#945 - Dr. Roddy McGee

Apr 12, 2017

Dr. Roddy McGee is a Board-Certified Orthopedic Surgeon, fellowship trained in Sports Medicine and is part of the Total Sports Medicine Center in Las Vegas, Nevada.

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org number 30 30 we're also brought to you each and every episode is the last one each and every episode by on a.com if you've never heard of on it before if you know my podcast you know this commercial so I'll try to make it as brief as possible on it is what we call a total human optimization company our goal at on it is to promote an ethic of self-improvement to inspire people to go out there and do their best and to provide you with all the information and all the tools to go do that

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I don't do podcast without it I don't do the UFC without it I don't do stand up without it I'm a fucking dummy without it how about that on a.com oh and it use a codeword Rogan and save 10% off any and all supplements God how we did it my guest today is my friend dr. Rodney McGee I know many of you have heard me talk about the stem cells treatments that I've had in Vegas and I got them through dr. McGee and his company and his his Clinic rather so without

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he further Ado interesting podcast fascinating we talked about a lot of cool shed a lot of Science and up-to-date with all the latest and greatest technology and Innovations and breakthroughs when it comes to fixing injuries and shit so give it up for my pal dr. Rodney McGee

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hello ladies and gentlemen hello dr. McGee that sounds not me ping if you're hearing that you like what is this is this a podcast in a bathroom no that's coffee how everybody good thank you for having me thanks for being here for folks who have heard me rant and Rave about the Fantastic results that I have had getting treatment on my shoulder where I was that close to getting surgery it's this gentleman dr. McGee who has who's fixing

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to me up out of Las Vegas Nevada and now we're going to talk about it yeah I appreciate the chance to be here why do you remain a very short words today he's very talkative before the podcast folks that's how girls but now I'm hearing myself and I was a weird amount yeah we took them off we took them off as too weird never done a podcast like this for our you did John Donley's yeah not such was excellent we could take it off I might have to okay let's take it off I don't want to freak you out that better this is a little more like a normal conversation I don't want to freak you out to me it's

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better because like I can hear like if it's things are wrong what's what's the notes Daddio we got there just a couple of things I jotted down just make sure gives you all the information you want to hear well I just want to tell you that I feel super fortunate to have met you and to have been treated by you and to be able to have these conversations with you and your office which is why I wanted to have you here to talk to you because I mean I was having some really significant shoulder issues before you treated it and it's amazing the results and

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what you know I mean what what I've avoided avoided and shoulder surgery

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yeah I mean you've had a tremendous result so obviously we're very thankful that you're able to get that benefit and I think were in my community of Orthopaedic surgery and Sports Medicine you know we're very excited about the possibility and eager to continue to learn about it and see what it can be and how it can help and what it does best for what now where's all this stuff coming from like Witter where is this science coming from and how has it evolved over the last few years well a lot of the stuff that we're

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using is not new in terms of the tissue or that type of thing but it's actually the application for Orthopedic Sports Medicine so you could go back decades to when it's been used in plastic surgery for corneal ulcers is one of the original applications of placental tissue so the idea of it isn't necessarily new it's just that as we've gained more understanding in our community of orthopedic surgery

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hurry now we're starting to see what the applications can be now when you say plastic surgery like what have they done with it with plastic surgery mostly helping with wounds so that's been a big application wound healing and the potential for there to be wound healing without scarring so that's that's one of the things that we'll get into how do they do that it's part of the mechanism of how the cell helps the process of the healing so but we'll talk about that for sure now when they extract the placental tissue

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like how they're doing it on young women who have had cesarean sections Crasher so bypasses a lot of the ethical concerns that a lot of people had during the Bush Administration well let them okay so lets you set a couple of different important things okay so let's start breaking that down a little bit so the first thing is you know where does it come from it comes from a young healthy mother in this case what we're talking about this particular category of biologic treatment or cellular tissue this

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comes from a young healthy mother that's having elective C-section and prior to the delivery has agreed to make a charitable donation and then they have been screened and there is a process that must be followed by the American Association of tissue Banks and they have a series of blood tests that they have to go through and so you're checking to be sure that there's no communicable disease you know for example hepatitis or HIV things of that nature and so once that has been

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cleared in there an acceptable donor than they go through the delivery the tissues collected and as you said this is stuff that typically would go in the garbage so essentially the you know the ethical and the moral dilemma shouldn't exist for that portion of it because you know otherwise it's just garbage now that's taken by the company that has harvested and they have their processing center which also has

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has to be evaluated and approved by this aatb American Association of tissue Banks to be a facility that is up to their standards so they have a sterilization process the tissues not contaminated their packaging is appropriate that are you know they're shipping is not causing problems with the tissue so if the meet all these standards is very stringent and so if you have that if a company has that approval then you know they meet the standards allowed so that that

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stuff can then go either to an office or to a hospital

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so now the next thing of what you said let's talk a little bit about President Bush and that whole discussion so first of all that is about embryonic stem cells okay an embryonic stem cell and that's you know that doesn't have anything to do with what we're doing and embryonic stem cell is when the the sperm and the Egg join and begin to form the beginning cells of life

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there's initially two cells and then it divides into 4 8 etcetera in the first five days of life that's called a blastocyst and those cells can be harvested and they are what we call totipotent that means they can become anything they have the ability to transform into any line of tissue or organ or in the case of that first five days of Life those individual cells can actually become a

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complete organism so that's that's where we had you know the cloning of the sheep mmm so that's what happened so they took the cells in that first couple of days and then they move on process to allow it to continue to grow and and so you had two different from a single sperm and egg you had two organisms complete mammals you know created So when you say this blastocyst is as I said that's just the term for the initial you know the ball of cells that's formed

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how many cells is in a blastocyst well they're dividing over the number of days and doubling each time so then you know five to ten thousands not by that time know hundreds you're 16 you know 32 so if you have 32 how many different organisms can you make off of those 32 cells technically if you have a totipotent cell every individual cell has the ability to become a complete organism whoa so that could be one blastocyst could be 32 different people I guess potentially wow I don't know if that experiments been carried out

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out but theoretically lyrically yeah wow so now when they have like frozen embryos and people do things like that when they decide they want to have kids later in life and they freeze their embryos how the hell are they doing that what's that about and I'm not like a reproduction okay actually so we might be getting you know about those Buzz Frozen embryos a lot of times they don't get used right I don't know that I don't know how that works because I know there's been battles like people that battles with their ass

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guys and share a little bit of stuff yeah it's very much the my understanding of it would be that if you're you know you're freezing it with the intention of maintaining the cell viability and so somebody has demonstrated that you could then thaw that cell and it still has the opportunity to divide produce and you know become a living thing wow I was thinking like for the non-viable ones or the ones that don't get turned into people they could probably use those as well right well that that's a big that was the thing

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right that was a big George Bush thing well okay so let's back up on that because I think there's a lot of misconception about that and I hear like very strange comments made about it all the time in the media so the thing that George Bush signed in 2001 stated that the federal government was not going to supply money for embryonic stem cell research that's it it was not a ban on the a politician on stem cell research so for all of that time I mean private

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Equity companies in any private investor could have and probably has been spending the money to continue to research that and and develop it and find it so I always find it interesting when I hear on TV oh like the our country has been set back a decade because they signed this you know Bill like so you feel that's wrong yeah it's so but all he said was we're not going to dedicate Federal money to it right that's different than a ban on any study but how much research does

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on federal funding no no I mean there's there's private funding for all kinds of things is it more common now than it has before or has it always been the case well the private funding so President Obama in 2009 lifted the ban on the federal funding so Federal funding has been going on for it since since then interesting yeah so what is the difference in terms of the viability of placental stem cells that you would get from a woman in a cesarean section versus something that you get from a blast

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Jesus well so a couple of things about that one there's it's actually to our benefit in Orthopedics not to be using that line of cells because those cells starting from that time Point have the ability to have teratogenic potential so what that means is they can potentially form tumors so that makes it obviously a big disadvantage

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because now we're adding our risk to what we're doing once they've gotten to the point where it's a part of the whole you know we call this like a human placental stem cell or mesenchymal stem cell and that includes the placenta the umbilical cord the Wharton's jelly is a mucus type substance that surround the arteries of the umbilical cord the amnion or the amniotic sac which is the inner layer around the baby and then the outer

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layers called the chorion now all of that has cells in it that we would put in the category of mesenchymal stem cell we're mesenchymal stem cell now what that means is they have a specific line of tissues that they can become so now back to when I was explaining the the formation of the the blastocyst becomes a Moria Le becomes a an embryo eventually so in that process

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you have this ball of tissue and then it starts to kind of fold in on itself and then it starts to layer out into these three layers you have endoderm ectoderm mesoderm the each of those kind of is directed towards a certain line of cells and tissues the the mesoderm and what these the mesenchymal stem cells can become are all of the things that we care about in Orthopedics so cartilage bone muscle ligament tendon so we have

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whole line of cells that this particular cell has the potential to become so when we talk about a stem cell the by definition what it means is one it can divide and become another stem cell so it can it can duplicate itself so that now you have another cell that can divide and become another cell or it can divide and differentiate into a cell that then

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has the characteristics of the things that you're hoping it will become now that's a directed and ordered approach in embryology and in the case of treating an injury what we're hoping is that that can differentiate into the injured tissue and how long have they been doing that

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while studies on that have been going on for at least 10 years so I want to say maybe back as early as 2007 now we've been if you go you know way back to the early days of arthroscopy and that would be like the late 70s and early 1980s and I don't know exactly what year you know he would have started doing this but dr. Steadman at

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at in Vail Colorado and he was in Reno and Lake Tahoe area before that they would this he's the one that developed microfracture procedure I don't know if you're familiar with that you've had a couple of knee surgeries so I know if you've heard that term but I have but I don't really recall exactly what it is sure so basically if a patient had a small cartilage defect he took a small an all or like what looked like a tiny little pick and made a puncture

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to the Bone and what that did is it releases marrow elements along with blood and they were able to see with time and you know there were occasions when they got to have second look arthroscopy that that cartilage could fill in now they also found that that didn't become the native cartilage it becomes something called fibrocartilage so when you look at it under a microscope it looks different compared to our normal cartilage yeah appearance like physically looks the same but under the microscope looks

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different what is the difference well the main difference in what's applicable is that it's doesn't have the same structural properties so it was more easily able to kind of come off with a Shear Force so just picture like what sighs door opening yeah you could kind of flake off or or in some cases just didn't form as well as you know you would want so so that experience and I

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you know having conversations with the the guy that I trained with his name's Larry Lemak in Birmingham he noted just over his career that he always felt like patients that had worse arthritis but they would do this microfracture procedure on in knee arthroscopy actually would do better than patients with less arthritis but that they didn't do the procedure and so it had always been in his mind that that somehow that marrow stimulation was was providing something that was helping with either healing or pain relief

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and it's only now that we start to understand you know because the bone marrow has some of these as income will stem cells available also and we'll kind of talk about the differences and stuff like that so it's essentially like a crude version of some stem cell transplants like yeah I think that's probably that's a good way to put it yeah I mean our hope is that we're we're using cells that can again change into other things that we want and when do they start applying this on people like in terms of

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just tests and studies but actually in practice like what you do well in Orthopedic Sports Medicine I don't think I started to hear about it until around 2012 so that was the the first year that I was in practice and I attended a conference in Las Vegas and it was called the emerging techniques in Orthopedics so they were kind of talking about what's the newest and you know

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most forward-thinking ideas that are coming through so a company presented and in one of the Physicians presented information showing that they had harvested fat tissue from patients abdomens and injected into their knee for patients that had knee arthritis and they were showing new growth of cartilage and actually Improvement and some of the x-rays so when you look at an x-ray

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there's some characteristics that we look at that you know Define what arthritis is so patient has narrowing of the joint space or they have bone spurs things like that they were actually seeing more space between the bones on some of these serial x-rays so you know I saw that and that was just like so incredible and something that I never heard about read about or you know had encountered before and that's really what kind of sparked my interest and what are they doing with the fat while because I've heard that they do SM

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to harvest the fat similar to like a like a mining liposuction right and then they're you know they either spin it in a centrifuge or there's a there you know these syringes that you can pass it through a filter and then you re-inject it and and what you're trying to do is is again take advantage of the fact that there's these mizenko male stem cells in the tissue and like what can they just are they just taking the fat like when they spin in a centrifuge like what does that accomplish just separates out the

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cells so then you can you know inject the portion that you want until we do that it usually had it with PRP yeah yeah so it's just I've had it with Regina Kane which is like a form of PRP correct yeah with a heated up and right take lie becomes like a yellow serum right so whether platelet layer of the blood that you're looking at okay yeah and so the red cells separate out and you can you can easily see that in the tube and what is the difference in the results from someone who

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ooh does that because I know quite a few people have done it that way they've had injuries treated for they suck the fat out or there isn't any any research to differentiate like one of these treatments versus another yet it's just not available so it's all anecdotal its terms of like talking to Patient it's happening I mean people are collecting the data but it's just not you know it's not at the mature stage where you know where it's available and we have you know published stuff to look at in about personally know of anybody who's had really

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results using the fat method Yes actually physician friend of mine in Memphis Tennessee her name is dr. Laura Lenderman she has utilized that quite a bit and she's been very happy with the patients that she's treated and naturally some people do better than others but right you know the real the rigorous study of this though is still yet to come hmm it's that's really fascinating like do have you considered trying

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that or you just definitely yeah but you don't so far you just do the stem cells haven't had anybody specifically request it and it's really wants to lose a little fat and fix her neighs yeah I mean that's that's probably taken things in a direction I don't want to be going but but plastic is there are we know you know there are a number of different options in terms of where these sources of the cells can come from bone marrow is certainly had a lot of use and Daniel needs to be had

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done let's say he told me yeah he had a pulled out of his hip and he said it was brutally painful then he was walking with a limp for like two weeks it's obviously it's a procedure there's pain and there's you know morbidity there's a consequence to you know putting a sharp object into the bone and drawing that were barely yeah so that means a bad thing I don't like that word it's we don't like it either in medicine morbid is about word we have conferences called morbidity and mortality and that's where you basically

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Lee own up to things that you've done a terrible job with or explain you know why somebody has died as a result of your care and it's a awful thing to go through and it's critically important to be able to evaluate yourself and understand what things happen when they don't go the way that we want them to so it's an important exercise that Physicians go through to you know review cases are totally imagine yeah I mean especially if you're dealing with people that are broken apart I mean essentially as an orthopedic surgeon

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you're dealing with people's bodies of failed right yeah limbs of failed ligaments of torn off the bone knees of exploded I mean you've told me some gnarly stuff in terms of the kind of injuries that you've had to treat and I could only imagine some of that things yeah and so your time doing this with placental stem cells how long have you been doing that it's been a couple years so essentially you did mine I think

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how long ago was it was July of 2015 yeah so I kind of came in pretty pretty early yes Jeff Davidson did Doctor from the UFC he was the one who told me about it because he had shoulder surgery and he was very stiff and had real problems after the shoulder surgery and was just very unhappy with his range of motion and the pain that is experiencing and then he got some stem cell treatments and it just all went away and he trains a lot yeah trains really hard and and he's very fit I was pretty impressed with

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you know what he told me about how he was what he was able to get back to you after you know he had been treated with that type of injection yeah yeah so he told me and then I was like on the fence I mean I'd seen an orthopedic surgeon the only thing that was keeping me from getting surgery is you know he put me through all these stress tests where he pushed down on my arm and all this too and I resisted all of them he's like this is It's kind of odd that your injuries this bad but you have so much strength in your

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joint still yeah like maybe you should hold off a little bit before you get the surgery he's like because I thought that when I examined you too because I really couldn't reproduce your pain yeah so and that and that's that's another reason and I probably would have been in the same boat as the first guy in terms of you know trying to make a decision about surgery because you know if your physical exam doesn't you know show that somebody has some significant deficit it's it's hard to make the jump

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to take some of the surgery well during normal everyday life there'd be like zero pain right problem is what I put my body through is has nothing that resembles normal everyday life and change your Jutsu and kickboxing and kettlebells and archery and yeah this is so much explosive movements and so much weight bearing movements and it is you're doing really high demand stuff yeah so in that in that case that was one of the reasons why I was thinking like I don't want to walk around with a compromise body I'm like if I have to just get

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surgery and then take six months of rehab or whatever it was like what is the for a type of shoulder injury that I had what is the rehabilitation time you know for sure probably three months I mean it can be longer than that it depends on the patient somebody like you that one of the things that we

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have trouble with with some patients they've never even lifted weights for example oh yeah so for them the rehab recovery and Rehab we're introducing things to them that they've never seen or done right and they don't understand the difference between you know being sore and and pain that's that they should be conscious about in challenge it's hard work and it's uncomfortable and so some patients you know there they struggled to get through that part of it and a

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we will take longer to improve so it's harder for them to get their motion it's longer much longer for them to return their strength now you already have like a significant Baseline level of strength so you know much easier in your case to bounce back and then also the things that you would do in rehab there so rudimentary you would move through that very quickly and then once you're at the point where you have had enough tissue healing and it's safe to progress you you know through higher level

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sizes then you could really push it and you would you mean you would be committed to it dedicated diligent I mean we'd almost have to hold you back yeah that was another question I had how often do you have people wear that is the the issue like I know you've treated a bunch of Fighters and when you treat MMA fighters is that an issue where you're trying to like slow them down go all the time you got to let people know like and one of my you know one of the lines that I'd say to all my patients regularly is you got to respect biology

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like you have to allow the healing to happen I know you feel good I know you're moving good and you're ready to go you want to be back on the court on the field things like that but if we don't take the proper progression you know we risk having you reinjure then you're right back in that same boat we don't we only want to have you miss the most limited block of time that you can so I never want to I don't want people to miss one more practice game you know match workout or whatever than they have to but see

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same time we don't want to put them in a situation that's unsafe so it's always it's a balancing act so in your time of doing this have you had people that didn't respond to this particular type of therapy yeah definitely yeah and were they the people that we talked about before that don't exercise and our nominee or is it across oh or you know I would have to go back and look and kind of critically evaluate each case certainly you know we worry about the patient that has lower like base

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line Fitness like their overall health is poorer you know and what their response might be but I think that's information that is still you know to come but definitely I mean some of the people that have responded the most dramatically like for example you and John Dudley I mean you guys are fanatical about your nutrition your working out regularly you're doing all kinds of things to optimize your chance to not you know in this case he'll

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but in other instances perform and I have to believe that that has you know that's a huge Factor yeah I would wonder what how much of a factor it is if your body is conditioned in a way to constantly generate muscle tissue breaking down and rebuilding and sure it's always constantly under stress definitely has to be a part of it mmm you know I think it's it's not the typical realm of my specialty to be looking at all those other factors but I

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I think with all of the information that's becoming available one of the cool things for me has been it's forcing me to have to learn about it it's forcing me to have to take a look at you know how can we do better you know what are we ignoring and I think if you're not looking at every aspect of that wheel then you're missing a chance to do as good as you can for for each patient and it might be things that we have to do before somebody even has treatment we may have to bring them up to some baseline level with a number different things

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you know and so and the other side of it too is we're we're in a were in a system now where there's so much information you know one person can't be your source for everything so you really have to have a good team all around you I think that's really important so is that I find myself more and more seeking help and just saying hey I just don't I don't know enough about this like can you can you help me with this or explain it better or right you know can I have the patient talk with you and

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he gets more information and I think that may give them even better chance to do well just because the options and the possibilities are so comprehensive and time mmm so you know in a typical Orthopedic practice you don't have a ton of time to go through all of this with every patient and so you just have to make sure that you're providing resources and and getting them as good information is available one of the things I thought was interesting you were telling me that there's been really good results with people going into a sauna directly after treatment

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well I don't know that there's been good results I think it's it's interesting and the things that you've talked about for other applications in terms of heat shock proteins you know there's some belief that that may either assist the cells and proliferation or their ability to you know have as robust a response as possible you know that's not proven that's that's hypothesis you know but I think it's interesting and again it's it's falls into the category

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the glory of a lot of these things that we're talking about where the science the basic science is there like we understand how it happens in embryo in the developing child we know what it does in a lab like we can add these things to a petri dish and watch it watch these changes happen but nobody has demonstrated this in a human in a clinical trial where we're treating an injury right so we have to be very careful about that and that in fact the FDA is very clear that you know we cannot be making those

► 00:38:00

claims companies can't be making those claims about their products and Physicians cannot be making claims and marketing their practice to drive people to them stating that these things are happening now when you talk about heat shock proteins I don't know if you can answer this question but is there a difference between the Heat shock proteins that you receive from say like a steam shower like a steam room versus on versus even a hot bath I've heard people saying that you get heat shock proteins from a very hot bath and I

► 00:38:30

you would have to there would have to be some kind of biopsy or blood test and you know sample like have people go through each of those things and control for all those factors right the whole idea is just being involved in an environment that's extremely hot what your body is like what is this guy doing and then it produces the heat shock proteins try to compensate you as a protective mechanism so that just though the knowledge of this I mean this is really interesting because people have been using saunas forever and it was all sort of anecdotal okay

► 00:39:00

Sana makes me feel great and and I would look at him like what are these assholes doing they're going to go in there and sweat I always thought it was people that were just like lazy and they didn't want to lose weight and so they went to Saint and they thought they lost weight wet it down yeah I really did think they're just dropping water but talking to dr. Rhonda Patrick and she was explaining the benefits of sauna where there was one study where mortality decreased 40% from all causes through think I literally asked this on

► 00:39:30

all cause mortality was less yeah 40% here it is right now using this on a four to seven times per week associated with a 40% lower at all cause mortality might be heat shock proteins science daily.com fascinating stuff I click on it click on it young Jimmy here we go so skillful are that's I mean Journal of American Medical Association so serious stuff right I mean that it's a peer-reviewed journal yeah

► 00:40:00

yeah you can assume that there may be some validity of the information amazing yeah I mean if that's correct if if all I have to do is get in the sauna and I you know can decrease my chance of death from old all diseases by 40% like yeah I'm home honor heart attack okay me amazing here's what a suitable replacement hot bath won't be as robust but can increase blood flow of a heart rate and cleat increase heat shock proteins so she saying it just won't be as robust

► 00:40:30

she's never taken one of my bath so you know a simple thing to find out or like what you could do yourself is check your heart rate blood pressure temperature you know just like just take those is like a nice line right after each of those you know sessions and see if there's difference how much does your body temperature elevated during those things and how much of it is a surface area you can you can you can't elevate your core temperature too much or you're going to have some saying enzymatic breakdown and like these bad things are gonna happen

► 00:41:00

Owen yeah Wonder like what the line is the point of diminishing returns where the sauna becomes detrimental versus beneficial yeah and I wonder like how cryotherapy comes into play with that as well because cold shock proteins also shows some great benefit in reducing inflammation and yeah it's just an amazing time for all the different definitely the options that are available to people you know I think at the same time one of the things that we have to be

► 00:41:30

conscious of is you know being responsible about how we use this information and what we're telling patients and you know I think there's a lot of misinformation and a lot of people taking advantage of that and so you know we want to try to avoid that I want to try to give people get information so that they can ask the right questions and they can evaluate places where they're going to see if they're comfortable with what they're being told and what's being offered so I think there's something like

► 00:42:00

200 plus regenerative medicine clinics that have popped up in the last couple of years hmm and I mean at least 40 of them are bullshit my mouth I mean maybe maybe 80 maybe more than that I don't know he's 90 well I just think people have to be cautious and careful about you know whether meeting what they're saying and some of these places have received direct letters from the FDA saying hey you can't say that right you can't be making claims

► 00:42:30

let's go over some stuff that's definitely beneficial like platelet-rich plasma PRP injections people have had real benefit from that right sure so that has some validated outcome studies there's a comparison study with PRP on tennis elbow or lateral epicondylitis comparing that to corticosteroid injections which is a common treatment for attempt to give pain relief in the particular study that I'm thinking of they had you know 73% of the

► 00:42:59

patients that receive PRP had relief of their pain compared to about 50% of patients with a steroid injection so that's a head-to-head study comparing treatment and you know the advantage seem to be to PRP now what is the difference between the results I don't know if you've even know this between the results of PRP androgenic e'en I don't know much about that product actually I mean I know what it is I know that it was you know going on in Germany yeah I know a lot of people

► 00:43:30

traveled T running Kobe Bryant always guys flew Alex Rodriguez I think yeah Dana White did to the president of the UFC he went in there for tinnitus and you know and found through intramuscular injections there's a deep relief of tinnitus mmm-hmm yeah so that mean that's great and again there there may be great applications for all of the different things that fall into this category of biologic treatment time is going to tell us what things

► 00:43:59

things pan out clinically to be best I mean you can look at all kinds of factors and we can draw conclusions from that but ultimately it you know the proof is going to be when we have you know robust clinical studies that compare treatment and you know we have follow-up physical exams we have follow-up Imaging to see exactly what's happening so we know what we are hoping for we know what we want to see we want to see that yeah we

► 00:44:30

the cell that has a potential to differentiate into other tissue and actually causes healing but nobody has demonstrated that yet there are some studies I mean there's there's 35 studies 29 or animal they're six six or seven that are human trial I just saw this review paper and I don't I didn't know if the review paper had been written before one of the more recent clinical trials was published there is

► 00:44:59

is so only the one was on knee arthritis and the others were on mostly Foot and Ankle stuff the most recent as from USC and in combination with a doctor that's in Indiana and they looked at patients that had a knee arthroscopy and they respected part of the meniscus so we call it a meniscectomy and part of it was essentially cut out so there was a tear they cut out the bad tissue they left the remaining healthy tissue

► 00:45:29

and they did an MRI and they measured on the MRI the volume of meniscal tissue and the injected the patient with a bone marrow aspirate so in this case was the you know be Mac or bone marrow aspirate Twitches stem cells extracted from bone Mallet Like the Way Daniel Cormier had done correct okay so they injected that into the knee and then I think I want to say it was four or eight months later I think was eight months they re

► 00:45:59

urged the knee and they found that there was a 15 percent increase in the meniscal volume so the patients had apparently grown meniscal tissue I had a meniscus scope on my left knee from an ACL injury that I had I had ACL surgery but there were still some meniscus damage and then they'd I think at the time of the ACL injury they tried to stitch up the meniscus okay they just

► 00:46:30

they tried to repair it cut it out and it was a problem for me for several years and then finally at or became a bucket handle tear where it locks you know so lock my knee out brutally painful in the middle of a Jiu-Jitsu class it was really bad so I had to get it scoped and then once I got it scoped it was okay it was functional but it would provide me with maybe every couple weeks it would be painful there would be something going on literally a kit would be a

► 00:46:59

a problem you shot some stem cells in there a year ago I've had zero problems with sense zero nothing it's like like I don't even acknowledge that I have a knee that's weaker than the other knee anymore it doesn't even feel like that anymore my left knee feels exactly like my right knee no yeah it's crazy like I mean for a decade plus I had pain in that knee

► 00:47:25

one chicken one injection a year later nothing and it was almost

► 00:47:31

within two months within two months after the injection I felt like a significant difference I was like waiting for those days because those days when I pushed it hard particularly after kickboxing there's something about those like hard pad work the kicking the pads and it's going to say any particular things that you were doing that made it feel the worst that was the big one this is striking because striking is just jarring and it's just so much and I just think there's just there was laxity in the knee so the word yes

► 00:48:01

sound wrong no I know it's word I say that it sounds sounds wrong now I laxity something wrong sounds like a laxative it sounds like I'm making up a word you know I was laxity from my laxative but that kicking motion would always you know and it would just hurt I would put ice on it would be just go about my day I'd like wow it's fine it's not swelling up to now it's something you don't think about dude it's zero I ran a trail yesterday in the mountains like brutal steep Trail for two miles I have zero pain

► 00:48:31

and it today so this is the kind of thing that I think gets a lot of us excited about what the potential is yeah you know you've got a patient here that you had them meniscal tear then you so you had attempted to repair we know that about 15 to 22 percent of those fail the meniscal repairs you know it's a disappointing number you know we like things to be much higher than that but that's what the facts are that's what the you know larger scale

► 00:49:01

is have told us and to anybody that has a miniscule injury that's a risk worth taking because if you know that feels like to have a bucket handle tear and someone says hey you have an 80% chance of success like I'm in yeah I'll take it well also for the this is what we know this is why we will take the risk so for a young person that has the tear you know we want to preserve that meniscal tissue and for as long as their life as we can so certainly you are willing to risk and even you sometimes might attempt to repair something that you think even has a lower chance

► 00:49:31

it's just because they're young and you want to preserve that why you want to preserve it as we know that if you even resect a small amount of the meniscal tissue like say up to 25% it will change the contact pressure in the knee so they do these you know color pressure studies where it shows you the amount of force and its distribution and with a normal meniscus it's evenly distributed into the you know on the medial femoral condyles

► 00:50:01

end of the femur and then the tibial Plateau is the top part of the chin bone so when those come together with a normal meniscus in there the pressures even if you resect part of that now you see this point loading so you see these hot spots where it's there's a much greater amount of pressure sort of like when you go to a restaurant and you sitting at a table and it's wobbly you have to stick a napkin under one of the legs but about it now is maybe probably about an hour I'm not following you but you know I'm talking about done that what you're eating good and then the guy

► 00:50:31

comes any kind of the one leg a little higher yeah piece of wedge under there and I know what you're saying yeah I don't know that it's not the best that makes sense for you it doesn't that's fine I tried I swung on and missed let's continue it's all right but the point of the story is that we know if we cut part of that out your cartilage is gonna have some wear and tear over time now whether or not you develop symptoms from that is hard to it's hard to predict well I'm pretty sure that that's what was going on with my knee because because it was uneven and the jaw

► 00:51:01

whirring action of kicking a heavy bag or kicking pads so I think that what I was trying to get to and I was taking the long path to get there was that you know in the past what we might have said as yeah you know you had an ACL tear you had a meniscus tear you know you're nice crappie sorry like you're gonna have some pain but and what are you trying to what do you kick boxing for at your age anyway I've heard that this is this would be the attitude right and really what that means is I'm uncomfortable because I don't have a

► 00:51:31

an easy solution for you so I'm going to blame you for there's also people wanting you to adopt their lifestyle or them to think that your lifestyle is foolhardy there's definitely that I mean I had another just trying to find it easy solution so that you don't come back into the office and complain about something that we don't have an easy solution for also I think they're trying to talk sense into you that may be true to and their mind you know like if you don't do martial arts you see some knucklehead lower risk of having to come to my office that's true it's also you see someone who's doing this in her

► 00:52:01

themselves and you tell them hey look you've got to stop doing that you know because you think you're doing the right thing by telling them that right but you know you're essentially telling someone that all that stuff that makes you feel amazing yeah alleviate stress builds confidence it makes you it's prettier so yeah it's a big part yeah so how am I supposed to rip that away from you like well for some people that's it becomes a real it me obviously with certain injuries yeah but some people we have to have the hard discussion it's like look you know I know you want to keep doing this

► 00:52:31

this I know you think your head in that direction but this is over well when they do Replacements now because I know a guy who's got a knee replacement and one of the things he was saying actually I know quite a few people one of them was on the podcast name's Dan Pena and he was saying that the problem is with his knees is they only Bend this way now they don't move side to side there's no lateral movement in the knee okay like there's no wiggle room all right like you can't go side to side like the knee is just

► 00:53:01

goes straight up and back like this okay artificial knee so make sense no you got skeptical hippo well there's depends on a lot of factors may be for him there may be other patients that don't have you know quite as much stiffness in their knee but no one who gets a hip replacement is doing triathlons it shouldn't be or a knee replacement rather they shouldn't be

► 00:53:27

yeah so it's limited with a hundred percent certainty that implant will loosen and fall apart huh why can't they make Annie of fake knee that's as good as a real knee hmm that's a long question are they lazy no I wouldn't think so certainly certainly lots of motivation and you know an economic reward if you God if they could fix any and turning me into a superior need to the knee that you have now

► 00:53:57

so the I mean the it's like an overall question right why can you not replace something better than you can repair it well wouldn't wouldn't we want to be going more towards repair and renewal right regeneration and we wish we wish we're hoping that we can you know figure something out for that but that's the factors that they need replacement you have a metal component that you're either you know cementing to the Bone or your you know

► 00:54:27

applying it to the Bone and having bony in growth into the implant so there's an interface between that implant and the body and to come up with something that would never allow that to separate I mean that's you know how would you do that yeah I know a guy who had bone cancer it's a really kind of a terrible story but he lived near a golf course and the golf course used these horrible pesticides and it leaked into the groundwater and all the

► 00:54:57

in his neighborhood got cancer look a huge epidemic of cancer in his neighborhood and he got bone cancer and they replaced one of his femurs with a metal rod and it causes them significant discomfort in some of those in my training it's did you pretty gnarly surgery what's that about talk to me total femur yeah I cut someone open like a fish and stick a new leg in there you literally do it's an incision about that long whoa he's making his arms about what this pressure on me

► 00:55:27

for me it's 3 feet it's the entire length of however long your thigh is how she wow yeah that's gnarly yeah they all get infected they do it seems like it wow no post-op like right away or you mean entire time Mmm Yeah just because your body's rejecting it doesn't really with election it's just you got this big hunk of metal and bring up with urea you bacteria forms you know this sort of slime layer that can't be

► 00:55:58

even with antibiotics you know blood can't get to the metal so you form this layer and then it's just it's once it's contaminated you can't control it whoa so the metal on the leg the fake leg just gets slimy and not so much that it gets slimy it's just the stuff that's produced by the bacterial adheres to the metal so it's just so much metal in the body there's so much opportunity do you know what I mean yeah so what do you do when it gets infected

► 00:56:27

it going to open them up again clean it up you do you try but the the end of the line is you notation the lamb has to go whoa Daddy Jamie's Jamie almost threw up you got an image pull it up pull it up you don't cause you're a doctor how dare you how dare you say don't pull it up your this is what you do man that's like I'm feeling bad it's like me saying she was right I don't know where anybody who know where you're going to get the total femur what yeah that's gold

► 00:56:57

large with that sir I want to see that I don't even holy Jesus whoa oh my God first of all what am I looking at there so that's the femur no that's a metal femur and the hmm just Google replace femur and with the legs opened up there and you have to make measurements and so it's basically a total knee and a total hip and then all of the bone in between has been replaced with that metal wow

► 00:57:27

and your foots just attached to your regular Shin below it correct and what is this normally used for like how often what is this so that would be in the case of infection and you know there's the cases that we had were usually multiple fractures below a hip replacement and then and then below a longer stem hip replacement finally you've got just no bone the other reason would be infected bone that you had to resect and

► 00:57:57

then still another reason would be in the case of tumor where you have to you're doing limb Salvage yeah that was this gentleman's now that one above Jamie where it's got like they're spreading it apart far right yeah right there what's going on there what's all that stuff on the outside that orange stuff oh so that's called IO band and it's a thin film that we cover over where we're making an incision in surgery it's help prevent infection so we naturally have you know staff and other bacteria on the surface of the skin

► 00:58:28

and you put this sticker cover on top of the skin and then anything that's around the wound is is contained this is play video I think you should listen to them click on that and see what that is yeah let's see who this is oh just a picture that that says that I can visit page click play video there we go whoo scared yet nervous whole daddy whoa boy whoo now that seems that Li I like to do surgery through incisions

► 00:58:57

seems like that are about this big yeah little tiny incisions now that seems odd because that seems like a very old person like I'm looking at the lack of muscle tissue either very old or very unathletic yeah and this is like evaluation that's incredibly traumatic than I mean that's

► 00:59:15

there how does someone recover from that it's slow

► 00:59:20

now is there a potential use of stem cells in the case of like is it participate possible to regenerate a bone I know they've built a woman a artificial bladder through Center ethically bone is one of the tissues that is a part of that line of the mesenchymal stem cells right sometimes it comes from the mesoderm so you think that could be something down the line that they could be able to accomplish there I mean replacing that femur and its cartilage covering at the knee and the hip I mean I think that's

► 00:59:50

at this point of fantasy yeah but isn't that what I said when when if someone came up to the person that had the Telegraph and said hey do you think one day I'll be able to send dick pics from this thing will right now that's fantasy right don't you think probably most likely you know they would look at you like you're a crazy person well when I was this is embarrassing story to admit but when I was about 13 I went next door to my neighbor's house and he was kind of

► 01:00:20

of a computer nerd at the time but you know computer nerds at the time were playing with like Commodore 64 right and he's like dude look at this I can hook my computer up to the phone and I can type on the screen in my friend on the street will see what I wrote and I was like that's the dumbest thing I've ever heard dude can we like go play football like what are you talking about I so apparently I'm not very forward-thinking guy because obviously we're doing that quite a bit now I have a Showtime

► 01:00:50

special in 2005 a Netflix special actually eventually wound up on Showtime but I had a joke in there about cell phones about people send you a text message and the part of the joke was like it takes you four presses to get an S right like why don't you just call me because like this before anybody had figured out right you know what keyboard and I'm like why are you making me read like this is so stupid I thought it was just like a dumb Trend that was gonna go away and now

► 01:01:20

now if someone calls me I love fuck you call me for yeah like it's very strange what's happened in just 12 years yes it's total shift in how we communicate with people right a massive one I mean how how disruptive to your life is it to have to like send emails now

► 01:01:39

I mean to sit down and like type and eat like email respond back some emails you like people email me with like a bunch of questions it's a big chore it's like homework I gotta sit down and takes a lot of time whereas you know text is like a quick response like hey when I just I'm so used to email I send a lot of emails I'm so much email and why do all the booking for the show too I mean while have a guy Matt Staggs who contacts people but I reach out to a lot of people as well so like a lot of the booking and the different things that I

► 01:02:09

do I contact people sure and you know the best way to do it is through an emails like hey you know I would really love to talk to you about this or that I have a question about it there's a brief emails I would bet sometimes yeah but I've gone I've had some yeah that's the problem is the volume the sheer volume I get is just unmanned alight so the point will people think I'm ignoring them like man I'm not ignoring you I didn't even see it it just got lost in the tsunami of emails that came in like if I go on vacation I hardly communicate

► 01:02:39

Anna Kate I barely do anything maybe I'll put up a social media post and you know just just to like this because it's kind of a part of the job right but I don't pay attention to emails I just leave them alone and then I get home and I'll go oh my God there's two thousand emails I'll have two thousand emails in a few days I don't know I'm not exaggerating do you go through all those I do my best try to I look for my friends yeah you know I look for people that are important and look for acquaintances that I like

► 01:03:09

you know you gotta have this work related stuff yeah but it's a mess I've several email accounts to which helps like people that are important to me get the big one you know you don't get you don't get the bad and I don't know don't worry about it I like you don't think I don't have any dude I'll give you the real one all right why don't you know I won't tell anybody people don't like to be on the outside you tell them about that know like which one do I have bro yeah all right why worry about it man what list am I worried about it man yeah but if you have to ask the question yeah

► 01:03:39

yeah it's not good I wonder when it's going to pass what we're doing I mean when it's not going to be this it's not going to be typing I what's the next thing what is you know it's definitely not going to be videos where you force people to watch the beautiful thing about an emails I can kind of scan it through what's this guy saying not interested next have you messed around with like Dragon Dictation yes yes it's amazing for notes it's gone you're in a car or when if I have an idea in my head and there's no way I can type it in my phone that

► 01:04:09

please have you ever seen how good it works it's no it's very good yeah no the we'll just what comes like the most recent versions of it yeah like this right here check this out

► 01:04:21

dr. Roddy McGee is an amazing human being he has fresh breath and his hair is wonderful

► 01:04:29

look at that perfect perfect perfect Yeah a hundred percent that's incredible that's pretty good I mean it is it really is incredible and you could do that in your car if you have an idea so you're not some asshole it's texting because sometimes like Neal Neal Brennan had the best analogy for it you know Neal Brennan is stand-up comedian and Coho creator of the Chappelle show he had the best analogy he owes my notebook is essentially like a net for catching ideas yeah you gotta catch those ideas yeah it's quick as you can make sure that's a good way of looking at it

► 01:04:59

so like if you're if I'm in a car and I have an idea I'm like oh my God I got to get this out before I forget so I start repeating it to myself and then if I'm at a red light or something I press that record button very responsible of you I'm I'm very responsible when it comes to texting and driving that's good I just I think that is one of the most exhilarating things that's fucking terrible it's like you're going 60 plus whatever miles an hour the amount of distance that you cover in a glance Where You Are

► 01:05:29

not looking at the road and things can happen at any moment just to me it's super disturbing yeah anyway back to the back to the Grind what did what do you got there that you would like to cover well so you know okay so we talked a little bit about about you know all of the all of the elements of the care of the person right so it's it has to be more than just giving you a shot and send you on your way right if you truly have an injury

► 01:05:59

trying to recover you then what also comes along with that is the appropriate rehab protocol and none of those are defined yet for for what some of these things that we've done but we're trying to develop that and and dial it in and hone it down for me for me right now the easiest thing is to try to adapt it from a surgical rehab and I'm not a physical therapist obviously so I try to collaborate with those guys and and girls that are smarter than me in that Avenue

► 01:06:29

but the principles are the same right so you have you have an injury that you're trying to heal now in some cases it's you know we've created the injury or we've done the thing that the patient has to recover from in the case of an injection you have an injury you've done the injection and now we need the effect to happen whatever it is that we're hoping that will be so but then you can't ignore the fact that if somebody has a bad shoulder

► 01:06:59

well maybe we may decrease the pain but if they if they're if they're motion is poor if their strength is poor if it's not functioning correctly then how can we be achieving the best result if we're not also attending to that right so it's a multi-step no doubt and then in the more that we're learning about all these other factors I mean like again for you I mean you're paying attention to your sleep you're paying attention to your nutrition here on you know a variety of supplements that are

► 01:07:29

are you know meant to help a lot of these processes and I think we're going to get better and better at it diet has got to be pretty critical as well right it's got to be hugely important specially like staying away from inflammation enhancing Foods or inflammatory foods yeah no doubt so yeah I think it's got to be critically important and we try to share that information with people there's four athletes like a website that you can pull up and we can share as the college and professional

► 01:07:59

lead dietetics Association I think it is collagen professional college and professional athlete I was like what college and professional athletes don't even know what that mean we all have collagen right college and yeah so these guys have some great information and good infographics that that we utilize you know since I'm not a that looks good I'm not a dietician so I have to rely again on people that have good information I think these guys have

► 01:08:29

have good reliable they're good reliable source and they've got great infographics if you go to

► 01:08:49

hmm educational resources there you go yeah so this will pull up some some different things bouncing extra exercise-induced information now here's a good question because it's pretty much universally agreed that rest ice compression elevation all those different things that people have said in the past that there is benefit to a particular icing things yeah there's a lot of debate about right there's some debate now certainly there's like a definite

► 01:09:19

anti-ice Community yeah what is that out there do you think it's legit well there can't there's not a downside to it I mean sighs I don't think so I mean we've used it regularly and so I don't know there's there's definitely a group that and I don't know all of their arguments against but Miesha Tate former UFC bantamweight champion she had a podcast with this guy who's the anti-ice guy yeah I got this whole thing the flat earth guy to know but he doesn't believe in dinosaurs I mean it's not nice

► 01:09:49

I meant that up yeah if it I don't know I mean so you I believe he's a doctor but he you know I might be a fucking Veterinary works on yeah cat infections or something I don't know but yeah I don't think there's a down kidding about the whole to and so in my opinion you know I've definitely had athletic injuries I was a pitcher previously we routinely I star shoulder and elbow after pitching I did it as a matter of routine it made me feel good I felt better when I did it the right

► 01:10:19

didn't but here's the question it felt good at the time but it is that feeling good in any way slowing the healing process hmm

► 01:10:30

hard to know I mean that's where it gets weird right yeah I don't know to be frank God damn it yours I like you know you're you're the fuck is back genius doctor guy

► 01:10:43

if you don't know we're doomed get back to me so what I'll get you some good information on thank you appreciate it what else you got here

► 01:10:53

so you know I think one of the interesting things about this whole topic and the possibility of healing from utilizing this type of treatment is how it allows you to go through the process of healing without this fibro vascular response so the typical healing Cascade has an inflammatory phase proliferative phase and the maturation

► 01:11:23

so in the inflammatory phase you have neutrophils and white blood cells and these enzymes that are present that are trying to start the process then in the proliferative phase you're having what's called angiogenesis that means the development of new blood vessels and vasculature to the area and your body is producing fibroblast and you're laying down tissue in this sort of haphazard manner so it's just kind of piling on in there

► 01:11:54

and the maturation phase is when you have remodeling so those that scar tissue is changing over time and and developing into tissue that's more like or is the native tissue so that occurs over a period of time and then a lot of times during that process before you're fully matured in the healing your back to activities the best so let's just take an example like when you sprain your ankle and then you

► 01:12:23

you know you start feeling better and maybe go back to basketball within a couple weeks at that point if you've actually torn one of the ankle ligaments you don't have native ligament tissue that's the same structural properties it's not as strong I mean you might be developing the strength around it but it's not like the native tissue

► 01:12:45

now the hope is that we can demonstrate now we know that this is the science this is what it's supposed to do this is what it does in the developing fetus we see it in kids you know how you know when your your daughter was real young she scratch your face the healing will run like gone like the next day yeah so healing without scar is you know has to do with not forming this these fiber this fibroblast or Fiber vascular response and and fibrotic phase

► 01:13:16

now what the cool potential of this to me is if we can skip that and we can have more complete healing and quicker resolution to the native tissue then you're going to have those the same property as you're going to be stronger you're going to be better you know technically and hopefully you know clinically this pans out that you would be more resistant and lower risk for repeated injury because that's really our goal is

► 01:13:45

in treating patients is get them back to their activity and decrease the chance that they have to miss more time and how do you know how much to inject into nobody knows oh Jesus nobody knows that that's this is one of the big questions that right that will be discovered with again you know rigorous studies where we can look at you know what should the dosing be what should the frequency of the treatment be and what should these the protocols before and after be it's not defined and anybody that's telling a patient that they have

► 01:14:15

exactly what it should be I mean be wary of that because it's that has not been discovered yet so trying to we're trying to take you know we're taking the information from our experience and applying it that way it's it's not the it's not the best way to go about this and it's one of the things that PRP suffered from is that all of the things everybody was using it for so many different things and and just kind of hoping that it was the Magic Bullet that it was going to treat all the things that we had difficulty treating

► 01:14:45

hmm and even all of the studies that were coming out you know people were using different centrifuges and applying it for different reasons different protocols just a mishmash of information wasn't valuable how does platelet-rich plasma work so it has growth factors and cytokines and the platelets release proteins and things and those things help mediate that inflammatory response and help the healing process I mean that's kind of the basics do you think that they

► 01:15:15

good work in a symbiotic fashion with like this there's no information that adding PRP to some cellular treatment like bone marrow fat or the placental tissue and that line of treatment can help expand the cells whoo so that gets us to an important point which is expanding the cells has been done and is not currently legal in the United States so there was a place and they

► 01:15:45

they do it in other countries but here if you if you more than me this is a mouthful the more than minimally manipulate the tissue then that is not under the guidelines of the FDA for use of human cellular tissue products so they were taking for example bone marrow and plating it and growing more cells bring the patient's back two weeks later and injecting them with this you know super

► 01:16:15

in of cells mmm which probably is great but we don't know we don't know if that's safe and and that has to be that has to be taken through the appropriate process mmm so so you can't necessarily recommend someone taking PRP while they're taking some sort of a stem cell injections so here's the difference of that okay a manufacturer can't say

► 01:16:40

that we have a product that is a combined PRP stem cell injection right and it does this right that's illegal but if you are a patient when I can't put on my website right I have the magic potion it's PRP and amniotic fluid and tissue we inject it and it can heal anything I admire how responsible you are how you keep cutting me off whenever I was suggesting some ridiculous things but is would there be a benefit for a

► 01:17:10

potential benefit who's getting stem cell injections and also gets PRP at the same time or is it just theoretical theoretical right now yeah but but definitely definitely there's potential and it's encouraging to you know that the possibility is there hmm it appears to be safe there you know we don't have adverse reactions to it

► 01:17:36

and so and the point that I wanted to make is that a physician can prescribe something and use it off label right so the FDA doesn't regulate the practice of medicine I can do that in my office but I can't make claims about it and I can't put it on social media and on my website and say if I'm gonna do this and I'm going to fix your shoulder like come here if you have a meniscus tear

► 01:18:05

we do this injection and it's going to make you better that's illegal that's I understand so but if somebody comes to my office you know I can elect to do that because both things are available they have we have permission you know to use them but we're using it off label I understand so when you say maximize cells that's the term used maybe what did it turn the term used about PRP in conjunction think that it can increase the proliferation of the mesenchymal stem cell

► 01:18:35

oh and how much of a time period would have to be between the injection and the PRP that's undefined again so what would you say that the way that we're doing is we would do the injection at the same time I say yeah putting it in there together so we only have a narrow window from when we take those Frozen cells and then we thaw them you know we have a short window when we can then inject them and then there's you know maybe between 7 and 21 days at those cells are viable in

► 01:19:06

your shoulder your knee wherever we inject it so if someone gets that injection and does PRP they would have to essentially get that done within those 7 to 21 days to have some sort of a benefit of what you're saying theoretically rather yes that yeah that that's that's how I would do it currently based on that information it's fascinating stuff yeah what else is there well so we just I thought it was important to talk about the it's called section 361 of the Public Health Service Act

► 01:19:35

and this is the definition from the FDA on the use of human cell tissue and cellular tissue products so it has to match these criteria so you have to have minimal manipulation that means you can't add things to it you can't combine it with other stuff you can't like I was saying you can't you know put it in the lab and grow it and add things to it and then come bring patient back and treat them how this isn't part of the part of it but we you

► 01:20:05

can't treat patients on a on a different day it has to be at the same time whenever you're harvesting the cells or utilizing whatever it is you're using it has to be something called homologous use and what that means is whatever tissue you're taking has to have the intention of the purpose of that tissue for when you put into somebody's body

► 01:20:28

so for example if I have if you have a fracture that's not healing and I take a bone graft product so cadaver bone and we're going to use that to help heal your fracture that hasn't healed that is that's homologous use we have we're taking bone we're using it to become bone we're going to be the scaffold for bone to heal and grow

► 01:20:51


► 01:20:55

it can't be combined with something else and it can't have it can't be intended to have a systemic effect so now all of these things that I'm explaining these are rules for manufacturers and what they can what the rules are for them to be able to Market their product so for example you can't take amniotic fluid and say this is a product meant for IV infusion for treatment of

► 01:21:22

whatever diabetes is right that is something that people do in other countries right they're doing other countries you can do that in you technically can't do that you can't manufacture a product and put that on the labeling but that's what it's intended for but do they do that in America IV stem cells I've been told by patients that they've gone to places that have suggested to them that that was going to be the treatment right and what I on there I'm not aware of it what how does that even work

► 01:21:52

it's not your wheelhouse nobody and nobody knows if it does hmm so it's just experimental it is I'm all of this you know Bas Rutten is former UFC champion you ever treat him I have no right to say that I don't think I can say talk about any patient that unless I tell you how can set it or they're sitting in front of me talking about it and okay I'll give you permission it's it's HIPAA violation I don't ya help information session for the record I give you permission Bas Rutten went to

► 01:22:21

did he go to Peru or something like that went to the Jungle some dude kill the chicken and then shot some stem cells into him but blood right he's made he was saying it was fucking amazing if you hit you know you're her to wait boss cause he's like it's like the energy was coming out of my body like he said that he literally felt like like some kind of Kung-Fu movie where energy was like shooting off his fingertips he said it was amazing like the emperor he's not the only guy that said that you know Dan Bilzerian

► 01:22:51

no Dan Bilzerian is the not pursue Graham guy with the boobs and the but he told me the same thing he said that when he got done he said it's amazing he goes to Mexico to get it done

► 01:23:05

not recommended but this is he can talk about off air he'll be a little Chatterbox just you wait yeah maybe well what I'm interested in what I was thinking for you threw me off there is what is he going to with a specific intent of treating something or is he just like looking for the Fountain of Youth I think he fucks so much he doesn't have any sperm in his body

► 01:23:34

and he's trying to kicks I don't know that guy's an animal but I think he's got a series of injuries I know that because it had Regina Kane for his neck he put it up on Instagram like with Instagram stories he was videoing himself while I was getting injections in his neck which I've had Regina King many reactions yes it cured my cervical disc bulge what yeah yeah that and disc decompression spinal decompression

► 01:24:04

decompression you know with like a harness where they're pulling on your neck that I had a bulging disc in my neck that was pushing on my are solved yeah but completely resolved I got an MRI it doesn't exist anymore where I was getting numb hands because the ulnar nerve is being pressed upon yeah huh yeah it works that's not a massive anti-inflammation properties I just don't think that it has the same healing potential it seems like it reduces inflammation to Giant way what's going on with by the way I had Regina Kane shot -

► 01:24:34

to that's what you told me so then really have the same effect this is a little bit so patients like yourself that have had a number of injuries in a number of treatments one of the things that's got me enthusiastic about the potential of all this is when somebody tells me look I've had this this this and this and then I had this what we're talking about and the it was just completely different game change I'm just a hundred percent better and different

► 01:25:04

look mine right shoulder is not 100% but it might be 90% you know and it's strong as fuck like I could do a lot of shit with it like it doesn't you do some insane stuff yeah it's it doesn't bought things that I probably wouldn't recommend but no pain like God can why could do I take these 90-pound kettlebells and I do windmills with them where you know you're pressing overhead you know what a windmill I do yeah I don't do that with 90 pounds but I know what it is but the if the

► 01:25:34

fact that I can do that with a shoulder that was on this way probably to getting surgery on is just amazing my bow tie the most impressive thing was that push up with the wheel thing that thing called oh the ab wheel now it's like a little roller that you had your hand on oh yeah those things when you go forward and what's that calls it the comfortable Havoc creates it there's sliders Havoc sliders okay I mean that was like YK sliders there's a video of it on see that there's a video on my

► 01:26:04

I'm Jamie from quite a while ago but it was post certain post excuse me injection it's from way back I want to say it least a year ago I was doing that but yeah there's my range of motions a hundred percent it mean at the most it's uncomfortable in certain things but for a big one for me was archery because

► 01:26:31

you know I really enjoy it I do it all the time and it's very meditative to me I just love archery so for me like the idea of not being able to pull my bow back I was really disturbing I was like God I'm gonna have to get the surgery done yeah you can pretty committed to it for a while now right I'll shoot a hundred plus arrows a day and I'm pulling back 84 pounds 284 pound compound bow and I'm shooting it a hundred times a day and is no pain I did it yesterday I'll like four hours me and my friend cam Haynes who you know you

► 01:27:01

yeah who came to talk to you as well you kind of indirectly got me into it I don't want our trip through John John Dudley yeah yeah I know you're shooting all the time now right yeah so John got me this unbelievable you know Hort Hoyt carbon spider bow it's like if you want to you want to see any of my friends like make the greatest faces you've ever seen I just pull this thing

► 01:27:31

hang out and it's like you know some space-age weapon it looks like a bow the Batman would have yeah to Baka yeah Chewbacca yeah something like that yeah I would say Batman but yeah but yeah it's some those bows are there amazing it's incredible and it's I've only been able to go a couple of times but I'm definitely hooked it's the most amazing meditation I love it it's because it's you when you're focusing on that shot you literally have no room for anything else

► 01:28:01

it requires so much concentration you're concentrating on that front hand position front shoulder position where where the string touches the tip of your nose the corner of your mouth and and John is just an amazing coach yeah so you know totally unfair I get that's the bow the first bow that I get to shoot with and then John gives me the first lesson that I've ever pulled a bow back he's standing there right with me there's an Olympic coach by the way he's coached the Olympic team

► 01:28:31

well he's amazing yeah I mean he really got can take he's a great guy too and he can take years off of people's learning prime mean he's absolutely taking years off my learning curve yeah I'm gonna sneeze

► 01:28:49

I hate when you say you're going to sneeze and he put a lot of pressure on yourself you like man I'm might not it will just look like a weirdo for a few minutes did you find that video no it's in there I swear to God so here's another kind of crazy thing about the placental derived treatments is that they actually have antimicrobial properties whoa so this is crazy mean we kind of know this you know what

► 01:29:18

functions of the amniotic membrane is to protect the developing baby right hmm But in one of the things it does protect it from infection but what they were able to demonstrate was that when they they've actually introduced bacteria like literally injected bacteria on to these membranes and then they come back and and check and it has destroyed the bacteria

► 01:29:47

so huh so ability to resist scar formation move through the fibrotic phase of healing and then also the antimicrobial properties is so amazing that would be super beneficial post-surgery right because it's a giant issue staph infections in the like it's one of the things that you know frightens us most about you know doing our procedures is you know can we prevent infection yeah it's a giant issue where people I mean

► 01:30:16

knows because of the nature of martial arts just everybody I know is that surgery yes pretty much and the big issue is post in post-surgery infections yeah those guys are they're getting abrasions and everything like that on the mat and then so then there are colonized with you know MRSA any number of whatever Funk is in that gym I tell everybody if you are a Grappler this is super important I want you to look up

► 01:30:46

defense soap defense soap is a soap company that was created by my friend guy Sacco and what is it it is all natural soap that promotes healthy bacteria doesn't destroy the healthy bacteria but it's all tea tree oil eucalyptus oil the shit is amazing and I used to get I've gotten staff at least twice I used to get ringworm all the time well not all the time but I got a couple of times and until I was like super diligent about

► 01:31:16

myself like immediately afterwards but once I started using two things probiotics which is huge acidophilus yeah eating yogurt and drinking kombucha and then the next one was enough in the old soap probably not have that it's an option it's a little bit of something that's a little bit of something I just think it's good to have it's good to have probiotics I like kimchi I try to take my Pro app probiotics and multiple forms this stuff that I was drinking when you got here kombucha

► 01:31:46

Pooja I love this stuff yeah I drank your coffee flavor that you like or do you mix my got to be careful because I'm a low sugar guy so like the grapes are some of them that are delicious but they have a lot of sugar sure this this multi greens does not have a lot of sugar and let me see what it's got I think it's something like 10 grams per serving or something like that it's really that sounds High I think I've seen them lower O2 yeah that's how to grams so yeah that's what you want the grapes hi hmm grape is but the

► 01:32:16

taste wonderful right it does he's yummy that's the problem this does not taste so good but you know you're getting something good in there and this is the important your way through it the important stuff is that you get the strong kombucha this is the brand that I really like I don't work for them they're not a sponsor GTS kombucha GTS this stuff is awesome but you have to be over 21 because it has more than one half of one percent alcohol by volume because the fermentation process because so strong it's a so they make you get show your

► 01:32:46

D interesting they actually pulled it from Whole Foods I don't know if you know this I thought see I thought I that's where I've seen yeah they have it back but the whole it from Whole Foods till Whole Foods had to like put some regulations in place to keep you would literally if you were 8 years old you could drink one and not get drunk I mean it's not like it's not like you're going to get drunk off of it but just do the regulations you have to let her The Loft exactly

► 01:33:12

what else you got

► 01:33:14

got a lot of papers there buddy that drawings and shit charts and graphs of the think about probably a bunch of stuff you say don't let Joe talked about this don't what other questions of you

► 01:33:30

come up with along the way or one big question I wanted to talk to you about was something that I had a discussion with dr. Davidson about okay recently Jeff was telling me that the most recent procedure with stem cells is injecting them directly into the disks for people that have degenerative disc disease and that there's some really promising results I've heard anecdotally of a number of very positive outcomes

► 01:34:00

with treatment like that mmm but that's amazing again we you know too early so lot of surely affect many conservative about this I really really really do appreciate that all I'm getting ready time I really went yes old I really wrestled with it because you know again our whole training is based on you know we need to do things that have an Evidence base for operations mean this is kind of the foundation of what we do and so but we're in a unique

► 01:34:29

Nick situation so we have patients that one we this stuff is available and it's legal to do and it's there and people know about it now so they're seeking the information they come to us and even you know even before we started talking about it you know it started to be like here and there and then all the sudden it's like two three patients a day now even more are saying what about what about stem cells should can I have stem cell and like okay well you know then we have to back

► 01:34:59

cup and like have the whole discussion like okay well let's talk about what that is and what maybe it can do and so people are seeking the treatment it's available but we don't know we don't have a lot of information so we just have to be forthcoming and say look this is experimental we've had encouraging early results I can tell you anecdotal stuff we've even seen images where somebody had you know full thickness rotator cuff tear eight months later what looked like a healed rotator cuff on

► 01:35:30

an MRI now did that happen on its own well we know that that happens at a lower percentage but it is possible to heal it's just a lower percentage did it happen because of the treatment that hasn't been established so I have to really explain all that and the other category to that patients will come in and they'll explain an injury and and I've had to turn away a lot of people that were they were fully ready to come in and have treatment and they were fine

► 01:36:00

if paying out of pocket because of course not covered by Insurance because it's experimental because there's you know no data yet but that's not true there's not no data but there's there's not enough data to support treatment for you know certain conditions but you know I've had to tell people I don't think this is appropriate even even to try even if you want this and usually the category is excuse me

► 01:36:30

if it's something mechanical so I think this makes intuitive sense to people so for example had you come to me and you said hey you know I dislocated my shoulder seven times and can you just put an injection in there well the problem with that is that the in that case in this example the ligaments of the shoulder have been stretched and disrupted and in the case of a dislocation there's oftentimes a labral tear that comes with that now I don't

► 01:37:00

Eve and I could be proven wrong over time but I just don't believe that that an injection on its own would magically decrease the volume of the capsule you know tighten the static structures in the shoulder and resolve the pain for that patient now but those people have to be right there was two artists in my head sure I believe there was something that came up a few years ago where they were doing something where they were heating up the insults are capsule shrink thermal capsulorrhaphy what is that was very popular

► 01:37:30

for you said was yeah now it's close to malpractice oh Jesus yeah so it's interesting the way these things go so there was a huge wave of interest in this and essentially what guys would do is they're looking inside the shoulder you have a radio frequency wand and you're using that to heat the tissue and you can watch it literally shrink in front of you then Richard Hawkins is a very accomplished orthopedic surgeon kind of iconic guy that's

► 01:38:00

and tons of research he was also went in Vail Colorado now in Carolina and he published a paper that showed a very high rate of failure from these procedures and so as a result of that it's fallen out of favor so huh it but it was done very frequently on lots and lots of shoulders Now High rate of failure was like 20% okay but here's the question is that because you're talking about already compromised joints right which is a very complicated joints

► 01:38:30

joint that shoulders very complicated so I think there's certainly a number of reasons why that could have failed but there was a lot of problems with basically damage to the tissue from the radio frequency oh so it was weakening things yeah I see yeah so that that way that's it of it well you could watch it and you were seeing the decrease in the volume of the capsule so you are where structures had become loose you were seeing it become tight it at

► 01:39:00

x 0. What about doing that in conjunction with some sort of a stem cell therapy

► 01:39:08

so it makes sense yeah I should be a doctor right you're very close yeah you're you're only ten years in school only 14 years away 14 yeah that's all 14 for regular people give me 20 so so why did they think that it would work in the first place like what was the the idea behind there there's there's early published papers that were saying that the outcomes were better if you used it wow

► 01:39:36

so it's it's murky I mean there's things that over time we discover that what we thought we were looking at you know we didn't fully understand and how long does it take before became malpractice or at it problem and exaggerated term problematic I don't know the exact year that his paper was published but it was it was before my residency training I started I've graduated medical school in 2006 so it was before that that people weren't doing that anymore okay so bring it back around so when

► 01:40:06

someone has had like if you talk to somebody to play football or something had multiple shoulder dislocations like what would you do to me you would encourage surgery so the you know the typical course for recurrent instability the shoulder would be a stabilization procedure now a lot of that is based on the exam and what you see on Imaging some people can do well with a simple shoulder arthroscopy and then you pass a

► 01:40:36

stitches you repair the labrum you can tighten the capsule at the same time and young patients progress really well through that hmm when there is you know more complicated problems such as the there's bone loss on the front of the socket so when you have a dislocation the head goes forward it it goes out the front that's the typical and anterior shoulder dislocation is the usual one and then as it tries to come back into place the

► 01:41:06

head bangs into the glenoid or the socket so you can you'll tear the front of the labrum you'll stretch the front of the capsule but then you can also get a dent in the back of the humeral head so well the correct procedure means I keep throwing you off track but when someone does have a shoulder dislocation what are you supposed to do supposed to pull on it just take him to the hospital there's probably no harm in doing that there's there's a great

► 01:41:36

Nick called the zaharie technique spell zah iri and it's just the name of the guy that wrote the paper but it's essentially it would be a really easy thing for you learn because it's kind of a leverage thing just like Jiu-Jitsu yeah so it's a way to Leverage The the arm so that you can get the muscles to relax it's easy on the person and you can actually do it awake and like at the field so I actually did it on a

► 01:42:06

I'm a professional steer wrestler at the rodeo how hilarious is it that you can be a professional steer wrestler like yells amateur for a few years but ya know there there's there's pretty serious about that super serious you were talking about your bucket handle meniscus the first Rodeo Cowboy that I took care of had a flipped bucket handle meniscus tear and he came in the the day that the National Finals Rodeo was starting

► 01:42:37

and he's also a steer wrestler by the way and had print been a previous thing he was a champ or he want a bunch that's for sure so they basically they taped his knee got a come closer they taped his knee yeah in about 30 degrees of flexion

► 01:42:53

and he competed the whole nine days whoa just yeah roped up me just taped it up got on his horse and was jumping off and throwing 600-pound steers on the ground first yeah those guys are crazy I want to tear up on TV I've never even been to one live because I'm terrified you need to come to I don't we did an episode of Fear Factor where made people ride Bulls made him write it that's hurting that's you can die I mean that's not its die no matter what you're dealing with a goddamn steer

► 01:43:23

so I'm saying that's all I'm saying you can die getting on top of stairs not a bowl well it's ours this year old right and we had Bulls no no steer wrestling is different right steer wrestling is the gravel they take off your role here in the guy in the horse take off at the same time you jump off you grab it you grab it by the horns and turn its neck and throw it on the ground and then they wrap the yeah see with steer is a bull that doesn't have any balls right yeah that pulls but they're also they're younger than the ones

► 01:43:52

that they caught their chop your balls off before they get a chance to mature that's why when they rolls are terrifying so I've been right down next to the Bucking Chute and it's like frightening actually had a clod of dirt get one of them kicked it up and it hit me in the head like a baseball I mean yeah see their little babies yeah and they have no balls so this guy jumps off what a did you turn on head that is so wack what a stupid fucking thing to be excited about these are did it possible that thing I was trying to

► 01:44:23

in a way around by his natural handles and I took them down look out quick look at their moves it's like a darce choke and the cows like what in the fuck man why is this even happening look cows like what is going on I gotta get out of here look how they always do it the same way to they do it's similar to like a choke hold what a dumb fucking thing to be excited about these well of the neck and flip him on the docks not it's outside of your world but I'll tell you this on these are some of it these are some of the nicest

► 01:44:52

this guys I've ever met in my life honestly and there are some of the toughest athletes oh yeah I would imagine those guys are tough as hell you have to be they gonna do it on free compete through every injury there is no injury that they don't that they won't compete you have to you're always broken up and you have to we have you done can also they've had no I don't make money if they're not competing so right way to do not fear fact it was a steer Champlain or Rodeo Champion rather he had nine shoulder surgeries shoulders just like sliced all open yeah and I don't know how long off at his

► 01:45:22

Katie goes get ready time like I could open up a card or it'll pop out of socket like yeah Ikes yeah it's bad yeah um so back around to where we're at what what do you do how does this is I hear technique you can you describe it is that I said right is a hearing the jiri yeah every technique so that one of the guys that we trained with in our my sports medicine program and Alabama showed us this and

► 01:45:53

it was like one of the first things that we reviewed at the beginning of the year and so basically you have the person lying flat on their back and I would hold your wrist and then I Loop my arm under your arm and then grab onto mine for for leverage and then I literally just sort of lean back and I'm using the muscles in my back so I'm not pulling with my arms so right a small person can do this on a very big athlete and you're fine because you're using all of the

► 01:46:22

muscles in your body right so you literally just lean back and you hold Traction in that position so you've got the arm is positioned like this you got to describe to people that are listening the arm is in front of the person while they're laying lying on their back and again I have my right hand on your right wrist if it's a right shoulder dislocation well it's just a video you got to get a video of it that's what hard to find it but I'm going to hopefully guess that this is maybe it that's it yeah

► 01:46:52

okay let me explain to people at home what this is like as if you were trying to give someone an armbar you it's you get a hook on the left side and so the hook is your lat if you're trying to armbar someone on the right there right arm and you were inside control you would hook it with your left arm and then you would trap it in place and what a person does when they don't want to get armed guard their defense is this they grab their hands together so you Loop your arm in yeah and pull it back like that so that would be real similar what you're doing you're using the

► 01:47:22

left arm you're connecting like this and then you're actually just using traction yeah so the the treater in this case on the right side he just going to lean back and hold and you just wait and in about 10 seconds to pop some place the deltoid and the pack and the biceps relax and just slides in oh that's interesting you can actually do that and I mean the Kinder way to do this is you know with some anesthesia right but a lot of

► 01:47:52

of times you can do that and then they're perfectly comfortable huh in there immediately better on the shoulders back in while they're not completely better but the pain is relieved from the initial event but you told me when you looked in my MRI that you think that my shoulder was dislocated at some point in time I don't remember exactly your MRI but if you had a tear of the front of the labrum if you had and you had that any evidence of that little dent in the back of the humeral head than then that would be consistent with that engine

► 01:48:22

do not remember ever having a dislocated shoulder but I've had a been Kimura you've had a bunch of time that you've had it slip maybe a little bit well when just the nature of your shoulder locked you know there's been a mini americana's in my past and Kimora's and all these different like hardcore you know the thing you were on the receiving end yeah before this injury I never Americana you could definitely have at least a subluxation of the shoulder for yeah I'm sure I'm sure

► 01:48:52

you fight it off too because you don't want it to happen so you resisting and before this injury I didn't do any shoulder exercises I just worked out but I didn't do any specific exercises just to strengthen my shoulders I think that was a big mistake and I kind of emphasize that with people I doing external and internal rotation exercises doing like I'm a big fan now of inverted kettlebell presses and yeah that's one been one of my giant right favor

► 01:49:22

Ali to definitely a challenge you don't need much weight and yeah this little 40-pound Ironman kettlebell I use this one it's amazing yeah that's a lot of weight for that exercise that's pretty good well it's just they say you should be able to do 50% of your max weight or is that 50 percent 90 percent

► 01:49:42

forget what they say forget me don't listen to me well it it depends on I think I said 90 yeah obviously in the in the injured patient or the person that's recovering we're going to be starting with much lower much lower much in the all that focuses on your the motion your your posture engaging your core keeping your ribs down in and having the full motion the strong first protocol I think what they're trying to say is in order to have really powerful shoulders so you should be able to do 90% of your

► 01:50:12

Max kettlebell press like say if you can Max Kettle press 90 pounds now that's with the with the handle down build down right okay yeah all right with Max that would be your max like what like only one rep max yes or you know what you would pretty much you maybe could do two or three if you really had to you know you talked about a lot of weight yeah you know what you would more normally like max out it like there's some there's a protocol that this guy papal tat

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sueleen follows that's really kind of interesting you know Pavel right well he's the Kettlebell guy right he's the guy that brought him they call him the Godfather of kettlebells in America but the guy that I trained with talks about that whole time yeah the the idea behind it is don't do your like if you could do 10 reps you do five and you you wait a long time and then you do another five and you wait a long time then you go do another five and you never worked a failure and that working to failure is actually not healthy it's not smart and you

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really get stronger that way with my recommendation is that for an and and this is coming from not this isn't from the orthopedic surgery world this is what I've read from strength and conditioning people the thing you want to avoid in doing something to failure is with load and a skill activity right so for example like a clean or you know a snatch or something exactly of coordination yeah well you have to time it requires you know sound

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mechanics right and you're doing it with load it's bad to do that to failure because what happens as you fatigue is your mechanics are going to break down that's where you're going to get hurt well what Pavel talks about is that strength is a skill and that all these different things for sure think of them as a skill and then don't do things to failure and if you're looking for you know endurance or something along those lines you want to do light weights and you do want to do multiple repetitions it's not what you're doing when you're trying to get stronger

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no yeah so it's this a but there's you know a lot of different arguments one way or another mean talk to powerlifters then like that guy's a pussy you got to do it to failure yeah I don't know talk to Crossfade people they want to do a hundred reps you know yeah so now there are activities that you can train to failure and there's no risk so for example like like pull-ups it mean when you fail you just you just can't get up right like you just gonna come off the bar right the battle ropes

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you just going to fatigue out like there is you're not gonna hurt yourself right but they even believe that when you're doing chin-ups like if you doing pull-ups and chin-ups that when you're doing it you shouldn't go to failure you should just stop like close to it or halfway there and then take a long time off and then do another five reps like say if you're Max's 10 reps get to five stop take a break do another five stop take another five ten minutes do another five keep going and just

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you're working on form and your muscles are performing these actions in a very clean smooth delivery and that this is the best way to recover or to build strength and that you just do it more often don't do it to failure once a week and then be a wreck for like three or four days afterwards because you know that feeling when you when you lift weights and you lift weights for a week or you lift weights and you if waste a failure rather and you're sore for so long I can't get anything done this idea is

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do more frequent workouts and you don't go to failure but don't go over 5 reps I think one of the biggest mistakes that we see and reasons that people show up in my office it is because of overload and and you know no time for Recovery right from the training that you're doing so you don't see people period izing and incorporating the times when they're just allowing rest I mean you can't be working

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at Max Capacity all the time right exactly so the big thing with fighters huge yapping them for working hard is so hard to do yeah so I always I try to emphasize with and and we have to really talk about this with our ACL rehab because that's a group that you know they're so eager to get back you know if they're competitive athlete that you know you got to remind them that look we have steps to go through and always say you got to work smart not hard like right you know we have a

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and there's a reason why this week may not be a whole lot of work your body needs rest and Recovery in order to put stress on it again so that we can continue to make your progress otherwise at some point you're either going to Plateau you're not going to be making changes going to get frustrated or you're just gonna get hurt right all right we got to bring this home so anything else we need to cover on this I don't think so I think we got we got to talk about quite a bit yeah we really did thank you very much for doing this I really appreciate it because this is we've always had this really cool

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conversations When I visit you in your office and I'm really glad we got a chance to do this now if people want to get ahold of you and they want to seek treatment please give them the necessary information oh sure so our website is www.totalperformancept.com I like a people still say www like yeah I can probably still get there right yeah you can just Total Sports Medicine.com yeah and then we have information on there in terms of how to contact us and

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be happy to get additional information to patients if they have questions awesome well again thanks for everything you've done for me it's been a lifesaver and thank you very much for allowing me to come down my pleasure brother thank you dr. Rodney McGee ladies and gentlemen and that's it for this week we'll see you next week bye bye thank you everybody for tuning in to the podcast thanks to caveman coffee for hooking up with hooking us up with some sweet and delicious coffee caveman coffee co.com

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go to ONN it use the code word Rogan and save 10% off any and all supplements okay ladies and gentlemen whoo we got a hell of a week next week lot of good guests I'll tell you one Dennis McKenna psychedelic royalty he'll be here on Monday and we got more some one of them I don't want to talk about until we have them keep it down no people all right thank you everybody appreciate the fuck

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out of you and will see you soon bye