Health Series 4: Tristan Steinberger / Gable Pain Clinic

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Welcome to another episode of
Come Together

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and we're rolling Doctor
Steinberger, how we doing?

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Welcome.
Welcome to having me, of course.

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And of course, so you know, I
usually tell people to tell me

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about themselves, but I'm
actually, I was really excited

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when I came.
So you reached out to me

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originally about a ultrasound
machine.

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And then I was like, hey, man,
Well, I said I went on your

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website to just check if you
were legit, especially to using

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Machineo.
And I was like, well, is this

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guy a real guy?
And I saw that you were a board

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certified anesthesiologist and
that you, but your practice is

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generally in kind of health
related chronic, chronic health

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and recovery.
Yeah.

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So I'm really excited to hear
about your trip and, and to

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learn about the, the, you know,
the, the stuff that you

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practice, the medicine that you
practice.

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Yeah, well, yes, on my board
certified anesthesiologist.

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And then I did a one year pain
fellowship and chronic pain

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afterwards.
And so I'm a chronic pain

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specialist.
So I do run a a pain clinic in

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South Florida.
I know that can bring up some

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bad connotations in South
Florida, but it is a very

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specialty.
Back pain is probably second

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most common medical issue.
And so it's a very common issue,

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hard to treat, but yeah, that's
what I do.

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So why?
Why do you say it has a negative

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connotation in South Florida?
Especially in South Florida,

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there's a lot of Medicare,
Medicaid fraud, a lot of opioids

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that are used not responsibly.
That really all started in Ohio.

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But South Florida's kind of just
exacerbated the issue.

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There's a lot of, they're called
pill mills.

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Patients come in with pain and
they just give them scripts of

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Percocets or Dilaudid and
doctors go to jail for life for

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this stuff.
And but it's very common.

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It's easy money and but
ultimately it doesn't help the

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patient.
I had a friend of mine that was

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on the podcast the other week
and the way I met him was he

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was, he was a big advocate for
ibogaine and he said, and he

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told me that he, he told me that
he played a lot of golf.

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I think he tore, he tore his ACL
or meniscus or something.

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And, and he went to the doctor
and the doctor was busy for the

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next month or so.
So until then he just prescribed

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him painkillers and then, you
know, so he was, he took him for

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a month and then he went, you
know, then he went in for the,

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you know, got got the surgery,
whatever he did.

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And then he got another couple
of weeks of painkillers and then

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he started coming back.
He's like, I have these

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withdrawal symptoms.
And he's like, yeah, you're a

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drug addict.
And he's like, I'm a what?

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He's like, yeah, you're an
opioid addict.

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I'm sorry you got to go to
rehab.

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And he's like, what the heck is
that about?

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Well, I even remember this in
medical school.

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They which is true.
They told us that one out of

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every six patients that takes
opioids for more than I believe

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it was two weeks, just two
weeks, one out of six will

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become addicted.
They're very powerful.

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I, I do not prescribe long term
opioids, strong opioids, like

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Perkins said.
I will do them for a short

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course, like 10 days to get over
a hump.

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But in terms of chronic pain
management, they've been shown

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over and over again that they do
not help pain, make pain worse.

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They wind up the nerves.
So you just get more and more

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pain.
They weaken your immune system.

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They can actually cause some
osteopenia, weakening of the

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bones.
So they're really good long

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term, yeah.
Wow, wow.

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So so let's dive into a little
bit.

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So so how so you So anesthesia
is a very prestigious, you know,

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fields of medicine.
I say, yeah, we kind of like the

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referees.
We had to be quiet.

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If if we do our job well, we
just nothing happens and you

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don't hear us.
Yeah, that's right.

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And then and why'd you just, and
I'm sure I mean to specialize,

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how long did it take to how
much, how much of Med school did

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it take to?
So I kind of had, I was

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interested in research during
Med school, so I took an extra

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year.
And what actually brought me to

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pain is orthobiologic
regenerative medicine.

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But the whole training itself I
was in school with in training

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for a total of 15 years.
Holy cow.

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I did, yeah.
I did 5.

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I did my MBA before Med school.
I did five years in Med school

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and interneer residency
fellowship patrol total were 5 S

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15 total.
Why I chose anesthesia,

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Honestly, I didn't know what I
wanted to do in Med school and I

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did not match because I wanted
to do ERI did ER last minute.

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I changed cuz I just wow, didn't
do ERI was in Atlanta and and

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they're a huge ER that prison
cells in the ER just is too

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much.
So I changed last minute.

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I didn't match.
I I just called up a program in

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Las Vegas and they had just
opened up and they said, yeah,

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we're still looking for people.
This the day after it was

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probably the most stress I've
ever felt.

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I didn't match.
Imagine five years in Med

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school.
We didn't get a job.

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So but I called him up cold,
called him interviewed next day.

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He sent me the contract.
I ended up in Las Vegas for

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residency and they just so
happened to open up an

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anesthesia residency.
In Med school.

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You don't get much experience
doing anesthesia.

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It's not a sexy profession like
plastics or dermatology or

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ortho.
So it's not a required rotation.

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I did it and I really like to
the pharmacology, the Physiology

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and it's very procedural.
So I liked it and it was an easy

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transition and I just, I stayed
in Vegas and Vegas is why I'm in

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Miami now.
So I guess it all kind of worked

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out.
Where are you from originally?

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I was, I did my school in
Kansas, but I've kind of lived

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all over.
My parents were in medicine.

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So I was born in Michigan.
I lived in New Orleans for a

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little bit.
Wow.

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And yeah, I ended up in Kansas
for a good amount of.

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Years.
And how'd you like Kansas?

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Kansas is quiet.
Is it quiet now?

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I was ready to get out.
It's if you want to raise a

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family.
It's a good place.

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Now my family's in Charleston,
SC Cool.

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Which is more a little closer?
Yeah.

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Yeah, Yeah.
Definitely more vibrant for

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sure, but OK.
And so you started with an MBA.

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Why was that So?
What was it the concentration

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in?
I actually just did general.

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I didn't do any finance or
healthcare.

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I typed in general.
I chose it because in undergrad

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I was a biochemistry major and I
had finished biochem, I had

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finished my whole college and I
felt so sheltered and one sided.

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I didn't know anything about
business, my interpersonal, my

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presentation skills,
communication.

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I didn't know how the world
worked, worked in terms of

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assets, liabilities and so I
knew I needed a year off One, I

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was very burnt out and I wanted
to learn more about business and

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just working on the software
communication skills.

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So I did that for a year and
that was what my was my driving

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impetus.
Did you would you find that it

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was valuable?
Did you find that the MBA was

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worthwhile?
100% you can't quantify it on

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paper, but in terms of my
development, I think was very

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helpful.
I really pushed myself.

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I joined a Toastmasters
presentation group.

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I started taking salsa classes.
I started doing a lot of

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different stuff just to like
volunteering opportunities.

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So I just work on my really
people skills because I just

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felt so I was around science
people for four years and I felt

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so not developed in that regard.
Wow, wow.

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It's cool of you to notice that,
by the way.

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And it's cool of you to try to,
to take that risk and try that

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out, you know, because it's,
it's something that's really

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daunting to a lot of people, you
know, that like, oh, I guess,

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you know, that's a whole part of
my life that I'm not good at.

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Well, I guess I'll just avoid
it, you know, it stinks for me,

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you know?
Yeah, it's good to do something

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about it.
Yeah, I, I appreciate it.

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So yeah, it was useful 100%.
I would.

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I think it's getting out your
comfort zone is good in general.

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Yeah, I, it's funny that you say
that about on paper, how it

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wasn't, as you know, that it's
more valuable than experience

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than paper, because I felt the
same thing.

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I got a creative writing and
literature degree, which, yeah,

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you know, obviously on paper is
not going to do very much for

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you.
But I think that a lot of the

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skills that I just developed as
a as a human being, you know,

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came from, came from that.
Because, you know, one of my

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teachers, the first teacher that
I loved that like really got me

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into English, told me a great
writer, a great create

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storyteller, loves at least 50
things more than writing.

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Because you need something to
write about.

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You need to have like passions
in life.

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You need to have things that
like light a fire under you,

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that like make you want to
capture that.

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And he's like, if you guys don't
do anything with your life

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except for just right then like,
you know, what kind of writer

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are you going to be?
So you have to love it.

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You have to prioritize so many
things.

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And writing just has to be
consistent.

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Exactly.
That makes me think of the

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author of Old Man in the Sea.
I can't believe I can't remember

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his name, but he lived.
He must have lived the most

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adventures exciting life and you
just wrote about it.

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I wish I.
Yeah, the Old Man of the Sea.

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I'll look it up after.
I could even post it in the show

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notes, captions.
I like to, whenever we talk

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about particular books or topics
or ideas that I could like share

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that people could reference, I
like to post that.

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So we'll find that after.
That's awesome.

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So, So what was Med school like?
Would you?

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Would you?
Would you, would you?

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What was it?
What was your experience?

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Where were you?
Med school, I was in the at the

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University of Kansas.
Yeah, it was.

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It was difficult.
I I, I did have difficulty with

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medical school.
Just my mind.

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Schedule with the material, with
the tests, with what?

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My mind works.
I was, it was really the

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schedule's fine, the long hours
are fine.

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It was just, it's all, it's
pretty much root memorization.

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As a biochemistry major, I'm
more mathematical and I like to

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synthesize and analyze problems.
So biochemistry, I was doing

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physical chemistry, physics and,
and undergraduate and that was

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much as you synthesize
information Med school, you just

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regurgitate environment
information.

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You must hold a lot of
information at once and then put

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it out.
And so just a different style of

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learning, which is less
critical, but it's, it's how

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magical it is.
So I just found it difficult.

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I, I got through obviously, but
it was tough and the clinicals

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were very difficult.
You are working 12 hours a day,

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you come home and you study for
your shelf exams every month.

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And so you're pretty much
effectively working 16 hours a

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day.
I just, I worked out.

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I would still have some time.
I do one hour a day.

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I would do salsa dancing or
something for that one hour and

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I'd work out.
Besides that it was, it's

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physically, physically
exhausting, but emotionally and

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mentally exhausting.
Always being criticized, always

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being the bottom of the totem
pole is is tough.

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Do you do you think that that's
there's a reason for that and do

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you think it's the most
effective way to kind of train

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and also how much of information
that you that you were forces

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off to memorize do you retain?
I do find that learning useful.

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I do find that the information
we used, that we were taught in

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Med school is useful.
But I can't say that it needs to

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necessarily be 4 years.
The intensity of it, there's so

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much information that you need.
You could only touch a surface

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on some of it.
I do think it is necessary, but

227
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I think the IT could be changed.
It could be changed how you

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approach it.
Having said that, the issue if

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you make it easier, I think it's
just going to attract more

230
00:12:32,560 --> 00:12:36,880
people who aren't necessarily
ready for the commitment.

231
00:12:36,880 --> 00:12:41,160
So I think the good thing about
it being rigorous and difficult

232
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to get in is it we doubt people
who are not committed to the

233
00:12:44,160 --> 00:12:47,760
path.
It's a long path and I get it.

234
00:12:47,760 --> 00:12:49,760
If you're not in Med school,
you'd be working somewhere else.

235
00:12:49,760 --> 00:12:53,840
But it's still, it's different
when everyday you're constantly

236
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you're made to perform and you
must perform above a certain

237
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level or you're, you're kicked
out.

238
00:12:59,120 --> 00:13:02,640
So you must perform at a high
level for pretty much all of

239
00:13:02,640 --> 00:13:06,800
residency and Med school or else
you are let go.

240
00:13:06,800 --> 00:13:11,760
So I I think it's, it's a good
and bad.

241
00:13:12,160 --> 00:13:14,320
Yeah, yeah, yeah.
That's the that's the most

242
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compelling argument that I've
heard is that it really weeds

243
00:13:17,560 --> 00:13:21,440
out a lot of people.
I think that the biggest

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challenge that we're going to
have going forward is that is,

245
00:13:25,120 --> 00:13:29,640
is figuring out how to create a
new Med school system with AI,

246
00:13:30,920 --> 00:13:34,400
you know, and, and, and to
figure like, you know, part of

247
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the value, I was talking to a
friend about this the other day.

248
00:13:36,880 --> 00:13:39,960
Part of the value that people
used to place in education is

249
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how much information you can
retain that you have disposable

250
00:13:42,720 --> 00:13:44,760
at your fingertips, you know,
and that's part of what the

251
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value is that you have over
everyone else.

252
00:13:46,440 --> 00:13:48,480
So that you have all this
information that you spent next

253
00:13:48,480 --> 00:13:51,880
amount of time and next amount
of hours accumulating and no one

254
00:13:51,880 --> 00:13:54,080
else really has.
And that like, even if you read

255
00:13:54,080 --> 00:13:55,360
it somewhere, is it peer
reviewed?

256
00:13:55,360 --> 00:13:57,760
How's that, you know, how, how,
how, how, how, how legit is it?

257
00:13:58,400 --> 00:14:00,040
There's a lot of garbage out
there, you know, how do you

258
00:14:00,040 --> 00:14:01,880
figure out how to, you know,
sort it through?

259
00:14:01,880 --> 00:14:05,760
And like, you really do need a
professional to be able to, you

260
00:14:05,760 --> 00:14:08,840
know, to do that.
And AI kind of just like mixes

261
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the whole thing up in the sense
that like the amount of time it

262
00:14:13,720 --> 00:14:17,400
takes to get the meta
information, you know, that

263
00:14:17,400 --> 00:14:20,760
would ordinarily take years,
could take, you know, seconds.

264
00:14:22,320 --> 00:14:24,440
Yeah.
No, I think you're right.

265
00:14:24,440 --> 00:14:28,200
I mean, they now have the Watson
IBM as a computer that can pass

266
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the medical school entrance exam
and I believe it's a board exam

267
00:14:32,240 --> 00:14:33,600
now for.
No way.

268
00:14:36,080 --> 00:14:41,520
But there, there is a hospital
in China now that has robotic

269
00:14:41,520 --> 00:14:45,520
physicians that's almost, I
think fully AI robotic.

270
00:14:45,760 --> 00:14:51,760
I don't know exactly how it
works, but I think that AI has

271
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definitely has a place more than
some people would like.

272
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I still think you need a
physician, someone who overseas

273
00:15:01,760 --> 00:15:04,480
sure who sees it.
I think it it'll like bowling,

274
00:15:04,480 --> 00:15:07,400
will keep you in the right
direction, but you still need

275
00:15:07,400 --> 00:15:10,040
someone to supervise it and make
sure it's adequate.

276
00:15:11,480 --> 00:15:13,080
Right.
So the, but so the skill set of

277
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what you'd be learning as a
doctor when you're going to Med

278
00:15:16,280 --> 00:15:19,840
school would not necessarily be
to be the AI to have all the

279
00:15:19,840 --> 00:15:23,120
information, but it's how to how
to direct it, you know, how to

280
00:15:23,120 --> 00:15:24,440
manage it.
Like, you almost become like an

281
00:15:24,480 --> 00:15:27,400
AI manager that's a medical
professional, you know, as

282
00:15:27,600 --> 00:15:30,160
opposed to just spending your
time just studying, you know,

283
00:15:30,440 --> 00:15:32,960
you know, studying facts.
That's true.

284
00:15:33,640 --> 00:15:36,160
At a certain point that you say,
do you need to be a doctor to do

285
00:15:36,160 --> 00:15:37,840
that?
Yeah, that.

286
00:15:38,000 --> 00:15:41,800
Too.
I don't know if I mean no one

287
00:15:41,800 --> 00:15:45,480
can predict what will happen.
I'd be interested to see.

288
00:15:46,720 --> 00:15:48,600
I've been saying for a couple.
I've been saying a little bit

289
00:15:48,600 --> 00:15:50,560
now.
The the thought struck me when I

290
00:15:50,560 --> 00:15:54,520
was doing a podcast with, Oh my
God, I'm going to be so upset if

291
00:15:54,520 --> 00:15:56,040
I forgot her name because I
liked her so much.

292
00:15:58,960 --> 00:16:02,480
Allison Levitt.
And we were talking about how

293
00:16:03,280 --> 00:16:05,560
there should be doctors of
medicine and doctors of health.

294
00:16:06,080 --> 00:16:08,560
And like, you know, like there's
doctors that like prescribe that

295
00:16:08,560 --> 00:16:11,080
you come to once you're sick and
once you need like some kind of

296
00:16:11,080 --> 00:16:12,880
medication.
And then there's doctors of

297
00:16:12,880 --> 00:16:17,320
health that kind of every, every
step before that step.

298
00:16:17,440 --> 00:16:19,520
You know, how do you stop
someone from getting to that

299
00:16:19,520 --> 00:16:21,200
point?
You know, I mean myself, for

300
00:16:21,200 --> 00:16:24,440
example, I have a, you know, you
started to talk about lower back

301
00:16:24,440 --> 00:16:28,160
pain or back pain in general,
kind of a little bit of lower

302
00:16:28,160 --> 00:16:29,560
back pain.
I have a good buddy of mine

303
00:16:29,560 --> 00:16:33,240
that's a chiropractor and he
gave me a couple exercises to do

304
00:16:33,240 --> 00:16:34,800
at home.
And he's like, everyone just

305
00:16:34,800 --> 00:16:37,080
needs to strengthen their back.
Like you just, and also the way

306
00:16:37,080 --> 00:16:39,600
that I'm standing and the way
that, you know, that, you know,

307
00:16:39,600 --> 00:16:42,520
the way that I held myself, my
posture all had a difference.

308
00:16:43,040 --> 00:16:44,120
And I just need someone like
that.

309
00:16:44,120 --> 00:16:46,280
Just tell me like, hey, man,
you're being, you know, this is

310
00:16:46,280 --> 00:16:47,840
to be healthy and you need this
to be healthy.

311
00:16:47,840 --> 00:16:50,560
You need these vitamins and this
and this, you know, diet and,

312
00:16:50,880 --> 00:16:53,000
and hopefully you won't need a
doctor, but if you do, then

313
00:16:53,000 --> 00:16:54,080
here's another doctor you can
go.

314
00:16:54,080 --> 00:16:55,160
Do you know?
Yeah.

315
00:16:56,240 --> 00:16:59,440
I think it's what's happening to
the airline industry with

316
00:16:59,440 --> 00:17:03,400
pilots.
Most pilots the take off the

317
00:17:03,400 --> 00:17:10,040
flight is all it's autopilot.
No way actual human human

318
00:17:10,040 --> 00:17:15,000
involvement is I very little on
a commercial flight, but you

319
00:17:15,000 --> 00:17:19,480
still at this point need a pilot
to make sure everything goes

320
00:17:19,480 --> 00:17:25,839
right and to account for any
mistake or the system fails.

321
00:17:26,359 --> 00:17:28,800
So I think medicine is going the
same way.

322
00:17:30,440 --> 00:17:33,960
I know for anesthesia they do
have robots now who who can

323
00:17:33,960 --> 00:17:36,640
intubate.
They can intubate patients and

324
00:17:36,640 --> 00:17:39,640
some they've even tried to
administer some kind of minister

325
00:17:39,640 --> 00:17:43,160
medicines.
But we're still at the point of

326
00:17:43,160 --> 00:17:48,200
full autonomy.
But procedure based healthcare,

327
00:17:48,200 --> 00:17:50,000
I think it's difficult to be
full autonomy.

328
00:17:50,880 --> 00:17:54,080
Surgeons are using the Da Vinci
robot every day to do most

329
00:17:54,080 --> 00:17:58,240
procedures.
It makes it cleaner, but I just,

330
00:17:58,240 --> 00:18:02,040
I don't see a point yet where
you're fully automated.

331
00:18:02,120 --> 00:18:06,400
That's a scary day when you are.
You just have to pay everyone a

332
00:18:06,400 --> 00:18:08,280
basic income I guess.
Yeah.

333
00:18:08,280 --> 00:18:12,560
So the so the automated date, I
don't think is that I listen,

334
00:18:12,840 --> 00:18:15,560
it's, it's in the future, but I
don't think it's a very distant

335
00:18:15,560 --> 00:18:18,680
future because all you got to do
is take those robots that Elon's

336
00:18:18,680 --> 00:18:21,720
working on, those Tesla robots.
And all you got to do is put AI

337
00:18:21,720 --> 00:18:23,560
chip in them.
And then all of a sudden they're

338
00:18:24,360 --> 00:18:27,960
they're a walking version of,
you know, of, of an AI that can,

339
00:18:28,040 --> 00:18:29,480
you know, that has the physical
capabilities.

340
00:18:30,040 --> 00:18:33,200
Yeah, that's not too far that
that can't was it, let's say

341
00:18:33,200 --> 00:18:35,960
crazy 50 years.
I mean, you know, 100 years, you

342
00:18:35,960 --> 00:18:38,000
know, but that's not even that
the pace of things are moving.

343
00:18:38,320 --> 00:18:41,680
Yeah, I don't mean the idea of
similarities.

344
00:18:41,680 --> 00:18:45,560
As technology advances, it
advances at a faster and faster

345
00:18:45,560 --> 00:18:47,080
rate.
I think what, 100 years ago

346
00:18:47,080 --> 00:18:50,920
we're still with a horse and
buggy and now in five years

347
00:18:50,920 --> 00:18:53,880
we've got a couple, Well, who
knows, 10 years from the

348
00:18:53,880 --> 00:18:57,120
computer to AI, is the jump even
quicker?

349
00:18:57,440 --> 00:18:59,720
Yeah, yeah, I, I So we'll see
what happens.

350
00:18:59,720 --> 00:19:02,280
It, it, it, it, it, it does
freak me out a little bit,

351
00:19:03,800 --> 00:19:06,440
especially when like, I feel
like the blurs between like,

352
00:19:06,440 --> 00:19:09,080
what could potentially be
reality, like what AI creates

353
00:19:09,080 --> 00:19:12,160
and what's not, you know, starts
getting harder and harder to

354
00:19:12,160 --> 00:19:17,120
differentiate, you know, but you
can't think too much about it.

355
00:19:17,120 --> 00:19:18,960
You can't sleep, you know?
I mean, it really freaks the

356
00:19:18,960 --> 00:19:20,960
hell out of me.
There's that mean that is going

357
00:19:20,960 --> 00:19:24,800
around that I tell Chad GBT
thank you every time.

358
00:19:24,800 --> 00:19:28,400
So I think for the world it will
spare my life.

359
00:19:28,480 --> 00:19:31,080
Dude, I am.
So polite to my chat bots.

360
00:19:31,080 --> 00:19:33,360
It's so funny.
I'm like, please, can you break

361
00:19:33,360 --> 00:19:34,920
that down so far?
I don't understand.

362
00:19:34,920 --> 00:19:36,320
I appreciate your time.
Thanks.

363
00:19:36,520 --> 00:19:38,720
You know, like, yeah, just don't
kill me later.

364
00:19:40,840 --> 00:19:43,280
I mean, I think I don't know
there is my reason truth to

365
00:19:43,280 --> 00:19:46,760
that.
I I, I don't think it's out of

366
00:19:46,760 --> 00:19:48,440
the picture.
I mean, I don't know.

367
00:19:48,440 --> 00:19:51,000
And, you know, I mean, Can you
imagine?

368
00:19:51,000 --> 00:19:52,000
I mean, do you ever remember the
book?

369
00:19:52,000 --> 00:19:56,080
I don't know if you ever read
it, but not even a brave new

370
00:19:56,080 --> 00:19:58,520
world, That's who it was a brave
new world, Yeah.

371
00:19:58,520 --> 00:20:00,920
Where, like, humans are just
grown in gestation and, like,

372
00:20:00,960 --> 00:20:03,240
they're just creative.
They're just, you know, like

373
00:20:03,240 --> 00:20:05,840
these.
These embryos are just placed

374
00:20:05,840 --> 00:20:11,240
into different social and
physical hierarchies based on

375
00:20:11,240 --> 00:20:13,920
like.
Whoever the creator decides that

376
00:20:13,920 --> 00:20:17,360
they're going to be, you know,
and like, OK, so your embryo is

377
00:20:17,360 --> 00:20:20,640
going to be stronger and taller
and more athletic and, and

378
00:20:20,640 --> 00:20:22,200
smarter.
And then you're going to be the

379
00:20:22,240 --> 00:20:25,320
plebeian that's going to be
shorter and, you know, Dumber

380
00:20:25,320 --> 00:20:28,160
and, you know, not even capable
of thinking of, you know, even

381
00:20:28,160 --> 00:20:30,520
wanting a better life, you know,
and like, that's just what the

382
00:20:30,680 --> 00:20:34,600
that's and like.
And Aldous Huxley, if you like,

383
00:20:34,600 --> 00:20:37,200
if, if you Google the, the year
that he came out with that book,

384
00:20:37,200 --> 00:20:39,400
I forgot it was, it was early.
It was I think maybe the 40s

385
00:20:39,480 --> 00:20:43,120
forties or the 50s, if you, if
you googled what technology was

386
00:20:43,120 --> 00:20:47,960
at the time, like it was nothing
and like he could already see

387
00:20:47,960 --> 00:20:50,320
where things are heading.
So like, I don't know, man.

388
00:20:50,320 --> 00:20:52,080
It really, it really skis me
out.

389
00:20:52,680 --> 00:20:55,280
Yeah, it's it can be scary, but
exciting.

390
00:20:56,520 --> 00:21:00,840
There are so many things now in
the world that it can go in so

391
00:21:00,840 --> 00:21:03,200
many different directions.
Yeah, yeah.

392
00:21:03,200 --> 00:21:05,280
What gives me, what gives me
hope in the end of the day is

393
00:21:05,280 --> 00:21:09,560
that like we live in a pretty
benevolent, like we live in a

394
00:21:09,560 --> 00:21:12,640
world that like, things are
generally like we aspire for

395
00:21:12,640 --> 00:21:15,640
good and good always kind of
feels like it's trying, like

396
00:21:15,640 --> 00:21:17,240
it's like pushing out and
emerging.

397
00:21:17,240 --> 00:21:22,240
And like, I think that that like
is so common for so long in so

398
00:21:22,240 --> 00:21:25,960
many different aspects of life.
It's so it's so interconnected.

399
00:21:25,960 --> 00:21:29,480
Just do everything that like, I
think the universe is built to

400
00:21:29,480 --> 00:21:31,480
support life and like life is
good.

401
00:21:31,480 --> 00:21:33,120
Like that's what goodness is.
So.

402
00:21:33,120 --> 00:21:35,560
Yeah.
I, I, I liked it.

403
00:21:35,560 --> 00:21:41,160
I heard this quote that said we,
we have fundamentally our issues

404
00:21:41,160 --> 00:21:42,960
are the same as they were 2000
years ago.

405
00:21:42,960 --> 00:21:47,480
We have just right now we have
God like technology, we have

406
00:21:47,640 --> 00:21:50,560
medieval laws, but we still have
reptilian brains.

407
00:21:50,560 --> 00:21:53,640
A lot of our issues are made
from our differences.

408
00:21:53,800 --> 00:21:57,240
The differences we have in our
communities are our religions.

409
00:21:57,480 --> 00:21:59,760
That's what really is pushing
all this.

410
00:22:00,840 --> 00:22:06,120
The fear is that we use a
technology to justify these

411
00:22:06,120 --> 00:22:10,400
reasons that are from the
Cavemen era, that we have to

412
00:22:10,400 --> 00:22:14,280
almost work on ourselves and
then we can improve our society.

413
00:22:14,640 --> 00:22:16,320
Yeah, totally.
I believe that.

414
00:22:16,520 --> 00:22:20,480
I believe that religion is the
consciousness, the evolution of

415
00:22:20,480 --> 00:22:22,840
consciousness.
I believe that like the general

416
00:22:22,840 --> 00:22:27,240
concept of trying to strive
beyond our, you know, primal

417
00:22:27,240 --> 00:22:31,000
animalistic nature and like
invest in a future world for

418
00:22:31,000 --> 00:22:33,280
better times and better
community or better, you know,

419
00:22:33,280 --> 00:22:36,840
family or whatever it is.
I feel like that is the like

420
00:22:37,120 --> 00:22:39,640
that's that like there was a
certain stage of evolution that

421
00:22:39,640 --> 00:22:42,240
was physical and then at a
certain point, the bet the next

422
00:22:42,240 --> 00:22:46,480
way for evolution to kind of
like manifest is through our

423
00:22:46,480 --> 00:22:48,360
consciousness and like we have
to force out.

424
00:22:48,360 --> 00:22:51,480
You have to shed that kind of
primal animal, you know,

425
00:22:51,480 --> 00:22:57,080
reptilian aspect of us and like
truly just be conscious, which

426
00:22:58,080 --> 00:23:01,280
is kind of Rick, it's recurring
throughout a lot of different

427
00:23:01,280 --> 00:23:04,560
religions and ancient tribal
stories and like ideas of like

428
00:23:04,560 --> 00:23:06,960
collectivism and like 1
consciousness.

429
00:23:06,960 --> 00:23:09,480
And like, you know, people take
psychedelics and they see all

430
00:23:09,480 --> 00:23:12,240
these experiences where
everything is 1 and you're like,

431
00:23:13,000 --> 00:23:16,200
well, it's everywhere.
You know, like, maybe it's not

432
00:23:16,200 --> 00:23:18,840
the complete truth, but there's
got to be, you know, aspects of

433
00:23:18,920 --> 00:23:20,720
of truth that are definitely
sprinkled in there.

434
00:23:20,880 --> 00:23:24,760
Well, I, I think you and
scientifically we are all

435
00:23:24,760 --> 00:23:27,520
connected.
We are really are all Stardust.

436
00:23:27,520 --> 00:23:33,200
We are compressed atoms from the
sun where we are part of Suns

437
00:23:33,200 --> 00:23:35,800
that have collapsed and have
created heavier elements.

438
00:23:36,080 --> 00:23:38,720
Most of our bodies are carbon,
hydrogen, oxygen, they're

439
00:23:38,720 --> 00:23:42,160
organic elements.
And so we really are just all

440
00:23:42,160 --> 00:23:45,800
the same.
We're connected, but yeah,

441
00:23:46,080 --> 00:23:49,680
scientific basis, but on a
spiritual basis, I I get that

442
00:23:49,680 --> 00:23:54,240
too.
It's hard for people to come

443
00:23:54,240 --> 00:23:58,280
together, accept a lot of facts
that they see a differences and.

444
00:23:59,000 --> 00:24:01,240
Well, that's the point of the
podcast, I hope, you know, And I

445
00:24:01,440 --> 00:24:04,560
think that I think that we, I
think that in it's funny because

446
00:24:05,360 --> 00:24:11,160
there's definitely a cycle
between like, I guess you could

447
00:24:11,160 --> 00:24:16,480
call authority or establishments
and then abuse of power.

448
00:24:16,480 --> 00:24:19,400
And then it collapses and then
builds back up again based on

449
00:24:19,400 --> 00:24:21,240
like a new level of trust.
And then somewhere along the

450
00:24:21,240 --> 00:24:24,480
line of claps like it's, it's,
it's constantly cyclical, but I

451
00:24:24,480 --> 00:24:27,400
think that the ripples that
happen become bigger and bigger

452
00:24:27,400 --> 00:24:29,320
ripples in the, and the, you
know, and the, and the

453
00:24:29,320 --> 00:24:30,800
breakdowns are bigger and
bigger.

454
00:24:31,040 --> 00:24:34,520
I think the COVID breakdown was
like a global breakdown.

455
00:24:34,800 --> 00:24:37,720
And now there's a global, it
feels like at least there's like

456
00:24:38,040 --> 00:24:39,840
at least in the country.
But, you know, I don't know

457
00:24:39,840 --> 00:24:42,040
about the I really don't know
much about the rest of the

458
00:24:42,200 --> 00:24:47,040
world, but that there's like a
there's a reassessment as to

459
00:24:47,040 --> 00:24:49,840
like, hey, man, like what's
really the story about anything?

460
00:24:49,840 --> 00:24:52,000
Because like we don't know what
to believe anymore, you know,

461
00:24:52,000 --> 00:24:55,240
and like that's and that's good
that that keeps us incur, you

462
00:24:55,240 --> 00:24:58,720
know, looking for truth then and
then we could rebuild our trust

463
00:24:58,800 --> 00:25:03,000
as we see truth kind of pop out
and did all the pile of crap

464
00:25:03,000 --> 00:25:07,000
that's there.
Yeah, I think I just think as as

465
00:25:07,000 --> 00:25:10,560
humans individually, we're not
very impressed if it is only

466
00:25:10,560 --> 00:25:14,080
when we work together that we
can make phenomenal, fantastic

467
00:25:14,080 --> 00:25:17,080
advances in science, medicine,
math, religion, whether whether

468
00:25:17,080 --> 00:25:18,480
it be the airplane, the
computer.

469
00:25:19,160 --> 00:25:21,960
But the issue is once you get so
large, humans are very

470
00:25:21,960 --> 00:25:25,040
distressful.
This distrustful of large

471
00:25:25,040 --> 00:25:29,840
organizations and governments
that seem to have authoritarian

472
00:25:29,840 --> 00:25:31,880
power, They're very distressful
of that.

473
00:25:31,880 --> 00:25:34,920
So it's just a yin and Yang to
yeah.

474
00:25:35,200 --> 00:25:36,160
Yeah, there's something.
Yeah.

475
00:25:36,360 --> 00:25:39,320
That that it's so funny you say
that because I don't know.

476
00:25:39,400 --> 00:25:41,520
I haven't figured out how to get
past this, really.

477
00:25:41,520 --> 00:25:45,320
And I don't know if we can.
I feel like humans operate best,

478
00:25:45,600 --> 00:25:47,560
or at least my experience is
that I've operated best in

479
00:25:47,560 --> 00:25:50,680
smaller communities and smaller
sects as opposed to bigger, you

480
00:25:50,680 --> 00:25:54,800
know, like I've lived in, you
know, in Manhattan and I've

481
00:25:54,800 --> 00:25:58,000
lived in upstate Binghamton,
upstate New York, you know.

482
00:25:58,000 --> 00:26:01,480
And like, what I've found
generally speaking, just, you

483
00:26:01,480 --> 00:26:05,040
know, all the different places
I've gone, even for my own life,

484
00:26:05,040 --> 00:26:11,280
is that I feel like with in a
world I thrive in a smaller set

485
00:26:11,280 --> 00:26:16,400
of familiar people as opposed to
a big rush of crowds who I don't

486
00:26:16,400 --> 00:26:17,920
know who was going to be where
at any moment.

487
00:26:17,920 --> 00:26:20,320
And if I don't, if I'm going to
recognize anyone at any point?

488
00:26:21,080 --> 00:26:24,480
Yeah, and I think I've heard
that you can really only have

489
00:26:24,480 --> 00:26:28,000
your circle, your community.
What, 50 people?

490
00:26:28,240 --> 00:26:30,120
That's really what the humans.
Yes, that's right.

491
00:26:30,120 --> 00:26:31,280
A lot of what?
You keep track of.

492
00:26:31,600 --> 00:26:34,560
Organizations in New York City I
have a lot of friends in New

493
00:26:34,560 --> 00:26:35,680
York.
I had a lot of friends in New

494
00:26:35,680 --> 00:26:37,960
York City.
In New York, City is a lonely

495
00:26:37,960 --> 00:26:40,840
place.
Everyone is in their own life.

496
00:26:40,880 --> 00:26:42,800
They don't interact much with
each other.

497
00:26:42,800 --> 00:26:44,760
They like their own.
They have their headphones in

498
00:26:44,760 --> 00:26:47,360
the subway.
They don't really interact.

499
00:26:47,360 --> 00:26:50,160
So it's a lot of people, but all
my friends would say it's

500
00:26:50,160 --> 00:26:51,000
lonely.
Here.

501
00:26:51,160 --> 00:26:53,360
People are alone.
They have their dogs, they keep

502
00:26:53,360 --> 00:26:55,680
them company, but they live
solitary lives.

503
00:26:56,440 --> 00:26:59,280
I don't.
Remember, if this is still

504
00:26:59,280 --> 00:27:02,160
accurate, but as of a couple of
years ago, I think the, the

505
00:27:02,160 --> 00:27:06,720
average household in Manhattan
had two dogs and 1.5 children.

506
00:27:08,080 --> 00:27:11,080
And you know, and people are
just more inclined to like, you

507
00:27:11,080 --> 00:27:13,520
know, I think that, I mean, I'm
sure it speaks a lot to the

508
00:27:13,520 --> 00:27:15,560
demographic too.
You know, that typically cities

509
00:27:15,560 --> 00:27:18,200
are filled with young people
that are, you know, you know,

510
00:27:18,200 --> 00:27:20,640
commuting and OK with
departments and, you know,

511
00:27:20,640 --> 00:27:22,280
they're, you know, they're
looking to just be close to

512
00:27:22,280 --> 00:27:24,320
work.
And then, you know, so like, I

513
00:27:24,320 --> 00:27:26,640
do hear that there's obviously
going to be biases in that

514
00:27:26,640 --> 00:27:29,240
staff, but like, it's still
pretty crazy to me that, you

515
00:27:29,240 --> 00:27:32,160
know, the dog rate, the rate of
dogs that we own is more than

516
00:27:32,160 --> 00:27:33,440
that of children that we're
willing to have.

517
00:27:35,000 --> 00:27:36,240
Let's go.
Let's talk a little bit about

518
00:27:36,240 --> 00:27:38,480
medicine.
And so you finished

519
00:27:38,480 --> 00:27:40,320
anesthesiology in Vegas.
First of all, how do you like

520
00:27:40,320 --> 00:27:43,560
Vegas?
I love Vegas, obviously, I like

521
00:27:43,680 --> 00:27:45,480
I like big cities with a lot of
energy.

522
00:27:45,480 --> 00:27:49,200
I like the energy and it's a no
judgement place.

523
00:27:49,240 --> 00:27:51,800
Obviously in Vegas, you need to
have discipline.

524
00:27:51,840 --> 00:27:55,680
I knew residents who got lost
and they had they, they dropped

525
00:27:55,680 --> 00:27:57,280
out, got kicked out of
residency.

526
00:27:58,520 --> 00:28:00,840
Vegas has a lot to offer.
I could.

527
00:28:00,840 --> 00:28:05,320
I really liked my classmates, my
the people at the hospital.

528
00:28:06,040 --> 00:28:07,120
What?
Kind of stuff were you doing in

529
00:28:07,120 --> 00:28:10,680
the hospital?
So I was doing my first year, I

530
00:28:10,680 --> 00:28:12,880
did internal, I did a
transitional year.

531
00:28:12,880 --> 00:28:15,280
So I did internal medicine,
journal surgery, some

532
00:28:15,280 --> 00:28:19,160
dermatology, and then I did
anesthesia the last three years

533
00:28:19,680 --> 00:28:22,040
and I was at 5 different
hospitals in Las Vegas.

534
00:28:22,520 --> 00:28:24,320
Wow.
Yeah, I was there doing a

535
00:28:24,320 --> 00:28:26,560
shooting when I had that large
shooting there.

536
00:28:26,560 --> 00:28:30,400
No way, really.
Yeah, that was 20/14/2013.

537
00:28:31,800 --> 00:28:38,160
That was, you know, I can't, I
think it was 13 or 14, but I'm

538
00:28:38,160 --> 00:28:41,440
not, I don't remember the the
actual year.

539
00:28:41,960 --> 00:28:44,360
Yeah, I remember it happened
towards the end of the night and

540
00:28:44,360 --> 00:28:50,200
they are removing patients from
one hospital to our hospital

541
00:28:50,200 --> 00:28:51,720
because they had to make room in
the ER.

542
00:28:52,480 --> 00:28:54,800
So yeah, it was a large, large
event.

543
00:28:55,320 --> 00:28:59,320
That's crazy.
Is an anesthesiologist.

544
00:28:59,640 --> 00:29:03,120
They know this because my wife
just went through this a couple

545
00:29:03,120 --> 00:29:05,960
weeks ago.
They do the what's the pain code

546
00:29:05,960 --> 00:29:08,160
that they give women that are
about to give birth.

547
00:29:09,800 --> 00:29:12,400
It's not, it's not There's that
big needle that they send all

548
00:29:12,400 --> 00:29:13,680
the dads out because they're
afraid they're.

549
00:29:13,720 --> 00:29:15,320
Going to pass out.
Yeah, they need the epidural.

550
00:29:15,600 --> 00:29:18,320
Epidural, yes.
Yes, yes, that's what I do in my

551
00:29:18,320 --> 00:29:20,480
paint thing.
I do the cervical, the neck

552
00:29:20,480 --> 00:29:24,280
epidurals, the lumbar epidurals.
I used to do the OB epidurals.

553
00:29:24,280 --> 00:29:29,840
I work at a hospital here in my
Baptist and so I work in Manoir.

554
00:29:29,840 --> 00:29:34,120
But the labor epidurals, the OB
is very satisfying to do.

555
00:29:34,160 --> 00:29:37,040
But those labor epidurals as
opposed to what we do here in

556
00:29:37,040 --> 00:29:39,440
the clinic, we have older
patients with hardware.

557
00:29:39,440 --> 00:29:42,240
So we use X-rays to find the
needle in the spine.

558
00:29:42,240 --> 00:29:45,960
They do a blind so and they but
younger females.

559
00:29:45,960 --> 00:29:46,760
Why would they do?
Why would you?

560
00:29:46,760 --> 00:29:49,040
Why would someone do a blind as
opposed to using needles?

561
00:29:51,040 --> 00:29:55,000
What one for habit?
Just tradition Pain medicine.

562
00:29:55,000 --> 00:29:58,040
It's outpatient clinic.
The patients are older, they

563
00:29:58,040 --> 00:30:00,920
have spinal hardware.
They're, the spaces you have to

564
00:30:00,920 --> 00:30:05,080
enter are much smaller, so you
have a less room for error.

565
00:30:06,320 --> 00:30:11,480
And so that's why they do it in
pain medicine just because also,

566
00:30:11,480 --> 00:30:14,600
if you're doing an epidural in
the neck, you want to be very

567
00:30:14,600 --> 00:30:16,800
precise.
There's much less room for

568
00:30:16,800 --> 00:30:19,440
error.
So you want to use an X-ray when

569
00:30:19,440 --> 00:30:22,520
you're doing it for labour and
women, it's always at the L45 or

570
00:30:22,760 --> 00:30:25,880
in that lumbar area.
They're, they're sitting up.

571
00:30:25,880 --> 00:30:28,480
This space is very wide open.
They're young.

572
00:30:28,480 --> 00:30:31,440
So you can feel the, the
ligament, you can feel like

573
00:30:31,440 --> 00:30:34,080
where you're at exactly as you
age, as the ligaments can become

574
00:30:34,080 --> 00:30:36,640
more relaxed.
You can't feel where you're

575
00:30:36,640 --> 00:30:39,560
entering, so that's why.
I see.

576
00:30:39,560 --> 00:30:42,720
And when you when you do a
lumbar epidural or something

577
00:30:42,720 --> 00:30:45,280
like that on an older patient.
That's that's.

578
00:30:45,880 --> 00:30:49,800
Is that the same thing as?
Is that the same medicine as

579
00:30:49,800 --> 00:30:52,000
epidural that my wife was
getting?

580
00:30:52,000 --> 00:30:53,000
What's the difference?
How does?

581
00:30:53,360 --> 00:30:56,400
That work usually in the
epidural laboring epidural

582
00:30:56,400 --> 00:30:59,440
they'll use bupiricane, some
fentanyl.

583
00:30:59,600 --> 00:31:03,000
This to give you some one for
bupiricane.

584
00:31:03,000 --> 00:31:07,520
You won't feel anything and the
fentanyl will relieve any pain

585
00:31:07,520 --> 00:31:10,720
you do feel.
Provide some just some general.

586
00:31:10,720 --> 00:31:12,560
Quite a cocktail.
Yeah, exactly.

587
00:31:12,920 --> 00:31:17,600
I in our in our clinic or any
pain clinic for an epidural,

588
00:31:17,600 --> 00:31:20,880
they'll use steroid which is
anti-inflammatory and then a

589
00:31:21,160 --> 00:31:25,560
small dose of Marcaine
bupivacaine that just it's for

590
00:31:25,560 --> 00:31:30,480
short term like that day.
But the real a medicine is a

591
00:31:30,480 --> 00:31:32,280
steroid which works.
That's so interesting.

592
00:31:32,720 --> 00:31:35,080
Yeah, it's anti-inflammatory
because the nerves are very

593
00:31:35,080 --> 00:31:36,840
inflamed.
We want to calm them down.

594
00:31:37,040 --> 00:31:40,440
Or, as in laboring women, the
nerves are fine, you just want

595
00:31:40,440 --> 00:31:41,880
to numb them up.
Yeah.

596
00:31:41,880 --> 00:31:43,600
You just want to make sure that
she's not feeling anything going

597
00:31:43,600 --> 00:31:46,560
on.
Yeah, because my grandfather had

598
00:31:46,880 --> 00:31:48,920
back pain and he'd go and get
injections all the time.

599
00:31:48,920 --> 00:31:51,560
And I'd always ask him like,
what are they injecting you?

600
00:31:51,560 --> 00:31:55,600
And he's a, he's AGI, you know,
You know, and, and it's like, I

601
00:31:55,600 --> 00:31:56,800
don't, you know, I don't even
know.

602
00:31:56,800 --> 00:31:59,000
I think he maybe even told me
steroids, but I don't even know

603
00:31:59,000 --> 00:32:00,560
what it meant.
And he never explained it to me.

604
00:32:00,560 --> 00:32:03,120
But like he'd go and then you
get this relief and I'd be like,

605
00:32:03,320 --> 00:32:04,760
what, what are they even doing
to you?

606
00:32:04,800 --> 00:32:06,680
You know, So I, it's, it's good
to know.

607
00:32:08,040 --> 00:32:09,920
It's good to know that's what
people buy ultrasounds, right?

608
00:32:09,920 --> 00:32:12,520
To do that, to do that needle
guided, inject those needle

609
00:32:12,520 --> 00:32:14,760
guided.
Injections and so for those for

610
00:32:14,760 --> 00:32:19,440
ultrasound guided that's more
for peripheral joints and you

611
00:32:19,440 --> 00:32:22,800
can visualize with ultrasound
even better than fluoroscopy

612
00:32:22,960 --> 00:32:25,920
X-ray, you can really, you can
see tendons, you can see muscle.

613
00:32:26,160 --> 00:32:30,400
And so it's very good for not
only steroids, but now as we're

614
00:32:30,400 --> 00:32:34,680
approaching this regenerative
age, you can do plasma

615
00:32:34,880 --> 00:32:37,520
biologics.
So it's easy to get into those

616
00:32:37,520 --> 00:32:40,200
tendons.
So let's talk about that.

617
00:32:40,800 --> 00:32:43,120
I wrote a bunch of words down
that I don't know what what they

618
00:32:43,120 --> 00:32:45,880
meant on your website of
treatment that you offer.

619
00:32:45,880 --> 00:32:47,480
So I'm very excited to learn
about them.

620
00:32:49,320 --> 00:32:50,800
Plasma therapy.
Yeah.

621
00:32:51,880 --> 00:32:56,920
So we mentioned South Florida.
South Florida is a hotbed also

622
00:32:56,920 --> 00:32:59,920
for this.
I call it false advertisement

623
00:32:59,920 --> 00:33:03,880
for regenerative medicine, which
was my research interest

624
00:33:04,240 --> 00:33:05,720
starting back from
undergraduate.

625
00:33:05,720 --> 00:33:11,160
The regeneration of tissues of
the body, which animals in

626
00:33:11,160 --> 00:33:14,880
nature, the salamander, axatol,
they can do it.

627
00:33:14,880 --> 00:33:18,600
The body's capable of doing it,
but the promise that we offer

628
00:33:18,600 --> 00:33:22,360
patients that we're it's called
regenerative tissue.

629
00:33:22,840 --> 00:33:26,920
We're not regenerating tissue on
a clinical scale, not in clinic

630
00:33:26,960 --> 00:33:30,680
yet It's anti-inflammatory in in
academics, the studies, yes,

631
00:33:30,680 --> 00:33:34,040
we're regenerating.
And so the idea with plasma, you

632
00:33:34,040 --> 00:33:40,080
mentioned platelet rich plasma,
they have found that platelets

633
00:33:40,080 --> 00:33:43,960
when you centrifuge it off,
there's growth factors in those

634
00:33:43,960 --> 00:33:47,720
platelets that if you reinject
it into the body, it provides

635
00:33:47,720 --> 00:33:52,920
some anti inflammation and
hopefully some healing

636
00:33:52,920 --> 00:33:56,800
potential.
Whether that healing that well,

637
00:33:56,800 --> 00:34:00,360
that healing now is our bodies
is fibrosis.

638
00:34:00,360 --> 00:34:02,240
When you cut yourself, you
develop a scar.

639
00:34:02,520 --> 00:34:06,120
When you get surgery you have
scars and abdomen adhesions.

640
00:34:06,280 --> 00:34:11,280
So our bodies form scars, but
young kids, neonates, when they

641
00:34:11,280 --> 00:34:14,000
are cut, they don't form scars,
They regenerate tissue.

642
00:34:14,400 --> 00:34:18,280
So the, the whole aim of this
whole field is to, for instance,

643
00:34:18,280 --> 00:34:21,480
if you have arthritis in the
shoulder, right now, we put

644
00:34:21,480 --> 00:34:24,960
steroids, they want to
regenerate that cartilage.

645
00:34:24,960 --> 00:34:27,120
The reason you have pain is
because there's no cartilage.

646
00:34:27,120 --> 00:34:29,320
It's bone on bone.
Exactly.

647
00:34:29,320 --> 00:34:32,159
So you want to replace, you want
to regenerate that cartilage.

648
00:34:32,159 --> 00:34:34,960
That's the Holy Grail.
That's the, that's the goal of

649
00:34:34,960 --> 00:34:37,199
this regenerative therapy.
Why can't?

650
00:34:37,199 --> 00:34:38,840
We just insert more cartilage in
there.

651
00:34:39,440 --> 00:34:43,320
Because the cartilage is once a
vascular, it's very hard to grow

652
00:34:43,320 --> 00:34:47,560
in a lab or to even to grow and
then to keep it in the body is

653
00:34:47,560 --> 00:34:51,159
even harder to keep it there.
So there's.

654
00:34:51,199 --> 00:34:54,360
Re nourish it if you re find a
way to re nourish it or quote UN

655
00:34:54,400 --> 00:34:57,800
quote regenerate it.
You could probably grow some

656
00:34:57,800 --> 00:35:01,240
cartilage in the lab, but if you
keep it, the joint space is a

657
00:35:01,240 --> 00:35:03,720
very harsh environment.
It has to stay there.

658
00:35:03,720 --> 00:35:06,760
You have to find a way for the
interface between the bone and

659
00:35:06,760 --> 00:35:11,240
the cartilage, and that has to
be like glue.

660
00:35:11,240 --> 00:35:13,880
You can't, because you can just
take a plate of cartilage in the

661
00:35:13,960 --> 00:35:15,320
shoulder, but it won't stay
there.

662
00:35:15,320 --> 00:35:19,560
You have to keep on a way to
keep it stuck to the the bone.

663
00:35:19,840 --> 00:35:21,320
And the technology is not there
yet for that.

664
00:35:21,560 --> 00:35:25,120
We're not there so a lot we're
promising, people are promising

665
00:35:25,120 --> 00:35:28,040
regeneration.
It's not regeneration yet, it's

666
00:35:28,040 --> 00:35:30,440
restoration or anti
inflammation.

667
00:35:30,800 --> 00:35:32,920
And when would I personally do
this?

668
00:35:32,920 --> 00:35:35,640
Biologic, Yes, but I'm just not
going to believe it's

669
00:35:35,640 --> 00:35:38,040
regenerating tissue.
Right, right, right.

670
00:35:38,040 --> 00:35:41,160
So, So what so, so I mean, I, so
typically speaking, your

671
00:35:41,160 --> 00:35:43,640
patients are a little older in
your in your practice.

672
00:35:44,000 --> 00:35:49,840
Yeah, as we age, yeah, we get
more thrice or bones, more wear

673
00:35:49,840 --> 00:35:50,880
and tear.
So yeah.

674
00:35:50,880 --> 00:35:54,920
But a lot of patients who want
their regenerative therapy are

675
00:35:54,920 --> 00:35:57,920
younger athletes.
Kobe Bryant was one who's

676
00:35:57,920 --> 00:36:00,720
getting PRP, Right, Right,
right.

677
00:36:01,120 --> 00:36:05,280
So athletes want it.
And for younger patients, I

678
00:36:05,280 --> 00:36:09,680
would recommend PRP because the
steroids, yeah, steroids they

679
00:36:09,680 --> 00:36:12,920
can cause if you're injecting
the in the fascia or tendon, it

680
00:36:12,920 --> 00:36:15,320
weakens it actually.
So you can have it makes it more

681
00:36:15,320 --> 00:36:18,800
likely for a rupture.
A lot of the ablations we're

682
00:36:18,800 --> 00:36:23,880
doing for the, for the neck of
the back, they, they ablate not

683
00:36:23,880 --> 00:36:26,000
only the nerve for pain, but a
nerve for the muscle.

684
00:36:26,000 --> 00:36:28,240
So you weaken the neck, you
weaken the lower back.

685
00:36:28,760 --> 00:36:31,560
And so it's not something you
want when a young active person.

686
00:36:32,160 --> 00:36:33,800
Wow, interesting.
But so why?

687
00:36:33,920 --> 00:36:35,760
So why would you give it to an
older person if they have a

688
00:36:35,760 --> 00:36:39,640
harder time recovering?
So you give it to an older

689
00:36:39,640 --> 00:36:43,320
person, one, because the goal
for an older person is to just

690
00:36:43,320 --> 00:36:47,200
maintain mobility.
You want to make sure just get

691
00:36:47,200 --> 00:36:49,040
them over the really painful
hump.

692
00:36:49,040 --> 00:36:51,440
You don't want to be doing these
procedures all the time,

693
00:36:51,480 --> 00:36:54,880
ablations, steroids, but most of
the time these this pain is

694
00:36:54,880 --> 00:36:56,240
acute.
Maybe there's six weeks.

695
00:36:56,240 --> 00:36:59,040
You want to get them over that
hump and the goal is to continue

696
00:36:59,040 --> 00:37:01,560
mobility.
The the model of our clinic is

697
00:37:02,160 --> 00:37:04,280
restore and maintain an active
life.

698
00:37:04,800 --> 00:37:07,520
If you don't, if you stop
moving, your joints fuse.

699
00:37:07,520 --> 00:37:10,680
And when joints fuse, you get
more pain, you can't move and

700
00:37:10,680 --> 00:37:13,520
you just create more problems.
So even if you have pain, you

701
00:37:13,520 --> 00:37:16,680
want to move a little bit, you
just keep the joints need

702
00:37:16,680 --> 00:37:19,400
movement for lubrication.
You just need to keep moving.

703
00:37:20,240 --> 00:37:21,440
Yeah.
Yeah, I know.

704
00:37:21,480 --> 00:37:24,280
And we do very, very little of
that these days.

705
00:37:24,280 --> 00:37:27,560
Unfortunately, yeah, exactly.
So are you seeing a younger

706
00:37:27,560 --> 00:37:31,200
demographic come in for
typically what would have been

707
00:37:31,200 --> 00:37:34,160
considered older deterioration
or deterioration that's more

708
00:37:34,160 --> 00:37:42,040
common when you're older?
No, young people are most people

709
00:37:42,040 --> 00:37:46,480
in general, most these
procedures for PRP exosomes,

710
00:37:47,000 --> 00:37:48,400
they're cash.
They're cash pay.

711
00:37:48,600 --> 00:37:52,480
So people don't want to spend
disposable cash on a pain

712
00:37:52,480 --> 00:37:54,200
procedure.
They want to spend on a cosmetic

713
00:37:54,200 --> 00:37:59,080
procedure or something that they
can see that pain is not sexy,

714
00:37:59,080 --> 00:38:00,640
it's not fun.
So they don't.

715
00:38:00,640 --> 00:38:04,040
Yeah.
So the PCP is our blood have

716
00:38:04,040 --> 00:38:07,720
platelets in it.
You're you, you cycle it, you

717
00:38:07,720 --> 00:38:10,440
take it from the from the
particular area where it's

718
00:38:10,440 --> 00:38:14,320
already in pain.
No, you, you, you put an IV in

719
00:38:14,360 --> 00:38:18,400
and you want to, you get all 50
CCS, usually a blood, you put it

720
00:38:18,400 --> 00:38:21,800
in a centrifuge and you spin it
for a few minutes and it'll

721
00:38:21,800 --> 00:38:24,640
separate the blood with the
plasma and the serum.

722
00:38:25,360 --> 00:38:30,200
And you take the A layer and
that layer has the platelets

723
00:38:30,200 --> 00:38:35,240
with the growth factors and that
you you get that and then you

724
00:38:35,240 --> 00:38:37,960
get that back in the body.
So you're putting their blood

725
00:38:37,960 --> 00:38:39,480
back?
It's almost like enhanced blood

726
00:38:39,600 --> 00:38:42,600
with extra.
And so the PCP stands for what?

727
00:38:43,440 --> 00:38:46,320
PRP, Lander Ridge plasma.
Gotcha.

728
00:38:46,320 --> 00:38:50,200
PCP is primary care provider.
That's your your name, Doctor.

729
00:38:50,480 --> 00:38:51,720
OK, gotcha, Gotcha.
Gotcha.

730
00:38:51,800 --> 00:38:53,200
Right.
It's a lot.

731
00:38:53,240 --> 00:38:54,840
It's a lot of what do you call
it?

732
00:38:56,320 --> 00:38:57,160
Shoot.
What do you call it?

733
00:38:57,160 --> 00:38:59,200
The acronyms.
A lot of acronyms.

734
00:38:59,720 --> 00:39:04,000
And so now we have, we have the
PRP now and now we have the next

735
00:39:04,000 --> 00:39:07,560
generation of PRP, which is
called exosomes, which now they

736
00:39:07,560 --> 00:39:14,280
have found exosomes are simply
the PRP with a transport vehicle

737
00:39:14,720 --> 00:39:16,320
that allows it to enter the
cell.

738
00:39:16,640 --> 00:39:19,000
And so now they've found that
these exosomes, they can

739
00:39:19,000 --> 00:39:23,480
concentrate them and it's even
might be more beneficial than

740
00:39:23,480 --> 00:39:26,600
PRP.
So in that, so let's say with

741
00:39:26,600 --> 00:39:29,200
the original PRP case, you're
kind of flooding that blood back

742
00:39:29,200 --> 00:39:31,280
in your system and you're hoping
that the cells take it because

743
00:39:31,280 --> 00:39:34,920
it's new blood in with exosomes,
it's more inclined to latch on

744
00:39:34,920 --> 00:39:37,680
or hang.
In, yeah, well, PRP, you're not

745
00:39:37,680 --> 00:39:39,600
getting back in the IV you're
giving.

746
00:39:39,600 --> 00:39:43,480
You're injecting it into the
area of pain in the back or the

747
00:39:43,480 --> 00:39:46,320
shoulder and the knee.
Same with the exosomes.

748
00:39:46,480 --> 00:39:49,640
You're taking the blood out,
centrifuge it, and then you get

749
00:39:49,640 --> 00:39:53,560
the exosomes, which are just the
growth factors in the transport

750
00:39:53,560 --> 00:39:57,160
vehicle.
Yeah, it's the lipid bilayer,

751
00:39:57,160 --> 00:39:59,680
which is and it just enters a
cell more easily.

752
00:39:59,960 --> 00:40:01,760
Isn't that how hair transplants
work?

753
00:40:01,840 --> 00:40:05,280
You take like the hair that's
like growing from 1 area and

754
00:40:05,280 --> 00:40:07,760
then you pop it into the root
and you pop it into the area

755
00:40:07,760 --> 00:40:09,440
where the hair is not grown,
continuing to grow.

756
00:40:09,680 --> 00:40:14,160
That they they use PRP and
exosomes for they they use it

757
00:40:14,160 --> 00:40:16,800
for hair loss.
I don't, I don't know.

758
00:40:16,800 --> 00:40:18,960
No, no, no, I'm not talking
about using PRP for that, but

759
00:40:18,960 --> 00:40:20,840
I'm saying the similar concept
in the sense that like you're

760
00:40:20,840 --> 00:40:24,240
taking the, you know, starting
good, good, good growing hair

761
00:40:24,240 --> 00:40:26,600
from 1 area and you're popping
it to another part of your head

762
00:40:26,600 --> 00:40:28,000
and hoping that it that it grows
there.

763
00:40:28,160 --> 00:40:30,040
But my dad did that.
It didn't work for that all so.

764
00:40:30,240 --> 00:40:34,280
I don't think I could know.
I've seen people, but no, I

765
00:40:34,280 --> 00:40:36,760
don't think that's more like a
transplant because you're taking

766
00:40:36,760 --> 00:40:40,080
hair from a good area and
putting it into a bad area.

767
00:40:40,080 --> 00:40:44,680
The exosome, the idea is it
doesn't enter the shoulder

768
00:40:44,880 --> 00:40:48,160
because blood doesn't get there
and so they get good growth

769
00:40:48,160 --> 00:40:50,520
factors there.
You have to inject it because it

770
00:40:50,520 --> 00:40:53,280
is a vascular and you can't get
the blood there.

771
00:40:53,920 --> 00:40:55,520
Right, right, right, right.
Cool.

772
00:40:55,520 --> 00:41:00,680
And is that so when people walk
in, are they asking for that or

773
00:41:00,680 --> 00:41:02,960
are they coming in in pain and
you're making recommendations

774
00:41:02,960 --> 00:41:04,960
based on like what their what
their pain is?

775
00:41:05,120 --> 00:41:08,280
I will make recommendations.
There are some clinics that

776
00:41:08,280 --> 00:41:11,440
specialize in that.
The issue is I didn't want to

777
00:41:11,440 --> 00:41:17,640
specialize in that because it's
not the level of being able to,

778
00:41:19,680 --> 00:41:23,640
in my opinion, be on its own.
It should be combined with I

779
00:41:23,640 --> 00:41:26,720
don't be charging patients cash.
I mean, some of these procedures

780
00:41:26,720 --> 00:41:30,800
are $3000 and we have a limited
evidence that they even work.

781
00:41:31,160 --> 00:41:35,960
My, my belief is that we can do
the standard procedures that

782
00:41:35,960 --> 00:41:42,120
have been shown to be effective.
Even them, even those aren't

783
00:41:42,120 --> 00:41:44,160
evidence based, but at least
they're covered by insurance.

784
00:41:44,240 --> 00:41:47,720
They're not super expensive and
if you don't work, we could

785
00:41:47,720 --> 00:41:50,840
consider PRP exercise, but I
don't want to have to push

786
00:41:50,840 --> 00:41:54,600
patients to a procedure that
might not work and so I like to

787
00:41:54,600 --> 00:41:57,240
offer everything.
Right, right, right, right.

788
00:41:57,240 --> 00:41:59,360
How did you become so open
minded about?

789
00:41:59,360 --> 00:42:03,720
This I don't think.
It's pretty niche I think, no.

790
00:42:03,760 --> 00:42:08,160
It is very niche.
It was just the idea of the body

791
00:42:08,160 --> 00:42:12,160
regenerating itself was
fascinating for me in medical

792
00:42:12,160 --> 00:42:15,680
school or an undergraduate.
So it's never about creating a

793
00:42:15,680 --> 00:42:17,880
business model or promising
something false.

794
00:42:17,880 --> 00:42:19,920
It really was about getting to
the.

795
00:42:20,320 --> 00:42:27,240
Point for sure, I believe that.
So I guess I, I just, I don't, I

796
00:42:27,240 --> 00:42:29,000
can't say that medical school
developed it.

797
00:42:29,000 --> 00:42:32,840
I think you just have to be open
minded and just know it sounds

798
00:42:32,840 --> 00:42:35,600
basic, but I think that that's
it.

799
00:42:35,960 --> 00:42:39,000
You just realize that if you
don't really want to help,

800
00:42:39,440 --> 00:42:41,840
you're not helping my falsely
promising stuff.

801
00:42:41,840 --> 00:42:45,440
You have to really make sure it
works works and make sure it's

802
00:42:45,440 --> 00:42:49,280
evidence based.
Yeah, yeah, I, I guess the fact

803
00:42:49,280 --> 00:42:52,200
and I mean, and does evidence
grow?

804
00:42:52,200 --> 00:42:54,600
Based on your like, if you're,
if you're successful with X

805
00:42:54,600 --> 00:42:57,000
amount of patients, right, are
you like, you know, I noticed

806
00:42:57,000 --> 00:43:00,840
that, you know, are there a lot
of, are there a lot of trials

807
00:43:00,840 --> 00:43:04,160
going on regarding this kind of
Medicare medicine?

808
00:43:04,400 --> 00:43:07,400
Yeah, so there are, there is.
And I actually reached out to

809
00:43:07,400 --> 00:43:10,040
the University of Miami Medical
School of Medicine.

810
00:43:10,360 --> 00:43:12,200
They're doing a lot of clinical
trials with this.

811
00:43:12,200 --> 00:43:16,280
They have a stem cell institute
that I'm, I am cool with.

812
00:43:17,080 --> 00:43:21,960
And so I, I've spoken with them
to, I mean, obviously the idea

813
00:43:22,080 --> 00:43:23,560
would be to have clinical
trials.

814
00:43:23,560 --> 00:43:28,480
So the issue is a lot of these
clinics that do PRP, they're not

815
00:43:28,480 --> 00:43:30,680
regulated.
They're doing the PRP in house.

816
00:43:30,680 --> 00:43:33,200
You don't know how they're
centrifuging it, if it's even

817
00:43:33,200 --> 00:43:36,480
PRP ever even works.
With these clinical trials.

818
00:43:36,480 --> 00:43:39,520
The goal is to regulate it how
the FDA makes sure what you're

819
00:43:39,520 --> 00:43:42,000
doing is correct and what we're
doing is actually working.

820
00:43:42,760 --> 00:43:45,760
Are there that you you know of
many many.

821
00:43:45,760 --> 00:43:48,240
Cases of doctors that are just
making this kind of thing up,

822
00:43:48,240 --> 00:43:50,800
they're like.
Oh yeah, I mean, I know doctors

823
00:43:51,360 --> 00:43:54,480
who are promised saying it cures
erectile dysfunction, that it'll

824
00:43:54,480 --> 00:43:56,960
cure hair loss.
We're putting it into the

825
00:43:56,960 --> 00:44:00,880
cosmetic, the procedures when
you do fillers, a lot of is PRP,

826
00:44:00,920 --> 00:44:03,320
it's safe, but it doesn't stay
there very long.

827
00:44:03,640 --> 00:44:06,840
So anything that's cash pay,
people will pay cash.

828
00:44:07,200 --> 00:44:10,120
There are there will be people
who will accept the cash for it.

829
00:44:10,160 --> 00:44:14,280
So if you want PRP for erectile
dysfunction or hair loss,

830
00:44:14,840 --> 00:44:17,000
someone will do it for you.
What else?

831
00:44:17,280 --> 00:44:19,680
What are the methods I noticed?
That I wrote down that I didn't

832
00:44:19,680 --> 00:44:22,280
know what it meant, but
peripheral nerve stimulator.

833
00:44:22,920 --> 00:44:28,080
Yeah, that's a newer technology
using an older known theory.

834
00:44:28,080 --> 00:44:32,880
So a lot of what we do in pain
management is temporary and

835
00:44:32,880 --> 00:44:35,800
you're just hiding masking pain
of nerve ablations.

836
00:44:35,840 --> 00:44:40,080
You're just using heat and burn
the nerve and it will regrow in

837
00:44:40,080 --> 00:44:42,440
a few months.
Steroids you just calming down

838
00:44:42,440 --> 00:44:45,480
the inflammation.
You're not really caught helping

839
00:44:45,480 --> 00:44:49,080
the root cause.
Neither is the peripheral nerve

840
00:44:49,080 --> 00:44:52,360
stimulator.
The nerve stimulator is only is

841
00:44:52,360 --> 00:44:56,000
sending a small electrical
signal to the nerve temporarily

842
00:44:56,000 --> 00:45:01,400
for six months maximum and it
resets the nerve to the point

843
00:45:01,400 --> 00:45:07,240
where it doesn't hopefully has
been shown this by evidence that

844
00:45:07,240 --> 00:45:10,800
it forgets about the pain.
It resets it to its standard to

845
00:45:10,800 --> 00:45:14,080
the normal nerve.
A lot of chronic pain is where

846
00:45:14,080 --> 00:45:17,280
the body's tricked into thinking
that you have a problem in your

847
00:45:17,280 --> 00:45:20,000
shoulder and your knee because
you're missing, missing

848
00:45:20,000 --> 00:45:23,320
cartilage and the nerves are
firing continuously because

849
00:45:23,320 --> 00:45:25,320
they're confused.
They think you have a problem

850
00:45:25,320 --> 00:45:28,560
there when in fact it's just
it's an issue, but they're just

851
00:45:28,560 --> 00:45:31,360
constantly firing.
And the idea with the peripheral

852
00:45:31,360 --> 00:45:34,360
nerve stimulator is you're
resetting the nerve, you're

853
00:45:34,360 --> 00:45:37,480
tricking it and making it go
back to its original state and

854
00:45:37,480 --> 00:45:41,640
not recognizing this thing.
Yes, stimulus as pain.

855
00:45:42,280 --> 00:45:46,520
So it's almost like a like a
guard dog that's that becomes

856
00:45:46,560 --> 00:45:50,120
familiar with you and it stops
and it stops barking and jumping

857
00:45:50,120 --> 00:45:51,160
on you and you walk.
Exactly.

858
00:45:51,400 --> 00:45:53,800
And the peripheral nerve
stimulator is not burning, it's

859
00:45:53,800 --> 00:45:57,120
not trinsecting, it's just
providing a small signal to the

860
00:45:57,120 --> 00:45:59,200
nerve to reset it.
Gotcha.

861
00:45:59,320 --> 00:46:02,080
Does does electroshock therapy
work in a similar way?

862
00:46:02,720 --> 00:46:05,920
Yeah, the spinal cord
stimulator, is that what you're

863
00:46:05,920 --> 00:46:10,240
referring to, like?
No, I know that you should use

864
00:46:10,560 --> 00:46:11,640
sound waves shock.
Waves, yeah.

865
00:46:11,640 --> 00:46:15,520
Shock waves, yeah.
Well, the shockwave is also

866
00:46:15,960 --> 00:46:19,080
around restorative.
The idea is it provides these

867
00:46:19,080 --> 00:46:22,880
shock waves that causes some
tissue trauma.

868
00:46:23,240 --> 00:46:25,560
And a little bit of tissue
trauma is good because in the

869
00:46:25,560 --> 00:46:28,880
areas like the fascia or the
tendon, that trauma will bring

870
00:46:28,880 --> 00:46:32,000
some 'cause some bruising, some
bleeding.

871
00:46:32,200 --> 00:46:34,720
And with that bleeding, you get
platelets and those growth

872
00:46:34,720 --> 00:46:38,600
factors to come to the area,
which are otherwise very hard to

873
00:46:38,600 --> 00:46:42,200
get to.
You can't get those those those

874
00:46:42,240 --> 00:46:44,520
growth factors to the area
without a little bit of trauma.

875
00:46:44,760 --> 00:46:50,400
And so the idea is it's called
in an older terms prolotherapy

876
00:46:50,520 --> 00:46:54,480
where you cause some, it's it's
counterintuitive you cause some

877
00:46:56,720 --> 00:47:02,320
damage the area to cause some
bleeding and bruising, which

878
00:47:02,560 --> 00:47:04,960
brings growth factors to the
area.

879
00:47:06,240 --> 00:47:09,400
I think that the whole premise
of vaccines is, is pretty

880
00:47:09,400 --> 00:47:12,360
similar, no, you're introducing
that substance to your body for

881
00:47:12,360 --> 00:47:14,880
the for the body to respond to,
to become familiar and respond

882
00:47:14,880 --> 00:47:16,800
to it.
Yeah, exactly.

883
00:47:16,800 --> 00:47:18,200
That's cool.
That's really cool.

884
00:47:18,200 --> 00:47:22,400
So that, so that, so that notion
of introducing something to kind

885
00:47:22,400 --> 00:47:25,720
of introducing something on a
smaller scale, you know, that

886
00:47:25,720 --> 00:47:28,720
it's so funny because unlike a
social level, we have that too.

887
00:47:28,720 --> 00:47:32,800
There's a, there's a book that I
just mentioned even today, a

888
00:47:32,800 --> 00:47:35,080
different, different podcast
called the the Ancient

889
00:47:35,080 --> 00:47:38,040
generation.
And one of the things that he

890
00:47:38,040 --> 00:47:40,640
talks about is that when you're
growing up for kids, that's

891
00:47:40,640 --> 00:47:43,920
important that they get into, he
calls them scrapes, not breaks.

892
00:47:43,960 --> 00:47:46,680
You know, that like they learn
how, like they learn that

893
00:47:46,680 --> 00:47:49,400
falling is not a huge deal, but
they also learn how to like,

894
00:47:49,400 --> 00:47:52,360
there's no consequences and that
like they could just bounce back

895
00:47:52,360 --> 00:47:54,960
up and they'll be OK.
And then they become more adept

896
00:47:54,960 --> 00:47:57,080
and more nimble and more, you
know, kids become a little bit

897
00:47:57,080 --> 00:47:59,600
more confident when they able to
get up and kind of brush

898
00:47:59,600 --> 00:48:02,520
themselves off.
But, you know, you if you get a

899
00:48:02,520 --> 00:48:04,840
break, obviously it's a lot more
significant.

900
00:48:05,160 --> 00:48:07,520
Exactly.
And and like, the shockwave

901
00:48:07,520 --> 00:48:11,160
itself doesn't cause any breaks.
There's nothing that goes in the

902
00:48:11,160 --> 00:48:13,440
body.
It just provides some gentle

903
00:48:14,680 --> 00:48:17,760
vibrations above the skin and
that breaks up the tissue enough

904
00:48:17,760 --> 00:48:19,560
to cause some.
Yeah.

905
00:48:19,680 --> 00:48:23,200
Yeah, yeah, I've, I think, well,
I don't know.

906
00:48:24,120 --> 00:48:28,680
So I went to one of those IV
bars one time in Austin and I

907
00:48:28,680 --> 00:48:31,400
sat there and actually, so it's
funny, I sold the guy an

908
00:48:31,400 --> 00:48:34,760
ultrasound machine and then I
happened to be visiting Austin.

909
00:48:34,760 --> 00:48:36,640
So I decided to stop by and
check out what the place looked

910
00:48:36,640 --> 00:48:39,120
like.
And he had me sit down one of

911
00:48:39,120 --> 00:48:45,960
these chairs and the chair would
vibrate more intensely based on

912
00:48:45,960 --> 00:48:50,360
how tense my, my back or arms
or, you know, whatever part of

913
00:48:50,360 --> 00:48:52,000
my body was sitting on the chair
was.

914
00:48:52,280 --> 00:48:56,040
And then as my body got looser,
the vibrations it would, or as I

915
00:48:56,040 --> 00:48:58,440
guess it opened up a little bit,
the vibrations would slow down

916
00:48:58,720 --> 00:49:00,280
until it would come to a stop
completely.

917
00:49:00,280 --> 00:49:03,240
But you didn't even realize how
tense you were until that.

918
00:49:04,160 --> 00:49:07,040
Until that started.
Exactly.

919
00:49:07,680 --> 00:49:09,040
Yeah, that's part of the whole
treatment.

920
00:49:09,600 --> 00:49:11,600
When how long?
When did you open a Gables

921
00:49:11,600 --> 00:49:14,480
paint?
So Gabus Pain has actually been

922
00:49:14,480 --> 00:49:17,840
open.
The LLC has been open since

923
00:49:17,840 --> 00:49:23,680
2022, but my doors have only
been open for six months because

924
00:49:23,680 --> 00:49:25,600
I've been fighting, not
fighting.

925
00:49:25,800 --> 00:49:28,880
I've been trying to get on
insurance contracts.

926
00:49:28,880 --> 00:49:33,440
Insurances are notoriously hard
to have you get on their panels,

927
00:49:33,480 --> 00:49:36,200
especially in large cities.
They don't want to pay more

928
00:49:36,200 --> 00:49:40,800
doctors obviously, despite there
is always a need, especially in

929
00:49:40,800 --> 00:49:43,320
pain, but it's just hard to get
on the insurance panels.

930
00:49:43,920 --> 00:49:48,320
So I finally got on most of
them, not all of them, about 6-7

931
00:49:48,320 --> 00:49:50,600
months ago.
So patients have been trickling

932
00:49:50,600 --> 00:49:52,760
in.
Wow, interesting.

933
00:49:52,760 --> 00:49:54,640
What, what, what, what, what,
what steps go?

934
00:49:54,680 --> 00:49:58,440
So when did you want to open
this up and what steps go into

935
00:49:58,440 --> 00:50:03,000
opening your own clinic?
Honestly, the pain I just had to

936
00:50:03,000 --> 00:50:07,280
be on my own in pain medicine
when I ended up talking to so

937
00:50:07,280 --> 00:50:10,200
many private equity firms who
had bought up these small

938
00:50:10,200 --> 00:50:17,560
private pain clinics and wanted
to hire me and work me who knows

939
00:50:17,560 --> 00:50:21,120
for how many hours since
patients doing procedures that I

940
00:50:21,120 --> 00:50:24,640
don't know if I even believed in
and the way I was treated, I I

941
00:50:24,640 --> 00:50:26,920
didn't appreciate it at all and.
What?

942
00:50:27,040 --> 00:50:28,720
What they want you to do that
you weren't sure you believed

943
00:50:28,720 --> 00:50:31,400
in.
I mean, the the issue is you've

944
00:50:31,400 --> 00:50:37,000
got, you don't have much to say.
You either accept what they want

945
00:50:37,000 --> 00:50:41,400
to do, or you just don't do it.
Yeah.

946
00:50:41,640 --> 00:50:47,120
Yeah.
So the reason a lot of it's

947
00:50:47,440 --> 00:50:49,960
really performance based.
So the more patients you see,

948
00:50:49,960 --> 00:50:52,720
the more procedures you do, the
more you get paid.

949
00:50:53,320 --> 00:50:57,040
And I mean, obviously that's
true for me too, but I'm not

950
00:50:57,360 --> 00:51:01,800
expected and held to a certain
number of patients that I don't

951
00:51:01,800 --> 00:51:05,240
have to.
I can practice medicine as I

952
00:51:05,240 --> 00:51:08,160
want to.
And I evidence based.

953
00:51:09,080 --> 00:51:12,080
There's multiple examples.
I think just the other day there

954
00:51:12,080 --> 00:51:16,360
was ACEO of a pain clinic in
Tennessee or Kentucky that they

955
00:51:16,360 --> 00:51:20,120
had I think 20 pain clinics.
They went to prison for 30 years

956
00:51:20,120 --> 00:51:24,320
for their use of injections.
They were almost in a million

957
00:51:24,320 --> 00:51:28,720
injections in in their patient
in a year which is wow crazy

958
00:51:28,720 --> 00:51:30,200
amount.
And so they're.

959
00:51:30,760 --> 00:51:33,000
They're pretty much care and
stick model.

960
00:51:33,000 --> 00:51:35,760
They were doing injections,
which is how you get the most

961
00:51:35,760 --> 00:51:39,920
money and the and to incentivize
patients for that, you give them

962
00:51:39,960 --> 00:51:42,720
opioids, you pretty much keep
them addicted.

963
00:51:43,120 --> 00:51:46,560
And so you give them opioids and
it's it's like a handshake

964
00:51:46,560 --> 00:51:48,400
agreement.
I'll give you opioids if you let

965
00:51:48,400 --> 00:51:51,480
me do injections on you.
And so they're doing injections

966
00:51:51,880 --> 00:51:56,080
once every other week, which.
Is that is crazy?

967
00:51:56,080 --> 00:51:58,120
What what what?
This was in Tennessee.

968
00:51:58,640 --> 00:52:03,280
Just in Kentucky or tenancy I
just saw oh man and.

969
00:52:03,280 --> 00:52:05,960
I feel like the I feel like the
opioid conversation has really

970
00:52:05,960 --> 00:52:08,240
blown up so much that I'm
shocked that it's still

971
00:52:08,240 --> 00:52:09,760
happening on the scale that it
is.

972
00:52:10,600 --> 00:52:14,480
Yeah, it's just it has a place.
For instance, today I had a

973
00:52:14,480 --> 00:52:16,400
patient who had severe back
pain.

974
00:52:16,400 --> 00:52:19,000
He cannot almost perform any
activity.

975
00:52:19,600 --> 00:52:26,040
And so I will do it for a short
course to relieve maybe 10 days.

976
00:52:26,480 --> 00:52:30,200
I have a Percocet just to take
just to get him past the hump,

977
00:52:30,800 --> 00:52:33,800
but I don't do more than that.
And if.

978
00:52:33,840 --> 00:52:36,440
I need to be like, real.
Of course everything has a place

979
00:52:36,440 --> 00:52:38,840
and time, you know?
Yeah, but the but the obvious,

980
00:52:38,960 --> 00:52:42,200
but the obvious conflicts of
interest and the obvious

981
00:52:42,200 --> 00:52:44,960
advantage that that people could
be, you know, that that people

982
00:52:45,840 --> 00:52:47,920
could get take people could be
taken advantage of pretty

983
00:52:47,920 --> 00:52:49,520
seriously, you know?
Yeah.

984
00:52:49,520 --> 00:52:52,480
Especially because we trust our
like, we trusted doctors,

985
00:52:52,480 --> 00:52:53,840
everything.
You know, I was talking to

986
00:52:53,840 --> 00:52:58,200
someone this past weekend and
and, you know, they were his

987
00:52:58,200 --> 00:52:59,800
bit.
He just went, he just had a kid

988
00:53:00,160 --> 00:53:03,640
and his he was telling me how
the dot, how they wanted to put

989
00:53:03,640 --> 00:53:06,400
this cream in the baby's eyes.
And Kate, I forgot what it was

990
00:53:06,400 --> 00:53:08,640
for exactly after the baby was
born.

991
00:53:09,000 --> 00:53:10,520
And he was asking the doctor
about it.

992
00:53:10,520 --> 00:53:13,000
And like, her response to him
was like, he just wanted to know

993
00:53:13,000 --> 00:53:14,160
what it was.
He didn't know what it was.

994
00:53:14,160 --> 00:53:15,320
And she's like, don't be one of
those people.

995
00:53:15,320 --> 00:53:16,600
Just do what you want your kid
to be blind.

996
00:53:16,600 --> 00:53:19,120
And like, he's like, no, sorry.
And like he like looked into it

997
00:53:19,120 --> 00:53:20,160
after.
He was like, I totally didn't

998
00:53:20,160 --> 00:53:22,760
need to do that, you know, But
yeah, you know, I think people,

999
00:53:22,760 --> 00:53:25,440
you know, you put on a coat, you
put on scrubs, you put on, you

1000
00:53:25,440 --> 00:53:28,680
know, the, the mask and you walk
in and you're the, you're the

1001
00:53:28,680 --> 00:53:31,800
figure of authority that knows.
And, and everyone kind of just.

1002
00:53:32,440 --> 00:53:35,600
And for by the way, in an ideal
case, that should be the best

1003
00:53:35,600 --> 00:53:38,200
thing in the entire world
because ideally there is no

1004
00:53:38,200 --> 00:53:40,160
taking advantage of people.
And ideally, you know, you don't

1005
00:53:40,160 --> 00:53:42,320
want to do that, you know, and
like, like what you do, you go,

1006
00:53:42,400 --> 00:53:44,480
OK, you know, I'll do 10 days to
hold you over.

1007
00:53:44,480 --> 00:53:47,960
But you can't go more than that
because, you know, literally

1008
00:53:47,960 --> 00:53:50,920
thirty, 2530% chance you get
addicted to these, you know, I

1009
00:53:50,920 --> 00:53:55,400
mean, is it worth it?
You know, it's an interesting

1010
00:53:55,400 --> 00:53:58,680
dynamic.
It's so interesting that the

1011
00:53:58,680 --> 00:54:00,280
abuse is still.
Going on SO.

1012
00:54:00,280 --> 00:54:01,760
Strongly though.
It's hard to fight it though.

1013
00:54:02,680 --> 00:54:08,840
It's very, I mean, opioids are
the most is the most addictive

1014
00:54:08,840 --> 00:54:14,360
substance on earth.
Methamphetamine and opioids, I

1015
00:54:14,360 --> 00:54:18,280
don't think, I think I think
methamphetamine might be a

1016
00:54:18,280 --> 00:54:22,840
little bit more addictive, but.
Yeah, yeah, yeah, yeah.

1017
00:54:22,840 --> 00:54:27,040
I hope we turn to, I think like
with the Netflix documentaries

1018
00:54:27,040 --> 00:54:29,280
and the books, like I, I just
read a book called The American

1019
00:54:29,280 --> 00:54:34,880
Cartel about the DEA trying to,
you know, trying to sue,

1020
00:54:35,360 --> 00:54:37,800
basically.
I think one of the harder things

1021
00:54:37,800 --> 00:54:41,160
about the opioids is it's hard
to figure out who to point the

1022
00:54:41,160 --> 00:54:43,120
blame to.
Do you point the blame to the

1023
00:54:43,200 --> 00:54:44,560
doctors?
Do you point the blame to the

1024
00:54:44,560 --> 00:54:46,160
manufacturers?
Do you point, do you point the

1025
00:54:46,160 --> 00:54:48,440
blame to the people that are
providing it to the corporations

1026
00:54:48,440 --> 00:54:52,280
that that provide incentives and
kickbacks and like say you're

1027
00:54:52,280 --> 00:54:55,000
the problem?
Or do you say to the middle men,

1028
00:54:55,000 --> 00:54:58,360
you know, like the Walgreens or
the, the CVS is, hey, did you

1029
00:54:58,360 --> 00:55:00,880
notice that one person is
getting X amount of

1030
00:55:00,880 --> 00:55:03,320
prescriptions picked up?
And like, that's not normal.

1031
00:55:03,480 --> 00:55:06,600
He's like, well, it's doctor.
It's like it's everyone has

1032
00:55:06,600 --> 00:55:09,160
plausible deniability along the
way, which makes it so much

1033
00:55:09,160 --> 00:55:10,240
harder.
To crack down.

1034
00:55:10,520 --> 00:55:12,240
No, exactly.
And I mean, I talked about

1035
00:55:12,320 --> 00:55:16,560
private equity, but I know a lot
of private pain doctors who went

1036
00:55:16,560 --> 00:55:20,200
to jail for life because they
just want to give its opioids

1037
00:55:20,720 --> 00:55:23,040
indiscriminately because they're
making a lot of money.

1038
00:55:23,440 --> 00:55:26,520
And so the blame is on every, I
mean on everybody.

1039
00:55:26,520 --> 00:55:30,760
You can't, I mean, common sense.
If I'm given Dew Point

1040
00:55:30,880 --> 00:55:33,520
Industries, the ones who made
Oxycontin said it was not

1041
00:55:33,520 --> 00:55:36,600
addictive, fine, that's fine.
They're going to come to you and

1042
00:55:36,600 --> 00:55:40,200
tell you give me, give me put
all your patients on this.

1043
00:55:40,480 --> 00:55:44,120
And if they start dying, I mean,
guests stop using the medicine

1044
00:55:44,120 --> 00:55:46,880
and we see them patients are
dying all the time from this

1045
00:55:46,880 --> 00:55:48,280
opioid.
Just stop.

1046
00:55:48,520 --> 00:55:50,640
It's greed all it's greed
everywhere.

1047
00:55:51,040 --> 00:55:52,400
That's what.
Yeah.

1048
00:55:52,400 --> 00:55:56,400
What, what, what new
developments are you are you

1049
00:55:56,400 --> 00:55:58,160
keeping your eye on or that
you're keeping track of that

1050
00:55:58,160 --> 00:56:01,000
you're excited about in terms of
in terms of chronic medicine and

1051
00:56:01,000 --> 00:56:04,600
well?
It's not chronic yet, but a new

1052
00:56:04,600 --> 00:56:08,480
drug called Dronavix just got
FDA approved in January.

1053
00:56:09,120 --> 00:56:09,840
OK.
And it.

1054
00:56:10,000 --> 00:56:14,160
Uses sodium channels and it's
non opioid based.

1055
00:56:14,520 --> 00:56:19,080
It's right now it's used for
post surgical pain and patients

1056
00:56:19,080 --> 00:56:23,760
take it after surgery and it
helps significantly reduces the

1057
00:56:23,760 --> 00:56:25,960
amount of pain they feel.
And.

1058
00:56:26,200 --> 00:56:30,000
I think it's only a matter of
time until it goes into the

1059
00:56:30,000 --> 00:56:32,720
chronic pain world, but it's a
fantastic drug.

1060
00:56:32,720 --> 00:56:36,960
It was just approved this year
and it uses a a novel receptor,

1061
00:56:36,960 --> 00:56:41,600
a sodium receptor that really
targets nerves specifically.

1062
00:56:42,600 --> 00:56:46,360
What is, what is what you say?
Sodium?

1063
00:56:46,360 --> 00:56:49,000
Is it sodium?
Yes, sodium channel.

1064
00:56:49,000 --> 00:56:54,880
So our our nerves work by they
use sodium potassium to move the

1065
00:56:54,880 --> 00:56:57,880
signal, move the polarization,
the charge.

1066
00:56:57,880 --> 00:57:02,120
And if you can just mess with
the some way they've altered the

1067
00:57:02,120 --> 00:57:05,520
way that the nerve responds to a
lidocaine, for instance, it's a

1068
00:57:05,520 --> 00:57:10,320
sodium channel receptor blocker.
It affects the sodium channel.

1069
00:57:10,320 --> 00:57:15,400
So genetics works in a similar
way, but obviously longer term

1070
00:57:15,400 --> 00:57:18,000
and slightly different.
Right, right.

1071
00:57:18,160 --> 00:57:19,880
Wow.
And I guess you don't have any

1072
00:57:19,880 --> 00:57:22,560
of the side effects or addictive
nature to that.

1073
00:57:22,960 --> 00:57:25,720
No, yeah, not have.
You been prescribing it?

1074
00:57:25,960 --> 00:57:28,160
No, because that's prescribed by
surgeons.

1075
00:57:28,480 --> 00:57:32,120
It's acute pain, so I don't deal
with acute pain.

1076
00:57:32,120 --> 00:57:34,400
For me, chronic pain is anything
over three months.

1077
00:57:35,360 --> 00:57:38,120
Oh, interesting.
Gotcha.

1078
00:57:38,800 --> 00:57:41,600
Gotcha.
But you OK, would you would you

1079
00:57:41,600 --> 00:57:44,400
use that as one of the holdover
acute pain like prescriptions

1080
00:57:44,400 --> 00:57:45,960
that you'd write instead of an
opioid?

1081
00:57:47,880 --> 00:57:49,200
Like for.
That 10 days or week or

1082
00:57:49,200 --> 00:57:52,120
whatever.
No, because it hasn't been FDA

1083
00:57:52,120 --> 00:57:55,640
approved for that.
It's approved for really

1084
00:57:55,640 --> 00:57:57,640
specifically right now for
surgical pain.

1085
00:57:58,240 --> 00:58:00,320
I see.
It doesn't mean it can be, but

1086
00:58:00,320 --> 00:58:08,160
it just doesn't have enough
studies to to kind of the way

1087
00:58:08,160 --> 00:58:10,680
I'm looking for is.
Confidence.

1088
00:58:10,680 --> 00:58:14,120
Warrant, warrant, warrant use in
chronic pain yet?

1089
00:58:14,120 --> 00:58:15,360
There's not.
I got you yet?

1090
00:58:16,200 --> 00:58:17,520
I got you, but you're excited
about it.

1091
00:58:17,520 --> 00:58:19,400
You think that'll be good?
Yeah.

1092
00:58:19,960 --> 00:58:24,400
That's awesome, that's awesome.
How do you keep up to date with

1093
00:58:24,720 --> 00:58:26,040
how much time do you spend
researching?

1094
00:58:28,360 --> 00:58:33,800
I actually tried to do recently.
I tried to do an hour a day of

1095
00:58:33,960 --> 00:58:37,880
either learning, whether it's
new ultrasound guided methods.

1096
00:58:39,120 --> 00:58:41,440
I ask chat DBT a lot just
because there's so much

1097
00:58:41,440 --> 00:58:44,400
information.
There's a chat DBT for science

1098
00:58:44,680 --> 00:58:47,040
where you can ask new
developments and to summarize

1099
00:58:47,040 --> 00:58:49,240
the new developments.
I do that a lot.

1100
00:58:49,520 --> 00:58:52,600
And depending on what it tells
me, I'll go read about it more.

1101
00:58:52,880 --> 00:58:56,200
There's a pain journal, there's
anesthesia journals, but I

1102
00:58:56,200 --> 00:58:58,960
really like the, the meta
analysis that provide this

1103
00:58:58,960 --> 00:59:02,400
provided by AI.
It's, it's succinct and you can

1104
00:59:02,400 --> 00:59:05,440
tell me the evidence based based
off all the studies out there.

1105
00:59:05,440 --> 00:59:07,400
So.
Right, right, right.

1106
00:59:07,400 --> 00:59:09,400
So you opened, you opened your
doors about six months ago.

1107
00:59:09,760 --> 00:59:13,240
Yeah, when so, So you had to, so
you had to get a lease, I

1108
00:59:13,240 --> 00:59:17,880
figure, right.
So the, the, the reason I chose

1109
00:59:17,880 --> 00:59:22,600
Vegas or Miami's because my, my
friend from Las Vegas who's an,

1110
00:59:22,760 --> 00:59:26,800
an internist has a clinic here
in Miami and he asked me to set

1111
00:59:26,800 --> 00:59:30,600
it up and I pay a sublease to
him.

1112
00:59:31,000 --> 00:59:32,720
So I don't want to pay a word
about the least.

1113
00:59:32,720 --> 00:59:36,440
It's much more economical and it
gives me just a way to get

1114
00:59:36,440 --> 00:59:40,280
started slowly.
And so I, I, I use some of his

1115
00:59:40,280 --> 00:59:44,080
staff.
I mean, I'm a separate entity,

1116
00:59:44,320 --> 00:59:47,920
but I can just, I'm Gables pain,
he's Gables medical.

1117
00:59:47,920 --> 00:59:49,640
So we just kind of piggyback of
each other.

1118
00:59:50,080 --> 00:59:52,000
Awesome, awesome, awesome.
I'm assuming you get a lot of

1119
00:59:52,000 --> 00:59:55,040
foot trafficking crossover
patients from one another,

1120
00:59:55,040 --> 00:59:57,000
right?
That's really, really cool.

1121
00:59:57,160 --> 01:00:01,080
Tell me about salsa dancing.
So I'm a very active person.

1122
01:00:01,080 --> 01:00:04,120
I just, I have a hard time
watching television and playing

1123
01:00:04,120 --> 01:00:06,680
video games.
So I picked up also dancing

1124
01:00:06,680 --> 01:00:09,920
maybe eight years ago.
I play soccer.

1125
01:00:09,920 --> 01:00:12,160
I do a lot of stuff just to stay
active.

1126
01:00:12,160 --> 01:00:13,800
Got you.
Just stay active.

1127
01:00:14,240 --> 01:00:17,640
And what about?
Yeah, but dancing in particular

1128
01:00:17,640 --> 01:00:19,880
is like a phenomenal workout,
right?

1129
01:00:20,800 --> 01:00:24,960
I think if you're much better at
it, yeah, I'm not at the level

1130
01:00:24,960 --> 01:00:27,120
worst.
It's exerting me physically, but

1131
01:00:27,120 --> 01:00:30,800
it's exerting me mentally to to
count steps and to figure out to

1132
01:00:31,320 --> 01:00:33,440
keep my arm.
So I can't say it's a good

1133
01:00:33,440 --> 01:00:35,360
workout yet.
No, not yet.

1134
01:00:35,400 --> 01:00:38,880
But it's more it's fun.
I I will be a little bit like

1135
01:00:38,880 --> 01:00:41,480
maybe a bit sweaty.
Not, not nothing like a workout

1136
01:00:41,480 --> 01:00:43,360
though.
Gotcha, gotcha, gotcha.

1137
01:00:43,440 --> 01:00:45,880
And what about diet?
What about what about what about

1138
01:00:45,920 --> 01:00:47,040
your, your diet?
How much?

1139
01:00:47,200 --> 01:00:50,880
How much did you pay to that?
Diet I try to eat a balanced

1140
01:00:50,880 --> 01:00:53,280
diet.
I do have I have fast

1141
01:00:53,280 --> 01:00:57,960
metabolism.
I don't have to worry about I I

1142
01:00:57,960 --> 01:01:03,280
still worry about eating right.
But in terms of diet I eat most

1143
01:01:03,280 --> 01:01:05,920
my meals.
My breakfast is usually yogurt

1144
01:01:05,920 --> 01:01:08,680
and granola with fruit and and
boiled eggs.

1145
01:01:09,120 --> 01:01:13,280
My lunch is my biggest meal of
the day and I stop eating after

1146
01:01:13,920 --> 01:01:17,520
5-5 or six doesn't sit well with
me.

1147
01:01:17,720 --> 01:01:26,240
I don't like waking up with this
feeling of just so I eat real 22

1148
01:01:26,240 --> 01:01:29,480
full meals a day and a small
dinner and yeah.

1149
01:01:30,200 --> 01:01:31,360
That's awesome.
That's awesome.

1150
01:01:31,360 --> 01:01:32,880
Have you ever looked in?
Have you ever, have you done

1151
01:01:32,880 --> 01:01:36,080
homework into the association
between the between diet and

1152
01:01:36,080 --> 01:01:38,720
inflammation and especially
chronic inflammation?

1153
01:01:38,800 --> 01:01:42,160
Yeah, and I believe it.
I think the more if we can just

1154
01:01:42,160 --> 01:01:45,200
eat a more organic diet with
less preservatives.

1155
01:01:45,200 --> 01:01:48,880
A lot of these preservatives
aren't good for our bodies.

1156
01:01:48,880 --> 01:01:51,080
And I think we've seen that
other countries have much

1157
01:01:51,080 --> 01:01:55,840
healthier diets.
My family's Italian and they

1158
01:01:55,840 --> 01:02:00,120
have a much cleaner diet, the
Mediterranean diet, very health.

1159
01:02:00,120 --> 01:02:03,720
My my grandmother is 100 years
old, living by herself.

1160
01:02:03,920 --> 01:02:08,040
No way I'm out here.
I'm going to go here next month

1161
01:02:08,040 --> 01:02:10,520
to celebrate her birthday, but
my point is, where does she

1162
01:02:10,520 --> 01:02:15,640
live?
In Genoa in Liguoria, northwest

1163
01:02:15,640 --> 01:02:18,960
Italy.
So my point the the diets that

1164
01:02:18,960 --> 01:02:23,160
are cleaner Okinawa in Japan,
they've shown that those diets

1165
01:02:23,160 --> 01:02:26,960
that are fish based, plant
based, they're less

1166
01:02:26,960 --> 01:02:30,400
inflammatory, we create less
reactive oxygen species.

1167
01:02:31,320 --> 01:02:34,480
So it's.
I've been noticing and I think

1168
01:02:34,480 --> 01:02:36,440
that's what part of what's been
exciting to me.

1169
01:02:38,480 --> 01:02:41,040
There's certain things I feel
like you can see and tell that

1170
01:02:41,040 --> 01:02:43,880
like culture and society is
changing despite what the news

1171
01:02:43,880 --> 01:02:47,000
or whatever tells you.
And I think that there's certain

1172
01:02:47,000 --> 01:02:49,960
like markers or indications.
So I've noticed recently that

1173
01:02:49,960 --> 01:02:54,320
when I go to Costco that a lot
of the snacks are being

1174
01:02:54,320 --> 01:02:59,040
advertised or actually being,
you know, healthier with five or

1175
01:02:59,040 --> 01:03:02,160
six ingredients, you know, they
opt out of using, you know, a

1176
01:03:02,160 --> 01:03:04,520
lot of times they'll opt out of
using seed oils or, or, or, or,

1177
01:03:04,520 --> 01:03:07,640
or, you know, emphasize that
they're using olive oil or, or,

1178
01:03:07,680 --> 01:03:09,320
you know, avocado or something
like that.

1179
01:03:10,080 --> 01:03:15,480
And what what makes me excited
about it that is that no one's

1180
01:03:15,720 --> 01:03:19,200
Costco is not, you know, in the
business of just doing what's

1181
01:03:19,200 --> 01:03:20,640
politically correct.
They're in the business of

1182
01:03:20,640 --> 01:03:23,280
making money and, you know,
giving people what they what

1183
01:03:23,280 --> 01:03:26,480
they want to buy, you know, and
like, if if that's what's moving

1184
01:03:26,480 --> 01:03:28,760
off the shelves and if the other
stuff is just kind of like, you

1185
01:03:28,760 --> 01:03:31,240
know, laying around and they're
incentivized to swap it over.

1186
01:03:32,880 --> 01:03:34,960
You see with everything, you see
it with cheese, you see it with

1187
01:03:34,960 --> 01:03:37,920
meat, you see it with snacks,
you see it with eggs, you see it

1188
01:03:37,920 --> 01:03:40,600
with milk.
Everyone just, it just feels

1189
01:03:40,600 --> 01:03:43,960
like there's just a mass
awareness that the food that

1190
01:03:43,960 --> 01:03:48,480
we're eating has been, it has to
be a little better and then.

1191
01:03:49,120 --> 01:03:52,160
It's trickling down not just to
the Whole Foods and not just to

1192
01:03:52,160 --> 01:03:54,600
the Trader Joe's that I guess
Trader Joe's is so expensive,

1193
01:03:54,600 --> 01:03:57,360
but you know, it's going to
places where everyone goes.

1194
01:03:57,360 --> 01:03:58,800
Costco is where you go with a
family.

1195
01:03:58,800 --> 01:04:00,680
That's where you go, you know,
to shop for 10 people.

1196
01:04:00,880 --> 01:04:05,400
So I think that it's a really
exciting time that that shows

1197
01:04:05,400 --> 01:04:09,280
that that we're we care about
what we're putting into our

1198
01:04:09,280 --> 01:04:11,080
bodies and that's, that's really
exciting.

1199
01:04:11,520 --> 01:04:13,240
Yeah, I know.
That's true.

1200
01:04:13,280 --> 01:04:16,520
That's true.
But I also think the flip side

1201
01:04:16,520 --> 01:04:20,000
is I think that a major issue in
our society right now is mental

1202
01:04:20,000 --> 01:04:23,200
health and physical health.
Obesity, obesity.

1203
01:04:23,440 --> 01:04:28,000
Oh yeah, 70% of our population
now is obese or overweight.

1204
01:04:28,360 --> 01:04:31,600
Yeah, I, yeah, I went to the, I
went to the doctor a year and a

1205
01:04:31,600 --> 01:04:34,520
half ago and they told I'm six,
I'm six.

1206
01:04:35,000 --> 01:04:41,080
I'm closer to 6-4 than six,
three and I was 220 4, right.

1207
01:04:41,560 --> 01:04:44,520
And actually like you're right
on the line of overweight.

1208
01:04:44,520 --> 01:04:49,240
I would is what they told me.
And like I went home and I was

1209
01:04:49,240 --> 01:04:51,400
like, I never thought I was
going to be that guy that was on

1210
01:04:51,400 --> 01:04:53,160
the line of overweight.
And I was like, I got to pull

1211
01:04:53,160 --> 01:04:58,040
my, I got, we got myself
together, you know, and I'm not

1212
01:04:58,040 --> 01:05:02,640
that anymore, thankfully.
But it started it just like, I

1213
01:05:02,640 --> 01:05:04,680
just need a little bit of a wake
up call where I just went to the

1214
01:05:04,680 --> 01:05:07,160
doctor and they're like, listen,
man, like that craft beer that

1215
01:05:07,160 --> 01:05:08,240
you have there is going to kill
you.

1216
01:05:08,520 --> 01:05:11,920
And I was like, yeah, I, I if
it's not going to get kill me,

1217
01:05:11,920 --> 01:05:14,880
it's going to give me diabetes.
Dude, there's a brewery I go to

1218
01:05:14,880 --> 01:05:17,640
that they, they, they used to
put, they changed it since, but

1219
01:05:17,640 --> 01:05:20,200
they used to put the amount of
calories in the pour that you're

1220
01:05:20,200 --> 01:05:26,280
going to get and a stout, you
know, you know, a dark beer

1221
01:05:26,280 --> 01:05:30,120
that's 1012%, I would have 4 or
500 calories in a four ounce

1222
01:05:30,120 --> 01:05:33,400
pour.
Yeah, it's just it's a lot and

1223
01:05:33,400 --> 01:05:35,440
it's great.
It's multiple beers, not just

1224
01:05:35,440 --> 01:05:37,160
one.
Oh, sure, yeah.

1225
01:05:37,160 --> 01:05:39,320
I mean, I can I tell you from my
own experience, you know,

1226
01:05:39,360 --> 01:05:42,360
definitely.
But yeah, I'm really excited.

1227
01:05:42,360 --> 01:05:45,320
So, so what's what's what's
what's what do you hope is next?

1228
01:05:45,320 --> 01:05:49,400
So you're, so you're, you're in
this place ideally in a year or

1229
01:05:49,400 --> 01:05:51,680
five or 10 from now, Where,
where do you think you'll be?

1230
01:05:53,200 --> 01:05:57,400
So I always tell people, I don't
know where the clinic is going,

1231
01:05:57,440 --> 01:05:59,600
clinic is going.
I can't tell.

1232
01:06:00,360 --> 01:06:03,720
I want to be, I want to do cool
things with cool people.

1233
01:06:03,720 --> 01:06:06,280
Meaning I want to be able to
offer these new therapies.

1234
01:06:07,000 --> 01:06:10,160
I want to offer the bread and
butter therapies safely and I

1235
01:06:10,160 --> 01:06:13,680
want to have a, a comfortable
and exceptional patient

1236
01:06:13,680 --> 01:06:16,160
experience which I can offer
now.

1237
01:06:16,360 --> 01:06:19,360
But I want to work more like I
mentioned with the, I'm working

1238
01:06:19,360 --> 01:06:21,720
with the University of Miami
middle school medicine.

1239
01:06:21,720 --> 01:06:24,440
I want to be able to have
clinical trials where we're

1240
01:06:24,440 --> 01:06:27,800
advancing this field of
regenerative medicine where we

1241
01:06:27,800 --> 01:06:31,720
can safely offer these therapies
that right now are promised in

1242
01:06:31,720 --> 01:06:35,480
the community at large falsely.
I want to be able to offer them

1243
01:06:35,480 --> 01:06:39,280
safely and with evidence.
And I want to say, I want to

1244
01:06:39,280 --> 01:06:44,360
guarantee and I can say with
confidence that they will or

1245
01:06:44,360 --> 01:06:47,720
generate this or they will help
your pain and we can offer that.

1246
01:06:47,720 --> 01:06:50,960
And I think that if I can do
that and be part of that, I'd

1247
01:06:50,960 --> 01:06:53,480
feel honored.
I'm really excited to see where

1248
01:06:53,480 --> 01:06:55,960
you're going to be in, you know,
like I'm really excited to see

1249
01:06:55,960 --> 01:06:58,360
where you're going to be in a
year or two or three.

1250
01:06:59,400 --> 01:07:01,680
Just following just like
sniffing around and following

1251
01:07:01,680 --> 01:07:04,560
what's interesting and you know,
kind of pursuing it because

1252
01:07:04,840 --> 01:07:06,600
that's where all the
groundbreaking and interesting

1253
01:07:06,600 --> 01:07:10,760
stuff is, you know, and I hope
that I hope that when that

1254
01:07:10,760 --> 01:07:13,120
happens, you either call me for
equipment or for another podcast

1255
01:07:13,120 --> 01:07:16,200
because we could talk about what
the what the updates going to

1256
01:07:16,200 --> 01:07:18,240
be.
But this sounds, this sounds

1257
01:07:18,240 --> 01:07:19,120
really, really cool.
Dude.

1258
01:07:19,120 --> 01:07:20,680
This has been so much fun and so
informative.

1259
01:07:20,680 --> 01:07:21,920
I really appreciate you taking
the time.

1260
01:07:22,320 --> 01:07:25,000
Yeah, 100%.
I definitely would appreciate

1261
01:07:25,000 --> 01:07:27,800
talking again and I appreciate
you inviting me on here.

1262
01:07:28,320 --> 01:07:32,120
Yeah, I don't do many podcasts.
I don't give many invites but

1263
01:07:32,120 --> 01:07:34,440
I've done a few and this has
been the best one.

1264
01:07:35,080 --> 01:07:37,640
Oh man, I, I, you know what?
We'll see when you do a couple

1265
01:07:37,640 --> 01:07:38,880
more whether you still say that
again.

1266
01:07:39,280 --> 01:07:42,320
Yeah.
Doctor, I really appreciate it.

1267
01:07:42,320 --> 01:07:44,400
Thanks so much.
And we'll be in touch.

1268
01:07:44,400 --> 01:07:46,320
I'll talk to you soon.
Have a good night.