Why I Stepped Away from 15,000+ Surgeries—and What I Do Instead

Next guest is Dr. Josh Schachter. He is an orthopedic surgeon and he's redefining joint care with a commitment to providing actual solutions for his patients. He spent over a decade as the chief of orthopedic surgery and did about 15,000 orthopedic surgeries. He excelled at this, but he saw firsthand the need for non invasive innovative solutions that address the root causes of pain and dysfunction rather than, rather than masking symptoms. He has a program called Pinnacle Method and in this method, he is moving away from the traditional approach of orthopedics to the integrative functional approach so that his patients will no longer need surgery. He has non surgical solutions using regenerative medicine and he empowers his patients to take control of their health and regain their quality of life. I think you'll really enjoy this episode with Dr. Schachter. Today I will be speaking on Stronger bones lifestyle to Dr. Josh Schachter. He is an orthopedic surgeon. You could listen to the intro on all the other amazing aspects of what he does and who he is. Today we are going to be, I want to say, kind of blowing up the notion around osteoporosis the way that we've been diagnosing, managing and treating it. So welcome, Josh. Cannot wait to have this discussion.

It's awesome to be here. I've been looking forward to this for, for a couple months, actually. Really appreciate you.

Yeah, thanks. All right, let's start. I want to hear, let's hear, who are you? What do you do? Let's tell us your story.

Well, I, Joshua John Rom Shachter, my parents were hippies. I grew up on a hippie commune actually outside of Ridgeway, Colorado, if anybody knows where that is. That's the middle name. I'm a board certified orthopedic surgeon. I'm actually in a small town in Texas, so in Wichita Falls, Texas. If you've ever seen the John Cusack movie the Ice Storm, that's our claim to fame. We're also a really interesting community. It's about 108,000 farming and ranching, but also oil and gas. We have. I was hired by the hospital here in 2008 and out of residency and I'm a general orthopedic surgeon, but I sort of subspecialized in adult reconstructive surgery and then also a lot of sports medicine. So ACL reconstructions and, you know, shoulder scopes where we do rotator cuff repairs, those sorts of things. So. And I was a very High volume orthopedic surgeon. I've done about 15,000 surgeries in my career of about right around, you know, 20 years if you count my residency. And then I've been in this community for almost 17 years. I worked for the hospital for a number of years. I was the chairman of the orthopedic department for 10 years. I ran a advanced orthopedic center of excellence. We managed to be certified as an advanced. We were the smallest hospital in Texas to be certified as a advanced servant excellence. And really quite an accomplishment that I was very proud of and was really able to develop some great programs around optimizing perioperative surgical care for my patients.

And we were kind of trucking along and doing well. And then my wife, when she was about 33, her father was diagnosed with kidney cancer. And it was a relatively rare form of kidney cancer. And I was sitting in the doctor's lounge talking to a friend of mine who was a ob GYN doctor and talking about my father in law and he's like, oh, that's a rare sounding kind of cancer. Have you ever heard of brca? So this is the BRCA gene or the breast cancer gene. And to, at that time, not many people had heard of it. It was a genetic test that was not paid for by insurance. I mean, what is. But. And then he said, well, you should really get your wife tested for that. And I didn't really think much of it at the time. And I came home and I said, honey, you know what, we should, we should test you for this just to be careful. You don't have it, of course, but, but we'll test you for it because your dad, you know, has this rare form of cancer. And she was diagnosed with BRCA gene 1, which is the most severe form of BRCA, which is a very, it creates very deadly cancers of the breast and of the ovary. And so at the age of 33, my wife, who by the way, I've been married, I've been married 29 years this year I made the love of my life. I met her when I was 15 years old. And we got married when I was 20 and she was 18. And we've been through everything together. So this really important person to me was diagnosed with this disease that basically wrote her future.

And it was a very impactful. And I was a busy orthopedic surgeon. I wasn't home very much. I was working 90 hours a week. I was doing 25 or 30 surgeries a week. And just really what we call Hammering it, doing my best to, you know, make a lot of money and do a lot of surgeries and take care of as many people as I could. And obviously, as a busy doctor, letting my family, you know, suffer the effects of that, which I, you know, look back on and some regret. But this was sort of. When she was diagnosed, everything changed. Everything in my life changed. Every. Every the way that I looked at medicine changed. Everything changed. And the recommendation at the time and is still, you know, the main recommendation for BRCA positive women, Angelina Jolie's one, is to have a mastectomy and a prophylactic mastectomy, a mastectomy to prevent breast cancer, and also to have the ovaries and the uterus removed. And so my wife, at the age of 33, in her 33rd year, she had 11 surgeries, including a mastectomy with reconstruction, breast expanders. And just shortly after that, her father passed away. So to sit at the bedside with my wife over and over and over and over, and to watch the process of her mourning her womanhood and becoming very, very changed physically was a painful process. And at the end of her sort of operative period, she'd sort of stabilized, and everything was good. By the way, Rob Whitfield is a great personal friend. My wife ended up developing breast implant illness, which she then had for 10 years. And that's another part of the story that we can get to. But at the end of that sort of initial process where my wife had gone through all these psychological changes, and my wife had been a Venus swimwear model, and she'd done a lot of modeling in her 20s. And so she's a beautiful woman. You know, Amber. She was then forced to age prematurely and was really at a loss, was very depressed, was really hurting. And we started talking about, well, what can we do? She started having severe hot flashes. She started having. She went into menopause, and she had to deal with these consequences of menopause for months. And. And she was just basically begging her doctors, what can I do to feel better?

There's no option for me. And her oncologist absolutely forbade her from doing any sort of hormone replacement therapy. Her obstetrician was a little bit. Or her GYN doctor was a little bit more open. He said, okay, well, no problem. We'll give you some hormones. So he basically grabbed a. A sample bag of hormones and handed it to her and said, here, take one of these a week, see how you feel, and in six weeks, we'll get back together. Tell me which one you liked best. And we'll write you a prescription for that one. And I thought, that's not very scientific. That doesn't sound like anything we want to be involved in. And so we actually, we got involved against our oncologists recommendations. We searched out a functional medicine BHRT provider and started working with him with hormone replacement therapy for her. About three years later, I started working with him as well. And it's really been a life changing experience. I truly believe that it's prolonged her life very significantly. It's helped her to be a full human being where she really didn't feel like that before. And so that really changed. And that combined with the experiences that I had sort of watching her being taken care of by this traditional system really changed the way I started to think about medicine. And so if we fast forward a little bit.

Well, wait before we fast forward, because I want to stay there, because I think this is really, really important. So I did not know all that about your story, which is amazing, which now helps me understand why you do what you do. And that's what's really important. But you just used the word traditional medicine and the disillusionment that came to you for that. And that is my big mission and what I really want to speak a lot to about here. And then we're going to move on to the future, what you do now, because I think that's really important that you have that backstory because then you have all that knowledge to do what you're doing. But when you and I were talking off camera, we were Talking about the 15,000 surgeries, I think you were said. So I want to still stay in that traditional model because what we need to do is we actually need to shed light on how wrong it is, how disserving and disempowering it is for women.

And.

And you, you mentioned that your experience with what Amber went through. So can we just speak a little bit more about that experience for you? You were a traditional orthopedic surgeon. Can you just give us some view of. I'd love to know hip fractures, pelvic fractures. You said you did adult reconstruction.

So many. Yeah.

And then also you were mentioning the medication's role potentially in some of this. So let's talk about the traditional model that you lived in when the bone health world, what you saw so we could learn about that.

So as a traditional orthopedic surgeon, and you know, everybody does it a little bit differently, there's some orthopedic surgeons who are more knowledgeable about bone Bone health. And certainly there's some pioneers out there. You know, we talked about a couple of them. Doug Lucas is one. Vander Vander Wright. You know, really pioneering folks in the bone health. You've had several orthopedic surgeons on your show. I come from a background of high volume orthopedics. Now I think it's really important for people to recognize and it's become a bigger problem.

As time has gone on. When I started in 2008, when you got employed by a hospital, in my case, I was a great partner to the hospital. I worked to help them extend their reach and I worked to do more surgeries. And we wanted to start to take care of more and more people. And so we developed programs to help people get into the clinic and be able to have more access to surgical care. What that has become in the last, probably, and I would say especially badly since COVID but we've really started to ramp up on the. We gotta get people to surgery where surgery is the only option. And we're gonna speak about bone health too. But I just wanna get on this little soapbox and say what I saw in my career from when I started to, when I finished with my employment was a drastic increase in the pressure for a surgeon to do more and more and more surgeries. And a lot of surgeons really love surgery. And for the longest time I certainly loved surgery. I think that surgery, and don't get me wrong, there's a lot of. You've had a hip replacement yourself. There's a lot of surgeries, particularly in orthopedics, that I think are super valuable. Joint replacement can be a life changing option for people. I think it should be the last option, but it can certainly be a life changing one. But what we've done in this country, particularly because 80 plus percent of orthopedic surgeons now are employed by a system, they're driven by the need to push volume. So we break patients down into something that's called a relative value unit. And so every patient is worth a certain amount of these value units. And that's how a surgeon's reimbursed, right? It's not per surgery, it's per unit. When we break these patients down into a unit, it dehumanizes them, makes them into just a surgery to us. And even in people who are super passionate about taking really good care of people, the goal is still to do as much surgery as possible. And so we end up, I think, making a lot of shortcuts in the traditional system. We sign people up for surgeries that we know that Almost up to 35% as of 2019, up to 35% of joint replacements at that time were being done what would be called prematurely. That's a, that's in one of our major journals and it's probably more now. And so that's a really concerning trend. And I like, and that's something that I talk to my patients about, is that we really, hey, there's a lot of opportunity for us to fix your joint without doing these big surgeries. Now to speak to bone health. In my career, I have seen so many women who have been under treatment for osteoporosis for many years who fracture, who have, you know, it doesn't seem to me looking grossly at the bone. And I get to look at a lot of bones right, just with the bare eye and I see, well, you've been on Fosamax for 10 years and your bone is like Swiss cheese. I saw over and over and over women being put through a system, given a DEXA scan, told they have a high fracture risk, and then put on a medication that one they tolerate very poorly because a lot of these medicines are pretty gnarly. And that don't work, you know, for what I, from an orthopedic surgeon's perspective. Well, you still broke your hip when you fell. You've been on fox, you're an 87 year old woman's been on Fox Max forever. And you still, every time you fall, you break something, you break your pelvis, you break your hip. So it's really to me to put somebody on a medicine or to do a surgery that's going to place them at increased risk when there's very limited effect of the medicine. It's a terrible travesty. And we are really seeing that in traditional medicine now. Now, not every single osteoporosis medicine is so horrible, but a lot of them I think are really wrongheaded. And the way that we treat osteoporosis in this country has been very wrongheaded. We know. I just heard JJ Virgin and Vonda both talk about the importance of weight bearing exercise as we age. You know, that is not something that I recommended in 2015.

Because I was in the traditional mode. Oh, hey, you don't want to do weight bearing exercise, it's going to cause your joints to degenerate more. Well, I have learned through my process, you know, through my, you know, coming into this space and being much more interested in taking good care of my patients, how important these things are critically important. And so when we substitute exercise, weight bearing exercise for, you know, you know, with some drug that, that basically kills your bones activity, that's what, you know, bisphosphonates, they don't do anything to build your bone up. They just make your bones stop remodeling. It makes it much more brittle. You know, it inhibits your osteoclasts, which, which help your bone remodel. And it's, it's. They're terrible drugs. We see a lot of problems from these drugs. You know, in particular, you see things like really weird femur fractures, like at the top of the thigh bone, you have these proximal third femur fractures. That's a signature of bisphosphonate treatment. You see jaw osteonecrosis. We see a lot of other things. And so I always sort of had this question, and then when I have a patient who breaks their bone, you have to stop all those medicines because the bone won't heal. And it doesn't make any sense to me to think, well, you're taking a medicine that prevents the bone that I'm trying to take care of from healing. How is that actually preventing osteoporosis in any meaningful way? And what we're finding now, you know, when I listen to you talk about it, when I listen to your experts talk about it, well, that's because they don't help. They don't. They make the, they make the problem worse. Yeah.

And you know, the other thing is. So that's the bisphosphonates, which is the most prescribed, but even the anabolic, the drugs that they came up with to say, okay, well, wait, so we're not going to stop the cleanup or the breakdown. We're going to focus on the buildup. But, but the problem is it's not physiologically correct. So we're artificially building up bone. And the minute you stop those buildup bones, you need to bring in this terrible drug that we're talking about, the bisphosphonates. And then you're in this vicious cycle. And what I hear from women who are on these, you've got all the digestive issues, you've got headaches that happen. There's all these side effects, and it's just. It's wrong.

No, it's totally, it's totally wrong. And it's an industry. It's a bit. Fosamax is one of the most successful drugs in history. Right. And something I tell my patients is no drug by itself is going to heal your joint pain. Right. No drug by itself is going to heal, is going to heal your osteoporosis either. It's a combination approach. It's a holistic approach. It's an integrative approach. And that's why we call what we do integrative orthopedics, is because we want to use these other measures beyond traditional measures to solve these problems.

Right, so where we move then, so we have the traditional. The way that we've done it since the 1990s, actually. The company that came up with Fosamax partnered with a company that had this machine to look at bone density and the criteria that was osteoporosis. And then they had a new diagnosis in 1992 called osteopenia. I know you know these terms, but now they could tell, say 50% of the women over age 50 have these either medical term osteopenia or disease osteoporosis. It was one of the first blockbuster drugs ever. And like you said, still to this day. So that's what we were doing. And really, the woman was taken out of the equation. There was no here. This is what you need to eat. This is how you need to move. This is how you need to think. You need to optimize sleep. There was none of those recommendations. And so the traditional approach is wrong. We need to change it. And I think really, where that shift comes, and I wonder if you would agree with me on this. When we could start to look at bone, bones and osteoporosis as a metabolic and inflammatory disease or condition. When we start to look at that, then we look at if this is the why, you know, traditional medicine looks at the what you have osteoporosis, here's the band aid or the pill. But when you start to look at the integrative approach, which is more the why, the root cause analysis, and if you look at osteoporosis as an inflammatory metabolic condition, that's where all this other wisdom starts to come into the picture.

Oh, absolutely. And I, you know, we. There are so many overlooked ways to, to treat this problem that, that one, they don't have the risks. They have massive benefits. I think the problem is we are so trained in traditional medicine that we need to make a diagnosis and then we need to give a pill. Right. I, I've. I remember very distinctly in, in medical school having a cardiologist come and talk to us in a talk that was sponsored by the company that makes, that made statins and tell us that statin should be in the water. Right. And and all of the lunches and the, you know, no matter. There was always a significant influence. And they get you very young in your career, and and so they convince you that you need to make a diagnosis and that you need to give a pill. And the system is set up to they don't have time to do anything else. Right. So in a traditional medical office, you go in and you talk to your doctor, I mean, your orthopedic surgeon. If you see your orthopedic surgeon for more than 10 minutes, you lucky, you know, and it might just be their advanced practice provider, you know, their PA or their nurse practitioner. It would in my practice, you would have been lucky, because I saw 50 patients a day, and my nurse practitioner saw 30 patients a day. So to get.