February 4, 2023 • 40 mins
As we get excited about all the possibilities and new shows for 2023, we look back at some of our favorite topics and conversations of 2022.
In 2022, we talked about several hot topics including the future of cartilage, meniscus, and ACL surgeries. We discussed internal bracing, fantastic tech wearables, and what it takes to make it to the next level. We thought a fun show looking back at some of our top segments would allow our listeners to hear some of the highlights they may have missed or some they may want to hear again.
In response to some of these segments, we have had a few updates including the introduction of one of the first cartilage stimulation products with Cartiheal Agili-C Implant (tag) which may be the future of cartilage transplants. Also, ACL repair (tag) has taken off including the tightrope and internal brace combination that has been impressing Dr. Garcia and his patients on their speedy recovery as we enter 2023. Finally, wearable technology was taken one step further at the World Cup in which high-tech soccer balls and player tracking apps were used to provide the best experience yet and allowed a fairer and safer tournament. (Read: https://www.jumpstartmag.com/4-cutting-edge-technologies-used-in-fifa-world-cup-qatar-22/)
Thank you to all our listeners. We hope you enjoy this 2022 recap podcast, and we look forward to bringing you new and exciting shows in 2023.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:01):
Thank you everyone, for listening to our podcast.
Once again, I'm with orthopedic surgeon and Sports Medicine
specialist dr. Grant Garcia, please check them
out. A grant Garcia, am d.com dr.
Garcia unbelievable. We are end of another year with
great information. This past year, just give us a
quick recap and your thoughts onthe year that was.
(00:24):
And as we wrap up 2022 and get really excited about 20-23.
Well, you know, No, you will hear about this in the summarize
podcast at the end of this. But you know it's been a great
year. We've talked about anything from
wearable technology to what it takes to be at the next level to
behind the scenes of sports medicine, surgery to behind the
(00:46):
scenes of being in the sports field and professional athletes
anywhere from ACL meniscus, cartilage surgeries and
Innovations. We have there to shoulder and
elbow injuries. So it's been a wonderful year.
Hear about all the updates and the advances in the World of
Sports Medicine, orthopedic and have a lot of fun too.
(01:06):
Because we talked a lot about a lot of great events, you know,
anywhere from the Super Bowl to just recent World Cup to the
Kraken. It's been, it's been a really
great run and I'm looking forward to the updates and the
new things we're going to do next year.
If there's something that standsout for you, from this show, go
back. Listen to our other shows for
(01:26):
the entire show. When we talked about ACLs, And
Robotics and virtual reality andwearable technology, and what it
takes, and all of these different things that we
discuss. And, you know, one of my
favorite was internal bracing. You know, I was just, you know,
just super fascinated by that whole conversation.
We just something in particular that really stood out for you.
(01:48):
Like, man, I can't wait to utilize this for my patients,
all the great things that we talked about this past year.
I think, for me, it's just the wearable technology in general,
you know? Are we going to go with the
future and will probably update this on later talks?
But you know what, what devices are there out there that are
(02:09):
making our athletes even better?That are allowing us to track
athletes, prevent injuries, those type of things because
that to me is really the future of sports medicine.
And then, you know, we talked about this ad nauseam in our ACL
talks, but the technology to heal ACL that are torn or to
internally braces. ACL that are torn and get
(02:31):
patients back faster with a morenatural ACL is a really
impressive new technology that'sInnovative and its continuing to
improve. Even in my practice, I've
noticed a huge change over the last six months or so with some
of the technology and I'm looking forward to giving
updates on this next year because I think that it's going
to be even more Innovative and we're on a horizon hopefully for
(02:55):
ACLS where we can have reconstruction still but reduce
the numbers of a bitch. That we do and reduce the
long-term comorbidity that are associated with that.
All right, before we get started, what our recap of 2022,
some of our favorite moments in our shows picked out by dr.
Garcia. I personally want to thank all
(03:16):
of our listeners for joining us and spending time with us, and
hopefully learning a little something along the way.
Dr. Garcia, last thoughts beforewe send our listeners to our
recap of the 2022? Show.
Well, I've won again. Thank our listeners as well.
You know, we had a lot of fun onthis show and hopefully you were
(03:37):
able to take away some stuff from the show that you wouldn't
see in a normal news or normal articles, you can sort of
behind-the-scenes information and hopefully was intriguing for
you to better understand the injuries that you were friends
may have had, because I know a lot of my personal friends,
neighbors, Etc, that had injuries that we talked about in
the show, that's why I bring them up because I have, you
(03:59):
know, you're out of hard. People ask me or tell me about
this. I heard about this thing.
Heard you doing this and thoughtmaybe the rest of the world, I
left the people of Esther listeners want to hear it.
So hopefully you enjoyed it. Thank you for listening.
We really appreciate your support and we're looking
forward to giving you a lot morein 2023 and in the future.
So thank you. It's been a pleasure working
(04:21):
with you dr. Garcia with further.
Without further Ado, here is some of the clips of the best of
our 2020 to show We've been really thinking about smart
watches, and these consumer wearables, keeping track of
Fitness levels going back to the60s and even Way Beyond that dr.
(04:42):
Garcia, when you talk about these consumer wearables, what
are some of the technology that's out there that exciting
for all of us? But also the fact that it's
really useful for you and in your field.
So I think we're, you know, you did a great job.
Introducing that topic. I think that what the patients
and people out there need to understand is that you guys only
(05:04):
see the tip of the iceberg, right?
This is a multi-billion dollar market and Athletics is the
spearhead, the and we can even get into you know how surgeons
are certainly use these type of things as well on their daily
routine. Which I've had a medium out
those recently, but just talk about the athletes more.
I mean, these wearables have been out for.
(05:25):
We always talk about the early on technology and, you know,
counting your steps. But that is That is not what
we're using for now. You know, those are obviously
fun things at for the standard daily patient to use.
You know, I wrote, I did my steps today.
I did my workout today, but we're really looking at is, how
can we get players and athletes,to last longer?
I mean, we've talked about before, longevity is key to
(05:46):
sports and key to, you know, these continual records were
seeing in key to seeing these athletes.
That are, that are beyond their Prime still continuing to be in
their Prime and wearable. Technology is really the sort of
a The thing that's hidden behindthe scene that is helping the
trainers and the department to do this, and we can go back and
forth and have discussions aboutit being, but you have people
(06:07):
like Tom Brady. Yeah.
But LeBron James, you have guys like Vince, Carter, you know,
just names there that are that performs a high level for much
longer than we ever seen from athletes.
And we talked about the money they spend on their bodies, Etc.
But really it's this technology.That's helping, not only these
high-level athletes. But athletes in general, I mean,
(06:28):
one of the princes, Inside coverof football games for my high
school on Mercer Island and the trainers have helmet Collision
monitors in all the helmet. Well, when a concussion or
helmet, hit is above your level,of what's considered normal for
a normal hit its registers, it has a player's number on it, and
(06:49):
it can pull the player out rightaway, and that's just the basic
level high school with high school budget.
And that's real time informationthat it, how does that get
communicated from point? A to point B to the Coach, and
real time. It's an automatic thing when
they gets hit. The alert goes off the center
break, the sensor goes off and it goes onto the handheld device
(07:10):
that they have. And it says this person was hit
too hard. You know?
And here's the level of was hit.And if you're worried about it,
you know, obviously if it's a malfunction of the helmet then
you don't worry about it too much.
But most the time you pull the player out, you do exam do a
concussive exam like we talked about on the field and see if
they qualify or not. This type of information, In is
(07:31):
pretty much that biofeedback that you're looking for, right?
This is what we, this is the Holy Grail of Athletics.
I mean, I think that this combined with, you know,
procedures and supplementation'sand biologics that we're able to
do for athletes, this is really what's going to keep our
athletes healthier longer and beable to do the right amount of
(07:53):
training. I mean, we could go on and on
there's there's a, you know, oneof the companies that one of the
doctors I work with when I was in residency.
Please do this for pitchers and it was a flea that they wore and
it chose them if they were there.
They were fatiguing or adding too much valgus their arm which
could increase the risk of the Tommy John injury, it tells you,
you know, number of pitches and you have to worry about having
(08:14):
somebody scorecard it, it's completely built into the
algorithm, you know, and there'sdifferent grading systems.
You know, this is going to give give teams real-time
information. You know, is this athlete
fatigued? You know, they have sensors in
the path to know whether or not they're getting hit too hard.
Whether or not they're sweating too much more than they not too
much fluids. I mean there's things that the
biggest concern with all these is there's too much data.
(08:35):
So what do we do with it? Because Adam like a single game
in the end up professional sports, you're getting hundreds
and thousands of pieces of data.So is that important or not?
You know what I mean, if you want to someone's heart rate,
every single minute for an entire game and you that for all
the players on the field, what does that mean in is that we
have to figure out these algorithms to calculate is this
(08:56):
injury or not, so it's using computers but also very
intelligent people in it. Ecology field to find a way to
do this. But this is one of the hottest
markets in the country, especially for athletics.
There's some reports out there that by 2025 one in every three
adult in America will wear a fitness tracker the global world
of wearable fitness trackers Market was valued at thirty
(09:17):
eight point. Six.
Eight billion in 2020 is projected to reach over 124
billion by 2028. So you know, this entire
industry is booming and along with that technology and I just
want to kind of simplify a little Lil Bit, I've worn a
whoop before that goes on. It's a, you know, these smart
watches that goes on the wrist, and it would tell me how I
(09:40):
slept, if I was ready, what kindof training?
I was ready for. So, even basic stuff, you know,
I like, you know, I work out. I like to do kettlebells.
I like to do certain things and that tracking would tell me say,
hey, this is a day, they need togo light, you know, this is a
day that, you know, you can really push it and push a limit.
So even just basically, Formation for someone just like
(10:03):
me. That's just a, you know,
whatever weekend warrior recreational athlete.
You know, I'm getting an important information there to
say, hey, go for it or maybe dial it back.
What is that important for you? That deals with so many
different patients besides athletes.
But just regular patients, like myself to have that type of
information and how, how are yougetting that information?
(10:27):
So, you know, again, we haven't had the technology yet and
unfortunately, It's hard as a surgeon to have time to kind of
review data like that. But I think with the future is
lying at is how do we treat our patients as a holistic approach?
You know, I think it's honestly is probably going to be more
like the primary care setting, where, you know, patient comes
in they say I'm not feeling. Well I'm not doing well and
you're like okay well let's figure out a way that we can use
(10:49):
these tracking devices. Okay.
Well I can see here. You're not been sleeping well
for the last two weeks that doesn't seem to be working well
for you. Your heart rate has not elevated
enough and figuring out this holistic approach.
She says, okay, this person needs to work on these different
things or you know, some of these wants to see people's
lives is a that arrhythmias or something else never wearing the
watch or the track or something else, and it's scene.
(11:11):
And there's there's there's numerous articles out there
about this in terms of these cases.
But what's really cool is this actually goes into the
orthopedic field, we have implants now that have trackers
built into them that can tell ushow the patients using them.
The wear patterns, what the cycles that can do if there's
kinematics or off? I mean, these are pretty new.
But again, this is a way that any for research purposes.
(11:33):
You can have a basically harmless, small additional
implant, put into your implant, and we can see how the patients
are walking is their gate, right?
Etcetera. It's more on the replacement
side of things, but that's whereusually where it starts, and
then a technology continues to move on.
But you know, the wearable technology thing is not just the
(11:53):
average Joe population. It's goes into surgeons, it goes
into surgeries Athletics, professional Semi-Pro and
everything. It's just The huge topic and a
huge huge Market. You know what I'm hearing?
Is that it's really personalizedHealthcare, right?
You know, for that individual isthat something that you're
asking at this point. And I know you mentioned that
(12:16):
there's it's, you know, it's hard to get all of that
information right now. But is this something that if,
you know, you have a patient that where's that type of
technology that you will ask them for any of that
information? Or is that something that maybe
We'll be something that you know, surgeons and, you know,
doctors in the future will ask their patients of.
(12:38):
I think in the future, it'll be something like, you know, what
it needs to be. For most of us in the health
care field, given the time constraints that were all given,
would be some way to have like an app or a printout that shows
like a summary of how you've been doing, you know, not
monitoring the day by day but like okay, come back and show me
how you're doing as an athlete in terms of all of this stuff
and then it gives me a printout shows like oh, you know, you've
(13:00):
been Been down from this month, with your sleeping up with this
month in your exercise, okay? Clearly you're exercise vo2max
your heart rate elevated. Clearly you're doing law for the
surgery, are able to go to a level that you weren't able to
go to beforehand. You know, especially if like, we
can get print out the like two years and I could see what
happened with them injured beforehand and how they were
able to exercise. Maybe not as much and exercise
(13:21):
afterwards. You know, I've been, I've been
injured and had to come back from an injury and I've already
noticed, even with my Apple watch that my fitness level is
increased to the level of was for the injury if that higher.
And so I'm able to tell that this on myself.
So I can see I can easily extrapolate that to my patients
and that's just on the best a basic level.
That's just the day-to-day stuff.
(13:42):
So ideally your you're mentioning that information
relayed directly into Patients health records could be
beneficial for all parties if and when not if I guess when we
get to that point, some of the concerns, you know, is this
going to be, you know, where does HIPAA kind of fall into
this and secure? And what compliant I may be
(14:03):
going down the rabbit hole with this.
So just let me know if I am, youknow, I don't think.
Oh, no Rabbit Hole. This is a that what you just
mentioned. There is probably the number one
concern of everyone. You know, does someone want an
Alexei in their house listing everything they're saying?
And then all of a sudden they goon their Amazon, purchase
listings. All listed there, you know, or
in so, being tracked as never someone as most fish.
(14:24):
Populations. Not happy with that.
The question comes in, you know,are you releasing your records
to your doctor? So I can make you he or she can
make you feel better. I think patients are more apt
amp to do that. But, you know, they would want
it, they probably want to release into a hospital or a
physician's office, you know, I think releasing it to like oh I
work for Facebook. Can I have your data?
(14:46):
People are not going to be pleased with?
Yeah. So we just have to be as it has
to be done in the appropriate Manner.
And I think it will have to be because all these applications,
anytime I use new technology. The number one thing they tell
you, is it typical client so half of HIPAA compliance with
it. So that comes Hand in hand, but
the trust in the application forcertain people, it may take
longer, but again, it's up to them again.
(15:07):
Everything in life, you come in my office, the patient, you'll
know, I'm all about, whatever the patient wants.
And so if they're on them, they don't want to detract or have
information that situation when that technology becomes
available, you know, I'll utilize, whatever resources are
willing to give me, how can you see this being beneficial to
toward telemedicine? So this is a good one, one
(15:28):
worth, you know, just for the standard vital signs, you know,
you can say upload, you know, I got your watch on the link it up
to the application. It tells me all your simp, your
Vital Signs, how you're feeling,you know, it can tell heart
rate, if you're in pain, etc. Those are important things and
that can be relayed or, you know, even with some of these
new programs I could send, you know, the potential future is
(15:48):
like I can send reminders or physical therapy through the
watch or something else and no, that's not out yet.
But yeah, remind your cape. Session today, do your
exercises, you know, have a system set up through a company
that does that the, the newer things, you know, we can do
transplants and a lot of fancy things for the cartilage.
But the stuff that's in Europe is really, what's going to be
(16:10):
coming here soon and then some Consulting for some companies,
but they're having these implants that basically, you
know, car transplant. Someone's cartilage.
Like from person that recently passed away, is it really safe
procedure? But it's a pretty big burden
economically. Also because if they're
expensive to put in There's always a risk of, you know,
infection Etc and again, very good success rates but not 100%.
(16:32):
There are more and more companies working on.
Can we just have something that you make synthetically 3D
printed scaffold? You put in someone's bone, the
bone grows back but then right where the cartilage starts, the
cartilage starts to grow back orcan we have a pace that we make?
That's combining little cartilage B with certain
biological factors and paste that on to grow cartilage.
(16:54):
And we are getting more and morearticles.
He's in the literature showing that this is becoming closer to
reality. Now, we are not there yet, and
again, a lot of this takes FDA approval and while we may get a
good technology, it could still be another 15, you know, two or
three or four, or five or ten years away.
It's coming. And that is where we're looking
at. There are these ways that we can
(17:14):
either save the cartilage? You currently have you use your
own cartilage or grow new cartilage?
From what we have for you, and we can do some of that already,
but it's going to get even better especially for smaller
defects where the insurance won't usually pay for East fancy
procedures in those have a situations.
But those defects still may be painful.
Can you envision something whereyou know you just kind of inject
(17:36):
something into the knee. I'm just using the knee as an
example where you trying to fillin cartilage and you're just
kind of, you know, spraying something, you know, like
whether it's foam or, you know, for lack of better word, they
just got to just fills in the Gap and it'll be a procedure and
you're like, okay, we filled it in your good to go and out the
door, you go. Yes, I think that that I don't
know how far off We are but thatis the goal.
(17:58):
The goal is, you know, the goal is ever, the goal is to do.
A, the endgame goal is to have an injection that you don't have
to look at. You don't have to do surgery.
You just put injection in the knee and the office.
You squeeze the material in there and it finds the areas
that are damaged and tells your needs time to repair this and
then finds a way to repair it with stem cells, Etc.
Yeah. We're pretty far away off of
that but the next step is a surgical procedure.
(18:20):
That is much more minimally invasive that we can go in
there. Find the whole inject, this
material, you know. Bone, send them to Bones,
involved to pick the bone and regrow the cartilage with this
sort of gel foam, Matrix material using both your own
biologic, so your stem cells or PRP and then also the growth
factors in there because again, they have to be told that it's
(18:42):
time to grow cartilage, right. And they've got to have those
mechanisms that take teach them to grow cartilage.
So yes, I mean we're on the, we're on the track but it takes
first growing a scaffold that will regrow this before, we have
an injectable gel. So again this is this is all
Fascinating stuff and it gets pretty nitty-gritty.
But, you know, there is stuff out there and we're getting
better and better. I mean we are so much better
(19:02):
than we were 10 to 15 years ago at helping patients, we catch
them earlier. The other thing is more, doctors
are trained in this. Now before, you know, there were
very few people that knew how todo this stuff.
And so a lot of doctors you would see you and be like oh
there's a hole in your car, there's nothing to do about it
now. We're way more aggressive seen a
number of occasions. I can help that are in their 20s
and 30s that I take care of on an everyday basis is much higher
(19:23):
than what you would normally seepreviously.
Again more people as my partner's understand what I do
as people in the community, understand what we do is
cartilage surgeons, you get moreand referrals and you can help
people sooner, let's talk about choosing medical providers as,
you know, they say, 68 percent of patients say they're more
likely to choose medical providers that offer the ability
to book change, cancel appointments online.
(19:46):
So as we wrap it up, let's just talk a little bit about that, so
yeah, I mean, that's important. I mean online presence is crazy.
I mean, it's, it makes or breaksyou in a big city like Seattle.
Yeah, you know if you're in, I'mpresence is poor.
You're not a veteran here, you know, you can see the patient
numbers are not the same, you know?
I I probably have 90 videos online.
Now, if not more, including our podcast.
(20:09):
And so I want patients before they come in, like you
mentioned, you know, my whole thing when I first started was I
wanted to put so many videos together that my patients came
to see me. They're like already know him.
Yeah. Right.
Like you seem like he's a good guy.
He seems like he's a nice guy and that's the first thing you
notice is you want to feel comfortable with the person.
And so, and I know that's why I like these podcasts because I
can be, you know, it's not so robotic, right?
(20:31):
You're not like, okay, I'm goingto talk about my doctor stuff
only and you know, not miss the personality part because even
though you may only see me threeor four times, I want to make
sure the patients, you know, enjoy caucus origin.
Feel comfortable if something happens to because like it's
much easier, if something happens if we get along to try
to figure out the problem because I don't ever talk to
patients about the best possiblestuff, right?
(20:52):
That's if you do well. And we high-five and my
patients, who if they heard this, If they'll know, like I
said this many times, you know, that's the easy conversation.
Yeah. The hard conversation is a
problem, right? And how do you deal with the
problem? Because that's not, that's the
one where, you know, you're you're, you know, you're the
doctor in there, you just feel terrible, right?
You just want to make this better.
Yeah. And if you have your personality
is something that matches with apatient and they can get through
(21:14):
that. That's the best possible
scenario. I mean, thankfully, we don't
have too many of those but nonetheless, you know, the whole
level got to be comfortable, my patients.
And I tell them all the time is like, if you're not comfortable
with me doing the surgery for you or you're not comfortable
with the situation, Action. And you sure as heck should do
with me, and if you're comfortable with it, and you're
going to do way better. And it's crazy because it really
works. I mean, it's patients are on
(21:35):
board fully and they decide an elective surgery, they do so
much better. It's a mental thing and we have
the whole nother show too, so wekeep coming up with ideas.
Yeah, we got plenty of ideas and, you know, we've talked
about it before and and I'll mention it again and whoever's
listen to multiple shows. I will always say the same
thing, you know, you've mentioned, you know, go get
second opinions. Make sure you're comfortable
(21:56):
with. With your doctor.
I mean this is out of the doctor's mouth.
Now mind you have said this yourself over and over again,
you know, you want your patientsto feel a certain way, a certain
comfort and be sure to come in and talk sports with dr.
Garcia and you know, getting outin the water and swim in.
And I sent a friend of mine overthere to Dory and Dory, I
(22:17):
believe was talking ahead, talking your head off.
So she's a little jibber-jabber and but it's just great and that
says more about you and your personality and the comfort.
So, It's just great to hear and and it's important.
It's more than just a cut and dry situation because we feel
uncomfortable. Most of us feel uncomfortable,
already walking into your officeand not personal.
(22:40):
It's just, we're usually going in there for a reason and we're
concerned and we want to feel better and we want to get
better. And you know, when you can have
other things put you at ease, itjust makes the whole process so
much better. I couldn't agree more and I feel
for the patient's. So you know, the key here is
almost say it. Again, you make you feel
(23:00):
comfortable, but understand, youknow, obviously you've got a
problem, so we got to figure it out.
But, you know, here, we're goingto approach the best we can give
you the best possible Tech. We can.
That's the safest, try to make sure we do everything the best
that we can possibly do, and that's what we keep striving
for. So, is there something in your
field, right? And I know you guys work a lot
(23:20):
of hours and there's a lot of pressure and all different
levels of clients, you travel the world.
Trainee. What is something that really
stands out for you when it comesto your profession?
What it takes in my field especially when you do Sports is
it's a different. You have a mindset the right
mindset first off the pressure cooker, right?
(23:42):
You know, I remember a couple days ago, I had a pretty high
level baseball player and the first thing, the parents said to
me, you know, Dad's dad standingnext to the door.
Mom, say next to the door kids on the kids, sort of upset
because they just tore their Tommy, John ligament and all
they call. I want to know is if when I can
get it back as soon as possible.Well, not even, you know, in
his, it happens all the time, you know, and it's not, it's not
(24:03):
their fault, they're really dedicated.
They put a lot of money and timeinto the baseball.
Yeah. But it's a big deal and you got
to sit down there calmly. And you say, Hey, listen, you
know, I A lot of times at least in my practice so my partner's
they'll send me the higher levelathletes just because they don't
it's it's a lot of work to deal with the parents and if I don't,
it's not a wrong thing, it's just that you know, when you get
that level everybody's invested,right?
(24:25):
Yeah. Yeah.
Parent of parent is my kids spending hours of the pool hours
playing baseball and they get hurt.
I sure as heck, one of the rightthere with the surgeon, what are
we going to do? How are we going to make this
better? You know, not just for me, but
for the kid too, and it's hard. And so your and that's even at
the high school level, you know,the people that you may not even
make it to college and then you get the college player and
(24:46):
they're like, hey, coach wants to talk to you, you know, all
those other things. So, it's not just the actual,
you know, the surgery Parshin ofit.
I hate to say it is actually more of the easy part.
It's the other stuff managing expectations.
We talked about As before. Yeah, every athlete.
You see, you have to manage expectations, you have to manage
expectations in your surgeries. You cannot go in there and tell
every single patient that you dosurgery on it.
They're going to be perfect because that is not true, no
(25:08):
matter how good you are. I worked a lot of good surgeons.
It is not the case, okay, while people do well, that's why we do
sport surgery. That's what we do Orthopedics
because it's a very fulfilling option, but you got to be ready
to take care of the hard stuff, too.
And if you can't the same thing as an athlete, if you can't
handle the pressure, then that'swhen the problems.
Awry or that some patients are upset because something happens
(25:29):
and they can't their doctors nottaking on their own.
It's the responsibility of the challenge.
You know, it's super easy and I tell patients is all the time.
It's super easy if ever seen oneof my patients in the office did
amazing. If I had a hundred percent
success rate, being a surgeon will be way too easy.
You have to be fairly honest with you, it's the hard part is
that 5% or 10%? You know where the kid that you
did, it made a perfect ACL on Andre tears.
(25:51):
It how do you deal with that? And that's the same thing with
athletes. How do you deal with?
That tear of your own ACL and getting back next level, when
all the odds are against you. Or in my case, I'm the one who
did the surgery, so I feel responsible.
Even if there was nothing, I didwrong.
I did exact same surgery for thelast kid, let's move on to
augmented ligament and, you know, fertilized ACL.
(26:13):
I know what fertilizes, but what's a fertilized ACL?
Oh my gosh, we're going to open another can of worms here.
So we'll try to make all this brief.
I would refer to listeners to our previous ligament internal
brace. Talk that's going to talk a lot
about this. Yeah but there's this talk of
this new ACL and it's been happening down in the South with
(26:33):
this guy doing these ligaments, he's doing young patients.
ACLS with a combined of bone graft and elixir of sort of
marrow from you stem cells and putting them into the knee and
doing ridiculous things in termsof recovery rehab.
So an ACL that requires a littlebit more effort.
The negative of the ACL is that it's also more expensive.
(26:56):
So there's out-of-pocket costs of the patients.
Yeah, but the data that he's showing right now is showing
patients are back to full activities and under four
months, And that's coming off a torn ACL.
After torn, reconstructed ACL. Now we've tried this in the past
and it failed where people have tried to get back earlier and
everything else and you have their stories about someone
(27:18):
coming back in three months and then they play one game and then
they rip it again. Yeah.
And there's something called ACLrepair that were always trying
to get better at. But again, there's been a lot of
negative press on that, as well,there are indications for it,
but not often. But this fertilized thing is
extremely. I just recently saw the talk on
it and at some point I think in the next year or two, I'm going
to bring it to practice here. Seattle area.
(27:39):
But it's an option. Where certain patients, who are
younger? You know, they're showing
patience running at two months. I mean, Target two weeks.
Now, this is going to be a lot of pushback from orthopedic
surgeons, but they're in clinical trials right now with
this option. And if this is really can
happen, the way it happens, is it takes a soft tissue.
Graft that normally would take six months to heal in.
(27:59):
That's why you don't want to youdon't run on something.
You don't do anything crazy withthese ligaments until they're
fully healed into the bone tunnels.
Yeah. And basically like putting bone
graft already in the tunnels, Soit's like speed up the healing
process by like two times and they have MRIs showing it to.
And so if there's something we can do, even if it's added cost
of the patients because it's a little bit more, fancy insurance
will cover it. Part of it, at least they'll
(28:21):
cover the ACL of the extra bone,grafts tough.
This would be for high-level athletes.
It should be Game Changer, right?
It's not an everyday, patient procedure, but if you're young
and you're a varsity, person canbe recruited and just tore your
ACL. And you have your, you know, at
the end of the season, you have the next season coming up and A
month and you want to get back and we have this crazy option to
do it. That would be the person that
(28:42):
you do it for. That's absolutely amazing.
I mean I knew that would get youwith that one.
About two weeks ago I was on online social media, you know,
MIT is, you know, doing these robotics facial expressions and
they wear the way they reacting and I'm like, okay, this is
straight out of Terminator, we're all going to die and this
(29:02):
is going to be crazy, but for your field in the purposes of
your field, How important is thefuture of Robotics going to be
in Orthopedics. So I think there's a couple ways
you can think about it. One is like straight up robots
like you hear, people are operating those robot actually
operating and you're doing it from.
(29:23):
You know, the long-term goal would be to take, you know, some
of the best surgeons you have and be able to give that access
to other people, right? So you're in other places
overseas etcetera and able to dothe surgery so that the person
can have the best person not to worry about flying, you know,
from India, or from Japan, and going to United States or vice
versa and see the best guy that's tough.
I think we're a ways out from that because obviously, you have
(29:44):
to worry about You know, internet lag, and those type of
things the future. What we currently have is, you
know, the sensors, the virtual reality.
So there's implants that people put in some of the Tony and
plants, you can now they have like sensors.
So they'll tell you how complacent, the patient is what
they're loading differently. How many, you know, when they're
taking breaks we can also monitor things, you know, speed
(30:05):
of the implant and those are thethings and look at where
patterns even in. It's completely safe to have
that in the built into the implant itself.
And you know, The 3D printing model.
That's an amazing. That's, that's a game changer
every last five years. I'd say, you know, I do shoulder
Replacements and I get a 3D printed model, the person
shoulder that I can work with onthe outside during the surgery.
(30:26):
So I can say okay, this is exactly where this special guy
will go. I've planned the whole surgery
before I go in there and then I have these augmented guides that
are 3D printed with and I can actually put the pin in the
exact spot that I want to put it.
It's way more precise even than doing it naturally.
Like, I can do it normally, but having this just adds even more
precision. Jessica complex cases and you
(30:47):
know, I'm doing the special osteotomies we can, they can 3D
print this guide with everythingon there with all the cuts and
then even have the little thingsyou want to.
If you want to add more surgeries to that actual cut, it
can be all built into the guide for you all 3D printed custom
for the patient's. So this is the, this is pretty
slick stuff and you see you're playing whole surgery ahead of
time. You can see your whole template
and you can adjust things. Like, I just talked to one
(31:09):
company from France and I was onthe loom, call with them, like,
okay, move this pin here a little bit more bubble ball and
you can like plan everything ahead.
And we discussed a couple shows prior to this one about
telemedicine and some of the regulations that have changed
since, you know, we've been in this, you know, the covid-19
world. Do you think that more
(31:30):
regulations will have to change or be lifted?
Especially if you're dealing with a patient may be out of
state or you know, some kind of Consulting.
So I think the regulations always are in flux.
Yeah, you know, and you know, and obviously the regulations
open. Up to get patients access to
care because they couldn't go into see the doctors and
(31:50):
unfortunately, sometimes it's what's first, the chicken or the
egg, and the situation you're like, is it going to be the data
is released and if people feel uncomfortable and then we have
to lock down more, or is it going to be the data's lockdown?
We have to slowly find ways to release it, so we can get the
information to patients. So if you see the second one but
sometimes that happens in the first one and then all of a
sudden you get some complaints that I don't feel safe with my
data. I don't want you to have all my
(32:11):
data. I want to be selective and then
you got it, rewrite the book butBut again, this is a, this is a
far ways out and we really need good studies to show that
benefits, you know, just me looking at your sleep habits for
the next six months, or your, your heart rate really going to
change the management of my of your problem.
If it's not, then there's no point.
Yeah, but I think we're comes into is like, we keep always
(32:33):
going back to it. I hate to mention just the
athletes again, but it's really the athletes.
It's can I my player, you know, have been my players from having
season-ending surgery. However, my players from
fatiguing early and getting dangerous complications, I mean,
you hear All the football players that unfortunately have
bad complications as you know, high school college level, that
sweat too much and have neurological complications.
(32:53):
Can we prevent that with trackers on them to see if their
heart rate jumps up? Because, you know, a lot of
athletes they just don't want totell you when they're not
feeling well and then all of a sudden it becomes too late where
their bodies can't compensate anymore.
And that's what we really want to protect against.
One of the things you mentioned also was the fact that everyone
can have some kind of measurement in tracking on how
they feeling including yourself.Elf.
(33:15):
So as a doctor that may not be feeling great.
And you have this type of technology is that something
that maybe you can see your employer mandating saying, hey
we want to know if your best nowbefore you go into a 5-hour
surgery. Yeah, that's a tricky.
That's a tricky situation to be,and it's a tricky question,
(33:36):
right? It's Tricky.
Oh, you know, background is, youknow, you have to learn how to
not be at your Prime all the time as a surgeon.
Yeah, you know, when you're in red, you're getting one hour of
sleep and they're expecting to be at the top notch.
You know what? I'll talk about a very brief
topic. Yeah, we just got the Navy SEAL
came in and gave us a discussion.
If the company high performance company that uses trackers on or
(33:57):
tan surgeons, and will tell their sleep patterns, how
they're feeling stressed. Levels of cortisol levels, Etc.
And we'll call the gameplan saying, Hey listen, you know,
you're fatiguing out. You're not getting the sleep,
you need, we should probably figure out a way to make your
body better, because we're kind of like that, that sort of
high-level professional that will push through anything.
(34:17):
You know, I know many many surgeons that have come into the
office feeling really not their best and push through the day.
Yeah, you know, with no teeth, no worries for outcomes for
patients. I mean, this is not some that
jeopardizes patient's Health butyou know and if they were Were
in the regular employment opportunity.
When it come in third, is our program, we're programmed at an
early age that you don't feel well or you're hurt, you still
(34:41):
come in. You know, I cope I took off like
one sick day in ten years. Well stuff that gives you an
example of the way I work and I can tell you right now that I
probably should have taken more but it's just the way you're
programmed. It's the same thing as you are
in the military type of style and you know that's what's
really important is that we really need to test our Doctors
(35:02):
and surgeons are at the highest level of stress, but they also
have the highest and I've littlestress high school, but
perseverance to sort of negativefactors and they have a pretty
important job you want them at their best.
And so if we this company basically looks at all those
things and will give recommendations and find ways to
decrease burnout. Decrease, you know hopefully not
(35:24):
MediCal errors. Decrease surgeon, turn over all
those things which happen you know, if you've been Not pay
attention your body, not sleeping, operating laid doing
all the things you can do and all of a sudden you just shut
down. You just, you know, you're
tired. You want to quit your job like
that could have been prevented if we had given you the right
resource. Yeah.
And so that company does they did it at at the Cleveland
(35:46):
Clinic a pretty big hospital andthey made some huge efficient
changes to the company and to the surgeons to make them more
efficient and more efficient, it's like more rested.
Okay, it's time for you to go tosleep, you know, next four
hours, it seems silly to have totell adults.
Title professional to do this but you know, we're normal
people too, and we want to, you know, stay up late.
Enjoy a movie here and there andit's good for us to understand
(36:09):
that, you know, if we want to prioritize being our best, those
are things you have to do. You know, I know I've changed my
habits even the last six to eight weeks with my tracker
taking in more of engine saying,Hey, listen.
If I get this amount of sleep, Ifeel way better, how can I make
myself better? Because that's where always
trying to do at least in my field and what I do is how can I
make myself better? How can I have better outcomes?
(36:30):
How can I reduce Is any medical errors, how can do all those
things, and that's what that helps me.
Do and ivory notice the difference personally, I could
jack, you see, you know, everyone getting kind of tracked
and you coming in and say, what listen, we saw your vitals
before he came in where, you know, you're not up to Optimum,
we're gonna get you a Gatorade, okay, we're gonna get you some
B12. We're gonna relax a listen, we
got to massage your feet, you know, he's feeling a little
(36:53):
stiff, he didn't sleep well lastnight, okay, all right, you
know, almost like a pit stop, you know, he just kind of coming
in and getting you ready? Are you ready to go?
Hit the road again? No, I'm making light of it but
and it's amazing that the Cleveland Clinic is taking that
information and say pretty much saying that we can be better by
making sure that the people thatwork for us.
(37:13):
We take care of them and make sure that they're at their
Optimum performance. What is some of the other
technology that's out there right now that our listeners
would be surprised to hear aboutand it's just exciting for you.
Well, I'm a summer so I can tellyou about these Technologies
came out. There's a heads-up display
that's in your goggles. And then some of the higher
level athletes are using it to for swimming.
(37:35):
And you will tell you your lap count and whether you're on Pace
and all, your vitals will link into your Smartwatch while
you're doing it. And a couple days ago, I was
climbing over and I some guy pops out of the pool and wants
to show me his goggles because they were these new heads up
displays. Yeah, then I just read about him
in a magazine to. So it's kind of interesting.
So that's a new fun piece of technology that you can actually
get your hands on. They have new something called a
(37:58):
Tesla suit, not related to Tesla.
Now we're talking about the bodycoaches and they think that this
technology could increase the championship caliber of boxers
by a significant amount because it's going to tell you, you
know, how many punches you're taking whether your forms off
etc? Those are just two examples.
A buddy of mine. Got the virtual reality goggles
and, you know, he sent me a video and he's a he's in his
(38:22):
early 50s and he's like, man, I got this and I'm just having a
blast and he's got the boxing game and he's coming and he's
like, I get no, I threw my shoulder out, I'm sweating.
I'm doing all these different things.
It's so it's so interesting. How virtual reality, you know,
being active is changing, you know, it's not going to the gym
and you know, grabbing a punching bag.
(38:42):
Obviously there's a huge benefits and just, you know,
doing something like that. But being in his living room
being, you know, someone that's working full-time coming home
late maybe not have the time to run to the gym but on his
virtual reality headset gets hisworkout in and and you know and
off you running. So just seeing where technology
is going. Is really fascinating.
(39:02):
I couldn't agree more. What is something that if you
had to share with your listeners, you want to share
with them. I think I would share this,
especially for the athletes, butkind of anybody, you know what,
it takes to get to what you wantto do, you will be, there will
be Roblox and you don't know what they're going to be, could
(39:24):
be something academic. Could be something Mathletics,
it could be something, your family, it could be an injury,
you know? Going to be roadblocks and
really, it's how you deal with those roadblocks and making sure
you do the research, get the right information to take care
of that, you know, finding the right person to take care of
your injury. Who feels good about this
finding the right person. Counselor, take care of the
(39:46):
academic side, whatever it is that you're missing is a piece
of you and is not going in the direction.
You want it to find a way to correct that, with whatever it
takes. And I guess, whatever, what is
it, what does it take versus? Whatever it takes?
I think that People that separate themselves, do whatever
it takes, obviously within the realm of things to get that next
(40:07):
level. And if you're willing to do
that, a lot of times you could be successful.
And again, as you mentioned before and I as I see all the
time and all my patients successis measured in so many different
ways and really it's about how you impact the people around
you. And in the end, the people that
I remember you the most your family.
So if you do those things, right?
(40:27):
That's the most important. But again, just making sure that
you stay on the course. That's the Hardest thing, let me
stay on track for any specialty and my job or being an athlete
or anything. That's the most important thing
is. Stay on track.
Stay focused and do what you love because you don't love it.
There's no point in doing it.
Thank you everyone, for listening to our podcast.
Once again, I'm with orthopedic surgeon and Sports Medicine
specialist dr. Grant Garcia, please check them
out. A grant Garcia, am d.com dr.
Garcia unbelievable. We are end of another year with
great information. This past year, just give us a
quick recap and your thoughts onthe year that was.
(00:24):
And as we wrap up 2022 and get really excited about 20-23.
Well, you know, No, you will hear about this in the summarize
podcast at the end of this. But you know it's been a great
year. We've talked about anything from
wearable technology to what it takes to be at the next level to
behind the scenes of sports medicine, surgery to behind the
(00:46):
scenes of being in the sports field and professional athletes
anywhere from ACL meniscus, cartilage surgeries and
Innovations. We have there to shoulder and
elbow injuries. So it's been a wonderful year.
Hear about all the updates and the advances in the World of
Sports Medicine, orthopedic and have a lot of fun too.
(01:06):
Because we talked a lot about a lot of great events, you know,
anywhere from the Super Bowl to just recent World Cup to the
Kraken. It's been, it's been a really
great run and I'm looking forward to the updates and the
new things we're going to do next year.
If there's something that standsout for you, from this show, go
back. Listen to our other shows for
(01:26):
the entire show. When we talked about ACLs, And
Robotics and virtual reality andwearable technology, and what it
takes, and all of these different things that we
discuss. And, you know, one of my
favorite was internal bracing. You know, I was just, you know,
just super fascinated by that whole conversation.
We just something in particular that really stood out for you.
(01:48):
Like, man, I can't wait to utilize this for my patients,
all the great things that we talked about this past year.
I think, for me, it's just the wearable technology in general,
you know? Are we going to go with the
future and will probably update this on later talks?
But you know what, what devices are there out there that are
(02:09):
making our athletes even better?That are allowing us to track
athletes, prevent injuries, those type of things because
that to me is really the future of sports medicine.
And then, you know, we talked about this ad nauseam in our ACL
talks, but the technology to heal ACL that are torn or to
internally braces. ACL that are torn and get
(02:31):
patients back faster with a morenatural ACL is a really
impressive new technology that'sInnovative and its continuing to
improve. Even in my practice, I've
noticed a huge change over the last six months or so with some
of the technology and I'm looking forward to giving
updates on this next year because I think that it's going
to be even more Innovative and we're on a horizon hopefully for
(02:55):
ACLS where we can have reconstruction still but reduce
the numbers of a bitch. That we do and reduce the
long-term comorbidity that are associated with that.
All right, before we get started, what our recap of 2022,
some of our favorite moments in our shows picked out by dr.
Garcia. I personally want to thank all
(03:16):
of our listeners for joining us and spending time with us, and
hopefully learning a little something along the way.
Dr. Garcia, last thoughts beforewe send our listeners to our
recap of the 2022? Show.
Well, I've won again. Thank our listeners as well.
You know, we had a lot of fun onthis show and hopefully you were
(03:37):
able to take away some stuff from the show that you wouldn't
see in a normal news or normal articles, you can sort of
behind-the-scenes information and hopefully was intriguing for
you to better understand the injuries that you were friends
may have had, because I know a lot of my personal friends,
neighbors, Etc, that had injuries that we talked about in
the show, that's why I bring them up because I have, you
(03:59):
know, you're out of hard. People ask me or tell me about
this. I heard about this thing.
Heard you doing this and thoughtmaybe the rest of the world, I
left the people of Esther listeners want to hear it.
So hopefully you enjoyed it. Thank you for listening.
We really appreciate your support and we're looking
forward to giving you a lot morein 2023 and in the future.
So thank you. It's been a pleasure working
(04:21):
with you dr. Garcia with further.
Without further Ado, here is some of the clips of the best of
our 2020 to show We've been really thinking about smart
watches, and these consumer wearables, keeping track of
Fitness levels going back to the60s and even Way Beyond that dr.
(04:42):
Garcia, when you talk about these consumer wearables, what
are some of the technology that's out there that exciting
for all of us? But also the fact that it's
really useful for you and in your field.
So I think we're, you know, you did a great job.
Introducing that topic. I think that what the patients
and people out there need to understand is that you guys only
(05:04):
see the tip of the iceberg, right?
This is a multi-billion dollar market and Athletics is the
spearhead, the and we can even get into you know how surgeons
are certainly use these type of things as well on their daily
routine. Which I've had a medium out
those recently, but just talk about the athletes more.
I mean, these wearables have been out for.
(05:25):
We always talk about the early on technology and, you know,
counting your steps. But that is That is not what
we're using for now. You know, those are obviously
fun things at for the standard daily patient to use.
You know, I wrote, I did my steps today.
I did my workout today, but we're really looking at is, how
can we get players and athletes,to last longer?
I mean, we've talked about before, longevity is key to
(05:46):
sports and key to, you know, these continual records were
seeing in key to seeing these athletes.
That are, that are beyond their Prime still continuing to be in
their Prime and wearable. Technology is really the sort of
a The thing that's hidden behindthe scene that is helping the
trainers and the department to do this, and we can go back and
forth and have discussions aboutit being, but you have people
(06:07):
like Tom Brady. Yeah.
But LeBron James, you have guys like Vince, Carter, you know,
just names there that are that performs a high level for much
longer than we ever seen from athletes.
And we talked about the money they spend on their bodies, Etc.
But really it's this technology.That's helping, not only these
high-level athletes. But athletes in general, I mean,
(06:28):
one of the princes, Inside coverof football games for my high
school on Mercer Island and the trainers have helmet Collision
monitors in all the helmet. Well, when a concussion or
helmet, hit is above your level,of what's considered normal for
a normal hit its registers, it has a player's number on it, and
(06:49):
it can pull the player out rightaway, and that's just the basic
level high school with high school budget.
And that's real time informationthat it, how does that get
communicated from point? A to point B to the Coach, and
real time. It's an automatic thing when
they gets hit. The alert goes off the center
break, the sensor goes off and it goes onto the handheld device
(07:10):
that they have. And it says this person was hit
too hard. You know?
And here's the level of was hit.And if you're worried about it,
you know, obviously if it's a malfunction of the helmet then
you don't worry about it too much.
But most the time you pull the player out, you do exam do a
concussive exam like we talked about on the field and see if
they qualify or not. This type of information, In is
(07:31):
pretty much that biofeedback that you're looking for, right?
This is what we, this is the Holy Grail of Athletics.
I mean, I think that this combined with, you know,
procedures and supplementation'sand biologics that we're able to
do for athletes, this is really what's going to keep our
athletes healthier longer and beable to do the right amount of
(07:53):
training. I mean, we could go on and on
there's there's a, you know, oneof the companies that one of the
doctors I work with when I was in residency.
Please do this for pitchers and it was a flea that they wore and
it chose them if they were there.
They were fatiguing or adding too much valgus their arm which
could increase the risk of the Tommy John injury, it tells you,
you know, number of pitches and you have to worry about having
(08:14):
somebody scorecard it, it's completely built into the
algorithm, you know, and there'sdifferent grading systems.
You know, this is going to give give teams real-time
information. You know, is this athlete
fatigued? You know, they have sensors in
the path to know whether or not they're getting hit too hard.
Whether or not they're sweating too much more than they not too
much fluids. I mean there's things that the
biggest concern with all these is there's too much data.
(08:35):
So what do we do with it? Because Adam like a single game
in the end up professional sports, you're getting hundreds
and thousands of pieces of data.So is that important or not?
You know what I mean, if you want to someone's heart rate,
every single minute for an entire game and you that for all
the players on the field, what does that mean in is that we
have to figure out these algorithms to calculate is this
(08:56):
injury or not, so it's using computers but also very
intelligent people in it. Ecology field to find a way to
do this. But this is one of the hottest
markets in the country, especially for athletics.
There's some reports out there that by 2025 one in every three
adult in America will wear a fitness tracker the global world
of wearable fitness trackers Market was valued at thirty
(09:17):
eight point. Six.
Eight billion in 2020 is projected to reach over 124
billion by 2028. So you know, this entire
industry is booming and along with that technology and I just
want to kind of simplify a little Lil Bit, I've worn a
whoop before that goes on. It's a, you know, these smart
watches that goes on the wrist, and it would tell me how I
(09:40):
slept, if I was ready, what kindof training?
I was ready for. So, even basic stuff, you know,
I like, you know, I work out. I like to do kettlebells.
I like to do certain things and that tracking would tell me say,
hey, this is a day, they need togo light, you know, this is a
day that, you know, you can really push it and push a limit.
So even just basically, Formation for someone just like
(10:03):
me. That's just a, you know,
whatever weekend warrior recreational athlete.
You know, I'm getting an important information there to
say, hey, go for it or maybe dial it back.
What is that important for you? That deals with so many
different patients besides athletes.
But just regular patients, like myself to have that type of
information and how, how are yougetting that information?
(10:27):
So, you know, again, we haven't had the technology yet and
unfortunately, It's hard as a surgeon to have time to kind of
review data like that. But I think with the future is
lying at is how do we treat our patients as a holistic approach?
You know, I think it's honestly is probably going to be more
like the primary care setting, where, you know, patient comes
in they say I'm not feeling. Well I'm not doing well and
you're like okay well let's figure out a way that we can use
(10:49):
these tracking devices. Okay.
Well I can see here. You're not been sleeping well
for the last two weeks that doesn't seem to be working well
for you. Your heart rate has not elevated
enough and figuring out this holistic approach.
She says, okay, this person needs to work on these different
things or you know, some of these wants to see people's
lives is a that arrhythmias or something else never wearing the
watch or the track or something else, and it's scene.
(11:11):
And there's there's there's numerous articles out there
about this in terms of these cases.
But what's really cool is this actually goes into the
orthopedic field, we have implants now that have trackers
built into them that can tell ushow the patients using them.
The wear patterns, what the cycles that can do if there's
kinematics or off? I mean, these are pretty new.
But again, this is a way that any for research purposes.
(11:33):
You can have a basically harmless, small additional
implant, put into your implant, and we can see how the patients
are walking is their gate, right?
Etcetera. It's more on the replacement
side of things, but that's whereusually where it starts, and
then a technology continues to move on.
But you know, the wearable technology thing is not just the
(11:53):
average Joe population. It's goes into surgeons, it goes
into surgeries Athletics, professional Semi-Pro and
everything. It's just The huge topic and a
huge huge Market. You know what I'm hearing?
Is that it's really personalizedHealthcare, right?
You know, for that individual isthat something that you're
asking at this point. And I know you mentioned that
(12:16):
there's it's, you know, it's hard to get all of that
information right now. But is this something that if,
you know, you have a patient that where's that type of
technology that you will ask them for any of that
information? Or is that something that maybe
We'll be something that you know, surgeons and, you know,
doctors in the future will ask their patients of.
(12:38):
I think in the future, it'll be something like, you know, what
it needs to be. For most of us in the health
care field, given the time constraints that were all given,
would be some way to have like an app or a printout that shows
like a summary of how you've been doing, you know, not
monitoring the day by day but like okay, come back and show me
how you're doing as an athlete in terms of all of this stuff
and then it gives me a printout shows like oh, you know, you've
(13:00):
been Been down from this month, with your sleeping up with this
month in your exercise, okay? Clearly you're exercise vo2max
your heart rate elevated. Clearly you're doing law for the
surgery, are able to go to a level that you weren't able to
go to beforehand. You know, especially if like, we
can get print out the like two years and I could see what
happened with them injured beforehand and how they were
able to exercise. Maybe not as much and exercise
(13:21):
afterwards. You know, I've been, I've been
injured and had to come back from an injury and I've already
noticed, even with my Apple watch that my fitness level is
increased to the level of was for the injury if that higher.
And so I'm able to tell that this on myself.
So I can see I can easily extrapolate that to my patients
and that's just on the best a basic level.
That's just the day-to-day stuff.
(13:42):
So ideally your you're mentioning that information
relayed directly into Patients health records could be
beneficial for all parties if and when not if I guess when we
get to that point, some of the concerns, you know, is this
going to be, you know, where does HIPAA kind of fall into
this and secure? And what compliant I may be
(14:03):
going down the rabbit hole with this.
So just let me know if I am, youknow, I don't think.
Oh, no Rabbit Hole. This is a that what you just
mentioned. There is probably the number one
concern of everyone. You know, does someone want an
Alexei in their house listing everything they're saying?
And then all of a sudden they goon their Amazon, purchase
listings. All listed there, you know, or
in so, being tracked as never someone as most fish.
(14:24):
Populations. Not happy with that.
The question comes in, you know,are you releasing your records
to your doctor? So I can make you he or she can
make you feel better. I think patients are more apt
amp to do that. But, you know, they would want
it, they probably want to release into a hospital or a
physician's office, you know, I think releasing it to like oh I
work for Facebook. Can I have your data?
(14:46):
People are not going to be pleased with?
Yeah. So we just have to be as it has
to be done in the appropriate Manner.
And I think it will have to be because all these applications,
anytime I use new technology. The number one thing they tell
you, is it typical client so half of HIPAA compliance with
it. So that comes Hand in hand, but
the trust in the application forcertain people, it may take
longer, but again, it's up to them again.
(15:07):
Everything in life, you come in my office, the patient, you'll
know, I'm all about, whatever the patient wants.
And so if they're on them, they don't want to detract or have
information that situation when that technology becomes
available, you know, I'll utilize, whatever resources are
willing to give me, how can you see this being beneficial to
toward telemedicine? So this is a good one, one
(15:28):
worth, you know, just for the standard vital signs, you know,
you can say upload, you know, I got your watch on the link it up
to the application. It tells me all your simp, your
Vital Signs, how you're feeling,you know, it can tell heart
rate, if you're in pain, etc. Those are important things and
that can be relayed or, you know, even with some of these
new programs I could send, you know, the potential future is
(15:48):
like I can send reminders or physical therapy through the
watch or something else and no, that's not out yet.
But yeah, remind your cape. Session today, do your
exercises, you know, have a system set up through a company
that does that the, the newer things, you know, we can do
transplants and a lot of fancy things for the cartilage.
But the stuff that's in Europe is really, what's going to be
(16:10):
coming here soon and then some Consulting for some companies,
but they're having these implants that basically, you
know, car transplant. Someone's cartilage.
Like from person that recently passed away, is it really safe
procedure? But it's a pretty big burden
economically. Also because if they're
expensive to put in There's always a risk of, you know,
infection Etc and again, very good success rates but not 100%.
(16:32):
There are more and more companies working on.
Can we just have something that you make synthetically 3D
printed scaffold? You put in someone's bone, the
bone grows back but then right where the cartilage starts, the
cartilage starts to grow back orcan we have a pace that we make?
That's combining little cartilage B with certain
biological factors and paste that on to grow cartilage.
(16:54):
And we are getting more and morearticles.
He's in the literature showing that this is becoming closer to
reality. Now, we are not there yet, and
again, a lot of this takes FDA approval and while we may get a
good technology, it could still be another 15, you know, two or
three or four, or five or ten years away.
It's coming. And that is where we're looking
at. There are these ways that we can
(17:14):
either save the cartilage? You currently have you use your
own cartilage or grow new cartilage?
From what we have for you, and we can do some of that already,
but it's going to get even better especially for smaller
defects where the insurance won't usually pay for East fancy
procedures in those have a situations.
But those defects still may be painful.
Can you envision something whereyou know you just kind of inject
(17:36):
something into the knee. I'm just using the knee as an
example where you trying to fillin cartilage and you're just
kind of, you know, spraying something, you know, like
whether it's foam or, you know, for lack of better word, they
just got to just fills in the Gap and it'll be a procedure and
you're like, okay, we filled it in your good to go and out the
door, you go. Yes, I think that that I don't
know how far off We are but thatis the goal.
(17:58):
The goal is, you know, the goal is ever, the goal is to do.
A, the endgame goal is to have an injection that you don't have
to look at. You don't have to do surgery.
You just put injection in the knee and the office.
You squeeze the material in there and it finds the areas
that are damaged and tells your needs time to repair this and
then finds a way to repair it with stem cells, Etc.
Yeah. We're pretty far away off of
that but the next step is a surgical procedure.
(18:20):
That is much more minimally invasive that we can go in
there. Find the whole inject, this
material, you know. Bone, send them to Bones,
involved to pick the bone and regrow the cartilage with this
sort of gel foam, Matrix material using both your own
biologic, so your stem cells or PRP and then also the growth
factors in there because again, they have to be told that it's
(18:42):
time to grow cartilage, right. And they've got to have those
mechanisms that take teach them to grow cartilage.
So yes, I mean we're on the, we're on the track but it takes
first growing a scaffold that will regrow this before, we have
an injectable gel. So again this is this is all
Fascinating stuff and it gets pretty nitty-gritty.
But, you know, there is stuff out there and we're getting
better and better. I mean we are so much better
(19:02):
than we were 10 to 15 years ago at helping patients, we catch
them earlier. The other thing is more, doctors
are trained in this. Now before, you know, there were
very few people that knew how todo this stuff.
And so a lot of doctors you would see you and be like oh
there's a hole in your car, there's nothing to do about it
now. We're way more aggressive seen a
number of occasions. I can help that are in their 20s
and 30s that I take care of on an everyday basis is much higher
(19:23):
than what you would normally seepreviously.
Again more people as my partner's understand what I do
as people in the community, understand what we do is
cartilage surgeons, you get moreand referrals and you can help
people sooner, let's talk about choosing medical providers as,
you know, they say, 68 percent of patients say they're more
likely to choose medical providers that offer the ability
to book change, cancel appointments online.
(19:46):
So as we wrap it up, let's just talk a little bit about that, so
yeah, I mean, that's important. I mean online presence is crazy.
I mean, it's, it makes or breaksyou in a big city like Seattle.
Yeah, you know if you're in, I'mpresence is poor.
You're not a veteran here, you know, you can see the patient
numbers are not the same, you know?
I I probably have 90 videos online.
Now, if not more, including our podcast.
(20:09):
And so I want patients before they come in, like you
mentioned, you know, my whole thing when I first started was I
wanted to put so many videos together that my patients came
to see me. They're like already know him.
Yeah. Right.
Like you seem like he's a good guy.
He seems like he's a nice guy and that's the first thing you
notice is you want to feel comfortable with the person.
And so, and I know that's why I like these podcasts because I
can be, you know, it's not so robotic, right?
(20:31):
You're not like, okay, I'm goingto talk about my doctor stuff
only and you know, not miss the personality part because even
though you may only see me threeor four times, I want to make
sure the patients, you know, enjoy caucus origin.
Feel comfortable if something happens to because like it's
much easier, if something happens if we get along to try
to figure out the problem because I don't ever talk to
patients about the best possiblestuff, right?
(20:52):
That's if you do well. And we high-five and my
patients, who if they heard this, If they'll know, like I
said this many times, you know, that's the easy conversation.
Yeah. The hard conversation is a
problem, right? And how do you deal with the
problem? Because that's not, that's the
one where, you know, you're you're, you know, you're the
doctor in there, you just feel terrible, right?
You just want to make this better.
Yeah. And if you have your personality
is something that matches with apatient and they can get through
(21:14):
that. That's the best possible
scenario. I mean, thankfully, we don't
have too many of those but nonetheless, you know, the whole
level got to be comfortable, my patients.
And I tell them all the time is like, if you're not comfortable
with me doing the surgery for you or you're not comfortable
with the situation, Action. And you sure as heck should do
with me, and if you're comfortable with it, and you're
going to do way better. And it's crazy because it really
works. I mean, it's patients are on
(21:35):
board fully and they decide an elective surgery, they do so
much better. It's a mental thing and we have
the whole nother show too, so wekeep coming up with ideas.
Yeah, we got plenty of ideas and, you know, we've talked
about it before and and I'll mention it again and whoever's
listen to multiple shows. I will always say the same
thing, you know, you've mentioned, you know, go get
second opinions. Make sure you're comfortable
(21:56):
with. With your doctor.
I mean this is out of the doctor's mouth.
Now mind you have said this yourself over and over again,
you know, you want your patientsto feel a certain way, a certain
comfort and be sure to come in and talk sports with dr.
Garcia and you know, getting outin the water and swim in.
And I sent a friend of mine overthere to Dory and Dory, I
(22:17):
believe was talking ahead, talking your head off.
So she's a little jibber-jabber and but it's just great and that
says more about you and your personality and the comfort.
So, It's just great to hear and and it's important.
It's more than just a cut and dry situation because we feel
uncomfortable. Most of us feel uncomfortable,
already walking into your officeand not personal.
(22:40):
It's just, we're usually going in there for a reason and we're
concerned and we want to feel better and we want to get
better. And you know, when you can have
other things put you at ease, itjust makes the whole process so
much better. I couldn't agree more and I feel
for the patient's. So you know, the key here is
almost say it. Again, you make you feel
(23:00):
comfortable, but understand, youknow, obviously you've got a
problem, so we got to figure it out.
But, you know, here, we're goingto approach the best we can give
you the best possible Tech. We can.
That's the safest, try to make sure we do everything the best
that we can possibly do, and that's what we keep striving
for. So, is there something in your
field, right? And I know you guys work a lot
(23:20):
of hours and there's a lot of pressure and all different
levels of clients, you travel the world.
Trainee. What is something that really
stands out for you when it comesto your profession?
What it takes in my field especially when you do Sports is
it's a different. You have a mindset the right
mindset first off the pressure cooker, right?
(23:42):
You know, I remember a couple days ago, I had a pretty high
level baseball player and the first thing, the parents said to
me, you know, Dad's dad standingnext to the door.
Mom, say next to the door kids on the kids, sort of upset
because they just tore their Tommy, John ligament and all
they call. I want to know is if when I can
get it back as soon as possible.Well, not even, you know, in
his, it happens all the time, you know, and it's not, it's not
(24:03):
their fault, they're really dedicated.
They put a lot of money and timeinto the baseball.
Yeah. But it's a big deal and you got
to sit down there calmly. And you say, Hey, listen, you
know, I A lot of times at least in my practice so my partner's
they'll send me the higher levelathletes just because they don't
it's it's a lot of work to deal with the parents and if I don't,
it's not a wrong thing, it's just that you know, when you get
that level everybody's invested,right?
(24:25):
Yeah. Yeah.
Parent of parent is my kids spending hours of the pool hours
playing baseball and they get hurt.
I sure as heck, one of the rightthere with the surgeon, what are
we going to do? How are we going to make this
better? You know, not just for me, but
for the kid too, and it's hard. And so your and that's even at
the high school level, you know,the people that you may not even
make it to college and then you get the college player and
(24:46):
they're like, hey, coach wants to talk to you, you know, all
those other things. So, it's not just the actual,
you know, the surgery Parshin ofit.
I hate to say it is actually more of the easy part.
It's the other stuff managing expectations.
We talked about As before. Yeah, every athlete.
You see, you have to manage expectations, you have to manage
expectations in your surgeries. You cannot go in there and tell
every single patient that you dosurgery on it.
They're going to be perfect because that is not true, no
(25:08):
matter how good you are. I worked a lot of good surgeons.
It is not the case, okay, while people do well, that's why we do
sport surgery. That's what we do Orthopedics
because it's a very fulfilling option, but you got to be ready
to take care of the hard stuff, too.
And if you can't the same thing as an athlete, if you can't
handle the pressure, then that'swhen the problems.
Awry or that some patients are upset because something happens
(25:29):
and they can't their doctors nottaking on their own.
It's the responsibility of the challenge.
You know, it's super easy and I tell patients is all the time.
It's super easy if ever seen oneof my patients in the office did
amazing. If I had a hundred percent
success rate, being a surgeon will be way too easy.
You have to be fairly honest with you, it's the hard part is
that 5% or 10%? You know where the kid that you
did, it made a perfect ACL on Andre tears.
(25:51):
It how do you deal with that? And that's the same thing with
athletes. How do you deal with?
That tear of your own ACL and getting back next level, when
all the odds are against you. Or in my case, I'm the one who
did the surgery, so I feel responsible.
Even if there was nothing, I didwrong.
I did exact same surgery for thelast kid, let's move on to
augmented ligament and, you know, fertilized ACL.
(26:13):
I know what fertilizes, but what's a fertilized ACL?
Oh my gosh, we're going to open another can of worms here.
So we'll try to make all this brief.
I would refer to listeners to our previous ligament internal
brace. Talk that's going to talk a lot
about this. Yeah but there's this talk of
this new ACL and it's been happening down in the South with
(26:33):
this guy doing these ligaments, he's doing young patients.
ACLS with a combined of bone graft and elixir of sort of
marrow from you stem cells and putting them into the knee and
doing ridiculous things in termsof recovery rehab.
So an ACL that requires a littlebit more effort.
The negative of the ACL is that it's also more expensive.
(26:56):
So there's out-of-pocket costs of the patients.
Yeah, but the data that he's showing right now is showing
patients are back to full activities and under four
months, And that's coming off a torn ACL.
After torn, reconstructed ACL. Now we've tried this in the past
and it failed where people have tried to get back earlier and
everything else and you have their stories about someone
(27:18):
coming back in three months and then they play one game and then
they rip it again. Yeah.
And there's something called ACLrepair that were always trying
to get better at. But again, there's been a lot of
negative press on that, as well,there are indications for it,
but not often. But this fertilized thing is
extremely. I just recently saw the talk on
it and at some point I think in the next year or two, I'm going
to bring it to practice here. Seattle area.
(27:39):
But it's an option. Where certain patients, who are
younger? You know, they're showing
patience running at two months. I mean, Target two weeks.
Now, this is going to be a lot of pushback from orthopedic
surgeons, but they're in clinical trials right now with
this option. And if this is really can
happen, the way it happens, is it takes a soft tissue.
Graft that normally would take six months to heal in.
(27:59):
That's why you don't want to youdon't run on something.
You don't do anything crazy withthese ligaments until they're
fully healed into the bone tunnels.
Yeah. And basically like putting bone
graft already in the tunnels, Soit's like speed up the healing
process by like two times and they have MRIs showing it to.
And so if there's something we can do, even if it's added cost
of the patients because it's a little bit more, fancy insurance
will cover it. Part of it, at least they'll
(28:21):
cover the ACL of the extra bone,grafts tough.
This would be for high-level athletes.
It should be Game Changer, right?
It's not an everyday, patient procedure, but if you're young
and you're a varsity, person canbe recruited and just tore your
ACL. And you have your, you know, at
the end of the season, you have the next season coming up and A
month and you want to get back and we have this crazy option to
do it. That would be the person that
(28:42):
you do it for. That's absolutely amazing.
I mean I knew that would get youwith that one.
About two weeks ago I was on online social media, you know,
MIT is, you know, doing these robotics facial expressions and
they wear the way they reacting and I'm like, okay, this is
straight out of Terminator, we're all going to die and this
(29:02):
is going to be crazy, but for your field in the purposes of
your field, How important is thefuture of Robotics going to be
in Orthopedics. So I think there's a couple ways
you can think about it. One is like straight up robots
like you hear, people are operating those robot actually
operating and you're doing it from.
(29:23):
You know, the long-term goal would be to take, you know, some
of the best surgeons you have and be able to give that access
to other people, right? So you're in other places
overseas etcetera and able to dothe surgery so that the person
can have the best person not to worry about flying, you know,
from India, or from Japan, and going to United States or vice
versa and see the best guy that's tough.
I think we're a ways out from that because obviously, you have
(29:44):
to worry about You know, internet lag, and those type of
things the future. What we currently have is, you
know, the sensors, the virtual reality.
So there's implants that people put in some of the Tony and
plants, you can now they have like sensors.
So they'll tell you how complacent, the patient is what
they're loading differently. How many, you know, when they're
taking breaks we can also monitor things, you know, speed
(30:05):
of the implant and those are thethings and look at where
patterns even in. It's completely safe to have
that in the built into the implant itself.
And you know, The 3D printing model.
That's an amazing. That's, that's a game changer
every last five years. I'd say, you know, I do shoulder
Replacements and I get a 3D printed model, the person
shoulder that I can work with onthe outside during the surgery.
(30:26):
So I can say okay, this is exactly where this special guy
will go. I've planned the whole surgery
before I go in there and then I have these augmented guides that
are 3D printed with and I can actually put the pin in the
exact spot that I want to put it.
It's way more precise even than doing it naturally.
Like, I can do it normally, but having this just adds even more
precision. Jessica complex cases and you
(30:47):
know, I'm doing the special osteotomies we can, they can 3D
print this guide with everythingon there with all the cuts and
then even have the little thingsyou want to.
If you want to add more surgeries to that actual cut, it
can be all built into the guide for you all 3D printed custom
for the patient's. So this is the, this is pretty
slick stuff and you see you're playing whole surgery ahead of
time. You can see your whole template
and you can adjust things. Like, I just talked to one
(31:09):
company from France and I was onthe loom, call with them, like,
okay, move this pin here a little bit more bubble ball and
you can like plan everything ahead.
And we discussed a couple shows prior to this one about
telemedicine and some of the regulations that have changed
since, you know, we've been in this, you know, the covid-19
world. Do you think that more
(31:30):
regulations will have to change or be lifted?
Especially if you're dealing with a patient may be out of
state or you know, some kind of Consulting.
So I think the regulations always are in flux.
Yeah, you know, and you know, and obviously the regulations
open. Up to get patients access to
care because they couldn't go into see the doctors and
(31:50):
unfortunately, sometimes it's what's first, the chicken or the
egg, and the situation you're like, is it going to be the data
is released and if people feel uncomfortable and then we have
to lock down more, or is it going to be the data's lockdown?
We have to slowly find ways to release it, so we can get the
information to patients. So if you see the second one but
sometimes that happens in the first one and then all of a
sudden you get some complaints that I don't feel safe with my
data. I don't want you to have all my
(32:11):
data. I want to be selective and then
you got it, rewrite the book butBut again, this is a, this is a
far ways out and we really need good studies to show that
benefits, you know, just me looking at your sleep habits for
the next six months, or your, your heart rate really going to
change the management of my of your problem.
If it's not, then there's no point.
Yeah, but I think we're comes into is like, we keep always
(32:33):
going back to it. I hate to mention just the
athletes again, but it's really the athletes.
It's can I my player, you know, have been my players from having
season-ending surgery. However, my players from
fatiguing early and getting dangerous complications, I mean,
you hear All the football players that unfortunately have
bad complications as you know, high school college level, that
sweat too much and have neurological complications.
(32:53):
Can we prevent that with trackers on them to see if their
heart rate jumps up? Because, you know, a lot of
athletes they just don't want totell you when they're not
feeling well and then all of a sudden it becomes too late where
their bodies can't compensate anymore.
And that's what we really want to protect against.
One of the things you mentioned also was the fact that everyone
can have some kind of measurement in tracking on how
they feeling including yourself.Elf.
(33:15):
So as a doctor that may not be feeling great.
And you have this type of technology is that something
that maybe you can see your employer mandating saying, hey
we want to know if your best nowbefore you go into a 5-hour
surgery. Yeah, that's a tricky.
That's a tricky situation to be,and it's a tricky question,
(33:36):
right? It's Tricky.
Oh, you know, background is, youknow, you have to learn how to
not be at your Prime all the time as a surgeon.
Yeah, you know, when you're in red, you're getting one hour of
sleep and they're expecting to be at the top notch.
You know what? I'll talk about a very brief
topic. Yeah, we just got the Navy SEAL
came in and gave us a discussion.
If the company high performance company that uses trackers on or
(33:57):
tan surgeons, and will tell their sleep patterns, how
they're feeling stressed. Levels of cortisol levels, Etc.
And we'll call the gameplan saying, Hey listen, you know,
you're fatiguing out. You're not getting the sleep,
you need, we should probably figure out a way to make your
body better, because we're kind of like that, that sort of
high-level professional that will push through anything.
(34:17):
You know, I know many many surgeons that have come into the
office feeling really not their best and push through the day.
Yeah, you know, with no teeth, no worries for outcomes for
patients. I mean, this is not some that
jeopardizes patient's Health butyou know and if they were Were
in the regular employment opportunity.
When it come in third, is our program, we're programmed at an
early age that you don't feel well or you're hurt, you still
(34:41):
come in. You know, I cope I took off like
one sick day in ten years. Well stuff that gives you an
example of the way I work and I can tell you right now that I
probably should have taken more but it's just the way you're
programmed. It's the same thing as you are
in the military type of style and you know that's what's
really important is that we really need to test our Doctors
(35:02):
and surgeons are at the highest level of stress, but they also
have the highest and I've littlestress high school, but
perseverance to sort of negativefactors and they have a pretty
important job you want them at their best.
And so if we this company basically looks at all those
things and will give recommendations and find ways to
decrease burnout. Decrease, you know hopefully not
(35:24):
MediCal errors. Decrease surgeon, turn over all
those things which happen you know, if you've been Not pay
attention your body, not sleeping, operating laid doing
all the things you can do and all of a sudden you just shut
down. You just, you know, you're
tired. You want to quit your job like
that could have been prevented if we had given you the right
resource. Yeah.
And so that company does they did it at at the Cleveland
(35:46):
Clinic a pretty big hospital andthey made some huge efficient
changes to the company and to the surgeons to make them more
efficient and more efficient, it's like more rested.
Okay, it's time for you to go tosleep, you know, next four
hours, it seems silly to have totell adults.
Title professional to do this but you know, we're normal
people too, and we want to, you know, stay up late.
Enjoy a movie here and there andit's good for us to understand
(36:09):
that, you know, if we want to prioritize being our best, those
are things you have to do. You know, I know I've changed my
habits even the last six to eight weeks with my tracker
taking in more of engine saying,Hey, listen.
If I get this amount of sleep, Ifeel way better, how can I make
myself better? Because that's where always
trying to do at least in my field and what I do is how can I
make myself better? How can I have better outcomes?
(36:30):
How can I reduce Is any medical errors, how can do all those
things, and that's what that helps me.
Do and ivory notice the difference personally, I could
jack, you see, you know, everyone getting kind of tracked
and you coming in and say, what listen, we saw your vitals
before he came in where, you know, you're not up to Optimum,
we're gonna get you a Gatorade, okay, we're gonna get you some
B12. We're gonna relax a listen, we
got to massage your feet, you know, he's feeling a little
(36:53):
stiff, he didn't sleep well lastnight, okay, all right, you
know, almost like a pit stop, you know, he just kind of coming
in and getting you ready? Are you ready to go?
Hit the road again? No, I'm making light of it but
and it's amazing that the Cleveland Clinic is taking that
information and say pretty much saying that we can be better by
making sure that the people thatwork for us.
(37:13):
We take care of them and make sure that they're at their
Optimum performance. What is some of the other
technology that's out there right now that our listeners
would be surprised to hear aboutand it's just exciting for you.
Well, I'm a summer so I can tellyou about these Technologies
came out. There's a heads-up display
that's in your goggles. And then some of the higher
level athletes are using it to for swimming.
(37:35):
And you will tell you your lap count and whether you're on Pace
and all, your vitals will link into your Smartwatch while
you're doing it. And a couple days ago, I was
climbing over and I some guy pops out of the pool and wants
to show me his goggles because they were these new heads up
displays. Yeah, then I just read about him
in a magazine to. So it's kind of interesting.
So that's a new fun piece of technology that you can actually
get your hands on. They have new something called a
(37:58):
Tesla suit, not related to Tesla.
Now we're talking about the bodycoaches and they think that this
technology could increase the championship caliber of boxers
by a significant amount because it's going to tell you, you
know, how many punches you're taking whether your forms off
etc? Those are just two examples.
A buddy of mine. Got the virtual reality goggles
and, you know, he sent me a video and he's a he's in his
(38:22):
early 50s and he's like, man, I got this and I'm just having a
blast and he's got the boxing game and he's coming and he's
like, I get no, I threw my shoulder out, I'm sweating.
I'm doing all these different things.
It's so it's so interesting. How virtual reality, you know,
being active is changing, you know, it's not going to the gym
and you know, grabbing a punching bag.
(38:42):
Obviously there's a huge benefits and just, you know,
doing something like that. But being in his living room
being, you know, someone that's working full-time coming home
late maybe not have the time to run to the gym but on his
virtual reality headset gets hisworkout in and and you know and
off you running. So just seeing where technology
is going. Is really fascinating.
(39:02):
I couldn't agree more. What is something that if you
had to share with your listeners, you want to share
with them. I think I would share this,
especially for the athletes, butkind of anybody, you know what,
it takes to get to what you wantto do, you will be, there will
be Roblox and you don't know what they're going to be, could
(39:24):
be something academic. Could be something Mathletics,
it could be something, your family, it could be an injury,
you know? Going to be roadblocks and
really, it's how you deal with those roadblocks and making sure
you do the research, get the right information to take care
of that, you know, finding the right person to take care of
your injury. Who feels good about this
finding the right person. Counselor, take care of the
(39:46):
academic side, whatever it is that you're missing is a piece
of you and is not going in the direction.
You want it to find a way to correct that, with whatever it
takes. And I guess, whatever, what is
it, what does it take versus? Whatever it takes?
I think that People that separate themselves, do whatever
it takes, obviously within the realm of things to get that next
(40:07):
level. And if you're willing to do
that, a lot of times you could be successful.
And again, as you mentioned before and I as I see all the
time and all my patients successis measured in so many different
ways and really it's about how you impact the people around
you. And in the end, the people that
I remember you the most your family.
So if you do those things, right?
(40:27):
That's the most important. But again, just making sure that
you stay on the course. That's the Hardest thing, let me
stay on track for any specialty and my job or being an athlete
or anything. That's the most important thing
is. Stay on track.
Stay focused and do what you love because you don't love it.
There's no point in doing it.
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