474: Why I Chose Disc Replacement Over Spinal Fusion + 5 Weeks Post-Surgery Reality Check with Dr. Jared Ament

And I've had scary situations where a patient wanted to avoid surgery at all costs. Went to, I don't know what country got stem cells illegally. I'm not even sure how they were harvested, where they came from. And the whole spine was basically eaten. And we had to go, whatever was in there just degraded the entire spine, the bone. We had to go in with rods. It's very scary.

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Welcome to Midlife Conversations. I'm your host, Natalie Jill and I'm passionate about having amazing conversations that matter to us midlife women. On this podcast, I do what I do best, taking complicated health topics and breaking them down simply so that we can optimize aging together. I share actionable steps to help you thrive in what I believe are our best years to come. Join me as I interview the most inspiring people living their best midlife years and dive into essential topics like hormone changes, health optimization, weight management, management, blood sugar, emotional well being, relationships, beauty and so much more. Today, at the time of this recording, I'm exactly 5 weeks post L5s, one disc replacement and I no longer dislike my doctor. I actually really like my surgeon now. I went through a bit of a rocky road, which we're going to talk about, but I am so happy I did this. I think if you have dealt with back pain, you have a loved one that's dealt with back pain. If you've been told you have degenerative disc disease or a disc bowl or disrupture, or that a fusion is your only option, you're going to love this episode. Today I'm bringing on my actual neurosurgeon, Dr. Jared Ament, and he is phenomenal. I wanted to bring him on live because we've been having a behind the scenes text and voicemail conversation for quite some time. I'm sure he's had moments regretting giving me his phone number as a patient because I have gone to him with literally everything. With everything every step of the way. If you've been following me on social, you've also heard me sharing details about my disc replacement placement. But I wanted to bring him on today and before I. I truly introduce him and bring him into the conversation. Just a quick little backstory here, like, no pun intended, but I have had degenerative disc disease for my, gosh, two decades. Two decades. And I had a disc bulge about a decade ago. And it was eight years ago, eight years ago that I had a full disc rupture. So I've been through the whole gamut of back pain and learning to navigate life with back pain with a rupture, with a disc bulge, with degenerative disc disease. It wasn't until that I had the disc replacement, it was not a known very well, a very well success surgery for years. And we're going to talk about all that today. So, Dr. Amend, thank you so much for being in today on this show with me. I know podcasting is not your thing. You are a neurosurgeon, you do brain and spine. But thank you for being here with me today.

Thanks for having me, Natalie. Pleasure. Pleasure. Nice to see you smiling.

So before I fully jump into the. I have so many questions for you and the conversation, can you just give us a little bit of background around, around you? I mean, obviously you're a neurosurgeon and it's brain and spine, but why did you get so interested in that and do they really go together in a lot of ways? Can you help us with that?

Sure. You know, neurosurgery people always ask, when did you want to be a neurosurgeon when you decided to be a doctor. You know, I always tell the story of a memory I had when I was 12 or 13. And I think my grandparents were babysitting, my parents were away and they remember getting angry at me because the lights were on at 3 in the morning. And I don't know what they thought a 13 year old was up to at 3 in the morning, but when they walked into the room, they saw me putting together a model of the brain and the spine. And maybe not the coolest thing, but it was maybe the nerdiest thing. I don't know. But I was very into using my hands, trying to figure out how things work. And when I finally went down that path of medicine, it just, and I have the utmost respect for all of my colleagues, but for me, just prescribing drugs to treat a test or a result, it wasn't enough. I needed more action. You know, that's sort of. I was a martial artist. I climb, rock climb. For me it was all action. I don't consider golf a real sport. I'm joking. But you know, I mean, I needed more. I needed more, I needed more action. I wanted to do something. And I also liked the challenge and the humility, which is. Most people say neurosurgeons are not very humble, but I liked the humility of not knowing it all. There's so much about neurosurgery, brain and spine that we still don't know or can't do that. Being at the frontiers excited me because of the possibilities to do real good. Now how are they connected if the spine isn't working, it doesn't matter what the brain tells it, right?

Yeah.

And vice versa. If the brain isn't working, doesn't matter if the spine is functioning. So they're intimately connected and from an anatomic perspective, lesson standpoint, they're connected by the brainstem. That's the thing that connects the brain to the spine. What's, what's fascinating is understanding the real in depth neuroanatomic significance of how they really do relate. And, and that's some of the things you and I have talked about kind of on the, in the background about how your mind and perception of pain and handling anatomy and changes. It's fascinating. And so there's a lot of it we're still learning, a lot of it we're pretty good at. So it's a great balance. And that's kind of how I found my, my niche.

I have so many questions for you. I don't even know where to start, but I'm gonna. I'm gonna kind of jump in, and we might go in a bunch of different directions here, but there's just so many things I want to ask you, and I want to start with kind of a. It's a little bit of a. Of a controversial one. But I know you and I sort of talked a lot about this. There's a. There's a whole train of thought that any kind of back pain or back injury is emotional. And I. You know, the original, like the book that Dr. Sarno wrote about emotional triggers and trauma creating back pain. Can you share a perspective there? Is there anything to that? Is that all pseudoscience? Like, what's your opinion as a neurosurgeon around that?

Yeah. No. I mean, there's both. There's a lot of pains that are emotional, cognitive, psychological, and there are a lot of pains that are mechanical and real. And we've measured that in the body. So it was. It was actually a sad state of affairs when some of that information came out. Insurance companies then mandated cognitive behavioral therapy before a patient would be approved for a back surgery. Because the perception is it's either in your head, it's not real. And we know as. As you know, as you're able to measure levels of pain via certain receptors and hormones that are produced, functional MRIs. As the technology became more advanced, we realized that it's much more complicated than putting anything in one box. There is true mechanical, structural problems that can cause pain, and there are other reasons that you can have pain that we can't attribute to mechanical and structural problems. So it's not black and white, and it's very important that people who follow you and follow other influencers and people who have, you know, there's an opportunity for education. We have to really take a balanced approach here and say, you know what? The truth is always somewhere in the middle, or the truth is these perspectives, science. Every 10 years, red wine is good for you, and every 10 years, red wine is bad for you. Right. So where. Where's the truth? Right. And so the truth is we have to look at the data and try and be as. As unbiased as possible and say, you know what? I actually can accept both answers and how and why makes sense.

You know, for years, I was really triggered by that whole book. I mean, I read it. I actually did a consult with somebody that's an expert in that, and I thought, this is a bunch of hogwash. This is so ridiculous. Like, I have a Real injury. But the more now that I'm on the other side of things, yes, I do mechanically have issues, but I also am not going to completely dismiss that because I saw how my brain played with pain and I can see where a lot of that is connected. I also have learned since my surgery from a lot of my own self reflection and digging, like how I even got into the situation of rupturing a disc and all of that. So I think there is something there with that emotional piece. I just like you said, I don't think it's as black as black and white.

No. And the other, and the other thing to remember is pain is often the body's way of telling us there's a problem. Now if this was all just cognitive and it wasn't real, then in my world, I mean, as a neurosurgeon, I consider myself and my colleagues to be the stewards of your nervous system. Right. We want to protect your nervous system. What does that mean? It's not just pain. Pain is the body's way of telling us there's a problem. But the number of times that I have seen patients ignore pain, mask pain, opiate epidemic, right? And there's a lot of ways that people have treated pain and then pain progresses to something else. If you have neurologic problems and the body's saying, oh my God, I have pain and you ignore it and something progress. Now maybe it doesn't progress, maybe it heals, great. But if it progresses and suddenly your foot stops working and you have functional changes, you lose sensation, you lose motor strength. God forbid. I've seen people with lumbar spine compression issues and they lose the ability to go to the bathroom to control.

Yeah, that's scary.

But so, so pain in this setting is not a fallacy or a myth. This is your body saying, wake up, we have an issue, we need to go to look into it and figure out how to prevent the next steps, progression of the problem from happening.

When I think back to my pain journey, gosh, even starting 20 years ago, I was feeling it in my hips and I, I kind of ignored it. Like, I'm like, oh, just put cortisone in there and. But I did. I wish I had dug down deeper then I would have seen that I had of degeneration. Then I. And I remember the day that I ruptured the disc. I was already in back pain and I knew I had a disc bulge. And here I am, nine hours jumping and doing things that most people wouldn't do. So, so there's you know, there's other things there where I look back and go, wait a minute, I can see that connection. There.

There were signs.

Yeah, there was definitely signs. Okay, I want to ask you about disc replacement specifically, because when I first had a disc rupture, that was my first question. Why can't we replace this disc? This was eight years ago. And I was told time from multiple surgeons. Multiple. Then it's. It's not a very predictable surgery. It's a very intense recovery. There's no guarantees. There's a high failure rate. You're better off either doing a fusion. And I had many doctors in this camp of do a fusion, lock it together, which my brain didn't want to do because I thought, well, if I lock it together, what other problems does that create? And then I had found Dr. C.H. kim, who's a mutual friend of both of ours, and he did something called laser and endoscopic, which I, for the time was great for me, where they just went in, minimally invasive, remove the rupture problem. And it was great for many years.

And he's fantastic, and we both have utmost respect for one another. So.

And then I asked him, as pain started coming back, you know, years later, because that was temporary, that definitely worked. And he never promised that would be forever. He said temporary. I kept saying, what's my next step? And he really was talking me out of a fusion, which I liked. But disc replacement was not something he personally does. He had said, I know this guy in Beverly Hills, if and when. But it was kind of like that. Why is fusion such a standard of care?

I will very honestly say I don't know. That's the crazy thing, right? There's so much data. So cervical disc has more data.

That's your neck, by the way, those of you that don't know.

Yeah, yeah. So the neck is. Obviously there's more data, and the reason for that is, is I unfortunately feel financial. And just because there's more people with degenerative neck disease and they've researched it more, and so it's a volume business for the industry, for the people that put these things out there. But regarding the lumbar and just in general motion preservation, why is fusion the standard of care? Why has it been the standard of care for the last four or five decades?

Initially, the answer is because that's all we had. Initially, that's all we had. And if you had a diseased joint or a diseased disc or a diseased problem in the spine, the theory which worked for A long time was if you immobilize it, it helps with some of the pain generators because the thought was, is that your spine is moving. And if it continues to move in the setting of pain, it makes the pain worse. It's like you have a sore muscle after a workout. You know, you can stretch it out, but you got to work through the pain. Right. If you just sit still, you're okay. Yeah. It doesn't mean you're actually doing the right thing, but you sit still, you're okay. So the concept of let's immobilize the joint that's causing pain and we'll deal with the repercussions down the road. Initially that makes sense. What's the standard of care now? If you have a bad hip or a bad knee, you replace them, right? Right. But 40, 50 years ago, those replacements didn't exist. The orthopedic world did the same thing. You put rods through the hip, rods through the knee, immobilize a joint. It really changes your quality of life and your function. Yeah, you wouldn't be able to walk.

You'D be walking weird, a straight leg if you didn't.

Right. But you have less pain. So now, many decades later, no one's putting a rod through your hip or your knee. The standard of care is replacement. And I always asked myself, my partner, Dr. Voeckshire, like, how is motion preservation in the spine not become the standard of care in these situations either? We have just specifically your case, lumbar, lower back, artificial disc replacement. Over 20 years of data and over a thousand peer reviewed publications on the topic. This is not something that should be refuted. And yet some insurance companies still say it's experimental. Experimental. We do things that are much more experimental than 20 years of data in a thousand review publications. And it's, I think in the past also people were just. There's two reasons. One, I think there's financial incentives. There's a lot of coding that goes on in the background for fusions. And when you put in a fusion cage and you put in a screw and you do this and you do that, there's a lot of codes that you can.

Okay.

And that always worries me about incentivizing everyone for just more money into the health care system and charging insurance. And charging insurance. When you do an artificial disc replacement, there's only one code, no other code you can use. And so from a billing standpoint, I worry about the incentivization there. And secondarily, I think people also safety. When you have a mechanical Moving joint around, something as sensitive as a spinal cord. People are nervous. And so where did all this technology initially come from? Came from trauma. It wasn't actually from a case like yours. Like, it's an overuse injury in many ways. Right. Because you're. You're very. You're hard on your body in a good way. It came from trauma. When someone, God forbid, has a major trauma and the spine is severed, there is no motion that you want to preserve. You want to stabilize that, right?

Yeah. That's emergency medicine, though. That's a little bit different.

But that's where the fusion technology came from. And it's just trained, translated on its way to sort of something like your case. The problem is, is that you're thank God for your brain because you knew you were intuitive and, and knew that it didn't make sense to lock up that. That area. Because how does that affect the rest of your spine? Yeah, when we look. When you look at the spine, it's not just the segment that's moving, it's also globally how your spine is working. And I always tell people the same analogy, and I think I said it on Max's podcast as well. But it. It's a really important one. Think about a card, a car, shock absorbers, wheels. And if they're all working together, right, there's some symmetry. But if we take one shock and one wheel and we, like, make it a cement block, that car, I mean, I guess you could drive it, it's not gonna be very comfortable. But what happens to the other three that are normal?

You're gonna get wear and tear on those other ones. You're gonna get misalignment.

Exactly, exactly. And it's the same concept in the spine.

So this is why I didn't want a fusion. So when I thought about. Because mine was L5S1, it's the very bottom. My other discs were pretty much healthy in my mind. If I was going to add stuff there to lock them together, what was that going to create on the disc above it? What was that going to create? My hips. What other problems? So my brain, logically, what I did, and I'm not saying this is the right thing, but what I did for eight years, which pretty much kept me out of pain for many, many years, was I thought I learned the anatomy and I thought, well, if I really develop my glutes, if I really develop my glutes strong and I really develop my core, I can almost take L5S1 out of the equation. So in my mind, I Might wake up in pain. But if I go do these exercises and activate, I'm going to bypass using that. So that's what I was trying to do. And that's still the advice I would give somebody not doing surgery right now.

Absolutely. I mean, you did the right thing and you probably lasted longer than most, but because of how healthy you are. But I am a huge proponent. I mean, we've looked at the numbers. I think the people who walk into my office or do, you know, out of state zooms or whatever, I think I operate on 15, 20%. So the goal here is not push people towards surgery. The goal is get the right surgery if you need one. Yeah. Everything that you did, your core stabilizing, there's a lot of musculature around that spine. Now, if you have a degenerative process that's happening, unfortunately, the technology doesn't exist where you can inject a stem cell and magically regrow a disc yet maybe it will. But what you can do is what you did. And you can do acupuncture, you can do all the holistic therapies to help keep that spine as healthy as possible. So what does it do? Slows down the degenerative process, which is.

In my case, what happened. I slowed it down. But in the last year, the reason I ended up doing this surgery is that just buys you more time. It doesn't fix. And I had also some misinformation. I was told, and sometimes this can happen. I was told if it auto fused together, meaning on its own, without a fusion, I don't do anything. And those it starts to fuse together on its own, I would have less pain. So I kind of held onto that. Like that's a good thing. What I learned in the last year is that's not always a good thing. And in my case, what that was doing as it was starting to fuse together is I started having nerve pain, I started having weakness. I started having crazy amounts of hip pain. Like, would wake up every morning in massive hip pain, hip flexor issues. And then I started having muscle wasting. I was losing muscle in my legs because I no longer could do anything to keep or build muscle. So it started to really deteriorate. And when I reached out about this surgery with Dr. Ament, he told me, and I want you to share the kind of the risk of not doing surgery. Can you share, like, what. How that would have progressed?

Yeah. I mean, but this is an interesting example how in your case, you know, pain is not an illusion. This created. This was a Creating real functional problems, muscle atrophy in someone who's muscular. So auto. The guidance you were given is not entirely incorrect. If people who auto fuse often have less pain at that segment, similarly to people who get a fusion. It works at the level it doesn't. It's not physiologically normal, but it stops some of the pain generators. So in your case the problem was. And you were auto fusing by the way. You know, remember we talked about this a little bit when I was in there. But when you auto fuse actually, you know what, I can bring this model show everyone. Yeah.

If you're watching on YouTube, you come look at this.

So the idea here, and I'm sorry for this kind of crude model, but the idea is, is that your nerves exit called the neuro foramen on the side and the spinal column and canal is going through the middle. We're not showing you that, that's kind of inside. But the way the nerves exit from the spinal column, they require a certain level of space. When your disc, when the shock absorber degenerates. Degenerates, degenerates, degenerates. This space collapses. When that space collapses, it's yeah, you can auto fuse and maybe the pain coming from the disc disease will get better. But before you know it, you've collapsed on the nerve.

Yeah. Which is what was happening.

Right. And so the other, let's say your nerve has enough space and even in your case it didn't, but let's say it does. You auto fuse and that segment feels better.

In that situation you may be just fine, but you haven't really changed the scenario that you've now your body on its own has changed the kinematics, the physiology, the motion of the entire spine and the adjacent segment. It's back to the car and the wheels analogy. So now you've auto fused, you may feel better until 4, 5 and 3, 4 and the cascade continues.

Yeah. And what I was starting to see was what I was starting to connect the dots were with is well, if I don't work out, I'm in less pain if I don't. So it was like, okay, but where does that lead? Because in my mind, okay, if I don't work out and I'm losing muscle, I might temporarily be in less pain. But then I would think five years out, 10 years out, that's going to be a big problem because now the, then I'm losing more and more muscle and we get a whole other set of problems. So that's why the timing made sense. To come in and do this.

Absolutely. Because you would have if you, if you waited, if you auto fused, if you continue to atrophy, we'd have a real problem at 5:1. And I bet you we would not only have had to dealt with 5:1, but we also would have had to deal with 4, 5, 3, 4. Maybe you would have had a much more complex problem.

Yes. So before I ask you more specifically about motion preserving and disc replacement and that tech that specifically, I want to address stem cells and PRP for just a minute here because a lot of throughout my journey people were like, oh, just go to my stem cell. Well, I want to share. I actually did stem cells and I did prp, but it was never going to grow back a ruptured out disc. Can you just share a little bit about like what those actually do versus who that's not who that's a waste of money for maybe?

Yeah. Well, I mean, so here's the other thing is your case is kind of a great example of this because you had the Dr. Kim do the endoscopic discectomy. Right. So the idea is, the idea is that when your disc ruptures and he does this discectomy, he does a beautiful job and he's an amazing man and surgeon.

It's not like he pushes it back in. No, right. I mean you can't.

And like the jelly is out of the donut. So we just have to get it out of your body now.

Exactly right. So it's not, you're not putting the jelly back in, you're taking that little bit of the jelly out. He's very good at taking just the right amount. But that process starts and there's a cascade of degenerative proteins that happens. There's only so much you can do to stabilize it. If we do things like PRP and stem cells, the data that we have suggests that it may help not restore your disc, just help with some of the inflammatory markers, inflammatory cytokines and inflammatory processes to help alleviate pain. Almost like you're adding a little bit of oil to the car, but not the right oil, you know, and so it's not going to last forever. It it. I would love to see the day where we could inject a stem cell intradiscal and see it regrow. It just doesn't exist yet. And I've had scary situations where a patient wanted to avoid surgery at all costs, went to, I don't know what country got stem cells illegally. I'm not even sure how they were harvested, where they came from and the whole spine was basically eaten. And we had to go. Whatever was in there just degraded the entire spine, the bone.

We had to go in with rods.

It's very scary.

That is. And I actually, I've had, I've interviewed Dr. Josh Ax on here who had. He's a fan of stem cells, but he had had a bad experience at one point with that he shared about an infection. So there's a lot of. You got to be really careful, like who are you going to.

What are you not against it? I'm not against it. I just don't think it's the panacea cure all yet that we're hoping it would be.

So when I did, I did PRP and stem cells and I went to Dr. Darrington who Dr. Kim said, I don't know, but you could try. And it was exactly what you said. It helped a little bit with inflammation and pain. It just wasn't going to fix the problem long term. I also want to share chronic use of NSAIDs. Can we talk about that for a minute? When I went to you, I said, when I'm desperate, I take an indomethacin. And Dr. Kim was always worried about that with liver, but he's. It was like for desperate. Can you just give your opinion and your share from long chronic use of NSAIDs?

So a lot of the data in, in the neurosurgical and spine world, I mean, there's obviously data on heart disease, liver and so forth, especially if you're mixing it with. If people have a glass of wine or two at night and you're on chronic NSAIDs. But from the, from the spine, specifically data, chronic NSAIDs has actually been shown to reduce bony healing.

Wow.

And so it really comes from the fusion data. But this is another, this is a little nuanced, but when you put an artificial disc in, you actually do want a little bit of fusion. That's what people don't realize. Right. So from the fusion data, chronic NSAIDs can prevent fusion from happening. Now, in the artificial disc world, I like people being on a little bit of NSAIDs right after surgery. Just for a couple weeks. Yes. But long term, I don't. Because the titanium end plate needs to bio integrate with your bone and so does the other titanium end plate needs to biointegrate with your bone. It's the part in the middle we don't want to bio integrate. That we want.

Makes sense.

So chronic NSAIDS in general around spine surgery scares me when it comes to healing.

Makes sense. Okay. Disc replacement specifically I know there's a specific time kind that you use and you do very complicated cases and you've been doing many of these procedures for many, many years. And there's not a lot of surgeons that are comfortable doing disc replacement. Why is that? Like what went wrong? Was it a different type of disc for many years? Is it just technique sensitive? Like why is that so scary for so many surgeons?

Yeah, it's a great question. I think you kind of already hit it. It's both the original, original lumbar disc that came onto which had reasonably good data in the late 90s, early 2000s, had abject failures. You know, after the two year trial mark, it was three, four, five years, they had a lot of failures and we couldn't figure out why it was taken off the market. So it got a bad rap also, you know, and one of my mentors, Dr. Lammon and Dr. Johnson.

Always said that anyone can put in a fusion device and get the body to fuse. Because you just stick in a wedge and a titanium wedge and let the body do its thing. You get inflammation, you can get fusion. Although there are failed fusions, it is easier to fuse than it is to place a motion preserving device to work normally and physiologically in someone's body. Everyone's body is a little bit different, right? And your spinal curvature is a little bit different than your neighbors. Now there are certain normative curves and standard deviations, but it's just a little bit more nuanced. So the disc that you have is actually the one with the longest track record in Europe and the United States with the longest data over 20 years of follow up data and it really, the next iterations of it have just changed the game from 60 to 70% success rate to 90s success rates. But it is a little user specific. Dr. Lamb and I often joke to my partner, Dr. Voaksher that maybe we should start a fellowship not for complex spine surgery, but a fellowship which is extra training after residency, specifically on arthroplasty motion preserving. Because it's not the same a fusion device, you measure it in the or in terms of height and width, put it in there and call it a day. But when you're, when you're, looking at preserving motion, you know, I'm looking at your X rays bending before surgery, after surgery. I'm measuring very nuanced details. I'm angles so that I can get your spine working as normally as possible. When I'm in the operating room, I'm doing the exact same thing to try to reproduce natural Motion. If you force the issue, which you can do in a fusion. In a fusion, you know, people are. If your viewers are watching, people give me a hunchback. Right. You know, God forbid they develop a deformity. When you do a fusion, you confuse that person perfectly straight and keep them there. But an artificial disc, you don't have that ability. The disc is going to go where the body wants it to go.

Yeah.

Right. So you have to be a little bit more detail oriented on how that's going to work in the person you're treating.

Makes sense.

Why?

When I was sharing. Because I shared literally every detail of my life going through the surgery and then recovery. I know you were like, oh, gosh, I hope it's. Yeah. You knew it was going to turn out great. But I will say I had a lot of people asking, like, why did he go through your stomach? How come you can't go through your spine? And you had told me it's going to be less invasive to go through the abdominal area. Can you talk. Speak into that a little bit?

Yeah. Not only is it surprisingly less invasive, it's actually the only option we currently.

Oh, okay.

Yeah. There. There is an artificial disc that's finished its trials. That is the only one available in the world that goes through the back. The problem is that it's. It actually ends up being a little bit more invasive because you. It. It goes through the facet joints, it goes through the posterior elements. It is metal on metal, two implants going from the behind. It's unclear to me.

What the utility of that will be. Unless there is a contraindication that we can't safely go through the front, then that's the type of patient that maybe will benefit from this. It's not FDA approved yet or out yet.

Okay.

But currently, around the world, the only artificial discs.

That exist that are available have to go through the front. That is the same for the neck. You know, the servo.

Yeah. They cut right through your neck.

Why is that? Because this. The disc is in the front. You don't want to be retracting on the spinal cord, you know, and going through the back, that's how you cause paralysis. Now in the lower spine, in the lumbar, your area, for example, there is no spinal cord. They're nerve roots, but there's no spinal cord.

Oh, I didn't know that. I didn't understand that.

Okay, so everyone's spinal cord ends approximately at T12, bottom of the rib cage, L1, L2 level. And so at the. You have. They Call it the horse's tail cauda quina. At the bottom, it's just a dangle of spaghetti. Now you could theoretically retract the spaghetti, which you can't do on the cord, a solid cord, and try to place something from behind. But the, the goal of the disc replacement is to get the maximal coverage as possible. You want it to meet your vertebra and the air, the, the, the amount of space that you have from behind to get there is just inadequate. And so when you go through the front with a good exposure surgeon, like when we, it is a very small incision, we don't open the peritoneal wall where you actually see the, the, the viscera, the guts and the organs. You don't even open that. He retracts very gently. He gives me access to the entire vertebral body width because I want to get the largest disc in there to replicate, replicate your disc size. If you go from, just by the way the anatomy works, if you go from behind, you're much more limited in size.

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All.

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Yeah.

Yeah. And is that in the same place that a C section scar would be.

Where you do that for an L5, for an L5 S1 for your level, it's very similar.

Okay, so it's a. It's a very. And. And I'm five weeks out today at the recording, and It's. I have a silicone strip over it right now, but it's. It's. I can see it's just going to be a little line. It's not a. It's not a big deal. The worst part about the stomach, going through the stomach for me was just the bloating. And he kept telling me, it's gonna go back. I felt like I was six months pregnant for a couple weeks there. But he kept saying, I promise you're not gonna look like that forever. And I.

It's. It.

He was right. It went away. But I definitely did not like the bloating.

I know. I got a lot of pictures.

Why does that bloating happen? What is that?

There's a lot of. Yeah. So, I mean, look, any type of surgery, even if we do it really nice and finesse and nuanced, is a trauma to the body. Okay. And when we go in there, there's an inflammatory process that happens, obviously. And there's also something called paralytic bowel syndrome or ileus, even if you're having bowel movements or passing gas, which I know it sounds funny to talk about, but a lot of times when we go through the belly, just by not even touching them, just moving them to the side of the bowels, they get stunned and they dilate. Even if you're passing it, they get dilated, they get bigger. You feel very bloated. Sometimes there can be fluid in there. A seroma, your body creates fluid, and it takes a while for that to sort of settle down. Now in you, you're particularly skinny and muscular, and so that showed more than a lot of people. Yeah. And bothered you. I got voice emojis from you about it. Yeah. But it's. It's completely normal. The interesting fact is that we did this on you as an outpatient. You went.

I did. I went. You told me to walk that day.

Yeah, I did. The reason people used to do these surgeries, any surgery through the belly, was because of the bloating and the concern that the bowels weren't going to kick start and they would keep people in the hospital for two weeks.

Wow.

It's crazy.

Yeah.

Infection rate, two weeks in the hospital in of itself goes up. If you're not moving, lying in bed, your risk of a dvt, of a blood clot goes up, up. It's crazy. And sure. I mean, it's. It's. I don't remember the last time we've had someone with a irreversible complication around the belly. Or the abdomen that would have needed a hospitalization. Thank God. I mean, it really is. You did everything right. You just noticed it.

So the pain level. I want to talk about that for a minute because I know, I'll tell you that I, it was very. I documented the whole journey and the first five days, the first two days, I honestly didn't feel much at all because I think you. There's a block or you're so numb. I would say then days, maybe like 2 to 3 to 5 was pain in my back. It was a back spasm. And you had shared that. That is common when you are as collapsed as me, but not everybody would have that. Is that accurate?

Yeah. I get nervous when I see people as collapsed at you as you. Not because we can't accomplish the goal, but because of the post operative pain when you're really, really collapsed. The more. And I put in the smallest height disc I could. Right. The more that you are distracted and opened up. Even though we go through the belly, when you do that on the spine, all the musculature around the spine, even posteriorly behind it is also stretched. And that stretching causes the muscles to really spasm.

So I had that muscle spasm and it was very. It was painful. But. But what I want to share with anyone listening is it was a totally different pain than my back pain prior. So wait, so I knew it wasn't that. It was just. It felt literally like a muscle spasm. Like I had done too many of the wrong exercise or something like that. But it just. That was that kind of intense. So that's where that pain was.

I love that when, I love when patients tell me that because that is, is a sign that we fixed an anatomic problem and replaced it with now a surgical post operative issue. But a lot of patients say I hate you. For the first five or six days it really hurts. But the pain is different. I'm like, that's okay, we'll get you there.

So then I had like two days of freedom and I'm like, this is great. And it's a week out. And I'm like, this is okay. I actually agreed to do a speaking engagement like the week after all this stuff. And then what happened was I had a week of very intense nerve pain which you also told me would settle down. But I was in the moments thinking, this is the worst thing I've ever experienced in my life. Can you share? Does that happen to everyone? And is that just because of the collapse? What's, what creates that?

Yeah, it doesn't happen to everyone. But I would say there's almost a direct proportional link to the amount of collapse and the amount of distraction. Because if you can imagine the model I was showing before, remember how I said the nerve doesn't have any room to exit?

Yes.

But when I. If you put in a new disc and you do this, the nerve also gets a little tethered. The trajectory is, instead of the nerve going straight out, suddenly we're opening you up and that nerve is being pulled. Right. So that distraction that I just explained on the muscles, why you had that muscle pain, it's very similar to why you can have radiating nerve pain. It's similar to kind of a what we call radiculopathy when you have a disc herniation. But this is called post operative radiculitis. It's a nerve irritation, because it's usually not that the nerve is impinged or being pressed on, it's just that it's being stretched. It's back to normal. But if you think about it contextually, you've worked on your collapse for years, maybe a decade or more. Right. And in a matter of 45 minutes to an hour, to an hour and a half, we've restored your disc height and your anatomy to how you were born.

Yeah. So it's like a correction. And so I just. And I'm sure you know these things, but the things that I figured out out of desperation, that would help with Nerf pain, because I. I was that person that would not take gabapentin even though he prescribed it. I was like, I'm not taking it. That or Lyrica. I was just like, I don't want them.

So I get it. I get it.

So I didn't even try. So those could have helped. But what. What I really found helped is when I was in surgery with you, you put those compression things on my legs that, like, they. And I found if I would wear those if I had a sit or they. It would almost distract my brain some. So those things post surgery actually helped with the nerve. I also kind of like a TENS unit or an E stem, but a way higher level one that I tried with called an H wave. You said you'd heard of it. That was great because also you can put it on the high level, and it's. I think it just distracts your brain. That must be what it does. But it. I would be able to put that on and I could sleep more. And then you had told me the more I walk, the better it would feel, which Was true. So the pain would typically come on it when you're resting or sleeping or sitting versus if I'm walking. That could get me out of pain for the nerve pain I figured out.

And I mean everything you did was great and everything. I loved your recovery in many ways because I mean obviously I was. I would love everyone to have zero pain, but there was a lot of anatomic correction that had to happen in you. So. But I really do love your recovery because you kind of approached it step wise. You looked at some alternative and holistic therapies, a lot of which I very much support. I'm a proponent of. But the one thing that I can tell you just from an anatomic perspective of what the lying versus the walking. The same concept when I'm using that diagram, the schematic of distraction and compression. Distraction and compression. When you lie down, your spine actually distracts more. So you're making it a little bit worse. And when you stand up, you weight bear and you axial load. And that compresses things and lets things settle even by a millimeter can be enough to give some relief.

What's wild is as I'm talking to you right now, like so I'm sitting on a chair and I could not really sit before the surgery. Like it was so painful. So not that I'm going to be a long term sitter, I like to move around. But the fact that I can sit and not have pain, I used to when I would. And those of you that have L5S1 issues, you, I'm sure you can relate to this. But I would never have bent over a sink to brush my teeth or bent over to pick something up. Anytime I had a bend over it was. I would have to activate my glutes and squeeze my core and use my glutes to like hunch me. I would never hinge. So in.

You disengaged that segment. You disengaged that segment.

Yeah, I literally disengaged it like and so. And so now and. Or if I would sneeze, I to would like like hold on to things. So it was like this whole process and now it's. I have to readjust my brain. Oh, you don't have to do all those things. Like you can literally just so I can bend. There's no pain. I can sneeze. There's no. I don't to brace myself anymore. It's just these subtle things that you have to retrain. And what I've been sharing with him is the pain in My back is gone. I might have little twings that feel familiar, but it's not. It's different. It's not the pain. It feels more muscular as my body's adjusting. That's how I would describe it because it's all. Everything's new and like feeling different. But I wanted to share that the. The pain is gone. My hip pain, completely gone. Like, no issues there with hip pain. That piriformis pain gone. That regular. The nerve pain I had prior, like that sciatica gone. No issues with that.

The weirdest thing that cleared up and I told him this and I was like, is there any connection? This is so weird. My left eye was blurry before the surgery. And I kept, I didn't know why. I kept thinking, why is my left eye vision getting so bad? And I was planning on, after the surgery, I would deal with that. Well, my left eye has been clear since the surgery, which we kind of talked about that and you said it's not that far off. Can you just share from your perspective, because that seems so random. Like, why would my left eye have cleared out?

Yeah, I, you know, again, the honest answer is a lot of this is theoretical and we don't know, but there, there is the brain's perception of pain. And your constant adaptation to that pain can do all kinds of things with the body. There's all kinds of endorphins and cytokine releases and receptors that are upregulated and downregulated due to pain. Now it's more common to see things happen bilaterally both sides of the body. Why one side versus the other was affected by whatever, you know, pain modulation pathway we were able to help with is unclear to me. But a lot of it can be stress mediated. I mean, when we have pain.

Yeah.

Our stress levels, our cortisol levels and cortisol, I mean, it's good when you're in danger, but we know long term cortisol elevation is very, very detrimental to our health. And so there's a lot of that that plays in. I mean, there's something called the HPA axis, the hypothalamus, pituitary, adrenal axis, and it's all related to cortisol and negative feedback loops. And the brain produces more of it or less of it. So there are links. Why left eye versus right eye versus both. That, I don't know. That's just, That's a Natalie and that's you.

Well, it's funny, when I look up, like I forgot what the phrase was. Like, I Think it was like functional chiropractic. I could find actually stuff about your eyesight and your spine. So that was interesting. But I guess you can find anything if you're looking for it. But, but it was just a random weird thing that I would have not expected. That is amazing. I also know my hip flexors don't feel tight anymore. My hamstrings don't feel sore. It's like my body feels new and I'm adjusting to it. It's, it's. But it's good.

Well, because it was a random shock to your. It's a trauma to the body. It's a different type of trauma. And you've been adjusting and adapting to what you had for so long.

You said that it used to be a 60 to 70% success rate. Now it's, it's 90. But you, I know you had told me you have a way even higher success rate than that 90. Like you. What would mean, what would that mean if it wasn't successful or if it failed? Like what? Talk to me about that small percentage. That, that doesn't work. Right?

Yeah. We've looked at our data and the cervical and the neck success rate is about 98% and the lumbar is about 96 and a half percent.

Okay.

Over hundreds, thousands of patients specifically for just these technologies.

And I don't, I'm not thinking I'm something special. It's just we're very detail oriented and very nuanced when it comes to this. But you know, if, if arthroplasty doesn't work, there are a few reasons. One, there could be a mechanical failure of the disc, which is less than a fraction of a percent. It's so exceedingly rare these days. One of the things we've seen in about, and this is not an insignificant number, is about 10%. 10 to 12% of discs, neck and lower back, but more in the neck actually over about a decade. Auto f. It's a really interesting concept. Why is it auto fusing? We just did this whole fancy surgery to prevent fusion. Right. So the idea of what we see is that anytime you do anything to the body, there's an inflammatory reaction. Hence why I put you on some anti inflammatories after surgery. But that inflammatory reaction could be the hip, could be the knee. Any implant can develop calcium deposits, fibrosis, scarring. You've talked a little bit about it with breast augmentation and implants. Right. That's our body's way of, of dealing with a foreign object. And So I always tell patients, you, I don't have to worry about. But I always tell patients, if you don't use it, you lose it. Yeah, right. Because it, you know, I think the orthopedic colleagues get away with the hips and the knees because unless you're not walking, you're always using your hips and your knees. Right. But if you sat in bed all day with a knee replacement, your knee would probably lock.

That makes sense. So, so most failures, if you're seeing, like if that were to happen in the rare case that it did, the majority would be from not using it and being stiff and having that.

Absolutely. Now there are other cases that we've. Yeah, absolutely. The lack of use. You know, it's like Newton's law. Things in motion, stay in motion. Things at rest stay at rest. And there's a, there's an anatomic and physiologic explanation for that. We have seen in some, not the disc that you have, but we have seen some discs, something called osteolysis, where the, the, the implant and the bone integration doesn't heal well. In very, very rare cases, we've seen some people with allergies to implants, but that's not new to disc replacement. That's any implant and that's about it. People ask me, you know, a lot about trauma and I always tell people, that's a very fair question. I mean, what's going to happen if, and I have a lot of professional athletes that have had disc replacement? What's going to happen if I have a hard tackle or I'm a mixed martial arts fighter or God forbid, I'm in a car accident, you know, and I tell people, look, I'm actually, if, if I'm happy with how your X rays and things are looking and how the surgery went, I'm not going to prevent you from doing any of these things. Because in a high speed rollover car accident or a major trauma, your natural anatomy can fail. We see it all the time. People come in with trauma with paralyzing, Christopher Reeve Superman paralyzing injury, falling off a horse. Right. So, so the, from what we can tell, the discs that we are putting in, once they're healed are as strong, if not stronger than your normal anatomy.

So yes, one off thing could happen. But your regular body. But that would happen too.

Exactly, exactly.

That makes sense. When many people asked what's the disc made of? Because, and that was one of my concerns because after having an explant and having that rupture, I was like, I Don't want silicone. Like, what is that? And you had mentioned it was titanium and something else. What else was in it?

That's in it. Yeah. So all the. Except for the lumbar, which is what you have lower back, all the discs are a little bit different. Some are ceramics, some are titanium, some are cobalt. But yours is a titanium kind of cobalt alloy on the end plates. The part that I want to integrate into the bone and the middle is a polyethyle ketone core. It's like a high grade medical plastic core that's already been tested by the FDA for wear and debris, which, you know, according to the FDA testing, this is, you know, 10 million iterations of movement should last the life of a human being. Now, full disclosure. The same type of testing is done in hip replacements. And we know hip replacements May or May 20, 30, 40 years. There may be a need to replace them from wear and tear, depending on how much people use it. Yeah, we don't know. But the, the extent of revisions that we've had to do in, in discs over the last 15 or 20 years where we have reasonably good data is exceedingly low.

Got it. Now, because you said the polyethyl. Do you do people with this disc replacement, me included or anybody, need to be concerned about things like an infrared sauna or things that say to help get toxins out of your body, Would that break down integrity? I know there's some concern around that with implants.

Yeah, no, no, we haven't seen any data to support that because, you know, red light and all these therapies is not actually new. It's just become very, very popular.

Well, the sun has both those things, but people don't.

Exactly. Yeah, we haven't. But other than scarring and cosmetic, we use your sunscreen. That's safe if you. I know there's a whole debate about that too nowadays, but, you know, people are still in the sun. So we have not seen any evidence because we do have people in Europe before it was approved in the United States walking around with these types of implants and discs for over 30 years.

Wow.

So we have not seen that that's the case.

So that's not okay. If you had. And there's a, there was a way you shared that you could even test if people are concerned about being allergic. You said there was one ingredient in it. It was a little bit of nickel or what was the thing you said that you test.

Yeah, for. We're actually very limited when it comes to the lower back, the lumbar Spine, because of the implants you have, is really the only one available here. There's one or two others in Europe that have mixed reviews that I know. Some patients have traveled overseas for Australia. There is a, there's trace amounts of nickel. And if you have a nickel allergy, it becomes a little bit controversial. So we do some. If someone has like wears jewelry or costume jewelry and they have a reaction, then I always will will test them with a metal allergy test. I've had patients who've come back with mild reaction to nickel. We still proceeded. I yeah, I mean, do you know that the American nickel, like the, the nickel coin, actually has 25 nickel.

Oh, wow.

And so I always tell patients, I, one of my mentors told me, I just tell them tape a nickel to their body and see what happens, like an actual nickel.

I chose not to do that because I was like, I don't want to put this in my head. I'm just this, it's going to work, it's going to be fine. So I chose not to do that.

It is exceedingly rare, except for the person that really has those contact dermatitis, allergic reactions to jewelry and costume jewelry. Then we are a little bit more diligent and sometimes.

Less than 4,5 that I can count on my hand. Where we've actually been really limited and not been able to do the okay.

And I would imagine if you had that kind of reaction once it's in your body and you weren't. No, you would have signs, you'd have fever, you'd have things that would show up, I would imagine.

Yeah, you'd have rejection shines on imaging, there be bony, you know, degradation, there'd be inflammation. You'd absolutely have signs.

And what you shared with me, that also made a lot of sense was like if something were in the off chance something were to not work or this wasn't the right thing, then you then would go to a fusion and then you'd have more assurance and it would be, you'd still be better off at that point doing that later.

So it's a really interesting point. I always say to you, and I say to everyone, fusion is a backup. It should not be the standard of care in a case like yours. It is our backup option. Even in a case like yours, let's say 10 years from now, something changes, something happens. Depending on how it's looking and depending on what's available to us in 10 years, I have, even today, I've had to change for a trauma or something happened, I've had to change a disc replacement and I put in another disc replacement.

Wow.

I don't always go to Fusion, but Fusion is an ultimate backup if all we need to do is just keep the spine stable and then we kick the can down the road for a rainy day and deal with the consequences.

But a Fusion is not reversible. So if someone has a Fusion, you can't, there's not a choice after that. Is that accurate?

It, yes. But it's also a little controversial. There are about three of us in the world that are looking at Fusion reversals. Wow. But I would say I would not hang our hats on that right now.

Okay.

That's very complicated, potentially very dangerous, and honestly, in some cases, potentially unwarranted. So I use Fusion as a backup when I have no other choice. And I just want to keep someone out of pain, but more importantly out of, of danger of neurologic dysfunction. And I'll deal with the consequences of Fusion later on as long as neurologically you're intact.

Now, sometimes, even though insurance loves Fusions, sometimes, sometimes insurance will pay back for replacements. It is not the common standard of care though. And I think a lot of people, that's their first question, well, how come my insurance doesn't pay for it if it's so good? Why insurance? And I have my own opinion and I'm going to ask yours. I mean, I hate having insurance dictate treatment. Insurance is literally a business and them dictating our treatment is just not great practice. And I, I just hate traditional medical insurance. I, I can't say that enough. I like health shares versus traditional medical insurance, but I feel that people pay so much into insurance hoping it's going to take care of them medically and it really doesn't. Like it might cover some things, it just doesn't cover that. And unfortunately, a lot of the best surgeons and best doctors, they've opted out of insurance based stuff too, because they're paid so little for what they've learned from insurance companies. So some of the best techniques and practices are not insurance covered. But I wanted to get your perspective on that because, I mean, I know you get that question every single person that walks through your door about insurance.

Every single person, you're 100% right. And it's not only just the reimbursement is, it's impossible to stay in practice and pay your bills and pay malpractice insurance. And it's not even that. It's also so fighting the insurance just to try to get an authorization can take up more than 50% of your time. You're no longer involved in patient care. You're not taking care of a person. You're fighting a, a business entity. You know, insurance is a for profit entity. There's a lot of algorithms and a lot of people with MBAs and not MDs making decisions. And that to me I think is grossly inappropriate.

Yeah.

Why fusion versus artificial disk. Look, fusion's been around 40, 50 years, even longer artificial disk. But again I said it earlier. Twenty years in the United States of published data, a thousand peer reviewed publications and to this day I will get a letter from insurance saying our experimental not proven. I'm like wow, it's just like, it's just a canned response. Someone pushes a click, right click of a button and that's. And I, I have a lot of theories too. I think that there are always going to be the fusion patients. They don't want, they don't, insurance companies don't like, there's actuaries, there's very smart people doing the mathematics and they don't want to say you have your fusion bucket and they, that it's just going to replace it with artificial disk. They are worried about it being an add on that's going to be more volume.

Is 1, 2. I, this is my cynicism and maybe conspiracy theory but I really believe that the, you know, the fusion industry, the lobbyists, the policymakers and the insurance industry, someone's in bed with someone together. Like I just, there is some incentive there that I don't understand.

You know, I personally know people that literally worked in insurance and don't have their own medical insurance. They have health shares now which health. You guys can look up what a health share is, but they've left the whole insurance system for this, this reason.

But I also want to address first of all, before you guys message and ask, first of all, this is not a sponsored episode. I did not do a trade for my surgery. I paid out of pocket for this whole surgery. I did. And I, and it's not like I have extra crazy amounts of money floating around by any stretch of the imagination. I did it because of quality of life and I saw what it was going to create in my life if I did not fix this. And I wanted to restore my original anatomy. So I was very aware going into this. And so I just, just want to kind of put that out there before you message me and say well that's lucky for you. Like I just like all of you had to go through this whole process in my in my brain.

And you.

And I have talked about this. I'm kind of new in this whole pod. I think my 13 year old knows more about podcasts and Instagram and stuff than I do other than obviously, you know, Max is, who's a friend who I treated as well. But I. My incentive here being when you asked me to be on the show is all about education. I want people to be informed and I think you have a great following and you do a great job at it. And I, I'm, you know, I'm very blessed. I'm busy and that's okay. I just want people to do right by themselves and get the right information.

By the way, I'm not done yet because I have some more questions. But the reason I even found out about Dr. Amen is, well, Dr. Chol Kim had mentioned him to me years ago. If you ever need a disc, if we ever want to go there. But then I was listening to Max Lugavir's A Genius Life podcast one day and he. I found this one on his L5s one I thought, huh? And I started listening, which I'll link that in the show notes too here for you all if you want to hear that one. But that's where he was interviewing Dr. Ament post his disc replacement about the same timeframe or maybe he was a little bit further out. And I thought, oh my gosh, he's describing exactly what I've navigated. So that's what made me reach out and want to do this. And I thought if this is changing my life and helping me, I'm like, I want to put him on mine because somebody else might be listening. And that same thing will happen for you.

Amazing.

Okay, I want to ask you about, I asked you post surgery and pre. I'm like, what supplements should I take or not take? And I asked you about peptides. I asked you about like BPC157 and TB500. I think I was asking you questions. And you said, post surgery, I'm fine with your BPC157 if you want to take that for healing. And you said, and I'm fine with you doing Axon. And I was like, what's Axon? And you said, well, I don't usually like talk a lot about it because it is a product I developed with my partner. But. But it's. And again, you guys, this is not sponsored. I'm just sharing. This is. This is his product and why. And he doesn't go heavy on promoting it because he doesn't want to create that conflict, but it's actually really good. And when I was trying it, I didn't know, you know, what I was even trying. And he's like, just try this. This is good. But I started reading some of the ingredients like lion's mane and cyto choline and I'm like, wait, I've heard things about these for focus and energy, which I've experienced with this, this. But you liked it also post surgery, can you just share more like why did you develop this and who's it for and where did you come up with these ingredients?

Yeah, I, I'm also, I am a little careful around it because it was this business model. But we really did it for all that, we hope, my partner and I, for all the right reasons. You know, the margins are low because we put all this into the best, best quality products for our patients and for ourselves. We take it. The idea as a nootropic is, you know, how can we help with cellular repair on a neurological level? How can we optimize neurologic healing for our patients in ways because we, and this is all honestly, it was my partner's idea for a decade ago. I just, you know, my wife and I helped kind of manifest it and make it into something real. But the idea is let's treat more than just the problem with a surgery. Let's be holistic and treat the body. And so the ingredients that we put in there is not only for energy, natural. There's no caffeines or anything like that, which some people suffer after surgery from real fatigue. But how to rev up cellular repair in the nerves like you had the post operative stretch and the pain, how to help that healing, take down the, the, the inflammatory process, use natural antioxidants, use cellular membrane. A lot of membrane repair in some of those ingredients is really important. So we created this, you know, proprietary blend that's listed. It's not like there's no trademark or anything like that. People can take their own. We just, just sourced high quality substances that we thought worked well together, did our research. A lot of this stuff has been researched individually, but not together. So we looked at all of that and said this is the best way that we have from a nootropic standpoint to optimize an aspect of neurologic health and healing. You did a lot of things in addition that I think were equally as, if not more important. It's a combination and a lot of them have synergistic effects.

So I noticed things like what, what got My attention on your, on this product there's not a lot of ingredients. It's pretty simple. But Lion's mane, I'd heard a lot about just kind of mushroom therapy, the non psychedelic mushroom therapy and so Lion's mane was one of them and cytokoline. But I also had saw the P.S. i had heard a lot. I'm not gonna pronounce it right. The foss. I can't pronounce that word. Yeah, I recently heard podcasts about that for focus. But then also like your B12 is methylated, which is great because like a quarter of people now say they have MTHFR gene issues.

Yeah. So. So the methylated one is important because a lot of the B12 people go, go to Costco and get you know, stuff. It's completely useless and it's not, it's not absorbed. The bioavailability is really low. So the methylated B12 and B6 is really important. Unless you're super deficient and you need an injection that you know the supplement does not replace that. But where the methylation is important. And also even something as simpler as magnesium, that's what required for neurologic function. The magnesium 3 and 8 is a specific type of magnesium that was studied at MIT with beautiful research to support its use.

So you, who is this actually for? Like did you make this for surgical recovery? Did you make this just for people and focus? Like who, who would benefit from this? Would people that are not doing surgery and in pain benefit from it? Like who, who do you think would should take?

Yeah, I mean we initially. So this is one of many products that we've been working on. This is our first major launch. It only started, we only soft launched it last December around Christmas time.

Okay.

Some of our patients sent it out just to please try it and it. We initially were designing this for post operative patients or even pre op optimization before surgery. We tell people, you know, eat clean, lots of leafy greens, go on walks. It's always hard. How do you walk and do these things if you're in pain? I mean it's really. So we, we created it initially for patients to have a holistic approach to healing. Not just in the operating room, but now. I mean I give it to my parents.

That's great.

There's a lot of things. And they didn't have surgery recently with us and or anyone they. It's designed for cognition, healthy neural. It's like I call it the multivitamin for the brain. It's a multivitamin for the Nerves.

Okay, so let me tell you guys my experience on this. So I, I'm definitely ADHD as Dr. Amanda's experience, where I'm not focused or hyper focused. It's like there's no in between. And I have dealt with this my whole life and I've never loved like ADHD medicines. There's different times in my life where I tried it. Like, like Adderall was always like way too crazy strong for me. What I have that I take sometimes as needed is a child's dose, like a child's dose of fast action Ritalin, which acts for like two hours. And even that can be like, I don't like, I just don't like taking anything that's stimulant based. But I will tell you, since I've taken this, I have not touched that at all. So. And this has helped me dial in and focus when I don't want to. So I. That's just like a real testimonial there for you on that. Because he didn't ask, he didn't even talk to about ADHD or any of that. He gave it to me for a different reason. And I've definitely noticed it helps me with that clarity and that focus and being able to, to kind of sit still. So there's something that it's doing there. I know that.

I'm glad.

I know that. What I do have a question about, though, it says on your. Even on the bag it says standard dose three, enhanced dose four. Like, how do you know what you're supposed to be taking? And can you get benefits from less of it? And do you have to do it consistently? Does it build up? Like, tell us a little about.

I mean, the problem with dosing on nootropics is that there's no way to test all of these things in the entire population. So the standard dose of three capsules was based on the mathematical calculation, looking at all the individual components and what the average person needs. And so we also want to be very careful because I think that it's important that anybody watching and listening to this knows even if it's a supplement, even if it's quote unquote natural, you can still do things that are harmful. You can reach toxic levels of vitamins. Right. And so the maximum dose was still well below those toxic thresholds in the standard population. So we just based this on normal standard deviation population curves based on the data that was available. Could, could you do get the same with less? The honest answer is oh no. Could you do better with even More than five maybe. But we picked the safest place to be be.

And I think people, I think we have to be so careful with the like everything is being marketed as a nootropic now and there's some scary stuff being marketed as nootropics. Like all of a sudden nicotine's made a huge comeback and I don't even want to get an argument with people about this but like all of a sudden nicotine's a nootropic and a kratom which is highly addictive is being talked about as a. So there's a lot of people saying that things are neutral. What makes something a nootropic?

Someone saying it's a nootropic. Right, that's, that's the scary thing is when nootropic is considered the, this smart. The, the online definition is like a smart drug designed to help neurological well being. That doesn't mean. What does that mean? So it's very, very, very, very scary. And I think the most important thing is to have, I mean you Max, these people that are, you know, you're out there talking about what you're doing, your experiences, your stories, going to sources that you trust. Your initial source was Dr. Cho Kim. It's a great source and you found me. And so I think it's, we need to keep that community really tight and honest and I think we have to have candid conversations about it because there are a lot of things out there that are scary and potentially harmful.

One thing I didn't ask about was long term recovery on a Fusion versus traditional old disc replacements versus what you do. Like I know from what you've shared with me you're pretty much, you're kind of limited like the first few weeks and you could do more. But at six weeks you pretty much said nothing is off limits. Explain nothing off limits like can you jump out of an airplane? What does that mean for people? People at 6 weeks versus if you had a Fusion?

Yeah, well, for you I have to always limit because I'm worried you are going to jump out of an airplane.

I'm not going to jump out of an airplane. I don't want to.

Thank you. So there is no question that the recovery with motion preservation is faster. The reason being is that if you're doing a fusion for whatever reason, but you truly need it to fuse. That spacer, that cage that you put in there is like, it's like railway tracks that are not complete. It's just a spacer. It's holding that position open in for the body to fuse, the body has to create the fusion. And fusion can take six to 12 months in those situations. So depending on your level of activity, you could really disrupt that spacer with an artificial disc. What we've seen is that the bony integration that is needed to the end plates because the middle doesn't need to fuse. We don't want it to fuse. Right. Only takes about six weeks. So I have golfers doing pretty aggressive swings and things like that. At six weeks, athletes not full blown, starting to train and practice with their teams. By three months, I'll let some of the contact sports athletes go back to work. But the early stuff is like what you were wanting to do a lot of the ab work and the exercises in the gym. I usually tell people around three to four weeks is a good time to start going back in cycling.

Low weight resistance or no weight resistant exercises until we get to that six week mark and we get a nice looking X ray where I see the position is in place, it's moving the way I want and so forth.

So at six weeks, if your X ray is good, you can do things like hang. Like I know you, you didn't want me to hang because that could like pull it apart or like no hanging abs or squats with weighted, that type of thing. That's after an X ray at six weeks.

Yes.

And then nothing's really off limits at three months. Like you could go ATVs. You could do what if you wanted to. You're gonna still have risk.

I have skiers. Yeah, that's.

But three months is that number where I would imagine you tell people they can go, they can actually push and actually go heavier weight, that type of thing.

Absolutely.

Three months. That's amazing. If people want a, to consult with you or to see if they are a candidate for this, what's the process where, how do they reach out to your office? What are they, what do they need?

Yeah, so I mean the best way is really to go through the office. Leslie, Alyssa, Diva. The girls in the office are amazing. Especially I mean almost 70, 80% of my patients like yourself are out of state. And so. And technology is amazing. So you know the email for, for Leslie in the front office is office at NSG the name of our practice, nsg-la.com you can also just go to nsg-la.com online to look. But and when, if you send her an email and just inquire, she's better than I am at getting like images uploaded to the server, getting everything organized and we do a zoom consult is.

Usually the first, which is how I started with you.

Yeah. And it's, for the most part, part, pretty reassuring. We can get a lot done. And the one thing I'll say is, you know, I truly respect that surgery and neurosurgery and spine surgery is scary.

Yeah.

I'm never gonna rush a consult. I'll spend 30 minutes, 45 minutes, an hour, hour and a half with patients on zoom because my goal is your goal. I mean, like I said, I'm busy. I'm very fortunate. I want you to have the best possible results. So I have to understand what you're going through more than just the anatomy and what you want to accomplish and what you want to achieve. So zoom and reaching out and letting me look at your images, looking at you, having you bend and do some things on the camera is a really good, harmless way of starting out. And I may say, you know what? I don't think surgery is the right path. Let's try this, try that. If you want to go see someone local, get a different opinion, that's okay. The other side of the coin is while I wholeheartedly respect how scary this is and how nerve wracking it is, I think some patients really go down the rabbit hole. And by the time they see me, they're on their 22nd opinion. And. And it gets. And I appreciate why that's happening. And I try to assuage concerns and do the best I can, but at the same time, there's an old joke. When you ask five spine surgeons how to treat a problem, you get six answers. So at some point, it gets so confusing. Second opinions, third opinions, great. But 30 opinions, it's like, at some point, point, that delay is actually potentially causing you harm.

Yeah, I didn't do any of that. I was like, well, I had spent eight years kind of knowing what I wanted, kind of waiting for the thing. And so the evidence to me was when I heard Max, and I. I mean, I don't know him well, but I knew him enough and trusted his opinion on that. And then having Dr. Kim and then so. And then my just feeling when I talked to you, and just so you all know, you don't have to go back and forth if you end up doing it to LA frequently. Like, I literally did the zoom content consult. It was on over zoom. He ordered me CAT scan and MRI here. I did that here in Phoenix. I flew in the day before my surgery. We planned to stay there. I think we were there five days or so. So. And then I could come back home. So you. It's not like you have to go back and forth to Los Angeles a million times. And also, side note, where. Where you stay.

Where.

At least where we stayed. It's great because you're. You're. He tells you to go walk, and you're like, I don't want to walk. But there's lots of surprises on the walk. Like an Erewhon. There's. It's a great walk talk. So there's lots. So I had motivation, everybody. I'm like, I'm gonna walk to Erewhon. That's great. So.

And I'll come to your hotel and make you get out of it.

Yeah.

So it was.

It was. It's a great, like, area to do it in. So if you're. If you're worried about that, Highly recommend. I'm even now. You know, Max texted me the other day, and he said, are you happy that you did it now? Yes, I'm absolutely happy I did it. I was never unhappy. I did it. I had two weeks in the beginning where I'd have these questions like, am I gonna be in pain? Like, that was. That was the question. But it still wasn't a regret because I understood anatomically what would happen if I didn't do the surgery. So it was more my living with this, or what's this new gonna be? And then I had my own little wonky things that probably would happen to nobody else. But of course, it happened to me. My husband's like, of course that happened to you. Where I had a reaction from the Celebrex, but whatever. That's. That's not normal.

It's okay. Another natalism. But it. But honestly, I know you've shared a lot online, which is amazing for education and people to learn and ask questions, but I don't think your trajectory and your recovery has been in any way bad. You've done great.

Yeah, I know. I look back now, I think it was great.

I mean, these patients used to stay in the hospital in bed for two weeks.

Yes. The biggest mistake ever that set me back was going and joining a Facebook group. So I quickly got out of that because you were right, what you said. You said people don't join Facebook groups to be rah rah and excited about their experience. They. And they join them to vent. So you're going to find the negative stuff. And I. That was. That was the wrong thing for me. There's plenty. There's amazing success stories. You even have some on your website. Of people that have had this very successfully. So stay focused on that. If you've been struggling with your pain and your what's the next best thing? And then my advice to myself eight years ago is I wish I had done this eight years ago. I wish I had known that it was a thing because I would have maybe still had the laser to get me initially out, but I would have then originally I would have started talking to you early, before I was so far compressed.

Yeah. And that would have made the recovery a little even faster. Yeah. Yeah. So that's. But it's okay. We don't think backwards, we'll think forwards.

So to anyone listening highly suggest if you've got spine issues to really consider, the motion preserving. Is that what it's actually called?

Motion preserving disc, artificial disc replacement, Motion preserving spine surgery? I mean, it's whatever, you know, the idea is that it's preserving motion in your spine while treating a problem.

Thank you. Okay, and everyone, I will in the show notes, I will put links to how to consult with his office. I'll put links to his supplement for Axon where you can get that. And I will also put a link to Max's show because that was the first episode that really got my attention on this. So you can listen to that if you want a second listen around this. Thanks everyone.

Thanks, Natalie.

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