In this episode, I share my insights from ten years of medical practice on why treatments don't always work as expected. I explore everything from the basic inefficacies of certain treatments to the complex interplay of dosages, patient compliance, and personal beliefs. I discuss the critical role of setting appropriate expectations and the often-overlooked impact of personal interactions and the healthcare environment. Join me as I unpack the multifactorial reasons behind treatment outcomes and share real-world experiences that highlight the importance of a holistic approach to patient care.

Here are the timestamps organized by main points for the podcast transcript:

1. **Introduction to Treatment Failures**

- [00:00.000 - 00:26.640] Introduction and overview of why treatments fail.

2. **Common Reasons for Treatment Failure**

- [00:27.280 - 00:59.720] Discussion on ineffective treatments and correct diagnoses.

- [01:00.000 - 01:23.640] Underdosing and its impacts.

- [01:23.640 - 02:01.320] Medication build-up in the system and its necessity (e.g., gabapentin).

3. **Patient Compliance and Expectations**

- [02:01.320 - 03:08.120] Challenges with patient compliance and setting expectations for treatment effectiveness.

- [03:08.120 - 04:11.200] Economic considerations and patient affordability.

4. **Disease Progression**

- [04:11.200 - 05:04.420] How advanced stages of conditions affect treatment success, using arthritis as an example.

5. **Setting Realistic Expectations**

- [05:04.420 - 06:09.000] Importance of clear communication between doctors and patients about what to expect from treatments.

6. **Impact of Personal Beliefs**

- [06:09.000 - 07:00.180] How personal beliefs and the power of suggestion influence treatment outcomes.

- [07:00.180 - 08:08.020] Examples of self-sabotage and the influence of others' opinions on treatment acceptance.

7. **The Role of Healthcare Providers**

- [08:08.020 - 09:06.700] Discussing the influence of healthcare providers' suggestions and the importance of their communication skills.

8. **Interpersonal Interactions and Staff Influence**

- [09:06.700 - 10:20.100] The significance of interactions between healthcare staff and patients, and how these can affect treatment perception.

9. **Concluding Thoughts**

- [10:20.100 - 15:26.180] Recap and final thoughts on why understanding these factors is crucial for both patients and healthcare providers.

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Hey there! I'm Fred Bagares, and you're tuning into the "Talking Rehab Podcast." Today, we're diving deep into the world of rehabilitation and the critical role of exercise in it. We'll explore everything from what rehabilitation really means to the different types of exercises and their purposes.

Certainly! Here’s a breakdown of the main topics covered in the podcast episode along with their corresponding timestamps:

**Introduction to Rehabilitation and Personal Background**

- [00:00] Definition of rehabilitation

- [00:02] Introduction of host, Dr. Fred Bagares

- [00:09] Dr. Bagares's experience and perspective on musculoskeletal medicine

**Purpose and Goals of the Podcast**

- [00:14] Overview of the podcast's aims and inspirations

- [00:20] Hopes for sparking discussions and sharing experiences

**Welcome and Segue into Main Topic**

- [00:27] Welcoming listeners to the "Talking Rehab Podcast"

- [00:35] Transition to main discussion

**Exercise and Rehabilitation**

- [00:37] Importance of exercise in rehabilitation

- [00:53] Different phases of injury and the role of exercise

- [01:57] Evolution of Dr. Bagares's understanding of therapeutic value

**Deep Dive into Therapeutic Exercise**

- [02:01] Exploring the therapeutic value and challenges in explaining it

- [02:54] Definitions and explanations of exercise from medical texts

- [03:14] Categories of exercise: therapeutic, goal-based, and recreational

- [04:19] Goals and biological benefits of therapeutic exercises

**Transition to Goal-Based Exercise**

- [05:57] From therapeutic exercises to goal-based approaches

- [06:05] Subcategories within goal-based exercises: skill acquisition, muscle hypertrophy, and improving cardiovascular health

**Challenges in Conveying the Importance of Varied Exercise Regimens**

- [07:55] The misconception about cardiovascular exercises in therapy

- [09:00] Importance of understanding different exercise goals and their therapeutic impacts

**Recreational Exercise and Personalization**

- [10:09] The role and benefits of recreational exercise

- [10:41] Understanding patients' recreational interests to tailor rehabilitation goals

**Conclusion and Reflection**

- [11:59] Encouragement for listeners to rethink their understanding of exercise

- [12:23] Closing thoughts and gratitude

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Today, we're diving into a topic that's not only central to my daily practice but also a fascinating subject for any healthcare professional dealing with the spine—epidural lipomatosis. This condition involves the excessive accumulation of fat within the spinal canal, leading to symptoms like pain, numbness, and weakness due to spinal stenosis.

[00:33:52] **Exploring Epidural Lipomatosis** - Introducing today’s main topic, understanding the condition as an abnormal fat deposition in the spinal canal.

[01:18:20] **Symptoms and Effects** - Discussing how epidural lipomatosis leads to spinal stenosis and its symptoms.

[01:38:80] **Interest in Epidural Lipomatosis** - Why I find this condition particularly intriguing and underreported.

[02:41:12] **Potential Metabolic Syndrome Link** - Exploring whether this condition could signify broader metabolic issues.

[04:01:76] **Treatment Considerations** - Discussing lifestyle changes, surgical interventions, and potential new treatments like Ozempic.

[06:02:24] **Call to Action** - Encouraging further research and reporting on epidural lipomatosis.

In this episode, I delve deep into how this condition affects our patients and why it's crucial for us as professionals to understand and recognize its implications fully. Whether you're a fellow physician, a healthcare student, or just someone interested in how the body works, this episode will provide valuable insights into a lesser-known but significant health issue. Thank you for joining me, and remember to like, subscribe, and share your thoughts on this topic. Let's keep moving towards better health together!

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Join Dr. Fred Bagares in this enlightening episode of the Talking Rehab Podcast, where he dives deep into the concept of the "perfect tool" in treatment. With over a decade of experience, Dr. Bagares shares his insights on the effectiveness, risks, and practicality of various medical tools—from biologics and steroid injections to non-invasive techniques and surgery. This episode is a must-listen for anyone interested in the evolving field of sports and spine medicine, offering a blend of professional expertise and practical advice aimed at improving patient care and treatment outcomes.

**Timestamps:**

- [00:37] Exploring the Best Tools in Clinical Practice

- [01:11] The Concept of the Perfect Medical Tool

- [01:55] Criteria for the Ideal Medical Tool

- [05:02] Non-Invasive vs. Invasive Tools

- [08:35] Evaluation of Current Tools in Musculoskeletal Medicine

- [09:06] Discussion on Over-the-Counter Medications

- [10:26] The Role of Steroid Injections

- [12:13] Cutting-Edge Regenerative Medicine

- [16:17] Challenges with Biologics and Regenerative Techniques

- [18:41] The Financial and Practical Aspects of Surgery

- [22:10] Recovery and Long-Term Outcomes Post-Surgery

- [25:00] The "Rent to Own" Approach in Treatment Options

- [25:35] Closing Thoughts: The Importance of a Comprehensive Treatment Framework

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**Episode Description:**

In this episode of the Talking Rehab Podcast, I discuss the use of diagnostic blocks to accurately identify pain sources in patients with spine and musculoskeletal disorders. I emphasize the importance of setting realistic expectations, accurately interpreting pain levels before and after injections, and the unique challenges that come with patient reporting. This discussion is designed to deepen the understanding of both clinicians and patients, enhancing the effectiveness of pain management and diagnostic accuracy in clinical settings.

**Episode Description:**

In this episode of the Talking Rehab Podcast, we dive into the complexities of diagnostic blocks and managing post-procedure pain. Our host, an experienced physician, shares insights on the use of diagnostic blocks to pinpoint sources of pain in patients with spine and musculoskeletal disorders. The discussion covers setting realistic expectations, interpreting pain levels pre and post-injection, and the challenges of patient reporting. This talk aims to enhance understanding among clinicians and patients alike, shedding light on the nuances of pain management and diagnostic accuracy in clinical practice.

**Timestamps for Episode Navigation:**

1. **Introduction to Diagnostic Blocks**

- [00:00] Overview of diagnostic blocks and their importance in identifying pain sources.

2. **Mechanics of Diagnostic Blocks**

- [01:50] Detailed explanation of how diagnostic blocks work and their application in clinical settings.

3. **Setting Expectations with Patients**

- [03:30] Discussing the importance of setting correct expectations about the procedure's outcomes and potential pain levels.

4. **Challenges of Patient Reporting**

- [05:10] Insights into the complexities of patient feedback and the interpretation of diagnostic results.

5. **Real-World Application and Outcomes**

- [06:45] Examples of real-world application of diagnostic blocks and variable patient responses.

6. **Pharmacokinetics and Duration of Effect**

- [08:20] Explanation of the medication's effects duration and managing patient expectations regarding the return of pain.

7. **Interpreting Variable Responses**

- [09:55] Discussion on the variability in patient responses and the clinical implications of late or prolonged pain relief.

8. **Educational Approaches and Patient Communication**

- [11:30] Strategies for educating patients and ensuring accurate reporting of symptoms.

9. **Conclusion and Reflections**

- [13:05] Final thoughts on the need for nuanced approaches in pain management and diagnostic procedures.

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The term "rehabilitation" is commonly used in the musculoskeletal world but it's really quite vague. There are several textbook definitions but ultimately every clinician needs to define it for themselves. In this episode, I discuss what rehabilitation means to me and how it affects my clinical approach.

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Welcome to the inaugural episode of the Talking Rehab Podcast with your host, Dr. Fred Bagares. Join us as Dr. Bagares, a seasoned sports and spine medicine physician from Virginia Beach, shares his 20 year history in musculoskeletal medicine. Starting as a high school student shadowing athletic trainers to his current clinical practice, he has witnessed the evolution of orthopedic care, inspiring him to question longstanding medical practices and studies. This podcast aims to reevaluate current musculoskeletal treatments and explore innovative approaches to improve patient care. Tune in for insightful discussions, guest expert opinions, and a deep dive into the complexities of healthcare practices. Your feedback and topic suggestions are highly encouraged—connect with us via email or social media. Thank you for joining us on this enlightening journey.

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