EP40. Explaining Regenerative Medicine (Prolotherapy, PRP, Bone Marrow, & Adipose Derived Stem Cells), and the use of Ultrasound

Episode Transcript
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(00:05):
Recording from the Sunshine City, St.
Petersburg, Florida, overlooking beautiful Tampa Bay.
This is the Sonography Lounge, sponsored by Gulf Coast Ultrasound Institute.
This podcast is dedicated to medical professionals and patients around the world interested in diagnostic and interventional ultrasound.

(00:25):
Our podcast will discuss everything ultrasound from news, trends, career paths, new technology, and industry updates.
Hosted by Lori Green and Tricia Rio of Gulf Coast Ultrasound Institute, they bring over four decades of experience in the ultrasound profession and are here to guide you through this journey. 7 00:00:43,574.999 --> 00:00:45,714.999 Now sit back, relax, and enjoy. 8 00:00:49,126.148697951 --> 00:00:54,556.148697951 Hey everyone, and thank you for joining us at the Sonography Lounge, where we discuss all things ultrasound. 9 00:00:54,916.148697951 --> 00:00:57,886.148697951 I'm Lori Green and I'm here with our co-host, Tricia Rio. 10 00:00:57,976.148697951 --> 00:00:58,396.148697951 Hey, everybody. 11 00:00:59,581.148697951 --> 00:01:09,141.148197951 We're so happy to have you with us because we just wrapped up day four of our intro and advanced interventional and Regen Med MSK course at our facility right here in downtown St. 12 00:01:09,141.148197951 --> 00:01:09,771.147697951 Pete, Florida. 13 00:01:10,191.148697951 --> 00:01:18,286.048697951 And we are excited to sit down with several of our expert faculty to chat about regenerative medicine while enjoying a little happy hour with some. 14 00:01:18,356.148697951 --> 00:01:19,326.148697951 Cold beverages. 15 00:01:20,46.148697951 --> 00:01:20,536.148697951 That's right. 16 00:01:20,906.148697951 --> 00:01:21,146.148697951 Yeah. 17 00:01:21,146.148697951 --> 00:01:23,126.148697951 Happy hour chat with some of our favorite people. 18 00:01:23,526.148697951 --> 00:01:33,156.148697951 Uh, for those who are unfamiliar, regenerative medicine is focused on developing and applying treatments that support the body and repairing, regenerating and restoring itself to a state of wellbeing. 19 00:01:33,426.147697951 --> 00:01:46,986.14769795 Regenerative medicine is a rapidly evolving field for MSK, even though it's been around since the 1930s with prolotherapy followed by platelet rich plasma or PRP in the mid 2000s and more recently bone marrow and lipo aspirate applications. 20 00:01:47,446.14869795 --> 00:02:00,366.14769795 Regenerative medicine therapies begin with the physician making an appropriate diagnosis of the MSK condition through clinical exam and imaging and use that info to determine which regenerative therapy would be the best treatment option. 21 00:02:02,96.14869795 --> 00:02:03,226.14869795 That's right, Tricia. 22 00:02:03,266.14769795 --> 00:02:06,766.14869795 So joining us in our podcast studio today is Dr. 23 00:02:06,766.14869795 --> 00:02:13,986.14819795 John Broussard, board certified in family medicine and sports medicine and co owner of Alliance Regen and Rehab right here in St. 24 00:02:13,986.14819795 --> 00:02:14,606.14869795 Pete, Florida. 25 00:02:15,116.14769795 --> 00:02:15,996.14869795 We also have Dr. 26 00:02:16,16.14869795 --> 00:02:16,981.04869795 Imran Siddiqui. 27 00:02:17,271.14869795 --> 00:02:22,661.14869795 partner and director of clinical operations at Regenerative Orthopedics and Sports Medicine in Washington, D. 28 00:02:22,661.14869795 --> 00:02:23,41.14869795 C. 29 00:02:23,561.14869795 --> 00:02:24,621.14869795 And also Dr. 30 00:02:24,621.14869795 --> 00:02:31,411.14769795 David Wang, founding partner and director of education and training of Regenerative Orthopedics and Sports Medicine in the Metro D. 31 00:02:31,411.14769795 --> 00:02:31,711.14769795 C. 32 00:02:31,751.14869795 --> 00:02:32,161.14819795 area. 33 00:02:32,161.14819795 --> 00:02:33,111.14869795 So welcome, gentlemen. 34 00:02:33,901.14869795 --> 00:02:34,881.14869795 Thank you for having us. 35 00:02:34,951.14869795 --> 00:02:35,511.14869795 Thanks for having us. 36 00:02:35,511.14869795 --> 00:02:35,951.14869795 Thank you. 37 00:02:36,111.14869795 --> 00:02:37,521.14869795 I'm so happy to have you here. 38 00:02:37,861.14869795 --> 00:02:43,641.14869795 So with further, without further ado, let's start things off with a discussion about prolotherapy. 39 00:02:43,651.14769795 --> 00:02:46,271.14869795 You know, what is it, how it helps your patients, et cetera. 40 00:02:46,781.14769795 --> 00:02:47,71.14869795 All right. 41 00:02:47,391.14869795 --> 00:02:47,561.14869795 Yeah. 42 00:02:47,561.14869795 --> 00:02:48,651.14769795 So thank you for that. 43 00:02:49,131.14869795 --> 00:02:53,701.14869795 Great introduction, and it was a, a nice kind of summary about, uh, regenerative medicine there. 44 00:02:53,701.14869795 --> 00:02:59,91.14869795 And so, uh, you know, the recent technologies, the, the advancements are, are just phenomenal. 45 00:02:59,91.14869795 --> 00:03:07,801.14869795 You know, it's, it's like every other month, you know, there's a new technology that seems to be coming out and new research that's really showing, uh, for the most part that these regenerative therapies work quite well. 46 00:03:08,171.14869795 --> 00:03:10,81.14869795 And so it's easy to get. 47 00:03:10,356.14869795 --> 00:03:25,76.14869795 Uh, wrapped up in, you know, the newest tech and what's the newest interosseous application of PRP and what's the, you know, uh, newest method for, uh, bone marrow extraction, things like that, which I think are all revolutionized in the field of general medicine, but it's also not bad to kind of look back historically and see. 48 00:03:25,776.14869795 --> 00:03:35,986.14819795 Okay, well, how did all this regenerative medicine start? Uh, and when you're talking about prolotherapy, uh, which is short for proliferative therapy, which is a, a term that was coined, I think, back in the 1950s by Dr. 49 00:03:35,986.14819795 --> 00:03:44,766.14869795 George Hackett, we realized that, okay, well, prolotherapy's been around since about 1937 when the first, uh, published, uh, article in the Lancet, I believe, by Dr. 50 00:03:44,766.14869795 --> 00:03:53,216.14869795 Earl Gedney, portrayed using a prolific solution for the sacroiliac ligaments in terms of improving stability in the, in the SI region. 51 00:03:53,496.14869795 --> 00:04:11,616.14869795 So this stuff's been around for, what, 80, more than 85 years, and prolotherapy is still a very, you know, decent, relevant, easy, minimally invasive technique that can be used, and a lot of it is also the, not just what's in the syringe, but the actual, um, technique of diagnosis and treatment. 52 00:04:11,926.14869795 --> 00:04:20,356.14869795 And that technique of diagnosis and treatment can be applied to, you know, not just regenerative treatments, but frankly, musculoskeletal diagnosis and treatment, you know, across the board. 53 00:04:20,596.14869795 --> 00:04:23,616.14769795 So it's an important foundational, uh, aspect of regenerative medicine, I think. 54 00:04:23,856.14769795 --> 00:04:33,806.14869795 Not to mention for your, uh, less severe cases of, uh, tendinosis, small grade partial tears, ligamentous injuries, and some, uh, low grade, uh, arthritis conditions. 55 00:04:34,601.14869795 --> 00:04:41,731.14869795 It can be very helpful, uh, and doesn't require drawing blood or, you know, obtaining, uh, uh, harvesting, um, you know, uh, fat or bone marrow and that sort of thing. 56 00:04:41,761.14869795 --> 00:04:44,801.14869795 So it's less invasive and, uh, you know, it, it, it, it has its role. 57 00:04:45,121.14769795 --> 00:04:45,471.14769795 Yeah. 58 00:04:46,216.14869795 --> 00:04:46,876.14869795 I agree, Dr. 59 00:04:46,886.14869795 --> 00:04:53,736.14869795 Wang, as a good synopsis of prolotherapy and where we've come from, right, as far as regenerative medicine. 60 00:04:54,266.14769795 --> 00:05:01,786.14769795 I think, uh, prolotherapy, like you mentioned, it's a technique, not just what's in the syringe. 61 00:05:01,786.14769795 --> 00:05:07,56.14869795 It's not just sugar, so prolotherapy is not a product, but a whole system. 62 00:05:07,836.14869795 --> 00:05:12,766.14869795 of thinking about restoring tissue, joint functions, stability. 63 00:05:13,116.14869795 --> 00:05:28,116.14869795 So, um, you know, prolotherapy is a good learning tool, a good launch pad, and, and like, like you guys do, like I do, like a lot of us do, is we use prolotherapy techniques and carry that over with our other regenerative treatments. 64 00:05:28,116.14869795 --> 00:05:33,616.14869795 So whether we're using PRP or, or anything else, we're using the prolotherapy system. 65 00:05:34,241.14869795 --> 00:05:37,651.14869795 Like you said, it's not what's in your syringe, it's how are you using it. 66 00:05:37,781.14869795 --> 00:05:38,291.14869795 Absolutely. 67 00:05:38,331.14869795 --> 00:05:46,491.14869795 And so that whole technique of not just controlling pain but providing stability and support for that structure is super important. 68 00:05:46,521.14869795 --> 00:05:56,151.14869795 And like you said, it's, it's, it's very cost effective for the provider, for the patient, um, you know, learning and doing it in third world countries. 69 00:05:56,151.14869795 --> 00:05:56,981.14869795 It's super easy. 70 00:05:56,981.14869795 --> 00:06:01,761.14869795 And, um, and the nice thing about prolotherapy is, uh, when you run out. 71 00:06:02,201.14869795 --> 00:06:03,651.14869795 And guess what? You just make more. 72 00:06:03,731.14869795 --> 00:06:04,11.14869795 Yeah. 73 00:06:04,501.14869795 --> 00:06:05,491.14869795 And so like Doritos. 74 00:06:05,711.14869795 --> 00:06:09,541.14869795 And so for PRP, you know, you've. 75 00:06:10,366.14869795 --> 00:06:11,306.14869795 You get what you get. 76 00:06:11,396.14869795 --> 00:06:13,796.14869795 You got a blood draw, you get your PRP and that's it. 77 00:06:13,846.14869795 --> 00:06:18,976.14869795 You have to really plan ahead for these treatments and then, you know, bone marrow, same thing. 78 00:06:18,986.14769795 --> 00:06:19,836.14869795 You get what you get. 79 00:06:20,166.14869795 --> 00:06:25,366.14869795 Um, and so with prolotherapy, you finish your treatment and your tray is empty. 80 00:06:25,376.14869795 --> 00:06:26,606.14969795 You're like, I want to hit this. 81 00:06:26,636.14869795 --> 00:06:30,636.14869795 Well, you just reach over and grab some more and, and it's, it's great. 82 00:06:30,696.14869795 --> 00:06:34,36.14869795 You know, so far as you know what you're doing, your needle prolotherapy is very forgiving. 83 00:06:34,706.14869795 --> 00:06:36,286.14869795 Um, it works very well in the. 84 00:06:36,656.14869795 --> 00:06:46,76.14869795 Everything, really, spine, you know, you can, I like to use prolotherapy when I'm seeing a patient for the first few times and they have a lot of stuff going on. 85 00:06:46,846.14869795 --> 00:06:49,636.14869795 So I tell the patients, okay, like, let's pull some weeds. 86 00:06:49,666.14869795 --> 00:06:54,486.14869795 Let's, let's get this, like, let's get the smoke and the clouds out of the way. 87 00:06:54,636.14769795 --> 00:06:54,716.14769795 Right. 88 00:06:54,846.14869795 --> 00:06:57,616.14869795 Let's treat all your stuff super comprehensively. 89 00:06:58,226.14869795 --> 00:07:12,806.14869795 Yeah, you got some bad facets, and you got some stuff that we can do some PRP on, but let's do some prolo, shore everything up, once there's stuff left, then we can come in with our big biologics that, if you need it, right? I mean, that's how I kind of use it. 90 00:07:13,716.14869795 --> 00:07:14,396.14819795 I don't know, Dr. 91 00:07:14,396.14819795 --> 00:07:21,746.14869795 Siddiqui? Yeah, uh, no, prolotherapy is, uh, it's a great place to start for both physicians who are learning and also patients. 92 00:07:21,956.14869795 --> 00:07:30,666.14869795 Um, it's been around for a long time, and despite, These great newer treatments like PRP and bone marrow aspirate and MFAT. 93 00:07:31,276.14869795 --> 00:07:35,596.14869795 Prolotherapy works and works on a lot of people and for a lot of conditions. 94 00:07:35,606.14869795 --> 00:07:42,466.14869795 And so, you know, despite it being kind of the old G and the older treatment, we still use it a lot. 95 00:07:43,31.14869795 --> 00:07:45,621.14869795 And, uh, you know, like, like you said, uh, Dr. 96 00:07:45,621.14869795 --> 00:08:06,311.14869795 Broussard, um, uh, for patients with a lot of things going on, especially hypermobile patients, um, it's my go to for hypermobile patients to start with because, um, you need a lot of volume in, in those patients because not only do you need to treat the injured ligament or tendon, but you probably got to treat all the other ligaments and tendons in the area because everything's loose. 97 00:08:07,111.14869795 --> 00:08:11,231.14869795 And, um, they're not going to get fully better unless you tighten up that area. 98 00:08:11,231.14869795 --> 00:08:13,371.14869795 So, um, it's a great treatment. 99 00:08:13,371.14869795 --> 00:08:17,41.14869795 Great for comprehensive, uh, cervical neck treatments. 100 00:08:17,51.14769795 --> 00:08:19,931.14869795 Great for comprehensive low back treatments, because you need a lot of volume. 101 00:08:19,931.14869795 --> 00:08:21,311.14869795 You need to hit a lot of structures. 102 00:08:22,111.14869795 --> 00:08:24,151.14769795 Um, so, so great from the patient care. 103 00:08:24,151.14769795 --> 00:08:31,171.14869795 And also, you know, for, for providers who are getting into this, um, it's very important that they learn prolotherapy. 104 00:08:31,171.14869795 --> 00:08:31,851.14869795 A lot of them. 105 00:08:32,416.14869795 --> 00:08:34,516.14869795 But they're kind of skipping over it. 106 00:08:34,516.14869795 --> 00:08:34,606.14869795 Mm-Hmm. 107 00:08:34,846.14869795 --> 00:08:38,116.14869795 And they're going straight to learning the p rrp and learning. 108 00:08:38,221.14869795 --> 00:08:39,376.14869795 Well, P p's sexy. 109 00:08:39,436.14869795 --> 00:08:40,186.14869795 It's sexy. 110 00:08:40,726.14869795 --> 00:08:41,656.14869795 It's stem cells are sexy. 111 00:08:41,656.14869795 --> 00:08:42,826.14869795 Right? Yeah. 112 00:08:42,916.14869795 --> 00:08:43,156.14869795 Right. 113 00:08:43,156.14869795 --> 00:08:43,666.14869795 It's trendy. 114 00:08:43,756.14869795 --> 00:08:44,116.14869795 Yeah. 115 00:08:44,446.14869795 --> 00:08:48,271.14869795 Um, no one wants the 90-year-old prolotherapy, right? Yeah. 116 00:08:48,736.14869795 --> 00:08:58,426.14869795 So, um, it's, uh, um, but, but it's, it, it serves as a great basis and great foundation for learning because you use those techniques. 117 00:08:58,976.14869795 --> 00:09:07,636.14869795 Doing PRP and doing bone marrow and doing adipose, if you don't, if you don't have the good skills and good basis from prolotherapy, you're not going to be as good with those other things. 118 00:09:07,656.14769795 --> 00:09:08,56.14769795 Totally. 119 00:09:08,146.14869795 --> 00:09:50,601.14869795 And to expand on that a little bit, by the way, I love how you're referring to, uh, prolotherapy as the OG, so regenerative treatment, instead of original gangster, I think we can call it like, uh, orthobiologic glucose, right? How In terms of, uh, this comprehensive approach here, just to comment a little bit on, uh, tensegrity, you know, so this is a concept that, uh, a lot of experienced regenerative medicine, uh, docs will talk about, and tensegrity being basically tension or tensile integrity is an interesting concept where a lot of biological systems The integrity of the system is based on their ability to, uh, basically resist tension as opposed to compression. 120 00:09:50,601.14869795 --> 00:10:01,511.14869795 And so a common, uh, I guess analogy for this is that a building with, you know, brick and mortar and all that is designed to resist compressive forces of gravity, right? Which is fine for a building because the building doesn't move. 121 00:10:01,631.14869795 --> 00:10:17,71.14869795 Right? But if you have something that's a dynamic structure that has to move and there's different angles and you got to deal with gravity and you have to deal with centripetal forces, this idea of tensegrity, where that structure can resist tension from multiple angles, uh, is important in the overall stability. 122 00:10:17,966.14869795 --> 00:10:18,646.14869795 Of that structure. 123 00:10:18,646.14869795 --> 00:10:24,826.14869795 And so a giraffe's neck, for example, is a nice, uh, example of a tensegrity structure compared to a building. 124 00:10:25,96.14869795 --> 00:10:33,326.14869795 And so many biological structures from the cellular level all the way up to us, in this case, us as human beings, are tensegrity structures. 125 00:10:33,946.14769795 --> 00:10:36,166.14869795 So the advantage is that you can take something very lightweight. 126 00:10:36,371.14869795 --> 00:10:46,721.14869795 that has these tensile, uh, in, in terms of biological systems like ligaments, tendons, fascia, these different soft tissues that are very pliable and flexible and lightweight that can resist a lot of force. 127 00:10:46,761.14869795 --> 00:10:55,761.14869795 But the disadvantage is that if you have a compromise or injury to, uh, a part of that system, it can affect the integrity of that entire system. 128 00:10:55,761.14869795 --> 00:11:00,31.14869795 And so this is why in basic prolotherapy concepts, you want to treat. 129 00:11:00,166.14869795 --> 00:11:02,466.14869795 the entire system, that entire tensegrity system. 130 00:11:02,466.14869795 --> 00:11:11,596.14869795 So you kind of have to fix up everything to maintain integrity of that entire structure, which is why comprehensive prolotherapy is designed to treat, you know, multiple structures. 131 00:11:11,606.14769795 --> 00:11:14,836.14769795 Sometimes we're talking, you know, 20 or 30 structures in one sitting. 132 00:11:15,66.14769795 --> 00:11:21,441.14869795 Now, I find that especially with the application of Diagnostic ultrasound, it helps you to be much more exact where you're treating. 133 00:11:21,441.14869795 --> 00:11:23,561.14869795 So I find that I don't have to treat as many structures. 134 00:11:23,561.14869795 --> 00:11:28,861.14869795 I can use about one third the amount of solution as I used to, and still get very, very good long term results with that. 135 00:11:29,121.14869795 --> 00:11:37,31.14869795 But the idea of tensegrity, I think, is something that's easily missed because you can end up kind of getting tunnel visioned with where you want to apply your treatments. 136 00:11:37,41.14869795 --> 00:11:39,71.14869795 But I don't know how you folks feel about that. 137 00:11:39,371.14869795 --> 00:11:40,111.14869795 A hundred percent. 138 00:11:40,111.14869795 --> 00:11:40,661.14869795 Spot on. 139 00:11:41,281.14869795 --> 00:11:50,961.14869795 Um, One of the things, one of the common questions that I get from patients with when we talk about prolotherapy is they ask about their blood sugar. 140 00:11:51,521.14869795 --> 00:12:13,471.14869795 Was my blood sugar going to increase? And maybe they're diabetic or maybe they're just conscious of their blood sugar and What I tell them and I can tell this confidently is it's not going to move and the reason I know that is because I've had a number of patients on pumps and monitors And they've watched their blood sugars and it hasn't changed. 141 00:12:13,741.14869795 --> 00:12:14,21.14869795 Same. 142 00:12:14,31.14869795 --> 00:12:21,991.14769795 So if anyone's out there listening to this and you're considering prototherapy, but you're scared of the dextrose or the sugar, you don't have to worry about it. 143 00:12:22,446.14869795 --> 00:12:23,836.14869795 It's not going to mess up your sugar. 144 00:12:23,836.14869795 --> 00:12:26,26.14869795 You're not going to have to adjust your insulin or anything like that. 145 00:12:26,176.14869795 --> 00:12:32,176.14869795 And I'll tell you this, the cortisone injection that the other orthopedist is offering, that's going to raise your blood sugars a lot. 146 00:12:32,176.24869795 --> 00:12:38,736.04769795 Plus, yeah, I've seen patients in the low 400s from cortisone. 147 00:12:38,736.14769795 --> 00:12:40,366.14869795 For our non physician listeners. 148 00:12:41,126.14869795 --> 00:12:42,356.14869795 Well, um, that. 149 00:12:43,571.14869795 --> 00:12:45,491.14869795 I love listening to you guys talk about this stuff. 150 00:12:45,491.14869795 --> 00:12:46,781.14869795 It's just so fascinating. 151 00:12:46,901.14869795 --> 00:12:53,881.14869795 I know I've been looking forward to this podcast for so long since you told me about it to be in the same room with these guys. 152 00:12:53,921.14869795 --> 00:12:54,431.14769795 I mean, like. 153 00:12:55,861.14869795 --> 00:12:58,101.14869795 Um, this is what we used to do on a daily basis. 154 00:12:58,141.14869795 --> 00:12:58,541.14869795 I know. 155 00:12:58,721.14869795 --> 00:12:59,71.14869795 So. 156 00:13:00,11.14869795 --> 00:13:00,391.14869795 Y'all work together. 157 00:13:00,391.14869795 --> 00:13:01,401.14869795 Three musketeers. 158 00:13:02,741.14869795 --> 00:13:03,881.14769795 Stooges, musketeers. 159 00:13:06,21.14869795 --> 00:13:08,61.14869795 Yeah, I'm just honored to be in the same room with you guys. 160 00:13:08,71.14869795 --> 00:13:16,761.14869795 So, before we move on to PRP, um, as far as your patients go, do you, um, oftentimes, this is a, a regular. 161 00:13:17,121.14869795 --> 00:13:51,981.14869795 situation where maybe they have certain conditions and you say we're going to start with prolotherapy and and this is going to get us to from point A to point B and then it's going to segue into utilizing PRP or some other um, you know, stem cells or whatever, um, or is it usually that you're just pretty much depending upon the condition that they have, you've made the decision that's what you're going to do, see how the patient does and then Later down the road that you decide or is that something that you do like a plan of a treatment plan with the patient? Yeah, I can start on that. 162 00:13:52,11.14869795 --> 00:14:08,891.14869795 Um, so yeah, it is it is Injury dependent the severity of injury that will be the thing that most significantly Steers which biologic or regenerative treatment I'm going to be offering. 163 00:14:09,321.14869795 --> 00:14:17,941.14769795 But a lot of times people are in the middle, you know, they, you could treat it with prolotherapy or PRP or PRP or, uh, bone marrow or whatever. 164 00:14:17,941.14769795 --> 00:14:36,246.14869795 And, and so in those situations, I have the conversation with the patient, you know, these are the two options you'll likely need, you know, three to five treatments of prolotherapy or one to two treatments of PRP and Give, you know, give them the pros and cons of everything and let them decide what they want, what they want to do. 165 00:14:37,166.14869795 --> 00:14:46,896.14769795 But, you know, as I touched on, my hypermobile patients who have a lot going on and their joints are really loose and everything like that, definitely steer towards prolotherapy to start. 166 00:14:47,306.14869795 --> 00:14:48,96.14769795 Like Dr. 167 00:14:48,96.14769795 --> 00:15:00,461.14869795 Broussard said, you know, clean everything up, get everything functioning, functioning normally, and then if there's an injury here that hasn't healed or there that hasn't healed, Then you can do PRP afterwards to kind of finish, finish it off. 168 00:15:00,651.14869795 --> 00:15:00,921.14869795 Great. 169 00:15:01,721.14869795 --> 00:15:02,81.14869795 I agree. 170 00:15:02,111.14869795 --> 00:15:03,321.14869795 I approach it the same way. 171 00:15:03,891.14869795 --> 00:15:03,941.14869795 Great. 172 00:15:04,311.14869795 --> 00:15:13,601.14769795 Um, especially with those hypermobile patients, you know, we can get academic about it. 173 00:15:13,621.14969795 --> 00:15:17,551.14869795 We can look at their research and we can say, Oh, PRP is stronger. 174 00:15:17,611.14869795 --> 00:15:18,481.14869795 It works better. 175 00:15:18,951.14869795 --> 00:15:23,531.14869795 Well, not everybody wants to have their blood drawn and not everybody. 176 00:15:23,551.24869795 --> 00:15:27,541.14869795 can financially do PRP or one of these big things. 177 00:15:27,791.14869795 --> 00:15:31,701.14869795 So you have to look at your patient and see who's in front of you and make this decision with them. 178 00:15:32,201.14869795 --> 00:15:35,241.14769795 And for a hypermobile patient, that's a patient for life. 179 00:15:35,461.14869795 --> 00:15:39,821.14869795 Like, we're not fixing your hypermobility, we're managing it and we're making you more functional. 180 00:15:40,311.14869795 --> 00:15:47,201.14869795 So, yeah, PRP may be more potent, but you need the volume and you need the frequency of the treatments. 181 00:15:47,821.14869795 --> 00:15:53,111.14869795 And so, prolotherapy, I think, It works fantastic for that population. 182 00:15:53,221.14869795 --> 00:15:53,341.14869795 Right. 183 00:15:53,891.14869795 --> 00:16:06,611.14769795 Um, you know, and like, let's say, let's say you got really bad arthritis, and we want to talk, we're talking about fat, or infat, or bone marrow, and we need to put something in there. 184 00:16:06,871.14769795 --> 00:16:07,781.14869795 I'm still doing prolotherapy. 185 00:16:08,911.14869795 --> 00:16:12,81.14869795 We still gotta address everything outside of the joint. 186 00:16:12,391.14869795 --> 00:16:15,651.14869795 The ligaments, the fascia, the tendons, the stuff that Dr. 187 00:16:15,651.14869795 --> 00:16:16,551.14869795 Wayne was talking about. 188 00:16:16,801.14869795 --> 00:16:18,781.14869795 So we're still incorporating some prolotherapy. 189 00:16:19,166.14869795 --> 00:16:20,16.14869795 into the treatment plan. 190 00:16:20,396.14869795 --> 00:16:21,726.14869795 So it's, it's kind of always there. 191 00:16:23,76.14869795 --> 00:16:31,56.14869795 And, and for our listeners out here, uh, uh, hypermobility, another, um, a term that you may hear is Ehlers Danlos syndrome. 192 00:16:31,446.14869795 --> 00:16:36,716.14869795 Um, hypermobility is becoming a more commonly diagnosed condition. 193 00:16:36,716.24869795 --> 00:16:40,646.148698 A lot of people with fibromyalgia, we're seeing it's actually hypermobility. 194 00:16:40,976.148698 --> 00:16:45,496.148698 And basically what hypermobility is, is when your tissues are just naturally more elastic. 195 00:16:45,996.148698 --> 00:16:58,656.147698 Then, then, uh, the norm and airless Danlos is a subset of hypermobility and as it's becoming more popular, a lot of providers are calling all hypermobility airless Danlos so it can get confusing. 196 00:16:58,666.148698 --> 00:17:01,126.148698 So if you hear hypermobility for now. 197 00:17:01,486.148698 --> 00:17:04,426.148698 Until we sort this thing out, um, they're pretty much the same. 198 00:17:04,456.148698 --> 00:17:05,166.148698 It's a continuum, yeah. 199 00:17:05,466.148698 --> 00:17:05,876.148698 It's a continuum. 200 00:17:05,876.248698 --> 00:17:06,66.048698 Yeah. 201 00:17:06,66.148698 --> 00:17:06,246.148698 Yeah. 202 00:17:06,246.148698 --> 00:17:20,756.148698 There, there are, was it six subtypes or something like that of Ehlers Danlos? I think type three is the hypermobility only subset where you don't have effects on the heart because there are other aspects of Ehlers Danlos that can affect your cardiac or heart function and that sort of thing. 203 00:17:21,56.148698 --> 00:17:30,396.148698 There are methods of genetic testing and it gets pretty sophisticated and that's not something that, um, I'm not intimately familiar with, but I think the idea in terms of, you know, having these patients for life. 204 00:17:30,746.148698 --> 00:17:36,906.148698 The idea is that the connective tissue, so the collagen fibers that make up that connective tissue, um, are, as Dr. 205 00:17:36,906.148698 --> 00:17:50,286.148698 Siddiqui was saying, they're, they're more elastic, and it is almost like a, on a cellular level, um, something that is, uh, you know, kind of, uh, for that individual, it affects all of their, their collagen tissues. 206 00:17:50,676.148698 --> 00:17:59,366.148698 Uh, and so you can Temporarily fix them with things like regenerative therapies and really get those elastic structures to become more solid, more stable. 207 00:17:59,626.148698 --> 00:18:11,771.148698 But because of that cell turnover and that collagen, um, just from that, you know, kind of, uh, biological basis, eventually those collagen and fibers will become more elastic again, and then their symptoms can return. 208 00:18:11,771.148698 --> 00:18:15,101.148698 So unfortunately, you do have to treat them kind of longitudinally. 209 00:18:15,341.147698 --> 00:18:21,541.148698 But a lot of times I find that with the regenerative treatments, they'll be good for, you know, six to 12 months if, uh, in some cases. 210 00:18:21,691.148698 --> 00:18:22,871.147698 And it can affect multiple joints. 211 00:18:22,871.148698 --> 00:18:26,231.147698 And so sometimes some joints are more heavily affected than others. 212 00:18:26,961.148698 --> 00:18:31,661.148698 But the regenerative therapies are one of the few things that can really get, uh, these folks lasting benefit. 213 00:18:32,101.148698 --> 00:18:36,811.148698 Even though you do have to do them, you know, longitudinally, it really improves their quality of life quite a bit. 214 00:18:37,586.148698 --> 00:18:43,476.148698 And I'm just, I'm just thinking of a patient, um, who I had with very bad hypermobility. 215 00:18:44,56.148698 --> 00:18:45,786.148698 And this is when I was with you guys. 216 00:18:46,946.148698 --> 00:18:55,616.147698 This girl literally could not walk through water, even a few inches of water, without her toes dislocating. 217 00:18:56,196.148698 --> 00:18:56,776.148698 Oh, wow. 218 00:18:56,906.148698 --> 00:18:57,616.148698 It was that bad. 219 00:18:57,926.148698 --> 00:18:58,276.148698 Wow. 220 00:18:58,616.148698 --> 00:19:00,536.148698 So, we treated her with prolotherapy. 221 00:19:01,976.148698 --> 00:19:05,156.147698 Uh, cost effective, dextrose based prolotherapy. 222 00:19:05,156.247698 --> 00:19:06,861.148698 Um, Her toes are fine. 223 00:19:07,951.148698 --> 00:19:21,61.148698 So, you know, there's, there's a, you know, with all these sexy, um, regenerative treatments out there, these stem cell clinics popping up, especially here in Florida, they're outnumbering Starbucks by now. 224 00:19:22,221.147698 --> 00:19:23,61.147698 That seems something. 225 00:19:23,131.147698 --> 00:19:28,521.148698 I mean, you don't, you don't need crazy, expensive, multi thousand dollar treatments. 226 00:19:29,171.148698 --> 00:19:34,231.148698 All you need is someone who knows what they're treating and how to manipulate a needle. 227 00:19:34,291.248698 --> 00:19:39,861.148698 And functionally to help your tissues and you can do that with sugar, dextrose. 228 00:19:40,931.148698 --> 00:19:49,671.147698 Is that right? A dextrose, uh, treatment by a skilled provider done to, you know, a comprehensive treatment to the knee joint. 229 00:19:49,681.147698 --> 00:19:54,371.148698 So you do the ligaments, you do the capsule, you do the tendons, you do, you do the joint. 230 00:19:54,761.148698 --> 00:19:59,1.148698 Um, that is, is 10 times more valuable. 231 00:19:59,366.148698 --> 00:20:03,306.148698 Then a stem cell, 10, 000 stem cell treatment where they just put it in the knee. 232 00:20:03,446.148698 --> 00:20:03,886.148698 Yep, exactly. 233 00:20:03,886.148698 --> 00:20:04,646.148698 Just put it in the knee joint. 234 00:20:05,86.148698 --> 00:20:08,446.147698 And that's what you see is going on with all these stem cell clinics. 235 00:20:08,936.148698 --> 00:20:10,736.147698 Is they're going in, they don't know what they're doing. 236 00:20:11,236.147698 --> 00:20:18,46.147698 They're, they're, they're creating these stem cells properly because they have the guidance of, of, uh, industry. 237 00:20:18,456.148698 --> 00:20:22,126.148698 Um, but then they're just dumping it in the joint and saying we treated your knee. 238 00:20:22,436.148698 --> 00:20:26,56.148698 And yeah, maybe 40 percent will get better, maybe half. 239 00:20:26,901.148698 --> 00:20:35,81.148698 But for how long and, and they're not fixing the, the functional, uh, problems and they're not fixing the ligaments and supporting structures. 240 00:20:35,691.148698 --> 00:20:41,401.148698 And so that, you know, it's, it's going to catch up and these, you know, it's not sustainable for people to be paying that kind of money because it's. 241 00:20:41,781.147698 --> 00:20:42,331.147698 Right. 242 00:20:42,511.148698 --> 00:20:42,731.148198 Yeah. 243 00:20:42,731.148198 --> 00:20:48,271.147698 It's the difference between the profitability and the managing patients care and giving them the best outcome. 244 00:20:48,461.147698 --> 00:20:48,701.147698 Yep. 245 00:20:48,941.147698 --> 00:20:49,451.147698 So Dr. 246 00:20:49,451.147698 --> 00:20:50,541.148698 Wang, I have a question for you. 247 00:20:50,541.248698 --> 00:20:54,761.148698 Uh, uh, you're well equipped. 248 00:20:55,191.148698 --> 00:21:03,381.148698 Um, So, there is, there is, I was going to comment on that for a little bit. 249 00:21:04,371.148698 --> 00:21:04,981.148698 Oh, please do. 250 00:21:05,791.148698 --> 00:21:13,191.148698 So, there, there is um, a misconception out there, probably from old school providers. 251 00:21:14,46.148698 --> 00:21:21,596.148698 passed down to patients and it scares some patients that they don't want prolotherapy because it causes scar tissue. 252 00:21:21,656.148698 --> 00:21:21,936.148698 Yep. 253 00:21:22,336.148698 --> 00:21:24,186.148698 Can you speak to that? Right. 254 00:21:24,346.148698 --> 00:21:25,96.148698 So sure. 255 00:21:25,106.147698 --> 00:21:27,976.147698 How that came about and what's actually really going on. 256 00:21:28,36.148698 --> 00:21:28,286.148698 Yep. 257 00:21:28,776.147698 --> 00:21:37,336.148698 So as we mentioned before, so prolotherapy or the, uh, concept of, uh, the technique of prolotherapy was first introduced around 1937. 258 00:21:37,746.148698 --> 00:21:42,326.148698 But the term prolotherapy was not coined until the mid 1950s, uh, by, uh, Dr. 259 00:21:42,326.148698 --> 00:21:42,656.148698 Hackett. 260 00:21:43,276.248698 --> 00:21:52,236.148698 Between 1937 and 1950s, it was called sclerotherapy, right? Because back then, it was felt that you're injecting these irritating solutions. 261 00:21:52,236.148698 --> 00:21:55,766.148698 And dextrose was, I think, not really on the, uh, radar at that time. 262 00:21:55,766.148698 --> 00:21:57,636.148698 They were using more caustic solutions and such. 263 00:21:58,6.148698 --> 00:22:00,776.148698 And they were thinking that it was causing, like, scar tissue buildup. 264 00:22:01,336.147698 --> 00:22:08,636.048698 And one of the reasons for that is because, originally, sclerotherapy was being used for, uh, treating, uh, um, inguinal hernias. 265 00:22:08,636.148698 --> 00:22:09,46.148698 Mm. 266 00:22:09,316.148698 --> 00:22:10,486.148698 And they actually were. 267 00:22:10,946.148698 --> 00:22:35,881.148698 encouraging scar tissue development in order to scar that area down to be able to keep that hernia from actually protruding, protruding through, right? But the problem is that they were taking that concept and applying it to a prolotherapy treatment of like ligaments and tendons and all that and they, uh, from there were histologic studies done in in the 1950s that showed that that was not the case that it was actually creating the repair of healthy tissue. 268 00:22:35,881.148698 --> 00:22:38,141.148698 This was done in rabbit tendons, I believe it was. 269 00:22:38,571.148698 --> 00:22:41,221.148698 And then this was followed up by multiple studies through the 70s. 270 00:22:41,501.148698 --> 00:23:13,931.148698 And then when ultrasound was being used for diagnostic purposes, then there were more recent studies like, uh, Brad Fullerton's study from 2008, for example, is a, is a very key study where you could, uh, demonstrate the return of normal organized collagen fibers and body tissues after dextrose prolotherapy that had nothing to do with scar development, right? So I think that unfortunately that idea of scar tissue development was kind of an erroneous thing from the 1940s that had been basically debunked, uh, has been debunked for many decades now. 271 00:23:14,761.147698 --> 00:23:15,11.147698 Cool. 272 00:23:15,21.147698 --> 00:23:15,721.048698 See, I told you. 273 00:23:16,781.148698 --> 00:23:17,261.148698 I'm Willitquick. 274 00:23:17,261.248698 --> 00:23:17,641.148698 He is Willitquick. 275 00:23:19,511.148698 --> 00:23:24,743.2931424 He's just, where do you keep all of that? I don't know, man. 276 00:23:24,743.2931424 --> 00:23:25,451.148698 Oh goodness. 277 00:23:25,721.148698 --> 00:23:35,26.148698 You know, it's something that I would like to, uh Uh, mention so, you know, being, being the old guy in the room here, it, it's so interesting how things will, will come full circle with this. 278 00:23:35,656.148698 --> 00:23:47,386.148698 So, when I started my practice and we were the second academic institution to do PRP, this is back in 2006, I think, uh, when I was in, uh, my residency up at, uh, Harvard, uh, uh, Spalding, uh, where Dr. 279 00:23:47,386.148698 --> 00:23:49,36.148698 Sidiki also, uh, uh, trained. 280 00:23:49,606.148698 --> 00:23:52,756.148698 And I used to do more PRP back then. 281 00:23:53,911.148698 --> 00:23:57,111.148698 Because it was, you know, we had good access to it, it was very effective. 282 00:23:57,641.148698 --> 00:24:13,21.148698 And then as I found as I developed my skills, both in diagnostic, especially in diagnostic ultrasound, but also just in, you know, basic, uh, clinical, you know, acumen, I found that I could get this, the same types of folks better with just a couple of prolotherapy treatments. 283 00:24:13,741.148698 --> 00:24:18,201.148698 So as my skills improved, I was doing less PRP and more prolotherapy. 284 00:24:18,421.148698 --> 00:24:29,111.148698 But then after, I don't know, another decade, It's starting to come around the other way, where I'm realizing that PRP in many cases ultimately is actually a more cost effective approach. 285 00:24:29,411.148698 --> 00:24:31,731.148698 It is more expensive, it's, it's higher technology. 286 00:24:31,751.148698 --> 00:24:34,841.148698 However, it's a good three times more powerful than prolotherapy. 287 00:24:34,841.148698 --> 00:24:46,331.148698 So I'm finding with some of these conditions in my more chronic, my, my patients with the, you know, chronic musculoskeletal issues that just doing the prolotherapy repetitively, it doesn't quite get them over that critical mass of healing. 288 00:24:46,786.148698 --> 00:24:53,116.148698 But if I apply just one or two PRP treatments, it's like that seems to be like the magic thing, and they seem to do a lot better. 289 00:24:53,116.148698 --> 00:25:01,346.148698 So even my patients that have these chronic conditions, multiple body areas, they've done well with prolotherapy, but it's like they're always somewhat symptomatic. 290 00:25:01,626.148698 --> 00:25:04,361.148698 I treat them with PRP, and then now they're like, you know what? Dr. 291 00:25:04,361.148698 --> 00:25:12,641.148698 Wang, you know, I really like the prolotherapy, but the PRP is just a lot better and they need fewer treatments and overall cost is actually lower because they don't need as many treatments. 292 00:25:12,991.148698 --> 00:25:24,631.148698 So it's an interesting balance to strike, right? Between the lower cost prolotherapy, but you need more treatments versus maybe just one or two PRP treatments, fewer visits, less time off of work for them, right? So there's this give and take. 293 00:25:24,811.148698 --> 00:25:25,101.148698 Yeah. 294 00:25:25,301.148698 --> 00:25:47,981.148698 And that's where the relationship with The patient comes in, and it's relational and not transactional, and you figure out what do you need from me right now, and what are your goals, and what can we do to get there? If somebody's traveling two hours to come see us, I'm not doing prolotherapy, right? We're doing PRP. 295 00:25:47,981.148698 --> 00:25:52,471.148698 I'm not going to make you come two hours every month for the next six months. 296 00:25:52,731.148698 --> 00:25:54,771.148698 We're going to do PRP and hammer this thing. 297 00:25:55,496.148698 --> 00:25:58,356.148698 But if someone lives down the street and they want to do prolo, yeah. 298 00:25:59,896.148698 --> 00:26:02,86.148698 And often, to, to your point, Dr. 299 00:26:02,86.148698 --> 00:26:06,646.148698 Wang, is um, you know, those patients who are getting the prolo therapy, they're getting better. 300 00:26:06,646.148698 --> 00:26:11,296.147698 There's often, you know, a couple spots that just aren't responding as well. 301 00:26:11,296.147698 --> 00:26:12,846.148698 They're just more significantly injured. 302 00:26:12,986.148698 --> 00:26:13,336.148698 Absolutely. 303 00:26:13,426.148698 --> 00:26:22,636.148698 And then that's what's driving the, the, uh, maladaptive biomechanics that's putting more stress on everything else and why they keep on having to do repetitive prolo therapy. 304 00:26:23,191.148698 --> 00:26:32,361.148698 And then if you treat those specific spots, you can do everything with the PRP, but making sure you treat those specific spots with the PRP, they turn the corner, and then everything else falls in place. 305 00:26:32,381.148698 --> 00:26:32,751.148698 Okay. 306 00:26:33,451.147698 --> 00:26:33,791.147698 So. 307 00:26:34,141.148698 --> 00:26:37,389.415198 Well, you guys have kind of segued for us, which is great. 308 00:26:37,389.415198 --> 00:26:39,251.148698 Um, so we're talking about PRP. 309 00:26:39,261.148698 --> 00:26:51,471.148698 So for maybe our listeners who don't know what that is, can you kind of elaborate on what that is, what it's used for, why it's indicated in certain situations, and what is the importance of ultrasound guidance? Right. 310 00:26:51,471.148698 --> 00:26:51,631.148698 Okay. 311 00:26:51,631.248698 --> 00:26:51,638.648698 Thanks. 312 00:26:51,638.648698 --> 00:26:51,646.048698 Bye. 313 00:26:53,386.148698 --> 00:26:53,726.148698 I'll take it. 314 00:26:53,736.148698 --> 00:26:54,216.148698 Yeah, go for it. 315 00:26:54,216.248698 --> 00:26:57,46.148698 So, PRP, platelet rich plasma. 316 00:26:57,676.148698 --> 00:27:02,526.147698 So, um, in our plasma, in our blood, we have multiple components. 317 00:27:02,556.148698 --> 00:27:04,846.147698 Red blood cells, white blood cells, platelets. 318 00:27:05,216.148698 --> 00:27:15,426.147698 Uh, platelets, along with some other compounds and proteins, are what rush to the surface of your skin when you cut yourself, form a scab, allow the tissue to heal underneath. 319 00:27:16,6.148698 --> 00:27:28,886.147698 Uh, so we take those platelets that are rich in various growth factors and we concentrate those platelets and we use, and we inject that into the damaged tissue that, uh, facilitate healing. 320 00:27:29,886.148698 --> 00:27:36,336.148698 So, we are in the United States where we have pretty much anything we want, whenever we want. 321 00:27:36,356.148698 --> 00:27:40,516.148698 One of those things being anti inflammatories, hurt yourself, sprain your ankle. 322 00:27:40,786.148698 --> 00:27:42,766.148698 What do you do? Pop a bunch of Advil. 323 00:27:43,201.148698 --> 00:27:50,541.148698 What does that do? That stops the inflammatory process of all of these good nutrients rushing to the area to repair tissue. 324 00:27:50,931.148698 --> 00:27:52,271.148698 We need inflammation. 325 00:27:52,271.148698 --> 00:27:58,71.147698 We need to go through the process of all the inflammatory phases to allow tissue repair. 326 00:27:58,941.147698 --> 00:28:12,571.211198 So, the nice thing about Prolo PRP, whatever, we're taking your body back through that injured phase, reinitiating inflammation, giving your body the constituents that it needs with the growth factors to support the healing face. 327 00:28:13,291.211198 --> 00:28:19,631.210198 Ultrasound guidance has, I mean, it is totally transformed my practice. 328 00:28:20,121.210198 --> 00:28:24,431.210198 I learned how to do parole therapy, palpation guided. 329 00:28:25,166.211198 --> 00:28:27,556.211198 through the Hackett Hemwall Foundation with Dr. 330 00:28:27,556.211198 --> 00:28:29,526.211198 Wang as my fearless leader. 331 00:28:30,146.211198 --> 00:28:36,846.210198 And, um, and, uh, I got pretty good at it, you know, palpation based. 332 00:28:37,296.211198 --> 00:28:42,736.210198 And then with the addition of ultrasound, I actually got to see a lot. 333 00:28:43,326.211198 --> 00:28:45,406.211198 I got to see what I'm injecting. 334 00:28:46,51.211198 --> 00:29:11,301.211198 Also, it also put a little healthy fear in me because I got to see how close I was to some bad stuff when we were injecting and, um, so not only does it increase your accuracy, so your You're safer, but you're also going to help the patient more because now you can quantify this tissue. 335 00:29:11,951.211198 --> 00:29:15,941.211198 And so we can prolo things all day long, palpation based. 336 00:29:15,941.211198 --> 00:29:19,301.211198 But if we don't know what we're actually treating, they're not going to get better. 337 00:29:19,341.210198 --> 00:29:25,901.211198 Like, Oh, doc, you know, we've been doing prolo therapy here for about a year now to the same spot and I'm not getting better. 338 00:29:26,341.211198 --> 00:29:28,321.211198 Should we get an image? And then there's like a huge tear. 339 00:29:29,91.211198 --> 00:29:35,171.211198 So, maybe prolotherapy might not have been a good option, right? Maybe we need to put something more powerful in there. 340 00:29:35,581.211198 --> 00:29:39,141.211198 So, ultrasound has helped me in that aspect from the get go. 341 00:29:39,151.211198 --> 00:29:48,191.211198 And I tell patients and other providers that we help teach, um, even this week, you know, they ask about the ultrasound, and do you have them come back? I'm like, no. 342 00:29:48,581.211198 --> 00:29:53,241.211198 When I get there in the morning, I turn my ultrasound on, and it's an extension of my physical exam. 343 00:29:53,301.211198 --> 00:29:57,361.211198 I want to know exactly what you're dealing with right now, so we can come up with a game plan. 344 00:29:58,491.211198 --> 00:30:03,461.211198 Um, so it's, it's like a vital sign, you know, it's part of our physical exam without that. 345 00:30:03,971.211198 --> 00:30:10,791.211198 I'm going blind and you're not getting better and so yeah, accuracy, safety, best outcomes. 346 00:30:12,261.210198 --> 00:30:14,421.211198 Can you do a lot of what we do without ultrasound? Yes. 347 00:30:15,371.210198 --> 00:30:23,241.211198 Can you do it to the same level and the same degree of accuracy and same degree of benefit for our patients? Absolutely not. 348 00:30:23,851.210198 --> 00:30:26,941.211198 Um, ultrasound, it's now, it's the standard of care. 349 00:30:27,451.211198 --> 00:30:28,661.211198 Um, it is in Canada. 350 00:30:28,751.211198 --> 00:30:31,131.211198 They're moving towards it in the next couple of years. 351 00:30:31,131.211198 --> 00:30:33,91.211198 You won't be able to do injections without an ultrasound. 352 00:30:33,571.211198 --> 00:30:36,331.211198 And there's a reason for that because of the accuracy. 353 00:30:36,331.211198 --> 00:30:54,651.211198 Studies show that they took, um, uh, orthopedic surgeons with at least five years of clinical experience using their traditional palpation based quote unquote blind injections versus a First or second year resident, I can't remember. 354 00:30:55,101.211198 --> 00:30:59,771.211198 Um, this was a study, first and second year residents with one month, just one month of ultrasound training. 355 00:31:00,281.211198 --> 00:31:02,891.211198 Doing, and they went head to head on injection accuracy. 356 00:31:03,361.211198 --> 00:31:08,701.210198 Um, injecting with a little bit of dye and then doing a, a CT scan or x ray afterwards to see accuracy. 357 00:31:09,121.210198 --> 00:31:15,821.211198 And, and the, the uh, one month trainees with one month of ultrasound, uh, training. 358 00:31:16,516.211198 --> 00:31:18,546.211198 completely blew out of the water. 359 00:31:18,546.211198 --> 00:31:21,586.211198 The orthopedic surgeons with five plus years of experience. 360 00:31:22,156.211198 --> 00:31:31,456.211198 Um, the only thing that came close, I think, was the knee, which was about, uh, like 90 percent about 85 90 percent accurate with the palpation based. 361 00:31:31,906.211198 --> 00:31:33,996.211198 It was 99 with the ultrasound. 362 00:31:34,656.211198 --> 00:31:40,526.211198 But like the elbow was like 50 60 percent with with palpation based and still everything. 363 00:31:40,546.211198 --> 00:31:43,496.211198 Everything was above 90 percent for the for the ultrasound guidance. 364 00:31:43,506.211198 --> 00:31:48,536.211198 So So, I mean, that, and there's, that type of study has been reproduced over and over and over again. 365 00:31:48,706.211198 --> 00:31:50,436.211198 So, it's, it's the gold standard. 366 00:31:50,656.211198 --> 00:31:52,6.211198 Everyone should be doing it. 367 00:31:52,216.211198 --> 00:31:55,406.211198 If you're not doing it, you're not treating your patients properly. 368 00:31:55,986.210198 --> 00:31:56,936.211198 Um, So, Dr. 369 00:31:56,936.211198 --> 00:32:23,636.210198 Siddiqui, if, um, I'm a patient of yours, and we're talking about, uh, bone marrow or MFAT with some stem cell and other, you know, healing factors, and, um, You know, I trust you and I'm farking up a lot of cash for this, and you tell me that I can, with about 50 to 80 percent accuracy, that I'm going to get this in the joint. 370 00:32:24,676.211198 --> 00:32:25,806.211198 That's not good enough for me. 371 00:32:27,216.210198 --> 00:32:28,146.210198 It's not good enough for anybody. 372 00:32:28,706.210198 --> 00:32:30,666.111198 80 percent is on the high side for him. 373 00:32:30,666.211198 --> 00:32:30,766.211198 80%. 374 00:32:31,526.210198 --> 00:32:36,186.211198 If you tell me about, there's about an 80 percent chance that your 5, 000 is going in your knee. 375 00:32:37,556.211198 --> 00:32:38,446.211198 I'm not okay with that. 376 00:32:38,456.211198 --> 00:32:42,456.211198 We're going to go through all the written rule, we're going to, we're going to Numb up your skin. 377 00:32:42,466.211198 --> 00:32:43,606.211198 We're going to numb up your fat. 378 00:32:43,626.211198 --> 00:32:45,996.211198 We're going to spend half an hour taking out your fat. 379 00:32:46,66.211198 --> 00:32:47,156.211198 We're going to process it. 380 00:32:47,476.211198 --> 00:32:49,996.211198 We're going to use the right anesthetic so we don't kill the stem cells. 381 00:32:50,416.211198 --> 00:32:53,508.8056424 And then we're not going to use ultrasound and pray that it gets in the joint. 382 00:32:53,508.8056424 --> 00:33:08,116.211198 It's, it's a flawed system and it's, and it's, you know, it's people trying to do things that are sexy, right? That they're just not apt and well trained to do so they need to Come down here to Gulf Coast and get trained up and do it right. 383 00:33:08,336.211198 --> 00:33:08,826.211198 Absolutely. 384 00:33:08,826.211198 --> 00:33:09,206.211198 Join us. 385 00:33:09,236.211198 --> 00:33:10,236.211198 No shortcuts. 386 00:33:10,426.211198 --> 00:33:10,816.211198 Right. 387 00:33:10,876.211198 --> 00:33:11,836.211198 You've got to make the commitment. 388 00:33:11,836.211198 --> 00:33:13,806.211198 If you're going to do it right, then do it right. 389 00:33:14,336.211198 --> 00:33:25,626.211198 And you're going to have to invest in the right equipment and the training so that you provide the best service to your patients and they're going to get the best outcomes and your patients then will come back to you. 390 00:33:25,626.211198 --> 00:33:35,191.211198 But isn't it nice to be able to see the anatomy, not just where you're looking to Do an aspiration or injection, but also the surrounding anatomy. 391 00:33:35,551.211198 --> 00:33:40,641.211198 There might be anatomical variations, blood vessels going where they don't normally go. 392 00:33:40,651.211198 --> 00:33:43,151.210198 Nerves, nerves, things like that. 393 00:33:43,151.310198 --> 00:33:47,141.211198 That could be devastating, right? Not everybody reads the anatomy books. 394 00:33:47,161.211198 --> 00:33:48,111.210198 Yep, yep. 395 00:33:48,731.211198 --> 00:33:49,351.210198 Patients are different. 396 00:33:49,351.210198 --> 00:33:49,981.211198 There's variance. 397 00:33:50,31.210198 --> 00:33:50,721.210198 Exactly. 398 00:33:50,971.210198 --> 00:33:59,251.210198 And I get patients, not uncommonly, it's become more and more frequent, they say, Oh, well, I, I, they, they come in with an injury that they've had for three, four years. 399 00:33:59,676.211198 --> 00:34:01,266.211198 And they say, I've already tried PRP. 400 00:34:01,276.211198 --> 00:34:10,306.210698 So the first question I ask is, okay, who did it? Then I ask, did they use ultrasound guidance? If they say no, then I say, we're not sure if you got PRP. 401 00:34:10,636.210698 --> 00:34:15,126.211698 They may have put your PRP somewhere, but I don't know if it went in the injury. 402 00:34:15,126.211698 --> 00:34:16,136.211698 Most likely it didn't. 403 00:34:16,756.211698 --> 00:34:32,786.211698 And then the third thing I ask is, is, you know, do you know what kind of Either kit or everything that they use, because there's a wide range of quality of PRP and, and that's even among these, these, uh, popular brands. 404 00:34:33,146.211698 --> 00:34:36,836.211698 Um, you know, and, and that even bleeds into the research. 405 00:34:36,836.211698 --> 00:34:45,501.211698 There are a lot of articles that have been written, um, uh, that are, that are negative to PRP when you look in the, in the nitty gritty details. 406 00:34:46,276.211698 --> 00:34:59,196.211698 The PRP kits they use actually don't create PRP they create just whole blood pretty much like one to two times X of of your normal platelet concentration, which is not PRP. 407 00:34:59,216.211698 --> 00:35:01,26.211698 That is normal platelet concentration. 408 00:35:01,646.211698 --> 00:35:13,466.211698 And so we we've seen and over and over again that platelet dose matters and the higher dose up to a very high threshold, but a certain threshold is more beneficial. 409 00:35:13,866.211698 --> 00:35:20,271.211698 And if you don't get to that 56 six to eight times X, you're not getting a good PRP treatment. 410 00:35:20,751.211698 --> 00:35:24,971.210698 So when those patients come to me, I say, well, you may have gotten something, but you didn't get PRP where it needed to go. 411 00:35:25,281.211698 --> 00:35:26,751.210698 So we often have to do it again. 412 00:35:27,441.211698 --> 00:35:49,726.211698 That actually ties into making sure, from the physician's standpoint, that if you're going to be offering that service, and you're, you need to invest in the equipment, you need to invest in the training, but you also need to invest in the time to learn about these things, because a lot of Physicians probably aren't aware of that, that there are differences between kits and so forth. 413 00:35:50,36.211698 --> 00:36:06,946.211698 And unfortunately, the, the, um, the industry and the, the, um, You know, the manufacturers and, and, you know, those who are selling the devices are doing a lot of the education for these individual practices, right? And then you're getting skewed information because they're trying to sell you a product. 414 00:36:07,446.211698 --> 00:36:11,356.211698 Um, you know, they're invested in getting the patient better, but that's not their primary outcome. 415 00:36:11,356.211698 --> 00:36:12,926.210698 Their primary outcome is to sell the product. 416 00:36:13,576.211698 --> 00:36:18,666.211698 So we have to take that education out of those hands and make sure they're getting it from, from the leaders in the field. 417 00:36:18,926.211698 --> 00:36:19,196.211698 Right. 418 00:36:19,236.211698 --> 00:36:21,491.211698 And how much training have they had? Right. 419 00:36:22,371.211698 --> 00:36:26,671.211698 I've seen reps who've had two, they're like, Hey, I asked him how they're doing. 420 00:36:27,201.211698 --> 00:36:27,441.211698 Yeah. 421 00:36:27,451.211698 --> 00:36:28,351.211698 I've been here for two months. 422 00:36:30,291.211698 --> 00:36:32,251.210698 You ask him, you ask him a technical question. 423 00:36:32,251.210698 --> 00:36:34,561.211698 They're like, Oh, let me get back to you on that. 424 00:36:34,611.211698 --> 00:36:35,101.210698 That's right. 425 00:36:35,171.210698 --> 00:36:35,381.210698 Yeah. 426 00:36:35,421.210698 --> 00:36:46,551.211698 So one, one thing that I, like you said, and that's very common here actually is, uh, we get patients who they've had PRP or they've had. 427 00:36:47,121.211698 --> 00:36:49,81.211698 stem cells or whatever they want to call it. 428 00:36:49,421.211698 --> 00:36:50,461.211698 And it didn't work for him. 429 00:36:50,801.211698 --> 00:36:51,291.211698 Same thing. 430 00:36:51,301.211698 --> 00:36:56,361.210698 Who did it? Because we, you know, we're, we're at the top of the game. 431 00:36:56,361.211698 --> 00:36:58,481.211698 We know people around the country who did it. 432 00:36:59,61.211698 --> 00:37:00,941.211698 If I don't know the guy, I'm looking them up. 433 00:37:01,781.210698 --> 00:37:16,221.211698 And, um, you know, what I tell people is in residency or, you know, they'll ask, well, You know, how long did you have to go to med school to learn this? You don't learn this in med school. 434 00:37:16,631.211698 --> 00:37:17,801.211698 You don't learn this in residency. 435 00:37:18,461.211698 --> 00:37:20,821.211698 Like, we touched on it on fellowship. 436 00:37:21,591.211698 --> 00:37:28,981.210698 But what they teach you in med school and residency is how to inject cortisone into a joint and a bursa. 437 00:37:29,941.210698 --> 00:37:32,721.211698 So, you want to get into the PRP world. 438 00:37:33,961.211698 --> 00:37:38,241.211698 And it's a little bit more than just switching out what's in your syringe. 439 00:37:39,81.211698 --> 00:37:42,521.211698 Any, like I can teach a monkey how to find your joint. 440 00:37:43,221.211698 --> 00:37:43,591.211698 Yeah. 441 00:37:43,661.211698 --> 00:37:45,821.211698 But again, it goes back full circle. 442 00:37:45,821.211698 --> 00:37:47,751.210698 It's the whole, it's the organ system. 443 00:37:47,751.210698 --> 00:37:50,561.211698 What are we doing with the stuff that's in our syringe? Yeah. 444 00:37:50,831.211698 --> 00:37:52,841.211698 It doesn't matter what it is. 445 00:37:53,41.211698 --> 00:37:54,441.211698 You gotta put it in the right spot. 446 00:37:54,871.211698 --> 00:37:57,951.211698 And also cortisone, like if you're using cortisone, you can be sloppy with it. 447 00:37:58,121.211698 --> 00:38:03,571.211698 Cortisone has a very regional effect, right? You can inject it near the structure, kind of near the structure. 448 00:38:03,571.211698 --> 00:38:04,711.210698 Some in, some out. 449 00:38:05,41.211698 --> 00:38:07,761.211698 You can inject it, heck, you can inject it in a muscle. 450 00:38:07,791.211698 --> 00:38:10,11.211698 You can inject it in your glute muscle, in your migraine. 451 00:38:10,501.211698 --> 00:38:11,201.211698 Exactly. 452 00:38:11,221.211698 --> 00:38:13,221.210698 So, so cortisone is really powerful. 453 00:38:13,221.211698 --> 00:38:13,711.210698 It backs us better for a week. 454 00:38:15,41.211698 --> 00:38:15,571.211698 It's true. 455 00:38:16,31.211698 --> 00:38:17,431.211698 For better, for worse, it's really powerful. 456 00:38:17,431.211698 --> 00:38:19,281.211698 You can put it anywhere and it's going to help. 457 00:38:19,631.211698 --> 00:38:22,281.211698 So, so, you know, that's why a lot of. 458 00:38:22,636.211698 --> 00:38:24,646.211698 You know, people have been working with cortisone. 459 00:38:24,656.211698 --> 00:38:28,106.211698 They don't have to be precise with their injections because it still works. 460 00:38:28,376.211698 --> 00:38:35,226.211698 But for our stuff, if you want it to work and you want it to work well and you want your patients have good outcomes, it has to be extremely precise. 461 00:38:35,226.211698 --> 00:38:37,696.210698 What do you say, Dave? In your lecture today, 0. 462 00:38:37,696.310698 --> 00:38:38,546.211698 2, what? 0. 463 00:38:38,576.211698 --> 00:38:40,966.212698 02 millimeter, millimeter, 0. 464 00:38:41,16.211698 --> 00:38:41,146.211698 0. 465 00:38:41,196.211698 --> 00:38:43,346.211698 2 millimeter accuracy with ultrasound. 466 00:38:43,496.211698 --> 00:38:44,226.211698 Yeah, right. 467 00:38:44,686.211698 --> 00:38:44,976.211698 Yep. 468 00:38:45,376.211698 --> 00:38:46,26.211698 Uh, you need that. 469 00:38:46,86.211698 --> 00:38:47,796.111698 You need that stuff. 470 00:38:47,796.211698 --> 00:38:56,841.211698 We can see on ultrasound, right? People bring their MRIs in, well my shoulder hurts, or whatever body part, my x ray was negative, my MRI was negative. 471 00:38:57,951.211698 --> 00:39:00,211.211698 What are you going to find with that thing? Well, let's see. 472 00:39:00,301.211698 --> 00:39:00,581.211698 Yep. 473 00:39:00,641.211698 --> 00:39:02,481.211698 Why didn't my doctor do that? I don't know. 474 00:39:02,481.211698 --> 00:39:03,31.211698 Go ask him. 475 00:39:03,111.211698 --> 00:39:03,421.211698 Right. 476 00:39:03,661.211698 --> 00:39:03,901.211698 Right. 477 00:39:04,821.211698 --> 00:39:07,311.211698 So, so to comment a couple of comments. 478 00:39:07,321.211698 --> 00:39:14,791.210698 So I, I love that this, this very important fact that cortisone has this kind of regional effect or even systemic effect now. 479 00:39:14,931.211698 --> 00:39:28,341.211698 Granted, if you do, you know, a cortisone injection in the gluteals and it helps with the migraines, is it even more effective if the person has their head up their rear? And I, I wonder if there's like a, you know, scale there in terms of effectiveness, but we won't go into that. 480 00:39:28,351.211698 --> 00:39:29,591.211698 That's so asinine of you. 481 00:39:31,641.210698 --> 00:39:33,811.211698 Well, I just, you know, I like to be the butt of my own jokes. 482 00:39:36,431.211698 --> 00:39:40,191.211698 But, um, two things that I'd like to bring up, one being the. 483 00:39:40,506.211698 --> 00:39:46,966.211698 Paradigm shift with regenerative medicine and in the second being the paradigm shift with ultrasound diagnostic ultrasound very fascinating. 484 00:39:47,146.211698 --> 00:39:56,741.211698 So When I went through my training, uh, you know, so Harvard trained conventional, traditional, very good musculoskeletal training, and you learn your basics. 485 00:39:57,51.211698 --> 00:39:59,961.211698 I learned a little bit of regenerative medicine at the time because Dr. 486 00:39:59,961.211698 --> 00:40:09,361.211698 Joanne Borgstein, who was heading up the outpatient MSK program, was really getting into some of the, uh, ultrasound, diagnostic ultrasound and PRP, so she's been a fantastic mentor. 487 00:40:09,931.211698 --> 00:40:12,691.211698 Uh, but, uh, we were one of the few facilities to do that. 488 00:40:13,301.211698 --> 00:40:41,16.211698 And when people talk about regenerative medicine, unfortunately, as we had touched on before, many times they will take regenerative medicine products and solutions and sort of stick that into the paradigm of traditional orthopedics, right? So they're taking that square peg, trying to put it in the round hole, and they're just taking that PRP and they're just sticking it in the joint where they're taking that, you know, B MAC and just sticking into the joint, and they're not thinking at all about tensegrity, not thinking at all about the comprehensive nature of musculoskeletal structures. 489 00:40:41,316.211698 --> 00:40:55,676.211698 And so the training in regenerative medicine, I think, was very helpful to expand, you know, uh, our horizons with regards to, Oh, what's this ilial lumbar ligament? Oh, you can get sprains on that? Oh, hey, you can treat that with regenerative medicine? It can help their back pain? Wonderful. 490 00:40:56,336.211698 --> 00:41:01,606.211698 Then on top of that, you bring on Diagnostic ultrasound and again big paradigm shift. 491 00:41:01,896.211698 --> 00:41:12,916.211698 So here I am thinking I knew some stuff right because I had very good quality prolotherapy training I Probably learned how to inject 200 something structures right in my training. 492 00:41:12,916.211698 --> 00:41:13,926.211698 I thought I knew some stuff. 493 00:41:14,206.210698 --> 00:41:31,136.211698 Well, then I started doing diagnostic ultrasound I hated that machine for like the first two years because it slows you down We had that old green beast, that old BK, you know, the machine's like this big and the screen's like, like this, right? And it's very grainy, you don't know what you're looking at, and we struggled with that thing for a couple of years. 494 00:41:31,466.210698 --> 00:41:32,856.211698 And it felt like I didn't know what I was doing. 495 00:41:33,56.211698 --> 00:41:40,406.211698 But the more I used the ultrasound, the more I realized, number one, it is extraordinarily helpful and effective for targeting the conventional orthopedic. 496 00:41:41,246.211698 --> 00:41:43,476.211698 type things, right? You see your partial supraspinatus tear. 497 00:41:43,476.211698 --> 00:41:43,716.211698 Great. 498 00:41:43,716.211698 --> 00:41:48,206.211698 You can see it on sub millimeter accuracy and really get it into that little partial tear. 499 00:41:48,726.211698 --> 00:42:06,686.210698 But even more importantly, there was another paradigm shift where now I'm able to see things and treat things that even with high level regenerative medicine, prolotherapy training and high level basic orthopedic conventional training, you know, uh, aside from that, now there's things that I can see, like for example, these fascial micro tears that are. 500 00:42:06,866.211698 --> 00:42:08,966.211698 literally a quarter of a millimeter thick. 501 00:42:09,496.211698 --> 00:42:11,826.211698 There's no way to be able to diagnose them otherwise. 502 00:42:11,826.211698 --> 00:42:13,786.211698 You can't even diagnose them through palpation. 503 00:42:13,796.211698 --> 00:42:16,856.211698 There's no way you're gonna see it on MRI, CT scan, they're invisible. 504 00:42:17,226.211698 --> 00:42:18,866.211698 But on ultrasound, you can see them. 505 00:42:19,146.211698 --> 00:42:23,286.211698 Not only can you see them, but now you can treat them with that accuracy of 0. 506 00:42:23,286.311698 --> 00:42:23,766.211698 2 millimeters. 507 00:42:24,16.210698 --> 00:42:29,916.211698 Now this opens up, again, an entire new treasure trove of things that you can identify and treat effectively. 508 00:42:30,336.211698 --> 00:42:38,876.211698 And folks that have tried other treatments, even advanced regenerative medicine treatments, and they didn't quite get fully better, Now we can use the diagnostic ultrasound and really identify those things. 509 00:42:39,16.211698 --> 00:42:39,936.211698 Absolutely amazing. 510 00:42:40,126.211698 --> 00:42:43,896.211698 So we all do the same stuff. 511 00:42:43,956.211698 --> 00:42:47,336.211698 We're changing the game and orthopedics and sports medicine. 512 00:42:48,136.211698 --> 00:42:54,236.210698 And we have a lot of highs in our day, right? There's a couple of lows, but there's a lot of highs. 513 00:42:54,766.211698 --> 00:42:56,336.211698 And one of my favorite. 514 00:42:56,381.311698 --> 00:43:16,571.211698 One of my favorite points, one of my best points in my day, is when someone comes in with some vague pain, maybe chronic, they've seen a lot of people, and we find that little spot, and we put a needle in it, and, ah, that's my spot, that's my pain, you found it, what is it? That's the best. 515 00:43:16,591.211698 --> 00:43:17,441.211698 You did that for me. 516 00:43:17,771.211698 --> 00:43:19,531.211698 It's like, I had that tiny little tear. 517 00:43:19,541.211698 --> 00:43:20,536.211698 MRIs are normal. 518 00:43:20,536.211698 --> 00:43:21,121.211698 In my rotator cuff. 519 00:43:21,291.211698 --> 00:43:23,91.210698 Why didn't anybody else find it? You proloed it. 520 00:43:23,121.211698 --> 00:43:25,31.211698 Cause we had a high resolution ultrasound. 521 00:43:25,41.211698 --> 00:43:25,71.211698 Yep. 522 00:43:25,646.211698 --> 00:43:33,966.211698 With our exam, our knowledge of anatomy, you find that little spot and then you change somebody's world and you know what's coming next. 523 00:43:34,746.211698 --> 00:43:45,616.211698 And then my next best thing is when they come back and say, I can play with my grandkids now, you fixed my pain and like, yeah, but it's just great because you see where you can see, I have a question. 524 00:43:45,626.211698 --> 00:43:49,476.211698 You guys hit on briefly cortisone and I know a lot of people out there. 525 00:43:50,116.211698 --> 00:43:52,886.211698 I hear them say, I'm just going to go get a cortisone injection. 526 00:43:53,146.211698 --> 00:44:00,756.211698 So why are we introducing different treatments? Like what is the difference between cortisone and prolotherapy and PRP? Oh, that's easy. 527 00:44:00,756.211698 --> 00:44:02,79.5773646 I can take that one. 528 00:44:02,79.5773646 --> 00:44:04,366.110698 Can I take that one? Yes. 529 00:44:04,366.210698 --> 00:44:10,726.211698 So the reason that we're introducing these treatment options is because we don't work for insurance companies. 530 00:44:12,266.211698 --> 00:44:15,476.211698 And um, that's the bottom line. 531 00:44:16,296.211698 --> 00:44:17,946.211698 So we want what's best for our patients. 532 00:44:19,741.211698 --> 00:44:32,901.211698 Traditionally, if you look at diagnosis, and we talked about this earlier this week, if you look at diagnosis codes, like over decades, you see rises and falls of diagnosis codes and procedures that are being done. 533 00:44:33,871.211698 --> 00:44:36,621.211698 Are the diagnoses going away? No. 534 00:44:37,241.211698 --> 00:44:40,51.211698 They're just not being reimbursed anymore by the insurance companies. 535 00:44:40,381.211698 --> 00:44:45,41.211698 Are the procedures not good enough anymore? These nerve blocks not working? Of course they're working. 536 00:44:45,501.211698 --> 00:44:47,241.211698 But the insurance doesn't pay for them anymore. 537 00:44:47,621.211698 --> 00:44:54,861.211698 So you start to see diagnoses rise when insurance reimburses well for these diagnoses and these procedures. 538 00:44:55,401.211698 --> 00:44:58,141.211698 And, and that's kind of how medicine works. 539 00:44:58,401.210698 --> 00:45:04,981.211698 And you have all these cortisones and, um, you know, hyaluronic acid and surgeries and that's about it. 540 00:45:05,681.211698 --> 00:45:14,191.211698 So we have a bigger toolbox that we operate out of, regardless of who is telling us what to do and what not to do based on. 541 00:45:14,601.211698 --> 00:45:15,531.211698 Reimbursement codes. 542 00:45:15,611.211698 --> 00:45:20,451.211698 We work for our patients, not the insurance companies, you know, on a granular level. 543 00:45:20,451.211698 --> 00:45:55,61.211698 That's that's absolutely right I mean, it's it's a shame that Whoever's sitting up there in the you know Control panel 200th floor of the building making these decisions, but Unfortunately They are the cortisone, eh, and, um, we're kind of at the mercy and there's so many layers of bureaucracy, right? It's like, you know, the, the business that you work for most often if it's private health insurance, selects the insurance based on most often cost. 544 00:45:55,91.211698 --> 00:45:56,711.211698 Mm-Hmm, right? 'cause it's damn expensive. 545 00:45:57,191.211698 --> 00:46:01,721.211698 And then they aren't really looking at what's, what's covered and what, what's not, what is. 546 00:46:02,171.211698 --> 00:46:06,731.211698 And then, uh, the patient just knows that they have this insurance, they're. 547 00:46:07,126.211698 --> 00:46:13,676.211698 They're injured or hurt, and they assume you can do everything you can to fix it under that insurance, and unfortunately, you can't these days. 548 00:46:13,746.211698 --> 00:46:19,96.211698 Um, that's becoming the norm in all specialties, more so, um, not just ours. 549 00:46:19,456.211698 --> 00:46:30,786.210698 But also on a granular level, cortisone is, is a, it's a natural hormone in our body, um, that does, does a lot of different things, but one thing is it's anti inflammatory. 550 00:46:31,346.210698 --> 00:46:36,446.211698 Um, and we give super therapeutic doses when you need your cortisone shot, like a thousand times the normal. 551 00:46:36,506.311698 --> 00:46:38,16.211698 body's concentration. 552 00:46:38,176.211698 --> 00:46:38,386.211698 Yep. 553 00:46:38,526.211698 --> 00:46:49,276.210698 And so basically what it does, it's, you know, I think of it as like the napalm, you just getting rid of every inflammatory molecule, good, bad, ugly, everyone, all, they're all gone. 554 00:46:49,736.211698 --> 00:46:51,956.211698 And so people feel better on cortisone. 555 00:46:51,956.211698 --> 00:46:55,631.111698 That's one reason why it's used and why, why it's continues to be used. 556 00:46:56,181.211698 --> 00:47:06,321.211698 But as you see in the movies, when people get a cortisone shot and then they continue to play on it, they, you know, tear their ACL or whatever, you know, these cortisone shots are just masking pain and masking injuries. 557 00:47:06,471.211698 --> 00:47:08,161.211698 They aren't actually fixing anything. 558 00:47:08,631.211698 --> 00:47:29,881.210698 Um, so, you know, you're masking the pain and then you're going out continuing to play on it, you're doing more damage to it, and on top of that, more and more research is showing that the cortisone itself has negative effects specifically on cartilage and ligaments and tendons that kill cells at those super therapeutic thousand time dosages. 559 00:47:29,971.211698 --> 00:47:32,451.211698 And so on top of that, you're weakening the tissues even more. 560 00:47:32,971.211698 --> 00:47:41,11.211698 And so, you know, the traditional orthopedic model for, for the vast majority of conditions is, you know, you do some physical therapy. 561 00:47:41,11.211698 --> 00:47:46,141.211698 If that doesn't work, cortisone shots until everything's damaged enough that you need surgery. 562 00:47:46,181.211698 --> 00:47:48,1.210698 And that's, that's for joint replacements. 563 00:47:48,1.211698 --> 00:47:49,291.210698 That's for tendon injuries. 564 00:47:49,736.211698 --> 00:47:50,506.211698 That's everything. 565 00:47:50,886.211698 --> 00:47:53,576.211698 And so, um, and it's this cycle over and over again. 566 00:47:53,576.211698 --> 00:47:54,736.211698 What we're trying to do is stop that. 567 00:47:54,736.211698 --> 00:47:56,446.211698 Let's prevent the surgery. 568 00:47:56,476.211698 --> 00:48:00,326.211698 Let's prevent needing to take a year off to recover from this. 569 00:48:00,406.211698 --> 00:48:03,686.211698 Let's fix the, the ligaments, the tendons. 570 00:48:03,716.211698 --> 00:48:05,176.211698 Let's fix your biomechanics. 571 00:48:05,206.210698 --> 00:48:06,706.211698 Go see a good physical therapist. 572 00:48:07,256.212698 --> 00:48:09,676.210698 Uh, and let's rehabilitate the entire body. 573 00:48:10,36.210698 --> 00:48:10,306.210698 Yeah. 574 00:48:10,746.210698 --> 00:48:22,476.211698 The, the irony of that is that more and more research is showing that application and exposure to cortisone accelerates degeneration of both cartilage and joint as well as soft tissue. 575 00:48:22,806.211698 --> 00:48:31,956.211698 So you've got these, uh, you know, uh, practitioners that are doing these cortisone injections, and they say, okay, well keep doing this until you need the joint replacement. 576 00:48:32,166.211698 --> 00:48:37,996.211698 But it's actually accelerating the timeline to get the joint replacement because you're causing that additional degeneration. 577 00:48:37,996.211698 --> 00:48:39,186.211698 Put you in the express lane. 578 00:48:39,206.211698 --> 00:48:39,616.211698 Yeah, right. 579 00:48:39,646.211698 --> 00:48:40,56.211698 Exactly. 580 00:48:40,56.211698 --> 00:48:40,556.211698 Exactly. 581 00:48:40,616.211698 --> 00:48:52,426.211698 And one way that I like to put it is that The reason that cortisone can work well for pain and inflammation is that it reduces cell metabolism, right? So by reducing cell metabolism, it reduces the release of those inflammatory mediators. 582 00:48:52,636.211698 --> 00:48:53,776.211698 So it does reduce pain. 583 00:48:54,136.211698 --> 00:49:00,876.210698 But when you reduce cell metabolism, you also reduce the cell's ability to maintain the structure that it's responsible for. 584 00:49:01,76.211698 --> 00:49:03,346.211698 So if it's a cartilage cell, then the cartilage degenerates. 585 00:49:03,346.211698 --> 00:49:05,496.211698 If it's a tendon cell, then the tendon degenerates. 586 00:49:05,856.211698 --> 00:49:08,406.211698 And so those tissues will degenerate. 587 00:49:08,516.211698 --> 00:49:09,46.211698 faster. 588 00:49:09,346.211698 --> 00:49:13,976.211698 And regenerative therapies are actually the opposite of that, right? We're actually promoting metabolism. 589 00:49:13,976.211698 --> 00:49:21,696.211698 We're increasing that cell metabolism so that you can get that release of the necessary growth factors to repair the collagen and other damaged structures. 590 00:49:21,866.211698 --> 00:49:27,36.211698 So in essence, we're doing the opposite of what cortisone does in order to repair these tissues. 591 00:49:29,466.211698 --> 00:50:05,331.211698 On that note, regenerative and Versus degenerative medicine, um, how about these patients who, they, they listen to their physician because they trust them as they should, um, but as many physicians, uh, as a whole, we've done a disservice to our patients, but these patients maybe have migraines, um, um, Typically migraines. 592 00:50:05,341.211698 --> 00:50:06,301.211698 Let's go with migraines. 593 00:50:07,451.211698 --> 00:50:16,211.211698 And their doctor is doing Botox to treat their migraines or other, you know, physical ailments. 594 00:50:17,111.210698 --> 00:50:19,891.211698 For me, that's degenerative medicine. 595 00:50:20,711.210698 --> 00:50:36,851.211698 Yes, you're controlling, you're masking the problem, but how about if we, instead of paralyzing the muscle, we fix the enthesis of the muscle, which is where the tendon attaches to the bone. 596 00:50:37,781.211698 --> 00:50:42,461.211698 And we heal that tissue, and then the muscle stops screaming. 597 00:50:43,71.210698 --> 00:50:45,811.211698 And then we don't need degenerative medicine. 598 00:50:46,161.211698 --> 00:50:48,131.211698 Cortisone, Botox, etc. 599 00:50:48,131.311698 --> 00:50:55,181.211698 Any other thoughts about that? Absolutely, and, and, you know, I do use Botox in my practice, but it's a, it's a, It has its place. 600 00:50:55,211.211698 --> 00:50:56,61.211698 It's a last line. 601 00:50:56,91.211698 --> 00:50:56,891.211698 Yeah, it has its place. 602 00:50:56,891.211698 --> 00:50:58,751.211698 It's, it's if we've tried to fix everything else. 603 00:50:59,501.211698 --> 00:51:07,721.211698 And we can't, for whatever reason, get this muscle to turn, turn off and it's whatever if they have, uh, a neurologic disorder, it's usually a neurologic disorder that, that causes it. 604 00:51:08,371.211698 --> 00:51:09,771.211698 Um, but I agree. 605 00:51:09,811.211698 --> 00:51:25,481.211698 We see too often that, that, you know, practitioners are jumping to Botox for migraines or muscle spasm anywhere when a lot of the time that's the downstream effect of a primary injury somewhere else. 606 00:51:26,251.211698 --> 00:51:34,661.211698 And you have to do your due diligence and look for that primary injury because, you know, Botox for insurance companies to Botox is expensive and you need it every three months. 607 00:51:35,261.211698 --> 00:51:38,341.211698 Um, so, and it's also not healthy for the muscles. 608 00:51:38,341.211698 --> 00:51:42,391.211698 If you look at muscles that have had Botox over a long period of time. 609 00:51:42,871.211698 --> 00:51:43,971.211698 They're fibrotic. 610 00:51:44,11.211698 --> 00:51:45,271.211698 It's full scar tissue. 611 00:51:45,731.211698 --> 00:51:46,571.211698 They're thin. 612 00:51:46,821.211698 --> 00:51:47,331.211698 They're weak. 613 00:51:47,411.211698 --> 00:51:52,951.211698 Like once they're in that situation, they can never rehabilitate back to their norm. 614 00:51:52,951.211698 --> 00:51:55,451.210698 They're on Botox for the rest of their life. 615 00:51:56,71.211698 --> 00:52:03,971.210698 So, um, um, while I use it, like I said, I use it sparingly and only as a last resort when when we've exhausted everything else. 616 00:52:04,911.210698 --> 00:52:05,931.210698 Yeah, I agree. 617 00:52:06,321.210698 --> 00:52:12,821.211698 And, um, with those muscles looking Like trash with Botox. 618 00:52:14,11.211698 --> 00:52:23,921.210698 How about people with spine pain who just love their RFAs? Let's just burn the nerve to cut the signal to your pain. 619 00:52:23,931.211698 --> 00:52:39,106.210698 What happens in those situations? Well, so, so what doctor started for those you're listening is talking about is they for people who are having pain in their spine that's localized to the joints in the back of the spine. 620 00:52:39,656.211698 --> 00:52:46,386.210698 Um, there are these nerves that that provide sensation to that and only sensation to those areas. 621 00:52:46,876.210698 --> 00:52:53,166.211698 And so if you're having pain in that area, they're the primary nerve causing that's relaying that pain signal to your brain. 622 00:52:53,641.211698 --> 00:52:58,981.211698 And so, what the traditional pain management treatment is, is you go in and you burn that nerve. 623 00:52:59,461.211698 --> 00:53:03,411.211698 Um, and it seems, seems like a decent idea on the surface. 624 00:53:03,781.210698 --> 00:53:04,31.211698 Pain's gone. 625 00:53:04,91.211698 --> 00:53:05,151.211698 Uh, pain's gone. 626 00:53:05,311.211698 --> 00:53:09,341.210698 Um, and it's gone for two or three years, but the nerve will grow back and you've got to do it again. 627 00:53:09,751.212698 --> 00:53:13,821.211698 But every time you go in and burn that nerve, You're creating more and more scar tissue. 628 00:53:13,821.311698 --> 00:53:21,731.211698 And, and at the same time, it's been shown that, you know, it causes, um, that these nerves may not be all sensory. 629 00:53:22,121.211698 --> 00:53:23,911.211698 There may be some motor function to them. 630 00:53:24,51.210698 --> 00:53:33,811.211698 And that you get atrophy of the paraspinal muscles, which are the exact muscles that you're trying to rehabilitate in physical therapy for back pain, which has been shown to be beneficial. 631 00:53:33,871.211698 --> 00:53:34,81.211698 Yep. 632 00:53:34,81.311698 --> 00:53:34,426.111698 Yep. 633 00:53:35,16.211698 --> 00:53:37,496.211698 So, you know, you're, you're decreasing the pain. 634 00:53:37,506.211698 --> 00:53:40,896.161698 It's kind of, kind of like a, you know, cortisone shot 2. 635 00:53:40,896.161698 --> 00:53:46,606.211698 0, right? You're mortgaging your future to, to get a, um, a pain benefit right now. 636 00:53:47,606.210698 --> 00:53:47,906.210698 Dr. 637 00:53:47,906.211698 --> 00:53:57,646.211698 Siddiqui, are you telling me that RFA could be also an express lane treatment option to back surgery? Oh, absolutely. 638 00:53:57,796.211698 --> 00:54:04,231.211698 So who wants that? Uh, everyone, everyone who performs back surgery there. 639 00:54:04,231.211698 --> 00:54:16,366.211698 It's, so we, we talked a lot about, you know, pros and cons of these treatments and who's doing them, who's not doing them? Who should be doing 'em, should not be doing them. 640 00:54:17,326.211698 --> 00:54:26,721.211698 Who, what kind of questions can we ask potential doctors who are doing these treatments to vet them? Dr. 641 00:54:26,731.211698 --> 00:54:45,841.111698 Wang, who, what can I ask you? If I'm interested in prolotherapy, PRP, as a patient, as a patient, and I'm calling your office, what kind of questions should I be asking? You know, I think that the devil's in the details, right? I mean, we spent some time during this podcast talking about the importance of quality of training. 642 00:54:46,101.211698 --> 00:54:49,771.211698 making sure that the practitioner truly has an understanding of what's going on. 643 00:54:50,261.211698 --> 00:54:55,911.211698 I think that's one of the difficulties about regenerative medicine is that it's a little bit like the wild, wild west. 644 00:54:55,931.211698 --> 00:55:00,691.211698 There's not, there isn't sufficient oversight, really, in these technologies. 645 00:55:00,891.210698 --> 00:55:04,881.210698 The technologies, some of them are very great technologies that are going to help a lot of people. 646 00:55:05,171.211698 --> 00:55:15,636.211698 But it's a very low barrier to entry, right? Uh, you know, a product, uh, representative, uh, just basically has to show up at the practitioner's door and say, Hey, you know, it, we got a package deal today. 647 00:55:15,636.211698 --> 00:55:21,856.210698 If you get, you know, six, uh, packs of this particular orthobiologic, then, you know, we'll give you the seventh one free or whatever. 648 00:55:22,56.210698 --> 00:55:24,366.210698 And they send you these little tubes of growth factors. 649 00:55:24,376.211698 --> 00:55:27,936.211698 Next thing you know, you're doing stem cell treatments, which really aren't stem cell treatments. 650 00:55:28,216.211698 --> 00:55:29,846.211698 So it's a very low barrier to entry. 651 00:55:29,846.211698 --> 00:55:33,986.211698 There's no, uh, you know, qualifications per se that you have to have. 652 00:55:35,486.211698 --> 00:56:04,881.211698 And the marketing is very intensive for these types of practices, as you know, right? And so I think the number one thing is to understand what is the experience level of the practitioner, and how do they kind of go about doing what they do? Like, for example, An important thing is, are there patients that they will consider as not being good candidates for regenerative medicine? And how do they figure that out? If everybody is a regenerative medicine candidate, then they're not necessarily doing their due diligence for proper diagnostics. 653 00:56:05,261.211698 --> 00:56:31,471.211698 And so I do tell people, like, one important consideration is, uh, uh, you know, patients will ask potential docs, okay, well, how many of this procedure have you done, right? If you're getting a surgery, well, how many of those gallbladder extractions have you done, right? How many of these, in this case, PRP treatments have you done? How many stem cell treatments and so on? And people have the tendency to think that docs that perform the most procedures are the most experienced and therefore are the best. 654 00:56:31,901.211698 --> 00:57:04,921.211698 Docs to see but that's not necessarily the case, right? I would prefer to see the doc that hasn't done 20, 000 PRPs I'd rather see the doc that's done maybe 5, 000 PRPs they've done plenty of PRPs to be experienced But they're not doing PRP on every single person that walks through the door, right? And I've seen this happen where docs that have done something like 20, 000 PRPs They PRP everybody They get a lot of failures and those failures, unfortunately, come to our office, right? And then you see the lack of diagnostic thinking, you know, that they go through. 655 00:57:05,621.211698 --> 00:57:15,571.210698 So you have to ask the right questions to make sure that that doc is thinking critically about your case and that they really care about you and care about getting you better for, hopefully, in the most cost effective way. 656 00:57:15,711.210698 --> 00:57:16,11.210698 Right. 657 00:57:16,741.210698 --> 00:57:17,171.210698 That's good. 658 00:57:17,381.210698 --> 00:57:17,661.210698 Yeah. 659 00:57:17,781.210698 --> 00:57:24,891.210698 I gotta say, like, right off the bat, like, so from a patient perspective, I've seen, as far as red flags, you gotta watch out for. 660 00:57:25,931.211698 --> 00:57:26,571.211698 Luncheons. 661 00:57:26,611.211698 --> 00:57:42,21.211698 There's, I've been to one before where, uh, you know, I was actually looking for instructors, you know, we, we went around and we go, we went to a luncheon and they basically promised the world to a room of elderly folk and they said, blah, blah, blah. 662 00:57:42,41.210698 --> 00:57:43,351.210698 This is what we're going to do. 663 00:57:43,411.211698 --> 00:57:56,706.211698 And then they had a number of people come in and, uh, basically prove that they could walk again and say, Oh my god, after two weeks, I was going up flights of stairs, and I had been immobile for, for years. 664 00:57:57,46.211698 --> 00:58:04,46.211698 And, it was going to be about 10, 000, you know, you would put up front, at this luncheon, you would put your down payment. 665 00:58:04,786.210698 --> 00:58:11,646.210698 And I was like, this is not right, and I was talking to the directors, and I was like, do you guys use ultrasound guidance, asking questions? No, they didn't. 666 00:58:11,806.210698 --> 00:58:15,526.211698 And they were using some, some questionable products. 667 00:58:15,586.211698 --> 00:58:18,256.211698 And, uh, that was a pretty scary thing. 668 00:58:18,266.211698 --> 00:58:28,926.211698 There was another time where I, um, I have friends that have gone to facilities and they went for one evaluation and they were told, you, right off the bat, you need 12 treatments. 669 00:58:28,986.210698 --> 00:58:29,456.210698 Wow. 670 00:58:29,476.210698 --> 00:58:30,346.210698 At a dollar amount. 671 00:58:30,596.211698 --> 00:58:31,476.210698 I was like, you need Wow. 672 00:58:31,506.211698 --> 00:58:32,206.211698 For PRP. 673 00:58:32,666.211698 --> 00:58:34,576.211698 And I was like, this is It's for PRP. 674 00:58:34,676.211698 --> 00:58:36,319.0207889 I would call that the dirty dozen right there. 675 00:58:36,319.0207889 --> 00:58:45,901.211698 Do you remember Kim? What did they say to Kim? I've seen that to do X amount of I'm pretty sure we got her very happy in three or less treatments. 676 00:58:46,231.211698 --> 00:58:49,371.110698 I think it was one she was feeling like, yep. 677 00:58:49,371.210698 --> 00:58:55,611.211698 Yeah, or they'll say, Well, we're going to try the PRP or the prophyllotherapy. 678 00:58:56,71.211698 --> 00:58:58,611.211698 It's a 50 50 chance you'll be, you'll be able to do well. 679 00:58:58,621.211698 --> 00:59:00,41.211698 That doesn't work for surgery. 680 00:59:00,121.211698 --> 00:59:05,861.210698 And if that doesn't work, we'll have to, we'll, you know, at least we tried the non invasive and then we'll have to do surgery. 681 00:59:05,971.211698 --> 00:59:08,301.211698 Do they use ultrasound guidance? Nah. 682 00:59:08,466.211698 --> 00:59:10,686.211698 So one of their, they want it, they want it not to work. 683 00:59:10,686.211698 --> 00:59:12,781.211698 That's part of their business model, folks not work. 684 00:59:13,446.211698 --> 00:59:15,926.211698 There are folks in our area too, I'll show you. 685 00:59:15,926.211698 --> 00:59:16,556.211698 It doesn't work. 686 00:59:16,826.211698 --> 00:59:18,536.211698 You know, pay, pay me a thousand dollars. 687 00:59:18,541.211698 --> 00:59:20,368.211698 We'll, we'll, I'll prove it'll prove it. 688 00:59:20,373.211698 --> 00:59:20,641.211698 We'll prove it. 689 00:59:20,981.211698 --> 00:59:22,201.211698 I'm doing surgery on you anyway. 690 00:59:22,701.211698 --> 00:59:24,401.211698 You might as well get some surgery. 691 00:59:25,221.211698 --> 00:59:26,726.211698 It can be plenty to prove it's sad. 692 00:59:27,176.211698 --> 00:59:30,986.211698 I mean, there's always gonna be, you know, the, that situation out there. 693 00:59:30,986.211698 --> 00:59:31,946.211698 We have plenty of. 694 00:59:32,591.211698 --> 00:59:53,901.211698 Orthopedic and sports medicine, um, physicians that are here at our class and they're doing it the right way and they've invested the time and, and, and, uh, they're purchasing the equipment, investing the time and they want to do it right, but I think it's really, this is, uh, definitely a good discussion because most, most people that have the patients, they aren't aware of even it. 695 00:59:54,591.211698 --> 00:59:57,191.211698 The different types of treatment options that are available. 696 00:59:57,191.211698 --> 01:00:04,311.211698 They don't really understand the value of utilizing ultrasound guidance and they don't know the questions to ask. 697 01:00:04,651.211698 --> 01:00:13,361.211698 And they're just going to their orthopedic or whoever, you know, the primary care may have referred them to someone and, and they're just going in with the trust. 698 01:00:13,361.211698 --> 01:00:22,381.211698 You're a doctor and whatever you say is the gospel truth and I'm just going to do what you tell me and what to do, you know? And so it's, it's on the patient too. 699 01:00:23,36.211698 --> 01:00:27,36.211698 To be informed, ask questions, ask questions, do your homework. 700 01:00:27,556.211698 --> 01:00:45,346.211698 If your doctor or whoever you're seeing, it should be a doctor, but whoever you're seeing, if they don't do a proper physical exam and hear your story, do an exam and do some imaging, you should leave. 701 01:00:46,366.211698 --> 01:00:48,836.211698 Um, you know, I hear your story. 702 01:00:49,586.211698 --> 01:00:50,606.211698 I already know what's going on. 703 01:00:51,176.211698 --> 01:00:54,756.211698 I do a physical exam to support that theory. 704 01:00:55,216.211698 --> 01:00:58,766.211698 I do diagnostic ultrasound to support that theory. 705 01:00:59,126.211698 --> 01:01:01,946.210698 We'll do diagnostic injections to support that. 706 01:01:02,966.211698 --> 01:01:05,6.211698 After all of that, we're golden. 707 01:01:05,36.210698 --> 01:01:05,816.210698 We know what we're doing. 708 01:01:05,816.310698 --> 01:01:09,656.211698 And if your doctor doesn't do that, And go somewhere else. 709 01:01:09,806.211698 --> 01:01:12,986.211698 And a big issue on the patient side too is the insurance model. 710 01:01:13,76.211698 --> 01:01:13,166.211698 Mm-Hmm. 711 01:01:13,406.211698 --> 01:01:13,496.211698 Yes. 712 01:01:13,496.211698 --> 01:01:18,506.211698 It takes now what, three to three months to a year to get in to see somebody. 713 01:01:18,776.211698 --> 01:01:25,556.211698 You've already invested that time and now you are like, well I can't, like, I don't wanna waste more time going to find another doctor. 714 01:01:25,561.211698 --> 01:01:26,216.211698 Yeah, that's true. 715 01:01:26,216.211698 --> 01:01:26,906.211698 Is true. 716 01:01:27,176.211698 --> 01:01:30,296.211698 Right? We run into that all the time personally. 717 01:01:30,536.211698 --> 01:01:32,666.211698 Or you just stop looking 'cause you don't trust anybody anymore or you stop looking. 718 01:01:32,726.211698 --> 01:01:32,966.211698 Yeah. 719 01:01:33,296.211698 --> 01:01:34,676.211698 You just waited him, he been burned. 720 01:01:35,991.211698 --> 01:01:40,961.211698 And also, like, the types of, even if they are using ultrasound, what type of system are they using? Yeah. 721 01:01:40,971.211698 --> 01:01:42,131.211698 Not all systems are the same. 722 01:01:42,131.211698 --> 01:01:42,531.211698 That's true. 723 01:01:42,591.211698 --> 01:01:51,221.210698 There's a lot that get into it for the first time, and they might go by cost of that system to get, but then they're not going to have the resolution to be able to actually diagnose certain things. 724 01:01:51,441.210698 --> 01:01:51,691.210698 Alright. 725 01:01:51,731.211698 --> 01:01:52,91.211698 Yep. 726 01:01:52,181.210698 --> 01:01:52,371.210698 Yep. 727 01:01:52,401.211698 --> 01:01:57,391.211698 There are three, there are three questions for, for all your patients out here, and everyone could be a patient at some point. 728 01:01:57,391.211698 --> 01:02:00,911.211698 So for anyone interested in this stuff, uh, three questions you should ask your provider. 729 01:02:00,911.211698 --> 01:02:01,381.211698 I'm very patient. 730 01:02:02,441.210698 --> 01:02:03,201.211698 You are very patient. 731 01:02:04,191.211698 --> 01:02:06,81.211698 There are three, there are three questions you need to ask. 732 01:02:06,111.211698 --> 01:02:14,681.210698 One is, one is, um, what, what kit or, or are you using? And if they can't answer that, go somewhere else. 733 01:02:15,191.211698 --> 01:02:18,821.210698 Um, and if they do answer it, research it yourself to see what exactly you're getting. 734 01:02:19,351.211698 --> 01:02:30,731.210698 Number two is, uh, are you using image guidance? An ultrasound is best, uh, but fluoroscopy can be used as another image guidance for, for a lot of joint injections. 735 01:02:31,91.211698 --> 01:02:32,781.210698 Um, it's not as good for soft tissue. 736 01:02:33,346.211698 --> 01:02:47,996.211698 And then, um, uh, three, probably the most important is what structures are you treating? So where are you putting the, the injections? And if they just say, oh, we're putting in the joint, it's gonna leak into where it needs to go, or it's going to go where it needs to go. 737 01:02:49,836.211698 --> 01:02:51,286.211698 That's when you walk out the door. 738 01:02:51,286.311698 --> 01:02:55,406.111698 It's your body's AI. 739 01:02:55,406.211698 --> 01:03:00,636.211698 Hopefully, you have an MRI, and at the end of the MRI, it will summarize the multiple different injuries that you have. 740 01:03:00,646.210698 --> 01:03:05,676.211698 If they aren't listing those injuries as all the areas they're going to treat, it's not going to be a good treatment. 741 01:03:06,291.211698 --> 01:03:07,181.211698 So I think That's good advice. 742 01:03:07,291.211698 --> 01:03:08,641.211698 Yeah, that's really good advice. 743 01:03:08,651.211698 --> 01:03:10,671.211698 So AI doesn't mean artificial intelligence. 744 01:03:10,871.211698 --> 01:03:13,461.211698 In that case, it means like, you know, adversely performing injection. 745 01:03:13,531.211698 --> 01:03:15,651.211698 Yes, exactly. 746 01:03:16,231.211698 --> 01:03:23,301.210698 Oh, and another interesting piece to bring up is that a lot of times, uh, you know, patients will see us, right? They'll, they'll get our opinion. 747 01:03:23,581.210698 --> 01:03:31,131.211698 And then they'll either go back to their orthopedic doctor or seek a second opinion with an orthopedic physician or orthopedic surgeon, which is perfectly fine. 748 01:03:31,401.211698 --> 01:03:39,651.211698 But you have to also ask the Orthopedic surgeon the right questions and many times our patients will say well, you know, dr. 749 01:03:39,651.211698 --> 01:03:45,171.211698 Wang or you know, dr So and so suggested regenerative treatments and you know, he feels the idea of the prolotherapy or PRP works. 750 01:03:45,171.211698 --> 01:03:47,321.211698 What do you think of that? You know, dr. 751 01:03:47,321.211698 --> 01:03:51,411.211698 Orthopedic surgeon And unfortunately, now this is changing. 752 01:03:51,411.211698 --> 01:03:58,671.211698 A lot of orthopedic surgeons are really starting to realize the value of regenerative treatments, but many of them still will just without even a second thought, they say, Oh, that's voodoo. 753 01:03:58,681.211698 --> 01:04:01,11.211698 Or like, well, if you want to flush your money down the toilet, go ahead. 754 01:04:01,701.211698 --> 01:04:04,91.211698 Now, some of them are not necessarily that. 755 01:04:04,526.211698 --> 01:04:05,986.211698 Uh, you know, course about it. 756 01:04:05,986.211698 --> 01:04:10,566.211698 They'll say, well, there's no evidence that the regenerative treatments, uh, you know, are shown to be beneficial. 757 01:04:10,836.211698 --> 01:04:11,206.211698 Okay. 758 01:04:11,606.211698 --> 01:04:14,326.211698 Many orthopedic surgeons will say that exact phrase. 759 01:04:14,336.211698 --> 01:04:32,796.210698 So I implore the, uh, folks that are seeing them to ask, well, What have you seen in your literature search? Have you done a search of, uh, uh, research studies on regenerative medicine? Because I, myself, have asked this question of many orthopedic surgeons that tell me, Hey, you know, there's no evidence behind that. 760 01:04:32,796.211698 --> 01:04:37,486.211698 And I say, Well, have you looked? And it's like, Well, no, but my understanding is that the research is just not there. 761 01:04:37,626.211698 --> 01:04:42,176.211698 They haven't even looked for the research, and they claim that there's no evidence. 762 01:04:42,486.211698 --> 01:04:43,976.211698 And this happens all the time. 763 01:04:44,306.211698 --> 01:04:44,736.211698 All the time. 764 01:04:44,766.211698 --> 01:04:50,471.211698 Most orthopedic surgeries Do not have level one evidence. 765 01:04:50,691.211698 --> 01:04:57,221.210698 Only one out of the top ten performed surgeries in orthopedics has level one evidence. 766 01:04:57,241.211698 --> 01:04:57,871.211698 Only one. 767 01:04:58,221.211698 --> 01:04:59,831.211698 And that's carpal tunnel release. 768 01:05:00,231.211698 --> 01:05:01,511.211698 Everything else, there's not. 769 01:05:01,511.211698 --> 01:05:02,351.211698 That's all investigational. 770 01:05:02,351.311698 --> 01:05:05,71.211698 What? So now we're on the same playing field. 771 01:05:06,126.211698 --> 01:05:07,56.211698 It's not even the same claim though. 772 01:05:07,226.211698 --> 01:05:11,606.211698 There's actually more level 1 evidence for regenerative therapies for different diagnoses in orthopedic surgery. 773 01:05:11,706.211698 --> 01:05:12,396.211698 That's why we have Dr. 774 01:05:12,396.211698 --> 01:05:12,806.211698 Wang here. 775 01:05:13,366.211698 --> 01:05:15,56.211698 Not just his jokes, but his intellect. 776 01:05:15,666.211698 --> 01:05:16,416.211698 It's not artificial. 777 01:05:16,416.311698 --> 01:05:17,386.210698 It's not artificial. 778 01:05:17,836.211698 --> 01:05:21,286.110698 He is real, real, real. 779 01:05:21,286.210698 --> 01:05:22,926.211698 AI right here. 780 01:05:23,346.211698 --> 01:05:31,546.211698 the car back on the road here because we're running out of time and we don't want to miss out on, um, the last two techniques, which are the bone marrow and lipo aspirate. 781 01:05:31,566.211698 --> 01:05:38,406.211698 So maybe we can touch on that quickly if we could touch on that and talk about where that comes into play, why you would recommend that. 782 01:05:38,406.211698 --> 01:05:43,546.210698 And then maybe just a quick little guide for patients who's who have been told they need that. 783 01:05:44,126.211698 --> 01:05:52,106.211698 So, so there's, there's in a nutshell for, for joint symptoms, you know, prolotherapy takes care of your. 784 01:05:52,791.211698 --> 01:06:05,961.211698 Your mild to moderate symptoms, PRP your hangs out around the moderate and then we get into your, your adipose and bone marrow for things that are more severe. 785 01:06:06,901.211698 --> 01:06:08,991.210698 So arthritis in general is graded. 786 01:06:09,551.211698 --> 01:06:10,801.211698 Uh, 1 to 4. 787 01:06:10,801.211698 --> 01:06:16,161.211698 It's not a very sophisticated system, but but it's been, uh, reliable. 788 01:06:16,481.211698 --> 01:06:21,51.211698 And, um, so great 34 is basically bone on bone, so to speak. 789 01:06:21,341.211698 --> 01:06:33,491.211698 So grade three is kind of the sweet spot for These, uh, tissues that are rich in stem cells, bone marrow, and adipose, which is fat, um, uh, that's kind of the sweet spot for them. 790 01:06:33,671.211698 --> 01:06:39,111.211698 But there's been a lot of evidence that it works on grade 4, and it also works really well on grade 2 as well. 791 01:06:39,471.210698 --> 01:06:43,461.211698 Um, so that kind of grade 2 to grade 4 is where we want to use it. 792 01:06:43,681.211698 --> 01:06:48,311.211698 So the moderate to severe, um, arthritis when you have a lot more going on. 793 01:06:48,681.211698 --> 01:06:51,471.211698 Um, sometimes we try PRP and it doesn't work. 794 01:06:51,871.211698 --> 01:06:58,941.211698 Um, but more often we're, we're, nowadays we're, we're seeing the patients and we're saying, Hey, listen, this is beyond PRP. 795 01:06:59,331.211698 --> 01:07:05,261.211698 Your choice is either a joint replacement or a, uh, adipose bone wear of treatment. 796 01:07:05,571.211698 --> 01:07:19,851.211698 And in other cases for say, wrist arthritis, uh, thumb arthritis, um, areas where they don't have a good option of where joint replacement hasn't been developed or, or isn't, uh, isn't well utilized. 797 01:07:20,191.211698 --> 01:07:32,411.211698 The only other option is either cortisone injections until it's there's nothing left or doing a stem cell rich tissue treatment such as bone marrow or adipose. 798 01:07:33,171.211698 --> 01:07:36,641.210698 Yeah, again, severity, proximity. 799 01:07:37,621.210698 --> 01:07:42,171.210698 Like if someone's coming here from colorado or or l. 800 01:07:42,171.210698 --> 01:07:42,381.210698 A. 801 01:07:42,391.210698 --> 01:07:43,331.210698 Which happens a lot. 802 01:07:43,591.211698 --> 01:07:45,801.211698 Um, we're not going to do a bunch of P. 803 01:07:45,801.211698 --> 01:07:45,901.211698 R. 804 01:07:45,901.211698 --> 01:07:46,191.211698 P. 805 01:07:46,271.211698 --> 01:07:47,431.210698 We're gonna hit hard. 806 01:07:48,346.211698 --> 01:07:57,656.210698 Also, like you said, severity of the arthritis, but also a tendon or a ligament issue that has a huge defect in it and there's a hole. 807 01:07:57,666.210698 --> 01:08:04,926.211698 So that's where the diagnostic injection under ultrasound comes into play because I do these on every single patient before I treat. 808 01:08:05,726.210698 --> 01:08:09,216.210698 Um, I want to see what that tissue does in response to fluid. 809 01:08:09,346.210698 --> 01:08:16,96.211698 So if I inject that tissue and it opens up and I start seeing my fluid inject a swirl around. 810 01:08:16,851.211698 --> 01:08:17,751.211698 I'm thinking more. 811 01:08:17,751.211698 --> 01:08:18,511.211698 I need a tissue. 812 01:08:18,521.211698 --> 01:08:19,351.211698 I need a graft. 813 01:08:19,541.211698 --> 01:08:20,971.211698 So I'm thinking probably fat. 814 01:08:21,231.211698 --> 01:08:21,491.211698 Yep. 815 01:08:21,971.211698 --> 01:08:28,671.212698 I also have told patients you don't need fat or bone marrow. 816 01:08:28,721.212698 --> 01:08:37,386.212698 So not, not only When do you use it? When do you not use it? Alright, so, let's say, we'll pick on knees because that's huge. 817 01:08:38,56.212698 --> 01:08:41,946.212698 Um, someone comes in for their knee pain and their arthritis. 818 01:08:42,436.212698 --> 01:08:46,196.211698 Someone calls and says, I've got bone on bone, what can you do for me? I'm not scared. 819 01:08:46,586.212698 --> 01:08:47,376.212698 We treat that all the time. 820 01:08:48,316.212698 --> 01:08:49,596.212698 But I gotta examine them. 821 01:08:49,856.212698 --> 01:09:18,306.212698 So, what is their, what is their alignment like? Do they have a huge valgus deformity? Are they lacking 20, 30 degrees of extension? Then you got to have a real conversation with these people, you know, yeah, we can do this stuff, but This is going to be the likely outcome and are you okay? Are you okay with not having your range of motion back because we're not getting that back Prolotherapy PRP bone marrow BMAC or bone marrow adipose. 822 01:09:18,636.212698 --> 01:09:23,676.212698 These are great procedures But they're not silver bullets and they don't they're not a miracle. 823 01:09:23,686.212698 --> 01:09:30,266.212698 They don't treat everything So you got to have a doc who's? Okay, saying this is not for you. 824 01:09:30,266.212698 --> 01:09:35,46.212698 You need, you actually do need a replacement, but we got to examine the patient. 825 01:09:35,186.212698 --> 01:09:36,276.212698 We got to see what's going on. 826 01:09:37,556.211698 --> 01:09:38,176.212698 Absolutely right. 827 01:09:38,886.211698 --> 01:09:43,166.212698 So one question I had, uh, Oh, wait, sorry, really quick before you say that, hold that thought. 828 01:09:44,86.212698 --> 01:09:45,476.211698 Just to play devil's advocate. 829 01:09:46,346.212698 --> 01:09:47,266.212698 There is Dr. 830 01:09:47,326.212698 --> 01:09:47,906.212698 Topal. 831 01:09:48,446.212698 --> 01:09:58,506.212698 In Argentina, who did dextrose prolotherapy, a single intra articular injection for arthritis. 832 01:09:59,6.212698 --> 01:10:01,166.212698 It was a great study because they had tissue. 833 01:10:01,486.211698 --> 01:10:03,876.212698 They actually did staining and did biopsies. 834 01:10:03,946.212698 --> 01:10:04,376.212698 Correct. 835 01:10:04,636.211698 --> 01:10:07,526.212698 Um, and they have great outcomes. 836 01:10:08,176.212698 --> 01:10:15,896.212698 The, the kicker is they didn't classify their, um, their grades of arthritis. 837 01:10:15,956.212698 --> 01:10:19,396.212698 They had Level 1, or grade 1 to 4. 838 01:10:20,316.212698 --> 01:10:25,816.112698 So you're getting great outcomes with dexterous prolotherapy with a grade 4. 839 01:10:25,816.212698 --> 01:10:29,626.211698 So, we get, I mean, we get thrown for loops all the time. 840 01:10:30,696.212698 --> 01:10:35,986.211698 So, again, you gotta trust your doc and have a conversation. 841 01:10:36,686.212698 --> 01:10:36,966.212698 Yep. 842 01:10:37,476.212698 --> 01:10:38,596.212698 I get surprised all the time. 843 01:10:38,616.212698 --> 01:10:38,866.212698 Right. 844 01:10:38,866.212698 --> 01:10:39,876.212698 You can have grade 4 arthritis. 845 01:10:39,906.212698 --> 01:10:48,736.212698 And, you know, we've known since the 1970s that you cannot correlate necessarily, uh, radiographic evidence of graded arthritis with symptoms. 846 01:10:48,956.212698 --> 01:10:51,886.212698 You can have a grade 4 arthritis and have relatively mild symptoms. 847 01:10:51,926.212698 --> 01:10:54,186.212698 You can have a grade 1 arthritis and have horrible symptoms. 848 01:10:54,661.212698 --> 01:11:02,661.212698 probably because of the soft tissue contributions, right? And so you can have dextrose prolotherapy that can potentially have a positive effect on grade four arthritis. 849 01:11:03,11.212698 --> 01:11:06,771.212698 Uh, I think it's going to be the minority of grade four arthritis conditions, but that can happen. 850 01:11:07,271.212698 --> 01:11:07,631.211698 Uh, yeah. 851 01:11:07,701.211698 --> 01:11:07,841.211698 Yeah. 852 01:11:07,841.212698 --> 01:11:08,91.212698 Dr. 853 01:11:08,91.212698 --> 01:11:10,781.212698 Topal has done some, some remarkable research, by the way. 854 01:11:10,781.212698 --> 01:11:12,41.211698 I just saw him at AOM. 855 01:11:12,121.212698 --> 01:11:13,751.212698 still looks like he's 20 years old, man. 856 01:11:13,751.212698 --> 01:11:18,41.212698 I mean, the guy's like PRP in the face, right? No Botox. 857 01:11:18,41.212698 --> 01:11:18,931.212698 It better not be Botox. 858 01:11:18,931.312698 --> 01:11:26,691.212698 But, uh, yeah, one question I think that, uh, is important to discuss. 859 01:11:27,196.312698 --> 01:11:46,126.212698 is this idea about the difference between true cellular treatments where we're harvesting the appropriately bone marrow and adipose from the individual versus these so called stem cell treatments, these, or these orthobiologic treatments that, you know, it's like stem cell in a bottle, right? Are they really stem cells? Are they not? Uh, you know, Dr. 860 01:11:46,126.212698 --> 01:11:48,97.512698 Siddiqui, you, you lecture on this, uh, regularly. 861 01:11:48,97.512698 --> 01:11:49,161.212698 Are they viable? They're right. 862 01:11:49,161.212698 --> 01:11:49,571.212698 Exactly. 863 01:11:49,571.212698 --> 01:11:50,501.212698 Yeah, they contaminated. 864 01:11:50,501.212698 --> 01:11:52,961.212698 What can we say about this? Because this is a very important point. 865 01:11:53,291.212698 --> 01:12:04,311.212698 So first things first in the United States to be able to use a off the shelf product that is a biologic, it needs to be FDA approved as a drug. 866 01:12:04,791.212698 --> 01:12:14,181.212698 And to my understanding, there's still no single product out there that is FDA approved to be injected into a joint or your soft tissue. 867 01:12:14,976.212698 --> 01:12:17,356.212698 And therefore, it is illegal in the United States. 868 01:12:17,356.212698 --> 01:12:22,286.212698 But still, there are many, many practitioners who are doing this, okay? But so, first things first, it's illegal. 869 01:12:22,746.212698 --> 01:12:30,206.211698 Um, second thing is, one of the reasons why it's illegal is this, this false advertising and marketing that's going on. 870 01:12:30,206.211698 --> 01:12:32,46.212698 And it, and it is industry based. 871 01:12:32,66.212698 --> 01:12:38,466.212698 And these, like we said, these, these, uh, these drug reps are coming to physician offices. 872 01:12:39,6.212698 --> 01:12:47,816.212698 touting their, their, uh, injection or whatever they're, they're promoting as the, as a stem cell treatment that's going to fix all their patients. 873 01:12:48,156.212698 --> 01:12:58,476.212698 And it's easy to do because you just pop the bottle off, put it in a syringe and inject it and you can charge thousands of dollars, often tens of thousands of dollars for these treatments. 874 01:12:59,136.212698 --> 01:13:05,886.212698 And so, uh, the dollar signs are lighting up in these, these, uh, uh, doctor's heads and they're, they're doing it. 875 01:13:06,381.212698 --> 01:13:14,71.212698 And, um, you know, first things first, these, these are not, um, uh, uh, stem cell treatments. 876 01:13:14,301.212698 --> 01:13:31,831.212698 They had stem cells at one time, but by the time it gets from the donor, which is usually umbilical cord blood during, during, uh, uh, delivery of babies, uh, to the patient, it's going through processing, freezing, thawing, multiple different things. 877 01:13:31,841.212698 --> 01:13:32,821.212698 Those cells are all dead. 878 01:13:33,321.212698 --> 01:13:33,741.212698 Um. 879 01:13:34,131.212698 --> 01:13:37,621.212698 And so, um, by the time it gets to you, there are really no stem cells left. 880 01:13:37,701.212698 --> 01:13:40,531.212698 There are growth factors, and there are growth hormones in there. 881 01:13:40,751.212698 --> 01:13:41,341.212698 Exosome. 882 01:13:41,371.212698 --> 01:13:41,961.212698 Exosome. 883 01:13:41,991.211698 --> 01:13:43,351.212698 So it could be beneficial. 884 01:13:43,681.212698 --> 01:13:48,441.211698 Um, and before, when we used this before the FDA crackdown, we were getting good benefits. 885 01:13:48,491.211698 --> 01:13:49,921.212198 Similar to more so a PRP. 886 01:13:49,921.212198 --> 01:13:50,151.211698 Yeah. 887 01:13:50,151.212698 --> 01:13:51,121.212698 Yeah, about PRP level. 888 01:13:51,131.212698 --> 01:13:52,281.211698 Not a stem cell. 889 01:13:52,381.212698 --> 01:13:54,51.212698 It's not as strong as a bone marrow. 890 01:13:54,51.212698 --> 01:13:55,881.212698 So extremely expensive PRP. 891 01:13:55,881.212698 --> 01:13:57,621.212698 So basically extremely expensive PRP. 892 01:13:58,121.212698 --> 01:13:58,811.212698 Exactly. 893 01:13:58,931.212698 --> 01:14:02,861.212698 Yeah, I was talking with, um, a new graduate. 894 01:14:03,476.212698 --> 01:14:47,1.211698 recently from residency got into the regenerative medicine world and he was a little cocky and he does the pop the bottle insert needle injecting the joint and he's like oh yeah patients love it he told me how much they charge and I'm like what he's like y'all they love it they keep coming back that's not a good sign and exactly I was like why do they keep coming back Like it's some kind of cult, obviously you're not getting a better, what's going on over there? Yep, you're giving, you're giving them some growth factors and, and anti inflammatory cytokines, make them feel better for three months, maybe a year. 895 01:14:47,1.211698 --> 01:14:48,281.212698 And then they're back to square one. 896 01:14:48,531.212698 --> 01:14:48,761.212698 Yep. 897 01:14:48,891.212698 --> 01:14:50,591.212698 Well, yeah, it's something else. 898 01:14:52,716.212698 --> 01:15:06,286.211698 So, well this has been very, very, um, good discussion and I think not only for the medical providers listening but, but also for the patients because this is information that is not widely known and really needs to be known. 899 01:15:06,286.212698 --> 01:15:10,141.212698 So, um, I really appreciate you guys joining us. 900 01:15:10,411.212698 --> 01:15:11,871.212698 I think we're running out of time. 901 01:15:11,881.212698 --> 01:15:19,671.212698 Yeah, we could go on and on and I was just about to say that you had to cut us off at some point because we can talk about dinner reservations. 902 01:15:21,461.212698 --> 01:15:22,11.212698 Sorry guys. 903 01:15:22,251.212698 --> 01:15:29,951.212698 Um, but we really, really enjoy, um, having you here, and we, we so much enjoy working with all of you. 904 01:15:29,951.212698 --> 01:15:30,456.112698 And this was awesome. 905 01:15:30,776.212698 --> 01:15:31,266.212698 Awesome. 906 01:15:31,316.212698 --> 01:15:36,726.212698 And I hope that all of our listeners really enjoy this because I think this is very useful information. 907 01:15:36,726.212698 --> 01:15:38,76.212698 I wish you could do this more often. 908 01:15:38,116.212698 --> 01:15:38,336.212698 Yeah. 909 01:15:38,366.212698 --> 01:15:42,196.212698 Because really, I think a big part of this too, is patient education. 910 01:15:42,766.211698 --> 01:15:42,946.212698 We can. 911 01:15:42,966.211698 --> 01:15:43,246.211698 Really. 912 01:15:43,246.212698 --> 01:15:43,976.212698 We should do this more often. 913 01:15:44,216.211698 --> 01:15:44,526.211698 Yeah. 914 01:15:44,536.212698 --> 01:15:44,916.212698 We need it more often. 915 01:15:44,926.211698 --> 01:15:44,946.211698 Yeah. 916 01:15:44,946.212698 --> 01:15:46,246.211698 You're right upstairs, you know. 917 01:15:46,256.211698 --> 01:15:46,676.212698 We're here. 918 01:15:46,686.212698 --> 01:15:46,966.212698 I know. 919 01:15:47,6.211698 --> 01:15:47,356.211698 You're right here. 920 01:15:47,366.212698 --> 01:15:56,126.212698 The, the reason that we, um, I'm, I'm a humble guy, but I'm going to sound not humble for a second. 921 01:15:57,86.212698 --> 01:16:00,106.212698 The reason that we are so good at what we do. 922 01:16:00,696.212698 --> 01:16:02,816.212698 We owe a lot of that to Gulf Coast. 923 01:16:03,806.212698 --> 01:16:09,376.212698 If I did not have the ultrasound skills that I learned at Gulf Coast, and Dr. 924 01:16:09,376.212698 --> 01:16:10,696.212698 Wang, and Dr. 925 01:16:10,696.212698 --> 01:16:12,946.211698 Siddiqui, and Dr. 926 01:16:12,956.212698 --> 01:16:17,966.211698 Victor Ibrahim, and everyone who came before us, we wouldn't be where we are. 927 01:16:18,186.212698 --> 01:16:18,746.212698 So, thank you. 928 01:16:18,936.212698 --> 01:16:21,146.212698 Yeah, I agree with that 100%. 929 01:16:21,546.212698 --> 01:16:22,286.212698 Great, yeah. 930 01:16:22,596.212698 --> 01:16:27,146.212698 It's a continuously learning experience, right? You never stop learning. 931 01:16:27,466.212698 --> 01:16:30,361.212698 As soon as you think you know it all, You're in trouble. 932 01:16:30,951.212698 --> 01:16:35,421.212698 As soon as you think you know it all, you get a rash of patients coming in back to back to prove you wrong. 933 01:16:35,531.212698 --> 01:16:36,361.212698 Exactly. 934 01:16:37,71.212698 --> 01:16:38,431.212698 All I heard was you get a rash. 935 01:16:38,431.312698 --> 01:16:41,61.212698 You get a really bad rash. 936 01:16:41,71.212698 --> 01:16:45,791.211698 You get like three or four patients in a row with some weird stuff and you're like, I don't know about that. 937 01:16:46,391.211698 --> 01:16:48,631.212698 It'll bring you, it'll put some humility back in you. 938 01:16:48,631.311698 --> 01:16:51,781.212698 You got that right. 939 01:16:51,801.212698 --> 01:16:53,801.212698 Well, we call it the practice of medicine for a reason. 940 01:16:53,841.212698 --> 01:16:55,501.212698 We're practicing science. 941 01:16:55,661.211698 --> 01:16:56,661.211698 We're always practicing. 942 01:16:56,661.211698 --> 01:17:01,536.212698 We're never going to get like, Perfected it, right? Right, it's not perfect and it's never going to be perfect. 943 01:17:01,596.212698 --> 01:17:03,766.212698 Until AI takes over, right? Just like everything else. 944 01:17:03,856.212698 --> 01:17:04,526.212698 Yeah, right. 945 01:17:04,646.212698 --> 01:17:06,686.212698 Until what? Until AI takes over everything. 946 01:17:06,876.212698 --> 01:17:08,586.211698 Yeah, AI is going to rule the world. 947 01:17:09,626.211698 --> 01:17:10,206.211698 No, for real. 948 01:17:10,416.211698 --> 01:17:11,456.211698 No, it's always, um, Yeah. 949 01:17:12,96.212698 --> 01:17:23,416.211698 It's such an experience to sit down with you guys and hear you and every time I'm in a room with you guys, I'm like, wow, I just, you're, you're so passionate about what you do and you're such great patient advocates. 950 01:17:23,416.212698 --> 01:17:29,886.112698 And I just wish everybody could have a doctor like you guys because I know there's so many people out there who are just. 951 01:17:29,886.212698 --> 01:17:41,936.212698 Desperate for answers, so, you know, all I say to our listeners is go out there and find a doctor who will have these discussions with you and aren't going to dismiss you and blow you off and will actually engage in conversation with you and not just tell you. 952 01:17:42,411.212698 --> 01:17:45,561.212698 That you're crazy or that they, this is how we do it. 953 01:17:45,561.212698 --> 01:17:50,521.212698 And they don't want to explain why, you know, they should be willing to sit down and engage with you. 954 01:17:50,751.211698 --> 01:17:50,771.211698 Yeah. 955 01:17:51,341.211698 --> 01:17:51,981.211698 Better yet. 956 01:17:51,981.211698 --> 01:17:52,531.211698 Educate yourself. 957 01:17:52,561.211698 --> 01:17:54,381.211698 Go visit one of these three guys. 958 01:17:54,381.211698 --> 01:17:57,941.211698 You know? We won't have to worry about it. 959 01:17:57,941.311698 --> 01:17:59,861.212698 You know, they know what they're doing. 960 01:17:59,921.212698 --> 01:18:00,161.212698 Yes. 961 01:18:00,641.212698 --> 01:18:00,971.212698 Obviously. 962 01:18:01,31.211698 --> 01:18:01,711.211698 Come see us. 963 01:18:01,751.211698 --> 01:18:02,381.211698 We're amazing. 964 01:18:02,891.211698 --> 01:18:09,191.212698 But if you're not, if you're not near us, just call us and we might know somebody in your area. 965 01:18:09,971.212698 --> 01:18:10,732.511948 We can point you to. 966 01:18:10,732.511948 --> 01:18:11,23.712198 Sure. 967 01:18:11,23.712198 --> 01:18:11,314.912448 Right. 968 01:18:11,314.912448 --> 01:18:11,606.112698 Yeah. 969 01:18:11,776.212698 --> 01:18:12,666.212698 Because you do know a lot of people. 970 01:18:12,696.212698 --> 01:18:14,6.112698 We do know a lot of people. 971 01:18:14,6.212698 --> 01:18:14,586.212698 Casey's got something. 972 01:18:14,616.212698 --> 01:18:19,406.212698 We'd rather see you see somebody good than some bobo out there. 973 01:18:19,926.212698 --> 01:18:21,426.212698 Yeah, you know, I know a guy. 974 01:18:21,906.212698 --> 01:18:22,926.212698 I know a guy. 975 01:18:23,866.211698 --> 01:18:24,406.212698 Or a gal. 976 01:18:25,666.211698 --> 01:18:28,496.212698 That being said, where can everybody find you guys? Right. 977 01:18:28,516.212698 --> 01:18:29,26.212698 Yeah. 978 01:18:29,276.212698 --> 01:18:30,516.212698 For us, come to our website. 979 01:18:30,576.211698 --> 01:18:32,366.212698 I'm sure the same thing for you, Dr. 980 01:18:32,366.212698 --> 01:18:32,746.212698 Broussard. 981 01:18:32,756.212698 --> 01:18:33,366.212698 Uh, Dr. 982 01:18:33,366.212698 --> 01:18:38,346.212698 Wang and I work for Regenerative Orthopedics and Sports Medicine, ROSM, uh, dot org. 983 01:18:38,751.212698 --> 01:18:39,761.212698 Um, look us up. 984 01:18:39,771.212698 --> 01:18:41,521.212698 We have a lot of patient information on there. 985 01:18:41,741.212698 --> 01:18:41,971.212698 Yeah, you do. 986 01:18:42,11.212698 --> 01:18:45,291.212698 Um, the educational materials, research articles. 987 01:18:45,761.212698 --> 01:18:50,301.212198 Um, you know, we've, we've multiple locations throughout the DMV area, uh, D. 988 01:18:50,301.212198 --> 01:18:50,501.211698 C., 989 01:18:50,501.212698 --> 01:18:51,421.212698 Maryland, and Virginia. 990 01:18:51,951.212698 --> 01:18:55,621.212698 And, um, but yeah, come to our website and, yeah, feel free to call us up. 991 01:18:55,681.212698 --> 01:19:02,846.212698 Well, if, if, if you call up and ask, You know, who's good and so and so part of the United States, we'll, we'll, uh, we'll figure it out for you. 992 01:19:02,946.212698 --> 01:19:03,196.212698 Yeah. 993 01:19:03,406.212698 --> 01:19:05,146.212698 You've got a great Facebook page, too. 994 01:19:05,346.212698 --> 01:19:05,576.212698 Yep. 995 01:19:05,916.212698 --> 01:19:10,36.212698 And John? Yeah, so, um, this is John here, Bruce Hart. 996 01:19:10,286.212698 --> 01:19:12,266.212698 Uh, Alliance Regen and Rehab. 997 01:19:12,876.212698 --> 01:19:15,29.578698 Uh, our website is www. 998 01:19:15,29.578698 --> 01:19:15,522.845698 allianceregen. 999 01:19:15,522.845698 --> 01:19:16,16.112698 org. 1000 01:19:16,16.312698 --> 01:19:19,96.212698 The alliance Rx like a prescription. 1001 01:19:19,366.212698 --> 01:19:19,826.212698 com. 1002 01:19:20,486.212698 --> 01:19:21,766.212698 Uh, you can visit our website. 1003 01:19:21,766.212698 --> 01:19:24,346.212698 You can call us, uh, phone numbers on there. 1004 01:19:24,766.212698 --> 01:19:28,546.211698 If you are in Florida, um, we are a great place to stop. 1005 01:19:28,576.211698 --> 01:19:33,246.211698 Or if you are in driving distance to an airport, we're also a great place to stop. 1006 01:19:34,316.211698 --> 01:19:38,346.211698 Um, no, we love you guys. 1007 01:19:38,346.211698 --> 01:19:39,596.212698 We just want the best thing for you. 1008 01:19:39,646.212698 --> 01:19:41,136.212698 Uh, you don't have to get treatment with us. 1009 01:19:41,136.212698 --> 01:19:42,936.212698 Just don't do something stupid. 1010 01:19:43,196.211698 --> 01:19:43,596.212698 That's right. 1011 01:19:43,816.212698 --> 01:19:52,656.212698 Yeah, we are very blessed to be able to work with the best of the best and these guys and all of our faculty that we work with are the top experts. 1012 01:19:52,726.212698 --> 01:19:55,866.211698 So, you know, we're happy to help you out as well if you. 1013 01:19:56,806.212698 --> 01:19:57,776.212698 Can't find somebody in here. 1014 01:19:57,866.212698 --> 01:20:00,26.212698 Yeah, you can always come to our website, gcus. 1015 01:20:00,26.212698 --> 01:20:00,206.212698 com. 1016 01:20:00,606.212698 --> 01:20:01,426.212698 We'll get you hooked up. 1017 01:20:01,476.212698 --> 01:20:02,216.212698 We'll get you going. 1018 01:20:02,446.212698 --> 01:20:02,876.212698 Excellent. 1019 01:20:02,966.212698 --> 01:20:03,266.212698 Yeah. 1020 01:20:03,676.212698 --> 01:20:08,676.212698 Well, as always, it's just a remarkable privilege to have a chance to work with your team. 1021 01:20:08,676.212698 --> 01:20:09,566.212698 Thank you so much. 1022 01:20:09,586.212698 --> 01:20:13,856.212698 It's always a good time and your level of expertise continues to amaze me. 1023 01:20:13,876.312698 --> 01:20:15,186.212698 So so much for the opportunity. 1024 01:20:15,296.212698 --> 01:20:16,296.212698 Thank you very much. 1025 01:20:16,326.212698 --> 01:20:16,616.212698 Yeah. 1026 01:20:17,56.212698 --> 01:20:17,266.212698 All right. 1027 01:20:17,266.212698 --> 01:20:19,716.212698 And to our loyal listeners, we really appreciate you guys. 1028 01:20:19,716.212698 --> 01:20:21,436.212698 We wouldn't be what we are without you. 1029 01:20:21,436.212698 --> 01:20:22,416.212698 So thank you. 1030 01:20:26,691.4291559 --> 01:20:28,731.4291559 Thanks for listening to the Sonography Lounge. 1031 01:20:29,121.4291559 --> 01:20:35,641.4291559 Don't forget, if you like this episode, please subscribe and leave us a review on iTunes, Spotify, or wherever you get your podcasts. 1032 01:20:36,731.4291559 --> 01:20:43,661.4281559 You can also find us on Instagram, at Sonography Lounge, and Twitter, at Sonography LNG. 1033 01:20:45,511.4291559 --> 01:20:54,761.4291559 If you have any questions, comments, or topic suggestions, feel free to send an email to us at sonographylounge at gmail dot com. 1034 01:20:56,161.4291559 --> 01:20:59,51.4291559 Have a great week, and scan, scan, scan.

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EP40. Explaining Regenerative Medicine (Prolotherapy, PRP, Bone Marrow, & Adipose Derived Stem Cells), and the use of Ultrasound

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