What to Do When Joints Hurt, Ache or Need Replaced? A Doctor Viewpoint

Real quick, before we dive into this episode, I have a little sleep secret I want to tell you about. Look, sleep is crucial for your fitness, but it's crucial for just plain old everyday life and function. And I find I sleep great unless I have a migraine. And I've had more than my fair share since perimenopause all the way through postmenopause. My secret weapon was Blue Sky CBD sleep gels. Each gel contains 25mg of CBD and 25mg CBN for deep restorative sleep. Something about it helps to reduce inflammation, which I believe for me was key in helping me get to sleep. But the biggest thing is so many of the over-the-counter solutions, whether for sleep or migraines, can ruin gut health, and liver health. Neither one of those did I want to be problematic for me. So this option is recommended by healthcare providers worldwide and backed by thousands of happy customers, many of whom come from our Flipping 50 community. There is zero THC, so it's non-habit-forming. It's made by a trusted family-owned company that we all can feel good about. Third-party tested for purity and potency. And if you're interested, you too can try a sample for just $6. But even better, you can get 30% off forever with discount code FLIPPING50. That's FLIPPING50. Just go to flipping50.com/blueskycbd. We'll put that link in the show notes and you'll find it everywhere on Flipping 50 at My Favorites. What are you waiting for? Good night. If you've got joints, aches and pains, you're wondering what are your alternatives, or you fear that this is the beginning of the end, the end of movement as you knew it, the end of at least pain-free movement, or maybe the beginnings of joint replacement, and you've never thought about that before and really wish you'd never have to think of it again, this is your episode.

I'm Debra Atkinson, and you're listening to Flipping 50. I started this podcast over a decade ago to answer questions about fitness and menopause and beyond before you know to ask them. The goal to help accelerate your results with the science and the practical application of proven protocols while living your best life. There's no more powerful health influencer in the world than a midlife woman. It's not just you, but it's the 3 generations that you influence. My unique 40-year career, including being a university senior lecturer in kinesiology, an industry subject matter expert, an international speaker, to founder of the first and the only exclusively made-for-menopause-and-beyond fitness membership in the world. Every week I interview experts behind the science of optimal hormone-balancing fitness and longevity and share answers to our community's questions so you can have the vitality and the energy you want, need, and deserve.

What do you do when your joints hurt? Do you, like me, maybe think this is only temporary? This is just because I did too much of something, or maybe not enough of another thing. Maybe I, I just landed wrong, too many lunges, too, too little this. Yeah, and then there's that, but it's been around for a couple weeks, or no, has it been in a couple months, or gosh, has it been like 9 months? Yes, I get you. If that's you, this is your episode. We're going to be talking about what you do when joints hurt, or they at least ache, and whether you're thinking, or you've been told, knee replacement, but maybe don't do it now, or you want to wait because you're too young and it won't last. If you've ever been told those, you've ever heard those, you know a loved one who's been, or you know maybe that's coming down the pike, this is for you. My guest is Dr. Joshua Schachter. He's America's holistic orthopedic surgeon, and he's redefining joint care with a commitment to providing actual solutions for his patients. After graduating from Oklahoma State University College of Osteopathic Medicine in 2003, completing his residency at Doctors West-Grant Hospital in 2008. Dr. Schachter spent over a decade as Chief of Orthopedic Surgery and Director of the Advanced Orthopedic Center of Excellence at United Regional Health— Healthcare System. While excelling in these roles, he saw firsthand the need for non-invasive innovative solutions that addressed the root causes of pain and dysfunction rather than masking symptoms. But it got personal when his wife and lifelong partner Amber was diagnosed with the breast cancer gene at the age of 33. Dr. Schachter watched and tried to help as she navigated the uncaring, dehumanizing traditional medical system. After living through the pain, uncertainty, and abandonment that are a part of our American healthcare experience, the Schachters became obsessed about wellness, health, and how to accomplish true healing. Frustrated with the limitations of surgery, steroid injections, and pain medications as the standard treatments for joint pain, Dr. Schachter dreamed of a more effective and patient-centered approach using Amber's modifying patient journey. As a starting point, the pair envisioned a holistic integrative orthopedic practice which provided for the whole patient, combining advanced regenerative medicine, functional medicine, and holistic wellness practices into the Pinnacle Method. I think you're going to love this, and I'm hoping that you'll share it with anyone that you know that's struggling, from athlete to aging parent, spouse, partner, you name it. Dr. Joshua Schachter is in the house. Thank you so much for making a house call with us today.

Yes, ma'am, it's a pleasure.

All right, so, you know, you have quite a story, and I know we get to talk to you, we get to talk about your wife and this story of how you got to be where you are, and And I always find it so very interesting when you've got somebody like yourself, an orthopedic surgeon, who's not necessarily promoting orthopedic surgery. But talk to me about why. Why is that? How did that come about? Tell us a little bit more about Amber and your experience.

Yeah, absolutely. So like, like you said, I'm a board-certified orthopedic surgeon. I've done about 15,000 procedures. So for me to shift is a big deal.

Uh, by the way, sorry to interrupt, but what most— what have you done most?

Knee reconstruction, without a doubt. Knee and hip replacement. I, I was a specialist in, in adult reconstructive. So, um, in my practice, I came out, started in 2008, and, um, I was just super busy. I did almost 1,000 cases a year for years. Um, and I really focused primarily early in my career on orthopedic sports, so reconstructions of the ACL, you know, shoulder scopes and rotator cuff repairs and instability surgeries. And of course, we did a lot of fractures. And then the later couple of years have really been more focused on joint reconstruction, so joint replacement. And that sort of became part of the impetus for me to get into doing more regenerative therapies. Because if you've ever had a friend or a loved one who's had a joint replacement that didn't go quite as we would expect, you know that it's a horrible experience. And joint replacement, even if it goes well, you know, can you can have up to a 35 or even 40% complication rate in some settings. So, I mean, and that's not life-changing complications like an infection, but stiffness, prolonged pain, all of those sorts of problems. And so that's been my career. And one of the things that I really noted through my career was, one, I worked for a hospital, so I was a hospital employee. I started orthopedics as a practice when people were really switching from being in private practice to being employed. And, um, and I was hired by a large hospital system in here in Wichita Falls, and I started in 2008. And what I've noticed over the last, you know, at least the last 5 years, but really probably more my entire career, is more and more and more focus on operative intervention, more and more focus on getting the patient into the operating room, um, to the tune that, that, you know, I started to feel a little— I definitely felt pressured by my employer to do more surgery. Yeah, so, uh, and, and it shows up in our statistics. You know, as of 2019, about 35% of joint replacements done in the United States were done what we would say prematurely. So just sit with that for a second. If you think about the amount of people, and you know, and we're doing 8— there's, there's many, many millions of joint replacements that are done, right? So you have, you have quite a, quite a quite an amount of patients who are getting surgery without necessarily needing that surgery right then. And there are a lot of options. Um, I— and I sort of started, you know, being on the inside and being a surgeon in the system, you're sort of insulated from some of the problems of the system, right? You don't— you know, I'm seeing 50 patients a day, but I haven't necessarily been a patient and had to see a doctor that saw 50 patients a day, right? My PA saw 30 patients a day on average. And so between the two of us, 80 patients a day, we'd be rocking it out. And then my wife got sick. So my wife, Amber, who is the love of my life, I met her when she was 13 and I was 15. We're high school sweethearts.

Wow.

She really is the love of my life. Best friends since we were kids. And then we started dating in late high school and we got married right out of high school. So I was 20, she was 18. And so we've been through the whole path together. Her father was diagnosed with a rare type of kidney cancer, and this was back in about 2009. And, um, and so we— I was actually talking about her father just randomly in the surgeon's lounge, and one of our local, uh, GYN doctors, who is a smart dude, was like, oh, that's a rare type of kidney cancer. Has your wife ever been tested for BRCA? And that's the BRCA gene, right? So that's the gene that causes breast cancer, and there's a BRCA1 and BRCA2. And, you know, this particular type of kidney cancer is associated strongly with the worst type of BRCA gene.

Really?

And it's a genetic problem, right? So in this type of— and he was like, well, you really need to get your wife tested because the research is coming out. And there was more and more evidence in that time suggesting that this gene in particular, which was, you know, new, um, had just been discovered. Really had a very close association with very aggressive breast cancer in a young age. And we started talking, and my wife's had, you know, several first-degree relatives who've had young— who've had cancer young. Her mother had breast cancer when she was in her late 30s and actually passed away because of ovarian cancer that was metastatic. So a lot of strong family history. So we ended up getting a— and this is in 2000, I want to say it's 2009 or 2010. My wife is a beautiful woman, my opinion, but also substantiated. She modeled, you know, bikinis for Venus when she was younger. She did a lot of really cool stuff. So in her early 30s, she's diagnosed with this BRCA gene. Long story short, we end up getting the genetic test and it's positive. So just imagine that sort of pit in your stomach. And at the same time, our doctors are like, well, you have this gene, we better get a mammogram. 33-year-old. So we take her and we, and we get a mammogram and we find a mass, right?

Oh, wow.

And I just remember I was in the gym, I was in my gym at home, and I get this call from my general surgeon friend and he's like, yeah, we found this mass and we're going to do this biopsy. And I just collapsed. I just said, you know, you just, you never know how that's going to go. Am I still going to have my, you know, my wonderful wife in a year? I don't, I don't know the answer to that, uh, at this point. So we, we start down this path. We had this, we had the BRCA positive. Her biopsy ended up being negative, which was a godsend. Very thankful. And but, but the recommendations at that time were that if you have this gene, you need to have a mastectomy because you have such a high risk of estrogen-sensitive, invasive, aggressive adenocarcinoma. Right. So aggressive cancer. Yeah. And they want you to have this mastectomy as soon as possible. Right. And so, and not only that, but we have to have all of the estrogen tissues out. That was the conventional thought of the day. I honestly, I think we could do it better now. And I think we do, but, but this is what we, but this is what we had back, you know, 15, 16 years ago. So the recommendation was we do a mastectomy first with a primary reconstruction, and then we do a hysterectomy and oophorectomy. So we take out all of, all of her female parts. And so at the age of 33, my wife goes through 5 surgeries in a calendar year, including a mastectomy with reconstruction. And I'm going to tell you, any plastic surgeon that says that those spacers don't bother you when they put them in there and inflate them, that's a damn lie. I watched my wife cry through multiple appointments, and it's just— and so she ended up having— and I— there were so many parts of this experience that really formed me into the, the provider I am. But at one point, just to give you an idea of how we, how we really see women's health in this country, and it was just this really eye-opening experience for me. My, my GYN friend, who was an amazing surgeon, really good doctor, a very caring person, when she was about to have her hysterectomy and take her ovaries out, he came in the room, and this guy's my friend. I mean, it's just I can't believe it, but he comes in the room and he says, all right guys, we're about to make the perfect woman here. And it just— that, that is this— I think that's the statement that really describes the whole process, right? The whole way that we, that we see women's health, the whole way that we see our hormone axis, the way that we look and treat women in, in so many different ways, but definitely surgically. And we see so many of these, you know, really terrible things that happen to women. Because the answer is, if you're, if you're, you know, you've got a problem with your uterus or your ovaries, we'll just take them out, right? So we went through that, um, and after, you know, long story short, sat at the bedside for, you know, the— when she had several that she was in for 3 to 5 days, sitting at the bedside just watching the system not take great care of her. Even though I'm a, you know, I'm the chief of orthopedic surgery at my hospital, and even I can't get the nurses to come in and, you know, do the things that they need to do all the time. So if you don't have an advocate in the American traditional medical system, it's, it's bad. Um, so just going through that process and seeing the way that she, you know, suffered in our system going through these procedures. Well, you know, fast forward a couple months, um, and she's, you know, she immediately starts to go through menopause. Right, so my wife is 33. She's a former Venus swimwear model. She's a beautiful, vibrant, gorgeous woman, mother of two, um, professional. She's an entrepreneur. She owns restaurants. She does a lot of stuff, and she couldn't function because her hot flashes are so bad. She had brain fog. She had no motivation. It just was horrible to watch that. And so we, we start to think about, well, can we replace your hormones? Of course. I mean, how hard would that be? Well, we go to her oncologist and are absolutely forbidden to do any bioidentical hormone replacement therapies, right? Because she has the chance of having an estrogen-sensitive tumor even though we've taken out everything. So, you know, why, you know, what's the next step? And, and the answer was, well, you can't, you can't do hormone replacement therapy from the oncologist. Yeah, sit with that for a second and you'll— and you're thinking to yourself, that's total BS. That's not in line with the studies. That's nothing that we've learned in the modern— in the last well, in the last 25 years about hormones, right? That, that, that there's any reason for this woman not to have hormones. But then we went to her, her GYN doctor, and he said, he said, oh sure, you can do hormones, it's no problem. Here's a bag of samples. And he hands us this bag of birth control samples. Why don't you have her take one of these? Oh my God, I know, you're right, you're like, it's crazy. Have take one of these for, for you know, for 3 weeks and then try another one. And whatever makes you feel best, we're going to put you on that one.

Oh my God.

So we're going to take the woman who has a risk of estrogen-sensitive cancer and then we're going to put them on a synthetic estrogen.

Oh my gosh.

Yeah. So terrible stuff. So that didn't seem very scientific to us. And Amber was like, this is not going to work. I can't— this is— I, I can't tell any difference. So we, we went against our oncologist and we found a functional medicine doc who did bioidentical hormone replacement therapies. And Blaine did an amazing job with her. And long story short, she's been on hormone replacement therapy since, since the age of 33. And she's 46 now. She's been cancer-free for years. And, you know, we have no indication that she would have any problems. And basically it's changed her life. Wow. And, and so for me, that was a huge— that was the first huge eye-opener of the process. And it's a lot. And then we actually end up going back for another surgery. So she had this mastectomy. If anybody's had a mastectomy, I mean, I would talk to Dr. Rob Whitfield before you choose a reconstruction because, you know, Rob's, Rob's a magic man. And I totally believe in breast implant illness because my wife had it for 10 years. So she developed breast implant illness from her silicone implants. She decided, she decided in '22 that she was— she needed to have those out because it was really affecting her her life. I mean, those implants are terrible. You swim in cool water and it makes you cold. I mean, it's just— you can't move your chest, you can't take a deep breath. It was just constant. And so for, for her, she elected to have a flap reconstruction, which is a vascular procedure that can be a really intense procedure. It's a big deal. And so this was— and, and this was— I had been doing orthopedic surgery for years at this point. You know, I thought the traditional system is XYZ. I did have these experiences with Amber, but I didn't really you know, put everything together at this point. And then we had this surgery, and she ended up having a bit of a complication from the surgery, ended up in the hospital for 11 days and almost died. She had 8 units of blood, ended up having about 6 surgeries, over 30 hours of surgery.

Oh my God.

And so when we got her home, and through that process we really learned— I mean, even if you have the doctor's number, the system is still still so unwieldy, right? It's still something that really basically prevents the patient from, from engaging in their own care in a lot of ways. And so just through that experience of taking care of my wife, being at the bedside, witnessing firsthand the kinds of, of care that my patients are getting in the hospital when I'm putting patients in the hospital, it really changed the way that I think about things. Um, and long story short, she's done great, she's doing really well, but functional medicine and optimization and hormone replacement therapies have really, I fully believe, saved her life and changed her course. If we had listened to doctors and if we, if we had gone the traditional route, I don't know if she would be here with us because I don't know if she would have been optimized for the big event that happened in, in '22. And so for me, this is a labor of love but it's also a life's work. So, you know, when I decided— and I started to get really, really burned out about the traditional system right around this same time, started really to see, oh, we're pushing the indication on a lot of these surgeries. We're doing so much, and, and the hospital just wants volume. They don't necessarily want quality. And that's every hospital. It's just a numbers game, right? You have to produce. And so with that idea, I started to do some more research and look more deeply into it. And, and like I said, I, I found some options that could help prevent people from needing surgery, and that's orthobiologics. We started working on PRP and stem cells, and I've been doing that for years in the operating room, but we really started focusing on it. And I went to my hospital and I said, hey, you know, we can do all these things to get a patient better without surgery. We should start trying it. And they were like, that's not a good idea. We don't want you to do that. So I said, okay, well, how about I just try it by myself? So, so as a part of our experience, you know, our passion for bioidentical hormone replacement therapies and the magic that this— these sorts of things can do, and whole health and the power of our own biology, we formed Pinnacle Integrative Orthopedics. And we started that company in '23. And basically, it's, it's my wife's— it's my wife's baby. She's a brilliant woman. She thinks about— she's been doing this obviously for about you know, almost 13 years, and so to herself. And so she really was wanting to do a program that combined functional medicine, bioidentical hormone replacement therapies, and its best options with something that allows us to hopefully prevent patients from needing surgery, which is this orthobiologic. So the goal is really to get people as healthy as we possibly can while we're treating their joint with these, with these very advanced measures.

Amazing. An amazing story. And, and this episode would have been probably nothing, a shadow, without that. So I, I want to just start at the beginning with some of our listeners. So define for me, is, is orthobiologics a word that I can look up in the dictionary? Is this a word coined by you, or—

It's— no, I didn't make it up. Okay, orthobiologics is, um, there is actually an International Orthobiologics Foundation.

Okay.

Yeah, you can look that up.

Okay.

Um, and so it is the discipline of using the body's own ability to heal, magnifying that, and using joint-specific protocols. Um, it is the idea of using PRP or platelet-rich plasma, the body's own materials, right? And then combining those together, we can do things like use different types of mesenchymal stem cell applications. Like, we can use, we can use adipose tissue or fat, we can use bone marrow. There's a— and it even encompasses, in my opinion, the use of allograft tissue. So, you know, cord blood, Wharton's jelly, that sort of, that sort of technology.

Okay, so if we could bring this home for a listener to really like say, okay, I have this thing So I will use myself as a guinea pig. So I have this medial right knee thing going on. Where would I begin to explore?

What do I want?

Where do we start even?

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Well, I think the first place you start is with, you know, we look at the knee and you really want to start with some strengthening and mobility if we haven't done any of that. That's the thing that everybody can do, right? And we know that the knee— there's a sort of a misconception that the knee, when we have a knee injury, the quad gets weak. It's actually the hamstring and the glute, right?

Yeah, right.

So there's some nuanced strengthening. I think most orthopedic surgeons would refer you to, would tell you to do some quad strengthening. Strengthen your VMO, something like that. But we really want— you want to work on mobility, you want to work on hip flexor mobility, you want to work on posterior chain and stabilization.

So, if I told you you're preaching to the choir and I got those strengths, what now?

Okay, good. So, you did that. Perfect. And so, then the next option we would look at would be in traditional medicine, you might look at anti-inflammatories or whatever, but anti-inflammatories have their own problem, right? They cause metabolic issues, they can cause issues with your gut health, et cetera. What we would look look at would be biologics options. So first, we would do a full evaluation on your knee. So we want to see some X-rays, right? We want to see if you have some cartilage thinning. X-rays are pretty important. An MRI would be useful here as well because MRIs show us the soft tissue in the knee joint. MRIs importantly also show us where your bone may be a little bit inflamed. And so when you have a, when you have a bit of arthritis in a knee joint, it's not just, you know, it's not just that the cartilage becomes thin, but the bone itself becomes a bit irritated. So that's something we might need to treat. And then we would, and then we would sit down and we would discuss some options. Now, when you have, depending on what's going on in the medial knee, right, that can be a number of different things. You can have a stabilizing ligament that's your problem, right? Your collateral ligament. You could have had an injury back in the past. And that certainly is something that we would get out of you in a history. And so we would assess for stability. We would also assess whether your meniscus is causing you problems because a lot of times in a degenerative type knee, you'll have a bit of a meniscus tear. Used to be we thought that we had to operate on all of those, but that's one of the percentage of people that get operations that don't need them. It's actually been shown, it was shown about almost 20 years ago now, that all of these scopes that we're doing for arthritis, when, you know, if you had a knee scope and you were at arthritis, that's really not doing anything. It's not any better than a placebo. Like, literally, they did a comparison in Australia between doing a knee scope and a sham where they just made injection, they just made incisions. And there was no difference.

Wow.

So we want to try and avoid surgery there if possible. But the most powerful treatment that we find is biologic therapy. So we take and we either use your blood or your bone marrow or a combination of the two of those. And the goal, you know, the FDA has some limitations here that we can't really talk about. We can't say things like we're regenerating a joint, right? Legally, we can't say things like we're healing your arthritis or reversing your arthritis, but we can say that we're optimizing your joints' healing potential.

Got it.

And if it happens to make you better for a long time or forever, then that's great. So for you, especially for somebody who's healthy and optimized and in a great place as far as nutritionally and hormonally, your body's ability to heal, maximizing that potential is probably the best and safest way to go. Right? Traditionally, if you go to an orthopedic surgeon, you might end up with, "Hey, I have this little bit of knee pain. What can I do, doc?" And they might give you a steroid injection. Yeah. That's a really bad idea.

I totally agree. Yes. And I also wanna, I wanna make sure that we come back to the idea of doing something in joint replacement. So I wanna, I'm gonna hold my little finger up. So first of all, let's talk about injections because I, I've got some clients who are, you know, that's the first thing that they're told. And I'm like, whoa, whoa, whoa, whoa, wait. Like, you're not going to hear any noise from that. And don't we need to hear the noise if there's going to be some from that joint?

I think that— and by noise, you mean some symptoms, right? So that we can—

Yeah. So we're feeling like this movement I do hurts. That's feedback, isn't it? Right?

Absolutely. So, and the feedback is important to a point. I think what, what can happen is what can happen is if you have too much pain for too long, it causes your muscles to sort of atrophy, right? Because we're not using the joint as we should.

Yes.

Yeah. So we want to be a little bit careful about how long we listen, but definitely listening is important. And I think— so steroid, what it does is it's a powerful anti-inflammatory. So we inject this anti-inflammatory and it shuts down the inflammatory process in the knee. But part of it is, one, you need a little bit of inflammation to heal the knee.

Yeah.

And two, steroids typically will deposit cartilage into the knee joint and they damage your knee joint. So steroids have been shown to accelerate arthritis, so much so that if you have more than one or two steroid injections within a, you know, a calendar year, it can advance your arthritis by up to 20%. And a lot of people, you know, most responsible providers— yeah, I mean, it's crazy— most responsible providers don't want to do them any more than about 3 to 6 months apart, but I've seen people get them 3 months on a timer, right? Like every 3 months.

I want to inject here, and, and I want to say that there's a little blame here that also has to come back onto us. I think at some point we're pushing for that, aren't we? I mean, as a patient, we're saying, no, no, no, I'm in pain, give me a shot, right?

And the thing about steroid injections is they work relatively quickly, right? You can have pretty fast pain relief. But steroid injections are entirely temporary. And there are people out there who have a steroid injection and their inflammation gets knocked down and, you know, and they feel better for years. But that's actually, that's the exception. That's not necessarily the rule.

Got it.

And the problem is, I think the drawback of steroid injections outweigh the benefit.

Yeah.

Yeah, I totally would agree. And I want to come back to this. So I'm not quite sure how to phrase this. So it's not going to sound very sexy or articulate. Afraid. But there's my preface. I often will work with someone who is really limited with their range. I mean, they come to see me and they want an exercise and a, and a holistic health program that's going to help them, you know, achieve their longevity goals and maybe weight-related goals. And they will say, you know, well, I can barely do that because I'm bone on bone. And I'll say, well, how long has that been going on? And have you talked about the option of you know, a replacement? Has that conversation come up or what? What has come up? And they often are, are putting it off. And this is really, I think, before we were talking, you know, PRP or stem cells more frequently, that wasn't yet a go-to. But they're like, well, I don't want to do it yet, or I'm being told I'm too young or I should wait because it's not going to last. And I'm like, oh, is this like— does it make sense to me, so explain it to me. But I'm always thinking, but the rest of you, you're compromising. You're changing your gait. You're changing the way you hold your body. We're ruining the rest of you because we're afraid this thing, this one joint won't last. This doesn't make sense.

Right. So there's a couple of ways to look at it. That has certainly been shown that if we allow people to go too far down the road with really debilitating symptoms, that they get worse. Right? Overall, from a, from a health perspective, metabolism-wise, they get, they get worse, right? So we get less healthy, we get weaker, and we know that maintaining lean mass, lean muscle mass, is critical as we age, right? For everybody, not just women. Um, and then you, you start to lose bone mass. Like, there's all, all the different problems.

Yeah.

And so the argument then could be, well, we need to do surgery early. Well, that would be fine if surgery was the best or only option or without risk. Yeah, right. And, and so the nice thing about PRP and stem cells, they can provide much longer relief of your symptoms. In some cases, there's been some studies in, in bone marrow aspirate in knees that, that show that it can prevent knee replacement for up to 10 years, right? So it can slow or halt arthritic progression. Um, and, and then that's debated. I think orthopedic surgeons who do surgery certainly do not want to have you know, patients getting better without doing a surgery. There's— yeah, that's, that's a— I've even heard— I had one guy say— I had a, a friend in the office the other day, he's a doc, and he's like, man, I have a buddy who's an orthopedic surgeon and he's getting older, and he says, I hope that stuff doesn't get too popular before I retire because I need to, I need to make a living. And so that's kind of, that's kind of one way to think about it, right? I, I think that treating the joint in the healthiest, most supportive way is, is the best way to maintain your fitness. So, and, and it's also important that we get to it earlier rather than later. When we see some of these warning signs, when we start to have really sore joints and difficult problems, let's get to it before it becomes so bad, yeah, that we have to do a joint replacement. And that, that's the true magic, in my opinion, of these types of treatments, is because the goal is to reduce the inflammation in the joint. The goal is to reduce the amount of cartilage damage in the joint. And PRP has you know, protease inhibition, and it does a lot of cool stuff in the joint chemically to slow down that degeneration. And so does bone marrow aspirate and adipose and those sorts of products. And so if we can get to it early and do these treatments, then we can save people a lot of surgery. But we have to get off— we have to get off the hamster wheel a little bit right now. Traditionally, or, you know, our medicine— our one, you know, our our system has taught us that anything that is worth more than your, you know, anything that costs more than your copay is not worth having, right? So in the part of the challenge with these types of treatments is they're not covered by insurance, right? Right. So as an American, you'll go out there and spend $200,000 on a boat for the lake, but you won't spend, you know, a couple thousand dollars to get your knee better, right? Um, and then we also have the resistance of a system that's really built to drive surgery. You know, we're trying to make it easier and easier and easier to have surgery. Oh, it's safe. Oh, it's, you know, you can be in and out of the hospital the same day. You know, here, there's no risk associated. But there is. You have an infection in a joint replacement, and that's life-changing. Yeah, it changes everything.

Yeah. Let's talk to— can you talk us through, like, PRP? So let's pretend, you know, you and I talk, you decide, you know, PRP is my, you know, recommendation. This is where we'd start. What are we talking about in terms of, you know, is this multiple treatments? Is this we do one, we see how it goes? How long are we not able to exercise, or what can I do while I'm waiting for that to take? What is, what is the journey like?

Yeah, and so the journey for, for the journey for any regenerative procedure is, is a lot shorter than, than surgery. That's one of the benefits, right? We have very little downtime as far as we We do like for you to take it easy, you know, and some practices will recommend that you take it easy for up to 4 to 6 weeks after an injection. Some practices will recommend a single injection, some will do multiple, right? And I think the most— I think probably the most effective systems— our system is multiple injections. It turns out that when you stack those injections on each other, they become more effective. So In our system, we do a single injection, and we, and we will typically do another one within about between 2 and 4 weeks depending on what we're dealing with. And we like for our, you know, if you're doing a lot of— we like for you to be out of a high-impact exercise activity for about 4 to 6 weeks. But we have people get on an elliptical, we have people get on a recumbent bike within about 2 weeks typically. As far as heavy lifting is concerned, if you don't have an effusion, if you don't have any swelling, if you don't have any pain, then lifting is something that you can start to do. I like to have people wear a knee sleeve for some compression, but there's a lot of different— there's different philosophies in that, and you'll find different ways to go. In my opinion, I think that the longer you can wait to do real impact activity, like my runners, I like to slow them down a bit. Yeah, but it sure beats a knee replacement. You know, knee replacement, it's 6 weeks on a cane or walker in a lot of cases. It's, you know, it's 3— it's 2 to 5 years for it to get as good as it's going to get. You know, it's therapy for months and months. So just being off a couple of weeks is totally worth it for, for my patients.

Talk to me about the pain factor as far as PRP is concerned.

Yes, very little. So, and I've had all of these treatments, so I've had PRP and bone marrow aspirate. I have— I had an ACL tear in my left knee when I was 28. I was in a big air snowboarding competition and injured it in residency of all things. Um, and, um, so I have some arthritis and I had my last treatment over 2 years ago.

So it's been pretty—

some would say that is like, you know, you're asking to teach better lessons, right?

I would say that I've had a lot of experiences in my life where I got a chance to really learn some good lessons.

Nice, nicely said. Be careful what you telling the universe out there.

That's right, that's right. But I also have a little bit of an extreme personality, so it's, it's one of those things. But as far as the, the process for PRP is concerned, PRP is a really pretty straightforward process. We take about 180 cc's of your blood, depends on how much we need, and then we want to— we really want to concentrate it to about 10 times what's in your normal blood volume. So we want about— that seems to be the proper therapeutic dose for PRP. It's about 10 times your blood volume.. And so we'll typically end up injecting between 8 and 10 cc's into your joint. It takes about 15 minutes to prepare the PRP, and there's multiple different ways to do that. But, and there's also some nuances. You can use PRP in a number of different ways, not just in the joint, which we, we do. It's, it, it's a bit more advanced. And then we do those injections, and typically people will start— it'll be a bit sore that day, and folks might have a little bit of swelling because PRP can cause some inflammation. We have to jumpstart the healing process, and a little bit of that is pro-inflammatory. Yeah. Um, but then it typically subsides pretty quickly. We have most of our patients— it's usually between 1 and 2 weeks before they really start to feel good, but the majority of people start to feel some result within 3 to 5 days, myself included. That's— that was my experience. So really a pretty quick type of procedure.

Yeah, pretty amazing. Okay, so can you give us the bottom line? Any hints at how much, how much is this going to cost us?

PRP can cost anywhere in this country from $2,000 to $3,000 a dose up to, you know, $6,000 a dose. It depends. It depends on the practice that you're in. Um, there are some practices out there that are doing it for like a couple, you know, maybe $1,000 or $500. In PRP, it's almost like you get what you pay for. There's a lot of kits out there that might not be as that are not as effective in my opinion as the, as the techniques that we use here at Pinnacle. Um, and bone marrow aspirate stem cell procedures, I typically see between $7,500 and $12,500 to do those types of procedures. Um, we do a full package that, that includes PRP and, and a bone marrow aspirate procedure. And then we also do nutrition, we do some hormones, we do a number of different things, you know.

And I think we talked about this a little bit in the green room that I hate to wrap up without saying this, but talk a little bit about the, you know, relationship between hormones and aches, pains, joints. You know, I think it was summer of 2024, Dr. Vonda Wright finally gave a name to what so many trainers and, and PTs have seen for years, like women in midlife keep getting more frequent injuries, and they— the same woman will get recurring injuries, but there's no name for it. We know it's related to hormones. So she and her team finally call it musculoskeletal syndrome of menopause. But talk about hormone replacement therapy and what are you seeing true for joints.

I think that was a brilliant thing that she recognized that, and it, and it makes perfect sense. Um, there's also called There's a disease process called— that we call perimenopausal pain syndrome, where we have multiple joints that can be bothersome. Oftentimes we see patients in this age group who are misdiagnosed with fibromyalgia. So, um, but we know that estrogen really supports cartilage health. There are actually estrogen receptors in this— in the lining of your joints. So it really, through those receptors in the joints, it promotes the— it promotes joint lubrication and also promotes what's called proteoglycan synthesis, which is a component of good synovial fluid. Yeah. And then it reduces— it helps reduce inflammation significantly. So we find that, that post-menopause, your arthritis will often start to accelerate. So it looks like you're, you know, pretty stable, arthritic up until your mid-40s, and then all of a sudden it just takes off. And part of it might be because you were getting steroid injections, which can certainly impact your joint health. Significantly. But also, this low levels of estrogen and progesterone really lead to more progressive damage in the joint. We also know that progesterone is an anti-inflammatory, and it's also neuromodulatory. So it decreases some of the, some of the substances in your joint that can cause damage, right, like tumor necrosis factor alpha and, you know, interleukins and those sorts of things. And it also inhibits some of the pain response that you can get from arthritis. So progesterone again is really important. So that's estrogen, progesterone, right? And what you might find is progesterone cream can sometimes make a huge difference in patients with these problems. And then testosterone has just recently been found to be a main, like a major factor in progressive arthritis in both men and women. And so, you know, there's a study, I believe it's, I mean, it might've just came out, In 2023, we, we, we saw a study on anabolic hormone that increases lean muscle mass. You know, that's testosterone. So lean muscle mass loss is one of the problems with aging and one of the problems with progressive arthritis because our joints aren't as stable. So testosterone again feeds there, but it also has some tie with, with arthritic severity in both men and women. So all of these are super important.

Yeah. Yeah, so true. You know, and I— we come back to testosterone and growth hormone, and, you know, if somebody is doing strength training but yet we're not stimulating those enough, or we're not releasing them enough because we just don't have enough, they're not kind of getting the reward that they deserve from the work that they're doing. Absolutely.

So there's ways to cheat growth hormone. I mean, there's great— there's great options. I mean, peptide therapies can be really useful. You can actually send supplement growth hormone, which, you know, depends on how you look at it. But growth hormone is critical for joint health, right? Growth hormone stimulates your cartilage to grow, stimulates your cartilage to be healthy. So, the growth hormone deficiency is directly linked with muscle, with stiffness, decreased range of motion in our joints too. So, that's, you know, and when we dig into all of these, you find cortisol makes a big difference, DHEA can make a big difference. You know, thyroid hormone makes a big difference. All of the, all of the elements of the hormone axis can be really interesting when they interact in the joints.

Amazing. Such a great way to tie it up. Thank you so much for being here. Tell listeners where they can follow you, get more information if they've got questions.

Yeah, so we're on Facebook. You can look up Pinnacle Integrative Orthopedics or Dr. Joshua Schachter and follow me that way. I've got a YouTube channel at Dr. Joshua Schachter. There's also— we have a website, pinnacleorthowf.com. You can also search Pinnacle Sports Med and it'll come up. We have— we're on TikTok at Dr. Joshua Schachter. I've got a— you know, you can follow me on X, you can follow me on Blue Sky, and then we're always coming out with new posts and information.

Absolutely.

So good. Okay, and listeners, in case you weren't writing all that all down on your underwear band, I've got you. We've got it all in the show notes. So from the website to all the social platforms, no matter what you like to use, he's findable. So we've got it. Thank you again for being here. And listeners, what are you waiting for? Let's start Flipping 50 today.

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