“Why Joint Pain Keeps Coming Back | Dr. Joshua Schacter”

All right, welcome Back to the Dr. Doug Show. Today I've got an interview for you with Dr. Josh Schachter. Now, Dr. Schachter and I actually went to the same residency together. So he's an orthopedic surgeon. And he left the conventional medical model similarly to what I did, except that he still operates some, but he started to practice focusing on orthobiologics, focusing on things you might have heard of like PRP stem cells. We talk about exosomes. So he has a practice where he has really dug into the research on this. He's using this in a integrative orthopedic way, which is super exciting for me to see what someone else who, who wasn't happy in the conventional model has been able to do with their practice, with their team, with their passion for providing a different type of care. So I hope you enjoyed this interview with Dr. Schachter. All right, welcome, Dr. Schachter, to the Dr. Doug Show. Some really exciting items to talk about today. But first off, just let me say welcome and thank you for your time today.

Oh, man. Thank you for having me. I'm so excited to be here. I'd love to get the message out about what we're going to talk about. Amazing stuff.

Awesome. So I, I said in the intro the things that we are hopefully going to talk about. The two areas that I really want to dig into are orthobiologics, which we'll explain what that means if people don't know. And then I also want to talk about your experience with hormones and musculoskeletal pain because this is a something that I just learned about you recently that I really want to dig into. But let's give the audience a sense of what your background is to kind of lay the groundwork for this convers. So give us a sense of what you're doing professionally, how your career has changed in a similar trajectory as mine, but sort of ending up in a different place. So give us a little bit of your background.

Exactly. Well, I'm a board certified orthopedic surgeon. I practice currently in Wichita Falls, Texas. And I actually graduated from the same residency as you, my friend. And so I have been out in practice for 18 years, I believe. I practice.

Graduated in 2008 and I came to Wichita Falls to practice general orthopedics. And then general orthopedics is basically a broad cross section of orthopedic medicine. So we do everything from sports medicine to joint replacements. My specialty became adult reconstructive and sports medicine surgery. So I did a lot of joint replacements. I've seen a lot of arthritis in my time. And then I've also seen a lot of the other spectrum, so sports medicine injuries, ACL reconstructions, shoulder arthroscopies and shoulder scopes. And I, when I graduated from residency, it was early in sort of the doctors being employed period. And so I came to Wichita Falls as an employee. I very quickly became very busy. So in my 20 year career, I've done about 15,000 surgeries. I was a very aggressive senior resident as well. So I've been, I've always loved to operate. And quickly became the chairman of the orthopedic department where I served here at United Regional Healthcare center for over a decade. I also developed an orthopedic center of excellence for hip and knee replacement here in Wichita Falls. We actually managed to achieve the advanced certification probably about seven years ago. And I was the leader in that program for a decade as well. And basically that is a quality initiative in a hospital where we do the highest quality research based protocols around joint replacement. So I have an extensive experience in sort of adult reconstructive and replacement joints.

As I went in my career. There's two reasons I'm here. The first reason is that as I kind of progressed through my career and I did a really high volume of surgery, obviously.

The imperative right now in the American traditional medical system is that we do interventions and operations.

Through my work with safety and quality control in the joint center of excellence, I really started to have some doubts as to one, are we doing surgeries always at the appropriate time and are patients optimized so that they can get the very best outcome out of this intervention? Right. So we're doing all of these surgeries in people. And as I started to sort of dig into the data and have more experience with that, what I found was, you know, in my own clinical experiences, we're doing surgery on people earlier and earlier. Right. So we're doing more and more surgeries on, on young patients. And we're, you know, especially at that time, which is at this point about five years ago, there was not a lot of focus on.

Managing the patient's health around the operation. There's a little bit more focus on that now, but we really didn't see a whole lot. We checked their hemoglobin A1C to see if they're a poorly controlled diabetic. And I can't tell you how many people that we caught diabetes on. We actually made them quit smoking. At a time where no hospital was really willing to do that. So we were really starting to be health conscious and health forward. And I wanted, I saw a need to continue that and the hospital and my employer saw a need to have more and more surgeries on the books. So we were starting to have a little bit of a loggerheads there where that's concerned. And then I, I became more interested in regenerative therapy as my career advanced. So I've been doing regenerative therapy now for about 10 years. And I did it mostly in combination with surgeries that I did. But as I researched more of that, I started to come to the hospital with, hey, if we started to do PRP and bone marrow aspirate stem cells, maybe we could prevent some of these surgeries that we're doing. And that was not well received by any hospital administration. They were like, I don't know if that's necessarily something we want to focus on. And so that was a part of my practice when I left the hospital in 2023. Now, the second reason I'm here is, I think, the more important one, and it is, it is the reason behind my life's work. My wife Amber, I've been married for 28 years. I know I looked young, we got married very young. She's my best friend and I've been with her my whole adult life.

She is also a.

Wonderful administrator. She's also a great visionary business person. She's been an entrepreneur for years. But my wife was diagnosed with BRCA1 at the age of 33. At the same time, she was diagnosed genetically with the gene that causes a massive increase in breast cancer. We also lost her father to kidney cancer. And then a couple of years later, we lost her mother to metastatic ovarian cancer after she had had a hysterectomy, after she'd had a nephrectomy. So it was really pressing to her to have something done. And so at the age of 33, my wife had complete hysterectomy. She had her ovaries out, she had, she had a mastectomy prophylactically and had a big reconstruction. And in that year she had about 15 surgeries. And so sitting at the bedside and watching her progress through from a young woman to a middle aged woman with all of the hormone deficiencies that come with, with, with the transition into menopause all rapidly a matter of months was shocking to me, both as a physician and as a partner. And I remember she started having hot flashes almost immediately and they were just disabling. Right. And so I would just. I had to hold her hand. She'd be sweating. She'd be waking up in the middle of the night. It would just be terrible. She would have depressed mood, and she'd had all these surgeries, and it was really difficult as a partner to watch her go through that. And I remember her doing her own research and saying, I think I really need hormone replacement therapy. And us going to her oncologist and. And her oncologist absolutely forbade her. You cannot have hormone replacement therapies. You can. I know, it's ridiculous, right? You cannot have hormone replacement therapies. You cannot do that. It's going to cause your cancer. You're going to die.

Wow.

And then we went to her obstetrician or GYN doctor who had done her surgeries, and she said, I don't know why you need hormone replacement therapy. You just want to feel better. And.

She'S like, yeah, exactly. I just want to feel better. Well, and so he kind of had a little bit more robust plan. He said, all right, well, I have all these samples of birth control medication. Why don't you take one of these for about three weeks and then switch to another one? And at the end of six weeks, you keep a log. You come in, tell me which one makes you feel best, and we'll give you that one. This was, by the way, synthetic estrogen and progesterone, which would have increased your risks.

Right?

So. So that didn't seem very science back to us. So she continued to look. She actually found a functional medicine hormone provider and went to.

That person, and we were given a plan. We were given, hey, we're going to test these labs. We're going to look for this. This is what the benefits are going to be. We're actually going to protect you. The data shows that we're going to protect you from these things that everybody else is afraid of. And so she started hormone replacement therapies, and it has been a complete game changer to her life. It gave her her life back at the age.

Yeah.

And so at the time when she felt like she was going to just age and then die prematurely, she was given her life back. And to me, that was so powerful, and it made me really interested in what these type of measures can do for our patients, men and women. I personally have been on hormone replacement therapy now for about eight years, and it's made a huge difference in my musculoskeletal system and the way that I can respond to exercise and the way my joints feel. And so the literature does support us in using these measures to help with musculoskeletal complaints. And so that we've been doing a lot of that optimization. When we started Pinnacle in 2023, our goal was to incorporate these amazing methods and options that we've discovered that made such a big difference in our own lives, and to use those in combination with regenerative therapies to really supercharge the process. And so we've developed a process called the Pinnacle method. And it combines the most cutting edge in orthoregenerative care, orthobiologics, we call it. So prp, stem cell options, red light laser therapies, there's some other peptide therapeutics, nutraceuticals with a functional medicine approach to bioidentical hormone replacement therapies and metabolic optimization, gut health detoxification. And we find that it's really powerful and it makes these treatments much more durable and powerful.

Yeah, that's amazing. Well, first off, thank you for sharing that. I had not heard that story about your wife, so thank you for sharing her story. And it's interesting timing. Yesterday I did a talk for a group of 5,000 women in the UK who've gone through or are going through surgical menopause. And it's a really interesting population of women because so many of them experience what your wife experienced, which is no discussion of hormones. If they ask about them, they're denied care. But what blows my mind about this is that I looked this up before I did the talk. I was like, you know, acog, American College of Obstetricians, Gynecologists, the Endocrine Society, Menopause society, all clearly make the recommendation that for a woman going through a surgical menopause, the standard of care is HRT to prevent the like increased risk of heart disease and dementia. And like all the things now with the genetic history like there, I understand there's some concern around genetic risk for breast cancer, other cancers, the BRCA specific thing. But as you, I'm sure, did the research on you recognize that that risk already exists. And adding HRT does not change that risk. You already have that risk, so why deny a woman care because of that? That's, that's super frustrating. So it's something else you mentioned that I wanted, that I want to talk about too. And this is, I think people are starting to get this. But hospital systems who so frequently will say it's all about patient care, what they actually mean is it's all about patient Care the way that they want to do patient care.

Exactly right.

And so when you were saying, hey, I, I have found these tools which could help prevent these surgeries, hospital administrators are thinking, well, that's a terrible idea. Orthopedics is our biggest profit generating service line. Why would we prevent surgeries?

Absolutely. And it's interesting, you know, the data, especially as we all became employed right through the, through the mid-2000s and into the, and now it went from when I went out into practice, I believe it was about 30% of surgeons became employed and now it's 80%. And so we're being driven by, we're being driven by institutions who are interested in making sure that they have profit. Right. That they can, you know, orthopedics, the average orthopedic surgeon provides an institution between 3 and 5 million a year in profit. So I think it's important for people to recognize that when you go to your surgeon.

They have your best interest at heart. And I would never say that an orthopedic surgeon just operates willy nilly for no reason without, without some data to back that up. But they are being pressured by their employers to do surgery and they're being asked to do it in that institution in the way that that institution wants it done.

I think that it's subconscious. I've talked about this openly before because I went from an employed contract to a private practice contract and in the employed contract, my, for those that have never seen what these numbers look like, we have to hit certain productivity thresholds in order to achieve a bonus. The way, and I didn't know this going into it, but the way that they set up my thresholds, my, my bonus structure was not achievable under any circumstances. And so I didn't actually have that pressure. So I knew, because I knew I wouldn't get there. So I was really using my own indications and judgment and whatever. When I went into private practice, all of a sudden you have overhead to cover. All of a sudden like you realize, oh my gosh, like it's a different equation. Similar but different. I found myself wanting to do surgeries on patients that I felt were indicated, but when I was employed, I wasn't making that same call. And it's not that my ethics changed or my values changed, it's a subconscious pressure. So if you're in a hospital system as a surgeon which strongly prioritizes and pushes you to do more surgeries, you're probably going to do more surgeries. That's just the environment that you're in and that's why I also tell people when they are frustrated with the conventional medical system, just think about where you are. If you go to a doctor that prescribes drugs all day long, you're probably going to get prescribed a drug. If you go to a surgeon, you're probably going to get talked to about surgery. That's what the system is. It takes people who are coming out of it, these physicians like yourself, like myself, who come out of it and create a different business model so we can now help people the way that we want to help people. I'm actually really envious of what you created because I could not in my mind come up with a way to blend what I wanted to do with prevention, with nutrition, with functional medicine and stay as an orthopedic surgeon. Asheville is not a great market to, to open up a shop on your own. I didn't have capital to do it, so I made the huge leap and just went away from surgery altogether. But you've managed to actually combine these together. So give us a little bit of a picture. You kind of mentioned that you have the pinnacle approach in these, these protocols. But what does a patient experience in your clinical practice? Let's just use for example, you know, a 55 year old woman with knee arthritis. What is she going to experience as she comes in to see you?

So goal one, you know, first we do. We actually, you know, rather than just book a patient into the office, we actually like to get to know them a little bit before they come. It's a little bit of a novel experience, especially for people in Wichita Falls. Yeah. Weird. Why would you, why would your doctor want to know you before they meet you? Wichita Falls is, I think we, you know, you said Asheville is a difficult market. Wichita Falls is a tough one as well. We're a town of about 108,000. The population growth is pretty flat in north Texas. It's a wonderful community, but there are challenges. So for us it's a lot of education. When we have a first patient come in and we have your patient, 55 year old woman with knee arthritis. I think the traditional way to look at that is you're going to come to an orthopedic surgeon, you're going to get to spend. You'll wait for several hours, hours, months to see them, several hours in the office. You may or may not see the actual surgeon or advanced practice provider, PA or nurse practitioner. And then you're going to get either a steroid injection, a medication, maybe a prescription for physical therapy. With no clear instructions or follow up on how you're going to do that.

Or you're going to be told, diagnose and treat.

Yeah. You either need this surgery that I, that I know how to do or you are not ready for this surgery that I know how to do. So come back and see me when you are.

That is the, that is the model that we want to depart from. Right. That doesn't, that's not patient centered. That's not, that's not centering on improving a patient's outcome and wellness. That's looking at one tiny problem, which is the knee and not looking at the larger system which is the 55 year old woman sitting in front of you. And so our method, our first real goal is to, when we take it from functional medicine, we want to dig into the root cause. So why does your knee, why, why does your knee bother you? Well, structurally you may have some arthritis. Right. The knee joint may be worn, but that's not well explained by just your X rays. There are so many more opportunities and things that go into a patient's, you know, into a patient's well being and their symptoms from knee arthritis than just the structure of the joint at its local environment. Does that make sense? So if we can look deeply more, and you get this, if we can look more deeply into their hormone axis, if we can look more deeply into, you know, detoxification, gut health, overall metabolic wellness, then we can see reasons why this knee hurts so badly. Every orthopedic surgeon has seen a patient that their, their symptoms are not well explained by their X ray. Yeah, they're not well explained by their mri. You know, we look at patients with adhesive capsulitis. There is a definite meta. Adhesive capsulitis is stiffening of the shoulder joint. We can have it in the knee as well. There are definite metabolic indicators for why that's happening. And we believe, and we've been able to show, and that the literature is abundant, showing that hormones, particularly sex hormones, estrogen, progesterone, dhea, testosterone and growth hormones, cortisol, all of these hormones have an impact in the musculoskeletal system.

Yeah, yeah. So I want to pause you there for just a second and kind of bring this back around. I, I remember in practice because foot and ankle was my subspecialty and we would get people, you know, complaining of joint pain. I did general work too, and X ray knees and hips and it's, I mean it's not even like the exception that the X rays don't explain the symptoms, right? It's so easy to say, oh, I have knee arthritis. That's why I have pain. It's not really why you have pain. We see knee arthritis, ankle arthritis, hip arthritis that isn't painful all day long. So the question should be, why do you have pain? Because osteoarthritis, not, not inflammatory. But osteoarthritis is not an inflammatory condition. It actually by itself shouldn't be producing pain. So then why. Yeah, why, why do you have pain? All right, so then let's, let's continue down because now you just laid out like 50 different things, right? So how do you go down this pathway with somebody? Because I do this too, and it can be really overwhelming. So how have you figured this out?

Well, we start, we start with an evaluation of the joint and a, in a thorough patient history. So we want to learn if. Are there some autoimmune links there, you know, what's your overall gut health? Where are you as far as, as far as your hormone cascade? Are you in menopause? Perimenopause for men, you know, andropause. But. And then we do a structural exam of the knee. We also do some imaging studies. We do both X ray and ultrasound in the office to evaluate for some soft tissues. And we may even order some advanced imaging studies like MRIs. So we're getting to the structure of the knee. But when we want to see the root cause of the pain, to your point, we can have arthritis that's not necessarily symptomatic. So then we look more deeply into the metabolism. So we have a very comprehensive testing package that we do that includes our normal labs that we would get from a family practice doctor, like a comprehensive metabolic panel with your liver functions. And we look at lipids. We really want to dig deeply into the hormone axis. Then we also will do what's called a neutral valve. So we look at how you're processing your nutrients, we look at your, your methylation, we look at your genetics, and we want to, we want to look for some other risk factors for inflammation as well. We check a homocysteine level, we check inflammatory markers, we check thyroid function, because all these things intertwine to create a symphony where travel. So we look at how you're processing your nutrients, we look at your, your methylation, we look at your genetics, and we want to, we want to look for some other risk factors for inflammation as well. We check the homocysteine level, we check inflammatory markers, we check thyroid function, because all of these things Intertwine to create a symphony where, where, yeah, you know, if one little piece is out of whack, then we can, we can develop pain. We can really see in that data a lot of times where your root causes.

So then let's, let's stick with our patient with knee arthritis. So let's assume that she's got, you know, she's got some gut stuff to work on and you've talked about an anti inflammatory diet and you're kind of going down some of these pathways. But she really wants to focus on her knee. Let's talk about the orthobiologic side because this is a powerful tool that I think there's a lot of confusion about. So what are your kind of go to tools for the major joints in the orthobiologic space?

Well, I like to use sort of an evidence based approach.

And my approach is ever evolving as is everybody who's a responsible provider. I start with, we like to start obviously we start with an anti inflammatory diet. Believe it or not, I hate to go back to it, but an anti inflammatory diet can improve your joint symptoms by 30 to 50% within just a couple of weeks. So internalize that a little bit. I think food is medicine. We do that because we, you know, garbage in equals garbage out. And if we're going to use your body's ability to heal itself, it's fairly important we start with prp. And we do, we don't just do a single injection. There's some, there's some data to suggest that, that multiple injections can be superior in outcome and in, in the way that, in how long they last. So longevity. So we start with prp and PRP is platelet rich plasma platelets are a pretty magical little fragment of a cell in our blood and when we cut ourselves, what stops us from bleeding in that area is the platelet.

So PRP is derived from whole blood and we take that whole blood, we spin it in a centrifuge to concentrate the platelets. We want to get to a certain concentration that's usually about 10x what is in the patient's normal blood volume. And platelets aren't just for clotting, they're a mass. They're really loaded with growth factors and cytokines and also they slow down the damage in the joint. They have a tendency to sort of put the brakes on the inflammatory cascade that we see in the joint. And so they reduce inflammation, they sort of stimulate the tissue to start regenerating and where we really enjoy Platelets is. Platelets also have a signaling activity where they can signal stem cells to come to a site of injury. When we have an injury, right, part of the signaling that gets our own stem cells mobilized or circulating to that area is the platelet. So if we do a pre treatment with PRP and then we come in and we'll lay in after a couple of weeks for more severe cases, we'll do bone marrow aspirate concentrate is my preference. So those are mesenchymal cells, we call them mesenchymal stem cells, but they're pluripotential cells. So they can become other things and the goal is to get those into place to really accelerate the joints healing. They have a massive anti inflammatory effect. They're probably quite a lot more effective based on the literature than PRP alone and they can last quite a lot longer. Dr. Hernagow in France did some really amazing work on this and he found that he could slow or even maybe halt arthritic progression for a number of years. So that's, that's out there. There's multiple ways that you can use bone marrow aspirate concentrate, you can inject it into areas of bony inflammation in the bone itself, which can be extremely effective in an arthritic joint, particularly around the knee. And then we'll even, and between our treatments we'll add some sort of optimizer. So in our case that's red light laser therapy. We have an MLS laser. So we'll do cold laser therapies a couple of times a week for a couple of weeks after each injection. The goal is both to lessen amount of, lessen joint inflammation which laser can do by itself and then also it increases the amount of materials that the cells we put in place will release. So really effective treatments.

That's cool. So you know, we hear stem cell all the time. And before I get into stem cells, I just want to kind of wrap up PRP because you know, there are a lot of PRP providers out there. There's different ways to spin it, you know, all the different form you can make. How can somebody, you know, assuming they're not going to fly to you to get this done. How do you know if a PRP provider, a PRP protocol is any good? Or can you.

I think it's really hard. I think that's a difficult one. You can look at testimonials. Almost everybody has a good, good looking website nowadays. You can certainly talk to other patients of, you know, and we provide references to our patients. The problem with PRP is that there are so many different systems, there's so many different ways to apply.

Yeah, there are a lot of PRP providers out there.

There's, by this science that it can become really nuanced. And so I don't have great advice.

I mean, I would try different ways to spin it, you know, all the different formulations that you can make. How can somebody, you know, assuming they're not going to fly to you to get this done, how do you know if a PRP provider, a prp, you know, protocol is any good?

Or can you get an accredited person who's either, you know, who's been trained and does ultrasound guided injections? The folks that you want to avoid are the ones that you go and talk to at a dinner that would say, okay, we're going to come out to your house and inject you with some stuff. Yeah, that's pretty shady. We have a lot of that going on in our community.

Those are the types of things that you want to really avoid. But it is tough because a lot of times our treatments are based on the, on the kit that we use. And if you use something like, you know, if you use the, the less expensive arthrex kits, you're not getting great tissue constant. You know, I think it's really hard. I think that's a difficult one. You can look at testimonials. Almost everybody has a good, good looking website nowadays. You can certainly talk to other patients of, you know, and we provide references to our patients. You're not getting great platelet concentrations with that. And there's some other, there's some other kits. Don, the problem with PRP is that there are so many different systems. There's so many different ways to apply for in. Dallas has done some amazing research on, on different platelet kits and different concentrations. And to be honest, people who do in house processing probably have the best concentrations.

Okay, so somebody who's doing it in a clinic, which is, you'd think that'd be standard. Somebody who's spinning it themselves. Somebody who has an extensive history doing ultrasound guided injections. Those are things you're looking for in a provider. Yeah. Cool. So then let's, let's switch to the stem cell conversation because when I was in practice, I was using bone marrow aspirate as well. You know, it's used very commonly in the foot and ankle. We would get it from the pelvis. I'm assuming you're going. Are you going pelvis posterior?

Yeah, right in the back of the pelvis. That. Yes.

And that's, you know, and that's, that's.

A great place, this science, that it could become really nuanced. And so I don't have great advice. I mean, I would try and get an accredited person who's either, you know, who's been trained and does ultrasound guided injections. The folks that you want to avoid are the ones that you go and talk to at a dinner is to.

Get it because you can actually get good stem cells. I actually was an author on a.

That would say, okay, we're going to come out to your house and inject you with some stuff.

Yeah, that's a study where they were in the foot and ankle world. A lot of people will use the heel bone, the calcaneus, and there's really, there aren't really any stem cells in there. I think there was like one. So stem cell therapy is a really murky space. I get people that ask me because I have some. I have some amazing patients that are willing to really invest in their, their healthcare. And they're going all over the world to get stem cell treatments. They'll go to Europe to get something fancy. They'll go to South America to get something from some, you know, animal from outer space. It's really hard to.

Pretty shady. We have a lot of that going on in our community.

Those are the types of things that.

You understand some of these stories of what offerings are out there, but give us a sense of, you know, outside of bone marrow aspirate, you want to really avoid.

But it is tough because a lot of times our treatments are based on the, on the kit that we use. And if you use something like, you know, if you use the less expensive Arthrex kits, you're not getting great tissue.

Constant, you know, in the US what other things are there that are available that people could get without traveling?

This is a murky area. So right now in the US the FDA allows us to do. We can't, we can't substantially modify the product. So it has to come directly out, be minimally manipulated, and then go directly back in. And it's really not at this point legal from an FDA perspective to do treatments with cells from somebody else. You're not getting great platelet concentrations with that. And there's some other kits. Don Buford in Dallas has done some amazing research on different platelet kits and different concentrations. And to be honest, people who do in house processing probably have the best concentrations.

Okay, so somebody who's doing it in a clinic, which is. You'd think that'd be standard. Somebody who's.

Now there's lots of clinics that do it. So right now, bone marrow aspirate and lipo aspirate or fat cells, where we get. Where we do a small lipo liposuction. Are the two really clinically acceptable ways to use stem cells from yourself? I think it's important to differentiate. These are the types of cells that can become other things. And the data is sort of collecting. Collecting data on whether those cells are actually becoming other things in the tissue or whether what they release becomes more important for that. And there's all sorts of advertising about.

What these stem cells do and what's spinning it themselves. Somebody who has an extensive history doing ultrasound gu what they can and can't do.

I think it's important for us to.

Recognize that we're things you're looking for in a provider. Yeah. Cool. So then let's. Let's switch to the stem cell conversation because when I was in practice, I was using bone marrow aspirate as well. You know, it's used very commonly.

We're augmenting healing the saying that we're.

Regenerating tissue in the foot and ankle. We would get it from the pelvis. I'm assuming you're going posterior. Yeah.

Is difficult one for us to. For us to say. Although they are powerful techniques that we see work really well.

Now. The other option is we can use stem cells from somebody else. And that's typically what folks are going out of the country to do. And these can be treated in a number of different ways. We get treated with light. They can be treated with low oxygen. There's all different ways to manipulate those stem cells. The idea is to make it more effective. And none of. None of those cells are strictly legal to do in the United States. Although I think Florida maybe just pat right in the back of the pelvis.

That. Yes. And that's. And that's. That's a great place to a law.

That allows people to do more of those.

Yeah. So what about a place to get it? Because you can actually get good stem cells. I actually was an author on a study where they were in the foot and ankle world. A lot of people will use the heel bone, the calcaneus. And there's really. There aren't really any stem cells. Safety perspective. You know, if somebody is considering going to get a stem cell treatment, especially, you know, one of the things that scares me is like the IV stem cell treatments, people are just infusing stem cells from another person or from who knows what source into their body. What are some of the potential risks that they should be worried about?

Well, there's certainly, there's certainly a risk of having a reaction to the cells infections A risk. Anytime we're putting something in the body that's foreign. You know one of the, one of the, one of the arguments that that's pretty strongly for using our own cells is because our body's not likely to react to those. And a lot of these cells are the cells that the immune system is using to fight infection. So, so they can be really.

I was in there, I think there was like one. So stem cell therapy is a really murky space. I get people that ask me because I have some, I have some amazing patients that are willing to really more.

Effective in that way and a lot safer.

And so that's sort of my invest in their healthcare. And they're going all over the world to get stem cell treatments. They'll go to Europe to get something fancy. They'll go to South America to get something from some, you know, animal from outer space. It's really hard to.

My hesitation to use those types of treatments is that we don't really know the safety profile. They're used all over the place. But certainly there are some opportunities for some problems. IV stem cells I don't have any personal experience with. I know some providers and practitioners that do that and that say that they're really effect things like Ms. Or you know, some other neurologic disorders. I think the argument is that when we freeze these cells they die and so we're injecting sort of dead cells and the, the effect of those cells is that they're releasing the stored anti inflammatory materials and other beneficial materials that would be in stem cells into the bloodstream. But we don't have a way to predict how that's going to happen.

Yeah, yeah. That's the unpredictability of it that I, that I'm worried about. And I've heard understand some of these stories of what offerings are out there but give us a sense of you know, outside of bone marrow aspirate, some bad stories as well. So yeah, I Love, you know, PRP was an effective tool for me in the U.S. what other things are there that are available that people could get without traveling?

This is a murky area. So right now in the US the FDA allows us to do the bone.

Marrow aspirate we used mostly in the ore but that was an effective tool from a healing perspective. And that's as far as I generally recommend that people go in the US without more information. So listen, Dr. Schachter, I gotta go see a patient. I think we need to have a follow up conversation particularly around your experience with hormones. We just barely, barely touched the surface of that. So I'd say for now let's maybe, if you have any last, last words and suggestions for the audience, let's end there and then we'll probably have to, to pick this up on a version two.

Absolutely. I would say to your audience, I would, you know, your audience is obviously very hormone conscious, very health forward conscious. And when you're thinking about your joint pain, I would encourage.

We can't substantially modify the product so it has to come directly out, be minimally manipulated and then go directly back in. And it's, it's really not at this point legal from an FDA perspective to do, to remember you're not broken. I mean you may just not be optimized. There's a lot of ways that we can optimize your metabolism, improve your outcome with your joint and improve your longevity without doing a major surgery. And so I would really encourage you to think more broadly about the ways that you can improve your health to improve your joint pain.

Awesome. Great. Well, thank you so much. I look forward to doing this again in the near future and we'll talk more about hormones and musculoskeletal pain.

Absolutely. Thank you.

Awesome. Thanks so much for taking the time to listen to this and I hope that you found this conversation around orthobiologics, PRP stem cells, exosomes. I hope you found that helpful. I know this is a challenge.

Treatments with cells from somebody else. Now there's lots of clinics that do it. So right now bone marrow aspirate and lipo aspirate or fat cells, where we get, where we do a small lipo liposuction are the two really clinically acceptable.

Ways to use space. We're actually going to do a second episode of this is already on the schedule to talk about some of the things that we didn't have time to talk about today. So if you liked this one, take a look for part two coming out in the near future. And remember that a diagnosis of osteoporosis isn't the end, but deciding to reverse it is a beginning. Here's to aging with strength and grace.

Stem cells from yourself. Yeah, I think it's important to differentiate. These are the types of cells that can become other things and the data is sort of collecting, collecting data on whether those cells are actually becoming other things in the tissue or whether what they release becomes more important for that. And there's all sorts of advertising about what these stem cells do and what they can and can't do. I think it's important for us to recognize that we're augmenting healing. The saying that we're regenerating tissue is difficult one for us to say, although they are powerful techniques that we see work really well.

Now. The other option is we can use stem cells from somebody else, and that's typically what folks are going out of the country to do. And these can be treated in a number of different ways. We get treated in with light. They can be treated with low oxygen. They can be. There's all different ways to manipulate those stem cells. The idea is to make it more effective. And none of. None of those cells are strictly legal to do in the United States, although I think Florida maybe just passed a law that allows people to do more of those.

Yeah. So what about a safety perspective? You know, if somebody is considering going to another country to get a stem cell treatment, especially, you know, one of the things that scares me is like the IV stem cell treatments who are just infusing stem cells from another person or from who knows what source into their body, what are some of the potential risks that they should be worried about?

Well, there's certainly. There's certainly a risk of having a reaction to the cells, infections, a risk anytime we're putting something in the body that's foreign. You know, one of this. One of the. One of the arguments that that's pretty strongly for using our own cells is because our body's not likely to react to those. And a lot of these cells are the cells that the immune.

So. So they can be really more effective in that way and a lot safer. And so that's. That's sort of my, My hesitation to use those types of treatments is that we don't really know the safety profile. They're used all over the place, but certainly there are some opportunities for some problems. IV stem cells, I don't have any personal experience with. I know some providers and practitioners that do that and that say that they're really effective for things like Ms. Or, you know, some other neurologic disorders. I think the art.