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The New Nice Recovery System with Grant Kashner

Will Sanchez: Oh, Dr. Garcia, it's good to see you. Welcome to Sports Doc Talk. I'm Will Sanchez along with Dr. Grant Garcia. As always, we are really excited about today's show. We're always happy that you're joining us and be sure to check us out on YouTube and your friends. Favorite listening platform. Dr. Garcia, how are you?

[00:00:38] Dr.Grant Garcia: I'm good. I'm really excited for our guests today. Grant Kastner is going to be awesome. Talk about some innovative technology before we introduce him and talk about this amazing product is going to show us we have a really nice sponsorship we want to talk about. So today this episode sponsored you by recovery shop.

[00:00:57] Dr.Grant Garcia: And really, you know, this has been awesome for me. [00:01:00] I use this for my patients. And the problem is that, you know, when you get surgery, a lot of patients are like, Hey, what else can I do? What can I do to get better? What can I do to recover faster? I heard about all these braces and these creams and these patches and cooling products.

[00:01:13] Dr.Grant Garcia: We'll talk about one of those today. Recovery drinks, nutrition. We've had nutrition supplements on. You've had a lot of these people on here and the problem is that in the office, the patients are asking me tons of different questions. They'd ask me, where do I get them? Can you go on Amazon and help me find them?

[00:01:27] Dr.Grant Garcia: You know, a lot of things and it's just so time consuming. So I started partnering with this place called the recovery shop. And what it is, is it offers. The surgeon's ability to offer their patients all of these products I'm talking about, they can get pretty much anyone you want aftermarket and they're, you know, really high quality and it works together to help your patients find it all in one spot, and then they can, you know, buy those things for their surgery as they see fit.

[00:01:50] Dr.Grant Garcia: And it's really been a game changer for my patients. They really love the products they are offered. They're a lot more trusting than having to go through a bunch of Amazon reviews. And you know, I really [00:02:00] encourage it. So if any surgeons are interested, again, this is signed up for the surgeons for their, their patients to get them better.

[00:02:06] Dr.Grant Garcia: Feel free to reach out. I have a link on my website or you can visit the website link here for recovery shop. And yeah, thank you again, guys. Shop

[00:02:15] Will Sanchez: recovery. net. So be sure to check it out. Dr. Garcia, let's let's talk a little bit about our guests today and what our listeners and viewers are in for. [00:02:26] Dr.Grant Garcia: Well, you're in for a real treat. This is a product used by both the hosts of this, and it has been a game changer and basically started for us in. December, early December. And we have patient number one here who wants to show his experience.

[00:02:41] Will Sanchez: Yeah, it's a, it's, it was absolutely amazing. And you know, for those have listened to the show.

[00:02:46] Will Sanchez: Thanksgiving morning, I tore my Achilles. I went in for surgery. And then in December, I've got my nice, I love it. Nice package. Let's look back to December, 2023, [00:03:00] when I received that package. Hey, welcome everyone. I got a great package here from Nice Recovery System, a great company out there in Colorado.

[00:03:08] Will Sanchez: I want to thank. Grant Kashner: for sending this to me. This is really going to help me with my healing process, a cold and compression therapy system. Got a cool little boots, got all these great accessories, exactly whatever you need. So I'm really looking forward to utilizing this. I am 11 days out of.

[00:03:27] Will Sanchez: surgery. I ruptured my Achilles tendon. Thankfully for, for me Dr. Anthony Yee from orthopedic specialist of Seattle's did the procedure. In fact, he did the speed bridge procedure, which you might have had heard from our previous shows. So as soon as I can get out of this cast, start getting this compression therapy system working.

[00:03:47] Will Sanchez: I'm looking forward to getting healed and I'll keep everyone updated on my process. And what a product it was. I'm really excited to talk about it. And anyone that's thinking about it, that's a [00:04:00] patient that has gone through healing. This was absolutely incredible. And we're really excited to have Dr.

[00:04:05] Will Sanchez: Dr. Grant cash. Everybody's a doctor. He's so

[00:04:09] Dr.Grant Garcia: excited. Grant to have you on here. He can't even contain himself.

[00:04:13] Grant Kashner:: No, no. Thank you guys. I appreciate it. And yeah, that's certainly a great video. I've been through it myself being under the knife three times. So a patient as well as you know, luckily the first employee and yeah, been kind of worn all the hats as far as you know, getting to where we are today.

[00:04:28] Grant Kashner:: So thank you guys for having me. I'm excited to be here.

[00:04:31] Dr.Grant Garcia: Awesome. Before I tell my experience, Grant, once you tell them about we keep telling everybody about this nice machine, we'll show a secret little video. But why don't you tell everybody what it does? Because while we'll did amazing job, we still don't really know what it does.

[00:04:44] Grant Kashner:: Sure. So at the kind of the most basic definition, it's kind of the best pain control device on the market, right? It does cold and compression without the need for ice. So we use a thermoelectric technology. Where it gets the the water to a targeted [00:05:00] temperature in between kind of a 4 degree temperature range from 59 to 42 degrees.

[00:05:05] Grant Kashner:: And stays at a constant you know, temperature once it reaches that. So it's just kind of the best, you know, for lack of better term mousetrap on the market. Newest technology and kind of the most portable package for the patient.

[00:05:17] Dr.Grant Garcia: Yeah, this is awesome. So for those patients out there, so I I've gone through surgery.

[00:05:22] Dr.Grant Garcia: I've tried the old ice machines and my wife, I can tell you when I had to get this done, she was. Not pleased with having to change the ice bags every couple hours. We found every trick possible. We tried Frozen peas we tried frozen stuff and thrown in the water because that we literally could not produce enough ice To cool it down and I'm a sucker for ice.

[00:05:43] Dr.Grant Garcia: I ice my shoulder if it hurts. So when We started meeting up with Grant and we first were able to offer this product cause we were the first in the one of the first in the state to have this option for our Washington state patients. I was like, well, Grant, I love this. This is awesome. It sounds cool.

[00:05:57] Dr.Grant Garcia: But like. Let's try it first, right? [00:06:00] Cause I want to make sure that if I try, I always tell Will this, like my patients get offered innovative technology. I want to feel confident. And if I'm going to sell the product to my patients to get really excited about it, I want to make sure it is a difference. So the minute I grant got me one, he sent it to my house.

[00:06:13] Dr.Grant Garcia: I put it on. It was a huge difference. I mean, we're talking about. The cooling system has five cooling depths. I always, I'm a max kind of guy. So I went to five right away. Probably not always the best thing when you're post surgery, but you know, five up there, you don't ever refill it with ice, which is so fricking awesome. [00:06:29] Dr.Grant Garcia: Just a little bit of water. And the compression was really a big difference. And I think Will's nodding his head because he felt the huge difference as well. I mean, even I'm a guy that throws ice bags on my shoulders after I work out sometimes. And this was better than that. And my wife looks at it and goes, Oh, I really wish we had that for your surgery.

[00:06:45] Dr.Grant Garcia: That would have been a much better thing. And then it was funny because I had my father in law over. Who had surgery on his shoulder and he tried it and he was like, this is, what is this thing? This is awesome. And then I also had one of my good friends and she's pretty particular on things. She's actually was one of our [00:07:00] podcast recommenders early on.

[00:07:02] Dr.Grant Garcia: And she tried on her shoulder after she had sold the surgery and she was like, I'm sold. I wish I had this for mine. So right then and there, I knew we were onto something good. And it's a, it's kind of taken off after that. So thank you again, grant for getting, introducing us to this awesome product.

[00:07:15] Dr.Grant Garcia: And the patient experience has been off the hook. You know, they're, They're so happy. I don't want to take too much thunder, but we had to, we have patients. The crazy part of my job is I get patients with two knees, right? And so a year ago I did a couple of patients with their knees and then they wanted their other side done.

[00:07:30] Dr.Grant Garcia: And I got to literally have the head to head experience and patients when they tried it, they were like, why didn't you give me this before? I'm like, dude, listen, I wish I had the technology earlier, but we didn't. So anyhow, it's a, I really appreciate it. This is awesome. I'm so excited to have you on here and I want the viewers to be able to understand this better.

[00:07:48] Grant Kashner:: No thank you, and you kind of hit the nail on the head. It's we, we, I didn't, I didn't know this coming into the business, and I would've thought, you know, I would've, you know, definitely not thought this was the, the train of thought. We have patients that actually call us [00:08:00] and you know, they're, they're looking at doctors or, you know, surgeons in certain areas, and the ones that offer the nice machine.

[00:08:07] Grant Kashner:: They're considering going to them versus the ones that don't. And you know, we obviously have to tell them, you know, go to the surgeon that is the highest recommended that does the surgery that you need. Right. And then we will, we'll, we'll, you know, obviously we're about the the post-op process after, but that was something that we saw too, was just how much it really does affect the patient experience post-op in a very dramatic way.

[00:08:29] Grant Kashner:: So I'm glad you guys kind of see the same thing.

[00:08:31] Will Sanchez: Yeah, let me jump in real quick. It is not only great for the patient, it is great for your marriage. And dr Garcia alluded to that, that I was, this is not, this is, this is your saving relationships and marriages and partnerships. So thank you. Because the fact that I put it's what I felt was like an ounce or two ounce and I, and I'll let you describe [00:09:00] it of water into this machine and it's running for about a month.

[00:09:05] Will Sanchez: And, and I'm like, how is this possible? And I'm utilizing this at least once an hour, throwing this on, wrapping it up, putting the compression, getting the cold in there, utilizing this. My wife is sitting there with the remote. Like, well, all I got to do is just get food for this man. I don't have to get. An ice bag every hour and running to the [00:09:26] Dr.Grant Garcia: torture, torture, you're

[00:09:29] Will Sanchez: saving relationship.

[00:09:31] Will Sanchez: Forget about the patients. The technology is amazing. But the fact is that the fact that our wives still love us after disrupting their lives for months. I can't thank you and everyone there at nice. Thank you for saving our relationships. Well, I will come in today.

[00:09:49] Grant Kashner:: Yeah. We're going to add a, you know, marital bliss as well.

[00:09:53] Grant Kashner:: I

[00:09:56] Dr.Grant Garcia: love it. I love it. And y'all one more last shout out. So [00:10:00] I, my partner just had a big knee surgery. And he comes to me and he's like, Hey man, my knee's pretty stiff. And I've been doing the ice compression with the ice buckets and it's, it's, I don't know. I'm just still stiff. And I'm like, dude, did you hear about this thing I'm offering?

[00:10:12] Dr.Grant Garcia: He's like, what are you talking about? Right. And so I was like, Hey, I call Grant. He ships it to him next day. Such a, such a move, man. I really appreciate it. And he, he literally, this is my partner is amazing, but he doesn't really say much. Like he's chill and he's not going to like complain. He hasn't complained about anything.

[00:10:28] Dr.Grant Garcia: I had to literally ask him how he's doing. He's operated like a day, a month, a week and a half after like a massive surgery. I mean, this guy's tough. And he comes to me, he goes, All I wrote was nice, nice exclamation Mark. And he comes in the next day and he was like, dude, that was awesome. That is so much better.

[00:10:43] Dr.Grant Garcia: I can't believe it. So thanks again. I mean, it's been nonstop. People are nonstop impressed with the product. So it's I, I feel bad for other people that aren't able to offer it. But again, it's not that hard. And we'll get into like, you know, anybody can offer this option. This is not something that because I [00:11:00] do, you know, You know, I work with recovery shop and I work with you guys and stuff like that, that, you know, I have elite product access to it.

[00:11:06] Dr.Grant Garcia: No, there's the whole point of this show is to show people that anybody can have it. And patients want it. And it's the same thing we talked about before from a marketing standpoint. I mean, I hate to say it guys, but you know, when you're a surgeon, like patients come to me because I offer innovative stuff.

[00:11:19] Dr.Grant Garcia: Like it doesn't, I try to do a good job. I think I've got a decent reputation, but really like you said, people are calling, they're calling Arthrex, they're calling other companies and they're like, who should we go to? Right. And that's brings patient referrals and it's not like you should sign up for this or, you know, it's not, it's not a subscription or anything, but it's not like you should do something because it helps that.

[00:11:37] Dr.Grant Garcia: But if it's from a marketing standpoint and it's good for your patients, this is a win, win, win, right? Everybody wins. And that's always the key here in a, in a type of relationship. So any go, thanks again, Grant. This is awesome. Do you want to I want to kind of. Stop talking a little bit less and let you talk some more. [00:11:53] Dr.Grant Garcia: 'cause obviously I want everybody to hear about this. We don't

[00:11:55] Will Sanchez: even need grant cash. Grant, just hang out. Let us talk for you. In [00:12:00] fact, you don't just sit back. You got nice hat on. You got, this is great. He looks good. He's killing. And just go like that because we're doing all the talking for you. But , I appreciate it.

[00:12:13] Will Sanchez: We can tell you we are terrible

[00:12:14] Dr.Grant Garcia: on this.

[00:12:15] Will Sanchez: We are terrible. Hey, why don't you tell us a little bit about the company and how it started and the founder, let's kind of get down to the roots and what was the inspiration to, to start to look into this technology and how it developed from day one to where you're at right now?

[00:12:34] Grant Kashner:: Sure. No, and it's actually a really cool story. So our founder and CEO, Michael Ross, he you know, for Just, you know, again, not not the, you know, kind of kind of a buzzword. He term was a serial entrepreneur right in his career. A few different businesses move to Boulder to kind of figure out his next move.

[00:12:53] Grant Kashner:: Right? While he was in Boulder, he decided to take up ski racing right at the young age of 46 years old. So. If you [00:13:00] guys know about downhill ski racing you're going about 85 miles an hour turning, you know at about 45 degrees, you know every, let's call it, you know, few hundred yards. So I'm, I'm, I'm sure you know what happens next to a 46-year-old, you know.

[00:13:15] Grant Kashner:: Man, and he he destroyed one of his knees blew his IT band off, tibial plateau every ligament and was essentially you know, ski and ski out to the Steadman Clinic in Vail. So he had a series of surgeries done by Tom Hackett. At at Steadman and then used it, used our competitive product, which is a game ready.

[00:13:36] Grant Kashner:: And I know you're not supposed to say your competitors, but they did a great job you know, kind of seeding the market with a really good product. And then honestly just didn't ever product innovate. So Michael used this product, realized that there, you know, was just inefficiencies and there was better technology on the market.

[00:13:52] Grant Kashner:: So. Just being, you know, hard headed and kind of spiteful started engineering a better product and about two [00:14:00] years later brought a pretty good working prototype to the Stedman clinic showed Dr. Hackett as well as Dr. Philipp on, and they were, you know, jumped all over it. Technology wise similar, you know, you, Dr.

[00:14:11] Grant Kashner:: Garcia, they also love kind of the innovative technology and wanted to, you know, stand behind, especially an American made product, right. We're even then we set up, you know, American manufacturing in Boulder through a contract manufacturer. And then now we make everything in house. So long story short from there, he went to working on the FDA.

[00:14:32] Grant Kashner:: And then somehow, you know, I called him when I had a couple other things going on, just on some kind of, you know, advice and the timing worked out and this was in April of 2016. So I hopped on board and it truly was you know, a garage company, but he didn't have a garage. So it was in his home office.

[00:14:49] Grant Kashner:: So and then from there, about two months later, they were he was actually getting married. So we had to find an office building. So that kind of started the whole business was we had three units [00:15:00] produced. And we had to find an office, so it's been yeah, you know, every kind of building block figuring out this business.

[00:15:08] Grant Kashner:: I don't know if you guys are, you know, no, no, a lot about the, kind of the, the very niche kind of DME market, but it's it's a very interesting world as far as, you know, no insurance and figuring out kind of delivery service and product and, you know, just how to, how to How to bring a good solution to the market.

[00:15:26] Grant Kashner:: Right. And I feel like, you know, eight years later we finally have have arrived. So, you know, overnight success just takes, you know, about, you know, eight to 10 years.

[00:15:38] Dr.Grant Garcia: Well, this is, it's interesting for the viewers to hear that last part you said about, you know, the difficulty of the DME market. What they're not realizing is that like you don't have like a nice rep on the ground.

[00:15:48] Dr.Grant Garcia: Right. Like, it's not like, you know, you hear guys here about these products, like, you know, there's amazing arthritis products. There's lots of other ones we've talked about, you know, when we get those things, those are in, those are surgeries, like they're getting delivered before [00:16:00] we got a ton in house.

[00:16:01] Dr.Grant Garcia: Like I could do pretty much any surgery I want in house. It's all there. I got a little bag and I can grab whatever I need. This has to be shipped from all over. And so it's got to be shipped with quality and it's got to be functional. But I think the one really important thing about the product is that it's despite how tech, how smart is and technology driven it is, it's actually pretty easy to use and like you just don't need instruction manuals, which is really good for the patients because everyone, you know, and we have a lot of smart patients, but the technology can be a challenge, especially when you start doing, you know, in the total knee population as you get a little bit older, you know, they're not a big fan of using their phone or remotes or things like that.

[00:16:36] Dr.Grant Garcia: So again, It's a little less than my patient population, but overall, you know, there's so many outlets for this. And so it's amazing to have a technology that's simple, but effective. What what other institutions, I know you guys do a lot of Stedman. Are there any other places you guys have worked with around the country or you're kind of like I know you guys do a lot with HSS now too.

[00:16:54] Dr.Grant Garcia: Any other place for the viewers to kind of hear places you've worked with? Cause again, you're a lot bigger company than you were from three machines now. [00:17:00]

[00:17:00] Grant Kashner:: Yeah. Yeah. Yeah. So our roots are obviously in our backyard in Colorado, right. Where Michael got his you know, kind of, kind of got, got his, you know, fixed and kind of on this track.

[00:17:10] Grant Kashner:: So Stedman is the big, you know, kind of start from there. You know a lot of docs kind of train there and then go other places. Right. So we do a big volume of business in TCO. So in Minnesota, right. A lot of activity there. I think we're partnering

[00:17:25] Dr.Grant Garcia: with them now. We're Pelto. We're part of the alliance.

[00:17:28] Dr.Grant Garcia: So that's cool.

[00:17:29] Grant Kashner:: So yeah a very big presence there. Obviously HSS is another, you know, very big kind of stronghold for us. We do a good volume of work in resurgence in the Atlanta market as well. So yep. And then we have been growing significantly in the Carroll Clinic and the Dallas market.

[00:17:48] Grant Kashner:: You know. Kind of rapidly as we, and you know, Dr. Garcia, you kind of hit it on the head, right? It's you need good stewards of the product, right? We're the manufacturer and you know, we, we want to [00:18:00] choose with good people to represent us in the market because people, people remember the doc and they remember the product, right?

[00:18:06] Grant Kashner:: They don't really remember the people in between that because it's who fixed them and then what helped them after getting fixed, right? So it's really important to have good people that represent the product because If they don't deliver it or they don't service the patient or they don't, you know, communicate with the patient or communicate with the doc and the physician and the staff, then the patient experience just isn't like doesn't follow the quality of the product.

[00:18:32] Grant Kashner:: So the main, you know, a lot of the driver of our growth is also choosing really good partners to represent the product in certain markets. And that's kind of what goes hand in hand, right? We have a really good network, a really good product, and then we choose really good partners that service the product stewards to the patient.

[00:18:49] Dr.Grant Garcia: And I don't want to jet out of this topic, but one thing for the people that are listening is one, and this is a kind of a full circle episode. So, you know, one of the, one of the good ones you guys have is recovery shop. [00:19:00] So we work with them. And if, you know, a surgeon's part of recovery shop, they can get that product to their patients really easily.

[00:19:07] Dr.Grant Garcia: And it's been, they've been amazing. And again, I don't want to overdo it. Cause we already talked about them as a sponsorship, but for people to know, like this all is intertwined, right? How does this work? It's not like, you know, as good as grant is he can't deliver them all himself. So he's got to have someone help him.

[00:19:21] Dr.Grant Garcia: And so they've done an amazing job. And, and anybody knows that you can know when you partner like this, it's really nice to know that, like. You said like grants team is amazing, but also adding another amazing team like the recovery shop guys together allows us to automatically, you know, I patients are getting these things flown in all the time, you know, and if there's any issue, like sometimes patients will forget and they'll get it like the last minute and they get it to him overnight.

[00:19:42] Dr.Grant Garcia: Like this. It's not always easy in the winter snowstorms, but you know, we get the service has been amazing. And again, I'm in Seattle. It's not very easy to, We have the hardest place to go. I mean, it's one of the farthest distances from anywhere in the country. And patients have been really pleased.

[00:19:56] Dr.Grant Garcia: We've been doing this for, you know, six months. So anyhow, so [00:20:00] that's good for patients to know, like, how it works. Kind of behind the scenes. And it's easy, again. If, and again, what's, so what's the, so let's say a patient's listening to this, right? Or a doc's listening to it. Can a, can a patient, How does a patient, like let's say a patient wants to get one of these machines can they work through you guys or do they talk, can you talk to your surgeon?

[00:20:18] Dr.Grant Garcia: What do you guys recommend? What's the easiest thing? So

[00:20:21] Grant Kashner:: kind of it works both ways, right? What I always say is there needs to be an actionable event for which is a patient getting injured, right? Then, then what happens is that actionable event drives to a physician who writes a script for that, Patient right to obviously get surgery and then, you know, be fixed.

[00:20:39] Grant Kashner:: So it really drives from the patient side, right? The patient need. So that's really patients can get ahold of us and then physicians as well, right? We get a lot of surgeons that kind of, you know, see what you're doing, Dr. Garcia, right. And see what, you know, the guys at HSS are doing and see what the guys that, you know, resurgents are doing and see what, you know, kind of [00:21:00] the big clinics that really run very efficiently and very, you know professionally are doing and, and obviously want to copy it.

[00:21:06] Grant Kashner:: So mostly yeah, if patients want to rent it, they can, they can get in contact with us. We will get them in contact with the recovery shop who will service them. You know, immediately. That's another reason why we do such good work with them as I can send them a patient referral. And I know within 30 minutes, that patient's going to be contacted and you know, just have We'll have a very good service experience.

[00:21:33] Dr.Grant Garcia: That's important for them. And also for the patients, you mentioned something that's really important and it's, it's kind of confusing to think about it, but this is a rental guys. And I'll tell you why that's such a good idea because it sounds weird, right? You're renting a system and then you're giving it back.

[00:21:47] Dr.Grant Garcia: Right. But the, I own an ice machine and it's in my garage and I can't get rid of it. And, and I'm a Seattle guy, you know, we're [00:22:00] environmentally friendly here. And I've got a huge plastic thing sitting in my garage, and I know all my other patients have a huge plastic thing sitting in their garage. And so, they never get used again, or they get used once, or my friends take it from me and borrow it.

[00:22:16] Dr.Grant Garcia: And now you can rent something and you only get it for a couple weeks and then you can give it back. Which is great. And then it's reused. Essentially it's recycling, right? Which is awesome because you don't need this for, this is not a 10, 12, 14 week product, right? You know, for me, most of my patients are renting three weeks, four weeks.

[00:22:33] Dr.Grant Garcia: What do you think on average people for you guys are doing usually?

[00:22:37] Grant Kashner:: It all depends on case, right? So you know, for me that I had you know an ACL revision with an let, right. I was more in that eight. Kind of a six, eight week bracket. 'cause I was pushing it pretty hard in the rehab. Right. I'd say primarily most people are in that three week, right?

[00:22:55] Grant Kashner:: Four week, maybe five week range. And then scopes, you know, a [00:23:00] couple really what happens is the first two weeks are the pain control. Then once they start getting into pt, right. Just depending on how aggravated that kind of joint gets. Kind of deems how, you know, how [00:23:11] Will Sanchez: much,

[00:23:11] Grant Kashner:: how much they're going to need it.

[00:23:13] Grant Kashner:: But, but generally it's usually about two to four weeks. And just to add one thing to your point, Dr. Garcia, every patient gets a brand new wrap. So each wrap is a single patient use. I just wanted to clarify that. So that's

[00:23:27] Dr.Grant Garcia: important to remember. Yeah, no, no, no,

[00:23:29] Grant Kashner:: no. You get a brand new wrap super high quality four layer.

[00:23:34] Grant Kashner:: You know, air, water, and then the outside, you know, yep, exactly. So they're all ergonomically designed per joint or per site. And yeah, we keep expanding the wrap line. Well, I saw your video with our old ankle wrap, but we just brought on a new ankle wrap, which I was like, no, I wanted to get you that one, but [00:23:53] Dr.Grant Garcia: we'll get them up.

[00:23:54] Dr.Grant Garcia: We've got to give them an upgrade.

[00:23:55] Will Sanchez: Up. I want to say this. Listen, I don't know what these, these folks here are [00:24:00] talking about. Three weeks, four weeks, six weeks. I did not want to give it back. Okay. Because it was just like something was feeling a certain way. I had swelling. You know, you still kind of recover.

[00:24:13] Will Sanchez: You kind of go, I did not wanna give it back. I got my FedEx sticker to send it back, and I was just. Real sad face is putting in the bubble wrap and it just really folding it nicely. I was like saying goodbye to a friend. And then the first time I needed to use ice, I was angry. I was like these SOBs and I had to send it back. [00:24:37] Will Sanchez: So listen, yeah, send it back, utilize it. But the problem is once you get used to it and you utilize it and it's so simple and so effective that you don't want to give this back. So I don't, you know, I'm, I'm, I'm going off on a tangent here, but I was really angry when I had to send it back and disappointed my wife came with me to FedEx and to drop it off.

[00:24:58] Will Sanchez: So,

[00:24:59] Dr.Grant Garcia: so your, your wife's gonna [00:25:00] have to go with you cause it's a marital thing. Remember, right? With this nice

[00:25:02] Will Sanchez: machine.

[00:25:03] Dr.Grant Garcia: And then, and when you give it back, you're going to be sad. But when you get it, you're going to be happy. It's kind of a, it's a, this is a good, I like this part. So, yeah, I mean, basically what you're, what you guys can hear is that, you know, this, and the nice thing too, is like, Grant will say, when you work with these companies, the recovery, or, you know, just directly with you guys, If someone wants to keep it, they can, you know, they just extend the rental.

[00:25:24] Dr.Grant Garcia: It's not something you have to return, you know, and then re rent it or something like that. And what's cool is you guys keep coming out with new wraps, right? The, I like for my patients, the knee, we started doing a lot of straight wraps. Can you show the straight one over there? But then, you know, grants, like we have something even better.

[00:25:40] Dr.Grant Garcia: We have an articulating wrap. I think this is what separates you guys even more from the other companies too. Would you say, I mean, you have so many more options and it's customizable. I mean, you have a hip wrap. That's crazy. Right. Like I tried a few of these and they're really impressive. And [00:25:54] Grant Kashner:: that's kind of what what our company is built on, right.

[00:25:56] Grant Kashner:: Is innovation around, you know, we kind of saw [00:26:00] what Michael's really good at is seeing what our competition does and doesn't do well, right.

And they don't, they don't. They don't product innovate and they don't keep the, you know, the, the, the, the products moving forward. So the unit that we first produced in 2015, while it looks the same has probably, you know, 15 or so upgrades internally and slight, you know, slightly externally as well.

[00:26:25] Grant Kashner:: That we just want to keep upgrading the technology. Like we just put a brushless pump in there from a brushed pump. Right. Because the technology in the market is up, you know, is, is updated from eight years ago. And the wraps, that's another big area that we look at, right. We are bringing out ones that, you know, people aren't even really considering an amputee wrap, right.

[00:26:46] Grant Kashner:: A glove. We have an integrated. Solution with Aspen on their on their, on their bracing line where we can integrate cold into bracing. Right? We have a new ankle boot that fits into a boot Walker. So we're really [00:27:00] trying to to cover everything. Right? We have a new elbow specific come into the market as well.

[00:27:05] Grant Kashner:: That covers the distal bicep. So, like, we're really trying to look at, kind of the complicated stuff that not a lot of companies can cover. And really, really have good solutions for it.

[00:27:15] Dr.Grant Garcia: I think that's really important. What you just said, Grant, I think it's important. You said like the, sorry, well, I just say, make sure patients hear that.

[00:27:23] Dr.Grant Garcia: Like this is this product going to keep getting better too, which is awesome. And it's made for everybody. It's not like, Some things like the, you get two pads, right? It's like a back and that's it. And trust me, I had back and I was using a knee pad because there was no lumbar. There was no lumbar stuff.

[00:27:39] Dr.Grant Garcia: So yeah, I know it's, it's amazing. So anyhow, so keep going. Well, I'm sorry to interrupt.

[00:27:43] Will Sanchez: No, not at all. What you're saying is absolutely makes sense. I just wanted to kind of put up there and talk about what this is and just kind of describe it a little bit more for those that haven't used it. Right. So I alluded to that in the beginning, right?

[00:27:56] Will Sanchez: So you have this Pretty much it looks like a box. We've shown [00:28:00] it if, but if you're listening, just want to give you a description is a blue box. It has an led screen. You can set compression, no compression, how cold from one to five. So it gives you a lot of options, but going back to the no ice. What is, or how many ounces of water are you adding to the tank and what is the timeline depending on how, how long you use it, that you can keep, keep that on before you have to even add more water to it.

[00:28:31] Grant Kashner:: Sure. So great question. And we have a couple parts of the machine that aren't really, you know, pumped out there like that. And one being the water, right? It's nine ounces of water fits in the tank. Each wrap holds about, or, you know, let me use milliliters. Cause it kind of just converts a little bit easier.

[00:28:47] Grant Kashner:: 350 milliliters are in the tank, right? Each wrap holds about a hundred to 150 milliliters. So that's actually what we cool. And the other kind of. is extra, right? It's a [00:29:00] So essentially, unless th of, you know, kind of eva know, there's a couple of of the connector every on might have to put a coupl 2 3 months, just dependin hot it is outside, you kn Yeah, apart from that, the machine will actually tell you when it's too low.

[00:29:23] Grant Kashner:: And, you know, there are some, you know some machines in clinic that they probably, you know, because it's at a nice, in a nice cool area and, you know, it's been connected to the same wrap for, you know, forever. It's probably, they probably haven't put any water in it in, you know, a year or two. So.

[00:29:39] Dr.Grant Garcia: That's just amazing. That's amazing. That's just, I mean, that's just ridiculous. I, like, I felt bad keeping the water in there for like three days. Yeah, no, it's change it, but it's amazing what it can do.

[00:29:50] Grant Kashner:: And and for patients really the biggest thing, and I kind of touched on this, is it's the kinda the best pain control mechanism, right?

[00:29:56] Grant Kashner:: And it stays at a constant temperature. Now we have preset [00:30:00] programs on this and. Again, it's not one of those things that we pump out there, but if you know about it, then, you know, then the patients love it. So our preset timing programs have a 10 cycle memory. So that meaning we have you know, a 30 on 30 offsetting, which gets the patient 10 hours of runtime, 30 minutes on 30 minutes off without them having to touch the unit.

[00:30:20] Grant Kashner:: So for pain control at night, it's a game changer. Because usually to, you know, to heal, you need to sleep. Right. And if you can't sleep because of pain, you're usually grabbing for opiates, right? Because that helps you kind of leave the pain and sleep because this runs at that 10 hours of 30 on 30 off, your pain control mechanism is consistent, right?

[00:30:42] Grant Kashner:: And it's there every time so that you're not grabbing that three a. m. Right. Or, you know, you know, tapping your wife and saying, honey, yeah, go, go get me some ice. Fill this up. Exactly. Or

[00:30:55] Dr.Grant Garcia: pills or pills. So That's a huge thing. I [00:31:00] think that the opioid sparing is all over man, and it's a big deal, right? We've already we don't want to I don't want to go into the opioid pandemic and all the craziness But it's a big deal and for patients.

[00:31:12] Dr.Grant Garcia: I have so many patients that come in They're like I won't want to use a single opioid I'm like, well, I totally get it and I want to find every way possible. You know, I'm looking at all different alternatives. We're always looking for new technology to reduce that, but it's tough for these huge surges we're doing.

[00:31:26] Dr.Grant Garcia: I mean, the patients that benefit the most from the nice machine are the biggest surgeries. I mean, everyone benefits, but like my bigger, my more complex surgeries get a huge, huge, huge benefit from it. And I basically tell them it's just almost a non factor that they should get it right. But opioid use is humongous.

[00:31:43] Dr.Grant Garcia: And the fact is ice is so harmless and this machine's harmless. You know, again, I maxed out, I do ice bags and I've gotten some shoulder burns before on ice bags. And I had the nice machine cranked up. It felt just, it's crazy. It felt just as cold as the ice bag, but I didn't get a single concern about that.[00:32:00]

[00:32:00] Dr.Grant Garcia: Like I never, my wife at first was like, take it easy. Cause she knows I go all out with the ice and and, and I, I cranked that thing up to five and it felt just as good and just as relieving. But. Without the concern for the burn. And so that's why this 30 on 30 off.

[00:32:13] Will Sanchez: That's a big selling point right there.

[00:32:15] Will Sanchez: I think what you said right there, because sometimes we'll cheat it also, and maybe not use ice, but one of those ice packs that are kind of gel and that.

is a different type of cold. And if they, you apply that to the skin, you're having other issues, other complications. So that's another great thing to consider because for the same reason we're talking about either one, I can't make ice fast enough.

[00:32:42] Will Sanchez: I don't have the space in my freezer to buy an ice bag. Maybe I have some gel ice gel things that maybe I'm using something like that. If I use it, you know, I don't use it properly. I can cause skin irritations and things like that. So I think it's another way to kind of promote the technology and the benefit [00:33:00] of using the nice recovery system.

[00:33:02] Grant Kashner:: You actually just brought up a really good point that I don't think a lot of consumers or people know kind of about thermo kind of regulation on the skin. Right. So. If it's too cold, right? Meaning it's below 38 degrees, so the, so the nice goes to 42 degrees for a very specific reason, right? It's the coldest that you can get before you start to vasso constrict on the patient, right?

[00:33:25] Grant Kashner:: Which again, doesn't create blood flow, doesn't create the best healing environment, right? There's, there's a lot of reasons why you don't want it too cold. All the news, all the newest studies out of actually Nicholas Institute of sports medicine and technology in New York city, they actually did a bunch of trauma studies and saw the perfect temperature and the perfect kind of millimeters of mercury or compression level that created the, the, the best healing mechanism for the patient.

[00:33:52] Grant Kashner:: Right. And it's actually about 49 Fahrenheit. And about 15 millimeters of mercury or about our low [00:34:00] of squeeze. Right. And Dr. Garcia, to your point, everybody, especially athletes and just kind of high, you know kind of high motor individuals. We all, we want it cold, cold, cold, cold, cold, and squeeze, squeeze, squeeze, squeeze.

[00:34:12] Grant Kashner:: Right. But I

[00:34:14] Dr.Grant Garcia: put max on everything. So I'm just going to explain. I am definitely that person.

[00:34:18] Grant Kashner:: No, but it actually, all the. And we actually are hearing this now. It's funny how when we first came in, it was like, people were like, it's not getting cold enough. Right? And now everybody's like, no, we actually, it's perfect.

[00:34:28] Grant Kashner:: You guys, you know, it's kind of the best overall healing setting. So to your point, it's, you know, it's skin safe, it's, you know electronically controlled, right? By software on the, on the temperature. And, yeah, it really is for those big surgeries. I've had a couple absolutely massive ones just from being injured, you know, doing extreme sports.

[00:34:49] Grant Kashner:: It was I was shipping it around when I was flying to meetings and everything. I was overnighting it to hotels because it literally was the most important piece of equipment. And I was [00:35:00] like, you know, I was like, thank God I worked for this company because I'd be, I'd be running the, I, I mean, I, I would have bought one by now.

[00:35:07] Dr.Grant Garcia: Yeah. Well, I mean, it's, and also, but it's important for the listeners to know, I, I wouldn't recommend like taking this on all your trips with you. Cause it isn't, it isn't super small, but it's actually pretty easy. It's so light. I mean, how many pounds is it? You said nine pounds.

[00:35:22] Grant Kashner:: Yeah. And it comes in a carry case, which you can carry on.

[00:35:25] Grant Kashner:: Don't check it. Right. Just carry it on as a second carry on, if

[00:35:29] Dr.Grant Garcia: you need to. Yeah, it's not bad. I mean, the thing is, I've you guys ever carried one of those ice buckets? It's like so heavy, filled with water and ice. So, I mean, this full is still not even that heavy. So it's great for people, especially, you know, any type person can bring it around and carry it.

[00:35:45] Dr.Grant Garcia: Well, and pro sports, right?

[00:35:47] Grant Kashner:: So everything else is pretty big. So we do really well with pro sports because and college and high school because there's no ice in the dorms. It's really hard to find ice on the road, on the, in the hotels, on the team [00:36:00] bus. On the team plane. So we do really well with any, you know, teams that are traveling or people that are traveling that you know, kind of are needed, are, are needed.

[00:36:12] Grant Kashner:: The technology on the road as well.

[00:36:14] Dr.Grant Garcia: That's an awesome point. Remember I would do the training room for, you know, giants and the Mets, et cetera. And like, there was just like ice flying off the handles there. And like every guy wanted ice, but I can imagine that like, that's kind of the old way of doing things.

[00:36:29] Dr.Grant Garcia: You know, you get a couple of these machines and you know, the major leagues. or the NFL and it's so much easier just to throw it on and you can run it so much longer, you know, like the, you know, they, these pictures they'll come out and they got like an ice here, ice here and it's, and it's just not, it's not efficient.

[00:36:45] Dr.Grant Garcia: Right. And if they're, they can't do that on the plane, cause it's going to melt. Well, and that option,

[00:36:50] Grant Kashner:: it's really important to get the relief when you're needed, right? Like even, even a quick 20 minute session without having to, you know, fumble with ice, especially if you're. [00:37:00] Let's say you're on the road, you're moving around, right?

[00:37:03] Grant Kashner:: You're kind of six, eight weeks, 10 weeks out. Right. And that thing gets inflamed. Just having that machine there and the confidence that you can just hit a session quickly and not have to worry about it was the biggest confidence booster as well. Mentally coming back from an injury. And I think that's slept on a lot too.

[00:37:20] Grant Kashner:: And kind of forgotten is like kind of the mental battles that go along with injuries. And the pain and the, you know, the, will I get back to doing what I want to do and be where I want to be? And you know, alleviating the pain and at least getting, you know, range of motion and starting the PT process and having the, the post op process a little bit smoother is a major game changer as far as the mental, you know that's something that also really isn't talked about in the surgery.

[00:37:46] Grant Kashner:: It's always like no opiates, make sure you're doing this, but it's also like, Hey. you're, you know, that, that after surgery, you're feeling good about, you know, kind of getting back to where you want to be.

[00:37:58] Dr.Grant Garcia: Oh yeah. I mean, I, I tell [00:38:00] patients now I've gotten so used to the, I'm like probably 35 percent therapist now in the, right.

[00:38:06] Dr.Grant Garcia: Like I do a lot of surgeries, but I'm it's therapist. I mean, I tell patient, I'm like, you're going to be back in seven months, but this is not going to be back for at least a year. It's hard. And I think But one thing that's really nice about this option, just like so many other stuff we talked about is it gives patients the confidence that you're really invested in their, you know, their non opioid presence, recovering faster, because like, a lot of these patients, they come in and I try to, I got a lot of stuff on my website and everything else, and so they, you know, they know that I'm thinking about other things, but it's good for them to be like, you know, a lot of people get in the surgery and they're like, all the surgeon cares about is surgery.

[00:38:40] Dr.Grant Garcia: I am going to operate, I am going to fix you, I am a machine, and then you're going to be done with me. Right, that's the concern, that's the fear of like half my, I mean I do so many second opinions because of the fear of machine. It's a huge problem and listen, I'm not going to lie. I love surgery. Okay.

[00:38:59] Dr.Grant Garcia: I love [00:39:00] fixing people. But at the same point I really like people when I fix somebody, I want them to feel totally safe and confident and I want them to feel that they're getting the best care possible and that I'm not just another person churning out a patient in the office. I'm there to, I want to see them the whole way.

[00:39:14] Dr.Grant Garcia: You know, I have patients come by. Every week, someone goes, are you going to see me after surgery? And I'm like, did someone tell you that that wasn't going to happen? I was like, I see everyone as much as I can because I want to make sure you're doing well, right? And this is one of those things. I want to make sure patients do as well as possible.

[00:39:29] Dr.Grant Garcia: So offer the most innovative technology in the operating room, offer the best prehab, and then offer the best stuff postoperatively. And this is one of these options for them. And it's, it's important for me because less opioids, they have less pain. They have the less, they have less marital issues. They have less comfort, you know, all these things, right?

[00:39:48] Dr.Grant Garcia: Well,

[00:39:50] Will Sanchez: Oh yeah, I've got a two part question for you. Are you doing anything for kids sizes? Has there been any studies that, [00:40:00] you know, you say, okay, well, we're working on kids sizes and also this is the age that's appropriate. Like, so have you gone down that road yet?

[00:40:08] Grant Kashner:: It's actually a really good question.

[00:40:10] Grant Kashner:: And we, we, we, we have, to some extent, we've started down that path. And it's kind of stemmed from a couple of things. One is our HSS peds department. Right. We get a lot of, you know, unfortunate, you know, but, but, but fortunately for us, we can start to get ahead of it, right. And we can bring out products that really fit that age.

[00:40:31] Grant Kashner:: Mostly it's about 12 and up. Right. It's. But it's the smaller and, and not even peds. It's just kind of, you know, smaller people and even smaller, old, you know, ladies in general. And, and mostly the shoulders, right? We can, we can, we can fit a leg, we can fit a knee, we can fit an ankle. It's the shoulders and the hips that are the kind of the biggest target areas for us.

[00:40:53] Grant Kashner:: And that's really something that shoulders primarily we are focused on first, then hips, [00:41:00] everything else we can kind of maneuver right now with our current wraps. But we like to kind of, again, gauge the need. We love to work with, you know surgeons and facilities and, you know, orthopods that say, Hey, What about this?

[00:41:15] Grant Kashner:: Right. And something we haven't thought about or looked at, right. We, we can produce it and we can produce it pretty quickly. Or if we need to make changes, right, we have it, we have the process dialed so that that's a big, going to be a big focus of ours. Moving forward as a, a big peds line. It's exciting.

[00:41:31] Grant Kashner:: And

[00:41:31] Dr.Grant Garcia: that's so important. What you just said. I think the, for the surgeons listening and for the patients, you know, this is not just a product, like a machine that just pumps cold, this is more. This is the sales experience. This is the concierge aspect. If you have a problem, you can call them. This is working with surgeons who know what they're doing, working with the partnerships like recovery shop, but finally feedback, right?

[00:41:56] Dr.Grant Garcia: I've done so many, we've done so many company discussions [00:42:00] on this thing. And you tell somebody something and it just goes in one ear and comes out the other. And the fact is like, what you're saying is like, we listen to feedback. You know, the HSP is guys, that's where I trained. Right. They do so much peds and I, in my practice now I do 12 and up as well.

[00:42:14] Dr.Grant Garcia: And so for those patients, you know, you don't want to feel like they're underserved and this is not, this is a good way a kid could use. This is not a dangerous product. It's just more of the size fitting, right? Like anybody can use this. There's nothing, there's nothing kids have, I kind of have ice on their bodies and kids do stupid things with regular things.

[00:42:30] Dr.Grant Garcia: So this is not a dangerous product. Trust me, I have kids. So this idea, it will knows this too, but anyhow, the, the, the point being is that It's nice to hear that you guys are like, we just keep hearing this more innovation and this product, this, something, this is simple, right? It's a, it's a box that's got amazing technology in it that makes things cold and compresses, which is a phenomenal, but it's more than just that.

[00:42:51] Dr.Grant Garcia: It's like so many other things that are important that people don't think about, right? Like, what about a small arm? What about an elbow?

[00:42:57] Will Sanchez: Those are

[00:42:57] Dr.Grant Garcia: coming, right? Those, all those things you guys keep continuing [00:43:00] to improve. And it's just, it's just awesome. And, and we're looking forward to, you know, the, the next year or two and seeing what more is to come.

[00:43:07] Dr.Grant Garcia: Oh yeah, we got a lot under the hood. But we'll

[00:43:10] Grant Kashner:: add something to your kind of point you said before, right? It's, you know, you're, you're also a therapist, right? You fix the patients mentally, physically, all of that. And we hear that frequently on our side too, is that, you know, if you call us, you're going to talk to a human.

[00:43:25] Grant Kashner:: Right. You know, you, you know Dr. Garcia, you can text me and I'm gonna reply quickly. Right. It's like, and, and, and patients have that same experience, right? It's 'cause we, well we've been patients ourselves first, right? It's founder and CEO owned from an injury. So that really matriculates through the entire company where.

[00:43:45] Grant Kashner:: We understand the patient experience through and through, and you really feel that in the company and the products and how we treat people. And, you know, it kind of just perpetuates the whole company. And that's why we, you know, really, really like working with surgeons like you, dr. Garcia, [00:44:00] because, you know, we align so well.

[00:44:02] Grant Kashner:: Just in our basic ethos and the way we do business and the way we, you know, want to treat people. And that's really important to us from a medical, you know, I know we're a medical device manufacturer, but just as a, you know, a company and as, you know, as a person as well we like to work with good people and treat people well.

[00:44:19] Dr.Grant Garcia: I mean, I wouldn't call, you know, the thing I want to take your listeners see is, is we talk about a lot of different device things, but the mentality here, that one reason I like working with. Them so much. I think the patients like it is I do feel like it's a patient first mentality And that's a challenge to find all the time as will and I've talked about in the market.

[00:44:35] Dr.Grant Garcia: You know the ability like You know, you're coming out with all you don't have to make all those things A lot of these companies just make three pads, right? There's no reason you need to make a baby elbow pad No. Right. There's no reason for it. You still sell a lot of stuff and you do well financially, but that's not big deal. [00:44:50] Dr.Grant Garcia: Like, that's not the part, part the purpose for you. Mm-Hmm. The purpose is you, is you want people to feel good about it and do well, and that's why you have a product like that. That's why you guys worry about the, [00:45:00] the temperature you can do and you don't wanna max out here and you want to educate and things like this, the podcast so people can understand what it's all about.

[00:45:08] Dr.Grant Garcia: Right. It's not just a little box that does compression. There's more to it. There's so much that goes behind it. And to, you know, to hear there's constantly being updated. It just makes people feel good. Right? Like you don't want something that's been stagnant. You don't want old technology. Patients don't want that.

[00:45:21] Dr.Grant Garcia: At least the ones that I deal with. And they want to know they're getting something that's updated and better, and that's what they get. Do you, do you want to last, I guess, one more topic and then we can go and maybe quick future stuff. Do you, for any doctors interested. And using this, what do you recommend?

[00:45:36] Dr.Grant Garcia: I know we've talked about the recovery shop. That's an awesome outlet. So again, guys, check it out. And they work really well with the nice team. If someone wants to get involved and make sure they offer this product, cause I have a feeling after this episode, we're going to get a few. What do you recommend?

[00:45:50] Grant Kashner:: So I would say let's, we love to obviously get the product and like you guys, right? Let your, your experience. I want to put the product in your hands, make sure it works well for [00:46:00] them. They love it. Their patients love it. Their staff loves it. Right from there. We can figure out the details about the rental piece and how we figure out, you know, how we get it delivered.

[00:46:09] Grant Kashner:: That's usually what I like to start with is. Either, you know, contact me, go through our website and let's get you a demo. So will you wanna [00:46:16] Dr.Grant Garcia: put the website up one more time? There you go guys. Yep. You have a,

[00:46:19] Grant Kashner:: A form on there you can fill out. And again we like to start with a demo. Just to make sure you know, you like our company, you like our product, right?

[00:46:27] Grant Kashner:: We we align well, and then from there we can figure out kind of all the details in the middle.

[00:46:33] Dr.Grant Garcia: I like to say if you guys, if you guys liked it from the podcast, make sure you drop the podcast in your likes. So that grant knows, you know, you heard it on here so you have some background information.

[00:46:42] Dr.Grant Garcia: So again, you heard it from us here. Go to the nice recovery if you're interested and let 'em know what what you want to know. 'cause so I think practice and Dr always

[00:46:50] Grant Kashner:: go through you and you can connect us. You know, we, you know how to get ahold of me, whatever works as well. So yeah, whatever works. [00:46:56] Grant Kashner:: That's awesome.

[00:46:56] Dr.Grant Garcia: Yeah, you guys can reach out to us at wws sports do com. Doc. com. If you're [00:47:00] curious again, all outlets, we like to make sure I listen, I'm a competitive guy, but if every single person in the whole world got, got access to all this stuff, that's all I care about to me. I care. Number one, that your patients get this and they have access to this.

[00:47:14] Dr.Grant Garcia: I get no benefit from selling nice machines. All right. I'm getting no cut from this. I just think it's such a good idea. And like, I care way more about all this technology, you know, 99 percent of the stuff I talk about a hundred percent, I get no cut on it, but all I care about is that the patients get it.

[00:47:28] Dr.Grant Garcia: Do better. And they hear about this stuff and that, you know, either they come to me and offer it, or they go to somebody else that can offer it again. I'm not here to ask you that the only person that offers in the world is someone like me. There's tons of people that can offer it and anybody can. And so it's really important for people to know that.

[00:47:43] Grant Kashner:: Well, no, and I, I appreciate what you guys are doing here and sorry. Well, you can, but. I always tell people, right? It's the information's free, right? The, the app, you know, the the implementation is where it costs you. Right. But you guys do such a good job of being subject matter experts on [00:48:00] the information side of this niche that we're in that for patients, for surgeons, for, it just adds to your brand and your, you know, your expertise, right?

[00:48:10] Grant Kashner:: It's like, you know, about all the other elements of surgery around it. So obviously you probably have studied exactly what you do very well too. Right. So that's where I think, you know, apart from, you know, there's no monetary benefit, but you're the, the, I look at it and I say, wow, you know, from a patient standpoint, that would be a surgeon that I'd want to go to, and I've had five orthopedic surgeries myself, unfortunately.

[00:48:37] Grant Kashner:: So I look at the docs that are really pushing it because I'm like, They're really looking at all the elements for the patient, not just cutting, right? They're really looking at the holistic approach, underst, and that is so important in today's day with. With surgery and with the patient, you know, with, with the patient satisfaction.

[00:48:56] Grant Kashner:: So that's all I'll say on that. You guys are doing a great job. [00:49:00]

[00:49:00] Dr.Grant Garcia: We got to keep this. I knew we were going to go to an hour. Will, every time you say we're not going to go to an hour, we're going to go to our, we got to have one more last quick thing. We got to get Grant out of here. Show us the new technology coming really briefly.

[00:49:11] Dr.Grant Garcia: And then we got to go.

[00:49:13] Grant Kashner:: Okay. So this is coming soon. It's our first retail product. Quickly. The on the most efficient way. To, to cool. To cool. Your core temperature is through special nerve endings, which are in your, the palms of your hand, the bottom of your feet, and the back of your neck, right? So long story short the only reason that your muscles fail.

[00:49:36] Grant Kashner:: Right during workouts or, you know, running, sprinting, lifting, everything is because of heat, right? They get too hot and the heat causes them to fail. So if you've ever done a set of bench press and you feel that pump out feeling, it's because ATP is, it is not being delivered to the muscle anymore because it's too much heat being delivered.

[00:49:55] Grant Kashner:: So that being said, what this does, it's called the rock, right? It's a [00:50:00] palm cooling device. And again, there's so much around palm cooling on Huberman, Rogan you know, Dr. Craig Heller out of Stanford across the board, everybody, you know, all the girls basketball teams in the final four, the Duke men's basketball team, baseball team, everybody's using palm cooling because of the performance benefits.

[00:50:17] Grant Kashner:: So traditionally on the market, there hasn't been a good delivery of the product, right? So what we do really well is we deliver precise colds. In a very slick and innovative product that does it very well. So the, the rock does that it gets to a targeted temperature and stays there and the performance gains around it are insane to say the least.

[00:50:39] Grant Kashner:: So everyone we've given it to, it's been. We're, we're, we're, we're, you know, we're trying to keep it behind the curtain before we do a full launch on it, but you guys are the first, not anymore. Now to actually see, I know you, you're the first ones to actually see the product, so

[00:50:55] Will Sanchez: there you go off and running there. Before we before we wrap it [00:51:00] up and, we want to promote and go check out nice recovery dot com. And if you do go to the webpage, please check this page out and try to explain to everyone what is going on here. With all of the dogs before you grant. What is happening on your web page for those that can't see it, the entire team, including Grant and Michael Ross, the founder, they all have this beautiful dog in their hands and this is their picture, their team picture, their individual picture.

[00:51:36] Will Sanchez: Whose idea was this? How did this come about? I have to know before we let you go.

[00:51:41] Grant Kashner:: So we no, it's great. Right. We, Michael, our founder, right. He's he, he loves to, you know, kind of do things, you know, kind of a unique and special, you know, kind of way. Right. And he doesn't like to do things stuffy and didn't, you know, he wanted to put team pictures on there in a way that really [00:52:00] represented our company well, and he got a puppy.

[00:52:02] Grant Kashner:: And the puppy is obviously as, you know, as cute as it gets. So we had a round of pictures with the puppy. And yeah, it's been a big we actually hear a lot about the pictures. So I think, you know, we're a boulder company, so we're very into our animals. You know, we have, we have, We have dogs in the office frequently.

[00:52:21] Grant Kashner:: So it just kind of fits our brand and we want it to come off as like, you know, it's like, we're a patient we're, we're, we're not a stuffy medical device company. Right. We'll, we'll actually talk to you like a human. We'll ask what you're like, what surgery you haven't done. Right. What's, what's going on?

[00:52:36] Grant Kashner:: Do you have somebody taking care of you? What do you have somebody, you know, like, like we actually care about the, like. You know, the the details. So having a puppy kind of, you know, I guess shows that we have at least a softer side and we're not you know, a traditional medical device company. We, we love

[00:52:52] Will Sanchez: it.

[00:52:52] Will Sanchez: And we thank you so much. Grant Kastner CCO at nice recovery system. Thank you for taking some time and being a part [00:53:00] of the show. We really appreciate it.

[00:53:02] Grant Kashner:: Yeah. Thank you guys. This was this was great. So I, I really appreciate you guys having me on.

[00:53:08] Will Sanchez: Dr. Garcia. What can we say, man? It was absolutely fantastic.

[00:53:13] Will Sanchez: Having Grant on and we're listen, man, we, we, well, we say we do it less than an hour, we got to get to less than an hour, but there's so many great things to talk about. We have so many great guests that is hard to, and you know, it's just one of those things, but we both love the product. This was easy.

[00:53:31] Will Sanchez: This was like. No homework needed for this show.

[00:53:34] Dr.Grant Garcia: So much homework on these shows, but not this one. This was,

[00:53:38] Will Sanchez: this was an absolute layup. I don't know how we coordinated with all the green that's going on. That's not Celtics fans.

[00:53:44] Dr.Grant Garcia: We're not Celtics fans,

[00:53:45] Will Sanchez: Celtics fans. And as we wrap it up, man, we always like to let everybody know, check us out at sports.

[00:53:51] Will Sanchez: talk. com. You have Dr. Garcia's face there with a nice little purple tie represent his, his colors. But more [00:54:00] importantly, we have our podcast.

We have our transcripts of the show. We have absolutely everything. He mentioned that you can find information on the nice recovery. com. All of that stuff. So, I mean, who better to explain it?

[00:54:13] Will Sanchez: Last words, Dr. Garcia, because I'm going to jibber jabber all over the place. How do you want to wrap up this show as we say goodbye?

[00:54:20] Dr.Grant Garcia: Well, first off, it was awesome guests. And as usual, we got close to an hour and it was just too much fun. The product's awesome. You can find everything, like you said, on our website and you hit, there's a link that goes to my main website and you can find the recovery shop.

[00:54:35] Dr.Grant Garcia: You can find my accelerated recovery stuff and we'll have this podcast. For the nice, in addition, you can find ways to access it and, you know,purchase it and find their website. We have, we want to make this easy for patients. We want to make it easy for surgeons. They want to get involved. Again, no cut from us.

[00:54:50] Dr.Grant Garcia: The key here is just so you get the best possible options and you hear about the products. Again, all orthopedics, all sports, all the time. That's what I want our patients to have and hear the most [00:55:00] cutting edge technology. So thank you.

[00:55:02] Will Sanchez: Yeah. And think twice before you give the nice recovery nice package.

[00:55:05] Will Sanchez: I, I should have just kept it and just avoided his phone calls. That would have been the smart way to do it. Now I'm all disappointed. Thank you, boys and girls and everyone else. We had a great show. Thank you for listening to sports doc talk. Thank you to our guests, Grant Cashner there and nice recovery.

[00:55:23] Will Sanchez: And we'll catch you next time. Bye. Dr. Garcia.
Audio Transcript

ACL Injury, Surgery and Biologics

ACL Injury, Surgery and Biologics

[00:00:00]Welcome everyone and thanks for listening or if you're watching on YouTube. Thanks for watching and listening to Sports Doc Talk. I'm Will Sanchez along with Dr. Grant Garcia. Dr. Garcia, what is this? It's just a party of two. Normally we've been having all these great guests and uh, and today we get a chance to uh, Catch up, do a one on one and really kind of do a topic that is near and dear to your heart.

[00:00:30] How are you, Dr. Garcia? I'm good. I'm, you know, we've had, like you said, so many good guests, but you know, it's time for us just to hang out. You know, we haven't done this in a while. You used to do this pretty much all the time. Uh, and we've had some phenomenal guests. Um, and you know, people were getting tired of just hearing me and you talk all the time, but I FaceTime. 

[00:00:49] So this is good. Uh, this actually, this topic, Um, while near and dear to my heart and we get lots of patients asking about it, it was actually a patient [00:01:00] request. So we had someone go through the website. You've seen we've had a couple of those we've presented on recently since we've had the new sports stock talk website and you know, the patients actually, uh, it's actually a patient of mine, um, but they went separately through the website to ask this question and I thought it was really good because. 

[00:01:17] Especially the patients for me, you know, we see a lot of local patients. We have patients that drive three or four hours and then we have patients and this patient is actually from out of the state. And so they'll come from out of the state and they want, they want something different, right? Like, you know, They don't want to fly up for surgery and say, Hey, listen, I want to go fly to you. 

[00:01:34] You know, you do, you do a decent ACL or whatever, but they want to know like, is there anything else you can do? And in some cases there is sometimes there isn't, but they, you know, they want to ask those questions, right? Cause they haven't, they feel like there's more out there. They've done research, they've done Dr. 

[00:01:48] Google, which we know is never the best thing. Um, but it does help in some, it does help in some aspects because I think the problem you have is you don't always know what you don't know. And you don't know what the surgeon doesn't want [00:02:00] you to know, or you don't know what's available and what options are. 

[00:02:03] We've already seen different ways of doing ACLs. We've seen different ways of doing ACL repairs. I mean, even in the city of Seattle, if you went to three different doctors, two of them may never even bring up the word repair. And so it's important for people to have all these information. It's also why it's important for second opinions. 

[00:02:16] But I think the point here is biologics is in its infancy. And it also matters about how you ask the right questions. So the thought is, you know, they've heard about the repairs, they've heard about bear, they've heard about ACLs injuries. They've read about this thing called bio ACL, which we'll get into in a minute. 

[00:02:33] And we've actually talked about on the show, just a different name. Um, You've heard about bone marrow, you've heard about PRP. So we're gonna talk about like, how does it all integrate together and kind of work our way down from the basics to more complex. Um, and hopefully the listeners will learn a little bit on the way. 

[00:02:48] Yeah, it's, uh, like we said, it's right up your alley and, uh, you know, talking about, uh, you know, our ACL injury surgery and biologics, uh, event. And as we get it right before we get into that though, I'm kind of backtracking a [00:03:00] little bit here. You know, we're six months into the new year and we had, uh, you know, uh, Dr. 

[00:03:06] Acevedo and Bashai and, uh, uh, Dr. Jazieri and, and, you know, with his peptides and different techniques and, uh, whether it's Leah Winter, which was at the end of 2023 before we started 2024, uh, just kind of reflecting, uh, already just the tremendous amount of shows and, and we have some great guests lined up. 

[00:03:29] As we, you know, Oh my God, head into the summer. And next thing you know, it'll be fall again. And the kids are off to another grade and, but I'm getting ahead of myself. So let me just kind of slow down a little bit, but I think it's just a great reflection to just to thank the audience members, to thank our guests. 

[00:03:45] That have listened, watched, and been a part of the show that have reached out that want to have these conversations. And we just want to thank you. And whether you're watching us on YouTube, check us out on Spotify or Apple or any of your favorite platforms. So I'm just giving a [00:04:00] quick, you know, tip of the hat. 

[00:04:01] And if you're watching right now, I'm tipping my little hat right over to, to all the fans and guests. And just thank them, uh, anything that you want to add there before we get into talking about ACLs without surgery and all this good stuff. Yeah. So, I mean, it's just. Yeah, the guests have been phenomenal. 

[00:04:18] We have more to come. You know, I think one thing we've heard, I've heard a lot from actually from other orthopedic surgeons I've talked to, or other people in the industry, medical device companies, et cetera. What they like, I think most about the podcast, which we didn't think about originally was, While it's all sports, all orthopedics, that doesn't always mean surgery. 

[00:04:37] We're talking about innovation, nutrition, talking about how other people deal with interpersonal stuff. I mean, Acevedo and Bechet are two of some of the best surgeons I know, and they didn't spend most of their time not even talking about the surgeries. We talked about how you prep for surgery, all the behind the scenes stuff. 

[00:04:53] I mean, this show is keeping it real. You've heard so much stuff that you will not hear on many places and [00:05:00] getting to hear how it works behind the scenes. We had the tech. You know, the tech show, obviously with us, you know, that people don't even hear about that stuff, right? You may be here to the cocktail party. 

[00:05:09] If you happen to run in and be, be with a surgeon, they've had a few drinks. Maybe they'll tell you the truth. Um, but you know, the, the thing is it's, it's a really exciting, um, and there's more to come and you're going to see other things that you're not expecting. Right. Other guests that are, maybe you're not surgeons. 

[00:05:24] Right. That are going to come in and they're going to have topics that are, that are important for orthopedics or sports, but maybe not always surgery involved. So anyhow, we're getting off topic again, like we always do. And we're trying to keep, that's okay. It's part of what we do, but going back, Hey, check out the tech trends unveiled. 

[00:05:39] That was a great episode. And let's give a shout out to Dr. Schaefer. Right? He was another guest that we had on. Just so many. So if we forgot anybody, just, we're always thinking about you. But right now we just, you know, kind of jumping around, but let's talk about this ACL injuries, surgeries and biologics. 

[00:05:57] And the first thing, when you sent your notes over to [00:06:00] me was like you, like you mentioned, to start the show. This was a request. This was someone that wanted more information about it. So when we talk about A. C. L. Injuries that heal without surgery, um, can you start with, like, primary repair? Like, what does that entail? 

[00:06:17] When you when you think about Or, or when you're discussing primary repair when it comes to these ACL injuries. Perfect. So we'll go one step back further. So there's a lot of hype. You may have seen the articles. You're looking at your Apple news and you see ACL repaired without surgery. Magic, right? 

[00:06:34] They'll get like 200 MRIs. It's usually a European, European study and no offense to the Europeans, but you know, they, they, they tend to have, it tends to be, I know a different different data sets, at least for some of these things. Um, and it's in a journal you've never heard of. And they're saying, hey, they repaired all these ACLs. 

[00:06:52] You gotta be really careful about this because it's someone that does a lot of ACL repairs now. Um, you know, when I get in there, I pretty much I've never been in one where I get in [00:07:00] there and all of a sudden the ACLs completely stuck to the wall and I don't have to do anything to just kind of attach it like we talked about with the tightrope and it goes back there. 

[00:07:07] I mean, I was had one last week and I said, there's absolutely no way this would heal on its own. You know, these ACLs, they were tracked. Imagine like recoil, right? There's a springiness to the ligament. And so when they tear, they recoil. So while they're still stuck on the wall of the, the femur, they're pulled back. 

[00:07:23] And when you stretch them out and retighten them, it's amazing to see how they go right back into the orientation of when you see a normal ACL. Because we do a lot of surgeries on people that have normal ACLs for other reasons, since we, we know what it looks like anatomically to be normal. And so you got to be really careful because the idea of it healing is not the case now maybe in patients with partial ACLs. 

[00:07:44] So that's a different topic and we're not going to go too much into it. But partial ACLs or sprains are actually fairly common too. We see probably, I would say maybe out of one out of every ten ACLs I see is a sprain. Now again, I'm seeing more surgical ACLs. It's a bias to come to the surgeon with a [00:08:00] surgery ACL, but people that sprain their ACLs, we see a lot, especially my team, you know, Tim, the teams I cover and everything, because they're coming to me regardless of whether it needs surgery, um, these partial ACLs where it's like either a partial bundle or it's just a little bit of a stretch, you know, those are ones that sometimes can get away without surgery. 

[00:08:18] And I tell patients maybe 30, 40 percent of patients may need surgery at some point and sometimes it's lower, you know, you never know, it depends on the amount of injury and that's where biologics, you know, such as potentially PRP, which is where we take your blood and spin it down or bone marrow. We take bone marrow out, maybe helpful again. 

[00:08:36] We don't have a lot of data on it. They've looked at ACLs and PRPs for sprains and the data does show that some studies show there may be some slight benefit. And others show nothing at all. So it's something to be aware of now doing PRP when you acutely injure it. There's no downside. We'll talk about these biologics. 

[00:08:54] There's no downside to biologics except for the cost. And not covered by insurance. Like me just really, it's the platelet [00:09:00] rich plasma, which is the PRP. So if anyone's listening, doesn't know what dr Garcia is mentioning, uh, like myself, as I'm, you know, I'm just a, uh, doctor on the radio here, but platelet rich. 

[00:09:13] plasma. Um, for the PRP people out there. So I'm sorry to interrupt Dr Garcia. Go ahead. No, that's perfect. And that's a good segue. You get, it's important to mention that. So anyway, so the PRP or the platelet rich plasma, the bone marrow aspirate, which is from your bone marrow, like your hip, your knee, you know, we can take it from all different places. 

[00:09:29] And the idea is in the acute phase, you give that to somebody and maybe to help them heal. Now, like I said before, data's mixed. So that's the, that's the idea. That's on the non surgical, maybe biologics options. And that's something that people can try again. There's no downside except for the cost. So, you know, depends on the place you go. 

[00:09:46] But there's a cost these things and they're not covered by insurance. So if you have to be aware of that, you know, that does change the aspect and that's important to bring up. It's just like the Tech trends, you know, all these sexy biologics we're going to talk about. They are not covered by [00:10:00] insurance and it's different than like implants. 

[00:10:02] So like if you have an implant, it's all bundled in the price, right? So you can basically like sometimes it's more expensive and it's something that won't, it can't be done because it's just too expensive. The surgery won't cover it. Your insurance won't cover it. And there's no way to get around that with biologics. 

[00:10:18] It's never covered by insurance and there's no way to get around it getting covered by insurance because basically, They're expensive to do. And so the patient has to be on the patient's own as to do it. So understanding all this stuff sounds really great when it comes to the biologic side, but people who ever get these are paying out of pocket extra for them. 

[00:10:36] Real quick. Is that something also that the insurance can, uh, find a way to excuse saying, You don't really need this or you might not need this. We can treat this differently. It may not be at the level of biologics, but you know, fine. We can put a bandaid on it. It might not be the, the, you know, nice H wrap band to hold it together, but [00:11:00] it's still as effective. 

[00:11:01] Is that their way of kind of working around, you know, uh, paying for some of these things? Yeah. So the, the, we still use codes, like I told you before. Yeah. Uh, for these, these biologics as a PRP code, there's a bone marrow asper code, but they're considered experimental and Don't get scared by the word experimental because it doesn't mean you're being experimenting on and no one's ever done this before It just means that's the insurance company's way of saying we're never paying for this There's not enough And and the good news for you is you can actually pay for it because in some of these things Yeah, we've talked about some of the implants They're so expensive that an insurance company will never pay for them by contractual rules. 

[00:11:38] You're not allowed to pay extra So then you're just, you're just stuck. You just don't know. You just never get it versus this. At least you can get off. There's no contractual rules that you can do it. So that's the one thing. And it's, they're really safe. I mean, there's no downside. Like I said, to most of these things, except for the cost. 

[00:11:54] We're getting sidetracked on that, but just to have patients hear this, uh, you know, that's how it works. Um, [00:12:00] but basically talk about repair. So, you know, we talked about this before and you could bring it up, you know, my favorite, which is the tight rope repair, um, for ACL. So, uh, Let's say you decide you want biologics or you're like, Hey, I want to biologics and I need my ACL fixed. 

[00:12:14] Well, obviously in one of the, the, the, our, um, our request was how do you save proprioception? So the idea behind the repair, we've brought about this about a million times now in this podcast is that if you save the ACL, these patients, they, I'll tell you, I done a lot of these, I'm up to like 40 or more. 

[00:12:31] And we just, we just flew down to San Diego to teach about this. So, you know, this is a hot topic. We fix them with this device. And they, if you know, when it goes on to heal their, they can, their knee feels better because of the proprioceptive things are saved, right? When we do a reconstruction and we're removing all of that, or a lot of it, as much as the doctor tells you to try to save as much, you can't really do a good ACL reconstruction by keeping the entire ACL there. 

[00:12:57] So the idea is you're saving some of the proprioceptive receptors, [00:13:00] which is important for certain people. Um, if it heals and then, you know, there's less, less stuff that comes out. You're not making a big a bone tunnels. And there's less pain. You know, the patients are doing a lot. They're doing, they're feeling different. 

[00:13:14] That being said, not everybody's a candidate, like I brought up before. I would say, I do a lot of ACLs, so I'm probably done, you know, if I'm doing probably one every six or seven, now my indications keep getting a little bit broader as I get better. Do more of these and I see, okay, this group is doing really well. 

[00:13:29] I'm going to broaden a bit more. This group is doing really well. And I'm going to keep going slowly, so I do this appropriately. Because again, I told patients before, I'm not here to experiment, but I want to give them the cutting edge stuff. So, what people don't understand is they always ask, you know, they ask for biologics with this too. 

[00:13:45] They're like, hey, what else can I do? Like, ACL repair, that's great. Like, that's old news. Right. We're onto new, new stuff. What's the newest thing you can do or what they don't realize. And you can bring up this little, the little pick device is that whenever time we do a repair, whether it's a bear, an ACL repair with the tight [00:14:00] rope, a combination of both, we'll get into that in a second. 

[00:14:03] We use this device. This is a, this is a power pick. There's other ways of doing this too. And basically what we do is we make little holes. in the bone where the ACL and the PCL sit. And we actually do this for meniscus tears as well. And this brings bone marrow in. So it's actually covered by insurance, this procedure. 

[00:14:19] So that actually is nice for patients because they're not paying out of pocket for the PRP, which is the platelet rich plasma or the bone marrow. And there are people that are looking at whether we can add more biologics. Can we add bone marrow, which you, you know, don't always get from just this alone that's concentrated or platelet rich plasma that's concentrated. 

[00:14:36] And it's the same thing they've looked at with meniscus tears. Again, it's hard to show a big difference because this micro fracture thing causes improved healing as it is. So that's already, it's hard to show something that's as effective as this and biologics being better. Does that make sense? Yeah, I guess my question is, um, this tool is creating [00:15:00] the holes, right? 

[00:15:01] And then what do you mean that it's promoting bone marrow? So you'll see, and we don't have a video to show you, but when I do this, you see a fat bone marrow coming out as you're doing it. And by creating a hole, now it's going in and then doing it's own, it's coming out. Coming out. Okay. So you're essentially going out into the knee and what it does actually simulates an ACL tear. 

[00:15:24] Because we've seen when you, when you tear your meniscus and then you tear your ACL at the same time and you do the surgery at the same time, they heal way higher rates than if it just meniscus alone. So you want to simulate this ACL tear, um, and even if you don't, when you do a reconstruction or a new repair, you're not making as big of tunnels, you're not doing as much trauma, and so as a result, you want to still simulate this ACL tear. 

[00:15:49] Fluid stuff coming in. So people will heal. So how does that risk your recovery by doing this procedure? Like you're, you're adding this, um, [00:16:00] uh, you know, lack of better word, kind of like simulating this injury in order to promote healing. That's a perfect exam. So I tell patients sometimes they'll have a little bit more swelling in the first few weeks, but. 

[00:16:13] We also have tricks to reduce the swelling that we give patients medicine called TXA. So. It's negligible. The problem is, you know, if I have a something that's going to increase your success rates by 25 percent for a meniscus Yeah It's pretty hard for me not wanting to do that regardless if you feel swollen for two more weeks, right? 

[00:16:30] Like any patient any person would say I would want that I want to heal better with the first time you try it then dealing with swelling for two or three weeks So that's really the that's the downside of doing this Uh, it's pretty low. Um, but people are looking at this. I mean, we're, we're looking at this. 

[00:16:47] I work with, you know, I work with the Arthrex company. You've probably seen a lot of my stuff. Uh, you know, we're looking at finding ways to add more biologics. They're talking about putting collagen patches on to help the ACL heal. And so we're, they, we're [00:17:00] getting there. And one of the ones that does this is bear, you know, let's bring that up to like, we've talked about this before 

[00:17:08] the thing, the thing with the bear here is people don't get is that they think the bear is the entire surgery. And we just posted our newest video. We actually use the Arthrex ACL tight rope. And then all we do at the end is slide the bear down there and add it. So the way that was FDA approved as a different type of technique, and we continue to improve this. 

[00:17:29] If you look online, there's like 20 now videos out. All these are the top guys doing bear ACLs and each one of them does something different. So it's just wild because the idea of bear is literally just the implant. All it is, is the collagen implant soaked in whole blood. And put into the knee and then everything else they don't really like it's really not a step for doing that. 

[00:17:48] Like the old technique, the FDA approved us great, but it's not as strong in my opinion. And so that's why I started doing the tightrope with them. And then I'll add the bear like I just did one a few weeks ago. And so what we're seeing with [00:18:00] that is that you're hopefully going to have, you know, you, you get the ACL to hold up to the wall. 

[00:18:04] And then the bear implant, which is this collagen with, uh, you know, The whole blog, people are actually using PRP sometimes. And there, as soon as you know how this works, as soon as it hits the market, you have all these like smart surgeons that are like trying to figure out a better way to make it better. 

[00:18:21] And they're all trying to tinker a little bit cause they want to find the golden ticket. Like which one's going to be even better than what's currently out there. Right. Yeah. And it's. I hate to say the word off label because not really because there's really not a label for how you should do this. Like there's a technique guide, but the FDA doesn't say you have to do it this way. 

[00:18:36] They just want you to make sure you, you have to do a certain things that are, that are allowed, which is like, you know, soak the blood, put in the knee, lay the groundwork down. And then it's up to if you're going to be a little creative or what works for you. And then I'm going to oversimplify it for people that are listening to the show. 

[00:18:50] They may not really understand. Think of you having a hole in the wall. Right? And then you're creating this compound, right? And it was stucco and you're [00:19:00] you're covering the hole to in order for it then to harden and heal correctly. And this is kind of what this bear implant, this bridge enhanced ACL repair is kind of happening. 

[00:19:13] Obviously, I'm dumbing it down here, uh, and not to, to take anything away from it, but it's just kind of gives you a visual idea of what this, this compound or silly putty or whatever you want to call it, that's kind of holding everything together so it can heal correctly. Right? Am I wrong in that assessment there? 

[00:19:32] You're pretty good on that. I mean, we brought this up before, but like the MCI, which is the ligament on the outside of your knee almost never needs surgery. And so what they're doing is trying to turn this into an MCL tear. So ACLs used to never heal. That's the thought process. And now we're doing more repairs. 

[00:19:46] The bear's out. People are doing more bears. And the idea is that basically it causes clot that guides it to keel in a very, you know, we've heard of the word college and impregnated. Everything's college and impregnated. Right. The what about UCL internal [00:20:00] brace? We talked about this from the, from Brock Purdy and the throwing collagen impregnated suture. 

[00:20:05] Well, in this, the FDA didn't have the internal brace. So now I do an internal brace. I do a tightrope and then I add the bear at the end brace. The thing you're trying ask your, the thing you're trying to ask yourself is, wait a second, you're doing an ACL tightrope, which is identical to the other surgery you're talking about, and all you do for the bear is just add the bear. 

[00:20:24] And the answer is yes. So the problem is there's no head to head studies at this point because is it the bear? Is it both? What's ha what is causing this improvement, healing, or peer patients doing well? So, so there's no study right now saying, um, And this is all right. I'm going off track. I apologize. I like it. 

[00:20:45] No, this is good. I'm talking too much. I want to hear your question. When you do a surgery and you say, okay, I did the bear. I did the tight rope. I did, you know, whatever I'm doing. And then I say, I did these [00:21:00] three different techniques for this. That's not going into, uh, some kind of database that they get, then you can have, you know, the recovery time, the patient, this, this was what happened and it goes into a national database where everybody's now kind of keeping track and or some kind of form. 

[00:21:17] Is there nothing out there like that? Where I, instead of the FDA just kind of doing their own studies, but you know, the surgeons themselves. They are putting in the combination. Well, I only did the bear and I did the tight rope or I only did the tight rope for this one. And then you're seeing those comparisons based on the severity of the injury. 

[00:21:37] Oh man, you were open up a can of worms. I love it. Well put. No, it's great. So, um, first off, those studies are expensive, right? So who's going to pay for them, right? Like, are you going to have the search? Google docs. It's not, no, because you got to get permission for the patient, right? Like, it's not like I can just throw in HIPAA. 

[00:21:55] Yeah, technically. I mean, uh, technically a study where no [00:22:00] patient's information is given out is, is okay. But what about within your office, right? Or, or your doctors or still has to be approved. So to be approved, I can't start logging a spreadsheet, like a whole, like a, there's like a committee that has to like, look at this and I'm going to talk to the committee. 

[00:22:16] Can you take me to your next conference? I've got a couple. I will. I will. So, so basically we're going to try not to get too off topic here, but basically the idea is it costs a lot of money to keep systems to do that. And we're getting there. Bayer has their own reps, the people that bring the implant and they ask questions about the surgery, like when did the Powell was the patient, when they get injured, how they choose you. 

[00:22:36] They ask all those questions. They keep track of it. And every six months I get a message from them with the entire national information in it. It's all confidential at this point because they're, they got what they want to publish it and make it, you know, peer reviewed and, you know, fully, fully reviewed and checked out, but yes, the answer is, it's really hard to do all these in certain places. 

[00:22:53] I'm prior practice, so I don't have a lot of research assistance, you know, and I don't have fellows, but a lot of places I've worked, HSS. And, [00:23:00] uh, rush their machine so they would have someone in the hour like writing everything down patient when they signed 15 consent forms. One of them is the IRB. So they're illegally allowed to were allowed to keep their information and follow it. 

[00:23:11] Um, so yeah, I mean, you can and you can track it retro. You can track it afterwards. There's different. We can look up codes and stuff of patients. And I've done that before. And then you can call them a two or three years later and see how they're doing. So we're going to get there. We're just not there yet. 

[00:23:26] And this stuff so new. Um, but you're going to see more things coming out of the pipeline, but imagine surgery comes out, you need at least one, two years, if not three years after the surgery, because you gotta make sure enough of the surgeries have been done. So we're just not there yet, but this comparative study is a really interesting one, and it's something that some of the companies are thinking about. 

[00:23:42] So, one of the things they've been doing with the bear, It's actually grinding it down into the, because you may have seen it's like this big honking piece of collagen and then you put stuff on it and then it starts to get gooey and you put it in the knee. Some guys are grinding it down, soaking it with stuff and then just squirting it in the knee. 

[00:23:59] So it doesn't, [00:24:00] there's, we're finding other ways to deliver it to you and that's another like, You know, maybe off label, but that's a biologic thing is like, is this just the, is it just the, it doesn't have to be the actual implant size. It's just the stuff in the knee that you can get in there. Okay. And it's always going to be kind of like a silly putty, right? 

[00:24:16] You're never going to throw it into like a, uh, a NutriBullet and grind it up and then sprinkle it in there and do some kind of concoction. You never know. You never know. And, and, and one of these questions we always have is, can we do, well, how do we keep it in there? So the word collagen, like a lot of these different things we talk about. 

[00:24:33] They're, they have a, they have something that brings it in. It's a conduit. So that's the idea behind this collagen thing is it can soak up the blood and then it starts to create clot formation. Um, and yeah, everything's about conduits. Like if you just push stuff in the knee, it just like floats around and disappears, right? 

[00:24:49] Like the idea is like, that's great, but with some of these things you want a delivery system. And so that's where this becomes challenging because then you start talking about manipulating biologics. And then that technically is [00:25:00] FDA. Oh geez. Put some balloons on there. That's exciting. So manipulating, you want to be careful. 

[00:25:06] So you gotta, you gotta stay with it. And I think you got to stay with the new limits. I definitely think they put the balloon. Anyhow. So we, uh, so that's, that's it for the ACL repair and biologics. Oh, that was perfect. Let's see if we can do it. Will it work? I'll try one more time. Air quotes. It's not working. 

[00:25:25] No. Maybe we'll get better. I think everything is better. We should end every segment with balloons. So I think that is perfect. No, it's, uh, it's fascinating to think about that. And it was interesting because, you know, you obviously made the point that you needed to stay, not just put it in there, but to stay, because, uh, you know, my first visualization of when I was making the joke about, you know, grinding it up and Nutribullet is like, you know, if you ever had a wound and you put salt, In the wound, you see it bubble up, right? 

[00:25:58] And it starts to, you know, [00:26:00] obviously it's painful and things like that, but it bubbles up and kind of kills everything. You see everything kind of happening. I was just having this vision of you sprinkling this, this concoction into, you know, the knee and, uh, And who knows what works. But anyway, we get, we get sidetracked. 

[00:26:15] Um, let's, let's move on. And I know we were talking about the key components, benefits of the Bayer implants and ACL. And, uh, you wanted to jump into, uh, ACL grafts and things like that. Yeah. I mean, so, you know, one of the guys, uh, the listener patient is he's already had an ACL done. So he's wants to know more about the graft options, right. 

[00:26:35] Cause the repair is sexy, but You know, there's a lot of ACLs that are done and people have an injury again and they want to know what to do after it, right? Or there's people that can't get their ACL repaired, right? Like, the idea of the ACL repair is very sexy, it's very cool, but it's not for everybody. 

[00:26:47] I mean, it's like less than 10 percent of patients. And so it's just most patients are never going to have that option. Dr. Justin Marchegiani Wow, I did not realize that, why is that? Dr. Brandon Miller There's some people pushing the envelope, but it's [00:27:00] really the certain pattern of tear. It's got to be torn off the femur. 

[00:27:03] Um, if you look at it, you know, I can't remember the exact data, but it's like maybe 10, 20%. And maybe we should be repairing a few more of these and we're starting to get better at it. But, you know, I'm a surgeon that pushes the limit. I do probably the most repairs in Seattle. Uh, if not the whole area, um, I teach on this and I'm still not comfortable trying to repair all these ACLs. 

[00:27:22] It's just, we're not there yet. But you have a program of rehabilitation anyway, also. Yes. And I'm a proponent of all these things. I'm a proponent of reconstructions. I'm a proponent of all these things. It's just, it's important for the listeners to understand. So, I think the important thing you should understand is it's not just like adding biologics and doing, so let's move on to the ACL reconstruction because that's actually the more common thing. 

[00:27:43] So, you know, let's say your surgeon doesn't want to repair it or it's not a repairable tear. Well, majority of them get reconstructions and when you get a reconstruction, there's three things you got to figure out a way to improve if you want to, if you want to get someone back faster. So like all of this is like, people do this, people are worried [00:28:00] about their graft healing, like the grafts will heal. 

[00:28:05] It's just a question of how long it takes. And so that's the thing that people, I think people are worried. They think that if they're going to get biologics, that they're going to basically, they're going to heal way better than anybody else. And then they're not, they're going to get back faster or they're going to get back, uh, and have a stronger ACL. 

[00:28:20] That's not the case here. There's some things we'll talk about that may add some structural integrity to it, which we've mentioned before, but really it's about speed, right? Like if I could do an ACL on you, the reason people want the ACL repair is it's faster recovery. Not the bear. You've got to follow the protocol, but the repair tight rope, people are back faster. 

[00:28:37] And so that's why they choose it. I mean, it's, I literally I'll offer it. It's like 95 percent of people. So this fertilized ACL is a perfect point, but you want the graft to heal to the bone faster. So it depends on the graft option. You've got patella tendon, which is bone. So that'll heal versus other tenant options, which is what the fertilized ACL is. 

[00:28:55] And then member, you're taking a tendon out, which is a tendon is a bone to [00:29:00] muscle attachment. So you've got the hamstring tendon, you have the quad tendon. There's a few other options too, but you're putting in, you wanna make it into a ligament. So a ligament is where it's attached to bone on both sides. 

[00:29:12] And so it's gotta go a process where it goes ligamentization, where it basically turns into a ligament, and then you wanna make sure it doesn't tear as it's getting bigger and better. And so the idea is if you can make it heal faster and you can make it remodel faster. And you can keep it safe and stable. 

[00:29:30] Then you've come up with the perfect solution. And so the idea behind this fertilize HCL, which we've heard about it, you actually interviewed, we talked about it and then actually was a couple of years ago and then Chad Lavender reached out to you, you had a whole topic with him. And so, you know, maybe we'll have you be a great guest to have on at some point. 

[00:29:48] Now, yeah, Adam Marshall, you know, he's, yeah, he's, uh, And, and he's a sports guy too, so it'll be interesting. Uh, you know, maybe he might be a good one for the fall as we get into football [00:30:00] season. He'll be excited for college fall for sure. I think I added him to the list. This would be great. Yeah. So typical ACL nine months to a year to get back. 

[00:30:07] And so what, uh, Dr. Lavender, Chad Lavender has done is something called the fertilized ACL. And actually my, um, my, uh, patient asked about this. It's called. For Arthrex company itself, it's called bio ACL. It's the same basic principle. And so what they do is they take PRP or your own blood and they put it with, you know, uh, allograft bones called mineral bones. 

[00:30:29] So the hope, the key is to hopefully it's a conduit. So it's like soaks it up and then they inject it into the tunnels. And then they can take some of your own bones. So they have this, this device that as you shave, it sucks bone up and it filters it. Imagine like a, um, a pool filter. And so the bones all mixed up there. 

[00:30:45] It's your own bone with some other bone and then the PRP, and then you can inject it in the tunnels and the whole, and what he is trying to show is that patients will get the bone to bone healing bone to tendon healing faster. And then potentially the ligament [00:31:00] is faster and so therefore they can get back faster. 

[00:31:02] So he has looked at some studies and shown some patients that have gotten back at six months with this. Now the caveat, which if you look at the studies, and I know we've done some of these, is he's had some trials where he's had really good results, but some of the trials, not all the patients came back for the follow up. 

[00:31:22] And so you've got to be a little careful, right? Because Who's the most likely patient not to come back to a follow up? 

[00:31:31] I don't know, would it be a young person? Probably someone who's not happy. Right? If you're gonna get called, and all of a sudden, in two years. So I'm not, it's not that his data is not accurate. I totally, I, I think it's awesome what he's doing. I'm, I'm all for it, and I think it's legitimate. But the, the, the, the, the You know, if you, when you start losing followup at two to three years, you have to be say, Hey, listen, is this, is this, uh, is, are all of these patients, did you lose followup because they left the state and that's totally legitimate? 

[00:31:58] And that happens all the time. Like [00:32:00] there's, it's really hard to find if you're doing surgeon and people and they're flying in for surgery, that they're going to call you back or listen to the pickup, right? That doesn't mean that you just have to have a little bit of a healthy bias. Or healthy skepticism and say, Hey, listen, this is pretty awesome what they're doing. 

[00:32:14] They are getting patients back. I mean, I've seen promos for this, uh, you know, it's pretty impressive. And these patients, you know, we talked about this, they're, they're returned to sport function. They're 80 percent of normal compared to 35 percent for regular ACL. They're functional tests. Um, yeah. They're 80 percent of the 30%, um, and their CT scans, which is cat scan, where you look at bone, show that they had less tunnel widening and they're already starting to form bone around the quad tendon. 

[00:32:39] Now, again, this is only for one type of ACL, which is quad, which is where you take a piece of your quad. It's not for patella tendon and it's not for hamstring, which are actually way more commonly done ACLs. And so it's something to be aware of too. It's only been tested on one type of ACL. So there's a lot of caveats to this, but it's really cool because he's addressed everything that we're concerned about [00:33:00] and he's pushing the envelope because no one's willing to do this. 

[00:33:03] I mean, he's just, he's, he's letting these guys rip. I mean, he's releasing them to full activity at six months. And that's terrifying because if you have a kid tear their ACL at six months after you let them go inadvertently is that's that's really traumatizing, right? And he's a surgeon. I mean, as a prior practice surgeon, I don't know if I get away with that. 

[00:33:24] Like I'd have to, I have to see some data before I did it. Just cause, you know, patients would immediately tell everyone, you know, my surgeon let me go at five months and they'd say, he's crazy. Right. And like the ACL repair, I had to slowly integrate it in. And I had to see how the first patient did second patient. 

[00:33:38] Okay. I'm going to let more and more do it. And he obviously has gone for the gusto. So I have only utmost respect for someone like that. It's something that patients would be aware of. So this is a biologic option. So we do your ACL, we add either bone marrow or PRP, one or the other. And then we do this putty, which helps grow it in faster. 

[00:33:57] Okay. And it's a little bit technically challenging too, um, [00:34:00] and the idea is you do it all but doesn't go inside the knee, right? Just stays in the tunnels. So you know, and there's, and there's a certain way they do it too. It's a, it's a different technique than some of us do for the ACL. So you've got to do everything exactly as a study or you're technically not following it. 

[00:34:12] The protocol. Yeah. Does that make sense? Yeah. So it's a, it's, it's really good. I mean, it'd be nice that this needs to be expanded basically. It needs to be expanded for other surgeons because I haven't seen, when I was looking up for this show, I looked up fertilized ACL or bio ACL and he's the only one that's published about it. 

[00:34:27] And so it would really be nice to see someone else who didn't invent the technique showing good study results as well. So there's a lot more work to be done, but this is something really interesting for patients and it's definitely a viable option. I think it's totally legitimate. I just want to see more information. 

[00:34:41] Yeah. I mean, it's, uh, it's really interesting. Uh, and just to think about, you know, we were thinking about this, uh, this mix that we've been talking about for now, uh, for a while now. And how does that evolve? Yeah. Right. Does that keep evolving to, you know, finding the right [00:35:00] mixture and, you know, whether it's, you know, holding, not holding soft or harder, you know, like how that affects certain things, but obviously, um, you know, you do test on cadavers and things like that. 

[00:35:12] Is there a way to kind of expanding on this quote unquote kind of silly putty that you're utilizing, uh, to fill in the gaps on, you know, just cadavers or do eventually you need to have. You know, real folks to get real data, uh, going forward. If you're doing different mixtures, kind of a little bit on conversation right now. 

[00:35:33] Yeah. I mean, the nice thing about this is that none of these things are dangerous. They're doing other than like, you know, the idea of dangerous is like, you know, something that's not approved for patients, but all this stuff, like the putty, the PRP, you know, Yeah. Uh, everything I talked about, we put that in me all the time. 

[00:35:46] I just, I did two of these today. Like I added putty and I added PRP and patience today. Like it's a little, I got to say putty too. You're going to be saying putty to everybody. No, but it's called, we actually call it. I go open the putty. It looks like putty. It looks like putty. [00:36:00] So all of these things we're already doing in the knee all the time. 

[00:36:04] And so what he did is found a concoction that works for him. He kept it regimented. He documented it. And then he looked to push it to the next level. And he did everything right. MRIs, CT scans. Watch the players getting ready. The one thing that you got to understand though is they probably had really good physical therapy and probably therapists that were willing to let them rip. 

[00:36:24] Right? That is incredibly important. You stole my thunder, I was about to say that. No, keep going. You know what I'm talking about. I was going to ask you, I was like, wait a minute, this all tells me in order for him to say, Hey, six months, go. What kind of physical therapy are they getting? Is it once a week or they're in there, you know, mandatory? 

[00:36:42] How many days, right? So that's the even bigger conversation now besides the surgery is right. Because we talk about it, right? You know, hand in hand, your physical therapist, the homework, when you go home, how much are you working? How much are you doing? You know, what's the requirement? If you have this type of surgery, you want to get back at six [00:37:00] months while you're seeing your physical therapist three times a week. 

[00:37:02] So, you know, these are, you know, mandatory. You know, questions that you would like to, to, uh, to know besides the procedure, what's really going into it. What's the Molotov cocktail in order for you to have success. I think it's a perfect point. And I mean, remember I do ACL repairs. My patients still come in slow sometimes because PTs are so nervous, they've never seen this protocol before. 

[00:37:24] So like, these are probably finely tuned for the clinical trial. Right. They saw the same therapists who did all of these. And so that's where you got to be careful. Can you extrapolate this general population? I mean, if I'm operating on, I have a patient, she, she flew in from Montana for an ACL repair. 

[00:37:39] Like I have no way of dealing with her physical therapist in Montana, right? I, we have patients that come in. I can't, I can't. I have to have a surgery that will, that they can follow my protocol, but they're still nervous. I mean, even some of my regular ACLs, if I'm more advanced than some other surgeons, or I do something differently, they still want to keep it their own way because they're nervous. 

[00:37:59][00:38:00] So they also, they don't want to be responsible. They feel responsible. The person tears their ACL to at six months to a year. Are you doing video calls for out of state folks after a post op? I usually will just do phone calls. Uh, the video I find doesn't add a lot of value except for just looking each other in the camera. 

[00:38:17] And it's really hard because I can't just FaceTime them because of the HIPAA. So I have to use like a program. And so then if you have to schedule it, we used to do video calls during the pandemic and we've stopped because it's really hard to schedule stuff for patients cause they, they want to be called at a certain time. 

[00:38:34] But if you have time in the middle, they, so we just do phone calls out of state. And it works perfectly fine. If patient wants a video call, I'm happy to arrange it. But usually, I mean, most of the time you're just talking to the doctor. Gotcha. Gotcha. All right. Let's move on because I'll sidetrack you continuously here. 

[00:38:49] Yeah. So let's put up that slide to look at the growth factor. So we talked about, this is with reconstruction. The fertilized acetyl is the best example we have for biologics. So it's important again, we brought this up and we can throw this [00:39:00] off in a second. Everything we're looking at is called autologous, which means it's from your own body. 

[00:39:04] There's allogeneic, which is from somebody else. Uh, and those are just two doctors, you know, lay, uh, medical terms. And again, you got to be careful here. You want to make sure, again, the FDA doesn't really regulate whether you use these things. It just, as long as you don't manipulate them. And that's the biggest thing we talked about. 

[00:39:20] You don't want to over manipulate these, um, and manipulation means like doing stuff beyond the machines process, like trying to add other factors in that no one talked about. You didn't consent them for that. And again, we don't do that. And a lot of people, I don't know anybody that does, but it's just important for people to understand. 

[00:39:35] So everything we're talking about is your own body. Um, there are people that do stem cells from amniotic fluid and things like that. We are not talking about that today. There is not a lot of data on that stuff. So you just gotta be careful and it's incredibly expensive. So I want you to that next in the next slide. 

[00:39:52] So again, this is a, this is a really good, I always have to quote the studies from this. This is Rodriguez and Merkineck all 2021. Um, but this is [00:40:00] really good for patients to see this. These are reconstructions and these are the growth factors that they're currently looking at. So they're looking at growth factors, stem cells we talked about, bone marrow, aspirate. 

[00:40:08] autologous tissue, pharmaceuticals, and there's different types of things. So go to the next slide. You'll see what we're kind of going at. So these are everything that people are currently looking at. And so if you want to ask what biologic you're looking at, we're looking at everything. BMP, BMP growth factors are, is basically that putty we talked about. 

[00:40:27] So can they add that and make people's ligaments heal harder to bone? Yeah. There's a bunch of other ones. Fibroblastic growth factor. I'm just going to go on and on and on and on. This TGF beta is really important and there's been some studies that can you add it back and help people heal their ACLs better. 

[00:40:43] Um, so, you know, again, this is going to get a little boring, so I don't want, you know, you people ask about biologics, but then there's a lot of information in the background because you can't just throw in these potions. You got to look at the data, see if it's safe. VEGF is one that we hear about. The problem with VEGF is it increases blood flow. 

[00:40:58] So is that, you know, [00:41:00] we see VEGF actually in cancers. So you want to make sure you're not just throwing that into people and causing more vascularity in an area. And then you've seen PRP. This fibrin clot's really interesting. So the idea behind it is, uh, it's, you actually make these clots. But again, it's the idea is can you put the fibrin clot or have PRP in some sort of gel form and then bring it, bring it in the knee? 

[00:41:21] It's a conduit, right? If you just inject PRP. Into the knee. It might help with some anti inflammatory properties like for arthritis, but is it going to stay where you want it to stay? So you have to have a conduit to get it in there and the fibrin clots nice because that's that's a thicker Modality, so it's important for people to hear this and understand, you know, what each of these things means I think we probably can get off that. 

[00:41:46] That's, that's good. I don't want to get, I don't want anybody to start yawning on us. No, no, it's good. And if anyone's listening on the podcast, please check us out on our YouTube page. We have some slides, we have some information. [00:42:00] Uh, the negative is that you're going to see our faces, but besides that, we've got some really good information here. 

[00:42:05] So, uh, please check out our YouTube page. All right. Let's talk about this PRP there. Go ahead, buddy. When we talk about the PRP, um, I want to go back one more thing though. I go back up to the other slide real quick. So there's the DBM putty you keep bringing up. So the idea they've looked at this and they looked at this with how does it combine with graphs from animals because a lot of these studies are in animals. 

[00:42:27] They looked at different factors, you know, can you add the PRP and then add, you know, collagen scaffold and can you apply it? And they've seen in models of rats and rabbits that if you add this DBM putty, it increases the tendon to bone healing. So again, the key is to soup up the healing so that your tendon that's in the tunnels closes off with bone quickly. 

[00:42:51] One reason that's good is because you can hopefully stress it sooner. But the second reason is some of these grafts like a quad or a hamstring, they're [00:43:00] soft tissue so they can windshield wiper. It doesn't happen usually with In the short period, but one reason if you get the tunnels healed faster, there's less likely chance that they'll get bigger. 

[00:43:09] And when they get bigger, you can imagine what happens when they get bigger. They can get looser, right? Looser. And so you don't want that again, not that common if done well, but you know, if there's an, if the tunnels are off and you don't have them healing fast enough, they can cause a little wiggle factor. 

[00:43:26] What do you mean by tight, like tighten quickly? Like, what is that timeline? You know, when, when these are kind of like, you know, hardening and, you know, it's getting set in place. What's the timeline from when. You're operating, are we talking a week, two weeks, two months? Like what's the process there for that healing for to get heart? 

[00:43:46] It depends on the person, six months to a year and maybe more. And so that's why people aren't ready to go back yet. And sometimes we don't know. I mean, we're not getting MRIs and CT scans at everybody. I mean, like you're ready to go back. Does that make sense? Yeah. And so that's something to be [00:44:00] aware of. 

[00:44:00] So the idea is like, can you give them this thing so you boost them and then you let them go back faster knowing that they've healed faster or assuming, but you know, we deal with fractures all the time. I told you I do these osteotomy sort of realignments. Last week I saw three patients back. They were all within five years of each other. 

[00:44:16] One patient was 20, was 50 percent healed, one patient was 80 percent healed, and one patient was completely healed. Exact same surgery, exact same surgeon, within like 3 weeks apart. And what were the age of the patients? 45, 50, 52. Okay, we're not this is I'm talking about like literally everything the same. 

[00:44:38] So we don't know how can we make one better than the other, but maybe that patient that was a slow healer, if we had known that we would have added some stuff. So can we make them all the same? Can we get these patients back? That's another thing to be concerned about. Obviously, you know, Chad Lavender's patients were really young, right? 

[00:44:53] But the average age of an ACL tear now is like 27 to 29. And that's, I would say that's pretty common. Like I do a lot of young [00:45:00] kids. But I also do patient, I do do patients in their 30s, 40s, 50s, uh, that have ACLs that want to get back because there's lots of data they do well too. And so it's important to understand that as patients get older, they don't heal as fast. 

[00:45:13] And so would this fertilize ACL work on 40 year olds? I don't know. Would they be able to get back in six months? Would they even care if they get back in six months? Because everyone can say that I really want to get back in six months, but like these patients from Marshall, they're, you know, high level athletes, right? 

[00:45:29] Like three or four months for a pro athlete's great, but does it really make a difference? for a recreational athlete. Like everyone wants to be back faster, but does it really make a difference now? You know, I'm sorry, keep going while you're doing it. And I'll add my last piece. No, no. Yeah. Because I'm about to ask you something about when it comes to the age, right? 

[00:45:49] So I'm just going to jump the gun. So try to remember what you were going to say. You know, we're talking about the ages and we talk about the Biologics, especially of each individual, [00:46:00] right? And if you're a baseball fan, one of the biggest stars in baseball got hurt again, uh, Ronald Acuna. And, uh, he is, he tore his ACL and his left knee on May 26, right. 

[00:46:12] Before that in 2021 tore his right ACL. So now he's torn his left ACL in 2021. He tore his right ACL 2018. He sprained his left ACL. Um, so between when he was 20 years old and now that he's 26 years old, he's had two ACLs. and a sprain, both ACLs on each leg knee. So, you know, you know, is it, is it something that because of the ACL, maybe other things weaken, or it's just sometimes just your body and the way you hold up and are able to just deal with the rigors of life, right? 

[00:46:54] Every body type is different. And that's why I'm kind of bringing this in when you're talking about the comparison, the [00:47:00] 45 to 50 to 53 year old, same procedure, same everything else. different results. Is that an example or is it a little bit more to it? No, it's example. There's some patients that just are higher risk, right? 

[00:47:12] Like, I mean, I did two, two ACLs today and both patients had ACL done on the other side. So it's just, some people are higher risk. I mean, once you tear your first ACL, the second ACL is 6 percent risk on the other side, just from the idea that you've already had one ACL. Um, it's actually higher risk to re tear your ACL on the other side than it is to re tear the ACL you just had done. 

[00:47:39] So it's, think about that. Yeah. So the, and that's what happened with him, right? Like it's just, these, some people are at higher risk and there's anatomy issues. There's, you know, it's higher in females. It's the way they land. And again, he's male, but it's the same type of thing. The, you know, One of the patients today was male, um, that had had other side done. 

[00:47:58] So it's just [00:48:00] people are at higher risks and we want, it's a key is, can we identify those risks? I mean, we, we're going to do as much as we can and we'll, you know, I'd like to finish up this part. Um, we're doing as much as we can to prevent people from having retairs. And there's lots of things we talked about, you know, adding the internal brace. 

[00:48:14] Can we add biologics? Can we do some fertilized option, um, to help them not have that issue? What, uh, It band tinnitus is like, can we add all these other things so that they don't have that happen again? And now we're getting digressing, but the idea here is what you're hearing about is. And what patients want is, I don't want to do this again. 

[00:48:33] I want to do it once, I want to do it right, and I want to make it perfect. Well, it's never going to be perfect, but can we make it right? And can we give you a better shot than you currently have? Which is what we're doing here. Oh, I did it! The balloons! So, it must be the, it must be this or something doing that. 

[00:48:50] So, can we, can we I think your daughters are sitting in another room with your wife and they've got some kind of remote control or something clicking on the [00:49:00] button, the balloon button. Oh. Yes. So anyway, so that's the idea behind this is can we give you let people like up? Um, so with the PRP, you can bring that up. 

[00:49:10] We'll go through that quickly. Uh, they looked at, they looked at this for adding, you know, PRP again, this take your own blood and then this is injecting the knee and in a surgery, you'd add it into the ACL and there's different conduits that you can use this through. We've talked about this, adding putty, adding collagen, you name it. 

[00:49:29] And so, they showed in this one study that there were like 109 knees, 101 patients. So they obviously, some people were bilateral. It's a Burtis et al. Uh, and they had a lower retail rate for the younger patients that had the PRP college and matrix added. Um, now began one study. So be, you know, be aware of this, but there is a, there is a study showing that there is improvement. 

[00:49:53] There's also a study showing that that maybe these people, uh, this is Vogren et al. [00:50:00] And some of these people that got the PRP, a different study, uh, that they maybe had higher blood flow into the ACL graft. So again, you're getting the ligament, turning the ligament faster, hopefully. And then again, sort of like a VEGF, which is that blood flow thing I told you about, but obviously a different type of material. 

[00:50:19] And some of these are gels. So they're PRP that's in a gel. You can see that that's actually what, that's what PRP looks like. It's a, Maybe usually not that exact color. So, uh, but it's usually around that color. And then can you put that into a gel? So it just stays there and resorbs. Like it's like a, um, a time release capsule, right? 

[00:50:36] Like you've seen medicines that are quick acting, but you want, in this case you want something that's slow release. So this is another, another option. There is some data on it. It's just not really good. And I, I don't routinely offer this to my patients. You know, there's, If patients really wanted it, I tell them, you know, I'm happy to do it, but obviously it is also an added cost. 

[00:50:55] Uh, so, you know, we're not, we're not there yet, but it's just some interesting information. [00:51:00] Let's briefly bring up the BioBrace. I think it's important to see it. Um, I don't want to overdo this. So this is a relatively new implant. Um, it was designed for a lot of things. You can see rotator cuffs here. Uh, you have this idea. 

[00:51:14] So the idea behind this is to. Uh, it's another collagen reinforcement or microfilament. And then basically what it is, is it's, it's got a strength modulus to it. So it's like an internal brace type of thing, but it's supposed to reabsorb with the tissue and people are doing ACLs with this. And actually my patient or what do you mean reabsorb with the tissue? 

[00:51:33] What does that mean? It's supposed to grow in with the tissue and add some structural basis to it. I got you. So it stays in. I got you. Where it has really been helpful is in hamstrings. So in hamstrings, people take their hamstring tendons. They're generally smaller. Then the average ACL we do and in under 25, we've seen less and less people recommending doing them. 

[00:51:52] So the idea that we used to do is if the tampering wasn't big enough, we would add cadaver tendon to right. So make it bulkier. [00:52:00] But now what people are doing is they're adding this bio brace to it to make it thicker. The problem is obviously it's expensive, so it's not everyone might not be able to get it. 

[00:52:09] Um, but the idea is that there's good strength and you know, they've been seeing that if you, the goal is if you can get these hamstring tendons, like imagine we're going to get too off topic, but basically if you take a tendon, imagine the width you want the width of a tendon, the width of your tendon, your ACL to be bigger than eight millimeters. 

[00:52:28] But if you take a small girl or a small woman, um, a lot of times it's smaller than that. It's seven millimeters. So how do you make it bulkier? Well, this is a, this is a biologic that you can add with some soaking of other Biologics and you can add it right into the ACL. And there's some idea that we don't haven't seen enough. 

[00:52:44] Most of the articles on there are not actually, um, studies, but basically they're showing techniques how to do it. So we're not there yet, but there is some future hope for this potential option for patients. Are you adding anything to this implant? Like, are you, [00:53:00] you know, coding this in something or coding it where, you know, putting a PRP on it before you put it like it, or is it just kind of going in there? 

[00:53:09] Is this something that you can add to it as well before, uh, putting this in? Yes. I mean, you can add, um, You can add like PRP, you can add bone marrow, and a lot of times you just basically integrate it into the graph. So there's certain suturing techniques you can use as well. Um, you don't really need to add much for this because it's really its own thing. 

[00:53:30] Uh, and so again, we're, it's, it's, the idea is can we, How does this going to enhance the strength of our graft? And especially one of the highest risks, the highest risk you are tearing your ACLs between three and six months. And so by adding this, can we prevent that from happening? Right? Again, this is not that common. 

[00:53:48] I mean, I can't think of anybody on my half my head and my patients that's torn their graph at three to six months, but like, The reason is they're also not going crazy, right? But, but Chad Lavender's patients are [00:54:00] going nuts at three to six months. So that's the other issue. So can they go faster? And then therefore they've got this backup tissue. 

[00:54:06] So we are, we're, we're attacking these things in really good ways and we're going to get there, but we're just not there yet. Um, I think let's kind of skip over this last one for the sake of time. But basically the last thing is allografts. So we've talked a lot about your own tissue, right? Like there's hamstring, there's quad, there's teletenin, but some patients, It's not an option. 

[00:54:28] They either had, I mean, I had a girl that's just 24. She had three failed ACLs. They took every single piece of her tissue. So she's got nothing left. So what are you going to do? Well, how can I make it better? Well, there's some studies in this in sheep, but again, using cadaver tendons, combining the BMAC bone marrow aspirate and the PRP. 

[00:54:47] And they did see some improved incorporation. Again, just the, just the sheep study. Um, and there's some ideas also looking at, can you add this sort of, this is bone marrow seen from the hip, you get from the knee. Now here [00:55:00] is AVN. So they're injecting it into the knee to kind of help it heal, but you can see other ways you can do it. 

[00:55:05] This is, we can take it from the crest here. This is in the back. Um, and the idea is that they've seen that hopefully maybe the tunnels won't get as wide with these tendon, these, uh, these cadaver graphs. Again, it depends on the type of cadaver graph to use. I use, um, Exclusively patella tendon. So it comes with bone on both sides. 

[00:55:22] So the idea is behind that is there's no concern for this windshield wiper. Remember I told you about that where it goes back and forth, back and forth. But a lot of people don't use that type of cadaver graft. They use something else that's got tendon on both sides. So if you have that, you have to get it to heal faster. 

[00:55:38] And how do you do that? Maybe you add something like this. So there's a lot of You've got to think about when you talk about this and be careful you're not comparing apples to oranges, right? So this was done on probably soft tissue, which is what we talked about that I don't use for allograft. So it may not be compatible for someone like me and the way I'm doing it may be [00:56:00] different or may heal better or worse. 

[00:56:01] You know, we don't know. Um, I've had good results with it, but it's important to understand that everything is a little bit different and there's, there's so many caveats to this. But also ACL is a real, we'll go into this. We'll just talk about this very briefly, but ACL is a really good surgery. It's definitely not perfect, but there's some of my happiest patients and they get back to things they want to do. 

[00:56:21] Again, not perfect. There are patients don't get back to the sports they want to do, but it's just, it's also really popular surgery because it's really common. One of the most common surgeries I do is ACLs, but it's just hard. You got to be careful, right? Like you'd never want to do a surgery for an ACL kid. 

[00:56:36] And then make them worse, right? Like that's the whole most horrible thing you can possibly do because these are not like, it's like you get your second and third and your fourth within a couple years. Like that's not a good thing for you. Like, it's not like you just go redo an ACL l and it's no big deal, right? 

[00:56:50] Like it is a big deal. No, it's not cool. Even though it's obviously life threatening. It's not, it's not cool. Those none of it is. So let's talk about this last topic. So we've gone in a lot of biologics. [00:57:00] We've talked about a ton. I mean, this could be like a three hour show of your scene. Well, we, we got two and a half minutes left. 

[00:57:05] Well let, let's talk about the last piece. It's all well and good. But one of the concerns is like, how, how do you get, why are things not healing as fast? Well, some studies have shown that basically, the reason things don't heal as fast sometimes is there's an indolent infection. So like, people will tell you like, my graft failed at like a year. 

[00:57:23] And thankfully I haven't had those issues, but that can happen. I've heard about it. And one thought is that maybe the graft, the certain thing you put in had a little bit of infection in it, but not bad enough to cause a real infection, right? Like it's a subclinical, like you don't notice it. And as a result that the graft failed or over time after two to three years, all of a sudden you get an MRI and then ACL is gone. 

[00:57:43] Like, how did that happen? The patient never felt a pop. So it did dissolve from the infection. So what we're doing now for every single ACL I do, allograft, you name it, I wrap the ACL in something called vancomycin, which is an antibiotic. And there's been studies that show it drops the infection [00:58:00] rate to literally zero. 

[00:58:01] And I'll knock on one. I have not had one. An infection after an ACL is an absolute devastation and you never want that. So the thought process is not only in like, it's great to prevent the big one, right? Like, I never want that to happen. Yeah, it's pretty uncommon. But these indolent infections, there are some thoughts that are way more common. 

[00:58:20] And so Ken, And it improved their healing just by wrapping their ACL antibiotics. Yeah. So that you left a big one for the end. I mean, that's, I know that's amazing. I think the problem here is that patients are so worried about getting their ACL better. They don't realize they're already doing a lot of things. 

[00:58:44] And so the problem I think is, Is I just told you a lot of really sexy awesome stuff, but then we've got to start executing on it, right? Like we've got it once the data comes out. You got to push it, right? Like if my bear patients are getting the same surgery as my [00:59:00] acl tyro, but my acl tyro patients are allowed to go back at five months and my bears are making them wait till nine months because the fda protocol Am I doing the right thing for my patients with the B. 

[00:59:09] E. A. R.? Yeah, it's uh, if you're gonna tell people that you're reducing the chance of infections and that after this is one thing less to worry about, that's a big one because that's obviously a main concern. Oh, it's that time. Dr. Garcia, we're going to wrap it up here. This was a great episode. So happy and check us out at sports doc talk. 

[00:59:36] com. We've got a lot more information, a lot more stuff going on. We really appreciate everyone listening to the show.
Thank you very much. Thank you.
Audio Transcript


Surgical Nutrition: Amino Acids and Peptides with Dr. Jazayeri

Surgical Nutrition: Amino Acids and Peptides with
Dr. Jazayeri.

Will Sanchez: [00:00:00] Welcome to the show. Welcome to sports doc talk. I'm Will Sanchez along with Dr. Grant Garcia. Dr. Garcia, we have a fantastic show. We have an incredible guest, but before we get to him, let's just remind everybody, check us out at sports. talk. com. We're on YouTube and Odyssey and Spotify and Apple and all of the goodies.

[00:00:28] Will Sanchez: And be sure to check out our website where we have previous shows and we have transcripts. We have so much information that we provide, especially from you, Dr. Garcia. I've rambled on for over a minute. Let's welcome you in, man. How are you, Dr. Garcia?

[00:00:45] Dr. Grant Garcia: I'm great. This is awesome. I'm so excited. It's always so fun when we get to, you know, we've had, we get a lot of guests on here and we've had different doctors and everything else, but it's so fun to see a topic that comes up or your patients ask about, [00:01:00] and then you find like the best expert for it.

[00:01:03] Dr. Grant Garcia: And plus, A normal, cool orthopedic surgeon. So this is going to be super fun. I'm a little worried that we're likely going to try to go over an hour. So we'll keep me in check because I have a feeling this is going to be one of those times. I've already had a pre conversation with Reza, and I'm not sure we're going to be able to make it.

[00:01:20] Dr. Grant Garcia: under an hour. Do not go off the deep end, okay? So I'm just letting you know. I've never done that before, Will, right? I've never done that before. No, no, no. So let me introduce, before you put them on, let me introduce. So when in, uh, in the office and you know, Will, you brought this up a couple of shows ago, but in the office patrons keep asking me about supplementation.

[00:01:39] Dr. Grant Garcia: They're asking about post recovery. We're going to go into that. This is, we have first good topic on nutrition, but they're asking me about how they can get better after my ACL surgeries and my cuff surgeries, my big surgeon meniscus cartilage transplants, where they get significant atrophy and it takes them nine, 12 months to fully recover.

[00:01:55] Dr. Grant Garcia: And they're, and these are Seattle patients. They're looking up everything and they want to know the best of the best. Like, how do I get to the next [00:02:00] level? And for a long time, we had very little. We're starting to get more things through different things we'll talk about.

[00:02:05] Dr. Reza Jazayeri: Yeah.

[00:02:05] Dr. Grant Garcia: But one of the number one things is nutrition.

[00:02:07] Dr. Grant Garcia: And then you're seeing on LinkedIn, people are talking about nutrition. How do we get people better, faster? And this is not just knee replacements, patients with hip fractures, you know, patients that are elderly that need to gain their muscle back. This is athletes. And I mean, I see athletes All the time that we operate on and they come in and their their leg looks like half the size and they felt they only had surgery like three or four weeks ago.

[00:02:25] Dr. Grant Garcia: Right? So how do we get them stim faster? And patients are like, how do I get my quads back faster? And one of these things is nutrition. And Uh, Dr. Jazayeri, who we're going to have on in a second, we have a big article called J AOS. And so it's one of like the number one journal we all look at. And he wrote the, he was the lead in this article about amino acids.

[00:02:43] Dr. Grant Garcia: So immediately after seeing this, having seen his content online, I reached out to him and he was, um, awesome to come on our show today and tell us a little bit more about this and understand like what's so hot about this. We're at an infancy right now. We're going to see more and more of this coming up and people are looking how they can get their patients back faster.

[00:02:59] Dr. Grant Garcia: And [00:03:00] this is one of those things. And he started this awesome company. So I'm really excited to have them on. Let's bring them on

[00:03:04] Dr. Reza Jazayeri: guys. Thanks for that intro. I totally agree. This is an exciting topic for all of us. And, uh, Like I was sharing with you Grant earlier, I'm, I'm a fan of you and the stuff that you're doing.

[00:03:16] Dr. Reza Jazayeri: So it's just kind of great to be able to, um, share ideas and especially this one. I think it's, it's, it's something that people are interested in. We're interested in, and we're, like you said, we're, we're at the infancy. So, um, uh, I think it's our challenge and our kind of responsibility to kind of know.

[00:03:35] Dr. Reza Jazayeri: this material because our patients are demanding it. And I think it's a part of now our practice to understand this, if we can have this dialogue.

[00:03:43] Dr. Grant Garcia: Yeah. And it's important to, you know, uh, res is a sports surgeon down in California. He does the same stuff I do. He's curl and Joe fellowship. Awesome. One of the top sports fellowships in the country.

[00:03:53] Dr. Grant Garcia: So, you know, he gets these things and he and I have the same mindset of like, how can we get these patients that are athletes back faster? And [00:04:00] And you're getting the same patients in downtown in California, you know, they they're active patients They're like, I don't want to sit around for two days. I don't want to sit around for two weeks, right?

[00:04:07] Dr. Grant Garcia: And so you developed this thing So I guess tell us more about the practice and the interest you have and then we'll get into the nitty gritty too

[00:04:15] Dr. Reza Jazayeri: Yeah. Yeah, you know, um, I think we're all a product of where we trained kind of who we are And then also where we practice and our patients around us. Right.

[00:04:24] Dr. Reza Jazayeri: And so I'm like a block down from Gold's gym, Venice. Right. So my patients are, I have a sports practice, like do you like you, but I also do a lot of shoulder and arthroplasty and revisions. And I'm the guy in my practice who like, no one wants to touch the stuff. And then they're like, just give it to rise a heel, do it.

[00:04:41] Dr. Reza Jazayeri: And I'm like, okay, you know, I'm happy to do it. Right. So I have almost like a sports trauma practice. And I say trauma because peck ruptures, biceps tears, hamstring ruptures. You know, these are these athletes who are on a different level and who are coming in with much higher expectations for [00:05:00] me. So throughout the years of my practice, I have Learn to kind of now have higher expectations of my patients to say, Hey, if you expect me to do this, then I need you to optimize yourself.

[00:05:11] Dr. Reza Jazayeri: And I think that's where I started to realize, look, you and I can sit here and talk about ACL graphs and screws or buttons or suspension or flip cutter or this and that. That's already kind of tapped out what we ask our patients to do. How can they optimize themselves? What are they bringing to the table?

[00:05:32] Dr. Reza Jazayeri: How can they be a better fit patient to have a better success? This is where I think we can make a big impact on their outcomes. So this is how I got into the nutritional piece.

[00:05:43] Dr. Grant Garcia: Well, and I think you're making a point point, you know, patients are like, why can't I get back? You know, why is, why is the ACL surgery you guys did 10 years ago, still at nine to 10 month recovery now?

[00:05:52] Dr. Grant Garcia: Why is the shoulder surgery, the rotator cuff, that one, or the pec ruptures? I mean, those are massive tears. Why do they still take so long to recover? [00:06:00] And the problem is that patients, and I think you're perfect point. When I think that we should really emphasize this and will, you can hear this too, but you got to flip it around on them because it's not just my surgery.

[00:06:10] Dr. Grant Garcia: Like your work, right? You do an hour, a half of work. They're doing hours and hours of stuff. And so they're expecting your work. to get them back as quickly as possible. But if you don't do the extra stuff, I always tell them the PT and the recovery stuff, that's actually way more important than even the surgery, right?

[00:06:26] Dr. Grant Garcia: Because you know, there's, there's so many different things you can ways you can fix it, right? It doesn't really mean they're not all perfect and they're not all the best, but the other stuff is important.

[00:06:33] Dr. Reza Jazayeri: You know, basically when these patients are coming in, they're already at a disadvantage because they took a hit.

[00:06:40] Dr. Reza Jazayeri: And what happens to the patients after an ACL injury or any kind of injury, actually, the muscle starts to change its physiology. It becomes kind of resistant to growth and there's both neurological and physiological changes. So, you know, I have this philosophy of the [00:07:00] surgical athlete. So I treat all my patients like an athlete training for an event and that event is their surgery.

[00:07:06] Dr. Reza Jazayeri: So I tell him, look, we got to prep you up for this. We got to get you ready. So all my A. C. L. S. Get prehab, they get B. F. R. I get him into exercising before the surgery. I check The nutritional status before surgery, we do all these things to prime them up. How are

[00:07:22] Dr. Grant Garcia: you checking their, sorry, interrupt. How are you checking their nutritional status?

[00:07:25] Dr. Grant Garcia: What are you doing?

[00:07:26] Dr. Reza Jazayeri: So albumin is, uh, uh, uh, uh, albumin and prealbumin, um, are good ones to check. And we can get into that a little bit more. That, that really ends up being a factor in, in the, in the elderly group. But it's interesting. You'll also pick it up in younger patients, especially revisions.

[00:07:44] Dr. Reza Jazayeri: infections. Um, and you know, I'm in California, so I'm getting a lot of these vegetarians and vegans and don't get me wrong, I'm, I'm, I'm vegetarian myself, except when I'm eating steak, you know, but, but, but the reality is these patients don't heal the same way. They just don't

[00:08:00] because they're not getting the substrates.

[00:08:02] Dr. Reza Jazayeri: And so when you check these variables, you're actually better off holding off on surgery for a little bit, optimizing them, getting them ready. So when they, you know, when they enter the operating room, they have all the necessary variables. Besides just the implant that we do in order to get them to heal faster.

[00:08:18] Dr. Reza Jazayeri: So kind of what this graph is showing here is that this decrease in mobilization is is a problem because they have muscle loss. And so if you can kind of mitigate that by improving prehab, you build the resilience. And this is what we'll talk about when nutrition comes in to also improve their muscle resilience.

[00:08:36] Dr. Reza Jazayeri: So This hit that they take, everybody gets this, by the way, this is the best case scenario, guys, this is a healthy athlete, you get someone to do a joint arthroplasty, that line is much lower, much further down, and then the one with the hip fracture, 30 percent die in a year, so, We have a lot of work to do in this kind of opportune time where the body's really breaking down its own tissue.

[00:08:59] Dr. Reza Jazayeri: [00:09:00] And this is where, you know, the, the, the strategies through, you know, nutrition and amino acids come in to really effectively mitigate that drop that you see right there.

[00:09:09] Dr. Grant Garcia: I see a lot more of this too. If I do a lot of meniscus cartilage transplants, struggling in the cartilage patients, they're struggling for like a year, two years, three years.

[00:09:18] Dr. Grant Garcia: So then they do their surgery. And the problem you have is like, I mean, I had patients today, they're nine months out, they have no pain, but they're still feeling like they're, they're tell us got not tracking right or something because their quads been shut down for like 10 years,

[00:09:30] Dr. Reza Jazayeri: you know, before surgery.

[00:09:32] Dr. Reza Jazayeri: Um, and then after surgery, and then the amount of atrophy that we've seen, the quadriceps is really profound. And if you look at, we let most of our athletes, they want to get back by a year. Sometimes they're pushing to get back even earlier. But if you really critically look at the literature on ACLs, for example, at one year, not many patients are at 100%.

[00:09:52] Dr. Reza Jazayeri: Actually, most are about 75 percent other contralateral side. And so a lot of them are not getting back to where they want. And it's [00:10:00] closer to a year and a half to two years before, after an auto, after an autograph, they were able to get back to higher nineties. And so interestingly, we see the most we rupture rates in the first 12 months in the early phase.

[00:10:14] Dr. Reza Jazayeri: And so that's where I think Improving on the muscle side is just as important as getting the graft to heal.

[00:10:22] Dr. Grant Garcia: And we always talk about this in ACLs, right? When we do an ACL, your patients are always like, they're like, I make them so focused on their number. And obviously that's, there's a lot of other things contributing, but like quad strength is so essential for the testing.

[00:10:34] Dr. Grant Garcia: Right. And there's the 90 percent factor we look for and they're just harped on it. But if, but it's like, it becomes a situation where if they're like 75%, they feel like they let me down at 10 months. Right. And I'm like, listen, it doesn't not. And they all want to be, the problem is you get like 80, we brought this up.

[00:10:48] Dr. Grant Garcia: You got the Adrian Peterson who probably went back too early, but this is a freak of nature. Right. And he goes back at six months. So they assume everyone should be back at that Sam. Well,

[00:10:58] Dr. Reza Jazayeri: Well, he was probably on [00:11:00] some supplements that helped him.

[00:11:01] Dr. Grant Garcia: There we go.

[00:11:02] Will Sanchez: No, no, no, no. There we go. I like the way you say supplements.

[00:11:06] Dr. Grant Garcia: Perfect segue. I

[00:11:08] Will Sanchez: think Aaron Rodgers was on some supplements also after his Speedbridge, uh, surgery.

[00:11:14] Dr. Reza Jazayeri: That's, um, actually I can't say yes and I can't say no, but I can tell you that Everyone, uh, you know, uh, uh, curling job, for example, who, who, um, you know, they're very familiar with, with, with the amino acid supplement and it's, it's at their DMV.

[00:11:29] Dr. Reza Jazayeri: So we, you know, we, that's something that, you know, we're using and professional athletes and, uh, it's, it's being supported by, you can read between

[00:11:37] Dr. Grant Garcia: the lines. Well, Neil ElAttrache is at curling job. And they're on DME for that. So therefore you can read between the lines. We're

[00:11:43] Dr. Reza Jazayeri: very fortunate. Dr. Ellis has been a supporter of accelerated recovery.

[00:11:47] Dr. Reza Jazayeri: It's, it's, it's, it's been great. Yeah. Um, so I think that's what, so, you know, one thing to kind of recognize is look, everyone's going to have a hit, but it's mitigating that hit. And if you don't drop, then you don't have to [00:12:00] fight to get back up. And the older you get, the harder it is. And I'll just tell you this, it takes 12 weeks of strength training to put on.

[00:12:10] Dr. Reza Jazayeri: what you lose in two weeks of immobilization. So it's a it's a big difference in how fast you lose and how hard it is to gain. And so if you can prevent the loss, that's the win right there.

[00:12:23] Will Sanchez: Yeah, I just want to jump in real quick. Um, obviously you're, you know, we're not talking about the Achilles, but just because it happened to me, I had surgery on December 1st and, um, just sitting around for a couple of weeks was just absolutely brutal.

[00:12:38] Will Sanchez: And then so much muscle loss, uh, you know, calves, so much skinnier and, you know, just doing the work now, calf raises, seated calf raises, trying to do, you know, single leg stuff. But, You know, as you said, because I sat around for, you know, a month and a half. Um, before putting, you know, weight bearing and little by little, I'm [00:13:00] still nowhere close to where I was when I was running, playing, jumping, and moving.

[00:13:05] Will Sanchez: So just, it resonated with me when you said, you know, in two weeks. You're already gonna have this sustained muscle loss, let alone sitting around, um, you know, for a month and change, almost two months, and then slowly starting to, you know, get, become active again. And also having those, you know, those restrictions in your mind as well, saying, well, you know, can I do this?

[00:13:29] Will Sanchez: What can I do? Am I going to hurt myself? Because, you know, same thing you're talking about re injuring, you know, it's, you know, You guys tell me, but the re injury part could happen when those first six months, right? So that's kind of like in the back of your mind as well. So there's so much that a patient thinks about and it's great to hear that you're saying, Hey, this pre op preparation should be a part of You know what you do and obviously, you know, you can talk about when the situation doesn't call for when you [00:14:00] have to go in because it's an emergency and you don't have the flexibility to do that.

[00:14:04] Will Sanchez: Yeah. What are those situations where you can't, you know, prepare your patient in advance for surgery? Is this something that stands out?

[00:14:12] Dr. Reza Jazayeri: Oh, yeah. I mean, you know, I was telling you earlier. Some of my practice is like sports trauma where they're coming in with an immediate tear or rupture. It's not, it's not so elective, right?

[00:14:21] Dr. Reza Jazayeri: So those cases, um, then you, you, you don't have that opportunity to pre have them. So it's even more important to, to really start the weight bearing. So, so weight bearing is something that is something where we can really help patients with preventing muscle loss. And so, uh, this is where, look, everything ties in.

[00:14:40] Dr. Reza Jazayeri: There's no magic bullet, right? But, but if you have a very strong construct that you feel confident in that, that, that, that, that implant then gives you the ability to wait there earlier. Okay. And so then if you can wait there earlier because of your implant, then you can have less muscle loss. And if you can bring on the [00:15:00] supplementation along with exercise and then tack on like BFR, okay.

[00:15:05] Dr. Reza Jazayeri: Then you see how you got this Domino effect of multiple things meshing so you can't just say it was just this one thing It's really this comprehensive approach and then don't forget. It's the mindset too You have your pictures are going to have this fear of getting back. So You know, I never want to say hey, I got this.

[00:15:23] Dr. Reza Jazayeri: There's this magic bullet it's really understanding all of it, but not leaving anything on the table because you don't want to shortchange the surgery that you did by just missing out on these key variables.

[00:15:34] Will Sanchez: I got I got a quick follow up. Um, how important is it for your P. T. Person to be on board with what your your mindset is for your patient?

[00:15:45] Will Sanchez: post op. And how does that normally work? Because there's different variables like, hey, you know, pick one of these places you go and I'll see you in six months, you know, how hands on are

[00:15:58] Dr. Reza Jazayeri: you? So the [00:16:00] time that the physical therapist spends with the, with that patient is way more than they spend with me.

[00:16:05] Dr. Reza Jazayeri: And so the reality is, the better that relationship is, the better that patient is going to do. And so for me, my, my ideal ACL patient, for example, is they have their physical therapist that I know at the prehab. So they're already working with them. So it's not like, you know, Samantha comes out of her A. C.

[00:16:23] Dr. Reza Jazayeri: L. And says, Who am I going to go to? And then, you know, find somebody. And then they're like, Okay, hi, Samantha. Nice to meet you. It's no, no, no. How did the surgery go? We've been working for a few weeks together. I know where you're at. So you have the report. So for me, the physical therapy piece is extremely important and the literature has already shown prehabilitation before, you know, these kind of surgeries actually does enhance the recovery process.

[00:16:44] Dr. Reza Jazayeri: So, um, That's a very they're all important but that particular relationship is something that I try to foster

[00:16:52] Dr. Grant Garcia: So let's talk about really quick She'll pull up the amino acids peptides because people keep asking about it and they're using interchangeably But they're not and you were mentioning before, you know [00:17:00] ones and one we can have potentially one.

[00:17:02] Dr. Grant Garcia: We're not there yet um Perfect. Yeah, so there's amino acids. So kind of run through this real quick with us. Okay,

[00:17:09] Dr. Reza Jazayeri: okay, so You know, what you see on here is when our body is going through surgery, it's a very unique time. The requirement for these building blocks is extremely elevated. It's about 80 percent more.

[00:17:26] Dr. Reza Jazayeri: Why is that? Because, well, let's back up and say, okay, what are amino acids? So think about the vocabulary that we have with our alphabets, right? We got 26 letters and we can use these 26 letters to create sentences and paragraphs and tell the whole story. Okay, And you're only doing that with 26. So amino acids, our entire body has only 20 amino acids, but these 20 amino acids can similarly be kind of coupled to have a particular [00:18:00] function.

[00:18:00] Dr. Reza Jazayeri: Okay. And so these 20 amino acids come together to form all the precursors that we need for muscle and for bone mineralization and collagen synthesis. So this is where your body is really requiring these amino acids. to produce these things that we are really looking for in a orthopedic surgical recovery.

[00:18:21] Dr. Reza Jazayeri: Those are the three variables, in addition to all the enzymes and immunity for, uh, for fighting off infection. And so there's this demand that's really elevated. What happens is when you don't have those available. When you and I were cavemen, you broke down your, you broke your leg and you fell. Well, you have fat sores.

[00:18:43] Dr. Reza Jazayeri: Everyone knows fat is there for, so you don't starve. You don't have a reserve for skeletal, for, for amino acids that's hanging around. That's your muscle. So you actually start to harvest, you break down your own muscle to provide these key amino acids. So this is what happens when people lose weight [00:19:00] after surgery.

[00:19:01] Dr. Reza Jazayeri: fat. They actually just l because you broke down yo to provide these really k you need for all these di And guess what happens af have much appetite. People want to eat. And guess wh before surgery. You tell is. So this is why now yo such a change. So our protocol now with with with the accelerated recovery program, we do carb loading, right?

[00:19:27] Dr. Reza Jazayeri: I mean, think what a marathon runner with a jujitsu fighter go into their fight fasted. They're gonna do terrible, right? And so if you go into, but so guess what? When you go into surgery after overnight fast, our livers have about 120. Maybe if you're really well trained, maybe 150 grams of glycogen after overnight fast, it's almost gone.

[00:19:47] Dr. Reza Jazayeri: By the time you hit surgery, You don't have much. So your body says, okay, no problem. I'm just going to go to my muscle, break it down. Gluconeogenesis breaking you, you know, make new glucose from muscle. And so essentially you're [00:20:00] harvesting your own tissue. This is why now we're providing the amino acids and the carbohydrates.

[00:20:06] Dr. Reza Jazayeri: So your body is kind of prepared for the surgery and you're not wasting your own tissue. So that's kind of the essence of it.

[00:20:13] Dr. Grant Garcia: So you get to your, I saw your thing. So you got the pre, uh, That's the carb loading, right? And then the post supplementation is the essential amino acids. So the important thing is for the listeners to the essential amino acids, you can't get those.

[00:20:25] Dr. Grant Garcia: You have to, you have to, those are from diet. Um, and they're hard to get sometimes,

[00:20:30] Dr. Reza Jazayeri: right? So of these 20 amino acids that we have, nine of them are called essential. Essential means they need to come from the outside source. Your body can't make them. And the only place it could, Get it from is again, breaking down your own tissue.

[00:20:43] Dr. Reza Jazayeri: And it's the essential amino acids that have the same profile as your skeletal muscle tissue. That's why they're really essential. And so you, so this is why you really break those down during this time of stress burns injury. And that's where. these amino acids at the the [00:21:00] right time is given t it needs.

[00:21:03] Dr. Reza Jazayeri: So it doesn't b tissue. We actually start before. And this is what when you give patients am week before, Hans driver They did biopsy studies at the time of total knee arthroplasty. They took muscle tissue at the time of surgery on these patients who were supplemented for a week prior, and they found that regenerative tissue in the, in the muscle, they're called satellite cells, usually stem cells.

[00:21:29] Dr. Reza Jazayeri: They actually got higher in number. Which then led to having a quicker recovery? So it's really fascinating to see there's a sailor mechanism And the rationale for why you're supplementing

[00:21:41] Dr. Grant Garcia: so, you know Give an example of like do you have examples of this for the and I know you work with a lot of athletes We've seen on your profile.

[00:21:46] Dr. Grant Garcia: You've got the ce certification right ce or something you can or you can talk about it Sure

[00:21:51] Dr. Reza Jazayeri: Sure.

[00:21:52] Dr. Grant Garcia: Yeah. So, I mean, yeah. What have you seen from athletes? What is your experience? You're obviously clearly involved in curl and job with their stuff, uh, doing and other things like, [00:22:00] what's that, what's your sort of data or information you have on that?

[00:22:03] Dr. Reza Jazayeri: So basically, you know, in, in, in order for any athlete. Whether it's professional football collegiate level, you know, and all the international in order for them to take a supplement, it has to be NSF or sports certified. NSF for sport does an extremely good job and making sure everything is pure. and they they check it in multiple levels to make sure that these athletes are not getting anything that's banned.

[00:22:29] Dr. Reza Jazayeri: There's no contaminants. And it's kind of the we went to the FDA said, Hey, what's the best, safest thing that we can do for our athletes? And it's the NSF for sport. So if you don't see an NSF for sport on the supplement, um, It's probably hasn't gone. It hasn't gone through the testing and the professional athlete can't take it.

[00:22:45] Dr. Reza Jazayeri: So, so that's that's any supplement that an athlete takes has to be NSF for sport. Um, so well, and that's

[00:22:52] Dr. Grant Garcia: a concern to write. You see on the news. These people that said they took something. They didn't know what it was. And all of a sudden now it's a banned substance. So that's important for people to hear that as well.[00:23:00]

[00:23:00] Dr. Grant Garcia: Sorry. Keep going.

[00:23:00] Dr. Reza Jazayeri: No, no. So that's that's really important. So that's why it's for us. It's been really exciting that we've been sharing the supplement with, you know, NFL Major League Baseball. All the professional teams have been really Excited to have this. And one, the discussions I have with their nutritionist and their dieticians, they're like, oh my God.

[00:23:15] Dr. Reza Jazayeri: Finally someone who took all these different supplements that we've been kind of thinking about and put it together with the right dose and, and, and is providing it at the right time. So this is where, this is where kind of my practice was able to. Look, because I live in Venice and I'm, and I'm around these athletes and these bodybuilders, they're, they're coming in with so much knowledge that this is the stuff that you and I never got in residence here in medical school, right?

[00:23:38] Dr. Reza Jazayeri: So I have to actually take a sabbatical on this because they're coming in with all this stuff and I have to re educate myself to understand, wow, there is, because this stuff, look, when I see a patient who's completely supplemented, we can talk about the whole regimen that some of these guys are doing and what we're working on.

[00:23:53] Dr. Reza Jazayeri: It's day and night. Their recovery is so much faster. They have less muscle loss and they're able to get back. Now it's our, [00:24:00] it's on us now to do the good academic science and the research to show safety and efficacy, but there's a huge gap. But I can tell you on that side, these guys have been doing this for a long time, and they have.

[00:24:11] Dr. Reza Jazayeri: High success rate with it.

[00:24:13] Dr. Grant Garcia: Well, and also will, we talked about this before on the number of things, like what it takes, right? We had a website on what it takes for these pro athletes and why, like, and I've said, this is a kind of a joke aside, but everyone can hear this on here. Why, you know, like if you do a good surgeon, a pro athlete, they'll still do well.

[00:24:26] Dr. Grant Garcia: If you do a great surgeon, a pro athlete, they'll still do well. And why one, they're freaks in nature to, you know, like, but they also, they have all these extra tricks in their bag. Like you said, for Adrian Peterson. They're pre supplemented, they're post supplemented, they're getting, they have nutritionists working with them.

[00:24:40] Dr. Grant Garcia: And this is just one component that Will and I did never talk about. And it's been ignored on a lot of these different things discussing about it because we don't understand it. I don't get any nutrition training, you know. To me, this concept is, I've always known it was better for patients, But it's just really hard to stay up to date on everything.

[00:24:58] Dr. Grant Garcia: You would take a sabbatical to learn about [00:25:00] this. You're, you're involved with bodybuilders, you know, these bodybuilders are like, I mix all my things together. They have their potions and with their creatine, other things that they mix together that we don't see on a daily basis, you know, I'm not taking 45 supplements.

[00:25:11] Dr. Reza Jazayeri: Yeah, well, if it weren't for that and sitting with these guys and going to the lab and, you know, um, spending time with them and seeing what works, I wouldn't have got this experience myself. It would just meet me also, you know, being here. And then the other, the other part of this is, look, if, if these athletes, um, are not given this whole, um, this whole aspect of you need the surgery.

[00:25:36] Dr. Reza Jazayeri: We also need the safety. And this is where we come in. Right? And I think a lot of surgeons, the concern that I've been hearing from some of the athletes is my other surgeons don't want to hear about it. They just poopoo it or they just turn the other way. I don't think that's necessarily the best approach for us because just the same way we talked about having good engagement with your patients and physical therapists, you want to be able to have a good rapport with [00:26:00] your athletes and with all your patients.

[00:26:02] Dr. Reza Jazayeri: And if your patients are asking, you don't want to say, I don't know. Yeah. Go to someone else. This is where it's important for us and I think we need to actually lean into this and, and study it for ourselves and get more information that, and that's where we're gonna really have this cohesive approach.

[00:26:17] Dr. Grant Garcia: Re this happens all the time in practice. I had three patients a day that told the surgeon that they tell my surgeons don't work. My Macy's don't work. My Carly's transplants don't work. I do ACL repairs now with the new tight rope. I've been, they've been rocking it and they say it doesn't work. You know, I just gave a lecture down and talking about it.

[00:26:33] Dr. Grant Garcia: And people are just like, they didn't even seen this thing before. You know, you're so used to this. You get the same thing and your supplementation thing. I have no doubt that 75 percent of the surgeons poo poo it because they have no idea what's going on. And I always my my favorite response to this is if they don't ever try it or do it and they say no, then there doesn't their opinion doesn't count.

[00:26:52] Dr. Grant Garcia: And it's the exact same thing. Their surgeries, they say they've never done it before, so it doesn't work.

[00:26:55] Dr. Reza Jazayeri: Yeah, and I think this is just, uh, what we expect with, with medicine. Things take time, you [00:27:00] know, from actual, from actual being, you know, from, from ussing it into a lab, into research, and then finally being common practice.

[00:27:07] Dr. Reza Jazayeri: There, there's such a, there's such a delay in that. Uh, but now I think with technology and science, uh, we're, this is, this is definitely exploding.

[00:27:16] Dr. Grant Garcia: And you've seen it all the time. I mean, you, you're a big article on JOS. Obviously I'd seen your stuff online. I'd seen the guys you worked with. I know Acevedo, he's done some stuff with you guys and you obviously have a lot of neat people that you've worked with, a lot of good doctors on your website that you've advised with.

[00:27:29] Dr. Grant Garcia: So it's not like you have a bunch of schmucks out there working with you. No, we're very fortunate.

[00:27:33] Dr. Reza Jazayeri: Yeah. You know, and we have a couple of Clinical studies coming up with Johns Hopkins, looking at total knees with NYU. We're doing a hip fracture study and, uh, also a ACL study looking at this stuff. But these things take time as you know, writing IRBs, getting patients enrolled, you know, understanding, you know, how to best approach these.

[00:27:50] Dr. Reza Jazayeri: These are very tough studies to do. There's so many confounding factors. I mean, look. You know, uh, I do a double row repair, uh, on my rotator cuff repair, but it, it's, you know, you can find a lot of studies that say, [00:28:00] Hey, just do a single row doesn't make a difference. So something we know biomechanically totally works.

[00:28:04] Dr. Reza Jazayeri: Okay. And then you do the same thing in a patient. And then our, our data. Because the way we study it doesn't show it, right? And so people can poo poo it. But, but, but we, we still have this kind of understanding on a biomechanical side. This is the problem with our research and actually, you know, getting to that next step, the confounding factors.

[00:28:25] Dr. Grant Garcia: Well, also you need power, right? Like, I mean, for instance, I do a lot of surgeries. How many post op wound infections do I have? I don't have that many cause I'm doing scopes, right? But you get one, you wish you had supplemented them, right? So it's, it's, it's, it's, it's going to be, it's hard to get the numbers like you're talking about for the data.

[00:28:40] Dr. Grant Garcia: And I totally agree with you. I mean, you're gonna get people that are going to poo poo you cause you don't have 45, 000 patients in your study to show your supplementation works for certain aspects, but the same point. You have to realize like at a visit at six weeks, if I come into my patients, I mean, I have these other things I'm doing already now for post op recovery in terms of some other machines.

[00:28:57] Dr. Grant Garcia: I'm using different ice machines and things like that. I [00:29:00] noticed already patients are feeling better and that makes me feel good. And anecdotally, I can say that I feel like it works well, but I don't have the research back like you do for certain, some of these certain things, but it helps me to feel better that I can give my patients some enhancement, which is why it's awesome that I can offer this.

[00:29:15] Dr. Reza Jazayeri: Yeah, you know, I'll tell you right now, the joint arthroplasty and the hip fracture literature is really is really good. And it's there. So there's, you know, there was a recent systematic review of randomness control trials looking at totally arthroplasty and amino acid supplementation. And it's clear, you know, if you provide this one week before and two weeks after.

[00:29:33] Dr. Reza Jazayeri: You have an impact on their outcomes. And so, you know, you can extract. And so why they pick total knees because need total knees. We're gonna be doing so many of them in the future. Right? And so those are right. High volume. And so that's where the focus on the industry has been right. But because I started as a sports guy looking at a C.

[00:29:48] Dr. Reza Jazayeri: L. S. Um, that's how I first got into and I see the benefit there. You know, there may be the delta is gonna be maybe different for someone who's gonna have fracture versus someone who's having a C. L. You know, you're not gonna [00:30:00] die from an A. C. L. You may just get back later or, you know, you may retear hip fractures.

[00:30:04] Dr. Reza Jazayeri: These patients have significant morbidity and and the sarcopenia, the muscle loss leads to a lot of complications. So I think we can help everybody, but they're all going to be helped differently. So getting an athlete back is very valuable to them, but also preventing a hip fracture death and getting them out of the hospital on the other is also valuable for the system as a whole.

[00:30:27] Dr. Grant Garcia: And I want to do one thing that's going to, this is going to resonate with the patients, because this is what always, they always ask me. I'm like, you know, I do a PRP on somebody and they're like, well, what's the downside? What's the downside of supplementing patients?

[00:30:37] Dr. Reza Jazayeri: Zero, absolutely not. Zero. I mean, look, look, everybody, no matter what, is going to have a catabolic hit because of surgery.

[00:30:47] Dr. Reza Jazayeri: Your body is just going through the stressful response. And in order for you to be able to keep up with that, you're just going to harvest your own tissue, your own muscle. And so that was an evolutionary kind of, set for our [00:31:00] muscle to have this reserve to be able to kind of deal with this catabolic stress.

[00:31:04] Dr. Reza Jazayeri: But now if we can provide that, so I'll tell you, one of the really cool things that we're working on is we're doing intro up amino acids. Okay. There's good literature on that now when total hits, how do you do that? So you, you, you know, five years ago you weren't hanging a bag of TXA, were you? But you now

[00:31:23] Dr. Grant Garcia: I do it all day.

[00:31:24] Dr. Grant Garcia: My, my scrub check is TXA all day is his slogan.

[00:31:27] Dr. Reza Jazayeri: Okay. There you go. Okay. So for my shoulder arthroplasties, I do one in the, uh, in the beginning, one at the end. Right. And, and so

[00:31:33] Dr. Grant Garcia: every time. Every time.

[00:31:34] Dr. Reza Jazayeri: Right, right. And so before we, our shoulder arthroplasties by reverses, they would see in the hospital, two, three days wait for the drain to go down.

[00:31:41] Dr. Reza Jazayeri: And this, I'm getting an outpatient. I haven't kept the patient in hospital for arthroplasty. Maybe I had like a periprosthetic you know, it was a big deal, but otherwise they all go home. Right? So the same way you hang a bag of TXA, you hang a bag of amino acids now and we have that. And so, and so we're doing with some of the spine guys in New [00:32:00] York who are doing like really rapid recovery.

[00:32:02] Dr. Reza Jazayeri: Our advanced protocol we haven't even put this up yet, but I'm giving you a little teaser What what's coming is we have a latest and greatest

[00:32:08] Dr. Grant Garcia: here on this podcast. You're gonna hear all the earliest stuff

[00:32:11] Dr. Reza Jazayeri: Yeah, so we're doing intra up amino acid infusion And so what you see is when you and I are sitting here right now, we're making and we're breaking muscle It's it's like a it's like a dynamic just like bone right making breaking making breaking And so if, if you look at what happens during surgery, you, you break down a lot more and you're not making as much.

[00:32:30] Dr. Reza Jazayeri: So the net is you lose after the two hours of surgery, when you give intra op amino acid infusion, you stay exactly like you are now. So you're able to mitigate that drop. And so essentially you leave the surgery and you haven't had the muscle loss. So the impact of that will lead to, you know, faster recovery.

[00:32:48] Dr. Reza Jazayeri: So now this, we need to show the clinical side of it, but the intra op muscle synthesis and breakdown. The data is already there. That was a 2021 study.

[00:32:56] Dr. Grant Garcia: A lot of people that watch this show, orthopedic surgeons [00:33:00] who are going to tell their patients, they're going to see this and they're going to say, well, I want to get this product or whatever.

[00:33:03] Dr. Grant Garcia: And we'll go through this product really quickly in a minute. Um, but so what are you telling, like, is there a, so for me and my patient, right, I got my meniscus mastectomy patients and I have my, you know, my biceps tedious patients, the simple kind of recovery ones. But then I have my bigger stuff, like my ACL meniscus, Carlos transplant, we're talking about like three hours of surgery, a lot of work, a lot of atrophy, non weight bearing Carlos transplants, you name it.

[00:33:26] Dr. Grant Garcia: So are those the ones that you would focus on first if you're kind of trying to start this practice Hundred percent and trying to start the nutrition?

[00:33:32] Dr. Reza Jazayeri: Yeah. I, I, so we have kind of this, um, if, if you, on the website we have this kind of the high demand patients and we've broken up into two categories. We got the, we got the high risk, which are the infections, diabetic smokers, revisions, you know, the elderly patient, um, massive rotator cuff tear, right?

[00:33:48] Dr. Reza Jazayeri: You got, you got that group. Those are the kind of high risk patients. And then on the other side, you got the high demand patients. Those are essentially our athletes, our patients trying to get back faster. So I think, [00:34:00] you know, those are the two, um, patients that really are, are looking for, or would really benefit from it.

[00:34:06] Dr. Reza Jazayeri: And you can arise,

[00:34:07] Dr. Grant Garcia: you can have sometimes they can cross. I mean, I've got some patients that are crazy high demand. I've had three failed surgeries too. And that's also important. And those are the ones that are higher.

[00:34:14] Dr. Reza Jazayeri: That's a no brainer. That's a no. So, you know, in my conversation with my patients, you know, we all go through our discussion with our patients and one thing that comes up regardless of who you are, what.

[00:34:23] Dr. Reza Jazayeri: is patients always ask ab right? So tell me about are you doing whatever yo long am I gonna be in a s

[00:34:34] Dr. Reza Jazayeri: add this to my conversation. I say, look, in order to improve your recovery, we try to optimize your nutrition by using a supplement that provides you what you need for improved healing. That's it. You know, and, and, uh, and then, you know, really the, the company really takes over as far as there's a whole, it's like a concierge type service where they explain this to the patients.

[00:34:53] Dr. Reza Jazayeri: We have a whole, well, it's on the muscle sensor calculator. So if I, if I could do it for you right now, I would, you can go online and you could put in your [00:35:00] body weight, your sex, your age for you. And then it would give you a meal plan. So again, it's not just about the supplement. It's not just about the physical therapy.

[00:35:08] Dr. Reza Jazayeri: It's also where you're actually consuming. So we provide all these resources for patients who would otherwise have to go to some nutritionists or something. Does that come with

[00:35:16] Dr. Grant Garcia: your, is that, uh, okay, let's pause there. I want to talk about your company. Cause no one even said anything. We haven't even shown a picture of it and we're getting distracted, but I want to focus.

[00:35:27] Dr. Grant Garcia: So. That topic. So tell us about this company and then tell us about what comes with it. So you got your, your supplementation, but also the background stuff that you were just getting into.

[00:35:36] Dr. Reza Jazayeri: Sure. So, you know, I'll tell you how this kind of started actually. So I might, so my personal background before med school, I was in skeletal metabolism, and so I was, you know, That was pretty mad.

[00:35:46] Dr. Reza Jazayeri: So I was like kind of doing biopsies on rats anyway, and understanding how muscle works. And that was before meds, you know, so I kind of had this in my well,

[00:35:54] Dr. Grant Garcia: he was a natural surgeon. He was biopsy muscles before.

[00:35:58] Dr. Reza Jazayeri: So, so I [00:36:00] had this in the back of my mind, but then a few years back, I had a patient who came to see me for a revision ACL and he did an osteotomy.

[00:36:05] Dr. Reza Jazayeri: He came back and he's like, doc, my leg is finally stable, but I lost all my muscle. What do you have for me? And so, you know, I live in an area where the primary care docs, you know, they talk about anabolics, they talk about growth hormone, they talk about peptides and they talk about, you know, supplementation.

[00:36:21] Dr. Reza Jazayeri: And so when I talked about supplementation, he's like, well, doc, you know, are you, do you know about the, all the amino acids stuff that we're, that we're using for NASA? And I said, Oh, whoa, what do you know? And so that, so that blew my mind. So I called him back and we brought him on essentially. We are really, really late to the game.

[00:36:39] Dr. Reza Jazayeri: The guys who've been really studying this. NASA got onto this a long time ago because they had to study what can they do in order to prevent the like the really rapid muscle loss that happens when you go to outer space. And so in order to be able to prevent muscle loss, you can't take a bunch of food with you.

[00:36:56] Dr. Reza Jazayeri: But they identified what were the key amino acids that you can [00:37:00] consume to prevent muscle loss. This is where all the studies actually started from. Okay. It came from muscle loss studies in order to prevent that degeneration that you see in outer space. And then that got extrapolated now to a lot of the stuff that we're doing now.

[00:37:16] Dr. Reza Jazayeri: So that's how the company actually started. So, you know, this was, this is how it kind of got started. And then when I kind of tapped into this, that's when I kind of really dove into this. I looked at, you know, we looked at burn patients, right? Burn patients are supplemented with these amino acids and they're getting better faster.

[00:37:32] Dr. Reza Jazayeri: And I realized, wait a minute, What is a burn have to do with orthopedics? What's collagen? Collagen synthesis. They have the same underlying pathophysiology, right? You want to increase blood flow. Well, how do you increase blood flow? We're doing it for guess what? Angina supplements. There's supplements for erectile dysfunction.

[00:37:48] Dr. Reza Jazayeri: You know, there's supplements for a lot of different things in the body. And similarly, they're being used for burns as well. So when I looked at that, I said, wait a minute, if we can improve blood flow to an area, well, guess what? They're using these [00:38:00] supplements for diabetic wound ulcers, right? So to me, when I started to look at all these supplements are being used in different subspecialties in AIDS patients, in wasting disorders, and I'm like, this is actually ideal for an orthopedic surgeon, because these are the issues that we're dealing with muscle loss.

[00:38:17] Dr. Reza Jazayeri: And and wound healing and bringing more blood flow and giving the key amino acids at the right dose To be able to enhance these processes

[00:38:25] Dr. Grant Garcia: and i'll say a little tidbit and this is just off topic But when I I had a major surgery a couple years ago And the first thing I was looking at supplementation and I went on and got some collagen powders and did all the stuff I could But obviously didn't have this stuff Available and I would have jumped on it right away.

[00:38:39] Dr. Grant Garcia: I mean, but obviously I, but it's still knowing that I had to do all that extra stuff myself, legwork, figure it all out. And I wasn't really doing a lot of evidence based medicine. I just wanted to give myself the best possible option. And so why wouldn't I do that for my patients? And now that I have a much easier option, not just saying, you know, I used it in my surgery.

[00:38:58] Dr. Grant Garcia: So therefore you should [00:39:00] use it more like we have evidence based, but it's just interesting to hear this because I'm just like those patients in Seattle that come in and they're like, I want everything. Like, I want to get back. The fastest I don't have any time like I, I need to be back on my feet in the operating room in four weeks or I was going to be freaking out.

[00:39:15] Dr. Grant Garcia: I'm private practice. Like I had to be back and I don't have time. And again, I'm not a pro athlete, but we have a pretty aggressive job and we don't get to use these. That's right. Have anything. That's right. That's right.

[00:39:26] Dr. Reza Jazayeri: So, so, so that, so that's, this, this was what was born out of, of kind of, you know, that, that one patient that really stimulated, it.

[00:39:33] Dr. Reza Jazayeri: you know, think about this. And I've already been recommending supplements and working with some of the guys here. But then I said, you know what? I didn't trust the supplement out there. That was the problem. So then understanding who to work with, getting the NSF for certification, knowing exactly the right dose, basing on literature that you and I are comfortable with.

[00:39:49] Dr. Reza Jazayeri: This was like 56 years in the process to finally have this conversation with, you know, and gathering data. And it's and it's interesting now to see The orthopedic community is now looking at this [00:40:00] more initially because of the hip fractures and the elderly patients because muscle loss in them. So sarcopenia is a big issue, but now we can extrapolate it and implement it for, you know, our, all our patients actually.

[00:40:12] Dr. Grant Garcia: And I think it's important for patients again, to remind them there is no downside to this. It's, it is going, if anything, it gives you even a few weeks better recovery, in my opinion, it's worth it. If it was my surgery, I would do it no matter what. And just the problem is you need to be able to have the access to it, right?

[00:40:28] Dr. Grant Garcia: And you need to have the understanding of it. And this is really, it's really key. And I'm excited that we're all, we're having you on the show and everyone can hear about this. Um, cause now I can reference this talk, right? It's, you know, it's like you said, you just tell them I'm going to supplement you after surgery because To be honest, we can have this whole 43 minute talk.

[00:40:44] Dr. Grant Garcia: If you had this talk to every single person, you would have no time left in your day.

[00:40:47] Dr. Reza Jazayeri: Well, so you, you just took the words out of my mouth. I was just going to tell you. So when I realized putting this together, because I don't, we don't have the time to do this. What I, what I wanted to create was the pain point, not just for the patients, but also for our practice.

[00:40:59] Dr. Reza Jazayeri: I [00:41:00] don't have the time to have this kind of discussion, even though I really, really want to, okay. It just doesn't exist. So we created a kind of a concierge service for any patient who signs up for this, has access to. someone will call them bac explain to them what it i list is dietary support t there's a lot of look pat Covid.

[00:41:19] Dr. Reza Jazayeri: They're much more consume, what they can do We don't have the time, but if we have a good resource that we can provide them, this is how we can make a positive impact.

[00:41:33] Will Sanchez: I think that's awesome. That's awesome. What's the process for, for your patients, uh, for you to determine, um, what is the right combination for each patient?

[00:41:42] Will Sanchez: Is it lab work? Uh, you know, what, what, what goes into it? Blood work? What, what happens for you to make that determination? This

[00:41:49] Dr. Reza Jazayeri: is a, so great question. So because. The body goes through this catabolic stress and the requirements are elevated for these [00:42:00] key amino acids that are needed for muscle and bone and collagen synthesis.

[00:42:04] Dr. Reza Jazayeri: You can apply this to any orthopedic surgery. Actually, to be honest with you, we're getting a lot of interest and a lot of positive feedback from bariatric surgeons and plastic surgeons. We even have a one of the guys who's really been using this a lot as a breast reconstruction surgeon, right? Same issue, right?

[00:42:18] Dr. Reza Jazayeri: Patients, those patients, Or or after cancer, chemo, radiation have breasts and then now they're really mal malnourished. They need everything they can. So this, so this actually has simplified it, right? That's the other thing that's really important. If you're gonna do something that's gonna work, it also has to be simplified, right?

[00:42:36] Dr. Reza Jazayeri: So this is simplified. This is one week before, two weeks after. and it's been dose where a 14 year old ACL can take it. Also, your 82 year old grandmother can take it. So under

[00:42:46] Dr. Grant Garcia: 18 can have this too.

[00:42:48] Dr. Reza Jazayeri: Yeah, the only issue is if you're under 70, um, they're, you know, we decrease the packets usually take two packets a day for someone who's under [00:43:00] 70.

[00:43:00] Dr. Reza Jazayeri: They just don't need that. Uh, we just because I'll just pee it out. It's like there's there's zero issues with toxicity on this. These are amino acids that are free form. You know, you consume them. Otherwise they go through the unit.

[00:43:11] Dr. Grant Garcia: So they'll do this and they'll get how many packets with

[00:43:14] Dr. Reza Jazayeri: this? So it's three.

[00:43:16] Dr. Reza Jazayeri: So they get three boxes. and each box has 14. So they do two of the two a day for, uh, for three weeks. So that's all, that's all, you know, that patients have to think about is a three week supplementation one week before and two weeks after. I have some patients who feel better afterwards. They like the energy.

[00:43:34] Dr. Reza Jazayeri: They, you know, we, we, you know, we, we hear all these different things where you're doing ACL and someone, but they're like, Hey, my upper body strength is better. My mood is better. My energy is better. So they're, they're actually not coming back. And we have a patient that's Like a subscription where they stay on it as a daily, but you really want to hit them for that opportune time that we can be showed on that graph is, is that, is that, is that critical time?

[00:43:53] Dr. Reza Jazayeri: The one week before in order to build the resilience to build up the amino acid pool. And then the two weeks after when [00:44:00] they're most catabolic, if you can, if there's one time to hit them, it's that three week window. And

[00:44:06] Dr. Grant Garcia: if you can't get it, let's say you were saying, So two weeks after most important, but if possible, three weeks is recommended.

[00:44:12] Dr. Reza Jazayeri: Yes. So when I see my patients, I usually see my patients about a week and a half to two weeks before. And then there's a QR code that they just scan and then the company just ships it to them. And I think you work with, uh, um, recovery shop. Yeah. So we're on multiple platforms. Recovery shop is one of them.

[00:44:28] Dr. Reza Jazayeri: They're great because the patient just scans your QR code and then they drop ship it to them. Um, some surgeons like to have it at their place, like a curling joke. It's at their DME. So they see Dr so and so and they walk down and they pick up their box and they go home with it. So there's different ways of doing it and we have kind of a mix for different facilities.

[00:44:46] Dr. Grant Garcia: Yeah, for me, I mean, my longterm plan with it, obviously, and I'll tell patients, they're going to, this is going to be offered probably very soon. It's already in the works since we've been talking. Uh, but it's part of this enhanced recovery protocol, right? So you get a, we'll talk about the next, next episodes.

[00:44:59] Dr. Grant Garcia: Can we talk about the nice [00:45:00] machine? And the episode after that, we'll talk about the other machines we have and other options. And so it's all part of this bundle where it's like the enhanced bundle, right? You get the recovery, you get the machines, things that you just can't normally get. That's

[00:45:11] Dr. Reza Jazayeri: actually what we're seeing.

[00:45:12] Dr. Reza Jazayeri: Like, um, Some of the guys at HSS are also using, um, the recovery shop and it's, they have these bundles that they do. And then, so they put XR in their, in their like ACL or their total knee or total shoulder bundle, you know? And, and so it's no

[00:45:27] Dr. Grant Garcia: coincidence. I went to HSS, so I got to

[00:45:31] Dr. Reza Jazayeri: Are you getting

[00:45:32] Will Sanchez: folks that, that kind of want something like this, uh, even post op and saying, man, I'm feeling really good.

[00:45:38] Will Sanchez: I'm starting to work out. I really need to kind of elevate myself, you know, as someone that's like I said, we discussed earlier recovering that I still am struggling with that. Absolutely. You have a patient like myself saying, please, I, I, I need, I need a boost. How do, how do they go about that?

[00:45:55] Dr. Reza Jazayeri: So, so interestingly, you know, when, you know, we, we, we, we have [00:46:00] done this on multiple, um, kind of demographics.

[00:46:03] Dr. Reza Jazayeri: Um, and you know, obviously we're talking about the surgical patients and they need a higher dose of that. But I'll tell you what's really fascinating with these really extreme athletes. they're willing to put their bodies through some ridiculous things. Okay. And, and the amount of stress that they put through their bodies as like one of these crazy bodybuilders, their demand is actually not that different than what we want in our patients who are coming out of orthopedic surgical recovery.

[00:46:30] Dr. Reza Jazayeri: Right? So they want muscle synthesis, they want collagen enhancement, right? They don't, they don't want, they don't want to, um, They want to be able to get back to their sport and where we're seeing this used a lot right now. So one of our, um, one of our teams that's using this, you know, for Major League Baseball, um, they.

[00:46:48] Dr. Reza Jazayeri: won the championship last year. Okay. But, um, they are using it as a, almost like a preventative. And I'll tell you something really interesting. A lot of the science that we have on this [00:47:00] didn't come from orthopedics. It came from the, the scientists were have been studying this on athletes. So something that athletes get, I've heard of DOMS, delayed onset muscle soreness.

[00:47:09] Dr. Reza Jazayeri: When you work out, you're sore. Yes. Uh, okay. But if you, if you look at it in an objective way, there's something called EIDM, exercise induced muscle damage. What that basically means is if you train really, really hard, you break down your muscle tissue. And just like when you get a heart attack, you can check troponin levels.

[00:47:24] Dr. Reza Jazayeri: You can say, Oh, someone had a little heart attack or a big heart attack. Based on how much to form well up where you can check how much you damaged the muscle tissue by the intensity of your workout and you can objectively look at that by the creatine kinase level. And so creatine

[00:47:39] Dr. Grant Garcia: like next level, like the people that go do CrossFit too much and they can get like go to the hospital, right?

[00:47:43] Dr. Grant Garcia: Exactly. So much damage.

[00:47:45] Dr. Reza Jazayeri: Exactly. And so you can use these amino acids and these amino acids, you know, we talked about the essential amino acids. Those are the nine that are essential. There's something called branch chain amino acids. Those are the BCAAs. You may see that. Those BCAAs, those are the

[00:48:00] three of those essential amino acids.

[00:48:02] Dr. Reza Jazayeri: They're still essential, but the three of them have these branched chain. Those have been shown, particularly in the exercise world, to reduce that exercise induced muscle damage by creatine kinase levels. So a lot of the athletes, a lot of the, um, strength coaches and the major league baseball nutrition and dietitians are aware of the science and so they use this for enhancing their athletic recovery.

[00:48:25] Dr. Reza Jazayeri: Okay. And recovery is really the key now for enhancing performance because no longer are our athletes limited by how much they can work. They're limited by how fast they can recover. And that's where we're seeing the difference, okay? Because if you have nine months to train for something, and if you work out really hard, but you're sore for four days before your next ability to train and build on that previous gain, you've only had so many sessions.

[00:48:51] Dr. Reza Jazayeri: But if you can shorten that training period by having improved recovery, Then in that nine month period, you've really tacked on a lot more [00:49:00] training, effective training sessions. That's where these athletes are using it. So it's your point, Hey, you know, who else can use this or benefit from this?

[00:49:07] Dr. Reza Jazayeri: Especially if they've this for years. Well, this sounds like a

[00:49:11] Will Sanchez: game changer, especially when it comes to sports, because, you know, this is, you know, You know, I'm a huge sports fan. I've worked in sports forever. Um, you know, this was the conversation when you had, when you talked about a Barry Bonds and a Mark McGuire and certain athletes that were affiliated with the steroid era.

[00:49:27] Will Sanchez: And, you know, say it's not going to help you hit a ball. It was the recovery, right? That's that these athletes were looking for. And if there's something like this, not just for the athlete, but for, but that's

[00:49:38] Dr. Grant Garcia: legal and not steroids.

[00:49:42] Will Sanchez: It's the recovery process, whether it's athletes or ourselves, that we can feel better quicker.

[00:49:47] Will Sanchez: We can go to the gym three, four times a week, and our recovery time is better. Just maybe having something like that in the future, and it's all working naturally with the amino acids that belong in our body, that's a part of [00:50:00] it. That's just, it's like the, the, the fountain of youth, the holy grail.

[00:50:05] Dr. Reza Jazayeri: Well, I'll tell you, you know.

[00:50:07] Dr. Reza Jazayeri: Nutrition and what you put in your body is, is, is really key. I mean, mm-Hmm. not to get too deep into the science of it, but literally the amino acids that were tagged in some of these studies that you consumed, you can biopsy them outta your muscles in, uh, in, in about a day. And so our body is, is turning over about.

[00:50:25] Dr. Reza Jazayeri: All of us right now are in one day, we're turning over about 300 grams of protein. We're making, we're breaking, we're making, we're breaking. If you eat maybe a hundred grams of protein a day, that means 200 of it is being recycled. So there's a huge turnover. And so during the time of surgery where you're breaking down so much, you just can't keep up.

[00:50:43] Dr. Reza Jazayeri: So you lose it. So this is very simple. We can take something very complicated, really simplified to say, look, during this time of surgery, when you got this huge hit, just give your body the exact amino acids it needs. To then prevent that loss. And that's where we're seeing that improvements. Exciting.

[00:50:59] Dr. Grant Garcia: Well, I don't want Reza, [00:51:00] you, we could talk, as I mentioned before, so basically

[00:51:03] Dr. Reza Jazayeri: tell us

[00:51:05] Dr. Grant Garcia: about

[00:51:06] Dr. Reza Jazayeri: the future

[00:51:07] Dr. Grant Garcia: horizons of it. And then we can wrap it up.

[00:51:11] Dr. Reza Jazayeri: Yeah. So one thing we didn't really get into, we talked about amino acids, but peptides are a little bit different. Peptides are usually injectable. Okay. And, and that's a, and that's a little bit different than, than, I mean, so I mean as you can orally consume, you can get them, you know, uh, at, at, at your GNC or whatever, but, but peptides are a little bit different peptides is when two amino acids come together.

[00:51:36] Dr. Reza Jazayeri: Okay. When they get linked, so what's a peptide that we're all familiar with? Insulin, for example, insulin is a peptide. We use it all the time. Oxytocin is another peptide that we can constantly, these, um, uh, the GPL one agonists, these are all peptides. These are for diabetes. So peptides are being used. For, for since 1920, since they were identified.

[00:51:58] Dr. Reza Jazayeri: The one that is be, [00:52:00] be being used in the, in the recovery world, that's still not FDA approved, but being used by a lot of these athletes, for example, um, is B PC 1 57. That's what maybe some of your patients asking salt tissue repair one, right? Yeah. And that one I'll tell you. If it weren't for me seeing, and by the way, I sent you guys a couple of art.

[00:52:18] Dr. Reza Jazayeri: I sent you an, uh, the articles, these references. So you have a grant. If you want to put it up for your patient, this was done in, this is, these studies were done mostly on, I have to say this on rats and on animals. So they're not on humans yet. Okay. But there's so much literature, MCL study, MCL tears, Achilles tendon tears.

[00:52:33] Dr. Reza Jazayeri: They take these, uh, these animals and they, you know, basically cause this injury and then they take this BPC, which is, Body protection compound. This is a peptide that lives in our guts already. Why in our gut it's so important for recovery because we're constantly needing to keep everything outside because from our, from our mouth, through our butt, essentially, that's the GI system and is constantly regenerating.

[00:52:56] Dr. Reza Jazayeri: So this BPC com peptide [00:53:00] increases, angiogenesis, increases vascularity, and helps with FibroGen. production. This is why it's used in all sort of colitis. It's been used in all these G. I. Issues. These athletes now have been injecting it for years now, and I see them because they come back and they look very different.

[00:53:20] Dr. Reza Jazayeri: So that's what that's the next step that we're looking into is, is can we safely study this? The problem with these peptides? The reason the FDA is saying no is because anytime you say we're increasing angiogenesis and you and I are excited because we're like, wait a minute, that's why I do a micro fracture.

[00:53:35] Dr. Reza Jazayeri: That's why I do PRP. That's why I do all the stuff that I'm doing. You can increase baby cancer and that's where everyone says, okay, I'm gonna hold off And so we're trying to find a happy means to hey, look if someone's having surgery and for six weeks They got a third rotator cuff repair that we can't get to heal and we're seeing Biological histological studies on these rats showing improved tendon healing Incredible studies done, but [00:54:00] we still haven't been able to translate it into the human.

[00:54:02] Dr. Reza Jazayeri: So I think this is where we're going to see the next of where these peptides safely being studied where some of the Um researchers are we're looking at setting a usc

[00:54:10] Will Sanchez: And can you give a quick warning because when I look it up I can see it out there, you know And so I don't know if it's the real thing or what somebody's it's aftermarket.

[00:54:20] Will Sanchez: So if Someone that's listening to the show is seeing a bpc, you know bbc 157 somewhere You What is your warning to anyone out there besides the fact that this hasn't been approved?

[00:54:32] Dr. Reza Jazayeri: So it's being utilized. It's been used for probably over a million people have used it now. Okay. Um, so it's the, the, the, the LD 50, which is the lethal dose on this is extremely high.

[00:54:43] Dr. Reza Jazayeri: You really can't hurt yourself on. That's why it's been utilized for so long. It started out in Europe, but in the States now it's extremely common. You know, like I said, half my patients here who come already, you know, are on it or asking me about it. And we're just modifying it with some of the other docs.

[00:54:58] Dr. Reza Jazayeri: Who are providing it. So [00:55:00] I would tell you don't get it online. Do not get it online. Even though you can go to a licensed physician who has been practicing this for a long time, who understands peptides and understand your risk, I can't say yes and I can't say no. I can tell you it works okay. But we're at currently today as it stands, orthopedic surgeons.

[00:55:19] Dr. Reza Jazayeri: Don't prescribe it. Uh, it's not in our armamentarium yet, but for sure it works. And so it's just a matter of time. And this is where, you know, when you see something that works by the time the FDA actually approves it, uh, it's going to be further down the line. So I'll tell you, here's the future. It involves immediate weight bearing after injury.

[00:55:40] Dr. Reza Jazayeri: I can't stress that enough. How important weight bearing is. Okay. Starting the, starting the amino acid supplementation at the time of injury and getting into the prehab intra op amino acid supplementation as soon as you can, weight bearing and actually safely BFR pre op and

[00:56:00] post op. And then these peptides I think are promising for, you know, for the immediate post op period for the six to eight weeks.

[00:56:08] Dr. Reza Jazayeri: Some people live on them. You know, um, but I would say from a safety perspective, um, 68 weeks is not unreasonable.

[00:56:17] Dr. Grant Garcia: That's going to be an awesome quote. I love it again. Remember everybody peptides orthopedic surgeons can't prescribe them But there's other doctors that can that know them better. So go to those people for that last piece Everything else we can safely do and it's fda approved.

[00:56:31] Dr. Grant Garcia: Uh, and so this is going to be awesome

[00:56:32] Dr. Reza Jazayeri: You guys there's a lot of information. So I work with a lot of residents and stuff So there's a lot of clinical studies that we put on so if you go to xr science, um This is essentially an organization of, um, you know, providers and athletic trainers and surgeons who've come together

[00:56:51] Dr. Grant Garcia: on the screen guys.

[00:56:52] Dr. Reza Jazayeri: Yeah. So there's a lot of good. If you look under the, um, healthcare provider section, you'll see the clinical studies. Um, and so that then you guys [00:57:00] can reach out to our team out there if you have any questions, but this is really an exciting time because it's more than implants now, you know, we have, we have to be more educated on this stuff so we can better help our patients.

[00:57:09] Dr. Grant Garcia: We finally have more tools because like, I'm sick of my first few years of practice. I was sick of telling them that like, I'm just going to give them all the best implants. And then you get like, then that like gets boring. And then you're like, I have nothing left to give you. And then like, but I want to be better.

[00:57:22] Dr. Grant Garcia: And how can you beat the guy next to me? And how can you give, how can I be more enhanced and, you know, other than weird off label things and things that are inappropriate that I would never want to offer now, I have these things. You know, this is one of those things I'm not gonna be able to offer.

[00:57:35] Dr. Reza Jazayeri: Yeah.

[00:57:35] Dr. Reza Jazayeri: And I'll tell you of the things that I told you, the amino acid is so elementary actually, in my mind, now that I've seen what's out there and what we're using, like, so when people are like, Oh no, these amino, and I'm like, Oh my God, this is like, so elementary. I'm not even going to explain it. tell you the other stuff that we're already doing, you know, because it's just too much, you know, you have to, yeah, no, no

[00:57:54] Dr. Grant Garcia: baby, baby steps for everybody.

[00:57:56] Dr. Grant Garcia: But to be honest with you, as we know with orthopedic surgeons, it, everything takes a [00:58:00] little bit of time and you have, you get stuck in your ways. Um, but the one last thing that's really cool about this company too, is that it was started by you as an orthopedic surgeon. I think that people, when we offer things, Like PRP and things like that and they come to us they like it because we're the orthopedic surgeons offering it It's not someone who doesn't have expertise in the surgical and the non surgical route and so this is really important for us because it's just there's so many of these random companies that offer things that are not approved or they're They're in a run by just businessmen and there's not any background to science on it, right?

[00:58:30] Dr. Grant Garcia: And there's not the certifications and those things so it's really nice to have that you've done all the work You're a clinician, you're a good guy, you've done the research, you've got the certifications, the safety things, it's all important for our patients to know that, that, that the surgeons like myself, I can confidently go in tomorrow and I had a patient Yesterday I said I got this guy on a podcast.

[00:58:48] Dr. Grant Garcia: You're gonna love it. You're gonna get some amino acids for your post op recovery. Just wait till it pops up and they're like, when is it coming? When is it coming? I'm like, listen, we'll see how fast it gets edited and things like that.

[00:58:57] Dr. Reza Jazayeri: Yeah,

[00:58:57] Dr. Grant Garcia: but you know, this is I feel totally comfortable [00:59:00] tomorrow Offering this and this is good for everyone to listen to and hear

[00:59:03] Dr. Reza Jazayeri: You know, we've been using this for over a couple of years now, and I'll tell you, I'm still learning so much.


Dr. Reza Jazayeri: And these, these conversations that we're having are, I'm just excited to kind of share this with you because I learned through the process and, you know, maybe we can study some of your patients. And I'm always interested in research and learning more. By no means is this the end. I think this is actually the beginning.

[00:59:23] Will Sanchez: Thank you so much, uh, xrscience. org Guys, thank you so much for having

[00:59:29] Dr. Reza Jazayeri: me. This is exciting. And, uh, you know, we'll keep this going. And, uh, look forward

[00:59:37] Will Sanchez: to, you know, pushing this together. very

[00:59:40] much. Appreciate it.
Audio Transcript


Dr. Andre Shaffer: Spine surgeon and cutting edge technology in spine

Tech and Innovation: Roadblocks to Success.

Will Sanchez: [00:00:00] Dr. Garcia, welcome. That's my jam right there. It got a little like, you know, you guys did such a good job. We did such a good job. Anyway. Hey, thank you everyone. And thanks for listening to sports doc. Talk. Be sure to check us out on your favorite listening platforms. We're on Apple. We're on Spotify. I heart you name it.

Will Sanchez: And now with our videos, please check out our YouTube page. Dr. Garcia, we're really excited about our guests, but before we bring on our guests, how are you? I know I was having some issues. I didn't know if we would get the show going today because I was having internet issues and I was scrambling, but I'm hoping that your day was a little bit better than mine.

Dr. Grant Garcia: I was scrambling, but not from internet issues. Uh, it was [00:01:00] good, busy, you know, as usual. Uh, but yeah, I'm excited we can do this show. I mean, we just put on one last week, but this is, A really important guest that I'm excited for people to share. And, you know, we have breaks coming up and everything. So I was hoping we could get this on.

Dr. Grant Garcia: And I'm so excited, uh, to introduce this. As you guys know, I ranted for about five minutes introducing this show about a week ago. Uh, so hopefully anybody heard that. If not, you will hear the update today. Um, I don't know if you want to kick it off and we'll go from there.

Will Sanchez: Yeah. Let's bring on a, he's in our green room.

Will Sanchez: All right. We're going to send somebody to go get them. No, it's not that, not that complicated. Let's bring on a Dr. Schaefer there. Dr. Schaefer. Welcome. Thanks for hanging out with us. Uh, Dr. Schaefer, I, I, I bothered Dr. Schaefer there and I was like, uh, are you still in the operating room? You got your scrubs going on, but I love how he said, you know, you, you gotta be ready to stay ready.

Will Sanchez: So, uh, welcome to the show. Dr. Schaefer.

Dr. Andre Shaffer: Thank you. Thank you. Pleasure to be on really. Uh, it's a privilege.

Will Sanchez: Go ahead, Dr. Garcia.

Dr. Grant Garcia: Yeah. [00:02:00] Schaefer. This is Dr. Andre Schaefer. He's a spine surgeon actually in my group, which is awesome. And we actually know each other really well. I've been friends for way too long.

Dr. Grant Garcia: Uh, we went to hospital surgery, special surgery together, and he had the privilege of taking care of some pretty amazing athletes as well. Uh, while he was there with me. Um, and we've got along working together in residency. Yeah. Um, he actually went to Cornell, uh, undergrad as well, so he's kind of a slacker.

Dr. Grant Garcia: And then now you have him having triple fellowship training, uh, as he did one, uh, in Harvard for trauma, uh, two at, um, in two in Seattle, he did hip preservation, but really the big thing in one of his real passions, again, with some minimally invasive stuff coming out with spine. And so he just, He finished his spine fellowship.

Dr. Grant Garcia: He's been in prior practice for a little while and now he's joined us and we are so happy to have him. I can tell you right now that I have way too many partners coming up to me telling me how [00:03:00] excited they are to have Dr. Schaefer as part of the group. Um, and for me it's near and dear because it's really been nice to have somebody like that that takes things by the reins and he's doing so many cutting edge things in Seattle.

Dr. Grant Garcia: Uh, I don't want to brag too much about you, Andre, cause you have to speak at some point. Um, but he is, he was the first, uh, person in all of Washington state, uh, to perform endoscopic spine. And I think I'm an endoscopic spine outpatient, especially with the new Arthrex system, which. We know we like to talk about that and it was no internal brace will, but he still did it with just a regular scope.

Dr. Grant Garcia: So we're going to talk about this procedure. It's really important, near and dear to me as well. Um, but enough of that, let's talk about how Dr. Schaffer is doing.

Dr. Andre Shaffer: Ooh, I got three kids and my wife's putting them to bed. So I'm, I'm happy to be up here talking about spine.

Will Sanchez: That is great. In fact, you know, let's, let's, let's take a quick look at the beautiful family. I mean, your resume [00:04:00] is legit, you know, as you know, Dr. Garcia tongue in cheek over here saying you're a slacker. But, uh, I mean, your, your journey has been a very interesting one. You know, can you just give us a, just a brief look in insight into, you know, how you went from firefighter to now just say a renowned surgeon, you know, just, uh, a little bit of that journey.

Dr. Andre Shaffer: Yeah, absolutely. Yeah. You know, so, um, I was born and raised here in Seattle. I was a Seattle firefighter for seven years. Um, and it was really a colleague of mine who, uh, fell about 45, 50 feet. Um, while training that even got me to go to college. Um, and so, uh, you know, went to the university of Washington, a proud Husky.

Dr. Andre Shaffer: Um, and while I was in college, I kind of found my footing academically and decided, you know, maybe I should shoot for something a little bit more. Uh, [00:05:00] Um, sort of rigorous than just being a firefighter. Loved being a firefighter, nothing

Will Sanchez: rigorous than a firefighter. That's a, that's something that you don't always hear.

Dr. Andre Shaffer: Yeah.

Will Sanchez: Being just a firefighter. That's amazing.

Dr. Andre Shaffer: Yeah. So, you know, I, I, I, I went to, I guess I went to undergrad did well. And then, yeah, I got to go to Cornell. I applied. Um, and got in. And so then, you know, sort of like the dog that caught the car, you know, so I got, I got into medical school. So I should, I should probably go.

Dr. Andre Shaffer: Uh, so went to medical school, um, at Cornell. And then me and Grant met, uh, first day of sub eyes actually, uh, in Seattle at University of Washington. And then we ended up matching at HSS together

Dr. Grant Garcia: on the other side of the country. Yeah. And so it is history. You can't make that up dude. We literally worked together for a whole month in Seattle at University of Washington doing trauma, which by [00:06:00] the way, everybody knows I'm not a huge fan of that.

Dr. Grant Garcia: I like sports. Uh, but nonetheless I did it because I was interested in going to U Dub and then we ended up together in New York, which was crazy because we didn't really know until We showed up, I saw your picture and I was like, dude, I know that guy.

Dr. Andre Shaffer: Yeah. Yeah. It was a good time. So, so yeah. So now, yeah, now I'm here.

Dr. Andre Shaffer: And I, you know, I, uh, you know, when I was in residency, I wasn't, um, you know, a lot of our spine was open. I was, I was interested in spine, you know, from biomechanics and sort of, it's, it's, it's, it's, it's, it's important, right. Spine connects your head to your torso. And so, uh, Very important stuff, but just, it was so open that I wasn't really as much of a fan of that.

Dr. Andre Shaffer: And, and, you know, the patients had a hard time kind of bouncing back from some of the bigger surgeries that we were doing. And so it wasn't until I was in my trauma fellowship and I'm, um, and you know, I'm seeing some of the, some of the work that people like Andrew Simpson was doing up at [00:07:00] Harvard, you know, big MIS proponent, um, and watching them do tubular micro decompressions and seeing like, Oh wow, there's, there's an alternative.

Dr. Andre Shaffer: And so that was what got me interested in spine. Um, and then when I was doing my hip preservation fellowship as well, seeing how much overlap there was between the hip and the spine and how many patients would come in with hip problems that we would send off for their spine. And vice versa. Um, and so, you know, that, that kind of primed the pump and then I went off and did trauma and hit for a while.

Dr. Andre Shaffer: And then, you know, finally, when I started hearing about, you know, spine endoscopy or endoscopic spine surgery, that was the thing that kind of told me, Hey man, we gotta, I gotta, I gotta go back. I gotta circle back and figure that out. And so I got to work with, uh, Some, uh, really great neurosurgeons and orthopedic surgeons in my spine fellowship, uh, down in Phoenix, Arizona.

Dr. Andre Shaffer: And, you know, they, they enabled me to kind of go to whatever classes and courses I wanted and kind of check [00:08:00] stuff out. And, you know, my program director was interested in endoscopy as well. And so we, we did, you know, uh, a handful of them. during the year. And then I, that kind of, I kind of took that, um, that basis or that, that, that foundation and said, Hey, let's run with it.

Dr. Andre Shaffer: So

Dr. Grant Garcia: this is a good segue. So we'll see this. You saw this with, uh, Dr. Acevedo. Um, you went from open spine surgeon to minimally invasive spine surgeon to if patients don't know what this is, you are essentially scoping their spine. And you took this to the next level because people, we talked about this in the surgeries I do.

Dr. Grant Garcia: You see the surgery. You practice, you practice, you practice, and then you do it on a patient. I've seen where you, I know what you've done behind the scenes, obviously, because we chat about it all the time, but maybe tell the audience, like, how did you get this level? Like, it's not, everyone can say, like, this is, this is like going from, like, making cereal to A filet [00:09:00] mignon.

Dr. Grant Garcia: Like this is next level stuff. Like he went to, he's going to, you can't see anything that's going on until you put that scope in. So you're finding it localized. And this is this incision, this looks massive, but you know, I'm an arthroscopist. This is, this is my wheelhouse in terms of these scopes, that incision on the screen is like this big.

Dr. Grant Garcia: So tell the audience like what it takes to get this level. So people need to know that, you know, this is not something that just straight over simple, easy to do.

Dr. Andre Shaffer: Yeah, no. So, I mean, you have to have a number of, um, skills. And I think. You know, this is where some of my other experience doing trauma, you know, kind of kind of comes in because a lot of the first portion of your case is localization with an x ray.

Dr. Andre Shaffer: And that's something that if you do trauma, you're really comfortable, you know, steering needles, steering, you know, dilators to specific place using an x ray and doing it safely. Right. So, you know, the first thing is understanding the anatomy, understanding what you're trying to actually accomplish with your tools.

Dr. Andre Shaffer: So that you can use an x ray [00:10:00] machine to get there safely. Um, and so that, and that, that, that, that's tricky, right? Because you have to, you have to find out where you make your incision. You have to find the trajectory and there's a lot of planning and work that goes into it. You know, you know, the patients, you know, get, Onto the table and, you know, I'm taking x rays and measuring things and being really careful and they almost look like a blueprint, you know, because there's so many markings, but that's, you know, because I'm trying to make sure that we make one incision that we're being as minimally invasive, but also as safe as possible in the process.

Dr. Andre Shaffer: Um, and so, you know, you make an incision, you take x rays that are, you know, AP lateral, which are different types of views, you take some oblique views, um, and you kind of combine them so that you get a sort of a three dimensional representation of what you're looking at in your mind. And then it just, you know, it's, you know, you know, sports grant, it's, it's, it's, uh, triangulation and, and just, you know, kind of having the hands to, to say, this is the angle that I'm going to go for.

Dr. Andre Shaffer: And this is, this is where it's at. Um, and so what that took for me was, you [00:11:00] know, going to, you know, cadaver courses and then beyond that, you know, practicing on cadavers and, you know, practicing, you know, in the lab a number of times so that we, you know, so we felt like we were ready for, For primetime. And so at this point, I've probably done 40, 50 levels in the lab, just making sure that I can, you know, consistently target that I can consistently get access to the, to the foramen or consistently get access to the interlaminar space so that we can be safe and effective.

Dr. Grant Garcia: And I think it's important for people to know, like, this is not a skill that's, easy. Uh, I everyday scope, right? I'm doing five scopes, six scopes and UC residents to try to do it or fellows as they start and they struggle the triangulation. So Dr. Schaefer went from a spine surgeon. He had the hip arthroscopy skills.

Dr. Grant Garcia: He has the skills he learned at HSS. He has this trauma trauma skills, but he had to put all those together to do this. The result [00:12:00] is A significant improvement for patients, but also it shows dedication, right? Like there's a lot of people that don't want to do this. Not only is it challenging to get this product in a surgery center outpatient, which we will talk about in a minute.

Dr. Grant Garcia: But on top of that, getting an outpatient and doing it safely and doing it well is no feat. It is very, very challenging. This is, this is no, there's no joke here. And the fact that he's able to do it consistently is really impressive. And I think that I really want patients to know about this option because we've seen it.

Dr. Grant Garcia: And this is basically where sports was. About probably 15 years ago, and I think that we're literally at the cusp and I feel like will and I could have this conversation with you in two years and you'll be like, dude, I'm way beyond that. Like we're already like on this trajectory. And what do you think about endoscopy?

Dr. Grant Garcia: Um, and spine surgery? And where do you think this is going? I mean, I

Dr. Andre Shaffer: think it's I think it's it's it's at its infancy. You know, it's been good. It's what's crazy is it's not It's not new. It's been happening for 20 years, but it just hasn't gotten [00:13:00] the acceptance right in the United States. You know, people were doing it out in South Korea and Japan, but not as much in the United States.

Dr. Andre Shaffer: And so, um, you know, I'm kind of happy to be one of the one of the few people locally that, you know, doing it and, and, and being able to, um, being able to do it in the ASC and get people home right away. Right. You know, I, I, uh, I tend to call my patients, you know, two, three days later. And I had a, I had a guy a couple of weeks ago who I operated on and I called him, you know, on a Friday and I hear all this commotion in the background.

Dr. Andre Shaffer: And I'm like, Where are you? And he's like, I'm at work. I'm like, dude, two days

Dr. Grant Garcia: post op. What are you doing? He did his surgery on the Wednesday. So people need to hear this is two days later.

Dr. Andre Shaffer: I called him on Friday. He's like, I'm at work. And I was like, why? And he's like, I feel too good not to work. And I was like, are you taking it?

Dr. Andre Shaffer: He's like, I'm taking Tylenol, you know? And so that's, that's just, that's, you know. And what do

Dr. Grant Garcia: you think this guy with, with an open discectomy, what do you think would have happened for him?

Dr. Andre Shaffer: Again, it's different, hard to tell

Dr. Grant Garcia: per patient. Yeah,

Dr. Andre Shaffer: no, he probably [00:14:00] wouldn't have gone to work for three weeks or so.

Dr. Andre Shaffer: Yeah. Just because, you know, you have all, you have, you have so much more soft tissue dissection with an open discectomy, right? And even a tubular discectomy, you're taking bone, there's, there's more that you're doing. you know, getting there just to just so that you can see the just that you can see the tissues.

Dr. Andre Shaffer: Um, you know, there's a lot more that you do. And so this and this is one of the this is kind of one of the cool things is that you can make these really small incisions and they're powerful because you can see so much more because of the the magnification of the scope. Um, and one of the other, you know, large benefits of this is that When you, um, when you do this, because you're, because sort of the, the, the, the approach is so small, you have more muscle that's working and working.

Dr. Andre Shaffer: right away. And, you know, the people who love that as patients for sure, but you know, who else loves it as physical therapists, [00:15:00] right? At the end of the day, they're the ones that are spending, you know, hours and hours and hours with these patients afterwards, trying to get them back, you know, into the game, trying to get them back to where they're going.

Dr. Andre Shaffer: So this is one of my favorite slides, right? Orthopedic surgeons, we love what we do. We're pretty happy, but you know, it's, it's ultimately the physical therapist that kind of, you know, Kind of flushes that, you know, dunce the ball, right? We, we pass it off to the, to the, to the PTs and we do, we do a great job, but what we do essentially is we fix anatomy and then the physical therapists will sort of help rehab these patients.

Dr. Andre Shaffer: you know, across the finish line. And so that's, that's, I think that's one of my big reasons for, you know, spine endoscopy and minimally invasive spine surgery in, in all is just, you know, taking these, taking sort of what spine used to be, which was this open morbid, you know, difficult recovery. And, you know, hearing these amazing patient stories where they're like, I have no pain.

Dr. Andre Shaffer: I didn't take any medications. I feel great. I [00:16:00] mean, I think that's that to me is like one of the most, um, satisfying things about it. And that's why I'm so passionate about it. Right? I get to, I get to, I get to, I get to scope the spine. It's great.

Will Sanchez: Dr Schaefer. Um, I just wanted to kind of follow up there with, uh, from the patient's point of view when you say, and I've had friends have surgery and we'll kind of maybe we'll get into that in a second here.

Will Sanchez: I'm going in for back surgery. And you go, Oh, shit, you know, it was there for the young ins, but it is, you know, that that stigma of Oh my, you're going in for back surgery. What does that entail? How debilitating it is. I had a friend and this was probably about 12, 13 years ago, went in for major back surgery from the back and then cervical in the front, about eight years.

Will Sanchez: eight hours, took him. He didn't feel right for almost a year and to the point where he was like, I wish I didn't [00:17:00] have surgery. In about a year time, he started to feel better. It was like, okay, I'm, I'm finally better. I can walk. He's a, he's a chef. So standing up long hours, everything like that. But you know, that stigma about back surgery, you know, now with this new technology, instead of maybe being fearful, maybe we get excited because.

Will Sanchez: There's hope and relief for people that are suffering through this type of debilitating pain. And if you, if anyone's had back issues, you can't walk, you can't sleep, you can't move. It is

Dr. Andre Shaffer: by far the worst. Yeah, you know, these patients with, with, with radiculopathy, you know, you have a disc herniation and you essentially get in through a minute, you know, eight millimeter incision, you find it, you localize it, you find it and you start pulling that disc out and then.

Dr. Andre Shaffer: You close, you know, it takes two sutures to close. You, you know, glue the skin close [00:18:00] and put a little Band Aid on the Band Aid.

Dr. Grant Garcia: I saw his patient, they literally this tiniest little.

Dr. Andre Shaffer: And they go home and they're showering and they're, they're out of pain, you know, like you go see him in the recovery room after surgery and they're moving their foot and they're just looking at it.

Dr. Andre Shaffer: Like. This is amazing work. It works, you know, the pain's gone. And that's, I mean, it's just, and then, you know, well,

Dr. Grant Garcia: you can, you can see the Dr. Schaefer is pretty low key, low enthusiasm for this procedure.

Will Sanchez: Yeah, no, it's important. And obviously he, you know, he made a mention at the beginning of the show that he was inspired from what he saw, you know, that kind of, you know, it's, it's Always wonderful when our paths go down a certain certain route that especially if we're not expected, but, uh, to to give people an option to be pain free.

Will Sanchez: You're giving quality of life, right? That's I mean, I've had piriformis flare up and I'm like, I can't [00:19:00] move. I'm picking up my leg to swing it over the bed, you know, different issues at different times that that that's happened. And I can't imagine anything worse than that. Yeah. Um, maybe I'll stick with that right there.

Will Sanchez: Why is something like piriformis, um, happened so frequently? Is that something that's just body or, you know, over time or stress from playing ball or, or anything like that? Is there anything that you can pinpoint or is it just, just a matter of time as, uh, you get older, maybe a little arthritis, just wear and tear, what, what's, what's a normal cause because I know so many people suffer through piriformis or something similar like that.

Dr. Andre Shaffer: You know what I think it is? So, your nerves don't like being touched. Nerves, in the human body, is something that, you know, Grant knows, if you, to find a nerve, you find fat. And that's because the body puts fat around nerves so that nerves don't get touched. And so, [00:20:00] if you are touching a nerve, it's going to irritate it.

Dr. Andre Shaffer: If you're touching a nerve in two places, it's going to irritate it even more. It's called double crush syndrome, okay? And so, you may have some tightness, you may have some spasm in your piriformis muscle, but I think what happens is as your, as our backs start to, Degenerate a little bit, right? A little bit of degeneration.

Dr. Andre Shaffer: That's that's that second hit, right? That's that that's the second place that that nerves being touched. And so, you know, if you if you have a little bit of degeneration in 1 place and a little bit of, you know, in the other place. It's, it's not like they're adding, they're multiplying, right? Cause nerves, nerves just, they don't take a joke.

Dr. Andre Shaffer: They don't like being touched at all. And so, um, that's, I think part of what it is, right? You know, you, you, you push a nerve around a little bit too much. It'll let you know. And that, that's why, that's why it's so debilitating. That's why it's so painful for folks.

Dr. Grant Garcia: So I want to go, I love the piriformis syndrome, but I want to go back to endoscopy.

Dr. Grant Garcia: I love talking about it. So the, uh, so [00:21:00] what makes this so difficult outpatient? Like, why are we not seeing this more frequently? You know, again. Yeah. Dr. Schaeffer Proliance first one, like this is not easy. And I think there was a number of things that collided here. Um, but maybe you could tell a little bit of a story.

Dr. Grant Garcia: 'cause I think that's important for the listeners to hear too. You know, doing your surgery at hospitals sounds all great. The problem you have is you can hit with a massive bill. I know I've had spine surgery to hospital. I can show you how big the bill is. Hmm. And I've seen, I know surgeries at the surgery center and how much they cost too.

Dr. Grant Garcia: So there's differences just in that component. And then the other thing is finding a provider that even can do it. I mean, we see it all the time. I see it all the time. I didn't even know this was an option. No one told me about this. And Will and I talked about this. How do you find innovative people? And so what, what is the journey that you did briefly to get to this level?

Dr. Grant Garcia: You know, you're doing now things outpatient arthro, uh, anoscopy, and still no one's figured out how to do it yet.

Dr. Andre Shaffer: Yeah. So, so when I was. You know, like I said, this is the [00:22:00] reason I went back to do a spine fellowship, right? I was practicing, I was happy doing, you know, drama and, and, and, and hip stuff. Um, but saw this technology and said, Hey, I gotta, I gotta get on with this.

Dr. Andre Shaffer: I gotta, this is something I gotta do. Um, and so right from the start, when I was in my fellowship, I was, you know, talking to companies about, Hey, like, How do we get, you know, how can I do this, you know, after I finished this fellowship and, you know, they all, they all want you to buy a very expensive tower and they want you to buy very expensive equipment and, you know, the outlays.

Dr. Andre Shaffer: 250, 000 at least, right? Just just to get it. Um, and so, you know, that was kind of a thought like, all right, we'll build a practice and, you know, slowly but surely we'll get the equipment. Um, but one of the cool things about our our surgery centers, we have essentially, you know, half of the equipment that you would have to buy already [00:23:00] because it's used for arthroscopy, right?

Dr. Andre Shaffer: And so if you're, you know, if you're part of a big hospital, the big hospital, you know, if they don't have, um, you know, a certain tower, like an Arthrex tower, if they have a different company tower, they're not gonna, um, they're not going to buy a tower just for you to do spine endoscopy or very few will.

Dr. Andre Shaffer: Um, and so it can be difficult just to get the equipment, just to get the basic equipment in. Um, and so, you know, I kind of got on in on the ground floor with, uh, with a company Arthrex that's, you know, really trying to revolutionize spine endoscopy. Um, they're doing a lot of development work and they're, you know, taking off.

Dr. Andre Shaffer: And so I got in. Really early with them and, you know, got to go to one of their first labs. And I've been, you know, going to a lot of lab, you know, a lot of lab time. Like I said, probably 40, 50 levels at this point, um, and, you know, helping develop, you know, helping, helping develop, you know, tooling and evaluating things and things like that.

Dr. Andre Shaffer: Um, [00:24:00] so that, you know, we know what we can use, we know what's safe, so we know what's efficacious. Um, so there's that. So that, so I think the cost is one is one aspect of it. I think, you know, a lot of the spine surgeons who are out there, I think are Our good surgeons and are very capable surgeons. But this is essentially arthroscopy.

Dr. Andre Shaffer: This is a different skillset. It's a different way of looking at something when you try to do, you know, an open ACL, which I know no one does that anymore. Right. Especially not, not, I'm gonna, I'm gonna, I'm gonna shake

Dr. Grant Garcia: on the camera a little bit. She

Dr. Andre Shaffer: not in Grant Garcia's neighborhood. Right. But you know, if you, when you go from open to trying to do it through.

Dr. Andre Shaffer: You know, a small incision with, you know, that's, that's, that's, and you're in an instruments that are 15 centimeters away from where. the pathology is that's that's difficult. That's a different set of hand skills. And so, you know, I had the benefit, I had the benefit of doing, you know, [00:25:00] 150 hip scopes in fellowship and doing, you know, knee scopes and, and, and, and, and percutaneous access, uh, for some of these, you know, for some of the nails and other, you know, intramedullary things that I did as part of trauma.

Dr. Andre Shaffer: And so I just had, I had the benefit. It's not like I'm, The greatest thing since sliced bread. It's just, I had the benefit of being able to have some of these skills already from different equipment. Right. So if you have those skills and you're saying, Hey, I want to do something smaller, well, there it is right there for you.

Dr. Andre Shaffer: Right. And if you have those skills, then it's not going to be, you know, for our ordeal to take a disc out. Right. It's going to be, and I

Dr. Grant Garcia: think that's also a big thing, right? I mean, we've had, you had a lot of pushback before you came, not just, not for me, but in general from. Everybody because you know, before the Arthrex system came out, it was a very expensive.

Dr. Grant Garcia: The cost will probably heard that cost. That's pretty high, even for a medical facilities. And so you [00:26:00] basically have complete barrier. We talked about this before. Well, right. This is a perfect example of tech and blocking, right? No one pays for that equipment except for the surgeons. And then it. Gets reimbursed over time and pays itself back.

Dr. Grant Garcia: But going in the black that much is usually not a really good benefit. And it's hard to get everybody on board when, you know, open disks do fine, but they're not great. And so as a result, it's hard to really convert. And that's why that's one of the reasons. And the other thing is the skill set and the other thing is like taking a long time.

Dr. Grant Garcia: Like if Dr. Schaefer starts doing these and instead of it taking one hour, it's taking four hours and patients are doing worse. That's another problem too. So we'll, we've talked about this. Like the surgeries that I do for some of my crazy surgeries are more memes. We're still efficient. And if we're not, that's when problems happen.

Dr. Grant Garcia: So when people dabble, and I always tell people, if you're seeing somebody, you don't want to dabble her, right? It's okay if people are a little slower. There's not about different timing and, you know, being 10 minutes faster. Like you don't want to time yourself in the OR and things like that. That's not appropriate.

Dr. Grant Garcia: But if you are proficient, you should be efficient in the operating room. And efficient in the operating room is actually [00:27:00] important. And some of the best surgeons are the most efficient. It doesn't mean they're the fastest because there's not the fastest. I'm saying it's efficiency. I told Will before, it's like a You know, like you're in an orchestra, right?

Dr. Grant Garcia: You're doing it. But the fact that, you know, Dr. Schaeffer's first endoscopy was what, like an hour and 15 minutes. And it was a really tough case and your second one was like an hour or something like that. I mean, we're talking about, this is not much added time and all those benefits we see there. And honestly, The drawbacks are really, you know, that's again, just, those are standard risks.

Dr. Grant Garcia: Uh, and I think we've talked about all the different things, but I don't think most of those will eventually kind of go away. Right. I mean, most of those things are minimal.

Dr. Andre Shaffer: I think, I think it's, you know, I think a lot of it is, you know, like the operative time, it depends just, again, it depends on the pathology, it depends on the patient.

Dr. Andre Shaffer: Um, and you're, and honestly, I think a lot of it is your surgeon's comfort level, right. With the equipment and with the technique. Um, um, So, you know, yeah, my first, my first one took, what, I think it was an hour and 45, I don't think it was an hour and [00:28:00] 15, I think it was an hour and 45 minutes, but it was a really difficult case, you know, and then my next one was an hour.

Dr. Andre Shaffer: It was just under an hour, you know? And so it's, it's, it's. You know, there is, there is a learning curve there, but it's, I think it's a pretty steep one. I think it's pretty rapid in terms of the progress that, um, that you can make, especially if you have some, you know, other skills that are applicable to what you're doing.

Dr. Grant Garcia: Well, I think also Will sees now, we talked about this many times, Will, with all the other surgeons we've had on. Practice, practice, practice, practice a little more, think about it, get better. And so that's, for the viewers, that's the most important thing in your surgeon, in my opinion. And Will probably, I don't know if Will agrees with this, but like, you know, the mentality of like, you know, getting better each time, right?

Dr. Grant Garcia: What did I do? What do I need to make notes on? What I need better? Like, until you got it. And then once you got it, don't get complacent. Right. Six months later,

Dr. Andre Shaffer: keep

Dr. Grant Garcia: going, keep getting better. It's better for the

Will Sanchez: patient, right? You know, access that certain doctors have compared to [00:29:00] others, right. You know, whether if they're working at a hospital, what equipment is available to them.

Will Sanchez: Um, so I, there, there's a lot of levels, uh, to all of this, just from the prior discussions that we've had, uh, with folks, you know, where, you know, maybe not privy to some of this stuff, right? And you know, and that's why we always tell the patient, you know, please go get a second opinion, right? And obviously with insurance, that can make things pretty complicated.

Will Sanchez: You know, and so we start to go down a slippery slope here with a lot of the discussions, right? So, you know, whether it's, do you have the option to have a fusion or a dis replacement? Maybe you don't have it, you know, why would insurance then say, well, you're better off to have a dis replacement, but we're going to approve the fusion where I'm not sure what the percentages are, but you may have to reoperate on those.

Will Sanchez: So it's a, it's a, I guess a gray area and you guys would know better than I would. But just from [00:30:00] listening to these, the conversations, there's a, there's a back and forth dance that kind of happens between patient, the doctor and insurance. Uh, so that's always an interesting, uh, dilemma.

Dr. Grant Garcia: Well, well, you, you, you, you had to go there now it's time to talk about disc replacements.

Dr. Grant Garcia: Sorry. It's okay. No, no. I love it. So this is important. So I want to talk shape around here because this is stuff is this stuff is really new as well. And so I want him to talk about, you know, I think let's start with the one that's more common, which is the cervical disc replacement, kind of tell about the differences in that and really why it's better for younger patients and what's the benefit.

Dr. Grant Garcia: And then let's talk about lumbar because lumbar to me is valuable, but I also have a personal interest in this. So, you know, this, this to me at first, obviously cervical. So, you know, tell us what's the cervical disc replacement and we'll maybe throw up a slide there so people can see. Um, and then, yeah, there you go.

Dr. Andre Shaffer: So one of the, one of the ways that you can help patients. So generally [00:31:00] when you're doing. Surgery in someone's neck. It's for nerve compression. Okay. And it's for nerve compression from a disc that's herniated, that's squeezed out the back and pushing on the nerves, right? Like we said earlier, nerves don't like being touched.

Dr. Andre Shaffer: by anything, including pieces of your own body. So one of the, one of the most powerful ways of getting that compression off is by taking that disc out from the front generally, which believe it or not is easier for patients and is less invasive than going from the back. Um, But going through the front, finding the disc and pulling it off, decompressing the nerves.

Dr. Andre Shaffer: And once you've done that, you have a space that's open. Um, and that can be, uh, that's a lumbar disc replacement there. Um,

Dr. Grant Garcia: we'll go back to the

Dr. Andre Shaffer: cervical one. But yeah, once you, once you, uh, once, once you get that space open, you can do, you have to put a spacer in there to sort of hold the bones apart and keep, you know, keep all of the anatomy in the right, Place that [00:32:00] it's supposed to be in.

Dr. Andre Shaffer: You can do that one or two ways. You can do that with a fusion and with, uh, uh, a static spacer that doesn't move, or you can do that with one of these, you know, uh, disc arthroplasties that you see here. And what those do is those have in plates and a little core that allows the end plates to move and flex and bend.

Dr. Grant Garcia: So more natural, right?

Dr. Andre Shaffer: Much more natural. You don't lose as much, you don't lose as much motion. Um, and what we're, what we're finding is, you know, there's a risk of something called adjacent segment degeneration, right?

Dr. Grant Garcia: Well, this is what you were talking about.

Dr. Andre Shaffer: Where, where when you have one segment that's fused, all of the, the patients still move, right?

Dr. Andre Shaffer: Just because you fuse one level doesn't mean your neck is going to be rigid. You're going to move. You're just going to put more stress on the other discs. Uh, while you're doing that, if you're young, that means you have a longer lifetime of more stress being put on the desks. Also, you think about your 30 year old patient, your 35 year old patient, [00:33:00] they're doing more intense things, right?

Dr. Andre Shaffer: They're doing CrossFit, they're running marathons, they're doing things. They're really using their neck as opposed or their spine, as opposed to maybe a, you know, It's a, it's 65 year old, you know, uh, do a workout of the days. Right. Um, and so, you know, younger patients put a lot more stress on their neck and if they have a level that moves, that's a lot better for them.

Dr. Andre Shaffer: Um, ultimately, because the lower, because there's a lower risk of adjacent segment degeneration. But there's also better outcomes. You know, patient reported outcomes are far superior with a disc arthroplasty. Um, you know, my brother had a disc herniation and I made sure he got a disc arthroplasty as opposed to a fusion because he's younger than me.

Dr. Andre Shaffer: You know, he's in his thirties. And so it's, it's really important to, it's really, really important to. Um, I think to preserve motion in the spine as [00:34:00] much as you can. And so I'm, I'm, you know, maybe a hair less passionate about, uh, cervical disc arthroplasty and lumbar disc arthroplasty than I am about. Um, about, you know, endoscopy, right?

Dr. Andre Shaffer: I like endoscopy, but I love, I love, I love disc arthroplasty as well. There are some, there are some times when you shouldn't use a disc arthroplasty. And a lot of that is based on, you know, how much arthritis you have in your facet joints. And those are the joints in the back of your spine, behind your spinal cord.

Dr. Andre Shaffer: And so some people disc arthroplasty still aren't, uh, or aren't, aren't a good option in. Um, but

Will Sanchez: arthritis affect that just so we can have a better understanding. If you have arthritis buildup back there, why wouldn't you want to do something like that?

Dr. Andre Shaffer: So if you have arthritis in your neck and the facet joints in the back, they still move when you have a disc arthroplasty.

Dr. Andre Shaffer: So you can still have residual pain in the back of your [00:35:00] neck. It may be something that's, It may be something that you can tolerate. So that's why it's always a conversation with your, with your physician. I always talk about what the goals are, but it may be something that you need that, that, that, that if your, if neck pain is a big part of what's going on, as opposed to arm pain.

Dr. Andre Shaffer: Then sometimes, sometimes you, you say, yeah, well, maybe we should do a fusion, but you know, foreign, you know, generally most patients, especially younger patients do a lot better with disc arthroplasty as opposed to fusions.

Will Sanchez: So, I'm sorry, your evaluation, then it goes across multiple levels, right? Um, the age, what's happening to them physically, what needs to be done, maybe if they have an arthritis.

Will Sanchez: So, you're, you're taking all of this. You know, wealth of information. And then coming up with what's the best course, uh, to treat this particular ex patient, uh, moving forward for what's happening now and, you know, maybe how it [00:36:00] affects them in the future.

Dr. Andre Shaffer: What do you, you know, occupation, uh, are you, are you hyper mobile?

Dr. Andre Shaffer: Are you, you know, what do you do things where you need overhead? We need to be able to do things overhead. Absolutely. Picking up three kids at

Will Sanchez: home,

Dr. Andre Shaffer: right? Exactly. You know, we'll, we'll put different, we'll put different, we will put different disc types into different patients based on, you know, how their, how their body is, right?

Dr. Andre Shaffer: Some, some discs move less. They're more constrained. Uh, other discs are less constrained. And if you have a patient who's hypermobile, you're going to put a more constrained disc in generally.

Dr. Grant Garcia: Well, that's interesting to hear. You'll first off to comment, Will, you heard about the dreaded back surgery, right?

Dr. Grant Garcia: Well, one of the other things people worry about is with back surgery, you get recurrence. Like a lot of these back surgeons patients are for life, right? You know, every five years you come back and get your next level fused. So the idea behind, I think this is not only is it, It's a one time surgery or, you know, last a lot longer [00:37:00] and you're having less issues above and beyond.

Dr. Grant Garcia: So the goal is, I think, long term, right? Would you say this, Andre, that you had to have the patients are not coming back all the time, right? It's all the goal is to reduce the number of long term surgeries for these patients because a lifer of spine is never a good outcome. for at least for what I've seen and will seen.

Dr. Andre Shaffer: So there, there's a number of reasons. I think that, you know, disc arthroplasty is, is the future of spine surgery, right? One, you get better patient outcomes to fewer, you know, neat, fewer, you know, less need for operations. You know, they're supposed to be, I was just seeing something the other day that says there's supposed to be a 1, 500, 1, 200, uh, spine surgeon shortage in the next like 10, 15 years.

Dr. Andre Shaffer: And, you know, if I've got patients who keep coming back, cause they need That's so many patients that, you know, don't get care, right? And if you and the longer you delay spine care, you know, it tends, it tends to constrain your options to things like fusions, right? Um, you need patients who've [00:38:00] ignored their neck, ignored their back for 20 years and it's harder, right?

Dr. Andre Shaffer: So I always tell people, Hey, you know, make sure you're doing your physical therapy exercises. And I say, Hey, but if you're having issues, don't ignore them. Come back. You know, the sooner you come, the sooner you come to see me, the sooner that I can do something small. As opposed to having to do something big, you know, and if I can do something small and get you kind of back on the way, that's so much better than if I have to do, you know, big multilevel fusion.

Dr. Andre Shaffer: I'll do them if I have to. I'll do them through MIS techniques so that we get people back up and moving quickly, you know, more quickly. My preference is to do something small that, you know, preserves motion and, you know, You know, has people, you know, extremely happy right away. And that, that's it. That's that's cause that's, that's what I, that's what I ultimately want to do.

Dr. Grant Garcia: And I think for this is important. Will, we have said it before. This is why second opinions are so valuable. You know, even today I saw six second opinions and three of them had heard opinions that were completely different than what I told them. Right. And you're getting an opinion saying you need to have a fusion of your neck and [00:39:00] you're below 60 years old or 65 years old.

Dr. Grant Garcia: And you're like, it's only been bothering me for a little while. You know, that's someone you should maybe think about it because sometimes if there's not a lot of arthritis, the fusion sometimes is the easier option, right? It's easier to get approved by insurance. It's cheaper for the surgery, but it's not the right answer.

Dr. Grant Garcia: It sure as heck is not the right answer. So you got to make sure. If you're a patient you really go to the people if the person does I tell someone If they tell you cervical arthroplasty or they tell you something doesn't work They better be the one that also does those surgeries. Cause when someone says it doesn't work, and there were people I've seen that have said my, some of my surgeries don't work cause they don't, they don't, they never seen him before.

Dr. Grant Garcia: I'm like, that's not very helpful. Like you want someone with experience that has all options. And so that's why it's great to have someone like you on here to talk to the patients, to hear about this, especially the younger patients who want to get back to sports. They want to get back to things. So you don't want your neck fused.

Dr. Andre Shaffer: So one of the things that's interesting, uh, Grant is that, you know, disc arthroplasty is actually cheaper. [00:40:00] dis arthroplasty is actually cheaper than when you start, when you start adding up all of the, all of the fusion, the fusions, right? Than fusions. Yeah. Fusions. There's, there's, you know, I hate to say it, there's a, there's a, there can be a financial motive, you know, that that exists for, you know, people saying fusion

Will Sanchez: is, is the fusion something that, um, I'm not trying to throw insurances out there.

Will Sanchez: the bus. But, um, is this something that they kind of defer to? It's kind of like, uh, you go to the doctors and they say, well, we're going to take an x ray first. And you go, I don't have a broken bone. Like, I know I need an MRI. Well, we got to go through the x ray first. Is that just part of the, the process when it comes to something, uh, like this in your field, when it says, well, we're going to explore this route first before we go to the next?

Dr. Andre Shaffer: I think the reason that, uh, insurance companies, uh, like to steer patients away from arthroplasty is because, um, arthroplasty [00:41:00] doesn't have the same volumes. And so there aren't the same discounts on, uh, on implants. Now that said, the amount of implant that you put in is generally greater, right? So if I do it, if I do a disc arthroplasty, that's the one implant that I put in, right?

Dr. Andre Shaffer: So that's the one implant that your insurance company pays for. But if I do a fusion, I'm putting a static spacer in, I'm putting a biologic in, I'm putting his plate and screws in, right? There's a lot more that goes into it. Um, and again, sometimes a fusion is the right thing. It's not, you know, again, I don't want to come off as dogmatic and say it has to be an arthroplasty because I tell page, I tell plenty, plenty of patients.

Dr. Andre Shaffer: Um, and I do plenty of fusions, you know, um, if I can avoid it, I like to, right. If, if, if it's safe to do it, if it, if it looks like it's going to work for the patient, Then I'm then for me, I'm looking to do a fusion or I'm sorry, I'm looking to do an arthroplasty as [00:42:00] my default and I have to have a reason to not do the arthroplasty first option.

Dr. Grant Garcia: That's that's 100%.

Dr. Andre Shaffer: Yeah,

Dr. Grant Garcia: that's that's a listen. Everybody hear that. We're going to repeat that on the next thing. That is the number one thing you need to hear your surgeon. What is your default? Yeah. Okay. You're a spine restoration surgeon basically at this standpoint. And when people, it's the same thing with mine, you come into my office, the default is to save your knee.

Dr. Grant Garcia: The secondary third tertiary or fourth option is to do a knee replacement. Right. Right. Or do a shoulder replacement. Right. So this is what I'm talking about. This is really important. I think Will would appreciate this. The best outcome for the patient is to save as much as possible of the person's body.

Dr. Grant Garcia: That's not the default. If that's not the default, then you should be concerned. Okay. Now again, you say the default is that, but that doesn't mean you can't jump. Um, I don't want to get too sidetracked. I want to jump to the lumbar spine because that's that, even though these seem like they're the same, [00:43:00] they're not.

Dr. Grant Garcia: And for insurance authorizations and getting approved, and we've heard about the tech, the roadblocks, the lumbar spine, would you agree has more roadblocks and the cervical spine?

Dr. Andre Shaffer: Absolutely. You know, I think insurance companies are more, uh, Um, more reticent to approve lumbar disc arthroplasties than they are, you know, lumbar fusions.

Dr. Andre Shaffer: And I think, I think it's probably one of the more, um, I think it's probably one of the more, uh, unfortunate things that are, that's kind of happening right now. Um, this is actually a newer, this is a, this is an investigational device, uh, that's having some pretty good, uh, you know, kind of reports initially.

Dr. Andre Shaffer: Um, it's doing, they're, they're going through their ID. They're already enrolled. Um, but this is, this is a most, most lumbar disc arthroplasty is you have to put in from the front. So you have to have an incision on the front of your abdomen. You have to have a vascular surgeon, you know, move some of the structures so that you, so we can get access to that, to the, to the spine.

Dr. Andre Shaffer: [00:44:00] And then we have to take the disc out and put the, put the arthroplasty in that way. But this is actually something that you can put in from the back. And what's really cool about it is you can put it in through minimally invasive Uh, incisions and with a minimally invasive approaches so that you're not, uh, devitalizing a lot of the muscles alongside the spinous processes.

Dr. Andre Shaffer: And I think that's one of the reasons, uh, to get back to that. You know, we'll talk about adjacent segment degeneration and people taking such a long time to bounce back from spine surgery. I think it's because of. the traditional approaches where it's a big incision and you essentially, you know, make a midline approach and you just reflect or move a bunch of muscle off of the bone.

Dr. Andre Shaffer: Well, when you do that, that muscle doesn't work the same way. And if you ever have to come back and look at that muscle, it's scar afterwards versus if you can do it through a minimally invasive approach where you're going through a small incision and you're spreading muscles opposed to. stripping muscle that ends up with patients who, you know, have dramatically less pain.

Dr. Andre Shaffer: That's why that's, I [00:45:00] think one of the reasons why endoscopy is so powerful is because you're spreading muscle, you're not stripping muscle. The other reason is the fluid, you know, whenever you're washing away all that, all that inflammatory, uh, sort of the inflammatory chemicals that happen as a result of surgery, you just have less inflammation postoperatively.

Dr. Andre Shaffer: To get back to discard to plasticity, um, that modus is going to, I think, going to be a really, I think that's going to be a game changer when it, when it comes out and get approved.

Dr. Grant Garcia: And again, we like new tech. So this is important for patients. This is a young person's surgery, right? You fuse their, you, you don't fuse their back.

Dr. Grant Garcia: You give them this replacement. And the nice thing is if you can do it to the front, the back, you don't have to stay over house, right? Usually those patients, that could potentially be someone that goes home

Dr. Andre Shaffer: and

Dr. Grant Garcia: potentially a surgery that's done at the surgery center for outpatient purposes. Is that correct?

Dr. Andre Shaffer: Versus

Dr. Grant Garcia: when you get it from the front. You're going to the hospital for that. Yeah. Um, and that's more challenging and you're already fighting with insurances and as soon as you get a hospital stay and insurance doesn't want to cover it and you have to pay out of pocket, you're looking at. you know, [00:46:00] 57 times cost to the patient, right?

Dr. Grant Garcia: Because it doesn't get doesn't go to anybody but the patient when it's not covered, which stinks. Um, so I think this is really important for patients. I think the one last part we're going to, we're going to get close.

Will Sanchez: Looks like we lost him, but we'll, we'll just kind of keep that going as, as he comes back.

Will Sanchez: Um, I saw today on a good morning America. Um, something that they had determined at the Mayo Clinic and let's bring Dr Garcia back. It's okay. I'll just finish my thought and then we'll get you back in there. Dr Garcia. Um, saw no good morning America today. They had done a paralysis stem cell study at the Mayo Clinic.

Will Sanchez: They had 10 patients, 7 of them had really great results. 3 didn't have bad results, but pretty much stayed as is. So my question to you is, the, the role that something like stem cells, uh, will play a part in, In surgery, back surgery [00:47:00] going forward, uh, especially with something like this that, you know, they were talking about this, uh, just today on, uh, good Morning America.

Dr. Andre Shaffer: Yeah, I think I, I, I'm, I'm a big believer in stem cells. Um, but I'm, but I, I'm measured about their use in the back, especially right now. Um, you. You have to know why something works in order to use it appropriately and have patients get good benefit from it. I think, you know, are there patients that get benefit from stem cell injections into their back?

Dr. Andre Shaffer: Well, it depends on what the cells are. Right. Are they, you know, it depends on who the patients are, right? Are these young patients or these old patients? How bad is their back

Will Sanchez: paralysis? I mean, that was the study. So it really bad, right? I mean, they're, they're pretty much dire the lowest.

Dr. Andre Shaffer: That's probably their nerves, right?

Dr. Andre Shaffer: I think a lot of, a lot of patients. Come and ask me about, you know, disc herniations and well, can I just put [00:48:00] stem cells into it? Okay. That's yeah. You can put stem cells into it, but if your disc is already degenerated to the point that it's not, you know, that the, that the mechanical environment isn't going to let the stem cells make.

Dr. Andre Shaffer: uh, cartilage or make, you know, um, make type, you know, type one and type two collagen, then it probably isn't necessarily going to work. And so you got to be, I think you got to be careful. I think in 20 years, we're going to be a lot closer to, to that kind of Holy grail of, you know, saying, Hey, you have a problem with the disc and we're going to do an injection of stem cells and

Will Sanchez: fat out of you and put it in your lumbar.

Dr. Grant Garcia: Right. Yeah. I'm telling you, Dr. Schaefer is coming back on in a year or two. We're going to hear about the, The modus spine happening all the time. We're going to hear about him scoping everything in the back, front, who knows. And then we're going to hear about, we get to hear about biologics and spine.

Will Sanchez: Yeah. I wanted to bring it, bring it up because I'm pretty sure that people will, you know, approach you about that without having the information, the knowledge. So I think it's important to at least discuss [00:49:00] it. So it's great. for talking. And,

Dr. Grant Garcia: and obviously interested time, but I do got to ask this question.

Dr. Grant Garcia: Do you ever do. Oh, is there ever a reason to ever consider doing PRP in the back? Like I know people get it done as a guy that has a lot of PRP in the knee and occasionally the shoulder. I get a lot of patients asking about it for the lumbar spine or for the cervical spine. Is there any data that's out there or what's the, what's the top?

Dr. Andre Shaffer: I think it's, I think it's actually, so there's data that says it's as effective as a, um, as an epidural steroid injection. Um, yeah. So would you consider

Dr. Grant Garcia: doing that? Like, let's say someone failed, like, you know, you have one epidural, two epidurals and they're just okay. Would you ever say someone's like, dude, I don't want my disc done.

Dr. Grant Garcia: Would you say, Hey, listen, they're like, I want to do a PRP. Yeah. Would you consider that? Is that something that time we would kind of think about it?

Dr. Andre Shaffer: Absolutely. Yeah. I think if you've, I think if you've done, if you've, and so, so the, the interesting thing about the disc injections is that, or a spine injections is that epidurals are helpful.[00:50:00]

Dr. Andre Shaffer: Diagnostically for us as well as therapeutically for patients. And so, you know, I want to see that you're getting some improvement from the epidural injection, at least temporary right now, if it doesn't work, I can always do another one. And if that works, but doesn't really get it done, you know, if you don't have anything that's compressing.

Dr. Andre Shaffer: On nerves, then I'm, I'm inclined to say, Hey, yeah, let's do some PRP at that point. Right. And that, that's, I think the stem cells, right. That, that I think are that, that we kind of have a good sense of, okay, it may work for us. Right. As opposed to some of the, you know, Taking fat out of somebody's, you know, thigh and say, you got a little lipo and you got a little disc injection, you know?

Dr. Andre Shaffer: Um, I mean, look at,

Dr. Grant Garcia: look at Dr. Schaefer. He's a plastic surgeon and spine surgeon, all mixed in one.

Dr. Andre Shaffer: I wish, I wish. No, but yeah, I think, I think, you know, it's, it's, uh, I think PRP is something that's a little bit different, right? There's a lot of data [00:51:00] behind PRP that shows that it's effective and shows that it's safe.

Dr. Andre Shaffer: Um, and now there's data that's shown that it's essentially got, you know, similar efficacy to, uh, to the, you know, to epidural steroid injections. And so, you know, I'd consider it for a disc that's, that's, that's really bad, but not that bad, right? I might consider it for a desiccated disc as opposed to a completely degenerated disc.

Dr. Andre Shaffer: Awesome.

Will Sanchez: All right. Well, we wrap it up. I just, I just wanted to just show this here and I didn't show it to Dr. Schaefer. And if, if you're listening on, um, on a podcast, check us out on our YouTube page so you can see the slides and see our beautiful faces. So please check us out. Um, we always talk about patient relationships and how important it is.

Will Sanchez: And I just wanted to share. a few things from the patients. Uh, just recently from the last month or so. If you go to patient reviews, um, please check it out. I'm just going to highlight a couple of things. [00:52:00] He fielded all my issues fully in a manner that made sense to me, even if he probably felt like he was drawing a crayon, just making it really, uh, uh, visually and, uh, just breaking it down so they can understand, you know, Dr.

Will Sanchez: Schaefer exceeds far beyond standard care. It's another review. I appreciate that he starts with the least invasive treatments and continues from there, depending on results. And by the way, I had this all set up before we even talked about it. So that is a great, uh, way to just showcase what we've done.

Will Sanchez: When you have this feedback from patients, when they walk out of your office and they're happy with not only the treatment, but the doctor patient relationship leading up to the treatment and post, what, what does that, what does that mean for you as, as someone that does this, you know, in their profession, but you know, that helps so many.

Dr. Andre Shaffer: Yeah, you know, I mean, it's doing doing what we [00:53:00] do is a gift. It's an honor, right? It's a privilege to be able to help people in the way that we that we do, right? You think about, you know, how, how privileged you are to be able to help somebody get back to their life. And so, you know, that's, that's what I want, right?

Dr. Andre Shaffer: I want people to, you know, I want people to understand what their options are. I want people to feel comfortable with the options. I want people to feel comfortable with which options they're choosing. And then I want them to feel like, you know, the experience is as, as least traumatic as it can. Right.

Dr. Andre Shaffer: Cause if you think about how scary it is to go to a doctor's office and how scary it is to have them talk about, you know, procedures and surgery and things like that, that's That's not really an enjoyable, you know, that's just, it's just not enjoyable. Right. And so I don't, I don't really want to be somebody who's just sort of, you know, slogging through patients and then you take it or leave it.

Dr. Andre Shaffer: That's just not really, that's, that's not my personality. Um, and so I want people to, I want people to feel like they're, you know, [00:54:00] like they play a meaningful role in their care because they do play a meaningful role in their care. Right? If they're, I think if people are happy that they're going to, they're going to do better if they feel like they got the best shot at, you know, getting what they wanted and, and it helps, they're going to do better.

Dr. Andre Shaffer: And that's, that's all that, that, that's what matters is people doing, you know, people having excellent outcomes, um, you know, through, you know, minimally invasive, you know, means and, you know, Helping them out.

Dr. Grant Garcia: So I think that's important for the listeners to hear. You've heard dr. Schaefer talk You've seen his innovative stuff, but also the personality is important And I find that when people come and they get extra opinions again another reason just get another opinion because sometimes you got a gel With the surgeon.

Dr. Grant Garcia: I mean like we've we've Dr. Schaffer can mention this, but if a patient doesn't feel comfortable with you, I don't want them doing surgery with me. Right? No, I want it to be. Everyone's got to be comfortable. As soon as I had a patient [00:55:00] today that was terrified of the other surgeon and she wants to go to him because she knows the person and I'm like, that's the silliest thing I've ever heard in my whole life.

Dr. Grant Garcia: I was like, you should feel comfortable. If you're afraid of the person that's operating on you or you're nervous about it or something, unless you absolutely have something that's the only person in the world, which is pretty much never the case. Get another opinion. See someone that you, that you like, that, you know, and that's why we do these videos.

Dr. Grant Garcia: You know, this podcast with someone like Dr. Schaffer so people can, can meet him and understand that, you know, we just talked for an hour. That was pretty easy. Uh, and we talked about some pretty intense stuff. And so you're in there, you're nervous, you're getting your first back surgery, just, just reach out.

Dr. Grant Garcia: So, you know, you've got, this is, this is a good option for patients. And then think, if you don't feel comfortable about the situation, there's something you think, there's something else you're missing. That gut feeling you have inside when you meet somebody and you're like, I think there's more to this. I think it can be done differently.

Dr. Grant Garcia: There's got to be another way. Just look it up on your own and find the right person for it, but I think it's really important I think we'll know this back surgery is terrifying especially big stuff [00:56:00] and sometimes it might not be necessary Or the key is just to get the right stuff, right? Well

Will Sanchez: 100 percent Doctor Schaffer.

Will Sanchez: Thank you so much for being our guest and just sharing your knowledge and just kind of hanging with us. We'd like to thank all of our listeners and viewers. Check us out at sports dot talk dot com and we're on sports dot com. Sports Talk podcast and on YouTube, Ben iHeart and Spotify. Dr. Garcia. Stop me, I'm gonna keep rambling.

Dr. Grant Garcia: Oh, you keep going. I'm listening. And check us out our website, You can see everything. You'll see transcripts of the show. You'll see video podcasts, you'll see split video podcasts and on all the social media we posting. And you're gonna be seeing Dr. Schafer's beautiful face pop up a few times in the next month or so.

Dr. Grant Garcia: So check it out. I'm excited to show you guys off and show this stuff off. Patients need to know about this. This is not common surgery in the Washington state area. You need to hear this, consider it, think about it. This is, I can't tell you guys anymore. I've done my best. Okay. That's it. There's no [00:57:00] more I can do.

Will Sanchez: All right. Dr. Schaffer, go back to being dad. Now, out of, out of any roles that you have. Thank you so much for hanging with us. Take care.

Dr. Andre Shaffer: Thanks for having me. Take care guys.
Audio Transcript


Tech and Innovation: Roadblocks to Success

Tech and Innovation: Roadblocks to Success.

Will Sanchez: [00:00:00] Dr. Garcia, welcome once again, and we want to thank everyone for listening to sports doc talk. Um, we're just ecstatic with everybody listening to the show and commenting. So we always love to hear from everyone. Uh, that Garcia, as you see, I'm excited. It is the start of the 2024 baseball season. You Mariners fans relax.

It's okay. I can be a Yankee fan. Don't be upset about everything in 80s and 90s. You should be upset about the Dodgers and everybody else at this point. Get over it. Anyway, this is not the way to start with the fan base. Dr. Garcia, I apologize. Welcome to the show. How are you? What's going on?

Dr. Grant Garcia: I'm good. It's been a little hiatus, but, uh, now we have some good shows coming up, so this'll be excellent. Yeah, things are good. We're busy. Ski season, as we talked about before, is very busy. So, uh, I'm good. There's no rest for me at this point.

Will Sanchez: Are you excited, excited about [00:01:00] baseball? Are you, you know, I know you're a huge football fan and you know, it's one of the things that, uh, we always get a chance to talk about, but what's your, uh, your fandom when it comes to, uh, baseball here?

Dr. Grant Garcia: I like baseball. I'm not like a, I'm not a massive fan in terms of like watch it every day. Um, but you know, be taking care of so many baseball players. I mean, things have really picked up. We have so many more baseball players coming in because you know, the weather's getting nicer. Uh, and so. That connection with my love of the hate to say to the fans, the Yankees, um, you know, it's exciting to get excited for, for everything.

Will Sanchez: Let's get into this, uh, this new tech in the roadblocks and challenges. We spoke a little bit before we started the show. So let's kind of catch, uh, folks up on, you know, some of these tech that you've been working on and that you're excited about, whether it's Misha and bear balloon and things like that. So let's kind of jump into it right away.

Dr. Grant Garcia: Yeah. So this episode. I think I thought was important because I wanted people to see [00:02:00] behind the scenes and I want people, you know, unfortunately, and we're not doing advertisement, but you know, we're promoting really cool products that help patients and that sounds really glamorous and glitzy. And unfortunately, not everything is free, and unfortunately, not everything can happen for everybody. And so I think that the understanding that what roadblocks there are to tech for the average patient, for certain patients with certain, you know, providers, uh, and the new roadblocks also for just providers to actually use it, and depends on where you work. So this is a pretty complicated topic. We're not going to go deep into it. Too crazy on this because I obviously don't want to overload the audience with, you know, minutiae and nerdy details about the technical aspect of getting this new product because it's already, that's, I know, I know, I know it is, but I don't want to overdo this one because, but this is sort of like the, it's a little bit more of the business side of things, which is interesting.

And as a surgeon who's private practice, You know, every cost I see. And so I understand the [00:03:00] numbers game about this and how it works. But also I'm someone who likes to offer the latest, the newest stuff because. I think it's going to help the patients, right? I at least offer what I think is going to help the patients and what is going to get them better And most of the time thankfully i've been correct in terms of it being an improvement Um, but the reason we're doing this is so to keep people more informed, right? We talk about all sports all orthopedics all the time. Well, how does that happen? Well that happens from innovation and how does innovation happen? Well, it doesn't happen for everybody It doesn't happen overnight and there's a there's a continual attack To get these things done and some things are easy and some things are not so, you know We'll we can we're not going to go through each product individually, but you know, you got the misha You have agility.

You have all these really nice new cartilage products coming out autocart. Um, The there's other ones for other different companies. There's the balloon we've talked about before there's prochondrics, which we've used before There's an extensive list of products. There's acl repair [00:04:00] Right. Two types balloon and preservation technique.

We've talked about, you know, how do these matter? What do these matter for getting them into the into the operating room? Can every patient get it? You know, not everybody is a qualified. I had an ACL repair that I was supposed to do last week and the patient was all set up to go and he was excited. I was excited and two days before the insurance said it's not indicated.

Will Sanchez: Oh my God.

Dr. Grant Garcia: And had to change the surgery and do a reconstruction. So it happens. It's not often actually, it was the first one I've had in a while, but the insurance carriers make a, add a big part. So we don't want to go, we'll, we'll, we'll do it piecemeal right now, but that's the, that's the gist of this topic.

And hopefully people get informed and honestly, it might even inform some doctors and surgeons because you know, if you're looking at adding something new and you kind of haven't thought about this, it's important. And again, it matters where you work as well. So we'll go into that.

Will Sanchez: Yeah. And utilizing the, you know, the technologies to promote, um, improve outcomes. Um, maybe the, the [00:05:00] speed of the surgery, the patient recovery, right? There's so many different aspects of it. And then you're adding the insurance part of it. And, you know, I'm, I'm not privy to that information, how it works, but, um, Is there a typical time frame when you're dealing with something like that and you're looking into someone's insurance that you can kind of get that information, you know, upfront instead of so close to a surgical date or it all depends depending on the insurance and you know, everything else.

I'm really feel like I'm going into the deep woods right now. Uh, you're going a

Dr. Grant Garcia: little deep.

Will Sanchez: For

Dr. Grant Garcia: the first time ever on this show, I'm going to try to go less deep. Okay. All right. Yeah,

Will Sanchez: I'm good. I caught myself.

Dr. Grant Garcia: So no, so it's totally normal. So most of the time these surgeries, you try to preauthorize them. So the patients are, you know, make sure that the insurance is going to get, is going to pay for the procedure and the patients aren't left with a big bill because that's never good for anybody. Right. It's not good for us and it's not good for the patients. Um, and so we try to preauthorize things, but you know, and then again, [00:06:00] that's also what can delay people getting surgery.

So they come into the office, right? They hear about the product. They're super excited. They're like, I want that. You know, that's the one I want. I trust you. I've seen the data. I've seen the shows. Like I know about this. I've done my research. And then we go, okay. So they walk over to the surgical desk and they sign up for surgery.

The problem is. That when you have someone like my practice that has a lot of innovative products, sometimes I have to say, Hey, listen, I know you're in pain. I know you want this surgery, but we can't schedule you yet until we confirm that they're going to allow us to do it because I don't want to give you, or I don't want you to get a big bill in the mail. That's never good. You've heard stories of that all the time, right? You've seen on the news. It's not surprise billing because we give information if they need it, but it doesn't look good for anybody. And so that's hard. Now it doesn't happen that often. Thankfully, most of these things before I offer them, you know, there's, I'm strategic about this. Like, you know, I put it on my website, I've done the research. I've already practiced in the lab. [00:07:00] I've seen the product plenty of times. And then I go live, right? So when I go out, it doesn't happen with everybody, but when I go out, I've done more than enough information in the background. So you feel, so the patient will feel comfortable and I feel comfortable, like adding that stuff is not technically challenging for the most part.

Um, but at the same point, and I've done the background research on the insurance, but I can't do so much, right? Like sometimes I get out there, I offer it. And all of a sudden I get one, one of the company's switches. They're like, well, as of yesterday, we don't pay for I'm like, how is that possible? But it's just the world we live in.

Um, and when you have a middleman, like the insurance company, uh, you're going to have to, um, make sure that you, you know, work the system to allow this, to get patients, to have it be offered to them.

Will Sanchez: And there's a lot of variables also, um, when it comes to, geez, here we go again, uh, from state to state, uh, state to state, um, the different types of insurance, the levels of insurance.

copays and you know, things like that, that plays a part, [00:08:00] um, in assessing, um, how the patient is going to be able to, you know, pay for this type of surgery. Besides all that, when you have, and you, it was perfect, you know, uh, example that you mentioned that you had to pivot, um, Is that part of the options that when you're talking to a patient and you're offering this, you know, maybe this technological advancement that can help and speed up and then something happens that you're not able to do that process and you have to pivot and re explain and kind of go through all that.

Are those options up front that you kind of focus on and say, we can do this or we can do that? I know when I got my Achilles, they said, well, we can do the speed bridge or we can put a cast on, you know, and we can do it this way. So I, I got my options up front. So let's say something happened with my insurance.

At least I wasn't blindsided. I knew in the back of my head that there were other options to do.

Dr. Grant Garcia: Yes. So the one thing I'll step back and for your [00:09:00] example is there are some of the products we offered are called imp. They're implants and they're not much different in cost than the older ones, right? Mm-Hmm. . Okay. Maybe a little bit more. Okay. And so those are really easy to bring in. And like for instance, like the ACL or para from arthrex, right? It actually is better for certain respects because I'm using less of something else for a reconstruction. So it may actually be less expensive. But it's newer and better.

So that's a really good one versus bear, which is a good surgery as well. But that's, you still have to do the repair and then you have to add that on top. So it's like buying a car and they're like, well, you don't get the cruise control and you don't get the new headlights. So if you want those two things, that's added.

Now it's not charged to the patient, but the insurance company says, we're not going to pay you extra for that. And so we've already given you your lump sum of your insurance. And if it doesn't cover the rest, you're on the hook. And you know, it's not usually the doctors paying the extra amount. It's usually dealt with through the hospitals or the surgery [00:10:00] center.

And unfortunately, it goes on to the patients. And so the important part is to make sure that doesn't happen or that the surgery center is not eating the costs. And then you're doing surgeries that are below cost. We know how that works. If you have a store and you sell products, About you sell products and it costs more than the actual product. That's never good Um, and so, you know, we want to make sure that we're those things are important But it just changes right like your speed bridge and doing another technique. There really isn't a significant cost difference Uh, and so that's a good one. But like you talk about a misha implant. Yeah misha amazing It's really interesting, but it's very difficult to get approved right now because There is no particular, and this is another, we can jump to this, there's no particular, and so people might want to know about the code. Do you have any questions about that before we jump into that section?

Will Sanchez: No, go ahead. Yeah, let's, let's jump into that because you're talking about the, the Misha, right? And, you know, it's, it's really interesting when you, you see, you know, and we've talked about it with other, uh, um, advancements, but this is their fifth [00:11:00] iteration before it was approved by the FDA, so there's all these back and forth and kind of tweaking, you know, this technology and this advancement. So kind of, does that play a part in it also, you know, how many, how many times did things kind of go in front of the FDA, maybe get read, you know, just did and go back and forth. Am I touching upon something here that can, uh, add to it?

Dr. Grant Garcia: Yes. So the, we'll try to make it really brief. We talked about the F the five, five, 10, the five, 10 K pathway. So some of these implants and surgeries, they just go right through the next one, like Arthrex and they'll like update an acre, right. Or they'll do the tight rope. And like, it's a lot faster to get approved, but like the Misha, that's like all brand new, right. They're going to try to find something when you have like a hip replacement and you tweak it. You can easily get a new one approved for the most part. I got you. And some of these cartilage procedures, they can just kind of like navigate. you know, it depends on Macy's difference of pharmaceutical thing. It's like a lot more complicated, but overall [00:12:00] these, the FDA approval, like the bear implant took 10 years to get approved.

Wow. Right. And on top of that, it's the other thing that's that you have to understand is like usually who's selling the product did not design it like bear, like Micah did not design the bear. It was designed at Harvard. And then these companies wait until it's really good. And then they buy it out.

Right. So they bought out that new implant and now they have to make money on it, but they just paid a lot of money for it. And so they have to figure it out. Um, and the same thing is can also think of it as like a drug, right? The drugs come out, they're really expensive at first. Um, and insurance sometimes says, well, I don't really know if you need that. There's not enough studies on it. And so you've got to be strategic. The good thing is. And again, I'm not touting my own horn as an orthopedic surgeon, but doctors are, some doctors are pretty smart and we end up being, figuring out things pretty quickly. So I have little tricks and ways of getting most of these things done or making sure we say the right things to the insurance company to make sure that you get it approved.

Cause obviously what I care more about, [00:13:00] I don't, I don't care about the insurance company. I only care about the patients. I mean, that's the only reason I spend all this time. I mean, being on the cutting edge stuff. Is a lot more time. Like if I just did regular ACLs and regular rotator cuffs all day, I would have an extra 10 hours of my week back.

Right. But that'd be, that's not what I want to do. I like those things, but I also want to be able to offer these innovative things.

Will Sanchez: Yeah. You mentioned that, um, insurance companies often rely on specific codes to determine reimbursement for, uh, surgical procedures. Can you explain that a little bit?

Dr. Grant Garcia: Yeah, that's a perfect example. So in surgery, we have a code book and the code book is like, you know, let's say you have an meniscus. They're each separate codes. And the code is how much the code is set by the insurance company or whomever. And it's a negotiated rate. And so, you know, that code is not only goes like the code is like what I get reimbursed, but also that code is important for the hospital or the surgery center because it's how much they're getting paid, which is actually the more important part of the implants, right?

[00:14:00] If I use all these fancy things, like I don't. Make any more from it like there's no code as a matter of fact a lot of times It's a net loss for everybody because I'm it's a more expensive thing, right? But it's better for the patients which has been in the end was way more important for me But what's but for the hospital or the a surgery center these fancy things are a big bright and they're expensive and so If there's not a code for it, it basically has to get eaten out of another code.

So imagine, let's say I gave you 10, right? And you're all the codes out to 10. Um, if there was another code, it'd be 15 and then you could pay for that more expensive thing and then add it together. So sometimes those two codes are enough to pay for everything. And you can add this fancy implant on top of it. And sometimes it's not. So, so how do they navigate,

Will Sanchez: how do they navigate this? If they don't have, if. They don't have an existing code. Who determines what code to select in order to apply certain costs? Are we getting ourselves in trouble here? But like, [00:15:00] that's, you're knocking yourself

Dr. Grant Garcia: in trouble. This is, this is the, this is the most frustrating thing of innovation. So sometimes. You can use, they have outlets of like unlisted, right? Like this doesn't, this code doesn't fit anything like this. Me champagne doesn't fit anything that currently exists, which is why it's so cool and so innovative, but at the same point, there's nothing like it. So there's never been a surgery like it.

There's never been a procedure like it. And so the insurance company has no marker for what they did, what it's worth. So they're like, you know, what's number, what's number one priority of the insurance company. No, right. So then we got to be like, okay, well, this is kind of like this and it's more like this.

And then that's where the team of the company, my, my group of people, you know, me as a surgeon writing letters and saying, it's actually really beneficial. Here are some studies. And then at some point, eventually things get. easier, but in the beginning it's tough. And sometimes that can be the barrier. I mean, companies go under even with a really good product because of the cost.

And so it's important for us as surgeons to understand, is this [00:16:00] worth it for us to push it? And why would he push it? For me, I push it because there's a niche that it needed to fill and. It's a benefit to patients and patients want it and it's going to be, it's going to do better things for them just like a lot of the other products I've talked about, right?

Like two years ago, I didn't even two or three years ago, we didn't even have really good ACL repair instrumentation. We had some, but not as good as the newer stuff. And now patients are rocking these surgeries. And so it's like, if I never, we never did that for patients, imagine all those people that have had to get reconstructions unnecessarily, or wouldn't have had to keep their own ACL. So it's just, you know, just think about those things, but it's also hindsight's 2020.

Will Sanchez: So is it up to you and maybe the hospital to push? for fair compensation for the medical teams and patients. Do you have to do the legwork after that, after being denied and then say, well, this is, let me explain to you why we should be doing this or X, Y, and Z. Do you even have a, if that's the case, do you even have [00:17:00] a team that solely has to focus on that? Because knowing that they're going to get a pushback based on what you may be doing in the future.

Dr. Grant Garcia: Yeah, I don't mean to smirk during these comments, but it's just because I'm, I'm, I like hearing your response because nobody hears about this side of the thing. And so seeing someone who's lame in terms understand what goes on behind the scenes is really interesting because that's the way I would expect you to respond. Um, but yeah, so. I have a team, you know, I do some of the work, uh, obviously I deal with the headache, right? Cause I'm the one, I'm the one in the front, right? I'm the one that showed the patient the product. I'm the one that talks on the

Will Sanchez: podcast. You're the doctor name that's attached to the surgery.

Dr. Grant Garcia: So I deal with the brunt of frustration half the time, but my staff does too, right? They're the ones getting calls being like, can I schedule it? Can I schedule it? Can I schedule it? Um, but it's like, it's a, it's a group effort here. Yeah. Most of the time it's actually not the hospital. You'd be surprised. They're the ones saying no, no, no. And until it's approved by the insurance company, they don't really do much, [00:18:00]

Will Sanchez: which is kind of

Dr. Grant Garcia: crazy. It's the onus is on the doctor because their incentive for something really expensive and new is very little. Why would they do that? Right? Like why would they offer it? Yeah. Um, unless they're going to bring them more business and so one of the number one questions they have is can you bring more business as a result of this, which is kind of crazy, but that's just the way it works at the surgery center. It's a lot different, which is where I actually do most of my stuff. You know, they're that's a little different because. I'm significantly involved in that. And so as a result, I make a lot more decisions there so I can get things pushed way faster, which is why we're able to do a lot of the fancier, newer procedures at the surgery center outpatient. But I'm also privy to way more of the costs. You know, a lot of doctors not in private practice, they don't see any of this stuff. So like this, this may be brand new to them. They're like, I didn't know it was more expensive. I just do it. It's not a big deal.

Will Sanchez: Right.

Dr. Grant Garcia: But as me, I have to be conscientious about that. But I also have to, you know, deal with the pushback. Um, and you know, they'll, they'll hear the pushback, but they won't know why. Right. Like they're not going to be told from the hospital. It's this much [00:19:00] X more or less. And you're not going to, we're not going to get reimbursed. So we're not letting you do it. Um, but, but the code thing is important part, right?

Like some of the things when something's so far out there and so new, just like a new drug, It's really difficult to get approved at first. And this is talking about like amazingly renovated, revolutionary product, right? Like the speed bridge, amazing product, the tweaks that Arthrex does amazing products, but they're not revolutionary to the point where they need to have their own separate new surgery type, right? It's just a modified modification of a current surgery. And when you modify a current surgery, that's a lot easier to get the coding done. Right. Because most of the time it's like, Oh, it's like the code for ACL repair and the code for ACL reconstruction is the same and it's actually already listed. And so the nice thing is when I start doing repairs, I didn't have to add any, there was no coding issue and the costs were fine. Um, and it's not an issue, um, but it did become a problem with the bear implant because I had to still do all that surgery and add the bear on top and the bear is not inexpensive. [00:20:00] Um, and so that's important for, you know, people to understand because. As soon as it came out and I started doing it, I had floods of people coming and asking for the bear. Um, and we had to be understanding of saying, hey, how is this going to work? Can we offer this to patients? Because the hospital wasn't doing it. They're not allowing it. because it's too expensive.

Will Sanchez: So here's the million dollar question. Ready? Stand by. Here we go.

Dr. Grant Garcia: I know this is where this is going.

Will Sanchez: How do we get hospitals to get on board for technological advancement while still surviving and having financial stability and then getting approval with insurance where it could be one happy pond between doctors, hospitals and insurance and the beneficiary out of all this is the patient. The show's not that long.

Dr. Grant Garcia: I, I am not even sure I'm gonna fully answer this question for you out of, out of, uh, the fact this is gonna go live at some point. Um, so it's not, I don't know if it's gonna happen for a [00:21:00] long time. It depends. But with Covid, um, and Okay, it depends on the place. Yeah. With Covid it depends place.

There were a lot of cuts in things and a lot of hospitals lost a lot of money and so they were more strictly evaluating things. So like basic surgeries, they love those right. Basic surgeries, they love them or, you know, a hospital based surgery is loved, but when it's a quick, easy outpatient surgery, and then it's super expensive, they get no money from, you know, the most expensive thing they make off of like is spine surgery or a surgery where you're in the, you're in the hospital for multiple days. Right. Because then you get like, it's the, the charges. Like, you know, I had surgery, I had to go to the hospital. It's like, you know, you see your bill. I won't you

Will Sanchez: there that long too. So it's kind of a, really a cash 22. Now they're like, you're saying they want, they, they get, they make money by keeping you there, but they really don't want you there as well. They're, they're kind of pushing you out the door.

Dr. Grant Garcia: Nobody knows what they want at the hospital sometimes. So I'm also very biased because I do 99 percent of my surgeries outpatient surgery center. But the reason that that's beneficial to patients [00:22:00] is that when I do a surgery, We do the highest level surgeries in the area pretty much. Um, we're doing really complex surgeries, but we're doing them outpatient and the insurance company is paying a lot less for those surgeries because they're not paying for the other things that are involved in the hospital and the patients are paying less to, you know, even patients that end up paying out of pocket sometimes, which happens, we have patients from Canada or overseas, or they don't have insurance and they want to pay for a surgery. Still, it's much less than going to a hospital, like four or five times less sometimes it's crazy.

Will Sanchez: And.

Dr. Grant Garcia: You still get the same amount of care plus the efficiency of the surgery center and you know, the cleanliness and everything else and the ease of getting implants in like when I have these conversations, like I'll be, you know, once every two or three weeks, I'll call one of these new companies and I'll say, you know, let's talk about the implant and they're like, well, how fast can you get it improved? I'm like, how fast can you make it economical for the patients and everything else? Because that's not hard for me to get it approved at the surgery center. You know, I get. new products. And in like two weeks, we're using one of the first renditions of a live [00:23:00] surgery in like a couple of days or a week. And, you know, we didn't need approval for it. You know, as long as the patient's okay with it, I can wear a head camera and navigate and teach other surgeons how to do this surgery. You know, it's not hard to get new products involved. Um, it's really more of, is it the, it's more of the cost. You know, is this going to make, is it going to be good for everybody? Is it going to be something where like we actually can do this and make it fair and even and not have a situation where, you know, if everybody's just, if the surgery center is just making no money or no, it's just all above cost. That's a big problem.

Will Sanchez: All right. It's 2024. Um, I just did, uh, an event, you know, I do a lot of events and I just did one from Microsoft with, uh, Satya introducing now, uh, Mustafa, which is now part of the AI team that they pretty much got from Google and the long way that I'm pretty much getting to is how is AI going forward can maximize, [00:24:00] um, the little things to maybe ensure that we could get closer to that middle ground where we can save money financially for the hospitals, right? Um, implement maybe faster procedures because we're spending less time on certain things. So there's money saving their costs there, and then the patients can get what they want. Um, so pretty much identifying cost Effective alternatives as AI ensures like groundbreaking treatments that's accessible to patients. Can you see a world now where AI is working on all of these aspects and speeding up the process where you're saying, you know, we can save money here because we're changing it, but it's still the same. Can we see that implemented possibly? where all of a sudden we get closer to that middle ground of everyone's a little bit happier.

Dr. Grant Garcia: We can, but you got to think about this. You got to change the [00:25:00] mentality. It's not no first, then yes, right? It's, It's, you know, there's certain, there's a com, I'm not going to bring up an insurance company, but they review every single chart now. And they never used to do that. If there's a certain code, you just get it approved and they trust the doctor. Now, every single surgery needs to be approved specially. So it takes an extra three months for the patients and it's torture for them, right? And so if they program the AI to say, we're going to deny this surgery first. And then make them do a secondary review and that's built into the AI, there's no way it's going to work, right? If it's, if it's like, okay, these guys have been to medical school for four years, five years of residency, one year of fellowship. They've taken care of thousands of patients and they want to do a surgery on a patient because they think it's the right thing for them. How is that the, not the person that should be dictating whether or not it's the right thing to do? I understand, you know, evaluating big fancy things or really expensive surgeries. Should we relook at them? But for the basic stuff, it's, it's absolutely absurd. So they're, they're wasting so much [00:26:00] time trying to cut costs and trying to roadblock things. And you've seen it so many times in the news, right? Of people who had these surgeries and they wanted to get the newest thing. You got friends.

Will Sanchez: Yeah. Yeah. So

Dr. Grant Garcia: they need to, they need to get. Right. So for the simple stuff. They need to just get rid of that stuff completely. Maybe the

Will Sanchez: stuff that AI is using the algorithm that reads the correct codes, right? We go back to codes or the correct

Dr. Grant Garcia: notes, the correct notes. That's really the key. So they can see like, okay, Dr Garcia

Will Sanchez: codes or notes. If you match that, then we can push that along. And then the more, the complicated stuff, we spend a little bit more time dissecting or something like that, but instead of a hundred percent kind of deep diving and really kind of, um, dissected it all. You know, some of the stuff that hits all the codes, hits all the notes, reads it, and then it gives it a thumbs up automatically. And then maybe that gets pushed and speeds things up. I don't know. We're just making stuff up.

Dr. Grant Garcia: No, I think we should talk about this. Another topic. It's a, this is a fantastic, this is not where [00:27:00] I thought this would go, but this is awesome. So the way the AI can help in the way I see this doing is if first off, the insurance companies are not priority is not denial. It's it's approved, right? You know, you have raising premiums and higher denials. Like that's never good. Right. So if the priority is approve and I, and I trust the surgeons, so, you know, 75 percent of the stuff they do, we're going to trust them. Right. And if they, if, if there's a surgeon that's got a bad track record and trust me, not everybody's great. We know how this works. Then maybe they're, their stuff's being more scrupulous, but for the ones that every day come to work and work 80 or 90 hours to help people, you know, for, uh, for these causes or try to get these new things approved, you know, most of the things we do should just be, we're done. You're good. And the AI sees like, you know, ACL tear, pain, more than a couple days, all the, you know, risks and benefits were discussed. Like, just do it. Go get it done. Get done for the patient, right? Okay. Super fancy cartilage procedure. You're going to realign their knee and like, just wait a second. Let's just take a, [00:28:00] let's take a look at what you've done so far because that's a lot of surgery. But what they can do is the AI can have all of the data. that we already know built in. They can see the, you know, the 1500 studies on cartilage transplants and know that like they work because I still get insurance companies after transplants and cartilage transplants been out for almost 15 years, if not more. I'm probably even probably incorrect on that. And there's over 1500 studies that are really good. And I had, I have really good insurance companies that say it's still experimental. I was like, I don't know what,

Will Sanchez: yeah, that's, that's

Dr. Grant Garcia: great. That's crazy. As a matter of fact, there's been like multiple versions of cartilage transplants and how they get better over the last 15 years. It's just, it's, that's impossible to say, right? Like if a car was 15 years old, you would say, you would say it's beyond experimental. You're like, it's time to refresh. Yeah. Yeah. It's just like, so the, that's the biggest thing we, the AI can be like, yeah. Here's all the studies, you know, because a lot of times people don't know when we do [00:29:00] insurance approvals, I get on the insurance call and the person on the other call is an anesthesiologist and no offense to the anesthesiologist, but that does not orthopedic surgeon. And half the time I get on the call, they just want me to talk to them. So they'll give me approval. So I'll be like, hi, here's what I'm doing. And they're like, I'm not even sure what surgery you're doing. And I'm like, excuse me, but you're the one denying the surgery right now. Yeah. And so like we need, we just need it to be where the AI is so smart. It says, okay, 1500 studies and cartilage transplants. They've done alignment. They've checked all this stuff. Everything's good. Boom. You're done. You're approved. The surgery center

Will Sanchez: utilization that the patient. Um, you know, whatever is happening with them, finding the cost effective pathway that I can maybe utilize that as well. That makes insurance feel a certain way about it. Um, but I think I can possibly bridge a big gap right now that's happening, um, and maybe get us a little bit closer because if if they can help plan and assess [00:30:00] these strategic. Um, accessibility and deniability and kind of reduce some of that, then maybe we get closer to some of these goals. And then, like you said, if it's something that's really complex and I think you, you illustrated it perfectly saying, hey, wait a minute, hold on before we go that route, you know, let's go this route, let's explore this route before we do something that's complicated. But if you have the data, you have the notes, um, You know, it, it would be great just to, you know, click on the button. You know, this is what I'm doing. And I'm, I'm, what are you doing? Well, there's between start to finish. I'm inputting six codes and I'm, these, these are the six codes I'm putting in. It reads it, it understands what's happening and what's the diagnosis and goes, yeah, that sounds good. Check approved next, you know, and if we could get to something like that, that would be just ideal. And, um,

Dr. Grant Garcia: And it would also on the costs, you're really appointed because you asked me, how do I get all these things done? Well, I have an ex, a lot of staff that [00:31:00] helps me and that's not inexpensive, right? And so people ask, why is the United States so expensive for healthcare? Well, it's expensive because the healthcare costs in, in Canada. and they have lower healthcare costs. They have a lot more rationing of costs, which is why I see a lot more patients coming down for cartilage transplants or some of the fancier surgeries cause they're not a practitioner. So they ration or sorry, rationing of care. And so, you know, total knee replacement, I'm sorry, you know, regular, regular surgeries, ACLs. Those are, those are easy. It's a long wait, but you get them done. Right. But when it's a fancier surgery, they just say, we just don't pay for it. Right. It's too expensive for the healthcare. I gotcha. For the whole thing. Um, and so that's, that's how you keep the costs down, but also, you know, there's less insurance authorizations, right? It's because all through the government, so you're not having multiple companies changing their policies and you're not having for profit, right? I mean, look at, look at the Yankees stadium, how many insurance companies are on the back [00:32:00] of that wall? Yeah. You know, like how many insurance companies we can talk about insurance all day. We've taught this. We don't want to go too much detail, but insurance, anything right there, but they're pretty much run all sports. And they run all the advertisements. How do they have so much money to do that? You know, that's interesting to me and then I have we have this conversation about how people can't Um get the things that they want and we're not talking about, you know, it's it's money it's they're expensive but not as much as a the name on a stadium costs So, you know, it's unfortunate, but you know what I mean? The thing is also we're not going to be Debbie Downers here. I think what people need to understand is that,

Will Sanchez: no, I think this is good. I, I mean, I'm not sure how people feel about, I mean, I think this is really good topic. I mean, something that it's something that it's, Something that we don't always talk about, right? We're usually talking with technology and we're having our guests and things like that. I think having this topic to have these discussions and having real discussions, right? There's a real conversation that we're having, uh, that is concerning to every single patient, [00:33:00] doctor and hospital provider. They all are dealing with this in some way, shape or form. And then, um, and. I love hearing about how the pandemic, you know, added to this and made this even more difficult because of what was happening to the medical, uh, field during that time. So I think this is, I think this is great topic. So

Dr. Grant Garcia: yeah,

Will Sanchez: and then one

Dr. Grant Garcia: thing I'll tell, no, I, I think it's good and that's why I wanted to bring it up, but I think what I think the patients should take away from this, and we have a couple of little things I think we still want to chat about, but, um, Is that I, as a physician or orthopedic surgeon, and there are a lot of us out there, and if you're listening, most of the time we can get this new technology done, okay?

I'm very, I'm always thinking of creative ways to get it paid for for you, so that you can get it done, and I'm always thinking about, not only do, I mean, It's great to have something that's so new and awesome and works so well, but that's, I'm [00:34:00] also want to figure out how it's going to be able to happen for you.

And so by the time I'm offering it, most of the time I figured it out. Um, and most of the time, a lot of the doctors have figured it out. So the good news is that this is not that common. It's just good for the patients. If hopefully someone listens to this, that comes in my office and says, yeah, I know that that's going to be tough to get approved. But like, I really want it. And honestly, a lot of the, like, I have a guy waiting for the Misha implant and he's like, I know it's going to take a couple months for the insurance company. I know it's going to be a fight back and forth. I'm okay with it. And like, that's why I want something like this, right?

Like I want someone to understand that like, when you want like the newest, fanciest, shiniest thing, and it's going to be better for you because it's avoiding knee replacement. That you're okay with being a little bit patient, right? Cause we know in the United States that the word patience is not the best thing. And listen, I am probably one of the worst people of that, but nonetheless, it's important for people to understand that most of the time that these things aren't out of reach. And thankfully, if you live in the United States and you go to good physicians or surgeons that have been trained well, and they really care, [00:35:00] you know, you can get these things done.

Um, it's just, it's all about access and it's not access. That you, if you have an insurance company, you're not going to get access. It's more like finding the people that are willing to offer it for you. And that's what we keep talking about. Innovation, sports, orthopedics all the time.

Will Sanchez: Yep. And there you go with innovation and AI. You know, we, we're going to get to these AI capabilities and, uh, we're going to help navigate the complex landscape of medical technology by prioritizing patient outcomes and financial sustainability. That's the goal.

Dr. Grant Garcia: All right. So this, so just to remark this, this is going to be AI in orthopedics is going to be a topic. Will and I have way too many pending topics, so this will be on the docket maybe towards the summer. Um, the one thing I wanted to bring up with people, uh, is that we've talked a lot about the costs. But the other balance in the roadblocks is, you know, there's a, there are a handful of people that [00:36:00] like these new texts, but not everybody's willing to jump on it right away.

And some people want to see the long term data. And so there's a lot of naysayers too. And so that's also hard for people. I see a lot of second, third, fourth opinions. And sometimes I get opinions that are also reverse opinions. They've seen me. They've seen someone else and then they come back and see me and they're said, the doctor said that the surgery you do, it doesn't work.

And I said, okay, well then we have to work this out. Now again, I'm not offering things that are experimental. My things have been studied. Sometimes it's because it's a competitive nature, right? You know, if that surgery is not offered by the other person and they're upset because they know they're not going to be able to take care of you. They may say it, right? And that's something people need to be aware of as well. It's important, but it's also why I always tell people to get at least one other opinion.

Will Sanchez: Yes.

Dr. Grant Garcia: Because you never know what you're going to find out. And honestly, we joke all the time about Dr. Google, but I will tell you that Dr. Google, in some [00:37:00] cases, if the appropriate search terms are used, can actually be really helpful for patients. I've had so many patients be like, I didn't even know that you could fix that. Because my doctor said it wasn't possible.

Will Sanchez: And

Dr. Grant Garcia: then they come into that and go, wow, actually that's really possible. And so that's important, but it's also important to understand why some doctors may be hesitant, right? If you're, we're all risk avers like I'm not the type of person that's going to have a bungee cord and have a little bit of frame in it and just jump off the bridge. Right. Like I know that I'm, I'm, I need that. I need two bungee cords.

Will Sanchez: I want nothing to do with bungee cords. Let me stop you right here. Right. I've jumped out of a plane. I've done, I've done a lot of stuff. There's no way you're strapping me to a rubber band and having me jump off at anything. I digress right here, but I just want to stop you right there. There's that, that exact, there's no way I'm doing a bungee cord. Anyway, go ahead.

Dr. Grant Garcia: All right. So you know what? Let's, let's do like, uh, like lottery. You know, they're not, a lot of our friends aren't going to play the lottery. They want to have, they want to have a [00:38:00] guarantee, right? They want to make sure that what they're doing is going to work. I don't want to go in the OR and say there's a one in five chance that I'm not coming out with any type of good outcome, right? That's never, that's never my goal. My, I go in there feeling like this is 99, a hundred percent. Right. Even if it's not always that case, um, but some in a lot of surgeons want more long term data. You know, I'm willing to push the envelope a little earlier, but also my patients know that. And so I've had that balance. I built that practice to do that, but it's totally fine that surgeons aren't ready for that. You know, that doesn't, you don't have, and especially if you're new in practice, it's really gutsy. If you're new in practice and you're ready to feel like the patients are concerned about your age, your abilities, because you're new, In practice, and I know because that was me a little while ago, right? And it's okay to be nervous to try something new, and it's okay to wait longer to have more information, right? You're not going to miss the boat on this. And I think that's important for people to understand. And just because you see someone online [00:39:00] promoting some really cool new product, it doesn't mean you have to do it. Um, but at the same point, you should have an open mind because that's what I've started to do is have an open mind. When I first, when I first started practice, if you asked me if I would repair an ACL, I'd tell you absolutely not. I'd say that's, I don't think it's a good idea.

Will Sanchez: Gotcha.

Dr. Grant Garcia: And now look at me, I'm going down to talk about, to talk to all these surgeons through Arthrex about how ACL repair is so amazing. So you have to just have an open mind. And the best way that innovation happens is cautious optimism. And so my first patient I did an ACL repair on, I told them this might not work. Here's the data. It's a higher chance of retear. And all of a sudden, you know what? It worked really well. And then the second one, I told them this might not work.

And I've done one of these. And the next patient told they've done a few of these next patient, you know, and then now I'm now I'm at like 35 patients and I can say, okay, my last 35 I've done really, really well, you know, for the most part, we're [00:40:00] talking about a very successful procedure, still short term follow up, but successful. So you build upon those things or you build upon experience, you know, someone coming in saying, I saw Dr Garcia's lecture on ACL repairs. He's done this many and they've done that. Well, I feel good. That I do it the same way or the same technique that's online or that that's available that I'll do that.

They will do well as well. So it's just it's important for people to understand that though. Um, and, and then, and that this is the way it works. This is the way innovation happens. It also happens from us being willing to share, you know, I'm constantly texting on my phone. I've got texts from different people.

Like, how do you do this surgery? How do you do this surgery or vice versa? I'm asking them like, Hey, You know, we did a really unusual surgery today that you see once every two or three years Um really uncommon and I used a a special tight rope fixation. Oh yeah. Will will like, um, and the old surgery for this was a huge reconstruction passing tendons. You have to be non wavering. I did the surgery [00:41:00] in 30 minutes. It used to take about an hour and a half, which just trying some new technique with new implants and new innovation. So it's important to understand that you want to take the risks sometimes. And it can really help, but it doesn't, it's not always that case. And just to understand, like you want to make sure you look at the data before you do this and that everybody's a little bit different.

Will Sanchez: Yeah. And I think the highlight for those listeners is pretty much to, you know, you're engaging the patients in this decision making right. And, and having that informed decision. And we, I think we mentioned it every other show. to always get a second opinion, right? We talk about I'm doing this and I'm doing that, but we always encouraged to get that opinion to get that information. Um, and, and making sure that you're comfortable with that process because more importantly, the patient is the one that's kind of going through this and having being informed on what they're about to get into is, is really important. So they're not surprised or caught off guard. You want to be [00:42:00] happily surprised, not the other way around. So I think communicating that and, and sharing, uh, that information is really, really important, uh, for the patient. So once again, we always encourage, especially when you have these procedures to, it's fine to talk to multiple people, you know, and even my friends, they're like, I have a doctor. I say, great, go for it. Get all the information. I recommend just because you're doing something big. You know, I had a friend that had hip surgery. Um, you know, after an accident, it just does not hurt to talk to somebody else. You have to wait anyway before, you know, you're going to have the surgery, go talk to someone else and hopefully they're going to tell you the exact same thing and you're going to feel really comfortable about this decision making and you go with whoever's you're most comfortable with. So I think that's the, the big picture. Get your information. Be informed. So your decision making process, you feel comfortable going into it.

Dr. Grant Garcia: Yeah. So two points to that one. Yeah. [00:43:00] And a lot of times I see second, third opinions. They just came in. I go, I totally agree with that. He said, you know, I think that that's awesome. I think you go with whoever you want to go with. We feel most comfortable with and about 75 percent of the time. That's what happens. 25%. I might have a differing opinion, but that's also my experience. Um, and so, and that's the way I feel again, I'm never knocking another doctor. That is the last thing you want to be that type of person. So I say, here's what I would recommend and you choose what works for you. And I've told you this before, I, and I have a, I kind of have a running joke with my patients and obviously, you know, if patients in pain, I'm not, we're not joking around by different options, but nonetheless, I give people a book, like a menu of surgery options, and they're not used to that.

Sometimes they're told this is the way it is. I'm, I'm the surgeon. I'm going to do this. Dude, this thing for you and I had a patient last week. I gave them six ICL options and they said, Oh my God, I wasn't expecting to have so many choices. I said, well, I want you to decide because this is comes to starting a new tech. When you offer something like that, you have to [00:44:00] give them an out. If they don't feel comfortable with it after they do some research, right? And I, and most of the time for some of these procedures, they're all in, but sometimes they get nervous. You know, I've had patients that have been scheduled for the bare ACL and they've backed out and the patients have been scheduled for ACL repair and they've backed out and that patient has been scheduled for any of these types of procedures and they backed out cause they were nervous.

And that gets to your point on, do I have alternatives? 95 percent of the time I tell them, here is what we used to do. Here's what we do. And you used to use like. six months ago. And I just have the luxury that patients come in asking for the new tech because of my website, my social media, my reputation for having some of the new tech referral for my partner saying this guy's got the new tech.

And so I get, I'm, it's, I am, it's easier for me to have these conversations. The problem, the hardest part is when you have the patient come in and this is, I keep bringing up ACL repair because this is the best example. You have a patient come in, they've seen three doctors. All of them said they need a reconstruction [00:45:00] and I think I can fix it.

And that's where things are like, you know, you give yourself an extra 10 minutes, you close the door, you sit down, you lower your voice, and you're about to tell them something that they did not hear before. And that's going to be a little bit of a shock. Right. And those are the hard ones. And for people that are just starting out to offer new tech, that's by far really daunting.

Right. It's really daunting to say, you know, I'm going to do something that's a little bit new, right? Because if you've just gone through a few years of practice and you've now established yourself and you're no longer, people no longer looking at you as a baby face surgeon, that's maybe learning how to do these surgeries.

And now you're offering a new procedure. It's important to come with some confidence, but also it's important to understand, you know, where the patient's coming from too, because. Some patients I tell them, I'm like this. I told them the first person did a lower trapezius transfer on, which is where you transfer this.

And we've talked about this very briefly. Yeah. I said, listen, I've gone to the conferences, I've learned about this, but this is the first one I've done. I feel very confident that I'm going to do well and for you, but they have to know that, right? And then when, and then [00:46:00] they didn't end up doing amazing and then the next one and the next one and the next one, but you know, it's, what's your reaction

Will Sanchez: when, when you have a patient that, that, I'm sorry. What's your reaction when you have a patient that you can tell is intimidated by maybe the situation or, uh, the procedure, but you can tell, right? That, that there, there, there's maybe there's some doubt or they're intimidated where they may just, you know, just say yes to anything, you know, because I'm pretty sure you have. you know, people, because that's just natural reaction. You know, is that a red flag for you? Is there something there where you kind of notice what's going on and say, well, wait a minute, I, I kind of want, I want them to have this procedure, but at the same time, I don't want them to just go along with this, um, feeling a certain way.

Dr. Grant Garcia: Yes. So to answer your question, there are two types of those types of patients. The first one is the one where there are these, you know, patients that are [00:47:00] just so trusting of the surgeon and they're not doing any research and they just want you to tell them what to do, right? Most of the time that's good, but sometimes I'm like, okay, wait a second.

Like, you know, you came in like ready to sign up for surgery and I don't think you need it. Right. Or I'm not sure you're ready for this. Like, do you understand? Like, I've just told you I was going to break your leg, straighten it out. I was going to replace your meniscus. There's complications. And they just said yes right away.

Like, that's never normal in my opinion. And I love when I went, sometimes they come in, they're like, you know, some of my engineers from Boeing, they're like, Oh, I got it. Like, here's the alignment you're going to correct. And like, I get it. I get it. Like, that's not that person I'm worried about. Yeah. Yeah.

Yeah. So yes, occasionally I will be honest with you. This happens every single day in my office. You have heard about the procedures that I do. I have a patient coming in, they say they have anterior knee pain, and I tell them they have a cartilage defect, we're going to need to do some realignment. When you do really complicated, fancy procedures, and you do big combinations of them, I mean, we do some of the most complex procedures in Washington State.

There is no way that you don't get patients in the office. I have [00:48:00] patients that start off the visit crying, because they're so upset. They've had 10 years of pain. I've had patients coming in, So angry because they've seen three doctors and no one said they could help them. I get to see every variation.

And honestly, 10 percent of my patients, I have a patient that I had to see five visits before her ACL reconstruction because the first time she had ACL surgery, it was such an atrocious experience. She had PTSD and did not want a surgeon to touch her. But she was so miserable, I had to basically earn her trust for five visits straight.

And you know what's really cool? I just did her surgery and I just got a, we got a big hug. So that was awesome. So we're back on track, but you, you have to adapt to each person. I mean, this is another show topic. It'd be the personality. The personalities needed or how you have to adapt in the office to each patient because that's really important. I tell people with the first visit when I throw out, and you know me, I talk fast and I have lots of information I want to say. And that's not always the best idea, uh, with some patients that are a little bit nervous, but it's just my personality type. [00:49:00] So, I tell them it's okay to feel like a deer in headlights.

Okay, this is normal for the first visits. You are not required to do anything today and I don't want you to. Now most of the time those big surgeries that I do require initial simple scope and so that's pretty easy to conceptualize, right? Well, like I'm going to take you to the operating room, we're going to put two poke holes in and we're just going to go look and figure out what's going on.

We do that for a number of reasons. One, because I can tell me more information in the MRI and two, because I might be able to get a little bit of benefit and three for the insurance company. So they can see, like, look at that hole. Like you can't not get, let us do the surgery on them. Right. And then, so once they do that, then they go to my website and they do all the review of the stuff. And then all of a sudden the second visit. Third visit.

Will Sanchez: Yeah,

Dr. Grant Garcia: and then I feel ready and then when they start repeating and telling me what surgery they're getting and they're like I'm getting MPFL TTO Macy cartilage transplant. I go you're ready. You're ready. No now you're informed And so yes, [00:50:00] most of my patients for the really complex stuff Which is probably about 30 percent or 40 30 percent of my practice is really really complex.

They're always like that well And they're most of the time completely shell shocked by the options. Very, very rarely are they shell shocked the day before surgery. So that is, that's what I pride myself on. That is the hardest but most fun part of my practice. Yeah. Is taking something super crazy complicated and super intense And making it them feel completely comfortable with it and understanding.

And that's why I spent so much time on the surgical videos and so much time on the podcast and so much time, all this. So my patients can see all of that and they go, Oh, that makes sense. It doesn't look fun. But it makes sense.

Will Sanchez: It doesn't look fun. Nope. All right. We should wrap it up soon. Let's talk about our next guest here. Why don't you talk about, uh, about Dr. Schaefer here?

Dr. Grant Garcia: All right. I'm super excited about this one. You know, I, when I asked him to come on, I'm, I'm really excited. So [00:51:00] Dr. Uh, Andre Schaefer is probably one of my best friends as well. We both went to hospital special surgery together in New York. Um, both taking care of all the professional sports teams, which we've talked about. Um, and he is now back in Seattle and we're actually both from Seattle. He's originally a firefighter, but what's really cool about him is he's triple fellowship trained, but he is now our newest spine surgeon. By new, I don't mean new to practice, just new with us. And he is, has some of the most cutting edge, innovative spine surgeries you can imagine. And we have a lot of good spine surgeons in the area, but the stuff that he's offering, he's going to talk to us about scoping people's backs. And I just saw one of the patients in the operating room. He, the next, the patient called the next day to ask if he had actually had surgery, you know, and, and spine surgery is not supposed to be fun.

And he is, he has made this into, he is on the edge. And again, he's just, you know, he's just building a Seattle practice, but the, the, the, The stuff that he is doing [00:52:00] is next level. And people need to know about this because very few people in the area are doing this. He's doing disc replacements of your neck, disc replacements of your lumbar spine.

We never used to do those. Everyone was told fuse, fuse, fuse, fuse, fuse, which means. That something's going to happen to the next disc below and you're a repetitive spine patient, you know, and he's doing these scopes where he's taking these discs out and it's just these mini tiny incisions. As a matter of fact, he was teasing me. He goes, my incisions are smaller than yours now. And I was like, dude, come on. And you can see they're smaller than the pinky.

Will Sanchez: He's talking

Dr. Grant Garcia: smack. I like it. You're going to see, you're going to hear so many cool things, and this is near and dear to my heart because I've had a herniated disc, and I almost had to have surgery for it, um, and it was nothing fun about it, and I looked, and I had a lot of trouble trying to find someone, and I am an orthopedic surgeon in Seattle to do the surgeries that he's doing, and so one of the reasons that it was really near and dear to me when he was available to be taken and come to our group was that he [00:53:00] offered endoscopic spine because that's the only way I was going to get my disc done.

And it literally took me three months to find somebody that I could even consider doing this surgery on me. And so that's no joke when you're a surgeon trying to look for that. I was willing to have to fly out of the hospital. Out of the out of the state to do it now. I don't have to if I have it. He's gonna do it.

Trust me Um, but you know what to have this opportunity to offer this technology to patients. They need to see they've already seen. Dr Ye They've seen dr. Weil there's so many other good partners in my group that offer these type of things But this spine stuff is in infancy This is what sports was 10 years ago.

You have people scoping spines doing many, many, many incisions and patients doing really, really well and doing much better than they used to do. And so I'm getting too excited, but I want everybody to understand that you are going to be blown away by what is capable of happening in spine surgery because people are terrified of spine surgery, right?

Will Sanchez: Oh yeah. It's terrifying. It's something that we talk about. Like, I don't [00:54:00] want nobody to touch my back and screwing something up. And no, and fearful about it. And, uh, a buddy of mine had back surgery major where he, uh, also he, they, they cut them in the back and then did a C section in the front. He was under for like eight hours repairing this back of his. That was just so messed up. This was a while ago. It was major, major surgery, uh, that eventually brought him relief. But maybe the first nine months he was like, I regret having surgery. And then finally he started to feel better. Anyway, I don't want to scare people here, but no, no, that's it. No,

Dr. Grant Garcia: leave that thought for everybody because one of the surgeries is going to talk about, used to have to be done with the back and the front. And as a matter of fact, in the next six months, he's going to be able to offer the surgery from a mini little incision just in the back.

Will Sanchez: That's probably

Dr. Grant Garcia: so much what your, what your friend had. And I tell you right now, one of the potential surgeries and maybe the longterm future for me is something you're talking about where maybe the back and the front needs to be done.

And [00:55:00] just talking to Andre a few weeks ago saying, no, dude, you just wait a couple of years. It'll just gonna do it from the back. It'll be a little mini guy. Like, as if like I'm going to be wait for the next upgrade. Uh, to come. So, you know, I think we're going to see something. I think people are going to learn so much and understand what's available out there because, you know, he did the first scope of someone's back in Washington in ProLiance. Like six, eight weeks ago in pro liance, that's huge. And so you're going to see, this is like, this is innovative. This is cutting edge stuff that you've never heard of. Your friends have never heard of this and maybe they have, but the ability now that Washington state and Seattle has this opportunity to have a guy like him there. Who's also, by the way, super nice. So this will be really, this'll be a really good talk. So

Will Sanchez: let's get out to the nitty gritty. All right. And what kind of fan fan he's going

Dr. Grant Garcia: to be as he's a Seattle guy, man. He's lived here. He's not going to jump ship with us on the

Will Sanchez: Yankees. We'll see. We'll see what happens. How that [00:56:00] conversation goes. What we might have to, but we'll, we'll find out. Figure it out, we'll figure it out. A fun fact, uh, I broke my wrist playing football and I had surgery at the hospital for special surgery. So we always kind of find a way to kind of bring it back around. And as we do that, we wrap it up. We want to thank everyone, all of our listeners and viewers. Check us out at sports doc, talk, uh, dot com, and also our Gmail sports doc, talk podcast at gmail. com. But you can go to sports doc, talk. com and get all our information. We have transcripts, we have our shows, we have videos. You can request topics. Uh, we have links to Dr. Garcia's website and a whole bunch of fun stuff. I don't know what else am I leaving out? Dr. Garcia.

Dr. Grant Garcia: You're not leaving out much. And we got stuff for each one of those. We got a, we had a really good one today for, uh. Hot topic. We got a really great guest that's requested, you know, do all those things, go to the website, check it out. And then it links to my site too. If you want to see how the procedures are done or learn more about them. If you [00:57:00] want to see a great video, well on there, you should also go on there. Uh, you can see all those different things. So, you know, learn about it. The website's awesome. It's been really, we've had a lot of lists. I mean, we've had people from all around the world that take a look at it. I get to see the, uh, the information. Um, but we're just here for you guys. We're here to teach. We're here to give information. And again, a lot of it's information that is likely is true, but again, take some of it for his opinion as well. So hopefully you enjoyed it and we're really looking forward to our guests next week.

Will Sanchez: You're here. Thanks for joining us.
Audio Transcript


A Year in Review: Newest Ortho Sports Tech Update

A Year in Review: Newest Ortho Sports Tech Update.

Will Sanchez: [00:00:00] Dr. Garcia is unbelievable. We've found a technology. Welcome everyone. Welcome to sports doc talk. I'm Will Sanchez along with our orthopedic surgeon and sports medicine specialist, Dr. Garcia, man. What a great show. We're really excited about this show. Because we're celebrating it's an anniversary.

Will Sanchez: We're celebrating 2023 as a full year has gone by with our incredible guests. Amazing topics and you, the listeners, we appreciate everyone. Dr. Garcia, can you believe it? You dealt with me for the entire year for this anniversary. And now we are celebrating by scaring people. I apologize, everyone, because now we're on video.

Will Sanchez: We're on [00:01:00] YouTube besides your favorite listening platform, Spotify, Apple, iHeart, Amazon. We are now bringing. The noise to you too. How you doing Dr Garcia? I

Dr. Grant Garcia: know I'm excited. Happy anniversary. So one year ago from today we decided to do something different. Mix up our the old NYSE podcast, you remember?

Dr. Grant Garcia: And we came up with the idea of Sports Doc Talk. A lot of time building that logo. That logo seems simple, but it's not. It's a lot of conditions to figure out what was most important was whether it looked like Will or not. I didn't really care about my part, but I really cared more about that. We made sure it looked, it looked, will look good in the picture.

Dr. Grant Garcia: So that was,

Will Sanchez: I think you would need a lot more Photoshop to make me look good. So we're just happy. We eventually just gave up and like, it ain't getting better than this brother. And I,

Dr. Grant Garcia: and I get, we can say this on the podcast, since we're going to have a little bit of fun too. I think it's good for us to mix it up, but the microphone wasn't easy to do and not make it appropriate.

Dr. Grant Garcia: So we so we did a lot of. [00:02:00] stuff on that logo, but we're really excited about it and it was good commissioned work. So, and you know, we've come a long ways. I mean, this has been a really awesome experience. And again, the, we've had people requesting to be guests. We've had people from all around the country.

Dr. Grant Garcia: I mean, I texted will just a little while ago about, you know, I had my med school friends. There's about 20 of them, all different surgeons from throughout the country, not just locally. As a matter of fact, no one's even from the Washington state area. And they asked me about the Q collar. And they're like, you know, but this guy, Dr.

Dr. Grant Garcia: David Smith, the Q collar. And I was like, dude, I put it on my podcast. And the first response was I had no idea you had a podcast, but the second response was that's pretty cool. So it's just to give you an example of like who we've been all the interview. It's been awesome. And then on top of the topics, you know, patients coming in all the time asking about these different topics.

Dr. Grant Garcia: So, I mean, we've got over 1500 listens in 10 countries. We've had six renowned guests at least. We've had 15 episodes. It's been awesome. So thank you guys.

Will Sanchez: Yeah, definitely. And I [00:03:00] remember when Dr. David Smith reached out or, or his, his peoples, his peeps reached out to us and, you know, we had the conversation like, Hey, this is real.

Will Sanchez: Then what do you think? And he's like, yeah, no, this is legit. And, you know the, the season prior, we saw a couple of guys in the NFL level wearing this Q collar, right. Is, you know, this This design that goes around your neck and for you football fans out there and maybe some soccer. I'm not sure if they're utilizing soccer, but definitely football.

Will Sanchez: You might see this band that kind of goes behind the neck and this is what this cue collar is. It's to mitigate the absorption of slosh. Right. That sloshing that's supposed to be woodpecker around in your brain. And, and Dr. David Smith gave that great example of the woodpecker, right. And how the tongue goes out and wraps around the head and protects it.

Will Sanchez: And I'm probably saying it all wrong. I apologize, Dr. David Smith, but. You are a great guest. It was a great topic and we saw it all season, right? As we wrap up the football season, [00:04:00] we're getting ready for Super Bowl Sunday. We'll get into that a little bit later because you know, we might have to have a pick here or there before the show wraps.

Will Sanchez: So I, if you could see Dr. Garcia holding his

Dr. Grant Garcia: face going, Oh God, what are we doing now? They could just see my face. Before they weren't seeing it.

Will Sanchez: So, yeah, no, just some great guests. Recently Dr. Acevedo and Dr. Bashay the shoulder surgeons we had a really good time with them. They like to keep it light and fun and which makes them fantastic guests.

Will Sanchez: So we really appreciate those guests coming on. Who else stands

Dr. Grant Garcia: out for you, Dr. Garcia? I mean, we had Leah winters, obviously starting the napkin to reality. That was pretty amazing. She was absolutely amazing. All the guests have been awesome. I mean, everyone's different, right? Each person's different.

Dr. Grant Garcia: And the nice thing is it builds in a little flavor. You know, you don't have to hear me talking about all the orthopedic stuff. You get people doing different things. And. What's interesting, I think, is like when we started off the podcast, we had some vision for it and it kind of morphed. I mean like literally [00:05:00] some of these guests came out of nowhere, like we, these weren't planned.

Dr. Grant Garcia: And all these different topics, some of these topics weren't planned either. You know, we have a topic plan. All of a sudden someone reached out to us and we're like, we'll enter like scrap that topic for this week. We're going to do something different. About the, the podcast is like we have our, our main goal is orthopedics, sports medicine, teaching you guys cutting edge techniques and things that are real and happening.

Dr. Grant Garcia: But at the same point we pivot because something's cooler and more interesting that we know the viewers are going to like, but it has to do with the sports medicine world. You know, you see Aaron Rogers, Nick Chubb. Lonzo ball with a cartilage transplant. All these crazy things that people are like, what's the surgery?

Dr. Grant Garcia: I don't know anything about this. I've never heard about it. And all of a sudden, well, they're like, boom, we have something for you. You know, we've been talking about it the whole time, but no one's listening. So now they're listening because it hits the new

Will Sanchez: and it's funny because the two people that you mentioned, right?

Will Sanchez: Aaron Rodgers and Nick Chubb, yeah. Those were really spur of the moment shows because normally we do our show, we kind of plan it out about three weeks, a month, we come up [00:06:00] with a show. We already have the plan, but due to time and, and and really kind of doing what we want to do and being specific about it.

Will Sanchez: But when, you know, the biggest news to start the 2023 season to kick off, right? Monday Night Football, the New York Jets sold out stadium. They come out the lights off, you know, people have their cameras on and Aaron Rogers run now with the American flag. And it's just like, what a way to kick off the season jets fans are going.

Will Sanchez: We're finally gonna win. It's going to happen and three plays in the Achilles rupture and what a story to tell and that's one of the reasons why we love sports, right? Sports is my reality show. I'm not watching the Kardashians. I'm not watching anything like that. My reality TV is sports. So it, you know, that when that happened in Nick Chubb, we jumped on it because we thought it was important to share.

Will Sanchez: I, I remember when I texted you and you were [00:07:00] like,

Dr. Grant Garcia: Oh my God, right. You know, they were all talked about how this is going to be a single surgery. It's going to be so simple. And I'm like, dude, I've done this before. I know that I know we're not going that route. And then all of a sudden, you know, they get in there.

Dr. Grant Garcia: There's more damage than they expected. But again, it's also media hype. You know, we know how this works. It's like, you know, it's fun. I can say whatever they say, but it's also, you know, that they're not talking about the surgeon didn't say that. Like that's what the media wants. Cause they want people to think, oh, there's like this hope.

Dr. Grant Garcia: It's going to be super fast. And he's going to be back in two months. You know, Aaron Rogers is going to lead the jets to the, to the super bowl.

Will Sanchez: Yeah, that was, that was a lot, a lot of hope there, but there was a lot of conversation. It was like, Hey, do you, do you think this actually can happen? And you're like, yeah, now, bro, that's not, that's not happening.

Dr. Grant Garcia: I think it's a valiant effort though, for publicity. So anyhow, so, but we pivot. We pivot. You see us here now we're on video and so you're like, what's going on? Well, I mean, we had a lot of, we had a lot of requests. We had my friends who wanted to talk about the Iron Man. We had different requests from [00:08:00] guests.

Dr. Grant Garcia: Yeah, that was a good one. One request we kept getting is video. And he said, you don't, we don't see you got your funny faces on the video enough. So, and again, for the stuff that we're talking about, you know, the hands, the hand signals you can hear. The voice inflections are important, but people want to watch the video.

Dr. Grant Garcia: And so we listened and I think, you know, from now on, you're going to be seeing video podcasts of sports stock talk. So it's going to be awesome. And not just that same rendition of the logo over and over again. You're going to get to see some, a little bit of freshness. And I mean, we do have a master producer here with Will Sanchez, so I

Will Sanchez: don't know about that.

Will Sanchez: Now, this is all going to get screwed up here. So we'll apologize there. Another great guest guest, Dr. I'm sorry, Dr. Zach Smith, physical therapist, high def P. T. He was Dr. Amazing. The plethora of information that was, that was, he was talking about and the innovative techniques and technologies. And he had the app that Theracentric app.

Will Sanchez: I know I missed [00:09:00] this, a blood flow restriction and how they utilize in that. I'm just sitting there. He was gone. I was like, we're going to go four hours on this show. I mean, he will

Dr. Grant Garcia: doesn't know is my goal. The show is to always get him excited. So I bring on the most exciting things I can. And then I surprise him with something even more exciting.

Dr. Grant Garcia: So by the end, I mean, at this point, he's got his honorary medical degree. I mean, he's had what we had like 40 episodes of this. You're essentially trained once you get that internal brace degree, we're gonna be set.

Will Sanchez: All right. If it was only that easy. Anything else that stands out for you? I know we've Done so many and we could talk about so many different things.

Will Sanchez: And, and I'm, you mentioned Leah winter, right? And that was also, I feel like it was part two of the napkin to reality show that we had that you absolutely love. And I believe it was one of our most listened shows, everything that we're talking about right now, please go back and check out the podcast and our amazing guests, because we're not just.

Will Sanchez: You know, coming up with this, these are [00:10:00] shows that we had and we are definitely not doing justice right now, just with a little quick synopsis here. So please go back and listen to these shows and amazing guests that talk about what they do. But going back to Leah Wintour and that napkin of reality, I mean, tell me about that show and the response that you got from that show.

Dr. Grant Garcia: I mean, a lot of people, obviously Leah was happy to be a part of that, but it's just, you know, the idea of hearing about someone like her with a, you know, again, we talk about big companies, Arthrex. Macy, we're gonna talk about a few more. These are massive companies. This is a single person who with behind the scenes is using other you know, help people to help her along the way and, and doing something great.

Dr. Grant Garcia: I mean, she's on LinkedIn, she's got her own corporation. She flying around the country doing stuff with this. You know, innovative, but simple, but innovative idea and it's impressive. So it was really fun to have someone like that on there and hear the story. And honestly, like you heard before, but the reason she came, one of the reasons that she was so excited about this is she listened to the [00:11:00] napkin reality podcast, and then we had her on to talk about the napkin reality that she has occurred and that she went through.

Dr. Grant Garcia: So it was just full circle. You know, and again, I know we could talk all night about this, but that's obviously, this is just the we're just the taster of the podcast. But again, the website to check it out, www. sports. talk. com. It's got everything on it. And again, we spent a lot of time on this, you know, video podcasts, transcripts, and we know we track everything.

Dr. Grant Garcia: So we know people are watching these. We know people are watching, they like the transcripts, which is great. You know, our averaging about a hundred views a month on just the, on just the website itself. And then what's cool is if you able to link to my website and some of my, a lot of my patients know this, but we've got a ton of surgical videos, pretty much all these fun and interesting surges you hear about, we've got a video on it and it's, it's myself doing it and seeing the technique.

Dr. Grant Garcia: So if you want to see, like, how do you do an ACL repair with internal brace, how you do an MCL repair with internal brace. You know, again, all these things we talk about, all these funky, crazy surgeries, they're on there. [00:12:00] So, you know, visit the website. You can see right there, GrantGarciaMD. com. But again, all the links are built in there.

Dr. Grant Garcia: And if you want to learn a little bit about Will and I too, it's all on there. There's tons of information and people have really enjoyed it. So again, it's just been, we just want to kind of overview everything that's gone on and how it's been. And I'm pretty excited. I think this is going to be even more a more productive year because we just have more, we have more experience now.

Dr. Grant Garcia: So.

Will Sanchez: Yeah, before we started talking about the other topics which is future horizons, right? And, you know, when we talked about this show, we said, okay, this show can be three hours. I mean, there's so much information. So we said, okay, let's kind of, you know, pay our respects to 2023 and all of our great guests and talk a little bit about them.

Will Sanchez: And we'll dibble dabble a little bit on the future horizons. But really, this is a this is a teaser for everyone, because throughout this 2024 year, we're We're going to go back to some of this stuff that we're talking about right now. We're going to go in depth. We'll have other guests coming on and speaking about it.

Will Sanchez: So we're really excited about all of it, but [00:13:00] before we move on, right, we were talking about innovations and technology and the one that cracked me up and I'm laughing right now. So if you're looking at my face, I'm pretty much smiling. And I was like, Dr. Garcia, I'm going to bring it up. He's like, what are you talking about?

Will Sanchez: All right, I'm gonna bring it up. He's like, ah, really? Okay. Yeah, it was the hydration sensors in the Jacksonville Jaguars

Dr. Grant Garcia: You're hoping you weren't gonna bring that

Will Sanchez: up. Yes Where we talk about things that we're talking about and in the stories in the show I was like, you know what I have to bring it up again because That was amazing.

Will Sanchez: You got sensors in your urinals to tell the players if they're not

Dr. Grant Garcia: sure it's the best tech we talked about, but it's definitely the most interesting. And I'm investing. I'm investing. That's my, that's my goal now to get invested in Jacksonville Jaguar urinal hydration sensors. I

Will Sanchez: need one in the house.

Will Sanchez: So I know when I haven't had enough. water. It's going to turn a certain color. It's going to yell at me. It's like, once again, you're not [00:14:00] getting enough water. You're getting dehydrated. Do something about it. It's just, it's just a sensor to shame me into doing what I need to do. So we'll see if there'll be a home product coming soon to everyone anyway.

Dr. Grant Garcia: Awesome. All right. I think we probably should go into the cutting edge. Cause again, like you said, we're going to go brief on this. So you guys have, may have questions. You may hear about this again. This is these topics. I had two people come in today for the, for the asking about these particular innovative surgeries and they did.

Dr. Grant Garcia: I want this. I heard about it on the internet. And so today is a day just to go very briefly through it because this stuff that people do, people have entire presentations on this. So we're going to go briefly kind of see how things went. And we'll go from there.

Will Sanchez: All right. Let's start with this. Misha implant.

Will Sanchez: Am I saying it right? Misha? Misha? Yeah. Misha's

Dr. Grant Garcia: right. Misha's right. Misha, right? Yeah. All right. So this, this is cool. So I'm glad we got the audio. So this looks like, this looks wild. This looks like, you know, [00:15:00] 2, 200 year we're implanting this. But what's, what's really cool about this in the background to this is there's patients that have these, That have that have issues with their arthritis and I see a lot of them.

Dr. Grant Garcia: I saw two people today that were potentially candidates for this and when they come in, they have arthritis and a lot of times the arthritis on the inside of the knee or the medial portion of the knee. And that's the most common one. And a lot of those patients nowadays, if they're in their late forties, fifties, their doctors say, Hey, listen, I don't have any other options for you.

Dr. Grant Garcia: We're going to do a knee replacement. The knee replacement is a partial, but nonetheless, that's not ideal. I mean, if you're 40 to 50 and you have a knee replacement like that, it's not your last. It's going to wear out. And the other issue is that you have restrictions. You know, you got to take antibiotics when you go to the dentist, you have, you have other issues where that can last only a year you're restricted in terms of high impact activities, and so that's really kind of one of the reasons that this came about.

Dr. Grant Garcia: The second reason is, there's a procedure which we have talked about and we are going to [00:16:00] talk about called the high tibial osteotomy, and so this is something that not that many surgeons do, it's kind of a lost art. I do a fair number of these, and what happens is people that have that, that issue with arthritis, they start to fall in.

Dr. Grant Garcia: If they fall too much, then they only can get the osteotomy where we actually straighten their leg out is pretty wild and people do really well from it. You can see on our website testimonials, but the people that are just a little bit or the people that are people that just a little bit, those people may, you know, right now we have the osteotomy or we have a partial knee replacement, but the osteotomy is a big surgery and the knee replacements.

Dr. Grant Garcia: You know, a decent sized surgery. So this option is basically this little spring. It takes away 30 percent of the pressure. It actually acts as a sort of knee brace and we've seen awesome results. Again, there's a lot of European data in there. They have up to seven year data on this. This is the second generation.

Dr. Grant Garcia: I think the hardest part is just getting approval for it, but we're working on it and again, this is, this is a, it's a, it's a pretty easy surgery and pretty easy recovery and the patients are doing great and there's no restrictions. And again, you know, absolutely worst case in this scenario. [00:17:00] We never want to have a, an issue, but you know, removal of it.

Dr. Grant Garcia: If you have to have it done is pretty easy as well. So this is sort of the newest cutting edge thing that's coming out. And this is a really good bridge for patients that want to buy some more time and keep up their activities. And again, Will and I know we're in Seattle, you know, every time you look down the street, there's like 15 people running with each other, you know, biking, climbing, bouldering, it's just nonstop sports.

Dr. Grant Garcia: I mean, I had a patient, two patients today, they're 50s and they're like, you know, I'm really active. I'm like, dude, this is Seattle. I get it, you know, 60 being like, you know, I like to run marathons. I'm like, I get it. I get it. I get it. So yeah, so this, this, we're going to go more into this later. As this hits more mainstream again, this is, this is something that people have really not heard about.

Dr. Grant Garcia: They're getting now I talked to the company, they're getting, I think they're getting over 2000 inquiries a week for it and waiting to find surgeons that are going to be trained in this, that are going to do this. And so we're going to be right there with you telling you kind of our experience, but we're really excited on the pipeline and this is coming really soon.

Dr. Grant Garcia: Really sick ands, FDA approved. Is this [00:18:00] something

Will Sanchez: that you, I I, is this Well, that's great. Is this something that you can utilize, even if you've already had knee surgery and maybe it's not taking, or you're not being supportive, I'm not sure if I'm saying the right words here, but is this something that you can utilize to for lack of better word, kind of go back and fix maybe some of the stuff that didn't work the first time and, and put this in?

Dr. Grant Garcia: Yeah, so this is a good example. The guy that we're doing it on shortly. You know, he had his meniscus cleaned up and people don't see this. They don't realize it. Maybe he had a little bit of that, you know, kind of bowleggedness. But on top of it, the people that the biggest people you worry about is a straight leg.

Dr. Grant Garcia: So they have completely perfect legs. He had his meniscus cleaned up. Didn't do too hot. Six months later or a year later, he comes in now for me to second pinion. And I'm like, what about trying this? He's 50. He wants to run. And so that's really what it is. It just basically takes enough. It's crazy. 30 percent of the pressure gets rid of all that pain.

Dr. Grant Garcia: And that's really what we do with the osteotomies and the braces. It's just that those are more invasive and the braces are hard to wear. So this is that middle ground. And as soon as I heard about [00:19:00] this, I was like, listen, I've got these people. I don't know what to do with them. They don't want an ear placement.

Dr. Grant Garcia: We can't do injections anymore. And boom, we got this. And you keep seeing this. There's all these, these companies are finding niches. And there's a niche for all these things we're going to talk about. And again, like I said, we, we're going to talk about it for two minutes and we're about six minutes in but this is what happens on this show, but I'll stop there.

Dr. Grant Garcia: Learn about it on my website. We'll move on to the

Will Sanchez: NEP talk. All right. Well, I'll hold my my questions when we focus on that topic. Anyway, let's talk about anchors, right? You know, another great guest that we've had, Anthony Yee. You know, I felt like everything that we talked about went around, you know, anchors and the fibulox and the push lock and the, you know, the anchors and I don't know, any lock that you could think of.

Will Sanchez: So this is another lock. Let's let's get into this a little bit here.

Dr. Grant Garcia: All right, so this is pretty cool. So this company is separate from a lot of the companies we talked about and what they did is you can see this anchor. So the [00:20:00] anchor itself is not anything crazy innovative. I mean, this is a this is a very similar copy to a lot of other anchors that are out there.

Dr. Grant Garcia: But what the issue is, is the materials it's made out of. And that's the game changer. So the way it is, is we have three main type of anchors. implants. The first one is the biocomposite. So those are the ones that turn into bone, but they're super soft. And so they can crack sometimes, especially in hard legs or hard bone.

Dr. Grant Garcia: And those are the ones that people, patients want those because they turn into bone, but they're not very useful in a lot of different cases. I use them in the shoulder more, but in the knee because the leg is bones are so much stronger that can actually crack them. And so we don't use those devices as often.

Dr. Grant Garcia: Then you have peak, which is a plastic. That's what I use a lot of. So those are invisible to MRI, but they're inert, so they don't go away. And so patients don't like that. It doesn't go away. They want it to go away. But the issue you have is you have to have a harder anchor because you don't want it to break during the surgery or your surgery won't work.

Dr. Grant Garcia: And then the third step, [00:21:00] Well, everyone knows is the metal, trust me, one of the reasons that I get some of my patients come to me just because I don't use metal in certain cases. And so can we get an anchor that has the properties of metal or peak but turn into a biocomposite? Well, these guys figured it out.

Dr. Grant Garcia: And the first time I put one of these in. I like freaked out because I was like, this is awesome. I'm putting it in. And instead of the normal crack, crack, crack, which I've used plenty of companies before, this went straight through and it was, it's stronger than the plastic, but is biocomposite. So it turns into bone and it doesn't.

Dr. Grant Garcia: Some of these biocomposites also, they're so soft, they actually turn into cysts. So they're not exactly doing what you tell them they're going to do. And so this product material they've designed and found a way that it turned. And actually, they're actually competing with metal now. So it's amazing to imagine like a bone material that's as strong as metal.

Dr. Grant Garcia: And so the future and this is a lot of foot and ankle and they're now working towards they're doing some sports medicine and I use these in the [00:22:00] surgeries.

Will Sanchez: And you said and you like to use them in the shoulder area, right? Because you mentioned the foot and ankle, but you're also using no. So I like to use them.

Dr. Grant Garcia: The shoulder, it's not as, it's not as concerning in terms of the strength, but the, the, the knee is a problem. So my knee anchors break a lot of times if they're soft, and so that's why I use almost exclusively the plastic anchors and I don't use biocomposite. And my patients are like, why don't you use biocomposite?

Dr. Grant Garcia: I'm like, they're softer, they break. Well, these don't. And so I use these now more frequently because they don't break, but they turn into bone. And so that's really the winner. The future is like everything that we use to fix bone with, like my tubercle osteotomies, or we use metal to fix with. They're coming out potentially with some screws that are, but the only weird thing with the screws is they're invisible.

Dr. Grant Garcia: So when you do them, What do you mean invisible? They're invisible on x ray. So they look cool to me when I'm putting them in, but when you get an x ray, it looks like nothing's there. Because they're completely invisible. And so there's some strategies they're doing. And then the next step is to make these [00:23:00] bigger, right?

Dr. Grant Garcia: Because when we fix an ACL, we fix them with big screws, you know, like. Nine, 10 millimeter screws and they can right now they only have up to like five millimeter. So they're not there yet with their sports line. But this is once those things happen, which I'm expecting in the next year, this is going to explode.

Dr. Grant Garcia: And it's, this is the next generation of anchors. I think everyone's going to be competing for this material. And again, I, I was, it took me a little bit to believe in it. And when I tried it for the first time, I was really impressed. So yeah. You know, we'll see where they go. But you know, this is pretty cool and we definitely have to have an update on this in the near future.

Will Sanchez: Yeah. Do you feel like there'll be a jump even within a year or so that you know, as far as them having maybe something bigger, stronger that you can utilize for other parts of the body that you feel that needs, you know, more

Dr. Grant Garcia: support? Yeah. I mean, the biggest thing here is people just, it's just conversion.

Dr. Grant Garcia: It's like you're, it's a dogma is that if you have a screw, it should be metal. Right. Because that's strongest. And like, we don't, the last thing I want to do is put [00:24:00] one of these in and have it break off at like two days. And then my surgery failed. Like, right. Like I talk about all these cool innovations on this podcast, but if, if, if my innovation fails right away, that's a failure of myself.

Dr. Grant Garcia: Like I feel badly. And obviously that's terrible for the patient. I'm very fortunate that I spend. Lots of time preparing and thinking about this and being like, listen, like I'm talking the company. I'm like, I'm not using your screws until I know for sure that they're not going to break off. And if I do it, maybe I do one of these and two of the metals.

Dr. Grant Garcia: And so I'm like, Oh, this didn't break. Okay, now two of them at two of these and one of the metals. So I'm trying to if I'm integrating this and it's slowly. But obviously faster than still a lot of people do because, you know, we just, we did the first in the state of one of these anchors in the miniscule route, just, you know, four months ago or something like that.

Dr. Grant Garcia: So, you know, it's not, this is coming quickly and it's innovating quickly.

Will Sanchez: I got a quick question. I apologize, but we said we were gonna do this for two minutes, but here we are. Do they tell you what the torque is for lack of a better word is like, you know, there's a pound per pressure [00:25:00] per millimeter of screw going into this type of tissue or bone.

Will Sanchez: This is your kind of your, your sweet spot. Anything more than this is going to

Dr. Grant Garcia: fail. So The answer is sort of, but really it's also like a test, you know, we're doing it in the surgery and they're like, they're like, okay, well, don't tap it this time. You know, you tap screws. They're like, don't tap it this time.

Dr. Grant Garcia: Let's see if it breaks or not. So we're doing it. And I'm like, this isn't breaking. It's making a lot of noise, but it's not breaking. You put a screw in, it's really tight squeaking. Yes. That's what happened with this one. And I told, I looked over the rep and I said, yeah, If this doesn't break, I'm going to buy lunch.

Dr. Grant Garcia: I was like, this is crazy and it made it the whole way and it didn't break. I was shocked. So I had to buy lunch, obviously. But the but you know what? This is again, this all safe environment. We're not you again. This anchor breaks. You can easily pull it out. And the nice thing too about these is if the anchor does break, you can just drill it right out because it's just.

Dr. Grant Garcia: This material at time zero, you can actually get rid of you if you have a metal anchor break in [00:26:00] there. It's a big problem, right? You can't get it out. So that's what's cool about this. You can reuse that hole over again. It's just this is another topic. Like we said, we're ready. We're already past our timeline.

Dr. Grant Garcia: We should have a counter on here for me and it should beep at me and tell me I got to get it move on.

Will Sanchez: Well, I should stop asking you stuff also. So we'll just move on. All right, let's, let's talk about this. This implant here, which I was like, what is this thumbnail? When I first saw it, I got

Dr. Grant Garcia: around. So the thumbnail, so the thing here, you can see, so this is for, we're, we're switching topics.

Dr. Grant Garcia: So we just talked about knee knee. Now we're on the shoulder. Yeah. So again, the key here is cutting edge. So when we put in a shoulder replacement right now, we put in a shoulder replacement, we put a metal ball. And we put a plastic socket. Okay. Sometimes we don't do that, but most of the time that's what we do.

Dr. Grant Garcia: The problem you have is there's a lot of crazy weightlifter guys or guys that had surgery because they had lots of dislocations or whatever. And so I get these like. 40 year olds to early 50 year olds coming in there like I need my shoulder place. [00:27:00] Everything again is restorative. How do we prolong the person's shoulder and avoid needing a replacement just like the Misha or other things?

Dr. Grant Garcia: Well, in a shoulder arthritis, it's really hard to prolong it too long. So how do we have implants that last longer? So this is really cool. And I actually got to see the guys in France. Are a part of this team that designed this. And this has been out for a little while in Europe, but we just got this FDA approved in the United States a few years ago.

Dr. Grant Garcia: So it's a pyro carbon. So it's a way softer metal. It's actually pretty funny. So when you normally put one of these metal ones in, you know, you're hit it decently hard to get it in with this one. It's got like a doink, doink, doink, like a, like a pinball machine. Cause it's so soft, the metal that you can actually damage the metal when you hit it in.

Dr. Grant Garcia: So it's got its own special thing, but what's cool about this. And you can see here, there's a little reversion of technology and for FDA approval. So normally we do this actually without a stem. But with these type of implant, you can't do that yet. That's not fully FDA approved, but hopefully soon.

Dr. Grant Garcia: So we usually, we do our normally stemless shoulder replacements with a socket. So what the cool part [00:28:00] about this is, is you don't put the socket on, the plastic part, and you just have this soft metal, and it's made for patients and they're like, Late thirties forties to early fifties and they've found that the where properties are very low.

Dr. Grant Garcia: So these patients who normally would go on and have like really bad problems after like five or ten years because Trust me, none of these 35, 40 year olds, once you make them feel better with their shoulder replacement, they go crazy with the lifting. You can imagine like Jim, I mean, I'm 38 and if I had to get a shoulder place, I can tell you right now, I don't know if I would listen and I'd probably be doing all my weights still.

Dr. Grant Garcia: And so these are, you know, I get these mentality, these guys, so I have to protect myself when I do these. And so this way you don't do the socket replacement because one of the number one reasons for Having a failure of a shoulder replacement is that you wear out the socket and these active like kind of crazy athlete mostly are men.

Dr. Grant Garcia: I'll be honest. The women listen, which is good. The men are the ones that don't follow the rules as we know. So they you know, they can wear out that socket a lot faster. So you don't. Replace [00:29:00] the socket. And if you have a softer metal, it doesn't wear down whatever's left over. So imagine like a it's like a softer tire on the on the road.

Dr. Grant Garcia: So you just have less damage, but it's just as strong.

Will Sanchez: You mentioned the age. Is there a certain age where you wouldn't utilize this? This polycarbon? Yeah, because

Dr. Grant Garcia: you're not, it's not FDA approved to put the socket in. So a lot of people have like really bad sockets by the time they're in their 60s.

Dr. Grant Garcia: And so if you have a really bad socket, it's imagine like imagine like a P a ground in the putting green, but there's like a hole in it. So the putty, the ball will never go through that. Does that make sense? Yeah,

Will Sanchez: there's already been significant amount of wear and tear in the shoulder. Yeah. At this point, that's, it's not going to be, you know, at that point, if you're doing that repair, you're doing, you're utilizing something else.

Will Sanchez: You're not using, utilizing this. So this is more for younger

Dr. Grant Garcia: patients. Yeah. And if you get into your mid sixties, then I do a good shoulder replacement on you with a regular metal and a plastic piece. It might never need [00:30:00] anything else again. So, I mean, I've done tons of these and I, my patients haven't come back and been like, I'm loose and I'm have a problem, you know, most of them do really well.

Dr. Grant Garcia: So if you balance it well, we, again, you can always hear my voice and you can see this. What are we missing currently on the market? And this is what they figured out. They found a way to fill that niche. That niche was, what do you do for the patient that's 35 that comes in, who can't lift his arm because he has so much arthritis?

Dr. Grant Garcia: That's a bad problem. Those guys usually see like six surgeons. You know, I'm usually one of those guys they're seeing. They're like, listen, how do you fix me? And everyone's like, dude, I don't want, this is, this is not a good scenario. And so now we have this option. I think 35 is a little bit too young for this situation even, but maybe when that those 40 year old patients that we initially were saying, let's just pray and do a regular shoulder replacement, we're not doing that now.

Dr. Grant Garcia: And we have this option. So it's so cool and I'm excited for the patients that have the opportunity to have this because I think this is we're going to see in the next 10 years. These patients really were saved and we bought them more time. My office is half time. I'm going to buy you more time. That's what I [00:31:00] need.

Will Sanchez: That's perfect. I mean, I think I'm getting to the age now where I don't think that's going to apply to me, but for all the young folks out there and then hopefully with, we're always talking about innovation and technology, hopefully it'll be something along the lines for someone as we get older and, and even better, hopefully I won't even need a shoulder surgery because I've had enough surgeries already.

Will Sanchez: I'm kind of done with that. I need a break.

Dr. Grant Garcia: Well, it's interesting. You know, before we jump on this, I had a patient that came in and she needed something and she said, have I, did I wait long enough for the next thing? And I was like, you made it. I was like, you finally made it. You know, she was trying to, she actually, I think she was coming in for the, the Misha and she was asking, you know, like I told, you know, 10 years ago, I need an ear placement and I held out, I held out or the coming for the shoulder.

Dr. Grant Garcia: You've talked about that lower trapezius and they're like, you know, they told me no one can fix me. Yeah. And I need a shoulder replacement, but they're 55 and I'm like, well, we finally have it. So there is. There is this, this lag that actually is important, but it's also finding the right people, right?

Dr. Grant Garcia: Like [00:32:00] some people go, they might go, they might call their surgeon tomorrow and be like, I want the Misha. And he's going to be like, dude, I don't know what you're talking about. Like, what is this thing? Pyrocarbon? Like, get out of here. Osteofiber? I got none of

Will Sanchez: those things. We don't. Well, I got this episode of sports doc talk.

Will Sanchez: So why don't we play this for you? Yeah, that's going to go really well in the office. You're going to get a phone call like can I speak to Dr. Garcia here? Can you please not talk about stuff like this? No, not at all. All right, let's, let's move on. Let's talk about this from this new clip techniques here.

Will Sanchez: Yes. So

Dr. Grant Garcia: this is one of the two companies. There's this one in called body cat as well. So this is so cool. So, you know, and again, Will likes this full circle. So those people that are eligible for the Misha implant, but people that have more of this bowleggedness. Yeah, they need to have certain, we need to straighten them out.

Dr. Grant Garcia: And so what we used to do is, and again, I still can do a lot of this. Like, you know, it's like, imagine like, imagine I build like an entire structure of Legos without ever seeing the [00:33:00] instructions. That does pretty well. But imagine you at, you give me a really good instructions and I do it exactly as planned.

Dr. Grant Garcia: It's gonna be perfect every time. Right. So what this is, is actually we get a CT scan of the person's, and again, most of the ones, you did a lot of different implants here, but the ones we're talking about mainly are on the right side. Those two that the femur and the tibia. You can see I, I

Will Sanchez: grabbed all the pictures I could get, you know, I got You did.

Will Sanchez: And, and I, I love it too. 'cause it's like red and black and they add this whole

Dr. Grant Garcia: kind of, some of this has nothing to do with this, which is great. I love it. Yeah. This is perfect . So, so. We straighten them out. We use these plates to straighten out their legs and we can save people like I mean, I've done I last this week.

Dr. Grant Garcia: I've done three of these. They were 35, 40, 35 years old, 49 and 24. And all these people had problems where they needed. They were told they needed knee replacements. So we do this to straighten out their leg to buy them more time. But then there's some fancier stuff, which we're not going to go into too much today.

Dr. Grant Garcia: But you know, one of the girls I did, she had her A. C. Heard in, actually dogs have this [00:34:00] when they have a slope. So like there's slopes like this. Imagine your knee just keeps sliding forward, right? It just too much slope. So what I do is with this and with this surgery, I'm able to 3D model the entire knee and then they as engineers and we calculate where the cut's gonna go.

Dr. Grant Garcia: And it's literally like the most amazing puzzle you've ever done. And it tells me where to cut, how much to take off. And it's like, you know, like you like your torque numbers. I mean, this is four, I do nine degrees, three on the right, two on the left. And I can calculate all this stuff. And I'm on the Google with that got Canadian grump company.

Dr. Grant Garcia: And I'm saying, Hey, take off one more on this side. And they're showing me all this. And then they send me this printout now on this case. We didn't have this technology at that day, but a lot of times when we have it, I send, I think it can be a 3d model where it's printed cut guides and you cut it and you literally can follow the paint by numbers.

Dr. Grant Garcia: Now, again, there's still a lot of nuances to this, so this isn't as easy as I'm making it sound, but it gives when you already know what you're doing, it makes you that much better. And if you [00:35:00] don't, and if you're learning, it's a lot safer. So it's actually better for both levels. So there's people who do 10 to 15 a year or more, which is what I do.

Dr. Grant Garcia: And there's people that are just getting out of fellowship and they're doing one or two of these a year, maybe, or they're really nervous because they've never done one of these in practice. And this technology makes it so that that person gets the same quality as a 15 or 20 surgeon. And which is really important because again, everybody is.

Dr. Grant Garcia: In their early stages of learning, and we want to make sure everybody gets a good, like the same parameters, because when you mess, if you mess something up, it is a big problem. If you don't do these correctly, there can be issues. So this, this technology is awesome. And this 3D planning, we've talked about this before.

Dr. Grant Garcia: This is a repeated process. Innovation line custom everything for patients. It does much better.

Will Sanchez: So what do you need to do? You have the situation with the patient, right? How are we going to repair this? Right? And you're this is for, you know, getting 2D and [00:36:00] 3D planning for this procedure. What measurements?

Will Sanchez: What do you have to take? Just kind of give me a really simple overview so we don't get into minutia of it and go three hours on it. But. Are you taking measurements? Are you send this out to the company? Now they're taking your measurements, creating this 2D, 3D, and then they're shipping it back to you.

Will Sanchez: So what do you send them? How long does it take in order for you to make these plans for the surgery?

Dr. Grant Garcia: So measurements two types of measurements, x rays and CT scans. So x rays, I do those all in the office. Like the one I did today, I did it in about 30 seconds. So I can do all the measurements and calculations.

Dr. Grant Garcia: The CT scan takes once you get it done, two weeks to get to the company. They process it with their engineers about, you know, 20 minutes for the meeting and then two months, two to three weeks to print it. They all use the 3d printers. So six week turnaround ish, sometimes even faster. So again, that's pretty normal.

Dr. Grant Garcia: So we usually plan six to eight weeks for our surgeries [00:37:00] for the most part, especially on the complicated ones. And I just tell the patients, you know, if we somehow can sneak them in earlier, I'm like, it's not worth it. Like, you want to get the custom one if needed again, a lot of times I don't need this, but when you're like, when there's tougher cases, and again, like I said before, I'm taking care of people with three or four failed ACLs, terrible alignment, really wacky, unusual injuries that are really uncommon.

Dr. Grant Garcia: Like that's when you got to step in and use this stuff. And so for me to have these tools at my disposal. It's awesome. And then we have, we can talk a whole other story about this. Yeah,

Will Sanchez: I'll wrap it up, but you know, I'm not going to wrap it up. So what's the communication process once they have that information?

Will Sanchez: Do they go back and forth with you a few times? Is there something that they can make sure before you receive this, that they can compare it to you? Yeah. What, what, is there anything like that before they just ship it out to you and you open up the box and say, okay, I got a new toy and we're going to fix this.

Will Sanchez: And here we go. Yeah.

Dr. Grant Garcia: Well, they all know that I'm pretty OCD. So I almost always fix something that [00:38:00] they did. And I'm watching every number. So, so many times, usually it's a quick call. It depends on the situation, but it's really complicated. Like I said before, like I had this big surgery I did on last Wednesday.

Dr. Grant Garcia: It was that that was one of these really complex ones. So on Tuesday I got on the phone with Canada. For 15 minutes on a Google drive between case on Google. Whatever the zoom, the Google device call is, and I talked to them for 15 minutes and I was like, titrate this up this and again, we were just planning and trying out the software so they can do that pretty quickly.

Dr. Grant Garcia: And then I'm like, send me the approval. They sent it to me that night. And then I, I emailed them back the next morning being like, we're good to go. So it's actually pretty quick and they've gotten it. So they've gotten really, really fast at doing this. So. I think this will be a great topic for a major topic is I want it.

Dr. Grant Garcia: I can throw up one of the plans and show on the video podcast like how I do it. And that would be awesome because like I do this for this for shoulder placements. We do custom ones. We've had some awesome results so I can do episodes on 3D planning so people can see how we do it because I think [00:39:00] people would love that because everyone always asked me like how do you do it?

Dr. Grant Garcia: But I've you know, I don't have time in the office to go through one of these. I mean, I usually torture them with all this information, but nonetheless, You know, it's good for us to see how we do it. So that's a great idea. So we'll do this as one of our new technology episodes. This

Will Sanchez: is the way this is kind of the way my wife tells me to move on as well.

Will Sanchez: She kind of gets, she compliments the situation and then kind of pushes me in a direction. That's what Dr. Garcia is doing right now. It's like, yeah, let's say this for another time. This is great. I love it, but let's move on. So let's move on. We've got some goodies here, Dr. Garcia, let's let's talk about this bear implant.

Will Sanchez: And it's something that we talked about in 2023, but as we constantly know that technology is changing. So why don't you give us an update on this?

Dr. Grant Garcia: Yeah. So I'm going to be brief on this because I've had like four requests for separate podcasts and I've already just did one with Cairo. So we're going to, that'll be posted soon so they can hear the whole details.

Dr. Grant Garcia: But basically, you know, the update on this is it's doing well. It's the, [00:40:00] the, what we do is instead of taking away the ACL and doing a reconstruction, we can repair it. So you can see here we're repairing the ACL and then there's just this collagen implant that's. That you put in the knee, and this is a really dumbed down version, this is actually not the technique that most of us use now, but this is the technique from the website, and actually it's on my website, and you can watch my videos on how we, how the newer stuff we're doing, but basically you shuttle this implant in with the tear.

Dr. Grant Garcia: And again, you can see the tears of the femur side, which is more important. So you repair the ACL back, and then you have this clot, and the clot allows it to heal. And what we've seen is, again, re tear rates equivalent to ACL reconstructions. You know, again, we're still, I, I'm still, the data is still out whether it's the same, but there's been some decent, the newer data is looking pretty good.

Dr. Grant Garcia: The patients ACLs feel really good. So they actually feel like they're healed and they're back to sports. I mean, has had a patient on a video testimonial. She's back to skiing after one of these and we saved her ACL. So the right patient, right timing. [00:41:00] All this stuff is really important for it. Listen to our previous podcast on it.

Dr. Grant Garcia: You're gonna learn a lot. But again, this is. This is probably one of the biggest innovations in surgery we've had and definitely of all the things I talked to you about, it's the most common it's the most advertised, most marketed. It's one of the hottest topics. Like everybody wants to talk about the bear ACL.

Dr. Grant Garcia: And honestly, it's working. I mean, there's definitely downfalls of it. You get a little bit stiffer. There's some other little things here or there, which we can go into in the main, if we want to do another episode on it, which you probably will. But for some new technology to have that few setbacks is pretty impressive.

Dr. Grant Garcia: And congratulations to the company, but honestly, congratulations to Martha Murray. She's the doctor that invented it because they just, they just rolled with it. And she's the, really the one that came up with the idea. So Martha, shout

Will Sanchez: out to Martha Murray. Thank you, Martha. So we all want to there.

Will Sanchez: All right, let's move on here because like you said, we'll be talking about that bear. in 2024 and we've already discussed in 2023. So if you need more information please check out our [00:42:00] episodes and check out grantgarciamd. com. So there's a lot of information. All right. We've got the tight rope.

Will Sanchez: We're not just walking the tight rope, but talk about this tight rope here.

Dr. Grant Garcia: I'm obviously I lecture for this with the company. So all that is disclosure. But this is probably one of my favorite innovations. And why? Because the bear is sexy, right? There's lots of marketing of it. This doesn't have a name.

Dr. Grant Garcia: And so that's the problem that like people don't haven't heard about the second repair. So this is repair is where we repair it back as well. We don't have to add any special collagen, but this new, this technique you can see here with the button is the reason I started doing these. And I started them about a year and a half ago.

Dr. Grant Garcia: We started doing this before ACL repairs didn't do that great. And now we're at the situation where we have this tensioning device and the biomechanics of it are incredible. And you can see Will's favorite devices right through the middle of that's called the internal brace.

Will Sanchez: Oh yeah, baby. I was smiling.

Will Sanchez: I will tell you, you can see I was smiling, right? I was like, yeah, I know this. I know this [00:43:00] technique.

Dr. Grant Garcia: So I will tell you this. I have been shocked with my results. It has been awesome. I mean, I've indicated probably six people for it in the last few weeks. This, they get back faster, which is really difference between, you know, the bare ACL is really sexy patients do well.

Dr. Grant Garcia: But it's the same timeline, and so it's 9 10 months. So people have trouble. It's hard to sell a new product when you don't get any better other than saving your ACL. And that's kind of a hard sell when I sell this product. And I try to be careful because I make sure it's someone that's definitely gonna do well.

Dr. Grant Garcia: It's 100 percent of people want it like everybody wants this. And so I'm really careful. I mean, I had a guy last week or two weeks ago came in from the podcast. He's like, I want the tightrope ACL repair. I was like, okay, well, shut out. Do you do you do you know what that is? And so I was like, let me explain it to you and see if you're a candidate first.

Dr. Grant Garcia: But he was very adamant about it. So anyway, so he's going to get it and he actually was a candidate, which was awesome. But basically we do is repair it and the patients came back in five months and again, Okay. You know, I had a guy that I got a guy [00:44:00] that's now six months out. He came in with from the podcast.

Dr. Grant Garcia: Another one he wanted. He came in. He only wanted that done. I did it. He's back to everything. And he was so happy, even found the podcast cause he hadn't heard about it. And we have this, keep having this. I mean, I've done, I did one of the, I did one of the doctors that works at Pro Alliance. That was not an easy sell because the other orthopedic surgeons in her group were going to probably thought I was crazy doing a repair.

Dr. Grant Garcia: And she ended up getting back to everything she wants to do. You know, I did a guy that works that, that the beach club that I'm members of, that was a really risky one because if he didn't do well, all the people in the club are going to find out. So it turns out

Will Sanchez: that they were going to take a membership away.

Dr. Grant Garcia: Well, and, and he, and he's an, he's a nice guy, but he's very chatty. And so as a result, this was a really risky move. I should have probably thought about it better. So I did it. It did awesome. He was back in five months. So you want to hear what happened? Will everyone kept. Everyone kept getting mad because they wish they had had that surgery done and they were mad that didn't go to me and have the surgery done.

Dr. Grant Garcia: I'm like, listen, that's not for everybody. So of course it was like bad [00:45:00] advertisement because all the patients, like someone who had, who had, who knew me, but didn't want to do me to go with me because it was her friend or whatever wasn't offered an ACL repair. And so they ended up getting the reconstruction and they're ticked.

Dr. Grant Garcia: So they're coming up to me being like, why didn't you tell me about this? And I'm like, dude, I'm not even, I didn't even know your toy or ACL. You know, and getting that at the, at the club. So it was it was a good and bad thing. But it's been pretty cool.

Will Sanchez: I tell all my friends, man, did they get hurt?

Will Sanchez: Something like that was like, Hey, let me know. Let, let me know. We, we, at this point we have a plethora of talented people in our basket. And it just, you know, when I, when I ruptured my Achilles, you know, we. You probably heard in another podcast. And I joke around, my first phone call was not to my wife.

Will Sanchez: It was Dr. Garcia on the treadmill on Thanksgiving morning going, Oh shit. Let me pick this up. This fool doesn't call me normally like this. And sure enough. And he was like, and then I called my wife, but she was like, I was, she was like, are you going to hospital? I was like, Nope. I already called Garrett Garcia.

Will Sanchez: It makes no [00:46:00] sense to go to the hospital. I know exactly what I'm doing. I just got to hold tight. Eat some you know, eat some Thanksgiving dinner, watch some football, be pissed off, and then get in for surgery the following week. So, you know, if, if you've got a friend in me. And you've got some issues, reach out to your peoples because they know what they're doing.

Dr. Grant Garcia: Still, that's still going to be one of the best stories. We're going to have to do that every year, talk about your Achilles. And I don't even, I don't usually stop the treadmill for somebody. But when Will calls, I was like, something's wrong. I was like, no one calls me on Thanksgiving. And then all of a sudden it's like, boom.

Dr. Grant Garcia: And you know what, we, we got your surgeon on the phone pretty quickly to end up fixing you. Yeah. Yeah.

Will Sanchez: Spoke to him and Dr. Yi, Dr. Anthony Yi. And I was like it's okay. I'm not going to play NFL football, but we've talked about the speed bridge. And, you know, this is something that we're going to do.

Will Sanchez: And obviously there's different ways to tackle these Achilles ruptures. You know, you can throw a cast on it and immobilize it. And, you know, [00:47:00] that's one route. And I was like, no, I, I think I want something a little bit more sturdy. So this is the route I chose to go. The incision is tiny. You can't even imagine.

Will Sanchez: I've got a tiny incision in my calf and then two at the bottom of my heel. And you wouldn't even realize that, you know, you had sutures and pulling in and anchoring it down. And it's just. Absolutely amazing. I'm sidetracked right now because we started talking about it, but it's absolutely amazing. You look at my leg and I can imagine even six months or a year from now, you'll be lucky to see a scar.

Will Sanchez: My scabs off, everything is healing. There's no way if I've got a sneaker on, you're not going to see the seal decisions in the heel and you'll barely see it on my calf. It's, it's absolutely amazing. Anyway, I digress. I hijacked the show.

Dr. Grant Garcia: My bad. No, it's good. It's good. But you know what I did? I did call Dr.

Dr. Grant Garcia: Yi on, [00:48:00] I did call Anthony on Thanksgiving too. And I said, you don't have a choice. You're fixing Will on Monday. So it was it was, I had to get a little aggressive, but he's my man. So he's not, it's not the first time.

Will Sanchez: He's great people. And we have another friend, Now, now we're going down to deep end. We have another friend, shout out to Dory that she's come to see Dr.

Will Sanchez: Garcia and she's seeing Dr. Ye. He's helped her to recover. She's finally out of her boot because she had broken her ankle. She went somewhere else. I was, and then she was like, And I'm going for a second opinion. I was like, why don't you tell me? I was like, Dr. Yee. And then sure enough, she goes, Dr.

Will Sanchez: Yee, sure enough. She's, she's better now. Things are working. And then she told me, and I swear, this is a true story. She says what are they doing over there at orthopedic specialists of Seattle there? Do they just hire. All good looking. Oh my god. I was like, Dory, Dory, park yourself, but she's great.

Will Sanchez: I love Dory. She's so funny. She's, you know, she's, she's a teacher and she's a tennis [00:49:00] coach and she has great humor, but she was like, what is the criteria besides having talent? Do they just hire attractive doctors there? I was like, it may be, but it just works out that way. So shout out to

Dr. Grant Garcia: meet all of them yet.

Dr. Grant Garcia: So,

Will Sanchez: well, hopefully she doesn't break anything else. Anyway, we talked about the ACL and you've done this surgery at this point. And then for us, the next step, which this is our segue here is into the Rebless and using this type of device. Talk about the Rebless.

Dr. Grant Garcia: So I think this is kind of the grand finale final thing.

Dr. Grant Garcia: So we've had a lot of topics we've talked about again. You've shared some really good updates. This one spent about a year and a half. We've had it. It's been awesome. You know, this is really this is my post operative complex knee device. You know, I probably did seven complex knees this month. And all those people are going to get this and we've got a new system in place, which we'll talk about at some point where we can get this to your patients.

Dr. Grant Garcia: We deliver it to the [00:50:00] house and we're able to use it. But the reason it's so great is it works on passive bending, which is kind of the older version. You maybe have heard about these machines. People used to sit in. They kind of bent their knee back and forth, back and forth. And that's they've had those for years.

Dr. Grant Garcia: This one's portable. It can be programmed. It's got remote technology. So the company I work with the company actually that helps with this. So I help advise them on what to do and how to get it better, which is pretty cool. And on top of that, it can do active assist, which that's really the game changer.

Dr. Grant Garcia: It does PT for you. So it does active, which means instead of you passively bending your knee back and forth, actively, it will actually help you up and help you down if you're weak. And the best part about this is the third piece of it, it does, it does resistance. So it's actually like a weight machine.

Dr. Grant Garcia: And I've done this on level 10. And it is awesome. You know, and this will work for the knee. We have ankle. You can see here, elbow and wrist. And this is the older version, which we again, older year and a half old will knows that on our show. Things are old when they're over a year. So, you know, now we're on [00:51:00] to.

Dr. Grant Garcia: The new company is designing something again. I can't say much more than that, but it's going to be a little more innovative than this using the same technology. So, you know, this is this is really great for my patients and we're really lucky. You know, in Washington state, we're one of the few people that can get this right now because again, these are startups and patients have loved it again.

Dr. Grant Garcia: New technology cutting edge. I think the problem we have almost in our practice at OSS As you've seen, it's just there's so much technology patients are just like overwhelmed, right? They come in there like my knee hurts and all of a sudden they like leave being like I might need to have like I don't even told me they could fix it and now you're talking about alignment and this rebless and You're not even gonna go into the nice machine, but you know, that thing is that thing is rocking too We got to talk about that at some point.

Will Sanchez: Oh, yeah, I'm using I'm still utilizing the the nice machine It's absolutely amazing I don't even know, except for me draining it one time. I don't even know if I filled it up with [00:52:00] water more than the one time and then drink. It's absolutely amazing. This thing wraps around is wrapping around my ankle.

Will Sanchez: It's pumping this cold into it. I time it. I could put the compression. I could put how cold it is from scale of one to five. There's some straps so I can get, I can really kind of focus on certain areas. And that's just the ankle. They have all these other parts that you can utilize depending. And it's just plugs in.

Will Sanchez: I have a little chair. I have a little recliner recline. I grabbed my remote control. I wrap it over my ankle. I turn it on, I program it. And it's, I'm not running for ice. I'm not running out of ice cubes. I'm not dealing with any of that stuff, especially since I was in mobile, luckily, and now I'm moving around, but being a mobile and having that.

Will Sanchez: That nice And I feel like it's like, it's like an 80s term is nice, this nice machine that you can utilize and and it was just so [00:53:00] convenient and I, I used it so much, especially the first two months of this rehab and I, I can't, I can't say enough good things about this machine.

Dr. Grant Garcia: Yeah. So we won't go too much details, but Will is probably one of the first in the state to get this.

Dr. Grant Garcia: I trialed it. With the company and I was like, we got it. We got to have this for our patients. So we'll got it. He loved it to signed up to get it for more patients is definitely looking ahead. And now patients are getting exclusively. So they're getting our practice. It's awesome. So all my knees get it.

Dr. Grant Garcia: My shoulders get it. Dr. Weil just signed up. He's going to start using it for hand stuff, which is crazy. There's no machine out there like that. So we can have little mitts for the hand, little mitts for the wrist. Oh, check out his podcast too. He did an awesome job. Ankle, Dr. Yi's signing up too, doing it soon.

Dr. Grant Garcia: So we have the opportunities to do this and more to come. You know, we're going to be working with the company to get the word out because this was designed by professional athletes for professional athletes. And we're giving that same care to our patients. And again, this is not. You know, [00:54:00] you've seen the technology far and superior.

Dr. Grant Garcia: I mean, I've had surgery. I had to use the ice man. It's not very good. Like my wife was like, my wife was like, if you get surgery again, I'm never using the ice man. And so as soon as, and she's like, I'm never doing it for you again. Cause she was tired of filling up the ice. It's a lot of work. You can't get it up and go.

Dr. Grant Garcia: So when she saw this nice machine, I showed it to her and I was like, what do you think? She's like, first off, it just takes my white when she gives me a thumbs up. I'm like, I'm all good. Like, I'm happy. So no,

Will Sanchez: we're going to, no, no, we passed that. We can forget about it. We're at that point. We're going to wrap it up.

Will Sanchez: And you know, and that was our segue to looking ahead. That's one of the shows that we're going to have in 2024. I'm talking about this type of technology because we are yeah. We definitely want to always talk about innovation technology along with the things that are out there, but things that are coming which provides information and gives patients hope, right?

Will Sanchez: Because Dr Garcia is here to provide this information. I'm here to ask questions and [00:55:00] also to make sure that we're, we're really focusing on. Our listening group, and usually our listening group are patients or potential patients. And as Dr. Garcia always says, Hey, you don't have to come here. You don't have to always get a second opinion, but have the information, right?

Will Sanchez: You can't have enough information so you can ask questions, whoever you decide to go to. And that's what we want to provide. So, you know, looking ahead, we have, we're going to have some great guests. We're going to have some great topics. And more importantly, we want to say thank you. I mean, Dr. Garcia, you know.

Will Sanchez: All of our listeners, you know, family, friends, loved ones, people that just walked in saying, I've heard the podcast and I want, you know, I want this, which is great. So at least more information, we just want to thank you. We're trying to have a good time with this and provide, things that we think will benefit everyone.

Will Sanchez: Dr. Garcia.

Dr. Grant Garcia: Yeah. I mean, I second that. I mean, I want to thank all the listeners. I know there's a lot of [00:56:00] patients. There's a lot of potential patients, also a lot of doctors and orthopedic surgeons and reps that are on this that listen, but really the patients and again, not even the ones that come to see me, the ones that just hear about it and they go to their doctor and the doctor goes, that's a really good idea.

Dr. Grant Garcia: I should do that. I mean, that's if I, if I had no patients from the podcast, yeah. And I just heard from periphery that someone heard that and they went and did a surgery and they, they had the, they had the option they thought was better for them. That would be important to me. I'm just trying to give information, right?

Dr. Grant Garcia: Like in clinic, that's where I get my patients. I show up, I do my job. This is fun. I like talking about this stuff cause I, I totally nerd out. I mean, and this is, this is the way I'm in the office too. But you know, we'll tell you behind the scenes on the same way I get, I get totally jacked about this stuff and I want to make sure people know about it.

Dr. Grant Garcia: Because if they know about it, they're better. And for someone that has to do a lot of revision surgeries and a lot of surgeries, third, fourth time issues, it probably would have been good if someone knew about it the first time. And so it doesn't have to be me. It could be anybody. And again, second opinions are really important.

Dr. Grant Garcia: You know, people always say to me, they're like, [00:57:00] Hey, I don't you know, my surgeon didn't want me to get a second opinion. I'm like, well, that doesn't make any sense. Like if you get a second opinion on my patient, I'm okay with it. It doesn't bother me. You go whoever works best for you. The one final line I always say to people is if you're not feeling comfortable with the surgeon.

Dr. Grant Garcia: Then you shouldn't do surgery with me. One hundred percent. Like you got it. You got to be all on board. You got to enjoy the experience as much as it's not always fun. But again, thank you to all the listeners. This has been a lot of fun. This turned out this podcast went in a different direction. That was great.

Dr. Grant Garcia: And we have so much future stuff for you for the most part. You know, but the but it's good. I mean, we have all this, you've heard of this technology. There's going to be a lot of questions about it. And we're going to go into each one of these again. And as Will knows, I'm going to throw some curve balls and I'm going to give him more technology throughout the year.

Dr. Grant Garcia: But for now, this is what we have and it's pretty cool. And again, this is just sports knee and shoulder. I mean, I'm not even touching on the ankle. I'm not even touching on the hand. Not even touching on the spine. More to come, guys. Some awesome guests coming up. Some things you've never heard about or you want to [00:58:00] know about.

Dr. Grant Garcia: So, thank you. All

Will Sanchez: right. We just wanna thank everybody. Please check us We, we talk sports, we talk orthopedics. Okay? Apparently we talk all the time, so it's kind of what we do here. So we just wanna thank everyone and if whether you check out, we have our transcripts.

Will Sanchez: We have a lot of information. Also check out Dr. Garcia's website @ Thank you very much, Dr. Garcia. You ready for 2024? Let's do it. Take care everyone.
Audio Transcript


Shoulder Experts Dr. Acevedo and Dr. Shariff

Shoulder Experts Dr. Acevedo and Dr. Shariff

Will Sanchez: [00:00:00] Welcome everyone, and thank you for listening to Sports Doc Talk. Check us, all sports, all orthopedics, all the time. Except for today. We've got two great guests. I'm Will Sanchez, along with our orthopedic surgeon and sports medicine specialist, Dr. Grant Garcia, our guest today. You have to listen to their podcast.

Will Sanchez: : It's absolutely amazing. What incredible guests is the name of the podcast is called. I'm a pod star, not a doctor. Check them out on your favorite listening platforms. Check them out on YouTube. They've got their shows. They've got snippets of great moments. Let's bring them in. Dr. Daniel, Danny Acevedo. A. K.

Will Sanchez: A. Cuff Daddy, I know it's like a rap star here, and Dr. Sharif Bashay, A. K. A. the American Gangster. Oh, fellas, thank you so much for taking time. I'm a huge fan of the show. I've been watching it. I love the snippets. I think it's [00:01:00] genius, right? The little two minute, three minute snippets just gives you that nice little taste and flavor if you're not listening to the whole show, and really gives an example of the creativity and the diversity of your show from, you know, golf and surgeons and you name it.

Will Sanchez: And I've seen interviews with you guys. Anyway, I'm yip yapping along the way. Thank you very much for being here. Dr. Garcia, how excited are you to have these two gentlemen on the show?

Dr. Grant Garcia: I'm super excited. This is, this is going to be a good mix. You have guys that are incredibly well known on the internet and throughout their world for their techniques, their cutting edge, they're teaching everything, but they're also super funny.

Dr. Grant Garcia: Chill and their podcast is awesome. You know, it's a completely different vibe than. Honestly, what our podcast is like or some of the other ones out there. AndBishai you know, you may hear from them, you know, the goal is for them, if you learn something by accident, that's awesome. But otherwise just here to have fun.

Dr. Grant Garcia: I'm

Will Sanchez: really excited. [00:02:00] Excuse me. I'll start real quick. You know, every time we have doctors on the show, I have to, you know, it's, it's respectful, right? And you have to say, you know, Dr. Bishai, Dr. Acevedo. But with these two, it doesn't feel that way. Dr. Bishai, this sounds funny saying it. Bishaithank you so much for being here.

Will Sanchez: How has the show been, doing this podcast? How's this experience been, been for you?

Dr. Shariff Bishai: Man, I love it. It'sBishai I'm, I'm hanging out with my boy. And so whenBishai Danny and I are on the mic, it's like, I'm to picked up the phone to hang out. And our DJ producer, Bobby, he's the creativity. He's the one who comes up with all that stuff you love.

Dr. Shariff Bishai: And so we got to throw him a shout out. And so that's Bobby digital. And we just have a good time. And so for me, if anyone's listening, great. If no one's listening, I'm still having a good time.

Dr. Shariff Bishai: And so we got to throw him a shout out. And so that's Bobby digital. And we just have a good time. And so for me, if anyone's listening, great. If no one's listening, I'm still having a good time.

Will Sanchez: Dr. Acevedo, Danny, the cuff daddy., once again, thank you so much for being on the show. [00:03:00] Bishaitell me about the idea of this podcast and how this got started.

Will Sanchez: Bishai who was the creative genius, you know, putting this together? Obviously we got a shout out from Bobby, but as far as the concept of putting this show together, explain that a little to me.

Dr. Daniel Acevedo : Well, the name, I came up with the name.

Dr. Shariff Bishai : So

Dr. Daniel Acevedo: no, so, you know, I met, I met SharifBishai at one of, at the ASCS meetings. And I see him at meetings, you know, we're both like lecturing and teaching and, and we kind of clicked, we got a similar vibe and, and I was trying to find somebody to, to have a podcast with.

Dr. Daniel Acevedo: And, and I didn't really want to do like. You know, I wanted to do a fun podcast. I mean, obviously we all ever, there's a place for every podcast. You guys have a place. We do sports. Very cool. I don't want to copy anybody. I just wanted a place where I could showcase like my normal self and, and just how normal and cool, like some of my doctor friends are and some of my other friends are.

Dr. Daniel Acevedo: And then, so Sharif hit me up and, and then he's like, [00:04:00] HeyBishai would you be interested in having a podcast? And I was like, Oh, yeah, I've actually been thinking about a podcast. I'm like, who could I do it with? And then he texted me back and he's like, me. And I was like, oh, okay. So that's kind of

Dr. Shariff Bishai: how it came up.

Dr. Shariff Bishai: Yeah, that's where it goes back even further. So a couple of years ago, Bobby reached out to me and he was like, Hey, we have a great idea. Why don't we have you on? Bishaiwe'll make you the host. So we'll interview all these other kinds of doctors. And I'm like, orthopedist is like, no, no, no. Like family practice and urology.

Dr. Shariff Bishai: I'm like, that sounds terrible. And so it kind of died. And then when Danny and I started, you know, getting to know each other and I call, I was thinking to Bobby, I was like, you know what, I think I got a guy. So I called Danny and then Danny's like, well, let's have a meeting and. We can figure out if this will work.

Dr. Shariff Bishai: And he like essentially going to interview us to see if we were cool enough to hang out with them. But then

Dr. Grant Garcia: obviously we passed that. Gangster dude. He's cuffed daddy. It takes a lot.

Dr. Daniel Acevedo: Bishai yeah. It's all about the [00:05:00] vibe. You guys, you know, you guys have good chemistry. You know, I know me and SharifBishai have good chemistry, so that's huge.

Dr. Daniel Acevedo: Right? Like I was thinking of some other people, but it actually worked out great. And I'm having a good time. Bishaiyou know, we're having fun on our podcast and we're just kind of doing the thing.

Dr. Shariff Bishai: The hardest part about our podcast is LA internet period.

Dr. Grant Garcia: I can see Danny's shut down a few times with his LA internet.

Dr. Daniel Acevedo: : Dude, it's the LA internet. Like the LA internet sucks. Like, like at five o'clock everybody's home and there's like probably like a million people like where I live, like alone.

Dr. Shariff Bishai: I thought people went outside and exercised and ate avocados and shit. No dude, you're playing Fortnite

Dr. Daniel Acevedo: and whatever they're doing at night.

Dr. Shariff Bishai: When we first met he goes, you're a Gemini. And I was like, okay, I didn't realize that you could figure that out, but that's cool. And he was absolutely right. And so the Gemini, you know, it means there's the, the yin and the yang kind of thing. And so it kind of makes sense why I'm American Pharaoh and Dr.

Dr. Shariff Bishai: Bishai. So it kind of all fits. [00:06:00]

Dr. Daniel Acevedo: That's awesome. It's like residency grant. Didn't you have a nickname in residency? I'm sure you did. I think

Dr. Grant Garcia: I probably had a few of them. Yeah. Yeah. TBishaih, they're all over the place. Depends. I'm usually pretty hyper, so I get like the, you know, like in the, I'm always like full speed everywhere.

Dr. Daniel Acevedo: Yeah. It's funny. Cause like when, you know, when I was thinking I wanted to do a podcast a while back, I saw that you guys had a podcast. I was like, oh, that's cool. And then I liked, you guys talked about sports and ortho and I was like, oh, that's really cool. So I like that. And then, you knowBishai Scott Sigmund has his podcast and.

Dr. Daniel Acevedo: And at the time I was like, dude, I really want to have a podcast, but you know, I don't follow sports like that. Like I'm more of like a, like a, I go to meetings and then I'm crazy on the side. So like, where, where do I fit in? And thenBishai it's funnyBishai when me and Sharif Bishai kind of metBishai at a meeting, we kind of started talking and, and we both were like looking for a podcast partner.

Dr. Daniel Acevedo: And then he kind of hit me up. He's like, Hey, do you want to do a podcast? I was like, Oh yeah. I [00:07:00] was like, I've been totally thinking about when I was like, who can I do one with? And he's like me.

Dr. Grant Garcia: Anybody, anybody but you know,

Dr. Shariff Bishai: it was like, it's like, no, you really, you know, but Bobby, who is our producer and DJ, he was great because he reached out to me a while back and he's like, Hey, I want to do a podcast with you and you could be the host.

Dr. Shariff Bishai: And each week we'll bring on a different type of doc and blah, blah, blah. And I was like, Hey, that sounds terrible. I mean, I have no interest to do anything but orthopedics and preferably just sports. Bishaiand then so it kind of died. And then when I, when Danny and I started talking, he calls, he's like, why don't we meet?

Dr. Shariff Bishai: And if this sounds like it may work, then we can move forward. So he's like, essentially, we're, he's interviewing us. It's like, cause he's got options.

Dr. Daniel Acevedo: No, dude, it's not even that. It's like, like your podcast is awesome. You guys do sports. Like I'm not into sports like that. Right. And I'm already, we're already into orthopedics.

Dr. Daniel Acevedo: You're into orthopedics. I see some of your videos, Grant. They're [00:08:00] awesome. BishaiSharif has videos. We all teach. We're all a part of this, but I just, I wanted an outlet where I was like, look, a lot of people that meet me are like, you're a doctor. Like, you're really cool. Like, I really like your vibe, your, your.

Dr. Daniel Acevedo: different. You're down to earth. And then I just wanted to be like, you know what? There's a lot of people that I hang out with that are actually like me. And I wanted just a platform just to kind of showcase that, you know, I mentor students. I mentor my own children to try to get people to be doctors, to be like us.

Dr. Daniel Acevedo: And I think the best way. To kind of get people to know who we really are. Like it's just to kind of show it right. And obviously not to be too crazy, but that's kind of where the idea came from is I just wanted to kind of show like other stuff that I'm into, like the friends that we talk to stuff we talk about,

Dr. Grant Garcia: you know, I love that.

Dr. Grant Garcia: I love that idea. I mean, it's just like the, I think that's, that's what in my office, like the same sort of thing. It's like, I'm, they're so used to someone either like rigid, quick, just want to go, go, go and to get out of the office or they're not used to like the [00:09:00] personality type. So if you have a little personality, it can really connect with the patients, especially, you know, you guys are super fun.

Dr. Grant Garcia: And so like, if you already have, you already have all the skills. Right. And so then now you're just the fun person. So you can, the doctor, it just eases their stuff. Cause I mean, I see what you guys are doing. Like these aren't, some of these aren't straightforward cases. I'm sure your patients aren't coming in just giggling before they meet you.

Dr. Grant Garcia: So, you know, you don't talk to you about, so yeah. So it's like you're decompressing. Difficult situations with all the stuff you do. And honestly, the stuff that you guys are doing is the stuff that I've always look forward to doing at some point and just getting, breaking out and showing your true personality.

Dr. Grant Garcia: Cause most of us have personalities that people want to hang out with. You know, we have 95 percent of my 99 percent of my friends are not doctors. So, you know, that doctor persona that you have to have in the office sometimes is not, you know, where you're always are and you guys are kind of. Letting loose and showing people the other side, which is what people think is fun and entertaining.

Dr. Grant Garcia: You're like, Hey, listen, this person could be, you can have a beer. You always think, I always tell people, like, if you feel like you could have a beer with your surgeon or like [00:10:00] chill with your surgeon, you think they're a good person and on top of the fact, they're going to do a good job, that's the best type of personality to deal with.

Dr. Grant Garcia: Because it's just, it's a, it's a different level of care. I thinkBishai when they're, cause that, that personality persona you guys are showing, you know, it's just something that's like a connection.

Dr. Shariff Bishai: Yeah. I thinkBishai Danny and I vibed the second we met. And I think it's important, like you said, I think the first thing's first we're docs and we have to be good to our patients, offer a product that is.

Dr. Shariff Bishai: Going to make them better, but at the same time you got to be human and I think you definitely see our human side I think there's this this need from people to think that doctors have to be a certain way They have to be that rigid person and and then at the same time while they want us to be that way then they say well That doctor doesn't have a good bedside manner.

Dr. Shariff Bishai: It's like well, you can't have it both ways so I think you got you got to straddle that line a little bit and kind of Come in and out. I don't think you [00:11:00] necessarily need to be friends with every one of your patients But you need to have that respect for them as they'll have for you And I think what comes of that is a nice doctor patient relationship But at least for our pod whoever's listening because now I have patients coming in saying oh, I listen to your show And I'm like, oh shit what I say, you know careful You just

Dr. Grant Garcia: mentioned, you went to HarvardBishai to hang out with your buddy.

Dr. Grant Garcia: You guys are all over the internet on your non podcast stuff. And all the, all the really prestigious things that you guys do. How, I've talked about like what I do to try to stay cutting edge for my patients in Washington and Seattle area. What do you guys do? Like, what is it that you can do that, that allows you to keep doing those things?

Dr. Grant Garcia: I mean, you're teaching about arthroscopic. DTAs, arthroscopic latergies, and for some of the patients, they'll look those things up. They've talked about those before. So like, how do you guys do it? What, what's your, what's the trick? What's the

Dr. Shariff Bishai: flavor? What's the magic? For me, it was my patient population and I kept on seeing these things that I just didn't have.[00:12:00]

Dr. Shariff Bishai: An answer for, I knew there was an answer out there. And so I said, well, how do I task myself and challenge myself? And I said, I'm going to just go learn. So I went to Europe and I went to Lafaz. I went to Ravenscroft in Manchester, England, and then I went to Paul Favarito in Cincinnati and George Athwell and Hamilton, Ontario.

Dr. Shariff Bishai: And, you know, bounced around, did a couple other labs and it took me. From the day that I said I wanted to learn arthroscopic glottis A to my first case was almost two years and I don't think it takes that long now because there's a lot more opportunities than there were back in 2013 to 15 when I did this.

Dr. Shariff Bishai: So I think it was. The, the shift in the way I thought about things. And I thought we were, why are we seeing so many failures with bank cards? So I need to figure that out. And then I did the same thing with like lower trapezius transfers. What are we going to do? SCR doesn't work and you know, we don't know what the balloon's going to be.

Dr. Shariff Bishai: And not everybody at a young age needs a reverse. So I got to have. [00:13:00] I have to find something and that's when that whole thing started and Basim taught me that as well. So for me, it was the patient population I was seeing, giving them an answer and making sure that I could do it with my hands. And if I couldn't, then I needed to get them to somebody who could.

Dr. Daniel Acevedo: Yeah, that's kind of what I do. Like I always joke with my, my colleagues. I always tell them, I'm like, you got to stay ready to be ready. And they look at me like I'm crazy, but that's kind of how I am. Right? Like if I see new techniques come out, I go to meetings, people talk about these techniques. I try to learn them.

Dr. Daniel Acevedo: I'll set up a labBishai or I'll either do it. Sometimes I don't need to do a lab and I'll just like do it on the patient. And just kind of tell them, Oh, this is the first time I'm doing it, but it's not a big deal because you know, we're all. Technically gifted after like a certain point. And I think after like six, seven years of getting my reps in and I finished my fellowship and I, I kind of knew what I could do and what I couldn't do.

Dr. Daniel Acevedo: I tried to do the stuff that I couldn't do. And I challenged myself, you know, arthroscopic Latter day was always something I wanted to do. And once I got my scope skills up, I learned how to do it. [00:14:00] You know, I talked to LaFoss, I talked to Boileau and then, and then I figured it out. And then, and then as far as the videos go, like, I just like teaching, you know, I like, I like.

Dr. Daniel Acevedo: Videos and the social media type thing so I would make Vumedi videos if I did a good case And I thought that I had something to offer somebody else trying to learn how to do something Like I did a SCR video early on I did an arthroscopic later J video early on in a trap transfer You know because I know a lot of people want to learn how to do it, and I think for me.

Dr. Daniel Acevedo: I'm like People know me. I'm like, here, this is what I did. Check this video out. And then it kind of helps people. And it's, it's always nice because people will text me. It's like, Hey, I watched your video before the surgery really helped. And, and for me, that helped, that helps me want to continue to teach other people just how to help patients, man.

Dr. Daniel Acevedo: Like it's, we're all in the game. You know, I watched stuff that you do and like how you teach patients and, and stuff that you're, we're all learning from each other, which is great. So for me, I think just, I just follow other like minded people. And then I just try to push myself to, to continue to be

Dr. Shariff Bishai:better.

Dr. Shariff Bishai: And if they think that I can do it, then they're [00:15:00] usually like, Oh, I can do it. If Bashay can do it, I can do

Will Sanchez: it.

Dr. Grant Garcia: No, I, I love it that, I mean, this isBishai Will's heard me talk about this before, but it's good to, that's why I wanted, it's good to have you guys on here for him to see sort of, this is, this is not just one person doing something, trying to get better or whatever, it's all different ways to do things.

Dr. Grant Garcia: And this is what, you know, listen, he's traveling, you're traveling out to outside of country to France. Bishaiyou're going to Canada to learn these new techniques. You know, it's good for the patients to hear this stuff because they don't, you know, they don't always understand that some of these more complex things sometimes take that stuff.

Dr. Grant Garcia: You know, not all the time, you knowBishai what Daniel said is true too. I mean, I hate to say it. Sometimes you watch a YouTube video. If you, if you know the steps, if you got everything else, I just tell them, it's just combination. You're just changing the order, right? It's like for the lower trap transferBishai for me, it was just the dissection.

Dr. Grant Garcia: So I did that in the lab a couple of times just to kind of get that feel. And then the trance I did SCRs before. So that wasn't the hard part. BishaiIn terms of the conversion rate. So for it's interesting to see what you're saying. And what you mentioned about [00:16:00] the videos is exactly what early on. I was like, I'm putting out these videos.

Dr. Grant Garcia: I'm like, I don't know if anybody cares. I think it's cool. Actually, it helps me. It helps me a lot, actually, though. I like having the video. I'm like, I haven't done a surgery in like a year. I'm like, how do I do it? I'm like, Oh, it's on my video. So

Dr. Shariff Bishai: it's helpful. I think videos are so important. AndBishai I'm the chair of the orthopedic video theater for the academy right now.

Dr. Shariff Bishai: And so for us, we want as many videos as we can get, because we will review those peer review those and make sure that they're to the standard of the academy and then make sure that when they get out there. Everybody can use them. And it's not something that, oh, you got to pay for this or you can only do this if you're not.

Dr. Shariff Bishai: We want people to see these because these are experts that are putting it out there. They're reviewed by a contact a context expert. And then at that point, anybody can watch him. So it's great for residents and fellows and even people in practice. So I think video is the new way. And then once I starts kicking in and we can layer those [00:17:00] with the papers that we discussed within our videos, I think it's gonna be amazing.

Dr. Grant Garcia: it. Go for it. Tell me your journey. I want to hear your journey. And I might chime in on some things, but you know, I do a little bit of IP. Again, I'm a surgeon by most of the time. You are the expert.

Will Sanchez: Have you ever gotten anyBishai videos where you goBishai yeah, man, we can't, we can't put that out there. That is justBishai just something. Is there any video that's ever stood out there? You're like, yeah, nope, that's, that's not going to work. And makes you question about that, doctor.

Will Sanchez: We don't have to say names. We don't have to say names. Oh, gosh. Will, you did do it. You did it,

Dr. Daniel Acevedo: didn't you? Let's just say it's a Maybe a style difference, right? Like, it's just like people, some people dress better than others, but you know, they're still wearing clothes.

Dr. Shariff Bishai: That's fair. That's nice. I like that.

Dr. Shariff Bishai: That was very diplomatic. You know

Dr. Daniel Acevedo: what I want to do? And I don't even care if I give this idea to all these listeners that you have. BishaiI want to do this thing called the cuff cloud. And then basically like, it would be like this. Stop it, stop it, stop it. It's coming up. Stop it.

Dr. Shariff Bishai: Now we just tease the listeners. [00:18:00] I like it.

Dr. Grant Garcia: They're going to be all, they're going to type it out. Cuff cloud

Dr. Shariff Bishai: now. Yeah. End of Q1, it'll be out.

Will Sanchez: Can, can you get some scrubs made with like really big cuffs and then walk in to the operating room? Can you get something like that? So they, you know, cuff daddy's walking in with these big cuffs.

Dr. Daniel Acevedo: Dude, no, I need to get a chain though with like a big C on it. That would be super cool. Bishaibut there's a, there's a doctor in Beverly Hills. I don't want to say his name, but he's, he has these special scrubs where they're cut off. And like, he's, he's always like showing his cutoff scrubs. And I was going to DM him cause I wanted to see where he got those.

Dr. Shariff Bishai: He got them at the store and then he got scissors. That's where he got it.

Dr. Daniel Acevedo: Hey, I was going to ask you, Grant, I think it's pretty cool. Like, I like what you do. I don't think I could do that. I like how you were doing on your podcast. Bishaiand you talk about like you sports and, and so do you, do you use your podcast to kind of like help the community with these topics and stuff?

Dr. Daniel Acevedo: And like, how are you promoting it in your community?

Dr. Grant Garcia: So [00:19:00] I, I just do like, if I get something crazy, like our patients are confused about something, I'll do a podcast for it or to promote the actual like thing, like ACL repair or, you know, other things. And then I'll, I'll use it and publicize it on, you know, all the social media things I can, but it's actually funny.

Dr. Grant Garcia: I get people coming in asking for the surgeries on a podcast. BishaiI mean, I very frequently patients come in, I mean, and I, some like device companies I work with, like for like rehab stuff, people come in asking for that stuff after the rest of the podcast. So it's really interesting how you really, you have to be careful, obviously, because whatever you're putting out there, I realized really quickly, like if you, as long as you make sure it's real information, you could see you're talking about, you knowBishai you guys talking about like vetting the videos.

Dr. Grant Garcia: We're, we're known surgeons now. So you start putting something out that's not accurate. That's a big problem as well. Bishaiso that's good. Like I found out really quickly that if you promote the right things and the things that are fair and reasonable, people want to listen to it. So I kind of swerve around and I'll, I'll hit up to Will.

Dr. Grant Garcia: : I'll be like, well, what do you think about this topic? Cause obviously he [00:20:00] knows more of the layman term stuff and he's like, that's super cool. Let's talk about it. Bishaiand I try to promote mostly cutting edge stuff because I think. For me, I'm super excited about like the next cool thing, the next cool thing, the next cool thing.

Dr. Grant Garcia: And so for me, I'm like, I want to get that up to date. I'm like telling people about how to fix a rotator cuff to me is boring. Bishaiyou know, I want to talk about like how I'm going to make it better. I'm going to do some crazy patch or do some, some other type of thing that there's out there. So that'sBishai that's kind of the way I think about it.

Dr. Grant Garcia: I'm not that answered your question. Yeah,

Will Sanchez: and Bishai and just to piggyback on thatBishai I've worked with a lot of coaches between high school, middle school, youth coaches. My background is a producer at master square garden. I used to work with the high school Rangers Knicks. SoBishai when we still have texts and conversations and we want to make sure that we communicate these things and, you know, and, and try to get some information like.

Will Sanchez: This is what we're seeing on the field. This is what's happening. So then when Garcia and I [00:21:00] talkBishai you know, that's where I go. Yeah. That, that sounds really good. And that's something that's important. Bishaiyou know, talking about, you know, the Q collar, knowing how concussions Yeah. Playing a big part ofBishai just the, the conversation right now.

Will Sanchez: Right. I just saw that California is now trying to make a movement here to banBishai football. tacklingBishai and football. I don't know when it's 2028, whatever that is. I don't have the information in front of me. So, so it's a big topic. So when we could talk about these things and address them and speak with great guests like yourselves, it's just, I think people resonate to the conversations.

Will Sanchez: So that's how we kind of come up with some of these topics here. Well,

Dr. Shariff Bishai: well, I'm going to jump on that. You know how you get rid of concussions in football? Tell me, take off the

Will Sanchez: helmet. You're not the first person to say that. Or I've also heard, take the face mask off.

Dr. Shariff Bishai: Yeah, because if you, if you look back at the statistics, it's as technology gets better, the concussion rate gets higher, the, [00:22:00] there, there's certain things.

Dr. Shariff Bishai: I mean, yes, we've changed rules. You can't target, you can't do, they can't lead with the crown of the helmet, but it's a weapon. Just like when you put a kid in a cast, the first thing I tell 'em is like, this is not a weapon. You can't get the crap outta your little brother and sister.

Dr. Daniel Acevedo: That's why you, that's why you can't get a cast in jail,

Dr. Shariff Bishai: right?

Dr. Shariff Bishai: You go, we learned

Dr. Grant Garcia: some. See you were gonna learn something

Dr. Daniel Acevedo: on this today. Well, we used to have a jail at the USCBishai at the USC county. We go to jail and like they wouldn't like us to put cast on 'cause the, the inmates would use them as weapons.

Will Sanchez: There you

Dr. Shariff Bishai: go. It

Will Sanchez: totally makes sense too. So what do you do?

Will Sanchez: Just soft cast, ace band?
Dr. Daniel Acevedo: Or we like cast them and then they like keep them there or they put them in isolation or something. I don't remember. I hated going up there. It was scary.

Dr. Grant Garcia: I did. I saw that. I went to my USC interview. I saw the prison there. I was like, this is interesting. That was scary.

Will Sanchez: This is interesting.

Will Sanchez: That's

Dr. Grant Garcia: where you learned all your cutting edge techniques, I thought.

Dr. Daniel Acevedo: Yeah, dude, it [00:23:00] is. I mean, it was a great place to train, you know. I don't want to say we practiced on these people, but yeah, we practiced on these people. But, you know. Everyone's practicing. I don't know. You can't sugarcoat it. I mean, what are you going to do?

Dr. Daniel Acevedo: Just, you know, Isn't

Dr. Grant Garcia: that where we're in? We're in practice. I was, I spread that to people. They're like, listen, I try to tell even the new fellows that people call me, they're like, I saw your video. Tell me about this. And I'm like, dude, if you're doing the same thing you learned in fellowship. In your first few years, you're not doing it right.

Dr. Grant Garcia: I was like, I remember I did like 20 surgeries. I never learned in fellowship and I thought like Cole and everybody knew everything and they're awesome, but like, you know, my third case, I did a glenoid fracture and I'd never seen one done arthroscopically. And I'm like, oh my God, how do I do this? And they're like,

Dr. Grant Garcia: smoothly. This is so important. I think the listeners should this is going to be our longest podcast ever, this is so exciting.

Dr. Daniel Acevedo: you, you Mills video.

Dr. Daniel Acevedo: That's what I did. And then I did it. I,

Dr. Grant Garcia: I, that's what I did actually, but I, it actually worked, so I was like, this is pretty cool. Yeah. So yeah.

Dr. Daniel Acevedo: So for everyone listening, yeah, everyone listening, if you're a doctor, you got to keep putting these videos out because we're all watching. We're all looking

Dr. Grant Garcia: for sure.

Dr. Grant Garcia: It's weird. It's so weird to hear. It's so great to hear it. Like it [00:24:00] took a little while before we started hearing it. But people were like, I was down like giving a talk or something else. And then people were like, some from random, you know, private practice docs, like I watched your video on that. That's really cool.

Dr. Grant Garcia: And I'm like, what? You know, that's it. It makes you feel good to be helping and teaching. Obviously, like, I think the good thing is like the open forum. Like, I like YouMedi a lot because it's super chill. Like, every once you get a thumbs up, you know, you know, someone thinks it was okay. You get a weird comment every once in a while that you don't respond to.

Dr. Grant Garcia: But outside of that, you know, my biggest concern with the videos was like, someone's gonna be like, that's not right at all. They're trolling. They're

Dr. Shariff Bishai: trolling the trollers. But how many times have you watched a video and you're like, that's not right. No, no, that's or at least the narration that you say the wrong thing.

Dr. Shariff Bishai: So I went to Memphis to teach a course two weeks ago and one of the guys is a buddy of mine that I was teaching and he said, Hey, I watched your artscopic letter J video andBishai yes, 53 minutes. You didn't edit it. Thanks for doing that because it was made it really [00:25:00] nice to be like every step of where you struggled.

Dr. Shariff Bishai: I'm like, well, that was the point. Bishaiand he goes, but, but you called theBishai you called it. The coracle chromium ligament. And you were talking about the coracle clavicular ligament. So I'm like, bro, if, okay, you know, but dude,

Dr. Grant Garcia: the guy, you should give the guy luck. I would never watch 53 minute video that he should give him.

Dr. Grant Garcia: So he can say whatever he wants about your video. He sat there for 53 minutes and watched it. That's fair.

Dr. Shariff Bishai: That's impressive. I want to shoot him a text.

Will Sanchez: Right now. Do you think he's watching the video as he's in surgery and just hitting pause on the button and then kind of doing the procedure and then, dude, there you go.

Will Sanchez: You know, is that, is that why, you know, he's like, yeah, I sat through the whole video because this is exactly what I did in the

Dr. Shariff Bishai: operating room. So funny story, Danny did that, but on a cadaver. So when he watched my video while practicing it, so they had it on a screen for him here and a screen over here where he was working on and he was watching back and forth.

Dr. Shariff Bishai: And that's the skillset Danny has. Yeah. Is like, I

Dr. Grant Garcia: wanted

Dr. Daniel Acevedo: to play with the screws. Cause I was doing, I'm doing arthroscopic later days with the button. And I'm like, let me [00:26:00] check this screw game out. So I set up a lab. And I saw Sharif's video and I was like, Hey, can I put this video up on the screen? And the Dubuque techs are like, yeah, why?

Dr. Daniel Acevedo: I'm like, I'm going to race it. And they're like, what? I was like, yeah, just put it on. So then I was like, go. And we played and I just kind of like did it. And I was looking at his video to make sure I did the steps. And then I finished it in like 45 minutes. And then I took a picture.

Dr. Grant Garcia: That's like the Ridge race.

Dr. Grant Garcia: Remember like the Ridge racer with like the shadow car. Yeah, trying to, but

Dr. Daniel Acevedo: the cadaver doesn't bleed to be fair. Right. It doesn't bleed. And you know, I wasn't really worried about nerve damage, so I'm just kind of going in there doing it. ,

Dr. Grant Garcia: I think. I think Will's jaw's about to drop

Will Sanchez: to the ground here, here and all.

Will Sanchez: No, I go like this. La, la, la, la, la la la. I didn't hear anything. The cadaver. I know, but you know

Dr. Grant Garcia: what though? This is, well this is the good part about what you guys do. You bring out like the real stuff. 'cause like this is all anybody that tells you, they just like know how to do it. And then on top of that, there is a certain skillset.

Dr. Grant Garcia: I mean, Danny, your skillset is not common, right? Like [00:27:00] people always say, like, like say to the holiday Inn, it's like, no, I watched the YouTube video and I did it. Like, that's not like, not everybody does

Dr. Daniel Acevedo: : that. I do stay in my lane. You know, I have a nice. Practice now, I get to do shoulder elbow, a little bit of knee, but like, you know, I'm not doing everything right.

Dr. Daniel Acevedo: Like I have, I do cuffs, arthroplasty and instability. Those are my top three, but I'm not in fractures, but I'm not like a general ortho, right? So it's, it's really tough for these general ortho guys, man, that are like doing a lot of different stuff. Right. I mean, I think that's, there's still a role for that, but like you're a sports guy, right?

Dr. Daniel Acevedo: So you're doing a lot of sport shoulder. So you're kind of in your lane. You know, so you could be really good.

Dr. Grant Garcia: Yeah. No. And that's the, that's the point. It's hard for people to understand. Cause they see like some guys, like the guys that were talking about my videos, they're like, I saw your TTO, Macy MPFL.

Dr. Grant Garcia: It looked really cool. I'm like, dude, you shouldn't try that for your first one. I was like, you know, they're like talking about meniscus transplants. I'm like, dude, it's the, it------------------------------'s a, it's not like a see one, do one, teach one type of thing. But your point is, your point is well taken. Right. Cause it's hard for people to [00:28:00] process that every, not everybody knows that.

Dr. Grant Garcia: Even you see the word sports surgeon, or you see the word shoulder surgeon, it's not always the same. Or, you know, the word surgeon, right? Orthopedic surgeon could mean many different things. Bishaiso it's, that's important indication as well for people that, you know, we're talking about like, this is high level, like we stay in line, but you don't want to see me do an ankle.

Dr. Daniel Acevedo: Yeah. I mean, I'm sure you're good, right?

Dr. Grant Garcia: I just not, I just feel like I'd rather, I'd rather do a meniscus transplant to be honest with you. But yeah, so I like ankles.

Dr. Shariff Bishai: You would do a meniscus transplant over an ankle fracture.

Dr. Grant Garcia: I love meniscus transplants. So I agree with him. He's a neat guy. I'm a glutton though for punishment.

Dr. Grant Garcia: I love all the fun stuff. I'm not sweating after cases. It's not, I'm a high octane. Probably like Danny. I'm like, I'm like the Ridge Racer, you

Dr. Shariff Bishai: know, with the ghost. No, but I agree. I think, but that's what is going to make you. I mean, you're still young, but as you get older, you're going to realize how good you are.

Dr. Shariff Bishai: At what you do, because you've picked your poison and said, this is where I'm going to be. I think there's a place for the [00:29:00] general orthopod and they're needed without question. However, if you have a unique injury, I think it's important for that patient to really Interview and get a second opinion, essentially figure out, talk to your doc.

Dr. Shariff Bishai: Now they ask funny questions and say, how many have you done? And that's always interesting to me because the answer is more than one. However, I always ask them, what's the number you're looking for? Because I don't even think they know what they're asking. They just want to make sure it's not your first one.

Dr. Shariff Bishai: So I say, when they'll say, how many of these have you done? I'd be like, what's the winning answer.

Will Sanchez: Thousands, right? Exactly. I think that's the go to. Thousands. Or you could

Dr. Grant Garcia: be like Danny and just tell your patient it's always his first one.

Dr. Daniel Acevedo: No, I tell them, I tell them real numbers. You know, I'm pretty, it was nice that my old job, I had like a database, so I actually knew my real numbers and my complication rate, which was awesome.

Dr. Daniel Acevedo: No, I tell them, I tell them real numbers. You know, I'm pretty, it was nice that my old job, I had like a database, so I actually knew my real numbers and my complication rate, which was awesome.

Dr. Daniel Acevedo: And I wish some of my newBishai hospitals had that. Like I like to know what's my complication rate, revision rate, like how many did I do [00:30:00] just to be able to tell patients, right?

Dr. Grant Garcia: And I try, I keep like a track of my surgeries. I'm able to know like rough numbers, but it's, you know, at the same point, you're right.

Dr. Grant Garcia: Like, what does it matter? Right. I've seen doctors that I've seen. I know that do like 200 and I'm like, you did, there's no way you did the first one 99, you know, as proficiently. So it doesn't, you know, the number doesn't always matter either. Like you said, like, what are you looking

Dr. Shariff Bishai: for? Exactly. Because I think there's also the person that's done a thousand but has done a thousand, maybe not the best way.

Dr. Shariff Bishai: So that's their way and there's new techniques or whatever. Right. And. So I think that number is arbitrary. I think it's about being proficient and knowing the data. And I think personally, I mean, I keep all my own data and I still, you know, publish. And we looked at the complications of the arthroscopic clatter Jay to make sure that I was doing a service to the community and not a disservice.

Dr. Shariff Bishai: And we found that after 25 is the year learning curve and it matched the other articles that were already out. So I was like, cool, there's five other articles that all said [00:31:00] 25 and that's where mine was. And. And we went from there. So I'm at 92 now, and it's, I feel like as though I'm in a, in a, in a nice space to help the area people in the area.

Dr. Shariff Bishai: I mean, I had a guy, you know, that was sent to me from Dallas to have it done all the way to Detroit. And I explained to him, I'm like, you flew over four dudes that could have done this for you arthroscopically. But somehow he got to me, but I was happy to have

Dr. Daniel Acevedo: it. I haven't had that yet. I thought about that the other day.

Dr. Daniel Acevedo: I had someone drive like a few hours and I was like, Oh shoot, that's cool, man. But like, I feel like if someone flew to see me, I might cry. I might like tear up a little and then

Will Sanchez: Would they get like a little gift basket or something like that? A little memory? Yeah, I'm gonna call my

Dr. Daniel Acevedo: mom. I'm like, Mom, I made it.

Dr. Grant Garcia: It's different depending on market to like I get a lot of people flying like from Alaska, Idaho and like other places, but they, it's also different in like Seattle. It's different market than you guys, LA. I mean, where you're at is crazy. And in Detroit too,

Dr. Shariff Bishai: it's just different. There's a lot of dogs here.

Dr. Shariff Bishai: And I [00:32:00] think the, the key is with, with those, I call them my mail orders. And so when the mail order comes in at my scheduler, they'll see me on a Monday, they'll have surgery on a Tuesday. So me post up day one. So they'll be in town for two nights, three days with me, and then they're off. And if they want to come back, happy to do it, or else I'll help them facilitate care wherever they're from.

Dr. Shariff Bishai: So I think what's cool about it is they feel that individualized, like, concierge type medicine. I don't love it because I want my data. I want to know how they're doing. And if I feel like I can't get to them, I feel like I'm not I'm not where I want to be, but at the same time, if that's the only place where, how we can do it, then, then, you know, you just do it.

Dr. Shariff Bishai: Yeah. I got a

Will Sanchez: question regarding the show of a pod star, not a doctor. Okay. So there's a segment on your show. There's lots of segments on your show and it's called keeping it gangster. Gangster. Now, who came up with this idea? How did this idea come to [00:33:00] fruition?

Dr. Daniel Acevedo: That was my idea, so, I, you know, even in residency, like, everyone would, I would be kind of up with the slang, and then I would just say words, and nobody knew what the vernacular was, and so it happened.

Dr. Daniel Acevedo: to me at meetings, I'll be at meetings and I'll be like, Oh yeah, low key or I'll be like, yeah, bruh. Or I'll say Riz or something. And then one of my friends, Melissa was like, I don't understand half of the shit that you're saying. I was like, I'm going to have a segment to teach people how to speak slang.

Dr. Daniel Acevedo: Right. So that's kind of how that came up. Sharif,

Will Sanchez: what were your thoughts when you were like, All right, we're going to roll with this. What were yourBishai initial thoughts

Dr. Shariff Bishai: on that? I thought this was amazing just because it's like listening to my 16, myBishai 13, and my 11 year old speak. So I was like, this is perfect.

Dr. Shariff Bishai: Now I can have a conversation. Yeah. I mean, we helped, we

Will Sanchez: helped so many dads. Now, do they think you're cool or they're like, Dad, come on now. Please just, just don't, don't say those words to me. Come on. What's the reaction you get?

Dr. Shariff Bishai: So if you look at my Instagram, the first thing it says is hashtag manchild.

Dr. Shariff Bishai: [00:34:00] So they know I'm a kid. So to me, they were like, that's fine. We will accept it.

Will Sanchez: All right. This is, this question is for both of you. What's your favorite Keeping a gangster episode because obviously that's going to tie around a guest, maybe a reaction, maybe some of the words that you used. What's your favorite?

Dr. Shariff Bishai: I would say it was our first episode and it was with Kamran Hamid out of Chicago who is also rapping. He's great for you. Danny's cracking up already. Bishaiyeah, he was great. He's awesome. We were showing, so I, I made up the words and I was showing them and Danny and Cameron had to read them and he wrote one back, but he put your instead of like you are.

Dr. Shariff Bishai: He wrote it. Why? Oh, you are apostrophe. So I'm like, and he kind of put it up and he brought it down. It was like, no, no, no, no, no, no, no, no. Pull that back up. Where did you put that [00:35:00] apostrophe? Bishai

Dr. Daniel Acevedo: I don't know. I had fun with my friend, Jessica Mina. She, she, she was giving us some new words. We never heard about like shooketh and stuff.

Dr. Daniel Acevedo: Bishaiit's, you know, it's just fun. It's just, like I said, just trying to loosen people up and, and just kind of show like, look, we all have kids, you know, we're around this stuff too. You're not the only one. And just kind of like making light of it. And just. Like I said, just having fun. I think it really, it loosens the guests up and it kind of catches them by surprise because they're like, wait, what?

Dr. Shariff Bishai: Yeah, we have one coming out inBishai I think like a couple of weeks where he plays the game. What am I sitting on? We'll just leave it at that.

Will Sanchez: Well, that's, that's a teaser right there.

Dr. Grant Garcia: The audience is dying to see this now. This in the cuff cloud. Everyone wants to know about

Dr. Daniel Acevedo: it. Dude, we're just, we're just having, we're just having I mean, you know, I worked all day, like tomorrow I got like three big cases.

Dr. Daniel Acevedo: And so like, it's fun to just, to just come, like come in and like hang out with Sharif and [00:36:00] whoever, I guess is like, we're talking to you guys. Like we're just chilling. Like, so it's, it's fun to decompress and just be silly. So I have a lot of fun. It's it's,

Will Sanchez: it's good. It's great. BishaiI saw a couple of them and.

Will Sanchez: I forgot, I should have wrote it down Bishai but you were speaking to someone and you, you had a keepin it gangsta with golf terms. Oh yeah.

Dr. Shariff Bishai: And I

Will Sanchez: was dying. I thought it was hysterical. I've never, some of those I've never heard before. So that's a teaser for anyone that's listening. Please go check out Emmy pod star, not a doctor.

Will Sanchez: They have so many great shows and there's so many great segments. And one of my favorite is keeping a gangster because most of the time, Danny can't keep a straight face. He's just dying throughout the whole thing. AndBishai and just like Sharif said, he's, he's got the card. He's holding them up. like the word and flips around.

Will Sanchez: If you get it right or wrong, it's just whole great segment. And obviously it's well produced. So congratulations to the both of you for, you know, one having fun, right? Let's just start right there. Just the way you alluded to that. [00:37:00] This is kind of a break into your normal daily life. And now all of a sudden this has turned into something that people resonating because they could tell you having a good time.

Will Sanchez: You're having fun with, with what you're doing and you're entertaining and you have incredible guests that are coming on. Just like you mentioned that, you know, you have a golfer and you have someone from the Pistons and you have a doctor and there's just, it's great. It's, it's really, really fun and I really enjoy it.

Will Sanchez: So I just want to personally say congratulations on the podcast and Bishai I look forward toBishai listening and watching

Dr. Shariff Bishai: it. Well, the good news is you guys are going to be guests on our show soon. So that's going to be a lot of fun. Cause I'm going to, I'm going to break Grant out of his Dr. Garcia. We're going to come up with Something for

Will Sanchez: G money.

Will Sanchez: I'm

Dr. Grant Garcia: ready for it. I'm gonna have to, I'm gonna do some calisthenics beforehand. I'm ready.

Dr. Shariff Bishai: We might, you know, you don't know if you're keeping a gangster or might be in like a pushup contest with us. Who [00:38:00] knows ,

Will Sanchez: that's, oh, I, I, I saw that one. I, I, Danny, didn't you have an issue there? You got challenged to a pushup contest at what was at a conference or something like that?

Will Sanchez: Yeah, it was like

Dr. Daniel Acevedo: two in the morning out. It was two in the morning and we were coming back from, we were hanging out all night. And then like, Paul's like, push up contest, like it's down. So then I was doing push ups and I was like, watch me do these plyos. And I just kind of like missed and hit my

Dr. Grant Garcia: face.

Will Sanchez: I saw that one.

Will Sanchez: Sharif went at you pretty good with that one. I was like, Oh man. So yeah. SoBishai push up contest that, thatBishai that'll be a good one. So we got to find a great nickname for Dr. Garcia, double G something along. G Money. Yep.

Dr. Grant Garcia: I like that one too.

Will Sanchez: So we got, we got a couple of good ones. Listen, I know it's getting late.

Will Sanchez: We really appreciate your time, especially being on the East Coast. And SharifBishai real quick, I see Detroit Lions helmet in the back. We got some stuff going on. We got a big matchup. [00:39:00] Matthew Stafford is coming. I don't know, I would say coming homeBishai to go against the lions. So this, I find it extremely, there it goes.

Will Sanchez: We were seeing an autographed helmet from, from Stafford. AndBishai what, you know, what are your thoughts? I mean, he's coming back, they made the trade. We thought it was kind of, you know, maybe one sided. And now both teams have really benefited from this trade. And now it comes down to this playoff game where whoever wins or loses, it's.

Will Sanchez: The conversation is going to be extremely

Dr. Shariff Bishai: interesting. Yeah, I think Detroit's begging for this. I mean, it's been 30 years since we hosted a playoff game, which is insane. I mean, I remember back in the nineties when that happened andBishai where that was, was that the Pontiac Silverdome, which is now an Amazon fulfillment center.

Dr. Shariff Bishai: Bishaithey knocked down that building and built that. So you can tell that it's been a while now from the standpoint of these lines, I think, first of all, Decker reported. So [00:40:00] we'll just leave that. Okay. And then I'll say that. So we should have won a Dallas. However, I think it was good that thing lost because they, this Dan Campbell team is really interesting.

Dr. Shariff Bishai: I mean, when he came out originally and he showed up in Detroit and said, we're going to bite kneecaps and we're going to claw and appeal to the press conference. Yeah. He's like, what the hell? But now you realize what he was talking about. It's like, we're going to be blue collar. We're going to just, you know, We're going to work hard and that's what they've done.

Dr. Shariff Bishai: I mean, when he came out originally and he showed up in Detroit and said, we're going to bite kneecaps and we're going to claw and appeal to the press conference. Yeah. He's like, what the hell? But now you realize what he was talking about. It's like, we're going to be blue collar. We're going to just, you know, We're going to work hard and that's what they've done.

Dr. Shariff Bishai: So I think with Stafford coming back, who is great in this community, I got to know him when he was here. I did a lot of work with one of the rehab places here. And so he's just a good dude. His wife is great and just a great family. And he still comes through Detroit whenever he gets a chance. So the problem is he's the enemy this time.

Dr. Shariff Bishai: So it's going to be weird to, to, to see him like that. And they've actually banned people from wearing Detroit lions, Stafford jerseys for the game. So you can't, if you're wearing it, they won't let you in, which is crazy. Bishaibut I think it's going to be great when loser draw, I think. [00:41:00] The Lions have turned the corner.

Dr. Shariff Bishai: They're going to be a presence in the NFL for a while, at least in the NFC North, and we'll see.

Will Sanchez: Bishaiit's going to be a, it's going to be a great game. It's one of thoseBishai if you're a Lions fan, I would think that you want to see Stafford play well because he meant so much, but still go home with an L. So that would be my thought on that

Dr. Shariff Bishai: one.

Dr. Shariff Bishai: And so Danny and I got to figure out what our bet's going to be because he's in LA and I'm in Detroit. And here we go.

Will Sanchez: Danny, what's, what's the bet here? Push ups?

Dr. Daniel Acevedo: I don't know, I don't like betting money, I'm cheap. I would rather do push ups.

Dr. Shariff Bishai: Late night push ups. I got it, I got it. If I win, so if the Lions win, Danny has to eat red meat.

Dr. Shariff Bishai: And then if, and if he wins, then I'll go vegan for a week. What? No,

Will Sanchez: I don't

Dr. Daniel Acevedo: want to eat

Will Sanchez: meat.

Will Sanchez: Sounds like a little kid. I don't want it. No, I don't want that. [00:42:00] Dr. Garcia, any final words before we let this gentleman go?

Dr. Grant Garcia: Dude, thank you guys so much for being on here. This is awesome. Hopefully the listeners really enjoy this. I'm looking forward to letting loose at the next one. It'll be

Dr. Shariff Bishai: good. Yes. Grab your favorite drink, sit down, enjoy.

Dr. Shariff Bishai: Just to remind

Will Sanchez: everyone, it's Dr. Daniel Danny Acevedo, aka Cuff Daddy, Dr. Sharif Bashe, aka the American Gangster, and check him out, I'm a pod star, not a doctor. Please everyone, check him out. Thank you for listening to the show.
Audio Transcript


Guest Lia Winters: Easy Whip Inventor

Guest Lia Winters: Easy Whip Inventor

Will Sanchez: [00:00:00] Welcome, everyone, and thank you for listening to Sports Doc Talk. Please check us out at SportsDocTalk. com. It's a great website. We have a lot of information. Dr. Garcia has some great references. You can check out transcripts from our shows. So, really, we want you to go there and check out our website.

Will Sanchez: And, once again, I always remind our listeners, We are on every platform that you can think of, Apple, Spotify, Amazon, you name it. So please, whatever's your favorite listening platform, go check us out. I'm Will Sanchez, along with Dr. Grant Garcia, you know how we like to do. We talk all sports, all orthopedics, all the time.

Will Sanchez: We have a great guest with us today. The Leah Winter from Winter Innovations, co founder and CEO. We're going to get to her in a moment. But before we do that, let's bring in our orthopedic surgeon and sports medicine specialist, Dr. Grant Garcia. Happy [00:01:00] holidays. How are you? And maybe the kids aren't listening.

Will Sanchez: Have we taken care of, you know, some of the holiday goodies for the kids?

Dr. Grant Garcia: So I'm doing good. Happy holidays to you as well. You know, always orthopedic surgery end of the year is busy, but we're looking forward to the holidays and If the kids aren't listening, yes, everything is good so far, and I think Santa's gonna come in hot this year, so we'll see.

Will Sanchez: That is great. , Dr. Garcia, please bring in Leah Winters, as you introduce her, tell, tell me, what really excites you about this conversation about this guest for our show today?

Dr. Grant Garcia :So, you know, Leah Winter, we're gonna talk to in a second, and she's, again, the CEO and co founder of Winter Innovations.

Dr. Grant Garcia : And you can hear the word winter is in her name. So obviously she's the founder and I think you know, we had our most popular episodes are so far has been napkin to reality We had so many listeners on that and we talked about taking the napkin idea And taking it all the way to the product line and I talked about a few companies [00:02:00] that took large products on a large scale and that takes a lot of people.

Dr. Grant Garcia : This is somebody who did this with basically 1 person working their way up and very impressive person, but also she's going to give us more details that we miss because we're always open to correction. So this will be great, but I thought it was an excellent option. And again, an innovation orthopedics.

Dr. Grant Garcia : What the listeners should understand is that it's easy to tweak something small or to tweak a, you know, go up to a brand new product, but she, she found a way to make a stitching unit smarter, faster, better, which is incredible to find a niche in a product line, such as that. So she took a very innovative approach, excited to talk about her journey, her product and the future.

Dr. Grant Garcia : So with that, with that, I'd like to introduce Leah Winter.

Lia Winter: Thank you so much, Dr. Garcia. You're so kind. Really appreciate you giving me the opportunity to be here. Excited to dive in.

Will Sanchez: Leah, you know, we, I was listening at your [00:03:00] story and please go check out Leah's website I was on your LinkedIn page snooping around and I saw a great little piece that they put together. And I see that some of that inspiration and I want you to kind of talk about this was you mentioned that when you were 16 years old, your mom.

Will Sanchez: tore her ACL, and unfortunately, she had to have revision surgery 10 days later. And a surgery and a recovery that should have been a lot shorter took her almost two years. How did something like that become so impactful and lead to where you came up with this idea for your technology?

Lia Winter: I love to talk about this because for so many entrepreneurs, their family and experiences that their families have lived or experiences that they have lived themselves end up being the passion and drive behind the new products and innovations that come out.

Lia Winter: So exactly like you said, my mom tore her [00:04:00] ACL while she was at the gym playing volleyball with her friends. This was when I was about 16 years old. She had a world class surgeon do her ACL surgery. But there, as a lot of the listeners know, there are a lot of steps, a lot of technical details in the surgery.

Lia Winter: And unfortunately her surgery had to be revised 10 days later, which meant she went under the knife again. So what typically is a six month recovery. Recovery for ACL surgery became two years for her. So, I, I kind of knew from that experience, and again, I was young, younger here, but knew that if a surgery doesn't go right the first time, what happens to a patient and how difficult that journey could be because I saw my mom live it herself.

Lia Winter: So, fast forward a few years, I was an athlete in high school and everything, and like many orthopedics industry. Went through my own orthopedic injuries, had treatments, and that inspired me to become a biomedical engineer. And during my [00:05:00] biomedical engineering training, I had the opportunity to do research and development.

Lia Winter: I was always drawn to sports medicine. So there was a day in the lab where I was doing an R and D project on ACL grafts and how they were stitched. I had to sit there for six hours with products that were currently out there and figuring out. out how to stitch the grass and then biomechanically test them.

Lia Winter: And I know Dr. Garcia talked about this a little bit on NAPKIN to reality. So during this testing, there was a moment where it really stuck with me about The needle products that were used to stitch were very tedious for me to use. Then as my my R& D project continued on I started watching surgeons come into the lab and and Saw that stitching really was a bottleneck in the surgery So this experience helped me realize that from a technical side There was an opportunity to improve and then from the personal side my mom and her experience really stuck with me So those two things really were were my inspiration behind Starting my company and coming up with the [00:06:00] idea for my product.

Dr. Grant Garcia: I think this is an excellent point, which he's bringing up. I think from an orthopedic standpoint, it's important to hear this. Cause the listeners are like, well, you know, stitching, tell me more about it. You know, what happened to your mom is incredibly unfortunate. And when the stitching, you know, we, a lot of things we do and how most of my ACLs, at least half of them.

Dr. Grant Garcia: There's a stitching component that's not built into the system that we're stitching and sometimes you can see when you're stitching the way the tissue is the way that the biomechanics of it are done is there can be a little bit of cut out and what cut out for the The listeners and again, we're not going to go into the engineering component is that you can kind of split the tissue.

Dr. Grant Garcia: Again, you want to keep the goal is you want a stiff construct and you want the sutures to be built into the tissue. But sometimes the needle itself you guys can think about it like imagine you're, you know, you're trying to you're passing something you have to make a hole in it. And so if you make the whole inappropriate direction, or you make a certain type of stitch, you can actually cut through the middle, and that can [00:07:00] cause those problems you're talking about again, it's not common.

Dr. Grant Garcia: For that particular issue that your mother dealt with, but it's obviously catastrophic and enough to someone like you to change the way you're doing your course and your path. And so it's really important to have this down because again, I've heard on my podcast before, but our margin for error should be zero.

Dr. Grant Garcia: And so that's why innovations. It's so important.

Lia Winter: Absolutely, yes, Dr. Garcia. And if it might be helpful for the listeners, I'd love to share a little bit of background and context on ligament and tendon surgeries, because I know that you do have a pretty wide range of listeners. So just a little bit of background.

Lia Winter: These ligaments and tendons are the soft tissue structures that are either connecting bone to bone in the case of a ligament. Or muscle to bone in the case of a tendon. And unfortunately these tendons can tear when too much force is put on a joint. And a lot of people are familiar with these things from sports and they can happen in many different areas of the body, but it's not just athletes.

Lia Winter: Every day, [00:08:00] people can experience these injuries, the weekend warrior. These are things like ACL tears. biceps tears, Achilles tendon tears. And I think these are hot topics, especially for sports medicine surgeons. I mean, this is your bread and butter, Dr. Garcia. And I know a lot of your listeners have heard of some of these from your recent segments.

Lia Winter: So like, for example, Nick Chubb and Aaron Rogers but. For the most part, severe tears require surgery, and most of these ligament and tendon surgeries actually require stitching of the tissue. The surgeon is taking sutures, which is a fancy word for medical grade string, and passing them through the tissue with a needle.

Lia Winter:So, for example, for, we talked, I mentioned Achilles. For Achilles tendon surgery, a common approach is repairing. Where the native tissue is sewn back together for something like an ACL surgery. The common approach here is to reconstruct it. And this is where [00:09:00] tissue is taken from another part of the body.

Lia Winter:A lot of times this is called a graft and the graft is stitched before this construct is implanted into the knee to replace the old torn ACL. And that's the kind of surgery that that my mom had. So I think before we talk about stitching. It's important to understand the overall context of the surgery because it, it is quite a simple thing, but it does have a big impact on the overall steps, especially in ligament and tendon surgery.

Lia Winter:So, Dr. Garcia, would you like to weigh in on that at all?

Dr. Grant Garcia: Yeah, I mean, if the part, if the listeners want to hear how important this is, this week, I will probably do this stitching technique and I'll probably do stitching overall, probably 10 times. So, that's ten times in one week, multiply that by 52 weeks, and again, you know, this, it changes sometimes, sometimes it's four times, but I don't think I'd go a week without doing stitching like this.

Dr. Grant Garcia: So this is an everyday thing that we deal with. And and again, I'm a sports surgeon, so I probably see a higher volume of things that require to be [00:10:00] stitched, but flexor tendons for hand, you can talk about other knee ligament tendons, a lot of ankle tendons we can talk about. I mean, again, Leah is making this as simplified as possible, but there are more tendons that we fix with these types of stitches than we had fingers on her.

Dr. Grant Garcia :Fingers and toes. So it's really important to understand that.

Will Sanchez: Yeah, I'm sorry, go ahead. Go ahead, Leah. No, go ahead, Will. No, I was just going to say, just to let the listeners know, as I'm listening to all this tendons and sutures and everything else, and I've kind of gone through my ruptured tendon. So I have a cast on right now, and luckily I had a great surgeon.

Will Sanchez: One of the surgeons that was actually on one of our shows. Dr. Anthony Yee performed that. So when we're talking about the sutures and the stitching and everything else, I am the example. You two are the doctors, and I'm the example here. So if we were in a room, I could just show up my leg and just talk about really the importance of it and having that [00:11:00] assurance of of that.

Will Sanchez: that suture to really kind of hold things in place so these, tendons can unite and start to heal. And all of a sudden, you know, for us weekend warriors, go out there and have some normality as we were joking before we started the show so my wife could get some peace because right now she's holding down the fort at home and it makes it very difficult.

Will Sanchez: And I was thinking about your mom where you mentioned. what she went through, not only the strain that it puts on her physically, but what it does to her emotionally, mentally, and what it does to the rest of the family, just because she had such a difficult complication, how that can be inspiring for something that you have created here.

Lia Winter: Exactly. Yes. That's definitely my story and inspiration. What keeps me going forward and Why I love doing what I do with Winter Innovations.

Lia Winter: So if I may, I would [00:12:00] love to share a little bit more specifically about what Easy Whip is and how it solves some of the problems that I observed through, one, my mom's patient story, but two, the technical things that I observed as a biomedical engineer. So Easy Whip really is the first and only two part needle for stitching in orthopedic surgery.

Lia Winter: We have some really good graphics and videos on our website if anyone's interested to see how the product works. But for listeners, think a needle within a needle, that's what a two-part needle means. So these two portions are attached to opposite ends of a length of suture. So again, medical grade string.

Lia Winter: So when they're connected, the suture is a loop. But when they're separated, it's straight. This is a really simple change to conventional needles, but it drastically changes how stitching can be done. With Easy Whip, it can be used to create a traditional whip stitch, and this is where the product gets its name, Easy Whip.

Lia Winter: And we also have a new patented stitch method, which we call the [00:13:00] Whiplock. This adds additional strength to the stitch, and surgeons can create hybrid patterns based on the needs of each patient and surgery. So really, a more custom approach. And then in addition to the versatility and strength benefits, it can also save time from avoiding extra movements and reducing the number of needle holes through the tissue, which Dr.

Lia Winter: Garcia was talking about how important the placement of the holes and making sure the tissue integrity stays intact, how important that can be. And I would add

Dr. Grant Garcia: to that, again, I whip stuff all the time. The contracts we currently have are a fixed loop, so they imagine a fixed loop. So if you want to pass it through, you gotta have another assistant that uses, that releases their hand and passes it through.

Dr. Grant Garcia: It's a, it's an art. It's like a ballet in the operating room. And sometimes it's challenging. And you have a needle flying around all the place. So it becomes challenging. With this technique, you don't have to ever do that. The, the tendon stays straight. And [00:14:00] as you release it, I've never seen a double needle like this before until I got to see yours.

Dr. Grant Garcia: So it was really, really cool. And the idea that it works so functionally well and the way it stitches, but that hybrid thing she was talking about is really, you know, the whip is amazing. But the hybrid technique is honestly the game changer in my opinion, because you can really do this special locking stitch with it.

Dr. Grant Garcia: And so that reduces, if you pull hard enough on these other, some of these other techniques, you will see the tendon get cut. Again, it doesn't happen all the time or we'd have a lot bigger problems, but enough to cause traumatic things such as your mom's issue and so this sort of lock stitch is really what excited me the most about the product and it's really cool that you can do this and it's basically technically, technically dependent, right?

Dr. Grant Garcia: Because, you know, we could do all different things with the same stitch. Is that correct?

Lia Winter : Yes, yes, the same product. So the surgeon can decide based on the needs of each patient in each case when they are about to create each individual stitch, what is most needed, a locking [00:15:00] stitch or just a simple traditional whip stitch.

Lia Winter : And overall, that kind of depends on the case. And The overall context of the surgery, but really a lot more versatility. And I exactly like you said, Dr. Garcia, that's what's resonating with surgeons the most and getting them really excited about using our product.

Dr. Grant Garcia: And it's good for the, I want the listeners to hear this again.

Dr. Grant Garcia: It's just really impressive. You know, this is a, this is like she reinvented the wheel. Like the stitch is so common and this stick technique we used to use before is like everywhere. And she found a way to have an innovative product on something that is time tested for so long and have it be, make it better.

Dr. Grant Garcia: And as soon as you see this, you're like, wow, that is a lot better, but you don't realize it until you see it. So this is one of those things that I just, that's why I'm so excited about having her on here. Because I just, I want everybody to hear the brains behind this. And honestly, too, the, you know, the personality type of you is, is going to be great for the listeners to hear how this happened.

Dr. Grant Garcia: Because it's, this is not [00:16:00] often that we get to meet someone like this. Yeah.

Will Sanchez: So Leah, we talked about your mom being inspiration,

Will Sanchez: but who was your inspiration for you to say, Hey, you're on the right path. You're doing a great job. pretty sure like anything , doubt kind of may creep in or am I heading in the right direction? But that person that motivated you because I can see that you're in a position now where you can motivate our young folk and young people that are involved in the medicine field.

Will Sanchez: So what are your thoughts on that? There are a

Lia Winter:lot of people who have helped me along this journey. And I would say being an entrepreneur is very hard. So a strong support system of people encouraging you, helping you find the right resources is so critical to the success. So I, a little bit more context.

Lia Winter:I my background is in biomedical engineering and I started my company when I was in graduate school at the university of Tennessee, pursuing an MBA and a [00:17:00] master's of science and biomedical engineering. I, I. engineering foundation, but realized that in order to understand how the products I was researching were actually impacting patients and the business overall it would help to add business skills to my engineering foundation.

Lia Winter:So it started out when I was in graduate school and I wouldn't say I really set out to start a company from the beginning. I Looked at the resources provided by the University of Tennessee and was, became aware of the entrepreneurship program at the university and kind of said, well entrepreneurship would be a good thing to combine business and engineering exactly the way I say I want to.

Lia Winter:So I decided to start getting involved in the Entrepreneurship Club on campus. And I had a friend and a mentor who said, you know what, it would be great if you pitched your idea for EasyWik. So EasyWik had started out as a Class project at one of my engineering classes. And they said, if you, it would be great [00:18:00] if you pitch this in a competition, kind of like shark tank and started preparing your kind of business skills, but putting the legs underneath of this idea to actually make it become a reality.

Lia Winter:And I, I said, I'm an engineer. I don't like talking in front of people. And it was just that I hadn't learned or practice those skills and decided really to rise to the occasion, enrolled in my. First pitch competition, which was 90 seconds. So I think shark tank, if anyone has seen the the show but basically you get up there, talk about the idea and I won first place and 1, 500.

Lia Winter:And the next day I took that money and got a business license and officially. It was started off as a sole proprietorship, but that really was the beginning. And continue to do pitch competition. So ended up winning about 30, 000 from the university of Tennessee, and then looked at the broader resources and realized there was this thing called the pitch competition circuit with a bunch of universities that host pitch competitions and.[00:19:00]

Lia Winter:Traveled around the country my last semester of graduate school to the University of Louisville, the University of Georgia, and kept winning all of these pitch competitions. So I had about a hundred grand in funding by the time I graduated. And that's when, again, some family and mentors said, you have something here.

Lia Winter:You really should go ahead, try this see if we can make it into an actual commercialized product and company.

Dr. Grant Garcia: That's amazing. I do want to chime in here. So I got to tell listeners his background on Leah because this is, this is going to be awesome. So Leah is saying she's, you know, shy engineer trying to work on her pitch competition.

Dr. Grant Garcia: So Will can tell you this because Will was one of the. You people I responded to on LinkedIn who asked me to do podcasts and now we're at three plus years later. We're doing this awesome show But I get probably five messages a day From about products for people either from an investment side to try my new product out and pretty much delete all of them So we're talking about over a [00:20:00] thousand messages Leah is the only message I've ever seen and I still am surprised how she did it.

Dr. Grant Garcia: So she sent me a personal video Telling me that about the product and ask and with my name on it and everything else I've never seen that before in like the last five years and I I showed to my partners I was like check this out and immediately responded back to her The first thing I think I said to you leo was i've never seen someone Now again I'm not telling anybody else on LinkedIn, I'm not going to respond to your messages just because you do this video now, but I've never seen that before and her pitch was awesome, so I'm she had me at that.

Dr. Grant Garcia: And so that's why again, it's also, I just remember that as we're talking. And so I think she, I think she's gone a pretty good ways from an engineer just behind the scenes. Well,

Lia Winter: Like everything you guys were talking about was so true. So research Dr. Garcia [00:21:00] on LinkedIn, sent him that video, flew across the country to meet him in person and do a demo with easy whip. And now here I am. So I love that this story has come full circle.

Will Sanchez: It's awesome. That is amazing.

Dr. Grant Garcia: So let's tell us what we got wrong with Map into Reality. Again, in the nicest way possible, obviously. No, no, no.

Will Sanchez: Go for

Dr. Grant Garcia: it. Go for it. Tell me your journey. I want to hear your journey. And I might chime in on some things, but you know, I do a little bit of IP. Again, I'm a surgeon by most of the time. You are the expert.

Dr. Grant Garcia: You are the, this is the reason you're on this show is you've gone the whole way, and you know more behind the scenes than anybody I know. So tell us what you had to do to do this. I want the listeners to hear this. This is what it takes, guys. So this is going to be interesting. So go.

Lia Winter: Of course. Yeah. So just a really high level overview of our company.

Lia Winter: So graduated from the University of Tennessee in 2019 and officially founded the [00:22:00] company, became a full time entrepreneur. The first thing we did when we graduated, so I teamed up with my co founder, this is when I start talking about WE. We did an accelerator program so an amazing resource for startups that are actually trying to go forward with the next steps of their company.

Lia Winter: It's called Zero to 510, and it's in Memphis, and it's a play off the name of the 510 and the 510 K, which was discussed a lot in Napkin to Reality and the pathway that WE took, so we'll talk about that a little bit. So did that accelerator help set us up really well to prepare for fundraising? So we got tired of living big check to big check and pitch competition to pitch competition.

Lia Winter: So raised our first round of investment funding in 2020. Use that to put towards all of the testing necessary to get clearance from the FDA through the 510k. And that went through in 2021. And then had our first surgery in the very end of 2022. So that's just kind of a high level of where we've been and what it's been [00:23:00] like, and a lot of work and steps have gone into that.

Lia Winter: So I kind of mentioned that for me, what made this a reasonable journey and gave the motivation and inspiration was just breaking it up into individual steps. And so one of the things very early on, someone said, after I won a pitch competition was. You need to get a patent to protect your idea. Dr.

Lia Winter: Garcia talked about a lot of different pathways You can partner with a larger big company or take the path that I took and start your own company regardless protecting the invention is the key first step So I, I really remember it was again, we were just winning pitch competitions and scraping together the first capital.

Lia Winter: I was on the phone with our patent attorney who had just finished the application and it was ready to submit, which means the fees hit and everything. And I remember our patent attorney telling me. Patents are like potato chips. You can't have just one and I was on a call, but I kind of like I made a face He couldn't see me, but that's [00:24:00] crazy.

Lia Winter: I we barely have enough money for one. Well fast forward We now have a patent portfolio that has three u. s. Patents 13 international patents across the country. So this, that advice that I got really early on has been critical to building value from the earliest stages for our company.

Dr. Grant Garcia: I think that's important for listeners to, you know, there's two routes.

Dr. Grant Garcia: Leah took the higher risk. But higher reward and harder work, right? There is partnering with companies where you have a smaller chunk of ownership of the patent, you know, maybe, you know, hopefully some ownership and that's what a lot of the orthopedic surgeons do initially on but what Leah did is a different animal.

Dr. Grant Garcia: And so it's good for you guys to hear this because that's really neat. That's a less common route especially to get all the way to the success level she did. I mean, each one of these, she could fail and she found a way not to. So sorry, keep going.

Lia Winter: So true. And again, it goes back [00:25:00] to some amazing people that we worked with and, and we'll talk about that a little bit more when we specifically get to maybe the FDA and five 10 K, but before we could even get to that right.

Lia Winter: We had a, a patent to protect the idea, the innovation. And the next thing was how do we go about even making the product? And I, I always laugh, the first versions of Easy Whipp were hand-built prototypes. I was ordering things off of eBay, finding other sutures on the market that I could find that were maybe expired or, or things, purchasing those, ordering needles, and hand milling them on a, a mill, and drilling, and just to have feasibility prototypes that we put in the hands of surgeons, like, Family friends that we knew other surgeons in our network and said, Hey, how's the size of this?

Lia Winter: What materials does it have to be made out of? And that was a big step to start actually talking about the device and Not being so proud that it had to be perfect to get it in the hands of a surgeon. I think that was a really [00:26:00] good step that we took early on was to just get what we call a minimum viable prototype or product and get it in the hands of a potential customer to really get feedback early on and make sure how the device is being designed.

Lia Winter: Is built for the surgeon and something that, that can bring value and benefit. So those early prototypes really were important. And then it was getting the attention of a manufacturer and being a startup and asking about their capabilities. And when we said, Oh, our first run, we're thinking maybe a thousand and manufacturers laughing and saying, we heat the machine up, it warms up and it makes a thousand thousand sutures.

Lia Winter: So. Finding a manufacturer that had the capabilities. We just tapped into our network and started pitching not as much the business case, but also the inspiration behind it. And then we found an amazing manufacturer that just makes surgical needles, a really specialty niche in the market, if you will, that was a critical step early on to making sure we [00:27:00] succeeded and passed all of these tests and necessary steps like.

Lia Winter: Dr. Garcia mentioned is so important.

Will Sanchez: Absolutely amazing. Just because it sounds like you've been slacking for the last couple years what are the future goals for the company? What, what's your vision down the line or at least hopefulness for winter innovations? Yes.

Lia Winter: Yes. So right now, I would say a lot of the focus is on growing our customer base, getting new, innovative surgeons who are excited about new technology, looking for partnerships to get easy, efficiently into the hands of as many surgeons as possible and doing that at a nationwide scale.

Lia Winter: So those are kind of the long term business goals, and I'd say on the research side of things. We recently won a grant from the government. It's called a small business innovation research grant. It's a million dollar grant from the National Science Foundation, and that will fund product expansion as well as cadaver studies and biomechanical testing, which I know was also a big [00:28:00] topic in the napkin to reality.

Dr. Grant Garcia: Yes. Will you go, will you go through your, you know, again, briefly your 510k you had to go through so that the listeners can hear this again. Again, this was our most popular episode. So hearing this from someone who's gone through it is going to be excellent. And then maybe, you know, shoot down to some surgeries that weren't the first surgeries like

Lia Winter: Yes, yes.

Lia Winter: So the 510k pathway, again, just a quick summary. This is the expedited pathway for products that are currently out there, but might have a different tweak. So sutures are products that have been on the market. So we were able to use this 510k pathway. I think you talked a lot about biomechanics testing, which was a really big part of it.

Lia Winter: We did have to present that data to the FDA, but even before that just everything, I think additional context that goes into making sure a device is safe and effective. We had to do sterilization testing, make sure the product was sterile and clean for it to be open in the OR. [00:29:00] We had to do Testing on the packaging to make sure that even after it was shipped halfway across the country, the packaging still stayed intact and the product was still sterile.

Lia Winter: We had to do biocompatibility testing. We had to do manufacturing process validation. And then once all of that was finished and proven, we did additional biomechanical testing. So looking at the different stitch patterns. Pulling them apart, looking at the ultimate strength, all of those things that Dr.

Lia Winter: Garcia talked about in Napkin to Reality. We took all of that work and put it into a 510K, which really is your case to the FDA for why this product is safe and effective. And our 510K, and this is a pretty simple product, it's again a suture, was 1000 pages long. So it's a lot of work that goes into this preparation.

Lia Winter: And this is also a fun fact is that in order to actually get this submitted to the FDA, we had, you have to mail them. The submission on a flash [00:30:00] drive. So that was something that was funny when we were ready to submit and our our regulatory expert told us that's how it's actually done. So our 510k went through the FDA in less than two months, which is, which is really fast, especially for a startup.

Lia Winter: Most take about six months. So that's a metric that we're really proud of. And again, we worked with some great testing partners and manufacturers to help make that

Dr. Grant Garcia happen.

Will Sanchez: Awesome. Absolutely.

Dr. Grant Garcia: Go ahead. Yeah. So again, And for listeners, this is a, this is really impressive. So I think, you know, but you hear all these steps, right?

Dr. Grant Garcia: So she's gotten all the way to the FDA, but all your products can be great, but how do you present it to the surgeon? You know, I may seem like a chill guy, but sometimes if I'm, you know, not interested in something, I'm not always going to look at it. And there's a lot of other different personalities in the operating room, which we'll be able to tell you.

Dr. Grant Garcia: And so you got to work with all these different surgeons who may have their own personality types, or you got to have these surgeries that go [00:31:00] perfectly. And sometimes you get one shot. And so, you know, those first surgeries are important for your testing, but also just for your confidence. And so, so how did that go?

Dr. Grant Garcia: And then obviously we'll get to the next level, which is, you know, trying to talk to other surgeons and how did that approach go and, you know, your, your future stuff.

Lia Winter: You are so right about the different personalities of surgeons and all are so busy. So getting their attention, we were fortunate to have a very excited surgeon to be the first user of our product.

Lia Winter: So the approval process, getting it in, it all went very smoothly. I almost say we were spoiled for the first case, but I will say being in the OR for that first surgery was honestly the proudest moment of my life. I was able to see a product that I, I came up with this idea and it was being used for the very first time to help not only a surgeon, but most importantly, a patient and have been really fortunate to be in a lot of cases with easy whip now and every time, again, it's that same feeling.

Lia Winter: And when I hear a surgeon utter the value [00:32:00] proposition that I've pitched so many times or in my sales pitch, when I, I hear either the surgeon or the PA, whoever's stitching utter those words out of their own mouth, like, wow, this really was easier. I felt like it was a stronger repair. I'm not worrying as much about the tissue ripping.

Lia Winter: That's what makes all of the hard work and steps worth it. So we do have to work really hard to get the product in front of other surgeons. Some of those creative things, like I said, Dr. Garcia's example of Doing personalized videos one by one, researching our surgeons, social media has been really important for us, we've started going to conferences like the American Academy of Orthopedic Surgeons or sports medicine conferences, things like that and, but I would say the thing that's The best is referrals and testimonials from our, our happy surgeon customers that definitely goes the furthest.

Lia Winter: And so we try to really make sure those first cases go well. Like Dr. Garcia said, you have to make sure it goes right. And so I will a lot of times travel and go to the first [00:33:00] cases and help build the relationships with the surgeons and make sure it goes

Dr. Grant Garcia: smoothly. This is so important. I think the listeners should this is going to be our longest podcast ever, this is so exciting.

Dr. Grant Garcia: So the This is really important. I mean, this is something I do on it for all the, a lot of these companies I work with, you know, and again, I'm different than Lia. I'm a surgeon. She's trying to show her product off. Surgeons are skeptical and some, and there's some that want to do innovation, but there's a lot of people that want to be careful and it's fair enough.

Dr. Grant Garcia: Again, you don't, when something goes wrong, it's not good. Or if you're doing something and it, it ends up being not the result you wanted with the new product, it's stressful. And there's, there's previous history of products like that. Again, this is different, but there's still that concern that some surgeons have.

Dr. Grant Garcia: And so, you know, when a testimonial of another surgeon is like, this is amazing, you know, that goes a long ways, like she said, and you know, the fact is that she's excited about it. She's smart. She could talk all these things. Those are all really important because that's not the commonality. And that's [00:34:00] why she's gone so far, because I'm sure there are a lot of smart people out there.

Dr. Grant Garcia: I'm sure there are a lot of engineers out there. But you have to have the full combination. And again, it shouldn't deter you if you don't have those. Check all those boxes. But it is interesting for the listeners to see. This is not, this is a full package thing. It's like, you know, these athletes we talked about, right?

Dr. Grant Garcia: They're not just good at one little thing. They have all these things going for them. And the one thing that Leah said that she was worried about initially was her ability to pitch and talk in front of doctors or talk in front of people, and she's clearly mastered that. And so, the point I'm saying is that you don't have to have everything to start.

Dr. Grant Garcia: But you should, it's good for you to listen to mentors and be humble and understand like what it takes. You know, I came out of medical school, my comfort level is not nearly what it's like now. And talking in front of people or talking to, you know, I was just at a teaching event and half the people were older than me by 5 to 10 years in terms of surgeons.

Dr. Grant Garcia: And so that takes a lot of guts for me to try to go out there and try to teach somebody else. And so it's the same type of thing. And so it's really important to understand that like, you have a [00:35:00] purpose here, you know, you're not, and this is not threatening, you're trying to help everybody. And if that's your intent, things are going to go a lot better.

Dr. Grant Garcia: And that's the way that Lia presents herself. Yeah,

Will Sanchez: Lia would have had me if she would have had on subject title I had this great in invention called Easy Whip. Just the name alone, I would have like, I gotta check this out. Because it's like a cool 80s music video from Devo. So I love the name.

Will Sanchez: Easy Whip is awesome. Well sold

Dr. Grant Garcia: already. You don't even need to

Will Sanchez: do any product testing. No, no, I'm sold. I'm sold. The name of my invention is called Easy Whip. I was like, okay, this is awesome. So great job on the name. . I know we're going to wrap it up soon. I, I want to do a quick little rapid fire thing with you.

Will Sanchez: We're going to call this, you know this, that, or, we'll send it to the rack here. All right. And you're from the university of Tennessee. So tell me Peyton Manning, Pat Summit, or someone else when you think about the The Vols. Oh, [00:36:00]

Lia Winter: that's a tough one. I'm going to have to go with Peyton Manning.

Lia Winter: Or Dolly Parton.

Will Sanchez: Oh, there you go. Country singer. Did Dolly go to Tennessee, to University of Tennessee, or just because she is Tennessee?

Lia Winter: She is Tennessee. The last UT game that I was at, she came and performed. Peyton Manning walked her out on the field, so it

Will Sanchez: was quite fun. There we go. Okay. So dry or wet ribs?

Will Sanchez: What are we doing here? Dry. Okay, we're going with the dry rub. Alright, last one and, you know, sticking with the food theme. Goo Goo Clusters or banana pudding? I know it's big in Tennessee. What are we doing here? Banana pudding. There we go. There it is. Thank you so much, Lia. Any last words for Lia Dr.

Will Sanchez: Garcia as we we wrap it up? Because if I don't stop you, we're going to keep Lia on right through the night for another three hours. I know [00:37:00] you're so excited to talk to her and she's got some great things. She teased it already, so I'm hoping that she's going to come back to the show in the future and discuss where, where the company is going and all the other great things that are happening with.

Will Sanchez: Easy whip and her company.

Dr. Grant Garcia: Absolutely. Well, guys first off, thank you so much for being on here. I'm really excited about this product. You guys, hopefully we'll get a chance to try it out in the next month or so. Just, you know, obviously things are, things are crazy over everywhere in the end of the year.

Dr. Grant Garcia: So, you know, this is a really innovative option. And you guys will be hearing from me report on it soon. And I really appreciate you continuing on efforts and telling us your story. Cause this is it's good for the listeners to hear this and they get to see the real napkin to reality.

Lia Winter: Thank you, Dr.

Lia Winter: Garcia. It's been such a pleasure. Appreciate you giving me this platform and supporting entrepreneurs like myself.

Will Sanchez: That's Leah Winter from Winter Innovations Co-founder and CEO. What a great name. [00:38:00] Easy whip. I can't wait to see where this all goes. And you know, big Dolly Parton fan there. We want to thank everybody for listening to Sports Doc Talk.

Will Sanchez: Please check, check us I would like to wish both of you Happy Holidays. Merry Christmas, happy new Year, however you celebrate. I hope you're having a great time with your family, friends throughout this holiday season as we get ready for a spectacular 2024.

Dr. Grant Garcia: Happy holidays, everyone.

Dr. Grant Garcia:Thank you guys.
Audio Transcript


Deshaun Watson Injury: Glenoid Fracture Surgery

Watson Injury: Glenoid Fracture Surgery

Will Sanchez: [00:00:00] Welcome everyone, and thank you once again for listening to Sports Doc Talk. I'm Will Sanchez, along with Dr. Garcia. First off, this show is kind of coming out of the blue. Literally, it was put together in the last hour, and less than that Dr. Garcia reaches out to me and says, Hey. I'm really excited about this injury and just to let you know, only an orthopedic surgeon would be really excited about talking about someone's injury.

So we were like, yes, we have to do it. Let me set it up real quick before we bring in Dr. Garcia. I'm going to admit, I have a fantasy football team. And I get this notification this morning, saying Deshaun Watson out for the season being selfish. First and foremost, I go, Oh man, I'm out of a quarterback.

What am I going to do? Right. That's the first and foremost. I know you fancy football players out there fans. They know exactly what I'm talking about But more importantly it was about this injury and then dr. Garcia chimes in so dr Garcia when you heard about Deshaun Watson's [00:01:00] injury And the fact that he's out for the year the star quarterback player for the Cleveland Browns that they spent a lot of money Draft picks to get what was your first initial thoughts before we talk about the injury

Dr. Grant Garcia: itself?

I mean, obviously going out for the season is a big deal and his contract was a big deal. I mean a significantly guaranteed contract after kind of a lot of dilemmas that he went through you're kind of expecting only the best. But we know how it works in the NFL, especially with high pay contracts, but you know that, and then getting injured now for the season.

I mean. You know, this is not looking like a good for the Cleveland Browns with their trade. So this is, this is pretty frustrating if you were a Browns fan. And then not to mention the uniqueness of this injury.

Will Sanchez:Yeah. And I, and I can't wait to get your take on this injury. Especially how common or.

Maybe not so common of an injury it is just so just to give the audience some context. Deshaun Watson was playing against the Baltimore Ravens had a fantastic game and [00:02:00] actually came back and won the game and beat the favorite Baltimore Ravens in that game. He injured as we found out now after an MRI on Monday.

And then make an announcement on Wednesday that watch Watson sustained a shoulder fracture during the first half of the game and continue to play before we get into the injury by him. Continue to play with that injury in the first half. Does it have any bearing on how severe it became or it didn't matter?

And before you answer that, why don't you tell the audience what exactly, actually the injury that he sustained?

Dr. Grant Garcia:The only clarification I want to ask before I answer this is this is his throwing shoulder or non throwing shoulder? This is his throwing shoulder. Yeah. First off, I am shocked that he played through the rest of the game with this injury.

So to kind of go over it with the audience, and the reason I want to talk about this is something called a glenoid fracture. There's also another name for it, which is a bony [00:03:00] Bankart fracture based off of the description by Dr. Bankart. But when you dislocate your shoulder, Or have a direct blow to it.

You can dislocate the shoulder where the ball comes out of the socket. We hear about that all the time in the NFL. And those players come back in a few weeks. You know, usually they get rehabbed or something like that. And they get a labral tear. So, usually that will heal. And maybe that goes on to mean something surgical, but not always right away what he must have done.

And again, I don't know, don't obviously know the x rays or the, any type of other imaging he had done, but he may have partially dislocated his shoulder. He may have had a previous injury that we don't know about, and he broke off a piece of the golf tee. So imagine you've got your socket, which is the golf tee, and then you've got your ball.

That's the humerus. And when you break off the golf tee, that's really bad. For a number of reasons, one, it makes your shoulder incredibly unstable. And to be honest with you, this is one of the few times I've heard about someone able to keep playing through. So he may not have had as [00:04:00] big of a fracture as I was thinking initially.

But then the fact that piece of bone broke off with it, that if you miss that. And that he goes on to keep playing for another couple weeks. This is a big problem because the shoulder has such good healing potential that basically what'll happen is if you break off a piece of the golf tee and it falls down, you can't get it back up once it heals.

Because it'll heal and turn into it in the wrong spot. That's called a malunion. So even if he is stable but the golf tee's gone, then he's at a much higher risk of re injury.

Will Sanchez:So he mentioned that you know, he quote unquote said the whole second half that he was throwing, it was extremely painful to throw the football.

And and just talked about, you know, the severity of the playing. By the way, he completed all 14 of his passes in the second half and led them to a winning field goal to beat Baltimore 33 31. If you, just in case. So, I, like you said, I can't imagine. Having the injury, let [00:05:00] alone with my throwing arm and for any football fans out there, the amount of velocity that you have to put into that ball so it doesn't get intercepted or knocked down or however far that ball travels I can't imagine what are your initial thoughts about with him playing?

I know you mentioned that maybe the fracture wasn't as severe, but still having a fracture in your throwing shoulder to compete at the NFL level, let alone, I don't know if he got hit. took any sacks, ran with the ball, hit the ground, or anything like that. What are your thoughts on just, you know, we talk about these superhumans all the time.

What's your

Dr. Grant Garcia: thought? This is a perfect example of superhuman. I don't care if it was even a small fracture. I mean, that's, this is, most of the patients that I see with this injury, there's absolutely no fracture. I mean, the last two patients I've seen with that have been almost many back in to the area.

They come in with their arm completely locked at their sides. And this is not a, this is not an injury that you see someone come in and you're finding it [00:06:00] randomly. You know, again, If it was a very small shell of piece of bone but usually they don't say this is definitely has to have surgery. So it probably was a pretty decent injury.

And he, what happened is it may have worsened from him playing, right? It could have been a small fracture that hadn't moved. And then he played through it and then it broke off more as he played through it. And that's very well could have happened with the type of forces that he's putting on his shoulder.

So yes, I mean, he's a superhuman, right? He's incredibly good athlete. And you know, be it what it may, you can think about him whatever way you want. But his ability to play through this is, just shows his level of you know, athleticism, his pain tolerance. I mean, this is, this is incredible that he's able to go on to win The game with the, with this injury.

And then, you know, we can always, I love to go into sort of the injury itself. So the, so the, my patients and people listening will understand it a little bit better because it is, it's a little different animal. But again, we talked about the golf key, but the problem is, is not the injury. [00:07:00] The problem is not that he played through it.

It's the problem is that the surgery, so this is one of the hardest things to fix. And the issue with this type of injury is we see labral tears all the time. We can talk about, I'm sure we have a laundry list of players that have torn their labrum and had it fixed. That is a technically not very challenging surgery.

You know, it's still a surgery. We take it seriously, but that's not a technically challenging surgery. When you fracture a piece of bone, that's where things go awry and in a lot of groups There's usually like one or two people even that even know how to fix this thing and even that that that's still tough You know, I've seen these types of surgeries take three four hours now again We've got newer techniques and I'll go over some stuff that we're doing now Yeah But the older version of this was to do a big open incision to find it and put screws in it The problem you have is a really small piece of bone.

It doesn't work And sometimes you damage things and a lot of people still do it that way and they struggle. And this is one of the, one of the hardest shoulder injuries [00:08:00] to fix. And so the fact is that he got this is not ideal. And then with newer techniques, we're much faster. And in the last few patients I've done of this have done quite well, but it's a bad injury.

And the number one thing I'm worried about in him is this. Again, I've had lots of wrong predictions on these players because they're superhuman, but he's going to have to have the bone fixed and the labrum, imagine like it's all going to have to be rebuilt. And I'm assuming he's going to get a surgeon that can do it arthroscopically because that's really the way to go.

I mean, doing this open, the results are just, they're not the same. You know, my patients, now I do it all arthroscopically through scopes. It's a lot more technical. But I can do it more efficiently and I get good results and keep that bone up, but I just don't know how he's going to get it done. And I'm assuming he's going to go to someone incredibly good surgeon because he's obviously getting opinions about this, but the problem is stiffness.

And a stiff shoulder in a thrower is a career ender. So I don't know if that's going to be the case. Again, I [00:09:00] don't know how bad this was. But this is really concerning because I worry a lot about a thrower when I have to do a labral repair like this. Okay,

Will Sanchez: so let's go back to what you said, right? So...

I'll start with the last thing you said. Stiff shoulder. Now are we talking about just stiff shoulder after the after the surgery? Or are we talking about something that can stay with that person, athlete, whoever it is, to have a stiff shoulder and not regain the mobility that they had in that shoulder at one point?

Dr. Grant Garcia: That is a hundred percent correct. So it's, the answer is it's not, it's, this could be more of a permanent situation. This bone heals very well. I mean, it'll heal in the wrong zip code. I've never seen one of these not heal, whether it's healed inappropriately and they come to see me at two or three months or whether, you know, once, if you wait six weeks or more on this, the person doesn't get a repair anymore.

They have to get another procedure where we actually move a piece of bone to the front of the shoulder. So it tells you how quickly you need to act on this type of [00:10:00] injury. And then at that point, if you fix them, there is a chance cause you have to, you have to take tissue and fix it back up. You can stiffen the shoulder up.

And one of my number one concerns with this injury is the stiff shoulder. A regular labral repair is different, but generally if you have to do something urgently. surgery urgently. That's never ideal in a situation with any knee or, or shoulder, right? If we have ACL tears, we usually want to wait. There's a lot of data that shows we should wait between eight and 11 weeks after an ACL tear because of the fact the knee is really stiff, unless it's an emergency, like a piece of meniscus is stuck or something else, but those patients are at much higher risk of getting a stiff knee.

This is the same way with the shoulder. And on top of that. You have a massive healing response because the bone in the shoulder is so well, so much blood supply and it's a really high risk of instability, a really high risk of your shoulder getting stiff. The good news is This type of injuries, patients have a much lower chance of re dislocating their shoulder [00:11:00] or re injuring it.

But the stiffness is much more of a concern with a guy that's, you know, what is it, 230 million contract? Yeah. So I'm pretty concerned about that.

Will Sanchez: So, some, just some, the cliff note version is this is gonna heal real fast for the most part because of the location, the blood flow. The biggest concern besides the...

is where it heals in that placement, right? And, and if it heals, starts healing in the wrong place, is that something that if it doesn't heal correctly, you have to go back in and then do a different procedure to try to put it back where it belongs?

Dr. Grant Garcia: Yes, but that's usually if you don't fix it, like the surgeon that he's going to have to do it will likely fix it back to the right spot and keep it in there, and now it doesn't always hold perfectly because these are really tough.

I mean, imagine you're trying to hold, imagine you have the side of a deck, I'll try my best, and there's a, you have a little tiny post on that deck, but it's really loose, and you can only fix it with a few little, you can't fix it [00:12:00] with a screw. You can't fix it with a big mount. You can only fix it with a few toothpicks, and that's essentially what you're doing here.

You've got to fix it the most delicate way possible so you don't break the piece of bone because it's so thin, but you want to get it to hold up in the pedestal. So we have new technology using Arthrex technology and other technology that we actually use that we now can fix it without using any, any screws or anything like that.

So I can do this all minimally invasive. I'll give you a picture of one of my One of these patients, you'd never know they did surgery on them because everything is hidden. It's all these really minimally invasive, really low profile, brand new sort of anchor constructs, but it's still the concern is the stiffness that we talked about.

Will Sanchez: What is something that a surgeon would have to look for when you're putting, let's say, these suture anchors in if, most likely doing orthoscopic? Is it the amount of tightness, or putting it in the right place, or am I just kind of overthinking this at this

Dr. Grant Garcia: point? You are not overthinking, but the hardest part is just getting this piece fixed back.[00:13:00]

Because this is gonna, it moves around, it's very challenging. You know, this is one of those ones that we if... The listeners want to check out the website. I just posted a brand new video on actually how to fix this Which is why I was so interested in talking about this Yeah, because I was just talking about this topic and showing some people the new technique we use But you know you want to see how you fix one of these arthroscopic glenoid fractures I will when we do this post I will post about my website link so you could take a look at it but it's just a really interesting injury pattern because it's also, it's really uncommon.

You know, I see a very high volume of shoulders instability. Maybe I see over 100 to 150 patients that have unstable shoulders a year and probably have to operate on 75 of them a year, 80 of them. I see probably two or three of these a year and I have to get referrals from them from all around the area.

So if you imagine how uncommon this is in comparison to regular injuries, it's pretty low. Some surgeons who, you know, a lot of my patients come for second opinions for these and when they see another surgeon, [00:14:00] some surgeons that, some of these surgeons say, I haven't seen one of these in three or four years.

So if it just shows you how uncommon, how difficult, it's kind of a, It's kind of a nasty combo. Now again, if you know what you're doing, you can get good results. So I don't think that Deshaun Watson is going to have a poor result. I hope he doesn't. But nonetheless, it's something that people should be aware of because this is not just a standard injury.

Will Sanchez: What's normally the injury or... The action that the patient is involved in when you normally see these type of injuries in the shoulders is something that's like, if you do this, this is a common injury for that, whether it's a sport or falling on your shoulder, skiing or what, is there anything that's common or it's just kind of random because it is a random injury as, as it is.


Dr. Grant Garcia: this injury usually comes with a shoulder dislocation. So the person arms outstretched all the way back, like a cocky motion, like a throwing motion. And that's when it could come out. The last two though, randomly I had one guy was in the middle of a. Was in the middle of a park, got his [00:15:00] arm caught on a bush, 10 miles out, and had to, had to limp home and drive for 4 hours into my office.

Oh my lord. So that just gives you an example of, and that gives you an example of it just comes randomly. You know, I had one person that fell on their bike, one person got hit by a Amazon delivery truck. So, you know, I, there, the, the, the, the the injuries are different all over.

Will Sanchez: I'm sorry, I'm sorry for laughing.

Dr. Grant Garcia: They're doing fine. They're all doing fine. But nonetheless, for just for the, for the listeners, really just to understand the injury and the differences in it. And again, maybe we'll look back in a year and Deshaun Watson will go on to win the MVP next year. And I'll be wrong again. But even though it heals fast, we're still looking at a solid five, six month recovery for him.

So this is not something that is going to be quick fix. And he's gonna be back. I mean, hopefully next season but we'll see throwing shoulder is not ideal.

Will Sanchez: : If everything goes right, is there still any concern, right, I'm thinking about a quarterback here, and throwing a football, of a range of motion, is there any [00:16:00] concern, or because it's in the throwing shoulder, it automatically becomes a concern, no matter what the results of the surgery is?

Dr. Grant Garcia: : I would be very concerned if I were the Cleveland Browns, because of the range of motion. I mean, that's the only thing I'm concerned about, like we had mentioned before, when you fix labrums labral tears, just the one he probably has, he has a labral tear and a piece of bone that broke off. They come together, kind of stuck together.

So just the labrum repair it alone, even throwers do well, but those are still concerning. This is a piece of bone and that, and it's at a much higher risk, it's got to get fixed so quickly. It's not like he tried to play through the season. It's not like he got his motion back. I mean, we're talking about this.

He's probably getting surgery in the next week and if he's not, I'm surprised. But once they made the announcement, I'll be getting surgery in the next week. I mean, you want to fix these within the first two to three weeks.

Will Sanchez: : Yeah. If you can. You know, I, I think about football players and I think about football pads working out, throwing a ball, getting hit by 300 pound men, [00:17:00] multiple 300 pound men.

Are we, is there concern with continuous pain with a, with an injury like this, or if everything heals right, it's just going to be the normal pain of getting hit by a 300 pound man?

Dr. Grant Garcia: :Yeah. So the there's not a lot of good long term data on an injury like this because there's so uncommon, but what we could tell you is at any time you break that joint surface, your knee like a fracture of the knee or a fracture of the elbow or a fracture of the wrist.

You, no matter how good the surgeon is, they don't always put it back exactly right. And hopefully they do. And even if you get it perfect, they're still damaged the cartilage and the cartilage doesn't like to be damaged. It doesn't like to be separated, beaten up, pulled back. It just doesn't like it. So his risk of arthritis in that shoulder is significantly higher as a result of this injury.

He won't feel that pain for a long time. And he may not ever feel it, but nonetheless, that is what his risk is. Short term pain [00:18:00] with this, it tends to be very minimal. You know, my, my patients are happy with the result, but my patients aren't Deshaun Watson. Yeah. When, with this injury, I mean, I don't, can't think of the last athlete I've had with an injury.

I've had football players with a small bony bank cart. But if he took off a bigger piece of bone, that is concerning. But again, I wasn't there. I don't have the x rays that are on the CT scan. Yeah. But I think it's good for the, for the listeners to hear the different levels of this injury and what this means.

But the, you can imagine, this went from like, Oh, we don't know. This is okay. He played through the thing. Now he gets surgery. It's done. You know, there's not even a question,

Will Sanchez: :man. Obviously we know he's going to rehab the hell out of it because they're just programmed to just kind of work all the time.

That's usually that, you know, we've had these discussions on many shows that that's the main component after you've, you know, rebuilt and fixed the patient. And we had the discussion with our physical therapist that the next step is the rehab just [00:19:00] to kind of give. Some context, if it was just kind of like a regular, you know, John Doe walking into your office and they had this type of surgery.

What is a similar kind of rehab or exercises that you're now looking to do to fix the shoulder, stabilize the shoulder, strengthen the shoulder, and trying to get back to some normality?

Dr. Grant Garcia: : Yeah, so the, the problem with this injury is if you have a regular labral repair, you can move someone pretty quickly.

Yeah. You know. Sling for a week or two come out of it really quickly get motion back and we're getting more and more aggressive the better Technology we have they've got to fix a piece of bone and the bone takes about six weeks to heal So if you imagine he doesn't want to overstress his shoulder so quickly Yeah, but you want to get the motion back?

But if you get the motion back too quickly, you can pull that piece of bone and break the entire fix It's a catch 22 and so, you know, he may get repeated x rays, he may get CT scans and check and make sure he's not moving it. I don't know what level of overkill [00:20:00] they're going to do to check them. Or they may say, Hey, listen, we'll get it good enough.

Even if it moves a little bit, you're going to be stable. You're not going to have pain. So I'd rather you not get too tight and you can throw again. So I don't know what they're thinking. Per se, if I was, if I was taking care of him, I'd probably give him a little bit more accelerated protocol than my regular patients.

He's also really, he's still a young man, so he's going to heal really fast. I mean, I would tell you half these injuries are, are usually in patients over 30 years old and so they tend not to heal as fast. They still heal well, but they're not as fast. He's younger. And he's a super athlete. And so, probably better to get him going sooner.

Is it enter risk is this place pulling off and not healing and having further issues is a pretty low risk him getting stiff is a pretty high risk. So if you're thinking about how we determine what someone should do for their rehab, we try to, yeah, well, that's the way it works in life. You know, not all my surgeries are, they're, they're custom approaches.

You can't just, every person's [00:21:00] different. And so he's going to hopefully get a custom approach. You know, so he's going to start strengthening at six weeks. Like, our goal is hopefully that four, you know, five to six month mark, but he may get, he may start throwing sooner. Who knows? I mean, there's no way to do an internal brace in him, but who knows if they'll try it.

You know, for just to make you happy. Well but the but nonetheless, you know, we've seen freak and we've already seen freak recoveries with Aaron Rodgers thrown out of the field. So maybe he'll prove me wrong.

Will Sanchez: Everyone should get an internal brace. I'm just saying it's everyone, you get an internal brace and you get an internal brace is like Oprah, like just giving out internal braces everywhere.

Looking ahead. Right. And obviously there's no way for you to determine, because obviously you're not, you're not going to be with Deshaun Watson with their team. You haven't seen you know whether it's. MRI results and going forward because pretty much you're telling me they're going to get in there, they're going to fix it, try to do a great job and then monitor and then try to maybe fast track it without injuring it so we could, you know, be aware of stiffness, try to get some mobility and [00:22:00] then work your way up.

So there's, this seems like there's all these different levels. And the only way to do that is to monitor the situation constantly, which obviously they're going to have the best doctors and try to. Tech, their monstrous investment of a player going forward, but training cap, it's in seven months. I know this is crazy.

I know we're in football season right now. We're kind of holidays are coming along and everything else, you know, you're throwing the ball, you know, June is one of the things we saw Daniel Jones get injured and how long he's going to be out seven months from now, throwing an NFL ball, is it? There's, is it really no way to determine what the result's going to be and, or I guess maybe the better question is, what would be a concern for you if in, let's say, four months from now, Deshaun Watson is not doing what?

And then that might determine whether they're going to be ready for the next season or not.

Dr. Grant Garcia: I just [00:23:00] think if he's not throwing the ball yet, I mean, you, the thing is he's going to probably have to wait. I mean, it's, this is, a thrower is different than any other athlete we deal with. This is the hardest of all the things we do when it comes to a shoulder injury.

For me, my hardest thing in the, in my office is dealing with a pitcher or a quarterback that injures their shoulder with a labral injury. So this is the hardest thing in terms of surgical outcome. Because you just don't know what they're going to do. And we've seen better and better results. And our, our results are getting better.

Our data is getting better. But you just don't know. And so I, you know, I'd like to see him consider start throwing at four months and hopefully that seven month mark he's rocking it and whipping it and accuracy is there and everything else. Yeah. But if you're five months out and you're not seeing him try any throwing, you should be really concerned because they're clearly trying to figure something out now again.

I don't know. We'll see how it goes and maybe he'll be on the field throwing balls at two months and everyone will say, Dr. Garcia has no idea what he's talking about, but we'll see. [00:24:00]

Will Sanchez: Hey, we say that already jokingly. lIsten, everybody get an internal brace. Ask, ask Santa for it and put in your stocking stuffer, whoever you're asking for.

Everybody stuffers. It's just going to make life a lot easier. Anything else as we wrap it up, br>
Dr. Grant Garcia: Dr. Garcia? Now I just want to make sure the listeners learned about this injury. It's very interesting and really when you see that you're saying Oh, what the heck happened? He broke his shoulder, but the good news is it's not as bad as what we a lot of other injuries We see people that fall off ladders, etc Yeah but it's a unique injury to an athlete such as this and people should know what the outcome is and the surgery and this is Not gonna be a chip shot.

So they get him back next year on the field Kudos to those

Will Sanchez:surgeons remind everyone to check us out at sportsdoctalk. com. We've got some great content there. And we always remind our listeners, there's transcripts of our shows. So if you don't want to listen to, to us, then please read up [00:25:00] on us. We've got some great information.

Remember we're talking all sports, all orthopedics, all the time. I'm Will Sanchez and Dr. Grant. Garcia that gets extremely excited sending me text messages when people get hurt. Only, only Dr. Garcia can love you a certain way. So Dr. Garcia, thank you so much for your time and everybody out there. Thank you for listening.

Dr. Grant Garcia:Thank you guys.
Audio Transcript


Football Injuries and Innovation: Grass vs Turf and 5G Heads Up Display Helmets

Football Injuries and Innovation: Grass vs Turf and 5G Heads Up Display Helmets

Will Sanchez: [00:00:00] Listening to Sports Doc Talk. I'm Will Sanchez along with Dr. Grant Garcia. Like always, sports, orthopedics, all the time. This is what we do. This is what we love. And we love talking with you and just talking about the things that we really care about. Before we get into our show topic, let's welcome in Dr.

Will Sanchez: Grant Garcia, our orthopedic surgeon and sports medicine specialist. And just a reminder, check us out at sports. talk. com. Dr. Garcia. How are you this, this beautiful fall as we get ready for the holidays. Is everyone excited? I know you got some little ones running around the house. Are they starting to get the excitement of the holidays coming around or is this a little too, still too soon?
Dr. Grant Garcia: They're excited. You know, the. It's my daughter's birthday before the holidays, so she's, she's way more into that than the holidays yet. So once that passes in early December, then the holiday rush will come. Once the, you know, once we get the tree up [00:01:00] and everything else, people tend to get, the kids tend to get more excited.

Dr. Grant Garcia: But we're good. Yeah, no. End of the year is crazy though for orthopedics, so it's hard to Get super excited about the holidays. Yes.

Will Sanchez: Now, I'm going off topic right now for what we're about to talk about. But do you tend to see some of that uptick, one, because people are starting to do activities that they haven't done since maybe last winter?

Will Sanchez: Or two, they're trying to get some things done, you know, whether it's insurances or trying to get certain things at the end of the year. Or is it a combination? What has been the pattern for you that you've noticed with patients coming in?

Dr. Grant Garcia: So some patients may know this, but basically the worst time to get surgery by North Peak Surgery is in December because it's the busiest because everyone has their ductible.

Dr. Grant Garcia: And so they meet their ductible and then they decide to like, okay, I'm going to get my knee done. I've been waiting two months and waiting six months and waiting a year. So December is the busiest time of the year for pretty much all my partners, um, right before the holidays and up to basically patients will be, you know, they'll be asking for [00:02:00] surgery all the way till I've done surgeries as New Year's Eve.

Dr. Grant Garcia: Oh my God. I want to get done before the end of the year. So the yeah, the end of the year is a big deal. As a sports surgeon, unfortunately, as we know, ski season's coming up and so that's a. That's a different level of busyness, but the end of the year is always the busiest time of the year. You know, we all prepare and staff prepare for a higher amount of cases.

Dr. Grant Garcia: It's just busier. All right, so let's all

Will Sanchez: insurance related. Yeah, you know, it sounds like it and I know personally for myself I used to snowboard a lot and you know, I've been far enough removed where I'm going Yeah, you're starting to get a little too old for that. Not so much getting too old for that But the fact that I've haven't Snowboard in over a decade and now I'm just like I feel like I'm gonna go out there.

Will Sanchez: Something's gonna happen utilizing muscles and I'm not used to doing and used to carving and things like that, but Like I said, we're getting way off topic about what we're going to talk about today, because what we're going to talk about today is really an underlying [00:03:00] theme that's been around for a long time, and it finally seems to be at a heightened state, especially the last year in football, and that's been the argument between turf and grass, and that's the topic that we're going to get into today.

Will Sanchez: We're going to talk about the differences of the turf, Turf, grass, and maybe what kind of roles it plays when it comes to injuries, non contact injuries, and so on, so on and so forth when it comes to that. So, real quick, Dr. Garcia, what are your thoughts for someone that is an orthopedic surgeon that has been a part of professional teams and high school teams and seeing all these different, from the professional player field to just, you know, the high school field.

Will Sanchez: What are your thoughts initially when you hear the topic of turf versus

Dr. Grant Garcia: grass? I mean, the first, the first thing you're thinking of with this is, you know, this is [00:04:00] a, this is one of those ones where this is a open box and it's, it's kind of, it's an underlying theme, obviously, I think in football, if you look at it, because It's really the debate is grass versus turf, but it's also players versus owners And there's a huge cost factor in here that I am not saying is related to why the decision is to do grass versus turf but we're preparing for this episode.

Dr. Grant Garcia: I mean it really opened my eyes to sort of the differences and You know, what what are these sort of conundrums and you know, you hear the players, right? Someone gets hurt on the field, a non contact injury. You know, Odell Beckham Jr., a couple years ago, you've got, you know, there's just a plethora of players that have gotten hurt, and they all say it's a result of the turf, right?

Dr. Grant Garcia: And the Players Union is talking about that. But then you have some studies that show, you know, there's maybe no difference, and maybe those were earlier studies. And you always have to be careful in like, who's the bias here? And understand all these different things. But I think the audience is going to just enjoy hearing about...

Dr. Grant Garcia: You know, what goes on with that debate and then the [00:05:00] preparation, right? Because, you know, I didn't even know anything about that there was, there was, they were looking at the quality of the turf and they have to have a certain criteria in order to meet that in order for the game to be allowed to be played.

Dr. Grant Garcia: And the same thing with grass. So, you know, this is a really interesting topic and it's, you know, we're not going to solve it today, but hopefully we get more information. And there may be a little bit of bias opinion here, but again, I'm also somebody who doesn't, as much as I, as much as I make my living off of injuries I have no interest in people having more injuries.

Dr. Grant Garcia: And so I do think it's important for people to understand the differences.

Will Sanchez: 100%. Just to give context, there are 32 NFL teams in the NFL which means that there's 30 stadiums, two teams share. the stadium. You know, we're fans of the Giants. They share the stadium with the Jets and the Chargers and the Rams share their stadium in L. A. So there's 30 NFL stadiums and right down the middle, 15 of them [00:06:00] use grass fields.

Will Sanchez: The other 15 use some kind of synthetic turf. And last year, the NFL P. A. president, J. C. Tretter, called for a ban on specific turfs, especially what's called slit film turf. It's citing safety concerns. And this type of turf has statistically have had higher in game injury rates compared to other surfaces for each of the following, right?

Will Sanchez: The non contact, missed time, lower extremities, foot and ankle injuries. So let's start right there. When it comes to non contact injuries, that is something that As a surgeon, that piques your interest right away, right, because those usually tend to be, and correct me if I'm wrong, the more serious type of injuries that you can sustain.

Dr. Grant Garcia: I think it probably depends on what you're thinking of, but I think that yes, I mean, you see those non contact injuries, you know ankle sprains. You know, ACL tears, I mean, there was [00:07:00] a number of times when you see a player run on the field, usually wide receiver someone open field, you know, it's pretty hard to get a non contact injury if you're kind of in the center of the line and you'll see them twist and grab their knee.

Dr. Grant Garcia: So it's a kind of a, it's kind of a combination of those things, you know, the, the contact injuries like Nick Chubb suffered. You know, that was pretty gruesome and that's a totally different animal. So you know, they tend to be just a different, they just a different look to them. They're just more worrisome to me because.

Dr. Grant Garcia: You're trying to figure out what happened, right? You're just, you know, when you see someone just get clobbered and then he goes in another direction, or their hip goes a different direction, or their arm goes a different direction, or whatever, we don't want to, you know, go into too many details, you know, you kind of know what happened.

Dr. Grant Garcia: But when someone just tweaks, runs on the field, twists, and then all of a sudden go down, you're trying to figure out, you know, that's a, that's a, that's kind of a conundrum. You're trying to go, immediately go look into what's going on.

Will Sanchez: This might be a stretch here, but... Have you noticed or in your profession, a higher tick of [00:08:00] injuries from turf to grass, or it's just, is that just too hard to really kind of realize or, you know, having asked that question with your patient From what you've seen from, you know, players coming in, whether it's soccer, football, lacrosse, you know, because especially I guess at the high school age, they're probably going to play more on turf fields because of the cost savings for these stadiums compared to maybe some of the other fields that are happening, you know, at the You know, the city park or something like that,

Dr. Grant Garcia: I think that's important point.

Dr. Grant Garcia: So, you know, I'm not asking him. Unfortunately, when you're in the office, you know, did you plan grass or into yourself on turf? But it makes more sense to me, right? The idea of grass more give, right? It can rip apart, it can pull, and if you have these thick cleats on, you're still going to kind of make some turns.

Dr. Grant Garcia: The turf, as much as we always try to have the word synthetic and more natural, it's not going to rip. It's supposed to be [00:09:00] longevity. I mean, you can't design, grass is not high longevity. But turf is, that's why it looks so good all year round, no matter how much they try to make it and put, you know, tire chunks in it and all other fancy stuff.

Dr. Grant Garcia: And again, I don't even know all the different types of turf, I'm not a turf expert, but, you know, it makes sense to me that there would be more injuries on it. And especially injuries that require very, you know, precise movements or these sort of small tweaks. I mean, we've seen this already in the sense that more recently there are, they are a higher number of foot and ankle injuries found.

Dr. Grant Garcia: And there's been a couple of studies which we'll talk about but with I think the point you brought up That's really important for everybody to understand and say, you know, why does this matter? Why is this not being fixed? Well, the word cost is real. Yeah I mean I was hearing about this and I think it's well, I mean we may talk about this or not But you're talking about you know turf field to maintain to put in It's moderately expensive, but it's not very hard to maintain.

Dr. Grant Garcia: The grass can be, you know, upwards of two to 3 [00:10:00] million. And, you know, you have these owners who don't want to spend more money and would rather have the money be profits versus using all grass. But what the interesting statement is when we were doing some research on this is that the grass now and all the technology grass can be done at any level.

Dr. Grant Garcia: Right. And I think, I think a few of the places like green Bay, who you'd imagine would not be able to handle grass or places like. Miami or whatever that can't have grass because of the heat, they both maintain them. So the weather is not a factor anymore. And so there's really, really the reason I think is because it's harder to maintain and more expensive.

Dr. Grant Garcia: But then again, you're, this is my own opinion.

Will Sanchez: No, let's keep it real. That's exactly what it is. I mean, let me, let me, let me grab a quote from Tiki Barber. He he mentioned this on his his radio show about two weeks ago. And this is his quote. He said, Whatever the cost is, isn't that worth the maybe 500 million of salary on your team?

Will Sanchez:[00:11:00] You are putting that investment in each player at risk every time they play on this terrible surface. Barbara explained on that Monday, every single week, I feel like someone is getting hurt on this turf. If the giants and the jets are serious about player safety and the NFL, they have to change that turf to grass.

Will Sanchez: : I don't care how much it costs. It's worth it in the last player's salaries, paying guys to be on injured reserve and just. For the non football fan out there, Tiki Barber is a former running back, great from the New York Giants. He has affiliations with the Giants, he works with the Giants, he works on their flagship store, he has relationships with the owner, John Mara.

Will Sanchez: So he is really kind of putting himself out there, this is not coming out of left field from someone that's not, that... It doesn't have insight. So this seems really, really personal and, and kind of a reach out there to the owner [00:12:00] to say, Hey, you have to get this done no matter what the cost, because the cost of losing these franchise players are going to cost you more.

Will Sanchez: What do you think about when you hear that quote from Tiki Barber?

Dr. Grant Garcia: I think that's an incredibly good point. And it also makes the question, you know, why have we not done this? And I know that. The problem you have and we've talked about studies on this. This this show and how they can be really, you know, challenging and they're always a little bit biased one direction or the other.

Dr. Grant Garcia: And there's statistics we have to look at, you know, if you have the same study being done multiple times, which we can talk about that 1 we were mentioning previously, you know, recently showing a significant uptick in foot and ankle injuries with artificial turf. They're not lying. And you have players arguing for it and you're absolutely right.

Dr. Grant Garcia:: I mean, we all talk about this, you know, why do I do certain treatments on a professional player? That's different than I do on a regular natural athlete there. Unfortunately they are paid more [00:13:00] money. And so as a result, even if they miss getting back one game earlier, it's worth the more expensive treatment or the out of pocket expense.

Dr. Grant Garcia:Because I want to get them back. But if I get back one week earlier, or you get back one week earlier to your, you know, our day jobs, it's not the same financial difference. And so, you know, these, these guys being out and being paid on injury reserve. You're absolutely right. It's not that expensive to put grass in and maintain it compared to one of your best players or a combination of players.

Dr. Grant Garcia: I mean, even one or two players that are making two to three million dollars a year, which is probably, it's considered low for the NFL. You know, if they are an injured reserve, that already pays for the grass. And so it's, it's, it's kind of a silly thing. It's almost at this point now, an ego thing, I think.

Dr. Grant Garcia: And just sort of like, that's the way it's been done. Right. And these, and obviously it makes it easier for them. It is a lot of hassle. They have to change it over all the time. But at the same point, it's not like there's only one or two teams doing it. Half the teams already have graphs. And so I, I, and I, I think that his [00:14:00] quote is excellent.

Dr. Grant Garcia: He's got good insight. Again, he's not a statistician, he's not a grass master, he's not a turf master but nonetheless you know, he's done this enough that I would really trust his opinion and he cares for his players, but he also cares for the Giants. So for him to say that, it's a, that's a big

Will Sanchez: deal.

Will Sanchez: yeAh. And we're talking about a player, like I said, for, for the, the listeners that don't know who he is. He retired at... The height of his football career, he led the NFL or was the second leading rush in the NFL when he retired and he retired because of the fatigue that he felt that, you know, it's getting beaten, beaten up on Sundays by players, but also landing on turf and for anyone that's ever played right now, I'm not just saying football, soccer, anything.

Will Sanchez: When you fall down, we look at, we look at them, they fall, they get up. Yeah. That hurts. Those fields, those turf fields hurt. It's like it's [00:15:00] just falling down on something hard, and it's just it makes a big, big difference. I want to put in context because. If you're looking on a grand scale around the world, the biggest game around the world is soccer.

Will Sanchez: And the biggest league is the Premier League. And just to give you context, their football, they call them football pitches, you know, as far as their field. And stadiums opt for a high quality, hybrid, grass. system in that hybrid grass system, which the NFL does have for their grass fields, especially in Arizona, right?

Will Sanchez: We go back to these weather you know, hot weathered states or cold weather states. They using this hybrid grass. They use about 95 percent of this hybrid grass with then it's reinforced with like this artificial turf fibers like the other 5 to 10 percent depending on the quality of grass. So if you If the premier league, [00:16:00] which is at, like I said, at the highest level with the biggest sport in the world, this is what they're doing for their players because they pay them a lot of money.

Will Sanchez: Maybe the NFL should take a page out of that. and put that into their stadiums because these players have been asking for grass fields for quite a long time. Dr. Garcia, when it comes to high schoolers playing that have no choice and they're playing on turf fields, what are some of the concerns or have you noticed concerns besides injuries?

Will Sanchez: Is there uptake in concussion or anything like that from hitting these hard turfs? Or once again, is this something that You know, if you don't ask the turf when you have the communication with the patient, it's hard for you to really know.

Dr. Grant Garcia:I mean, I think this is a challenging and sort of loaded question, but I'm used to it on this show.

Will Sanchez: Yeah, yeah, yeah. I know, I know.

Dr. Grant Garcia: My bad, my bad. No, it's okay. [00:17:00] So basically, you know, we're talking about costs again. So you did Premier League and the NFL. These are where money's no matter, and the word multiple millions of dollars get thrown around like it's just candy. Yep. Right? This is different than the high school team.

Dr. Grant Garcia:And you know, again, I take care of Marshall High School. We have, you know, reasonable funding, but we do not have NFL level funding. And so to have a grass field, especially in Seattle, would be a disaster. And so the artificial turf is nice because even if it rains, it doesn't, it's not very slick. Yeah. But I do worry.

Dr. Grant Garcia:I mean... There's, we know there's an uptick in concussions. We know there's an uptick in injuries in general because players are getting faster and you have these mismatches, especially in high school. I mean, it's almost more of a risk, right? Because the, some kids haven't gone through full puberty yet, et cetera.

Dr. Grant Garcia: But I do think that, you know, when I see those players hit those the turf. Field, it looks harder. It looks more comfortable. You know, I myself have played on fields like this before. And it feels different. Now again, it [00:18:00] depends on the weather, whether you like it or not. But, you know, it's but again, in the lower levels, there's no choice.

Dr. Grant Garcia: It's just, it's just without a doubt, the upkeep. The ability to keep it good quality, because again, we're talking about good maintained grass, but we're not talking about poorly maintained grass versus turf, because I imagine a poorly maintained grass is probably a much higher injury rate than turf.

Will Sanchez: Yeah, and some of these turf fields are as you say, not in great shape.

Will Sanchez: They're kind of coming off at the seams. I know Magnuson Park, which is in Seattle, it's a big park out here. They have a couple of fields. One of them is in excellent shape. They changed it about two years ago. And they have another one where I've seen rugby games being played. It's coming apart, and I think they finally closed it up.

Will Sanchez: So I'm assuming that they're going to start working on it. So even some of the turf fields, it makes it even worse if they're not in great conditions, but you know, like you said, those are the situations. There's only but so many fields out here and [00:19:00] you know, you just kind of wish that you know, things could be a little bit better, but it is what it is.

Will Sanchez: As we wrap up the turf versus grass conversation, I'm going to be a little cynical here, but I'm feeling kind of that way. I'm, this is the week I'm kind of having. So I'm going to go, I'm going to go a little cynical here and say that. I think also you take it with a grain of salt when I think about these owners, maybe being hesitant to change right away and give the players what they want.

Will Sanchez: I start to think about negotiations and give a little and take a little and we'll give you this, but we want that. And you know, we got 17 weeks. We will love 18 weeks and we can do this if you could do that. Like I said, I have no idea, no justification, but we know. This is a business and businesses with owners and players is a give and take type of situation.

Will Sanchez: So I'm not saying that that's what the case is, but there's always that little voice in the back of my [00:20:00] head because I'm playing cynical this week that that possibility may be there.

Dr. Grant Garcia: I think that's an excellent point. I I think you I think you may find out sooner or later you may be more correct than you think.

Dr. Grant Garcia: Well,

Will Sanchez: I'm hoping nobody comes knocking on my door. I'm not that, you know, let's, let's make sure we don't have Goodell's goons coming after

Dr. Grant Garcia: me. Well, you, you know, you've hit it, you know, you've hit it big on the podcast start knocking on

Will Sanchez:your door. Alright, let's, let's make sure we don't hashtag the NFL when we release this.

Will Sanchez: All right, let's go to a great story. I was really excited about this. I saw this a few months ago, and then I'm watching Sunday Night Football, and there it is. There's a commercial by AT& T, and I was like, this is amazing. I was talking with Dr. Garcia about this. We said, next show, we're going to talk about it.

Will Sanchez: Sure enough, commercial on Sunday Night Football, and this is their AT& T 5G helmet with which is, which has been AT& T logo. Used this year on October 7th at [00:21:00] the Gallaudet University, This school is for the deaf. And they have a football team. AT& T created this helmet that they can utilize and it has a screen in front of their helmet, a clear screen, where the coach can put this information, the play call, the quarterback can see it, and the rest of the players, and they know exactly what's going on.

Will Sanchez: So this is really a game changer. Before we get into all that, what are your initial thoughts on this type of technology that's out there and how do you think that can benefit you?

Will Sanchez: Because we always talk about technology in your field and what can you see as a next level for this type of technology?

Dr. Grant Garcia: Well, in the interest of time, I won't get too excited about this, but... They know this when I saw this and you showed it to me. This is a this is pretty impressive technology I think it's good for the audience to hear about it I mean the ability for these deaf players to be able to see the heads up display screen And see it in [00:22:00] action plus the idea of the 5g helmet having all the communication signals I mean remember the old shows when people were trying to tap on their helmet because they couldn't hear the play call Yeah, it sounds like this is completely new technology And so this is really interesting to see because we always talk about concussions and helmets But not really what else that can be brought into them and the ability of this to sort of run new plays or especially for some of these players that go you know even in the nfl level but college, you know high school when you're learning the place To have one of these heads up displays, especially for some of the wide receivers, et cetera especially if you, you know, you just started on the team and you haven't been able to chance to learn them all.

Dr. Grant Garcia: That's pretty awesome. You know, a lot of times we use, you know, in our high school, we use signs and things like that to show them, but to have this sort of technology with this helmet built in I think it'd be a game changer in terms of just being able to do more plethora of things and keeping everybody organized.

Dr. Grant Garcia: : For my work, we already do some of this stuff, and this is pretty awesome. You know, this heads up technology slash virtual reality is kind of a coalescence together. You know, when I do some of my surgical [00:23:00] videos, I have some of this, I have this 4D or 4K head camera that I wear, and I actually have a heads up display in my eye when I'm operating, and I can see what I'm doing, so I know whether the picture is going to be good quality.

Dr. Grant Garcia: So I already do some of this stuff. And the new features we're talking about are You know, you get 3D mapping of the patient for shoulder replacement, and then you can actually see if you put the implant in and you can actually virtually put it in with your hands. Now, again, that technology is limited and there's different things, and this is going to be, I think, one of the next generations of technology for surgeons, because what we could do is get an MRI or a 3D, a 3D CT scan, so what it is is like a CAT scan.

Dr. Grant Garcia: And then it can, and then it basically will show someone's bones or anything in three dimensions, and you can spin it around in your helmet, essentially like having a computer right there that's sterile. And then it can also have part of your surgical plan. So as you're putting things in, it will show you if you're doing the right orientation.

Dr. Grant Garcia: They already do a lot of this guidance, sort of 3D modeling and spine surgery. And we're doing it in a [00:24:00] lot of other places because we've noticed that the precision that we can do things is even better. So you have a highly trained, skilled surgeon. With incredibly high technology, it's just gonna, it's gonna make your surgeries better, more precise and faster.

Dr. Grant Garcia: And the less time you're under surgery, the better you do. It's just, there's no doubt about it. You do a good surgery, but you're also efficient. That is the best case. And I've seen in surgeries when I have really efficient surgeries over time as I've gotten better and better, I've seen that my patients are doing better and better.

Dr. Grant Garcia: And I'm doing maybe the same surgery, you know, the exact same thing from the year or two before that. But as you get more efficient and you have less time under anesthesia, it just makes more sense. And so, you know, this, all this technology is only going to help patients, which is pretty awesome. And yeah.

Dr. Grant Garcia: I think that you see technology in the higher level for the for football.

Will Sanchez: How do you see this as a teaching tool? Let's say Dr. Garcia, you know you know, a few years from now where maybe he's now teaching the young bucks, the young men and women of the [00:25:00] future surgeons, and you. sitting there as a proud papa and having some kind of technology like this that you can sit there almost kind of like a coach and guide them through something like this or maybe something beyond even our thought process.

Will Sanchez: You know, this is stuff I think about. I'm like, just besides what you're doing right now, but how can you use this as a guidance or a teaching tool going forward? What are your thoughts on something like that?

Dr. Grant Garcia: Well, I hate to tell you that there's actually more reality than you know right now. So, you know, I do some of this stuff, again, we used to do it with the avail system we had talked about previously, where the camera system was in there, we went live and I'd done a few of these from my operating room, where I would teach people how I'd do something and show them it.

Dr. Grant Garcia: And there are certain companies that if you need to learn a new procedure, the surgeon will actually bring in, you'll have a camera come in and do a sort of video live for you so you can, they can help you walk through or you can watch them in the operating room through this type of situation. But the newer technology, which is really not there yet, it's hard.

Dr. Grant Garcia:Even the camera system I use is quite [00:26:00] technically challenging and it's not the best system out there. It's just pretty good. There's just nothing like it. Yeah. But really the next step I think is. You have a head camera on it's a great camera. It's really you don't really have to think about it Because you don't want to have distractions in the operating room.

Dr. Grant Garcia: That's never a good thing but you have the ability to have this camera on and watch you It's guided by your head, so it sees your bird's eye perspective, which is really, that's the part that people can't see usually in the operating room, right? There's, in certain cases, there's only one person, even though there's a few people operating that can actually see exactly what's going on, that's usually me, the surgeon.

Dr. Grant Garcia: And so then I can do that huddled together with this, or a heads up display to see what I'm showing them, and then they can actually ask questions and you can teach. And so the answer is yes, this is a very early market for this type of technology, and this is going to be a game changer. Even in the last few years since, you know, residency fellowship and now surgery and then starting to build, you know, build a repertoire teaching other surgeons about certain techniques that we do in the complex [00:27:00] stuff that we do over here in Seattle now.

Dr. Grant Garcia: You know, this technology like this is incredibly helpful. It also saves a lot of time. I mean, it's a lot of effort for me to fly out to someplace to teach where I could teach directly from my operating room where I normally work anyways. Yeah. And so it's, it's really, it's better for all parties involved, lower costs too, because you're not paying for someone to fly out in hotels, et cetera.

Dr. Grant Garcia: It's just, it's overall better quality for everybody. And so that's really what's important. But you're also utilizing technology. It's like Zoom. But for surgeons,

Will Sanchez: which is pretty cool. You think besides whether it's the cameras or the technology getting better, but outfitting the operating rooms, whether it's having, , 25 mini cameras from different angles

Dr. Grant Garcia: It will. And it's also the push. It's the push for the companies who want to teach. It's the push for the surgeons who want to have that better perspective. I mean, hospital social surgery, where I trained, we had cameras, we had one camera and the lights. And so you could bring it over to right where you want it to be.

Dr. Grant Garcia: And so we have so many people that would come from all over the world to watch our surgeons operate because obviously it's one of the best hospitals in the world for orthopedics. Yeah. And we had so many visitors all the time from international that they would sit in the back and they could watch the whole surgery and ask the surgeon questions.

Dr. Grant Garcia: So you know that and that's that's what a lot of these new operating rooms and technologists do. We're more of a private practice so it's a different teaching facility but a lot of facilities nowadays they're starting to do more outfitting that right because you want to be able to see and people want to come in if they're going to shadow you.

Dr. Grant Garcia: : And watch, they don't want to see someone turned around talking and kind of mumbling. They want to be able to see the whole thing, you know. It makes the experience better, and [00:29:00] as we all know, you know, what you hear, you hear about 20%. But when you see it, it's a whole other animal. You're like, that makes perfect sense to me.

Will Sanchez: It's funny. I was thinking of like some old movie where the surgeon turns around and looks at, you know, the young surgeons that are coming up , , all dressed in white, I am now going to do this and, you know, turn back around. They've got a little you know, pencil and notepad and taking notes and things like that so thanks for that, that visual.

Will Sanchez: What do you think about the university and the football players? This university for education for the deaf

Dr. Grant Garcia: I Saw a video when they introduced the helmet, they introduced the technology. To them saying this is going to be available to you and said, man, I'm really happy for the kids that are going to college and playing football and, and having something like this. And I'm looking forward to the technology that's going to keep expanding and who knows where this kind of goes.

Will Sanchez: What are your [00:30:00] last thoughts on on this technology and just, you know, this 5G helmet that Gallaudet was able to use?

Dr. Grant Garcia: Well, I'm just really excited. You know, hopefully we can do another episode like this in a year or two and talk about, Hey, remember that episode we had on the 5G helmet from the, from the prestigious university in DC?

Dr. Grant Garcia: Yeah. Now look at it being used more. You know, these, we get, it's so fun that we've done this for so long now. You know, with the new rebranding of the show, but even our old episodes, you know, we've done this for almost what now? Three years? And we can now look back on episodes and be like, Oh, look how wrong we were, but also every once in a while we can say, look at all the cool technology we're talking about.

Dr. Grant Garcia: Look what it is now. I think this is going to be a good segue to the next few episodes, which hopefully our listeners will enjoy. The next episode, we have an excellent entrepreneur we're going to talk about. Talk about some new technology and napkin to reality, which everyone will really enjoy that.

Dr. Grant Garcia: It was extremely hot on our podcast. And then the end of the year episode, which I know Will and I are really excited about is [00:31:00] I talk and we'll talk about a lot of fancy things that we do in orthopedics and sports. But you know, I talk about like, Hey, check this new thing out. We're going to be doing, but that thing we talk about doing is only six months old.

Dr. Grant Garcia: Well, now it's been about a year or two. So where are we at? What were you right about? What were you wrong about? And, you know, hopefully we get more rights than wrongs, and, you know, we're pretty happy with the new technology, but I think that the listeners want to hear about it. This is the most cutting edge stuff, and there's some new things, too.

Dr. Grant Garcia: And again, I tell everyone in my patients that if you come back to my office or my PAs, if you come to my office in a year or two and I'm doing exactly what I did before, then I'm not getting better. And that's something you should be worried about. And so every year we're advancing. And so I'm really excited to have listeners here about all this new technology that I can offer them, and how we continue to push the envelope in the future.

Dr. Grant Garcia: So that'll be our sort of Christmas episode. So we're excited. Thank you all for listening and follow us on our all the platforms we've talked about. And Will, [00:32:00] I hope you feel better. And obviously, you know, many thanks for coming on tonight. I know you weren't feeling up to it, but I think that...

Dr. Grant Garcia: I think that the listeners will be really happy to hear our turf discussion and our 5g helmet. So

Will Sanchez: Before we go You know, I got some trivia for you.

Will Sanchez: You're trying to sneak on out of here. You were like, all right people, thanks for coming. Good night, y'all. No, no, no, no. Hold on a second. Hold on a second. All right. We were talking about the 5G helmets and all these wonderful deaf and blind athletes. Well, it's a deaf and blind school. So that's why I mentioned the deaf and blind athletes, but they're deaf athletes.

Will Sanchez: So, and I think you got this here. All right, so Some of the hearing, you know, impaired players was Bonnie Sloan and Larry Brown and Kenny Walker and even Flozel Adams, he played with Pittsburgh and the Cowboys, some really well known kind of players if you're a football fan, right? But the first [00:33:00] legally deaf person in the NFL, do you know who that player was?

Dr. Grant Garcia: Oh my gosh, no, I have no idea.

Will Sanchez: He was a Super Bowl champ and he played for the Seattle Seahawks.

Dr. Grant Garcia: Not Jim, not Jim Zorn, no he's not deaf. Who,

Will Sanchez: no, who is it? Derrick Coleman. Derrick Coleman was on the football team really with the Legion of Boom. He he won the Super Bowl with them. He was, he is recognized as the first legally deaf person. The other players I mentioned before. They had some hearing issues and loss of hearing, and I think some of the loss of hearing is probably getting smacked upside the head by Too Tall Jones and some other players, but that's a whole other story.

Will Sanchez: But the first legally deaf person in the NFL was Derek Coleman from the Seattle Seahawks, and he won himself a Super Bowl. So just tying all of that [00:34:00] there together. So imagine how difficult it was for him to play in the NFL. NFL at the NFL speed and still be able to be a player. And he was, he was a player five, six years, at least, you know, I don't have the numbers in front of me, but he played and he made it.

Will Sanchez: So kudos to Derek and everyone else out there that are playing and doing their things, whatever the challenges are just a little information. And, you know, I know Dr. Garcia was trying to get out of here before we got to the trivia. So we just want to thank everyone. Thank you for listening to SportsDocTalk.

Will Sanchez: Check us out at SportsDocTalk. com. We've got our shows. We've got transcripts of the shows, right? We're talking about you know, this is a great episode, right, for Deaf, right? We, we're, we're there. We, we have this information on our website. You can read. All the mumble jumble that I'm talking about right now.

Will Sanchez: You can read it in our scripts and our transcripts. So please check out the website. There's a lot of great information. Dr. Garcia [00:35:00] always has some really cool stuff and talk about cool toys and all the other stuff that we talk about. So please check it out. Dr. Garcia, before we go, any last words? No,

Dr. Grant Garcia: thanks to all those listeners.

Dr. Grant Garcia: Always fun. Thanks Will. And I'm looking forward to the next episode. All

Will Sanchez: right. Thank you everyone. Thank you, Dr. Garcia. Take care.

Dr. Grant Garcia: Take care.
Audio Transcript


Innovations in Physical Therapy with Hidef Co-Owner Zach Smith

Innovations in Physical Therapy with Hidef Co-Owner Zach Smith

Will Sanchez: [00:00:00] Welcome everyone and thanks for listening to Sports Doc Talk. Be sure to check us out at SportsDocTalk. com I'm Will Sanchez and once again we are so thankful and grateful for everyone listening and checking out our websites and I think Dr. Garcia promised the next 1, 000 fans to listen to our show A Miniature Pony but we'll bring him on in a second to confirm that.

Will Sanchez: So we are just so excited about it. We have a great guest today, but before we get to that guest, Dr. Garcia, can you confirm, are you giving out miniature ponies for our 1000 listeners ?
Dr. Grant Garcia: Oh, yeah. I, I wish I had a thousand miniature ponies, so I can't confirm that, but it's a, it is a good idea.

Will Sanchez: Listen, we're really excited about today.

Will Sanchez: We have a big component of what you talk about, seems like every single show, and that is the work that you do, getting to the patient, repairing them, um, getting them [00:01:00] back to where they need to go. But really the next step is your handoff to someone that really does the work as far as physical therapy.

Will Sanchez: putting in all the work that has to go into recovery so they could get back to normality. And we have an exciting guest today, Dr. Garcia, please introduce our guests. And before you do, please explain a little bit more why it's so important to have a physical therapist to get you on your road to recovery.

Dr. Grant Garcia: So you know, we thought about this show and you guys all hear the fancy stuff that we do. We're cutting edge procedures. We do, you know how we're trying to push the envelope. Yeah, that's all well and good. But, you know, my, my surgery is hopefully anywhere between an hour to two hours worth of work, you know, there's some pre discussion, but really that's it, you know, most of that's handoff and the handoff is to physical therapists.

Dr. Grant Garcia: And if you don't have a good team, you'll see pretty quickly. That despite how good a surgery you do or whatever you do in the operating room, it really doesn't matter if you don't have a good team. And [00:02:00] so, you know, being now in Seattle for a little while and getting to meet a lot of good physical therapists, there's just some really high quality places, um, that I think Really will help things and also when you those difficult situations where you need to have second opinions second opinions for physical therapy Because the things not going the way you want, you know, I've got my go to's Tonight, I'm really excited to introduce Zach this is he's one of the co owners of high death And you've really been instrumental in helping me take care of my patients.

Dr. Grant Garcia: I know I've sent Plenty of patients his way, um, even for second opinions on top of my standard surgical patients. So some of my patients will drive an extra distance just to see him and his team. Um, and they take care of anything. You know, there's, there's sometimes you have in physical therapy, the procedures that we do are unique.

Dr. Grant Garcia: And they're not commonly done. So you see a meniscus transplant, you see a Carlos transplant, um, and that can, that can make people nervous as they rehab, but this team does not falter and I've never had any issues before and they've taken care of plenty of those patients of mine. So, [00:03:00] um, it's a pleasure to have them on.

Dr. Grant Garcia: And I really want to talk about. What cutting edge stuff that they're doing to help our patients get ahead and with our better outcomes, because again, all these athletes are seen online, Aaron Rodgers, Nick Chubbs, you name it. Lonzo Ball is going to come back from his Carlos transplant. Most of that work is being done by amazing physical therapists.

Dr. Grant Garcia: So thank you Zach for being on here and love to

Zach Smith: hear more about your stuff you're doing. Well, thanks for having me on and I appreciate you guys taking the time, uh, to bring me on here and, and I've had nothing but positive experiences with you and your team and, and never hesitate to send people over. I know you guys are the best in the business over there.

Zach Smith: So we've enjoyed being able to be on the cutting edge of. of medicine with you and bringing some of the passion that we have for sports medicine and recovery of some of these complex surgeries. And so it's been a, it's been a really fun thing to work with you and your team. I was actually just online yesterday watching a bunch of your surgeries that you're doing.

Zach Smith: So I've been, I've been loving what you've been doing with taping the surgeries. Sometimes I'll [00:04:00] be at parties and I'll be watching your surgeries and people will look over at me and they'll see that I'm on a phone looking at surgeries and they're like, what are you doing? And I'm like, Hey, come over here.

Zach Smith: You got to see this. This is what This is Dr. Garcia. He's got these surgeries that he records and it's really well explained. And so, yeah, I'm even bringing some of the people that are not in the medical field into the fold on some of the stuff that you're doing. And so, so, uh, thank you so much for having me on and, you know, I'm looking forward to it.

Will Sanchez: Awesome. It sounds like Zach's hanging out with a bunch of guys like myself, just kind of randomly looking at these, uh, surgeries, these internal braces, you know, that's my thing right there. So Zach, I can relate Zach Smith. He's a physical therapist and co owner. Sure. Like. Garcia mentioned at hi-def pt, that's H i d E F p

Will Sanchez: So you could check out, check him out and check more information out there, at his website, uh, de Garcia, uh, please, can you continue?

Dr. Grant Garcia: So, I mean, I think. I want to know more and I kind of talked to Zach about this and [00:05:00] I'd like to know more about like, what do you guys do? How do you guys do it? You know, I've told everyone kind of my backflow and my secrets to sort of how I try to stay on top.

Dr. Grant Garcia: But you know, I'm not, I'm not as experienced in the PT world. I know I send them to you. You do an awesome job and the patients come back looking really good. But what does it take? You know, what does it take for you guys to stay on top? And, uh, you kind of explain your methods and what you're doing that's new.

Zach Smith: Yeah, I mean, the first thing is, I think what it takes is consistent team effort on education and keeping up with the latest in what's going on with surgical techniques with rehab and performance and all of that. So I think in the Pacific Northwest, like you said, there's so many great clinics and so we're just happy to be a part of, of the community of PT here up in the Pacific Northwest because there are so many good physical therapists up here.

Zach Smith: And, and really what, what I think is, has led to us being one of the leaders in sports rehab and performance, um, has just been our, our attention to education. So, like [00:06:00] this upcoming week, we're, we're bringing in a course, um, from a guy named Tim Gavitt, which is all about load management. Um, you know, he's a, he's a legend in the, in the field coming out from Australia.

Zach Smith: We host a lot of courses on a, on a variety of different topics. And then on top of that, our team stays up to date by. Um, a bi monthly full company wide meetings where we review, uh, journal articles relating to new stuff that's coming out, maybe some old stuff as well. We go through case studies and case reviews, so some of these, uh, more difficult surgical procedures, uh, some of the harder rehabs and the more complex patients, what we'll do is someone will present that case at our, at our bi monthly meeting, and, uh, and we'll get weigh in from, from all 11 of our physical therapists, um, and plus, you know, we bring people in.

Zach Smith: Like yourself, uh, to help educate our physical therapists on these procedures and help make sure that, you know, we do right by the patients because, you know, there, there are the simple straightforward procedures like, you know, metastatic needs, total knee replacement, [00:07:00] total hip. Like some of those are kind of, you know, like they're, they're fairly simple, they're fairly routine.

Zach Smith: We kind of know what to expect unless we get a curve ball, um, with some of the healing processes, but with things like, uh, you know, complex, even like a simple ACL, that's a complex rehab. And if you don't know how to test and make sure that you're loading the knee correctly through that rehab process, there could be a lot left on the table as far as like return to sport timelines.

Zach Smith: And you're seeing guys like Jordan Brooks returning to practice at six or seven months, um, returning to, I think, full play at eight months and. I think a lot of that, that type of faster return to sport, not that it's always advised early on like that early, right. But a lot of that is, is because of dedication and time spent and diligence with physical therapy, not just on our side, though, from the physical therapy and clinic side, but also helping to make sure that our patients are also ACL,[00:08:00]

Zach Smith: you know, That takes a lot of effort, right? That's, you know, I've got, I've got patients who are professional athletes where it's their full time job is now an ACL recovery. And so when we have patients that take that sports mindset that like they attack the recovery, we see really good results. And so we really try to bring that level of energy and effort into the clinic.

Zach Smith: And everyone who comes through our doors is treated like an athlete and that mindset. helps us to propel these people forward. You know, they're in three of our four locations are inside of gyms. One of them is is a standalone but looks like a gym. And when people come in, they don't necessarily feel like they're in a medical center.

Zach Smith: They feel like they're in a training facility, which for a lot of these injuries, right? We don't want to push people too early. We're always safe. We make sure we respect all the protocols and and all of that. But when the time comes to load and make sure we have adequate load for adaptation, um, You've just got to really understand how to do that and how to do that safely.

Dr. Grant Garcia: I [00:09:00] think that's a great point. I mean, I think we made a number of excellent points. You know, I think the one thing is education is really important. And I find that you have groups that are maybe not as up to date and you have some groups that are. I mean, the reason you guys will get a weird, you know, they'll get a Bay Area ACL, or you'll get a meniscus transplant, or you'll get a Carlos transplant, you'll get an NPFL, or you'll get a revision ACL of mine.

Dr. Grant Garcia: And there's really not many questions. You can follow the protocols and you do your education. And I think that's really nice. Like, you know, I love that. I love being able to teach those sort of more complex things, but it is nice to, when there's some breadth of knowledge, you know, even the fact you're joking about the videos, you clearly care enough to watch them, to learn about it.

Dr. Grant Garcia: And so that's really important. I, I think for me when I'm handing off my patients, you know, I want to know I, you, we've all heard the stories before. I have them plenty of patients come back and said that the person they worked with didn't have any idea what type of surgery they had done. Um, even though we had sent them with operative notes and you know, it's not to knock anybody.

Dr. Grant Garcia: It's just that that that's hard for me when I do a lot of work and I'm spending a lot of difficult, uh, you know, time [00:10:00] doing this. And so it's good for me to know people that Really care about the education. It's good for the patients. You know that too. You know, we you know this there is a difference between good PT and bad PT And if your therapist on board if you care about it, you read literature, you understand how things are adapting That's good.

Dr. Grant Garcia: And so, you know, you know me like I'm okay with feedback to you're like you listen, you know, dr Garcia, you're not really there's some newer things that we're doing like have you thought about this and that's really good idea Thank you, right? Like I can't read every paper I just like you can't read every paper.

Dr. Grant Garcia: So we're here as a team. Um, and I think we drop our egos cause all we care about is the patients. Um, so that's really important. And the ACL thing is like, you're dead on on that. I mean, there's patients that don't get the athletic mindset early on and it's a long recovery. And when you have that athletic mindset, you know, you can do big things.

Dr. Grant Garcia: You know, the one thing, you know, you probably heard me ask the patients before, it's like, how is your testing? And they'll be like, what are you talking about? You know, and if I get them from someplace like yours, You know, they got their testing with them as a sheet, you know, they've had everything done and they know they're ready or they know they're not ready and that's really important [00:11:00] too.

Dr. Grant Garcia: And so that's just the basics of just ACL in general, so I don't mean to interrupt

Zach Smith: you too much, but yeah, that's important. No, no, that's, that's perfect. And really that, that points to like one of, one of the things that we try to stay on top of, which is, you know, you mentioned the testing and when we talk about testing, we talk about the main one for, for ACL is quad.

Zach Smith: Testing with dynamometry, isokinetic strength, um, isometric strength. So we test at 60 degrees and we try to take more of a criterion based measurement of progress, right? There's, there's constraints from, from, from, uh, the physiological healing side. And then there's constraints from a strength and Performance side.

Zach Smith: And so what we try to do is try to marry both of those concepts and make sure that, hey, we're not stressing the graph too much in certain ways or like a meniscus repair, right? We can't load it in certain ways. But we want to make sure that if we can load something that we're not just fearful of, hey, we can't load, you know, anything, right?

Zach Smith: So someone that [00:12:00] comes in with a meniscus injury and they've got a brace locked There's no reason they can't do hip and core work. There's no reason they can't do upper body strength work. All of that helps to simulate their body and keep them from, from astro sitting elsewhere. So one of our big focuses on is on hitting other areas, right?

Zach Smith: So they come in with a knee injury. We could still potentially work ankle, definitely hip. Definitely core, um, and upper body. And so that's one of the things we work on. And then with the, with the testing, we've also got a very, uh, stringent return to sport testing that we utilize. So there's, you know, there's a lot of testing out there.

Zach Smith: They have sport court tests, which test basically muscle, uh, endurance and strength. Um, we'll do some, some one on one numbers, but there's really, and some single hops and double hop numbers, but really the big one is like you said, it's. The strength number, right? So there's certain things that we want to hit.

Zach Smith: And if someone doesn't hit those numbers, it's going to be really hard to progress them in their program. You know, if someone comes in and they want to start running [00:13:00] at 12 weeks, but they only have a 50 percent limb symmetry on quad strength, that's going to be very difficult from my perspective. But, but very easy to explain to the patient also.

Zach Smith: And most people understand that because we set these goals and expectations up front. Hey, this is what I would like you to be at eight weeks. I'd like you to hit 70%. Limb symmetry with your quad. And so this is the stuff that's going to take to get there. And if you don't do it, it's like a math test, right?

Zach Smith: You come in, we know that you haven't really done the work or we haven't helped to guide you in that work to get you to that 70 percent or there's something else going on and we need to reevaluate our approach as a physical therapist and a physical therapy clinic of why we're, you know, we're sitting at 50%.

Zach Smith: Um. At eight weeks, and you know, maybe there's a pain issue that we need to deal with, you know, maybe there's some manual therapies or something else we can do, or maybe we need to do some more blood flow restriction therapy to help boost that strength in the early phases, and so all of [00:14:00] that we try to take into account with the testing, but the testing really guides us and tells us, because there's been a lot of cases, you know, on both sides where I get someone, and I test, and I anticipate that they're going to be very strong, and then we test them, and And they're not strong.

Zach Smith: And then we have to look and say, Hey, why is this happening? Hey, we need to refocus. And sometimes it's a little bit of a reality check for patients, but in a good way, it helps them refocus. Because if I wouldn't have had those objective tests that can't, that just cannot, those numbers don't lie. And, and if I didn't have that test, I could have gone through six months of rehab, not knowing that, Hey, the quad actually is not getting stronger.

Zach Smith: We're just working on, you know, compensation methods through the hip and through, through the calf. And so there's a lot of things that we could do to help to, to guide them in the right direction. But we have to know these problems are happening. Um, and so like, obviously the easiest stuff is like range of motion measurements, everyone takes that.

Zach Smith: But really this, like most phases of the rehab, the [00:15:00] strength and the ability to accept and, and, uh, load eccentrically, that's going to be the most important piece of, of this rehab process.

Will Sanchez: Hey, Zach, is this something that you're measuring day one? So let's say, you know, someone like Dr. Garcia sends you a patient, they walk in through the door and you're doing this, you know, whatever it is, dyno meters kind of measurement, you know, that you're measuring the force and the power and what's.

Will Sanchez: the muscular strength. , are you doing that day one? And then how often, I guess, depending on the injury, how often are you going back to this test to see what the measurements are for the patient as for you to figure out you and your team to figure out that they're progressing in the right direction or you have to change course?

Zach Smith: Yeah, for something simple like a meniscus, uh, uh, Like a metastectomy where we don't, where Dr. Garcia doesn't go in and repair the meniscus. So we're not worried about tensile load on that meniscus. We can test them a lot earlier on, depending on the patient, usually like second or third visit. Um, for [00:16:00] ACL, we really don't want to test it.

Zach Smith: There's really no reason to test until about eight weeks. And so there's this period of time where we have to really motivate these patients within this early phase of rehab, because we're not even going to do that test. The knee is already, it's swollen. It's inflamed. The quad probably isn't even activating.

Zach Smith: The quad muscle isn't activating for the first few weeks very well. So we're using a lot of electrical stimulation and blood flow restriction therapy to try to maintain size of the quad. And so there's really not a whole lot of benefit to testing it that early on for us, as far as like the numbers that we see, because a lot of it's going to be inhibited by pain and fear.

Zach Smith: And so at about eight weeks, if we've worked them out correctly, we can get a very good, accurate number. Um, I've seen numbers as early as six weeks, uh, on an ACL and it's all going to depend on the, on the protocol, right? So like a, a meniscus repair or a root repair, and Dr. Garcia, you might be able to speak a little bit more on this.

Zach Smith: Um, we're not going to test those nearly as early because we can't load them into flexion. [00:17:00] And so it's going to be a lot more difficult for that. And so there's other metrics that we can take though, quad, quad girth. Like making sure that they're not getting so much actually in the quad that, you know, we know that muscle cross sectional area is directly related to strength.

Zach Smith: And so we know if we have those metrics, uh, you know, we've got some idea of what's going on. Um, and then after we take the initial test, it's every two to four weeks and we're doing a serial testing, right? Because strength testing can go up and down by anywhere, you know, like on a max effort day. Plus or minus 20%.

Zach Smith: And so sometimes we'll test somebody and then test them two weeks later and they're actually down a little bit or we test them in four weeks and then they've had a good restful night's sleep the day before and they haven't taxed their sexual nervous system. And then all of a sudden they've got a massive improvement.

Zach Smith: So we try to take regular tests throughout the process so we just can track it a little bit more Uh, like a linear progression and we can really see what's going on, like every few weeks, but really like every week, we [00:18:00] probably wouldn't get that much result with testing it week to week for the time, uh, sacrifice of it just because adaptation of strength takes a while to gain, um, especially in the later stages of rehab, but earlier, definitely closer together helps us gain some valuable information.

Zach Smith: Um,

Dr. Grant Garcia: yeah, I mean, that's a, those are important points you brought up, you know, the dynamometry is important. You'd be surprised some people don't do that, and, uh, I don't really get it. That's how I get the best test for me in terms of how people are doing. You know, cause they complain, they'll say, I've got some anterior knee pain, you know, I feel weak.

Dr. Grant Garcia: And I'm like, what's your dynometry? And they just don't know cause they haven't been tested for it. So it's really important. And I'm obviously not, I don't get that from your group, but that's an important thing to be part of. I think for Will, if he's heard this, he brought up this, this term a few times called blood flow restriction.

Dr. Grant Garcia: Oh baby. This is a really hot topic. And, uh, this might be the internal brace of, physical therapy. So if you don't want to listen up, but tell him a little bit about what your blood flow restrictions like. What do you guys like to use it for? You know, [00:19:00] it's a, it's a kind of sometimes controversial topic.

Dr. Grant Garcia: I'm obsessed with it. I love it. I would do it for all my patients if I can. Um, I do think it makes a difference. I tried it myself a few times. Uh, but maybe tell the listeners and, uh, maybe do, uh, help Will out too so he can do his prescription for blood flow now.

Zach Smith: Yeah. Yeah. Uh, so blood flow restriction therapy is basically, um, it's, it's a class of tourniquet, but unlike in surgery where we fully occlude the blood flow to the extremity, um, we occlude a certain amount.

Zach Smith: So basically how it's done is there's a cuff that's placed up at the Very top of the thigh right by the kind of in the groin area, um, and it wraps around the thigh and the, the customer we have are very smart. They have a built in Doppler and they have a built in pump. And so they're completely wireless and they run the Bluetooth to our phones.

Zach Smith: And what we first do is we take your what's called limb occlusion pressure. And we figure out how much pressure does it take on this cuff to include all of the blood flow in your leg. [00:20:00] And then the maximum at which we work is that 80 percent of occlusion. So we're not including full arterial, uh, blood flow, but we are including most of the venous, uh, flow.

Zach Smith: And so there's not a lot of return of blood from the limb. And so the science behind this is now very good. It's been mostly done in ACL cases. And we've shown that we can, um, we can really slow down the rate, and if not even pause the rate of atrophy, if done early. In rehab for post op cases such as knee, post op ankle, post op foot, we usually use it.

Zach Smith: Our clinic is mostly using it in the lower extremity. We use it a bunch in the upper extremity though to elbow, hand, wrist. Um, there's even some good, some good literature that shows that even though the cuff on the arm is placed at the armpit, it still has some effect. Because of the backflowing of the arterial system into the rotator cuff.

Zach Smith: And so basically what this does is it tricks your body [00:21:00] into a muscle hypertrophy. So there's three different ways that our muscles grow in size and grow a muscle growing in size is called muscle hypertrophy. And basically there's three different ways. One way is by eccentric loading. So that's the slow lowering on a squat or a bench press.

Zach Smith: So we overload that phase of exercise and we under load the concentric phase or the up phase. That's one way. Uh, another way is progressive overload. This is like the standard way that. Weightlifters get strong and big. They just progressively increase the weight at which they lift over time, right? Today, I lift 200 pounds on bench press.

Zach Smith: In six months, I lift 250. I will gain size and muscle by doing that. The third way is what's called metabolic overload. And that's basically where the muscle produces a byproduct during exercise. Usually it's, it's hydrogen ions and lactate and, and those are a signaling mechanism for your body to [00:22:00] increase muscle mass because your body is under stress.

Zach Smith: And so what these BFR cuffs do, the blood flow restriction is they block the blood flow from going back up into the body. And so it pulls those hydrogen ions and lactate and all of the other metabolic byproducts in. Muscle activation and physical exercise. And so it stimulates this massive response where your body thinks you're doing a lot more exercise than you are, which helps you to maintain and activate your mTOR pathway, which is the pathway for increasing muscle size and strength.

Zach Smith: And so. This is the basic mechanism. There's a lot of ways to do it. Um, there's some rules around it, right? There's some contraindications. There's certain people that can't do it, uh, because of like things like, you know, uh, having a blood clotting disorder, being on blood thinners, things like that. There's, there's a few things that, you know, would preclude you from being able to do this, but most, most healthy people can do blood flow restriction.

Zach Smith: Um, there's really not a whole [00:23:00] lot of downside. There are some, um, cases of, of a few injuries that have occurred with, with probably improper use and non high tech cuffs. But the cuffs that we use are, are very, are very high tech, very easy to operate and they're, they're, they're fairly user friendly and are very user friendly.

Zach Smith: And so, um, some of the protocols that we do for blood flow restriction therapy is we do a little bit higher reps and lower weights. So some of the studies are showing. That at about 30 to 40 percent of your one repetition max. So the maximum amount of weight you can lift you with BFR, you can get the same amount of muscle hypertrophy at early phase rehab, as if you're lifting.

Zach Smith: 80 percent of your one repetition max and about 80 percent of your one repetition max. And so the good thing is, is for things like ACL with like people that have anterior knee pain, uh, people who have had a meniscus transplant or a cartilage surgery that can't take a lot of Mechanical load [00:24:00] or a lot of weight load.

Zach Smith: We could do exercises with much less weight and get similar result in maintaining, uh, muscle hypertrophy. And so that's been a huge piece of our postoperative rehab for both the upper extremity and lower extremity. Unfortunately, you can't do it for like core injuries and back injuries, things like that.

Zach Smith: Although I did have an interesting case of a guy who had a, a, uh, radiculopathy, an injury to the nerve that came from his lower back, and he had almost no calf strength, and we did BFR for six months, and he was able to produce, uh, body weight strength of that calf. By the end of six months, which was very cool because, because previous to that, uh, he just couldn't physically load his calf enough because of the lack of nerve, uh, reception to the calf.

Zach Smith: So, um, we've seen really good results with it and it's just, you know, another tool in our bag that we use early on, especially in post op cases to help people get back to a hundred percent. [00:25:00] Hey,
v Will Sanchez: Zach. Um, yeah, I know. I love it. Yeah. Are there any restrictions? I, you, you mentioned certain restrictions when it comes to maybe the type of medicine you're on and blood thinners, things like that.

Will Sanchez: And, and, uh, I know Dr. Garcia and I talked about, , B F R before and, , and kind of going back to this KATSU training. , but. Is there an age restriction? Is this for all ages or is there a ideal age group that this would benefit?

Zach Smith: No, that's, that's a great question. Um, it really could benefit from people from all ages.

Zach Smith: So I've, I've used it up to people age 75. Uh, you know, obviously, and unfortunately, as, as we age, people, people tend to gain comorbidities and they tend to have You know, things like elevated blood pressure, they're on statin drugs, they're, uh, maybe they've had a stroke in their history or TIA, and they start to gather these, these, these contraindications to blood flow restriction.

Zach Smith:[00:26:00] So I think, you know, like, as the population ages, you become a little bit less of a candidate for blood flow restriction therapy, but you're not necessarily precluded because of age. The younger ages, that's kind of an interesting topic right now going around and I talked to a couple surgeons recently who say, you know, Hey, as long as someone, um, is, you know, 12, 13 years old, basically hitting puberty.

Zach Smith: I've got absolutely no problem with them doing blood flow restriction therapy. Um, It's all about tolerance though, right? Cause these cuffs at 80 percent occlusion of your, of your lower extremity. Um, we usually don't start at 80. We start to get them comfortable at 60. Then we worked up to 80 percent at 80%.

Zach Smith: Those cuffs are tight and maybe, you know, Dr. Garcia, I'm sure you felt this too. It's not the most comfortable thing in the world when pressurized or around your thigh and squeezing. And so, you know, some younger kids [00:27:00] don't have as. wouldn't have as good of tolerance to it. And some people in general don't have as good of tolerance to it.

Zach Smith: But I'm always surprised when I'm like, Hey, you know, I warn people, I say, Hey, this is uncomfortable. Let me know if it bothers you too much. It's not a hundred percent essential to your care, but it will definitely help you. And most people are able to just, Hey, I got used to it and now I love it. And we have a lot of patients that actually end up buying the cuffs for themselves to continue to do their workouts.

Zach Smith: Uh, Because, you know, they love, they love the results so much. And that's

Dr. Grant Garcia: a, that's a big thing, Will. The people do that all the time. I hear that they come in, they say, I bought my own because I was so happy with the results. Yeah. It's a big deal. And for me, it's one of the, you know, if I've got go to PT's, I really want to make sure blood flow restriction is an option, uh, for the patients.

Dr. Grant Garcia: You know, especially with some of those patients, you know, they're four months out, you know, Zach, and they're, Quads don't look great and they're ACL and you're like, are you doing blood flow? And they said no, I never tried it before and to me that's a concern, right? I'm also concerned if they say they are doing it and they look they look [00:28:00] weak But that's I don't tend to see that as often again Antidotal one surgeon, but I think it's important and it's a real thing I have a couple videos of me doing it and there's a burn Well, you you feel like you you feel very weak within a couple within a couple sessions

Zach Smith: And I actually do it a lot myself.

Zach Smith: Yeah, I do it a lot myself. I've had, I've had knee surgery on both my, uh, on both my knees. I've had, uh, posterior patellar surface cartilage injuries, osteochondral defects. Um, and so, so like injury to the cartilage behind my kneecap. And, uh, one of my, one of my training tools. When I'm doing knee load to maintain quad size, especially of my right knee is, is blood flow restriction and, uh, and, and yeah, even just bicycling, cycling for 15 minutes with blood flow restriction cuffs on is even on light resistance, it is a massive feel of workout.

Zach Smith: Like you're, you're like, you're on fire by the end of it. [00:29:00] And, uh, and the great thing is you don't have to load the knee. So my knee never hurts after I do BFR. But my muscles are always sore, and that's a sign to me of something that I need to be doing for my own personal need. And I know that a lot of my patients experience the same thing where they say, Hey, yeah, my knee didn't bother me at all.

Zach Smith: But my glutes and my, and my quads and my hamstrings are really sore, but like in a, in a good muscle way that I haven't gotten to feel for a while.

Will Sanchez: Yeah, it sounds amazing. I mean, , it sounds like we should do an experiment, but, , that'll be a conversation for another day. For my birthday, my buddy, , sent me a,

Will Sanchez: I'm looking at it right now. MetaQuest 2, uh, VR,, you know, going into, 2023 and beyond, right? We're seeing Apple jumping on it. We, you know, obviously we know about MetaQuest and I know that virtual reality is something that, uh, you're dabbling in. Can you explain a little bit about that?

Will Sanchez: Because virtual reality is just, you know, it's the future and it's here and I can't imagine where it's going to be [00:30:00] 5, years from now.

Zach Smith: Yeah, so we're using, using, uh, via, uh, VR and, um, kind of in a way that you probably wouldn't expect. So I think there, there's a lot of cool applications. Um, some of the stuff that we don't do, which, which I think we, we will now that we actually have a, uh, someone who's specializes in working with amputees is, is working on limb reintegration of like sensory stuff.

Zach Smith: So, you know, like phantom limb pains that people have. There's, there's some stuff coming out with via VR technology and. And using VR to reduce those phantom limb sensations. What we like to use it for right now currently is what we call sensory reweighting. And so basically when you get one of these lower extremity surgeries, like an ankle, uh, an ankle surgery, a knee surgery, hip surgery.

Zach Smith: You lose something called proprioception, or you diminish your proprioception, you don't lose it fully. But what happens is, because you've had some disruption to the [00:31:00] mechanoreceptors, or the things that recept, uh, information from your leg, like sensation, um, that's disrupted, you start to re weight. your sensation or your, your balance system to the other two systems.

Zach Smith: So there's three ways that we maintain our balance. There's your vestibular system or your inner ear, which basically helps you to a sense the, the, the horizon. And so, you know, some people get vertigo, they have a disruption of their vestibular system. You've got your, uh, proprioceptive system and your proprioceptive system basically senses.

Zach Smith: where your position is in space, right? So you've got, you've got your feet on the ground, your skin is in contact with the ground, you know your foot is flat because you can feel that. Your knee knows that it's slightly bent because you've got mechanoreceptors in your knee. And then the last system is visual.

Zach Smith: And the visual system is obviously like, if anyone's ever tried to balance and close their eyes, it automatically becomes harder because you've removed one system of [00:32:00] balance. And so what we do is we put people on hard surface, with a barefoot and we start to try to reweight the system back to the proprioceptive system.

Zach Smith: So after you've gotten one of these injuries or surgeries, your body is relying heavily on your vision and on your vestibular system. And so, uh, especially, you know, like for older adults who have vestibular dysfunction, but even like in dark situations, you'll notice that people are more likely to fall and get injured in the dark because.

Zach Smith: They don't have good proprioception and now it's dark. So they've eliminated their vestibular or their visual system. And then maybe they're turning their head. So their vestibular system has changed and they're more likely to get injured. And so what we want to do is we want to try to start to get that sensation back into the proprioception so that person can sense what position their knee, their foot and their ankle are in, in relative to themselves so that their injuries are less likely.

Zach Smith: So what we do is we. We put someone in a VR headset, and we have them do [00:33:00] things like riding roller coasters, or we have them do, um, like, like mazes and courses, or we'll have, uh, you know, like, they'll be watching gymnastics, and people will be flipping, so, basically, we're removing the visual system, or the actual visual feedback that's happening, and then, that change in movement from the, uh, roller coaster also helps to disorient the vestibular system, and it makes them rely very heavily on the sensory.

Zach Smith: Okay. On the proprioceptive system and what type of feedback they're getting from the floor through their foot, through their ankle, through their knee, through their hip. And so that's a lot of what we're doing right now, as far as balance training in VR. And it's incredibly difficult. I've ridden a lot of roller coasters now with a VR headset on, uh, standing on one leg.

Zach Smith: And, and it's incredible how much of a deficit you will pick up in someone like, like my right knee versus my left knee because of my surgeries. My right knee when I first started this, uh, was incredibly [00:34:00] diminished with proprioception, which led me to understand that, hey, my quad strength. And my lack of proprioception is leading to continuous injuries in this leg.

Zach Smith: And so if I want to try to prevent continuous injuries in my knee and my ankle on my right side, I gotta make sure that my proprioception is, is up to, up to par, and that I re weight a lot of my balance from my visual and my vestibular system. And so there's a lot of ways to do that without having VR.

Zach Smith: It's just a really cool and fun and engaging way to do balance, rather than just having someone stand on there. foot eyes closed and turn their head, right? So it becomes a lot more, um, engaging and fun for patients to gain back their proprioception. That's a great point. I hadn't

Dr. Grant Garcia:heard that before. I know a lot of stuff you're talking about, but that technology sounds incredible and it's a nice option.

Dr. Grant Garcia: And I, I, you know, I've been injured before too. And I've noticed that when my eyes closed, one of my legs is not as strong as the other in terms of balance. And Uh, I might have to [00:35:00] watch some more roller coasters to get stronger now that I hear this.

Will Sanchez: It sounds like a trip to Busch Gardens. Let's just go and do it for real. Anyway, , I know you've got a lot of stuff going on, with PT and you have some other technology, you've partnered with, , Theracentric, , and it seems like this is, an app for exercising for patients at home. If you want to talk about that a little bit and describe kind of like what, what is the benefits of patients having access to something that they can do at home?

Will Sanchez: Yeah.

Zach Smith: Yeah. I mean. Like Dr Garcia said about his surgeries of like, you know, two hours to three hours of work when he's doing surgery with physical therapy. The maximum amount that I'm going to have somebody in is three times a week, you know, for 45 to 60 minutes depending. But the typical person is really only going to be able to make time for one or two appointments.

Zach Smith: And so out of your entire [00:36:00] week and the amount of workouts that you have, one to two times a week is just not enough. And so if you really want to get the results and you have a high level goal, right? Like you have an activity goal. Hey, I want to be able to, I want to be able to hike up, um, poopoo point on tiger mountain, or I want to be able to jog a 5k, or I want to be, go back to basketball or tennis.

Zach Smith: Then, you know, you've got to, you've got to work outside of the clinic. It's not just about what you do inside the clinic, because if you rely on just what you do inside the clinic, you're definitely not going to achieve the result. And so we have partnered with several physical therapy exercise apps in the past, and this one is probably, is definitely the best that we've had.

Zach Smith: Um, and it's great. It gives access to patients, um, anywhere they go. Everyone takes their phone, right? Like if you give someone a printout. Or even yet, like, you know, some, some PT clinics are still drawing stick figures, um, which is fine, right? Like if that gets the job, if it actually gets the job done, that's fine.

Zach Smith: But the nice thing is with our [00:37:00] app, you've got videos of every, every exercise. It'll time your rest breaks. It'll help you count your sets and reps. Um, it's very smart how it'll guide you through. It'll help you motivate gamifies. You know, streaks of getting into physical therapy, exercise in your home exercises.

Zach Smith: Um, and so all of that combined helps people be more successful. And the cool thing is that I love about this exercise is that I can on the spot. With HIPAA compliance. So I can, I can be compliant with the medical laws. I can shoot a video of you doing your exercises and put them into your own exercise app, and so you could see me or you could see yourself doing your actual exercise.

Zach Smith: Um, so instead of a patient. Taking these videos on their phone and then trying to figure out how many reps and sets we can actually integrate these videos right into the app where they see the reps and the sets and the rest breaks and all that. And then when they pull up the video at the video of them inside of our clinic, doing that very specific exercise.

Zach Smith: And so that's the great thing is like, if we come up with a unique, very, um, [00:38:00] customized exercise for somebody, then we could say, Hey, this is like. This is exactly how you do it and when I voice over the, the, the video as I'm, as I'm shooting the video, they get the very specific instructions. So every time they're at home, they hear me coaching them through the exercise or they can hear me coach them through the exercise that they want and we found that our compliance rate with home exercise program has, has over doubled.

Zach Smith: Since we switched to this, to this technology based, um, home exercise program with higher tech, uh, app. And so like, if I can get somebody at 70%, 80 percent compliance with home exercises, um, we know we can do a great job versus industry average of 30%. It's just, it's really not enough load to get the adaptation that people are going to go for, especially, um, if you're trying to get back to an activity.

Dr. Grant Garcia: No, and I think that's a good point. Go ahead. I think it's a good point that the, you know, the on the number of patients I see that, you know, they kind of forgot about the home [00:39:00] stuff and then just do the PT at home, PT. And then as you know, as your insurance starts to run out toward the end of the year or by the end of your surgery recovery, you know, the home stuff is really important.

Dr. Grant Garcia: So I think it's good for listeners to hear that. There's a better option out there than just stick figures or print offs. I mean, I've seen the same thing, you know, my family members have gone to other PT places just cause it was closer. Um, not that they shouldn't have gone to high def, you know, uh, but nonetheless, when they go there, we get printouts and they're going to lose those things.

Dr. Grant Garcia: I mean, I, first time my mother in law brought home printouts, they were lost within 24 hours. And so the, the, the, the online ability, don't

Will Sanchez: get yourself in trouble. Dr. Garcia.

Dr. Grant Garcia: They may be listening. I'm not getting myself in trouble. Okay. I'm not getting myself in trouble. I'm good. I'm always in trouble though.

Dr. Grant Garcia: Let's be honest. So the, uh, so, but it's important. It's important. And that's a really good thing for the patients to know that there's a high quality app out there that'll make their lives easier and get them back faster, which is again, that's the whole point of our show. That's the whole point of what we do.

Dr. Grant Garcia: That's the whole point of what you do [00:40:00] and what I do. We try to find a way to get our patients back faster, be more compliant, do well and look good. Because honestly, if they do their homework, it's going to make you look good. And it's going to make me look good. And let's be honest, those are all important things.

Dr. Grant Garcia: So the key here is all patient compliance is important.

Zach Smith: Yeah. And there's like one more thing on that printout thing. The thing that always got me with those printouts is that you have a picture of the start and you have a picture of the finish, but you miss everything in between those two pictures. And that's really where the money is, is, is in execution of the exercise and knowing that you are, Executing it correctly and people also feel more confident when they can see the exercise and they also hear the Explanation of the exercise and we go.

Zach Smith: Oh, yeah. I remember when he said that to me in clinic This makes all the sense in the world versus back back You know four or five years ago when I was giving out printouts people come in and they'd like yeah They're doing this right the whole time and I'd recheck it and it's just completely off And, [00:41:00] and not that there's not variation to exercise, but it's like some of this stuff would be completely, uh, you know, like this wasn't even close.

Zach Smith: Um, and so that's really what, what, what I've loved. And then also on our end, we get to see when patients log in, how many exercises they've done, how many sets they've done, and I can see how many minutes they've spent in the app. And so I can really help to hold people accountable, which is kind of. The way that I think physical therapy should be going is into not just rehab and the clinic, but health coaching somebody through their entire journey of physical therapy and helping them to stay motivated because, because I know I like to work out and I like to get in the gym, but I always train better.

Zach Smith: When I've got a coach or someone looking out for me, or I've got a workout buddy. And so that's what I think that this helps us to bring is, is the accountability side and people feeling like, Hey, this person's in it with me versus, you know, Hey, I see this person once a week. And then when I'm not in there, it's kind of out of [00:42:00] sight, out of mind.

Zach Smith: Exactly.

Will Sanchez: This is Zach Smith, physical therapist and co owner of HiDefPT. Check him out at H I D E F P T dot com. Zach said it earlier in the show. If you go to his Instagram and check everything out that he's posted, some really cool stuff. But he mentioned in the beginning. It's walking into a gym.

Will Sanchez: It looks like a gym. It feels like a gym and they're getting to work like a gym. Zach, thank you for your time. We really appreciate everything and please check out his website. Reach out to him. We need to get into a bunch of other stuff and dry needling and God knows we could have gone on and on but please check out his website.

Will Sanchez: Reach out to Zach and his team. They've got a lot of great benefits. Obviously, Dr. Garcia loves dealing with him, sending his patients over there because they know they're in great care. Zach, thank you so much for your time. Thank you for being with us today.

Zach Smith: Will, Dr. Garcia, thank you guys [00:43:00] so much. I appreciate you having me on.

Zach Smith: It was a fun conversation. We'll have to run it back again. I've got some questions, uh, for Dr. Garcia. Um, and so I think we could jump into some cool stuff. I appreciate you guys though. Thank you.

Dr. Grant Garcia: Awesome. Yeah, no, thank you. I know we always, every time we do this, Zach, we always have like a million things afterwards, a question.

Dr. Grant Garcia: So let's do

Zach Smith: it again for sure. Yeah. Yeah. Let's

Will Sanchez: do it. Okay. Take care, Zach. Dr. Garcia, great show. , most important thing that I want to kind of, you know, relate to the audience and you talk about it, Zach's talked about it, is the physical therapy part of what it is. we need to do, right? When I had, I tore my Achilles, I've had injuries, I've had surgeries.

Will Sanchez: The only reason I've gotten back is because I went to physical therapy and I was diligent about it, right? And I went home and did my homework that was put out there for me. And now, like, my left leg that I had Achilles, my [00:44:00] Achilles injury, my rupture is stronger than my right leg because I worked so hard at it and I did ladder drills and, and did balancing acts.

Will Sanchez: and single leg, , exercise and all these other things. So I just want to reiterate to everyone out there, you get what you put into it. And if you put the work in post surgery, you're going to have great results. Dr. Garcia, as we wrap it up, last thoughts, , on this show.

Dr. Grant Garcia: Well, it was just, it's incredible to hear all the technology coming out there.

Dr. Grant Garcia: And again, I completely second and third what Zach and you said. about compliance. It's really important. It's good for our patients to hear. Listen, there are if you have something that you're dealing with some problem or either non surgical surgical, um, and you're feeling like you're not getting what you need.

Dr. Grant Garcia: You know, there are places out there that can do it for you. Or if you are certain things that you're missing, there might be, you know, pay people or we know our bodies and it's important understand that there's technology out [00:45:00] there. That's why I do all the marketing. Um, for myself, because patients don't understand what's out there.

Dr. Grant Garcia: I mean, I've saw multiple patients even today that had, that we had technology we've been doing for the last few years and they had no idea they could have saved their knee with this, this opportunity. So it's just more information gathering for patients to teach them. So they're not, they're learning better and they're understanding what gets them back in the game.

Dr. Grant Garcia: And in the end, like we've said before. Patients first, getting them back to things they love, because when that patient comes back and they say they're back to everything, that smile on their face, it's worth everything. For Will

Will Sanchez: Sanchez and Dr. Garcia, special thanks to Zach out there, and I promise Dr.

Will Sanchez: Garcia is going to work on getting that miniature pony out there for our listeners, don't blame me, blame Dr. Garcia. We appreciate you listening. Thank you for listening to Sports Doc Talk. Dr. Garcia, have a great night.

Dr. Grant Garcia: Take care.
Audio Transcript


Highlight Episode: Nick Chubb Injury and Aaron Rodgers Surgery

Picture of athlete holding their knee

Will Sanchez: [00:00:00] Welcome

everyone and thanks for listening to Sports Doc Talk. I'm Will Sanchez along with our orthopedic surgeon and sports medicine specialist, Dr. Garcia. Dr. Garcia, I had everything planned out for this show, right? We were like, we're going to do a show on Aaron Rodgers. We're going to talk about his Achilles and the procedure and who he went and how he went into the darkness is going to come back and, you know, in three days and rise again for the New York Jets.

But we'll get into all of that. Unfortunately, we've got some really bad news and we know how difficult, how beautiful the sport of football is, but at the same time, how difficult it is. Nick Chubb had an injury tonight and we're doing the show Monday night, Dr. Garcia, when you saw the injury, you heard about what happened to Nick Chubb, what was the first thing that you thought about and let's get [00:01:00] into what type of injury this is.

Dr. Grant Garcia: So I'm, you know, I had my usual friend group and I saw this and get texts blowing up saying, you know, do you see what happened? You see what happened? And looking at the injury footage and then hearing from most people, I mean, it's only been injured for less than an hour. And I've heard from about six people asking what happened.

So obviously this is a pretty hot topic and people want to know because he's a very high profile player with a pretty bad injury. So basically had a knee dislocation and in isolation, this is really not a good thing. You know, for me as a sports surgeon that is the last thing I want to see on the field.

You know, there's obviously severe neck injury with paralysis. We don't want to see that or, you know, the Demir Hamlin injury, but those are really rare. This one's not as rare, but fairly rare. We've seen a few players with it, but having knee dislocation is just awful. It's one of the worst things we can think of.

And there's been a few players that have had this, but unfortunately for Nick Chubb, this is actually the second injury of knee dislocation on that same knee, which just makes this a whole [00:02:00] other level of. But basically if you look at it, and again, I'm not there examining under MRI, but if you see it in slow motion, it's pretty obvious what happened.

You can see he tears his MCL, which is the ligament on the outside. Almost definitely tears his PCL, which is the ligament on the inside. That's the one you hear about less, probably tore his ACL. His posterior corner, or LCL, which he had reconstructed in Georgia in 2015, may be okay, but this is considered a grade 3 or 3 ligament dislocation, and the other concerning thing is an injury to his artery, which I know there was a Bears player, or one of the players, about last year, that had to get rushed emergently to the operating room because he had an injury to his artery, so this is This is a bad combination of things and we'll obviously see how it unfolds and I just hope that this obviously is not the end of his career, but also that he can, you know, there's no major arterial damage and they can protect him and they will again with NFL.

We've seen them. They can do things that most places if you got injured on a field, you wouldn't be able to do. So I do have faith [00:03:00] that they're going to get that done.

Will Sanchez: All right, I have a question here. So just kind of going back to let the listeners know you mentioned in 2015 as a sophomore when he was still attending University of Georgia, he dislocated his knee toward the MCL PCL LCL in the same left knee that he had the injury tonight.

If you're in a physician, if you're running out in the field to treat him what is the one of the first things that you need to do? Because obviously there's Some besides the the physical trauma what's happening emotionally because it's such a serious injury So you have a team go out there What are the some some of the first things that you have to concern yourself with the player and the injury at the same time?

Dr. Grant Garcia: Well, let's assume they saw the footage before they went out there or they saw them the injury itself And they might not have and they ran out right because he goes down Says he's injured and then now you're seeing the game footage on the screen or on ESPN P. N. But that was the zoomed in one. Let's say they saw the footage.

The first [00:04:00] thing I'm worried about is his state of his leg. Because you know, I've seen in residency and things like that, injuries like this where they go on attended and you have a major problem because you've lost arterial or a supply of the blood to the leg. So the first thing I'm running out there doing is obviously making sure that it's relocated so that it needs an appropriate position.

But the other important thing is making sure that there's a pulse in the leg and you see that people check their pulse in their neck, their arm, you know but you can also check in your feet and that doesn't give you the whole story of whether this is a real injury. There's some other tests you have to do, but just checking for that initially is something that's important and making sure that the foot looks like it's got some normal perfusion and not like all of a sudden it's becoming, you know, pink or a different color.

And again, really quickly it just happened. So it might not have happened at that moment. Yeah, but that's the first thing I'm checking and then I'm getting him off the field as soon as possible.

Will Sanchez: When it comes down to this type of traumatic injury, right, and whether it's the femur, the tibia, whatever that's no longer connected to the knee, and it's, [00:05:00] for lack of a better word, it's not funny, but it's one of those words that is used, dislocated knee.

It doesn't sound bad, but then obviously when you describe what the injury is, it's really bad. What is the concern and how do you check for possible nerve damage in that immediate situation? Or is that something that you have to do when you get back to the locker room? What's what's that concern like and how do you recognize it immediately?

Dr. Grant Garcia: So damage to the nerve is usually on the outside of the knee, there's a nerve. You can have damage to the other nerve on the inside of the knee, but that's a lot less common. Okay. But damage to the outside of the nerve was with someone, you've probably seen someone that wears a brace called a, it's like an AFO or something where it keeps the foot from slapping.

So the nerve, the nerve that lets your foot lift up can be injured in this type of injury. Probably, Nick Chubb probably didn't have it at the initial time, because obviously he wouldn't be the level he is right now. But that can happen and that's a big deal. I've seen that before a number of times.

With these massive meatus locations, so you can have a nerve injury and you can have an artery injury. The [00:06:00] nerve injury is A bigger problem in the long run, right? Because sometimes it doesn't come back. But the artery injury, the nerve injury, if it happens and you notice it, there's nothing you can do at that moment.

As long as you've relocated the knee. The biggest thing is to get the patient's knee, or to get the player's knee in alignment, and get them checked out to make sure it's not an injury to the artery. That's the number one thing to do right now.

Will Sanchez: All right. And the last thing before we move on just because I'm just fascinated by this type of injury and I just, I can't imagine going through something like that.

How do you deal with the dislocation? Is that something that you're going to deal with before you go to the hospital that you have to pop it back in place or move it into place? I'm not, I'm probably not saying it correctly as far as you saying the word. Those are good questions. But you know, how do you deal with that?

Because this knee is. out of place, and I'm assuming that this is extremely painful.

Dr. Grant Garcia: So, the answer to that last question is yes. [00:07:00] But the the problem is this is the second knee dislocation, right? Yeah. Because when you tear three ligaments, usually the whole knee dislocates. Now, this is quite bad. It went backwards.

You could see it just completely go in a different orientation. Ugh. And bend in a way it's not supposed to go. And so he's gone through this before. And this may be one of the reasons that dislocated like this, because the ligaments you make in theory, they're stronger, but they're always a little bit higher risk.

And once you got damaged to your ligaments and things like that, you're at a higher risk. Now, again. He hasn't gotten injured or had significant injury like this since 2015, so he's done fairly well since his Georgia injury. So that's impressive, and I didn't realize he had dislocated his knee before until this happened.

Because you wouldn't expect a player of that caliber with this injury. So he's already proven he can do it, but revision surgery, we've seen with Odell Beckham Jr. with an isolated ACL revision. much longer recovery. And this is a bad, bad one. I mean, this is the second injury of this caliber. I don't, we have to probably look it up.

But I don't know of anybody that had a second one in the same [00:08:00] knee and made it back. But again, I have to do my research, but this is not the one that I would wish upon anybody. And again, we don't have the actual, you know, maybe his ACL is okay. Maybe it's his PCL but to dislocate your knee that far back, usually you have to take advantage of a number of ligaments.

And it's going to be also tricky, I think, again, this is, we don't want to get this podcast too long for the listeners. Too late. But the other problem you have to think about, yes, too late. So, well, this is complicated, but this is super interesting, people that want to know about it. It is. So basically, this is a whole nother level of injury, if you want to talk about complex, like the guy getting this injury right now, and I don't know if they're in the Cleveland Brown Stadium, if they are because a few of my friends are actually

Will Sanchez: team docs.

No, they're at the Steelers. facility, in fact, the fans did a good job and cheered for him, so it was nice.

Dr. Grant Garcia: Yeah, so there's some really good surgeons there at University of Pittsburgh, and I imagine that the surgeons for Cleveland are there also for the game, and so they're both going to go right now to figure out what we need to do for him.

He won't operate on everything right away, because you don't want to do that, because there's a lot of... This is a whole [00:09:00] nother lecture we could do and talk on this. We may want to add this as a talk later on. But basically they want to stabilize him. The same thing as trauma. This is like a trauma to the knee.

It's like a car accident, right? Like you're not going to fix everything right away. Yeah. You're going to figure out, like, let's calm everything down and do the big stuff later. So let's not worry about the major stuff. But the problem you have is he's had reconstructions already of his PCL. Probably his LCL and probably his MCL.

So he already has new tissue either used from his own knee or from cadaver, but probably a combination of both. And so now where are you going to get it from? So he can't use his own tissue because a lot of it's been taken already. And maybe from the other leg, but do you want to do that in a running back like him?

Yeah. And will he, can he, can a cadaver ligaments hold up in an NFL player? Don't know. So, you know, this is a, and now he's got tunnels and probably hardware in there. So this is not like, this is a straight up simple, let's go reconstruct everything. They're going to have to figure out things to avoid.

Because he's took him, he's done some wear and tear on these ligaments over time. And it's not the same as your own natural ligaments. So this is going to be and there are some really good [00:10:00] surgeons at both those places. And he's probably going to get some second opinions very quickly. But this one is going to be this

Will Sanchez: is going to be a dizzy.

All right, I'm apologize right now because I have another follow up question, and I'm really sorry, but this is I've got so many thoughts on this Will they consult the original surgeon? I don't know who it was right from Georgia or whoever they wherever he had a surgery When it comes down to something like this that they're going back in to Refix something that was already broken and fixed would they make a phone call or hey?

You know like consult at all or go back and look at some of the old film To, to see what they're dealing with, you know, before they jump in.

Dr. Grant Garcia: This is a great question. This is a revision question. So I do a lot of revision ACLs and revisions such as this level. I mean, this is a pretty unusual injury. But whenever you're doing a revision, you want to get data from before, right?

Because let's say they use something that's metal. You don't know how to take it out. Right. It's there's hundreds of metal implants out there, and they're all required different [00:11:00] screwdrivers and different removal devices. So if he's got a bunch of metal in his knee, and I don't know, I've never seen the inside, but he's got multiple screws that are different sizes.

It's like you go into a car and you don't read the instruction manual. How do you take out the engine appropriately? If you don't have all the right, the right ratchets and the right wrenches, et cetera. So if this is something where it has that, this could be a whole nother level. Again, these guys are good.

This is not something, you know, you're used to going into the operating room, and if you have to kind of audible things, you will but they're definitely going to consult previous notes. I don't know if calling the surgeon is something that they would always do, because, you know, how are they going to remember from 2015?

Obviously, he's a big deal, so maybe they do remember that surgery. But overall, you know, it's But you, we all use somewhat similar techniques. We have different variations, but you know, there's some, there's good ways to do an a c l. There's good ways to do a posterial corner. There's good ways to do an MCL l.

Yeah. So if you do it relatively a good way, you know, kind of what's going on. And a guy like him who was checked out a number of times during the draft and each time he's gotten through physicals. Yeah. You know, his knee was checked out for quality. And so, you know, I don't, I'm not super worried about that [00:12:00] part.

But yeah, they're gonna do some homework tonight for sure. This is gonna be an all night event. At least preparing if they have to do anything for him. So this is behind the scenes. This is a whole nother animal. We had a lot of these giants players that had these severe urgent injuries and not even this level.

And it was, you know, this is going to go into the wee hours, probably. Man,

Will Sanchez: that wow. All right, we're gonna move on. I, I, I'm telling you, I could, I could ask a bunch of other things. And, you know, we, we've done so many shows with new tech and everything else, and we're 2023, and this, this procedure happened in 2015, so I could imagine the changes from Then to now and going back and you know, whether they have to, like you said, finding the right screws and you see him, I, whatever I'm going down to rabbit hole.

Let me, let me move on. He's going

Dr. Grant Garcia: to have a few internal braces. If I have to make a comment

Will Sanchez: about that. Oh man. You know, you just, you, you just like, you just like saying the term brace because it gets, it gives me a hype, man. I get so high. Let's, let's get right into it. You know, Aaron Rogers, man, traded to the jets on April [00:13:00] 24th, 2023.

I mean, Every JET fan, and I have a lot of friends that are JET fans, they ran out and they got, they bought tickets. In fact, my buddy's going with, with his son and his grandkids to the JETS Kansas City game. They got tickets because it was the kid, the kid's birthday and everyone's excited. And HBO is like, we're going to put them on hard knocks.

And the NFL is like, well, opening night, we're going to have them play Buffalo Bills division rivals. on September 11th. And that night, you know, it's packed stadium. Aaron Rogers comes out by himself running out of the tunnel with the American flag and it's waving and the crowd is just rambunctious and just Absolutely rock star atmosphere.

The place is jumping. The savior is here. We're finally going to win a Super Bowl after 54 years, going back to 1969 and Willie Joe, name it. And four [00:14:00] plays later, Aaron Rodgers gets sacked. He stands up and he sits back down. And something is wrong before we get into a real quick when you heard about what had happened when I heard about when I saw it was unbelievable.

I couldn't believe it. But when you heard about what had happened, what was the first thought? Because you're a Giants fan. You're a football fan as a fan. What was your thought

Dr. Grant Garcia: as a fan? It was horrible. You know, that's the last thing you want to do for a team that really needs the motivational boost. And, you know.

You think about what you, what you want about Aaron Rodgers and other things he's done, etc. But you know that what he's brought to the team and what he's brought to the fans in New York Jets, you know, and the fact that this happened so quickly after the first game. I mean, it's just, it's just frustrating as a fan of any team and just you feel badly for those, the Jets fans, you know, and you feel badly [00:15:00] for him.

Too because this is not an easy injury to recover for and I think you'll get back but That's not why we're doing this show is because whether or not we think you'll get back. We're doing it for the The innovative tech that he was supposedly given.

Will Sanchez: Yeah, get into this orthopedic surgeon that had performed this surgery.

He has a history of working on athletes and some notable ones, so can you talk a little bit about this specific doctor and the type of work that, and the type of players that he's already done some of these surgeries on? Yeah,

Dr. Grant Garcia: so I think the more important part of this talk is the behind the scenes. because this

Dr. Grant Garcia: is, this is no cakewalk to take care of Aaron Rodgers. And you probably heard that he texted the doctor right after he got injured, you know, telling him, get ready. I'm getting operated on tomorrow type of thing. So this is a guy with a speed dial to professional athletes at that level.

Wow. So this is Dr. Neil Elitrosh. He's the team physician for the Los Angeles Rams. He is the Grand Master of Curl and Jobe, which is a extremely prestigious [00:16:00] LA fellowship. I actually had the pleasure of interviewing with him. He's a really nice guy and obviously, you know, really well known. You know, my most memorable post I saw of him was him with having operatable Sylvester Stallone and Arnold Schwarzenegger in the same day.

So this is the type of guy that we're talking about. He's on Saquon Barkley, you know, Joe Burrows, Tom Brady you know, and he's, he always is pushing the envelope too. You can see, you know, he mentioned the word internal brace a lot, you know, with he talks about Tom Brady, how he internally braces MCL to get him back when he had that MCL injury.

And he does a lot of behind the scenes celebrities as well. But, you know, if you look up at so many professional athletes and he's. He's always been a high level player in terms of you know, one of the cutting edge leaders, one of the leaders for the celebrities and for the athletes. But over the last like five to six years, he's really taken off and, you know, he's really good friends with the CEO of Arthrex.

And so he's done a lot of innovative things through Arthrex. Obviously that's, we've talked about them as an innovator. And so he's, he's well known throughout the world. You know, he's the Tommy John guy. He's [00:17:00] the now knee guy. He's the shoulder guy, you know For Jacksonville, he's the one that did the eight anchors on the quarterback for, he's the one that said that was the worst tear I've ever done and, you know, ended up putting, you know, eight anchors in the shoulder of a normal human being is a lot.

So, you know, he's a, he's, he's done every one you name. I mean, if you look up his type of injuries he's done extremely prestigious. So, Dr. Neal Eltrage is the physician, and you'll probably, you know, he may get consulted on this one. You know McGregor?

Will Sanchez: Yeah. McGregor went down. Conor McGregor from

Dr. Grant Garcia: UFC.

Yeah, look him up. So my friend did the, my friend is a trauma surgeon at UCLA, did the surgery, but Neil Alatrosh was, was required to be in the operating room to do it as well. So Neil Alatrosh, I'm not sure he is an expert at tibial shaft fractures, but he was in the surgery because he's a celebrity surgeon.

Yeah. So that gives you an example of how big a deal he is that McGregor wants you in the operating room.

Will Sanchez: All right, let's talk about this procedure, right? And you know, I, I was excited not about the injury, but the fact that they did this internal brace and [00:18:00] I went to look at it because I'm just, I'm fascinated.

You know, I'm, I'm dying to do it on, on a patient and we got to find a way. I might have to go to a different country to get away with it, but they showed where they, they drilled in and placed internal brace and how they pulled it. The Achilles together to hold it in place. So just talk about that procedure.

And I don't know, what are they calling this? The speed bridge for this torn Achilles? Yes.

Dr. Grant Garcia: So I will burst the bubble a little bit that this is not new. This has been around for a little while. Yep. The idea, the word internal brace, which we've talked about, and please listen to our previous episodes about internal brace, internal brace is where you do a bone to bone.

So in this situation, he technically wasn't internally braced, but everyone loves that idea. And so now everyone's using it for anything. It's now a catchphrase. It should be your catchphrase, but nonetheless... I'm gonna get a

Will Sanchez: t shirt that says, I love internal brace.

Dr. Grant Garcia: I'll get you one. I need to get you one.

There you go. So the so basically he wasn't [00:19:00] technically internally braced because remember the word brace is to sort of make it rigid. And you don't want to make the Achilles rigid because the Achilles has to stretch so far. Yeah, you need that flexion, right? Yep. Yeah, and again, you don't internally brace tendons, you internally brace ligaments.

So ligament is the UCL. A ligament could be the A C L that you internally brace. The M C L is a ligament, but the a achilles is a tendon, and so by bracing the tendon that would be very bad. So he technically wasn't internally braced. So the procedure that he had is called a speed bridge. We do it in the shoulder as well.

I've done this in the Achilles before. It's a really slick way of doing it, and the thought process is that when you tear your Achilles, You split it mid substance. Initially, the older way of doing it was to do it open and then they came up with percutaneous techniques where you can do it through a small little incision, maybe like, you know, a little bit longer than your thumb.

And then you can connect them together and sew them. Well, the third way of doing it is the way that Aaron Rodgers had it, where you kind of say the bottom [00:20:00] part's like pretty good, so you maybe put a stitch in that, but the top part's where the big part of the Achilles is. And so you sew that directly into the bone, so the fixation is much more rigid and you can move people faster, and there's a lower chance that they're gonna tear out.

So they dumped it into his heel bone, which is what you probably saw. And the speed bridges, that means it's a lot faster with no knots or anything, because the knots can cause injuries. Because one of the biggest complications of Achilles is to get an infection. And so that's why these percutaneous techniques have been invented, because Achilles were known for having problems with having wound infections.

With these new percutaneous techniques, it's extremely low, and now you have this newer technique, the speed bridge technique, which fixes it into the bone, so it's much more rigid fixation. You never want to really be repairing tendon to tendon together, that's why this newer technique is so impressive.

Will Sanchez: Your tendon snaps, right? So, there's a part of it that's up and there's a part of it that's low and they're not connected. So, when they did this procedure and they're bringing them close together, are they just bringing it close [00:21:00] together and letting the body heal itself because now they're next to each other?

Or do they have to, at that point kind of connect them?

Dr. Grant Garcia: So that's, that's the best question you could, you've asked tonight and you've asked some good ones. So that one is the trick that people do that. Even when I was learning this and we learned about this, it doesn't make any sense. So it's a lot of people can be treated without surgery with an Achilles injury.

If you keep the person in the elevation, eventually the tendon will grow back together in some cases. So there is some data that you can do non operative treatment, especially in patients as they get older. So the idea is that it doesn't have to be in the same, the same zip code, right? Or maybe this is the same household.

And so. We used to tie them together either with a big open incision or this percutaneous technique. But what I was saying before is they really don't care about that bottom tendon, and they just pull the thing down as close as possible and keep it rigid. And then the idea is that by keeping that part rigid and stretched out, you don't have a likely chance it's going to pull off.

You can start moving faster, and the little leftover tendon We'll heal back there [00:22:00] and eventually it'll be fine. And the first couple of times I did this, it was really weird because you're used to like repairing everything back together. Like you want to make things look perfect, right? Yeah. I'm an OCD perfectionist and you have to tell them, no, don't worry about it.

It's not a big deal. It'll be fine. And that's what these newer surgeries, you have to kind of come to the comfort level. And it's always these. Really big innovators that cutting edge that understand this and learn this and teach this and invent these techniques understand ahead of time, and then you slowly pick up on them, but that's exactly the point.

So this is it is a partial repair, but really, it's just basically putting in the same household and then the body will heal it because it's not moving, right? Because it's been braced down to the ground.

Will Sanchez: Are you, are you doing anything or are you adding anything to that area to speed up the healing process besides, I'm, I'm assuming that they're going to put them in a boot, but is there anything else that they can do to kind of, yeah, we're in the same neighborhood, but we want you guys to be a little bit friendlier, quicker, and not just kind of you know, bumpy to each other in the street, [00:23:00] you'd be like, hey, no, you're, we're, we're putting you in the same in the same place.

Dr. Grant Garcia: So they're probably using, you know, they may have used. And again, the data is kind of mixed and whether any of those type of biologics help them, but it's Aaron Rogers. So why not throw everything at him, right? The other thing is you don't want to give him too much stuff in there and then causing infection, right?

Cause you give him too much things. You're not really, you're kind of experimenting with and trying new things. You want to be careful, right? It's just a fine balance. Now, if you're in Dr. Neal Alatrosh doing this. You're not super worried about your reputation because you've got such a big deal. So you want to try something that's going to get them back faster, that's going to look better, right?

Yeah. And then they're going to use that special dressing I think they had talked about that's an antimicrobial because again, we don't want an infection because the most common place to get an infection is right here where you had it. Now again, probably had it done percutaneously if Dr. Neal Eltrash did it.

Yeah. But nonetheless, you know, that's something to be aware of as well. So. They're, they're attacking the healing process from rigid, solid, incredibly good fixation so you can start moving early, because remember we've talked about [00:24:00] this, the faster you can move our patients, the better they're going to get back to, that's why internal brace works so well, because you can move them faster and test the ligament faster.

That's the whole, that's the whole reason why it's so effective. And things don't stretch out. Two, you know, you want to make sure you don't get an infection. So you have a special dressing and three potentially biologics. So you've done everything right in the body to make it go better. And I think this is be a great topic at some point for one of our, our show is to kind of say.

What makes things better, right? And this is this, this device, this technique has made better. And, you know, where it came from, Arthrex, which we talked about before. So this is, this is a combination of, and you could see they jumped right on. I mean, there have been multiple Arthrex posts about this new technique in the speed bridge and really bringing light to it because it's done a little less frequently than the side to side repair.

And it's just surgeon preference, but I've done it before and I've been extremely happy and that's sort of the way I now fix these because of the fixations are rigid in the bone. But also I'm a proponent of rigid fixation as it is. I'm an internal brace guy. You know that. Oh baby. [00:25:00]

Will Sanchez: And also having a smaller incision also helps with the healing process, right?

I mean, I had my Achilles done years ago and you know, I have a. Six inch scar right down my Achilles compared to the, you know, the small incisions that Aaron Rodgers had for

Dr. Grant Garcia: this procedure. Yeah, and that's 100%. I mean, that's why we started doing it. It was helping with healing because the other thing is when you get your whole Achilles opened up and I don't want to gross out the viewers but there's, there's a tendon sheet around that that has blood supply into it and that can get damaged as you open it up and try to repair it.

So, you know, I think we go for smaller and smaller decisions, not because the idea of it's sexy that you can do minimally invasive, but it's actually better for the patients and the less trauma that your body has, the faster it can heal. Okay. And so that's why minimally invasive works if obviously there's certain areas where we can't be minimally invasive if you shatter your heel.

You know, you're not getting a minimally invasive repair because you have to open it up and get all the pieces back together and etc. But we are getting better and better at [00:26:00] minimally invasive surgery and this is one of the reasons why so we can get you back faster.

Will Sanchez: Okay, he's talking about recovery and getting back by the end of the season he's 39 years old.

He just had this procedure. He wants to get out there by the time you know, playoff start, which I don't think the Jets will be in the playoffs, but that's a whole other conversation. We're just talking about the timeline. If you had to, if you were a gambling man for 39 year old, after this procedure for him to get back on a professional football field with 300 pound men chasing after you, What would the odds be of that?

Dr. Grant Garcia: So we've been wrong on gambling many times on this show. I will tell you absolutely not. But I will tell you absolutely not. This is, this is ludicrous that he was told he was four months. But you know what? Everybody's talking about it. We hit ESPN. I saw a big huge article on ESPN talking about he's going to get back in four months.[00:27:00]

But again... You know, my primary surgeries that I do are, you know, shoulder, knee, and elbow. I do do Achilles, and I do the innovative technique, but four and a half months seems is just a little, it's a little bit too. But again, it's Aaron Rodgers. He loves to get people excited about things he says. He also was talking about things he does with, listens to dolphin noises to get his healing better.

So we have to talk about, there's, there's different things that, that he said that we don't know the credibility of. But listen. More power to him if he's motivated to get back, and he will get back, and like I said before at the very beginning of the conversation, I think he'll be back, but he's not coming back this year.

Will Sanchez: Anything that works, if it puts you in a great mental space for you to deal with your injury and think that you're recovering faster by listening to Dolphins, then I'm all for it, right? Whatever gets us to our happy spot. Dr. Garcia, you know, this was supposed to be a 10 minute show, and then we started yippity yapping, and I've got, you know, 85 questions, so let's wrap it [00:28:00] up.

I just want to remind everybody, please check us out at sports. talk. com. Our shows are there, transcripts are there, just cool information. Dr. Garcia has tons of stuff on the website, so please check us out. Dr. Grant Garcia, orthopedic surgeon and sports medicine specialist. If you haven't figured it out, he knows what the hell he's talking about.

Dr. Garcia. We didn't even get a chance to talk about our boy getting hurt. Our, our Saquon Barkley with that ankle sprain, which is probably going to be out three, four, maybe longer weeks. Very concerning, but Hey, this is a tough sport. Thank you for your time tonight. And let's do it again.

Dr. Grant Garcia: And again, yeah, thank you so much for having me on.

And again, hope both these athletes recover quickly. Check us out on our website. And again, also, you know, on our website, we have posts. You can post questions. We are happy to go through a show where we answer questions from our listeners. You know, again, it's, it's always nice to hear the questions from Will, but you know, the listeners as well [00:29:00] would be great.

Will Sanchez: So. Yeah. Less of me and more of you. That should be the motto. That's another t shirt. Take care, Dr. Garcia. Thank you for your time.

Dr. Grant Garcia: Thank you very much. Bye.
Audio Transcript


NFL Kickoff 2023: Predictions, Injuries, Data and Tech

Picture of football player

Will Sanchez: [00:00:00] This is the most exciting part of the year for myself. I know for Dr. Garcia, what do I smell? I smell pigskin. I know that sounds a little nasty, but it's football season 2023. We're about to kick off. I'm Will Sanchez. This is Sports. Talk. Check us out at Sports. Talk. com. You can find our shows. You can find our gmail, please send us your request for show topics, all sports, all orthopedics all the time.

Will Sanchez: And we once again have our favorite orthopedic surgeon and sports medicine specialist, Dr. Grant Garcia. Dr. Garcia, it's football season. Welcome to the show. It's so good to talk with you once again.

Dr. Grant Garcia: Yeah, it's good to be back. I've had a little summer hiatus, but I'm extremely excited. We have the first Giants game coming up, got a brand new looking team, faster [00:01:00] team and so far healthy team.

Dr. Grant Garcia: So this is really exciting. And I'm excited about the show today because it's football season and everyone loves to talk about football.

Will Sanchez: Oh, yeah, once again, man, it's football season for those fans that haven't listened to our previous shows I'm from new york now in seattle. We have dr. Garcia here in seattle We're both giants fans.

Will Sanchez: So that is the common thread. This is how we we meet and conclude in the middle of this beautiful relationship friendship partnership It's the New York Giants that have tied us all together. So that's where our allegiance lies. How excited are you for this Giants season? After a 10 8 1 season last year, Coach Brian Dable, Coach of the Year, led t