Outcomes Rocket Podcast_Meredith Langhorst: this mp3 audio file was automatically transcribed by Sonix with the best speech-to-text algorithms. This transcript may contain errors.
Saul Marquez:
Hey, everybody! Welcome back to the Outcomes Rocket and I’m excited to continue this series with the, really the topic around lower back pain and all of the things that we could be doing differently to give folks better relief and long-term results. And today I have the privilege of hosting Dr. Meredith Langhorst and actually one of her patients, Eric Osborn. A little bit about Dr. Langhorst, she is a specialist in Spinal Diagnostics Therapeutics and also restorative neurostimulation. She sees patients of all ages with spinal disorders, back and neck pain. This includes disc herniation, degenerative disc disease, spinal arthritis, and many of the other ailments that affect the back, including the topic of our discussion: mechanical low back pain due to muscular dysfunction. She focuses on maximizing the medical management of these conditions through rehabilitation, as well as minimally invasive interventional procedures. We also have Eric Osborn joining us. He’s a military veteran and an outstanding member of society. And he’ll be sharing with us his experience with his back pain and some of the things that have helped him in his recovery. So, I’m really excited about today’s podcasts. I want to start with you, Dr. Langhorst. First of all, welcome to the podcast.
Dr. Meredith Langhorst:
Thank you for having me. I’m excited to be here.
Saul Marquez:
Absolutely, you know, and so, you know, this is part of a series that we’re doing on this topic. And so talk to us about your experience with the Reactiv8 therapy.
Dr. Meredith Langhorst:
So I’ve been practicing for just shy of 20 years now, and chronic low back pain is probably one of the things that I come across most often in my practice, and prior to my experience with Reactiv8, and even in the early years, it’s been very challenging and very difficult to meet the needs for these patients because oftentimes we don’t have any interventions or therapies that will give these individuals long-standing, durable improvement that they can have with them for months or years to come. They typically go through episodes of recurrent symptoms that just over time become more progressive and more kind of life-encompassing. And so when I first got introduced to Reactiv8, I, just by the mechanism of how it works, I found it very interesting. I come from kind of a strong rehab background and mechanical evaluation of patients for physical exam. And so I really saw how this could bridge the gap for, I mean, more than half of my patients. Now as we started the clinical trial and I really started to see how my patients were doing and then ongoing, it just, it really solidifies how undertreated these patients have been for so many reasons, and the opportunities now for them to change their entire lifestyle is, I mean, that’s the part I’m so excited to be a part of.
Saul Marquez:
Yeah, that is exciting. And I understand that the results, the pain relief that results is long-lasting and it stays.
Dr. Meredith Langhorst:
Yeah, so the treatment is meant to be rehabilitative and therefore restorative, which is very different than palliative treatment options which we treat the pain, and palliative treatment options, which is part of our practice, but typically those are either short-lived or temporary by nature. And so when we look at rehabilitative or restorative treatment options, this is where we’re building up that function over time, and those functional improvements over time lead to improvements in pain. And that’s the difference here with this restorative neurostimulation. And the nice thing is over time, it gets the improvements, get more robust and more robust, and it doesn’t appear to be susceptible to loss of efficacy over time either, which is really novel in this space.
Saul Marquez:
Yeah, that’s fantastic and impressive. Thank you for sharing that. So, Eric, you know, I think it’s fantastic to hear that these types of therapies are actually working for people. And so, tell us a little bit about you and describe life before Reactiv8. Tell us about your background and then how is life now after the Reactiv8 therapy.
Eric Osborn:
Well, I graduated in 2003. In 2005, I joined the United States Navy, Seabees, went through all my training, ended up going, in 2007, got deployed to Iraq. Prior to going to Iraq, and never had any back issues or anything like that. And about two years after I got home, I started having issues, and it just kind of snowballed from there.
Saul Marquez:
Yeah, and so talk to us, what types of things were you feeling? And, you know, what was life like with that pain?
Eric Osborn:
Well, it was, at first, it was more of a just like a nagging pain. And then over time, it just kept getting worse and worse. I believe in 2009 was the first year I came and seen Dr. Langhorst, but when it came, when it started, it happened really quick. I remember I was at work pushing, I worked at a crankshaft factory, and some of these crankshafts were several hundreds of pounds and we pushed and pulled them on big chains. And one day I was pushing a crankshaft and my back went out, and I spent several months off of work, ended up losing that job because I was on a short-term disability and right now a short-term disability. But outside of that, I love to hunt and fish. I love to be outside a lot and it really limited and started limiting me what I could and could not do. Especially, you know, I didn’t know when I was going to have back pain or a flare-up or something was going to cause me a problem, I couldn’t get too far away from the house. My wife was always worried that I was going to get stuck out there somewhere and she’s going to have to come and find me. But it was just one of those things where, you know, prior to all that everything was normal for the most part, after deployment, getting back, things just started slowly creeping up on me and really started just limiting me to what I could do and started taking stuff away from me that I used to be able do a lot more of.
Saul Marquez:
Yeah, and so Dr. Langhorst was describing the therapy, Reactiv8. After you got that, it’s meant to restore the muscles. Can you tell us a little bit about how that impacted you positively as a result?
Eric Osborn:
One, the big issues I had was sleeping all night because the pain was just constantly bothering me. It would wake me up if I tried to turn over while asleep and the pain would just kind of scrap me, wake me up. So my sleep pattern was absolutely horrible. And after the Reactiv8 device, after it was turned on, within, it was just days, I believe it was, when it was that, one morning I woke up and realized I’d slept all night. So for me, that was a huge thing. And then on top of that, normally prior to that, I felt like I would always have to pop my back or try to adjust, just after I got up out of bed. But that morning was one of those, I just got up and I started moving around without having to do that, and that was absolutely huge. I mean, that was one of the big improvements, the first improvements I noticed within just a short amount of time after the device was activated.
Saul Marquez:
And how long ago was that, Eric?
Eric Osborn:
I believe five years ago.
Saul Marquez:
And are you still feeling that pain-free feeling that you’ve had since the beginning? Which is huge.
Eric Osborn:
Yeah, it’s huge, yes.
Saul Marquez:
Wow, thanks for sharing that, and thanks for your service, Eric. I didn’t get a chance to say that. Thanks for everything you’ve done for our country. We appreciate you, and you deserve this kind of relief. Dr. Langhorst, you know, I’m sure, and you mentioned, right, it’s great to have solutions for amazing people like Eric. You know, this therapy certainly solves patient care. How do you identify patients? Like who’s a good fit for this type of therapy?
Dr. Meredith Langhorst:
That’s a great question, and I think, I become more attuned to patients that have what we call lumbar multifidous dysfunction or mechanical lower back pain. More and more every day I see these patients and have conversations with them. So for me, it’s clinical history, so it’s listening to your patients and the things that give them problems or troubles, when they have challenges, the episodic nature of those challenges, and how those even become more stacked on each other over time, and then physical exam assessments. So there’s very, typically very specific movement patterns that you’ll see in these patients or a change from normal movement patterns, and then some very specific physical exam findings that we look for as well. And for me, the clinical history and those physical exam tests and both of those are on par. Then in my mind, I have a very good idea of which patients have this mechanical back pain, I feel, and then who might do best. And that is based off of just my experience with the original clinical trial back in 2016, the Reactiv8 V Trial, which is our pivotal trial, that produced the level-one data that got us to the FDA approval. And for me, I use imaging more to rule out the patient, maybe from treatment because for whatever reason they need surgical intervention or something else is going on, or maybe they’ve had prior surgery. So for me, it’s really the clinical history and the physical exam, which is I think, challenging for some, just because it takes time, right, it’s, sometimes I think it’s easier maybe to put up a picture, and look at it and just see the picture and then say, okay, we’ll treat that. Whereas this requires, I think, some engagement from, between the provider and the patient, and for them to understand too, the underlying issue that’s going on. Because many of these patients have had back pain for years and they have received other diagnoses or they were told, well, your pain is because of this and we’re going to treat this. And so they’ve heard a lot of things over the years, and sometimes I feel that maybe they don’t necessarily have very much confidence in what they’re being told because they don’t get long-term improvements. So it’s, I think, a way to educate the patients too, on the underlying issues and by examining them. And you can show them what we’re seeing and interpret that for them and then use the imaging sometime to show them as well.
Saul Marquez:
Yeah, thank you for that. And it’s a new way of looking at things, right? I mean, we’re looking at this. We always try to fix broken things and, you know, fix, people are not broken, you know. You know, there’s an opportunity to restore, and this is what this tech does. And Eric, I mean, five years is huge. And Dr. Langhorst, kudos for you to to have an open mind and an approach like this that not everything needs a knife. There are ways to help folks like Eric. Let’s talk about payer coverage. With such compelling data, why is there still lack of payer coverage? And I’ll ask you this first, Dr. Langhorst, and then I’ll open it up to you, Eric, to chat to, a message to the insurers.
Dr. Meredith Langhorst:
You know, it’s a great question. I wish it were such that we have the data, we’re FDA-approved, that means we automatically get coverage, but unfortunately, it doesn’t work that way. And the continuing need to ask for coverage and review the data, it just becomes very challenging for the providers. It becomes challenging for the patients. What I find, unfortunately, is, one of the big roadblocks that I find is that the people sometimes that are making the decisions of the coverage aren’t necessarily always up to date with the data or understand it, or have had time to read it in all of its forms. And so I think sometimes education is the best in the payers that I’ve had on the phone or conversations with, and you can actually explain how the mechanism works and the transparency of the data. Then we start to get some aha moments and individuals on the other side of the phone saying, wow, I really do think this takes another look. Let’s dive into this even more. And so I think the more and the more we can educate the people that we’re trying to partner with to help our patients, the better off will be long term. But that’s always on the front end an uphill battle. It’s just, it’s getting the right people on the other side of the phone call with you that are willing to listen to a paradigm shift in treatment and make it relevant for them that they can save dollars, right? But at the same time providing good patient care.
Saul Marquez:
Totally, yeah, no, great callouts. And you mentioned that, right, Dr. Langhorst, there’s three years of data. It is FDA-approved. It’s just hard to change habits and learn new things. So kudos to you as a physician that you’re working to spread the word on this, so thank you for that. And Eric, what message do you have for insurance providers listening to this podcast today on covering this therapy and providing access to patients?
Eric Osborn:
All honest, there’s been so much more than just my back pain that’s, or the, you know, the less back pains come out of this. For me, it’s been a completely help, a health change. There was a lot of things in my life that was going in the wrong direction, and because of this, I was able to have the opportunity to lose weight, to get my blood pressure, my cholesterol, everything back in check because all the pain was causing me, that was causing me to have just anxiety, depression, a lot of that stuff, and so that was affecting my job. And for, it’s allowed me to stay at work a lot more than where I was at before. I can do now more stuff for the company. I can, I’m more, more reliable, I’m there and I’m not having to take time away from my job. And then on the other side of it is that I’ve been able to find a lot of things that I love that I didn’t know that I actually loved, like running and a lot of physical fitness stuff. For example, I’m up at 2:00 every morning and I’m running every day.
Saul Marquez:
Nice.
Eric Osborn:
So things for me, I found that through this device and this opportunity that it’s given me a lot more enjoyment in life, and there’s just, in a steady job. I can, I know that I’m not going to have issues. I know that because of this, it’s given me just a lot more opportunities at work.
Saul Marquez:
Yeah, you could provide for your family in a way that you’re not even worried about. As you think about the impact that this type of therapy could have to the military in a positive way, do you think that this could have that type of impact more widely if it was available?
Eric Osborn:
I do, I do. You know, a lot of our guys struggle with PTSD. A lot of that comes from injuries or things that they have experienced. And with this back injury, you know, it would lessen the burden on them. It also would be able to get them back into being a crucial part of the military, whether it be just as operations or maybe they can get into, you know, back onto the field itself, upfront. But it would at least allow them to have more people rather than discharging them from the military, and they could finish out their career, whatever they were wanting to do or whatever they’re doing.
Saul Marquez:
Yeah, yeah, it sounds like it could be really impactful, and so thank you for sharing that. And switching back to you, Dr. Langhorst, you know, talk to us about some of the experiences fighting for patient access and battling insurance med directors. You know, talk to us about that. That could be a war in itself.
Dr. Meredith Langhorst:
It is, and it can be very frustrating and time-consuming in the midst of trying to run busy clinics and do procedures, and tend to patients and then having to kind of repeat the same story over and over. I mean, for my patients, it’s worth it. I think I’m prepared to go into battles full forge ahead, but it’s challenging, especially when I try to review the data and the questions that I get, or you can see that the provider on the other side of the phone or the payer or the individual that I’m having the conversation with hasn’t likely read the data because of the type of questions that we might receive. And I think it’s also hard for me too, because I’ve been involved with this therapy for so long, and I see how it has drastically changed the lives of so many individuals that I have worked with. And I know that because the patients that I personally implanted from the get-go from the Reactiv8 trial in 2016, every one of them has been a patient of mine for five years, ten years, fifteen years. So I understand how their chronic low back pain has impacted their life for decades, and I see, even in short times of months to years, how they’re transformed. And they’re doing things, some of the goals that they met, that they wanted to meet prior to getting the therapy they’ve met and then far exceeded those expectations for both, I think, themselves and myself. And you see that, and you just want others to understand so that they can offer that same type of treatment to people everywhere. And, you know, the more challenging it is to get access to payment for this, the more challenging it is to get to the patients, and that shouldn’t be.
Saul Marquez:
Yeah, I agree with you. And, I mean, Eric’s a great example of the success that can happen, you know, for number one, the individual, but number two, society, right, like, and his family and now the local economy, as a result of having somebody that’s able to work and not worried about that.
Dr. Meredith Langhorst:
Right, right, chronic low back pain, I mean, it’s one of the primary reasons people seek medical attention, right? We spend billions of dollars a year trying to treat chronic low back pain, not very successfully, right? And over time, it affects your activities of daily living. You become more sedentary, right? Then there’s weight gain, and there’s cardiovascular issues, then there’s depression. It affects your family life, your relationships, your sleep patterns. I mean, if you’ve had chronic low back pain, significant, moderate, to severely disabling chronic low back pain for an extended period of time, you have all of those other components I just mentioned. It’s, you almost can’t, you can’t not have those components, right? And so that’s part of the interesting thing is with this three-year data that’s just been published, too, is we looked at the people that were really burdened from chronic low back pain. No, not the people that were mildly to moderately impaired, that had pain here and there. I mean, these were patients that were burdened with this day in and day out. So in other words, some of the most challenging patients, if you would, and for sure the patients that didn’t have any other long-term viable, durable options, right? These weren’t surgical candidates. So it’s not like they could say even, oh, I’m not going to have Reactiv8, I’ll go for surgery, right? I mean, sure, some of them might end up with surgery because there are some people that will do surgery, you know, they’ll get surgery for anything. But traditionally, these are not surgical patients, and so they didn’t have other options. And so you’re taking these really severely burdened individuals and it is life-changing. And I love their story, and I’m just, I get tears in my eyes every time he tells it. But the fact of the matter is Eric is even just one of hundreds and hundreds of patients that now have the same story like he does, right? They’ve had their lives transformed, whether it’s, whether they were active duty or reserve before, whether they were parents or grandparents or construction workers or manual laborers or desk workers. You know, their stories are all very similar to Eric’s, and they’re doing things in their life they would have never expected to have been able to do with any other treatments that they’ve received.
Saul Marquez:
Yeah, wow, that’s powerful. And look, I’m going to pause here and for anybody listening to this, that the story resonates for you, whether you’re a payer thinking about, hey, wow, this is something I need to consider or you’re part of a vertically integrated delivery network where you guys pay for your own stuff and you’re responsible for the community. You’ve got to seriously consider this because if you’re not, you’re not doing the right thing. I’m going to be bold and say that. There’s a need for this type of therapy to be considered, and Dr. Langhorst and Eric are proof of this for sure. So thank you, Dr. Langhorst. You know, Eric, switching back to you and kind of here winding down the time, I know we could spend a lot of time talking about this. Eric, what would you tell a patient who has mechanical low back pain about Reactiv8 and the decision to go forward with therapy?
Eric Osborn:
I would definitely do this all over again. For me, it’s honestly just, it’s changed my life, my lifestyle. It’s improved my family life. And it’s given me the opportunity to be part of our local community and even our veteran community on a much larger scale. Having this procedure done, it’s given me a purpose to do things. I’ve been able to be able to do these runs and everything else has a purpose. And I have a reason why I like to be able to do it, but before the surgery, I was honestly, really, I was at my wit’s end trying to figure out what was next, living the lifestyle of constant pain. It was like my normal and my normal way of living was just always in pain. That was just every day. And now that I don’t have that, I look back at that time and I’m just very, very grateful for the opportunity to be a part of this. And for anybody that would be questioning whether this might be something for them or not, I would say definitely take a good hard look at it, because for me and several others that I know that have been through the program itself, having the device put in, it’s been a game changer. And I would, if I had to do it, I’d do it all over again, just to be able give me the opportunities that I’ve had to have since my surgery.
Saul Marquez:
That’s awesome, Eric, thank you for sharing that. And actually, folks, you can’t see, but I’m on video with Eric and Dr. Langhorst and I just, I saw Eric’s daughter. She was sitting on his lap for a little bit and just to think about her, Eric, you know, and your family dynamic, and that dad is available, and that dad’s bringing the bread home, and all these things, they matter, right? And you’re doing your 2 a.m. runs, like this is huge. So I want to thank you Eric, for being bold and sharing your story today. And Dr. Langhorst, I want to thank you for also being bold and taking the steps necessary to provide this type of therapy to the people that need it. So thank you both for spending time with us and definitely really appreciate it.
Dr. Meredith Langhorst:
Thank you for having us.
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