Podcast Transcripts

Dr. Grant Garcia: is good.

It's a long, uh, but I got to see my roots. That was my first time in Brazil, so that was pretty fun. And the race was awesome. Uh, but I'm, now we're covered, so I'm back onto Seattle time zone, so that's the most important thing.

 Will Sanchez: All right. Well, we're glad to have you back. And before we bring on our guests, we will like to handle our business because you know, Mike b likes when we talk about him.

Let's give a little, uh, talk about Mike b in the recovery [00:01:00] shop there.

Dr. Grant Garcia: Yeah. So just again, a shout out to them. Thanks to our sponsors. Again, I just, you know, patient today, same experience. So post-surgical recovery, looking for, you know, solutions and what could they can do after surgery. So the ability to have these sort of aftermarket products all in one spot works really nicely, uh, for the patients as sort of a menu, Hey, do you want to enhance it with this, this, or this?

And they've been great. So contact Mike b, they're awesome. If you're a surgeon, you can use them, uh, to your benefit in this sort of recovery process. And the patient satisfaction level's been very high. So thanks guys.

 Will Sanchez: Yeah. Thank you Mike. B we, uh, we appreciate all the love. Let's get right to it because this man I believe is on the East coast.

We're keeping him up late. Let's, uh, bring in Dr. Greg Kovich. Dr. Kovich. Um, hey, first off, thank you for taking time to join us. We really appreciate you being here. Uh, how are you this evening?

Dr. Greg Kolovich: Good. Thanks for having me, guys. Yeah, I'm on East Coast time, but everybody's asleep, so it's a nice quiet evening for me.

[00:02:00] Oh, nice.

 Will Sanchez: That's great.

Dr. Grant Garcia: So again, to introduce, you know, again, you went to, looks like med school, Ohio State, uh, and then hand fellowship in a, a, a low level place called Harvard. Uh, you know, um, and then, you know, you did your residency training there in Ohio State. Um, and then now you work in, uh, Savannah, Georgia.

Is that correct?

Dr. Greg Kolovich: Yes, sir. Yep. I'm in private practice in Savannah, Georgia. We have a. 25 surgeon group and, um, we cover pretty much all southeast from Georgia and, and then, uh, up in the Hil head all the way down in the Florida, and then as east to Macon and the southern outskirts of Atlanta. So we cover a wide variety, but multi specialty orthopedics.

Dr. Grant Garcia: Awesome. And then, you know, you also, one of the reasons we're gonna talk about tonight is you co-founded, uh, micro C, which is now, I don't you say That's right. Yeah. I got the background. I got the background. Yeah, yeah, yeah. Uh, nonetheless. So we want to get into that, but I think before we start with that, um, will you [00:03:00] kind of talk about, you know, you're engineer by background.

 : Mm-hmm. So

Dr. Grant Garcia: how did this sort of engineering student to orthopedic surgeon cross over? And kind of what was your, what was your reasoning for that?

Dr. Greg Kolovich: Well, so engineering, uh, I was, I went to Georgia Tech and I was an electrical engineer and, um, now I'm an orthopedic surgeon like you. So you, you can attest to the fact that orthopedics is, is very much engineering and practice.

It's, it's not always algorithmic. You have to sort of, um, ad lib and use, um, creativity and engineering has always taught me how to think outside the box, how to use different techniques and tools to get the job done. 'cause it doesn't always go the way you draw it up. And, um, I think that really, uh, led me to a career in orthopedic surgery because it's, uh, you know, orthopedic surgery is, is really engineering and practice.

Um, but there was, there was that sentinel moment, um. Uh, I was actually, I, I was an engineer and I started dating a girl who was pre-med. Uh, it's always has to be about a girl. There it is, right there. [00:04:00] It's so, um, to get in her good graces, uh, she and I, I was always struggling to pay, you know, rent and dues and tuition, so.

We got this job doing Oregon procurement for a company called Lifelink. Um, I'm sure you guys have out on the west coast, but, uh, they do all the MTF tissue, uh, stuff that we Oh,

Dr. Grant Garcia: I know who it is. Yep.

Dr. Greg Kolovich: So you get called in the middle of the night and you'd have to go out and just harvest tissue and bone and.

It was kind of gruesome, but it paid a lot of bills. It paid well and um, it got me really interested in anatomy. So then I started taking, um, as part of my engineering, cre engineering, uh, credits. I also started taking organic and inorganic, and then I took my mcat. Um. But I was an engineer, so I scored really well on the, uh, the, the math and physics part of, of the memca, who was the biology part that I struggled with.

But, but yeah, it was always about a girl. And then, um, I really, uh, I was doing what's called co-op. And so you work a semester and then you go to, [00:05:00] uh, school and I was working for a company and, uh, we, we, we started this cool idea, um, and couldn't really patent it because we. We were just co-ops and, um, basically that, that idea went and sold for a bunch of money and we didn't get anything.

So at that point I was kinda like, I wanna work for myself, um, and not get screwed by sort of the big company. So I really wanted to do something that was, um, that I, I had more autonomy and, and I was already doing medicine, so, so those kind of converged and then I, I, I switched paths from engineering to medicine.

Dr. Grant Garcia: And then in your background, I know you do hand surgery, I mean microvascular. Tell us about your specialty that you do, what you specialize in, and kind of the stuff that you see on a day to basis.

Dr. Greg Kolovich: Sure. So, um, I, I do hand surgery, but I also do, um, you know, free tissue transfer and microsurgery. I do a lot of peripheral nerve.

Um, you know, I'm sure in your practice you find everybody does trigger fingers and carpal [00:06:00] tunnels. Cubital tunnels and, and, and those kind of things. Um, I really wanted to separate myself from, from everybody and do something that no one really wanted to do. Peripheral nerve is, is something that not a lot of people have interest in.

It's, it can be difficult. Um, I do a lot of nerve transfers, uh, nerve reconstructions, so I'll do anything from like a brachial plexus to Oberlin, transfer to elli, transfers in the hand. Basically anything that is like iatrogenically. A problem, um, axillary nerves that are injured during total shoulders. Um, I, I do nerve transfers and I'll do tendon transfers.

So I do a really, a lot of complex stuff. So I, I get a lot of second, third, fourth opinions, um, desperate, uh, cases, cases where, uh, a lot of people, uh, so there was really nothing left and I, I usually come up with a plan for it. So that's actually another part of using engineering. Um. You know, basically if someone comes in with a horrific injury, you gotta find out what they have and then sacrifice what they have to give them something that they need.

And really at that point, it's about adding [00:07:00] functionality to their life. Um, I'll give you an example. I did a, I did a reverse Pelli uh, transfer. Where you take, this is for an ulnar nerve palsy. Um, we try to add, pinch this, this is Elli two, where you take the deep branch of the opponents and transfer it to the deep branch of the ulnar nerve to give them more, um, first horse neurosis and um, adductor pinch.

And that can be a big game changer for someone who has, um, an ulnar nerve palsy or, you know, someone with, uh, who needs to get elbow flexion. You can do an Oberlin transfer, stuff like that. Axially nerve injuries are big. Um, there's all kind of transfers, uh, that you can do to sort of give them that forward elevation.

And then I've actually, my peripheral nerve, uh, interest has really gotten me into the leg. So I do a lot of common peral nerve stuff. Uh, satic nerve. Piriformis releases any, I, I can go anywhere and anywhere with, with nerve.

Dr. Grant Garcia: That's awesome. Well, I mean, those are big things. I mean, we, in orthopedics, I, you know, and I like the point you made.

It's interesting, right? 'cause you said you're private [00:08:00] practice, but you do complicated second, third, fourth opinions. Uh, so I, I like that because obviously in my practice I'm private as well. Uh, and do complicated stuff like the osteotomies and meniscus and cartilage transplants and things like that, that not as many of the people in the area want to do.

So the idea behind that's interesting. I mean, it probably took you a little while to build that practice, I would imagine, um, in that area. Or maybe, maybe it was easy 'cause no one wanted to do it. I don't know. Uh,

Dr. Greg Kolovich: nobody wanted to do it. So I mean, when you're, you gotta be affable available and able, right?

Able is probably the least important. Uh, just be available. Um, you know, private practice is a different animal. Uh, a lot of my friends and colleagues work in academics. Um, I feel in private practice, you, you really, um, it can be extremely rewarding, uh, but it can also be very challenging because you don't have a big, um, you don't have a big organization with deep pockets supporting you.

So, um,

 Will Sanchez: so going into that safety net, right? It, you know, with the private practice, you're missing that safety net from [00:09:00] maybe if you were in a private practice.

Dr. Greg Kolovich: Yeah, well, you can't really say no. I remember one of the first, uh, things I did was some, I got a call randomly on like a, a Saturday and it was an infected from another doc.

Um, but the primary care surgeon, the primary care doc actually called me and said, would you be willing to take over care? And I was like, maybe six weeks into my practice. So I just took it right. Complicated osteomyelitis of an elbow in a young person. Okay. I took it, uh, you know, went in, grafted it, put antibiotic beads in it, got it to heal.

That, that doc has sent me patients for 10 years, like, like nonstop. I mean, just so thankful. And then of course, taking self pay Medicaid, you know, you just, you don't put up barriers, so you just send it. No one, no one ever asks what insurance I take. I don't, I take all come, because in the end, like. You know, I always find it frustrating when my partners sit there and nitpick about what insurance the patient has, because in the end, you're gonna have some workers' comp that are gonna pay really well, and you're gonna have some people who are not gonna pay well.[00:10:00] 

In the end, it's all gonna, if you just keep the ball moving, it all works out in the end. And the, and the idea is, it is just too good patient care in the, in the end, the outcome really matters. So I, I stopped nitpicking about insurance or about this or that. Um, my phone, everybody has it. My cell, I give my cell phone all the time.

I'm happy to do second opinions. I know some of my partners don't see second opinions, and I, I, I, I find that you're, you're, you're never too advanced. You're never too comfortable to do second opinions. 'cause some of these patients really need help and sometimes they just need a second set of eyes to see whether they're falling down the, the right path or not.

And just, just, you know, give them 10 minutes of your time. It's not super difficult thing to do. You can always say no if they can't help. Can't help.

 : Yeah.

Dr. Greg Kolovich: So, yeah, just being available and, and, and, and, and, and being able to, uh, be a resource for people to go to. It has really helped me because I don't have a, a steady, you know, some of these hospital systems have hundreds of primary care doctors and ERs that are flooding their, their referral.

I, I don't have that. So I had to go out and give, you know, go door to door, knock on doors, you know, send Christmas [00:11:00] cards, um, do people favors, um. In the end, you get this point where you're established and it, and it just kind of flows steadily.

Dr. Grant Garcia: Do you wanna, um, will, can you pull up that slide? I wanna know more about this, 'cause that might have to do with sort of the giving back and stuff that you do.

Will you just talk about this a little bit more, this slide? Sure. So,

Dr. Greg Kolovich: uh, these are couple film, uh, pictures. Uh, some of, one of these is from a comp, uh, a couple missions that I did. Part of that is in a country called Sini, formerly Swaziland. Mm-hmm. Um, we've been to Kenya, we've been to, uh, Ethiopia, we've been to India.

One of my partners has an orphanage in Central India, in a place called Salem, which is in the middle of nowhere. So we used to go there. Um. We, we do a lot of mission work. I went to, um, Honduras every year in residency with a, a place, uh, a program called Podemos. So mission work has been really, really important, uh, for me and my family.

You can see that central picture right there is my, [00:12:00] my oldest son now, he, God, he was young back then. He's 13 now. He's a lot tall. He's actually taller than me. There's my wife. Uh, he comes too. Um, but on the left, that's us doing microsurgery. Uh, there was a machete injury. On the right. I believe we're doing, uh, something up in brachial plexus.

Looks like it's a, it's an upper arm. Looks complicated. There's, there's the clinics, right? You can see these patients come from far and wide. We would have five, 600 people just show up randomly. And, uh, you know, you work. It's exhausting. Anyone's done mission work. I hope you guys have, it's exhausting. You work 18, 19 hour days.

Sometimes you work by candlelight, literally. And, uh, it's probably the most rewarding thing you ever do. You, you realize that, um. You realize the, the incredible power that you have, uh, to help people. Um, oftentimes we, we don't see that in our day-to-day clinics. Um, people can become very entitled in our world.

But, but in, uh, in the dark part of Africa where they, some, some of these places don't even have electricity. Uh, you can see our [00:13:00] handheld battery powered x-ray right there. There's no electricity in that building. So we brought our x-rays. It was really helpful. Of course there's one in the locker room that, so that's a, that's our Oxo machine.

But

 Will Sanchez: Dr. Kovich, uh, you know, we talk about mentorship. Uh, a lot of times on this show, uh, usually there's been an inspiration and it could come from different areas, different people, um, with your, uh, diverse background and, and everything else that you're kind of doing with, um. Within your organization, what has been inspiring or who has inspired you to kind of take the baton and keep, uh, setting, setting the ground rules for the way you go about your business?

Dr. Greg Kolovich: Oh, uh, wow. Too many. Uh, I could name names. Um, Jesse Jupiter was, uh, was my, I mean, he's one of the most, yeah. Uh, published surgeons in not just orthopedics, probably in all medicine. Uh. He, he would just give me advice all the time, and he would let, he, [00:14:00] sometimes he never lets the fellows scrub in and he would let me do the case, which I was really happy about.

And, you know, he is not one to give easy compliments. And at the end of my fellowship he said, Kovich, you don't annoy me. And that's, that's the best compliment I ever got from him. But, um, you know, at, at that time it was a big deal because like, you know, he, he would never give easy compliments. And then later I was the president of Georgia Hand Society and he was one of my first speakers.

I still see him, uh, at, at meetings. A guy named Dr. Michael Ruff, uh, was the head of hand surgery at Ohio State, really took me under his wing back when I was, uh, I think I was probably a first or second year med student. I would basically, uh, come in on Sunday mornings. Just kind of like sneak in and scrub in and do these, he would do these like latissimous flaps and these, these complex things.

I mean, all the stuff that that would take nine, 10 hours, we'd be in there with like plastic surgery fellows and orthopedics, those big cases. And I remember him saying to me, he goes, I go you, these are orthopedics. And I asked him why we were doing these micro cases. He goes, you know, I mean this is just.[00:15:00] 

We, we, we were in the Midwest, so it was a farmer who got sort of a, a horrific injury. He was upper extremity and we were just covering him up and, and doing some tendon and, and free flaps. And, um, I felt like he was this X-Men, like he was just doing stuff that no one wanted to do. And he was kind of the doctor's doctor.

And he walked around with like such a sophistication and like, he wasn't like pompous or anything, he was just like the man. And I remember thinking like, this guy's coming out on a Sunday, not on call, just loving his job, loving his family. He was a, he was a big mentor to me. I mean, there's, there's so many.

Um, you know, God, I mean, I remember, um, I, I, I really appreciated people that, um, were good, but you didn't have to, they didn't have to sell it. You know what I mean? I, I'm sure you guys have come across people like that. Everybody knows who the best surgeon is in their group or in in town. And oftentimes it's really, it's really exciting when that person is not the one who's, um, you know.

Broadcasting it. You just, they just walk around with [00:16:00] confidence and, and, and they tend to be really good, not only in their practice, but also in their life. They love their family. They, they spend time in the community. They do other things. Those are the people that have always, and I can name about a hundred names of people I would've spoke.

Those are the two people that really sort of, uh, steered me in the hand surgery.

Dr. Grant Garcia: That's awesome. You will you tell us a little bit more about kind of your day-to-day practice, like your day in the life. I mean, you're doing these kind of crazier cases, you're taking on hard things. I mean, are you kind of.

Situated one office. Do you move around? Like how does it work for you in your practice? And we'll kind of get into your aspirations outside of medicine.

Dr. Greg Kolovich: Sure. Um, well I started like everybody taking level one trauma call. Um, there weren't a lot of hand surgeons who were doing replants. I started doing that and actually upset some of the people in my, my town for doing that because I just came from Mass General.

We were doing a replant every night. I mean, every night, um, every night you would do some sort of replant or reattachment or reask. We got so used to it when I went into private practice, I would just accept everything. And when I started doing that, [00:17:00] my town in Savannah was getting sort of known for accepting this thing because of me and some of my, uh, colleagues, not, not, not so much in my group, but other people were getting upset with me and I realized I was sort of upsetting the herd.

So I sort of backed off on that and kind of, um, did it sort of more word of mouth because I still wanted to do that stuff. But in private practice you have to go where the patients are. So our group is, is, is pretty big. We own two surgery centers and a hospital, and then we own about 17 satellites. So, um, I like to spend one day traveling 'cause I think it's.

It's nice, it's funny. So one, so like Toma on Wednesday, I go from Hilton Head. I have a clinic in Hilton Head, Bluffton area, which is a lot of retired golfers, lot of well to do people. And then I, I immediately go down to Statesboro, which is a, you know, a college town. And then I get into Reedsville, which is a, which is a really rural country town.

And you'll see these really like, you know, salt to the earth farmers. And then these really like, like super end, like Wall Street [00:18:00] vc, just on the same day, you know, and, and to see everyone in between. It's kind of, it, it's a spice of life. Variety is a spice of life. So see, seeing patients from all different backgrounds is sort of fun for me.

Um, I don't stay put in Savannah just because, uh, you know, patients are getting more sophisticated. They're, they're, they want access. They don't always wanna drive two, three hours. So I, I, I do meet them halfway in many cases. So, um, yeah, I, I, I stay in Savannah. Um, probably three outta five days. I travel on one day and then, uh, we go, we have a rural hospital in, in a place called Reedsville, which I do a lot of complex cases.

The, the big stay overnight, Braco Plexus, TMR cases, and, and then I do most of my cases as the outpatient in our ASCs.

Dr. Grant Garcia: Awesome. Can you, so obviously you, you know, you. Do a lot of really great hand surgery, microvascular, really complicated stuff. Um, but you also, that's engineering background. You've had, you talked about the company that you were initially with that just, obviously you [00:19:00] did a lot of work for them and didn't get the same recognition that you wanted to.

Um, and then you came up with some ideas, right? So you co-founded this company called Micro C, that's now Oxo w uh, will you, will you bring up that slide? Will you kind of go through that background of like how that started? What was your reasoning for that? I mean, there's some, we can make some aspirations of this, but I'd love to hear it from you.

Dr. Greg Kolovich: Well, um, there's actually two, two stories that come to mind. The first, I was in Honduras as probably a fourth or fifth year, and we're in the middle of the jungle and we're seeing, you know, four or 500 patients a day, and we never had x-ray. I know that one of our, we, we used to go down there with the dental students and it had this small dental thing that you could probably take a picture of, the tip of a finger, but that's about it.

It was built for taking a picture of a tooth and it was battery power. And I remember thinking then as a fourth year med or a fourth year resident, like how cool would it be if we could expand this to a larger field of view, uh, make it battery powered and portable? So that was really the first time I thought about it.

And then when I got in fellowship, um, in, in Boston, um, I was doing a hand [00:20:00] replant, literally like replanting a hand one night by myself with an intern. Um. The hand literally kept falling off the radius like I was trying to plate it and I had the intern who didn't wanna be there, and I'm trying to turn a screw First, first step.

Any replay is get bony stability, right? So I'm turning, I'm trying to hold this dorsal plate spanning plate. On the carpas and the metacarpal, and I'm like, hold it. And I'm putting the screw in and the thing just kept falling off and I'm trying to bring in this 800 pound x-ray. We had the big C-arm and I kept knocking the nurse over.

I mean, it was, it was three in the morning. I was tired. I was up all night. I was like, man, it would be really cool to have something. I could just literally like a camera, just shoot a picture and not have to bring this 800 pounds to the Armin and my light bulb went off. I'm a little bit engineered in A-D-H-D-I guess.

So then I finished the case and then immediately went to a lab and started thinking about how I can miniaturize a c-arm. And, um, then I, I took that 800 pound c-arm and built this, this is like an eight pound battery powered. [00:21:00] Now, this, this will do, uh, I mean this, this as a nine inch tech, this will do everything that Big C-Arm does.

It's, it, it is fantastic. So we were able to miniaturize that and we, we realized is that. You know, miniaturization is not all that. It's all that it seems. It, it is a, it is a giant and if you guys want to dork out with me and get the engineering of how we had to do that, I'm happy to do that, but, but it becomes a giant heat transfer problem because you can get bolt of lightning.

I mean, imagine 90,000 volts, that thing will go up to 88,000 volt. 90,000 volts of electricity are going through that thing. So it's a bolt of lightning.

Dr. Grant Garcia: So is that in, is that the same thing that happens in a large crm? It just doesn't take the same amount of heat. So like how is that different than, yeah.

Dr. Greg Kolovich: Uh, so, so that's a, okay, so this, I, I'm glad you've gone on that. I didn't want to be that guy that, that, that totally dorks on you. But, um, okay. So let me give you an example. Okay. So let's take, let's say you take a frying pan. It's with burning [00:22:00] oil. You could throw that into a bath of water and cool. That frying pan off pretty quickly.

Right? That's a good way to, to cool off a frying pan that's hot and it's gonna hurt somebody. So that's a cool way to dissipate heat quickly. You can't, that's kind of what a big C-arm does. They pot the, uh, x-ray tube in what's called dielectric oil. And dielectric oil is extremely heavy. So that's why those things are extremely heavy.

So they're essentially throwing a boiling, like a, a, a hot frying pan into a a, a pot of dielectric oil. Ours is a little bit more sophisticated. We had to be really creative 'cause we don't have, ours can't be really heavy, so we had to be, ours is eight pounds. So we had to use really sophisticated heat sink transfers and what's called phase change heat sink.

Which I, you know, I can really nerd out with that one. But, but essentially we had to come up with a really unique way to spit off heat quickly. Because when you shoot an x-ray, 99% of the energy is given off as heat. And when you've got 90,000 volts going through your hand, you've got to shield [00:23:00] that high voltage electricity from the low voltage, like the PCB board, your motherboard, all the stuff that runs your electronics is, is low voltage.

Right? And that's probably two, three centimeters away from a high voltage too. So when you shoot high voltage, all these ed currents are given off and they can really shock and like basically blow up your low voltage PCB board or your motherboard. So we had to do potting shielding, heat transfer, all these really like material science things to make it safe and then also to give off heat.

And then we had to do all the other things about like focusing the, the, so the FDA, there's. So the first step is you gotta make it safe. You can't kill anybody. You, you gotta basically harness a, a bolt of lightning in your hand and not fry everything that's low volt. That is a conversation for another day.

I'm happy to have that conversation, but it, that's a lot of material science that we had to figure out. But then second, you gotta focus the x-ray. So when you shoot an x-ray, you can't just shoot in the space. The FDA won't allow that. [00:24:00] You can't just shoot free, uh, photonic energy. It's unsafe. Yeah. The ener, the photons have to be focused on the detector.

So we have a collimator, which basically conforms like a lens. It focuses the beam. So think about it when you're far away and you can see my hands. Yeah, you're far away. The beam is real narrow. When you're close, the beam is flat when you're kind of off to the side, the beam kind of skews this way. So we have a collator that's contorting the shape of the photonic beam in 3D.

So the detector always has to know where the emitter is. So they talk through lidar.

Dr. Grant Garcia: Do you have a detector on that device or how does that work?

Dr. Greg Kolovich: Yeah, yeah. Oh, no. You, some of, some of the ones that you'll get from Japan or the ones, the cheaper ones, uh, they don't have a detector, so they sell you this emitter and then you gotta go buy a hundred thousand dollars detector.

And if they don't always, like, I mean, I don't know. I, we didn't wanna do that. We wanted to do a whole focus system, so the detector will talk to the emitter and they always talk [00:25:00] and, and. We to satisfy the, the rules and regulations of the FDA. We had to create all of this new technology that we've patented, similar to driving car, like when you drive a car, it, it's using lidar to, to tell you where you, where you are in space.

Our detector and our emitter always know where they are. So you're, you're not spilling radiation off the detector and they have a stop out. So if I take the detector and point it at your face, it'll lock me out. I can't shoot it at you. Got it. It knows, it knows it's not coordinated with the detector. So these two.

So you need that

Dr. Grant Garcia: detector to, you need a detector to show where it's going.

Dr. Greg Kolovich: Yeah. They always that the talk and if they're not focused on it, if it's in a position where it can't focus, it'll lock out. And that's how we were able to satisfy having it, um, move in space. And that was a really, that was a really, at the time we didn't have a lot of technology.

I mean, back in 20 16, 20 18, we started that. The technology had to sort of catch up to our innovation. So we were [00:26:00] able, I mean, I went, I had these brilliant Georgia Tech engineers, my, my, my friend Evan, who's our CEO now. He and I were really, really kind of going outside the box on this because the FDA put up such a high fence, like a high, I mean, they were like, okay, the only way you're gonna be able to get a handheld device is if they talk and move and it's locked out.

And then, you know, it's extremely safe where it doesn't blow up and hurt anybody. So they. They put, they made it extremely challenging for good, for good reason. I mean, it's, you want everything to be safe. So it was an extremely challenging feat of engineering to get this thing approved.

Dr. Grant Garcia: And how did you test it?

It's like you, are you, are you testing this like in a room? Like how do you test it for the radiation dosage, et cetera?

Dr. Greg Kolovich: Oh, well, we built a radiation room, uh, that we just, I mean, some of the tests, uh, so they do drop testing, you gotta drop it from a certain height. Uh, you gotta fatigue it. You gotta shoot millions of x-rays.

Just keep pop, pop, pop. So we have these lead line rooms where we just keep shooting x-rays and it's all, we have these, like, we have these, like, [00:27:00] you know, these meters that just literally, um, they, they add up all the dose, they add up all the fatigue, stress on everything. So like, so yeah, we beat the heck out of it, um, to satisfy the FDA.

And, uh, there's a place called, there's a company called Intertech, which helps us with the imaging, I'm sorry, with the, the testing. So hats off to the fda. A they make it challenging for, for a good reason. But yeah, it was really difficult to pass their test. So, I mean, the thing is extremely safe. Um, and this was, this was your, was not,

Dr. Grant Garcia: and this was your first version, right?

This was the initial one. You know, you got that new one coming out?

Dr. Greg Kolovich: No, we're at, we're at mc two. The first version was, uh, was actually our al our Alpha version, which, you know, one thing that we harp on in, in any company is customer discovery. Call that up. Well.

Dr. Grant Garcia: Yep.

Dr. Greg Kolovich: Yeah, that's our second version. So that's completely battery powered.

Um, it's got a, it is got a pretty long battery life. Uh, we use that thing on, in for pro sports teams. Uh, I [00:28:00] cover a hockey team. We use that, uh, in a hockey, uh, locker room. Um, we use it obviously in our rural clinics. We take, I'm take, I think one of 'em is gonna Bangladesh next week. Um, it goes all over the world.

We've taken it. I've taken the first version Africa twice. Um, but yeah, you can, it was funny 'cause my first version, I took it to, uh, Mombasa and I was going through TSA, I was going through security and the lady thought it was a bomb. So she actually, I mean, there, there was a language there, there was a, I'm serious.

They brought guys with like loaded rifles, like, and me and my wife were like, it's not, it's not a bomb, it's an x-ray. And there was a language barrier there. So I actually had to. Plug it in and show that I could take an X-ray to, to prove to them that it was safe. They didn't know what it was. So, um, it's really cool to be able to take a, um, you know, an x-ray unit, uh, abroad on a plane because you can take it on these mission trips, which was really, really helpful.

We couldn't have done any of the surgery that we did, uh, without that. So it was really helpful. But, [00:29:00] um, yeah, we use it in rural clinics. We use it. I use one in my office 'cause it just, it helps. We have an x-ray suite as well, but having it in the office allows me to do x-rays and, and streamline the things.

Yeah. And then I can do, uh, DR and fluoro and all that other stuff too, as well.

Dr. Grant Garcia: Yeah. So explain, uh, so explain how this, so explain the DR to the patients, the dynamic digital radiography, and versus explain that, how the differences and what you use it for.

Dr. Greg Kolovich: Yeah. Okay. So, um, you guys have all, you guys probably all have a 4K td.

It's really clear you're watching movies like never before. But, uh, some of us, uh, are old enough to remember the analog TVs, the ones where like, um, the big old heavy ones with the cathode on the back. The ones where like the quarterback would throw the football and there'd be a streak behind the ball.

You remember those old TVs? Um, so those were the analog TVs. Um, Floris fluoroscopy is kind of like analog. The X-ray is just on, so that's why when you move the shoulder or the wrist, you see this, uh, blurred. We call it motion artifact. So that's kinda like the old analog [00:30:00] tv. It's basically the x-ray tube is just on and whatever sort of vibratory or motion effect you get, you get kind of a blurry image.

You guys have all used a a a C-arm or fluoroscope to know that with, that's called motion effect. That really bothered me. Um, particularly in small joints when you're trying to look at like a skate fluid or where the. Where the screw is or where your K wires. So we, um, there's been this big push for DRDR is like a 4K tv.

So a 4K TV is basically a bunch of still images stitched together at a high frame rate. So the reason why a 4K TV is crystal clear is because in some cases it's taking 60 images or more per second, and it's stitching 'em together like a flip book. You guys have all, remember the flip book from grade school, the little stick figures that they move and you're flipping it through.

So DDR is basically pulsing shooting x-rays at a frame rate, and then it's stitching them together for a video. So you get a crystal clear image without any motion artifact. And the only, there's, there's two reasons why DDR R is is better than floral Number one, you [00:31:00] pulse the x-ray so you don't just leave it on so you're not just, is

Dr. Grant Garcia: that less radiation?

Dr. Greg Kolovich: Uh oh, a hundred percent. A hundred percent. So the dose is the area under the curve. So if you look at the dose, if you think of like if, and I'm using my hands here. Uh, if you, if you look at like the radiation dose from Time Zero, it's just on. So you're getting all this dose underneath the curve. Yep. DR you're pulsing it, pulsing it, pulsing it.

So they're, you're basically taking a bunch of line and sticking 'em together. So the area under your pulse, DDR, is far less than, than fluoro. So, um, DDR is, is, is sort of a way to get a clearer image with less radiation. And there's a lot, there's some companies, uh, I know Conica Minolta is big into DR you.

That's gonna be a big, you're gonna see a lot of companies coming out with DDR. It is. You, you, you get a far clearer image with safer radiation. Uh, plus you can stop it. What I like about that is you can actually, I mean, if you see our device, you can roll through the images and just stop that, whatever image.

I mean, you guys have, you guys have iPhone. Oh, I

Dr. Grant Garcia: see what you're saying. So you're like, you're not before you do live fluoroscopy. You can't stop at a [00:32:00] certain point. You're like, okay, stop right there. And then they stop. But it doesn't always stop in the spot. Yeah. You can go through your old, like pictures.

Yeah. It's like basically taking is like the iPhone where you like take like 20 photos and then you can skim through and stop at the one you want. Yep,

Dr. Greg Kolovich: a hundred percent. So if you took a video from your iPhone, you can just scroll and stop at that picture and then like splice that picture and print it.

You're taking a bunch of still pictures and stitching it together as a video. So Yeah, it is. Um, it is, it is, it is the difference between an old analog TV from the 1980s and a 4K tv. Yeah. So if you see it now, hopefully guys, uh, if you on a website, there's a bunch of like crystal clear video. It is literally like looking at a movie of a skeleton.

It is crystal clear imaging. And, and one thing that, I don't wanna oversell it, of course, because no one ever believes that, but you just have to see it to believe it. And I think one of the comments that we always get. Is I, I, I can't believe how crystal clear the DDR is, so I mean, I, I, I hope hopefully you guys will see it.

Dr. Grant Garcia: Do you, um, with this product, do you, uh, from a, from a [00:33:00] patient or from a standpoint of like, obviously clinic efficiency, right? Like if we got four providers in clinic and you have one x-ray machine, that's pretty slow, right? Yeah. And there's certain aspects. Is there different? Like when we looked at new machines in our office, there were certain specialties that it was more beneficial for, like hand Yeah.

Uh, the smaller machines we're better for, but like I do shoulders and knees. Mm-hmm. Is that, do you have, is that the capabilities of this device or is this mainly for the hand extremities?

Dr. Greg Kolovich: So we we're submitting a new, um, a new clearance for larger anatomy. Um, everything needs to be cleared by the FDA, so shoulder and, and, uh, hip and shoulder and knee are on that.

Interesting. Um, but you know, it, it has the same power to, to to do that. Now we have to convince the FDA of that of course. But, uh, um, that, that is, that is on horizon. So. So right

Dr. Grant Garcia: now in your clinic, foot and ankle, and can foot and ankle use it or is it mainly hand,

Dr. Greg Kolovich: foot and ankle and elbow down? Yep. And I, so, so what, what, what I like it for is the fact that, okay, so, you know, um, I want to get a quick, so let, let, let me give you an example.

[00:34:00] Um, instability is a big part of my practice. Anybody that does revision stuff or second opinion is gonna get an SL tear, right? Just like you're gonna get a label tear, right? Anterior lab, you want to, you wanna see dynamic stability, so you wanna stress the arm and see if it kind of comes out. And we, we

Dr. Grant Garcia: can't do that right now 'cause it's too much radiation for somebody.

Dr. Greg Kolovich: Yeah, so our, ours is, well, I mean, we have all kinds of, well, we

Dr. Grant Garcia: can't go in the office and do a fluoroscopy of somebody. It's just, it's just not like, versus being able to bring it into your office like that, you know what I mean?

Dr. Greg Kolovich: Sure, sure, sure. Um, well, so we, I mean, we, we have remote triggers, so there's a footpath, so you don't have to be right next to 'em.

Now, I, I, we can argue about, you know, the radiation exposure and everything, but like for me, getting like when someone feels a pop in their wrist and they're a young guy or young athlete, particularly like a hockey player or like, you know, football player. I worry about SL tear 'cause you don't catch that early.

Then you get, start getting DC and SL diastasis and then you miss the opportunity to fix it. And we, you, you probably remember from, from residencies that SL, chronic SL tear do terrible. Probably like a chronic, you [00:35:00] know, a bank heart that was missed probably will do terrible. You're gonna get glenoid wear and, and all kind of problems.

So, um, if I can catch an SL tear the week of and go fix it with like an internal brace or something, they're gonna do great. So the problem are you saying

Dr. Grant Garcia: Will's favorite word? Be careful.

Dr. Greg Kolovich: Oh, sorry. Internal brace. Oh, I love, oh, okay. I won't, I won't.

Dr. Grant Garcia: He loves that. He gets too excited. He starts. Oh,

Dr. Greg Kolovich: no. Well, I mean, I'm, I'm, I'm very fond of Arthrex, obviously, but, um, the, um, my, my point is, uh, if you catch it early, like it's a difference between salvage procedure like A PRC and having your risk back to normal within a couple months.

Right. I mean, it, it is really like, and the problem is they, they, the x-rays are normal. So you get a still image and it's normal. So you

Dr. Grant Garcia: need dynamic. You need, yeah. Yeah.

Dr. Greg Kolovich: So what I do is I go in there, so I don't even bother taking em over to, I mean, I don't even bother taking 'em over to my x-ray and get a still image because it's not gonna tell me anything.

I could do a clench fist view, but even that can be, so what I do is I just say, look, I want you to do this back and forth, [00:36:00] and then I'll just, I'll, I'll hit the pedal and they'll just go in like this. I'll be, you know. Across the room, and I'm staring at that big screen and I'm looking boom, that the, the skateboard is flexing and the, the lunate is extending and they got clear DC and you see the diastasis and the DDR R is so clear.

I can literally stop on that image and show what a diastasis. So that's a big, that's a big plus for me. And there's all kind of billing parts for that, right? For like DR versus static, but. My, my point is that's a big, and then you, you probably work, uh, with elbow. Um, I, I, I look for Tommy John, uh, ulnar later ligaments.

The other thing I like to look for is MCP and P, particularly MCP instability. That's one that's often missed. Or, um, fracture dislocations of the PIP joint to see where it's stable. You know, I mean, some of those are real stable. If you just, you know, do an extension block, uh, pin or even like a, a splint, you can get away without doing surgery.

But to know where they're unstable is really helpful when you're doing ddr R 'cause you could just [00:37:00] sort of take a freer or even your finger and just, just do that. And you'll see when they come out. And then elbow dislocations, that's another one. I put 'em flat on there after they come with an elbow dislocation.

If they're not super swollen enough for, for me to test them, I kind of look where they just come out and if they're coming out like 30 degrees, I'll put 'em a dynamic splint, say full flexion to like just at 30 or maybe a little bit before then. And then, so I can get 'em, get a DDR of their elbow and find out right where they're coming out and I can sort of brace 'em and, and, and, and I can, um, harbor conservative treatment.

By just watching 'em to see where they come out become unstable. So Ddr r has really changed my practice because it's giving me all kind of things to know where, where their actually dynamic instability is. I think shoulder is a, I don't do a lot of shoulder, but a shoulder would be extremely helpful for, particularly for, for laxity, posterior, anterior, um, I think it would be extremely ddr r DDRs would really help a, a shoulder surgeon.

Dr. Grant Garcia: Well, we don't have that. I mean, most of the time, I mean, I think I have a question for you. I mean, this is something that. I, [00:38:00] in fellowship, I did work. I went to HSS for, uh, residency. We had a lot of good hand surgeons who did some of the crazy surgeries you're talking about brachial plexus, et cetera. Um, but to dynamically see it in the office is very uncommon.

We just don't, we just didn't have that diagnostic tool set. So you're basically allowing, this is allowing you to do, diagnose, a whole nother set of things faster. Than you would've been able to do before that? I mean, 'cause before what were you doing? You weren't, you weren't checking that or were you even doing anything if you didn't have it?

Dr. Greg Kolovich: Well, so I, I don't know about MRIs are disappointing in many cases. I can't tell you how many times I've gone in, uh, and scope the wrist or an elbow thinking I'm gonna see X when I really see y I'm sure in shoulder you go to, you go to a scope of shoulder and the rotator cuff's completely fine and you think it's torn.

Um, that happens a lot. Um. For, for DDR, uh, particularly with fractures, I, I, I, you really kind of find the point of dislocation, which actually really helps me, um, with my pre-op plan. Um, and the, the one thing that [00:39:00] I've always, uh. So, so I, I get a lot of like high energy, uh, TFCC and DREJ dislocations, you know, you're gonna find out where to even splint them.

And the, I swear, I, I, I've done hand surgery for 10 years and sometimes I even get confused. I'm like, do I splint 'em in supination or pronation? You know, which ligament is torn and you kind of know the textbook stuff, but like, you just want to see it pop in and become stable. So what's really nice about this for A-D-R-E-J dislocation.

Or TFTC injury, I can actually find out where they become unstable. It gives me an idea of whether the vol or dorsal complex is, is torn, and I don't, can't tell you how many times I've gone in and, um, I had an MRI, which said that this was torn. And then the DR literally like, blew that outta water. Like the DR completely, uh, did not match.

The dynamic stability did not match up with the MRI. So if I would've treated the MR, I would've got the wrong outcome. So DDR is really, if you can do it and you can fit that in your practice, it will sometimes, [00:40:00] it will sometimes, um, contradict, uh, an MR MRI result. I think MRIs sometimes are, we over rely on 'em.

Dr. Grant Garcia: Yeah.

Dr. Greg Kolovich: Um, seeing a joint where it wants to be, particularly in a hand and wrist, um, it's so easy to do, especially if you've got this in your clinic. Uh, it's really, it's really made me not go down the wrong path in some cases.

Dr. Grant Garcia: Well, I think it's also like you keep saying it's better for the patients, better for the clinicians.

'cause I, I find that, and I think we'll, we'll attest to this, that if you can have a better preoperative expectation for your patients, that's a big deal. Right? Like, if you're like, I'm gonna go in and do this, and you, they wake up and they get that. Sure. That's usually the people that are very satisfied with their outcome.

Even in comparison to people. You know, these, I get second opinions, thirds like yours and they're, or they come back after surgery and they're like, A doc said, I was just gonna figure out what happened inside. Right. That doesn't usually, that outcome's not usually the same. Or it's not as frequently as good as if someone's like, my doc said I was gonna get this and I got this and I feel really good about the thing.

Right. You're basically [00:41:00] giving them more information ahead of time and they're feeling more confident diagnosis, not only from the patient interaction, but also now the interaction between the doctor and the patient.

Dr. Greg Kolovich: Well, I mean, think of it like, think about when, so we always say you could teach a monkey to operate.

You can't teach a monkey when not to operate. Right. And that's, that's really the, the hardest part of our job. Once you, once you learn all the surgeries and you're at that point in your career. Um, the hardest part is learning when not to operate. And I think, um, for me, like if I have someone like, like say MDI like a young girl with, with, you know, a high.

You know, high maintenance family, you don't wanna operate on someone with MDI, you just gotta kind of coach 'em through it, right? So if I can show them safely that you know, their elbow's popping or it's hyperextending and it's clicking, or their shoulder's sort of the sulcus sign, if I can show them that and they can actually see the glen, I mean, they can see the head popping back in and that it's not hurting her 'cause she's not wincing that that does a lot of good for the patient and her family.

You can say, look, they're popping out. [00:42:00] Like without me hurting her. And this is just who they are. And I think that's really, that's really help bailed me out of some typical situations where you've got a patient who's complaining to their mom that they hurt, they don't need surgery, but you gotta convince the family that they don't need surgery.

So DDR is really helpful in that case. And I think ultimately like for the, for the, I had a young patient with an elbow dislocation and um, the mom, the mom was really asking me why I don't do surgery. I was like, well, you not, the body can fix. I mean the ligament's torn, but it's, it's not, it's gonna heal.

The LU C's gonna heal. Let me show you. And I was literally showing this lady, I blocked her a little bit to make her comfortable and I could show how the elbow would sort of come out and pop back in. And I said, this is why we're gonna split you to here. And in two weeks we'll go a little bit further and we'll just, every time you come in, we're gonna go a little bit further.

That ligament heals. And this avoids surgery. It's, it's, it's not gonna create a scar tissue and you'll get to where you wanna be with extension. That really. Because the MR MRI looks, the MR MRI is always terrible, [00:43:00] right? The MR MRI says a million things are torn. They look, they come with you the report and like you need to fix this.

You, your L UCL L is torn. There's a non-displaced OID fracture and they, the MR MRI just shows all these things and you're like, none of that stuff needs surgery that will heal. And a young patient, um, lemme show you. So DDR can be a really nice tool to sort of walk them back. From insanity, right? Like, why are we operating on this poor kid that's gonna do well if we just treat it not, not

 Will Sanchez: you?

You mentioned, um, that you've worked with, uh, sports teams. How has DDR been, uh, helpful and impactful with teams and how can you see the future of DDR supporting teams, whether it's, whether it's professional or yeah, you know, college or local. Did, does it become like almost like a on the field triage type?

Can you explain a little bit about that?

Dr. Greg Kolovich: Uh, well, so, so hockey players are animals. Hopefully anybody, hopefully you get a chance to take care of a hockey team. Those guys are the toughest, [00:44:00] I take care of minor league hockey too. So these guys are so tough, they're super nice. They just wanna get back on the ice and hit somebody and, and in some cases you have to be like, I'm using DDR R to like pull these people back.

In some cases I'm like, look, you're unstable. We gotta stop 'cause these guys will literally go back. You know, if you give them any green light. So for me, um, you know, hockey, you'd be surprised how many hand and wrist injuries they get. Um, I see a lot of, uh, forearm fractures, finger dislocations. I don't know how they dislocate their finger.

They're wearing gloves, but they do. I see a lot of rib fractures. Um, I think as we get more advanced with DDR, like looking at like, uh, shoulder instability, uh, cervical spine, I think it could be extremely helpful. Um. Uh, in, in the cervical spine. Lumbar spine, uh, as we, as we get, uh, you know, more sophisticated DR techniques, would,

 Will Sanchez: would someone like you need to be a, as skilled as you would need to be that person that's operating this machine, or would it be something as far as like just the team doctor?

Like what's the level?

Dr. Greg Kolovich: Oh, no, no. [00:45:00] I, I, I don't shoot the, the at does it the athletic trainer? Yeah. Um, uh, I'm usually like. Uh, you know, sometimes I'll be i'll, sometimes there'll be, he'll be down there shooting it, and then they'll, we have this little walkie talkie. He'll be like, come in the room. We want, I want you to look at this.

Or sometimes we have a, we have a platform where we can see the x-rays live, or, you know, I mean, we, we have all, oh, that's pretty cool. We made it extremely easy. I mean, we can remotely see the x-ray. Um, so, and we can see the DDR R remotely. So even if I'm, you're not at the game, like those images can be shared securely, uh, to the team doctor.

So we, we really try to make it. Extremely easy for the team doctor because sometimes you're not, you're on the road, you're not on the road with the team and you need to know what's going on. So we, we, we definitely take, um, you know, remote, uh, access and portability to another level, of course. 'cause you can put it in a suitcase and take it with you, right?

Um, so, so that's pretty

Dr. Grant Garcia: cool. So you can be, they, the team can be getting on a way, on a game. They injure themselves. They call you and say, Hey Doc, I want you to take a look at this. And you can literally watch [00:46:00] them do the DDR R.

Dr. Greg Kolovich: Oh yeah, we have a secured access. Yeah, we can log in and look at it. That's pretty cool.

Yep. That's really cool. Um, middle night doesn't matter, especially if they're on the west coast. Yeah.

Dr. Grant Garcia: Uh, chu we want, in the sake of your time, I know it's getting late, we want to kind of know for you what's the roadmap for this technology in the next five, 10 years? Sure. What are you guys thinking?

Dr. Greg Kolovich: Um, well, um, our goal is to make it, uh, more powerful.

Um, we definitely, uh, we know there's a lot of need in, uh, larger anatomy, so, um, we need to get a more powerful x-ray. So we've had a lot of patents around the monoblock. We need, we need to make it more powerful. We need, we, we want to get a bigger detector to cover more anatomy. Those, those are the next goals.

We have a lot of, um, we have a lot of, uh, special vendors. Um. I, I can't really say who they are, but they, they have certain needs, uh, particularly for, um. Department of Defense, um, uh, you could imagine how important it's to be able to get, you know, uh, a, [00:47:00] a chest tube or a central line in the right spot. Um,

Dr. Grant Garcia: yeah.

Dr. Greg Kolovich: You know, I mean, beginning, oh, you

Dr. Grant Garcia: can't do that. You have to have, you can't have a c-arm dragging in there with power.

Dr. Greg Kolovich: Well, I'm talking about putting one on a flight on a helicopter or like a Well, my point is that you couldn't do that

Dr. Grant Garcia: with

Dr. Greg Kolovich: any of the current devices. So, so we have a lot of aspirations for home care.

We, we hope one day that, um, we can, um. I dunno if you guys have children, but I have four. And if you've ever been to the ER on a Sunday, uh, with a kid with a presumed broken wrist, it's a miserable experience. Yeah. It's also very costly. So, uh, we hope to, because it's so portable and safe, we hope to be able to, to dial up an x-ray where you can have a, one of our technicians or one of our, one of our, um, associate, uh, portable companies come and, and shoot the x-ray and then not only get you diagnosis.

Like at the point of care, like in your home or on the sideline, but then also triage you with someone, uh, like you, uh, Dr. Garcia, and then some or someone like me who can, who can then get you an appointment that day. Right? So, um, you might be [00:48:00] sitting, you know, at home on Sunday, you might get a text and say, Hey, there's a patient in your area that, that would like to see you for, you know, a proximal humerus fracture.

And, you know, you can just. Use our, our user interface to go and say, make that person appointment. So, you know, using technology will be able to help you as a surgeon work smarter, not harder, where you don't necessarily have to take these calls and, you know, put yourself out there and cover all these ERs where you can just use a technology that's out there doing it for you.

And just being an early adopter, you can, you can increase your referral basis, uh, and you can start triaging people because it's gonna be cheaper and safer. Right. I mean, I had a $4,000 bill, uh, from a both Bone parum fracture. And one of my children, it was also four, six hours, four to six hours of waiting.

Not a great experience on a Sunday. Ruined my weekend actually. But I mean, it is what it is, uh, especially when your kid is in pain and you trying to helpless. I mean, really, like for me, like she wasn't even that much pain. So like, I just need to get her in a splint and I need to get an x-ray, you know, so I know like, what's going on, so, and I need to get an [00:49:00] appointment.

I mean, you know, so I want to get one of my partners, but um, I was out of town, right? So you needed, you had to do what you had to do. But, um, so we, we hope to, to sort of streamline the process by making it safer and faster, but basically bringing access, portable X-ray to the point of care.

Dr. Grant Garcia: Yes. Yeah. And do you, and right now you bring up, you're bringing up kids and I wanna want to take a time, wrap it up for you and then make sure you can go home and, I mean, go, go to sleep and relax.

Uh, but the, uh, is this, is this approved? Can you use it in children right now or you, is that next step for you with FDA?

Dr. Greg Kolovich: Um, I believe that is on the, uh, this application.

Dr. Grant Garcia: Cool.

 Will Sanchez: Great. Uh, as we wrap it up, first off, you know, once again, thank you for your time. I wanna know where your allegiance lies on Saturday.

Are you, uh, you know, John, the farmer? Are you, are you pilgrim? Are your yellow jacket are your buck? It's very confusing. Well, we need to know where, where, where's your allegiance?

Dr. Greg Kolovich: Well, my Georgia Tech yellow jackets are 9 0 1. We [00:50:00] barely beat Boston College. Our defense has got some work to do. I, I, but everyone, I live on an island off the coast of Savannah.

Everybody's a Georgia fan. So, um, but I also grew up in Ohio, so I, I, I'm a big Ohio State fan, and, and Ohio State's a big, uh, they're actually a big proponent of our technology, so they've been great to us. Oh, yeah. Yeah. I, I, I would probably, Ohio State is, has always been, uh, you know, I've always bled scarlet and gray, but, um, is nice to see Georgia Tech, which is not traditionally a great football powerhouse, although we have a great history to be nine one.

I just hope we can hang in there with Georgia. We beat Georgia. That will be my national championship. Are you gonna be okay with your, with your friends there? If, uh, no. I'll wave my flag. I'll wave my wine and go. I, my, my white and gold flag will be out there all year if we beat Georgia.

 Will Sanchez: That's great. Uh, Dr.

Kovich, uh, thank you so much for your time. We really appreciate it. It's really informative. It's exciting to hear where the technology is going and it seems like, um, there's a lot of possibilities. [00:51:00] Someone that has done work in Dominican Republic, my wife is in Nigeria right now. Uh, just hearing that you're traveling and helping out these communities, I, I know how difficult it is.

You usually work in conjunction, not only with the locals, but also their, their politicians. And sometimes you don't even have, uh, you know, you're not even able to go into certain. Places without telling someone where it can get pretty hectic and scary if you don't abide by their rules. So just hearing the work that you're doing out there, it's uh, it's, it's heartwarming.

So I, I personally wanna say I, I appreciate hearing that from you.

Dr. Greg Kolovich: Thank you. I really appreciate that. And I, I, you know that in the end, I, I create an x-ray for the purpose of, of, of helping people really, it's really what it's about. And, and we stick to that mission every time and we, we really do enjoy doing mission work.

Is, is, is the icing on the cake for us? Awesome. That's great. Thank you,

 Will Sanchez: Dr. Garcia. Uh, it was great having Dr. Kovich. Um, I mean the, the possibilities are [00:52:00] endless, right? I, I was even thinking about the, uh, wilderness first responders, right? They're coming in their helicopters.

Dr. Grant Garcia: There is so many options for this.

Yeah. You

 Will Sanchez: have people training. They could, maybe, could do some of these, uh, these, these imaging beforehand. So then by the time they get to the hospital, they already kind of know what's going on. They identify, especially when you have an injury out there in the woods. That can be, you know, extremely dangerous.

Every second counts, especially if you have a tour or anything. Right. So just hearing about stuff like that, that was one of the things I started thinking about, uh, along those lines. Um, uh, I, let's do it. Hey, for. Check us out, sports talk, catch every episode, transcripts. We'll have a transcript of this show.

Um, you wanna be our next guest? Reach out to us. We're, we're extremely thankful for all of our viewers on YouTube, for everyone listening on different platforms, whether it's Apple and Spotify and iHeart and everything else. Uh, we just want to thank everyone, uh, for joining. We hope that [00:53:00] you're learning something That's really the reason that we kind of got into all this.

Uh, besides us talking about the giants and what kind of miserable fans we are, but be, besides that, we're really happy to, uh, provide great information, great guests, uh, last words, Dr. Garcia.

Dr. Grant Garcia: Well, I know great guests, really cool technology. Really gonna be next level for us. Just showing doctors we still have a void in.

Diagnostics, right? MRIs are great. Cts are great. This is a new pattern of things we haven't really got into and easier to use than something that's like ultrasound machines, easier access faster. So all these things are gonna improve for patients. But really the key here is as you keep hearing it's patient first.

Yeah, fix the problem, find a problem, find a solution. So anyhow, thank you. Thank you so much, uh, Dr. Povich for coming on, and um, thanks viewers. Appreciate it. All right.

Audio Transcript

We won't talk about the Johns. We'll just move on. How are you? Let's talk about that.

Dr. Grant Garcia: I was hoping you weren't gonna say anything. It's always one of us that brings it up. But you know what we're, I'm good outside of that. Life's good. We got some great guests coming on. Super excited about this, so this will be really good.

Will Sanchez: Yeah, we have two incredible guests, but as we always do, we wanna make sure that we take care of the folks that take care of [00:01:00] us, that take care of our patients, or more importantly, your patients, the recovery shop, and just talk about Mike B at the Recovery Shop and how good they are.

Dr. Grant Garcia: I think that's our new slogan, takes care of us.

That takes care of them. That takes care of the patients. I like that. I'm gonna tell those guys. Uh, so yeah, so big shout out to them, Mike b uh, for sponsoring us. Uh, they're great. They're really, it's really nice for the surgeons to have these sort of aftermarket options for patients. It's, it's literally today I had.

Probably five people ask about it. So, uh, it's really nice and concise. The patients really like it. We love the nice machine. We're really loving some of the other products. This nutrition is huge. We're gonna talk about some other things today that are really important for the postoperative and preoperative portion of surgery.

So they do a good job. But without further delay, we wanna, we wanna announce our really nice, great guests.

Will Sanchez: You know, today we're talking about something that, you know, every parent coach athlete thinks about, you know, what are we doing, what's right for our kids? Uh, also, you know, how can we keep playing as we get older [00:02:00] without breaking down?

We've had this discussion many a times because I am an older weekend warrior that have broken down, and we're always trying to make sure that we could get things legit. Let's bring on some folks that know what they're talking about and can help us in these areas, like to welcome Dr. Starman and Dr.

Winter. Uh, thank you so much for being here. I'm very excited that we have four people. We have this Hollywood Squares thing kind of going on. We had a center, uh, square. We'll be good to go. But welcome to the show. Thank you for being here.

Dr. James Starman: Uh, great to be with you guys tonight. Yeah, thanks for having me.

Dr. Grant Garcia: Yeah, so you guys both come from Ortho Carolinas and for the, the listeners, it's a really, really prominent orthopedic institute, orthopedic, uh, you know, conglomerate down over there in uh, Carolina. And so it's really great to have you guys on. And I know you guys have a strong emphasis on a bunch of different things, but I think kind of to start, and we'll kinda jump around just to make sure that everybody gets the chat.

Um, but, uh, [00:03:00] Jim, why don't you tell us a little bit about, I know you said you, you know, you emphasize in a bunch of different things, right? The shoulder, knee, and some cartilage. Um, but kind of talk about your background and what brought you over to Ortho Carolinas. I know you trained with Freddie Fu rest in peace, uh, but very prominent orthopedic surgeon.

Um, maybe talk about how that influenced you and et cetera.

Dr. James Starman: Sure. Yeah. So I'm originally from Pittsburgh, which, uh, as fate would have it led me to Dr. Fu. And so he was a big influence in my early career and, and honestly in my, uh, choice to pursue sports medicine. Um, so I, um, I had a chance as a medical student at the University of Pittsburgh to work with him, uh, take actually a whole year off of my, um, medical training to work with him.

So I got a chance to sort of see how he treats athletes from all over the world. Which really influenced me, uh, significantly in, in choosing orthopedics and choosing sports medicine specifically. Uh, so feel really blessed to have known him and obviously it's a great loss that he's no longer with us, but, [00:04:00] um, his legacy certainly has lived on in a lot of other people, so we're really fortunate for that.

Dr. Grant Garcia: Awesome. And what do you do current? Will you talk a little bit more about your practice at, uh, ortho Carolinas for the listeners, especially some of the focuses.

Dr. James Starman: Sure. So I focus on, um, a lot of sports injuries, of course, and also, uh, the weekend warrior population makes up a big part of the people I take care of.

So it's really kind of cradle to grave as far as the knee is concerned. Uh, so I do anything from cartilage restoration, micro fracture, oats procedures, uh, all the way up through knee replacement, and, um, uh, similar kind of profile for the shoulders, uh, from cradle to grave for the shoulders.

Dr. Grant Garcia: Awesome.

Mm-hmm. And, uh, Dr. Winter, can you give us a, can you give us kind of your background too? I know you're kind of in your same, are you guys in the same, I know that Ortho Carolinas is actually quite large. Are you guys in the same sort of subgroup or you guys work on different areas, different offices, and then we'll give us sort of your background too.

I know you did a little more of a shoulder focus.

Dr. Bradley Winter: Yeah. [00:05:00] Dr. Shaman and I are both work in the Winston-Salem office. Uh mm-hmm. Or in like the triad area, which is Winston-Salem, Greensboro, Kernersville. So we worked together fairly, fairly regularly. Um, in my, my journey to sports medicine came from playing soccer.

I grew up playing competitive soccer and then played in college at Vanderbilt and got a chance to hang out with, uh, with the sports medicine guys there at Vanderbilt during my time. Just really enjoyed the. The time learning from them and getting to see what taking care of athletes looks like. Not only from folks they took care of high, local, high schools around Nashville, but taking care of us, um, as athletes at Vanderbilt and just kind of spurred my interest to, to keep pursuing that and moving on.

I. Um, to med school and, and then fortunately, um, had the opportunity to train at Steadman Hawkins with Dr. Hawkins. And, um, really learned a lot about the shoulder from him and, and really spurned my interest in, in shoulder surgery and, and, uh, move forward to where we are today. [00:06:00]

Dr. Grant Garcia: And for shoulder, do you have a, a specific thing you, you know, you like to focus on or you do more, uh, arthroscopy, combination of that replacements or kind of a, are you more sports shoulder focused?

How does it work for you?

Dr. Bradley Winter: A little of both. Um, I, I, I do some traditional sports medicine, knee, knee and shoulder, um, arthroscopy and then open shoulder as well with shoulder arthroplasty and fractures.

Dr. Grant Garcia: And, uh, I think you guys probably can each answer this separately, but kind of what drew you to Ortho Carolinas, obviously big name.

I looked at that for a number of different things from fellowship to residency, et cetera. What, what drew you guys, and we could start off, you know, from right to left, but, but you know what drew you guys to Ortho Carolinas?

Dr. James Starman: Uh, so from my perspective, I, uh, actually did my residency in Charlotte, Carolina and Atrium Health, uh, this partnership with them.

Uh, so I actually got to know a lot of the partners in this group as a resident and they kind of brought me along and, and helped train me and. I did my [00:07:00] fellowship at University of Virginia and then I went into private practice initially in Florida. Uh, but after a few years, we decided that we wanted to come back to the Carolinas.

And so, uh, thankfully I had some contacts up here and was able to, uh, you know, come at the time when there was a, an opening in, in the Winston-Salem market. So that's where we ended up. But um, we've been real fortunate to come back.

Dr. Grant Garcia: Awesome.

Will Sanchez: Yeah. Um, Dr. Witter, uh, what kind of drew you to the specialization?

You, you mentioned that you had a soccer background, but for you to fi, uh, focus on shoulder and elbow, what drew you in that field? Because I don't equate soccer with the shoulder and the upper body with the arms. So what was the correlation there?

Dr. Bradley Winter: I really didn't grow out of, out of my interest in soccer.

Soccer, kind of pushed me into sports medicine in general. And then the exposure to it during training. Just the, the variety of, of things that you see in the shoulder, the complexity of it, um, and some of the challenge, um, that I, that I've just found [00:08:00] very interesting as it relates to taking care of, of the, you know, even.

Young kids with throwing injuries to, to older folks with rotator cuff injuries, to, to, uh, you know, shoulder replacements. Just really get to see the gamut of population. And, um, I just, I found it very interesting and fascinating that the different types of surgeries and, and rehab that you could to do within the shoulder.

Will Sanchez: Uh, did, go ahead. Go ahead, doctor. Keep going. Well, no, what I was gonna say was, did you have an experience, you know, with seeing the shoulder injuries? I, you know, when I think about sports, uh, injuries, uh, especially for youth, it's either football or baseball when it comes to shoulder injuries. So it was this, there was an uptick or there's something there that kind of drew you.

Um, where you wanted to help, because I know Ortho Carol Carolina has an emphasis on serving the community and being a part of it. How does that all kind of intertwine with [00:09:00] what you do with youth sports and, uh, ortho Carolina commitment to, uh, youth sports?

Dr. Bradley Winter: I think probably the biggest thing we see for, for youth sports with throwers is, is throwing shoulder and throwing elbow pain.

There's a, there's a huge number of kids who are, are playing baseball and throwing on a regular basis that, especially during the middle school years, when you start to play middle school ball and travel ball and little league and a lot of those overlap, you, you end up throwing a lot of pitches or, or throwing a lot of bullpens and warm up and, and cool down and, uh, and your pitch counts start to rise.

And so you see a, a big uptick in, in kids that have either throwing shoulder pain or throwing elbow pain. Just being able to, to kind of walk those families through the process of this. Yeah, this isn't the end of your career. This isn't, you know, this isn't something you need to retire from, from, uh, from baseball at 13 or 14.

Now we can, we can get you through this. We can rehab you and we can get you [00:10:00] back thrown again safely and effectively, um, without, you know, really being high risk for long-term injuries. Um.

Dr. Grant Garcia: I, I think it's a, I want to, I want to follow up on that. I like this. This is good. So we're gonna, this is not always going the right direction, the directions we're thinking, which is good.

So can you fill in the listeners, this is a big thing. We have a lot of people actually listen to the podcasts and their families that come in. Not just in salary, but you know, they'll come in, maybe your office and they'll have heard this, but they're really concerned about their kids' throwing ability.

It's less football, much more baseball. I'm assuming that's the same way in your situation where you've got like two parents, a coach and a trainer, and they're all in the same room, and you come in to talk to the player. Right. And they've got a high interest in this. Like how do you, how does that conversation start with you?

Right. Maybe you're lucky and you've had the MRI, you know, it's something that they need surgery or maybe they don't have anything, or maybe you have information, you know, it's not that bad. Like how do you kind of start that conversation with the players and let's say mostly baseball, right? The parents think they're pro, [00:11:00] they're probably not pro, but you gotta figure out a way to navigate that.

How would you, how do you deal with that situation? It's just probably interesting for the, for the parents to hear this as well.

Dr. Bradley Winter: I like to just hear where they're at right now. I like to hear what they've been doing, you know, where they're playing, what teams they're playing on, what coaches they're working with, and just try and get a sense of the overall amount of work that they're doing, the amount of throwing they're doing, and, and try and weave into that, who's really keeping track of the pitch counts.

Um, because oftentimes you can see. Nobody's really taking care of the pitch counts. You know, coaches may be watching them for their particular game with the travel team, and then high school or middle school may be watching that team, but nobody's really counting up all of the pitch counts. So trying to assimilate that and get them to see what we're seeing, which is that this tends to be overuse and not a specific event that their thrower [00:12:00] had, uh, and, and kind of walking them through.

Seeing how much they're throwing and how much they're working outside of practices and how much they're not really keeping track of their pitch counts, tends to lead to these overuse types of injuries. And then let them, you know, let them kind of sort through. How do we move forward from that without overwhelming the, you know, the, the risk of, uh, you know, everybody wants to get to Tommy John immediately, right.

Um, yes, not overwhelming that discussion and, and just, you know, trying to walk them through that if, if we're not convinced that there's something bigger. Obviously if there's something bigger than we go to imaging and, and have those discussions.

Dr. Grant Garcia: Awesome. I

Dr. James Starman: think, I think that's a great point that Brad makes.

And I would, um, add to that as well, that I think it's really important that you understand kind of the goals of the athlete and not necessarily just the goals of the parents or the coaches for that athlete, because that can also inform a lot. Of kind of how we counsel, um, these [00:13:00] types of conversations and, um, trying to allow them to continue to enjoy the sport that they're participating in and not just doing it for the wrong reasons or with this pursuit of perfection that they may never achieve.

Um, and just trying to help, um, you know, guide those conversations and, and maintain the focus on letting these athletes enjoy their sport and, and enjoy their, their participation.

Dr. Grant Garcia: I think that's a really good point. Will, we've talked about this is the focus is on. Player first, then everything else around them.

Right. And what do they, what do they think? And sometimes, like we were making the kind of, I don't wanna say a joke, but when they come in and they, you know, one person thinks they're pro and the other one's just like, I like

playing baseball 'cause it's fun. I put my friends, the conversation changes a little bit different.

Yeah. And also how, what their caliber is, right? I mean, there's, you have to kind of modify your conversation, your thoughts. Right.

Will Sanchez: Yeah, a quick follow up there, um, for, have you seen uptick, right? You're in, you're in [00:14:00] the south warm weather, right? You, you know, if you're the Pacific Northwest, east Coast, northeast coast, you have the changes, but you're not playing baseball all year long or you're not.

Playing football all year long compared to, uh, a warmer climate states. Do you see any differences when you treat a patient that's maybe coming from warmer states where they can play the same sport all year long compared to, uh, colder states where sometimes they have no choice but to play multiple sports?

Any, any data on that?

Dr. James Starman: Um, I, I don't have any specific studies to cite to you on that topic, but I would tell you that I think that, um, most of us would probably agree that there's been a, a general trend nationally and, and elsewhere, um, towards year-round participation at a younger age for most of our athletes.

And that goes across multiple sports, not just. Baseball, we're throwing sports. Mm-hmm.

Dr. Grant Garcia: So I

Dr. James Starman: think that, I think that that's a problem. I, I understand the reasons for it are multifactorial and there's a lot of people [00:15:00] chasing college scholarships and, and dreams of participating at the next level. And it actually creates, I think, sort of a.

Perverse motive that kind of forces everybody to follow suit as you continue to see this decline in sort of truly recreational youth sports. And it becomes this hyper specialized, uh, thing where if you're not playing baseball year round, you really just can't compete against the other kids who are, and so it then becomes less enjoyable for kids to participate in sports unless they're doing it year round.

So I think that that's a problem. That we have not solved. And if anything, I think that's probably getting worse and probably driving some of the, the trends in overuse injuries in this, in this population.

Dr. Grant Garcia: And that's kind of this slide you guys had up here, right? The kind of the risk of, I think this is really interesting because like you said, ev I mean, I'm my kids, I'm not a baseball family.

We're a swim family, right? My kids yesterday, were having a conversation. They're eight and 10, and my wife's telling me [00:16:00] how the other kids are doing like 500 lessons a day. They're gonna hurt themselves, but that's the way it is. Everybody, everybody's trying to one up each other in these scenarios. And it's the same way with baseball, football, you name it.

So obviously there's, it's a balanced conversation. So how do you guys, how does you or Arthur Carolinas, et cetera, like how do you, how do you get involved in this type of conversation? Right, because it's hard. It's almost like preventative, which is more challenging. As a surgeons, that's not really our. We don't really do as good a job in that, at least maybe it's just me, but, uh, the, the preventative stuff is important, but we don't talk about it a lot.

Dr. James Starman: Yeah, I would, I would agree with you. I think that we were more, I

Dr. Bradley Winter: seems to have lost the audio from Jim, but I'll, I'll chime in here. Um, I think getting, getting involved with, with some of the local sports organizations where, you know, your, either your kids are involved or you have patients involved and just like you said, trying to get on the early side of this.

Um, and, and. Even the, the soccer club that my [00:17:00] kids grew up playing for, I got in with the coaches early on and, and talked to them about overuse injuries and, you know, what does it look like to have time off throughout the year for, for some of the kids. Just to see if you can build that into the program, like you said, on the preventative side.

'cause it's much harder to, to work backwards after the kids are injured or they have these obese injuries. 'cause then they're sitting time out and families are unhappy. They want to be playing. Get back as soon as you can. So, yeah, I think it's very much a, a preventative thing, which like you said, is not easy.

'cause that's not our forte. Our forte is taking care of people after they're injured and figuring out how to get them back to sport rather than, than keeping them healthy.

Dr. Grant Garcia: And Jim, I think your audio is working on our side. Do you wanna try it again?

Dr. James Starman: Uh, yeah, as long as you can hear me okay, we, yeah, you're good.

Yep. Yeah, I just can't hear him for some reason. I'm

Dr. Grant Garcia: not sure. He's doing a good job of talking. I can tell you he's doing a great job. Perfect. Yeah. Jim, why don't you continue with your conversation. On. The idea of the sports specialization, like how, how would you intervene? I mean, you're, you're [00:18:00] doing a lot of ACL tears and you're dealing with this.

I mean, we can go to that in a second. Um, but like, what do you think the, how do you think these interventions work? Right? Like, we know that in ACLS you can reduce significantly with neuromuscular training, et cetera, which we'll jump to in a second. But from this sports participation, it's a really challenging thing to deal with because it's like, it's really hard to tell people to like, stop doing that, right?

Because that's what everybody's doing. So like when you do the outreach programs, are they effective? What do you guys think?

Dr. James Starman: I mean, I think that, um, for the people who walk in the door to the clinic, they're coming in with a specific problem and they're looking for a specific solution to that problem.

And so I think our, our job is, is too faceted. The first part is to address the reason they're there, um, and to, you know, accurately diagnose and come up with a plan that's going to resolve that issue. And then the bigger question is, is how do you prevent these issues from continuing to come up? And I think that if you can.

Um, if you have the right parent or the right coach or the right athlete, [00:19:00] that you can kind of have that, that conversation about, um, you know, athlete burnout and, and overuse injuries from over participation and, um, and get that concept of cross training and, and sort of multi. You know, multi-sport participation.

I think that some people can be receptive to that and other people just aren't going to hear what you're saying. And I think that that's just, uh, the reality of, of trying to have that conversation. But I do think it's worth it to try to broach that topic when you're seeing people for these overuse injuries in particular.

Will Sanchez: How much responsibility does, uh, the coach have when it comes down to taking care of taking care of our kids? Uh, Dr. Winston mentioned before that, you know, not everyone's being diligent. About, uh, the pitch count. You know, normally, like if you throw over, uh, I guess literal league rules are if you throw over 66 pitches, you're supposed to be off for four, four days.

There's different rules or regulations. So [00:20:00] staying with that, you know, preventative, uh, outlook, does some of this need to fall? The parents, the coaches, or just everyone needs to kind of, you know, come together to make sure that we're taking care, we're taking care of our kids and athletes.

Dr. Bradley Winter: Ideally, I think it's an everybody approach, but, uh, I think especially in the throwers that I see it, it's, it's kids who are playing for multiple teams.

So you can't, you can't ask the coaches to necessarily be entirely responsible because if they're playing for two and three different teams and they're working with a pitching, pitching coach. Nobody's, nobody's talking to each other for the most part, so nobody's keeping track of how many pitches you threw Tuesday night for your middle school when you're playing Thursday night for your travel team, and then you got three games on the weekend.

Um, or working with your coach in between. So ultimately I think the parents are the ones who are, are gonna hold a lot of that responsibility, but they're also the ones who are probably feeling the most pressure to keep up with the neighbor down the street who's doing the [00:21:00] same thing and the kid who's beating 'em out for the spot on the team.

And so it just, it just gets caught in this really vicious cycle of, of trying to keep up with everyone else who they are perceiving to do all of the things that they. Want their kids to do, but that kid's not getting injured. So why is my kid getting injured? And, um, it's, it's a, it's a tough conversation that takes often a couple of visits to kind of get the parents on board with you to understand that, that a lot of this is not related to a specific moment in time or a specific injury, but it's all of the things that you're doing cumulatively that, that are where you are now.

Dr. Grant Garcia: Do, do you guys maybe I'll, uh, Dr. Starman, do you guys find that, obviously, I mean, I brought this up probably multiple times in the last year on these podcasts regarding baseball, but I know there's other sports. Are there other sports that you see this in that, and I don't, I mean, baseball's just a very particular one for me, for the players, but do you see other sports that you see this in?[00:22:00]

What sports are those and how is, is it different? Is it the same? Like how, how is that conversation different, Dr. Starman?

Dr. James Starman: So the, the best example I can think of on, on that would be gymnastics, which, uh, hits close to home for me. 'cause I have two competitive gymnasts in my house. Um, one who's 10 and one who's 12.

And so. You know, I certainly, um, understand the idea of, of year round participation in a single sport because that's essentially the nature of gymnastics. There's really no other option for them to be competitive gymnasts other than to do it year round. And so, you know, we've dealt with our own set of.

You know, minor overuse injuries just from the repetitive pounding of landing, various flip maneuvers on the floor. And, um, you know, thankfully in my house at least, we've not had to deal with any of the, um, spine issues that can sometimes come up, uh, related to spondylosis and gymnasts, uh, with all these repetitive hyperextension movements in the spine.

But I think that, uh, you know, those are [00:23:00] definitely concerns and, and things that we have to constantly be on the lookout for. Great.

Dr. Grant Garcia: Um, will, do you wanna bring that up? I don't wanna jump into the acls. I mean, that's a big topic, right? So I don't wanna put you on the spot with the Freddie food stuff, but have you, do you, are you, um.

Are you still a proponent of, do you do double bundles ever or do you ev mostly do single bundle acls?

Dr. James Starman: So I do 100% single bundle acls. Um, always have, and I think that, um, obviously Dr. F's legacy is, is double bundle and it always will be tied to that. But I think that, um, he would probably. Argue that, that his legacy should really be more about anatomic ACL reconstruction more so than double bundle as a technique.

And I think that that, that is probably the greatest thing that, that he helped me learn with respect to that surgery is how to place an anatomically correct graft. Um, and so I think that, um. You know, that's really been my focus is, is trying to [00:24:00] make sure that I'm getting a, as accurate graft placement as I can.

Um, and I go so far in, in my cases to actually use fluoroscopy on every case to make sure that I know exactly where my tunnel, um, pin is gonna be placed before I drill my tunnel. Um, and that's based on, on some of the techniques that he had made use of when I was with, um, you know, with him observing him.

Um, and so I think that, uh. You know, that's, that's really to me the, the best lesson that, that he taught me, um, as it relates to ACL surgery. But I think that, you know, the double bundle, the literature is out there. I, I certainly don't think that anyone is obligated to use two bundles to recreate the anatomy.

Um, but I think at this point, I would hope at least that we can all agree that there are two bundles. Um, yes. How that was something of a debate for some people, but. But yeah, there's, you definitely did quite a bit to stimulate the, uh, the discussion on that topic.

Dr. Grant Garcia: Well, and I, again, the goal was not to be a controversial one.

I love that con, I like actually where you went with that. I think that we're gonna [00:25:00] jump to this in one second, but the idea you brought up of the Good done, the well done ACL anatomic right. If you do acls, you sports, you probably do revision acls and a lot of times you do it for non anatomic acls, probably the most common reason.

And so the idea that you're focusing on that is really great for the athletes. 'cause like obviously we wanna reduce ACL risk, which we can talk about. Um, but we also wanna make sure when we do it, we do it correctly. So that's a really important point you brought up. And the idea of maximizing anatomic, you know, there's some companies coming out with CT guidance for some surgeons to do ACL tunnels.

And so it's just a really interesting topic that we could bring up at some other point. Will, uh, to talk about how you get so precise, right? Because it matters. Would you agree? I mean, you really want to do a good job, like you get one shot?

Dr. James Starman: Oh, absolutely. Yeah. I think, um, you know, there's, there's no way to recreate a hundred percent of the footprint with a single bundle graph, but if you have it in the right spot, you're gonna get just the right amount of pl and to, to give you that, that anterior translation control in [00:26:00] addition to the rotational component.

I think that absolutely 100% impacts people's results and their ability to recover and, and probably the risk of re-injury as well. For sure.

Dr. Grant Garcia: Um, I don't wanna leave out, uh, Dr. Winter. He's just, he's always been adding good conversations here. Would you, would you help us out with this slide to talk just a little bit about this?

I think that I get this a lot like. My friends who have young female athletes always are like, why do you do more acls and females than males in certain age groups? And they, you know, they hear about it, but they don't know enough about it. And I have to try to explain it to 'em. So it's good that we have this slide.

Dr. Bradley Winter: Sure. Yeah. Happy to, happy to chime in. Um, yeah, I think like you, we see a lot of, a lot of, uh, female ACL injuries. I see a lot of soccer players with, uh, with ACL injuries and, and basketball as well seem to be the two, two big ones around, uh, around, for me anyway. Um, but yeah, you know, female has a little bit wider pelvis, so increased Q angle.

Um, so more, more valgus stress at the knee. [00:27:00] Um, you know, a lot of, a lot of, uh, people looking into ligamentous laxity and whether there may be some component of, um, hormonal cycle changes that increases ligamentous laxity during certain times of, of a female cycle that may put them at increased risk for injury.

Uh, you know, certainly, um, you know. Changes in intercon or notch, um, somewhat narrowed notch, uh, in females, seems to be higher risk for ACL injuries and then changes in in muscle strength and activation. You know, certainly somewhat more. Um, hamstring, hamstring tight seems to be, uh, somewhat of a risk, uh, for folks.

Dr. Grant Garcia: Um, a question for you guys, both of you on the notch thing, 'cause this just came up. Someone was asking about this when they, I saw doing surgery. Do you guys always, I'm a routine notch Platy guy. I like to see the back, the lateral wall. I know we're getting into the, the weeds here, but do you guys find.

Like, I feel like in females, I try to improve that notch. So if I'm gonna do a ACL as [00:28:00] an impend, is that common for you guys? Or you guys are fine with not doing that? How does it work for you?

Dr. James Starman: Um, for me, I'm, I'm not a notch Platy guy. I've, I've never done them. Um, and, uh, yeah, I, I'm not really a big proponent for that.

Dr. Grant Garcia: Okay.

Dr. Bradley Winter: I do it probably 20% of the time, depending on what I see during the operation. If I think it looks fairly narrowed or I can't see back to the back corner, then I'm probably doing an otoplasty.

Dr. Grant Garcia: Right. Cool. Um, let's go to that next slide. I want to know the, um, this one, so these landing issues, obviously you can see them so that, so in, in some of the places, like, uh, in your institution, do they have you guys measure this for the players?

Like obviously you can see here that somebody did these measurements and stuff. Explain this to the, the listeners or viewers.

We will go with Dr. Starman.

Dr. James Starman: Yeah. So for, um, you know, the landing in valgus, it's, it's gonna increase your load on the [00:29:00] ACL. Uh, this is, uh, you know, not one that in my practice that we routinely monitor or measure. Just with the setup that I have in my office, we're just not really equipped for this, you know, particular type of measurement.

So it's not something that I normally routinely use, but I'm not sure, Brad, if you do that at all in, in your practice.

Dr. Grant Garcia: Go ahead, Dr. Winter, he wants to know if you do the same in your practice or do you guys have physical therapists that you work with that do this or trainers?

Dr. Bradley Winter: Um, I have a conversation about. This often with patients in the office, but, but really having the, the, um, the therapist working with folks on this when we, when we start the, the kind of more sports specific, um, phase of, of ACL rehab.

So kind of the six month plus phase for me is when we're working on a lot of this stuff, but. Yeah, I haven't paid less attention to, to valgus knee, knee landing or valgus, uh, valgus positioning. [00:30:00] And, um, you know, certainly the hyper extension at, at uh, at landing as well. Um, I think these videos are probably from the Charlotte, um, Charlotte Rehab group.

I think they have a little bit, uh, little more video technology than we have in our therapy office to do some of this.

Dr. Grant Garcia: Do you guys focus though? I mean, do you ever talk to the players, like, I have this a lot where the, the ACL's done and then they're worry about the other knee, right? Mm-hmm. They come in, they ask about that.

I think since Dr. Winter you're speaking, do you ever have that conversation with them? Like, you know the, in theory, right? There's higher chance of retear on the other side. Uh, so is that the preventative conversation than you? You, you get to chime in 'cause right, you're not really, if they don't, if they haven't turned their ACL yet, you're probably not seeing them at the beginning before they have that.

Right.

Dr. Bradley Winter: So every once in a while you get a sibling in the room and you're like, Hey, do these, you know, do these exercises so you don't have the same injury. But most of the time you're right, you're talking about the other neat. Um. I have a big, big group of, of soccer players somewhat. 'cause I'm plugged in with that [00:31:00] community.

My kids play competitive soccer and so I get more of those kids just being around the fields and things. So, you know, a a lot of the, the female soccer players, I'm having conversations about how do we, how do we decrease the risk on the other knee, you know, some of the FIFA 11 warmup and, and cool down exercises.

And then specifically some of these. These, uh, preventative type, uh, uh, situations of preventing the valgus when you're landing primarily, is what I'm discussing with them.

Dr. Grant Garcia: Got it. And Dr. Starman, how about you? What kind of conversations do you have with this sort of. The, the, you, you get the athlete in, you've done the ACL surgery or it's a, maybe it's a partial ACL and you're gonna try non-op.

Uh, but that conversation, how, what's that conversation like for you about this sort of the landing methods or ways that, you know, can you make they say, Hey, can I, how can I reduce my chance of ACL tear on the other side, or how can my sister not get it?

Dr. James Starman: Yeah, I mean, for me it's, um, when I'm kind of.

Reaching the one year point with, uh, somebody who's been [00:32:00] reconstructed. I'm, I'm focusing most of my conversation on, on the operative knee and the concept of graft maturation. Um, and how that, how that relates to risks moving forward for, for, mostly for the surgical knee. Um, and trying to put that in terms relative to the contralateral side.

So. Uh, they understand that at, at one year their risk of re-injury is roughly equal to their contralateral knee. And at two years that, uh, as you point out, that the risk of injury is actually less on the reconstructed knee than it is on the non reconstructed knee. Uh, which I think is, is helpful for some athletes in terms of the mental hurdle of getting back into participation and trusting that need that's been reconstructed.

Dr. Grant Garcia: That's a great point. Will you explain that to the listeners and Will and everybody else? What do you mean by the maturation of the graft?

Dr. James Starman: Sure. So when we are reconstructing the ACL with, uh, whichever type of graft you're selecting, whether it's uh, auto graft or allograft tissue, uh, the graft tissue that you put in has to go through a process of [00:33:00] integrating with the body and turning into.

Uh, what would be, you know, equivalent to a ligament, um, histology wise. And so that takes time. And that's something that is really not a function of how hard someone is working at their rehab process, but it's just a biological process that takes a defined amount of time, and that's directly correlated with the risk of re-injury.

We know that around three or four months post-surgical that the, the load to failure for the graft tissue that we've placed is actually less than at the time of of which the surgery is completed. And by, you know, roughly six to nine months, uh, that it's starting to get stronger, but still not as strong as the native ligament.

And then by one year it's typically equivalent to the, the normal load to failure strength of the ACL. But not until two years is it actually at its maximum, uh, which actually becomes less, uh, less likely to reinjure than the contralateral native ligament. So I think that's, that's a concept that I think it's important to note for [00:34:00] people that, that have this kind of.

Idea that they're a fast healer and if we can just work hard enough, we can get them back to sports faster. And you have to kind of debunk that idea and, and tell them that this is not something that they're in control of as much as they would love to be.

Will Sanchez: Awesome. Dr. Winter. Um, there are a lot, I, I'm assuming there's a lot of difficult questions, right.

That you have to have with the patient, with the family for all of you, right? But directing it to you, Dr. Winter, well, how difficult is it to tell an athlete maybe right before an injury or they've had a small injury that they need to back down? Right. We, we started off the show with. Everyone wants to be at the next level.

Now, NIL has added an extra element, just like the cherry on top with the whipped cream where everybody wants to be a pro athlete. That's so much money to make, not even at the pro level, but at the college level. But what are some of those difficult conversations you have when you have to tell an athlete that someone, I need you to back off, [00:35:00] and that might be in their senior season and having those conversations.

Dr. Bradley Winter: Yeah, those, those are tough conversations. Having, having played. I think helps, uh, having an understanding of what that feels like to, to be in that moment in time in life and, and have an injury to kind of have, have some understanding of where they're coming from is helpful. I think one of the bigger challenges we have is a lot of these people, we don't have a relationship.

The first time you see 'em, they may come in with a new injury and, and you may never have seen them before. You may not know the family, you may not know the athlete, and kind of establishing the trust and the rapport to say like, this is important that. You take this time off and you understand what your injury is, and this is what the rehab timeline looks like, and, and getting the buy- in from them and understanding, especially if you don't have advanced imaging yet and you don't have like real data to say, this is the injury and this is the time we need to spend out.

Just we like we need, we need to. To start from scratch. We [00:36:00] need to kind of build that trust to say like, you know, we're, we're gonna be out for a certain amount of time. We're gonna get you through this. This is the, this is the approach we're gonna take. This is the timeline I think we're looking at to get you back.

'cause you're right. Nobody wants to hear you're out. But everybody wants to hear what's the timeline? That's always the next question, when a hundred percent, when when can I return? When can I start practice? When, when can I look at playing? And so trying to get that timeline as quickly as possible for folks, I think starts to establish that trust again.

And starts to get you to the point where you can have those more realistic conversations of. What does this look like? How long is my rehab process? And, and when do you see me getting back to play?

Dr. Grant Garcia: So this is an interesting, uh, maybe side question, um, for, we'll go with Dr. Starman first with your return to play criteria for particular surgeries.

Do you ever change it? For a different athlete? Or do you keep it the same for the kind of the procedure like an ACL or, you know, meniscus repair or something else? Like how, how does that approach for you [00:37:00] work or how do you feel about that?

Dr. James Starman: Yeah, so I think that's, um, that's a great question. I, I think that as we evolve as orthopedists, um, we're seeing more and more of this sort of notion of personalized medicine that's not just cookie cutter, not just following a, a protocol written on a piece of paper.

Looking at the goal of the athlete, uh, the specific injury, um, the, the quality of the repair or fixation that you feel that you have, um, and sort of the risk tolerance for that, that patient and kind of what's at stake. And so I, I always talk with people about, um. In particular with overuse injuries when people are trying to get back for the end of their sports season, and kind of what are the stakes of that season for that athlete and what are the stakes of that injury for that athlete?

And so there's, there's definitely situations where I'll allow somebody to try to, to go and participate. That may end up not being able to kind of perform at their desired level or even, you know, fully participate. [00:38:00] Um, but for them it's really important to get that, that last. One or two games in of senior year of high school in, in football or basketball.

And as long as it's not something that's going to put them at a, an undue risk long-term, I think that's a reasonable conversation to have and, and kinda let that athlete make that decision, uh, with their parents or with you, uh, as the, as the treating doctor, but. I do think that we're gonna see more of that moving forward and, and as we, um, you know, have more insights into these rehab processes, I think that that becomes a more achievable thing to do.

Dr. Grant Garcia: Excellent. Uh, Dr. Winter, do you feel like for, so this may be me again, just talking out loud and there's no data on this, but this, uh, for shoulder, I tend to see that shoulder return to sport in my practice is a lot more variable than the. Then the knee return to sport for some reason, like I'll have lab repair patients that are like, you're ready to rock at like four and a half months.

And maybe I'm crazy for letting 'em go back, but [00:39:00] like, or four months. And they're like, beg, they're begging them football players. And some guys take like six, seven months. Do you notice a little more of, I mean, you do both knee and shoulder, so do you notice any variability in that? Am I crazy for seeing that or is that something you've seen in your practice?

Dr. Bradley Winter: Oh, I, I definitely see the same. I, I have some, some instability patients who. I mean, at two and a half months you're like, I can throw, and I'm like, oh, let's, let's hold on. Um, I'm not, I'm not sure we're ready for that yet. Or I, you know, I, I'm, I'm ready to play football. I'm like, well, you may feel that way, but you know, the biology isn't there yet.

Right. The, the biologic phase of healing isn't, isn't quite there. Um, but yeah, I, I totally see the same, I mean, interesting, interesting story to the, you know, to the point of do you change your rehab. I had an instability case in a soccer player, which is not very common, but I felt like we could get him playing again relatively quickly with pretty low risk.

And, and, uh, you know, parents were ecstatic. She's like, oh my gosh, we're playing at three months. That's incredible. But, [00:40:00] um, yeah, I, I definitely see a lot more variability, I think, in shoulder than knee. And some of it may be my own. Bias about ACL graft maturation. To Jim's point earlier of like not really wanting to stress that graft too earlier in the rehab program and just probably sitting on some of those a little longer because you're waiting for really the biologic healing, you know, more so than is, than he rehabbed or not.

Dr. Grant Garcia: Well, it's also probably, it might also be too of the weight- bearing status, right? Like you're just constantly stressing that graft versus like, you know, they're playing football, right? One big hit, maybe the one that's gonna stress it, but they're not always getting constant stress on the shoulder. It's just a little different.

Baseball, baseball is different, obviously. Um, I, I wanna make sure we have time 'cause we do we're, we are wanna make sure we have time on This always happens with these conversations. Uh. For, to switch topics. 'cause I know that the aging athlete is a really interesting one. This is actually the one that gets a lot more hits 'cause the people talk a little bit less about the aging athlete.

And now with like regenerative medicine, people aging, [00:41:00] everyone's, you know, the forties, the new, the new thirties. Thirties, the new 2060s, the new 40. Who knows? So, uh, we have a slide on that. I wanna bring it up and maybe have each one of you com uh, talk about it. Will you wanna pull that up for me? Sure. So I don't accidentally delete it.

So can you guys talk about this? Let's say I just talked to, let's say Dr. Starman, can you kind of go after this and talk about this? What happens? And you know, we won't doom and gloom this 'cause we have the next slide on how we can keep people strong.

Dr. James Starman: Sure. So just kind of taking it from the top here. So, uh, obviously as we age a lot of things change and, uh, that is.

Certainly, uh, true of our muscles as well. So, uh, physiologically we see a decrease in muscle mass, which, uh, you know, generally accelerates as you age. Um, the, uh, overall strength, uh, comes along with that and the ability to recover. So as we age, we, we lose muscle mass more easily. And we struggle to build it as quickly as when we're younger.[00:42:00]

Um, going along with that is a decrease in bone density and our joint cartilage integrity. So we see, um, kind of irreversible changes to the cartilage surfaces, which, uh, open them up to more cracking and fissure development and, and flaking off of the cartilage in general Thinning. Um, and then obviously we see osteopenia and that continuum towards osteoporosis.

Uh, we see decreases in the elasticity of tendons, uh, which makes them, uh, less able to adjust to kind of sudden loads and, and changes in length, which obviously can lead to a higher rate of, of strains and tears. Um, slower recovery and tissue repair, which I think anyone over the age of 40 needs, no explanation of that.

Uh, myself included. And, um, a gradual decline in the VO two max and endurance, uh, capabilities. Um, so a lot of these injuries that we see are overuse injuries, tendinopathies stress fractures. Bursitis or inflammation. Uh, related [00:43:00] changes, uh, degenerative changes, um, which, uh, the big one of course is osteoarthritis of the knee or, or other major joints.

Uh, meniscal labral tears, which is, uh, kind of a breakdown in some of the, uh, surrounding structures that, that provide cushioning to these joints and, uh, other tendinopathy changes including the rotator cuff achilles tendon. Which relates to, you know, decreases in some of the blood flow to, uh, the watershed zones of some of these tendons, uh, hamstring injuries with, uh, decreased flexibility and, and tissue resilience.

Dr. Grant Garcia: Awesome. And

Will Sanchez: I think, can I keep going? Yeah, yeah. I just wanted, so can you give us a Adam Cliff note version for things for us to, um, look out for? Right. Because you mentioned es, you mentioned the hamstring. Obviously, you know, as we get older, a lot of us don't do a good job of elasticity, stretching besides the strength training.[00:44:00]

So if there's something there that you could say, Hey, you're gonna, you're gonna go out, you're gonna play ball on the weekends, you're gonna do certain things, make sure you should be doing at least these 3, 4, 5 things. Um, Dr. Starman, I, I'll start with you. Um, in case, uh, Dr. Just not here in here. Good.

Dr. James Starman: Uh, so yeah, the things that I always emphasize are, um, the ones that I also don't like doing, which is stretching and warming up.

Um, because I think, uh, our tendency, especially, uh, when you're pressed for time, which many of us are at that point in life, is to just go out that front door and, and start moving. And, um, you know, it really makes a difference to take that extra five or 10 minutes just to warm your body up properly. Also to, you know, focus on cooling down when you're done, uh, with your activity.

Um, so I think that's, that's one that we all probably could do better with. Uh, are we

Will Sanchez: talking dynamic, A dynamic warmup?

Dr. James Starman: Yeah, I mean, uh, just static stretching and, and some dynamic warmup [00:45:00] stuff I think is both important. And, um, you know, some people, you know, do some heat on their muscles before they're, you know, getting started.

Um, and so I, I emphasize a lot with, you know, heat before activity and ice when you're done with activity, um, as a way to kind of get the blood flowing to the muscle tissue before you're asking it to perform and then to limit inflammation at the end of whatever activity you're doing.

Will Sanchez: Yeah. Uh, Dr. Winter, you know, we, you, you, um, we talked about a couple different things here, but what are some of the things that you have to be concerned about?

Because unfortunately, we don't have a cure for arthritis. Right. And we're getting older. We're still being active. You know how not yet

Dr. Grant Garcia: will, not yet.

Will Sanchez: How do we play within the constraints of having arthritis and trying to be safe, but the same time still participating and living our lives? Do you have any, any, uh.

Any recommendations there?

Dr. Bradley Winter: Yeah, I mean, the old adage is, is motion is lotion. So you get, you know, you gotta keep moving, uh, you know, you got, [00:46:00] gotta keep flexibility. Um, you know, certainly I think, I didn't hear everything Jim was saying, but, you know, warming up, cooling down, flexibility is, is gonna be important.

Uh, and I think, I think managing symptoms kind of over time, understanding what drives your symptoms. Is it, is it playing three games instead of two that's gonna gonna make you more sore and have more trouble getting around the next day? Or, um, you know, can you manage, uh, with, with icing after you play with, with periodic NSAIDs and then of, of course to the, you know, to the explosion of these new biologic treatments.

How does that help manage? Yeah. You know, some of, some of your more long-term symptoms and can you. Mitigate some of the six month, you know, return issues of cycling through injections and, and things with some of these biologic treatments. That, that I would say we don't entirely know, um, what the answer to that is, but certainly some promising, uh, some promising outlook there.

Dr. Grant Garcia: Uh. Winter, will you, will you [00:47:00] elaborate on the biologic thing? That's a really good one, and especially like how in your practice does it, you integrate it in both the non-operative as well as the operative side of things? Because I mean, today I got two people on, on non-op and two people on the op side asking about biologics.

Dr. Bradley Winter: Sure. Yeah. I think for, for my practice, I'm using it mostly in knee arthritis from a front end, non-operative side. I think that's where evidence is probably the strongest other than some tendinopathy stuff. So some tennis elbow. Um, and this is, are

Dr. Grant Garcia: you talking mostly about PRP or other biologics? Yeah. Yeah.

Dr. Bradley Winter: PRP for me is pretty much all I'm doing at this point. Um, but, but. Managing, managing knee arthritis symptoms and folks who are either not at the point where they need a knee replacement or ready for a knee replacement or, or want to do activities that the folks who do knee replacements are telling 'em they shouldn't do.

Um, and are trying to find other ways to, you know, keep playing basketball and, and whatever else. Um. And, and I think we've had a pretty good success with that. It certainly isn't a perfect science and not everyone gets as much relief as we'd [00:48:00] hope, but it is another, another option that we have, another tool that we have to manage some of the symptoms to keep people playing, to keep people exercising and, and doing the things they enjoy.

And I think. You know, as, as we have those discussions with, with patients, really trying to understand what is it that they want to get back to and, and how can we help maintain their level of independence and, and ideas about exercise that are, are keeping them either healthy or active or, or enjoying the, the activities that they're doing so they're not coming home hurting and, you know, trying to manage their symptoms for the next six days so they can play basketball on Saturday again.

Dr. Grant Garcia: hundred percent. Uh, Dr. Starman, will you chime in? Oh, sorry. Will keep going.

Will Sanchez: No, I'm, I'm asking the same question. Go ahead.

Dr. Grant Garcia: Yeah. Dr. Starman, chime in on yours. What biologic options do you think about, or anything, some of the sports stuff as well?

Dr. James Starman: I'm pretty similar to Brad in the sense that, um, you know, I, I'm mostly just PRP and, and in fairly limited amounts, uh, for my population.

The biggest barrier is [00:49:00] cost, um, and, and lack of insurance coverage, which I think. Um, you know, unfortunately that kinda limits, uh, for a lot of my patients who can get that treatment. Um, but I agree with Brad. I see that as an option for people with mild arthritis and certain tendinopathies, but, uh, not a whole lot beyond that, that I'm recommending that for, uh, for most of my patients.

Um, and I think, uh, you know, to Brad's point about, um, trying to understand the goals of your patients with respect to, you know, maintaining that aging athlete in, in whatever sport they're participating in, some of that is coaching them on how to participate differently in a sport that they've done for a long time.

And, you know, the example that comes to mind for me is with skiing. You know, as a downhill skier, you know, I've done plenty of moguls in my day and, and as I age and get a little bit older and you realize how hard that is on your knees, I think, you know, looking for other ways you can still enjoy and participate by maybe doing some of the different runs that maybe don't have quite the same level of, uh, intensity and, and still getting the enjoyment outta that.

So I think [00:50:00] having those conversations and trying to help understand what, um, you know, a specific person's goals are for participating and. Trying to guide that conversation, guide that thought process for them to help them, you know, discover what they can do and, and do with enjoyment is, is important to have that.

Dr. Grant Garcia: I think probably we'll bounce on both of you guys, but uh, maybe I'll start Dr. Winter. Do you guys have anything you guys to do? I mean, at the beginning of the show we talked about one of the companies we work with, but they talk, we talk a lot about, but we've had people on here for nutrition, sleep. Other active recovery options.

Is that something you guys ever think about, uh, in your practice, or do you ever, I mean the nutrition now is hot, like you could see it everywhere online and people talking about it. Do you have any thoughts on that or what are your thoughts on that sort of future of that stuff?

Dr. Bradley Winter: We don't have, we don't have a really robust, uh, program to, to walk patients through post-surgical nutrition and, and supplements and things.

I mean, that, that's a question we get all the time is what supplements gonna take that are gonna help me heal faster, you know? You [00:51:00] know. What do you think about, insert your favorite supplement that is, you know, new on social media of the, the last one I BP

Dr. Grant Garcia: 1 57 literally every week.

Dr. Bradley Winter: Yeah. Yeah. That's the hot one right now, I think for sure.

But, uh. It, it morphs over time. I mean, two years ago it was CB, D, now it's, you know, BP 1 57. Yep. Yeah. Who knows what it'll be six months or a year from now. But, uh, yeah, trying to keep up with that, trying to understand, you know, what does it look like to, to coach people through eating, eating the right foods.

So, you know, eating clean. Healthy foods, healthy fresh greens, you know, lean proteins during, you know, during healing and post-surgical phases and, and then managing other symptoms like, you know, use, we use magnesium a lot for folks who can't sleep, um, from shoulder pain after shoulder surgery. Studies that show it can be helpful.

Um, and just how do we, how do we coach them through that without having. A dietician on staff are really a lot of formal training and, and [00:52:00] dietary, you know, kind of questions. Um, so learning as we go, I think, I guess is my, my take.

Dr. James Starman: And I would, I would echo that and, and also say that, um, I think it's important to make sure patients understand what is, um, what is being promoted on some of these social media nutritional supplements.

Um, I know one I just saw in the news recently had to do with a lot of these protein supplements that were found to have high levels of lead. And, and you know, obviously that's not something anybody wants to put in their body if they know about it. Um, but I think people don't always understand that stuff.

That's not, uh, regulated by the FDA. You really just don't exactly know what you're getting with any of these products. And so it really truly is buyer beware, which I think some people are comfortable with that and other people maybe aren't. But I think it's important that we educate our patients on those risks.

Dr. Grant Garcia: Dr. Star and conversation's challenging sometimes. I mean, when we've had nutritionists on there, certain thi certain things we can't talk about on the show from a perspective of doctor, because [00:53:00] it's not really considered something you should be having a conversation with as a medical, with a medical professional.

So it's important. You're right, like on social media, you can say whatever you want, but it doesn't mean it's accurate.

Will Sanchez: Yeah. I was just gonna chime in. Uh, you know, we're, we're talking about all the different things. What about, um, specifically what, is there wearable technology or anything like that, that you're recommending, uh, perhaps with a patient, whether it's post-surgery or anything like that?

Is it something that you guys do in your office with that, you know, kind of biotech and things like that?

Dr. Bradley Winter: I wouldn't say I have a lot of experience with patients, but one of my sons wears one, uh, for soccer that we monitor his load, uh, based on how much he's training, how many practices he's got, how many games he's got on the weekend.

Um, and we're watching how many miles he's running. We're we're looking. He likes to look at his top speed. Which I tell 'em it's not that fast, but, uh,

Dr. Grant Garcia: classic kid. Classic

Dr. Bradley Winter: kid,

Dr. Grant Garcia: that's okay. Yeah,

Dr. Bradley Winter: [00:54:00] exactly. But, uh, I, I mean, I think it, it does give you a lot of information. I think especially in folks who have muscle injuries.

It, it probably is a valuable tool to understand how much load you're, you're putting on those folks. You know, people with hamstring injuries, um, quad injuries, that you're, you're trying to ramp them back up slowly without overwhelming, um, overwhelming the system.

Dr. Grant Garcia: I wanna chime in real for Starman. I had a patient today you'd like the second order.

He said he had his ring, his aura ring, and he says, I know I need my rotator cuff fixed. 'cause I woke up 12 times last night. That was what he told me was the indication for the surgery. He hadn't gotten the MRI back. He's like, I have had woke up 12 times. 'cause my ring told me was he right? I need to have.

Yes, he was right. But that nonetheless, it doesn't matter. Sorry, Dr. Tarman, keep going. You just answer that question for us please.

Dr. James Starman: Uh, yeah, I mean, I, I, I don't really have a whole lot more to add to what Brad, um, you know, said on that one. I'm not really using that routinely in my patients, but I, I do think it's a very interesting technology and I think it's. Kind of fascinating as a spectator, uh, at the, uh, professional level to see some of [00:55:00] the, you know, monitoring from a performance standpoint. Then all the mountain of data that's able to be collected on these athletes at the really elite levels and, and how they're able to apply that back to improve performance and, and probably also to drive some of the, the training.

Dr. Grant Garcia: Um, so as we always do, we are very close to running outta time. Maybe will, I know you always have fun questions, but I wanted to ask one more for each of you. Go ahead. Uh, maybe since Dr. Starman started, what do you think kind of the, you know, both sports, so what do you think the future of stuff that you like is going?

Dr. James Starman: Yeah, so as far as, uh, sports medicine, I think to me the most exciting thing that's coming down the road. Uh, is, is kind of related to personalized medicine and, and what, uh, artificial intelligence may influence in that realm. So, I know AI is kind of like a hot topic in all realms of life at the moment, but I think as it relates to sports medicine, the, the potential upsides of being able to [00:56:00] integrate the vast amounts of research data that have now been generated.

Um, and to kind of integrate that in a way that we can benefit individual patients. Um, really AI is I think one of the more exciting options that we can use to achieve that. And I think that we need to, um, you know, kind of do our best to, to find ways to integrate that technology and to how we practice and to not see it as a threat.

To, you know, what we do and, and to see it more as an opportunity. But I think that that's really the only reliable way that we could potentially integrate all of the, the data that's been generated with research over the last 20, 30 plus years in this, uh, in this realm in a way that can become useful for individual patients and, and for us as clinicians to make those decisions about treatment and, and rehab and, and specific surgical techniques for specific patients.

Dr. Grant Garcia: Awesome. Dr. Winter, how about you? Yeah,

Dr. Bradley Winter: I think Grant you brought up, uh, you know, navigated surgery and patient specific, uh, uh, imaging integrating into [00:57:00] surgery. I think there's a. There's a huge opportunity there, especially with wearable devices like glasses and things that you may be able to wear during surgery that could reference imaging.

And, and can you overlay that to like real life anatomy, um, and, and actually see the imaging overlying what you're looking at in surgery, that that could be revolutionary in terms of really getting patients specific to like the millimeter detail. Which in theory should, should give us really, really good anatomic outcomes, um, from surgeries.

Um, I think the other is the ability to put a camera on a needle at this point and potentially start to do even less invasive operations, maybe even requiring less significant anesthetics, you know, could that, could that push us to even more, more rapid outcomes. And then combine that with the biologics.

Can we get even faster healing? Can we get more [00:58:00] rapid in-growth of implants and grafts and, and faster biologic healing so that we can rehab folks even faster and get them back quicker?

Dr. Grant Garcia: I love it. That's great. Excellent.

Will Sanchez: All right, let's, uh, let's wrap it up. You know, we, uh, that's a great, great way to end the show.

Um, really excited, especially as a patient to hear that you're gonna cut me less and find ways to kind of advance technology and embrace an ai. Um. For, I, I'm always, uh, I'm always wondering how a pick guy that went to Virginia is now in Tar Hill country. I don't know how that all works out and how the fandom does with all the colleges, but I'm pretty sure that it all gets worked out Big thanks to Dr.Starman and Dr. Winter from Ortho Carolina for joining us. Thank you so much. Dr. Garcia, um, any last words as we say goodbye?

Dr. Grant Garcia: No, thank you guys. It was great. We, this is our first two guests out of time. You guys did awesome. It was, I really appreciate it. So thank you. Thank you. [00:59:00]

Dr. Bradley Winter: Yeah. Thanks for having us.

Will Sanchez: All right. Take care. Bye-bye.

Audio Transcript

Dr. Grant Garcia: We see we're gonna get in trouble regardless.

Will Sanchez: It doesn't matter. I know, I know. Michael, listen, Michael's been at the forefront of innovation, em embracing in sports, uh, medicine for decades from his early work at Don Joy to his leadership role today. We're gonna bring him on in second, but first and foremost, Dr.

Garcia, how are you? [00:01:00] 

Dr. Grant Garcia: I'm in a much, well, some sadness with the neighbor's diagnosis of the ACL tear. But the positives of Dart finally wins a game, and we actually look like a legitimate team. So otherwise, yes,

Will Sanchez: and we're not, we're not here to talk about neighbors. Okay. So we're gonna kind of go through all that stuff, but when we're talking about recovery, we're talking about Mike B at the Recovery Shop.

Let's give a shout out to the recovery shot. Dr. Garcia. Tell us why the Recovery Shop works for you.

Dr. Grant Garcia: So big thanks to our sponsors. You guys have seen this time and time again. Um, and as our show grows, it's been great having them as sponsors. So again, for surgeons, postoperative recovery is important.

People are always asking like, what's the next level? Like, what can I do better? And they have the opportunities to have pretty much anything you want. That's sort of something that's out there. And we may even get into that today. We're getting to see some maybe new innovative things and hear about the future of recovery.

From bracing, biologics, et cetera. I don't wanna give away too much, um, but you may see some of this, some of the recovery shop in the near future as well. So this is pretty exciting. And [00:02:00] again, you never know who we're gonna have a guest on here. This started off as a sports surgery podcast. We have had some cool requests, um, and uh, just really been excited to have some awesome guests.

And I think this one is gonna be very exciting for every.

Will Sanchez: And I, I don't, I thought Michael was gonna cancel on us es especially after the results on Sunday when the Giants, the lowly giants got a win over his chargers. Uh, he was still kind enough to come on. Let's see if he's still there. He may have left.

Michael, thank you for joining us. Thank you for being a good sport. We appreciate the win because we, we get very few wins the last five years when it comes to New York Giants, but welcome to Sports Talk. Thank you for your time.

Michael McBrayer: Well, well, thanks for having me. Uh, number one, it is really hard to be a. San Diego fan of sports.

So, you know, we just take that into, you know, into account. Now they move. So I don't even really care anymore. That's, that's okay. Um, I did, I [00:03:00] wanna let your listeners know and, uh, I really appreciate you guys letting me. Off last Monday, uh, for you. Uh, I was really sick last Monday and, and still sound a little nasally.

So, so bear with me. But, uh, I did want to thank you guys for letting me, um, get a week to get healthy and, and try to do the show. So appreciate that.

Dr. Grant Garcia: No problem. We're looking forward to having you on. This will be great for our listeners. Um, I wanted, before we jump into this, uh, I think we wanna make sure that we understand, can you explain the difference?

Obviously you can see on both sides of me, I got Don Joy or what if you, anything Orthopedic knows about John Joy, it's Don Joy. And then pronounce the name for the listeners because I know we're gonna mess it up again

Michael McBrayer: in

Dr. Grant Garcia: it's,

Michael McBrayer: yeah, so the new, the, so our. Corporate entity and how we are traded on the New York Stock Exchange.

The company is Enova Enova. And um, yeah, so we went, I'll take you guys through some history, but the public entity, [00:04:00] so we went public again, um, in April of basically two and a half years ago. So, um, but in Novus is the umbrella entity that. Like I said, it is our New York Stock Exchange way of trading our, our stock, but then the brands of DonJoy and Aircast, uh, live underneath that, uh, umbrella.

Dr. Grant Garcia: Okay. And then of those, did you tell us about kind of what you started off with, where you came from and your background there and how that kind of comes in full circle to now?

Michael McBrayer: Yeah. Thank you. So I, I can kind of tell the history of the company because I am. Part of the history of the company. I've been, um, in December, it'll be 38 years.

Congratulations that I've been with the company. Yeah. Well, I don't know if it's congratulations, but it's, um, it's been a great ride. The company DonJoy has a wonderful beginning. Um, it started in 1978, [00:05:00] so. Mark Norquist was the offensive line captain for the Philadelphia Eagles, and that picture that you're seeing there was from basically from 1978.

So he would come back to Carlsbad, California in the off season to play basketball, so was as good a football player as he was. He was a wonderful basketball player as well, and he came back with inner tube rubber on his knees and his elbows. The athletic trainer for the Philadelphia Eagles at that time was Moose Dead.

And Moose is the first individual to ever put inner tube rubber on people to warm their joints and keep, you know, keep the joint moving. Um, so when he came back to play basketball, there just happened to be another little company here in Carlsbad called Body Glove. So make your wetsuits. Um, Ken Reed, who was an attorney in town, and Mark thought that was a better material than the inner tube rubber.[00:06:00] 

And we literally started cutting up wetsuits, um, to make the products make knee sleeves and elbow sleeves. They, they thought it was a good enough idea to create a company and needed to get some money to launch the company, and they leveraged their homes. So wow. New loans on their homes, and in order to get their wives to sign on the new loans, they named the company after their wives, Donna Reed and Joy Norquist.

Dr. Grant Garcia: Smart, smart Men. That was the smartest thing they could have done

Michael McBrayer: that. That's the first thing they could have done.

Oh, wills.

Maybe it's better that Will's muted. I don't know.

Will Sanchez: No, I was just saying that, you know, it's smarter them to, you know, we're gonna put the house up as collateral, but we'll name the product after you, so everything will be fine. So that must have went over quite well. But so did Moose kind of is the [00:07:00] inventor of what we know as the sleeve by him doing that back way back when.

Michael McBrayer: Correct. So they ended up creating a company called Pro. So, you know, Dr. Garcia, I don't know if you know the company Pro,

Dr. Grant Garcia: I haven't heard of the company Pro, but I'm sure it's prob Is it still, I mean, is it still around? So

Michael McBrayer: it's sold mostly to athletic trainers and to training rooms. Okay. Um, and pro and pro is still around.

Um, but the, it's just not as big as, as DonJoy.

Dr. Grant Garcia: It's

Michael McBrayer: interesting. Yeah. Well, the reason DonJoy, the original products were sold to tennis shops. So it was not orthopedically driven to begin with. In fact, they signed, uh, rod Laver to a, um, to an endorsement deal, kind of, and, and Rod Laver. It wasn't a great endorsement deal because Rod would not wear the elbow sleeve in competition.[00:08:00] 

He would wear it in practice. He loved the product, but he didn't want the competitor to think they were at an advantage. So we wouldn't wear it in competition.

Dr. Grant Garcia: What, and we have that now with some other products we just interviewed. We have another podcast coming out with a product that some of the NBA players, they won't wear it during the game.

'cause of sponsorships too. Some of those things. Right, exactly. I mean, obviously braces are a different animal. Um, do you, will, can you pull that other timeline? Can you describe to us, kind of like dondre, what was the, the, you're talking about a lot about elbow. I think obviously a lot of things here are the knee braces.

Why the knee? Why? What was the kind of talk about the history again, we don't have to go too crazy on each version of that. Yeah, yeah, yeah. Why, why start with that? I mean, I can talk a lot about the knee stuff, but I think that you're obviously more important here. So,

Michael McBrayer: oh, I, not more important. It's just the fact that when these, when they were trying to sell products into the tennis shops.

At the end of a season, the tennis shops would send back the products [00:09:00] because the season's over. So like in the Northeast, right now in New York and places those tennis shops are done. And so the only reason the company took a turn towards orthopedic is that they did have some accounts that physicians were buying these sleeves.

And it was, it's like, well, why don't we sell? We don't get product back from an orthopedic surgeon. And we get all these broken packages coming back from, from tennis shops. So it, it wasn't by like, Hey, we need to be in orthopedics. It was just the fact that broken boxes were not coming back. And at this point in time in sports medicine, you had individuals like John Fagan and, you know, Dr.

Berg fell from the Cleveland Clinic and Jack Houston down in, in, in Georgia. They didn't even know what A ACL was back then. They would reference it as a trick knee. And, and it was only about this time that they started understanding what the ACL did [00:10:00] and that they, they should try to do something about that, ACL.

And that's why bracing got, got started. Um, the company actually really took off on that. Um, if, if you can see it where it says the, the super sport and ah, yeah. Yeah. I was at a point in my career where. Sports medicine was so new, and these physicians that are, are now, you know, part of the A-O-S-S-M, that's the Sports Medicine Society's Hall of Fame.

Um, they were really looking for, you know, what can we do, what can we do for these patients? What, you know, they, they want to get back to their sport. They wanna, you know, get back to the same level they were. And, and there were some pretty archaic procedures going on back then. Extra articular reconstructions and things that Dr.

Houston used to do. Um, so as, as the fortunate thing for me was the timing [00:11:00] because these people would see me, they would take time, effort, and consideration to actually teach me things and, and have me be involved in the discussion about how they were gonna try to rehabilitate these individuals. And it was a very, very open.

Conversation. Um, it, it, it's a lot more difficult to, to get into, to see you today, right? As a single individual rep. It's like, how do I go in to, you know, get to see Dr. Garcia? It's not easy. And, and it was just very fortunate at my time, and you had Dr. Curlin and Dr. Job up in Los Angeles and they were starting these fellowship programs.

Um, so there were a handful of these fellowship programs. I got to be involved in and, and meet those individuals that then created their own fellowship programs. So as you went to Rush and spent time with Dr. Cole, you know, yes. These become [00:12:00] mentors and, and people that you will engage with, you know, for the rest of your career.

And that's how my career started, just because of the engagement with these individuals looking to try to help patients.

Dr. Grant Garcia: Yeah, and we, I mean, we don't wanna jump ahead with other episodes coming up, but we're gonna talk to people like that that have been branching. It's amazing when you work with someone and we have, we get experience as fellows.

I think Will can hear this from people that I've talked to, some of my mentors you've even had on the show, right? When you show them something that you like it, it spreads like wildfire. Especially at the top places. I mean, will, I've told you this before, the job procedure is the UCL reconstruction. He invented it.

Right? He's talking about a guy that invented the Curl and Job Institute is one of the top fellowships in the country. Right. And these are the two guys curl and job. So, you know, we have, and they treated me

Michael McBrayer: like I was somebody, they, they actually welcomed me in to their clinic and, you know, and, and that's what's sports medicine physicians on [00:13:00] whole.

I may, you know, get, uh, Dr. Garcia's head a little too big. But the sports medicine's, physicians in whole in orthopedics are quite open to suggestion and quite open to saying, okay, what, what else can I do? What else can I learn from others? Whereas, and I don't, you know, I'm gonna profile some things with a broad brush.

Spine surgeons, total joint surgeons. You know, they don't have the same kind of approach to these patients. They have a hammer and nail and they're gonna use the hammer and nail. Whereas a sports medicine surgeon, you really tries to understand what that patient's trying to to do and the the approach. So I think sports medicine surgeons are.

You know the animal that you want taking care of these, these kids.

Dr. Grant Garcia: Yeah. Well, it's also, I think the point you're bringing up is important because I think will sees it on these podcasts. Like we talk about my patients. I had a patients today and I said, if you come to me in 10 years and I'm [00:14:00] doing the same surgery, you should leave my office and go to somebody else 'cause I'm not doing the right thing.

Yeah. So that's the way sports is. Like, we're always, look, we talk about this. Will and I are always looking about futuristic. We're gonna get into futuristic questions here. This timeline doesn't exist unless you try to get better and our patients expect that. I mean. As much as we talk about trying to be on the forefront.

If you're in sports and you're in a big city, like I'm in Seattle, you cannot be behind. You just won't be able to be a busy physician. And patients want that. The internet now chat, GPT, it tells you what, what you want people, patients want to hear. They come in already knowing what they want. You just gotta hope that you're in the same page as them, uh, in in these cases.

Yeah, it's just, it's just the way everything you say is accurate.

Michael McBrayer: I do find, you know, the, the lay population though. In some cases doesn't understand the specialty. I, I even get it in my company, you know, somebody goes, Hey, hey, I, I, I'm getting my shoulder done by so and so. Mm-hmm. It's like, wow. I, I don't know [00:15:00] that name.

Who, where, you know, where are they in practice? Yeah. Well he did my C'S fine. Operation and I'm gonna let him do my shoulder. I said, no, you're not.

Dr. Grant Garcia: Listen, Will's, Will's Will, is a doctor by this show. So he has his MD four. Exactly. He knows that that's, that seems unusual. Yeah.

Will Sanchez: I, I could do the spine surgery if you want, you know, if, if, if that's the case, if you're just gonna say, well, you know, you fix my toe, so now fix my neck.

So that's, uh, yeah. Why, why not? So that it sounds like it's great advice that you're telling them. Yeah. I don't think that's the correct route for you to go.

Dr. Grant Garcia: So, so I guess let's go. So we talked about some of the bracing. Sure. So can you, I know we talked about this, AO S Sm, you got selected to the circle of honor.

This is a big deal. I mean, it was on the internet. If you look up stuff, it's like the first thing comes up. It's a huge deal for any of those listeners. Aos, SM, I'm a member of it. It's got a huge membership. It's probably now. I actually would say it's better than AO s In terms of meetings, it's probably one of the top, it's probably the top sports meeting.

They work with [00:16:00] A JSM, which is one of the top papers, you know, this is, this is the creme de la creme for sports medicine. So can you explain that a little bit more to the listeners to understand what this means? Well, for you to be recognized for this?

Michael McBrayer: Yeah. Well, thank you for bringing it up and, and yes, they, A-O-S-S-M is.

I think the heartbeat of sports, it, it, it's the way that, um, again, the meetings, this is where all these physicians learn and et cetera. So to give, um, recognition to individuals that are not physicians. So that's what the circle of honor, uh, was created for. Now, they probably should have given it to the company, not to me, my, in my name personally, because, you know, sports medicine's a team sport.

And, you know, my team is my company's, so at the time it was DJO. So we probably should have given the circle of honor to DJO and I could have accepted it. Um, Michael Ti and Jim Bradley. Jim Bradley was the president in 2020. Yeah. Uh, when they came up with [00:17:00] the idea to give the awards. So they, they introduced and recognized four people in 2020.

Um, the, the four people were Ken Langone. Yeah. Stanley Drunken Miller, Reinhold Schmidlin and myself. Will you know that? That's CEO Arthrex? Yeah. Yes. And so Reinhold is the owner and operator of of Arthrex, which is a huge company. Uh, those other two names, and he himself, all three of those are billionaires.

I am not, I don't know how I missed out on that, but

Dr. Grant Garcia: I thought that came with the award. You got that

Michael McBrayer: with the award,

Dr. Grant Garcia: right? It wasn.

Michael McBrayer: Well, I'm going back to O SSM and escort then, if that's the case, we'll back you up

Will Sanchez: on

Michael McBrayer: that.

Will Sanchez: Okay. I appreciate that. You're being really humble here, but I, I think what Dr.

Garcia is like. What, what, what does it mean for you personally, professionally, for, for you to have this [00:18:00] award with this distinction that comes from the people that you've worked with for so many years? I, I mean, this is, I mean, you may not be the billionaire, but this is, this is an amazing award. So let, let's, let's, I know you're giving kudos to your team and everyone else, but just personally, what does this mean to you as far as impactful?

And, you know, you go home to the wife and going, I, I can't believe I got recognized like this.

Michael McBrayer: Yeah, that's, uh, so it wa the distinction is, is it was a very impactful piece to me. So it, like, like I said, in 2020 we did it, doing it via Zoom and, and, and Dr. Bradley, I've known chief maybe since he did his, started his fellowship.

Maybe just a Michael TI was a curl and job. Both of those are Curl and job fellows. Um, so not only do I have a personal and professional relationship. These individuals, they, we've become friends and, and friendships, [00:19:00] you know, kind of go deeper than just a, a transaction in business. And, and for, I, I, I feel that they understood what my impact has been related to helping and creating opportunities for education because the, the sports society is really dedicated to, to education.

And I've been. Very engaged in the traveling fellowship program for A-O-S-S-M. I've helped establish other traveling fellowship programs for Foot and Ankle Society, for the American Medical Society, for Sports Medicine, for Sports vt, because I know the interactions that happen with these. So a traveling fellow, there's three that are chosen, and they choose a senior individual that go to Europe.

South America or Asia, in fact, uh, the last traveling fellowship for A-O-S-S-M just got back from Asia.

Dr. Grant Garcia: Yeah.

Michael McBrayer: But these are [00:20:00] life-changing experiences and we as a company support those programs because we know what the benefit is. Um, I mentioned a name earlier, John Fagan who, um, was at Duke. Um, he's the one who came up with this idea of a traveling fellowship, uh, years ago.

And. Aircast company at the time was funding it and we made the acquisition of Aircast. And, and John was, uh, concerned whether or not we were gonna continue to fund it. And, and Dr. Fagan was a, is West Point guy. Uh, he's deceased, but he, he, he was a West Point guy. And I knew when this conversation was gonna have to be serious with Dr.

Fagan because he would call me Mc Brayer. Hmm. Says, Hey, mc Brayer. I, I need to talk to you, um, about, you know, this traveling fellowship. And I knew the, the, the conversation was gonna be casual if he called me [00:21:00] Michael. So he goes, McBrayer, Hey, what are we gonna be doing without this traveling fellowship? I said, well, you know, not only did we acquire a wonderful company called Aircast, but one of the nice pieces that added to that is that we will continue and be a part of the traveling fellowship.

And he says, Michael, that's a good idea.

Dr. Grant Garcia: I. So then see you got on this good side. See, I'm gonna call Sanchez and Garcia, or it's Will and Grant. So we'll now know how we can talk to each other differently. Now we Exactly. Mood.

Michael McBrayer: Now whether it's,

Dr. Grant Garcia: or you, you also see that that's gonna be the new hint on the podcast.

Everyone's gonna be expecting to see how, how are them, how are their, how's their mood today? Um, this is great. So can you talk? So again, one of the big things, we want to go into the larger company, but I think the DonJoy is important. Sure. Can you kind of talk about, some of you know briefly about the science, about how the bracing has shifted over the last, you know, 10, 15 years.

Again, history's great by our listeners. They obviously like cutting edge stuff, right? They're gonna want to know like, where are we going with this? The [00:22:00] orthopedic surgeons listening, they've heard your name, right? They've heard DonJoy, they know all this stuff. True. But for the listeners who are looking at these products, what, what does it, what does it mean for you guys?

How have you guys shifted your mentality for the bracing that you're doing?

Michael McBrayer: Yeah. And, and so knee bracing is just a portion of it now, right? I mean, so when early on we wanted to prove that braces were actually doing something for these ACL reconstructions. We did research at the University of Vermont and it was very cutting edge at the time.

It's been a few years ago now, but we were putting strain gauges on the intact ACL. So we did cadaver work. Initially, we were showing that we were strain relieving, getting strain off of that ACL with our brace. And then somehow we got some volunteers. To have a strain gauge put on their ACL intact ACL [00:23:00] and then put loads on their and Wow.

And show that we can Yeah, exactly. I I still, you wouldn't be able to get that IRB

Dr. Grant Garcia: approval anymore. That's impressive

Michael McBrayer: that IRB would never get approved again. Ever. And I don't know if you wanna explain what an IB is, but it's will, it means that the institution would

Dr. Grant Garcia: approve someone to put an implant in someone's knee without actually needing the surgery.

Michael McBrayer: Exactly. Um, so as a portion of how we've looked at and tried to, um, confirm that our products are doing what they say we do these pieces of research. Uh, we've also done economic studies. So like when you see the college football teams, um, we only have one division, one school that's not in our knee braces.

Um, the rest of 'em are in DonJoy and we've done some, there it is right there. And so the down linemen that are looking to be protected because they get their own player to roll up on them. Um, so they're not, these are contact [00:24:00] injuries, not non-contact injuries, uh, which a brace can be very, very effective for.

And we did a study at University of South Carolina looking at just the economics. Of, okay, you've purchased these braces. How many acls did you have, and what was the cost of that ACL? Um, it's devastating to the player. But from an economic standpoint, we, you know, we, we wanted to prove what the benefit was.

Um, it's important.

Dr. Grant Garcia: Can you tell, um, I mean, it's important Will, I think that that brings this point up. We talked about the cost of injuries. You brought it up on the last show, uh, that we just had. We've talked about it before. It's devastating. Right? And we talked about this, which we will hope, you know, I think the po.

Podcast just came out, you know, on how long does it take to get back and what is the benefit of doing these things. It's really important. As much as everyone says you don't, we don't wanna talk about the cost of something, it's, that actually is really important. Like, is it worth spending the money to get a brace?

Correct. If it's not gonna help you. Right. If it looks nice, that's great. But so for your guys' [00:25:00] bracing, you guys have looked at ACL, um, I'm assuming, you know, MCL and other ligaments is the ACL, the big one you guys are focused on. It's obviously the biggest one. We just talked about a player of ours that, uh, we're dealing with the ACL tear situation.

Mm-hmm. But the, in general, is that your major one you look at, or what other things have you guys looked at or thought about in terms of the bracelet, what you guys do from that?

Michael McBrayer: So, I'm gonna, and I'm gonna shift gears a little bit because ACL's is a big segment of our business, but when you talk about the sheer number of injuries, foot and ankle, total number of injuries is significantly higher.

The total of, you know, sprained ankles and, and et cetera, et cetera. So when you start looking at the, the total number of joints and injuries, ankle is the number one joint for some kind of injury. And, and so these same thing, whether or not we're trying to as a company in Novus is quite different than any other [00:26:00] orthopedic company because we look at the patient from trying to prevent injury.

To post injury, to operative care and postoperative care. And there's no other orthopedic company that does that. You know, the big, big companies, Stryker and Zirin and big companies like that only are working on that patient when they're asleep, um, you know, in the or. And, and so we think we have a unique approach to trying to, this what we call a continuum of care.

So any joint in the body. So foot and ankle is a huge one because we, you, you know, there was a player on the Dallas Cowboys last night. I won't name his name, but he had our walker on, he's on the sideline. Um, I noticed it probably no one else did. Um, and then you talk about, um, there's a surgeon that. Most of these ideas and things come from surgeons.

The surgeons are looking for these ways [00:27:00] of trying to take care of patients and physician up in Los Angeles, Steve Snyder, if you ever met Steve, Dr. Garcia and Steve Snyder's shoulder surgeon was the first one to start putting people in a postoperative pillow position themselves and take strain off of the, you know, the reconstruction for their, their shoulder.

And, and, and so it's what I'm most excited about this as a company and as an, and continuing to work for another 38 years or whatever it's gonna be, is the innovation that's coming from the surgeons. When they see a problem and they're not satisfied with what they're trying to, to do for that patient, they raise their hand and they, and they're, they, they reach out and say.

Hey, I have an idea, or, boy, have you guys thought about this? Um, it, it's, and, and that's gonna continue. That, that's not gonna change that, that I can see from, certainly for sports medicine surgeons.

Dr. Grant Garcia: Yeah, I mean, I think that's an important point. We've talked about this before, will, [00:28:00] but you know, the innovation is a collaborative effort, as you mentioned, right?

It's not only do we see, how do we see the problem finding the company to work with and finding the right people to work with from both parties. Right for the company's party and then finding the surgeon the best fit and then finding a problem that actually works, and then looking at the science behind it.

It's all really important. We've talked about this from the sort of, we talked about from the napkin to reality, like one of our first episodes, how you take an idea. It's a lot and it's a lot, and again. What's different though, I think which you could bring this up, is from the bracing standpoint, the innovation is still a pretty strong long period, but it's a little bit faster, right?

You don't need the same regulatory stuff as you would. That's with like a biologic or something else. So you guys can have ideas to, I mean, what would you say? This is interesting for the listeners, and actually I just think for all of us to hear, what do you think, like, let's say I came to you with a great idea, right?

And it's something that we kind of just knew you gotta test the water, see if there's any patents or other things out there. But let's say it's a good idea, it's a, it's a workable idea. What [00:29:00] is kind of the timeline for you guys to kind of put a product out like that roughly?

Michael McBrayer: So it's a great question because we, we do get the napkins occasionally of the, the napkin to, to a product.

Uh, we get, um, individuals who have. Fully blown, uh, prototypes and, and have worked on their ip, et cetera. So you have that spectrum that you, you just described. So the napkin to something could be, you know, like, like a three year project, uh, to get it all through your, our requirements. So these devices are what we call class one devices and Class one devices do not have very large hurdles.

To get over in order from an FDA standpoint? Um, yeah. So we don't have those kind of requirements that, uh, implants have, uh, for bracing. So obviously our implants for foot and ankle and our surgical total hips, total knees, total shoulders, all have those requirements. And, and those, like you said, take longer term because of some of the, those requirements.

Um, but [00:30:00] it's still an arduous mechanism to try to get something that's a manufacturable. Reproducible economic product, um, that you can launch and, and have an impact in the marketplace.

Will Sanchez: Are, are, Michael, are you, are you seeing or have you seen in the last 12 months? Six months, three months and uptick of ideas now that everyone, uh, has access to ai.

Where they can pop in ideas and that's, and come up with things. And so are you seeing anything like that futuristic that's kind of going across your table or maybe the table of others in the company?

Michael McBrayer: No, and I, so no, there hasn't been an influx of new ideas. Now we're, so AI for us as a company on the bracing side.

Mm-hmm. Mm-hmm. Um, we haven't. Really made much progress with it in the standpoint of [00:31:00] creating manufacturing product. Okay. Where the implant or the importance for AI has been for us is we, we have a software package and program that runs D-M-E-D-M-E is durable medical equipment, so all the braces and supports that are in a physician's clinic.

Are can be insurance billed. So if you went in to see Dr. Garcia and he says, you need a walking boot, or you need a, um, an elbow brace, or whatever the case is, those products have a billable code that then insurance companies will reimburse that patient for those items. But it has to be done properly. It has to be coded properly, the inventory has to be done.

So this. What we call Motion MD is this operative software system that gives information to the clinic. We run, uh, clinics for that as [00:32:00] well, but it, it's complicated business. You know, it used to be the practice of medicine. Now it's the business of medicine. Right. You can't, you used to be able to not worry about whether you build something properly or you gave product away or something and you, you just, you can't do that anymore.

So this product, what I call a product, but it's a, just a software that you can get the patient's insurance in real time. Medicare and these entities are making requirements. There's a thing called Same and similar. So if you had a product four years ago and Dr. Garcia decided that that's, he wanted to prescribe that, didn't know that that patient had already had a product similar to that, that Medicare would call that.

It's, it's pretty scary. Um, so we have the same in so we can, we can quickly check for the patient to see if they had something like that. So it's operationally we're using [00:33:00] AI from the standpoint of how we react, you know, work with a clinic and, and a group. Um, we haven't used it much in, in what I call product development yet.

Dr. Grant Garcia: I think that's a good point. Will, I think the thing you're, the thing we keep thinking about is we still think I, AI is so smart that it's, you're gonna be like, Hey, gimme the next bracing idea and we're gonna put it out. The problem is, I think right now, we talked about this on our AI in Medicine episode.

We did it a few months ago, but it really, right now it's just not smart enough. To come up with that level of whatever. And then, okay, by the way, we need to do this. It's multiple levels of steps, right? I see a problem. How do we fix the problem? What is the problem? What's realistic problem? Before you even come to a company like this to show that?

And we've already, I mean, I know this 'cause I work with a bunch of comp different companies on different product design things, and you think you have such a good idea, you spent years planning, prepping, thinking about it, and then you send it out and it's like. Yo dude, that's like, we've done that like seven times.

Like that's not the idea. [00:34:00] So, you know, and then, and then it's more like, you know, it's, I guess AI can throw more things at the window till they get the right one. But it's, it's, it's not so straightforward and the command you need for that. So I think we've, I think Will was, will, so this when we did our episode is that a lot of times this AI really is just how does it make your things more efficient and not make mistakes?

And within insurance companies, how do we, how do we improve our efficiency to get our things approved and make sure we follow all the rules. Really, no one here is here for any fraud or any other attempts in medicine. All we wanna do is make sure the patients get what they want, and our barrier is insurance and we need to make sure we do that appropriately so.

But they make it complicated. Oh yeah. I know. I have a lot of You have the best

Michael McBrayer: intentions. Yeah, so the intentions are not, you know, I agree with you. Nobody's sitting out there going, Hey, I wonder how much I can get out of an insurance company. You're just trying to follow. Stay on the road, keep on the guardrails.

And, and go about your business and that's what this software can [00:35:00] do.

Dr. Grant Garcia: Can you talk about, uh, some of the, I guess this is important. There's two parts. I think the first part is has is three. We've talked about 3D. We're gonna talk about 3D printing I think in the near future. Yeah. For an episode. It may come actually out before this episode, but we have to see.

But how is 3D printing is any part of that part of your scale or where you guys are going in the future?

Michael McBrayer: So we're, we made a, um, recent acquisition, uh, Lima, uh, which is a surgical, uh, company in, in Italy. Um, they, we actually house a 3D printing segment at HSS in New York City. Uh, but it's for surgical implants.

Um, our experience for 3D printing on the bracing side has been. That it's a very expensive mechanism to create something that we make with different materials already. So, um, so far the expense of 3D printing has [00:36:00] not allowed us to, to do it On the bracing side, it, we are as, as I said, working with it, uh, as a surgical implant product.

Dr. Grant Garcia: Cool. Yeah, that's a great segue. That's perfect. Um, on, so go bracing. I kind of wanna get into the major company itself too in a second. Mm-hmm. Um, but I really want to know the, we talked about the surgeons. Do you guys ever, how do you guys work with, like, you know, you have the athlete, right? You have that initial start, right?

The guy wore the sleeve, doesn't wanna show it in the games 'cause he doesn't wanna have his things. And now it's all about branding. I mean, we've talked to a few companies, which we, we will, we can go into later. But that have said that, you know, like they have a lot of trouble. Some of the athletes wanting to, I mean in the NFL and those things sometimes we're embracing, you can't, right?

You just don't Correct. You can't wear the elbow brace. You can't in some cases.

Michael McBrayer: W

Dr. Grant Garcia: have you, what barriers have you had from, for athletic adoption of these braces? If it was allowed? So like, you know, we saw Thibodaux, uh, for the Giants, he wears an elbow brace, like that's allowed, right? So there's certain things that are allowed, certain things, but they don't have the [00:37:00] brand on.

Michael McBrayer: Okay, got it. So, so that's important. So no branding. So the, so the equipment manager, at least in the NFL world mm-hmm. Is responsible for what they call uniform infractions. Yep. And we get away with a couple. I'm not gonna tell you how, um, no, I'm kidding. The, but they, they're serious. I mean, like, if the quarterback when he goes to the sideline doesn't wear the right hat, the NFL says, you didn't wear the right hat.

Um, all of our braces, so they're, you're not supposed to show the DonJoy brand 'cause we put it on the calf cuff of a brace, knee brace. Uh, we have these wrist wraps that a lot of players wear and has DonJoy on it. You know, they'll typically tape over that so that, uh, the NFL is very, the no fun league, if you wanna call it.

Um, they're very critical because there are. They know if we [00:38:00] wanted to get a sponsorship from them of, and, and we can, we could approach the NFL and say, Hey, we, we want to be the knee brace of the NFL and it costs an a significant amount of money and we just don't see, the patients are not making a choice.

They're following their doctor's orders. So it's not like they're going to the store trying to find a DonJoy knee brace. Um, so we haven't done anything like that from a, what I would call a commercial standpoint, except I would, and the NFL is very, would,

Dr. Grant Garcia: I would second to you on that one. I do have patients asking for a DonJoy, even though it is not good a, uh, but you know what I mean?

People ask for these braces will, I don't know if you've ever heard the name, but people ask for, I want, I, and I'm not, I don't wanna bring up your competitors, but I have, you know, they ask about the competitors and they just say, I want this. Predator. I'm like, but you don't even know what that means.

They're like, I've heard the name, so I want the DonJoy. But there's like you, you guys have probably, I mean, how many different braces do you think you have even for the knee? [00:39:00] 

Michael McBrayer: Oh my gosh,

Dr. Grant Garcia: too many, quite honestly. So when someone asks for a DonJoy, they don't really know what they're asking for. They're, they have like no idea, I want a car, I want a Mercedes, Jordan's.

Michael McBrayer: Well, because we have osteo arthritic knee braces, we have patella femoral knee braces, we have, so all these, in fact, Dr. Cole actually helped us with a, uh, our OA Rome brace. Um, so yeah, you're right. They have no idea what they're talking about.

Dr. Grant Garcia: Yeah. Um, so I want to pivot, even though I love the bracing, we could always come back to it, but we also have a, in a matter of time, we, we have to, we always do this, but at 60 minutes we have to cut it off 'cause it's just 'cause of the way social media.

Oh. I'll be tired of you guys

Michael McBrayer: by then

Dr. Grant Garcia: for sure. I'm tired of you guys right now. So can you talk about the other companies you guys work with? Uh, yeah, because I think, I think the biologic one is gonna be hot. Like what companies do you have from the biologic standpoint and how does that influence, you know, the other sports medicine realms?

Michael McBrayer: So we, we haven't entered the biologic, uh, [00:40:00] space yet. So the, the areas of, um, of the company that we haven't, um, if you want to call it musculoskeletal care, um, we. We don't have anything surgical in spine. We don't have what you would reference surgical sports medicine. So those are big, big segments for, in Novus to, to consider, to try to enter as a market because they're, they're large, they're growing.

Um, our largest, uh, growing segment is our foot and ankle surgical business, and we put that together through acquisitions. Multiple acquisitions now has made that a hundred million dollars, uh, surgical foot and ankle business. And, and I, I, I, I profiled sports medicine surgeons as the, the darlings, you know, foot and ankle surgeons are good people too.

They, they, they kind of have the same profile of, of approach to patients and such. [00:41:00] Um, our total joint business. Total hips, total knees, and total shoulders is very, very small in comparison to the large competitors. Uh, where we do compete quite well is in, uh, the total shoulders. Mm-hmm. Reverse total shoulders being the, the probably the biggest, uh, competitive piece that we have.

Um, and, and, and a. A surgical intervention that's, that's quite successful. Right. I How do you find that integrates

Dr. Grant Garcia: well with the bracing side of things? Like, I mean, again, the comp, the company's got multiple brands to it. Right. You guys have talked about, you know, you do, I wanna talk about this electrotherapy, some of the other equipment stuff you do on side of the braces, uh, in a minute.

Um, but how does your abil, how does your company having reconstructive implants. You know, for hips, knee, and obviously biggest is shoulder. I've heard about the shoulder for sure, and a lot of the other ones. But in Nova, uh, NVU, uh, for the shoulder is important. How does that help integrate with the protein?

How does that make you guys better?

Michael McBrayer: Yeah, so again, we're, if we take [00:42:00] this continuum of care approach, so you may or may not be fa familiar with the No Pain Act.

Dr. Grant Garcia: I ha It's a little bit, I mean, I think I get too many emails about it, and I, I can't imagine that I, I'm not gonna say I read 'em all. Yeah. But I So you explain that

Will Sanchez: because I, I, I'm not aware of that.

Yeah. So, so,

Michael McBrayer: so the, the No Paying Act was a recent act and, and by the congress and Senate to pass to include mechanisms for reducing opioid use, postoperative care. So they were looking for, um, products that would be, um, use that would reduce opioid use and be safe and effective. Well, cold therapy, motorized, cold therapy has been, and a very, very effective product.

And there, there used to be a billing code. You guys are wonderful with the yard. A little [00:43:00] flash up there. Good job. Um, but cold therapy had a code that people were billing, but it was abusive. They, they were billing it improperly. And so Medicare just stopped reimbursement for cold therapy 20 years ago. Uh, even though it's a very, very effective mechanism for postoperative pain.

So through the No Pain Act. Uh, we've been going through a comment period. We're supposed to hear quite soon whether or not, uh, this iceman device is going to be approved by Medicare to be reimbursed. So, Dr. Dia, when you were saying, you know, how does it, how does this happen now? Okay, I have a total shoulder surgeon or have a, a total knee surgeon, so.

Now we say, even though they're two different entities, the divisions are different, but we can introduce the cold therapy now to take care of this opioid issue and pain relief as one entity, right? [00:44:00] We're gonna come to you and say, Hey, we know you use our shoulder. This No Pain Act now gives us an opportunity to take care of your patient with a reimbursed cold therapy device.

That's important point. And so that's where's important point connection

Will Sanchez: can come. Gotcha. Thank you. And

Dr. Grant Garcia: also, I think the thing you bring up was like, like a lot of you said, we keep talking about these cold therapies. They're not covered by insurance because it, it's just, even though, even though I will tell you, and you know this and we don't need to go into different products that we use, but the cold therapy situation, it, it, it makes a huge difference.

I will tell you that, that it's not just anecdotal. It is, I, I, I don't know enough about the data on cold therapy and I wish I did. Um, but I can't imagine, I think will, will say the same, that cold therapy is not, does not reduce opioid use. It's just, I mean, I'm sure it does, but I'm just, I can't believe there's not more things.

The problem you have obviously with all these studies, postoperative pain is that, you know. All surgeries eventually stop hurting, hopefully, if they're done well, and it doesn't usually take that long, so it's hard to [00:45:00] capture that data. Right. Like two or three days left. Pain.

Michael McBrayer: Well, pain studies period are difficult to do.

Uh, yes. The one study that we, um, that was recently done, I don't know if you know the name, Sarah Edwards. University I do not of California, of San Francisco, so, oh, okay. Look, look for her recent, uh, research that, um, we think her paper was the thing that crossed the barrier from Medicare to get it reimbursed.

So that study was, was paramount to, to our approach in getting, um, getting it, getting it approved.

Will Sanchez: W was that a postsurgery study?

Michael McBrayer: A post-surgery postsurgery recovery, yeah. Post

Will Sanchez: study.

Michael McBrayer: So it's, um, so Sarah Edwards, like I said, is at the University of California San Francisco. The paper, I'm trying to remember where it, so she's presented already and it's been accepted in one of the journals.

I don't know if [00:46:00] it's the Anna Journal, but it, you'll find it. Yeah, I can. I mean, again, the key here is just abstract. We wanna

Dr. Grant Garcia: show, you know, we want to show, basically the key is for patients to hear. This is like, it does make a difference. Opioid reduced reduction is very important. It's now tied to insurance reimbursements.

Uh, and again, hopefully it's just, again, hopefully it all, it all comes down the same line. Can you, um, talk about now do you have any, like, how, how does this sort of, I know you, I'm again, I I have the list of the brand portfolios that you guys work with. Yeah. And I'm interested in each one of these things.

How does the re rehab, so you, you can talk about this, you have all the lines, right? You have the surgery, you have the pre-surgery, you have the post-surgery, you have going towards potential long-term. Biologics, things like that. How do you, how does the electrotherapy and the rehab sort of side of things help with your stuff?

I mean, I, I kind of know where it's going, but what are your thoughts? Yeah. Like how does that go?

Michael McBrayer: So, some of the recent, um, product [00:47:00] enhancement, so we, laser therapy Yes. And shockwave therapy, both, um, are very effective and. Can take care of tendinopathies. So when, when patients come to you, um, with a tendinopathy issue, so like, you know, the, the Achilles flaring up, not a tear, right?

Uh, tennis elbow, you know, golfer's, elbow, whatever. All these littleon issues are non-operative issues for an orthopedic surgeon, and you don't want a lot of those people coming into your office because. You're a surgeon and you want to do surgery. Um, so I'm not gonna deny you, I'm

Dr. Grant Garcia: not gonna deny you. I,

Michael McBrayer: I, you're called a surgeon for a reason.

Um, but the, what I, I mentioned the American Medical Society for Sports Medicine. These are fellowship trained primary care. You know, sports trained individuals [00:48:00] and so they can take care of non-operative issues in using laser, using shockwave and mechanisms for these patients to, again, get back to, to the level of what they were trying to do without a, uh, you know, getting cut on, so to speak.

Um, so that whole spectrum for primary care sports as well as physical therapists, sports, physical therapists. You know, the, the, the, the PT networks and, and you know, there's a, again, the specialty of sports, physical therapists, um, that know how to take care of these patients, um, again, potentially non-operatively.

And then, you know, I. Every good orthopedic surgeon has their favorite physical therapist to take care of their patient after they do an an operation as well.

Dr. Grant Garcia: Yeah. Well, I, I think that's great. I think that, that, I don't wanna segue too much in that will, but that obviously the laser therapy and the shockwave therapy is humongous.

It's humongous for tendinopathies, but also the [00:49:00] laser for postoperative, which a lot of there. But also as an orthopedic surgeon, you're entrepreneurial business-minded. A lot of us, I'm private practice, so you always look at how a way to keep the patients to make sure you have every level for them to take care of it.

So, you know, a lot of people use the laser therapy preoperatively and also sometimes postoperatively for wounds, et cetera, and pain control. And there's been recent some AO s data on that, which we won't go into too much, uh, today, but that's a really important part you brought up. So again, you see, sorry, you keep going.

Michael McBrayer: No, I was just gonna say, and those, those types of, uh, procedures are un unfortunately today at least, that those are things you have to talk to the patient about paying cash for.

Dr. Grant Garcia: But, so as we know in this day and age, there are patients that want to pay that, which we've talked about before. Absolutely.

And the thing is, I would rather my patient be offered at a cash option than nothing. So at this point, it's not like I always tell that to the patients. I think Will, this is obviously a topic we talk about. We've talked [00:50:00] about it with the recovery shop I brought up. Yeah. A lot of things aren't covered by insurance, but patients want more.

I know I'd be in the same boat. I know a lot of us would be in the same boat. We all know that. Like if we want, as much as the surgery is covered by insurance and it's a huge financial burden and it covers. You don't want a problem with it. And so sometimes the, the little extra things to reduce those things are a big deal and people are willing to do it, especially if it's not covered by insurance.

Again, my whole goal as we talk about before and you talk about this, is get as much as you can from the insurance company to approve and if you want something extra, here are the options. Here are the risks and benefits. And again, the goal is to make it, you're not gonna break the, you don't wanna break the bank.

You just want to offer something that's you think is gonna be helpful to them. And we all know that insurance is 10 years behind what we're doing, if not more, in terms of the options that they can give to patients. It's just, I mean, sports medicine, we know this all the time. I have this on a daily basis with, talked about recently the fertilized ACL right?

Insurance won't pay for it, but there's good data on it. And we just talked about it with Chad Lavender. So [00:51:00] it, this is important, uh, stuff to talk about. I don't want to, well I think it's belabor

Michael McBrayer: it. Well, I think it's, I, I reference it now as the consumerism of medicine. So now an educated consumer can make a choice about their care.

Um, and, you know, in the past I've just, well, my insurance is gonna take care of it. I'm so, so having an intelligent choice and having them be a consumer of this kinds of things, I think is, is good for, for everybody.

Dr. Grant Garcia: I think one more question then we'll do kind of a wrap up future question. Do you guys deal with, oh boy, pediatric p No.

It's hopefully easy for you 'cause you've, you've done this for so long, you know this, so the PIA pediatric bracing, do you guys deal with that and is that a different level of what you have to, is it anything different for you or is it just part of the same envelope?

Michael McBrayer: Yeah, so we've been treating it in the same envelope and we [00:52:00] shouldn't, um, pediatric, um, injuries and, and pediatric patients are not small adults.

They're, they're, they're different. And, and we, we as a company need to make an effort related to changing our thoughts and, and how we approach these, um, injuries in these types of patients. Um, the pediatric sports medicine specialist. Is, is now a thing. You, you have organizations that are strictly, uh, focused on pediatric sports medicine, pna, um, as an organization.

So, you know, people are doing a sports fellowship and then doing a specific pediatric sports fellowship. And, and so the, the number of these individuals is growing. So the fact that that specialty is growing, we as a company have to. Listen and start approaching these patients differently than what we, and then just making an extra, extra small, that's, [00:53:00] that's not gonna get the job done.

Dr. Grant Garcia: I brought this up before on the show and Will knows this, but we've, we've come along in sports medicine, which is whether you wanna say it's good or bad, but we've had become more aggressive with pediatric patients because it used to be the thing like, dislocate your patella as many times as you want, you're fine dislocate your knee as much as you want, your fine dislocate your shoulder.

And I mean, there are a number of papers coming out that. Even first dislocation is not okay. Correct. Second dislocation agree is not okay. And so as a result, this is a really important point because that's why you have more surgeries, more people being involved in pediatric. 'cause we realize that if I can, that's the whole point of joint preservation.

Like I just saw a 16-year-old girl today dislocated her kneecap and broke off piece of cartilage. It's like, ugh. Some people might have just left it alone for another 10 years and waited till she had a lot of pain, but we're gonna actually take care of it because I know that that's not gonna be good.

10 years. I know that's not gonna be good in 20 years if we don't intervene. And we've learned that. Yeah, I agree. Right. It's the same situation. I completely agree. Is what you're talking about. Uh, [00:54:00] the, I guess we'll probably ask any closing questions, but where do you see the kind of, I know the company itself, where do you see the future of DonJoy going and where do you see the future of the company going

Michael McBrayer: and the, the future I, I, I referenced earlier is, is that these physicians are gonna continue to make us.

Change and do things. So that collaboration, um, which we have a, a reasonable reputation that people approach us because we have a, uh, we've done things with surgeons and, and reputable surgeons, and people know that we will at least listen and try to do some things. It may not turn into a product, but the innovation and needs for, uh oh.

Did you guys leave?

Will Sanchez: No, we're still here.

Michael McBrayer: We hear you. Oh, good. We are here. My, my screen just went blank. Um, I think when you look, you still look good. You

Dr. Grant Garcia: got it going. Keep going. Sorry.

Michael McBrayer: The collaboration between [00:55:00] surgeons who are gonna want to try to continue to take care of their patients and companies, not just a ovu, um, is still the most exciting thing for me to, to, to be involved in.

Will Sanchez: Awesome. Michael. Uh, thank you so much for your candor and really, uh, honest answers. I, I mean, it, it was, uh, it was a privilege hearing about your journey, the vision for the future. Uh, not only the company but sports medicine and, um, it is just, uh, we really appreciate your time. We're glad you're feeling better.

Uh, tell Christina I hope her, uh, dolphins are doing well from all of us. And, um, once again, thank you so much for your time. We'll, we'll let you go. I know it's laid out there on the East coast.

Michael McBrayer: Oh no. I'm in California, brother. I'm all good. Oh, sorry, Christina, go to

Will Sanchez: bed. It's late for Christina.

Michael McBrayer: Thank you so much.

Hey guys, I enjoyed it. It was, it was, it was a nice experience. I appreciate your time. Thank you, Michael. Thank you. Take care.

Bye.

Audio Transcript

Dr. Grant Garcia: I'm good. It still sunny for another day or two where summer's just stretching on in Seattle, so I can't complain.

Uh, unfortunately the giants are back to being terrible, which we don't have to talk about today. But the Seattle teams are doing well decently, so that's good. Mariners won. So we're excited about that. I guess.

Will Sanchez: Yes. Let's not bring up, why are we starting off the show with the Giants? Dr. Garcia? Man, you, you know,

Dr. Grant Garcia: it's always

Will Sanchez: we need

Dr. Grant Garcia: something.

Will Sanchez: Not doing this.

Dr. Grant Garcia: We had one game. We had [00:01:00] one game.

Will Sanchez: Oh my Lord. All right, man. Let's get to people that really care about us, 'cause obviously you are just trying to break my heart. Let's talk about the good folks at the Recovery Shop. The shout out to contact Mike b. Talk about the recovery shot and why you love them.

And our guests as well loves them as well.

Dr. Grant Garcia: Great. Yeah, so we, we like them because honestly, patients ask for a little bit extra sometimes, and it's challenging as a surgeon, you send them to, you know, Amazon or online to look for their stuff. So the option of having this for the patients is really nice. Uh, and the patients do appreciate it too because it's all kind of there together.

And you have the nice machine, which Dr. We, I think just tried out one of the new elbow devices, uh, which is really nice for patients. That's really a, a niche that many of the companies can't provide. Uh, so they've been really happy with them and I think the patients are really happy, which is more important.

Dr. Wayne Weil : Mm-hmm.

Dr. Grant Garcia: Uh, so if you're a surgeon, reach out to them. If you're a patient, you don't have that option, reach out to them. They can try to get your surgeon set up with it so that you can have that opportunity.

Will Sanchez: Let's get right to our guests [00:02:00] because we're keeping him from getting dinner, and that's a tease for something that we'll talk about later on.

Um, let's bring in the doctor, the hand, the wrist and elbow specialist himself. Dr. Wayne Wild. Dr. Wild, thank you for being on. Thank you for hanging with us and I apologize for Dr. Garcia bringing up things to start off the show in a negative way. How are you?

Dr. Wayne Weil : Uh, doing great. Uh, happy to be here. Thanks for the invitation.

Dr. Grant Garcia: Yes. Uh, so for the viewers introduced Dr. Al. He's a hand surgeon, actually, he's my partner. And we do a lot of cases together. Complex, uh, elbow surgeries. Um, and he specializes in hand, uh, wrist, um, and elbow and then dabbles with trauma as needed, uh, but really super specialized in the hand and nerve, uh, surgeries.

Also, chief of orthopedics at the Swedish Hospital system. And board of directors. So he is got extensive title and Pro Alliance as well as Pelto and he actually does family stuff as well on top of all that huge list. [00:03:00] So pretty impressive. Well, thanks for coming on. Really appreciate it. I'm sure Will's gonna have lots of questions to ask too.

Um, for the viewers, do you think you can kind of give a quick background? You know, I know you came from New York. Talk about your stuff and you know, now you're in Seattle, so just give us a little update and into who you are and where you came from.

Dr. Wayne Weil : Sure. Uh, yeah, I'm an East Coast guy originally, uh, grew up, uh, outside, uh, Bethesda, Maryland.

Uh, ended up, uh, uh, doing my, uh, college in Philadelphia and then, uh, resident med school and residency in New York City. Uh, then ended up out here, uh, for a hand surgery fellowship. Uh. And just kind of fell in love with the Pacific Northwest. And one of our other partners, uh, Dr. Shapiro, uh, who's a shoulder specialist here, uh, I knew him from New York, from, he was a fellow while I was a resident, and he ended up recruiting me to stay out here.

And, uh, now 21 years later, I'm, I'm [00:04:00] still here in Seattle. Uh, we now have five kids. As Dr. Garcia mentioned, uh, I've gotten involved in, uh, sort of, uh, non-practice stuff, uh, with, uh, being chief at, uh, Swedish and the board positions at Proliance. And, and then I've still, uh, at my, uh, practice where, uh, you know, I really enjoy just treating, uh, elbow, wrist, and hand and, uh.

I do a lot of that, whether it's uh, you know, sports injuries and, and younger folks or, or degenerative stuff and older people, arthritis, uh, stuff. So kind of do a little bit of everything, uh, except maybe sleeping, which, uh, I would like, but that's okay.

Will Sanchez: Dr. Uh, what can you tell us what first sparked your interest in hand in, in microvascular surgery, you know, how do you go along that [00:05:00] path and have that interest?

Dr. Wayne Weil : Yeah, so that really started in, in my, uh, fourth year of, uh, residency, um, as part of our residency program at NYU and Hospital for Joint Diseases. Uh, we do, uh, a four month rotation down in Baltimore at, at, uh, shock Trauma Hospital down in Baltimore. Um, and at the time, uh, there's a surgeon there, uh, Andy Seder.

Um, and, uh, Dr. Seder, uh, to this day, I think is the, the best surgeon I've ever seen operate. Just, uh, you know, I think, you know, for, for lack of a better, uh, descriptor, you know, gift from God in terms of, uh, he could do anything and it was always perfect. And, uh, so he really got me interested in, in microsurgery and, um.

Uh, kind of the rest is history from there. [00:06:00] Uh, so, so it's, I think, you know, in a lot of our lives, uh, you know, just exposure to, to, uh, a good mentor really can pave the way moving forward in terms of, uh, uh, really career paths in general. And, uh, yeah, I think, uh, Dr. Seder is really the, the, the person who who got me interested in, in, in what I'm doing today.

And then, um, you know, fast forward a couple years, uh. Doug Hanno, um, at, at University of Washington, who I did my hand surgery fellowship. Uh, another just phenomenal surgeon. Um, and, uh, you know, uh, Doug in, in a very similar way with Dr. Eder, you know, could fix anything and, and just an incredible surgeon and, and so, you know, like having the exposure to those two docs in particular. You know, I, I, [00:07:00] I stand on the shoulder of giants, uh, and, um, you know, I, I, I certainly give a lot of credit to those two guys for, for getting me to where I am today.

Dr. Grant Garcia: Uh, Wayne, I wanted, I wanna bring this up. I, because I think that's probably your answer is gonna be this too, but. You know, we see in the office, we talk about, I do a lot, you know, we talk about the sports surgeries that I do, but I see you doing a lot of really complex hand and wrist surgeries that not everybody would want to take on, even as a hand surgeon.

Do you think, and I don't wanna put too many words in your mouth, you think that stems from that background you're talking about? Or why do that? Like you could, your private practice, you could just do carpal tunnels. Yeah, procedures. You don't have to do the hard stuff. Why do you choose to?

Dr. Wayne Weil : Uh, you know, uh, maybe I'm just a masochist.

Uh, but I think that's true of kinda all the guys in our practice. I mean, we could all just do the simple stuff, but, uh, I think [00:08:00] we all enjoy the challenge. Um, you know. For me personally, if, yeah, I enjoy doing carpal tunnel surgery, but you know, uh, I would get bored if I just did that all day long. And, and, you know, for me, uh, maybe I'm blessed with the ability to do the hard stuff.

Uh, and, and I enjoy doing it. And, and I think that serves a, a niche for our patients. Uh. In terms of, you know, we, we see a lot of patients in our practice and, and, and you do, uh, as well, where, you know, they've bounced around to different docs in the community and, and just, uh, for whatever reason, you know, I haven't been able to, to get the care that they need.

And, and so for me it's, it's very gratifying to, to see a patient who's maybe seen a few docs, uh. And, uh, [00:09:00] has been told, you know, uh, we can't help you. You gotta live like this for the rest of your life or whatever it is. And, and to be able to see them and say, actually that's not true, uh, that we can help you and I can make you better.

Um, and, and I think. You know, that's why we went into medicine is, is to make people better. And, uh, um, you know, it's very gratifying. I think the, the more complicated a, a problem is in a lot of ways, it, it's even more gratifying to, to get to the other side where, where you've made somebody better. Like, um, so, and, and again, I think, you know, going back to the training, um.

Both at Shock Trauma in Baltimore, both at Harborview. I mean, we saw the craziest stuff you could ever imagine, you know, horrible injuries, uh, you know, whether it's, you know, explosives or industrial [00:10:00] injuries or, or what have you. And, you know, those two guys in particular, handle and Eder, they were just, you know, always so calm, always had a plan and, and able to execute it.

And I think having that kind of exposure where, where you've seen, you know, everything. Um, so when somebody walks in the door with something complicated, uh, you know, you, you, you rely on your b on your training and then your experience, you know, I've been doing this now for 21 years, been in practice. Uh, so I feel like, you know, there's not much out there that I haven't seen.

Uh, and so. That, that makes me prepared to, to take on the complicated stuff.

Dr. Grant Garcia: Awesome. Um, do you, so I know we talked about this, but the, obviously we might switch gears a little bit. Yeah. But the, coming from the complicated to maybe the more minimally invasive stuff that you do, I know you're, [00:11:00] you know, we know you're one of the only surgeons in the area that does this sort of endoscopic carpal tunnel, endoscopic cubital tunnel.

Will you talk a little bit about those procedures? The audience. And then what is the benefit, in your opinion, of doing it this way? I mean, it's also more challenging technically, but obviously what's the benefit to the patient? Why would you do that versus the standard open?

Dr. Wayne Weil : Yeah. Well, I mean, uh, the name of the game in, I think all of surgery is, you know, being less invasive, less destructive to the tissues.

Um, and, and that really. Um, you know, helps on the backend in terms of there's less stuff to heal. Right? Um, again, going back to my residency, you'll, you'll appreciate this story. Um, I was a third year resident and, uh, uh, scrubbed a case with a doctor, uh, who was, he was the only one in the NYU system still doing open [00:12:00] acls and.

And I done it. I'm shivering

Dr. Grant Garcia: by the way.

Dr. Wayne Weil : I'm

Dr. Grant Garcia: shaking. I'm having like,

Dr. Wayne Weil : you've probably never even seen one. Uh, so, um, and, and this is now circa 2003. So at this point, uh, or 2000, 2001. Uh, at this point, you know, uh, arthroscopic ACL surgery was a standard thing. I mean, it's not like, uh, it was brand new. People have been doing arthroscopic ACLS for 15, 20 years probably at the, at that point.

Um, and so yeah, so I scrubbed this case with this guy who's doing open ACL and, you know, the whole knee's filet open and, and. I couldn't believe what I was seeing. I, and I can't imagine what the recovery from that was. Uh, and having had an ACL done on, on my own knee, arthroscopic [00:13:00] ACL, I mean, it's, you know, worlds apart.

And so that experience in particular was like, well. Why would I ever do something that that was that traumatic, uh, if I can do it in a way that's, you know, not nearly, uh, as, as destructive to the surrounding tissues. Um, and so, you know, in residency actually, uh, we started doing, uh, endoscopic carpal tunnel releases.

And again, uh, smaller incision, less tissue invasion. And we'd have patients who, you know, had an open on one side and then came back and had the endoscopic on the other side, and they were like. The, every single one of those patients couldn't believe how much easier the, uh, the recovery was with the [00:14:00] endoscopic.

Just less pain, quicker return to work, better function. And, um, you know, the data has kind of borne that out, uh, when you look at the recovery. Um, again, just less pain, quicker return to bur and, uh, better grip strength in, in the first three months of recovery. Um, the opens end up catching up in the end and they do fine.

And, you know, at, at nine months, one year, everyone's the, the same. But why have an operation that takes you nine months to recover from when you can have the same operation, but it only takes you, you know, three months. Uh, and so similar to, to the, uh, ulnar nerve, uh, the cubital tunnel. Decompression the ulnar nerve.

Um, same idea, uh, is, you know, little incision. We do everything from the inside out instead of the outside in. And so, uh, again, you don't have to cut through any of the [00:15:00] muscles to get to where you wanna be. Um, and that just decreases the amount of time for recovery and, and, and gets people going a lot faster.

Um, and I think that's really. The exciting part in orthopedics, uh, where we're moving towards in general is, um, all the stuff we do is becoming less and less invasive. Uh, you look at a hip replacement, you know, you were in the hospital for a week when I was a resident. Now we do hip replacements, and you go home the same day.

Um. Same with, you know, knee replacements, uh, you know, a lot of the, the cartilage stuff that you're doing. Um, all of it is, is really starting to become outpatient surgery. I mean, even spine surgery is moving to, to outpatient surgery. Uh. And, and you look at the results, people do better when they're [00:16:00] home, uh, versus sitting in the hospital.

You know, you take the same operation, same person, your risk for infections and, and, and worse outcomes are higher if you stay in the hospital than if you go home. Um. So, uh, I think all of orthopedics, and especially in my specialty, you know, trying to do things in, in a minimally invasive way, it just, it just makes sense and it's better for the patients.

Um. In a lot of ways it's more fun for the surgeon 'cause uh, we get to play with cool, uh, new instruments. High

Dr. Grant Garcia: priority. That's the high priority there.

Dr. Wayne Weil : That's right. Um, you know, it's fun to go to the lab and kind of innovate and, and, and work with, uh, some of the, uh, companies to, you know, come up with, uh, you know, novel ways to do things.

Um, so, uh, I think it's sort of a win-win all the way around.

Dr. Grant Garcia: Will, can you pull up that slide? [00:17:00] Um, on the nano? I don't want to see, 'cause we're talking about, we're in the perfect example. Segue. Go to the next slide here. Lemme just do it.

Will Sanchez: Yeah, I have, I have, well,

Dr. Grant Garcia: yeah, Wayne right

Will Sanchez: there.

Dr. Grant Garcia: Yeah. So this is a, this is good.

You, I mean, we don't have to do the proprietary discussion here. I just was a picture, 'cause I know you've used this before. So for your minimally invasive situation, I mean, what would you use. Something small like this for, right. Yeah. Like the idea behind patients are always curious like, well how, how small can you go?

I've seen you scope some pretty small joints, right? Something I would never consider doing. So what are your uses of this and like how do you help, what does it help you with?

Dr. Wayne Weil : So, uh, yeah, we've gotten to the point now where, uh, you know, the instruments, uh, have gotten small enough where, you know, in the old days you could basically do a shoulder, uh, and a knee, and, and we've now, you know, uh, gotten to where we [00:18:00] can basically scope.

Pretty much any joint in the body for the most part. Uh, uh, you can scope out to even, uh, the PIP joint, um, proximal interphalangeal joint in the finger. Um, you can, uh, scope, you know, the base of the thumb. That's probably the most common one that I, I do now. Um, 'cause the base of the thumb, the carpal metacarpal joint, that's the one that, uh.

Becomes, uh, classically arthritic. And so, uh, there's, uh, procedures now that we can, uh, do kind of like in the knee where we do, uh, for arthritis, uh, some clean out procedures. So the instruments, not only the camera, but also, um, the different little shavers and the probes and instruments that we use, uh, are small enough that they fit in there.

Uh, so you can really do kind of what the large joint [00:19:00] arthroscopists do. Uh, you know, the stuff that you do in the knee and the shoulder grant. Now, now I can do, uh, to some degree in, uh, the base of the thumb and, and in the wrist. Um, and so we're, we're definitely catching up, I would say, to to the large joint, uh, uh, arthroscopists.

And a lot of it just has to do with. The ability to, to make the instruments smaller and smaller. It's kind of like our, uh, computers and our iPhones and everything else in the world. Yeah. Um, you know, the first iteration is, is big and, and then, uh, as we get, uh, better with manufacturing and, and the technology, it just.

You get smaller and smaller and smaller, so then we can start really having a good time, uh, with the, the small joint instrument, uh, small joint arthroscopy.

Dr. Grant Garcia: Would you say with this, I mean, when I first saw you do one of those thumbs, I was like, this [00:20:00] is crazy. This is cool. Uh, would you describe, like, what were you like for that patient?

You know, you, when you do the metacarpal, when you do the scope of the thumb

Dr. Wayne Weil : Yeah.

Dr. Grant Garcia: For some arthritis. Yeah. What were you doing before for them? Right. Because these are patients, they're not, they're not old enough for you. Sure. Or any other thing. So what were you doing before? Were you, or just is this at a new surgery for you?

Dr. Wayne Weil : Yeah. So, you know, uh, I think of it like arrows in, in, in your quiver, right? And, and so. Um, you've got only a certain amount of, uh, arrows in, in the quiver. And, and if you can have more arrows, that's awesome. So, uh, for those patients, you know, that was like your, your 40 and 50 year olds with, uh, early stage degenerative arthritis.

Uh, they've had, you know, splints and braces, but nobody likes those. 'cause uh, you need your thumb to actually live life and do things. And so if you lock up your thumb. You know, it's pretty miserable. You can't [00:21:00] really do much at all. You can't type on a computer, you can't hold an iPhone. Um, you know, you can't garden or play tennis or whatever it is.

Um, so people don't tend to wear 'em 'cause they're, they really inhibit your activities. Um, so you, you know, the, the braces were sorta, yeah, you can wear a brace, but nobody likes that. Uh, then there's occupational therapy. Um. You know, to some degree, some patients find it helpful, but it's not really solving any of the issues, uh, internally.

Um, then we move on to steroid injections and sometimes those can be helpful. Um, PRP injections, sometimes those can be helpful, and then you're kind of stuck after that. There's not really any non-operative treatments that, that are reasonable to do. And then operatively, then we start talking about joint replacement, uh, which, you know, it's a big step for a [00:22:00] 40-year-old to, to undergo.

And so now we're able to do a, uh, procedure that can, uh, potentially buy people some time. Uh, and put off, you know, the eventuality of a joint replacement by ideally 10, 20 years when it's more appropriate to do the joint replacement as opposed to when they're 40 or 50. So, so it's really opened up a whole new, uh, ability to treat patients.

'cause otherwise it was, well you're 45 years old and we've tried everything. So either live with it or, or have a joint replacement. Whereas now I can say, well, you, you've, we've tried all the non-op stuff. We can, uh, now think about doing an arthroscopy and kind of clean stuff up for you. And, and ideally we'll buy you another 10, 20 years and then you have your joint replacement, you know, when you're 60 or 70.

Um, so it is been fantastic in, in being [00:23:00] able to, you know, treat patients, uh, uh, in a, in a much better way, uh, as opposed to just telling them well live with it.

Will Sanchez: I had a question for you. Um, talk about common hand and wrist injuries, uh, whether it's the pro and recreational athletes, and what's your thoughts on some of these names, like the skier's thumb?

Yeah. Or the jersey finger. You're from the East coast? I don't think the Jersey finger is what I'm thinking of. Ain't

Dr. Wayne Weil : the Jersey Shore,

Will Sanchez: it's not the Jersey Shore. So can you talk about that a little bit? Because the names are absolutely fantastic and Jersey finger means a thing on the East coast.

Dr. Wayne Weil : Yeah, no, it's, uh, so, you know, the hand world, uh, ends up with lots of crazy EPIs and uh.

As Grant knows, you know, people, uh, call us the hand weenies, uh, 'cause kind of the, the, it's the reputation of the hand. Surgeons are kind of the nerdy guys who, uh, [00:24:00] are way into minutia and. You know, uh, Dr. Gel Seder used to always say, you know, the leg is just a stupid weight-bearing joint, right? You can cut a leg off and put a piece of wood and give someone a peg leg and they can walk.

Um, but the hand, you know, that's a whole nother kettle of fish, right? You take somebody's hand off and, and they're really debilitated. Um, so, um. Yeah, the hand world. We've got all kinds of names for crazy stuff. Uh, you know, skiers thumb, uh, which actually was a gamekeeper's thumb in the old days. Uh, and not 'cause you're, you're playing games, but, uh, keeping game like small games, small animals.

So, uh. You know, uh, the farmers would be, uh, the classic is snapping the necks of rabbits, uh, with their hand and over time. Story

Dr. Grant Garcia: is crazy.

Dr. Wayne Weil : The ligament, uh, of the, uh, the [00:25:00] ulnar collateral ligament of the thumb would, would basically just tear. From overuse in all the years of snapping rabbits. Next. So Dr. Grant Garcia: we'll pull that slide up.

Pull the, not the rabbits. We don't have a rabbits.

Will Sanchez: We don't have the dead rabbits. No, no.

Dr. Grant Garcia: Hold the thumb. Uc. Pull the thumb UCL up while he continues. Keep going Wade.

Dr. Wayne Weil : So, so, you know, fast forward a couple of centuries and, uh. You know, skier's thumb or mountain biker's, thumb, you know, if you can imagine you're holding a ski pole and uh, you fall, your thumb's kind of exposed out there and it gets wrenched back and, and it gets torn, uh, the ligament gets torn.

Or if you're mountain biking, uh, same idea. Your thumb's kind of exposed and you go over the handlebar and kind of superman out and your thumb gets yanked back. Uh, so it, it ends up tearing, uh, the ulnar collateral ligament, um, [00:26:00] which is the, the kind of, i I tell people that's the ACL of the thumb, right? So if you tear your, your ulnar collateral ligament, what it ends up happening is, is.

You can use your thumb and you can move it. And once it's the, you're, you're, uh, recovered from the acute injury, but the, the cartilage is going to, uh, be stressed in a way that it was not built to be stressed, uh, as the thumb kind of pivots abnormally when your power pinching and grasping. And so, you know, the reason to repair the thumb, UCL.

Kind of like the ACL is in a large ways is to prevent arthritis, uh, from happening, uh, in a pretty short, uh, amount of time with the cartilage damage that occurs with, you know, in the knee we call it pivoting. Where, where you have these moments where, where the femur and the tibia kind of shift on each other.

Same thing [00:27:00] in the thumb. So, so the goal and when we repair these is, is to restore that stability, uh, to the joint so that the, uh, cartilage, uh, doesn't have that or abnormal stress on it. And, and so folks can have, you know, a good joint, uh, moving forward. Um. You know, it looks like here we've got this, uh, slide with the internal brace, which, uh, that's been, you know, in talking about sort of minimally invasive surgery and innovation in, in, in surgery.

There's been a real game changer for us, uh, in the hand. Um, and, and really what it does is it, it allows folks to, to start their rehab basically, you know, the day after surgery in large part. So in particular with thumb, uh, ulnar collateral, ligament repairs, uh, in the past, before doing internal braces. Um, we [00:28:00] would put people in a cast for six weeks.

I, oh, sorry guys. Um, and after, uh, after being in the cast for six weeks, they'd come out and they, they'd be really stiff and then, you know, it takes another six, eight weeks to get them moving. Then once we got them moving, then we'd add in strengthening. So, so the whole rehab process was, was probably more like four to six months.

Whereas now with the internal brace, um, we, uh, we can basically, um, get people moving. I get people moving about five days after surgery. Uh, so. My protocol now is, um, a post-op splint.

They see the hand therapist at day five. Uh, splint comes off. They get a removable brace and they start, uh, working on range of motion, uh, so [00:29:00] that by basically six weeks they have their full range motion.

Uh, and we've already started working on some strengthening. So, um, the total rehab program is, uh, basically three months before back to normal. So it, it's, it's shortened their total rehab time by about 50%, um, which is awesome.

Dr. Grant Garcia: Yeah. And we've seen some crazy ones, right? You know, there's Joe, your, I know one of your friends is one of the guys that.

Proponents of it, kind of taught it to many and to a lot of the pro athletes. Uh, somebody trained with

Dr. Wayne Weil : Yeah, yeah. Lots of, lots of pro athletes now get the internal brace and, um, you know, that's kind of the way things evolve, right? Is uh, you know, the, the pros get, uh, the stuff first and then it kind of trickles down.

But, uh, at this point, uh, I, I wouldn't. Necessarily even think about doing the, the surgery without an internal brace. [00:30:00] 'cause I just, again, it's like an open, uh, an open ACL versus arthroscopic ACL or an open carpal tunnel versus endoscopic, you know, people just get better faster. And, and, you know, in our patient population here in Seattle, um, you know, people don't wanna spend, you know.

Months at a time, either outta work or not kayaking, or not skiing or mountain biking or doing, you know, the things that they'd love to do. Um,

Dr. Grant Garcia: and for the listeners too. Oh, so I was gonna say the listeners too. It's also important that it's now that we'll stand line, right? So people are looking this up, they're already coming to you.

We're in a tech heavy market, so it's not like, you know, open ACL in New York is different animal. In Seattle, you wouldn't even see a patient in the office. They wouldn't show up to your office knowing that you do open acls. I mean, and this is, we can say Mike Trout, Bryce Harper. These are some names that done.

I did. We actually worked with Curtis Anderson when he had his UCL, [00:31:00] uh, Terry. You have Drew Brees. I mean, it's pretty extensive. The list is pretty impressive. Yeah. How people have had this surgery done. So sorry. We'll keep going.

Will Sanchez: No, no, I was gonna follow up on that. You know, uh, we're talking about pro athletes and we know that they kind of en endeavor this, uh, pain threshold.

What are some of the ramifications if you have a pro athlete or a quarterback or a golfer that puts off surgery when they need it, waiting for the off season or something like that? What, what are some of the repercussions or some of the concerns when you have, uh, a high profile athlete that really needs surgery?

Dr. Wayne Weil : Yeah. You know, that, that, that's a, that's a great question. And, and sort of that intersection of medicine, sports business, uh, you start really having different forces at play, right? In an ideal world, you know, somebody has a torn ligament, you know, you get 'em in, you fix 'em. Uh, they rehab. [00:32:00] But, uh, you know, with, with these, uh, high

performance athletes who, you know, getting paid, you know, millions of dollars to, to play, um, and these are all, you know, super competitive people too.

They, they want to play, they, they don't want to just kind of ride the bench and, and, and miss out on a season. Um, so not only are they super. Um, uh, competitive and want to, to, to be out there. Um, but the, you know, the teams want them out there. The agents want them out there. Uh, so you definitely have to navigate those forces.

Uh, you know, when you're treating, uh, a professional athlete or, or a high level college, uh, athlete. Um. You know, as a physician, I, I always just, you know, uh, kinda, um, uh, harp back to [00:33:00] you gotta do what's right for the patient. And, and so, you know, I tell my patients, look, you can play, uh, you can grin and bear it, but there, there may be serious consequences, you know, down the road, uh, when we.

You know, ultimately fix it. If there's, you know, been further damage, um, I might not be able to make you as good as you once were. 'cause you've damaged that joint to, to a point where now it's, it's, it's, you know, a salvage operation versus an operation where, where you're gonna be, you know, basically normal again.

So you may play this year, but you may not play, you know, for the rest of your career. Um. So, you know, and, and some of this has to do with just timing of things, right? So, you know, beginning of the season versus end of the season teams, you know, in the playoffs, not in the playoffs. Uh, [00:34:00] so, you know, you, you gotta kind of juggle all those, uh, factors.

Uh, but at the end of the day, I think, uh, as a doc, you know, my job is to educate my patients. Um, and it is a, you know, ultimately it's, it's their decision. Um, you know, patient autonomy is important. Uh, and I feel really strongly that, you know, if I give somebody all the information, uh, that they need to make a, a decision that's, that's good for them, then I'm okay with whatever they, they decide.

Um, but, uh, I'm not gonna sugarcoat it. I'm not gonna tell them. Oh yeah, you can delay and you'll be fine. You know? Yeah. I tell them, I tell 'em the truth.

Dr. Grant Garcia: Yeah.

Will Sanchez: Gotcha.

Dr. Grant Garcia: Uh, with that, uh, I want to go back and I appreciate all your insights on these. We talked about scoping, but the risk scope stuff that you do, especially with the TFCC and some of the ligament stuff, like what sort of newer stuff you [00:35:00] talk about the wrist arthroscopy a little bit.

I mean, that's the stuff that. The minimally invasive stuff that you're doing now, you're adding more things, right? You're doing different things you weren't able to do before with the scope. Yeah. Like what do you, what new stuff are you doing with the risk scope then why is that beneficial to patients?

Dr. Wayne Weil : So, so yeah, with the risk, the arthroscopy and especially the the TFCC, which stands for triangular fibro cartilage complex. That's why we call it TFCC 'cause. Is pain in the ass to say, but, uh, so, uh, and that's a pretty common injury from a fall and, and people think of it, ah, it's just a wrist sprain. It'll get better, but.

People, uh, oftentimes will end up, uh, with sort of chronic, uh, ulnar sided wrist pain, which is kind of the pinky side of the wrist, and oftentimes that that's due to, uh, this tear of the TFCC, which, uh, again, I like to use the knee as, uh, uh. Uh, an example for folks. 'cause everybody's heard of the meniscus of the [00:36:00] knee.

Uh, the, the TFCC is kind of similar in that it's the shock absorber, uh, for the ulnar side of the wrist and helps with some stability of the wrist. Uh, and so, uh, now that again, we've gotten sort of minimization of the instruments, uh, and the anchors. Um, we can start really, uh, doing much, uh, better, uh, repairs of the TFCC as opposed to just cutting it out.

So, uh. You know, like Dr. Garcia does in the knee in terms of repairing the meniscus versus chopping it out. Uh, our ability now to, to do repairs is, is much, much better than even five years ago where, um, you know, we were doing repairs but they were not so easy to do. And the default was always, you know, just cut the min, cut the TFCC out, um, which certainly helps with pain relief, but you [00:37:00] know, it's always better to repair something than chop it out if you can.

Um, so that's really been one of the big innovations in terms of, uh, uh, wrist arthroscopy, uh, and um, then also on, on the ligament side. Um, working, uh, to, to get some better, uh, repairs, uh, of those ligaments. Arthroscopically, uh, is, is certainly in the works, um, to, to work on instability issues, uh, in the wrist.

Arthroscopically. And then, uh, you know, starting Wayne,

Dr. Grant Garcia: would that be, would that be like, uh, people that have unstable ligaments, like they, or they tear like a mechanism that keeps, will you describe that briefly for the patient? Dr. Wayne Weil : Yeah, so, so like, uh, potentially, uh, STA four ate ligament, uh, repairs, uh, done arthroscopically, uh, again, uh, the SL ligament, uh, very similar, uh, to, uh, ACL in the knee.

This is. You know, we have the [00:38:00] ACL of the thumb, that's the ulnar collateral ligament. And then we have the ACL of the, uh, wrist. That's the scavo lunate ligament. Um, and so, yeah, well they can

Dr. Grant Garcia: internally brace those. Do you internally brace those? Ev don't get well, too excited. Try.

Dr. Wayne Weil : We're getting there. Uh, so, so yeah, that's sort of the next iteration of things is, is, uh, doing those, uh, repairs, uh, arthroscopically instead of open.

Um, and, uh, then also, uh, maybe doing some cartilage work as well. Um, and, and just really being able to, um, minimize, uh, all our surgeries that we're doing open. So, uh, we are, uh, definitely pushing the envelope all the time. Um, in terms of what, what we can do

Dr. Grant Garcia: when you do those scap illuminate ligaments, can you.

Can you do like an arthroscopic assisted, like that's sometimes what I do for some of my surgeries. Like you could see 'em go back together. So you don't have to do x-ray. You really can see 'em touching with the [00:39:00]

Dr. Wayne Weil : thought process. Yeah. So that's, that's, I think, uh, you know, kind of the, the, the spot that we're in now is, is arthroscopic assisted.

Um, really just kind of helps, uh, see, you know, where you are with the, uh, joint surfaces, um, and, and when you're closing them down. And then you can even stress, uh, the, the joint and really see that, you know, the, the ligament that you fixed. Um. Uh, is stable. Uh, and, and you can see, just see it much better than an x-ray.

Right? Uh, you're looking directly at it with the scope, uh, versus, uh, with an x-ray. You know, you're just kind of interpreting, you know, the, the shape of the bones and how they're relating, but you're, it's, it's better to see it directly.

Dr. Grant Garcia: Yeah. And for the listeners you're talking about. The ankle. A lot of people with ankle fractures, you see the, nowadays, all these newer surgeons like Dr.

Yee, we talk about, or Dr. Reed. Yeah. [00:40:00] They're scoping the, they're scoping the ankle with the fracture of the ankle. Right. So they're making sure that the cartilage is not too damaged. Or when the knee, when we have a tibial plateau fracture, sometimes we do an arthroscopic to see how well we line the surfaces up.

'cause as you said, x-ray's only so good. Plus it reduces x-ray time, which is always better for. The patients and for the surgeon not having to get fluoroscopy all the time.

Dr. Wayne Weil : Yeah. So, so one of the things that, that you mentioned, yeah. I think in, in fracture work, uh, arthroscopic assisted is, is, is awesome.

Like I, I will, uh, for wrist fractures just to raise fractures, uh, I'll put the scope in at the end. Uh, sometimes, uh, if I'm concerned about the, uh, articular surface, the joint surface to, to just make sure that all the little. Uh, surfaces are, are well lined up. 'cause you know, with fractures, the, the biggest thing is, is getting that joint surface smooth again.

You don't wanna leave the joint surface with the giant pothole in it. 'cause, because that's where, when people end up with, [00:41:00] you know, post-traumatic arthritic problems is, is 'cause the joint surface wasn't, uh, fixed properly.

Dr. Grant Garcia: I think that's an excellent point 'cause it's always hard to see sometimes on these, and you're dealing with even smaller bones.

So for the listeners to hear that like. If you've got some issue, you know, that's something you talk to your surgeon about, right? Like arthroscopic assisted is is the, the new gold standard.

You know, not in every case, but in those challenging cases it's, it's important factor to have in order to preserve the joint, which is really where you're going.

It's going joint preservation. I do knee joint, sometimes shoulder joint, and you do hand and wrist joint preservation and so that's a key point preservation. 'cause we don't want to be fusing and replacing, its. Not nearly as much fun too, right?

Dr. Wayne Weil : That's

Dr. Grant Garcia: right. So, uh, will you, were about to jump on something.

You had a question?

Will Sanchez: Yeah, no, just a quick question. Uh, regarding, you know, anyone that's listening that's either a patient or just, uh, nothing personal. I really don't want to come see you because I have a broken hand or wrist. Right. So is there any hand [00:42:00] exercises or stretches or anything that. That's been documented to kind of maybe reduce the risk.

Obviously if there's trauma, that's something else, like falling off a mountain, grabbing and twisting your arm back. Yeah. Are there exercises or, or stretches that you can utilize to unfortunately not go see you?

Dr. Wayne Weil : Yeah. Yeah. Great question. So, uh. In terms of, uh, you know, I think just holistic view of, you know, our bodies in general.

Um, you know, there's clear data that just, um, you know, use is good. Uh, sitting around on the couch doing nothing. That's bad for you. Right? So, so being active and, um, that I think is number one, the biggest, uh, benefit to, to longevity in general. So, you know, if you look at sort of those blue zone studies, you, you know, people who live on, [00:43:00] uh, hilly areas.

Live longer. Why? Because they have to walk up and down hills all day long 'cause they're getting exercise. So, so same thing with hands. Uh, and I think that's, you know, true of any joint in our body is, is using it, staying, um, flexible, uh, working on your flexibility, uh, working on your strength. Um, and, and ideally you, you know, I think there's not, I would say one specific exercise that's awesome for you, you know, working on your grip strength, and if you lead an active lifestyle, you know your hands will be exercised.

Uh, you know, it's the folks that, you know, sit around on, on the couch watching TV all day. Those are the ones that I worry about a lot more. Got you.

Will Sanchez: Thank you.

Dr. Grant Garcia: Let's, we wanna, in the sake of time, make sure Wayne has, can get outta here. Eventually meet the traffic. The, uh, but one other, I want one other talk [00:44:00] topic to talk about really quickly and then a little bit of fun, and then we can get you outta here.

Will you, okay. I know Mike Trout had this recently. I've seen you deal with some of the baseball players

Dr. Wayne Weil : Yeah.

Dr. Grant Garcia: On Merc round teams, et cetera. This one happens a lot. We hear this a lot. And this idea of removing the hook of handmaid or doing something, can you describe it to. What's the most common person athlete you see with this?

And then how, what's the kind of treatment regimen you normally deal with?

Dr. Wayne Weil : Yeah, no, these are, uh, this is a great, uh, uh, photo. Actually. I just saw a patient today, uh, with this injury, um, the most common baseball players. Um, and it's an interesting injury. In that you would expect it's a blunt force trauma, but it, it typically happens on a, on a swing and a miss.

Uh, so where, where they strike out, um, and it's the rotation of the bat, uh, through the follow through when, uh, the, the hook of the handmade [00:45:00] fractures, uh. And so, um, the hook of the Hamid, as you can see here, acts, uh, a little bit, uh, like a pulley, uh, on that, uh, small finger flexor tendon. Um, and it, it has a reputation for, for not healing.

Um, the blood supply to there is not great. And so, um. The, the treatment for this typically is just you excise that portion, uh, that's, uh, where that arrow is pointing. So, so the top part or, or the hook. Uh, as opposed to the body of the hamate. And then you kind of smooth out the, the fracture zone. Um, 'cause you don't want the flexor tendon, uh, a braided by the, um, the, the bone, uh, that's been fractured to kind acts, uh, almost like a [00:46:00] saw on the, uh, on the flexor tendon.

So, so you smooth out that fracture and. And it is an operation that, uh, works really well in terms of, uh, relieving pain, uh, and getting people back, uh, uh, to, to playing baseball. Golfers can get it as well. Um, and then, um, the other sort of cohort of folks who, who, uh, break their, uh, hook of the hammit, uh, are people who kind of use their hand like a hammer.

And are are banging on, on their hand. Uh, uh, you know, there's a, a board in your porch that's a little bit up and so you, you know, you smack the, the board down with your hand and you can injure your handmaid that way. Um, but uh, yeah, it's, it is interesting. It's an interesting injury. 'cause, 'cause you'd think it was more of a blunt force injury or, or, you know, when, when, in baseball, when.

And the batter connects with, [00:47:00] with the ball, but it's, it's actually when they strike out, when it happens,

Will Sanchez: is it the hand, is it the bottom handle of the bat that's rounded, that's coming through on the follow through and grabbing that part of the hand? Is that what

Dr. Wayne Weil : some of that also is just the force transmissions, you know, as the hands are turning over and you've got this giant lever arm, which is the bat.

Will Sanchez: Yeah.

Dr. Wayne Weil : Uh, and it just torques the, the hand just in a perfect way to, to break off the, uh, hammit, um, really common in, in actually, uh, pro baseball players. Uh, um, we, we see it kinda, uh, pretty regularly.

Will Sanchez: And you don't see it with golfers.

Dr. Wayne Weil : Yeah. You see it with golfers too. Okay. Uh, usually with golfers it's more they hit, you know, a really fat shot and their club gets stuck.

In the ground and then their hands kind of rotate over it. Um, but, but [00:48:00] it's a gratifying injury to treat 'cause uh, you know, you just take out the hook of the handmaid and, and people get back really quickly. So, yeah. Um,

Will Sanchez: that's interesting.

Dr. Grant Garcia: Awesome.

Dr. Wayne Weil : Yeah.

Dr. Grant Garcia: Uh, so I guess since you know, you're well known for all your hand surgeries.

But actually what the viewers don't, may or may not know if they're doctors or patients listening to this, you actually are more popularly known for something else. So as of now, you are now famous for other things. So I'd like to show the viewers and maybe a better understand and hear the background story behind this.

Dr. Wayne Weil : So lonely. That's, yeah. This is, uh, this is my, uh, new, uh, sky gig,

Dr. Grant Garcia: and he's [00:49:00] smiling the whole time positive. Amazing. Well pull, pull

Dr. Wayne Weil : up his

Dr. Grant Garcia: followers,

Dr. Wayne Weil : director in the background. Smile.

Dr. Grant Garcia: That's pretty impressive.

I think it went up since we started the show. When I told you how many followers you had, it literally went up between this entire show recording 'cause Will just changed it.

Dr. Wayne Weil : Yeah, it's uh, it's gotten kind of crazy. We, um, yeah, this is, uh, something that's just kinda come out of the blue for us. It was kind of a joke.

Uh. Started actually December 1st, last year after Thanksgiving. Um, we, uh, my wife is, uh, used to be a private chef, so she's a, she's an awesome cook. [00:50:00] And, uh, and all our friends, uh, and family know that she's amazing. She should open up a restaurant. Um, but, uh, her classic, classic Thanksgiving is. To die for and, and it's our family favorite.

My wife was actually born on Thanksgiving, so it's kind of a big deal for, for our family. And she does this really traditional Thanksgiving with, you know, giant Turkey. Usually it's like a 28, 30 pound Turkey and, uh, with, you know, four different pies and all the sides you could ever want. You know, it's a massive undertaking. And so this year she's like. We're not doing Thanksgiving. I'm tired of it. And

Will Sanchez: what

Dr. Wayne Weil : everyone, we were so depressed. 'cause it literally, our whole family looks forward to it every year. It's like, I wanna make a Turin. Uh, so, um, for those of you who are, uh, [00:51:00] John Madden fans, back in the old day, if you look up some of the videos of John Madden in, in New Orleans, uh, this comes back to, uh, the Turin.

Um mm-hmm. So a Turin is a, is basically it's a Turkey and a uh, uh, a chicken and a duck all stuffed, uh, inside the, the Turkey. And so, um, my wife asked me to learn how to deone the Turkey and chicken and duck and then, uh. Um, so I, you know, watched a couple videos on how to do it and so we, we made this tur Duckin, um, and uh, at the end you, you basically, you sew the Turkey back, uh, together.

So it looks kind of like a Turkey again. Uh, and it's stuffed with the stuffing and the chicken and the, and the duck. And I don't know why, uh, 'cause we never video stuff. [00:52:00] Uh, or we hadn't videoed anything previously. We, we took this video and it was like three in the morning. I, you know, just got back from skiing and so it was kind of an unhinged video in general.

Um, but, um. So we go to, we actually had Thanksgiving at a friend's house, and, and there's about four other families there. And we brought the Uck in and, and, uh, one of the docs, uh, actually, uh, one of the, the families, uh, who was there, she's, she's a doc, uh, but she all night long was like, you gotta post that video.

It's awesome, and blah, blah, blah. That's great. And so we made a TikTok account. We just posted the video after being browbeat all night. The next morning we had like 40, 50,000 views on this video. My wife who works in social media for a skincare [00:53:00] company, um. She's like, that's actually really odd 'cause you have no followers.

And uh, you know, that's a lot of views for a brand new, you know, account with no followers. And so then we posted another video, um, and that got, you know, like. Another 50, a hundred thousand views pretty quickly. And so then we just started posting these videos of, of me cooking We, and we called the account Seattle Hand Doc.

And, you know, fast forward 11 months or 10 months, we, yeah, we have, you know, 360,000 followers on Instagram, about 350,000 on TikTok. And, uh. It's become, uh, our, our, our, you know, nighttime activity, our, our, our second job for both of us. So yeah, we we're now the [00:54:00] point where, you know, starting to get recognized by people out and about and, uh, you know, different companies are reaching out to us to, to collaborate with them.

And, uh, so it's been really fun. Uh, I've actually learned a lot. Um. You'd think as a surgeon I'd have good knife skills, but, uh, uh, when it comes to the kitchen and chopping onions, uh, mine are terrible compared to my wife's, but, uh, I'm getting better. Um, well in

Dr. Grant Garcia: general, in general, you have to realize your wife's better than you would, pretty much everything.

Dr. Wayne Weil : yeah. Well, that goes without

Dr. Grant Garcia: saying you, you and I already have figured that out.

Dr. Wayne Weil : Yeah, we

Dr. Grant Garcia: knows that.

Dr. Wayne Weil : Yeah, no doubt about it. Uh. But, uh, yeah, it's been really fun 'cause uh, you know, uh, traditionally, uh, my wife did all the cooking. I did all the cleaning. Uh, but now we kind of do everything together. So it's, it's brought us, uh, together to some degree.

Although I screw up almost every night and I [00:55:00] get yelled at, but that's okay. Um, for the most part, we're having a good time. And, um, yeah, I've learned a lot and it's, and it's, it is, it's fun. It's, it's, uh, it's brought us together, which is really, really, um, the best part of all of it.

Dr. Grant Garcia: What's your highest views on a video so far?

Dr. Wayne Weil : Oh, wow. We, we've got, uh, I, I think it's still our nachos video, uh, which is up, it might be 12, 14 million views. Yeah, it's pretty crazy. Uh, and we,

Dr. Grant Garcia: dude, when are you gonna have speed? When are you gonna have speed speed on your cooking show? You mean That's the key. He's all over the place. Yeah.

Dr. Wayne Weil : Yeah. No, it's, it'd be awesome.

Will Sanchez: what do, what do your kids think about this? I mean, they've gotta be like, mom and dad is rocking it. I mean, you know, the, the younger generation, oh, they're on it now. This is supposed to

Dr. Wayne Weil : be, yeah. So that's been

Will Sanchez: seen on there. What are their thoughts?

Dr. Wayne Weil : It's been interesting to, to see that. [00:56:00] So, so we have five kids, so I think that's part of the draw in terms of, uh, you know, our, our account.

So our two college kids, uh, you know, from the get go, they were, they were all in and they thought it's awesome. Um, my, uh, at the time they were in middle school, now they're, they're freshmen in high school we have twins. Uh, they were horrified. Um, you know, like, can, you know, 'cause you know, when you're 13, 14, 15 years old, you know, nothing your parents do is cool, right?

You just, uh, they, your parents are, you know, the worst people ever. Um, and then my junior, now senior in high school, he was kind of lukewarm on it. Um, and so, uh, but now the kids have, have gotten around to, uh. Um, having a good time with it, and we pull them in on some of the videos. The, the three older kids are definitely more into it, uh, [00:57:00] than, um, than the youngest, the twins.

But we, we can cajole them into a video too, here and there, and. Actually my daughter, Charlotte, uh, one of her videos I think has about 4 million views, so she's a rockstar. Um, wow. But, uh, yeah, it's been fun. It's, it's, uh, and I've learned a lot in terms of just the whole social media world and influencers and, um.

To me, that's one of the things that I, I found most interesting is just that, you know, it's a lot of work and, um, you know, I used to kind of poo p the idea of, uh, social media and influencers and. You know, you look at people like the Kardashians or, or Jake Paul and, and Mr. Beast, and you know what they're doing.

And, you know, someone who's was basically uneducated like me would, would just say, well, that's ridiculous. You know, [00:58:00] why, why do they have so many, you know, why are they making millions of dollars doing this stuff? And, and now that I've, you know, just, just scratched the surface of, uh, of this whole social media world.

You know, I get it. You know, they, they have a product that, um, you know, people enjoy, uh, and, and they work at it. I mean, you know, they're putting up content every day. Um, it, it is a job, uh, no doubt about it. And, uh, so for me, that's, that's been kind of fascinating to, to come through that, uh, experience, to, to really have an appreciation for, for what people are doing out there.

Dr. Grant Garcia: So as we saw that we, uh, we went too long, we have, um, exactly a minute and 22 seconds before we have to stop because of the one hour social media limit. So you did good job, Wayne. You

Dr. Wayne Weil : awesome.

Will Sanchez: Thank you so much. Dr. Wayne Wild and a Seattle Hand Doctor, uh, orthopedics, [00:59:00] uh, surgeon, hand rest and elbow specialist, TikTok, influencer, you name it.

They've got too many titles. If not, we'll spend the next five minutes talking about the titles. Most importantly, thank you for spending some time with us and educating, uh, the listeners and patients and everyone. So once again, thank you for your time and have a good night.

Dr. Wayne Weil : Awesome. Thanks guys.

Dr. Grant Garcia: Safe drive home.

Dr. Wayne Weil : Alright, appreciate it. Been fun. Thank you very much. See y'all. Bye.

Will Sanchez: Bye.

Audio Transcript

Dr. Grant Garcia: I'm good. It still sunny for another day or two where summer's just stretching on in Seattle, so I can't complain.

Uh, unfortunately the giants are back to being terrible, which we don't have to talk about today. But the Seattle teams are doing well decently, so that's good. Mariners won. So we're excited about that. I guess.

Will Sanchez: Yes. Let's not bring up, why are we starting off the show with the Giants? Dr. Garcia? Man, you, you know,

Dr. Grant Garcia: it's always

Will Sanchez: we need

Dr. Grant Garcia: something.

Will Sanchez: Not doing this.

Dr. Grant Garcia: We had one game. We had [00:01:00] one game.

Will Sanchez: Oh my Lord. All right, man. Let's get to people that really care about us, 'cause obviously you are just trying to break my heart. Let's talk about the good folks at the Recovery Shop. The shout out to contact Mike b. Talk about the recovery shot and why you love them.

And our guests as well loves them as well.

Dr. Grant Garcia: Great. Yeah, so we, we like them because honestly, patients ask for a little bit extra sometimes, and it's challenging as a surgeon, you send them to, you know, Amazon or online to look for their stuff. So the option of having this for the patients is really nice. Uh, and the patients do appreciate it too because it's all kind of there together.

And you have the nice machine, which Dr. We, I think just tried out one of the new elbow devices, uh, which is really nice for patients. That's really a, a niche that many of the companies can't provide. Uh, so they've been really happy with them and I think the patients are really happy, which is more important.

Dr. Wayne Weil : Mm-hmm.

Dr. Grant Garcia: Uh, so if you're a surgeon, reach out to them. If you're a patient, you don't have that option, reach out to them. They can try to get your surgeon set up with it so that you can have that opportunity.

Will Sanchez: Let's get right to our guests [00:02:00] because we're keeping him from getting dinner, and that's a tease for something that we'll talk about later on.

Um, let's bring in the doctor, the hand, the wrist and elbow specialist himself. Dr. Wayne Wild. Dr. Wild, thank you for being on. Thank you for hanging with us and I apologize for Dr. Garcia bringing up things to start off the show in a negative way. How are you?

Dr. Wayne Weil : Uh, doing great. Uh, happy to be here. Thanks for the invitation.

Dr. Grant Garcia: Yes. Uh, so for the viewers introduced Dr. Al. He's a hand surgeon, actually, he's my partner. And we do a lot of cases together. Complex, uh, elbow surgeries. Um, and he specializes in hand, uh, wrist, um, and elbow and then dabbles with trauma as needed, uh, but really super specialized in the hand and nerve, uh, surgeries.

Also, chief of orthopedics at the Swedish Hospital system. And board of directors. So he is got extensive title and Pro Alliance as well as Pelto and he actually does family stuff as well on top of all that huge list. [00:03:00] So pretty impressive. Well, thanks for coming on. Really appreciate it. I'm sure Will's gonna have lots of questions to ask too.

Um, for the viewers, do you think you can kind of give a quick background? You know, I know you came from New York. Talk about your stuff and you know, now you're in Seattle, so just give us a little update and into who you are and where you came from.

Dr. Wayne Weil : Sure. Uh, yeah, I'm an East Coast guy originally, uh, grew up, uh, outside, uh, Bethesda, Maryland.

Uh, ended up, uh, uh, doing my, uh, college in Philadelphia and then, uh, resident med school and residency in New York City. Uh, then ended up out here, uh, for a hand surgery fellowship. Uh. And just kind of fell in love with the Pacific Northwest. And one of our other partners, uh, Dr. Shapiro, uh, who's a shoulder specialist here, uh, I knew him from New York, from, he was a fellow while I was a resident, and he ended up recruiting me to stay out here.

And, uh, now 21 years later, I'm, I'm [00:04:00] still here in Seattle. Uh, we now have five kids. As Dr. Garcia mentioned, uh, I've gotten involved in, uh, sort of, uh, non-practice stuff, uh, with, uh, being chief at, uh, Swedish and the board positions at Proliance. And, and then I've still, uh, at my, uh, practice where, uh, you know, I really enjoy just treating, uh, elbow, wrist, and hand and, uh.

I do a lot of that, whether it's uh, you know, sports injuries and, and younger folks or, or degenerative stuff and older people, arthritis, uh, stuff. So kind of do a little bit of everything, uh, except maybe sleeping, which, uh, I would like, but that's okay.

Will Sanchez: Dr. Uh, what can you tell us what first sparked your interest in hand in, in microvascular surgery, you know, how do you go along that [00:05:00] path and have that interest?

Dr. Wayne Weil : Yeah, so that really started in, in my, uh, fourth year of, uh, residency, um, as part of our residency program at NYU and Hospital for Joint Diseases. Uh, we do, uh, a four month rotation down in Baltimore at, at, uh, shock Trauma Hospital down in Baltimore. Um, and at the time, uh, there's a surgeon there, uh, Andy Seder.

Um, and, uh, Dr. Seder, uh, to this day, I think is the, the best surgeon I've ever seen operate. Just, uh, you know, I think, you know, for, for lack of a better, uh, descriptor, you know, gift from God in terms of, uh, he could do anything and it was always perfect. And, uh, so he really got me interested in, in microsurgery and, um.

Uh, kind of the rest is history from there. [00:06:00] Uh, so, so it's, I think, you know, in a lot of our lives, uh, you know, just exposure to, to, uh, a good mentor really can pave the way moving forward in terms of, uh, uh, really career paths in general. And, uh, yeah, I think, uh, Dr. Seder is really the, the, the person who who got me interested in, in, in what I'm doing today.

And then, um, you know, fast forward a couple years, uh. Doug Hanno, um, at, at University of Washington, who I did my hand surgery fellowship. Uh, another just phenomenal surgeon. Um, and, uh, you know, uh, Doug in, in a very similar way with Dr. Eder, you know, could fix anything and, and just an incredible surgeon and, and so, you know, like having the exposure to those two docs in particular. You know, I, I, [00:07:00] I stand on the shoulder of giants, uh, and, um, you know, I, I, I certainly give a lot of credit to those two guys for, for getting me to where I am today.

Dr. Grant Garcia: Uh, Wayne, I wanted, I wanna bring this up. I, because I think that's probably your answer is gonna be this too, but. You know, we see in the office, we talk about, I do a lot, you know, we talk about the sports surgeries that I do, but I see you doing a lot of really complex hand and wrist surgeries that not everybody would want to take on, even as a hand surgeon.

Do you think, and I don't wanna put too many words in your mouth, you think that stems from that background you're talking about? Or why do that? Like you could, your private practice, you could just do carpal tunnels. Yeah, procedures. You don't have to do the hard stuff. Why do you choose to?

Dr. Wayne Weil : Uh, you know, uh, maybe I'm just a masochist.

Uh, but I think that's true of kinda all the guys in our practice. I mean, we could all just do the simple stuff, but, uh, I think [00:08:00] we all enjoy the challenge. Um, you know. For me personally, if, yeah, I enjoy doing carpal tunnel surgery, but you know, uh, I would get bored if I just did that all day long. And, and, you know, for me, uh, maybe I'm blessed with the ability to do the hard stuff.

Uh, and, and I enjoy doing it. And, and I think that serves a, a niche for our patients. Uh. In terms of, you know, we, we see a lot of patients in our practice and, and, and you do, uh, as well, where, you know, they've bounced around to different docs in the community and, and just, uh, for whatever reason, you know, I haven't been able to, to get the care that they need.

And, and so for me it's, it's very gratifying to, to see a patient who's maybe seen a few docs, uh. And, uh, [00:09:00] has been told, you know, uh, we can't help you. You gotta live like this for the rest of your life or whatever it is. And, and to be able to see them and say, actually that's not true, uh, that we can help you and I can make you better.

Um, and, and I think. You know, that's why we went into medicine is, is to make people better. And, uh, um, you know, it's very gratifying. I think the, the more complicated a, a problem is in a lot of ways, it, it's even more gratifying to, to get to the other side where, where you've made somebody better. Like, um, so, and, and again, I think, you know, going back to the training, um.

Both at Shock Trauma in Baltimore, both at Harborview. I mean, we saw the craziest stuff you could ever imagine, you know, horrible injuries, uh, you know, whether it's, you know, explosives or industrial [00:10:00] injuries or, or what have you. And, you know, those two guys in particular, handle and Eder, they were just, you know, always so calm, always had a plan and, and able to execute it.

And I think having that kind of exposure where, where you've seen, you know, everything. Um, so when somebody walks in the door with something complicated, uh, you know, you, you, you rely on your b on your training and then your experience, you know, I've been doing this now for 21 years, been in practice. Uh, so I feel like, you know, there's not much out there that I haven't seen.

Uh, and so. That, that makes me prepared to, to take on the complicated stuff.

Dr. Grant Garcia: Awesome. Um, do you, so I know we talked about this, but the, obviously we might switch gears a little bit. Yeah. But the, coming from the complicated to maybe the more minimally invasive stuff that you do, I know you're, [00:11:00] you know, we know you're one of the only surgeons in the area that does this sort of endoscopic carpal tunnel, endoscopic cubital tunnel.

Will you talk a little bit about those procedures? The audience. And then what is the benefit, in your opinion, of doing it this way? I mean, it's also more challenging technically, but obviously what's the benefit to the patient? Why would you do that versus the standard open?

Dr. Wayne Weil : Yeah. Well, I mean, uh, the name of the game in, I think all of surgery is, you know, being less invasive, less destructive to the tissues.

Um, and, and that really. Um, you know, helps on the backend in terms of there's less stuff to heal. Right? Um, again, going back to my residency, you'll, you'll appreciate this story. Um, I was a third year resident and, uh, uh, scrubbed a case with a doctor, uh, who was, he was the only one in the NYU system still doing open [00:12:00] acls and.

And I done it. I'm shivering

Dr. Grant Garcia: by the way.

Dr. Wayne Weil : I'm

Dr. Grant Garcia: shaking. I'm having like,

Dr. Wayne Weil : you've probably never even seen one. Uh, so, um, and, and this is now circa 2003. So at this point, uh, or 2000, 2001. Uh, at this point, you know, uh, arthroscopic ACL surgery was a standard thing. I mean, it's not like, uh, it was brand new. People have been doing arthroscopic ACLS for 15, 20 years probably at the, at that point.

Um, and so yeah, so I scrubbed this case with this guy who's doing open ACL and, you know, the whole knee's filet open and, and. I couldn't believe what I was seeing. I, and I can't imagine what the recovery from that was. Uh, and having had an ACL done on, on my own knee, arthroscopic [00:13:00] ACL, I mean, it's, you know, worlds apart.

And so that experience in particular was like, well. Why would I ever do something that that was that traumatic, uh, if I can do it in a way that's, you know, not nearly, uh, as, as destructive to the surrounding tissues. Um, and so, you know, in residency actually, uh, we started doing, uh, endoscopic carpal tunnel releases.

And again, uh, smaller incision, less tissue invasion. And we'd have patients who, you know, had an open on one side and then came back and had the endoscopic on the other side, and they were like. The, every single one of those patients couldn't believe how much easier the, uh, the recovery was with the [00:14:00] endoscopic.

Just less pain, quicker return to work, better function. And, um, you know, the data has kind of borne that out, uh, when you look at the recovery. Um, again, just less pain, quicker return to bur and, uh, better grip strength in, in the first three months of recovery. Um, the opens end up catching up in the end and they do fine.

And, you know, at, at nine months, one year, everyone's the, the same. But why have an operation that takes you nine months to recover from when you can have the same operation, but it only takes you, you know, three months. Uh, and so similar to, to the, uh, ulnar nerve, uh, the cubital tunnel. Decompression the ulnar nerve.

Um, same idea, uh, is, you know, little incision. We do everything from the inside out instead of the outside in. And so, uh, again, you don't have to cut through any of the [00:15:00] muscles to get to where you wanna be. Um, and that just decreases the amount of time for recovery and, and, and gets people going a lot faster.

Um, and I think that's really. The exciting part in orthopedics, uh, where we're moving towards in general is, um, all the stuff we do is becoming less and less invasive. Uh, you look at a hip replacement, you know, you were in the hospital for a week when I was a resident. Now we do hip replacements, and you go home the same day.

Um. Same with, you know, knee replacements, uh, you know, a lot of the, the cartilage stuff that you're doing. Um, all of it is, is really starting to become outpatient surgery. I mean, even spine surgery is moving to, to outpatient surgery. Uh. And, and you look at the results, people do better when they're [00:16:00] home, uh, versus sitting in the hospital.

You know, you take the same operation, same person, your risk for infections and, and, and worse outcomes are higher if you stay in the hospital than if you go home. Um. So, uh, I think all of orthopedics, and especially in my specialty, you know, trying to do things in, in a minimally invasive way, it just, it just makes sense and it's better for the patients.

Um. In a lot of ways it's more fun for the surgeon 'cause uh, we get to play with cool, uh, new instruments. High

Dr. Grant Garcia: priority. That's the high priority there.

Dr. Wayne Weil : That's right. Um, you know, it's fun to go to the lab and kind of innovate and, and, and work with, uh, some of the, uh, companies to, you know, come up with, uh, you know, novel ways to do things.

Um, so, uh, I think it's sort of a win-win all the way around.

Dr. Grant Garcia: Will, can you pull up that slide? [00:17:00] Um, on the nano? I don't want to see, 'cause we're talking about, we're in the perfect example. Segue. Go to the next slide here. Lemme just do it.

Will Sanchez: Yeah, I have, I have, well,

Dr. Grant Garcia: yeah, Wayne right

Will Sanchez: there.

Dr. Grant Garcia: Yeah. So this is a, this is good.

You, I mean, we don't have to do the proprietary discussion here. I just was a picture, 'cause I know you've used this before. So for your minimally invasive situation, I mean, what would you use. Something small like this for, right. Yeah. Like the idea behind patients are always curious like, well how, how small can you go?

I've seen you scope some pretty small joints, right? Something I would never consider doing. So what are your uses of this and like how do you help, what does it help you with?

Dr. Wayne Weil : So, uh, yeah, we've gotten to the point now where, uh, you know, the instruments, uh, have gotten small enough where, you know, in the old days you could basically do a shoulder, uh, and a knee, and, and we've now, you know, uh, gotten to where we [00:18:00] can basically scope.

Pretty much any joint in the body for the most part. Uh, uh, you can scope out to even, uh, the PIP joint, um, proximal interphalangeal joint in the finger. Um, you can, uh, scope, you know, the base of the thumb. That's probably the most common one that I, I do now. Um, 'cause the base of the thumb, the carpal metacarpal joint, that's the one that, uh.

Becomes, uh, classically arthritic. And so, uh, there's, uh, procedures now that we can, uh, do kind of like in the knee where we do, uh, for arthritis, uh, some clean out procedures. So the instruments, not only the camera, but also, um, the different little shavers and the probes and instruments that we use, uh, are small enough that they fit in there.

Uh, so you can really do kind of what the large joint [00:19:00] arthroscopists do. Uh, you know, the stuff that you do in the knee and the shoulder grant. Now, now I can do, uh, to some degree in, uh, the base of the thumb and, and in the wrist. Um, and so we're, we're definitely catching up, I would say, to to the large joint, uh, uh, arthroscopists.

And a lot of it just has to do with. The ability to, to make the instruments smaller and smaller. It's kind of like our, uh, computers and our iPhones and everything else in the world. Yeah. Um, you know, the first iteration is, is big and, and then, uh, as we get, uh, better with manufacturing and, and the technology, it just.

You get smaller and smaller and smaller, so then we can start really having a good time, uh, with the, the small joint instrument, uh, small joint arthroscopy.

Dr. Grant Garcia: Would you say with this, I mean, when I first saw you do one of those thumbs, I was like, this [00:20:00] is crazy. This is cool. Uh, would you describe, like, what were you like for that patient?

You know, you, when you do the metacarpal, when you do the scope of the thumb

Dr. Wayne Weil : Yeah.

Dr. Grant Garcia: For some arthritis. Yeah. What were you doing before for them? Right. Because these are patients, they're not, they're not old enough for you. Sure. Or any other thing. So what were you doing before? Were you, or just is this at a new surgery for you?

Dr. Wayne Weil : Yeah. So, you know, uh, I think of it like arrows in, in, in your quiver, right? And, and so. Um, you've got only a certain amount of, uh, arrows in, in the quiver. And, and if you can have more arrows, that's awesome. So, uh, for those patients, you know, that was like your, your 40 and 50 year olds with, uh, early stage degenerative arthritis.

Uh, they've had, you know, splints and braces, but nobody likes those. 'cause uh, you need your thumb to actually live life and do things. And so if you lock up your thumb. You know, it's pretty miserable. You can't [00:21:00] really do much at all. You can't type on a computer, you can't hold an iPhone. Um, you know, you can't garden or play tennis or whatever it is.

Um, so people don't tend to wear 'em 'cause they're, they really inhibit your activities. Um, so you, you know, the, the braces were sorta, yeah, you can wear a brace, but nobody likes that. Uh, then there's occupational therapy. Um. You know, to some degree, some patients find it helpful, but it's not really solving any of the issues, uh, internally.

Um, then we move on to steroid injections and sometimes those can be helpful. Um, PRP injections, sometimes those can be helpful, and then you're kind of stuck after that. There's not really any non-operative treatments that, that are reasonable to do. And then operatively, then we start talking about joint replacement, uh, which, you know, it's a big step for a [00:22:00] 40-year-old to, to undergo.

And so now we're able to do a, uh, procedure that can, uh, potentially buy people some time. Uh, and put off, you know, the eventuality of a joint replacement by ideally 10, 20 years when it's more appropriate to do the joint replacement as opposed to when they're 40 or 50. So, so it's really opened up a whole new, uh, ability to treat patients.

'cause otherwise it was, well you're 45 years old and we've tried everything. So either live with it or, or have a joint replacement. Whereas now I can say, well, you, you've, we've tried all the non-op stuff. We can, uh, now think about doing an arthroscopy and kind of clean stuff up for you. And, and ideally we'll buy you another 10, 20 years and then you have your joint replacement, you know, when you're 60 or 70.

Um, so it is been fantastic in, in being [00:23:00] able to, you know, treat patients, uh, uh, in a, in a much better way, uh, as opposed to just telling them well live with it.

Will Sanchez: I had a question for you. Um, talk about common hand and wrist injuries, uh, whether it's the pro and recreational athletes, and what's your thoughts on some of these names, like the skier's thumb?

Yeah. Or the jersey finger. You're from the East coast? I don't think the Jersey finger is what I'm thinking of. Ain't

Dr. Wayne Weil : the Jersey Shore,

Will Sanchez: it's not the Jersey Shore. So can you talk about that a little bit? Because the names are absolutely fantastic and Jersey finger means a thing on the East coast.

Dr. Wayne Weil : Yeah, no, it's, uh, so, you know, the hand world, uh, ends up with lots of crazy EPIs and uh.

As Grant knows, you know, people, uh, call us the hand weenies, uh, 'cause kind of the, the, it's the reputation of the hand. Surgeons are kind of the nerdy guys who, uh, [00:24:00] are way into minutia and. You know, uh, Dr. Gel Seder used to always say, you know, the leg is just a stupid weight-bearing joint, right? You can cut a leg off and put a piece of wood and give someone a peg leg and they can walk.

Um, but the hand, you know, that's a whole nother kettle of fish, right? You take somebody's hand off and, and they're really debilitated. Um, so, um. Yeah, the hand world. We've got all kinds of names for crazy stuff. Uh, you know, skiers thumb, uh, which actually was a gamekeeper's thumb in the old days. Uh, and not 'cause you're, you're playing games, but, uh, keeping game like small games, small animals.

So, uh. You know, uh, the farmers would be, uh, the classic is snapping the necks of rabbits, uh, with their hand and over time. Story

Dr. Grant Garcia: is crazy.

Dr. Wayne Weil : The ligament, uh, of the, uh, the [00:25:00] ulnar collateral ligament of the thumb would, would basically just tear. From overuse in all the years of snapping rabbits. Next. So Dr. Grant Garcia: we'll pull that slide up.

Pull the, not the rabbits. We don't have a rabbits.

Will Sanchez: We don't have the dead rabbits. No, no.

Dr. Grant Garcia: Hold the thumb. Uc. Pull the thumb UCL up while he continues. Keep going Wade.

Dr. Wayne Weil : So, so, you know, fast forward a couple of centuries and, uh. You know, skier's thumb or mountain biker's, thumb, you know, if you can imagine you're holding a ski pole and uh, you fall, your thumb's kind of exposed out there and it gets wrenched back and, and it gets torn, uh, the ligament gets torn.

Or if you're mountain biking, uh, same idea. Your thumb's kind of exposed and you go over the handlebar and kind of superman out and your thumb gets yanked back. Uh, so it, it ends up tearing, uh, the ulnar collateral ligament, um, [00:26:00] which is the, the kind of, i I tell people that's the ACL of the thumb, right? So if you tear your, your ulnar collateral ligament, what it ends up happening is, is.

You can use your thumb and you can move it. And once it's the, you're, you're, uh, recovered from the acute injury, but the, the cartilage is going to, uh, be stressed in a way that it was not built to be stressed, uh, as the thumb kind of pivots abnormally when your power pinching and grasping. And so, you know, the reason to repair the thumb, UCL.

Kind of like the ACL is in a large ways is to prevent arthritis, uh, from happening, uh, in a pretty short, uh, amount of time with the cartilage damage that occurs with, you know, in the knee we call it pivoting. Where, where you have these moments where, where the femur and the tibia kind of shift on each other.

Same thing [00:27:00] in the thumb. So, so the goal and when we repair these is, is to restore that stability, uh, to the joint so that the, uh, cartilage, uh, doesn't have that or abnormal stress on it. And, and so folks can have, you know, a good joint, uh, moving forward. Um. You know, it looks like here we've got this, uh, slide with the internal brace, which, uh, that's been, you know, in talking about sort of minimally invasive surgery and innovation in, in, in surgery.

There's been a real game changer for us, uh, in the hand. Um, and, and really what it does is it, it allows folks to, to start their rehab basically, you know, the day after surgery in large part. So in particular with thumb, uh, ulnar collateral, ligament repairs, uh, in the past, before doing internal braces. Um, we [00:28:00] would put people in a cast for six weeks.

I, oh, sorry guys. Um, and after, uh, after being in the cast for six weeks, they'd come out and they, they'd be really stiff and then, you know, it takes another six, eight weeks to get them moving. Then once we got them moving, then we'd add in strengthening. So, so the whole rehab process was, was probably more like four to six months.

Whereas now with the internal brace, um, we, uh, we can basically, um, get people moving. I get people moving about five days after surgery. Uh, so. My protocol now is, um, a post-op splint.

They see the hand therapist at day five. Uh, splint comes off. They get a removable brace and they start, uh, working on range of motion, uh, so [00:29:00] that by basically six weeks they have their full range motion.

Uh, and we've already started working on some strengthening. So, um, the total rehab program is, uh, basically three months before back to normal. So it, it's, it's shortened their total rehab time by about 50%, um, which is awesome.

Dr. Grant Garcia: Yeah. And we've seen some crazy ones, right? You know, there's Joe, your, I know one of your friends is one of the guys that.

Proponents of it, kind of taught it to many and to a lot of the pro athletes. Uh, somebody trained with

Dr. Wayne Weil : Yeah, yeah. Lots of, lots of pro athletes now get the internal brace and, um, you know, that's kind of the way things evolve, right? Is uh, you know, the, the pros get, uh, the stuff first and then it kind of trickles down.

But, uh, at this point, uh, I, I wouldn't. Necessarily even think about doing the, the surgery without an internal brace. [00:30:00] 'cause I just, again, it's like an open, uh, an open ACL versus arthroscopic ACL or an open carpal tunnel versus endoscopic, you know, people just get better faster. And, and, you know, in our patient population here in Seattle, um, you know, people don't wanna spend, you know.

Months at a time, either outta work or not kayaking, or not skiing or mountain biking or doing, you know, the things that they'd love to do. Um,

Dr. Grant Garcia: and for the listeners too. Oh, so I was gonna say the listeners too. It's also important that it's now that we'll stand line, right? So people are looking this up, they're already coming to you.

We're in a tech heavy market, so it's not like, you know, open ACL in New York is different animal. In Seattle, you wouldn't even see a patient in the office. They wouldn't show up to your office knowing that you do open acls. I mean, and this is, we can say Mike Trout, Bryce Harper. These are some names that done.

I did. We actually worked with Curtis Anderson when he had his UCL, [00:31:00] uh, Terry. You have Drew Brees. I mean, it's pretty extensive. The list is pretty impressive. Yeah. How people have had this surgery done. So sorry. We'll keep going.

Will Sanchez: No, no, I was gonna follow up on that. You know, uh, we're talking about pro athletes and we know that they kind of en endeavor this, uh, pain threshold.

What are some of the ramifications if you have a pro athlete or a quarterback or a golfer that puts off surgery when they need it, waiting for the off season or something like that? What, what are some of the repercussions or some of the concerns when you have, uh, a high profile athlete that really needs surgery?

Dr. Wayne Weil : Yeah. You know, that, that, that's a, that's a great question. And, and sort of that intersection of medicine, sports business, uh, you start really having different forces at play, right? In an ideal world, you know, somebody has a torn ligament, you know, you get 'em in, you fix 'em. Uh, they rehab. [00:32:00] But, uh, you know, with, with these, uh, high

performance athletes who, you know, getting paid, you know, millions of dollars to, to play, um, and these are all, you know, super competitive people too.

They, they want to play, they, they don't want to just kind of ride the bench and, and, and miss out on a season. Um, so not only are they super. Um, uh, competitive and want to, to, to be out there. Um, but the, you know, the teams want them out there. The agents want them out there. Uh, so you definitely have to navigate those forces.

Uh, you know, when you're treating, uh, a professional athlete or, or a high level college, uh, athlete. Um. You know, as a physician, I, I always just, you know, uh, kinda, um, uh, harp back to [00:33:00] you gotta do what's right for the patient. And, and so, you know, I tell my patients, look, you can play, uh, you can grin and bear it, but there, there may be serious consequences, you know, down the road, uh, when we.

You know, ultimately fix it. If there's, you know, been further damage, um, I might not be able to make you as good as you once were. 'cause you've damaged that joint to, to a point where now it's, it's, it's, you know, a salvage operation versus an operation where, where you're gonna be, you know, basically normal again.

So you may play this year, but you may not play, you know, for the rest of your career. Um. So, you know, and, and some of this has to do with just timing of things, right? So, you know, beginning of the season versus end of the season teams, you know, in the playoffs, not in the playoffs. Uh, [00:34:00] so, you know, you, you gotta kind of juggle all those, uh, factors.

Uh, but at the end of the day, I think, uh, as a doc, you know, my job is to educate my patients. Um, and it is a, you know, ultimately it's, it's their decision. Um, you know, patient autonomy is important. Uh, and I feel really strongly that, you know, if I give somebody all the information, uh, that they need to make a, a decision that's, that's good for them, then I'm okay with whatever they, they decide.

Um, but, uh, I'm not gonna sugarcoat it. I'm not gonna tell them. Oh yeah, you can delay and you'll be fine. You know? Yeah. I tell them, I tell 'em the truth.

Dr. Grant Garcia: Yeah.

Will Sanchez: Gotcha.

Dr. Grant Garcia: Uh, with that, uh, I want to go back and I appreciate all your insights on these. We talked about scoping, but the risk scope stuff that you do, especially with the TFCC and some of the ligament stuff, like what sort of newer stuff you [00:35:00] talk about the wrist arthroscopy a little bit.

I mean, that's the stuff that. The minimally invasive stuff that you're doing now, you're adding more things, right? You're doing different things you weren't able to do before with the scope. Yeah. Like what do you, what new stuff are you doing with the risk scope then why is that beneficial to patients?

Dr. Wayne Weil : So, so yeah, with the risk, the arthroscopy and especially the the TFCC, which stands for triangular fibro cartilage complex. That's why we call it TFCC 'cause. Is pain in the ass to say, but, uh, so, uh, and that's a pretty common injury from a fall and, and people think of it, ah, it's just a wrist sprain. It'll get better, but.

People, uh, oftentimes will end up, uh, with sort of chronic, uh, ulnar sided wrist pain, which is kind of the pinky side of the wrist, and oftentimes that that's due to, uh, this tear of the TFCC, which, uh, again, I like to use the knee as, uh, uh. Uh, an example for folks. 'cause everybody's heard of the meniscus of the [00:36:00] knee.

Uh, the, the TFCC is kind of similar in that it's the shock absorber, uh, for the ulnar side of the wrist and helps with some stability of the wrist. Uh, and so, uh, now that again, we've gotten sort of minimization of the instruments, uh, and the anchors. Um, we can start really, uh, doing much, uh, better, uh, repairs of the TFCC as opposed to just cutting it out.

So, uh. You know, like Dr. Garcia does in the knee in terms of repairing the meniscus versus chopping it out. Uh, our ability now to, to do repairs is, is much, much better than even five years ago where, um, you know, we were doing repairs but they were not so easy to do. And the default was always, you know, just cut the min, cut the TFCC out, um, which certainly helps with pain relief, but you [00:37:00] know, it's always better to repair something than chop it out if you can.

Um, so that's really been one of the big innovations in terms of, uh, uh, wrist arthroscopy, uh, and um, then also on, on the ligament side. Um, working, uh, to, to get some better, uh, repairs, uh, of those ligaments. Arthroscopically, uh, is, is certainly in the works, um, to, to work on instability issues, uh, in the wrist.

Arthroscopically. And then, uh, you know, starting Wayne,

Dr. Grant Garcia: would that be, would that be like, uh, people that have unstable ligaments, like they, or they tear like a mechanism that keeps, will you describe that briefly for the patient? Dr. Wayne Weil : Yeah, so, so like, uh, potentially, uh, STA four ate ligament, uh, repairs, uh, done arthroscopically, uh, again, uh, the SL ligament, uh, very similar, uh, to, uh, ACL in the knee.

This is. You know, we have the [00:38:00] ACL of the thumb, that's the ulnar collateral ligament. And then we have the ACL of the, uh, wrist. That's the scavo lunate ligament. Um, and so, yeah, well they can

Dr. Grant Garcia: internally brace those. Do you internally brace those? Ev don't get well, too excited. Try.

Dr. Wayne Weil : We're getting there. Uh, so, so yeah, that's sort of the next iteration of things is, is, uh, doing those, uh, repairs, uh, arthroscopically instead of open.

Um, and, uh, then also, uh, maybe doing some cartilage work as well. Um, and, and just really being able to, um, minimize, uh, all our surgeries that we're doing open. So, uh, we are, uh, definitely pushing the envelope all the time. Um, in terms of what, what we can do

Dr. Grant Garcia: when you do those scap illuminate ligaments, can you.

Can you do like an arthroscopic assisted, like that's sometimes what I do for some of my surgeries. Like you could see 'em go back together. So you don't have to do x-ray. You really can see 'em touching with the [00:39:00]

Dr. Wayne Weil : thought process. Yeah. So that's, that's, I think, uh, you know, kind of the, the, the spot that we're in now is, is arthroscopic assisted.

Um, really just kind of helps, uh, see, you know, where you are with the, uh, joint surfaces, um, and, and when you're closing them down. And then you can even stress, uh, the, the joint and really see that, you know, the, the ligament that you fixed. Um. Uh, is stable. Uh, and, and you can see, just see it much better than an x-ray.

Right? Uh, you're looking directly at it with the scope, uh, versus, uh, with an x-ray. You know, you're just kind of interpreting, you know, the, the shape of the bones and how they're relating, but you're, it's, it's better to see it directly.

Dr. Grant Garcia: Yeah. And for the listeners you're talking about. The ankle. A lot of people with ankle fractures, you see the, nowadays, all these newer surgeons like Dr.

Yee, we talk about, or Dr. Reed. Yeah. [00:40:00] They're scoping the, they're scoping the ankle with the fracture of the ankle. Right. So they're making sure that the cartilage is not too damaged. Or when the knee, when we have a tibial plateau fracture, sometimes we do an arthroscopic to see how well we line the surfaces up.

'cause as you said, x-ray's only so good. Plus it reduces x-ray time, which is always better for. The patients and for the surgeon not having to get fluoroscopy all the time.

Dr. Wayne Weil : Yeah. So, so one of the things that, that you mentioned, yeah. I think in, in fracture work, uh, arthroscopic assisted is, is, is awesome.

Like I, I will, uh, for wrist fractures just to raise fractures, uh, I'll put the scope in at the end. Uh, sometimes, uh, if I'm concerned about the, uh, articular surface, the joint surface to, to just make sure that all the little. Uh, surfaces are, are well lined up. 'cause you know, with fractures, the, the biggest thing is, is getting that joint surface smooth again.

You don't wanna leave the joint surface with the giant pothole in it. 'cause, because that's where, when people end up with, [00:41:00] you know, post-traumatic arthritic problems is, is 'cause the joint surface wasn't, uh, fixed properly.

Dr. Grant Garcia: I think that's an excellent point 'cause it's always hard to see sometimes on these, and you're dealing with even smaller bones.

So for the listeners to hear that like. If you've got some issue, you know, that's something you talk to your surgeon about, right? Like arthroscopic assisted is is the, the new gold standard.

You know, not in every case, but in those challenging cases it's, it's important factor to have in order to preserve the joint, which is really where you're going.

It's going joint preservation. I do knee joint, sometimes shoulder joint, and you do hand and wrist joint preservation and so that's a key point preservation. 'cause we don't want to be fusing and replacing, its. Not nearly as much fun too, right?

Dr. Wayne Weil : That's

Dr. Grant Garcia: right. So, uh, will you, were about to jump on something.

You had a question?

Will Sanchez: Yeah, no, just a quick question. Uh, regarding, you know, anyone that's listening that's either a patient or just, uh, nothing personal. I really don't want to come see you because I have a broken hand or wrist. Right. So is there any hand [00:42:00] exercises or stretches or anything that. That's been documented to kind of maybe reduce the risk.

Obviously if there's trauma, that's something else, like falling off a mountain, grabbing and twisting your arm back. Yeah. Are there exercises or, or stretches that you can utilize to unfortunately not go see you?

Dr. Wayne Weil : Yeah. Yeah. Great question. So, uh. In terms of, uh, you know, I think just holistic view of, you know, our bodies in general.

Um, you know, there's clear data that just, um, you know, use is good. Uh, sitting around on the couch doing nothing. That's bad for you. Right? So, so being active and, um, that I think is number one, the biggest, uh, benefit to, to longevity in general. So, you know, if you look at sort of those blue zone studies, you, you know, people who live on, [00:43:00] uh, hilly areas.

Live longer. Why? Because they have to walk up and down hills all day long 'cause they're getting exercise. So, so same thing with hands. Uh, and I think that's, you know, true of any joint in our body is, is using it, staying, um, flexible, uh, working on your flexibility, uh, working on your strength. Um, and, and ideally you, you know, I think there's not, I would say one specific exercise that's awesome for you, you know, working on your grip strength, and if you lead an active lifestyle, you know your hands will be exercised.

Uh, you know, it's the folks that, you know, sit around on, on the couch watching TV all day. Those are the ones that I worry about a lot more. Got you.

Will Sanchez: Thank you.

Dr. Grant Garcia: Let's, we wanna, in the sake of time, make sure Wayne has, can get outta here. Eventually meet the traffic. The, uh, but one other, I want one other talk [00:44:00] topic to talk about really quickly and then a little bit of fun, and then we can get you outta here.

Will you, okay. I know Mike Trout had this recently. I've seen you deal with some of the baseball players

Dr. Wayne Weil : Yeah.

Dr. Grant Garcia: On Merc round teams, et cetera. This one happens a lot. We hear this a lot. And this idea of removing the hook of handmaid or doing something, can you describe it to. What's the most common person athlete you see with this?

And then how, what's the kind of treatment regimen you normally deal with?

Dr. Wayne Weil : Yeah, no, these are, uh, this is a great, uh, uh, photo. Actually. I just saw a patient today, uh, with this injury, um, the most common baseball players. Um, and it's an interesting injury. In that you would expect it's a blunt force trauma, but it, it typically happens on a, on a swing and a miss.

Uh, so where, where they strike out, um, and it's the rotation of the bat, uh, through the follow through when, uh, the, the hook of the handmade [00:45:00] fractures, uh. And so, um, the hook of the Hamid, as you can see here, acts, uh, a little bit, uh, like a pulley, uh, on that, uh, small finger flexor tendon. Um, and it, it has a reputation for, for not healing.

Um, the blood supply to there is not great. And so, um. The, the treatment for this typically is just you excise that portion, uh, that's, uh, where that arrow is pointing. So, so the top part or, or the hook. Uh, as opposed to the body of the hamate. And then you kind of smooth out the, the fracture zone. Um, 'cause you don't want the flexor tendon, uh, a braided by the, um, the, the bone, uh, that's been fractured to kind acts, uh, almost like a [00:46:00] saw on the, uh, on the flexor tendon.

So, so you smooth out that fracture and. And it is an operation that, uh, works really well in terms of, uh, relieving pain, uh, and getting people back, uh, uh, to, to playing baseball. Golfers can get it as well. Um, and then, um, the other sort of cohort of folks who, who, uh, break their, uh, hook of the hammit, uh, are people who kind of use their hand like a hammer.

And are are banging on, on their hand. Uh, uh, you know, there's a, a board in your porch that's a little bit up and so you, you know, you smack the, the board down with your hand and you can injure your handmaid that way. Um, but uh, yeah, it's, it is interesting. It's an interesting injury. 'cause, 'cause you'd think it was more of a blunt force injury or, or, you know, when, when, in baseball, when.

And the batter connects with, [00:47:00] with the ball, but it's, it's actually when they strike out, when it happens,

Will Sanchez: is it the hand, is it the bottom handle of the bat that's rounded, that's coming through on the follow through and grabbing that part of the hand? Is that what

Dr. Wayne Weil : some of that also is just the force transmissions, you know, as the hands are turning over and you've got this giant lever arm, which is the bat.

Will Sanchez: Yeah.

Dr. Wayne Weil : Uh, and it just torques the, the hand just in a perfect way to, to break off the, uh, hammit, um, really common in, in actually, uh, pro baseball players. Uh, um, we, we see it kinda, uh, pretty regularly.

Will Sanchez: And you don't see it with golfers.

Dr. Wayne Weil : Yeah. You see it with golfers too. Okay. Uh, usually with golfers it's more they hit, you know, a really fat shot and their club gets stuck.

In the ground and then their hands kind of rotate over it. Um, but, but [00:48:00] it's a gratifying injury to treat 'cause uh, you know, you just take out the hook of the handmaid and, and people get back really quickly. So, yeah. Um,

Will Sanchez: that's interesting.

Dr. Grant Garcia: Awesome.

Dr. Wayne Weil : Yeah.

Dr. Grant Garcia: Uh, so I guess since you know, you're well known for all your hand surgeries.

But actually what the viewers don't, may or may not know if they're doctors or patients listening to this, you actually are more popularly known for something else. So as of now, you are now famous for other things. So I'd like to show the viewers and maybe a better understand and hear the background story behind this.

Dr. Wayne Weil : So lonely. That's, yeah. This is, uh, this is my, uh, new, uh, sky gig,

Dr. Grant Garcia: and he's [00:49:00] smiling the whole time positive. Amazing. Well pull, pull

Dr. Wayne Weil : up his

Dr. Grant Garcia: followers,

Dr. Wayne Weil : director in the background. Smile.

Dr. Grant Garcia: That's pretty impressive.

I think it went up since we started the show. When I told you how many followers you had, it literally went up between this entire show recording 'cause Will just changed it.

Dr. Wayne Weil : Yeah, it's uh, it's gotten kind of crazy. We, um, yeah, this is, uh, something that's just kinda come out of the blue for us. It was kind of a joke.

Uh. Started actually December 1st, last year after Thanksgiving. Um, we, uh, my wife is, uh, used to be a private chef, so she's a, she's an awesome cook. [00:50:00] And, uh, and all our friends, uh, and family know that she's amazing. She should open up a restaurant. Um, but, uh, her classic, classic Thanksgiving is. To die for and, and it's our family favorite.

My wife was actually born on Thanksgiving, so it's kind of a big deal for, for our family. And she does this really traditional Thanksgiving with, you know, giant Turkey. Usually it's like a 28, 30 pound Turkey and, uh, with, you know, four different pies and all the sides you could ever want. You know, it's a massive undertaking. And so this year she's like. We're not doing Thanksgiving. I'm tired of it. And

Will Sanchez: what

Dr. Wayne Weil : everyone, we were so depressed. 'cause it literally, our whole family looks forward to it every year. It's like, I wanna make a Turin. Uh, so, um, for those of you who are, uh, [00:51:00] John Madden fans, back in the old day, if you look up some of the videos of John Madden in, in New Orleans, uh, this comes back to, uh, the Turin.

Um mm-hmm. So a Turin is a, is basically it's a Turkey and a uh, uh, a chicken and a duck all stuffed, uh, inside the, the Turkey. And so, um, my wife asked me to learn how to deone the Turkey and chicken and duck and then, uh. Um, so I, you know, watched a couple videos on how to do it and so we, we made this tur Duckin, um, and uh, at the end you, you basically, you sew the Turkey back, uh, together.

So it looks kind of like a Turkey again. Uh, and it's stuffed with the stuffing and the chicken and the, and the duck. And I don't know why, uh, 'cause we never video stuff. [00:52:00] Uh, or we hadn't videoed anything previously. We, we took this video and it was like three in the morning. I, you know, just got back from skiing and so it was kind of an unhinged video in general.

Um, but, um. So we go to, we actually had Thanksgiving at a friend's house, and, and there's about four other families there. And we brought the Uck in and, and, uh, one of the docs, uh, actually, uh, one of the, the families, uh, who was there, she's, she's a doc, uh, but she all night long was like, you gotta post that video.

It's awesome, and blah, blah, blah. That's great. And so we made a TikTok account. We just posted the video after being browbeat all night. The next morning we had like 40, 50,000 views on this video. My wife who works in social media for a skincare [00:53:00] company, um. She's like, that's actually really odd 'cause you have no followers.

And uh, you know, that's a lot of views for a brand new, you know, account with no followers. And so then we posted another video, um, and that got, you know, like. Another 50, a hundred thousand views pretty quickly. And so then we just started posting these videos of, of me cooking We, and we called the account Seattle Hand Doc.

And, you know, fast forward 11 months or 10 months, we, yeah, we have, you know, 360,000 followers on Instagram, about 350,000 on TikTok. And, uh. It's become, uh, our, our, our, you know, nighttime activity, our, our, our second job for both of us. So yeah, we we're now the [00:54:00] point where, you know, starting to get recognized by people out and about and, uh, you know, different companies are reaching out to us to, to collaborate with them.

And, uh, so it's been really fun. Uh, I've actually learned a lot. Um. You'd think as a surgeon I'd have good knife skills, but, uh, uh, when it comes to the kitchen and chopping onions, uh, mine are terrible compared to my wife's, but, uh, I'm getting better. Um, well in

Dr. Grant Garcia: general, in general, you have to realize your wife's better than you would, pretty much everything.

Dr. Wayne Weil : yeah. Well, that goes without

Dr. Grant Garcia: saying you, you and I already have figured that out.

Dr. Wayne Weil : Yeah, we

Dr. Grant Garcia: knows that.

Dr. Wayne Weil : Yeah, no doubt about it. Uh. But, uh, yeah, it's been really fun 'cause uh, you know, uh, traditionally, uh, my wife did all the cooking. I did all the cleaning. Uh, but now we kind of do everything together. So it's, it's brought us, uh, together to some degree.

Although I screw up almost every night and I [00:55:00] get yelled at, but that's okay. Um, for the most part, we're having a good time. And, um, yeah, I've learned a lot and it's, and it's, it is, it's fun. It's, it's, uh, it's brought us together, which is really, really, um, the best part of all of it.

Dr. Grant Garcia: What's your highest views on a video so far?

Dr. Wayne Weil : Oh, wow. We, we've got, uh, I, I think it's still our nachos video, uh, which is up, it might be 12, 14 million views. Yeah, it's pretty crazy. Uh, and we,

Dr. Grant Garcia: dude, when are you gonna have speed? When are you gonna have speed speed on your cooking show? You mean That's the key. He's all over the place. Yeah.

Dr. Wayne Weil : Yeah. No, it's, it'd be awesome.

Will Sanchez: what do, what do your kids think about this? I mean, they've gotta be like, mom and dad is rocking it. I mean, you know, the, the younger generation, oh, they're on it now. This is supposed to

Dr. Wayne Weil : be, yeah. So that's been

Will Sanchez: seen on there. What are their thoughts?

Dr. Wayne Weil : It's been interesting to, to see that. [00:56:00] So, so we have five kids, so I think that's part of the draw in terms of, uh, you know, our, our account.

So our two college kids, uh, you know, from the get go, they were, they were all in and they thought it's awesome. Um, my, uh, at the time they were in middle school, now they're, they're freshmen in high school we have twins. Uh, they were horrified. Um, you know, like, can, you know, 'cause you know, when you're 13, 14, 15 years old, you know, nothing your parents do is cool, right?

You just, uh, they, your parents are, you know, the worst people ever. Um, and then my junior, now senior in high school, he was kind of lukewarm on it. Um, and so, uh, but now the kids have, have gotten around to, uh. Um, having a good time with it, and we pull them in on some of the videos. The, the three older kids are definitely more into it, uh, [00:57:00] than, um, than the youngest, the twins.

But we, we can cajole them into a video too, here and there, and. Actually my daughter, Charlotte, uh, one of her videos I think has about 4 million views, so she's a rockstar. Um, wow. But, uh, yeah, it's been fun. It's, it's, uh, and I've learned a lot in terms of just the whole social media world and influencers and, um.

To me, that's one of the things that I, I found most interesting is just that, you know, it's a lot of work and, um, you know, I used to kind of poo p the idea of, uh, social media and influencers and. You know, you look at people like the Kardashians or, or Jake Paul and, and Mr. Beast, and you know what they're doing.

And, you know, someone who's was basically uneducated like me would, would just say, well, that's ridiculous. You know, [00:58:00] why, why do they have so many, you know, why are they making millions of dollars doing this stuff? And, and now that I've, you know, just, just scratched the surface of, uh, of this whole social media world.

You know, I get it. You know, they, they have a product that, um, you know, people enjoy, uh, and, and they work at it. I mean, you know, they're putting up content every day. Um, it, it is a job, uh, no doubt about it. And, uh, so for me, that's, that's been kind of fascinating to, to come through that, uh, experience, to, to really have an appreciation for, for what people are doing out there.

Dr. Grant Garcia: So as we saw that we, uh, we went too long, we have, um, exactly a minute and 22 seconds before we have to stop because of the one hour social media limit. So you did good job, Wayne. You

Dr. Wayne Weil : awesome.

Will Sanchez: Thank you so much. Dr. Wayne Wild and a Seattle Hand Doctor, uh, orthopedics, [00:59:00] uh, surgeon, hand rest and elbow specialist, TikTok, influencer, you name it.

They've got too many titles. If not, we'll spend the next five minutes talking about the titles. Most importantly, thank you for spending some time with us and educating, uh, the listeners and patients and everyone. So once again, thank you for your time and have a good night.

Dr. Wayne Weil : Awesome. Thanks guys.

Dr. Grant Garcia: Safe drive home.

Dr. Wayne Weil : Alright, appreciate it. Been fun. Thank you very much. See y'all. Bye.

Will Sanchez: Bye.

Audio Transcript

Garcia, how are you? I'm

Dr. Grant Garcia: good. I'm good. I'm, things are good over here at summer in Seattle. Can't complain. I'm really excited for our guests coming up. Uh, we've talked at nausea about ankle sprains and how long the issues with them and the recovery process and, you know, on our football updates, we're always like, well, when are they getting back?

I don't know. I don't know. Yeah, it's a huge, it's probably, it, it goes every one of these [00:01:00] sports and, and it's not above that. And for the NBA, so I'm really excited for this.

Will Sanchez: Yeah, so am I and someone that's had major, uh, ankle injuries as well. Um, you know, we probably could have used some of that technology and some of the things that we're gonna talk about, but we're talking about injuries, so we're talking about recoveries.

Let's give a shout out to our folks there at the Recovery Shop.

Dr. Grant Garcia: Yeah, so special thanks to Mike and those guys for Recovery Shop and Sponsorship. Again, like I say before, you know, this is maybe something that you can eventually find better guards on. The idea behind here is that for people that are recovering from something or some sort of rehab ability, uh, you can use this especially as a surgeon, to kind of keep everything put together for your patients.

They're always asking, what more can I do? What better can I do? How can I protect myself? And this is your option. So it works great. It can be customized and the patients like the personalized experience similar to something we're gonna show in a minute.

Will Sanchez: All right, let's, uh, let's not waste any more time.

Let's bring in our guests. Uh, we're really excited to have our guests, uh, KK Lyles, thank you so much for being a part of the [00:02:00] show and being with us and sharing your knowledge. I will do my best to keep Dr. Garcia under control. He likes to ramble a lot. Um, love it. Yeah. Yeah. So first and foremost, what, what are we thinking about the Allen Iversson shirt?

How you feeling about that?

Keke Lyles: I love, I, I miss the old Slam Magazine, obviously. That's what we grew up on, right? So,

Will Sanchez: yeah.

Keke Lyles: Yeah. I loving it that

Will Sanchez: that was, that was kinda like the fangoria for sports fans, basketball fans. I don't even know if Fangoria still exists. And as you see, I digress. I go off all.

Different tangents, which is one of the things that gets me in trouble here. But, um, let, let's talk about your career. We have so many things to get on, uh, to talk about, but you, you've worked with some of the top athletes in the world. Um, you have NBA experience. Why don't you just give, uh, our folks, our listeners, our viewers, a little bit of a background on the things that you've done and will lead up to the things that you're doing now.

Keke Lyles: Well, first appreciate you guys having me on as a guest. So excited to have this conversation. Um, yeah, my background, uh, doctor in physical therapy, uh, grew up [00:03:00] playing sports and, and really is when I was in PT school, uh, I, I started working as a strength and conditioning coach. For the university. I went to Northeastern, uh, out there in Boston.

Mm-hmm. Um, and it, it was during that time when I really started to develop this idea of like, especially in athletics, like injuries and performance is really, uh, on a continuum. Uh, and especially during a season, you know, we're either, uh, trying to optimize performance or maybe, uh, recover from an injury.

And so it's kind of all along that same continuum. And I love technology. I love, um, trying to understand things at a higher, maybe a deeper level. And so I've always been, uh, attracted to different, different tech, different data sets, uh, to inform my decisions or kind of my hunches and, and have kind of, uh, you know, built a career around that, I suppose.

And so. Fortunate after grad school, um, got on with the Minnesota Timberwolves as a head SNC coach. After a few seasons there went to Golden State, uh, as director of performance. Um, had obviously [00:04:00] success, uh, team success, winning a championship in Golden State, which I think opened up more opportunities for me.

Um, and, and eventually went to the Atlanta Hawks as executive director, kind of overseeing everything sports medicine, sports performance. Sports science, you name it. Um, and, and try to build systems, uh, build out systems in place that we can, uh, assess our athletes, try to understand 'em on an individual level and, and build programs to, uh, help them achieve their goals.

Dr. Grant Garcia: Yeah, I think it's important for we listeners to see that we're the person here who's gonna talk about this product we're gonna talk about. This is not something where you just all of a sudden showed up and decided to do this. It's, you lived it, breathed it. You've had to deal with injuries to all those sort of high level players and with the professionals.

We keep talking about these injuries, right? Like one day out is a lot of money, two days out's a lot of money. Mm-hmm. It's a huge investment for the team. It's also hugely dissatisfying and frustrating for the players. So I think that this is a great setup to kind of the, the next steps.

Keke Lyles: Yeah, and I [00:05:00] think honestly, you know, I mean obviously you said it all sports deal with ankle injuries.

Uh, but a any injury to your point, like our job is really to try to prevent as many as the, you know, kind of preventable injuries that are out there, soft tissues, overuse injuries, things like that. Uh, but some injuries are unavoidable. Um, and when that happens, our job is to get the player back as quick as we can.

So, uh, we, we kind of look for anything and everything that's gonna help us in that process. And over the years, um, you know, since being with the NBA team, obviously meeting better guards and the ankle bur company that we're gonna talk a little bit about, like it's just a game changer, not only helping prevent the injury from happening, but then also speeding up the recovery afterwards.

Dr. Grant Garcia: Awesome. So what we kind of hinted at it, people have seen in my background, they saw it on the intro, they're gonna see it on all the blasts, but tell us how you got to that point and then I kind of wanna show off the product really quick with the video and then we'll go back to doing more questions.

Keke Lyles: Yeah. [00:06:00] So, uh, when after departing with Atlanta Hawks, uh, moved out to Southern California where I'm still at, and, uh, worked with Navy Special Warfare and started consulting with teams and individual athletes. Uh, did some projects, uh, around, uh, with the NBA League office. As well. And that's when they started the launchpad, uh, program.

Uh, and that's when how I got introduced to better guards. And so when I first met that team, uh, through the launchpad program with another company I was working with at the time, advising, I just immediately was like, oh, where has this been? Uh, I got super excited about it, obviously. Um, and started advising, working with the team, um, and, and really just trying to get it out in, in front of as many athletes and get feedback.

And obviously they're coming out with their 3.0 brace. So, you know, they, they do a great job of taking feedback from athletes more around the comfort, um, than anything and making it more and more comfortable, which, you know, it's just testament to the company 'cause. I thought the version one was really comfortable.

So the [00:07:00] fact that they're on version three already is is pretty awesome.

Dr. Grant Garcia: Well, and I think one of the negatives of all these braces is you can constantly hear like. It may be high stiffness, but maybe not in this case. We'll show that in a second, but really, it's comfort, right? And a lot of the players don't wanna play it.

It's just like ACL braces. Like if you're not gonna get a player to wear an ACL brace, they're not comfortable. And maybe they protect you, but they're not comfortable and you're not gonna play your higher performance. So it's a really important point.

Keke Lyles: Yeah. And you know, to be honest too, I mean obviously in Golden State working with staff like, and through some of his injury stuff, like, I mean, the comfort of the brace is gonna be probably more important to the player than the function of the brace.

And that's just the reality of it. Um, and so you may have the best brace in the world, but if the player, to your point, if the player's not comfortable wearing it. They're just not gonna wear it. And so there has to be, uh, a perfect balance of comfort and function. I think

Dr. Grant Garcia: that's

Keke Lyles: an

Dr. Grant Garcia: awesome segue. Will pull up the video and then let's go back.[00:08:00] 

You got it.

Will Sanchez: Great videos. Doesn't get any. Yeah, you're seeing the flexibility, you're seeing the jump. I used to jump like that many moons ago. Not really. Actually you catch like that too, right? You got, oh yeah. Well, you know, to be fair with the gloves that they have now, any of us can pretty much catch. But yeah, I don't wanna get in trouble with any, uh, any of these athletes here.

But anyway, go ahead.

Dr. Grant Garcia: Anyhow, so [00:09:00] I love the video. Obviously it shows, you know, you've got the next step, right? You see someone actively using it in addition to the fact that. There. They're playing football, they're able to do their thing. So we obviously not talking about football today, but I let you know the promo video's a good setup for this.

So maybe, uh, kike you can kind of explain to the, the viewers and stuff kind of what this is. 'cause here, this podcast, we focus really, we get a lot of guest requests and we don't take many of them because the focus is on sports, medicine, rehab, and athletics, and how it all mixes together. How can you make my job easier by not having to constantly fix these ankle surgeries and or deal as a team physician?

As you know, you've worked with, I'm sure all the team physicians for those teams. They're really good guys. Uh, but it's a pain in the butt, right? Like double time of rehab. These ankle sprains are not fun to treat, right? Yeah. It's just you can't fix 'em all the time and you're just waiting and waiting for them to recover.

So kind of talk about the better guards and your stuff.

Keke Lyles: Yeah, I think, uh, so one of the things that really stands out and is unique about the Better Guards Brace is that it's [00:10:00] actually quite flexible. And, and I have one here so I can just show it like, you can see, like, it looks like, yeah, that's super flexible.

You know, that look like that

Dr. Grant Garcia: looks crazy.

Keke Lyles: Yeah. And so, like, when you put it on it, it really feels like a compression sock, which is great. I mean, because it, it, it allows freedom of movement. And so that

Dr. Grant Garcia: slide, while he's talking.

Keke Lyles: Yeah. And I know when I grew up playing sports and had my fair share of ankles, pants too, like I used to wear the, the like the really thick ankle brace that pretty much restricts all movement.

Um, and even as a kid and I just didn't like it, you. No even, well, those are pretty bad too. But even the, you know, the, like the ones after you have surgery where you, you know, they're just plastered on the sides. You can kind of dorsiflex and plantar flex and that's it. Um, and so I think having this freedom of movement is, is the thing that at least the athletes love because it's like they don't feel like they're wearing an ankle brace now.

The protection. Their tagline is, it's [00:11:00] a, a seatbelt for for the ankle. And you can see it in the picture there. But what it has is, and the technology is pretty cool, is this little piston on the side there.

Dr. Grant Garcia: Go to that slide. There's a slide there. I wanna show the viewers this. This is cool. Yeah, I mean, you guys can see really quick, we can see all the people that use this.

It's pretty fricking awesome. So yeah. And all these other things, but go to the, the tech, the tech slide is really good. Keep going.

Keke Lyles: Oh, with the different braces. Oh yeah. Here we go. So here's, here's like, the magic is that little piston. And so even the one I'm holding, like you can kind of pull it out and you know, it's not that big of a deal, but when you go fast, it locks up just like the seatbelt, right?

You can pull a seatbelt on nice and slow, buckle it in. Oh, but when you go to pull it fast, it locks up. And so that's the idea here with this little pissing and, and how the brace works is it allows freedom of movement. But when there's a sudden. Roll of the ankle, quick movement, then it stiffens up and protects the ankle.

And so that, that's really what sets this brace [00:12:00] apart. Um, it's really unique and obviously genius designed by the group, uh, in Germany that created it.

Dr. Grant Garcia: That's awesome. And then in, so like in here, this is, it looks rigid only because of the way you guys had to make it for the 3D, but your one is like so soft, so it's like almost like a sock kind of material.

You said neoprene. And then it has that one hinge or the piston?

Keke Lyles: It has the one piston, yep. And, and what's different? You know, I was talking about the different versions, like you can see here, like where this little, uh, bracket is. Like some, some athletes would complain, like they could feel that bracket.

And so they've, they've moved that up on, on the 3.0 just to make it more comfortable. So it literally feels like you're just wearing a compression sock.

Dr. Grant Garcia: Awesome. And then, um, yeah, keep going while you go.

Will Sanchez: Yeah. Yeah, I, no, I just wanted to kind of bring it up. Did was some of the inspiration or, um, any of those conversations, obviously you dealt with Steph Curry, right.

And he had, I mean, he's probably, besides Grant Hill, one of the most famous athletes that I can remember, [00:13:00] that we actually considered or was concerned that he may not have a career because he had so many ankle injuries. Davidson, 2011, he had a bunch of injuries. 2012, he, I, I believe back to back years, he had the surgery while 2012, they went in, they cleaned everything up.

Um, and there were a lot of concerns. So working with him, working with the, with the team doctor, you know, everyone involved, was there some inspiration on that where you saw firsthand like, these are the problems that we deal with and with my expertise, I can give that feedback to a company like this.

Keke Lyles: Uh, it was a little bit of that, although by the time I met better guards, they had already designed it.

Um, and so I was, I was more of like the, the assurance of like, yes, this is gonna make a difference. Um, just working with all the guys that I've worked with, like wishing we had this back, you know, in 20, I joined the Warriors in 2013, so right after Steph really had all his surgeries and everything like.

We were exploring everything on the market [00:14:00] back then, uh, obviously, and that's what you do in the team setting. Like you, you kind of have to leave no stone unturned. Um, and so yeah, I wish I had this, uh, like I said, when I first saw it, I was like, this is a no-brainer when you put it on, feel it, start moving around, feel the protection.

Uh, and so, and I think that's why they're having the success. Like, I mean, it's, it's blown up really in the last year. I mean, it's going off like gangbusters now. Hmm,

Dr. Grant Garcia: kk, will you describe to the viewers? You know, I could do like the surgical side of things, but I think from you being the performance coach, like you guys.

I mean, this is actually a really cool side conversation that we can have with the viewers hearing this, because what they don't understand is that the conversation between the doc, the team doc, like myself and the performance coach is actually really vital. And we do that a lot behind the scenes, as you know.

I mean, you probably spend more time with the doctors than you even do with the players sometimes. Yeah. Like, Hey, what do I do here? I tried this. It's not working. What are your thoughts? This is all a team collaboration. And you know, it's funny, most of the doc, most of the teams think the docs do all the work and they do like very little comparative to people like you.

Like you do most of the work and you're the one [00:15:00] that's like doing all the titrating and you're like the chemist, right? Yeah. And I come in, I'm like, Hey, listen, may not surgery, may need surgery, but you're the chemist. I'm like, what do you think? Yeah. You know, it's always like you're the ones in charge.

Yeah. So it's really, so how would you, so before this, how would you rehab or try to prevent ankle injuries, these sprains? 'cause they're so common. And then let's talk about after.

Keke Lyles: Yeah. So I think, you know, yeah. Um, I, I think you're right. I probably did have more conversations with our team docs than, than the actual players.

And part of that is, you know, we're working with athletes every day, um, and so we kind of have an idea of their strengths. Well, we better have an idea of their strengths and weaknesses for sure, but how they're moving, how they're responding to different things that were thrown at them. Um, and so we, we kind of have that intimate knowledge, and then we have, you know, obviously when the team docs gets involved, it's like, okay, this is what we're seeing as a performance staff or as the medical staff on the, from the team side, right?

And we're saying, Hey, you know, he. We may look at force plate, we can look at balance, we can look at, you know, use [00:16:00] all the technology in the world and then use our eyes on the court. This is how they're moving, this is how they're responding. Uh, and then when we kind of have this conversation with the team docs, it, it, it's really about, okay, from a medical standpoint, what.

What can we do? What are our options? Right? Surgery, yes or no? Um, is it some sort of orthobiologics, some injections or something like that, right? That can this help or that help and um, or we bring in a podiatrist and what can we do to the footwear? Um, what, what is his current footwear or her current footwear, and how is that affecting their kind of biomechanics?

Um, and so what we try to do is have this really holistic picture of like, okay, here's what we think is the problem. Here's ways we can address that problem. And depending on, you know, the athlete, where they're at, uh, where the injury's at. We may be super aggressive or we may be super conservative. Um, and, and so that's part of the conversation as well.

And so we take the plan, we go back, we implement the plan, and we start working on it. And then, you know, depending on how the, [00:17:00] the athlete's responding, we we're gonna have to adjust. And sometimes that goes well and sometimes it doesn't go well. And so, you know, an example is we may. We may know surgery is an option, but we may not want to go there first.

Right? And so we're gonna try some of the other exercises and, and kind of building up, you know, you asked like, what did we do before this? And it's really building up like the foot and the ankle. Muscles, but it's also like the whole kinetic chain, like all the way up, um, how they're implement or how they're using their movement strategies.

Do they load their hips or are they very knee dominant? Um, and all these things that, how someone moves will determine, you know, our intervention. And so. Sometimes that intervention works, but when it doesn't work, we say, okay, I think we need to go to surgery. Um, and and that's where having the team docs involved in the process.

'cause they know what we're trying, they kind of sense, hey, this is probably going down the right path, or Hey, this is not. Really going down the right path. Let's jump in now. And I think with [00:18:00] athletes, it's like you, you know, if you have to have surgery, then you want to have it sooner than later, but you don't wanna have it too soon if you don't have to have it.

Right? So, well, I think that's, I think that's an important point

Dr. Grant Garcia: too. That's a really important point for people to hear right From, from, because they can hear it from me. But hearing from you. The when to do surgery sometimes is really challenging. Decision motion too, right? Yeah, because like, yeah, they wanna get fixed, they wanna get back, they wanna get back on their contract or win the championship or whatever else they're gonna do.

But you also don't, that's the art, right? That's the art of working with guys like you. To decide if this is the time to, to pull the trigger. And you know, all these sports docs you see that come outta school and they're like, I'm gonna be a sports surgeon. I got this. And then you get to like team coverage and you're like, whoa, this is totally different than what I learned.

Right? Like the book answer is like, if you tear this, you fix this. Not in professional athletes, it's a whole nother, there is like a different category, which there is no book written for it. And it's feel, and it's learning with your team and it's why like. It's funny, we're used in the operating room being kind of like control of the thing.

When you're on a team, like the team doctor is like, let's talk to all [00:19:00] the other people like you guys. Tell me what you need. I'm here as a resource. You gotta put your ego down when you work with the professional teams and it can be challenging for some surgeons. So the important part is to like, it's a team environment, but jumping a little forward.

So talk about what do you think now with, I mean. People still probably get some sprains of this. Maybe not. We can show the data, but like do, have you noticed, like, we'll look at the data in a second, but have you, what would you say now, like if you, I know you work more with the company, you've done a little less with the teams in the last few years because you're more of the consulting.

But what do you think a team now having this product would feel in terms of their rehab or how they're feeling? Like, is this a, is a product just if you sprain your ankle, is it a preventative thing? Use it for both. Or like, what I care about too is like you sprain their ankle. Let's say the player doesn't wanna use it, right.

They're like, I don't wanna use this new product. Which again, some people might won't want to. So they sprain their ankle or they injure their ankle. And then do you use this afterwards too? Like what are the uses for it?

Keke Lyles: Yeah, so, uh, definitely a couple, a couple good points there. You know, being a new product, uh, [00:20:00] you can imagine, especially professional athletes are like.

There, there's a handful of guys who are just like, no way I'm wearing that. Uh, it's new, right? And so, um, they, they, they had to find the right players who were willing to try it and, and give it, give it a shot. Um, and that's been happening over the years. And I think that's why I'm saying like, there's been a lot of growth this last year because now like players and athletes across leagues have been using it and getting more and more comfortable with it.

Um, and, and I think, you know, the biggest thing is you, what you see is, yeah, you can still, obviously if you land on someone's foot, right? Even if you're wearing this, like you could roll your ankle. Um, but what, what we're seeing and what the data has showed is like, it's, it's a major reduction in severe ankle sprains.

So now you know potentially what might have kept you out for four to six weeks may only keep you out for one to two weeks. And obviously, you know, that that's huge for us. Like it's huge for the athlete. Um, and then the other part is, is yeah, if an athlete [00:21:00] really doesn't wanna wear it, um, you know, as a protective mechanism, they can certainly wear it post-injury.

And the reason that's valuable is, is because it gives you the natural mechanics and, and the freedom of movement like. You're not compensating, you're not developing an abnormal movement pattern. And so you get the protection of, you know, the athlete feels the proprioceptive, protection of the compression, obviously the pistons there.

So if they were to roll it, it's protected. Uh, so that's why they're seeing, uh, an increase in return to play from a normal compared to not wearing it post-injury.

Dr. Grant Garcia: Awesome. So, yeah. So can I ask clarifying, so you're saying. So the, let's go 'cause let's try to convince more people on this show. Like that's better, right?

Like players that are already using it, they know it's better, right? Yeah. That's the easy one. Like those are on hard cells, but the players that aren't using it or the people that aren't using it. So you get, let's say you get, we can already show the reduction in risk injury, and I wanna talk about that.

That's an easier discussion. Let's say you get injured. So if you were the performance coach, let's say you're back on the [00:22:00] Warriors, right? Player gets injured right away, they injure their ankle, they're the ones that didn't want to do it. And you don't wanna say I told you so, but you just wanna say, Hey, here's what I would recommend.

So how would you rehab a player now with this brace?

Keke Lyles: So as soon as they injure it, uh, we'd get 'em in the brace and have them wear it just all the time walking around everything, you know, and depending on again. Okay. Yeah. Depending on the severity, you know, if they're not walking yet, they can still wear it.

Um, and, and develop that confidence in it, that it's gonna protect them. And that's what the, the study showed a, I think it was 54% faster return to play with wearing the brace. Yeah. We pull that after the injury. Um, and so after somebody gets, gets hurt, that's awesome. Yeah. 54% faster. So you're essentially half the time.

Right? And, and that, that is huge for, uh, any athlete to get back. And so I, I mean, we we're still gonna treat it the way you would treat any ankle sprain, right? You're gonna do all, you know, whatever you have access to, you're gonna [00:23:00] do what you nor normally would. We're just adding the brace on.

Dr. Grant Garcia: Do you, do you see, again, I know, I know.

You work with a company, probably not on the floor, giving these out every time, but in what you've heard anecdotally from the athletes, this 54% return to sport faster, do you feel like they're just, they're meeting all their checklists? Like is that, is that what's getting them back faster? Like, Hey, listen, you no longer have pain in there.

You're able to run with confidence you're not limping, right? 'cause there's always a return to play protocol for all these things. Concussions, acls, you name it. So are they, basically, you're saying that they're, they're beating, they're checking the protocol faster with this, roughly. Yeah.

Keke Lyles: Right? Yep. Yeah, that's it.

And I think the biggest thing, like when you compare, just anecdotally, like in my experience, uh, before kind of better guards, you know, this like early 2000 tens, like when someone rolls their ankle sprain, you know, rolls their ankle has an ankle sprain. Um, you know, around like the three or four week mark, they're feeling pretty good, but they, it's always that last like 10 to 15% that just seems to [00:24:00] drag out forever.

Um, and I think to me that's the biggest thing that's changing is like, this is all happening much quicker now. And you hear athletes use the word, like, I just feel so much more confident in it. Um, and so I think that's a huge aspect, like, because it's protecting them because they have their normal kind of, um, biomechanics at, at the foot and ankle, like they just are confident in, in returning to play.

And I think it just gets 'em over that last 10 to 15% much faster than what they previously did.

Dr. Grant Garcia: Right. So you just, you're just gonna see less long haulers. I mean, we've seen these, N NFL is notorious for it, NB a's notorious for it, right? The, the guys are like, they should be back, you know, like you see the ankle sprain and you're just like, you know, will and I have talked about this injuries.

You're like, is this gonna be a one or two weeker or is this gonna be a six weeker? Is this gonna be half the season? It's crazy 'cause it it, for injuries that I deal with, it's kind of on a minor level, right? 'cause it's a sprain.

Keke Lyles: Yeah. But they're

Dr. Grant Garcia: so, they're so frustrating to take care of and so, and there really hasn't been a good eye mean.

Doing surgery is all great, but you're out for a [00:25:00] while and like, you can't just do surgery on everyone. That's not the right answer. Right? So like, and you can pump them as much biologics as you want, but it's still not the answer. I mean, we will to her to say so many times, prevention. Is by far the best medicine for injuries, right?

You can prevent it if there's something you can prevent. If I had something to prevent all my injuries, I would give it. Like if we had a better brace for acls to prevent tears. The data's not there yet, right? Like skiing and I think MCLs and linebackers or in, um, and linemen. But this, this is pretty awesome.

We'll pull up that. I wanna talk about injury prevention now because we're kind of talking about it, but I wanna run through that number, uh, that 40% or think there was something like that up there. Can you pull that up?

Keke Lyles: Yeah. And as you're pulling that up, you know, the one thing, I'll tell you a story, like we had, we had a guard, uh, who is a chronic ankle sprain, you know, guy his entire life.

And I'm sure you see this and I'm sure people listening, you know, there's gonna be a handful of people of like, just sprain their ankle over and over and over to the point where there's really, there's no integrity of the [00:26:00] ligament anymore. And we, we had a guard who came down on someone's foot in the middle of the game, in his lateral malleolar.

So the bone on the outside. Hit the ground. I mean, he rolled it so hard that it hit the ground. And everyone heard that from the, and we, we thought he just broke his ankle. Uh, and, and so at that point, like, you know, what kept him out was the bone bruise, not the, the, the ligament damage. And so that's the other part of this is like if you just chronically or spraining your ankle, like the integrity of the ligaments become.

You know, gone useless. Yeah. And, and now you're dealing with these bone bruises. 'cause when you roll the ankle, you know the bone is hitting bone and, and, and that's usually their pain. And those can take forever. And, and, you know, and, and there's not really anything you can do with bone bruise other than like, we kind of just deal with it and eventually you gotta work your way through it.

And so that, that's another reason. To your point. Prevention is so key because it's like if you get to that point, it's just really difficult.

Dr. Grant Garcia: Well, and also the surgeries are long and not always successful. [00:27:00] This might be a good segue will at some point to have our, our in-house Dr. Yi, on the episode to talk about this for the full ankle.

Ankle, but like, it is a good point you're making, I mean, right. You have no, when your ligaments torn, it's no longer there. You basically are adding another ligament. I don't wanna oversell the product with the piston. The idea behind that is like, that's a cool, I'm sure that's not like a super common injury.

Like it's common, but I'm sure it's not like the, so it might be hard to study, but the idea behind like the, it's more than just about ankle sprains, right? Only the public only sees ankle sprains. Like, we all know this, well, we've seen this on the injury report. The injury report's like, yeah, uh, he's got a knee sprain.

It's just bull. It's not a knee sprain. There's something really wrong with his knee. They just don't wanna mention it. So it's like he's got an ankle sprain, but he may have much worse than that. He may have a high ankle sprain, he may have a bone bruise there. And obviously that scares the people, or it can change the perspective of the team.

Um, but you know, there is more that these can prevent than just that alone. Um, do you, and do you say like, so if someone has this, would you recommend both sides or just the injured side? How does it work for you guys? Like when your players have done it, what do they usually do?

Keke Lyles: Yeah. Um, [00:28:00] there are some, some athletes who are just really concerned about 1, 1, 1 foot, one ankle.

Uh, but the idea to, you know, you said it and that's what we preach. It's, it's prevention. So it's like, why would you not wear it in both? And I think, you know, traditionally what athletes are used to are these more bulky braces. And so for them, the idea of wearing on both, they're like, I don't want to do that.

Like, forget that. But then once they try it. The better guards and they're like, oh, this is comfortable. Um, you know, the adoption to use in on both seems to be much higher,

Will Sanchez: but what's the best feedback you've gotten from a professional athlete wearing the product, you know, with someone you know, with a word of mouth or directly to you where you went, man, that, that, that was pretty good.

Keke Lyles: I think for me, honestly, it's just hearing ev like every athlete say, like it feels like I'm not wearing an ankle brace. Like I'm not, you know, it doesn't take up all the space in my shoe. Um, it, it just feels normal and I think like, and at least when I hear like. An athlete say it feels normal. Like that's [00:29:00] huge because I want them to be comfortable.

I want them to express their athleticism, do everything they want to do. I don't want them thinking about, oh, I have an ankle injury or an ankle problem, or I got this big, bulky thing in my shoe that I have to worry about. So for me, uh, that's huge.

Will Sanchez: Across the board. So you could wear this with low mids and high, right?

Yeah. So it doesn't matter if, if KD has a line out and he's got some mids on, or somebody's wearing high tops, which I'm not seeing a lot of high tops, but that's a whole conversation. Yeah. You know, this so low. So this, this, um, ankle protector can, you could wear with any kind of shoe. So if they have endorsements, sponsors, it's not gonna affect them because it is.

Not bulky, it'll fit with anything. Right. So that has to be a plus as well. 'cause now we're talking about money sponsorship, your own brand. Sure. Right. We're thinking big, big picture when it comes to something like that.

Keke Lyles: Yep. Yeah, I mean that was, it's funny that you mentioned some of the sponsorships.

'cause even like the early adopter. Players in the NBA. Um, you know, that was a big [00:30:00] talk, like where the better guards kind of logo is. Can it be shown? Can it not be shown? Like there's lots of rules around that. Uh, and so That's crazy. Yeah. But yeah, you can wear it with whatever you want. And I actually had a guy that I was working with just two years ago.

Um, who, who had an injury? You know, like I think most athletes, like when they're at home, right, they wanna wear sandals and everything, and it's like, just wear the brace even when you're wearing your sandal. Like, just wear it. Um, and so for them, they're, you know, they thought that concept was formed, but then they loved it and, you know, they saw the results.

So, uh, that

Will Sanchez: always helps. Are you doing multiple colors for like, you know, let's say it's golden State, you got the gold, or are, are you doing things like that? The bucks green or purple? What? No. Right, right,

Keke Lyles: right now it's white and black are are the options. Um, yeah, and mostly because, you know, especially at the professional level, it's a lot of like color of the socks and team socks, what's allowed, what's not allowed.

Mm-hmm. Um, it's more around that, but yeah, I, I'm sure, I'm sure as the company continues to grow, especially like for youth, [00:31:00] uh, you know, it's gonna become like style. So for sure.

Dr. Grant Garcia: Uh, kk do you, one thing we noticed, we talked about the Guardian helmets on one of our episodes and some of the things how the NFL now is saying, Hey, listen, you know what, like you probably need to wear this.

And like, they start recommending it. Like, what do you think the data's gonna have to show on this thing before? I mean, like if I'm a team owner, right? And I know that my players had six ankle sprains and they refused to get surgery and I just paid this guy 20 or $30 million a year. He doesn't wanna wear a brace, that's still a relatively reasonable cost.

When do you think the owners say, you know what, it doesn't really matter if you don't like it or you don't wanna use it, or, not that, not like it, but like when does that, but like at some point some of this technology comes in, right? We know about this. It sucks. But then when the player gets, kind of forced into it.

But like if you guys eventually show that, I mean that's, that would be obviously amazing for you guys to have that sort of reputation, that it's so good that the owners think you need it. But like that could be a situation where you're at Theron coach, like, listen, [00:32:00] are you di of getting ankle sprains?

Like you're gonna be outta commission more. Like you need to try this. Like you, you don't wanna lose any more money on your contact.

Keke Lyles: Yeah. And I, I, yeah, it's an interesting question. And that's where it's like you gotta get the players union kind of behind it as well. You know, there's one NBA team that does force, uh, players to wear ankle braces and like knee pads for practice.

Uh, and, and there's a lot of pushback initially, but now it's the culture there, right? Um, I've been involved with conversations with players that previously did not wear any sort of ankle protection, uh, who've had, you know, recurrent ankle injuries and it's like, okay, ownership does get involved and say, Hey, we gotta do something right.

Like, nothing, like we can't, no longer. Do nothing. Uh, so let's work with the athlete to figure out what's gonna work. Uh, and I think better guards is gonna ultimately start winning a lot of those kind of conversations. Because again, if a guy who, or if an athlete who doesn't like wearing ankle braces, puts this on, it doesn't feel like an ankle brace.

And so now they're like, okay, I'll try this. [00:33:00] 

Dr. Grant Garcia: We'll pull up that slide to show the comparison. I mean, I know we kind of talked this in nauseam, but you can do like the mobility high, low. Uh, you have one more?

Keep going. Keep going. Right there. Yeah. Yeah. So you can see, I mean, this is what we have option wise, right? Like, I mean, you've got, there's some fancier looking ones, but nothing does what this does. No one has. The key is you check off all the highs, right? Yeah. High protection, high mobility, high comfort.

You have to have all of those. The problem is it's really easy to get the fir, the second two, if you have no protection. Yeah, exactly. So you can do, so you gotta have, it's like, it's like the, it's the mix of the two. Um, and so, you know, like when someone, when a player's looking at this, right? That's their alternative option.

So it's a huge niche too, right? Like underserved. Which is why I think the technology is so cool. And having you on here discuss this is really cool 'cause it's something we talk about and we have not seen anything in the news or anything that's been other way to like help this. And the negative of anco sprains is that they're not like sexy, right?

Like the Tommy John surgeries or like the. [00:34:00] ACL tear so they don't get as much publicity. But right now you can see it right here. But the big data shows that obviously it's a problem. I mean, one in, one in four NBA players injure their ankle each season. That's crazy. And it's the most com, as I mentioned, like if you just take, it's agonizing how many of these you see.

Keke Lyles: Yeah, no, and, and you know, that's the other thing, like a player may kind of sprain their ankle and it might be a pretty minor sprain and they miss a week and you don't think much of it. But then it happens again in what we were talking about. Earlier, it's like these recurring ankle sprains and how much worse it gets each time.

And so it, you know, I think a lot of people think of it like the first time anyone sprains their ankle, it hurts, right? Like they're crying. It hurts so bad. Uh, you ask someone who's like, sprained at the 10th time and they're like, yeah, it's not as bad, right? And it's like, that's not a good thing. Uh, that, that, that's much worse than what, what people think.

And so. Um, yeah, I think there's, you know, obviously a massive opportunity to help athletes across, [00:35:00] across sports to kind of, you know, get ahead of this. Are you

Will Sanchez: seeing, um, any, I I know we're talking about the ankle, right. But you know, the big conversation this past NBA season was the Achilles. Yeah. Right.

And are are, is there any data or anything that leads up to, like, let's say, if. You, you have a bad sprain on your right ankle and obviously Dr. Garcia is right up your alley here. You know, uh, it's right, you know, spraining your right ankle, it's not healing right now you have some soreness in your calf and you know, now you're leading into other injuries.

Is there any data that kind of shows any correlation with that? And I know we're talking apples to oranges. As far as the injury uptick that happened this season, I believe it was seven NBA players had Achilles injuries. Nine altogether, including the two players that got hurt in, uh, summer ball. I forgot their names.

So I don't know. Or was, am I going off on a, a whole different, well you're going

Dr. Grant Garcia: off on a tangent, but you, like I always do. But you're helping with a [00:36:00] question would be, I would rephrase it 'cause it was so, it was well put. But I would add a question in there to say, is there a future for better guard's, piston and other.

Opportunities. I'm not trying to give away your future RD. Yeah. Um, but you know, the idea is if it works that well on the ankle, why the hell wouldn't you use in other places?

Keke Lyles: Yeah. So I think to answer both of those, um, you know, I, I don't know if there is clear data that shows ankle injuries to like Achilles injuries, but for sure, like there's plenty of research that suggests after an injury, you know, movement patterns change, which then, you know, can affect.

More, uh, other injuries, right? Uh, and so I think there's a, a link there for sure, uh, to some degree. Um, not to say that all Achilles come from prior injuries, but for sure, and that's why, you know, restoring normal movement is so key. Uh, and that again, that why I was personally excited about better guards.

Um, and then yeah, to your second question, yeah. They're already exploring the pistons in, in different, like knee braces, elbow [00:37:00] bracing, uh, there Yeah. There's lots more opportunities to kind of apply this technology to other joints.

Dr. Grant Garcia: Yeah. This is cool. I'm already thinking about some things in my head. I like the, the MCLI like some ACL stuff.

I mean, if you have a brace that smooth. And then you've got an acute piston thing like that is pretty sick. I, it's funny, when I looked at your product, I, I saw the piston and I learned about it, but I didn't really get it until you showed it. So today is pretty cool. It's a little eyeopening. Um, so hopefully for the listeners too, they can see it.

I think, I mean, like I said before, like the idea of putting, like, to me, like I put on these ankle braces before the old ones suck, right? Like the stiff ones, they're like this. I like, I wouldn't wear it. Like, I'm like, but if I had something, I'm going out and I have a loose ankle. The other thing is like a lot of people don't want surgery.

I mean, no offense, but like I do a lot of surgeries and like you just don't wanna have surgery on your ankle. Ankle surgeries are hard. They take longer to recover. The blood flow's different down there. Listen, I have tons of friends that have had ankle surgery. They do well sometimes, but sometimes they don't.

And so it's like, yeah, if someone's like, well, [00:38:00] why would you just do the ankle surgery? I'm like, it's not a hundred percent right. So if you have something that's preventative, like, I'll be honest with you, if there was a brace good enough to stop people from dislocating their knee with acls, there probably would be less ACL L surgery.

Right. Like people don't want surgery. They'd rather wear abrasive. It's comfortable. And so another point you made, right, that person with the chronic ac, the chronic ankle, they probably should have gotten surgery, but they're not ready to, they're an NBA player and they don't wanna take the risk. So like that's another important point.

Or athletes, they don't wanna do anything until they're done with their career. So that's even more important.

Keke Lyles: Yeah. Yeah, absolutely. Yeah. It's funny, uh, you know, coming from physical therapy background, like I, we, I think myself, but I'm sure plenty of others like view surgery as like a chance to reset everything.

Like sometimes there gets to a point where it's like, you need the surgery, you need to reset, but it's like. You have to put in the work, right? And it's like the rehab is, you know, just as important as the surgery. Like if you just have surgery and do nothing, it's like usually those patients don't do very well.

Dr. Grant Garcia: I, [00:39:00] I, dude, that's exactly right. Like I spend my time in the office. I'm like, my job is like an hour or two hours, maybe I talk to you a few times afterwards. And then all the work is done with the physical therapists and strengths and conditioning coaches. And so you don't put the work in, you don't have patients, same surgery, same surgeon, four different patients, same day of the office.

Two are killing it. Two, were not killing it. Exact same technique. There's a reason. There's a lot of reasons there, but one of them is the work. There is a really, there is a difference and it's hard, you know, and you get to the bottom of like, and they won't bring it up with you. Maybe you, in the professional level, they tell you, but in that one or two instance, if you're seeing them, they might not say, oh, I stopped doing my stuff, I only do it once a week.

Right. You're like, that makes sense.

Keke Lyles: Yeah, and I think that's the big difference between professional athletes and general population, like professional athletes, like they have teams of people to take care of them and making sure they're motivated. Obviously it's their job to be out there performing, uh, where the general population, like you might see a physical therapist to three times a week [00:40:00] post-surgery.

It's just not the same level. And then, you know, life gets in the way. You're busy. I got school, I got the, and then now next to your point, like you can have the exact same thing and have some patients do really well and other patients do really poor. Uh, and so it's like if you can just avoid all that to begin with, it is so much better off.

Yeah.

Dr. Grant Garcia: Well, and I think. I actually think as much we talk, we keep talk the professional stuff's super sexy. Talk about like, you hear the word NBA on a podcast and you're like, oh, this is interesting. Right? But like, to be honest with you, this is probably be more important for non NBA, right? The kids, right?

Because like Curry's talking about Davidson, right? Like that's before the NBA. So like you have like this is the end. Once you got to the NBA, you like, we've seen this in Tommy John's. I do players all the time. These young high school players, they have trash ucls, right? Can we prevent these before that even happens?

So like, is this kind of like the concussion protocol? Like let's get these ankle sprains down at the high school level. You know, and I think that's something has what's better guard's thoughts on sort of the [00:41:00] education? Obviously they're doing well with the marketing and the products. They've done a good job with the design.

Like how does that work? 'cause like that's a hard part, right? Like you can only market so much, but you really gotta get the, the buy-in and, and the lower down.

Keke Lyles: Yeah,

Dr. Grant Garcia: athletics or the high school athletics or college is honestly more important sometimes.

Keke Lyles: Yeah. And I think actually the, you know, this year I think is a big opportunity for them.

They did a, a big partnership with the NBA Athletic Trainers Association, uh, kind of built around this of like, how do we spread the word to athletic trainers? Across, across, you know, across sport, across levels, you name it. Um, you know, being the NBA Athletic Trainers Association, they, a lot of people look up to them and Okay, what are they doing?

Yep. Right. What, what do they have? And so I think that partnership's gonna be huge to kind of reach the, the high school levels and that, that's part of the mission of the brand too. Like reaching kids at a younger age. 'cause Yeah. Obviously if we can prevent it much younger than those, those kids are gonna have.

A, a better career, whether that's professional or not. Right. And, and they're, they're not gonna be dealing [00:42:00] with pain and injuries as much. I think that's a win-win.

Dr. Grant Garcia: And then, can I ask, I mean, I'm assuming you guys did NBA, 'cause it's probably one of the highest ankle sprain populations. Yep. Um, and that's been your focus.

And then obviously, I mean, I'm assuming you're branching out to other sports. I know you've got a lot of other sports on that list. Yeah. Um, but your focus has been NBA because of the highest, it's one of the highest ankle sprain populations. Is that correct?

Keke Lyles: Exactly. Yeah, that's kind of the initial focus.

Uh, football, NFL, like it was surprising. Athletes responded really quick to it. Um, baseball had a quick response. Um, and then what was really interesting, and I, I work with a couple of soccer players. You know, soccer is so unique because those cleats are so small and compact, um, that like ankle braces are just.

Out of the question. Um, if they do anything, it's usually tape. And you know, most tape is like after the first like 10 minutes, whatever kind of protection it provided is not there anymore. And so now we're seeing as soccer players are starting to get exposed to it, like, oh, this can really help. Um, you'd be surprised, you [00:43:00] know, ankle.

Ankle sprain or you're not surprised, but the, the listeners would be surprised. Ankle sprains. And I'm surprised soccer players are super hot. Surprised. I like it. Yeah.

Will Sanchez: I mean, our famous, I had no idea. That's awesome. Williams. You know, she always had her ankles, you know, uh, you know, braces and things like that.

So, you know, tennis also is probably a great sport. We just saw Roland Garrels where they're running back and. Forth and do it splits and sliding, and I don't, I don't understand how they're not having, uh, higher ankle injuries, but let alone maybe on the lower level they are. So that's an interesting support as well.

Dr. Grant Garcia: I, I think it's interesting too, you always notice on this. Podcast. He always said, you learn something, right? Well, we learn so much from everybody about these different sports and the injuries and no matter how much you think, you know, you know, this is why, like getting people on, talking about this stuff, hearing the details, it just really breaks everything down to understand it better.

Right? It's not just a product. It's like, no, this is a product that's been tested, it's been revised, it's been improved. We're on [00:44:00] 3.0, um, with two more follow up and I want to kind of let you go so you're not being on all night. Uh, first one is like, so I know we kind of advertised for the 2.0. Initially when I was working with you guys to kinda get this podcast set up, it was a 2.0.

Now you get a 3.0. What's the difference in the upgrade? For the 3.0.

Keke Lyles: Yeah, mainly the positioning of, of this little part here at the bottom. So that, like I said, like some players, and I think it was really dependent on the type of shoe that they're wearing. Like they would feel like it kind of dug in and so they moved that up and outta the way.

So it's just, yeah, totally removed that. Um, but no change in the

Dr. Grant Garcia: PIs.

Keke Lyles: No, no, the piston's the same. Yep. And so that, that's the same, that's, uh, tried and true. So no, no reason to change that. It's really just creating more comfort around the brace and, um, they did relieve the 3.0 is out now, so everyone is, is getting that now.

Okay.

Dr. Grant Garcia: Perfect. And then I would say, sort of, kind of follow final up question. And then I know Will's maybe has a fun question or something, who knows? He's always got something hidden there. The, uh, the, what's the future? I mean, we kind of talked about it, but what's the future for you guys? Where do you guys [00:45:00] see yourselves in the next three to four years?

Or what do you wanna do for these products?

Keke Lyles: I think, you know, as we mentioned, like it's definitely gonna be, um, some expansion into other joints, protecting other joints. Um, you know, obviously working with NFL guys like knees are a big, a big issue. Um, and just alignment, like you, you said it, MCLs are like, I think it might be the number one injury for offensive and defensive linemen.

And so if if there's a way to help protect them, uh, yeah, we're gonna do it. And so I think. Exploring what other joints, how much of a difference we can actually protect you. You mentioned the UCLL in, in the elbow and, and pictures like, is there something here? You know, we're exploring that and so I think that's gonna be really interesting.

Uh, and then just generally, like the more adoption, the more people are hearing about it, learning about it, uh, and understanding how beneficial it it will be for them, I think is, is gonna be the real focus. Awesome.

Will Sanchez: Great. Um, I'll do a two part question. Um, when you first came over, right, and I believe you, you mentioned you came over for the [00:46:00] Minnesota Timberwolves.

You show up to Golden State Warriors the year after the surgery for Curry. Uh, what was the pressure like for you saying, man, I'm coming over here. We know what the bread and butter is for Golden State right now is making sure that we're getting curry back on the court. You know, changing maybe his regimen.

Obviously he got bigger, I believe when he first came in he had some hip issues and things like that. So if you could explain some of that. And my second part is. What did it feel like winning A NBA championship?

Keke Lyles: Yeah, so first part of that question is kind of interesting. So I'll tell you my first, uh, day in, in the practice facility of Golden State, I joined the team during the summer out in Vegas, during summer league and then after summer league, uh, we come in my first day in, um, I won't say who, but it was another player who's dealing with a knee, a knee injury.

And he kind of put me to the test. Like he didn't tell me what was going on. I didn't know what was going on. And I just kind of like, Hey, something doesn't seem right. What's going on? [00:47:00] What's going on? You know? Um, long story short, uh, you know, he goes, you think I need surgery? I was like, no, I don't, I don't think you need any surgery.

And he, he kind of starts yelling, I told you I don't need surgery. I told you. I was like, what did I just, what? What's going on? Uh, so long. Story short, but essentially he, he, he had a, um, a, a small quad tendon tear that the team, you know, everyone's trying to figure out and they kind of had settled on doing a surgery and he was gonna miss, you know, obviously at the beginning of the season.

Uh, he really didn't want the surgery for whatever reason. Uh, and so I was like, okay, I think we can, we can handle this and, and kind of rehab him back. And so, uh, to be honest, like I was. Literally like, am I gonna get fired on day one? Like what did I just cause? Uh, and so thankfully it all worked out. He played, he didn't miss any games that season, uh, the player with the knee, which was pretty awesome.

And so, to be honest, like with Steph though, Steph is such a great like dude and a good person. And, and I think he saw honestly what we were doing with that other player in his knee. And he is like, all right, just [00:48:00] tell me. And I also, I tell everyone all the time, I had the advantage of like coming in when they.

Tried millions of things and it's like, okay, well let's look at this one other thing. It's like, let's just think outside the box and see how this helps. And obviously it's a combination of everything, right? Like it's the surgery, it's his work that he put in on the rehab part of it. His willingness to like do what I was asking of him, uh, to try to help kind of change some of his movement patterns a little bit.

And so it's everything that kind of made it like, to me, the step part was kind of easy. It was the other guy that I was like, oh my goodness, get on day one. Yeah. Good test

Dr. Grant Garcia: now. We'll know that for now on. Good test. Yeah.

Keke Lyles: So, uh, and then winning a championship, I mean, it's, yeah, it's incredible. I think you hear a lot of people say like, there's so much work that goes into, I think any, any sport, right?

Professional sports, like you're in it day in and day out. Um, holidays, weekends, you, you know, I kind of told everyone, like when I worked in the NBA is. Like 12 years, you know, seven [00:49:00] days a week. I've, you know, I got maybe a week off here or there, uh, in the off season over that course. And it's just like, you put so much time and energy into trying to win and it's like one team wins.

That's it. Like it, you know, it takes a little bit of everything to come together. Uh, so it was incredible. Uh, and at the same time it's like, okay, what else? How do we get better? You know? And you get like, that's next year. Repeat. Yep. And that's the thing about sports. It's like you, you win it and you celebrate it, and then it's like a couple days later it's like, all right, let's get back to it.

Let's, how do we get better? So it's, uh, that's just, it's pretty wild.

Will Sanchez: Last thing, um, if you had your choice, when you win a NBA champion Chip. Should you be able to take the trophy and celebrate the way they do with the Stanley Cup? Everybody gets it. You get a few days, you could travel with it, take pictures, put babies on it, whatever it is.

What, what, what, how do you think, what if you could change one thing for the championship, what, what would it be? Would it be something like that?

Keke Lyles: Ah, yeah, man, that's a good question because I [00:50:00] think me personally, and you know, I can't, it's not really fair to speak for players, but I don't think players get caught up in the trophy as much as the fans do.

Like for the fans. It's really cool and it's special to like see it, to feel it, to touch it. But I think for the players, coaches, staff, everyone, it's like, it's the work, the, you know, it like, it's the memory of like the whole process that matters more. Um, so maybe for the fan's sake, it would be cool to travel it around and get it out there.

I think some teams try to like show it off a little bit, but yeah, I, I think for them, for sure, it would matter. I think for the players it, it probably doesn't matter to them as much.

Dr. Grant Garcia: Makes sense.

Will Sanchez: I like it. Uh, listen, thank you so much for your time. Um, as Dr. Garcia mentioned throughout, uh, the show, we, uh, we learned so much.

We're really excited about the product as well. It's very unique. It's very different, and, uh, all the points that you highlighted, it just illustrates why, you know, players should be using it, but just not. Only at the professional level, but [00:51:00] obviously at the amateur level. We'd love to see some high school kids, uh, use it as well because maybe then that allows them, you know, to not have these injuries and maybe their career could go a little bit further.

'cause we've seen so many talented individuals never make it to the highest level. So, uh, Dr. Garcia last words, but, uh, kk, thank you so much. I can just

Dr. Grant Garcia: say, I'm gonna get a lot of ankle sprains outta this episode. Ask me about my better guards. Yeah, no, we gotta show that off in the office. This is awesome.

So anyhow, I, I, I love it. Thank you so much for being on. This is really cool. I love the new tech, um, and anything to help the players and the, the kids and not have to do as many surgeries as good. So, thanks for coming on. I really appreciate it. Thank you. Thank you. Shout out

Will Sanchez: Danielle. Thank you, Danielle.

We didn't hear from you. Thank you, Danielle. Thank you. Take care.

Dr. Grant Garcia: Thanks.

Audio Transcript

Once again, the New York team start out oh and six. And I may need some therapy. I may need something stronger than water, but, um, anyway, how are you? What's going on

Dr. Grant Garcia: outside of the Giants? I'm good. Things are good. You know, it's, uh, unfortunately end of summer in Seattle here, but we're still getting a few [00:01:00] more sunny days and, uh, yeah, it's been good.

Everything's going well. I'm excited to talk about this topic. It's, uh, it's interesting 'cause it's kind of like you hear it, but. You don't really see it that much and you, you heard about it. Everyone knows about it. You know, the doc that's doing a lot of these surgeries. Um, but you know, it's just one of those ones, it's kind of like the hidden, the hidden injury. We don't talk about too much, but it really affects people significantly.

Will Sanchez: Yeah. And before we get into the topic, I mean, we can talk injuries every single week. I mean, we could turn this show into that. We, once again, Nick Bosa torn ACL out for the season cd Lamb High Ankle Spring. We've talked about that in the past.

Three to four weeks, but that's, that can be something that just lingers for a lot longer. Um, an Najee Harris is out with a non-contact football, uh, foot injury. And James Connor, severe ankle injury. We're talking about major, major stars in the NFL that are hurt. We had five quarterbacks last week starting quarterbacks that didn't play.[00:02:00] So this, this is, this is something that reoccurs, it's part of the business. It's why we love the game, uh, just because it's exciting, it's fast paced, but there comes a cost. And with that cost as they get recovery, you know who we're gonna shout out. We're gonna shout out Mike b at the Recovery Shop. Dr.

Garcia, man, let's talk about the recovery shop a little bit.

Dr. Grant Garcia: Yeah, shout out to our sponsors. They've been awesome for the last year or so since we've been working with them, but you know, they're, they're really great. Honestly, I have 'em in my practice and my patients. Always asking about this and always complimenting about this ability to order sort of aftermarket things that'll get them back like the nice machine or, um, you know, more innovative braces or more innovative machines.

Like the Relists, like the ability to have that option in all in one area is really great for your patients from a recovery standpoint and working towards more nutrition, which again, we've had two nutrition specialists that are doctors on this show. So, you know, it's, it's, it's not just about the surgeries.

These cool things we'll talk about. It's about [00:03:00] the. Postoperative care, and that's really what they specialize in. So reach out to 'em. If you're a surgeon, if you're a patient, talk to your surgery surgeon, they might be able to offer it. So,

Will Sanchez: you know, the topic that we're gonna get into is turf toe and um, and.

It's a, it's a great segue, especially what happened with Brock Purdy. He's supposedly going to be out for a few weeks and we're gonna get into some of those things. When I think of turf toe, uh, Patrick Mahomes recently, you know, a few super bowls ago, he played through it. I can't imagine the pain that goes through it, and you're gonna explain why that is.

And then Dion Sanders, you know anyone that knows Dion, that knows about his story you suffered through this injury that pretty much led to amputation of toes. So it is, it is, it has a funny name, turf Toe. It doesn't sound like a strong football player. Should be out for the season or alpha weeks with a name like Turf Toe.

But what is Turf Toe? Uh, anatomically, you know what, what, what, what structures are [00:04:00] affected by this?

Dr. Grant Garcia: Well, so yeah. So let's show that diagram so it's easier to describe to our listeners. Um, yeah, that's a good one. We can do that one first. So we're talking more about the Joe Burrows thing, right? Yeah. He's gonna have surgery now on this.

It's a really big deal, but again, it's so small and you're kind of like, what are they dealing with? And you know, this may be what Malik nabs is dealing with. They don't really talk about his toe injury. He had. Okay. You know, there's all these recurrent injuries you hear about with players, and we'll go into some of them.

Yeah. But basically this is that the first. It's a big toe and where it connects to what we call the metatarsal, that's the long shaft there. And underneath that there is something called a plantar plate. And that plate gets torn. Now, here is not the best anatomy, so if you want to go to, let's go about two slides, I think over one more.

You're perfect right there.

Will Sanchez: Yeah.

Dr. Grant Garcia: So you can see this is again, a really anatomic figure. You underneath that, you have the tendons that allow you to flex the big toe, and then underneath that is a capsule and a plantar plate now, and that tears. The thing is when you [00:05:00] have it on your foot, the most important toe is that big toe for planting flexion and explosion.

And just the tear of this can reduce your explosiveness significantly to the point now where basically you go from an NFL player to to a recreational athlete. Right. And it's pretty impressive that they can be knocked down that far. You lose your explosiveness, and this has been a problem for a number of NFL players, and it happens outside of the NFL too, but this is a big deal.

And so that's what happens here. Now sometimes, which we'll talk about in the potential surgical, you can see there, there's something called these little sesamoids or tiny little bones that sit in the middle of this sort of ligaments. These all these accessory ligaments and everything else. Well, those can be injured too.

With this. Now again, it's like, it's like we talk about a knee sprain, right? It's not just a knee sprain. It may be an ACL, it might be a meniscus, it might be cartilage damage, right? The turf toe has various. Degrees. You can get cartilage damage of the two joints, just like you can get cartilage damage of the knee and you can tear these, the plantar plate and split these sesamoids.

Or you can tear the sesamoids or you can fracture the sesamoids. And so there's various different things that can [00:06:00] happen with that. Now we don't know exactly which one he got, but we know that Joe Burrows is probably a high level one given the fact that he

Will Sanchez: Rock. Rock. Yeah. Yeah.

Dr. Grant Garcia: Rock pretty up.

Will Sanchez: Yep. Um, so how, how do you grade it from a mild to severe?

What are you looking for when you're assessing that? When he comes over from the sidelines saying, you know, I've got the discomfort. Um, what are you doing there?

Dr. Grant Garcia: So the first thing you're doing is you're, you're looking at this and you're trying to assess, like you basically, you're gonna test that ligament out.

You're gonna basically try to extend the, the toe, oh, flex the toe down. And you're gonna, I mean you pretty much can probably make some of your diagnosis there, but really the key here is gonna be that MRI, so to look and see whether or not it's the, you know, what we're dealing with. And so that's first thing.

Is there

Will Sanchez: anything instantaneously, like, you know, obviously you took, you tear. Your Achilles, you squeeze the calf. If the foot just dangles and doesn't flex, then you know that it's, you know, the Achilles has popped. Is there anything that you can see on the field right away, [00:07:00] or is this something that's just a pain threshold and then you have to get to an MR? I

Dr. Grant Garcia: mean, generally your NFL, you're going straight to that. So, you know, that's a combination of, of both and for us to clarify for the players. So the Joe Burrows underwent the surgery just recently and Brock pretty also got the injury. So actually we're talking about two players here.

Will Sanchez: Yeah. Okay.

Dr. Grant Garcia: So Burroughs, it looks like he went actually to the Andrews Institute intra, interestingly enough.

Um. To repair it, but I was under the impression he was gonna go to Bob Anderson. So that's a, that's an interesting finding. But Bob may have flown down there to help out 'cause he's one of the Green Bay Packers team doctors. So, sorry, let's continue on. So the, yeah, yeah. So you're gonna get the, every, all these players, all these players are gonna get MRIs and they're gonna get 'em on the next day.

I mean, when we were taking care of the Giants, we would have Monday morning MRI review of all the players that were injured during the week. Then we'd go through them and say, okay, this is what it is. This is what it is. So they've got the M MRI the next day. [00:08:00]

Will Sanchez: Okay. And then you don't think that's something, if they're at their home stadium, that they could go do?

Well at that point they're still kind of in the middle of the game.

Dr. Grant Garcia: They're not gonna do it mid game probably because it just doesn't make any sense to do it. It's not urgent enough to do that. And it wouldn't generally. Right. It's always about like, what would the management do? Right? You get the x-ray, make sure they don't have anything broken.

Yeah, not broken. Then. And they're good enough to play, then maybe they put that back in. But if they're worried enough in this situation, they're out for the game. Right? And then they're gonna reevaluate on Monday in the facility. 'cause it's kind of a standard practice, right? You want your own radiologist to look at it.

Like a lot of these teams, even if the, let's say all the radiologists, I mean, we know a lot of these doctors, they're all great. Like, you know, they, as much as they like, appreciate the team physician taking a look at their guys, they're like, no, no, no, no. We'll take care of it. This is our team. They're very possessive of their players, which is totally acceptable.

You just wanna keep everything in inside, so they'll fly. I mean, we know this, how this works, but pretty much every time a player, when they finish their game, even if it's 10 o'clock at night, [00:09:00] they're hopping on the private plane and they're flying straight home and they land at 4:00 AM and then they're gonna MRI at 8:00 AM So they're, they're always at home the next day, unless there's some sort of unforeseeable storm, um, that they can't make it.

But it, it, it, they're getting this MRI as soon as possible.

Will Sanchez: Alright, so explain the severity difference between a Brock Purdy that they said, I don't know, ev between two and five weeks, which to me is, that's a pretty big range when you say two to five compared to a, you know, Joe Burrow. That possibly could be the season if they haven't already declared 'em out for the season yet.

Dr. Grant Garcia: I think he's out now because he had just had the surgeries. I'd be shocked. Maybe he'll get back. But we can talk about ways that people are accelerating those. Will Sanchez: Okay.

Dr. Grant Garcia: So you know, you have different levels. You have grade one, two, and three. So you know the grade one is just sort of a sprain. Grade two is a sort of partial tear of the turf.

Turf toe, and that's the mild turf toe injuries. When you do kind of rest, you tape 'em anti-inflammatories. That's about a two to six weeks. So it's a pretty broad range. [00:10:00] Yeah. When you get to severe, that's where we have them full rupture, so he probably had a partial tear of his plantar plate, and so that's why he was in that small level, but now they're finding out.

Again, this is similar to many of the injuries we're seeing that like sometimes when you have these full tears. It's faster to fix 'em and more reliable than a partial and try put the player back out there more than a partial or than just continuing to non-op them, right? Like we know that like some of these players that we'll talk about later continually had non-op treatment.

Non-operative treatment and they would push limp them along for weeks and weeks and weeks, and they re-injure themselves the next year. And now we're realizing with a lot of these things, like, you know, some of these players are the baseball players. It's like, you know, they're just not throwing as well.

Like, we should just pull the trigger and do surgery. Yeah. Yeah. So it's like we're, we're learning more, unfortunately in some cases, that surgery sooner. As much as we wanna be a conservative. Culture that surgery sooner for this with a fresh tissue or with these newer techniques like internal bracing, which we'll get into.

I know you love that word. Oh baby. The, [00:11:00] I need a t-shirt. We, there's just, we do do need a t-shirt. So I mean with that, the, there's no reason why you wouldn't be more aggressive with this. So mild turf tour is different. But this plantar plate rusher, I mean, did you they with burrows? They did, he injured it and like a week later they said he is getting surgery.

So there wasn't even a question that, well, it was clear. The

Will Sanchez: MRI clearly indicated that this is, yeah, we're done here. This is not treatable. 'cause obviously with someone at his level, one of the top three, top five quarterbacks in the NFL, you know that they would say, no, there's just no recovery from this.

Let's go the route of Brock Pur. Let's say it's two to five weeks, two to six weeks for that recovery. I don't know if you could you fully recover when, you know, when you finally get back on the field, you're planting, you're stepping, you're planting, you're throwing, you're running away from very large men, you know people are landing on you.

I, I don't, and it is early in season, not lake, where it like happened with Patrick Mahomes, where he is like, I'm almost at the finish line. I'm just trying to [00:12:00] gut it out. But you still have the whole season. What are the repercussions? What are the, what is Brock Purdy gonna have to go through for this season?

Dr. Grant Garcia: I mean, it's, it's, if he gets back too early, he could chance to re-rupture. Right. And then he is gonna get surgery on it. The other thing is like, does he just play, you know, basically with a, with a lack of push off. Is there some sort of du he's gonna have some sort of bracing on for a while. Even when he gets back, they're just not gonna let him go full boat unless he's completely pain free.

And maybe an MRI shows he's completely healed. Where does, remember the MRIs are only so good.

Will Sanchez: Does foot on a toe, where does a brace go? Is, is it a shoe, is it a ankle stability? What, what do you mean brace? Well, it

Dr. Grant Garcia: depends on the, depends on the injury. But in these cases, you know, they have, sometimes they have these like extended foot toe things.

So it's like a, it's like a, um. It, it's like a, basically like a sole of the shoe, but as an extended toe plate. Like a metal toe plate he might have on there probably wouldn't be able to play with that. Um, but they, you know, these guys have like master orthotics, right? So there's someone in there like molding these custom things and they're like, [00:13:00] okay, let's try this.

Yeah, yeah. Boom, that doesn't work. Go to the next one. Mean it's unlimited supply of cash here. So they can try all these different things. For him, and they're gonna do literally everything to get this tow. They're gonna use all these sort of fancy gadgets, um, that we probably haven't even heard about yet.

So, I mean, it's gonna be, they're gonna try everything they can to get him, to get him back.

Will Sanchez: So rest, um, immobilizing taping 3D models of somebody mad scientist, Dr. Frankenstein, trying to create something that will fit his foot and, and in a kind of a way you go, uh, next question is, why is this called Turf Toe?

Why don't we have like a cooler name? Like, you know, when you hear rupture. Or, you know, tendon, you know, or, you know, ACL knee blown turf toe. Hey, can you come up with a creative way to rename this? And maybe we could kind of rebrand this and take credit for it. What, what, how would you go with it about that?

Dr. Grant Garcia: I, I can't think of a good name for this 'cause it's, it's, it usually happens in [00:14:00] football players. That's why they call it turf toe. It's the, it's a, it's 'cause it happens. And maybe we could, this nother discussion we talked about turf versus grass. Yeah. But maybe, you know, grass, toe doesn't sound any better, so at least it turf

Will Sanchez: toe.

Okay. Alright. Alright. We're going down the Rex Ryan tree right now with these toes. You we're done with the toes. Let's go with, uh, today's, uh, technology. Right? Uh, Deion Sanders went through this in the nineties, right? He, he had severe, uh, you know, with the turf toe. It's something that lingered. What are the differences between in the nineties when Dionne was suffering through turf toe and probably playing with it where he probably shouldn't have.

Right. You know, especially with that man up, you know, mentality. What are the difference from then to now that you can explain to our audience?

Dr. Grant Garcia: Yeah, so go back to that picture before you can show the fan the new technology, which we'll talk about. Again, we've talked about this at nauseum, but that's one more.

So this is a picture. Go back. That's perfect. Of all the ways [00:15:00] we use internal braces now and. This while these, some of these things are a little newer. Some of these are a little bit older. This is older in like the last few years, so they're talking about internal bracing now for even bunions. But you know, you have ankle fractures.

You add internal brace in there to help with the stabilization. You're doing these sort of ankle, the ankle instability. We talk about ankle sprains and adding internal brace.

Will Sanchez: Yeah. But

Dr. Grant Garcia: you can see there in the bottom left hand corner, there's plantar paint, internal bracing.

Will Sanchez: Yeah.

Dr. Grant Garcia: And so this is sort of one of the additions.

It's just like the UCL repair with internal brace. Right. Without that internal brace, UCL repair is not a good surgery. Like very few people to success. It was very, it was very unsuccessful.

That's why for years it wasn't successful. That's why ACL repairs, we talk about now saving acls 'cause we add the internal brace.

So this internal brace has been a game changer for these more simple repairs or 'cause or. In a lot of cases the repairs sometimes suck like this. Don't do that. Well. Yeah. And so now we have so many more surgeries that we can repair so we keep the [00:16:00] person's native tissue and avoid adding graft and tunnels and holes.

Will Sanchez: Yeah.

Dr. Grant Garcia: And that we can do this the more, if we can repair everybody, that would be the best case scenario. If you could repair all ligaments that ever got injured. That would be the holy grail, and we're getting closer. We're not there yet. And of course there's chronic injuries, which are different than acute injuries, but now they have this ability to internally brace the plantar plate.

And so as a result, they see that. They see him tear it. They're like, we have this new surgery, and maybe he'll get back instead of the four to six months, maybe three months. And so three months is not as bad, maybe two and a half months. Who knows? I mean, they tried to get Aaron Rogers back again. It was the Jets, but they tried to get him back in 10 weeks after an Achilles rupture.

'cause he had an internal brace as well. Yeah. So the idea is that these guys are gonna start pushing the envelope on this. Because remember in orthopedics, everything goes in like six weeks, 12 weeks, four to six months. It's just.[00:17:00]

So, you know, it's the, it's a pretty, we have these standard metrics that aren't always perfectly scientific. Right. You know, you always, you've always heard the word, it's four to six months. Right? That's a very common orthopedic term. Takes six weeks for the bone to heal. Well, it doesn't always heal in six weeks.

Sometimes it heals in four weeks. Sometimes it heals in eight weeks. But we like that word. We like the six weeks, we like the 12 weeks. We like the way the follow ups work.

Will Sanchez: Yeah.

Dr. Grant Garcia: So. The idea is that people are gonna keep pushing the envelope on a procedure like this, but remember, there's other things that go on with this procedure.

So not only is he gonna so go to the two slides over, I, it's, it's the best image I could find of this without grossing out the audience and showing an actual live surgery of this. So now this is not. Um, the actual turf toe repair, because this is the second, which is the other toe. It's the toe next to the big toe.

Will Sanchez: Yeah.

Dr. Grant Garcia: But this is the same sort of technique. So what, what they do is this, that plantar plate, you can see it's popped there in the bottom. And that's, so basically if you go on over the gray toe, that's what, that's how you'd fix this.

Will Sanchez: Yeah. Yeah. [00:18:00]

Dr. Grant Garcia: And they were threading the suture through, and then they do this very complicated repair technique, and then you anchor it on the other side.

In addition to that, you add something called the internal brace. So you add this synthetic suture, this thick fiber tape, and you anchor that on both sides as well. Obviously there's a little, there's a little bit room, there are very few room for air. You can see how small this is. Right. So you really wanna make sure you're accurate.

Yeah. But there's sort of kits and things like that that, that Arthrex has to help with this as well. So that's the, that's the first part. Another part is, you know, adding some sort of PRP or biologics sometimes can help. Yeah. We've talked about the fertilized ACL. We literally just had Chad Lavender on here.

Yeah. Um, having that conversation. So that's important. And then. As you see between those toes, there's cartilage. And so sometimes that cartilage is damaged. And so that may be something that we want to additionally do because if you don't take care of the cartilage damage and he has it there, it could go on to being painful.

So now you have lost power. Or let's say your plantar plate heal great, but now you still have pain 'cause the toe has [00:19:00] arthritis in between it. Mm-hmm. And that's a big problem.

Will Sanchez: Yeah, and we talked Dr. Grant Garcia: about this a long time ago. I think it was Serena Williams had this and she had to have a fusion, so it's not ideal.

To have cartilage damage there. So all those things. And then the last one, which again, little simple injury, that's so astic, the moid bones, those little tiny Holt bones that I showed you on the previous thing.

Will Sanchez: Yep.

Dr. Grant Garcia: If those are fractured, they can sometimes fix them or take them out, which is uncommon. But the other thing is they can tie all this in 'cause those sesamoids live inside of that plantar plate area.

With the ligaments, those little bones live in there. You see how they're all connected together? Yeah. Right. When you do the, when you do the dissection, it doesn't look like this. I wish it did. That'd be amazing. Every surgery would be amazing if it always looked like the picture. Right. But we know that's not real life.

So anyhow, so no. So the idea is you repair it all together. So that's what they did for, uh, Joe Burrows and I have a feeling that he'll be back faster. But again, it just depends too about, you know, the Bengals don't do well. Like why race him back? You know, if they're doing [00:20:00] really well, maybe they change their mind on when he comes back.

It's really tricky. I think that's the hardest part of some of these recoveries is you don't really know what the true return to sport is for this player. Because let's say they're, let's say now it's September, so October, November, December, three months, and they're not even close to playoffs. Why would they put him back in?

Will Sanchez: Yeah, I, I agree. I agree.

Dr. Grant Garcia: You're never gonna know. I mean, he could take him, they're gonna say he got back in five months, but he could have gone back in three. It all depends on when they get hurt. It's just like all this in-season stuff.

Will Sanchez: Yeah. Yeah. Um, and so can cleats help lead to these type of injuries?

Is is that common or is this just the way it is, you know, stressing that area? Pushing off. All of a sudden that you developed it? Or is it maybe

Dr. Grant Garcia: 300 pound people landing on your foot? Yeah. You know, there's lots of things on there. I'm just wondering

Will Sanchez: footwear as, because foot, the cleat is very different than anything else that we wear.

Right? Yeah. Mean this

Dr. Grant Garcia: is, this is a, this may be a, I mean, the challenge is on [00:21:00] the bottom to protect it. It's different than like ankle sprains, which we may have a sneak peek at that later on in the next few weeks with, um, some new episodes being released. Yep. But I'm sure there's people that are looking at it.

I mean. Anytime an injury happens, we've looked at the numbers, it's extremely expensive. I think I texted you recently that the number we had wasn't even close to what they're seeing now. They're like, yeah, talking about in the, in the billions of dollars lost per these players because it's so much money.

What about

Will Sanchez: training? Is there anything that you can do? You know, I, I'm reaching over here with the bottom of your foot, trying to see if there's anything that you can do. Is it training, is it strength? Is it, is it flexibility? Is it stretching? I know that there's been these contraptions that you put over your foot and you can pull, you know, are you doing anything with band work to just kind of keep that, uh, inflection going on in that area?

I'm just curious for what you've learned and spoken with your colleagues. Is there anything that says if you do this, you lower the risk by, you know, 3% [00:22:00] or something like that? Dr. Grant Garcia: So this is a great point. I don't wanna belabor this on the show 'cause it's a lot, but there is this small sub faction of people that have started talking about prophylactic surgeries, prophylactic internal bracing.

So. In these people that are really high risk is adding like an internal brace ahead of time where there's really no recovery, right? You just anchor it and you just let 'em go back. You let the incision heal. Yeah. Would that protect someone from having a turf toe and not in this case, but they talk about it for ACL tears, or do you add like a second ligament?

Back it up so you can prevent the ACL. I mean, it's a little crazy right now, preventive

Will Sanchez: medicine then. But the

Dr. Grant Garcia: idea of preventing, I mean, let's say you kind of knew you're like this, these, these six players are at high risk from AI algorithms, right? Which talked about before AI in medicine. Yeah. Yeah. So let's say you have an AI algorithm and it shows that like you, these are your top 2% of players that are at risk of getting.

W, and you're out for four months or lingers. You're never the same, [00:23:00] right? Yeah. I mean, some people might consider it, or do we do a minimally invasive thing where you just do two micro incisions, you throw the tape underneath, you avoid the tendons, you do it all in their ultrasound guidance, and you can do it in the player's back in two weeks.

Right. Like that, we may get there at some point. Yeah. So this is, this is something to be considered. 'cause if nothing else is torn, then it's, again, I'm not advocating for surgery that's not indicated or surgery before someone gets hurt. Uh, but, but it, the concept's pretty crazy because, or if we all of a sudden did it and then saw that no one got turf toed for like an entire season.

Will Sanchez: Yeah.

Dr. Grant Garcia: You know, we don't know. That's,

Will Sanchez: maybe we get to the point where it's not permanent, that you plant something in just for the season and then you remove it.

Dr. Grant Garcia: Or do we have biologics? Right. You start having soreness. You see that you throw biologics in there. I mean, that's probably where we're going.

'cause that's the easiest sell. To these NFL athletes is like, Hey, did you, you know, like, oh, your toe's turning into Season MRI shows as a small partial tear. Let's just pump you with a little bit of [00:24:00] some PRP or bone marrow or other stem cell options. And then, you know, you heal, then you're good. It scars in.

We got a new MRI. It looks good. Yes. So, you know, there we're, we're not there yet, but it's, uh, there's more things down the pipeline and there's things we're not even talking about on the people are working on. So,

Will Sanchez: yeah. And we're talking about a billion cazillion dollar industry where the quarterback position.

Is by far the most valuable position no matter what anyone says. Well, it's the past rusher, the running back, the wide receiver. No, your, your team cannot function without a, a high level quarterback, uh, as we've seen for the last decade with the New York Giants.

Dr. Grant Garcia: And he didn't even have turf toe. That's a sad, and

Will Sanchez: he did.

They have turf toe. This is a, this is a great topic. We're gonna have a lot of, uh, other topics to follow. We always wanted to let everybody know. Check us out@sports.talk.com for more episodes, transcripts, and we've had some. Very welcoming, curious, and talented, uh, request to be [00:25:00] on the show. So, but keep it coming.

We, we love it. We love to talk to you. We love that you reach out, so we really appreciate it. Uh, Dr. Garcia, you got anything to put a bow on this or internal brace on this?

Dr. Grant Garcia: Internal. Exactly. That's right. So, no, thanks for listening and, uh, yeah, keep the requests coming. We get a lot of requests, so it's, it's nice.

It's just, again, we want to stay focused on the, uh, sports talk, talk and, you know, all orthopedics, all sports all the time. So that's our, we try to keep that focus for our, for our viewers.

Will Sanchez: All right. Thank you very much, Dr. Garcia. Take care.

Audio Transcript

There you go. Right there. The elite mindset. It's, uh, and before we get into that, um, you had the elite mindset just recently, you know, at your, uh. Competing and swimming and, and I, I, I, I have to bring it up 'cause I know you don't like to bring it up because you're killing me here. People don't realize that you are a, a d one athlete.

You [00:01:00] love your swimming, you love competing. So it's not just what you do, um, you know, with your surgery and, and everything else and, but the guidance which you patients, but you know, you are a dude that gets out there and you wants, you know, you want some, so how was that? Dr. Grant Garcia: I, well, I would tell you that I make a joke that people, I'm not very competitive, but everybody knows that there's a, it's like I'm a type AAA personality, I call it. So a little bit competitive. I try not to pawn it off too much on my children, so I get to have, I keep it to myself, which is good. So, but again, it was good. We did a swim for our club or local club that I used to coach as a kid. And now it's full circle 'cause my kids swim there and then I actually swam there as a kid.

So it's pretty awesome. So it's a full circle moment. Uh, and then I got to do something I really enjoy, which is swimming in the lake. But it was a little harder than I remember the last time. So I gotta work on my fitness. This

Will Sanchez: you getting old. Um, you know, it's, it's great that you didn't get hurt because you know we have some friends that would've taken care of you at the Recovery Shop.

Let's give a [00:02:00] shout out to Mike b. Tell the audience about the Recovery Shop and all the things that they do for us.

Dr. Grant Garcia: Yeah. Well first off, I love our new flashy yellow. This is awesome. So, yeah. Anyhow, thank you again to Recovery Shop. You know, they've been our sponsors for a long time. I mean, just the other day I had a patient that got injured and they're like, Hey, I want the same thing that your other player got.

Like, I want that nice machine. I want to be, I want that accelerated recovery program that he got. And I'm like, no problem. Happy to do this. It's, it's funny, I actually had a friend's family member in the middle of the country just called me and they're like, Hey, my, your, my sister had surgery with you.

She did awesome. Can you just gimme, you didn't operate on me, but can I have your thing? Because I can't get ahold of it. So he was able to go to the recovery shop and use that. So this is something that's really good for you to have at your fingertips as a surgeon. It'll help with the physical aspect.

There is no mental recovery aspect of this area, which we're gonna go to the second part of that in a minute. Um, but the goal here is for surgeons to offer all the latest things for our patients to get 'em back to what they need. Before we jump in our next topic, I think it's really [00:03:00] important. We have brought up so many times and behind the scenes we have so many checklist items.

Yeah, of things we wanna show to our, to our listeners. But the one biggest one has been the mental aspect of injury. And we've talked about it. I get it all the time in my office, all the time. I was just talking about today. I had it right, but we don't have anybody. It's always hard to find an expert and then we happen to cross paths with one of the elite sort of mental aspect.

Athletes in all levels. And so I really like to introduce, uh, Gary Chopik for his, uh, and I'm really looking forward to hearing more about this from the elite mindset. So thank you so much for coming on.

Gary Chupik: Yeah, thanks for having me, fellas. We're all Seattle guys. Huh?

Will Sanchez: Yeah, it's nice because sometimes, uh, a lot of times we have, uh, east coast guests and, and it's tough if we have a six to seven o'clock, you know, show based on our schedule and things that we're busy.

You know, we, we've got people coming on nine, 10 o'clock at night and sometimes, and they're tired. And Dr. Garcia just rambles on and [00:04:00] on and on. So we go really late, you know, so we always thank them. So it's nice to have someone on the west coast that we know that we are. Hopefully not being too intrusive with your time.

And once again, as, uh, Dr. Garcia mentioned, you know, thank you so much for, uh, being on the show and, um. Sharing your, your knowledge. So, Dr. Garcia, why don't you, uh, kick us off and, uh, talk about Yeah. Um, you know, let's get on topic here.

Dr. Grant Garcia: Well, again, we're, this is, we always jump around, but obviously we have an expert here.

So will you go, will you just initially, first off, introduce yourself, tell us about this elite mindset that you've developed. You know, brief game plan and kind of how you became a mental coach. Like, it's such an important thing, but it's actually kind of hard to find someone that's really good at this.

Gary Chupik: Yeah, it really is. Uh, it's a really interesting field. So I grew up a pastor, believe it or not, for 28 years. And I'm originally from Saskatchewan, Canada. So I just, I'm a prairie boy at heart, but I've been another Canadian, another. This is

Dr. Grant Garcia: awesome.

Gary Chupik: Yeah. And uh, and I got married to a [00:05:00] girl from Seattle, Washington, and so love brought me south.

And I've been here, uh, 33 years now, and it's, it's been a wild ride. There's a lot of interesting, uh, dynamics between what it's like to live in Canada and what it's like to live in America. But, um, but I grew up a, uh, a pastor. I've kind of been a reluctant leader all of my life, and I, so I'm an ordained pastor and have been for 28 years.

And then in, in 2017, I had a burnout. And I just hit a wall and I didn't know what to do. And I think when you're in an industry for so long, the language becomes so familiar, especially when you're on the helping side of things. And I, I think I just needed a different framework. And so I ended up, uh, studying sports psych for about a thousand hours for the next couple years, just trying to figure out how to get out, out of this exhaustion phase I was in in my life.

And, uh, and then I had a, a friend that I had met. Who knew Trevor Moad and Trevor Moad at the time was Russell Wilson's mental performance coach. I read his book, it Takes What It Takes, and then this [00:06:00] friend said to me, would you like to meet Trevor one day? And I said, well, of course I would like that. Who wouldn't wanna meet someone who was at the top of their game?

In fact, at that time he was on ESPN. He was. NBC, he was like top of the food chain in our industry. And, uh, and then to be mentored by a guy like that, it was just a, a once in a lifetime opportunity. And so one day, uh, he said to me, Gary, if you were to help a professional athlete, uh, tell me your process, what, how would you help them?

What, what process would you take them through? And so he said, 30 days from now, I want you to show that to me. And so 30 days went by. And I was prepared and showed him the process that I had come up with and he hired me on the spot. And so I worked with Limitless minds for the next couple years and then went out on my own the last five.

So it's been a wild ride to get here. I just would've never have thought that in my lifetime that I would be doing what I was when I'm doing, but I can't imagine doing anything else right now. And in fact, in many ways I live a dream life partly because, uh, of the clients that I get to work with, but also.

Just my, my challenge [00:07:00] to other people to live life to the fullest and make sure their head is in the right place and the right spot. And so I now, I work with professional athletes, uh, TV celebrities, uh, yeah. And businesses all over the area in the country and in fact have started traveling internationally.

And so it's just been a lot of fun. And, uh, yeah, I just, it's a wild ride and I, I just can't imagine doing anything else.

Dr. Grant Garcia: Um, and then will you kind of go into, I mean. I'm, I imagine there's probably different types of ways you have to structure it, or do you have the same sort of similar structure for an executive or, you know, like, or a surgeon or an athlete, or is it kind of all different?

Like how do you break that down?

Gary Chupik: Yeah, for me it's about 80% commonalities between, uh, whether it's sports and business or different fields. And I would say 80% of it's the same. I would say 20% of it's different and you gotta learn that 20% 'cause it's pretty crucial. And so I often find myself having to call up other mental performance coaches that are experts in that particular sport and learn all that.

I can chat. GPT can be [00:08:00] helpful, but one of the shortcomings of chat GP Ts, it doesn't understand sequence. And, and how to teach someone how to, um, you know, get, get control of their thoughts and their mindset. There's an actual sequence to it. It's like baking a cake. You can have all the right ingredients, but if you don't know how to sequence it, you're not like, not gonna get the intended result.

And so teaching someone how to sequence all the mental skills is actually really, really crucial.

Will Sanchez: You know? Um, I, I love kind of where you're going with this because a lot of us know what we're supposed to do. But getting to do that or acting upon it and, and taking those steps, that's a whole other area that a lot of people struggle with, you know?

So what are some of those things, or, or how do you communicate that to someone that. Knows what's happening or knows what they need to do, but you help them, you know, see it clear clearly and start them to, to, to get on that right path.

Gary Chupik: Yeah. So sometimes you do a crisis [00:09:00] intervention, right? Like you're gonna step in and, and rescue someone or, or something.

And there is a time and a place for that. And so there're in crisis and you deal with that issue. But if you have a little bit of time, that's when you can really lay a really solid foundation. So for me, and, and the way that I think, and in my world. For me, uh, motivation is not the holy grail of all performance.

I think it's helpful to have it. It's almost like an icing on top of the cake, but it's really not that necessary. What really is, I think, the holy grail of all mental performance, if you have the time to teach it, is self-leadership. And so the self-efficacy of someone understanding their life and getting to choose the thoughts that they think, like a lot of people think that they don't have a choice to think what they think.

You know, they kind of feel like, you know, it's kinda like a bird landing on your head. You know, someone once said that you can't stop a bird from landing on your head, but you can certainly stop it from building a nest there. And your thoughts are really quite similar. You can have all types of crazy thoughts and thank goodness we don't act on all [00:10:00] of them, but we can kind of police them and we can kind of say or reject some thoughts and accept and receive others that are more productive for us.

Dr. Grant Garcia: Is that kind of the thought in the sense that like, oh, I'm in my own head, but I, you know, I can't fix that. Like, that's just me. I'm kind of like a, you know, I would say there's certain different surgeon mentalities, like, you know, hey, like I'm just anxious for this case. 'cause it's a tough case, right? Like, that's just, I'm just never gonna get over that. That's just the way it is. And, and what you're saying is that's a wrong, that mindset already is the wrong thing. Right? That's, I'm making that up in my head.

Gary Chupik: Yeah, it's really strange. Like I, I, you know, one of the things that I've been teaching recently in my business that it's made a lot of sense to me is having your thoughts be outside of yourself.

Because when you're so introspective, and we just live in this dage of analytics now, like, I mean, there's wearable tech, um, people are looking for data. I mean, and it is just the information's everywhere. And so what happens is, is that we just intend to internalize everything and we overthink everything, and then it paralyzes us and it causes us to hesitate [00:11:00] and hesitation, whether it's in sports or business.

Or in the medical field can be quite costly if you're not confident enough to, to remove the hesitation. So the issue really is in, in my view, is limiting the amount of thoughts that you have so that you can be successful at the things that are the most important. For example, I think thoughts are like calories.

If you have too many calories that you don't expend what happens to you, you get slow and lethargic in the same way. Thoughts are like that. When you have an abundance of thoughts that you can't expend, then you just kind of eventually carry them and they get really weighty. And so you have to figure out what thoughts are producing something good in you and what thoughts are not so helpful.

Dr. Grant Garcia: Is this kinda like the idea of over extension. You know, it's the, the idea that like, hey, listen, you know, a lot of us are going different directions and these athletes are getting, you know, sponsorships and then they're getting told performance, and if they get hurt, they're told recovery. And like, it's kind of, is that the idea of like, you just have too many things come in at once.

You need to focus on the high efficiency. Directions [00:12:00] Or what is that? Just to clarify?

Gary Chupik: Well, both. So internally, you can have too many thoughts that you have to be able to narrow down. I mean, uh, Steve Jobs would talk about signal, uh, the signal and, uh, and a distortion ratio, right? Would like or signal to noise.

So you have to like focus on the things that are the most important in that moment and then outside of yourself. Yeah, I mean, athletes are more distracted than ever with social media and with the opportunities that are coming their way and, and now with NIL, it's like just focus on the game. But you know, a young athletes can't even barely do that anymore because they're looking for sponsorship deals and they're looking for opportunities to get paid.

And so there's so much distraction. In our world today for athletes and I'm, I'm not sure it's that much different for the rest of us in different vocations where the, the distractions are s immense and your ability to learn and know things are just immense. But there's a difference between knowing [00:13:00] something and experiencing something.

So we might be book smart with something, but in terms of like actually getting to know something intimately, it's just very different. And there's no way to really know things until you experience them. But if we're spending so much time in the knowledge arena, uh, and inside of our own heads, or we're, you know, studying something on our phones or using chat GPT, that's not really knowledge per se.

It's information, but it's not really, you know, intimate knowledge of something. Uh, do you want, do you have an

Dr. Grant Garcia: exercise you use? Oh, sorry. Will

Will Sanchez: No, no. Go ahead. Finish, finish that and I'll jump in. Go ahead.

Dr. Grant Garcia: Do you have an exercise? Like, what would you do for, for that player? Right. So like, let's say you're kind of saying, Hey, you have to experience, right?

But if your experience is like, you have to experience winning the game, right? They're not gonna win the game to exp like the whole point of what you're doing is hoping that they can win the game. 'cause they're clear and their mind's clear. Like, how would you get them to get that experience or knowledge rather than.

Just seeing it on chat GBT or the internet or talking about it? [00:14:00]

Gary Chupik: Yeah. I mean, there's no way to help a player by teaching them and adding on to what they already know without removing something. So there's gotta think of it like a cup. Like you can only pour so much into a cup where you have to say, okay, listen, what do you, what thoughts do you need to let go of?

Like, what do you need to subtract from your life? I remember, uh, being a leader, uh, in a nonprofit in the church for many, many years. I led on a, a local, national, regional and national level. And my wife would always say to me like, Gary, you know, for everything that you take on, you have to let go of two things.

I'm like, there's no way I can do that. Like this is such a great opportunity and, but she would just sort of ground me and say, no, no, no, you gotta let go of two things because it has to be that important. And I think in the same way, you thoughts just have to be poured out of your head. There has to be some type of subtraction so that you can perform at a high level.

And in fact, I call it intentional naivety. You have to like choose to be naive about something or not know [00:15:00] something so that you can become really excellent at what you do. So in some ways, I like to teach it as perfecting the simple. So just perfect the simple things. Perfect. Your thought process, so it becomes so instinctual that you don't really have to think about it.

But there's no way to do that without getting in the mental reps and the physical reps so that you can, you can perform at a high level.

Will Sanchez: I wanna go back to the NIL and, and it's clear now that your wife is the original elite mindset master behind all this because she has set the guidelines, given you, the tools for you to share with the rest of us.

So we want to thank her in advance for everything that she has done to get you where you need to be. Um, going back to the NIL. Obviously this is all brand new, right? And we're seeing kids it, it's remarkable. I think I saw recently this week that another athlete is changing school. This is the sixth time in their college career.

That they have moved on. [00:16:00] What are some of the, some of the conversations you're having or maybe some of the advice, because you said something really important there with having too much information and maybe they're getting that from the parent coach agent, where they're not really enjoying or fulfilling their obligation to themselves to having a sustainable college career.

And they're, they're looking for the next thing and they're moving around. What, what have, what? What are some of the concerns when you have athletes that are going through something like that?

Gary Chupik: Well, it's interesting how important environment is, and in order to be successful you have to be in an environment long enough.

But we live in this day and age now where, where you're right, you know, players are moving back and forth and now what they're doing is signing one and two year contracts. Because with a college, because they wanna, they want the freedom after a year or two to be able to go somewhere else. And the, and the colleges with the really good players are asking them to commit to longer contracts.

And so we're just in [00:17:00] territory that we've never been in before. And it's incredibly confusing and, and everyone's just trying to keep up with the changes. But in order to be successful at something, you really do need a level of consistency. And, and, and repetition and rhythm. Like a lot of people don't like to talk about discipline and habits and that kind of thing, but even in terms of like being in one place for a given amount of time can be so valuable.

In other words, you can take an athlete that's really good in one environment, change the environment. And he's not very good or she.

Will Sanchez: Mm-hmm. And in the

Gary Chupik: same way, you can take an athlete that's really struggling in one environment or on one team and change the team, and all of a sudden they start to thrive because of the system or because of the players that are around them or because of the culture.

But you don't ever really get a chance to grow roots in a system or process or environment if you're not there long enough. So it's a crazy world, like, I don't even know. Like, I have a couple, uh, baseball players I'm working with right now, and this is his third team in three [00:18:00] years. And Wow. And he just doesn't feel like he's getting the plane time he wants.

And he was a stud in high school and Yeah. A stud in his first year. And so when you're a stud in your first year, you wanna go to a bigger and better school, but you might be sitting on the bench at that school. It, it wasn't what you were expecting. Whereas if he would've stayed with the program that he was in.

He could have very well, um, you know, he knew the system, he knew the process, he knew the coaches, but that disgruntledness is always there thinking that the grass is greener on the other side of the fence, and oftentimes it's not. I,

Dr. Grant Garcia: is this something now that you're, do you feel like this is something that's trickling down on a professional level?

Like obviously the pros are making still more money, but there's a lot of money in NIL. Mm-hmm. Do you feel, from your experience working with some of the professional athletes, like is this something that's already been there and kind of like for you, is this harder now to deal with the NIL players because of your, or is it you're like, okay, now I already have this, I have these older players, right, the ones at a professional level and I kind of have the framework?

Or is it a different framework you're dealing with? 'cause obviously they're. [00:19:00] They're younger and they still have parental advising, advising and things like that. So it's a little bit more challenging. And the school things different than the teams?

Gary Chupik: Yeah, it's, it's diff it's, it's a lot of it's the same.

There are differences, but a lot of it's the same. In other words, like, I'll never forget, I was in Buffalo watching the bills play the dolphins, and I'm sitting with a player agent, and the player agent is watching his defensive end play. And Buffalo would score a touchdown, um, or probably the other team.

Uh, no, Buffalo would, would get a sack, but it wasn't his player.

Will Sanchez: Hmm.

Gary Chupik: And let's say he's rotating in and out. Let's, so let's say every, let's say every drive, they rotate. Yeah. Well, the, the guy that was rotating in, the other guy that was rotating in, that was not this agent's player when he got a sack. He would be so angry and frustrated.

That's crazy. 'cause it would make his player look bad. And so it was just like a world that was like so foreign to me that I, it was hard to even comprehend. And so this is the day [00:20:00] and age that we live in where those agents, when they get to the players at a really young age, they can take advantage of them.

They can, uh, at least the pro player sort of has been around a little bit and they kind of know in addition to a player agent, they also have a player manager. And those managers are gonna become more and more popular at the college level. In other words, you have these, they're not really an agent. Well, in addition to the agent, now you have a player manager who's managing that player's life.

So it's like appearances. It's brand deals. It's not done by the agent, the NIL agent. It's done by the manager. Of that player. Wow. So that if that manager isn't a really, a great person with high integrity and high character, they control so much of that player's life, where they go, what they do, and what they say to that player and their interaction.

So it is, it is a very difficult world. And I'm 56, like I, I've been around a little bit, so, you know, I've lived, lived a little bit and you see a lot of things. But when you're, [00:21:00] you know, even an NFL player seems really young to me, right? Like they're, they're just 2020s. Yeah, I feel so old. And, but they're in so many ways, they're so young.

But when you start talking about college players, they're huge human beings. Like they're massive and you, and you think that they're older than they actually are, and when in reality they're just, they're 22-year-old, you know, young men. I,

Dr. Grant Garcia: I think talking about the players. Can we, um, go into this next slide Will too.

I don't wanna get, I love tearing all the Gary's information. I wanna make sure we talk about, you know, will you describe this a little bit to us? Is this sort of like something you use in sort of your initial assessment or how does this work for you?

Gary Chupik: Yeah, so, uh, this is something I created and I've taught it to obviously professional athletes.

I've also taught it to the FBI, I've also taught it to, um, you know, you know, uh, you know, law enforcement and, uh, fire. It's, it's just been so helpful in so many different ways. I've also taught to businessmen, and so I [00:22:00] created a four step process that brings the best out of athletes and high performers when the pressure is on.

So I call this Cape like a superman Cape, CAPE. So C stands for control yourself. A good example to use in all of this is baseball, but if, but we can change the vocation later and we can even change it to your vocation as you're gonna do something that requires a lot of attention and focus. So C stands for control Yourself.

The universal sigh to relax and slow down your breathing is just to take a deep sigh. Okay, so when you play tense, you don't play as well. And I think in the same way with other professions, it's the same thing. When you're more relaxed, you're more limber. For example, I saw a tennis player play recently, a pro tennis player who.

As the match went on, he became more tense and he started to tighten up his swing, and I could see it happening because he was feeling the pressure instead of being really just kind of loose and flowing. So C stands for control yourself. So in baseball [00:23:00] it's take that deep sigh, right? Look around, look up, look in the stands for a second, and then focus back.

So it's C stands for control yourself. So that definitely has, there's also, uh, some, uh. There's also some hormonal aspects to what we're talking about when you take that deep sigh, but really it's getting your breathing under control. So it's C stands for control. A stands for assess the situation. Now, this is the one, one of the most interesting things to me in the entire world, because if I said to you, you know, look behind you just for like half a second and then look back into the camera.

You don't really realize it, but you could probably tell me 50 or 60 things about your surroundings in that one second. That's how fast neurologically your brain functions. It's like faster than the fastest computer. It's unbelievable. So the amount of information that your brain can assess very quickly is remarkable.

In baseball, the, the average in a time between a pitch is [00:24:00] like 13 to 16 or 17 seconds. So that baseball player that pitcher's assessing. All types of things where the runners are in base. What's the pitch count? Um, you know what the, he is getting the, the signal from the manager where the pitch clock, there's pitch clock, there's the catcher throwing signs.

Like it's just remarkable how much information that he's assessing. So that's assess the situation. And there's a limit to it though. You can't keep assessing. You got, you gotta cut it off.

Then p is, you gotta make a plan. So not only is it what happens if the ball comes to me, it's like, what happens when the balls hit to the shortstop?

What happens when the balls hit to the first baseman? What happens when there's all these different dynamics? So you gotta make a plan. And then E is, is stands for execute, which is trust your plan. Trust your training and trust your instincts, because we know that when an athlete trusts their training and they play instinctually, they, that's usually where their best [00:25:00] performance is.

So the overthinking piece and the too many thoughts come into play here where we do really just want you to play instinctually. But you gotta, you gotta put in the work though. You gotta, you gotta do the C, you gotta do the A. You gotta do the p. You gotta understand the plan, you gotta trust your training, but we do want you to play instinctually, and that's where your money's made is, is your instincts.

Will Sanchez: It's funny you mentioned, uh, control and um, the famous story for me is in the Super Bowl against the Cincinnati Bengals, Joe Montana is on the game winning drive. And everybody's kind of feeling real tight and he's looking around and he is like, oh, you see that? And it's, it is John Candy that he is hanging out in the end zone and the players around him looking at it, are you serious?

We're trying to win this game. We're we're the Super Bowl drive. He is like, yeah, Joe. Cool. What's the perfect nickname for him? Him, he used hanging around, looking around. So where he's assessing, right? He's looking around on the timeout, pointing things, being under control. So, uh, I, I, I think there's a lot to it, especially when we see the elite [00:26:00] athletes, whether it's a, a Joe Montana, a Brady, some of these other athletes, they just find a way to control Andrew.

Andrew Huberman talks about breathing control and taking that deep breath and that extra sniff. Yeah. And then double breath. And the double breath and how to reset your body and what you're doing. So there's so many things that are resonating when you're talking about this Kate, uh, program that, that you're, you're utilizing to help people mo navigate through all this.

So anyway, go ahead, Darthy. And,

Dr. Grant Garcia: and Gary, would you say, uh, for this, like how would you approach this sort of timeline? Obviously the, an acronym's great. The title's great, everything's great, but how does that kind of work? Would you have a plan? How do you do, I know you have sort of a plan you listed as sort of like a way that you go through this with athletes.

Like, how would you do this for an athlete if they came in and they're like, Hey, we're gonna do this for a, you know, a week period, a month period. How does that work?

Gary Chupik: Yeah, it's very interesting. So, again, if I have a little bit of time, I can go through my process. So think of it like, um, like a pyramid [00:27:00] with a circle in it and in the, and the core of that circle is self-leadership, your ability to lead yourself.

Is, it's everything. Whether you are, uh, playing a sport, whether you're in your vocation and you're, you're, um, you know, you're, you're about your craft, your ability to lead yourself even when you don't feel like it is everything. So if you don't get the self-leadership piece down, you're in big trouble. So I teach something called the Leadership Pyramid.



It was something that I came up with years ago that every time that I. I don't do it. I regret it on so many different levels, especially if, if you've ever hired anybody, it's such a great, uh, analogy. So the bottom layer is self-leadership. If you mess up on the self-leadership at at the bottom or, uh, the foundation of the pyramid, you're in trouble And, and your actions and, and the lack of your integrity and self-leadership.

Is gonna cause the entire pyramid to fracture, and you'll see why in a moment. So that bottom layer of self-leadership, it's [00:28:00] everything and it never ends. It's always present. So you investing in yourself, you, um, taking time to, uh, recover, you having, uh, integrity and character as a leader and, and being self led, it just never ends.

So the bottom layer is self leadership. The next layer is couple leadership, but I don't necessarily mean romantic. It's just. You think of like, um, you know, being an example to somebody else or coaching somebody else, or mentoring somebody else or leading somebody else. So when you do self-leadership. The next in the sequence is that you can do couple leadership and why shouldn't you lead another person if you don't lead yourself well, you're being a bad example, right?

You're bringing in all this baggage into this relationship, and it's actually not helpful to the person you're trying to help. The next layer is group leadership, but we all know that a great group leader is mentoring the next in line, right? So whoever's next in the bullpen. But you can't do that if you've never led at the couple level.[00:29:00]

So we want you to lead at the group level, but we, you need to have at least had couple experience and self-leadership experience. You have to be able to demonstrate that you are capable of leading a group by the previous two levels. And then you have area or department, and then ultimately you have organizational leadership.

So when you put somebody in leadership at the group or area, department level, that has never done group leadership or couple leadership, you're in trouble. So they might have, you know, they might be charismatic or have charisma, but they actually don't know what they're doing. So when we hire people as leaders in our businesses, or the people that we associate with, if we don't have them go through those steps or that pyramid, we're, it's really to our detriment and our organization's de detriment.

Because when you have a leader, let's say an organizational leader, that doesn't show good self leadership, it affects everything. The entire organization, the entire [00:30:00] structure. All of a sudden people don't know that, you know, they're supposed to be accountable for their actions or what they say. People will lie to one another and be dishonest.

I mean, it doesn't take, doesn't take a pair of binoculars here in the Seattle area to see which companies really have struggled by passing the buck. And which ones take responsibility for them. So I think in a CEO or a business leader who takes responsibility is a great self leader. So I've set all that to say self-leadership in that leadership pyramid is, if you have time, is to teach people that there's nothing more important.

Than you leading yourself even when you're not motivated. And then you can reinforce that by a next concentric circle with your habits and daily rhythms that you have in your life. A lot of people are viscerally, uh, moved when I say the word disciplines or habits, but just think of rhythms. So now that you have self uh, leadership, you wanna reinforce that with rhythms in your life that put you in the best position to succeed.

So one of the things I say in [00:31:00] my business all the time is you can't control outcomes. But you can always put yourself in the best position to succeed. So let's work on the best position to succeed. What does that look like when you wake up every day, what, what puts you in the best position to succeed?

And then you have different parts of the inside of that triangle now in the corners. And to me, mental imagery and having or knowing your personal philosophy and having domain management. Is, are the three keys to, uh, you know, causing this, you know, this paradigm or this, this entire image work? Because if you don't have control over the different domains of your life, it affects your play on the field or affects your craft at work.

In other words, uh, we can all point to athletes that when they get, uh, whether it's distracted or they're struggling in a different domain of their life, it totally affects their gameplay. It Totally. And, and it affects, you know, even for me, it affects my life when things aren't going well with this, you know, wonderful woman called Molly in my life, if I'm struggling in my marriage, it totally [00:32:00] affects my craft.

Dr. Grant Garcia: Mm-hmm.

Gary Chupik: So the domain management is just as important as, as anything. And so when we talk about helping an athlete, what we're really trying to do is, number one, we're trying to put out the fires. So I, there's a, uh, there's a image that I have that you guys have there. It's the mental health, uh, mental health bridge, bridge assessment.

So if there is a crisis going on in their life, or let's say that they're really struggling in an area of their game, let's say, and well, the idea is to put out the fire and, and figure out the crisis as quickly as possible. And then we can help stabilize them, simplify the complex, you know, give them the support that they need.

So, and then help them create a short term plan. And then re again, remove any of those unhealthy thoughts. Or a stimuli that's in their life to help them go from crisis to coping. So coping is super helpful because we can give them tools to be able to, um, help them get outta that crisis. And if they can, [00:33:00] uh, implement those tools on their own and we can teach 'em how to use those tools, then they, they don't always need, you know, someone who's performing surgery on them all the time.

But this is the big fault of mental health in our society is that we almost always stop. At the coping and prevention level. It is one of the, really the, one of the great tragedies of our day and age where we pour all this money and, and time and energy, even at the school, elementary school, high school, middle school level.

We just stop at prevention and we don't actually teach kids how to thrive and transcend. There's, there's, in fact, when we're thriving or transcending, we're almost distracted by all the best things in life and all the good things in life so that we're not even thinking much about crisis and coping.

We've already. Like decided that we are gonna be the very best we can be. So I think we just, we stop at the coping and prevention, uh, pillar and we just don't go far enough. It was like me walking [00:34:00] into a, a professional football facility and the coach and I are walking around the facility. And we walk by the training room and I say, Hey coach, you know, that's a, a lot of what mental health is all about is, you know, getting bandaged up and taped up and getting iced.

But mental performance is like the gym. And so we walk into the gym and we hear the clank of the weights and guys getting stronger and there's a lot of energy and a lot of excitement in the room. And that's what I feel like I do as I help the athletes to thrive and, and elevate their game. So is there a place for crisis and helping a player that's really struggling with something? A hundred percent. And the job, my job is to assess that as quickly as possible, and sometimes we can do it. Sometimes it's easy to do. Like I had one defensive tackle that said, Gary, can you make me two tenths of a second faster? And I was like, Kay, I'm on it. Let's go. And I had about two or three sessions with him and he was two tenths of a second faster.

He was on one of the, ended up being on one of the best defenses, uh, an integral part of one of the best defenses in the NFLA year and a half ago. [00:35:00] So sometimes we can do that. If the player knows exactly what they want and I can help them do that, then let's go for it. Other times, um, you know, you're sort of slow dripping your mental performance, so they get a more well-rounded view of, of performance.

Dr. Grant Garcia: That's awesome. So you're, so what you're Stacy's saying is that, you know, most of the time these athletes, you know, they've, they've got crisis, they have coping, but really sometimes any, those are the ones that are recovering from some sort of major injury, uh, et cetera. But there are a lot of times many these athletes are, they're fairly healthy, right?

And so they need to go to more of the thrive. The Thrive and whatever the other slide, the other part was transcend. Yeah. So that's kind of where that transcend, that's, that's where you're stepping in. In majority of the cases. Right. So you're saying that you could cover all the areas, but in a lot of times these, for the higher level athletes, you don't, you only need to go to those next two steps, uh, to get them to the next level, but it's also less covered.

Gary Chupik: Yeah. I mean, so yeah, that's often the case, but there's a lot of players who, let's say, I mean, every player gets in a slump or they don't perform as well, [00:36:00] and you don't always know why and nor do they. 'cause if they knew they would fix it right away. So sometimes it takes a little, like, I, I, I mean, I, I like it to digging for treasures.

It's like, I'm, I'm gonna go dig in here and find out what the pain points are and figure out how I can help this player. And it might take me a while. Like, I, this is really embarrassing to say. 'cause it's not, it is not really, um, you know, it doesn't reflect well on me, but it took me a year to figure out a player one time.

An entire year, and once I figured it out, I was like, oh, like I'm connecting all these dots. I'm meeting with him four times a month or three times a month, and I just, I couldn't figure it out. I couldn't figure why he was just sort of plateaued in his performance. But after a year I was like, oh, I started to connect the dots a little bit.

It's, it's kind of like staring into the sky, looking at the stars, and all of a sudden seeing a constellation, you're like, okay, now it all makes sense. Okay, this is what we need to work on. And then we, we really spent the next four [00:37:00] weeks working on this one issue and solved all the problems. Like, well, I mean, performance changed.

Dr. Grant Garcia: don't think, I think, I think that the best leaders, like you mentioned, can admit that they're not always perfect and that they would take some longer for certain aspects. I mean, I'll be honest with you, I have patients come in, I have patients occasionally that I'm like, first time I see them, I know exactly what they need.

It could be crazy complex. I know the exact surgery they need, and sometimes I go patients I'm like. I don't know what you need. And it takes multiple visits, right? So you're, we're supposed to be the experts, but the expert expert doesn't always mean fast. It means we're gonna be, we're gonna do our best and use all of our knowledge to figure it out.

So, I mean, the fact is that you didn't give up. I think that's probably the most important aspect. I'm not trying to mental health coach you, but I'm just saying that's a great, that's a really, that's a great asset that you

Gary Chupik: brought up. But the grant, I mean, there's, there's pressure, right? Like you get hired to do a job and it's not working.

And so you just kind of go, wow, like I gotta figure this out. And you start reading books and talking to people and replaying the conversations. And then [00:38:00] we're talking to one of their friends or their loved one, like you're trying to, you're going digging and it just takes a little bit of time. And you know what?

Sometimes the client isn't aware of what the problem is, like it's subconscious for them, and they don't even know what it is. So it just, it takes a while and the patience is really helpful. And you know, at one point I was thinking like, well, maybe they need to get a different mental performance coach.

'cause it's not, I, I don't see it like I'm, I'm really having a, a struggle trying to find out what the, the issue is and what the cause is. But sometimes, you know, it, it, it takes a while.

And you know what, there's a definition of mindset. There's, they're like a generic definition of mindset, which for me is, is too generic.

It is a condition set of beliefs that drive behavior. Well, yeah, but where do your beliefs come from? Like where do, where does that come from and how do we form thoughts and, and beliefs about things? And so it took me seven years to figure out what I'm about to tell you. Seven years, but it was really helpful for me in deciphering what was going on with this athlete.

So my definition, it's [00:39:00] kinda like a physics equation. My definition is you have an experience. Could be it happened to you or you initiated it. You just have an experience. So think of your own kids, right? Like they have an experience, maybe they're playing a sport and they have an experience, and then you have thoughts and feelings and brackets.

You have thoughts and feelings associated with that experience. And they could be positive, they could be negative. You don't know. They're just, they are thoughts and feelings. Sometimes you're aware of them, sometimes you're not. But if you go outside of that parentheses or those brackets, and then you get to choose a response.

Now when you're older, you probably get to choose a response. When you're younger, you, you don't often don't get a chance to choose your responses. So you might not even be aware. Your response might even be subconscious. So for example, when I was younger, I was in geo trade class. I don't know anything about geo trade.

Like that is not my strength. But I was in geo trade class and so I would go to this class and my teacher. Would embarrass me 'cause I didn't know [00:40:00] the answers. And he was kind of a fun guy. He was a hockey fan. I was a Bruins fan. He was a Canadians fan. So we kind of were bantering back and forth and, and whenever, you know, the Brus would win.

He would be extra mean to me. But he made a put, sort of put me on spotlight and embarrassed me. So my response to being asked a question he knew I didn't answer was to be the funny guy. So I would just like say, well, yeah, the answer is 3.7 1 6 8, 9 4, 2, 3, 1 2. Mm-hmm. The entire class would laugh and I'm not a funny guy, but I didn't, that was my response in that moment.

'cause I didn't know how else to respond.

Will Sanchez: So your coping, your coping mechanism

Gary Chupik: totally was a coping mechanism. Yeah. So out of the experience, thoughts and feelings, my response, now I have a belief. So you form a belief that's the next part of the equation. You form a belief about yourself. Well, what do you think my belief was about myself and I wasn't very smart.

All right? I wasn't a smart kid, right? So I just figured I, I wasn't really gonna [00:41:00] do much in my life, and I just had to get used to it. So my mindset was no school for me after high school because I wasn't smart enough. I was gonna swing a hammer. Not that there's anything wrong with that. Mm-hmm. But I just figured for the rest of my life, I was gonna have to use my hands to make a living.

And so when I decided to go to college, um, you know, my grades weren't very good because I believed that I wasn't very smart. Well, what's really interesting about this was that I ended up graduating in my master's degree with high honors. Not to brag, but just to say I barely passed high school. But it, when I dialed in and I took the right subjects that were more up my alley, I ended up killing it.

And I came to realize that if I could go back to my former self, to my 16-year-old self or 15-year-old self, and if I could whisper, if I could coach myself in the moment when my instructor was making fun of me, you know what I'd probably tell myself? I'd probably say, Hey Gary, you know what? Did you know that there are nine different kinds of intelligence [00:42:00] and geo trade's not yours?

I, I, I wish I could have told myself that, but in that moment I just believed that I was stupid. You know, there's spatial intelligence, there's linguistic intelligence, there's musical intelligence, there's kinetic intelligence, there's philosophical inte intelligence. I mean, there's all these different kinds of intelligence, but a couple of the subjects they didn't teach in high school was psych and philosophy, and those were my two best subjects, but they did, I didn't get to take that in high school, so it was only when I went to college that I figured out, Hey, wait a minute, I have an aptitude for these.

Kinds of arenas of knowledge. So the, the where a mindset comes in and that, that's how you form a mindset. In fact, Andy McKay from the Seattle Mariners, um, he taught me, Gary, you just can't end with mindset. So you have your experience, thoughts, feelings, your response. Your belief. That forms your mindset.

But he said, Gary, you can't end with your mindset. It always has to result in new and improved. Behaviors, which is kind of like a new experience, [00:43:00] right? So this is how like it cycles back to experience. So you start to give yourself new and improved experiences with new and improved thoughts and feelings, with new and improved responses with new and improved beliefs. That create a new and improved mindset and it keeps cycling over. And so that's how you build a mindset. But sometimes you have to go back to that experience. And it was really funny because I didn't think that I had anything in my past that, you know, people always say, you know, are you gonna go back in your past and figure yourself out and whatever?

I'm like, I don't know. I don't, I don't have anything. But when I took the time to really slow down and say, oh, you know what, that classroom, that geo trade class was very formative in my mindset for many, many years. And it had a huge impact. And that's how I put together my equation. So I think you can build a mindset.

I think you might have to do a little digging sometime with a client, Hey, what happened? And sometimes I'll just say like, somebody is like a player is struggling with something, or a business owner is struggling with something, and I'll just say, Hey, what [00:44:00] happened? They're like, what? What do you mean what happened?

I'm like, yeah, what happened? Well, what are you talking about? You're stuck here, right? Like, tell me about something that happened in your past where you're really struggling with something, you know, that was really painful or hurtful. All of a sudden, no one, no one's ever asked them that question, and all of a sudden you start digging up.

Junk or stick or digging up garbage, but you kind of gotta get there and it might take a little while 'cause you don't know how hidden that treasure is, but once you find it, it unlocks people. And so that's what I do is I unlock performance. Sometimes I gotta find out where that treasure is. Sometimes it takes me a little while on a wild goose chase.

But I can do it pretty quickly normally.

Dr. Grant Garcia: What, uh, I know we were in the sake of time for your time, but what percent, and maybe one of our last questions, what's your percentage of these players with slumps? Do you find that a lot of this is the, you know, you're unlocking something, right. It sounds like, to me, like I keep bringing up in the show is like, there is, it's, it's [00:45:00] everywhere, right?

I mean, how frequently are you getting asked to help a player? And then you realize that like your job is the most important thing, right? It's, they've done all this stuff, they've had the doctors check them, everything else is good, and now it's your turn.

Gary Chupik: Yeah, it's, it's, it's so weird. Like I remember Tom Brady, the Tom Brady said after Bill Belichick, the head coach, the most important coach on the team was the mental performance coach.

I. That was such a telling. And Pete Carroll told me one time, Gary the best, always want a coach. They always want, and Trevor Moad, my mentor, said, Gary, I talked to Russ 365 days a year.

I'm like, get outta here. Like what? Is there something so wrong with Rus Will? No, he just wanted to keep sharp all of the time.

And I just, I respect that so much. And so Trevor would always say, you don't have to be sick to want to get better. And if, for those of us who are, you know, if you're looking, you know, especially an athlete, you're looking for that constant competitive edge to be better. 'cause everyone [00:46:00] is good at that level.

You're always looking for that competitive edge. So, you know, I think living a lifestyle of high performance. Now kicks in and comes into play. So the question is, is can you live a high performance lifestyle? So I have something called the Game Plan for life, which is, so I have my elite mindset stuff, my process.

But what I learned was, was that if I can teach someone how to live a high performance life is, is you get to live on those two last pillars. The thriving and yeah, elevating or transcending pillars. And if you can kinda live between those two pillars, you live a totally different life. So I think the best players always want to get better, but it's the players.

And Pete Carroll told me this, it's the players who don't think they need coaching are the ones that need it the most. Hmm.

Will Sanchez: Yari. And I know we gotta let you go. Um, but before we do, I know you are a foodie guy, right? I, I know it. You love it. How did you know this? I, I, you [00:47:00] know, I gotta do my research here, so, we'll, we'll pose one question here.

Okay. So if you can have dinner, you can have an, an athlete, a coach, and maybe a, a spiritual advisor or someone from Faith, since we know that's part of background. If you could have these three individuals come to dinner, who would they be and what are you cooking?

Gary Chupik: Oh, man. Okay. So I would probably start up my smoker.

And I would be doing probably beef ribs. Okay. Would be my, my favorite. I was doing pork ribs forever, but beef ribs always going dry. Rub what? Do, what, what's going on there? Yeah. I would say definitely dry rub that. Yeah. Like, I like to enter competitions with my smoking. And so definitely that's the, that is the telltale sign that it's a, that that person's a good smoker.

So I would say, I would say, uh, you know, brisket and, and uh, and beef ribs and the three people who they would be Wow. Um. [00:48:00] So I'm a big fan of Saint Ignatius. Okay. Just 'cause I think we're body, mind, soul, and spirit. And he really focused on the soul part of, so like where your emotions come from, where your personality comes from.

So he would probably be one, another one would probably be Sigmund Freud. Um, he was so instrumental, I think. In, uh, in this field of psychology. And then, uh, you know, besides my Christian faith and being, you know, saying something obvious, um, I would say Tom Brady would be fascinating, just his mentality to be around him.

And I think most athletes pay a real cost. Like I think there's cost to thinking, uh, there's a cost to thinking well. And it, it doesn't come free. Like if you're gonna be an elite athlete at, at that level, you're gonna probably gonna burn a lot of bridges. It's gonna be really tough. Like you just, you just sort of expected the great Thomas soul.

Maybe he would be another one if I could invite four. Mm-hmm. The [00:49:00] historian said everything in life is a trade off. And that has been such an amazing phrase for me because now I can think to myself, well, yeah, I mean, I want something, but what? What's it gonna cost me? Well, it might cost me something that I.

I really enjoy what I really like, but that's the cost. So we call it the illusion of choice. It's like if you want to be average, you have lots of choices. Think of the menu at the Cheesecake Factory. You wanna be an average eater. Pick anything you want. You wanna be a good eater. You have to really limit the amount of choices that you have.

But if you want to be an elite eater, you have no choice. This is just how you. And so, uh, Thomas Sole, I think would be another one because it just, he really impacted my life. He has like, you know, his top 10 greatest quotes or things like, they're just mesmerizing. So I think it would be Thomas Sole as well.

Awesome.

Will Sanchez: Gary, thank you so much for your time. Uh, Garcia, last words here as we wrap it up. I just, I'm motivated.

Dr. Grant Garcia: I, I cleared my mind. I am ready to [00:50:00] crush my cases tomorrow. This is gonna be awesome. So, no, I really appreciate it. Thank you. I think this is really good. This will be something we can pop back on and discuss, uh, other times as well and jump back to this episode.

And this will be really great. I think that the listeners are really gonna appreciate it, the athletes listening, the ones that recovering from surgeries. Uh, so thank you so much for your time and it's really awesome to have someone like you on here.

Gary Chupik: Yeah. Thanks

Dr. Grant Garcia: for having me,

Will Sanchez: Gary. Tubik.

Dr. Grant Garcia: Founder

Will Sanchez: of Elite Mindset.

Thank you for your time.

Audio Transcript

Dr. Garcia, how are you?

Dr. Grant Garcia: I'm fairly certain that that intro changes every single time. I have no idea where it's going, so I just have to sit there and smile. I'm good. Yeah, no, it's a, it is a scorching day in Seattle, but, uh, super nice. So we're, we're lucky we're soaking up the last few weeks of summer, so.

Will Sanchez: 100%. And as the title showed, we're gonna talk a little bit about the [00:01:00] 2025 kickoff. We're gonna get into some key injuries for some of the players and, uh, and we're just gonna have some fun banter because this is what we do is football season. I'm super excited about this season because, uh, as some of you know, we are miserable New York Giants fans.

And once a while, long time ago, we were very happy with our team. Celebrating Super Bowl championships at the defeating the New England Patriots. But we've been suffering. That was a Dr. Grant Garcia: long time ago,

Will Sanchez: and I, I don't know about you. It, it hurt a little bit. I felt good for him, but it hurt a little bit to see Saquon win a championship more because he was with the Eagles than anyone else.

So I'm still trying to get over the season. What are your expectations for the Giants before we kick off this show? I,

Dr. Grant Garcia: I mean, the problem is, it's just, they're so hyped right now. They're like, they're, they're so hyped. This is like one of the best I've ever seen the introductions for the team. I think the challenge will be like, we'll see what happens in those first few games.

The [00:02:00] NFC East is tough. They have three really good teams they play against now, and there's no schmuck, quarterbacks or anything. I mean, it's just, it's legit. Every team is legitimate.

Will Sanchez: Yeah, they ranked, uh, the New York Giants as the hardest. Schedule for this upcoming season out of all 32 teams,

Dr. Grant Garcia: that's what they need for so and so poorly last.

Yeah, yeah,

Will Sanchez: exactly. You had the worst record where, here's the hardest schedule. Go off and be somebody. They've got the chiefs, they've got the Lions, Minnesota, the NF Cs, the A FC West. It is going to be a gauntlet and you know, if I have a, have trouble sitting there on Sunday. Trying to recover from the pain and misery.

Hopefully not from the Giants. This is not the same, but it's a weird segue. Let's shout out to the recovery shop. Can they help me recover on a bad Sunday?

Dr. Grant Garcia: They might be able to. They've got all sorts of things. So, you know, the, the nice thing is that this is, again, I, I, even today I had patients asking about this, so.

For [00:03:00] surgeons, it's nice to offer to your patients. They can use this for things extra they want, right? They want to have a nice machine, they want to do relists. They wanna have other different innovative tools to get them back. We're starting potentially working on more nutrition supplementation and other things as well.

So it's all part of this sort of package deal you can have for your recovery, and the patients have been elated with the service. And I have been as well as a, as a surgeon, to give it to my patients and hear about it. So it's just another thing that makes that whole postoperative recovery process good.

So thanks again for our sponsors

Will Sanchez: and shout out to Mike b at the Recovery Shop. So please reach out to Mike b He can help everyone out there. So we, uh, we can't thank Mike and the, that entire team enough. Listen. 2025 is gonna be real interesting. Before we get into some of these injuries, we, you know, we're gonna have a little bit of fun.

We're gonna talk a little bit of tech, we'll talk about some injuries. This is not a fantasy football show, but if you are a fantasy football fan and some of the people that we talk about help you make [00:04:00] a decision whether you're gonna grab 'em in the first round, or maybe you hold up to the second. Hey, listen, we're, we're, uh, we're we, we can help you in many different ways, but looking at the 2025, we have some NFL fun facts.

The international games, we know that football is global, is king of sports, at least here in, um, in the United States of America. Soccer rules the world globally, but for, for us, here it is, football League record, seven games. Oh, look at this. Where, what's that? That game up there. Chiefs versus charges. Where they're playing at.

Dr. Garcia.

Dr. Grant Garcia: Sao Paulo.

Will Sanchez: Sao Paulo. What, what, what are your thoughts on that one?

Dr. Grant Garcia: That's pretty cool. That's gonna be awesome. That's like, yeah, that's a big deal. That's a long flight though. That is a long flight. Uh, but that'll be really interesting.

That's, I mean, SA Paulo's off the hit, I mean, they do the F1.

: Yep.

Dr. Grant Garcia: Uh, in November. Um, so they've been really big and they, they had a game there, or didn't they have a game there last year or two years ago? I thought the chiefs, I thought the Eagles [00:05:00] played at some point, if I remember correctly. But maybe I'm wrong.

Will Sanchez: Yeah, I'm not, I'm not sure. If not, I would be lying.

But the fact that they're getting them, they, you can't have enough good, good games at Dublin. Obviously. We see a lot of college football games. They've been going out there. I know, uh, Notre Dame. Is a big fan of going out there. Lots of Guinness. We have a good time. Madrid, I love Madrid. I love Spain, dolphins and the Commanders.

I'm hoping that the Dolphins win, knock out the commanders because like we said, we're Giants fans and we could, anytime we can get a loss from one of those NFC East teams, we appreciate it. London, three times, Berlin. Uh, once real quick. This is not the topic of the show. Concerns with doctors, team doctors.

When you're traveling so much, you're traveling so far, making sure the recovery, what are some of the things, or at least highlight one specific thing that a team doctor will make sure that his, their players are doing.

Dr. Grant Garcia: I mean, as a team physician, your biggest [00:06:00] concern is not really the injuries, but rather sort of the sleep performance.

We've talked about this, we should probably get someone who manages sleep and athletes, because I think that would be a really good thing. I know we have some other episodes coming up, uh, that talk about the mental aspects, but the sleep is no joke. I mean, that is one of the hardest things for these athletes, uh, to deal with is how you change the sleep time zones.

I mean, I do. A lot of consulting things and I'm flying 24 hours down to Florida and back and, and that isn't a joke. And again, I'm not having to perform mentally. Yeah. Maybe a little bit physically, but not constantly doing that. I mean, the time zone is a big deal. I mean, this is, they're probably gonna leave a, I think they leave a little bit earlier Right?

If it's a, probably a few extra days. Yeah. Um, but generally they make them come right back, uh, on that next. Flight out for the following thing. So it's hard. I mean, the good news is they're all younger and healthier than we are. Yeah. So they can handle it a bit better. Mm-hmm. Um, but that, that is a, that's a topic in of itself is the, the challenges of sleep.

We brought it up once before, I think a couple times in our show.

Will Sanchez: [00:07:00] Yeah.

Dr. Grant Garcia: Um, but that is a big deal.

Will Sanchez: Yeah, we think it's important to just kind of highlight, but that's part of the recovery and that, you know, that's part of everything that these players can, are concerned about or could possibly lead to injuries.

Uh, quarterback carousel 12 new starters. Who knows? It might be more. We just know that that's kind of the way here in Seattle. Sam Donald Gold from Minnesota Vikings. Now the started quarterback for the, for the Seahawks. Uh, the Raiders get, um, you know, those old Seahawks quarterback, he's there. Our old friend Daniel Jones, he's gonna be the starter for the Indianapolis Colts.

So lots of moving and shaking. I mean, Aaron Rogers with the Steelers, you name it. Lots of storylines. This,

Dr. Grant Garcia: this is just the classic NFL. It's just a shake around the box, grab the quarterback and hope that there's a, there's a chance he's better than the last time we got them. : Yeah,

Dr. Grant Garcia: I, we'll see. I mean, we, it worked with Sam Darn.

But you know, it's, it's, unfortunately the roulette doesn't always work in [00:08:00] everybody's favor. So hopefully the fresh start for the Giants is the one that wins out.

Will Sanchez: Yep. And we, we will have Russell Wilson. We'll see how long he stays there, uh, before they'll start calling for the Dart Man, Jason Dart. So anyway, let's talk about this.

We wanna talk about some of the NFL Tech, and this was really fascinating because. The NFL always, you know, staying ahead of technology. They're using different, um, tech. For their players, for their organizations. I think it was a year ago, something like that. I was making fun of the urinals. That's a whole other conversation.

If anybody wanna goes back to that. My favorite

Dr. Grant Garcia: NFL tech. That is my favorite

Will Sanchez: monitoring, uh, hydration there with the UR urinals. But, uh, to, to kick it off the catapult GPS with speed, load and fatigue. Uh, why don't you talk about this and how that's beneficial to some of these teams, um, as they're, uh, partnering with Catapult for the monitoring.

Dr. Grant Garcia: I mean, the one thing [00:09:00] you always know is like all these teams that go after the NFL first or these, or these, uh, companies, right? Because if they can get them on board Yeah. They're willing to spend the money for their players to give 'em a little bit of an edge. Mm-hmm. And everyone's looking for that. I mean, you go into these team locker rooms and they've got tech you've never seen before.

They're like, oh, this is a startup. This company's a startup, and we're trying to get this. So the idea here is obviously you're. Using this GPS wearable technology. Um, and then you're really gonna get a lot more detailed information, like, again, like how fast are you're doing, what kinda load are you putting on, uh, the body.

And then by that, there's some calculations that can do algorithms to determine fatigue. And I, I think the key here is we always say like, as a cer as a physician on the team, you want to know when the player's too fatigued. It's very hard to figure that out. And so if we can find an algorithm or.

Proprietary information that'll tell us, Hey, this player is like, pretty close to getting injured. Or like, you know, you know what I mean? Like, you've seen it in the NFL, you've seen it little, you've seen it in all levels of football. The player's, like, I, you're like, you're out, you know, and the [00:10:00] coach is yelling them to come out and they're like, screw you, screw you.

I'm staying in. Mm-hmm. Right? Like, so can we, it's the same thing with the concussions, right? They have the helmets, not as much in the NFL, but our high school team, she's got, we, our trainer has a helmet monitor, right? When they get hit really hard, we'll know before the player will know. Yeah. And so the idea is that like, can we track all these things in real time?

'cause as much as they're players, they're also. They're owned by the, by the NFL teams and there's a lot of money on stand if they get hurt, which will show about how much the injuries cost. It is a massive amount of money. So can we find a way to reduce injuries And yeah, he's, listen, this person needs this, this guy needs two downs, right?

He's, we use him on first, let's save him for third or four or on the fourth tower going forward or something. So it, it's really important to all that stuff. I think that other, the other tech you wanna talk about, that next one's gonna be really interesting 'cause that is something that's more universal, I think with a lot of people.

Will Sanchez: Yeah. And right before I get to that, and I know that you're on the orthopedic side, so you're, you're, you're kind of getting the, you know, after the [00:11:00] injury has been, has happened, but is there anything that you're doing, or at least the people that you're working with, whether it's, um, a watch or whoop or anything like that, that you're kind of incorporating, or at least the partners that you have, are incorporating for the regular, you know, the regular Joe's that are trying to recover?

Dr. Grant Garcia: I think, I think the answer is we're always looking for something, but the problem you have is the market's really saturated. Right. The, the challenge here is like if I go and sell a watch, I'm competing with Apple, right? Like there was an article I read about one guy that had a fitness app and he was basically bankrupt until LeBron James happened to be the one of 200 people that bought the watch, right?

And it was like his last dollar. And LeBron James like showed it off in a commercial by accident and he went from that to like. A hundred million dollars in like a couple weeks by accident because just Wow. Sans happened to be wearing his device. So, and I've worked, and I've been part of discussions with, you know, as a, as a, on being [00:12:00] social media presence and being on the podcasting because I get emails all the time for New tech, uh, saying, Hey, you wanna look at my new product, this, that, and that.

And, you know, it's, it's really common. So unfortunately there is a lot of stuff that we do, so it's always hard to tell, uh, and to get really involved in one particular thing. And I, I think that the, I think that that's where more of the physical therapy side of things in people coming injuries, but also it's just really about stuff like this, right?

Can we talk online and say, Hey, listen, you really need to be using your watch, like your heart rate's dropped. Like, but we just don't have enough good stuff out there yet. It's all really expensive and it requires, you know, subscription based. It also requires someone, an algorithm to do it in, like, what they really need to do is like partner with a place like Apple or, or uh, Fitbit or things like that.

Yeah. And basically wear it on your wrist and it says you are getting fatigued. Like you were at, you were at a 64% chance of injury. You know, like from the minority report type of like Yeah, yeah. Fewer algorithms like ai, right? Can we predict regular people getting injured like, you're skiing and like you're just outta control like your legs are, or your [00:13:00] legs are gassed, like you're not firing everything in sync.

But again, it's. There's so many different muscles they have to monitor, but can you think about different things? So like, you know, maybe we're coming up with an idea, maybe we just let on some information that we shouldn't have, but who knows? So anyhow.

Will Sanchez: Yeah, I, I love the example that you just gave because I remember one time I went back up snowboarding.

I was like, I got one more ride in me, you know, and I got up there and I maybe got a quarter of the way down and I was like, oh no. Like my knees, I was starting, my legs were getting shaky.

And I was like, I still gotta get off this mountain. I should have stopped when I was still feeling good. I should have went to the clubhouse, get the hot cocoa, kind of relax, wait for the friends to finish off their last run instead of pushing it.

Anyway, I digress. This is what happens. This is what we do. Let's hop hop onto the next tech on the underwater treadmills, uh, joint protection, things like that. Um, let's talk about this. Joint protection and benefits of having these underwater treadmills, especially for these NFL teams.

Dr. Grant Garcia: This is huge. I mean, we [00:14:00] were winning the White Sox.

They had underwater pools. The underwater treadmills are expensive, but they're really nice. It's almost, I actually would think this is a little bit better. Then the, the G treadmills, you guys know those, they're very hard to find, but you basically strap yourself in and it lower, it lowers the resistance you can have on there.

Yeah. I've had a couple high level players, soccer players and basketball players that are basically almost pro level to pro level, and they usually, you use this and you could see the recovery difference is huge. Right. But again. The challenge here is like, how do you get access to this? Like, I'll be honest with you, outside of working with the teams, I've never even seen an underwater treadmill.

So like, it's not like you go to the gym and you're like, you're like, oh, there it is, right? Like, it's expensive. Like they have these treadmills actually for dogs that go underwater, but it's, I don't think it's the same, the same caliber. Uh, but nonetheless, the, the idea is that obviously it's just like blood flow restriction, right?

You want to put load on the joint, you want to have mobility on the joint without putting a lot of load. So when I tell patients like, you need 25% of your weight on the joint, well, you know, [00:15:00] when you get in the water, you lose a lot of that weight. It is buoyant. And so can you do this therapy low load the joint not cause inflammation, and then get stronger.

The, the whole key between like PRP and all these other injections is can we find a way to get that knee to not be so swollen so that you can strengthen the area around it and then therefore you can recover back to the level you were at without having continued setbacks. I mean, like, I, like I asked multiple patients today that are recovering from my surgeries, you know, the number one complaint was like, Hey, my knees have is a little bit swollen.

It still feels a little bit sore. I, I feel like I can't get the strength I want back 'cause it's still a little bit bothersome. That's pretty part, that's part of the normal recovery. But women have found a way to reduce that, right? If all these patients just went to the underwater treadmill, they could get it back.

So this is a big deal Now again. We've talked to and we will talk to more strength coaches for professional teams, right? And these strength coach professional teams will tell you that everyone has different philosophy. There's a, there's a general philosophy, but these strength and kissing coaches, which we, we [00:16:00] don't wanna let onto new episodes coming up, but we've had a few we've talked to.

: Yeah.

Dr. Grant Garcia: And the, you know, they, if they have a different philosophy, they'll say, Hey, I think the anywhere treadmill's best for me. This is best for me, you know, type of thing. So they're not always gonna have the same stuff. Now again, they also. They're very competitive, right? Yeah. So if someone's like, yeah, the chiefs have it, I'm sure the other teams are gonna be considering it, so

Will Sanchez: Oh yeah, definitely.

Um, force plates jump asymmetry. Um, we're gonna talk about that. They're, they're saying that the teams are known to use force plate ta, uh, plate testing, talk about forced plates and how they're so beneficial, um, for recovery.

Dr. Grant Garcia: Yeah. Well this is huge. I mean, we just saw this recently. You probably saw the, when, when we showed the Pro Mobil uh, video for Driveline.

Yeah. And you saw the guys jumping, that's the forest plates. Yeah. So the idea behind this is obviously. Asymmetry is humongous problem. I mean for, especially for soccer players, right? That increase the risk of ACL. Like these, when females, they land, they land in vow kiss. So I had, you know, three [00:17:00] female, or more than that, maybe four female acls just today, this morning.

Jesus. And, and they were all young females and they probably landed in, you know, they were at attack, they were injuries, like on the field somewhere. Hit somewhere every, but females are a much more common risk. And so something like this, you know, in athletes to find the how you're, how you're landing. So that's a preventative situation.

But also for professional athletes, especially for these professional teams. If the players like, oh, I feel great, but they're like, wait a second, no, you're not great, right? Like, this thing is off from this one. When we look at testing, we generally do asymmetry, uh, for acls and recovery. And so if you are, if your strength is down, your power's down, you have imbalances in that one knee, you're not ready to go back.

Even from a short period of time. But you know, the most commonly studied injury is acls. But there's so many of the things that we do and there's so many long recoveries, like it's really important for you to have this. And the jump asymmetry is that whole motion from the initial [00:18:00] takeoff to landing, and that's really where the power comes from.

So you really wanna make sure you're powering the whole leg appropriately.

Will Sanchez: Yeah. And that was a great segue to, um, talk about, uh, you know, if you haven't checked out our episode with Driveline, uh, that, that's a good one. So check that one out as well. Um, we're gonna go on to the next one. Sleep trackers.

We've talked about this in the past. Um, I, I gotta be honest with you, sometimes they make me a little bit nervous. I gotta be honest. I wake up. I saw that I didn't sleep as well. So obviously if you're gonna work out, it kind of tells you, you know, take it easy. Phone

Dr. Grant Garcia: alerted,

Will Sanchez: but at the same time, it makes me a little bit nervous going, I hope I got a good night's sleep.

Because if not, you know, it makes me feel a certain way. I don't know, I'm a little bit weird. I don't know if anybody else feels that way, but when it comes to sleep trackers great to know how I'm gonna prepare for the activity level in my day and how hard I'm gonna hit the gym. But at the same time, there's kind of like this competitive thing going, you know, I wanna hit a X amount percent on my [00:19:00] sleep recovery.

There. It's,

Dr. Grant Garcia: I I don't think that you're weird. I think that that's exactly what your other cohost does. So I think that what you're feeling is totally normal. That's the point of these apps, right? They get you hooked, they get you, you're like addicted to your sleep. But the problem you have is that you. It.

This is, so we had a, a while ago now, maybe multiple years, we had someone come in who used to be a Navy Seal and they do a lot of corporate stuff. So as for surgeons, we're known for high stress environments, very similar to some of these, some stressful things. Mm-hmm. Yeah. And they do a lot of stuff with professionals like that or athletes and help them get their stuff back. So companies will kind of monitor the sleep and actually help working with your staff and say, Hey, listen, you've got six surgeons on your staff, or you've got 20 players or 53 players on your team, and half of them are like totally undersleep. So that is actually a huge deal. We were just, this will be a good topic, maybe we can add this later, will, but longevity, right?

That's just athletics, but in longevity. Uh, read an article just. [00:20:00] Top 10. We won't go through all of 'em, but one of the number one things is outside of exercise was sleep. You're writing it down. I like it. Yep. But the, the, the sleep issue is humongous and it's the one that we can do. It's kind of messed up, but it's actually one of the easiest of all the things that we can do for optimization.

But it's also the hardest because it means we can't be doing fun stuff. We have to sleep, we have to like go to bed early. We have to like. Prioritize. And even though I continually harp on this and I know that if I get one more hour of sleep, I think I'll perform better. And I can know when I, my numbers go from, you know, I'm like a seven, I'm a six a low sixes.

I'm really, it's a, I can get through one or two days, but I really need, I really need to be a seven. Yeah.

Dr. Grant Garcia: and if I get eight, I'm like killing it. Right. But eight might be too much if I'm hyped up before surgery. So I'm more like a seven. See, I know my numbers. So the, the fact is like. When I'm at a, if I hit five, three days in a row, that's a disaster.

And so if you're an athlete, it's the same [00:21:00] way. Yeah. But you don't know it until you're tracking it. Right. Like I used to never know it until I had my Apple watch. Um, and now I kind of know and I actually, and you're right. But there is definitely a mental component. Like am I looking and saying, oh God, it says five.

Five hours and 30 minutes, like that's not good.

: Yeah. Yeah.

Dr. Grant Garcia: Right. And I don't know how well they work. 'cause I feel like sometimes I get less sleep than it actually says I did and things like that. But I, I definitely know that it gets me, I think it alerts you more to it and it makes you more aware and it prioritizes something that's a very simple fix.

And so I, it makes perfect sense to me why sleep quality and duration is so important. And I, I hate to say it, but my, my patients ask me all the time, like, what else can I do? And like, this should be brought up. Like, you can sleep more during your recovery and, and you gotta find ways to do that. You gotta be active, you gotta, you know, shut down the electronics an hour before.

Yeah. Yep. You gotta get clear the mind. I mean, there's nothing, like, the worst possible thing I've ever, I ever do in the last few weeks was check my email. Two minutes before I went to bed and found an email that made me frustrated. Oh, no, no. For some reason or another, gotta respond. I mean, it had [00:22:00] happened to me last week.

It was the stupidest thing ever. And so you can't do that stuff to yourself. You really have to stay fo, you have to really focus on, just clear your mind.

Will Sanchez: It's hard, you know? It's, it's amazing. Like you, you've heard Mark Wahlberg talk about, I go to bed at 8:00 AM and I wake up at, at, you know, at, I'm sorry, 8:00 PM wake up at 4:00 AM and I go work out in the train.

Go, there's that eat and go back and train and work out and sleep. And that when you go on the David Goggins of the world and so many other, uh, high level athletes or performers, um, I'm envious that they're able to be so dedicated and get to bed and get X amount of sleep. Now, I don't know if they're lying.

I don't know if it's just the social media, you know, where they're saying they're doing X, Y, and Z and you know, maybe most of the time they are and they're not. But, um, it, it's a hard thing as you, as you. Preface it. It's easy, it's simple, but it's not. So I,

Dr. Grant Garcia: I think actually we should try to find a sleep expert.

This is gonna be really good. I have it right now.

Will Sanchez: Sleep and longevity. We're, [00:23:00] we're ready to go. We're definitely ready to go.

Dr. Grant Garcia: So the sleep. So one more thing on the sleep. So another thing is they showed professional athletes and some of the best athletes in the world actually sleep a ton. Ronaldo, he does, they said he does 14 hours a day.

Now, again, I don't know how that's possible, but is he a dad?

Will Sanchez: We need to

Dr. Grant Garcia: show the, we need to show the sleep. There's a, there's a sleep bar graph. I know we're di I know we're gonna, I know we're going off topic, but there's a sleep bar graph, which we need to show the, the viewers at some point and it shows a bell curve and there are, there's, majority of people are in the seven to eight.

There are people in the nine to 10 and 11 hours. I know my best friend is actually an a 10 hour person. What? Which is unusual. Yeah. It's crazy. Yes, I know, and he'd be laughing if you heard me talking about this, but he is a solid nine to 10. Every time we were college roommates it was nine to 10 hours solid and it, I, there is people on that bell curve, but there are also people which have these special abilities that can do four to five.

And so this will be a great topic to come up with later. 'cause I kind of love this [00:24:00] idea. I love thinking about this 'cause I always wish I was a four to five, but unfortunately the four to five also lives shorter. So there is a, a whole nother discussion topic.

Will Sanchez: My, my wife has a, an incredible skillset that she can take a nap.

We could stay up for an hour and then it'll be like bedtime and she can go back to bed and not have any issues. I take a nap. I'm up to two, two o'clock in the morning. I don't, I don't know how she does it. It's a superpower. It's amazing. It's a

Dr. Grant Garcia: superpower. It's your wife and you just shouldn't ask questions.

That's problem. The problem is that you're even thinking about it. Follow to you.

Will Sanchez: I'm making sure she's not looking at me.

Dr. Grant Garcia: I think she follows us. We might be screwed right here. We're gonna have to mute this out.

Will Sanchez: That's all right. Okay. I will, I'm gonna edit this out. All right, let's talk about helmet sensors.

We've talked about the, the helmets, we've talked about the guardian. There's so many, so much that's kind of going toward the helmet, toward the sensors. Um, let's just kind of get into a little bit. More about that and the benefits of the helmet sensors and [00:25:00] how teams are utilizing them. Um, I just kind of, I put this together, it said the NFL had a pilot program using helmet sensors to measure impacts, but this was suspended due to concerns over data accuracy, and we're gonna get into that real quick.

And reliability according to science and ESP. While the specific program was halted, the lead continues to research and invest in advanced concussion assessment tools, including eye tracking technology and impact sensing mouth guards. Dr. Garcia, when it comes to accuracy and re reliability, that's one thing. And then going into the other assessment tools, what are your thoughts on that?

Dr. Grant Garcia: I don't mean to smile, but I'm smiling because this happened to us on our teams. So we had the tracking sensors, the impact sensors, and one time my trainer looks at me and she goes, check this out. And like the, the player was just running around.

It just showed they had a massive impact. So, oh, there, there is some inaccuracy in the sense that it might over call things, um, or sometimes it doesn't, doesn't register it. Now [00:26:00] again, that was 3-year-old tech. Not in the NFL. And so was it the top of the line? Yeah. I don't know. The challenge you have obviously is they're getting hit.

They have these like chips in them and registering. And you also gotta be really careful, right? Because the last thing you wanna do is pull out your player during a playoff game because it says they got hit really hard and they have no symptoms. And then you gotta do a full assessment. So this is really complicated.

And the other thing is like, what do you do with that data, right? Like if you, if you see it and they get hip, but you know it's not accurate, but now you've got it documented. As a team physician that this player just had a massive hit. You kind of have to pull them out. For medical legal reasons. So it's really tricky.

And the NFL obviously there's a lot of money and there's both two sides to the story, right? There's the owners and the players association. Yeah. And so did the, did the players want them tracking them? The players don't wanna get pulled out because all of a sudden now they, they, they took 60 snaps instead of a hundred, uh, 70 or 80 snaps, and maybe they dropped their contract.

Right. And they're gonna be like, oh, well you keep getting hits on the, on the thing. Yeah. So there's the, [00:27:00] this is a business, this is a, this is a. A big, a lot of money involved with this, and unfortunately you want to protect the players, but at the same point, there may be situations where if you, you don't wanna have mismanagement of the system or inaccuracies.

So until it's perfect, it's gonna be really challenging and it's gonna be a lot of work. We know this is like always on the forefront of them because

: Yeah.

Dr. Grant Garcia: Concussions, we've talked about this at nauseam. Yeah. Especially with the recent two episode we had and other issue, other episodes we've had regarding this, like this is. This is their hot topic. If they could choose one thing to figure out and be done with, it'd be concussions.

Will Sanchez: Yeah, I, I agree o over anything else, right? So, and that, whatever. I'm not gonna get into it 'cause we've, we've gotten into this discussion and you know, so anyway, I'm gonna move on 'cause we're already yip yapping for almost 28 minutes.

So let's kind of show this here. Uh, the trends last year. Apparently everything kind of went down a little bit. 17% overall. Awesome. Less concussions, uh, kickoff con concussion, 43% [00:28:00] with the new rule. So it, some of those, I'll just quick recap. You no longer allowed to run down the field. You're no, no longer able to load up extra players on either side of the ball.

It has to be the same amount of players you're kicking off into a specific area and then no one's starting to run until the ball is. Caught or lands in that area. So the con, the collisions are less. You don't have someone running down 30, 40 yards to field before they smash into somebody. So that's makes sense that the concussion rules, uh, have led to less concussions, a drop of 43%.

Kickoff leg strains. That's really kinda interesting. 48% lower extremities strains in general. I don't know what to make of that. What does, what does that mean? Lower extrem, uh, lower extremity strains? Is that just kind of fall under some of the, I think that's

Dr. Grant Garcia: like hamstring, quad, achilles calf. And it makes sense, right?

Because the, I'm assuming that's not just the, the, the [00:29:00] kicker. Yeah, but like you're going full. Like those guys go so much faster than the average player. 'cause like most time, like you're not getting a breakout, right? Like maybe the wide receivers are running for a route, but generally, unless there's an explosive play, they're not very far distances, but the kickoffs, you're just going as fast as you can.

And a lot of those players aren't playing the rest of the game. Yeah, right. So they're not warmed up and then they're like, let's just go as fast as we can to make my mark. I gotta get the tackle. So they'll take me off special teams and put me in the regular game.

Will Sanchez: 100% and that, and that is coached, right.

You know, you've, you work with high school football teams. I've worked with high school football teams. That is something that we used to say, you run down there and if you're, if you're the first one, be the first one down there running through the end zone. Even if you see on fair, you know, catch a ball, they're running through the end zone.

So that kind of piggybacks. They're flying as fast as they can. Having these collisions. We talk about cost not only in this show, but on on previous shows, the cost of injuries, right? We, we mentioned it [00:30:00] when we were talking about basketball, uh, and now we're talking about football. It's just some of the numbers there.

Bucks. 23 million last year, 21 million for the Steelers. And this is not even true numbers to me. I think that some of these, I don't think those are true. Yeah, they're, they're not. Those are, those are too low. That's just a portion of some of those numbers, not including the ones that got hurt before the season started that went right to the ir, you know, things like that.

So, but it, it becomes interesting, um, as far as the topic of just saying. Injuries, cost, money, and NFL and every professional team are gonna do everything possible to reduce injuries, whether it's tech, whether it's sleep, whatever it is, they're gonna keep investing in that money.

Dr. Grant Garcia: Well, and I hate to say this, but no matter how expensive everything is, it's not near as expensive as the player getting hurt.

What So there is, there, I know the cost of a lot of these things and they are not even [00:31:00] close to a 20 million.

: Yeah,

Dr. Grant Garcia: they can't. They won't. No. What team's gonna pay that money? But the fact is you have something that's, you know, we talk about products on here, there are sometimes 200, 500,000. That's a lot of money for the average person.

: Yeah. But.

Dr. Grant Garcia: For an NFL player that's making 20 to $30 million a year, that's around. I mean, we talked about what before, got 55 million a

Will Sanchez: year. What if he's out for the year? $55 million investment.

Dr. Grant Garcia: Or what about, we talked about this before with like, LeBron spends a million dollars a year on his thing.

That's a, that's like a, that's a rounding error for him. That's nothing. But you know how much ti much he can get for that? A lot because a million dollars is still a lot of money. Yeah. And so as a result, these guys will do whatever it takes and there's no number. We, we could, we can go at nausea and different players.

We might not, probably don't have time to go through everything, but the idea behind this is like if you find anything that reduces injuries, it's game changer. That's why the guardian helmets blew up. Right. It is like reduce the concussions for practices. Increase it for certain players, like that's a big fricking deal.

I mean, concussions are a nightmare. [00:32:00]

Will Sanchez: Yeah, and you know, and we've seen it, uh, we'll talk about a couple players and then we'll just kind of wrap it up. Obviously our focus was on the tech and, you know, the, some of the excitement about the NFL, but, uh, key players to kinda look at Matthew Stafford, 37 years old, low back, uh, uh, disc issues.

Uh, he's had back issues in the past. He's played her tough guy throughout his career. A long career concerned because once again. Of money starting quarterback for the Rams. You know, if he stays healthy, they have a team that can be a playoff team. When I say low back disc issues, what is your red flag?

Dr. Grant Garcia: I mean, red flag is the idea behind, like, what's that?

Not only is the disc out, but is there more damage to the actual, the two spaces and it becoming a little bit of arthritis in that area. Um, and he has a disc. He's getting injections. He's probably getting PP, he's doing traction. He's doing all sorts of fancy things under the sun, but he's not gonna get a surgery and Right.

So if he's got nerve issues, if [00:33:00] he, you know, lower back pain from disc can happen. That's really common. And the nerve issues are the pre problem, right? Because if he starts getting nerve weakness, he herniates more. Like those are bigger issues and we know we've had a couple other high level players in the basketball realm, just recurrent, right?

And those things are nasty. I mean, disc, I've had this before. It's horrible. And so the idea is like, you don't, you really don't want to do it. You don't wanna have, if you can, and obviously of all the injuries, like you get a, you have an injured arm or something, he can still throw, you get a little bit of a leg injury, you can still push through it, but lower back, like everything's involved with that.

So anyhow, it's, it's not, it's not a great thing. But to get these, tend to be more chronic and I bet you'll play through it. He'll, you know, get an epidural, make it four or five games, throw one more epidural in there. They'll get 'em through the season with us most likely.

Will Sanchez: Um, you've had back issues, you've had back pain.

How does a 275 pound man run at you and then hitting you and laying on top of you? How does that, how does your, how does your back feel when I say that?

Dr. Grant Garcia: Well, if you're paying me $55 million, I might change [00:34:00] my response. Um, but if I had to just take that hit and not get anything for it, I think that the answer is that I'd be pretty, pretty terrified.

Will Sanchez: Oh man, Tyreek Hill, one of the most explosive wide receivers in the NFL. Um, he's coming back from an oblique injury, right? This core injury for an explosive wide receiver, not a big framed, uh, player. I'm not sure if that matters whether the, the size of the player, but what are some of the concerns with, uh, with this type of injury?

Dr. Grant Garcia: Well, these injuries suck. Look, that's all I gotta say. I mean, so the, the answer is that like the, the problem with the obliques is people don't realize is like all your power comes from your core, right? Like they're like, use your core. Use your core. Mm-hmm. So these oblique injuries, these rib injuries, the intercostal injuries, they are really, really tough.

They're painful. There's really nothing you could do. Uh, I can tell you this 'cause I just recovered from one of these. I was foiling and I fell at 20 miles an hour and I had a, oh. Bad intercostal, and I thought it was totally fine, right? I could push through it and after the week of trying to push through [00:35:00] it, it just got worse and worse and worse.

You couldn't do core exercises, you can't do anything. You can't run, you can't lift. Even though every other part of your body feels good, it's literally just hurts to do anything. So these, this is a, this is gonna be a challenge for him. He's, you know, he's relies on speed, right? That explosive speed that he has.

Yeah, yeah. Change your direction. Yep. The other challenge is that just they're usually not fixed and you just sit there and wait for them. Now again. The challenge is which type of core injury? There's lots of core muscles, so if it's something that he can get through, maybe he'll push through it. We wrap him up.

What the like reinjury. I mean, if he doesn't wanna wait for it to reinjure, it doesn't to heal. It could happen continually and then it could full tear. Now again, it depends, right? There's, there's always like three levels of most of these. There's like the partial tear. Or the, the like small, tiny tear.

There's a full, near full tear and then full, full tear. Yeah, full, full tear is usually surgery again. Depends on this area. Um, probably has a one or two, probably more like a two if they're bringing it up. Yeah. Uh, but I mean, generally these do end up returning to stuff, so I think it's [00:36:00] just gonna be a little bit of challenge.

Will Sanchez: Uh, this player's not gonna play this season. Um. Uh, Rashaan Slater, he, uh, signed a massive contract with the, with the Chargers, uh, trying to protect their quarterback as we talk about injuries for quarterbacks, the patella tendon rupture, even though he is not gonna play, it's something that's kind of right up your alley.

So I wanted to bring it up, you know, what does that entail? Especially for a man that size, he's gonna miss the entire season, you know, that patella tendon rupture. How does that affect him going forward?

Dr. Grant Garcia: I mean, this used to be the player killer. Right. I mean, with this before, some newer techniques, this was a 50% return to sport.

Yeah. So one of the lowest in the NFL. I've talked about this before on previous, I think, radio shows, and then I think we had it on here a while ago. Um, but this is, this is not a good one. Uh, the good news is that we've got some new stuff. I mean, they'll do. Standard repair. We've got videos even on the website of how we do this kind of enhanced repairs.

They, you know, they, now we add, now we add internal braces. If you've done correctly, it's, [00:37:00] it's a little bit trickier to set the internal brace of this 'cause it's so much flexion. Yeah. So you don't wanna obviously put an internal brace that doesn't move. Um, but there are, there are lots of tricks that these docs can do with some newer implants and techniques.

Um, and we have definitely seen a higher return to sport over the last few years with this injury. So I wish him well, but this is a solid seven, eight months.

Will Sanchez: Um, let's saw Christian McCaffrey. I'm kind of jumping around. I have a long list of injuries, but you know, for time I'm gonna jump around and kind of key on some of the, the top players.

Uh, Christian McCaffrey, 49 ERs running back all pro stud, uh, coming off the season, uh, that he sustained an Achilles injury. We're gonna talk about some of the recovery a little bit later on. What are some of the concerns? He's had quite a few injuries, even though his production has been high. He's had a lot of injuries throughout his career.

What are some of the concerns with that Achilles injury besides, you know, what we've normally talked about?

Dr. Grant Garcia: I mean, the challenge with him is it's, it's not a full [00:38:00] rupture. Right? So it's just like dealing with the inflammation. Dealing with the inflammation. Bilateral tendonitis is not ideal. You know? And this is also a guy, like you said, he's very productive, but he's, he continues getting injured.

I mean, it took him, all, people couldn't figure out what was going on with him for weeks. Yeah, yeah. Right. He just wasn't back. Right. That's never good. Like the thing is, if they're not publicizing what he has, they might not know how to fix it. That's, what does that

Will Sanchez: mean? Bilateral Achilles tendonitis? Just for the people that don't really understand what that means.

I mean, Achilles, I'll be honest. It's clear, right, but what does that mean? Yes, I,

Dr. Grant Garcia: I mean, Achilles tendonitis is basically like, it continues to hurt. The idea of that tendonitis means that there's inflammation in the tendon. So he's just got, every time he is running, and he's probably pain in the back, his ankle.

The challenge is right, like, is this tenitis gonna lead to rupture? Well, bilateral rupture is pretty unusual. Achilles can happen. K McCaffrey's not really the type of guy that would get it, but he could get it right. You know what I mean? Like usually it's bigger guys, like the, the defensive ends and you know, the linebackers, [00:39:00] he's a little bit built a little bit differently from that, but it can always happen to any of these high level sprinting players.

Um, but I mean, that guy has tried everything, you know, I think he went to Germany for some specials, type of cell injections, gyros, he's gone.

Will Sanchez: He's doing gyro, gyro

Dr. Grant Garcia: stand,

Will Sanchez: you know, that, uh, doing a, but, and here you go. Not to start any, any, uh, any rumors here, but the 49 ERs traded for Washington. Uh, commanders starting running back.

Brian Robinson, uh, right before the start of the season. So going back to what did the 49 ERs know, even though McCaffrey's saying I look good, I feel good, I sound good. I, you know, everything's in order, but the 49 ERs go, yeah, we're gonna trade for another running back. You know, besides what they have, so, you know, if you're in the room, what's the, what's the thought process there?

Dr. Grant Garcia: Thought process is you need an insurance policy. I mean, he could do everything he wants, but the problem you have is, a lot of this is talk, like we've talked about before, like we talk about all this tech, but does it really work? [00:40:00] Right? Is it really getting you that much better? Like yes, but like, do you, I mean, McCaffrey would be good probably without any of this stuff.

Like he, he was, he's naturally talented. Right? And he's, he's the same thing we talk about with some of these other players, right? Even when they're a little bit injured, they're still better than most. So yeah, the challenge is are you gotta be able to pick up and right. And he, he knows he's now more on the chopping block than before.

Right. He's been out so much. Is it worth paying him? Is it worth doing all his things? And hate to say it, he's kind of getting old for a running back. Yeah, it be, yeah. He's a tremendous lifespan of running backs are a challenge.

Will Sanchez: I mean, he's exciting, he's great to watch, you know, it's just, uh, injuries.

Right. Um, I want to touch on two more players and then, uh, we will get ready to wrap it up. Uh, Jonathan Brooks from the Panthers, ACL. The reason I bring it up, because there's bio biologics, there's some graft shifting. Is this a lavender style kind of, uh, surgery [00:41:00] that Jonathan Brooks may have gone through?

Is, is it our, our buddy Chad Lavender? Is he involved with something like this?

Dr. Grant Garcia: Uh, I wouldn't be surprised with this one. The challenge here is that the biologic, ACL requires a quad, so it's a different type of graft. The issue you have is that a lot, even though the quad ACL is a very popular graft, I do a lot of matric, majority of my acls, which is the similar thing that what lavender was saying.

The challenges that patella tendon, which is what most of the professional athletes get. Like even Ella, who's amazing surgeon. Yeah, yeah. He, if he, he's he love, he likes the quad idea, but he's kind of like. And you know, in the NFL, he is like, I'm not NFL player. I'm not gonna mess with it. Right. I'm gonna do the Patel attendant.

That's what we've been doing for years. That's the, that's the option. And so, but we all know that, like nowadays with this, with the media and agents hearing more stuff, like something like the lavender ACL would get picked up on and potentially could he return a bit faster? Yes. But we [00:42:00] also heard from lavender and he wanted to emphasize this, this is not like four months, this is six months.

So it depends on when he has the ACL tear, is it even worth it? Right. You know what I mean? Yeah, yeah. Or is it just like they're going to, the thing is to me, I tell people there's no downside. If you wanna return in the same window. You want to have the biologics to hopefully help enhance the bone to bone, the healing of the tendon.

Yeah. There's no downside, but the costs right in the NFL, they don't care. That's cost. It's small cost. Yeah. But for my, I mean, a patient this day that asked about the fertilized acl l they wanted the bio acl l and I said, here are the risks. Here's the benefits from the podcast. Here's some understanding my research.

Um, you know, and they, and they opted in that space actually to not do it. But sometimes they play, you know, I have someone, I have one a couple weeks that wants to do this. They want everything under the sun to get back to the best possible level. Gotcha.

Will Sanchez: That'll be interesting to see how he recovers and, and get a little bit more information.

Uh, last but not least, um, really, he was in the running for defensive player of the NFL last year, the heart and soul of the [00:43:00] Detroit Lions. I think if he would've been healthy, I think they could have gone to the Super Bowl. I think they potentially could have beaten the Eagles and advanced, uh, Aiden Hutchinson, uh, for the Detroit Lions went to University of Michigan. Tibula, fibula, fracture, surgical, uh, nail fixation, advanced bone stem. What Yeah. Does all of that mean?

Dr. Grant Garcia: So you, you said it well, which is good. So basically, we've had this before, some of the players where they snap the mid shaft, this is actually what Alex Smith had.

: Yeah. So, but

Dr. Grant Garcia: his was open.

: Oh,

Dr. Grant Garcia: much worse.

Yeah. Yeah. So when you break the middle of the, the bone and the tibia. It can just be a break, which is bad. It can be a break with a hole. It can break with a bigger hole, and the bigger the hole, the increased risk of infection and wound complications, which is what Alex Smith had.

: Yeah,

Dr. Grant Garcia: but a clean break with maybe a poke hole or nothing.

Usually what they do is they could put a rod down there. The nice thing about the rod is that it's [00:44:00] instantaneously stabilized and it's inside the knee, so the incisions are really small, right? You go from a certain angle, you usually put it from the top down in someone's leg, and it can stay there permanently.

From the kneecap, correct? Yeah. Uh, there's two ways to do it, but usually from the kneecap areas, the way you do it then, are you keeping it

Will Sanchez: it permanently or is this something that's an option to take out? Because I've heard different variations. Go

Dr. Grant Garcia: ahead. So generally you just take out the screws that hold it in.

Imagine you gotta like, you know, you got the, the big pipe in there and then you gotta pin it right. To keep it in there. Yeah. So a lot of people get the screws out. 'cause taking the pipe out is a nightmare. Oh, you can do it, but you can imagine it's very hard once it grows in to try to pull that thing out and things are so that's actually

Will Sanchez: right.

And they, they're healing around it as well.

Dr. Grant Garcia: Like, we have one guy in our office, our PA that loves to take him out. So it takes him like 30 minutes of just hammering to get this thing out. And we literally, him come to every case. He gets so excited to help out. But anyhow, so the, the long story short is like generally we leave the metal in there.

Um. Then the advanced stem, I mean, the [00:45:00] idea here is like, can we make someone heal faster? Right? Like that's the whole point of the biologics. Can we, and again, the stem for a general patient would be really hard to get, right? Like, I can't get these, I can't get these approved half the time for insurance.

Yeah. Unless they have a really, really bad issue. But obviously, you know. No big deal, just throw some money at it and get it to heal the bone stimulators do help. And so the idea is like anybody's willing to do it. If it was me and I had to pay outta pocket to so I could heal and walk faster and run faster two months later, earlier, I'd definitely do it.

Will Sanchez: Wow. Okay. I'm grossed out a little bit on that one. Um, are you, before we wrap up, are you, are you, you, I think you want some trivia, right? You want a little trivia? A little NFL trivia to kick off this season. Everybody loves

Dr. Grant Garcia: this part.

Will Sanchez: I think I know you love it. This is your favorite part. This is better than surgery right now.

That's right. I love it. I love it. Okay, listen, week eight, if nobody gets hurt, this is, which is we're talking about injury. Uh, Michael Pennix from the [00:46:00] formerly from the University of Washington for Atlanta Falcons is going to match up with two uh, taco Viola. It'll be the first time since 2000, I believe 12.

Since two left-handed quarterbacks have started against you against each other, which is really, really interesting. Can you name the last, there's only been two Super Bowl winners, super Bowl quarterbacks. Can you name either one of them that have won a Super Bowl, the last left-handed quarterback to win a Super Bowl?

One of two.

Dr. Grant Garcia: I'm like, in my head, I'm trying to think about them playing, but then half the time you see 'em, they're like, you're seeing 'em from the other directions. So you don't even know. I don't know. We'll say Kurt Warner,

Will Sanchez: he's not left-handed.

Dr. Grant Garcia: I have no idea. This is absolutely impossible. Trivia.

Will Sanchez: All right, so the hard one is Ken Stabler.

Jake the Snake finally got into the Hall of Fame [00:47:00] postmortem and, um, Steve Young. Steve Young.

Dr. Grant Garcia: Oh.

Will Sanchez: Last left-handed quarterback. Uh, interesting. There's only been 11 left-handed quarterbacks to come into the NFL since Michael Vick got drafted back in 2001.

Dr. Grant Garcia: That's crazy. Well, it's less common. I mean, I'm left-handed.

It's 10%.

Will Sanchez: Why, why do you think, real quick before we wrap it up, why do you think that we're not seeing left-handed quarterbacks, uh, in the NFL?

Dr. Grant Garcia: First off, there's not an advantage. So if you're not an advantage, like in baseball, there's an advantage, right? Like in you're

Will Sanchez: onto something. I, that's my thought. I think what you're doing is you're getting left-handed hard throwers and you're getting them to commit to baseball.

Instead of football,

Dr. Grant Garcia: which is more lucrative. It's much more lucrative.

Will Sanchez: That's my guess. So,

Dr. Grant Garcia: yeah, I mean, I agree with you.

Will Sanchez: That's my guess why we're not seeing left-handed quarterbacks, but they're going, wait, if you're left-handed and you throw [00:48:00] 98, don't go throw a football, go throw a baseball and we'll make you filthy rich and a 275 pound man, it's not gonna land on.

Dr. Grant Garcia: Well, I also would say that you don't have to be as good and left-handed. Does that make sense? So like, you're not even like, they're not even getting that level. Like if they're that good, they're getting recruited hard from the baseball, but like, they're just pull basically, basically baseball's pulling anybody that's decent thrower that's left-handed.

: Yeah.

Dr. Grant Garcia: Because there's so, there's so much less common, right? Like if you have, if 10% of the population is left-handed. Ideally you have the same amount of throwers that are right. You, you have the same, probably less. You have only 10% that throw as hard as Right-handers. That's a small pool. And then they're throwing 'em so much money on them 'cause they're so uncommon.

Yeah. But that's why you see so many more left-handers in MLB, but it's actually not even close to equal.

Will Sanchez: All right. Let's say goodbye. We went over our time because that's what happens. Um, thanks for listening to Sports Doc talk. Check us out sports doc talk.com. We have transcripts, we have shows, uh, check out our [00:49:00] polls.

We are getting requests for, uh, topics and new shows. Thank you for everyone that's reached out to us. We've had plenty of people reached out and email us. Um, we we're very thankful for our guests, so. I don't know what else to say. Dr. Garcia, you wanna wrap it up?

Dr. Grant Garcia: Yeah. So thanks again to all listeners and, uh, for the, we had a lot of guest requests this summer, so hopefully we get to see some of those show up.

Um, and again, if you're interested in being a guest in the show, let us know. Obviously it's important to us that. We get a lot of requests that may not fit the show book. We're really gonna try to stick with this sort of orthopedic sports, uh, kind of innovation topic. But, you know, it doesn't hurt. Reach out and we'll, we'll vet it and see if it works for us.

So thank you. We really appreciate everybody. Let's go Big blue baby.

Audio Transcript

Dr. Grant Garcia: you did.

I'm gonna have to work on some of your typing skills. I don't know what's going on over there. Yeah. Okay.

Will Sanchez: Yeah, yeah, I definitely do. Listen, we're really excited about, uh, our guest today. Uh, but before we get to our guest, Liz Handel, a little housekeeping there. Uh, you know, we love Mike B and The Recovery Shop, but who can talk about the Recovery Shop better than You can take it away, [00:01:00] buddy.

Dr. Grant Garcia: Yeah, so again, big thanks to our sponsors, you know, from these, for any surgeons out there. This has really been nice for me because the patients always ask what extra we're gonna get into, extra you can do during the surgery. But how about after the surgery? Right? So after the surgery, the ability to have sort of sort of advanced rehab stuff, nutrition, things like that, it's all available here.

And the nice thing is each surgeon can have a customized page for their patients. So it really is nice. It's sort of like an a la carte option. So my patients in Seattle, they love it. They're always asking questions on what else they can do. Um, they're gonna, we're gonna bring up one of the topics they talk about all the time, but before we jump to that, uh, this recovery shop thing is awesome.

So look into it.

Will Sanchez: Yeah. And maybe they can find a way to fix my background since they're able to fix everything else. So I don't think that's what they mean by the recovery shop, but shout out to Mike B and everyone else, uh, you know, we really appreciate them. Listen. We don't care about the doctor that's coming on because he's the pride of Chesapeake, West Virginia, [00:02:00] right? He is the pride of West Virginia. Let's bring on Dr. Chad Lavender. Dr. Lavender. Listen that, how big is that town? That town is less than what? 1500 people? 1200 people. I mean, you must be the talk of the town. Not only. In your town, but across the United States, across the globe. But what's the feedback just getting, uh, you know, from, uh, the folks in your town?

Dr. Chad Lavender: Oh, you know, I think, uh, so I practice maybe 30 minutes from where I grew up and, uh,

Will Sanchez: beautiful

Dr. Chad Lavender: in, in a, in a slightly larger town. Not much. But, uh, you know, um, that's part of the, the beauty of, uh, being here, uh, where I grew up is I get a treat. Fan, you know, basically my extent of everybody here is related some way to me, right?

So, um, you know, many people I've known all my life or their kids, you know, and I think, um, so that's why I've chose to stay in this area, uh, is very fulfilling.

Dr. Grant Garcia: So, again, to overall, to introduce him, [00:03:00] uh, Chad Lavender is Marshall Orthopedic Surgeon. The big reason, obviously he's here for many reasons we'll get to in a second, but you guys have all heard the thing we've talked about at numerous episodes even before we had our video episodes, the Fertilized ACL.

I will tell you that pretty much weekly to every other week, I get someone asking about this. I hear it at conferences. I work with Arthrex too, just like Chad does. So I get people talking about this as well. This is a very hot topic and we'll get into in a second why it's so important. Then obviously we got some other twists and turns here. So we're gonna talk about the nano scope. We've heard about it with, uh, we talked with Chubb when they talked about how his recovery was better because of the nano scope surgery he had done.

So we'll pop in and ask Dr. Lavender, who's sort of a specialist at this, and then obviously as a football player so we can tell us about his experience with little players and how that coalesced.

Um, and then just classic board certified. So this is awesome. So thank you so much, Chad, for coming on. I think everyone's really excited. I. I want to, you know, kind of hear more about [00:04:00] your background, maybe kind of, I know you told briefly, but sort of how'd you get to this point, and then we can jump into some of the topics.

Dr. Chad Lavender: Yeah, so we talked to a very small town in West Virginia. Uh, very blessed to have a great family, uh, support and, and community support and coaches. And, uh, ended up, uh, walking on at WVU and played backup long snapper there. Um, and then went to medical school at WVU and then attended Marshall, which is where I currently work for residency.

And then I spent a year specializing in sports medicine in Richmond at Orthopedic Orthopedic Research of Virginia.

Will Sanchez: So nice. Yeah. Dr. Lavender, I, I, I know what you do is really complicated. Um, and you know, as Dr. Garcia mentioned, you know, we've talked about, uh, this procedure in numerous shows, so we're really glad that you're here.

But is there anything harder than walking on to West Virginia and China? Get on the team team as a long snapper, and not [00:05:00] only getting off of that season, but pretty much the, the seasons that came after that. How difficult was it, was it to just be in that situation and be blessed to be a part of that university?

Dr. Chad Lavender: Oh, it was, it was a dream of mine. You know, to be able to live your dream is something very few people. I get to do and I had a dream to do that and then be an orthopedic surgeon and I'll tell you that I can remember vividly coach Neland, he looked at us, our first team meeting and he said The hardest thing that you'll ever do in life is maintain on this football team for four to five years.

You know, um, because it takes consistent work, much like medical school. I mean, it's very, very similar to medical school. I think it prepared me very well for those years in residency because. Um, it was grueling, not just physically, but also mentally, you know? So then you get to medical school and it's mostly mental, right?

It's not as much physical, but like, uh, I think it was, it was [00:06:00] the 5:00 AM workouts and the things they put you through that really helped the mental toughness, you know. Um, so yeah, it was really hard. I mean, I'm five, I was five 11, maybe I'm five 10 now. I was listed as six foot, so

Dr. Grant Garcia: I love it. Well, you can see Will though, again, this is the reason, and Chad can remember this, but the athlete checkbox is huge for orthopedic.

There's a reason for that, right? They just don't give up. I did four years. I was not football, but swimming, you know, it's, it's the, it's the commitment, right? Like the one year athlete, like that's great, right? That's, that. You can do that. That's, that's easy to do. That's hard to do in some cases. But the four years, what you did, you know, that shows dedication and it's, it's gonna jump right into the next topic, right?

Because what you did for four years now, you've gotta basically do something and you wanna do something that's different than what people have done before. Like, yeah,

Will Sanchez: the,

Dr. Grant Garcia: this fertilized ACL, and we can get into it in a second. Like, this is bucking [00:07:00] the norm will, like, this is not like, like we've talked about, like ACL repairs, like mm-hmm.

It's the same sort of situation. Like nobody, everyone's against you. Right. You're really, they're really against you and No, and you have to like, kind of be like, am I gonna take this on? Right. I mean, Chad, you had the, you have the weight of. You know, 10,000 or more surgeons that are like, no, this is the way we've done it for years and years and years.

I mean, what was even that that started making you think that you could take this on?

Dr. Chad Lavender: So, um, I think it, I would go back, I would go back a second and say where we're practicing. Okay. Which is in small town West Virginia, and I wasn't a team doctor for XNFL team or. Division One Power Five program, and the patients that came to me trusted me.

And, you know, and, and we would have informed consent and I would say, look, I think this is going to help you. This is what we, you know, we're planning. [00:08:00] Um, this is research and they trusted me and the patients that are in the trial that you're gonna mention, many of those are from this area and they had full trust, uh, in what we were doing, you know?

Um, so it, it's, it's, it's interesting. In the very, very early days, we weren't under the micro microscope like you're discussing, and then really quickly it turned into, okay, I'm on a stage and there's a thousand orthopedic surgeons out here. They're wanting to throw tomatoes at me. I mean, it, I can remember it.

I can, I wa I can remember the first time that I presented just the technique. Okay. Just the technique. And I'm outside and I'm nervous. And, um, you know, because like you said, it's one thing to present in front of people about acls and hamstrings versus quad tendons. It's another to present a completely.

Mind, uh, changing, you know, procedure. And so, uh, I remember [00:09:00] the guy outside, one of the reps, he, uh, came up to me, he said. And he was telling me this story about a mountain biker or an ex games type guy, and he was like, and he said, the worst thing that can happen is I could die. You know? And I was like, why are you telling me that when I'm getting ready to go on stage, man, come on.

And uh, so that kind of lightened my mood. I went up there. I think it's all about putting things in perspective and really, um, you know, I would, and I, and, and I've talked to other innovators, uh, since in the last eight years. And, you know, I would say that. There's really, uh, there's really three different phases.

There's the very difficult early phase where everyone is against the idea. They really don't want to believe or ha don't have open minds. Then they start asking questions and they're inquisitive. Then you get to the phase where people start to adopt the procedure and ask about the procedure, and want to learn about the procedure.

Um, we really got to the third phase [00:10:00] fairly quickly. Um, and I would say, you know, I think our first, our first publication, um, on the procedure was around 2017, 2018. Um, and you know, there's two different parts of the procedure we'll talk about again, but I would say that the internal brace was more controversial than even the biologic portion.

Interesting.

Dr. Grant Garcia: That's, it's funny. 'cause Will, and I think about that, and that's Will's favorite topic, so be careful when you bring up the word internal brain. Internal brain. Will Sanchez: He gets way too excited. I love it. Every

Dr. Grant Garcia: surgery I bring up, he wants to add it. So, uh, but anyhow, the, that's, that's amazing, right?

Because to me, I had, you know, I had six people with ACL tears today in the office, and every one of 'em, I was like, that's internal brace part's not the problem. Like, that's been studied, you know? And so they, and they're, and they're coming in like two of 'em asked for. So to me that you say in the internal brace part was, the hard part at the beginning is super interesting because that's just the difference now with the internet, [00:11:00] right?

Like the last two weeks I've had people with chat, GPT, they came to me, we talked about ai, and they're like, Hey, my surgery, I need to have this. I'm like, came up with that idea. They're like, yeah, it's an internal brace. They wanna have a quad. And I'm like, did you talk to the surgeon? They're like, no, chat.

GBT told me what I needed. I'm like, oh, that's interesting. But anyhow, the fact that that's out there, right? Yeah, it, it's, yeah.

Dr. Chad Lavender: Yeah. So, you know, I can remember in the early days, uh, we were in Naples and I ran into Dr. Pat Smith, who, um, he was doing it with hamstrings and, um, some canine research at the same time that I was using it as part of our fertilized bio, ACL.

Okay. And so we were simultaneously really doing the initial research on the internal brace. And there were so many questions about does it cause synovitis, does it work, does it over constrain the knee? You can talk about all those things. And um, now sitting here eight years later, it's not controversial [00:12:00] anymore, but like when you asked me the question, what was the hardest, uh, part of the selling the procedure or talking about the procedure, I would say I had a lot more questions.

And concerns about the internal brace than using the bone graft in the bone. Interesting.

Dr. Grant Garcia: Well, I, I see that part. I meant more like, I think we'll get into the recovery timeline. Yeah. Uh, but yeah, I mean, selling the biologic idea, at least in my practice, has never been the challenge in terms of like, you know, everyone wants, like we talked about this to recovery shop, we talked about these other things, will, like, everybody wants the best right.

These patients are coming in and they want the best. And so, you know, Chad's got this sort of super innovative new technique, like they're super interested and he is got the trust locally. Like I know I grew up, I grew up where I practice. So I have the same situation. I mean, I see people I went to school with, coached, you name it.

Like those are the patients that are more willing to trust me and try something like this that's different. And I understand that, which is, that's interesting that that background was there for [00:13:00] you. Um, do, do you know what, so can you explain, and I want to go over this eight fertilized ACL in a second.

Can you explain what the importance of dealing with the ACL was? Like, what's the, I can go in nauseam, but obviously you're the one here and you're the expert. Why did you choose the ACL? Like why did you choose ACL reconstruction and why'd you choose something like this? What was the reasoning?

Dr. Chad Lavender: Man, rotator cuffs are a lot more easy for me, uh, in the, or like, I mean, you know, you can do a, a double row rotator cuff and like, I can't tell you how many times I've said, man, I should have developed a new rotator cuff procedure.

It takes 35 minutes, you know, but, um, and, and the, and the ACL all, you know, an autographed ACL takes longer than that. But, um, no, the reason is because in my opinion. When you have a re-rupture of an ACL in a 17-year-old, you're almost, that's almost like athletic, the end of their athletic career in most cases, [00:14:00] because you take an injury that was maybe one year, and now you've made it at least two years long off the field, right?

So in most cases, let's say you get hurt in August, you miss that football season. You come back in the spring, you re-air, you miss a whole nother season. So my goal was, and, and here's how we got started with this process. A patient came in, for example, and did not want a staged reconstruction. Okay? And so you start to think about ways that you can improve the healing process and the bone.

And that's kind of how I came up with the idea of using bone graft in a primary setting. You understand what I mean? So instead of staging, yeah. Instead of staging with bone graft and then going back in, I said, okay, wonder if this would work. And then once I did it, once I started saying, okay, let's just do this in all of our primaries to improve the healing process.

And it made sense to [00:15:00] me.

Dr. Grant Garcia: Yeah. Um,

Dr. Chad Lavender: so Will,

Dr. Grant Garcia: that's to jump in that, that's, we talked about this with Chubb. So basically you get these patients with big tunnels and so you don't want to do another ACL on them. And so what he's saying is that he found this way to try to like, can I bone graft and do the ACL at the same time to skip that step.

Will Sanchez: Yeah, but the inspiration is off the re-rupture, right? So after the re-rupture, that was the inspiration. And then once you caught onto something that you're like, this is working, then that became your primary, uh, for any procedure that had to do with the ACL, not just a re-rupture, but the inspiration to kind of, you know, be motivated about finding a solution, especially for these young adults that are losing two plus years of their athletic career.

Came from this re-rupture, which is, which is fascinating. So it's as, as we talk to other doctors and we hear about inspirations, it is usually that inspiration to help someone to help the patient have a better quality of of life. So I always find that key when I hear [00:16:00] these things and saying, this is what motivated me.

This is what inspired me, was to find a solution. And, and Chuck, can you talk

Dr. Grant Garcia: about the delay? What's the delay? What is the delay in the recovery of ACL? Right? Like you talk about tunnel healing, right? So what's that? That is part of your process as well, I'm assuming.

Dr. Chad Lavender: Yeah, and I think, um, the biggest, the biggest reason I, I chose ACLS is my main, um, interest of, of research and, and innovation.

It was because of my, it goes back again to my, my upbringing and, and you know, having friends that tore their ACL both in high school and college, and seeing what they went through to get back from that surgery. And my thought process was okay. Yeah, the patella tendon may be a, a great autograph. But it are, is there another option that hurts less, possibly long-term, hurts less earlier, and we can get patients back easier and, and, and, and maybe let their recovery be, be easier and, and more thorough.[00:17:00]

You know, that, that was my, that was my whole thought process. Some of those questions we're actively still studying almost a decade later, guys. I mean, and when we get to the study, we can talk about that, but I mean. It is, it's, it's unbelievable how long it takes to find answers. You know? I mean, real, legit answers, not just, we can do this.

I think it works. It works in some people. Right? You know? Does it actually work? And so

Dr. Grant Garcia: can you describe, I know we have this really nice slide here, and I want to get to this and just kind of show this for the viewers, but can you describe your newest tech? 'cause obviously you've done some slight modifications in trying to make the perfect titration.

You don't have to go through too crazy details. People have seen this. I've already talked about the first slide, this is like the fourth time. But obviously the first time having someone like you, the expert that invented it on, can you tell the viewers kind of what you're doing right now, uh, to do a fertilizer seal so they understand the differences?

Yeah, that was because people think they think they do. But

Dr. Chad Lavender: man, that's an excellent point. [00:18:00] Um, that's a really excellent point because early on, the first time that I published it, it was with a patella tendon graft. And I, I, I threaded an internal brace through the interference screw on the tibia. Long story short, I was using a patella tendon graft, then I used, um, amnion, you know, I went through an amnion stage and then I settled on the use of a quad tendon with the composite graft, the bone grafting in the tunnels, and an internal brace right next to the, to the quad tendon.

So I settled on the soft tissue graft. With an internal brace, um, and the composite grafting of both tunnels and that, that period and that process probably took a year or two. And then we started actively looking at our results. And still to this day, um, now I'm looking back at some of the six year data that we have, you know, and, and trying.

[00:19:00] I mean, we had a research meeting this evening before I came on here, and we're actively trying to find. Uh, those that may be interested in looking up those results, call 'em patients still, you know, finding patients, seeing how they're doing. And I mean, it, it's a la it's a labor of intense love. You know, research is, I would say.

Dr. Grant Garcia: So, and then you're adding biologics. So what are you usually adding to this? Because, so for the, for the listeners, you got the bone graft you take, which is, we can learn about that, but

Dr. Chad Lavender: in, in simple terms, what we're adding is, we'll, we start the procedure and we take bone marrow aspiration from their shin bone.

Okay. Okay. That liquid gets spun and you could take, you can use PRP or you could use BMC, which is bone marrow concentrate. That's been, that has, um, stromal cells. Don't really like to use the word stem cells. Okay. So stromal cells. Uh, so it has stromal cells, uh, within that BMC. So that's liquid. And we'll add that to, [00:20:00] uh, a demineralized bone matrix.

That's, that forms a putty. Okay. It's, it's thicker and it, and it forms a really almost solid putty that's a graft. Um, and those two components, um, really form our, our composite graft that we inject into the, into the tunnels. That's kind of how we come up with, with, with the, the slush puppy. Pe People like to call it a slush puppy because it's, it looks like a slush puppy.

Yes.

Dr. Grant Garcia: And it coats the graphs. The idea is it coats the inside the tunnels for the listeners, and there's a gap right now. There's just, there's just nothing's there. It's a, if you, unless you like, have a perfect tight squeeze, which you won't get the ACL through, you have to have a little bit of a gap. So now you're basically accelerating that hopeful healing process.

So let's go to the clinical trial and then maybe, uh, Chad can explain it to us. 'cause this is sort of the big one.

Dr. Chad Lavender: Yeah. So, uh, this, you know, uh, let's go ahead and talk about this. So, 2021 is your date here, and it [00:21:00] didn't fully publish in arthroscopy, the Journal of Arthroscopy until late last year, 2024. So the, and I, and we started before COVID, so we're talking about 2019.

Uh, we started enrolling in this trial or earlier, and the reason is, so you enroll, okay, 60 patients or a hundred patients, you do their surgeries. Then after their surgeries, you have to wait two years to properly publish. It doesn't matter if you're looking at six month CT scans. Two week results, three month hop test.

It's not getting published until two, two years after that last patient. Well,

Dr. Grant Garcia: especially in the journal, you published it, right? Yeah. I mean, you go, you went big.

Dr. Chad Lavender: Yeah, that's that. We went big and, and, and there's always flaws that people will point to in any study, but in our study it was randomized and it was controlled.

It was a [00:22:00] randomized controlled trial. Uh, 60 patients, and we used both autographs and allograft based on age. So it wasn't just a bunch of 18-year-old soccer players, right. We're, we're looking at across all age ranges and made sure that all that was even okay. And, um, half the half the patients received the, uh, augmentation with the internal brace and the biologics. The other half didn't. And what we found is. The half that had the, uh, bio ACL fertilized, ACL, um, had improved function at just 12 weeks, as you see, 80%, uh, they scored 80% on their HOP testing, which is a measure of their function compared to the opposite group, which was around 35%. And many of those patients didn't even perform the HOP testing.

So, yeah, that's pretty

Dr. Grant Garcia: impressive at 12 weeks. That's just not common. Yeah, it's,

Dr. Chad Lavender: no, it's not. And so not, [00:23:00] and the, and the bigger issue is we found that the, um, the tunnel widening was less. Okay. So radiographically the bone incorporation was better and there were no re ruptures in either group. Uh, and several, every single subjective measurement that they filled out.

On their surveys throughout the study favored the group that was augmented. Only a couple were statistically significant, but they all favored the augmentation group. So, um, based on this study, we put our heads together and we said, okay. How do we see if, uh, what's important now? So we did the randomized control trial.

So we said, well, let's look at this in a larger population of athletes and let's look at less than 25 years old. Okay. So currently right now at Marshall, what we're doing is we're doing a 125 patient [00:24:00] prospective earlier return to play study. And what we're doing is looking, we're seeing if that three month hop test.

Is similar. And I think right now, if I pulled it up on my computer, it's 70%, 75, so very similar to that. 80% at three months. Um, we're testing MRIs at six months and we're seeing on average less than or equal to one millimeter widening on the femur in the tibia, which is about exactly what we found. And we're also seeing, um, you know, we're, we're not seeing poor results.

Does that make sense? So not re-rupture those types of things.

Dr. Grant Garcia: This is great. So I, I don't want to cut you off. I wanna make sure that we, you're doing a fantastic job presenting. I wanna make sure the layman people can hear this. Yeah. Because this is, these are the people coming in, like the orthopedic surgeons.

Like we read the fertilizer cell, we get it. Like I, I'm all on board. I love this. So this, the tunnel widening, the CT scan for everybody listening is like, the concern with some of these soft tissue grafts is they have bigger tunnels. That's one issue. The second issue is the, the reason [00:25:00] they can't get back faster is for many reasons, but one of them is because the ACL isn't healed to the wall fast enough.

So that's why people are scared to let people go back at 7, 8, 9, 10 months. So you basically showed that your way is getting the bone heal faster and that they're stronger. So it's like the perfect trifecta, which is why you've shown some crazy videos of some people doing insane things at a much faster rate.

Dr. Chad Lavender: Yeah, those, I

Dr. Grant Garcia: mean, I know you're laughing, but I videos, those didn't go over well. Those

Dr. Chad Lavender: didn't go over very well in the orthopedic community. I'm sure it

Dr. Grant Garcia: didn't. I'm sure it didn't, but I loved it. So, I mean, I remember seeing the first one like three years ago. I was like, is this real? So it's pretty awesome.

Dr. Chad Lavender: I talked to somebody today, um, I don't know, they were maybe six or eight weeks, and I said, uh, so, so they were asking about an activity and I was like, listen, if. If you do that, just don't tell me about it. You know what I mean? So I was like, no.

Dr. Grant Garcia: I think the idea is that you're this, it's, you feel a lot more confident with, you know, I have those patients come in there six months, they're like, I'm still nervous.

And you're like, no, listen, I know that [00:26:00] this is stronger. I've done the tests on this. Right. Like, just so the listeners know, you don't normally get a CT scan. You don't normally get an MRI at six months, right? No, that's a study based thing. So you're doing every check right. Right. A JSM is going to be like, I don't trust this thing.

It's totally out here and we need to make sure, like this was literally sealed, tight study. So they did everything possible, like anything negative that someone can think about. You already covered it. And so that's really important for the listeners.

Dr. Chad Lavender: So we did cts and MRIs in our previous trial when we compared the groups.

This trial, we're doing six months MRIs, and the reason is. We can, you know, it's less radiation on 125 patients. So

Will Sanchez: yes,

Dr. Chad Lavender: that would've been hard to get through the I rrb. So, uh, the MRIs can still tell us the, the tunnel widening, which, you know, it's like, uh, like I said, less than one millimeter at six months in both groups right now, and I think we're up to 70 patients.

Wow. Um, so the other thing that we're finding and we're looking at is I have an independent radiologist that's [00:27:00] looking at the signal of the ACL graft. So I'm trying to, so some of what we do in research and what we're doing with this study, um, we're also doing hop testing at three months, four and a half months and six months, and I'm doing virtual reality testing.

So I hook 'em up to a, I have somebody that, that's their whole job is they take our ACL patients and they put sensors on them and they do dors CV testing and they do virtual reality testing.

Um, on a, on a screen, like a PlayStation move, you know, it's not that. Yep. But it's simple. And then that gives them limb symmetry, indices and things of that nature that we'll be able to go, hopefully, four years from now and say, okay, the patients that had issues.

Or re ruptures or didn't do what, you know, when you look at their RSI scores and, and all these things, we'll, we'll go to try to correlate that with all that data that we're getting. So, you know, we're trying to get a treasure [00:28:00] trove, uh, if you will, of data not, and like I said, maybe we'll find that. You know, um, the, the signal to noise ratio on an MRI of the ACL graft after, after this is improved and that helps, helps you with your re rupture rate.

I don't know, but like, you're right, we, we wanna look at every detail that we can and not just, not just say, well these patients scored better on a subjective measurement. Yeah.

Dr. Grant Garcia: And, and, and it matters too, right? Like the data's good, but you wanna make sure you have everything covered, right? Like, 'cause patients don't really know what the.

Your, their IKD score means or anything else. They're like, oh, that's great. They want to know, am I gonna be stronger, faster? Am I gonna get back longer and is there higher? Am I gonna rupture sooner if I go back earlier? 'cause right. The whole debt, the whole thing we've ever been taught is that the sooner you go back, the sooner you re rupture.

Right. You go back before six months, you know, there's a concern. Not in this case, but you know what I mean, like there's been data about that. Yeah. So that's a concern. Which is why we never let people rip until [00:29:00] seven, eight months until we've had new data. I know you're, I know you're laughing about it, but it's a big deal.

I mean, that's patients. Well, I,

Dr. Chad Lavender: I, I'll tell you a story. Um, so Dr. Tim Hewitt, who is a world expert in biomechanics after ACL uh, reconstruction, he's the one that wrote all of the data that we have on preventative techniques for ACL, you know, uh, for female athletes and things. So, um, a, a mutual acquaintance of ours, uh, we're at a conference we didn't know each other.

Um, he had just written a paper that said, you need to wait two years to get back after an ACL or else. Right? And so, uh, oh, this is gonna go well. Yeah. So they, they set us down to the lunch at a, it was at a, it was at a meeting in Nashville. And so we sat down and, um, we started talking, we're across from each other, and, and he.

He's hammering me about the technique and my thought process and, you know, and I'm listening to [00:30:00] him and his, his views on things, which he makes sense and he has data behind. And, um, and he's a, he's a world class researcher. So rather than us getting into an argument, we end up realizing that, hey, the only way to really figure this out is to work together.

So he comes to Marshall. Now we're working together on this research study, and he's studying the biomechanics. I'm studying, you know, I'm doing the surgeries and the clinical scores and the MRIs, and we're putting our heads together to find out if six, and we're letting patients go back at six months.

And then we're gonna say, Hey, is it smart or not? You know, and, and let's figure this out, is if they did, if they went back at six months, what was their re-rupture rate? And what's that compared to in other studies and, um, will show

Dr. Grant Garcia: that comparison up there.

Dr. Chad Lavender: Yeah.

Dr. Grant Garcia: So Chad, I mean, this is amazing, right? Will he found the highest critic possible?[00:31:00]

For his study and decided to make him his colleague.

Will Sanchez: Like

Dr. Grant Garcia: that's insanity. Yeah. I love it. Like if your study works, I am all in. I already believe in this, but like you did the worst possible research thing ever and you found your biggest critic to do the work

Will Sanchez: for you.

Dr. Grant Garcia: So like this is incredible. Like listeners, like there is, you cannot fight this man.

Like he has done everything possible to try to destroy what he's doing and he is still not doing it. So this is fantastic.

Dr. Chad Lavender: I think you, you don't want to, uh, no matter what you're doing, you know, you don't wanna surround yourself with, uh, yes people. Mm-hmm. You want people in the room that are gonna question everything you do, because if I get on a show like this, or if I get up on a podium.

I want to have already answered those questions that you're gonna ask me. I mean, it just makes sense, right? So, so he was able to come in and really look at, look at, help us design this, this, this study that we're doing now, which is, it's, it's called a early return to place study after, after fertilized ACL.[00:32:00]

And, uh, yeah, we're doing 125 patients. We're gonna follow 'em for, um, two years and then five years and, and, and all that. So.

Dr. Grant Garcia: We'll pull that back up. Don't go away from that slide. I need him to look at that. I like this so everyone thinks this is good 'cause Chad's getting the heat here, but I'm about to get the heat in like a co like a month when this, when this, uh, publishes and I'm gonna get the heat in terms of like my own patients asking about this.

So it's important that I show them all this stuff because they're gonna want to know it. Like this podcast can be listened to. And I'm gonna hear you're on your podcast, you said this and so it's important like right Chad. Chad has his own thing. He's invented this fertilized ACL, but there's hundreds of thousands of doctors that are doing this, and they're gonna see this and they're gonna say, Hey, listen, tell me more about this.

I want to know about this six month recovery. We're looking at it, the limb symmetry, the tunnel widening, but this comparison's really important and people come to that. So again, six month is not crazy, right? We have our own patients that are non traditional acls that are six months, seven months. So this is not insane.

And [00:33:00] again, I think. Part of this is what your technique is and part of it's probably you feel comfortable at 12 weeks with them doing the strengthening the limb symmetry, right? Yes. I would imagine it's kind of a combination of everything.

Dr. Chad Lavender: Let me explain our thought process there for a second. Yes. Um, so when we went into the design process of the study and I talked to Dr.

Hewitt, we were going to do like several different arms of the study and have some patients able, if they pass testing that to go back at four and a half months. I go to a couple conferences and I realize that, hey, people are still up there on stage talking about nine months, and I come back, I talk to him, I said, listen, let's just, I've let every patient for 10 years go back at six months.

Let's just show that that's safe. Let's get an actual re-rupture rate at six. Work your way down six months with the internal brace and the biologics, and let's prove that part of it before we go crazy. Try to and try to reinvent the whole rehab [00:34:00] process. You, you see, I think that's why, that's how we fell on a, on a six month timeframe.

And the other thing I wanna point out if I can, is people and surgeons and patients sometimes take grains of what's out there and they say, oh. I'm going to get back like within six weeks or 12 weeks because these patients did well at 12 weeks. That's not what we're promoting, that's not what we've shown.

Yeah, we're showing improved results at 12 weeks, but in, in no case have I signed a letter of release at 12 weeks. Okay. So I think that's, that's important to point out. I wait until the six months, even if they pass their, their hop testing and, and, and are doing excellent, I wait until six months. So,

Dr. Grant Garcia: and, and it's

Dr. Chad Lavender: important too

Dr. Grant Garcia: that you're saying that, right?

Because they all take this and they're like, well, that was me, but I'm not average. Right? Right. I'm better than average. And so I'm a four monther. And what you're saying too is the shock factor, right? Like the [00:35:00] video I had seen showed the four and a half months insane response. Yes. And so, like you said, like even someone like myself that's all on board with this, I work with Arthrex, I do the biologics, I'm all into the innovative stuff.

And I'm looking at this like, holy cow. Right? Like, it's not someone who's been indoctrinated for 20 years into the exact same surgery. Right. It's a, it's a shock. Yeah. So the six months, to me, I'm like, I can handle that. Like, I can easily tell my patients three more months. Yeah. I'm gonna cut your time in half.

That sounds insane. Like, that's the other thing too, is that it almost seems like too good of a, I hate to say the word sales pitch, but you know, locally, right? But you've got patients flying in for the surgery right now, and so the idea is that like. You wanna be careful with your pitch too, because you are selling it, you're still selling the procedure, uh, to the patients.

So it making sure that it's sort of like the appropriate expectations. Uh, but this is awesome. I, I think it's really important that we brought that up.

Dr. Chad Lavender: So thank you, Chad. I really appreciate it. I, I do think there's, we have a, um, important aspect, uh, protection for our patients, you know, I mean, and, and [00:36:00] because sometimes, and, and a lot of times patients will call from, you know, I mean, we've had patients come from other countries.

To, to this small town in West Virginia. And I know they get here and they're like, what in the world is this the right idea? You know? Um, so, and they, and sometimes they get lost to follow up. I mean, you know, as much as we try to call. But anyways, um, I'll tell you that, um, that it's very important, uh, to make sure you carefully word what you're saying.

Especially in promotional activities. I've learned a lot about that. I mean, and we still do let patient, like any videos that you see me repost, generally are posted by the patient. Okay. So I don't really do a lot of posting of the videos anymore. Like most of our videos are patient driven. Post because they're excited about their rehab.

And you know, I, and I, and I, and we wanna support that, but we don't let them go out and play at, at three months. And, and I think that was the, that was a [00:37:00] big misconception, um, that we were rushing people out there. Um, and that was, you know, let's, let's talk about that for a second. 'cause that was frustrating to me.

Okay. That's important. This is good. Yeah, because, because we were putting so much work into. The design of the technique, the design of the research. And following up on patients and, and really closely mo, I mean, I literally at, at times have sent people to high schools to make sure we get data on patients that were lost to follow up at certain time points.

That's how, I mean, that's how much we're, how passionate we are to get the research data, you know? Yeah. And so it's frustrating when people would come back and say, you're out here telling people they're going to just, you're rushing 'em back to activity. And, and that's just not, that's not true. That's a false narrative, um, entirely.

Did you hear that more from your peers? More than anybody else? Not so much people. Yeah. Oh, yeah. I mean, because head mouthing, because what happens, I dunno if

Dr. Grant Garcia: I call the [00:38:00] peers, but they, yeah. I mean, what

Dr. Chad Lavender: happens is somebody goes into his office and they say, yeah, well, Dr. Lavender over there at Marshall is letting people go back at three, three months.

That's just not true. And so when they call us, you know, and, and they get to me and, and what, and our, we have a protocol we do with out-of-state patients. Um, yeah. When they, when I do finally talk to them, I spend 20 minutes or more talking to them about expectations.

Will Sanchez: Mm-hmm.

Dr. Chad Lavender: Don't come here for surgery if you think.

You're going to be released at three months. That's not okay. And it happens this time of year every year because they, the football players want to get back before football season. Yeah. It's just not gonna happen. Okay. Now, maybe the end of the season, maybe if they're a high level player and they play in December or January or whatever, that's different.

But like, um, it's just not gonna happen in three months. And so, um, very, very, I make sure that I'm very clear with them about expectation. And, you know, come [00:39:00] here if you, if you believe in the procedure, if you believe in the science, or you know, if you, if you trust us. But, but don't have that expectation that you're just going to be, um, progressed at a rapid pace, uh, on purpose and, uh, you know.

Yeah, and, and you know, I mean, I, every night it seems like I'm texting with patients about their rehab and things like that from out of town, and I mean, I think that's a very important part of the process is making sure they have an understanding at each stage what they're allowed or not allowed to do.

Will Sanchez: It sounds like you've had a, a lot of support, um, from Marshall. What, what, what has that that experience been for, for you and, uh, and, and for your peers there? Um, just kind of working at the facility, embracing the fact that you're, you're doing something that's cutting edge and embracing all that. What, what has that experience been and how has that helped, uh, you know, to get you where you're at now?

Dr. Chad Lavender: Um, really it's the hospital system and, uh, and Marshall [00:40:00] both, you know, I can't say enough about some of the residents that have been involved with me. Um, I mean, we've had residents that have won awards and, um, really put in, you know, that study that got published. For example, I'm gonna say his name, Andy Shaver, uh, Dr.

Shaver. He put in at least 50 hours of work after this, after the study got. Really not denied, but you know, the re like accepted with revisions kind of stage. I mean, yeah, it was, it was a ton of work on his part. And without people like that in your life and, and in your workplace and supporting you, man, you can't do this.

You know? I mean, it took me, I mean, we got the book finished in maybe six months, but it was every morning I was up, you know, five 30 or six because. They're in a different country doing their revision. So they would send it to me late at night and then I'm up doing it before I go to work. It was, that was the thing that was [00:41:00] different than a study, because you write a study once you write that book chapter, it seemed like over and over and over, you know, there was always a different edit.

But, um, but yeah, back to your point, you know, Marshall's been great and I think, um, you know, I, I, I'll say this, as you go through your career, it's very difficult because. You know, um, you, you exponentially grow in volume and it's very difficult to continue to grow with that volume. You know, there's days, uh, we'll go to clinic and see 90 people, 80 people, and um, and have patients from, you know, have telehealth and all this stuff, you know, and, um, and it's very, you have to add staff and, and kind of grow with that.

And, uh, Marshall's been great about. Uh, supporting this in all aspects, you know? Yeah. And, uh, it's really cool to look back on where we came from and, you know, and, and the area we're in. Uh, if you've never been here, you should come and, and see how small of an area it is, you know? I mean, it's really [00:42:00] remarkable that it, that somewhere like this, um, people come to, you know, but That's amazing.

That's awesome.

Dr. Grant Garcia: Well, I think, I think that, that, this is a, it's a perfect segue, but also. For all listeners, we've talked about this, what does it take, right? Like this is not like a guy woke up, orthopedic surgeon. He came up with the idea. He started doing this on people, and now like a week later he is got results.

This is hours and hours and hours of grind. This is years of discussion, and this is also understanding that like innovation's not easy. Like there's nothing easy about what you had to do. And the heat that you had to take and like, it's all great. Now we can talk about this, like we got pictures from ai.

I got patients coming asking about the fertilized acl. Mm-hmm. Who are in Seattle who have seen your stuff, right? Like this, you've had, there's a lot of work to get here. Now you're at the top and you've done it and it's really awesome and I'm, and I, I would just say it's extremely impressive. But thank you for sharing your story.

'cause I think people need to hear this. 'cause again, this is the most important part. What's the background, right? The sexy stuff's great. Like at the end you got the [00:43:00] marketing. You got arthrex backing you. Like all those things are amazing, but that is not it. It is not easy.

Dr. Chad Lavender: Right. And you did it. I'd like to say something about that because you, that that's a, that's probably the most excellent point that anybody could ever make is research is hard.

And when I got, when I got started with that study, as we mentioned six years ago, I was 38 years old. And, uh, you know, I'm like a young guy then. And that thing got, finally gets published, I mean, a half a decade. And so they're like, well, what are you gonna do now? And I said, I don't know, probably my last study.

I'm just gonna be honest. You know, it takes, if it takes almost a decade to do a do that, I'll say too, I wanna point out that, um. One interesting thing that you learned. So, you know, our re-rupture rate right now has been about 3% compared to [00:44:00] 10% that we've seen. Um, so we have 3% re-rupture, over 10% contralateral tears in our patient population.

Yeah. Okay. We haven't, we haven't changed contralateral tears, which in my opinion points to two things, the validity of our research, but also the fact. That contralateral tears are a separate subset and unrelated to how well the ACL is on, on that knee. You know, I th I th I think, I, I think, I think it proves the patients are getting back to a high level of sport and therefore they're, they're, they have, uh, a high level of contralateral tears.

The other thing I wanted to point out is we found, uh, I think it was nine to 10% of a re. Um, of a, of a, of a, of a need for necessary of a need for a manipulation and or release in our study. And, and it wasn't different between the two groups. That's important. And [00:45:00] so, you know what I did? I said, Hmm, what, what is different about my out-of-state patients? Because my out-of-state patients, man, they came in here and, and, and they're here for two weeks. And they come in inevitably at two weeks, and they've got 120 degrees of motion. They've got quadras, they're walking. I mean, the one guy, you know, that went viral with a TikTok who was walking without crutches, like literally the same day of surgery.

And I said, what's, what's different about this patient population? Well, you could, you could, you can say several things. One of which is they're here solely focused. On their ACL and they've made a major commitment financially and timewise to come here to have it a hundred percent so that that's a separate population of folks.

Or you could say they just want, they knew that I wouldn't let 'em outta West Virginia until they get their,

Dr. Grant Garcia: I, I don't know. I think, I think both points of, but I would tell you my out state patients in [00:46:00] general have some of the most incredible results. Yes. 'cause it's like. I, it, I kind of, I hate saying the word outta state, like professional athlete, but they're like, they got all the time in the world.

Like they're like, I'm taking off two weeks. I'm flying out there. I don't care what happened. I'm gonna make this look good. And you know, the TikTok guy probably had a lot of motivation for it to look good. He is now exploded on there. He's like, I gotta show on my knee. Right? Like, they're more in, they're, the social media aspect of it is also, and I

Dr. Chad Lavender: think so, so what the point I was gonna make is, so, um, what I started doing is I said, well, maybe my local patients.

Are not going through therapy, uh, as frequent, okay? Mm-hmm. So I went old school and, and got as many CPM machines as I could possibly get, and we leased these to the patients now. And so we retrospectively looked, and I haven't published this, if anybody out there wants to publish it, a medical student or whatever.

Call me, call, you know, I, I don't have time reference Spark stock talks. They know you gave me here. I don't have time to [00:47:00] write up every paper. But, but, uh, anyways, what we found was, you know, that 10% went down to, I think two out of the last a hundred patients. Wow. Yeah. And so you could make a case, you know, the reason CPMs went away is they didn't make long-term differences.

Remember we talked about two year dates. Yeah. But man, for an athlete getting that motion back and not having to have a manipulation. Is everything. And that 10%, um, manipulation need is very similar to I think, nees data a after quads, you know, with, with his, uh, I think he presented, uh, it was like seven or 8%.

So I think that's pretty, it's the

Dr. Grant Garcia: most common surgery I do for acls. Yeah. It's the most common second surgery by far. Right. Like this week, last couple weeks I spent half the patients are mine and half somebody else's. Yeah. From an ACL surgery. So it, it, it's. It's no doubt a problem. It's funny, my complex knees, my meniscus transplants, hts, they don't get stiff 'cause I give 'em CCP M right away.

Cole and I, I learned that at Rush, like I'm [00:48:00] super aggressive with the cpm so my bigger surgeries actually get s Ahe less than my acls. Yeah, it's 'cause of what you're saying. I'm like, oh, CPMs old school. Right. And that's not the case.

Dr. Chad Lavender: You were talking about secondary procedures. I wanted to go ahead and tell you I've had about four patients, two of which of which I think were in our trial.

Um, that. I had secondary meniscus tears. Okay. Late, like a year or two out after they played a season and they had major knee injuries tear their meniscus and I go in and they tore their internal brace. And the ACL looks great. Yes. I just had one of, had one of these. See, so it's, we weren't crazy eight years ago, you know what I mean?

Dr. Grant Garcia: I literally just had one two weeks ago, meniscus tear, internal brace tour. Somehow I forgot to hit the video button 'cause I wanted to show that off on social media. 'cause I was like, this is crazy. It's, I've seen it before, but this was like very obvious. ACL perfect quad, just like you're talking about like.

I wish it was a [00:49:00] fertilized ACL that would've been sicker, but it wasn't. But anyhow, it was, uh, it was pretty cool. Uh, Chad, I want to do your last part 'cause if I don't, we have to get off at an hour. 'cause that social media is not like over an hour. Gotcha. So we got 10 minutes to talk about Nano and if I keep going we could talk to you for like two minutes.

No, we got like

Will Sanchez: five minutes. 'cause we, we need to little football. So can we just, we gotta talk to Chad. We're not interrupt,

Dr. Grant Garcia: we're not trying to cut you off. You're just an amazing guest. But can we talk about the nano really quick for you? Because I know you wanted to bring that up. Yes,

Dr. Chad Lavender: here's the nano needle.

This is live, and, uh, that's what it is. So you might want to go to the slides you have, um, and we can talk about it real quick. Show us. So, yeah, explain

Dr. Grant Garcia: to the patients what's the difference, like why do nano,

Dr. Chad Lavender: okay, so the nano needle is much, I think I sent a slide over, but the nano needle is much smaller.

There you go. It's 2.4 millimeters versus 5.9, or slightly smaller than on a regular sheath. Uh, so you're, you're, you can do it through a really, a needle stick. Um, [00:50:00] really with, it's, it's so much less invasive. You're push pushing less fluid into the joint. Um, and um, you know, I was an early adopter to this back when it was called the nano scope, which was way, you know, it is bulkier now, it's just a needle scope.

They're also getting ready to release hopefully soon. Uh, the Nano Needle 2.0 show that Will, is going to improve resolution greatly. I've had the chance to look at these in the lab. So the old nano I've, I've got video comparing the old nano to the new nano to a regular scope and the new nano that's coming out.

Is very, it's very, very close. It's HD and it's close to a standard scope, and you're just using a needle. And so it's remarkably, uh, more vivid and gives you that great visualization that you need. Um, and so what we're gonna be able to do with that is you're gonna be able to do, um, uh, secondary viewing.

[00:51:00] Like I wrote about this in the book years ago because I knew this was where this was headed. You can park that in a joint, say the shoulder, and it'll give you, and now with the new software, you'll be able to put picture and picture or side by side views and have a standard scope view with a nano needle or multiple nanos, and be able to work almost hands free.

Right. And so that's where I think it's going. Um, but I, I think the nano is, is outstanding. Um, also, so we just finished a randomized control trial with the nano, uh, multicenter showing that it had, uh, 56% less narcotic use in the first 24 hours. Wow. That's huge, right? That's huge. That's huge. This was just for standard neco, partial meniscectomies.

Um, Dr. Arar, uh, who was in Washington, DC was the other site, and we randomized patients. I think we had 70 or 80 patients in that trial. We'll be publishing that. Um, sooner rather than later. I'm not waiting for [00:52:00] two years on that one because we're just gonna, you don't need to. No, it's two, it because two, the two and six week scores were better.

And so that's all we're looking for, right? So I don't, I'm not waiting two years. So we'll get that out there. But, um, we also did a retrospective review and showed the same. So I can tell you with certainty that the nano. Uh, it gives you very similar to better scores and less pain, you know, less narcotic use.

Yeah. Which I think we're all trying to decrease the amount of narcotic need after any surgery. Right. So I think that, that, that has long lasting, that's why I wanted to bring that up. 'cause I think the nano has long lasting ramifications.

Dr. Grant Garcia: Well, and the thought process will always asking what's next, right?

Mm-hmm. Smaller scopes. Tighter spaces and multiple views, right? Like what's gonna make me more? So you have the nano scope, right? Newer technology, maybe a little higher cost with newer technology, but like it comes at a price, right? Faster or time? Can you get two? Two. So you're not having someone [00:53:00] hold the scope, moving around.

You're trying to play the game like sideways, upside down. What are they looking? Right now you've got multiple views and can you do your surgery more efficiently? Right. You said a 35 minute rotator cuff. Can you do it in 20 'cause you're not spending so much time transferring portals.

Dr. Chad Lavender: Yeah. And safer. So I'll put it in the back of the knee when I'm doing a PCL.

Yes,

Dr. Grant Garcia: this is

Will Sanchez: huge.

Dr. Chad Lavender: It's direct visualization so I can tell a patient I'm gonna be watching while we're drilling your tunnel right next to the vessel. You know, I mean, so we have, we put all those techniques in the book years ago, and now I think people are actually gonna start adopting them when the, when the visualization becomes hd, you know?

But, uh, but. Yeah, it's been fun, man. You know, I, uh, I've had a lot of fun doing these innovative techniques and learning. Um, and I, I will say to any younger surgeons out there, um, or residents, uh, research makes you learn and question more each day. You know, you, you find [00:54:00] answers. But for every answer you find, it seems like you asked 10 more questions.

So

Dr. Grant Garcia: Well, and I would also say what's interesting is you, you know, you went from a small town team, doctor, now Marshall, people are flying in for your surgery. Right? You've, you've now had this sort of fame of your innovation and that adds another layer too, right? You did all this work and all of a sudden now you get on a podium for Arthrex or for some other company, and you're, and you're up there and you're talking.

Now you got a thousand surgeons and you know, the first time you're bringing this up, it's no joke, right? It's not, it's no longer you're just in this small little facility or small area talking like this. People are listening, right? You know, you're on this podcast, you're on other podcasts. Like you, you've got a presence, so you've also gotta back it up too.

You've had a lot of, like, a lot of P practice.

Dr. Chad Lavender: It's been a lot of fun. You know, I can remember when we had, uh, we had an article one day. Um, you know, life has a way of just completely, I, I will say this, completely humbling you. But, um, you know, uh, we [00:55:00] had, I can remember one day the, the sporting news article hit and I thought, I knew it was coming out sometime soon and, and, you know, and I thought, man, this is gonna be awesome.

And then it hits and like. My day was the same as every other day of my life. You know what I mean? And it was just like, okay, onto the next day. You know, what's the next, what's the next? But, but it's taken us all over the country. I mean, I've been all over the country doing, um, education and, and talks and, and really have, I've met some fascinating people across this country.

Um, surgeons, patients, um, and really talented individuals across all, like from, from all walks of life. You know, you just, it's, it's, it's really remarkable. And, um, so yeah, I think, I think that there's that small town appeal of the story. Uh, but, you know, um, it's been a lot of fun and I think, um, you know, I will always say, you know, Keith, the main thing, the main thing, and that's, that's patient care, and [00:56:00] that's, that's what we, that's what we're trying to improve the patient experience and their outcome.

Dr. Grant Garcia: hundred percent. Well, Chad, this has been awesome. I know Will has some will. You're, you're, no, we're just gonna wrap it up. You're ready to go? You have a few minutes.

Will only,

Will Sanchez: no, no. We're just gonna wrap it up. Um, uh, once again, uh, Dr. Lavender, thank you for, uh, taking so much time. I know you're excited you brought back Coach, uh, rich Rodriguez, are you excited about your mountaineer?

Dr. Chad Lavender: We got a

Will Sanchez: Woo,

Dr. Chad Lavender: really excited there. What's going on with that? I play, I played for, um, I played for Rich Rod. Yeah. And then also Marshall's new coach, Tony Gibson was on that staff. So both coaches in state, you know, I played for at WU and I was down. My son, he's like a, he's nine. And um, he was down at Gibson's camp and I got to talk to him and I was saying, man, life comes full circle, you know, that's great.

I mean, here you are here. And uh, but what was funny is he called, he told me, he said. I never dreamed my first day [00:57:00] here, uh, at Marshall. I get called about somebody wanting to get in to see you for an ACL.

Dr. Grant Garcia: So

Dr. Chad Lavender: he,

Dr. Grant Garcia: he told me

Dr. Chad Lavender: that story, dude, you're,

Dr. Grant Garcia: you're doing the hometown of awesomeness. That is so fun.

Will Sanchez: That, that is great, man. We, we, we we're getting excited about that football season here. Yeah. We're excited,

Dr. Chad Lavender: we're excited at Marshall and WVU, you know, with two new coaches, so we're excited with both of 'em. So, uh, you, you got your tickets, you're gonna go, uh

Will Sanchez: oh. Yeah. Okay. I knew that. I knew that Dr.

Lavender, thank you so much for your time. We really appreciate it. This was absolutely wonderful. I, I felt like we have so many other things to, to chat about and I mean, we can go on and on.

The good, the good guests

Dr. Grant Garcia: like you, we could go forever. This is like, we're gonna have to have like a 24 hour show sometime at this.

Great. I, these guys are so fun.

Dr. Chad Lavender: And uh, you know, I think the great thing is, I don't know how many years ago we were on together, but, um. We have a lot more to talk about this time. So, you know, that's, that's a good thing, right, guys? Always, always. It is a good

Dr. Grant Garcia: thing. You're doing good work. So thank you, Chad.

I really appreciate it.

Will Sanchez: Thank you [00:58:00] guys. Dr. Chad Lavender. Thank you so much. Thank you for your time, Dr. Garcia. Say goodbye. Bye-bye. Thank you. Bye.

Audio Transcript

Dr. Grant Garcia:, you, you see how that just kind of flows outta my mouth at this point? Dude, you're getting better each time. You are our specialist and top doctor, but enough with the accolades 'cause you don't need any more hyped up.

Uh, we've got a great show. We have a topic that, um, it's really concerning, really interesting. So I'm really looking forward to, uh, discussing it. But before we do all of that, we're talking about injuries. That means that we need to talk about the recovery shop. Let's give a shout out to Mike B and tell everybody why you love the recovery shop.

Dr. Grant Garcia:: Well, big thanks to our sponsors. They've been our sponsors for a long time now, man, it's been at least [00:01:00] a year or more. Uh, no, we've been, yeah, I appreciate it. So, any else? So the idea is if you're a surgeon, you're taking care of the injuries we're gonna talk about today, right? These patients get a lot of swelling afterwards.

They ask for, what else can I do? It's not just the standard medicines you can give them, there's other options for them. Supplements, nice machines, more advanced recovery systems. And so we have those there at the recovery shop. And as a surgeon, you can have your own specified section, which is really pretty cool.

'cause you know, patients can use it for non-surgical injuries, surgical injuries, whatever they want. It all kind of comes in one package and the nice thing gets vetted by the surgeons. You can vet, we own products with them on things that are, you know, DME approved, et cetera. So it's pretty awesome. So reach out to Mike b.

I've been super happy with it. I have patients all the time calling me, even non-patients, asking, Hey, can I get something your got? I'm? Yeah, no.

Will Sanchez: The reason we wanted to do the show, um, was because of this injury and I was watching the Match Live and we're talking about Gregor [00:02:00] Demerol's, uh, Wimbledon exit, uh, as he was up two games or two sets.

To none on the number one player on of the world, Yannick Sinner, which eventually won Wimbledon. And he was cruising along and I'm watching it and I'm like, man, he's, he's gonna beat this. I think he was, I think they were tied two, two in the third set and playing so well. Um, it, it was absolutely incredible.

And then you see a serve and he kind of grabs his pec a little bit. And then when he goes to serve again, which was an ace. He collapses to the floor. Um, first off, did you see the injury live or did you just go back to the video? You know, as we just decided to discuss exactly what had happened, what's your, your take on this, this?

So

Dr. Grant Garcia:: I didn't see it live. Uh, yeah, probably working, who knows what I was doing, but the, but nonetheless, the, that next day in the operating room, my tech was coming up to [00:03:00] me and my PA was like, Hey man, did you see what happened? It was crazy. It's really unusual for tennis and again. We hear about it in some of football players, right?

But to see it, you know, happen on real time and a tennis player is very unusual.

Will Sanchez: Yeah, there's picture there. If you're watching, uh, on YouTube, he is reaching for that right pec, and when I first saw it, I thought it was just some kind of like, yeah, maybe a muscle injury, a pull. You know, they're, they're, they're swinging so hard, right?

You look at 135 miles an hour, 118, you know, return serves at, you know, 87 miles per hour. Every swing, forehand, backhand, just, you know, it's, it's at the highest level, right? We're talking about the best athletes in the world. Why don't we talk a little bit about what this injury is and how it will affect, uh, g Gregor going forward?

Dr. Grant Garcia:: Yeah. [00:04:00] So why don't you pull up the slide. Uh, you wanna put that slide, that one Perfect. Yeah. Pull that slide up. So, uh, he had a pec tendon tear and I know we put downward partials 'cause you know, they're not always fully torn off, but you have a lot of issues with the lower part of the pec. You can see right there.

So there the peck has two heads. There's a particular head and the sternal head. Um, and sometimes you can get a partial tear and a lot of times the challenge here is as soon as it's hard to see exactly what type of tear they had. But a lot of times it's from, you know, getting caught on a tree. I've had caught on a tree.

You've had wrestlers, you have bodybuilders, you have football players. A lot less common in throwing sports and tennis. This is actually one of the first professional athletes I've seen with a pec tear that was a tennis player. So it's quite unusual, but that massive force caulking back. Basically what that tendon does is it gives you that nice cont where we all know about, you know, pecs Yeah.

And pec flex. Um, but it usually pops off of where the humerus is, so there's a little tendon. The misnomer though is that it's apec tendon tear. 'cause usually the tendon is so [00:05:00] thin and the tendon's so short that you pretty much never have tendon left on it. It's very unusual. It's usually something we call a myo tenus junction tear, where it tears where the muscle and the tendon connect together.

What's interesting though, as you guys see on the picture there, on the top right, that's the muscle, but underneath that is something called a fascia. So you've probably seen, like when you're cutting meat, you have got that thin white stuff in between. That's kind of hard and tough.

Will Sanchez: Yep.

Dr. Grant Garcia:: When you're cutting the steak, that's exactly what that is.

So that fascia that gets ripped off, it's a lot harder to fix, but that's the ones we want to have. Get the, get the fascia on there, plus the tendon and that pec, but it's such a big muscle, it balls up and you can really see a lot of deformity. So he was clutching the area that he tore it on. Um, the problem is sometimes it depends on what type of tear you have.

Now, his was something, you know, he had surgery. Like be successful. Obviously the tear that was repairable. Sometimes though you can tear it in the middle of the muscle and those are not fixable, but it's a different look. So it's a little bit tricky 'cause these are kind of hard to see on MR mri. Like no matter how much people say they look at these [00:06:00] MRIs, they know exactly what they're looking at.

These MRIs are a little challenging to read compared to my, you know, rotator cuff tears, shoulder dislocations, acls, you name it. Uh, they can be more challenging. And obviously this is a time dependent thing, which we can get into in a second.

Will Sanchez: Yeah. Yeah. Um, so I, I wanna go back to what you said. You said if it's in the middle, it's unrepairable.

Why can you explain that? Because, you know, that was Yeah. So the key that you mentioned there.

Dr. Grant Garcia:: Yeah. So it can attach to the humerus, which is around the biceps area, and that's where there's tendon attached. It attach it to the chest wall on the inside, right? That's when people have their pecs. They, you can see it flexes all the way to the middle of their sternum, and so if it tears off there, the good news about those is they usually heal a lot faster and they usually get the contra back.

The problem is if they tear the other one. That's where the power comes from with this muscle. 'cause the muscle is so big like this. Yeah. And then it weaves down into some tiny little bit of a tendon and the muscle attachment. So that's usually the weaker point. And that's the, the, [00:07:00] the way it happens is usually the last four to five inches of the bench press, that's almost always where it happens.

Or an abrupt check, or from what he had is that tennis serve. But these linemen that have gotten, you know, we talking about JJ Watt shortly, but they get caught and then it pulls back. And it pops a tendon. The challenging part here is that, you know, if you don't do a lot of these, I've been in surgeries before when even in training with some good guys that they were, it was challenging to fix sometimes because it gets really distorted in there.

It's not the same as like a biceps tendon. Where it pulls off, you can see the muscle. The te the muscle is like a three dimensional, it's like a u, it's like a circle and it, it folds on itself. So you have to understand the anatomy a little more when you fix these. Plus it's such a powerful muscle, and the time is dependent, right?

Like we can fix bicep tendon tears up three months, but you get past. Six weeks, five weeks, you have to reconstruct this, which is a big problem, right? Like it's not, they just don't do as well if you have to reconstruct it. They, they [00:08:00] have good results, but it's just not the same as if we have a fresh pec tendon repair.

Uh, back to the bone. Right. Anything's always better when it's your own natural anatomy.

Will Sanchez: Yeah. And if you're watching, I, I put, uh, some of the examples between the surgical repair and the non-operative for, for partial tears, a low demand patient. Yeah. Uh, if you could just explain, uh, both options when it becomes a non-operative and how you make that decision.

Yeah. Compared to the surgical repair, which may seem obvious, but still, I would like for your input on that. Yeah.

Dr. Grant Garcia:: So the word partial tear is kind of a misnomer, right? Like a partial tear here, he partially, he didn't tear off both heads. So usually you still have the sternal head. Yeah.

So he pulls off the sternal head and then he keeps the clavicular head.

And then the thing is that basically that's a partial tear, but all the contour and muscle strength is gone. Does that what make sense? Yeah. So that still needs to be fixed. Now. Someone really low demand like. You know, maybe eighties, maybe seventies. They don't really need to do a lot. Yeah, it's a [00:09:00] big surgery 'cause you're pulling that all muscle back.

You gotta make a big incision in the shoulder and pull it back. You wouldn't do it for, but even up to sixties. I've had weightlifters, bodybuilders in their sixties that I've done it on and they've done quite well. It kind of depends on the patient. It's exactly the same thing. It's a custom approach.

Let's say you have that, it pulls off, then you want to fix it. Usually we try to do it in the first six weeks, but I'll be honest with you, I have a guy who's actually, thankfully he's doing well. He was like seven, eight weeks out. I thought it was gonna be super straightforward. I went into the P tendon, I tried to pull it back, and the tendon was about four centimeters too short.

So look at this. That's a lot, right? You gotta fill that with something or you leave him, right? But this is the guy. He's 40 years old and he has, he can't get his, he can't pull his arm in like this total contour loss. Oh. So I remade it with a cadaver tendon. Um, and that, that's a pretty effective cadaver and s

Will Sanchez: scooters and things like that.

They're just trying to, at that point you're connecting.

Dr. Grant Garcia:: Yeah. Well, we'll see that. The audience will see shortly in about six weeks we're gonna post the technique and how I did it. Uh, but the idea is that you basically take this Achilles tendon. [00:10:00] The Achilles is from. The lower part of your ankle, you fan it out and then you weave it into the muscle, which is pretty sick.

And then you sew it in. There's some, there's a little bit of techniques, but on this one, you're gonna love it. 'cause I added an internal brace, which has not been out published yet. So that is a pretty cool con. I knew it. I knew it. So the cool part about this is, it's amazing. He came back at eight weeks and he looked like JJ Wall, not the same size, but the same outcome.

I mean, literally killing it. So. I wonder if that had some level to do with it. But the idea is that basically now we're using these, as long as we can fix the brace from one side to the other side, we're adding these fiber tapes, internal braces, uh, to patients. So I'm finding any ways I can do it. So, you know, they got the graft, they have the graft tendon integrase, and now they also into the bone, have this internal brace.

Will Sanchez: Um, you brought up JJ Watt and I remember when he tore his pack and you know, over here it says that, you know, it's supposed to be out four to six months, but he was back in [00:11:00] 10 weeks. And for the football fans, they remember he wore that big, bulky black. You know, restraint on his arm that went all the way down and he pretty much, I think he played with it for the rest of his career, I think at that point.

Yes. He kind of kept that on. So let, let's talk, it's twofold. The question one, what did they do for him to get back so fast? And then two and two. Why? Why should he, you know, especially playing football, keep that protected for the rest of his career? Is it something that at that point it would've been vulnerable?

Yeah. Due to age sport or maybe the procedure itself in order for him to get back fast.

Dr. Grant Garcia:: So let me make the caveat that you have now hosed me for any of my pet tendon repair patients, because I used to think that not as many people were listening to this, but I've had multiple patients ask me, they're like, you said on your podcast that this is the way it is.

So just so everybody here, there's a disclaimer here. This is [00:12:00] JJ Watt, a professional athlete with millions of dollars on the line and the playoffs. This is a different level. If he had torn it like his other, uh, Whitney Marcellus, who was also on the team. Yeah. If he had torn it at the end of the season, they would've taken him out for the entire recovery period. Right. So that's, that's a first caveat.

Will Sanchez: Six months to six months. Correct.

Dr. Grant Garcia:: Yeah. I'm sure they did some crazy stuff during his surgery. I'm sure they repaired it. And I used to work with some of the guys that did a lot of the football players and whatever they did. They might have added something, addition.

So if they got an acute repair, which is what they did. For, for our, for, uh, Gregor, they got to him so quickly, like, you know, my average time to see these is three to four weeks, just 'cause you gotta wait to see the doctor and get an MRI and everything else. But if you're on the field and they tear, they can fix it right away.

You can get a really good fixation right away, but I bet you with him, they added something else too, right? Did they add a patch? Did they add some extra stuff in there that, you know, not always the best case scenario, [00:13:00] but in this case helps him back it up. But at the same point, you know, if he's not. I mean, grappling is good, but if he's got this so solid restraint, he's really not using his arm.

He just needs to use it as like a peg.

Will Sanchez: Yeah, yeah,

Dr. Grant Garcia:: yeah. Right. So when I let him play. I can't say that I feel comfortable enough to let my a player play at 10 weeks after a massive injury like this, but again, I am Will Sanchez: was defensive player of the year. Also, as they're making a run, they gave them all this money.

Like yeah, we, we've talked about, we don't know

Dr. Grant Garcia:: what the contract was though either. So the answer is that that's really impressive. We know they continue to prove it. Right. We've always said like, some of these players get back faster, but the, the, the part of it that's important for people to understand is that the average time.

For this is like a six month recovery, right? The average time is six month recovery. That is what you should expect if you're getting this surgery. He is an outstanding one. Now I know there's been other players that have been in like the 10 to 11 week recovery, but you need to understand again that this is, there is [00:14:00] different constraints on the line here, so this is what the point, pardon?

You got this sort of immobilization phase four weeks, then you start working on gentle motion. 'cause remember this muscle's so massive. So strong in many of the players and patients that we take care of, you know, no offense, but the little old ladies are not popping their pecs.

Will Sanchez: Yeah, yeah, right.

Dr. Grant Garcia:: The guy I just saw today that I need to fix his pec tear, he's 280 pounds and he moves stones, right?

Like this is not you. This is not something that these people are not weak liens that are hearing something. So there's massive muscles and massive strength you need here, right? They're bodybuilders, they're high level weightlifters, they're football players. They're very. High intensity laborers, right?

This is, or there are massive injuries where they hit a tree or something, so you're progressively letting this muscle sort of scar down, and then you start the motion, usually four to six weeks, then they start moving their arm and strengthening, and really six months is that sort of return to sport, four to six months?

It depends on the athlete. Depends on the, on how they're doing and [00:15:00] what they have to get back to. It also depends on getting emotion back the

Will Sanchez: sport. Right? I mean, I would think for, uh, for Gregor, that has to swing his arm, right? His, his tennis season is completely done. He won't be back in time for us open.

Yeah. The next time that he plays maybe is AAU Australia, or if not, maybe waiting to Wimbledon. Well, let's, but let's

Dr. Grant Garcia:: talk about what I think might happen to him, because if he doesn't get a perfect repair. That whip that he does that in, we call that like that's the internal rotation where you're like belly pressing.

Mm-hmm. And you're pushing in, that's his pec. His pec allows him to whip it around that fast. Does that make sense? Yeah. Yeah. It's his rotator cuff, but really the pec is what's pulling on it. And it, as it as it, it's, yeah. It's like basically launching that arm forward. So the concern we have here, right, is he gonna be the same in terms of his, his serve speed

Will Sanchez: 30?

He's probably gonna have a

Dr. Grant Garcia:: lot of it.

Will Sanchez: 34 years old. Doctor, I just wanna add that as you're speaking.

Dr. Grant Garcia:: No, and I, I think that's important. And I think, [00:16:00] you know, modern medicine, we've talked about this, I'm sure maybe the, maybe they added an internal brace to 'em, maybe they added some graft, maybe they did all these fancy things.

And the recoveries are quite good. I mean, usually we can get them relatively symmetric. We can get really good results with these, and my patients tend to do quite well with this. So it's not like it's something that's like, you know, incredibly poor results and people don't do well, but. It's you. The data shows you will lose power, right?

You lose some bench press power no matter what. Talk show you look at. This is not something we're like, we've looked at this return report. It's actually on one of these papers for p and the, the bench press max decreased on the injured side, no matter how much we try to do. So again, we know this are papers, they're not perfect.

It's an average. So there's always someone that's above and there's always someone that's below. So it's important to have that in understanding of this. Now, again, there are young pec tears, the 20 fives, thirties high level athletes like this.

Will Sanchez: Yeah.

Dr. Grant Garcia:: They're a different animal than the [00:17:00] 50 to 60-year-old pec tear.

Yeah. So it's just, there is still a difference and the recoveries are faster, but also some of these bacteria get really, really, really stiff. Right. Because you're not moving them and you're trying to get it up. And my biggest thing to turn is can he get his motion back? Because that's his sort of.

Throwing, serving shoulder. I mean, we talked about some baseball players. You stiffen up the shoulder in a baseball player. They're done.

Will Sanchez: Yeah. Yeah. No, that, and that's what I was gonna ask. So, uh, you know, when that injury looked, I mean, he finally sat down right after he felt it the second time, so I'm not sure what the damage was.

Obviously he tore it on the first time when he felt it, and then finished it off on the second one, and then sat down, grabbed the. Himself. I mean, I'm assuming that in that muscle area, by the chest area, by the arm area, that's extremely painful as well, right? From a cough to a move to laying on your side.

Yeah. They hurt everything [00:18:00] that that's going along with it, let alone, because you know, on the graph they were talking about, it was like zero to four weeks. We're just managing and we're managing pain. You know, and, and they, well, and

Dr. Grant Garcia:: he, and he might start earlier, right? Because I mean, there's no way JJ Watt was zero to four weeks if he's that fast at 10 weeks.

No, but I mean, the good news here is there was a recent, there is 2022, there was a study by ggi, uh, at all and 90% return to sport. Now, again, they're not looking at professional tennis players 'cause it's not that common. But here's the caveat, 74% return to pre-injury performance. So it's not a hundred percent.

We know of players. Terrell Suggs is one of them. He just was never the same. Afterwards, like, you know, not everybody comes back at full motion, but again, tennis serving me, me, a little bit less power needed if he's got other muscles and he is that good. But we also talked about this before, that some of these professional athletes, if they lose 5%, they're still elite, right? Like if LeBron James has three body [00:19:00] parts out of four total limbs. It'd probably still be equivalent to maybe some of the average players in the league. Right. So this just, it's a different animal.

Will Sanchez: Uh, two questions. Um, I've seen this scar from the injury in the past. It looked quite big with, in 2025. Has that SHR and down, or is this still something Yeah, 'cause of the, the operation, you're still dealing with that scar.

Dr. Grant Garcia:: It just depends on the. Surgeon approach, et cetera. And obviously as we get better, like I do, I do a fair number of these. So my incision, this is my phone right here. It's about half the size of my iPhone. I'm sorry. It's hard to see the picture. Yeah, but probably like my average size is like five to six centimeters, so it's not terribly big.

They're definitely. We definitely move it over to make it a little more cosmetic. It kind of depends on your approach. You can't go much smaller than that, especially on a big guy. Right? Like he's, the good news here is this is gonna be an easier approach than doing JJ Watt. [00:20:00]

Will Sanchez: Yeah,

Dr. Grant Garcia:: right. Like imagine it's probably half the distance.

Yeah, you gotta go to get in down there to the bone, right? Because he's not a very big guy. He is skinnier. So this is gonna be a pretty straightforward situation and it's acute. So, you know, you get in there and it's gonna basically show itself and you be able to fix it. I mean, it probably would take the surgeon under an hour to do that, which is good.

Obviously the, the surgery's not the big part. It's the recovery. Um, but, you know, this is a good outcome. I mean, this is of some of the, the times we talked about this is a good outcome.

It's just uncommon, especially in most players. I mean, we know JJY is a big deal. We know Dante Hightower, we know, uh, you know, Terrell Suggs, but it's overall not a common thing.

Like if you look up all the number of athletes, there's a handful. It's under 12.

Will Sanchez: Um, silly question, would this be a procedure that you would possibly use, kind of like that lavender effect, uh, to treat it depending on that surgery or is that something We're, we're talking about apples and oranges at this point.

Dr. Grant Garcia:: So [00:21:00] the idea behind biologics is, can you do like amniotic wraps? Mm-hmm. Or anything else to get adhesions, right? Like, 'cause really anything we do, we want it to heal faster. So like, if I could get the tendon to heal to the muscle in two weeks instead of six, then I would start moving them and then they'd go, they would, as soon as, because the, the challenge here is once you fix it, sometimes the patients take forever.

Like some of these patients are so tight 'cause I, I don't want to do a graft on them because a graft in my opinion is it's good, but it's not as good as the actual tendon itself.

Will Sanchez: Yeah. Yeah.

Dr. Grant Garcia:: I put 'em so tight that they're like this when they start and then they stretch out over time. Right. Some people like put 'em loose enough because they're not able to do, they're able, they're, they're fine.

You don't need to stress about it too much. But the ones that are super tight, they take a while to get back. But if I knew that they would be healed right. Faster with biologics, like using some sort of putty, some sort of bar, bone marrow aspect or amniotic thing, we could, the problem you have too though, is you don't wanna increase the risk of infection.

You start throwing on patches and everything else. [00:22:00] Oh, that's good. You don't wanna cause

Will Sanchez: Yep.

Dr. Grant Garcia:: It's different in the knee because the knee is getting flow with fluid. It's much lower risk. But, and also it's, the challenge here is like the outcomes aren't bad, right? Like there's not enough of them. They're kind of rare, like even high volume surges, they do like 5, 5, 10, a year.

Like I remember I saw a study, some guy like 26, I was like, that's incredible, right? It's not that common unless you cover the CrossFit games where they had almost over 20 of them in one event.

Will Sanchez: Wow. Wow. Well, you know, they're, they're, they're moving so much weight and it's so fast. You know, they, it's, it's almost kind of like you tell people when you're working out the gym, like, slow down, take your time.

You're trying not to get injured CrossFit games. You're, you're, you're just moving heavy weight and you're trying to get through it as fast as I'm just telling

Dr. Grant Garcia:: you that surgeon was very busy. Very busy that day.

Will Sanchez: It is like, we got another one. Geez. Um, yeah. Listen, you know, we, we hope for the best obviously as being a tennis player with that type of injury and his age is a little [00:23:00] bit concerning.

I know he's a fan favorite. I know a lot of the tennis players, uh, like him, sinner was really disappointed. This is the. Fifth major in a row that he has sustained an injury that, um, that made him pull out, uh, of the tournament, you know, for various reasons. I think it was one, a couple of them were leg injuries and groin and things like that.

So. Um, you know, maybe the toll of the body with this sport is not ideal. But he's a, he's a great player. He was phenomenal and I thought he was gonna be the number one player when I was watching him. And he, he, he had him right there until he suffered that injury. So, uh, you know, we wish him the best and hopefully he'll get a chance to, uh, play and going into, uh, next year.

So we'll see. Hopefully speed, speedy recovery. All right. Any last thoughts? I know you kind of teased it a little bit, that you're gonna have a video coming out in about six weeks, that's gonna discuss six weeks, all these things. So, uh, we'll, yeah, check it out.

Dr. Grant Garcia:: We'll refer back to this episode and, uh, hope you guys learned a little bit more about this.[00:24:00]

It's a, it's a really interesting injury. And listen, we, we always have this. Sports Talk com. We get guest requests all the time. We're getting them like, geez, like two, two a month now, uh, or more. We get questions from the audience, so let us know if you have any questions about this. We're happy to answer them and always refer to our websites.

Uh, there's tons of information on this, more than you need to know. So,

Will Sanchez: all right. Say goodbye, Dr. Garcia.

Audio Transcript

 00:00:00,160 --> 00:00:00,720
Will Sanchez: Foreign.

 00:00:16,160 --> 00:00:20,800
Welcome to Sports Doc Talk. Do not worry. I am real.

 00:00:20,880 --> 00:00:22,560
This is not AI I.

 00:00:22,560 --> 00:00:25,000
At least I hope maybe. I don't know.

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Dr. Grant Garcia: We never know.

 00:00:26,360 --> 00:00:30,480
Will Sanchez: Yeah, I didn't know if we should do the Terminator music, but I was worried about copyright

 00:00:30,480 --> 00:00:33,240
issues going into this AI discussion.

 00:00:33,480 --> 00:00:36,440
Anyway, I digress, as I usually do. Dr.

 00:00:36,440 --> 00:00:38,680
Garcia, welcome to the show.

 00:00:39,800 --> 00:00:42,840
He's our orthopedic surgeon, sports medicine specialist.

 00:00:42,920 --> 00:00:53,490
Before we get started, once again, sorry to do this to you. You're named top doctor. Once again. Congratulations.

 00:00:53,730 --> 00:00:55,530
I mean, you have a lot of accolades.

 00:00:55,530 --> 00:00:59,570
You put in a lot of work, you travel, you do your thing. This is not a.

 00:00:59,810 --> 00:01:02,050
A show about, you know, pumping you up.

 00:01:02,050 --> 00:01:07,170
And I didn't tell you about this beforehand, but I want our listeners to know that you're constantly

 00:01:07,170 --> 00:01:13,050
getting recognized, not only in your state, but nationwide, how talented you are.

 00:01:13,050 --> 00:01:16,690
So I just want to say congratulations before we get into real conversation here.

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Dr. Grant Garcia: I definitely blindsided by this, but I appreciate it. Thank you so much. Yeah, no, it's.

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It's a really nice honor.

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And, yeah, we take good care of patients.

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And this stuff's the fun part.

 00:01:27,050 --> 00:01:30,290
We get to talk about the random stuff and chill podcast mode.

 00:01:30,290 --> 00:01:31,130
I get to wear my hat.

 00:01:31,130 --> 00:01:36,010
About to go in the sun after this. Nice, relaxed, casual. So this is the.

 00:01:36,010 --> 00:01:37,290
This is the fun part for me.

 00:01:37,290 --> 00:01:43,450
And then in the office, you know, we make sure we take care of the serious issues. But no, as. Yeah, I appreciate it. No, it's been fun.

 00:01:44,040 --> 00:01:49,760
Will Sanchez: All right, let's give a quick shout out to our friends at the recovery shop. Dr. Garcia, take it away.

 00:01:49,760 --> 00:01:54,920
And just let everybody know why the recovery shop is number one on your list when it comes to recovery.

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Dr. Grant Garcia: I mean, I think the biggest thing for me is it's a busy day.

 00:01:58,080 --> 00:02:00,240
You're scheduling patients for surgery.

 00:02:00,240 --> 00:02:04,360
You're trying to make sure everybody's on time, give them their time, and then, you know, the

 00:02:04,360 --> 00:02:07,400
patient gets through the whole surgical conversation about schedule for surgery, and they're

 00:02:07,400 --> 00:02:08,760
like, what else can I do, right?

 00:02:08,760 --> 00:02:10,700
How do I make my thing better?

 00:02:10,860 --> 00:02:13,860
So this allows me to say, hey, listen, I trust this recovery shop.

 00:02:13,860 --> 00:02:14,700
I work with a lot.

 00:02:15,020 --> 00:02:19,260
We've handpicked some things from there, and so the patients afterwards can sort of have a potpourri

 00:02:19,740 --> 00:02:23,980
or a sort of catalog of what they want to get after surgery, of things that I would recommend

 00:02:24,540 --> 00:02:27,500
anywhere from recovery, the nice machine, to nutrition.

 00:02:27,500 --> 00:02:32,700
We've talked about this with two of the least the players on there and, you know, many other different things.

 00:02:32,700 --> 00:02:35,590
And if there's something that they want we can get it for them, which is really nice.

 00:02:35,740 --> 00:02:37,180
So it's all kind of one stop shop.

 00:02:37,260 --> 00:02:38,380
It's great for the patients.

 00:02:38,380 --> 00:02:43,820
Patients have loved it, had a lot of good reviews and for the doctors, you really should be

 00:02:43,820 --> 00:02:46,380
doing this or having something like this for your patients because the patients are going to

 00:02:46,380 --> 00:02:50,700
ask for more and so to be able to give this to them, it makes them feel and a lot of it data

 00:02:50,700 --> 00:02:59,660
driven that you can get people back with better outcomes as well. So it's been great. So contact Mike B. He's awesome. Yeah.

 00:02:59,740 --> 00:03:02,380
And maybe there'll be AI for that soon too. Who knows?

 00:03:02,800 --> 00:03:07,880
Will Sanchez: Who, who knows? You know, let's kind of get into that and we, we utilize an AI.

 00:03:07,880 --> 00:03:16,080
And what's amazing is that we've only had access to AI as far as common folk for a very short

 00:03:16,080 --> 00:03:20,080
time and it is booming in every aspect of our lives.

 00:03:20,880 --> 00:03:26,720
I'm, I do events, I do a bunch of different types of events in person hybrids, things like that.

 00:03:27,120 --> 00:03:28,800
I do a lot of work for Microsoft.

 00:03:29,730 --> 00:03:37,410
Constantly using AIs, constantly being part of conversations with AIs, senior leadership teams talking about AI.

 00:03:37,570 --> 00:03:39,490
I utilize it in my everyday life.

 00:03:39,890 --> 00:03:43,810
This boom of AI that's happening across the world.

 00:03:44,210 --> 00:03:49,090
How are you seeing that effect not only your everyday, but at work as well?

 00:03:50,210 --> 00:03:55,650
Dr. Grant Garcia: I mean it's not only from when I get home and open the news talk about AI, but you know, obviously

 00:03:55,650 --> 00:03:58,130
chat GPT everybody knows about and now everything's great.

 00:03:58,130 --> 00:04:02,870
Yet like, you know, the idea is that chat GPT in the next few years will be the new Google search terms. Right.

 00:04:02,870 --> 00:04:03,990
So no one's using that anymore.

 00:04:03,990 --> 00:04:08,670
My wife basically uses ChatGPT on her phone to figure out if she has questions rather than googling it. Right.

 00:04:08,670 --> 00:04:13,670
It's chat GPT in it, so it's here to stay and it's moving its way.

 00:04:13,670 --> 00:04:18,550
I think, I think the biggest thing for me is the goal is here is to make our jobs easier.

 00:04:18,550 --> 00:04:24,870
I think the concern, and we can jump to this in a second is for patients, is that, is it, is it a takeover? Right?

 00:04:24,870 --> 00:04:29,090
Like is this artificial intelligence from the movies where all of a sudden you have robots doing

 00:04:29,090 --> 00:04:32,210
everything for you and you never really see a human. Right.

 00:04:32,210 --> 00:04:36,410
There are certain aspects that there may be that case, but there's certain aspects where really

 00:04:36,410 --> 00:04:38,130
it's going to enhance the care that you're getting.

 00:04:38,290 --> 00:04:42,170
And that's what we're here to talk about today is really help the patients understand from the

 00:04:42,170 --> 00:04:44,970
sports and from the medicine side of things, where is AI?

 00:04:44,970 --> 00:04:49,170
Because I've been seeing way too many articles about this and they each touch on little tiny topics.

 00:04:49,330 --> 00:04:51,770
And patients are constantly asking me like, what's the future?

 00:04:51,770 --> 00:04:56,320
Well, this is the future, but this is a broad future. Right.

 00:04:56,640 --> 00:05:01,120
And I think again, the misnomer is this is version 2.0 of medical care.

 00:05:01,360 --> 00:05:04,000
This is not a complete flip 180.

 00:05:04,320 --> 00:05:09,959
You're not going to come into the office and see like, you know, you're going to see Dr.

 00:05:09,959 --> 00:05:13,360
Garcia for your knee surgery and you meet a robot, right?

 00:05:13,360 --> 00:05:14,640
Like that's not what's going to happen.

 00:05:15,200 --> 00:05:19,200
What's going to happen is that you're going to make a phone call and it's going to be easier

 00:05:19,200 --> 00:05:20,240
to get in touch with somebody.

 00:05:21,220 --> 00:05:24,020
Simple questions may be answered by some sort of artificial intelligence.

 00:05:24,180 --> 00:05:27,580
More detailed questions will get pinged up faster for you, which means that you're going to get.

 00:05:27,580 --> 00:05:29,460
Because the workforce can only keep up so much.

 00:05:29,700 --> 00:05:31,460
So now everything is going to be smoother for you.

 00:05:31,460 --> 00:05:35,260
You're not even going to know that it's AI and then what's going to happen is when you actually

 00:05:35,260 --> 00:05:40,460
really need to get the in depth stuff, you're going to meet the provider or the doctor or the

 00:05:40,460 --> 00:05:46,060
nurse or the PA and your whole experience could be better rather than, I mean, how many doctor offices have you called?

 00:05:46,060 --> 00:05:48,510
I mean, I would tell you that my doctor office does a really good job.

 00:05:48,510 --> 00:05:54,390
We do our best to get things moving along and we still have delays and people waiting on hold and they're frustrated.

 00:05:54,390 --> 00:05:56,870
Even in my office we're very efficient or private practice.

 00:05:56,870 --> 00:06:02,310
I mean my wife's call for appointments, 45 minutes hour for other providers in different hospital

 00:06:02,310 --> 00:06:06,990
systems on hold, waiting to get in touch with somebody and then delays in calendars and things like that.

 00:06:06,990 --> 00:06:07,950
So that's the whole point.

 00:06:07,950 --> 00:06:12,510
That's what it's going to improve, is improve care for patients, which people, it's hard for

 00:06:12,510 --> 00:06:13,590
them to think about it right now.

 00:06:14,660 --> 00:06:17,100
But let's not get too sidetracked with that.

 00:06:17,100 --> 00:06:21,860
I think really the continued discussion here is that it's, it's going to address everything

 00:06:21,860 --> 00:06:23,380
in all aspects of medicine.

 00:06:23,380 --> 00:06:29,140
And we know this is the future because we don't always talk about investment on this standpoint.

 00:06:29,859 --> 00:06:33,780
But, and we could put this, put this slide first before we get too far into that.

 00:06:38,180 --> 00:06:42,540
So and go one more further, we'll just talk about the investment thing first and then we can

 00:06:42,540 --> 00:06:44,180
pop back over to proceed barriers.

 00:06:45,040 --> 00:06:48,760
So this is a really good graph, but you can see the billions of dollars that are going into this.

 00:06:48,760 --> 00:06:54,760
So when you have companies like venture capital investing in healthcare startups, in AI, and

 00:06:54,760 --> 00:06:56,120
this is like, where they're all going, right?

 00:06:56,120 --> 00:06:58,480
Like, they're like, this is the next big thing, right?

 00:06:58,480 --> 00:06:59,680
You know that you're onto something.

 00:06:59,680 --> 00:07:00,719
You know, this is the future.

 00:07:00,800 --> 00:07:02,920
But it's also, it's good for patients to see this, right?

 00:07:02,920 --> 00:07:04,240
Because this is where the money's going.

 00:07:04,240 --> 00:07:06,480
So this means that this is where the innovation is going to go.

 00:07:06,880 --> 00:07:12,560
As much as we don't want to talk about money on this doctor's podcast, the money drives innovation.

 00:07:13,280 --> 00:07:17,120
None of these companies, it's reality. It's drug companies, too.

 00:07:17,120 --> 00:07:19,840
Like, you don't get these amazing new drugs because they're cheap and free.

 00:07:20,000 --> 00:07:24,160
You get these amazing new drugs because there's a lot of financial gain for the pharmaceutical company.

 00:07:24,320 --> 00:07:26,080
It's the same thing with these implant companies.

 00:07:26,320 --> 00:07:27,720
There's a, there's a financial gain.

 00:07:27,720 --> 00:07:30,800
We want to make patients better, we want to make them get back faster.

 00:07:30,800 --> 00:07:33,840
But there's also a, there's also a monetary aspect of this.

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So it's the same thing.

 00:07:35,000 --> 00:07:36,920
They're in VCs, investing, AI startups.

 00:07:36,920 --> 00:07:39,840
So this is here to stay and this is where the industry is going.

 00:07:39,840 --> 00:07:44,080
I mean, I've gotten calls with financial advisors and talking about, you know, we're really

 00:07:44,080 --> 00:07:48,840
looking at AI as the future, but how can we use it to decrease some of the workforce that we

 00:07:48,840 --> 00:07:51,920
don't need as much and switch over the jobs, not stealing jobs.

 00:07:51,920 --> 00:07:54,120
But now you have AI jobs, right?

 00:07:54,200 --> 00:07:58,600
You're in charge of designing AI programs rather than the AI taking your job.

 00:07:58,840 --> 00:08:01,960
Now, again, I'm not going to go into too much detail with this because obviously I'm not the

 00:08:01,960 --> 00:08:04,440
world's expert on it, but that's what we're seeing.

 00:08:04,900 --> 00:08:09,860
But if you want to go back to that first slide, I think this is really interesting for someone

 00:08:09,940 --> 00:08:12,820
maybe you, for more layman terms, can under, can think about this.

 00:08:12,820 --> 00:08:18,820
There's perceived barriers, right, in healthcare, and the one that you don't see is implementation

 00:08:18,820 --> 00:08:24,500
costs as much as this is going to speed us up, make us better, make us faster and make us stronger.

 00:08:25,140 --> 00:08:26,820
It is not cheap, Right.

 00:08:26,820 --> 00:08:29,900
And everybody's trying to make a buck off this. So you have companies.

 00:08:29,900 --> 00:08:34,500
I mean, I literally opened my LinkedIn yesterday and had six, six AI offers for companies that

 00:08:34,500 --> 00:08:42,820
wanted to AI my revenue, AI my billing, AI this, AI that, and for a small fee, they'll help you implement it, right? Yeah.

 00:08:42,900 --> 00:08:48,060
Or you have the people that are the chat GPTs that are not chat GPT, but they're faking it, right?

 00:08:48,060 --> 00:08:50,740
They're charging you for chatgpt on top of it, right.

 00:08:50,740 --> 00:08:53,020
Like everyone's trying to make a buck off this. So they're expensive.

 00:08:53,020 --> 00:08:57,860
I mean, and as much as AI is just computer, you think it's, it's low cost.

 00:08:58,020 --> 00:09:00,980
There is still a cost to it because people are programming this AI.

 00:09:01,290 --> 00:09:04,650
Maybe at some point you won't need to, but there are still people that have to be involved in

 00:09:04,650 --> 00:09:06,650
this and there's still implementation costs.

 00:09:07,050 --> 00:09:09,650
So that's really important to be aware of.

 00:09:09,650 --> 00:09:12,650
And obviously like you said that here you can see the workflow integration.

 00:09:12,650 --> 00:09:16,810
Like how do you work it in to a doctor's office that has really minimal medical records?

 00:09:16,810 --> 00:09:19,690
Like we have, we have a lot of digital, but some offices are paper.

 00:09:19,690 --> 00:09:23,330
How do you do an AI with a paper office? That's very challenging.

 00:09:23,330 --> 00:09:26,930
You got to start the infrastructure of that in Seattle.

 00:09:26,930 --> 00:09:32,310
It's less, but, but there's still plenty of offices that still do paper with some respect to the other, especially across.

 00:09:32,310 --> 00:09:38,910
Will Sanchez: The country, depending the communities and you know, how old people have been there, what you

 00:09:38,910 --> 00:09:46,150
know, because as most of us, you know, we kind of stay formatted with what we know best. Right.

 00:09:46,150 --> 00:09:48,390
And sometimes we don't proceed with change.

 00:09:49,190 --> 00:09:53,510
Kind of piggybacking on the fact that you're talking about how some offices wouldn't be there.

 00:09:53,590 --> 00:09:54,990
But the big one that I'm.

 00:09:54,990 --> 00:09:59,700
When we're looking at the graphic here, privacy and compliance, right, that to me is the big concern, right?

 00:09:59,700 --> 00:10:02,340
That's, that's going beyond AI.

 00:10:02,340 --> 00:10:07,980
Those are the Facebook conversations and data that's being shared.

 00:10:07,980 --> 00:10:12,260
And so when it comes to concerns, right, those are the big things.

 00:10:12,740 --> 00:10:19,780
Are there certain things that are happening in offices or are we still too early as far as making

 00:10:19,780 --> 00:10:27,070
sure that the privacy and compliance doesn't spill when it comes into AI and how information is being shared.

 00:10:27,950 --> 00:10:31,750
Dr. Grant Garcia: So I think when you think of AI, you think of like, you know, I think the layman person may

 00:10:31,750 --> 00:10:33,590
think like AI, this is a compute.

 00:10:33,590 --> 00:10:38,270
This is a self thinking learning module that we're going to set up.

 00:10:38,270 --> 00:10:40,190
So you really can't put bars on it, right?

 00:10:40,270 --> 00:10:40,630
Will Sanchez: Yeah.

 00:10:40,630 --> 00:10:44,230
Dr. Grant Garcia: But the thought process is this is still a program, it's still designed and then it has its

 00:10:44,230 --> 00:10:45,590
own learning capabilities to it.

 00:10:45,590 --> 00:10:48,830
But it really is, not only is it learning, but it's basically can pull a lot more information

 00:10:48,910 --> 00:10:54,140
from around the world and through the Internet than the average program too can do. Right.

 00:10:54,140 --> 00:10:55,060
It's just not as clunky.

 00:10:55,060 --> 00:10:57,620
It's like the upgraded computer, but much better. Right.

 00:10:57,940 --> 00:11:01,500
And so the, the process here is that, you know, there is HIPAA compliance.

 00:11:01,500 --> 00:11:05,939
We have hipaa, which is where we try to protect people's things. But it's hard, right.

 00:11:06,180 --> 00:11:09,940
Like if you, I think the thought is that basically it's not going to be an exput.

 00:11:09,940 --> 00:11:12,620
Like basically the idea is like it can gather information from you.

 00:11:12,620 --> 00:11:17,100
It's not going to like start sending off your data to other people. But yeah, you're right.

 00:11:17,100 --> 00:11:21,250
I mean if you have, if you design something that can like break through firewalls and it's like,

 00:11:21,250 --> 00:11:22,970
okay, how do I diagnose this patient?

 00:11:23,130 --> 00:11:27,490
Well, the only way this AI knows how to do it is to break into someone's records and take everybody,

 00:11:27,490 --> 00:11:31,530
every patient's ever had that diagnosis, look at all their symptoms and then diagnose your problem

 00:11:31,770 --> 00:11:35,090
that's concerning, so you have to have it.

 00:11:35,090 --> 00:11:35,810
But the problem is too.

 00:11:35,810 --> 00:11:37,530
It's also got to be more of a global thought. Right.

 00:11:37,530 --> 00:11:42,890
So, so we're not there yet, but there's certain implementations that are not really needed for hipaa.

 00:11:43,050 --> 00:11:49,060
Right there you're talking about like making a diagnosis without any provider available, without any other records.

 00:11:49,140 --> 00:11:52,260
But there's enough stuff online that like, you know, it.

 00:11:52,420 --> 00:11:54,060
Much as I hate some of the Dr.

 00:11:54,060 --> 00:11:55,260
Googlers, you know what I mean?

 00:11:55,260 --> 00:11:57,860
If you would come in and they maybe Dr. Jack Gpters.

 00:11:57,940 --> 00:11:58,300
Will Sanchez: Yeah.

 00:11:58,300 --> 00:11:59,180
Dr. Grant Garcia: You know what I'm talking about.

 00:11:59,180 --> 00:11:59,620
Will Sanchez: Yeah.

 00:11:59,780 --> 00:12:02,179
Dr. Grant Garcia: Diagnose themselves on chat GPT.

 00:12:02,500 --> 00:12:06,420
And I have to explain to myself how that may not be exactly right. Right.

 00:12:06,420 --> 00:12:08,140
Some of them are right and sometimes they're not.

 00:12:08,140 --> 00:12:08,780
Will Sanchez: Yeah, yeah.

 00:12:08,780 --> 00:12:15,110
Dr. Grant Garcia: But the, the point being here is that, you know, they, there is some aspect that you have, you

 00:12:15,110 --> 00:12:18,350
can get that innately you don't need to go into somebody's records and get that information.

 00:12:18,430 --> 00:12:22,910
Like if it's, there's enough data and enough textbooks out there that don't have patient information

 00:12:23,070 --> 00:12:26,510
that most of these programs can learn from. So I have low.

 00:12:26,510 --> 00:12:31,630
I don't much concern about it because I feel like it's very stringent and fortunately the medical

 00:12:31,630 --> 00:12:33,390
field's way more stringent than anything else.

 00:12:33,550 --> 00:12:37,440
So basically like, if I want to do something like, it's got to have gone through multiple checks. Right.

 00:12:37,440 --> 00:12:38,720
It's like the pharmaceutical injury.

 00:12:38,720 --> 00:12:42,240
Like you can't just like start putting things out there versus there's a lot of other things

 00:12:42,240 --> 00:12:46,840
which we can, we don't talk about now that are industries where there's no bars, there's no checks and balances.

 00:12:47,080 --> 00:12:48,920
I have tons of checks and balances on me.

 00:12:48,920 --> 00:12:51,200
So there's still always room, as we know.

 00:12:51,200 --> 00:12:52,919
If you look at the news, you've seen it before.

 00:12:52,919 --> 00:12:57,560
There's different ways people can be scrupulous, but it's a lot less likely in medical than is other fields.

 00:12:58,040 --> 00:13:05,720
Will Sanchez: That leads me right into this question between using AI as a diagnostical tool versus a decision making tool. Right.

 00:13:06,040 --> 00:13:12,170
You're still relying on everything that you've learned, all of your experience, maybe peer to

 00:13:12,170 --> 00:13:14,210
peer, how does that compare?

 00:13:14,210 --> 00:13:20,250
Or is that some of the conversations that happens within your office and just, you know, your peers?

 00:13:20,970 --> 00:13:24,450
Dr. Grant Garcia: Yeah. So let's go to that slide on the top clinical uses of AI in 2025.

 00:13:24,450 --> 00:13:27,850
I think that'll be good to go over that one and then we can kind of ping into the doctors.

 00:13:27,850 --> 00:13:31,010
So, yeah, I'd say next slide, because that AIs. Yeah.

 00:13:31,010 --> 00:13:32,170
So this is really good for patients.

 00:13:32,410 --> 00:13:37,900
So when you think of diagnostic tool, it really kind of depends on what you're talking about.

 00:13:37,900 --> 00:13:42,420
So the real use of this has been radiology and medical imaging. Right.

 00:13:42,420 --> 00:13:43,940
Can we use AI to help?

 00:13:44,020 --> 00:13:44,820
Will Sanchez: Why is that?

 00:13:45,780 --> 00:13:52,820
Dr. Grant Garcia: Just to get. Because radiologists are very important, but there is a lot more black and white there.

 00:13:52,820 --> 00:13:54,900
Like, you're not interpreting that picture.

 00:13:54,900 --> 00:13:56,900
They're looking for something on the image. Right.

 00:13:57,060 --> 00:14:02,070
And it's a lot different than, like, you don't have to listen to the patient, calculate the

 00:14:02,070 --> 00:14:04,790
mri, calculate physical exam, and then hopefully use your experience.

 00:14:04,790 --> 00:14:06,630
And then sometimes it's the patient's decision. Right.

 00:14:06,630 --> 00:14:10,670
You'll, like, you get a patient that comes in and they have an ACL tear.

 00:14:10,990 --> 00:14:13,870
The program may just say, you just need to fix it, fix it, fix it, fix it, fix it.

 00:14:13,870 --> 00:14:14,990
Like everything says fix it.

 00:14:14,990 --> 00:14:17,070
But the patient doesn't want that surgery. Right.

 00:14:17,070 --> 00:14:20,870
So how is the AI machine going to back off and say, listen, I got to listen to the patient here.

 00:14:20,870 --> 00:14:21,510
Will Sanchez: Yeah, yeah.

 00:14:21,510 --> 00:14:24,190
Dr. Grant Garcia: Versus in radiology, there's no conversation between the patients.

 00:14:24,950 --> 00:14:29,270
They're maybe talking to the doctor occasionally, but they're all they have is that one thing in front of them. Right.

 00:14:29,270 --> 00:14:32,230
And they have data pieces, maybe the patient's diagnosis.

 00:14:32,470 --> 00:14:34,310
So it's a lot easier to put in the data.

 00:14:34,630 --> 00:14:36,390
And then they can look at patterns. Right.

 00:14:36,870 --> 00:14:41,750
We all use patterns in our brain, but a lot of times my patterns are developed from multiple pieces.

 00:14:41,750 --> 00:14:46,390
It's physical exam, which you can't get from AI until it's actually been done. Does that make sense?

 00:14:46,550 --> 00:14:47,030
Will Sanchez: Yep.

 00:14:47,030 --> 00:14:52,820
Dr. Grant Garcia: And then there's experience. Then there's also conversation with the patient, hearing what they're

 00:14:52,820 --> 00:14:55,860
saying, because sometimes they don't know, like they'll give you exam findings that'll be all off.

 00:14:55,860 --> 00:14:59,140
And you've got to interpret that plus the mri, plus that. Does that make sense?

 00:14:59,140 --> 00:14:59,860
Will Sanchez: Yeah, yeah.

 00:15:00,740 --> 00:15:03,460
Dr. Grant Garcia: It's just a little bit, a little bit more complicated in that sense.

 00:15:03,460 --> 00:15:06,740
Not that radiology is not complicated, but it's pattern recognition.

 00:15:06,820 --> 00:15:08,460
They're very, very good at, these radiologists.

 00:15:08,460 --> 00:15:09,220
I mean you can see.

 00:15:09,220 --> 00:15:11,700
Go to the side before, just really quickly and show this.

 00:15:14,180 --> 00:15:15,220
If you can go by there.

 00:15:15,220 --> 00:15:16,340
I just want to show this for them.

 00:15:16,340 --> 00:15:20,710
I mean, that's AI versus for breast cancer, lung nodules, fractures.

 00:15:20,710 --> 00:15:22,190
I mean, it's very similar.

 00:15:23,870 --> 00:15:24,310
Will Sanchez: Yeah.

 00:15:24,310 --> 00:15:28,630
Dr. Grant Garcia: So it's not like it's, it's not like these, it's not like these radiologists are making mistakes and they're finding it.

 00:15:28,630 --> 00:15:30,910
And this is again, this is certain studies, right?

 00:15:31,150 --> 00:15:34,830
If you look at a thousand studies, some studies will be positive, some studies will be negative.

 00:15:34,830 --> 00:15:40,870
That's the problem with some of these massive problems that we look at, because you can interpret the data either way.

 00:15:40,870 --> 00:15:43,590
You can interpret this data and say, well, they're all higher in the AI.

 00:15:43,590 --> 00:15:44,900
So AI is better than radiology.

 00:15:45,610 --> 00:15:47,170
But like what are they diagnosing? Right?

 00:15:47,170 --> 00:15:49,370
Are they diagnosing non cancerous breast cancers?

 00:15:49,370 --> 00:15:52,330
Dan's gonna see cancerous breast cancers. They're different, right?

 00:15:54,970 --> 00:15:57,210
Yep. Let's be honest right here. Lung nodules.

 00:15:57,210 --> 00:16:01,209
And I look at MRI, saw two MRIs in the last three months that have shown a lung nodule.

 00:16:01,209 --> 00:16:03,210
But they're usually benign, right.

 00:16:03,210 --> 00:16:08,730
So now that person's got like extra aggressive findings that the AI machines like you have a

 00:16:08,730 --> 00:16:10,170
lung nodule and now they're freaking out.

 00:16:10,500 --> 00:16:11,540
Ends up not being a big deal.

 00:16:11,780 --> 00:16:14,820
So we gotta like, we're not there yet and we gotta like interpret that.

 00:16:14,820 --> 00:16:18,420
Like how, you know, when the, when the radiologist sends us the lung nodule thing, they say

 00:16:18,420 --> 00:16:21,340
cannot, you know, not concerning for major cancerous things.

 00:16:21,340 --> 00:16:25,180
But by this criteria, you know, you should look in six months and blah, blah, blah, blah.

 00:16:25,180 --> 00:16:29,940
But maybe the is just gonna be like long nodule, not good. Right. Like you don't know.

 00:16:32,900 --> 00:16:38,420
Will Sanchez: Also a checks and balances, you know, as far as in conjunction. Right.

 00:16:38,990 --> 00:16:46,110
So based on your diagnosis and then checking it with AI, you know, so is that tool being utilized

 00:16:46,590 --> 00:16:49,230
in that manner or in a different manner?

 00:16:49,870 --> 00:16:50,990
Dr. Grant Garcia: I think that's an excellent point.

 00:16:50,990 --> 00:16:54,430
I mean that's really what AI is for us in medicine. It's a conjunctive tool.

 00:16:54,830 --> 00:16:59,950
Like the, the expectation is not that you're going to send this, your images to an AI radiologist.

 00:16:59,950 --> 00:17:05,639
The area is going to scan it, and then they're going to send it back to you and no one will have checked it. Does that make sense?

 00:17:05,719 --> 00:17:08,759
Because I can tell you right now that I would never want my images done like that.

 00:17:09,159 --> 00:17:14,479
But what is going to happen is, let's say the radiologist, like t I had this week, I had a radiology

 00:17:14,479 --> 00:17:19,399
report that was not accurate compared to the mri, but I checked my own and it happens. It's the same way.

 00:17:19,399 --> 00:17:22,759
Someone can check me and they'll say, maybe Garcia is not perfect all the time. We're not perfect.

 00:17:23,159 --> 00:17:27,639
But what's going to happen is the radiologist reads the report and then the AI double checks

 00:17:27,639 --> 00:17:33,380
it, and if it finds a discrepancy, it calls the radiologist before they send it to you. So there's less mistakes. Right.

 00:17:33,380 --> 00:17:36,020
And so that's really what's going to happen. That's where we're going.

 00:17:36,180 --> 00:17:40,820
Or for very simple things, let's say you're in a rural place and you get an MRI and you can't get a radiologist.

 00:17:41,300 --> 00:17:43,020
You don't have a contract or something happened.

 00:17:43,020 --> 00:17:47,780
Or let's say you find a weird tumor and you're in the middle of somewhere and you don't have a.

 00:17:47,780 --> 00:17:51,100
You don't have a contract with a radiologist that knows that specialty well.

 00:17:51,100 --> 00:17:55,300
Now you can use AI to be like, okay, this is what I think it is, and it's a lot cheaper.

 00:17:55,540 --> 00:17:58,490
And then you can send it over to the appropriate people. Right? That's where.

 00:17:58,490 --> 00:17:59,730
That's where we're going to go with that.

 00:18:00,690 --> 00:18:08,610
Will Sanchez: Those interpretations more as a tool than just a straight hand over, say, well, you do it. You know, it's. It's in conjunction.

 00:18:08,770 --> 00:18:10,770
And then how does that benefit you?

 00:18:11,090 --> 00:18:18,730
Or does it at this juncture, as far as planning for surgical procedures or having conversations?

 00:18:18,730 --> 00:18:23,250
Because I'm, I'm assuming that you're having different conversations with different peers, especially

 00:18:23,250 --> 00:18:29,750
when your group, if it comes to something that needs multiple discussions depending on.

 00:18:30,950 --> 00:18:36,310
Dr. Grant Garcia: All right, so we're going down a rabbit hole. So we'll go. That's what I do. No, no, it's great. I love it.

 00:18:36,390 --> 00:18:39,390
But we'll go to this topic and then we'll bounce back because I think we're going to miss some

 00:18:39,390 --> 00:18:40,630
things that people want to hear about.

 00:18:40,630 --> 00:18:43,510
But the idea is guidance, right?

 00:18:43,510 --> 00:18:48,630
So like you get a CT scan, which is a scan you guys all know when we look at X rays, but a lot

 00:18:48,630 --> 00:18:53,150
of them combine so we can look at bones, and it's really good for guidance of Cutting, like

 00:18:53,150 --> 00:18:57,150
bone gutting things or shoulder replacement surgery. Talked about knee replacements.

 00:18:57,710 --> 00:19:02,790
So basically now you get the CT scan. You tell the. You tell and.

 00:19:02,790 --> 00:19:05,910
Or the CT scan tells you what you're going to do. Right.

 00:19:05,910 --> 00:19:07,710
And people were like, well, why would you need to be told?

 00:19:07,710 --> 00:19:09,590
Well, sometimes you can't always figure it out.

 00:19:09,590 --> 00:19:12,110
Or there's some subtleties so they can use more experience.

 00:19:12,190 --> 00:19:17,760
Like, if you're a new surgeon, then you have AI to help you, guide you what to do, and then

 00:19:17,760 --> 00:19:19,120
helps with the surgical plan.

 00:19:19,360 --> 00:19:21,600
Because sometimes that's the hardest part.

 00:19:21,600 --> 00:19:25,120
Like when you start doing osteotomy is like I've talked about before, where you correct the knee.

 00:19:25,120 --> 00:19:25,600
Will Sanchez: Yeah.

 00:19:25,600 --> 00:19:27,240
Dr. Grant Garcia: It's a lot more complicated than it sounds like.

 00:19:27,240 --> 00:19:29,320
The surgery itself is not like the execution.

 00:19:29,320 --> 00:19:33,920
If someone always told me what the right surgery to do every time was, my job would be a lot easier. Right.

 00:19:34,080 --> 00:19:37,400
The whole purpose of coming to my office and getting this special stuff and me being like, you

 00:19:37,400 --> 00:19:41,360
know, even though I do so many of these, I'm not always 100% sure what the right osteotomy is

 00:19:41,360 --> 00:19:42,560
until I get the final scan.

 00:19:43,130 --> 00:19:47,130
And so for me, and that's like, now I've done this for like seven years, and I've done a ton

 00:19:47,130 --> 00:19:50,490
of these and like, super high volume, so it's easier for me because I had the experience.

 00:19:50,890 --> 00:19:54,650
But if you're seeing like one or two of these a year, which is what the common person with a

 00:19:54,650 --> 00:19:58,010
common surgeon sees, like, how are you supposed to have that experience? Right?

 00:19:58,010 --> 00:20:01,090
Like, you can't just ping a friend every time you want to do something and.

 00:20:01,090 --> 00:20:02,010
Or you may not feel comfortable.

 00:20:02,010 --> 00:20:04,730
I mean, we all know that, you know, surgeons are.

 00:20:04,730 --> 00:20:06,330
They ask for help, but not all the time.

 00:20:06,490 --> 00:20:08,090
And some they don't know what they don't know.

 00:20:08,660 --> 00:20:09,660
And so it would be good.

 00:20:09,660 --> 00:20:10,740
It's good to have these programs.

 00:20:10,740 --> 00:20:14,380
That's what these CT programs do is they kind of, hey, this is where I recommend. This I recommend.

 00:20:14,380 --> 00:20:18,220
But even when you get a CT program now, it's not smart enough to say, hey, listen, surgeon,

 00:20:18,220 --> 00:20:20,100
you're not doing the right surgery for this patient.

 00:20:20,100 --> 00:20:21,540
You need to do this surgery instead.

 00:20:21,940 --> 00:20:24,180
And so that's where we're. That's where head is.

 00:20:24,260 --> 00:20:26,180
Those, like those tweeners, right?

 00:20:26,180 --> 00:20:30,980
Like the 10%, 20%, that's more complicated. That's when something.

 00:20:30,980 --> 00:20:35,620
That's when it basically gets bumped up to the AI and AI starts to help out with guidance here.

 00:20:35,960 --> 00:20:39,080
Or when you're doing, like, spine surgeries, like, it's guiding where your Placement is.

 00:20:39,080 --> 00:20:42,040
And says, oh, you're off by 2 millimeters. 2 degrees.

 00:20:42,120 --> 00:20:47,240
Move it 2 more degrees so you don't damage a nerve, right? So that stuff's like. And we're. We're kind of there.

 00:20:47,240 --> 00:20:49,720
We have some guidance, but it's just going to keep getting better.

 00:20:49,960 --> 00:20:54,680
Because I think one thing is, like, we keep saying in conjunction, it's version 2.0, right?

 00:20:54,680 --> 00:20:59,520
Like, I do dictations in my office, and so I do a dragon.

 00:20:59,520 --> 00:21:00,480
You may all know dragon.

 00:21:00,480 --> 00:21:02,200
It's old, it's been around for a while.

 00:21:02,430 --> 00:21:05,070
So basically I say, I tell it what I want it to say and then it spits it out.

 00:21:05,630 --> 00:21:07,710
I can tell you it's not perfect all the time.

 00:21:07,950 --> 00:21:11,790
And despite how fast I talk, it, like, cannot keep up even.

 00:21:11,790 --> 00:21:13,310
What's supposed to be this AI thing.

 00:21:13,630 --> 00:21:14,510
So we're not there yet.

 00:21:14,510 --> 00:21:15,830
So that's the same way with the computer.

 00:21:15,830 --> 00:21:17,830
Like, we need a faster. We know.

 00:21:17,830 --> 00:21:20,510
I was just telling Will, right? We design these backgrounds.

 00:21:20,670 --> 00:21:22,750
Takes like four minutes for it, right?

 00:21:22,750 --> 00:21:27,110
Like, yeah, you don't want your patient, thankfully, for planning purpose, doesn't matter how

 00:21:27,110 --> 00:21:31,000
long it takes, but you don't want your patient, you know, being, like, on the table.

 00:21:31,000 --> 00:21:36,600
And your doctor's using AI and AI is stalling out because it's too much bandwidth, right?

 00:21:36,600 --> 00:21:37,960
And that's not what you have to worry about.

 00:21:38,840 --> 00:21:41,560
Will Sanchez: We're just going to keep that knee open as we try to figure all this out.

 00:21:41,800 --> 00:21:45,520
Are these the conversations you're having, which appears like, what's the most interesting?

 00:21:45,520 --> 00:21:49,120
And I apologize, I'm kind of going sidetrack. What's the mo?

 00:21:49,120 --> 00:21:55,900
Like, the most interesting conversation you've had regarding AI with a peer or peers lately?

 00:21:57,260 --> 00:22:01,460
Dr. Grant Garcia: I think it's like, for me, it's like, how? Well, for what.

 00:22:01,460 --> 00:22:04,820
For what I could use AI for is, like, the complicated surgeries, right?

 00:22:04,820 --> 00:22:06,420
Like, how's it going to plan it for me?

 00:22:06,420 --> 00:22:11,460
Or also for me is like, this is the one thing I think AI is really important for is like, how

 00:22:11,460 --> 00:22:15,380
can I do all the things that I don't want to spend my time doing, like website design?

 00:22:15,380 --> 00:22:18,900
I mean, this sounds bad because it's like, we're not talking about the crazy cool stuff, but,

 00:22:18,900 --> 00:22:20,980
like, AI is literally freed me up.

 00:22:20,980 --> 00:22:22,460
I mean, everyone that says, like, you have.

 00:22:22,460 --> 00:22:26,370
You do too much stuff, like your website, you have your videos, you have your podcast, you do surgeries.

 00:22:26,840 --> 00:22:29,280
But, like, I have to do all this, all this with myself, right?

 00:22:29,280 --> 00:22:33,760
So now I can, like, have my website designed with my company and then spit out a Lot of information

 00:22:33,760 --> 00:22:36,200
with AI and then check it and then send it up.

 00:22:36,360 --> 00:22:38,640
Or, like, when we're designing this podcast, right?

 00:22:38,640 --> 00:22:42,400
We've had AI help us design this podcast because there's absolutely no way we could do this much research.

 00:22:42,400 --> 00:22:49,040
The amount of research that we were able to get from the AI could take literally, like, 25 hours, 30 hours, right?

 00:22:49,040 --> 00:22:52,520
Like, we're able to get a lot better content to patients. And then.

 00:22:52,520 --> 00:22:56,400
And then when we review it, I'm like, okay, that doesn't seem right. That's not accurate. That's not accurate.

 00:22:56,400 --> 00:22:58,440
That's definitely what I was thinking, you know?

 00:22:58,440 --> 00:23:01,760
And then, like, even making the images, right, like, this image before would have been a copyright

 00:23:01,760 --> 00:23:05,280
infringement, trying to find the right image, right? So it's just.

 00:23:05,280 --> 00:23:06,680
It saves us hours of time.

 00:23:06,680 --> 00:23:11,280
So now what I do is, instead of stressing about the small things, I only focus on, like, doing

 00:23:11,280 --> 00:23:16,720
a good job on surgery, talking to patients, making sure that we do a podcast that's got a ton

 00:23:16,720 --> 00:23:20,900
of content in it, and we're able to focus on that rather than been like, I'm just gassed, man.

 00:23:20,900 --> 00:23:24,140
You know, we spent 20 hours getting this ready. I'm done.

 00:23:24,140 --> 00:23:26,140
Like, I can't even talk about it right now. Like, it's just.

 00:23:26,140 --> 00:23:30,580
It's just all my brain is totally scattered, you know, Even, like, designing projects or research

 00:23:30,580 --> 00:23:32,780
papers or things like that, it helps with guidance.

 00:23:32,780 --> 00:23:35,580
I think of it as, like. Like, if you.

 00:23:35,580 --> 00:23:38,820
You get writer's block or something, and it's like, now you don't need to worry about that. Like, your.

 00:23:38,820 --> 00:23:40,820
Your skeleton's made, and then you can design it.

 00:23:41,300 --> 00:23:43,300
Obviously, it's a concern with some of these companies, right?

 00:23:43,300 --> 00:23:46,310
Like, is someone gonna have a whole PowerPoint made by AI?

 00:23:46,710 --> 00:23:49,270
But it's not there yet, at least maybe I don't know how to do it.

 00:23:50,710 --> 00:23:55,310
But I think the thing is, like, even when you ask it to, like, I want this article, make me

 00:23:55,310 --> 00:23:58,230
this article with these citations, it has, like, no idea what it's doing.

 00:23:58,230 --> 00:24:01,270
So it basically, like, it does a good job, and then it starts making up citations.

 00:24:01,430 --> 00:24:03,110
So you gotta be careful, right?

 00:24:03,110 --> 00:24:04,310
Like, what you tell it to do.

 00:24:05,270 --> 00:24:07,350
Will Sanchez: Have you seen anything on your end?

 00:24:07,350 --> 00:24:09,590
And I know you have kind of.

 00:24:10,770 --> 00:24:12,450
This is the surgery that we did.

 00:24:12,610 --> 00:24:18,690
This is kind of what I want to see after week one of the surgery, week two, a month, so on and so forth.

 00:24:18,690 --> 00:24:26,770
Are you utilizing AI as with part of the rehab now, or you incorporating any of that?

 00:24:26,770 --> 00:24:28,850
Or is that something that you know?

 00:24:28,850 --> 00:24:32,290
Or you're just kind of like, hey, this is what I normally do with this process.

 00:24:32,530 --> 00:24:34,930
So I'm sticking to what I know works best.

 00:24:35,820 --> 00:24:38,220
Dr. Grant Garcia: I think we're not there yet, but there are so many wearable devices.

 00:24:38,220 --> 00:24:41,100
I mean I think we're going into the path you want to go, which is great.

 00:24:41,420 --> 00:24:47,500
So I think that AI we're looking at from an, from a sports standpoint, we're looking at a bunch of things, right? Wearable devices.

 00:24:47,500 --> 00:24:50,020
So can we collect data on movement, vital signs?

 00:24:50,020 --> 00:24:52,140
I mean we got AI on my wrist, right.

 00:24:52,140 --> 00:24:54,140
Like, you know, the Apple watches are all smarter.

 00:24:54,460 --> 00:24:56,460
Apple got its huge AI upgrade recently.

 00:24:57,100 --> 00:25:04,060
You know, can we detect if someone's, you know, you're sick or you're not feeling well or you're dehydrated or everything else.

 00:25:04,060 --> 00:25:09,300
But then from the, where it's really the, the money's at is the professional level, right. Or athletes. Right.

 00:25:09,300 --> 00:25:11,940
Because that's where you know, we know these contracts are so expensive.

 00:25:11,940 --> 00:25:17,300
And now with the nil, it's like the college players and the pre high school players and everyone

 00:25:17,300 --> 00:25:18,820
else is making a bunch of cash.

 00:25:19,380 --> 00:25:21,380
So you know, we got to keep them healthy. Right.

 00:25:21,380 --> 00:25:24,540
You know, like the, the, the player has the investment, right?

 00:25:24,540 --> 00:25:29,940
Because now it's really nice too because it's not just the schools looking at your best interests, it's the player.

 00:25:29,940 --> 00:25:32,700
They're like, I want to stay healthy because I've got a five million dollar contract.

 00:25:32,700 --> 00:25:35,500
I'm a freshman in high school or freshman in college.

 00:25:36,860 --> 00:25:39,740
So yeah, I mean we want the, the wearable devices is huge.

 00:25:39,980 --> 00:25:43,140
And then there's like, there's different things like personalized rehab program, right.

 00:25:43,140 --> 00:25:47,620
Like so you know, I tell it, you tell the patient tells it what surgery it had and then it uses

 00:25:47,620 --> 00:25:51,300
like the best doctors around the country, if it somehow finds them and then puts together a

 00:25:51,300 --> 00:25:55,710
PT protocol for you and then it can make adjustments as needed. Right. So that's really good.

 00:25:55,710 --> 00:25:57,310
And like the real time feedback too, right?

 00:25:57,310 --> 00:26:00,430
Like you're doing something like this hurts and the knee and it can adapt it.

 00:26:00,430 --> 00:26:06,070
Now we're not there yet because again the problem with all of this stuff is it's super sexy.

 00:26:06,070 --> 00:26:11,190
But in the, in non professional or college sports it's very hard to do this because it's expensive.

 00:26:11,350 --> 00:26:11,750
Will Sanchez: Yeah.

 00:26:11,750 --> 00:26:17,350
Dr. Grant Garcia: Right. So insurance and so there's, so there's, there's, we have rehab machines like we've talked

 00:26:17,350 --> 00:26:20,230
about the Rebliss and other things, but you can do remote monitoring.

 00:26:21,120 --> 00:26:23,440
Insurance does not pay very much for that.

 00:26:23,440 --> 00:26:26,440
It's a very, very low reimbursement cost.

 00:26:26,440 --> 00:26:30,080
So if you have a machine that's designed not saying that that machine particularly, but if you

 00:26:30,080 --> 00:26:34,480
have a machine and they're like, it's a thousand dollars for that machine program. Right.

 00:26:34,480 --> 00:26:39,360
Or 500 bucks or something, like the insurance will pay like $35.

 00:26:39,680 --> 00:26:45,040
And so like there's just no way that with insurance that these, these fancy devices are going

 00:26:45,040 --> 00:26:48,170
to be paid for because you need to show that they're a huge difference.

 00:26:48,170 --> 00:26:51,450
And even at that, we all know, I mean, I hate to say I don't want to go off on insurance companies

 00:26:51,450 --> 00:26:53,730
on this thing, but like, look at the news.

 00:26:54,370 --> 00:26:56,130
Less care is more for them.

 00:26:56,450 --> 00:27:01,730
So why would they pay for something that's not going to be hugely beneficial unless there's a huge uproar?

 00:27:01,730 --> 00:27:07,410
But rehab is like, this is, is amazing and it's so important for patients, but I feel like it's

 00:27:07,410 --> 00:27:12,890
really neglected, it's very neglected by the insurance companies, this personalized idea.

 00:27:12,890 --> 00:27:17,010
Like they, that's not the way we're going with insurance.

 00:27:17,010 --> 00:27:21,450
And so there may be an uproar, but patients are willing to pay for it on their own, which I think is reasonable.

 00:27:21,450 --> 00:27:24,370
And I think that's, that's, that's unfortunately the way we have to go.

 00:27:25,250 --> 00:27:30,050
Will Sanchez: Yeah, it was interesting when you know, we first started talking about the show and you know,

 00:27:30,050 --> 00:27:35,850
we, we kind of went back and forth and I sent you some stuff on the smart console system and

 00:27:35,850 --> 00:27:41,000
there's a bunch of companies that are using that, you know, and they talk about injury prevention

 00:27:41,000 --> 00:27:48,480
and you know, subtle movements, you know, symmetries and compensations and you know, real world data collection.

 00:27:48,560 --> 00:27:54,879
I my long winded version of getting to a point of the more companies that come out with AI tech,

 00:27:54,879 --> 00:28:00,840
whether it's, you know, smart insole systems or wearable shorts and shirts.

 00:28:00,840 --> 00:28:07,180
We, I believe Gabriel Landscott, which we talked about with the hockey player that had the injury,

 00:28:07,340 --> 00:28:14,380
he was wearing that tech also so his doctors can monitor him and hopefully we get a chance to talk to Dr.

 00:28:14,380 --> 00:28:19,180
Cole and we can have this conversation again when it comes to smart tech and how that's being

 00:28:19,180 --> 00:28:26,300
utilized for rehab as companies develop and there's more of them that are hitting the market,

 00:28:26,460 --> 00:28:33,210
hopefully the price drives down and not so much athletes that will have access to this, but

 00:28:33,210 --> 00:28:40,730
you know, mom and pop and you know, Joe and Jill can also now maybe afford this and we see an

 00:28:41,050 --> 00:28:45,650
uptick in the rehab and monitoring and what that's going to be like.

 00:28:45,650 --> 00:28:46,969
So to me that's exciting.

 00:28:46,969 --> 00:28:54,130
What are your thoughts on that excitement level and where AI can Advance the future when it

 00:28:54,130 --> 00:28:57,370
comes to rehabbing and being beneficial to your patients.

 00:28:58,440 --> 00:29:02,800
Dr. Grant Garcia: Yeah, I mean, I think when the, when the, we keep that slide originally implementation costs.

 00:29:02,800 --> 00:29:08,000
So when implementation costs come down, then it's either affordable for the patients or the

 00:29:08,000 --> 00:29:12,200
doctor's office or which actually is gonna be more important is the rehab office.

 00:29:12,200 --> 00:29:14,680
We already talked about this. So perfect example.

 00:29:14,840 --> 00:29:18,200
Dylan Newcomer, physical therapy for players. Right.

 00:29:18,680 --> 00:29:21,080
They do some insurance and some cash options.

 00:29:21,080 --> 00:29:23,790
So the cash options are obviously the super fancy stuff you saw.

 00:29:23,860 --> 00:29:25,700
And there's just no way insurance would cover that level.

 00:29:26,100 --> 00:29:31,020
And that's okay though, because that's the players usually, and people want to pay for it because they want extra.

 00:29:31,020 --> 00:29:35,140
That's the way that works in the United States and that's just the way it is here, unfortunately,

 00:29:35,140 --> 00:29:36,740
or fortunately, whatever you want to say.

 00:29:37,460 --> 00:29:44,260
But that when that gets cheaper, then more people want to be involved and more people are not left out. Right.

 00:29:44,420 --> 00:29:46,900
But like, health care is also really expensive.

 00:29:46,980 --> 00:29:49,220
Like if you don't have insurance. Right.

 00:29:49,220 --> 00:29:50,500
And you just pay per meal.

 00:29:50,500 --> 00:29:54,000
Most healthy people actually save money not having health care insurance.

 00:29:54,000 --> 00:30:00,280
It's horrible to say that, but like when your premiums are $10,000 a year or $15,000 a year,

 00:30:00,280 --> 00:30:04,000
there's no way a young person is going to spend that much on health care unless they have a major accident.

 00:30:04,080 --> 00:30:04,520
Will Sanchez: Yeah.

 00:30:04,520 --> 00:30:08,840
Dr. Grant Garcia: So like these patients, and a lot of them work for high level companies where they're paying

 00:30:08,840 --> 00:30:09,920
very little for their health care.

 00:30:09,920 --> 00:30:12,960
So they're, they have extra expenditures they want to put towards other things.

 00:30:13,200 --> 00:30:18,520
I mean, we've seen these, these nutrition, we've seen these guys, you know, live forever type of situations.

 00:30:18,520 --> 00:30:23,810
The longevity thing, it's all about that, well, this AI is going to help people get back better.

 00:30:24,610 --> 00:30:28,130
And this, this rehab monitoring, this, the kinematic analysis is the pre.

 00:30:28,450 --> 00:30:29,530
But like, can we reduce.

 00:30:29,530 --> 00:30:34,130
You know, there's a, there's a machine learning for these athletes to find out who's higher risk.

 00:30:34,130 --> 00:30:38,850
I mean, I had two patients today or two patients today and a few this week.

 00:30:39,490 --> 00:30:40,610
The moms came up to me.

 00:30:40,610 --> 00:30:43,890
Obviously there's, there's a kid in there with an ACL tear. Right. And they need surgery.

 00:30:44,210 --> 00:30:46,130
One of them had actually the tore the other knee.

 00:30:46,130 --> 00:30:47,690
I did surgery on one and they tore the other one.

 00:30:47,690 --> 00:30:49,970
It's very, very frustrating and sad to see that.

 00:30:50,410 --> 00:30:51,850
And they ask, is there anything we can do?

 00:30:52,090 --> 00:30:54,050
And the answer is, yeah, you can do all these different things.

 00:30:54,050 --> 00:30:55,890
We can try to do it, it can try to reduce it.

 00:30:55,890 --> 00:31:00,890
We know females that are higher risk, but really like, can we do, you know, can we have an can

 00:31:00,890 --> 00:31:05,930
like the high school or, you know, the high school coach have this kinematic analysis at the

 00:31:05,930 --> 00:31:09,970
beginning of the year for every kid, especially girls and females in soccer, and then say, okay,

 00:31:09,970 --> 00:31:14,730
these three girls are at higher risk because of their kinematic analysis and, or they're at

 00:31:14,730 --> 00:31:15,870
higher risk of ACL tears.

 00:31:17,060 --> 00:31:19,420
And then from that, say, those.

 00:31:19,420 --> 00:31:23,260
Pick those three girls and say, hey, listen, you need to work on this, this and this to try to reduce it.

 00:31:23,260 --> 00:31:27,060
I think we can get it down, but it's just something they have to be continuing to work on.

 00:31:27,620 --> 00:31:31,460
Will Sanchez: Yeah. And I think you brought up an important part of it cost.

 00:31:31,460 --> 00:31:37,380
I mean, you know, we know how high school sports are and we know certain programs are going

 00:31:37,380 --> 00:31:38,820
to be able to afford certain things.

 00:31:38,820 --> 00:31:43,950
And you have other programs that can barely get cleats for kids. So that be.

 00:31:43,950 --> 00:31:45,110
That plays a big part.

 00:31:45,190 --> 00:31:53,310
So hopefully, as you know, the market gets flooded and there's more affordable, available options for them. You know.

 00:31:53,310 --> 00:31:58,310
Any concerns or have you heard any, any feedback from patients that talk about.

 00:31:58,390 --> 00:32:00,470
Well, I'm concerned about privacy.

 00:32:00,790 --> 00:32:03,030
I personally think it's kind of.

 00:32:03,030 --> 00:32:06,910
It doesn't make any sense to me since I feel like they have all our information anyway.

 00:32:06,910 --> 00:32:10,930
If you have a computer, you have a, you have a smartphone, they have all this stuff anyway.

 00:32:11,090 --> 00:32:18,130
But have you had any of that feedback from, from patients or peers when it comes to AI and that

 00:32:18,130 --> 00:32:20,530
data information that's being shared?

 00:32:21,650 --> 00:32:26,610
Dr. Grant Garcia: I haven't. Maybe after this podcast we will. I brought it up. So I haven't.

 00:32:26,610 --> 00:32:28,930
I think, well, I mean, it's. I think it's good.

 00:32:28,930 --> 00:32:32,610
My patients trust me, that I'm doing the right stuff and making sure that if I'm implementing

 00:32:32,610 --> 00:32:38,390
a tool in the office or post surgical or pre surgical, that I vetted it. It's HIPAA compliant. Yeah. Yeah.

 00:32:40,070 --> 00:32:41,430
But I haven't come up.

 00:32:41,430 --> 00:32:45,430
But again, you know, this is the same people that, like, these are generally younger patients.

 00:32:45,590 --> 00:32:51,630
They're on Facebook every day or Instagram getting all of their data tracked, and all of a sudden, like, they moved.

 00:32:51,630 --> 00:32:55,710
You know, it's like, I think we've all become kind of mute to it.

 00:32:55,710 --> 00:32:59,150
There are certain people that are like, you know, they'll do whatever it takes and not have their data.

 00:32:59,150 --> 00:33:00,790
They want privacy, privacy, privacy.

 00:33:01,030 --> 00:33:05,790
But to be honest with you, I think we're so inundated with it and so involved in our lives that

 00:33:05,790 --> 00:33:08,790
we kind of just gave up our privacy, which is sad.

 00:33:09,030 --> 00:33:15,070
Will Sanchez: My daily spam just becomes, you know, delete Report junk and move on. Like, it's just, it's.

 00:33:15,070 --> 00:33:16,470
Dr. Grant Garcia: I mean, medical stuff is scary.

 00:33:17,270 --> 00:33:21,270
A lot more private than like, okay, knowing that I like to watch cooking channel videos.

 00:33:21,750 --> 00:33:23,990
But you know, nonetheless, it's.

 00:33:24,070 --> 00:33:26,710
I think people, people are, they're.

 00:33:26,710 --> 00:33:29,430
People are more open nowadays too, which is good and bad. Right?

 00:33:29,730 --> 00:33:32,570
You know, like, how many times I got to.

 00:33:32,570 --> 00:33:34,090
I work on this myself, I'm not good at this.

 00:33:34,090 --> 00:33:38,930
But a lot of these people, you know, I see like these high level celebrities are like, I just had a massive surgery. Wish me luck.

 00:33:38,930 --> 00:33:41,690
You know, like I, I tore like everything in my knee.

 00:33:41,690 --> 00:33:42,530
I'm going to get surgery.

 00:33:42,530 --> 00:33:48,330
I got, you know, I hadn't recovered from cancer. Look at me, right? It's all great. It's awesome. But like there. People don't.

 00:33:48,330 --> 00:33:50,090
The privacy thing is kind of gone nowadays.

 00:33:50,090 --> 00:33:54,170
I feel like, I feel like it's obviously like if you're these influencers, right, they get hurt

 00:33:54,170 --> 00:33:57,300
and they use it as like the next step to get up to whatever.

 00:33:57,300 --> 00:34:00,940
I don't think it's obviously like a, a bad thing that they're telling all.

 00:34:00,940 --> 00:34:04,220
I think it's really great that they have the guts to go over there and talk about all their

 00:34:04,220 --> 00:34:09,340
medical conditions and feel really good because not all of us do that, but I think or lay out

 00:34:09,340 --> 00:34:11,460
all their laundry and their family and things like that.

 00:34:11,460 --> 00:34:16,220
But at the same point it's, I don't, I don't think it's as different day and age. Right?

 00:34:16,220 --> 00:34:17,580
People used to be a lot more conservative.

 00:34:17,580 --> 00:34:19,380
They used to be a lot more quiet about their stuff.

 00:34:19,460 --> 00:34:23,260
I mean, I, I've seen like nine surgeon speeds where they're just like, they're literally in

 00:34:23,260 --> 00:34:26,340
bed, like about to die and they're like, look at me, I'm about to get surgery.

 00:34:26,780 --> 00:34:30,460
And they're like, they're like, they, it's, it's just, it's just interesting.

 00:34:30,460 --> 00:34:31,900
It's totally different than what they used to do.

 00:34:32,220 --> 00:34:34,460
Will Sanchez: Yeah, I'm more concerned about the cooking shows.

 00:34:34,460 --> 00:34:37,500
Let's go back to the cooking shows that you're apparently watching, man.

 00:34:37,580 --> 00:34:38,780
What, what should go to?

 00:34:38,780 --> 00:34:39,740
Dr. Grant Garcia: Cooking show here.

 00:34:42,619 --> 00:34:46,100
Shout out. This is my new cooking thing. My partner, Dr.

 00:34:46,100 --> 00:34:52,859
Wayne Weil, Seattle hand doc, is a tick tock monster for cooking.

 00:34:53,019 --> 00:34:57,699
And he and his wife, he has a cool kitchen setup where he has the, like, he has like the, the

 00:34:57,699 --> 00:35:00,099
kitchen on the island so you can put a phone right in front of it.

 00:35:00,099 --> 00:35:01,339
Like they're, that's really hard to get.

 00:35:01,339 --> 00:35:02,779
Like my kitchen doesn't have like that.

 00:35:02,779 --> 00:35:03,899
And like it's very hard.

 00:35:04,139 --> 00:35:10,619
And he and his wife Nancy, they do it and fast forward and they cook and they have so many followers.

 00:35:10,699 --> 00:35:14,059
It's so funny too because it's linked to his account for orthopedics.

 00:35:14,059 --> 00:35:15,819
So he has like no orthopedics on there.

 00:35:15,899 --> 00:35:20,380
He just eats and makes food and he is killing it. It is awesome.

 00:35:20,700 --> 00:35:25,660
So we were going to have them on hopefully in the summer or a little bit later to talk about this cooking experience.

 00:35:25,660 --> 00:35:27,420
So that's the only really cooking thing I watch.

 00:35:27,420 --> 00:35:31,620
But I think because I'm friends with them and because I look at it, I think I get other cooking

 00:35:31,620 --> 00:35:33,100
stuff that I'm not interested in.

 00:35:33,660 --> 00:35:35,620
So, you know, I'm a big fitness man.

 00:35:35,620 --> 00:35:41,900
I have like the craziest workouts ever showing up on my stream and that is like the number one thing.

 00:35:41,900 --> 00:35:44,300
It's travel, crazy travel stuff.

 00:35:44,790 --> 00:35:48,150
And the workouts, like workout like exercises.

 00:35:48,150 --> 00:35:49,910
There's like, there's no humanly way I could do that.

 00:35:49,910 --> 00:35:52,070
Like, I'm gonna rip every part of my body apart. Yeah. Yeah.

 00:35:52,070 --> 00:35:53,070
Every once in a while I get one.

 00:35:53,070 --> 00:35:54,230
I'm like, I'm gonna try that one.

 00:35:54,950 --> 00:35:59,430
Will Sanchez: Oh, man. Dr. Weil, by the way, back surgeon. Surgeon.

 00:35:59,510 --> 00:36:02,710
Oh, but tick tock influencer first and foremost.

 00:36:03,430 --> 00:36:03,910
Dr. Grant Garcia: Yes.

 00:36:04,790 --> 00:36:10,030
Will Sanchez: That's hysterical. Real quick. I, like I said, we, we kind of go off the sidetrack, man.

 00:36:10,030 --> 00:36:11,830
What's the, what's the go to workout right now?

 00:36:11,830 --> 00:36:16,390
What, what's the one that you're like, this is my go to. I, I'm loving it. I know, I know.

 00:36:16,390 --> 00:36:17,550
We talked about this before.

 00:36:17,870 --> 00:36:20,110
You like the hit workouts, right?

 00:36:20,110 --> 00:36:21,350
You're a big travel guy.

 00:36:21,350 --> 00:36:24,710
Your itinerary is you, you should be posting itinerary.

 00:36:24,710 --> 00:36:26,190
We had this conversation last time.

 00:36:26,190 --> 00:36:27,110
You haven't done it yet.

 00:36:27,110 --> 00:36:30,190
Dr. Grant Garcia: I know. I'm not ready to crack yet.

 00:36:30,350 --> 00:36:35,870
Will Sanchez: Let's throw it on sports.talk.com we're going to drive all the travelers there and then they'll,

 00:36:35,870 --> 00:36:37,950
by the way, they'll see the shows as well.

 00:36:38,270 --> 00:36:41,800
But what's the, what's the workout right now that you're loving?

 00:36:42,840 --> 00:36:46,360
Dr. Grant Garcia: I mean, I just, I'm all about the hit, right?

 00:36:46,360 --> 00:36:51,480
Like high intensity burpees, box jumps, you know.

 00:36:51,560 --> 00:36:55,120
But again, I don't want to get hurt now because I unfortunately have to take care of all those

 00:36:55,120 --> 00:37:01,960
people that are my age doing hit and like coming in with like the meniscus tear or the ACL tear or whatever.

 00:37:01,960 --> 00:37:06,800
I mean, the CrossFit injury rate's like 78%, right? Like, CrossFit's great.

 00:37:06,800 --> 00:37:08,840
For Ortho, not good for the body.

 00:37:09,160 --> 00:37:11,080
Everyone who does it, they all look incredible.

 00:37:11,480 --> 00:37:13,880
But it's, it's, it's a, it's a scary thing.

 00:37:13,880 --> 00:37:15,400
But I mean I just.

 00:37:15,880 --> 00:37:17,080
For me it's just routine.

 00:37:17,080 --> 00:37:22,480
It's just continue to do it day in and day out and a little bit addicted to it. So obviously that's a.

 00:37:22,480 --> 00:37:23,240
But it's a good thing.

 00:37:23,240 --> 00:37:26,560
It keeps me sane and hopefully it keeps me.

 00:37:26,560 --> 00:37:27,400
The thing is, you got.

 00:37:27,880 --> 00:37:28,880
I think we should bring this up.

 00:37:28,880 --> 00:37:30,360
It's actually we should have this talk, right?

 00:37:30,360 --> 00:37:34,130
This is like surgery is a little bit like athletics.

 00:37:34,450 --> 00:37:42,650
Like my surgery days are so much like pumping, pulling, pushing stuff that like a lot injury rate.

 00:37:42,650 --> 00:37:46,010
Orthopedics is probably one of the highest of any of the surgeries. Right.

 00:37:46,010 --> 00:37:52,730
Like I'm leaning back, cranking my back, turning it sideways, lifting a 250 pound patient, lifting

 00:37:52,730 --> 00:37:56,050
a high level athlete, like six, seven leg. Right.

 00:37:56,050 --> 00:37:58,490
Like I'm doing that during the surgery. Right.

 00:37:58,490 --> 00:38:00,210
Like there's assistance, but I'm doing it.

 00:38:00,320 --> 00:38:00,680
Will Sanchez: You gotta.

 00:38:00,680 --> 00:38:04,240
Dr. Grant Garcia: When I was injured, it was a nightmare because it's so hard to do.

 00:38:04,480 --> 00:38:08,040
So like I've had to stay fit as possible. Right. And you get exhausted.

 00:38:08,040 --> 00:38:12,880
I mean there's some older surgeons that you can hear them like literally like huffing and puffing during the procedures.

 00:38:13,120 --> 00:38:15,680
And we're standing the whole time running around full speed.

 00:38:15,920 --> 00:38:20,240
And also that's not to mention the stress level of actually taking care of the person under

 00:38:20,240 --> 00:38:22,320
anesthesia and doing the complicated procedure.

 00:38:22,640 --> 00:38:27,820
So most orthopedic surgeons, they make a joke because the orthos are always like gym jocks, right?

 00:38:27,820 --> 00:38:29,340
They're in the gym, they're working out.

 00:38:29,340 --> 00:38:29,740
Will Sanchez: Yeah.

 00:38:29,740 --> 00:38:32,380
Dr. Grant Garcia: Like that's the medicine stereotype of orthopedics.

 00:38:32,620 --> 00:38:38,300
But this, the part of it is you actually need to be that fit to be able to do the surgeries

 00:38:38,300 --> 00:38:42,860
effectively because it's because of the grind you're doing all the time for the most part.

 00:38:43,020 --> 00:38:44,220
So like I love this.

 00:38:48,060 --> 00:38:52,700
Will Sanchez: Spartan race. This is like orthopedic surgeon, spartan race.

 00:38:52,780 --> 00:38:58,410
You jump over the, the operating table, you know, you do a couple burpees, you jump in.

 00:38:58,410 --> 00:39:03,530
Dr. Grant Garcia: I've actually been caught. I've been caught in the operating room once I fell over because someone

 00:39:03,530 --> 00:39:06,770
had, someone had took the steps to the sitting still away from me.

 00:39:06,770 --> 00:39:12,570
When I sat down and didn't see it and my tech grabbed me and caught me, it was the most incredible thing I've ever had.

 00:39:12,810 --> 00:39:17,450
It was, it was weird for like 10 seconds, but then it worked out. It was great.

 00:39:19,290 --> 00:39:20,890
Will Sanchez: This is the new, the new race.

 00:39:20,890 --> 00:39:22,530
We're going to be on espn.

 00:39:22,530 --> 00:39:25,630
The Ocho with his new obstacle course.

 00:39:26,110 --> 00:39:28,830
Dr. Grant Garcia: Right next to this. The squirrel in the water, the jet, the.

 00:39:28,830 --> 00:39:30,750
In the little water skis.

 00:39:31,790 --> 00:39:32,710
Will Sanchez: That's hysterical.

 00:39:32,710 --> 00:39:35,950
Dr. Grant Garcia: All right, dude, let's, let's digress back in. So let's go.

 00:39:36,030 --> 00:39:37,950
So we talked a little bit about sports, right?

 00:39:38,270 --> 00:39:41,310
And then for joints, you have these patient specific instrumentation.

 00:39:41,550 --> 00:39:43,870
So you have patient comes in, they get it.

 00:39:43,870 --> 00:39:47,550
The robotic machine, or the machine calculates it and says, this is exactly what you need.

 00:39:47,710 --> 00:39:52,880
Now, obviously the problem here is that like, patient specific is more expensive.

 00:39:53,280 --> 00:39:55,280
So we need to find a way to get that cost down.

 00:39:55,280 --> 00:39:59,520
Can they 3D print those for the same price as a regular implant? Right.

 00:39:59,520 --> 00:40:02,040
And we'll get there eventually. Robotic surgery.

 00:40:02,040 --> 00:40:05,880
This is the, this is the number one thing people want to talk about robotic surgeries.

 00:40:05,880 --> 00:40:12,960
They're worried that like, you get a robot done, it does your surgery, there's no actual surgeon there right now.

 00:40:13,760 --> 00:40:17,920
The way it works is again, there's these rare cases and there's some of the general surgeries

 00:40:17,920 --> 00:40:21,440
that are robotics and they've heard about remote surgeries for like a good surgeon that does

 00:40:21,440 --> 00:40:22,560
the surgery in like another country.

 00:40:22,560 --> 00:40:27,720
And they do it for people with underserved or whatever that's there, but we're not there yet.

 00:40:27,960 --> 00:40:32,280
But like in joint replacement, there's robots that help guide the surgeon.

 00:40:32,280 --> 00:40:35,840
Either newer surgeons, which is you always want to have obviously the highest level of skill

 00:40:35,840 --> 00:40:39,120
when you're doing this, but also helps with alignment and things.

 00:40:39,120 --> 00:40:41,710
There's certain things just hard to calculate on the fly. Right.

 00:40:41,710 --> 00:40:44,990
Like you can do everything you want there, but when you get in there, it's never always the same. Right.

 00:40:44,990 --> 00:40:47,950
Like as soon as you always say, you know, yes, the mechanic, like, what are you going to do in my car?

 00:40:47,950 --> 00:40:49,350
They're like, well, I think I'm gonna do this, this, this.

 00:40:49,350 --> 00:40:50,790
But we'll figure it out when we get in there. Right?

 00:40:50,790 --> 00:40:54,590
Like, there is some things you have to figure out when you're in there and you can't anticipate.

 00:40:54,750 --> 00:40:56,790
That's why our job is what it is.

 00:40:56,790 --> 00:40:58,270
And that's why our job is a little bit stressful.

 00:40:58,270 --> 00:41:06,230
Because I'll go into, you know, I did, I did 15 or 12 surgeries last week, and 10 of them were

 00:41:06,230 --> 00:41:07,500
exactly what I thought they were going to be.

 00:41:07,730 --> 00:41:11,330
And two threw me a curveball regardless of preparation.

 00:41:11,730 --> 00:41:13,970
And two of them were the same surgery they'd done the same week.

 00:41:14,530 --> 00:41:15,610
So you just never know.

 00:41:15,610 --> 00:41:16,690
You've got to be Prepared.

 00:41:16,930 --> 00:41:22,290
And so this robotic surgery is going to help to hopefully eliminate some of that and take away the stress.

 00:41:22,290 --> 00:41:23,890
But also as a stress factor, right?

 00:41:23,890 --> 00:41:30,050
Like, let's say you're doing a replacement, and all of a sudden you start doing it and you're like this. You can't.

 00:41:30,050 --> 00:41:31,570
You've had a really rough day, right?

 00:41:31,570 --> 00:41:33,750
You're doing your best, but you're tired, right?

 00:41:33,750 --> 00:41:39,310
It's the end of the day, your last surgery, and no matter who you are, you're a little gassed, right?

 00:41:39,310 --> 00:41:42,870
So you're trying to get your best to do the surgery right, and you're having trouble calculating.

 00:41:42,870 --> 00:41:44,670
You can't get the exact move fit. Right?

 00:41:44,670 --> 00:41:46,550
But we're all normal human humans, right?

 00:41:46,550 --> 00:41:47,790
And we have to deal with a lot of stress.

 00:41:48,350 --> 00:41:51,550
So the more frustrated you get, the less you start thinking. Right.

 00:41:51,550 --> 00:41:54,910
It's not like you're going to have an error during the surgery, but it's going to take you a

 00:41:54,910 --> 00:41:55,950
little longer than it should.

 00:41:56,270 --> 00:41:59,470
So having these robots to be like, listen, I have no emotion.

 00:41:59,470 --> 00:42:01,440
I'm going to calculate this for you. You're.

 00:42:01,440 --> 00:42:03,200
I can't get tired because I'm in a robot.

 00:42:03,360 --> 00:42:05,680
So they're going to be like, okay, it's 13.4 degrees.

 00:42:05,680 --> 00:42:07,760
And I'm like, oh, thanks, I don't have to do that math.

 00:42:07,760 --> 00:42:09,920
And they're like, you know what? This is not working.

 00:42:10,160 --> 00:42:12,600
When I put the two implants in, it feels tighter.

 00:42:12,600 --> 00:42:15,000
And you're like, you know, you're kind of already gas from the day.

 00:42:15,000 --> 00:42:18,000
And it's like, okay, drop it down 1.25 degrees.

 00:42:18,000 --> 00:42:19,280
Okay, so you can go do that.

 00:42:19,360 --> 00:42:20,440
So that's what I'm talking about.

 00:42:20,440 --> 00:42:23,560
So like a sensor or these are body things. Where do you put.

 00:42:23,560 --> 00:42:24,320
Where do you put it?

 00:42:25,040 --> 00:42:26,880
Yeah, so it can do those things.

 00:42:26,880 --> 00:42:30,320
Like, we have monitors with the pictures up there, so I can calculate in my head.

 00:42:30,320 --> 00:42:33,120
But this robot will be like, no, move your hand to the right a little bit.

 00:42:33,120 --> 00:42:36,400
Move your hand to the left for the really precise part, Right?

 00:42:36,400 --> 00:42:40,640
But then, of course, you know, if the robot's reaming and something starts bleeding, the robot's

 00:42:40,640 --> 00:42:42,200
not going to know what to do. Right?

 00:42:42,200 --> 00:42:43,920
So you do all that. That's the.

 00:42:43,920 --> 00:42:47,200
Then the surgeon steps in, so it's an assistant to help him.

 00:42:47,200 --> 00:42:49,920
And also makes your job a lot less stressful, right? If you have it.

 00:42:49,920 --> 00:42:54,730
I do a lot of planning ahead of time for some of my big surgeries because it makes it way less

 00:42:54,730 --> 00:42:56,690
stressful or it's a lot faster. Right.

 00:42:56,690 --> 00:42:57,730
Like, because I don't have to.

 00:42:57,970 --> 00:43:04,530
These patient specific instrumentation that I use for my osteotomies, it's cut down like 25 minutes of my surgery.

 00:43:05,170 --> 00:43:08,090
So I put it on there, I throw the pins in, I check it.

 00:43:08,090 --> 00:43:09,330
If it looks good, I'm done.

 00:43:09,330 --> 00:43:10,810
Like it's already been done for me.

 00:43:10,810 --> 00:43:15,890
All the hard, all the like, okay, check X ray, check less radiation. All that's done.

 00:43:16,130 --> 00:43:21,410
And so now we, you can get a surgery in half the time, which means less anesthesia, it means

 00:43:21,970 --> 00:43:24,850
less blood loss, Everything's better for the patient.

 00:43:24,850 --> 00:43:28,970
More surgery, as long as it's being used more.

 00:43:28,970 --> 00:43:32,210
And then for, you know, obviously you can do more surgeries and all those other things are important,

 00:43:32,210 --> 00:43:35,970
but the surgeon is also less stress, which makes your whole surgery go better.

 00:43:36,130 --> 00:43:39,690
I mean it's, it's a win win for everybody, honestly.

 00:43:39,690 --> 00:43:40,930
The number one thing is getting cost.

 00:43:41,170 --> 00:43:42,930
Will Sanchez: I like this. I could see it in my head.

 00:43:43,010 --> 00:43:48,400
So you, you kind of put on this, maybe even a helmet or like these meta goggles with a microphone

 00:43:48,400 --> 00:43:51,680
and say, I'm now cutting this part and I'm doing this.

 00:43:51,680 --> 00:43:53,640
And it's talking to you as well.

 00:43:53,640 --> 00:43:57,120
It's like, don't you know, it's 1.2 millimeters and this is that.

 00:43:57,120 --> 00:44:00,400
And then you're talking, you're talking through it.

 00:44:00,400 --> 00:44:02,040
So everyone in the operating room can hear.

 00:44:02,040 --> 00:44:06,000
But also the AI is hearing and is reminding you of the steps.

 00:44:06,000 --> 00:44:12,680
And then you're having this imaging with the goggles to see what you're viewing and assisting you along the way.

 00:44:13,810 --> 00:44:16,170
Dr. Grant Garcia: Yeah, you know, what's that, what was that movie with Jennifer Lopez just came.

 00:44:16,170 --> 00:44:19,810
I was like maybe a year old down the Avatar movie where you were like, they were in the machine

 00:44:19,810 --> 00:44:20,970
and the machine synced with you.

 00:44:20,970 --> 00:44:22,610
It's like the neural link. Yeah, yeah.

 00:44:22,610 --> 00:44:26,250
Like that's kind of like, that's kind of the future where we're going with this. Right?

 00:44:26,250 --> 00:44:30,210
Like you'll come in like there's already a, there's a new company that's coming out, has ac.

 00:44:30,450 --> 00:44:32,450
It can guide where you put your ACL tunnels.

 00:44:32,450 --> 00:44:35,490
So it's for, it's for complex surgeries.

 00:44:35,810 --> 00:44:38,530
Will Sanchez: Are we talking 10 years, two years?

 00:44:38,930 --> 00:44:40,530
Dr. Grant Garcia: I mean, AI avatar thing?

 00:44:40,530 --> 00:44:43,210
We're probably longer away from that, but.

 00:44:43,210 --> 00:44:49,290
Will Sanchez: No, but I mean something kind of like that, that first prototype saying this is the first one.

 00:44:49,290 --> 00:44:52,850
Like this one's been approved and you're kind of going through it as it advanced.

 00:44:52,850 --> 00:44:57,210
Dr. Grant Garcia: I mean, we have, we have like, we have, we have something that's similar to it.

 00:44:57,210 --> 00:45:00,570
So we're getting there again. It's just cost, man.

 00:45:00,570 --> 00:45:04,170
It's super expensive to get this and then you got to get it FDA approved and then you got to

 00:45:04,170 --> 00:45:08,250
get surgeons to buy on and then you need to have these, you know, you have all these hospital

 00:45:08,250 --> 00:45:10,120
systems that are cutting costs, right?

 00:45:10,120 --> 00:45:10,920
They don't want to pay.

 00:45:11,000 --> 00:45:13,640
You know, these spine surgeries are very expensive, right?

 00:45:13,640 --> 00:45:17,480
They're good revenue streams, but they're very expensive. We know this.

 00:45:18,760 --> 00:45:24,000
So these robotic navigation machines are extreme, like multiple millions of dollars, right?

 00:45:24,000 --> 00:45:26,440
And so some hospitals don't want to pay for it.

 00:45:26,520 --> 00:45:28,000
So they're like, no, you can't have it.

 00:45:28,000 --> 00:45:29,240
So the patient doesn't get it.

 00:45:29,240 --> 00:45:31,080
They've got to go find someone that's willing to do it.

 00:45:31,320 --> 00:45:35,720
You know, for small surgery centers, we have a robot because we have multiple surgeons that do the same thing.

 00:45:36,060 --> 00:45:38,460
But it's all part of a cost negotiation with these companies.

 00:45:38,940 --> 00:45:43,580
So it's a, that the cost is actually, unfortunately is the number one hindrance for this.

 00:45:43,820 --> 00:45:49,420
But as we've already seen with technology, right, like flat screen TVs were thousands of dollars years ago.

 00:45:50,060 --> 00:45:51,260
Now it's like dirt cheap.

 00:45:51,260 --> 00:45:57,540
Like, like if I break some, it's like I'm just going to, I'm just going to buy a new one, right? Like it doesn't matter.

 00:45:57,540 --> 00:45:59,020
Like it's not, they're not very expensive.

 00:45:59,340 --> 00:46:00,700
Will Sanchez: So it's hysterical.

 00:46:04,390 --> 00:46:10,230
I had an HDMI TV, weighed 200 pounds, like it was ridiculous.

 00:46:10,230 --> 00:46:13,590
And it was the newer one, you know, for the time.

 00:46:13,590 --> 00:46:18,510
And I was just praying that it wouldn't fall over and crush my child because it was so heavy.

 00:46:18,510 --> 00:46:23,830
And now These things are 90 inches and they weigh 6 pounds. It's absolutely unbelievable.

 00:46:24,950 --> 00:46:26,550
Dr. Grant Garcia: So, so let's go, let's go to.

 00:46:26,630 --> 00:46:28,510
I mean, we can talk about the radiology, but let's go to.

 00:46:28,510 --> 00:46:32,320
Like people were asking, you asked me before, like in my, in my office.

 00:46:32,320 --> 00:46:33,840
How do I, how would you notice it?

 00:46:33,840 --> 00:46:36,600
So I think there's different things, right?

 00:46:36,600 --> 00:46:38,800
There's, there's work, so there, so there's bigger hospitals.

 00:46:38,800 --> 00:46:39,560
I don't work in hospital.

 00:46:39,560 --> 00:46:42,680
Mostly I consult for hospitals, but I don't work in the hospital directly.

 00:46:42,680 --> 00:46:45,200
If you come to my practice, it's private practice, very niche.

 00:46:45,840 --> 00:46:49,640
But if you work in a hospital, there's obviously the prioritize of intermoral findings, right?

 00:46:49,640 --> 00:46:52,400
Like you come to the er, everyone screams that everything hurts, right?

 00:46:52,400 --> 00:46:53,000
Like if you go to.

 00:46:53,000 --> 00:46:54,080
Have you ever been to an er?

 00:46:54,400 --> 00:46:59,200
And hopefully you haven't, but if you have, unfortunately you'll know that like everybody looks

 00:46:59,200 --> 00:47:02,360
like most People look like they have an emergency, right?

 00:47:02,680 --> 00:47:04,840
But not all of them actually have an emergency.

 00:47:05,480 --> 00:47:10,120
So can AI come in there and scan them and say, okay, you're having a heart attack. You're first.

 00:47:10,840 --> 00:47:15,160
Your, your, your leg is like, you have like a bruise. You're gonna wait, right?

 00:47:15,160 --> 00:47:16,840
Like your liver is shutting down.

 00:47:17,080 --> 00:47:18,200
You need to go to the front.

 00:47:18,440 --> 00:47:25,190
Right now you're hoping the front desk person thinks you're nice and puts you higher on the urgent care. Yeah, yeah, yeah, Right. So that's one thing.

 00:47:25,990 --> 00:47:29,950
And then workflow, that would be huge. That would be huge.

 00:47:29,950 --> 00:47:30,990
And I'm sure it's coming the way.

 00:47:30,990 --> 00:47:34,870
Maybe I gave someone some idea and hopefully I'll get some royalties from that, but who knows?

 00:47:34,870 --> 00:47:38,030
Will Sanchez: Yeah, you have patients that, that cry wolf.

 00:47:38,030 --> 00:47:44,310
And then you have other patients go, no, I'm fine, and sit down. And they're literally dying. So that, that's great.

 00:47:44,310 --> 00:47:45,630
Dr. Grant Garcia: And that's in my office too.

 00:47:45,630 --> 00:47:46,870
I mean, that pops in there like.

 00:47:47,430 --> 00:47:49,310
And I have that now because I have a lot of.

 00:47:49,310 --> 00:47:51,430
My physician assistants will see my patients first.

 00:47:51,910 --> 00:47:54,310
So they're essentially triaging the situation.

 00:47:54,790 --> 00:47:59,950
But before, when I didn't have that, when I was newer, you know, I'd have three patients and I'd have two patients.

 00:47:59,950 --> 00:48:04,150
One patient, you know, would have nothing wrong with them. It's not their fault. Tons of pain.

 00:48:04,230 --> 00:48:06,390
You couldn't figure anything out. Everything was negative.

 00:48:06,470 --> 00:48:08,870
And they're upset with you because you can't find it. Right.

 00:48:09,350 --> 00:48:14,190
That patient would spend, you know, 45 minutes with me either, unfortunately, arguing sometimes

 00:48:14,190 --> 00:48:17,030
or telling me I don't know what I'm talking about if I can't find it. Right.

 00:48:17,280 --> 00:48:19,520
They've seen 10 doctors and I'm the one that's supposed to figure it out.

 00:48:19,520 --> 00:48:21,280
I can't figure it out. So that happens.

 00:48:21,360 --> 00:48:26,800
Thankfully, it's not that often, but that patient unfortunately wasted 45 minutes of resources.

 00:48:27,040 --> 00:48:31,760
And now the next patient who I get to is upset because I'm 45 minutes behind, which they're not seeing.

 00:48:32,160 --> 00:48:35,200
And then they have a bad experience or two or three have a bad experience.

 00:48:35,200 --> 00:48:37,800
And now, like, it's more than just that. It's like.

 00:48:37,800 --> 00:48:41,920
Or I'm flustered and maybe the next patient, I've got to reset my mind, right?

 00:48:41,920 --> 00:48:44,440
And I maybe miss something with the next one Again, that's.

 00:48:44,440 --> 00:48:47,920
This thankfully doesn't happen that often, but it's something to be aware of.

 00:48:47,920 --> 00:48:49,920
So, like, if you can keep your.

 00:48:51,120 --> 00:48:54,640
If you can keep the high functioning situation decrease.

 00:48:54,640 --> 00:48:56,240
It's always about decreasing stress, right?

 00:48:56,240 --> 00:48:58,640
Like every doctor show every doctor's channel.

 00:48:58,720 --> 00:49:02,320
There's such high burnout, there's high suicide rates.

 00:49:02,320 --> 00:49:03,920
These are scary things to talk about.

 00:49:03,920 --> 00:49:05,080
But why are they like that?

 00:49:05,080 --> 00:49:07,520
Because they're doing activities they don't need to be doing.

 00:49:07,920 --> 00:49:09,600
They're, they're filling paperwork out.

 00:49:10,050 --> 00:49:12,130
They're, they're the ones prioritizing the patients.

 00:49:12,370 --> 00:49:14,090
What happens if your machine did that for you?

 00:49:14,090 --> 00:49:19,090
And they're like, okay, now I've done like, I've done literally like 20 hours of work for you.

 00:49:19,170 --> 00:49:23,330
So now your 80 hour work week is 60. Right.

 00:49:23,330 --> 00:49:27,090
Like today I've got my new workflow where I see patients that really need surgery.

 00:49:27,570 --> 00:49:33,210
I see 20 less patients, just like Denard was talking about. Yep.

 00:49:33,210 --> 00:49:35,010
But my patients get more time with me.

 00:49:35,010 --> 00:49:37,570
And so the review, I don't get reviews. Like, I've been waiting.

 00:49:37,860 --> 00:49:39,820
He was late, you know, today I was a little late in the beginning.

 00:49:39,820 --> 00:49:41,780
I apologize to those patients if you're listening.

 00:49:41,940 --> 00:49:47,780
But for the most part I stay on, I stay on time and every patient has me sit down and usually

 00:49:47,780 --> 00:49:52,500
the patients are like looking at their clock because they're done talking to me. Right. Like, so that's good.

 00:49:52,660 --> 00:49:57,100
So the, the goal here is that like everybody's getting more of what they want and the frivolous

 00:49:57,100 --> 00:50:03,060
stuff is gone and I am less stressed because I actually normally am full speed ahead on everything I do.

 00:50:03,310 --> 00:50:04,990
And now in the or, it's more efficient.

 00:50:05,150 --> 00:50:10,470
I'm more efficient with workflow in the office and with AI, it's going to make it better. Like AI notes. Right.

 00:50:10,470 --> 00:50:15,030
Like the notes are great, but like half the time the note just repeats everything you just talked about. Yeah.

 00:50:15,030 --> 00:50:18,990
So like there's AI programs on your watch that I can walk in and it will come out and have a

 00:50:18,990 --> 00:50:23,390
note done for me and then it will document and then I can add a little bit of stuff to it and make sure it works.

 00:50:23,470 --> 00:50:25,110
And so like, that's amazing.

 00:50:25,110 --> 00:50:29,950
Like, wouldn't it be awesome if your doctor, most doctors said they spend like 75% and I'm in.

 00:50:29,950 --> 00:50:34,590
Surgeons was different, but most doctors suddenly send like, like 70 or something of their time

 00:50:34,830 --> 00:50:37,150
doing paperwork and non doctor stuff.

 00:50:37,150 --> 00:50:41,150
And surgeons, we have a lot of time, we sit around in the operating room waiting for the next surgery to come.

 00:50:41,390 --> 00:50:45,870
But women's, if we had like robotic cleanup so they could clean the OR faster so that we could

 00:50:45,870 --> 00:50:48,990
all be ready and get all your surgeries done and you're not wasting your time either.

 00:50:49,390 --> 00:50:54,110
And, and, and you're not as gas at the end of the Day because you're done at 2 instead of done at 5. Right.

 00:50:54,110 --> 00:50:57,430
There's all these other things that we're not even at the point yet where we're trying to talk

 00:50:57,430 --> 00:51:03,230
about limiting the surgeon or any of the staff members, but making an experience for the patients.

 00:51:03,470 --> 00:51:06,070
If they like called, they got someone on the phone. Right. And it was AI.

 00:51:06,070 --> 00:51:09,950
It plugged me into my office visit in the offices that saw you were like, hey, not a surgical

 00:51:09,950 --> 00:51:11,590
patient, but we're still going to treat you.

 00:51:11,590 --> 00:51:12,710
You can go see this person.

 00:51:12,710 --> 00:51:15,950
And then so far, you've just been AI'd in, but you've gotten this all done.

 00:51:16,110 --> 00:51:23,710
I can tell you right now if you pulled all the patients and I said if you like most time now in Seattle, unfortunately. And will.

 00:51:23,710 --> 00:51:27,350
You may or may not know this, if you want to have a provider outside of like an orthopedic surgeon

 00:51:27,350 --> 00:51:33,520
at one of the, one of the pro alliances, you're going to wait like six months to see a doctor. Unless it's an emergency. Right.

 00:51:33,920 --> 00:51:35,080
So it's like five, six months.

 00:51:35,080 --> 00:51:37,480
But what if I told you you could see someone in like a.

 00:51:37,480 --> 00:51:40,800
You could get, you could pick up the phone, call them, it would take you two minutes.

 00:51:40,960 --> 00:51:45,960
You'd be hooked up, you could see someone, you could maybe even talk to an AI person thing that

 00:51:45,960 --> 00:51:47,120
would kind of triage you.

 00:51:47,200 --> 00:51:49,920
And like, if you're really pissed off, then you can like override it.

 00:51:50,000 --> 00:51:53,320
But maybe you could be like, maybe that'd be enough for you to be like, okay, let's ping you

 00:51:53,320 --> 00:51:54,480
and get you into somebody else.

 00:51:54,880 --> 00:51:58,640
Or it can sense the tone of your voice, it can sense all these things and it can say, this one

 00:51:58,640 --> 00:52:00,960
sounds urgent, I should get them in. Right.

 00:52:00,960 --> 00:52:02,480
Like that stuff that you, Dr.

 00:52:02,480 --> 00:52:05,600
Never is going to get a chance to do, but now your doctor's seeing all the stuff that's important,

 00:52:05,600 --> 00:52:08,960
or not seeing patients that are pissed off because they waited six months to see you.

 00:52:09,120 --> 00:52:09,520
Will Sanchez: Yeah.

 00:52:09,520 --> 00:52:14,440
Dr. Grant Garcia: Right. So, like, there are so many aspects of this that are good for the patients that don't

 00:52:14,440 --> 00:52:17,240
require you not getting to see a doctor. Yeah.

 00:52:17,240 --> 00:52:23,200
Will Sanchez: You know, and it's going back to some of the things that I'm privileged to kind of work with

 00:52:23,200 --> 00:52:33,830
is you're talking about creating the correct agent and also learning what the correct prompt

 00:52:33,830 --> 00:52:42,590
is and putting those things together to have these diagnosis that hopefully will confirm, conform

 00:52:42,910 --> 00:52:49,150
to, to the needs of the patient and, you know, hit the, the warning signs for the doctor saying,

 00:52:49,150 --> 00:52:50,670
hey, we've got to get these patients in.

 00:52:51,840 --> 00:52:55,200
Dr. Grant Garcia: I think, I think the last, the Thing I'll keep bringing up is AI.

 00:52:55,600 --> 00:52:56,720
This is a good summary.

 00:52:56,960 --> 00:52:59,600
AI is going to make healthcare hopefully faster.

 00:53:00,080 --> 00:53:04,400
It's going to make it more efficient, it's hopefully going to make it more cost, conscientious

 00:53:04,400 --> 00:53:05,520
because you're not missing things.

 00:53:06,080 --> 00:53:11,760
And it's going to make it way better experience for the patients because like they're going

 00:53:11,760 --> 00:53:16,520
to get their MRI done and like you have AI MRI machine so it's faster at calculating things. Right?

 00:53:16,520 --> 00:53:19,910
Like the new MRI machine we're looking at, it's got AI built in to it so it can do like double

 00:53:19,910 --> 00:53:21,230
the scans in a day. Right?

 00:53:21,230 --> 00:53:27,150
So now you get, you sign up for an MRI and you, you get your MRI in one day rather than waiting three months.

 00:53:27,870 --> 00:53:32,390
Then it's interpreted faster because it's got AI and then it's pinged to the radiologist that

 00:53:32,390 --> 00:53:35,430
no longer has to look at like basic boring MRIs. It's got the ping.

 00:53:35,430 --> 00:53:36,830
So it's like this one you should look at.

 00:53:36,910 --> 00:53:42,110
So then the radiologist reviews the, the big ones and then that's checked off and now the radiologist

 00:53:42,110 --> 00:53:43,550
is less stressed so he can do it.

 00:53:43,550 --> 00:53:47,530
And all of a sudden now you're like, okay, you've got all this stuff, you've got to an ACL tear

 00:53:47,530 --> 00:53:48,650
or whatever, you got something going on.

 00:53:48,650 --> 00:53:50,370
So now we're going to ping you to the orthopedic surgeon.

 00:53:50,370 --> 00:53:53,730
We're not going to send it to a person to do it, we're going to ping it right to the orthopedic

 00:53:53,730 --> 00:53:59,370
surgeon's office and actually schedule you like you would be in like, I think that any, any

 00:53:59,370 --> 00:54:06,050
American and a non American, but American using the healthcare system would be absolutely elated to have that experience.

 00:54:07,010 --> 00:54:12,210
So I, I, and I think that you'll find that it'll miss less things because like I said before,

 00:54:12,790 --> 00:54:18,310
if we can remove all the frivolous stuff for our surgeons, doctors, they're going to be so much better at their jobs.

 00:54:18,630 --> 00:54:22,470
And so I think that's what we're going to see, is that you're going to see better health care for the patients.

 00:54:23,430 --> 00:54:27,110
But I guess that's just my opinion. So we'll see.

 00:54:27,750 --> 00:54:33,670
Will Sanchez: It sounds like an episode that we will eventually update and why it was.

 00:54:33,670 --> 00:54:35,430
Dr. Grant Garcia: So wrong and where we went wrong.

 00:54:37,110 --> 00:54:42,780
Will Sanchez: No, I think there's some great ideas and especially it's, it's a great understanding of how

 00:54:42,780 --> 00:54:50,060
we're utilizing AI and really this is the infantile stages of where we are with this technology

 00:54:50,780 --> 00:54:56,700
as we, you know, there are next, you know, Industrial revolution that's happening right before our eyes.

 00:54:57,020 --> 00:55:01,340
So it's a very exciting time and we'll see how it all shapes out. Dr.

 00:55:01,340 --> 00:55:04,380
Garcia, congratulations on top Dr.

 00:55:04,380 --> 00:55:05,610
Once again, that is wonderful.

 00:55:05,840 --> 00:55:11,280
One distinction that AI cannot take away because you're doing it the right way.

 00:55:11,760 --> 00:55:16,240
So I, I just wanted to shout you out and I know you've got some sun tanning to do, so we're going.

 00:55:16,320 --> 00:55:18,360
Dr. Grant Garcia: Yeah. Ready to go?

 00:55:18,360 --> 00:55:19,760
Will Sanchez: Got your sunblock ready?

 00:55:20,480 --> 00:55:24,160
Dr. Grant Garcia: I do. Well, the Brazilian skin helps a little bit, so I don't need too much on there.

 00:55:24,240 --> 00:55:26,600
Will Sanchez: Oh, baby. All right, enough of that.

 00:55:26,600 --> 00:55:28,960
Go do your hit and go enjoy yourself.

 00:55:29,600 --> 00:55:31,360
Thanks for listening to Sports Doc Talk.

 00:55:31,990 --> 00:55:33,110
We always want to hear from you.

 00:55:33,110 --> 00:55:38,790
Please check out our website, sports.talk.com we've got shows, we've got great information.

 00:55:39,030 --> 00:55:41,830
We've got links, we've got transcripts.

 00:55:41,830 --> 00:55:43,590
I don't know what else. Dr. Garcia, we.

 00:55:43,590 --> 00:55:44,870
What else are we missing from that?

 00:55:44,870 --> 00:55:46,870
Dr. Grant Garcia: We got social media. We got awesome guests.

 00:55:46,870 --> 00:55:51,070
I mean, honestly, this is one of our first big topic shows in like a few months because we've

 00:55:51,070 --> 00:55:52,910
had so many good guests. Yeah.

 00:55:52,910 --> 00:55:54,470
And we have so many more coming.

 00:55:54,950 --> 00:55:59,110
Oh, if you're listening, ping us as a guest.

 00:55:59,530 --> 00:56:00,850
We love to have the guests on.

 00:56:00,850 --> 00:56:06,170
We have some really good ones coming up and we're not going to let it out, but we have some good ones coming up.

 00:56:06,170 --> 00:56:07,050
That's all I'm going to say.

 00:56:07,210 --> 00:56:08,690
And the hot topics have been good.

 00:56:08,690 --> 00:56:10,650
This is the first big topic one in a while.

 00:56:10,650 --> 00:56:15,090
Well, this is awesome because we just thought it was time, you guys.

 00:56:15,090 --> 00:56:17,970
But again, there's a lot of good guests coming up, so stay in tune.

 00:56:17,970 --> 00:56:20,810
Social media, you name it, and check us out.

 00:56:21,050 --> 00:56:24,330
Will Sanchez: Yep. We appreciate the viewers, the listeners and all the support.

 00:56:25,060 --> 00:56:27,460
We hope to continue to provide information.

 00:56:27,700 --> 00:56:36,820
But as you said, we've got, we've got a lineup that's coming up in 2025 that's sure to be entertaining. Dr. Garcia, say goodbye.

 00:56:37,940 --> 00:56:38,740
Dr. Grant Garcia: Bye, guys.

Audio Transcript