#945 - Dr. Roddy McGee

[0] Five, four, three, two, one.

[1] Hmm, I'll start.

[2] Hello, ladies and gentlemen.

[3] Hello, Dr. McGee.

[4] That sounds not me peeing.

[5] If you're hearing that, you're like, what?

[6] Is this a podcast in a bathroom?

[7] No, that's coffee.

[8] How are you, buddy?

[9] Good.

[10] Thank you for having me. Thanks for being here.

[11] For folks who have heard me rant and rave about the fantastic results that I have had, getting treatment on my shoulder where I was that close to getting surgery it's this gentleman dr. McGee who has uh who's fixed me up out of Las Vegas Nevada and uh now we're here to talk about it yeah I appreciate the chance to be here well you've man of very short words today he was very talkative before the podcast folks that's how it goes but now I'm hearing myself oh was it weird you can take them off we can take them off it's too weird you've never done a podcast like this for right you did John Dudley's yeah not which was excellent we could take it off I might have to.

[12] Okay, let's take it off.

[13] I don't want to freak you out.

[14] Is that better?

[15] This is a little more like a normal conversation.

[16] Okay, I don't want to freak you out.

[17] To me, it's better because I can hear, like, if things are wrong.

[18] What's the notes, Daddy -o?

[19] What do you got there?

[20] Just a couple of things I jotted down.

[21] Just make sure, give you all the information you want to hear.

[22] Well, I just want to tell you that I feel super fortunate to have met you and to have been treated by you and to be able to have these conversations with you in your office, which is why I wanted to have you here to talk to you.

[23] Because, I mean, I was having some.

[24] really significant shoulder issues before um you treated it and it's it's amazing the results and what what you know i mean what what what i've avoided avoided in shoulder surgery yeah i mean you've had a tremendous result so obviously we're very thankful that you're able to get that benefit and i think we're in my community of orthopedic surgery and sports medicine you know we're very excited about the possibility and eager to continue to learn about it and see what it can be and how it can help and what it does best for what now where's all this stuff coming from like where is this science coming from and how is it evolved over the last few years well um a lot of the stuff that we're using is not new in terms of uh the tissue or uh that type of thing but it's actually the application for orthopedic sports medicine so you could go back decades to when it's been used in plastic surgery uh for corneal ulcers is one of the original applications of placental tissue.

[25] So the idea of it isn't necessarily new.

[26] It's just that as we've gained more understanding in our community of orthopedic surgery, now we're starting to see what the applications can be.

[27] Now, when you say plastic surgery, like what have they done with it with plastic surgery?

[28] Mostly helping with wounds.

[29] So that's been the big application, wound healing.

[30] And the potential for there to be wound healing without scarring.

[31] So that's one of the things that we'll get into.

[32] How do they do that?

[33] It's part of the mechanism of how the cell helps the process of the healing.

[34] But we'll talk about that for sure.

[35] Now, when they extract the placental tissue, like how are they doing it on young women who have had cesarean sections, correct?

[36] Sure.

[37] So it bypasses a lot of the ethical concerns that a lot of people had during the Bush administration, which kept them.

[38] Okay, so you said a couple of different important things there.

[39] So let's start breaking that down a little bit.

[40] So the first thing is, you know, where does it come from?

[41] It comes from a young, healthy mother.

[42] In this case, what we're talking about, this particular category of biologic treatment or cellular tissue.

[43] This comes from a young healthy mother that's having an elective C -section, and prior to the delivery has agreed to make a charitable donation, and then they have been screened.

[44] And there's a process that must be followed by the.

[45] American Association of Tissue Banks, and they have a series of blood tests that they have to go through, and so you're checking to be sure that there's no communicable disease, you know, for example, hepatitis or HIV, things of that nature.

[46] And so once that has been cleared and they're an acceptable donor, then they go through the delivery, the tissues collected.

[47] And as you said, this is stuff that typically would go in the garbage.

[48] So essentially the, you know, the ethical and the moral dilemma shouldn't exist for that portion of it because, you know, otherwise it's just garbage.

[49] Now, that's taken by the company that has harvested and they have their processing center, which also has to be evaluated and approved by this AATB, American Association of Tissue Banks, to be a facility that is up to their standards.

[50] So they have a sterilization process, the tissue is not contaminated, their packaging is appropriate.

[51] They're, you know, their shipping is not causing problems with the tissue.

[52] So you have to meet all these standards.

[53] It's very stringent.

[54] And so if you have that, if a company has that approval, then, you know, they meet the standards allowed so that that stuff can then go either to an office or to a hospital.

[55] So now, the next thing of what you said, let's talk a little bit of.

[56] bit about President Bush and that whole discussion.

[57] So first of all, that is about embryonic stem cells.

[58] Okay?

[59] An embryonic stem cell, and that's, you know, that doesn't have anything to do with what we're doing.

[60] An embryonic stem cell is when the sperm and the egg join and begin to form the beginning cells of life, and there's initially two cells, and then it divides into four, eight, et cetera.

[61] In the first five days of life, that's called a blastocyst, and those cells can be harvested, and they are what we call totipotent.

[62] That means they can become anything.

[63] They have the ability to transform into any line of tissue or organ, or in the case of that first five days of life, those individual cells can actually become a complete organism.

[64] So that's, that's where we had, you know, the cloning of the sheep.

[65] So that's what happened.

[66] So they took the cells in that first couple of days, and then they got a process to allow it to continue to grow.

[67] And so you had two different from a single sperm and egg, you had two organisms, complete mammals, you know, created.

[68] So when you say this blastocystis, is that how you say it?

[69] That's just the term for the initial, you know, the ball of cells that's formed.

[70] And how many cells is, you know, blastocystis?

[71] Well, they're dividing over the number of days and doubling each time.

[72] So then, you know, by the time.

[73] Hundreds, thousands?

[74] Not by that time.

[75] No, hundreds?

[76] You're 16, you know, 32.

[77] So if you have 32, how many different organisms can you make off of those 32 cells?

[78] Technically, if you have a toady potent cell, every individual cell has the ability to become a complete organism.

[79] Whoa.

[80] So that could be one blast assist.

[81] This could be 32 different people.

[82] I guess potentially.

[83] Wow.

[84] I don't know if that experiment's been carried out.

[85] But theoretically at least.

[86] yeah wow so um now when they have like frozen embryos when people do things like that when they decide they want to have kids later in life and they freeze their embryos how the hell are they doing that what's what's that about well and i'm not like a reproduction specialist so we might be getting you know but those those frozen embryos a lot of times they don't get used right i don't know i don't know how that works um because i know there's been battles like people have had battles with their ex -wives and shit over a little bit of stuff yeah yeah It's very strange.

[87] My understanding of it would be that if you're, you know, you're freezing it with the intention of maintaining the cell viability.

[88] And so somebody has demonstrated that you could then thaw that cell and it still has the opportunity to divide, produce, and, you know, become a living thing.

[89] Wow.

[90] I was thinking, like, for the non -viable ones or the ones that don't get turned into people, they could probably use those as well, right?

[91] Well, that's a big debate.

[92] That was the thing, right?

[93] That was the big George Bush thing.

[94] Well, okay, so let's back up on that because I think there's a lot of misconception about that, and I hear like very strange comments made about it all the time in the media.

[95] So the thing that George Bush signed in 2001 stated that the federal government was not going to supply money for embryonic stem cell research.

[96] That's it.

[97] It was not a ban on the application.

[98] On stem cell research.

[99] So for all of that time, I mean, private equity companies and any private.

[100] private investor could have and probably has been spending the money to continue to research that and develop it and find it.

[101] So I always find it interesting when I hear on TV, oh, like, our country has been set back a decade because they signed this, you know, bill.

[102] So you feel that's wrong?

[103] Yeah.

[104] So, but all he said was we're not going to dedicate federal money to it.

[105] Right.

[106] That's different than a ban on any study.

[107] But how much research does rely on federal funding?

[108] I don't I mean, there's private funding for all kinds of things.

[109] Is it more common now than it is before, or has it always been the case?

[110] Well, there's a lot of private funding.

[111] So President Obama in 2009 lifted the ban on the federal funding.

[112] So federal funding has been going on for it since then.

[113] Interesting.

[114] Yeah.

[115] So what is the difference in terms of the viability of placental stem cells that you would get from a woman in a cesarean section versus something that you would get from a blastocystis?

[116] well so a couple of things about that um one there's um it's actually to our benefit in orthopedics not to be using that line of cells because those cells starting from that time point have the ability to um have teratogenic potential so what that means is they can potentially form tumors so that makes it obviously a big disadvantage because now we're we're adding our risk to what we're doing once they've gotten to the point where it's a part of the the whole you know we call this like a human placental stem cell or mesenchimal stem cell and that includes the placenta the umbilical cord the wharton's jelly is a mucus type substance that's around the arteries of the umbilical cord the amnion or the amniotic sac which is the inner layer around the baby, and then the outer layer is called the corion.

[117] Now, all of that has cells in it that we would put in the category of mesencomal stem cell or mesenchymal stem cell.

[118] And what that means is they have a specific line of tissues that they can become.

[119] So now back to when I was explaining the formation of the blastocysts, becomes a morula, becomes an embryo eventually.

[120] So in that process, you have this ball of tissue, and then it starts to kind of fold in on itself, and then it starts to layer out into these three layers.

[121] So you have endoderm, ectoderm, mesoderm.

[122] Each of those kind of is directed towards a certain line of cells and tissues.

[123] The mesoderm and what these mesenchymal stem cells can become are all of the things that we care about in orthopedics, so cartilage, bone, muscle, ligament, tendon.

[124] So we have that whole line of cells that this particular cell has the potential to become.

[125] So when we talk about a stem cell, by definition, what it means is one, it can divide and become another stem cell.

[126] So it can duplicate itself so that now you have another cell that can divide and become another cell.

[127] or it can divide and differentiate into a cell that then has the characteristics of the things that you're hoping it will become.

[128] Now, that's a directed and ordered approach in embryology.

[129] And in the case of treating an injury, what we're hoping is that that can differentiate into the injured tissue.

[130] And how long have they been doing that?

[131] Well, studies on that have been going on for at least 10 years.

[132] So I want to say maybe back as early as 2007.

[133] Now, we've been, if you go, you know, way back to the early days of arthroscopy, and that would be like the late 70s and early 1980s.

[134] And I don't know exactly what year, you know, he would have started doing this.

[135] but Dr. Stedman in Vail, Colorado, and he was in Reno and Lake Tahoe area before that, they would, he's the one that developed a microfracture procedure.

[136] I don't know if you're familiar with that.

[137] You've had a couple of knee surgeries, so I don't know if you've heard that term.

[138] I have, but I don't really recall exactly what it is.

[139] Sure.

[140] So basically, if a patient had a small cartilage defect, he took a small an all, or like what looked like a tiny little pick and made a puncture into the bone and what that did is it releases marrow elements along with blood and they were able to see with time and you know there were occasions when they got to have second look arthroscopy that that cartilage could fill in now they also found that that didn't become the native cartilage it becomes something called fibro cartilage so when you look at it under microscope it looks different compared to our normal cartilage appearance like physically looks the same but under the microscope looks different what is the difference uh well the main difference in in what's um applicable is that um it's doesn't have the same structural properties so it was more easily able to kind of come off with a sheer force so just picture like your new bending yeah you could kind of flake off or or in some cases just didn't form as well as you know, you would want.

[141] So, so that experience, and I, you know, having conversations with the guy that I trained with, his name is Larry Leemak in Birmingham, he noted just over his career that he always felt like patients that had worse arthritis, but they would do this micro fracture procedure on in knee arthroscopy, actually would do better than patients with less arthritis, but that they didn't do the procedure.

[142] And so it had always been in his mind that that, somehow that marrow stimulation was providing something that was helping with either healing or pain relief.

[143] And it's only now that we start to understand, you know, because the bone marrow has some of these mesenchymal stem cells available also.

[144] And we'll kind of talk about the differences and stuff like that.

[145] So it's essentially like a crude version of stem cell transplants, like, or early version.

[146] That's a good way to put it.

[147] Yeah.

[148] I mean, our hope is that we're using cells that can again change into other things that we want and when did they start applying this on people like in terms of not just tests and studies but actually in practice like what you do uh well in orthopedic sports medicine i don't think i started to hear about it until around 2012 so that was the the first year that i was in practice and i attended a conference um in las Vegas and it was called the emerging techniques in orthopedics.

[149] So they were kind of talking about what's the newest and most forward thinking ideas that are coming through.

[150] So a company presented and one of the physicians presented information showing that they had harvested fat tissue from patients' abdomens and injected into their knee for patients that had knee arthritis.

[151] And they were showing new.

[152] growth of cartilage and an actually improvement in some of the x -rays so when you look at an x -ray there's some characteristics that we look at that you know define what arthritis is so if the patient has narrowing of the joint space or they have bone spurs things like that they were actually seeing more space between the bones on some of these serial x -rays so you know I saw that and that was just like so incredible and something that I never heard about read about or you know had encountered before and that's really what kind of sparked my interest and what are they doing with the fat well because i've heard that they do stem cell they harvest the fat similar to like a like a like a mini liposuction right and then they're you know they either spin it in a centrifuge or there's a there you know these syringes that you can pass it through a filter and then you re -inject it and what you're trying to do is is again take advantage of the fact that there's these mesanical stem cells in the tissue and like what can they just are they just taking the fat like when they spin in the centerfuge like what does that accomplish uh it just separates out the the cells so then you can you know inject the portion that you want and so we do that you've had it with PRP yeah yeah yeah so it's just i've had it with regenerine which is like a form of PRP correct yeah with a heated up and right it becomes like a yellow serum right so when that's the platelet layer of the blood that you're looking at.

[153] Okay.

[154] And so the red cells separate out and you can easily see that in the tube.

[155] And what is the difference in the results from someone who does that?

[156] Because I know quite a few people have done it that way.

[157] They've had injuries treated where they suck the fat out.

[158] There isn't any research to differentiate like one of these treatments versus another yet.

[159] It's just not available.

[160] So it's all anecdotal in terms of like talking to patients?

[161] It's happening.

[162] I mean, people are collecting the data, but it's just not, you know, it's not.

[163] not at the mature stage where, you know, where it's available and we have, you know, published stuff to look at.

[164] Do you personally know of anybody who's had really good results using the fat method?

[165] Yes, actually.

[166] A physician friend of mine in Memphis, Tennessee, her name's Dr. Laura Lenderman.

[167] She has utilized that quite a bit, and she's been very happy with the patients that she's treated and naturally some people do better than others but right you know the the real the rigorous study of this though is still yet to come hmm it's that's really fascinating like do you have you considered trying that or you just definitely yeah but you don't so far you just do the stem cells i haven't had anybody specifically request it and uh maybe someone who wants to lose a little fat and fix their knees yeah i mean that's that's probably taking things in a direction i don't want to be going.

[168] But the plastic surgery direction?

[169] We know, you know, there are a number of different options in terms of where these sources of the cells can come from.

[170] Bone marrow is certainly had a lot of use and continues to be used.

[171] Daniel Carmier had that done.

[172] That's what you told me. Yeah, he had it pulled out of his hip and he said it was brutally painful.

[173] Then he was walking with a limp for like two weeks.

[174] It's obviously it's a procedure.

[175] There's pain and there's, you know, morbidity, there's a consequence to, you know, putting a sharp object into the bone and drying that bone marrow out.

[176] Yeah, so that means a bad thing.

[177] I don't like that word.

[178] No, it's, we don't like it either in medicine.

[179] Morbid is a bad word.

[180] We have conferences called morbidity and mortality, and that's where you basically own up to things that you've done a terrible job with or explain, you know, why somebody has died as a result of your care.

[181] And it's a awful thing to go through, and it's critically important to be able to evaluate yourself and understand what things happen when they don't go the way that we want them to.

[182] So it's an important exercise that physicians go through to, you know, review cases.

[183] Oh, I can only imagine.

[184] Yeah.

[185] You know, I mean, especially if you're dealing with people that are broken apart.

[186] I mean, essentially, as an orthopedic surgeon, you're dealing with people whose bodies have failed, right?

[187] Your limbs have failed.

[188] Ligaments have torn off the bone.

[189] Knees have exploded I mean you've told me some gnarly stuff In terms of the kind of injuries that you've had to treat And I could only imagine some of them Yeah Yeah And so your time doing this With placental stem cells How long have you been doing that?

[190] It's been a couple years So essentially you did mine I think How long ago was it?

[191] I think it was July of 2015 Yeah so I kind of came in pretty early Because Jeff Davidson, the doctor from the UFC, he was the one who told me about it because he had shoulder surgery and he was very stiff and had real problems after the shoulder surgery and was just very unhappy with his range of motion and the pain that he's experiencing.

[192] And then he got some stem cell treatments and it just all went away.

[193] And he trains a lot.

[194] Yeah.

[195] He trains really hard.

[196] He's very fit.

[197] I was pretty impressed with, you know, what he told me about how he was, what he was able to get back to.

[198] after, you know, he had been treated with that type of injection.

[199] Yeah.

[200] Yeah, so he told me, and then I was, like, on the fence.

[201] I mean, I'd seen an orthopedic surgeon.

[202] And the only thing that was keeping me from getting surgery is, you know, he put me through all these stress tests where he pushed down on my arm and all this day.

[203] And I resisted all of them.

[204] And he's like, this is, it's kind of odd that your injury is this bad, but you have so much strength in your joint still.

[205] Yeah.

[206] Like maybe you should hold off a little bit before you get the surgery.

[207] He's like, because you.

[208] I thought that when I examined you, too, because I really couldn't reproduce your pain.

[209] Yeah.

[210] So, and that's, that's another reason, and I probably would have been in the same boat as the first guy in terms of, you know, trying to make a decision about surgery, because, you know, if your physical exam doesn't, you know, show that somebody has some significant deficit, it's, it's hard to make the jump to take somebody to surgery.

[211] Well, during normal everyday life, there'd be like zero.

[212] Pain.

[213] The problem is what I put my body through is it has nothing that resembles normal everyday life, yeah, which means jujitsu and kickboxing and kettlebells and archery.

[214] And there's just so much explosive movements and so much weight -bearing movements.

[215] Yeah, you're doing really high -demand stuff.

[216] Yeah.

[217] So in that, in that case, that was one of the reasons why I was thinking, because I don't want to walk around with a compromised body.

[218] I'm like, if I have to just get surgery and then take six months of rehab or whatever, like what is the, for a type of shoulder injury that I had, what is the rehabilitation time?

[219] You know, for sure, probably three months.

[220] I mean, it can be longer than that.

[221] It depends on the patient.

[222] Somebody like you that, one of the things that we have trouble with, with some patients, they've never even lifted weights, for example.

[223] Oh, yeah.

[224] So for them, the recovery and rehab, we're introducing things to them that they've never seen or done.

[225] And they don't understand the difference between, you know, being sore and pain that's, that they should be conscious about.

[226] And it's challenging.

[227] It's hard work.

[228] And it's uncomfortable.

[229] And so some patients, you know, they struggle to get through that part of it.

[230] And naturally will take longer to improve.

[231] So it's harder for them to get their motion.

[232] It's long or much longer for them to return their strength.

[233] Now, you already have, like, a significant baseline level of strength.

[234] So, you know, much easier in your case to balance.

[235] bounce back.

[236] And then also the things that you would do in rehab, they're so rudimentary, you know, you would move through that very quickly.

[237] And then once you're at the point where you have had enough tissue healing and it's safe to progress you, you know, through higher level exercises, then you could really push it.

[238] And you would.

[239] I mean, you would be committed to it, dedicated, diligent.

[240] I mean, we'd almost have to hold you back.

[241] Yeah, that was another question I had.

[242] How often do you have people where that is the issue?

[243] Like, I know you, you treated a bunch of fighters and when you treat MMA fighters is that an issue where you're trying to like slow them down all the time you got to let people know like and one of my uh you know one of the lines that i'd say to all my patients um regularly is you know you got to respect biology like you have to allow the healing to happen i know you feel good i know you're moving good and you're ready to go you want to be back on the court on the field things like that but if we don't take the proper progression, you know, we risk having you reanger and then you're right back in that same bow.

[244] We don't, we only want to have you miss the most limited block of time that you can.

[245] So I never want to, I don't want people to miss one more practice game, you know, match, workout or whatever than they have to.

[246] At the same time, we don't want to put them in a situation that's unsafe.

[247] So it's always a, it's a balancing act.

[248] So in your time of doing this, have you had people that didn't respond to this particular type of therapy?

[249] Definitely.

[250] Yeah.

[251] And were they the people that we talked about before that don't exercise and aren't in good shape or is it across the board?

[252] You know, I would have to go back and look and kind of critically evaluate each case.

[253] Certainly, you know, we worry about the patient that has lower, like, baseline fitness, like their overall health is poorer, you know, and what their response might be.

[254] But I think that's information that is still, you know, to come but definitely i mean some of the people that have responded the most dramatically like for example you and john dudley i mean you guys are fanatical about your nutrition you're working out regularly you're doing all kinds of things to optimize your chance to not you know in this case heal but in other instances perform and i have to believe that that has you know that's a huge factor yeah i would wonder how much of a factor it is if your body is conditioned in a way to constantly generate muscle tissue and breaking down and rebuilding and it's always constantly under stress?

[255] Definitely has to be a part of it.

[256] You know, I think it's not the typical realm of my specialty to be looking at all those other factors, but I think with all of the information that's becoming available, one of the cool things for me has been it's forcing me to have to learn about it it's forcing me to have to take a look at you know how can we do better you know what are we ignoring and i think if you're not looking at every aspect of that wheel then you're missing a chance to do as good as you can for for each patient um and it might be things that we have to do before somebody even has treatment we might have to bring them up to some baseline level with a number of different things you know um and so and the other side of it too is we're we're in a we're in a system now where there's so much information you know one person can't be your source for everything so you really have to have a good team all around you um i think that's really important so i find myself more and more seeking help help and just saying hey i just don't i don't know enough about this like can you can you help me with this or explain it better or right you know can i have the patient talk with you and and maybe get some more information and I think that may give them even better chance to do well.

[257] Just because the options and the possibilities are so comprehensive.

[258] And time.

[259] Mm -hmm.

[260] So, you know, in a typical orthopedic practice, you don't have a ton of time to go through all of this with every patient.

[261] And so you just have to make sure that you're providing resources and getting them as good information is available.

[262] One of the things I thought was interesting, you were telling me that there's been really good results with people going into a sauna directly after treatment.

[263] Well, I don't know that there's been good results.

[264] I think it's interesting and the things that you've talked about for other applications in terms of heat shock proteins, you know, there's some belief that that may either assist the cells in proliferation or their ability to, you know, have as robust a response as possible.

[265] You know, that's not proven.

[266] That's that's hypothesis, you know, but I think it's interesting.

[267] And again, it's, it falls into, the category of a lot of these things that we're talking about where the science the basic science is there like we understand how it happens in the embryo in the developing child we know what it does in a lab like we can add these things to a petri dish and watch it watch these changes happen but nobody has demonstrated this in a human in a clinical trial where we're treating an injury right so we have to be very careful about that and that in fact the FDA is very clear that you know we cannot be making those claims.

[268] Companies can't be making those claims about their products and physicians cannot be making claims and marketing their practice to drive people to them stating that these things are happening.

[269] Now, when you talk about heat shock proteins, I don't know if you can answer this question, but is there a difference between the heat shock proteins that you receive from, say, like a steam shower, like a steam room versus a sauna versus even a hot bath?

[270] I've heard people saying that you get heat shock proteins from a very hot bath.

[271] And I think there would have to be some kind of biopsy or blood test and, you know, sample, like have people go through each of those things and control for all those factors.

[272] Right.

[273] But the whole idea is just being involved in an environment that's extremely hot where your body is like, what is this guy doing?

[274] And then it produces the heat shock proteins to try to compensate.

[275] Yeah, as a protective mechanism.

[276] So just the knowledge of this, I mean, this is really interesting because people have been using saunas forever.

[277] And it was all sort of anecdotal.

[278] Oh, the sauna makes me feel great.

[279] And I would look at them like, what are these assholes doing?

[280] They're going to go in there and sweat.

[281] I always thought it was people that were just, like, lazy and they didn't want to lose weight.

[282] And so they went in the sauna and they thought they lost weight with sauna.

[283] Yeah, I really did think that.

[284] They're just dropping water.

[285] But talking to Dr. Rhonda Patrick, and she was explaining the benefits of sauna where there was one study where mortality decreased 40 % from all causes.

[286] through daily use of the sauna.

[287] Yeah, all -cause mortality was less.

[288] Yeah, 40%.

[289] Here it is right now.

[290] Using the sauna four to seven times per week associated with a 40 % lower all -cause mortality might be heat shock protein, sciencedaily .com.

[291] Fascinating stuff.

[292] Yeah, you can click on it, young, Jamie.

[293] There we go.

[294] Just get a little larger there.

[295] I mean, Journal of American Medical Association.

[296] So serious stuff, right?

[297] I mean, it's a peer -reviewed journal.

[298] Yeah.

[299] You're going to assume that there may be some validity of the information.

[300] Amazing.

[301] Yeah, I mean, if that's correct, if all I have to do is get in a sauna and I, you know, can decrease my chance of death from all diseases by 40%.

[302] Yeah, I'm on that.

[303] Cancer, heart attack, leukemia, amazing.

[304] Here's a, what a suitable replacement.

[305] Hot bath won't be as robust, but can increase blood flow, elevated heart rate, increase heat shock proteins so she's saying it just won't be as robust so she's never taking one of my baths so it's you know a simple thing to find out or like what you could do yourself is check your heart rate blood pressure temperature you know just like just take those as like a baseline right after each of those you know sessions and see if there's difference how much does your body temperature elevate during those things and how much of it is surface your skin you can You can't elevate your core temperature too much, or you're going to have an enzymatic breakdown.

[306] Like, there's bad things that are going to happen.

[307] Yeah, I wonder, like, what the line is, the point of diminishing returns where the sauna becomes detrimental versus beneficial.

[308] Sure.

[309] Yeah.

[310] And I wonder, like, how cryotherapy comes into play with that as well, because cold shock proteins also show some great benefit in reducing inflammation.

[311] Yeah.

[312] It's just an amazing time for all the different.

[313] Definitely.

[314] the options that are available to people you know i think at the same time uh one of the things that we have to be conscious of is you know being responsible about how we use this information and what we're telling patients and you know i think there's a lot of misinformation and a lot of people taking advantage of that and so um you know we want to try to avoid that we want to try to give people good information so that they can ask the right questions and they can evaluate places where they're going to see if they're comfortable with what they're being told and what's being offered so i think there's something like 200 plus regenerative medicine clinics that have popped up in the last couple of years hmm and that means at least 40 of them are bullshit by my math i mean maybe maybe 80 maybe more than that maybe 90 well i just think people have to be cautious and careful about you know what they're reading what they're saying and some of these places have received direct letters from the FDA saying, hey, you can't say that.

[315] Right.

[316] You can't be making claims.

[317] So let's go over some stuff that's definitely beneficial, like platelet -rich plasma, PRP injections, people have had real benefit from that, right?

[318] Sure.

[319] So that has some validated outcome studies.

[320] There's a comparison study with PRP on tennis elbow or lateral epaondylitis, comparing that to corticosterid injections, which is a common tree.

[321] treatment for attempt to give pain relief.

[322] In the particular study that I'm thinking of, they had 73 % of the patients that received PRP had relief of their pain compared to about 50 % of patients with a steroid injection.

[323] So that's a head -to -head study comparing treatment and, you know, the advantage seemed to be to PRP.

[324] Now, what is the difference between the results, I don't know if you even know this, between the results of PRP and regenerine?

[325] I don't know.

[326] I don't know much about that product actually.

[327] I mean, I know what it is.

[328] I know that it was, you know, going on in Germany.

[329] Yeah.

[330] I know a lot of people traveled to Europe.

[331] Peyton Manning, Kobe Bryant, all those guys flew in.

[332] Yeah, Alex Rodriguez, I think.

[333] Yeah.

[334] Dana White did too.

[335] The president of the UFC, he went in there for tinnitus, you know, and found through intramuscular injections.

[336] There's a deep relief of tinnitus.

[337] Hmm.

[338] Hmm.

[339] Hmm.

[340] Yeah.

[341] So that, I mean, that's great.

[342] And again, there may be great applications for all of the different things that fall into this category of biologic treatment.

[343] Time is going to tell us what things pan out clinically to be best.

[344] I mean, you can look at all kinds of factors, and we can draw conclusions from that.

[345] But ultimately, you know, the proof is going to be when we have, you know, robust clinical studies that compare treatment.

[346] and, you know, we have follow -up physical exams and we have follow -up imaging to see exactly what's happening.

[347] So we know what we are hoping for.

[348] We know what we want to see.

[349] We want to see that, yeah, we have this cell that has the potential to differentiate into other tissue and actually causes healing.

[350] But nobody has demonstrated that yet.

[351] There are some studies.

[352] I mean, there's 35 studies, 29 are animal.

[353] there's six, six or seven that are a human trial.

[354] I just saw this review paper, and I didn't know if the review paper had been written before one of the more recent clinical trials was published.

[355] There's, so one was on knee arthritis, and the others were on mostly foot and ankle stuff.

[356] The most recent is from USC and in combination with a doctor that's in Indiana.

[357] And they looked at patients that had a knee arthroscopy, and they resected part of the meniscus.

[358] So we call it a menacectomy.

[359] And part of it was essentially cut out.

[360] So there was a tear.

[361] They cut out the bad tissue.

[362] They left the remaining healthy tissue.

[363] And they did an MRI, and they measured on the MRI, the volume of menisical tissue.

[364] Then they injected the patient with a bone marrow aspirate.

[365] So in this case, it was the, you know, BMAC or bone marrow aspirate.

[366] Which is stem cells extracted from bone mal like the way Daniel Cormier had done?

[367] Correct.

[368] So they injected that into the knee, and then I think, I want to say it was four or eight months later.

[369] I think it was eight months.

[370] They re -imaged the knee, and they found that there was a 15 % increase in the menisical volume.

[371] So the patients had apparently grown menisical tissue.

[372] I had a meniscus scope on my left knee.

[373] from an ACL injury that I had.

[374] I had ACL surgery, but there was still some meniscus damage.

[375] And then at the time of the ACL injury, they tried to stitch up the meniscus.

[376] Oh, okay.

[377] They just tried not to cut it out.

[378] And it was a problem for me for several years.

[379] And then finally it tore, it became a bucket handle tear where it locks.

[380] So it locked my knee out, brutally painful.

[381] In the middle of a jujitsu class, it was really bad.

[382] So I had to get it scoped, and then once I got it scoped, it was functional, but it would provide me with maybe every couple weeks, it would be painful.

[383] There would be something going on, it would ache.

[384] It would be a problem.

[385] You shot some stem cells in there a year ago.

[386] I've had zero problems with it since.

[387] Zero.

[388] It's like I don't even acknowledge that I have a knee that's weaker than the other knee anymore.

[389] It doesn't even feel like that anymore.

[390] My left knee feels exactly like my right knee now.

[391] Yeah.

[392] It's crazy.

[393] Like, I mean, for a decade plus, I had pain in that knee.

[394] That's terrific.

[395] One injection, a year later, nothing.

[396] And it was almost within two months.

[397] Within two months after the injection, I felt like a significant difference.

[398] I was, like, waiting for those days.

[399] Because those days when I pushed it hard, particularly after kickboxing.

[400] There's something about those, like, hard pad work, like kicking the pads, all the impact.

[401] I was going to say any particular things that you were doing that made it feel the worst.

[402] That was the big one.

[403] It's just striking, because striking is just jarring and there's just so much.

[404] And I just think there's just, there was laxity in the knee.

[405] Is that a word?

[406] Yes.

[407] Why does it sound wrong?

[408] No. I know it's word.

[409] I say that.

[410] But it sounds wrong.

[411] Laxity sounds wrong.

[412] It sounds like a laxative.

[413] It sounds like I'm making up a word.

[414] You know, I was laxity from my laxative.

[415] But that kicking motion would always, you know, and it would just hurt and I would put ice on it.

[416] I'd be just go about my day.

[417] I'd be like, well, it's fine.

[418] It's not swelling up to me. And now it's something you don't think about?

[419] Dude, it's zero.

[420] I ran a trail yesterday in the mountains, like brutal, steep trail for two miles.

[421] I have zero pain in it today.

[422] So this is the kind of thing that I think gets a lot of us excited about what the potential is.

[423] Yeah.

[424] You've got a patient.

[425] here that you had a menisical tear then you so you had attempted a repair we know that about 15 to 22 percent of those fail the minusical repairs you know it's a disappointing number you know we like things to be much higher than that but that's what the facts are um that's what the you know larger scale studies have told us and to anybody that has a minuscal injury that's a risk worth taking because if you know what it feels like to have a bucket handle tear and someone says hey you have an 80 percent chance of success you're like i'm in yeah i'll take it well also for the this is what we know this is why we will take the risk so for a young person that has the tear you know we want to preserve that menisical tissue and for as long of their life as we can so certainly you are willing to risk it and even you sometimes might attempt to repair something that you think even has a lower chance just because they're young and you want to preserve that why you want to preserve it is we know that if you even resect a small amount of the menisical tissue, like say up to 25%, it will change the contact pressure in the knee.

[426] So they do these, you know, color pressure studies where it shows you the amount of force and its distribution.

[427] And with a normal meniscus, it's evenly distributed into the, you know, on the medial femoral condiles, the end of the femur, and then the tibial plateau is the top part of the chin bone.

[428] So when those come together, with a normal men, you know, minimal meniscus in there, the pressure's even.

[429] If you resect part of that, now you see this point loading, so you see these hot spots where there's a much greater amount of pressure.

[430] Sort of like when you go to a restaurant and you're sitting at a table and it's wobbly and you have to stick a napkin under one of the legs?

[431] Is that a bad analogy?

[432] Maybe.

[433] Probably bad analogy.

[434] I'm not following you, but...

[435] You know what I've done that?

[436] When you're eating is dump, dump, dump, then you're like, oh, this fucking table sucks.

[437] And he kind of twists the one leg a little higher.

[438] Yeah.

[439] A piece of wedge under there and...

[440] I know what you're saying.

[441] Yeah, I don't know that.

[442] It's not the best analogy.

[443] If that makes sense for you, that's fine.

[444] I tried.

[445] I swung and I missed.

[446] Let's continue.

[447] That's all right.

[448] But the point of the story is that we know if we cut part of that out, your cartilage is going to have some wear and tear over time.

[449] Now, whether or not you develop symptoms from that is hard to, it's hard to predict.

[450] Well, I'm pretty sure that that's what was going on with my knee because it was uneven and the jarring action of kicking a heavy bag or kicking pads.

[451] So I think what I was trying to get to.

[452] and I was taking the long path to get there was that, you know, in the past, what we might have said is, eh, you know, you had an ACL tear, you had meniscus tear, you know, your niece is crappy, sorry.

[453] Like, you're going to have some pain.

[454] And what are you trying to, what are you kickboxing for at your age anyway?

[455] I've heard that.

[456] This is, this would be the attitude, right?

[457] And really what that means is I'm uncomfortable because I don't have an easy solution for you.

[458] So I'm going to blame you for...

[459] Well, there's also people wanting you to adopt their lifestyle.

[460] or them to think that your lifestyle is foolhardy.

[461] There's definitely that.

[462] I mean, I had a conversation with a...

[463] They're trying to find an easy solution so that you don't come back into the office and complain about something that we don't have an easy solution for.

[464] Also, I think they're trying to talk sensitive to you.

[465] That might be true, too.

[466] In their mind, you know, like, if you don't do martial arts and you see some knuckleheads out there.

[467] You have lower risk of having to come to my office.

[468] That's true.

[469] It's also you see someone who's doing this and hurting themselves and you tell them, hey, look, you've got to stop doing that.

[470] You know, because you think you're doing the right thing by telling them that.

[471] Right.

[472] But, you know, you're essentially telling someone that all that stuff that makes you feel amazing.

[473] Yeah.

[474] Who alleviates stress, builds confidence.

[475] It makes you.

[476] It's part of your soul.

[477] Yeah, it's a big part.

[478] Yeah.

[479] So how am I supposed to rip that away from you?

[480] Well, for some people, it becomes a real, I mean, obviously with certain injuries.

[481] Yeah.

[482] But.

[483] Some people, we have to have the hard discussion.

[484] It's like, look, I know you want to keep doing this.

[485] I know you think you're heading that direction, but this is over.

[486] Well, when they do replacements now, because I know a guy who's got a knee replacement, and one of the things he was saying, actually, I know quite a few people.

[487] One of them was on the podcast.

[488] His name is Dan Pena, and he was saying that the problem is, with his knees, is they only bend this way now.

[489] They don't move side to side.

[490] There's no lateral movement in the knee.

[491] Like, there's no wiggle room.

[492] Well, like, he can't go side to side.

[493] Like, the knee just goes straight up and back like this, the artificial knee.

[494] Does that make sense?

[495] No, you've got skeptical hippo face.

[496] Well, there's, it depends on a lot of factors.

[497] Maybe for him, there may be other patients that don't have, you know, quite as much stiffness in their knee.

[498] But no one who gets a hip replacement is doing triathlons.

[499] They shouldn't be.

[500] Or a knee replacement, rather.

[501] They shouldn't be.

[502] Yeah.

[503] So it's limited use.

[504] With 100 % certainty, that implant will loosen and fall apart.

[505] Huh.

[506] Why can't they make a knee replacement?

[507] knee, a fake knee that's as good as a real knee?

[508] Hmm.

[509] That's a long question.

[510] Are they lazy?

[511] No, I wouldn't think so.

[512] Certainly, uh, certainly, uh, certainly lots of motivation and, uh, you know, economic reward.

[513] Oh my God.

[514] If they could fix a knee and turn a knee into, uh, a superior knee to the knee that you have now.

[515] So the, I mean, it's like an overall question, right?

[516] Why can you not, uh, replace?

[517] place something better than you can repair it.

[518] Well, wouldn't we want to be going more towards repair and renewal?

[519] Right.

[520] Regeneration would be the best.

[521] We're hoping that we can, you know, figure something out for that.

[522] But the fact is, with the knee replacement, you have a metal component that you're either, you know, cementing to the bone, or you're, you know, applying it to the bone and having bony ingrowth into the implant.

[523] So there's an interface between that implant and the body.

[524] And to come up with something that would never allow that to separate, I mean, that's, you know, how would you do that?

[525] Yeah.

[526] I know a guy who had bone cancer.

[527] It's really kind of a terrible story, but he lived near a golf course, and the golf course used these horrible pesticides, and it leaked into the groundwater, and all the people in his neighborhood got cancer.

[528] Like a huge epidemic of cancer in his neighborhood And he got bone cancer And they replaced one of his femurs With a metal rod And it causes him significant discomfort We did some of those in my training It's a pretty gnarly surgery What's that about?

[529] Talk to me Total femur Yeah, I cut someone open like a fish And stick a new leg in there You literally do It's an incision about bat long Whoa!

[530] He's making his arms about What?

[531] Spread your arm about four feet, three feet It's the entire length of however long your thigh is.

[532] Aichi, wow, wow.

[533] Yeah.

[534] It's gnarly.

[535] Yeah.

[536] They all get infected.

[537] They do?

[538] It seems like it.

[539] Wow.

[540] Now post -op, like right away, or you mean in time?

[541] Over time.

[542] Mm. Yeah.

[543] Just because your body's rejecting it?

[544] It doesn't have to do with it.

[545] It's just you got this big hunk of metal and the bacteria.

[546] Rubbing up against tissue.

[547] Bacteria forms, you know, this sort of slime layer that can't be, um, um, Even with antibiotics, you know, blood can't get to the metal.

[548] So you form this layer and then it's just, once it's contaminated, you can't control it.

[549] Whoa.

[550] So the metal on the leg, the fake leg, just gets slimy?

[551] Not so much that it gets slimy.

[552] It's just the stuff that's produced by the bacteria adheres to the metal.

[553] Oh.

[554] So.

[555] And it's just so much metal in the body.

[556] There's so much opportunity.

[557] Do you know what I mean?

[558] Yeah.

[559] So what do you do when it gets infected?

[560] You got to open them up again, clean it up.

[561] You do, you try, but the end of the line is, you know, the limb has to go.

[562] Whoa, daddy.

[563] Jamie's, Jamie almost threw up.

[564] I just saw that.

[565] You got an image.

[566] Pull it up.

[567] Pull it up.

[568] You don't, come, you're a doctor.

[569] How dare you?

[570] How dare you say don't pull it up?

[571] You're, this is what you do, man. That's like, I'm feeling bad.

[572] It's like me saying, don't show anybody.

[573] I didn't know where you were going to get the total femur.

[574] What?

[575] Yeah, that's pretty.

[576] Go large.

[577] with that, sir.

[578] Why?

[579] I want to see that.

[580] I don't even...

[581] Holy Jesus.

[582] It's making me sweat.

[583] Whoa.

[584] My God.

[585] First of all, what am I looking at there?

[586] So that's the femur.

[587] You know, that's a metal femur.

[588] And the...

[589] Just Google replace femur and look at the first picture.

[590] The legs opened up there, and you have to make measurements.

[591] And so it's basically a total knee and a total hip.

[592] And then all of the bone in between has been replaced with that metal.

[593] Wow.

[594] Wow.

[595] And then your foot's just attached to your regular shin below it.

[596] Correct.

[597] And what is this normally used for?

[598] Like how often, what is this?

[599] So that would be in the case of infection.

[600] And, you know, there's the cases that we had were usually multiple fractures below a hip replacement.

[601] And then below a longer stem hip replacements.

[602] Finally, you've got just no bone.

[603] The other, you know, reason would be infected bone that you had to resellum.

[604] and then still another reason would be in the case of tumor where you have to, you're doing limb salvage.

[605] Yeah, that was this gentleman's.

[606] Now that one above, Jamie, where it's got like, they're spreading it apart, far right, yeah, right there.

[607] What's going on there?

[608] What's all that stuff on the outside?

[609] That orange stuff.

[610] Oh, so that's called ioban, and it's a thin film that we cover over where we're making an incision in surgery.

[611] It's to help prevent infection.

[612] So we naturally have, you know, staff and other bacteria.

[613] on the surface of the skin and you put this sticker cover on top of the skin and then anything that's around the wound is is contained it says play video i think you should listen to him click on that see what that is yeah let's see who this is oh it's just a picture oh it's just a picture that that says that i can oh visit page click play video there we go oh i'm scared you get nervous oh daddy whoa boy who now that seems really i like to do surgery through incisions, like, better about this big.

[614] Yeah, a little tiny incisions.

[615] Now, that seems odd because that seems like a very old person.

[616] Like, I'm looking at the lack of muscle tissue, either very old or very unathletic.

[617] Uh, yeah.

[618] And this is, like, well, I mean, that's incredibly traumatic then.

[619] I mean, that's, how does someone recover from that?

[620] It's slow.

[621] Now, is there a potential use of stem cells in the case of, like, is it potentially, is it, is it possible to regenerate a bone.

[622] I know they've built a woman a artificial bladder through stem cells.

[623] Theoretically, bone is one of the tissues that is a part of that line of the mesenchymal stem cells.

[624] Right.

[625] That's what I'm saying.

[626] That comes from the mesoderm.

[627] So you think that could be something down the line that they could be able to accomplish?

[628] They're, I mean, replacing that femur and its cartilage covering at the knee and the hip.

[629] I mean, I think that's at this point of fantasy.

[630] Yeah, but isn't that what they said when, when, when, it's, If someone came up to the person that had the telegraph and said, hey, do you think one day I'll be able to send dick picks from this thing?

[631] They're like, well, right now, that's a fantasy.

[632] Right?

[633] Don't you think?

[634] Probably.

[635] Most likely, you know, they would look at you like you're a crazy person.

[636] Well, when I was, this is an embarrassing story to admit, but when I was about 13, I went next door to my neighbor's house, and he was kind of a computer nerd at the time.

[637] But, you know, computer nerds at the time were playing with, like, Commodore 64.

[638] right and he's like dude look at this um i can hook my computer up to the phone and i can type on the screen and my friend down the street will see what i wrote and i was like that's the dumbest thing i've ever heard dude can we like go play football like what are you talking about i so apparently i'm not very forward -thinking guy because obviously we're doing that quite a bit now i had a showtime special in 2005 a netflix special actually that eventually wound up on showtime But I had a joke in there about cell phones, about people sending you a text message.

[639] And the part of the joke was like, it takes you four presses to get an S. Right.

[640] Like, why don't you just call me?

[641] Because, like, it was before anybody had figured out how to, you know, make an actual keyboard.

[642] And I'm like, why are you making me read?

[643] Like, this is so stupid.

[644] I thought it was just like a dumb trend that was going to go away.

[645] And now, if someone calls me, I'm going to fuck you're calling me for.

[646] Yeah.

[647] Like, it's very strange what's happened in just 12 years.

[648] Yeah, it's a total shift in how we communicate with people, right?

[649] A massive one.

[650] I mean, how disruptive to your life is it to have to, like, send emails now?

[651] I mean, to sit down and, like, type an email, like, email respond back.

[652] Some of emails you, like, people email me with, like, a bunch of questions.

[653] It's a big chore.

[654] It's, like, homework.

[655] I've got to sit down.

[656] It takes a lot of time.

[657] Yeah.

[658] Whereas, you know, a text is, like, a quick response.

[659] I don't know, I just, I'm so used to email.

[660] I send a lot of emails.

[661] I have so much email.

[662] Well, I do all the booking for this show, too.

[663] I mean, well, I have a guy, Matt Staggs, who contacts people, but I reach out to a lot of people as well.

[664] So like a lot of the booking and the different things that I do, I contact people.

[665] Sure.

[666] And, you know, the best way to do it is through an email.

[667] It's like, hey, you know, I would really love to talk to you about this or that.

[668] I have a question about that.

[669] But these are brief emails, I would bet.

[670] Sometimes, yeah.

[671] Yeah.

[672] But I've gone, I've had some, yeah, that's the problem is the volume.

[673] The sheer volume I get is just unmanageable to the point where people think I'm ignoring them.

[674] I'm like, man, I'm not ignoring you.

[675] I didn't even see it.

[676] It just got lost in the tsunami of emails that came in.

[677] Like, if I go on vacation, I hardly communicate.

[678] I barely do anything.

[679] Maybe I'll put up a social media post and, you know, just to like, because it's kind of a part of the job, right?

[680] But I don't pay attention to emails.

[681] I just leave him alone.

[682] And then I get home and I'll go, oh, my God, there's 2 ,000 emails.

[683] I'll have 2 ,000 emails in a few days.

[684] I'm not exaggerating at all.

[685] I do my best.

[686] I do my best.

[687] I look for my friends.

[688] Yeah.

[689] You know, I look for people that are important and look for acquaintances that I like and, you know.

[690] You got to have a system.

[691] Work -related stuff.

[692] Yeah.

[693] But it's a mess.

[694] I have several email accounts, too, which helps.

[695] Like, people that are important to me get the big one, you know.

[696] You don't get.

[697] You don't get the bad one, do it.

[698] Don't worry about it.

[699] I like you.

[700] I don't think I have to go.

[701] If you do, I'll give you the real one.

[702] Just want to let you know.

[703] I won't tell anybody.

[704] People don't like to be on the outside.

[705] You tell them about that.

[706] And they're like, which one do I have, bro?

[707] Yeah, right.

[708] Why worry about it, man?

[709] What list am I on?

[710] Why worry about it, man?

[711] Yeah.

[712] If you have to ask the question, yeah.

[713] It's not good.

[714] I wonder when it's going to pass what we're doing.

[715] I mean, when it's not going to be this.

[716] It's not going to be typing.

[717] Like, what's the next thing?

[718] What is, you know, it's definitely not going to be videos Where you force people to watch The beautiful thing about an email is I can kind of scan it through What's this guy saying?

[719] Not interested next Have you messed around with like dragon dictation?

[720] Yes, yes It's amazing for notes when you're in a car Or when if I have an idea in my head And there's no way I can type into my phone that quickly Have you ever seen how good it works?

[721] No, it's very good Yeah, no Well, just what comes with your phone Like the most recent versions of it Yeah, like this right here.

[722] Check this out.

[723] Dr. Roddy McGee is an amazing human being.

[724] He has fresh breath and his hair is wonderful.

[725] Look at that.

[726] Perfect.

[727] Yeah, 100%.

[728] That's incredible.

[729] That's pretty good.

[730] I mean, it really is incredible.

[731] And you could do that in your car if you have an idea so you're not some asshole as texting.

[732] Because sometimes, like Neil Brennan had the best analogy for it.

[733] You know Neil Brennan is, stand -up comedian, co -ho creator of the Chappelle Show.

[734] He had the best analogy.

[735] He goes, my notebook is essentially like a net for catching ideas.

[736] Yeah.

[737] And you've got to catch those ideas, like as quick as you can.

[738] I'm like, oh, it's a good way of looking at it.

[739] So, like, if I'm in a car and I have an idea, I'm like, oh, my God, I've got to get this out before I forget.

[740] So I start repeating it to myself.

[741] And then if I'm at a red light or something, I'll press that record button.

[742] Very responsible of you.

[743] I'm very responsible when it comes to texting and driving.

[744] That's good.

[745] I just, I think that is one of the most infuriating things.

[746] It's fucking terrible.

[747] It's like you're going 60 plus whatever miles an hour, the amount of distance that you cover in a glance where you are not looking at the road and things can happen at any moment.

[748] Just to me, it's super disturbing.

[749] Yeah.

[750] Anyway, back to the, back to the grind.

[751] What did, what do you got there that you would like to cover?

[752] Well, so, you know, okay, so we.

[753] We talked just a little bit about all of the elements of the care of the person, right?

[754] So it has to be more than just giving you a shot and sending you on your way.

[755] If you truly have an injury and we're trying to recover you, then what also comes along with that is the appropriate rehab protocol.

[756] And none of those are defined yet for what some of these things that we've done.

[757] But we're trying to develop that and dial it in and hone it down.

[758] For me right now, the easiest thing is to try to adapt it from a surgical rehab.

[759] And I'm not a physical therapist, obviously, so I try to collaborate with those guys and girls that are smarter than me in that avenue.

[760] But the principles are the same, right?

[761] So you have an injury that you're trying to heal.

[762] Now, in some cases, it's, you know, we've created the injury or we've done the thing that the patient has to recover from.

[763] in the case of an injection you have an injury you've done the injection and now we need the effect to happen whatever it is that we're hoping that will be so but then you can't ignore the fact that if somebody has a bad shoulder well we may decrease the pain but if they if their if their motion is poor if their strength is poor if it's not functioning correctly then how can we be achieving the best result if we're not also attending to that Right.

[764] So it's a multi -step.

[765] No doubt.

[766] And then the more that we're learning about all these other factors, I mean, like again, for you, I mean, you're paying attention to your sleep, you're paying attention to your nutrition, you're on, you know, a variety of supplements that are, you know, meant to help a lot of these processes.

[767] And I think we're going to get better and better at it.

[768] Diet has got to be pretty critical as well, right?

[769] It's got to be hugely important.

[770] Especially like staying away from inflammation, enhancing foods or inflammatory foods?

[771] Yeah, no doubt.

[772] So, yeah, I think it's got to be critically important, and we try to share that information with people.

[773] There's, for athletes, like a website that you could pull up and we can share is the College and Professional Athletics Association, I think it is.

[774] College and Professional Athlete.

[775] I was like, what?

[776] college and professional athletes?

[777] I don't even know what that means.

[778] We all have collagen.

[779] College and.

[780] Yeah.

[781] So these guys have some great information and good infographics that we utilize, you know, since I'm not a dietitian.

[782] So I have to rely, again, on people that have good information.

[783] I think these guys have good reliable, they're a good reliable source.

[784] And they've got great infographics.

[785] If you go to educational resources, there you go.

[786] Yeah.

[787] So this will pull up some different things.

[788] Balancing exercise induced information.

[789] Now, here's a good question because it's pretty much universally agreed that rest, ice, compression, elevation, all those different things that people have said in the past, that there is a benefit to particularly icing things.

[790] Yeah, there's some debate about that.

[791] Yeah, right?

[792] There's some debate now.

[793] There's certainly, there's like a definite anti -ice community.

[794] Yeah, what is that?

[795] Out there.

[796] Do you think it's legit?

[797] Well, there can't, there's not a downside to it.

[798] I mean, I don't think so.

[799] I mean, we've used it regularly.

[800] And so, I don't know.

[801] There's definitely a group that, and I don't know all of their arguments against, but.

[802] Misha Tate, the former UFC Bannerway champion, she had a podcast with this guy who's the anti -ice guy.

[803] Yeah.

[804] Like that's his whole thing.

[805] Is it a flat earth?

[806] guy too?

[807] No, but he doesn't believe in dinosaurs.

[808] He does not?

[809] No, I made that up.

[810] Yeah.

[811] It fit.

[812] I don't know.

[813] I mean, so you, I believe he's a doctor, but he, you know, he might be a fucking veterinary works on cat infections or something.

[814] I don't know.

[815] But he, I don't think there's a downside.

[816] I'm kidding about that too.

[817] So in my opinion, you know, I've definitely had athletic injuries.

[818] I was a pitcher previously.

[819] We routinely iced our shoulder and elbow after pitching um i did it as a matter of routine it made it felt good i felt better when i did it right but here's the question it felt good at the time but it is that feeling good in any way slowing the healing process um hard to know i mean that's where it gets weird right yeah i don't know to be frank god damn it you're supposed to know you're the you're the fucking super genius This doctor guy, if you don't know, we're doomed.

[820] Get back to me. So what else?

[821] I'll get you some good information on it.

[822] Thank you.

[823] Appreciate it.

[824] What else you got here?

[825] So, you know, I think one of the interesting things about this whole topic and the possibility of healing from utilizing this type of treatment is how it allows you to.

[826] go through the process of healing without this fibrovascular response.

[827] So the typical healing cascade has an inflammatory phase, proliferative phase, and the maturation phase.

[828] So in the inflammatory phase, you have neutrophils and white blood cells and these enzymes that are present that are trying to start the process.

[829] Then in the proliferative phase, you're having what's called angiogenesis and that means the development of new blood vessels and vasculature to the area and your body's producing fiberblasts and you're laying down tissue in this sort of haphazard manner so it's just kind of piling on in there then the maturation phase is when you have remodeling so those that scar tissue is changing over time and and developing into tissue that's more like or is the native tissue so that occurs over a period of time.

[830] And then a lot of times during that process, before you're fully matured in the healing, you're back to activities.

[831] So let's just take an example, like when you spray in your ankle and then you, you know, you start feeling better and maybe you go back to basketball within a couple weeks.

[832] At that point, if you've actually torn one of the ankle ligaments you don't have native ligament tissue that's the same structural properties it's not as strong i mean you might be developing the strength around it but it's not like the native tissue now the hope is that we can demonstrate now we we know that this is the science this is what it's supposed to do this is what it does in the developing fetus we see it in kids you know how you know when your your daughter was real young she scratched her face the healing wolverine it was like gone like the next day.

[833] So healing without scar is, you know, has to do with not forming this, these fiberblast or fibro vascular response and fibrootic phase.

[834] Mm -hmm.

[835] Now, what the cool potential of this to me is if we can skip that and we can have more complete healing and quicker resolution to the native tissue, then you're going to have those, the same properties you're going to be stronger, you're going to be better, you know, technically and hopefully, you know, clinically this pans out that you would be more resistant and lower risk for repeat injury.

[836] Because that's really our goal is in treating patients is get them back to their activity and decrease the chance that they have to miss more time.

[837] And how do you know how much to inject into these?

[838] Nobody knows.

[839] Oh, Jesus.

[840] Nobody knows that.

[841] This is one of the big questions that will be discovered with, again, you know, rigorous studies where we can look at, you know, what should the dosing be, what should the frequency of the treatment be, and what should these protocols before and after be.

[842] It's not defined.

[843] And anybody that's telling a patient that they have exactly what it should be, I mean, be wary of that.

[844] Because that has not been discovered yet.

[845] So we're trying to, we're trying to take, you know, we're taking the information from our experience and applying it that way it's it's not the it's not the best way to go about this and it it's one of the things that PRP suffered from is that all of the things everybody was using it for so many different things and and just kind of hoping that it was the magic bullet that it was going to treat all the things that we had difficulty treating and even all of the studies that were coming out you know people were using different centrifuges and applying it for different reasons different protocols, is just a mishmash of information.

[846] It wasn't valuable.

[847] How does a platelet which plasma work?

[848] So it has growth factors and cytokines, and the platelets release proteins and things, and those things help mediate that inflammatory response and help the healing process.

[849] I mean, that's kind of the basics.

[850] Do you think that they could work in a symbiotic fashion with, like, this kind of?

[851] There's information that adding PRP to, some cellular treatment like bone marrow fat or the placental tissue in that line of treatment can help expand the cells.

[852] So that gets us to an important point, which is expanding the cells has been done and is not currently legal in the United States.

[853] So there was a place, and they do it in other countries, but here, if you more than men, I'm is a mouthful.

[854] If you more than minimally manipulate the tissue, then that is not under the guidelines of the FDA for use of human cellular tissue products.

[855] So they were taking, for example, bone marrow and plating it and growing more cells, bringing the patients back two weeks later and injecting them with this superproduction of cells, which probably is great.

[856] But we don't know.

[857] We don't know if that's safe.

[858] And that has to be, you know, that has to be taken through the appropriate process.

[859] So you can't necessarily recommend someone taking PRP while they're taking some sort of a stem cell injections.

[860] So here's the difference of that.

[861] Okay.

[862] A manufacturer can't say that we have a product that is a combined PRP stem cell injection.

[863] Right.

[864] And it does this.

[865] Right.

[866] That's illegal.

[867] But if you are a patient, I can't put on my website.

[868] Right.

[869] I have the magic potion.

[870] It's PRP and amniotic fluid and tissue.

[871] We inject it, and it can heal anything.

[872] I admire how responsible you are, how you keep cutting me off whenever I was suggesting some ridiculous things.

[873] But would there be a benefit for a patient, potential benefit, who is getting stem cell injections and also gets PRP at the same time?

[874] Or is it just theoretical?

[875] It's theoretical right now, yeah.

[876] But potentially.

[877] Definitely, there's potential and it's encouraging to, you know, that the possibility is there.

[878] It appears to be safe.

[879] There, you know, we don't have adverse reactions to it.

[880] And so, and the point that I wanted to make is that a physician can prescribe something and use it off label.

[881] Right.

[882] Right.

[883] So the FDA doesn't regulate the practice of medicine.

[884] I can do that in my office, but I can't make claims about it.

[885] And I can't put it on social media and on my website and say, if I'm going to do this and I'm going to fix your shoulder.

[886] Like, come here if you have a meniscus tear, because we do this injection and it's going to make you better.

[887] That's illegal.

[888] I understand.

[889] So, but if somebody comes to my office, you know, I can elect to do that because both things are available.

[890] They have, we have permission, you know, to use them, but we're using it off label.

[891] I understand.

[892] So, when you say maximize cells, that's the term used?

[893] Maybe.

[894] What is it, the term used about PRP in conjunction?

[895] We think that it can increase the proliferation of the mezzanimal stem cell.

[896] Oh, and how much of a time period would it have to be between the injection and the PRP?

[897] That's undefined again.

[898] So what would you assume?

[899] The way that we're doing is we would do the injection at the same time.

[900] Oh, I see.

[901] Yeah, putting it in there together.

[902] So we only have a narrow window from when we take those frozen cells and then we thaw them, you know, we have a short window when we can then inject them.

[903] Mm -hmm.

[904] And then there's, you know, maybe between seven and 21 days that those cells are viable in your shoulder or your knee wherever we inject it.

[905] So if someone gets that injection and does PRP, they would have to essentially get that done within those seven to 21 days to have some sort of a benefit of what you're saying.

[906] theoretically yes that yeah that that that's uh that's how i would do it currently uh based on that information it's fascinating stuff yeah what else got there well so um we just i thought it was important to talk about the it's called section 361 of the public health service act and this is the definition from the FDA on the use of human cell tissue and cellular tissue products so it has to match these criteria so you have to have minimal manipulation that means you can't add things to it you can't combine it with other stuff you can't um like i was saying you can't you know put it in the lab and grow it and add things to it and then bring the patient back and treat them how this isn't part of the part of it but we you can't treat patients on a on a different day it has to be at the same time whenever you're harvesting the cells or utilizing whatever it is you're using um it has has to be something called homologous use and what that means is whatever tissue you're taking has to have the intention of the purpose of that tissue for when you put it into somebody's body so for example uh if i have uh if you have a fracture that's not healing and i take a bone graft product so cadaver bone and we're going to use that to help heal your fracture that hasn't healed that is that's homologous use we have we're taking bone we're using it to become bone or to be the scaffold for bone to heal and grow so um it can't be combined with something else and it can't have it can't be intended to have a systemic effect so now all of these things that I'm explaining these are rules for manufacturers and what they can what the rules are for them to be able to market their product so for example you can't take amniotic fluid and say this is a product meant for IV infusion for treatment of whatever diabetes right that is something that people do in other countries right they're doing in other countries you can't do that in you technically can't do that you can't manufacture a product and put that on the labeling that's what it's intended for but do they do that in America IV stem cells I've been told by patients that they've gone to places that have suggested to them that that was going to be the treatment.

[907] Right.

[908] And what is going on there?

[909] I'm not aware of it.

[910] How does that even work?

[911] Do you know?

[912] It's not your wheelhouse?

[913] No, and nobody knows if it does.

[914] So it's just experimental?

[915] It is.

[916] I mean, all of this.

[917] Do you know what Boss Routon is?

[918] Former UFC champion.

[919] Do you ever treat him?

[920] I have not.

[921] Are you allowed to say that?

[922] I don't think I can say, talk about any patient that unless they tell you.

[923] They have said it or they're sitting in front of me talking about it.

[924] Okay.

[925] I give you permission.

[926] It's the, it's HIPAA violation.

[927] I understand.

[928] I just want to say, for the record, I give you permission.

[929] Um, Boss Rutan went to, where did you say to go?

[930] To Peru or something like that?

[931] Went to the jungle.

[932] Some dude killed the chicken and then shot some stem cells into him.

[933] Chicken blood, right?

[934] He's, he was saying it was fucking amazing.

[935] You know, you ever heard of the way boss talks.

[936] He's like, it's like the energy was coming out of my body.

[937] Like, ah!

[938] He said that he literally felt like some guy in a Kung Fu movie where energy was, like, shooting off his fingertips.

[939] He said it was amazing.

[940] Like the emperor?

[941] He's not the only guy that said that.

[942] You know, Dan Bolzarian?

[943] Do you know what Dan Bolzarian is?

[944] The Instagram guy with all the boobs and the butts.

[945] He told me the same thing.

[946] He said that when he got it done, he said, it's amazing.

[947] He goes to Mexico to get it done.

[948] Not recommended, but he can't talk about it.

[949] Off air, he'll be a little chatter.

[950] Just you wait Maybe Well, what I'm interested in What I was thinking Before you threw me off there Is he going with a specific intent Of treating something Or is he just like looking for the fountain of youth I think he fucks so much He doesn't have any sperm in his body And he's trying to kicks I don't know That guy's an animal But I think I think he's got a series of injuries, I know that, because he's had regenerine for his neck.

[951] He put it up on Instagram, like with Instagram stories.

[952] He was videoing himself while I was getting injections in his neck, which I've had regenerine injections, yes, it cured my cervical disc bulge.

[953] What?

[954] Yeah, yeah, that and disc decompression, spinal decompression, you know, with like a harness where they're pulling on your neck.

[955] I had a bulging disc in my neck that was pushing.

[956] on my nerves.

[957] Yeah, completely resolved.

[958] Like on an MRI, it doesn't exist anymore, where I was getting numb hands because the ulnar nerve was being pressed upon.

[959] Yeah, it works.

[960] That's nuts.

[961] Well, it's massive anti -inflammation properties.

[962] I just don't think that it has the same healing potential.

[963] It seems like it reduces inflammation in a giant way.

[964] What's going on with, by the way, I had regenerine shot in my knee, too.

[965] That's what you told me. It didn't really have the same effect.

[966] It worked a little bit.

[967] So patients like yourself that have had a number of injuries and a number of treatments.

[968] One of the things that's got me enthusiastic about the potential of all this is when somebody tells me, look, I've had this, this, this, this, and this.

[969] And then I had this, what we're talking about, and that it was just completely different.

[970] Game changing.

[971] I'm just better and different.

[972] Look, my right shoulder is not 100%, but it might be 90%.

[973] you know and it's strong as fuck like I could do a lot of shit with it like it doesn't you do some insane stuff yeah yeah and it doesn't bother things that I probably wouldn't recommend but no pain like um I take these 90 pound kettlebells and I do windmills with them where you you know you're pressing overhead you know what a windmill is I do yeah dropping down like that so your shoulder's rotating I don't do that with 90 pounds but I know what it is but the fact that I can do that with a shoulder that was on its way probably to getting surgery on is just amazing my bow probably the most impressive thing was that push -up with the wheel thing what's that thing called oh the ab wheel no it's like a little roller that you had your hand on oh yeah those things when you go forward yeah what's that called the comfortable havoc creates it there's sliders havoc sliders okay I mean that was like YK sliders there's a video of it on there's a video on my Instagram Jamie from quite a while ago but it was post excuse me uh injection um it's from way back i want to say at least a year ago i was doing that but um yeah there's my range of motions 100 percent i mean at the most it's uncomfortable in certain things but for a big one for me was archery because um you know i really enjoy it i do it all the time and it's it's very meditative to me i just i love archery So for me, like the idea of not being able to pull my bow back, it was really disturbing.

[974] I was like, God, I'm going to have to get the surgery done.

[975] Yeah, you've been pretty committed to it for a while now.

[976] Yeah, and I'll shoot 100 plus arrows a day, and I'm pulling back 84 pounds.

[977] It's an 84 -pound compound bow, and I'm shooting it 100 times a day, and it's no pain.

[978] I did it yesterday, like for hours, me and my friend Cam Haynes, who, you know, you met, who came to and talked to you as well.

[979] um you kind of indirectly got me uh into it i don't know into archery through john john dudley yeah yeah i know you're shooting all the time now right yeah so john got me this unbelievable you know hoight uh carbon spider bow it's like uh if you want to if you want to see uh any of my friends like make the greatest faces you've ever seen i just i pull this thing out and it's like you know some Space Age weapon.

[980] It looks like a bow that Batman would have.

[981] Or Chubaca.

[982] Or Chubaga.

[983] Something like that.

[984] Yeah.

[985] I would say Batman, but yeah.

[986] But yeah, it's, um, those bows are, they're amazing.

[987] It's incredible.

[988] And it's, uh, I've only been able to go a couple of times, but I'm definitely hooked.

[989] It's the most amazing meditation.

[990] I love it.

[991] It's because it's, when you're focusing on that shot, you literally have no room for anything else.

[992] It's, it requires so much concentration.

[993] you're concentrating on the front hand position, front shoulder position, where the string touches the tip of your nose, the corner of your mouth, and John is just an amazing coach.

[994] Yeah, so, you know, totally unfair.

[995] I get, that's the bow, the first bow that I get to shoot with, and then John gives me the first lesson that I've ever pulled a bow back.

[996] He's standing there right with me. He's an Olympic coach, by the way.

[997] He used to coach the Olympic team.

[998] He's amazing.

[999] Yeah.

[1000] I mean, he, that guy can take, he's a great guy too, and he can take years off of people's learning.

[1001] I mean, he's, he's absolutely taking years off my learning curve.

[1002] Yeah.

[1003] I'm going to sneeze.

[1004] I hate when you say you're going to sneeze and then you put a lot of pressure on yourself.

[1005] And you're like, man, I might not.

[1006] I'll just look like a weirdo for a few minutes.

[1007] Did you find that video?

[1008] No, it's in there.

[1009] I swear to God.

[1010] So here's another kind of crazy thing about the placental derived.

[1011] treatments is that they actually have anti -microbial properties.

[1012] Whoa.

[1013] So this is crazy.

[1014] I mean, we kind of know this, you know, one of the functions of the amniotic membrane is to protect the developing baby, right?

[1015] But, and one of the things it does protect it from infection.

[1016] But what they were able to demonstrate was that when they've actually introduced bacteria, like literally injected bacteria onto these membranes, and then they come back and check, and it has destroyed the bacteria.

[1017] So ability to resist scar formation, move through the fibotic phase of healing, and then also the antimicrobial properties.

[1018] So that would be super beneficial post -surgery, right?

[1019] Because that's a giant issue, staff infections and the like.

[1020] It's one of the things that, you know, frightens us most about, you know, doing our procedures is, you know, can we prevent infection?

[1021] Yeah, it's a giant issue where people, I mean, I know because of the nature of martial arts, it just everybody I know is that surgery, like, pretty much.

[1022] And the big issue is post -surgery infections.

[1023] Yeah.

[1024] Well, those guys are, they're getting abrasions and everything like that on the mat.

[1025] And then, so then they're colonized with, you know, MRSA or any number of, whatever funk is in that gym.

[1026] I tell everybody, if you are a grappler, this is super important, I want you to look up defense soap.

[1027] Defense soap is a soap company that was created by my friend Guy Sacco.

[1028] And it is all natural soap that promotes healthy bacteria, doesn't destroy the healthy bacteria, but it's all tea tree oil, eucalyptus oil.

[1029] this shit is amazing and I used to get I've gotten staff at least twice I used to get ringworm all the time well not all the time but I got a couple of times and until I was like super diligent about washing myself like immediately afterwards but once I started using two things probiotics which is huge acidophilus eating yogurt and drinking kombucha and then the next one was there enough in the yogurt soap probably not but it's it's a little bit a Something.

[1030] It's a little bit of something.

[1031] I just think it's good to have probiotics.

[1032] I like kimchi.

[1033] I try to take my probiotics in multiple forms.

[1034] This stuff that I was drinking when you got here, kombucha, I love this stuff.

[1035] I drink it all the time.

[1036] Is there a particular flavor that you like?

[1037] Well, you got to be careful because I'm a low sugar guy.

[1038] So like the grapes, there's some of them that are delicious, but they have a lot of sugar in it.

[1039] This multi greens does not have a lot of sugar in.

[1040] Let me see what it's got.

[1041] I think it's something like 10 grams.

[1042] grams per serving or something like that really that sounds high i think i've seen them lower oh two yeah that's not two grams so yeah that's what you want the grapes high grape is but the um tastes wonderful right it does taste yummy that's the problem this does not taste so good but you know you're getting something good in it and this is the important stuff is that you get the strong kombucha this is the brand that i really like i don't work for them they're not a sponsor gt's kombucha GTS, this stuff is awesome, but you have to be over 21 because it has more than one half of 1 % alcohol by volume because of the fermentation process because it's so strong.

[1043] I see.

[1044] So they make you show your ID.

[1045] They actually pulled it from Whole Foods.

[1046] I don't know if you know this.

[1047] See, I thought that's where I've seen it.

[1048] Yeah, they have it back, but they pulled it from Whole Foods till Whole Foods had to like put some regulations in place to keep.

[1049] You would literally, if you were eight years old, you could drink one and not get drunk.

[1050] I mean, it's not like, it's not like you're going to get drunk off of it, but just due to regulations you have to letter to the law kind of thing.

[1051] Exactly.

[1052] What else you got?

[1053] Got a lot of papers there, buddy.

[1054] Yeah.

[1055] Got drawings and shit.

[1056] Charts and graphs.

[1057] Stuff to think about.

[1058] Probably a bunch of stuff you say, don't let Joe talk about this.

[1059] Don't.

[1060] What other questions have you come up with along the way?

[1061] One big question I'm one.

[1062] wanted to talk to you about was something that I had a discussion with Dr. Davidson about recently and Jeff was telling me that the most recent procedure with stem cells is injecting them directly into the discs for people that have degenerative disc disease and that there's some really promising results.

[1063] I've heard anecdotally of a number of very positive outcomes with treatment like that.

[1064] That's amazing.

[1065] Again, you know.

[1066] Too early.

[1067] So a lot is...

[1068] I love the fact that you're very conservative about this.

[1069] I really, really, really do appreciate that.

[1070] Although I'm giving you a hard time.

[1071] I've really wrestled with it because, you know, again, our whole training is based on, you know, we need to do things that have an evidence base for our patients.

[1072] I mean, this is kind of the foundation of what we do.

[1073] and so but we're in a unique situation so we have patients that um one this stuff is available and it's legal to do and it's there and people know about it now so they they're seeking the information they come to us right and even you know even before we started talking about it you know it started to be like here and there and then all of a sudden it's like two three patients a day now even more are saying what about what about stem cell should can I have stem cell and And like, okay, well, you know, then we have to back up and, like, have the whole discussion.

[1074] Like, okay, well, let's talk about what that is and what maybe it can do.

[1075] And so people are seeking the treatment.

[1076] It's available, but we don't know.

[1077] We don't have a lot of information.

[1078] So we just have to be forthcoming and say, look, this is experimental.

[1079] We've had encouraging early results.

[1080] I can tell you anecdotal stuff.

[1081] We've even seen images where somebody had, you know, full thickness rotator cuff tear.

[1082] eight months later what looked like a healed rotator cuff on an MRI now did that happen on its own well we know that that happens at a lower percentage but it is possible to heal it's just a lower percentage um did it happen because of the treatment you know that hasn't been established so i have to really explain all that and the other category too that uh patients will come and they'll explain an injury and and i've had to turn away a lot of people that were they were fully ready to come in and have treatment and they were fine with paying out of pocket because, of course, it's not covered by insurance because it's experimental, because there's, you know, no data yet.

[1083] And that's not true.

[1084] There's not no data, but there's not enough data to support treatment for, you know, certain conditions.

[1085] But, you know, I've had to tell people, I don't think this is appropriate even to try, even if you want this.

[1086] and usually the category is if it's something mechanical so I think this makes intuitive sense to people so for example had you come to me and you said hey you know I dislocated my shoulder seven times and can you just put an injection in there well the problem with that is that the in that case in this example the ligaments of the shoulder have been stretched and disrupted and in the case of a dislocation.

[1087] There's oftentimes a laboral tear that comes with that.

[1088] Now, I don't believe, and I could be proven wrong over time, but I just don't believe that an injection on its own would magically decrease the volume of the capsule, you know, tighten the static structures in the shoulder, and resolve the pain for that patient.

[1089] Now, let me stop.

[1090] Can I pause you right there while I I still have this in my head?

[1091] Sure.

[1092] I believe there was something that came up a few years ago where they were doing something where they were heating up the inside of the capsule and shrinking.

[1093] Thermal capsulorophy.

[1094] What is that?

[1095] It was very popular.

[1096] Was?

[1097] You said it was.

[1098] Yeah.

[1099] Now it's close to malpractice.

[1100] Oh, Jesus.

[1101] Yeah.

[1102] So it's interesting the way these things go.

[1103] So there was a huge wave of interest in this.

[1104] And essentially what guys would do is they're looking inside the shoulder.

[1105] You have a radio frequency wand, and you're using that to heat the tissue.

[1106] And you can watch it literally shrink in front of you.

[1107] And then Richard Hawkins is a very accomplished orthopedic surgeon, kind of iconic guy that's done tons of research.

[1108] He was also when in Vale, Colorado, now in Carolina.

[1109] And he published a paper that showed a very high rate of failure from these procedures.

[1110] And so as a result of that, it's fallen out of favor.

[1111] But it was done very frequently on lots and lots of shoulders.

[1112] Now, high rate of failure.

[1113] It was like 40%.

[1114] Okay, but here's the question.

[1115] Is that because you're talking about already compromised joints, right?

[1116] Which is a very complicated joint.

[1117] Shoulders a very complicated joint.

[1118] There's certainly a number of reasons why that could have failed, but there was a lot of problems with basically damage to the tissue from the radio frequency.

[1119] Oh, so it was weakening things.

[1120] Yeah.

[1121] I see.

[1122] Yeah, so that went away.

[1123] What was the benefit of it?

[1124] Well, you could watch it and you were seeing the decrease.

[1125] in the volume of the capsule.

[1126] So where structures had become loose, you were seeing it become tight at the time zero period.

[1127] What about doing that in conjunction with some sort of a stem cell therapy?

[1128] Does that make sense?

[1129] Yeah.

[1130] I should be a doctor, right?

[1131] You're very close.

[1132] You're only...

[1133] Ten years in school?

[1134] You're only 14 years away.

[1135] 14?

[1136] Yeah, that's all.

[1137] 14 for regular people.

[1138] Give me 20.

[1139] So why did they think that it would work in the first place?

[1140] Like what was the idea behind it?

[1141] There's early published papers that were saying that the outcomes were better if you used it.

[1142] Wow.

[1143] So it's murky.

[1144] I mean, there's things that over time we discover that what we thought we were looking at, you know, we didn't fully understand.

[1145] And how long did it take before it became malpractice or problematic?

[1146] That's an exaggerated term.

[1147] Problematic.

[1148] I don't know the exact year that his.

[1149] paper was published but it was um it was before my residency training i started i graduated medical school in 2006 so it was before that that people weren't doing that anymore okay so i'll bring you back around so when someone has had like if you talked to some dude to played football or something had multiple shoulder dislocations like what would you do to you would encourage surgery um so the you know the typical um course for recurrent instability, the shoulder would be a stabilization procedure.

[1150] Now, a lot of that's based on the exam and what you see on imaging.

[1151] Some people can do well with a simple shoulder arthroscopy, and then you pass a couple stitches.

[1152] You repair the labrum.

[1153] You can tighten the capsule at the same time.

[1154] And young patients progress really well through that.

[1155] When there is, you know, more complicated problems such as the, There's bone loss on the front of the socket.

[1156] So when you have a dislocation, the head goes forward.

[1157] It goes out the front.

[1158] That's the typical and anterior shoulder dislocation is the usual one.

[1159] And then as it tries to come back into place, the head bangs into the glenoid or the socket.

[1160] So you can, you'll tear the front of the labrum, you'll stretch the front of the capsule, but then you can also get a dent in the back of the humeral head.

[1161] So what is the correct procedure?

[1162] I mean, I keep throwing you off track, but when someone does have a shoulder dislocation, what are you supposed to do?

[1163] You're supposed to pull on it or just take them to the hospital?

[1164] There's probably no harm in doing that.

[1165] There's a great technique called the Zahiri technique.

[1166] Spell it?

[1167] Z -A -H -I -R -I.

[1168] And that's just the name of the guy that wrote the paper.

[1169] But it's essentially, it would be a really easy thing for you learn because it's kind of a leverage thing.

[1170] Like jih -jitsu?

[1171] Yeah.

[1172] Yeah.

[1173] So it's a way to leverage the arm so that you can get the muscles to relax.

[1174] It's easy on the person, and you can actually do it awake and, like, at the field.

[1175] So I actually did it on a professional steer wrestler at the rodeo.

[1176] How hilarious is it that you can be a professional steer wrestler?

[1177] Like, well, I was amateur for a few years, but.

[1178] Yeah.

[1179] You know, they're pretty serious about stuff.

[1180] Super serious.

[1181] You were talking about your bucket handle meniscus.

[1182] The first rodeo cowboy that I took care of had a flipped bucket handle meniscus tear.

[1183] And he came in the day that the national finals rodeo was starting.

[1184] And he was also a steer wrestler, by the way, and had been a previous, I think he was a champ.

[1185] He won a bunch, that's for sure.

[1186] So they basically, they taped his knee.

[1187] You got to come closer.

[1188] They taped his knee in about three.

[1189] 30 degrees of flexion, and he competed the whole nine days.

[1190] Whoa.

[1191] Just roped up knee.

[1192] Just taped it up, got on his horse, and was jumping off, and throwing 600 -pound steers on the ground.

[1193] Jesus Christ.

[1194] Yeah.

[1195] Those guys are crazy.

[1196] I watch that stuff on TV.

[1197] I've never even been to one live because I'm terrified.

[1198] You need to come to it.

[1199] I don't.

[1200] We did an episode of Fear Factor.

[1201] We made people ride bulls.

[1202] Made them ride it.

[1203] That's terrifying.

[1204] You can die.

[1205] I mean, that's not.

[1206] die no matter what you're dealing with a goddamn steer that's what I'm saying that's what I'm saying you can die getting on top of one of those steer is not a bull right steer has been gilded right we had bulls no no no no steer wrestling is different right steer wrestling is the they grab them they take off yeah you rope them the steer and the guy and the horse take off at the same time you jump off you grab it you grab by the horns and turn its neck and throw it on the ground and then they wrap the yeah see with steer is a bull that doesn't have any balls right yeah that bull's not They're also younger than the ones that...

[1207] They chop their balls off before they got a chance to mature.

[1208] That's why when they...

[1209] The bulls are terrifying.

[1210] So I've been right down next to the bucking chute, and it's, like, frightening.

[1211] I actually had a claw to dirt get...

[1212] One of them kicked it up, and it hit me in the head, like a baseball.

[1213] I mean...

[1214] Yeah.

[1215] It was brutal.

[1216] See, they're little babies, and they have no balls.

[1217] So this guy jumps off.

[1218] What a dumb...

[1219] And you turn the head.

[1220] That is so whack.

[1221] What a stupid fucking thing to be excited about.

[1222] I did it I wrestled that thing I was trying to get away grabbing by his natural handles and I tuck them down look how quick look at their move it's like a dars choke and the cow's like what in the fuck man why is this even happening look the cow's like what is going on I gotta get out of here look how they always do it the same way too it's similar to like a chokehold oh what a dumb fucking thing to be excited about they grab the neck flip it on their back it's outside of your world But I'll tell you that these are some of the nicest guys I've ever met in my life, honestly.

[1223] And they're some of the toughest athletes in the world.

[1224] Oh, yeah, I would imagine.

[1225] Those guys are tough as hell.

[1226] You have to be.

[1227] We had a dude on Fear Factor.

[1228] They compete through every injury.

[1229] There is no injury that they don't, that they won't compete.

[1230] You have to.

[1231] You're always broken up.

[1232] I mean, you have to.

[1233] We had a dude on Fear Factor that had nine.

[1234] And also, you know, they don't make money if they're not competing.

[1235] Right.

[1236] We had a dude on Fear Factor was a rodeo champion, rather.

[1237] He had nine shoulder surgeries.

[1238] his shoulder was just like sliced all open.

[1239] And I don't know how often is it dislocated?

[1240] He goes, pff, get any time.

[1241] Like I could open up a car door, it'll pop out of socket.

[1242] I'm like, yikes.

[1243] Yeah, that's bad.

[1244] Yeah.

[1245] So back around to where we're at.

[1246] What do you do?

[1247] How does this Zahir technique, can you describe it?

[1248] Did I say it right?

[1249] Zahiri.

[1250] Zahiri, yeah.

[1251] So one of the guys that we trained with in our, my sports medicine program in Alabama showed us this.

[1252] And it was like one of the first things that we reviewed at the beginning of the year.

[1253] And so basically you have the person lying flat on their back and I would hold your wrist.

[1254] And then I loop my arm under your arm and then grab onto mine for leverage.

[1255] And then I literally just sort of lean back.

[1256] And I'm using the muscles in my back.

[1257] So I'm not pulling with my arms.

[1258] So a small person can do this on my arm.

[1259] a very big athlete and you're fine because you're you're using all of the strongest muscles in your body right so you literally just lean back and you hold traction in that position so you've got the arm is positioned like this you got to describe to people that are listening uh the arm is in front of the person uh while they're lying lying on their back and again i have my right hand on your right wrist if it's a right shoulder dislocation well let's just see a video you got a video of it that's It's really hard to find him, but I'm going to hopefully guess that this is maybe it.

[1260] Hopefully.

[1261] Oh, okay.

[1262] Let me explain to people at home.

[1263] What this is like is if you were trying to give someone an arm bar, you get a hook on the left side.

[1264] And so the hook is your left.

[1265] If you were trying to arm bar someone on their right arm and you were inside control, you would hook it with your left arm.

[1266] And then you would trap it in place.

[1267] And what a person does when they don't want to get armed barred, their defense is this.

[1268] They grab their hands together.

[1269] And so you loop your arm.

[1270] in that and pull it back like that so that would be real similar to what you're doing you're using the left arm you're connecting it like this and then you're you're actually just using traction yeah so the the treater in this case on the right side he's just going to lean back and hold and you just wait and in about 10 seconds it pops in place the the deltoid and the peck and the biceps relax and it just slides in oh that's interesting you can actually do that and And, I mean, the kinder way to do this is, you know, with some anesthesia.

[1271] Right.

[1272] But a lot of times you can do that, and they're perfectly comfortable.

[1273] Huh.

[1274] And they're immediately better when the shoulder's back in.

[1275] Wow.

[1276] Well, they're not completely better, but the pain's relieved from the initial event.

[1277] Now, you told me when you looked at my MRI that you think that my shoulder was dislocated at some point in time.

[1278] I don't remember exactly your MRI.

[1279] But if you had a tear of the front of the labrum, and you had that, any evidence of that little dent in the back of the humoral head, then that would be consistent with that injury.

[1280] I just do not remember ever having a dislocated shoulder, but I've had a been comorid a bunch of times.

[1281] I bet you've had it slip a little bit.

[1282] Well, when you...

[1283] Just the nature of your shoulder -locked, you know, there's been many Americana's in my past and Camoras and all these different, like, hardcore.

[1284] You know, the thing is...

[1285] You were on the receiving end?

[1286] Yeah, yeah, yeah.

[1287] Before this injury, I never did.

[1288] Americana, you could definitely have at least a subluxation of the shoulder, for sure.

[1289] Yeah, I'm sure.

[1290] And you fight it off, too, because you don't want it to happen, so you're resisting.

[1291] Before this injury, I didn't do any shoulder exercises.

[1292] I just worked out, but I didn't do any specific exercises just to strengthen my shoulders.

[1293] I think that was a big mistake.

[1294] And I kind of emphasize that with people, like doing external and internal rotation exercises, is doing like I'm a big fan now of inverted kettlebell presses and yeah that's been one of my giant right favorite lately too definitely a challenge you don't need much weight and uh yeah this little 40 pound iron man kettlebell I use this one it's amazing yeah that's a lot of weight for that exercise that's pretty good well it's just uh they say you should be able to do 50 % of your max weight or is that 50 % or 90 % I forget what they say Forget me. Don't listen to me. Well, it depends on...

[1295] I think I said 90.

[1296] Yeah.

[1297] Obviously, in the injured patient or the person that's recovering, they're going to be starting with much lower loads.

[1298] Much lower.

[1299] And all the focus is on the motion, your posture, engaging your core, keeping your ribs down, and having the full motion.

[1300] The strong first protocol, I think what they're trying to say is in order to have really powerful shoulders, you should be able to do 90 % of your max kettlebell press like say if you can max kettle press 90 pounds now that's with the with the handle down down right okay yeah all right with max that would be your max like what you would one rep max yes or you know what you would pretty much you maybe you could do two or three if you really had to but you know you're talking about a lot of weight yeah um you know what you would normally like max out Like, there's a protocol that this guy, Pavel Tatsulin, follows.

[1301] That's really kind of interesting, you know, Pavel, right?

[1302] Well, he's the kettlebell guy, right?

[1303] He's the guy that brought him, they call him the godfather of kettlebells in America.

[1304] The guy that I train with talks about that all the time.

[1305] Yeah.

[1306] The idea behind it is don't do your, like, if you could do 10 reps, you do five.

[1307] And you wait a long time, and then you do another five.

[1308] And you wait a long time, then you do another five.

[1309] And you never work to failure.

[1310] and that working to failure is actually not healthy.

[1311] It's not smart and you don't really get stronger that way.

[1312] My recommendation is that for, and this is coming from, this isn't from the orthopedic surgery world, this is what I've read from strength and conditioning people.

[1313] The thing you want to avoid in doing something to failure is with load and a skill activity.

[1314] Right.

[1315] So, for example, like a clean or, you know, a snatch or something like that.

[1316] involve coordination and where you have to time everything.

[1317] If it requires, you know, sound mechanics and you're doing it with load, it's bad to do that to failure because what happens as you fatigue is your mechanics are going to break down.

[1318] And that's where you're going to get hurt.

[1319] Well, what Pavel talks about is that strength is a skill and that all these different things, think of them as a skill and then don't do things to failure.

[1320] And if you're looking for, you know, endurance or something along those lines, you want to do life.

[1321] lightweights and you do want to do multiple repetitions.

[1322] It's not what you're doing when you're trying to get stronger.

[1323] No. Yeah.

[1324] So it's this, but there's, you know, a lot of different arguments one way or another.

[1325] I mean, talk to power lifters and they're like, that guy's a pussy.

[1326] You got to do it to failure.

[1327] Yeah.

[1328] I don't know.

[1329] Talk to the CrossFit people.

[1330] They want to do 100 reps, you know.

[1331] Yeah.

[1332] So, no, there are activities that you can train to failure and there's no risk.

[1333] So, for example, like, like pull -ups.

[1334] I mean, when you fail, you just, you just can't.

[1335] can't get up, right?

[1336] Like you're just going to come off the bar.

[1337] Right.

[1338] The battle ropes, you're just going to fatigue out.

[1339] Like there is, you're not going to hurt yourself.

[1340] Right, but they even believe that when you're doing chin -ups, like if you're doing pull -ups or chin -ups, that when you're doing it, you shouldn't go to failure.

[1341] You should just stop like close to it or halfway there and then take a long time off and then do another five reps. Like say if your your max is 10 reps, get to five, stop, take a break, do another five.

[1342] stop take another five 10 minutes do another five keep going and just you're you're working on form and your muscles are performing these actions in a very clean smooth delivery and that this is the best way to recover or to build strength and that you just do it more often don't do it to failure once a week and then be a wreck for like three or four days afterwards because you know that feeling when you when you lift weights and you lift weights for a week or you lift weights and you You lift weights to failure, rather, and you're sore for so long.

[1343] You can't get anything done.

[1344] This idea is you do more frequent workouts and you don't go to failure.

[1345] And that don't go over five reps. I think one of the biggest mistakes that we see and reasons that people show up in my office is because of overload and, you know, no time for recovery from the training that you're doing.

[1346] So you don't see people periodizing and incorporating the times when they're just allowing rest.

[1347] I mean, you can't be working at max capacity all the time.

[1348] Right, exactly.

[1349] So it's a big thing with fighters, huge.

[1350] Keeping them from working hard is so hard to do.

[1351] Yeah, so I always, I try to emphasize with, and we have to really talk about this with our ACL rehab, because that's a group that, you know, they're so eager to get back, you know, if they're a competitive of athlete that, you know, you've got to remind them that, look, we have steps to go through and I always say you've got to work smart, not hard.

[1352] Like, you know, we have a plan, and there's a reason why this week may not be a whole lot of work.

[1353] And your body needs rest and recovery in order to put stress on it again so that we can continue to make your progress.

[1354] Otherwise, at some point, you're either going to plateau, you're not going to be making changes, you're going to get frustrated, or you're just going to get hurt.

[1355] Right.

[1356] All right, we've got to bring this home.

[1357] So anything else we need to, uh, cover on this?

[1358] I don't think so.

[1359] I think we got to talk about quite a bit.

[1360] Yeah, we really did.

[1361] Thank you very much for doing this.

[1362] I really appreciate it because this is, we've always had these really cool conversations when I visited you in your office, and I'm really glad we got a chance to do this.

[1363] Now, if people want to get a hold of you and they want to seek treatment, please give them necessary information.

[1364] Oh, sure.

[1365] So our website is www .totototototottsportsmedicin .com.

[1366] I like how people still say www.

[1367] Yeah, you probably still get there, right?

[1368] Yeah, you can just, total sportsmedicine.

[1369] And then we have information on there in terms of how to contact us.

[1370] And we'd be happy to get additional information to patients if they have questions.

[1371] Awesome.

[1372] Well, again, thanks for everything you've done for me. It's been a lifesaver.

[1373] And I've had a massive benefit.

[1374] Allow me to come down.

[1375] My pleasure, brother.

[1376] Thank you.

[1377] Dr. Rodney McGee, ladies and gentlemen, and that's it for this week.

[1378] We'll see you next week.

[1379] Bye -bye.