Ending Knee Replacements with Regenerative Medicine, Dr. Marc Pietropaoli

Welcome everyone, I'm Will Sanchez. This is the man or the pedic surgeon, the sports miss and specialist Dr. Grant Garcia that apparently is busing my child because I just have a cute little knee here. He's like step up your, your AI game because he's got Dr. P's whole book back there. Listen Garcia, but I'm telling you right now, we're not doing this for 60 minutes, all right? Let's just, let's just cut the chase. Anyway, how are you? What's going on? Talk to me. I'm good. It's a finally sunny in Seattle. So that's a rarity here. We're taking advantage of it fully. So yeah, so things are good, busy, usual, excited to have our guests, really excited to talk about something, you know, a little more of the non-operative side of things too, but in different operative as well. So it'll be a good interesting topic other people talk about because as surgeons, we love to talk about surgery, but surgery is not always the answer. So it's a really good idea to have a conversation about this. And this little thing, I get a lot in my office patients come in, they don't want any of your placement, they want to talk about alternative options. So this will be really good. I'm from an orthopedic surgeon, which is great. So I'm looking forward to talking about our guests and everything else. I agree. And when you talk about surgery, we like to talk about recovery. Let's talk about our folks at the recovery shop and Mike B. So big shout out, I've gotten a lot of traction with this. I've had multiple doctors asking about it because they're interested. They get the same thing I get. You know, I just had a doctor a couple weeks ago call me about this. He said, I'm, my patients are asking for more. They want nutrition, they want newer tech newer things for post operative. And this allows us as physicians to offer to our patients. And it's kind of a one-stop shop. It's one, it's really nice too. And a benefit that I found is the patients don't have to go, you don't have to go through your list of things for a 10 minutes in the office and recommend things, right? It's all there already for you. So it saves you time in the office too. And the experience for the patients is much better. So it's a combination. It's a win for everybody. So thanks sponsors. All right, let's get to our guests. I'll do a quick little intro. Dr. Mark Bietro Paoli. Dr. P, everybody's going to go Dr. P. He's the founder of Victory and Motion, a number one Amazon best selling author. First surgeon in the world of performance specific FDA approved ACL repair procedure. We're going to get into all of that. He's treated over 30,000 patients and his mission, his actual state admission is the end, the need for knee replacement surgery by 2043. That's really specific. So I can't wait to get into that. Why 2043? That's not a tagline. That's a challenge. And today I'm going to find out if you can back it up. Dr. P, welcome to the show. Thank you for joining us. Well, thanks Will and thank you Dr. Garcia. Great to be here. Great. We appreciate it. Thanks for the kind intro. Thank you. Listen, let's let's take a rayback. Your third year medical student, 1994, first year for the pediatric rotation. You walk into that OR, surgeon looks at you and says that. Listen, knee cannot, cannot be repaired. And what were your thoughts? Were you like, yeah, okay, that makes sense. And let's just go about our day or was there a light bulb that went off in your head when you heard something like that? Yeah, well, I think, I think Grant, I think you'll appreciate this because you know, as a medical student, you go, you show up. And I'm sure, you know, I wanted to either be a fighter pilot, a rock star or a sports medicine doctor. And my eyes weren't good enough to be a fighter pilot at the time. And I'd probably be, you know, my parents would have never let me go into, you know, a rock and roll drummer. I probably wouldn't be talking to you guys. I'd probably be dead or something. But I had to choose the lesser, you know, and my, my uncle was a doc. And I said, I want to be a sports medicine doctor. So you got to be an orthopedic surgeon. So I was like, all right, I'm going to be an orthopedic surgeon. So it was at the end of my third year of medical school, which as you know, at least that, and back then, it used to be you did all your clinical rotations. You know, you finally got into that in your third year. So you're excited to get to see everything in ortho was my last one. So I had seen everything else. I liked it. And then I find out the next day, I'm going to be watching a new replacement performed by Dr. Murray, who was the chairman of our department, but he's also one of the original inventors, David Murray of new replacements. He invented his own new replacement. So I was all excited about that. Show up early, the junior residents, like Mark, you know, you're a medical student. You're not going to scrub and just kind of stand over in the corner there and don't touch anything, right? Don't touch anything. And then he says, but if you have any questions, feel free to ask. There's no such thing as a dumb question, right? How many times did you hear that? And that's cool, right? So the patient gets wheeled into the room. I'm all excited. You know, the nurse is transferred to the patient on the operating table. The anesthesiologist puts the patient to sleep. Dr. Murray comes in with the chief resident. They prep and drape. And then next thing I know they're making this huge incision and there's power saws and there's hammers and there's metal and there's plastic and there's cartilage and bone flying all over the place. I was super excited because my dad taught me how to use power tools because he'd put himself through college and law school. So I was like, I was like, oh, this is great. I get to fix people with the saws and hammers and chisels and stuff. And then I looked at that huge incision. I was like, well, this is whoever thought to put metal and plastic and somebody's needed it would actually work. But, you know, obviously, Dr. Murray did. And then I was like, this is actually kind of gross. So like, there's stuff going all over the place. I couldn't believe how huge the incision was. And then I was like, it's kind of barbaric. There's got to be some other way. I was like a star track. I like bones, McCoy. He had the tri-cordy. You could look inside somebody. And then you could treat them without, you know, even cutting or needles or anything, kind of like a, you know, ultrasound and a laser nowadays, you know. And so I remember what he said is that you can ask any question you want. So I raised my hand up. And, you know, he looked at me like, this guy's actually going to ask a question. And then the, you know, the anesthesiologist is kind of looking at me and the nurses are glared at me. And, you know, nothing happened. So I started to put my hand down. And then Dr. Murray looked over his glasses like, Mark, you have a question. I said, yes, Dr. Murray, thank you so much. Let me be here. It says amazing. But my question is, is there like, is there any way to cure arthritis? Is there anywhere to grow back carlages? Is there any way to repair any and not replace it? And before he could even get a word in the chief resident points, I was like, there's no cure for arthritis. There's no way to grow back carlage. There's no way to repair any and not replace it. So at that point, grant, right? I knew that there was such a thing as a dumb question, right? So I was very embarrassed, but yeah, well, the light bulb went on. And I'm like, I'm going to somehow I'm going to figure out a way to repair an ease and not replace it. I'm going to prove that guy wrong someday. And now, you know, like you alluded to, I 35 years later, I wrote a book. So repair, not replace. And it all kind of stemmed from that embarrassing moment. That's awesome. That's it. You're, you're, uh, your surgeon must have been like, oh, boy, I got one of these. He's going to be, he's going to be one of these difficult ones. You know, I was thinking about, you talking about being a pilot, I think everyone that saw a top gun in the late 80s, going to 90s, wanted to go into the Air Force or Navy and fly some, uh, some planes here. So I digress. I do this. It's hard to make a sequel that was as good as, you know, I thought the sequel was great, too. That's funny. You mentioned that. I mean, it's interesting. My first surgery was also a year placement. And it wasn't that level of, uh, I didn't have any, uh-huh moments. So maybe I should have thought about this more clearly. You're on a better chapter than I am. Uh, but the, but nonetheless, the, um, the points you're bringing up are really interesting, right? It's like, these a lot of these things stem from early on when we do them. But what's even more interesting is how you describe that event and Will was sitting there like, Carla just flying everywhere. It's like power saws. You know, some of the audience members are going to be like, oh my gosh. And I'm like, think, I'm like, okay, continue on. I like the details. This is awesome. So yeah, it's just, it's just fun to hear the, those intro stories. It's loud, right? It's really loud now. You don't realize how loud it is either. Well, you don't, if you're not used to it, right? To me, that's like, that's like my hum, right? I can like, that's, that's like, when I hear those sounds, those are what get me like, I'm like, oh, I hear, um, drill. I just, like, yeah. I just say you see how it goes, but other than that, we're good. Yeah. So talk about more about this. I mean, we can pull up the, we can pull up well, that slide for Dr. P. But kind of go through this process with you. I mean, you talked about where you kind of thought about it. So explain this more and how you kind of developed this in your practice because this is your practice, right? Up in, uh, are you up in Buffalo? Where are you up in? Dr. Syracuse, New York, excuse your case, your case, yes. Syracuse, yeah. Yeah. So, uh, well, you know, it will kind of to answer your question. Dr. Murray was one of the kindest gentlemen you can ever imagine. And I did feel as though I was going to get reamed out because he, he, he, he came up to me afterwards. And I was really nervous. I'm a third year medical student. And he's like, you know, Mark, that was a really good question. Uh, sorry, you know, he apologized for his chief resident. And um, he said, you know, maybe someday there's no way to do it right now, but maybe someday you'll come join us and you'll figure it out. So I really, that really met a lot to me. And I actually, that's right. I ended up doing my, my residency in Syracuse. And I'm telling you, we learned how to operate. Like, that's how you get good. So we did a lot of surgery tons and tons and tons of surgery. And that one of the reasons I chose to go there is because the residents got to do a lot of the surgery. So I became very, very, very good at surgery. But I didn't really, we didn't get a lot of patient care and nonoperative care or any of that stuff. We just heard all these patients do great. And what do we know, right? We didn't even barely see him before or after the surgery. We just did a ton of surgery, rounded in the hospital and then they were gone. So when I went and did my fellowship with Dr. Andrews, who is just, you know, the most amazing sports medicine doc of all time. He just recently retired. But just an amazing man. And that's where I learned how to take care of patients. Everybody knows him, you know, those of him as a surgery operating on all these elite athletes, Roger Clemens, you know, Drew Breeze saving his career, all these athletes, Tommy John surgeries. And but he probably could have done three or four times the amount of surgery that he did. But he always, you know, said a great surgeon knows when not to operate because you can definitely get into trouble, as you know, right? And complications can occur. And he had a great physical therapist, Kevin Wilk, who's still, and I'm still working with Dr. Wilk. And, you know, I would, I would like 80% of the people Dr. Wilk and his team saw and never needed surgery. And so he said, lead athletes would come down and they'd be like, I'm going to have surgery. And they're like, no, you're not. We're going to get you better without it. So that's kind of where I learned that, even though he did like maybe 20 surgeries a day, he could have done 40, 80, who, I mean, he was just under very high demand. And Kevin, I would also say that because I learned surgery so well during my residency, I didn't have to do extra surgeries during my fellowship. We did a lot. But I also had time to go into the clinic and do a lot more clinic work and also go into the PT. And that's where I heard you, Grant, talking about this in one of your videos, how it's such a team effort. And you have to coordinate all the different factions, the PT's, the ATCs, the strength coach, the coach themselves, the, you know, the agent, the mom, the dad, the family. I mean, all these. So you really learned that and you know, I learned a lot of preventive stuff down there. I learned about diet and I learned about a total body rehab. Kevin Wilk has some, you know, he didn't just work on the knee. He's working on the hip and the ankle. Well, the person's standing on a, on a bounce and he's throwing balls at him and stuff like that. So I really learned a lot about nonoperative and even laser. Like I've talked Kevin one day. I saw him waving this wander on on someone's shoulder. I'm like, what is that? A tricorder? He's like, no, no, no, it's a laser. I was like, what does it do? He's like, well, it increases blood flow. It stimulates the mitochondria. It helps with scarring and and I said, well, why are you going like this with it so fast? He said, well, I can burn it. I thought, oh, that's kind of dumb. Like, why would you ever want to do that? But further on down the road, eventually, you know, that at least those things peaked my interest. I also Dr. Bradley, who was the head team physician for the Steelers, Pitford Steelers. He kind of, he gave us a talk. We get these talks from all these famous doctors and we all thought he's going to talk about all the surgery he was doing on the on the Steelers. But he was a huge pioneer in PRP, Platelet Ridge Plasma, taking someone's blood, spinning it down, getting the platelets out, has growth factors, inject them in and helping someone heal. He was doing that before a lot of other sports doctors were and he came and he got up on stage and he's like, you know, this is to a bunch of surgeons. So there's PT's and ATCs also in the room, but like the surgeons are on the front row. And he says, you know, our body has an amazing ability to heal itself. And I've been using patients blood to help them heal. And like the whole surgeon rose like, this is like, this is stupid. I'm never going to do that, you know. And they had a little, they had a demo where the reps came and you could go do that. And I was the only resident. I mean, the fellow who showed up, like there was a couple of PT's in myself. And I had a my platelet 10 was killing me from running this Boston Marathon the year before. And so I actually got it. I don't know. It was probably wasn't PRP at the time. It was probably mostly blood, but it hurt, but it worked. And so those are the things that were the foundational principles that kind of made me realize that, you know, that you can give people better without surgery. And then even if you don't, you get them in the optimal condition before you do the surgery, they're always going to do so much better. Like prehab was a word down then down there way before it was anywhere else. And, you know, I heard you talk about like that. Was it the recovery story you were just talking about? Yeah, recovery shop. Recovery shop, right? I mean, that stuff is getting people nutritionally in shape, getting them, you know, getting them ahead, you know, I've heard you talk about PT going to PT ahead of time, getting all that range of motion back. All that stuff leads to better results, but a lot of times, it also leads to no surgery, which is fine. I've had five surgeries who want surgery, you know, if you don't need it. So then my dad got a, he got an infected hip replacement 10 years after his hip was in. And he did. In fact, he wouldn't go away. They had to open it up. They had to, it looked like a sharp bite, you know, huge wound. And they had to just let it heal from the inside out, which is very difficult. And, you know, within a year or that, he had pancreatic cancer and he passed away. So to me, that was the, that was kind of like, like, I had the idea in 1991, but, you know, I, that's when I decided I'm going to do something about it, because I knew most, not most, at least 25 to 30% of, of dormant placements are unnecessary. Several studies have shown that. I think it's even higher, but I mean, yeah, studies, you know, so that's kind of how I got on this path. Well, I think that's good point you bring up. I mean, there's a lot of stuff we can, we're going to ping about each thing you talked about, but I was just talking to Will before you came on, and before we started this show, that the important side of this is that you're, we're talking to North Peak Surgeon, just lots of surgeries, knows a lot about surgeries, but at the same point, the non-operative stuff's a big deal. But stuff we didn't, we didn't learn in residency. It's the same for me. It was fellowship or rush with coal. And he sees so many people that don't need surgery and treats them well. We've had him on here, and he's talked about that as well, right? Like, the surgeries are sexy stuff, but I've had multiple patients today came in there like, and number one thing that actually many of the patients in society who cartaged preservation come in asking, they said, "How do I avoid a knee replacement?" So there's this sort of underlying thing, and a lot of the patients who come in and see you, I'm sure you have the same thing, they were told by everybody else they need a knee replacement. And so sometimes there are alternatives to especially total knee replacement. So it's, every way is approaching is really interesting. And again, you have patients, like you said, there's, there are patients that need this knee replacement, but there are a lot that don't. And it's a really quick, easy fix for someone that doesn't have a lot of cards in their deck, right? Which you can go into. I mean, what's your experience in the office? I want to talk about all the stuff you're doing, but your experience in the office of these patients that, hey, they've got a little bit of something, maybe a little bit arthritis, and maybe one compartment, and they're kind of like knee replacement because it's the easiest, fastest thing for someone to get the patient done. How do you approach those scenarios? Well, it now I approach them differently than I did maybe five years ago, or even 10 years ago, because I was in the insurance world of healthcare. And the last three years, I worked my way out of that. And as of January 1st, 2025, I've been out completely out of insurance, which is a very rarity for that's a whole other show. But so I handled it differently now because I think people come to me because they now know that I don't do near one COVID hit. I mean, you want to get into another catalyst. So I was doing knee replacements right up until COVID when COVID hit. And I was doing PRP since 2008, and I was doing bone marrow since 2017 and laser since 2017 and the nutrition. So I had all these kind of pieces that I did, but I never I always kind of dreamed of putting them together as a program. But I was just afraid. First of all, I was afraid of my own colleagues like being labeled a quack, you know, and I was afraid patients wouldn't do it because let's face it, insurance doesn't cover, you know, most of this stuff. And because it's your own body healing yourself. And so when cover near replacement, but that's about it. Yeah, for like 30,000 to 60,000 total dollars out of the insurance industry. But anyway, they I had patients who were scheduled for near replacement and patients who needed one. And they were like, what are we going to do? And I said, remember all those things we talked about? Like why don't we put them together? Insurance was paying for telehealth, which I think is one good thing that came out of COVID. There's not, you know, there's some good things and bad things that, you know, something good always comes out of something bad. And even this like that, you know, this is exploded zoom calls and all these different, uh, this tele, tell us stuff. So I said, we've, you know, we've gotten that approved. Let's put this stuff all together and ask your insurance company if they'll let us do stem cells and PRP and laser and, you know, because you can't have surgery right now, we don't know when the hours are going to open back up. So we put it all together, sent it to the insurance company, and they were like, yeah, you can do it. I'm like, okay, well, are you going to cover it? Well, we'll tell you after the fact. And yeah, we couldn't get, we couldn't get around that. So I had some brave patients, Bill's one of them, uh, who's the first chapter in the book, but I had several patients who decided to do it because they're in so much pain. And honestly, I mean, I know you've, you've dealt with, uh, biologics, but isn't it like, it, it's so amazing when someone gets better and you're like, I don't know, all I did was take some cells, concentrate them and put them in the, and like our bodies had this amazing ability to heal ourselves. And it blew me away how all these people were doing meantime. So within three months, they're doing pretty amazing. These people with these programs that we, you know, and we can't forget the, the total body fitness part of things as well, the rehab, whatever you want to call it. And so these patients were doing well. We went back and forth with the insurance companies and eventually they said, no, we're not paying for it. So I have to go in the room, you know, three, four, six months after they paid up money out of their pocket and say insurance didn't cover it. And honestly, not a single person said, not a single person was upset. They were like, I figured that is like, but I don't care because I didn't have to miss work. I didn't have an incision. My body had surgery. He still can't kneel. Like, and I'm like, I'm onto something here, you know, it's not just a shot. It's not just a laser. You put these things together. They work synergistically. And it came down to developing programs. programs in systems, you know, just like anything else you do, but it came down to doing programs and continually refining and refining and refining these with my team. Well I want to pull up it. Will you pull up this slide, the clarity day thing, and we can talk about that. So this is something, can you talk about this a little more? I mean, this is obviously tools where it stem from, but this thing, this day of like, how do you get that evaluation done? Sure. So well, first of all, that cycle of insanity there. I think the first patient in the book, his name is Bill, his wife actually got him to come in. He didn't trust anybody. But he, he was like, I told him, I said, you know, I have your old records. I looked at them, but you know, what happened? He's like, well, it's insane. It's insanity. So I was going to call Bill's cycle of insanity, but every patient, we're all patients, right? We've all been through this. It's a patient, right? You say you have knee pain. You got to go see your primary care. They don't have time for it. They're going to spend 10 minutes with you. They'll like take some, you know, go take some towel and all whatever and see me in two months. You come in two months, your knees still killing you. They're like, okay, we'll get an x-ray, but you have to go down the street to the imaging center to get the x-ray. They won't give you the results. You have to wait for your doctor to call you, wait a couple weeks. Then they finally, the doctor might call your someone and they're typing on the computer, looking at a report. They never look at the x-rays. Oh, you have arthritis, you know, and we're going to send you to an ortho. And in his case, he didn't want to see the same ortho who'd operated on his shoulder and told me I had a rotator cuff tear and he didn't have a tear and his shoulder was doing worse. He didn't trust me at all. I didn't even do a surgery and he didn't trust me. And so he, you know, so, you know, they said, you know, he actually got referred to a different ortho before he even saw me. That was six weeks. And then he says, well, you know, if you're going to tell me I'm going to do surgery, I'm going to leave. And the guy said, well, we can't tell you that anyway. You have to go to PT first for six weeks, twice a week. And he gets to PT. He actually had both his knees and his shoulder were killing him. And they said, Bill, what's going on? He said, well, both my knees hurt. My shoulder, they said, pick one. He's like, what do you mean pick one? Pick one because the insurance only lets us take care of one thing at a time. And we don't have time to take care of all three anyway. So he, his knee didn't get much better. His other knee and his shoulder were killing him. Then he got the cord of his own shots, which worked. But then his wife looked it up online. He's like, cord of his own is bad. So he goes back and reams that guy hounds as I don't want cord of his own. He gets the hyaluronic acid, the quote unquote gel injections. He's told they're going to last six months. They only last three months. Then he demands an MRI. The insurance only approves the MRI for the right knee because that's the only one he had to PT on. He waits four weeks to get the results. And they told him, you have arthritis and you need a joint replacement. So he's like, what if I don't want one? They're like, well, you're going to have to suck it up when your pain gets bad and bad enough come back and see us. And so they get, you get two options, you know, either do the replacement or suck it up. And there is a third option. And that's, you know, let's figure out what's really wrong and try to treat the root problem. And, you know, repair the knee. There's ways to repair. Even people who there's, you know, there's people who just don't want surgery, no matter what. And you would never think someone who's has x-ray looks so bad, you could actually get better. But that's where the underlying thing is, is that a lot of times it's in the bone and arthritis, you get these bone marrow lesions, which are actually stress fractures, they're micro fractures. Yeah. Bone has millions of pressures and nerve fibers. Most of the pain comes from the bone, because the articular cartilage, the tread on the tire cartilage, doesn't have any nerve fibers. So that's what he ended up having. And that's what we were able to actually inject is Dr. Hurnigo, a great study. He had 140 patients. He's a French orthopedic surgeon. And just to make it quick, he basically did a knee replacement on one knee. And he did stem cells on the other knee into the bone marrow lesions and to these stress micro fractures. And he filed these people for at least 10 years, which is amazing, because most studies are like two years, you know, a year, and all that. We're doing great. So 10 years, and by the time the study was over 15 or 20 in some patients, so the average file was 15 years. At the end of that study, these are people who were told they needed knee replacements. 82% of the needs that just got the bone marrow only into the lesions, not even in the articular, they never needed a knee replacement. And they felt their knee felt better than there. Then most of them felt their knee felt better than their knee replacement knee. And then 15% of those knee replacements needed a revision. And you know, revisions are they're harder surgery presses on. There's more, there's more risks. So point is, I was also frustrated with this cycle of insanity. We've all been through it. It took Bill over a year to get through it. So I just said to myself, why don't, like, if we figured all this stuff out in one day, yeah, you're doing a MRI right away. You're doing an ultrasound, you're taking your time with patients, you're spending four or five hours with them. But you can figure it out in one day. And in my mind, it's way more cost effective. I don't know why the insurance companies don't do it. But I think it's because people quit along this cycle of insanity. Bill made it through 54 weeks. He probably, they probably lost money on him. But some people quit when their primary care tells them, you know, I don't have time for you or they quit when they know they might need surgery. They're not going to go see, I'm not going to go see an orthopedic surgeon. So they suffer in pain or, you know, they do the PT. It doesn't work. They give up. I'm old. I, you know, I can't, I'm never going to get better. So we basically, you know, we spent, I'm able to, now that I'm not in insurance, I can spend as much time as I want them to the patient. I'll spend, you know, I'll spend an hour with them in the beginning of the day. And then we'll look at all their old records, go through everything. I'll actually do a physical exam on them, which I know you do because you did an amazing fellowship and residency program. But a lot of docs, they just throw the x-rays up and say, you need surgery. They don't even, how many patients tell you this is the first time someone's ever like examined me. I'm sure you do. I'm trying to get it more than you'd think. It's like, oh, you saw, you looked at my, or the, did you look, you actually looked at my images? I don't want to get a lot. We're showed them to me. You've been showed them to me. So I'm going to level that's, I don't want to overwhelm them sometimes. I give them at least the exam and the same thing. But yes, they get, well, you probably don't have that, you know, it's not your fault. And wasn't my fault, when I was seeing 60 patients a day, you don't have time for it, right? 30, 40, 50, 60 patients. It's crazy. So we slowed it down, get all that done in a day. People do have to invest in it. The insurance covers some of that stuff. If I'm a non-participating provider, they can still submit like the MRI codes and things like that. But when it comes down to doing the PRP and the bone marrow and all those things, the laser, that's not covered by insurance. And people know that. At the least, though, at the end of the day, they know exactly what's wrong with them. It's been explained. We've showed them everything. They know how to read an x-ray by the time they leave. And we spend the time with them, try to figure out what their actual goals are. Like, as a sports medicine doc, we do that a little bit better, probably than other docs, only because with an athlete, you do have to know, like, what position do they play? You know, what level they're at? What's their time frame? What's their contract like? But like, all those different things, you really do have to sit and listen. It does take longer to be a good sports medicine doc. So I think that's where we have a bit of an advantage. We have to listen. We have to go the extra mile. And so I just took that to the next level with everybody. And Dr. Andrews always, you know, he treated lead athletes. But he always said, we treat everybody like an elite athlete, whether it's a grandma or a mom or a brother or a sister. You know, it doesn't have to be an elite athlete. You treat everybody that way. No, it's excellent point you bring up. I think there's a number of points you brought up. Obviously, we'll talk about that cycle, the treatment options you're using. But I think one of the things you're doing that's that we can't do right now, many of the doctors, as you mentioned, is the holistic approach to evaluation of these patients, especially with, you know, my knee hurts and take some months. I mean, the thing is also, there's a not saying all that your treatments are perfect. But sometimes there's also a little placebo effect of you just being available and listening as well. You know, there's a combination of everything mental. You talk about it, right? The mental you said, you said, one of your talk, one of your podcasts, you said, it's at least 50%. Like, especially with athletes, right? So when someone in when someone finally commits to a program and they do have to invest their own money in it, they are committed. And so either committed be yet, there's always, even honestly, some of the surgeries that are done on athletes, there's a placebo effect as well. Oh, I've seen images of some ones that do not work very well, not gone well. I mean, I never forget I saw one of the Hall of Fame player for baseball team. I mean, a nameless with an ACL alligraft at 25 years old, unstable knee in my examination during the white socks. And he was saying he felt amazing. But I had to check it out. So went with a doctor to kind of look at it. I saw the x-rays vertical tunnels. I'm like, you know, I mean like this is just this is a guy that just is a different level player, right? With did not have a good setup. And they still did well, right? So it's like you said before, there are plenty of times we see patients have had surgery, especially these athletes where the result wasn't good, but somehow they're still doing well. And it's just the nature of the beast. But they said there's a placebo effect, the result of a effect of what you're going to get to in a minute is the alternatives, right? Like the PRP, the bone marrow, it's important aspects. But what about like you talked about like you'll show this, can you put this V slim thing? I want to learn more about it. So there's there's a part that about so one part that's really interest about in your face, which I think you're going to bring up is there's some patients that don't want to lose weight due nutrition because they just don't want to do it. They don't have they're not invested in it. So if you're getting patients to already do that, that's already a partway there that most docs can't even do. Yeah, and you have to have time right to educate them. So that's the thing. So I mean, Bill was a gardener and I'm a gardener. So that's kind of where this gardening analogy came from. But you know, I asked them when you in the like it's springtime. So right now you go on the garden, you're going to rake out all the bad stuff. You're going to get pick the weeds. He said, I would take a weed eater and get rid of the weeds. And then I would put top cell down. I said, well, what is the, you know, I said, why do you get rid of the weeds? You know, facetious question. But why do you get rid of the weeds? He said, well, because they choke out all all the other plants that said we'll inflammation does the same thing. And fat causes inflammation. And I said, "Well, what about the topsoil?" And he's like, "Well, there's no weeds in it, and it has nutrients." I said, "Well, how do you get your nutrients?" He's like, "Well, you know, from my diet." I said, "Well, how do you know what the right diet is?" He said, "I don't know. They tell me to eat more protein." I said, "Well, the only way to really know, and this took me a while to get this figured out, too, because I had a lot of different dietitians and nutrition people, and they all have their own take on things." As you know, they focus on one thing, and it's not necessarily wrong, but one size doesn't fit everybody for nutrition for sure. And your genetics are the huge thing. That's the kicker. So it's a simple mouth swab. You get a 32-page report back. It tells you, you know, what percentage of fats, carbohydrates, and proteins. But then it goes into a lot more detail on your micronutrients. It goes into the vitamins, the minerals, any sensitivities, allergies, even exercise was the best exercise for you. It just so happens. I like endurance events, but I didn't know that that was my genetics, and it turns out that's what my genetics actually is. So we can figure a lot out from people's genetics, and it can be a lot more specific. So the weed eater part is a little different. Laser therapy that Kevin Wilk, I was talking about, with that's more of a laser laser. Yeah, that's more of like a class four laser, and that stimulates the mitochondria, which, okay, Will, do you know what the mitochondria is? You remember from high scobiology? Mm-hmm. And also, I'm a doctor on this show. Our house to the cell, baby. So that stimulates that mitochondria to produce more energy, and it releases nitric oxide, causes, you know, increased blood flow, decreased swelling, decreased inflammation. The cells work better, because they're producing more ATP. And also, it has a direct pain-leaving effect inhibiting the noces after the painful nerve fibers. And I didn't necessarily think it was true either to like tore my calf muscle, run it in a marathon, and just messed it up, and it bothered me for several years. And then somebody said, hey, you want to try this laser, and this actually happens to be an MLS laser, multi-wave locked system. So there's two wavelengths of light that are locked together, and unlike the one that Kevin Wilk used, this one cannot burn you. It's patented in a way. You can shine that on somebody all day long. It's not going to burn them. So it basically got my calf better when nothing else did, and then I was a total believer in it, and I've had, you know, had some version of laser. Actually, I even have a handheld laser right here. It's not the same power, but they, it really is amazing how light energy can help, and that's called photo biomodulation. But there's other light energy, red light laser, which is, you know, maybe 600 and something nanometers. That laser can cause your fat cells, the pores to open up, and actually breaks down the layer around your fat, and then when that breaks down, then your cells, the fat cells release it, it goes into lymphatics, and it's either used for energy production, or you just eliminate it, and you're, you know, and you breathe it out, or you pee it out or poop it out. So, but it decreases inflammation in fat, and then the side effect is it also decreases weight and decreases inches. So it's pretty crazy how light energy can help with all those things. So to your point, it's really hard to get somebody convinced them that they're going to lose weight, and get out, I'll get on them, even if it's genetic diet, like it's going to take time still. So these, these red light lasers, the one that you showed before, that will, people will lose, is that this one? Yeah, yeah, actually, there's not a, I must not have sent you the picture, but it looks just like, it's almost like a tanning booth, it's a red light laser, it's a kind of, you know, rectangular, maybe 25 by, you know, 12 inch red light laser display, and people lose about 3.5 inches of fat per treatment. Now, I always tell them, if you go home and drink beer and eat, any twinkies, you're going to, you're going to gain it all right back again, you're going to fill your fat cells back up. So my point is, it gives them quick wins, and when they see those quick wins, then they're, it's a lot easier to get them on board. So if that makes any sense, sometimes we'll give them a treatment, and just to show them, you know, 98% of people lose at least two inches, you measure them, or we take pictures, and they lose weight. We don't want someone getting laser treatments for that sort of life. That's where the genetic power comes in, but at least get them a quick jump star. And it, I mean, the diets are amazing, they're anti-inflammatory, it's real food, but it's what your genetics allows you to eat to keep your inflammation in your body down. And you provide, so you're providing all those services. So you do the red light therapy, you also do the, the MLS one, right? Because it's a, yes. And that's the one that they're recent at the AOS recommendations on the MLS. Correct. Correct. Can you describe that a little bit to the listeners? The suggestion on laser for pain and for pain in inflammation modulation. I think they, they said just photo-biomodulation by itself or laser therapy. MLS is a certain brand, but there's a bunch of other lasers, brand name lasers out there as well. But yes, it did, they have now said that it's a viable recommended alternative. And there's enough science behind it that they could recommend it as a, as a non-operative treatment for pain relief, decreasing swelling inflammation pain. And do you use that? So you, are you using that to use the nutrition? Obviously, it's a big combination, clearly. You need a genetic evaluation. Then you have red light therapy for weight loss. Do you ever integrate in GLPs anymore now, or is that not part of the regimen yet? I have, I've tried to get people off meds. So a lot of people who lose the blood etc, they get off the meds. I'm not saying that I don't coordinate with other docs who do the GLPs, GLP ones. I, I, I don't have a problem with it if someone really needs it, but I, I mean, we've had a lot of people not need them. And they do have their side effects. And a lot of patients, some patients have already tried them and didn't like the side effects. So I'm not saying they're, they're, they're, some people really do need them. And there's a lot of, we can get into peptides and all that stuff too. There's a lot of, there's a lot of, a lot of stuff to, to go there, even hormone therapy. I mean, you can really go down a lot of radicals. But we're a whole person. Everything affects everything else. And that's where medicine has gotten. We've gotten so specialized and compartmentalized. We just treat, you know, if you just treat the knee and that's it. And they have a tight head flexor and their backs got a problem and they have a tight Achilles tendon. Even with a knee replacement, those people have a lot of soft tissue pain still. 30% of them still have some soft tissue pain because that wasn't addressed. So you're, so your goal here and then when you, so that you're doing this treatment regimen. So how long is the process? Someone comes in to see you, you're working through this like how I know you said you do it in a day, but I'm sure there's some caveats to that. So explain it. Yeah, like, yeah, how, how it works? Sure, the diagnosis, the clarity day is all about diagnosing and figuring out what's wrong, coming up with a plan or giving them three options. And some people, if I can't help them, I'm not going to abandon them. I'm going to get them into who does, who I know is a, does a great knee replacement or who does a great back surgery or whatever if they need it. Or if they need, if they have an ACL tear, if they have a rotator cuff tear, if they have a loose body or a meniscus unstable meniscus tear, I still do surgery as well. So some people still need surgery, but that clarity day is about figuring out what's wrong very quick within a day. After that, if they're going to start a regenerative program and they're going to do all those components that you kind of showed there, I mean, that's going to take probably a good 12 weeks. It's about a 12 week program. First three days, I had it done on my elbow. So I had a really bad common extension. I know it's his quote unquote, tennis elbow, but like 12 years worth of it. So I said, I'm going to, I'm going to train my PA how to do this. And then his graduation is going to be, I'm the first one he's going to do it on. So he did a great job and he's done no pressure. Exactly. He did great. He's amazing. So yeah, I had it done on my elbow. So the first three days, because you know, we're trying to kind of restart the healing process. Most of these, most of these degenerative conditions are because the body's healing process is kind of slowed down or stopped from many reasons. And so we're just basically trying to restart the healing process. So I always tell them, the first three days, you're going to be pretty sore. I mean, we're kind of re-injuring us, but let's say it's a patellar tendon or even a, you know, your common extension tendon. You do have to kind of poke in there with the needle and kind of stimulate and break the tissue and inject the injector PRP and or stem cells in there. And so that the first three days are pretty pretty sore. First two weeks are the most restricted. After two weeks, I felt amazing. And I started to overdo it, which a lot of patients do. So that, you know, you're still, I think Dr. Buford says it best. I think that you're basically starting about at the six-week point after a surgery when you do one of these regenerative procedures. That's like your six weeks into, like, after a meniscus streak, but, you know, not repair, you know, parts of meniscactomy or some surgery, a rotator cuff, a self-acromative compression, acromionoplasty, something like that. So that's kind of where your starting point is. So you're not as restricted. And then I take the first six weeks, by six weeks, most people are feeling 50 to 90% better. And then at six weeks, we really start getting the total body, like, really going, getting them into whatever they want to do. Some people want to hike a mountain, some people want to travel, some people want to play with the grandkids, some people want to play pickleball. We really like to know what their top three goals are. And then we design a plan that fits with that. And that's where having studied under Kevin Wilk and then my PT's and my ATCs, et cetera. They are all strength and conditioning specialists as well. So they have a medical degree, they have a fitness degree and they just, yeah, they're amazing. I think that's a important point. I actually bring this up a lot. I really like you to say that that's good for the listeners to hear. When patients go for PT, it's good to have a physical therapist. But when they get to the next level, the strength conditioning inside, I don't know what different, it might be different certification. But I think of ATC like really like high level knowledge training. That doesn't happen all the time for patients. And so they don't understand as a difference, but there really is and Wilk, you know, recovering wise, you can, you know, this for first hand. But like there is a difference and I tell patients, if you can't find it, you got to pay for it because it's sometimes hard to find. But that's I think you're bringing that up that point is that it's just you really need that next level. And sometimes it's not that just bands and pullies and then medicine balls. It's more than that. There's a lot more that goes into it. Absolutely. And I mean, some of these people, especially the ladies 60, 70, 80, they have only walked for exercise their whole life, if that. And when they hear they have to do resistance training, et cetera, at first they're very resistant to it. But once they, you know, studies have shown people in their 70s, 80s, 90s, greatly improved with resistance training, confidence less, you know, better balance, less chance of falling, building muscle mass, bone mass. And they get so confident that, okay, their goal was to walk their dog and go up and down their stairs without pain. Next thing you know, they're like, oh, I want to dance at my grandson's wedding, you know, or I want to, I want to go, I want to start taking dance lessons and, and, you know, and, and, and start dating again. It's, it's amazing. The confidence that they get from exercise. So I have, I have one lady. She's 89 and she's probably been in for 250 or more strength and conditioning sessions after she got better from her program. And if you look at your niece, you would be like, oh my gosh, these things need a knee replacement, but she doesn't. It's amazing. Well, I think the point you're bringing up and we'll probably ask some questions is that not only does not everyone need a knee replacement, but the other side of thing is that we're all doing as surgeons, not doing a great job of titrating all the outside factors. Whether you want to talk about bone marrow aspirate, PRP, you know, there's definitely benefits of all those things and even the laser and things like that. But like the basic things, we're just not doing a good job. So you're already, you're already beating the system because you're tanking up all the simple things, which is not saying your job is simple, but simple things that we're missing and we have no time for that are, that are straightforward. And like, you know, you know, also that paid nine-year-old patient, she's going to PT. They're not giving her very much time and energy. Because insurance brackets, et cetera, and they don't have time either. I mean, there are no offense to physical therapy. It's the same problem, right? The problem is systemic and medicine. Totally, totally agree. I mean, diet and exercise. It sounds cliche, but it is massive. So you're right. It is simple. It is something that the ancient Greeks do. Like we have, you know, the ancient, everybody's known this, right? But we don't do it. But when you do, it's not a quick fix. Yeah, and when you do that, it's an amazing life-changing thing. And so you're, I mean, I like the idea. So you basically now, you're practice, you know, obviously do some of the sport stuff and you do this, all this thing. Your, your whole practice now is like holistic, whole body kind of fixing of the person, looking more outside. I always say that, like, you don't want someone's going to just talk about your knee, right? Tell me about your hip, tell me about the rest of your body, nutrition, background. I mean, it kind of comes together with things we've talked about well in this show. I'm sure you have a questioner, Stu, I can see your lips moving. You're ready to rock. What question do you have for Dr. Bell? No, no, I think there's, I mean, obviously there's so much that resonates. And I just want the listeners to really focus on, besides everything you're talking about, but the physical therapy, the resistance training. I know for people that train in strong first and, you know, pobble, you know, they talk about simple stuff, right, the get up, right? And they're saying, you don't need to load. It's just a basic motion for you to get up off the floor, right? And it's these simple trainings, the hip, the hinge, the squat for you to operate and move throughout life. And I think that that's something that even if you're, you know, taking something out of it as far as keeping that movement, you're talking about diet, all of these different therapies. And I have a question real quick on that as well. But you know, this is why we talk about not just physical therapy, but moving so you can have a quality of life. And if it's just picking up your child, you know, your grandchild, you know, getting enough from the chair, getting out of bed, right? I remember when I was injured, I went back to my kettlebell training. I was like, I'm rolling over to the elbow, to the palm, push myself off the bed, swing my legs around like basic stuff. Also, motion is medicine and I changed my name from victory sports medicine and orthopedics to victory and motion. So motion is big. You just hit the nail on the head. Yeah. We want to talk will. I know you want to jump on this, but we want to make sure we don't have time to answer this question. Explain the goal and point of 2043. I'm assuming you're not going to be retiring then. That's the one we started. What should I do? I know, but you never finished. You never finished the question. And we're running out of time. It's easier. We're getting to the end of the show. We get back to 2043. Well, 20, so first of all, I've run seven marathons and if you want to achieve a goal, you have to say what you're going to do and when you're going to do it by, and you say it as many times as you can and as too many people as you can. And so the first phase of knee replacement free by 43, by the way, rhyme, so there's your spoiler. Okay. It's going to, I know it would take about 20, it's going to, I mean, it's going to probably take 20 years to do this. And I might retire from operating, but I'm not going to retire from that goal. And if we can put, you know, I'm watching the lunar fly by right now. I mean, if we can put a man on the moon by, you know, in 1969 with 50s and 60s technology, there's no way we can't and the need for knee replacements. Just by the way, right now, it's more about getting the word out that there is a third option, but it's even more important by far. And I've heard you talk about this as well. And I know how hard this is because you both talked about it, but getting prevention, right? That's like the, that's the biggest thing. A lot of arthritis, a lot of our diseases are preventable and ACL tears are very preventable. 50 to 75% with the right programs. We've run those sports metrics programs for years. And it's not easy to get convinced parents, et cetera, et cetera. And kids that you're better off investing a lot less money in saving your knee from a non-contact injury, especially females than you are investing in all this equipment and getting in three leagues and getting an every indoor tournament you could possibly do. They spend so much money on that and then the kids get hurt from overuse because I've heard you guys talk about that and you're ahead of the game on that. So anyway, I outline it in the book, but I think the two biggest things to really get to knee replacement pre, maybe three things by 2043 is, you know, number one, getting the word out that there are other options and getting people excited about it because I'm not going to do this by myself. I'm going to, I want to get, like, hopefully we work together someday on this day on this and we keep, we keep getting more and more people involved because a lot of people, even orthopedic surgeons, I know, who are getting more involved with this type of thing. So getting the word out, getting the word out to patients, most patients have no clue there's any other option than knee replacement, but then preventing, that's a huge thing. And then the advances in regenerative medicine and AI and 3D, I mean, you know what the Carlos Restoration you're doing, like, there's already been massive advances there and with like 3D printers and scaffolds and all this stuff, that's all going to happen. And I was just in Dubai before all the shooting went on and I was at a conference and with docs from all over the world. I mean, we can't even do so many of the things in the United States that are being done in other places in the world. And that, all that stuff's coming. So that's kind of the technology phase of things, but prevention, I still think is number one and that's the, that's going to be, that's the hardest one of all, but that is a lot of this is preventable. And the right diet, the right exercise, all those things, you can prevent arthritis a lot of times. I mean, there's some genetics to it for sure, but you can, you can prevent the need for new replacements by doing simple things, as you said, but simple is not always easy. Sometimes simple things are the hardest thing. 100%. We'll pulp that slide. Let's give them one last punch. So again, big shout out, Dr. Pease book, he really kind of gave us the headway, but there's way more nice details on the inside. So any last plugs for your book here? It's written for patients, just so patients know this. So it is written for patients. It has a bunch of patients, real patient stories in it, real names. These are real people who've been through this, including myself, all my experiences. And so a lot of what we talked about is in there. There's some free stuff that you can do on your own, I mean, drinking, blotter, and moving more, right? Those are two easy things to do, less sugar cutting, you know, so they sound cliche, but they do work. And so, and then when you do buy the book, a dollar of every book goes to the Arthritis Foundation, we're trying to raise a million dollars to at least get the word out there to start with. We're going to need to raise more than that. [BLANK_AUDIO] We're gonna start with a million and go from there. - Awesome. - Dr. P, any final questions? - One quick question here, with everyone's technology, we now have the power in our hand to look things up. Are you getting patients that are coming in more informed or less informed with the amount of technology that they have now in access? Are they already coming in with a certain goal and you're just kind of shaping that goal in 2026? - Yes, for sure they're coming in, but it's an, I've been an active process. I mean, I've myself and a lot of other regenerative medicine docs have been getting a lot more word out there. I mean, anybody who reads my book, they come in and they're much, much more, the vision appointment goes much better because they've already read it. It takes four or five hours to read and they're more informed, I think, the better. And frankly, I welcome them to bring a spouse or a loved one or whoever. I almost demand, we pretty much demand that they bring someone with them, which is so hard to do when you're a traditional medical practice. You don't have time to, you just don't have the time. You know, the average time a doc spends with a patient nowadays face to face is like seven minutes, eight minutes, it's crazy. Not you though, because I know you're a good sports medicine doctor, but. - Yeah, maybe sometimes it's hard. Do you just know it is? - No, it is, there's no way around it. I mean, you've definitely had a nice setup there, so it's great. Well, thank you so much for coming on. I think we'll have the same way. We're excited to show this. Let listeners know there's another side, there's another option, and promote the book, et cetera. So anything final will? - No, just, obviously I have lots of questions, but we'll get into that another time, you know, we talked about a lot of different things. And you know, I'm curious about arthritis and what the technology is going to be, that's the big one that we always talk about in these shows is, you know, getting to a point that we can kind of, you know, say goodbye and arthritis is a conversation for another time. But Dr. Pete, thank you so much for your time and your patience. This was really informative. I know that patients and doctors alike will really enjoy everything that you said. So thank you so much. - Well, thank you Will and thank you, Dr. Garcia. You guys doing a great job spreading the word, and I love your show. - Thank you. - As Dr. Pete, he was on the, you know, we have to send him a check for that beautiful plug there. So we just, the checks in the mail, Dr. Pete, thank you so much. You know, going back to what we say, there's just so many things, you know, yeah, I was a BP157 and this and that and like, you know. - When it's gonna get started, Will, we have to have another episode on this. You always do this. - You know, the wheels are turning, I've got things down, I've got a whole booklet full of notes. And, I knew it, but I had to cut you off and you're gonna ask me 15 questions and then we're gonna be your online. - Is this gonna be rude and cut them off then? - No, no, we're not gonna do that, but we wanna remind everybody catches out sports.talk.com. We are on YouTube, your favorite listening platform where there's Apple's Spotify, iHeart, Google. I mean, I was checking in some like random places there with the show. So we just wanna thank everyone. And please check out the website. We have transcripts, we wanna hear from you. We wanna hear from new guests. We just wanna keep spreading the word. We wanna talk about these things. We wanna have real conversations. It's really important to us. And that's really kind of why, the whole reason that we got into this, right? The platform for us to talk and get into things that really matter. And I think having a guest like Dr. P really matters. So, Dr. Garcia, our orthopedic surgeon sports medicine specialist, you keep rocking it. I hope you have a great one. Thank you for spending some time with us. You wanna say some last words here? - Yeah, I mean, you just notice with the show, the nice thing is we always have different perspective, which is key, right? You just, you gotta see everything. It's always tell the patients in the office, get multiple opinions, get different sides of the story and pick whichever works best for you. Some patients, you know, again, different methodologies work for different patients. And you just gotta find the right patient for each thing. But there are different, everything works for somebody. And so we just find what works best for you. So thank you guys, thanks Dr. P and check us out. - That's right, be like Dr. P, ask questions, even if they look at you weird and operate a room, but that's the way how we get to all this stuff. And do me a favor, I thought you were gonna go with the will cycle of insanity. We're not using that phrase, okay? So just stay away from there. Thank you very much, take care. - Bye.