Well, how about this? I'll show you, I'll talk to you about it. Since you're the only one here, you'll get the full, anyone who walks in can chime in. Otherwise, I'll just give you a little chance to look at the microphone while we do it. But like this here is a patient who's on TTR. This particular patient has lupus and has abdominal vasculitis. And she's had recurring abdominal pain, nausea, vomiting. Her consultant is GI, the organic station of the lupus. And, you know, she's had everything, ketamine, opioids, and nothing's really worked. But at this moment, she's looking at a virtual reality headset. And I'll show you in a little bit what happens when she uses it and what the reaction is. So let me just go ahead and show you a few things here. And you can just ask me whatever questions you want. This one on the upper left is the one that we use. It's the one that we give to our patients. It's called the MediQuest. Are you familiar with it? Yeah, I'm not familiar, but I saw it. So, yeah, this one on the upper left is very, very popular. There's about 50 million of them out there in the United States alone. So a lot of people have these now. They might have gotten them for their kids. It's like a holiday gift or it's just sitting around. They don't even know what it is. It just sits in their house. And then we say, well, you know what? Yes. And they're surprised by that. The one at the bottom is the newest one by Apple Computers. The one that they've been to. Very expensive. It's $3,500. I'll show you what it looks like. It's pretty growthy because it's very high resolution, very beautiful. But it's much too expensive for everyone to use. So we expect the price of that to come down a lot. And eventually it's going to be just on glasses. That's where we're moving now. So we're starting to see a big push in that direction. Let's skip all this. So this was all the way back in 2015. I started using this. You can see there. It's a very old headset. That's a Galaxy S7 smartphone snapped into a headset. But what I find really amazing about this picture, this particular patient has severe pain from sickle cell anemia. And before we put on this headset, he was doubled over in pain. And then when we started VR, he had this emotional reaction. You can see on his face. And so this is the first key thing. There's three ideas that we work with. The first is emotional impact. And getting into this moment where you literally feel like you're somewhere else. Right now it's a helicopter flying over Iceland. And it distracts him from his pain. But it also creates a very strong emotional sensation. This is another picture where we're treating a patient with pain. That's me with our psychiatrist. He actually creates the software with us. And he's a programmer too, a psychiatrist. And in that headset, we're measuring the patient's heart rate and their heart rate variability. So the headset can be executed. This one is not the ones that people have. But this one is a research-grade headset. And so we can see this is a sympathetic nervous system and what's happening in the body. And then we use our visual intelligence to take in the data. And then it will change what they're seeing in the headset. Depending upon what they're seeing. So like this is an example of one of the scenes that we used. Just to put people into different forms. And we feel like they've been transported to a different place. It's a lot of sounds. The music. And then here's another example. This is a patient with Crohn's disease. He comes from a hospital in the town. He likes to go into outer space. And when he looks back upon the planet, he says it gives him the sense of awe. Like he's part of something bigger than himself. And it gives him goosebumps. And so we can actually look at goosebumps. This is a study called Are You Odd Yet? How VR Gives You Goosebumps. And the study is they took patients and they put them in VR. This was in Vancouver. And they flew them over Vancouver. They flew them over the Canadian Rockies. And they flew them up into outer space. And then in outer space they look back upon the planet. And the whole time they're actually measuring their goosebumps. Actually with a camera. And they found this very strong relationship between being blasted into space. Like the astronauts in international space station look down upon the planet. They say they feel like they're part of something bigger. Very transcendent feeling. Psychologically powerful. And these patients report the same thing when they're put in virtual reality. So those are the three ideas. And I'll show you a video now. In this room there's a patient of mine who has irritable bowel syndrome. And this patient can't see a video. Has had recurrent abdominal pain, discomfort, diarrhea. And has had many, many therapies. Has tried antibiotics. Has been to the bathroom. Has tried antipsychotic antidepressants. Has tried low FODMAP diet. But she still has abdominal pain and quivering. And a lot of anxiety. Plus she lost her son in a car accident six months before this video was taken. Which is what made things more difficult for her. So we decided we were going to try virtual reality. And so this is actually a clinic. We have a VR room. And there's two screens here. On the left is her biosensor data. I'll show you in a second what it looks like. Her sympathetic nervous system we can measure. And on the right, it is what she's seeing. Except this is only a two-dimensional screen. What she feels, she feels like she's literally on a beach. And she is looking at this mandala that expands and contracts with her breathing. And so as it starts, you can see the breathing in and breathing out. And she starts to calm down and relax. And over here on the left, you can actually see when she first came in. She had a lot of stress and anxiety. And then as soon as the VR starts, you see this collapse. It goes straight down. It's the sympathetic nervous system. And about halfway down, you can go to the second level. And she started to say that she was in heaven with her son. And she said she felt like she was floating. That she had no pain at all. And she started to cry. And this happens a lot in my clinic. And so then I take them out. And I say, well, how do you feel? And they say, well, I have no pain. I feel like no pain at all. And so when that happens, we say, you know, why do you think you don't have pain? Because I didn't give you medicine. I didn't do your procedure. I didn't inject you with anything. You have the ability with your own mind to control the experience of your body. And when that happens, I show them this. I keep this video of mine. I pull this up on the screen. And this is called the last brain. And I say to my patients, I say, look, this is your brain. Your brain is constantly active, constantly changing. Just like any other organ in your body. It's constantly changing. You just changed your brain. And I'll say, look, we didn't insure your IBS today. But you now realize that you have this ability. If we work together in the next eight weeks, I'm going to teach you how you can do this without personal doubt. And they're always interested. And I say to them also that, you know, even if you're in physical distress, we can still modify how our brains perceive our body. And I talk about my five medicines, but I can't have that conversation until they've tried it. Now they're very open to it. If you just say that, then it doesn't really sound very meaningful. So any questions so far? How do you measure the symbolic response? So you're measuring heart rate variability, which would be to be variation in heart rate, which is aligned with the tone. And we're measuring pupil diameter. So the pupil diameter changes. So that's how we estimate it. But there's also sometimes we'll use galvanic skin resistance, which is bigger on the foot, right on the finger. It measures small amounts of sweat eating up at the skin. And these are all systems you can get and you can put in the clinic. So you don't need to do that. You can do it for research, but you can just tell when somebody's going to be stressed instead of anxious. Is it talking about the brain-gut axis? No. And if they seem interested, then I'll say, well, how about this? If you want to try something here, you have to take a virtual reality, and I'll offer that at some point. I'll say, well, yeah, but we're not playing games. This is actually different. And I'll show you more so you can see what I'm talking about. You're going to see it's going to be like a test. I want to see if we can calm your nervous system. And then I want to see how you feel. And we'll see. It's like almost like a diagnostic test, because when they have that kind of response, that's when I say, well, listen, I mean, you're blind at the bottom of the neck, aren't you? And they say, yeah, absolutely. And I say, well, that's something that we can work with. Because we didn't give you any medicine. All I did was show you pictures and things. And it's very powerful. And virtual reality is different than looking at a TV screen. Because you're completely surrounded in it. Your brain ain't there. That's the amazing thing about it. And here's the other thing that's crazy. So what you're looking at here is a paper that was published, a health-preventive assessment, a physiological and psychological response to virtual reality. What we're looking at here is we wanted to actually measure the physiology, to see if there's changes in the body. Those are cortisol levels, stress, and hormone levels. We looked at heart rate and heart rate variability. We looked at what cells count in high temperature. And what we did here is there were two different conditions. So that's still a lot of data to see at first. But one condition was we showed them the relaxing wire. And I can show it to you. And the other was a very stressful situation. You had to jump off a cliff. And then we looked at their heart rate. And what we found was when we stressed them out, of course, their heart rate is higher. But also their body temperature goes up. Their cortisol goes up. This is a heat map looking at pre- versus post-cortisol levels. Those are formation coefficients. But the bottom line was the intent is if we give them a relaxing environment, we lower cortisol by circulating cortisol lowers. White blood cell. I was shocked to see white blood cell count change statistically. Wow. After 15 minutes of relaxation compared to stress, heart rate variability, you can see how close they link to the bottom line. We know this is why we use trisylate with the antidepressants. But it's so important. So that was a really important study. And then the question of what a clinic means is work. So what we're looking at here are two studies that are not in the field, but we've learned a lot from them. These are randomized controlled trials. In both of these cases, half of the patients get ER, and the other half is not. On the left, at the University of Washington, these are patients who have severe burn injuries, and they're going through bandage changes. On the right, University of Michigan, these are women going from daycare to daycare, randomized between ER and regular ER for their childbirth. And so on the left, the black bar is ER, and on the right, the white bar is ER. And the outcome measures are how much time did you spend thinking about the pain during the procedure, how unpleasant was it. Same thing on the right. And then it was fun. Yeah. All right, cool. All right. Hello. How are you doing? Okay. Oh, yeah. Yeah, right. Okay. Well, we have a very, very small group here, as you can see. Yeah, that's right. So are you joining us? Okay, cool. So I was kind of in the middle of it now, but, you know, since there's just three of us here, we could chat. But I'm showing some of the data and kind of how we use VR. And so what I'm showing here is outside of GI for a second. These are just two studies. And on the left, this is at the University of Washington, patients with burn injuries going through bandage changes. And on the right, that's the University of Michigan. These are women going through labor and delivery, randomized between VR or no VR. And what ends up we see over and over again is not only does the pain perception go down when they're in VR, but also the cognitive and affective components, how much time do they spend thinking about the pain and how unpleasant is the pain. And so really what's so amazing is this slide right here. This is from a guy named Hunter Hoffman, and he's at University of Washington. Look at this. This is from 2007. So this is not recent. And here we are at 2025. There's two of you in the room, right? And yet this is the most powerful thing that we've ever seen for managing IBS. Okay, and yet, you know, people want to hear about acute pancreatitis and acute liver failure or whatever. But this goes all the way – that's just fine, by the way. It goes all the way back to 2007. And these data are really powerful. And so anyway, what we're looking at here is a brain, functional MRI. And on the left is a patient experiencing significant pain. And then on the right is when they put on a VR headset, what happens to the brain. And so on the left, you can see those yellow flares. Those are the pain signals. There's pain in the sensory cortex. You can see it flaring up there. But also in the middle of the brain, the limbic system, the insular cortex, also lights up. That's because pain is both a physical experience and an emotional experience. And on the right, when you turn the VR on, it tamps down the signals, both the sensory and the affective cognitive parts of the pain. So this has been repeated over and over again now. And we've seen that it can definitely reduce the perception of pain. And earlier, before you walked in, I showed one of my patients with IBS. And I'll show some more using VR and having a very similar kind of response. So, yeah, you can just interrupt me whenever. But this is a randomized controlled trial we did in the hospital. So this is in the hospital here where we have all these patients with pain on opioids, on ketamine, this, that, and the other. And usually the pain service calls us because they can't handle the pain. They call the VR. We have a VR consult service now called the Virtualists. So they call us in. And we did a study. We randomized 140 people, two arms. One arm got virtual reality at the bedside. And the other arm actually got an active control. It was a TV screen, two-dimensional screen, where they watched health and wellness videos. And this is what we found. We found that among all patients, VR led to a lower perception of pain compared to watching relaxing videos on a TV set. And then when we specifically looked at those with the most severe pain, 8, 9, 10 out of 10, that's where we saw the largest benefit in the hospital in favor of VR. So this is the hospital. We'll get to the endoscopy unit and the clinic in a second. But we really found there's really large effects. This is another more recent study from 2023 using VR for surgical drainage of perianal abscess. So this is pretty painful. And they decided to randomize people between VR and control during this painful procedure. And what we end up finding, again, is the mean visual analog scale score for pain over the course of 20 minutes was statistically lower in favor of virtual reality. It's a little hard to tell, but that's the darker bar on the left. We're doing a study right now for GI cancer. If you have any patients with GI cancer, GI malignancy who have pain, they can enroll in the study. We actually ship the equipment to them. So they don't have to be in Los Angeles. It could be anywhere in the world. And it's a three-arm study. This is NCI, NIH-funded, where one group gets a sham VR, one group gets just pure distraction. They go to these beautiful worlds and just relax in them. The third is actually cognitive behavioral therapy. That's someone named Beth Darnell. She's like Princess Leia in this thing. And she's a pain psychologist from Stanford who created this software program. It's actually FTA cleared. Yeah, yeah, yeah. Go ahead. Yeah. Yes. Yes, so the VA has a great VR program out of central office. And I can get you in touch with them if you want to learn what software they're using. A guy named Mark Sang and a few other people who are involved. The VA is among the leaders now in using VR. Are you at West LA VA or where are you? You're in Baylor, right? In Houston VA, yeah, yeah. So before we leave, I'll make sure to connect you with those people so you can find out if they may already have VR programs at Houston VA. Yeah, it's very easy to do this in clinic. There's no reason you can't get a headset and start using it. I use it every week in my clinic. Oh, so this immersive skills-based VR is actually an FDA cleared program. And I don't have any conflicts to be clear with that company. But they have a program called Ease VRX and it's FDA cleared. It's a prescription pain therapy program. It's not specific to GI though. It's really designed more for chronic low back pain, but it's for pain in general. I'll tell you more about our GI programs in a second. That woman that you saw there in the video, her name is Beth Darnell and she's a world renowned pain psychologist at Stanford. And she helped to develop this particular software program. So we're using it because it's been validated, but it's not GI specific, although it still is fine for GI patients. We have created a separate GI program that I'll show you in a second that we're testing right now. So that's what this one is all about and that's available online. So speaking of the VA, this is a study from the West LA VA. But if you look at the date, it's 1998. And Tony Lumbo, you may or may not know Tony Lumbo. He was a fellow at the time. He's at the Cleveland Clinic now. Emoryn Mayer is a very famous gastroenterologist who was one of my mentors and Bruce Nalabaugh. This goes all the way back to then. And what they did here is they took vets who were coming in for Flex Sig. And this was before they, we used to do a lot of Flex Sig. And they randomized them into three groups. They either got nothing or they only listened to music audio or audio visual. They listened to music and they saw these pretty pictures using a really old, very archaic form of virtual reality. And even then it was clear that the pain intensity was lower in the group that got this very old form of VR. They looked at some other endpoints too, including anger and fatigue and anxiety and attention. And once again, found benefits for the full audio visual immersion to basically distract them from the painful experience. This is such an old study. It almost looks like they hand drew those figures. It's so ancient. But more recently, a little bit more recent, this is a study from Japan. I think it's around 2003. I have to keep meaning to put the reference at the bottom there. But what they did here is they also need a very old version of virtual reality. This particular patient you can see has his left arm, left hand on a patient controlled analgesia or patient controlled sedation button. So he's deciding when to give himself propofol. So this is a colonoscopy study and they randomized patients, getting colonoscopy into three groups. Group one just got visual plus PCS is patient controlled sedation. So they all got patient controlled sedation. Group two got audio visual. Group three got just the button, nothing. And it's amazing if you look at these results, the mean dose of the propofol, if you look at the middle column, was lowest in the full AV group. The mean pain score was lowest. Satisfaction was highest. And the willingness to repeat the procedure with the same mode of sedation was by far high in a way among those who got virtual reality during the procedure. We use this now in our endoscopy unit. Not all the time, but sometimes people want it or they didn't come with a ride. And we're like, well, we can try it with VR if you want. And in many cases, it works great. And this is early evidence that it can work. My question, you know, they did some time which we can't tell the case but they can drive it. Mm-hmm. Mm-hmm. So you're saying that using these, you're able to bypass the areas that you don't get sedation because you don't need it? Yeah. Yeah. Yeah, no sedation at all. We just, we put them in the headset before they go into the room and we calm them down, get them relaxed. They go to some beach or they can go wherever they want. We have different locations for them. They can sit on a lake, go to a forest, go up in a mountain top and just, you know, relax. They can do breathing exercises. I'll show you some more. We have something called the chill room. And, you know, if you're interested, we can get you access to it. And they just sit and relax. And then we say, okay, we're going to bring you in now. And you're going to feel some pressure. We walk them through it. And for the most part, and not everyone, some people don't want to use VR, but for the most part, people don't need any sedation at all during the colonoscopy when they have the VR on. Very low requirements. So this study is from 20 years ago. And then here's a more recent study. This is from about a year ago. What they did here is they looked at pain scores, but they also looked at skin conductance. And I was mentioning this before. You can put a clip on the finger and it will measure skin conductance, which is a measure of sympathetic tone. And what they actually showed with biosensor data is lower sympathetic tone in the group that gets the virtual reality. Skin conductance after colonoscope insertion time, insertion. So just more evidence. For upper endoscopy, it's hard though, because you need access and we don't want people moving their head around. For colonoscopy, it's no problem because we're on the other end of the body. They can look around whatever they want. And if they look around, they get more immersion because they can see. But it's really not distracting. It's not difficult for us. And they're usually on the other end, relaxing and meditating during the whole procedure. Now, we do a lot with disorders of gut-brain interaction. And I mentioned that a little earlier. This is a paper we published last year with Brian Lacey and David Kanjemi at the Mayo Clinic in Florida. And they're doing a lot of work right now at the Mayo Clinic using VR for functional dyspepsia and for IBS. And I'll tell you more about that. But this is basically a review article where we talk about the brain-gut axis and how virtual reality can snap into that to help reduce visceral afferent signaling and improve central down regulation. So you can check this out if you're interested in seeing more about how we're thinking of this, how to explain it to your patients. There's a lot of useful language in there. This is a paper we published in the Red Journal, VR for Functional Dyspepsia. This was a randomized double-blind study. And it was a small study. And now we're doing a bigger one. But we saw reductions in pain scores and improvements in quality of life in the group of dyspeptics that got the VR. So again, feel free to interrupt. Since there's just a few of us here, I'm kind of flying through it. Now we're using it for inflammatory bowel disease. And this was unexpected. But we know that pain and anxiety could affect immune response in the gut and in the body. And we actually got a brand new NIH grant just recently with David Rubin, the University of Chicago, and with Gil Melmed in our place at Cedars-Sinai to study VR for IBD. And not only are we looking at pain, but we're also looking at CRP and fecal calprotectin. So I don't have any results yet. But if we can demonstrate an eight-week treatment course can actually lower fecal calprotectin and CRP, then we have a whole new approach to thinking about this stuff. I'm sure you'd be happy to talk. You've got some resources. I probably have two years' worth. Yeah, yeah. Yeah, absolutely. So we'll see. Now I'm gonna show you a little bit more about how we do it. This is Omer Liron. So he is a psychiatrist. And he also programs all of our software. So he's really quite brilliant. And we have a cart, a mobile cart, not an endoscopy cart. This is a VR cart. And we push this around the hospital. Again, this is not what you would do in your clinic, but we have him available to push the cart around. It has a UV light box. So we'd have to clean the headsets. And we use ultraviolet light exposure. If you're gonna reuse a headset between patients, you naturally need to clean it down. And we wipe it down. And then we have some storage stuff for the VR headsets. And I'm gonna show you now a video of two patients using VR for the first time so you can see what their experiences are like. These are inpatients. And that's the music that they're actually listening to. I'll tell you more about the music in a second because we have a whole bunch of different music for different situations. She's doing breathing exercise now. Pace breathing. So we see this a lot. It's a visual response. Yeah. Yeah. Right. I don't even have the words to explain it. It's beautiful. It's touchy. What you guys are doing is so cool. It's really striking to see that kind of emotional reaction within minutes. Yeah. Yeah. Just when I'm like, oh, I could just sit here sitting on the lake. Yeah. That's right. That's true. Pretend like we've got some barbecue. That's all I need. Just chill there all day. Yeah. So it's pretty amazing to see this. So I'm gonna show you now is their latest research, combining VR plus AI. And this has been pretty amazing. Just to set up this next part, and I'll be finishing up soon here. This is a study that we didn't do, but I just want to show it to you first. Pretty incredible. This is comparing physician versus AI chatbot responses to questions. And what's amazing here is the chatbot is considered to have higher quality answers than the doctors. And amazingly, to be much more empathetic than the doctors. And this is to me, a very, it's a challenge to us. You know, I think that 50% of this now is blind. Uh-huh. 80% of this paper did 80, where the participants have four and two kids. Yeah, yeah, where they blinded. Yeah, I believe they were. I have to go back and confirm that. But I believe that they were blinded. And we've seen this also in our own work. We have some other studies where they are blinded. And continuously, the AI is outperforming the doctors. Yeah, for sure. So with that background, I'm going to show you what we're doing right now. This is the Apple Vision Pro, which we talked before you walked in, is a very expensive headset, $3,500. So not many people have access to it, but we're using it. And we're using it because it's really beautiful. It's actually incredible. It's 23 million pixels. It's an 8K display. You feel like you're in a new world. And so I'm about to show you a video now of what we're doing in our clinic. What we do, and in the hospital too, is we put patients in this headset, and then they see a robot. It looks like something out of a Disney movie, okay? It's specifically a robot, not a human, it's a robot. But she looks at you, and she's a she. She has 150 different facial expressions. And hey, and she will literally like communicate with you and use virtual reality to talk with you, okay? And uses AI. So this is literally what that looks like. Let me see. So this is an example. Have you seen this yet, Jamie? This is brand new stuff. So yeah, we have a very intimate group here. That's okay. We're doing great here. So this is Zaya. She's using, yeah, she's amazing. So she's using artificial intelligence to have a conversation in a typical client environment to provide mental health support for our patients. She decides what the scene should look like depending upon if she's talking about the light on her chest, meaning in tune with her heart rate. She might decide, based on the situation, to change the music, to make a violin that's florist. She's constantly changing, it's called GR. We call this generated reality. She generates reality or imagery based upon what this patient needs in that moment. And then, after all of this, she literally writes a note and she puts it in the chart. And it's the best note like you'll ever see in your life. This is what it looks like. Oh, we wrote this paper that's validating this in Nature Digital Medicine. And she just puts a note and puts it on the chart. I'm gonna go check it out. We were right. Yeah, go for it. Yeah. This is for Zaya. This is a note. Now, in this case, it's not a GI note, but I'll show you in a second we're doing this in GI. This is a note that she wrote for the psychotherapist. And our therapist will take the note and then they'll go in and see the patient still. But this robot's pretty amazing. So, in the background, what's happening here is the VR is listening to the patient. And then it decides based on what the patient says whether to use cognitive behavioral therapy, motivational interviewing, supportive therapy. It has different modules and it will decide. And it even will decide based upon what the patient's saying if it's working well or not. If it feels like it's not working, it's gonna actually back up and change and keep changing until it finds something that's working for that patient. It's called an appropriateness classifier. That's actually a second AI system that's policing the first AI system. So if AI were ever to say something stupid or inappropriate, it will never get out because the second AI won't let it come out. It hasn't triggered yet, but we have backup systems in case the AI decides to do something stupid. And then again- How does the robot listen to the response of the patient? So it's listening to what the patient's saying. And it decides what level of emotion the patient has had and what content it has and what it is talking about. And then she will change her facial expressions. She'll look you in the eye, she'll look away, she'll smile, she'll frown, she'll look sad, she'll look happy. It all depends on what the patient's talking about. So it's really- And then it picks the right music for the right moment. And then again, we have the EHR note at the end. And what you're looking at here is a paper we published just at the end of last year, where we're looking at- There's two graphs here. Okay, the top one, it's called digital standardized patients. But basically that's what the patient is saying. And the bottom is what the robot is saying. And what you're looking at is called tone score, where higher means more positive, lower means more negative. In terms of the language you're using. If you're sad, if you're depressed, if you're upset, that's negative. If you're happy, if you're positive, that's higher. And it turns out what the robot is doing is it literally will figure out what level of language the person's at, and it will go slightly lower. And then it'll start to slowly pull the patient up through the course of the conversation. And we see this over and over again. And this is actually how a therapist is supposed to conduct an interview. It makes sense to me that these are people who have changed people, humans have changed people. Yeah, that is okay. Yeah. It's easy for a human being to be honest without it being- That's exactly right. Yeah, and then you're more open and say, yeah, you got my point. Yeah. But that's what we're seeing. In fact, I'm gonna skip this. This is a paper we published where we did this with alcohol-associated cirrhotic patients. This is a whole different population. And the patients emphasized the nonjudgmental feedback and unique openness that allowed users to share deep personal thoughts they might typically withhold. They told us, this robot doesn't judge me. The robot doesn't care the color of my skin. It doesn't care what I'm talking about. It always gives me incredible advice. And so this has been really, for us, revolutionary. And we're now using this in our hospital and the pain service or psychology services using this we as I said we're using it with patients with cirrhosis and alcohol use disorder who run the liver transplant waiting list to stay at you know abstinent and you know hepatologists aren't psychologists okay but to be able to give them access to a world-class psychologist at their house and if they ever say they're suicidal by the way the robot immediately contacts a psychiatrist within two seconds it will actually email and text message the psychiatrist and say your patient just said they had a suicidal ideation here's their phone number and I'm going to keep them on as long as I possibly can and the robot will keep talking to the pick you try to keep the patient engaged and so the psychiatrist calls yes 100% definitely we'll talk to a see how you work with the CIA right yeah oh you were a transplant hepatologist oh my goodness oh that's amazing okay so we're using this with our transplant liver team but we're actually gonna put in a grant around this so if you're interested we could talk more about it this is more as a lot of data here but I think I would like to use the mental health support program frequently I found the program you know basically what was their perceptions these are these are cirrhotics with alcohol use disorder and for the most part they found it easy to use they didn't think it was too complex and they would want to use it again for the most part which was good now here is another thing we're doing this is of course a note this is a note from a patient Fred Alvarez this is a real note name has been changed patient who came to clinic with abdominal pain what we're doing now is we're actually having that robot take a whole history and the patients love it they'll sit there and we do it before we see them in clinic and now we have it that they don't need a VR headset we just through epic we send them an email and they get an access to they just talk to her her voice and they have a conversation it's HIPAA compliant I'm going to show you what it sounds like what it looks like and then this is actually how it looks for the patient to start can you tell me what your main symptom or health concern is right now my belly hurts this is a real report sorry to hear you're experiencing belly pain Fred can you describe the pain for me is it sharp dull crampy or something else I'm not really sure how to describe it it just hurts that's okay Fred sometimes it can be hard to put into words on a scale of zero to ten with zero being no pain and ten being the worst pain you can imagine how would you rate your belly pain right now right now I don't feel the pain because it comes and goes but when it comes it can get up to a nine I see Fred it sounds intense when it does occur when did you first notice this belly pain so it goes on like this and then she does an entire history and then we get this in it goes into epic so we have it already ready to go before we've seen the patient with the assessment of plan so we're doing this with our fellows right now it's it's you know what I've gotten to the point where if I don't have this I have like I better go and take a hit take a closer history myself it's much better than the fellows I mean it's much much better and the patients over and over again they tell us they'll say things like well I didn't expect that but boy it was very thorough and I know she really asked a lot of good questions and I felt like it was we're getting somewhere and it's all there let me skip the head okay here's the last thing I was going to show you guys so I mentioned that we have our own program now specifically for VR and GI and this was the paper where we validated this program focusing on irritable bowel syndrome and so what this is is an eight-week program and they go home with the headset and over the course of eight weeks the program brings them through a whole bunch of different experiences and those are the names of all these different modules but what they're doing is we're slowly building skills using cognitive behavioral therapy gut-directed hypnotherapy and a whole bunch of other gut-directed you know validated approaches to you know behavioral health and at the end what we start to do is we try to titrate them off of the VR they have an app also so they're doing exercises during the week thought experiments thinking about this thinking about that and by the end of the eight weeks we want them off the VR completely and hopefully they now have learned these skills and they can go into the world with these skills not relying on the VR anymore and that's how this is all set up and so this actually I heard this video is not working it turns out but we have a little robot here too she's not as pretty as the the Apple one but she's very good and it's very hard to imagine until you put it on what it's like but she describes the brain-gut axis you look at holograms to look inside your body and it introduces all of these different concepts about how the nervous system works in the gut and what happens when you have carbohydrates that form gas and how that can cause a stretch on the bowel wall all these kinds of things this I'm gonna skip but it's not working it turns out but what we do here is we will literally have people practice we'll throw them into a bathroom public bathroom and you're like sitting there and you look around the video is not working but you think you're in a bathroom and it's like okay that's very stressful experience for people with IBS and then we say okay there's people waiting for you you're late for a meeting all right how does this make you feel and then we do cognitive behavioral therapy in the bathroom on the back of the stall on the wall so the next time they're in a bathroom they have already practiced what it's like and so whether it's a bathroom or giving a talk or being on an airplane or being a you know at a dinner all right I'm gonna skip all this stuff other than to say we have this has become a whole branch of medicine it turns out the FDA now has a name for this it's called MXR medical extended reality and it started in March of 2020 when the FDA first announced that this will be a new branch of medicine and there's even a whole FDA process now to get treatments approved by the FDA it's very exciting we now have the American Medical Extended Reality Association which is and we have our own journal now the Journal of Medical Extended Reality International VR Healthcare Association in the very first issue we created a conceptual framework for what this field is and what it looks like we have a website virtualmedicine.org and on that website you can get a lot more information more videos lectures we put on a conference every year in March and it's always amazing conference and we video all those lectures so you can go on and see if many of those things interest you this is just some screenshots from the conference that we put on every year at Cedars-Sinai it's really a lot of fun really interesting people from all around the world from all specialties this guy in the middle is a surgeon and he uses VR to help train surgeons how to do certain procedures and I wrote a book about this a few years ago if you're interested it's called VRX and then I also wrote this in ACG magazine if you want to learn more about where we are at AI and GI I talked about some of that today oh this is my new book coming out so hopeful that this has to do with a completely different topic which is how gravity shapes your body steadies the mind guides our health in the work with virtual reality we've learned that when people are rising up literally feel like they're anti-gravity they feel better and this led me down a rabbit hole about how gravity was here long before life was here and it will be here long after we're gone it stands to reason that every part of your body every cell every sinew every organ is evolved to manage the force of gravity and our goal in life is literally to stand up and stay up as long as we can and as well as we can until finally we get pulled back down so that's what this book is about so that's it yeah what do you guys have questions do you have yeah yeah it's about an 80% response rate and when I do it like in clinic for example start there if I see a patient who I think would benefit which a lot of patients certainly patients with IBS people who tell me about how stress may be affecting their GI I will I have somebody who helps me so they'll bring the VR headset in I've trained them they and I can go into the next room and see the next patient and then they'll usually use VR for about 15 minutes so I'll come back in about 15 minutes and see how they're doing and then we'll debrief talk about it and it's just very I think patients really love this because they feel like they're getting something different and they feel like they're getting just a high-touch experience and even if it didn't help them they never mind it's like at least it was interesting but other people I'll walk back in and they're crying just like I showed you and sometimes I'm like a psychologist in there because what the VR is doing is just revealing to them a much deeper like view of their own consciousness it's very profound so you do need to kind of be prepared to be able to talk about these things openly and get comfortable talking about it because I think that's it's the debrief where we really make the most progress it's like well what just happened I mean how are you feeling so much better and we just I just have like open-ended discussion with them but it's about 10 to 15 minutes in the hospital after 20 minutes people can get a little dizzy and sometimes they can get nauseous so it's called cyber sickness you know yeah oh yeah so it depends in about 20% of patients there's really no benefit or you know they might say it was interesting but they're like yeah I still have a lot of pain the other 80% they'll say actually my pain does feel better then the question is how long is it going to last for a single treatment just a one-time therapy usually we're talking about a short benefit it might be 30 minutes to an hour okay for some people it literally goes on for the entire day into the next day but one treatment we're not expecting it to be like you know it's like an opioid only works for six hours right it's gonna wear off if they're better that's when we say okay this is gonna your pains can come back okay but we just learned that you have this ability to inhibit the pain and you have to now learn how to do that whenever and wherever you want and so we're gonna work together for eight weeks and I'm gonna send you home with this headset and for eight weeks you're gonna go through it's self-administered and then the question is how long does it work after that and for chronic pain we now have two-year follow-up data not in GI though but for musculoskeletal pain like back pain after an eight-week treatment course two years later we still see differences in pain perception in a randomized control trial so the first studies that were done looked at eight-week follow-up then they looked at one year follow-up and now they follow them for two years and they still see persistent differences in pain perception in favor of the VR group so it could work it could last for up to two years so far but that requires eight weeks of work a single treatment is not going to lead to you know two years of pain benefit does that make sense okay great great yeah yeah so like I said there is there are people that be a doing this I can get you in touch with them so why don't we exchange notes where we leave here and I'll make sure to email it and connect you with people that be a doing VR yeah yeah yeah so maybe I'll talk we could talk about whether you want to so we're again we have clinical risk the trials that we're starting mm-hmm yeah yeah so you know some of this is available right now though and if you have a patient who has a VR headset and a lot of them do I was saying there's about 50 million headsets out there right now there's great software they can download right now it's free I mean it's not free it costs like $20 or something to get the software the headset cost about $300 so I'll definitely get you in touch with Mark Zhang and his team and I'll tell them that we met that you're at Houston VA that you have this interest and see what resources they can hook you up with yeah yeah yeah sure yeah well we're we're not doing protocols all the time we actually use it just in regular practice yeah I use it in regular practice so what do you take away from this we have a whole pharmacy already inside of our body we have our own opioids we have serotonin we have it's a matter of knowing how to deploy them mm-hmm yeah there's a bunch of people at Stanford doing this I mean Beth Darnell is one of them so she's been focusing on pain but you're not Stanford right yeah oh okay yeah so there's somebody named Jeremy Bailenson B-A-I-L Bailenson E-N-S-E-N I think Jeremy Bailenson and he's at Stanford he runs their VR research lab and he's very very good and definitely somebody to look at at Stanford yeah yeah he's very good yeah yeah yeah we're all done hey thanks for coming in you want me to connect you with here you know it would be the easiest things you have to go here just do you have a but if you have a camera all you got to do is scan this and there it is and then yeah so if you want to just email me I'll respond and connect you directly to the VA people yes yeah yeah go ahead just you know there it is the yellow bar right thank you sure thing thanks for coming up I got invited they give various forms of this so I'm giving us a different one tomorrow and it's sold out tomorrow yes she said they were tentative team signed up but that's okay yeah I appreciate you coming by yeah all right guys thank you okay yeah oh yeah thank you yeah appreciate it yeah I hope you learned something and hopefully open your eyes some new opportunities okay enjoy the rest of the meeting Bye. Thanks. Thank you very much.

virtual reality

pain management

gastrointestinal disorders

cognitive behavioral therapy

artificial intelligence

virtual environments

medical treatment

cortisol levels

virtual robot therapist

chronic and acute settings