June 11, 2025 • 51 mins
Have you ever been told "just stop doing that activity" was your only option for joint pain or injury? Dr. James Gaddis is revolutionizing orthopedic care by offering effective treatments that fill the massive gap between conservative approaches and going under the knife.
In this eye-opening conversation, Dr. Gaddis breaks down the science behind regenerative orthopedics – from simple prolotherapy to advanced bone marrow concentrate injections. He explains how these treatments harness your body's natural healing mechanisms to address everything from tennis elbow to bone-on-bone arthritis, often allowing patients to avoid surgery altogether while continuing their active lifestyles.
Perhaps most shocking is his revelation about common corticosteroid injections: a standard shot delivers approximately six million times your body's natural steroid production – "the difference between a matchbook and the Empire State Building." This massive dose, while temporarily reducing inflammation, accelerates joint degeneration with repeated use. Dr. Gaddis offers smarter alternatives that provide relief without the devastating long-term consequences.
Through fascinating case studies, including a distance runner with advanced hip arthritis, we learn how regenerative treatments address not just the painful joint but the entire kinetic chain. Dr. Gaddis's unique background combining neurology with regenerative medicine gives him exceptional insight into complex conditions affecting the spine, headaches, and TMJ disorders.
For anyone facing joint pain, sports injuries, or arthritis who wants to stay active without surgery, this episode provides crucial knowledge about cutting-edge options that most traditional doctors won't discuss. Dr. Gaddis also shares four essential questions to ask before pursuing any regenerative treatment to ensure you're getting effective care rather than expensive pseudoscience.
Listen now to discover how your body has everything it needs to heal itself – with the right guidance from experts who understand both the science and your desire to stay active and pain-free.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:00):
If you're a driven, active person who wants to reach
and pursue a higher qualitylife with some ambition, then
guess what this podcast is foryou.
This is the Driven AthletePodcast.
What's up?
Y'all?
It's your man, dr Kyle.
Welcome back to the DrivenAthlete Podcast.
We've got a really cool guest,dr Gaddis.
Dr James Gaddis, thank you forcoming in, man.
I know you're a busy dude fromyour practice, so thank you for
(00:22):
coming in, dude.
Thanks for having me um the uh.
So tell us more about um yourpractice, regenics, right where
you're at and what y'all domainly yeah, so it's a uh.
Speaker 2 (00:34):
The practice is called palm beach regenerative
sport and spine.
Okay, and within my practice Ioffer regenics, musculoskeletal
care and Regenexx is basically anetwork of physicians that
perform essentially regenerativeorthopedics.
We use biologics, your ownbiologics, like PRP, super
(00:54):
concentrated platelets and bonemarrow concentrate and a host of
other things, to sort ofaddress any sort of
musculoskeletal condition, fromthe top of your spine all the
way down to the smallest bone inyour toe.
Um, it's all injection-basedtreatments under image guidance,
x-ray guidance, ultrasoundguidance, um, and really it's,
(01:16):
it's more than just, you know,injections to fix a joint or
something like that.
It's a different sort ofapproach to musculoskeletal care
to address that massive gap inbetween conservative care which
is what insurance companies liketo call it and surgery, and we
know now that a lot of surgeriesthere are many surgeries that
(01:36):
are absolutely necessary- andthere are a lot of surgeries
that might not be necessary butare overutilized because of a
lack of options, essentially,and we're starting to discover
now that their outcomes aren'treally any better than high
quality or just doing nothing,and if they can find some high
quality therapy, they might dobetter than getting surgery.
So I occupy that space inbetween, cool.
Speaker 1 (01:59):
So you find yourself.
A lot of the treatments thatyou all do are enriched uh.
Platelet injections right prpbone marrow, dense uh injections
right like bone, utilize thebone marrow yeah, contents yeah
and then um uh stem cells that'sso.
Speaker 2 (02:19):
Yes, I'll kind of start from our shopping list of
things that we use perfect fromthe most simple, which, by the
way, I forgot to answer yourquestion earlier.
So, we're just down the street,okay, we're on palm beach,
lakes, boulevard, uh and villageright next to renegades okay,
yep you ever been to renegades?
Speaker 1 (02:34):
fun place.
Yeah, yeah, yeah, get yourcountry dance on, yeah exactly,
um.
Speaker 2 (02:38):
so our sort of armamentarium of tools, from the
very most simple, isprolotherapy.
Prolotherapy is sort of likethe godfather of regenerative
orthopedics.
It's just concentrated sugarwater and we use that to treat
simple conditions liketendinitis, tennis, elbow, any
type of ligament laxity.
(02:59):
We can use prolotherapy as asimple option.
It acts as a mild irritant tothe tissue and causes
proliferation of cells that areimportant for ligament growth
and ligament health, things likefibroblasts and it lays down a
lot of collagen and so on.
Speaker 1 (03:14):
Okay, so it stimulates fibroblast activity
to lay down new collagen bycreating a little bit of
irritation on purpose within thearticular, Well within tissues
within the ligaments themselves.
Speaker 2 (03:26):
So let's say you have like a lax MCL and you're
getting a lot of nevalgus.
We'll inject it into the MCLand it doubles in the sense that
you have the proliferationbecause of the inflammatory
reaction.
But it also acts as an osmotic,meaning it's concentrated, so
it kind of draws fluid out ofthe tissue and tightens the
tissue up.
There some debate about howtrue that is, but you still, you
(03:48):
know, improve ligament healthby using that.
So that's our most simpleoption.
The next most common thing weuse is called super concentrated
platelets, which is actuallysort of one step past prp.
Okay, meaning um.
Prp is basically you take wholeblood, you spin it down, you
get rid of the red blood cellsand what you're left with is
plasma full of platelets we callit platelet-rich plasma and
(04:11):
that's usually about one and ahalf times the concentration of
the platelets.
That's just floating around inyour blood as is, which is
useful.
But we take it one step furtherby taking that plasma and
concentrating it even more, andthen from there we have, like
this dense pellet of just youknow, several billion platelets,
(04:31):
and then we can use whateverleftover plasma there is to
tailor the concentration of PRPOkay, which is important because
some tissues require higherconcentrations of PRP than
others, which, by the way, letme know if I'm getting two in
the yeah, no, I love this um,yeah, so we're able to
concentrate the pr or I shouldsay scp, super concentrated
(04:52):
platelets.
Okay, um, to differentconcentrations depending on what
I'm treating, meaning you know,ligaments and tendons.
I can usually five to seven xconcentrated is good, but if
we're treating, let's say, youknow, a herniated disc in the
lumbar spine, you need 20x andyou know that requires a lot of
blood to get to that 20xconcentration, but it matters um
, so that's scp.
(05:14):
And then we typically use thosefor mild to moderate conditions
and most most spinal conditions.
Okay, um, beyond that we enterinto the realm of bone marrow
concentrate, and that's wherethe word stem cell sort of fits
okay I don't like to say stemcells alone, because that
implies a whole nother process.
(05:36):
That is not, you know, not fdaapproved in the us right now and
certain facilities can do itcorrectly overseas and so on.
But as far as what we can do inthe US with your stem cells is,
we can get your bone marrow.
Very similar to what they do inthe hospital for, you know,
cancer patients and so on.
They aspirate bone marrow fromthe pelvis, from the big iliac
(05:59):
crest on the side there.
From there we take anywherefrom 60 to 90, in some, some
cases, over 100 cc's of bonemarrow and we can concentrate
that down and take specificallythe white uh, the white cells or
the buffy coat.
The buffy coat has all the stemcells essentially.
So let's say, out of a 90 ccbone marrow concentrate draw,
(06:23):
I'll probably get three or fourccs of concentrated what we call
mesenchymal stromal cells.
They used to be calledmesenchymal stem cells, now
they're called stromal cellsokay yeah, think of them as like
stem cells with a collegedegree okay, meaning they used
to be pluripotent.
Like they, they could becomeanything.
(06:44):
And then, because of where theyare, they essentially have
differentiated into some sort ofmusculoskeletal tissue.
They're either going to turninto ligament, tendon, cartilage
, bone or muscle and, dependingwhere you inject them, they sort
of learn from their environmentthat you've injected them into.
What kind of cell they turn intoand they follow suit, exactly,
(07:05):
exactly environment that you'veinjected them into, what what
kind of cell right turn into andthey follow suit.
Yeah, exactly, exactly.
So out of you know, out of a 90cc bone marrow, you get maybe
four ccs of concentrated bonemarrow cells.
And then out of that four ccsyou might have, like you know,
several hundred million or a fewbillion stromal cells, mscs, uh
, and within that there's likemaybe 100,000 actual true stem
(07:26):
cells.
Yeah, so you do have a smallconcentration of your true stem
cells inside your bone marrow,but it's a small number.
Speaker 1 (07:33):
Right.
Speaker 2 (07:35):
Up until about 2009, it was possible to isolate those
few stem cells, analyze themand then culture them, grow them
out, and so then you couldexpand, or what we call culture.
Expand those stem cells toseveral billion, and now you
could store them and have themfor later.
(07:55):
But in 2009, the FDA ruled thatthat was called more than
minimal manipulation.
There's basically these lawssurrounding what you can do with
human tissue, and minimalmanipulation is one of these.
So basically, you can't changethe chemical properties or grow
things without it beingconsidered a new drug, and a new
(08:16):
drug requires phase one, two,three.
Speaker 1 (08:19):
FDA trials.
It's a several billion dollarindustry.
Speaker 2 (08:21):
So those facilities that were able to do that sort
of moved offshore.
For example, regenexx has auniversity-style lab in the
Grand Cayman Islands where theydo this.
They basically culture yourstem cells, expand them, store
them so you can use them foryears and years and years later.
As soon as I get the chance,I'm going to go out there and do
(08:42):
that before I turn 40, get somepre-40 stem cells.
But going back to the US, andwhat I do essentially in clinic
is we isolate bone marrow, weconcentrate it down and then
from that we can inject thatback into more severe, severe
arthritic conditions like boneon bone.
Arthritis is a commonly usedone bone death, avascular
(09:04):
necrosis of the hip, things likethat.
We can inject it into the boneand it essentially halts the
progression of of arthritis.
Speaker 1 (09:11):
Yeah, Pretty good success rates.
That's really cool.
That's awesome.
Um for SCP um super condensedplatelets, super concentrated
super concentrated plates Closeenough, yeah, yeah For herniated
discs?
Um, and then I was also goingto ask about tendinosis, like
maybe a golfer's or tennis elbowor something like that.
Is there super common like whatthey call like recalcitrant
(09:34):
development or progress for likehealing?
Um, what's for hernia discs?
What's the mechanism?
Speaker 2 (09:40):
So it depends on what kind of disc you're you're
treating.
So let's say a disc that has alittle tear in the outside of
the disc an annular tear.
We know that if you just pumpthat disc full of super
concentrated platelets theymight just leak out of that tear
.
So what you have to do isdecide, okay, where is this tear
(10:02):
and what's the best way for meto approach it?
Because you really want to putthose platelets right in that
tear, because those plateletswill stick and aggregate and
then they sort of open up fromthere.
So let's say you have a disctear that's sort of out
laterally on the side, itactually makes more sense not to
even go into the disc but tojust, with the needle under
x-ray guidance, just go right upto that little tear and park
(10:25):
the needle right in front of thetear and deposit your platelets
there.
Very few cc's.
If you're dealing with a discthat's a little bit more
degenerated, um, or is, you know, bulging, then it makes more
sense to sort of go into thedisc itself, um, and from there
you have to sort of decide first.
You know, is this the discthat's bothering the person,
(10:46):
cause usually there's more thanone disc.
Speaker 1 (10:48):
Yeah.
Speaker 2 (10:48):
So you do what's called a discogram.
So we basically guide theneedle in there.
The patient is awake, um, andwe inject a small volume of a
combination of antibiotics and,uh, contrast.
Contrast agent basically showsa dark on an x-ray.
Speaker 1 (11:02):
so we can see it.
Speaker 2 (11:03):
And we try and provoke that disc.
We fill it up a little bit andthen we ask the patient does
that reproduce the same painthat you have?
And a lot of times they'll sayno, that's something different.
And so you sort of have to lookand maybe it's not the disc
that you expected, maybe it's adifferent one.
So you know, of course, correct.
Once you sort of reproduce thatpain, then that's when we
(11:24):
inject about, you know, three tofour cc's, depending on the
disc, of that highlyconcentrated prp uh, and it has
your white blood cells in it, sowe call it leukocyte rich prp,
gotcha.
And that's more of a protectivefactor because the discs are
prone to getting infected.
(11:47):
They oftentimes are colonizedwith a certain type of bacteria,
and so you want to have yourwhite blood cells in there to
sort of manage that party, right, yeah totally.
Yeah, so again, it reallydepends on the disc.
If you're dealing with anannular tear, which is usually
the most painful, you want toget as close to that tear as
possible.
Um, there is a device by thelate great dr greg lutz, uh, who
(12:12):
recently passed away.
Um, it's like a catheter thatbasically kind of curves around.
So you enter the disc and thenyou introduce this catheter, it
curves around and you can directit right to that little tear
and you just deposit yourplatelets right there
interesting, which is amazing.
It's amazing device or you justfill up the disc itself.
Speaker 1 (12:28):
Yeah, interesting, um , and then the platelets will be
in there, they'll aggregate,proliferate and then help scar
down and heal up the tear.
Speaker 2 (12:38):
Essentially, yeah that that's the goal.
So, um, there's a lot ofstudies that show that the more
that degenerated the disc is,the more likely those platelets
are just going to immediatelyleak out.
So if you have a completelydesiccated or degenerated disc,
then you sort of have to decideis it worth injecting the disc
and putting the patient at thatrisk, or do you want to do a
(12:58):
more aggressive treatment anduse culture expanded stem cells?
And use culture expanded stemcells, which those have been
shown to improve verydegenerated and desiccated discs
, because they sort of they havethese receptors on them, called
CD19 receptors, that they stickto whatever surface that
they're injected on.
They stick within like threeminutes.
Speaker 1 (13:18):
Cool yeah, so a lot better stick rate.
Speaker 2 (13:21):
A lot better stick rate.
Yeah, exactly.
Speaker 1 (13:23):
And for a patient like that, how many rounds of
those injections?
Let's say it's like a verydegenerative disc and they're
having referred pain right Backpain.
Yeah, they got an image.
Looks bad.
Do this right.
How many rounds of that?
Speaker 2 (13:39):
So, and then re-image like in six months and they'd
see an improvement, or eightmonths oftentimes we will let
re-imaging like let the patientdecide if they want re-imaging
or not, because we don'ttypically when it's.
It's definitely nice to havesomebody come back with a
post-injection mri and it likelooks beautiful yeah, generate
like see everybody, look, lookexactly but more often than not
the disc will look exactly thesame.
(14:01):
On the mri you might have someyou resolution of some tears and
whatnot which we can see.
We actually published a studyon this out in Colorado where we
did pre and post MRI studies ofintradiscal injections of
annular tears.
It required a lot of sort ofMRI software programming to be
able to determine the grayscaledifference on these different
(14:21):
discs.
Speaker 1 (14:22):
But, anyways.
Speaker 2 (14:24):
yeah, sometimes you'll get image resolution of
the disc.
That's always good, but moreoften than not the patient's
symptoms will improve and theirdisc looks exactly the same.
You don't want to go into thedisc.
That often it is a riskyprocedure.
Speaker 1 (14:38):
So the disc looks very, very similar, but their
symptoms are a lot better.
Speaker 2 (14:43):
Yeah, most often that's the case.
Sometimes you get thisbeautiful post injection MRI
where the bulge is resolved andthe annular tear is resolved.
Speaker 1 (14:51):
So, if that looks the same, where do you like?
What are your thoughts on like?
What was the symptom reductionfrom?
Speaker 2 (14:57):
A lot of times it's leakage of the inner contents of
the disc.
Um, that has a lot ofinflammatory cytokines in it.
There's a nerve that sort ofencompasses the disc called the
sinovertebral nerve.
You don't see that nerve inlike neurology textbooks.
It's hilarious.
You just kind of skip over thatand find out about it later.
(15:18):
So you can definitely haveirritation of that sinovertebral
nerve because of theinflammatory cytokines that leak
out of a degenerated disc.
And oftentimes those sameinflammatory cytokines can
irritate the nerve roots andthat's where you get not
radiculopathy meaning like youknow down symptoms of a nerve
but you get radiculitis.
So hypersensitivity, pain andsort of tingling and things like
(15:41):
that.
So that tells me that, oh,there's something's irritating
the nerve but not compressingthe nerve necessarily so by
injecting platelets, you'rehopefully stopping that leakage
and reducing that inflammatoryreaction.
Speaker 1 (15:53):
Right, right Totally, and then with tendinosis, right
Degenerative tendonprogressions.
Do you do a lot with that?
With that too?
Speaker 2 (16:02):
Yeah, that's like our bread and butter a golfer's
elbow, tennis elbow?
Speaker 1 (16:05):
yeah, a lot of stuff, a lot of achilles, yeah and
achilles you can do some prettycool stuff.
Speaker 2 (16:10):
But basically you know a lot of times an mri you
know you get somebody withtennis elbow will look at an mri
and if there's no obvious tearthere it doesn't really tell me
100 that there's no tear.
So oftentimes when we'retreating with PRP I will sort of
explore with the needle meaning.
I'll introduce the needle intothe tendon and I'll gently test
(16:34):
with some pressure and ifthere's resistance, then I know
that that is an intact tendon.
There's no tear there.
But sometimes you put a littlevolume of fluid and a tear that
it was hiding now all of asudden opens up.
You could see it hiding inside.
You would have never seen thaton an on an mri um, and so we'll
sort of, when you see that youwant to like fenestrate the
tendon, you want to increase thesurface area of that tear so
(16:57):
that these platelets canaggregate open.
Speaker 1 (16:59):
yeah, interesting, yeah, that's really cool.
I mean chronic lingering tenniselbow and golfer's elbow.
It's like I battled thatrecently, like where the last
maybe 10 months, probably maybeeight months, oh yeah, just
lingering.
Speaker 2 (17:15):
Um.
Speaker 1 (17:15):
I'll needle myself like dry needling myself and
stuff, but, um, man, it can it.
It's uh, it's annoying, it is,you know, like a lingering
tennis elbow or achillestendonitis, like a lot of
patients stumped.
You know what I mean.
Speaker 2 (17:27):
Yeah, um, that's good , though one thing that I would
add to that is um, you know,when somebody has a chronic
tendon issue, it's worth lookingoutside the tendon.
You've got to wonder why, likeyou know why is this guy having
this recurring tendon issue?
right exactly, and so a lot oftimes, especially especially
with people who have well, yeah,let's say, tennis elbow or
golfer's elbow.
I'll look upstream.
(17:48):
I'll look at the shouldermechanics.
I'll see if their arm is, youknow, tends to be pronated.
I'll look at any cervicalissues.
There might be a subclinicalradiculitis there, you know.
If they're having a golfer'selbow, well that's your sort of
T1 dermatome.
So I'm looking at C8, T1 nerveroots to see if there's any
issues there.
(18:08):
Is there any forward headposition?
Is there any irritation of thefacet joints in that?
Speaker 1 (18:14):
area.
Speaker 2 (18:14):
Yeah, totally so I'll likely treat that whole kinetic
chain.
So we'll do platelet epiduralsat those levels.
We'll treat the ligaments,we'll treat the joints and then
we'll treat wherever the actualtendonosis is.
Speaker 1 (18:26):
Sure, that's awesome, I think, something that
separates like a person likeyourself in orthopedics you know
what I mean and I'm like that'swhat of course like as a sports
physical therapist.
Like we're not going to do PRPinjections, although dry
needling can be helpful totallybut anyway, we definitely like
when we got to look at thescapula you know, on the
shoulder Cause, like if I'vealways under the impression some
mentors described it like atendon at this point is the
victim.
(18:46):
If it's overwhelmed and likechronically a tendonitis problem
.
You know what I mean.
It's like usually it's becausethat thing is a victim and it's
overworked and over requiredbecause of compensation issues
elsewhere, and especially like afull body movement, like swing,
like a tennis player right oreven um, there's got to be other
conversations elsewhere.
That's maybe like what'sleading to the tendon getting
(19:07):
lit up and overwhelmed in thefirst place, like we have to
address those things, and thenthat'll actually follow suit,
versus, like, just treating thetendon like this.
Um, it's just a, you know, atertiary problem yeah, it's a
very like kind of binocularsview.
Exactly, yeah, which ishonestly that exactly right.
Speaker 2 (19:22):
there is why I left pain management, because I was
in pain management initially andI was like I need something
more.
Speaker 1 (19:29):
Like we're missing something.
You know I was going to ask, sotell us more.
All right, A little morebackground story.
Originally, where are you from?
Yeah, and then where'd you goto med school?
And I know you were in Coloradodoing a lot of neural research,
right?
Yeah, yeah, yeah.
So you know I like long walkson the beach.
Speaker 2 (19:48):
Yeah, yeah, yeah, my folks are actually from Egypt,
first generation Americans.
So I grew up in like the woodsin Georgia.
Speaker 1 (19:54):
Okay, where in?
Speaker 2 (19:55):
Georgia Marietta, like outside of Atlanta.
Speaker 1 (19:57):
Okay, yeah, Because we took we as a family
Thanksgiving trips up innorthern Georgia.
Speaker 2 (20:02):
Oh nice.
Like Blue Ridge Mountains areayeah, yeah, yeah yeah.
Speaker 1 (20:05):
So we passed through Atlanta and go to like Helen or
what's it?
Dahlonega, Dahlonega, yeah,yeah.
Speaker 2 (20:09):
They got one of the roller coasters at Six Flags up
there.
It's called the Dahlonega MineTrain.
Speaker 1 (20:14):
Oh, really that's cool.
No, we love it up there, man,we want you know it's a
beautiful, it's beautiful yeahyeah, beautiful forest, um.
Speaker 2 (20:29):
So yeah, grew up there, moved down to fort
lauderdale in like 2003, uh.
And then I went to high schoolpompano beach high school and
it's actually there where I hada ap biology teacher who she was
the one who sort of got me onthe medicine track.
Speaker 1 (20:43):
Cool.
Speaker 2 (20:44):
She was a biology teacher.
Speaker 1 (20:44):
What was her name?
Speaker 2 (20:45):
Dr Sinkhornrat.
Speaker 1 (20:47):
Okay, if she's out there, shout out.
Yeah, exactly, you are thereason, dianne Sinkhornrat, yeah
.
Speaker 2 (20:53):
She was great, that's cool.
I didn't know this at the timebut her husband was like 15.
And she would show us all thesecool techniques and these
philosophies and all this stuff.
And I was just so intriguedthat from that point I sort of
decided, okay, I'm going to dothis whole medicine thing.
It was a long and crazy roadwith college and all that stuff.
(21:15):
So I graduated high school,went to the University of
Florida, go Gators, and gotaccepted into lake erie college
of osteopathic medicine.
And before I did that Iactually worked for a year down
in miami doing, uh, research ata neurology clinic.
We were researching botoxinjections for upper and lower
(21:37):
limb spasticity, for tbi andpost stroke patients.
Um, it was like 11 simultaneousclinical trials.
It was crazy, wow.
But I learned a lot and I sawthat and I was like, okay,
neurology sort of is on my radar.
Went to med school, you know,did the whole first, second year
, step one, step two justmadness.
Speaker 1 (21:58):
Insane yeah.
Speaker 2 (21:59):
And then in that process I sort of decided I was
actually really half and halfbetween PM&R doing physical
medicine rehab and neurology andI just was.
So I was very undecided and ifyou asked me to do it again I
would still like have a hardtime deciding which one.
But I ended up going toneurology because I really
enjoyed neuroanatomy.
So I matched into a neurologyresidency.
I went to University of SouthFlorida in Tampa and there you
(22:22):
know it was bread and butterneurology.
You know stroke, epilepsy,dementia, movement disorders,
parkinson's, things like that.
I was fortunate enough to go toa program that was very
musculoskeletal focused and wehad a pain management program in
the neurology department.
Speaker 1 (22:38):
Cool.
Speaker 2 (22:38):
There's only one of two in the country that do that.
Speaker 1 (22:40):
Yeah, really cool.
Speaker 2 (22:47):
So went on to do pain management.
So I graduated that residency,did a pain management fellowship
, worked in pain management forabout a year like in private
practice, and quickly realized Iwas like I don't know if I feel
good about, you know, doingthis for 40 more years or
however many more years I wouldwork because it was just, it was
very dictated by insurance.
You are either strictly doingmed, med management, um, and we
(23:10):
all know what's, you know allthe stuff surrounding med
management, pain management, um,or you're doing just a lot of
corticosteroid injections, andwe all know that steroids are
highly toxic to not only thetissue that you're injecting but
like everything else in yourbody.
Or you're kind of being pushedthese really higher level
procedures like spinal cordstimulators and these like
minimally invasive fusiondevices, that kind of hedge on
(23:33):
pseudo surgery.
And I just thought, you know,let me see if I can find
something different.
Speaker 1 (23:39):
Yeah.
Speaker 2 (23:40):
And that's when I reached out to Regenexx out in
Colorado.
I'd actually been followingthem for like several years and
decided you know what, now's mychance.
So I reached out to them,inquired like how do I learn
this stuff?
Blah, blah, blah.
And they were like well, wehave a fellowship out here.
And I said get out of here.
Speaker 1 (23:57):
Sweet.
Speaker 2 (23:58):
Yeah, so I decided I wasn't married, I don't have
kids.
Speaker 1 (24:03):
I could afford to live in Colorado for a year.
Yeah, let's go Pick up and go.
Speaker 2 (24:06):
Signed up.
You know they offered me.
The position which I discoveredlater was, like you know, not
that easy to get and I had noclue, which was kind of nice.
Speaker 1 (24:14):
Cool.
Speaker 2 (24:15):
Went to Colorado for a year and everything about
regenerative orthopedics, uh,and I learned all these like
just the amount of proceduralskill that came in with that
fellowship was absolutelyincredible.
I felt like I learned more inthat year than I did for like
the previous four years, it wasgreat.
Speaker 1 (24:30):
Cool.
Speaker 2 (24:31):
Yeah, highly recommend, if anybody physicians
out there, uh uh, fellowsresidents that are interested in
pain management, sportsmedicine, musculoskeletal care
management, sports medicine,musculoskeletal care, check them
out.
Centeno Schultz Clinic.
They have a fellowship, one totwo fellows a year.
Very worth it.
Speaker 1 (24:46):
Cool yeah, that's awesome.
Real quick corticosteroidinjections super common, handed
out like candy.
What are your thoughts?
Speaker 2 (24:56):
So in that year that I worked pain management which
was only like nine months Icounted it rough estimate I
think I injected somewhere onthe order of like 500 grams of
corticosteroids into patients.
It's a lot of steroids, yeah.
(25:17):
And so you know, basically withevery steroid injection it, you
know, doubles your risk ofgetting a abascular necrosis, it
increases your risk ofosteoporosis, we all know.
It messes up your metabolism,blood sugar, it suppresses the
hormone axis or your pituitaryaxis, ruins your sleep, the list
goes on.
I mean, it's a miracle drug.
(25:37):
We used to use very, very highdoses of steroids in neurology
for people who had multiplesclerosis and NMO and all these
devastating neurologic diseases,but outside of that it's
overkill.
Routinely, we would inject 4 or10 milligrams of dexamethasone
into a patient and, to give yousome perspective, we naturally
(26:00):
produce these chemicals.
We naturally producecorticosteroids, but if our
body's natural amount ofsteroids was about the height of
, let's say, a matchbook, theamount of steroids that we give
in your typical, just kneeinjection is the height of the
Empire State Building.
It's a massive difference, yeah, and so, as you can imagine, I
had no idea.
Speaker 1 (26:19):
Yeah, it's a huge difference.
Speaker 2 (26:20):
It's about six million times the dose.
Speaker 1 (26:23):
Oh my gosh, a matchbook.
Yeah, yeah, I thought you weregoing to say like the ceiling.
Speaker 2 (26:28):
I'd be like what.
Speaker 1 (26:29):
The Empire State Building yeah.
Speaker 2 (26:33):
Holy smokes.
And so basically, with repeatedinjections, you're just
completely eliminating anypossibility that that
musculoskeletal tissue is goingto ever regenerate on its own.
Speaker 1 (26:44):
Yeah, it just helps to stimulate degenerative
changes in the articularcartilage and the surrounding
soft tissue musculoskeletaljunction.
I've heard, and you tell mewhat your thoughts on this.
You have like one or two freetokens, yeah, and it's fine, not
a big deal.
Speaker 2 (27:00):
The old idiom is like you don't want more than three
in a year, um per year, per yearper year.
But that's just.
That's also somewhat dictatedby what insurance will reimburse
.
Speaker 1 (27:11):
They're not going to reimburse I also imagine, like I
mean, let's say, somebody'sexperiencing moderate knee
discomfort at the age of 42, twoa year until they're 80.
You know what I mean?
Yeah, that's kind of a lot.
Speaker 2 (27:23):
Yeah, yeah.
And think about patients thatcome in in their mid to late 30s
for a steroid injection and nowin their mind, okay, that's the
fix.
Yeah, got it Perfect.
And so, cumulatively, over theyears, they're going to get a
lot of steroids.
Speaker 1 (27:37):
A lot of things happen in addition, like you
were saying all the hormonesespecially too.
There's been plenty of patientsthat I've met, talked with in
the past, like in passing andother workshops or seminars and
things, and they're like, yeah,at the beginning of the season
I'll get an injection, before Ileave I'll get an injection, and
it helps maintain where I'm atand manages my knee pain, my
(27:57):
back pain, I'm good, yeah, nowby all means I don't want to
live like that you know, that'sjust me but yeah, now there's.
Speaker 2 (28:04):
There's definitely instances in which, like a
steroid injection is, you know,somebody comes in with acute,
you know, discogenic pain.
They got a bulging, bulging Idon't hate it.
If you put platelets there,they're gonna flare up like 10
times much so yeah sometimessteroid injections are indicated
totally, totally, but there'salways a but.
You still don't really need touse that high of a dose.
(28:25):
For instance, in our clinic weuse I call it low-dose
dexamethasone.
It's about a millionth of thedose of your standard injection.
Oh, one millionth.
Speaker 1 (28:35):
One millionth.
It still sounds great, onemillionth, yeah, yeah.
Speaker 2 (28:37):
It's 400 nanograms as opposed to milligrams.
So it's 400 nanograms asopposed to milligrams.
So nanograms is like 10 to thenegative six, I think yeah yeah,
and we use that because that'sa lot closer to your physiologic
level.
If you place that directly nextto what you're trying to treat,
then you're going to have theright amount of
anti-inflammatory reaction.
The volume of the fluid sort ofpushes away those inflammatory
(28:58):
cytokines.
And there's a study out ofEngland I, I believe that showed
that these physiologic doses ofcorticosteroids actually
promote uh, tenocyte andsynoviocyte proliferation.
So it's like, oh okay, well,you're getting kind of the best
of both worlds yeah, yeah.
Speaker 1 (29:15):
So I would say, like I assume the synovium for
synovial fluid is that you'retalking about.
Speaker 2 (29:21):
Yeah, yeah, so look, these are the cells that make up
the joint capsule and then theyline the inside of the joint
capsule and they make synovialfluid.
Yeah, got it.
Speaker 1 (29:29):
It's pretty, that's awesome yeah, um, okay, sorry,
continue where we were at wewere talking about.
Uh, oh, man, I forgot the trainof thought we were before I
brought up the corticosteroidquestion.
Speaker 2 (29:40):
Oh, what were we talking?
Speaker 1 (29:41):
about that, about that you were at, you finished
up your fellowship oh this guy.
Speaker 2 (29:43):
Oh, yeah, yeah, yeah, okay, yeah, finished up your
fellowship.
Speaker 1 (29:45):
It was a one-year fellowship, one-year fellowship,
and then that's when you movedback to, moved back here.
Speaker 2 (29:50):
Yeah, so you know, there was a lot of
decision-making process in that.
While I was in move, you know,I had some.
I actually had some reallyreally good opportunities to
work with some like amazingdoctors, people that I looked up
(30:11):
to for years and, uh, he'sactually out in Sarasota, he's
got some locations in Sarasotaand Tampa, um.
But at the same time, you know,I'd been away from South
Florida since 2008.
And you know, I was just kindof felt like I needed to get
closer to my family again.
At the same time, my fiancee,you know, she had the same
feeling.
She's like well, you know, it'sbeen a long time, let's move
back to family.
(30:32):
So my folks live down in fortlauderdale and her folks live,
and well, her mom lives in, uh,jupiter, oh nice uh and so we
sort of split the difference andmoved to west palm yeah and I
was, like you know, I spoke tomy older brother and I spoke to
a lot of people that I reallylook up to about, hey, you know,
what do you think about openingup a practice and taking the
leap?
You know totally, and, um, yeah, you just, at some point you
(30:55):
gotta just close your eyes anddo it, pull the trigger and
write a bullet.
Speaker 1 (30:59):
You know, yeah, and it's calculated, you know
exactly, it's been a rollercoaster, awesome.
Speaker 2 (31:03):
We I moved down here in january um and opened up like
four weeks ago so that sixmonths of just you know that
grueling startup process.
But I learned a lot, you know.
You look back you're like, ohwow, I really did quite a bit to
get this thing open.
Speaker 1 (31:18):
Yeah, I um man, entrepreneurship, I'm a.
I love entrepreneurship stufflike, yeah, I'm a nerd when it
comes to that I mean, yeah,you're a perfect example,
totally reinvigorated my careerand like this outlook on life
and perspective.
I'm like this makes sense yeah,exactly okay, so tell me about
these books all right.
Speaker 2 (31:34):
So those books are authored by a doctor named chris
centeno and, uh, he basicallyhim and his partners sort of
started experimenting withorthobiologics for orthopedic
problems back in like the early2000s okay, and they were the
first ones to do culture,expanded stem cells into
(31:55):
vertebral discs and showimprovement, so they were kind
of like the godfathers of this,more or less.
There's definitely people thatprecede them, um, and so dr
centeno sort of put these bookstogether as a as a manual for
patients, but it does get alittle bit in depth so it's not
like for the right person to becool when integrating.
(32:17):
Yeah it's a medium read.
It's not a light.
But basically what we do is wego through our diagnostic method
, which is called the SANSmethod.
Sans stands for um, symmetry,articulation, neuromuscular, uh,
connection and stability, andso we evaluate all those things
when, when we're addressing aproblem, um, so we talk about
(32:39):
the sans method in there, wetalk about the, the differences,
and you know the types oforthobiologics that we offer,
the differences and what weoffer and what is commonly found
out just in the industry orjust wherever.
you know, prp, that you can get,and, or stem cells that you get
in mexico, and things like that.
So a lot of distinction there,um, and then we break it down
(33:04):
into the different books.
Basically, as you can see,there's shoulder 2.0, this is
how we approach shoulder issues.
Speaker 1 (33:08):
Y'all can't see we got shoulder 2.0, how you can
avoid invasive shoulder surgery,orthopedics 2.0, which I
imagine is like a-.
Speaker 2 (33:15):
Yeah, that's like the encompassing, yeah.
Speaker 1 (33:17):
How to avoid back pain the spine owner's manual.
Speaker 2 (33:20):
Spine owner's manual.
Speaker 1 (33:21):
yeah, and then how to avoid game-changing invasive
knee surgeries.
To stay active as you age, theknee owner's manual, the knee
owner's manual.
Yeah yeah, we have ankleowner's manual and elbow and all
the fun stuff.
They're all around ankle.
I own a shoulder.
I got two of them pickable.
Yeah, cool.
No, I have to agree, that'sreally cool to read them they're
all um online for freedownloadable on my website.
Speaker 2 (33:41):
I think a really cool thing is like.
Speaker 1 (33:42):
It seems like in my but I mean ultimately right.
Our perspectives and beliefsshape our world and like what we
are the lens in which weperceive everything.
But as a biased conservativetherapist, you know what I mean.
It seems like medicine's goingthis route less allopathic and
like if someone has and someonedecides that they want the
awareness of like is there othermethods besides just allopathic
(34:06):
?
Take this med, you're good forlife.
Take synthroid for yourhypothyroidism, you're good
forever like is there an optionlike what is this?
I was just told, but is thereanother way?
Right?
Or like type 2 diabetes, right,totally reversible right um or
just, and also joint pain umorthopedics yeah, a huge one.
You know huge industry butanyway, uh, it seems like it's
(34:27):
going that route, which isreally cool, um, and I love it,
you know, I think it's reallyinteresting.
Speaker 2 (34:31):
Yeah, I think patients are sort of waking up
to the fact that what yourinsurance company tells you to
do is not necessarily your onlyoption.
And there are a lot of reallysmart minds out there and there
are a lot of you know.
There's a lot of data comingout supporting all this, so it's
definitely worth.
It's interesting.
I will say this.
(34:53):
I don't know how much time wehave, but I'll say this Buyer
beware, because this isn't FDAapproved it is FDA regulated,
but it's not FDA approved, whichmeans that people can offer
whatever they want, andoftentimes they make a lot of
claims and those claims canbasically be based on on on
nothing, and so you might findyourself paying thousands and
(35:15):
thousands of dollars for somemiracle stem cell treatment, but
in reality, we don't reallyknow what you're getting.
Speaker 1 (35:25):
Interesting, just like supplements.
Speaker 2 (35:26):
Just like supplements .
Yeah, so I would always say youknow if, if you're interested
in you know non-surgicalorthopedics or regenerative
orthopedics.
There's four questions youshould be asking.
Number one is where is thisproduct coming from?
Right, is it coming from you oris it coming off the shelf?
So it should be coming from you.
Anything that's coming off theshelf essentially had to have
(35:48):
gone through some sort ofsterilizing or processing
process, which means thatthere's no living cells in there
, and we've proven that time andtime again.
There's no such thing as livingstem cells in one of these like
off the shelf umbilical cord.
Placental Wharton's jelly stemcells, um, but they're not
useless.
I mean, they still have goodgrowth factors in them, so they
can.
They have about the same effectas like PRP, essentially.
(36:09):
So where is it coming from?
It should be coming from you,number two, um.
What is it being injected into,you know?
Are they just doing a blindinjection into the joint and
hoping that it miraculously fixyour joints?
Probably not the best.
You need to evaluate the entirekinetic chain.
You need to look at all thedifferent structures.
You need to look at ligamenttendon, you know meniscus.
(36:29):
You need to look at theneuromuscular connection.
You need to look at upstreamissues.
So that's important.
Number two what's the dose?
The majority of your sort ofoff-the-shelf kind of bedside
PRP kits will only concentrateyour PRP to like maybe twice,
which barely meets the actualdefinition of PRP.
So it's important that you getthe right concentration because
(36:50):
it matters what you're injecting.
It also matters depending onthe age, which barely meets the
actual definition of PRP.
So it's important that you getthe right concentration because
it matters what you're injecting.
It also matters depending onthe age.
So the older you get, thehigher concentration you need
essentially.
And number four is who isinjecting it?
You know there are a lot ofvery skilled nurse practitioners
and medical assistants andthings like that out there, but
(37:11):
in order to provide the level oftreatment or level of injection
that I would offer, you need tobe a board certified physician,
having gone through fellowshiptraining.
I mean, I went through twodifferent fellowships to get to
where I'm at.
Speaker 1 (37:25):
So there's a different skill level.
Speaker 2 (37:27):
Yeah, and you got to know all the risks that go along
with what you're doing and yougot to know how to mitigate
potential complications anddisasters.
You got to know all the risksthat go along with what you're
doing and you've got to know howto mitigate potential
complications and disasters.
You've got to know how thisfits in with a lot of other
medical disorders.
It's not a one-size-alltreatment and not everybody can
just go get a bone marrowaspiration or draw 60 tubes of
blood and so on, so youdefinitely need a medical
professional behind itInteresting.
Speaker 1 (37:48):
Yeah, that's a good point.
When you arrived here, you'retalking about a patient that you
just had.
That was super interesting,right.
Speaker 2 (37:54):
Yeah, tell us about what was going on.
Speaker 1 (37:56):
Yeah, so she Typical client, of course.
Yeah, so de-identified.
Speaker 2 (37:59):
So she, you know, middle-aged, very active.
She's a distance runner.
You know her favorite activityis to go run for like 15 plus
miles, which that's impressive.
Speaker 1 (38:10):
Cool yeah, I think what was interesting is like it
seems like healthcare.
You know practitioners likeourselves.
We hear that story andimmediately, at least my head,
is like awesome.
Speaker 2 (38:21):
Yeah, I get excited Versus like all right.
Well, you're battling knee andhip pain.
Speaker 1 (38:25):
Maybe you should stop running because it's bad for
you.
Yeah, it's like people likethat are tired of going to,
people that are like just don'tdo that anymore.
Why don't you just rest ice andtake Advil?
Speaker 2 (38:34):
Like problem solved.
Oh Advil, don't get me startedon Advil Like man like?
Speaker 1 (38:38):
what about?
Like?
How can we enable this personthere has to be something going
on and like longevity wise.
Speaker 2 (38:53):
How can we enable and ?
Speaker 1 (38:54):
empower this person to like continue what they're
doing, and what strategies andstuff can we implement to allow
this?
Let's high five and assistversus like resist and then just
tell them to stop, like, oh ithurts, oh, don't do that.
Yeah, problem solved.
Yeah, oh my gosh, yeah, I meananyway, that's a conversation I
have a lot of patients.
Speaker 2 (39:00):
It's like you know, there's no cure for arthritis
and we're not going to fix orcure the issue.
But the goal here is to giveyour body the tools it needs to
sort of get you back to what itwhatever it is you were doing
and simultaneously try toaddress what it was that got you
there.
You know, so that's for example,I never do injections without
(39:20):
also making sure that thatperson is getting high quality
physical therapy.
Never Because I can inject allI want, but unless the body is
being taught how to avoid thatinjury again.
Or you know the tissue isactually taught how to avoid
that injury again, or you knowthe tissue is actually getting
the physical stimulus in orderto know how to heal.
Speaker 1 (39:36):
Yeah, it's just it's not really gonna come back,
you're not gonna get the bestresults, yeah, so you have to
couple both of them, yeah yeah,cool, okay.
Speaker 2 (39:43):
So yeah, lady coming in yeah, lady coming in
endurance runner, endurancerunner decides to change up her
cadence or her stride.
Uh, one day and like halfwaythrough her run, just intense
anterior hip pain and groin pain, like searing groin pain, and
ever since then she's hadsitting intolerance.
She gets a lot of pain withinternal rotation and inflection
(40:03):
.
Uh, even with external rotationshe started to get some kind of
adductor type pain yeah, um sohip imping, so hip impingement
hip impingement underlying.
Speaker 1 (40:11):
FAI probably.
Speaker 2 (40:12):
Right.
Speaker 1 (40:12):
Somewhat.
Speaker 2 (40:13):
Yeah and um, she came to my clinic, um, and we looked
over her, her x-rays, and sheactually has like grade three
arthritis.
You know it was like prettyadvanced Uh, but which goes to
show you she was likeasymptomatic all the way up to
this point.
Speaker 1 (40:27):
Super interesting, right, yeah, yeah.
Speaker 2 (40:30):
Um so we did a physical exam.
Sure enough she had all the faisymptoms.
She also had some, you know uh,pain over the greater
trochanteric bristis or all theglute muscles attached.
Um she was having somedecreased multifidus activation
on the back.
Um her pelvis was slightlyposteriorly rotated on the right
(40:51):
and sort of out flared and soshe had some psoas tightness on
that on that right side as wellshe had that.
Speaker 1 (40:56):
Yeah, I love that because, like that's, yeah,
totally s, the sij is super, yes, involved exactly.
I mean anyway, sorry throughthe ultrasound on.
Speaker 2 (41:05):
I always ultrasound exam.
Um, just that's.
It's an extension of myphysical exam.
So I put the ultrasound on andI was able to see that she had
some bowing of the hip capsulewhich made me think that there's
an effusion in there.
She had some degeneration ofthe anterior and superior labrum
, some tendinopathy of the glutetendons at the GTB.
She had some tendinopathy atthe iliac crest and then what
(41:29):
else?
Speaker 1 (41:30):
was there.
Speaker 2 (41:33):
Oh, she had a little bit of hamstring tendinopathy as
well and then she had this bigold bursa of fluid underneath
her psoas.
So there's definitely someirritation of the psoas that's
going over the anterior hipthere.
Um worked her up and then gother in for treatment, which was
today, actually right before Icame in and basically we did 10X
concentrated plateletsintraarticular into the hip and
(41:55):
then we did 7X concentratedplatelets into the anterior and
posterior hip capsule, into theanterior and superior labrum,
and then we use what's calledPL-prolo or platelet lysate in
prolotherapy.
Basically, we take PRP or superconcentrated platelets, we
freeze them, we break open theplatelets, we pass them through
(42:17):
a 200 micron filter and we getall the goodies without the
thrombotic platelet factors, andthen we take that and we mix it
with prolo.
So you're basically takingprolotherapy and supercharging
it with all the nutrients andgrowth factors from platelets.
Speaker 1 (42:30):
Yeah, that's really interesting.
Speaker 2 (42:31):
Yeah, Take and supercharging it with all the
nutrients and growth factorsfrom platelets.
Yeah, that's really interesting.
Yeah, take that and we injectthat into the SI ligaments,
sacrotubris, sacrospinousligaments, and then, under
fluoro, I did platelet lysateinjections of the iliolumbar
ligaments, interspinousligaments at L5 and S1.
, and then a transferaminalplatelet epidural at S1 as well.
Speaker 1 (42:52):
So really just addressing that whole kinetic
chain that whole component, yeah, the lumbar down to hip, and
then I'm actually sending her toyou guys.
Cool, Well, I'd love to helpher.
Yeah, yeah, Because I mean it'sinteresting, they're a
different breed and we loveworking with endurance athletes
because they're in the same boatof like no, this is what I do.
Like no, this is this is what Ido.
Speaker 2 (43:10):
Yeah, exactly Awesome , let's get it.
Speaker 1 (43:12):
Yeah, um, but that like that, enthusiasm and buy-in
always just helps outcomes.
You know, yeah, um.
Why not do the PRP injectionslike that all the time to avoid
the thrombitic properties, likeyou were describing Thrombitic
being like you want to describethrombosis, like yeah, yeah.
Speaker 2 (43:32):
So basically you know platelets they like to clot.
That's their main job.
They basically stick and thenthey break open and in some
cases, like if I'm injectinginto the epidural space or into
the spinal column, I don't wantthere to be any sort of risk of
clot.
It's a theoretical risk, butit's a risk nonetheless.
So we basically take thoseplatelets, concentrate them,
break them open and then filterout the goodies.
So we use platelet lysate inthe spine just to reduce the
(43:54):
risk of thrombosis or clotting.
But for ligaments, I mean, Icould inject platelets in there
and you still get a goodresponse.
But sometimes you want to useprolotherapy and so I'm just
essentially combining them.
And so if you take prolo, whichis just dextrose, sugar, water,
(44:15):
and then you combine it withPRP, what happens is that
because the sugar is soconcentrated, the dextrose is
concentrated, it basically turnsthe platelets into like raisins
and so they becomedysfunctional.
They can't stick and they can'topen up.
So you're basically destroyingthe PRP.
But if you just get rid of theplatelet part and you take all
(44:38):
the factors, the nutrients, frominside.
You can mix that withprolotherapy and there's there's
no issue at all, basically.
Speaker 1 (44:41):
So what that does is that lets me sort of volume
expand, meaning I can treat morestructures without having to
take so much more blood, yeah,from the patient, yeah, yeah, so
to combine the prolotherapywith that, it's's a like the
prolotherapy is small,purposeful irritation of the
joint of the structure playthat's in there as the heroes
that go in and solve the problem.
Speaker 2 (45:01):
Yeah, Basically you just you're giving them all the
nutrients they need to sort ofregenerate Cool.
That's really interesting man,it's awesome.
Speaker 1 (45:07):
I love that.
We'd love to help her See a lotof runners and stuff.
Yeah, cool man.
Well, I appreciate that.
So, all right.
Last question what would yousay is like your wheelhouse.
My wheelhouse, ideal patientyou guys crush home runs with
these people.
Speaker 2 (45:22):
Every patient's an ideal patient.
Speaker 1 (45:24):
I mean honestly like I feel the same way of like yo.
It doesn't matter if they'rejust motivated and enthusiastic
and they're ready to to want tosee good outcomes and results,
yeah, the fact that they'recoming to me means that they're
in the mindsets of I want to getbetter.
Speaker 2 (45:38):
Not not just oh, fix this and let me get back to my
life, yeah, um so my wheelhouse,I would say spinal conditions
um, especially like cervicalspine, so neck pain, so neck
pain, headaches, shoulders, jawpain, TMJ, things like that.
Speaker 1 (45:52):
I love doing that and that's partially because of my
neurology.
I was going to say that's acool link, yeah right.
Speaker 2 (45:58):
So I mean a lot of like when I was in residency.
I mean it was always justmigraine until proven otherwise.
Speaker 1 (46:07):
And now I'm discovering.
Speaker 2 (46:07):
Oh well, there's more to it than this.
Yes, you can have migrainefeatures, but we need to be
looking at the neck, because ifthere's, any sort of instability
if there's forward head, ifthere's loss of the curve of the
neck, like you're going to getneurological dissonance.
Speaker 1 (46:17):
Cervical genetic headaches yeah, absolutely.
Tmj referral totally.
We've been seeing some more TMJpatients, which is interesting.
What do you do for TMJ patients?
Internal mobs yeah, yeah, andif it's hypermobile or
hypomobile either side and thendry needling is really effective
into the joint underneath the,the in the joint, yeah, the
(46:40):
lateral pterygoid masseter andthen the temporalis muscles.
Speaker 2 (46:44):
How do you get to the lateral pterygoids?
That's through the joint.
Yeah, I know.
Yeah, it's kind of scary.
Speaker 1 (46:48):
Go through the temple like the sphenoid region and
then just below the condyle, andthen straight through, so
you're going through the mouth,no right here straight through.
Take like a one-inch needle,nice.
Usually we use like the.
I think they're 15-millimeterlength needles for the masseter,
the temporalis and then thejoint itself intraarticular, but
(47:13):
then for the lateral p a lot ofto reach it.
You get like a one inch needleand go straight through that's
hardcore.
I like it, but it's interestingis like it really doesn't feel
like people get freaked out.
You know, they're so tiny, youknow what I mean.
Yeah, um, like the needles, butum, it's just, it's really
effective.
Yeah, that's awesome.
Yeah, okay, and then you, stim,put the stimulation on it too.
Speaker 2 (47:31):
I have a very good friend who she has bad.
You know bruxism.
She grinds like crazy and hermasseters are just like rock
solid.
Yeah, yeah, yeah, totally, andso I was trying to figure out.
You know, what do I do beforewe put Botox in there, basically
, yeah, yeah, um, anyone who'sgetting like Botox for migraines
.
You know, the typical protocolfor migraine Botox is to, you
(47:53):
know, obviously inject aroundthe head, but they also inject
into the neck muscles and thatcan actually cause a lot of
problems down the road, becauseby weakening those, I mean, you
know, by weakening thatposterior chain, you get this
more instability, yeah, so youknow I decided that you know
when I treat my migrainepatients with Botox that I'm
going to do the typical, youknow, cranial injections, but
(48:16):
just avoid the posterior.
Speaker 1 (48:18):
We usually, I mean like from our head.
We don't do injections right,it's not our thing.
But for fixing headaches it'slike, how can we help improve
this?
We definitely consider uppercervical, suboccipital cervical,
genic headaches.
Tmj is definitely on this too,and then not our realm right,
(48:39):
but if something's bruxing atnight, clenching, clearly
there's some kind of anxiety,psych there's.
We can't neglect, there's apsychological component to a
pain experience.
You can't separate the mind fromthe body.
But that's also something thatwe can't neglect and be like
that's something I would diveinto right, not me, but like
that's something I wouldinvestigate on your end and I do
have some mental healthprofessionals that would
recommend totally but that'ssomething that I'm like we can't
neglect.
That either.
You know what I mean.
Speaker 2 (48:59):
Yeah.
Speaker 1 (48:59):
It's a delicate dance of a conversation.
Of course we're not.
You know we want to validateand, like you know, do the
things.
We can't separate the mind fromthe body or neglect.
There's a psychologicalcomponent to pain too, something
I don't want to leave any stoneunturned.
Speaker 2 (49:15):
Having those resources is invaluable.
To be able to say to recognizeokay, there is a significant
sort of psychosocial componentto this.
We need to address it.
The biopsychosocial model,exactly.
So to be able to send them outis good.
Speaker 1 (49:28):
Yeah, it's not what we do, but.
Speaker 2 (49:29):
Yeah, it's not what we do.
I want to help you withbiomechanics, pain for sure
strengthening stuff.
Speaker 1 (49:34):
But I do know people that do and if you're interested
we'll reach out or we'll giveyou the information if you want.
But anyway, sorry, go ahead.
Speaker 2 (49:44):
Migraines and Botox.
Yeah, basically, if I do Botoxfor migraines, I treat
appropriately, but I just avoidthe posterior cervical chain
because it's it might help yourmigraines but you're going to
eventually get cervical problemsand maybe cervicogenic
headaches down the road.
It's important thing yeah, yeahtotally, but other than that I
mean going back to thewheelhouse.
Like you know, I my favoritething is treating spine.
(50:05):
I love being with the c-armfluoroscopy just hitting facets,
transferaminal, getting theligaments multifidus just
getting the whole functionalspinal unit.
which man, I could talk aboutfunctional spinal unit for like
hours, functional spinal unit.
Speaker 1 (50:17):
Yeah, exactly.
Speaker 2 (50:19):
And then so that's like my favorite.
My least favorite is ankles.
Ankles are tough, they're verytough, very tough.
They're hard to.
I mean they Very tough.
They're hard to.
I mean they're very painfulwhen they're in pain.
Anatomically they can be very,very challenging.
Yeah, but if you get it rightyeah, if you get it right, you
can really change someone's life.
Speaker 1 (50:39):
Cool yeah, a lot of moving parts, oh yeah.
Speaker 2 (50:41):
A lot of force, like a lot of weight and tension, and
you know it's a very toughjoint.
Speaker 1 (50:46):
Yeah, totally, all right, man, alright, man, well,
dude, thanks for coming in,we'll have to do another round.
Speaker 2 (50:51):
I'm down the street, man, just let me know.
Speaker 1 (50:52):
Talk about all the other stuff we can nerd out on
you know which is cool butthanks for coming in.
If people want to reach out,what's the best way to reach you
?
Speaker 2 (51:00):
well, two ways.
You can find me on Instagram,docregen d-o-c-r-e-g-e-n, or you
can go to my website,palmbeachregencom.
Or, if you are listening andyou are like in Alaska or
something like that, go toregeneratecom R E G E N E X X
and find a regenerate providerin your network.
There's about 120 of us aroundthe world.
(51:20):
Oh cool, that's interesting.
Speaker 1 (51:22):
I had to chat with them too, like you know some
kind of that's awesome.
Yeah, Cool man.
Well, we'll get round two onthe books soon and if y'all have
any questions, we're alwaysopen to questions, opinions,
comments.
Concerns conflicting opinionstotally, and if you have any
questions as a patient,definitely reach out.
We love to chat and share someinsights, if we can help.
The best way to reach us isteam at athleterccom or our
(51:44):
phone number at 561-898725.
And we'll catch y'all next time.
If you're a driven, active person who wants to reach
and pursue a higher qualitylife with some ambition, then
guess what this podcast is foryou.
This is the Driven AthletePodcast.
What's up?
Y'all?
It's your man, dr Kyle.
Welcome back to the DrivenAthlete Podcast.
We've got a really cool guest,dr Gaddis.
Dr James Gaddis, thank you forcoming in, man.
I know you're a busy dude fromyour practice, so thank you for
(00:22):
coming in, dude.
Thanks for having me um the uh.
So tell us more about um yourpractice, regenics, right where
you're at and what y'all domainly yeah, so it's a uh.
Speaker 2 (00:34):
The practice is called palm beach regenerative
sport and spine.
Okay, and within my practice Ioffer regenics, musculoskeletal
care and Regenexx is basically anetwork of physicians that
perform essentially regenerativeorthopedics.
We use biologics, your ownbiologics, like PRP, super
(00:54):
concentrated platelets and bonemarrow concentrate and a host of
other things, to sort ofaddress any sort of
musculoskeletal condition, fromthe top of your spine all the
way down to the smallest bone inyour toe.
Um, it's all injection-basedtreatments under image guidance,
x-ray guidance, ultrasoundguidance, um, and really it's,
(01:16):
it's more than just, you know,injections to fix a joint or
something like that.
It's a different sort ofapproach to musculoskeletal care
to address that massive gap inbetween conservative care which
is what insurance companies liketo call it and surgery, and we
know now that a lot of surgeriesthere are many surgeries that
(01:36):
are absolutely necessary- andthere are a lot of surgeries
that might not be necessary butare overutilized because of a
lack of options, essentially,and we're starting to discover
now that their outcomes aren'treally any better than high
quality or just doing nothing,and if they can find some high
quality therapy, they might dobetter than getting surgery.
So I occupy that space inbetween, cool.
Speaker 1 (01:59):
So you find yourself.
A lot of the treatments thatyou all do are enriched uh.
Platelet injections right prpbone marrow, dense uh injections
right like bone, utilize thebone marrow yeah, contents yeah
and then um uh stem cells that'sso.
Speaker 2 (02:19):
Yes, I'll kind of start from our shopping list of
things that we use perfect fromthe most simple, which, by the
way, I forgot to answer yourquestion earlier.
So, we're just down the street,okay, we're on palm beach,
lakes, boulevard, uh and villageright next to renegades okay,
yep you ever been to renegades?
Speaker 1 (02:34):
fun place.
Yeah, yeah, yeah, get yourcountry dance on, yeah exactly,
um.
Speaker 2 (02:38):
so our sort of armamentarium of tools, from the
very most simple, isprolotherapy.
Prolotherapy is sort of likethe godfather of regenerative
orthopedics.
It's just concentrated sugarwater and we use that to treat
simple conditions liketendinitis, tennis, elbow, any
type of ligament laxity.
(02:59):
We can use prolotherapy as asimple option.
It acts as a mild irritant tothe tissue and causes
proliferation of cells that areimportant for ligament growth
and ligament health, things likefibroblasts and it lays down a
lot of collagen and so on.
Speaker 1 (03:14):
Okay, so it stimulates fibroblast activity
to lay down new collagen bycreating a little bit of
irritation on purpose within thearticular, Well within tissues
within the ligaments themselves.
Speaker 2 (03:26):
So let's say you have like a lax MCL and you're
getting a lot of nevalgus.
We'll inject it into the MCLand it doubles in the sense that
you have the proliferationbecause of the inflammatory
reaction.
But it also acts as an osmotic,meaning it's concentrated, so
it kind of draws fluid out ofthe tissue and tightens the
tissue up.
There some debate about howtrue that is, but you still, you
(03:48):
know, improve ligament healthby using that.
So that's our most simpleoption.
The next most common thing weuse is called super concentrated
platelets, which is actuallysort of one step past prp.
Okay, meaning um.
Prp is basically you take wholeblood, you spin it down, you
get rid of the red blood cellsand what you're left with is
plasma full of platelets we callit platelet-rich plasma and
(04:11):
that's usually about one and ahalf times the concentration of
the platelets.
That's just floating around inyour blood as is, which is
useful.
But we take it one step furtherby taking that plasma and
concentrating it even more, andthen from there we have, like
this dense pellet of just youknow, several billion platelets,
(04:31):
and then we can use whateverleftover plasma there is to
tailor the concentration of PRPOkay, which is important because
some tissues require higherconcentrations of PRP than
others, which, by the way, letme know if I'm getting two in
the yeah, no, I love this um,yeah, so we're able to
concentrate the pr or I shouldsay scp, super concentrated
(04:52):
platelets.
Okay, um, to differentconcentrations depending on what
I'm treating, meaning you know,ligaments and tendons.
I can usually five to seven xconcentrated is good, but if
we're treating, let's say, youknow, a herniated disc in the
lumbar spine, you need 20x andyou know that requires a lot of
blood to get to that 20xconcentration, but it matters um
, so that's scp.
(05:14):
And then we typically use thosefor mild to moderate conditions
and most most spinal conditions.
Okay, um, beyond that we enterinto the realm of bone marrow
concentrate, and that's wherethe word stem cell sort of fits
okay I don't like to say stemcells alone, because that
implies a whole nother process.
(05:36):
That is not, you know, not fdaapproved in the us right now and
certain facilities can do itcorrectly overseas and so on.
But as far as what we can do inthe US with your stem cells is,
we can get your bone marrow.
Very similar to what they do inthe hospital for, you know,
cancer patients and so on.
They aspirate bone marrow fromthe pelvis, from the big iliac
(05:59):
crest on the side there.
From there we take anywherefrom 60 to 90, in some, some
cases, over 100 cc's of bonemarrow and we can concentrate
that down and take specificallythe white uh, the white cells or
the buffy coat.
The buffy coat has all the stemcells essentially.
So let's say, out of a 90 ccbone marrow concentrate draw,
(06:23):
I'll probably get three or fourccs of concentrated what we call
mesenchymal stromal cells.
They used to be calledmesenchymal stem cells, now
they're called stromal cellsokay yeah, think of them as like
stem cells with a collegedegree okay, meaning they used
to be pluripotent.
Like they, they could becomeanything.
(06:44):
And then, because of where theyare, they essentially have
differentiated into some sort ofmusculoskeletal tissue.
They're either going to turninto ligament, tendon, cartilage
, bone or muscle and, dependingwhere you inject them, they sort
of learn from their environmentthat you've injected them into.
What kind of cell they turn intoand they follow suit, exactly,
(07:05):
exactly environment that you'veinjected them into, what what
kind of cell right turn into andthey follow suit.
Yeah, exactly, exactly.
So out of you know, out of a 90cc bone marrow, you get maybe
four ccs of concentrated bonemarrow cells.
And then out of that four ccsyou might have, like you know,
several hundred million or a fewbillion stromal cells, mscs, uh
, and within that there's likemaybe 100,000 actual true stem
(07:26):
cells.
Yeah, so you do have a smallconcentration of your true stem
cells inside your bone marrow,but it's a small number.
Speaker 1 (07:33):
Right.
Speaker 2 (07:35):
Up until about 2009, it was possible to isolate those
few stem cells, analyze themand then culture them, grow them
out, and so then you couldexpand, or what we call culture.
Expand those stem cells toseveral billion, and now you
could store them and have themfor later.
(07:55):
But in 2009, the FDA ruled thatthat was called more than
minimal manipulation.
There's basically these lawssurrounding what you can do with
human tissue, and minimalmanipulation is one of these.
So basically, you can't changethe chemical properties or grow
things without it beingconsidered a new drug, and a new
(08:16):
drug requires phase one, two,three.
Speaker 1 (08:19):
FDA trials.
It's a several billion dollarindustry.
Speaker 2 (08:21):
So those facilities that were able to do that sort
of moved offshore.
For example, regenexx has auniversity-style lab in the
Grand Cayman Islands where theydo this.
They basically culture yourstem cells, expand them, store
them so you can use them foryears and years and years later.
As soon as I get the chance,I'm going to go out there and do
(08:42):
that before I turn 40, get somepre-40 stem cells.
But going back to the US, andwhat I do essentially in clinic
is we isolate bone marrow, weconcentrate it down and then
from that we can inject thatback into more severe, severe
arthritic conditions like boneon bone.
Arthritis is a commonly usedone bone death, avascular
(09:04):
necrosis of the hip, things likethat.
We can inject it into the boneand it essentially halts the
progression of of arthritis.
Speaker 1 (09:11):
Yeah, Pretty good success rates.
That's really cool.
That's awesome.
Um for SCP um super condensedplatelets, super concentrated
super concentrated plates Closeenough, yeah, yeah For herniated
discs?
Um, and then I was also goingto ask about tendinosis, like
maybe a golfer's or tennis elbowor something like that.
Is there super common like whatthey call like recalcitrant
(09:34):
development or progress for likehealing?
Um, what's for hernia discs?
What's the mechanism?
Speaker 2 (09:40):
So it depends on what kind of disc you're you're
treating.
So let's say a disc that has alittle tear in the outside of
the disc an annular tear.
We know that if you just pumpthat disc full of super
concentrated platelets theymight just leak out of that tear
.
So what you have to do isdecide, okay, where is this tear
(10:02):
and what's the best way for meto approach it?
Because you really want to putthose platelets right in that
tear, because those plateletswill stick and aggregate and
then they sort of open up fromthere.
So let's say you have a disctear that's sort of out
laterally on the side, itactually makes more sense not to
even go into the disc but tojust, with the needle under
x-ray guidance, just go right upto that little tear and park
(10:25):
the needle right in front of thetear and deposit your platelets
there.
Very few cc's.
If you're dealing with a discthat's a little bit more
degenerated, um, or is, you know, bulging, then it makes more
sense to sort of go into thedisc itself, um, and from there
you have to sort of decide first.
You know, is this the discthat's bothering the person,
(10:46):
cause usually there's more thanone disc.
Speaker 1 (10:48):
Yeah.
Speaker 2 (10:48):
So you do what's called a discogram.
So we basically guide theneedle in there.
The patient is awake, um, andwe inject a small volume of a
combination of antibiotics and,uh, contrast.
Contrast agent basically showsa dark on an x-ray.
Speaker 1 (11:02):
so we can see it.
Speaker 2 (11:03):
And we try and provoke that disc.
We fill it up a little bit andthen we ask the patient does
that reproduce the same painthat you have?
And a lot of times they'll sayno, that's something different.
And so you sort of have to lookand maybe it's not the disc
that you expected, maybe it's adifferent one.
So you know, of course, correct.
Once you sort of reproduce thatpain, then that's when we
(11:24):
inject about, you know, three tofour cc's, depending on the
disc, of that highlyconcentrated prp uh, and it has
your white blood cells in it, sowe call it leukocyte rich prp,
gotcha.
And that's more of a protectivefactor because the discs are
prone to getting infected.
(11:47):
They oftentimes are colonizedwith a certain type of bacteria,
and so you want to have yourwhite blood cells in there to
sort of manage that party, right, yeah totally.
Yeah, so again, it reallydepends on the disc.
If you're dealing with anannular tear, which is usually
the most painful, you want toget as close to that tear as
possible.
Um, there is a device by thelate great dr greg lutz, uh, who
(12:12):
recently passed away.
Um, it's like a catheter thatbasically kind of curves around.
So you enter the disc and thenyou introduce this catheter, it
curves around and you can directit right to that little tear
and you just deposit yourplatelets right there
interesting, which is amazing.
It's amazing device or you justfill up the disc itself.
Speaker 1 (12:28):
Yeah, interesting, um , and then the platelets will be
in there, they'll aggregate,proliferate and then help scar
down and heal up the tear.
Speaker 2 (12:38):
Essentially, yeah that that's the goal.
So, um, there's a lot ofstudies that show that the more
that degenerated the disc is,the more likely those platelets
are just going to immediatelyleak out.
So if you have a completelydesiccated or degenerated disc,
then you sort of have to decideis it worth injecting the disc
and putting the patient at thatrisk, or do you want to do a
(12:58):
more aggressive treatment anduse culture expanded stem cells?
And use culture expanded stemcells, which those have been
shown to improve verydegenerated and desiccated discs
, because they sort of they havethese receptors on them, called
CD19 receptors, that they stickto whatever surface that
they're injected on.
They stick within like threeminutes.
Speaker 1 (13:18):
Cool yeah, so a lot better stick rate.
Speaker 2 (13:21):
A lot better stick rate.
Yeah, exactly.
Speaker 1 (13:23):
And for a patient like that, how many rounds of
those injections?
Let's say it's like a verydegenerative disc and they're
having referred pain right Backpain.
Yeah, they got an image.
Looks bad.
Do this right.
How many rounds of that?
Speaker 2 (13:39):
So, and then re-image like in six months and they'd
see an improvement, or eightmonths oftentimes we will let
re-imaging like let the patientdecide if they want re-imaging
or not, because we don'ttypically when it's.
It's definitely nice to havesomebody come back with a
post-injection mri and it likelooks beautiful yeah, generate
like see everybody, look, lookexactly but more often than not
the disc will look exactly thesame.
(14:01):
On the mri you might have someyou resolution of some tears and
whatnot which we can see.
We actually published a studyon this out in Colorado where we
did pre and post MRI studies ofintradiscal injections of
annular tears.
It required a lot of sort ofMRI software programming to be
able to determine the grayscaledifference on these different
(14:21):
discs.
Speaker 1 (14:22):
But, anyways.
Speaker 2 (14:24):
yeah, sometimes you'll get image resolution of
the disc.
That's always good, but moreoften than not the patient's
symptoms will improve and theirdisc looks exactly the same.
You don't want to go into thedisc.
That often it is a riskyprocedure.
Speaker 1 (14:38):
So the disc looks very, very similar, but their
symptoms are a lot better.
Speaker 2 (14:43):
Yeah, most often that's the case.
Sometimes you get thisbeautiful post injection MRI
where the bulge is resolved andthe annular tear is resolved.
Speaker 1 (14:51):
So, if that looks the same, where do you like?
What are your thoughts on like?
What was the symptom reductionfrom?
Speaker 2 (14:57):
A lot of times it's leakage of the inner contents of
the disc.
Um, that has a lot ofinflammatory cytokines in it.
There's a nerve that sort ofencompasses the disc called the
sinovertebral nerve.
You don't see that nerve inlike neurology textbooks.
It's hilarious.
You just kind of skip over thatand find out about it later.
(15:18):
So you can definitely haveirritation of that sinovertebral
nerve because of theinflammatory cytokines that leak
out of a degenerated disc.
And oftentimes those sameinflammatory cytokines can
irritate the nerve roots andthat's where you get not
radiculopathy meaning like youknow down symptoms of a nerve
but you get radiculitis.
So hypersensitivity, pain andsort of tingling and things like
(15:41):
that.
So that tells me that, oh,there's something's irritating
the nerve but not compressingthe nerve necessarily so by
injecting platelets, you'rehopefully stopping that leakage
and reducing that inflammatoryreaction.
Speaker 1 (15:53):
Right, right Totally, and then with tendinosis, right
Degenerative tendonprogressions.
Do you do a lot with that?
With that too?
Speaker 2 (16:02):
Yeah, that's like our bread and butter a golfer's
elbow, tennis elbow?
Speaker 1 (16:05):
yeah, a lot of stuff, a lot of achilles, yeah and
achilles you can do some prettycool stuff.
Speaker 2 (16:10):
But basically you know a lot of times an mri you
know you get somebody withtennis elbow will look at an mri
and if there's no obvious tearthere it doesn't really tell me
100 that there's no tear.
So oftentimes when we'retreating with PRP I will sort of
explore with the needle meaning.
I'll introduce the needle intothe tendon and I'll gently test
(16:34):
with some pressure and ifthere's resistance, then I know
that that is an intact tendon.
There's no tear there.
But sometimes you put a littlevolume of fluid and a tear that
it was hiding now all of asudden opens up.
You could see it hiding inside.
You would have never seen thaton an on an mri um, and so we'll
sort of, when you see that youwant to like fenestrate the
tendon, you want to increase thesurface area of that tear so
(16:57):
that these platelets canaggregate open.
Speaker 1 (16:59):
yeah, interesting, yeah, that's really cool.
I mean chronic lingering tenniselbow and golfer's elbow.
It's like I battled thatrecently, like where the last
maybe 10 months, probably maybeeight months, oh yeah, just
lingering.
Speaker 2 (17:15):
Um.
Speaker 1 (17:15):
I'll needle myself like dry needling myself and
stuff, but, um, man, it can it.
It's uh, it's annoying, it is,you know, like a lingering
tennis elbow or achillestendonitis, like a lot of
patients stumped.
You know what I mean.
Speaker 2 (17:27):
Yeah, um, that's good , though one thing that I would
add to that is um, you know,when somebody has a chronic
tendon issue, it's worth lookingoutside the tendon.
You've got to wonder why, likeyou know why is this guy having
this recurring tendon issue?
right exactly, and so a lot oftimes, especially especially
with people who have well, yeah,let's say, tennis elbow or
golfer's elbow.
I'll look upstream.
(17:48):
I'll look at the shouldermechanics.
I'll see if their arm is, youknow, tends to be pronated.
I'll look at any cervicalissues.
There might be a subclinicalradiculitis there, you know.
If they're having a golfer'selbow, well that's your sort of
T1 dermatome.
So I'm looking at C8, T1 nerveroots to see if there's any
issues there.
(18:08):
Is there any forward headposition?
Is there any irritation of thefacet joints in that?
Speaker 1 (18:14):
area.
Speaker 2 (18:14):
Yeah, totally so I'll likely treat that whole kinetic
chain.
So we'll do platelet epiduralsat those levels.
We'll treat the ligaments,we'll treat the joints and then
we'll treat wherever the actualtendonosis is.
Speaker 1 (18:26):
Sure, that's awesome, I think, something that
separates like a person likeyourself in orthopedics you know
what I mean and I'm like that'swhat of course like as a sports
physical therapist.
Like we're not going to do PRPinjections, although dry
needling can be helpful totallybut anyway, we definitely like
when we got to look at thescapula you know, on the
shoulder Cause, like if I'vealways under the impression some
mentors described it like atendon at this point is the
victim.
(18:46):
If it's overwhelmed and likechronically a tendonitis problem
.
You know what I mean.
It's like usually it's becausethat thing is a victim and it's
overworked and over requiredbecause of compensation issues
elsewhere, and especially like afull body movement, like swing,
like a tennis player right oreven um, there's got to be other
conversations elsewhere.
That's maybe like what'sleading to the tendon getting
(19:07):
lit up and overwhelmed in thefirst place, like we have to
address those things, and thenthat'll actually follow suit,
versus, like, just treating thetendon like this.
Um, it's just a, you know, atertiary problem yeah, it's a
very like kind of binocularsview.
Exactly, yeah, which ishonestly that exactly right.
Speaker 2 (19:22):
there is why I left pain management, because I was
in pain management initially andI was like I need something
more.
Speaker 1 (19:29):
Like we're missing something.
You know I was going to ask, sotell us more.
All right, A little morebackground story.
Originally, where are you from?
Yeah, and then where'd you goto med school?
And I know you were in Coloradodoing a lot of neural research,
right?
Yeah, yeah, yeah.
So you know I like long walkson the beach.
Speaker 2 (19:48):
Yeah, yeah, yeah, my folks are actually from Egypt,
first generation Americans.
So I grew up in like the woodsin Georgia.
Speaker 1 (19:54):
Okay, where in?
Speaker 2 (19:55):
Georgia Marietta, like outside of Atlanta.
Speaker 1 (19:57):
Okay, yeah, Because we took we as a family
Thanksgiving trips up innorthern Georgia.
Speaker 2 (20:02):
Oh nice.
Like Blue Ridge Mountains areayeah, yeah, yeah yeah.
Speaker 1 (20:05):
So we passed through Atlanta and go to like Helen or
what's it?
Dahlonega, Dahlonega, yeah,yeah.
Speaker 2 (20:09):
They got one of the roller coasters at Six Flags up
there.
It's called the Dahlonega MineTrain.
Speaker 1 (20:14):
Oh, really that's cool.
No, we love it up there, man,we want you know it's a
beautiful, it's beautiful yeahyeah, beautiful forest, um.
Speaker 2 (20:29):
So yeah, grew up there, moved down to fort
lauderdale in like 2003, uh.
And then I went to high schoolpompano beach high school and
it's actually there where I hada ap biology teacher who she was
the one who sort of got me onthe medicine track.
Speaker 1 (20:43):
Cool.
Speaker 2 (20:44):
She was a biology teacher.
Speaker 1 (20:44):
What was her name?
Speaker 2 (20:45):
Dr Sinkhornrat.
Speaker 1 (20:47):
Okay, if she's out there, shout out.
Yeah, exactly, you are thereason, dianne Sinkhornrat, yeah
.
Speaker 2 (20:53):
She was great, that's cool.
I didn't know this at the timebut her husband was like 15.
And she would show us all thesecool techniques and these
philosophies and all this stuff.
And I was just so intriguedthat from that point I sort of
decided, okay, I'm going to dothis whole medicine thing.
It was a long and crazy roadwith college and all that stuff.
(21:15):
So I graduated high school,went to the University of
Florida, go Gators, and gotaccepted into lake erie college
of osteopathic medicine.
And before I did that Iactually worked for a year down
in miami doing, uh, research ata neurology clinic.
We were researching botoxinjections for upper and lower
(21:37):
limb spasticity, for tbi andpost stroke patients.
Um, it was like 11 simultaneousclinical trials.
It was crazy, wow.
But I learned a lot and I sawthat and I was like, okay,
neurology sort of is on my radar.
Went to med school, you know,did the whole first, second year
, step one, step two justmadness.
Speaker 1 (21:58):
Insane yeah.
Speaker 2 (21:59):
And then in that process I sort of decided I was
actually really half and halfbetween PM&R doing physical
medicine rehab and neurology andI just was.
So I was very undecided and ifyou asked me to do it again I
would still like have a hardtime deciding which one.
But I ended up going toneurology because I really
enjoyed neuroanatomy.
So I matched into a neurologyresidency.
I went to University of SouthFlorida in Tampa and there you
(22:22):
know it was bread and butterneurology.
You know stroke, epilepsy,dementia, movement disorders,
parkinson's, things like that.
I was fortunate enough to go toa program that was very
musculoskeletal focused and wehad a pain management program in
the neurology department.
Speaker 1 (22:38):
Cool.
Speaker 2 (22:38):
There's only one of two in the country that do that.
Speaker 1 (22:40):
Yeah, really cool.
Speaker 2 (22:47):
So went on to do pain management.
So I graduated that residency,did a pain management fellowship
, worked in pain management forabout a year like in private
practice, and quickly realized Iwas like I don't know if I feel
good about, you know, doingthis for 40 more years or
however many more years I wouldwork because it was just, it was
very dictated by insurance.
You are either strictly doingmed, med management, um, and we
(23:10):
all know what's, you know allthe stuff surrounding med
management, pain management, um,or you're doing just a lot of
corticosteroid injections, andwe all know that steroids are
highly toxic to not only thetissue that you're injecting but
like everything else in yourbody.
Or you're kind of being pushedthese really higher level
procedures like spinal cordstimulators and these like
minimally invasive fusiondevices, that kind of hedge on
(23:33):
pseudo surgery.
And I just thought, you know,let me see if I can find
something different.
Speaker 1 (23:39):
Yeah.
Speaker 2 (23:40):
And that's when I reached out to Regenexx out in
Colorado.
I'd actually been followingthem for like several years and
decided you know what, now's mychance.
So I reached out to them,inquired like how do I learn
this stuff?
Blah, blah, blah.
And they were like well, wehave a fellowship out here.
And I said get out of here.
Speaker 1 (23:57):
Sweet.
Speaker 2 (23:58):
Yeah, so I decided I wasn't married, I don't have
kids.
Speaker 1 (24:03):
I could afford to live in Colorado for a year.
Yeah, let's go Pick up and go.
Speaker 2 (24:06):
Signed up.
You know they offered me.
The position which I discoveredlater was, like you know, not
that easy to get and I had noclue, which was kind of nice.
Speaker 1 (24:14):
Cool.
Speaker 2 (24:15):
Went to Colorado for a year and everything about
regenerative orthopedics, uh,and I learned all these like
just the amount of proceduralskill that came in with that
fellowship was absolutelyincredible.
I felt like I learned more inthat year than I did for like
the previous four years, it wasgreat.
Speaker 1 (24:30):
Cool.
Speaker 2 (24:31):
Yeah, highly recommend, if anybody physicians
out there, uh uh, fellowsresidents that are interested in
pain management, sportsmedicine, musculoskeletal care
management, sports medicine,musculoskeletal care, check them
out.
Centeno Schultz Clinic.
They have a fellowship, one totwo fellows a year.
Very worth it.
Speaker 1 (24:46):
Cool yeah, that's awesome.
Real quick corticosteroidinjections super common, handed
out like candy.
What are your thoughts?
Speaker 2 (24:56):
So in that year that I worked pain management which
was only like nine months Icounted it rough estimate I
think I injected somewhere onthe order of like 500 grams of
corticosteroids into patients.
It's a lot of steroids, yeah.
(25:17):
And so you know, basically withevery steroid injection it, you
know, doubles your risk ofgetting a abascular necrosis, it
increases your risk ofosteoporosis, we all know.
It messes up your metabolism,blood sugar, it suppresses the
hormone axis or your pituitaryaxis, ruins your sleep, the list
goes on.
I mean, it's a miracle drug.
(25:37):
We used to use very, very highdoses of steroids in neurology
for people who had multiplesclerosis and NMO and all these
devastating neurologic diseases,but outside of that it's
overkill.
Routinely, we would inject 4 or10 milligrams of dexamethasone
into a patient and, to give yousome perspective, we naturally
(26:00):
produce these chemicals.
We naturally producecorticosteroids, but if our
body's natural amount ofsteroids was about the height of
, let's say, a matchbook, theamount of steroids that we give
in your typical, just kneeinjection is the height of the
Empire State Building.
It's a massive difference, yeah, and so, as you can imagine, I
had no idea.
Speaker 1 (26:19):
Yeah, it's a huge difference.
Speaker 2 (26:20):
It's about six million times the dose.
Speaker 1 (26:23):
Oh my gosh, a matchbook.
Yeah, yeah, I thought you weregoing to say like the ceiling.
Speaker 2 (26:28):
I'd be like what.
Speaker 1 (26:29):
The Empire State Building yeah.
Speaker 2 (26:33):
Holy smokes.
And so basically, with repeatedinjections, you're just
completely eliminating anypossibility that that
musculoskeletal tissue is goingto ever regenerate on its own.
Speaker 1 (26:44):
Yeah, it just helps to stimulate degenerative
changes in the articularcartilage and the surrounding
soft tissue musculoskeletaljunction.
I've heard, and you tell mewhat your thoughts on this.
You have like one or two freetokens, yeah, and it's fine, not
a big deal.
Speaker 2 (27:00):
The old idiom is like you don't want more than three
in a year, um per year, per yearper year.
But that's just.
That's also somewhat dictatedby what insurance will reimburse
.
Speaker 1 (27:11):
They're not going to reimburse I also imagine, like I
mean, let's say, somebody'sexperiencing moderate knee
discomfort at the age of 42, twoa year until they're 80.
You know what I mean?
Yeah, that's kind of a lot.
Speaker 2 (27:23):
Yeah, yeah.
And think about patients thatcome in in their mid to late 30s
for a steroid injection and nowin their mind, okay, that's the
fix.
Yeah, got it Perfect.
And so, cumulatively, over theyears, they're going to get a
lot of steroids.
Speaker 1 (27:37):
A lot of things happen in addition, like you
were saying all the hormonesespecially too.
There's been plenty of patientsthat I've met, talked with in
the past, like in passing andother workshops or seminars and
things, and they're like, yeah,at the beginning of the season
I'll get an injection, before Ileave I'll get an injection, and
it helps maintain where I'm atand manages my knee pain, my
(27:57):
back pain, I'm good, yeah, nowby all means I don't want to
live like that you know, that'sjust me but yeah, now there's.
Speaker 2 (28:04):
There's definitely instances in which, like a
steroid injection is, you know,somebody comes in with acute,
you know, discogenic pain.
They got a bulging, bulging Idon't hate it.
If you put platelets there,they're gonna flare up like 10
times much so yeah sometimessteroid injections are indicated
totally, totally, but there'salways a but.
You still don't really need touse that high of a dose.
(28:25):
For instance, in our clinic weuse I call it low-dose
dexamethasone.
It's about a millionth of thedose of your standard injection.
Oh, one millionth.
Speaker 1 (28:35):
One millionth.
It still sounds great, onemillionth, yeah, yeah.
Speaker 2 (28:37):
It's 400 nanograms as opposed to milligrams.
So it's 400 nanograms asopposed to milligrams.
So nanograms is like 10 to thenegative six, I think yeah yeah,
and we use that because that'sa lot closer to your physiologic
level.
If you place that directly nextto what you're trying to treat,
then you're going to have theright amount of
anti-inflammatory reaction.
The volume of the fluid sort ofpushes away those inflammatory
(28:58):
cytokines.
And there's a study out ofEngland I, I believe that showed
that these physiologic doses ofcorticosteroids actually
promote uh, tenocyte andsynoviocyte proliferation.
So it's like, oh okay, well,you're getting kind of the best
of both worlds yeah, yeah.
Speaker 1 (29:15):
So I would say, like I assume the synovium for
synovial fluid is that you'retalking about.
Speaker 2 (29:21):
Yeah, yeah, so look, these are the cells that make up
the joint capsule and then theyline the inside of the joint
capsule and they make synovialfluid.
Yeah, got it.
Speaker 1 (29:29):
It's pretty, that's awesome yeah, um, okay, sorry,
continue where we were at wewere talking about.
Uh, oh, man, I forgot the trainof thought we were before I
brought up the corticosteroidquestion.
Speaker 2 (29:40):
Oh, what were we talking?
Speaker 1 (29:41):
about that, about that you were at, you finished
up your fellowship oh this guy.
Speaker 2 (29:43):
Oh, yeah, yeah, yeah, okay, yeah, finished up your
fellowship.
Speaker 1 (29:45):
It was a one-year fellowship, one-year fellowship,
and then that's when you movedback to, moved back here.
Speaker 2 (29:50):
Yeah, so you know, there was a lot of
decision-making process in that.
While I was in move, you know,I had some.
I actually had some reallyreally good opportunities to
work with some like amazingdoctors, people that I looked up
(30:11):
to for years and, uh, he'sactually out in Sarasota, he's
got some locations in Sarasotaand Tampa, um.
But at the same time, you know,I'd been away from South
Florida since 2008.
And you know, I was just kindof felt like I needed to get
closer to my family again.
At the same time, my fiancee,you know, she had the same
feeling.
She's like well, you know, it'sbeen a long time, let's move
back to family.
(30:32):
So my folks live down in fortlauderdale and her folks live,
and well, her mom lives in, uh,jupiter, oh nice uh and so we
sort of split the difference andmoved to west palm yeah and I
was, like you know, I spoke tomy older brother and I spoke to
a lot of people that I reallylook up to about, hey, you know,
what do you think about openingup a practice and taking the
leap?
You know totally, and, um, yeah, you just, at some point you
(30:55):
gotta just close your eyes anddo it, pull the trigger and
write a bullet.
Speaker 1 (30:59):
You know, yeah, and it's calculated, you know
exactly, it's been a rollercoaster, awesome.
Speaker 2 (31:03):
We I moved down here in january um and opened up like
four weeks ago so that sixmonths of just you know that
grueling startup process.
But I learned a lot, you know.
You look back you're like, ohwow, I really did quite a bit to
get this thing open.
Speaker 1 (31:18):
Yeah, I um man, entrepreneurship, I'm a.
I love entrepreneurship stufflike, yeah, I'm a nerd when it
comes to that I mean, yeah,you're a perfect example,
totally reinvigorated my careerand like this outlook on life
and perspective.
I'm like this makes sense yeah,exactly okay, so tell me about
these books all right.
Speaker 2 (31:34):
So those books are authored by a doctor named chris
centeno and, uh, he basicallyhim and his partners sort of
started experimenting withorthobiologics for orthopedic
problems back in like the early2000s okay, and they were the
first ones to do culture,expanded stem cells into
(31:55):
vertebral discs and showimprovement, so they were kind
of like the godfathers of this,more or less.
There's definitely people thatprecede them, um, and so dr
centeno sort of put these bookstogether as a as a manual for
patients, but it does get alittle bit in depth so it's not
like for the right person to becool when integrating.
(32:17):
Yeah it's a medium read.
It's not a light.
But basically what we do is wego through our diagnostic method
, which is called the SANSmethod.
Sans stands for um, symmetry,articulation, neuromuscular, uh,
connection and stability, andso we evaluate all those things
when, when we're addressing aproblem, um, so we talk about
(32:39):
the sans method in there, wetalk about the, the differences,
and you know the types oforthobiologics that we offer,
the differences and what weoffer and what is commonly found
out just in the industry orjust wherever.
you know, prp, that you can get,and, or stem cells that you get
in mexico, and things like that.
So a lot of distinction there,um, and then we break it down
(33:04):
into the different books.
Basically, as you can see,there's shoulder 2.0, this is
how we approach shoulder issues.
Speaker 1 (33:08):
Y'all can't see we got shoulder 2.0, how you can
avoid invasive shoulder surgery,orthopedics 2.0, which I
imagine is like a-.
Speaker 2 (33:15):
Yeah, that's like the encompassing, yeah.
Speaker 1 (33:17):
How to avoid back pain the spine owner's manual.
Speaker 2 (33:20):
Spine owner's manual.
Speaker 1 (33:21):
yeah, and then how to avoid game-changing invasive
knee surgeries.
To stay active as you age, theknee owner's manual, the knee
owner's manual.
Yeah yeah, we have ankleowner's manual and elbow and all
the fun stuff.
They're all around ankle.
I own a shoulder.
I got two of them pickable.
Yeah, cool.
No, I have to agree, that'sreally cool to read them they're
all um online for freedownloadable on my website.
Speaker 2 (33:41):
I think a really cool thing is like.
Speaker 1 (33:42):
It seems like in my but I mean ultimately right.
Our perspectives and beliefsshape our world and like what we
are the lens in which weperceive everything.
But as a biased conservativetherapist, you know what I mean.
It seems like medicine's goingthis route less allopathic and
like if someone has and someonedecides that they want the
awareness of like is there othermethods besides just allopathic
(34:06):
?
Take this med, you're good forlife.
Take synthroid for yourhypothyroidism, you're good
forever like is there an optionlike what is this?
I was just told, but is thereanother way?
Right?
Or like type 2 diabetes, right,totally reversible right um or
just, and also joint pain umorthopedics yeah, a huge one.
You know huge industry butanyway, uh, it seems like it's
(34:27):
going that route, which isreally cool, um, and I love it,
you know, I think it's reallyinteresting.
Speaker 2 (34:31):
Yeah, I think patients are sort of waking up
to the fact that what yourinsurance company tells you to
do is not necessarily your onlyoption.
And there are a lot of reallysmart minds out there and there
are a lot of you know.
There's a lot of data comingout supporting all this, so it's
definitely worth.
It's interesting.
I will say this.
(34:53):
I don't know how much time wehave, but I'll say this Buyer
beware, because this isn't FDAapproved it is FDA regulated,
but it's not FDA approved, whichmeans that people can offer
whatever they want, andoftentimes they make a lot of
claims and those claims canbasically be based on on on
nothing, and so you might findyourself paying thousands and
(35:15):
thousands of dollars for somemiracle stem cell treatment, but
in reality, we don't reallyknow what you're getting.
Speaker 1 (35:25):
Interesting, just like supplements.
Speaker 2 (35:26):
Just like supplements .
Yeah, so I would always say youknow if, if you're interested
in you know non-surgicalorthopedics or regenerative
orthopedics.
There's four questions youshould be asking.
Number one is where is thisproduct coming from?
Right, is it coming from you oris it coming off the shelf?
So it should be coming from you.
Anything that's coming off theshelf essentially had to have
(35:48):
gone through some sort ofsterilizing or processing
process, which means thatthere's no living cells in there
, and we've proven that time andtime again.
There's no such thing as livingstem cells in one of these like
off the shelf umbilical cord.
Placental Wharton's jelly stemcells, um, but they're not
useless.
I mean, they still have goodgrowth factors in them, so they
can.
They have about the same effectas like PRP, essentially.
(36:09):
So where is it coming from?
It should be coming from you,number two, um.
What is it being injected into,you know?
Are they just doing a blindinjection into the joint and
hoping that it miraculously fixyour joints?
Probably not the best.
You need to evaluate the entirekinetic chain.
You need to look at all thedifferent structures.
You need to look at ligamenttendon, you know meniscus.
(36:29):
You need to look at theneuromuscular connection.
You need to look at upstreamissues.
So that's important.
Number two what's the dose?
The majority of your sort ofoff-the-shelf kind of bedside
PRP kits will only concentrateyour PRP to like maybe twice,
which barely meets the actualdefinition of PRP.
So it's important that you getthe right concentration because
(36:50):
it matters what you're injecting.
It also matters depending onthe age, which barely meets the
actual definition of PRP.
So it's important that you getthe right concentration because
it matters what you're injecting.
It also matters depending onthe age.
So the older you get, thehigher concentration you need
essentially.
And number four is who isinjecting it?
You know there are a lot ofvery skilled nurse practitioners
and medical assistants andthings like that out there, but
(37:11):
in order to provide the level oftreatment or level of injection
that I would offer, you need tobe a board certified physician,
having gone through fellowshiptraining.
I mean, I went through twodifferent fellowships to get to
where I'm at.
Speaker 1 (37:25):
So there's a different skill level.
Speaker 2 (37:27):
Yeah, and you got to know all the risks that go along
with what you're doing and yougot to know how to mitigate
potential complications anddisasters.
You got to know all the risksthat go along with what you're
doing and you've got to know howto mitigate potential
complications and disasters.
You've got to know how thisfits in with a lot of other
medical disorders.
It's not a one-size-alltreatment and not everybody can
just go get a bone marrowaspiration or draw 60 tubes of
blood and so on, so youdefinitely need a medical
professional behind itInteresting.
Speaker 1 (37:48):
Yeah, that's a good point.
When you arrived here, you'retalking about a patient that you
just had.
That was super interesting,right.
Speaker 2 (37:54):
Yeah, tell us about what was going on.
Speaker 1 (37:56):
Yeah, so she Typical client, of course.
Yeah, so de-identified.
Speaker 2 (37:59):
So she, you know, middle-aged, very active.
She's a distance runner.
You know her favorite activityis to go run for like 15 plus
miles, which that's impressive.
Speaker 1 (38:10):
Cool yeah, I think what was interesting is like it
seems like healthcare.
You know practitioners likeourselves.
We hear that story andimmediately, at least my head,
is like awesome.
Speaker 2 (38:21):
Yeah, I get excited Versus like all right.
Well, you're battling knee andhip pain.
Speaker 1 (38:25):
Maybe you should stop running because it's bad for
you.
Yeah, it's like people likethat are tired of going to,
people that are like just don'tdo that anymore.
Why don't you just rest ice andtake Advil?
Speaker 2 (38:34):
Like problem solved.
Oh Advil, don't get me startedon Advil Like man like?
Speaker 1 (38:38):
what about?
Like?
How can we enable this personthere has to be something going
on and like longevity wise.
Speaker 2 (38:53):
How can we enable and ?
Speaker 1 (38:54):
empower this person to like continue what they're
doing, and what strategies andstuff can we implement to allow
this?
Let's high five and assistversus like resist and then just
tell them to stop, like, oh ithurts, oh, don't do that.
Yeah, problem solved.
Yeah, oh my gosh, yeah, I meananyway, that's a conversation I
have a lot of patients.
Speaker 2 (39:00):
It's like you know, there's no cure for arthritis
and we're not going to fix orcure the issue.
But the goal here is to giveyour body the tools it needs to
sort of get you back to what itwhatever it is you were doing
and simultaneously try toaddress what it was that got you
there.
You know, so that's for example,I never do injections without
(39:20):
also making sure that thatperson is getting high quality
physical therapy.
Never Because I can inject allI want, but unless the body is
being taught how to avoid thatinjury again.
Or you know the tissue isactually taught how to avoid
that injury again, or you knowthe tissue is actually getting
the physical stimulus in orderto know how to heal.
Speaker 1 (39:36):
Yeah, it's just it's not really gonna come back,
you're not gonna get the bestresults, yeah, so you have to
couple both of them, yeah yeah,cool, okay.
Speaker 2 (39:43):
So yeah, lady coming in yeah, lady coming in
endurance runner, endurancerunner decides to change up her
cadence or her stride.
Uh, one day and like halfwaythrough her run, just intense
anterior hip pain and groin pain, like searing groin pain, and
ever since then she's hadsitting intolerance.
She gets a lot of pain withinternal rotation and inflection
(40:03):
.
Uh, even with external rotationshe started to get some kind of
adductor type pain yeah, um sohip imping, so hip impingement
hip impingement underlying.
Speaker 1 (40:11):
FAI probably.
Speaker 2 (40:12):
Right.
Speaker 1 (40:12):
Somewhat.
Speaker 2 (40:13):
Yeah and um, she came to my clinic, um, and we looked
over her, her x-rays, and sheactually has like grade three
arthritis.
You know it was like prettyadvanced Uh, but which goes to
show you she was likeasymptomatic all the way up to
this point.
Speaker 1 (40:27):
Super interesting, right, yeah, yeah.
Speaker 2 (40:30):
Um so we did a physical exam.
Sure enough she had all the faisymptoms.
She also had some, you know uh,pain over the greater
trochanteric bristis or all theglute muscles attached.
Um she was having somedecreased multifidus activation
on the back.
Um her pelvis was slightlyposteriorly rotated on the right
(40:51):
and sort of out flared and soshe had some psoas tightness on
that on that right side as wellshe had that.
Speaker 1 (40:56):
Yeah, I love that because, like that's, yeah,
totally s, the sij is super, yes, involved exactly.
I mean anyway, sorry throughthe ultrasound on.
Speaker 2 (41:05):
I always ultrasound exam.
Um, just that's.
It's an extension of myphysical exam.
So I put the ultrasound on andI was able to see that she had
some bowing of the hip capsulewhich made me think that there's
an effusion in there.
She had some degeneration ofthe anterior and superior labrum
, some tendinopathy of the glutetendons at the GTB.
She had some tendinopathy atthe iliac crest and then what
(41:29):
else?
Speaker 1 (41:30):
was there.
Speaker 2 (41:33):
Oh, she had a little bit of hamstring tendinopathy as
well and then she had this bigold bursa of fluid underneath
her psoas.
So there's definitely someirritation of the psoas that's
going over the anterior hipthere.
Um worked her up and then gother in for treatment, which was
today, actually right before Icame in and basically we did 10X
concentrated plateletsintraarticular into the hip and
(41:55):
then we did 7X concentratedplatelets into the anterior and
posterior hip capsule, into theanterior and superior labrum,
and then we use what's calledPL-prolo or platelet lysate in
prolotherapy.
Basically, we take PRP or superconcentrated platelets, we
freeze them, we break open theplatelets, we pass them through
(42:17):
a 200 micron filter and we getall the goodies without the
thrombotic platelet factors, andthen we take that and we mix it
with prolo.
So you're basically takingprolotherapy and supercharging
it with all the nutrients andgrowth factors from platelets.
Speaker 1 (42:30):
Yeah, that's really interesting.
Speaker 2 (42:31):
Yeah, Take and supercharging it with all the
nutrients and growth factorsfrom platelets.
Yeah, that's really interesting.
Yeah, take that and we injectthat into the SI ligaments,
sacrotubris, sacrospinousligaments, and then, under
fluoro, I did platelet lysateinjections of the iliolumbar
ligaments, interspinousligaments at L5 and S1.
, and then a transferaminalplatelet epidural at S1 as well.
Speaker 1 (42:52):
So really just addressing that whole kinetic
chain that whole component, yeah, the lumbar down to hip, and
then I'm actually sending her toyou guys.
Cool, Well, I'd love to helpher.
Yeah, yeah, Because I mean it'sinteresting, they're a
different breed and we loveworking with endurance athletes
because they're in the same boatof like no, this is what I do.
Like no, this is this is what Ido.
Speaker 2 (43:10):
Yeah, exactly Awesome , let's get it.
Speaker 1 (43:12):
Yeah, um, but that like that, enthusiasm and buy-in
always just helps outcomes.
You know, yeah, um.
Why not do the PRP injectionslike that all the time to avoid
the thrombitic properties, likeyou were describing Thrombitic
being like you want to describethrombosis, like yeah, yeah.
Speaker 2 (43:32):
So basically you know platelets they like to clot.
That's their main job.
They basically stick and thenthey break open and in some
cases, like if I'm injectinginto the epidural space or into
the spinal column, I don't wantthere to be any sort of risk of
clot.
It's a theoretical risk, butit's a risk nonetheless.
So we basically take thoseplatelets, concentrate them,
break them open and then filterout the goodies.
So we use platelet lysate inthe spine just to reduce the
(43:54):
risk of thrombosis or clotting.
But for ligaments, I mean, Icould inject platelets in there
and you still get a goodresponse.
But sometimes you want to useprolotherapy and so I'm just
essentially combining them.
And so if you take prolo, whichis just dextrose, sugar, water,
(44:15):
and then you combine it withPRP, what happens is that
because the sugar is soconcentrated, the dextrose is
concentrated, it basically turnsthe platelets into like raisins
and so they becomedysfunctional.
They can't stick and they can'topen up.
So you're basically destroyingthe PRP.
But if you just get rid of theplatelet part and you take all
(44:38):
the factors, the nutrients, frominside.
You can mix that withprolotherapy and there's there's
no issue at all, basically.
Speaker 1 (44:41):
So what that does is that lets me sort of volume
expand, meaning I can treat morestructures without having to
take so much more blood, yeah,from the patient, yeah, yeah, so
to combine the prolotherapywith that, it's's a like the
prolotherapy is small,purposeful irritation of the
joint of the structure playthat's in there as the heroes
that go in and solve the problem.
Speaker 2 (45:01):
Yeah, Basically you just you're giving them all the
nutrients they need to sort ofregenerate Cool.
That's really interesting man,it's awesome.
Speaker 1 (45:07):
I love that.
We'd love to help her See a lotof runners and stuff.
Yeah, cool man.
Well, I appreciate that.
So, all right.
Last question what would yousay is like your wheelhouse.
My wheelhouse, ideal patientyou guys crush home runs with
these people.
Speaker 2 (45:22):
Every patient's an ideal patient.
Speaker 1 (45:24):
I mean honestly like I feel the same way of like yo.
It doesn't matter if they'rejust motivated and enthusiastic
and they're ready to to want tosee good outcomes and results,
yeah, the fact that they'recoming to me means that they're
in the mindsets of I want to getbetter.
Speaker 2 (45:38):
Not not just oh, fix this and let me get back to my
life, yeah, um so my wheelhouse,I would say spinal conditions
um, especially like cervicalspine, so neck pain, so neck
pain, headaches, shoulders, jawpain, TMJ, things like that.
Speaker 1 (45:52):
I love doing that and that's partially because of my
neurology.
I was going to say that's acool link, yeah right.
Speaker 2 (45:58):
So I mean a lot of like when I was in residency.
I mean it was always justmigraine until proven otherwise.
Speaker 1 (46:07):
And now I'm discovering.
Speaker 2 (46:07):
Oh well, there's more to it than this.
Yes, you can have migrainefeatures, but we need to be
looking at the neck, because ifthere's, any sort of instability
if there's forward head, ifthere's loss of the curve of the
neck, like you're going to getneurological dissonance.
Speaker 1 (46:17):
Cervical genetic headaches yeah, absolutely.
Tmj referral totally.
We've been seeing some more TMJpatients, which is interesting.
What do you do for TMJ patients?
Internal mobs yeah, yeah, andif it's hypermobile or
hypomobile either side and thendry needling is really effective
into the joint underneath the,the in the joint, yeah, the
(46:40):
lateral pterygoid masseter andthen the temporalis muscles.
Speaker 2 (46:44):
How do you get to the lateral pterygoids?
That's through the joint.
Yeah, I know.
Yeah, it's kind of scary.
Speaker 1 (46:48):
Go through the temple like the sphenoid region and
then just below the condyle, andthen straight through, so
you're going through the mouth,no right here straight through.
Take like a one-inch needle,nice.
Usually we use like the.
I think they're 15-millimeterlength needles for the masseter,
the temporalis and then thejoint itself intraarticular, but
(47:13):
then for the lateral p a lot ofto reach it.
You get like a one inch needleand go straight through that's
hardcore.
I like it, but it's interestingis like it really doesn't feel
like people get freaked out.
You know, they're so tiny, youknow what I mean.
Yeah, um, like the needles, butum, it's just, it's really
effective.
Yeah, that's awesome.
Yeah, okay, and then you, stim,put the stimulation on it too.
Speaker 2 (47:31):
I have a very good friend who she has bad.
You know bruxism.
She grinds like crazy and hermasseters are just like rock
solid.
Yeah, yeah, yeah, totally, andso I was trying to figure out.
You know, what do I do beforewe put Botox in there, basically
, yeah, yeah, um, anyone who'sgetting like Botox for migraines
.
You know, the typical protocolfor migraine Botox is to, you
(47:53):
know, obviously inject aroundthe head, but they also inject
into the neck muscles and thatcan actually cause a lot of
problems down the road, becauseby weakening those, I mean, you
know, by weakening thatposterior chain, you get this
more instability, yeah, so youknow I decided that you know
when I treat my migrainepatients with Botox that I'm
going to do the typical, youknow, cranial injections, but
(48:16):
just avoid the posterior.
Speaker 1 (48:18):
We usually, I mean like from our head.
We don't do injections right,it's not our thing.
But for fixing headaches it'slike, how can we help improve
this?
We definitely consider uppercervical, suboccipital cervical,
genic headaches.
Tmj is definitely on this too,and then not our realm right,
(48:39):
but if something's bruxing atnight, clenching, clearly
there's some kind of anxiety,psych there's.
We can't neglect, there's apsychological component to a
pain experience.
You can't separate the mind fromthe body.
But that's also something thatwe can't neglect and be like
that's something I would diveinto right, not me, but like
that's something I wouldinvestigate on your end and I do
have some mental healthprofessionals that would
recommend totally but that'ssomething that I'm like we can't
neglect.
That either.
You know what I mean.
Speaker 2 (48:59):
Yeah.
Speaker 1 (48:59):
It's a delicate dance of a conversation.
Of course we're not.
You know we want to validateand, like you know, do the
things.
We can't separate the mind fromthe body or neglect.
There's a psychologicalcomponent to pain too, something
I don't want to leave any stoneunturned.
Speaker 2 (49:15):
Having those resources is invaluable.
To be able to say to recognizeokay, there is a significant
sort of psychosocial componentto this.
We need to address it.
The biopsychosocial model,exactly.
So to be able to send them outis good.
Speaker 1 (49:28):
Yeah, it's not what we do, but.
Speaker 2 (49:29):
Yeah, it's not what we do.
I want to help you withbiomechanics, pain for sure
strengthening stuff.
Speaker 1 (49:34):
But I do know people that do and if you're interested
we'll reach out or we'll giveyou the information if you want.
But anyway, sorry, go ahead.
Speaker 2 (49:44):
Migraines and Botox.
Yeah, basically, if I do Botoxfor migraines, I treat
appropriately, but I just avoidthe posterior cervical chain
because it's it might help yourmigraines but you're going to
eventually get cervical problemsand maybe cervicogenic
headaches down the road.
It's important thing yeah, yeahtotally, but other than that I
mean going back to thewheelhouse.
Like you know, I my favoritething is treating spine.
(50:05):
I love being with the c-armfluoroscopy just hitting facets,
transferaminal, getting theligaments multifidus just
getting the whole functionalspinal unit.
which man, I could talk aboutfunctional spinal unit for like
hours, functional spinal unit.
Speaker 1 (50:17):
Yeah, exactly.
Speaker 2 (50:19):
And then so that's like my favorite.
My least favorite is ankles.
Ankles are tough, they're verytough, very tough.
They're hard to.
I mean they Very tough.
They're hard to.
I mean they're very painfulwhen they're in pain.
Anatomically they can be very,very challenging.
Yeah, but if you get it rightyeah, if you get it right, you
can really change someone's life.
Speaker 1 (50:39):
Cool yeah, a lot of moving parts, oh yeah.
Speaker 2 (50:41):
A lot of force, like a lot of weight and tension, and
you know it's a very toughjoint.
Speaker 1 (50:46):
Yeah, totally, all right, man, alright, man, well,
dude, thanks for coming in,we'll have to do another round.
Speaker 2 (50:51):
I'm down the street, man, just let me know.
Speaker 1 (50:52):
Talk about all the other stuff we can nerd out on
you know which is cool butthanks for coming in.
If people want to reach out,what's the best way to reach you
?
Speaker 2 (51:00):
well, two ways.
You can find me on Instagram,docregen d-o-c-r-e-g-e-n, or you
can go to my website,palmbeachregencom.
Or, if you are listening andyou are like in Alaska or
something like that, go toregeneratecom R E G E N E X X
and find a regenerate providerin your network.
There's about 120 of us aroundthe world.
(51:20):
Oh cool, that's interesting.
Speaker 1 (51:22):
I had to chat with them too, like you know some
kind of that's awesome.
Yeah, Cool man.
Well, we'll get round two onthe books soon and if y'all have
any questions, we're alwaysopen to questions, opinions,
comments.
Concerns conflicting opinionstotally, and if you have any
questions as a patient,definitely reach out.
We love to chat and share someinsights, if we can help.
The best way to reach us isteam at athleterccom or our
(51:44):
phone number at 561-898725.
And we'll catch y'all next time.
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