Podcast
July 17, 2020

BioElectronics and Innovation with an NHS Nurse

Marnie Faundez
Communications Manager

The BioElectronics Podcast: BioElectronics and Innovation with an NHS Nurse

This week, Rick and James are joined on the podcast by Brenda Lloyd, an NHS nurse with decades of experience with treating patients in areas such as palliative care.

We were kindly introduced to Brenda, through a beautiful letter we received from her co-worker, who was lent one of NuroKor's devices and was subsequently able to help her mum with the use of bioelectronics. Brenda kindly tells us how she was introduced to bioelectronics herself, as well as a moving story around recommending our device to someone who was, once again, able to walk, pain free, after a number of treatments.

Lots to take from this one if you’re considering bioelectronics as a patient or a clinician. The letter from Brenda's colleague, Jackie is transcribed below for further context.

Listen to the entire episode here:

New episodes of The BioElectronics Podcast are released weekly on a Thursday. It is currently available to listen to on Spotify, Google Podcast, Apple Podcast, Anchor and more.

Jackie's letter to NuroKor:

Her letter to NuroKor: 

"MiBody - Thank you for the loan of the ultra wearable body therapy system

Mum who is 86 lives with dad 86 and has their own place, lives happily with no carers etc. Mum has had a bad calf problem for a year or two or three (she never moans as does not want to be a problem to anyone), she has been to the doctors (eventually) and they have scanned the leg but said that it was rheumatism in her muscle. No meds were given just to use creams etc. 

She has not been able to sleep at night for the sheer agony she has been in and spent most of her nights downstairs on the sofa. She has also not been able to walk far at all maybe around the house or upstairs but was still in pain. Most of the time she sat on the sofa with her leg up on the table with compression bandage on. 

So along came Brenda our nurse at the surgery where I also work and she was discussing this machine and I said oh i would like to have a go I have arthritis in my right knee… then i said could i borrow it and let mum have a go over the weekend of which she agreed. 

Well you will not believe this over the weekend the pain had been a lot less… upon telling Brenda she said that let her keep it for the next week or so. 

So during the last ten days mum has not had to use it every day as the pain has practically gone but the best part is that now she can actually walk 50 times further than she has done for quite a few years. 

It is quite unbelievable really and they would like to buy the machine for further use. 

Signed - Jackie"

Podcast Transcript:

Rick Rowan:
Welcome to The Bioelectronics Podcast by NuroKor. I'm your host, Rick Rowan. This is where we can hear about how bioelectronics is changing healthcare and providing benefits to both patients and healthcare systems worldwide.

Rick Rowan:
Welcome to this week's Bioelectronics Podcast. My guests today are James Somauroo, who's the co-host, and Brenda, Brenda being a very experienced NHS nurse working on the frontline. Good morning both, how are you?

Brenda Lloyd:
Very well, thank you.

James Somauroo:
Yeah, I'm all good, Rick, thanks, mate.

Rick Rowan:
Brenda, could you tell us, or tell the audience a little bit about yourself and your experience in healthcare?

Brenda Lloyd:
I started off as a Macmillan nurse up at a hospital which unfortunately is now closed, called King Edward VII, in Midhurst, West Sussex. I was on the Macmillan unit for nine years. I then went upstairs and did what's called the bariatrics where they staple the stomachs for obese patients. Did that for three years. Then I left nursing for a bit because I had my children. Then I've ended up working at my local doctors practice, which happens to be the first doctors surgery where the COVID was found. So we had lots of... I know.

Rick Rowan:
Wow.

Brenda Lloyd:
We're a very small village, so it was a little bit of a shock. So, yes, it was quite interesting how that happened. So, yes-

Rick Rowan:
That might be world news. England's ground zero.

Brenda Lloyd:
Yeah. Haslemere. I'm from Haslemere. So suddenly Haslemere was on the map.

Rick Rowan:
Wow.

Brenda Lloyd:
So I've been at this doctors practice for 10 years, 11 years in September, and I love my job. So it's a bit different now because we're having to wear PPE, and also I'm helping with the COVID hub sometimes. Luckily to say, our numbers are really low at the moment, so that's all good. Just very tiring.

Rick Rowan:
Wow. That's quite a story. Obviously there's been a lot of changes with regards to practice during the past few months and everything that's happening.

Rick Rowan:
Something that's probably going to lead us into the story of your colleague's mom, but something that has come up in previous... actually, I think it was our last podcast, was just the... outside of normal healthcare, there's this huge mobility issue, and many other factors for patients and healthcare outside of just the normal medical care things, like physiotherapy and mobility and other health concerns that are somewhat challenging during these... or have been somewhat challenging.

Brenda Lloyd:
I think the biggest thing is the diabetes and the lack of... people having to have their legs amputated because there's no blood getting... the circulation and everything. So I think that is a big thing as well.

Rick Rowan:
That's a very interesting point.

Brenda Lloyd:
Because they can't feel their feet, can't feel their hands, and I don't think it's been dealt with in the... we need to look at different ways of coping with that because as the obesity rises, more and more people... we'll have more and more people with no limbs, which is not a nice thought.

Rick Rowan:
No, not at all. It leads very well into the story of your colleague. I'll let you tell the story, and I'll try not to interrupt. James may, if he wants to, but I'll let you tell that story.

Brenda Lloyd:
Whoever wants to interrupt-

James Somauroo:
I've got more license to interrupt than you, Rick. That's great.

Brenda Lloyd:
No, you can all interrupt me, it's fine. We've got some friends of ours, Derek and Julie, and I went round to dinner with Derek and Julie, and Derek was talking about your company, and then he brought this tiny little machine down for me and said, "Would you like to have a go? Would you like to try it?" So I took it to work and, of course, I showed a couple of GPs.

Brenda Lloyd:
So I then went into the reception room and my good colleague, Jackie, I explained how it worked and she said, "Oh, would you mind if I gave it a go with my mom because she's in so much pain. She hasn't been able to walk very far at all for five years. She hasn't been able to go shopping. She struggles to get up the stairs." So I said to her, "Why don't you take it for the weekend and see how you got on?"

Rick Rowan:
May I ask how old her mum is?

Brenda Lloyd:
Her mum is 84. So she took it for the weekend. I gave it to her on the Thursday. Fridays are my day off. On the Monday, she said it was a miracle, it was fantastic. Her mum walked to her front gate, which she hadn't done for over five years.

Rick Rowan:
Wow.

Brenda Lloyd:
She also said it was the first time in five years that she'd slept all night. So she kept it for a couple of weeks, and then I think she felt a bit bad so she gave it back to me. But then her mum got bad again, so then I felt bad, so I gave her the machine back and said, "Look, don't worry about it." Since then, her health has really improved. So there we go. So that's my story.

James Somauroo:
So from your point of view then, Rick, and, I suppose, Brenda, what do you think was... well, firstly, what was going on? You mentioned there was obviously arthritis, and then what seems to be quite a fast treatment, from a pain perspective. So, I suppose, Rick, your understanding of the technology and what that might have been doing, why do you think that's added so much value, and potentially why in this case so specifically?

Rick Rowan:
Obviously without making a... I'm not a doctor, but without any type of physical or medical evidence, I can tell you what the likely scenario was with that particular device. Again, using an assumption that Jackie's mum probably didn't change the mode, she would have put it straight on in the first mode, which is a very broad spectrum formulation. The frequency formulation in that first mode has both a combination of pain pathway, or pain blocking frequencies, so specifically to help manage pain, but it also combines that with some lower frequency formulations that are specifically helpful for improving circulation through muscle stimulation. So, at a guess, she's gotten benefit from that combination. So circulation has improved where she's used it, which is obviously helpful, as you mentioned earlier, Brenda, around circulation issues.

Brenda Lloyd:
Yes. It's the circulation, I think, that is the main issue, especially with the elderly and the vulnerable. I see a lot of legs, but the circulation is really bad.

Rick Rowan:
Yeah. I suppose, almost as incredible as that story is the fact that we were not using this type of technology. We know that anecdotal efficacy, and obviously we see a lot of and hear a lot of these types of stories, keeping in mind that this little device that you're talking about was never intended for clinical use in this regard, but it most certainly is applicable and easily used by someone at home, as evidenced by Jackie's mum at 84.

Rick Rowan:
But it would have been a combination of things because, adding to that, once you start to manage the pain, then mobility starts to become easier, or more accessible. So you're actually then combining... instead of a circular or downward spiral, it actually is an upward trajectory, as in pain is relieved so that they can become more mobile. You're improving circulation which is then also reducing pain. A whole range of factors. But this is the beauty of bioelectronics or electroceutical applications.

James Somauroo:
Sure. Brenda, from your point of view, obviously seeing that in someone that you knew and seeing such a recovery and her being able to do things that she wasn't really able to do for a long time, how did make you feel in terms of this new technology that I assume you knew absolutely nothing about really, other than knowing of Rick's company?

Brenda Lloyd:
I literally had no idea. I actually thought it was a bit like a TENS machine, great for pain relief. Obviously I haven't seen Jackie's mother, because she is a work colleague.

James Somauroo:
Sure.

Brenda Lloyd:
But for Jackie to come and be so grateful and thankful, it was nice. As you know, it's part of our job, isn't it? You love it when you feel you've helped someone. I just wish sometimes that people would be more open-minded for things like this, rather than-

James Somauroo:
I think that's it, right? I think that's it. I think there's a journey that we all go on with this. You and I, from the medical world, and encountering, as you have with the GPs, I think even with ourselves internally, we always question things when we don't understand them. I think that's rightly so. We always want evidence, and we want to understand the physiology and all the rest of it. But I've said this on a few times, we still don't know how anaesthetic drugs actually work.

Brenda Lloyd:
No.

James Somauroo:
We don't actually know, but we've become okay with that. I think as the evidence base grows for these types of things, I think it only-

Brenda Lloyd:
I think Australia is much more open to things like that than England.

James Somauroo:
I don't know, Rick. What do you reckon, mate?

Rick Rowan:
Well, I'd probably argue the opposite. It's all about perception, isn't it? Or actually preconceived perception in a lot of cases.

Brenda Lloyd:
Because when I was in Australia a few years ago, my youngest wasn't very well and we went and saw a GP and he recommended she take olive leaf, which I'd never heard of. So that's why I have that perception of Australia, because a GP recommended that a herbal tablet for-

James Somauroo:
That's quite interesting, to be fair.

Brenda Lloyd:
My daughter still uses olive leaf because she finds it does help her.

James Somauroo:
There you go.

Rick Rowan:
A whole other Pandora's box there!

Brenda Lloyd:
Yeah, exactly.

Rick Rowan:
But in the case of, you mentioned TENS before, using the GPs at your practice as an example, we make assumptions around things, and there's a common phrase that is used: We don't know what we don't know. TENS has been, unfortunately, a term that has been used both in the industry, in the medical industry, in the scientific areas, for the description of nerve stimulatory treatments provided through the skin, so transmitted through the skin.

Rick Rowan:
The equivalent of that is using the delivery method for pharmaceuticals, and you need to think of electric therapy or bioelectronics as the electronic version of pharmaceuticals, as in, pharmaceuticals, with each compound or drug, it's for a specific purpose. Similarly, within electroceuticals or bioelectronics, each frequency or formulation or waveform set is for a specific outcome. There are sham TENS when we're doing double blinds, etcetera, there are sham TENS, so frequencies that we know do not work that are used against frequencies that we're testing to work.

James Somauroo:
Interesting.

Rick Rowan:
So, similarly, if someone said to you, "Look, here's a new pill," the first thing you're going to ask is, "What's in it?", or, "What is it?" Similarly, one type of drug can be delivered transdermally, it can be delivered orally, it can be delivered intravenously. There's a whole range of delivery methods. What we're talking about when we're talking about TENS is simply a delivery method for nerve stimulation treatment. A lot of the time, people say, "Oh, that's a TENS." That doesn't tell you anything. That's the equivalent of saying, "That's a pill," or, "That's a transdermal patch." You're just describing how it's delivered, not what it's delivering.

Rick Rowan:
It has been a little bit of a slower process but we're starting to gain quite a bit of momentum, particularly with GPs actually. We've recently had a GP, who's also a nutritionist, on that point, join our investor team, investment team, and actually we did an interview with her recently as well.

Rick Rowan:
You can't argue with patient results. James and I have discussed in the past, whether it's placebo or otherwise, if the patient's having a positive result, the patient's having a positive result. In the case of Jackie's mum, how it worked doesn't really matter. The fact is that she's had a huge change and improvement in quality of life.

Brenda Lloyd:
Exactly. That is my whole thing, about it works for that person, then you have to go forward.

James Somauroo:
I think that's the thing, right? I guess your experience of the device and helping someone that you know, or a friend of a friend sort of thing, has led you to be more inquisitive, has led you to be, "Okay, well this thing is working. I want to learn more." I think that in itself is an interesting point because... and I'll come back to this. Coming from the NHS and the kind of education that we have had, that everything needs to be evidenced and everything needs to be evidence-based-

Brenda Lloyd:
And you have to prove everything.

James Somauroo:
Right. At least seeing positive results means that we seek that. As you've said, "I want to go out and find that evidence. I want to present that to people, and I want to learn more." It's the challenge of any frontier technology. It's the challenge of any technology, whether you're a digital therapeutic, whether you're a brand new device, whether your software is a solution for AI, it could be anything, but the challenge at the frontier is always to do that.

James Somauroo:
I think it's a challenge of NuroKor as much as it is a challenge for Google Health or anybody else that's doing things in these spaces, that getting that evidence for new technologies, particularly when they're digital and in digital health and health tech, is a challenge. But by galvanising people with positive results to actually see that hey, this is worth doing the evidence for, it's worth getting that research done, I think that in itself is a very positive step.

James Somauroo:
It's interesting for you, Rick, making the choice to sell consumer. I think that's a really good and interesting way of getting it in the hands of patients. You are CE marked, it is a medical device. You are able to do that. I've run accelerators, I've helped hundreds and hundreds of start-ups do things, and you see so many people fall at a hurdle where they just try and sell to an NHS organisation, or they try and mystically think that there's a deal that you can get done at head office and just suddenly be rolled out across the country, and it just isn't the case. People have to think innovatively about how they do get that evidence. They have to think innovatively about how they do get it in the hands of patients.

James Somauroo:
I suppose it's a good route that you've gone down. Selling to consumers, getting those anecdotal stories gets starting to build your own evidence base, working with universities to build it, and obviously then developing that health economics for the B2B world, be that in the NHS or, indeed, any other healthcare system. So, interesting, I suppose.

Rick Rowan:
Interestingly, on that point, the majority... I don't know if it's the majority, but a large number of discussions that we've had, whether that's with surgeons or GPs or pain centres, et cetera, has been patient driven. The patient's had a result, they've gone to the GP or the surgeon, and said, "This is what's worked for me," or, "This is the result that I've had," and that has instigated the next conversation. Obviously we're not discounting going through the usual medical channels but I think that demand, bottom-up demand augments that journey tremendously.

James Somauroo:
I think it more just allows you to build your own space as well. It builds up this bank of actual data of it helping people. Because, as you've said before on this podcast, you're looking to personalise the formulations, the waveforms, the pulse settings, for certain conditions and for certain people. I suppose you only get to that point by getting it in the hands of people, which is why that initial B2C strategy has made sense for you.

James Somauroo:
There's probably entrepreneurs that are listening that are stuck in this conundrum of: "Do we go B2C and risk our credibility or do we try and sell to the NHS straight away and hope that we get all this credibility and the deal?" It's like, well, you're not going to lose credibility in the B2C space if you actually just do things properly. You are still a credible, regulated medical device which is CE marked. So you can do both, it is possible.

James Somauroo:
It's obviously a knife edge having to walk it, but I think that's what you guys have done well because you've been able to create that bottom-up demand, which is why people like Brenda and her colleague and everybody else can end up putting pressure on the system, I suppose, to then start saying, "Well, let's do some proper clinical trials. Let's actually have a look at building this in." Because I'm sure people... Brenda, you can probably talk to this as well. I'm sure people are pretty cynical about things like acupuncture which we both know are done in pain clinics all the time.

Brenda Lloyd:
Yeah.

James Somauroo:
I imagine it's probably a similar curve.

Brenda Lloyd:
Definitely. And osteopaths as well. This is the thing. That's the other way of getting through to people, is through the physios. When people have hurt their legs and the circulation, and you're trying to get them to do exercise, and obviously trying to do all the exercise when you have no energy because the blood's not circulating round your legs properly, your legs are heavy, it's not easy. So that's the other option, is to talk it through with a lot of physios who have to deal with people who have... trying to encourage them to do exercise on a painful leg.

James Somauroo:
It's funny. When I was training, I can remember there was, very early on in my career, one of my consultants, when I was a junior doctor, I was looking through some patient notes, and a physio had written a block of text, and I skimmed the page and just turned the page. He smacked the page back down and he just said, "If you're going to listen to anybody in the hospital, you listen to physiotherapists because they are the only other person in this hospital that will put a hand on a patient and know more than you."

Brenda Lloyd:
Exactly.

James Somauroo:
He was very clear that you listen to physiotherapists. So just to echo your point, I think you're absolutely right.

Brenda Lloyd:
I think it's true. Even when I was doing palliative care, there are a lot of people who are in so much pain. I don't know if it would help the pain, but to see people suffering, if you could help, rather than just giving them a drug which then makes them sick, makes them constipated, it's just such a vicious circle. If there was another way of helping to relieve the pain for people, it would just a) save so much money, and b) just make their end life so much better for them.

Rick Rowan:
Agreed. You've brought up a lot of very pertinent points.

James Somauroo:
You're looking at cancer pain quite a lot, aren't you, Rick?

Rick Rowan:
Yes, definitely. We've initiated several discussions on this.

Brenda Lloyd:
It would be amazing. I've seen some... especially bone cancer is one of the most painful... well, I'm sure you know, James, as well... one of the most painful things to have. Bone cancer is absolutely hideous. Because the drugs don't always work.

Rick Rowan:
No. Adding to that, as you mentioned, trying provide the best quality of life that's possible in palliative care is... it's a challenge between, as you said, the pain relief drugs, the side-effects will then produce other issues for the patient. Any intervention, even if it's used as an adjunct, which is the primary way we're trying to get in because it's just too challenging to say we can replace... but even just being able to manage that palliative care is... it's a huge area and one that we feel that we can present a lot of value, not just from the economics of it, but present value to the patient, as in value of quality of life.

Brenda Lloyd:
I think one of the most important things with palliative care is death with dignity. That was the big lesson I learned when I did 10 years of it. It was giving people a good death, as it were. Sometimes you just couldn't do that because they were in so much pain.

Rick Rowan:
It's definitely something that is on our road map to discover... further discovery, for sure.

Brenda Lloyd:
That would be fabulous.

Rick Rowan:
If we look at just the points that you've raised during this conversation, things like diabetes patients, Jackie's mum who's... Jackie's mum is not an isolated case. Mobility in the elderly is an area actually that we are already in discussions with around funding for specific projects because it's just such a big one. If you just look at those two things, and then if you added in things like palliative care, the scope, or the potential for impact, if other patients were having the same results as Jackie's mum as an assumption, is just... it's so large. The scope is so large for having such an impact.

Brenda Lloyd:
Definitely. We'll just have to see how the next five years go because I think, with the COVID, NHS is literally not going to have any money.

James Somauroo:
It is a good point though, and actually it does raise the value of doing the health economics behind this because, yes, you've also got the patient benefit at the end of this, so taking the evidence that we do have behind this right now and extrapolating it means that a lot of patients will be able... some won't, but a lot of patients will be receiving better pain relief as a result of using the technology like this.

James Somauroo:
But also you've got to look at the economics of it. It's like what you showed me in wound care, Rick, so what Raj has worked up with the health economics stuff. Extrapolating what that might do to a CCG or clinical commissioning group, which are sort of the regional centres around the country, for those listening... but what it can save for them, all of a sudden, if you start doing that data, it actually makes sense because if you can heal non-healing ulcers by stimulating the tissue around it through microcurrent and all these different technologies, it means that ulcers will heal, it means that healthcare becomes cheaper. It means that patients get better too.

James Somauroo:
I think, yeah, you're right, Brenda. The NHS is going to be stretched. Getting rid of this backlog is going to be expensive, it's going to be difficult. Also, there are a lot of people that haven't presented with cancers. There are a lot of people that haven't presented with chronic conditions, and so we're going to see some late presentations of things because people haven't been able to get out.

James Somauroo:
I think anything that's going to help make healthcare cheaper, more innovative, more efficient, whether that's a backend admin system that frees people up, or whether it is a technology like this that can come in and do a job, I think... We've already seen NHS Digital and NHSX being more open to things like AI, and other things like that. So I think all of these things together will just provide at least a route out of where we are. As you rightly pointed out, Brenda, with your very practical example, it's just getting the time to stick it in front of somebody to give it a read. That's actually the practical difficulty.

Brenda Lloyd:
Yeah. Because they're very busy and stressed, as everybody is. So at the moment, it's just really bad timing.

Rick Rowan:
For many things.

Brenda Lloyd:
Yeah.

James Somauroo:
Exactly.

Brenda Lloyd:
I know. It's sad. My daughter was meant to graduate as a nutritionist and she's not getting her graduation, so she's a bit down. But that's just life at the moment. I'm doing her graduation here.

Rick Rowan:
Unfortunately it is.

Brenda Lloyd:
I've got her a cake and a gown. She doesn't know.

Rick Rowan:
Well done, mum!

Brenda Lloyd:
I know.

Rick Rowan:
When's her graduation? We'd better make sure we don't publish this podcast before-

Brenda Lloyd:
Yes. You're right. It's next weekend.

Rick Rowan:
Very good.

Brenda Lloyd:
Her result's next week, so that will be good.

Rick Rowan:
Just for our listeners' benefit, Derek that you mentioned is actually NuroKor's chief financial officer. So I'm sure, Brenda, you can hit Derek up for a replacement device.

Brenda Lloyd:
Yes. I'm sure I can. Bless him. He's such a lovely man.

Rick Rowan:
He is. Derek, if you're listening, there, you [inaudible 00:26:26] All right. Look, it's been wonderful speaking to you both. I appreciate, Brenda, you giving us your time this morning.

Brenda Lloyd:
It's a pleasure.

Rick Rowan:
Thank you, James, for joining and co-hosting as usual.

James Somauroo:
No worries, dude.

Rick Rowan:
I look forward to when we're able to share this amazing story with our listeners.

Brenda Lloyd:
You take care. Thank you very much. Keep safe.

Rick Rowan:
Thank you. Same to you.

Brenda Lloyd:
Bye, bye.

Rick Rowan:
Hi, everyone. Thanks for listening to The Bioelectronics Podcast by NuroKor, and for making it to the end of this episode. If you enjoyed it, remember to subscribe, rate us, and leave a review. We'd much appreciate it. You can head to the description of this episode and follow us on all of our socials so you don't miss out on any of the latest bioelectronic content.

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