Episode 104: A Holistic Approach to Joint Pain and Mobility with Dr. Joshua Schacter

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Dr. Rob Whitfield, the board certified plastic surgeon specializing in explant surgery. Breast implant illness is a topic that is not often talked enough about, especially in medical community, but is something that affects many women. In this podcast, I will be discussing the latest research, treatment options and personal stories of women who have undergone explant surgery in an effort to heal breast implant illness. In this podcast, we'll explore the symptoms of breast implant illness and delve into the latest surgical techniques for explantation and the recovery process. Whether you are currently experiencing breast implant illness or are considering explant surgery, this podcast is a valuable resource for anyone looking to take control of their health and wellness. So let's dive in.

Well, today I have on the show, Dr. Joshua Schachter. And so Josh and I met at a meeting last year in September, the Mindshare Summit, and we wanted to have him on. He's an orthopedic surgeon in Wichita Falls, but he has a very unique approach to his practice. He uses and integrates functional medicine practices, lifestyle, nutrition as components to get a better approach to taking care of patients. Not too dissimilar from what we do with our patients who are undergoing explant surgeries. So welcome to the show, Josh.

Thank you. Thank you, my brother, for having me on.

It's taken a little bit because you're an orthopedic surgeon. I'm plastered. And try to get us to schedule. So we're filming in Florida at a meeting because that is the best time we could find to get this done.

Ships passing in the night.

Yeah, this is perfect. It's early in the morning. It's a little hazy outside, but that's all fine. So when we met and first discussed this, I have a great interest in all things stem cell related, orthobiologic related. I was an associate professor of orthopedic surgery before I finished my academic career, before they, you know, shuttled me off. So I did plastics and ortho and I helped. I mean, I worked with orthopedic surgeons closely throughout the time I was in training, of course, and then in practice when I started, I worked with musculoskeletal oncologists. So I did all of the, predominantly their reconstruction and their, their skeletal reconstruction. Things are just unbelievable, the things they, they do for other patients.

It's amazing. It's, you know, there's some really cool stuff in orthopedics and plastics.

Yeah, the things that I saw frightening. So as we move, you know, through practices and transition to different you know, forms of, I guess, our practices.

Right.

So I predominantly do explants, not implants. I use a big functional medicine approach and detox approach with all of my patients. And so for the audience listening, how do you do that with your patients with, say, joint pain or problems that are musculoskeletal problems that we probably, as we all age, have?

Oh, yeah.

And I'm not immune to this every day. Got some ache and pain when I get out of bed.

Right. I mean, it just, it's so common, especially, especially in America, especially with our lifestyles, our busy lifestyles. It's. It's like we don't slow down until something stops us. Right. Like we, you know, it's very American. All of a sudden, all of a sudden, we just fall off a cliff with our joint pain. Joint pain is so multifactorial in orthopedics. One of the things that I've noticed through my career, and I've been doing this for 20 years, I've done thousands of surgeries. But we really focus just on the structure, Right. We're so focused on the structure that might be causing the pain that we really lose sight of what the bigger picture is, which is what are the contributing factors? Right.

That's where you're going to tell me, like, spine surgery doesn't work.

I've had spine surgery. It does work.

You know, spine surgery is the scariest of all the structural surgeries.

I totally agree.

You're talking about, but not saying spine surgeries. Wow, that's amazingly complicated from a structural standpoint.

Right, right. So if you have a nerve that's being pushed on by a structure, you know, if it makes sense that if you move that structure off the nerve, it's going to feel better. Right. So that's, that's the basis of spine surgery. I'm not a spine surgeon, so. But to me, you know, looking at, particularly with large joint, you know, you look at knee, hip, shoulder are my sort of specialties. And I've done adult reconstructive for years. We really are focused in on, well, that joint's arthritic. Let's replace that joint. But. And so through my career, I sort of saw this. You know, we're just focused on that joint. Are we focused on the general patient health? Do we want to reduce complications by helping patients with nutrition? You know, I had patients that would come to us, and in a traditional orthopedic practice, you're seeing 50 patients a day. My PA would see 30. We'd see 80 patients together. And so the line is, well, we need to do a joint replacement. Let's go ahead and lose some weight and be healthy. Hard stop. That's all of the information that we could give. And so as we go through this sort of spectrum, as you work through that, you know, you work with those patients, what I found through my career is that we're really, really focused, particularly in orthopedics, particularly in a practice where you might be an employed surgeon. You really start to focus more on getting a patient into an operation than getting that patient healthy and getting to the root cause of what might be more fact. There's more factors to that pain, right?

Do you feel like now more so than ever with a peptide, I'm sure we'll get sensory for same peptide, but with a peptide that now everybody understands what peptides are. With semaglutide, which is a zempic. And I'll just use that as, as an example. The, the mentality of what pill shot drug can I take to lose weight, right? And those all work.

They do. They work great.

And you see, I've thought about this. So my. Philosophically, you have to follow unfortunately, the money. So if those drug companies knew that they would alter the use of diabetes medications, they would decrease the amount of fast food being eaten, they would lose so much weight that they probably avoid joint replacements, Would they have done what they did because they're so altruistic in nature?

I don't feel like pharmaceutical companies are altruistic in nature. I think that's an interesting point. So one of the coolest things about our approach at the Pinnacle method is that we are. Our goal is to prevent people from needing these major orthopedics all. So what if you could come and what if you could have some lifestyle management, apply functional medicine principles so that we can reduce inflammation, get the gut healthy. Right. Optimize our nutrition, and then treat the joint locally with some modalities that we can really start to prevent major orthopedic surgery or put it off for years and years. But drug companies, it's not in the best interest of pharmaceutical companies to necessarily prevent surgery and hospitalization, right? Don't feel like drug companies have our best interest at heart, for sure. And we see that, doctors see it, patients see it. So the question is, would a drug company have put out this drug if they thought they could reduce surgery and improve health? And I really, personally, I don't believe that the goal of any pharmaceutical company is to improve population health. I feel like the purpose of these drug companies you gotta make money. Yeah, they make money. The shareholder is the purpose. Right. So even though semiglutide is extremely effective at losing weight and we're finding all these amazing things, right, it reduces Alzheimer's, it reduces joint pain, that's not just because it reduces overall weight, it reduces inflammatory changes due to high glucose. Right. And insulin.

Well, if you don't and are not interested in eating fast food or binging on things, it's amazing what will happen to your body.

That's. Yeah, yeah. So if we get this toxic, if you will, out of population. But so there's so many benefits to these drugs that were unforeseen by drug companies. I think that, you know, they're just sort of rolling with it, but at the end of the day they're going to try and they're coming up with more and more options and ways to have people use medications rather than.

I'm so cynical because like I thought for sure, because I'm sure in your career, as you started to see younger and younger patients need joints because they were so overweight and they had worn out a joint, it's an epidemic that you're like whole, I thought for sure before the release of Those peptides, the GL1P agonist that you're going to be taking care of like some 20 somethings with worn out joints.

Youngest person I've ever done is 27, which is absolute.

Everybody listening. That is absolutely ridiculous.

It's bananas. Now, in these cases, in very young joint replacement, there are usually underlying problems, pathologies. Right. We have a, you know, a hip malformation that can cause us to the most concerning trend that I see in orthopedics, other than the fact that we're doing about over 30% of joint replacements done in the United States. And this is a study that was done in 2018. So it's probably more now, right. Quite a bit more are done what we would call prematurely. So we're doing joint replacements in younger patients who are not as healthy because the American lifestyle has impacted all of our health. Right, right. Who are eating inflammatory foods, who are taking drugs that are not metabolically optimal, who are living a lifestyle that's not metabolically optim, and they're having joint replacements at a much younger age. So the average age has shifted in the last 15 years from in the 60s to in the low 50s and even into the 40s. And so what's the consequence of that? Not only do we have an increased problem with those patients needing joint replacement revisions, which are a much More complicated procedure, which have a much poorer outcome, but they also have the metabolic consequences of having major surgeries.

Because go back to what you said. So, like, for everybody listening, the first time to operate on someone is the best time. Every time thereafter is always more complex for a host of reasons. And typically would start with. Each time you operate, you reduce blood flow to an area, so its ability to heal is always compromised each and every.

Yeah, we damage the small vessels. Right. So you get scar tissue. That scar tissue isn't just painful to you, isn't just stiff, but it also is less healthy. Right. It doesn't heal as well, it doesn't move as well, doesn't metabolize as well. So it's a major impact. And so when we have major. And orthopedic surgeries, whether we're doing them minimally invasive, when we have all these techniques, robots, you know, robotic surgeries, computer assisted surgeries, those can help with your outcome, but they're not helping with the local soft tissues.

Yeah, it's comical because for 19 years all I did was oncologic reconstruction. So we were joking a little bit earlier is the people I worked with who did musculoskeletal oncology, which is basically for sarcoma care. Tumors of bone, muscle, of course, fat. Just an amazing array of things that you would see the most aggressive reconstructive surgery from a skeletal standpoint for the orthopedic surgeons. And then some of the strangest things I ever got.

Yeah. Flap reconstructions and yeah.

Asked to reconstruct from soft tissue perspective. But the time, if there was a recurrence and revision of any of those, just like, yeah, there's a recurrence of revision. Anything I do, there's always more of a increase on the complication rate. No matter who's doing it. Makes no difference. No matter who's doing it. Because the. For anybody, you know, listening, like, if he's doing an implant revision or if I'm doing an explant surgery, if we're taking all the material out, that's probably the best case scenario. But for a skeletal reconstruction, he can't do that. You have to have that material in place or your knee doesn't work or hip doesn't work or your shoulder doesn't work for explants, when I take everything out, I'm removing all the scar tissue, which relieves what can be a pretty significant biofilm burden, depending on the patient. And there are tons of reports in the literature over time that when I was writing my paper about Bacterial contamination on explant specimens. The species of bacteria called Ketobacterium acnes, which used to be called propion bacteria that was shown in shoulder implants.

Yes. Problem, because major problem.

That bacteria is in a high concentration on the skin of the shoulder, the chest, the neck and the face. So when people.

Right in the armpit.

So would people tell me or criticize anything about, you know, the papers or like we are like making things up. I'm like, well, this has been in the scientific literature in the orthopedic space for an incredibly long time.

Yeah, it's one of the worst pathogens that we can have in a shoulder replacement and it's also one of the.

Most common because of where.

Because of where it is, where it is, the location, location.

I try to explain this and it's frustrating. And this bacteria readily produces biofilm, which makes it more complicated for your body's immune system to clear.

And the challenge with orthopedics when we do major revision surgeries is we're taking an implant out that. And the most common reason for revision is infection. Right. So you take an implant out with an organism that already had a biofilm and then you. There's a lot of techniques, right. We could do multiple stage revisions and put antibiotics, spacers and these things. But then we go and put it back in. And then the most common complication of that is infection.

So I want to go back for a second because there was a term that I know you'll enjoy, it was always called aseptic loosening.

Yes.

I love that. That is code for biofilm.

That's. Well, you know, the argument is you see it in your college, right. I read your paper. I love it. In the cervical heart. Yeah. We look at stuff and we go, oh, that doesn't exist. It's not an infection. Now we're allergic to a metal. Now we have a metal allergy. Right. It's an aseptic glucing. I think that bacterial burden, even if it's not grossly infected, plays a role in a lot of these revisions. And I think the take home is not necessarily that revision surgeries are complicated or that they're dangerous or they're causing a lot of societal burden and cost to the system. But that we're having to do them because we're doing so many surgeries so early now. Right. We're doing all these interventions on people that don't necessarily right now need it.

What's the life cycle of the joint?

So, and this is really interesting because we have A lot of technology now, right? We got computers and robots and special stuff and programs and protocols and joint centers of excellence. And our longevity in joint replacements is not much more than it was in the 80s. So it's 10 to 15 years. If you get 25 out of a really good joint replacement, you're going to be super lucky. But they don't last forever. And if you're getting a joint replacement in your late 40s, then there's a good chance that you're going to need a revision and that that revision is going to have a suboptimal outcome.

So I'm going to risk pants here because I know if I went to a regular orthopedic surgeon each, you know, if I got a bunch of opinions, they'd want to replace my knees.

They're like, opinions are like assholes, right?

Because. Well, because I've had. I've had five knee surgeries. I've had each one micro fractured, which, you know, yeah, absolutely, very well. And started having more and more pain. And I was pushing like maybe 185 for those of you listening pounds and for, you know, my, my folks in Europe, 80 kilos plus. And so I like, well, I got a couple choices. I can go see Dr. Josh or I can just get my lazy self up and start, you know, working out and go in the morning. And man, if you lose five pounds, I can see the change in someone's face and neck. And I don't know, you know, your parame for, like, in your mind, you probably have a tell about whether it's 10 or 15 or whatever. But it does affect how your joints feel to take the stress of the weight off of those. So I'm much better in terms of how I feel when I stand all day and operate. And I do a lot of recovery things now, as we've talked about. But for those people who don't. So your goal is to get them tuned up so they don't need potentially joint surgery. So you're going to do. I'm all right, I'm your patient. I'm 55. My knees are achy all the time. And I'm. Let's just say I don't know that I should not be eating gluten. What do you do for me?

So historically in orthopedics, we say, well, everybody's too heavy. We need to lose some weight.

Right, Right.

So weight loss is going to be critically important. We know that for every 10 pounds that we lose in an average American who would be, you know, 180 to 220 pounds. Every 10 pounds that we lose when we're in that over 30, 35 BMI that your knee scores will improve by several points. Right.

What's the knee score?

So there's a who's and a coup. There's like, there's functional scores that we have using orthopedics and there's scores that we use both before and after joint replacement. So it combines pain, function, that sort of thing. Yeah. So you're going to improve just simply by weight loss. And it can be as little as 5% of your, you know, your body weight. But that's a very. But that. And that's what most orthopedic surgeons will look at. So. Okay, well, I need you to lose weight and I need you to generally be okay and healthy. But other than that, I need to get you into the operating room because I got to do a bunch of surgeries because insurance pays me less and less for everything that I do. You know, that sort of. But when we look at you as a whole organism, when we look at you, when we take a functional medicine approach, when we use our pinnacle method, the first thing that we want to really do is assess your metabolic state.

Okay.

Right. So we want to get down into why you have knee pain. There's a mechanical problem. Right. You have arthritis. But why would some people with moderate arthritis have very severe pain? And why would people with more end stage arthritis in some cases not have much pain at all? What's the underlying problem there? Right. Like is it, is it really that the joint's not functioning well, or is it that the metabolism is contributing so much to your joint pain?

Because you said structurally, unless it's compressing a nerve, there shouldn't necessarily be a ton of pain.

We don't have to have a whole lot of pain in a nerve arthritic joint. You know, the cartilage surfaces don't have any nerves at all, Right. It's the bony surfaces, it's the lining of the joint that really has the nerves. So if those bony surfaces are inflamed and irritated and over compressed, then that can cause pain. If the lining of the joint is really irritated and inflamed, then that can cause pain. And we in an orthopedics, in pure traditional orthopedics, we look at it as, oh, it's a structural problem, right. It's this problem that we have in the joint itself. And they don't really take into account the fact that that joint is connected. The knee bone is not just connected to the leg bone. It's also connected to the heart and the liver and the gut. And if we just, in simple terms, if we look at the overall systemic inflammation, then we can make major changes in how your joint feels.

So how are you going about measuring inflammation? Like, obviously you have historical things they will tell you maybe they don't methylate well, so they have prolonged problems with recovery after if they could exercise.

Yeah.

Are you using specific biomarkers that you prefer?

We do well, we use inflammatory markers. You use crp, sed rate, there's, you know, all those, the basic inflammatory markers. But we also do biomarkers. In our method, we do about 165 different biomarkers. So we look at methylation, we look at overall metabolic health and wellness, and then we also look at the gut. So the gut's so critical in what you do. Right. It's a huge problem.

How do you assess it?

So we do GI mapping.

Okay.

And we do food sensitivity testing. And then we're constantly sort of expanding as functional medicine. And as the approach becomes more sophisticated to the gut, we're expanding our method as well. So we're learning, you know, how important the gut is in how your joints feel. I mean, how many we have as a part of our approach before we do an intervention, whether it's a surgery or an orthobiologic intervention. And full disclosure, I don't hate surgery. I think it's amazing. I just hate the way we do it in this country. Right. Like getting people into high volume practices where all our goal is just to do a joint replacement. You know, you had a steroid injection that didn't give you the relief that you wanted. We did two physical therapy visits and then we said, oh, you failed physical therapy because that's what the insurance company requires. And then we go to surgery. That's not the way we want to do it at all. But.

But when we do, there are other alternatives.

There are so many alternatives. But. But when we just really look at, at your overall inflammatory rate, it makes a huge difference. One of the biggest movers in our practice is an anti inflammatory diet. We have a health coach, we have health coaches that when we start and when we start the journey with a patient, we put them on an anti inflammatory diet. And oftentimes in two weeks, the patient's joint pain will be reduced. Even in severe, like end stage arthritis with deformities, joint pain will be reduced by 20%.

Now you're in Wichita Falls, I imagine you have some people that like their high fructose corn syrup. So is that part of your. You cut that out of the diet?

Yeah, so we remove, we've got to get that gone, you know, not just high fructose corn syrup, it's an evil one. But processed foods in general. Oh, inflammatory. If you don't believe in leaky gut, that's okay, but leaky gut believes in you. So that's the problem. Right. So, you know, your gut is about 70% of your immune system. And if we don't take that into account with joint care, we're missing the boat. We're missing a lot of things.

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Yeah, I mean, I always joked about the orthopedic surgeons that I trained with and worked with because there were some of the. I knew they were incredibly bright. They were just a little bit lazy at times. I mean, they're just super bright people. Right. What Dr. Schachter is talking about, obviously if you think of how your gut works with your brain and then integrates with everything else in your body, it's incredibly important that everything you put in your body and on your skin and what you breathe and what you drink goes into making how you feel experience things better or worse instances. If I do all those changes over a three to six month period, but I still have like lingering pain. Tell us kind of what you would do, you know, as a. More of an intervention.

Yeah.

With one of your best kind of orthobiologic preps.

So our, you know, in our practice, most people come and they want to have. Probably need to have something done. The problem with a joint is it's sort of this environmental. It's connected to the whole body, but it is an environment that's sort of hard change sometimes because the closed, it's a closed space. And when you have a compromised joint. So you have some arthritis. Right. The arthritis itself can cause you minimal discomfort. But when the joint becomes inflamed and irritated, the lining of that joint becomes really inflamed and irritated. And it can be very difficult to lessen that inflammation. So the synovium, the synovium, the lining of the joint, the synovial lining. Well, what we find is that we can do lifestyle management, we can do gut, we can do functional medicine, we can add supplementation, we can do things like GLP1s can make a huge difference. Losartan, which is a. Anti like a blood pressure medication, can actually help with joint pain. There's a lot of strategies that we can use, but if we don't do something directly to the joint, it takes a really long time for wellness interventions to get people where they want to be as far as their activity levels. And our patients that come to see us, they don't want surgery, they want to avoid that, but they also are very active. So they want to play golf, they want to pick their grandkids up, they want to play soccer, they want to ref those football games, and they want to have something done. So our goals really are to get those patients turned around pretty quickly. And a direct joint intervention earlier than three to six months often makes a lot of sense. So what we do is we clean up the metabolism, we do the anti inflammatory diet, we start with supplementation, we have health coaching, we do mobility work, but we also will do an intervention. So we'll start with an orthobiologics program and that typically will start with prp. Platelet rich plasma can make a huge difference in the, and how much inflammation we have in the joint. The platelet is a, it's pretty magical little fragment of a cell. And when we do a prp, we take your blood, we spin it in a centrifuge to concentrate those platelets very highly. Typically what we want to get is about 10 times or 10x what's in your normal volume of blood.

Right.

And we inject that into the joint, but we don't just do the joint itself. And this is, I think one of the pitfalls is that, you know, a lot of orthopedic surgeons in particular that are trying to do regen, they just put the stuff in the joint, we need to put it around the joint. So we do what's called a segmental approach. We treat the tissues around the joint and in the joint with prp.

Okay.

And we can actually use different formulations. So we can use PRP that's more specific to treat soft tissues. And we can use PRP that's better for Inside the joint. There's different ways we can do that. The cool thing about PRP is not only is it a massive anti inflammatory, it also works pretty fast. So if you do a steroid injection, which is terrible shit, don't do steroid injections into joints and we can talk about that. But when we do prp, not only does it act inside the joint, but it also has a bit of a systemic effect. So we get an anti inflammatory effect system wide and very powerful locally. But another cool thing about PRP is it sort of preps the joint for stem cell and stem cells, or mesenchymal stem cells is my preference to use as an orthopedic surgeon. That's rocket fuel for your joint. So oftentimes what we'll do is we'll do PRP first and then we'll come back in and we'll do what's called bone marrow aspirate conc, where we take actually some of your bone marrow, which the best place to get that is the pelvis. We do a minor procedure that's relatively painless and we take and concentrate those cells and then treat the joint with that. Typically it's within a couple of weeks to about a month after the first injection and that joint has been prepped and sort of.

So that's your sequence?

Yeah, that's our sequence. And then we'll even come in and lay on another PRP injection if we need to. And then we have some treatments that actually augment and increase the amount of materials that those cells release when we put them in. For us, that's laser therapies. It's an MLS M6 laser that we use. But shockwave therapies are effective here as well. There's several different therapies and what we find is that when we're doing the metabolic approach with orthobiologics together, it makes a huge difference in how patients do.

Can you. Because I get asked about the shockwave approach for different therapeutics and because that's not ever really been part of what we would typ do. Can you explain like how that would work in your practice? Why is that a good therapeutic option?

Shockwave itself?

Yeah.

Shockwave is a technology where basically you take high frequency sound and you inject it into the tissues so that it, at a microscopic level is sort of shaking those tissues and it causes them, it stimulates them, it can break up scar tissue. And by stimulating the small vessels and small, the microscopic portions of those tissues and collagen, it can sort of break up and Help collagen sort of reform into a more organized fashion.

But it's more frequency.

Yeah, it's frequency.

Okay, so it's not like a theragun.

No, a theragun would be where we're actually doing a mechanical. Yeah, theragun's hitting you. This is high frequency sound. And I think it's a fascinating technology. It's something that.

So it's a. It's an application of frequency therapy, of sound. Frequency therapy. Okay. As I have gotten questions in the comments about that with the other shows that I really didn't have, that's not my background, honestly. So they do this and whether you layer on other approaches or aspirate and then you're looking for the hue score improvement. So obviously you have a baseline make their modifications in lifestyle, diet, exercise, prioritizing, sleep for everybody listening very much.

And mindfulness. Don't forget mindfulness. The mind is so powerful, especially when we have.

Yeah, you know, I was gonna say, like at your place. So when we have. Because I do obviously a lot of explant surgery, we're immediately trying to get people in a parasympathetic state or a recovery state, if we want to just basically say that as quickly as possible. So we have all sorts of modalities that because we as surgeons spike cortisol with surgery, we have people who are in high states of activation. And so when they come in, we use hyperbaric in our office and we have these lymphatic massage devices from New Zealand that actually warm the. The trunk area and really help get people into a more parasympathetic state. But obviously sleep is incredibly important. And then I try to get people to perform what's called resonance breathing or like belly breathing. So you're calming yourself and increasing your heart rate variability just to promote recovery.

Right, right. Breath work. And so my wife and I, over the last probably 10 years with our own health journeys, have found our way to sort of meditation and Eastern tantra and breath work and these things. And we can make it as simple and scientific and American as vagal breathing. Right. Or box breathing. But those breathing techniques can make a huge difference for pain response, as you know. Yeah.

What I try to get people to do is not focus so much on the 19,000 types of breathing, but like just breathe in through your nose to account to four and out, remount or count to six so that you're expanding your diaphragm. So you bring your belly out, not suck it in.

Yeah. Prolonged exhale.

You want to. And that will Just for lack of a better, not more detailed description, help you in terms of recover.

It's all, you know. And when we do these, I think when we can approach joint care using all of these tools, what we find is that very few people actually need that major surgery. Right. Then there's always going to be a group of people that are patients that come in who are going to need that joint replacement. And there's nothing wrong with surgical intervention when it's appropriate. But when we're doing almost 40% of our joint replacements in this country are being done prematurely for moderate arthritis or these types of problems, that you can make an intervention and prevent those types of people from having to have that surgery for years. And the literature, especially with bone marrow aspirate, some of these studies are preventing people from requiring joint replacement for six to 10 years with a single injection of bone marrow aspirate. So now if we can optimize you, if we can get you to think more critically about your health and make some health decisions using anti aging principles and the idea of longevity and functional medicine principles where we're getting to the root cause of your pain, then you might never need that joint replacement.

That's my goal. So let's do this. So currently you have to drive, fly, you know, use your transportation to see Dr. Schecter in Wichita Falls. So I want him to tell you exactly where to contact him and how to follow him.

Yeah. So you can follow us on Instagram. Pinnacle Integrative Orthopedics. Pinnacle Integrative Orthopedics and sports medicine is our, you know, full practice. Name our website, www.pinnacleortho. wf.com. Give us a call. 940-285-5007. I'm on TikTok. Dr. Joshua Schachter. For now. For now. For now. That's right. But we don't know for how long. We're on blue sky. We're on Facebook. Yeah. Come see us. Currently, we have people that travel from. We have people that travel as far as California and the east coast to see us. Wichita Falls is an interesting place to travel to. You can fly into Dallas. You can fly into Oklahoma City. We're about two hours away from each. Get a audiobook. I've got some recommendations.

Listen to the gene. Right now, it's driving me crazy. It's reminded me of medical school and my biology degree. All right, well, I appreciate you coming on. I look forward to, you know, watching your practice grow and learning more about how you can help people avoid joint replacement.

Thank you, brother.

All right.

Appreciate you.

Thanks for joining me today. I hope you found the information to stories shared on this podcast helpful and informative. Remember, taking control of your health and wellness is key to recovery from breast implant illness. If you're looking for additional resources and support, be sure to visit our online store, Dr. Rob's Solutions at drrobsolutions.myshopify.com you'll find a wide range of wellness products and supplements to support your journey to recovery. From specially formulated detox supplements to personalized skincare products, we have everything you need to aid your recovery. Visit Dr. Rob's Solutions today at DrRobs solutions.myshopify.com Thank you for listening and we'll be back with another episode soon. Remember, you're not alone in this journey, and together we can overcome breast implant illness. Take care.