The Joe Rogan Experience - Joe Rogan Experience #945 - Dr. Roddy McGee

00:00:02.000 Five, four, three, two, one!

00:00:10.000 Hmm, false start.

00:00:11.000 Hello, ladies and gentlemen.

00:00:12.000 Hello, Dr. McGee.

00:00:14.000 That sound is not me peeing.

00:00:16.000 If you're hearing that, you're like, what?

00:00:18.000 Is this a podcast in a bathroom?

00:00:21.000 No, that's coffee.

00:00:22.000 Okay.

00:00:23.000 How are you, buddy?

00:00:24.000 Good.

00:00:25.000 Thank you for having me.

00:00:26.000 Thanks for being here.

00:00:27.000 For folks who have heard me rant and rave about the fantastic results that I have had getting treatment on my shoulder where I was that close to getting surgery, it's this gentleman, Dr. McGee, who has fixed me up out of Las Vegas, Nevada.

00:00:43.000 And now we're here to talk about it.

00:00:45.000 Yeah, I appreciate the chance to be here.

00:00:48.000 You're a man of very short words today.

00:00:49.000 He was very talkative before the podcast, folks.

00:00:52.000 That's how it goes, man.

00:00:52.000 Well, now I'm hearing myself.

00:00:54.000 Oh, is it weirding you out?

00:00:55.000 Yeah, a little bit.

00:00:55.000 You can take him off.

00:00:56.000 We can take him off if it's too weird.

00:00:57.000 You've never done a podcast like this before.

00:00:59.000 You did John Dudley's, which was excellent.

00:01:02.000 We can take it off.

00:01:03.000 I might have to.

00:01:04.000 Okay, let's take it off.

00:01:05.000 I don't want to freak you out.

00:01:06.000 Is that better?

00:01:07.000 This is a little more like a normal conversation.

00:01:08.000 Okay.

00:01:09.000 I don't want to freak you out.

00:01:10.000 To me, it's better because I can hear if things are wrong.

00:01:14.000 What's the notes, Daddy-O? What do you got there?

00:01:16.000 Just a couple of things I jotted down.

00:01:17.000 Just make sure I give you all the information you want to hear.

00:01:21.000 Well, I just want to tell you that I feel super fortunate to have met you and to have been treated by you and to be able to have these conversations with you in your office, which is why I wanted to have you here to talk to you because, I mean, I was having some really significant shoulder issues before you treated it and it's amazing the results and what,

00:01:40.000 you know, I mean, what I've avoided, avoided in shoulder surgery.

00:01:47.000 Yeah, I mean you've had a tremendous result so obviously we're very thankful that you're able to get that benefit and I think we're in my community of orthopedic surgery and sports medicine you know we're very excited about the possibility and eager to continue to learn about it and see what it can be and how it can help and what it does best for what.

00:02:07.000 Now where's all this stuff coming from?

00:02:09.000 Like where is this science coming from and how has it evolved over the last few years?

00:02:14.000 Well, a lot of the stuff that we're using is not new in terms of the tissue or that type of thing, but it's actually the application for orthopedic sports medicine.

00:02:26.000 So you could go back decades to when it's been used in plastic surgery for corneal ulcers is one of the original applications of placental tissue.

00:02:36.000 Really?

00:02:44.000 In our community of orthopedic surgery, now we're starting to see what the applications can be.

00:02:50.000 Now, when you say plastic surgery, what have they done with plastic surgery?

00:02:54.000 Mostly helping with wounds.

00:02:56.000 So that's been the big application.

00:02:58.000 Wound healing.

00:02:58.000 And the potential for there to be wound healing without scarring.

00:03:02.000 So that's one of the things that we'll get into.

00:03:05.000 How do they do that?

00:03:07.000 It's part of the mechanism of how the cell helps the process of the healing.

00:03:12.000 But we'll talk about that for sure.

00:03:14.000 Now, when they extract the placental tissue, they're doing it on young women who have had cesarean sections, correct?

00:03:21.000 Sure.

00:03:22.000 So it bypasses a lot of the ethical concerns that a lot of people had during the Bush administration, which kept them...

00:03:27.000 Okay, so let's...

00:03:27.000 You said a couple of different important things there, so let's start breaking that down a little bit.

00:03:32.000 So the first thing is...

00:03:35.000 Where does it come from?

00:03:36.000 It comes from a young, healthy mother.

00:03:56.000 And then they have been screened.

00:03:58.000 And there's a process that must be followed by the American Association of Tissue Banks.

00:04:04.000 And they have a series of blood tests that they have to go through.

00:04:07.000 And so you're checking to be sure that there's no communicable disease, for example, hepatitis or HIV, things of that nature.

00:04:14.000 And so once that has been cleared and they're an acceptable donor, then they go through the delivery, the tissues collected, and as you said, this is stuff that typically would go in the garbage.

00:04:26.000 So essentially the ethical and the moral dilemma shouldn't exist for that portion of it because otherwise it's just garbage.

00:04:38.000 Now, that's taken by the company that has harvested And they have their processing center, which also has to be evaluated and approved by this AATB, American Association of Tissue Banks,

00:04:53.000 to be a facility that is up to their standards.

00:04:57.000 So they have a sterilization process.

00:04:59.000 The tissue is not contaminated.

00:05:01.000 Their packaging is appropriate.

00:05:03.000 Their shipping is not causing problems with the tissue.

00:05:05.000 So you have to meet all these standards.

00:05:07.000 It's very stringent.

00:05:08.000 And so if you have that, if a company has that Approval, then, you know, they meet the standards allowed so that that stuff can then go either to an office or to a hospital.

00:05:21.000 So, now, the next thing of what you said...

00:05:26.000 Let's talk a little bit about President Bush and that whole discussion.

00:05:33.000 So first of all, that is about embryonic stem cells.

00:05:38.000 An embryonic stem cell, and that doesn't have anything to do with what we're doing.

00:05:43.000 An embryonic stem cell is when the sperm and the egg join and begin to form the beginning cells of life.

00:05:50.000 And there's initially two cells, and then it divides into four, eight, etc.

00:05:55.000 In the first five days of life, that's called a blastocyst.

00:05:59.000 And those cells can be harvested.

00:06:03.000 And they are what we call totipotent.

00:06:06.000 That means they can become anything.

00:06:08.000 They have the ability to transform into any line of tissue or organ.

00:06:13.000 Or, in the case of that first five days of life, those individual cells can actually become a complete organism.

00:06:22.000 So that's where we had the cloning of the sheep.

00:06:26.000 So that's what happened.

00:06:27.000 So they took the cells in that first couple of days, and then they had a process to allow it to continue to grow.

00:06:34.000 And so you had two different, from a single sperm and egg, you had two organisms, complete mammals, created.

00:06:43.000 So when you say this blastocyst, is that how you say it?

00:06:46.000 That's just the term for the initial, you know, the ball of cells that's formed.

00:06:50.000 And how many cells is blastocyst?

00:06:53.000 Well, they're dividing over the number of days and doubling each time.

00:06:56.000 Hundreds, thousands?

00:06:58.000 Not by that time.

00:06:59.000 No?

00:06:59.000 Hundreds?

00:07:00.000 You're 16, you know, 32. So if you have 32, how many different organisms can you make off of those 32 cells?

00:07:07.000 Technically, if you have a totipotent cell, every individual cell has the ability to become a complete organism.

00:07:12.000 Whoa.

00:07:13.000 So that could be one blastocyst, could be 32 different people.

00:07:16.000 I guess, potentially.

00:07:18.000 Wow.

00:07:18.000 I don't know if that experiment's been carried out.

00:07:21.000 But theoretically at least.

00:07:23.000 Theoretically, yeah.

00:07:23.000 Wow.

00:07:24.000 So, now when they have like frozen embryos and people do things like that, when they decide they want to have kids later in life and they freeze their embryos, how the hell are they doing that?

00:07:34.000 What's that about?

00:07:35.000 I'm not like a reproduction specialist, so we might be getting, you know, out of my region.

00:07:41.000 But those frozen embryos, a lot of times they don't get used, right?

00:07:44.000 I don't know.

00:07:45.000 I don't know how that works. 0.99

00:07:47.000 Because I know there's been battles, like people have had battles with their ex-wives and shit. 0.96

00:07:52.000 Yeah, it's very strange. 0.91

00:07:54.000 My understanding of it would be that if you're, you know, you're freezing it with the intention of maintaining the cell viability, and so somebody has demonstrated that you could then thaw that cell and it still has the opportunity to divide, produce, and, you know, become a living thing.

00:08:09.000 Wow.

00:08:10.000 I was thinking, like, for the non-viable ones or the ones that don't get turned into people, they could probably use those as well, right?

00:08:17.000 Well, that...

00:08:19.000 That's a big debate.

00:08:20.000 That was the thing, right?

00:08:21.000 That was the big George Bush thing.

00:08:22.000 Well, okay, so let's back up on that, because I think there's a lot of misconception about that, and I hear very strange comments made about it all the time in the media.

00:08:31.000 So, the thing that George Bush signed in 2001 stated that the federal government was not going to supply money for embryonic stem cell research.

00:08:42.000 That's it.

00:08:42.000 It was not a ban on The application?

00:08:46.000 On stem cell research.

00:08:47.000 So for all of that time, I mean, private equity companies and any private investor could have and probably has been spending the money to continue to research that and develop it and find it.

00:09:00.000 So I always find it interesting when I hear on TV, oh, like...

00:09:05.000 Our country has been set back a decade because they signed this bill.

00:09:09.000 So you feel that's wrong?

00:09:10.000 Yeah.

00:09:11.000 All he said was, we're not going to dedicate federal money to it.

00:09:16.000 Right.

00:09:16.000 That's different than a ban on any study.

00:09:19.000 But how much research does rely on federal funding?

00:09:22.000 I don't know.

00:09:23.000 I mean, there's private funding for all kinds of things.

00:09:27.000 Is it more common now than it is before, or has it always been the case where there's a lot of private funding?

00:09:32.000 So President Obama in 2009 lifted the ban on the federal funding.

00:09:36.000 So federal funding has been going on for it since then.

00:09:39.000 Interesting.

00:09:40.000 So what is the difference in terms of the viability of placental stem cells that you would get from a woman in a cesarean section versus something that you would get from a blastocyst?

00:09:52.000 Well, so a couple of things about that.

00:09:55.000 One, there's...

00:10:01.000 It's actually to our benefit in orthopedics not to be using that line of cells because those cells, starting from that time point, have the ability to have teratogenic potential.

00:10:15.000 So what that means is they can potentially form tumors.

00:10:18.000 So that makes it obviously a big disadvantage because now we're adding our risk to what we're doing.

00:10:24.000 Once they've gotten to the point where it's a part of the whole, you know, we call this like a human placental stem cell or mesenchymal stem cell.

00:10:34.000 And that includes the placenta, the umbilical cord, the Wharton's jelly is a mucus type substance that's around the arteries of the umbilical cord.

00:10:44.000 The amnion or the amniotic sac, which is the inner layer around the baby, and then the outer layer is called the chorion.

00:10:52.000 Now, all of that has cells in it that we would put in the category of mesenchymal stem cell or mesenchymal stem cell.

00:11:01.000 Now, what that means is they have a specific line of tissues that they can become.

00:11:09.000 So, now, back to when I was explaining the formation of the The blastocyst becomes a morula, becomes an embryo eventually.

00:11:18.000 So in that process, you have this ball of tissue, and then it starts to kind of fold in on itself, and then it starts to layer out into these three layers.

00:11:30.000 So you have endoderm, ectoderm, mesoderm.

00:11:34.000 Each of those kind of is directed towards a certain line of cells and tissues.

00:11:39.000 The mesoderm and what the mesenchymal stem cells can become are all of the things that we care about in orthopedics.

00:11:47.000 So cartilage, bone, muscle, ligament, tendon.

00:11:50.000 So we have that whole line of cells that this particular cell has the potential to become.

00:11:58.000 So when we talk about a stem cell, By definition, what it means is, one, it can divide and become another stem cell.

00:12:09.000 So it can duplicate itself so that now you have another cell that can divide and become another cell.

00:12:15.000 Or it can divide and differentiate into a cell that then has the characteristics of the things that you're hoping it will become.

00:12:25.000 Now that's a directed and ordered approach in embryology.

00:12:30.000 And in the case of treating an injury, what we're hoping is that that can differentiate into the injured tissue.

00:12:40.000 And how long have they been doing that?

00:12:42.000 Well, studies on that have been going on for at least 10 years.

00:12:48.000 So I want to say maybe back as early as 2007. Now, we've been...

00:12:54.000 If you go way back to the early days of...

00:13:00.000 Arthroscopy, and that would be like the late 70s and early 1980s.

00:13:05.000 And I don't know exactly what year, you know, he would have started doing this, but Dr. Stedman in Vail, Colorado, and he was in Reno and Lake Tahoe area before that, they would...

00:13:19.000 He's the one that developed the microfracture procedure.

00:13:23.000 I don't know if you're familiar with that.

00:13:25.000 You've had a couple of knee surgeries, so...

00:13:27.000 I don't know if you've heard that term.

00:13:28.000 I have, but I don't really recall exactly what it is.

00:13:31.000 Sure.

00:13:32.000 So basically, if a patient had a small cartilage defect, he took an awl, or what looked like a tiny little pick, and made a puncture into the bone.

00:13:43.000 And what that did is it releases marrow elements along with blood.

00:13:47.000 And they were able to see with time, and there were occasions when they got to have second-look arthroscopy, that that cartilage could fill in.

00:13:57.000 Now, they also found that that didn't become the native cartilage.

00:14:02.000 It becomes something called fibrocartilage.

00:14:04.000 So when you look at it under a microscope, it looks different compared to our normal cartilage.

00:14:09.000 Appearance, like, physically looks the same, but under the microscope looks different.

00:14:12.000 What is the difference?

00:14:14.000 Well, the main difference in what's applicable is that it doesn't have the same structural properties.

00:14:24.000 So it was more easily able to kind of come off with a sheer force.

00:14:29.000 So just picture, like, your knee bending.

00:14:31.000 Yeah.

00:14:32.000 You could kind of flake off, or in some cases just didn't form as well as, you know, you would want.

00:14:37.000 Hmm.

00:14:39.000 So that experience, and having conversations with the guy that I trained with, his name is Larry Lemack in Birmingham, he noted just over his career that he always felt like patients that had worse arthritis, but they would do this microfracture procedure on in knee arthroscopy,

00:14:57.000 actually would do better than patients with less arthritis, but that they didn't do the The procedure.

00:15:03.000 And so it had always been in his mind that somehow that marrow stimulation was providing something that was helping with either healing or pain relief.

00:15:13.000 And it's only now that we start to understand, you know, because the bone marrow has some of these mesenchymal stem cells available also.

00:15:21.000 And we'll kind of talk about the differences and stuff like that.

00:15:24.000 So it's essentially like a crude version of stem cell transplants?

00:15:28.000 Yeah, that's a good way to put it.

00:15:31.000 Yeah.

00:15:32.000 I mean, our hope is that we're using cells that can, again, change into other things that we want.

00:15:38.000 And when did they start applying this on people, like in terms of not just tests and studies, but actually in practice, like what you do?

00:15:47.000 Well, in orthopedic sports medicine, I don't think I started to hear about it until around 2012. So that was the first year that I was in practice, and I attended a conference in Las Vegas, and it was called the Emerging Techniques in Orthopedics.

00:16:03.000 So they were kind of talking about what's the newest and, you know, I think?

00:16:29.000 And they were showing new growth of cartilage and actually improvement in some of the x-rays.

00:16:36.000 So when you look at an x-ray, there's some characteristics that we look at that define what arthritis is.

00:16:43.000 So if the patient has narrowing of the joint space or they have bone spurs, things like that.

00:16:48.000 They were actually seeing more space between the bones on some of these serial x-rays.

00:16:52.000 So, you know, I saw that and that was just like so incredible and something that I never heard about, read about, or, you know, had encountered before.

00:17:02.000 And that's really what kind of sparked my interest.

00:17:05.000 And what are they doing with the fat?

00:17:06.000 Because I've heard that they do stem cell fat injections.

00:17:09.000 They harvest the fat similar to like a mini liposuction.

00:17:11.000 Right.

00:17:12.000 And then they either spin it in a centrifuge or there are these syringes that you can pass it through a filter and then you re-inject it.

00:17:22.000 And what you're trying to do is, again, take advantage of the fact that there's these mesenchymal stem cells in the tissue.

00:17:29.000 Right.

00:17:30.000 And like what can they just are they just taking the fat like when they spit in a centrifuge like what does that accomplish?

00:17:36.000 It just separates out the cells. 0.74

00:17:39.000 So then you can, you know, inject the portion that you want.

00:17:43.000 So we do that.

00:17:44.000 Do it visually?

00:17:45.000 You've had it with PRP. Yeah.

00:17:46.000 Yeah, exactly.

00:17:48.000 I've had it with Regenikine, which is like a form of PRP. Correct.

00:17:52.000 Yeah, where they heat it up and it becomes like a yellow serum.

00:17:55.000 Right.

00:17:56.000 That's the platelet layer of the blood that you're looking at.

00:17:59.000 Okay.

00:18:00.000 Yeah.

00:18:00.000 So the red cells separate out and you can easily see that in the tube.

00:18:05.000 And what is the difference in the results from someone who does that?

00:18:09.000 Because I know quite a few people have done it that way.

00:18:11.000 They've had injuries treated where they suck the fat out.

00:18:13.000 There isn't any research to differentiate one of these treatments versus another yet.

00:18:19.000 It's just not available.

00:18:20.000 So it's all anecdotal in terms of talking to patients?

00:18:23.000 It's happening.

00:18:24.000 I mean, people are collecting the data, but it's just not at the mature stage where...

00:18:31.000 You know, where it's available and we have, you know, published stuff to look at.

00:18:36.000 Do you personally know of anybody who's had really good results using the FAT method?

00:18:41.000 Yes, actually.

00:18:43.000 A physician friend of mine in Memphis, Tennessee, her name's Dr. Laura Lenderman, she has utilized that quite a bit and she's been very happy with the patients that she's treated.

00:18:56.000 And naturally some people do better than others, but...

00:18:59.000 You know, the rigorous study of this, though, is still yet to come.

00:19:04.000 That's really fascinating.

00:19:06.000 Have you considered trying that?

00:19:09.000 Definitely.

00:19:10.000 Yeah, but you don't so far?

00:19:11.000 You just do the stem cells?

00:19:12.000 I haven't had anybody specifically request it.

00:19:16.000 Maybe somebody wants to lose a little fat and fix their knees. 1.00

00:19:18.000 Yeah, I mean, that's probably taking things in a direction I don't want to be going, but...

00:19:24.000 The plastic surgery direction?

00:19:26.000 We know there are a number of different options in terms of where these sources of the cells can come from.

00:19:33.000 Bone marrow has certainly had a lot of use and continues to be used.

00:19:37.000 Daniel Cormier had that done.

00:19:39.000 That's what he told me, yeah.

00:19:39.000 Yeah, he had it pulled out of his hip and he said it was brutally painful.

00:19:42.000 Then he was walking with a limp for like two weeks.

00:19:45.000 Obviously, it's a procedure.

00:19:48.000 There's pain and there's morbidity.

00:19:50.000 There's a consequence to...

00:19:52.000 You know, putting a sharp object into the bone and drawing that bone marrow out.

00:19:56.000 Yeah, so that means a bad thing.

00:19:58.000 I don't like that word.

00:20:00.000 No, we don't like it either in medicine.

00:20:02.000 Morbid is a bad word.

00:20:04.000 We have conferences called Morbidity and Mortality, and that's where you basically...

00:20:08.000 Oh, yeah.

00:20:31.000 I can only imagine.

00:20:32.000 Especially if you're dealing with people that are broken apart.

00:20:36.000 Essentially, as an orthopedic surgeon, you're dealing with people whose bodies have failed.

00:20:40.000 Your limbs have failed. 0.80

00:20:43.000 Ligaments have torn off the bone.

00:20:45.000 Knees have exploded.

00:20:47.000 I mean, you've told me some gnarly stuff in terms of the kind of injuries that you've had to treat, and I can only imagine some of them.

00:20:54.000 Yeah, yeah.

00:20:55.000 And so, your time doing this with placental stem cells, how long have you been doing that?

00:21:01.000 It's been a couple years.

00:21:03.000 So, essentially, you did mine, I think, how long ago was it?

00:21:09.000 I think it was July of 2015. Yeah, so I kind of came in pretty early.

00:21:14.000 Because Jeff Davidson, the doctor from the UFC, he was the one who told me about it because he had shoulder surgery and...

00:21:21.000 He was very stiff and had real problems after the shoulder surgery and was just very unhappy with his range of motion and the pain that he's experiencing and then he got some stem cell treatments and it just all went away.

00:21:33.000 And he trains a lot.

00:21:34.000 Yeah.

00:21:34.000 He trains really hard.

00:21:36.000 He's very fit.

00:21:37.000 I was pretty impressed with, you know, what he told me about how he was, what he was able to get back to after, you know, he had been treated with that type of injection.

00:21:48.000 Yeah.

00:21:49.000 Yeah, so he told me, and then I was like on the fence.

00:21:52.000 I mean, I'd seen an orthopedic surgeon, and the only thing that was keeping me from getting surgery is, you know, he put me through all these stress tests where he pushed down on my arm and all this stuff, and I resisted all of them.

00:22:03.000 And he's like, this is, it's kind of odd that your injury's this bad, but you have so much strength in your joint still.

00:22:09.000 Yeah.

00:22:09.000 Like maybe you should hold off a little bit before you get the surgery.

00:22:12.000 He's like, cause you- Well, I thought that when I examined you too, because I really couldn't reproduce your pain.

00:22:18.000 Yeah.

00:22:19.000 So, and that's another reason, and I probably would have been in the same boat as the first guy, in terms of trying to make a decision about surgery.

00:22:31.000 Because, you know, if your physical exam doesn't, you know, show that somebody has some significant deficit, it's hard to make the jump to take somebody to surgery.

00:22:40.000 Well, during normal everyday life, there'd be like zero pain.

00:22:43.000 The problem is what I put my body through has nothing that resembles normal everyday life.

00:22:49.000 Between jiu-jitsu and kickboxing and kettlebells and archery and there's just so much explosive movements and so much weight-bearing movements.

00:22:58.000 Yeah, you're doing really high-demand stuff.

00:23:00.000 Yeah.

00:23:01.000 So in that case, that was one of the reasons why I was thinking, because I don't want to walk around with a compromised body.

00:23:06.000 I'm like, if I have to just get surgery and then take six months of rehab or whatever, what is the, for a type of shoulder injury that I had, what is the rehabilitation time?

00:23:18.000 You know, for sure, probably three months.

00:23:21.000 I mean, it can be longer than that.

00:23:23.000 It depends on the patient.

00:23:26.000 Somebody like you that...

00:23:28.000 One of the things that we...

00:23:31.000 Have trouble with.

00:23:32.000 With some patients, they've never even lifted weights, for example.

00:23:35.000 So for them, the recovery and rehab, we're introducing things to them that they've never seen or done.

00:23:43.000 And they don't understand the difference between being sore and pain that they should be conscious about.

00:23:50.000 And it's challenging.

00:23:52.000 It's hard work.

00:23:53.000 And it's uncomfortable.

00:23:55.000 And so some patients, you know, they're, they struggle to get through that part of it.

00:23:58.000 Um, and it naturally will take longer to improve.

00:24:01.000 So it's harder for them to get their motion.

00:24:04.000 It's longer, much longer for them to return their strength.

00:24:06.000 Now you already have like a significant baseline level of strength.

00:24:10.000 So, you know, much easier in your case to bounce back.

00:24:14.000 And then also the things that you would do in rehab, they're so rudimentary, you know, you would move through that very quickly.

00:24:20.000 And then, uh, Once you're at the point where you have had enough tissue healing and it's safe to progress you, you know, through higher level exercises, then you could really push it.

00:24:31.000 And you would.

00:24:32.000 I mean, you would be committed to it, dedicated, diligent.

00:24:36.000 I mean, we'd almost have to hold you back.

00:24:38.000 Yeah, that was another question I had.

00:24:39.000 How often do you have people where that is the issue?

00:24:42.000 Like, I know you've treated a bunch of fighters.

00:24:45.000 And when you treat MMA fighters, is that an issue where you're trying to, like, slow them down, go...

00:24:49.000 All the time you've got to let people know.

00:24:52.000 One of the lines that I say to all my patients regularly is, you've got to respect biology.

00:25:00.000 You have to allow the healing to happen.

00:25:02.000 I know you feel good, I know you're moving good, and you're ready to go.

00:25:05.000 You want to be back on the court, on the field, things like that.

00:25:12.000 Right.

00:25:33.000 So it's always a balancing act.

00:25:35.000 So in your time of doing this, have you had people that didn't respond to this particular type of therapy?

00:25:41.000 Oh, definitely.

00:25:41.000 Definitely, yeah.

00:25:42.000 And were they the people that we talked about before that don't exercise and aren't in good shape, or is it across the board?

00:25:48.000 So, you know, I would have to go back and look and kind of critically evaluate each case.

00:25:53.000 Certainly, you know, we worry about the patient that has lower, like, baseline fitness, like their overall health is poorer, you know, and what their response might be.

00:26:06.000 But I think that's information that is still, you know, to come.

00:26:10.000 But definitely, I mean, some of the people that have responded the most dramatically, like, for example, you and John Dudley, I mean, you guys are...

00:26:20.000 Fanatical about your nutrition.

00:26:21.000 You're working out regularly.

00:26:23.000 You're doing all kinds of things to optimize your chance to not, you know, in this case, heal, but in other instances, perform.

00:26:32.000 And I have to believe that that has, you know, that's a huge factor.

00:26:36.000 Yeah, I would wonder how much of a factor it is if your body is conditioned in a way to constantly generate muscle tissue and breaking down and rebuilding and it's always constantly under stress.

00:26:48.000 Definitely has to be a part of it.

00:26:50.000 You know, I think it's not the typical realm of my specialty to be looking at all those other factors, but I think with all of the information that's becoming available...

00:27:03.000 One of the cool things for me has been it's forcing me to have to learn about it.

00:27:07.000 It's forcing me to have to take a look at, you know, how can we do better?

00:27:11.000 You know, what are we ignoring?

00:27:12.000 And I think if you're not looking at every aspect of that wheel, then you're missing a chance to do as good as you can for each patient.

00:27:21.000 And it might be things that we have to do before somebody even has treatment.

00:27:25.000 We might have to bring them up to some baseline level with a number of different things.

00:27:31.000 And the other side of it, too, is we're in a system now where there's so much information.

00:27:39.000 One person can't be your source for everything.

00:27:42.000 So you really have to have a good team all around you.

00:27:46.000 I think that's really important.

00:27:48.000 I find myself more and more seeking help and just saying, hey, I don't know enough about this.

00:27:54.000 Can you help me with this or explain it better?

00:27:57.000 Can I have the patient talk with you and maybe get some more information?

00:28:01.000 And I think that may give them an even better chance to do well.

00:28:04.000 Just because the options and the possibilities are so comprehensive?

00:28:07.000 And time.

00:28:10.000 In a typical orthopedic practice, you don't have a ton of time to go through all of this with every patient.

00:28:16.000 And so you just have to make sure that you're providing resources and getting them as good information as available.

00:28:22.000 One of the things I thought was interesting, you were telling me that there's been really good results with people going into a sauna directly after treatment.

00:28:29.000 Well, I don't know that there's been good results.

00:28:33.000 I think it's interesting, and the things that you've talked about for other applications in terms of heat shock proteins...

00:28:40.000 I think?

00:28:53.000 That's not proven.

00:28:54.000 That's hypothesis.

00:28:55.000 But I think it's interesting.

00:28:57.000 And again, it falls into the category of a lot of these things that we're talking about where the science, the basic science is there.

00:29:05.000 We understand how it happens in the embryo, in the developing child.

00:29:10.000 We know what it does in a lab.

00:29:12.000 We can add these things to a Petri dish and watch these changes happen.

00:29:17.000 But nobody has demonstrated this in a human, in a clinical trial where we're treating an injury.

00:29:22.000 So we have to be very careful about that.

00:29:24.000 In fact, the FDA is very clear that, you know, we cannot be making those claims.

00:29:30.000 Companies can't be making those claims about their products and physicians cannot be making claims and marketing their practice to drive people to them stating that these things are happening.

00:29:41.000 Now, when you talk about heat shock proteins, I don't know if you can answer this question, but is there a difference between the heat shock proteins that you receive from, say, like a steam shower, like a steam room, versus a sauna, versus even a hot bath?

00:29:55.000 I've heard people saying that you get heat shock proteins from a very hot bath.

00:29:59.000 And I think there would have to be some kind of...

00:30:03.000 Biopsy or blood test and you know sample like have people go through each of those things and control for all those factors, right?

00:30:10.000 But the whole idea is just Being involved in an environment that's extremely hot where your body is like what is this guy doing?

00:30:18.000 And then it produces the heat shock proteins to try to compensate as a protective mechanism So, just the knowledge of this, I mean, this is really interesting because people have been using saunas forever, and it was all sort of anecdotal. 0.98

00:30:29.000 Oh, the sauna makes me feel great, and I would look at them like, what are these assholes doing? 0.99

00:30:33.000 They're going to go in there and sweat? 1.00

00:30:34.000 I always thought it was people that were just, like, lazy and they didn't want to lose weight, and so they went in the sauna and they thought they lost weight in the sauna.

00:30:40.000 Yeah, I really did think that.

00:30:42.000 They're just dropping water.

00:30:43.000 But talking to Dr. Rhonda Patrick, and she was explaining the benefits of sauna, where there was one study where mortality decreased 40% from all causes through daily use of the sauna.

00:31:00.000 Yeah, all cause mortality was less.

00:31:02.000 Yeah, 40%.

00:31:02.000 Here it is right now.

00:31:04.000 Using the sauna four to seven times per week associated with a 40% lower all-cause mortality might be heat shock protein.

00:31:12.000 ScienceDaily.com.

00:31:14.000 Fascinating stuff.

00:31:16.000 Yeah, click on it.

00:31:17.000 Click on it, young Jamie.

00:31:19.000 Here we go.

00:31:20.000 Let's get a little larger there.

00:31:22.000 Journal of American Medical Association.

00:31:25.000 So serious stuff, right?

00:31:26.000 I mean, it's a peer-reviewed journal.

00:31:29.000 Yeah.

00:31:30.000 You can assume that there may be some validity of the information.

00:31:34.000 Amazing.

00:31:35.000 Yeah, I mean, if that's correct, if all I have to do is get in the sauna and I can decrease my chance of death from all...

00:31:44.000 We had all diseases by 40%.

00:31:46.000 Yeah, cancer, heart attack, leukemia, amazing.

00:31:51.000 Here's a, what a suitable replacement.

00:31:52.000 Hot bath won't be as robust, but can increase blood flow, elevate heart rate, increase heat shock proteins.

00:31:57.000 So she's saying it just won't be as robust.

00:31:59.000 Honestly, she's never taken one of my baths.

00:32:01.000 So a simple thing to find out, or what you could do yourself, is...

00:32:06.000 Check your heart rate, blood pressure, temperature.

00:32:10.000 You know, just, like, just take those as, like, a baseline.

00:32:13.000 Right.

00:32:14.000 After each of those, you know, sessions and see if there's difference.

00:32:18.000 How much does your body temperature elevate during those things and how much of it is a surface of your skin?

00:32:22.000 Well, I mean, you can't elevate your core temperature too much or you're going to have...

00:32:26.000 Right, that's what I'm saying.

00:32:27.000 ...enzymatic breakdown.

00:32:28.000 Like, there's bad things that are going to happen.

00:32:30.000 Yeah, I wonder, like, what the line is, the point of diminishing returns where the sauna becomes...

00:32:36.000 Detrimental versus beneficial.

00:32:39.000 And I wonder how cryotherapy comes into play with that as well, because cold shock proteins also show some great benefit in reducing inflammation.

00:32:48.000 It's just an amazing time for all the different options that are available to people.

00:32:55.000 I think at the same time, one of the things that we have to be conscious of is being responsible about how we use this information and what we're telling patients.

00:33:09.000 I think there's a lot of misinformation and a lot of people taking advantage of that.

00:33:15.000 And so, you know, we want to try to avoid that.

00:33:18.000 We want to try to give people good information so that they can ask the right questions and they can evaluate places where they're going to see if they're comfortable with what they're being told and what's being offered.

00:33:27.000 So I think there's something like 200 plus regenerative medicine clinics that have popped up in the last couple of years.

00:33:35.000 Hmm. 0.99

00:33:37.000 That means at least 40 of them are bullshit. 1.00

00:33:39.000 By my math? 1.00

00:33:40.000 I mean, maybe...

00:33:41.000 Maybe 80?

00:33:42.000 Maybe more than that.

00:33:43.000 Maybe 90?

00:33:44.000 Well...

00:33:45.000 I just think people have to be cautious and careful about what they're reading, what they're saying.

00:33:51.000 And some of these places have received direct letters from the FDA saying, hey, you can't say that.

00:33:57.000 Right.

00:33:57.000 You can't be making claims.

00:34:00.000 So let's go over some stuff that's definitely beneficial, like platelet-rich plasma, PRP injections.

00:34:05.000 People have had real benefit from that, right?

00:34:07.000 Sure.

00:34:07.000 So that has some validated outcome studies.

00:34:11.000 There's a comparison study with PRP. Mm-hmm.

00:34:21.000 Mm-hmm.

00:34:43.000 Now, what is the difference between the results, I don't know if you even know this, between the results of PRP and Regenikine?

00:34:51.000 I don't know much about that product, actually.

00:34:54.000 I mean, I know what it is.

00:34:55.000 I know that it was, you know, going on in Germany.

00:34:58.000 Yeah.

00:34:58.000 I know a lot of people traveled to Europe.

00:35:01.000 Peyton Manning, Kobe Bryant, all those guys flew in.

00:35:03.000 Yeah, Alex Rodriguez, I think.

00:35:04.000 Yeah, Dana White did, too, the president of the UFC. He went in there for tinnitus, you know, and found through intramuscular injections there's a deep relief of tinnitus.

00:35:14.000 Yeah.

00:35:16.000 Yeah.

00:35:17.000 So, I mean, that's great.

00:35:19.000 And again, there may be great applications for all of the different things that fall into this category of biologic treatment.

00:35:27.000 Time is going to tell us what things pan out clinically to be best.

00:35:32.000 I mean, you can look at all kinds of factors, and we can draw conclusions from that.

00:35:38.000 But ultimately, you know, the proof is going to be when we have You know, robust clinical studies that compare treatment and, you know, we have follow-up physical exams and we have follow-up imaging to see exactly what's happening.

00:35:53.000 So we know what we are hoping for.

00:35:56.000 We know what we want to see.

00:35:57.000 We want to see that, yeah, we have this cell that has the potential to differentiate into other tissue and actually causes healing.

00:36:07.000 But nobody has demonstrated that yet.

00:36:09.000 There are some studies.

00:36:11.000 I mean, there's 35 studies.

00:36:13.000 29 are animal.

00:36:14.000 There's six or seven that are human trial.

00:36:19.000 I just saw this review paper, and I didn't know if the review paper had been written before one of the more recent clinical trials was published.

00:36:30.000 So one was on knee arthritis, and the others were on mostly foot and ankle stuff.

00:36:37.000 The most recent is from USC and in combination with a doctor that's in Indiana.

00:36:44.000 And they looked at patients that had a knee arthroscopy and they resected part of the meniscus.

00:36:50.000 So we call that a meniscectomy.

00:36:52.000 And part of it was essentially cut out.

00:36:55.000 So there was a tear, they cut out the bad tissue, they left the remaining healthy tissue.

00:36:59.000 And they did an MRI. Okay.

00:37:21.000 So they injected that into the knee and then I think, I want to say it was four or eight months later, I think it was eight months, they re-imaged the knee and they found that there was a 15% increase in the meniscal volume.

00:37:35.000 So the patients had apparently grown meniscal tissue.

00:37:40.000 I had a meniscus scope on my left knee from an ACL injury that I had.

00:37:48.000 I had ACL surgery, but there was still some meniscus damage.

00:37:52.000 And then at the time of the ACL injury, they tried to stitch up the meniscus.

00:37:58.000 Oh, okay.

00:37:59.000 They just tried not to cut it out.

00:38:01.000 And it was a problem for me for several years.

00:38:05.000 And then finally it tore.

00:38:06.000 It became a bucket handle tear where it locks.

00:38:09.000 So it locked my knee out.

00:38:10.000 Brutally painful.

00:38:11.000 In the middle of a jiu-jitsu class, it was really bad.

00:38:14.000 So I had to get it scoped.

00:38:16.000 And then once I got it scoped, it was functional.

00:38:19.000 But it would provide me with...

00:38:24.000 Maybe every couple weeks, it would be painful.

00:38:27.000 There would be something going on.

00:38:28.000 There would be an ache.

00:38:29.000 It would be a problem.

00:38:30.000 You shot some stem cells in there a year ago.

00:38:34.000 I've had zero problems with it since.

00:38:36.000 Zero.

00:38:37.000 Nothing.

00:38:37.000 I don't even acknowledge that I have a knee that's weaker than the other knee anymore.

00:38:43.000 It doesn't even feel like that anymore.

00:38:44.000 My left knee feels exactly like my right knee now.

00:38:47.000 It's crazy.

00:38:49.000 I mean, for a decade plus, I had pain in that knee.

00:38:53.000 One injection, a year later, nothing.

00:38:59.000 And it was almost...

00:39:01.000 Within two months within two months after the injection, I felt like a significant difference I was like waiting for those days because those days when I pushed it hard particularly after kickboxing There's something about those like hard pad work like kicking the pads I was gonna say any particular things that you were doing that made it feel the worst that was the big one is Striking because striking is just jarring and there's just so much and I just think there's just there was Laxity in the knee is that a word?

00:39:31.000 Yes.

00:39:31.000 Why does it sound wrong?

00:39:32.000 No.

00:39:32.000 I know it's a word, but it sounds wrong.

00:39:35.000 Laxity sounds wrong.

00:39:36.000 It sounds like a laxative.

00:39:38.000 It sounds like I'm making up a word.

00:39:39.000 I was laxity from my laxative.

00:39:42.000 But that kicking motion would always, and it would just hurt, and I would put ice on it.

00:39:48.000 I'd just go about my day.

00:39:50.000 I'd be like, well, it's fine.

00:39:51.000 It's not swelling up to me.

00:39:51.000 And now it's something you don't think about?

00:39:53.000 Dude, it's zero.

00:39:54.000 I ran a trail yesterday in the mountains.

00:39:57.000 Like, brutal, steep trail for two miles.

00:40:00.000 I have zero pain in it today.

00:40:02.000 So this is the kind of thing that I think gets a lot of us excited about what the potential is.

00:40:08.000 Yeah.

00:40:08.000 You know, you've got...

00:40:11.000 A patient here that you had a meniscal tear, so you attempted a repair.

00:40:16.000 We know that about 15% to 22% of those fail the meniscal repairs.

00:40:22.000 It's a disappointing number.

00:40:24.000 We like things to be much higher than that.

00:40:26.000 But that's what the facts are.

00:40:29.000 That's what the larger scale studies have told us.

00:40:33.000 And to anybody that has a meniscal injury, that's a risk worth taking.

00:40:36.000 No doubt.

00:40:49.000 You know, we want to preserve that meniscal tissue for as long of their life as we can.

00:40:54.000 So certainly you are willing to risk it and even you sometimes might attempt to repair something that you think even has a lower chance just because they're young and you want to preserve that.

00:41:04.000 Why you want to preserve it is we know that if you even resect a small amount of the meniscal tissue, like say up to 25%, it will change the contact pressure in the knee.

00:41:16.000 So they do these, you know, color pressure studies where it shows you the amount of force and its distribution.

00:41:25.000 And with a normal meniscus, it's evenly distributed into the, you know, the medial femoral condyles, the end of the femur, and then the tibial plateau is the top part of the shinbone.

00:41:35.000 So when those come together, with a normal meniscus in there, The pressure's even.

00:41:40.000 If you resect part of that, now you see this point loading.

00:41:43.000 So you see these hot spots where there's a much greater amount of pressure.

00:41:47.000 Sort of like when you go to a restaurant and you're sitting at a table and it's wobbly and you have to stick a napkin under one of the legs?

00:41:54.000 Is that a bad analogy?

00:41:55.000 Maybe.

00:41:55.000 Probably a bad analogy.

00:41:56.000 I'm not following you.

00:41:57.000 You know what I'm talking about?

00:41:58.000 I've done that.

00:41:58.000 When you're eating, it's dum-dum-dum.

00:42:00.000 Then you're like, ah, this fucking table sucks. 0.99

00:42:01.000 Yeah, and then the guy comes and he kind of twists the one leg a little higher. 1.00

00:42:04.000 Or he puts a piece of wedge under there.

00:42:06.000 I know what you're saying.

00:42:07.000 Yeah.

00:42:07.000 I don't know the...

00:42:08.000 It's not the best analogy.

00:42:08.000 If that makes sense for you, that's fine.

00:42:10.000 I tried.

00:42:11.000 I swung and I missed.

00:42:12.000 Let's continue.

00:42:12.000 That's all right.

00:42:14.000 But the point of the story is that we know if we cut part of that out, your cartilage is going to have some wear and tear over time.

00:42:21.000 Now, whether or not you develop symptoms from that is hard to predict.

00:42:26.000 Well, I'm pretty sure that's what was going on with my knee because it was uneven and the jarring action of kicking a heavy bag or kicking pads.

00:42:35.000 So I think what I was trying to get to and I was taking the long path to get there was that, you know, in the past what we might have said is, you know...

00:42:44.000 You had an ACL tear.

00:42:45.000 You had a meniscus tear. 0.98

00:42:46.000 You know, your knee's crappy. 0.95

00:42:48.000 Sorry.

00:42:48.000 Like, you're gonna have some pain.

00:42:50.000 And what are you trying to...

00:42:51.000 What are you kickboxing for at your age anyway?

00:42:53.000 I've heard that.

00:42:54.000 This would be the attitude, right?

00:42:56.000 Yeah.

00:42:57.000 And really what that means is I'm uncomfortable because I don't have an easy solution for you.

00:43:03.000 So I'm going to blame you.

00:43:04.000 Well, there's also people wanting you to adopt their lifestyle or them to think that your lifestyle is foolhardy.

00:43:10.000 There's definitely that.

00:43:12.000 They're trying to find an easy solution so that you don't come back into the office and complain about something that we don't have an easy solution for.

00:43:19.000 Also, I think they're trying to talk sense into you.

00:43:21.000 That might be true, too.

00:43:22.000 In their mind, you know, like, if you don't do martial arts and you see some knuckleheads out there...

00:43:26.000 You have lower risk of having to come to my office.

00:43:28.000 That's true.

00:43:29.000 It's also, you see someone who's doing this and hurting themselves, and you tell them, hey, look, you've got to stop doing that.

00:43:34.000 Because you think you're doing the right thing by telling them that.

00:43:37.000 But you're essentially telling someone all that stuff that makes you feel amazing, alleviates stress, builds confidence, it makes you...

00:43:46.000 It's part of your soul.

00:43:48.000 Yeah, it's a big part.

00:43:49.000 So how am I supposed to rip that away from you?

00:43:52.000 Well, for some people, it becomes a real, I mean, obviously with certain injuries.

00:43:56.000 Yeah.

00:43:56.000 Some people, we have to have the hard discussion.

00:43:59.000 It's like, look, I know you want to keep doing this.

00:44:01.000 I know you think you're heading that direction, but this is over.

00:44:05.000 Well, when they do replacements now, because I know a guy who's got a knee replacement, and one of the things he was saying, actually, I know quite a few people.

00:44:13.000 One of them was on the podcast.

00:44:14.000 His name is Dan Pena, and he was saying that the problem is, with his knees, is they only bend this way now.

00:44:21.000 They don't move side to side.

00:44:23.000 There's no lateral movement in the knee.

00:44:25.000 There's no wiggle room.

00:44:27.000 He can't go side to side.

00:44:30.000 The knee just goes straight up and back, like this.

00:44:34.000 The artificial knee.

00:44:35.000 Does that make sense?

00:44:36.000 No, you've got a skeptical hippo face.

00:44:39.000 Well, it depends on a lot of factors.

00:44:43.000 Maybe for him.

00:44:45.000 There may be other patients that don't have quite as much stiffness in their knee.

00:44:50.000 But no one who gets a hip replacement is doing triathlons.

00:44:53.000 They shouldn't be.

00:44:54.000 Or a knee replacement, rather.

00:44:55.000 They shouldn't be.

00:44:57.000 Yeah, so it's limited use.

00:44:59.000 With 100% certainty, that implant will loosen and fall apart.

00:45:03.000 Huh.

00:45:04.000 Why can't they make a knee, a fake knee, that's as good as a real knee? 0.57

00:45:09.000 Hmm.

00:45:10.000 That's a long question.

00:45:12.000 Are they lazy?

00:45:13.000 No, I wouldn't think so.

00:45:15.000 Certainly lots of motivation and economic reward.

00:45:20.000 Oh, my God.

00:45:20.000 If they could fix a knee and turn a knee into a superior knee to the knee that you have now.

00:45:28.000 So, I mean, it's like an overall question, right?

00:45:32.000 Why can you not replace something better than you can repair it?

00:45:38.000 Well, wouldn't we want to be going more towards repair and renewal?

00:45:42.000 Right.

00:45:42.000 Regeneration would be the best.

00:45:44.000 We're hoping that we can, you know, figure something out for that.

00:45:47.000 But the fact is that the knee replacement, you have a metal component.

00:45:51.000 That you're either cementing to the bone or you're applying it to the bone and having bony ingrowth into the implant.

00:46:00.000 So there's an interface between that implant and the body.

00:46:07.000 And to come up with something that would never allow that to separate, I mean, that's, you know, how would you do that?

00:46:14.000 Yeah.

00:46:15.000 Yeah.

00:46:24.000 Mm-hmm.

00:46:37.000 And it causes them significant discomfort.

00:46:39.000 We did some of those in my training.

00:46:41.000 It's a pretty gnarly surgery.

00:46:43.000 What's that about?

00:46:44.000 Talk to me.

00:46:46.000 Total femur?

00:46:47.000 Yeah, I cut someone open like a fish and stick a new leg in there. 1.00

00:46:50.000 You literally do.

00:46:51.000 It's an incision about that long.

00:46:53.000 Whoa! 0.71

00:46:54.000 He's making his arms about...

00:46:56.000 Spread your arm about four feet?

00:46:57.000 Three feet?

00:46:58.000 It's the entire length of however long your thigh is.

00:47:01.000 Ai chihuahua.

00:47:03.000 Yeah.

00:47:03.000 It's gnarly.

00:47:05.000 Yeah.

00:47:05.000 They all get infected.

00:47:06.000 They do?

00:47:07.000 It seems like it.

00:47:08.000 Wow.

00:47:08.000 Now, post-op, like right away, or you mean in time?

00:47:11.000 Over time.

00:47:13.000 Just because your body's rejecting it?

00:47:14.000 Doesn't have to do with it?

00:47:16.000 It's not really rejection.

00:47:16.000 It's just you've got this big hunk of metal, and bacteria forms this sort of slime layer that can't be...

00:47:28.000 Even with antibiotics, you know, blood can't get to the metal.

00:47:32.000 So you form this layer and then it's just, once it's contaminated, you can't control it.

00:47:36.000 Whoa.

00:47:37.000 So the metal on the leg, the fake leg, just gets slimy?

00:47:42.000 Not so much that it gets slimy.

00:47:43.000 It's just the stuff that's produced by the bacteria adheres to the metal.

00:47:48.000 Oh.

00:47:49.000 So...

00:47:51.000 And it's just so much metal in the body.

00:47:53.000 There's so much opportunity.

00:47:54.000 Do you know what I mean?

00:47:55.000 Yeah.

00:47:55.000 So what do you do when it gets infected?

00:47:57.000 Got to open them up again?

00:47:59.000 Clean it up?

00:48:00.000 You do.

00:48:00.000 You try.

00:48:01.000 But the end of the line is...

00:48:05.000 Amputation?

00:48:06.000 The limb has to go.

00:48:08.000 Whoa! 0.71

00:48:08.000 Daddy. 0.71

00:48:09.000 Jamie almost threw up.

00:48:11.000 You got an image?

00:48:12.000 Pull it up.

00:48:13.000 Pull it up.

00:48:15.000 You're a doctor.

00:48:16.000 How dare you?

00:48:17.000 How dare you say don't pull it up?

00:48:18.000 This is what you do, man.

00:48:21.000 I'm feeling bad.

00:48:21.000 It's like me saying don't show anybody.

00:48:24.000 I didn't know we were going to get the total femur.

00:48:26.000 What?

00:48:26.000 Go large with that, sir.

00:48:28.000 Why?

00:48:29.000 I want to see that.

00:48:31.000 Holy Jesus.

00:48:32.000 You're making me sweat.

00:48:33.000 Whoa.

00:48:34.000 My God.

00:48:36.000 First of all, what am I looking at there?

00:48:37.000 So that's the femur.

00:48:39.000 You know, that's a metal femur.

00:48:44.000 Just Google replace femur and look at the first picture.

00:48:46.000 The legs opened up there and you have to make measurements.

00:48:48.000 And so it's basically a total knee and a total hip.

00:48:52.000 And then all of the bone in between has been replaced with that metal.

00:48:55.000 Wow.

00:48:57.000 And then your foot's just attached to your regular shin below it.

00:49:01.000 Correct.

00:49:01.000 And what is this normally used for?

00:49:04.000 Like, how often?

00:49:04.000 What is this?

00:49:05.000 So that would be in case of infection and, you know, there's the cases that we had were usually multiple fractures below a hip replacement and then and then below A longer stem, hip replacement.

00:49:20.000 Finally, you've got just no bone.

00:49:22.000 The other, you know, reason would be infected bone that you had to resect.

00:49:26.000 And then still another reason would be in the case of tumor where you have to, you're doing limb salvage.

00:49:32.000 Yeah, that was this gentleman's.

00:49:33.000 Now that one above, Jamie, where it's got like, they're spreading it apart far, yeah, right there.

00:49:39.000 What's going on there?

00:49:40.000 What's all that stuff on the outside?

00:49:43.000 That orange stuff.

00:49:44.000 Oh, so that's called ioban.

00:49:46.000 And it's a thin film that we cover over where we're making an incision in surgery.

00:49:51.000 It's to help prevent infection.

00:49:53.000 So we naturally have, you know, staph and other bacteria on the surface of the skin.

00:49:57.000 And you put this sticker cover on top of the skin and then Anything that's around the wound is contained.

00:50:04.000 It says play video.

00:50:04.000 I think you should listen to them.

00:50:06.000 Click on that.

00:50:07.000 Let's see what that is.

00:50:08.000 Yeah, let's see who this is.

00:50:10.000 Oh.

00:50:10.000 It's just a picture that says that.

00:50:12.000 Visit page.

00:50:13.000 Click play video.

00:50:14.000 There we go.

00:50:16.000 I'm scared.

00:50:17.000 Are you getting nervous?

00:50:18.000 Oh, daddy!

00:50:20.000 Whoa, boy!

00:50:23.000 Now, that seems really odd.

00:50:25.000 I like to do surgery through incisions that are about this big.

00:50:29.000 Yeah, little tiny incisions.

00:50:29.000 Now, that seems odd because that seems like a very old person.

00:50:33.000 Like, I'm looking at the lack of muscle tissue, either very old or very unathletic.

00:50:38.000 Yeah.

00:50:39.000 And this is like...

00:50:41.000 That's a good evaluation.

00:50:42.000 That's incredibly traumatic then.

00:50:43.000 I mean, that's...

00:50:45.000 How does someone recover from that?

00:50:48.000 It's slow.

00:50:50.000 Now, is there a potential use of stem cells in the case of, like, is it possible to regenerate a bone?

00:50:57.000 I know they've built a woman an artificial bladder through stem cells. 1.00

00:51:01.000 Theoretically, bone is one of the tissues that is a part of that line of the mesenchymal stem cells.

00:51:07.000 Right, that's what I'm saying.

00:51:08.000 That comes from the mesoderm.

00:51:09.000 So you think that could be something down the line that they could be able to accomplish?

00:51:13.000 Yeah.

00:51:13.000 They're, I mean, replacing that femur and its cartilage covering at the knee and the hip, I mean, I think that's, at this point, a fantasy.

00:51:23.000 Yeah, but isn't that what they said when, if someone came up to the person that had the telegraph and said, hey, do you think one day I'll be able to send dick pics from this thing? 0.70

00:51:31.000 They're like, well, right now, that's a fantasy. 0.92

00:51:34.000 Right?

00:51:35.000 Don't you think?

00:51:36.000 Probably. 0.99

00:51:37.000 Most likely, you know, they would look at you like you're a crazy person.

00:51:40.000 Well, when I was...

00:51:42.000 This is an embarrassing story to admit, but when I was about 13, I went next door to my neighbor's house and he was kind of a computer nerd at the time.

00:51:52.000 But, you know, computer nerds at the time were playing with like Commodore 64. Right.

00:51:56.000 And he's like, dude, look at this.

00:52:00.000 I can hook my computer up to the phone and I can type on the screen and my friend down the street will see what I wrote. 0.96

00:52:08.000 And I was like, that's the dumbest thing I've ever heard, dude. 0.88

00:52:10.000 Can we, like, go play football? 0.99

00:52:12.000 Like, what are you talking about?

00:52:14.000 So, apparently I'm not a very forward-thinking guy, because, obviously, we're doing that quite a bit now.

00:52:19.000 I had a Showtime special in 2005, a Netflix special, actually, that eventually wound up on Showtime, but I had a joke in there about cell phones.

00:52:29.000 About people sending you a text message and the part of the joke was like, it takes you four presses to get an S. Right.

00:52:36.000 Like, why don't you just call me?

00:52:37.000 Because like it was before anybody had figured out how to make an actual keyboard.

00:52:42.000 And I'm like, why are you making me read? 1.00

00:52:44.000 Like, this is so stupid. 1.00

00:52:45.000 I thought it was just like a dumb trend that was going to go away. 1.00

00:52:49.000 And now if someone calls me, I go, what the fuck are you calling me for? 0.99

00:52:53.000 Yeah. 0.98

00:52:54.000 Like, it's very strange what's happened in just 12 years.

00:52:57.000 Yeah, it's a total shift in how we communicate with people, right?

00:53:00.000 A massive one.

00:53:01.000 I mean, how disruptive to your life is it to have to, like, send emails now?

00:53:09.000 I mean, to sit down and, like, type an email, like, email, respond back, so many emails you, like, people email me with, like, a bunch of questions.

00:53:16.000 It's a big chore.

00:53:17.000 It's like homework.

00:53:17.000 I've got to sit down.

00:53:18.000 It takes a lot of time.

00:53:19.000 Yeah.

00:53:20.000 Whereas, you know, a text is, like, a quick response.

00:53:23.000 Like, hey, what about this?

00:53:23.000 I don't know.

00:53:24.000 I just, I'm so used to email.

00:53:25.000 I send a lot of emails.

00:53:27.000 Really?

00:53:27.000 I have so much email.

00:53:28.000 Well, I do all the booking for this show, too.

00:53:31.000 I mean, well, I have a guy, Matt Staggs, who contacts people, but I reach out to a lot of people as well.

00:53:36.000 So, like, a lot of the booking and the different things that I do, I contact people.

00:53:41.000 Sure.

00:53:41.000 And, you know, the best way to do it is through an email.

00:53:43.000 It's like, hey, you know, I would really love to talk to you about this or that.

00:53:46.000 I have a question about that.

00:53:48.000 But these are brief emails, I would bet.

00:53:49.000 Sometimes, yeah.

00:53:51.000 But I've gone...

00:53:52.000 I've had some...

00:53:53.000 Yeah, that's the problem is the volume.

00:53:55.000 The sheer volume I get is just unmanageable.

00:53:58.000 To the point where people think I'm ignoring them.

00:54:01.000 I'm like, man, I'm not ignoring you.

00:54:02.000 I didn't even see it.

00:54:03.000 It just got lost in the tsunami of emails that came in.

00:54:06.000 Like, if I go on vacation, I hardly communicate.

00:54:09.000 I barely do anything.

00:54:10.000 Maybe I'll put up a social media post and, you know, just to like...

00:54:16.000 Because it's kind of a part of the job, right?

00:54:18.000 But I don't pay attention to emails.

00:54:20.000 I just leave them alone.

00:54:21.000 And then I get home and I'll go, oh my god, there's 2,000 emails.

00:54:24.000 I'll have 2,000 emails in a few days.

00:54:27.000 I'm not exaggerating at all.

00:54:28.000 Do you go through all of those?

00:54:30.000 I do my best.

00:54:31.000 I look for my friends.

00:54:33.000 I look for people that are important and look for acquaintances that I like and work-related stuff.

00:54:42.000 But it's a mess.

00:54:43.000 I have several email accounts too, which helps people that are important to me get the big one.

00:54:49.000 You don't get the bad one.

00:54:51.000 Don't worry about it.

00:54:53.000 I don't think I have any of them.

00:54:54.000 If you do, I'll give you the real one.

00:54:56.000 I just want to let you know.

00:54:57.000 I won't tell anybody.

00:54:57.000 People don't like to be on the outside.

00:54:59.000 You tell them about that, and they're like, which one do I have, bro?

00:55:01.000 Yeah, right?

00:55:02.000 Why worry about it, man?

00:55:03.000 What list am I on?

00:55:04.000 Why worry about it, man?

00:55:05.000 Yeah, if you have to ask the question.

00:55:08.000 Yeah.

00:55:09.000 It's not good.

00:55:10.000 I wonder when it's going to pass what we're doing.

00:55:13.000 I mean, when it's not going to be this.

00:55:15.000 It's not going to be typing.

00:55:16.000 Like, what's the next thing?

00:55:19.000 It's definitely not going to be videos where you force people to watch.

00:55:22.000 The beautiful thing about an email is I can kind of scan it through.

00:55:25.000 What's this guy saying?

00:55:26.000 Not interested.

00:55:27.000 Next.

00:55:27.000 Have you messed around with, like, dragon dictation?

00:55:30.000 Yes.

00:55:31.000 Yes.

00:55:31.000 It's amazing for notes when you're in a car or if I have an idea in my head and there's no way I can type it on my phone that quickly.

00:55:39.000 Have you ever seen how good it works?

00:55:40.000 No, it's very good.

00:55:42.000 Yeah, no.

00:55:43.000 Well, just what comes with your phone.

00:55:44.000 Like the most recent versions of it.

00:55:47.000 Yeah, like this right here.

00:55:49.000 Check this out.

00:55:51.000 Dr. Roddy McGee is an amazing human being.

00:55:54.000 He has fresh breath and his hair is wonderful.

00:55:59.000 Look at that.

00:56:00.000 Perfect.

00:56:01.000 Perfect.

00:56:02.000 Yeah.

00:56:03.000 100%.

00:56:03.000 That's incredible.

00:56:04.000 That's pretty good.

00:56:05.000 I mean, it really is incredible. 0.99

00:56:08.000 And you could do that in your car if you have an idea so you're not some asshole that's texting. 0.99

00:56:12.000 Because sometimes, like, Neil Brennan had the best analogy for it. 0.99

00:56:16.000 You know who Neil Brennan is?

00:56:17.000 Stand-up comedian, co-creator of The Chappelle Show.

00:56:20.000 He had the best analogy.

00:56:21.000 He goes, my notebook is essentially like a net for catching ideas.

00:56:25.000 And you've got to catch those ideas as quick as you can.

00:56:27.000 I'm like, oh, that's a good way of looking at it.

00:56:29.000 So if I'm in a car and I have an idea, I'm like, oh my god, I've got to get this out before I forget.

00:56:35.000 So I start repeating it to myself, and then if I'm at a red light or something, I'll press that record button.

00:56:41.000 Very responsible of you.

00:56:42.000 I'm very responsible when it comes to texting and driving.

00:56:44.000 That's good.

00:56:45.000 I just, I think that is one of the most infuriating things. 0.99

00:56:49.000 It's fucking terrible. 0.97

00:56:50.000 It's like, you're going 60 plus whatever miles an hour, the amount of distance that you cover in a glance where you are not looking at the road and things can happen at any moment. 0.99

00:57:02.000 Just to me, it's super disturbing.

00:57:04.000 Yeah.

00:57:05.000 Anyway, back to the grind.

00:57:08.000 What do you got there that you would like to cover?

00:57:11.000 Well, okay, so we talked a little bit about all of the elements of the care of the person, right?

00:57:20.000 So it has to be more than just giving you a shot and sending you on your way.

00:57:27.000 Right.

00:57:27.000 If you truly have an injury and we're trying to recover you, then what also comes along with that is...

00:57:33.000 The appropriate rehab protocol.

00:57:35.000 And none of those are defined yet for what some of these things that we've done.

00:57:40.000 But we're trying to develop that and dial it in and hone it down.

00:57:44.000 For me right now, the easiest thing is to try to adapt it from a surgical rehab.

00:57:50.000 And I'm not a physical therapist, obviously, so I try to collaborate with those guys and girls that are smarter than me in that avenue.

00:57:58.000 But The principles are the same, right?

00:58:02.000 So you have an injury that you're trying to heal.

00:58:06.000 Now, in some cases, it's, you know, we've created the injury or we've done the thing that the patient has to recover from.

00:58:13.000 In the case of an injection, you have an injury, you've done the injection, and now we need the effect to happen, whatever it is that we're hoping that will be.

00:58:23.000 But then you can't ignore the fact that if somebody has a bad shoulder, well, we may decrease the pain, but if their motion is poor, if their strength is poor, if it's not functioning correctly, then how can we be achieving the best result if we're not also attending to that?

00:58:43.000 Right.

00:58:43.000 So it's a multi-step...

00:58:45.000 No doubt.

00:58:45.000 And then the more that we're learning about all these other factors, I mean...

00:58:49.000 Like, again, for you, I mean, you're paying attention to your sleep, you're paying attention to your nutrition, you're on a variety of supplements that are meant to help a lot of these processes.

00:59:02.000 And I think...

00:59:04.000 We're going to get better and better at it.

00:59:05.000 Diet has got to be pretty critical as well, right?

00:59:07.000 It's got to be hugely important.

00:59:09.000 Especially, like, staying away from inflammation-enhancing foods or inflammatory foods.

00:59:14.000 Yeah, no doubt.

00:59:15.000 So, yeah, I think it's got to be critically important, and we try to share that information with people.

00:59:21.000 There's, for athletes, like a website that you can pull up and we can share is the collagenprofessionalathlete.com.

00:59:31.000 Dietetics Association, I think it is.

00:59:33.000 Collagen Professional?

00:59:34.000 No, college and professional athlete.

00:59:36.000 I was like, what?

00:59:37.000 Collagen Professional Athletes?

00:59:39.000 I don't even know what that means.

00:59:41.000 We all have collagen.

00:59:42.000 Right.

00:59:43.000 Collagen and...

00:59:44.000 Yeah, so these guys have some great information and good infographics that we utilize, you know, since I'm not a...

00:59:52.000 That looks good.

00:59:53.000 I'm not a dietician, so I have to rely, again, on people that have good information.

00:59:57.000 I think these guys have a good, reliable source, and they've got great infographics.

01:00:05.000 If you go to...

01:00:19.000 Hmm.

01:00:20.000 Educational resources?

01:00:21.000 There you go.

01:00:22.000 Yeah.

01:00:23.000 So this will pull up some different things.

01:00:25.000 Balancing exercise-induced information.

01:00:28.000 Now, here's a good question.

01:00:30.000 Sure.

01:00:32.000 It's pretty much universally agreed that rest, ice, compression, elevation, all those different things that people have said in the past, that there is benefit to particularly icing things.

01:00:43.000 Yeah, there's a lot of debate about that.

01:00:45.000 Right?

01:00:45.000 There's some debate now.

01:00:47.000 There's like a definite anti-ice community out there.

01:00:51.000 Yeah, what is that?

01:00:52.000 Do you think it's legit?

01:00:54.000 Well...

01:00:55.000 There's not a downside to it.

01:00:57.000 To ice?

01:00:58.000 I don't think so.

01:00:59.000 I mean, we've used it regularly, and so, I don't know.

01:01:02.000 There's definitely a group that, and I don't know all of their arguments against, but...

01:01:07.000 Misha Tate, the former UFC Bantamweight champion, she had a podcast with this guy who's the anti-ice guy.

01:01:13.000 Yeah.

01:01:13.000 Like, that's his whole thing.

01:01:14.000 Is he a flat-earth guy, too?

01:01:16.000 No, but he doesn't believe in dinosaurs.

01:01:18.000 He does not?

01:01:18.000 No, I made that up.

01:01:19.000 Yeah.

01:01:20.000 It fit.

01:01:22.000 I don't know. 0.99

01:01:23.000 I believe he's a doctor, but he might be a fucking veterinary. 0.99

01:01:27.000 Works on cat infections or something. 0.99

01:01:30.000 I don't know.

01:01:31.000 I don't think there's a downside.

01:01:32.000 I'm kidding about that, too.

01:01:33.000 In my opinion, I've definitely had athletic injuries.

01:01:39.000 I was a pitcher previously.

01:01:40.000 We routinely iced our shoulder and elbow after pitching.

01:01:45.000 I did it as a matter of routine.

01:01:46.000 It felt good.

01:01:47.000 I felt better when I did it than when I didn't.

01:01:49.000 But here's the question.

01:01:50.000 It felt good at the time, but it is that feeling good in any way slowing the healing process.

01:02:00.000 Hard to know.

01:02:01.000 I mean...

01:02:02.000 That's where it gets weird, right?

01:02:03.000 Yeah.

01:02:03.000 I don't know.

01:02:04.000 To be frank. 0.99

01:02:06.000 God damn it. 1.00

01:02:06.000 You're supposed to know. 1.00

01:02:07.000 You're the fucking super genius doctor guy. 1.00

01:02:13.000 If you don't know, we're doomed. 1.00

01:02:15.000 Get back to me.

01:02:17.000 I'll get you some good information on it.

01:02:19.000 Thank you.

01:02:19.000 Appreciate it.

01:02:20.000 What else you got here?

01:02:23.000 So, you know, I think one of the interesting things about this whole topic and the possibility of healing from utilizing this type of treatment is how It allows you to go through the process of healing without this fibrovascular response.

01:02:45.000 So the typical healing cascade has an inflammatory phase, proliferative phase, and the maturation phase.

01:02:53.000 So in the inflammatory phase, you have neutrophils and white blood cells and these enzymes that are present that are trying to start the process.

01:03:04.000 Then in the proliferative phase, you're having what's called angiogenesis, and that means the development of new blood vessels and vasculature to the area.

01:03:14.000 And your body's producing fibroblasts, and you're laying down tissue in this sort of haphazard manner.

01:03:20.000 So it's just kind of piling on in there.

01:03:23.000 Then the maturation phase is when you have remodeling.

01:03:27.000 So that scar tissue is changing over time and developing into tissue that's more like or is the native tissue.

01:03:37.000 So that occurs over a period of time.

01:03:39.000 And then a lot of times during that process, before you're fully matured in the healing, you're back to activities.

01:03:48.000 So, let's just take an example.

01:03:50.000 Like, when you sprain your ankle, and then you, you know, you start feeling better, and maybe you go back to basketball within a couple weeks.

01:03:58.000 At that point, if you've actually torn one of the ankle ligaments, you don't have native ligament tissue that's the same structural properties.

01:04:07.000 It's not as strong.

01:04:08.000 I mean, you might be developing the strength around it, but it's not like the native tissue.

01:04:15.000 Now, the hope is that we can demonstrate.

01:04:17.000 Now, we know that this is the science.

01:04:20.000 This is what it's supposed to do.

01:04:21.000 This is what it does in the developing fetus. 0.93

01:04:25.000 We see it in kids.

01:04:26.000 You know how, you know, when your daughter was real young, she scratched her face.

01:04:30.000 They healed Wolverine.

01:04:31.000 And it was, like, gone, like, the next day, right?

01:04:33.000 Yeah.

01:04:34.000 So healing without scar is, you know, has to do with not forming this fibroblast disease.

01:04:42.000 We're fibrovascular response and fibrotic phase.

01:04:46.000 Now, the cool potential of this to me is if we can skip that and we can have more complete healing and quicker resolution to the native tissue, then you're going to have the same properties.

01:05:02.000 You're going to be stronger.

01:05:03.000 You're going to be better.

01:05:05.000 You know, technically and hopefully, you know, clinically this pans out that you would be more resistant and lower risk for repeat injury.

01:05:13.000 Because that's really our goal is in treating patients is get them back to their activity.

01:05:18.000 And decrease the chance that they have to miss more time.

01:05:21.000 And how do you know how much to inject into these?

01:05:24.000 Nobody knows.

01:05:25.000 Oh, Jesus.

01:05:26.000 Nobody knows that.

01:05:27.000 This is one of the big questions that will be discovered with, again, rigorous studies where we can look at what should the dosing be, what should the frequency of the treatment be, and what should the protocols before and after be.

01:05:41.000 It's not defined.

01:05:42.000 And anybody that's telling a patient that they have exactly what it should be, I mean, be wary of that.

01:05:48.000 Because that has not been discovered yet.

01:05:51.000 So we're trying to take, you know, we're taking the information from our experience and applying it that way.

01:05:57.000 It's not the best way to go about this.

01:06:01.000 And it's one of the things that PRP suffered from is that all of the things, everybody was using it for so many different things and just kind of hoping that it was the magic bullet that it was going to...

01:06:12.000 Treat all the things that we had difficulty treating.

01:06:16.000 And even all of the studies that were coming out, people were using different centrifuges and applying it for different reasons, different protocols.

01:06:24.000 It was just a mishmash of information.

01:06:26.000 It wasn't valuable.

01:06:27.000 How does platelet-rich plasma work?

01:06:30.000 So it has growth factors and cytokines, and the platelets release proteins and things, and those things help mediate that inflammatory response and help the healing process.

01:06:43.000 I mean, that's kind of the basics.

01:06:44.000 Do you think that they could work in a symbiotic fashion with, like, this kind of...

01:06:52.000 So some cellular treatment, like bone marrow fat or the placental tissue, and that line of treatment can help expand the cells.

01:07:02.000 So that gets us to an important point, which is expanding the cells has been done and is not currently legal in the United States.

01:07:11.000 So there was a place, and they do it in other countries, but here...

01:07:19.000 If you more than minimally manipulate the tissue, then that is not under the guidelines of the FDA for use of human cellular tissue products.

01:07:32.000 So they were taking, for example, bone marrow and plating it and growing more cells, bringing the patients back two weeks later and injecting them with this super production of cells, which probably is great.

01:07:48.000 But we don't know.

01:07:49.000 We don't know if that's safe.

01:07:52.000 And that has to be taken through the appropriate process.

01:07:56.000 So you can't necessarily recommend someone taking PRP while they're taking some sort of stem cell injections?

01:08:05.000 So here's the difference of that.

01:08:06.000 A manufacturer can't say...

01:08:10.000 That we have a product that is a combined PRP stem cell injection.

01:08:15.000 Right.

01:08:16.000 And it does this.

01:08:17.000 Right.

01:08:18.000 That's illegal.

01:08:18.000 But if you are a patient...

01:08:20.000 I can't put on my website.

01:08:22.000 Right.

01:08:23.000 I have the magic potion.

01:08:25.000 It's PRP and...

01:08:26.000 Amniotic fluid and tissue.

01:08:28.000 We inject it, and it can heal anything. 0.96

01:08:31.000 I admire how responsible you are, how you keep cutting me off whenever I'm suggesting some ridiculous things.

01:08:36.000 But would there be a benefit for a patient, potential benefit, who is getting stem cell injections and also gets PRP at the same time?

01:08:45.000 Or is it just theoretical?

01:08:46.000 It's theoretical right now, yeah.

01:08:48.000 But potentially?

01:08:50.000 Definitely there's potential, and it's encouraging to...

01:08:55.000 That the possibility is there.

01:08:58.000 It appears to be safe.

01:09:00.000 We don't have adverse reactions to it.

01:09:05.000 And the point that I wanted to make is that a physician can prescribe something and use it off-label.

01:09:16.000 So the FDA doesn't regulate the practice of medicine.

01:09:20.000 I can do that in my office.

01:09:23.000 But I can't make claims about it.

01:09:25.000 And I can't put it on social media and on my website and say, I'm going to do this and I'm going to fix your shoulder.

01:09:33.000 Come here if you have a meniscus tear because we do this injection and it's going to make you better.

01:09:38.000 That's illegal.

01:09:39.000 I understand.

01:09:40.000 But if somebody comes to my office, I can elect to do that because both things are available.

01:09:48.000 We have permission to use them, but we're using it off-label.

01:09:52.000 I understand.

01:09:53.000 Now, when you say maximize cells, that's the term you used?

01:09:57.000 Maybe.

01:09:58.000 What is the term you used about PRP in conjunction?

01:10:01.000 We think that it can increase the proliferation of the mesenchymal stem cell.

01:10:05.000 Oh, and how much of a time period would it have to be between the injection and the PRP? That's undefined, again.

01:10:13.000 What would you assume?

01:10:14.000 The way that we're doing it is we would do the injection at the same time.

01:10:17.000 Oh, I see.

01:10:17.000 Yeah, putting it in there together.

01:10:19.000 We only have a narrow window from when we take those frozen cells and then we thaw them.

01:10:25.000 We have a short window when we can then inject them.

01:10:28.000 And then there's maybe between 7 and 21 days that those cells are viable in...

01:10:35.000 Your shoulder or your knee, wherever we inject it.

01:10:38.000 So if someone gets that injection and does PRP, they would have to essentially get that done within those 7 to 21 days to have some sort of a benefit of what you're saying?

01:10:46.000 Theoretically, yes.

01:10:48.000 That's how I would do it currently based on that information.

01:10:54.000 It's fascinating stuff.

01:10:55.000 Yeah.

01:10:56.000 What else is out there?

01:10:58.000 Well, so we just, I thought it was important to talk about the, it's called Section 361 of the Public Health Service Act, and this is the definition from the FDA on the use of human cell tissue and cellular tissue products.

01:11:13.000 So it has to match these criteria.

01:11:16.000 So you have to have minimal manipulation.

01:11:18.000 That means you can't add things to it.

01:11:20.000 You can't combine it with other stuff.

01:11:22.000 You can't, like I was saying, you can't put it in the lab and grow it and add things to it and then bring the patient back and treat them.

01:11:32.000 This isn't part of it, but you can't treat patients on a different day.

01:11:37.000 It has to be at the same time, whenever you're harvesting the cells or utilizing the Whatever it is you're using.

01:11:45.000 It has to be something called homologous use.

01:11:48.000 And what that means is whatever tissue you're taking has to have the intention of the purpose of that tissue for when you put it into somebody's body.

01:11:58.000 So, for example, if you have a fracture that's not healing, and I take a bone graft product, so cadaver bone, and we're going to use that to help heal your fracture that hasn't healed, that's homologous use.

01:12:15.000 We're taking bone, we're using it to become bone, or to be the scaffold for bone to heal and grow.

01:12:21.000 So, it can't be combined with something else.

01:12:28.000 And it can't be intended to have a systemic effect.

01:12:32.000 Now, all of these things that I'm explaining, these are rules for manufacturers and what the rules are for them to be able to market their product.

01:12:41.000 So, for example, you can't take amniotic fluid and say, this is a product meant for IV infusion, for treatment of...

01:12:52.000 Whatever.

01:12:52.000 Diabetes.

01:12:53.000 Right.

01:12:54.000 That is something that people do in other countries, right?

01:12:56.000 They're doing it in other countries.

01:12:58.000 You can't do that in...

01:12:59.000 You technically can't do that.

01:13:01.000 You can't manufacture a product and put that on the labeling.

01:13:04.000 That's what it's intended for.

01:13:06.000 But do they do that in America?

01:13:07.000 IV stem cells?

01:13:09.000 I've been told by patients that they've gone to places that have suggested to them that that was going to be the treatment.

01:13:16.000 Right.

01:13:16.000 And what is going on there?

01:13:18.000 I'm not aware of it.

01:13:19.000 How does that even work?

01:13:21.000 Do you know?

01:13:22.000 It's not your wheelhouse?

01:13:23.000 No, and nobody knows if it does.

01:13:26.000 So it's just experimental?

01:13:28.000 It is.

01:13:28.000 I mean, all of this...

01:13:29.000 Boss Rutten?

01:13:29.000 Do you know who Boss Rutten is?

01:13:30.000 Yes.

01:13:30.000 Former UFC champion?

01:13:31.000 Do you ever treat him?

01:13:33.000 I have not met him.

01:13:33.000 Are you allowed to say that?

01:13:35.000 Boss...

01:13:35.000 I don't think I can talk about any patient unless they have said it or they're sitting in front of me talking about it.

01:13:42.000 Okay.

01:13:43.000 I give you permission.

01:13:44.000 That's a HIPAA violation.

01:13:46.000 I understand.

01:13:46.000 Health Information Protection Act.

01:13:47.000 For the record, I give you permission.

01:13:50.000 Boss Rootin went to, where did he say he go, to Peru or something like that?

01:13:53.000 Went to the jungle.

01:13:54.000 Some dude killed a chicken and then shot some stem cells into him.

01:13:58.000 Chicken blood, right? 0.99

01:13:59.000 He was saying it was fucking amazing. 0.99

01:14:03.000 You know, the way Boss talks, he's like, it's like the energy was coming out of my body, like, ahhh! 0.98

01:14:09.000 He said that he literally felt like some guy in a kung fu movie where energy was like shooting off his fingertips.

01:14:16.000 He said it was amazing.

01:14:17.000 Like the emperor?

01:14:18.000 He's not the only guy that said that.

01:14:20.000 You know Dan Bilzerian?

01:14:21.000 Do you know who Dan Bilzerian is?

01:14:22.000 Not personally. 1.00

01:14:23.000 The Instagram guy with all the boobs and the butts. 0.99

01:14:26.000 He told me the same thing. 0.98

01:14:28.000 He said that when he got it done, he said it's amazing.

01:14:31.000 He goes to Mexico to get it done.

01:14:34.000 Not recommended, but you can't talk about it.

01:14:37.000 Off air, he'll be a little chatterbox.

01:14:40.000 Just you wait.

01:14:41.000 Maybe.

01:14:45.000 Well, what I'm interested in, what I was thinking before you threw me off there, is he going with a specific intent of treating something, or is he just looking for the fountain of youth? 0.98

01:14:58.000 I think he fucks so much, he doesn't have any sperm in his body, and he's trying to... 0.98

01:15:05.000 I don't know. 1.00

01:15:06.000 That guy's an animal.

01:15:08.000 But I think he's got a series of injuries, I know that, because he's had Regenikine for his neck.

01:15:13.000 He put it up on Instagram, like with Instagram stories, he was videoing himself while he was getting injections in his neck, which I've had.

01:15:23.000 In your neck?

01:15:25.000 Yes.

01:15:26.000 It cured my cervical disc bulge.

01:15:29.000 What?

01:15:34.000 You know, with like a harness where they're pulling on your neck.

01:15:37.000 I had a bulging disc in my neck that was pushing on my nerves.

01:15:40.000 Yeah, completely resolved.

01:15:41.000 Like on an MRI, it doesn't exist anymore.

01:15:43.000 Where I was getting numb hands because the ulnar nerve was being pressed upon.

01:15:47.000 Yeah.

01:15:48.000 Yeah, it works.

01:15:49.000 That's nuts.

01:15:49.000 Well, it's massive anti-inflammation properties.

01:15:52.000 I just don't think that it has the same healing potential.

01:15:56.000 It seems like it reduces inflammation in a giant way.

01:15:59.000 What's going on with...

01:16:02.000 By the way, I had Regenikine shot in my knee, too.

01:16:05.000 That's what you told me.

01:16:06.000 It didn't really have the same effect.

01:16:07.000 It worked a little bit.

01:16:09.000 So, patients like yourself that have had a number of injuries and a number of treatments, one of the things that's got me enthusiastic about the potential of all this...

01:16:20.000 Is when somebody tells me, look, I've had this, this, this, and this, and then I had this, what we're talking about, and that it was just completely different.

01:16:31.000 Game-changing.

01:16:31.000 I'm just better and different.

01:16:34.000 Look, my right shoulder is not 100%, but it might be 90%. 0.99

01:16:39.000 And it's strong as fuck. 1.00

01:16:41.000 I could do a lot of shit with it. 1.00

01:16:42.000 I've seen you do some insane stuff. 0.99

01:16:44.000 Things that I probably wouldn't recommend.

01:16:47.000 No pain.

01:16:48.000 I'm glad you can.

01:16:51.000 I take these 90 pound kettlebells and I do windmills with them.

01:16:54.000 Where you're pressing overhead.

01:16:56.000 You know what a windmill is.

01:16:57.000 You're dropping down like that so your shoulder's rotating.

01:17:00.000 I don't do that with 90 pounds, but I know what it is.

01:17:03.000 But the fact that I can do that with a shoulder that was on its way probably to getting surgery on is just amazing.

01:17:11.000 My bow...

01:17:12.000 Probably the most impressive thing was that push-up with the wheel thing.

01:17:16.000 What's that thing called?

01:17:18.000 Oh, the ab wheel?

01:17:19.000 No, it's like a little roller that you had your hand on.

01:17:21.000 Oh, yeah, those things when you go forward.

01:17:23.000 Yeah, what's that called?

01:17:24.000 The company called Havoc creates it.

01:17:26.000 They're sliders, Havoc sliders.

01:17:28.000 Okay.

01:17:29.000 H-A-V-Y-K sliders. 1.00

01:17:31.000 There's a video of it on my Instagram, Jamie, from quite a while ago.

01:17:37.000 But it was post-injection.

01:17:42.000 It's from way back I want to say at least a year ago I was doing that but Yeah, there's my range of motions a hundred percent.

01:17:53.000 I mean at the most it's uncomfortable in certain things but for a big one for me was archery because You know, I really enjoy it.

01:18:02.000 I do it all the time, and it's very meditative to me.

01:18:05.000 I just, I love archery.

01:18:07.000 So, for me, like, the idea of not being able to pull my bow back, it was really disturbing.

01:18:12.000 I was like, God, I'm gonna have to get the surgery done.

01:18:14.000 Yeah, you've been pretty committed to it for a while now, right?

01:18:16.000 Yeah, and I'll shoot 100 plus arrows a day, and I'm pulling back 84 pounds.

01:18:21.000 It's an 84 pound compound bow, and I'm shooting it 100 times a day, and it's no pain.

01:18:26.000 I did it yesterday.

01:18:27.000 Oh, like for hours.

01:18:29.000 Me and my friend Cam Haynes, who you know, you met, who came to talk to you as well.

01:18:34.000 You kind of indirectly got me into it.

01:18:39.000 Into archery?

01:18:40.000 Through John?

01:18:40.000 John Dudley?

01:18:41.000 Yeah.

01:18:41.000 Yeah, I know.

01:18:42.000 You're shooting all the time now, right?

01:18:43.000 Yeah, so John got me this unbelievable...

01:18:46.000 You know, Hoyt carbon spider bow.

01:18:51.000 It's like, if you want to see any of my friends make the greatest faces you've ever seen, I pull this thing out and it's like some space age weapon.

01:19:05.000 It looks like a bow that Batman would have.

01:19:07.000 Yeah.

01:19:08.000 Or Chewbacca.

01:19:08.000 Yeah.

01:19:09.000 Or Chewbacca, yeah.

01:19:10.000 Something like that.

01:19:11.000 Yeah, I would say Batman, but yeah.

01:19:13.000 But yeah, those bows, they're amazing.

01:19:16.000 It's incredible.

01:19:18.000 I've only been able to go a couple of times, but I'm definitely hooked.

01:19:23.000 It's the most amazing meditation.

01:19:24.000 I love it.

01:19:25.000 When you're focusing on that shot, you literally have no room for anything else.

01:19:31.000 It requires so much concentration.

01:19:33.000 You're concentrating on the front hand position, front shoulder position, where the string touches the tip of your nose, the corner of your mouth, and John is just an amazing coach.

01:19:45.000 Yeah, so, you know, totally unfair.

01:19:49.000 That's the bow, the first bow that I get to shoot with, and then John gives me the first lesson that I've ever pulled a bow back.

01:19:57.000 He's standing there right with me.

01:19:58.000 He's an Olympic coach, by the way.

01:20:00.000 He used to coach the Olympic team.

01:20:01.000 He's amazing.

01:20:03.000 Yeah, really good coach.

01:20:04.000 He's a great guy, too.

01:20:05.000 And he can take years off of people's learning.

01:20:09.000 I mean, he's absolutely taken years off my learning curve.

01:20:12.000 Yeah.

01:20:13.000 I'm going to sneeze.

01:20:19.000 I hate when you say you're gonna sneeze and then you put a lot of pressure on yourself.

01:20:22.000 And you're like, man, I might not.

01:20:24.000 I just look like a weirdo for a few minutes.

01:20:26.000 Did you find that video?

01:20:27.000 No?

01:20:28.000 It's in there.

01:20:28.000 I swear to God.

01:20:29.000 So here's another kind of crazy thing about the placental-derived treatments.

01:20:38.000 Is that they actually have antimicrobial properties.

01:20:43.000 Whoa.

01:20:44.000 So this is crazy.

01:20:45.000 I mean, we kind of know this, you know, one of the functions of the amniotic membrane is to protect the developing baby, right?

01:20:54.000 Mm-hmm.

01:20:55.000 And one of the things that does is protect it from infection.

01:20:59.000 Right.

01:20:59.000 But what they were able to demonstrate was that when they've actually introduced bacteria, like literally injected bacteria onto these membranes, and then they come back and check, and it has destroyed the bacteria.

01:21:16.000 So ability to resist scar formation.

01:21:23.000 Move through the fibrotic phase of healing and then also the antimicrobial properties.

01:21:29.000 It's pretty amazing.

01:21:30.000 So that would be super beneficial post-surgery, right?

01:21:33.000 Definitely.

01:21:33.000 Because that's a giant issue, staph infections and the like.

01:21:36.000 It's one of the things that, you know, frightens us most about, you know, doing our procedures is, you know, can we prevent infection?

01:21:44.000 Yeah, it's a giant issue where people, I mean, I know because of the nature of martial arts, just everybody I know is at surgery, like pretty much.

01:21:53.000 And the big issue is post-surgery infections.

01:21:59.000 Yeah.

01:21:59.000 Well, those guys are, they're getting abrasions and everything like that on the mat.

01:22:03.000 And then, so then they're colonized with, you know, MRSA or any number of whatever funk is in that gym. 0.99

01:22:11.000 I tell everybody, if you are a grappler, this is super important, I want you to look up Defense Soap.

01:22:18.000 Defense Soap is a soap company that was created by my friend Guy Sacco.

01:22:23.000 What is it?

01:22:24.000 It is all natural soap that promotes healthy bacteria, doesn't destroy the healthy bacteria.

01:22:31.000 But it's all tea tree oil, eucalyptus oil. 0.99

01:22:33.000 This shit is amazing. 0.99

01:22:36.000 I've gotten staph at least twice. 1.00

01:22:38.000 I used to get ringworm all the time.

01:22:41.000 Well, not all the time, but I got it a couple of times.

01:22:43.000 Until I was super diligent about washing myself immediately afterwards.

01:22:48.000 But once I started using two things.

01:22:50.000 Probiotics, which is huge.

01:22:53.000 Acidophilus, eating yogurt, and drinking kombucha.

01:22:57.000 And then the next one was defense soap.

01:22:59.000 Is there enough in the yogurt?

01:23:01.000 Probably not, but it's a little bit of something.

01:23:04.000 I just think it's good to have probiotics.

01:23:09.000 I like kimchi.

01:23:10.000 I try to take my probiotics in multiple forms.

01:23:14.000 This stuff that I was drinking when you got here, kombucha, I love this stuff.

01:23:18.000 I drink it all the time.

01:23:18.000 Is there a particular flavor that you like or do you mix them around?

01:23:21.000 Well, you've got to be careful because I'm a low sugar guy.

01:23:23.000 So like the grapes, there's some of them that are delicious, but they have a lot of sugar in them.

01:23:27.000 This multi-greens does not have a lot of sugar in them.

01:23:30.000 Let me see what it's got.

01:23:31.000 I think it's something like 10 grams per serving or something like that.

01:23:35.000 Really?

01:23:35.000 That sounds high.

01:23:36.000 I think I've seen them lower.

01:23:38.000 Oh, two.

01:23:39.000 Yeah, that sounded good.

01:23:40.000 Two grams.

01:23:41.000 So, yeah, that's what you want.

01:23:43.000 The grape's high.

01:23:44.000 Grape is...

01:23:45.000 But the...

01:23:46.000 Of course, it tastes wonderful, right?

01:23:47.000 It does taste yummy.

01:23:49.000 That's the problem.

01:23:50.000 This does not taste so good, but you know you're getting something good in it.

01:23:53.000 And this is the important...

01:23:54.000 Just fight your way through it.

01:23:55.000 The important stuff is that you get the strong kombucha.

01:23:58.000 This is the brand that I really like.

01:23:59.000 I don't work for them.

01:24:00.000 They're not a sponsor.

01:24:02.000 GT's Kombucha.

01:24:03.000 GTS. This stuff is awesome, but you have to be over 21 because it has more than one half of 1% alcohol by volume because the fermentation process is so strong.

01:24:14.000 I see.

01:24:15.000 So they make you show your ID. Interesting.

01:24:17.000 They actually pulled it from Whole Foods.

01:24:19.000 I don't know if you know this.

01:24:20.000 See, I thought that's where I've seen it.

01:24:22.000 Yeah, they have it back.

01:24:23.000 But they pulled it from Whole Foods until Whole Foods had to put some regulations in place to keep...

01:24:28.000 You would literally...

01:24:29.000 If you were eight years old, you could drink one and not get drunk.

01:24:32.000 I mean, it's not like you're going to get drunk off of it.

01:24:35.000 But just due to regulations, you have to have a letter of the law kind of thing.

01:24:39.000 Exactly.

01:24:41.000 What else you got?

01:24:44.000 Got a lot of papers there, buddy. 0.98

01:24:46.000 Got drawings and shit. 0.97

01:24:48.000 Charts and graphs. 0.99

01:24:49.000 Stuff to think about.

01:24:51.000 Probably a bunch of stuff you say, don't let Joe talk about this.

01:24:57.000 What other questions have you...

01:25:01.000 One big question I wanted to talk to you about was something that I had a discussion with Dr. Davidson about recently.

01:25:08.000 Jeff was telling me that the most recent procedure with stem cells is injecting them directly into the discs for people that have degenerative disc disease and that there's some really promising results.

01:25:22.000 I've heard anecdotally of a number of very positive outcomes with treatment like that.

01:25:32.000 That's amazing.

01:25:33.000 Again, you know...

01:25:35.000 Too early.

01:25:36.000 I love the fact that you're very conservative about this.

01:25:39.000 I really, really, really do appreciate that. 0.99

01:25:41.000 Although I'm giving you a hard time, I'm fucking with you. 0.98

01:25:43.000 I've really wrestled with it because, you know... 0.99

01:25:46.000 Again, our whole training is based on we need to do things that have an evidence base for our patients.

01:25:54.000 I mean, this is kind of the...

01:25:55.000 The foundation of what we do.

01:25:58.000 But we're in a unique situation.

01:26:00.000 So we have patients that...

01:26:02.000 One, this stuff is available.

01:26:05.000 And it's legal to do.

01:26:07.000 And it's there.

01:26:08.000 And people know about it now.

01:26:09.000 So they're seeking the information.

01:26:11.000 They come to us.

01:26:12.000 And even before we started talking about it, it started to be here and there.

01:26:19.000 And then all of a sudden, it's like two, three patients a day now.

01:26:22.000 Even more are saying, well, what about stem cells?

01:26:25.000 Can I have stem cell?

01:26:27.000 And, uh, like, okay, well, you know, then we have to back up and like have the whole discussion, like, okay, well, let's talk about what that is and what maybe it can do.

01:26:34.000 And, um, So, people are seeking the treatment.

01:26:39.000 It's available.

01:26:42.000 But we don't know.

01:26:43.000 We don't have a lot of information.

01:26:44.000 So, we just have to be forthcoming and say, look, this is experimental.

01:26:47.000 We've had encouraging early results.

01:26:49.000 I can tell you anecdotal stuff.

01:26:51.000 We've even seen images where somebody had, you know, full thickness rotator cuff tear.

01:26:56.000 Eight months later, what looked like a healed rotator cuff on an MRI. Now, did that happen on its own?

01:27:03.000 Well, we know that that happens at a lower percentage, but it is possible to heal.

01:27:07.000 It's just a lower percentage.

01:27:10.000 Did it happen because of the treatment?

01:27:12.000 You know, that hasn't been established.

01:27:13.000 So I have to really explain all that.

01:27:15.000 And the other category, too, that patients will come and they'll explain an injury...

01:27:23.000 And, and I've had to turn away a lot of people that were, they were fully ready to come in and have treatment and, and they were fine with paying out of pocket because of course it's not covered by insurance.

01:27:34.000 Because it's experimental, because there's, you know, no data yet.

01:27:38.000 And that's not true.

01:27:39.000 There's not no data, but there's not enough data to support treatment for, you know, certain conditions.

01:27:48.000 But, you know, I've had to tell people, I don't think this is appropriate even to try, even if you want this.

01:27:54.000 And usually the category is...

01:27:57.000 Excuse me.

01:27:59.000 If it's something mechanical.

01:28:01.000 So I think this makes intuitive sense to people.

01:28:04.000 So for example, had you come to me and you said, Hey, you know, I dislocated my shoulder seven times.

01:28:10.000 And can you just put an injection in there?

01:28:13.000 Well, the problem with that is that the in that case, in this example, the ligaments of the shoulder have been stretched and disrupted.

01:28:22.000 And in the case of a dislocation, there's oftentimes a labral tear that comes with that.

01:28:27.000 Now, I don't believe, and I could be proven wrong over time, but I just don't believe that an injection on its own would magically decrease the volume of the capsule.

01:28:41.000 We're good to go.

01:28:48.000 We're good to go.

01:29:00.000 Was.

01:29:00.000 You said was.

01:29:01.000 Yeah.

01:29:01.000 Now it's close to malpractice.

01:29:03.000 Oh, Jesus.

01:29:04.000 Yeah.

01:29:05.000 So it's interesting the way these things go.

01:29:08.000 So there was a huge wave of interest in this.

01:29:14.000 And essentially what guys would do is they're looking inside the shoulder.

01:29:16.000 You have a radiofrequency wand and you're using that to heat the tissue and you can watch it literally shrink in front of you.

01:29:23.000 Then, Richard Hawkins is a very accomplished orthopedic surgeon, kind of iconic guy that's done tons of research.

01:29:31.000 He was also in Vail, Colorado, now in Carolina.

01:29:35.000 And he published a paper that showed a very high rate of failure from these procedures.

01:29:40.000 And so, as a result of that, it's fallen out of favor.

01:29:45.000 Huh.

01:29:46.000 But it was done very frequently on lots and lots of shoulders.

01:29:49.000 Now, high rate of failure...

01:29:51.000 It was like 40%.

01:29:52.000 Okay, but here's the question.

01:29:54.000 Is that because you're talking about already compromised joints, right?

01:29:58.000 Which is a very complicated joint.

01:30:00.000 Shoulders, very complicated joint.

01:30:02.000 There's certainly a number of reasons why that could have failed, but there was a lot of problems with...

01:30:09.000 Basically damage to the tissue from the radiofrequency.

01:30:13.000 Oh! 0.60

01:30:14.000 So it was weakening things.

01:30:15.000 Yeah.

01:30:16.000 I see.

01:30:17.000 Yeah, so that...

01:30:18.000 What was the benefit of it?

01:30:20.000 Well, you could watch it and you were seeing the decrease in the volume of the capsule.

01:30:24.000 So you were...

01:30:24.000 Where structures had become loose, you were seeing it become tight at the time zero period.

01:30:31.000 What about doing that in conjunction with some sort of a stem cell therapy?

01:30:37.000 Um...

01:30:38.000 Does that make sense?

01:30:39.000 Yeah.

01:30:39.000 I should be a doctor, right?

01:30:41.000 You're very close.

01:30:43.000 You're only...

01:30:46.000 10 years in school?

01:30:47.000 You're only 14 years away.

01:30:49.000 14?

01:30:49.000 Yeah, that's all.

01:30:50.000 14 for regular people.

01:30:51.000 Give me 20. So why did they think that it would work in the first place?

01:30:57.000 Like, what was the idea behind it?

01:31:00.000 There's early published papers that were saying that the outcomes were better if you used it.

01:31:06.000 Wow.

01:31:06.000 So it's murky.

01:31:08.000 I mean, there's things that, over time, we discover that what we thought we were looking at, you know, we didn't fully understand.

01:31:14.000 And how long did it take before it became malpractice?

01:31:16.000 That's an exaggerated term.

01:31:18.000 Problematic.

01:31:19.000 I don't know the exact year that his paper was published, but it was before my residency training.

01:31:28.000 I graduated medical school in 2006, so it was before that that people weren't doing that anymore.

01:31:34.000 Okay, so I'll bring you back around.

01:31:36.000 So when someone has had, like, if you talked to some dude who played football or something, had multiple shoulder dislocations, like, what would you do to him?

01:31:43.000 You would encourage surgery?

01:31:46.000 So the, you know, the typical course for recurrent instability of the shoulder would be a stabilization procedure.

01:31:58.000 Now, a lot of that's based on the exam and what you see on imaging.

01:32:01.000 Some people can do well with a simple shoulder arthroscopy, and then you pass a couple stitches, you repair the labrum, you can tighten the capsule at the same time, and young patients progress really well through that.

01:32:15.000 When there is more complicated problems, such as there's bone loss on the front of the socket, so when you have a dislocation, the head goes forward, it It goes out the front.

01:32:30.000 That's the typical and anterior shoulder dislocation is the usual one.

01:32:34.000 And then as it tries to come back into place, the head bangs into the glenoid or the socket.

01:32:40.000 So you can, you'll tear the front of the labrum, you'll stretch the front of the capsule, but then you can also get a dent in the back of the humeral head.

01:32:49.000 So...

01:32:49.000 What is the correct procedure?

01:32:52.000 I mean, I keep throwing you off track, but when someone does have a shoulder dislocation, what are you supposed to do?

01:32:58.000 Are you supposed to pull on it or just take them to the hospital?

01:33:00.000 Um...

01:33:02.000 There's probably no harm in doing that.

01:33:05.000 There's a great technique called the Zahiri technique. 0.71

01:33:09.000 Spell it.

01:33:09.000 Z-A-H-I-R-I. And it's just the name of the guy that wrote the paper.

01:33:14.000 But it's essentially, it would be a really easy thing for you to learn because it's kind of a leverage thing.

01:33:19.000 Like Jiu Jitsu?

01:33:20.000 Yeah.

01:33:20.000 So it's a way to leverage the arm so that you can get the muscles to relax.

01:33:28.000 It's easy on the person and you can actually do it awake and like at the field.

01:33:34.000 So I actually did it on a professional steer wrestler at the rodeo.

01:33:41.000 How hilarious is it that you can be a professional steer wrestler?

01:33:47.000 Well, I was amateur for a few years, but...

01:33:49.000 Yeah, no, they're pretty serious about stuff.

01:33:52.000 Super serious. 0.83

01:33:53.000 You were talking about your bucket-handled meniscus. 0.71

01:33:56.000 The first rodeo cowboy that I took care of had a flipped bucket-handled meniscus tear.

01:34:01.000 And he came in the day that the National Finals Rodeo was starting.

01:34:06.000 And he was also a steer wrestler, by the way, and had been a previous, I think he was a champ, or he won a bunch, that's for sure.

01:34:13.000 So they basically, they taped his knee.

01:34:16.000 You gotta come closer.

01:34:17.000 They taped his knee in about 30 degrees of flexion, and he competed the whole nine days.

01:34:25.000 Whoa.

01:34:26.000 Just roped up knee.

01:34:28.000 Just taped it up, got on his horse, and was jumping off and throwing 600-pound steers on the ground.

01:34:35.000 Jesus Christ.

01:34:36.000 Yeah. 0.99

01:34:36.000 Those guys are crazy. 0.99

01:34:38.000 I watch that stuff on TV. I've never even been to one live because I'm terrified. 0.56

01:34:42.000 You need to come.

01:34:43.000 I don't.

01:34:43.000 We did an episode of Fear Factor where we made people ride bulls.

01:34:47.000 Made him ride it?

01:34:47.000 That's terrifying.

01:34:48.000 Ride him! 0.92

01:34:48.000 You can die. 0.92

01:34:49.000 I mean, that's nice. 1.00

01:34:50.000 You can die no matter what. 1.00

01:34:51.000 You're dealing with a goddamn steer. 1.00

01:34:52.000 That's what I'm saying. 1.00

01:34:53.000 That's what I'm saying.

01:34:54.000 You can die getting on top of one of those.

01:34:56.000 Yeah, but a steer is not a bull, right?

01:34:57.000 Oh, it's been gilded, right?

01:34:59.000 No, no, no.

01:34:59.000 We had bulls.

01:35:00.000 No, no, no.

01:35:01.000 Steer wrestling's different, right?

01:35:03.000 Steer wrestling is the...

01:35:04.000 They grab them.

01:35:05.000 They take off.

01:35:06.000 Yeah, you rope them.

01:35:07.000 The steer and the guy and the horse take off at the same time.

01:35:09.000 You jump off, you grab it, you grab by the horns and turn its neck and throw it on the ground and then they wrap that.

01:35:13.000 Yeah. 0.99

01:35:14.000 See, a steer is a bull that doesn't have any balls. 0.99

01:35:17.000 Right. 0.98

01:35:18.000 Yeah, that bull's not the same animal.

01:35:21.000 But they're younger than the ones that... 0.98

01:35:23.000 They chop their balls out before they get a chance to mature. 0.99

01:35:26.000 That's why when they... 0.91

01:35:27.000 The bulls are terrifying.

01:35:28.000 So I've been right down next to the bucking chute, and it's, like, frightening.

01:35:32.000 I actually had a clod of dirt get...

01:35:34.000 One of them kicked it up, and it hit me in the head like a baseball.

01:35:37.000 I mean...

01:35:37.000 Yeah.

01:35:38.000 See, they're little babies.

01:35:40.000 Yeah. 1.00

01:35:40.000 And they have no balls. 1.00

01:35:41.000 So this guy jumps off. 1.00

01:35:43.000 What a dumb... 1.00

01:35:43.000 And you turn the head. 1.00

01:35:44.000 That is so whack. 1.00

01:35:46.000 What a stupid fucking thing to be excited about. 1.00

01:35:50.000 I did it. 1.00

01:35:50.000 I wrestled that thing that I was trying to get away. 1.00

01:35:53.000 Grabbed him by his natural handles and I took him down.

01:35:56.000 Look how quick.

01:35:56.000 Look at their move.

01:35:57.000 It's like a Darce choke. 1.00

01:35:59.000 And the cow's like, what in the fuck, man? 1.00

01:36:02.000 Why is this even happening? 1.00

01:36:03.000 Look, the cow's like, what is going on?

01:36:04.000 I gotta get out of here.

01:36:06.000 Look how they always do it the same way, too.

01:36:09.000 It's similar to a choke hold.

01:36:11.000 Yeah. 1.00

01:36:12.000 Oh, what a dumb fucking thing to be excited about. 1.00

01:36:15.000 They grab the neck and flip it on their back. 1.00

01:36:17.000 It's outside of your world.

01:36:19.000 It's outside of this world.

01:36:21.000 These are some of the nicest guys I've ever met in my life, honestly.

01:36:25.000 And they're some of the toughest athletes in the world.

01:36:27.000 Oh, yeah.

01:36:27.000 I would imagine those guys are tough as hell.

01:36:29.000 You have to be.

01:36:30.000 We had a dude on Fear Factor.

01:36:31.000 They compete through every injury.

01:36:32.000 There is no injury that they won't compete.

01:36:35.000 You have to.

01:36:36.000 You're always broken up.

01:36:37.000 I mean, you have to.

01:36:38.000 We had a dude on Fear Factor that had nine...

01:36:39.000 And also, they don't make money if they're not competing.

01:36:41.000 So...

01:36:42.000 Right.

01:36:43.000 We had a dude on Fear Factor was a steer champion, or a rodeo champion, rather.

01:36:46.000 He had nine shoulder surgeries.

01:36:48.000 His shoulder was just, like, sliced all open.

01:36:50.000 Yeah.

01:36:50.000 And I go, how often does it dislocate?

01:36:53.000 He goes, pfft, at any time.

01:36:55.000 Like, I could open up a car door, it'll pop out a socket.

01:36:57.000 I'm like, yikes.

01:36:59.000 Yeah, that's bad.

01:36:59.000 Yeah.

01:37:01.000 So, back around to where we're at.

01:37:05.000 What do you do?

01:37:07.000 How does the Zaheer technique, can you describe it?

01:37:11.000 Did I say it right?

01:37:12.000 Zaheerie? 0.83

01:37:12.000 Zaheerie, yeah. 0.83

01:37:13.000 Zaheerie technique?

01:37:13.000 So one of the guys that we trained with in my sports medicine program in Alabama showed us this, and it was like one of the first things that we reviewed at the beginning of the year.

01:37:27.000 So basically, you have the person lying flat on their back, and I would hold your wrist, Loop my arm under your arm and then grab onto mine for for leverage.

01:37:39.000 And then I literally just sort of lean back and I'm using the muscles in my back.

01:37:44.000 So I'm not pulling with my arms.

01:37:46.000 So a small person can do this on a very big athlete and you're fine because you're you're using all the strongest muscles in your body, right?

01:37:54.000 So you literally just Lean back and you hold traction in that position.

01:37:59.000 So you've got the arm is positioned like this.

01:38:01.000 Yeah, you got to describe to people that are listening and The arm is in front of the person while they're lying on their back.

01:38:09.000 And again, I have my right hand on your right wrist if it's a right shoulder dislocation.

01:38:14.000 Well, let's just see a video.

01:38:15.000 You got a video of it?

01:38:17.000 It's really hard to find it, but I'm gonna hopefully guess that this is maybe it.

01:38:21.000 Hopefully.

01:38:22.000 Yeah.

01:38:22.000 Oh, okay.

01:38:23.000 Let me explain to people at home.

01:38:24.000 What this is like is if you were trying to give someone an arm bar, you get a hook on the left side.

01:38:30.000 And so the hook is, if you're trying to arm bar someone on their right arm, and you were in side control, you would hook it with your left arm.

01:38:38.000 And then you would trap it in place.

01:38:41.000 A person does when they don't want to get arm barred.

01:38:43.000 Their defense is this.

01:38:44.000 They grab their hands together.

01:38:45.000 And so you loop your arm in that and pull it back like that.

01:38:49.000 So that would be real similar to what you're doing.

01:38:51.000 You're using the left arm.

01:38:53.000 You're connecting it like this.

01:38:55.000 And then you're actually just using traction.

01:38:58.000 Yeah.

01:38:58.000 So the treater, in this case on the right side, he's just going to lean back and hold.

01:39:05.000 And you just wait.

01:39:07.000 And in about 10 seconds...

01:39:08.000 It pops in place.

01:39:10.000 The deltoid and the pec and the biceps relax and it just slides in.

01:39:13.000 Oh, that's interesting.

01:39:15.000 You can actually do that.

01:39:17.000 And, I mean, the kinder way to do this is, you know, with some anesthesia.

01:39:21.000 Right.

01:39:22.000 But a lot of times you can do that and they're perfectly comfortable.

01:39:25.000 Huh.

01:39:26.000 And they're immediately better when the shoulder's back in.

01:39:29.000 Wow.

01:39:30.000 Well, they're not completely better, but the pain's relieved from the initial event.

01:39:34.000 Now, you told me when you looked at my MRI that you think that my shoulder was dislocated at some point in time.

01:39:38.000 I don't remember exactly your MRI, but if you had a tear of the front of the labrum, and you had any evidence of that little dent in the back of the humeral head, then that would be consistent with that injury.

01:39:52.000 I just do not remember ever having a dislocated shoulder, but I've been comored a bunch of times.

01:39:58.000 I bet you've had it slip a little bit.

01:40:02.000 Just the nature of your sport.

01:40:03.000 You're shoulder locked.

01:40:05.000 There's been many Americanas in my past, and Kimuras, and all these different hardcore... 1.00

01:40:11.000 You were on the receiving end?

01:40:13.000 Yeah, yeah, yeah.

01:40:14.000 Before this injury, I never did...

01:40:17.000 Americana, you could definitely have at least a subluxation of the shoulder, for sure.

01:40:21.000 Yeah, I'm sure.

01:40:22.000 I'm sure.

01:40:22.000 And you fight it off, too, because you don't want it to happen, so you're resisting, and...

01:40:27.000 Before this injury, I didn't do any shoulder exercises.

01:40:29.000 I just worked out.

01:40:31.000 But I didn't do any specific exercises just to strengthen my shoulders.

01:40:34.000 And I think that was a big mistake.

01:40:36.000 And I kind of emphasize that with people.

01:40:39.000 Doing external and internal rotation exercises.

01:40:45.000 I'm a big fan now of inverted kettlebell presses and Yeah, that's been one of my favorite lately.

01:40:53.000 It's definitely a challenge.

01:40:54.000 You don't need much weight.

01:40:56.000 Yeah, this little 40-pound Ironman kettlebell, I use this one.

01:40:59.000 It's amazing.

01:41:01.000 That's a lot of weight for that exercise.

01:41:03.000 That's pretty good.

01:41:04.000 Well, it's just they say you should be able to do 50% of your max weight.

01:41:09.000 Or is it 50% or 90%?

01:41:12.000 I forget what they say.

01:41:13.000 Forget me.

01:41:14.000 Don't listen to me.

01:41:14.000 Well, it...

01:41:16.000 It depends on...

01:41:18.000 I think I said 90, yeah.

01:41:19.000 Obviously, in the injured patient or the person that's recovering, they're going to be starting with much lower loads.

01:41:25.000 Much lower.

01:41:25.000 And all the focus is on the motion.

01:41:29.000 Your posture, engaging your core, keeping your ribs down, and having the full motion.

01:41:34.000 The strong first protocol, I think what they're trying to say is, in order to have really powerful shoulders, you should be able to do 90% of your max kettlebell press.

01:41:43.000 Like, say if you can max kettle press 90 pounds.

01:41:47.000 Now, that's with the...

01:41:48.000 With the handle and the bell down, right?

01:41:51.000 Yeah, with max.

01:41:53.000 That would be your max.

01:41:54.000 Like a one rep max?

01:41:56.000 Yes.

01:41:56.000 Or what you would pretty much...

01:41:59.000 Maybe you could do two or three if you really had to.

01:42:02.000 But you know you're talking about a lot of weight.

01:42:05.000 What you would normally max out of.

01:42:08.000 There's a protocol that this guy Pavel Tatsulin follows.

01:42:13.000 That's really kind of interesting.

01:42:14.000 You know, Pavel, right?

01:42:15.000 Well, he's the kettlebell guy, right?

01:42:17.000 He's the guy that brought him, they call him the godfather of kettlebells in America.

01:42:21.000 The guy that I train with talks about that all the time.

01:42:23.000 Yeah.

01:42:24.000 The idea behind it is, if you could do ten reps, you'd do five.

01:42:31.000 And you wait a long time, and then you do another five.

01:42:34.000 And you wait a long time, and then you do another five.

01:42:36.000 And you never work to failure.

01:42:38.000 And that working to failure is actually not healthy.

01:42:40.000 It's not smart, and you don't really get stronger that way.

01:42:43.000 My recommendation...

01:42:44.000 Is that for, and this is coming from, this isn't from the orthopedic surgery world, this is what I've read from strength and conditioning people.

01:42:54.000 The thing you want to avoid in doing something to failure is with load and a skill activity.

01:43:01.000 So, for example, like a clean or a snatch or something like that.

01:43:07.000 Things that involve coordination and where you have to time everything.

01:43:10.000 If it requires sound mechanics and you're doing it with load, it's bad to do that to failure because what happens as you fatigue is your mechanics are going to break down.

01:43:20.000 And that's where you're going to get hurt.

01:43:21.000 Well, what Pavel talks about is that strength is a skill and that all these different things, think of them as a skill and then don't do things to failure.

01:43:31.000 And if you're looking for, you know, endurance or something along those lines, you want to do light weights and you want to do multiple repetitions.

01:43:39.000 It's not what you're doing when you're trying to get stronger.

01:43:42.000 No.

01:43:43.000 Yeah.

01:43:43.000 But there's, you know, a lot of different arguments one way or another.

01:43:48.000 I mean, talk to powerlifters and they're like, that guy's a pussy. 1.00

01:43:50.000 You got to do it. 1.00

01:43:50.000 It's a failure. 1.00

01:43:52.000 Yeah.

01:43:52.000 I don't know.

01:43:53.000 Talk to the CrossFit people.

01:43:55.000 They want to do a hundred reps, you know?

01:43:57.000 Yeah.

01:43:57.000 So, no.

01:43:58.000 There are activities that you can train to failure and there's no risk.

01:44:01.000 So, for example, like pull-ups.

01:44:05.000 I mean, when you fail, you just can't get up, right?

01:44:07.000 Right.

01:44:08.000 Like, you're just going to come off the bar.

01:44:09.000 Right.

01:44:10.000 The battle ropes, you're just going to fatigue out.

01:44:13.000 Like, you're not going to hurt yourself doing that.

01:44:15.000 Right, but they even believe that when you're doing chin-ups, like if you're doing pull-ups or chin-ups, that when you're doing it, you shouldn't go to failure.

01:44:23.000 You should just stop, like, close to it or halfway there, and then take a long time off and then do another five reps.

01:44:30.000 Like, say if your max is ten reps, get to five, stop.

01:44:35.000 Take a break.

01:44:35.000 Do another five.

01:44:37.000 Stop.

01:44:38.000 Take another five, ten minutes.

01:44:39.000 Do another five.

01:44:40.000 Keep going.

01:44:41.000 And just you're working on form and your muscles are performing these actions in a very clean, smooth delivery and that this is the best way to recover or to build strength and that you just do it more often.

01:44:56.000 Don't do it to failure once a week and then be a wreck for like three or four days afterwards.

01:45:00.000 Because you know that feeling when you lift weights and you lift weights for a week, or you lift weights and you lift weights to failure rather, and you're sore for so long.

01:45:08.000 You can't get anything done.

01:45:10.000 This idea is you do more frequent workouts and you don't go to failure.

01:45:16.000 And that don't go over five reps.

01:45:18.000 I think one of the biggest...

01:45:21.000 Mistakes that we see and reasons that people show up in my office is because of overload and no time for recovery from the training that you're doing.

01:45:34.000 So you don't see people periodizing and incorporating the times when they're just allowing rest.

01:45:40.000 I mean, you can't be working at max capacity all the time.

01:45:44.000 Right, exactly.

01:45:45.000 It's a big thing with fighters.

01:45:47.000 Huge.

01:45:48.000 Keeping them from working hard is so hard to do.

01:45:52.000 Yeah, so I try to emphasize with, and we have to really talk about this with our ACL rehab, because that's a group that they're so eager to get back.

01:46:03.000 If they're a competitive athlete, you've got to remind them that, look, we have steps to go through.

01:46:08.000 And I always say you've got to work smart, not hard.

01:46:11.000 We have a plan, and there's a reason why this week may not be a whole lot of work.

01:46:16.000 Your body needs rest and recovery in order to put stress on it again so that we can continue to make your progress.

01:46:22.000 Otherwise, at some point, you're either going to plateau, you're not going to be making changes, you're going to get frustrated, or you're just going to get hurt.

01:46:29.000 Right.

01:46:29.000 All right, we've got to bring this home.

01:46:30.000 So anything else?

01:46:32.000 We need to cover on this?

01:46:35.000 I don't think so.

01:46:35.000 I think we got to talk about it quite a bit.

01:46:37.000 Yeah, we really did.

01:46:38.000 Thank you very much for doing this.

01:46:39.000 I really appreciate it.

01:46:41.000 We've always had these really cool conversations when I visit you in your office, and I'm really glad we got a chance to do this.

01:46:45.000 Now, if people want to get a hold of you and they want to seek treatment, please give them the necessary information.

01:46:51.000 Oh, sure.

01:46:52.000 So, our website is www.totalsportsmedicine.com.

01:46:57.000 I like how people still say www.

01:47:00.000 Yeah, you can probably still get there, right?

01:47:02.000 Yeah, you can just, totalsportsmedicine.com.

01:47:04.000 Yeah.

01:47:05.000 And then, we have information on there in terms of how to contact us.

01:47:11.000 And, you know, we'd be happy to get additional information to patients if they have questions.

01:47:15.000 Awesome.

01:47:16.000 Well, again, thanks for everything you've done for me.

01:47:18.000 It's been a lifesaver, and I've had massive benefit.

01:47:22.000 Thank you very much for allowing me to come down.

01:47:23.000 My pleasure, brother.

01:47:24.000 Thank you.

01:47:25.000 Dr. Roddy McGee, ladies and gentlemen, and that's it for this week.

01:47:28.000 We'll see you next week.

01:47:29.000 Bye-bye.

The Joe Rogan Experience - April 12, 2017

Joe Rogan Experience #945 - Dr. Roddy McGee

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