The Evolution of Orthopedic Techniques - Episode 346

The number one reason that I see people get injured is a mental error. So if you ask a skier, if you ask a soccer player, if you ask a basketball player, they almost always knew a microsecond before they got injured that they were either in the wrong spot, they were going too fast, and almost always that was their mind wasn't in the space. It was either on their girlfriend, on their boyfriend, on the distraction.

Welcome everybody to the Gladden Longevity Podcast. I'm your host, Dr. Jeffrey Gladden, and today we're gonna focus on living young for a lifetime. I'm gonna be interviewing an orthopedic surgeon out of San Francisco, Dr. Kevin Stone, and he runs the Stone Clinic out of San Francisco, and he's doing some very, very innovative and has been for several decades now, but it keeps getting better and better, sort of joint regeneration. If you have a joint problem like a knee, a toe, an ankle, a hip, or a shoulder, you're gonna love listening to this podcast. He's developed techniques that have enabled him to actually regenerate cartilage in the knee, both kinds of our cartilage, not only the meniscus, but the articular cartilage that's on the, uh, end caps of the bones. I found this conversation fascinating. He's a delightful guy. He has a great outlook on life and on the wisdom of playing and recovering stronger than you were before you might have had an injury is really refreshing. I've never talked to an orthopedic surgeon that was so forward-thinking, and I really, I really love this podcast. I hope you do too.

He went from saving hearts as a cardiologist to rewriting the entire aging playbook. Dr. Jeffrey Gladden believes 100 is the new 30, and he's got the science to back it up. This is the Gladden Longevity Podcast.

Kevin, welcome to the Gladden Longevity Podcast. It's a pleasure to have you here. It's an interesting topic we're gonna discuss, so thanks for coming.

My pleasure.

So tell me a little bit about how you worked your way into this kind of transplanting cartilage, regenerating knees and things like that. You didn't start off that way. I mean, that wasn't really in the field when you started, right? So how did you make your way there? Because not everybody, you know, kind of rises above their training, let's call it. But you were one of the people that did that. So I'm just curious to know how that came about.

I was out for a run one day with my mentor, a guy named Dick Steadman, who was the orthopedic surgeon for the US ski team in Lake Tahoe at the time.

Okay.

And he looked at my bow legs and my, the fact that I had lost my meniscus cartilage when I was playing soccer in college. And he said, you know, Kevin, if you could ever figure out how to replace the meniscus, you'd make a big contribution to orthopedics. And so in my Harvard arrogant way, I looked at him and said, sure, I'll do it. You pay for it.

No. Okay. Seems like a good, a good trade-off.

So that, that started us off in the mid-1980s. And, uh, I went around, I was an orthopedic resident at the time and I went around and visited the materials companies in the country, 3M and DuPont and said, hey, is there anything soft enough and durable enough that I could put inside someone's knee to replace the meniscus cartilage?

Yeah.

And the answer of course was no. And the reason is that you walk 2 to 3 million steps per year at normal gait at up to 5 times your body weight. And so anything soft enough to absorb that would have to be durable enough, but not then degrade the normal articular cartilage, the end of the bones that are bearing against this material. And so there was nothing soft enough and durable enough. And so I shifted from that initial inspiration and said, listen, if I can't replace it, can I regrow it? And so I designed and built the first collagen scaffold to act as a regeneration template in orthopedics, and where you would sew it into a missing segment of meniscus cartilage and regrow the meniscus. And, uh, that work became a company and a product. And then along the way, I started replacing full meniscus cartilages using human donor tissue.

Okay, that's really interesting. So let's talk about what we'll call repair as opposed to like full-on replacement. So just walk the audience through that the cartilage is a particularly tricky tissue to repair because it doesn't have a lot of blood flow. It's difficult to get nutrients into it to some extent. There are people that are doing injections below the joint space. Let's say the knee, they would, you know, do it at the top of the tibia and have the regenerative products kind of leach in, if you will, into the cartilage. And people are getting some improvement that way. But you were able to devise something that enabled you to add the scaffolding in and then actually get it to to be incorporated is what I'm hearing. And there has to be more to it than just putting it there. Is there, there must be, there must be other things that are using to support that, or I would think there might be.

So let's clarify for your audience that in the knee joint, and we'll focus on the knee.

Yeah.

There's two types of cartilage. So there's the articular cartilage, the bearing surface on the ends of all bones and joints. So that white shiny surface that you see when you crack open the chicken leg.

Yeah.

And underneath that articular cartilage is bone. And if you wear off that articular cartilage down to the bone, that's what arthritis is. And the second type of cartilage in the knee is called the meniscus cartilage, the fibrocartilage, that shock absorber in your knee. That's what I tried to create the trellis of collagen for, to regrow. For the articular cartilage, the bearing surface, we developed a technique called articular cartilage paste grafting. And have been doing that technique now for quite a long time to regrow that damaged articular cartilage. And we developed the two techniques, one, the meniscus scaffold, and two, meniscus replacement with donor meniscus to replace the second type of cartilage, that meniscus fibrocartilage.

Okay. So in one essence, on the articular cartilage, where are you getting the material from to do that?

Yeah, so the articular cartilage donor material comes from the intercondylar notch where the ACL goes through the knee. And the reason we know that we can take it from there is when we were doing ACL reconstructions, we realized that we had to widen the notch often in order to fit the new ACL graft in place. And the notch always grew back. And so we knew that we wouldn't hurt the patient by harvesting a plug from the intercollar notch.

Okay. And then when you harvest that, then you have some technique to spread it out across the articular surface and get it to adhere and attach and all that sort of thing. Is that— there must be something to that. I don't think you just kind of slop it in there, but maybe you can just slap it in there. I don't know.

It's a fun story because one thing we noticed is that the bigger the injury in young skiers that we were caring for in Lake Tahoe at the time, the more robust the healing response. And we didn't know anything about stem cells back in 1991 when I was doing this. We called them marrow cells. And we knew that if we could take that dead area of articular cartilage in arthritis, super microfracture, morselize it. And create a fresh bleeding bed. Then if we applied a paste to it, the marrow cells pouring out of the bone marrow would see that paste and the signaling factors in articular cartilage and be stimulated to form articular cartilage repair material if motion was applied. So it was very important to use a CPM machine, motion machine that moves the joint back and forth, stimulate that healing tissue. To become normal reparative articular cartilage.

Interesting. Okay. So really what you were encouraging the body to send off its own cascade of, you know, endogenous peptides and stem cells and things like that to actually get the paste to be incorporated. Right.

So at the time, that's exactly right. Now, since then, and since we're now in what I call the anabolic era of sports medicine and arthritis, we now no longer just treat people by repairing their tissues. We add anabolics to them to stimulate the healing response. And those anabolics are PRP and bone marrow aspirate and fat and sometimes mesenchymal stem cells and sometimes birth tissues. All these things that have huge amounts of growth factors and chemotactic factors that help the repair tissue heal and heal faster. So everybody asks, you know, why does it take a year to come back from an ACL injury or an Achilles rupture? And we're trying to speed up that healing time by adding these anabolic factors. And so in the cartilage regeneration world, While I did it without adding factors for a long time, we now are adding factors whenever we can.

Yeah, no, that's great. And when I think about anabolics, I also think about some of the benefits of like some growth hormone releasing peptides or, you know, making sure people's testosterone levels are adequate, things like that. We know that at least in the work that we do here with injecting joints and things like that, we try to combine it with CJC-1295 with ipamorelin to boost growth hormone release to also kind of another layer to it. We also use cord blood and placental tissue and things like that. We don't have the surgical techniques, but even with that, we've been able to improve joints. That being said, there are joints that we are beyond the scope of what those kinds of techniques can actually adequately help. And so being able to have access to the techniques that you're using would be really a great thing. Do you use any of the other peptides like CJC or BPC or any of those kinds of things, or not so much?

We certainly hear from all of our athletes that they use them.

Yeah.

We have a prospective trial going on in testosterone because we understand that when we hit somebody with an axe, otherwise known as surgery, yeah. Within 8 hours of that impact, they develop the instigation of muscle atrophy. Yeah. And that may be due to a huge cortisol release that binds the muscle receptors. And so the trial that we're now trying to get the second half of it funded is if we preload the patient before surgery with a long-acting dose of testosterone, can we bind those receptors and block that initial stimulus of muscle atrophy? And in that first trial we did was a safety trial. We showed it's safe to do that. And now we're trying to get an 80-patient clinical trial funded to look at the effects of, of blocking that stimulus for muscle atrophy. So we're big believers in, in the fact that as we're aging and as we're injured, The loss of key hormones and mostly many peptides is a wide open field right now that we're just probing to figure out how we can use these tools to help people. Given the constraints of the FDA and where we are situated, we do all of these studies through our institutional review board and approval process. So it's a, it's a slow, steady process. The aspect of growth factors that we all have immediate access to, of course, are PRP, bone marrow, and fat. Birth tissues are currently a controversial area for the FDA relative to OA, but are widely approved in wound healing. And so we know from our initial studies that, you know, there's 60 times the growth factor concentration in most of the birth tissues compared to PRP alone. So I believe this is an area that will expand greatly. And as the FDA gets more liberal, I think, with permitting the development of these tools, we'll use more and more of them.

Yeah, no, I hope they open this up. It makes sense to us as well. What about other joints besides the knee? Are you able to work on hips utilizing this? Are you able to work on hips utilizing this technology or shoulders or things like that?

We do for injections in shoulders and hips. Surgically, I only operate on shoulder, knee, and ankle, most of which is knee and ankle for cartilage regeneration. We don't do cartilage regeneration in the shoulder, and I don't operate on hips. So, so the, The treatment for those injuries non-operatively is injections, rehab, fitness. The ankle is a very interesting joint though, 'cause as you probably know, you never see ankle arthritis except from trauma. So nobody develops primary ankle arthritis. That's interesting. And so it's an unusual joint, unusual cartilage. And we see a lot of people who have had devastating ankle injuries present with an arthritic ankle, and they're told their only options are fusion or later in life joint replacement. And we've done a cartilage regeneration program for those severely injured ankles with a lot of gratifying results so far. We'll publish those later this year. But we do think the ankle's an unusual environment and quite receptive to stimulation.

Interesting. People also develop arthritis at the base of their thumb or the base of their big toe or things like that. Some of those joints can be, you know, problematic wear and tear. You're not a hand surgeon or a foot surgeon, I understand, but are any of your colleagues utilizing any of the techniques in, in some of these other joints, the hips? Maybe you've got people that are copying what you're doing in those other joints, or is this, are you the sole proprietor of this technology?

No, I run around the world and teach surgeons everywhere, and in my own surgery center, the foot and ankle surgeon does a lot of toe arthritis, and he does our technique of paste grafting there and augmentation with injections as well. And I've taught people around the world, so I wear 3 hats. One hat is as a clinician, Yeah. One part is I run a public nonprofit research foundation called Stone Research. You can see it at stoneresearch.org. And the other part is, uh, for-profit things when I'm inventing things or licensing things. So we're quite dedicated to teaching surgeons and physicians around the world how to use these techniques and develop the new effects and new understanding of them.

Great. What are some of the complications that you see from these surgeries? Are there any downsides to it? Or things that people need to be aware of that are potential risks for them if they were to consider something like this?

The risk to any surgery is bleeding, blood clot, and infection. We're maniacal about trying to avoid all three of those. We can always make a patient worse by trying to make them better. The range of response to either surgical procedures and regeneration or to injections is wildly wide. So when we tell a patient, hey, we're going to apply, let's just say an injection. Unfortunately, we're saying to that patient that we see patients who do not respond at all. We see other patients where it wears off too early. And we see other patients who come back once a year or once every other year saying, "Doc, I know the day that wore off. Do it again." And I have a whole host of severely arthritic knee patients who are skiers who come in just before ski season every year and say, hey, you know, their x-rays look horrible. They look like they'd be a joint replacement. Hey doc, I'm not letting you operate on my knee until that injection doesn't get me through ski season. So it's, it's a wonderful space to be in. I just wish I had predictability on who would be a responder and who would.

Yeah. And those people that want to do the, uh, the injection and have a ski season, are you using hyaluronic acid for those people too?

So we learned in a prospective double-blind randomized trial that we ran at the Stone Clinic that, uh, if you use HA alone, in general, we saw 3 to 6 months of relief. If we added an anabolic to it, PRP, in that case it was years ago, amniotic fluid, or other anabolics, you stimulate the lining cells of the joint to produce more HA, and they get longer-term relief. And we saw patients out to 18 months in that study where they got relief that patients with HA alone didn't. So we're almost always providing a cocktail for our patients of whatever we think at the time is the most potent version of stimulating lubrication, decreasing inflammation, recruiting the body's own stem cells, all the things that we think are important. Yeah.

I love your, I love your mindset about this, that you're constantly iterating on your successes, right? Because I think that's the right way here in the longevity world. We are really gravitating. We've always had this as a mindset, but now with the advent of AI and things, we're really gravitating into the systems biology approach, looking at the individual around, you know, 5 different areas. Actually, one is, is the life energy we call that, which is really the psychospiritual nervous system, which we know drives so much stress for people or lack of stress for people, which of course drives disease or aging, or actually the other. And then we look at the hallmarks of aging, right? The root cause of the root cause of aging itself. And then we look at health and all the different factors there. And then we look at fitness performance, if you will. And we, we think about that as another extension of the nervous system because the muscles don't work if they're not innervated. So it's really about training the nervous system for speed, quickness, agility, balance, cardiovascular capacity, things like that. So we have many ways that we do that. And then architecting the environments to support the mission, to remove toxins and also make it as frictionless as possible for people to comply. So we're putting all that into a systems biology approach, which is there to support, you know, interventions like what you're doing. So we know that people will regenerate and do better if they're in a parasympathetic nervous system state than if they're stressed all the time. There's some interesting data around that, right? So, so all of this becomes, you know, how do you bring the, the rainforest, the ecosystem back back into equilibrium and give it its best opportunity to, in our terminology, live young for a lifetime. So that's kind of how we're thinking about it. What I like about your approach, even though you're focused on the joint primarily, is that you're kind of looking at it as a system. You're not looking at it as a, an item, right? It's not like, well, we'll go in and replace the knee and get it to heal, blah, blah, blah. You're kind of starting to think in a systems approach to this when you're talking about anabolics and how you're gonna support this and other things like that. I don't know if that's how you consciously think about it or you've just kind of gravitated into that.

Well, it's actually a little bit more than you might have— I love your descriptions. We strongly encourage our patients to use their injury as an excuse to become fitter, faster, and stronger than they've been in years. Oh, I love that. I love that. So we care for our patients both to help them avoid surgery, or if they need surgery, to recover properly and well, and then to use our training and fitness team, which is all in-house. For a lifetime of fitness training and checkups every year or more frequently. And so we think that the patients who buy into that approach, who, you know, treat themselves like a pro athlete would treat themselves as an athlete in training and not a patient in rehab.

That's it.

Do the best. And when we communicate that well, and when we bond with the patient well, then really we're treating whatever brought them to the clinic at first, but we're treating them for a lifetime and adding in all the new things that we're doing research on, you, other people are doing research on, and we're learning from. In trying to help that patient play forever. And that, that's our approach.

Yeah. No, I love that. I really love that. You know, one of the things that we've found out here too is that people's mindset around their youthfulness makes a big difference, right? So in my case, I was born in 1954, but I wake up 27 every day. And that is such a massive driver for me in terms of if I don't feel 27, it's like, well, it's not that you're great for your age, you're mountain biking, you're snowboarding, you're running, you're doing all this stuff. It's like, no, no, what do I need to do to be 27? And, and it keeps me, you know, when I do bump into something, it, it enables me to actually get back to being 27 again. So what you're constructing for your, for your patients is to say, you're not an injured elderly person, aging person. You're actually a pro athlete. Let's get you back to being better than you ever were. Right. That's a really powerful, powerful thing. I don't know if the audience is catching that, but it's incredibly powerful how somebody's thinking about themselves, the image they have of themselves. Incredibly powerful in the healing prospect.

So thank you. We're even more granular than that. We, we're saying, listen, if you wanna play forever, how about training to play?

And, uh, that's it.

So what would a pro athlete do if they were injured? They'd optimize their nutrition, they'd optimize their fitness training, they'd optimize their, their sports coach, they'd optimize how they spend their time. You know, they may have a knee injury, but how about if they come back to their game better than they were before they got hurt? So they're gonna train their core and their upper body program. Cardiovascular program while they're healing their knee. So again, this using your injury or your state of mind at the moment as an excuse to say, okay, how can I be fitter, faster, and stronger? It's a really good way to look at it. And so, you know, set— we all have setbacks. We all, all good athletes get injured and the best ones come back better. And so, you know, mourn for a minute your injury, which is usually a mental error, by the way, we can talk about that, but then line up your resources right away and say, okay, this is my time to do stuff I haven't had time to do otherwise.

Yeah, no, I love that approach because a lot of times in more traditional thinking, if we can get you back to 90% of where you were, or 95% or 80%, you know, that's a good outcome, so to speak, right? Whereas in this case, it's really the idea of how do we make you more resilient, more robust than you were before this actually happened to you. I love that. So do you have some things that you recommend to people that haven't injured themselves as a way to protect their joints and things like that? Do you have some things? I'm sure you have some thoughts around that, but it'd be interesting to hear those.

The number one reason that I see people get injured is a mental error. And so if you ask a skier, if you ask a soccer player, if you ask a basketball player, they almost always knew a microsecond before they got injured that they were either in the wrong spot, they were going too fast, they were on a, you know, on back on their ski, they were, they were landing improperly. And almost always that was their mind wasn't in the space. It was either on their girlfriend, on their boyfriend, on something else, on the distraction. And so I think the coaching that matters the most for staying out of my office is when you're gonna go play. And by the way, we don't use the word workout anymore. We don't want you to go work out. Work is associated with work. We know that if you go play and play with friends, you'll get so much more out of it than if you go work out. I love that. In any case, if when you go to play out, if you can say, listen, put the phone away, put the other stuff away, put your mind in the, in the place where you wanna be right then. Never work, never get on a stationary bike or anything else watching TV or reading a book or listening to music even. Just put your mind in the sport. Listen to your heartbeat. Listen, feel your muscles. Know where you're getting to your limits and you can push past them a little bit. That's the training effect. And it's really mostly about paying attention to you. And if you can learn how to do that, it's far more potent than any Fitbit or, or other measurement tool or anything else. Just, you are your best coach and you're also your worst enemy in terms of getting injured. And it's distraction.

I love that. Yeah. I love, I love that you're saying that, you know, for us, the way that we do that here is we, we teach people about how to get into a flow state because when you're in a, in a mental flow state, right in the zone, so to speak, we can train their brains to actually go into gamma, which is the, you know, the EEG waveform, which coincides with the flow state. And we train people to actually understand what that feels like. We can do it with a device here called BrainTap that will put them into a flow state. And then sometimes we'll have them work out before they— not work out, play— before they do something, we'll have them listen to binaural gamma beats to kind of put their brain into that flow state. And then it helps them to carry that. And when you're in a flow state, of course, you're completely aware, it's the greatest place to be, right? When you're mountain biking in a flow state, your vision is not focused. It's actually broad. You're seeing everything and you're allowing the computer or the brain to just pace yourself and make the corners, right? It's, it's, you're in that place of flow and ease, if you will. And yet at the same time, you're going faster and better than you were if you were trying to overthink it. So that's kind of how we go about it, trying to get people to play in that flow state. So do you have a directory of surgeons? Is there a website where people can go and find somebody that can fix their knee or fix their ankle or hip or something?

We don't do it that way only because we never know the— you always need to know the bias of your surgeon. So I'm biased towards doing biologic things for patients. I'm biased towards doing partial replacements rather than full replacement. I'm biased towards just treating the broken part rather than the full thing. I'm biased towards making sure patients have a full rehab program associated with any injury and recovery. And so I never know the bias of somebody else. So what we do is we, at stoneclinic.com, we offer a complimentary opportunity for people to upload their X-rays and MRI and story, and then I'll get on the phone with them and talk about what I see. Best thing, of course, is if I can examine them in the office and then I can give them the best advice. But for people who live out of town or away, that's, we, we offer that for them. And then I publish a blog every week trying to keep people up to date with what we're thinking about and what's changing. And that's at stoneclinic.com/blog. And so I'm communicating in that way to try to be educational all the time. And then I run around the world and teach and give lectures at meetings and whatever else. I wrote a book called "Play Forever," and I'm just writing another book called "The Anabolic Revolution." And so that hopefully will come out next year. And these are the ways in which I think we can communicate in the best way.

Yeah, I love that, "Play Forever." You know, I think really one of the highest forms of engaging with life is in play. It really is. We tend to trivialize play, but it actually is one of the highest forms of engagement. Quite honestly, when we're playing, we're learning, we're pushing ourselves, we're laughing, we're, you know, in a flow state. I think it's one of the best states that we can possibly be in. So I love that you wrote a book entitled Play Forever. That's great. I guess I was thinking in terms of all the people that you've trained, if people, let's say they do a consult with you, but they live in Pittsburgh or something, is there somewhere where you recommend somebody that you trained in Pittsburgh or Or you don't have that kind of connection?

Not really. Most people will come out and we'll see them in San Francisco if they want us to treat them. And we found that's the most effective way to do it. We feel badly when people get referred and things don't go right.

Yeah. Got it. Okay. Well, that makes sense. And where are you in San Francisco?

Right in the marina.

Oh, okay.

Right by the marina Safeway. So it's great. I can take my boat to work a couple of days a week, which is fun. It's looking across San Francisco Bay and puts a smile on my face. And, uh, It's a wonderful place to be.

Okay, great. Beautiful. All right, cool. So you're writing the next book. What, what else is kind of on the horizon for you? What are you thinking about you'd like to do next? I mean, what's, what's out there kind of in the theoretical space for you?

So first of all, we want to prove that the testosterone use before and after surgery will diminish muscle atrophy. That's a high priority in our research programs. We want to make our cartilage regeneration technique better by adding various anabolics to it and see if we can treat bigger and bigger injuries for patients. And so that's the two major focuses of the research and the research foundation. I'm quite curious about where birth tissues will go. Clearly, if there's a fountain of youth, it's the placenta and all the birth tissues there. Babies are growing very fast, nothing growing faster than the fetus. And those tissues are thrown away at the time of a healthy woman's C-section. And so discarding such potent growth factors, cells, biologics is just, I think, an easy way for scientists to open up the future fountain of youth. So I think those are quite the important areas that I focus on now.

Okay, cool. Yeah, beautiful. Any other thing you'd like to communicate to the audience here?

I think it's, you know, we live in a wonderful era, as I mentioned, the anabolic era of sports medicine and orthopedics. I think that I, my counsel to patients often seek out physicians and rehab teams that think the way you do and, uh, understand their bias. Just ask 'em what their bias is. Sure. And if their biases fit with your vision of where you want to go and where, and if it's inspiring to you, and if they can design a program that's fun, or you can design a program that's fun, you're likely to do it. And if it's not fun, you're not likely to do it for long. And so adding a little bit of laughter and fun into your program and, uh, seeing the optimism, preserving your tissues as much as possible. You and others are doing a ton of work in this space that clearly we're not at the moment where injectables can truly regenerate tissues, but we're getting much closer. And so if you need me to do something surgically to replace a tissue or put a regeneration template in or whatever, we'll do that, of course. But we'll get to a stage pretty soon where a lot of the injured tissues, we can augment their healing and accelerate their healing. Better than we could do today. And so it's worth it to be optimistic. Come support research. You know, I run a public nonprofit research foundation, stoneresearch.org. Come support that. You know, philanthropy that helps you play forever is good philanthropy too.

Oh yeah, absolutely. Absolutely. Beautiful. I was just going to ask you this. It just came to mind. What, what injuries have you had that you've had to deal with?

All of them.

Okay.

Been skiing and surfing and playing for a lifetime. And I've, I've, uh, run into people, uh, had people run into me. I've made the mental errors that I've learned a lot from. And I think what we've all learned is that being injured is, is not fun. And so if you can avoid getting injured, you can have a lot more time to play, to live life, and to really enjoy it. Injuries set you back. And so yes, they, they're gonna occur given our exposure to the sports we're playing. Pickleball number is our number one referral right now. It used to be CrossFit. But if you're gonna play the sports we all love to play, prepare for them. Take the, take out a moment, you know, prepare your body, prepare your mind, be in the moment when you're playing them, and you'll stay out of my office much more often.

Yeah, I think that's, I think that's good advice. You know, one of the things that we've learned here too, uh, to your point about getting injured as a setback, is that the, the interesting thing is if you have an injury and you sort of decide that you're going to live with it, I think it's one of the worst things that you can do because the decline is so rapid. And it takes so much longer to get back to where you were. We are massive fans of if something happens, fix it ASAP because you don't have to pay all that, you know, going forward in terms of the decline that you then have to try to recover. So I think, I think if you get hurt, you should jump on it, right? With whatever's appropriate, you'll save yourself a lot of time and you'll maintain a lot of function that you might have to fight to get back otherwise. So anyway, Well, Kevin, it's been a pleasure chatting with you. I think the audience has learned a lot and has probably been inspired to play more, play harder, right? Play wiser. So that's good. That's our goal. That's it.

Great to talk with you.

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