Dr. Roddy McGee

00:025 4 3 2 1 false start hello ladies and gentlemen hello Dr McGee that sounds not me peeing if you're hearing that you're like what is this is this a podcast in a bathroom no that's coffee how are you buddy good thank you for having me thanks for being here for uh folks who have heard me uh r and Rave about the Fantastic results that I have had um getting treatment on my shoulder where I was that close to getting surgery it's this gentleman Dr McGee who has uh who's fixed me up out of Las Vegas Nevada and uh now we're here to talk about it yeah I appreciate the chance to be here you're man of very short words today he was very talkative before the podcast folks that's how it goes man well now I'm hearing myself oh is it weird you out you can take them off we could take them off it's too weird you've never done a podcast like this before right you did John

01:01excellent we could take it off I might have to okay let's take it off I don't want to freak you out is that better this is a little more like a normal conversation okay I don't want to freak you out to me it's better cuz like I can hear like if it's things are wrong what's uh what's the notes Daddyo what do you got there uh just a couple of things I jotted down just make sure uh get 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 in your office which is why I wanted to have you here to talk to you because I mean I was having some really significant shoulder issues before um you treated it and it's it's amazing the results and what what you know I mean what what I've avoided avoided in shoulder surgery yeah I mean you've had a

01:48tremendous result so uh obviously we're very thankful that you're able to get that benefit and I think we're in my community of orthopedic surgery and Sports Medicine you know we're very excited about the possibility and eager to continue to learn about it and see what it can be and how it can help and what it does best for what now where's all this stuff coming from like where where is this science coming from and how has it evolved over the last few years well um a lot of the stuff that we're using is not new in terms of uh the tissue or uh that type of thing but it's actually the the application for Orthopedic Sports Medicine so you could go back decades to when it's been used in plastic surgery uh for corneal ulcers is one of the original applications of placental tissue uh so the idea of it isn't necessarily new it's just that as we've uh gained more understanding in

02:44our community of orthopedic surgery 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 the 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 um it's part of the mechanism of how the cell helps uh the process of the healing so but we'll talk about that for sure now when they extract the placental tissue like how would they do they they're doing it on young women who have had cesarian sections correct so it bypasses a lot of the ethical concerns that a lot of people had during the Bush Administration which kept them okay so let's you said a couple of different import things so let's start breaking that down a little bit so the first

03:32thing is um you know where does it come from it comes from a young healthy mother in this case what we're talking about um this particular category of biologic treatment or cellular tissue uh this comes from a young healthy mother that's having an elective C-section and prior to the delivery has agreed to make a charitable donation and then they have been screened and there's a process C 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 uh things of that nature and so once that has been cleared and they're an acceptable donor then they go through the delivery the tissues collected and as you said this is stuff that typically would go in the garbage so um essentially the you know

04:29the ethical and the the moral dilemma shouldn't exist for that portion of it because you know otherwise it's just garbage um now that's taken by the company that has harvested and they have their processing center which also has to be uh evaluated and approved by this aatb American Association of tissue Banks uh to be a facility that is up to their standards so they have a sterilization process the tissue is not contaminated their packaging is appropriate their you know their shipping is not causing problems with the tissue so you have to meet all these standards it's very stringent and so if you have that if a company has that uh approval then you know they they meet the standards allowed so that that stuff can then go either to an office or to a hospital so now the the next thing of what you said um let's talk a little bit about uh do uh President Bush and that

05:32whole 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 um an embryonic stem cell is when the the sperm and the Egg join and begin to form the beginning cells of life and there's initially two cells and then it divides into four eight Etc in the the first five days of life that's called a blast assyst and those cells can be harvested um and they are what we call toy potent that means they can become anything they have the ability to transform into any line of tissue or organ or in in the case of that first five days of Life those individual cells can actually become a complete organism so that's that's where we had you know the cloning of the sheep so that's what happened so they they took the cells in that first couple of days and then they

06:31have a process to allow it to continue to grow and and so you had two different from a single uh sperm and egg you had two organisms complete mammals you know created So when you say this Blas Tois is that how you say it that's just the term for the initial you know the ball of cells that's formed and how many cells is in a blasticus well they're dividing over the number of days and doubling each time so then you know by thousands not by that time 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 tody potent cell every individual cell has the ability to become a complete organism wow so that could be one blast assis could be 32 different people I guess potentially wow I don't know if that experiment's been carried out but theoretically at least thetically yeah wow so um now when they

07:25have like frozen embryos when 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 what's that about well I'm I'm not like a reproduction specialist so we might be getting you know out of my region those those frozen embryos a lot of times they don't get used right I don't know I don't know how that works um because I know there's been battles like people have had battles with their Ex-Wives and a little bit of stuff like that it's very 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 nonviable ones or

08:13the ones that don't get turned into people they could probably use those as well right well that that's a big the thing right that was the 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 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 app on stem cell research so for all of that time I mean private Equity companies and any private investor could have and probably has been spending the money to continue to research that and and develop it and find it so I I always find it interesting when I hear on TV I know oh like our country has been set back a decade because they signed this you know Bill like so you feel that's

09:10wrong yeah that's so um 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 rely on federal funding I don't know I mean there's there's private funding for all kinds of things so is it more common now than it is before before or has it always been the case where there's a lot of private funding so President Obama in 2009 lifted the ban on the federal funding so Federal funding's 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 cesarian section versus something that You' get from a blasticus well so a couple of things about that um one there's um it's actually to our benefit in Orthopedics not to be using that line of cells because those cells starting from

10:09that time Point have the ability to um have teratogenic potential so what that means is they can potentially form tumors so that makes it obviously a big disadvantage because now we're we're adding our risk to what we're doing once they've gotten to the point where it's a part of the the whole you know we call this like a human uh placental stem cell or meenal stem cell and that includes the placenta the umbilical cord the Wharton's jelly is a mucus type substance that's around the arteries of the umbilical cord the amnon or the amnionic sac which is the inner layer around the the baby and then the outer layer is called the coron now all of that has cells in it that we would put in the category of meenal stem cell or mesenchimal 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

11:14the blasticus becomes a morula becomes a an embryo eventually so in that process uh 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 um each of those kind of is directed towards a certain line of cells and tissues the the mism and what these uh the mesenchimal stem cells can become are all of the things that we care about in Orthopedics so carage bone muscle ligament tendon so we have that whole line of cells um 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 has the characteristics

12:22of the things that you're hoping it will become now that's a a directed and ordered approach in embryology and in the case of uh treating an injury what we're hoping is that that can differentiate into the injured tissue and how long have they been doing that well studies on that have been going on for at least 10 years um so I want to say maybe back as early as 2007 um now we've been if you go you know way back to the early days of uh arthoscopy and that would be like the late 70s and early 1980s uh and I don't know exactly what year you know he would have started doing this but um Dr Stedman at uh in Vil Colorado and he was in uh Reno and Lake Tahoe area before that they would um this he's the one that developed the micr fracture procedure and I don't know if you're familiar with that uh you've had a couple of knee surgeries so I don't know if you've heard that term I have but but

13:29I don't really recall exactly what it is sure so basically if a patient had a small cartilage defect he took a small uh an all or like what looked like a tiny little pick and made a puncture into the bone and what that did was 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 um now they also found that that didn't become the native cartilage it become something called fioc cartilage so when you look at it under a microscope it looks different compared to our normal cartilage H appearance like physically looks the same but under the microscope looks different what is the difference uh well the main difference in in What's um applicable is that um it's doesn't have the same structural properties so it was more

14:25easily able to kind of come off with a sheer force so just picture likeing yeah you could kind of flake off or or in some cases just didn't form as well as you know you would want H so so that experience um and I you know having conversations with the the guy that I trained with his name is Larry lemac in Birmingham uh he noted just over his career that he always felt like patients that had worse arthritis but they would do this micr fracture procedure on in NE arthoscopy actually would do better than patients with less arthritis but that they didn't do the 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 um and and it's only now that we start to understand you know because the bone marrow has some of these um meenal stem cells available

15:21also and we'll kind of talk about the differences and stuff like that so it's essentially like a crude version of St stem cell transplants like yeah I think that's 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 did they start applying this on people like in terms of not just tests and studies but actually in practice like what you do oh 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 um in Las Vegas and it was called the emerging techniques in Orthopedics so they were kind of talking about what's the the newest and uh you know most Forward Thinking ideas that are coming through so a company presented and in one of the uh Physicians presented information

16:18showing that they had harvested fat tissue from patients abdomen and injected into their knee um for patients that had knee arthritis and they were showing new growth of cartilage and an actually Improvement in some of the x-rays so when you look at an x-ray there's some characteristics that we look at that you know Define what arthritis is so if the patient has narrowing of the joint space or they have bone spurs things like that um 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 CU I've I've heard that they do St they harvest the fat similar to like a like a mini lipos suction and then they're you know

17:14they 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 meenal stem cells in the tissue and like what can they just are they just taking the fat like when they spit in the centrifuge like what does that accomplish uh it just separates out the the cells so then you can you know inject the portion that you want and we do that do it visually you've had it with PRP yeah yeah yeah so it's just i' I've had it with regenicin which is like a form of PRP correct yeah with a heated up and take it becomes like a yellow serum right so when that's the 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

18:06difference in the results from someone who does that because I know quite a few people have done it that way they've had injuries treated where they suck the fat out there there isn't any uh any research to differentiate like one of these treatments versus another yet it's just not available so it's all anecdotal in terms of like talking to patients 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 um you know where it's available and we have you know published stuff to look at and do you personally know of anybody who's had really good results using the fat method um Yes actually uh a physician friend of mine in Memphis Tennessee her name is Dr Laura Lenderman um 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

18:59you know the the real the rigorous study of this though is still yet to come H it's that's really fascinating like do you have you considered trying that or you just stick yeah but you don't so far you just do the the stem cells I haven't had anybody specifically request it and um maybe somebody wants to lose a little fat and fix their knees yeah I mean that's that's probably taking things in a direction I don't want to be going butg 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 um bone marrow is certainly um had a lot of use and had that done that's what you told me yeah yeah he had it 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 uh obviously it's a procedure um there's pain and there's you know morbidity there's a consequence to you

19:52know putting a sharp object into the bone and drawing that bone yeah so that means a a bad like that word no it's we don't like it either in medicine morbid is a bad word we have conferences called uh morbidity and mortality and that's where you basically 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 Ians go through to you know review cases I can only imagine you know I mean especially if you're dealing with people that are broken apart I mean essentially as an orthopedic surgeon you're dealing with people whose bodies have failed right your limbs have failed ligaments have

20:43torn off the bone knees have 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 bad things yeah yeah and so your time doing this with placental stem cells how long have you been doing that uh it's been a couple years so essentially you did mine I think how long ago was it I think it was July of 2015 yeah so I kind of came in pretty pretty early CU Jeff Davidson the doctor from the UFC he was the one who told me about it because he had shoulder surgery and um he was very stiff and had real problems after the shoulder surgery and was um just very unhappy with his rain emotion and the pain that he was experiencing and then he got some stem cell treatments and it just all went away and he trains a lot he trains really hard and and he's very fit I was pretty impressed with uh you know what

21:39he told me about how he was what he was able to get back to after you know he had been treated with uh that type of injection yeah yeah so he told me and then um I was like on the fence I mean I'd seen an orthopedic surgeon and the only thing that was keeping me from getting surgery is you know he put me through all these um stress tests where he pushed down on my arm and all this and I resisted all of them and he's like this is It's kind of odd that your injuri is this bad but you have so much strength in your joint still like maybe you should hold off a little bit before you get the surgery he's like cuz 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 and I probably would have been in the same boat as the first guy in terms of uh you know trying trying to make a decision about

22:30surgery uh 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 to take somebody to surgery well during normal everyday life there'd be like zero pain the problem is what I put my body through is has nothing that resembles normal everyday life between Jiu-Jitsu and kickboxing and kettle bells and archery and yeah there's just so much explosive movements and so much weightbearing movement you're doing really high demand stuff yeah so in that in that case that was one of the reasons why I was thinking CU like I don't want to walk around with a compromised body I'm like if I have to just get surgery and then take six months of rehab or whatever like what is the for a type of shoulder injury that I had what is the rehabilitation time um you know for sure probably three months I mean it it can be longer than

23:23that it depends on the patient um somebody like you that one of things that we um have trouble with with some patients they've never even lifted weights for example oh yeah so for them the rehab the 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 um and it's challenging it's hard work and it's uncomfortable and so some patients you know they're they struggle to get through that part of it it um and it naturally 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

24:16they're so rudimentary you know you would move through that very quickly and then uh once you're at the point where you have had enough tissue healing and it's safe to progress you um you know through higher level exercises then you could really push it and you would I mean you would be committed to it dedicated uh diligent I mean we'd almost have to hold you back yeah that was another question I had how often do you have people where that is the the issue like I know you 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 uh you know one of the lines that i' say to all my patients um regularly is you know you got to respect biology like you have to allow the healing to happen I know you feel good I know you're moving good and you're ready

25:05to 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 Ranger then you're right back in that same bat 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 uh but at the 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 def definitely yeah and were they the people that we talked about before that don't exercise and aren't in good shape or is it across the board you know I would have to go back and look and and kind of critically evaluate each case um certainly you know we worry about the

25:56patient that um has lower like Baseline Fitness like their overall health is poorer you know and what their response might be um 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 you're working out regularly you're doing all kinds of things to optimize your chance to not you know in this case heal but in other instances perform uh 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 and breaking down and rebuilding and it's always constantly under stress uh definitely has to be a part of it you know I I think it's uh it's not the typical realm of my specialty to be

26:57looking at all those other factors but 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 um and it might be things that we have to do before somebody even has treatment we might have to bring them up to some baseline level a number of different things you know um and so the other side of it too is we're we're in a we're 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 um I think that's really important so I find myself more and more seeking help

27:50help and just saying hey like 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 you know can I have the patient talk with you and and maybe get some more information and I think that may give them even better uh chance to do well just cuz the options and the possibilities are so comprehensive and time so you know in in a typical Orthopedic practice you don't have a ton of time to go through all of this with every patient um and so you just have to make sure that you're providing resources and and getting them as good information as available one of the things I thought was interesting you were telling me that there's uh been really good results with people going into a SA directly after treatment well that 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

28:37for other applications in terms of heat shock proteins you know there's some belief that that may either assist the cells in Pro proliferation or their ability to you know have as robust uh um 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 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 the 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 the FDA is very clear that you know we cannot be making those claims companies

29:30can'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 when you talk about heat shock proteins um I don't know if you can answer this question but is there a difference between the Heat shock proteins that you receive from say like a steam shower like a steam room versus a sauna versus even a hot bath I've heard people saying that you can get heat shock proteins from a very hot bath and I think 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 where your body is like what is this guy doing and then it produces the heat shock

30:19proteins to try to compensate yeah as a protective mechanism the so that just the the knowledge of this I mean this is really interesting because people have been using saunas forever it was all sort of anecdotal makes me feel great and and I would look at them like what are these 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 in the sauna and they thought they lost weight sauna yeah I really did think that they just dropping water but um talking to Dr Ronda Patrick and she was explaining the um the benefits of uh sauna where there was one study where mortality decreased 40% from all causes through daily of the sauna yeah all cause mortality was less yeah 40% here it is right now using the sauna four to seven times per week associated with a 40% lower all cause

31:09mortality might be heatshock protein sciencedaily.com fascinating stuff um yeah click on it click on it young Jamie here we go so get a little larger there Journal of American Medical Association so serious stuff right I mean that it's a peer-reviewed journal yeah you know you're can to assume that there may be some validity of the information amazing um yeah I mean if that's correct if that if if all I have to do is get in the sauna and I you know can decrease my chance of death from all you all diseases by 40% like yeah cancer heart attack leukemia amazing here's a what a suitable replacement hot bath won't be as robust but can increase blood flow Elevate heart rate inre increase heat shock proteins so she's saying it just won't be as robust I she's never taken one of my baths so you know a simple thing to find out or like what you could do yourself is check your

32:07heart rate blood pressure temperature you know just like just take those as like a baseline right on after each of those you know sessions and see if there's difference how much does your body temperature Elevate during those things and how much of it is a Surface SC me you can you can't elevate your core temperature too much or you're going to have that's what I'm saying enzymatic break down and like there bad things are going to happen yeah I wonder like what the line is the point of diminishing returns where the sauna becomes detrimental versus beneficial yeah and I wonder like how uh cryotherapy comes into play with that as well because cold shock proteins also show some great benefit in reducing inflammation and yeah it's just an amazing time for all the different definitely options that are available to people you know I think at the same time

32:58uh one of the things that we have to be 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 uh you know we want to try to avoid that we want to try to give people good information so that they can ask the right questions and they can evaluate places where they're going to see if they're comfortable with what they're being told and what's being offered so I think there's something like 200 plus regenerative medicine clinics that have popped up in the last couple of years H and that means at least 40 of them are well by my math I mean maybe maybe 80 maybe more than that who knows maybe 90 well I just think people have to be cautious and careful about you know what they're reading what they're saying and some of these places have

33:52received direct letters from the FDA saying hey like you can't say that right you can't be making claims um so 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 um that has some validated outcome studies um there's a comparison study with PRP uh on tennis elbow or lateral epicondilitis comparing that to corticosteroid injections which is a common treatment for attempt to give pain relief um in the particular study that I'm thinking of they had you know 73% of the patients that received 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 seemed to be to PRP now what is the difference between the results I don't know if you even know this between the results of PRP and

34:50regenicin 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 traveled to Europe Manning Kobe Bryant all those guys flew in Alex Rodriguez I think Dana White did too president of the UFC he went in there for ttis and you know and uh found through uh intramuscular injections there's a deep relief of uh ttis yeah so that I 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 um time is going to tell us what 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 you know the proof is going to be when we have you know robust clinical studies that compare treatment um and you know we have follow-up physical exams and we

35:50have 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 have this cell that has the potential to differentiate into other tissue and actually causes healing um but nobody has demonstrated that yet there are some studies I mean there's there's 35 studies uh 29 are animal there's six six or seven that are uh human trial I I just saw this uh review paper and I don't I didn't know if the review paper had been written before one of the more recent um clinical trials was published um there's so one was on uh knee arthritis and the others were on mostly Foot and Ankle stuff um the most recent uh from USC and uh in combination with u a doctor that's in Indiana and they looked at patients that had uh a knee arthroscopy and they reected part of the meniscus so we call that a menisectomy and part of it was

36:53essentially cut out so there was a tear they cut out the bad tissue they left the remaining healthy tissue and they did an MRI and they measured on the MRI the volume of meniscal tissue then they injected the patient with a bone marrow aspirate so in this case it was the you know bmac or bone Mar aspirate um treat which is stem cells extracted from bone M 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 it was eight months they reimaged the knee and they found that there was a 15% increase in the meniscal volume so the patients had apparently grown meniscal tissue I had a meniscus scope on my left knee um from uh an ACL injury that I had I had ACL surgery but there was still some meniscus damage and then uh they they on at the time of the ACL injury they tried

37:56to stitch up the meniscus and they just tried to cut it out and it was a problem for me for several years and then finally it tore became a bucket handle tear where it locks you know so it locked my knee I brutally painful in the middle of a jiujitsu class it was really bad so uh I had to get it scoped and then once I got it scoped it was O it was functional but it would provide me with maybe every couple weeks it would be painful would be something going on would ache it would be a problem you shot some stem cells in there a year ago I had zero problems with it since zero nothing it's like like I don't even acknowledge that I have a 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 now yeah it's crazy like I mean for a decade plus I had pain in that knee one one injection a year later nothing and it was

39:00almost within 2 months within 2 months after the injection I I felt like a significant difference I was like waiting for those days because those days when I pushed it hard particularly after kickboxing there's something about those like hard pad work like kicking the pads I was going to say any particular things that you were doing that made it feel the worst that was the big one striking cuz striking is just jarring and there's just so much and I just think there's just there was laxity in the knee is that a word yes why does it sound wrong no I know it's a word but it sounds it sounds wrong laxity sounds wrong sounds like a laxative it sounds like I'm making up a word you know I was laxity from my laxative um but that kicking uh motion would always you know and it would just hurt I would put ice on it you I'd be just go about my day like well it's fine

39:50it's not swelling up to and 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 in it today so this is the kind of thing that I think gets a lot of us excited about what the potential is that you know you've got a patient here that you had him meniscal tear then you so you had attempted a repair we know that about 15 to 22% of those fail the minuscal repairs you know it's a disappointing number you know we like things to be much higher than that uh but that's that's what the the facts are um that's what the you know larger scale Studies have told us and to anybody that has a minuscal injury that's a risk worth taking because if you know what it feels like to have a bucket handle tear and someone says hey you have an 80% chance of success you're like I'm in yeah take

40:42it 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 of their life as we can so certainly you are willing to risk it and even you sometimes might attempt to repair something that you think even has a lower chance just because they're young and you want to preserve that why you want to preserve it is we know that if you even resect a small amount of the meniscal tissue like say up to 25% um it will change the contact pressure in the knee so they do these you know color pressure studies where it it shows you the amount of of force and its distribution and with a normal meniscus it's evenly distributed into the you know on the the medial femoral condil the end of the femur and then the tibial Plateau is the top part of the chin bone so when those come together

41:37with a normal meniscus in there the pressure is even if you reect 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 of pressure sort of like when you go to a restaurant and you're sitting at a table and it's wobbly and you have to stick a napkin under one of the legs um is that a bad analogy maybe probably bad analogy I'm not following you but you know what I'm talking about done that when you're eating like the guy and he kind of twists the one leg a little higher a piece of wedge under there and I know what you're saying I don't know that it's not the best if that makes sense for you that's fine I tried I swung and I missed let's continue that's all right but the point of the story is that we know if we cut part of that out your cartilage is going to have some wear and tear over time now whether or not you

42:22develop 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 jarring action of kicking a heavy bag or kicking pads so I I think the what I was trying to get to and I was taking the long path to get there was that you know in the past what we might have said is eh you know you had an ACL tear you had a miniscus tear you know your niece is crappy sorry like you're going to have some pain but and what are you trying to what are you kickbox him for at your age anyway I've heard that this is this would be the attitude right um and really what that means is I'm uncomfortable because I don't have an easy solution for you so I'm going to blame you for well there's also people wanting you to adopt their lifestyle or them to think that your lifestyle is fool hearty there's

43:10definitely that I mean I had a conversation with they're trying to find an easy solution so that you don't come back into the office and complain about something that we don't have an easy solution for also I think they're trying to talk Sensi to you that may be true too in their mind you know like if you don't do martial arts you see some knucklehead out there RIS of having to come to my office that's true it's also you see someone who's doing this and hurting themselves and you tell them hey look you've got to stop doing that you know CU you think you're doing the right thing by telling them that right but you know you're you're essentially telling someone that all that stuff that makes you feel amazing yeah who alleviates stress builds confidence it makes you it's part of your soul yeah it's a big part yeah so how am I supposed to rip that away from you like well for some

43:52people it's it becomes a real I mean obviously with certain injuries yeah but um some people we have to have the hard discussion it's like look I know you want to keep doing this I know you think you're heading that direction but this is over well when they do Replacements now cuz uh 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 his name is Dan Pena and he was saying that uh 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 like there's no wiggle room well like he can't go side to side like the knee just goes straight up and back like this artificial knee does that make sense no you got skeptical hippo face well there's depends on a lot of factors um maybe for him um there may be other patients that

44:47don't have you know quite as much stiffness in their knee but no one who gets a hip replacement is doing triathlons they shouldn't be or a knee replacement rather they shouldn't be yeah so it's limited with 100% certainty that implant will loosen and fall apart huh why can't they make a knee a fake knee that's as good as a real knee H that's a long question are they lazy no I wouldn't think so certainly uh certainly lots of motivation and uh you know economic reward oh my God if they could fix a knee and turn a knee into a superior knee to the knee that you have now so the I mean it's like an overall question right why can you not uh 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 we wish we wish we're hoping that we can you know figure something out for that but fact

45:48is with the knee replacement you have a metal component that you're either you know cementing to the Bone or you're you know applying it to the Bone and having bony ingrowth into the implant so there 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 all the people in his neighborhood got cancer like a huge epidemic of cancer in his neighborhood and he got bone cancer and they replaced one of his femurs with a metal rod mhm and uh it causes him significant discomfort we did some of those in my training it's a pretty garly what's that about talk to

46:45me total femur yeah I cut someone open like a fish and stick a new leg in there ah you literally do it's an incision about that long whoa he's making his arms about what your arm about 4tt it's the entire length of however long your thigh is I chihuaha yeah okay it's gnarly yeah they all get infected they do it seems like it wow now posttop like right away or you mean in time over time yeah just because your body's rejecting it doesn't know what to do rejection it's just you got this big hunk of metal and the um bacteria forms you know this sort of slime layer that can't be um 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 wow so the metal on the leg the fake leg just gets slimy uh not so much that it gets slimy it's just the the stuff that's produced

47:46by the bacteria adheres to the metal oh so and 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 get gets infected got to open him up again clean it up you do you try but the the end of the line is uh utation the limb has to go whoa Daddy Jamie's Jamie almost threw up you got an image pull it up don't pull it up you don't you're a doctor how dare you how dare you say don't pull it up you're this is what you do man I'm feeling bad I didn't have pictures right I didn't I didn't know where you're were going to get to Total femur what yeah that's Go Large with that sir why I want to see that I don't even holy Jesus making me sweat wa my God first of all what am I looking at there so that's the the femur you know that's a metal femur and the just Google replace femur and look at the first pict open up there and you

48:47have to make measurements and so it's basically a a total knee and a total hip and then all of the bone in between has been replaced with that metal wow and then your foot's just attached to your regular Shin below it correct and what is this normally used for like how often what is this uh so that would be in the case of uh infection and you know there's the cases that we had were usually multiple fractures below a hip replacement and then and then below uh a longer stem hip replacement finally you've got just no bone uh the other you know reason would be infected bone that you had to reect and 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 yeah right there what's going on there what's all that stuff on the

49:42outside that that orange stuff oh so uh that's called ioban and it's a thin film that we cover over where we're making an incision in surgery it's to help prevent infection so we naturally have you know staff and other bacteria on the Sur surface of the skin and you put this sticker cover on top of the skin and then anything that's around the wound is is contained it says play video I think you should listen to him click on that let see what that is yeah let's see who this is this is just a picture of oh it's just a picture of that that says that I can visit page cl play video there we go oh I'm scared you getting nervous Oh Daddy whoa boy now that seems really odd I like to do surgery through incisions like that are about this big yeah a 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

50:36either very old or very unathletic uh yeah and um this is like one good evaluation that's incredibly traumatic then I mean that's the how does someone recover from that it's slow now is there a potential use of stem cells in the case of like is it is it possible to regenerate a bone I know they've built a woman a artificial bladder through theoretically bone is one of the tissues that is a part of that line of the meenal stem cells right that's what I'm saying that comes from the mism so you think that could be something down the line that they could be able to accomplish there I mean replacing that femur and and its cartilage covering at the knee and the hip I mean I think that's at this point um a fantasy yeah but isn't that like what they 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

51:30thing they're like well right now that's a 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 uh this is an embarrassing story to admit but when I was about 13 uh I went next door to my neighbor's house and he was kind 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 um I can hook my computer up to the phone and I can type on the screen and my friend down the street will see what I wrote and I was like that's the dumbest thing I've ever heard dude can't 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 had a Showtime special in 2005 a Netflix special actually that eventually

52:24wound up on Showtime but I had a joke in there there about cell phones um about people sending you a text message and the part of the joke was like it takes you four presses to get an S right like why don't you just call me because like it was before anybody had figured out how to you know make an actual 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 going to go away and now if someone calls me I go are you calling me for like it's it's very strange what's happening in just 12 years yeah it's a total shift in how we communicate with people right a massive one I mean how uh how disruptive to your life is it to have to like send emails now I mean to sit down and like type an like email respond back somebody emails you like people email me with like a bunch of questions it's a big chore it's

53:17like homework I got to sit down it takes a lot of time yeah whereas you know a text is like a quick response like hey I I just I'm so used to email I send a lot of email I have so much email well I do all the booking for this show too I mean well I have a guy Matt Stags 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 do I I contact people sure and you know the best way to do it is through an email it's like hey you know I would really love to talk to you about this or that I have a question about that these are brief emails I would bet sometimes yeah but I've gone I've I've had some yeah that's the problem is the volume the sheer volume I get is just unmanageable to the point where people think I'm ignoring them I'm like man I'm not ignoring you I didn't even see it it just got lost in the tsunami of emails

54:05that came in like if I go on vacation I hardly communicate I I barely do anything maybe I'll put up a social media post and you know just just to like 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 2,000 emails I'll have 2,000 emails in a few days I'm not I'm not exaggerating do you go through all of those I do my best I look for my friends yeah you know I look for people that are important and uh look for uh acquaintances that I like and you know got work rated stuff yeah but it's a mess I have several email accounts too 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 one D don't worry about it I like you I don't think I if you do I'll give you the real one want to let you know I won't tell anybody people don't like to

54:58be on the outside you tell them about that and they're like which one do I have bro yeah why worry about it man what list am I on why worry about it man yeah yeah you got if you have to ask the question 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 like what's the next thing what is uh you know it's definitely not going to be videos where you force people to watch the beautiful thing about an email is I can kind of scan it through what's this guy saying not interested next have you messed around with uh like Dragon Dictation yes yes it's amazing for notes when you're in a car or when um if I have an Ida in my head and there's no way I can type it on my phone that quickly have you ever seen how good it works it's no it's very good yeah no well just what comes with

55:44like the most recent uh versions of it yeah like this right here check this out Dr Rody McGee is an amazing human being he has fresh breath and his hair is wonderful look at that perfect perfect perfect yeah 100% 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 that's texting cuz sometimes like Neil Neil Brennan had the best analogy for it you know Neil Brennan is standup comedian co- creator of the Chappelle show he had the best analogy he goes my notebook is essentially like a net for catching ideas yeah and you got to catch those IDE as as you can it's a good way looking at it 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'll

56:38press that record button very responsible of you I'm I'm very responsible when it comes to texting and driving that's good I'm I just I think that is one of the most infuriating things it's 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 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 um what did what do you got there that you would like to cover well um so you know okay so we touched 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 then sending you on your way right if you truly have an injury and we're trying to recover you then what also comes along with that is the appropriate rehab protocol and and none of those are

57:36defined yet for for what some of these things that we've done um 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 um 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 uh Avenue but the 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 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 um whatever it is that we're hoping that will be so but then you can't ignore the fact fact that if somebody has a bad shoulder well we may decrease the pain but if they if their if their motion is

58:34poor if their strength is poor if it's not functioning correctly then H 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 and 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 you're on uh you know a variety of supplements that 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 especially like staying away from inflammation enhancing Foods or inflammatory foods yeah no doubt so um yeah I I think it's got to be critically important and we try to share that information with people there's um for athletes uh like a website that you can pull up and we can

59:26Shar is the uh collagen professional athlete uh dietetics Association I think it is collagen professional college and professional athlete I was like what college and professional athletes I don't even know what that means we all have collagen right but college and yeah so these guys have some great information and good infographics that um that we utilize you know since I'm not a that looks good I'm not a dietitian so I have to rely again on people that have good information I I think these guys have uh good reliable they're a good reliable source and uh they've got great infographics if you go to um uh H educational resources there you go yeah so this will pull up some some different things balance extra exercise induced information now here's a good question um because uh it's pretty much universally agreed that rest ice compression elevation all those

60:37different things that people have said in the past that there is benefit to particularly icing things but there's ofate right there's some debate now there certainly there's like a definite uh anti ice Community yeah what is that out there do you think it's legit well there there's not a downside to it I mean Ice 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 um and I don't know all of their arguments against but Mesa Tate former UFC banway champion she had a podcast with this guy who's the anti- ice guy yeah like that's his whole thing is he a flat earth guy too no but he doesn't believe in dinosaurs I made that up no I made that up yeah if it I don't know I mean so you I believe he's a doctor but he you know he might be a Veterinary works on cat infections or something I don't know but he I don't

61:31think there's a down I'm King about that too so in my opinion you know I've definitely had athletic injuries uh I was a pitcher previously we routinely iced our shoulder and elbow after pitching um I did it as a matter of routine it felt good I felt better when I did it than when I 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 hard to know I mean that's where it gets weird right yeah I don't know to be frank God damn it you're supposed to know you're the you're the Super Genius doctor guy if you don't know we're doomed get back to me so uh what else I'll get you some good information on it thank you appreciate it what else you got here um so you know I think one of the interesting things about this whole topic um and the possibility of healing from utilizing this type of treatment um is

62:36how it allows you to go through the process of healing without this fibrovascular response so the typical healing Cascade has an inflammatory phase proliferative phase and the maturation phase 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 and that means the development of new blood vessels and vasculature to the area um and your body is producing fiber blasts and you're laying down tissue in this sort of halfhazard manner so it's just kind of piling on in there um then the maturation phase is when you have remodeling so those that scar tissue is changing over time and and developing into uh tissue that's more like or is the native tissue so that occurs over a period of time and then a lot of times

63:41during that process before you're fully matured in the healing you're back to activities um the best so let's just take an example like when you spray your ankle and then you you know you start feeling better and you maybe you 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 now the hope is that we can demonstrate now we 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 scratched her face they he W was like gone like the next day right um so healing without scar is you know has to do with not

64:38forming this these fiber this fiber blast um or fibrovascular response and and fibrotic phase MH 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 properties 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 repeat injury because that's really our goal is 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 these nobody knows oh Jesus nobody knows that that's this is one of the big questions that we have that will be discovered with again you know rigorous studies where we can look at you know what should the dosing be what

65:36should the frequency of the treatment be and what should these the protocols before and after be uh it's not defined and anybody that's telling a patient that they have exactly what it should be I mean be wary of that because it's that has not been discovered yet so we're trying to we're trying to take you know we're taking the information from our exper experience and applying it that way it's it's not the it's not the best way to go about this and it 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 um 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

66:24was just a mish mash of information it wasn't valuable how do how does platelet rich plasma work so it has growth factors and cyto kindes and the um the 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 could work in a symbiotic fashion with like this kind there is information that adding PRP to uh some cellular treatment like bone marrow fat or the placental tissue uh in that line of treatment can help expand the cells oo so that gets us to an important point which is uh expanding the cells has been done and is not currently legal in the United States so there was a a place and they they do it in other countries but here if you if you more than man this is a mouthful if you more than minimally manipulate the tissue then that is not under the

67:27guidelines 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 bringing the patients back two weeks later and injecting them with this you know super production of cells which probably is great but we don't know we don't know if that's safe and and that has to be you know that has to be taken through the appropriate process 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 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 would I can't put on my website right I have the magic potion it's PR and amniotic fluid and tissue inject it and it can heal anything I admire how

68:31responsible you are how you keep cutting me off whenever I'm suggesting some ridiculous thing but is would there be a benefit for a patient potential benefit who's getting stem cell injections and also gets PRP at the same time or is it just theoretical uh it's theoretical right now yeah but potentially definitely uh there's potential and it's encouraging to you know that that there possibility is there it appears to be safe there you know we don't have adverse reactions to it um 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 going to do this and I'm going to fix your shoulder like come here if you have a miniscus tear because

69:35we do this injection and it's going to make you better that's illegal that's I understand so but I if somebody comes to my office you know I can elect to do that because both things are available um they have we have permission you know to use them but we're using it off label I understand now um when you say maximize cells that's the term used maybe what is the term used about PRP in in conjunction we think that it can increase the proliferation of the maal stem cells oh and how much of a time period would it have to be between the injection and the PRP that's undefined again so what would you assume the way that the way that we're doing is we would do the injection at the same time oh I see 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

70:27then inject them MH and then there's you know maybe between 7 and 21 days that those cells are viable in your shoulder or 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 yes that yeah that that's uh that's how I would do it currently uh based on that information it's a fascinating stuff yeah what else you got there well so um we just I thought it was important to talk about the it's called section 361 of the Public Health Service Act and this is the definition from the FDA on the use of human cell tissue and cellular tissue products 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 um like I was

71:25saying you can't you know put it in the lab and grow it and add things to it and then bring the patient back and treat them how this isn't part of the U part of it but we you 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 um 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 it into somebody's body so for example uh if I have uh 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 um that is that's homologous use we have we're taking bone we're using it to become bone or to be the scaffold for bone to heal and grow so um

72:25it 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 whatever diabetes I'm that is something that people do in other countries right they're doing in other countries you can't do that in you technically can't do that you can't manufacture a product and put that on the labeling that 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 what is going on there I'm not aware of it what how does that even work

73:21do you know it's not your wheelhouse no but I and nobody knows if it does so it's just experimental it is I mean boss do you know who boss rutin is former UFC champion do you ever treat him I have not you allowed to say that um boss I don't think I can say talk about any patient that unless uh they have said it or they're sitting in front of me talking about it anyway okay I give you permission it's the it's HIPPA violation heal information for the record I give you permission um boss rtin went to where did he said he go to Peru or something like that went to the Jungle some dude killed a chicken and then shot some stem cells into him blood right he was saying it was amazing if you you know you ever heard the way boss talks he's like it's like the energy was coming out of my body like ah he said that he literally felt like like some guy in a kung fu movie where energy was

74:14like shooting off his fingertips he said it was amazing like the emperor he's not the only guy that said that you know Dan ban do you know Dan ban is the Instagram guy with the uh he told me the same thing he said that when he he got it done he said it's amazing he goes to Mexico to get it done not recommended but you can't talk about it off air he'll be a little chatter box just you wait maybe um well what I'm interested in what I was thinking for you uh threw me off there um is is he going to with a specific intent of treating something or is he just like looking for the Fountain of Youth um I think he so much he doesn't have any sperm in his body and uh he's trying to kick I don't know that guy's an animal but uh I think he's got a series of injuries I know that cuz he's had regenicin for his neck uh he put it up on uh on Instagram like with the Instagram stories he was videoing

75:19himself while he was getting injections in his neck which I've had uh regenicin yes it cured my cervical disc um bulge what yeah yeah that and dis decompression uh spinal 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 nerves yeah completely resolved like on an MRI it doesn't exist anymore where I was getting numb hands cuz the owner nerve was being pressed upon yeah huh yeah it works well massive anti-inflammation properties I just don't think that it has same healing potential it seems like it reduces inflammation in a giant way what's going on with um by the way I had regenicin shot in my knee too you told me didn't really have the same effect worked a little bit so patients like yourself that have had uh a number of injuries and a number of treatments one of the

76:16things 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 mhm and that it was just completely different game changer just 100% game and different look my right shoulder is not 100% but it might be 90% you know and it's strong as like I could do a lot of with it like it I've seen you do some insane stuff yeah yeah and it's it doesn't B things that I probably wouldn't recommend but no pain like uh glad you can well I could do um I take these 90 lb kettle bells and I do windmills with them where you you know you're pressing overhead you know what a windmill is you're dropping down like that so your shoulders rotating I don't do that with 90 lbs but I know what it is but the the the fact that I can do that with a shoulder that was on its way probably to

77:08getting surgery on is just amazing my bow that probably the most impressive thing was that pushup with the wheel thing what's that thing called oh the ab wheel no it's like a little roller that you had your hand on oh yeah those things when you go forward what's that called the com Havoc creates it there sliders Havoc sliders okay uh H YK sliders there's a video of it on see there's a video on my Instagram Jamie um from quite a while ago but it was post post excuse me uh injection um it's from way back I want to say at least a year ago I was doing that but um yeah there's my range of motions 100% I mean at the most it's uncomfortable in certain things but for a big one for me was archery because um you know I really enjoy it I do it all the time and it's it's very meditative to me I I just I love archery so for me like the idea of not being able to pull my bow back I was it was really

78:11disturbing I was like God I'm going to have to get the surgery done yeah you've been pretty committed to it for a while now yeah I I I'll shoot a 100 plus arrows a day and I'm pulling back 84 lbs it's a 84 lb compound bow and I'm shooting it 100 times a day and it's no pain I did it yesterday like for hours me and my friend cam Haynes who you know you met yeah who came to and talked to you as well um you kind of indirectly got me uh into it I don't know I into archery 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 H ho uh carbon spider bow it's like uh if you want to if you want to see uh any of my friends like make the greatest faces you've ever seen I just I pull this thing out and it's like you know some space age weapon it looks like a bow that Batman would have yeah or chewbaca yeah or chewbaca

79:10yeah something like that yeah I would say Batman but yeah but yeah it's um those bows are they're amazing it's incredible and it's uh I've only been able to go a couple of times but I'm I'm definitely hooked it's the most amazing meditation I love it it's cuz it's when you're focusing on that shot you literally have no room for anything else it's it requires so much concentration you're concentrating on the 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 the first bow that I get to shoot with and then JN gives me the first lesson that I've ever pulled a bow back he's standing there right with me he's an Olympic coach by the way he used to coach the Olympic team he's amazing I mean he that guy can take he's a great

80:05guy too and he can take years off of people's learning Pro I mean he's he's absolutely taking years off my learning curve yeah I'm going to sneeze Bo I hate when you say you're going to sneeze and then you put a lot of pressure on yourself and you're like man I might not I 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 uh kind of crazy thing about the the placental derived treatments is that they actually have uh antimicrobial properties whoa so this is crazy I mean we kind of know this um you know one of the functions of the the amniotic membrane is to protect the the developing baby right mhm but um and and one of the things it does protect it from infection but what they were able to demonstrate was that um when they they've actually introduced bacteria like literally injected bacteria onto

81:09these membranes and then they come back and and check and it it it has destroyed the bacteria so huh so ability to um resist scar formation move through the the fibrotic phase of healing and then also the antimicrobial properties it's pretty amazing so that would be super beneficial postsurgery right because that's a giant issue staff infections and 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 I know because of the nature of uh martial arts it just everybody I knows at surgery like pretty much and the big issue is post in uh post surgery infections yeah well those guys are they're getting abrasions and everything like that on the mat and then so then they're colonized with you know MRSA or any number of uh whatever Funk is in that JY

82:11I tell everybody if you are a Grappler this is super important I want you to look up defense soap defense soap is a soap company that was created by my friend guy scko and he 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 this 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 it a couple of times and until I was like super diligent about washing myself like immediately afterwards but once I started using two things probiotics which is huge um acidophilus eating yogurt and uh drinking kombucha and then the next one was soap probably not but it's it's a little bit of something it's a little bit of something I just think it's good to have it's good to have um probiotics I like kimchi I I try to take

83:11my prob probiotics in multiple forms um this stuff that I was drinking when you got here kombucha I love this stuff I drink particular flavor that you like or do you mix well you got to be careful because I'm a low sugar guy so like the some of are delicious but they have a lot of sugar this multi greens does not have a lot of sugar let me see what it's got I think it's something like 10 grams per serving or something like that really that sounds High I think I've seen them lower oh two yeah that's sound two gr so yeah that's what you want the grape's high grape is but the um course it tastes wonderful right it does taste yummy that's the problem this does not taste so good but you know you're getting something good in there and this is fight 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

84:00they're not a sponsor GTS kombucha GT GTS um this stuff is awesome but you have to be over 21 because it has more than one half of 1% alcohol by volume because of the fermentation process cuz it's so strong I see so they make you get show your ID interesting they actually pulled it from Whole Foods I don't know if you know this Oh I thought see I thought I that's where I've seen it yeah they have it back but they p 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 due to regulations you have to letter of the law kind of thing exactly uh what else you got got a lot of papers there buddy well got drawings and charts and graphs stuff to think about probably a bunch of

84:52stuff you say don't let Joe talk about this don't um what other questions have you 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 um and Jeff was telling me that the um most recent procedure with stem cells is injecting them directly into the discs for people that have degenerative dis disease and that there's some really promising results I've heard uh anecdotally of a number of uh very positive outcomes uh with treatment like that but that's amazing again we you know too too early so a lot of I love the fact that you're very conservative about this I really really really do appreciate that although I'm giving time wrestled I've really wrestled with it because uh you know again our whole training is based on you know we need to do things that have an Evidence base for our patients I

85:54mean this is kind of the the foundation of what we do and so but we're in a unique situation so we have patients that um one we this stuff is available and it's legal to do and it's there and people know about it now so they they're seeking the information they come to us right and even you know even before we started talking about it you know it started to be like here and there and then all of a sudden it's like two three patients a day now even more are saying what about what about stem cell should can I have stem cell and uh like okay well you know then we have to back up and like have the whole discussion like okay well let's talk about what that is and what maybe it can do and um so people are seeking the treatment it's available um 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

86:48early results I can tell you anecdotal stuff we've even seen images where somebody had you know full thickness rotator cuff tear 8 months later what looked like a healed rotator cuff on 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 um did it happen because of the treatment you know that hasn't been established right so I have to really explain all that and it the other category too that uh patients will come and 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 and they were fine with uh paying out of pocket because of course it's not covered by Insurance um because it's experimental because there's you know no data yet and that's not true there's not no data but

87:40there's there's not enough data uh to support treatment for you know certain uh conditions um 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 um and usually the category is excuse me 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 uh you know I dislocated my shoulder seven times and uh can you just put an injection in there well the the problem with that is that the in 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 often times a a laboral tear that comes with that now I don't believe 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

88:41structures in the shoulder and resolve the pain for that patient now can I pause you right there while still this in my head I believe there was something that came up a few years ago where they were doing something where they heating up the inside of the capsule and shrinking thermal capsule ory what is that was very popular you said was yeah now it's close to malpractice oh Jesus yeah so it's interesting the the way these things go so there was a huge wave of um 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 uh Richard Hawkins is a very accomplished orthopedic surgeon kind of iconic guy that's done tons of research he was also went in Vale Colorado now in Carolina and he published a paper that

89:37that showed a very high rate of failure from these procedures and so as a result of that um it's fallen out of favor so huh but it was done very frequently on lots and lots of shoulders Now High rate of failure 40% okay but here here's the question is that because you're you're talking about already compromised joints right which is a very complicated joint the the uh shoulders very complicated joint there's certainly a number of reasons why that could have failed but uh there was a lot of problems with uh basically damage to the tissue from the radio frequency oh so it was weakening things yeah I see yeah so that that what the benefit of it well you could watch it and you were seeing the decrease in the volume of the capsule so you were where structures had become loose you were seeing it become tight at the time zero period what about doing that in conjunction with some sort of a stem

90:35cell therapy um does that make sense yeah I should be a doctor right you're very close yeah know you're you're only uh 10 years in school you're only 14 years away 14 yeah that's all 14 for regular people give me 20 yeah um so so so why did they think that it would work in the first place like what what was the uh the idea behind there's there's early published papers that were saying that the outcomes were better if you used it wow 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 did it take before it became malpractice or exaggerated term but problematic um I I don't know the exact year that his paper was published but it was um it was before my residency training I started I graduated medical school in 2006 so it was before that that people

91:33weren't doing that anymore okay so I'll bring you back around so when someone has had like if you talked to some dude who played football or something had multiple shoulder dislocations like what would you do you would encourage surgery um so the you know the typical um course for recurrent instability the shoulder would be a stabilization procedure now a lot of that's 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 couple stitches you repair the laum you can tighten the capsule at the same time and young patients progress really well through that um 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 an anterior shoulder dislocation is the usual one and then as

92:34it tries to come back into place the 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 humoral head so what is the correct procedure let mean I I keep throwing you off track but when someone does have a shoulder dislocation what are you supposed to do you supposed to pull on it or just take them to the hospital um there's probably no harm in doing that there's there's a great technique called the zahiri technique spell it z a i r i and that's just the name of the guy that wrote the paper um but it's essentially it would be a really easy thing for you to learn because it's kind of a leverage thing just yeah so it's a way to um 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

93:32like at the field so I actually did it on a uh uh professional steer wrestler um at the rodeo how hilarious is it that you can be a professional steer wrestler like I was amateur for a few years but yeah no they're they're they're pretty serious about stuff super serious you were talking about your uh bucket handle miniscus the first Rodeo Cowboy that I took care of had a flipped bucket handle miniscus tear and he came in the the day that the National Finals Rodeo was starting and he was also a steer wrestler by the way and had been a previous I think he was a champ or he he won a bunch that's for sure um so they basically they taped his knee you got to come closer they taped his knee yeah in about 30° of flexion and he compet reped the whole nine days whoa just roped up knee just taped it up got on his horse and was jumping off and throwing 600 lb steers

94:34Jes on the ground J Christ yeah those guys are crazy I watch that stuff 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 we made people ride Bulls made them ride it that's tery that's you can die I mean that's ni you can die no matter what you're dealing with a goddamn steer that's what I'm saying that's what I'm saying you can die getting on top steer is not a bull right steer been gilded right we had Bulls steer wrestling is different right steer wrestling is the they them they take off steer and the guy and the horse take off at the same time you jump off you grab it you grab by the horns and turn its neck and throw it on the ground and then they wrap that yeah see a steer is a bull that doesn't have any balls right yeah that B's not same they're younger than the ones that they cop chopped their balls off before

95:24they got a chance to mature that's why when they the Bulls are terrifying so I've been right down next to the bucking shoot and it's like frightening I actually had a claw of dirt get one of them kicked it up and it hit me in the head like a baseball I mean yeah see they're little babies yeah and they have no balls so this guy jumps off what a that is so whack what a stupid thing to be excited about these I did it I wrestled that thing I was trying to get away grab him by his natural handles and I took him down look how quick look at their mov it's like a Dar choke and the cow's like what in the man why is this even happening look the cow's like what is going on I got to get out of here look how they they always do it the same way too they do it's it's it's similar to like a choke hold oh what a dumb thing to be excited about they grab the neck and flip them on

96:17their back it's not it's outside of your world but I'll tell you these are some of these are some of the nicest guys I've ever met in my life honestly and they're some of the toughest athletes in the world oh yeah I would imagine those guys are tough as hell you have to be we had to do it on they 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 I mean you have to we had to do it on Fe that had nine they don't make money if they're not competing so right we had a dude on Fear Factor was a steer Champion or uh Rodeo Champion rather he had nine shoulder surgeries his shoulder was just like sliced all open yeah and he I don't know how long often is it dislocated he goes anytime like I could open up a car door it'll pop out of socket I'm like yikes yeah it's bad yeah um so back around to where we were

97:03at what um what do you do how does this zaher technique can you describe it did I say right zahiri zahiri zahiri technique so the one of the guys that uh we trained with uh in our my sports medicine program in Alabama showed us this and um it was like one of the first things that we reviewed at the beginning of the year and uh 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 a small person can do this on a very big athlete and you're fine because you're you're using all the strongest muscles in your body right so you literally just lean back and you hold Traction in that position so you've got the arm is positioned like this you you got to describe to people

98:02that are listening uh the arm is in front of the person uh 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 let's just see a video you got you got a video of it that's really hard to find him but I'm G to hopefully guess that this is maybe it hopefully oh okay let me explain to people at home what this is like is if you were trying to give someone an arm bar you it's you get a hook on the left side and so the hook is uh your left if you're trying to armar someone on the right their right arm and you were in side 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 armbarred their defense is this they grab their hands together and so you Loop your arm in that and pull it back like that so that would be real similar

98:51to what you're doing you're using the left arm you're connecting it like this and then you're 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 it pops in place the the deltoid and the PEC and the biceps relax and it 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 times you can do that that and they're perfectly comfortable huh and they're immediately better when the shoulders back in wow well they're not completely better but the Pain's relieved from the initial event now you told me when you looked at my MRI that you think that my shoulder was dis dislocated at some point in time I don't remember exactly your MRI but if you had a tear of the front of the laum if you

99:44had and you had that any evidence of that little dent in the back of the humeral head then then that would be consistent with that injury I just do not remember ever having a dislocated shoulder but I've had I've been camor bet you've had a bunch of times I bet you've had it slip a little bit well when you shoulder locked you know there's been many americanas in my past and koras and all these different like hardcore you know the thing is on the receiving end yeah yeah yeah before um this injury I never Americana you could definitely have at least a subluxation of the shoulder for sure yeah I'm sure I'm sure and you fight it off too CU you don't want it to happen so you're resisting and um 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 and I think that was a big

100:35mistake and I I kind of emphasize that with people like doing uh external and internal rotation um exercises doing like um I'm a big fan now of uh inverted kettle bell presses and yeah that's one been one of my uh giant right more favorite lately definitely a challenge you don't need much weight and uh yeah this little 40 lb Iron Man kettle bell I use this one it's amazing that's a lot of weight for that exercise that's pretty good well it's just uh they say you should be able to do 50% of your max weight or is that 50% or 90% I forget what they say forget me don't listen to me well it it depend I think I said 90 yeah obviously in the in the injured patient or the person that's recovering going to be starting with much lower all the focus is on your the motion your your posture engaging your core keeping your ribs down and and having the full motion the strong first

101:35protocol I think what they're trying to say is uh in order to have really powerful shoulders you should be able to do 90% of your max kettle bell press like say if you can Max Kettle press 90 PBS now that's with the with the handle and the belt down right okay yeah with Max that would be your max like what you one rep max yes or you know what you would pretty much maybe you could do two or three if you really had to but you know you're talking about a lot of weight um you know what you would normally like max out at like there's um there's a protocol that this guy pavl tatul follows that's really kind of interesting you know pavl right well he's the kettle bell guy right he's the guy that brought him they call him the Godfather of kettle bells in America but um the guy that I train with talks about that time yeah the the idea behind it is um don't do your the like if you could

102:29do 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 do another five and you never work to failure and that working to failure is actually not healthy it's not smart and you don't really get stronger that way what you my recommendation is that for and 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 uh or you know a snatch or something like that things that involve coordination yeah and where you have to time everything it requires you know sound mechanics and you're doing it with load it's bad to do that to failure because what happens as you fatigue is your mechanics are going to break down and that's where you're

103:20going to get hurt well what pavl talks about about is that strength is a skill and that all these different things think of them as a skill and then don't do things to failure and if you're looking for you know endurance or something along those lines you want to do lightweights and you want to do multiple repetitions it's not what you're doing when you're trying to get stronger no yeah so it's there's but there's you know a lot of different arguments one way or another I mean talk to powerlifters and they're like that guy's a you got to do it to failure yeah I don't know yeah talk to CrossFit people they want to do 100 reps you know yeah so now there there are activities that you can train to failure and there's no risk so for example like like pull-ups I mean when you fail you just you just can't get up right like you're just going to come off the bar right the battle ropes

104:12you're just going to fatigue out like there is you're not going to hurt yourself right but they even believe that when you're doing chinups like if you're doing pull-ups or chin-ups um 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 your max is 10 reps get to five stop take a break do another five stop take another five 10 minutes do another five keep going and just you're you're working on form and your muscles are performing these actions in a a very clean smooth delivery and 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

105:03weights for a week or you lift weights and you you lift weights to failure rather and you're sore for so long can't get anything done this idea is you do more frequent workouts and you don't go to failure that don't go over five reps I I think one of the biggest uh 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 periodizing and incorporating the times when they're just allowing rest I mean you can't be working at Max Capacity all the time right exactly so it's a big thing with fighters huge keeping them from 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 um because that's a group that you know they're so eager to get back you know if they're a

106:03competitive athlete that you know you got to remind them that look we have steps to go through and I always say you got to work smart not hard like right you know we have a plan and there's a reason why this week may not be a whole lot of work I your body needs rest and Recovery in order to put stress on it again so that we can continue to make your progress otherwi wise at some point you're either going to Plateau you're not going to be making changes you're going to get frustrated or you're just going to get hurt right all right we got to bring this home so anything else we need to uh 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 these really cool conversations When I visit you in your office and I'm I'm really glad we got a

106:45chance to do this now if people want to get a hold of you and they want to seek treatment please give them the necessary information oh sure so our website is www. totalsports medicine.com I like how people still say www like yeah probably still get there right yeah you can just total sportsmedicine.com yeah um and then uh we have information on there in terms of how to contact us and uh you know we'll be happy to get additional information to patients if they have questions awesome well uh again thanks for everything you've done for me it's been a lifesaver and uh I've had massive benefit me to come down my pleasure brother thank you Dr Rody McGee ladies and gentlemen and that's it for this week we'll see you next week bye-bye