well, we're not really sure because we don't know. So we're just gonna crank it up, make sure she or he listens to us and pays attention to what's happening.

Boots Knighton [: 00:36:38

So in that vein, with the scar that we heart patients all hopefully wear proudly. I know a few patients that just can't even. They hide it all the time, even from themselves, and that's their journey. And I can now, having worked with you, I can see how that could be problematic from a pain perspective and an autonomic nervous system perspective.

Ann Alton [: 00:37:06

Yes.

Boots Knighton [: 00:37:06

Would you agree?

Ann Alton [: 00:37:08

I do. I do. Again, it's. It's their journey, and it's. It's something that, you know, people. I would encourage people to work through that, find somebody to help them work through that, because, you know, we all have scars. And if you might have noticed, I don't have a finger on this hand. And it's, you know, it's part of me.

Ann Alton [: 00:37:28

It's part of my journey. If I ever looked at my hand, in fact, I did look at my hand in a mirror one time, and it. I had a left hand with a pinky finger on it, and it was the freakiest thing I've seen in my entire life. It was terrifying. But, you know, so. So being able to accept those things and understand that, you know, we look at trees all the time. Every single tree is gorgeous. And every tree has scars.

Ann Alton [: 00:37:52

Every tree has a crooked branch. Every tree has leaves on it that aren't perfect. Perfect. Right. And we don't blame the tree. We don't think any less of the tree for that. And so the same should be given. The same grace should be given to people and to ourselves.

Ann Alton [: 00:38:11

And so I would encourage people to try to work through that and to understand that this is. This is a battle scar that, you know, life has given them. And that looking at it and understanding it and seeing. Seeing how well it's healed is an indication of how well things are healing on the inside as well. That visual representation of that healing is what is also happening to the heart is also happening on the inside. So I always encourage people to look at their scars. A lot of them don't. There are people that don't like to.

Ann Alton [: 00:38:46

And initially, I guess, it's their journey. If you want to cover it up with a tattoo or whatever, I would just hope that people understand that. Gosh, you know, nobody gets out on skate. This is life, right? Nobody gets out on skate, right? Everybody has some sort of trauma.

Boots Knighton [: 00:39:06

Well, I think that is a beautiful place to end. Wow. I'm just so grateful to you. I think of this conversation as a conversation of hope that whatever pain we go through, whatever physical maladies we experience in our life, that the pain that comes with it doesn't have to be lifelong. And that I'm also feeling really empowered that we can rewire our brains and we have way more ability to heal than the western medical establishment establishment likes to let on.

Ann Alton [: 00:39:50

Yes, absolutely. Absolutely.

Boots Knighton [: 00:39:52

That's my big takeaway today.

Ann Alton [: 00:39:54

Yeah, it's a good takeaway.

Boots Knighton [: 00:39:55

Well, Doctor Ann Alton, thank you so much. And I will see you in the office very soon.

Ann Alton [: 00:40:02

Sounds great. Look forward to it.

Boots Knighton [: 00:40:04

And that is the show for today. Thank you for listening all the way to the end. And as a special treat for you today, you get to be some of the first to know that I am going to be changing the name of this podcast, which I will unveil on the June 4 episode. Be sure you have subscribed so you can be the first to know the new name of the podcast. Also, I want to hear from you. Do you have a heart story you want to share on this podcast? Do you have a topic you want me to cover? You can send me an email@bootsheheartchamberpodcast.com. be sure to share this episode today. Pain is one of the hardest things we humans have to deal with.

Boots Knighton [: 00:40:56

But as you could hear in this episode, Ann Alton is a wealth of knowledge, and pain can be an informer instead of destroying our life. I love you. Thank you for listening. Be sure to come back next Tuesday.