Dr. Dimitrios Kostopoulos is board certified in clinical electrophysiology. He is a leading, world-renowned expert in myofascial pain, and he has more than 30 years of clinical experience and over 20 years in electrophysiology testing. When he was younger, he had a revelation, and from that point on, he had discovered that he wanted to impact the medical field. Dr. Kostopoulos believes that as healthcare professionals, we must show appreciation for those around us.
Thank you so much for your time! I know you are a very busy person. Can you tell us a story about what early experiences brought you to choosing a career in the medical profession?
When I was 5 years old, I was diagnosed with TB. I was born and raised in Greece and received tremendous medical attention from the pediatric department of one of the biggest hospitals in Athens. And I was so impressed to see the degree of treatment and intervention that I was receiving, but, even more so, at that age of 5, I was so impressed to realize that these people can actually help someone survive a severe ailment.
It became a moment that’s always stuck out in my mind. I remember the precise moment itself when it clicked for me. It was Good Friday, it was just before Easter, and I walked outside onto one of the balconies of that hospital. I remember that it was Good Friday because Greeks have processions where they go in the streets and walk around with different icons and sing ecclesiastical hymns. And that’s when I made the decision, that’s the point I decided that I’m going to do something meaningful in the medical world. “I’ll become a doctor.” That was the moment that I made the decision. And since that moment, everything I did and have done has been learning more, applying more, innovating in areas that I could.
Can you share the most interesting story that happened to you in your career as a doctor?
In 1991, I was working side by side with a very famous rehab doctor, Dr. Reuben Ingber. He’s very well published. And what was interesting was I was seeing patients, and I would figure out what was wrong with the patients, and I would treat them, but if he happened to see this same patient, sometimes he would come up with a different diagnosis than my own. And when I would implement treatment for the diagnosis that he gave, the patient would do better. So I was always in this mystery, why sometimes when I would come up with a diagnosis through a physical examination of the patient, I would not always be accurate and therefore not always effective in my treatment. But when this guy does it, he’s accurate like 99 percent of the time. What made that difference? And that is when I realized that he was not just using physical examination testing on his patients, but he was using diagnostic studies with his patients. It was the use of Electromyography special studies that helped him get more accurate diagnosis. And that is what intrigued me, and I started looking into learning how to do these diagnostic studies. And that led me to start doing my first EMG in 1996 and I made the decision that without using these diagnostic tools you cannot really have totally accurate results in all types of patient cases.
And this has changed everything for me.
I have many stories that I can share about me and my patients, but I am most proud to share the story that I was told by one of the people that I have since taught how to do these same diagnostic procedures. And this is a very recent story actually. It is not a story necessarily that someone would say, “Oh my god! This person’s life was saved!” No as matter it’s a little sad story.
There is this physical therapist in Idaho who partnered with me some time ago learning how to do electromyography studies and musculoskeletal ultrasound. He has developed a Hands-On Diagnostics approved diagnostic center. A patient walked into his office complaining of pain in the lower extremity and pain near the back area. He worked with a practitioner who had not studied the diagnostic tools, this practitioner started treating the patient’s low back.
After eight weeks of treatment, the numbness and pain that this guy had down by his feet and the weakness still continued. He went back to the orthopedic surgeon. The orthopedic surgeon did a quick MRI, and found there was a slightly bulging disk and suggested that the patient undergo surgery. The patient underwent surgery, but weeks after the surgery the patient continued having the same problem. It’s called post-surgical back pain syndrome. He had the same pain in the back area, the same pain and numbness in the feet. So, the patient went back for physical therapy. At this time, he was seen by the person trained in the diagnostics program I run. This practitioner decided to do an EMG study and found that the patient had an entrapped nerve in what is called the tarsal tunnel near his ankle joint. He had tarsal tunnel syndrome. In other words, it was a pinched nerve. An entrapped nerve on his foot that was causing the weakness, and that was causing the pain, and that was causing the numbness and all of that. And the pain in the back was just a muscular type of pain.
This poor patient had to undergo unnecessary back surgery. Had the test been performed sooner, the patient would have avoided an unnecessary surgery on his back.
So, the good news is that the physical therapist who understood the diagnostic approach made the decision that all appropriate patients will now receive a diagnostic test before making any diagnosis so that they know the exact root of the problem.
Like I said, this one is not the happiest of stories by any means, but it led to an organizational shift at this practice that will affect every patient moving forward for the better.
Can you share a story about the funniest mistake you made when you were first starting out on your career? What lesson did you learn from that?
So, I’ll give you two stories. First story is that there is something called the “tilt table.” A tilt table is a table that goes from horizontal to vertical, or any degrees in between. So, I’m working with a patient on the tilt table, and the patient is tilted all the way down. At some point, I started raising the table up with the patient, who is paralyzed from the waist down, and too late, I realized I had not used the proper belts. And the patient collapsed on me.
The second story, which is even funnier. Again, I’m working with a patient who was paralyzed from the waist down. I was doing some ambulation, walking with the patient, and helping him with walking. Going from sitting down to standing up and start walking. And at some point, the hinge from the long braces that he was wearing snapped, and the patient almost collapsed to the ground. And as I tried to grab the patient and I’m doing some kind of maneuver; I pulled a muscle called the gluteus minimus muscle. You know, right in the buttock area. I pulled that muscle as I jumped and grabbed the patient. And that specific muscle, when it has what is called a myofascial dysfunction, is pretty interesting, it’s called gluteus minimus myofascial dysfunction. It’s referred pain, meaning that even though the problem with this muscle is right in the butt, the person feels the pain all the way down the leg. And I was limping for three days until I got this resolved. I had to see lots of patients despite that.
Both of these stories led to an important lesson for me: always be certain about what you are doing, but don’t allow your certainty to become arrogance.
To #DareToCare means to survive and thrive in today’s medical world. How do you take care of yourself? What’s the routine you must do to thrive every day?
Now, everything really, even when considering the physical body, the physical body’s not the root where everything stems from. It is the mental part of you, the psychological part of the individual. So, we don’t get motivated strictly by the body. Sure, there are hormones that can make someone more happy or more sad. At the same time, for an individual who does not have a hormonal imbalance, things stem from psychology. Things stem from how you feel about yourself, how determined you are, how disciplined you are, and how inspired you are by things. I am not going to be your “super perfect superhero guy” who gets up every morning fully inspired to exercise. I am mostly your down-to-earth, real guy who has challenges, who is challenged by life, who is challenged by the kind of life we have that is with less movement, with more sitting in front of a Zoom meeting in front of a computer.
And at the same time, I’m the guy who gets inspired easily. Inspired by others, inspired by looking at life, inspired at a partly sunny day instead of a partly cloudy day. I like to see the cup half-full instead of half-empty. So yeah, I have a routine. I use my Peloton as frequently as I can. But besides that, I like to move, and I like to stretch the body. Many times during the day, when I have meetings in front of Zoom, I’ll get up, I’ll stretch, I’ll walk. I maintain a positive attitude about life. At the end of the day, we cannot and should not worry about the things that we can’t change. And we cannot and should not worry about the things that we CAN change. Because the things we can change, we should just change them.
I write a series of letters to my Goddaughter in my latest book. In that same vein, what are five things you would tell your younger self?
Number one is to surround yourself with the kind of people you admire.
Number two is don’t just listen and do what the others say, but very, very openly observe what the others say, and based on your observation, create your own reality.
The third thing would be, never ever stop communicating with others. Everything, literally everything in life, can be solved with communication. And that may sound cliche, but even when things don’t seem to work out, never give up on communication. Because at the end of the day, the only reason there is a disagreement between two individuals, or more is that they have different viewpoints. The more you communicate and understand other people’s viewpoints and the more you try to get them to understand your viewpoint, the more common agreements you’re going to have.
Number four, show your admiration to others and don’t be afraid to admire others. Without admiration for others, you get some sort of superiority complex that gives you no room for learning because if you are the most superior, you are not willing to learn from others. There’s always somebody better than you, always somebody that you can learn something from.
And the final thing, number five, is to take responsibility for everything around you — even when you feel that you don’t want to. Because when you take responsibility for everything in life, then you are the cause of life. The things that you deny taking responsibility for, you become the effect rather than the cause. You can’t cause any change for the things that you deny responsibility for.
How can medical professionals reclaim heart-based healing amid pandemic, political, and other pressures?
I think a good example here is from the most recent events of COVID-19. You see, the COVID situation gave a lot of lessons to the entire society. Obviously, COVID became very much politicized. You can see partisans from all sides — right, left, up, down, in and out — they all started using the devastating situation for their own benefit. Through fear, the predicament of the whole situation, to make others right or wrong for their own benefit.
I wish that this did not happen because if the pandemic was not politicized from the right and the left, fewer people would have died, fewer people would have lost their lives because we could have done what science and medicine say instead of what politicians say.
At the end of the day, it connects back to what I was saying about responsibility. No matter what, it is the individual’s responsibility to look for answers, identify the right answers, and give those right answers and apply what is right for themselves. The responsibility of the medical professionals is to look at true data, true science, and communicate that the conclusions by the analysis are true data and true science to the patients. If coronavirus was a man-made thing that escaped from a lab or not, it is not a right-wing thing or a left-wing thing. It is a criminal thing if people did not take precautions or willfully and on-purpose let the virus out. It has nothing to do with Republicans or Democrats; it has to do with a criminal activity.
So, as medical professionals, we have to separate all that because we can, because we have access to the medical journals, because we have access to the true medical data, and we have to disseminate the true medical data to our patients and to society. But at the same time, every single member of society must take responsibility for themselves. Don’t expect everybody to spoon-feed you. You know, do your own research. The internet gives access to true data and gives access to gossip. We have to make the choice to stay away from gossip.
Is there a particular book that you read, or podcast you listened to that really helped you in your work as a healthcare professional? Can you explain?
I would not say I have a particular book that would apply to me as a medical professional per se. But I’ll tell you that there are several authors out there about business as well as life, that I respect and I read things that they’ve written: Tony Robbins, Mike Mikalowitz, Grant Cardone, Dave Ramsey, Napoleon Hill. They are all amazing. On the fiction side, Dan Brown and Wilbur Smith are very fun.
These authors and books help me to think about things from different viewpoints than my own, whether in a nonfiction or a fiction capacity. Getting to experience other people’s realities, other people’s universes, that expands you as a person, and it makes you explore more. You get to ask more questions because you recognize the fact that everybody has their own universe. It is the universe of our individual realities that has been created by individual experiences.
When you have in front of you a patient who tells you that they have back pain, if you just stop, if you just hear from them that they have back pain, and the pain goes down the leg and you do not continue probing with questions to find out what happens in their own universe, you will never get the answer. Because even if you give them a medication or physical therapy to fix the back problem right now, there may be something missing. For example, if this patient is a 75-year-old grandma with three grandkids that she has to babysit every single day because her daughter and her son-in-law are both working 12 hours a day to make ends meet at home, and she is running around behind these kids, lifting the baby up in her arms for hours and hours through the day. If you don’t understand that as a medical professional, how the heck are you going to help them?
You may help them temporarily, but unless somehow you help them change that part in their lives, you’re not giving them an answer. So if you want all of these writers, fiction or nonfiction, that I may be reading or have read in the past, they have helped me realize that I have to fully understand another person’s world — a patient’s universe — so that I can be able to help them effectively. So instead of looking at that patient as a symptom, you are looking at that patient as a person.
Because of the role you play, you are a person of great influence in the healthcare community. If you could inspire other doctors and nurses to bring change to affect the most amount of good to the most amount of people, what would that be? Said another way, what difference do you see needs to be made for our collective future?
I think a very important thing is to establish a balanced view of the healthcare system and the healthcare industry. If I tell you that what healthcare providers should do should be to keep the economics and the finances outside of the healthcare system and only look at how they can help their patients, that is very utopic, unrealistic, and doomed to fail as a viewpoint. Why? Because unless you are able to support the healthcare system financially, it will collapse. So that would be an ineffective idealistic type of viewpoint.
At the same time, if I give you and promote the viewpoint that prescribes to “everything in medicine should be about money”, that is so horrific and criminal at the same time. And it is obvious why it is. And that’s why I’m saying healthcare providers should adopt a balanced viewpoint about the healthcare system and the economics in the healthcare system. And that balanced viewpoint should promote things that maintain the survival, the economic survival, of the healthcare system while creating circumstances that provide access to the vast majority of people, or all people of society.
How can people connect with you?