In this episode, Dr. McGee and I discuss the use of placental tissue in orthopaedic surgery and the potential benefits it can bring to the field of sports medicine. We also discuss the ethical dilemma of whether or not it should be used in place of blood and blood products, and how it can be used to replace blood products like blood, blood, and platelets. We also talk about the potential use of placenta as a replacement for human organs, and the benefits of using placental cells in sports medicine and other areas of medicine, such as knee replacements, shoulder replacements, and knee replacements. This episode is sponsored by the American Association of Tissue Banks, a company that specializes in tissue donation and tissue banking services. To learn more about AATB and their services, check out their website here. To find a list of our sponsors and show-related promo codes, go to gimlet.fm/OurAdvertisers. We appreciate your support and look forward to seeing you in the next episode. Thank you so much for all the support we've gotten over the years! Your support has been so appreciated, and we can't thank you enough! We can't wait to see what you do for us in 2020. . Thanks to our sponsor, . . . We're looking forward to hearing back from you! Thanks for listening and supporting us in the future episodes of the podcast! - Your support is so appreciated. - Thank you for being a part of our community, we really means a lot to us and we really appreciate you. , and we appreciate you, much more than you know what you're listening to us, we can do it. We appreciate it. XOXO - Tom and we love you. Thank you, Maureen and much more! - Tom & Mike Tom & Sarah Tim Thankyou, - EJ & Mike & Joe Mike & Matt Cheers, Kristy, P. ( ) (A.M. ( ) ( ) - P.A. ( & P. & J. (.) (Thank you, B. & K. ) - K. & A.J. ( ). (M. & D. & B. (S. & G) (C. & S. ( ),
00:00:27.000For 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.
00:01:10.000To me, it's better because I can hear if things are wrong.
00:01:14.000What's the notes, Daddy-O? What do you got there?
00:01:16.000Just a couple of things I jotted down.
00:01:17.000Just make sure I give you all the information you want to hear.
00:01:21.000Well, 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,
00:01:40.000you know, I mean, what I've avoided, avoided in shoulder surgery.
00:01:47.000Yeah, 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.
00:02:07.000Now where's all this stuff coming from?
00:02:09.000Like where is this science coming from and how has it evolved over the last few years?
00:02:14.000Well, 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.
00:02:26.000So 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.
00:03:58.000And there's a process that must be followed by the American Association of Tissue Banks.
00:04:04.000And they have a series of blood tests that they have to go through.
00:04:07.000And so you're checking to be sure that there's no communicable disease, for example, hepatitis or HIV, things of that nature.
00:04:14.000And 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.
00:04:26.000So essentially the ethical and the moral dilemma shouldn't exist for that portion of it because otherwise it's just garbage.
00:04:38.000Now, 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,
00:04:53.000to be a facility that is up to their standards.
00:05:08.000And 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.
00:05:21.000So, now, the next thing of what you said...
00:05:26.000Let's talk a little bit about President Bush and that whole discussion.
00:05:33.000So first of all, that is about embryonic stem cells.
00:05:38.000An embryonic stem cell, and that doesn't have anything to do with what we're doing.
00:05:43.000An embryonic stem cell is when the sperm and the egg join and begin to form the beginning cells of life.
00:05:50.000And there's initially two cells, and then it divides into four, eight, etc.
00:05:55.000In the first five days of life, that's called a blastocyst.
00:07:24.000So, 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?
00:07:54.000My 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.
00:08:22.000Well, 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.
00:08:31.000So, the thing that George Bush signed in 2001 stated that the federal government was not going to supply money for embryonic stem cell research.
00:08:47.000So 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.
00:09:00.000So I always find it interesting when I hear on TV, oh, like...
00:09:05.000Our country has been set back a decade because they signed this bill.
00:09:40.000So 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?
00:09:52.000Well, so a couple of things about that.
00:10:01.000It'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.
00:10:15.000So what that means is they can potentially form tumors.
00:10:18.000So that makes it obviously a big disadvantage because now we're adding our risk to what we're doing.
00:10:24.000Once 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.
00:10:34.000And 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.
00:10:44.000The amnion or the amniotic sac, which is the inner layer around the baby, and then the outer layer is called the chorion.
00:10:52.000Now, all of that has cells in it that we would put in the category of mesenchymal stem cell or mesenchymal stem cell.
00:11:01.000Now, what that means is they have a specific line of tissues that they can become.
00:11:09.000So, now, back to when I was explaining the formation of the The blastocyst becomes a morula, becomes an embryo eventually.
00:11:18.000So 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.
00:11:30.000So you have endoderm, ectoderm, mesoderm.
00:11:34.000Each of those kind of is directed towards a certain line of cells and tissues.
00:11:39.000The mesoderm and what the mesenchymal stem cells can become are all of the things that we care about in orthopedics.
00:11:50.000So we have that whole line of cells that this particular cell has the potential to become.
00:11:58.000So when we talk about a stem cell, By definition, what it means is, one, it can divide and become another stem cell.
00:12:09.000So it can duplicate itself so that now you have another cell that can divide and become another cell.
00:12:15.000Or it can divide and differentiate into a cell that then has the characteristics of the things that you're hoping it will become.
00:12:25.000Now that's a directed and ordered approach in embryology.
00:12:30.000And in the case of treating an injury, what we're hoping is that that can differentiate into the injured tissue.
00:12:40.000And how long have they been doing that?
00:12:42.000Well, studies on that have been going on for at least 10 years.
00:12:48.000So I want to say maybe back as early as 2007. Now, we've been...
00:12:54.000If you go way back to the early days of...
00:13:00.000Arthroscopy, and that would be like the late 70s and early 1980s.
00:13:05.000And 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...
00:13:19.000He's the one that developed the microfracture procedure.
00:13:23.000I don't know if you're familiar with that.
00:13:25.000You've had a couple of knee surgeries, so...
00:13:27.000I don't know if you've heard that term.
00:13:28.000I have, but I don't really recall exactly what it is.
00:13:32.000So 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.
00:13:43.000And what that did is it releases marrow elements along with blood.
00:13:47.000And 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.
00:13:57.000Now, they also found that that didn't become the native cartilage.
00:14:02.000It becomes something called fibrocartilage.
00:14:04.000So when you look at it under a microscope, it looks different compared to our normal cartilage.
00:14:09.000Appearance, like, physically looks the same, but under the microscope looks different.
00:14:39.000So 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,
00:14:57.000actually would do better than patients with less arthritis, but that they didn't do the The procedure.
00:15:03.000And 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.
00:15:13.000And it's only now that we start to understand, you know, because the bone marrow has some of these mesenchymal stem cells available also.
00:15:21.000And we'll kind of talk about the differences and stuff like that.
00:15:24.000So it's essentially like a crude version of stem cell transplants?
00:15:32.000I mean, our hope is that we're using cells that can, again, change into other things that we want.
00:15:38.000And 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?
00:15:47.000Well, 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.
00:16:03.000So they were kind of talking about what's the newest and, you know, I think?
00:16:29.000And they were showing new growth of cartilage and actually improvement in some of the x-rays.
00:16:36.000So when you look at an x-ray, there's some characteristics that we look at that define what arthritis is.
00:16:43.000So if the patient has narrowing of the joint space or they have bone spurs, things like that.
00:16:48.000They were actually seeing more space between the bones on some of these serial x-rays.
00:16:52.000So, 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.
00:17:02.000And that's really what kind of sparked my interest.
00:18:43.000A 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.
00:18:56.000And naturally some people do better than others, but...
00:18:59.000You know, the rigorous study of this, though, is still yet to come.
00:21:03.000So, essentially, you did mine, I think, how long ago was it?
00:21:09.000I think it was July of 2015. Yeah, so I kind of came in pretty early.
00:21:14.000Because Jeff Davidson, the doctor from the UFC, he was the one who told me about it because he had shoulder surgery and...
00:21:21.000He 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.
00:21:37.000I 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.
00:21:49.000Yeah, so he told me, and then I was like on the fence.
00:21:52.000I 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.
00:22:03.000And 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.
00:22:19.000So, 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.
00:22:31.000Because, 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.
00:22:40.000Well, during normal everyday life, there'd be like zero pain.
00:22:43.000The problem is what I put my body through has nothing that resembles normal everyday life.
00:22:49.000Between jiu-jitsu and kickboxing and kettlebells and archery and there's just so much explosive movements and so much weight-bearing movements.
00:23:01.000So 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.
00:23:06.000I'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?
00:23:18.000You know, for sure, probably three months.
00:23:55.000And so some patients, you know, they're, they struggle to get through that part of it.
00:23:58.000Um, and it naturally will take longer to improve.
00:24:01.000So it's harder for them to get their motion.
00:24:04.000It's longer, much longer for them to return their strength.
00:24:06.000Now you already have like a significant baseline level of strength.
00:24:10.000So, you know, much easier in your case to bounce back.
00:24:14.000And then also the things that you would do in rehab, they're so rudimentary, you know, you would move through that very quickly.
00:24:20.000And 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.
00:25:42.000And 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?
00:25:48.000So, you know, I would have to go back and look and kind of critically evaluate each case.
00:25:53.000Certainly, 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.
00:26:06.000But I think that's information that is still, you know, to come.
00:26:10.000But 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...
00:26:23.000You're doing all kinds of things to optimize your chance to not, you know, in this case, heal, but in other instances, perform.
00:26:32.000And I have to believe that that has, you know, that's a huge factor.
00:26:36.000Yeah, 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.
00:26:50.000You 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...
00:27:03.000One of the cool things for me has been it's forcing me to have to learn about it.
00:27:07.000It's forcing me to have to take a look at, you know, how can we do better?
00:28:10.000In a typical orthopedic practice, you don't have a ton of time to go through all of this with every patient.
00:28:16.000And so you just have to make sure that you're providing resources and getting them as good information as available.
00:28:22.000One 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.
00:28:29.000Well, I don't know that there's been good results.
00:28:33.000I think it's interesting, and the things that you've talked about for other applications in terms of heat shock proteins...
00:29:12.000We can add these things to a Petri dish and watch these changes happen.
00:29:17.000But nobody has demonstrated this in a human, in a clinical trial where we're treating an injury.
00:29:22.000So we have to be very careful about that.
00:29:24.000In fact, the FDA is very clear that, you know, we cannot be making those claims.
00:29:30.000Companies 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.
00:29:41.000Now, 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?
00:29:55.000I've heard people saying that you get heat shock proteins from a very hot bath.
00:29:59.000And I think there would have to be some kind of...
00:30:03.000Biopsy or blood test and you know sample like have people go through each of those things and control for all those factors, right?
00:30:10.000But the whole idea is just Being involved in an environment that's extremely hot where your body is like what is this guy doing?
00:30:18.000And 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.
00:30:29.000Oh, the sauna makes me feel great, and I would look at them like, what are these assholes doing?
00:30:33.000They're going to go in there and sweat?
00:30:34.000I 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.
00:30:43.000But 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.
00:32:39.000And I wonder how cryotherapy comes into play with that as well, because cold shock proteins also show some great benefit in reducing inflammation.
00:32:48.000It's just an amazing time for all the different options that are available to people.
00:32:55.000I 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.
00:33:09.000I think there's a lot of misinformation and a lot of people taking advantage of that.
00:33:15.000And so, you know, we want to try to avoid that.
00:33:18.000We 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.
00:33:27.000So I think there's something like 200 plus regenerative medicine clinics that have popped up in the last couple of years.
00:35:04.000Yeah, 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.
00:35:19.000And again, there may be great applications for all of the different things that fall into this category of biologic treatment.
00:35:27.000Time is going to tell us what things pan out clinically to be best.
00:35:32.000I mean, you can look at all kinds of factors, and we can draw conclusions from that.
00:35:38.000But 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.
00:36:14.000There's six or seven that are human trial.
00:36:19.000I 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.
00:36:30.000So one was on knee arthritis, and the others were on mostly foot and ankle stuff.
00:36:37.000The most recent is from USC and in combination with a doctor that's in Indiana.
00:36:44.000And they looked at patients that had a knee arthroscopy and they resected part of the meniscus.
00:37:21.000So 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.
00:37:35.000So the patients had apparently grown meniscal tissue.
00:37:40.000I had a meniscus scope on my left knee from an ACL injury that I had.
00:37:48.000I had ACL surgery, but there was still some meniscus damage.
00:37:52.000And then at the time of the ACL injury, they tried to stitch up the meniscus.
00:39:01.000Within 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?
00:40:49.000You know, we want to preserve that meniscal tissue for as long of their life as we can.
00:40:54.000So 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.
00:41:04.000Why 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.
00:41:16.000So they do these, you know, color pressure studies where it shows you the amount of force and its distribution.
00:41:25.000And 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.
00:41:35.000So when those come together, with a normal meniscus in there, The pressure's even.
00:41:40.000If you resect part of that, now you see this point loading.
00:41:43.000So you see these hot spots where there's a much greater amount of pressure.
00:41:47.000Sort 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?
00:42:14.000But 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.
00:42:21.000Now, whether or not you develop symptoms from that is hard to predict.
00:42:26.000Well, 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.
00:42:35.000So 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...
00:43:12.000They'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.
00:43:19.000Also, I think they're trying to talk sense into you.
00:43:56.000Some people, we have to have the hard discussion.
00:43:59.000It's like, look, I know you want to keep doing this.
00:44:01.000I know you think you're heading that direction, but this is over.
00:44:05.000Well, 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.
00:49:05.000So 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.
00:51:13.000They'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.
00:51:23.000Yeah, 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?
00:51:31.000They're like, well, right now, that's a fantasy.
00:51:42.000This 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.
00:51:52.000But, you know, computer nerds at the time were playing with like Commodore 64. Right.
00:52:14.000So, apparently I'm not a very forward-thinking guy, because, obviously, we're doing that quite a bit now.
00:52:19.000I 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.
00:52:29.000About people sending you a text message and the part of the joke was like, it takes you four presses to get an S. Right.
00:53:01.000I mean, how disruptive to your life is it to have to, like, send emails now?
00:53:09.000I 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.
00:56:50.000It'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.
00:57:35.000And none of those are defined yet for what some of these things that we've done.
00:57:40.000But we're trying to develop that and dial it in and hone it down.
00:57:44.000For me right now, the easiest thing is to try to adapt it from a surgical rehab.
00:57:50.000And 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.
00:57:58.000But The principles are the same, right?
00:58:02.000So you have an injury that you're trying to heal.
00:58:06.000Now, 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.
00:58:13.000In 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.
00:58:23.000But 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?
00:58:45.000And then the more that we're learning about all these other factors, I mean...
00:58:49.000Like, 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.
01:00:32.000It'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.
01:00:43.000Yeah, there's a lot of debate about that.
01:02:23.000So, 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.
01:02:45.000So the typical healing cascade has an inflammatory phase, proliferative phase, and the maturation phase.
01:02:53.000So in the inflammatory phase, you have neutrophils and white blood cells and these enzymes that are present that are trying to start the process.
01:03:04.000Then 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.
01:03:14.000And your body's producing fibroblasts, and you're laying down tissue in this sort of haphazard manner.
01:03:20.000So it's just kind of piling on in there.
01:03:23.000Then the maturation phase is when you have remodeling.
01:03:27.000So that scar tissue is changing over time and developing into tissue that's more like or is the native tissue.
01:03:50.000Like, 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.
01:03:58.000At 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.
01:04:34.000So healing without scar is, you know, has to do with not forming this fibroblast disease.
01:04:42.000We're fibrovascular response and fibrotic phase.
01:04:46.000Now, 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.
01:05:27.000This 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.
01:05:42.000And anybody that's telling a patient that they have exactly what it should be, I mean, be wary of that.
01:05:48.000Because that has not been discovered yet.
01:05:51.000So we're trying to take, you know, we're taking the information from our experience and applying it that way.
01:05:57.000It's not the best way to go about this.
01:06:01.000And 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...
01:06:12.000Treat all the things that we had difficulty treating.
01:06:16.000And even all of the studies that were coming out, people were using different centrifuges and applying it for different reasons, different protocols.
01:06:24.000It was just a mishmash of information.
01:06:30.000So 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.
01:06:44.000Do you think that they could work in a symbiotic fashion with, like, this kind of...
01:06:52.000So some cellular treatment, like bone marrow fat or the placental tissue, and that line of treatment can help expand the cells.
01:07:02.000So that gets us to an important point, which is expanding the cells has been done and is not currently legal in the United States.
01:07:11.000So there was a place, and they do it in other countries, but here...
01:07:19.000If you more than minimally manipulate the tissue, then that is not under the guidelines of the FDA for use of human cellular tissue products.
01:07:32.000So 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.
01:10:19.000We only have a narrow window from when we take those frozen cells and then we thaw them.
01:10:25.000We have a short window when we can then inject them.
01:10:28.000And then there's maybe between 7 and 21 days that those cells are viable in...
01:10:35.000Your shoulder or your knee, wherever we inject it.
01:10:38.000So 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?
01:10:58.000Well, 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.
01:11:16.000So you have to have minimal manipulation.
01:11:18.000That means you can't add things to it.
01:11:20.000You can't combine it with other stuff.
01:11:22.000You 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.
01:11:32.000This isn't part of it, but you can't treat patients on a different day.
01:11:37.000It has to be at the same time, whenever you're harvesting the cells or utilizing the Whatever it is you're using.
01:11:45.000It has to be something called homologous use.
01:11:48.000And 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.
01:11:58.000So, 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.
01:12:15.000We're taking bone, we're using it to become bone, or to be the scaffold for bone to heal and grow.
01:12:21.000So, it can't be combined with something else.
01:12:28.000And it can't be intended to have a systemic effect.
01:12:32.000Now, 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.
01:12:41.000So, for example, you can't take amniotic fluid and say, this is a product meant for IV infusion, for treatment of...
01:14:45.000Well, 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?
01:14:58.000I think he fucks so much, he doesn't have any sperm in his body, and he's trying to...
01:15:08.000But I think he's got a series of injuries, I know that, because he's had Regenikine for his neck.
01:15:13.000He 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.
01:16:09.000So, 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...
01:16:20.000Is 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.
01:18:51.000It'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.
01:19:05.000It looks like a bow that Batman would have.
01:19:33.000You'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.
01:20:59.000But 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.
01:21:33.000Because that's a giant issue, staph infections and the like.
01:21:36.000It's one of the things that, you know, frightens us most about, you know, doing our procedures is, you know, can we prevent infection?
01:21:44.000Yeah, 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.
01:21:53.000And the big issue is post-surgery infections.
01:24:03.000GTS. 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.
01:25:01.000One big question I wanted to talk to you about was something that I had a discussion with Dr. Davidson about recently.
01:25:08.000Jeff 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.
01:25:22.000I've heard anecdotally of a number of very positive outcomes with treatment like that.
01:26:27.000And, 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.
01:26:34.000And, um, So, people are seeking the treatment.
01:27:15.000And the other category, too, that patients will come and they'll explain an injury...
01:27:23.000And, 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.
01:27:34.000Because it's experimental, because there's, you know, no data yet.
01:28:01.000So I think this makes intuitive sense to people.
01:28:04.000So for example, had you come to me and you said, Hey, you know, I dislocated my shoulder seven times.
01:28:10.000And can you just put an injection in there?
01:28:13.000Well, the problem with that is that the in that case, in this example, the ligaments of the shoulder have been stretched and disrupted.
01:28:22.000And in the case of a dislocation, there's oftentimes a labral tear that comes with that.
01:28:27.000Now, 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.
01:31:36.000So 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?
01:31:46.000So the, you know, the typical course for recurrent instability of the shoulder would be a stabilization procedure.
01:31:58.000Now, a lot of that's based on the exam and what you see on imaging.
01:32:01.000Some 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.
01:32:15.000When 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.
01:32:30.000That's the typical and anterior shoulder dislocation is the usual one.
01:32:34.000And then as it tries to come back into place, the head bangs into the glenoid or the socket.
01:32:40.000So 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.
01:37:13.000So 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.
01:37:27.000So 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.
01:37:39.000And then I literally just sort of lean back and I'm using the muscles in my back.
01:37:46.000So 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?
01:37:54.000So you literally just Lean back and you hold traction in that position.
01:37:59.000So you've got the arm is positioned like this.
01:38:01.000Yeah, 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.
01:38:09.000And again, I have my right hand on your right wrist if it's a right shoulder dislocation.
01:38:24.000What this is like is if you were trying to give someone an arm bar, you get a hook on the left side.
01:38:30.000And 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.
01:39:30.000Well, they're not completely better, but the pain's relieved from the initial event.
01:39:34.000Now, you told me when you looked at my MRI that you think that my shoulder was dislocated at some point in time.
01:39:38.000I 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.
01:39:52.000I just do not remember ever having a dislocated shoulder, but I've been comored a bunch of times.
01:39:58.000I bet you've had it slip a little bit.
01:41:29.000Your posture, engaging your core, keeping your ribs down, and having the full motion.
01:41:34.000The 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.
01:41:43.000Like, say if you can max kettle press 90 pounds.
01:42:44.000Is 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.
01:42:54.000The thing you want to avoid in doing something to failure is with load and a skill activity.
01:43:01.000So, for example, like a clean or a snatch or something like that.
01:43:07.000Things that involve coordination and where you have to time everything.
01:43:10.000If 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.
01:43:20.000And that's where you're going to get hurt.
01:43:21.000Well, 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.
01:43:31.000And 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.
01:43:39.000It's not what you're doing when you're trying to get stronger.
01:44:10.000The battle ropes, you're just going to fatigue out.
01:44:13.000Like, you're not going to hurt yourself doing that.
01:44:15.000Right, 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.
01:44:23.000You should just stop, like, close to it or halfway there, and then take a long time off and then do another five reps.
01:44:30.000Like, say if your max is ten reps, get to five, stop.
01:44:41.000And 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.
01:44:56.000Don't do it to failure once a week and then be a wreck for like three or four days afterwards.
01:45:00.000Because 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.
01:45:21.000Mistakes 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.
01:45:34.000So you don't see people periodizing and incorporating the times when they're just allowing rest.
01:45:40.000I mean, you can't be working at max capacity all the time.
01:45:48.000Keeping them from working hard is so hard to do.
01:45:52.000Yeah, 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.
01:46:03.000If they're a competitive athlete, you've got to remind them that, look, we have steps to go through.
01:46:08.000And I always say you've got to work smart, not hard.
01:46:11.000We have a plan, and there's a reason why this week may not be a whole lot of work.
01:46:16.000Your body needs rest and recovery in order to put stress on it again so that we can continue to make your progress.
01:46:22.000Otherwise, 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.