Podcast Transcripts

Will Sanchez: [00:00:00] Welcome to Sports Doc Talk. I'm Will Sanchez, along with Dr. Grant Garcia, our orthopedic surgeon and sports medicine specialist. Um, we kicked off the show with having every technical error that we could possibly have, but luckily it was at the beginning of the show, so hopefully from this point out we are moving and grooving and going strong.

Dr. Garcia, how are you?

Dr. Grant Garcia: I'm good. I don't know if anybody's gonna notice this, but uh, there is a little commonality between our two screens.

Will Sanchez: We're gonna drive, I guess, crazy. I don't, I I, I think our, our special guests, our triple threat, uh, Tom is gonna be like, this is just way [00:01:00] too much sports doc talk. I'm out of here.

But, uh, you know, we we're just really happy to have 'em. And, you know, before we get into all of that, let's give a quick shout out to our guests, our recovery shop friends. Take it away, Dr. Garcia.

Dr. Grant Garcia: Yeah. So again. You know, we keep talking about them, but obviously the idea is recovery postoperatively, um, or just when you get injured.

So obviously Tom's gonna be a great segue for this, but, uh, this allows me to offer sort of more cutting edge stuff for my patients. Um, and as a surgeon it's really important 'cause patients always ask for this. It's just, just nonstop. They want to know what's the best. How can I get the best? What can I do to be up this level?

Um, and that's what opt, that's what we have at the recovery shop. So the ability to get sort of advanced machines, advanced nutrition, et cetera. I'm sure Tom can wane on this and how he works on recovery, uh, but these guys have been awesome. So reach out to Mike. Uh, you'll not be disappointed. And I think, you know, as a patient, if you want this, you also can reach out to Mike and say, Hey, listen, I have a [00:02:00] surgeon.

I'm interested in using this opportunity and I want to have this for recovery. So this can go to patients or this can go to the surgeons. Uh, so reach out to Mike and he'd be happy to help. Will Sanchez: I mentioned at the top of the show, we have our guests here and he's the triple threat, right? When we say triple threat, it's because of the physiotherapist that he is.

And for those that are not aware, you know, that's usually a professional that deals with the physical techniques and the manual techniques and then, you know, puts it all together and.

Provides that education for his patients. So I like to call it the triple threat. So without ado, just, just talk about, uh, Tom, and let's bring Tom on.

Tom, thank you so much for being on. Um, we're really excited to, uh, to have you here and. Just to let all our listeners know, Tom's on the East coast and we're doing this show really late. So I was busting his chops when he first came on saying, Hey, I know you're a proponent of telling all your patients get, get eight hours of sleep [00:03:00] and rehydrate and do all these things, and right now we're probably keeping up, uh, keeping you up past your bedtime.

Tom Swales: I got all these bright lights in my eyes just so you can see my face, but you know, the clock's, clock's ticking. You know, we all wake up, we all make an alarm to get up, but most of us need to put a, set, an alarm to go to bed. So we're keeping that consistency and that circadian rhythm in check for, for better recovery and performance.

Dr. Grant Garcia: That's awesome. Yeah. Well, thank you so much, Tom, for coming on. I think. Yeah, no problem. I think for the viewers, they're gonna love this. You know, this is a guy, like, I would say the triple threat, I think will, we can jump in There is. You know, you have amazing physiotherapists and strength coach, you have unlimited experience taking care of high level athletes.

You'll talk about, but also, you know so much to some of these other celebrity guests that we've had on, uh, that's not all they do. Yeah. Right. He's gonna get into something. You divide a certification thing for physical therapists and strength coach, which is just the next level, right? Like that's so much extra work on top of your job.

It's like what I talk about, what I do. I'm the surgeon and then we do other things on top. Yeah. And

Dr. Grant Garcia: then he is the co-founder of [00:04:00] something called Comp Physio, which we can talk about as well. So this is somebody that's done a lot of stuff. We're really excited to have you on Tom, and I'm really excited for listeners, uh, to hear about you.

But obviously enough about Will and I, we could jabber on, as you know, for an hour with. Out talking to anybody else. Uh, so Alyssa, can you tell us a little bit about yourself so the viewers can hear?

Tom Swales: Yeah, so you guys touched upon it. I'm a physio strength coach, um, you know, uh, owner of concept of Movement, which is now com Physio and performance wellness here in Barry. Husband, father of two. Um, you know, my wife and I, we started our business 12 years ago. Uh, just the two of us. It was 4,000 square feet. I had this vision for this, not just rehabilitation, but. Full high performance facility. And we found this old garage, uh, it was a, a Harley Davidson garage. So we got the roll up door doors in the, uh, in the gym area, glass.

We turned into a big glass door, but we have a medical side and then we have the performance side of things. And, uh, it, it started with just the two of us. 12 years ago, she was [00:05:00] running the front desk. I was the only physio. We had one movement coach and we've grown it to now to 27 staff. So it's become chiro, massage, osteopath, acupuncture, the whole, the whole gamut because the way that we, we work with our clients and athletes, it's, it's a holistic approach.

And when you have more sets of eyes to look at a problem, you come up with better solutions to the problem. And that's kind of where, um, you know, over the course of my career, I've been doing this for over 20 years now as an, I'm also an athletic trainer. I got trained down in the states and, um, and. You come outta school and you're like, I want to take courses.

I mean, that, that was me. I was like, I need, I need to keep learning. I like what I have is good, but I know I could be better. And then you take course after course, after course. And it came to the point where I, I've done a hundred courses in certifications and it became flavor of the month all of a sudden.

Okay, great. I did a course. I'm excited to do my craft again. Everybody gets this this month. So then everybody gets dry needling, and then I'm like, well, this worked [00:06:00] for some people, but how come it didn't work for others? And then everyone gets manipulation, and then everyone gets positional release, and then everyone gets kettlebells.

Like it just became this guessing game. And the more I learned, the more I realized, I don't know, and I got more confused and disorganized. So I had to take a big step back and look at, okay, what are the fundamentals across all of these, all of these tools? Whether it's, you know, learn, becoming an RKC or kettlebell instructor, or learning gymnastics or, you know, all the way into needling and manual therapy.

And when you distill it down, we're, we're really composed of like five elements, and it's psychology, neurology, biology, chemistry, and physics. So I started thinking like, well, if I, if I have a better understanding of these five things, I can explain to patients what I'm doing, why I'm doing it, and how I can do it better.

Right? Like how often clients come in, they're like, oh, what does ultrasound do? Well, it's an electric concurrent coming into a crystal, creating a vibration, creating a piece, electric pulse. That pulse is [00:07:00] creating, uh, sound waves into the tissues, which is creating vibration. That vibration is, is shaking up the cells, creating heat and increasing blood circulation, breaking up scar tissue, and creating physiological effect.

We can get into light therapy and lasers and all that other stuff, but essentially it's a form of energy being applied to the body, creating a stress that causes an adaptation. So I can break it down into simple physics of like, well, it's just energy coming into the body, causing a stress and an adaptation.

That's the biology behind it, right? We know there's a lot of nuance behind it, but when you start breaking down the actual appointment, the relationship, well, what does it start with? A conversation. I. Okay, I'm gonna ask a person questions. They're immediately in the first 12 seconds, do I like this person?

Yes or no? Do I feel safe with them? Am I connecting with them? Can I trust them? Now, what that'll do is the nervous system will start to calm down if I get a positive response. If the nervous system shifts in the direction I want, well, what happens? Their breathing calms down. They go more parasympathetic.

Their blood pressure drops, and also their [00:08:00] organ, their nervous system starts to organize. All of a sudden, oh, my shoulder hurts less. Right, because they're not guarded. Even just simple words that we use have an impact on someone's physiology because of the psych psychological component. And then we look at biology and how cells and develop, like how we develop in utero, how we develop out of the womb from the ground up.

Then we look at chemistry. Everything's molecular, the food we eat, the air we breathe, the chemistry. Our pH has to be a certain way. And then we look at physics. Well, what does physics have to do with anything? Well, we live in a three dimensional world and everything's matter. Well, what's matter made of?

Well, when you start looking at Quantum, it's energy, it's com, it's composed in specific frequencies, vibration, frequency, and energy. And then when you look at the actual, like down to an atomic level, everything's empty space, right? 99.999% of all of us at every single atom is empty space. And then when you start to think about what affects that, well, thoughts do, because now it comes back up to person's psychology and belief systems because it creates specific frequencies [00:09:00] that affect biology.

So. So to come about in a very, like as short as, as a description as I can when I distilled what we do down as movement coaches and therapists, if we can understand what we do, which is relatively new. To these more, uh, older forms of education, it becomes a lot easier to explain what we're doing, why we do it, and how we do it better.

And then that allows us to build more information on top of it because if I bring in a new tool, I now have this, these principles in which I can bounce that tool off of to better explain why it has an effect. And we know that not everything works for everybody, but something will work for somebody. So having more tools, that's awesome.

Explaining what those tools do at the right time, on the right person for the right problem. Now you're gonna get the solutions that you want.

Dr. Grant Garcia: I love that. I mean, I think the point you're making for the listeners is obviously it's a lot of information you just distill. Yeah. And, uh, some things physics, some things biology, right.

But I think if I were to distill some points for the [00:10:00] listeners is you heard this is the same way as surgery, right? There is the psychological component. There's the actual component of biology, the physics of why we're doing this surgery. Um, and that's the same thing that you're talking about. And so it's really important that this is not just a concept that's to one thing.

This is the whole medical field. What you're doing versus what I'm doing is it's all the same stuff and there you have to treat everything, the whole body. Yeah. Uh, and I, I think that's a really important thing. I mean, you, you are probably dealing with this with some of the athletes you've taken care of, but I mean this is, I mean, how often do you say that you're dealing with injuries and you're having to deal with the psychological component of it

Tom Swales: all the time?

Because people come in with these beliefs of, I can't do this. I was told I will never be able to to do that. And I'm like, well, why? Because I have a degenerative disc disease. Like that's a stupid label, like that's like gray hair of the spine. Everyone's got it. Like some of the, some of the diagnoses we have, I mean, we need them so we can communicate and speak the same language.

So I can say one thing, I don't have to sit there and explain it, but to a patient who doesn't [00:11:00] understand that, it sounds scary, like degenerative disc disease, it's not disease. It's just, it's like the discs are wearing down. So why are we calling it a disease? It's aging. Okay, so a hundred percent. If we can change the language around some of these diagnosis and make them less scary all of a sudden, oh, they don't get this alarming.

I just had one of my colleagues come up to me, he had three clients doing it exceptionally well. One's a paramedic, one's a firefighter, and I think another one has a physical job. They were all doing really well. They go and get their MRIs, and one has a disc herniation in his neck, and all of a sudden everything got bad again.

So for that individual, the diagnosis made him worse. If he just focused because he put it into chat, GPT and looked at all the possible scary things that could happen. And, and he's got a, a family history of a LS, so that's where his head goes. I'm like, no, it's you. You have a disc herniation. We can change this, right?

We're gonna make this so. It's a double-edged sword. Some people need a [00:12:00] diagnosis, somebody need to know what's going on in my body so I can move past it and others if they know they're gonna get worse. So it get, it gets tricky, but the psychological component is huge and I'll, I'll give you another example because I had a personal experience last year.

I was in the hospital with an invasive strep A, and I went into toxic shock, and I was in the ICU for 10 days. They had to put me on respirators. Sure. My heart, I had heart failure, liver failure, kidney failure. My lungs were full of fluid. They put me on dialysis. Um, they told my wife, you know, um, put, get your affairs in order type of thing.

And I didn't know how sick I was. I just knew I was super sick. So my ignorance and I'm like, I'll get through this because I've put the time and energy into my health. In case shit happens. That's my insurance policy. So I get out after 10 days. ICU, the docs had to do surgery on my ankle got infected, my toes are all black.

They're like, you're not gonna come out of this with any limbs, like with your toes. I said, okay, but I didn't believe that. [00:13:00] And anyway, I have all my limbs. Um, I put the 50 pounds back on in five months 'cause I put the work in. But I didn't know how sick I was. I asked one of the doctors, I said, doc, how, how sick was I?

He's like, oh, less than 20% survival. I was like, oh, I was sick. He's like, you were super sick. So, and four other people in that same hospital that summer passed away with less stuff going on. Same thing. So he's like, the only reason you're here is because of how healthy you came in. But yes, I did the prep work in case shit happened, but I never believed I was dying.

I never had a moment of like, oh, this is it. Which may have saved me. I don't know. Right. I mean, I'm pretty stubborn. If someone's just like, yeah, you're gonna die. I'm like, no, I'm not. But not knowing and just kind of having that mindset of, you know, I'm just super sick. I'll get through this, I'll put in the work, whatever.

That may have, that may have also helped. So mindset is [00:14:00] everything.

Dr. Grant Garcia: Well, Tom, you, you, uh, I do, I do. This is classic sports doc talk. We just basically had like a billion questions come up as you were talking. Sorry. And that has nothing to do with what we were gonna talk about tonight. So this is amazing. No, it's fantastic.

Yeah. Yeah. This is gonna be. So I think, I think we, I do wanna get back to all the stuff that you do 'cause I love the listeners to hear it, but I wanna maybe like another few more minutes, we'll ping this around and we'll go back to. We will get off track for sure. I see Will's eyes, right? I, I, I got, I got, yeah.

I Will Sanchez: wanna ask some level. I'm trying to slow. Here I go. I'm slowing you

Dr. Grant Garcia: down. I'm slowing you down. You're about to go nuts. You know, you, you talk basically. Yeah. You gotta talk about this, this will thing. I mean, this is what it takes. We talk about these players too, right? Obviously, you know, I'm so glad you're here and you have this amazing recovery.

You know, medical, physical, and I have, you know, family members that have had bad lymphomas and things like that, and they, and they come in and they are only ones that didn't die. Right? Yeah. Because they had like this, this physical thing. I had a bad thing happen to me and I had to have major [00:15:00] surgery and I was shocked how well I was able to advance back.

And it was because I refused. Yep. To have to continue. I refuse to have a problem. Yeah. Um, but you know what, sometimes you can't refuse. It's just the way that the system works. Yeah. But the, I think this is a really important thing. I will, you can probably ask about this too. What you put in before does make a difference.

Right? And they're like, you know, why are you going to the gym? Why are you doing all the work? Why you do all this stuff? Because when shit happens, like you said, yeah, like you don't want to be in that type of shape. Those people are the ones that go fast. So it's a really, I mean, incredible point you just made.

Yeah. Uh, that the listeners can hear. We're getting some psychology here. We're getting some life changes. This is awesome. So, sorry, will you asked your question and then we're gonna try to digress if we can.

Will Sanchez: Yeah, I, I kind of want to piggyback on exactly what you're talking about. Right. So you, you talked about, uh, in the beginning of the show, you talked about training, right. So whether it's. I'm not sure what certifications, but you know, we know about CSCS and FRC and CF [00:16:00] SC and now Strong First. Right? 'cause now we've gone to Strong First instead of when it comes to Kettlebells, you have all these training that has built you up for a part of what you do in your profession.

Yep. But we, we talk about. Uh, mental fortitude and perseverance, not only for yourself, but also how you, uh, relay that information and encourage your patients. What, what does that training look like? How, how has that been evolved in your, your life to get mentally strong? And then how do you channel that with your patients?

Tom Swales: I always, I always, for me, for like mental health, whenever I'm in a bad mood, I. I move, I mean, to, to change the mind. I go through the body. It's, that's why Breath Works, works so well. I mean, have you guys ever told your spouse when you know if they're getting upset to calm down, like what a terrible idea.

It never works. No way. Don't do it. Telling

Dr. Grant Garcia: my, telling my spouse anything is a [00:17:00] terrible idea, right? So let's be honest,

Tom Swales: but, but don't tell 'em to calm down when they're upset because you're trying to change the mind with the mind. Now with my children, when they would get upset, if I can catch them in time, I would have 'em slow down their breathing because now they're taking their thought off the thing that's bothering them.

But I'm changing their physiology and their nervous system instantly just by changing their breathing. Because breathing is that bridge between the mind and the body. When we are upset, our breathing changes. When we're happy, our breathing changes. When we are sad, our breathing changes. When we're calm, our breathing changes.

So our breathing changes with our neurological state, sympathetic parasympathetic. But you can also back out of that by changing your breathing to change your state, which is why breath work has become so popular. Mm-hmm. I mean, aside from the Wim Hof and doing all the ice baths and all that cool stuff, which is fun to do.

I mean, it's a little bit of suffering, but you feel good doing it. The idea is you are, you're changing your state intentionally. You're [00:18:00] applying a eustress, a stress that's positive to create an adaptation to make you more resilient. So if, if I gotta get my clients outta pain, if someone's coming in and they're talking quickly and they're bracing like.

I can't, like their shoulders aren't gonna move their neck, nothing's going to move because they're in this locked up protective state. Their nervous system's too sympathetic. I just like, Hey, let's put one hand on your chest, one hand on your belly. See where you're breathing. I create awareness to what they're doing and how they're breathing.

Which hand is moving? Oh, the top hand. Which hand do you think is supposed to move? Oh, the bottom. Let's do that. Get them to do that five times and all of a sudden their shoulders come down. They start to slow down. Their, their, their breathing ray, they slow to slow down their talking, and all of a sudden they're like, oh, my neck doesn't hurt as much.

No, because we just, we, we, we took your foot off the gas or your nervous system off the gas to allow things to calm down a bit, and it's simply because of the state that they were in. But I didn't tell them to calm down. I told 'em, Hey, what's your breathing doing? And they shifted their [00:19:00] mind away from their pain.

Into what they're doing, into the first movement that we do, which is breathing. Which is why a lot of clients, athletes, especially, we look at their breathing. I'm like, how CO2 tolerant are you? Are you using your diaphragm? 'cause if you're not, guess what you're not using? You're not using your core muscles.

No wonder your back is all jacked up. No wonder your shoulders and neck are all jacked up because you can't even use the first core muscle that we started to use when we first came into this world.

Dr. Grant Garcia: This is awesome. I, you, we were gonna, we're gonna jump actually to a question we're gonna do later, but you just literally, we're going in different directions.

I love this. This is my favorite type of conversation. So you talked about athletes, right? Yeah. And you get 'em back and like there's different approaches, right? Yeah. So do you, what do you use as some of your tricks? You already mentioned some of 'em as the breathing. Yeah. What do you use to get some of these patients back?

Like, so when, let's say an athlete comes in, high level, athlete comes in and, and they're coming in obviously to you, not 'cause they're doing well, right? If they're doing well, they don't come see you. No. Right? That's generally natural. They don't come see me if they're [00:20:00] doing well. No, they don't come see me to say hi.

So the, if you, if someone comes in, do you, are you, you know, automatically saying there's something that can change. Is there genetics involved with these people? These sort of like accentuate healers, you know, like if someone were to put you in a lineup, they'd say, that's very impressive. Right? This guy survived.

Right. One out of five odds, right? Like, but those are what those athletes do, right? When they get injured, there's a certain percentage that don't get back and there's some that do. So what tricks do you use to try to get them back that area and try to enhance their recovery?

Tom Swales: So I think, I think a lot of us, a lot of people are getting caught in the weeds with all the, the nuances and the, the fancy sexy stuff to, to know where somebody needs to go. I need to know where they are right now, which comes into the assessment. So someone comes in, they got groin and low back issues. You know, they've been, I, I've had dry needling in my groin and they, I've had my back cracked. And I'm like, okay, cool. Well if we understand. What pain is. Pain is a signal for change.

Pain is a signal to pay attention, [00:21:00] saying, Hey, there's something wrong here. It might not be the problem, but I'm gonna create a loud enough signal here to make you pay attention to find out where the problem is. So some, even something as simple as, you know, a groin issue or low back. I wanna know, can you move your neck?

Like do you have dural tension coming from the neck? If you can't get your chin to your chest without any tension, there might, the dural tube might be not sliding up and down, right? Which is the covering of the spinal cord. If that's not sliding well, all the nerves out of it. Now you've got nerve tension.

Well, if I see Will and

Dr. Grant Garcia: I trying to go like this, both women are like, if you can't, you're done. You're done. Will's out.

Tom Swales: Right? Can you look up without any pitchiness? Can you rotate your head and touch your collarbone? If you have pin or pull, okay, then we need to find out why can't you do that? And then you might be asking, well, what does the neck have to do with a groin?

Well, a neck, the neck is a reflex, okay? It's a cervical colic reflex. When I look to the left, it initiates turn to the left, but that initiates rotation, which is a pivot or a cut [00:22:00] change in direction because where the eyes go, the neck goes, where the neck goes, the body goes. So if I can't turn my head to the left.

What might I be doing from my lower back? I might be rotating. Guess what? The low back doesn't do. It rotates. So now all of a sudden, oh, you're rotating for your lower back. You're destabilizing the pelvis and now you might be using hip flexors and groin muscles to try and stabilize the pelvis to do the best job it can to protect the spine.

'cause you're moving too much into the spine. So now we're looking at, oh, the hip is moving. The hip is doing its job, but it's doing two other, two other jobs that it's not supposed to do. And now we have overuse. We have these progressive tears, and it's not the groins fault, it's because the groin is trying to do too many jobs to protect other structures around that aren't doing their job.

So now we look at physics. Well, your, your head doesn't turn to the left, so you go into your lower back, and now you're rotating too much into the hip and overstretching the groin. Well, energy moved in into the area of least resistance, which is the groin. [00:23:00] So now we have this overuse problem, but it's an, it's an energy accumulation problem because.

Other parts around it aren't distributing forces across the body effectively. So I need to know what parts are moving, which parts are not moving first, and then I need to restore some balance because if I have somebody who's trying to snatch overhead, but they can't rotate through their T-spine, those shoulders are gonna get torn up

Tom Swales: because they can't extend and rotate to that one side.

Well, that's gotta go someplace. They're gonna over rotate through the shoulder, and all of a sudden now they're destabilizing their shoulders and then over time we're tearing them down. The shoulder moves well, but the TS spine doesn't. So when we, this is why, this is where physics come into play, and when we look at something as simple, can you touch your toes?

Like, if you can't touch your toes without tension, why are you swinging, kettlebells and deadlifting? Mm-hmm. Like, it's probably not going to go well. All right. Runners. I talk about runners all the time. They come in, I got knee, I got low back. Okay, great. Stand on one leg with your eyes closed for 10 seconds.

They can't [00:24:00] do it. I said, okay, you can't proprioception.

Dr. Grant Garcia: That is huge,

Tom Swales: right? You can't stand on one leg for more than three seconds. How do you think running's going for you when you're putting two to four times body weight through your limb? Now all of a sudden you got an Achilles issue, you got plant fascitis, you got low back issues, and it oftentimes, it's not the leg that's deficient, it's the side that works pretty well.

'cause guess what? You're doing a little bit more on that side. You're leaning into it. 'cause your nervous system says, well, this side's safer. So I'm just gonna overuse that. Then you can start looking up kinetic chain. Well, maybe the ankle doesn't reflex, maybe the glutes aren't turning on 'cause of the hip capsule issue.

And now we moved into the Achilles. Like when you start to look at injuries from what's moving and what's not moving, it gets so simple as to, oh, this is why you blew this up, because you accumulated forces into this area because the parts above and below aren't doing their job.

Dr. Grant Garcia: Is so important. You just said, will we need be done with the rest of our podcast?

We have all the answers to the injuries now. We've been waiting for this.

Will Sanchez: Yeah, it's, it's [00:25:00] really important. Right? So you, you guys mentioned that, that you, people usually don't come see you until there's a problem, right? So. How do we get ahead of this? Right? Because you're saying, you know, that it's almost kinda like the, the wrist bone connected to the elbow bone, like we're kind of going through all that stuff.

Yeah. How do we get that information out there? Or, or where it becomes preventative? Yeah. What, what's the, the, the thought process going forward and how do we channel this information to say. This is what you need to do to in order to run. Yeah. Or it, you know, when you wake up and if you can't do this, this, and this, then you should avoid these exercises or you might have complications.

How, how does this grow?

Tom Swales: Um, the, the, the solution I came up with, at least for my athletes, because I'm not gonna teach 'em the A MT stuff, it's, it's very clinical, it's very, you know, nuanced. Yeah. So I, I created what's called a SAM scan, a self-awareness movement scan. The research says, well, the biggest predictor of an injury is [00:26:00] an old injury.

And I agree with that when it comes to the, if it's, if it's a repeat injury. But I think the greatest predictor of an injury is a lack of self-awareness because people come in and they're typing at their desk all day and then they're doing this right, turning their head to the right a thousand times and they're like, my neck, oh, I got this neck pain, shoulder pain, and I have no idea where it came from.

No, you do. It's just you did a thousand of these for the last 10 years, and all of a sudden you drove. Now you can't turn your head to the left and everything's moving and you're compressing joints and nerves. I'm getting should,

Dr. Grant Garcia: I'm getting neck pain talking about this right now. Right?

Tom Swales: So it hurts. Wait, hold hip.

There's always a reason. It's just people aren't aware of what they're doing in their environment. So the simplest thing I could come up with. I kind of streamlined a little self-assessment scan. I call it the SAM scan, and I used three cerebellar tests to make sure there's no top-down control issues. So rebell like sharpen Romberg, a facu test, and some coordinated movements.

If those are clear, then we look at what's the neck doing? Can you [00:27:00] bend it, extend it, rotate it, side bend. Can you touch your toes, can you back bend? Can you rotate? Can you side bend, can you single leg balance? Can you squat? If any of those things feel different. It's hard to assess ourselves, but I tell the athletes, I'm like, you feel pinch painter?

Pull, and does one side feel different than the other? If there's a yes, now we go. It's a little bit of an algorithm. Okay. You feel like rotation's not working? Check the hip. Can you open up the hip with a favors test? Can you rotate your T-spine? Yes or no? And if there's a no to those, great. Now you know you need to improve rotation to the TS spine and rotation through the hip.

Go back, check your global rotation. Clean. Good. Off you go. It streamlines a lot of their prep work because the older they get, they come in with 30 exercises that they need to do before training. I'm like, you don't have time for this, so now you're gonna do a three minute scan, two minutes of corrective exercises, re-scan yourself, and then now you're balanced.

Now go do your warmup. So it's just helping them create a [00:28:00] little bit of self-awareness in what's optimal, what's suboptimal. What is deemed as if it's pinchy might be a joint, if it's pulley might be soft tissue. And if it's, if it does, if it doesn't feel right, it might be just a motor control problem. So then you have solutions to the problems that you're feeling as an athlete or even as a, as a just a general person who just doesn't want to get hurt.

But I think you, we have to have these baselines of movement and that's, that's the kind of the simplest thing I could come up with. And then you can even use something as simple as, you know, you go, it's deadlift day. Go lift, go deadlift your warmup weight. What does that feel like? If it feels like a one outta 10 easy, great.

You're probably good. If you approach it and you're like, this feels like a seven outta 10 effort, something's not right. So now you're using warmup weights that you know are safe. So it's a form of evaluation, but it doesn't feel right. Go do something to make that feel easy, because the nervous system loves easy.

Something feels easy. That means everything's organized. That means [00:29:00] the nervous system's all switched on the right way. If something feels difficult, the nervous system is protecting something. It's inhibiting, it's downregulating, it's guarding. So now when we look at the neuro, the nervous system, which is that second pillar, well, when we measure movement, that's neurology.

That's looking at our output. That's looking at is what we're doing safe. Or is it not safe? Is it desirable or undesirable? Because if something is desirable, the nervous system takes the brakes off, it organizes and it increases motor output, which is mobility, which is strength. If it doesn't like something or you moved inappropriately, it locks it down, creates inhibition and weakness.

Now we, now we feel weaker, so when we're paying attention to these things, our body will tell us exactly if we're doing something wrong or not. We just have to pay attention to it. Because the body's not stupid. If it was stupid, we wouldn't be here as a species

Will Sanchez: can you that you were talking about, it's that, that awareness, that self-awareness that we tend to [00:30:00] neglect and maybe you're trained at this point that you're really hyper aware of what you're doing.

Mm-hmm.

Will Sanchez: I think a lot of us, and I'm speaking for myself, that sometimes we kind of. We have awareness, but we kind of move through it anyway. Right, right. Yeah. And, and then that's where we kind of put ourselves in situations where, um, they can be, you know, consequences. Yeah. Or we're like, well, today was debt lift day, I'm going to go debt lift.

Mm-hmm. So how do we, you know, have that mindset to say, it's all right bro. Let's do something else.

Dr. Grant Garcia: Yep. And

Will Sanchez: back off of this anyway, go ahead Dr. Garcia.

Dr. Grant Garcia: No, I was gonna say, I don't wanna say track from comment. Do you do when you talk to these athletes about the sort of reset, right? That's the three minute, two minute kind of thing.

What's the re what's the evalu reevaluation period that you recommend for that? Right? Because like you're gonna each, you see these athletes, right? Like they, all these pros, it's like there's a new injury each, each time, right? So is it, when do you recheck yourself? When do you reset yourself? Or do you keep the routine [00:31:00] for a certain amount of time?

Tom Swales: Every time. Every time. Every, every client coming in. I, I do a quick scan. I wanna see how they're moving globally. Did the exercises that I gave them, the, the, the session before, did it make a change and did it make lasting change? Because if it didn't make lasting change, I have to start thinking, okay, that didn't hold why?

I need to go back through the system to find out what, what did I miss? Or maybe there's a higher priority that I missed because the body is organized in priority. When you think about how we're developed, embryologically, we're just layers. Like we have those germ layers, right? And they're all tubes. But then you look at how we're organized from, from just a structural perspective.

Where's all the important structures, right? In the midline, right? Spinal cord, organs, brain. And then as we move to the periphery, those structures are less important for survival. We need all this in the middle for survival. So if there's compromise to our center, then when we, if we start working outwards and we start increasing power and output, the nervous system [00:32:00] won't let us increase strength because this is compromised.

We developed from the ground up when, when we're looking at, you guys have children.

Yep. Yeah. Right.

Tom Swales: Where did they first learn to move on the ground? Yep.

Tom Swales: What are they developing? Their center of strength, their center of gravity, their neck control. How important? Like you're watching your baby and you're like, oh, neck control. Okay, but you see the head doing this?

Yep.

Tom Swales: It's a writing reflex. It's all reflexive. You put your, you put something in their hand. It's a reflex. When they activate the hand, the shoulder packs. Everything is reflexes early on. Right? And if we go back down to the ground and we start looking at our center, if we develop scent, strength, and mobility from the center out, well the periphery tends to take care of itself a lot of times too.

But if we start to sit on machines too much, or we start to strengthen the periphery, we. We start overpowering our center of like our spine. The nervous system starts to shut down and we get plateaued and people are just like, oh, I plateaued on my squat. I'm like, yeah, but you, you can't touch your toes [00:33:00] anymore.

Like you've got this little pain in your back. So your nervous system is protecting you. You should thank it. Why it gave you that plateau? Because plateau plateaus are protective. If, if there's no pain or dysfunction. Then we know it's a connective tissue or structure problem because the, the, the nervous system will not allow you to keep loading muscles.

If the joints and the tendons can't handle it, it's going because you're gonna blow them out. But when we look at biology, how long does it take muscles to adapt? Six to eight weeks. How long does it take tendons to adapt? Six to eight months. So it's a slower process, which is why when we, when we plateau, we have to be patient with that, keep working the repetitions, and all of a sudden, once the connective tissue and the structure catches up to the neuromuscular system, all of a sudden, next, next, next level.

Dr. Grant Garcia: I think this point you're making is really important. I think that the listeners always wonder, what do the athletes have that we don't? And they get someone like you, right? So that's, that's the difference, right? They're, they're special patients, but then they're, you hear [00:34:00] this like. All the knowledge that we just heard is, is fairly unique.

Even though this is something that you guys teach and some of the high level people teach. It's just that we don't hear this as layman people. I mean, even as orthopedic surgeon, I don't hear this that often. Right? And when the athletes say, how do I get back? I'm like, well, I can fix you. But you know, after the surgery's done, you're 90, near 95% of the work.

When they come to see you.

Yeah. And

Dr. Grant Garcia: so that's really important and hard, and hard for me to understand. Right. I'm in the office, I got five, 10 minutes with a patient. Yep.

Dr. Grant Garcia: Uh, they come in, they're in pain, or they're post-op and they're trying to recover. They're like, well, what else can I do? I'm like, honestly, they gotta see people like you because you guys can look at the whole body.

You can recenter them. I'm not the expert at the lower back. I'm not the expert of the core, but as you keep talking about. Core, well, core and lower back is just boring. Right. It's it's not no glamor there, right? No. You can get abs That's great. You can have a nice lower back. You don't ever say that guy's got a nice lower back.

I mean, maybe I, I don't usually say that, but Will Maybe does, but a different animal. Yeah, all the time. We, all the time. But you know what I mean? Like we all want [00:35:00] buys. We all want nice legs. We wanna be super athletic. Yeah. But this is the, it's the, I mean, there's so many people, I mean, look at me. I, I could barely lift my neck up 'cause I have so much surgery and I'm just like, my back's always in full spasm.

Right. And, and it's because we forget about that. I mean, those power lifters, like you said, like people can't touch their toes. Yeah. Right. Like it's a huge problem. Mm-hmm. And that's one of these things we always talk about, like, you see Will, we've talked about this, like these athletes that are doing like yoga and they're doing ballet and Right.

Why are they doing that? Because they're trying to go back to the basics, the idea of like. Simplest, like, you know, people used to tease about this stuff, but really it's, the funny part is like, that's what makes these, the, the really good ones. Yeah. Better than the lots of good ones.

Tom Swales: Yeah. I mean, so you, you can look at the other, you, you know, you have one end of the spectrum where you have your power lifters who are very tight and stiff, which to, to their sport can give them a mechanical advantage because they can use that stiffness, right?

They're a stiff spring. They don't have to use as much muscular energy to push and load the weight. They can use their connective tissue. But then you have the other end where [00:36:00] the, you have the yogis and they're two hypermobile or the dancers and Yeah, you got, you can do a full back bridge, but you have back pain too.

Yeah, but they're unstable. They can't hang on to tension long enough and they're moving too much. So now they're down. The nervous system is trying to lock up and stabilize them to prevent them from moving because they just can't hang on to tension. They're not strong enough. And then you have the power lifters.

Well, they have back pain because nothing moves enough.

Dr. Grant Garcia: So Well, I need something you have to worry about with surgery too, right? Yeah. Like our patients, like is this a loose patient or is this a tight patient? Right. People don't realize that, you know, the patient comes in, she's like, I've had 25 surgeries.

I keep dislocating things. I can go put my hand behind her back. Right? That's this. I have the same patient with dislocation of one thing. And I'm like, listen, it's a totally different perspective, right? One of them, I'm gonna force like no surgery. This is a bad problem. The other one I'm like, maybe this is an issue.

So the same thing you're talking about, we, I, in my head, each patient I see, I'll see three or four of the same thing, and each one has different category. Yeah. And it's what you're talking about. And the connective tissue makes a huge difference. This is [00:37:00] something that's important. Will you have something you're about to say?

Will Sanchez: No, I, I was just kind of. Pretty much, you know, what you guys are talking about, right? You're, you're talking about, you know, reducing pain and improving movements and, and I know that you've been teaching these, you know, neuro hacks, uh, to, uh, clinicians. I just wanted to see if, you know, if these were some of the examples that you're teaching, or do you actually have other ones that involve with the neuro hacks?

Tom Swales: Newer hacks as in like using

Will Sanchez: Yeah, like just to improve, um, movement. Oh, yeah. And, um, also creating strength, you know, as you're teaching that not only to, you know, the, you know, your patients, but also to the people that are working with you.

Tom Swales: Yeah. So we, we can use the, the fun part about the nervous system is when you apply something to it, if it's desirable, it changes pretty quick.

So will I see you're standing up, right? I am. Okay, so if you take a step back, can you touch your toes?

Will Sanchez: Oh, [00:38:00] probably not. I'd be standing up. Okay. Let's

Tom Swales: just, I wanna see if I can get you touching your toes right now.

Will Sanchez: Um, I, I touched my ankles.

Tom Swales: Okay. Not too bad. Okay, so you have a tight neck, correct?

Will Sanchez: Uh, a little bit.

Yeah,

Tom Swales: A little bit. Okay. I want you to just use a simple isometric. You're gonna take your hands, you're gonna take your neck as far as you can go. I want you to look down at the floor, okay? Push your head into your hands. Five seconds. I'm gonna do this too. Okay. And now bend forward and touch your toes.

Okay. Take your hands off. Touch your toes.

Will Sanchez: Yeah, I touched my toes, right? All right. Thanks for coming,

Tom Swales: Tom. We're done with

Will Sanchez: you, Carlos,

Tom Swales: but you, you can see how this is amazing. One end affected the other, and everyone's just like, well, I have tight hamstrings. I'm like, you probably don't. I mean, you might. You don't, but if your neck doesn't bend, these flexors, tie in with these flexors.

So if these aren't working, these flexors are not working. If these ones aren't working, guess where you're overusing? You're using all the extensors too much on the backside and now you're trying to use extensors to lower yourself to touch your toes [00:39:00] rather than use the flexors to pull yourself. All we did is we, we facilitated a circuit.

Flexor circuit starting from the neck and your eyes, because when you look down, it initiates flexion and all of a sudden the nervous system organized from the top down and all of a sudden you could touch your toes. It works the same way, like if you've got a tight neck or a tight low back.

Here we go, go

Tom Swales: here and then do a little back bend and see if it takes away a pinchy low back.

Dr. Grant Garcia: It feels good. I think we got, I think we got our new, uh, sports doc talk, rehab specialist. You know, every time we call someone, we get the docs are, the docs are tired, stiff,

Will Sanchez: be sick of us. He's gonna Guys, come on, man. Now I do. I do. You're Dr. Grant Garcia: gonna, you're gonna get so many people calling you for help after this episode.

I can't wait.

Tom Swales: I do, I do. I have a presentation that I, that I do. Um, I've done it at the Ontario Physiotherapy Association. It's my, uh, eight neuro hacks to move better and reduce pain in 60 seconds or less. And I make it interactive because it's a 30 minute presentation. But I, I use, uh, different breathing techniques, [00:40:00] eye exercises, isometrics, tapping for proprioception, um, and a few other, a few other things.

And all of a sudden everyone's touching their toes, their single squat, and. You know, I ask people, which one worked for you? And they're like, oh, for me it was the eyes. I'm like, okay, cool. Because we stretched out the eyes, and the eyes initiate the cerebellum. The cerebellum is the part of the brain that that, uh, measures rate, rhythm, force, and accuracy.

But it's 10% of the mass, but it's 90% of all the neuron, or 50% of all the neurons. So you've got a majority of those neurons in that 10% mass, but it regulates all your movement. But if you stimulate it. With canal balancing in the inner ear, the visual system isometrics, you know, spiraling anything, cross body or crane figure eights, it stimulates that part of the brain and that's the part of the brain that we first learned to use to move as children.

This is,

Dr. Grant Garcia: I, I feel will I, I feel do, I don't know about you will. I feel, I feel stiff, but I feel enlightened. [00:41:00] So this is great. Uh, Tom, I, I do not wanna miss out on the opportunity to talk about your certification. Sure. Okay. So, uh, we would, if we could have you on for like three hours. Then all the social medias would hate us.

Three hour show. No, we're not doing that. It'd be, it'd be, we're not gonna keep you on for three hours, I promise you. But I want get to the advanced movement therapist certification because obviously this is unique, right? Yeah. There's not many people I know. I do know tons of therapists in the area. I work with tons of'em as a sports doc.

Uh, but I wanna learn about this. Can you talk about like. The process you went through, what does it mean? I mean, this is something that people are gonna wanna know about. They're gonna wanna know, hey, if someone, one of the therapists I know sees this, they might be like, Hey, I'm interested in learning more of these, sort of the stuff that you're talking about.

So can you talk about what the, the certification is?

Tom Swales: Yeah. So I mean, it came outta my own frustration where, you know, like I said, I, it was flavor of the month for every client. I do more courses. I'm like, here's the answer to all my problems. And I, it just became Guess Wing and I hate guessing. And then finding these, these principles across it.

I started to organize it. [00:42:00] So what I did is I created a framework. We use, we look at posture assessment. How's the body holding itself? What's it avoiding? What's it hiding? I mean, a lot of people say, well, posture doesn't tell you much. No, it's true. It doesn't tell you much, but it can kind of guide you as to, well, what's the body hiding?

What's it protecting? What's it guarding? What, where's the atrophy? You know, like all these little things. And then you look at the how the body's moving as a system first, and then you start breaking down the parts. The third thing we always check is the neurological system because everybody is neuro until proven otherwise.

Why? Because the nervous system controls everything. If I have neuro tension, if I have central neurodynamic issues in my spine, if I do a slump test, I need to take care of that before I try and go after tight hamstrings or tight, low back. 'cause if the nerves aren't sliding. Nothing's gonna work. I need to look at myotomes.

I need to look at upper extremity. Then we look at the pieces. We start to split it upper, lower body. We start to look at what are the shoulders doing? What are the hips doing? What are the ankles doing? So we look, we start to break it down into the parts, but we need to know what the difference is between active and passive and what is [00:43:00] optimal.

If you don't have optimal range of motion, I'm like, well, why is that side moving different than that side? Is it an anatomical problem or is it a mechanical issue that we have to go after? Because if we can change it, I want to change it. So, because again, when we look at physics, we wanna see where's energy moving?

If forces are avoiding this area, but moving over here, this could be why you have this injury. And then we start to look at, and then you like the later things are the special test, but I literally organized. Everything we do as clinician in an orthopedic assessment in an algorithm, it's in this specific flow, and it starts with communication and then it works at the global movements.

It looks at neurology, and then it starts to look at the parts, and then as you move from there, you can start doing what, what I call connectivity testing the foot. Just like the, the hand in the shoulder, they have a reflex, but you can test them together to see if the muscles of the hip are being turned off because of a foot issue.

If you've got an over collapsed foot or there's a proprioception problem, if I put my hand on that foot and I [00:44:00] test the hip rotators, the hip turns off. Well, why? When I tested the hips on their own, they were fine, but we know, okay, the foot is inhibiting the hip, so then you can start to look at all this connectivity and what's influencing what in the system because nothing works.

Independently. So we, it, we, we start to go through the, the pieces and the parts, and then once we find those linchpins or those primary areas of dysfunction, we correct those and then we start working our way back up so we correct from the ground up. Most of the times people have to go back on the ground to reset stuff.

But then we start to look at, well, what can, what directions can you control? What body parts aren't talking to one another? If they have a concussion, there's a whole separate algorithm to look at. Cerebellum, visual vestibular, and then inner ear. So when somebody tells me in their history, oh yeah, I have an old concussion.

I need to screen that first. I can't assume that that's gone because even old, like old concussions can still cause new orthopedic problems because one side can fight different than the other. Dr. Grant Garcia: I don't wanna interrupt you, Tom, but this is a constant topic on our show concussions. [00:45:00] Yep. Right, will. Yeah. Yep.

So I think this is huge. I mean, it's always hard to find someone that deals with concussions. So the idea, I'm not gonna go after you with concussions right now, but. I wanna make sure listeners here, we, we later. But the idea is that, like, you just brought it up, it's just like he's, he's thinking about everything here.

Yep.

Dr. Grant Garcia: Um, Tom, will you tell us, uh, what sort of the, the, I saw on your website there's different certification timelines, like how long would a therapist most, I'm assuming most therapists are the ones that would do this course. Yep. Uh, how, how long would that take a therapist to do this course? Roughly certification.

Tom Swales: So the, it's a total of 28 hours. Level one and level two. I mean, it's go, it's go at your own rate. We have anybody who starts with our company, they have to have the level one done in the first three months. So this is a, I think this is a live workshop that I was doing. I was doing it live before, but now it's on demand.

So you can, everybody can start today. You go through quizzes, you go through the textbook, and then you finish the, the examination at the end of level one, and then you can [00:46:00] apply to take level two, which is when we get into the neurology, the uh, gate. The, uh, ballistics, the, all the high performance stuff is in level two when we get into kettlebells gymnastics and all the other, um, training components of it.

But, uh, I mean somebody, if, if someone's eager, they can finish it in a couple months. Level one and two.

Will Sanchez: Do you have a requirement for the type of person that you're looking forward to be with these, you know, be involved and learn from these courses? Or is it just open to anyone that just wants to learn?

Tom Swales: So over Covid, I was able to test this hands-free. This doesn't have to be anybody who's working with people who trying to get them out of pain. You could be a kinesiologist, you could be an athletic trainer. Yeah. What? So if you have hands, if you have a license to use your hands and test and use manual therapy, great.

Because that allows you to change the inputs faster. If you don't, well, this is when you use specifically lacrosse balls and foam rollers and bands to go after joint issues. But you're gonna learn wh when you apply those, at [00:47:00] what parts at the right time. Because a lot of times people just randomly foam rolling everything.

I'm like, what the hell are you doing? Like you don't need to foam roll. Like, you should be doing some rolling patterns, like you're not stiff. What? That was me

Dr. Grant Garcia: for a while. I understand. Sure. And it, it feels good. I've learned, but I've learned now from Tom. I'm not doing that ever again,

Tom Swales: but, but if it feels good.

Okay, so here's the thing I, I'll get on the formula. My lots tighten up. You know, it changes the inputs as long as you know what you're doing and what you're doing it for. And as long as it's making a change, I'm all for it. But if you don't know why you're doing it. If it's just randomly rolling around and you haven't checked anything to see if you're changing anything, then we're wasting our time.

Dr. Grant Garcia: Right. I think that that was, what you said was perfect. I don't want to interrupt you, but I love, I don't mind popping in, but I wanna make sure the listeners hear this. If you don't know if you made progress, there's no point in doing it. No, I think that is excellent. Because there's patients that come in and I'm like, so how do you feel?

It's been three months since we saw each other. I don't [00:48:00] know. Right. Geophys? I don't know. Uh, okay. Um, where does it hurt? I don't know. Um, or I can't tell you. Right, right. That is extremely important because if you don't have self-awareness of what's going on, you don't know. I mean, I, one of my, uh, my father-in-law is a occupies surgeon.

He talks about the pain scales. Yeah. And the interesting thing he brought up is that. Someone comes in to say the pain level of six or five, and the next six months they say it's the same level. It hasn't gone better. Right. Usually it means it actually has, it's just they got so sick of the pain that like they just can, they can't tolerate anymore.

Yeah. And

Dr. Grant Garcia: the ones that tell you that it's gotten worse, that's where it's actually gotten worse.

Right.

Dr. Grant Garcia: Uh, so you just, it's this concept of there's also the mental aspect.

Yeah.

Dr. Grant Garcia: But the idea is like if you have, you don't know how you were and where you're going Yeah. Or what you were at before, and you don't write it down or learn about it, you can't understand your progress.

And like you said. If you're rolling your foam and then like you never checked you, you know, will did his test, right? He put his hands, his head. Yeah. He's able put his lit feet down. If you don't check it and you don't know what you can't do and what you do now, yeah. Then you have no idea what's going on and you can't conceptually make progress.[00:49:00]

Tom Swales: No. You can't manage what you don't measure. Right. And what you don't measure, you can't change. So this is where like when I got will, I'm like, touch your toes first before we do anything. Okay, we have a baseline now let's do an intervention. We did the intervention, let's check our work. Let's see if it changed.

If it didn't change, let's try something else. Mm-hmm. The one thing that drives me bonkers is therapists. I'm gonna blame therapists. They're doing the same treatment on, on the person. There's no change. And when they finally come and see me, they're like, yeah, I was seeing so and so for like a year. I was like, well, they're super nice and you know, it felt good, but nothing changed.

I'm like, well, were they doing the same treatment all the time? Yeah. Well, percent. How did, how did you measure change? Oh, I don't know. I'm like, well, you know what? The definition of insanity is

Dr. Grant Garcia: doing the same thing, but not, yeah.

Tom Swales: And expecting it. So I blame both of them, but I blame the therapist more because they're the person in charge and who should be checking their work to see if the patient is making changes and if they're not, shame on you.

Dr. Grant Garcia: This is, [00:50:00] this is ex uh, will, this is like, this is literally like my day every day. Right. You have the patience. I have the patients that come in and I have my go-tos. Right? Am I really wanting good ones? Yeah. And I, and they come in, I, I know the patient's been checked, right? I'm like, what's your quad score?

Yeah. No idea, right? Like, what's your quad score? 75%. Boom. They know. So that's the therapist or that's the A TC or whatever's Doing the checks and doing the reset. Like, okay, you're not you, let's check your progress. I know there's some people and I go, wait a second. Who, what do you who you go to? Like, what are you doing?

Because you're clearly are not making progress. And then the problem is, see, for you, you're coming in, you're the opinion. For me, I'm the surgeon. I've fixed them. So they're expecting the results they want. I have the same surgery. One patient is absolutely killing it. One patient is not. And the reason is that some, a lot of times it's because they're not getting those checks and I have to switch things up.

It's like what you're saying. They're really nice, but they haven't done a great job. And I will fire people frequently and move on to another, a group because I'm not happy with the way the progress is going and I know what my patients should do. Right. It's [00:51:00] like you see this person. So that point is, uh, that point is so important for the patients to hear.

Yeah. Right. There's times when there's complications from surgery and you're not doing well because there's a. There's way more often a time where you've got stalled because you're not getting the repetitive checks and no one's giving you the goals where you actually need to be. Exactly.

Will Sanchez: You know, you're, you're such a passionate educator, right.

And we start off the show talking about you're, you're always consuming knowledge. You're at a standard now for yourself. Yeah. And for others. What, what are you looking for? Internally, externally, to keep growing in the areas that you are. Like, is there something there that like, yeah, I do this, this, and this.

I wanna keep building on that, but I wanna focus now on something else. Is there something else that, that, yeah, you're kind of looking forward to and being passionate about, that you're just kind of tacking onto your resume as your career, uh, continues to grow? [00:52:00]

Tom Swales: Yeah. No, like everything, everything is moving in the direction.

I can, I like to think outside the box. Mm-hmm. Because the more things, the more perspectives. Again, this is why I came up with those five tenets. 'cause I love learning about physics. Well, how can I apply that to the, the, to the physical body? How does that pertain to injury? How does that pertain to pain?

That's how, where I started to, you know, I started looking at physics. I'm like, oh, this is an overuse injury. Right. Uh, when I was, uh, when I was working with one of my mentors, he was huge in traditional Chinese medicine, acupuncture, and he would use some language that I'm like, I have no idea what you're saying, but I appreciate it.

I'm like, oh, shit. He's talking about physics and neurology. Like when he, when he is talking about the, the channels in the meridians, I'm like, oh, that's physics. I get it now, right? Mm-hmm. Like when, um, you know. When we're looking at, uh, specific things, I'm like, oh, that's the nervous system, right? Like it's when you, when you start to pull from all these different realms, you, and, and you have principles that you bounce those ideas off of, now you can [00:53:00] assimilate information more easily because I can compartmentalize it.

Gotcha.

Tom Swales: And, and now I can hear something once as soon as I compartmentalize that into the framework that I've created. I know when to pull that out because I've, I've, I've placed it in the right spot. It's not random information anymore. And now I can pull that out whenever I want that anecdote, that, that case study or whatever, because I've, I've put it into a file that makes sense in a framework based on principles.

Dr. Grant Garcia: Gotcha. And, and Tom, do you think that some of the stuff that you talked about, like you said, the certification and. Hearing your podcast with, you know, being on this podcast and seeing your stuff on your website, is that gonna help someone get up to speed? I mean, you have a lot of knowledge. You have a, you have a strict, you have an unusually awesome desire for more knowledge based of how many certifications you've done.

You know, I, I, I really hear what you're saying and learning all this stuff so quickly. But do you think, how would someone who's young, you know, and I know you're, you're young too, and we're all young, but basically someone who's new, how, how are they, how are [00:54:00] they gonna. How are they gonna not see this and go, oh my God, that seems like a no possible way.

I could be that way. What do you, what's your suggestion for the new, the new one? The new person?

Tom Swales: All I did was, I just distilled it down the way. I'm talking about the principles. We don't go over that in the certification. I'm actually writing a book right now on my experience and how to stay

Dr. Grant Garcia: tuned, guys.

Yeah, stay tuned

Tom Swales: that that is another journey on its own. So. A lot of the things that we talk about is gonna be in the book, but when it comes to the actual certification, it's, it's the nuts and bolts, it's the practical use stuff. You know, it's a lot of, it's gonna be very familiar to people, um, but it's gonna be organized in the exact way in which to apply it.

So I just helped create organization from the chaos in, in what we do as practitioners. Um, I'll give you, so as an example, we, we always, hi. We hire new grads. I love new grads. And, you know, when we first opened our clinic, we're like, okay, we're, we're the top clinic. The high expectations are high, [00:55:00] and we would hire 20 year vets coming in.

And they have so many bad habits. I'm like, okay, this isn't working, and they don't wanna learn. And then, and then like, okay, let's try new grads. And then they would wash out after six months because they're not effective at a school. And they lose confidence and their caseloads are emptying. Right? 'cause the expectations are high.

Coming into our facility, I'm like, what is it we're doing? Like how do I, how do I teach this? Mm-hmm. And then, so I use this as part of one I'm organizing what I'm doing. Two, it's a training system for all my staff so that they get really good, really quick. And then even for, for clinic owners. They can use this as a training manual, as a, a high standard across all clinicians, young or old.

Everyone's talking the same language. Doesn't matter who the patient sees, everyone's gonna be good. So I have, uh, I have a two year clinician. I would pit him against a 10 year who's got their f camped and needling any day to find the actual problem and be effective quickly. So. It really [00:56:00] shortcuts your, what I'm seeing and what the feedback I'm getting back, it's shortcutting a lot of their success.

We'll show

Will Sanchez: that feedback. Hold on a second. You just throwing stuff here. Well, we

Dr. Grant Garcia: got, we got four minutes left. I want you to show the feedback before we get up. I don't want to kick off Tom, but the, the social media's gonna be mad at us if we go over an hour and I knew this was gonna happen with him. So the, so, so basically, you know.

Obviously we gotta wind down. Sure. Uh, I know we, you know, maybe have you on in another year or so because it's been awesome and I wanna make sure that. But again, we really appreciate you coming on. What do you, what's, so what's the, you talked a lot about all the stuff you do and obviously you can see, look at these glowing reviews, um, to really sidetrack maybe your final comment for patients listening.

Right. 'cause not everyone can go visit you in Ontario. Sure. Right. That'd be awesome. They could, uh, but not everybody can, we are not doing

Will Sanchez: I thought we were going up there.

Dr. Grant Garcia: I'm,

Will Sanchez: I'm

Dr. Grant Garcia: ready to go up there.

Will Sanchez: I, he, I.

Dr. Grant Garcia: I got my plane ticket [00:57:00] book. I've been booking it while you guys have been talking.

Will Sanchez: Sure. Had a couple of nice restaurants that we could go to and hang out and meet the wife. We, we talking about his wife that's working with him. Will, you're digressing my question about,

Dr. Grant Garcia: I said we have three minutes left and now you're disrupting me.

My bad. I apologize. Uh, no, no. So for patients long lasting effects, like how do you keep this like, right, like how do patients see. 'cause someone's not gonna be able to see you all the time. Right. Either it's in the US it's insurance based or things like that. And Canada, it's sometimes a little bit different.

But nonetheless, like what's your sort of goals for these patients that get all this information? Like, you know, like Will's should, will go home every day and do this just so he gets self into a stretching mode. Right now, what's my

Will Sanchez: wife and daughter we're gonna, a lot of, a lot of

Tom Swales: it's just educating the patient, what's going on, what they can do.

Don't focus on what they can't do. Um, show them the changes that are happening so that there's buy-in. You know, you know, clients that come in for that first appointment, if all of a sudden I get their pain down from a 10 to a three and they're moving better [00:58:00] than they ever have, great, now I have buy-in.

They have belief because I showed them their ability and belief often comes before ability. Sometimes I have to change their ability to change their belief. And once we've changed that, now we've affected their psychology and then they can move forward and then they're gonna take what they know to continue to apply it, to continue to move forward.

Awesome.

Dr. Grant Garcia: Well unfortunately our time has ended 'cause we are 58 minutes and 26 seconds. Will do you want any closing remarks?

Will Sanchez: Tom, thank you so much for your time. Thank you for having me. We know it's past your bedtime. Uh, so it's, uh, it's something that, uh, we recognize it's great information and we, uh, once again, we're, we're just really thankful that you could take some time, join us.

I. Really educate the listeners, educate ourselves, because God knows what I'm going to show my wife and daughter now and see what we could take from that. But, uh, just remind everybody, check us out, sports.talk.com. Uh, we've got shows, [00:59:00] transcripts and we're always looking for, uh, other shows. Uh, so we're very happy and pleased with the feedback that we've been getting from everyone.

And as always, we're really thankful for our guests like Tom. Tom, thank you very much, Dr. Garcia. Say goodbye. Yep,

Dr. Grant Garcia: grant,

Will Sanchez: thank you. Thank you so

Dr. Grant Garcia: much Tom. I'm really excited for the listeners to hear this one. Awesome. And, uh, I think, you know, this is gonna be a real, um, uh, this is going, this episode's gonna come up a few times in our next podcast 'cause this is, we learned a lot today.

So thank you so much. And as always, this is not what I expected this episode to be, so this is absolutely awesome. It's way better. So thank you, Tom.

Will Sanchez: Thank you for having me to change the mind. I channel the body. I love it. Good stuff.

Audio Transcript

Will Sanchez: [00:00:00] Welcome to Sports Doc Talk. I'm Will Sanchez, along with our orthopedic surgeon and sports medicine specialist, Dr. Grant Garcia. Uh, Dr. Garcia, before we get into this, um, there's a Simpson kind of cartoon meme where, you know, uh, the dad kind of walks in and then grabs, puts his hat down and grabs a hat and walks back out.

That's how I'm starting to feel about my Yankees to start off this 20, 25 season. It's a revolving door of. I don't think that this is going to be a great season because of what we're going to talk about right now. And I know for most people watching this, they could give two hoots about that because they is, uh, as most people like to, uh, root or not root against the [00:01:00] Yankees.

Uh, this is sweet music to their ear. How are you? What's going on?

Dr. Grant Garcia: I'm good. Yeah, I know for us Yankees fans, this is a good, this is a tough one, but obviously if you are, you're either a Yankees fan or you're not a Yankees fan. That's pretty much the way it works. So, uh, the, this is a big, this is big news, but obviously I think the reason we want to talk about this is the fact that you can see how the news can construe things, right?

Like we saw with Aaron Rogers, Achilles repair or other things like, and what are these products that they're construing or what does it mean to try to like help the viewers understand better, right? Cause this, these two topics we're going to talk about are not new. But what does it mean? What are the nuances behind it?

Because obviously even CBS News and ASPN, they kind of got it a little bit wrong and a little bit different. So we've got to go over it.

Will Sanchez: Yeah, you know, and it's probably something that, you know, Cole's going to need down the road. But, you know, let's talk about our people over here at the recovery shop and might be just give a little shout out to these [00:02:00] folks out here.

Dr. Grant Garcia: Yeah, so shout out to our sponsors recovery shop. They're awesome. You know, patients love it. You know, my partners are doing more of these now too Because the patients really want to have that sort of extra special stuff I'd help them with their recovery from the nice machine to the rebless, you know, to all other options, scar creams, you name it.

And so they can all find it here and it can be individualized to the surgeons. So the patients feel like they're getting really a custom experience. Um, so reach out to Mike B. Uh, they're awesome. They'll work with you. They take care of a lot of different surgeons across the country. And we're happy to have his sponsors,

Will Sanchez: you know, um, it's tough, right.

As we go into the Yankee fandom here, uh, we lost Juan Cotto, you know, and kudos to him. He's staying in New York, um, with the New York nets, but that was a loss. We heard about, uh, Stanton and what he's going through. He's having this tell. tennis elbow issues. And there's some other stuff going on with his calves.

I think we could do a whole show on not [00:03:00] only his injuries, but past injuries that will probably check off every box that you have when it comes to orthopedic surgeons and surgery. But the big one was with Garrett Cole. right? And there were conversations at the end of last year that he was starting to have, um, potentially medical issues.

He wound up kind of just, you know, grin and bear in it and pitching throughout the season and finishing off, which pretty much you know, took him to the World Series as he tried to compete. Um, knowing now that he had to have Tommy John surgery, and this is exactly where we're going to talk about the procedure.

I want to reflect going back to, uh, last year. What do you think were some of the signs that The doctors were seeing that they were discussing within an organization and how they came to the conclusion to have the Tommy John surgery. Do you think that was something that came up in spring or this was something that was brewing since last year?

Dr. Grant Garcia: Well, what's [00:04:00] interesting is, if you look at, like, if you take care of baseball players, the small, the, you know, the High school level, college level, they tend to come in and they need it, right? It's like, there is some things on the fence and we have a lot of discussions with our players, but generally they come in, especially with the reconstruction.

They come in, they've blown out the elbow and they can't play again. It's a little different with some of these pros. I mean, you've seen a number of them where they kind of like limp along. They're still playing at a pretty high level. And then all of a sudden they like shut them down and then they get the surgery.

Right. And you're like, what happened? Like they didn't, they didn't throw in this blow out the elbow. So I, I think from the pro level, these guys are so good. And also I think there's a level of like, if he's dropping like two miles an hour. You know, or he loses some sort of pitch velocity pitch change, like it may not be enough that he's just going to not be an ace.

Right. And so they may have to just pull the trigger. Obviously, it's no small feat with a player of his level with his contract and the amount of money he makes and who he plays for.

[00:05:00] There is a situation where it's like, if they just can't be optimized, do we just go do certain, right? Like their arms are worth so much money, it's not worth it for them to try to play and hurt themselves.

So. It could, it could have been an acute issue, but generally it's also hard to tell on these guys because the MRI is all kind of, they over time, the UCL or the ligament, which you're talking about the one on the inside of the elbow. it gets stretched out. And so you don't always know if it's a good ligament or not just from the MRI alone.

So there's lots of other things that go into factors and all of it's also player, agent, surgeon, team's decision. So this is not just one person deciding on that.

Will Sanchez: Yeah. Yeah. And we've talked about that before and that was a perfect way to explain that. It's, there's so many people involved, including the player, uh, whether, like you said, the agents.

you know, general managers and you know what's good for the franchise, especially long term as he still has a hefty number on his contract and [00:06:00] they're just not looking at 2025 for the rest of his career. He just completed his 12th season last year. He was about to start the 13th season. Um, and we've seen these, um, these injuries occur.

Any concern with his age, the miles on the elbow as far as recovery. And I know I'm jumping ahead, right? I'm kind of putting the carriage before the horse because I'm already talking a little bit about post. But I'm just curious what your thoughts on initial thoughts on when it comes to someone that has had this longevity has been a power pitcher and is performed at the highest level.

Dr. Grant Garcia: I mean, you're always worried, right? I mean, any big surgery on the elbow. The return to sport is good, but it's not amazing. Now, this is one of the surgeries where people actually get back and they do play at a high level, and they've shown that even the first few years are really important. You know, maybe four to five years on the road, they drop off.

But at the same point, you know, he's, I think he's [00:07:00] 34. Uh, and so, or something like that. And so as a result, he's, by the time he's at that point, he would expect to have declined anyways, you know, maybe, obviously he's not a Berliner or whatever. Um, and maybe he will be. But, you know, that's something to be aware of.

Right? So it's like they do get back and they get back to a pretty high level, but not 100%. Um, but it's just something to be that you'd need to be on the radar for people that, you know, this is a good surgery, but again, it's always surgery. There's a chance he's going to back to his normal level and they kind of limp along.

Now, again, these guys are so high level that they can limp along and still be considered good. They're just not the best.

Will Sanchez: All right. Let's talk about what this surgery is. You know, we've heard, uh, Tommy John. surgery, and it's really this UCL surgery, right? And then I got excited because anytime that we could talk about internal brace, because, uh, if I'm going to sneak into an operating room, this is exactly what I want to perform.

I've watched too many videos and gotten my, my overall, uh, information on internal [00:08:00] brace. So I was like, Dr. Garcia. We got Tommy John and we got internal brace. Talk about what this procedure is and what's going on with that.

Dr. Grant Garcia: Well, let's back up in a second. So when we got the text, you texted me about this injury and we're like, let's do this, this podcast.

The The CBS article was incorrect. So this is why this is most interesting to talk about. So the article cites internal brace now going to recover faster. Good news. Yeah. Right. So the first thing I'm thinking is, wow, this is a high level picture that had a UCL repair with internal brace, which means we talked to us before and you can show the picture of it.

So we'll go through it very briefly. I will tell you that that is not the surgery end of having. But the way that the article spun it, this is what they thought they were talking about. So they, unfortunately, they didn't do as much research as they probably should have because if you look at three more articles, it tells you actually what he had.

So you can see here, this is the internal break. So what happens is there's the UCL, that's the elbow and that's the ligament that is. So that's the multimillion dollar ligament right there. [00:09:00] That's the Tommy John baseball ligament. So that ligament gets partially torn. And then over time, we can fix it. Now we have this internal brace, these sutures that are college and impregnated.

And the idea is that they grow into the ligament and add stability. And it used to be that you could ever do this. And now we've got this type of technique, which internal braces now all over the body that basically found that people will go back to throwing faster, like significantly faster, like six, seven months versus 12 to

Will Sanchez: 18.

And

Dr. Grant Garcia: so when we initially read that, we said internal brace surgery. So now as we get back faster, I'm like, wow, you got to use your repair. The problem is that the internal brace can also be added in a reconstruction. And so that's really what he had done because Neil L trusted. And we know he's the, you know, the man, the man of all men, uh, the surgeon of all surgeons.

Will Sanchez: Yeah.

Dr. Grant Garcia: So he added some extra flavor to it. So, uh, he ended up getting a reconstruction. The thought was he added the internal brace. So maybe you'll get back past, you know, there's not a lot of data to show that an [00:10:00] internal brace. With the reconstruction is going to get you back faster. So that is something that people should be aware of.

This is probably what he had done. This is the docking technique. It was designed by somebody, HSS. Um, and he might have done even a small hybrid because we're all working on ways to make this better. Right? But this is taking a ligament from his wrist or probably his hamstring, one or the other. Um, and that's the reconstruction that we all know that's the most commonly done one for pitchers.

That repair is becoming more popular in pitchers. And in fielders and MLB, and now, you know, all over the place, you've seen it multiple times, um, in, uh, in football, we talked about Brock Purdy, uh, Ben Roethlisberger had that, there's been a number of other quarterbacks, so there's, and then, there's a gamut of players that have had it in college and high school, but this reconstruction is really what he had done, but what they did is they added the internal brace in the middle, it's interesting because you can't find a photo of this on the online, like I have a picture from my own surgeries, But you can't find a photo of it online because the techniques have not been refined yet.

So these are sort of still [00:11:00] doing new ways to do this. The reason it's hard to do the internal brace with this surgery, if you go back to it real quick, I want to show the listeners. So normally the internal brace is fixed by two points, right? With those anchors. So go previously one more time. I want to show them, explain them again.

So you see how that internal brain has two little holes. Those are anchors. Now go back one more. I want to show that again. I know we're jumping around. Look at this. Here's a bone tunnel there. So you have to pull the brace through the tunnel. It's different than when you do it. And there's no anchor on the other side.

It's just another tunnel where you tie it. Now, Ella trash. I know this because I work with a company, Arthrex, just like he does. We're working on ways to make this better. So there's certain techniques like I've come up with the technique to try to do this with an internal brace and anchors built in. So that's pretty cool idea, but, and they're doing the same sort of thing.

So there is new stuff where they're going to have a brace more easily added, but right now this is the way you do it. And there obviously is, it's shown biomechanical benefit, but we're not seeing players get back faster. So that's obviously going to [00:12:00] be a little bit, you know, if you read the second or third article, it says.

They had the internal brace, but they ended up getting the reconstruction. So actually may not get back faster. And so that was like an ESPN one. So it's interesting. Normally these articles all get them right, but if these were not as accurate. So I think it's interesting for the viewers to hear this. So he's probably coming back mid 2026.

Uh, but we'll see.

Will Sanchez: Instead of potentially the beginning of 2026, if potentially. If you would have went the internal brace route, not the reconstruction with so.

Dr. Grant Garcia: So I think that that's the thing. It's a UCL. It's not the internal brace. So he got internal brace. You can do it with either one. The idea of the internal brace is to fix it on both sides.

So both of them, I would do an internal brace now to be honest with you.

Will Sanchez: Yeah.

Dr. Grant Garcia: But when they say internal brace, they were thinking he got the UCL repair and they didn't know. They didn't say that in the article. So that's what they were assuming he got and they were assuming it's going to get back faster.

They didn't realize the internal brace [00:13:00] because it's just the same way when we had the Achilles, right? With Rogers, everyone's like, yeah, the internal brace, it didn't make it get back faster, just protects it. Because while we want to get our players back faster, we add biologics and things like that. We don't want them to tear again, right?

That's the most important thing. And so the idea is by adding this internal brace, you're reducing the chance of them tearing again.

Will Sanchez: You know, um, one of the things, and you know, I'm going to bring up the stats here. I saw an article and it said 40 starting pitchers have thrown 100 plus pitches over 98 miles per hour since 2020.

63%, 25 out of 40 players have now had Tommy John's surgery in their career. When you hear numbers like that, and these are pretty big numbers, right? What stands out f you've worked with athlet the Mets organization, yo in hospital for special s a lot of different things that kind [00:14:00] of, you know, r you when you see numbers

Dr. Grant Garcia: be honest with you, this this level, this is an in For the viewers, Will sent this to me before this Jared Cole thing, and then all of a sudden, Jared Cole popped up and I'm like, this is a stat that the listeners need to hear.

So we've known about some of this stuff, right? There's an uptick. We know this in Tommy John surgeries, right? Because specializations happens earlier. So the ligaments are getting trashed much earlier, unfortunately. Um, and in players, they're being expected to throw harder, right? We talked about before a while ago, sowing over a hundred was considered incredible, right? It's very rare. Not anymore. I mean, there are a number of players that throw over 98 miles an hour, 40 starting pitchers since 2020.

Will Sanchez: Yeah. And

Dr. Grant Garcia: that's not counting the relievers too. So we know there's an uptick and there's an uptick in revision reconstructions, but this is a very good layman's term for us to see.

I mean, 63 [00:15:00] percent is the same. Yeah, right. That's the one good thing to hear is that I mean, in my assumption from the stat is that they're still throwing that is that 63 percent of players who had this or that means that those players who had the surgery, they got back up to the over 98 miles an hour.

Now that's not directly said here, but the assumption from that data would be there. But you can see, look at the, there are, there are 1, 2, 3, 4, 5, 6, there are six with multiple Tommy john surgeries. So those are revision surgeries.

Will Sanchez: And big names, right? Jacob deGrom, Nathan Evaldi, Dustin May, Shea McClanahan, Shohei Ohtani, right?

So that'll be interesting to see what happens with the Dodgers where they go, Hey, we need your bat in the lineup. Not sure if we actually need the pitching because we're staffed with pitchers. So it'll be interesting to see how that happens. I haven't followed along. at this juncture to see what's going to occur with their season and how it plays a part for [00:16:00] Shohei Ohtani. But for Shohei Ohtani to have two Tommy John surgeries already, that, that's, that's gotta be a warning, right? Or, or, you know, that's not in

Dr. Grant Garcia: good company. We've seen, the thing is that because there's more revisions now, we have more data. To know that there are certain again, these are very convoluted statistics when you look at the research projects.

I mean, they're very well done. I know a bunch of the guys that do the Brent Erickson, Tony Romeo. They're amazing surgeons. They've done these for they've done hundreds of these. They look at the hot stats. They look at other stats. Um, on what these are. But what we're seeing is that in revision patients, revision surgeries, uh, players do get back.

They just, it's not the same, right? There's just long term, they don't have the same data, but also it's just smaller numbers, right? You're looking at 10 starting pitchers. Like that's not enough to give you what we call a power or sample size. We know that it works. Now, again, we're not even talking about the surgery issue, right?

This is not an easy surgery to do. When you have to do a revision, Tommy John surgery, that is very rare. And it's very unusual. The person who has the most in the [00:17:00] country is probably Neil Ellitrage, right? I think he did probably almost all those players.

Will Sanchez: Yeah,

Dr. Grant Garcia: this is not easy to do because of the technical aspect.

And the main reason it's so hard to do is you probably saw that first image. You can go to that Tommy John reconstruction. When you have those two bone tunnels and you have to try to revise it, you can't do another bone tunnel. because you'll just break it. So what you need to do is like a button technique or something even more fancy, but like sometimes they blow through that tunnel and they break it.

And then you're like in a really big bind. So these are, these are not easy surgeries and they're scarred in and usually the nerves moved. So it's all going to be all over the place. I mean, the fact that these players are getting back to any level, you should be, you should be giving yourself a huge pat on the back for completing that type of surgery.

Cause that is not easy.

Will Sanchez: I can't imagine the rehab for the for the player to go through it twice and and to put yourself through it. And then you talk about it from the doctors or the surgeons perspective. We talked about this for those that are listening that didn't check us out when we talked about Nick Chubbs [00:18:00] injury, and when he sustained it, saying, whoever's going back in there to fix that knee again is it really has to start from scratch, kind of go through the mess of what's happened in the knee and then reassemble it. And that's kind of something that you're alluding to right now when you have to have a surgeon go back in to kind of fix whatever's happening in that elbow.

Dr. Grant Garcia: Well, and I would say it's even harder because, um, when you go back into a joint, like fluid in a knee, like the ACLs or PCL or whatever else, Nick Chubb tore, the scar tissue's not nearly as bad as when it's on the actual part of the body, like when you open up a part of the body.

The scar tissue is much harder and there's nerves in the way with some of Nick Chubb stuff. It was a very good surgery. Uh, James Vuze, I know him, he's a solid surgeon for the Cleveland Browns, but that, was a hard surgery, but going back into like an open surgery again, it just makes it way harder. It's a whole nother level.

And especially with the nerve being encased in scar, you're, you're [00:19:00] trying to figure out where it is and not damage it. Um, and again, preserving the ligament concern for the nerve itself during surgery. And that's exactly, uh, right. And also, I think Jared Cole probably got some nerve work, because we talked about one of the things, if you ask our players, is do they feel numbness when they're throwing?

So by throwing, they're damaging, they're injuring that nerve. That's actually what Tommy John, I think we brought this up before, but the original Tommy John surgery, they didn't move the nerve. And so as a result, he actually ended up getting a claw hand. After the UCL reconstruction. And that's because you lost his ability to use this on their nerve, which is the nerve right next to where we do the Tommy John surgeries.

So they're going to probably do something about Cole's nerve because he was having nerve issues. They said in some of the articles previously.

Will Sanchez: So do you think when they went in there, they could, could you potentially see if something was pinching that nerve? Right. Um, like I said, I've been spending way too much time on the Arthrex website and seeing how, seeing the surgery itself and they're moving things and they're, they're being very careful, careful with that [00:20:00] nerve and how that's going to move.

So when you go in there. And you already have this history of, you know, maybe complaining already by the player with the nerve, you know, you're going in there and you're going to be working around the nerve for, for, uh, the reconstruction. What is something that perhaps you're looking for before you even get into that elbow saying, I'm going to look for this because he's been complaining about that.

Well,

Dr. Grant Garcia: you're going to look for the nerve to be encased. So that's the normal one. The one you don't, the one you want to make sure you're aware is if the nerve is popping out. So people, I got a player that I did that did Tommy John on. And if you don't realize the nerves popping out when you go down into your dissection, you could actually injure it.

I didn't injure it. I knew it was there, but you could miss it because the nerve moved, right? You're so used to being a certain spot, right? Like this is not a real elbow because it's chat GPT. But you know, if it's in, it's supposed to be in a normal spot every all 500 times and it's in a different spot as a surgeon, like you don't, you only know so much, right?

You want to make sure you watch out for those things because you don't want to, it's like, it's like going down a road and all of a [00:21:00] sudden the roads has a cut. Huge drop off that never had before. Right. All of a sudden your car's in the dump. Is that

Will Sanchez: the first thing you're looking for when you, when you cut up, whether it's the knee or the elbow or anything like that, that you're going in there.

So I have to, I guess I'm curious about the steps, right?

Dr. Grant Garcia: That's the worst case scenario. It is

Will Sanchez: for that.

Dr. Grant Garcia: Well, that's like, you don't want to damage it. And again, it's pretty unusual. I examine it beforehand in the office, so I'm looking out for it because that is the one that you can nail if you, if you do an elbow scope, which some of these guys get elbow scopes, like when I used to work with all check and we did all these professional athletes,

Will Sanchez: we

Dr. Grant Garcia: would scope the elbow first and then do it.

So if you don't notice that nerve is popping in and out, which is like less than 5 percent of the population, I'll tell you, I have it so I can know that when the nerve pops out, sometimes you can feel it. And so as a result, the, if you can injure somebody, if you don't know, it's there ahead of time.

Will Sanchez: Okay.

Um, I had another question regarding, you know, you go in there, you're placing the anchors, right? You're, you're, you're setting up that [00:22:00] brace, you know, what, what are you determined, what's the determining factor for you as far as the amount of anchors you're putting in place? What stands out for you? You're going, okay, this needs another.

Yeah,

Dr. Grant Garcia: I mean, you wanna do smallest is better, right? 'cause it's you. Every time you, in my head, you're always like, am I gonna be back in here again, right? Mm-hmm . So you just don't wanna keep using Bigger is better 'cause you have bigger holes and then the next time you do it you need a bigger hole and right.

And, and these are elbows, despite gear hole, you know, being a big guy. Right. The elbow is only so big and you run out of room really quickly. So smaller anchors is better. Usually just two. Um, and that's the idea is these internal braces to use two anchors, one on each side, and that locks that thing in and fixates it.

Will Sanchez: Yeah. And then what is it? You use like that zero size anchor in my, in my deep dive in here.

Dr. Grant Garcia: Uh, I mean, you're doing a great job, but usually the anchors at zero would mean that it's not, uh, they do, the measurements are [00:23:00] usually based off of like They're 3. 5. So they're 3. 5 millimeters. They have 4. 75 millimeters, 5.

5 millimeters. Obviously, this is the Arthrex ones. Um, but they're, they're based off their certain millimeter sizes. Uh, and so as a result, you go with the three, usually three fives, they come with smaller too, but those are not used for the elbow.

Will Sanchez: Gotcha. And then you started off the show talking about collagen, right.

And, and utilizing the collagen. So just describing what that means when you're, you know, That fiber tape is dipped in that collagen to repair the native ligament. What, what's the, why, why do you need that?

Dr. Grant Garcia: Well, so the idea behind this, this is the same thing with all the internal braces. It's the, the collagen dipped in the theory is supposed to help with healing, right?

You all take, you've heard of people healing. They take the bone broth. Or they take collagen powder. Yeah, right. You know, I took collagen powder after one of my surgeries to help with healing. There's data to show that. Right? It does help your fingernails too. Uh, but nonetheless, uh, the [00:24:00] idea is that it's supposed to help with the healing process because this collagen, we have collagen, the meniscus and cartilage, their collagen.

There's different types of collagen in your body. So having the dip basically makes it more, uh, how will I say? More like your body. So the more like your body, the better it heals, the less it scars. You don't want to have a, the last thing you want to do is having a reaction, right? Your body doesn't like that.

It says this is a bad thing and tries to get rid of it. So by having this collagen, it's like, Oh wow, look, a part of my body's here. I'm going to come, come, come, come, come attached to me. Will Sanchez: I got you. I got that. That makes, that makes a whole lot of sense. Uh, describing it that way to make sure that your body doesn't reject this foreign object. Right. So you're, you're dipping it in and saying, Hey, he's one of us.

Dr. Grant Garcia: Well, it also just gives a little bit of boost, right? The key is a boost. We talked about this as biologics are, we talked about those ACL biology. Boost the gear is can we boost healing? And so this, this has been a mainstay for them for a number of years, this college and dip fibers tape.[00:25:00]

Will Sanchez: All right, I've got two more for you. Um, you know, we've talked about this in the past, right? And where that ligament is too tight and you've mentioned before that you've done some repair and realize that, hey, it's just a little too tight, a little too stiff. You kind of go back and loosen it. So you know, what is the determining factor?

Is it moving it to a certain degree, whatever that is, the knee or the elbow moving into a certain degree and seeing how that tightness is? What do you do, Dr. Garcia? What is Dr. Garcia go to? Dr. Grant Garcia: This is, this is what makes this surgery no longer a simple surgery, right? Because the idea is you have to know what you're doing with this because that ligament is unforgiving, right?

That internal brace is a solid construct. So if your tunnels are off or you put it too tight, Right. You just basically lock themselves elbow.

Will Sanchez: No, you can't pitch or what, what do you mean? What do you mean done?

Dr. Grant Garcia: You can't even get all your emotion back. You don't lock them up. Like literally like a, like a vice [00:26:00] grip.

Right. And again, it's not, I've never seen something with it. So thankfully, but again, I'm, I'm only seeing my own or occasional second opinions, but that's generally not the complaint with that. Cause people are so concerned about it, but there's so many different tricks to reduce that. But obviously the number one thing is getting all your stuff, right?

It's the same thing in the need to internal braces. You can internally brace someone too tight in the ACL. Like there's so many different ways you can, you can mess this up. Thankfully it's not commonly done because we all know there's certain steps we have to do and we double check ourselves. Like that's my number one thing I'm thinking about before I finish the case.

Um, and so the way I do it is I, I do a throwing position when I set it, which is their position where I want it to be the tightest. But I make sure that I can at least get beyond 90 degrees and it's not too tight. And then actually when you're in full extension, the brace should get loose. And so there's certain ways that I've tested it.

And then I'll check it throughout that. And then the thing is also knowing that it's going to be a tiny bit loose until you connect it to the UCL. Because you may have watched the video, but that brace has a tiny bit of bounce to it. And if [00:27:00] you don't have bounce to it, it's too tight. And you have to then, then as you repair it back to the UCL, it actually gets tighter.

It kind of sucks down. And that's how like, that's a sweet spot, but that's why we go to residency and why we go to fellowship so we can learn how to do that. So we don't do it for the first time on a patient.

Will Sanchez: Yeah,

Dr. Grant Garcia: that's without someone to monitor this.

Will Sanchez: Yeah, we don't want, we don't want that. We want you to get all your practice somewhere else.

Uh, is there any concern when you have a major league, uh, major league pitcher that maybe, do you leave it a little looser for the elasticity? Like, is there, or it's just like, nope, this is, this is the way we do it every single time.

Dr. Grant Garcia: I will tell you that's like operating on somebody you know. So, you operate on somebody you know, operate on a high level athlete, it's the same level of pressure in my opinion.

Will Sanchez: Dr. Tim Jackson

Dr. Grant Garcia: Okay. My strongest recommendation to anybody operating on them, and again, I am myself, there are these surgeons have done hundreds of these. You do exactly the same thing you do for everybody else. [00:28:00] If you're worried about something, maybe you add, you know, if you're doing like some sort of crazy ligament thing, maybe you add biologics because the person can, you know, they want to pay extra for it and they want to do this sort of fancier stuff.

But don't change the surgery because of them, that's where you're gonna have a problem. So you don't put it looser, you don't put it tighter, you do it exactly the same way. If you need to give yourself a double check because there's a level of stress involved with this, you do that. you know, I'm sure Neil L.

Trosh was cool as a cucumber doing this surgery. So I don't really think that there was a stress level for a guy like that.

Will Sanchez: All right. As we wrap it up, I want to know, you're already telling me I'm missing half of next season already with Gary Cole. So I'm not sure if I want to continue that conversation, but What's, what is the post op?

Like the first two weeks, uh, right away. Right. We we've talked about, especially, you know, the way things have moved forward, um, getting, whether it's movement or some kind of exercise, Garrett Coles gets out of surgery [00:29:00] three days later. What are you having him do at post op? You know, the first two weeks.

Dr. Grant Garcia: So, I mean, probably because of that internal brace, that's where that's where the internal brace comes in, right?

The internal brace is there. So you're probably going to start them. Maybe just. chill them out for like a week or so and then you start moving the elbow, right? Because you feel the issue is you don't want to stretch out the ligament reconstruction or the repair. So nowadays we move them a lot faster. We used to do like Casts and splints and really shut them down.

I mean, what I expect from these guys that six weeks, they're completely normal motion. And then they start working on strength and all the return stuff. So they're probably going to just let them chill out for a week or two, knowing that because if he said it right, and he has the internal brace and you're going to let them rip in terms of range of motion.

But that's big, that's been the, that's for me is the real reason the internal brace works so well. It's because it lets us move faster because we're protected, right? Like I always tell the people this for the most part, Adding the trinobrace for me helps the overall ligament itself long term, but it's [00:30:00] really small compared to the ligament, right?

It's not really like if you're using the AUCL returnal brace just for the whole repair, it really protects it so the thing doesn't stretch out. It's that first year. It's like wearing a brace on your knee. It's the same way, but it's internal. I got it. And so the idea is that you just want to protect something for the first year until it gets fully healed.

So now you have much more protections and stretch out and then you get better long term results.

Will Sanchez: So, so is he just in the sling at that point, knowing that you don't want to put him in a cast or you don't want to put him in a I mean,

Dr. Grant Garcia: he's probably in an elbow brace. That's what I would do. An elbow brace.

Will Sanchez: Right.

Dr. Grant Garcia: Yeah. So he has some sort of lock, so he can't go too crazy. And then you unlock it so he can range. So he has that sort of, he protects himself from those random forces, right? Like, let's say he had a couple extra pills of medicine or something and he got tired, he fell over, like you want to protect the elbow.

Will Sanchez: Yeah. Yeah. So, so does that get locked into like a 90 degree angle? Like what's that lock? All right.

Dr. Grant Garcia: Yeah. And then you start the ranging and then, you know, the whole standard protocol, I mean, this guy's going to get millions of tests and he's going to go to the best trainers and they're going to fly in anybody.

And he's going to get, you know, a little knob found him to check his throwing [00:31:00] motion and it's going to be insane.

Will Sanchez: Pretty bad, right? With amino acids and God knows what else. Well, you know what?

Dr. Grant Garcia: We, we don't want to go seek peak, but we have a guest coming up. That's going to go all over how this works.

Will Sanchez: Oh yeah, that'll be a, that'll be a show for there.

And then just to tie it back to the recovery shop. Is he getting a rebless? Is he getting something like that down the road? Well, how does that

Dr. Grant Garcia: probably getting some sort of fancy ice machine, the nice machine or another option he's getting biologics. I'm sure added. He's having the top of the line, everything. I don't think you need to read this for this one. He's going to have people that are probably going to hand bend his elbow.

This is the man on the Yankees. This guy's not getting the lack of treatment.

Will Sanchez: No, no, no. And if they need any help, I'll come over and move his elbow for him or something like that. I'm sure you will. I'll put your name in the list. We'll get them all taken care of. All right, man. What are the, some of your final thoughts as we wrap it up?

Um, you know, as far as, you know, the procedure that was done, you know, what really stood out for you? [00:32:00] Um, you know, and the reason that, you know, we taught, we wanted to, uh, talk about, yeah, well, this is such a,

Dr. Grant Garcia: such as like, if you talk to like a hundred people on the street, no one's had this surgery. Right.

But it's such a niche surgery. But in baseball, it's such a huge deal. It's like probably one of the biggest deals in baseball. So the only thing we talk about in baseball players when they get injured for the most part, um, cause the picture is so valuable and they're made, they're paid a lot of money.

And so it's just interesting to see at some such a niche surgery. That's so popular and everyone knows him. You say the word Tommy John surgery, like anybody on the street who watches baseball knows about this. But I think for me, the reason the show is important was we've talked about this a lot, but I think to understand the differences of what's going on and understand what you're reading these articles, right?

We we're here to help explain some of the layman terms. For the listeners, but also to explain what it means and to also change misinformation, right? If they're hearing that he gets some fancy new procedures and get back faster, if it's really true, I love to talk about it. But also understand [00:33:00] that some of the articles got it wrong and some got it right.

And it's just interesting to have this conversation because it makes it to me. If I'm if I'm not a educated. Reader, because I don't do these surgeries, which is most people aren't like, I would not understand what that is. I go, Oh my God, he's coming back in six to eight months and he had the reconstruction.

That's unheard of. But really that wasn't accurate. Like the other articles were like, no, 12 to 18 or maybe a year or more.

Will Sanchez: Yeah, I know. And that's, and that's what I was like, okay, yeah, we're starting off the season and then you start finding out that it was like, ah, okay. Uh, and, and I was excited about it because I thought it was going to be something kind of like when we talked about Lonzo ball.

We finally had this, this procedure that we don't see, uh, these high level athletes go through, you know, for many of reasons that we've gotten into in the past, you know, safety and concern and kind of stay in the course with their norm. So, uh, it was interesting to see, you know, what type of internal brace that, uh, Cole was going to have anyway.

I hope the season is going [00:34:00] to be good. Regardless, I'll be out there. I'm going to go check out the Mariners in a couple of weeks. My friend's birthday, we'll be out there checking out the A's and enjoying, uh, enjoying the baseball season. We've got soccer coming up this summer. It's going to be amazing. Uh, we should have a lot of fun.

We have some amazing guests. Check us out sports. talk. com. We're on YouTube. We're on your favorite listening podcast, Spotify, iHeart, you name it. We're everywhere. And we just want to, uh, let everyone know. We appreciate it. We hope, uh, people learn something at the same time.

Dr. Grant Garcia: Thanks guys. Appreciate it. Join us, listen to us.

We got more fun coming up. So, and thanks again.

Will Sanchez: All right. Thanks for listening.

Audio Transcript

Welcome everyone, Dr. Garcia. I'm clicking way too many buttons here.

I've got the title page. We've got music going on. Our guest is giving me a hard time about talking so he's not even on the show yet and already give me a hard time about yippity yapping.

Welcome everyone to sports. talk. I'm Will Sanchez along with Dr. Garcia, Dr. Garcia. How are you, buddy?

I'm awesome. I'm excited for this one. I also love the that our guest is giving you trouble already.

This is going to be good. I'm excited well you know what everyone knows we got our uh this is the new product we're gonna be talking about. I got my new background you never know what's going to be so it changes every show but we're really excited for this.

I think this is something that patients don't know about. I constantly get questions and it's actually not as much in the office because they commonly already know what they want. But the patients that I come on the street.

They're like, hey, your surgeon. I'm like, yeah, they're, if you really cool if we could like regrow cartilage. Don't you think that'd be really cool?

And I'm like, we actually can and they have like they're totally blown away. So from a layman terms, this is one of the most common questions that I get when they find out that I do sports surgery. So I thought it was kind of good for the the people out there to see what what's out there once's one of the sort of hottest most talked about products. um and uh learn about this and obviously we got super lucky because the CEO wanted to come on uh Nick and I'll be really excited to talk to him.

So Yeah, we're going to get into that in a in a second. um For me, when I saw the product and I saw you posting videos of LinkedIn and I was like, oh, this is this is pretty cool stuff, you know, and it's just once again, we're always talking about innovation.

We're talking about the future. We're talking about more importantly what these products do for the patient, right?

Because obviously you have, you know, your colleagues and then more importantly, it's the patience and how they benefit from this. So we're really excited about doing that.

But first, you know what we're really excited about?

We're really excited about the recovery shop. Why? Because we got a lot of love for the recovery shop because they help you, the patient just as we were discussing.

Dr. Garcia talked a little bit more about the recovery shop. So big thanks to our sponsors. I mean, it's not it's pretty much every day that I hear patients postsurgical say how much they're happy about how happy they' about this, you know, the ability to get all these aftermarket things that they want, you know, patients coming in, especially in Seattle, I asked asking for like, I want everything, right?

I want to have the best machines. I want to have the best recovery. I want nutrition.

It's all there for the patients. It's a one-stop shop. It's really allows them to have this sort of extra stuff.

And we're going to talk about cutting that stuff today. You know, they get to offer that stuff from the rehab standpoint. Sohow, so it's been great.

Again, any doctor surgeon interest in using it for their patients, let us know and or just just talk to space with Mike because it's easier that way. So thanks again, guys. All right, man.

Let's bring on our guests, uh, Nick, Nickangelo. Welcome to the show. uh Thank you for taking some time and being here. You have an awesome step and repeat behind you.

I mean, that is professional. Dr. Garcia, I think I may need one of these cool step and repeats. We talked about hats and things like, but, I think we have had a lot of guests on here, but I think you're the most professional looking.

Well, I'm going to guess that's a good thing and it's'll take care of you. We'll get you something for you. Let's make sure.

You know, first off, I'm sorry. I'm taking it over again. I apologize here.

You're from Pennsylvania, right? Is that where you were originally from? Are originally from Pennsylvania or Indiana?

Tell us a little bit about your background because uh, you know, I know you're on the east coast, so we want to share some of that before we get into everything else that you do here. Yeah, so it's upstate New York, uh so that's uh where I am from and you know, actually just by way of background. So lawyer by training, um and I actually started my career in industry about 30 years ago when I joined Eli Lilly and you know, I was really fortunate to, you know, start there as a tax lawyer, but, you know, after a few years to actually be moved over to the business side, which doesn't happen very often, and, you know, ultimately became kind of the director of strategy and business development for Lily's diabetes and obesity product group.

And, you know, it was a great foundational experience for me because the product group president of the the time was more of a commercial guy and he said, if you're coming over here to work for me, you're going out in the field to learn our customers. And so I was a sales rep for a little while, um selling, you know, Prozac and Lily's uh insulin products, which was great. And then, you know, really just kind of being in the middle of the whole product development commercialization and so on of a of a pretty important product group for Lily was just a great experience. And ultimately ran Lily's venture funds for a while. So, you know, over the course of my career kind of just had a lot of business development experience, acquiring developing and commercializing products and and enjoyed what was the predecessor company aerrisal about 12 years ago. So it's been quite a bit of time, but it's been a great, great experience as I'm sure we'll talk about.

So I think for the viewers too, to know, obviously, Verrisel is the major company, right? And then we hear this word Macy, right? So can you explain the difference in the two?

Because everyone hears me, you say the word Mac. They look at you, they see CEO of Veracel and they see Verasso in the background, so it'd be good for us to kind of understand that better. Yeah, so Vercel corporation is the company that commercializes, developed and commercializes Macy.

So, you know, we acquired Macy uh back in 2004. So the company that I joined um was actually called astron bioscices and it was a company that was in the cell therapy space conducting clinical trials for the treatment of severe, uh cardiovascular diseases, basically using a bone marrow derived multicellular therapy, uh, which was really attractive at the time. um and, you know, cellingene therapies weren't quite as prominent as they are now, but, you know, really reped sort of the next frontier of innovation uh in the industry. And so I was really excited to join a company that was kind of on the leading edge of of these emerging technologies.

So that's what brought me to the company. um, you know, at the time, Sonnofi, which is one of the largest pharmaceutical companies in the world, bought genzyme. and after they bought the company, they decided to divest what was essentially the genzyme biosurgery business. So there were a Pharma company. They weren't really a med Tech company, so they decided to divest what was called the cell therapy and regenerative medicine business.

And that's how we acquired this portfolio. So initially, it was the first generation cartilage repair product called cardicel. epicel, which is a skin graft product that uses a patient's own cells for severe burn treatment, essentially a a skin graft product. And then Macy was approved in Europe, but not in the US.

And so part of our, you know, development of that product was that we ended up submitting the BLA to the FDA and the US and getting approval for Macy in December of 2016. you know, so essentially that was a kind of a strategic um transaction for us that essentially took us from a development stage company to a commercialization company. And then we changed the name of the company to Verousel. We moved our headquarters to Boston, where our manufacturing is now.

And so it really was quite a transformative time for us. And as you alluded to, Dr. Grant, you know, now we're we're seeing as kind of a leading provider of advanced cell therapies for the sports medicine and severe bird care markets and we have highly differentiated portfolio of innovative advanced cell therapies and specialty biologics that essentially repair tissues and restore function. And we're really focused on changing the standard of care for patients with knee cartilage injuries.

Yeah. So I was thinking I think you did a good job of leading to this. I only reason I know is to hear this this little story from your rep.

So basically I heard a very positive story how you basically this was a herding product in 2014. And I know that some of the reps are going to kill me for telling you this, but it was a herding product in 2014 or not doing as well and you basically found a way to acquire this and now you have this situation where you you have a sort of, I would call the golden ticket of cartilage where it's under this biological option. It's been FDA approved.

And for those listeners, and I want to make sure Nick can respond to this, this is not easy to do, right? There are lots of car inserties that I'm telling you about that one insurance companies won't cover and two they're not FDA approved yet. So there's some sexy stuff in Europe that we hear about all the time, but you can't use it in the US.

Or there's some sexy stuff we've talked about on the show and you can't use it that frequently because it's hard to get insurance to cover it. This is a insurance covered FDA product. So it's a big deal.

And now it's a, you know, one of the most popular carage products and one of probably the most studied cartilage projects. So, I mean, I think that's if you want to kind of comment on the fact how you basically, how did you know this was going to be like this? Or and you don't have to go into a big detail, but kind of that story is kind of incredible.

Yeah, I mean, we, yeah, it really was because, you know, we were kind of really focused on, you know, focusing the predecessor company on which programs, we should be, you know, obviously kind of bringing forward in the clinic. But again, you know, it was a pretty nas industry at the time and you really want to diversify uh your your risk in a higher risk uh development, you know, situation. And so we were very, very fortunate to sort of, I mean, Sidi was running a process like, you know, many large companies do where they contact a lot of companies and, you know, we were probably one of what were a few natural buyers of the business.

We knew the cell therapy space. There weren't that many companies working there, developed a great relationship with our business development partners in Paris at Son.

It's a French-based company, um and kind of entered the process late, but sort of ended up winning the deal.

And to your point, yeah, at the time, you know, the whole business was doing maybe $40 million in revenue. It was kind of flat to declining. um and we were able not only to kind of get the commercial business sort of growing again at sort of industry or above rates, uh, but we also were able to get Macy approved in the US with a pretty creative regulatory strategy where we took one pivotal study from Europe, the extension study that I'll talk about later, the carticel data that existed in the US. and we actually didn't have to run any additional studies. And so we were able to get to the market very quickly with the, you know, the pivotal data from the phase three study in Europe kind of leafrogged the competition first to market.

And, you know, obviously that's allowed us to kind of achieve the growth that we've been able to achieve to date. So it's been a, you know, like everything itself a lot of hard work by a lot of really talented people, but, you know, it's very rewarding when you're able to take what was essentially, I'll call it a neglected business, right? Because genzyme had bigger products that they focused investment on.

And you see it a lot in the industry where companies, even my predecessor, you know, the company Lily, that I worked at when we would divest products, sometimes they get into other companies' hands and they grow into being multiillion dollar companies like varioscels become. And it's really because you've got a, you know, focused management team that's really kind of nurturing the product, um which again, may just not have been as high a priority in a bigger company at the time. Yeah Well, put up that slide the first one.

So I think I think you I think it'd be good for you to touch on on. We kind of can, you know, I can also charm into because obviously I know this product pretty well. But I think for the viewers, I don't understand sort of what the which we treat this articular cartage damage you see here with the Macy, that's how it's delivered for all those listeners, but really sort of what is what's unique about the Macy compared to other products out there?

I mean, I've had my podcasts, I've had every possible cartilage thing I've talked about. So what's the uniqueness of this Macy procedure? What what do what do you feel is the uniqueness of it? Yeah, so Macy is the leading product for the company, so, you know, this we just, you know, released our kind of preliminary financial results for 2024. And, you know, Macy will be close to a $200 million product in 2024 growing at, you know, around 20%. So as you mentioned, it really has become the leading restorative cartilage repair product on the market. um It's basically an advanced cell therapy that, you know, will show you more about that uses a patient's own cells to repair, you know, the damaged cartilage tissue and restore function.

Emis is unique in that. It's the first and only FDA approved product that applies tissue engineering processes to grow a patient's own cells on a scaffold, um basically, you know, using a healthy cartilage tissue to do that. And, you know, cartilage injuries, while everybody sort of hears more often probably about ACL terrors and meniscal injuries.

I mean, cartilage injuries are a significant issue. You can expound upon where, you know, basically cartilage is unique in that, unlike most other tissues in your body, which, you know, have intrinsic healing properties, that's not the case with cartilage, because there's no blood vessels to bring repair cells. There's no emphatics to get rid of cellular and tissue debris and no nerveves.

So, you know, cartilage, a focal cartilage injury, like weat tree is like a pothole on the surface of the knee. And if it's like untreated, uh, you know, it leads obviously to joint pain and dysfunction, but ultimately to ostearththritis and partial and full knee replacement. So, you know, that's the progression that we're focused on halting.

Yeah, that's perfect. And I think it's good for this slide. I'll show the listeners, but basically there's three types of cartilage stuff.

So we have the ones you clean up, which is what a lot of people used to do has been around for a long time. And you have the microacture and the drilling that's a little bit more old schooled, but it's not really it's just sort of trying to repair and try to fill it with something good. And then these are sort of the main products and obviously ACI, so the viewers don't the to not get confused.

ACI and Macy ACI is just the older version of Macy, right? And so the and now we have this better matrix. So obviously before we had to use the periostrial layer, which was as as you can put it, it was more challenging, right?

So now it's a lot easier to do these these procedures. I think this is kind of a good slide for to bring up. So you know, you guys went from sort of this arthronomy carticel, then you join the company, the company takes off 2016 big jump, right?

Like it just was a lot different. And so you guys described that in the process briefly sort of you went from now like when where did you how did you go from the this this really tedious So well, this used to take like three times longer. And then they figured out a way to make it so it did.

So how did you guys do that? You know, what was your thought process in going from that to this sort of 2016, 2018 product that's now, you know, much easier to use and much more reliable? Yeah, so, you know, in the US, so when we bought the business, Macy was already approved in Europe.

That's where the technology was developed by Dr. Peterson in Sweden. It was approved in Europe, uh, but cardicel was the product that, you know, was shown on the lefthand side of that slide. That was the product that was approved in the US when we bought the product.

And as you mentioned, it was a first generation ACI, so that's autologyus condorsite implantation, so taking a patient's own cells and implanting them in the defect. First generation ACCI product that was really a first commercialized in the US in the in the 1990s. And, you know, the as we'll talk about with the Macy procedure, what ends up happening is you can explain it, you know, add any color that you'd like, but, you know, when you suspect there's a cartilage injury, you know, often you'll go in and do what you' referred to as sort of the palliative techniques that do a contro plasty, a diagnostic arthroscopic procedure just to see what's going on in the knee.

And at that point, that's where you take a biopsy of healthy cartilage for at the time cardicel and not now Macy. So out of a non a tic-tac size biopsy out of a non- weightbearing portion of the knee that is sent to our manufacturing facility in Boston, where we process the biopsy, we isolate theondracytes, which are the cells that make cartilage, and we expand those cells, and then we cry or preserve them. So we freeze them down.

We wait till surgeons like you are and the patient are ready to move forward with the surgery. Once that happens and you pick a surgery date, we kind of work backwards. We thaw the cells, we further expand them.

We seed them onto that college of membrane that's shown in the second image from the left. At a density of about half a million to a million cells per square centimeter package it up, send it to the surgical site where the surgeon obviously kind of prepares the defect and essentially cuts the Macy membrane to the size of the defect, lues it in with fibberglue and is done. So in the case of cardicel, which was the predecessor product, the front end of that process was essentially the same.

Take a biopsy, expand the cells, but as it shown in that vial, the final finished product was a liquid cell suspension. Now, you can imagine that you alluded to this how hard it is to fill a pothole on the knee with a liquid suspension, right? We we like torture.

Yeah, you know, we we liken it to kind of spackling, you know, a wall, you know, with water, right? I mean, it it's it's very hard to do. And so what that required was opening up the whole knee, as you alluded to, you taking a periostial harvest off of the shin bone, microsutureuring that into place, injecting the cell.

So it was highly invasive, technically demanding, very time consuming. And so it became kind of a niche product at the kind of high-end cartilage repair specialists. And that's because, again, it's really the the way one of the only ways that you can truly repair the tissue because you're using a patient's own cells to regrow that cartilage.

Around the year 2000, in a company called Veren and Europe developed Macy, which was a next generation cartilage repair product, where those cells were seated onto the membrane, as I just described, and then genzyme acquired Vogin in 2004. We acquired the business from genzyme. And that's how Macy sort of made it into our hands.

And and as I mentioned, you know, it wasn't approved in the U. at the time. We ended up submitting the BLA in 2015, the FDA approved it late in 2016, and we launched the product in 2017. So the real sort of, as I mentioned, you know, this was kind of a niche product, you know, used because there's actually 20 year outcome data with cartil with carticel now.

So once you regrow this cartilage, correct me if I'm wrong, but it can really last a lifetime unless you have another injury, right? So that's why surgeons would take the time to do that. You know, the beauty of Macy and you see this often in the med Tech industry that when you take a highly invasive surgery, open heart surgery, and you and and you kind of progress to minimally invasive cardiac extents, you see that there's this broad adoption as the standard of care changes.

And that's really what's going on with Macy right now. So because you can't you have this product now that has the cells already on the membrane, as I mentioned, as you can see in the third image from the left, we actually developed custom cutters that actually would make an open Macy procedure. So it went from highly invasive to a miniarththotomy, um kind of trying to make it even simpler and less time consum consuming for surgents in an open procedure by developing these custom cutters that would allow you to score the cartilage and then stamp out the membrane exact size that you could then glue in.

And really, that was a big technological advancement that made it a less invasive, faster, simpler, uh surgery for the surgeons. And that's why our surgeon base has grown so dramatically since we launched the product., I want to stop for a second. So so first off, that's great.

So I think for the listeners to hear what he's saying, you know, they basically took a very challenging situation. They may keep making it simpler. I know people always think simpler is, you know, never good.

We want complicated. But in this stage, we want it simpler, right? The the last time under anesthesia, the simple cutters, you want more adoption, and then the more adoption means more people to see it.

So the idea that behind this is pretty cool. And I think will, you, I don't know if you have any questions about this, but he basically just said to the the listeners that we're going to take your cartilage, we're going to send it to Boston. We're going to it, we're going to freeze it.

This sounds like a movie, right? And then we're going to send it back to you in a box and then it's going to be sterile and then you're going to glue it on your knee. And when I tell it to patients, they don't like they were like what can actually work?

I don't know if you have anything else will you want to chime in being I mean, you a dinner you play doctor on TV, but well just the fact that it's a, you know, regenerating cartil, right? And and utilizing this component and I can imagine, right? We talk about sports uh, you know, on the show, the the athlete now, uh is recovering faster long-term effects, uh the flexibility, right? When you think about what you're utilizing as this component. So I know if if, especially if I'm an athlete but just anyone else, that I can have mobility, quality of life, you know, um in movement utilizing this, that that's all you want, especially after you've suffered a injury to kind of go back to, you know, this, this uh normality. And I think what you guys are hearing from Nick two is you have this product, right?

Like so the product has been around for a long time. And then every time they make a tweak to it, right? Like you don't want to make big tweaks with the FDA and everything else.

But, you know, they found like, we have this really great product that works. How do we make it work better? So how do we make it work better open, which is with a bigger incision?

That's what those cutters. And now, which we'll talk about, and I don't want to get away too much behind me, but the arthcopic approach to do this, which again, the goal here is extremely high technology, very small incisions. And we can get to that.

That's like sort of the perfect, the perfect formula, which we finally got to. Nick very briefly, can you kind of talk on touch on the slide and explain the dual membrane idea so people can understand and we'll show how it regrows in a minute. Yeah, so, you know, as I was describing earlier, once we expanded the patient cells, they're seated onto this college of membrane and there's a dense side that is on the top and then a kind of less dense side on the bottom. um the way we seed those cells is you kind of flip it over and, you know, contrytes are spindle cells, so they attach themselves to those collagen fibers. and then when it's implanted, it's the dense side up, the sort of cell side down.

And once the the um implant or the membrane is implanted at the bottom, as you show here, those spindle cells kind of migrate down to the subcondral bone. They start producing extra cellular matrix, which is essentially the cartilage, and it fills that defect from the bottom up and allows patients, as well alluded to, to kind of resume their normal activities, right? So our core patients in it'd be interesting in your take on this Dr. nursey, are really those sort of younger active patients.

So, you know, think about a bell curve from sort of late teens into early 50s, thinking the the summit pivotal study, um average age was about 35 same thing in the publication of the first thousand patients we treated in the US. So it really is that patient population that is suffering from significant knee pain that wants to fix the cartilage injury and get back to their sort of normal activities. Well, and I think what's interesting is we' con see that, you guys, I'm not sure the viewers saw that how it grows back.

That's literally how it works. And if you scope patients at three months, six months, nine months for other reasons, or they want to have, you know, there's some issue they're getting stiff or something because again, we all do these surgeries. You want 100%, but the word hundred percent never exists.

But if you go in there and you take a look, you can actually see that at certain stages, there's ways this thing looks. And when it gets up to the full stage, and I know because I do a lot of these, you can't get that cartilage off. Like Nick keeps saying like when you have a solid regrowth, will it like literally like even a night, you cannot take it off.

Like the first time I saw it, you it's very hard because you have to if you a surgeon had never seen one of these before, it's very hard to process because we're not used to products that do this. But when you see it, you can literally put your finger on it and it feels just like the rest of the knee. So the ability to regrow when you've been around for a long time and known that this doesn't really happen that often that we get really good regrow the cartilage, it's just mind boggling.

I remember the first time I saw it when I was like I called my rap and I was like, this actually works. Like it legitimately regrew. It looks just like the other stuff.

And if you were you know, you core out things or do things around that area, if there's if there's a part of it that you don't doesn't fully regrow and you have to redo something, you can't get rid of that other stuff. It's like stuck on. It's just like the solid good stuff.

So well, I don't know if that's any have you any questions about that because that is that's interesting. So obviously, um, you know, with something like this, we're talking about maybe severe cartilage damage. But have you seen anything come across your operating table where it's minimal, but based on the athlete or the patient, you're kind of going in and using this technique to make sure that whatever you're working on is extra sturdy because of of this product.

Well, Nick can probably jump on this too, but I basically, you know, we don't do this as preventative, but we do prevent other things, right? Nick, I mean, the idea is that you put this cartilage hole on one side to prevent damage the other side. Imagine this well, you got to tire and you got a road, right?

The road has a pothole in it. You'll damage the tire or the tire has a nail in it. You don't want to damage the road.

So if you fix one side, you avoid damage to the other side. So that's that's the preventative nature of this. It's it's still an invasive surgery and you know, we talk about 10 months to a year recovery, you got insurance authorization, everything else.

You don't want to go through this willy nilly, but but these patients are as nic will tell you, this is these patients with the carage damage are much more severely impacted than the ACL terms. Agreed. Yep.

Yeah. So, um the uh, I think one thing can chim in is, you know, you guys have done if there's a there's a couple of studies we've seen where it shows all the cartilage surgery and it shows the number of research projects research studies. Macy will has the most research on it of any of the current cartilage products on the market, which is pretty crazy.

So when people ask, like, is this been around? Do you trust the results? You know, if you don't trust the results of this one, you shouldn't trust any of them, because, you know, there are some strong results.

But I mean, I don't know if you can I mean, it's amazing that you guys just continue to I mean, Nick, you have so many projects out there and so much research out there. Why keep doing it? You know, you have so much data already.

So explain what's the desire for Macy to always keep doing it keep getting better, right? Like you ready you've already won the game. So why do you keep doing it?

Well, you know, I do think, you know, one of the advantages, well, several advantages to Macy that we talk about all the time. First of all, Macy has a very broad label that basically covered the indication for Macy covers, you know, single or multiple defects anywhere in the knee, you know, regardless of whether there's bony involvement or not. So it's applicable for a large number of patients and really has unsurpassed clinical data.

So Macy is the only FDA approved product that demonstrated superiority versus micro fracture, which Dr. Garcia mentioned, which is what the FDA requires as a compar in these phase three pivotal studies. So the summit study, which is the basiivotal study, basically demonstrated statistically significantly greater improvements in pain and function versus micro fracture at two years. That's the common end.

And then there was actually an expansion phase of the study that went out three additional years to five years, and the FDA was very interested in making sure we included that data in the label as well, which showed that the improvements that we're seen at two years carried all the way out to five years. So that's a pretty significant sort of longitudinal data that's in our label to begin with. But because Macy was approved in Europe and Australia since kind of the early 2000 thousands, what you're seeing now is even last year in the American journalist sports medicine, there was a publication of a prospective ten year outcome study, which showed, you know, positive improvements for Macy out to ten years.

And even one other publication, up to 15 years, and as I mentioned, Cardicel has data out to 20 years. And so, you know, it is really important, uh, especially when you have kind of an innovative premium priced kind of product that, as you mentioned, is covered by all the major insurance plans in the country, that you can continue to demonstrate that this is really kind of a restorative procedure that can last as it mentioned. And Nick, I want to I don't want to interrupt you, but I want to bring that point up you just said.

So you just said an expensive product, because that is a common misconception for patients. Right? And and I I'm I'm this in really important because I want the the viewers to hear this because I bring this up on every single talk and no one listens to me because somebody's doctor like this is an expensive product.

This is a pharmaceutical product, so it's very cool because it's you guys got a pharmaceutical allocation. It means you have a lot more rigors you have to go through, correct, right, for the biological stuff? But this is a pharmaceutical.

So this product is paid for by the insurance company. It's not paid for by the patient. It's not paid for by, you know, the hospital.

It's paid for by the insurance company, which we all know in the news that's that is not that that's the one we're okay with them paying for it because they're doing pretty well. But the important thing, I think is for people to understand that while all this product is expensive for the insurance company, for the patients, it's the same as anything else. And that's and now you get the superior product.

So it's really important for people to hear that, I think, because they hear, oh, you know, this is sounds so fancy. It sounds like the Mercedes-Benz or the BMW of products. Maybe I can't afford it. has nothing to do with that.

This is an insurance provided coverage. Yeah, and you know, the interesting part of that, so as you alluded to, you know, unlike most devices in the Med Tech industry, um, you know, Macy is actually very different. So Macy is actually regulated by the FDA as a combination product.

So there's different combinations, you know, there can be a drug device like the drug eluding stents, et cetera. In this case, you know, Macy's again regulated as a biologic device product with the college and membrane as the device component, and then, of course, the patient's own cells is the biologic component. And that has a lot of important implications, you know, in terms of the regulatory pathway that we had to pursue to get the product approved and on the market in the U. intellectual property protection and and as you alluded to, how the product is reimbursed compared to a typical product device.

So, you know, because Macy's bi a biologic, it had, you know, for example, additional 12-ear data protection, uh, which are, is afforded to all uh biologic products in addition to the patent life, it's actually reimbursed under a J code. So it's not part of a CPT code professional fee for the surgeon or facility fee. There's actually a J code that's listed in the compendia like other biologic and pharmaceutical products um that is uh reimbursed by the patient's insurance plan, as you mentioned.

And I think, you know, an important part of that. First of all, you know, well overin0% of the submissions for approval get approved, right? And a lot of that has to do with basically differs a little bit from a normal biologic or drug product, which are dispensed in a pharmacy, right?

So every insurance plan has a pharmacy benefit that we're all familiar with and a medical benefit, which is what Macy's comfort under. So a pharmacy benefit, you know, basically the the manufacturers kind of discount to get a formulary position and then once it's sort of on a formulary, you know, your your physician can write a script. Nobody really says, Dr. Garcia, do you really have hypertension?

It's just sort of managed by where they kind of discounted on a formulary tier. In the case of a product like Mac that's reimbursed under a medical benefit. Again, every major plan in the country covers it.

And they basically have to approve it in advance of the surgery. So there will be in, you know, pick a Blue Cross Blue Shield plan. It'll say a patient's, you know, eligible for me see if they are this age with a grade three or four focalchondral defect, their ability, you know, they have an ability to do the rehab, et cetera.

The point being that the insurance plans know that every time Macy's being used, it's on an appropriate patient. So they know the price, they know the clinical benefit. They know, you know, the patients are going to benefit from that.

And that's why you get the prior approval. So I think one of the things that the company has done over the last decade is really sort of unlock a lot of value because we try to carry a lot of that load for the surgeons in terms of the benefit coordination between a patient surgeon, the insurance plan to make sure that the submission is done in a timely fashion doesn't sort of slow things down for when the patient and surgeon want to, you know, have the surgery and we invest a lot in that to make sure that, again, it makes it as streamlined as it possibly can be. But but that, you know, that is an important point that you brought up that, you know, when an insurance company is able to know that they approve every patient before the products used, and they know the benefit, that sort of, you know, erases the whole sort of, you know, kind of, I won't call it a phantom objection, but, you know, discussions around the price.

We've seen it right nick on the Internet. You see all these papers where someone posted like look at my rejection for my surgery that I need. Look at the rejection for my surgery that I need. You don't get it with this. And I think will, we should for the listeners, you we just keep this, right? This is a innovative product.

And I told you that, you know, this is obviously, it's a pharmaceutical. It's expensive for the insurance company. But if listen, the insurance company would never approve it if it didn't work so well.

That's the point we're trying to make. You have a company that you hear about all these insurance companies and how they're very stringent about costs, right? So if this is this has to be a product that has such a good quality of life improvement that they're willing to pay for it.

And so that shows you the value of this because you've already this it's approved with pretty much any insurance. Like people come in and like, oh, sure my insurance are covered. I'm like, I'm pretty sure that it'll insurance.

It's very rare that it's difficult to get approved. So, well, that's interesting, right? Like you have something it's like basically like you have a you have insurance companies that we hear all these things online.

We're not going to have a whole talk about that right now. But the, you know, you hear all this stuff online about these insurance companies and and you know that they're very stringent about costs and now you have a product that they're willing to do reimbursement for despite the cost because of the quality of life. Because quality of life is a really big deal, right You get your ACL and you don't get it fixed.

Sometimes you can get away with it and you can run around with it and you can do things when you have a cartilageole will, it really, really hurts. It's it's it's up there to like nearththritis because actually it's pre-arththritis. And so that's something that's really important for the listeners to hear.

They think Carlishold, that's not a big deal, but they hurt way more than anything else. These are my most satisfied patients, my cartil patients. And I would say there are publications out there that show, even though Macy is, you know, may cost more up front over the life of the patient or long term, it actually is equal or less than some other options that could have been done by the time you add in what will ultimately have to be done and just to kind of reinforce that innovation point. when you think about the cost of Macy, um, you know, compared to gene therapies that can be in the million to $2 million dollar range or or cartis cell therapies, which are half a million corpation.

I mean, yeah, that's the kind of innovative manufacturing and other development, you know, processes that you have to go through. But again, it's nowhere near that kind of of price point. And it's important what you said one second before what you said is like that the there this, when you do lesser surgeries will in these cartage stuff, people fail and like they come back and we're talking about my average cartilage surgery patient or sometimes I get to them, six surgeries, five surgeries.

Woms if I could do it in one surgery and avoided five more. And so you imagine that what he's saying is like, maybe each individual surgery is less expensive than the Macy, but it's going to prevent long term. And I I've seen what you're talking about.

So sorry, Will. I just want to bring that point up. No, it's fine.

It's right line cut of what you guys are talking about. I just wanted to ask Nick if he's gotten feedback from a patient, a doctor, um something that really resonated with you saying, man, your your product either save me money or save me from going back and having multiple surgeries changed my life. What's the story that you went home and you, you know, you told your significant others and say, man, this that this was a good, this is why this is why we do it.

What what what's that what's the one that sticks with you? Well, you know, we have all sorts of basy patient videos of kind of what it means to a young mother who couldn't walk up and down the stairs with her with her baby and how it changed her life to be able to do those things. And, you know, that is exactly why we're doing this.

And and it's interesting. This is a good time of year. You know, we typically and we'll do it again this year.

We'll be at the Super Bowl for Radio Row and we go on a lot of the sports medicine or the sports, uh channels and you know, one of the folks who would do it with me in the early days was Dere Torris, who was an Olympic athlete. She actually had carel in her in her left knee and she was one of the first Macy patients in her right knee. and she was actually able to go back and compete in the Olympics after she had her first, you know, surgery done with Cardicel. So, you know, those are the kind of life-changing outcomes that, you know, you're she was one who said, you know, would talk to me about how hard it was for her to even walk up the stairs, let alone sort of train for the Olympics, right?

Um And so that's kind of a, you know, you could probably say that about almost every patient we treat. They couldn't do the normal things that all of us do or whatever athletic activities and and, you know, Macy allows them to do that, which is obviously extremely rewarding.. Yeah.

Yeah, well, I think that what he touched on is perfect. I think I don't want to pivot, but obviously we still have a little bit of time with him so I promised him that we would pay under an hour. He didn't know if we could make it to an hour.

I think we're going to go over so that's what we're going to end up he down. But the well check off that cybercycle. I want to bring up this point.

I want to ask him. So I think we've talked a lot about, you know, you did some awesome job talking about the business behind Mac, which I think is super unique. I don't ever get to hear that perspective.

We don't ever hear that because we're mostly focused on the medical side of things. But for the listeners, we like to start from the ground up, you know, like with nap into reality, well, which is one of our first shows. Like how do you take something small and make it something big?

And we have the man here that did it, which is awesome. But so but Nick, there's obviously the postpart, which is or the stuff is like you have this awesome product, right? You keep making modifications to it.

You keep making it better. But there's something unique about you guys that I wanted you to talk about. So when it comes to like informing people, you have different ways of doing it, right?

You guys have, and you have Karla and other people in your office that do amazing job. But you know, you do local labs so that people locally can find out. You have people like me that fly around the country to talk about your product.

You have different directors that talk about your product, but you guys do so many things. And and there's some will you've seen me do this. You know, the headset thing I did on Friday. That was Macy. So like they're so into like every possible way that can show people how to do this surgery and they're dedicated, right? Like I just got on a phone call this morning and I was talking with the entire team on why I did the certain steps and they're just so into like how do we get better?

But it's where does that come from? Because I worked a lot of companies, some do some things, but they don't go to the extent that you guys do, which is like, I want to find every possible way to teach someone about this and it doesn't mean sell it. Don't sell the product card.

Just tell us how you do it and how we can make it better. Yeah, you know, I think it comes back to, you know, we have a unique sort of place in the industry and it's certainly the case with Macy, where we get a patient cells. We know every patient that we're treating, right?

We're not stamping out a million, again, hypertension pills and they're going to whoever they go to. I mean, it's a very patient centric and customer focused group. And that's true for Macy. It's really true for the catastrophic burn patients that we treat, you know, with epicel uh and exibt, our our other products. So that kind of culture of we're focused on the patients. We want to make sure surgeons really understand how to identify appropriate patients, make sure that we have good clinical outcomes.

That just kind of is built into the DNA of our company. And you're right. We we invest very heavily in surgeon, peerto- peer educational programs, including these boskills labs on, you know, with cadavernes and things like that.

And in fact, you know, it's really the largest discretionary commercial budget item that we spend money on, right? Because, you know, when we do these these programs and we fly surgeons in from around the country to train over the weekends, et cetera. I mean, it is a big investment, but, you know, again, it's all geared tours.

We want to make sure. First of all, we're so fortunate that we have surgeons like you and dozens of these passionate, dedicated surgeons that we partner with to make sure we're bringing quality educational programs to surgeons who are interested in sort of adding Macy to their practices and treatment algorithms. And, you know, the it's it's definitely the most important thing we do again, to make sure we optimize patient selections outcomes and so on.

So, you know, it's really just that. It's just sort of built into sort of how we operate and and what we do. we we because you know, we have an advisory board, we have speaker bureaus that we partner closely with. We want to know from the surgeons, sort of how can we best teach other surgeons, right?

So whether it's educational content or new technologies that we can leverage to make sure it's easier easier to consume by the surgeon customers? I mean, we're just always interested in that feedback. And I think, you know, as we were developing the Macy Arthro instruments, that was an iterative process where we would develop prototypes.

We'd have surgeons come in and work with them, make tweaks, develop, you know, come back with another one. You go through that four or five times and and again, it's just about getting that input to make sure we're kind of delivering the right innovation and technology for the surgeons in addition to the educational component. All right.

So I I know, I see the timer clicking down and I need to get to this last topic because no one has any idea what the thing is behind me and we've been here for 46 minutes and 53 seconds. So let's go to the next dick I appreciate everything you said this is awesome. So well, I'll say you keep hearing all this stuff.

We got the sexy carage surgery. We can grow it in the lab. We can glue it on your knee.

But until a year ago, other than some kind of offshoot random stuff that you people were doing, there was no way to do it through an incision this small. All right? It's always been incision this small, long in my hand, big incisions open.

I said, every time I told the patients, I was like, I'm just give me an open incision. The first step is a scope, that's easy, second step's open. You'll get through it not a big deal, but it's open.

It's big. And there was a lot of work that I went into this and it took, I was involved in this FDA trial and it's different than other companies, right? You can't just start to tweak the product a little bit and get it because it's a biologic, and we don't have to go too much into it so we can show the product.

We don't know if you can pull it up. there you have to do a lot more thing we had to do the FDA trial to show that it was not damaging the cells. And normally you wouldn't have to do that, but only because your product because it was so stringent because of the FDA that you had to basically show this product would be just just as good as the open one, even though it like all this kind of knew that. But you had to do it for the FDA and that you had to do some so many extra hoops that the average company doesn't have to do.

Is that correct? Yeah, that is, you know, when you develop kind of an instrument set like this for the arthroscopic delivery, you know, there's multiple workst streams, right? This took us two or three years to kind of develop.

There's the instrument development itself. And, you know, obviously that involves, as I mentioned, sort of the design phase of it where you develop, you know, you work with a vendor, we have a local vendor that you know, they did our custom cutters for or they'd done other work for us. the instrument kits for open, et cetera. um you know, we work with them. We develop prototypes.

We have surgeons come in, we refine it. You get a year, you know, that probably took almost a year till you finally even get to design phase. Then once the instruments are done, you go through a whole sort of set of validation, testing, et cetera, to make sure that they meet FDA requirements to make the the instruments commercially available.

Now, at the end of the day, as you alluded to, I mean, these are class one devices that we actually registered before Mac Arthur was approved. but that was just the device component. The trick here was that, you know, because Macy's approved under a biologics license application to be able to add the Arthuroscopic administration to the product label, we actually had to do what you were referring to, which is a human factor study that says, if we give surgeon this surgeon's this set of instructions, can they reproducibly um basically administer the implant uh using these arthroscopic instruments? And so to get it on the labels so that we could promote the instruments and then teach surgeons how to use them appropriately, we had to go through that was essentially a 10-month FDA uh review process, which, you know, we obviously were able to do successfully, which was was just great.

I think Will Ens to hear this. I can say it now the trial has been approved, but Will, you get a phone call. You got to fly out to Boston and then they don't tell you how to use it and they want to see how you do it without that in a black box.

And then you're on a video camera and then they say here's four different ways to do it. Let's see if you can do this without any instruction. And if you can do it without any instruction, then we know it's safe.

And that's what they did for what, 16 or something? They're more than any more than that surgeons. But basically, that was the game.

It was like almost a game, but it wasn't really a game because if you don't do it right, then you're either you're out or the FDA trial It's your own version of squid games. I got it. But you know, you know me you know me long enough that we love the game.

It was a fun game, but you're under scrutiny for it, but you can see guys, I mean, think people this like they foundarches they thought would do a reasonable job. They flew them all out there to do this just to show that this product was saved to put in the scope. So when people ask me, what you about thinking of this new thing?

I'm like, this has been tested more than anything I know, right? You guys have gone through so many hoops, but now you have this product that basically we've done five of them now and the first one in the Pacific Northwest, and we have this product where we can now insert this this product that's 20 years tested through a scope through an incision this small. I mean, what is your what is your feedback then so far?

I mean, I don't I could go on and on about this part. We've seen way too many of my posts, but Nick, I want to hear from you. What is your feedback then on the company in the first six months of this new product?

Because it's been out since it got approved at the end of August. Is that correct?, yeah, kind of launched sort of at the end of the third quarter. And you know, the physician feedback, surgeon feedback has been correct.

You know, I think in the market research we did before launch, you know, whether surgeons were Macy users at the time or not, you know, there was a high interest level. You know, surgeon said I would expect to do more procedures or even if I wasn't a user, I'd shift some of my procedures if a MacR throw, uh option was available. And, you know, so we have seen that out of all of our surgeon segments.

So we have, you know, folks like you who are, you know, strong users of the product now doing Macy Arthur cases. We had sort of our original set of surgeons that maybe hadn't adopted it yet. They're starting to use it.

And then we had another set of new surgeons that really just do arthroscopics, you know, procedures and that had never even used Macy. And and we've seen sort of cases scheduled or completed out of all of those segments. So that's great from a surgeon perspective.

And then from kind of a patient perspective, as you know, Macy open was is kind of a go-to product if you have a deep defect on the back of the kneecap or the Patella, if you have a larger defect four square centimeters or above, that's kind of like the go-to for Macy. uh but we've seen since we launched Macy Arthro that not only are you seeing these procedures? You know, the whole thing was designed to be to treat two to four square centimeter defects on the femmeral condile, which is the largest part of, you know, the Macy address of the market because you can explain this better than I, but, you know, the the end of the thigh bone, you know, bears a lot of the weight and that's where you get a lot of the injuries and and it there's just more smaller than than larger.

So that's what we were designing the instruments for, but we have seen now that those instruments are being used in the trolea behind the Patella.

We actually had a patella case where people can lift it up into the Patella without having to flip.s not easy to do well. I haven't tried it. It doesn't look easy.

It's not easy to do, but that's impressive. Sorry, keep going. Yeah, so so that's a feedback.

So just kind of on surgeon use of for Macy users and non-users, using it in different locations of the knee, not just the femmeral condile. And then I think what we've seen anecdotally, and you can share this better than I can. But you've seen what the reason the surgeons were interested in it based on our market research was less invasive surgery, less post-operative pain, faster post-operative recovery, better aesthetics.

And so you see these things on social media where, you know, they're talking about range emotion being, you know, significantly better than you would see from an open procedure and and so on. So I think, you know, that's something we, to your point earlier, we have, you know, different, you know, we have a registry going on now so that we can look at those early post uh surgical outcomes. And I think, you know, because we didn't do a clinical study, you couldn't measure them prior to approval.

So that's something we have to do post approval. uh and you know, hopefully, you know, that kind of bears out that you're seeing all those benefits that you would expect from less invasive yeah, I think that you might as been one of my LinkedIn posts then. So yeah, that's the uh, yeah, no, but will, I mean, I think people you can't slow them down now. They get this surgery now and before it was a lot slower and now you can't slow them down.

I mean, I've had out of the five I've done, I've had three where I've had to tell them to stop moving so fast. So that's a good thing when you're slowing the patients down that much, well. So anyhow, so the um, I think, Nick, we don't want to cut you off too soon, but I want to make sure you have a few minutes.

If you got about like two minutes, can you talk about what you think of the future is for this? Yeah, well, you know, for Macy generally, you know, we think, because again, I as I mentioned, um, we're still, I mean, we're eight years into the Macy launch, right? And you're still seeing this product grow 20% a year as we're adding more surgeons. you know, we look at how many biopsies or surgeries are done per surgeon as surgeons kind of identify more patients within their practice.

So, you know, we think the core Macy, you know, will continue to grow. We think with Macy Arthur on top of that, there's an opportunity, you know, for better patient outcomes and and more surgeries. And then, you know, they see in other joints.

So we expect to, you know, there's cartilage on the end of all the bones in your body articular cartilage. And, you know, the next biggest opportunity is in the ankle. And so we've been working with the FDA on kind of developing the the plan for us to launch a Macy ankle study, which we expect to do in the second half of this year.

So file an IND in the first half of the year, um and then initiate the study in in the back half of the year. And we think that will be we already know, you know, we can't promote it because it's not an approved use, but there's certainly publications out there of surgeons that have had that have treated ankle cartilage injuries with Macy. I mean, it's been used in the hips, the shoulder.

Again, we can't promote that. And, you know, in some of those other joints having an arthroscopic option will be important. hundred percent, especially the ankle, but that's the I mean, you're getting into the perfect topic. I think for the viewers, this is a knee surgery product off label uses the other areas like coming down the line, um and you heard it from the man himself.

So that's the plan. And once now that we've built our new manufacturing facility, which you need to come up and see in Burlington, uh which has its own training lab, so you uh I think you'll you'll enjoy doing that. But that also is has been, you know, this facility has been built for global manuf to meet global manufacturing requirements.

So our we're doing right now an assessment of sort of OUS opportunities in Europe, Latin America and certain countries in Asia. So that's an exciting opportunity for us as well. That's awesome. Well, Nick, thank you so much for being on. I don't want to cut you off, but you know how the social media doesn't like it if we go over an hour. But like like, I think I think I think I told you so, Nick.

We went to an hour. one quick. Hey, um you said you're going down to Radio row getting ready for the Super Bowl uh down in New Orleans. What are you going to eat Johna Beets?

What is the gay plan? We don't care about anything else. What's the food that you're going to consume?

It's going down to New Orleans? It is absolutely delicious down there. Will, I told you I grew up in upstate New York.

When the builds got bounced, you down? We're going to let the team uh take this one. I've been to a number of them, so other members of our team and other surgeons actually um a great guy, a former NFL Solomon Wilcott, who's was a CBS announcer and a member of the Bengals. uh he kind of does it with us. um and so there'll be other surgeons from around the country that that do that as well.

So I will be sitting this one out, unfortunately. Yeah it makes sense. I've I've got a lot of friends.

I'm originally from New York. I got a lot of friends back in New York that are um all I said was, I'm sorry and and I left it as that and and we're going to move on because I don't want to end this on a bad note. and I want Nick to be upset with me. uh Dr. Garcia made me ask that question. I'll just say that.

That's true. Thank you so much for being a part of. We appreciate your time.

This was fantastic and I hope everyone got some great information out of this. Thank you. Really appreciate it.

Thanks everyone. All right. Take care. Have a good night. Bye.

Audio Transcript

[00:00:00] Will Sanchez: Welcome to Sports Talk. I'm Will Sanchez, along with our orthopedic surgeon and sports medicine specialist, Dr. Grant Garcia. Dr. Garcia, uh, we almost didn't have a chance to do this episode because the weather out here is a little bit crazy. Lights are flickering, so hopefully we'll get through this. Um, but this was a good, uh, Good episode to talk about first and foremost, before we get into it.

[00:00:41] Will Sanchez: How are you? Are you, are you by candlelight? Are you ready with your lamp, your flashlight? What's going on over there?

[00:00:47] Dr. Grant Garcia: Uh, we're good. I was literally telling you right when we about to record this and then it kind of, everything shut down. I was like, do you hear the hail outside? And then lights went out, internet went out and about 40 minutes, we lost it.

[00:00:59] Dr. Grant Garcia: And we were thought we're [00:01:00] not going to get this episode recorded. So this is exciting. Uh, we may get cut short. Who knows how this is going to go. Um, I have candles, I have regular lights, so we're good. Uh, internet's working for now. So we're in a, we're in a good state.

[00:01:13] Will Sanchez: You know, we're about to have this conversation about the former number one pick in the NBA draft, uh, Mr.

[00:01:20] Will Sanchez: Win by Nyama. But before we get to it, because we're discussing injuries, we always want to give a shout out to our good folks here at the recovery shop, take it away.

[00:01:30] Dr. Grant Garcia: Well, again, you know, our sponsors recovery shop, and hopefully at some point we can have them on us can learn even more about them, but yeah, as a surgeon that does the complex surgeries.

[00:01:39] Dr. Grant Garcia: Uh, having the stuff here again today, I had a bunch of patients in the office that needed surgery and they were asking, you know, what else can I do? What else can I have? I know you're going to do a good surgery. I know you're going to give us the best that you can give us. But what about the post recovery?

[00:01:53] Dr. Grant Garcia: And that's really what's key here. So we have nutrition options for patients. We have the options for the nice machine, which has been fantastic. My patients [00:02:00] love it. Um, you know, the re bliss and other innovative things. And really, if there's a product that the patient wants, I can get it and put it on the recovery shop, which is really nice.

[00:02:08] Dr. Grant Garcia: So it all comes together in one thing. It's essentially hate to say is, you know, the equivalent of an amazon for surgical stuff, but really it's all vetted. It's good quality vendors, which is really nice. And as a surgeon to have this at your fingertips, to have your own personal shop that patients can go to and easily get what they want has been fantastic.

[00:02:24] Dr. Grant Garcia: So the, the reviews have been rave. So if any of the surgeons listening are interested, uh, let Mike know. And if you're a patient and you want something like this, uh, for your surgeon, you should let them know about it because it's pretty easy and anyone can do it. So thanks guys. Mike

[00:02:38] Will Sanchez: B at shop recovery.

[00:02:40] Will Sanchez: com. That's, that's a cool name, man. Mike B, Mike B. It's like a rapper. I don't know. I'm kind of going through, uh, my hip hop days. I've been listening to a lot of old school music. So I think that's what I'm triggered. Anyway, I digress like I always do. So let's get into this. The unicorn. Victor Wimbayama, right?

[00:02:58] Will Sanchez: [00:03:00] 2023 Rookie of the Year. 2024 almost upset the United States, won the silver, had an opportunity to win the gold. The, I mean, the sky is the limit for this athlete and Uh, less than a week ago, we get news that his season has ended and not in a way that we usually think, right? When you have someone that's seven, five, seven, six, right?

[00:03:27] Will Sanchez: And for someone that is a knee specialist, having someone that big, I'm pretty sure if I would have said, uh, Dr. Garcia, man, uh, uh, when by Yama's out, you would have, where are you? The first thoughts would have gone. injury knee, something like that. Like Zion. I'm thinking like Zion.

[00:03:44] Dr. Grant Garcia: I'm thinking meniscus. I'm thinking cartilage.

[00:03:47] Dr. Grant Garcia: I'm thinking, you know, just the, the, the sheer size, you know, you have Yao Ming, who is obviously a lot older player now, but foot injury, you know, it's always lower. [00:04:00]

[00:04:00] Will Sanchez: Yep. And instead we get a diagnosis of this deep vein. Uh, what is it? Thrombosis, a DVT, uh, in his right shoulder. So why don't you explain to the viewers, the listeners on really what this means.

[00:04:15] Will Sanchez: And, you know, I, I'll let you talk about it because I've got lots of questions. Awesome.

[00:04:22] Dr. Grant Garcia: Um, I thought it was a good episode because I think that for. For people listening, they're gonna say, what the heck is this? This is like really weird. And for my patients, this is actually a very high concern level for them.

[00:04:35] Will Sanchez: Yeah.

[00:04:35] Dr. Grant Garcia: And I would say that every day when I'm counseling patients, this is something that comes up and they ask about this. So as an orthopedic surgeon, I deal with DVTs all the time because it's lower extremity or upper extremity. Um, and so this diagnosis is a big deal. So basically what it means. is that there are different areas you can caught the blood.

[00:04:53] Dr. Grant Garcia: So the blood flows around your body like pipes, right? So you got the hot water, the cold water, the cold water is the veins, which is the blood coming back [00:05:00] that has no oxygen. And the hot water is the red part. That's your arteries. That's where the blood is fresh with oxygen. Now. Most of the time, the arteries don't get clotted very often, except for like, you know, heart attacks or things like that.

[00:05:12] Dr. Grant Garcia: But the blood clots usually happen in the veins. So that's why you call them the, you know, deep vein thrombosis. That's where it's most likely caused. The problem here, which is really weird. So basically, if they get a clot somewhere, and that clot backs up fluid, and you can get pain and everything else.

[00:05:30] Dr. Grant Garcia: That sounds bad, but the real problem with this is when the clot goes to either your brain, which is much less likely. But the one that you worry about the most is the lung. And even doing some research on this, there's a few famous people that have actually died from a blood clot in the lung. And I have thankfully never had a patient have this, but I have heard of patients that have had blood clots and it's gone to the lung.

[00:05:51] Dr. Grant Garcia: So that's what we worry about more, Beth. The DVT idea is not as stressful. The idea of the blood clot going somewhere else is a concern. [00:06:00] And that's why it's going to be really important discussing this situation. Because in, there's other athletes that have had this, even basketball players in the last few years.

[00:06:09] Dr. Grant Garcia: And those Were a lot of them were lower extremities. So the leg, which is much, I see much more commonly, this was in the shoulder. So how many shoulder blood clots do I see a year? Maybe one, if we're lucky, we actually saw them increase a little bit with COVID. But this is not related to that, um, but upper extremity blood clots are very uncommon.

[00:06:30] Dr. Grant Garcia: They're actually more common in athletes than anybody else, but they're just not common. And so one of the thoughts here, we can go into this in a minute is how did he get this, right?

[00:06:38] Will Sanchez: Yeah.

[00:06:38] Dr. Grant Garcia: What size was it? So they're diagnosed with something called thoracic outlet syndrome. If you read some of the articles again, we don't have a diagnosis yet.

[00:06:45] Dr. Grant Garcia: Yeah. Um, the number one thing is to get the blood clot out of there. So not with surgery, but to thin it out. But anyhow, so I can go off on this in a second, but this is a big deal because obviously he's out for the season. And the question is why, right? Why is he out for the season? Well, he has to be on [00:07:00] blood thinners for six months.

[00:07:02] Dr. Grant Garcia: And if you're on blood thinners, imagine your blood, like six months.

[00:07:06] Will Sanchez: Wow. Is that just standard? I know you're getting into the explanation, but I just want to cut you off there. Is that standard if you're having a blood clot that you go, hey, automatic, we're getting you on thinners. You're doing a mandatory minimum of six months.

[00:07:20] Will Sanchez: What's the protocol when it comes down to something like this? Or does it vary due to age, size, location?

[00:07:28] Dr. Grant Garcia: So first off, many people get blood clots are People to post surgery. So they're not going back to sports at three months, three to six months ish is when we treat these blood clots. The thing is he's playing high impact sports.

[00:07:39] Dr. Grant Garcia: So if he hits his head or he hits his arm and he cuts himself, he could bleed and not stop with this. So that's the biggest problem. And the number one risk is the head, right? Because if you hit your head, usually, you know, you knock it, you get a concussion, right? Like to a stuff. The blood vessels are small, but they can clot pretty quickly.

[00:07:59] Dr. Grant Garcia: If he's on [00:08:00] blood thinners and he gets hits his head, he could die. It will keep bleeding. It will not stop. And so that's the reason that he stopped having to stop doing these things because he could get bl blood bleeding other places. And that could cause much more serious issues. Right. Like let's say he was elbowed in the spleen or something and it popped.

[00:08:16] Will Sanchez: Yeah.

[00:08:16] Dr. Grant Garcia: Right. Or he has like a, he has an injury to his something. 'cause he gets, and these guys are getting knocked, all

[00:08:21] Will Sanchez: burn in the ball, right? He, he dunks the ball, doesn't land on his feet, lands on the side. We've seen that a lot of momentum. Somebody's hanging off the rim, legs go flying up in the air.

[00:08:31] Will Sanchez: come crashing down into the back, the lung, the kidney. Those are some of the ramifications, not just getting elbowed or, you know, or bumped into, right?

[00:08:43] Dr. Grant Garcia: Yes. And that's the reason to stop him playing. But also the reason is because if his blood clot's not gone and you hit him or he moves around, you could release the blood clot into his lung.

[00:08:52] Dr. Grant Garcia: Now, the weird part here is they're thought, they think that maybe this blood clot came from his leg and got into his shoulder. But [00:09:00] that's kind of weird because you got to go through the heart and there's not, you can have a hole in the heart where it goes through, but imagine there's got to be certain stops.

[00:09:06] Dr. Grant Garcia: But the problem is you don't want it to go to his lung because that's called a pulmonary embolus and that one is not good.

[00:09:12] Will Sanchez: So as a doctor, how do you, how do you check that? What's the, what's the process if, because you just told me three different things. It's in the shoulder. They think it's in the leg.

[00:09:21] Will Sanchez: You may come from the heart. So how do you, how do you backtrack to find out where the source is and then at that point go forward in treating?

[00:09:31] Dr. Grant Garcia: So generally patients with blood clots in their, in their legs or their arms, they're going to have a lot of swelling. So like for instance, you know, even one of my partners who I work with, I got a blood clot after a surgery.

[00:09:41] Dr. Grant Garcia: It wasn't mine, but it was still a surgeon nonetheless. And you know, even some first orthopedic surgeon, it took a while for them to figure out like a couple of days. And basically what happens is a lot of patients, at least post surgical and in this case, probably similar. When you get a blood clot all of a sudden it really hurts and it's really swollen and it's red and it's inflamed because remember now the blood [00:10:00] it doesn't always completely clot off but the blood can't go anywhere so it's getting blocked so then it starts to swell up and sometimes it can even get like little infections and things like that but generally it just swells up and it's really red.

[00:10:10] Dr. Grant Garcia: So it looks like it's an infection, but a lot of times it's a blood clot. And so this is most common in the calf. And so you'll, you'll, you see these patients and you say, when you're surgery recovery, you're two or three weeks out. If all of a sudden you get worse, there's generally only one thing it can be, and that's a blood clot.

[00:10:28] Dr. Grant Garcia: I got you. And so to be honest with you as an orthopedic surgeon, I probably see one of these every month or so, you know, if you, if you don't see these blood clots, either you're not looking for them and that's really scary. Or you don't do enough surgeries because the odds are very high of seeing them.

[00:10:45] Dr. Grant Garcia: And everyone, every orthopedic surgeon I know has seen one of these. And you can get them before or after too. Like, like your Achilles injury, that is extremely high risk for a blood clot.

[00:10:54] Will Sanchez: Yeah.

[00:10:54] Dr. Grant Garcia: Beforehand. Or ACL tears. You have patients come in, I had a patient that flew in for surgery [00:11:00] recently. And they didn't even check her before, and they didn't realize that she had a blood clot, so I caught it before the surgery.

[00:11:05] Dr. Grant Garcia: That's okay, as long as you catch it, then you put him on something which he's probably on, which is a blood thinner.

[00:11:11] Will Sanchez: Yeah.

[00:11:11] Dr. Grant Garcia: And then you can do your surgery, you take a break from the blood thinner for a couple days, and then you go right back on it to prevent the clot from expanding.

[00:11:20] Will Sanchez: Is it normal for someone his age that didn't have surgery, that is in great shape, that runs around, not overweight, he's a slim guy, he was just in the NBA All Star game where they announced this, what, a day or two later, he was just there participating.

[00:11:38] Will Sanchez: I mean, are there some things that you're going, hey, wait a minute, what, you know, we haven't seen this or we didn't see it coming. Or is it something like it doesn't matter? It just occurs out of, it could come out of anywhere.

[00:11:50] Dr. Grant Garcia: So there are, there are certain rare conditions. So baseball players get this and it's from overhead throwing and it can be from two scenarios, one constantly [00:12:00] moving the arm and irritating the vessels.

[00:12:02] Dr. Grant Garcia: So there's something called burkhouse triad. So it's, it's where you have blood that's extra clotty. Probably not in his case. They would have caught it already, but he could be diagnosed with something like that. Right. So some people who have this cloudy blood, they don't find out till they get their first blood clot and then they get tested and they find out or they have a family member that passed away from a blood clot and then eventually they get tested.

[00:12:25] Dr. Grant Garcia: So I've seen all these different scenarios. This is probably not that case. Then there's something where he's like, It's not moving, right? Where it's like he just like sits around like you go on a plane flight, right? People get blood clots after plane flights sometimes. It's why you can't fly after surgery for the first few weeks That's why you're not recommended because you can increase your risk of a blood clot Yeah, you probably see people walking around the plane on long flights That's what they're trying to stop and then the third one is injury to the blood vessels and that's what he could have had which is you know got smacked in the arm or got nailed the arm or the leg and And then somehow that injury caused the clot.

[00:12:59] Dr. Grant Garcia: Now, [00:13:00] again, not that common, but Will, we were looking to show up. There's been what? There's been four that we know of that are big. Chris Bosch, right? We all know Chris Bosch.

[00:13:09] Will Sanchez: Yeah. Yeah. So

[00:13:11] Dr. Grant Garcia: many clots.

[00:13:12] Will Sanchez: Yeah. Yeah. They, he, he thought he could complete, uh, he could play through it. He thought he took enough time, but, uh, and you're the perfect person to talk about this.

[00:13:24] Will Sanchez: The doctors were like, I don't feel comfortable, uh, clearing you, you've had a great career. Why don't you, uh, go home and chill out, you know? So when it comes down to something like that, and maybe you could talk to the severity and that's what we're getting at, you know, what is the ultimate right as a fan and just, you know, being concerned about the injury, what's the level of severity, it can be, you know, something that it's on one scale of severity, or, you know, if you have.

[00:13:54] Will Sanchez: whatever signs that you want to call it, this can be a little bit more concerning than what you [00:14:00] originally may think. What, how does that get diagnosed now?

[00:14:04] Dr. Grant Garcia: Well, I think the thing is figuring out what he has, right? So everyone you've talked about are generally lower extremity. So there's been Brandon Angram in the New York, New Orleans Pelicans.

[00:14:13] Dr. Grant Garcia: He made it back after a season, but his was a lower, he was a lower extremity, a blood clot, if I remember correctly. And then Azura Thomas, he's the Pistons. He was actually just diagnosed in March. with another blood clot again in the leg. And he's going to eventually be cleared, hopefully at the end of the season.

[00:14:30] Dr. Grant Garcia: So the question is, why did he get this? Because those are all leg ones, right? I think Chris Bosch's was the leg. I think actually Chris Bosch got something to the lung too at some point. Yeah. Which is not good. Yeah. That's what we talked about, right? The, the danger in the lung. Go ahead. Yeah. And it's usually from the leg, right?

[00:14:46] Dr. Grant Garcia: Because the leg goes all the way up into the heart. The heart can distribute things out to the arms.

[00:14:50] Will Sanchez: Yeah,

[00:14:51] Dr. Grant Garcia: so there is some thought this came directly from the arm itself If it came from the arm itself, it can be random, which is very rare again I've seen in covid covid [00:15:00] shots or could be like at covid.

[00:15:01] Dr. Grant Garcia: I've had a couple that got it from that That's a weird one We only saw that we saw like two in one month in our practice and then we hadn't seen him since then But that's a very rare thing, but generally it can come with tos. So thoracic outlet syndrome now again we don't have time to go through this entire thing, but basically what it means is like Your brachial plexus.

[00:15:19] Dr. Grant Garcia: Why don't you pull up that uh, that image and see if we can show people So this is this is a good thing go to the next one Let's see if we can show so before we go back to tos you guys can see so the blood clot in the leg It's the swelling, the redness I told you about, and then it can go to the lung.

[00:15:37] Dr. Grant Garcia: If it goes to the lung, that's when people get a lot of symptoms. They have trouble breathing, and they can do a, they usually do a CAT scan or a CT scan, and they check to see how the arteries in the lung are doing. Now, people can survive from this. I mean, I have had patients that have gotten PEs, probably three or four off the top of my head.

[00:15:54] Dr. Grant Garcia: Now, they all were healthy, and they all did fine. Big blood clots can kill and or [00:16:00] if patients are older that can also be an issue. So it is real but just because someone says they got a PE doesn't mean that they're going to die. That's something that's something good for people to know. But obviously we don't ever want that, right?

[00:16:09] Dr. Grant Garcia: Like do everything we can to avoid it. Um, Why don't you go to the, uh, the next slide? Um, One more over there. Um, go to the end ones that we showed him. I'll show him thoracic outlet. Keep going. Yeah, that's good. Go back to the other one. So this one's really good. So this is a good image. Again, you can see there's that big blue vein.

[00:16:29] Dr. Grant Garcia: That's a subclavian vein. I don't want to gross out the viewers too much, but that vein can get compressed and that's probably what he got here. Uh, blood clot and blood clot went all the way down into the arm. Now, thoracic outlet is where you can see that kind of in the middle of the neck. There's, there's, there's a muscle there.

[00:16:46] Dr. Grant Garcia: There's, people can have an extra rib and it can push on, it can push on the area as they get like more tension or they do something like their throwers. Throwers get it from this constantly cocking back scenario. And the TOS can [00:17:00] come in three versions where it can be a version where it pinches the nerves.

[00:17:04] Dr. Grant Garcia: And people talk about their hands going numb. That's not what he probably had. The other one is where they feel like their arm goes to sleep. So they lose all their sensate, all their blood flow to the arm. That's an artery one. And then the third one is a blood, the vein where it pinches the veins. And that could be what he had.

[00:17:21] Dr. Grant Garcia: He could have been doing so much of this and blocking and doing all these things. He compressed it.

[00:17:26] Will Sanchez: His arms are usually up. He blocks shots. You know, he's, he's maybe, you know, he's, he's a unicorn, right? That this, this monster giants of a man that's just makes it impossible. He was runner up for defensive player of the year where his countrymen Rudy go bear one last year.

[00:17:44] Will Sanchez: So he's intimidated on the floor, but going back to having those arms up, moving around, you know, especially in that upper area, um. you know, whether that played a part or not. So knowing the information that we have right now, what [00:18:00] is the main concern for you? If you go, hey, we're gonna test, we want to identify where this started, wasn't the shoulder, was at the leg, wasn't somewhere else and then go from there.

[00:18:11] Will Sanchez: So what's your biggest concern? Um, when you're doing this evaluating evaluation process and you've already put them on these blood thinners.

[00:18:21] Dr. Grant Garcia: So let's assume, so to diagnose it usually other than the SCAT scan, usually it's an ultrasound. So they look at the blood clots and they can see the arteries and the veins.

[00:18:29] Dr. Grant Garcia: So for me, one, the number one concern is making sure it's not from anywhere else, because if it came from the leg, we have a big problem, right? Cause I mean, it's floating around, right? If it came from the shoulder directly, that's a better scenario in my opinion, because a TOS thing, a thoracic outlet thing, that's something that's not always that easy to treat, but if you know, he's got it, you could, you know, be much more cautious about it and maybe do repeated ultrasounds, which are really low risk.

[00:18:51] Dr. Grant Garcia: Um, but what worried me the most is that they found out that he had a blood clotting disorder, right? Because if he can, if he makes his blood extra thick, then he [00:19:00] has to be on constant blood thinners. That could end his career. I don't think that's the case here. Um, and I think they would have been a little bit [00:19:05] Will Sanchez: more.

[00:19:06] Will Sanchez: How do you check for blood clot disorder? What are the signs and how do you check for that?

[00:19:11] Dr. Grant Garcia: So the signs are you get blood clots, but that's generally the, there's other things that can be associated genetically, but it's very uncommon. Okay. So I got a

[00:19:18] Will Sanchez: quick follow up question here. I, I, I'm going to interrupt you here.

[00:19:22] Will Sanchez: So do you think San Antonio spurs? They have this information when they got it. It's really interesting because like I said, he, this was announced right after the NBA all star break. He was at the all star game, but now what's the documentation as a professional trainer with the information you have, and now you're reaching out to maybe.

[00:19:45] Will Sanchez: The, the French ball club, the other clubs that he had been with in the past, how far back now you start tracking down that history to see if they've been any other sites,

[00:19:56] Dr. Grant Garcia: probably not that much. Cause I feel like if you have a clot like this, either [00:20:00] he would have had a major problem or not, or not. I don't think I probably did a pretty good background check for his family.

[00:20:06] Dr. Grant Garcia: So he may have reached out to his family and they would have been like, Hey, you know, tell us if history of blood clot in your family, but generally you don't, that doesn't really matter because if all, if everyone, his family got blood clots. You'd probably know it's genetic, but if they didn't, it doesn't mean he doesn't have it.

[00:20:20] Dr. Grant Garcia: So I think, it's a, it's, it's a lot of, I think what they do is there's these, there's people, doctors called hematologists, and they can run these panels where they take your blood and they look for anything genetic in there. And they have all these different clotting disorders. There's rare ones. I don't think this is the case here, but I will tell you in my opinion, in my practice, the people that I told you that got those lung clots or people that have gotten really bad blood clots and have had.

[00:20:45] Dr. Grant Garcia: Almost all of them, we're the ones that found out they had this. Because it was the first time they ever knew it. I mean, I can think of a girl, uh, two years ago that got a blood clot after a big surgery I did, and it went to her lung. She did really well afterwards. No issues later on. And [00:21:00] we turned out that she found out she has a special clotting disorder.

[00:21:02] Dr. Grant Garcia: She had no idea. She was 33. She made it all the way to 33 until she figured that out.

[00:21:08] Will Sanchez: So with this disorder, right, we're talking about minimum six months. That puts us probably end of August, right? So shortly after that, maybe we're looking at a month or so, maybe six weeks before they start to do training camp and they kind of ramp up, you know, you know, all get, uh, October.

[00:21:26] Will Sanchez: So what does that look like now? Six months, we've done six months. What's the process? What's the next steps? So if you're a fan of the Spurs fan of this young man, you're kind of going, okay, this, this should be the steps. And if he clears these steps, we can see him participate back in activities for the start of the 20, 25, 2026 season.

[00:21:51] Dr. Grant Garcia: Well, obviously, you're going to probably get repeat ultrasound to make sure that blood clot goes away, right? The blood clot's gone. And that's a good thing. Right. And then what you're going to [00:22:00] do is he's going to go to this fitness to play panel. And it's made up of three different doctors and they're going to review the case and they're going to make sure they feel it's safe and they're not really related all to the San Antonio Spurs, which is good.

[00:22:11] Dr. Grant Garcia: It's the same thing. It's a concussion thing we talked about, right? Because as much as we're team physicians and we want what's best for the player, there's also the team that, you know, they can always be in your ear. And you know, if it's kind of a gray zone, you don't want the doctor to feel obligated one way or the other.

[00:22:27] Dr. Grant Garcia: Right? So you pull out that scenario. Um, interesting enough, actually, we were looking this up. There is actually a study on this, and they found that upper extremity, they found that athletes with upper extremity played return to play faster than those with other type of, uh, uh, blood clots. So even though I told you six months, it's actually average of 4.

[00:22:49] Dr. Grant Garcia: 3 months for return. If you have isolated upper extremity, which is what which what upper isolated with the two key things that you said their upper and [00:23:00] isolated. So those other players were lower extremity. They were a longer recovery. So it's just interesting to, to see that. Um, the one other thing is sometimes they do surgery on this.

[00:23:11] Dr. Grant Garcia: Hopefully he won't need that, but they can actually go in there and core out the blood clot. They probably won't need to do that in him, especially if they caught this early enough. Um, but again, there are, there are not that many cases of this. So it's not like we have a lot to go on. I'm giving you, you know, over the last five, 10 years, I just told you about four players.

[00:23:29] Dr. Grant Garcia: That's not very many in basketball, right? If you talk about how many people have ACL tears or cartilage injuries and things like that. But it's also not, I mean, I don't know if anybody knows this, but we, we found this out too. Serena Williams had tons of blood clots and she was able to play with it. Now again, tennis, not contact, even though it's a, you know, it's a tough sport, it's not contact.

[00:23:51] Dr. Grant Garcia: And. You know, it's, it's just a different animal there. But the problem you have too, is what people don't think about is, and I didn't even realize until we did this, this [00:24:00] episode, the travel, right. They're constantly flying. That's what I

[00:24:04] Will Sanchez: was going to bring up, man. I'm so glad you brought that up. That's exactly what I was going to ask you, you know, the travel, do you.

[00:24:14] Will Sanchez: stretch, cool down a certain way before you get on the plane. Uh, Steve Kerr was recently complaining about you want his own prime time tv. We're finishing up and getting out of the locker room at one o'clock in the morning and we have to get on the flight for three a. m. Because we have a tip off at noon on the east coast.

[00:24:35] Will Sanchez: So You know, someone that is in your position, you know, and we'll treat athletes and someone that travels as many times as they do right. LeBron James recently posted on X saying, look at all the games that we have back to back nights that he was complete. He's like, this is ridiculous. So what are your thoughts with travel, professional athletes [00:25:00] and from going from zero to 100 back to zero and now on a flight?

[00:25:06] Dr. Grant Garcia: I mean, it's, it's no joke. I mean, that's one of the reasons these guys have trouble getting back sometimes. I mean, they can return to well, but the, but he's going to be always forever risking this happening again, regardless of what people say, because as soon as that word blood clots in your history, if I have that in my patients, like you get, you tell me I've had a blood clot, like I'm automatically putting you on blood thinners for every surgery.

[00:25:29] Dr. Grant Garcia: Like I'm, I don't want that ever to happen again. So like, you know, if he ever needs a, if he ever gets a surgery, he's getting a different level. Now, again, Upper extremity is a bit different and if they find out that he has TOS and it was caused by that rather than anything else in his body. I think the biggest concern for anybody with PIM is that whether they, if they found nothing.

[00:25:50] Dr. Grant Garcia: We have no idea why he got it. We have no idea where it came from. Which I'd be surprised, hopefully they can find a reason. Um, that's when we get a little bit more concerned, right? Because then, [00:26:00] do we just have to assume he's, this is, we have assumed worst case scenario for, you know, this could be a cloudy disorder, we can't figure it out, or something else, and we have to be extra cautious of him.

[00:26:09] Dr. Grant Garcia: Um, but I can sure as heck tell you that if he has any issues, anytime in the next multiple years of playing, they're going to check everything again for this and it will be on everything. And again, I, I think a couple of years of playing really well without any new more blood clot. That's fine. But we know, I mean, look at that.

[00:26:24] Dr. Grant Garcia: I told you Serena Williams had multiple. Yeah, this may not be the last time.

[00:26:28] Will Sanchez: And would you just assume that she was on those anti anticoagulants, you know, when, because of those multiple blood clots and even when she was pregnant, right? I mean, she was yeah. She was pregnant. She gave birth. That's a really

[00:26:41] Dr. Grant Garcia: risky.

[00:26:42] Dr. Grant Garcia: That's really risky because some of the medicine can have problems. So there, I'm sure there are different things. Now you can get something called a filter where they put a thing inside of your vein to prevent it from going to the lungs. But in his case, there's no way to prevent it from the shoulder.

[00:26:57] Dr. Grant Garcia: So, like, this is, it's a very, it's a little bit [00:27:00] more complicated, just the way the blood flows.

[00:27:04] Will Sanchez: Extremely interesting. This is, this is absolutely fascinating, especially to see what the outcome's going to be. Uh, I'll be curious to see if they ever, you know, uh, share that type of information and say, No, this was isolated. We're good. He's, he's good. Don't worry about it. But as you have already mentioned, Yeah.

[00:27:25] Will Sanchez: Now that I, I'm aware of this blood clot next time or anytime that I'm treating that particular patient that's in the back of your mind and you're making sure you're doing your due diligence prepping the patient for wherever, you know, he may need in the future. Because as we know, we're professional athletes.

[00:27:46] Will Sanchez: He is only a matter of time. It's not if it's when. That they're going to eventually be in some have some kind of surgery, whether no matter how big or small it is.

[00:27:56] Dr. Grant Garcia: Well, and I think we could say it's pretty impressive how well he's done so [00:28:00] far without any injuries, right? I mean, yeah, is that how many big men and again, he's got a different build, but he's how many big guys like him have gotten drafted and then just.

[00:28:12] Dr. Grant Garcia: Not done that great. Obviously, he was different. He was extra special, but there are a lot of big guys that have just kind of injury, injury, injury,

[00:28:20] Will Sanchez: Northwest Greg Oden, you know, all these guys have come and go throughout the league and that's what made them special. That's what makes them exciting to watch that.

[00:28:28] Will Sanchez: You know, that's why you buy your NBA package. You know, to see these, these incredible athletes, when we watched the Olympics, he was one of the reasons to watch, to see him out there and playing and representing his country and knowing everything that, uh, that's a part, you know, someone that could block a shot, could dunk a ball and then shoot a three.

[00:28:48] Will Sanchez: I mean, special. Right. And that's why you hope that as a fan, you know, he bounces back and that's why it was so interesting to have this conversation about this player. [00:29:00]

[00:29:00] Dr. Grant Garcia: Yeah. And I think, I think for the listeners, I think he'll bounce back. I think he will be, we just have to be, you know, you know, in the show, I'm always more cautious, right?

[00:29:07] Dr. Grant Garcia: Like there's always a potential risk here or there, but like I said before, from the studies, you know, the upper extremity players get back faster, so there's a chance that he's ready to play sooner, but it won't really matter, right. He's gonna start the next year of the season. They're not gonna push him any earlier.

[00:29:22] Will Sanchez: Yeah, no, and it's smart by them doing it. And, and, you said, exactly, you're cautious, you're optimistic, I'm the ones going What if? What if this doesn't work? Tell me the worst case scenario. I'm that guy. I'm, I'm the one that just going, Oh my, what's got the lights are flickering. We're all going to die, you know, like, so, you know, that's part of the yin and yang of our show, you know, that's why any, uh, any last thoughts as we get ready to wrap this up, um, whether it's about him or just, uh, blood clots in general, that may be informative for, uh, for our listeners.

[00:29:59] Dr. Grant Garcia: [00:30:00] I tell the patients that and listeners. So, you know, obviously this thing's really rare. If you ever have something where you have a lot of swelling and problems in an area and you've got a history of this, be aware of it. If you've had surgery, be aware of it. You just don't want it to miss it. So if you're, if your doctor's saying, Hey, this is not a big deal, which hopefully they're not.

[00:30:17] Dr. Grant Garcia: Just go get it checked out. It's pretty easy to get this. You can get an ultrasound anywhere you want. I mean, you can walk into a clinic, you can walk into an urgent care, and get the ultrasound done just to see whether or not it's there. I will tell you that it's unfortunate how many of these I've caught when someone else had said, oh, it's not a big deal.

[00:30:35] Will Sanchez: Yeah, and as you mentioned, the lung, the stroke, the heart attack, or anything like that, a lot of it can be affected, so. Alright, now that we've scared everybody, Uh, we want to thank everyone. Check us out, sports Doc Talk. We've got some great shows, we've got transcripts, we've got some great guests coming up, so we're really excited about that.

[00:30:54] Will Sanchez: And as always, we love the people that first off, always support us and give us some great [00:31:00] shout outs. So if you wanna give us a shout out, you have some show ideas, you want us to talk about certain things, check it out, sport sports.talk.com. We appreciate you Dr. Garcia. Say goodnight. Goodnight guys.

[00:31:14] Will Sanchez: Thanks.

Audio Transcript

[00:00:00] William Sanchez: Welcome everyone. And thank you for listening, watching, however you're enjoying Sports Doc Talk. We are really happy that you are with us. This is our Super Bowl edition. Obviously, Dr. Garcia has a incredible background. Uh, we, we had to do this. We didn't plan on doing a show, but we're like, we've got to talk a little sports.

[00:00:37] William Sanchez: We got to talk a little bit of injuries, little fandom here. So Dr. Garcia, our orthopedic surgeon and sports medicine specialist. How are you?

[00:00:46] Dr. Grant Garcia: I'm good, excited for Super Bowl, excited for, like you said, like the audience should hear, you know, we were, we've had way too many recordings in the last few weeks and we're getting requests for guests and unfortunately, our time is limited since this is [00:01:00] not our primary job.

[00:01:01] Dr. Grant Garcia: But I am good now, I'm excited and we just want to make sure we have this episode for our listeners because people are always interested in what's going on. They want to hear Will. tease me about my lack of knowledge, uh, other than orthopedics. And, uh, and then also for the injury reports, because I think that the injuries some people don't understand and or the NFL purposely sort of construed the picture a little bit for people.

[00:01:24] Dr. Grant Garcia: So we'll go through that.

[00:01:26] William Sanchez: Hey, it's Super Bowl 59. It's a rematch from Super Bowl 57. Where, uh, the Chiefs defeated the Eagles 38 to 35. If we get a matchup like that, then we're going to be in for a treat. Uh, before we get started, I am wearing my Tiki Barber Giants jersey. And I want to explain because it was pure comedy this season for the Giants.

[00:01:49] William Sanchez: I have my Wayne's World hat on. Because if you didn't laugh, you would cry, uh, just real quick. Looking back at the season, what were some of the [00:02:00] things that, uh, that stood out for you that you remembered? And I know you're a fan of the Giants. Just, I don't know, rambling along. It was a long time. If you're [00:02:10] Dr. Grant Garcia: a Giants fan, there's not much to remember.

[00:02:12] Dr. Grant Garcia: Uh, you know, you know, got, got a lot of fun stuff, like watching players for other teams run rampant when they should have been on your team, but. I think the Malik neighbors, it's probably my favorite thing just to see a player. I mean, imagine, I keep talking about it, basically, you have a player as good as him that put up the numbers that he did with four different quarterbacks, all subpar quarterbacks pretty much.

[00:02:34] Dr. Grant Garcia: So, you know, the fact is he gets a good passer. With a decent team, you know, what can he possibly do? So, and, you know, even better wide receiving crew or whatever else happens. So I, I'm hopeful we're going to see continued improvement. Uh, and so that, that's what I have to look forward to. That's kind of the only highlight from the year and Tyra, I think, uh, what's his name, Tyrod, uh, he did really well as well, [00:03:00] Tracy, Tracy, Tracy, Tracy.

[00:03:02] Dr. Grant Garcia: He did really well. I was pleased with him too. Those were the kind of like two highlights. Um, you know, minus your best players getting hurt like midseason. Uh, so that's, uh, unfortunately it's a, it's a very short episode when you talk about what happened with Jaya.

[00:03:15] William Sanchez: Yeah, definitely. Um, interesting season.

[00:03:18] William Sanchez: You know, we're fans. Um, you know, just looking back, I feel, you know, for for the fandom in Detroit, uh, Dr Bashai, right? Sharif, big Detroit Lions fans. So shout out to him. You know, he I know that he was must have been agonizing over the loss that that they suffered, uh, at the hands of Washington for being a fan of the NFC East.

[00:03:42] William Sanchez: I don't know what we're doing. We, we got one of the top teams now to, you know, you know, back two out of three years, the Eagles are in the super bowl. Now you have this superstar quarterback with Washington. I don't know what to think of when it comes to the giants and looking around, you know, heartache to all my [00:04:00] friends back in New York that are Buffalo bills fans.

[00:04:03] William Sanchez: I don't know what to say anymore. I just go, sorry, there's nothing else to say. They have gone through so many different things, so many different expectations, uh, suffering another loss. It was, uh, it's difficult. I guess the, the moral of the story is, you know, you're concerned with everyone else we suffer, but we don't want, we don't want company in our misery as giants fans, but we, we know a lot of people out there that suffered and what comes down to at the end of this game.

[00:04:31] William Sanchez: There'll be one fan base that's going to be happy and everyone else will either say we had a terrible season. We had a good season. We had a great season, but we didn't win. And that's, what's going to come down to a fun fact. We'll do a little trivia before we kick off. Uh, New Orleans has the most. Super Bowl appearances, uh, tying them with Miami with 11.

[00:04:57] William Sanchez: So have you been

[00:04:59] Dr. Grant Garcia: to New Orleans? [00:05:00] I've been there too many times for a little bit of fun and work events. Okay. So,

[00:05:06] William Sanchez: so real quick, what is your go to either meal, snack, or to do when you go to New Orleans?

[00:05:14] Dr. Grant Garcia: Well, like my travel, which you talked about and like my surgeries, I like unusual, so I like the gator sandwich.

[00:05:21] Dr. Grant Garcia: What? I really like it. I like gumbo. I love the gumbo. Gumbo's love public. There was a place we went, there was a place we went there that had like all Southern cooking and in Seattle it's like really hard to find. Yeah. So I remember having amazing gumbo, but I always search out the gator sandwich. I love gumbo.

[00:05:39] Dr. Grant Garcia: I don't want to like eat it all the time, but I want to try it. I want to say I did it. That's what I have to do without getting sick. What did you think I was going to

[00:05:48] William Sanchez: say? What is it? Just describe it real quick. What's the gator sandwich besides the gator in it? It's legitimately

[00:05:54] Dr. Grant Garcia: gator. No, so it's gator, fried gator, like in a po'boy.

[00:05:57] Dr. Grant Garcia: So it's a po'boy

[00:05:59] [00:06:00] gator.

[00:06:00] Dr. Grant Garcia: But po'boys, I like the crawfish po'boys and then obviously the beignets. Right. If you like New Orleans, you love the beignets. I'm not a huge fan of the late night bourbon street, but I love the, uh, the food there is so good. And like, I could eat gumbo pretty much every day of the week.

[00:06:15] Dr. Grant Garcia: I love gumbo.

[00:06:16] William Sanchez: Love gumbo. Love the pralines. Went there back in 2000 with a bunch of friends. We were hanging out, going for Mardi Gras and our budget pretty much had us down to, uh, Uh, an alcohol budget and a praline budget and now is it and enough gas to drive backwards. We drove down in a huge van with a bunch of us.

[00:06:36] William Sanchez: That's all the story and that's not for this crowd. So we're gonna move on. We've got some people that we're going to show some love. Dr Garcia show some love to the recovery shop.

[00:06:46] Dr. Grant Garcia: So big thanks to our sponsors recovery shop. You've heard this before. It's the more fun episode. But, you know, again, for patients, I had a patient today ask about it.

[00:06:53] Dr. Grant Garcia: They're like, Hey, you know, like I want, like, I love all this stuff you're doing, like a lot of this stuff, but what, what else can I do to get better? I [00:07:00] want like the top of the line, especially from Seattle. They come in with a lot of research, um, and they want to know the best stuff. And so the nice thing with the recovery shop is I can put, you know, normal level, top level, whatever you want.

[00:07:11] Dr. Grant Garcia: And you get to kind of order. It's a nice menu of things for your post op recovery. Um, and ranging from nutrition, which we'll talk about more at some point in the near future. Uh, to, you know, machines that can bend faster and new tech in terms of, um, different ice machines, such as a nice machine we talked about.

[00:07:27] Dr. Grant Garcia: So it's an awesome option for surgeons to offer their patients and it gives them that sort of next level stuff. And again, it's no obligation for the patients, but a lot of patients want this. They want more. And if you offer that to them, they want it. So it's a great thing. So again, reach out to Mike. Uh, they've been an awesome resource.

[00:07:44] Dr. Grant Garcia: And the patients are absolutely love it. So

[00:07:46] William Sanchez: yeah, you know, just we can't say enough good things and you summed it up perfectly. Um, dr Garcia, there's been a lot of Super Bowls. We've seen a lot of Super Bowls. Um, do you have a memorable [00:08:00] injury or occurrence that had happened in the past that really stands out for you?

[00:08:05] William Sanchez: Whether a plane player going into Super Bowl with an injury or sustaining one in the big game that you can recall there?

[00:08:13] Dr. Grant Garcia: Well, I mean, the one I keep seeing about, oh, I hate to say it's from like a malpractice reason in the sense that like seeing it, but Terrell Owens, when he, when he waived the doctors, I think he had, we, I don't know if we're going to talk about it, but the fibular, he had a fracture of his ankle and he was basically not allowed to play on it.

[00:08:31] Dr. Grant Garcia: And he had to do it right over consent that he wasn't going to sue the surgeons to release him to play in the game. And then he ended up having a phenomenal game. Um, only freak athletes as we keep saying there are regular athletes like, yeah, I'm not even maybe a regular athlete, but a regular athlete.

[00:08:47] Dr. Grant Garcia: And then there's guys like that, right? That like, even when they're 70%, they're better than most people are ready. And so the fact that he's able to do that is just mind boggling. I don't remember any serious injuries, but again, [00:09:00] I'm I'm not the great person for, you know, watching everything at full, full speed completely.

[00:09:04] Dr. Grant Garcia: But, uh, that one really rang a bell to me because that's just insane.

[00:09:09] William Sanchez: Yeah. And it's a perfect segue to this game, right? Because he's with the Philadelphia Eagles. There was a question. He questioned Donovan McNabb's toughness, right? We're going into the little bit more of the sports talk right now than the doctor talk, you know, when, when he played in that game, 122 yards, nine catches was absolutely phenomenal.

[00:09:28] William Sanchez: You know, but can you just describe what that pain threshold or what kind of setback where you're talking about that, that, that fracture and the spring [00:09:38] and

[00:09:38] William Sanchez: you're going into this game and you're playing football, let alone running around to hand touch, but then getting tackled and you know, they tackle you low and God knows there's a little extra little tweaking and twisting here and there just from a pain threshold from either something that you know, or just when your patients go through.

[00:09:57] William Sanchez: What? What are we can't? Can we put any thoughts [00:10:00] on what what's happening there to be in a position for you to play an entire game in those conditions.

[00:10:06] Dr. Grant Garcia: So I take care of a lot of people. I do lots of surgeries and postoperative pain. There's different levels and everyone's got different thresholds. You know, there's some people that they say they like pain tolerance.

[00:10:16] Dr. Grant Garcia: They really don't feel that have a high pain tolerance and they do. And then there's this level. So when you look at the body, there's different nerve receptors. The most insensitive ones are in the bone. Okay. And that's when you break a bone. That's why people are like screaming, right? Because they're like, you've seen him in the movies, you see him in the ER, like the broken bones, like one of the worst, right?

[00:10:35] Dr. Grant Garcia: Like there's kidney stones. Those are really bad. There's other things that are bad, but a broken bone really hurts. And not to mention a broken bone when you don't move hurts. So imagine what a broken bone feels like when you're walking on it. So it's like this is this is like a level 10 out of 10 that you're playing on this thing and he's running on it and getting hit.

[00:10:54] Dr. Grant Garcia: So there's no pain describable. Again, I think women take the cake in terms of being able to [00:11:00] handle pain with having pregnancies and everything.

[00:11:02] William Sanchez: Of course.

[00:11:02] Dr. Grant Garcia: And most men couldn't make it very far, we all know. Uh, but nonetheless, the, um, I would say that running on a broken, a broken ankle is, uh, right up there with, uh, one of the most kind of toughest things I've ever heard of.

[00:11:17] Dr. Grant Garcia: So that's a pretty impressive.

[00:11:19] William Sanchez: Okay, let's get to the game. Uh, let's start on the line, right? Because if, if, if this game is going to be determined, it's going to be determined by the line play. Um, we, we kind of know the recipe for Philadelphia this year has been, we are going to run the ball and kudos to them because a lot of teams kind of get away from their bread and butter, you know, what makes it really good.

[00:11:41] William Sanchez: They're not, they're not afraid of that, right? This is what they do. And for them on their offensive line, their big offensive tackle is lane Johnson, and he suffered an, uh, abdominal injury and he's been dealing with that, uh, injury, uh, for a while now. What is, [00:12:00] what are we talking about when, uh, when it says abdominal injury, because it seems a little vague.

[00:12:04] William Sanchez: So maybe you could explain that a little bit better because we go back to the way you started this show. We kind of get some information, but we don't get the whole story.

[00:12:11] Dr. Grant Garcia: Yeah. So, you know, these abdominal injuries, they're usually oblique injuries. They're hard to treat. There are people that do fix them, but they're not that common.

[00:12:19] Dr. Grant Garcia: And generally they just nag, right? Like, so imagine you have. An external external, you have different oblique muscles layers in there and they pull it off and there's like a little hole in the muscle and it hurts. Every time you're twisting or moving, it can feel it pulling. It's kind of like a hernia, but higher up and, and they're really uncomfortable.

[00:12:38] Dr. Grant Garcia: It's like a groin pull, right? We've seen like, you know, LeBron James, he talked about it took him forever to get back from a groin pull. As a swimmer, I had a couple of groin pulls. They're not fun. It's essentially like that. It's a little tear of the muscle and you want it to heal or the muscle tendon and you want it to heal back.

[00:12:52] Dr. Grant Garcia: It's like a partial hamstring tear, you know, those just nag and it's in the abdominal area. So that's what he had likely, obviously, they're not gonna tell you [00:13:00] exactly what he had. Because basically, if he can play, they don't really have to report it fully. The issue is when they get surges and they have to tell you, but again, it's also this like weird HIPAA versus NFL rules.

[00:13:12] Dr. Grant Garcia: And you know, they don't want the team to know, right? Like if it's something that you think that's going to really limit them, you don't want the team to know that he's that limited. because then they're gonna go after him for the play. Obviously, if he's limited enough that it's still safe for him to play, there is a strategy here.

[00:13:25] Dr. Grant Garcia: I mean, some of the coaches are known for really limit, really dumb, dumbing down these injuries. And there's probably borderline to like, are they even following the rules? You know,

[00:13:34] William Sanchez: um, you know, if that's something that after the season you're kinda looking at, is there anything that, is that just time and recovery or is that something that eventually you may go in there and tweak it, or it just, it depends on what, you know, what the medical records say based on that injury.

[00:13:50] Dr. Grant Garcia: I mean, this is one of those ones that I think that rest alone should help. I mean, abdominal surgery is not that common. Um, people do sports hernias and things like that, which this is something similar. [00:14:00] Um, but in general, that's probably not what they're going to do for this if he's been able to deal with it so much.

[00:14:05] Dr. Grant Garcia: Uh, so he probably will just sort of rest it off and the good news is he'll have some downtime after this. Um, but you know, these guys are tough. Like they play through a lot more than we would normally play for. And now the Super Bowl's here, right? Like the team's, you know, the team's about, has a losing season.

[00:14:19] Dr. Grant Garcia: They got like nothing to play for. You know, that's a different animal. Yeah. This is like the final game. And like every one of these players counts that we're going to talk about.

[00:14:26] William Sanchez: Yep. And then on the other side of the ball, someone that's relying on the pass rush, uh, one of the great defensive tackles, uh, in the game, uh, Chris Jones, uh, don't get confused with his brother.

[00:14:40] William Sanchez: Which is the UFC heavyweight champion, but that's a whole other, I digress. See, I go down these loopholes. He has a calf strain. So when you have a calf strain, they're saying they've been sitting them out from practice. So, and this has been kind of lingering. So I wonder what the degree of this calf strain is for you as a big man to [00:15:00] run up against somebody else that's big, push off of them, excel, throw them off.

[00:15:04] William Sanchez: run after quarterback, run after running back on every single play. What are your limitations? Or what are some of the concerns as a doctor that you're that you're treating and maybe rehabbing as you get ready for this big game?

[00:15:17] Dr. Grant Garcia: I mean, the power, obviously, right? There's power in this calf muscle. We've seen it before with other injuries, right?

[00:15:23] Dr. Grant Garcia: These calf muscles are, these don't usually end up in surgery, except that they tear their Achilles lower down. So, you know, you people, you heard of a cat problem and then they tear their Achilles later. So that is a risk in this situation, but probably not that common. These calf or we call them gastric tears.

[00:15:38] Dr. Grant Garcia: Uh, they just are such a nuisance and you know, he's probably booting He's probably treating he's getting maybe prp He's getting tons of other different all these little all the little voodoo things They could possibly do to give him to make him better. Is he and they're probably just trying do you think you put him?

[00:15:53] Dr. Grant Garcia: Yeah, put him in the boot when he's not practicing or something like that to what what is the boo? Yeah, but the issue is they get stiff if you get [00:16:00] the problem You're on is like you want to keep it loose right like you want it to not get No, you want it to heal, but if you get him too stiff and he goes back and fires, right, that'll rip it through again.

[00:16:08] Dr. Grant Garcia: So it's one of those ones that's just a pain in the butt to deal with. I mean, these, these are some of the worst injuries. I mean, these are, I've had, I've had patients take six, seven weeks more than that to recover from one of these. So these are, these are really nagging, which is why they keep them out of practice, right?

[00:16:22] Dr. Grant Garcia: Like if he's that good, he doesn't need to practice, you know, they give him treatment and then hopefully he can make it through the game.

[00:16:29] William Sanchez: Yeah. Does he need the Rebless? I'm over here doing the recovery shop here now. Does he get on the Rebless? He doesn't have to worry about it. I think he's getting even,

[00:16:37] Dr. Grant Garcia: I think he's getting above the Rebless right now.

[00:16:39] Dr. Grant Garcia: I think he's getting more treatment than you would ever imagine.

[00:16:42] William Sanchez: The full time treatment. Alright, as we get ready to move on to some other injuries. Uh, when it comes to the Super Bowl, whether it's you, the household, the wife, the kids, what are some of the things that you look forward to when you're actually sitting down and watching the game?

[00:16:58] William Sanchez: Uh, you know, [00:17:00] anthems, commercials, blah, blah, blah, blah, blah. You know, what are some of those thoughts when it comes down to it? Well, well,

[00:17:04] Dr. Grant Garcia: first off, Mike, I'll tell you right now, my wife has zero interest in the Super Bowl. So she's, I got to like. So right there, that's already, like, she just wants to see the commercials.

[00:17:13] William Sanchez: Okay. Oh, so she's there. She's, she's there.

[00:17:17] Dr. Grant Garcia: She's, she always is there. She will be there. She has zero interest in that type of wife. She is. She just shows up for the Super Bowl. Okay. So she'll show up for the Super Bowl, but she has no interest in who wins. Even if it's a giant, she doesn't. So she did. So that's the thing, the kids, they just think it's fun to hang out with dad and watch the game.

[00:17:36] Dr. Grant Garcia: And they liked the football. They used to watch, like, I have little pictures and they were babies. And they were like on my lap watching the giants. That was before that the giants would make the kids cry. Uh, now that's a different theory. Uh, but, but, [00:17:48] but to be

[00:17:49] Dr. Grant Garcia: honest with you, they really liked this year bowl because they know it's like that there's like, come on.

[00:17:54] Dr. Grant Garcia: We're just hanging out. We're having a good time. They love the commercials, but they don't get them like these to read it. Like some of these commercials are so light. [00:18:00] You know, my kids are still young. So for them, they're not funny. I love the commercials. I like the food. I like to hang out. I just like the experience, right?

[00:18:07] Dr. Grant Garcia: Like the whole thing. And usually it's actually kind of nice when I don't root for the team, because then I don't have to really focus on the game and watch the giants. I'm like fully focused. So it's like, it makes it more of a social aspect, but I think the social aspect of it is good for the whole family.

[00:18:19] Dr. Grant Garcia: So that's what we really like about it.

[00:18:21] William Sanchez: Yeah. Um, wow. Uh, my wife, I. Right there loves commercials, you know, then she'll, she'll watch, she, she watched a little bit more football this year. It's almost one of those things where, you know, the games will be on and we're doing other things. You know, but we'll have the games on the background.

[00:18:38] William Sanchez: Stop once in a while, watch the game depending, right? Because as you know, family, you have other commitments, especially on the Sunday, you're doing all these different things, right? Thursdays, you know, depends, but for her, she loves commercials. I like some of them. I'm more, I critique more gone. You spent all this money for this commercial.

[00:18:58] William Sanchez: This is, so that's where my critique is. I [00:19:00] become one of those people, right? I critique over. I think about the money you spent for this platform that you're doing. Uh, for me, I'm really looking forward to the anthem this year with John Baptiste. He's one of my favorite artists. I think he's a musical, creative, artistic genius.

[00:19:16] William Sanchez: I, I think, uh, he's absolutely incredible. So I want to see what he's going to do with it. If, uh, for fans out there on Netflix, American symphony kind of follows his, his year where, uh, he, he won for the Grammys. He performed in radio and, uh, where am I thinking? Uh, Carnegie Hall. Uh, his wife went to cancer.

[00:19:37] William Sanchez: Like, it's, it's absolutely amazing, but he's, he's one of these, uh, geniuses. So, that's, I'm looking forward to, uh, a lot of it there. Let's talk about some other key injuries. Uh, you know, speaking with music, we, I don't want to get any of the Swifties concerned, you know. No,

[00:19:55] Dr. Grant Garcia: no, no. Be careful with this one.

[00:19:57] William Sanchez: We can easily get canceled.

[00:19:59] William Sanchez: [00:20:00] Easily. So let's just be careful, but let's talk about Travis Kelsey, the all pro future hall of famer, tight end, uh, dealing with his hyperextended knee and bone bruise. He suffered in doing the practice and it said resulted in significant. Uh, does all of that makes sense to some of it go away? You can't have one without the other.

[00:20:25] William Sanchez: What are you some of your thoughts when you hear

[00:20:27] Dr. Grant Garcia: about

[00:20:27] William Sanchez: this?

[00:20:28] Dr. Grant Garcia: So this is a good one. I see this frequently with skiing. So they like land and they'll tweak their knee up or like, you know, they'll fall and they'll go hyper extension. And some people's knees go hyper more than others. He's a pretty big dude.

[00:20:38] Dr. Grant Garcia: So I highly doubt. Yeah. But, you know, he's one of those ones, that's one of those ones where, you know, when you know, when you've seen the players, they get hit and then he goes backwards and everyone gets disgusted. Yep. That's, that's like previous. So this is like one step before that. So thankfully nothing else happened because the back of the knee, the structures in the back of the knee are really stiff.

[00:20:59] Dr. Grant Garcia: There's a [00:21:00] capsule and everything else. So when he hyperextended it, he went like this. and the bones actually in the front click together, which is pretty uncommon, but you can get that and you get a bone bruise in the back in the front. And this can be just like this. The problem is you basically sprain the back of the knee.

[00:21:14] Dr. Grant Garcia: He may have sprained, you know, hamstrings and kind of tweak them a little bit. So that's why it was swelled up a lot. My assumption is that hopefully he didn't do any significant damage, and I don't think he did, or they would have done anything, uh, they're saying no structural damage. Um, so this is one of those ones you'll probably get back, you'll probably be a little bit sore, uh, but I don't think the risk long term is much for this one.

[00:21:33] William Sanchez: So, so the knee is not only, it's not only affecting the knee with that hyperextension, but it's affecting the hamstring? Because it's putting pressure or strain?

[00:21:40] Dr. Grant Garcia: Yeah, well the hamstrings come, the hamstrings, there's a knee joint like this, and the hamstrings come past the knee joint. So those hamstrings and the calf muscles, they go on either side.

[00:21:50] Dr. Grant Garcia: They protect the knee from going into the hyperextension they're firing so that they don't, they lock up. So he

[00:21:54] William Sanchez: doesn't go farther. So when it, so when it happens, he's putting a straight on that. So he [00:22:00] could, so he can actually feel that any risk of. Possibly a hamstring pull or something like that. Is there any kind of, uh, you know, damage or not damage, but you know, a strain toward that hamstring since it was affected by it, or that's not something you really think about?

[00:22:15] William Sanchez: Pretty

[00:22:16] Dr. Grant Garcia: low risk. The hamstring that we, that people usually strain are the hamstring where it attaches in the butt up higher. The lower hamstring which attaches is much less commonly torn because there's mostly tendons down there

[00:22:26] Yeah,

[00:22:26] Dr. Grant Garcia: and so that's going to be a less likely issue, but he could have inflammation right like the calf muscle Higher up is the one that the same thing is talking about the calf strain the calf muscle lower down is the achilles So either it pops It doesn't usually strain.

[00:22:40] Dr. Grant Garcia: It's hard to strain a tendon. So as a result it's pretty, it's a lot less likely that he has a sort of long-term indications from this.

[00:22:48] William Sanchez: Alright, if this eagle's offense is going, going to click, we know a big part of his Saquon Barkley, but. What has made his season so successful now [00:23:00] is the line play, but the threat of jail and hurts running as well, right?

[00:23:05] William Sanchez: So Jalen hurt is his left knee against the Rams. He's been wearing a brace. He's been playing through. We've seen him play. So he's been playing through it. Um, what are some of the concerns and restrictions with that left knee? And I guess we're going on. three weeks or close to a month now. Do you have less concern about that injury and feel like he's going to be, you know, closer to his normal self or is it something like depending on the severity, this could linger a little bit longer and all you need is to maybe not take the right hit, but turn the wrong way on a hit for you to kind of reactivate that.

[00:23:43] Dr. Grant Garcia: Yeah. So again, obviously this is the classic NFL thing. He hurt his left knee, right? Like I looked it up. There's just no way to figure out what's going on. Yeah, it's been pretty, it's been pretty sort of locked down. Um, generally, a hurt knee is like a little [00:24:00] meniscus tear, but I highly doubt that, because I don't think he would have it.

[00:24:03] Dr. Grant Garcia: enough to get by if he had torn his meniscus. The, could it be a little cartilage defect? Maybe, but you know, we all talk about this, it's probably MCL, right? He probably sprained his MCL a little bit, like DK Metcalf did, and he's probably just has this lingering sort of knee sprain thing that he's wearing that brace for, because you don't wear a brace if you have just, you know, if you have just a little bit of like inflammation in the knee, because there's no support there, right?[00:24:28] Yeah. So

[00:24:28] Dr. Grant Garcia: it's probably some sort of ligament sprain. He can play through it. I mean, the concern is obviously if he. Keeps going with it. Can you tear it more? You know, tearing the MCL more is not going to keep him out of the game unless he actually does like a big one afterwards. He could tear something else.

[00:24:42] Dr. Grant Garcia: I think the odds of him considering he's had this for so long and he's been able to play those last couple of games. I mean, everyone's trying to hit him there, right? Like it's not, it's not like it's new for the Super Bowl that he's going to get attacked in this area and he's had two extra weeks of rest.

[00:24:55] Dr. Grant Garcia: So I don't think it's going to affect him too much. But again, it's always that thing about the athlete, like [00:25:00] the big game, his knees, not perfect. Yeah. Does it slow him down, does it tick, right? Like, does he run or pass? Does he run or pass? Is that going to slow him down from the run? He's just going to think about it for an extra second before he goes.

[00:25:12] Dr. Grant Garcia: Is he going all out when you're injured? I don't care who you are. There is definitely this split second thought.

[00:25:21] William Sanchez: Yeah. And, but at the same time, we know these guys built differently. They think differently. They're, they're wired differently. And the fact that he already lost the Superbowl to the, to the chiefs, I'm thinking that he's going to be like, Okay.

[00:25:34] William Sanchez: Um, this is I gotta go for it. He's a tough guy. He's mentally tough, you know, coming from the programs that he did in college and transferring and is still staying the course. So we know mentally he's tough. So I don't be surprised. Staying with staying with Jalen Hurts. I just wanted to read a little note.

[00:25:53] William Sanchez: The last time a quarterback played the Super Bowl with 18 or fewer passing touchdowns in the regular season was Trent Delpher with [00:26:00] the Baltimore Ravens. I'm going back to now to more shame for the Giants because that's the game that the Ravens kicked the snot out of the Giants in that Super Bowl.

[00:26:09] William Sanchez: Dilfo had 12 touchdown passes that season hurts has 18 passing touchdowns, 28 total because he has the 10 rushing. So that would be an interesting stat. Um, if the Eagles win with Jalen hurts. Um, so Yeah, it was just one of those things. I was just curious. I wanted to kind of look it up. We'll wrap up two other key injuries for Kansas City.

[00:26:34] William Sanchez: Uh, Jalen Watson. Uh, he's missed the last 11 games with a broken leg, but returned for the playoffs. What are some of your thoughts about that? And, uh, just kind of describe that injury and maybe what, what you're looking for if you're the, in that room with the medical team when it comes to him.

[00:26:51] Dr. Grant Garcia: I mean, the good news about the broken leg is we've seen this before some of these basketball players.

[00:26:55] Dr. Grant Garcia: There's one while ago that broke his leg in half and had to go straight to the emergency room. They put a nail on it. So [00:27:00] generally gets a nail down it, which is kind of crazy sounding, but he's got a piece of metal inside of there that stabilize them so he can start walking on it. But the good news is generally, if you do it right, you can avoid damage to the inside of the knee, right?

[00:27:11] Dr. Grant Garcia: Like broken bones. Like, so imagine you have your bone, you have your joints, like you have your knee, you have your ankle, and then you got the long bone in the middle. You break the long bone in the middle and it heals. The ramifications are not that bad. The issue is when you start damaging the joints.

[00:27:25] Dr. Grant Garcia: Because the joints are what have the cartilage and you don't want injuries to that. So ramifications for him, he's probably going to be playing pretty well. And now he's got sort of the bionic leg. So he's going to have a metal rod in between there that protects him. I mean, occasionally they can break through the rod, but it's not that common.

[00:27:39] Dr. Grant Garcia: Um, but if I was going to get an injury that bad, this is, and I was, I knew it was going to heal. This is the one to get less, like it have damage otherwise. I mean, it's, it's morbid, but as long as you don't damage your joint, I would never want damage to my joint. The joints, the key, right? That's where the pain comes from.

[00:27:56] Dr. Grant Garcia: He heals his bone nicely, you know, he's got the rod in there. He may take that out [00:28:00] at some point, but it's not a It's a thing I see, you know, every so often people with trauma like ski injuries, and they're able to get back to everything they want to do. So again, a well done, a well done surgery will do very well with you.[00:28:11] Yeah.

[00:28:12] William Sanchez: A key injury for the Eagles, Landon Dickerson, he suffered a left knee injury. I don't know what that means. Maybe you could explain it. Suffered left knee injury, just so generic, an NFC championship game. He was playing center at the time. What, what does that mean? And is this something that you or, or We don't know what it means because it's just so this is,

[00:28:35] Dr. Grant Garcia: this is like, if he's a lineman, it's probably an MCL L again.

[00:28:39] Dr. Grant Garcia: Again, you tear your posterior corn, you tear your ACL, you tear your PCL generally your out for a bit, you know, he's gonna, probably all the lineman wear braces. It's a fun fact.

[00:28:49] William Sanchez: Yep.

[00:28:49] Dr. Grant Garcia: It's one of two things that, so the data has demonstrated braces help for only two things. Skiing injuries after ACL tears and NFL lineman and M MCL L tears.

[00:28:59] Dr. Grant Garcia: So if you see all this [00:29:00] ant those braces because it p the M. C. L. Tears. And s what he got, you know, us are so vague and they don know. Um, but you know, t what he has again. Uh, an those is generally kids t them, doesn't need surger will we brought this up b What you guys may see is all of a sudden, when this whole thing's done, they're gonna be like, Dr.

[00:29:25] Dr. Grant Garcia: Garcia and Will, they have no idea what they're talking about. Every one of those guys got surgery at the season. But, you'll know, I mean, that first week is, you know, when we were, I was looking with the Seahawks and stuff, they, at the end of the week, at the end of that week after the season's over, is like, surgery mania for the, uh, for the sports players, right?

[00:29:43] Dr. Grant Garcia: They all come in and they get cleaned up, they get fixed up. And basically then you're, then you cleaned house and then you focus on getting back to the next season.

[00:29:51] William Sanchez: It's fascinating. And I love. how everything can be just very general, right? Just like, oh, he's got a little bruise. He's got a boo boo [00:30:00] here.

[00:30:00] William Sanchez: He's got a boo boo there. You'll be all right. This hurts. That hurt. Like, what do you mean? What, what happened? Right. You know, if it was one of our kids, but like, no, what happened? Oh, just something happened. Um, before we wrap it up, key player for the Eagles, not playing. Um, one of the Really one of the captains and we'll, we'll see if he's going to retire or not, right?

[00:30:21] William Sanchez: Because he, he had a great season, but we're not sure what's going to happen. Brandon Graham tears his tricep, I don't know, maybe about six weeks ago. What kind of injury is that? And we're just talking about injuries. We know he's not going to play that type of sustained injury for the tricep. He mentioned at his locker room, he was, you know, really feeling emotional about it.

[00:30:43] William Sanchez: And he was like, I knew. what that was. So, so what, what happens there when you take a tricep? What's going on with that?

[00:30:51] Dr. Grant Garcia: Well, first of all, that's a pretty uncommon injury, but we had the player for the giants that tore it twice. And, uh, it was a few years ago, one of the, um, I think it was one of [00:31:00] our tight ends or somebody anyhow.

[00:31:02] Dr. Grant Garcia: So he, or a fullback maybe, but he basically tore his, uh, tricep, um, off the bone and that's the muscle that extends your elbow. That's what gives you that sort of contour in the back. Um, and when you tear that, it's pretty much surgery every time. I mean, unless you really have, you know, have a lot of, you're very frail, et cetera.

[00:31:19] Dr. Grant Garcia: And it's a decent recovery though. And the problem you have, it's like tearing your pec or tearing your biceps tendon. You know, these are power muscles. So this is a long recovery. And again, there is a chance that, I mean, you can get back from that. We've seen it before. It's just that, and again, upper extremity stuff like arms and stuff are much better to get back than lower extremity, [00:31:39] right?

[00:31:40] Dr. Grant Garcia: Because you're not running on them like a patella tendon rupture. We talked about, it's kind of a nightmare, but triceps up here, there's a chance we'll get back, but this is just, could be the icing on the cake. Right. But this is, this is a long recovery and we're talking about six months, nine months to recovery.

[00:31:54] Dr. Grant Garcia: And again, is he ever the same? Does he have the same power? You know, we have a good, we have been repair these really well with all this [00:32:00] fancy things. Um, but nonetheless, it's, it might not be the same, but these big muscle ruptures are a big deal.

[00:32:06] William Sanchez: All right, let's, uh, let's, what, what should we do now? Let's, let's wrap it up before we wrap it up.

[00:32:12] William Sanchez: Let's do a little trivia time. I'm going to try to make it all kind of go, go along the rounds of You know what we suffered through this year with loses Saquon and just seeing him just be the great player that we always thought he could be with the right situation and the Eagles, the way they they protect the way they open up holes just was the perfect storm for the year that Saquon had.

[00:32:42] William Sanchez: Can, do you know who has, and I could take the player's name, I could take the Super Bowl, which is impossible. I would, I would never guess the Super Bowl, or at least a team. What player had the most rushing yards in a Super Bowl game? Can [00:33:00] you think of the team, the player? And I think if, if the Chiefs are going to have, I'm sorry, if the Eagles are going to have a chance at winning the Super Bowl, Saquon may come close to Achieving this record,

[00:33:17] Dr. Grant Garcia: uh, Terrell Davis was it?

[00:33:19] Dr. Grant Garcia: Or

[00:33:20] William Sanchez: is it? Let me see. this is not it. But he, h one point. Oh, that's, th if I even got that close, good. I'll take it. He ha was timmy smith, washington the time. Um, they beat t This is where the Denver on that buffalo bills, lo Oh, to the Giants, like, you know, before they got, uh, Terrell Davis. Uh, Terrell Davis is on the list, but he did, he is not number one.

[00:33:54] William Sanchez: In fact, uh, Terrell Davis. Who's number? Well, it depends, right? They have it by [00:34:00] appearances because the most yards ever is Frankel Harris, but that's over four appearances and I'm starting to get into the woods where nobody's gonna care at this point. So I'll just leave it as this. Um, hey, let's get predictions.

[00:34:12] William Sanchez: Who's winning the game?

[00:34:15] Dr. Grant Garcia: Well, I can tell you what I want. I want a tie. So neither one of them wins. That doesn't work. You can't ask for a tie. Um, I don't know, man. The eagles are just, I know the chiefs have been lucky and they've got a lot of things in their back pocket, like referees, et cetera, whatever you want to call it.

[00:34:35] Dr. Grant Garcia: Um, but I, I don't know, the Eagles look so good. They're pretty untouchable. And unfortunately they haven't, I mean, for me, I don't want to ever root for them, but they haven't had a running back like Saquon. And it's just going to be hard to beat them because when teams struggle, they go to their ground game.

[00:34:51] Dr. Grant Garcia: And that's like their best game right now. So it's just going to be really difficult. I don't know how they're going to be stopped. I don't think anybody's minus the chaos they [00:35:00] had early on. Um, it was not that much, but they haven't been, they've been untouchable. So

[00:35:06] William Sanchez: yeah, they made the,

[00:35:08] Dr. Grant Garcia: they made the commanders look like a joke and they were amazing.

[00:35:11] Dr. Grant Garcia: I mean, no one could stop jayden daniels and they just,

[00:35:15] William Sanchez: yep, their defense is good. They're rushed is good. Um, if they stick to the plan and they don't get cute and they run the ball, the chiefs rushing defense have not been good. The only thing that the really the chiefs has been really good at a defense is Points allowed.

[00:35:32] William Sanchez: They, they, they let you run up and down all over the field. And then they get to that, you know, to that zone, the red zone or whatever you want to call it. And they've done a good job of stopping teams from scoring. I think they were ranked number two, uh, this season in scoring defense. The problem is the Eagles had the number one, uh, defense where, uh, where points allowed and one of the top rushing games, uh, in the NFL.[00:36:00]

[00:36:00] Dr. Grant Garcia: It's a one two comma. That's a problem, right? You can stop one, but you can't stop both.

[00:36:03] William Sanchez: Yeah. And the fact that the Chiefs lost Rasheed Rice, which I thought was a big, big loss for the season really hurt. I know they have some other players to step in, but he was different, you know, different looking player, different speed, uh, different weapon.

[00:36:19] William Sanchez: That said, I'm rooted for the Chiefs. All right. I just, I can't, I can't, I know everybody else would be like, they have chiefs fatigue and I saw a map. It was like, it was like Kansas city root for the chiefs, Philadelphia root for the Eagles. And then it had the rest of the country. It was like, no one cares, right?

[00:36:39] William Sanchez: They care about the game, but they just, they can't root for either team. I can't stand Nick Sirianni. He's one of those guys, but. Like I said, I'm biased. I am a Giants fan. I feel a certain way. I feel a certain way about the Eagles, the Cowboys. We're going to, uh, obviously I'm going to feel a certain way about Washington, especially the way their future looks.

[00:36:59] William Sanchez: So I am just, [00:37:00] I'm okay. I'm happy saying I'm just grumpy and I want misery. It's, it's hard. It's my part of my fandom, right? I'm completely fine with that. So go Chiefs. But my brain says, If the Eagles put it together the way they've been doing all year and just stay the course, they don't have to do anything extra.

[00:37:17] William Sanchez: Just stay the course. They're going to have a great chance of winning this game. Anyway, let's wrap it up. Let's thank everybody. Please check us out at sportsdoctalk. com. We've got episodes, we've got shows, we've got transcripts. If you don't want to listen to us, read about us. It's probably way better than listening to me jibber jabber all over the place.

[00:37:37] William Sanchez: So grab a transcript, check it out. If reading is your thing, uh, We love your emails. We love ideas about future shows. We've had people reach out to us to be guests on the show. So keep it up. Sports. talk. com. Dr. Garcia, any last words as we wrap it up?

[00:37:58] Dr. Grant Garcia: Yeah, lots of fun [00:38:00] stuff coming. We got a bunch of guests already that were going to be lined up.

[00:38:03] Dr. Grant Garcia: We're really excited. I think our issue now is just finding time to get all the guests on. Um, but we want to make sure we get back to some of those things. people like some of the c we talked about. So they in here between these and want us to talk about, le we're open to any topics. this show pivots, you nev show, next show is

[00:38:23] William Sanchez: going true.

[00:38:25] William Sanchez: We hope everyone en sunday and they have a gr Had too many drinks. We got uber. We got lift. We want everyone to be safe and happy. Even if you're miserable because the team that you root for didn't win. It's okay. We want to make sure that you're around so you could roof your team next season. Thank you, everyone.

[00:38:47] William Sanchez: Will Sanchez, Dr Garcia. We're out. Enjoy the game.

Audio Transcript

[00:00:00] William Sanchez: Welcome to Sports Doc Talk. Check us out at SportsDocTalk. com. I can't talk. What is going on with me? I'm a hot mess, Dr. Garcia. Welcome to the show. Our orthopedic surgeon and sports medicine specialist, I am tongue twisting Will Sanchez. Dr. Garcia, how are you? We have a great guest, but before we get to him, how are you?

[00:00:40] Dr. Grant Garcia: I'm awesome. And, uh, sticking with the thing, we have our logo in the background, heart health for Dr. Dave. He's going to love that. So anyhow, I am good. I'm super excited for this guest. Uh, you know, this is going to be, I've been waiting for something like this because again, we've talked about this so many times.

[00:00:57] Dr. Grant Garcia: Bronnie James, DeMar Hamlin. [00:01:00] And we talked about it. I talked to my friends that are cardiologists, but to have a celebrity cardiologist on with us today, that's going to go over all this is pretty awesome. And I think this is a good episode, obviously, to go over everything, you know, we had, we're going to, we had some technical difficulties with this, and this is, this is going to be important for people to see.

[00:01:18] Dr. Grant Garcia: We had to salvage this episode, right? Cause it was, and it was so valuable and honestly, everything Hopefully we'll hear and everything else be so important that we were able to save it. So I'm pumped. There's a lot of work to save this episode, but I really think that the viewers are going to appreciate it.

[00:01:34] Dr. Grant Garcia: So if it's a little different than our other one. Just bear with us. But if you're listening on, uh, if you're listening on the, um, Spotify, it probably won't be a big difference. If you're on the YouTube channel, it'll be a little different. But again, the content's the same. You're going to learn something.

[00:01:51] Dr. Grant Garcia: It's going to be more than you wanted to know about. It'll be awesome. And you might even get a little conspiracy theory on this one. Who knows?

[00:01:57] William Sanchez: Yeah, no, this, uh, just to [00:02:00] reiterate with Dr. Garcia Sand, uh, this is a great episode and that's the reason why we've gone through so much to make sure that you get the information because Dr.

[00:02:09] William Sanchez: Dave is damn awesome and his information is great and we just really appreciate him. Uh, so. As Dr. Garcia said, it's going to be a little bit different. We're going to do some, some segments. We're going to toss to what he's saying, but I think overall the information that you're going to get out of it, you're going to be really, really happy.

[00:02:29] William Sanchez: But before we do that, we know that we have some friends at the recovery shop because we talk about them all the time, all the goodies from the HR robotics and the nice machine and all the other things. But, Let's not listen to me because I'm not the doctor. I just, I use some of the stuff when I'm injured, but Dr.

[00:02:49] William Sanchez: Garcia is, this is his wheelhouse because he's going to let the patients know what they could use from the recovery shop.

[00:02:57] Dr. Grant Garcia: So thank you to our sponsors for recovery shop. You've seen it [00:03:00] before again, for surgeons that want to go take their practice, the next level, their patients are going to come in and ask them.

[00:03:06] Dr. Grant Garcia: Yes, that surgery sounds great. Your techniques sound great. I trust you. What else can you do for me, though? What you're doing is not enough. I want more. And I'm going to tell them this is your option. Right, you have paid, you have this place where you don't have to go online and search for 15 different items to help a patient get back.

[00:03:22] Dr. Grant Garcia: You don't have to go on Amazon and find them something unique that's maybe not even from the United States that they're buying. This is a way they can get the top of the line ice recovery machines. The top of the line from a vending machine standpoint. Scar creams, you name it, all stuff that you wanted your patients to have that you have solidified as a good part of your practice.

[00:03:41] Dr. Grant Garcia: And finally, if you want something that's not on there, it's really nice as a surgeon, you can add it. Again, I get, you know, this is a sponsored show, which is beneficial, but I get no cut for you signing up for them. So, again, I just really wish that all surgeons offer this because if I was a patient, I would want to know like what other options can I do, right?

[00:03:58] Dr. Grant Garcia: Like there's only the [00:04:00] insurance covered standard options and that's not good enough for a lot of my patients. Uh, so it's awesome to have this, this extra thing. So thank you guys. So, again, we're going to sidetrack back into Dr. Dave Montgomery. This is a cardiologist, founder of the Prevent Clinic, executive producer of his own podcast, TV personality.

[00:04:21] Dr. Grant Garcia: I mean, this guy's got it all and you'll see why in a minute, uh, but, you know, again, Will will go after it too, but again, this guy, I'm so excited when we get this opportunity to have him on, you're going to see so many different things. We'll talk, show you his website, his Instagram. Not a bad looking guy too.

[00:04:36] Dr. Grant Garcia: So it's going to be a great combination of things.

[00:04:38] William Sanchez: Yeah, no, it was absolutely amazing and, uh, check him out DaveMontgomery. com amongst his other things. And it was so funny. Uh, you know, we teased about it. It's like, what don't you do? And at the time we did the recording, we were having all this, you know, remember we were talking about the weather.

[00:04:55] William Sanchez: I was like, are you a weatherman? Also? He's like, I do the weather also. So he was just, he [00:05:00] was absolutely great and we appreciate his time. But to kick off the show. Especially with the NBA season off and about and one of the main things that happened on the offseason was with Bronny James and what happened to him on the court when he was at USC before he got drafted to the NBA to play with the Lakers.

[00:05:21] William Sanchez: And Dr. Dave has some great insight on that. Enough from talking about and hearing from us. Let's toss it, toss it over to Dr. Dave. The

[00:05:29] Dr. Dave Montgomery: truth

[00:05:29] William Sanchez: of

[00:05:30] Dr. Dave Montgomery: the Bronny James story is we don't really know what happened and There's a lot of sort of gray area in there, right? He's practicing, this is last year. He's practicing, and apparently collapses.

[00:05:43] Dr. Dave Montgomery: Now, so, you know, Doc, you know this. If you have one of the most common forms of fainting, we call it vasovagal syncope. Fancy words for your brain just shut the lights out because it wasn't getting enough blood. And when you have vasovagal [00:06:00] syncope, everything goes down. So the opposite of the fight or flight system is the rest or digest system.

[00:06:06] Dr. Dave Montgomery: The rest or digest, kind of think about a rest. Everything goes down, you go down, heart rate goes down, blood pressure goes down. But you also get some digestive stuff too. With the rest and digest system, your heart rate can be so slow that if I came up to you, After you passed out on the court and, and checked for a pulse, right doc?

[00:06:25] Dr. Dave Montgomery: Boy, I may not feel one for four, five, six seconds. And you don't have to necessarily have cardiac arrest. If you do that and you're not patient enough, what, what would you do? You would immediately start doing chest compressions, especially because it had been in the news. Everybody's talking about it.

[00:06:45] Dr. Dave Montgomery: You've got arenas in high level sports arenas and practice facilities like that, people are ready to go. What I think the wild card is there, just in that story, is whether or [00:07:00] not they pulled out the AED, the Automated External Defibrillator, and applied it to his chest. Now, if they did that The AEDs are pretty smart, right?

[00:07:09] Dr. Dave Montgomery: I mean, it will tell you if there is a rhythm that is incompatible with life. And it will recommend that you shock the person. So, here's the bottom line. If Bronny got shocked, he had cardiac arrest. If Bronny did not get shocked, you can't convince me that he had cardiac arrest. You just, you just can't convince me.

[00:07:32] Dr. Dave Montgomery: He didn't get cooled, we didn't hear anything. Now, listen. All of this is, is, is roughly speculation because we don't really know much. And it's his prerogative not to talk about it at all. His family's prerogative. Hey, you've got to, you know, protect the brand. I got it. But if he had truly a cardiac arrest and remember the family came out, the representative of the family said he has a diagnosable.

[00:07:58] Dr. Dave Montgomery: [00:08:00] anatomical condition and that it's treatable to the point where he'll be back to play soon. Something like that. You remember this? I, I remember jumping on Instagram as soon as I heard it. I was like, Whoa, this is good. Yeah. So I go back to, you know, the old college cardiology, like textbooks, like. Wait, what condition gives you bona fide cardiac arrest that you have an anatomical condition that is treatable to the point of cure?

[00:08:31] Dr. Dave Montgomery: Now think about it. There are some conditions, and we'll probably hit on some of those, where there, we don't have a cure yet for, for the most common form of some of these, uh, cardiac arrests, the common, the common cause. So I'm thinking to myself, well, what in the world could this be? This is like a, you know, an episode of House.

[00:08:49] Dr. Dave Montgomery: Like, what is this?

[00:08:50] Dr. Grant Garcia: And

[00:08:51] Dr. Dave Montgomery: that's why, and I grab back on those same networks. Um, and, and, and speculated, I [00:09:00] speculated that, in fact, he did not have a cardiac arrest, that he probably passed out, and maybe there, listen, doc, there's so many things, right? Well, you know, there are conditions that you're born with, you have a hole in the heart, the top chamber, bottom chamber, you know, there's electrical abnormalities, right?

[00:09:16] Dr. Dave Montgomery: There are things that you could have that are treatable that will just make you pass out. Um, and I think one of the big gaps that leaves everybody wanting to understand it is because you say, Well, boy, this is happening a lot. Happened to DeMar Hamlin top of the year, then happened to Brawny later in the year.

[00:09:37] Dr. Dave Montgomery: Like, what's really going on? And it just sort of leaves us without any information about, you know, what to do next. How do I protect my kid who's 10? I want him to play ball, but I don't want him to die. On the field of play

[00:09:51] Dr. Grant Garcia: enough of this enough of this. We finally we finally actually want to hear about what Dr.

[00:09:56] Dr. Grant Garcia: Dave does because he went straight into brawny. We know it's a hot topic. [00:10:00] You got LeBron James and his son playing together, but we haven't heard anything about what Dr. Dave actually does. It's minus my Explicit and extravagant introduction of him. But please talk about, Dr. Dave, your passions for the industry, the Prevent Clinic, the Health Mastery Cafe show, all the marketing things you do for heart disease.

[00:10:21] Dr. Grant Garcia: You know, you're a real doctor, right? You don't just play one on TV. So tell us more about that.

[00:10:27] Dr. Dave Montgomery: I'm a cardiologist. I'm a preventive, non invasive cardiologist here in Atlanta. And, um, I recently, six years ago, I guess that's not so recent, but, six years ago I branched off from a very large, um, cardiology and cardiothoracic practice to start my own.

[00:10:43] Dr. Dave Montgomery: clinic here in Atlanta called Prevent Clinic with capital P R E, like defense, prevent. We want to get there before the event happens. The events that we're really, um, focusing on are preventing people from dying from heart attack, [00:11:00] stroke, and heart failure. And we know how to do that, right? And it's not just because Dave Montgomery started a clinic.

[00:11:04] Dr. Dave Montgomery: It's like That's the biology, that's science, that's the current state of medicine. And I just decided to practice in a different way than I was able to practice in a large group and very happy about it. Our podcast is called the Health Mastery Cafe and believe it or not I started the podcast back in 2011 in Chicago, so I was still training.

[00:11:25] Dr. Dave Montgomery: Um, in my last year of training at Northwestern University in, in Chicago. And, um, I, it was, I was struck by, when I was a, a, you know, a second year resident, I was struck by hearing how heart disease is the number one killer far and away, and exceeds all of the common cancers combined. But there are two kickers here.

[00:11:53] Dr. Dave Montgomery: So everybody kind of knows that, not everybody, but most people know that. But the kickers are, we know what causes it, [00:12:00] Grant, Will, we know what causes most of the forms of heart disease that kill people. We don't know what causes many of the cancers. Here's the second thing. We know how to prevent people from dying.

[00:12:12] Dr. Dave Montgomery: So now, somebody's got to tell me, how does a condition, a set of conditions, that far and away kill more people than anything else, That we know how to prevent from killing bit. Why is that still look at? Why are we? Why am I still saying this right now to you on your podcast in 2024? And the problem to me is that we have a marketing problem.

[00:12:35] Dr. Dave Montgomery: We have first, we have a public relations problem, but that's that's the bigger problem, right? That that sort of came out in covid. You know, we really have a PR problem. But the marketing problem, what in the world is going on where we can't get the basic message out to most Americans, most people everywhere, remember heart disease is the number one killer in most of the world, and say these are the things you should do to prevent yourself from dying from heart disease.

[00:12:59] Dr. Dave Montgomery: Now I didn't [00:13:00] say we could stop everybody from developing forms of heart disease. But we know how to stop people from dying. And we know how to help people recover. And so I just decided, you know, way back then, that this, you know, just seeing patients, which I love, do it every day, um, was not enough. That, that, oh, if I can just change one person.

[00:13:20] Dr. Dave Montgomery: No! That's not enough. When are we going to say no? Changing one person's not enough. Changing large, at scale, uh, lives, that's what we really should be doing. And so I decided to go into media, and, and, boy, it was hard. Started off in print media, then I started, uh, then I went to, to radio. We'd do a live show every, you know.

[00:13:43] Dr. Dave Montgomery: Once a week, I was kind of the Dr. Oz of this radio show, so I would sneak off, Grant, I'd sneak off into the call room in the middle of the day on like a Wednesday. Like, where's Dave Fung? You know, Pagers going off, because we had Pagers back then. Pagers are going off, meep meep meep, and I'm on this 30 minute, you know, [00:14:00] call, um, taking it from the call room.

[00:14:02] Dr. Dave Montgomery: And then I started doing television, and then this podcast came along after we had some success with television. And wanting to have long form conversation, you can already tell. Talk a lot, right? I want to have long form conversations, but I wanted to do it in a way that was a little bit more approachable, a little bit more accessible, and not a whole bunch of scientific mumbo jumbo.

[00:14:21] Dr. Dave Montgomery: Like, I've got a bunch of scientific mumbo jumbo for you, but that's not what gets to people. So I started it in a cafe in Chicago. It used to be called Crew Cafe. It's no longer there. And we literally would have two microphones like this and be talking at the table, drinking whatever we were drinking.

[00:14:36] Dr. Dave Montgomery: And that's where the, the, um, the name of the podcast came out. The Health Mastery. I think in order for us to be in this body, we gotta be in this body every single day. We may as well master it. Um, and just do it in a cafe, the Health Mastery Cafe. Boom, there it was. It sounded a little wonky. People told me that was a stupid title.

[00:14:54] Dr. Dave Montgomery: I'm like, I'm sticking with it. It's like Google. Like, who loved Google when they first came up with that title? [00:15:00] Um, but that's, that's it. And so what we're trying to do now is elevate the conversations. into the current topics that people are talking about, because there's a lot of misinformation. Um, and I want to bring conversations to people where they are, without, you know, using a bunch of jargon, um, but hearing people's authentic stories.

[00:15:21] Dr. Dave Montgomery: That's a real common word now in the common parlance, right? Authentic. But that's really what drives people. It's the emotion of story. And that's what we're doing here. We're taking people's stories, their health stories, and extracting keys and tools for mastery. And that's what we do. [00:15:40] William Sanchez: So obviously, you know, Dr.

[00:15:41] William Sanchez: Dave is doing so many different things. Um, we're really excited that he was here, uh, and able to provide all this information. The next segment coming up, he really kind of gets into really his passion, right? And that's screening athletes and screening tests. And he's going to explain in depth. [00:16:00] Why these tests are so important.

[00:16:02] William Sanchez: He's going to go over a bunch of tests, but really highlight three of them. And at the same time, he's going to talk about the lack of marketing. So Dr. Garcia, when it comes to marketing in your field, how important is it? Because. Dr. Dave is going to get into that, but just, I want to know what it is for, for you as a surgeon, why marketing is so important for the patients to understand what options they have.

[00:16:24] William Sanchez: I

[00:16:25] Dr. Grant Garcia: mean, this marketing is, and you're going to hear from them, cardiologists don't do it well, orthopedic surgeons don't do well. The marketing is essential. It's not just essential to get patients into your clinic from a clinical standpoint or surgical standpoint, but it's our most important actually to get your message out.

[00:16:41] Dr. Grant Garcia: And that's what we do this for, you know, this is a unpaid thing that we do. We do this because we enjoy it and we want to get our message out. I want to teach people about these injuries. I want to teach you about these concussions. I want to teach you about these surgeries so they know they exist. They know the protocols.

[00:16:56] Dr. Grant Garcia: So if something they see doesn't seem right and they're like, listen, that does actually [00:17:00] help. I mean, that's what I get a lot of my patients coming in for. They're like, I had no idea this has been an option and that's why I do it because I want to make sure that everybody gets the best possible care.

[00:17:09] Dr. Grant Garcia: And that's exactly what Dr. Dave does as well. It's awesome.

[00:17:14] William Sanchez: Yeah. And besides the, the test he talks about the messaging of why it's important. So people could get more of information, be become knowledgeable. He hits us up with a Demar Hamlin and his thoughts on it. It's a must listen. So I'm really excited to tease what's coming up next.

[00:17:34] William Sanchez: Don't listen to us. Let's go back to Dr. Dave.

[00:17:38] Dr. Dave Montgomery: I want us to come back to the DeMar Hamlin, um, story because I've got a, another angle, but before we do that, the, the message that came out, um, I think was really clear after DeMar had his arrests and he had more than one, um, was that we should be screening our elite athletes at the collegiate level, [00:18:00] at the professional level, period.

[00:18:04] Dr. Dave Montgomery: It is too simple to do a stress test, folks. To do something called an echocardiogram, which is an ultrasound of the heart. And, um, to do a basic, you know, exam in an EKG, right? It's too simple to do that, and it casts enough of a broad net. In the cardiovascular world for that age group to be able to find the commonest forms of sudden cardiac arrest.

[00:18:30] Dr. Dave Montgomery: The most common forms of sudden cardiac arrest would be found in those three things. EKG, echocardiogram, different than the EKG, electrocardiogram. So, EKG, dots on your chest, ultrasound, echo, think sound, ultrasound, echocardiogram. and a treadmill stress test. Most of the ones, the anatomic ones, like hypertrophic cardiomyopathy, HCM, or the electrical ones, like long QT syndrome.

[00:18:56] Dr. Dave Montgomery: We've got a whole bunch of little fancy words, but many of those would be caught [00:19:00] with those exams. Now tell me somebody, please, in our elite athletes that we know are leaving high school and going to, you know, really rigorous sports programs in college, collegiate programs across the country, or from college, and no matter when they're leaving, to professional.

[00:19:17] Dr. Dave Montgomery: Tell me why we shouldn't. Does it, is it the cost? Are you kidding? I would get, listen, I don't even know who to talk to, but I could call Nike right now and boom, I've got a, I've got a title sponsor right there to make sure everybody gets screened. Like, these are not, uh, expensive exams. And it's, the, the point, uh, that you make, Grant, is because you're an elite athlete, you don't think about your health.

[00:19:44] Dr. Dave Montgomery: It's the last thing you're thinking about. Tom, how old was Tom before he said, you know, I got to stop eating this crap. I got to stop drinking this, this getting drunk, you know, the weekend before the game, you know, the week before the game, like it, it, it, it takes an evolved [00:20:00] human being to go there. And I'm not really sure because, you know, I was 22 before I was not evolved at 22 thinking about, you know, the implications for my health.

[00:20:11] Dr. Dave Montgomery: Nobody's thinking about that at that age. You are running faster than anybody on the planet. You're hitting people. I mean, it's just, it's unbelievable the kind of feats that these guys can do, guys and gals, because it's not just guys, for example. But if we don't test, you don't know. That's what I tell patients all the time.

[00:20:29] Dr. Dave Montgomery: You can feel amazing. We all have heard of stories of, of, of marathoners, triathletes. Oh my God, they were, you know, so healthy. But what happened to them? Boom. We've all heard of it. Oh, it's about to cross the finish line. And that's not a myth, by the way. That's not like folk folklore. That's real people, you know, about to cross the finish line and literally have a cardiac arrest before they cross.

[00:20:50] Dr. Dave Montgomery: We've heard of all of that before. Who's healthier than a marathoner? Nobody. So if you, there are some things, and here's the other thing I tell my patients, Grant, [00:21:00] Not everything that can harm you hurts. Not everything that can harm you hurts. Not everything that can change your life instantly will give you a symptom.

[00:21:10] Dr. Dave Montgomery: That means there's a bunch of things that are asymptomatic. And in this group of patients, this group of people, who we really are asking for so much, tell me why we shouldn't be doing it. Somebody, please. Tell me why we couldn't just spend, I don't know, a thousand dollars, twelve hundred bucks, I don't know, less.

[00:21:29] Dr. Dave Montgomery: In my lifetime, I've never seen what happened to Neymar and Hamlet. We've never seen that before. So, truthfully, it is rare, but it should just never happen. That shook the entire world. This is, this is, you know, there are some guys who were sitting on, standing on that field that saw that, that right now Are seeing a therapist.

[00:21:52] Dr. Dave Montgomery: This is far more. This is it's got far reaching implications. This is not just, Oh, yeah, we just, you know, one guy had a cardiac arrest. [00:22:00] These guys are PTSD. You know, how many games did it take them to start hitting each other the same? Like a lot. I mean, we could, we could have an entire movement afoot starting at, at, you know, sort of Collegiate bound high school athletes.

[00:22:14] Dr. Dave Montgomery: Just start with that small Group and just scream those folks because I want people to understand that although it seemed like there's a whole bunch more cardiac arrest We had Caleb White after Brawny and then then before Brawny we had DeMar Hamlin like all of that and it was in the news, but the truth of the matter is Um, kids have, you know, playing, playing sports, have cardiac arrests every year.

[00:22:37] Dr. Dave Montgomery: It's about the same, one in 100, 000. So I would get asked on the news, Hey, is it more common? No, we just had two super high profile, um, examples, super high profile, like right in the middle of a game. Are you kidding? We've never seen that before. And then, you know, the son of the king, I mean, we've never seen that.

[00:22:56] Dr. Dave Montgomery: But the numbers are about the same. I [00:23:00] will tell you that, um, one of the things that I want to say here that I, that I said, I just made a little small, um, Instagram post because there was a, a, I got a lot of questions, uh, when DeMar, Um, with Brawny, I'm sorry, when Brawny had his event, who again, we don't know what happened.

[00:23:18] Dr. Dave Montgomery: And they were saying, well, you know, why is it more common in black athletes? And it just sort of seems like that would be right, because there are a lot of different heart conditions that are more common in blacks than there are in other populations, particularly whites. This is not one of them. And there's a number of reasons to talk about this.

[00:23:39] Dr. Dave Montgomery: Number one, if we're going to start screening athletes, but you think that only a certain population of athletes is affected, what if you don't have that kind of athlete at your school? There are plenty of, uh, uh, you know, uh, schools, you know, great programs across the country, that have zero black athletes, right?

[00:23:57] Dr. Dave Montgomery: So if you think it's only black athletes, you [00:24:00] won't get an AED. You're not gonna screen any kids? Are you kidding me? What's an EKG? What do I do that for? But here's the truth. It all came from an older study when it looked at a five year period of NCAA, um, athletes. This is the only data that we had of this magnitude.

[00:24:16] Dr. Dave Montgomery: And it really was a survey study, a retrospective study. And in that study, what it showed, and I pulled it up, I'm just going to kind of pull it up here just so I can kind of quote right from it. The main graph on the study grant, Um, showed that there were, uh, uh, 45 total NCAA athletes that had, uh, deaths from cardiac arrest in this time frame.

[00:24:38] Dr. Dave Montgomery: Okay, the five year time frame. Here it is. 45 deaths, 11 of them were female. We don't really think females when we think cardiac arrest. It's a quarter of them, they're having cardiac arrest too. Of those, um, 27 of the 45 were white, 17. We're black. [00:25:00] Wait, stop. What are you talking about? It's more. Ah, I see.

[00:25:04] Dr. Dave Montgomery: You have to do a statistical manipulation. Now, I've said on my, um, my little post, uh, grant that the, the larger, uh, public, the society doesn't care about some statistical, uh, manipulation. There were more white athletes that had cardiac arrest than there were black. And we have to say, okay, well, if that's true, that means.

[00:25:26] Dr. Dave Montgomery: White athletes are having a man, but we should just start, you know, when it comes to, uh, a screening, when it comes to preventing it, we got to target everybody. The way that it happened, here's the, here's the bottom line, the way that it happened was the sample size for blacks was so much smaller than whites.

[00:25:40] Dr. Dave Montgomery: And so when they did the rate, right, the death rate, it made it seem like there were more. And the question always is when you have, um, an uneven, non, uh, controlled, randomized control where every, both sides are the same. is if I had more subjects in one side with the [00:26:00] numbers of deaths changed. So here it is.

[00:26:02] Dr. Dave Montgomery: I'm not, I don't want to get too wonky, but there were 300, 000 athletes that they looked at. They call them athlete years, but to make it simplified for, for viewers, 300, 000 athletes, let's call it. Those were 300, 000 black athletes to 17 deaths. There were 1. 6 million white athletes. to 27 deaths. So you see the rate makes it seem like that it's more likely to happen in black athletes.

[00:26:30] Dr. Dave Montgomery: They're just more white athletes that are in this study that are in the NCAA. Okay. So the question always is for people who are being statistically rigorous. What if those numbers were the same? What if there were 1. 2 million black athletes? What would the numbers be? And that's why I said, hey, listen, the, the, the reasons for cardiac arrest, the main and common reasons for cardiac arrest are not more prevalent in blacks than they are in whites.

[00:26:59] Dr. Dave Montgomery: HCM [00:27:00] is not a condition more common in blacks. We know that. Uh, um, you know, long QT is not more common in blacks. ARVD is not more common in black. You get what I'm saying? So, if we're going to be rigorous and we're going to be right about it and not just sort of have, uh, you know, a, um, uh, something for the news, right?

[00:27:21] Dr. Dave Montgomery: Because this is, this has more implications than being sexy and attractive. and pithy for your new soundbite. This is like people's lives. Like who wants to lose their child playing sports? So let's get really wise about this. I see people across all races, across everything you can imagine. Celebrities, not celebrities.

[00:27:41] Dr. Dave Montgomery: You just, you name it. Judges, it doesn't matter. I see them all. And I care about every last one of them. And so I care about their kids. We don't want these kids to die. You should be screening all the athletes that you think are going to go to that high level, whether it's collegiate or pro, and it's easy to do.

[00:27:58] Dr. Dave Montgomery: At the end of the day, we've got to say [00:28:00] cardiologists, people who study heart disease, that's the whole cabal, all of us, we just don't market well. So the reason why it's not on, you know, the radar for the owners association. meetings is because nobody's making no, listen, if we would do half of what Susan G Komen did, think about this.

[00:28:23] Dr. Dave Montgomery: I mean, you got big old defensive ends, man, pink all the way to the boom, pink, you know, underwear, like everything that's marketing. At least you, you've increased awareness of where the people who are involved in it are just so emotionally involved that they don't care about what color That's the marketing.

[00:28:42] Dr. Dave Montgomery: So let's find the Susan G. Komen's for the hard people. I, that's what I think the main things and the main reason is. That we aren't, that we don't see it more commonly now, and that we're still talking about the need for it now is because not somebody else, it's us. And until we take [00:29:00] responsibility and say we're going to do something differently about it, and then go and get some, some, some supporters and, and sponsors to make it as big as Susan G.

[00:29:09] Dr. Dave Montgomery: Komen has done, then we're going to keep having these conversations. I think that athletes get smart when they leave, right? Because I actually do. I see, uh, a lot of former athletes. I see referees, active referees, uh, across sports. Um, and, you know, they come in and, you know, sometimes I have a question. I'm like, man, you know, if we could just get your whole team, because I'm marketing, man, okay?

[00:29:34] Dr. Dave Montgomery: If we can get your whole squad to just get one of these Echoes. Wouldn't that be great? Um, I actually know people in the, in the PA. Uh, you know, the kind of, you know, help run that. Um, men and women in the, in the different player associations. And, you know, it happened to be Patience, right? Um, and I, hey, yeah, you know, when the DeMar Hamlin thing, I wrote something up, boom, slide this over.

[00:29:54] Dr. Dave Montgomery: I don't care who you slide it to, I'm just shooting my shot. I'm shooting my shot. Somebody's got to start [00:30:00] thinking about this. And before I'm done talking and yabbering my, you know, the, the, the, the time when I just hang up my jersey, my podcast and TV jersey, I will have done the best that I could to try to get the message out.

[00:30:15] Dr. Dave Montgomery: I did want to hit DeMar Hamlin if I could, because Um, I, I don't know if people remember, I, I'm, I'm, if you don't remember, I want you to go back to the video. There's a lot of different clips on YouTube. We all were asking the question, what happened to Demar? And it was, you know, just sort of one of the more popular things to say that he had what's called commotio cordis.

[00:30:43] Dr. Dave Montgomery: When you get hit in the heart at the very wrong time and you hit it at a certain phase of the EKG, if you will, the electrical activity, it can throw it into a very chaotic heart rhythm and that chaotic heart rhythm causes your heart essentially to arrest. It [00:31:00] stops beating and you have cardiac arrest.

[00:31:04] Dr. Dave Montgomery: That has to happen with a relatively direct blow to the chest and at the right time. We've seen that in lacrosse. Ssssah! Pow! Right? Hockey! Bang! Right? We've seen that before. If you get Baseball! Yes, okay? If you go back to the hit, Higgins on Hamlin. Speed it up. Go double time. Slow it down. It doesn't matter.

[00:31:33] Dr. Dave Montgomery: Watch every angle. I watched every angle before I got on the news. Every angle, he did not hit him hard enough. That's, think, go, go back and look, I wish we had a clip. He didn't hit him hard enough in the chest in order, and direct enough in the chest. There was one view, guys, that I saw. And it was from over here.

[00:31:54] Dr. Dave Montgomery: Okay. Damar, the helmet of [00:32:00] Higgins, went up and into the jaw of Damar Hamlin. Now let's stop for a second. The jaw is an extension, I don't have to tell the orthopedist, the jaw is an extension of the skull. I mean, come on, he's getting his bell rung, I don't know, a couple, five times a year. He gets his bell rung.

[00:32:21] Dr. Dave Montgomery: When he went down, do you remember what he did? He stood up. Now, Doc, he stood up. He adjusted his helmet and about two seconds later, what did he do? He went down and he didn't. He went straight down. He had lost consciousness. Now, he didn't guard himself. He didn't brace himself. His arms didn't go out and he popped his head again.

[00:32:48] Dr. Dave Montgomery: Now, I know it's not popular. I said it on a whole bunch of outlets. Until proven otherwise, he had traumatic brain injury, right? [00:33:00] He had traumatic brain injury that turned into a traumatic cardiac arrest. We've seen that before. That's not like something new that we just made up. You can have such a traumatic brain injury that you go into cardiac arrest.

[00:33:10] Dr. Dave Montgomery: That's known. And if you think about it, his heart didn't stop immediate. Camoscio Cortis, my friends, your heart is not doing a thing. It's shaking. Pop, and are you going to get up and have enough blood flow to the brain to adjust your helmet? Right? And then he was moving when they first went to him. His legs were moving.

[00:33:33] Dr. Dave Montgomery: You don't move a thing when you've got commotio cortis. Think about it. He wasn't in cardiac arrest immediately. Comotio Cordis doesn't say, let me wait for it, wait for it, boom, let me get, no. That's not how it works. And I know I'm being a little tongue in cheek, but that's not how Comotio Cordis works. So I'm sitting there as a scientist, I'm like, that's not Comotio Cordis, guys.

[00:33:58] Dr. Dave Montgomery: And then, [00:34:00] remember how long it took for the, the um, paramedic to come out and start to, right? I mean, that was a long time. Comotio cordis doesn't behave like that. It's just not biologically feasible. I mean, somebody falls from a high, you know, from a high altitude and lands on the ground, they go into cardiac arrest.

[00:34:16] Dr. Dave Montgomery: Not because the heart got smashed, because it was such a traumatic thing. You get this overload of adrenaline and all the other hormones that make your heart, and you just go into, So we know that this is a real thing. Um, I, I did want to just sort of talk about, um, how he went back into cardiac arrest. So once they got his heart back, which if you get there fast enough in commotio cordis, okay, maybe, maybe you can save him.

[00:34:43] Dr. Dave Montgomery: But to your point, Doc, listen, it's really hard to save him in commotio cordis. Um, they got him to the hospital. And he went into cardiac arrest again. If it were commotio cordis, [00:35:00] he didn't get hit again. He didn't get hit again. Why did he go back into cardiac arrest? Now, you could say there's a number of reasons.

[00:35:06] Dr. Dave Montgomery: Oh, you know, the, the, the fluids, you know, all the stuff. And, and I think that that's feasible. And maybe that's a weaker point of what we're talking about. But when he stood up and, and, and adjusted his helmet, He reminded me of Tagovailoa, when he got his bell rung a couple times, you remember that? He got up, uh, uh, yeah, right?

[00:35:26] Dr. Dave Montgomery: Yeah, I mean, he was like, he was stunned, did that, right? It's this, it was a similar kind of thing. Now, it's not sexy for the NFL to have heard that, but I also said on Tom Llamas, Listen, the NFL is doing the absolute best that they can to try to make this game as safe as possible. We've never seen that before.

[00:35:45] Dr. Dave Montgomery: Come on, it's the first time for everything. It's not like they were like, oh yeah, we don't care about the players. Nobody believes that anymore. We just have never in our lives seen that kind of hit. And guess what? You're not telling folks. Hey, got my [00:36:00] bell rung, right? If you get up and stupor around a little bit.

[00:36:02] Dr. Dave Montgomery: Okay, you got to go on, you know, concussion protocol. But I mean, there are a whole bunch more bells rung than we'll ever know. Right? I mean, think about pop Warner. You don't even talk about it when you're like this big. Um, so it could very well be that that was just the last one that his body could take.

[00:36:19] Dr. Dave Montgomery: He's like, Oh, well, you know, that's not enough. How do we know how many he's had? Through the course of two years, three years, I don't know. I'm really excited about this movement toward body imaging, full body imaging for, you know, the general population, but certainly for athletes. I'm looking forward to AI being, um, dovetailed with the current medical science and turning scans into super rapid, uh, accurate exams for stuff like HCM, ARVD, right?

[00:36:49] Dr. Dave Montgomery: I mean, some of the structural stuff that we can see. That changes people's lives. And then some of the other things, right? Right, Doc? So, you know, I mean, think about if you've got this super fast, uh, you [00:37:00] know, imaging MRI that you don't have to, you know, take somebody way off, you know, across the city to get a really high tech, uh, MRI.

[00:37:08] Dr. Dave Montgomery: And so when it comes to imaging and, and preventive testing, That's what I'm excited about. I can't wait till they get this right so that it's not such a big deal to to have your, um, your college athlete who, you know, is going to the pros to just go to one of these centers, soup, soup, soup, do the test and come out with.

[00:37:28] Dr. Dave Montgomery: Uh, you know, uh, what to do, you know, what not to do, what to eat, what not, I mean, that kind of stuff.

[00:37:33] William Sanchez: I really hope that you, the audience had a chance to learn something, to be excited about it, and really to get some information, you know, as I know for myself, whether it's the Echo exam, the EKG, the stress test, just.

[00:37:48] William Sanchez: You know, I'm getting older and we're talking about it from someone my age, but really the importance of our young athletes that are playing football, playing these sports to have these tests to [00:38:00] find out about DeMar Hamlin. We can't thank him enough. You know, what was some of the key points that that really you took away from Dr Garcia as we get ready to wrap up our show?

[00:38:09] Dr. Grant Garcia: I mean, so many first off, uh, Dr. Dave, thank you for being on here. This was awesome. I mean, just to be able to have someone of your, your caliber. The way you and the way you were able to effortlessly explain this and go through so many different scenarios. I feel like we could have done two or three hour show, but our listeners would probably get exhausted, you know, but, uh, I took away, you know, the brawny dreams thing is fascinating.

[00:38:33] Dr. Grant Garcia: Demar Hamlin. And then just just the points you make about. The ease of testing and how we are under testing because it's, it's, it's a, people don't understand that, right? Like the big glitzy stuff, the sports stuff, the orthopedic stuff that we talk about that gets in the news more frequently, right? We talk about that all the time, but this, these type of tests are actually saved lives.

[00:38:55] Dr. Grant Garcia: Like what I do, I love my job. But I don't frequently save [00:39:00] lives. You save lives, which is awesome. And so that's what the important part here is that we can save lives. It may not be that many with these sort of tests, but even one counts, right? Because anytime someone passes away from something like this, it's all over the news.

[00:39:13] Dr. Grant Garcia: We don't want that, right? We want these people to be saved. And so it's an opportunity to save lives. So thank you again. This was amazing. And thank you to all your listeners. This was well worth it for us to get, get this episode on for you. And, um, I hope you learned a bit.

[00:39:28] William Sanchez: As we wrap it up, just remind everybody, check them out.

[00:39:31] William Sanchez: Health Mastery Cafe with Dr. Dave. Um, the Prevent Clinic, you know, he's at a PreventATL. com because his clinic's at Atlanta. So if you need some more information, there it is. And as always. Check us out. Sports doc talk. com. We have our shows. We get feedback from you, the listeners and viewers, and we love it.

[00:39:55] William Sanchez: It means so much to us that allows us to do other shows. We have [00:40:00] transcripts. We have a plethora of information. Um, it's just been great. And we really appreciate you. Dr. Garcia, last words as we wrap it up.

[00:40:10] Dr. Grant Garcia: Always fun to have a guest, especially like this. So thanks guys. Thanks. I love your

[00:40:13] William Sanchez: background. Dr.

[00:40:14] William Sanchez: Garcia. I just want to say my last time out

[00:40:16] Dr. Grant Garcia: today a little ortho and a little bit of heart at the same time. So,

[00:40:20] William Sanchez: all right, we're out on that one. Thanks for listening. Bye.

[00:40:24] Dr. Grant Garcia: Take care.

Audio Transcript

[00:00:00] Will Sanchez: Welcome to Sports Doc Talk. As you can see, we have Dr. Grant Garcia. I'm Will Sanchez. Uh, Dr. Garcia, unbelievable. It's the end of the year. We're wrapping things up. And before the year was over, we wanted to make a mention, um, of some key injuries, looking at 2025, even though 2024 Major League Baseball season just ended.

[00:00:39] Will Sanchez: But with the winter meetings concluding, So many players out there. If you are Juan Soto, you just got paid, baby. So for life, he's not going

[00:00:50] Dr. Grant Garcia: to be playing anywhere else.

[00:00:52] Will Sanchez: Oh my God. That, that is, that is absolutely amazing. Gary, listen for there's over 3000 division one [00:01:00] players in the transfer portal in college.

[00:01:02] Will Sanchez: Forget football, go learn how to throw a curve ball, hit some blind drives, hit some home runs, go get paid, go get that baseball money is guaranteed. I think, I think I'm gonna start having babies again. You, you have some young ones, maybe, maybe your wife needs to hear this episode and let's, let's get some babies back on, let's get some baseball players.

[00:01:24] Will Sanchez: You're an athlete. Am I starting trouble? I don't know, but there's money out there. I'm really excited. It's a lot

[00:01:30] Dr. Grant Garcia: of money. That's a lot of money. Holy cow.

[00:01:34] Will Sanchez: Before we get to, um, these key injuries, as we look forward to 2025. Uh, for the baseball season holidays, maybe I should whisper us, maybe we should keep it quiet.

[00:01:46] Will Sanchez: Did, did you do your shopping? It's the end of the year. Did, did you take care of the shopping? The kids taking care of wife, taking care of what's going on. This is a safe place. You could tell us, you could tell us.

[00:01:58] Dr. Grant Garcia: Everybody knows that, you know, I'm too [00:02:00] busy to do that. There's no way I'd be capable of physically doing that.

[00:02:03] Dr. Grant Garcia: You know, there's a, my friend sent, my wife sent me an little Instagram ma'am, and it shows this little squirrel. That's like very excited and looking around. It says, that's what dad looks like on Christmas. Cause he's never seen the presents either

[00:02:15] Will Sanchez: messed up. Well, so I do, I do get all those companies.

[00:02:20] Dr. Grant Garcia: I do my best when I can, but unfortunately the, you know, the boss of the house is in charge and there's no way my gift would be good enough anyway, so I might as well just let the boss deal with it.

[00:02:32] Will Sanchez: A smart man. That's exactly what you should do. It's like you pick out what you want, and then I'll go, we'll all be surprised on Christmas morning.

[00:02:40] Dr. Grant Garcia: Yes, precisely. I like it because it's like for me, it's the Christmas as well. I get everything surprised. So it's very nice.

[00:02:46] Will Sanchez: Yeah. And for those that have listened to the show, if you need some travel plans, Dr.

[00:02:50] Will Sanchez: Garcia is the travel master. So you, you will coordinate all the vacations, all the travel, and the wife will take care of all the presents and make [00:03:00] sure that everyone's having a wonderful holiday as we wrap up the year. I think that's a good, uh, that's a good plan right there.

[00:03:07] Dr. Grant Garcia: Absolutely.

[00:03:08] Will Sanchez: All right, let's move on because if not, we're just going to keep going.

[00:03:10] Will Sanchez: I do this all the time. I apologize to everyone. Uh, the Dodgers have wrapped up the world series. Uh, they defeated my Yankees, which was just tough, tough, tough, tough, but you know, they've got a squad. They've deferred over a billion dollars and God knows what's going to happen going forward. But one of the star players on their team got injured and one of the star players, you know, most recognized.

[00:03:35] Will Sanchez: Players in the world. Uh, Shohei Ohtani, he had orthoscopic surgery to repair a labrum tear in his left shoulder, right now his right that he sustained during the world series, uh, while he was sliding into second base. Um, and you can explain this, right? The surgery known as was a Bankart shoulder repair involves reattaching damaged ligaments, the [00:04:00] proper position in the shoulder joint.

[00:04:02] Will Sanchez: So I hear. A very specific shoulder repair. So you got to tell me why it's called that, but also you're using ligaments to put the shoulder back in the proper position. So what happened with this injury and what does this all mean?

[00:04:18] Dr. Grant Garcia: Okay. So, uh, we talked about shoulder dislocations before, but when he slid into the, uh, the base and dislocated his shoulder, basically when you dislocate your shoulder, you're pulling the shoulder out of the joint.

[00:04:30] Dr. Grant Garcia: And there's a suction seal on it called the labrum and I draw this for so many of my patients, but imagine my hand like this. I'll try my best if I can do it. And it's probably gonna be best like this. So there's a suction seal around there called the labrum. He tore the labrum. Generally, when you dislocate your shoulder, it's out the front.

[00:04:45] Dr. Grant Garcia: So front, An inferior, so an anterior inferior tear. That front anterior tear is called a bankart tear from, you'll never guess. Dr. Banhart, he described it first. Genius. [00:05:00] So it's called a bankart repair, but basically repairing that anterior labrum. And there's various versions of this. Trevor Lawrence had a tear like this, but it was much bigger.

[00:05:11] Dr. Grant Garcia: It went all the way around. Remember them bragging, he had a seven or eight anchor repair, you know, there's been, there's been a few of these types of injuries, um, before, but this dislocation pretty much people always ask, how do you know it's torn? You don't even need an MRI to really confirm this. Cause when you have a dislocation, almost always is labrums torn.

[00:05:32] Dr. Grant Garcia: The question is whether he's had it before. Probably not. Yeah, and they did it in the first try. It's probably because now this is interesting. So this is actually the bigger point here. If he's never had dislocation before, it's his first one, right? So fixing it's almost a little bit controversial. Now, there's more.

[00:05:49] Dr. Grant Garcia: We used to tell people and I just had a patient, two patients today that I talked about this with, we used to say you can dislocate your shoulder a bunch of times, who cares? just deal with it. We've talked about this before in the season. You know, the in season [00:06:00] athlete, what do you do with them? Just look at your shoulder.

[00:06:02] Dr. Grant Garcia: But to be honest with you, we're getting more and more data to show that we should really be fixing these patients right away because the longer you wait, you get glenoid fractures like Deshaun

[00:06:11] Will Sanchez: wants and

[00:06:13] Dr. Grant Garcia: lose bone. And then this simple Bankart repair that was done is no longer an option. Um, and so I think they also what happened is it was probably as a result of the timing.

[00:06:25] Dr. Grant Garcia: I think if he dislocated his shoulder in the middle of the season or in the beginning of the season, he would not have gotten surgery, but it's that set classic like NFL thing to, you know, as you hear about the players, you're like that player wasn't injured. And then all of a sudden got surgery at the end of the season.

[00:06:38] Will Sanchez: Yeah. Yep.

[00:06:39] Dr. Grant Garcia: They probably said it wasn't worth the risk. There may have been more to the damage than we thought because it's, it's still fairly aggressive to do it, especially on the non throwing shoulder. Um, the swing in the back by February, I think is reasonable. He injured this in November. Right. Or October, end of October.

[00:06:57] Dr. Grant Garcia: Yeah. Yeah.

[00:06:57] Will Sanchez: It would, uh, yeah, it would end of [00:07:00] October. Yeah. Middle. Yeah. So

[00:07:01] Dr. Grant Garcia: we got surgery. He probably got surgery with a couple of days because he just calls his buddy Alitrosh. Yeah. You know, the one guy, the same guy did his elbow. So he's, he's going to be one, two, three, four months. I mean, usually full return for one of these, you're full return four and a half, five months.

[00:07:16] Dr. Grant Garcia: six, five and a half months. That's back to everything. So his swinging, they said February, probably March, and he'll probably be ready for the season for pitching again. It's his non pitching shoulder pitching shoulder. It will be

[00:07:29] Will Sanchez: his lead swinging shoulder. If as a left handed hitter, right. So, I mean, that is your pull.

[00:07:37] Will Sanchez: Yeah, but that doesn't. There's no concern when it comes to that.

[00:07:42] Dr. Grant Garcia: I mean, his power is going to be from the drive, right? The follow through is important. Yeah. But he's not going to dislocate his shoulder following through with the bat. Especially after one of these. This is a very bad thing for a pitcher.

[00:07:54] Dr. Grant Garcia: But thankfully it wasn't his pitching side. So,

[00:07:56] Will Sanchez: okay. So if it was, yeah, that would

[00:07:58] Dr. Grant Garcia: be, that would be kind of not, [00:08:00] that would not be good. This is coming off an

[00:08:02] Will Sanchez: injury already from pitching as well.

[00:08:05] Dr. Grant Garcia: I mean, the question you have obviously played amazing, but what is the longevity now? This is the third, this is the second surgery on his body in the last few years.

[00:08:14] Dr. Grant Garcia: Granted, obviously this is, You know, unfortunately the part of the game for some of these players, but you know, this is, this is another, another procedure you underwent, you know, it'd be back. It's not, this is not something that's, it's not a small procedure to do.

[00:08:28] Will Sanchez: So, so this type of procedure, if it was whatever the dog days of summer, right?

[00:08:34] Will Sanchez: June or July, if this would have happened and this surgery probably wouldn't have happened, they would have treated something, uh, very differently. Or Because maybe there was a, if there would have been something more severe, then you go, well, we have to go in and fix it and not just be as dismissive as, uh, we're just kind of fixing that labrum.

[00:08:55] Dr. Grant Garcia: Yeah. Like Deshaun wants a type of thing. Um, or there's something called a [00:09:00] Hillsacks legion. So he has a big one of those, or this wasn't his first one. You know, we don't know that probably his first one. I feel like we would have heard about this before. Um, And the, the mechanism was so traumatically generally when people have multiple dislocations, they don't dislocate it traumatically.

[00:09:14] Dr. Grant Garcia: It's like, Oh, I dislocated my sleep. I dislocated like putting my arm over my head. So it was probably his first one. And there was probably a little more damage than we're hearing about. And it's him. He's worth a lot of money. The Dodgers. Oh yeah. They have no interest in him being out next season.

[00:09:30] Will Sanchez: Yep.

[00:09:31] Will Sanchez: They probably made

[00:09:32] Dr. Grant Garcia: a game time decision.

[00:09:33] Will Sanchez: All right. So hopefully he'll get back. Um, unless there's some complications, if they are, we'll be back on here talking about it. So that, that, that's a plus for us then, but I don't know if that sounds a little selfish. It's a pretty

[00:09:44] Dr. Grant Garcia: low risk. It's a pretty low risk surgery and Ella trust does a good job.

[00:09:47] Dr. Grant Garcia: I, he'll be a very low chance of him not getting back.

[00:09:51] Will Sanchez: You have your Atlanta Braves logo behind you and I apologize to any Braves fans, but it seems like there you're some of your best players got hurt this past [00:10:00] season. And if you're a fan of the team, you know that firsthand. You don't need me to tell that because, uh, there were so many key injuries and, uh, that's going to be some NL East race now with Lindor and Soto and with the Mets.

[00:10:13] Will Sanchez: And then hopefully they get guys back. Like Joe humanists, uh, the land of Braves key reliever. He has surgery to repair the cartilage damage in his left knee. And he was, the surgery was performed by, you know, your buddy, Dr. Brian Cole on October 29th, 2024. He's expected to miss roughly a calendar 12 months, um, which is a big blow to, uh, the bullpen.

[00:10:41] Will Sanchez: You know, he had a fantastic ERA at two 62. So. A couple of things. October 29, 2024 is really, I mean, the season's over. So is this something, you know, when, when you hear about an injury like this and when it happened, when you're having [00:11:00] surgery, how the length of it, what do you think that process was? And we're dealing with hypotheticals here, but what do you think happened there with this picture where they realized that he had to go get this repair, the repair, the cartilage on this knee?

[00:11:15] Dr. Grant Garcia: So, I mean, this wasn't, this wasn't a spur of the moment decision. This was probably planned. Right. It's the same thing as what we talked about before is at the end of the season, you have a string of players, you know, you take care of the professional teams that Latin and that week after is like open season, right?

[00:11:32] Dr. Grant Garcia: You got to fix everybody up, get the team ready to go because it's the maximum amount of time for recovery. Uh, so this was a planned surgery, likely, um, you know, nothing we heard about and obviously he wouldn't have played so well if he had been, you know, it had been something had to get done acutely.

[00:11:48] Dr. Grant Garcia: Right. Right. So, it clearly was bothering him enough to get this done. Eight to twelve months is a long time. It's a long time. So, you're, you're looking at probably a more advanced cartilage surgery. Okay. [00:12:00] So, so yeah, break

[00:12:00] Will Sanchez: that down. What do you mean advanced?

[00:12:02] Dr. Grant Garcia: So again, the problem you have with some of these layman terms they put in here is they try to dumb it down so much, um, that unfortunately it's hard for someone like me to really diagnose it.

[00:12:11] Dr. Grant Garcia: Like, you know, the Lonzo Ball thing, we had to hear multiple rounds of injuries. Yeah, this is a bad enough that Brian Cole had to get involved. Yeah, there's some minor more minor procedures that he can do. We've talked about like bio cartilage where you can kind of micro fracture that area and you put some Yeah, some juvenile cartilage.

[00:12:29] Dr. Grant Garcia: There's some newer procedures out there that he may have done for him. Eight to 12 months in my opinion is like a cartilage transplant, which is we talked about with Lonzo ball. So, you know, maybe Dr. Cole is getting more brazen with the cartilage transplants because he now has done a few of them. He did the professional hockey player recently.

[00:12:46] Dr. Grant Garcia: Um, he just did, uh, he did Lonzo ball. And now all of a sudden, maybe this is like, I told you, what did I say in the last, Podcast. I said this could open the floodgates for more and more of these surgeries. So I wouldn't be surprised if he did something like [00:13:00] that, like a cartilage surgery. They may not announce it anymore 'cause it may not be considered hot news.

[00:13:04] Dr. Grant Garcia: Right. You know, I've had a few of 'em in the Yeah, that's in the, the NLB that's, so it's like, oh yeah, he just had a cartilage transplant. No big deal.

[00:13:11] Will Sanchez: Yeah, that's really concerning. Um, Ronald Kuia Jr. He tore his left ACL in May. Uh, he's expected to be out. You know, a couple months of the 2025 season, so that's pretty much almost a full calendar year.

[00:13:25] Will Sanchez: Second major knee surgery in three years. I mean, so what are we concerned about with his knee, with his health, um, and, and maybe what's left in that knee.

[00:13:36] Dr. Grant Garcia: That's perfect. That's a lot. Your last comment was very good. You know, you're gonna, you're gonna get your MD soon at this show. You keep going. So the, uh, So anyhow, so the, the second surgery is to me is always the word meniscus, right?

[00:13:50] Will Sanchez: Yeah,

[00:13:51] Dr. Grant Garcia: probably not cartilage damage. Generally, he gets bad enough cartilage damage. It's less common in these ACLs. When you get it, you're starting to address it or they're having a lot of pain and [00:14:00] swelling and just the cleanups don't work anymore. The ACL tear obviously needed the surgery, but my assumption is he probably had some sort of meniscus tear that they either fixed the first time or they cleaned up.

[00:14:11] Dr. Grant Garcia: So now he's had two major knee surgeries. And we're worrying, is this going to be a situation like you had with Lonzo Ball where by the time you're done with him, he's got minimum meniscus left. That being said, when you have minimum meniscus, it doesn't mean you need to be completely out of the, uh, out of the season or you're done for the, you're done for your next five years.

[00:14:32] Dr. Grant Garcia: Uh, so it's important, um, to understand that, uh, this. this meniscus injury just could be a blip. Obviously, if it goes into cartilage stuff, that's a problem. But from the meniscus standpoint, you know, we'll just have to see and hopefully we all know that when people have these A. C. L. Tears and they're reconstructed, um, the return to sport is good, but the overall longevity of the knee Is, uh, is not as good on when the [00:15:00] meniscus is gone

[00:15:03] Will Sanchez: for those who are wondering what the hell happened.

[00:15:06] Will Sanchez: I had to get my charger as I'm trying to listen to you and I disappear. So it's all, it's all very interesting. Dr. Garcia. Well, you know, the good [00:15:17] Dr. Grant Garcia: news is that I tried to keep talking until you came back.

[00:15:21] Will Sanchez: He's probably like,

[00:15:23] Dr. Grant Garcia: where did he go? I was thinking, I was like, I'm pretty sure I'm done with this. This thing, the podcast is over right now.

[00:15:30] Dr. Grant Garcia: Will's just told me it's time to leave. He just slowly exits the screen.

[00:15:35] Will Sanchez: Just see it. That's how you know, at the end of your episode here, uh, Ronald, we, we really do care about, we're really concerned about your knee. Um, as, as you can tell. So basically what

[00:15:48] Dr. Grant Garcia: we had said, Will was. Meniscus damage with an ACL, not as good of result, definitely a concern.

[00:15:55] Dr. Grant Garcia: There's been lots of data that the time that people go back, this increases the chance of [00:16:00] ACL. We want to save the meniscus at all costs. Not sure his meniscus was saved based off hearing all this stuff. And we don't want to turn into Alonzo ball situation where this turns into cartilage damage. You know, you have a really good young player here.

[00:16:11] Dr. Grant Garcia: Um, so. But again, you know, the age, the age issue with these, uh, ACLs is there's always a little secret stuff in there and you got to figure out if there's anything else wrong and how they're going to do. But generally these guys do well for a while.

[00:16:25] Will Sanchez: What would be your red flag for you? If he gets out on the field next year, starts playing, starts running or swinging.

[00:16:41] Will Sanchez: And he complains of, you know, certain pain, especially if it's not obvious if it's something that, okay, he just, you know, running the outfield or, um, you know, taking a swing and that torque in that lower body area and all of a sudden he walks up, [00:17:00] feels like, yeah, I'm, I'm, I'm kind of feeling something, you know, what's, what's, I guess, what's the next big concern for you now that he's had multiple injuries and surgeries?

[00:17:09] Dr. Grant Garcia: Yeah. I mean, I'm always thinking about his meniscus, right? If it's been trimmed or removed, you know, the ACL, you can get retears. It's just not that common, especially in baseball players. Right. We don't hear about it that frequently that you have someone. reconstruction and then retear. That's more like NFL, rugby,

[00:17:26] Will Sanchez: you

[00:17:26] Dr. Grant Garcia: know, occasionally basketball, but, um, and baseball players, I'm sure can get it, but it's just not as common.

[00:17:32] Dr. Grant Garcia: So, you know, I worry about like he starts to run and he says swelling, you know, all of a sudden you see him going on the DH more frequently, right? Like those are the things that worry me. The deficiency syndrome where basically you get some of your meniscus removed and you get into Alonzo ball situation.

[00:17:46] Dr. Grant Garcia: It's not that common. So I, I don't think he's going to have that issue, but if they fix his meniscus, well, if it's the second attempt to fix his meniscus or save any part of it, that can retear. That's a higher chance that he's going to have a retear of his meniscus. [00:18:00] If he got it fixed, then if he has part of his meniscus removed and he has a problem, it's just a much, it's just a higher percentage, 20 percent or something.

[00:18:07] Dr. Grant Garcia: So we'll see. Um, I think he's probably going to do well, but if there is issues, you know, you worry about his knee long term. I mean, the good news is obviously it depends on, he may be able to change positions if he, you know, up to that, but I think he's going to do well, uh, with just this surgery alone.

[00:18:24] Will Sanchez: Staying with the Braves. Once again, apologize. Braves, uh, Spencer Strider, you had to

[00:18:27] Dr. Grant Garcia: have him up.

[00:18:29] Will Sanchez: Yeah, no, it was just one of those things. And, and it's, it's a thing that we're just, you know, keen on certain injuries and it just kind of happens to be a lot of those players. Uh, Spencer Strider, and I'm going to kind of go back a little bit here, right?

[00:18:42] Will Sanchez: So he had Tommy John surgery in 2019. Okay. In 2024, he had elbow discomfort. Right. It began, he began to start feeling it in spring. He tried to pitch through the pain. So I want to ask you about pitching through pain, [00:19:00] especially when it comes to the elbow area. And then the MRI, uh, showed that there was damage to the UCL.

[00:19:08] Will Sanchez: And then he had surgery in April 13, 2024. He had the UCL surgery with Internal brace, you know how we like that stuff. So with all of the concerns, right, 2019 Tommy John surgery, elbow discomfort, you have the UCL surgery now with the internal brace, which is different than your traditional, uh, Tommy John surgery.

[00:19:34] Will Sanchez: And I want you to explain the difference with that. Uh, by the way, we'll always shout out the, uh, procedure by Dr. Keith Meister. That's a pretty cool name, right? Meister. Um, so let's just kind of talk about. the differences between the UCL surgery with internal brace compared to the regular Tommy John surgery.

[00:19:53] Will Sanchez: And what are some of your concerns and thoughts on it?

[00:19:57] Dr. Grant Garcia: So, um, the first part I'll make, I think for any of the doctors [00:20:00] listening is obviously I'm not sure he actually had a full reconstruction. We'll, um, we have to look at it. Cause if you have a reconstruction, you have no more UCL left there or Tommy John ligament left there.

[00:20:09] Dr. Grant Garcia: So you can't repair it. So I'd, I'd be interested to hear if that was, if maybe he had like some PRP done to it and they thought it was a procedure, um, on his UCL. So we'd have to look, we have to look into that. That's the only thing I'll say from that data that they give that you were given. Um, but, but let's go through the surgery procedures.

[00:20:26] Dr. Grant Garcia: So Tommy John obviously is the first picture that had it done. We've said this before. Yeah. We've talked about Brock Purdy. This is a really big deal and I'll explain to you why. It's not just because of the surgery is because of his status and then what had was done. So this is again, This is doctors breaking surgeons breaking in to the cutting edge material and I'm this is why I told you guys before about new tech we said does do athletes get the new tech right with Dr.

[00:20:50] Dr. Grant Garcia: Liu?

[00:20:50] Will Sanchez: Yeah, yeah, yeah.

[00:20:51] Dr. Grant Garcia: They are much slower to get the new tech because people don't want to test it out, right? Like, yeah. Carlos transplant. I told the. Guys before has been around for [00:21:00] years and we've gotten it better and better and better. And I've done hundreds of them, pro athletes, very few.

[00:21:07] Will Sanchez: And that's why you made a mention about Lonzo ball and how him having that surgery, you know, this new tech opens up the floodgates.

[00:21:15] Will Sanchez: Go ahead.

[00:21:16] Dr. Grant Garcia: So that's where we're going to go with this. So Tom John reconstruction is where you take a ligament from either the wrist, someone with the palmaris, or you take it from the hamstring, whether or not, cause some people don't have this ligament in the palmaris. It's like old cat claw. You can see it right there.

[00:21:28] Dr. Grant Garcia: Yeah. Okay. Some people don't have that. So they use the, uh, ligament in the, in the knee and then you can reconstruction. Now, we've got some newer techniques we're working on, but generally you're talking about a 12 to 18 month recovery. Okay. This newer procedure, which is maybe not even new anymore. It's almost five years old or more.

[00:21:47] Dr. Grant Garcia: Um, we repair the UCL, this tear. And again, certain tears can get this, not all of them. And then we do an internal brace, which is this, this, uh, synthetic suture. We've talked ad nauseum on this and one of Will's favorite, uh, [00:22:00] slogans, um, the internal brace as well. So the, it's a faster recovery. If it can be done, the results are the same as a UCL reconstruction, but you're back in six, seven months, kind of depends on the picture, but it's a much faster recovery.

[00:22:14] Dr. Grant Garcia: Ideally, everyone would do this. When this came out. My number of reconstructions dropped my repairs went up.

[00:22:22] Will Sanchez: Yeah,

[00:22:22] Dr. Grant Garcia: I do more repairs now that I do reconstructions and that's a good stat You should be doing that because there are so many more you can rip There's so many of these you can repair and get the patients back.

[00:22:31] Dr. Grant Garcia: So reconstruction is still has a place but it's not as high But what's really interesting for the audience to hear is that this was done on a pitcher So you hear the word pitcher all the time, but generally before the last few years They reserved this surgery for College pitchers, high school pitchers, little league, not as common pitchers and outfielders and infielders in professional baseball, but not for the pitchers.

[00:22:59] Dr. Grant Garcia: The [00:23:00] pitchers in professional baseball are the highest standard and as a

[00:23:04] Will Sanchez: result,

[00:23:05] Dr. Grant Garcia: the moneymaker. But the same point, do you want to test a surgery on a professional pitcher? Do you want to be the first guy to do a UCL internal brace on a professional pitcher and have it stretch out and tear in the first year?

[00:23:17] Dr. Grant Garcia: Right. It's just devastating. And so for, for, for years, these pitchers were the pitchers, even though other players were getting, I remember when we were taking care of the white socks, you know, six, seven, seven, eight years ago, the outfielder we did it on was like one of the few, our catcher was one of the first ones that got the UCL repair with internal brace, and that was a big deal, but they did not, they had a pitcher tear their UCL and they were like, no way.

[00:23:40] Dr. Grant Garcia: We're doing a reconstruction right now. Professional pitchers are starting to get this surgery because. The surgery works really well. There's been so much data to show that why were we doing reconstruction just because they're pitchers. If it works just as well on other players, there's no reason why a professional pitcher wouldn't work well for.

[00:23:57] Dr. Grant Garcia: So the fact that he's getting that shows that one, the [00:24:00] doctor is willing to push the envelope, which is great. And two, it's not really pushing the envelope because there's so much data out there for it. But this is what the audience should hear. This is a pretty unique thing that, right. That's the first thing I picked up when I heard this.

[00:24:11] Will Sanchez: Yeah. And, and we talked about it before. It's not just. One part of it at that level, right? It's a player, it's agent, it's ownership. It's it's, it's, there's so many factors to where everybody has to, you know, get on board and, and approve it. Um, and then obviously, you know, it'll fall under the player and who knows if there's something in the contract, you know, when they do something like that and say, well, we're, we're recommending reconstruction over repair.

[00:24:43] Will Sanchez: You know, if something happens. So I. Well, and you

[00:24:47] Dr. Grant Garcia: know, no, we're not. I mean, yeah, I know, but it's good. We couldn't, we don't want to go too crazy on this, but you know, like when they go to Ella Trosh, Ella Trosh does what he wants.

[00:24:54] Will Sanchez: Yeah. Yeah.

[00:24:55] Dr. Grant Garcia: I don't, no one tells Ella Trosh what to do, but that's not, [00:25:00] that's not who did his surgery.

[00:25:01] Dr. Grant Garcia: And that's who not to, that's not who does all these surgeries.

[00:25:03] Will Sanchez: Meister.

[00:25:04] Dr. Grant Garcia: And good. I think I, I, I, I think I know him. He's actually a good guy, but the, the point being is that if you're doing a handful of pro athletes and handful of college athletes, and you're the big name in your area, You obviously don't want to push the envelope too much, but also if an agent calls you and they want, when you take care of one of their players, they're going to be like, you should really do this, right?

[00:25:24] Dr. Grant Garcia: Like in the end, the surgeon makes the decisions, but let's be on the pros. This is the whole combination. I mean, frequently we would do the players in HSS, there would be a trainer in the room watching you do the surgery. Like, this is like how, this is how intense the situations are. It's not like, you know, you just get to do whatever you want on these professional athletes, right?

[00:25:41] Dr. Grant Garcia: You, everything's this, this discussion of doing the UCL repair was probably like six opinions in.

[00:25:48] Will Sanchez: It's, it's fascinating, but you know, with someone like Stryer and you know, some of these other pitchers and the Lonzo balls of the world, and we're starting to see, you know, people saying, okay, [00:26:00] let's, let's kind of go this route with some of this, you know, It's not new tech, but it's newer for the, for the, uh, players that's being done on, um, it'd be really interesting because when, once you start to do more, more things like that, and you open up the floodgates to, you know, do other things and present new, you know, new opportunities.

[00:26:20] Will Sanchez: So, um, it'd be really interesting to follow along that case, uh, this summer, and if everything goes well, you know, that bodes well, not for people, two, three years down the road. The season, right? I mean, if they see that this works for, for the pitcher in the season, obviously we know in, you know, people get hurt, there's gonna be a lot of injuries.

[00:26:42] Will Sanchez: And if they can say, Hey, we could get back sooner and not have that major reconstruction and it worked for this player. And we have the same agents or, you know, we're in the same major league baseball, because that's a, that's a small club. We think, you know, major league baseball, a lot of players, that's very few people that are [00:27:00] in that.

[00:27:00] Will Sanchez: So once

[00:27:02] Dr. Grant Garcia: they're all similar. Right. They know they're going to call this one. Who's your guy have, who did yours, right? Like this is, there's so much, I mean, when you have over 700 million invested in a contract for a player, you're going to make a lot of decisions to make sure that the contract keeps going.

[00:27:17] Dr. Grant Garcia: Yeah. All

[00:27:18] Will Sanchez: right. We got, I got two more players here. We're going to wrap up, uh, Walker Bueller, uh, well known pitcher, just kind of go back a little bit. 2022 Tommy John's then he had a flexor tendon repair that, uh, along with. the surgery. Um, so that was done at the same time, but it added to the recovery time.

[00:27:40] Will Sanchez: So I want you to explain why that added to recovery time. And then last year, this past season, he had hip inflammation. Right, right hip inflammation that complicated his return and then he was put on IL and he's kind of had struggles right including the reduced velocity and [00:28:00] They running out of gas getting fatigued So what are some of the things that you're hearing there as I'm explaining this this?

[00:28:10] Will Sanchez: History pattern of injuries with Walker Buehler.

[00:28:13] Dr. Grant Garcia: I mean Unfortunately, we always talk about the players that make it back, but there are players that do not make it back from these surgeries. So this could be just one of those issues. But when I hear the word flexor, that's weird. Now, was it included in the surgery?

[00:28:27] Dr. Grant Garcia: Because in order to do this surgery, you have to attach the flexors at the elbow or do you actually have a rupture of Or I don't think this, I don't want to say this, but did he have some complication during the surgery, right? When you harvest the Palmaris, did you damage another part of the wrist when you did the procedure? [00:28:44] Dr. Grant Garcia: Probably unlikely. Um, but it's very weird to have a flexor tendon tear on top of the Tommy John at the same time. So, or, or did he get it fixed and then it pulled off or when they got in there was a

[00:28:57] Will Sanchez: pair, right? But we don't know what that means between [00:29:00] repairing.

[00:29:01] Dr. Grant Garcia: Did, did he have, did he, when he tore it, did he tear his elbow?

[00:29:04] Dr. Grant Garcia: And then also his flexors. So we had to have that repaired and that took longer to come back. It just, the problem is the Tommy John takes so long to come back from that. I just don't understand how it took that much longer, or I bet he might have complications. Like if you had a flexor tendon repaired in his hand, um, they can get some stiffness in that and then it can not glide as well.

[00:29:21] Dr. Grant Garcia: So that could be another issue too. Anyhow, we won't know, but those are some, those things doesn't bug me. But that's interesting because, [00:29:29] Will Sanchez: because I was thinking about the, the, how even rehab could play a part in that, right. You know, whether if, you know, we have an elbow and we having the hand, the strength and what's not working and, you know, dealing with those things.

[00:29:43] Will Sanchez: So that, that's kind of interesting. Um, the big one for me is, uh, the phenom, the Japanese pitcher phenom, that's going to wind up going to one of these teams, an off season.[00:30:00]

[00:30:05] Dr. Grant Garcia: Will, you're muted.

[00:30:12] Will Sanchez: I don't know how that happened. There's going to be a lot of editing.

[00:30:16] Dr. Grant Garcia: No, don't edit it. Show them that we're normal. I

[00:30:19] Will Sanchez: don't know what happened. I didn't even touch anything. Anyway, so, uh, Roki Sasaki, Japanese phenom pitcher, uh, 2023. oblique injury, right? So that's always interesting. He was limited to 91 innings because of that injury.

[00:30:38] Will Sanchez: Um, that obviously affects the power and rotation and things like that. You could describe it better than me. And then 2024 right arm discomfort. I love these sayings. The discomfort and, you know, these key keywords that, you know, go, ah, there's nothing there, but, you know, right on discomfort, the issue has been a reoccurring problem and the [00:31:00] team had been cautious about the workload.

[00:31:02] Will Sanchez: So when you're having a young pitcher, right, that's about to make so much money in major league baseball, right? They're going to, he's already been posted. Uh, one of these teams are going to throw millions and millions of dollars. He's only 23 years old. But he's had an oblique injury. Now he's had this arm, uh, right arm discomfort and they've had to manage his innings pitch.

[00:31:27] Will Sanchez: What are some of the concerns there, especially for me is, uh, discomfort and the oblique, which is interesting.

[00:31:35] Dr. Grant Garcia: Yeah. I mean, oblique to me, doesn't bug me too much, but you know, the problem with those oblique injuries. It's not that it's not. They can reoccur, but also they're just hard to treat. Right. We just, there are very few people treat them.

[00:31:46] Dr. Grant Garcia: If you tear the oblique, you can get it fixed, but it's just not that common. So generally it's just something you kind of deal with. Maybe he had treatment, maybe rested it. And eventually I'm assuming,

[00:31:55] Will Sanchez: but they can linger, right? I mean, like a mid has had, um, like we've seen [00:32:00] players that they've had.

[00:32:02] Dr. Grant Garcia: Remember LeBron James is growing for like an entire season. I mean, these, these injuries let linger for months until you stop playing. Right. So he had to take a break probably to get the thing down and eventually it probably calmed down, but it's a recurrent, just strain. Right. And they're, they're torturous, but.

[00:32:20] Dr. Grant Garcia: At the same point, it's not something you need surgery most of the time. So he got over that. I'm not as worried

[00:32:24] Will Sanchez: discomfort for a 23 year old

[00:32:27] Dr. Grant Garcia: that, that could be again, is it the words or is it real? Right? We all talked about this. You've seen these amazing ways. They write up like partial sprain of the Tommy John, right?

[00:32:39] Dr. Grant Garcia: So generally arm discomfort is pretty common in baseball players, right? From even a young age, you know, I see them frequently. They come in, they think they tore the Tommy John. They didn't, you know, it's a flexor strain. So this is a recurrent flexor strain. That's fine. The problem is You know, the MRIs are only so good for seeing the UCLs or the Tommy John [00:33:00] ligament.

[00:33:00] Dr. Grant Garcia: So is he having attritional partial tearing of this and not able to see it on the MRI? I'm sure he's getting the highest quality. I'm sure they're watching him like a hound. Every team that's going to, uh, recruit him is probably going to get a new MRI on him.

[00:33:14] Will Sanchez: Oh, the medicals.

[00:33:18] Dr. Grant Garcia: Yeah. You don't want to be, he's going to have more MRIs than any of any of us have had in like a month.

[00:33:23] Dr. Grant Garcia: As he starts getting his final contract stuff because every team is going to want their own, right? So to be honest with you, he's probably going to be fine if a team signs him. They've done a lot of diligence on this, but it does bother me that, you know, now he's got two injuries. We've seen it. It's just, unfortunately it's the nature of the beast.

[00:33:42] Dr. Grant Garcia: And this is a, maybe this would be another podcast would be great. What makes a player resilient and what makes them not. It's just bad luck. Sometimes, you know, you have these players that are phenomenal and all of a sudden they just get injured. They get injured, they get injured, they get injured, and then they're just done.

[00:33:58] Will Sanchez: Yeah.

[00:33:58] Dr. Grant Garcia: I'm not saying it's the case, [00:34:00] but you have some of these players that are just like, never, they never get hurt or they just keep bouncing back. I mean, how many injuries did Tom Brady have? And he just kept popping back and he had a couple of bad ones, right? Like you just, that'd be a great topic to be like, what's the difference.

[00:34:14] Dr. Grant Garcia: And Answer is sometimes it's not. Sometimes it's surgery. They had a surgeon go as well, but sometimes it's just bad luck. I mean, you talked about Walker Bueller and his issues, right? He's had three injuries in a very short span, still not back. And the problem is the longer you're out. The harder it's to get back no matter how good you are.

[00:34:34] Will Sanchez: Yeah, that makes, that makes sense. And then you could be, uh, someone maniacal, like a Ronnie lot where you don't wanna miss a game, so you're gonna cut off your finger because it's, uh, you know, dislocated and broken and you, you're supposed to miss the rest. I just, Hey doc, Dr. Garcia. Just, just, just cut it off.

[00:34:50] Will Sanchez: I gotta, I gotta play in the Super Bowl. I just, just cut it off. I don't, it's, I, I got nine other fingers. These, they're built different. These people built different. So we talk about all [00:35:00] the time. Anyway, we'll wrap it up. I hope you get a great presence. I know we're going to do one more end of the year kind of recap on 2024, which should be a lot of fun, but for the holidays for you and your family and the little ones running around, not destroying the Christmas tree or anything like that.

[00:35:21] Will Sanchez: Or if they are just like, leave them. It's okay. Whatever you buy another one next year, just take it out. But, uh, I wish you guys the very best. Um, and, uh, I hope you enjoy the holiday. I hope you get some time off. Which I know this time of year where everybody's trying to get, get in their surgeries before they deductible start to, uh,

[00:35:40] Dr. Grant Garcia: I'm going to be operating until, uh, until January one.

[00:35:43] Dr. Grant Garcia: I've decided I'm not going to leave. I should, I'm doing this podcast for my OR.

[00:35:47] Will Sanchez: Yeah. Yeah. Yeah. You're doing that. So am I, I'm just, I'm, I'm in the next room. I'm scrubbing up. I'm getting my internal brace ready. I get all set up. [00:35:57] Dr. Grant Garcia: Well, happy holidays to your family and happy holidays to [00:36:00] all the listeners.

[00:36:01] Dr. Grant Garcia: We're going to have another end of the year episode, so it's not our final one. Um, but this was a good one just for the, for everyone to hear about it. And there's brought up a couple of good topics. I think that, you know, what are these injuries about and why do some people bounce back from injuries better than others?

[00:36:16] Dr. Grant Garcia: You know, there's a psyche thing. We've always wanted to have a psychologist on this show. And at some point we will, uh, when we can find the time to find somebody. Um, but. You know, happy holidays, everybody. Thanks again for listening again, follow us on all of our different ones. You've seen, we've had some shout outs on LinkedIn recently, um, with some topics.

[00:36:33] Dr. Grant Garcia: So this is exciting. There's a lot of momentum building. So thank you

[00:36:36] Will Sanchez: all check us out. Sports doc, talk. com for more content, uh, great information, transcripts, and, uh, we'll appreciate you. And I don't know about that. Bringing in a psychologist or something like that. I'm going to be in tears and the episode is going to get messy, but whatever.

[00:36:52] Will Sanchez: Thank you everyone. Bye guys. Audio Transcript

[00:00:00] Will Sanchez: Welcome to Sports Doc Talk. I'm Will Sanchez, along with our orthopedic surgeon, sports medicine specialist, say that a bunch of times, Dr. Grant Garcia. Dr. Garcia, look, man, I don't know if you can see, man, I got my, I'm hanging with my gnomies because it's the holiday season. I know we're going to talk about our injury spotlight, um, but you know, we're just, we're just, we're I can't believe it's the end of the year and it's, uh, it's been a great year.

[00:00:45] Will Sanchez: I want to throw that out there. It's a, it's always a pleasure working with you and, uh, and doing these shows. So, um, how are you?

[00:00:53] Dr. Grant Garcia: I'm good. No, it's end of the year. End of the year for some people is like, Oh, Christmas is coming. End of the year for me means that. [00:01:00] I work as many days of the week as possible because the deductible season is not done until December 31st.

[00:01:06] Dr. Grant Garcia: January though is great. January is usually a lot chiller. Yeah,

[00:01:10] Will Sanchez: that's a lot chiller. So, so can you get a t shirt that says, you know, Mr. Deductible or something like that? Like just wear it in December? I don't want to

[00:01:19] Dr. Grant Garcia: make it about the deductible, but patients come in just absolutely begging to get it done.

[00:01:23] Dr. Grant Garcia: They're like, I've had my, my Farris surgeries, my family's other surgeries. Now it's. free. So I want to do it now. Nice. In January, it's not. And I'm like, okay, well, you know, unfortunately we waited all year to decide on this, but nonetheless, we got to get them done. So we're going to stay busy, but we still have time for the podcast because we have way too much fun on the show.

[00:01:45] Will Sanchez: Too much fun. Listen, I see you have your Miami Dolphins background. And wait, and before that, let's give a little love to our peeps out here. Because you know, when we're trying to recovery, where do you need to go? The recovery shop. [00:02:00] Dr. Garcia, tell us about the recovery shop.

[00:02:03] Dr. Grant Garcia: Big thanks to our sponsors.

[00:02:05] Dr. Grant Garcia: We've had this, you know, repeatedly on here. They've been great sponsors of the show and I love talking about them. I mean, it keeps coming up my patients, right? So your patients, they get high quality surgery. They want, they expect the best. And they, after surgery, they're like, what else can I do? Right?

[00:02:19] Dr. Grant Garcia: Like I got this surgery. You talked about all these fancy things. You've talked on this show, internal bracing, you name it, but I want to make sure that I have the best recovery. So yeah. On there we have, uh, nutrition supplementation, which is all over the internet and one of the hottest topics. We have the Nice Machine.

[00:02:36] Dr. Grant Garcia: We have new braces. We have the ReBliss for some of the patients who are having a more complicated knee surgery. That's pretty

[00:02:41] Will Sanchez: cool.

[00:02:42] Dr. Grant Garcia: Yeah, and the patients can get this and it's a, it's easy. The patients have been thrilled with it. I mean, we have patients that had issues with snowstorm deliveries and they made sure that they overnighted these products for them.

[00:02:52] Dr. Grant Garcia: Um, and my patients love it. Again, there's no cut from me for you signing up for this. The key here is just to give information for [00:03:00] surgeons or patients. If you did a surgery done and you want something like this, talk to your surgeon about using this opportunity because it's a really nice opportunity.

[00:03:07] Dr. Grant Garcia: It's beneficial for all parties. Um, And again, the goal is for the patients to get the best. And sometimes it's hard to get the best just insurance alone. So this opportunity is great. Reach out to Mike at recovery shop. com. He's all over the website. A fantastic group to work with a strongly recommended for any surgeon who wants to, to offer patients a little bit extra.

[00:03:28] Dr. Grant Garcia: So thanks guys.

[00:03:29] Will Sanchez: Yeah. Once again, Mike B at shop dash recovery. com for more information. And uh, that's what we're doing here today, right? We're providing everyone with a little bit more information. We were watching, um, you know, NFL Sunday, right? NFL football. There's only so many weeks left. It's a sport that we love.

[00:03:48] Will Sanchez: that we're into, but we also know it's a sport that is dangerous, that we have severe injuries in there. And, uh, unfortunately, once again, a Miami [00:04:00] Dolphin has sustained a concussion. Mike DuBose, um, you know, catching the pass across the middle, getting hit and pretty much laying there. Obviously, um, There was a lot of concern.

[00:04:14] Will Sanchez: And as the doctors that go out there and we think about these head injuries, right? And you're like, okay, well, he got hurt. There's a head injury. Um, unless it's super, super serious. We usually don't see the cart or stretcher being, you know, called out, you know, they go into the blue tents. then eventually maybe get, you know, back into the locker room, things like that.

[00:04:37] Will Sanchez: But for this situation, that wasn't the case. So they came out and they brought out the spine, uh, the boarding. So while we, we wanted to talk about the importance of spine boarding in these situations. Um, so while we start with there and Dr. Garcia, just explain a little bit, like what's that procedure, right?

[00:04:56] Will Sanchez: You, you have to play it there. You have concern [00:05:00] and. we don't really think about spine boarding when we think of concussions. So tell us a little bit about what happened and how did they get there?

[00:05:09] Dr. Grant Garcia: Yeah. So, I mean, you can watch the videos. It was, uh, it was pretty atrocious looking in terms of the hit. You see the head cock back and then you see him go down and you see a posture position and then you see very limited movement of the arms.

[00:05:21] Dr. Grant Garcia: Now, again, this is just what they showing, right? They pull away from the athlete once they're injured. Yeah, and then the medical team comes in. So we're not really getting to see that much from someone who's recently had to spine board a patient on the field. I can tell you that you don't just start pulling the spine board out just for fun.

[00:05:39] Dr. Grant Garcia: It's a pretty serious situation you're concerned about. I will tell you this is like, it's When in doubt, spineboard. Okay, so that's the number one thing I'm going to tell you. It's just like when you learn in lifeguarding, right? I was a lifeguard when I was a kid. You know, if you're concerned about, again, they were probably, they were not initially concerned about a head injury.

[00:05:57] Dr. Grant Garcia: I'm sure they were, but that's not why they [00:06:00] spineboarded him. They spineboard him because they're worried about a neck injury. And they worry about a spine injury. So the board is for the spine to keep it straight. So really what the key is, is if you think there's damage to the spine, either the bones or the spinal cord, which we've all talked about, those are the worst possible football injuries we can think of.

[00:06:19] Dr. Grant Garcia: Um, you don't want any movement of that spine. So you need this board to be on there and then you need to be able to find a way to strap them on there. Now, this sounds really simple. Right. You slide the board on, move them. It's not so simple to move a 240, 250 pound human being who has completely gone limp or is not moving, whether or not they have a real injury and actually get them on the board.

[00:06:42] Dr. Grant Garcia: So there's actually a procedure and you've seen, I will give you examples. So I take care of a high school team, right? Mercer on high school. I've been there now for six years. We've had injuries on the field. And in one game, I had a spine board, two players. No joke. [00:07:00] It's a traumatic thing for the players.

[00:07:01] Dr. Grant Garcia: It's very traumatic for the, for the field. Obviously the worst is for the player. The

[00:07:06] Will Sanchez: parents also, right? The parents. For

[00:07:08] Dr. Grant Garcia: the parents, for the other players and for the stands. I mean, as soon as I spine bore these patients, there was concern to the players that died. There was concerns of the players, you know, they paralyzed and So, but you have to do it, right?

[00:07:22] Dr. Grant Garcia: Because you're concerned about it. So in both those cases, the players were not moving their legs or said they had severe back pain and they couldn't move. So you have to spineboard them. So that's the same thing that happened here. Thankfully in mine, both players were okay. And I will tell you that probably a majority of time that we spineboard the player, the player, a person is okay.

[00:07:41] Dr. Grant Garcia: Um, but there are definitely instances where it's not. We've seen this on the news. You've, we've talked about this before with players getting paralyzed, but here, They thought there was something wrong with the cervical spine and so they got a spine board. The key is you don't, you imagine when you're rolling somebody, their whole thing is they're going to hold collapse, right?

[00:07:58] Dr. Grant Garcia: So you got to keep them on. [00:08:00] But now there's the catches here. He's also got a helmet on. So how do you get the helmet on without bending the neck? Or extending the neck. Okay. That's the first part. So they have to take off the face shield, which they did, right? That's they can see, make sure he's breathing.

[00:08:14] Dr. Grant Garcia: Sometimes it would take off the guard and the actual helmet. And sometimes you have to sneak in there. The other thing is you want to keep the airway open. So if they're worried, he can't breathe. They're going to have to elevate the chin so that he can breathe and put a mask on him. And I know they brought out the oxygen for this as well.

[00:08:29] Dr. Grant Garcia: So this is not a joke with there. This is not an exercise. Yeah. Yeah. And,

[00:08:32] Will Sanchez: and they also hooked them up to EKG. So he was hooked up to EKG and, um, I, I'm obviously do not have the experience you do. Um, I do have my certification WFR and the wilderness, uh, certification and talking about how, um. You're stabilizing.

[00:08:51] Will Sanchez: You have that person right behind the head behind them and stabilizing the neck. And they're like, do not let go [00:09:00] of that head. You're and you are

[00:09:01] Dr. Grant Garcia: like in charge.

[00:09:02] Will Sanchez: Yeah.

[00:09:03] Dr. Grant Garcia: Like you are the most important person. So our average number of people for a spine boarding is five. So when I did it, we had five EMTs and two surgeons there.

[00:09:11] Dr. Grant Garcia: It turns out my buddy, Dr. Wayne, while I was also on the field, we had to do it together. Um, but you know, You get in there, players either not conscious and or players can't speak right and or players as they have numbness and tingling or back pain. The first thing you do is check it out. The second thing you do is if you're really worried, you're going to put them on the spine board and you're going to take them away to the hospital.

[00:09:34] Dr. Grant Garcia: And the reason is you want to get that CT scan, the cat scan of their neck and spine to double check for any breaks. If they have to do an urgent MRI, they will many times on the way to the hospital, the decrease in anxiety for the player, the calm situation of being on the spine board and or the amount of time from the injury.

[00:09:54] Dr. Grant Garcia: Most of the time, the real symptoms will either subside or still be there, right? So that's the biggest [00:10:00] concern. There were some other things that you mentioned when you initially texted me yesterday about this injury that were, that's pretty alarming for the people watching. It's cutting off all the pads.

[00:10:10] Dr. Grant Garcia: Right? You don't get to see that that often either. Like, how often do you see a player leave with no shirt on? Right. I thought it

[00:10:16] Will Sanchez: was something else. I was like, Oh my God, are we, you know, we dealing with something, a Demar Hamlin situation, right? And you know, and you know, I'm going to tease an episode that's going to be out in about another month.

[00:10:28] Will Sanchez: So with us and Dr. Dave and Dr. Dave was concerned not only about the heart, but maybe this was more of a traumatic injury to the brain. Anyway, I digress a little bit.

[00:10:39] Dr. Grant Garcia: You don't digress though, because you're right, this is some, this is a similar situation. He had an EKG tested, maybe for arrhythmia issues when he got hit.

[00:10:48] Dr. Grant Garcia: Similar thing to tomorrow. He had, he had the spot. So the reason they cut off the pads is so we can check the back of the neck and it can check the back of the player because you want it. [00:11:00] The first thing you do is you, the back of the spine has a lot of points on it and you want to feel those points because if any of those are tender, there's a concern that something called a burst fracture, which is not good, but basically it means That the spine is like a hole in it, right?

[00:11:13] Dr. Grant Garcia: So your cord can go through there and then surrounds by bone. When you have a burst fracture or crack, you can have a crack and it can go into the spinal cord or it can be unstable and that can cause a shift, which would cause spinal cord damage. So that's how we're checking for that. And so all those things are important.

[00:11:29] Dr. Grant Garcia: So when I did one of these players, he kept complaining that I was hurting his back when I was touching him and I'm not touching the muscles. I'm touching right on the bones. That to me is spine board. Don't, you know, get them over there. Do all this stuff like so they probably checked his hands. They probably checked himself and he's like, I can't feel my fingers, right?

[00:11:44] Dr. Grant Garcia: Cause he had just gotten hit. So he's just totally out of it. Yeah, he may not even been conscious. He may have not been able to say anything. He may have been limp and completely knocked out. That's what, that's what

[00:11:54] Will Sanchez: it looks like. He did not look, there was that slight movement, but it looked like, you know, [00:12:00] that could be also from the falling and he [00:12:03] Dr. Grant Garcia: basically got, he basically got KO'd boxing style and that's essentially what happened.

[00:12:08] Dr. Grant Garcia: Um, and so, you know, they don't know what to do with this right now. So this is split second decision. And I think that the, the, the part that I really like about this is that this was the safest bet to do. And when in doubt, you do that. So you've done your, so let's say you've taken your helmet off. Now you're starting to get off the head.

[00:12:23] Dr. Grant Garcia: Now you do, again, the hardest part is the roll, right? You have five people, you need to roll a 250 pound monster. I mean, the kid I did was about the same size as him. So I don't understand. It's, it's not easy. You roll them off, you slide the pads out, you're getting the back feeling, and then you're putting them back on the board.

[00:12:38] Dr. Grant Garcia: And then you got to slide them onto the board. Now, again, none of this, you want any movement of the spine. So it's a lot harder than it sounds, and it's good to have a concerted effort, but it's amazing when you get a team that, you know, we had four EMTs, so they were just like, boom, boom, boom, boom, boom, and they took over in terms of how to move, like these guys just do this all the time, and they're really good at it, and [00:13:00] that's essentially what they're, I mean, the team position wasn't leading the spine boarding.

[00:13:04] Dr. Grant Garcia: That was the ATCs on the field and the EMPs that were there, uh, to do that. So,

[00:13:09] Will Sanchez: yeah, the team physician would go with them. Is that something, you know, when he gets in the ambulance or is his responsibility to stay with the team and somebody else from the team goes with them and reports back of what's happening?

[00:13:24] Will Sanchez: What's normally that's,

[00:13:25] Dr. Grant Garcia: that's an excellent question because that is brought up a lot. And that's really hard when you start to be a team physician, you don't really understand like where your place is, right? Like as a doctor, if I'm on, if I'm like doing surgery, I would never like leave my patient, right?

[00:13:38] Dr. Grant Garcia: And go somewhere else. But at the same point, You have to because your job is to come after that plays done. He's got 52 other guys,

[00:13:46] Will Sanchez: right?

[00:13:48] Dr. Grant Garcia: Yeah. Or you, and you have all the entire field you have to take care of. So as a team physician, what you do is you pass it off. So you're basically the EMTs go there.

[00:13:56] Dr. Grant Garcia: And I, and like the same thing happened to me when I'm in the high school game. [00:14:00] Right? Like I'm like, okay, send the player to the hospital. And then I will, if there's an update, they'll have my number. They can call me. Usually the trainers will update me as to what's going on. But once they're kind of at the hospital, they've got the appropriate emergency room care.

[00:14:12] Dr. Grant Garcia: So the same thing happened there. They probably called, had the hospital get ready. Then he went straight to the emergency room. He probably had all the testing done. And it sounds like he's doing really well. So this is really good news. Obviously wheel brought up at the beginning, head injury. But if we had had this discussion last night, that's not what we've been talking about because this is new information, um, from the last 24 hours.

[00:14:33] Dr. Grant Garcia: But it's important for you guys to the, the listeners to hear this. Cause this is not just. Orthopedics is his team position. Um, at any surgeon or person, resident ATC that takes care of the team position, you need to know how to spine board and you need to know the threshold to do it. Um, like I said, I've been covering these games for six years plus fellowship plus residency, and I've only had a spine board a couple of times, [00:15:00] but when it happens, it's, You gotta make the decision, you gotta be becoming more,

[00:15:04] Will Sanchez: it's becoming more of the norm because you know, we, we see it more now.

[00:15:10] Will Sanchez: So I wonder what's the standard? What are those conversations? We know, especially at the high levels, I'm pretty sure in NFL College High School, you're involved with high school, have these conversations, especially in the off season of going into a new season saying, hey. When we have these type of injuries, we're always going to caution on the safer side because we're seeing, you know, players treated in this manner.

[00:15:34] Will Sanchez: You know, it's not going back to like the Dennis Bird days where they're just laying there and it seems like people are not sure what to do. And, you know, now it seems like there's a plan, you know, what's that checkpoint system, right? You mentioned, do you have feel in your hands? Do you know what, what's that process when you go in there and you're saying, Oh, wait a minute.

[00:15:54] Will Sanchez: I see one sign. And let's, let's do this.

[00:15:58] Dr. Grant Garcia: Yeah. So obviously there's [00:16:00] the big red flags, which we talked about. There's the consciousness, things like that. So obviously those have not changed, right? Like what you look for has not changed in the last 20 years. But what has changed is technology, information, social media, right?

[00:16:13] Dr. Grant Garcia: Like, yeah. If there's a delayed response on the field, that doesn't look good for anybody, right? It's just, it's just serious there. We don't know. I don't think of, and again, I, I hope obviously this is just my opinion or what I've seen. So this is definitely not 100. This definitely hasn't been fact checked,

[00:16:28] Will Sanchez: but

[00:16:28] Dr. Grant Garcia: I haven't seen an increase in.

[00:16:30] Dr. Grant Garcia: Issues with delayed responses from the NFL, right? We haven't seen a part of players that have had like that have died. They weren't taken care of. I mean, if anything, we talked about to Mary Hamlin is like a stroke of a stroke of pure amazement that they were able to get on the field that fast and take care of that.

[00:16:45] Dr. Grant Garcia: So, and nothing but accolades for all the, the secondary, uh, you know, uh, the EMTs and everything else in the ATCs on the field. So what I have seen is probably an increased response time, like you said. So there's just more speed to get there. Yeah. And probably [00:17:00] from Damir Hamlin and other, we talked about this with Dr.

[00:17:02] Dr. Grant Garcia: Joe Liu, you know, the entire team probably has extra checks. And I would imagine from some of these more serious injuries, Bronny, Damar Hamlin, and other players that we've seen, that there are probably an increase in what they're going to start doing stuff. And they're, you know. We've seen really bad injuries and note and everybody knows that like sometimes response time is really important with any of these things So we've just probably seen and we're also now looking for it more will but I would say that I do I do think that they have that the checklist for these injuries has probably increased and there is with Litigation increasing with NFL lawsuits, which we saw talked about with dr.

[00:17:40] Dr. Grant Garcia: Liu.

[00:17:41] Yeah,

[00:17:41] Dr. Grant Garcia: you know But there is no doubt in my mind that all of that has helped persuade people to do things a little bit more aggressively

[00:17:49] Will Sanchez: caution, caution, caution, caution, right? I mean, it's, uh, you know, just making sure that, you know, if you're going to side anyway, in any [00:18:00] direction, you're siding in an area that's just being extra cautious, right?

[00:18:03] Dr. Grant Garcia: Well, if there's ever a doubt. You spying board, there's just no, there's, there's no one, I mean, I had, I had to, I had to send, I had a patient. I thought I had broken their neck on one of my teams and tons of pain in the back of the neck. The dad was an orthopedic surgeon. I don't think he was very happy to me that I sent his son to the emergency room to get a CT scan, but I didn't really care.

[00:18:27] Dr. Grant Garcia: Right. Because I'm like, I don't really care what the dad thinks. I don't care what anybody else thinks. It's going to be a nuisance. They're going to get called at two in the morning because they have their CT scan of their son back. But to me, all I care about is that I'm making sure that the person has that the player is fine.

[00:18:40] Dr. Grant Garcia: And they ended up being fine, which was great. Um, what is the number? We don't one miss over a hundred non misses is well worth it still. So again, I'm not spying, boarding everyone on the field. Like I told you before, it's very rare that I have to do it, but there was enough that you had these. You had these team physicians calling for it.[00:19:00]

[00:19:00] Dr. Grant Garcia: And yeah, I mean, we could, we could go at nauseam with this, but again, it's the importance here is understanding that this was clearly more serious. They expected it to be more serious and thank goodness it's not. And hopefully he has a full recovery and this goes into concussion protocol. And in a few weeks, he's back to playing.

[00:19:17] Will Sanchez: Yeah. And for me, it's, it's the evolution. That's what stands out for me because I was like, wait a minute, this was head trauma, right? It wasn't, I can't feel my legs. Or anything like that. So just seeing the evolution of, of how, uh, players are being treated and taken care of, and you, you know, illustrate it perfectly, especially what has happened since DeMar Hamlin.

[00:19:42] Will Sanchez: And I can imagine those conversations you're starting the day after. With every team physician, you know, with those types of scenarios, it's just being overly cautious and just being careful and making sure that, um, because that's the scariest thing that anything could happen to the NFL, right? Is having a [00:20:00] player, God forbid, die on the field.

[00:20:03] Will Sanchez: And, uh, and all of a sudden now, Oh, you know, Moms and dads all over the place is saying, well, go make one Soto money and go play baseball and get off the football field. Um, and just real quick, you know, you mentioned that, you know, you do work with Mercer Island. Um, at one point I was, uh, one of the coaches with Franklin high school, and we had a player that got absolutely demolished kickoff.

[00:20:28] Will Sanchez: Return. Um, and we had to call the ambulance. They had to get spine boarded. And they wound up going to Harborview. All of us. I can't imagine the parents and everyone else in the stands, as you mentioned, but from the coaching staff, we were playing against hail from the coaching staff. I just wanted the game to be over.

[00:20:51] Dr. Grant Garcia: Well, they canceled our game. The game got forfeited when we did it.

[00:20:54] Will Sanchez: Yeah. It was so

[00:20:55] Dr. Grant Garcia: traumatic for people that the entire game was forfeited.

[00:20:58] Will Sanchez: Yeah. And [00:21:00] I kind of wish that we would have done the same thing, right? I'm not, I wasn't a head coach, but it's one of those things like, all I want to do is get out of there, get in my car, And then myself and the head coach, we went to the hospital, checked in on them, got the update, the parents were there, you know, like, and by the, and then once we were all done, we were like, I was looking at the coach.

[00:21:20] Will Sanchez: I was like, let's, let's go get a slice of pizza and a beer. I need a, I need to say, I can't go home right now. I need a second. So it's just, it is just so scary to see anyone so vulnerable. Um, so, you know, one of the reasons also that we were kind of talking about this as well.

[00:21:39] Dr. Grant Garcia: No, and it's good. I mean, it's just important for people to understand that I'm glad I was taken seriously.

[00:21:44] Dr. Grant Garcia: This is an, this is important people understand when you see the spine board come out, it's again, the, the, the goal of this episode I think is, and again, we're not going to run on too much longer, but the goal of the episode is to show people that people are, it's when you see a spine board, it doesn't mean there's a, some catastrophic thing.

[00:21:59] Dr. Grant Garcia: You know, I don't, [00:22:00] we want to, we don't want to cause more trauma to people when they see this spine board come out, but I want you also to hear that it's. It's expected that you should feel trauma like to see the spine board is very traumatic like the traumatic response I got when I got home. My wife is telling me I saw the Instagram posts about what happened at your game.

[00:22:17] Dr. Grant Garcia: What happened? And I hadn't even been home yet. It was like one hour, right? And it was a lot of traumatic and they canceled the game and everything else. So that's totally expected response. But at the same point is it's also doctors and, and EMTs just doing their job because we want to be safe. So a lot of times it isn't as big a deal.

[00:22:34] Dr. Grant Garcia: Um, but to understand that, you know, you, the number one thing you should think about is obviously the safety of the player and to, you know, Just making sure that it's good to know that people are on the field that want to make sure the player gets the safest, most lowest risk potential, um, scenario. Yeah.

[00:22:51] Will Sanchez: Look at this picture over here. Look at that. Sports Do talk.com. All sports, all orthopedics all the time. [00:23:00] Check out our website. You got the Look at this guy right here. Look at that picture. I mean, what a hand. I'm gonna change

[00:23:05] that to your picture. I got that. The greatest picture ever in the, in the logo one.

[00:23:10] Will Sanchez: Check out our past episodes, our transcripts. Um, we'll always want to hear from you. So if you have some suggestions for shows, we've had a couple of people request certain shows and we make sure that we give our listeners, uh, what they want, especially, you know, being informative. So we, uh, we want to hear from you, but please check out the website.

[00:23:31] Will Sanchez: Check out our podcast. We have audio podcasts, video podcasts on YouTube. We're on every stream and platform, Spotify, iHeart. Apple, you name it. We're there. You're probably sick of us at that point, but we really appreciate you because you know what? I'm hanging with my Nomi's right here and this is my Nomi right here with me. [00:23:51] Will Sanchez: Dr. Grant Garcia. Uh, happy holidays. Uh, you're all squared away for the holidays and ready to go. Except for the 18 surgeries you're doing [00:24:00] in the next two days. Is that, that, that, uh,

[00:24:02] Dr. Grant Garcia: yeah, we're, we're good. I, I, listen, I ha that's why I have a great wife because I can do my job and she's going to. Take care of all the stuff. [00:24:10] Dr. Grant Garcia: She's going to take over everything that's actually important and I'm just going to focus on my doing my stuff. So, and you know, I appreciate all your listeners, uh, happy holidays. This is going to be the last episode of the, of the new year, but we've got a lot more to come and I'm really looking forward to next year.

[00:24:26] Dr. Grant Garcia: Um, and we've sound, we've seen a lot of changes in this. This podcast, you know, we've got these injury updates, we've got guest appearances. It's been awesome. And I think the viewers like all of it. So, I mean, I just heard about his tongue. Well, I heard a couple of patients even this week asking about the podcast and things that they had seen about it.

[00:24:41] Dr. Grant Garcia: So we keep doing this so you guys can be informed. This is fun for us. This is not our full time job. Uh, so this is just something we, this is something we just record late at night.

[00:24:51] Will Sanchez: Yeah. It's spooky. Anyway, happy holidays, everyone. We want to wish everyone a, uh, Merry Christmas, uh, Hanukkah, [00:25:00] however you celebrate with your loved ones, happy new year and, uh, be merry and be safe.

[00:25:05] Will Sanchez: Uh, Dr. Garcia, I appreciate our relationship, our friendship and our, uh, partnership. So let's keep it going.

[00:25:13] Dr. Grant Garcia: My Nomi.

[00:25:14] Will Sanchez: My no me. Bye peoples. Audio Transcript

[00:00:00] Will Sanchez: Welcome to sports doc talk. I don't know. I got this vertical thing going on. Hold on. Let's go. Here we go. That's our look. Will Sanchez along with Dr. Grant Garcia, our orthopedic surgeon, sports specialist. How are you Dr. Garcia?

[00:00:33] Dr. Grant Garcia: I'm good. I'm good. It's a good day. And, uh, you guys have, we got a new logo in the back.

[00:00:38] Dr. Grant Garcia: So we're going to learn a little bit about this. You never know what's going to be up there.

[00:00:42] Will Sanchez: Dr. Garcia is constantly changing his background. We started out with a promise in early September rooting for the Giants, having the Giants background. And apparently Dr. Garcia has put the kibosh on the Giants with the background.

[00:00:56] Will Sanchez: So now he's going with different backgrounds for all our shows. [00:01:00] It's still not working. I'm not sure what we need to do next. Maybe I need to change the blue light to a red light or yellow light or green light. Oh, you know what? I should have done green light for today's show because we have a phenomenal guest.

[00:01:15] Will Sanchez: But before we get to our guests, this kind of, uh, give a little housekeeping here and give a little shout out to our sponsors, the recovery shop. Garcia, this is your bread and butter. Take it away.

[00:01:26] Dr. Grant Garcia: All right. Well, again, this is, it's awesome. I've I talked to Mike and those guys and they said that they've had some people contact from the show interested.

[00:01:33] Dr. Grant Garcia: I had a surgeon that sent me a patient that asked to use this because the patients love it. So the idea behind recovery shop is any of your performance things that you want after surgery. People kept asking, I want more. You're doing all the cutting edge tools, but what else can I have? What else can you get me to get me better?

[00:01:50] Dr. Grant Garcia: Um, and we've seen some of these different products on the show with the Nice Machine, the Nutrition Supplementation, the Rebliss, you name it. So now my patients can go to this sort [00:02:00] of page that's mine and get whatever they need in terms of that for the recovery. So if you are a surgeon, you're interested in this or you're a surgeon, you're about to get surgery and you want your surgeon to offer this, I'll reach out to them and Mike likes and be contacted directly.

[00:02:13] Dr. Grant Garcia: So it's easier for you again I got no say in this other than the sponsorship. So just use this direct line Um, and hopefully you enjoy it for your patients and i've been super happy. So

[00:02:23] Will Sanchez: yeah, that's it's great for everyone and We're going to tease our own website at sports. talk. com. You can find transcripts.

[00:02:32] Will Sanchez: You can find previous shows. You could go to YouTube, check us out your favorite, uh, listening podcast platform, whether it's Spotify, Apple, you name it. So I am doing a shameless plug, maybe not so shameless plug of our show and all the great guests that we've had on, uh, Are you tired of listening to me talk at this point?

[00:02:51] Will Sanchez: Should we tease who's about to come on our segment and what they do?

[00:02:56] Dr. Grant Garcia: Yeah, I think we mix it up each time. So let's do a little quick intro for the, [00:03:00] uh, the viewers, uh, and also the listeners to hear what's up next.

[00:03:04] Will Sanchez: All right, here we go. The future of sports medicine is a biologic based. We owe

[00:03:10] it to our patients to bring the most up to date technology that'll make their recovery easier and also allow for them to heal faster.

[00:03:19] It's forming a new bone within 24 months. It integrates so there's no trace left behind. We've gotten away from using truly artificial means and restoring the body to its native structures. Osseofiber is going to revolutionize sports medicine.

[00:03:36] Will Sanchez: Dr. Garcia, we're really excited to have our guests. We have Brennan Marilla and I know the last name.

[00:03:43] Will Sanchez: I know how to say it. Let's go. Brendan Marella. Thank you so much. He's our chief commercial and operating officer at Osseo. Thank you for taking some time and to join us tonight. We appreciate it.

[00:03:56] Brennan Marilla: Thanks guys. Appreciate it. Thanks for playing that video. That video always gets [00:04:00] me pumped up every time I see it.

[00:04:01] Brennan Marilla: So, uh, hope you enjoyed it.

[00:04:03] Will Sanchez: It's a great video. Um, before we get into all the, all the toys that Dr. Garcia likes to use and obviously, uh, what you're providing, um, just for our listeners and viewers, we reached out to you a couple of weeks ago. We were trying to plan an earlier show and unfortunately, like so many others affected by The hurricane season, you were affected with the hurricane that came through hitting the Tampa and Orlando region.

[00:04:32] Will Sanchez: Uh, first and foremost, before we get to the show, how are you, how's your family doing, , what's going on? Because that was some scary, scary stuff.

[00:04:41] Brennan Marilla: Yeah. Well, hey, thanks for asking. Uh, this is, this is a rental home. We're in and I'm grateful to be in this house and I've got my, I've got my two adult children with me too.

[00:04:51] Brennan Marilla: So it's, we're back to a family of four because my kids also had their places flooded. Uh, but we had a, we have a house on a barrier Island here

[00:05:00] in the, uh, kind of the Sarasota area. And, uh, unfortunately, Helene, um, uh, Helene, uh, flooded our house. So we had about two feet of water throughout the entire house.

[00:05:10] Brennan Marilla: So, uh, while we were in the process of removing, you know, all of our furniture and all of our things, and ripping out the drywall and the insulation, you know, kind of there's a race against time for. You want to get it out before the mold sets, uh, in the middle of all that we had to evacuate because Milton was coming and, uh, unbelievable, you know, so it was kind of a one, two punch.

[00:05:32] Brennan Marilla: It's been kind of a wild, uh, wild month for us. Uh, but I think we're starting to kind of get our feet out, feet under us now. And, uh, you know, life is starting to get back to normal, but we're starting the long rebuild process now, but everybody's safe and, uh, you know, the area, the community has been great.

[00:05:49] Brennan Marilla: And I think, uh, We'll be back soon.

[00:05:52] Will Sanchez: Do you have them do, do, do you have the kids now doing chores? Are, are they raking leaves, throwing out the garbage, loading up the [00:06:00] dishwasher? Like are you, are you taking advantage of the full labor that maybe is, uh, happening in the house or now they're too grown and they can't be told what to do?

[00:06:08] Will Sanchez: What's going on there?

[00:06:09] Brennan Marilla: Yeah. No, I'm cracking the whip, just like the good old days.

[00:06:12] Dr. Grant Garcia: smart man.

[00:06:14] Brennan Marilla: Yeah, they're living rent free right now, so. Uh, you know, now I have to just kind of negotiate things, you know, like I need you to do this. I need you to do that. I, I'll, you won't have to pay utilities if you take the trash out.

[00:06:25] Brennan Marilla: So when they get, when they become adults, you have to do a little bit more negotiating cutting deals versus just telling them to go to their room.

[00:06:33] Dr. Grant Garcia: So we're learning, I'm learning so much from this. Well, anyhow, I'm glad you're safe. Everything's good. Uh, we're really excited to have you on her. I know it's been a lot going on in your life, but this product you guys have heard about it before on our show, right?

[00:06:46] Dr. Grant Garcia: This idea of harder than, you know, some of the other competitors on the market turns into bone faster, uh, and replacing metal. And honestly, this is just what patients have been asking for. I mean, I know that the couple of shows I put out with I put out before had [00:07:00] questions about this. We finally have someone who's an expert on it.

[00:07:03] Dr. Grant Garcia: I've used the product. I use it a lot. I'm really pleased with it. But obviously, you know, we have experience here with one of the man himself. So, Can you, we can talk about a little bit about your background and kind of why you got an Osseo before we go after the product, because it's going to be really awesome.

[00:07:17] Dr. Grant Garcia: We start talking about it, but as well knows we're gone once we start going after it, because it's going to be so much stuff we're going to have questions on.

[00:07:24] Brennan Marilla: All right. What do we, what are we talking about first? I'm ready to go. Well, I love

[00:07:30] Will Sanchez: the title on the website. If you go to Osseo. io. It's great. It says don't settle for metal.

[00:07:37] Will Sanchez: It's the first thing that you see on the website. And right there, it is so simple. It is so catchy. And all of a sudden, if you don't know what's happening or what it's about, just those three words alone already kind of puts you on the path saying, Oh, wait a minute, this is something different. So tell us a little bit about, uh, how you got involved with the company first, before [00:08:00] you get into the product itself.

[00:08:01] Brennan Marilla: Yeah, sure. So I've been in med tech about 30 years. Most of my career has actually been in cardiovascular, actually peripheral vascular and aortic disease. Spent a lot of most of my career at big companies. I've done some small companies, some big companies. I was at Medtronic for many years at Covidian.

[00:08:16] Brennan Marilla: Um, you know, one thing I learned from coming from the peripheral vascular space is that the mantra in that space is in terms of opening arteries, things like that, instead of leaving Instead of putting stents in like they used to, the market is moving towards, uh, like shockwave ultrasound or drug coated balloons.

[00:08:34] Brennan Marilla: The mantra is leave nothing behind. And the body leave nothing permanent behind. So, uh, when, uh, when Brian Verrier, who's our CEO, who I've worked with, uh, for many years at a few other companies told me he was thinking about taking this job as the CEO and, uh, I was at a different company. We had just sold that company.

[00:08:57] Brennan Marilla: Uh, and he called me and said, you know, I'm thinking [00:09:00] about doing some different things. There's this company Osseo. Um, would you take a look at it? I just want some advice on whether I should take this job or a different job. And I said, sure, I'd love to see it. And he sat down with me and showed me kind of the management presentation and some early animal studies and the idea of osteofiber.

[00:09:17] Brennan Marilla: And I said, God, I think that sounds like one of the most compelling things I've ever heard. I, the value proposition is, is obvious. I mean, you could explain to your next door neighbor, Hey, wouldn't you love to have orthopedic surgery? And instead of. a metal implant, you have an implant that turns into your own bone.

[00:09:34] Brennan Marilla: Uh, you know, immediately they're like, of course I would want that. You know, so we, I thought, geez, there's a huge, uh, unmet need here. It's very compelling to patients, to surgeons, even payers. Um, and, uh, you know, it's a five, 10 K path. It's very disruptive versus being something that's incremental. And I said, you know, you ought to take that job.

[00:09:56] Brennan Marilla: And by the way, if you take that job and you raise some money, why don't you bring me on? [00:10:00] Uh, and let's do this together because I think this sounds really, really interesting. The other thing that caught my attention was that, um, again, I was new to orthopedics seven years ago when we, when we kind of got Osseo off the ground, the United States.

[00:10:13] Brennan Marilla: Um, but, uh, I just thought it was interesting that all of, you know, most of the large companies, uh, have tried this over the years. They've tried to come up with non permanent implants because it's, it's, the need is obvious. Uh, the benefits are fairly obvious. But no one's really been able to quite crack the code on a non permanent implant that's weight bearing that is really strong and also is very biocompatible.

[00:10:40] Brennan Marilla: Um, and so that's why I thought Osseo could really be very disruptive. across multiple sectors of orthopedics.

[00:10:50] Dr. Grant Garcia: I want to chime in there. So we'll to you have, and obviously I wanted you guys on the show. I've been pretty excited about the product since I first saw it myself. [00:11:00] I would say, well, you have now have two people on this show and I'm assuming Will's going to be that way in a minute that when I heard about this idea, I said, that's, I've never heard of anything like that.

[00:11:09] Dr. Grant Garcia: And then when I used it, I felt the same way. So the disruption you have here to the listeners or to will is metal is very strong, right? Like we think of metal is like kind of what, almost, I hate to say the gold standard, right? Like when you're putting something in, you would never put in a plastic, you know, you put in plastic screws and drywall, but you wouldn't put a plastic screw into wood, right?

[00:11:32] Dr. Grant Garcia: I mean, it just not, now we can talk about this thing, but you wouldn't do that originally. You think it's break, it's not strong enough. And there's no products that we see out here for drywall stuff that we see that is often. In the bone, in the, in the body, it's the same way. And so people are just like this idea that every time we use a product, that's sort of supposed to dissolve or turn into bone before I've seen this.

[00:11:52] Dr. Grant Garcia: They would crack

[00:11:53] Brennan Marilla: right? Hard,

[00:11:54] Dr. Grant Garcia: hard bone. It cracks. Sure. So the first time I put this into something that was hard, I was [00:12:00] expecting it to crack. And instead it worked just as well in terms of strength as the metal, which we're going to go to in a second. There are various different types of screws that are not metal.

[00:12:11] Dr. Grant Garcia: And I have not seen one yet that turns into bone as well, but it's also as hard, which is just an extremely unique pattern. And I think that Brendan's going to go into this, but for the people to see this, it's like, there's so many different products out there, but there's, this one seemed to figure it out.

[00:12:28] Dr. Grant Garcia: And so that I think is what the uniqueness of the product is. And that's why I want people to hear about it. And I'll, we'll explain more of this in a minute as to why this is so important. Sorry, keep going, Brendan.

[00:12:37] Brennan Marilla: No. So what we tried to do is we, we wanted to create a new category. Uh, called bio integrative implants.

[00:12:44] Brennan Marilla: Um, we didn't, we especially didn't want to call this a bio resorbable or a biocomposite. That's not what it is. We, these are made differently. And Brendan,

[00:12:53] Dr. Grant Garcia: will you explain everybody why you didn't want to call that?

[00:12:56] Brennan Marilla: There's just a lot of baggage and a lot of negative baggage with bioresorbables [00:13:00] for a couple of reasons.

[00:13:00] Brennan Marilla: One is they're primarily just. Polymer based implants. Um, biocomposites introduced a little bit of minerals, some resin to kind of give it a little bit more, um, uh, structure, but they're still, it's still kind of powder. So basically traditional bioresorbables, uh, that have not been widely adopted, uh, in, in orthopedics.

[00:13:22] Brennan Marilla: And that's why metal is still still around 150 years later. Everybody's tried this and haven't really, haven't really been able to succeed is because polymer is very, it's not strong enough. If you drill it in, if you, if you nail it in, if you screw it in, um, you know, the, sometimes the, they'll, they're very brittle and they'll break or after you, uh, after you fixate bone, they might not be weight bearing, uh, they might break.

[00:13:47] Brennan Marilla: And, but if you get them in successfully, What happens is, um, these big polymer, these polymer implants can have these acidic breakdowns two, three, four years down the road. And when that happens, [00:14:00] patient feels inflammation, pain, uh, you guys see cystic formation, bone void, things like that. Uh, also the other issue is that if you want to do a revision surgery, whether it's metal or even peak, it's in your way.

[00:14:14] Brennan Marilla: Uh, and so we thought that, you know, if you. Um, if you have a technology that turns into bone, there's, there's nothing in your way if you need to go back in for any reason. Um, so we make these differently than the non permanent implants of the past. And that's why we call these bio integrators because that's really kind of the nature of how it works.

[00:14:35] Dr. Grant Garcia: We'll put that slide back up. I think that was important. The one we just had. So to chime in on this, he, what he hit on his thing, the cysts and the cracking for the biocomposite is a big concern. And. And the idea behind plastic, you're still leaving behind something that you've got to take out. And some of the plastics you can drill through, but some you can't.

[00:14:56] Dr. Grant Garcia: And this is a big problem. Alright, Will, so here's an example. Nick Chubb, we just had the [00:15:00] discussion. He had a revision surgery, right? There's a low chance that the surgeon used a biocomposite screw for him. So they probably used either a metal screw. Or a plastic screw, a peak screw. So when they did the second ACL for him, they had to either take them out.

[00:15:17] Dr. Grant Garcia: And by the way, everybody knows no one looks good taking out hardware. And so you're talking about stripping a screw pulling out. I do a ton of revision ACLs. I do a ton of revision surgeries. I mean, I just had a patient today. She's doing awesome. You could see she's got, I took out all these metal from the ones you had before.

[00:15:33] Dr. Grant Garcia: They just got track marks all over the inside of her bone. And I had to worry about those when I'm doing the surgery. Is it going to get in my way? Is my going to get by fixation? So there's still these things. And if they have a biocomposite, the CIS formation is actually worse. Taking out a screw and having a hole is a, is frustrating and certain surgeons can figure out different ways of doing it, but the cyst is a nightmare.

[00:15:53] Dr. Grant Garcia: And so you, the fact is you leave no trace doing a second surgery or doing a third surgery, which we [00:16:00] never want to do, but it's like probably something I do twice a week or three times a week. Yeah. It makes my life so much easier. And so that's another point of it as well. So else, sorry. Can you describe the, the strength prat, the strength graph and the regeneration graph you have here?

[00:16:15] Brennan Marilla: Yeah. So the, um, the graph on the right is just kind of, uh, an illustration of kind of what we set out to do was, you know, the kind of the Holy grail of, of, uh, materials, fixation materials and orthopedics should be that they're natural. Um, they, they leave nothing behind, leave no trace, but they're also strong.

[00:16:36] Brennan Marilla: So if you kind of look at that chart, you've got strength on one axis and you've got kind of natural bone regeneration on the other axis. Um, you can see where we're twice as strong as peak or about five times as strong as a traditional bioresorbable. Uh, and, um, and we also have that natural bone regeneration happening.

[00:16:53] Brennan Marilla: So that upper right hand corner is kind of where you want to be in terms of orthopedic fixation materials in the future.

[00:17:00] Dr. Grant Garcia: All right, well, let's go to that next slide. By

[00:17:01] Brennan Marilla: the way, Um, you mentioned Harbor Removal Surgery, uh, obviously there's a huge cost benefit here too. Um, obviously patients don't want a second surgery, especially, uh, children, which is why we have a pediatric label for most of our products now.

[00:17:16] Brennan Marilla: Um, but Harbor Removal Surgery is one of the most common surgeries in the United States. Of any surgery and that's and you also started foot

[00:17:24] Dr. Grant Garcia: and ankle, which is the most common, right? So as a knee surgeon, I take out plates. I take out I I don't do many metal in you're talking about surgeons Still love this product not being a metal guy.

[00:17:34] Dr. Grant Garcia: I'm an anti metal surgeon if I could do it I mean I have to do metal occasionally But i'm anti metal and I tell my patients I try not to do metal But even that that type of surgeon that does anti metal this product is very very unique still Right, so, you know you're comparing to metal and that's actually the most common thing we see You Um, but even people that don't always use metal, there's still a huge benefit of this, right?

[00:17:54] Dr. Grant Garcia: It's just that you're, you, we're always, metal is the gold standard for hardness. Um, but taking out [00:18:00] removal of hardware is very common. And in foot and ankle, I have a bunch of really good partners. I would tell you that 30 percent of their surgeries are removing the hardware they put in the foot.

[00:18:08] Brennan Marilla: Exactly.

[00:18:09] Brennan Marilla: It was really important to us that we bring you guys, the surgeon community, um, a technology that would not have, would not have trade offs so that you could get the benefit, the patient benefit. You could get the benefit of leaving nothing behind and preserving your landscape without feeling like you're trading off strength.

[00:18:29] Brennan Marilla: Or ease of use. And we've worked very, very hard at that. So the way we get our strength is, is this, this chart here, this, this, um, kind of illustration here. Um, we take basically minerals found in bones, silica, calcium, magnesium, et cetera. Um, Iran, our founder, uh, figured out how to take, uh, these minerals and how to, um, engineer them into these long, continuous fibers.

[00:18:55] Brennan Marilla: like fiber optic cable and then he layers them in different directions. You layer [00:19:00] them in different directions, uh, and you create like this matrix infrastructure and that gives you unbelievable strength. Um, it gives you a lot of body, a lot of structure and a lot of strength. And as a matter of fact, we make our, our implant, if you know, if we make a screw different differently than we make a staple or an anchor, we can just take these fibers and we orient them in different ways.

[00:19:21] Brennan Marilla: to dial in different mechanical properties. But each time we do that, we definitely continue to overlap and weave them. So they're really, really strong. Um, what that does is it gives you really, it gives you. Uh, strength higher than cortical bone at time, zero through six months and beyond. And then, and then over time, what happens is bone attaches to this immediately.

[00:19:42] Brennan Marilla: We saw in our animal studies at two weeks tra trabecular bone formation on the implant. Bone thinks this is bone and then it starts to infiltrate the implant. It's a little porous bone cells infiltrate the implant and then over time it just mineralizes and just regenerates and just becomes bone. [00:20:00] So at about in all of our animal studies and in our human studies as well, but in the animal studies where you can look at histology.

[00:20:06] Brennan Marilla: At two years, there's no evidence there was ever an implant.

[00:20:10] Dr. Grant Garcia: And well, this is a really, I want to explain to you what you said for the listeners. Cause obviously the surgeons get it. Med device company, people might hear this and understand some of it, but we'll cortical bones, the outside of the bone. Okay.

[00:20:22] Dr. Grant Garcia: And I think, can you go to the next slide? Is that the one with the bones? So I can show them. Yes. Right here, guys. Okay. So cortical bone is the surrounding bone. You guys see the bottom, that sheep study that's cortical bone. That's the hard stuff. So like, and I don't want to gross too many viewers out when you're drilling, you're hit cortical bone.

[00:20:39] Dr. Grant Garcia: You're like, that's hard. It's like really solid. And then you go through the counsellors bones, like where the bone marrow is. That's like, well, if you ever eat bone marrow, it's super soft and gushy. And can sell us bone is like very soft. So there's really not much there. And then you go to cortical bone.

[00:20:53] Dr. Grant Garcia: So the idea is that this is the hardest bone you want is cortical. Like we always are looking for cortical purchase. It's like in a [00:21:00] wall, right? You have, you're looking for the stud. That's absolutely right. But what's cool about this product is that it basically, what we're finding and you're going to see us in a second is that that's the screws are essentially turning the entire tract into cortical bone.

[00:21:15] Dr. Grant Garcia: So you're actually getting, you're actually making the bone harder in certain spaces. Which is pretty crazy to think about. So the idea is that in some of these cases, they're actually able to heal bone. You're going to see that from the knee bar study. And the idea is like helping with union, right? So if you've got two, you split that bone in half right there.

[00:21:32] Dr. Grant Garcia: Imagine you've got two, the shell casings are good, but when you, when you put it back together, you still have the soft stuff in the middle. And that can take a little while to heal. So the idea that we're still working on is if we put that screw through the middle in a metal one, there's nothing's going to grow, right?

[00:21:45] Dr. Grant Garcia: It's just going to grow around it, but not in the middle. So you're going to have a part that's not actually healed. If this turns into solid bone, are you actually going to turn this? This bone into like a three part thing. So now you're going to have a piece of cortical going through the middle, which is kind of a crazy concept.

[00:21:59] Dr. Grant Garcia: You're [00:22:00] essentially get, you essentially could make people's bones harder, which is really fricking wild. I don't know, Brennan, if you were going to talk about that, but that idea to me was, that's one of the things we're working on is the future. Right.

[00:22:11] Brennan Marilla: Yeah. That's interesting. You know, the, uh, over time it'll end up, it'll end up like it was never there.

[00:22:18] Brennan Marilla: Uh, and so, um, you know, you don't have to worry about any of these kind of like, uh, uh, extra articular structures and like that on the, on the, on the bottom there, that's a, that's a plate study that we did, um, years ago. Uh, a little feasibility study, the sheep tibia, and what's interesting about the study is you look, we put a plate on top, you can see in the kind of the 13 week on the far left, and then over time, it looked like bone kind of tense up to the side of it, and then it all remodels back down to the cortical surface.

[00:22:48] Brennan Marilla: So for us, for, for us, you know, we are working towards a plate technology. Um, but the staple that we launched, we launched a staple a year ago. We just launched a small staple that has a lot [00:23:00] of foot and ankle applications, a little hand and wrist. They do a lot of Aikens with these little nines and 11s.

[00:23:04] Brennan Marilla: But, um, but this was, uh, this, this helped us with the FDA in terms of getting this, the first non permanent staple in the world to market, because people wondered, we knew what happened in bone. We wanted to know what happens on bone. And this is what happens on bone. It completely remodels down to the cortical surface

[00:23:21] Dr. Grant Garcia: and that's incredible to create

[00:23:22] Brennan Marilla: a speed bump.

[00:23:23] Brennan Marilla: You don't have to worry about, uh,

[00:23:25] Dr. Grant Garcia: uh, overgrowth

[00:23:26] Will Sanchez: looking out. Yeah. Brendan. Um, what was this seems, you know, we we've had so many shows, um, With different technology, um, you know, different, you know, medical advances from the beginning, right? You got the phone call, the company, things like that. But what was the process to talk to the doctors to see what worked?

[00:23:52] Will Sanchez: What didn't work? What did that look like? What was the studies? How many people did you guys talk to? Um, was it just, you know, [00:24:00] United States was expansive. Did you, you know, what, what was the research? I'm just curious to. To come up with the concept and just hear from the different, um, whether it's orthopedic surgeons or anyone else saying we need something else besides metal.

[00:24:16] Will Sanchez: And what did that look like as far as trying to figure that out and get, and get into the point where you're at now, because obviously like all the, all this technology is start somewhere. Yeah.

[00:24:25] Brennan Marilla: You're talking about developing the technology or developing the go to market plan. Well, no, just, just, yeah, no,

[00:24:32] Will Sanchez: just really just kind of just having the conversations, you know, how did those conversations start with other doctors and realizing that, you know, there was a market for something like this and how do we get to the point where we can get away from metal?

[00:24:45] Brennan Marilla: Yeah. I mean, look, I, I think like I said earlier, the, uh, um, the market had already been kind of validated. The need had been validated. Everybody's been trying to bring, you know, uh, non permanent implants, the market that can be mainstream. I mean, we wanted this to be. the [00:25:00] first credible replacement to metal implants and other permanent implants like peak.

[00:25:05] Brennan Marilla: Um, Iran price bloom is our founder. He deserves all the credit for this. Uh, I call him the Elon Musk of orthopedic fixation materials. He's a very talented biomedical engineer, uh, studied at Columbia university, uh, orthopedic research department. His thesis was the interaction of metal and bone. He became very obsessed with the fact that, uh, there's so much innovation in orthopedics.

[00:25:27] Brennan Marilla: I mean, there's a lot of innovation in this part of med tech, but fixation materials is not one of them. And, uh, and they're, and they're problematic for all the reasons that we know, of course it works and, you know, and using it for a hundred plus years. But you know, why, why are we going to put somebody.

[00:25:44] Brennan Marilla: On mars in the next 10 15 years and we're still using metal implants. It's kind of ridiculous. So he was obsessed with it and and uh, and was able to Uh bring this concept to life and uh You know, we got some smart, you [00:26:00] know early, um advisors around us. Uh, we were able to raise money Um, we were able to get some seed money from the israeli government because the technology center is based in israel Okay, and um, and we were able to get it off the ground Get it off the ground and, and get it into some successful animal studies.

[00:26:18] Brennan Marilla: Um, when we just, when we started, um, our, when we kind of got our plans together to go to market United States, when we, you know, in about 2017 is when we, uh, opened up the Boston headquarters and started hiring people in United States. And, um, and at that point we began to go out and try to understand the perceptions of the market around non permanent implants.

[00:26:43] Brennan Marilla: And what we found was what we, what we thought we would find, which is everybody loves the idea. There's not a single surgeon that just says, yeah, that's not a good idea. Like, why are you even thinking about this? That's, that's not even the, you know, kind of validating the need we don't need to do. We have to prove that this is [00:27:00] different from prior attempts.

[00:27:01] Hmm.

[00:27:02] Brennan Marilla: And so we had to get out and we had to understand what were, you know, what did they like and dislike about, you know, the, the other, um, the other non permanent implants that had been on the market are still in the market, including the biocomposite market, which is still very, that that's been a successful part of non permanent implants is shoulder biocomposite acres.

[00:27:21] Brennan Marilla: Um, but otherwise anything weight bearing has not been typically. Um, so we went, we had to go out and try to understand, you know, uh, how would the market view this, how would, how do we need to explain it? And we just decided to go out and just be as transparent as we possibly could with how we make it all the animal studies.

[00:27:39] Brennan Marilla: Um, we wanted to be a very scientific company. Uh, we wanted that to be part of our brand personalities to be, to be very scientific and innovative. And, um, and we also decided to brand the category differently with, which is biointegrative. And that has been a term that I think has been very sticky for us because once you have a chance to explain this, um, [00:28:00] to a surgeon or even to a patient.

[00:28:03] Brennan Marilla: Uh, it just makes a lot of sense and people want to evaluate it and try it. So

[00:28:09] Dr. Grant Garcia: the, uh, I think we'll also, you're trying to get at the way these surgeons think again, I'm obviously just one of them. There's many of them. Um, all the stuff that Brennan saying is really good. Right. And we listened to that, but obviously the same thing is it's got to perform.

[00:28:24] Dr. Grant Garcia: When you actually do it, so when I did my first trial, so we can hear this, I picked the hardest scenario because I was like, if it doesn't mess up on this, then we're good. Right? So I eat the tibia, which is the tibial bone. And so I do certain surgeries that require the fixation of the tibia. And I have tried a lot of anchors.

[00:28:42] Dr. Grant Garcia: And I've had a lot of reps upset when they crack when I'm doing them. And I remember the first time I put one of these in, I put it in and it just kept squeaking, which means, as you know, squeaking in the wall means like, there's only two ways this is going. It's going to snap in half

[00:28:57] Will Sanchez: and I'm not

[00:28:57] Dr. Grant Garcia: going to be done using it or it's going to go all the way [00:29:00] down and it's going to work.

[00:29:01] Dr. Grant Garcia: So I remember doing it and went all the way down. I look over at the rep and I said, how did you guys do that? I was sure this thing was going to crack because I heard it squeaking the entire time. And then the next time I did it, I was like, let me make this even harder. So, you know, you're supposed to tap up screw.

[00:29:15] Dr. Grant Garcia: He's like, just the reps, like do only a little bit. And I was like, dude, that's going to break for sure. And I did the exact same thing, but I'm like, if this breaks, it's no big deal. Right. The cool part about these implants is, you know, again, doesn't happen, but if they crack, you can just drill it out and do it again.

[00:29:30] Dr. Grant Garcia: It's not like when you have a wall, you have a whole hole, you can't use it again. So I tried it again and it squeaked even more. And I'm like, this is definitely going to break. And sure enough, it didn't. And I looked at him, I was like, where can I get more of these? This is awesome. So that's all honestly, will, I hate to tell you that you can, Brendan can talk all day about all the data he says.

[00:29:48] Dr. Grant Garcia: And that's really great. And that helps me feel good to tell my patients about it. But in the end, it's got to perform. It's just like these athletes, right? Like all day you can train, but if you can't shoot the hoops, there's no point in even being on the court. So [00:30:00] anyhow, go to the next slide. This is, this is really good.

[00:30:06] Dr. Grant Garcia: So you can see where they're at. I mean, Brennan, you can see where we're going to ask about what are your, what are the service lines you're looking at? And we want to make sure we get to all this stuff cause we could go all day with this. We,

[00:30:17] Brennan Marilla: we see this as a platform technology, uh, and you could make, you can make endless number of implants across all the, all the sectors of orthopedics.

[00:30:26] Brennan Marilla: Um, I mean, you know, uh, you know, Iran, our founder, he wanted to go into spine first. Okay. We were like, well, maybe let's, let's pick a different space. Uh, first that's, that's a little bit of the wild, wild West right now. He is,

[00:30:38] Dr. Grant Garcia: but he is the Elon Musk. So he's just,

[00:30:41] Brennan Marilla: listen, we think there are many great applications of spine, but we said, you know, why don't we start with a foot and ankle and we started in foot and ankle for a few reasons.

[00:30:49] Brennan Marilla: One is we thought that was maybe where the biggest unmet need existed because you're walking on these implants, people feel them in their feet, even when you have a successful union, a

[00:30:59] Dr. Grant Garcia: lot of removal of [00:31:00] hardwares is probably the

[00:31:01] Brennan Marilla: very high hardware removal rate. Um, and there just wasn't a lot of, uh, non permanent implants available for that market.

[00:31:11] Brennan Marilla: So we went to that market first and we've had a lot of success in that market. We've, you know, we're over 40, 000 implantations now. Um, And, and that just in a few years. And so this is our current portfolio. Um, thanks for pulling this up. You know, we started off with, we started off with something really easy.

[00:31:29] Brennan Marilla: We thought, geez, a hammer toe implant would be really a easy place to start. Uh, it's also an interesting study because we did our first in human study was, it was in hammer toe. And not because we wanted to really, we were super interested in hammer toe. It's just that we wanted to show biointegration and safety and efficacy.

[00:31:48] Brennan Marilla: And, um, that implant fills up a lot of that, uh, intramedullary space. So it's actually a really good test. But anyway, so we start off with a hammer toe. Uh, we introduced these nails, these nails, think about rebar, [00:32:00] uh, anywhere where you need stability or strength, uh, if you need to add fixation. Um, these nails, these trimmable nails are super interesting to use really strong.

[00:32:09] Brennan Marilla: You can hang 350 off the end of one of these nails and you can trim them. You can customize them. Um, and then we introduced screws. Uh, we then followed with, uh, the suture anchors that you've, you, that you've used Dr Garcia, uh, then this, then the, uh, different staples. And then we have a new product that we literally launched a few weeks ago, which is the fully threaded trimmable nail, or it's kind of like a fully threaded screw, but we have a really interesting way to, uh, to trim them and then to, um, resharpen the tip.

[00:32:45] Brennan Marilla: So it's a, it's, it solves the scourge of the end of the industry that one of the biggest problems in the industry is. Inventory management. Imagine one length screw, essentially it's a nail and you trim it. And then, um, [00:33:00] you've got a little pencil sharpener there and you, you basically have a driver that's adjustable and you would just adjust the driver to the length of the, of the nail after you cut it.

[00:33:10] Brennan Marilla: And then you just resharpen the tip. And then you, you put it in, you can drive it in really easily. You don't even have to tell you

[00:33:17] Dr. Grant Garcia: don't have to tell you is you can use, you can have one long nail and put in three small screws with it. Is that what you're saying?

[00:33:22] Brennan Marilla: No, you can have one long nail. Oh, so on the, on the trimmable now, just the normal, just the typical nails, the ones we've had for a while.

[00:33:29] Brennan Marilla: You can cut those in half or in three pieces and you can get two or three implants out of those nails. The, the fully threaded nail. Uh, I think that may be difficult to do. I think you're going to get one implant out of that nail. You're just going to be able to trim it to length.

[00:33:44] Dr. Grant Garcia: Yes. So you're only having one side of the table.

[00:33:47] Dr. Grant Garcia: So you're not having to have like 10. So, well, the other issue you have with these implants is obviously stock, right? Like I'm lucky I've got a pretty good stock area, but like I can't carry every single size. So what he's saying is it comes in and you have one size fits [00:34:00] all, and then you can adjust it and customize it.

[00:34:02] Dr. Grant Garcia: So it means everything's a lot easier.

[00:34:04] Will Sanchez: I love that wording. The pencil sharpener is like, okay, you know, it's a three inches long. We need to get it down to two and a half. Well, we're just going to, you know, just, uh, Use the, the trimable nail and get it down to two and a half where I need it. And there you go.

[00:34:18] Will Sanchez: There's the exact size that you need for whatever the size of the bone or the area that you're going in. Because as we know, every person is built differently. Everyone is a little bit longer or shorter or things like that. So, uh, that's a, that's a great concept. Uh, what, what was the mindset behind that was to just realizing that there was a need and finding a tool would.

[00:34:42] Will Sanchez: You know, satisfy that?

[00:34:45] Brennan Marilla: Well, yeah. I mean, uh, our, our, our compression screws are, are, uh, partially thread at compression screws. They're really strong, but they're, um, not as sharp as metal. So you, you do have to tap them in hard bone, especially. Um. With the [00:35:00] fully threaded nail, you don't have to tap because the driver extends through the, uh, along the nail.

[00:35:07] Brennan Marilla: So you don't have all the torque in the head. And also it gives you better visibility when you're placing the implant because the driver, you can see the tip of the driver at the very end of the implant.

[00:35:15] Dr. Grant Garcia: Yes. Well, that's a good point you brought up. You can't see them on x ray either. So after you're done, you have to be able to find it.

[00:35:20] Dr. Grant Garcia: So this is why they did the beat, beat the trick on there. Yeah.

[00:35:23] Brennan Marilla: Yeah. So we actually used instrumentation to solve a few of the, uh, maybe some of the minor objections we had with our original screw. And we think this is the platform moving forward and the compression you get is amazing. And the squeaking, the surgeons love the squeak.

[00:35:37] Brennan Marilla: Uh, and I actually, I think this is a great TTO product for, uh, for, for sports medicine. Surgeons a great product for. using for TTOs and some of the other applications. But, um, we're going to have four and a half. We have five and a half. So we're going to launch next month. And we also have a hand and wrist.

[00:35:54] Brennan Marilla: So we have a kit for foot and ankle and sports medicine. Other, you know, kind of, kind of a universal kit. [00:36:00] Uh, and then we have one that's specific to hand and wrist for, so they can use these as metacarpal nails. So you asked like in terms of what sectors we're in, we're in foot and ankle. Um, we've been in foot and ankle for five years.

[00:36:11] Brennan Marilla: We've been in sports medicine for about a year. We're having great success in sports medicine right now. And then we're just, we're kind of entering hand and wrist. We've done, been doing hand and wrist cases, but this is our first like specific hand and wrist product. Is the, trimmable nail with the hand and wrist kit.

[00:36:26] Brennan Marilla: Go For metacarpal surgery, um, which obviously you don't, you hate to, you hate to revise those with metal on the way, uh, and patients don't want metal in their hands. So, you know, we think this is a winner for that application to really excited about this product and we'll continue to make all, we'll make smaller diameters and we'll make larger diameters.

[00:36:45] Brennan Marilla: We want to make big seven O's for big hind foot surgeries, hip, things like that.

[00:36:50] Dr. Grant Garcia: Yeah. Will, I want to tell you one more thing. So this product, again, I had the older trim old nail. I remember they showed me and they brought it in. They were like, okay. So they gave it to me. And this is all part of the intro [00:37:00] cock with the surgeon.

[00:37:00] Dr. Grant Garcia: And they said, and I've had this before where it hasn't gone well, not with you guys, but other companies. And they said, break it. And I was like, Okay. So he goes, break it, bend it. You're strong. You think you're strong, break it. And you're talking about, you know, it's this, I don't even know. It's as long as this chapstick.

[00:37:15] Dr. Grant Garcia: Right. But if it's thin, it's, this is only 4. 5 millimeters. That's not very thin. That's not very thick. And they were like, break it with your hands. So I'm like squeezing and it's, it's literally not moving. And I'm trying, I'm put on the table and I'm trying to break it. You can't break it on the table. So right then and there, you're like, okay, what's going on here with this?

[00:37:32] Dr. Grant Garcia: Not only is it not breaking, the threads are not shaving off. So that's a pretty impressive product. I remember specifically doing that cause I was 99 percent sure it was going to crack in half.

[00:37:44] Brennan Marilla: I'm glad it didn't. I wouldn't expect it. But

[00:37:48] Dr. Grant Garcia: you know what though, that's how you guys, that's how you guys get people to believe it because I remember, well the thing about this product is it's budding what we're [00:38:00] so used to.

[00:38:00] Dr. Grant Garcia: We're reached a really integrative, uh, Materials being soft and really strong materials not being integrative. So it's just, it's, it's so different that it just takes a lot of people to figure it out and a lot of time with people and it takes us for someone like me, it just takes me, I got to see this to believe it, right?

[00:38:22] Dr. Grant Garcia: I got to try this. I got to test how strong it is. Then I got to see how the patients do. And again, I've seen plenty of studies on this. I know the product works well. I'm not concerned about this in terms of. Recovery from the patients or cystic changes. I feel really good about it. But the, the hardness to me was the hardest part for me to, to bear.

[00:38:39] Dr. Grant Garcia: And I needed to test it out on the hardest stuff. And I've been pretty impressed. I

[00:38:44] Will Sanchez: just wanted to ask you, you've been with the company now for a while. What was that? Wow. Moment for you when you were like, obviously the, you know, you were all in, you believed in the product, but from seeing the products, you know, we saw the timeline right up till [00:39:00] now.

[00:39:01] Will Sanchez: What was that wow moment for you saying, okay, we got, we got something incredible on our hands and the future is just sky's the limit.

[00:39:10] Brennan Marilla: Gosh, that's a tough question. There's been a lot of wow moments. Um, uh, I'll give you a recent one and I'll maybe try to back up and give you some of the early ones. I think a recent one is getting the pediatric label from the FDA, uh, being able to treat children down to two years old.

[00:39:26] Brennan Marilla: Um, that was a big vote of confidence by the agency, um, in our, in our technology. Um, and, uh, and, and having surgeons across different specialties that have treated, um, pediatric, uh, pediatric patients tell us success stories, show us x rays. Um, we've been able to interview some of the parents and some of the children.

[00:39:51] Brennan Marilla: That's a major wow factor because when I first thought, when we all first thought about this opportunity, you know, should we, should we do Osseo or not? Um, we always thought [00:40:00] that pediatric avoiding a second surgery for a child that falls off a bike or breaks their ankle. Uh, is, is, uh, that's kind of the Holy grail.

[00:40:12] Brennan Marilla: That's why you get out of bed in the morning. It's not just the money. It's not the resume. It's not all the other benefits that, you know, all the other motivators that are kind of exist in jobs. It was. Gosh, that's just a really, that's just a really cool thing to be able to do is to put these and put these in children, have them just turn into their own bone and they have to, they don't have to go back for a second surgery and go through all that pain and, and you know, all the, all the hassle of having to do that.

[00:40:40] Brennan Marilla: So, so that's been very exciting for us as of late early on. I think it was just having surgeons use the product, um, having them, um, be so impressed with the strength of it. But, but more importantly, having them tell us three months, six months, a year, two years later, they're like, God, my patients are doing so well.

[00:40:58] Brennan Marilla: And no one's complaining. [00:41:00] Like no one comes back and says, Oh, I, you know, I've got this, you know, my, I've got all the swelling now, a year out. I mean, we just didn't hear that. And so that was, And then that's a foot and ankle

[00:41:09] Dr. Grant Garcia: thing too, what you brought up, Brendan. I mean, they picked. And they all say they pick foot and ankle because the market was underserved, but they also pick foot and ankle because like I said, I tried it on the tibia, the foot and ankle stuff.

[00:41:20] Dr. Grant Garcia: If the hardware is not going to work with foot and ankle, it's not going to work anywhere else. It's the hardest place to heal. It's the smallest place. It's the place that can patients complain by far the most of hardware, right? You guys, the easiest thing for you guys would have been to start with sports.

[00:41:36] Dr. Grant Garcia: Right. The sports has a lot of innovative, but there's not as much stuff. You pick the hardest one. I mean, spine would have been, spine would have been a hard one, but it wouldn't be the same because the patients have a lot of other stuff going on. Right? Like you pick the one where like, my mom's had multiple foot surgeries before.

[00:41:50] Dr. Grant Garcia: I know how hard it is to recover. Right. Then done plenty of foot surgeries at HSS. And you picked a very difficult one. And the fact is that that market was so successful that you moved on to [00:42:00] other ones should tell people how this product's doing.

[00:42:02] Brennan Marilla: You know, one thing that, one thing that kind of, I was thinking about as we were thinking about entering foot and ankle was seeing all the competitors in foot and ankle, or they were like, I don't know, they were like 25 or more companies that make.

[00:42:14] Brennan Marilla: Make hardware, uh, for foot and ankle. And I thought, geez, that's a really red ocean. Um, but in some ways it told you that first of all, these are all great competitors. There's a lot of phenomenal startups and big companies that are, that, that compete in foot and ankle. But when it, when you have that many companies making hardware, you wonder how does the market support that many companies?

[00:42:35] Brennan Marilla: Uh, and I've thought, you know, maybe it's because they're just not very differentiated and there's nothing that's really come in. That's replaced all of it. And that would take many years to really knock out all these, all these other, uh, uh, products. But, but when the, when a market's that noisy, you just say to yourself, geez, maybe if there was one great product, you wouldn't have to have 30 different companies with hardware.

[00:42:57] Brennan Marilla: Maybe that's not the right way to think about it, but why just, we thought that [00:43:00] that was both a, uh, a sign that's very competitive. So it's going to be difficult, which, you know, which it is. But it's also, um, because there's little differentiation, that's an opportunity. It's not also

[00:43:13] Dr. Grant Garcia: not someone dominating, right?

[00:43:15] Dr. Grant Garcia: It's like you're saying, like, when there's 200 answers for something, clearly, maybe you don't have the answer yet. Right? Like if there was, if it was, if someone had the right thing that worked every time, The other companies wouldn't be able to compete.

[00:43:27] Brennan Marilla: Exactly.

[00:43:27] Dr. Grant Garcia: Right. They'd be out right now. All my screws a little different than this screw.

[00:43:31] Dr. Grant Garcia: My plate's a little different than this plate. You know, it's all the repetitive same stuff so they can take their market shares and spread them out. So we'll, it's, it's, as a matter of fact, the more competitors you have, the better it's a, it's a kind of a backwards thing to think about. But I, what you're saying is perfect.

[00:43:44] Will Sanchez: Well the competitors are starting to, you know, spread thin because top 10 innovations. Best Technology Award, Best Practices Award, Global Excellence Award, Best Orthopedic Medical Device Company. Your [00:44:00] award winning technology is on display and is getting recognized. Uh, so competitors, I know it's very competitive field, but you guys are definitely leading the way.

[00:44:10] Will Sanchez: And, uh, I'll let you get back on topic as we always tend to steer in different directions there. Um, let me get back that, uh, That beautiful slide there, but congratulations. I mean, the, the, the awards, the recognition, um, it's gotta be exciting when, when you get that, you know, notification when the company, uh, when the founder gets recognized like that.

[00:44:36] Will Sanchez: So, uh, it's gotta be, it's gotta be a special thing just to validate all the work that you guys are doing.

[00:44:41] Dr. Grant Garcia: Will, let's show that foot and ankle side for the sake of time. I want to keep going. There we go. Show them that. And Brendan, you tell this. Why is it such a big deal?

[00:44:48] Brennan Marilla: Yeah. Again, um, not, not that anybody's watching your show to, to, to look at hammer toe studies.

[00:44:54] Brennan Marilla: Uh, there's more, I'm sure there's more. You never

[00:44:57] Dr. Grant Garcia: know. You never know.

[00:44:58] Brennan Marilla: There's might be more [00:45:00] exciting things to talk about, although it's a, it's, it's a, it's a highly prevalent issue and it's important issue for people. Um, so we did that, we, you know, that was our first product. So we did our first in human study.

[00:45:10] Brennan Marilla: Using a hammer toe implant and not because we were not not because we the market needed another hammer to implant or another hammer hammer to implant paper, but it was a great first study for us because we were looking really at safety biointegration and A hammer toe implant actually fills up quite a bit of an intramedullary canal.

[00:45:31] Brennan Marilla: So it's actually a really good test You really put it to the test and you can see here on x ray. You can see it two years You can't see it on x ray You It's in that second toe there. There's no joint

[00:45:43] Dr. Grant Garcia: left, guys. You can see there's no joint left. It just looks like a big long bone.

[00:45:47] Brennan Marilla: Yeah, it's a big fusion.

[00:45:48] Brennan Marilla: Nice fusion there. That's what you want to see when you get your hammer toe, uh, uh, fixed. And then on the right side is an, is, is a MRI. And you can see there's no fluid accumulation. And the implant is gone at two years. Um, [00:46:00] so that was the basis for, you know, our, some of our first publications. That came out first human publications.

[00:46:05] Brennan Marilla: And, uh, these were really important. And by the way, we got great, we got great fusion rates for, uh, for hammer toe implant.

[00:46:12] Dr. Grant Garcia: 96%. Well, if I did anything in my life, 96 percent would be good. So let's go to the next study. Let's go to the next study for him to show 100 [00:46:19] Brennan Marilla: percent patient satisfaction. That was, that was one of the most important metric we actually did.

[00:46:22] Brennan Marilla: That was an end point in the study was patient, uh, uh, satisfaction. We had a hundred percent patient satisfaction and, and usually patients aren't too happy with hammer toes. It's just a tough procedure. We thought that was a, we thought that was really, really good.

[00:46:35] Dr. Grant Garcia: All this is really good. I know you want to go this.

[00:46:37] Dr. Grant Garcia: I want you to touch on that last one. The biocomposite comparison. And I want to show people the difference because you, people say when I have a biocomposite anchor, I've got an anchor that's turns into bone. It turns in right away, right? I want you to show this 24 month thing.

[00:46:53] Brennan Marilla: Yeah. So, um, I believe one of your mentors, Brian Cole, uh, Brian Cole did this study with us [00:47:00] and, uh, we did this at the vet school at Colorado state and, um, we compared osteofiber to, um, A couple of the leading biocomposite anchors in the market and, uh, we were looking at a couple of things, uh, strength on strength at implantation.

[00:47:16] Brennan Marilla: Uh, we did really well there. And then on biointegration and, um, what we saw at two years, we're essentially completely biointegrated that point. Um, and what we saw with the biocomposite anchors is they really haven't broken down very much at that point. There really is not a lot of degradation that's happened.

[00:47:34] Brennan Marilla: Um, there's a lot of anchor left. And, uh, so at two years we didn't see much of a, uh,

[00:47:40] Dr. Grant Garcia: yeah. So when we, when people are selling some of these things, they're telling you. My biocomposite anchor, you want to use it because it turns into bone. And the idea is that more surgeons are, know this, and we all know this, that like, yeah, it might turn into more bone than a plastic one, right?

[00:47:55] Dr. Grant Garcia: Cause that's not going to go anywhere. That's inert, but it's not going to turn into bone as fast as you [00:48:00] think. And they can leave behind reactions, which is why he keeps saying it did not react because the common thought process is reaction happens with these. It's cystic changes. I mean, look at that.

[00:48:10] Dr. Grant Garcia: That's still not integrated. It. You see them too, Will? I mean, you don't have, you have an MD from the show, but outside of that, that's, but you know what I mean, Will, can you see the differences in that?

[00:48:19] Will Sanchez: Oh yeah, 100%. You can definitely see it. You can tell the difference, tell the graph.

[00:48:24] Brennan Marilla: One of the other things that's really cool about this study, um, we looked at graph cellularity.

[00:48:29] Brennan Marilla: So we wanted to see, you know, the biologics around the kind of the anchor graph interface. And we had a statistically significant Significantly better, uh, higher graft cellularity versus the, uh, control. Um, so we thought that was really interesting. So it heals really, really nicely. In addition to the strength, um, this, this heals really, really well.

[00:48:51] Dr. Grant Garcia: All right, let's go to the next one and see if there's anything on there. That's the, so this is, this is pretty cool. This knee bar thing is what I talked to you guys about [00:49:00] when I said, if you put it through something, it can kind of like heal it because actually it might promote healing because of the way it's structured.

[00:49:07] Dr. Grant Garcia: Right. Is that part of the thought process?

[00:49:08] Brennan Marilla: Yeah, yeah. Again, this is, we're, we're evaluating this in a clinical study right now. Um, looking at our trimmable nails that are already on the market, indicated for fracture fixation. Uh, looking at, um, uh, looking at, looking in the knee at, uh, at treating insufficiency fractures.

[00:49:28] Brennan Marilla: And is the, is the raftering, you know, basically is the kind of the scaffolding from this, um, from these nails. Is that having an effect and is the kind of the bone regeneration around that implant having an effect to reduce edema and pain? Um, again, this is, this is, uh, we're, we're doing a study. Um, uh, we're seeing very, very promising results.

[00:49:52] Brennan Marilla: Uh, uh, I know, uh, Dr. Cole's a manuscript that's, uh, you know, hopefully we'll get a publication soon. There's something that's, uh, [00:50:00] you know, in process right now on the, on the feasibility. Yeah. The, the, the initial feasibility. And, uh, this looks very promising. Uh, we're still learning, we're still trying to perfect the technique.

[00:50:09] Brennan Marilla: Um, but, um, but we're very excited about the, the potential for. this application, um, and it's interesting

[00:50:19] Dr. Grant Garcia: for them. It's interesting to see this stuff. I mean, this stuff is pretty impressive because we've all tried this. Well, so in this, this stuff you're seeing here, this edema, this is what pain it comes from.

[00:50:29] Dr. Grant Garcia: And so I'll do, you know, if they have this, it's either, you know, you either have to do eventually it's bad enough. You do an knee replacement. So if you can turn the, you see there, the one on the right, you see all of them, you see the white stuff going to no white. That's a really good thing. That's a really, really good.

[00:50:44] Dr. Grant Garcia: That means that person doesn't have pain anymore. Generally. Speaking. So this is the idea that you can do this without having to do a lot of other stuff. Cause some of the stuff on the market now is, you know, you blow it up with calcium and that actually really hurts, right? Versus something that's a screw that they're not going to feel.

[00:50:59] Dr. Grant Garcia: I mean, people don't [00:51:00] generally feel screws when you put them in after the first few months, they have achiness from the screw later on, sometimes with the change in weather. But the idea that you're putting this screw in, it's not a very painful process after the first few weeks. Uh, but the idea is that it heals in, which is pretty cool.

[00:51:15] Brennan Marilla: And will you asked about the wow factor? This has been a big wow factor for us. Um, um, and, uh, you know, we've been, uh, uh, a little stealthy with this because we wanted to make sure we had good scientific evidence before we really went out and, uh, and, and, you know, pursued this. Um, but, uh, the wow factor is definitely there.

[00:51:36] Brennan Marilla: The patients are really happy about their result and the surgeons are really happy. Really excited about what they're seeing so far. Um, more to come on this.

[00:51:46] Will Sanchez: Yeah. And, uh,

[00:51:48] Dr. Grant Garcia: maybe another episode.

[00:51:49] Will Sanchez: The, the, the wow factor is really the next slide that's coming up. Right. And even if you're not sure exactly all the things you talked about.

[00:51:58] Will Sanchez: It's clear as day when you [00:52:00] look at the results from the examples of metal to what Asio, the comparison, I mean, the pictures speak a thousand words. Uh, I have a buddy that broke his fibula and tibula jogging, a nasty accident. He has a rod and he had metal screws put in. And they didn't get taken out. So he still has them and he has a bunch of complications at times he could feel them.

[00:52:25] Will Sanchez: So having metal in his body at, you know, 53 years old and getting older in New York city with the heat, humidity, cold, we didn't, we didn't even talk about how the weather makes the body feel right. We, you know, just dealing with all of those elements, especially on the East coast where you have the extreme temperatures.

[00:52:45] Will Sanchez: I mean, he talks about it. So. Seeing this right here and seeing this slide and example, uh, metal compared to Osseo, the picture says a thousand words.

[00:52:55] Brennan Marilla: We treated a, uh, we actually have a video on our website. You can look at it. There's a, it [00:53:00] was a Kentucky Derby jockey, uh, out of Louisville, Kentucky. Really great guy.

[00:53:03] Brennan Marilla: And he had metal, he had a lot of metal from a lot, you know, a lot of accidents, these jockeys get. You know, throwing off his horses a lot and he had a lot of metal in his foot and his ankle. And, uh, in, in the, in the winter that gets so cold, he would go back down to Louisiana and train down there because he couldn't stand, uh, how his foot felt.

[00:53:20] Brennan Marilla: So he actually had the hardware removed and, and, and they replaced it with osteofiber and he's, it's, it's been a game changer for him. So we made a video with him. It's, it's, it was really inspirational. Um, you know, what's the other thing that, that, uh, that that's been really fun is to, um, we've been advertising on meta, the different meta platforms.

[00:53:38] Brennan Marilla: Um, around elective proce bunions, hammer toe proce patients research and sho say on the sidelines beca of surgery. And so we've awareness to the patient reception we've gotten ha We have about 350 surgeons Um, [00:54:00] and, uh, and we, this, so far this year, we've had over a hundred thousand patients click our ads and then go to our locator, a hundred thousand.

[00:54:10] Brennan Marilla: Uh, and we're not even spending that much money on advertising. I mean, we're a small company. We're not, we're not spending like millions of dollars on this. So, uh, we're getting a really strong interest, a really strong patient demand, and they're asking for it. They're going to their surgeon and saying, I want osteofiber.

[00:54:25] Brennan Marilla: And, and I've seen them, by the way, I'm seeing patients now in chat rooms and they're like resource groups that are online, these Facebook bunion groups and things like that, and they're in there and they're talking about osteofiber. And it's really, really, uh, really great to see that because the more patients are educated about this, the more they can go in as an informed consumer and say, Hey, is this right for me?

[00:54:48] Brennan Marilla: And if it is, you know, I want it. And, and they rave about it. So that's been a strategy of ours to educate, educate patients about this and certain sports medicine applications might be tough. [00:55:00] to advertise because I don't, people really shop for, okay, what kind of an anchor am I going to get when I have rotator cuff surgery and things like that.

[00:55:06] Brennan Marilla: But there are definitely, there are definitely opportunities there that we're also exploring in terms of some of those applications that are more relevant to your practice. Um, Dr. Garcia.

[00:55:16] Dr. Grant Garcia: Well, you know, I would, I would, I would counter you, Brennan, and tell you that patients come in asking for everything that I do.

[00:55:22] Dr. Grant Garcia: They asked for the every possible thing you could think of. They're like, I want this type of surgery. And we'll, we've talked about this before with a lot of the other companies, you know, they come in asking for specific things. I mean, today in the office, I had three or four specific requests for specific surgeries, specific implants.

[00:55:39] Dr. Grant Garcia: So they're really educated. We're in Seattle. They're like doing, you know, I bet you half my patients are already on your chat blog and they're going to be going on there now to figure out what this thing is and ask for it. So I would say that this is, this happens everywhere and any surgeon that does a practice where they require, where they're reliant on patients to look them up and find things and come to their website and things like that.

[00:55:59] Dr. Grant Garcia: This is a [00:56:00] great opportunity from a marketing standpoint for a good product that differentiates itself and to be able to offer this for your patients because they're going to ask for it. And these surgeons say they don't ever ask for it. I don't know you're talking about. You know, I just do my surgery the way you do it.

[00:56:12] Dr. Grant Garcia: Well, that's okay. You can be left in the dust if you want. Uh, but it's important that you understand that this is, this is coming, whether you like it or not, this is an excellent product and patients are going to ask for it, Brennan, even with your small amount of marketing.

[00:56:25] Will Sanchez: And if you're going to ask for it, you know what to say already, right?

[00:56:29] Will Sanchez: Don't settle for metal. Don't

[00:56:30] Brennan Marilla: settle for metal.

[00:56:31] Will Sanchez: Don't say

[00:56:32] Brennan Marilla: nature remains, baby. Leave nothing behind.

[00:56:34] Will Sanchez: Leave nothing behind. It's right on the website. It's amazing. I love it. I'm all for it. Whoever, whoever put that up there, the problem is now, well, it's going

[00:56:44] Dr. Grant Garcia: to repeat it like over the next five

[00:56:46] Will Sanchez: podcasts, every show, it's going to be like a little Easter egg.

[00:56:51] Will Sanchez: Yeah, that's great, man. Don't settle for metal.

[00:56:53] Brennan Marilla: There's a great foot and ankle surgeon in Baltimore, Stuart Miller, all the foot and ankle surgeon knows Stuart Miller. And he used to say when we first [00:57:00] introduced Osco to him, he used to say, I just want to set it and forget it. You set it and forget it. I just want to, I just want to treat that pain.

[00:57:07] Brennan Marilla: I want to just put that implant in there and not have to worry about it again. Set it and forget it. So I always, always remember that one.

[00:57:12] Will Sanchez: It's like an infomercial.

[00:57:13] Brennan Marilla: I

[00:57:13] Will Sanchez: love

[00:57:14] Brennan Marilla: it.

[00:57:16] Dr. Grant Garcia: So we'll we're at, we're now out of time.

[00:57:19] Will Sanchez: We are out of time. Let's say goodbye to Brennan. Brennan, thank you so much for your time.

[00:57:24] Will Sanchez: Um, I mean, we've talked about it. Check out asio. io. I mean, the webpage is amazing. I mean, it's good. We don't need to say anything. I mean, the awards say, speak for themselves. Um, we wish you and your family, uh, you know, just speedy recovery for the house, for the home, getting back, kicking the kids out, or if not putting them to work, whatever it is.

[00:57:46] Will Sanchez: Um, we just wish the best for you and your family and I'm hoping that this is a positive, right? To get the, get the family back under the roof and, you know, spend some quality time. And I know you kicked them out of the room because you were doing this show, so we really [00:58:00] appreciate it. That was, that was really fun.

[00:58:01] Brennan Marilla: I keep telling myself that, well, that's good. That's a good, it's a good positive outlook. So no, we're happy to be together. And, um, listen guys, if you, if you buy a house in a flood zone, just make sure it's really, really high. Okay. Just that's my, that's my lesson. Let me serve as a warning to others. Okay.

[00:58:19] Will Sanchez: All right. Or have some kayaks or something. All right.

[00:58:26] Brennan Marilla: All right. so much. Appreciate it. Talking to you. Enjoy the opportunity. And uh, Dr. Garcia, I'm so, so happy. Your patients are doing so well with this technology. So thanks again, guys. Great to meet you. Well,

[00:58:38] Will Sanchez: thank you. Likewise. Dr. Garcia. That was Brennan Marilla.

[00:58:42] Will Sanchez: I mean, providing information, right. And talking about tech and we emphasize a lot on the tech. And I mean, Osseo speaks for itself. Uh, the don't settle for metal. I'm going to say it all the time. Don't settle for metal. I'm gonna drive you [00:59:00] crazy. All right. Enough of that. Will Sanchez, Dr. Grant Garcia. Do you want to, anything to, before you wrap it up, Dr.

[00:59:05] Will Sanchez: Garcia?

[00:59:06] Dr. Grant Garcia: I don't know. Check it out. This book. Product's awesome. Check out the stuff they're doing. I hope that people are informed again. It's all orthopedics, all sports, all the time. Obviously we talked about it with some other specialties, but it was good. Follow us. We're almost running out of time. Cause they're not going to like it.

[00:59:19] Dr. Grant Garcia: If we go over an hour. Thank you.

[00:59:22] Will Sanchez: All right, people don't settle for metal.

Audio Transcript

[00:00:00] Will Sanchez:Welcome to Sports Doc Talk. I'm Will Sanchez, along with our orthopedic surgeon in sports medicine specialist, Dr. Grant Garcia, uh, Dr. Garcia, before we get started and before we welcome our guests today, um, what's going on with your background? The last couple of weeks we've had the New York Giants, we're already hyped up, you know, for the season and Danny Dimes.

[00:00:38] Will Sanchez: And this is our year. We're going to make it.

[00:00:43] Dr. Grant Garcia: Not a good showing last week and we had to change it. I still cheer for them, but I can't represent right now. Got to represent what's doing well. The podcast. That's much better. That's a great picture, by the way, of Will. I got to work on mine, but that's an excellent picture. [00:01:00] That's the best rendition I've seen.

[00:01:01] Will Sanchez: I got, yeah, I got my little haircut kind of going on. Surprisingly,

[00:01:05] Dr. Grant Garcia: surprisingly, he looks even better in real life than the picture.

[00:01:09] Will Sanchez: Anyway, um, You know, it's perfect, right? Because our guests has been working with sports, works right in your field, you know, you know him really well.

But before we get to him, let's kind of give a shout out to our sponsors, the recovery shop, Dr.

[00:01:26] Will Sanchez: Garcia. You know, we talked about them before we even started working with them, but Tell us a little bit about why the recovery shop just works so well.

[00:01:35] Dr. Grant Garcia: Yeah. So we, you know, we've said this on all the episodes, but really the recovery shop for me has been awesome for my patients, right? There's certain things they can't get and I can get them to the recovery shop.

[00:01:45] Dr. Grant Garcia: And so instead of going online and having to look up, you know, which products they want, braces, more advanced ice things, the re bliss, other scar creams. It's now all available for my patients on their recovery shop. And each one of us surgeons has their own landing page. So my [00:02:00] patients feel comfortable with the stuff that I've pre approved.

[00:02:02] Dr. Grant Garcia: And I review all those things and do it. It's been rave reviews from the patients just because of the ease of it. And then they can, you know, they're always coming to me like, I want nutrition supplements. We have those from the show on there. Uh, I want to have the Reblesses on there. I want the Nice Machine.

[00:02:16] Dr. Grant Garcia: It's on there. All those things are all together and they can order them whatever they want. And a lot of times with the complicated surgeries we do, they want to be going to the next level. And it's not just the surgery. It's not just the rehab. They want the extras. And so this provides it for them. So, again, I get no cut from this, you know, go on there, go to, go to the recovery shop, uh, talk to them, uh, see if they're interested for surgeons is an awesome outlet to offer your patients the next level and stuff, especially there when they're asking for more.

[00:02:44] Dr. Grant Garcia: So without further ado, we got to get to the, to our awesome guests tonight. All right.

[00:02:50] Will Sanchez: Bring in our orthopedic surgeon, uh, Dr. Lu, Joseph Lu, uh, thank you for taking some time to be with us. And it's funny. Dr. Garcia mentioned something about the [00:03:00] Rebless and we'll get to that later on because I saw a really cool video of you checking out the Rebless.

[00:03:06] Will Sanchez: Well, we'll get back to that first and foremost, you know, it's, it's all about the company you keep. And obviously you're friends with Dr. Garcia. How in the hell do you guys have a relationship? Tell us a little bit how this relationship started. And, uh, and we'll take it from there.

[00:03:22] Dr. Joseph Liu: Well, Will and Grant, thank you so much for having me on the show.

[00:03:26] Dr. Joseph Liu: Um, just like you said, I've known Grant for Basically forever. Um, he and I were co residents, meaning we were the same year. We entered at the same time, uh, in residency at New York, in New York City at the Hospital for Special Surgery, which is basically the number one orthopedic hospital in the nation.

[00:03:42] Dr. Joseph Liu: And if that wasn't enough, we spent five years together there. Uh, we actually spent an additional year of subspecialty training when we traveled to Rush, uh, in Chicago together and did our one year sports medicine fellowship at the Midwest Orthopedics at Rush. So, you know, it's been a long time and we've been friends ever since.

[00:03:58] Will Sanchez: Dr. Garcia, before you [00:04:00] jump in, this is an important question here. You spent all this time in New York, uh, I'm originally from New York. In fact, I, my broken wrist was treated at the hospital for special surgery, but. Where was the hangout spot? All right. We're in the city. You guys are working together and spend all this time.

[00:04:18] Will Sanchez: Where's the watering hole? What was the spot? Are we hanging out on Second Avenue? We're going to fifth. We're going to Madison and we're going midtown uptown. Where was that? What was that

[00:04:27] Dr. Grant Garcia: Mexican restaurant that we always went to? It was so good.

[00:04:31] Dr. Joseph Liu: It was on second and 70th. I just remember the sangria. Okay.

[00:04:34] Dr. Joseph Liu: Okay. Okay. So this

[00:04:36] Dr. Grant Garcia: place, this place, this place will, we, the HSS, if you don't know, they try to track the best residents. And so by doing that, they subsidize housing. So we basically have our own building. And so we get like insane rent, uh, to go there. So it's like a, it's a no brainer when you want to go to New York and plus working at this place.

[00:04:53] Dr. Grant Garcia: So Joe and I all live in the same building for five years. So he like, we got, you know, not only do you work with the person, but you live in the same building as them. [00:05:00] And they see all your outside stuff, all your personal stuff. So there's no, there's all the dirty, the dirty things are released at that point.

[00:05:07] Dr. Grant Garcia: But on the way, literally we only have to walk two blocks and this is dangerous cantina between the two that has like the best sangria ever. And literally every time you walk home, you see some sort of one of the residents or fellows or whatever at the place. So, and I remember we would go there way too frequently.

[00:05:25] Dr. Grant Garcia: Uh, but it was an awesome hangout spot. Good. I think it was, it was Mexican. I'm almost positive. There's so many ones in New York, but that one was like dangerous cause you literally could smell it as you walk by or like your friends are like trying to hand you a margarita on your way home from the residency.

[00:05:40] Dr. Grant Garcia: Not the way in, obviously would never do that on call. Well, the

[00:05:43] Dr. Joseph Liu: worst is when you're covering the night shift and everyone's coming home and they're meeting up at this, uh, you know, corner tapas or sangria bar and you have to go in for the night shift and you can't, you know, take anything with you. And you're the only one in the hospital that evening.

[00:05:58] Dr. Joseph Liu: And so then you're just jealous for the rest of the [00:06:00] night, missing out. I don't think the audience wants to know about the night

[00:06:03] Dr. Grant Garcia: shift. The night shift, I don't wish the night shift upon anybody. Up is down, down is up. The only person that can handle the night shift was Dr. Joe Lu here. He's a master of that.

[00:06:14] Dr. Grant Garcia: He could do no sleep. You run around the hospital on fire is amazing. Well, that's hanging

[00:06:19] Will Sanchez: out at the cantina, right? I know. Grant was hanging out at the cantina. That's after six months. I was

[00:06:23] Dr. Grant Garcia: smart. I was smart. I was at the cantina. He was working. That's the way it rolls. Well,

[00:06:28] Will Sanchez: I'm glad the patients heard that.

[00:06:29] Will Sanchez: So they, they know that they were always safe, but they were in good hands with Dr. Liu. So that's good.

[00:06:35] Dr. Grant Garcia: So I wanted to introduce Dr. Liu, because obviously. You know, he had amazing training, HSS rush. He went to UCSF and then Stanford for undergrad. So he's clearly a slacker, uh, on the show. Um, but on top of that, you know, he's currently works with, uh, USC.

[00:06:52] Dr. Grant Garcia: He's done the USC athletes been on the field team physician. Um, and also works with the Sacramento, right? Sacramento Kings LA [00:07:00] LA Kings, LA Kings. And does the hockey team, but the hockey team is unique because we haven't talked about hockey, professional hockey coverage. It's a totally different animal than the football players.

[00:07:11] Dr. Grant Garcia: And we're going to go into this later, but there's also the side of the business, which is taking care of the players, the grit, the glitzy part. But then there's the other side. We talked about the last episode or two episodes with Tua and what happens with the clearance of him. So Dr. Liu is going to kind of, kind of refer to us as on that as well.

[00:07:28] Dr. Grant Garcia: But Joe, kind of talk about your practice, you know, what you do, uh, and then, you know, go from there and we'll keep jumping around.

[00:07:37] Dr. Joseph Liu: Yeah, so, you know, I'm an academic sports medicine surgeon at Keck Medicine of USC. Uh, I work with residents. I have sports medicine fellows that we train on a yearly basis as well.

[00:07:48] Dr. Joseph Liu: Um, I also do some, um, work at L. A. General Hospital as well, where you take care of, like, level one trauma or trauma associated sports medicine care. Lots of knee dislocations and multi ligament, you know, knee dislocations and things [00:08:00] like that. Um, and then I'll, you know, as an adjunct, because we're part of the USC faculty, we take care of the sports team.

[00:08:05] Dr. Joseph Liu: So USC Athletics, the USC football's almost like a professional team. Their yearly budget is You know, basically the same as a professional sports team, except for the salaries and with NIL, that's also a changing story as well. And then we also work with the Los Angeles Kings. And I think it's a great mix of taking care of, um, you know, patients from all walks of life.

[00:08:26] Dr. Joseph Liu: You have. You know, patients who are in, you know, kind of lower socioeconomic status at the LA General, where you get to take care of people that are very in need of care, and sometimes don't have great access to care. And then you have the flip side of things, where you take care of professional athletes, uh, collegiate athletes, where, You know, they're getting the, um, they're getting immediate care, you know, day zero care, and they're trying to, you're trying to get them back to sport immediately, you know, a lost day on a lost hour is, is too much for them.

[00:08:52] Dr. Joseph Liu: So they're trying to get back immediately. And I think that's the dichotomy between taking care of professional sports versus taking care of patients in [00:09:00] our office who come in and see us on a kind of outpatient basis.

[00:09:03] Dr. Grant Garcia: Uh, Joe, two questions that came from that, obviously questions from you introducing yourself, the NIL, right?

[00:09:09] Dr. Grant Garcia: We talked, we've heard about this. Have you noticed a difference in the USC team since the NIL was instituted? Is there any difference in the players, the way they're acting or the way you have to treat them differently? Right? Because before you take care of players, something happens. They don't really have a contract yet.

[00:09:24] Dr. Grant Garcia: Now they're worth millions of dollars. They're essentially pro athletes, right? So it's a different, it's a different, did you notice anything different when that happened? I mean, it's kind of been three or 10 years.

[00:09:33] Dr. Joseph Liu: I think the first thing that I noticed number one is that I think it came with the transfer portal.

[00:09:38] Dr. Joseph Liu: So the transfer portal changes as well as the NIL kind of occurred, not simultaneously, but around the same time period. And I think the combination of the two really changed the way we view. Um, or not necessarily the medical staff still treats them the same, but the way the players kind of try to, uh, kind of see their career.

[00:09:57] Dr. Joseph Liu: And that's part of it is their tenure at any [00:10:00] one university, USC included may not be that long, right? So you, what happened is when I started in most of the time, when you recruit someone, you're recruiting someone in the past for their entire collegiate career. They might have one transfer and it used to be where you had to wait a year before you were eligible.

[00:10:14] Dr. Joseph Liu: So transfers were a lot more, taken a lot more. Um, they just gave it a lot more thought. Nowadays, if you're not doing well or performing well, you might get injured. You might register early because you can transfer immediately and get asked either to another school or get a better contract through the NIL and you don't lose a year of eligibility.

[00:10:33] Dr. Joseph Liu: So I think the combination of the NIL money as well as the transfer policies have now made it so that players are, um, Are more apt to not be free agents. It college seems like a more of a little bit more like a free agency these days than it has in the past. I think that's probably the biggest change.

[00:10:52] Will Sanchez: Yeah, 100%. And, um, there's been articles coming out, especially lately, as far as. [00:11:00] What's going to be the next step. And so I want to ask you that question. And it's a really, it's a little bit of a vague question because we're alluding to the fact that these kids are now becoming professionals, right? And as we know, college sports and, and amateur sports, we are getting so far away from that at this point that we can, I can see the landscape changing all together where it, whether it's going to be a.

[00:11:27] Will Sanchez: Professional minor league or whatever it is. Um, are you starting to see that on your level in even as month to month, day to day, as we get closer and closer and seeing these changes that you're noticing that you're having a lot more influence, whether it's the coach or staff. Player player agent, you know, things like that, where there's a higher level of concern, especially when it comes to someone being injured.

[00:11:58] Will Sanchez: And, and I know it's a weird question [00:12:00] because as you mentioned earlier, you're going to treat each individual, give them the same care, but it doesn't mean that you had the same amount of stress. So I'm wondering if you're starting to see that or your staff or just across the board, maybe not yourself directly, but indirectly with your peers as well.

[00:12:17] Dr. Joseph Liu: I think that's a great question. And I think what you're alluding to is the fact that there is just more at stake here for these athletes, even at the collegiate level, right? Whereas before, um, maybe that transition was more at the professional level or CoachingBadminton. com because there wasn't as money as much money at stake.

[00:12:36] Dr. Joseph Liu: Um, there may have been a little bit more leeway to get these athletes back into, you know, back to playing status or you just had a little bit more time because there was kind of a little bit less at stake because you weren't trying to get them back for that season. So otherwise they would have transferred out or something like that.

[00:12:51] Dr. Joseph Liu: You had kind of more time to develop them. Um, but I do think that in this day and age, whether it's Just the competitive of collegiate [00:13:00] sports at every level has become greater. There's more money involved. There are just more, um, minds kind of in, in, uh, started behind every athlete. And so whether it's the parents that are more involved or there's an agent, or there is the, the kind of the posse behind these players that all have to be, you know, all want to be involved in, in their care and all have, there are people that they want to give their opinion.

[00:13:25] Dr. Joseph Liu: Um, I think that's part of it. Um, I think it's the second thing is we're probably more apt to, if someone's not doing well, to have second, you know, earlier opinions from other experts, whether it's from our partners or, or either from partners within USC or even partners within the town or even partners across the United States, where we send them to a specialist that is just known to treat all of the, you know, these athletes with this specific problem.

[00:13:50] Dr. Joseph Liu: Um, there's no expense spared because, you know, probably Neil

[00:13:53] Dr. Grant Garcia: Alatrosh. Right. We talked about this way too many times. Well, yeah.

[00:13:58] Will Sanchez: Yeah. That's interesting [00:14:00] to hear about that collaboration. So, you know, are you seeing your, uh, you know, to use an old term, your Rolodex kind of opening up and saying, well, we know how to treat this, but we're going to, you know, collaborate with a different group where they specific hand injury or Thumb injury for quarterback.

[00:14:16] Will Sanchez: That's just not healing. Right. And you know that, you know, someone across the country has a little bit more experience. So are you starting to see a wider pool of, or an openness to collaborate with your peers, uh, across the board? Because there's so much at stake.

[00:14:32] Dr. Joseph Liu: I think that's absolutely the case. And I don't think that's necessarily, I think, uh, USC athletics is very much like that, where we're very open to collaboration with the experts across the nation.

[00:14:45] Dr. Joseph Liu: Um, and it's always a case by case basis. Right? I think if it's something that's very, um, uh, you know, standard in terms of an injury, such as an ACL tear, uh, you know, shoulder dislocation very commonly treated, then, you know, certainly [00:15:00] keeping, keeping it within, sorry, keeping it in house is very reasonable.

[00:15:04] Dr. Joseph Liu: And if it's a very esoteric injury, so for example, we had, there was a foot injury that we recently sent out. Um, or, you know, there've been a couple of foot injuries that we've sent out to Dr. Anderson, who's one of the premier foot and ankle specialists across the nation. Um, you know, he's known to get these athletes back in a timely fashion.

[00:15:20] Dr. Joseph Liu: You know, there, there was, there are certain circumstances that require us to basically collaborate with these experts across the nation.

[00:15:27] Dr. Grant Garcia: Well, and do you ever, I mean, when we taking care of the pro teams as well, you know, you had a lot of these players, did they ever ask to go outside? Or whether, because they, they have agents now, right?

[00:15:36] Dr. Grant Garcia: With NIL, are they doing agents? And so a lot of times the agents will just float them. There'll be like, we're going to get another opinion, right? Whether or not you choose to, because now there's so much more money at stake. I mean, that's the one people don't realize. Like you could be a team doc. I mean, many of these team doctors don't operate on the players, right?

[00:15:52] Dr. Grant Garcia: The big players, they go wherever they want. They just pick and choose and they fly around the country. I remember seeing a few of the. Seahawks in my office. And it was just like, I [00:16:00] was opinion number six, right. And they'd already seen like they'd already, but they'd already had like the entire United States they'd seen and they were asking other opinions.

[00:16:07] Dr. Grant Garcia: And it was all the agent, the team was not, was not validating that, but that's not their, you know, the team doesn't make that decision. Unfortunately, in the end maybe a different for the college stuff. No, I think

[00:16:17] Dr. Joseph Liu: as a result of, you know, the NIL Monday, NIL money, I think these athletes have more people in their circle, whether it's their agent or.

[00:16:26] Dr. Joseph Liu: Um, family, friends or whoever, and they have all have their own connections. That's kind of how they get into the circle. Right. And they may have their opinions or you need to see X, Y, you know, this person to get their opinion because they know best and, you know, it kind of depends on who's talking in the athlete's ear.

[00:16:41] Dr. Joseph Liu: I'm not, I don't think an 18 year old who comes into college definitely knows, you know, the nuance ins and out of them, but if they get connected with an agent, there's enough money on the line, there's going to be someone who's talking in their ear that. Basically may recommend someone who they would see.

[00:16:55] Dr. Joseph Liu: And I think that's okay in sports, you know, and I think in medicine, it's, it's okay to get several [00:17:00] opinions. And I think when there's more consensus, then I think these athletes often, uh, have more confidence in their care as well.

[00:17:07] Dr. Grant Garcia: And I think the thing that people need to understand when they're hearing this is that As much as everyone thinks it's so great to operate a professional athlete, right?

[00:17:14] Dr. Grant Garcia: It sounds so cool Right. Like everybody always asks me that they're like, who do you operate? And obviously you don't tell them you can't say anything, but like, who do you put professionals? Do you operate? Have you operated on her? Who you fixed? They don't realize like, that's like, that's absolutely torture.

[00:17:26] Dr. Grant Garcia: Right. That's like calling the agent. They have to perform well, they don't perform well. And you're not one of the bigger top five sports guys in the country. You know, you're, it's your fault. Right. And there's the med legal, which we'll get into in a second as well. So like I, you know, we all welcome multiple opinions and there are certain guys that can just take on the risk.

[00:17:43] Dr. Grant Garcia: Neil Elitrosh somehow is the golden hands, right? He can operate all these players. He, I'm sure he's got issues with legal stuff dealing with it. No matter who you are, you have the James Andrews, you have Anderson. Um, you know, you have all check at HSS. Uh, you have all these guys that basically they, they're [00:18:00] basically, their practice and their whole setup is tuned to take care of these athletes and they can handle that volume, right?

[00:18:05] Dr. Grant Garcia: Cause if, if Neil Elitrosh does surgery on a professional athlete, right? And he doesn't get back, They're not going to blame Neil Altraz. They might, but he'll be like, I've done other, I've done 50 other guys like you and they all got back. So it's not my fault. If one, no offense to one of us, but if we do, we do one of the top players, they don't get back.

[00:18:22] Dr. Grant Garcia: They might be like, well, their Garcia hasn't done that many pro athletes. Maybe we didn't do a good job.

[00:18:27] Dr. Joseph Liu: Yeah. I think in the, uh, in the professional world, in terms of surgery, there are a select number of trusted surgeons that are the standard in terms of getting athletes back to sport, even if it's the same surgery that any of us would offer them, right?

[00:18:41] Dr. Joseph Liu: Um, that being said, it's, you know, that's their reputation. It's their history. Um, it's their, um, relationships with the agents and the players themselves kind of through the leagues that they've worked with. And I think that's confidence and trust that's built through You know, several decades of experience.

[00:18:57] Dr. Joseph Liu: And, you know, I think that's why there are a few, you know, [00:19:00] just a few surgeons that are out there that are, you know, in the echelon.

[00:19:04] Dr. Grant Garcia: It's a, this is this topic we could keep talking about all day. I mean, it's the, the thing people interesting that they don't understand is you're right. It's it 99, 95 percent of the time.

[00:19:15] Dr. Grant Garcia: Cause I mean, you and I both worked at rush HSS. We got bulls, white socks, U. S. Open giants, you name it. And we can talk about that experience, but you know, these are really good surgeons, but the surgeries that we do or the surgeries that I've seen by other doctors, Are just as good in many respects. And sometimes they use newer nuances.

[00:19:35] Dr. Grant Garcia: 'cause sometimes we've talked this in the pros, but they don't always get the like most up-to-date stuff 'cause people aren't willing to mess around with them. Right. Well like there's newer ACL techniques and if, like, I just saw an article that they pulled all these professional athletes and all, all these professional, uh, NFL doctors and they all would do the same ACL that we've done for the last 20 years.

[00:19:54] Dr. Grant Garcia: They wouldn't add anything extra to it. They would just do the exact same basic ACL. Now it's worked. It's time [00:20:00] tested. But the fact is that there was no innovation added to that. Meanwhile, I'm out there and Joe's out there doing things that are like 10 steps ahead because we don't have to be worried about the norm.

[00:20:11] Dr. Grant Garcia: Right. We want the best for the patients with best for the newest data. We've read 15 papers over the last two years showing how much better it is to add this stuff. But in that professional athletes, they can't, you can't start experimenting. I mean, that's why the Lonzo ball meniscus Carlos transplant is so crazy if he gets back, but there's only one person that could do it.

[00:20:27] Dr. Grant Garcia: And get away with it. And we all know that's Brian Cole, uh, outside of that is not possible. So hopefully it gets back. That'd be a whole nother topic to talk about. But Joe, on that topic, can you talk about your experience? I mean, everyone's heard me talk about HSS and rush, obviously awesome experience, you do the same stuff.

[00:20:47] Dr. Grant Garcia: And then like how that helped you or what you felt like going into the USC and then taking care of the hockey team. And like, kind of get the ins and outs of that briefly, you know, I think people love hearing that stuff because behind the scenes, they just see us running around on the field [00:21:00] and they don't really know what goes on, right?

[00:21:01] Dr. Grant Garcia: They don't understand the behind the scenes stuff.

[00:21:04] Dr. Joseph Liu: Uh, yeah. So are you talking about, you know, just my experience training at HSS and Russian? Yeah. And

[00:21:10] Dr. Grant Garcia: you know what, taking care of the pro athletes, what you, what you saw, what you, You know what, briefly what you did, you know, those kinds of things. And then how did it translate into your sort of taking care of the hockey teams, the USC, because we'll kind of jump in basically trying to talk about being a team doctor and all the stuff that you had to go through and like how you got prepared for it.

[00:21:27] Dr. Grant Garcia: Right. Cause not everybody gets the experience that we get in those first six years is vital. There's a reason there's a high HSS in Russia, some of the highest amount of professional team doctors in the country because they, they breed that, right. They want that.

[00:21:41] Dr. Joseph Liu: Yeah. I mean, I think. Number one is just HSS is just the mecca of orthopedics and sports medicine, right?

[00:21:48] Dr. Joseph Liu: We have, you know, some of the godfathers of sports medicine there that have, you know, so Dr. Warren is taking care of the, or previously taking care of the, uh, the giants for the last 40 or 50, you know, 40 years. And, you know, now [00:22:00] he's passed it on to Dr. Scott Rodeo, uh, who's, you know, been the head team physician for a number of years recently, and just watching them, uh, you know, getting, um, you know, watching them take care of patients on and off the field in the office.

[00:22:13] Dr. Joseph Liu: Uh, in the training room. I think that is a very unique experience. It's not necessarily available to all of the residents across the nation, right? You basically can only get that in very special, you know, specialized training facilities. Uh, I think also just the volume and the complexity of care that was taken, you know, done at special surgery, which is an orthopedic only hospital.

[00:22:33] Dr. Joseph Liu: Uh, working with, uh, basically every subspecialty, there's a giant in that field and, you know, probably not just one of them or a couple of them are, you know, at special surgery. That's kind of how unique it was. Uh, and then going to, you know, rush in Chicago, I think, you know, being involved in the White Sox and the Bulls and watching Dr.

[00:22:50] Dr. Joseph Liu: Brian Cole take care of the Bulls and see, you know, seeing how he managed those, you know, both in season and out of season players. I think that's the critical thing, right? I think the difference in taking care of professional [00:23:00] athletes is depending on where they are, the type of injury. Where they are in the season that you're it's going to be managed differently And I think there's only one way to see that you can't see that in the office Unless you're taking care of that style of patient If you just take care of, you know, someone like myself walking into the office, they're going to just give me physical therapy and see you in six weeks, right?

[00:23:19] Dr. Joseph Liu: But when you're taking care of professional athletes, you're trying to timeline and try to get them back to, you know, tomorrow, the next week, you're going to get, you're going to see them on a daily or, you know, uh, on a daily basis, occasionally to try to get them back to kind of see how they are. They might be day to day in terms of their status.

[00:23:34] Dr. Joseph Liu: And I think that's not something you can experience unless you're in the training room in the dugout. Uh, at the games, you know, seeing these injuries real time, uh, assessing them right at the time of injury, seeing them in the office the next day, seeing, you know, seeing the combination of their imaging, as well as their symptoms basically evolve over the next couple of days.

[00:23:53] Dr. Joseph Liu: I think that's the difference in terms of professional athletes. It's the speed at which you have to treat these injuries and trying to get [00:24:00] them back in the quickest way possible because days off are considered. Um, You know, they're, they're taboo, right? You, they're, they're playing for their next contract.

[00:24:09] Dr. Joseph Liu: They're playing in a contract year. Those are so, those considerations are so different. And so as a result, those are the things that aren't taught in normal orthopedic residency or education. They're not taught in normal medical education. You know, we're just, you know, in normal medical education, just taught to take care of the patient, try to get them back.

[00:24:26] Dr. Joseph Liu: But there's not really, um, that urgency. Um, that changes the way, you know, things are done in professional sports. I will say the other thing that I learned, and I don't know if you guys talked about it previously, is there is, uh, probably a little bit more reticence to, or sorry, more, um, incentive to do surgery on an earlier basis sometimes, so there's some things that potentially in the lay person you might treat nonoperatively.

[00:24:49] Dr. Joseph Liu: Because there's probably a more variable outcome or sorry timeline for healing. So for example a fracture that we might treat, you know A broken bone that we might treat non operatively in in the professional [00:25:00] athlete You're more likely to operate on them because once their wounds healed you have a much faster more reliable healing Uh timeline and you can get them back faster.

[00:25:08] Dr. Joseph Liu: And so as a result, uh Those indications are slightly different than what we would indicate for potentially someone who's just a community, uh, you know, someone coming into our office, basically.

[00:25:20] Dr. Grant Garcia: I think that's like literally the best points ever. I mean, Will, you should hear this because this is from like a layman standpoint.

[00:25:25] Dr. Grant Garcia: This kind of like blows people's minds. It's like we don't treat them differently, but you have to, right? You just have to like we try not to, but like sometimes I mean, Joe, what Joe's saying is right. Like certain things you treat them more aggressively. Right. Like a clavicle fracture, they go straight to ORIF, right?

[00:25:41] Dr. Grant Garcia: Because they want to get them back. And that means fix plating it. You know, there's a lot of things. But there's also some surgeries where we treat them less aggressively. Like cartilage, right? We wouldn't do a cartilage transplant on a professional athlete, obviously, until Alonzo Ball. But generally, we're going to do, they're going to do microfracture and things that like, would be considered like a huge no no now in my [00:26:00] practice.

[00:26:01] Dr. Grant Garcia: Right. But we change our methods for each doctor. I remember seeing one of the players and he had a terrible cartilage lesion with me from a condyle. And that will would be like, I'd be like, yeah, this needs like a pretty big cartilage procedure. And I, and I basically, the player was in a contract year and I had to tell him, you know, we're just going to do some stem cells or we're going to do some PRP and try to get you through the season, but like a lame person will walk in, I've been like, don't run.

[00:26:27] Dr. Grant Garcia: Don't walk. We're going to go to surgery in like six months. Like this is not good for you. So you just have like, everything's just different perspective and you don't, and then you can't be taught that you need to see other guys that other guys and gals that do this to learn how to do it that way. I mean, the in season out of season thing you mentioned.

[00:26:46] Dr. Grant Garcia: Joe was, is so vital. And there was no textbook for that. And even just even now treating just like high school and college athletes, they come in. I'm like, when's your season over with? I mean, even the martial arts high school kids, it's like, do you treat the dislocation in the [00:27:00] middle of the season? Do you treat at the end of the season?

[00:27:02] Dr. Grant Garcia: What surgery do you, you can tell them, okay, maybe you're gonna get a basic surgery now, but if you wait till the season, it's going to be bigger. Like everything you said was just on par. I don't know if Will has any questions about that, but it's like, I don't think we've talked about this on the show.

[00:27:13] Dr. Grant Garcia: We've had like over 40 episodes. But this is, this is amazing. This is exactly what we were hoping to get out of Dr. Liu today.

[00:27:20] Will Sanchez: This is more of a curiosity question just because, um, just from watching games and kind of seeing the speed and the movement of the reaction of the doctors on the field. We just saw Aiden Hutchison have a, you know, just pretty much breaking his leg.

[00:27:37] Will Sanchez: Instantaneously people are coming out, you know, getting his leg in a cast. Um, and in less than 24 hours, he already has surgery. So when you're working with the LA Kings, what's the protocol for someone like yourself or a team of physicians on game day? Like how many people need to be there, be ready just in case something happens.

[00:27:59] Will Sanchez: [00:28:00] What's the protocol of an injury of that magnitude happens that Yeah, we're hitting the ice. We've got four of us on standby. We have automatically this hospital ready to go. The aim, like just to kind of get a behind the scenes because when you watch it and if you're paying attention, it happens really, really fast and we've seen it with, you know, especially in the NFL where it, every second matters, right?

[00:28:27] Will Sanchez: Whether it's a DeMar Hamlin or anything else. So what's your protocol for game day? What does that look like behind the scenes? Yeah.

[00:28:34] Dr. Joseph Liu: Uh, that's a great question and um, I think the most important thing is there are more doctors than you can imagine that are That starts with that it starts with who your personnel is I think that's a character preparation so Uh at in in the nhl you're required to have an orthopedic surgeon who is the kind of head team physician there then you need to have um An er doctor typically our er doctor is in a general surgeon as well as er [00:29:00] trained.

[00:29:00] Dr. Joseph Liu: They're kind of combined, you know They have there are um, you know They're kind of code co trained. They, we have a dentist there for, you know, cause we get a lot of, uh, facial or, or mouth injuries. Oh, yeah, yeah, yeah. E and T doctor or a plastic surgeon who takes care of a lot of facial lacks or, uh, we have an ophthalmologist for eye injuries.

[00:29:17] Dr. Joseph Liu: Uh, we obviously have a general medicine doctor there for concussions. Um, uh, those are probably the, uh, those are the most common ones that we have in hockey. Uh, for football, we also have on staff neurosurgery that's involved as well. Uh, I know the NHL ha oh, sorry, NFL has their own kind of independent neurologist, uh, that's available to deal with depression, but that's not required at the collegiate level.

[00:29:39] Dr. Joseph Liu: Um, and then, um, So in terms of what's available on game day, we have paramedics are basically right off the ice, right? So you in, in USC football, they're just kind of right in the, in the tunnel that leads to the stadium. And then on the, uh, in for, um, for the NHL, they're just right off the ice. And we basically have, you know, uh, hospitals that we [00:30:00] know that, you know, we go to for certain problems.

[00:30:03] Dr. Joseph Liu: So if it's a cardiac event, they're going to go to a certain hospital. They're going to, if there is a traumatic injury, they're Uh, whether it's, uh, like a broken bone or something like that, we have another, it's a separate hospital for that. And so we know the contact and we go over the contact with, uh, the opposing team before game.

[00:30:19] Dr. Joseph Liu: So there's this pre game kind of huddle to make sure that everyone's on the same page. Uh, if there's like a cervical spine, a neck injury, we know how they like to basically position and get the patient uh, athlete off the, uh, off the rink to make sure they're transported safely. I see. I think these are, you know, it's all in the preparation more than so that when something like this happens, we can react on a moment's notice.

[00:30:38] Dr. Joseph Liu: And we're not, we're just following protocol at that point. We're just going to say, okay, this happened. We're going to do X, Y, and Z, and we're going to get them to the right location.

[00:30:45] Dr. Grant Garcia: And I want to bring up a point because I actually was, my friend was asking me this lot two weeks ago. He said, what's the craziest thing you had in your residency or fellowship?

[00:30:54] Dr. Grant Garcia: And you remember the White Sox player that had the aneurysm? And, and will [00:31:00] the, He's, I can't remember the guy's name. I just looked it up. He'll survived. White Sox player had an aneurysm on the mound. So he ruptured a blood vessel in his brain.

[00:31:09] Will Sanchez: Do you hit by a ball or was it just something that was building up

[00:31:12] Dr. Grant Garcia: sporadic?

[00:31:13] Dr. Grant Garcia: I mean, I don't know if there's a history of him. What he had is, but he probably had something brewing at some point, but he's just passed out and normally you'd like die from that and they somehow got him actually one of our co fellows with the doctors there, got him to the hospital. They got him taken care of and he survived.

[00:31:30] Dr. Grant Garcia: And he wasn't brain damaged. I mean, throw out a first pitch a few years. And that was on when dark, that's when Joe Lou and I were both at rush. We actually were not on that game, but we could have been. Um, and it was, I heard it was quite a traumatic experience for everybody there in the field. I mean, there's also the side of this is like, I mean, you're at the NHL and you get that carotid artery injury.

[00:31:49] Dr. Grant Garcia: That's no joke, man. So it's like most of the time, a lot of these games you deal with small things, but I mean, how many times Joe, we've had a couple and I will, we haven't even talked about this, but like we've [00:32:00] had a couple where we're like, we, the residents are called in. Because we're at HSS and we had to fix one of the Giants that broke his leg at like Saturday night, right?

[00:32:08] Dr. Grant Garcia: They're like, you're not even working and they're like, you get like a ring on your phone. It's like, we need you in the OR. You know, thankfully you're sober, so you run to the OR to help them out because you're not on call. And you need to go see, you know, whatever. I'm not at the cantina

[00:32:20] Will Sanchez: on 2nd Avenue and 70th.

[00:32:21] Will Sanchez: No,

[00:32:22] Dr. Grant Garcia: you're not in the cantina when you get the call to go fix the Giants. But, um, it happens. I mean, probably most, I think the most traumatic stuff is generally football, but there, we can pick a story from any one of those, but it's a, there's a lot of stuff that goes on behind the scenes. I think that's an excellent question.

[00:32:38] Dr. Grant Garcia: And it's really interesting for the, cause you just see that on the field. And all of a sudden you get a news report, right? You don't see the like hours of work behind the scenes. And I mean, how many times you prepare for this stuff and nothing happens. Right. So you got to be on alert. It's yeah.

[00:32:53] Dr. Joseph Liu: I mean, it, it can happen.

[00:32:55] Dr. Joseph Liu: Obviously the games are the most high profile, but it can happen anytime. Right. There's some players, [00:33:00] you know, who basically had a cardiac issue, you know, in practice and how to get them to the hospital, you know, And so those are things that, you know, at the most high profile situations are the games where other stuff is going on, and that's why protocol is really important.

[00:33:17] Dr. Joseph Liu: This can happen not just to the professional athlete, this can happen to anyone. And I say, so I think, you know, having these protocols at these locations that we, um, Uh, take care of. I think it's really critical and knowing who your resources are. I think that's another part of it. No one can ever do this alone, right?

[00:33:32] Dr. Joseph Liu: No, you know, there's, we're, we're all sub specialists in our own field. We know how to take care of what we know how to do very well. And we're going to rely on. Um, partners to take care of the, you know, things that they're specialized about. And so having a team that's in place beforehand, like I said, the preparation and having the right team available and having those protocols in place is going to keep our athletes safe.

[00:33:55] Dr. Grant Garcia: So I want to, I want to Change pace a little bit. This is always going to be, this is [00:34:00] always the hardest part of our jobs, but it's important for the viewers to hear this because we brought it up with the two, a conversation, but the med legality of team coverage, it is no joke. And the sexy thing of saying you're the team doc for this or the team doc for this, that's all great, right?

[00:34:19] Dr. Grant Garcia: Patients want to see you. You've got clout. You're solid. You know, that's, that's, that's, that is the highest level of marketing you can have as be a professional athlete, team physician, right? Like any, any, any sports guy coming out, that's the first thing they're thinking about doing, especially when you come from places like we did, right.

[00:34:34] Dr. Grant Garcia: They're just like, when are you gonna take care of the professional team? The problem is it doesn't always go the way you like. And sometimes you get issues. And we talked about the most recent one. And I want to know your opinion, but this is, this is for the viewers. This is the largest lawsuit in the history of the NFL, right?

[00:34:52] Dr. Grant Garcia: And one doctor, Dr. James Bradley, who's a great guy, great surgeon, Pittsburgh Steelers, but took care of this player. [00:35:00] And they sued him for, what, 29 million dollars, which is insane. And Rothman, who took care of the Eagles, which no longer does, got sued for, I don't know, I can't remember, 12 or 19. And they didn't even actually take care of him, they just did the rehab.

[00:35:13] Dr. Grant Garcia: So the fact that the lawsuit was dropped on them as well is absolutely insane. And this is going to change the market for teams. I mean, the teams can't even get coverage now because they're workers comp injuries. They can't even get coverage for some of these teams. Have you noticed, did you guys talk about that when it came out?

[00:35:29] Dr. Grant Garcia: Like I remember every surgeon, all my partners were talking about it. When it came out and they're like, did you hear about this? Did you hear about this? Like it's a big deal

[00:35:38] Dr. Joseph Liu: Yeah, so i'm not sure it's trickled down to the collegiate level yet Um, but we did have a specific meeting about it at the nhl team physician society And so what happened was?

[00:35:50] Dr. Joseph Liu: Um, this was, you know, like Grant said, the largest settlement that's ever been, um, you know, kind of doled out for a malpractice suit. And not [00:36:00] only was it the size, it was not, it was about future earnings, right? So there, in, in very, in certain states, there are short reform for painting suffering that's limited to a certain number.

[00:36:09] Dr. Joseph Liu: Uh, but there is no limit on future event, future earnings. And so that's basically why the number became so high, right? Um, and they just,

[00:36:18] Dr. Grant Garcia: and one second for the listeners, that's why professional athletes are the hardest, the hardest issue for malpractice because the word future earnings is killer because most insurance is like, no offense, but like if a standard person got injured, their future earnings are not going to be a hundred million dollars.

[00:36:33] Dr. Grant Garcia: Right. So, and most policies won't go that high. So that's the, sorry, keep going, but that's the reason why the future earnings is a huge deal.

[00:36:40] Dr. Joseph Liu: And so just like Grant was saying, our typical policies for just taking care of patients, right, is usually like a 1 policy. That's for just taking care of normal patients.

[00:36:51] Dr. Joseph Liu: And that, you know, that includes pain and suffering and, you know, any sort of negligence, that type of thing, malpractice associated payouts, you know, bodily harm, [00:37:00] um, that type of thing. But that's you, like Grant was saying, that takes into account what, you know, normal people are going to make in their lifetime.

[00:37:07] Dr. Joseph Liu: And so that's usually why that policy won't be maxed out. But in the professional level, there's typically not a secondary coverage that you're taking just because you're a professional, you know, a team physician. And so what, because this settlement was so high, there's never been in the history of a policy that's been that high for one individual surgeon.

[00:37:26] Dr. Joseph Liu: And so the fact that they personally had Dr. Bradley, um, uh, liable for, you know, 29 million himself was, you know, astronomical. That's crazy, right? There's no policy that's going to cover him. And then the secondarily, when the health system, you know, from Rothman was, you know, Uh, you know, on the hook for another 1 3rd, you know, basically another 1 3rd of that settlement, you know, that's how they got in trouble as well because I don't think I think the apartments themselves had to, um, they didn't, I don't think they had necessarily had secondary insurance that was that high that could cover that.

[00:37:56] Dr. Grant Garcia: Well, that's not a good day when you asked to write a check of that size and you didn't [00:38:00] even have to take care of the person.

[00:38:01] Will Sanchez: Yeah, 14. 3, right? So, um, that was their stake in what they owed. What does that do to a doctor? It, when you get sued at that level at 29. 2 million or whatever it is personally, What does that do to you?

[00:38:19] Will Sanchez: How does that affect not only obviously your wallet, but as far as you working with an institution, another hospital, like what are the ramifications at that level is it's, well, this doctor's legit. So it's just bad luck and we can move forward or do people hesitate saying. Hey, we cannot afford bringing, you know, to bring him in and have a lawsuit on our hands at that size.

[00:38:45] Will Sanchez: Can you, can you even answer that?

[00:38:48] Dr. Joseph Liu: I mean, I obviously I don't have personal experience with that number, but this is what I would imagine. There's two parts about it. Number one is. Are you insurable? [00:39:00] Right? Will insurances be with that type of settlement against you continue to cover your malpractice? Or are they willing to cover your malpractice insurance going forward?

[00:39:11] Dr. Joseph Liu: Because you have a suit of this type. size. You

[00:39:14] Will Sanchez: set the standard already, right? I mean, if you have, somebody has the same injury and something goes wrong, well, they already paid out at this. So that's where I'm starting my,

[00:39:24] Dr. Grant Garcia: well, that's a whole nother topic. Well, that's the, that's the worst part of this whole situation, which we haven't talked about.

[00:39:30] Dr. Joseph Liu: You know, just going forward, as you keep taking care of patients, you're in theory, in the eyes of the, in these insurance companies, you're much higher risk because you have this, Against your record whether you're at fault or not, right? And so this is just a statistic that you can no longer get rid of it's like kind of like getting uh, you know, a Something on your record tattoo or something like that Like that exactly that's exactly correct Um, I think the second thing is the mental aspect of it, right?

[00:40:00] Dr. Joseph Liu: Are you willing to take on you have the confidence? To take on that stress of getting someone back it at that level. That's a good It's not necessarily that you're not confident in your own surgical skills, right? But are you confident to treat them because they're going to potentially come back and bite you in the butt again, right?

[00:40:20] Dr. Joseph Liu: Meaning that are will they? If they have a bad outcome, are you always going to think what if they have a bad outcome? You treat them differently because of that. I think that is the thing that I can't answer because obviously I've never been in that mental space, but I would certainly think about that.

[00:40:36] Dr. Joseph Liu: And that's what I, I think that's what team physicians have to start thinking about. At the professional level, at the NIA level, when that much money is involved, right? Do, are these athletes going to suddenly turn around and start saying, because did you, whatever you did stopped me from these future earnings, therefore I'm going to sue you now, right?

[00:40:54] Dr. Joseph Liu: And I think that's really critical to think about. That maybe in the past we didn't think about because we were so focused on [00:41:00] the other side, the glamorous side. This is the, the very, You know, kind of the, the dirt of the, the, uh, team position side for sure.

[00:41:07] Dr. Grant Garcia: This is so important for the listeners to hear and to hear Dr.

[00:41:11] Dr. Grant Garcia: Liu's thing, because when you're a team, when you're a sports surgeon and you have some sort of clout in your community, the number one thing people ask is, are you taking care of a professional sports team? It's not how are you doing? You busy in practice? It's how are you taking care of your professional sports team?

[00:41:26] Dr. Grant Garcia: So there's a lot of motivation to do it. But the downside is there are too many surgeons I know who did sports teams who got so burnt out from the medical legal stuff or so scared that they were going to get sued by a player and lose all of their earnings for one thing. And by the way, The lawsuit, the lawsuit against this guy was not a mistake.

[00:41:50] Dr. Grant Garcia: It was actually a legitimate reason. It just somehow was able to find a way to win this lawsuit with a trauma surgeon that I went against an orthopedic surgeon. It's actually like absolutely some of these lawsuits, facial [00:42:00] professional athletes, they were on, you know, the problem you have, this guy's on, you know, guys on a contract year, he gets hurt, will can't 20 million contract if it hadn't been for you.

[00:42:10] Dr. Grant Garcia: Right. And you have a

[00:42:13] Will Sanchez: champion that goes to validate him, right? You know, I mean,

[00:42:18] Dr. Grant Garcia: because they're the because they know all about

[00:42:20] Will Sanchez: it and said he was a great player that can't get back on the field. So you have this Philadelphia Eagles Super Bowl champion that has a statue in front of the stadium saying, if it wasn't for you, He would be earning money and be back on the field.

[00:42:35] Will Sanchez: So there's a whole other aspect of it because now, now you're getting into public opinion, you're getting into fandom. I mean, we just talked to him. We started the show talking about the giants, right? So you're, you're, you're pulling on all of these emotional strings. And then you're having a decision made by a judge and now you have these ramifications.

[00:42:58] Will Sanchez: So I think going back to what you were [00:43:00] originally talking about, what happens to the Eagles? What happens to, uh, will we see a norm where eventually teams kind of take a step back because of something like this? Is there anything that you can foresee or guess that could sway a certain way?

[00:43:17] Dr. Grant Garcia: I don't think this is going to go over very well, this comment, but I'm going to say it anyways, because that's what we do here.

[00:43:22] Dr. Grant Garcia: Unfortunately, there are way too many of us young surgeons that turn into little lemmings. And we want to have the team coverage because you want to be busy when you come out and you're in private practice. I've had this experience and you open up your doors and you're, you're six months in and all of a sudden nobody's there.

[00:43:39] Dr. Grant Garcia: You got to pay the bills and you're stressed.

[00:43:42] right?

[00:43:42] Dr. Grant Garcia: Or you're two years in or three years in. And thankfully I was able to build my practice very quickly in Seattle. So for fewer years in that stress reduced. But to be honest with you, I had the same stress and I had this opportunity for potential professional athletics and I'm so glad I did not do it.

[00:43:58] Dr. Grant Garcia: But it was there and it would have [00:44:00] been very glorious to have opportunity. And Joe knows this, but you know, everyone we ever talked to, whenever we talk about how things are going, if they got onto a professional sports team, that's the number one thing they tell us. Guess what? I'm doing the trailblazers.

[00:44:11] Dr. Grant Garcia: Guess what? This team does this so that I think that's never going to go away. And unfortunately it means that young. Physicians and surgeons are going to be put up as lemmings and then eventually have some sort of burnout from something else. I don't know if Joe feels the same way, but, um, it's sad, but you know what?

[00:44:28] Dr. Grant Garcia: For some people, they really need that to boost their practice. And so I'm not faulting them for it. I just think it's, I wish there was a safer method and I wish there was more tort reform, but you know, we could go on and on about this. I don't know what you think, Joe.

[00:44:40] Dr. Joseph Liu: Yeah. So that's definitely the case.

[00:44:42] Dr. Joseph Liu: So, um, as long as they're surgeons that are willing to become team physicians, this problem is solved. We're all we don't have the leverage basically if that's what you're I think that's what you're pointing to is At this level from the team position level that you don't have leverage against this type of possibility, right?

[00:44:59] Dr. Joseph Liu: You certainly want [00:45:00] um You know our surgeons society is to kind of police themselves to make sure that surgeons are At an appropriate level to take care of these athletes and you're doing the right thing And I think that's also you know, just to point out that you had talked about previously who is kind of testifying on this athlete's behalf and drawing, you know, tugging on their heartstrings and things like that.

[00:45:20] Dr. Joseph Liu: The biggest issue is that, you know, in these medical legal cases, as you're trying to, you know, Basically, you're trying to basically convince these, the jury who are, you know, typically lay people, not medical people on purpose, right. Kind of the nuances of these surgeries. Right. And I think this is a very nuanced situation in terms of what Dr.

[00:45:39] Dr. Joseph Liu: Bradley decided to do in the, at the time of surgery that, you know, the lay person doesn't necessarily understand. And I think that's the complexity of surgery and sports medicine, especially at the highest level is that it's not just. One or the other there's not one right answer and often it's a judgment call of what you see at the time of surgery in the context of the what you see [00:46:00] in the rest of you know the athlete's you know body or the joint or whatever we're operating on it's not just the one thing that they're talking about right and so I think that's very hard to describe to the lay person and so a trial by peers is You know, not perfect because of the fact that the people that are actually sitting on the jury don't have the education to make such a, um, you know, the call to say someone's truly liable or negligent in this situation.

[00:46:26] Dr. Joseph Liu: And I think that's what's required in malpractice, right? These, you know, is the, is the negligence portion.

[00:46:31] Dr. Grant Garcia: And the problem you have too, is the experts. that they find they have trouble getting the good experts, right? Nobody's going to go against James Bradley if they think what he did was legitimate, right?

[00:46:41] Dr. Grant Garcia: Like you've gotten calls with Joe. I've gotten calls to be an expert witness against a sports surgeon that did something legitimate. I mean, I got a call six months ago. The surgeon did very little, definitely not enough to get sued. And I was like, I'm not testifying against them. That was completely legitimate.

[00:46:58] Dr. Grant Garcia: But of course, you know, [00:47:00] like they're going to find somebody eventually, right? And that's the problem. So it's a whole nother ballgame. I, we could keep going on this. I got a few more minutes. I got what I do, but I want you do your follow up question. Then we're going to go to NHL. I want to NHL's decision.

[00:47:13] Dr. Grant Garcia: So you do your follow up question. And then cause we're going to go all night. Will we do this all the time?

[00:47:17] Will Sanchez: I definitely go all night. So can you see a world where the contracts change? Between player and team, where, where the team is protective when it comes to, uh, the medical treatment and also maybe combining that with insurance policies, which we've seen, but I don't know if every player has them.

[00:47:42] Will Sanchez: So with the insurance policies covering the player and also the contracts that the player signed with the team, as long as you know, if you're going using our. Physicians or facilities or something like that, where maybe something is put in place where everyone is getting [00:48:00] something out of it, if something goes wrong, where someone's not getting smeared, if something happens, players are insured, can you envision something like that?

[00:48:08] Will Sanchez: I know there's certain things in place and some players have it, but I don't know if that's across the board.

[00:48:14] Dr. Joseph Liu: Um, so I think this might get at Grant's point that we're going to talk about very shortly, but I think. You obviously want players to earn their money, right? And so as all of these sports become more and more popular, they're just more and more money involved.

[00:48:27] Dr. Joseph Liu: And that's why these numbers are just going up and up, right? Our contracts nowadays for. You know, all of these sports are two, three times 10 X, what they were 10, 20 years ago. But it's also

[00:48:39] Dr. Grant Garcia: 10 X compared to the average population, right? They've gone up exponentially higher than all of us. Normal earners, right?

[00:48:46] Dr. Grant Garcia: We just, there's no way that we can't match the exponential growth of them. So that's a problem too, but keep going.

[00:48:51] Dr. Joseph Liu: So basically, and I'll bring this up a little early, um, is that, you know, when the NHL team positions were started to talk about this dilemma and, you know, [00:49:00] who should be coverage covering it, you know, they, they started to talk to the players association as well as the league.

[00:49:05] Dr. Joseph Liu: And I think what they came up with is that in, um, that probably the, the person that makes them, or the entity that makes the most sense to cover or provide kind of the secondary coverage is the league itself, right? Because that's where all the money's funneled through. Uh, and so if the league, you know, and that allows team positions to do what they are supposed to do, which is take care of players in the best way possible, not think about these consequences.

[00:49:28] Dr. Joseph Liu: And so if you have this larger entity that kind of obviously wants the best for their, you know, wants the players to do well and be healthy because that's their, you know, that's their product. Right. And wants their team positions to be available to keep taking care of. Um, players and not be afraid of kind of the possibility of these lawsuits occurring, then all of these leagues that have, have all this revenue that's then ultimately divided amongst the teams and the players, if they are the entity that covers them, then that's going to be the one, the entity that has the most amount of money that can cover them, right?

[00:49:58] Dr. Joseph Liu: So whether the, you know, I [00:50:00] think ultimately if they're, we're able to, they're able to come up with an agreement with all of the, you know, team positions, the team position society, as well as the players association and say, okay, well, you know, the league is going to head, you know, kind of. lead this kind of secondary insurance policies above and beyond what they carry normally, right?

[00:50:16] Dr. Joseph Liu: You don't need it for, you know, normal malpractice. You need the secondary insurance for basically, you know, out of this world settlements like, you know, the most, right, exactly.

[00:50:25] Dr. Grant Garcia: So this is amazing. What Joe just brought up as many point and the people, when they listen to this, These NFL teams literally have dead money and every year because they trade a player that's atrociously playing and they paid them so much money.

[00:50:40] Dr. Grant Garcia: 29 million dollars is like a rounding error for some of these teams. But meanwhile, you have James Bradley and Rothman that literally are like, sunken because of this lawsuit. And if the NFL literally could do this, it would be a game changer for all team positions and they could really take care of their players.

[00:50:58] Dr. Grant Garcia: And it would be no, this would be very little [00:51:00] burden, to be honest with you. I mean, the largest lawsuit ever is that big. I mean, that's like one year salary for one of these players. I mean, it's not like

[00:51:07] Will Sanchez: it's less than a year salary for Daniel Jones. Enough said, and

[00:51:12] Dr. Grant Garcia: that's, that's, that's saying a lot. So my point being is that what Joe is getting at is that is the future.

[00:51:20] Dr. Grant Garcia: And the only way you're going to get the best surgeons and the best people to take care of the players and they can do their best. And it's not going to incentivize us to do a poor job. It's going to send us to do a better job because when my number one concern, when I was offered to do more professional teams and I wasn't going to be fully employed and it was going to be a contractual relationship is that if I touch the player, I'm going to get sued.

[00:51:40] Dr. Grant Garcia: If there's a problem and I'm not protected in Washington state, we have employment laws that actually protect this situation. So if you're a team physician, but you're in fully employed with the sports team, supposedly you cannot be. sued by the sports team. So this would not happen in Washington state, which is interesting.

[00:51:55] Dr. Grant Garcia: And so we have very strict employment laws. Now, again, it may have changed recently. [00:52:00] That's something that's not in most of these states. It's clearly not in Philadelphia. Philadelphia is the largest Joe knows. This is the largest per capita of lawyers in the country, right? You just, you just, you run into a lawyer when you walked on the street.

[00:52:12] Dr. Grant Garcia: I mean, that's just, this is just the way it goes when I trained it, uh, in Penn. But this isn't, this is just really important. People understand there is a solution for this. Um, I just think the greed of the NFL needs to be fixed and uh, you can see this right now. I mean, it just protect your players, let them get the best possible treatment.

[00:52:31] Dr. Grant Garcia: And every team physician's thinking this when they're thinking of the player, they're worried about this. It doesn't matter who they are. I've, we've talked to, we've had seen so many amazing surgeons we've worked with and this is one of their concerns. I mean, it's right, Joe. It's medical legal. Everyone's concerned.

[00:52:45] Dr. Grant Garcia: No one wants to talk about it.

[00:52:47] Dr. Joseph Liu: Yeah. I mean, I think you're just, you're covering your eyes and you're covering your ears and hoping for the best, right? When you're taking care of these players, obviously, I think, you know, ultimately all of these leagues that, you [00:53:00] know, have all the revenue. They're the ones that have the deepest pockets to be able to cover these.

[00:53:04] Dr. Joseph Liu: And it's going to be up to, you know, the negotiating power of these teams. physician societies, as well as, you know, and as long as the players, I think associations are also on the same page. I think there will be enough leverage to hopefully get these kind of, um, entities to cover, cover the, uh, cover the physicians.

[00:53:20] Dr. Grant Garcia: Well, I think maybe the hope of this NHL thing is that it shows the other teams that they could do it. Um, and. I hate to say you keep saying the word deep pockets, but this isn't very deep. I mean, it's like I said, this is the rounding errors for NFL. Like there, how, how often will, and Joe, are there's, is there money that's like these teams when they, they get rid of a quarterback mid season, right.

[00:53:41] Dr. Grant Garcia: Who's done terrible. And it's got like 29 to 30 million of dead money. And we're talking about like a lawsuit here against the, one of their team physicians. For a, for a one single instance, that was likely not even negligence, right? It was, there's, from what I've understood about it, this is, this is, again, we know this is [00:54:00] extreme situation, but many of these are like player just can't play and they didn't get back to what they wanted to do.

[00:54:05] Dr. Grant Garcia: And so it's really important for people to understand that this is not a huge financial burden for these teams. And it's just, it destroys physicians who are doing teams and you don't get the best people, in my opinion, don't get people that you don't, you don't get the cream and you don't get your full pick, right?

[00:54:21] Dr. Grant Garcia: It's just, it's just the way it is, or you get people and they're scared. So it's just, it's a, it's a sad state. But again, we're not here to depress the viewers. We're just here to give them information.

[00:54:32] Will Sanchez: I see. You got five minutes because you just, you don't let Dr. Lou talk and you're jumping in all over the place.

[00:54:38] Will Sanchez: I'm so excited. I'm so

[00:54:39] Dr. Grant Garcia: excited to talk about this.

[00:54:42] Will Sanchez: It's all right. I stole a lot of your time, man. It was my bad. Listen, uh, how do you work your, uh, work life balance, uh, Dr. Liu? Just, uh, you know, you're busy, USC, and Kings, and, you know, dealing with Dr. Garcia. That's taking up all your time. What are you doing for, uh, for fun?

[00:54:59] Will Sanchez: And what's your work [00:55:00] life balance like? Just so, uh, just so we know here.

[00:55:02] Dr. Joseph Liu: Yeah, I think that's really critical for our longevity in any career. Uh, and, uh, I think now that I've come, uh, uh, Grant is gonna make fun of me because I used to be the most, uh, frugal person that he knows, and he might still be the most frugal person he's ever known in his life.

[00:55:17] Dr. Grant Garcia: He definitely is. This kid, this guy could retire. He's so frugal.

[00:55:21] Dr. Joseph Liu: But, I think, uh, you know, just finding, uh, Time on a daily basis to keep yourself, to keep my body healthy, as well as my mind healthy, working out, going to the gym, I think travel, you know, broadening your horizons, I think, you know, spending all your time working, I think that's, if it's, obviously, I think it does give someone purpose, but I think, um, going outside, learning about new things, I think learning about new cultures, uh, diversity, that kind of thing.

[00:55:47] Dr. Joseph Liu: I think that's the way to stay grounded in the fact that, you know, there's more than to life than just work. There's more to life than just taking care of sports. There's more to life than just doing surgery. Um, I think getting to know [00:56:00] new people, I think that's always exciting. I think that's, you know, but in a, in a situation that's not medicine, right?

[00:56:04] Dr. Joseph Liu: I think that's the interesting part, right? Um, that's what gives me joy. I think travel does that because you're, Uh, instantaneously going to go to a different place, uh, a walk of life that you may not have, um, You know, been able, been exposed to in the past. And I think, uh, you know, my girlfriend is loves to travel.

[00:56:21] Dr. Joseph Liu: She, you know, she's hit more countries and she she's gone through more passport books. As you're

[00:56:26] Dr. Grant Garcia: hearing the girlfriend changed him. Thank you.

[00:56:30] Will Sanchez: Have you gotten the, gotten the travel itinerary from Dr. Garcia? Right. And you know about this.

[00:56:38] Dr. Grant Garcia: Thankfully we're running out of time. So Joe can't tell me.

[00:56:41] Dr. Joseph Liu: I should be a separate podcast.

[00:56:43] Dr. Joseph Liu: If it hasn't already been featured.

[00:56:45] Dr. Grant Garcia: It's a, well, first off, I just want to tell everybody the, one of the best parts of my job as orthopedic surgeon is also the colleagues that I met and my friends and Joe's one of my best friends [00:57:00] and it's awesome. To be able to talk about random stuff, work stuff, anything.

[00:57:05] Dr. Grant Garcia: And honestly, I have a lot of work life balance, but the decompression, when I have a tough case or when stresses like not hopefully this level come up, I have someone like Joe that I can call and I would tell you, I've bounced, he's heard me talk way too many times and I've, he's bounced stuff off me. Um, and that's really the key to longevity.

[00:57:24] Dr. Grant Garcia: In practice and taking care of people, uh, because as much as we want to be perfectionists, nothing's perfect in life and we can bounce things off. And I am better because of friends like Joe and I hope that Joe's better because they're friends like me. And so that's what this really is important for the podcast too.

[00:57:40] Dr. Grant Garcia: Obviously we talked a lot about medical legal, but we both fricking love our jobs, right? But I like my job too, because I have people like Joe that I can talk to and I feel really good about my decision to do this thing. So thank you, Joe.

[00:57:53] Dr. Joseph Liu: No, thanks, Grant. I, I definitely want to echo Grant's sentiments about, you know, even though we're, a lot of us are [00:58:00] taking care of patients one on one, I think number one, it's, you know, our collaborative experiences from our training, you know, training, training with the best of the best and the greatest in orthopedics and sports medicine.

[00:58:11] Dr. Joseph Liu: And then it's not a community. You know, once you're in, so, you know, practice on your own, you don't finish learning, right? I think it's a lifelong learning experience. You continue to talk to friends and colleagues, uh, about difficult cases. Um, and you know, I I'm still learning every day with every patient.

[00:58:30] Dr. Joseph Liu: Um, I think that's the most, the best thing about orthopedic surgery, about sports medicine, is that not everyone is exactly the same, and everyone has their own story, and you can treat them, you know, you just need to treat them with kindness, and, uh, you know, understand that Okay to have a team behind you to give them the best possible care.

[00:58:51] Dr. Grant Garcia: Thank you so much, Dr. Liu. We really, really appreciate you coming on and normally we could keep talking, but we're going to go past an hour and Instagram does not like an [00:59:00] hour.

[00:59:02] Will Sanchez: Hey, we just want to, we want to thank everybody. We want to thank your time. Check us out at sports. talk. com. We have episodes, transcripts, you name it.

[00:59:10] Will Sanchez: Uh, we're going to get, uh, Dr. Grant Garcia's, uh, travel itinerary. It will be bigger than war and peace. Uh, so just be prepared. We'll see if we could do a cliff note version and we have to get a Dr. Lou talking about, you know, all of the travel shared here and, uh, everything that Dr. Garcia has done. Thank you, Dr.

[00:59:32] Will Sanchez: Lou. Thank you. Thank you, Dr. Garcia. our favorite orthopedic sports medicine specialist. And we, as always, we want to thank the listeners. Say goodbye, everyone. Thank you. Bye.

Audio Transcript

[00:00:00] Will Sanchez: Welcome to Sports Doc Talk. I've got our orthopedic surgeon, sports medicine specialist, Dr. Grant Garcia, Will Sanchez, Dr. Garcia. I mean, your background says it all. It's incredible. MBA time. I got to be honest with you. I'm a Knicks fan. I'm a little triggered from all the Jordan and Pippen beatings, but I'm going to, I'm going to excuse.

[00:00:39] Will Sanchez: I know you've worked with them in the past and I know you have some affiliations, so I'm gonna let it go. But before I ramble on and get excited about our show, how are you? And are you a bulls fan?

[00:00:51] Dr. Grant Garcia: I'm not a bulls fan. So first off, I don't want to throw off the viewers. We're going to, we're starting to do some stuff.

[00:00:56] Dr. Grant Garcia: You never know what's going to be on my background. So today we're going to talk about. [00:01:00] Obviously took care of the bulls. You know, working with them was awesome. Um, but the player we're gonna talk about today, which we'll go after in a minute is Lonzo ball, who is currently going to be starting with the bulls.

[00:01:11] Dr. Grant Garcia: Let's say three days, right? Thursday, I think is the start of the season.

[00:01:15] Will Sanchez: Yeah. So, um, that'll show will be the morning of, uh, the start of the season for them. So we're really excited about this 20, 24, uh, 2025, like I said, I'm a Knicks fan, so I'm hoping for good things this upcoming season, but for the business that you're in and what we like to talk about, um, This is right up your alley.

[00:01:35] Will Sanchez: We talked about it in the show previously, but before we get into that, because we're going to talk about recovery and this is kind of what we do. Let's talk about the recovery shop. Take it away.

[00:01:47] Dr. Grant Garcia: So again, thanks for our sponsors. Uh, we've heard this before, but this is what's essential for these big surgeries.

[00:01:53] Dr. Grant Garcia: You get these big surgeries, patients like professional athletes, regular athletes, college athletes. They were like, what do I, can I do? I need [00:02:00] what you're doing is good. But I need more. Yeah. Right? So what can we offer? So as a surgeon, we can have a place like this as a landing page and the surgeons can offer their patients that they go there or they get a call from the recovery shop offering these services and they can buy a bunch of these different things that they want.

[00:02:16] Dr. Grant Garcia: Different advanced ice machines, advanced recovery machines. You know, we got scar creams, uh, we got special bending machines. I mean, pretty much anything you want, you can put on there. I mean, that's the nice thing about this. It's not like you have to stick with something and it's something you value. So if it's something different that you want, you can talk to them.

[00:02:33] Dr. Grant Garcia: They can do it again. Obviously there are sponsors, but I get no affiliation if you sign up. Um, so just, you know, check it out, contact them as a surgeon. It's always good to have this. armamentarium because the patients are going to ask for it. Don't pretend like they don't, you know, you unfortunately have way too many visits where the patients come in, they go, what else can I do?

[00:02:49] Dr. Grant Garcia: And you'll say, well, you got this or this, you know, we can offer nutrition. So it's been an awesome outlets for my, for my patients.

[00:02:57] Will Sanchez: Yeah. And let's get kind of get started about, uh, [00:03:00] today's show. You know, we, uh, we talked about it last year. just the concern, right? And you know, when we're talking about Lonzo ball, you know, when we heard about his injury, um, he's had, I believe three arthro arthroscopic surgeries since the 2021 2022 season, which would be 2022.

[00:03:18] Will Sanchez: I believe the last time he stepped on the court was January, 2022. So he's finally been cleared after the torn meniscus, which has happened twice the surgeries. You know, we talked about it. Very concerning. This is something that most likely this player, even at such a young age in his twenties, may never play again.

[00:03:45] Will Sanchez: But now there's the chance he stepped on the court for the first time during preseason. He got a chance to play. Um, why don't you tell our listeners and viewers more about the injury that leading up to it and the procedure that he had, because, [00:04:00] um, like I said, we both discussed it and we didn't think that this was something that he may come back from.

[00:04:05] Dr. Grant Garcia: So first off this episode, I'm really excited about, uh, many reasons. First reason was when we did this initial show, you can go back and listen to it. We did not know that he had his meniscus replaced because it was never announced. We said we had an entire show, one of our hottest shows on the internet about cartilage transplants.

[00:04:26] Dr. Grant Garcia: Yeah. And we talked all about cartilage transplants, the recovery and everything else. And then all of a sudden, like six months ago, it came out that he had a meniscus transplant and a cartilage transplant. Which is a humongous surgery and that's near and dear to my heart. And there's a couple of reasons.

[00:04:42] Dr. Grant Garcia: One, this is my, this is my absolute favorite surgery to do. This is my absolute favorite surgery to take care of patients. This is a highly niche practice. There are a few very few people in each state that do this. So this is a very cool that I can talk about this in an NBA player. And [00:05:00] finally, The most cool part of this is the person that taught me how to do meniscus and cartilage transplants, who did this on Lonzo Ball, is the person that did it to it.

[00:05:10] Dr. Grant Garcia: Dr. Brian Cole, the godfather of cartilage and meniscus transplants. So, and, happens to also be the Bulls team doctor. So this is a, Awesome conglomeration of everything that I've worked for, for since I've been here to talk about this and to be able to show off this, this really cool procedure, you know, patients know about this, they come in asking about it, but, and we tell them it's for recreational athletes, professionals have never gotten it before.

[00:05:35] Dr. Grant Garcia: A cartilage transplant, but the meniscus transplant is even the next level. And so now we're about to see an NBA player who's already played preseason play in his first professional NBA game. The first player in history to have this type of procedure. I think he's the first player with a cartilage transplant and the first player with a meniscus.

[00:05:51] Dr. Grant Garcia: And they decided to go after both at the same time. And we can explain that in a minute why they did that. But this is a humongous deal. It's a technical surgery. [00:06:00] And it has obviously its own risks, just like any other surgery, but let's roll through the slides for the, for the viewers. They can understand what he did.

[00:06:09] Dr. Grant Garcia: Now I have inside information. Not only do I do this procedure, but I've done this procedure with the person that did the surgery on him. So I can tell you, this is exactly how he did it. So this is really cool. So on the left hand side, you see the black and we'll please chime in because for the viewers, I I'm going to, I'm geeking out right now.

[00:06:27] Will Sanchez: Yeah, I know. I'm just giving you a little room to breathe and stuff. Cause I've got some follow up questions, but go ahead, man. You're like a little kid in a candy store. I know.

[00:06:36] Dr. Grant Garcia: Okay. Thank you so much for the opportunity. So the. So the meniscus transplant you see here on the left. So what we do is this is called a If you're not

[00:06:44] Will Sanchez: watching this, and it's a great way to promote our YouTube page.

[00:06:48] Will Sanchez: Uh, Dr. Garcia has got a smile ear to ear. I mean, he may hurt his cheeks from smiling so much. I'm sorry to interrupt. A mental

[00:06:56] Dr. Grant Garcia: break. I got a mental break after this. I'm too excited. So, and we [00:07:00] got to keep this short because it's supposed to be a blast episode. As you know, we do a good job of that.

[00:07:03] Will Sanchez: Yeah.

[00:07:03] Dr. Grant Garcia: Okay. So, so first off, this is the meniscus transplant. So you can see here, now this is a lateral one. I'm pretty sure he had a medial one. That's more common with the issue he had, but nonetheless, gets his meniscus removed a few times. All of a sudden gets a hole in the meniscus or a hole in the cartilage, as we talked about.

[00:07:19] Dr. Grant Garcia: And then all of a sudden has no meniscus left either. The problem you have and what some surgeons do is they say, Hey, the meniscus is really hard. The meniscus is the hardest part of this whole surgery. So let's say the surgeon skips that, right? That's not good because now you've lost the cushion. You need to get all three things fixed.

[00:07:34] Dr. Grant Garcia: The cushion, you need the tibial plateau and you need the cartilage to be good. The tibial plateau is usually not the issue, which is the bottom part of the tibia right here below where the transplant is. Then you have the meniscus transplant and then you have the cartilage portion. So if you fix the hole, you fix the meniscus and the plateau is good.

[00:07:49] Dr. Grant Garcia: Then you have a good knee again. And right. And that's where the pain goes away and allows you to get back to activities. So the way he did this, as you see here, this is like a keyhole. It's actually crazy. It's just like woodworking. So [00:08:00] you cut that hole in, um, And then you slide the meniscus in like that, but you don't see here.

[00:08:04] Dr. Grant Garcia: And I didn't want, I couldn't find any images that were not gross for the viewers. So I apologize, but you attach it with stitches. Now that looks like it's really simple, but this is one of the most technically challenging surgeries that we do in orthopedic sports medicine because of all the nuances and little complications that can occur when you do this.

[00:08:21] Dr. Grant Garcia: So you do all that. And then on the same time, On the right hand side and this surgeries happen at the same time. This is not something you do separately and you come back. So you, I mean, Dr. Brian Cole is amazingly skilled at this and he's very efficient in the operating room. You take a piece of cartilage from someone else that has passed away.

[00:08:38] Dr. Grant Garcia: Generally someone younger. It's unfortunate to talk about it like that, but you that's the way it is. They just recently passed away three to four weeks. So it has to be fresh. And when you get it, you do some things, prepare it, and you actually core it out just like a bone dowel. So, so you see here, it's a bone plug, and you push that thing right back in.

[00:08:55] Dr. Grant Garcia: You generally don't need any screws or anything else. It literally just press fits. It's designed in the system to do [00:09:00] that. And those two things together are going to instantaneously give the patient a better joint surface. And then you're talking about a long recovery. I mean, Lonzo Ball's recovery was more extended than I would do for a regular athlete.

[00:09:12] Dr. Grant Garcia: I think they

[00:09:12] Will Sanchez: said it was 18 months or something like that. I mean, that sounds unreal to have a recovery that long for the surgeon. Go ahead.

[00:09:21] Dr. Grant Garcia: But you know what? He had bone edema. He had other issues going on. What's bone edema

[00:09:25] Will Sanchez: for those? I don't know.

[00:09:27] Dr. Grant Garcia: Obviously, he's starting to get like basically that means the bone is not happy, right?

[00:09:30] Dr. Grant Garcia: He has no meniscus. He has no cartilage and he's on that pre arthritis stage So if they don't do something soon, this is going to go really poorly, which is why he had so much pain, right? There are athletes i've taken care of nfl athletes Nba athletes that have had early arthritis or arthritis in their knees and they're fine, right?

[00:09:46] Dr. Grant Garcia: It hurts but they can push through it Lonzo ball clearly had something else going on the swelling the constant pain that he had but His knee didn't react very well to losing that meniscus and it doesn't happen to everybody. Um, he's just lucky that everything else [00:10:00] was in his favor. Good ACL, good everything else.

[00:10:02] Dr. Grant Garcia: So he basically had this special surgery, which again is incredibly unique. It's not unique in general, probably do. I mean, I think Dr. Brian Cole probably does 60 of these a year. He probably does a hundred cartilage transplants a year. You know, I do 20 of these a year with cartilage about 45. So it's not uncommon that we do them.

[00:10:23] Dr. Grant Garcia: I do one every couple of weeks, uh, but to do it in a professional athlete is, uh, is the next level. So this 18,

[00:10:30] Will Sanchez: I'm going to interrupt you as we go along. Why is that something that becomes a risk and why you normally wouldn't do it on an athlete like this?

[00:10:40] Dr. Grant Garcia: So first off, very few people have the. Have the cojones to go after the, be the first one, right?

[00:10:45] Dr. Grant Garcia: No one wants to be the first one with a surgery like this. If it fails, right? Like let's say Alonzo ball goes out in two weeks. And again, I hope not. I don't think it's going to happen. He's obviously been checked a million times. I'm sure he's had way too many MRIs to make sure everything's looking good.[00:11:00]

[00:11:00] Dr. Grant Garcia: Uh, and I'm sure Cole's seen him. I'm sure other people have seen him and make sure that he's cleared and ready to go. Right. There's no way the Bulls are letting him put in an experimental NBA thing and then go after it. Right. The surgeon experimental, but it's the first time done on an NBA player. Yeah.

[00:11:13] Dr. Grant Garcia: So the idea is that like that's, that's the big problem here, right? That's what we have to worry about. Like, what else, what else is going to happen? So what can happen is you can tear your meniscus again, right? The meniscus, even though, so that meniscus transplant is from somebody else. It's a cadaver as well.

[00:11:30] Dr. Grant Garcia: Now, those are frozen. And the cartilage is fresh. So the cartilage sustains itself better. Those less likely damage themselves. So other professional athletes have gotten cartilage transplants. There was a hockey player that just recently got it from Brian Cole. There's a few other athletes that have had the cartilage transplant.

[00:11:45] Dr. Grant Garcia: Those are way more durable. Those are way more solid. Like I do those and I kind of set and forget. I mean, people can have issues with them, but it's just not as often. The meniscus, the meniscus has three zones. There's the zone with the blood supply. That's the very far back [00:12:00] zone. Then there's the middle zone and there's the white zone, which is the edge.

[00:12:03] Dr. Grant Garcia: And you can see that here when the meniscus transplant heals. And it's pretty crazy. I just scoped someone last week that had a meniscus transplant. You can't tell all the sutures have dissolved. Everything looks like it's a regular meniscus. I grab, sometimes I grab a nurse in the room and I say, Hey, what is this real or not real meniscus?

[00:12:18] Dr. Grant Garcia: And they can't tell. So they look the same, which is amazing because it's been from somebody else. The, that little layer, the layer without the blood supply never gets integrated into the rest of the body. And so there's a risk of tearing again. It's a little more brittle. It's a little more fragile than maybe the one you were born with.

[00:12:35] Dr. Grant Garcia: You know, obviously nothing's as good as what we were born with.

[00:12:38] Will Sanchez: Yeah. But.

[00:12:39] Dr. Grant Garcia: And it depends on you. Well,

[00:12:40] Will Sanchez: can I assume that depending on the age of, of where you're getting this transplant from can also be a factor as far as let's say, you know, like Lonzo balls is 26 years old, you know, and if you got a replacement from someone that was in their twenties, you know, maybe that is a little bit more stable and stronger compared to [00:13:00] someone that's older.

[00:13:00] Will Sanchez: Can that be a part of making the decision making when you're selecting a transplant? That specific, um, you know, part of the body for the transplant.

[00:13:10] Dr. Grant Garcia: That's an excellent point. So the answer is we rarely would put something older than 30 to 30 years old in a knee like his. I'm sure he got something younger than him.

[00:13:21] Dr. Grant Garcia: He got a patient younger than him. It's just, that's unfortunate. Unfortunately, there's way too many, Bad things that happen out there. And we have a lot of these transplants to do. And again, I don't want to go into the ethics and, you know, stressfulness of the situation of getting donors. Um, but yeah, it's real.

[00:13:37] Dr. Grant Garcia: I mean, it's, we all know what happens. Listen, I

[00:13:40] Will Sanchez: I'm a donor. Gaffa bits. You know, when my time comes, if there's anything still working, please take it. And it's really

[00:13:48] Dr. Grant Garcia: nice too. Like what you can do and you do these, my patients will write letters to the family. that donated. And so you can actually, I've done my, I mean, I did one of my best friend's wives and she got [00:14:00] a cadaver ligament for her ACL and she wrote a really nice note to the family.

[00:14:03] Dr. Grant Garcia: And actually they, that's really cool. I get it frequently. My patients do it cause I do a lot of these. Um, and it's a really cool thing you can do. Uh, and again, I'm sure it makes the family feel better that they went to, went to a good cause and made a patient feel better and made someone feel better. So.

[00:14:17] Dr. Grant Garcia: Anyhow, on that, on, on back to the topic, the recovery 18 months is pretty long, but not for, uh, athlete of his level, you know, these, the average return to sport on these is about 10 months to a year. Um, and I have my patients, you know, the thing is, what's crazy about these is he probably felt pretty fricking good by about 8, 10 weeks, you know, there don't usually feel, they feel a difference in their knee very quickly.

[00:14:41] Dr. Grant Garcia: Despite how big of a surgery this is, but he probably had to reduce that bone inflammation. He probably had to reduce all that stuff and he had to strengthen his knee. And also because he's an NBA athlete, I'm sure they were just going super slow with him. I mean, one of the things that

[00:14:57] Will Sanchez: they mentioned was, Oh, one of the articles I read was [00:15:00] that he had to relearn to walk.

[00:15:03] Will Sanchez: Now, why would that be something that happens? Is it the procedure? It is it the way you want it to heal a certain way. So even though you're saying you're going to feel a certain way, eight to 10 weeks that you want to make sure that you're not advancing. So why is that?

[00:15:20] Dr. Grant Garcia: I'm so glad you're on here. Well, this is great.

[00:15:22] Dr. Grant Garcia: These are the questions that I don't, I just assume people know. So this is excellent. So when you get a meniscus transplant, you cannot put weight on it. For up to six weeks or so. So the first four, again, it depends on the surgeon. It depends on the procedure you do. It depends on your comfort level, but generally four weeks of no weight on this.

[00:15:41] Dr. Grant Garcia: So, and then two weeks of sort of partial weight, I think Cole's very similar. So by six weeks, you're walking pretty normally, maybe more aggressive walking by seven, eight weeks. Right. So that's the, that's the thing here is he had to relearn to walk. One, he probably was limping or having pain frequently.

[00:15:58] Will Sanchez: Yeah.

[00:15:58] Dr. Grant Garcia: And two, and generally his pain [00:16:00] pins are not doing very well when they start beforehand. And then he had to learn to walk again. And then he probably was walking abnormally. Because he was probably hurting right enough. They shut down so many times. Um, I mean, he basically, I don't think he was probably normal with his knee for two to three years before this.

[00:16:18] Will Sanchez: And, and who knows if he was normal or what we, you know, quote unquote normal because he had already had an injury prior to the one that set them back to where he's at right now, uh, with that meniscus injury or the meniscus tear, uh, prior. So, um, and also we've talked about it, right? You're laid up, you're losing strength, you're losing muscle.

[00:16:41] Will Sanchez: Um, just everything that kind of goes into it, right. We've had different discussions now to saying that this is something that they use, but you know, we've talked about peptides. We've had different conversations with different people, amino acids. How do we, you know, get certain things. So, you know, it'd be great to know what was the goodie bag, right.

[00:16:59] Will Sanchez: If we're [00:17:00] going into Halloween, right. to look into our bag of goodies and what did the doctors put in there to try to help him even though it's such a long process to get them going as fast as they can.

[00:17:11] Dr. Grant Garcia: A hundred percent. I'm sure there was more than you could possibly imagine. I mean, I've, I've had to take care of some of these bulls players and the screening tests we do for them, you would, they're not normal, you know, you're getting like checked for literally everything, right?

[00:17:24] Dr. Grant Garcia: They're getting, they're getting way more information. They've got, Cutting edge technology above what we have. Like we've shown before, you know, guardian caps, uh, Q collar, plenty of other technology that makes it to the NBA much faster than we would make. Right. They don't, there's no insurance costs. They don't care about that.

[00:17:41] Dr. Grant Garcia: They've unlimited supply of money and they're like, whatever it takes, let's do it. It's cutting edge. It's not going to hurt. The player and it's going to give him a leg up. Let's do it. So you, yeah, no, they're, I mean, they're, they look like, unfortunately, the NBA training rooms look like a science experiment because they've got all these different little potions and things there that you, that we [00:18:00] don't even have, we don't even access to yet.

[00:18:02] Will Sanchez: We've talked about recovery plenty of times, right? H robotics, rebel list, things like that. What would be something that they would use for Lonzo in this healing procedure?

[00:18:14] Dr. Grant Garcia: So this is what I use as the rebus for. This exact surgery. So this procedure. So basically he gets this surgery and I'm not sure if Cole used just our standard bending machine or he used, I mean, he didn't use the rebless, but another machine of some similar thing, we start using that right away.

[00:18:30] Dr. Grant Garcia: And that we used to use those bending machines for everything, ACL, you name it, but that's also a little more old school. But now with these machines, you want the patient to get bending because as he bends, he, he, he, he, He puts fluid through his knee. It's like lubrication and it gets the things moving and he wants to put a little bit of Bend on it because it actually pushes that meniscus out To the capsule where you want it to heal to and with the transplant it keeps it flush, right?

[00:18:55] Dr. Grant Garcia: So he's checking up before he finished the surgery He's gonna re scope at the knee be like that all [00:19:00] looks perfect Everything nothing's moved since I've bent the knee and then he's gonna let him bend his knee to try to get him back because you Want him in like week one or two to have very little pain and to be really moving that knee really well You Like by week six, you want them to let them loose.

[00:19:12] Dr. Grant Garcia: And you're going to say, go to full motion and you want them walking smooth, glide, no issues.

[00:19:18] Will Sanchez: All right, so it's not Lonzo's leg, right? So I'm gonna take Lonzo's leg out of it. Dr. Garcia has just had this operation done. What's the normal, and I know everyone is different, so just for our listeners to take it with a grain of salt, what's the normal progress for the bend?

[00:19:34] Will Sanchez: So if the, if the leg is straight, completely horizontal, you know, That week, first week, two weeks, whatever it is, what's the degrees that you start to implement? And if everything is on on par and going the way you want it as a doctor, when do we get to that 90 degrees, uh, in that timeframe?

[00:19:54] Dr. Grant Garcia: So it's actually fairly quickly with these, which is pretty impressive.

[00:19:58] Dr. Grant Garcia: I mean, I would say [00:20:00] I start them. I let them go all the way to 90. If they can in the first, Week now most people can't the first week if they get swelling everyone's different like you said But I let them go to 90 and I want them to keep going to 90 Repetitively because as you know after a surgery, especially a big surgery your swelling is going to keep coming back So you can't you gotta if you set it and forget it and then you stop doing it.

[00:20:20] Dr. Grant Garcia: It's going to lose motion again So you have the motion? Of the knee and the motion of the shoulder, but really mainly the knee for these surgeries is so important It's so important that that's why we give people these machines You So they can do bending. I mean, my patients talk about falling asleep in the machine.

[00:20:35] Dr. Grant Garcia: So they're just falling asleep and they get six to eight hours of just bending their knee while they're sleeping. And that's a really, really good thing for the knee. There's no damage caused by this. If you're worried about damage, then you did the, the surgery was not, uh, up to par. Um, so it's, uh, it's really important to have that aspect.

[00:20:53] Dr. Grant Garcia: So it's a good question. So then progress for me outside of the bending, you know, walking [00:21:00] fairly normally at six weeks, seven weeks. That's when you start to be like, Hey, how are you feeling really? That like up to three months is when you start to really notice a difference in your knee. Um, three months doing some elliptical ish stuff.

[00:21:12] Dr. Grant Garcia: Running, it's going to be like five, six months. Now again, this is, this could have been delayed more with Lonzo ball and then you have sort of the high impact stuff, seven, eight months, full return, 10 months to a year, but eight to 18 months is not considered abnormal. I mean, I've had patients that have taken 14, 16 months, even just from the transplant to get back.

[00:21:33] Dr. Grant Garcia: So that's what I tell people. The return to sport data is 10 months, but not everybody's the same and a high level cutting basketball player is different than my. patients who want to hike Mount Rainier or one of the

[00:21:46] Will Sanchez: biggest concern with this surgery for the basketball player, right? We're talking about one explosion to the basket or that quick cut, quick shift.

[00:21:56] Will Sanchez: You know, he's a point guard. I'm not sure how much they're gonna play him to the point [00:22:00] guard, which means you're you're stopping, starting, accelerating, coming off the pick and roll, things like that. So what are your concerns when you're thinking about uh, you know, your lateral to horizontal movements. If you're looking at this player, your patient, you're going, okay, this is what I want to see when he's doing, you know, X movement.

[00:22:19] Dr. Grant Garcia: Yeah. So, I mean, that is by far the most, I mean, you have a, you have a young 20 year old NBA level basketball player. Who's going to be playing all out. I mean, he's going to be scared that first six months. I don't think you're going to see him at his number one. There's just no way because he's going to be too concerned about damaging this.

[00:22:35] Dr. Grant Garcia: It's been two years. We've talked to us before. There's a massive mental aspect to this. And I mean, this is a guy that his, his livelihood is required, you know, him, him to be able to continue on and do in the NBA and do stuff he loves, but also get paid. He's got to be able to play well. And now he also has to worry about his knee because he's now the first one ever in the NBA to have this.

[00:22:57] Dr. Grant Garcia: That being said, this isn't a, this is not a [00:23:00] surgery that is experimental. This has been around. I mean, um, Brian, Dr. Brian Cole has done this for like 15 or more years. Right. He's done over 800 to a thousand, right? This is not a, he, no offense to Lonzo ball, but he probably did this as like he had his morning coffee and then he walked and he did lots of well, that's type of guy that Brian Cole is.

[00:23:19] Dr. Grant Garcia: So this is not something that we should be stressed about the quality of the surgery, just that it's unknown. And um, I mean there's plenty of athletes I've done this on that had done really well, but never professional obviously, or you know, but that cutting maneuver is, is a concern. And that's what I'm watching out for.

[00:23:37] Dr. Grant Garcia: You may get into this, but the two biggest things we worry about with this, the number one, and I hate to say it, retear of the meniscus transplant because, and it can happen. It's like 10, 15 percent in the first year, it can be up to it. So 75 percent of these transplants are still intact at 10 years. The problem you have is you have some, that's in general, right?

[00:23:58] Dr. Grant Garcia: So my, my 40 year old patients, I [00:24:00] do this on, And they're not going back to cut high level cutting sports. Yeah. So he may not last as long with this new meniscus, but again, if we get him three or four more years in the NBA, that'd be amazing.

[00:24:13] Will Sanchez: That's a, that's, that'd be interesting. I I'm, I'm looking forward to, obviously I'm, I'm, I'm a sports fan, basketball fan.

[00:24:20] Will Sanchez: I want to. see what his minutes restriction will look like, you know, especially in the beginning. Um, you know, obviously the league is always talked about, especially the players nowadays with the back to back games. I would be shocked to see him in any back to back games. Um, but it'll be, it'll be interesting to see what the progress is from when, you know, and maybe at the end of the season, you know, we're talking about the NBA finals, maybe some key injuries or NBA playoffs.

[00:24:48] Will Sanchez: You know, we could kind of look back at the, this injury and, you know, whether the bulls are in the playoffs or not, uh, they have a young team and we'll see kind of what happens with them, but kind of say, Hey, got through the [00:25:00] season. Hopefully we're saying got through the season, went from, you know, six minutes of game, no back to backs by the season, he was up to 22 minutes a game or something like that, able to contribute.

[00:25:11] Will Sanchez: Looks like things like that. And I know we're, we're starting to go along here, but, um, where are you feeling as a doctor? What's that over the hump, right? Because you already said there's always a chance of tear, right? And it almost seems like you you'll be surprised if there wasn't, especially with this high impact.

[00:25:33] Will Sanchez: But I mean, if I did this,

[00:25:34] Dr. Grant Garcia: I'd be nervous all season, right? If I was, if I was, if, Brian Cole, I know, is able to, he's a cool, calm guy. I love him. He's awesome. But, and there's, I don't think he's nearly as stressed as I am watching Lonzo Ball play. Just because I know the level of the surgery and the level of two years of recovery and obviously being the first one.

[00:25:52] Dr. Grant Garcia: Yeah. Um,

[00:25:54] Will Sanchez: but there's not a point there where you go, well, he's up to 20 minutes. He's, he's, he's reacted. Well, obviously I [00:26:00] can't imagine how many times he's being checked in, right? You know, at this level that you're, you know, you know, dr cole's checking in on him. How you feeling? What's going on? Okay, let's, let's get your ice and You know, this is what I want you to do when you come off the court and, and after the game and before the game, like this whole process, I can't even imagine, uh, what goes into it.

[00:26:20] Will Sanchez: So there, there's no point of it where you go, all right, anything can happen. But overall, I'm kind of feeling pretty good where we're at. And, you know, everything else is just kind of, you know, we'll, we'll see.

[00:26:30] Dr. Grant Garcia: Well, so I think to me is he's had a long discussion with the agent. I'm sure family, uh, Alonzo Cole had discussion with many other different surgeons too, to make sure this call was the right call.

[00:26:41] Dr. Grant Garcia: And I think it is because this has not been done before and it's needs to be done. I mean, you have players, you have, this is, this is a, this is a humongous first start. And I think that there is not, I think, I think that as the games go along, there's gonna be less and less stress. And you're going to see that if this works, Lonzo is going to be playing better than he's [00:27:00] probably played in a while because

[00:27:02] Will Sanchez: when

[00:27:02] Dr. Grant Garcia: patients get this, like my, my, this is one of my highest.

[00:27:06] Dr. Grant Garcia: The reason I like the surgery, I already told you it's extremely challenging. It's a really niche thing that very few people do, but when you do it right and well, the results are mind boggling. I mean, you get patients that are miserable with pain, swelling, frustration, and you can make them feel stable.

[00:27:24] Dr. Grant Garcia: They have this thing they call stability, which is very weird because they're not actually unstable, right? They have normal ACLs. And you can make their pain go away and they feel like the fullness of their knee feels better, right? It's like a car and they're like you're driving you feel like something's missing like the belt's not working, right?

[00:27:38] Dr. Grant Garcia: You can just feel it clutching you feel something weird going on. Yeah, when they get this they go My kneel my knee feels different. It feels strong. It feels stable. It feels not swelling. It's not painful These are weird comments that you don't hear when you do other surgeries. Like I do lots of other procedures I Thank you.

[00:27:56] Dr. Grant Garcia: I feel better. My pain's better, but they'd like they'd like they can like put their mouth on it. They can put their [00:28:00] words to it and they can say this is what this is.

[00:28:02] Will Sanchez: Yeah.

[00:28:02] Dr. Grant Garcia: And if he gets that if he gets that and again, it happens more frequently than then it doesn't happen Um, that'll be so cool. I think we're gonna see some impressive things and I think that You know, we're talking about 10, 12 games of the season.

[00:28:15] Dr. Grant Garcia: He's following the restrictions slowly improving. We're going to see some pretty impressive things. And I'm confident in this procedure. I hope he does really well. And even worst case, I'll let the viewers live this even worst case. If he does get a small tear at the end of the season or something that gets cleaned up, it doesn't mean that it's a failure.

[00:28:29] Dr. Grant Garcia: Right. Because he's still going to have a lot of his meniscus left. He's still gonna have that cartilage transplant, hopefully. So even a small hiccup, it doesn't mean that you're failed, right? Most of these cleanup procedures, you still keep going. So I know we go all day with this, but I'm really excited about this.

[00:28:42] Dr. Grant Garcia: Obviously, I think that it's really cool for the listeners to understand this. The last piece I'm going to tell the listeners, be prepared. This is not going to be the last person that gets this surgery. If this works in the next year, Because there are so many other athletes that need this done that no doctor wants to do this surgery on them because they're terrified.

[00:28:59] Dr. Grant Garcia: So because [00:29:00] they don't want to be, have this fail, right? This is a higher complication rate than an ACL. This has a higher complication rate than a meniscus cleanup, right? It's got all of the things. But if this works and gets back a player that has, there's, this is, this is career ending. You're going to see, uh, not a flood, but this is, this is going to be something you're going to see every year in the news after this.

[00:29:19] Dr. Grant Garcia: I, again, I could be wrong, but we'll see.

[00:29:23] Will Sanchez: It'll be, uh, it'll be great to watch. Um, you know, just as we wrap it up, we think about injuries and what's happening on the court and, you know, you've had injuries, I've had injuries and probably every, you know, everyone that's listened is not. Just the injury of what you're doing.

[00:29:40] Will Sanchez: It's laying in bed. It's trying to sleep. It's trying to be comfortable. It's just being uncomfortable and having this, this issue with whatever it is, whether it's your knee or elbow or neck or whatever. So just having some, something there that can be Kind of will make him feel better and even sleeping, right?[00:30:00]

[00:30:00] Will Sanchez: Maybe getting your full eight, nine hours to sleep and everything else. It's got to be beneficial, uh, for, you know, physically and mentally. So we, we hope that everything goes well and we know what it is to just be in pain, right? And that's one of the reasons that we talk about the show, you know, being in pain is not fun, not just walking, but even doing nothing, you can be in constant pain.

[00:30:23] Dr. Grant Garcia: Well, and again, for this one, It's not, he probably wasn't in pain constantly. The people, these, most of my patients are athletes, right? They're like, it hurts when I run, it hurts when I do sports. And that's what we're here for a sport surgeon. I want to fix you so you can do sports again.

[00:30:35] Will Sanchez: Yeah.

[00:30:36] Dr. Grant Garcia: Um, but you know, also wanted to let them know the lesson, let the listeners know, thanks again for all the requests I had.

[00:30:41] Dr. Grant Garcia: I've had three patients in the last three weeks asked me when the show was going to happen. And I didn't tell them I was going to do it. So people are waiting for this Lonzo ball show to hear about it. So I've been excited. The start of

[00:30:52] Will Sanchez: the

[00:30:52] Dr. Grant Garcia: NBA season. Right.

[00:30:54] Will Sanchez: Well, opening night, we had to, we had to come back to this.

[00:30:59] Dr. Grant Garcia: Thank [00:31:00] you to the listeners for. Continuing to encourage us to do stuff like this, because this is what this what's all about. Want to teach people about this surgery. You know, people come to me like this is so new. I'm like, it's not new, but you just haven't heard about it. So we're going to inform you and learn.

[00:31:14] Dr. Grant Garcia: So thanks again.

[00:31:16] Will Sanchez: Yep. And please check us out at sports. talk. com because that's where you can put in your requests for other shows and anything else you want to listen to. You could check out our previous shows transcripts. You get tired of listening to us babble, but you love the information. Check out the transcripts of the show.

[00:31:33] Will Sanchez: We have everything there. So, uh, we appreciate you guys and, uh, let's go next. Let's see if we could finally win one. It's been damn too long. It's been since 73 and I don't want to have to talk about John Starks anymore, missing all those shots. I'm not going

[00:31:50] Dr. Grant Garcia: to, I can't root for the bulls, but I'm going to say go Lonzo.

[00:31:52] Dr. Grant Garcia: No,

[00:31:54] Will Sanchez: no, we, we always root for our guys recovering, uh, things like that. So Dr. Garcia, this is

[00:32:00] great, man. Thank you so much. You have a good one. Bye.

Audio Transcript

Dr. Grant Garcia:Oh, and you can see my, my logos changed. Unfortunately, the Giants are, uh, So we're Cleveland, but, uh, we're going to be starting. I can't represent right now. So we decided to put this up in [00:01:00] honor of So this is, this is the new sports stock talk for the next year. We're going to keep trying to do logos.

[00:01:07] Dr. Grant Garcia: You're going to guess my logo is coming up for each show.

[00:01:09] Will Sanchez: Oh, maybe we should do that. Right. What's the, what's the logo of the next show? Um, you know, geez, we had this, this show last year, right. And we mentioned the, the Nick chop injury. I believe it was Sunday night. football. I think it was Sunday night football.

[00:01:25] Will Sanchez: I forget why we were watching them and it was just a nasty, nasty leg injury with the helmet to the knee and the leg moving in places that you just don't want to, you know, see it move. Uh, for those that didn't see the injury, I'm pretty sure you could find it on YouTube and anywhere else going back to that run.

[00:01:47] Will Sanchez: And we talked about it right away. You were like, this is, this is a tough one, right? With the damage to the medial collateral ligament, the medial capsule and the meniscus. Um, before we update where he's at today, [00:02:00] let's go back to that, you know, that injury and kind of recap what that injury entails.

[00:02:08] Dr. Grant Garcia: Yeah, so I remember when we were talking about the, when the first show happened, it was just so nasty and actually I would tell, I would tell you that this is lucky compared to what I thought it was just because it looked like a full knee dislocation.

[00:02:19] Dr. Grant Garcia: So he tore the MCL, which commonly happens with these ACLs, but as we remember, he had an ACL done already. This is now a second surgery. Go back to college. Yes, exactly. And so it's never the same, right? It's not like a fresh situation we're going into. So this is not a guy that tore his ACL for the first time.

[00:02:37] Dr. Grant Garcia: This is a second ACL tear. This is an MCL tear. And what was not mentioned is the bone grafting, right? So he supposedly had some bone grafting done because the tunnels were not perfect. Like we had talked about this. He might need that. And then it turns out he ended up needing that. So he got his September surgery.

[00:02:53] Dr. Grant Garcia: He got his MCL fixed. He got his meniscus fixed and that's what they did to obviously help out with some of the trauma, [00:03:00] right? Cause all the surgery at once might be traumatic. He got some bone grafting and then basically September, October, November, three months. As soon as they could do it, they did the second surgery.

[00:03:10] Dr. Grant Garcia: They talked about using some smaller scopes to try to help with inflammation and they gave him a new ACL. Uh, and they use some special screw options to try to help integrate the bone. And we can talk about the future of those at some point. And maybe in a future show, who knows, we don't want to hint too much on upcoming guests.

[00:03:28] Dr. Grant Garcia: Um, but. They use some biocomposite screws. So these are screws that turn into bone. And so the idea is that just leave no trace, right? Everything will be natural when he's done and hopefully give him the best, uh, option to recover. And also it fills any of those old tunnels of graft. Um, so pretty bad injury, revision ACL, new MCL or new MCL repair and meniscus repair.

[00:03:51] Dr. Grant Garcia: I mean, this is, this is not ideal. But we have seen players come back from this, but you know, 390 something days after [00:04:00] the injury. We can pull that up. Um, that's the impressive. Uh, and I mean, 11 carries a touchdown in 22 yards. Not too shabby for an NFL player, especially coming back from injury. This level.

[00:04:12] Dr. Grant Garcia: We're going to see this. We've talked about this well with our other players that have gotten injured the first day, the first week, the first month. It's not the same. Right. They, it takes them a while to get back and we've seen the return to sport data for different players and running backs are not ideal, right?

[00:04:28] Dr. Grant Garcia: Quarterbacks different, which is Dan Jones, which we, we can't really talk about too much anymore now. Uh, but, uh, you know, for him. This is, uh, this is impressive that he's back out there doing what he loves to do. Um, and big shout out to Dr. James Vu's, who is the team doctor for Cleveland. And one of my friends also, uh, Jacob Kelsey, who, who probably was assisting or some part of that surgery as well.

[00:04:53] Dr. Grant Garcia: So, uh, you know, I know these guys, they're really good surgeons and, um, just to be able to get a guy back like this is [00:05:00] awesome. And again, it's a team. Right. We've talked about this way too many times. We'll have something coming up soon. Maybe about Lonzo ball, something about the recovery for other athletes.

[00:05:10] Dr. Grant Garcia: It's everything, right? Everything matters. It's not, you know, the surgery is incredibly important. The techniques you use are incredibly important, but it's the entire, it's setting expectations is telling Nick Chubb 150 times. You're not going to go out there and run 200 yards and plow through everybody.

[00:05:27] Dr. Grant Garcia: Your first game. It's just not going to happen.

[00:05:30] Will Sanchez: Yeah, I, I'm curious, right? So obviously the injury was just, you know, as you mentioned, it was really nasty, right? When we first saw it and, you know, we decided to do the show and we, in fact, we touched upon a couple of other injuries. I'll bring up an injury, um, you know, going forward that we talked about, but, um, Were they, are there any benefits with going back in and having that type of injury and fixing kind of what was [00:06:00] done, whatever it was five or six years prior, right?

[00:06:03] Will Sanchez: We have new technology, right? We're always talking about new tech and new toys and, and things like that. And maybe it was something that whether the knee was going to eventually go or whatever case, maybe But is there any benefit to going back in, kind of redoing what was done, taking out the old, putting in the new, getting the knee, maybe even stronger.

[00:06:25] Will Sanchez: Right. We think about re injuring. And when I hear re injure, I go, you're weakening, you're re weakening something. Is there any positive that could come out of that?

[00:06:36] Dr. Grant Garcia: So a lot, I mean, if you're in a concern that there's going to be, remember the tunnels that we had before are no longer bone, right? They're tendon.

[00:06:44] Dr. Grant Garcia: So they don't, they never fill with bone again. So they can be windshield wiper. And so the tunnels are too big. or not perfect spots or they've, they've changed over time. You want to have that ACL at the exact spots, right? So it stops the knee from going forward. And so I do a lot of these [00:07:00] revision situations.

[00:07:00] Dr. Grant Garcia: If it's not a situation where you're exactly happy with it, you want to redo the whole thing

[00:07:05] Will Sanchez: because

[00:07:05] Dr. Grant Garcia: it's not very hard to redo. And with a guy like Nick Chubb. So like a standard athlete, three to four months is what I'd wait between the two surgeries. But understanding that like he has, he can wear a special brace, they'll protect him from not injuring his ACL, but still let him work.

[00:07:19] Dr. Grant Garcia: Some of my patients, they kind of, they don't always listen as well as someone like Nick Chubb would because they don't have all the resources, right? So I worry, the only thing you worry about between those two times is does he injure himself because now he doesn't have an ACL, right? He had no ACL for almost three months.

[00:07:34] Will Sanchez: That's what that

[00:07:35] Dr. Grant Garcia: is. And he doesn't, you don't need it for walking. You don't even really need it for running. Um, and a guy like him, I bet you that his exam would be hard to tell if you actually tore his ACL at the beginning. Cause look at his legs. He can overpower you. Like some of these guys, you can't even tell you need them to be sort of like almost paralyzed for a second before you can get the exam.

[00:07:53] Dr. Grant Garcia: Um, we've talked about players like Heinz Ward, right? For the Steelers, there's been players that have had no ACL and still been able to get away with [00:08:00] it. So these guys are really strong and they can, they can beat the system in certain respects. Uh, so like it is, it is definitely an advantage to what they did.

[00:08:07] Dr. Grant Garcia: And they added new technology. I'm sure they added internal brace. I know who's just talking about the nanoscope that they use, the special mini scope, that's an Arthrex product. Um, they, they used, they use the most cutting edge technology for him and they probably use some things we haven't even heard of, uh, because they have everything there.

[00:08:23] Dr. Grant Garcia: Like I said, this is, they're going to, they're going to pull out all expenses for the Cleveland Browns. Um, and the, uh, the, the. With the hospital system that he got done at. So

[00:08:31] Will Sanchez: I was going to ask you about that when you talked about the holes, if they would go internal brace or fertilize ACL or any of the other things that we've talked about before to maybe fill in some of those gaps to make it stronger and for it to operate.

[00:08:44] Will Sanchez: I bet they did

[00:08:45] Dr. Grant Garcia: everything. I bet they did everything. I mean, you're talking about, they're talking about the smaller scope they used. They probably use some sort of stem cell PRP option to help the ACL integrate. We talked about this with revision ACLs on our, you guys look back. If you want to go see how this [00:09:00] happens.

[00:09:00] Dr. Grant Garcia: We talked about this on our bio biologics and ACL surgeries. One of our, one of our more popular episodes, they did a lot of things to try to get him back faster. Now, again, 398 days is not faster, but for the type of injury had, that isn't faster. I thought,

[00:09:14] Will Sanchez: I thought it could be his career, let alone, you know, being back.

[00:09:18] Will Sanchez: Yeah. This is,

[00:09:18] Dr. Grant Garcia: this is, this is a, this is a, I mean, 3 98 days is an average for some of these NFL players. Yeah, yeah, right. Who just getting race regularly.

[00:09:25] Will Sanchez: He got, he got hurt, I believe it was week two of the 2023 season, and now we're in week seven of the 2024 season and he's out on the field. I mean, that is.

[00:09:35] Will Sanchez: mind boggling when you look at the type of injury that he had the violent nature of the collision. This is not a knee that just kind of, you know, buckled on his own. This was a man running into your knee and making it go in a direction that is not supposed to go right. Just to kind of give context to it.

[00:09:54] Will Sanchez: So, uh, fast forwarding, what are your concerns, um, going forward? [00:10:00] He had, he went out on the field, he got contact, you know, he, he huddled, he, you know, he gotta take it to the ground. So, you know, what is this week looking like for him that you would, if you had to guess? You know, as far as his recovery.

[00:10:16] Will Sanchez: afterwards and then just kind of getting ready, um, for each game as he goes forward for each season. If you're treating him as a doctor, knowing the type of injury and the type of sport, what are some of the key things that you're looking out for, uh, for this upcoming season for Nick chuck? [00:10:33] Dr. Grant Garcia: I mean, the first thing I'm doing is just symmetrical strength and activity.

[00:10:36] Dr. Grant Garcia: I'm just making sure that after the game, he still looks like he's walking normally, he's active normally, right? Like making sure that he still stays symmetrical, right? His goal is like, you got to work both sides. You're going to try to shut down any inflammation. He's going to, he's going to swell like heck.

[00:10:49] Dr. Grant Garcia: I'm sure his knees swollen more than average right now, because you just, he just put it through a ringer that he's hasn't, you know, as much as you practice what you do, do in the game. The game's totally different animal. Right. He's going to, [00:11:00] his adrenaline is going to kick in. Um, and then finally, you just want to make sure he recovers down.

[00:11:04] Dr. Grant Garcia: You get that swelling down as soon as possible. Um, and then I think the last part, which I'm sure they're doing at the Browns is a mental health coach. Like he's got to get in with the mental health coach, but like, how did that feel? Right. Like you had a devastating career, any injury and you just play it again.

[00:11:19] Dr. Grant Garcia: Like, how are you feeling? Like, do you feel good about this? Are you ready to go back for the next game? Did you have any hesitancy, like going through a play by play virtual in his head, like how it went, that's what I would do. Yeah. Um,

[00:11:31] Will Sanchez: Yeah. And he, he was emotional leading up to the week. The, the fan base, you know, cheered for him.

[00:11:38] Will Sanchez: Um, you know, his teammates came up to him afterwards when he scored and, you know, gave him that, you know, the pat on the butt and everything else. So, uh, I'm pretty sure, and I love that you brought that up, right? The mental aspect, because it looked like the teammates rallying around wasn't rallying around because of the injury was rallying around with the person saying, okay, you did it.

[00:11:58] Will Sanchez: Yeah. And him having kind of [00:12:00] that expression of gratitude and maybe some relief. So it's really, uh, I'm really glad that you brought that up his teammate. Unfortunately, Deshaun Watson, and this is why I kind of go back to the original show, because we've talked about his shoulder displaced fracture in the glenoid and I don't know, I'm, I'm out of my depths over here with some of these wording, you're doing

[00:12:21] Dr. Grant Garcia: great.

[00:12:21] Dr. Grant Garcia: You're doing great.

[00:12:23] Will Sanchez: You know, we talked about the severity of that injury. Um, I looked at the replay today and we're doing a show on Sunday night. Um, and it looked like his Achilles popped. It's exactly what you want. You have the closeup on the, on the Achilles. He steps to go forward and you see the muscle go like, you know, and he hits the ground.

[00:12:44] Will Sanchez: So, uh, it looks like back to back seasons, uh, for Deshaun Watson, for him being out. So. It's just, uh, Cleveland Browns, not good for the quarterback and, uh, of their team, but great news for Nick Chubb being [00:13:00] back on the field and, you know, resuming a career where last year I wouldn't have been surprised if you said, yeah, he's done that.

[00:13:08] Will Sanchez: That knee is just not going to cooperate on the level of being an NFL player. He can walk again, he'll do this, but to perform at that level and squat 600 pounds and. Run over 300 pound lineman them days are over. So it's a, it's a great story. Any last thoughts before we wrap it up?

[00:13:29] Dr. Grant Garcia: Yeah, I mean, thanks to listeners.

[00:13:30] Dr. Grant Garcia: Uh, this obviously is kind of an important injury to talk about, uh, just cause it was so devastating. We had the previous episode and do some followup on this. So hopefully they enjoyed this, learned a little bit more and, uh, awesome job. Congratulations, Nick Chubb for getting back and we may have some more update injuries coming up soon.

[00:13:47] Dr. Grant Garcia: So thanks for listening. Take care guys. Bye bye. Audio Transcript

Dr. Grant Garcia: So I was honored to get Castle Connelly, which is actually one of the ones when I first started, I really was excited to get, you don't really know you're going to get it until they email [00:01:00] you.

And then Castle Connelly does a Latino and Hispanic section. They have different sections for different diverse backgrounds. So they selected me for top doctor for Latinos as well. So it was cool. I think my dad was pumped about that. I think my post, but Yes, my dad was born in Brazil. He came over here when he was nine.

He was, he learned how to learn English. He ended up doing really well. And now I'm here. So my mom's from Jersey, so she didn't have to do the same type of stuff nonetheless, and grew up a Giants fan. So this is why. We still root for them.

Will Sanchez: Yeah. Congratulations, man. It's you're achieving a lot and just to get recognized like that and see what you're doing.

It's important. It's great for Latinos to see the possibilities. And being rep, having representation in every field is important, so it matters. And not only is a great honor for you, but it's a great honor for someone else that recognizes that. Anyway, enough. [00:02:00] No more compliments.

I'm completely done with it. I'm blushing. We got to move on. Let's go. I'm blushed. Let's make it

Dr. Grant Garcia: cut.

Will Sanchez: Yeah, your cheeks are a little red, man. It might be all that little sun. The sun's going away. We're about to get the clouds and rain, so no more sun for us. I

Dr. Grant Garcia: know. I know.

Will Sanchez: We were talking about it.

And once again another scary site, right? And this time it was less traumatic. We're talking about to a tongue of Iola suffering another concussion just to give you a recap. Last year he didn't have a concussion that we were aware of, but the year prior against Miami.

I'm sorry against Buffalo. He sustained an injury in Miami where he was hit. He got up. He stumbled. We all clearly saw that this injury he sustained had everything that you would deem to be a concussion. The doctors approved him to play the following week against the Bengals. Since then, After the Bengal injury, which was a nasty [00:03:00] injury when he was sacked and flung to the turf, laid out there.

For those that don't know, he suffered what's called fencing, and I'm going to tee you up in a second for you to explain what fencing is. And now once again, he has suffered another concussion, three concussions on the biggest stages, one on the Sunday afternoon game, Another one on a Monday night game and then again on another prime time event where the world kind of watches since NFL rules our universe here in the United States.

First off, describe what fencing is and to what was the first thought you had when you saw that to a sustained another concussion, a third concussion that we're aware of in this short time frame.

Dr. Grant Garcia: So Yeah, first off fencing you whenever you get traumatic injuries or traumatic brain injuries, it goes back to your prenatal state.

And so when you're getting hit, this idea of fencing is you flinging back the arms, everything's just like abnormal motion. Actually, like the fencing position, [00:04:00] like when you fence in the Olympics, it's the idea of what it looks like. It's not good. And we had this. Entire podcast a year and a half ago.

You guys can listen to our episode about this exact same injury. And so when does it happen again? And all of a sudden now the articles are coming out about concussions. It just has to come up again. We have to have the conversation because this is not just a hot topic because it's a hot topic because it's a good player.

It's a hot topic because we're just, we're seeing a bad injury and a difficult situation for someone like to as to what to do. You have the media spoken people that are saying retire, retire, but you also, you have no idea what's going on behind closed doors, right? We're just seeing a bit.

We're seeing just the tip of the iceberg. And we've seen the shows, movies, concussion. We've talked about this. We've seen We've had Dr. David Smith on here talking about ways to reduce traumatic brain injury in these sort of events. And now we're having another thing come up, and it was on the stage, and it's not like he got up and he was dizzy.

He went into [00:05:00] fencing position again. Which is just, this is just not a good thing.

Will Sanchez: Yeah. For me, it was really scary because if you look at the hit and for those that haven't seen it, just go back to playing against Buffalo he's rushing for a first down. He's trying to get close to the end zone.

He runs into, of all people, DeMar Hamlin, which we've talked about, this sustained a life threatening injury on the field in Cincinnati. Also just a little over a year ago and the contact was not extreme. And that's really what kind of made me go. This is not good. This wasn't a defensive player coming at him and coming with the crown of his head, banging his head or anything like that to actually ran into the Mars chest, which, that's scary itself because that's how he sustained this injury just was running, ducked into it, ran into his chest and collapse.

Demar, it was the most, the [00:06:00] softest tackle pretty much is almost like he's just. cradling him as he's running into him to tackle him. And the fact that he had this concussion and his body had that reaction, went into this fencing state. And that for me was scary because I'm saying if he got hurt like this on a tackle play, that when you look at the NFL, it is a non violent type of tackle play.

Where do we go from here when it comes to this man and this injury?

Dr. Grant Garcia: The problem you're going to have too is who's going to clear him, right? They'll find somebody but like you've been seeing I was just bringing up my partners You've been seeing these massive lawsuits in the nfl, right?

There was the one for the philadelphia eagles so bad The lawsuit was so bad that the philadelphia eagles got dropped by rothman institute. Like that just doesn't happen Like on the news, they say we are no longer going to cover the Philadelphia Eagles and they had to find the scrambled and found an old doctor that did them.

I'm sure doctors great, but it's not Rothman Institute. [00:07:00] And so for those that

Will Sanchez: don't know, I'm sorry to interrupt for those that don't know, can you explain that Rothman Institute, Rothman

Dr. Grant Garcia: Institute, Rothman Institute is one of the biggest orthopedic places. I train eight spousal special surgery.

You have Rothman down there in the Philadelphia area, but now they basically run the whole West East coast. And they are, their main hub is in Philadelphia, actually across the street from where I went to the med school in Penn. And they're known for just being really big powerhouse orthopedics.

And they've got A number of teams. I think they did the flyers they used to do the Eagles, and they have really good surgeons. They're really good guys and they got a massive lawsuit. We're not here to talk about medical legal of football, but they got a massive lawsuit and they dropped the Eagles and they announced it on NF on the ESPN and all these other shows that they're dropping because of that lawsuit, because it was the largest lawsuit in the history of the NFL.

And so now if you see this situation where you have a player that got two injuries, another concussion. You clear him. He goes back out there and gets another one. All of a [00:08:00] sudden he can't, he has no cognitive ability. Some of the things have happened, again, I don't want to predict this, but the brain is scary.

We have no idea which way it goes. You see these, you boxers get hit repeated times. They're going to hit more than obviously this. Clear him to go back and then he has another instance, another week or two, and now he's like out for another season. The, they find some way to let him go, get him pushed off.

The dolphins are screwed in this situation. Anyways, we saw well, they played last week. Yeah,

Will Sanchez: they look

Dr. Grant Garcia: terrible. This is a really difficult situation. And if he doesn't, and if he doesn't retire himself, if he hasn't, he has to get medically retired for him to have all that money. And it's a lot of money, like 120 million I think is on the table.

So this is a really difficult situation because you have, Medical legal side from the doctors. You have that dolphins, which I know they care about him. So I'm not going to hear to talk about NFL being a bad person, but at the same point, they want to win. So they want to maximize stuff. And this is just difficult.

This is a business. [00:09:00] It's as if this is just a difficult situation. And now you have players. We used to see Steve Young just get smashed every single game, right? And just right. Concussion after concussion, bread, barb, concussion. It's no longer that way. We know the risks. We've seen it way too many times.

We've got, we've seen shows about this. There's, we're not going to bring up too much today, you've got the league of the Niles article, the PBS special that we just watched. This is a, this isn't ending. This is not going away. We are looking for new things. And as we've seen, there is so much technology out there and we still can't stop it.

You, we brought this up to a did, I think I had showed you, he was practicing jujitsu classes to learn how to fall and hit the turf better. That's a really great thing that they talked about, fricking way that's going to stop him from getting, if he's got baseline. This wasn't a hit. Like you said, this wasn't a traumatic thing.

He didn't smash his brick. I don't care how well you learn how to fall. If you get hit blindside, it doesn't matter who you're the best athlete in the world. You're not [00:10:00] going to see it coming. It's all about, when you do jiu jitsu, right? I have a lot of take care of jitsu people.

They're, they see their opponent. They know what their opponent's gonna do. It's MMA too. You see what they're doing to do. They may be fast, they may do something, but they're coming at you. They're not blindsiding you in the ring. Yeah. It's a totally different thing. I think we can do whatever, we'll talk about some preventative measures, but again, we keep seeing upgraded helmets, upgraded protocols, and there's a reason for that because we still haven't gotten the answer.

Will Sanchez: Yeah. I'm going to be selfish here and I want to be clear and let our listeners know, right? I'm going to give you a selfish point, right? And this is my selfish take on this, his injury and the way he's. the way he has suffered this injury in front of everyone has almost become not fair. It's not fair to his teammates.

It's not fair to his opponents, and it's [00:11:00] not fair to the fans that every time This man draws back to pass or starts running that you are going to think about his safety. And that is what has happened when I've watched him play. When he started taking off running, I felt like the announcers were almost saying slide, the fact that Demar Hamlin did not take a shot on him.

That you're running, you got a quarterback and usually is Hey, the game, let's take them up. You didn't see that if we're his teammates. So now whether it's blocking Lyman blocking or him getting sack the coaching staff, whatever it is, his teammates have to look at this player back there saying, I hope today is not the day his opponents that are trained to be violent.

In this sport are saying, I hope I'm not the one and for fans saying, I hope I'm not going to witness anything [00:12:00] on the field that is going to be lasting. And we've seen different injuries. We've seen bad injuries. We've seen Derek Dennis bird, Corey stinger. We've seen men paralyzed on the field and what that does.

We saw what happened with the more Hamlin and everyone just being emotional, but. Almost to the point now, if two is back under center, there is no way as a football fan that you're not watching that game saying, I hope that we don't see something today. But

Dr. Grant Garcia: It's true. I think he's going to be back.

I think someone's going to clear them. They'll find a neurologist to clear them. That's the NFL. But, and I don't think he's going to retire. Yeah, I just don't see it. They just it's just not a good situation. Know we, I think we, I think I brought it up to you, but, there have been players that have retired.

Before we had the original one, that's the Luke Cooke [00:13:00] Cooke's league or whatever you he's the one that just

Will Sanchez: recently retired.

Dr. Grant Garcia: Yep.

Will Sanchez: Linebacker, same thing, but a lot of injuries had concussions, probably borderline hall of famer. If you're a Panthers fan you're saying definitely hall of famer.

A guy that made it to the league out of, I believe it was Boston college and became the captain of the team and went to a Superbowl with Cam Newton. Yeah. And. Same thing, had to leave the game due to those injuries. And we saw some bad ones. You mentioned the Eagles, Lane Johnson, starting left tackle for the Eagles concussion, right?

Devante Smith and nasty concussion where he was hit from behind and his helmet came flying off. And he experienced some of that fencing as well. Scary stuff. So the fact that you mentioned the Philadelphia Eagles, now they've got two major injuries right now. The Devante Smith, that was really serious.

He's not a big guy. I'm, he's lucky if he's buck 90. He is a skinny Y receiver and [00:14:00] you wish him the best. I wanted to put up there for those that are watching and not just listening. I'm putting up the five phases for the NFL concussion protocol and I'll just go through them real quick.

And then I want to ask you about this protocol and also whether you have a similar protocol since you are a team doctor as well. And maybe some of the symptoms that you see and what you expect from before you clear player. So phase one symptom limited activities, light aerobic exercise phase 20 minutes of running stationary bike under supervision.

Phase three football specific exercise like non contact drills, strength training, cone drills, phase four club based non contact training. So that's participation, running, throwing, catching, still non contact. And then phase five is pretty much full participation in practice without, with [00:15:00] any restrictions.

If any of the player's symptoms return at any point during any of the phases, they will return to the previous phase of the protocol. Can you talk about that a little bit?

Dr. Grant Garcia: Yeah. So this is important. And I think we brought this up. We've had a few concussion episodes just cause it's such a hot topic, even though it's not,

It's an orthopedic thing, but it's not really we don't see these every day as an orthopedic surgeon, especially sports surgeon. But if you take care of teams and players, you're going to have to know how to deal with this, right? Cause it's it's just the nature of the beast. There's an neurologist on the field during the high school games.

Sometimes the college games, there's no neurologist NFL. Yes, but different animal. Yeah. So the, those phases, those one through five, it used to be, I think actually seven. So it was always hard. And it may not have been NFL level that had the seven, but you can see that each one of those steps is really important.

And they're monitoring for symptoms. You always say I don't know if they're gonna clear the protocol, right? So they go phase one, phase two, phase three. All of a sudden, player get some symptoms, lose a day, go backwards. And that's [00:16:00] why you have Injury on Sunday really starts on Monday, right?

They may not be cleared, right? But if they have five days, they can be like Friday, you hear Friday, Saturday, oh, they cleared the protocol. And I don't know, I would, I want to say they're strict, but I don't know how it works. If the guy had very minimal symptoms, they call them out of the game.

They go phase one, two and two days in one day. I don't, it's just this, the problem is this is a really fancy little page, but how does it, this is not always the case. It's not exact science. The other thing is, what about like training in hot facilities versus cold facilities and how are you going to have symptoms, ready to get a concussion, but you also have to have a little bit of heat, and do stuff, but you gotta be careful about like when you're skipping these phases.

This is a guideline, it's important to have it, we're much more stringent on it in high school and college because, there's just less to lose by missing a game. Like I just, my players get hurt, they're out. And they're not out. They're not back until I feel really strongly. They're going to be safe, right?

It just doesn't matter. It just, I know they all play for the [00:17:00] championship. They're all, I want all the kids to do well, but I sure as heck don't want another kid to, if I saw a kid fence, I would never let him, I would never, that would be done for the season. So this is just not worth it. And the NFL is a different animal.

Yeah. He's got millions of dollars on the line. He's an adult. He's got an agent, right? Like they, this is, there's not just, this is not right. It's, we always talk about this. We treat everybody the same, but unfortunately the pros, it's just a different ball game. Yeah. It's just way too much money, way too much on the line and they're adults, right? My kids on the field, they're my kind of got a kid got hurt. He's got 15 years old. They got to ask the parents for permission to do something, right? Like It's just different different strokes, but anyhow,

Will Sanchez: and we talk about all the time they're built different, right? I cannot do what they do. I cannot get into that mindset.

And for them to always have that winning mindset of, I can do this at the highest level where 99. 9 percent of the people [00:18:00] that play the sport can't reach. I they cannot reach that level. So you have to be built different, so that's another part of it where they're, that's one of the things it's, who is the ultimate competitor?

I'm going to get out there. I, my team, imagine him sitting on the couch, watching that game against the Seahawks going. I can't help my teammate. They look like a bunch of scrubs out there. If I was out there, we could probably win this game. I could get the ball to Tyreek Hill. I can do these things.

I could go in there and support my brotherhood, and we've seen them compete at every level. And you talk about it all the time. These professional athletes are built different. And in all of the elements that you're talking about, what makes it so hard between the business, the mindset getting cleared, being an adult.

I can't imagine, being that team doctor or multi at this point, I'm assuming he's going to go to multiple specialists and doctors for them [00:19:00] to say. You passed my face. I'm clearing you. What about the next guy?

Dr. Grant Garcia: Exactly. For the sake of our short segment, we're trying to do is do a good job of, sorry, we should talk about this next thing because this is cool.

Cause I actually did not know much about this. We'll bring it up. So you guys have all been seeing, if you watch, I just watched the Giants game replays on highlights and you see a couple of the Cleveland Browns, which we beat, which is very exciting. The, these coffee caps and you're like, what the heck are these things?

So these are guardian helmet caps. And Guardian is the company. And these are actually, so they're now mandated in the NFL for practices. They're not actually that expensive. At least I looked them up. It didn't seem like they're that expensive. Now what's interesting is I hadn't seen these in the high school level.

No one talked about them and maybe they're using it in practice, but you've seen the practice. They had all those weird helmets and things like that. These are the new thing.

Will Sanchez: Yeah.

Dr. Grant Garcia: And if you can pull the timeline up, it's interesting to show this. So in 2017, they won this sort of NFL tech award.[00:20:00] They had validated and it turned out that they found that it was a 50 percent reduction in concussions. Now the problem here, obviously, and I don't want to be knocking this because I think this is like anything, anything that can help is always good, right? There's nothing. I'm not going to, I'm not going to pooh any technology.

That's great. But obviously what's the definition of concussion. We saw this with Dr. David Smith, right? It's very broad. There's not like a diagnosis. If someone has an ACL tear, there's very few people that are going to have a, like surgery, they can't figure that out, right? It's an ACL tear, you examine it and you get an MRI and it says ACL tear, right? Simple concussion. You do a testing system. We've gone over so many different testing systems, right? Those are pretty good, but these are still like, check boxes and try to do your best. There's no brain MRI. It's going to tell you there's a brain MRI for traumatic brain injury, but you don't want to get to that level.

You can start seeing it as I think Dr. David Smith said, if you can start seeing an MRI, you're beyond a problem.

Will Sanchez: So

Dr. Grant Garcia: we have to be aware of that. And then, so now they found this is so [00:21:00] in 2018 is validated the increase of use and all of a sudden, boom, 2022 mandated by the NFL for certain players.

So it was the offensive lineman, defensive lineman, tight ends and linebackers. Okay, but listen to this, listen to what we're going to say about the positions. 2023 expanded it to include preseason, regular season, postseason contact practices. So then they added running backs and fullbacks and then 2024 and this is where it's crazy.

They expanded it again. O line, D line, linebacker, defensive back. We'll go down the list. The only one, one of the only ones not on there. quarterback. So that's interesting. We'll talk that, that jumps segues right into our thing. And now you're seeing they're allowed as of this year. That's why you're starting to see them.

They're allowed to wear the guardian caps on their head, on their helmet, as long as the team logo is on there. So this is just super interesting because you're just seeing a piece of, again, we talk about this, we talk about orthopedic sports all the time, but we love technology. And so this is just something else and it's [00:22:00] simple, right?

It's a really simple thing. But if we can reduce these concussive symptoms. Anything helps now again, there was something else about maybe if they have a new helmet option, they don't need that, players are into this, they're trying to use it. You seen this, you see a player maybe has this on and the cue collar, which you guys can look at our old episodes, but this piece of tech is pretty interesting.

Will Sanchez: Yeah, it definitely is. And and I think you're bringing up a really good point as far as the technology, because, and I apologize, I don't know his name, but one of the head guys at the NFL, their doctor, their head doctor that kind of, does the rounds. He said that they've looked at 12 new helmets, six of them are being approved going forward.

And then one of the questions brought up was. This guardian cap and they're saying you're just putting the helmet on top of a helmet, and they go, yeah, we understand that, but this is what we have right now. We don't have [00:23:00] the amount of testing time, which then leads back to the conversations we have prior when it comes to technology yeah, they're utilizing it, but there's still, it's still not, approved and we're starting to see the groundwork.

And that was some of the things that they were simulated We, we are looking at stuff, but we have not had enough time from testing for it to finally get approved. So this is where we're at right now, but they realize that there's a huge emphasis on trying to figure this out. And we've talked about it before, right?

Do you have something new? And we've had guests talking about new tech. How long, right? We talk when winter was on, right? Winter innovations. How long does it take? From concept and testing to finally getting approval and going out there. What are we looking at? 10 years less, what's the normal.

Dr. Grant Garcia: Yeah, 10 years.

But that's the crazy part is this is the 2017 to 2024 use in the [00:24:00] NFL is actually fast, but they don't need like FDA, right? They don't need to make sure it's safe, right? Because it's padding, right? It's not it's a different thing. And it's not approved for patients. It's a different to pay for proof for NFL players in sports, right? So they just want to show, but they just want to show that efficacy for the NFL to approve it. But it doesn't need to be like mainstream. It's not going through insurance. It's not a medical device. Yeah. So it's just different. But yes, 10 years is from start to finish. Obviously there's different things.

We've talked about this before. We're not going to go into here. There's faster pathways, but from very basic idea, brand new idea to that 10 years is a pretty good timeline and that's a long ways to wait. It's a long way for anybody to wait for anything. Yeah, no, this is but this is, they're just trying to, this is a damn that is.

This is a dam and they're plugging the holes in the dam and this plus the two, a thing, it just. Just not good for them, [00:25:00] right? They're trying everything they can in the guardian caps. No offense. They look a little ridiculous, but nonetheless, if they work, that's awesome, but it just shows then makes you question why are we what's one of the helmets?

Like, why do they need this? If they have the helmets?

Will Sanchez: Yeah. And that's exactly what it is that they eventually need to figure out. It's almost like the NHL, they used to play without helmets and then it took forever for them to approve it. And then not only that for the players to buy in, as we see, you can wear it, but only a few players are wearing it. We showed a picture of Jonathan Taylor or Julius peppers or something like that. Not everyone is wearing it. And then based on some of the conversations we've had, Four prior with our doctors, they're going, yeah, the helmet's never going to treat it because your brain is going to squish around.

Anyway, it's still going to move. The helmet is not keeping the brain in place, so you're still going to have some issues. So it's fascinating. I think that's why we wanted to talk about, because it brings up conversation. It's not just what's happening with [00:26:00] two, but what's happening with all these players and with the sport and their biggest concern, and if you're concerned with your business.

You're going, Oh my God, this is happening. Everyone's seeing it and little, and mommy's not gonna let little Johnny play football and we're going to have a crisis of football players on our hands. 20 years from now.

Dr. Grant Garcia: Yeah. But the other thing you want to say is I think as orthopedic surgeons, we were so hyper focused on everything except for this.

And you can't, if you guys are not watching, it's I'm talking about my face or my head. Yeah. So you basically, we don't focus on it. Meanwhile, this is one of the things we've seen the most tech, right? We had the Bluetooth. Conversation stuff. We talked about the helmets. We've talked about multiple renditions of different helmets.

You've talked about areas, the Q collar to reduce, to increase the pressure inside the brain so that you're less sloshing of the brain when you get hit. We're still scrounging for options and this is, and there's no surgery to fix these problems. There's no pill, there's no medicine. [00:27:00] We are literally just using the same device, the helmet and modifying it.

Helmets. They look cool, but they don't look that much different than the helmets from 10 years ago, right? Did they? I don't really see much. I know there's a lot of technology, so I'm not belittling anything in the technology. But the fact is, now that we have to add these caps. That are like basically just like mittens on top of there to try to hopefully help prevent this situation It just shows the situation that we're in right but at the same point, I think it's awesome The side thing this to be I don't want to be a debbie downer because we're talking about concussions and you know all this stuff

Will Sanchez: Love also, let's be clear right?

This is what makes it hard right? These are tough conversations And this is a sport that we like to watch. You have a New York giants background, right? I've got, like we, we talk sports, right? That's our show, right? It's orthopedics and sports, and this is what we do. And this is what we love.

But at the same time, we can have real conversations and this is exactly what that is. And it's a little maddening [00:28:00] at the same time. Dr. Grant Garcia: And also I want the listeners when they're watching the games to be like, oh, that's the guardian Catholic. That makes sense, right? Like, why are they doing that?

Like, why is that guy wearing that thing on his head? That's what I said when I saw it the first time and you've seen him at practice and now when all of a sudden we're doing research on Tua and I watch an article on my feed, I see something about the guardian caps and it makes sense now and you read about it, but it's actually pretty interesting because I didn't realize his route for that long and the history is really interesting, but you know what I'm going to wonder?

Do you think they're going to be adding the QB to the mandated practice thing?

Will Sanchez: Yeah. Yeah. Let's see. Yeah. Yeah. Yeah. I know. I'm going to get a text from you and be like, Hey, guess what? Same, the same way we look for the, I look for the Q collar, right? We've had, we've talked about the Q collar. I recognize it.

The second I see somebody wearing it in the NFL game or college, I go, oh, he's wearing a cu collar. So just recognize that still. My, my favorite tech is the urinal with the player. I know it's you,

Dr. Grant Garcia: you want, you're upset because you missed out on the [00:29:00] patent on that one. I know you're upset about That was a good stuff.

Podcast is people learn. Every aspect of sports technology right now, they're seeing, you watch a show and you go, Oh, like they talked about Aaron Rogers speed bridge. You know what that is? You talked about, now you see the guardian caps. Now you see the Q collar. Now you see the new helmets. Maybe someone miked up, all those things.

Heads up displays, things like that, like where we're going. And so now we can give you what's the latest tech and how it relates to the medical field. And so anyhow, we did our, we did a good job of staying under 30 minutes, like we always do.

Will Sanchez: But yeah,

Dr. Grant Garcia: it's good.

Will Sanchez: By the way, that heads up helmet that we did a show on for deaf football players has finally been approved.

So they had approved it for one game when we first had this discussion. They just recently, maybe a week, two weeks ago, somewhere along that timeline approved it for full time use. So that's another thing with technology and it got more to come and good for those players now [00:30:00] to level the field a little bit.

When it comes to them enjoying the game, they love to play. So anyway, enough of that. Congratulations once again on your award. It's always great talking with you is always great.

Having these. Real discussions and we've got more shows, headed our way. Thank you Everyone

Dr. Grant Garcia: always good. All right. Peace out. Bye

Audio Transcript

[00:00:26] Will Sanchez: Regular fans, but I think hopefully they'll, uh, they'll excuse it. Dr. Garcia, man. Uh, first welcome. And then how excited you to finally have some football coming around.

[00:00:41] Dr. Grant Garcia: So excited. It's a, I'm not, I watch some sports, but my wife will say, you know, I do a lot of other stuff too busy in my life, but when it comes to football season, especially for the Giants, I find time.

[00:00:51] Dr. Grant Garcia: So I'm super excited. Uh, and plus, you know, Being a sports surgeon, this is where all the crazy stuff happens. You get to see crazy comebacks, [00:01:00] which we'll talk about today. Um, you learn about all the innovative stuff. I mean, really, when you talk about the cutting edge sports medicine, it's all to get players like these NFL players back in the game.

[00:01:12] Dr. Grant Garcia: And so, you know, it's really exciting. I love, I love football. It's my favorite sport.

[00:01:18] Will Sanchez: Yeah, listen, we're excited. And just to kind of let the, our listeners or viewers, um, know, you know, this is our 2024 NFL season. We're thinking about key injuries from last year coming into this year. Uh, comeback players, eventually I'm going to ask you, who's your comeback player of the year if you had to guess, uh, so we'll kind of get into all of that, uh, later on.

[00:01:40] Will Sanchez: September 5th, we kick off the season. I mean, Two teams, right? Possibly two MVP candidates in Patrick Mahomes and Lamar Jackson, Ravens chiefs, the defending super bowl champion. I mean, Derek Henry is now with the Ravens. He's left the [00:02:00] Titans. There's so many storylines, so many reasons to get excited. But for us, we're going to talk about the players getting ready for this year, but.

[00:02:09] Will Sanchez: I am super excited to kick off the NFL season, especially with that doozy on Thursday night. And as always, we like to give a shout out to our sponsor, the recovery shop. We know it's our favorite, not even our favorite, the patient's favorite, Dr. Garcia's favorite. When it comes to all the stuff that you need from the recovery shop, and I'll kick it over to Dr.

[00:02:31] Will Sanchez: Garcia because he uses them all the time for his patients.

[00:02:38] Dr. Grant Garcia: You know, I love this place. And again, you know, obviously they're sponsors, so we bring them up every episode, but it's great that people can hear about this. And I was just talking to my friend in the car who's works in California. He's going to plan on start using this.

[00:02:49] Dr. Grant Garcia: Cause he's like, Hey, how do I get this innovative stuff? Right? Like my normal products, I can't cover it. They're not covered. I can't get them into my patient. My patients want the newest stuff. And so the recovery shop allows you. [00:03:00] And what's really cool about it too, is if, you know, we have someone on this episode and they talk about something new I can offer at the recovery shop for patients.

[00:03:06] Dr. Grant Garcia: So it's all built into that one section. So it's really nice for surgeons to be able to offer patients. The newest stuff that may not be from the, the medical realm, but sort of the tech realm. Yeah. Um, on top of that, it's all, it's all together vetted for you. It makes it really easy. And the patients have raved.

[00:03:24] Dr. Grant Garcia: I mean, we're not gonna go again on this episode about how much we love the Nice machine, but you know, the ability to offer all those products like that, or the res or something else. The res, yeah, that's a good one in one place. And really I do, I do feel like. It improves the recovery for my patients. So check it out if you're a surgeon you can offer this to Uh contact myself, uh the website check out the website here Um at shop recovery.

[00:03:50] Dr. Grant Garcia: net and you'll see it on our links also. So thanks again guys

[00:03:54] Will Sanchez: Yeah. And that's a great one. And before we move on from that, you know, we started talking about this way [00:04:00] beforehand. So check out our previous shows. We talk about the next machine. We talk about the rebless. We talk about this, you know, these futuristic, you know, get better, heal better, something's better for your nutrition.

[00:04:14] Will Sanchez: We've gone in depth about these machines. So now we finally have a platform that we can also make a reference to. But if you want to hear more about that. Go back, check our shows. We always have great write ups. We have trans, uh, uh, transcripts. So check us out at sports doc dot, uh, talk. com. It's a mouthful right there, as you can tell, but I'm really excited, uh, about all of that, but we're excited about.

[00:04:37] Will Sanchez: This season, before we get into that, I just have a question. I know you do work with the high school kids. Are you picking up, uh, once again, working with the football team and working with the high school kids, give us a little update, uh, for the 2024 season for Dr. Garcia, uh, this upcoming football season.

[00:04:56] Dr. Grant Garcia: Yeah, so I, uh, you know, previously we took care of pro [00:05:00] teams and we've had opportunities for those things, but, and those are fun. We've talked about them before, but, uh, I have a special connection with Mercer Island High School, uh, and that's where I currently live on Mercer Island and I went to high school there too.

[00:05:13] Dr. Grant Garcia: So when I came back, that was, I wanted to take care of the team that used to be, I used to be with my, my wife also went to high school there. Wow. We went, yeah, no, listen, I'm told you I'm going to drop a little bit each time. So we went to high school there and I remember she was in the band and we used to go to the games and hang out and I had my Letterman jacket on and now I get to be the team doc for them.

[00:05:36] Dr. Grant Garcia: And I take care of the players. Now, of course, when they come into the office, they're like, you didn't go to Mercer on your way to old. I'm like, dude, I'm not that old yet. And so, you know, but it's so much fun. And so, yeah, I'm super excited, you know, myself, and actually, uh, you've had Dr. Wayne while in here.

[00:05:52] Dr. Grant Garcia: He's also going to be helping out, uh, because he does the, we all basically help. Like I do most of the sports. I did the triage and [00:06:00] then, you know, foot and ankle. We had one of the coaches tears Achilles. You never, you know, who fixed them. Yeah. Yep. Dr. Anthony. Yeah. Dr. Wayne. Wow. When they have the hand injury.

[00:06:10] Dr. Grant Garcia: So, you know, we have a whole list of docs that can help out the team. It's really awesome. And I'm on the field with them and I have a lot of fun and I get to see everybody went to high school with sometimes, uh, in the stands with their kids. So it's a super awesome experience. It's so fun to get back. So, yeah, I mean, I'm, I'm so excited.

[00:06:26] Will Sanchez: It's so amazing to think about that. Right. And it's just kind of a reminder for all of us as we do our part within our communities that, you know, you leave school, you go off to college, you, you live a life and then all of a sudden you're, you know, you're coming back, uh, um, you know, three 60 and, you know, back where you started, but now you're giving back, uh, to the community.

[00:06:46] Will Sanchez: Um, you mentioned Dr. Yee and, you know, it's, it's one of those things when it comes to Dr. If you see in them. And you're not there to see him as a doctor. It's great to see him, but if not, it usually means that something has gone [00:07:00] wrong. And, uh, if we look back to September 11th, 2023, uh, four plays in as the jets.

[00:07:09] Will Sanchez: Came out to kick off the season and they were taking on the Buffalo Bills and they were at MetLife Stadium and the stadium was going crazy. It was jam packed and they had the, the, the light show, the fireworks and their brand new toy comes running out of the tunnel with the American flag in his right hand, leading out the cheer and the crowd and the fans are going.

[00:07:37] Will Sanchez: Absolutely bonkers. And you're saying, oh my Lord, what a way to kick off the 2023 season. And for all my friends back in New York that are Jets fans, not so much my Giants fans, they are as excited as can be going back to maybe last time with Vinny Testaverde was with Bill Parcells and Curtis Martin saying, we have a [00:08:00] chance four plays into the season.

[00:08:04] Will Sanchez: runs out of the pocket and Dr. Garcia, what happens next?

[00:08:10] Dr. Grant Garcia: Achilles tear. Emilia calls his buddy, Dr. Elitraj, which we've heard all those things about and is on the opera room table in a few days. And unfortunately the rest of this history, except for the Recurrent news articles talking about speed bridge and how quick he was going to get back.

[00:08:27] Dr. Grant Garcia: So, you know, I think, uh, we'll see how the season goes. You know, we've, uh, this is obviously not, we've had this talk a few times. We had the Olympic talk recently. We had a whole separate section when he injured it. We talked about this. You've gone over your recovery too, with Dr. Yee. So we've had all these discussions on Achilles, but this is now again, quarterbacks are different, right?

[00:08:49] Dr. Grant Garcia: This isn't, uh, Simone Biles having to go jump around and do back flips. Or front flips or her own new tricks, you know This is a guy that can sit in the pocket and do his throwing, you know He's never [00:09:00] been known for his high level mobility. Um, But what's important I think for this episode which you can bring up and we're not going to go again We try to talk about orthopedic sports all the time yeah, but I do want to bring up a little data because this is really interesting because like Even as orthopedic surgeon I can fire off my opinion, right?

[00:09:16] Dr. Grant Garcia: My opinion is this is not a good injury My opinion he's not going to recover and patients, you know, that stuff that you know, they understand I got experience I see these things But the data doesn't lie. And so it's really interesting to see the data because we're so used to seeing like the one or two athletes that get back.

[00:09:31] Dr. Grant Garcia: But what about the guys in the practice squad? What about the guys on the, you know, that are not the starters? How do they get back from these injuries? Because really, they're the ones that, you know, we talked about before, like, an injured LeBron James is better than most of the players on the court, right?

[00:09:46] Dr. Grant Garcia: But an injured professional player is no longer a good player. Right. So how long does it take them to get back and can they get back? And this may segue into our discussion of our controversial quarterback, [00:10:00] Daniel Jones and his ACL tear. Um, but you know, there's two articles we'll talk about. So the first article is really easy to kind of go over, but basically it looks at return to play.

[00:10:11] Dr. Grant Garcia: So return to football in the NFL for wide receivers. Now it's not Dan Jones, a quarterback, but I looked these up because for this show, I was like, well, I want to know, cause I know Will and I are going to talk about what do we think Dan Jones is going to get back? What's his performance going to be like?

[00:10:23] Dr. Grant Garcia: And I was like, well, the other, I'm sure someone's looked at this, right? Like you want to know this data. So the wide receivers was interesting. A wide receiver. Achilles, patella, and ACL are, are the greatest effect on the career. And actually they do have a decrease in success after one year of surgery.

[00:10:42] Dr. Grant Garcia: And what's interesting, so we always talk about the one year mark, but I always tell patients, remember we talked about this, Will, other than the Adrian Peterson absurdity, which we saw. Yeah. Most players are not better the first year they're back and they're not at their full level. And it takes, I mean, Saquon Barkley, right?

[00:10:57] Dr. Grant Garcia: Obviously we, you know, it's kind of a dirty word now for New York. [00:11:00] Um, but, but, uh, you know, they found that, you know, this, it takes a section year and sometimes they don't get back. And of the four major sports, NFL players, so the hockey, football, basketball and baseball, the NFL, the shortest injury, the shortest careers afterwards in the highest decrease in performance after ACL injuries.

[00:11:22] Dr. Grant Garcia: So it's just something for people to be aware of. But if you're a New York Giants fan, you'll like the second article, second article, same guy, Burgess et al. And he, they found that there is no significant decrease in performance for AC reconstruction for quarterbacks. So that is a good thing for us to hear.

[00:11:41] Dr. Grant Garcia: And maybe the mental side of things, but not for the physical. So running backs, wide receivers, we added running backs, decreased performance, but for some reason, quarterbacks do not have a decrease in performance afterwards. And it's probably because. What's their main use of their bodies is their arms, right?

[00:11:56] Dr. Grant Garcia: I mean, they have to aim, they have to have core, but they're not doing the same [00:12:00] thing. A running back wide receiver, you want that explosive speed. You know, we've seen Odell Beckham Jr. Two ACLs, you know, it's, it's, uh, they're not as good the second time. And it takes longer. And you know, these guys are freak athletes.

[00:12:12] Dr. Grant Garcia: So

[00:12:13] Will Sanchez: yeah. And just to let, you know, let our listeners know, these are studies going back, uh, they reviewed it from 88 to 2017. So it's a, uh, large chunk of data, uh, that they were able to make a reference to for, for the numbers that Dr. Garcia just, um, explain. Go ahead, Dr. Garcia, you're going to say something.

[00:12:35] Dr. Grant Garcia: Well, we're going to make this even more complicated because you know, I like to do this. But if you think about this, we didn't have the new ACL techniques we do. I just read an article yesterday and Will's going to get too excited when I tell him that. So I'm going to say it quickly and hopefully we can move on from the topic.

[00:12:50] Will Sanchez: We're going to move on.

[00:12:51] Dr. Grant Garcia: Adding internal brace, any of your, any of your ACL constructions or hamstring, which is they have here, private teleten, [00:13:00] which they got in quad. So all three of the graphs from, and these are pro players are getting, they're getting Grafts from their own body, decreased tear rate, decreased, uh, increased speed, uh, sort of recovery and decreased the stretching of the graft.

[00:13:13] Dr. Grant Garcia: And so, you know, probably one of the reasons these people don't get back as much is part of it is also, is there some natural laxity? Do they re tear it? And those type of things. So maybe the data we might see in the next, you know, 10 years is actually, there isn't a decrease. So we have technology. So you gotta be careful.

[00:13:30] Dr. Grant Garcia: It's just like when you look at anything, I just told you all this data, but now we're not in 2017, are we? We're in 2024

[00:13:37] Will Sanchez: with new, with new technology, new concepts. Uh, our previous show, we were talking, um, with, um, with the gentleman from Arthrex and about how fast the technology is moving. Advancing. So it was like, okay, this works.

[00:13:54] Will Sanchez: Yes. But how can we make it better? Right. Just so yeah, 2024 [00:14:00] and 2028 and 2030, you know, we're probably looking at a whole slew of other things because as we know, we can see it in our regular, you know, day to day technology is moving so fast right now that the numbers are changing, um, at extreme rate, probably like we've never seen before.

[00:14:19] Dr. Grant Garcia: Well, and look at the, look at the, uh, look at the people now. I mean, we used to have Ember, Tommy John, you could never throw again. Now I'm talking about designing a new technique and how it's going to make people get better and how we're going to add the internal brace and how we're going to add different techniques and we're developing new things so that we can do the technique faster and more efficiently reduce revisions.

[00:14:38] Dr. Grant Garcia: You get us, if you get a first time, Tommy John reconstruction, you fail it. We now have better techniques for a second one. You've heard of people, you've heard of baseball players coming back after a second Tommy John. And so we, that was unheard of, right? None of this is, I mean, we could do a whole show.

[00:14:52] Dr. Grant Garcia: This might be a good one. We'll later on what we, what we do now that we like what players can get back. Now they never were able to come back. [00:15:00] I mean, a patella tendon rupture like Victor Cruz had or other players. Yeah. We've had that show a long time ago that was done. I mean, you were done, you were never coming back.

[00:15:10] Dr. Grant Garcia: Yeah. We have all this fancy gear, biologics. Awesome recovery stuff. You know, we've talked about nice machine talk about blood flow restriction. Uh, There are ways that we can do things now Now the human body is still the human body and we have to be there and you have to have the right surgeons Which nowadays, you know, if you're an athlete, you can go anywhere in the world, right?

[00:15:31] Dr. Grant Garcia: Like it's not like you got to like ride a horse and buggy to go find the next guy. Like you hop on your private jet and you go and get, you hope you go and get fixed up by the person you think is going to do the best job. So, you know, it's a, it's a different game than it used to be, but it's a, it's pretty cool too, because as at a sports fans or as a surgeon that likes to watch sports as well, it's exciting to see at, it's terrible to see an athlete get injured and never come back because.

[00:15:56] Dr. Grant Garcia: You know, the ones we're watching out for are the stars, right? It's really sad when [00:16:00] you lose that level. Of athleticism, obviously there's retirement from injuries and everything else, but it's pretty cool. Like, I mean, the, where we're going is hopefully we can see these players play longer, um, and play better, which is, which is awesome

[00:16:13] Will Sanchez: before we move on from Aaron Rogers, I kind of want to bring it up, right?

[00:16:16] Will Sanchez: So there's, there's two things I want to bring up his injury happened week one, September, right? Right now we have, uh, Kirk cousins that had the same injury week eight. Now. We'll find out if Kirk, he's not on the P, uh, the pup list and we'll kind of get into that later on, you know, but what are your concerns as a surgeon week one to week eight?

[00:16:43] Will Sanchez: So now we're talking two months later. Right. Coming back at the same time. Right. So you're starting off at the same time with week one in 2024. And then you're also comparing. So one of them is a time assisted and another one is age assisted since he's [00:17:00] younger than Aaron Rogers. So. Trying to see what's the way I want to kind of word this.

[00:17:05] Will Sanchez: If you had to pick one or the other, when it comes to healing fast and being ready for the start of the season, are you more concerned about the age? Or are you more concerned that one of them had recovery two months earlier?

[00:17:19] Dr. Grant Garcia: So no offense, Dr. Eltrod, he's amazing. So I'm sure his surgery was bomb proof, but I would choose the younger age to be more likely to, I'd be more motivated by the younger age.

[00:17:30] Dr. Grant Garcia: I just hate to say it, you know, Even a few years is a big difference. And Aaron Rogers looks old, Kirk Cousins still looks young and you know, people, people's bodies are different, right? Like I get in, I get into people's bodies and I do a lot of ACLs and ligament surgeries on these patients that between 20 to 40.

[00:17:48] Dr. Grant Garcia: And sometimes I get into a 35 year old knee and I say, this is not a 35 year old. This is a 40, 45 year old knee. And sometimes I get in and go, holy cow, this 35 year old's got bone of a 20 year old. Right? [00:18:00] And you can kind of, you know, you don't always tell, but you can kind of tell, you know, that the age is a little bit, is more showing on there.

[00:18:07] Dr. Grant Garcia: And so it does concern me that, you know, is, and also, I don't know, maybe is, is there other things at play too? Are they taking weird supplements? Are they weird dieting things they're doing? You know, I don't know all the background to that. Yeah. Um, but you know, I know that, I know that both of them probably got amazing surgeries.

[00:18:25] Dr. Grant Garcia: Yeah. Yeah. Um, but if I had to choose one, even with a little bit of a difference in the timeline, uh, I would choose, uh, Kirk Cousins.

[00:18:33] Will Sanchez: Got you. Got you. And then, you know, we always, we always want to remind our listeners that, you know, this is, we're always talking about what, what we think, but without dr Garcia actually going into the knee and you made a reference to that and being there to see the ins and outs.

[00:18:49] Will Sanchez: It's, you know, it's never a verbatim 100 percent but it's kind of like the guest because I was curious, right? Because those are two factors, right? Time versus age. I [00:19:00] know my injury later on, right? Was way different than when I've been injured earlier on. And, um, we know that we, we say it all the time, athletes are freaks, especially the way they, uh, they heal and perform.

[00:19:12] Will Sanchez: And we know that Aaron Rogers will not lose his fastball. But it will be really interesting to see a 40-year-old body start to take hits. From the season, so I don't wanna scare any of the Jets fans. We're gonna kind of move on because they've had enough suffering over the years. We might [00:19:29] Dr. Grant Garcia: get some, we might get some nasty comments on our podcast.

[00:19:31] Dr. Grant Garcia: Yeah, yeah, yeah. Some Angry Jets fans,

[00:19:33] Will Sanchez: um, you know, and the quarterback and the team that we're rooting for. We expecting a, a, a, probably a, a rough year, um, as far as wins and losses. So we're just kind of brace ourselves for that. But Daniel Jones is coming back, uh, from his injury. Why don't you talk about that injury a little bit and then we will, uh, we'll take it from there.

[00:19:52] Dr. Grant Garcia: So he suffered an ACL tear. We've talked about ACL tear ad nauseum on this show. It's obviously a very hot topic ever. It's so [00:20:00] common. I mean, we could go through the, we went through the, in this preparation for this player's, uh, injury list. You know, we basically, I kind of had to say, let's not talk about any more ACLs on here.

[00:20:08] Dr. Grant Garcia: Right. Cause we've done it so many times, but it's a big topic. So I don't know what else he had done. I'm assuming just ACL, they didn't say anything else on meniscus or anything else related, but we don't know. Um, but obviously he's out for the season now. He's back. Uh, you know, the question is Dan Jones, you know, you may, you like him or you hate him, right?

[00:20:25] Dr. Grant Garcia: There's nobody, there's no in between. There isn't. Yeah. Um, but he was known for his speed, right? He was fast. Like that's, I mean, give him that. He's one of the fastest. He was like one of the, he had the fifth and most in rushing and he was, he's one of the fastest quarterbacks, uh, in the NFL. Um, and he's tall and he is big.

[00:20:44] Dr. Grant Garcia: So, and he's bulked up, which is nice.

[00:20:46] Will Sanchez: He's a big guy. Yeah, but can you

[00:20:48] Dr. Grant Garcia: take, but can you take those same hits, right? Like,

[00:20:51] Will Sanchez: or should

[00:20:52] Dr. Grant Garcia: he, he's not a pocket player. Don't get me started on a pocket player. No, no, but he's not a pocket player, right? He's not, he [00:21:00] relied last year, the last few years on his ability to get out of the pocket and run and avoid tackles because he had such a bad offensive line.

[00:21:07] Dr. Grant Garcia: Right. So it's just, I don't know. I hope he can, but you know, there's that rust too of getting, you know, your ACL torn, right? He's got to come back from that. Oh, the one thing that he has dealt with is he's dealt with so much adversity and so much negative publicity and negative comments about him that I don't really know if this is going to make a difference for him.

[00:21:26] Dr. Grant Garcia: I think some of the players that have been the best themselves, the whole five years of their 10 years of their career, and then they injured their knees and they're worried they're gonna really get back, I think there's more of a mental aspect. I just don't. I honestly think he's too tough to even be stressed about it.

[00:21:39] Dr. Grant Garcia: To be honest with you, he's put up with so much stuff, more than most quarterbacks would ever have to do in their position,

[00:21:44] Will Sanchez: especially in New York. One of the reasons I brought up, um, Daniel Jones, besides, you know, the whole jets giants thing and, and everything else, but it's, my concern is The neck injuries and we talked about it briefly before we, uh, hit record on [00:22:00] the show.

[00:22:00] Will Sanchez: Um, he's had a few neck injuries he's had at different times. You know, I think going back to 2019, he suffered an injury and then, uh, last year before he got hurt, he had a neck injury. This, and then he hurt it again. They said it was unrelated. Um, so I am concerned. Not so much from the knee aspect and maybe you as a surgeon going, I'm concerned about the knee, but I'm also concerned about the neck, uh, injury.

[00:22:26] Will Sanchez: And, you know, I'm showing here for those that are listening and not watching us on YouTube Packers running back, AJ Dillon, which is their star running back. He's on the season ending IR he's done for the 2024, uh, seizing with a. Stinger injury and stinger is always kind of like, it's always a funny thing because I go, well, that doesn't sound like a big deal.

[00:22:49] Will Sanchez: It sounds like you got like a little pitch, something or other, and you're going to be fine in a week or two, but apparently it is. Can you talk about, you know, what kind of injury that is? And it sounds like. That's serious [00:23:00] enough that without taking a snap in the 2024 season, getting hurt in at a joint practice that you are already done for the year.

[00:23:11] Dr. Grant Garcia: So let's go through this. So first of, I'll talk about the Dan Jones thing. So anytime the word is repetitive neck injury, I get worried. And what the heck puts you out for a couple months? It's probably something cervical, which is in neck and it's probably in the disc and he could be getting some bulges and they're concerned about it.

[00:23:29] Dr. Grant Garcia: And maybe it's pinching a nerve. I don't really know. And they were super cryptic about it. I mean, he said he had a neck injury, but he's had this repeatedly three or four times. Yeah, that's not, that's not a neck spasm. That's something where they're worried about the health of his, him. And if he gets another hit, could he like get paralyzed type of thing?

[00:23:45] Dr. Grant Garcia: In my opinion. Okay. Yeah, I don't think it's that bad, but I think that there's something else going on. They're not telling us and that's that's okay That's what that's the nature of football and the nature of the show is we get to do a little guessing Um with the stinger, so usually a stinger is when [00:24:00] you get hit on one side It's unilateral.

[00:24:02] Dr. Grant Garcia: So one side you get hit on the side and it goes into your brachial plexus So you imagine i'm not going to get too much in anatomy But imagine you can try to show here imagine you have your neck and all the nerves come off and they go into like your upper chest Area down to the shoulder and they, they branch off like this.

[00:24:17] Dr. Grant Garcia: And when you stretch them, you get your whole arm. Just like, like you feel like a sting, like that's why I call it a stinger. Yeah. Okay. And that's like, remember you guys ever hit your funny bone? Yeah. Imagine the whole arm. The whole arm is where it happens. It happens and it goes away, right? And it's usually a single, like unilateral.

[00:24:34] Dr. Grant Garcia: We say you get a unilateral stinger. You're good. Like 10 minutes rest, make sure they're all normal and then they go. So that's why I don't understand about this. I think that they're trying to dumb down the injury. You get a bilateral stinger. That's when you basically likely had some real bad neck injury.

[00:24:48] Dr. Grant Garcia: Like you're like a disc in your cervical spine, which we've talked about with Dr. Schaefer before on this up on the show. And that does concern me because I don't even know if that's considered a real stinger, right? Like I think they're just doing, you know, they say like [00:25:00] knee contusion or knee sprain or meniscus meniscus contusion, because they're trying to dumb it down.

[00:25:06] Dr. Grant Garcia: Yeah. And what they're trying to do is try to play it off as not that big a deal. But the fact is, if you're out for the season with this, that is not good. So I think, you know, I don't know what he had. I'm surprised he's not getting surgery when he goes out like that. Um, but there are some notable neck injuries that have happened in the NFL.

[00:25:21] Dr. Grant Garcia: Obviously, the most prominent one is Peyton Manning. He had multiple neck surgeries. Uh, he had a spinal fusion, so they actually fused. We talked about disc arthroplasty, a replacement with Dr. Schaefer. Yeah, that's where they actually, and that's, that probably would have been, he probably would have had that now, but this was, this was a while ago, 2011.

[00:25:41] Dr. Grant Garcia: So now the new stuff, which we talked about again, remember if you look at all the performance of these surgeries and 10 years later, it's probably a different surgery, right?

[00:25:50] Will Sanchez: Yep.

[00:25:51] Dr. Grant Garcia: So

[00:25:52] Will Sanchez: yeah, we had a great discussion with dr Andre Schaefer. Um, you know, with, and he was showing us all the cool little gadgets and you know, everything else [00:26:00] that they're using, uh, in that cervical area.

[00:26:02] Will Sanchez: So, and we go back to 2011, that's a long time. We just started off the show saying it, things are moving fast, let alone going back to 2011. You know, what, what kind of recovery with Peyton Manning and he was getting a little bit older at that point too, but what kind of recovery would he have had because we know his super bowl season I mean, he could barely move and barely throw the ball because he was just so jacked up.

[00:26:25] Dr. Grant Garcia: Yeah, I mean, we think we talked about this a while ago, but at some point, he couldn't even feel his arm. He was just throwing with no triceps. Cause one of his nerves was out. So, I mean, it's just, just craziness, but you know what I said, LeBron James, Peyton Manning, when they're missing something, they're still really good.

[00:26:42] Dr. Grant Garcia: Yeah. Also helps have a good team with you. And then David Wilson's one of our, the favorite guys used to see him do backflips on the field. And I remember he was kind of a freak and they talked about the next big thing. And unfortunately after like a year or two, It's something called spinal stenosis. So it's where you're, I'll go into [00:27:00] basically briefly, but you basically have like your, your whole spine.

[00:27:02] Dr. Grant Garcia: This is like really straight and it's like not made to bend well. And if you get hit, it can be like instant paralysis. So if you have that, it's automatic retirement, which is what he had. And it actually can be happening commonly in football players. Uh, so it's a pretty scary thing. So when they diagnosed that with him, he was out.

[00:27:18] Will Sanchez: Yep. He was, uh, he was a promising, uh, running back also kick returner. Uh, we thought he was going to be another compliment along with Ahmad Bradshaw and, and, you know, some of the other guys that were on that Giants team. And I believe he was a either first or second round draft pick, maybe out of Virginia.

[00:27:35] Will Sanchez: Anyway, at this point, I'm probably just guessing here. Uh, no, I remember he used to do

[00:27:39] Dr. Grant Garcia: the best show. Is that, remember that little. Intro. They had him. He was catching rabbits in the field or something crazy. They showed how I got so fast. That's what you do. Well, you and I can do that. We should do rabbit catching.

[00:27:49] Dr. Grant Garcia: We'll get ourselves.

[00:27:50] Will Sanchez: I can't catch a spider right now. I ain't going nowhere. That's it. I'm going to see how fast I can catch the remote out of, out of somebody's hand on the couch. [00:28:00] That that's, that's the speed that we're at right now. But, uh, you know, stick, you know, listen, we're talking about catastrophic injuries to the running back.

[00:28:07] Will Sanchez: Um, there was. I don't recall last year and obviously the year before that we had the scariness that happened in Cincinnati on the field. But as far as devastating injuries, um, what happened to Nick Chubb on that game and we, we reached out immediately. You know, uh, when we were texting each other saying, Oh my God, did, did you just see what happened?

[00:28:35] Will Sanchez: Um, to, uh, Nick Chubb on, um, when he was playing against the Steelers where that leg bent in ways that, you know, You, you just, you just didn't want to see, you know, we, and I have a picture not of the injury. 'cause I just didn't even, I saw it and I just didn't wanna put it up there. But, you know, he, and, and I want you to break this down because it said damage to the medial to, to the MCL, the medial [00:29:00] capsule and meniscus.

[00:29:01] Will Sanchez: And then he had a second surgery on November 14th to repair a torn ACL. And I know some of this and, and this is why I'm gonna have you kind of break down this. Knee, what happened to the knee, what they did, and also the fact that they went back and fixed a previous ACL surgery, going back to Georgia, where he had a really nasty injury.

[00:29:23] Will Sanchez: I believe it was on the sideline where his knee bent in a way that it wasn't supposed to. And when they went back in, they said, well, we're going to fix, we're going to fix that also, and redo the entire thing, not just kind of leave it the way it was. When you hear about all of this and going in and doing first off multiple surgeries, it's not just one area of the knee and and how you're fixing certain things to connecting to others and whatever peptides or whatever else he's taken in order to recover.

[00:29:55] Will Sanchez: Just I don't even have a question. What's your initial thoughts when you hear [00:30:00] about all this?

[00:30:01] Dr. Grant Garcia: So I remember, I remember this show and we saw the knee dislocate. Right. And when you told me he was going to get a small surgery or he got a small surgery, I was like, there's no fricking way. Like, and, and the problem you have is I know Dr.

[00:30:16] Dr. Grant Garcia: Vose is awesome. I think he went to same place, HSS. And then I know the other team doctor, uh, who's a friend of mine went to residency with me. Um, They're both great surgeons, great guys. But I think this press release was a little, the press release they talked about his knee was a little soft and they tried not to dumb it down what he had.

[00:30:34] Dr. Grant Garcia: I mean, this is a nasty injury and you know, they did it in two parts. And one of the reasons they didn't two parts, which not everybody does it that way, but they didn't do parts to reduce the stiffness, right? Cause it's, you hit up, imagine like. If you repair only part of it, the knee, then it got to have time to calm down.

[00:30:50] Dr. Grant Garcia: They use the smaller scope and nanoscope is actually an Arthrex products. A big like thing is like, can we make this incision smaller? I'll be honest with you. It's a great product, but [00:31:00] I'm not sure that this made a difference in his swelling, but I know that it's kind of a fancy thing they like to talk about.

[00:31:05] Dr. Grant Garcia: The most minimally invasive opt and we can talk about this at some point. Yeah. And then they went back and they did, you know, they use special screws. for healing of the ACL. And somehow his PCL didn't get torn. So I'm I think this I think there was more to the story. but obviously this guy is a freak, right?

[00:31:23] Dr. Grant Garcia: So they obviously had to redo it. I think we had talked originally did some bone tunnel grafting because you know, the problem you have is once you have an ACL, if you, if it's not in a good spot or weakens out, you might need to get bone graft done, which we had talked about. Remember you and I were talking about this cause we were like, how are they not bone graft?

[00:31:40] Dr. Grant Garcia: And then all of a sudden you found it. They went in there and they didn't realize how bad it was. And then they ended up doing a bone grafting or something crazy. So Unfortunately, guys, with this one, I don't think that the article is correct. And I think there's missing some things. It's just way too simple sounding for what we saw on the TV.

[00:31:57] Dr. Grant Garcia: It was absolutely nasty. But [00:32:00] what's more important, I think, is if they finished the second surgery and they felt that they had a solid repair of everything and reconstruction, then. I think that, you know, hopefully a guy like that can come back, but I think his career is limited. Um, I don't think we're going to see the same Nick Chubb, but we will see, and that's the whole point of this show, right?

[00:32:18] Dr. Grant Garcia: To prove me wrong. Maybe there's, you know, the newer technology they used is going to get him back and things that we've never been able to see. But I mean, I just read an article on this, multiple ligament injuries. So ACL, MCL, multiple injuries actually get back the same amount as a regular ACL. Now, the problem is it's not a revision.

[00:32:36] Dr. Grant Garcia: Which is a different animal, right? A second time. And we all know second time for anything's not good. So, you know, we'll see. I think my hat off to Dr. Booz, if this, if Nick Chubbs comes back and does it just a similar season to what he had before, I will be, I will eat my words and I will be very impressed.

[00:32:53] Dr. Grant Garcia: So good luck.

[00:32:55] Will Sanchez: Yeah, I mean, listen, we don't need him to be the way he was because you, you know, [00:33:00] you, uh, we're very clear, you know, you usually don't come back to the way you were at least initially right away. But if he could get back on the field, take a couple of hits, the leg responds. Well, that fear because I'm, I'm assuming.

[00:33:15] Will Sanchez: That there, I know for myself, there will be that fear factor, right? Because this was a tackle. This was Minka Fitzpatrick coming in to tackle him. He didn't want to deal with the big man, went low, right. And then the leg didn't give out, stayed right where it was. And the knee went right. One way the leg went the other, and you know, the rest is, uh, a nasty, nasty, uh, history there.

[00:33:39] Will Sanchez: So if he can get back on, on the field and, you know, and big picture is yeah, you're, you're able to walk around as, as you get older. Right. And we're hoping that we have advances in arthritis and things like that. Right. Because we always try to think about not just today, but tomorrow, uh, like all the normal folks like us, you know, that just having some [00:34:00] quality of life there, but, uh, it's, it's absolutely amazing.

[00:34:05] Will Sanchez: And, and I, I remember when we were talking about this, I said, what happens if something's pinching something else and they have to go in right away? You know, did, did they, Put things back in place and let it calm down. Or is that something that was instantaneously that they had to go in? But perfect scenario is to let it calm down first, right?

[00:34:26] Will Sanchez: Stabilize it and then go in.

[00:34:29] Dr. Grant Garcia: So it depends on the way it is. I mean, if it was torn artery or something like we've seen those crazy ones in some of these, there was that one player for the Browns that had to have the artery. he dislocated his knee an emergency, right? Like yo lose his leg. I don't thin case.

[00:34:43] Dr. Grant Garcia: Obviously they chec as soon as they can. So, idea to let the body calm discussion we can have at kind of like the idea of So as a sports surgeon, someone comes in and they tear their knee like this, like multiple ligaments, there is some [00:35:00] discussion. This is a debate on all these. I mean, I was just talking at one of the meetings for Arthrex and I showed a case and they're like, wow, you did all four of those things at once.

[00:35:06] Dr. Grant Garcia: And I'm like, yeah, my team can do it. I did it. But some of the guys were like, I would have done in two parts like they did here. Yeah, and I did one part, let it calm down, do the second part, um, and come back and there is that, you know, there's, but then you always have to talk to the patient, like, are you okay with two surgeries?

[00:35:20] Dr. Grant Garcia: Right? Like Nick Chubb trusted his surgeon and he's a, you know, he's the professional player and they did whatever they thought was the best plan for him. Yeah. But the key is, yeah, I mean, there is some thoughts to, should you do these things in part? And when you have an urgent surgery, you can do whatever you want, right?

[00:35:35] Dr. Grant Garcia: Like the person's not going to go find some other surgeon that says, I'm going to do it together, right? It's not, it's not like there's, there's a little different factor when it's something that's, that you can go walk around and find different people for it. Um, but what's important to know is, yeah, I mean, their thought process here is less stiffness.

[00:35:50] Dr. Grant Garcia: So you do the first surgery. Sooner. Fix the ligaments on the outside, not inside the knee, and then do a little check to see what everything else is gone. And then the second surgery come [00:36:00] back and do the inside part when it's not as stiff. And that's exactly what probably was done here. That way you Is that stiffness?

[00:36:05] Will Sanchez: Is that better? You would think that you work inside out, but you're saying it is better to work outside in with something you decide to do two surgeries.

[00:36:14] Dr. Grant Garcia: This is a great question. So assuming you're not grafting anything, like you're not, you don't need to do this in two parts 'cause you're waiting for something to heal.

[00:36:20] Dr. Grant Garcia: Right. Like when you're grafting the bone, it means the tunnels in the ACL were not good. And if you put a new ACL and imagine like, imagine if like I put a hole out of the ground and there's a massive hole right there. Right. And then you want to put like something smaller in like a stake, but it's going to wiggle around.

[00:36:34] Dr. Grant Garcia: Right. Yep. So the only way to fix that is to fill the hole with good grass again, let it grow back and then stick it back in. Does that make sense? Yep. So that would be the, a reason that you do two parts and you'd want to wait. That's not related to stiffness, but when you want someone to not get stiff, you want their knee to get moving.

[00:36:50] Dr. Grant Garcia: Like what we tell people is you want your pre motion to be what your post motion is. So if he's stuck, I get to, he gets injured and I can't bend his knee past 20 degrees. [00:37:00] Then you don't want to go in there and do surgery. Cause they'll get stuck like that. But you can do the outside ligament spine, which are the MCL and the LCL.

[00:37:06] Dr. Grant Garcia: And then you can still be able to give his motion back. Cause you're not messing with the inside of the knee. It's like, it's kind of like a bomb went off in there and you don't want to get in there. So

[00:37:13] Will Sanchez: he started rehab after the first surgery, maybe using a rebless, a shout out to our sponsor there.

[00:37:19] Will Sanchez: Maybe that would be awesome. I don't know. Maybe, maybe grabbing a rebless and getting the, getting it. The nice machine probably. Get some stuff going on, starting to PT, uh, you know, as soon as possible before getting ready for the next surgery. Right. Now, something that we've discussed in the past with some of our other guests, right, starting that physical therapy, uh, prior, you know, obviously he did not know that he was going to sustain this.

[00:37:44] Will Sanchez: So you're not rehabbing prior to the surgery, but as soon as that first surgery is done and, you know, we're just, you know, we're just kind of guessing here as far as what may have happened. Um, I just kind of want to go back and I'm, I'm trying not to get stuck here [00:38:00] with these conversations and move on.

[00:38:03] Will Sanchez: But how do you determine the severity of the knee and knowing that you got to go in that maybe it's impinging on something? Is that, are you sending this to the MRI to get an MRI right away to see if it's on a nerve or, or on something? That can cause permanent damage or what, what's the process? Or can you tell right away?

[00:38:24] Will Sanchez: What's the, what, what are the steps there for you to go? Oh, this is, we, we cannot let this calm down. We have to go in ASAP.

[00:38:31] Dr. Grant Garcia: Great. So let's, we'll, we'll change around the knowledge base there. So that's perfect. So. Impinging on nerves pretty uncommon with these. The one you can do when you dislocate your knees, you can stretch the nerve on the outside of your leg and that causes a foot drop.

[00:38:42] Dr. Grant Garcia: You may have seen people occasionally that have like their foot drops and they've got to wear a brace to keep their foot up. It's called a, uh, and that's the perineal nerve on the outside. So if you dislocate your knee, that can go out. Generally, we're not going in to fix that because once it's stretched, you just want it to come back, right?

[00:38:57] Dr. Grant Garcia: You're not, it's not like usually it's cut. And unfortunately [00:39:00] those are a lot more permanent. Like when that happens, there's not really much we can do to save it. Right. We can do grafting and everything else, but usually you give it like 10 months to a year before it CO goes, but the artery is a different animal, right?

[00:39:11] Dr. Grant Garcia: The artery is the bad one. So that's the one that they got Chicago bears player had basically that's in the knee dislocates. It comes out. And the thing in the back gets torn. It's the artery. So we don't get an MRI on those. You get a CT scan. That's a, that's a bunch of x rays and then you run dye in there called a CT angio and you run dye down the artery and with a CT scan, you can do it really fast.

[00:39:32] Dr. Grant Garcia: Like they can do it in like 20 minutes. And so that's what you would do on top of checking the blood pressures. It's kind of crazy. It's called ABIs to check the blood pressure in the foot and the blood pressure in their arm. And you tell there's a difference, right? Cause if there's not, if there's a tear in the artery, the blood pressure is going to be lower in the foot.

[00:39:49] Will Sanchez: Yeah, it makes sense. So that's

[00:39:50] Dr. Grant Garcia: how they do it. So you check that originally you check pulses and then you go straight to the CT angio and then you're in the operating room that night, uh, if that, if that happens with the artery, so if the dye is leaking, [00:40:00]

[00:40:00] Will Sanchez: right, if the dye is leaking, then you, you know that you've, you've got, we've got trouble buzz.

[00:40:05] Will Sanchez: Yeah.

[00:40:06] Dr. Grant Garcia: Yeah. And you'll just see, I mean, like the, and then do your giants, like how you do right here. It's like, goes like this. And then you just see, you just see the stop. And there's nothing below it. It just out. And that's, that's a medical emergency. And that's when you get a vascular surgeon in there, they bypass it.

[00:40:20] Dr. Grant Garcia: And usually, unfortunately, they're probably not coming back and you can lose your leg, uh, if you don't do that, but hopefully we don't see many of those. And that's not what happened here. So

[00:40:30] Will Sanchez: have you had to experience anything close to that or something like that?

[00:40:36] Dr. Grant Garcia: I have seen, I have seen one of each. Um, I have seen the one where it was not caught and the person lost their leg. [00:40:46] Dr. Grant Garcia: And I have seen one where it was caught and it was fixed. So, uh, you don't want to be on the second, the first one. That's not a good day. Unfortunately, the person was under the influence and didn't wake up for like [00:41:00] 24 hours. And so that was a problem when they dislocated it. So that's nasty. But I don't want to gross the viewers out too much.

[00:41:06] Dr. Grant Garcia: No, it's it's

[00:41:07] Will Sanchez: it's it's what we do here. You know? Yeah. So

[00:41:09] Dr. Grant Garcia: if that happens to you and you're worried about it, get someone to see you quickly. But thankfully, it's just not that common.

[00:41:15] Will Sanchez: It's very, very rare. Wow, that's, uh, that's scary stuff, but it's good to kind of understand what the process is because, you know, when you see an injury like that, you assume the worst, right?

[00:41:25] Will Sanchez: Anyone that saw that injury, any fan that saw that, you, you go, what did, it lost his leg. He's never going to play again. That, that's just, you know, when, when players on the field cringe. That's usually a sign for me going. Oh, that's not good. You know, just that's my sitting at home when I see the players going.

[00:41:45] Will Sanchez: Oh, my God. When Lawrence Taylor is jumping up and waving over the medical staff that because of what has happened to Joe Theismann or what has happened to Alex Smith, when we see players react a certain way, you know, whatever has happened because these guys [00:42:00] have seen probably the it. the nastiest of injuries on the field, but when they react a certain way, you go, okay, that whatever's, whatever's happening right now, that's, that's not good.

[00:42:11] Will Sanchez: Anyway. Well, the Cleveland Browns have had it, uh, had a, had a rough year last year. And we probably could say that, uh, going back to probably the, the Bernie Kosar days, those are probably the last good days, uh, for the Cleveland Browns fans. But their superstar quarterback to Sean Watson. Um, he had a rough season last year before he got hurt in his shoulder.

[00:42:33] Will Sanchez: Um, multiple injuries. Tough guy. In fact, he he displaced this fracture that he had. I'm gonna let you break it down and kept playing throughout that game. With that injury just to kind of display the toughness of these, uh, of these athletes, but talk about this, uh, this displaced, uh, shoulder that he has.

[00:42:54] Will Sanchez: And, you know, the rumors about possible additional procedures he may have [00:43:00] had and the rotator cuff, he, he injured his rotator cuff week three before the broken bone in the shoulders. And they, you know, once again, uh, James Voss and, uh, Uh, Ella Trash was also was, uh, a part of this, uh, these decisions. So if you could talk about this injury.

[00:43:18] Dr. Grant Garcia: So we had another, this is another one of our special episodes last summer, hit all three of them. Yeah. So Dr. Ella Trash is obviously involved in all of these, I think. Um, anyhow, so, uh, he broke off, well, we don't know the full story. We actually got a couple, we didn't end up working out, but we got a couple articles, we got a couple of reporters from, I remember the Browns that reached out to us and wanted to talk about this.

[00:43:41] Dr. Grant Garcia: Cause after our, after our podcast, they were a little bit surprised to hear that we had some other thoughts. Yeah. Yeah. And you know, that was interesting to me that people were interested that much in the topic that the actual people that cover the Browns were asking about it. What's really interesting to me is we talked about this.

[00:43:57] Dr. Grant Garcia: If he broke a piece of his shoulder off, usually within a couple of [00:44:00] weeks of the heels, right? These heels so fast because, and if you have to heal in the wrong spot, they heal fast. And the fact you played through it is very impressive. Again, this is the classic example. I just don't know the whole story because it doesn't make sense to me.

[00:44:12] Dr. Grant Garcia: And I do this surgery. I mean, I, I do some fancy techniques to fix things like this. You want to fix these within three weeks, four weeks of their stock. But I heard a rumor. And again, I don't know if it's true is that maybe it was not fixable and something else was done actually to reconstruct the bone in the front of his shoulder, which would be absolutely insane.

[00:44:30] Dr. Grant Garcia: If that was truly done in NFL player. You know, we've seen the first carlet transplant being done. We've seen the first meniscus transplant being done in high level athletes. So I had heard that there was some possibility there was a reconstruction with something called an ankle bone or a distal tibial allograft.

[00:44:45] Dr. Grant Garcia: And again, I have no confirming data. This is what happened to his shoulder. But it does seems weird to me that when you break off the golf tee and it heals in the wrong spot, you can't rebreak it and bring it back up. It's stuck there. Is

[00:44:58] Will Sanchez: that shoulder? Is that closer [00:45:00] to the clavicle? Like where, where is this for, for those that don't understand exactly what you're discussing?

[00:45:07] Will Sanchez: Can you get, can we get a visual, um, of where this injury may have occurred in his shoulder?

[00:45:15] Dr. Grant Garcia: All right, let me do my best. So the black box is the. Golf tee, and that's the socket, right? Okay, I got you. Sockets like this. I

[00:45:26] Will Sanchez: got you, I got you. So

[00:45:26] Dr. Grant Garcia: imagine, imagine if I took off 25 percent of this and broke this off.

[00:45:32] Will Sanchez: No, that's not good. Now when I do

[00:45:33] Dr. Grant Garcia: this, it slips out, right? It slips, it slips out faster. But when you break a piece of plastic like this. If you maybe, maybe right away, you can glue it, but maybe after a couple of weeks, it heals the wrong spot. You can't get that piece up again. It's done. Like if it's there, you're not going to re break it and shift it up.

[00:45:49] Dr. Grant Garcia: It's just not going to happen. What you have to do is replace it with something else. And so I had heard potentially that he had something replaced there. Um, but that was never told on the, uh, [00:46:00] on the information of that. And if he got something, Is his

[00:46:03] Will Sanchez: rotator cuff had played a part in maybe, you know, something, you know, I think the rotator

[00:46:08] Dr. Grant Garcia: cuff tore when he dislocated his shoulder because that's a, that's a, like now generally only happens in people over 40.

[00:46:15] Dr. Grant Garcia: So if you're over 40, you dislocate your shoulder. You have a very high chance of tearing the rotator cuff. And I've fixed patients like that before. Or a 350 pound

[00:46:22] Will Sanchez: man landing on you, on your shoulder. That is

[00:46:24] Dr. Grant Garcia: a new indicator. That might be a new reason to have a 350 pound man lands on you. Then you're more likely to tear your rotator cuff.

[00:46:31] Dr. Grant Garcia: Okay. Okay. So, so again, more of the story is here. Like the good news is that these patients, if it's stabilized, actually do really well. I mean, it sounds like a nasty injury, But like, if you can stabilize his shoulder, I actually think he'll get back pretty well. Like I'm not worried. I'm not as worried about the Sean Watson as about the other ones we've talked.

[00:46:50] Dr. Grant Garcia: Now we'll see again, it's my prediction. Yeah, poorly. And the Browns are screwed, but you know, I, I think that, I think that whatever you had done [00:47:00] is probably going to keep them stable. And if Ella Trash was doing anything, he'll work his magic. And, uh, I think we're going to see another, another miraculous recovery from Dr.

[00:47:09] Dr. Grant Garcia: Ella Josh's surgery skills.

[00:47:12] Will Sanchez: So they determined the injury will require immediate surgical repair to avoid further structural damage. You made a reference that if you, if it sits around for a few weeks, you could have that permanently damaged. Is there anything that kind of, you know, has the light bulb go off in your head where you're like, this was an immediate surgery, um, that they had to perform once they kind of found out what was going on that they determined the head physician along with, uh, Dr.

[00:47:40] Will Sanchez: Al Trash.

[00:47:42] Dr. Grant Garcia: Well, so, I mean, as soon as you see that glenoid fracture, I mean, I have one of these coming up and then you're just like, oh, that's not a good thing, right? Like, once the bone's broken on the shoulder socket and he feels like his shoulder's shifted out of place, he'll just destroy his shoulder.

[00:47:55] Dr. Grant Garcia: He won't be able to throw. So that's why they wanted to fix it. Right. Cause like in a [00:48:00] normal human, doing normal activities, they can't tolerate this, right? It's slipping out. He's obviously not a normal human. He's super athletic, but he's also putting his shoulder at I mean, having to throw the ball and throw it, the velocities of the accuracy he does.

[00:48:14] Dr. Grant Garcia: And already having a, just a not perfect socket or base for the arm is not a good thing. And so, you know, you could see that. This was a, I think this was actually more of a surgery to help longevity rather than just for the acute situation. Does that make sense? Like it could have, like, if he could, like, if they wanted, they were probably worried it's gonna do more damage and they just put a lot of money in their investment.

[00:48:35] Dr. Grant Garcia: This was to save their investment.

[00:48:39] Will Sanchez: Yeah. I mean, you, you think about the torque, you think about the speed, the accuracy, you think about people landing on it. Um, they said, you know, he is a mobile quarterback. Um, he does run around. It would be interesting to see if that, you know, if they had that conversation with the coaches saying, Hey, you've got to find a way to coach them out of this a little bit.

[00:48:58] Will Sanchez: You know, some of the things that we'd [00:49:00] like to see Daniel maybe do a little bit less. So it all around. I don't have the player's name. I know they looked into their backup quarterbacks, making sure that their backup quarterbacks are kind of legit and ready to go as well. If without knowing everything that's happening, if everything goes smoothly, what's the, what's the timeline here?

[00:49:25] Will Sanchez: You know, for having, this was week 10, so two and a half months, October, November, I guess right before December, I'm guessing I'm not looking at the calendar, just thinking about the timeline or close to December, um, that he suffered this injury. We're now kicking off the NFL season, uh, the first week of September.

[00:49:47] Will Sanchez: You know, is that timeline concerning for someone that works on shoulders and, and things like that, uh, and for your thought process, or you're like, well, once that's done, they done X, Y, Z, they've done the rehab. [00:50:00] It's just a matter of going out there, getting contact and seeing how it holds.

[00:50:05] Dr. Grant Garcia: So what's crazy is with the shoulder stuff.

[00:50:07] Dr. Grant Garcia: Minus the baseball players and maybe quarterback might be a little different. Generally, we're talking about five months. I mean, I've had linebackers with these injuries come back in four and a half months, so it's crazy if done well, uh, as long as the bone heals, if they had to do a bone healing procedure or whatever, you know, you're talking about five and a half months and you're letting them rip.

[00:50:25] Dr. Grant Garcia: So it's different than a knee. So I think he'll be back. Like I said, I mean, I wouldn't wish any of these injuries on anybody, but I think if he had his, if, if, again, I don't know what happened, this glenoid fracture thing is still super crazy to me that it was injured months, weeks before, and they found him and they had to think through an urgent surgery.

[00:50:44] Dr. Grant Garcia: So I have no idea exactly what they found, but I can suspect what they did. But, you know, based off whatever they did, I'm assuming that they feel pretty good about it and I'm assuming that he, you know, hopefully we'll get back.

[00:50:56] Will Sanchez: AFC North has been, uh, Been getting, taking their [00:51:00] lumps, obviously one of the MVP kind of, uh, you know, one of these, one of these guys probably going to win the MVPs between, you know, Joe Burrow and, uh, Lamar and Patrick Mahomes.

[00:51:15] Will Sanchez: But, you know, once again, uh, Burrow ending his season, torn ligament, wrist. I mean, he had a real rough season where he had an earlier injury, uh, to start off the year with a cap injury. And then, you know, he had this torn ligament, any concern with the wrist area, uh, for Joe Burrow going into this season, besides, you know, he hasn't played much football, you know, the last year, um, as far as taking hits, spinning the ball, gripping the ball.

[00:51:43] Will Sanchez: Right. I mean, I think gripping is one of the concerns. And I think if we had a Dr. Whale here, we'd be talking about that. What are your thoughts on that?

[00:51:52] Dr. Grant Garcia: Yeah, I mean, I'm worried about that. With ligament stuff like this where you're not doing a reconstruction, you're just basically repairing it. I think if he doesn't get [00:52:00] anything stuck, I think he'll actually be pretty good.

[00:52:02] Dr. Grant Garcia: I think it's more the But that's just me, again, I'm not a hand surgeon, so I do less of these. But, I tend to see, I tend to be less stressed about something like this. You know, I'm more worried about, I'm more worried about the knee stuff and the damage and the revision situations. You know, unfortunately the knees take the longest.

[00:52:19] Dr. Grant Garcia: This is a good one though. So we'll move on. I want, this is a good one.

[00:52:21] Will Sanchez: Yeah. Yeah. Anthony Richardson

[00:52:23] Dr. Grant Garcia: thing.

[00:52:23] Will Sanchez: Yeah. Anthony Richardson, you know, I wanted to get to that because we've been yip yapping away. And, uh, as time is ticking over here, let's get to Anthony Richardson's with his AC joint sprain. And once again, we hear sprain or I hear spray and I go, well, that doesn't sound like it's too concerning.

[00:52:39] Will Sanchez: But, uh, grade three, uh, what, what's your biggest concern with this? Also, once again, it's the throwing arm.

[00:52:46] Dr. Grant Garcia: Yes. So this is controversial topic. Good. You picked a good job. You always do a good job with this. Well, so AC joint injury, acromion clavicular. So acromion is this, it's a shoulder separation, right?

[00:52:56] Dr. Grant Garcia: You've heard the word shoulder separation. Yep. It's a really common in [00:53:00] bikers football, direct blow on the shoulder. The thing about this is for every grade, there's six grades, but we almost never see the fours. Those are like with some weird, you know, the cloud was stuck underneath. It's just almost, I've never, I think I've seen one of my whole life.

[00:53:15] Dr. Grant Garcia: Um, but the threes and the fives, the ones you worry about, because those are the ones that might need surgery. One, two is like a little bit. Three is where it comes up a little bit more than five is where it's like way up. If he had had a five he would have automatically gotten surgery. Uh, but because he's a three The three is where it's on the fence And so the data shows that if you have a three That half those patients don't need any surgery.

[00:53:39] Dr. Grant Garcia: They'll get back on their own And I have one of the Mercer on football players. I just did this with and I was able to treat him without surgery, but some people come back and I've had this at like two months, three months, four months, and they still feel bad. They can't throw. They have like popping and it's unstable.

[00:53:53] Dr. Grant Garcia: And what they've seen now is it's actually maybe more like a three a and a three B. The A's can get back and the B's don't because there's actually [00:54:00] a component that's, we think about AC joint injuries, the chromium goes up, right? That's how we measure it. But we don't think about it. Remember, Our body doesn't work in one plane.

[00:54:09] Dr. Grant Garcia: It works in two planes. So the concern is that some of these eight, these grade threes actually have this stability and this, and when you have both, then you might not get back. My assumption is he just had this one, right? Or they would have probably done surgery on him, but we've done studies on this.

[00:54:25] Dr. Grant Garcia: Looking at baseball players is a really common baseball injury. And you ask about the team doctors and it was crazy because only half of them said they would ever do surgery on this. The other half said never would do surgery on a grade three. I will do surgery on somebody, but again, the studies show that you want to try no surgery first.

[00:54:41] Dr. Grant Garcia: So the surgery timeline, the recovery timeline for this is about one to two weeks for every grade. It's like an MCL without surgery without surgery. So six weeks.

[00:54:50] Will Sanchez: So, so you, you should, you should have the needed information for you to think about your next step within the two week period.

[00:54:59] Dr. Grant Garcia: Usually I [00:55:00] tell them six to eight weeks, you know, now with him, he's going to give you monitored more closely.

[00:55:04] Dr. Grant Garcia: But like I tell, like I told the football player and the office is going back and play, I said, you know, go back and play for the season if you can, and if it starts feeling unstable, you can't do it. We got to pull you out. We're going to do surgery on you. And if you can tolerate it and it's bad at the end of the season, then we do it at the end.

[00:55:20] Dr. Grant Garcia: So what he may do is he may, but again, you can see these bikers, they come in cause we have all this biking around, we're surrounding around the area, you know, the bikers have both of them. They look like little horns, right? They got AC joint injuries on both sides and they've been no surgery on it. So it's really depends on the patient and how they feel.

[00:55:35] Dr. Grant Garcia: But it's that, it's that shucking anterior posterior. So front backwards. And that's why we're starting to see these, like that, the, that the grading system we have may be too old school, right? Like it's just, it doesn't give us cause we reason we make grades and I'm going, I know we're almost over. We make grading systems so we can, we can determine.

[00:55:53] Dr. Grant Garcia: We can say, okay, that grade twos need this something, this grade three needs this something. Does that make sense? That's what we grade these things. [00:56:00] And we, so we can describe them more easily. Right. So like, we know grade one takes this long grade two, and we can just like, by having that documentation, it makes it faster.

[00:56:07] Dr. Grant Garcia: It's like a, it's like a, it's a, um, conversion chart for surgeons. You think it's time to

[00:56:12] Will Sanchez: reassess these grades for these type of injuries? Possibly without starting trouble.

[00:56:18] Dr. Grant Garcia: I think, well, no, we're talking about it. Well, you're going to start some trouble. I love it. No, no, no. You're absolutely right. And there are people looking at it.

[00:56:24] Dr. Grant Garcia: There was a paper about this recently that wanted to regrade some of these because we don't have a good system and this, this grade three, like the number of ones that create these come my office and I go, listen, you might need surgery, you might not. The only ones I benefit from are the ones that come in at like two or three months.

[00:56:40] Dr. Grant Garcia: They have a grade three and they're not happy because those are the ones I know need surgery, right? Like they've already declared themselves, but these acute ones, a lot of times you don't need surgery, but it's tough because they get different opinions and some people say you need it. So this is one of those ones.

[00:56:52] Dr. Grant Garcia: It's a gray box. This is a great topic.

[00:56:55] Will Sanchez: Any concerns for him this season as we get ready to wrap up? [00:57:00] I could talk about this for another two hours. Anyway, go ahead.

[00:57:04] Dr. Grant Garcia: I know you could. I know you could. You open up Pandora's box every time he asks you about an injury. Um, concerns for him are, I hope he doesn't have the bee.

[00:57:13] Dr. Grant Garcia: I hope he got the A. I'm assuming he does. He wouldn't have got surgery already. So, so we might, they don't damage the inside. All right. So, so once he

[00:57:21] Will Sanchez: starts playing football, gets hit, we're going to find out if, if something needs to be done. So there is a question Mark about his 2024 season. Um, you know, until we see what happens, right.

[00:57:36] Will Sanchez: Is that comfortable enough to say there?

[00:57:38] Dr. Grant Garcia: Yeah, I have a good feeling about it. I feel like you, I feel like they would have pulled the trigger already. I have a good feeling about it. So,

[00:57:45] Will Sanchez: all right. We had a bunch of other stuff to talk about, but we're not, we're going to end on some trivia to kick off the season.

[00:57:51] Will Sanchez: All right. Three players have won the NFL comeback player of the year award and a super bowl. Can [00:58:00] you name one of those three players? JJ Watt.

[00:58:04] Will Sanchez: Nope. One more.

[00:58:06] Will Sanchez: Tom Brady. Tom Brady is one of three players. He won the comeback player of the year in 2009 and then won the Super Bowl that same year. Peyton Manning won it in 2012 and then, uh, won the Super Bowl. And Rob Gronkowski also was a part of that. So hip, hip, hooray. I'm excited about the G. I got my Tiki Barber jersey on.

[00:58:32] Will Sanchez: Can't see it there. Tiki bar right now. You got your giants. I'm really excited. I got to put my

[00:58:36] Dr. Grant Garcia: brand.

[00:58:38] Will Sanchez: Yeah. And hey, we're going to update our, our listeners throughout the year. We think it's important, these injuries and top players. So being the look lock lookout, we're going to do some short, quick hitters.

[00:58:51] Will Sanchez: I hope we'll keep it short, but probably not. And, uh, keep all of our fans, uh, Ready to go for this season, man. I [00:59:00] appreciate you. Dr. Garcia is always good to chat with you and we look forward to our upcoming shows. Check us out at sports doc talk. com where we have plenty of content and transcripts. Say goodbye.

[00:59:13] Will Sanchez: Dr. Garcia.

[00:59:15] Will Sanchez: Bye bye.

[00:59:17] Dr. Grant Garcia: Thank you guys. Audio Transcript

[00:00:40] Will Sanchez: Garcia, how are you doing today?

[00:00:43] Dr. Grant Garcia: I'm good. I'm really good. You know, I'm excited for the show. Something different. Put a little spin on it. Each time you never know who's going to be on here.

[00:00:49] Will Sanchez: That's right. And as always, we always like to give a shout out. Where's our little shout out here? Let's give a shout out to The Recovery Shop.

[00:00:59] Will Sanchez: This [00:01:00] episode is sponsored by The Recovery Shop. Orthopedic surgeons like Dr. Garcia and patients alike love the recovery shop for its curated selection of physician approved post operative recovery products from braces to nutrition. We've had the nice machine, you name it, you, you, we have it all for you on

[00:01:20] Dr. Grant Garcia: there.

[00:01:21] Dr. Grant Garcia: The Rebless is on there too. The

[00:01:23] Will Sanchez: Rebless, so many cool things. Um, and obviously we know why Dr. Garcia loves it because it's easy. He can. Pushes patients that way. And, uh, it's just great for everyone. So, uh, check us out at the recovery shop and Dr. Garcia. Um, you excited about today's guests?

[00:01:43] Dr. Grant Garcia: I am. I'm excited.

[00:01:44] Dr. Grant Garcia: One more thing on the recovery shop. Again, we've brought it up many times. You know, this is, this is awesome for the patients, right? Like we want, you want something new, you know, if we hear something new today or on rehab, I can call them and say, Hey, listen, put that on the website. So my patients can find it easily, right?

[00:01:59] Dr. Grant Garcia: You're [00:02:00] not going to Amazon. You're not going to other proprietary websites where you don't know the quality. These are all been pre vetted by myself and working with these top guys in the recovery shop. And it's great for surgeons kind of have your own little hub, right? It adds a little personalization to it.

[00:02:14] Dr. Grant Garcia: The patients really like it. And honestly, the products which Will's tried, I've tried, they really worked. Will didn't want to give

[00:02:21] Will Sanchez: it back. And we had a grant on from the nice recovery. And I told him, I said, The best part about having the nice recovery and it is the way it worked wonders. And especially for my wife that I was laid up and she didn't have to run around getting me ice packs all the time.

[00:02:41] Will Sanchez: And I was able to use machine. But when I actually had to send it back, I was very disappointed. Let's not go down this rabbit hole. We know I'm going to stop. We got to move on. We got such. No, we always do this. Listen, we've got a great show

[00:02:55] Dr. Grant Garcia: is gonna be short. As you know, our show is always short.

[00:02:57] Will Sanchez: Oh, shut up, man.

[00:02:58] Will Sanchez: We're not doing that. Come on. You know [00:03:00] how that works. Come on. Let's bring in, where is he? Where's where's Austin? Austin. Austin Robinson working with Arthrex in Seattle and before Austin, I apologize because I'm jumping the gun here and I'm yip yapping away, I just want to let. The viewers and listeners know, right?

[00:03:18] Will Sanchez: We have nothing to do with Arthrex, any kind of financial standpoint or anything like that. Okay. We're talking about Arthrex and we're bringing you on because the product is so good and it's not only just beneficial for. are surgeons, but I could care less about that because I'm not a surgeon. I'm a patient.

[00:03:39] Will Sanchez: And when you've got cool tools to play with, it makes my recovery a whole lot better than everyone else out there. That's a patient. And for someone that actually has some gear in my leg, I'm very thankful. So. Austin, welcome to the show. Oh, Garcia, interrupt me because I'm talking too much. No, you're doing great.

[00:03:59] Auston Robinson: [00:04:00] Thank you for having me. It's a pleasure to be here.

[00:04:02] Dr. Grant Garcia: So I can choose Austin again. I'll bring that up again. This is, there's no monetization from Arthrex on this. I'm a consultant for them. I work for them. I help with product development and other things and videos, but nothing to do with this. The reason I bring someone like Austin on is first off, Austin, how long have you known each other?

[00:04:16] Dr. Grant Garcia: I think five, six years.

[00:04:18] Auston Robinson: Yeah.

[00:04:18] Dr. Grant Garcia: And we talk about internal brace, Will, don't get started yet. Wait, wait. And we talk about a sale repair. We talk about all this innovative stuff. Can you hear me talk about, you know, I visited here, we went here, we did this and that all sounds great, but that doesn't, it doesn't happen like that.

[00:04:35] Dr. Grant Garcia: You don't just go to those places. You don't just get those new products. There has to be someone behind the scenes. And when you're doing the type of complex surgeries that I'm doing in my surgery center, or you're looking to constantly be on what they have, and we'll go to Arthrex as alpha beta launches.

[00:04:49] Dr. Grant Garcia: So we get, will the products before other surgeons get them? How does that happen? Well, it happens through someone like Austin, right? And you, you you pair up to get those, they get those things [00:05:00] earlier, so you can try them, you can use them in safe manner. And there's so many different things that Austin's team offers, As a subunit of Arthrex and then the major corporate will get into too.

[00:05:12] Dr. Grant Garcia: Like, what is the benefits of this? Um, and what can surgeons learn from it? And this is, you know, a lot of different industry does this, but you know, they have a specific way of doing it for sports. And I remember, I won't get too much more Austin. Sorry. I don't want to take up time, but I remember when I was in residency, I know, I know, but I was wondering like, how did they get in?

[00:05:32] Dr. Grant Garcia: How are they able to get involved in so many things? And it's the. It's not just the products. It's not just the glitz and the screen in the background, which we'll get into in a minute. It's the, it's the whole thing. It's the videos. It's a teaching. It's a focus on the entire, the entire unit and making sure that surgeons are integral part in helping out, uh, with this sort of company.

[00:05:53] Dr. Grant Garcia: And it's, it's pretty awesome. So anyhow, without further ado, Austin is the owner and agency [00:06:00] owner of the Seattle Pacific Northwest. And he has been, he has done way too many jobs in the past. And he is now, he is now, he's a good friend of mine. We talk way too much. My wife's jealous of Austin. I talked to him more, I think, unfortunately, as

[00:06:11] Auston Robinson: well.

[00:06:13] Dr. Grant Garcia: So anyhow, well, thank you for coming on and we'll, do you want to pop his little bio up there as little.

[00:06:18] Will Sanchez: Yeah, I'll throw it up there. And, uh, in Austin, just real quick, man, how, how did you get involved with, uh, Arthur X?

[00:06:26] Auston Robinson: That's a great question. Uh, and thank you for having me. It's a distinct, distinct privilege to be on the program.

[00:06:31] Auston Robinson: This is a prestigious show. to catch every episode. It's always fun to hear. So it's a unique experience to be featured with you all and be part of the conversation. Obviously, Dr. Garcia, thank you so much for your approach to patient care, because it really aligns with Reinhold's vision at Arthrex of helping surgeons treat their patients better and helping people get better.

[00:06:50] Auston Robinson: Um, and you, you do that at the cutting edge. You're the tip of the spear in so many different modalities, but I, I found my way to Arthrex. I was working for a competitor as, as often as the story [00:07:00] Uh, in the medical device world. And, uh, uh, my previous boss, Bobby Adams, who was very influential in my life and career, uh, gave me an opportunity to, to embrace Arthrex is, is a lesser known fact about Arthrex, but something that is, uh, some, you know, feature that we take great pride in is Arthrex is one of the largest medical education companies in the world, if not the largest.

[00:07:21] Auston Robinson: And, um, he hired me into a role that was a burgeoning new department called. our local medical education department and, uh, just kind of progressively made my way through the, uh, the different levels of the organization and have been privileged and honored to be given the opportunity to, uh, take the helm with Arthuric Seattle.

[00:07:40] Auston Robinson: Uh, we have a tremendous team as I just play a very small part, but it's a really, uh, fun opportunity to be a part of it.

[00:07:46] Dr. Grant Garcia: I'm laughing. He doesn't play a small part. He's the man. This is the man. He's takes, he's a strong leader. It's amazing. All the different people that talk about how good a leader you are, Austin, but I'm not going to, I'm not making, so you can at least walk out of the room, [00:08:00] not have your head explode.

[00:08:01] Dr. Grant Garcia: So, yeah, I'm

[00:08:02] Auston Robinson: going to get my wife and see if she can listen in just to, you know,

[00:08:07] Dr. Grant Garcia: so the, so I guess this is, this is a good way to start when people hear, I think. When some patients hear industry, they think that's awesome. Like they see arthritis, you know, patients come in all the time asking me for, I want the tight rope.

[00:08:20] Dr. Grant Garcia: I want the internal brace. I want, you know, a swivel lock. I want the thing Aaron Rodgers had. I want the thing that, you know, Neil Alatrosh did to that other guy, that other NFL player, right. They ask for those things. So they have a, they have a reasonable perspective. I think the idea of industry and surgeon type of thing is not really a negatively influenced at this standpoint, but from a surgeon standpoint is a different.

[00:08:41] Dr. Grant Garcia: Uh, thought process and especially early on, you know, some, I think some places think of like, Oh, if you talk to industry or industry talks to you, you know, this is like, you shouldn't get involved. You shouldn't help out. And even early on for me when I was in practice. It was surprising to me working with you guys and I worked with, you know, [00:09:00] Arthrex a lot because they do, I do sports and that's like one of your biggest things, right?

[00:09:03] Dr. Grant Garcia: Like you're, you guys are, it's mega. And what I realized pretty quickly was like, it's not just about the implants. It's about what do you want to get better at? What do I want to improve on? How do I want to help my patients get better? And it was, it's weird because it, for me, it felt more like. family situation and understanding, like, what is the whole that we want to improve on?

[00:09:24] Dr. Grant Garcia: Like, if I, I go to Austin all the time, I'm like, what's new? What can I, what can you show me that's new? And I don't have to, you know, stive the internet, right? He's going to help me give me the catalog of things that I can look at and also being fair with pricing, which is, which is awesome. And so I think, what, how do you navigate that with surgeons that are skeptical of the idea of, Industry, right?

[00:09:44] Dr. Grant Garcia: It's a, it's alarming, especially new surgeons. You know, you have older surgeons that are like, you know, I don't, I'm not involved. I don't really care. I'll just do whatever. Um, and we all know that situation. We've talked about that before, but these newer guys, social media, they're hitting that. They want to prove themselves.

[00:09:57] Dr. Grant Garcia: They're gunning. How do you deal with that situation [00:10:00] where they're nervous about industry involvement?

[00:10:03] Auston Robinson: Yeah, that's a great question. Uh, and it's a great opportunity to just live up to our mission statement of helping you all treat your patients better. We, we, uh, you know, obviously we're a business. We're, we're trying to do well in, in that regard, but ultimately I think what, what drew me to Arthrex and what makes it so unique is that the patient is still the center focus.

[00:10:23] Auston Robinson: Reinhold has done an incredible job. ever since he started in 81 to keep the company private. So there's no shareholders that he has to appeal to. There's no quarterly statements that have to be emphasized, uh, or profits that have to be justified or decisions that need to be justified. And there's a lot of decisions that he makes.

[00:10:42] Auston Robinson: that don't make good financial sense. Uh, I wouldn't say a lot. He's been very successful, but there are there are certain instances where he will invest a tremendous amount of money into building a device or a tool to make the job of the surgeon easier so that you're not having to worry about that. You can keep your [00:11:00] mind focused on that patient's outcome, and we try to live up to that through our commitment to medical education locally.

[00:11:07] Auston Robinson: Every agency in the country is as if not one, several, uh, local cadaver labs that allow their surgeons to practice and rehearse and bring their team in. And that's a, you know, no cost to them, uh, accessory to their practice that they can use to continue to leverage their training into advancing their skills.

[00:11:27] Auston Robinson: So, uh,

[00:11:29] Dr. Grant Garcia: this is important for, I'm sorry, I'll send me interrupt you, but I want to hear this. I want the young surgeons. I want will to understand this because we'll always I went to the lab and I practiced it. And then I tried it and then I was able to take it to the patient and do a good job. And we had a Savito on, he was talking about that as well.

[00:11:44] Dr. Grant Garcia: Oh yeah. And a lot of the companies, and again, I'm not between any of the companies. I've worked with a lot of them. They're all, all of them have their different benefits of working with them. If I want to try something, I can call Austin. He's like, Hey, I'll get you a lab. We'll do it in the cadaver. We'll practice it.

[00:11:58] Dr. Grant Garcia: And I mean, awesome. We've come up with new [00:12:00] techniques. I mean, I would tell you, I would tell the patients that how many times I've been in the lab. It's way too many, right? I know that I grabbed my coffee. I know exactly where I'm supposed to go, right? But the thing is, that's how you get better, right? Like you don't want, we don't want to practice on a patient, right?

[00:12:13] Dr. Grant Garcia: Like we have like, We have nuances we can change in the operating room, but if it's something big, I mean, I remember starting practice. Well, like I called, uh, my rep who was, who's working with Austin at the time. And I was like, I want to try these two new surgeries. I'm about to bring to Seattle. Like, can we go and start before I started practice?

[00:12:29] Dr. Grant Garcia: That was. I'm now almost six years. It's crazy and basically was practicing in the lab to get ready for my patients and it makes me better Faster and more efficient and you know, it's crazy, too And again, you know, I don't know what the arthritis to think about this But like we've practiced that plus adding techniques right like new things not just the arthrix thing, right?

[00:12:48] Dr. Grant Garcia: So austin's all about What can you do to get better? Right? Like if I'm going to do five different things during a surgery and four are going to be arthrics and one is going to be non arthrics, that's okay with these guys because they want, they care about what the patient outcomes. And I think [00:13:00] that's, what's really hard for some of this newer surgeons to see is it's that like, you don't always have to be doing everything from one place.

[00:13:07] Dr. Grant Garcia: And what's the focus for them is like that you do good surgery, right? Because a good surgery you're like i'm gonna do that exact same technique and use the exact same instrumentation the same next time I don't know if you have any questions, but I will but it's just it's just

[00:13:18] Auston Robinson: yeah

[00:13:19] Dr. Grant Garcia: people don't understand It's so hard to get a cadaver lab at many of these companies.

[00:13:22] Dr. Grant Garcia: I've tried i've been like I want to do this in the lab And unfortunately, I'm spoiled because I have the access to Austin because we're friends and he's able to help me out. Um, and the Arthritics guys, I can get a lab whenever I want, you know, they're always available. It's such an incredible resource and it's so rare.

[00:13:36] Will Sanchez: Yeah, I wanted to ask you, like, how do you, how do you elaborate on the patient's Transcribed outcomes and satisfactions. Um, how do you measure that, you know, for making informed decisions for the product? So, you know, based on a reaction from the, from the patient, what, how do you give that feedback, um, that, you know, whatever that decision making is?[00:14:00]

[00:14:00] Auston Robinson: Uh, from my perspective, we rely heavily on people like dr Garcia. You know, um, he treats the patients and, you know, it's been very compelling. As you mentioned, ACL repair earlier, there's a variety of techniques out there. I am biased, but I feel like we have the best technique and the best product for that, you know, procedure.

[00:14:20] Auston Robinson: But we rely heavily on our on our surgeons to say, Hey, this needs to be improved. You know, this was a struggle. This was finicky. This was Uh, and Reinhold, he, that's how he started the company and that's how he's maintained the flow of information at the company is surgeons are in the, in the pilot seat where, you know, we're in the background trying to make sure that we can give the surgeons the tools that they can use to most optimally treat their patients.

[00:14:45] Auston Robinson: So when they say, you know, You know, this, it's, it's rare. I would say, Dr Garcia, you might, might agree with me. It's rare for Arthrex to produce something that is flawed. They do such a great job thinking it through because they have so many surgeons offering guidance and feedback. But in the [00:15:00] instance that there is a refinement that could be put in place, offered or interjected.

[00:15:04] Auston Robinson: Uh, we, the surgeons bring it and, and there's always, it's amazing. You go down to our headquarters in Naples, there's always people in the labs trying to refine the practice of surgical orthopedic surgery and spine surgery and laparoscopic surgery. Uh, it's incredible.

[00:15:20] Dr. Grant Garcia: Well, I don't want to have to there. I think you should, we shouldn't change the word from flawed, right?

[00:15:24] Dr. Grant Garcia: You have, when we had like, well, we've talked about this, there are these special anchors and they're so minuscule and they're so amazing for shoulder or labrum repairs. Right. Um, And then not less fiber attacks, right? And they've been changed four times in the last three years. And it's not because they're bad.

[00:15:38] Dr. Grant Garcia: It's not because they were flawed. It's like, Oh, some other person figured out how to make it even better. So I think what Austin is also trying to say is that there is a lot of change. I mean, you could have a product and you get like that swivel lock. You show there's been renditions. There's different changes of it.

[00:15:51] Dr. Grant Garcia: There's all these different things. And the reason being is not because the last product was flawed. They need to fix this, right? Occasionally there are products like that. [00:16:00] What's really interesting too, is that they have a lot of background input. There's alpha and beta, like I mentioned. And so before the product hits mainstream, they'll have surgeons and Austin's really big on this, have surgeons evaluate the products and they listen to it.

[00:16:14] Dr. Grant Garcia: I mean, every time I do a beta testing, I'm sending notes and the reps, you know, Rachel, we can talk about her at some point. She's amazing. Um, but you know, she's writing notes about what's going on the technique. Garcia didn't like this. He liked this part. This was good. And half the time you want to be, and obviously I'm, I have a lot of discussion where I say, Oh, maybe I did this wrong.

[00:16:32] Dr. Grant Garcia: And a lot of times it is the surgeon, the technique, we did it by holding the hands or something, but they're really good about making sure that they, they teach us the right way to do it. And if there's a, if there's something that we're concerned about, it's not, you know, most surgeons unfortunately will, and you may, may or may not know this.

[00:16:47] Dr. Grant Garcia: They like to blame others, which is not good. Um, for something that's not going right, and we all know that it's that we all have error in us, um, and it's never a bad thing if you have a little, you know, if you're putting the anchor and it didn't go exactly what you [00:17:00] wanted, it's not a catastrophic issue, but what we have, what we understand now is that, unfortunately, every surgeon's, surgeon's learning curve is different, and what arthritis really does is they don't want, they want to eliminate the learning curve, and that's really, really hard to do.

[00:17:16] Dr. Grant Garcia: And I found that out by working with Arthrex over the last five years that I'm like, well, I do this a lot, but like, maybe the surgeon next door doesn't do a lot of those. And so I'm like, I don't understand why you can't figure that. Or I do something. I'm like, I don't understand. I don't understand this thing.

[00:17:29] Dr. Grant Garcia: And they're like, you know, you tell them an idea and they're like, that's way too complicated. And you're like that. We're just talking about like an anchor, right? It's a little swivel. You pull it out, you pop the button, you know, this is straightforward. They're like, no, that might like, we're talking about a design right now.

[00:17:42] Dr. Grant Garcia: And I was told that they can't do two loops because sometimes they cut the wrong loop, right? Like you're like, that doesn't make any sense to me, but they're so keen on making sure that the surgeons. That the surgeons happy with the product and the product works flawlessly every single time. And that's really, really hard to [00:18:00] find the industry.

[00:18:01] Dr. Grant Garcia: Well, like, it's just amazing that they're like, I want someone that does one of these and does 10, 000 of these to be just as good every time to put it in. And that's extremely hard to do. That's way harder than you'd ever imagined.

[00:18:12] Auston Robinson: Uh, if I can interject, I know I'm just a passenger on this journey together, but that is, it seems like a perfect opportunity.

[00:18:19] Auston Robinson: If I can make a shameless plug for our people. Because I think a big part of that, too, is the technology is there. You're obviously a gifted surgeon, uh, and and surgeons are very well trained, but to have the support of, uh, you know, a competent rep in the background that knows the technology is prepared to do their job well, which, you know, You mentioned Rachel, Rachel Robinson.

[00:18:40] Auston Robinson: She's our rep that covers your, your, uh, surgery center. And she's super stellar. She's a rockstar and she wants to make sure that she doesn't let the patient on the table down or you down. And internally, I think that's another differentiator arthritis does really well is we have our own medical education director, a gentleman by the name of Bram Shamas, who's a brilliant [00:19:00] guy and devotes a lot of his time and energy to making sure that when we have a rep going to an OR, They know what they're doing and, you know, we all have room to improve.

[00:19:08] Auston Robinson: We're all continuing to grow on our journey. But, uh, you know, we, we invest heavily in those resources to make sure that we're not sending somebody into that procedure that can't assist, especially when, uh, something goes wrong. Right. And, and that's a, that's an

[00:19:24] Dr. Grant Garcia: incredible point. I don't think, Will, we do enough discussion of everybody else behind the scenes, right?

[00:19:30] Dr. Grant Garcia: Because it's impossible. Like, you've been productions. Like, you can't, you know, every camera person, every lighting person, you can't talk about it. I'm not trying to dumb down the reps or anybody else into like a, you know, a light or a camera or, um, but what's incredible about the reps on Arthrex, in my opinion, Is that there that you even get some people that are new and they're really, really intent on learning, right?

[00:19:51] Dr. Grant Garcia: I mean, we'll, I will tell you, and Austin may think we have some of the hardest surgeries we do in the state and our operating room, very complex, high volume, [00:20:00] really intense. Like I'm, I remember the best and we'll make me think this is funny, but inside information, I was always told that my OR is the most giggles.

[00:20:09] Dr. Grant Garcia: And the most stressful at the same time,

[00:20:12] Auston Robinson: because we're

[00:20:12] Dr. Grant Garcia: doing such complex procedures, but we're also having a good time. And so that to me is the key, but the fact that a rep can come into that situation, and they're prepared for it, and they have notes, I mean, Rachel, I, I don't want to make it about Rachel, because I know that she's going to blush when she hears this, but You know, I asked her about something I did and she's like, Oh, you did this like six months ago.

[00:20:30] Dr. Grant Garcia: You did this way. And I was like, how did you remember that? And right. Well, she's writing notes. So it's not like I am, I may steer the ship, but I have lots of people that help me out. Like my outcome in the end for the patient is because of Rachel, because of my scrub techs, because of my PAs, because of.

[00:20:47] Dr. Grant Garcia: My, my scheduler, like this is a combination. This is a team effort to get there. And if you don't, they are the final finish line, right? Like if you, when I'm doing something, if your rep's [00:21:00] not good and all of a sudden I do something that doesn't work, how do I decide? I've never seen it. Right. Like Rachel and I have been together most of the time, but she works with other surgeons or other reps do too.

[00:21:10] Dr. Grant Garcia: And if they, they actually have more experience than the surgeon does combined well, because they're going every day to the operating room. And so they know their product and they go, this doesn't work, do this. And early on, that was huge for me. I mean, I had Kyle, he's awesome. And he was like, he told me that something went wrong and he's like, this is how you fix it.

[00:21:25] Dr. Grant Garcia: I'm like, I had never even heard of that. And I'd been at HSS where these guys are using Arthrex products left and right, left and right. And you learn something new. And the cool part is they, if you keep an environment where you're like, Hey, just teach me because I want to learn too. And that's really, I think.

[00:21:40] Dr. Grant Garcia: The one thing you guys do a really good job of, you build a relationship. So the surgeons are willing to be taught, right? Like there's other companies and I will not name names where I don't want to be taught by anybody. Because to me, I don't feel like there's a lot of, there's the same caliber of what I'm getting, which is why to me, the relationship is so important, um, because of the consistency [00:22:00] and because of the personalities.

[00:22:02] Dr. Grant Garcia: I mean, Will and ROR, they're like our, The reps there for Arthur to come in. They're like best friends. Everyone's like, Hey, Rachel, thanks. Good morning. Let's get going. You ready for today? And she's like, Oh yeah. And they put so much effort in well, it's hustle all day long hustle. And that is a, that is a hard thing to do.

[00:22:16] Dr. Grant Garcia: And that's something that's built by the brand. Um, and You know, I think Austin, one thing I think that people would say is, and we'll might be able to test to this, but you know, one thing that one knock, I think people talk about arthritis, that the products are expensive, right? There, they maybe are more expensive than some of the other brands for the patients listening and for the surgeons is that unfortunately, when you have, you usually pay for what you get, right?

[00:22:41] Dr. Grant Garcia: So if you don't have the higher quality stuff or the higher quality thing, you don't get the rep in the room that knows what's going on. You don't get the medical videos to teach you how to do it. And we'll, I don't know what your thoughts are, but I think that if I offered you, and again, there's nothing wrong with a Honda or Toyota or a BMW or a, you know, [00:23:00] a Mercedes, I think, you know, which one you might choose.

[00:23:02] Dr. Grant Garcia: It's just, it's just the difference.

[00:23:05] Will Sanchez: It's funny. You're talking about this and, um, it reminded me, and this is, I'm really going off the beaten path here, uh, episode of the King of Queens, right. And, um, he wants to surprise his wife with a LASIK surgery. So he's like, all right, we, you know, for your birthday, we're going to get you the LASIK surgery, you're going to no more glasses.

[00:23:27] Will Sanchez: So, you know, he goes to take the surgery and she wakes up the next day. It's blurry. The day after that, it's blurry. Finally, she's at her birthday party. She can't see anything. And then, you know, one of the friends comes by and it's like, Hey, I heard you had the surgery is like, yeah, blah, blah, blah. Did, did you go to my guy?

[00:23:46] Will Sanchez: She was like, what are you talking about? Yeah, this guy is like, no, I went to this guy and she found out that her husband got cheap and kind of got like a Groupon 50 percent off of one eye or the other and wound up having to go back to the original guy to get it [00:24:00] fixed. So in a weird way, you know, like I said, I'm going off the beaten path.

[00:24:05] Will Sanchez: You're not off. You pay for what you get. In this case, he got cheap on it. Didn't get what the necessary tools. And the result was a very angry wife that did not celebrate a birthday. So

[00:24:19] Dr. Grant Garcia: it's one way to think about

[00:24:20] Will Sanchez: it.

[00:24:20] Dr. Grant Garcia: Thankfully, I mean, again, there are a lot of other product companies that have make good products, but I think what we're trying to get at here is that you have this consistent quality, which to me is really important.

[00:24:31] Dr. Grant Garcia: And I'm, my patients are looking for it. My patients are like, did you put metal in me? That's the one thing that's just put metal in me. What type of anchors did you use? Like I get the Boeing engineers, I get the Microsoft, I get the Facebook and they've done all the research, right? They've seen the Olympics and they saw the two players that got back after Arthrex and they're asking me, am I going to do it?

[00:24:50] Dr. Grant Garcia: We'll ask this, am I going to do a speed bridge? Right. So if you don't offer that option, what are you going to do? Right. You got to stay up with the times. And so to me, it's the patients [00:25:00] have gotten smart and that's what helped build, honestly, for surgeons listening. One of my, one of my biggest polling points is that I, is that I offer some of these products because the patients want it.

[00:25:09] Dr. Grant Garcia: I mean, it's just a no brainer patients want their ACL repaired, and if you can do a good job on it, you have an awesome product that you can support. It makes it easier. And it's a heck of a lot easier for me to. Offer the surgery for the patients when I feel like consistently I'm not giving up something right like if I knew something would save me money And it was inferior.

[00:25:27] Dr. Grant Garcia: I would absolutely never ever use it in a patient and I might and I talked about this with my partners and everybody else. It's like, why are you using this thing versus this? I'm like, I think it's better. And if I didn't think it's better, and that's the best part about Austin and why our relationship works out.

[00:25:41] Dr. Grant Garcia: If I don't think it's better, Austin's like, then don't use it like Austin's in sales. But I can tell you right now, if Austin sells me something that's expensive and crappy, sorry to put on the, on the call, he knows I'm done. I'm not going to ever trust him on that product. And so he, that's what's really good about them too.

[00:25:56] Dr. Grant Garcia: It's not overselling, right? We're in sales, [00:26:00] trust me, it's a business and that's the way it works. But at the same point, it's amazing to focus, you know, with corporate Arthrex, but also this relationship we have with Arthrex and Pacific Northwest. Austin's team is that it's, I mean, you can describe this better, but you guys really, you don't, that's not your goal.

[00:26:18] Dr. Grant Garcia: Like you're not, your primary goal is not, you know, we have to find a way to get involved in everything possible. It's more like, what do you, what do you need? What's going on here? What's the problem here? What's your issue here?

[00:26:29] Auston Robinson: Absolutely. I mean, you know, that's a another unique approach that I think Arthrex senior leadership has understood and done very well for a long time.

[00:26:37] Auston Robinson: They look at solutions for problems, right? You know, we're we're a partner and we're a symbiotic partnership between the two of us. You treat the patients. How can we make your job easier? How can we make sure that if that's my mother on the table, she has the best, most optimized outcome possible. And I, you know, I, I appreciate the fact that you, uh, recognize the value [00:27:00] there, because I think that's a really important part of what we do.

[00:27:03] Auston Robinson: Um, and you know, it's, it's not dissimilar to, uh, Surgeons reputations in the community, right? I mean, the value that you provide to a patient, the experience that you provide to the patient, uh, is not the only distinguishing factor that sets you apart, but it's certainly something that attracts patients to you from the word of mouth reputation that you've developed, uh, along with your, your exceptional skills.

[00:27:26] Auston Robinson: But we, you know, for us, it's very similar. We can come in and try to hammer you over the head with what we want you to use. But I'm not an orthopedic surgeon. Uh, you know, I understand it at a lower level, but I do know that we can offer solutions to problems and make the patient's outcomes better with the technology.

[00:27:44] Auston Robinson: So we want to introduce those things. We want to make sure people are aware and raise the awareness level. And Arthrex has done incredibly well at that as well with things like in terms of the living up to the You know, commitment to education with our orthopedia website, Reinholds invested immense amounts of [00:28:00] money into that resource that is not even branded Arthrex.

[00:28:03] Auston Robinson: It's just a resource for people to learn around the world on, uh, surgical techniques and biomechanics. Dr. Chris Adams, our global director of medical education, who's a Burkhart fellow orthopedic trained surgeon, very successful guy has committed a ton of hours with an impressive team to, Build out those resources where they, they go through the anatomy, then the biomechanics, then the clinical relevancy and, and so on and so forth.

[00:28:28] Auston Robinson: Uh, you know, you, you've seen that, that, uh, website, but it's an incredible commitment, you know, and, and they back it up with their actions, which is a really fun thing to be a part of.

[00:28:37] Dr. Grant Garcia: And I think before I talk about the thing behind me, um, I think we should tell people too, you know, people want to know they've seen posts of like, I fly to Naples, right?

[00:28:46] Dr. Grant Garcia: It's a far distance. And obviously there is some level of competition when I fly, but at the same point, it's still time away from work, time away from my family. So what's the reason for doing it? Well, the reason for doing it and the reason that, you know, any surgeon who's interested should [00:29:00] learn about it or see the headquarters or even go downtown to, uh, you know, Uh, you know, Kirkland to see it is the really the teaching and what's gone into the resources to allow us to do this.

[00:29:10] Dr. Grant Garcia: I mean, if you want to show the headquarters, I mean, it's just absolutely gorgeous. Well, it's, it's got, you know, pick a ball courts, its own hotel, its own restaurant. Like this is talking about, like, this is like, this is better than going to Vegas for an orthopedic surgeon. Trust me. And the, uh, and the labs.

[00:29:27] Dr. Grant Garcia: I mean, you, you might see eventually, well, a video where I'm in an operating room, it's not even the operating room. It's just like an operating. They've built up just for videos to show people like in an operating room. And they've got a studio, one of like seven in the country, and that's called studio X and that's behind me.

[00:29:42] Dr. Grant Garcia: And what it is, they can turn into anything they want, any environment, and they can film commercials there locally. It's pretty sick. But what they really do use it for is to teach. Other surgeons and to teach patients and I think they have you guys have you know You've we've talked about my videos on my website I've got so many 200 [00:30:00] 300 and part of that is honestly just mimicking stuff that arthrax has done Because it works so well for me to learn right like all of us want to learn and the surgical videos are so important But the, I mean, the amount of money that, that Reinholtz invested in it is, this is not like, there's no reason to have done that much money.

[00:30:17] Dr. Grant Garcia: He just did it because he's, he wants to show everybody and he wants to have the best video products, right? There's no reason to have 25 K videos for your products from us, from a monetary standpoint, right? It doesn't make a difference in my opinion to show that. And to make, you don't make more money off that.

[00:30:34] Dr. Grant Garcia: He's just doing it because he wants people to have the best and if he wants to, she wants to show his stuff in the best possible format, would you agree? And that's what you were talking about. You know, he doesn't always, it's not always about the dollar or it's not about the stockholder. It's about, it's about, well, how can I show that?

[00:30:49] Dr. Grant Garcia: How can I have the best? And how can I give everybody the best experience?

[00:30:52] Auston Robinson: Absolutely. Yeah. You know, not to sound cliche, but it's been described as a nexus of innovation. And, you know, as, uh, [00:31:00] as, uh, interesting as that may sound, it really lives up to its reputation. Reinholds designed it to be such so that, You know, people have a place in the country where they can go and inevitably you bump into another surgeon from, you know, another part of the country and they're talking about challenges or world, right?

[00:31:18] Auston Robinson: Yeah, we come across Europeans and South Americans and people from Asia Pacific region and they're experiencing the same challenges, same anatomy, same injuries. And you can rub elbows together and say, Hey, how can we make this better? And then Reinhold says, you know, to the to the degree of having rapid prototyping and, uh, you know, visually enabling technologies to improve the patient's experiences.

[00:31:42] Auston Robinson: And I can say without hesitation, He, you know, in, in even the personal conversations, he's so devoted and committed to the experience of improving the patient, uh, patient's experience, the patient's outcome and supporting the surgeon in a way that they have the resources and they see that as an extension [00:32:00] of their practice to be successful.

[00:32:02] Auston Robinson: It's, it's really a remarkable thing.

[00:32:05] Dr. Grant Garcia: So well, how many times, oh, sorry. One second. Ask a question. Well, how many times have you seen a company? As big as Arthrex and everybody knows the CEO by first and last name and where you go to a random event, let's say you have. Walmart and you go to a Walmart function and the Walmart CEO is hanging out there.

[00:32:25] Dr. Grant Garcia: Let's say you have like a McDonald's and the McDonald's CEO is out there. Again, not belittling anything that Arthrex does, but I don't want to get to the proprietary of other companies, but it's one of the few companies where the CEO is constantly there and involved. And that's what's, I think that's really what makes a difference, right?

[00:32:39] Dr. Grant Garcia: You know, I mean, I'm out there, Will, I'm out there for something. And all of a sudden he shows up at breakfast and he's like, Hey Grant. Hey Garcia. And I'm like, this is the CEO of Arthrex. And you know, he's just, he, he knows everybody. He just has that. And he asks, starts asking questions. What do you think about this?

[00:32:53] Dr. Grant Garcia: What do you think about this? I'm just like, holy cow. This is a lot of information. This is the guy who's the CEO of the company. So, I mean, it's just the [00:33:00] involvement and that makes you feel really good, right? Like, well, if you work for working for, if you're working for someplace, you never knew your boss, you never knew anybody else, and you just basically did your job and you kind of sat down and you kind of sat there, it's hard, right?

[00:33:12] Dr. Grant Garcia: But to see all those people involved and so committed is it's pretty. It's pretty impressive. It shows the mentality. [00:33:19] Will Sanchez: Yeah. And that shows that it's organizational culture, right? So obviously I've never met this individual, but what has been discussed and how his policy is, that is what he's promoting breeding and encouraging.

[00:33:34] Will Sanchez: Right. Is that culture. So he's setting the standard. So then. Everyone else could follow along. And that's why you have folks like Austin and some other people that will be a part of your community, because that's the culture that he's fostering. So on my culture there, anyway, so we talked about technology.

[00:33:54] Will Sanchez: We talked about innovation and it's 2024. And what is the hot [00:34:00] topic that's happening right now? That. Is the super advancement in technology, right? The, the industrial revolution of this, uh, decade in a century is going to be AI. So how is AI machine learning virtual reality? How are they starting to think about that?

[00:34:19] Will Sanchez: To apply that to not only the tech you have now. but future tech going down the road?

[00:34:27] Auston Robinson: That's a great question. Uh, and it's an exciting frontier to be a part of. Arthrex is always looking at ways to enhance, you know, the offerings that they provide the surgeons for the patients. And one of those areas that they can use machine learning is, uh, you know, we, we, in our shoulder arthroplasty, uh, portfolio, we have a tool that is, uh, uh, tool that is accessible to all surgeons.

[00:34:48] Auston Robinson: It's the, uh, we call it a VIP targeting system, but it's based off of the patient's native anatomy through CT, uh, examination, digitization. And so, uh, with machine learning, they [00:35:00] can look at this array of, uh, CT images of different shoulders and identify based on the patient's anatomy and the morphology of their scapula and the humerus and the chromium, there's an optimal position of the products and the implants.

[00:35:15] Auston Robinson: in, during the surgical intervention. And that is a game changer because you don't have to wonder, is this screw going to go through and hit a nerve? Is this a base plate going to be too far lateral? The machine learning, uh, based on the formulas and the weights and inputs that they include in the algorithms allow you to have a much more precise determination.

[00:35:32] Auston Robinson: And now they can start to, and we're, I think we're still exploring this, but can start to upload or include. other patient specific considerations like, uh, other other components of their health and their their genetic background, things like that to make more specific decision making that allows for the surgeon to not have to wonder as much.

[00:35:55] Auston Robinson: Not that they're I don't think the surgeons are necessarily wondering often, but [00:36:00] it reduces and eliminates some of that. uh, gray area in, in terms of implant position and implant sizing selections. That's just one unique way I think, uh, Arthrex is doing it. They're looking at, you know, different ways that they can, uh, visualize or the surgeon can visualize intraoperatively the anatomy, say for a spine and some of the revolutionary, uh, designs that Arthrex has partnered with some really, uh, exceptional surgeons in the spine world to better.

[00:36:28] Auston Robinson: visualize and identify patient's anatomy when they're suffering from extreme pain. Okay, just

[00:36:34] Will Sanchez: to follow up on that, uh, can you see a world where Arthrex is not only leading a technology with, um, what's, what you're doing now for surgical outcomes, but also in a preventive way with having this AI information about the anatomy and seeing where there may be certain situation because, you know, they've ruptured their Achilles twice and they know their tendons [00:37:00] a certain way where, where maybe, and maybe I'm going, you know, to keep

[00:37:04] Dr. Grant Garcia: going, keep going, we see

[00:37:07] Will Sanchez: this arthrax preventative, uh, innovation headed.

[00:37:12] Will Sanchez: down the road.

[00:37:14] Dr. Grant Garcia: So I'm going to help a little bit and then I'll let him jump in. Sorry, but this is amazing. Will. Arthrex's focus is not on putting a hundred implants into a patient and revision, revision, revision. Arthrex's, Arthrex's goal by adding such as the, and Will don't get too excited yet, internal brace, adding biologics, adding all these things is so that you don't have to come and do the surgery again.

[00:37:36] Dr. Grant Garcia: And whether it will be more cost effective, that's the key here is. No more second surgery. And that's why I use a lot of my Arthrex products. Because I don't want to do another surgery on a patient. I want to give them the internal brace. The regular ACL. If I need to add biologics, do what I will. With the ACL repair, we're working on more biologics, tissue engineering, biomaterials, you name it.

[00:37:58] Auston Robinson: Wound

[00:37:59] Dr. Grant Garcia: healing, [00:38:00] jumpstart, amniotic patches, well, we could go all day on this stuff. That is the number one thing they want they want to find ways to prevent the second surgery preventing original surgery There's biologics. There's all these different things too that they have again. I digress Awesome.

[00:38:18] Dr. Grant Garcia: Keep going. Sorry.

[00:38:19] Auston Robinson: No that no, that's great insight. Dr. Garcia. I appreciate it. But yes Will, your question, can I envision a world where Arthrex is leading the way in that space, uh, with the leadership that we have, uh, in the organization and the teams that we have abroad, I can envision, uh, leading in any space, but especially in the, the area of preventative medicine, uh, you know, we have among the companies that are in orthopedics and in, in the industry, the broadest portfolio of, uh, biologics.

[00:38:49] Auston Robinson: implements that are our customers are exposed to, uh, to consider the entire algorithm of care, if you will, in how they treat the patient prior to [00:39:00] degeneration of tissue or cartilage during the procedure and then also postoperatively. So biologics, I know, uh, internally, our leadership is So strongly supportive of that direction that they're implementing those things in their own bodies on a regular basis, you know, to prevent arthritis, prevent tendinopathies, different things like that, uh, in a way that is, it just shows the commitment to the development in the, into the space.

[00:39:29] Auston Robinson: And I think that that's something that Arthrex is going to, I can't speak for Arthrex, uh, in terms of, you know, organizational, uh, strategic initiatives. But from my perspective and from what I've heard, I would say that they're absolutely geared up to do whatever they can to make it so that the patient doesn't have to, uh, you know, have the problems that they're potentially going to have.

[00:39:49] Auston Robinson: And that's that's, you know, if the patient's at the forefront or in focus in a topic and there's a way to get better, Arthrex is going to at least from my perspective, continue to do [00:40:00] what they can and invest in developing ways to mitigate the risk for the patient.

[00:40:05] Will Sanchez: The key word that you said, you said a lot of important things.

[00:40:09] Will Sanchez: But when you said arthritis and there's so many people that suffer through that, um, and getting closer to, uh, relief. One of many different ways, uh, that, that should be excited for everyone along with, uh, all the other things that you talked about with, uh, you know, preventive medicine. So it's really exciting.

[00:40:28] Dr. Grant Garcia: Well, and one more thing, I think what Austin brought up, but that's really important. It's very rare in a company. Is the size of Arthrex is a little bit alarming to some surgeons and overall when you hear about it, but the size is what gives them their domination because they have crosstalk between the groups.

[00:40:43] Dr. Grant Garcia: Like I'm, when I work in on something with ACL repair and I'm like, Hey, I want to add biologics. I want my patients to even have a better healing rate. I'm not satisfied with. 90%. I'm not satisfied with 96 percent healing rates. I want 100. I want 99. They're looking at, and again, we can pull up the tight [00:41:00] rope, uh, which I love talking about, uh, in there, but they're like, let's get the biologics team involved.

[00:41:06] Dr. Grant Garcia: Or Austin's like, let me look at the portfolio. And because they have so much in their portfolio, um, this thing in three or four years, as amazing as it's going to hear. And obviously the whole knee team's going to hear me say this is probably going to be even obsolete for Arthrex soon. Cause it's just, it's so good, but we can make it even better, right?

[00:41:23] Dr. Grant Garcia: We can add biologics to it. Can we get the healing up? Right? Like maybe this technique is going to stay there, but there's going to be something added to it. Like we're, we're not even close. Uh, you know, we're not even, we're not even close to the end of this sort of rain of continuing to improve. Would you agree?

[00:41:39] Auston Robinson: Absolutely. I think, you know, as long as there's injuries, we're going to continue to pursue with vigor, better ways to treat them. Right. And in optimizing the patient's outcome, as long as there's a patient on the table, uh, we can get, we can continue to get better. And again, I can't speak to Arthrex corporate strategic initiatives as an agency representative in, in the [00:42:00] little, uh, state of Washington, but, uh, from what I know, from what I see, I would absolutely, uh, expect that if they're, uh, If there's an opportunity, they're thinking of a way to make it better.

[00:42:10] Auston Robinson: The thing in a way to make the patient get back to activity quicker, to get back to sport quicker, to get back to work quicker for the patients that, you know, a lot of these surgeries require a lot of downtime, you know, I think of, you know, somebody that's a single parent can't afford to take six weeks laying down because they have back pain.

[00:42:28] Auston Robinson: So, You, you know, the, we could go way off topic on that, that issue. But I, as an example, I was getting a haircut a couple of weeks ago. And, um, my barber is a female. She said, I'm really struggling with this pain in my leg and said, have you seen a spine surgeon? And she said, I have, they've done some injections.

[00:42:46] Auston Robinson: Now they want me to get surgery. They say I need a decompression. And I talked to her about, you know, our arthritis has recently made a foray into endoscopic spine surgery. And instead of doing a large two centimeter incision, you can do it through a scope, [00:43:00] eight millimeter incision. And she started. Dr.

[00:43:02] Auston Robinson: Schaefer, Dr. Schaefer. Well,

[00:43:04] Dr. Grant Garcia: that's what we have. We just had him on talking about arthritic stuff.

[00:43:07] Auston Robinson: Yep. Incredible surgeon. And, and, uh, similar to you cut from a similar cloth and in terms of, uh, you know, an affinity for innovation and how to optimize the patient's outcome. But she broke down. She said, I'm a single mom.

[00:43:19] Auston Robinson: And they told me I would have to take six weeks off of work. I can't afford to take six weeks off. And I said, talk to, yeah, I recommended Dr. Schaefer, gave her, uh, your practice's number and the website. And I said, people are getting, you know, endoscopic spine decompressions and they're walking out of the ASC.

[00:43:36] Auston Robinson: They're, they're back to work two days later. It's incredible what's going on. And, and, you know, that that's cool from a technology standpoint, but man, it's really impactful from a patient outcomes perspective.

[00:43:48] Dr. Grant Garcia: Well, and I think, I think what you brought up is really important. Some patients don't understand the technology sometimes, and that's why we have this show.

[00:43:55] Dr. Grant Garcia: Just tell people about the new technology. That's why I had as soon as Andre got in practice [00:44:00] with us to talk about endoscopic spine because I don't think and it's sad because what you said is calming. I mean, I literally just had Multiple patients I saw today in the clinic and the lady was like, I can't believe my ACL is going to be walking out of there and I'm gonna be moving this quickly and I'm gonna, you know, my, or my UCL, I can start throwing the baseball so soon.

[00:44:17] Dr. Grant Garcia: I thought that it would take longer. Like, my last one did not or the other surgeon told me this and I'm like, listen, the technology we have, I can let you rip. Right. We can, we can do it right. This, you have an internal brace in that ACL. You can go harder on it. Like, it doesn't mean that we're going to be too aggressive in room.

[00:44:33] Dr. Grant Garcia: I mean, we just had an ACL repair patient and she was worried cause she had seen other protocols and they were slow. And she's like, I don't, I'm worried about tearing this. And I'm like, listen, this new ACL repair is way stronger. I feel much better letting you go. And it just, you could just see her face just calm down.

[00:44:51] Dr. Grant Garcia: Oh my gosh. I'm not going to tear this right away. I know you're not, I trust it. That's why I do so many of these. And so I think we'll can attest to this, but [00:45:00] having that basic technology and we can bring it up, we can talk about internal brace for a few minutes. Well, if you'd like to bring it up, but it's just part of me.

[00:45:07] Dr. Grant Garcia: Yeah. Talk about that. Honestly, Austin, you, you, you, uh, you're, you're, you know, you're the master of all things. But how is the internal brace concept? changed your entire perception of things.

[00:45:24] Auston Robinson: It's incredible. I mean, you know, when you look at the incidents of of retail rates and a lot of these, we've, you know, Gordon McKay back in, uh, you know, the late early 20 teens, mid 20 teens really put some interesting work.

[00:45:39] Auston Robinson: A surgeon out of Scotland into the lateral ankle and Pat Smith and yourself and so many have really kind of been willing to give this a shot for their patients. And I think the data has shown that there is a tremendous value added to the procedure for the patient if it's incorporated. Um, you know, it started out as [00:46:00] a as a supplement for A.

[00:46:02] Auston Robinson: T. F. L. Ligament repair or, or, uh, you know, it's called a brochure procedure. Uh, and you have these patients that are, are frequently rolling their ankles. Cause I think Dr. Muffuli published, 10 year data that showed that they, the, the native tissue repair stretches out over time. So is there a way to strengthen this?

[00:46:20] Auston Robinson: So the patients don't, as you mentioned earlier, don't need a second surgery, don't need a revision to this. And it's, it worked so well. People started to think innovative surgeons started to think maybe this could be applied in other ligamentous. uh, areas of repair and reconstruction. And now we see, you know, people using these and we see second looks where a patient gets into a car accident and they hit their tibia on the dashboard and their femur slides way forward.

[00:46:46] Auston Robinson: And all of a sudden, uh, the tight rope or excuse me, the internal brace ruptures, but their ligaments intact. So we preserved them from needing an entire new reconstruction.

[00:46:57] Dr. Grant Garcia: I have personally had that. Where a patient I scoped [00:47:00] him and I saw the internal brace it, uh, had torn and the ligament was still intact or you go in there and you scope them for another reason.

[00:47:07] Dr. Grant Garcia: You see the internal braces grown into the A. C. L. It's just incredible.

[00:47:11] Auston Robinson: I mean, you know, the seventies people didn't work hard seatbelts, right? And then they were invented and somebody quickly realized we should put these in every vehicle. And it's very similar to the the advent of the internal brace where why you know Maybe it's not relevant to every procedure But why wouldn't you do it if you can give the patient a more optimal outcome with that backstop in the in the construct

[00:47:37] Dr. Grant Garcia: This is a good question I get this a lot from patients and will may have this question too since he has part internal brace in his body the uh, the I would say this question You Is it going to damage my ligaments?

[00:47:50] Dr. Grant Garcia: But I mean in your perspective I have I tell them I put in More I put in over that I've put in thousands of these and it actually grows into [00:48:00] ligaments Is that what you guys have seen like what is your experience with this? I mean that doesn't to me. It's very inert It's collagen impregnated, right?

[00:48:06] Auston Robinson: That's right. It's, it's synovializes with the ligamentous repair, uh, and healing process. And we've put millions of strands of fiber tape into human bodies since the early 2000s. And that reaction rate is, is, uh, insignificant. And so it's an incredibly safe, inert product that is there as a support for the construct that gives the patient the opportunity to prevent re tear of their ligament.

[00:48:31] Auston Robinson: Uh, you know, and it's a great adjunct to what's being done biologically there. Uh, because we all, I mean, you can speak to the science far better than I can, but as those graphs reincorporate, we know that they kind of turn into a jelly before they really reconstitute as a ligamentous tissue. So in that season of reconstitution, having something there that can offer a little bit of mechanical support.

[00:48:54] Auston Robinson: Makes a lot of sense. And, and I think the data shows that.

[00:48:58] Will Sanchez: Got a quick question here. Um, as [00:49:00] we get ready for, um, the NFL season that's coming up and just looking across the board, um, where around the world, football is the number one sport here. It's NFL. Can you see, um, a place where owners, and this is.

[00:49:19] Will Sanchez: Probably just personal thought, not trying to label the company's, uh, thought process behind us, but where these owners in these big industries could possibly start to incorporate some of these things in their, uh, players. For example, we see every offensive and defensive lineman pretty much wear knee braces, right?

[00:49:39] Will Sanchez: We know that between knees and ankle damages in the sport of football, um, It takes time away from the pitch and, you know, these billion dollars, you know, worth of revenue that come through. Um, especially if it's deemed safe, is it something that you can see, or is this kind of a [00:50:00] little farfetched as far as what, you know, we may see in the future of sport, protecting their investment and maybe not exactly the internal brace, but maybe there's some future tech alone.

[00:50:11] Will Sanchez: No,

[00:50:11] Dr. Grant Garcia: I think this is a great point. I think what. You're asking for is that's what they do. The arthritis teaches the team doctors. I mean, you have a team physician meeting. For all the team surgeons in the country that come to it and they learn about techniques that the other team positions are doing. And so it becomes a standard of care in the NFL, right?

[00:50:30] Dr. Grant Garcia: I mean, that's pretty much what that meeting is for. It's an incredible meeting. Um, and you can talk more about it briefly, but. Will, you're that's already happening. You just don't know about.

[00:50:41] Auston Robinson: Yeah, I think we, you know, we see more and more stories of high profile athletes that, you know, to your point of protecting the investment, uh, from the, the team's perspective, it makes sense, right?

[00:50:52] Auston Robinson: I mean, anecdotally, I've heard, uh, team doctors say that there's even been big linemen that, that have had a history of rolling their ankles, [00:51:00] asking for the internal brace prophylactically, uh, just as a preventative measure. Um, no, I don't think any surgeon in good conscious, uh, in good conscience to do that.

[00:51:09] Auston Robinson: Uh, you know, but the concept is there, uh, you know, be for the same reason you're asking the question. It makes a ton of sense to reinforce some of those, uh, injury prone anatomic location.

[00:51:22] Will Sanchez: And maybe this is the question that we're talking about leading into, you know, future tech, right? Because maybe it's not set up exactly the way it is now, but maybe as we go ahead and look five, 10 years from now and seeing a product that Is safe that can help, uh, players, you know, maybe this is something along the lines where there's Arthrex or anyone else that, you know, they're protecting this huge investment because we were seeing common injuries, injuries in certain sport, um, to protect.

[00:51:50] Will Sanchez: And, uh, it'll be interesting to see what happens. So as we always, I think you're on

[00:51:54] Dr. Grant Garcia: to a new show idea, by the way, this is phenomenal, this has been talked about in ACL [00:52:00] repair, there is, there was some theory. That if you didn't, if you didn't, uh, so an ACL repair, sometimes you do an extra ligament called the extra articular, um, tinnitus with called an IT band, or you can do an ALL reconstruction.

[00:52:13] Dr. Grant Garcia: There's some thoughts about doing that second ligament, but just doing internal brace, if someone hasn't told their ACL, but it's a high prone. And actually, I don't even know if there's a public study. I thought there was on this. It seemed like, I don't know how the IRB would approve it. Um, but some players have been considering doing that to prevent getting their ACL torn.

[00:52:31] Dr. Grant Garcia: Um, so you're onto this. And I. Don't know how it will ever ethically get approved or how anybody would ever undergo it, but there are some athletes that want the edge and an ACL tear is devastating or an ankle sprain. We've seen hundreds of those in the NFL, you know, Saquon, obviously not, no longer giants.

[00:52:47] Dr. Grant Garcia: We don't want to talk about it too much, but you know, roll, roll this ankle. Will and I are both giants fans, by the way. So, uh, I do think. [00:53:00] That it'll be prophylactic or though what we've seen now is surgery happens sooner. right? We have better instruments. So the old way of like, let's wait 20 times before you get surgery.

[00:53:10] Dr. Grant Garcia: Now it's like you're getting surgery right now. Like it's way better this new way, right? My homes are not homes. And there was other player that got an internal brace for his MPFL, his dislocating kneecap. And it was way earlier than he should have. And he ended up doing great because it's much faster recovery than standard reconstruction, right?

[00:53:26] Dr. Grant Garcia: Those are the type of things I will. So prophylactic before the injury happens or prophylactic before the standard would happen for surgery. Yeah. And therefore, you reduce the issues later on. So everything you're talking about is spot on. Well, you're, you should do it.

[00:53:40] Auston Robinson: Yeah, that's right.

[00:53:42] Will Sanchez: All right, Garcia, we, we need to wrap it up here.

[00:53:44] Will Sanchez: Um, but before we go, um, Austin, if you could control all of it, what would you like to see? Five years from now, 10 years from now, um, as far as a [00:54:00] revolutionary tool or something biometric to help the patient and surgeon collaborate to, uh, take this to a whole other level, you've got the power, you're the God of Arthrex and all this little toys, what would Austin do with this power?

[00:54:17] Auston Robinson: I'd love to come up with something unique, but I'm sure, uh, Reinhold's already thought of it. Uh, yeah, I, I, uh, I think that, you know, we would love to see things in from my perspective, you know, with the patient being the center of our focus, anything that we could do to anticipate the injury, like if there is a device that could be used to test the quality of of ligaments and tendons and look at their, their native tensile strength.

[00:54:42] Auston Robinson: Uh, before the sports injury occurs or, uh, if we could test the, uh, annular tissue of the, of the vertebral disc in, in determine whether or not their disc was going to rupture and go in and, uh, somehow with minimally or ultra minimally and basically, uh, Prevent that from [00:55:00] happening, I think would be remarkable technology, and I don't see why it's not gonna be something that we see in the in the near future, with all the development going on in the tech space and the merging of tech into into medicine.

[00:55:12] Auston Robinson: And, you know, you see different ads for a I being able to detect detect the breast tumor years before it actually develops those kinds of things that is going to Be a game changer for families around the world. Uh, and I think it would be a lot of fun to see Arthur X be a part of that because selfishly I'd love to be a part of it as well.

[00:55:31] Dr. Grant Garcia: I love that. And I think that's going to be the future. Right? You know, AI learning on MRIs. They're like, your disc is about to herniate. Go see the surgeon, 20 minute endoscopic procedure, little tiny patch, little internal brace on the disc will make him happy. And you know, the surgery takes 15 minutes.

[00:55:47] Dr. Grant Garcia: There's no recovery time because you never got hurt in the first place, right? You're almost got hurt, but didn't get fully hurt. And now you never going to tear that disc again. Right? Like that's, that's, that's what it's at. Well,

[00:55:58] Will Sanchez: Austin, thank [00:56:00] you so much for taking time. Uh, this was extremely informative and we really appreciate you, uh, being a part of the show.

[00:56:07] Will Sanchez: So, uh, thank you. I know Garcia talks to you all the time, but, uh, it was my pleasure to have you on. So thank you. Garcia. Thank you for the Austin.

[00:56:16] Auston Robinson: I really appreciate you having me. It's a real privilege. I'll talk to you

[00:56:18] Dr. Grant Garcia: tomorrow, Austin.

[00:56:19] Auston Robinson: I'll look forward to it.

[00:56:23] Will Sanchez: Dr. Garcia, man, Austin Robinson, that was awesome.

[00:56:26] Will Sanchez: Um, you talk too much. Look, we're almost at an hour. It's all your fault. We're just going to blame you for everything. I don't know. I know.

[00:56:33] Dr. Grant Garcia: It's because you give me too many layups, man. It's great. Unfortunately, I like all the guests too much. That's the problem. We need to pick some guests that are, I don't want nothing to do with.

[00:56:41] Dr. Grant Garcia: Then we won't chat. Yeah.

[00:56:42] Will Sanchez: Yeah, that won't be any fun. And we'll just be staring at each other and just comparing backgrounds. But listen, a lot of great information, right? You know, we, we talked about training, you know, a VIP targeting system, machine learning, preventative medicine, biomaterials, tissue, engineering, largest [00:57:00] portfolio,

[00:57:00] Auston Robinson: Austin

[00:57:02] Will Sanchez: has, I loved his answer on future tech.

[00:57:06] Will Sanchez: I mean, that is exactly, it is not a pie in the sky kind of answer. This is a legit answer where we all go. Yeah, that sounds great. Sign me up. I'll take one of those. And, um, you know, let me know when something's bad is going to happen in my body, right? Because that's what we want to get to. Right. And whether it's, I know, I know I'm going, here I go.

[00:57:28] Will Sanchez: I'm doing a one 80 here. Right. You go get a colonoscopy because you're trying to be prevented, right? You, you go through, you, you do certain things to make sure that you're going to be okay, and you're catching it early. That's exactly what we're talking about is having some tech besides the wonderful things that they do now is eventually, hopefully getting to that point as well.

[00:57:49] Will Sanchez: We can do better. Well,

[00:57:50] Dr. Grant Garcia: we can always do better, right? That's the one thing of the show. If you, I tell everyone this, if I'm doing the same thing I did five years ago, then I shouldn't be doing it because [00:58:00] you're not innovating. So preventative medicine is huge and preventive orthopedics is actually not talked about that often because I hate to say it.

[00:58:07] Dr. Grant Garcia: We like surgery. So, but if I could find a way to prevent people from having injuries and being fearful of injuring themselves and get to all the sports they love. I think that's honestly the best thing. And that is, I really appreciate Austin coming on and all the viewers listening. And I know we need to wrap it up cause we're on a minute and 40 seconds before we get kicked off.

[00:58:26] Will Sanchez: We're not going to kicked off, but we got to stay under the 60 minute. And I love the thing that you guys talked about in the beginning saying, yes, this works. But we can make it work better. And it's been changed two, three, four times, not because it didn't work or it failed is because you found a way to like, this works great, but if we do this, we can make it work better.

[00:58:47] Will Sanchez: So I, you know, that's something that I took out of it, that conversation as well, and that's something that. Everyone should be excited about. It's not, not only that this is, you know, we're doing something that's great and we utilize in the tool. That's great. But [00:59:00] how can we make it better? And I think that was the common theme throughout all this.

[00:59:04] Will Sanchez: How can we make it better? Dr. Garcia, we're going to wrap it up. We've got NFL and everybody's excited. I don't know how I'm feeling about the Giants. We'll talk about that the next show, but we're going to talk about key players coming back from injury, major injuries, how that affects the upcoming NFL season.

[00:59:21] Will Sanchez: And then somewhere along the lines, we'll probably take about two minutes and cry in our bowl about the upcoming Giants season. But as always, Dr. Garcia, our sports medicine orthopedic specialists, thank you for being with us. You rock as always. Um,

[00:59:42] Dr. Grant Garcia: Thank you, Will. Always good. Great episode. Thanks, guys. Audio Transcript

[00:00:38] Will Sanchez: He's got this cool, funky background going on, man. This is very like, wow, look at that. This is a Stanley Kubrick kind of thing going on, man. How

[00:00:46] Dr. Grant Garcia: are you? I'm good. This, this is a nice fun. I, you texted me this weekend. You said to this, you talked about this, uh, Mike trout injury. And I was like, you know what?

[00:00:53] Dr. Grant Garcia: It's time. This is our first. 15 minute segment. All the other ones have been [00:01:00] audio, so this is the first blast, um, and we're hoping for this season, uh, to do a few more of these, because I think that our listeners like these a lot, like, because it's more, it's more cutting edge, it's more, uh, recent, um, and this, this is the first time we've done this.

[00:01:15] Dr. Grant Garcia: meniscus stuff we're going to talk about is just keeps coming up. It's just nonstop with these. We just talked about an Olympic episode literally last week.

[00:01:24] Will Sanchez: Yeah. Yeah. And, and listen, it, when you have an injury to a first ballot hall of famer and Mike Trout, uh, someone that his career path was, you know, up there with some of the greatest players ever, except for the last five years now, where he's been pretty much robbed of a complete baseball season.

[00:01:45] Will Sanchez: And we'll show you the stats later on, uh, due to injuries. So just to recap on April 29th, Mike Trout, uh, was playing in a game. Uh, felt a little something in his knee, [00:02:00] went, ran the bases, played the outfield. Um, you know, came, came in, was like, yeah, I think I'm good. Didn't, no concerns. He goes home and, and I want you to kind of chime in on this.

[00:02:13] Will Sanchez: He goes home. goes to bed and it's like, Oh, something is not feeling right. I'm ha he's having pain. He, he's going through pain at night, wakes up in the morning, calls the doctors, like, Hey, I'm having some issues with, with my knee. Um, you know, maybe we should just go check it out just in case he wasn't thinking of anything because of the way that he was able to complete the game.

[00:02:38] Will Sanchez: Finds out when April 29th that he's, he tore his meniscus before we go further. What happened to Mike Trout? Is it just the adrenaline that kind of kept them going through or things didn't settle in? What happened when he got home at night, laid down, and when he was trying to sleep, all of a sudden this pain started coming off.

[00:02:59] Dr. Grant Garcia: So [00:03:00] one, you know, obviously you don't know the tear pattern. We didn't see the MRI. We talked about there's various tear patterns, right? You got these meniscus, it's C shaped.

[00:03:07] Will Sanchez: Yeah,

[00:03:07] Dr. Grant Garcia: you can have a radial tear. That's a big split. Probably not that usually that's a massive pop. And then you're like literally unable to walk, which is what we thought was happened to the Olympian.

[00:03:16] Dr. Grant Garcia: Right. Big crack. Yeah. This is a different thing. Uh, but again, we don't want to give away too much of it, but obviously it was repairable. So it was some tear pattern, maybe in the back of the meniscus where there's better blood supply. When you get a tear right there, uh, and usually it's a tear, it's a, it's a, he's probably from when he was batting or rounding the bases, right?

[00:03:36] Dr. Grant Garcia: Like it's a, it's a plant shift. And one thing that can increase the risk of this is probably the cleats, um, when he's batting, right? Cause you're, you're, you're plant the foot and then you're, you're cranking the knee. And if there's any pre, you know, they can have, you know, guys like this that are playing all the time, they can have these little small meniscus tears.

[00:03:54] Dr. Grant Garcia: We used to see, we took care of the giants, uh, and the mats and stuff. We'd have Monday morning kind of MRI [00:04:00] review and you get to see some crazy stuff in MRIs for players that are like still actively playing.

[00:04:04] Will Sanchez: Yeah.

[00:04:05] Dr. Grant Garcia: Right. So he may have had some small capsular tear that you couldn't really recognize, twisted, had some pain and maybe had a little tweak and he's like, Hey, I'm fine.

[00:04:12] Dr. Grant Garcia: I'm going to deal with it.

[00:04:13] Will Sanchez: Yeah. Yeah.

[00:04:13] Dr. Grant Garcia: Then he gets home. And what happens is these tend to ache and like my patients who have these special capsular tears or tears in the back where the blood supply, they say at night they have to put pillows between their legs and anytime they twist or move, it hurts a lot more and it probably started swelling up on it.

[00:04:30] Dr. Grant Garcia: So like, that's what he probably felt. And that's only me reading between the lines from experience from him at being in a fixable repair and just from the fact that the fact that it acted more at night and these, these tear patterns that he got these tend to be ones that people can kind of go up and down with, right?

[00:04:46] Dr. Grant Garcia: Like sometimes they know, but he's my trout. So he's getting MRI right away. Like some of these patients that come in, they're like, they've had it for two months. They've never really, they know they're just kind of like dealing with it.

[00:04:54] Will Sanchez: Yeah, so he has surgery on May 3rd, right? So we go back to April 29th.

[00:04:59] Will Sanchez: This is when he felt [00:05:00] that whatever happened to his knee, obviously we know that it was a torn meniscus, goes in May 3rd, uh, begins rehab assignment at AAA Salt Lake on July 24th. Before that, On the Thursday, they said that the MRI was clean and it was expected to start running shortly. And then he goes rehab assignment, plays two innings, leaves the game due to knee discomfort, right?

[00:05:27] Will Sanchez: And then they necessitated a follow up MRI, which revealed a new tear separate from the first one. And they're saying it's unclear. that how he tore his second or how he suffered a second tear. So I'm not going full, uh, conspiracy theory or what, but what is it? What, what, when you hear these things, what, what could have happened?

[00:05:54] Will Sanchez: Uh, because obviously this man is the franchise and the face of baseball. One of the faces [00:06:00] of baseball, the franchise for the angels, they wouldn't. I would assume that they're not going to risk his health based on them rushing him. So what happened? What do you think happened? The fact that he has an MRI, he has a meniscus tear and now suffers another one, uh, a month and a half later after surgery.

[00:06:20] Dr. Grant Garcia: Yeah, so again, obviously we don't hold me to this, right? We, or hold me to it, but you know how this works. We're predicting a surgery. Hold on. I'm writing down

[00:06:28] Will Sanchez: notes to hold you to it. Hold on a second. Write it

[00:06:30] Dr. Grant Garcia: down. Write it down. Maybe you'll find out in like six months. I had no idea what I was talking about.

[00:06:34] Dr. Grant Garcia: That's okay. That's how we do the show.

[00:06:36] Will Sanchez: So

[00:06:36] Dr. Grant Garcia: the uh, and again, thankfully my ego is not too soft. So I think I can handle it. So, you know, so the um, that's right. So basically he gets a fix. So you already know that the tear is a special type of tear, right? There's only certain tears we can fix. Some of these baseball players, school players, they get tears that are kind of just trashed meniscus, and you can't fix those, right?

[00:06:55] Dr. Grant Garcia: Probably not a root tear, probably not one of the more complex radial tears we talked about. He would have been out for a lot [00:07:00] longer, five, six months. So, I'm, I'm reading between the lines, right? He had a rate, he had a tear of the meniscus, and you guys see here, medial or lateral, generally they're medial, but I don't know which side his was.

[00:07:10] Dr. Grant Garcia: Medial means it's on the inside of the knee. You can see there. And then there's usually it's around the capsule. So the meniscus has blood supply in three zones, white, white, which means there's no blood supply. Those almost always get removed middle, which is red, white, occasionally fix those. And we're starting to push the envelope on fixing those, which you've talked about on previous episodes and younger patients.

[00:07:28] Dr. Grant Garcia: We fix them more. Um, and then red, red, which is right next to the blood supply. Those you want to fix as much as possible. Cause if you don't fix it. You remove a lot of meniscus and we've seen already we've talked about this a number of times on this on this show That removing that much meniscus is not good for people if you have to do it You know people ask like in their 50s like you're removing my meniscus.

[00:07:51] Dr. Grant Garcia: Why are you doing that? Well, I can't fix it then right it doesn't heal the same as it does in someone like mike trout who's still young uh active and healthy, um [00:08:00] And really the meniscus under, you know, 40, 30 years old. We just want to fix his man. He's

[00:08:04] Will Sanchez: 32 years old. Just to kind of give you the age group.

[00:08:07] Will Sanchez: He turned 32 years old. In fact, uh, it is, I think it's almost his birthday, August 7th. 33

[00:08:18] Dr. Grant Garcia: years old. Unfortunately, happy birthday to him. So anyhow, so the, um, so basically he gets this fixed and it's probably a capsular tear. He probably gets it fixed. There's different ways of doing this, right? There's stitches.

[00:08:29] Dr. Grant Garcia: You can do stitches from just two little poke holes. He can have a bunch of stitches in his knee and someone catches him out the back and he tie him in the back. And that's kind of like the more aggressive kind of gold standard method. So what happens is he gets that done and he gets his three month recovery.

[00:08:42] Dr. Grant Garcia: That's what makes me assume it was probably one of those, right? Cause it's only three months.

[00:08:46] Will Sanchez: Yeah.

[00:08:46] Dr. Grant Garcia: He starts running on it. He gets a clean MRI. The problem you have with the MRIs on these meniscus is you can't, I've been on my own meniscus and sometimes you think they MRIs are clean or you go in there for another reason, right?

[00:08:57] Dr. Grant Garcia: You rescope their knee cause they're having some other issue [00:09:00] or like a year or two later something else gets hurt, right? And you rescope them and then you go in there and you see like your meniscus repair is like mostly healed. There's still the stitches in there, but there's a line like where like imagine like your meniscus tear is like a full slit, right?

[00:09:13] Dr. Grant Garcia: It's the whole thickness of my fingers. Only like this much, only like this much healed, right? So you still have a layer that's a tear on the top, but on the MRI, it looks like it's a full connected tear repair. Cause what happens is scar tissue is really hard to pick up on these MRIs sometimes. So they always say like some of the reports, like I look at them as myself, but the reports say, Possible tear, but maybe due to surgery.

[00:09:38] Dr. Grant Garcia: So it may just be healing. Cause people always want to know, did it heal? So they think it healed, they let them go back out and he re tears it, or he ripped through the stitches. And that's what I think happened. He, the, the stitches we placed, you place that they're stress risers. And if it doesn't heal, those stretches are now holes in the meniscus and they can tug on them.

[00:09:58] Dr. Grant Garcia: And to be honest with you, I've had this happen to [00:10:00] me. You know, I do a lot of meniscus repairs and every once while you get in and the meniscus didn't heal. And now you've got this sort of rope. in the meniscus. And if it doesn't heal and scar in, it can act as like a knife and it can cut through. It's not anybody's fault.

[00:10:13] Dr. Grant Garcia: It's just the fact that didn't heal. And now he created a new tear.

[00:10:17] Will Sanchez: So that's why it was a

[00:10:18] Dr. Grant Garcia: separate area.

[00:10:19] Will Sanchez: I want to read a quote from him, right? Because to me, this is a warning sign or a concerning sign. And for you, it's probably nothing because you're like, yeah, I hear this all the time. He says, since my initial surgery on May 3rd to repair my meniscus, my rehabilitation proved longer and more.

[00:10:34] Will Sanchez: difficult than anticipated. But if you talk about the three month timeline, he came back right before the three month timeline. So if you're saying that you're, it was a difficult process and maybe it's just because these guys are super, super human. So it, you know, the fact that you don't recover as fast as you expect, you know, that all of a sudden there's a warning sign for the player, but when he says something like that, I don't know.

[00:10:59] Will Sanchez: Are [00:11:00] you concerned or is this something that it was just maybe bad luck for, you know, either didn't heal properly or he popped that, uh, that stitch and he suffered that tear?

[00:11:11] Dr. Grant Garcia: This is a classic sign that, again, first off, don't know the situation and he's also, you know, he's frustrated. You'll show a stat how many times he's been injured, right?

[00:11:23] Will Sanchez: Yeah. So to

[00:11:23] Dr. Grant Garcia: him, it's like any days down, he's like, this is so long, right? Like my, you know, I have this, I have, I'll see four patients, the same ACL surgery done within a few weeks of each other. Same surgeon, same technique. And one will be like, Oh, this process was terrible. It was so long. I'm like stressed.

[00:11:38] Dr. Grant Garcia: I don't want to do it again. Second one's like, thank you so much. You saved my knee. All of them look the same, but they all have different complaints, right? So you don't know the ones when I get these revision situations where something happens or I see someone that's had this and they'll say they go to get a second opinion, right?

[00:11:54] Dr. Grant Garcia: And they're like, my knee never felt right after the surgery. That's the ones you were kind of like, okay, that's a little bit [00:12:00] fishy. I don't think it's fishy with the angels. I think they probably did everything they're supposed to do. And also it's really easy for, I don't know when he quoted this, but it's really easy for Mike Trout to say My recovery wasn't as good as I wanted when he reto his meniscus.

[00:12:11] Dr. Grant Garcia: Oh, after

[00:12:12] Will Sanchez: the fact? Yeah, if it's after that, yeah. Like it's just

[00:12:14] Dr. Grant Garcia: total bias. So you know, you don't know. But, and also like we know Patience and Mike t Trout's no different. I mean, this is guy, this guy's smart, but he is not a rocket scientist. Like I'm sure the surgeon told him how long it was gonna be and he just was like.

[00:12:28] Dr. Grant Garcia: Whatever you want to do, doc, just fix me.

[00:12:31] Will Sanchez: Right.

[00:12:31] Dr. Grant Garcia: And sometimes they don't listen and they're sitting there like at two months. They're like, why is my knee still swollen? I'm like, I told you it's going to take a long time.

[00:12:37] Will Sanchez: So when it comes to the recovery process, right? Tear now retear 14 seasons in the major league baseball.

[00:12:49] Will Sanchez: He's going into his 15th season. just just turning 33 years old, so not old as far as age and even baseball. You kind of should be in your [00:13:00] prime, but he really started his career at an early age, which was really fast tracking him to this Hall of Fame resume. Uh, uh, What's the recovery process and then what are some of the concerns now?

[00:13:13] Will Sanchez: Obviously he's out for the whole season. So you'll have the rest of this year going into the winter and then coming back for spring. Are there any concerns at this point, uh, for as, as a doctor there, or is it something like, Hey, it's just. Shit happens, you know, go through the recovery process, you know, go through your PT, start over, get stronger and you know, we should see you back on the field or is it something where you go, all right, now we've got into that knee.

[00:13:44] Will Sanchez: What have we lost? Right? You're not looking at the knee. It's a process. What has been lost already from the surgeries to maybe impact not only his recovery process, but possibly continuing his career because he hasn't [00:14:00] played a full season in quite some time.

[00:14:04] Dr. Grant Garcia: And you can show the stats there. So basically, so to answer your question, this is really concerning.

[00:14:10] Dr. Grant Garcia: I mean, usually I tell them if, if, if someone good did a surgery, which I think it was, Um, the odds of it being fixable again are pretty low and going and trying it again on a guy like this might be a bad idea, right? Cause you're going to look pretty bad if he fails again in like three, in three months, right?

[00:14:28] Dr. Grant Garcia: We know about, it was a, one of the guys, uh, it was a guy that, you know, retore his triceps, sent him for the giants. And then he tore it again after, you know, playing it was out again for another six months. Right. Like he just doesn't, this is unfortunately get a little bit scary. I don't want to say this word, but it's sounding like Lonzo ball, right?

[00:14:45] Dr. Grant Garcia: They know like meniscus reminiscence. Now again, the first was a repair, but the second was likely a removal and we know where that went. And so that is the, that's obviously worst case scenario. But I, I, I don't think the amount of time that he [00:15:00] has to recover really matters to be honest with you.

[00:15:02] Will Sanchez: Yeah.

[00:15:02] Dr. Grant Garcia: It's what the health of the cartilage is and how much meniscus gets removed. If his cartilage is healthy, which we don't know. Probably is maybe hopefully. Um, cause he's still young, then he's going to be in a better situation. And if it's a medial meniscus, which what we showed on the board, medial meniscus, they do way better.

[00:15:23] Dr. Grant Garcia: If it's a lateral meniscus removed, they do a lot worse. And I mean, I've had a, I took care of an NFL guy that retired at 32. This guy was incredibly athletic. Had two lateral meniscus removals came to my office with a knee that was like knock me like this Terrible arthritis at 32, right? So that's what happens on the lateral side medials tend to last a lot longer So if he gets his medial meniscus removed At this point he may make it, you know He'll probably make it for the next few years of his rest of his career Um, and then obviously eventually may have issues in the long run But again, a lot of these athletes have that it doesn't it's not from this actual injury per se Um [00:16:00] But, but again, the problem is if he has all of a sudden he loses meniscus and he starts getting a cartilage hole, then we're looking at the same issue, you know, is he going to get a micro fracture, which we mentioned before, is he going to get a cartilage procedure?

[00:16:12] Dr. Grant Garcia: Is that even going to be possible for him? I hope not. We've got to see the worst case scenario with Lonzo Ball needing a really big surgery, like a Hail Mary surgery for a professional athlete. But those are the risks. If they do a repair, I'd be shocked. And then recovery wise, generally depends on the type of tear you repair.

[00:16:32] Dr. Grant Garcia: But usually, you know, two weeks of crutches, one week, no weight, one week, partial brace for six weeks with that sort of three to four month recovery. But everyone's different, right? Like Mike Trout's getting the best

[00:16:43] Will Sanchez: PT.

[00:16:45] Dr. Grant Garcia: Some patients takes five, six months. So it just depends on the level of what he's having.

[00:16:49] Dr. Grant Garcia: If he just gets a cleanup or, you know, that usual clean, you know, people go say they clean the knee, right. Did the little, the little cleanup of the knee, you know, that's probably six, six, eight weeks. So he doesn't [00:17:00] need all that time to get back. So we'll know how he's doing probably in the off season or towards the playoffs or pre.

[00:17:06] Dr. Grant Garcia: Um, but also depends like if he's out for the season, right. Cause you have August. I mean, September, October, they're out.

[00:17:12] Will Sanchez: Yeah, no, he's done. He's done for the year. And obviously it's a smart move. Um, let's wrap it up here because we've gone over our 15 minutes. So we got to change our 15 minute segment to 1723.

[00:17:26] Will Sanchez: But, um, I have to ask it any advancements right now when it comes to meniscus. Um, you know, recovery or surgery, things like that. We always like to talk about, you know, future stuff and all the cool toys that are out there. Is there anything that, um, that you can kind of throw out there that might be beneficial or depending on really kind of what's going on.

[00:17:49] Will Sanchez: And just to clarify with everyone that's listening or watching, it's hard to, we're talking about the injury itself. It's hard to know exactly what it is unless it Dr. Garcia was in [00:18:00] there looking at the knee. So I just want to kind of throw that out there as well.

[00:18:03] Dr. Grant Garcia: Well, and also for layman terms, right?

[00:18:05] Dr. Grant Garcia: Like everyone's here's the word meniscus tear. They all seem the same for me as a meniscus specialist. I go, if I go in like tomorrow, I'm doing three different types of meniscus tears repairs, right? They're all three different. Yeah, so for it's a very large gamut of that and I'm getting into the minutiae of it, but so advancements This is very similar to the ACL biologics.

[00:18:26] Dr. Grant Garcia: So the one advancement is we do the microfracture I told you about originally on the show poke holes where there's ACL PCL and with stem cells I'm assuming the surgeon did that there's been some studies on PRP So we take PRP injecting the knee after the meniscus repair hopefully help it One of the slick thing you can do is you can take blood turn into a vibrant clot and try to sneak that into the meniscus repair that you're doing it again.

[00:18:48] Dr. Grant Garcia: This is assuming that he's getting a meniscus repair. So you want to get that. Also, what matters is it kind of crazy, but you just have to do a good job of repairing it, right? Like you can't skimp. So this is getting the [00:19:00] details, but if you fix them, it's a meniscus. The meniscus fibers are radial. So they're circular.

[00:19:05] Dr. Grant Garcia: Does it make sense? Yep. Circular. So if you fix it horizontally, so I'm trying to do my best here to show you. If you fix it horizontally, you'll, you can go right through the meniscus. You see that if you fix it vertically, you cinch the meniscus and it won't tear out when you fix it. So when you do your repair, you wanna try to get your repair sutures like this rather than like this.

[00:19:26] Dr. Grant Garcia: I mean, you have to sometimes do that, but like this way stronger in the meniscus. So sutures, so all those things. Vertical,

[00:19:31] Will Sanchez: not horizontal, right? Because vertical. See, member, think about this vertical you got,

[00:19:36] Dr. Grant Garcia: I'm coming at you. Like this scissors vertical. You don't want vertical. There you go. I'm not, um. He might, that's gonna scare, that's gonna scare everybody now.

[00:19:44] Dr. Grant Garcia: Anyhow, so the, uh, so else, so the, uh, and then there's, and then there's Bone Mar Aspir. I'm sure he is getting everything. I'm sure he is doing that. I'm sure he is getting more stuff. And, and there's like collagen gels they're talking about. Again, this is the, when you figure out the solution on how you [00:20:00] can take an 80% success surgery.

[00:20:02] Dr. Grant Garcia: You know, without an ACL tear, this is a pretty, there is, there are people that do not do as well when you, if he tore his ACL at the same time, the success rate would go way up, right? So it's the, the issue is without the ACL, uh, is the problem here. And so we're looking at everything. I said, PRP, fibrin clot.

[00:20:20] Dr. Grant Garcia: I mean, I'm working on some of this stuff right now with other things and how we can make our ACL repairs better. So the biologics is a huge topic on this. We're just not there yet. But we're getting, we're going to be there hopefully soon in the next few years. So we'll see.

[00:20:33] Will Sanchez: Great job, Dr. Garcia. We hope that the three time AL MVP gets back on the field next season and, uh, is able to perform for all the fans out there that enjoy watching them.

[00:20:46] Will Sanchez: Because as you know, careers come and go pretty quickly. Uh, Dr. Garcia, say bye to the fans. Peace out guys. Remember vertical, vertical, not horizontal, and don't have Edward Scissorhands nightmares. [00:21:00] Peace.
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