278. Dr. Jason Snibbe: On Why Meniscus Surgery Backfires, Prehab, Peptides, & Robotic Joint Surgery

Our goal is to walk within an hour of the surgery. There's enormous amount of data showing that if you get up and walk on your joint replacement immediately, your confidence goes through the roof of trusting the joint. I love thought leaders like yourself that are really patient-centric and thinking about what is the best possible outcome for this patient to get back to full life. It's like you're an artist. You want that canvas to be good quality canvas. So if the canvas or the patient is not quality, they don't have good tissue or good metabolism and good health. No matter how great of a painting you draw, no matter how great of a surgery you do, you're going to have a bad outcome. The focus on pre-abilitation, post-abilitation, minimally invasive surgery and the use of all of the biohacking modalities tells me that you're really focused on the whole patient journey. My big passion is controlling the episode of care for these patients. Where do you see the future of orthopedic surgery going? I think the future of orthopedic surgery will be. Hey guys, welcome back to the Ultimum Human Podcast. I'm your host, Human Biologist Gary Brekka, where we go down the road of everything, anti-aging biohacking, longevity and everything in between. Today is going to be one of those really fascinating what I would call the in-between podcasts, because we're going to look at a classically trained surgeon who is doing some phenomenal things, not just with joint replacements, but with surgical interventions, minimally invasive, sparing as much muscle as possible and getting patients back to activity faster than traditional methods. And what I love about this surgeon is that he is also a biohacker. He's as curious as I am about ways that we can improve outcomes using things like nutrition and biohacking modalities to improve these surgical outcomes. So welcome to the podcast after Jason Steeby. Thank you for having me Gary. We're sure to find orthopedic surgeon and slash biohacker. That's right. Yeah. I love it. I wrote something down here that I thought was a really cool way to start the podcast. Prehab is the missing biohack. Certainly heard a rehab, but I've never heard a rehab. Absolutely. And before the podcast started, like a lot of my guests, we sort of ran a mini podcast in our hyperbaric chamber. Yeah, it was so nice. But I find it really fascinating that you take this whole patient approach to something like a surgical intervention on a joint. And I wonder if you might just talk about that for a minute. What was your journey from classically trained surgeon to now being one of the pioneers and arguably one of the leading authorities in the world on these minimally invasive robotic surgeries and your attitude towards this rehabilitation? I think my approach to surgery has always been how can we make it better? What are the little things that we can do to make it better? And when I started my career, I realized that if I'm super gentle on the tissue, I'm easy on the muscles. I don't put a traditionally at least heavy retractors that would tear through muscle and tear through tissue is kind of brutal. And I realized open-art surgery, like, I know they have ribs spreader. Yeah, just so brutal. And I realized if I just am gentle, then when I would go see the patient the next day in the hospital, I'd be like, wow, this guy's getting up out of bed. He's able to engage his muscles. He's able to move so easily and move so quickly without having all this trauma to the joint. So everything that we traditionally do, so for example, like in a knee replacement, traditionally people put a tourniquet on your leg. A tourniquet for, you know, the case would take an hour and a half, two hours. It would crush your quad muscle. Right. For two hours. Right. And so then they would say, okay, get up and move. You're like, I can't. Someone, it's like a car was sitting on my leg for two hours. Right. And so these things, by eliminating all these little things that were involved with the classical aspects of surgery, I refine my technique to be less and less and less invasive. And I realized on the back end, the patients were incredibly happy and satisfied, but they could, they could, they could, they were like, I got rid of my cane so quickly. Yeah. And my patients sometimes, it's a joke, sometimes that what they joke about, they say, the physical therapist comes to their house typically the first couple weeks. And they open the door and the patient walks up to the door with nothing. And they're like, they're like, let's say it's a man and they say, okay, is your wife? Where's your wife? And she goes, no, no, I'm the one that had the surgery. They're like, but you're walking around. Yeah. And because the results are just incredible. Wow. But I also think that like the neuro connectivity to your muscles and activating your muscles. For example, like you go to the gym and you're like, I want to work on my glutes and my quads. If you do really focus exercises on those muscles, you start activating those muscle fibers. You start getting neuro transmission to those muscles to activate those muscles. So by the prehab we talk about is getting you into that surgery, whether it's a shoulder surgery or knee surgery or hip surgery, activating the muscles around that joint. Also trying to mobilize the joint, try to stretch. Prior to surgery. Prior. Yeah. Sometimes you can't because it's arthritic and it's damaged, but as much as you can to stretch and mobilize the fibers and then increase blood flow and connectivity to your muscles. And so then when you come in, your muscles are activated and you have a much better, easier time to activate those muscles again. I don't think that a lot of people think about getting in shape for surgery. Right. And we talked about this a little bit too. I had some experience with the NFL Alumni Association where they were, you know, these athletes after they had retired from the league were having, you know, surgical interventions. I mean, the ones that had trauma went right away, but the repetitive use injuries that, you know, built up over time and now they need rotator cuff surgery or knee hip or shoulder surgery. And the difference in outcomes just by rehabbing them, I guess, you know, in getting their hemoglobin, anyone see under control, getting their, some of their inflammatory markers like C-Recta protein under control, getting them good clean diet to lower their inflammatory cascade. Absolutely. So what would be in a perfect world, I'm coming in for a knee procedure, let's say a joint placement. Yes. And what does a pre-hab cycle look like for you? How far out and what does that map look like? I mean, we like to get to people as early as possible, obviously, for many different reasons. And I think that way I look at it is that we try to be the best we can be. We try to create the best surgery, minimally invasive, I use robotic technology. We're doing so much to make that operation great. But if the base, the foundation is poor, no matter how good you are, you can't get a great result sometimes. And so we love to get to people many months before. Let's say three months, even maybe six months if possible, to get them organized, especially with their inflammation in their body, to lower the inflammation, to work on their diet. And then also whatever supplements they need, whether it's like I'm a huge fan of your amino acids. I go all over the world and talk about the perfect amino, which is what I think is an incredible supplement. It's so easy. And we're right now with the patients, we're getting them on perfect, if they let's say they're not taking it and let's say they want surgery quickly, we will put them on perfect amino every day, all the way up to the surgery. And then, and then, and then at least for six weeks after, most of the patients love it so much. They stay on it for the rest of the rest of the time. They just want to get every single day. I take that. Yeah. H2 tabs and a mineral salt. Yeah, every single. And I do the same myself. You do? Absolutely. Yeah, I'm a believer. I believe. Look, if your pantry looks exactly like my pantry. So I do, I do it. I believe I'm a firm believer. And I just think that putting people on those programs, you're creating an environment for them to gain, prevent as much muscle loss as possible. So gain the muscle mass quicker. You're getting rid of the antioxidants in their body to just rid themselves all this stuff. But also remember, we're giving them a lot of poison. Yeah. We're giving them anesthesia. We're giving them narcotics. We're giving all these horrible medications that they, that they pages don't like taking them, but they have to in order to begin in because it hurts. But to, to rid themselves of all this stuff, is this these supplements are very key to do that. I love that you're talking about, you know, diet, lifestyle factors, even even even prior to surgery. And I know that you and I have very similar viewpoints on sedentary lifestyle. And you know, when I was really drilling into your background, you spoken openly a lot about how very often the problem is not in the joint. It's from the lack of mobility, causing the joint to now be dysfunctional. And I think that conventionally, you would think the opposite, right? The more I use it, the more I wear it out. But your discussions around snowyville fluid, snowyville fluid and things like that and that mobility is critical for the, for the life extension of our joints. Absolutely. And I think it's, it's, it's not only weight training, resistance training, it's also stretching, working on your flexibility like keeping the tendons and the ligaments around the joint flexible. So there's natural movement because we know if I put your leg in a cast for six weeks and your knee doesn't move, your cartilage breaks down. Your cartilage breaks down from lack of movement. Lack of movement and load. Correct. Okay. And because naturally when you move the cartilage is on the surface of your bones, they have water. The sonovial fluid goes in and out of those cartilage cells by movement. So the more movement you have in the joint, the more natural environment of the cartilage will exist and it will be better for your joints to move. But also it's the muscles around it. You know like we see there's spine patients who they get spinal cord injuries and they lose 30, 40% of their quad, they get knee pain. Yeah. They have a normal knee on an MRI but they're knee hurts because they don't have the strength. So it's making sure that they build up that power and that strength in their legs. But the I tell every patient, you need to walk every day. You need to get out and walk and move because it's so important, especially as we age for balance, for mobility, for your whole system. And I talk all about this all the time with patients is the kinetic chain. So the minute your foot touches the ground, there's forces going through your leg, through your back, through your whole body. And so by walking, you're activating that whole kinetic chain in your body. As opposed to just doing like a bicep workout or just doing like a quad workout, you're working on all the little muscles all throughout your body. Yeah. I mean, I think walking is so uniquely designed to do everything that we need to live a long healthy life. I mean, it's it circulates lymphatic fluid. You know, it's actually a part of our detoxification pathway. You know, that's why sedentary lifestyle is the leading cause of all cause mortality. Yeah. When I was in the mortality space, I was fascinating that sitting had become the new smoking. Oh, yeah. And as an orthopedic surgeon, you're saying it's just as detrimental to the joints. Absolutely. Yeah. It makes you joints break down. It makes you it creates a lot more trouble and degradation of your of your cartilage and all your joints. Yeah. But specifically the weight-braying joints. So somebody that's in a position where they are considering a joint replacement, you know, probably out in necessity. I mean, most people don't get them to done because they don't absolutely have the time. Exactly. Well, I want to talk about what's unique about this minimally invasive muscle-sparing robotic surgery because there are not a lot of orthopedic surgeons that are highly skilled in that area. And you are not just the thought leader, but you're also you train other physicians on these procedures. You're also affiliated with a number of professional sports teams, heavily weighted towards basketball for some reason. Yeah. Yeah. I just I've been work a lot in NBA and NHL too. Yeah. Yeah. Listen, there's what I share on this podcast and then there's what I share with my inner circle. If you've been following me for a while, you know how I hold nothing back here, but my VIP community, that's where the real magic happens. Picture this, you're struggling with energy crashes, brain fog or just feeling like you're not operating at your peak and you don't know where to get real answers. But here's what really sets this apart. You're not just getting my insights. When I have incredible guests on the podcast, VIP members get to submit questions for a private podcast segment. So that world renowned expert we just interviewed, you get exclusive access to their knowledge tailored to your specific situation. This section is under the private podcast section in the ultimate human community. And speaking of exclusive, you're getting my personal protocols, the exact tools I use for water fasting, gut optimization and morning routines that have taken me decades to perfect. This isn't theory. This is what works in the real world. Your community launches challenges throughout the year where you get direct access to me and my network of experts. It's like having a personal health advisory board for less than $100 a month. Your health is your wealth and this investment pays dividends for life. Join the VIP community at the ultimatehuman.com/vip and step into your ultimate potential. Now, let's get back to the ultimate human podcast. I think trauma is one thing, right? We understand trauma and sports and, you know, you know, anytime you apply severe trauma to the joint, you're going to actually need to have surgery. But repetitive use injuries is something I think is, you know, broad category where people have just worn the joints out or they've had poor biomechanics to the point now where they're considing or replacement. What makes what you do with minimally invasive robotic surgery? First of all, I don't think a lot of people really understand what robotic surgery is. Like, you don't eat the room and a robot does it? I don't know. Okay, because I feel like Tesla is going to try to do that soon with her. I've been going to a sauna or a co-plunge in while the surgery is having you. Yeah, they can already wash your dishes too. I mean, they can drive your car. Exactly. Exactly. No, I think that so what we used to do before robotics became the mainstream or sorry, not mainstream, but before we had the opportunity to use robotics, we were doing the same operation essentially for everybody. We were kind of aligning joints. They said, this is the best way for this joint to be stable and this is for it to be aligned properly. What we do with robotics is we get a CT scan of the joint. Let's say we talk about the knee. We get a CT scan of your knee. Now we know literally your alignment from your hip down to your ankle rotationally in all three planes of the body. We know exactly where your knee lies. And then from that, we understand the size of the bone, the approximate sizing of the implant. And then during the surgery, I stress your ligaments, your ligaments, not somebody else's, not based on some research number. It's basically how your ligaments respond. And then based on those responses, the ligaments, we get a set of numbers and I adjust on a computer screen the implant to accept your ligaments. So it aligns your body to exactly the way your body is aligned. So you get the proper center of rotation. So that allows your leg to be in the perfect alignment. Not somebody else's Gary Breckas alignment. Yeah. The way your knee is aligned and your knee is balanced. But also the sizing is perfect and the alignment is perfect. So we're literally putting it in because if you look at the data on total needs, let's say 80% say I like it. 80% say it feels weird. It doesn't feel like it's right because we're putting it in this weird way. Yeah, you can't put like a perfect hinge into somebody that has genuine values for genuine various or wide hips and narrow angle. Exactly. Of course, narrow hips and more of a straight angle. Absolutely. So you're accounting for that anatomical physiology on a per person, per patient basis. Absolutely. And also imagine someone has a weird shape to their femur, a weird shape to their ankle. They had a broken ankle years ago. You're getting your you're going to count for all of that. And then what also makes it incredible is this idea called haptic technology. So when you're cutting the bone, the robot knows exactly where the bone is in space. So the saw will never leave the bone. So really? Absolutely. So I'm a big guy. I'm six four. I did it held the thing in your hand like. No, no, no, no, no, it's on the robotic arm. I tell people like I'm six four. I weigh about 215 pounds. If I lean all my body against that robotic arm, it will not move. Really? When we used to do knee replacements and people still do them without the robot, the saw would exit the bone and that would cut all your tissue and create more scar tissue, more trauma, more damage. So the haptic technology keeps the saw or the cutting device within the parameters of the bone and it will never exit. Wow. That makes it so, so perfect. And that's really where robotics is a game changer. And now we have it for the hip, we have it for the knee and we have it for the shoulder now. And so the accuracy of putting those implants in and getting the actual center of rotation where your muscles work the most efficiently, where you have the best result with range emotion and stability. You get all that without having to like use like, you know, kind of primitive x-ray or something that you don't understand. Now you know three dimensionally exactly the way it's going to be. So when you have a selection of, I'm just curious. I mean, when you have a selection of like different prosthetics, you know, knees, for example, I always thought everybody got the same knee. No, right. So, you know, like striker just made, yeah, well, 200,000 knees and you just bought it and stuck it in there. Well, I know it's, it's, well, I use striker. That's who the robot robot a company. I know you're trying to show that. Yeah, but but yes, so they come in different sizes and different kind of alignments and stuff like that. And that's what you pick. So like, for example, like a woman may be a size two or like I may be a size five, but we have different sizes, but it's the positioning of that implant to get the best range of motion and the guest best movement. But also we're not damaging any tissue while we're doing that's the big thing, right? Huge. And patients are so, so my mom Judy Barkos and the audience with us today. My mom, she had bilateral knee replacement. Yes. I wish we had known him when you had your knee replacement. Because she actually had to have one redone. Oh, yeah. She had an infection in one. So they put a temporary in that the two-stage or yeah, that I think had like antibiotics in it to kind of clean up the infection. I know. It wasn't that's a tough recovery. Yeah. And truthfully what happened was, and I've talked about this a number of times. and I can say it while my mom is here is, you know, she went to this rehab facility, post-surgical rehab facility, and they didn't get her out of bed for almost 45 days, except for like restroom and things like that. Oh my god. And this was an issue because there was this little loophole where one of the rehabilitation specialists could come in, and if my mom denied therapy, they would get paid for the therapy and they would just leave. So yeah, I found out that this, you know, young therapist was coming in on the day she was supposed to see my mom, and if she said, okay, you know, you're ready to go, Mrs. Brecker, and she goes, oh, I think I need to, you know, go to the bathroom and she goes, oh patient, denied therapy. And by noting that denial of therapy, they didn't have to do the rehab. So it set her back tremendously. And then she had the neighbor placement and she was starting so far beyond behind the eight ball. The muscle losses from that. The muscle loss. Incredible. Incredible. And she's working her way out of it now, you know, I have a rebuildative specialist comes to the house, what, three, four days, four days a week. Dr. Evan, big shout out to you. And does the post-surgical rehab and gate analysis and things like that? And it's helping a lot. It's helping my father with this case. But I wish we had known about the prehab. Yes. So for someone like my mother, what would, you know, where we've decided, yeah, it needs to be a bilateral needs and you're doing both at the same time, right? Sometimes, yeah, the right patient. Yeah. And with this robotic surgery, what would that prehab timeline look like? And what kind of biomarkers, if any, are you looking at before? I mean, we like, I mean, we obviously work with professionals that do the labs and we like to look at, you know, A1C, we like, you know, we like to look at all the inflammatory markets to pro team, reactive protein, all these inflammatory markers said sedimentation rate, different things to make, see, look what people's inflammation is and also to look at all other aspects of their, their health, you know, whatever they need as many biomarkers as they can check, you know, to just make sure that like even heavy metals and all those kind of things to just get them detox of all these things because I just think that more optimized you are. But like I said, I like to, we have to people as early as possible. Yeah. Most of the time we have about three months, yeah, you know, to get them going. And so getting men prehab and getting them through that process where they're getting stronger, but we also empower the patients. We say, you're getting up day one, and you're getting up immediately. And that's your job. And we walking the day of surgery. The day of surgery, we are goal is to walk within an hour of the surgery. Oh, me so you're so nervous. All right. If you have sleepy, do your surgery, you're up and walking day one. So there's there's enormous amount of data showing that if you get up and walk on your joint replacement immediately, your confidence goes through the roof of trusting the joint. And I tell this to patients all the time, I'm like, your joint place is like a delicate egg. It's not going to break. It's so strong. This is metal and plastic. It's really strong. Right. So we get them immediately up. And then when they have that confidence, they realize, Oh, wait, I'm okay. Yeah, I can put my weight on my leg. Yeah. It's I'm not going to collapse. I'm not going to fall and break something. I can actually put pressure on it immediately. Yeah. And that's one of the reasons it's a good segues is one of the reasons for us. For me, we want to I'm a big passion. My big passion is controlling the episode of care for these patients is how do we get the right people to touch our patients and have access to our patients through that process? Because in the medical system now, it's hard. Yeah. Because in in a hospital, some therapists buy into the system, they don't. Some internists buy into the system, some don't. And so I have spent my whole life, my whole career trying to control that episode of care to get them the best physical therapist. The best person to check all those markers. Yeah. The best person to give them the right medication, the right treatment to get them through that process. And we're starting to evolve into that. Yeah. Where it's all about like all the things that you do that I love. I was very flattered that you invited me in to be a part of your rehabilitation facility. Absolutely. And bring some of my biohacking tools there. And we would love that. We would maybe even take advice on how we could do, you know, better recovery through absolutely. Yeah. And that's what we want. We want a whole system. Because I think like it's almost like, yeah, you have to have a surgery and it's a process. But you can save that person's life. You know, if you do this whole analysis on them and you realize, hey, you need to lose some weight. You need to get your inflammation markers better. You can make their entire life better. Yeah. You know, the level of activity, their level of resilience and strength, you can change your life completely. Yeah. I love that. I also like that. Your outside the box. And you have a very progressive attitude towards things like PRP, exosomes, stem cells, and fascinatingly and very exciting peptide. Yes. You said that you're not only on peptides yourself, but yeah. Which is a good time. But you know, talking about peptides specifically for a moment, what peptides have you found in your surgical practice and your rehabilitation of patients post surgery have been the most effective. Like, what do you go to? So my go to is our BPC 157, TB 500 and Ipa morlin, which is a stimulation of your own growth hormones. Yes. Those are the main ones that we use and those are the ones that we tend to see great results with. And the peptides have been a game changer because we're putting people on these peptides and the lot of them are getting better without anything. Like I had a guy in the office of the day who had a rotator cuff tendonitis. We put him on BPC 157, TB 500. He texted me a month later because I'm in 80% better. Right. So it's incredible. And then I have my own story about peptides. So I had all these patients on peptides. I had this horrendous achilles tendonitis. It was so bad. My patients are like, Hey, Doc, why are you limping around? Yeah, it's not good to be limping as an orthopedic surgeon. Dude, it's not a good look. It's not a good look. It's like being a skinny chef. So I had this. And so I had a few patients actually a copage vagus and they were all on peptides. And I'm like, you know what? I just got to put myself. I put myself on it six weeks. Shirt. I had it for two years. Yeah. It was gone. Like 90, like if someone hit my Achilles, I'd like go through the roof. It was so painful. And so it literally just healed it. And so I'm a huge believer in it. I also think for me, I'm a surgeon. But my single, the principal that I've lived my life by is how do we avoid surgery when people come to me and a lot of people come to me in LA and from all over the country because they say go to snibby because if you don't need the surgery, he will tell you really because I always say I'm more, I'm more popular from the people I did not operate on than the ones I did. Because I like to, I like to look at things and look at there. And I asked the questions. I said, I was, I was told patients, I don't operate on your MRI. I have a brain how you feel. I love that. You saw that in your record. You could have, you could have a meniscus tear, a little arthritis. And you say, well, I can play golf five days a week and I'm exercising working out. So I'm like, well, what's the problem? Just go keep doing it. Yeah. And then the other thing is all these injections, these injections help continue the process of healing and promote healing into the joints, increase blood flow, lower inflammation. And all of these, these injections that we do, whether it's PRP, whether it's exosomes, are going to keep evolving. And you're on top of this data so much. No question. We're just, we're just at the tip of the iceberg of this thing where we're going to be able to modulate these things based on what you have. So they say, okay, you have arthritis. This is what we use. You have meniscus. This is what we use. Rotator come to the night. This is what we use. And I think that that's the key for me is that I'm always asking the question, how does this affect your life? How is it? How is it? What's the impact? I'm like, and I always tell them you can always have surgery. Right. You can have surgery tomorrow. You can have surgery three years from now. You can, I can always operate on you. And if I do it, I'll do a good job. Right. But right now, you don't need it. Go get your biomarkers better. Go get your nutrition better. Lose a little bit of weight, get your diet organized. And let's see what happens. You know, I'm all about optimizing performance. And lately, I've been using the ion weighted vest during my workouts. And it's been a game changer. It isn't your average weighted vest. It's designed to fit like a second skin, activating your core and proving blood flow and even helping you with recovery while you train. What I love most is that the weight is perfectly distributed. It doesn't pull on your shoulders or throw off your alignment, whether I'm doing strength training or cardio or just taking a walk. I'm burning more calories, building muscle and pushing my endurance even further. If you're serious about leveling up your training and unlocking your full potential, check out the ion weighted vest at iongear.com. That's a-i-o-n-gear.com. And you can use code ultimate for 10% off and start training smarter today. Now let's get back to the ultimate human podcast. You know, you and I have a friend in common, Ram Dandelaya. Yes. Ram Ram Ram Ram Ram Ram Dandelaya. Every every other Indian doctor I know is named Patel. So he's like, exactly. I think you almost have to be a Patel if you're Indian in your doctor. It's like, I think so. There's a lot of Indian doctors. - Yes, in India. - Yeah, yeah. - So, but he and I connected over Dana White's journey was his cardiac doctor. And he's out at Senors where you are. What I really find fascinating is what you guys are doing with this more than $100 million center that you're building for, not just surgery, but pre-imposed surgical rehab, bringing biohacking modalities like red light and hyperbaric chambers. And things like that to the table to really help patients accelerate their healing process. But at the same time, just improve their cellular biology. How is it that you're such a classically trained alopathic physician and surgeon, but you're willing to consider and you're open to some of these biohacking modalities and therapies that I would call non-mainstream. - Like red light and hyperbaric. - I think that when, like we said earlier, I think that it's like you're an artist, right? And you have a canvas. You want that canvas to be good quality canvas and that you can paint on. You make that beautiful picture. So if the canvas or the patient is not quality, they don't have good tissue or good metabolism and good health, no matter how great of a painting you draw and no matter how great of a surgery you do, you're gonna have a bad outcome. You're gonna increase your infection rate. You're gonna have wound healing problems. You're gonna have muscle wasting and muscle loss and sometimes they can never gain it back. And so like I said earlier, how do we control the episode of care? Because it's not a transactional thing. We're like, okay, you come in here, you have a near replacement, goodbye, I'll see you later. It's now a process where we can take them through and try to control some of these things and also mitigate risk and try to make sure that they don't have, they have a lower chance of, given the best chance for the wound to heal, put them in a hyper-oxygen chamber, put them in red light to increase blood flow. So the wound healing is better. So they get better blood flow to their muscles and their microvascular. - Yeah, it talks all about that. - All of that stuff is just such a huge part of it. And I think that for me, I've always thought, that's why I embrace robotic technology. 'Cause I said, this is where we're going. This is where the technology needs to be. And I don't wanna be in the back seat. I wanna be driving this. But then by building this beautiful hospital that will be done at the end of this year, you'll come see it. - Yeah. - We'll have-- - You're literally building a hospital. - Building a hospital, 70,000 square foot hospital. - Can you say building? Ground up? - Ground up, from ground up. Just a beautiful, gorgeous hospital that we can control all these aspects. So we can put hyper-barred, red light inside of it. Because when you work in a hospital system, there's so much regulatory issues that restrict you from doing the things that you really wanna do. And so I said to myself, I said, how do I, how can I make the experience on all levels amazing? But it's also, like we said earlier, the non-surgical patient. You know, you have a meniscus tear and you're gonna get an exosome in your knee. - I love that. - I want you, I want you doing all this stuff too. You know, I want you doing the red light and the hyper-barric and the peptides and the aminos. I want you on all this stuff to optimize your recovery. Even surgical or non-surgical. - Yeah, I love that. I mean, and I think the, I think the future of medicine in general is this whole patient approach. - Absolutely. - Absolutely. I think, you know, for so many decades, we've only treated the one little narrow symptom that's presented, like, you know, you know, the joint has degraded, let's replace the joint. And we just focus on that event, not this pre-abilitation and post-abilitation, you know, I had a North Peter Surgeon named Dr. Alex D. Simone and I'm grateful to that man to this day, because in 2009, I had an ACL, an MCL, and I actually clacked the lateral half of my tubular plateau in a bad knee injury. I wish I had a great story, the story was terrible. (laughing) I'm gonna make something up, so it sounds like heroic. But the truth is I'd had a few cocktails and decided that the one Jiu Jitsu class that I took at the YMCA qualified me to wrestle a D1 wrestler that was my business development director. - Oh my God. - And it was like this short little spark plug and we got to chat and at the board and insurance conference and I was like, hey, let's just go up to the room and figure it out. I'll hit toss you all over this place and I was like, you know, it's like one of those like, you know, like the guy that's taken two boxing classes and I'm like, no, don't grab me like this. Grab me like this. Don't stand there, stand over here with this like here and then I'm gonna like throw you across. He's like, we're gonna wrestle, we're gonna wrestle. Yeah. And he handed me with my ass and in the process, you know, broke my like dislocated knee. And but I remember what he said to me after surgery was and he said, I need you to hear these words because it's the most important thing you're gonna hear for the rest of your life. And this will determine the use, your pain level, your functionality for the rest of your life. He said surgery is 30% of your journey and your surgery went exceptionally well. I did a great job. You got great tissue in there. Joined's very healthy. He said 70% is going to be how dedicated you are to your post-operative rehab. And at some point, you're gonna feel like your tearing pages out of a phone book, meaning like your progress is gonna be so minimal. You know, for the first few weeks, it's like big progress. Yeah. You know, and I never forgot that. And I just, I hardcore dedicated six months of my life to just rehabbing that joint. And, you know, a few years later, I was age group champion for the state of Florida and medium and distance triathlons. I was, you know, and to this day, God bless him. I have zero pain, no loss of range of motion. That's great. You know, knock on wood. But he was, you know, I think a lot of patients think, okay, surgery's over. I'm going back to normal life. And they don't think about how much care do I need to give to this so that it doesn't, I'm just not buying myself a problem and telling you. Absolutely. And I tell patients all the time, like I take care of professional athletes. And yeah, you're, you're, you're roster, not to interrupt you. The LA Clippers, the Lakers, the Sparks, the Kings, and the Angels and assistant team physician ties to the Dodgers, Galaxy and others. I mean, you're, you're a monolithic mega giant. He's been very humble guys. Thank you. Thank you. You know, with his career, professional sports. And I was, say, like, when you, when you take care of professional athlete, they're back playing sometimes at six months, but then you have a conversation with them. And you say, when did you feel, if you ask the question, when do you feel like you were back? Like when did you feel like you were explosive as you were before you got injured? And a lot of them say a year. Yeah. Many of them say a year because it takes that long for those fast twitch fibers in your muscles and the explosiveness of your body to, to, to be able to do that. It's also really important for us as orthopedic surgeons to look at the whole body. Like someone comes in with knee pain. You got to do a good back exam. You got to do good hip exam. You really have to check other parts of the body. For example, I had a patient that a day who I did a knee replacement on, he goes, my knee replacement is hurting. I'm having trouble. And I examined him and his medial cladoligment was on fire. Like I just touched it. He went through the roof. And I examined him and examined his hip. His hip was arthritic. He'd worn out his hip. And I'm like, because your hips are arthritic, you're cranking on your knee too much. So guess what? We replaced his hip and now he's great. Really? No problem. By looking, not being so hyper focused on that one joint is really looking at the whole person. What other surgeries have you had recently? Have you had abdominal surgery? Have you had a back surgery? How is your life right now? Are you under a lot of stress? What's your work, life balance like? Thinking about the whole person is very important to understand what makes them tick, but also how to organize and customize their recovery and we're planning for their surgery. So you're building a hospital. You also launched your own shoe brand. I did it. Which I think is so awesome. It's so fast. It's great. Actually, it's really a fun project. Yeah. I mean, specifically designed around. Sounds like you did it out of need because, you know, designed around people that are on their feet for longer, long periods of time, which I wanted to in a hospital. And those are concrete or hard tile floors. Absolutely. You know, and standing on all that. I mean, I just noticed it walking around my own place because we've got tile in here. Yeah. If I walk around barefoot for too many hours, just being in here. I, I, it's a lot of stress. Yeah, it's a lot of stress. Yeah. So I spent about four years. My, my partner is a chef and I'm a surgeon. And so the two of us look to each other. Chef and a surgeon got together made a shoe. Really? Okay. Good. And so we, we said, our shoes are so bad. You know, we have these clogs that you can barely walk in. Where people just wear like a pair of Nike's or, or ASICs to the, to the hospital and the, the fluid gets through it and the padding in it wears out after like, let's say two, three months. And so we said, we spent four years designing a shoe, working with materials and testing them and going in the, I would go in the OR with them and spend days working with them. He would work with them and, and as a chef. Yeah. And we slow, and we put them on our friends and family and say, okay, how does this feel to you. And finally, we developed a company called Snims. It's a - It's not. - It's an IPS. - SNI PBS. And we created this amazing shoe. And then we also now have multiple levels of shoes. We have shoes that are waterproof and slipproof. Most of them are slipproof. We have a work boot. We have a clog. We have all different kinds of shoes for different environments. And it's really not just a doctor-chef thing. It's for anybody. Anyone that works on their feet, anyone that's out working and walking, people wear them to work out, people wear them for long walks. And people like we have people wear them on movie sets when they're working those 12-hour days, all kinds of environments. But it's to basically take the stress of your body away. And we always say, I would say about the shoes. It's like, I want you not to think about your feet at the end of your day. I want you to come home and think about, okay, how am I going to enjoy my night? I'm going to have dinner with my wife. I'm going to go do something relaxing. I don't want you to say, oh my gosh, my feet are killing me. Yeah. And so, and we realized by making great shoe wear, you take stress off your knees, off your hips, off your back. And that makes you perform better as a person. It makes you feel better as a person. And it also, we're also realizing that we're minimizing injury. And so we've done a couple projects. Actually, one of them was at Caesar's Palace in Vegas. We gave two 300 people shoes and none of them had a slip and fall. Over the course of about a six month period. And so we're realizing that we can actually have the potential to minimize injury. Is this because of the floor grip they anti slip? Exactly, the anti slip and also the fact that the shoe really captures your foot. And we also designed the shoe to allow for swelling. Now, your foot swells over the course of the day. It accepts that. And so those, we're realizing that we can actually even benefit the patients, and sorry, excuse me, the patients and also the employees by not having injury, which can take them out of their life and cause horrible problems for themselves. And what's unique about the padding? Is there something? The padding is a special kind of padding. It's a special rubber material that we proprietary designed that basically has resilience and cushioning, but it doesn't wear out in three months. It's not the same stuff that, like if you have a running shoe, like a hoca running shoe, the hoca running shoe is very cushy and bouncy, bouncy. It's great for about three months. Right, but after about 50 miles, I think it's what my son says he replaces him after. Exactly. So after that, it goes, but our shoe, we're not obviously running in them, but they have much more resilience. So they last a year, a year and a half of that cushioning. It's much more resilient. If you know me, you know I'm a huge believer in the benefits of hydrogen water. H2 tab delivers cost-effective portable tablets that generate ultra clean molecular hydrogen at 12 parts per million, one of the highest concentrations on the market, with over 1300 published studies showing benefits of oxidative stress, energy, recovery, brain function, and so much more taking charge of your health has never been easier or more cost-effective. Just drop a tablet in water, let it dissolve, and drink it back. It's less than a dollar a day. Science-backed and part of my daily routine. I never travel without this, and it is my favorite biohack. Visit drinkh2tab.com. That's drinkh2tab.com and upgrade your hydration today. Okay. So for you, you know, as an orthopedic surgeon, being in this minimally invasive category of robotic surgery, which I'm an enormous fan of, where do you see the future of orthopedic surgery going? Like what's like really exciting for you on the horizon? Is it faster healing through things like stem cells and peptides and exosomes and different biohacking modalities? Or is there new technology on the horizon that you've got your eye on that you think is gonna revolutionize orthopedic surgery? Or do you consider what you're doing right now to be the absolute most cutting-edge thing available? I think that I don't think that I think we're always changing and moving and learning and things of just being, and they're going faster than they ever have been. I think the future of orthopedic surgery will be even less invasive than what we do now. I think that we have the ability with the robot at some point to have what they call automation, where you basically, you know, you open up, you make even smaller incisions that we make now, where the robot can go in and prepare the joint or prepare things for us with cutting even less tissue and even less materials. You have to still make an incision to get the implant in there, but even less trauma to the soft tissues than we do right now. And so I think that's really important. I think that we already are using AI in when we get the CT scan, AI kind of prepares a 3D model of the joint for us. So we use AI already, but there's gonna be even more AI on data. So what there's gonna be happen is that in the future, it's gonna be like, okay, I think this person should have a hip that looks like this. And they're gonna say, well, of the last 5,000 hips that were done in the United States, that have a hip just like this, this is the decisions that they made. They use this implant, they use this sizing, this positioning, and those patients had 98% satisfaction. So we'll be able to use outcome data to correlate live during surgery to make sure that like, we wanna make sure that this person has the best result. - Wow. - So that's a big part of it. There's also some, you may, you've been knowing more part about this than me, I do, but there's also some data about muscle mass. He's special MRIs now looking at muscle mass. - Oh yeah, I am. - And all these, and looking at the quality of your muscle. So part of that prehab is that, how do we quantify muscle mass? Like, how do we know? We don't know, like someone comes to me and they have a bad hip, they've lost a lot of muscle mass in their glute. Did they lose 50%? Did they lose 20%? We don't know. So understanding the value, a quantitative value of like, how much muscle mass you've lost, and this is how much you need to gain. And we can check them post surgically to say, you've gained back 80, 90% of your muscle mass now. - Wow. - And so those are some things, but I also think the biggest part of this, in my life will be all of these biological things that we can do to patients without having surgery. - Yeah, I like that. - And how do we treat joints? For example, when you tore your ACL, right? Like, should you have gotten like 10 injections of exosomes over the course of a year, into your knee to protect you from post traumatic arthritis? Like, what are the things that we can do to prevent these things from happening? And also we're seeing people get arthritis and damage in their joints just from wear and tear, but also from metabolically, right? - Yeah. - Like women, their post metaposal, they lose their estrogen, they all of a sudden they wear out their joints. - Wow. - From lack of estrogen. And so how do we understand that better? How do we understand why you have so much inflammation in your body, because your diet is horrible, that your knee wears out? - Right. - And so it's understanding these things on a higher level, I think is gonna be the most incredible thing where people will, all the things that you do, they're so incredible that everyone will have access to that. - I love that. I mean, what's an example of somebody that had, let's say, ortho-ridic knees and you use some other intervention besides surgery? - Absolutely. - What ways have you intervened in that? - So one of the simple things is meniscus tear. So classically, if you tear your meniscus in your knee, an orthopedic surgeon like me would say, oh, we're gonna go in there and nibble away that meniscus. Well guess what? 30% of those patients, which is a big number, end up within three to six months with a knee replacement. - Really? - Because by just mucking them out and then - Going in and cleaning it up. - Going in and cleaning out. Just that little clean out, it's trauma. You know, surgery's trauma. So you're creating trauma inside the joint, which makes the knee deteriorate. So those patients, the simple injection would be platelet-rich plasma. You draw some platelet-rich plasma, you spin it down, you inject it into the knee. Sometimes if they have a little bit of arthritis, I'll put hyaluronic acid with it. But that simple injection, many patients get 70 to 80% better from one injection. - Really? - Absolutely. - ERP or hyaluronic acid or exosomes. - Or combo of that. Or sometimes we'll do exosomes. But the thing is, we get patients better with that simple meniscus injury. And I tell patients all the time, 'cause I'm 53 years old. If I tore my meniscus, I wouldn't let anybody touch it. Because I see so many problems with this meniscus surgery. And so I treat them with exosomes, with PRP, a good physical therapy, supplements, and then they get through it. And they're back, they're back on the tennis court, they're back playing golf, they're back exercising, and they're fine. Some of it takes a couple injections to get them advanced to finish life. - Yeah, but I mean, a couple of injections versus a full joint replacement is, or a surgery and then a joint replacement. - Absolutely. - You know, is a much easier road. - Much easier. And that's something that is, in my, in my, unfortunately, it's not the mainstay in all practices, but in my practice, that's what we do every time. - Yeah. - And that's why a lot of people come to me. People think like, oh, they come to Dr. Simi, because he's just gonna operate on you. They come to me all the time, they can say, I heard you do this PRP in the hip and to get me better. - Yeah. - And they're like, that's why I'm here. I saw three surgeons, they all want to operate on me. - Right. We do PRP and they're like, I got better and I can't believe I was going to have a surgery and you just fix me with a simple little shot. >> Yeah. And even in arthritic patients, these exosomes, the platelet rich plasma highly erotic acid, you see improvements in those arthritic knees that may not have dramatic anatomical issues, but pain. >> Absolutely. And then obviously every patient is different. I mean, we analyze the MRIs carefully. We look at the deformity of the knee, how much disease they have, how much they don't have. And I would say when you come to me, it's like a picture. I'm taking a picture of your knee in this one moment in 2020-6. And things can change and move. And sometimes it doesn't change. But we try to optimize that joint and get that joint happy as it can be right now. >> Yeah, it seems like I have a lot of friends for some reason right now that are having total shoulders. And not a single one of them has not told me that it was the most brutal thing they've ever been through. Like even though they prepared for it before surgery, like coming out of it, the length of time getting back to full mobility for them, TJ Dillish Halls, one of my buddies, BLC fighters, getting ready to have one. But I have a number of friends that have had them for some reason. And I wonder if there's, in your case, do you do? >> Yes, I do. >> Okay. And are there minimally invasive robotic procedures that lessen that kind of recovery time? >> Absolutely. So in a shoulder, a shoulder is a unique joint because it's like, I call it like a golf ball and a golf tee. The socket is a tiny little bone. It's called the glimmer. It's tiny. It's like, it's like some of them are like a quarter, maybe a little bit bit. It's like, it's a tiny little bone. The ball is big. But to put an implant on that little bone, that little golf tee, the socket is very difficult because you have to fire a pin down the bone that's in the perfect alignment. And so the robot, which is incredible, I was on the development team for the robotic shoulder. The ability to get that pin in the perfect position every single time with the robot is like, as accurate as it can be. It's incredible. And so that makes a big difference because now you're putting the implant in the right spot, but also you're minimizing bone loss. So remember we talked about haptic technology. The robot prevents you from taking too much bone or causing too much trauma around the joint. And so the robotic technology will make a big difference. It is making a big difference in the way people recover from those surgeries and the way they respond from those surgeries because sometimes the preparation of the bone and all the tissue causes a lot of trauma around the joint. Yeah, just getting in there. You're going to do a lot of damage getting in there. But also the issue with the shoulder too is like we talked about muscle mass. A lot of these people have these very arthritic shoulders that don't move. And so they have a lot of muscle wasting. So it takes them a very long time, sometimes a year to gain all that muscle back. But again, by doing things like perfect amino, by taking certain things in your body to help maintain your muscle mass and build your muscle mass. Because sometimes just you on your own eating, you know, fish and vegetables is not enough. Right. Right. So it's just a picture shoulder. Exactly. So you need supplements that will help build those things. Yeah. Dr. Steele, this has been amazing. I know my audience is going to be so excited to listen to this podcast and tear through this information. I love thought leaders like yourself that are really patient-centric and thinking about what is the best possible outcome for this patient to get back to full life and forget the surgery ever or even happened. And the focus on pre-abilitation, post-abilitation, minimally invasive surgery and the use of things like peptides and stem cells and exosomes and platelet rich plasma and all of the biohacking modalities, you know, tells me that you're really focused on the whole patient journey. And I really applaud you for that. I wish you know more of alipathic medicine would take this whole patient approach. It's really exciting. But so for my audience, I want to find out more about you. Where can they find you? So they can have on social media. Dr. Jason Snibby on my Instagram on Facebook. I have a website. Dr. Jason Snibby. Okay. So they can find me all over. Okay. I'll put links to both of those in the show notes so people can find it. And I'll put links to your new, when is your new, this new hospital? Those will be done being built in December. Oh, yeah. We're crazy. And then we'll probably do our first cases like January, February. Okay. And is this all outpatient? No, inpatient. You can stay overnight. Wow. So we'll have physical therapy in the place. They'll say a few nights, you know, and then they'll go home, but we'll have all of that there. And then we're going to, and then we're building out this whole thing. So we want to do this whole longevity kind of thing. Well, I'm going to do it with you. Yeah. I love it. I'm I would love that. We are dream. Yeah. Yeah. So I'll come out and see you next month. And we'll talk about how we build the most impactful rehabilitation center for this post-urgical patient that the world's ever seen. I love it. So I wind down all of my podcasts by asking all my guests the same question. There's no right or wrong answer to this question. Sure. But what does it mean to you to be an ultimate human? To be an ultimate human is to be a person that for me, to be, to help people, to really, really help people in what they, they're, they're struggles in their life and obviously for me orthopedically. And to be an ultimate human, I want to do whatever I can on every level of their life to make them move and perform and, and, and, and go through life, comfortable and happy and strong. And to me, that is the ultimate for me being the, that is what I would say is the ultimate human for me. That's awesome, man. Well, I think you're an ultimate human. So thank you so much for me. That means a lot. Yeah. Thank you. Thank you for coming on the ultimate human podcast. We're going to head over to my VIP room now. I've got some VIPs waiting for you to ask questions. They, they knew you were coming on the show and they, they, they, they asked a list of questions. So we'll go in and, and speak to those guys. And until next time, guys, that's just science.