The Daria Hamrah Podcast
Do you want to change or simply improve your life? Take your business or your personal relationships to the next level? Have you ever thought why change is so difficult? Ever wondered how people become successful and we just call them "lucky". The Daria Hamrah Podcast gives you Dr. Hamrah's personal insights and pathways to his successes and what he calls "true happiness". Featuring interviews with some of the most successful entrepreneurs, authors and experts in their field, he shares their insights into what he calls the "Secret of Life".
The Daria Hamrah Podcast
A New Era of Sports Medicine and Patient Recovery with Dr. Matt Thompson
Join us for an electrifying conversation with Dr. Matt Thompson, a pioneering orthopedic surgeon, as he helps us tear down the walls of traditional medical norms. We don't just scratch the surface; we challenge the very fabric of conventional medical practices. Inspired by Dr. Claude Bernard's wisdom, we question everything—cognitive biases, groupthink, and paternalism—and highlight the necessity of persistent curiosity in the medical field. If you're ready to embrace innovation and question the status quo, this episode is your call to action.
Peptides, stem cells, and the future of sports medicine take center stage as we navigate the complex landscape of alternative therapies. Through real-life stories and personal anecdotes, we discuss the excitement and skepticism surrounding these treatments. Despite the obstacles posed by regulations and the need for comprehensive clinical trials, the potential for accelerated recovery and treatment of complex conditions is undeniable. We weigh the promise of these unconventional methods against the rigid framework of traditional validation, urging a balanced dialogue in the medical community.
Our discussion also broadens to encompass the power of holistic health and lifestyle changes in revolutionizing patient care. With rising obesity rates and declining life expectancy, we emphasize the importance of proactive personal health management, from nutrition and exercise to advanced diagnostics and genetic markers. We also explore the challenges faced by private practices in maintaining autonomy amid healthcare industry consolidation. As we envision a future where technology and regenerative medicine become integral to surgical recovery, this episode serves as both a roadmap and inspiration for anyone passionate about medical innovation and wellness.
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All right, everyone, welcome to another amazing episode of the Daria Hamra podcast. Today is a very special day and I know you hear it every time I do this podcast, because every podcast is special, but this one is personal, just because what we're about to discuss with the person we're about to discuss was life-changing for me and will be life-changing for a lot of other people that are involved in my care, and hopefully you can spread the word so you can change the people's lives that you come across. Now we're diving into something today that's been on my mind a lot lately. In particular, I'm talking about cognitive bias, group thinking and a bit of old-school paternalism that are still affecting how we practice medicine. I mean, think about it. We're in this incredible age of information, right, With new research and breakthroughs happening all the time, but sometimes it feels like the field is still holding on to outdated habits, almost out of comfort or tradition, maybe a little bit of ego, I'm not sure, but we all know how easy it is to fall into a routine, right, I mean to keep going and doing with what's familiar because it feels safe. But that's where cognitive bias creeps in and it can really limit our ability to see things clearly and adopt new approaches. And let's not forget groupthink. It's that whole. Everyone else is doing it, so it must be right mentality which can make it so hard to push back against the norm, even when the data or even your gut tells you otherwise.
Speaker 1:But the real issue I want to address today is this kind of paternalism we still see within medical societies and the leadership. It's the way these organizations can make it difficult for members, doctors and scientists to challenge the status quo. It's almost like if you don't fall in line you're seen as a troublemaker or someone who's just not getting with the program. But real progress comes from asking tough questions, challenging accepted practices and not being afraid to stir things up when we see room for improvement. When we see room for improvement and this isn't a new struggle, by the way. Even Dr Claude Bernard, who is really known as the father of modern medicine, was onto this over a century ago, in the early 1800s. He said the true scientist is one who can resist the temptation of the first plausible explanation and is vigilant against his own biases. True science is the enemy of dogma. That's exactly it. Real progress in medicine means we've got to stay curious, keep questioning and never settle, even if it means standing up to the bigger system in place. So today we're going to unpack all of this, look at how far we've come and where we still need to push forward, push forward.
Speaker 1:Today's guest is a gentleman who I am proud to call a friend and colleague, whom I met almost to the date, exactly a year ago, when I was not feeling well. We casually met at a mutual friend's dinner and as I was going through a lot of health issues nothing serious, just the usual stuff my doctor called it I'm getting older, or I'm working too hard, or I'm stressed. You know what I mean your shoulders are aching, your knees are popping and hurting. You go one flight of stairs and you're huffing and puffing and you're thinking what's going on? What happened? All my life I was an athlete. All my life I thought I'm eating well, I thought I'm doing well, not least for people telling me and complimenting me all the time how in shape I am and how good I look. But none of that really mattered at some point. So Dr Matt Thompson, who is my guest today, in a very casual conversation which we're going to talk about, changed my life.
Speaker 1:But before we get to it, I want to introduce this amazing physician, an orthopedic surgeon, who grew up in a small town in Kansas. He spent his summers working at his dad's tire store, which instilled him with strong work ethics from an early age. He further went on to graduate with honors in chemical engineering from the University of Kansas, even becoming a national champion in the chemical engineering design contest. Also, he joined later the track and field team at Kansas and spent there a whole year. He further then went to get his medical degree at University of Pennsylvania School of Medicine before completing orthopedic surgery residency right around the corner here at George Washington University. He pursued his passion for sports medicine with a fellowship at the prestigious hospital for special surgery in New York City, which is considered number one in orthopedic hospital in the world. While there, he had the incredible opportunity to work as an assistant team physician with the New York Mets, and he continues to bring that expertise to athletes at all levels today.
Speaker 1:But his journey didn't stop there. Dr Matt Thompson joined forces with a fellow resident to build what is now Precision Orthopedics and Sports Medicine, growing the practice from just two doctors to 25 across 15 locations. Along the way, he also made his mark on the field of surgical innovation. Holding a patent on an FDA-approved surgical implant that's already in use today and, in true forward-thinking fashion, he is helping to improve an AI-driven physical therapy and surgical recovery app called my Health Track. He's passionate about the future of medicine, and that's one of the reasons why he's on my podcast and always looking ahead to where we can be in 5, 10 or 20 years. Today, we're going to explore insights on the newest frontiers in healthcare, sports medicine and how technology is transforming recovery and performance. So, Matt, I can't wait to dive into these hundreds of questions I have for you. So for the listeners, stay put, it's going to be a long one. So, Matt, thank you and welcome to my podcast.
Speaker 2:Thank you so much, Darya. Thank you so much. I'm excited to get started on all these questions. We've got so much fun stuff to talk about.
Speaker 1:Yes, so I have mentioned you on many of my previous podcasts, which you're the one that actually sent me down this rabbit hole of health and wellness, for the reasons I stated above, and I don't know if you remember, but it was exactly a year ago when we first met at a mutual friends dinner and I was really contemplating whether I should ask you or bother you, because I hate it.
Speaker 1:You know how it is You're a doctor, you're somewhere and people find out that you're a doctor and start hitting you up with millions of questions and because I'm aware of that, I usually try not to do that to other people. But it was something that I was really desperate people but it was something that I was really desperate and I had gotten a steroid shot in my shoulder that maybe helped 30%. I was told I could get up to three and obviously I know what the downsides of those are. So I wasn't very excited about it and keen on it and just try to through persistent and caution when I do my workouts to slowly build up the muscles around my joint. But then it was kind of like as I was doing it I was aggravating my joint and, needless to say, I had a labrum tear, I had previous rotator cuff injury and I was pretty much falling apart and, matt, it was getting into my head Now, looking back, I was actually a little bit depressed.
Speaker 1:It was affecting my mood. I felt like it's over now, almost like an athlete that had to hang up his cleats for good and was now wondering what's next. I was imagining myself with a dad bod, which is something that I just can't see myself ever, but it was happening just because all these issues affected first the level of my activity and then, eventually, my mental status, and I fell into that vicious cycle. And you better than anyone understands, because you do that for a living every day and now have these conversations with your patients.
Speaker 2:Oh, every day yeah.
Speaker 1:Right.
Speaker 2:I mean, I think we take health for granted. Um, if you ever get sick, the only thing on your mind is how do I get better? And if you're not thinking about it when you're healthy, you really take it for granted. But as soon as you have pain, as soon as you have an injury, that's the only thing that matters. And I feel you there exactly when you have that shoulder pain, and it's always right there nagging on you. That's the only thing that matters. And I feel you there exactly when you have that shoulder pain, and it's always right there nagging on you. That's the only thing that matters.
Speaker 2:You've got to take care of that, if you ever had a pinched nerve in your neck or your back. That's the only thing that matters, so I'm with you on that.
Speaker 1:Yeah, and it was even the simple things like washing my back in the shower or putting on a coat or my shirt. It was putting on a coat or my shirt. It was like a stabbing pain in my shoulder, to the point that I became so self-aware and hyper-aware that I was scared to do certain things because I knew my brain was conditioned and it was literally getting into my head and psychologically it really messes with you. And that's the part that I had never experienced and that really got to me. And we're going to talk about how easily I got over it just after a conversation with you. You probably didn't even know how much you helped me at that conversation. I didn't realize at the time.
Speaker 2:Yeah, you didn't even know how much you helped me at that conversation. I didn't realize it at the time.
Speaker 1:Yeah, you didn't realize it. You really didn't realize it, but what you did? You made me aware of something simple, which is looking at my lifestyle and my nutritional status, and introduced me to some peptides. That's all you did, really, and then that night I went home, I started doing my research and that took me down this rabbit hole and the mission I have been for the past year, to the point that it's your fault that I'm now writing a book. Okay, so now.
Speaker 1:I'm spending my free time to write a book because of you, so I'm certainly going to dedicate the foreword to you on that book, just because you started everything. So let's start with a big controversy and something that people talk a lot about on social media treatments that are almost common in other countries, but not in the US yet, that seem to have a lot of or show a lot of promise, and by that I'm talking about stem cells and peptides. As you know, they're gaining a lot of traction in orthopedics, yet clinical data is still emerging on this. So do you think we're jumping the gun or other countries, for that matter, are jumping the gun by using these therapies without more robust studies? Or is the anecdotal evidence enough to move forward?
Speaker 1:And I'm one of the anecdotal stories and evidence, so I feel like I'm all in, but I'm one of one, I'm N of one. So, who knows, maybe it was other stuff, but God, it was just so instant, it was so related that I truly believe it. But again, looking at it from a scientific perspective, you know, because you know, as Hippocrates says, you know you got to make habit of two things as a doctor is to help, or at least to do no harm. So what is your take on it? Are we doing harm? Are we helping? Is it both, perhaps?
Speaker 2:Yeah, I think we're doing it about right. To be honest, I really do think there is some promise. I do think that we do need those clinical trials, the true randomized, controlled studies that can give us that data we really want. I mean, when the academies that oversee us when they put out a position statement on peptides and stem cells, they say there is promise in this treatment but the clinical data is still conflicting. We need some really big, really robust studies so we can give a definitive answer. But at the same time you've got the bodybuilding community, the fitness community. He doesn't care what they say, they want the best stuff out there. The athletes they will try anything as long as it looks reasonably safe.
Speaker 2:You know, like anabolic steroids, there's a lot of safety issues there. There's a lot of side effects. But something like peptides and stem cells, especially the umbilical stem cells, there doesn't appear to be major reports of major issues, major side effects. With those based on what we've seen so far, there's just not a lot of data. We don't really have a lot of data.
Speaker 2:When the FDA banned 17 peptides back in September, I looked at the reason for each ban on a peptide and it was usually something pretty minor.
Speaker 2:It's like there was one report of a tumor in a patient one time, or there is potentially some heart issues, or they always found something that was a small safety signal, but nothing that was, you know, super alarming.
Speaker 2:So I think we're kind of doing it right where you have some people who are right at the forefront and going out exploring, experimenting and trying to find out anecdotally what works, and then you have everybody else, the organizations that set the guidelines, the governments and all that the FDA is saying we're going to just wait for all the data to come in. But I do feel a bit frustrated that you know, we haven't done those good studies, especially some peptides like the BPC-157. That's the really hot one right now and that's one of the FDA. Just they banned pharmacies from making it to sell to patients. But you can still buy it for research purposes. So it's not like completely banned, it's just something that a doctor shouldn't like prescribe and sell in his office because it's not FDA approved and he could get in trouble. He could kind of get in trouble for that.
Speaker 1:So now on the BPC-157, because I have to tell you I took it. I know you just told me about it back then. You didn't tell me to take it, you just told me actually you were very careful. Didn't tell me to take it, you just told me actually you were very careful. You said look into it. And I appreciate that and I did look into it and that was part of the reason why you know and, by the way, I'm not giving any medical advice, I'm just telling everyone what I did. It helped me and once in a while, when I feel some twinges in my shoulder because now I really bulked up on muscle, I mean, by the way, after bulking up on muscle, within doing that, I lost 12 pounds just within four weeks and people tell me like you don't look any different, you look the same. How did you lose 12 pounds? It was because I lost fat and I built muscle and so I just look ripped and my body fat is down to 8% right now.
Speaker 1:So that's phenomenal and that's because I've been able to work out and also I improved my nutrition. But back to BPC-157. Is there any randomized, controlled studies that you know of on this?
Speaker 2:I looked at all the data that I could find, most of it is animal studies. There is some very good controlled animal studies where they would cut the Achilles tendon in a rat or they cut both of them and one they'd give the BPC and one they would not, and it would heal. Incredible, it would heal a lot faster. It promotes fibroblast growth. It promotes angiogenesis the blood vessel growth. So we know in an animal trial there's multiple trials shown it's very robust for healing. The only human trial I found was just a group of people 20 patients who got injections in their knee for knee arthritis and there wasn't a control group and they basically said everybody tolerated it. 80% of the people got a lot better. But that's not the data we need to say this definitely works.
Speaker 1:Were they looking for any safety concerns, or why didn't they have a?
Speaker 2:control. Why wouldn't they have a control? It was just a small clinic that wasn't, you know, affiliated with a big university. It was just a guy who's doing it in his office and he says I'll publish my data, you know.
Speaker 1:Got it.
Speaker 2:Not the study the FDA wants to see.
Speaker 1:Yeah, certainly so, isn't that, by the way? Isn't that what did I? I may be wrong, but didn't aaron rogers, you know, remember he tore his achilles? Did he do something? I know he. He did something off label that was not recommended by his team, uh, doctor, and he just did it anyways. Do you know anything about that?
Speaker 2:I don't know if he said exactly what he used. If it was anything, it was probably the BPC-157, because there's a lot of health influencers.
Speaker 1:Yeah, that's what I heard. Which is interesting that his team physician a lot of these. Now you've been a team physician, you've worked with the New York Mets during your time in New York. How was that? Because we're talking about athletes. Their value is millions of dollars, hundreds of millions of dollars, and the loss these teams get. When one of their top athletes, for example, we saw Otani, he had a subluxation of his shoulder just I watched the game live. I mean, there's a lot at stake. Now, as a team physician, what do you do? Do you go by the book, by the recommendation of your society, and are you worried about repercussions from your society because you're not doing things based on their recommendations? Or when do you decide? Or how do you decide, to go off-label Because there is a lot on the line here? How do you resolve that conflict?
Speaker 2:Well, how it works is the team physician has a text group with every other team physician of Major League Baseball and they all have their chat group. They say, hey, I got a tough one here. What do you guys do? There's definitely a lot of discussion among the guys in the same realm. Like every major league baseball team doc is going to be talking to the others pretty much, so they always get dirty opinions right away for something this complex.
Speaker 2:But otherwise, as a team doc, you kind of you work for the organization and you work for the players. You know there's a little bit of a conflict there because you have to do what's right for your patients but also you have the organization saying, hey, there's a lot of money here. What do you think? Give me the medical opinion Are we going to get? Are we going to cut this guy? I need your medical truth. You know not. You have to tell us what's going on here. It's in the contract. So you kind of have to walk a fine line. A lot of the pro athletes will have their own team, their own doctor, their own orthopedist back home or they'll use somebody else and then they'll just go to the team doc for the basic regular care so they can do whatever they want, they can have multiple opinions.
Speaker 1:So team doc is kind of two loyalties the team and the players Interesting, I wonder if that affects our contract if something goes sideways, if they accept a treatment that was not recommended by the team doctor. But you know these are issues and you know, yeah, that can happen.
Speaker 2:That's definitely happened before where somebody's gone against a recommendation or gone outside of the treatment protocol and that gives the team the ability to void the contract. Often, if you don't, you know you didn't get your acl fixed or you didn't do it this way or there's a lot of things they could do so I'm sure that go ahead now, now.
Speaker 1:So, talking about these challenges, when you approach these elite athletes, you know, are there instances where you've had to take a bold or unconventional approach to achieve an outcome.
Speaker 2:Or you know, at least be in that discussion and you know, can you kind of like walk us through, um what happened yeah, yeah, I have a few, uh, professional athletes, some bodybuilders, some power lifters, um, and we definitely, because they're in the gym, that everybody in the gym knows about all the latest peptides, of course isn't that crazy, you know it is well, I was, I was.
Speaker 2:I was talking to my patient before surgery and I said, well, there is a lot more information out there about nutrition, about supplements, and they're like I know all that you don't need to tell me. So you've heard of bpc Yep 157. You've heard of TB, and she's 500. You know, knew everything. And then you heard of the NAD plus. Have you heard of that? Yep, I already got it. So they are really on top of it. These are people where that's their life, that's their career, and so this is one of those anecdotal examples of somebody that did well.
Speaker 2:A powerlifter had a pec tear in the pec muscle. It just ripped off on your bench press and they had a video of it. You can see it. Pop is like very, very clear. They probably had several hundred pounds on there. Um, well, after the surgery, um, we, I didn't prescribe a peptide. I I said, you know, these things aren't really FDA approved formal treatments, but you can use them if you want to. There's some evidence they may help and, of course, you know, on their own. They went and did the peptides and did some other, you know, nutritional supplements. Nothing that was really odd or anything, just everything that you can throw at it. And instead of being back at six months starting to lift heavyweight, they were back by four months already, bench pressing several hundred pounds.
Speaker 2:I was like you shouldn't be doing that. Yet it's like no, I feel great, I really do. You know they were already lifting heavy probably, you know, two months ahead of schedule, and that was just the end of one. That's the end of one, and it worked for tendon healing. And of course, that's not a study at all. That's nothing for the FDA, but that's enough to make me think.
Speaker 1:There surely is something to this, if people are getting better and I've seen some others do as well too- so I wonder when you guys sit in your societies or in your scientific meetings, you know, like I don't know, you go into a breakout meeting and you guys talk to each other. Do you talk about this stuff and what is like the general consensus, the unofficial one, in your society on this topic? Just because you know, I know, in my society is stuff like there's certain things that was postulated and, as we know, you know, even the experts would admit it. Half the stuff that we practiced is really dogma. I mean even scientific articles that have been published in top journals like Lancet, new England Journal of Medicine, jama, a lot of these publications. Sometimes they're being revoked, like 10, 20 years later, or completely debunked. So it's hard.
Speaker 1:So at some point you're like, okay, what should I believe? And do I just go with my gut feeling, based on my clinical appearance, meaning what I see happen? So do you guys have these discussions like offline?
Speaker 2:A little bit. I usually check in with all my co-fellows from my fellowship and, you know, at the meetings I'll just mention it to some people and I usually get like three responses. One it's as fairly common as no.
Speaker 2:I've never heard of that. No idea what that is, you know, like stem cells, or you know, I've never heard of that. Another common response is oh yeah, yeah, I've heard some people talking about it. We're going to wait for more data, but it could be interesting. And then the third response is I use it. Oh yeah, I've got it, I've done it. It's amazing. So it's not formally talked about like there's a big podium presentation on peptides.
Speaker 2:You know, that's you know, because there's not data to present yet. All you can really say is there's a lot of anecdotal evidence, but we need more studies. So the societies are all about there has to be research to present before you can really talk about it. So it's really just an offline thing.
Speaker 1:Yeah, I think that's the frustrating part, not just for patients who are looking for progress, but also for physicians trying to get the best treatment out there. You know, we were almost trained to think that way that unless there is a double-blind control, placebo-controlled study with a 10 year um history, that you can't just you can't recommend it and it's, it's, it's. It's sometimes so ridiculous that people ask you to to do a study on whether or not it hurts if I kick you in the shin. I mean, we don't have to do a study on whether it hurts or not if I kick you in the shin. I know some of these.
Speaker 1:MMA fighters. They actually have you seen that they break baseball bats with their shin? Have you seen that video?
Speaker 2:It's crazy. I've not seen that one, but I've seen them get their own way broken by getting kicked. I saw.
Speaker 1:One is like back to back. He broke two baseball bats with the shin.
Speaker 2:I got to watch that. It's insane.
Speaker 1:And so, but back to the studies and what we know anecdotally, or we have witnessed clinical improvements on treatments or therapies, whether there's peptides or other treatments, like now led light therapy, which has become very popular, um which in some of these cases is really hard to have long-term studies. But, would you say, it's feasible to offer it to patients as long as you don't see any harm, or there's no evidence for harm? And do you integrate these types of treatments?
Speaker 2:Yeah, I usually will have the discussion with the patient. That might be interested. I'd say, hey, are you interested in some of the off-label things I can tell you about? And sometimes they're like, oh yeah, I want to hear everything. I'm really into this, you know. And then I'll just say, well, here's some things that are out there. I have a list of maybe 10 supplements that I give them that do have research behind them, but that's common.
Speaker 1:Right there there's a lot of doctors that talk about supplements. What's the degree of reception of your patients? Are they very receptive? Are they very skeptical? Are they excited when you?
Speaker 2:offer them these alternative types of treatments. No, they really appreciate it. They're like wow, my doctor has never really told me a secret pill to take or a supplement. They feel like you're giving them something secret and it's like you really care about me. You want me to get better, you want me to have the best stuff. And then I'll say there's also some off-label things and some patients they're like nope, not interested, I don't want to do anything that's off-label and I'm not providing these treatments. I'm not giving peptides. You know, I stay out of that you know, since it's not FDA approved.
Speaker 2:But I will tell patients about the peptides and here's some things that people are trying. If you're really interested, you know there could be a small risk. They don't seem to be too bad but there might be really good benefits for healing. So if people are really interested in that, I'll talk about it. We'll talk about diet. We'll talk about all the other lifestyle factors too. So other things. I mean stem cells. I'll talk to patients about stem cells too, yeah, yeah. So as far as when is the status of stem?
Speaker 1:cells. I I know right now people are just going to like mexico or, I don't know, peru or south america, somewhere to get stem columbia to get stem cells. Uh, can you talk a little bit about that and kind of give us a little insight?
Speaker 2:yeah, so well, the two places people are going is, uh, panama and tijuana. Those are the big stem cell clinics. Those are the busiest and biggest ones. Those are the big stem cell clinics. Those are the busiest and biggest ones that I've heard of. They've had probably over 10,000 people at each one, I would guess, looking at their websites and everything.
Speaker 2:The thing people don't understand about stem cells is there's two very different types. There's the stem cells that come from your own body, which would be from fat cells or from your bone marrow. Those would be your own stem cells. Those are completely fda approved. They're okay. There's no problem doing that.
Speaker 2:Insurance won't pay for it because there's well, honestly, the research on those. For, say, injecting into your knee for knee arthritis. There's conflicting studies. Not every study shows that they work amazingly well. So I have not seen a huge, massive interest in that type of stem cell.
Speaker 2:But it's the umbilical stem cells from a baby's umbilical cord. Those are the ones where all the interest is and those are the ones that the FDA has regulated. They say that you cannot provide those and sell them in a medical office. Anything you do with those would have to be completely off-label and that's why people go to Panama and Tijuana for those, and those are the ones that have the most potential to really work. Well, because it's a more potent stem cell. It can differentiate easier into other tissues, cartilage, ligament, whatever. It's not been exposed to environmental factors and toxins like our own cells throughout our whole life. It's a pure cell. It has more growth factors with it.
Speaker 2:There's every reason to think that it would be a much more potent stem cell and there even are randomized trials on those for injecting them intravenously. They did a COVID study where they were giving IV umbilical stem cells in people in the ICU and they actually got better than the control group from acute respiratory distress syndrome. That's a real randomized trial on umbilical stem cells. There's also one on, I believe, heart failure. That they had improvement in heart failure and improvement in diabetes just by getting an IV injection, like basically getting a blood transfusion, except you're getting umbilical stem cells and they just tend to make the person healthier, whatever case it was.
Speaker 2:I mean that's three trials. There's no orthopedic indications for the umbilical stem cells yet, but they are indicated in some other things, like for bone cancer, for some other issues. So I'm really interested in the umbilical stem cells the most. Those are the ones that you have to go out of the country to get. Those are the ones that all the podcasters you listen to Joe Rogan and what he's got, and everybody that's been on there, all the UFC fighters all those people are going for the umbilical stem cells because that's the most interesting one, that seems to be the most potent, but we don't have it.
Speaker 1:I'm assuming the reason why we don't have the FDA clearance for it is because we don't have enough studies on this. Is that correct?
Speaker 2:That's exactly right.
Speaker 1:We don't have that big randomized, controlled trial of umbilical stem cells. Do you know of any trials that are going on currently in the US or elsewhere?
Speaker 2:I don't know exactly. I tried to look it up and I wasn't finding anything great on that.
Speaker 1:I'm sure we could do a deeper dive. It's so weird, I mean because, you know, I kind of feel like whenever it comes to something that can't be a therapeutic, that can't be monetized, that can't put a brand name on it, because no one is getting a piece of the pie, no one is getting a cut of the business other than the patient, which is their health.
Speaker 1:No, one is really keen on spending any money on doing any trial, not even academic institutions, because academic institutions they get their funding either from private institutions, from private companies or from the NIH, some NIH grant, and what's bizarre is that, for something that could be so groundbreaking and life-changing, how is it that no one is putting any effort because it could be the cure for so many different diseases, like you said, beyond orthopedics, beyond joints and you know? And so it's so bizarre that these big philanthropists, you know, like, where is Bill Gates in all of this? Like, why doesn't he fund, why doesn't the Gates Foundation fund it Foundation fund this study? Oh wait, I think they're more into vaccines, aren't they?
Speaker 2:Because you know the Gates Foundation is more into it.
Speaker 1:But isn't that bizarre and isn't that a shame? Because I feel when you. I just finished reading Mark McCary's.
Speaker 2:Marty McCary's book.
Speaker 1:Yeah, Marty McCary's book Blind Spots. He really puts it really. He put it really well as far as how the system works and he didn't call it corruption. But we all know how to interpret what's going on. We all know how the game is played and it's very sad. It's so disheartening that um, science is moving slow because everything that's powerful and groundbreaking if it doesn't bring in money for certain people and can't be monetized, it's literally put aside and um it even demonized um by big institutions and societies. If a clinician tried to use it off, like they're they're, they ridicule um you for um even talking about it and shame you and this paternalism that's going on in in in our medical societies and these. It's almost like this big boys club. If you're not part of the club, if you're not part of the editorial board of the new england journal of medicine or science or nature, um, no one wants to hear about uh, your, your research and and it's really a shame.
Speaker 2:Absolutely. And guess how much VPC costs. You can get a vial of that for $50 and have 10 or 20 doses. There's just no money in it. That's exactly it heard on Huberman Lab is that? Now, I'm not saying this is what's going on, but sometimes big pharma might have pressured the FDA. It was like, hey, can you kind of ban some of those peptides while we get a proprietary formulation that's something we can patent and is just like it, and then we can make a lot of money. I mean that's the kind of conspiracy that's been floated around. I'm not saying that's going on. You know there's reasons they banned them. But you know people think there's no money in some of these peptides. There's no money in aspirin anymore. I mean there's no money in exercise. There's. You know there's no money in lifestyle changes. So you know we don't go and promote that.
Speaker 2:You know, what my favorite fact is is that you can look at aspirin is 13 cents a pill and it will reduce the risk of stroke by 20% in somebody who has an irregular heartbeat, some atrial fibrillation. Eloquist is another blood thinner that reduces the risk of stroke 35%. You know a little better than aspirin in those people. And it's $13 a pill. It's a $13 billion a year drug. And then get this. There's one thing that reduces the risk of stroke 50% in everybody, not just people with atrial fibrillation and that is walking 7,000 steps a day, just walking 7,000 steps a day. If that was a pill it would be a trillion-dollar pill. I mean, there's been tons of research on just walking for 45 minutes will reduce your overall mortality by up to 70% and helps you in so many other ways. But you can pay for that.
Speaker 1:Imagine that was a multiple choice question on your USMLE exam and which one is more effective, and you cross 7,000 steps or more. You'd fail that exam, wouldn't you?
Speaker 2:Absolutely. They would say well, that's not a randomized trial, that's a correlation, not a causation, and then you know they pull something like that. But we clearly know that, you know it's good.
Speaker 1:Well, there are studies now that show that walking more than 7,000 steps a day reduces all-cause mortality by a significant percentage. I don't know the exact percentage, but it's a significant percentage and I don't think I've ever, when I was in training, that I ever overheard any of my attendings or my professors talking about it Ever.
Speaker 2:Yeah, never, it's 50% to 70% was all-cause mortality yeah, 50, yeah, nobody ever mentioned 50 to 70 percent and it's.
Speaker 2:It's phenomenal that we just completely ignore that and usually the excuse is oh, my patients will never exercise if I tell them to, it's not worth talking about. It's not worth talking about diet people won't listen. You know, people just like to brush it off like it's, you know, not worth worth talking about. It's not worth talking about diet. People won't listen. You know, people just like to brush it off like it's not worth even talking about or having the conversation when we should be, like our whole country, should be really focused on. Like guys, here's a cheap way to live longer, to be healthier, to start create a culture like like they do in Spain. You go to Spain, you go out to dinner after After dinner everybody goes on a walk for 30 minutes.
Speaker 2:I mean we got to develop a little more of that culture here and we can do that from top down if we have the right people saying it.
Speaker 1:It's actually amazing. I wore just to test for a month. I wore like a glucose monitor and I wanted to see what kind of foods do to my blood sugar level and what they do to my fasting level of my sugar.
Speaker 1:And then also I wanted to see how walking affects if I walk go on a brisk walk immediately after I have a meal, whether it is a high carb meal or just a regular meal, and how that affects me. I was amazed how just simple walking after a meal, like a dinner, would affect my glucose spike. So instead of it spiking 30 to 40 milligram per deciliter, it was like in the teens, in the low teens, like 10, 12. And it was completely stable. And the best thing was my fasting glucose at night when I was sleeping it was below 90 and it was completely steady, as opposed to if I didn't do it or I had like a late night meal. My fasting glucose was over 100. The whole night I had a terrible sleep and my cortisol levels were actually elevated because I take my blood biomarkers every three to four months. So I correlated that with my cortisol levels. My cortisol level was out of whack.
Speaker 1:My HSCRP, which is the C-reactive protein, which is a biomarker for inflammation, that went significantly down just by simply walking after a meal. So all of these things, believe it or not, got rid of the inflammation I had. Shoulder pain. Pain went away. Yes, I also took bpc 157. I uh modified my diet, I and and and I I paid attention to um more walking, taking 7 000 steps minimum, and I always thought, yeah, at work you know how we were uh run around in our clinic at work a lot. I thought. I thought, oh, that's 10,000 steps easy, Until I noticed it's only like 3,000 steps max. I was shocked.
Speaker 2:It's not that much. It's not as much as you think. No no.
Speaker 1:And here I was thinking, I'm running around all day long, but it's only at best 3,000 steps.
Speaker 2:Yeah, you really need those longer walks. That's where you get the huge benefit. You know and I go for a walk almost every night after dinner. Late in the evening, me and my wife will go for a walk, walk the dogs try to do 30 to 45 minutes, and I know, man, I feel so much better If I miss that. It's like something's missing.
Speaker 1:It really is just a simple. So this is a simple thing. Not everybody, yeah. So so, saying all that, what are what in sports medicine, you know, as it's evolving all these science is evolving? What emerging trends or technologies are you most excited about? You know, I know we talked a lot about a lot of things, but personally, what are you most excited about? Like, what do you see in your lifetime, in your career, really becoming standard of care?
Speaker 2:I'm excited to see what happens with robotics and 3d printing of things. I mean, I think that's gonna definitely have some benefit. I don't know what it's going to be exactly, but it could be potentially huge are you talking about joints?
Speaker 1:are you talking about joints and stuff?
Speaker 2:For 3D printing. It could be biologic tissue, like a meniscus. We've always struggled to make a perfect meniscus and you know I have friends at the top universities that are still trying and you know we're getting to somewhere but it's just a very, very tough one to do. But you know, robotic surgery, that's more for knee replacements and hip replacements, not as much for sports medicine, because we're doing a lot of soft tissue stuff. I think I'm really excited about the potential of stem cells, biologics and the peptides and the longevity stuff. If you listen to David Sinclair, he's a longevity researcher and there's Michael Levine at Tufts University. He's done some fascinating regenerative work there that could be huge implications in the future. So they're working on how to signal your own cells to heal better. That's kind of the whole point of stem cells and peptides. So I think that the biologics part is going to come around and we're going to have better protocols, like my dream rotator cuff surgery five years from now. I do some of this now would be you come to the office, we're going to do a rotator cuff surgery. It's definitely what we need to do. It's the right decision, of course first, and then you're going to get an app on your phone and that app is going to have a multitude of things to prepare you for surgery. It's going to have really extensive nutritional information of like.
Speaker 2:Here's exactly the research on what kind of diets you should eat and really what to avoid. You know. Basically it's mostly avoiding the junk food. Here's how you stay hydrated. Staying hydrated is more important than you think. Here is what you should focus on for sleep. Here's some techniques for getting that. Seven to eight hours. All this stuff is the most important Diet, sleep, hydration and, of course, the exercise. Here's some little exercises you can do prior to surgery to prepare you for it, so you can come out in optimal shape. And then it's also during the surgery.
Speaker 2:There's a lot of things we've done with anesthesia and perioperative care. To improve the experience we've done, instead of complete intubation for anesthesia, we do sedation with a nerve block. It's a little easier on you and we focus on better pain control. Some of that stuff's already happened, so we do all that. You go home the same day from your arthroscopic surgery to surgery center and then I hope that we finally have the research on all these peptides. I would expect that in the future we're going to inject probably BPC-157 or some cocktail with some other peptides right into the repair at the end of the surgery. And maybe we're going to inject umbilical stem cells right into the repair site right after surgery and then they'll come back to the office for six weeks and each week do a peptide injection.
Speaker 2:That's what I would hope that we get to at some point, and that's all dependent on studies showing that those work. If they don't work in a big randomized trial, then we found out we're not going to use them. But I can see a lot of biologics like that. Those are the ones I want to see studied the umbilical stem cells and the peptides in a surgical setting.
Speaker 2:Half the patients get them, half the people get a placebo. Who does better? What does the MRI show a year out from there? We look at everything and if they truly did help, then there's 7 million orthopedic surgeries per year that they might be useful for and they would improve healing, reduce infection, reduce the need for revision surgery and improve quality of life in patients. So if they really do work that well, we need to be studying them ASAP and not just kind of keep kicking them on the back burner and letting the bodybuilders play around with them.
Speaker 1:That's a very interesting insight, because I recently integrated the pre and post-surgical, Because I recently integrated the pre and post-surgical recommendations for my patients protocols when it comes to nutrition, when it comes to supplementation, when it comes to activity All of that is important. I always compare surgery to preparing for a 5K or something like that. You don't just go and run a 5K, you prepare yourself with diet, exercise, nutrition, supplementation, weeks, sometimes months, before you go into a 5K, and surgery not to mention orthopedic surgery, which puts more stress on your body than the facial surgery that I do but it's all in the name of not only better perioperative course but also post-operative healing and recovery, which could significantly change the outcome. So I love the ways. What did you or how did you get into that way of thinking? Because it's completely unorthodox. It's certainly nothing that you were taught or I was taught. How did you get, what opened your mind to this?
Speaker 2:You know I've always, ever since college, kind of been interested in a little bit of the holistic health and kind of alternative medicine. I just keep up on it. You know I was like, well, I want to do what works.
Speaker 2:But I'm always interested in what could there be. But I think, just like you, maybe a year before we talked, I was starting to listen to more podcasts and read more books about all of this stuff and I was watching the US public health. Look at our life expectancy go down. Look at our obesity rates go up. In fact, in the last 30 years I think 30 years ago the highest obesity in any state was mississippi, with like 14. Now there's not a single state that is below 14. Every state is 20 or more and it's maybe in the 40s in some areas. It's like it's unbelievable.
Speaker 2:So I started to see more about that. And then I'm like you know what. Maybe maybe diet, exercise and lifestyle actually does matter more than we give it credit for. And you know, maybe for people I look at my surgical patients and some of them that just do really well and some of them that don't. I'm like you know some of them tell me about their diets. I have one patient and she's like you know, some days I'll eat nothing but popsicles. All day, nothing but popsicles, really, you know I mean it is. It will surprise you how bad some diets are.
Speaker 2:It's like you know we just got to work on some basics here. You know if you can just check out some basic changes. So I started to get interested, just along with a lot of other people. And there's this more discussion about health, about the environment, about toxins in food and just about the poor American diet. All of that thing kind of comes together. You know, making America healthy again, all of that stuff that a lot of those docs and people are talking about. They present research. Now we have the evidence. If the evidence is there, then that's what we really need. And we finally got the evidence about diet, nutrition and lifestyle. So now we can move forward. And I'm just trying to bring it to my patients and say if you're having surgery, this is one of the most important things you're going to be doing. Let's do everything we can to optimize the outcome.
Speaker 1:Yeah, I think talking about the popsicles. That's funny. It reminds me of a quote by Marcus Aurelius. He said pleasures, when they go beyond a certain limit, are but punishments.
Speaker 1:So, it's funny that I have casual conversations with my patients about their lifestyle and diet in preparation for their surgery or sometimes even minor procedures.
Speaker 1:And it amazes me that, even though the cat's out of the back, like you mentioned, just like I we hear it through word of mouth, through podcasts, through the internet there's nothing, that there's absolutely no public health initiative that raised our awareness to these things.
Speaker 1:Like we had to go get that information, either ourselves online or, like you and I, just stumble upon it and then start diving into it, because common sense you can't help but ignore common sense. I mean all our lives we have been asking questions, we have been curious, trying to find solutions to problems. We were trained to find solutions to problems. We were trained to find solutions to problems but at the same time, we were urged to conform to a certain norm, without questioning those that set or postulate or dictate certain treatment regimens and protocols. And then, when we do, we get either ridiculed, we get, either shamed, we get either even nowadays you can easily get canceled or, like in the state of California, you know what the Internal Medicine Society does. If you don't do a treatment that's basically standard of care, If it's not recommended by the Internal Medicine Society. They can strip you of your board certification in the state of California.
Speaker 2:That's crazy.
Speaker 1:It's crazy, that's I mean. So what happened to science? The whole basis of science is to ask questions, to be curious, to question and challenge the status quo. I mean, how else is going to science advance? So I think politics is really spilling into medicine.
Speaker 1:Yeah, absolutely I think you know it's, I don't know. You know, to me nothing strengthens authority so much as silence. And if we don't speak up I don't know who said that, I think it was Da Vinci, leonardo da Vinci, who said that but if we don't ask questions, nothing is going to change. And those people in their authoritarian positions, they're so comfortable, they just don't want to give up their position, and they will defend it at no cost, even if the cost is the demise of the health of a nation. And so I think these conversations are important. That's why I was so excited to talk to you, because I feel that type of mindset.
Speaker 2:Mindset yeah.
Speaker 1:I think people like you are important, at least to initiate a conversation, to bring awareness, and then it's up to the individual physician, scientist, whoever or clinician to let their his or her curiosity lead down that rabbit hole just like it did with me.
Speaker 1:And now it's not surprising with the internet, with the advent of all this information now being out there, all these executive health clinics and preventative care clinics becoming more and more popular. I just had a full body MRI I think the name of the company is Prenuvo and I literally went there for 45 minutes. I was under MRI I think the name of the company is Prenuvo and I literally went there for 45 minutes. I was under MRI. I got a full body MRI functional brain, cardiac, everything. I could even check my prostate. I mean, it's amazing. Within 45 minutes I knew everything about my body. I had that peace of mind. And, as you know, mri there is no risk of radiation. You can do it as much as you want if you can afford it, but first of all it shouldn't be that expensive. Secondly, if the insurance companies really care about our health, if it's truly called healthcare as opposed to what it really is, which is sick care they should pay for an MRI, why wouldn't you?
Speaker 1:And one would think that if we don't have chronic illnesses, that the insurance companies would save money. Right, I mean, but it's not. It's not like that. It's not like that. And I don't know if you were aware. For example, uh the um, a lot of the money insurance companies make is off of the pharmacies, for, for example, aetna owns CVS. So you don't think that's a conflict of interest?
Speaker 2:Oh, absolutely yeah, the pharmacy benefit managers. They have kind of some accounting tricks where they really profit a lot on the drugs.
Speaker 1:And they don't want anybody to know about it. I think it was Brett Buehler who talked about it on the Joe Rogan podcast.
Speaker 2:Yeah, Brigham Buehler went over that whole scheme. I was like is that true? Somebody should really the government.
Speaker 1:Dude, it blew my mind. I was like, yeah, Do the universities, the medical, like the hospitals? Are they aware of that? Or are they putting their head in the sand?
Speaker 2:Yeah, Apparently it's legal, but it's kind of tricky and I just think that somebody should put a stop to something obvious like that.
Speaker 1:No, if it's really going on like that. What is you have your? Do you work for a, a system? Do you work for corporate, or is the business yours? Are you basically the?
Speaker 2:um, we're private. Yeah, so the practice is private. Yeah, we're not working for a hospital. We go to the hospitals and they call up the hospitals and work with them, but they don't, you know, pay us a salary or anything, anything.
Speaker 1:Did you make a conscious decision to go private versus working for a hospital system or one of those big orthopedic companies?
Speaker 2:I always find myself leaning towards, yes, going private. I mean, I would, of course, maybe coming out if there's a really good academic position that was available and you know I would consider something like that and absolutely there could be perks with that. But I definitely was more of a private practice guy to kind of do things my own way and I don't like to have bureaucracy and inefficiencies telling us you know what way we have to do something and you know we want to run a clinic. We want to run a clinic our way in our practice and do everything our way, run our surgery center in an efficient way. So I think it's you could be. Doctors are much better and more efficient when they have to do it themselves versus just relying on a hospital and a bunch of administrators to run the whole ship.
Speaker 1:But it's sad that the trend is going the other way. With all these, you know, um, even even our specialty, a lot of my colleagues have sell, sold to uh, these companies big groups, big hospitals.
Speaker 1:Yeah, yes, and and just because they're tired of running um the companies privately, because there's a lot of work associated with it. I mean, like I wear a CEO hat, cfo hat, cmo hat in addition to being in the operating room and in addition to seeing patients in the clinic. But you know what? I would never give it up for this one reason, which is I don't want a hospital system that is based on some arbitrary reward or a reward system that benefits them, not me or the patient to dictate how I should treat my patients, what the protocol should be, what the algorithm should be. I want to have conversations with my patients, I want to make them better, I want to make them happier. And in your specialty it's even more so difficult because you're actually the first orthopedic surgeon that I know that is not part of a big system that is actually private, because I think all of this started a lot with orthopedics, at least in our area here in the DMV, where these private clinics have been gobbled up.
Speaker 2:Yeah, all the small groups kind of joined into one massive group and you know you just have these big 200 doctor groups and it's a lot of bureaucracy and they kind of tell you how you're going to do things and they're probably somewhat efficient. They're not the hospital. But you know, the bigger you get, the more you lose your autonomy. Of course you know you kind of get told you're going to do this clinic and that clinic. Here's your days, you're going to operate. If you want vacation, tell us two months in advance. You know all those sort of rules where you kind of don't have the control that you want anymore.
Speaker 1:Yeah, I mean, I hope that you keep staying private, because I'm sure you know how do you? I'm curious when it comes to your own health, how do you go by that? Do you have like a primary care? Do you take things in your own hands through like direct-to-consumer lab testing? One of these companies? What do you do exactly?
Speaker 2:one of these companies. What do you do exactly? I've, of course I've gone to my doctor's visit to get all my labs drawn, all the basics, and I added on a couple to check for some you're talking about the 21. You're talking about the 21 biomarkers that they take, which is like our cake I yeah, I do that, of course, you know just check your cholesterol and ask them to check for the mthfr gene to see if I was in a double positive there. You know some little things.
Speaker 1:I look up.
Speaker 2:I've done. I've done some hormone tests, just, you know, not with my primary doctor. There's can you check the t levels and all the basic stuff, um and I. But I really just go by, kind of what I know and how I feel and I'm like, ultimately, I can test as many things as I want and I am going to get one of those whole body mris, by the way, but I just haven't set that up yet. I have a friend that's going to do it. I I really focus on what I know about nutrition. I'm super, super, um, careful about eating a lot of junk food. I used to be bad, you know, I'd always have a bag of Doritos or cheese that's around, and now it's like you know, I've got to cut that stuff out.
Speaker 1:I cut that shit. I cut it out. Cold turkey man I never thought I would be able to do that cold turkey. I thought it's like a process First I'm going to cut the Cheetos, then I'm going to cut the Cheetos, then I'm going to cut the Twizzlers, then I'm going to cut the chocolate.
Speaker 1:I was obsessed with chocolate and M&Ms and I never thought that it was possible, and let me tell you in a secret how it was possible because it wasn't willpower. It was not Most people think it's willpower, it's determination. It wasn't willpower. It was not Most people think it's willpower, it's determination. It wasn't. The only thing I did was I literally cut the carbs and I ate nutrient-dense whole foods meat like beef, chicken, fish, eggs, beans, leafy greens like spinach, fruits, nuts, berries, yogurt. The most processed food I ate was Greek yogurt. That was the most processed food. And so what happened is because I did that, I felt so satiated. My body didn't crave. I didn't have these sugar spikes and insulin spikes, so I didn't have these huge sugar drops, so I wasn't craving anything. So I was surprising myself that I hadn't had anything to eat for eight hours and I wasn't hungry and I was full of energy and I used to have like brain fog. I would like get tired, I would get jittery, literally, like you know, ringing in my ears, I would get hangry.
Speaker 1:Everything went away just by doing that and it amazed me and I actually didn't, even my brain didn't crave it Like the food noise. I call it the food noise. It completely went away.
Speaker 2:I'm with you. Same exact thing. Once we went hardcore on lots of organic whole foods, a little bit carnivore. I would eat a little more healthy meats and just cut out a lot of the sides and carbs and everything you said the fruits and nuts, the berries, the yogurt Yet suddenly I didn't really want to get a lot of the sides and carbs and everything you said the fruits and nuts, the berries, the yogurt yet suddenly I didn't really want to get a bag of burritos at the quick shop anymore, or cheeses. I even had them the other day once. I was like I just have a few of them. I felt like crap, you really, you really don't feel good, I know you don't feel good yeah and you know what the funny thing is.
Speaker 1:You know the funny thing is it's actually not funny, it's sad. When I talk to my patients about it, or friends, I tell them everything. I just told you. You know what happens, what? They don't buy it. They don't believe it. I don't know if they don't want to believe, but they don't believe it. They're like I'd rather die eating Cheetos or a muffin or a croissant than eating spinach. That's how they look at it. That's their mindset. So they don't even give themselves the chance.
Speaker 2:You're right. Yeah, you don't miss it once you're off of it. Our foods are terrible in America our junk foods and fast foods.
Speaker 1:I mean it's almost like denial, because I was a little bit of denial, because I actually convinced myself that I'm doing well, I'm eating well, and it wasn't until I was hurting like I told you in the beginning of the podcast that I went down that spiral of to the point that was getting me depressed. I said I've got to that I thought I could never give up. I literally believed that I can never give it up and I convinced myself I can outrun a bad diet in the gym. So I just hit the gym a little bit harder whenever I was a bad boy eating junk eating, uh, junk, and.
Speaker 1:But that kind of led me to this demise that the only way out was just to eat healthier food, nutrition, dense food and also organic foods, no pesticides, um, um, no chemicals. I mean it was a combination of a lot of things and, yeah you, you get a little bit annoying to people. I know I'm annoying my wife a little bit with my new dietary lifestyle because you know she's always like it's healthy and it's all about that. But I think in her mind, I, or in her eyes, I, I'm, I'm taking it to another level, which is sometimes it can be annoying, and I can totally see that, oh yeah.
Speaker 2:Yeah, you have to be careful with it, like always being a doer, because I'll get talking about microplastics and fluoride and all these things, and I could go on for a while. I'm like you know what? Let's talk about positive stuff but it's good to talk about it once, make the changes and then forget about it.
Speaker 1:You know there's a lot of things. Yeah, I mean, I want to talk about your practice and innovations. You know you mentioned the app that you're helping out with developing and kind of tell me a little bit about that, because I feel that's going to be the future in healthcare. I feel that's going to be the future in healthcare. I think that's going to be the future in how we communicate with our patients beyond them being in our office, meaning when the patient leaves our office, it's almost like there is no communication. But I feel like with this app, it's a way of continuing that conversation, communication, accountability, almost like helping patients beyond them spending time in our office and talking to us when they're on their own and their own homes and kind of like taking things in their own hands and holding themselves accountable and you being able to help them beyond that visit in your office.
Speaker 2:Oh yeah.
Speaker 1:Well, the app started just as physical therapy after orthopedic surgery.
Speaker 2:That was the simple goal for the start of it and I didn't develop it, but I do work with the company that makes the app.
Speaker 2:The most amazing thing has been how much better it's got just in the last year. It's getting so much better with AI and with all the things that are being added to it that it's going to grow to more. It starts out just as a little physical therapy app. It's going to be so much more and, you're right, it's going to be the way we communicate with patients in the future. So what it is is you see a patient in the office and now it's not just for surgery, but it can be for anything for patellar tendonitis, for knee arthritis, for rotator cuff tendonitis. I send them the app, they get a text message, they download it and the main thing it has is daily physical therapy exercises with videos, with instructions and exactly what to do, and you check off the boxes when you do it. It's exactly what you would do if you went to physical therapy no different, except you don't have a person physically there watching you do it, but you do have to check it off on the app.
Speaker 2:And the other good thing about the app it has a whole section on nutrition. It says here are the best things to eat, here are the best diets to follow. Focus on whole foods. It doesn't matter if you're vegan or carnivore, if it's whole foods, if it's organic. That's the goal. The main thing is what you don't eat. Don't eat the junk food, don't eat all the fast food and trash that the main thing. Don't drink sugars, don't eat all the candies. So it tells you all that and it has inspirational psychological advice. It has the quarterback alex smith is on there, who went through a really bad injury, of course, and so did the owner of the company. He went through a bad injury and he's like you know this. We need something to help with therapy. And they give a lot of psychological, motivational advice, because that's a hard part of recovering from an injury is the psychological part of it.
Speaker 1:Yes, and then yeah, that's true.
Speaker 2:And then it gives some nutritional, and then it gives some supplement advice, and it gives some advice on sleep, because we know that sleep is one of the absolute most crucial things to healing. It's when all your growth hormones are excreted and it's so crucial to healing. So it really hits all of those lifestyle factors and pushes those as well, and it's almost something that's good for just everybody in general. If you could just follow the app and it gives you some daily advice like did you drink, did you stay hydrated today? Did you get your steps in? Did you eat a healthy meal? You know just very basic things Did you get your eight hours of sleep? So? And I can check on the app and I can look up all my patients that are on it and see if they're doing everything you know I could just click, one click, and I was like well, everybody who's on here are they?
Speaker 2:did they check off their boxes, or did they have they not been using it? Um, so I think it's. It's. It is a little bit extra communication, for sure too. No, but no, the next generation will be amazing yeah, even the next generation of the app is going to be even more yeah, I.
Speaker 1:I so is available now to to patients or is it only available?
Speaker 2:to your patients in your clinic no, no, any patient any a doctor that signs up. There's hundreds of doctors that use this orthopedic app right now and and anybody that I see in the office can use it. I think you probably. If you tried to download it you, you probably could sign up for it without a doctor sending it to you. Um, it basically acts as a physical therapy. There might be like a small physical therapy visit fee or something to use it.
Speaker 2:I'm not sure how they would do it um, but so as of now it has to be almost prescribed by a doctor for a patient to be able to utilize it and participate yeah, if you want the actual physical therapy exercises and all those details that are personalized to you or a post-surgical protocol, I have all my post-surgical protocols on there and, uh, those are personalized to me and the patients. But if you want just a general app, there are a lot of general health apps. It's like get your steps, get your hydration. Here's some basic meals, those are out there.
Speaker 2:But for the personalized surgical and post-operative protocols, and specific injury protocols and there's also a lot of injury education. If you get the app on, say, rotator cuff tears, you can learn all about them. There's a lot of resources, so it's really kind of like an AI doctor for you. It's telling you all you need to know what you should do, what the treatments are, and it's sort of replacing us a little bit, or it's a compliment. It's complimenting us Amazing.
Speaker 1:I think that's the future and it's funny. I just had this conversation a week ago with someone who asked me why I don't have an app, because I was talking to that person about my perioperative protocol almost like functional health protocol and he was a software developer himself. He's like, do you have an app? I'm like, no, should I? Should I? And he's like, well, it would be very helpful if you have an app, because then a patient can continue, um, to follow your recommendation, um, as opposed to just you telling them here or giving them a piece of paper that they're probably not going to read or throw away or lose in a car or somewhere so I think, I think that is going to be the future.
Speaker 1:uh, the way we communicate, kind of like telemedicine. Telemedicine 10 years ago people would laugh at you when you just brought up the concept, and now we're having a podcast through television.
Speaker 1:But I want to address the elephant in the room here. A lot of people, including myself, were very skeptical and cynical when it came to supplements, because it's not something that you're taught in medical school, it's not something that is advocated as a matter of fact, it's something that's made fun of, that it's not real science, that if it's not a medication or a prescription it doesn't work. Otherwise it would be a prescription, and the reasoning was kind of like with diet that there's no real science, no evidence-based science behind it and there's so many controversies around it. Some people say it works, others say it doesn't work, some say it's actually bad for you, some people are saying it's great for you and so, because there is no consensus, it's really not discussed and not part of a physician's training, similar with nutrition. What are some of your recommendations when it comes to supplementations, as it particularly pertains to an orthopedic surgery patient, whether it is a surgical patient or a non-surgical patient?
Speaker 2:Well, I struggle with the same thing you're saying. Every time I hear about a new supplement, I always want to read the study, like was it a big study? Was it a small study? Has it been repeated multiple times? It is so hard. I'm always skeptical of a lot of supplements that are out there. You go to GNC. I'm sure that a lot of stuff in there doesn't really work, you know, and there's just a lot of money to be made though. So if there's money to be made, people are going to market and advertise and push it. Really, looking into all the supplements I could find, I looked at other people who were looking into all the supplements, and one place I started was, well, you know, brian Johnson, the blueprint. He's trying to live forever. He's the most studied man in the world. You know. He went out and found 75 supplements that actually had clinical data for longevity, and he put them together into his stacks the blueprint stack and he sells it for something like $400 a month.
Speaker 2:So I tell some patients like if you want to be the luxury, high end executive supplement protocol. Here's 75 supplements. I'll put together for you that all of them have some clinical benefit in a research study and it has things like creatine and vitamin D and a lot of stuff that we hear about, but there's also a few other ones that I hadn't really thought about and so like that is your your most extreme, if you want to go that way.
Speaker 2:You know, I kind of in the middle, I'll do athletic greens. You know that's athletic greens is one of those where, um, I think they do have some literature that's just coming out more but it's, you know, kind of a newer thing. But it makes obvious sense. It's like. It's like a really good multivitamin basically um probiotics. I love the probiotic, yes that's one of my favorite things about that. I still do athletic greens, of course.
Speaker 2:Yes and uh yeah and then uh, look at the supplements are the most studied? The behind behind a caffeine creatine is the number one or number two, most studied supplement. Tons of research, not just for physical health but for mental energy, for elderly people. I put my parents on creatine. I tell everybody over 60, or anybody really over 40, I guess say get on creatine Five grams a day, you'll feel better.
Speaker 2:You'll think better. It's even been shown to improve test performance for kids. I believe there's a study on that. So creatine is a pretty obvious one. Vitamin D is a pretty obvious one. 50% of us are low in vitamin D. They've shown that in multiple studies. A lot of people are critically low and we know critically low vitamin D has terrible outcomes for all sorts of diseases. I mean for COVID, for illness, for anything, for your hormones. So I'm a huge fan of vitamin D, of creatine. They have a lot of data behind them and there is a lot of other ones that are in that mid-tier where there's some decent research like they might help with mental function or mental health not something that everybody needs all the time, but something.
Speaker 2:I usually give people a list of about a dozen supplements and I say pick and choose from these what you're really looking for. They're the ones that have pretty good data behind them. One of my favorites is the NAD Plus booster. So that's kind of a newer one that's come out recently. But the NAD Plus boosters I believe we talked about that. You got some of those too. They do have a lot of studies on those that are pretty positive and I know that Peter Tien and Hubert Mann have had a big discussion like a whole podcast on them and it's definitely something that, uh, that I do promote. I tell my patients you know, look into this. If the price point is not too bad for you, I'd consider doing it, at least perioperatively for your surgery, because I don't know that it's something you need every day. But if you're doing surgery and it's going to help you heal better, you know there's some good data.
Speaker 1:I mean, um, I want to talk about the nad plus, which is nad booster. It's just too different. You know people always get it confused. There is the actual nad that you, that people take, are actually infused, because it's a very large molecule so you can't absorb it through your gi so you have to take it IV Very expensive, it's like. I think for one IV session it's like $1,500. And no study has yet shown its benefits. And I know Peter Atiyah actually talked about it.
Speaker 1:And the other one is the NAD booster, because NAD is a coenzyme that your body can regenerate through a pathway and that pathway kind of slows down and that, by the way, happens in your mitochondria. So that pathway slows down as we get older, get distracted elsewhere to repair a lot of other DNA damage stuff, general aging of the cells, like telomere shortening and stuff like that. All of that affects to take away or lower the function and the reproduction of the NAD, our natural NAD, so that slows down. So the other philosophy or the other strategy is to boost our natural NAD production. Those are the NAD boosters, which is basically niacinamide or vitamin B3, vitamin C and NR nicotinamide riboside and NR nicotinamide riboside, and so the supplement that I'm taking has the NAD booster, but I also take the precursor of NAD, which is NMN, which is nicotinamide mononucleotide, which is actually you introduced me to that which I take. It in powder form. I take, I think, one gram now I used to take just 500 milligram, now I take one to one and a half grams sublingual and that's like it's kind of like the raw material. It's a precursor of NAD, because that's more easily absorbable as opposed to taking the actual NAD, which one way to get over the poor absorption is to get it IV, which is very expensive.
Speaker 1:But here's the thing, here's the things. When it comes to NAD and NMN and all of that and NMN and all of that, we don't even know the amount to take that would show a clinical significance or relevance. And if you, because we don't have human studies, the studies that we have are in mice and I think David Sinclair did a lot of these studies on mice. If you take the dosages in those studies, they were given the mice and Peter Attia mentioned it several months ago on a podcast at the Huberman Lab where he said if you extrapolate the dosage of the NMN or NAD you would take. That's equivalent to what they gave the mice where they saw it improves their longevity.
Speaker 1:It would be 10, 20-fold what we are taking, or recommended to take with the one gram of NMN that I'm taking, which is way below that dose. So it's this long leap that we're taking and thinking that that would help. So what I am focusing now more of because of that, I mean it doesn't harm and if you have money to spend, yeah, you might do it. You don't know if it works. So it's not something I recommend, unless you have extra money sitting around and you want to feel like you're contributing to your health, but with the NAD booster to boost your own natural pathway.
Speaker 1:That we have evidence and for that I actually I'm focusing more on the NAD boosters because it's also very cheap. I mean, if you look at the downside, there's no downside, it's only upside. So that's how I try to reason it for myself when I do these things for myself and when I talk to my patients about it. And the other thing is the creatine. The creatine monohydrate is traditionally bodybuilders used to take it. I remember my uncle was a bodybuilder in the 80s and I saw him coming out of gym buffed and he would take this creatine. I thought he was doing cocaine. I'm like what is this?
Speaker 2:He said it's creatine. It's good for your muscle.
Speaker 1:He's like sure it is looked at creatine as for bodybuilders, but there's a lot of studies that show its effects on um neuroplasticity and mental acuity, not just for all the patients. You know, I've been taking, uh, creatine monohydrate now, um, I put it just, and I mix it with my athletic greens. I just put a scoop in there and then just take a concoction and just literally chug it with my athletic greens I just put a scoop in there and then just take a concoction and just literally chug it with my supplements. I'm much sharper.
Speaker 1:I'm much sharper. Actually. I had a hard time remembering a phone number, like if you gave me a phone number, I was like 703, uh, can you repeat the number again?
Speaker 2:and then I could only get three numbers at a time.
Speaker 1:Now it's like bam and I thought I'm getting old, which I was. My mitochondria obviously were not producing as much ATP as they used to, so all of that is the effects to me of the NAD booster. I see direct effect, and creatine is also one of the factors, and I love the fact that you're encouraging your parents to take that, because I feel everybody above the age of 60 should be on it. It's the cheapest supplement you can get and there's a lot of science actually emerging in that. And then, lastly, vitamin D is the one you mentioned, and vitamin D I take it routinely on my patients. On my pre-op labs I include vitamin D I never used to how smart.
Speaker 1:Because I want to know. You know it says so much about the immune system and so much about their healing ability, and so for me, that's one thing I look at, and you want to hear something crazy. You know what the highest vitamin d level was. The whole entire year I've been doing that. What 38 that's the highest that you saw, the highest on my patients to date, and I've been doing it for just this year and you know the ideal is. What was the maximum? That was the maximum.
Speaker 2:What was the?
Speaker 1:top. The top was 38.
Speaker 2:Oh yeah, On your panel. What was the top to be above high level.
Speaker 1:What was the range? The range is 30 to 80.
Speaker 2:And the highest range was at 38?.
Speaker 1:The highest was 38. And so my patient was like yeah my doctor said my vitamin D level is normal and I look at it, I'm like it's 38. You should be in the 50s. You should be in the 50 range. Yeah do you want to be?
Speaker 2:lowest 10th percentile.
Speaker 1:So, thank you. So these are things. So I include vitamin D and you, as you know, you have to take it with vitamin k, because otherwise, yeah, it doesn't, uh, transport the calcium into the bones, right? So can? You talk, talk to. I mean, I'm talking to an orthopedic surgeon here.
Speaker 2:So I want you to tell us that oh man, I haven't looked at that for years. Pardon, but no, d3 plus k2 is the best way to to do it.
Speaker 1:Um, but I mean the so does it work when you just take the vitamin b? Vitamin d, does it work or doesn't it?
Speaker 2:yeah, it does, but it doesn't absorb quite as well. I think you just want optimal absorption, um, but yeah, all the biochemistry of of all of that you know I haven't looked at all the details for a while, for quite a while, but we know, obviously vitamin D is very important for bone health and just for overall health in general. There's so many things that affects. So, yeah, that's a big one for me and I will often just prescribe it to patients because sometimes they're like, oh, I don't want to go get actual blood drawn right now. I just see them in the office. They have an injury, a fracture or something.
Speaker 2:It's like just start vitamin D, you're not going to overdose on it. You know I'll start them off on a fairly reasonable dose and then about, and then they come back three months later. It's like oh yeah, my primary care check my vitamin D, I was really low. There's so many times where their primary care half my patients at least say that oh yeah, I'm on my primary care, check me, I'm way low. So no, that's one of those just no-brainers. Vitamin d, for sure. Omega-3, omega-3 fish oils too, that's another one, and magnesium is the other one magnesium right, absolutely magnesium.
Speaker 2:There's a lot of data on magnesium. You know so um, again, um lot of data on magnesium. You know so um again, um, I, you probably have a. You have a. You have a very good specific protocol that you give everybody, or do you kind of give them a list of? Yeah, so that's a good so, so I don't.
Speaker 1:I don't do the shotgun approach like, um, you know, give them everything under the sun and I mean you could do it. Uh, like, yeah, you want to take brian johnson's for like 400 a month. If you have that type of money, that's great. I I do it very targeted. I take roughly about 100 blood biomarkers and I look I.
Speaker 1:And then I tell them to record a food diary for two weeks. That's great. And then so I look at the food diary for two weeks, that's great. And so I look at the food diary together with the blood biomarkers, the labs, and then I look what their deficiencies are and then I have conversations about how they can improve that with, simply, diet and nutrition and sleep and the four horsemen of longevity.
Speaker 1:And then I add supplementation to get them to where they need to be, at least preoperatively, because you can't teach an old dog new tricks in four weeks, right, but I can optimize them. But I can optimize them. And then I let their own transformation speak for itself and motivate them, because they come to me and say, oh my God, I feel so much better, I'm not tired anymore, I'm not craving. Essentially, everything I went through, I see my patients go through, and then postoperatively, when they look better, let's say I do a facelift or something. They already look better Now, they feel better. Now, matt, they're all in.
Speaker 1:Not only it transforms their lifestyle. I called it the longevity facelift. Part of it is the facelift, but you don't have to have a facelift. You can just have a simple I don't know eyelid surgery or brow lift, something really simple, something that you look in a mirror.
Speaker 1:You're like, oh, I love the way I look, I'm happy now, and then I combine it with just physical health and wellbeing, and that really gets them on the bandwagon of the longevity bandwagon, and so I look at it as a complete transformation, and whether you want to call it a holistic approach, which people like roll their eyes on it as soon as they hear the word holistic or functional. I call it really functional aesthetic medicine because it's functional health combined with aesthetics, which is all about self-esteem, self-confidence, self-worth and, ultimately, one's happiness. And so I'm so happy that you sent me down this rabbit hole that I'm able now to transform my patient's life, and I feel good about it because I feel I'm doing the right thing. I'm doing what we're supposed to do. I'm doing what patients deserve and they come to us and trust us for it.
Speaker 1:And it shouldn't be some influencer on Instagram that doesn't even have a science degree giving health advice or recommendations on this, which there's so many of them out there confusing the consumer because they don't even know how to interpret a scientific article, not to mention they don't even look at it. They just read a headline in a news article. That misinterpreted an article, because they just read an abstract and they didn't even know how to interpret it, and that's how rumors develop and confuse the public. And then you listen to it or read it. You're like what are they talking about? And then you go read the study. Did they even read the study? The conclusion is completely opposite of what the study's conclusion was. How could you be so blatantly either ignorant or lying? Could you be so blatantly either ignorant or lying? So I think we have to be the ones to be at the forefront and not just some tiktok influencer or instagram influencer.
Speaker 2:But there are a lot of good, uh, good, uh, there's a lot of people out there, but there's something you know just wanting the clicks when it comes to orthopedic surgery and sports medicine, I want to hear you talk.
Speaker 1:I don't want to hear someone that has a degree in physiology talk about giving me orthopedic or sports medicine advice, even though they might know a lot about it. But it's different that it comes from a clinician, someone that actually treats patients and sees results and is able to contextualize everything.
Speaker 2:Yeah, absolutely, you said it perfectly. There We've got a doctor. We can't just be technicians that are surgeons, that all we're doing is a technical thing and, hey, let somebody else worry about your health. It's very important for us to be guiding them through that perioperative journey, and I love what you say about the lifestyle factors of your patients. They buy all in on it, and I've noticed that with some of mine too, where they've really taken to the diet, the protocols, everything, all of that stuff, especially with the app as well.
Speaker 1:So I was wondering if that's the way to go. For you weight loss. What impact does weight loss have on your patients? I mean that must be huge.
Speaker 2:That's the biggest thing in my clinic. All the time I have patients that come in and they have knee pain and they're also 100 pounds overweight, and we all know, from the moment they walk in, the real cause of their knee pain, and I can give them cortisone shots until the end of time. You know, it'd be a band-aid though, and it's not that great form, and so I really have to have the conversation. Like you know, we're going to have to address the real issue here at some point. We have some strategies. It's not just people don't want to be told, hey lose some weight, why not?
Speaker 1:What is wrong with that? What is wrong? I thought that and I actually you know how I ended up including weight loss or weight management in my practice Like I would be the last person. I couldn't take patients to the operating room if they were above a certain BMI because my anesthesiologist would say it's not safe, right, which I agree.
Speaker 1:So, then I had to tell the patient I'm like, look, you need to lose weight. I mean, I don't want to do a facelift and kill you, so you need to. And, by the way, if you are like 40 pounds or 50 pounds overweight, you have metabolically you're not optimized. There's no way you're metabolically optimized. You know there's some degree of insulin resistance. There is, you know, all this adipose tissue that causes inflammation, and then not only I will have to deal with all that stuff post-operatively, but you'll be frustrated.
Speaker 1:So I don't want to send you on a journey, um, that is doomed for failure. Um, you come to me, you. You came to me for me to help you, so let me help you. And so first thing is first, we need to lose weight. And patients were like well, I've tried, I've been doing exercise. It's almost like helpless. They don't even know what to do and no one ever told them that it's their diet. No one even gave them health advice. So that's how I started then, getting involved in it. So are you integrating weight loss and management in your practice? Have you considered it perhaps?
Speaker 2:Oh yeah, I always anybody that will listen. I mean some of the patients they want to lose weight they say I'm trying, I need help. Some people there's always an excuse, it's like I can't, you know. And the people that really want help, I definitely integrate it in. I do have a colleague who does a telemedicine weight loss and they'll do all the Ozempex and my gluteus and all that stuff. Yeah, so I mean there's probably a role for that. I mean it seems like it's getting you know pretty hard right now and I mean there's definitely some benefits to it, but there's also some concerns long term. So but I think it's probably a good thing right now, you know we can have a whole discussion over oz and peck and all that.
Speaker 1:But I know like the craziest thing is. The craziest thing I heard is about. Sorry to disrupt you, but because you mentioned you know there's two sides of it. I mean, um, yeah, did you told me about the recent recommendation of the um um american?
Speaker 2:they had me pediatrics.
Speaker 1:Yeah, can you can you tell my, tell us about that. What was that about?
Speaker 2:yeah, I think it's for for kids. They're obese, they basically above a certain age I can't remember the exact age. They basically recommend Ozempac for life. They say that is our recommendation for children with obesity that maybe tried a little bit of nutritional stuff. I don't remember the exact wording of the recommendation, but I've heard that it basically says above a certain age, say maybe 12 or so, we recommend Ozempac in kids as a primary treatment for obesity, not like changing the diet or doing all the conservative things, but that's for life, basically, as long as they're overweight, for life.
Speaker 1:That's the American Academy of Pediatrics.
Speaker 2:Yeah, it's kind of wild. It is kind of wild, but that's just what they say. Yeah, I mean $1,000 a month for life.
Speaker 1:Yeah, and you know, as we know, most of the population are not the affluent population and the population that can't really afford. But I assume they are pushing that so that insurances start covering it.
Speaker 2:Oh exactly, there's a special bill in Congress, I think, for Medicare to cover it or Medicaid to cover it.
Speaker 1:See, that's incredible, that's like almost abusing the power of a peptide, instead of doing the right thing teaching them what to eat and how about getting rid of all these ultra-processed foods? How about putting pressure on the food industry? Uh, instead they're recommending um medications for life, whether it is peptides or medication for children age 12. That is crazy, you know, uh not any different than pushing vaccines like covid vaccines or flu vaccines for children.
Speaker 2:Yeah, we're the only country that does that, and all the European countries are like no, kids don't need all these COVID boosters. But here we'll be, recommending every kid six months, if not forever. Look at the money he's making money on that.
Speaker 1:But that's where the medical paternalism from our societies is trickling down and putting pressure on us and I think, something has to really change at the higher level.
Speaker 1:Either that or the patients have to just get smarter, and I think already a lot of patients have lost trust in the medical system, in doctors trying to self-diagnose themselves on Google and not following doctors' recommendations when they should. And it's important to go to your doctor. If you have a traumatic injury, if you have cancer, I mean, for those things you need, we have therapies that can help. But the thing is, because patients don't trust us anymore or lost trust because of all this controversial and ridiculous recommendations, it's not surprising that they don't trust us anymore, and I think for us to regain their trust, I think we can't treat them like I'm sorry idiots anymore. I mean we have to treat them with respect and we can't insult people's intelligence anymore. I mean, the cat's out the back.
Speaker 2:Yeah, our leadership needs to. You know, admit when they get things wrong and say, hey, you know, this was definitely wrong here. You, you know the way we did some certain things during the pandemic and you know if there was ever a recommendation that got reversed. Like you know, medical reversals there's so many medical reversals that have happened and like one was estrogen. I think that marty mccary was talking about that, or peter. Yeah, yeah, no, it's marty, yeah, no, that was Marty and Kerry about.
Speaker 1:HRT and that the study was the Women's Health Initiative, the WHI study in 2002, where the study itself concluded there's no significant significant risk risk for breast cancer. And then they said the opposite and the media ran with it and all the authors, the co-authors that were involved. They weren't even asked for the opinion, they didn't get a chance to review it. Some of them were so pissed that they actually left and others that raised their concerns they were literally fired. All because of ego and political power to send a generation a devoid generation of women from hormone therapy.
Speaker 1:And not only that, increased their risk of getting stroke and heart attack by up to 40% because they didn't get their hormone replacement therapy within the 10 years in their post-menopausal period, where it actually yields any matters and yields benefits.
Speaker 1:So you see this stuff, you're like who do you trust these days? So I really hope that I'm so happy that we have the platform of podcast where we can openly discuss, without any political or financial incentive, just transparently discuss where we are, where we should be and where we think we're going to go. And I want to thank you really so much again, uh, for uh opening my eyes and now coming onto my podcast and just uh chatting for um, almost, yeah, an hour and 42 minutes already.
Speaker 1:Uh not including our pregame show, oh yeah, which makes it two hours Um Monday night missing Monday night football. So I really appreciate that and I hope to just talk to you on a personal level on a lot of the things that you're doing and we can kind of share ideas and I'm really excited to one day perhaps work together on some of this stuff.
Speaker 2:Absolutely. It's been a pleasure being on with you. I love what you do. You really work hard at this and it's amazing how well you've done with this podcast.
Speaker 1:Thank you. Thank you, my brother, and I want to thank Dr Matt Thompson for coming on to my show. I hope you enjoyed the show as much as I did. I hope it was as eye-opening. His insights were as eye-opening as they were for me and if you have any questions, where's the best place for my audience to reach you, Matt?
Speaker 2:Oh, precision Orthopedics wwwprecisionorthopedicsmdcom. That's our main website. That's how to get in touch with us. I also have a LinkedIn profile, matthewthompsonmd, for any work stuff.
Speaker 1:All right, guys, you heard it. Have a great night and please don't forget to leave me a review on Apple iTunes and put your comments and questions in on Spotify, and hope to see you next time. Bye-bye, bye, thank you.