Latest / Come Together with Ephraim Herschmann / Health Series 4: Tristan Steinberger / Gables Pain Clinic

Transcript

Health Series 4: Tristan Steinberger / Gables Pain Clinic · Come Together with Ephraim Herschmann

0:01
Welcome to another episode of Come Together
0:15
and we're rolling Doctor Steinberger, how we doing?
0:17
Welcome. Welcome to having me, of course.
0:20
And of course, so you know, I usually tell people to tell me
0:23
about themselves, but I'm actually, I was really excited
0:26
when I came. So you reached out to me
0:28
originally about a ultrasound machine.
0:31
And then I was like, hey, man, Well, I said I went on your
0:33
website to just check if you were legit, especially to using
0:37
Machineo. And I was like, well, is this
0:39
guy a real guy? And I saw that you were a board
0:43
certified anesthesiologist and that you, but your practice is
0:48
generally in kind of health related chronic, chronic health
0:53
and recovery. Yeah.
0:56
So I'm really excited to hear about your trip and, and to
0:59
learn about the, the, you know, the, the stuff that you
1:02
practice, the medicine that you practice.
1:04
Yeah, well, yes, on my board certified anesthesiologist.
1:07
And then I did a one year pain fellowship and chronic pain
1:13
afterwards. And so I'm a chronic pain
1:15
specialist. So I do run a a pain clinic in
1:18
South Florida. I know that can bring up some
1:20
bad connotations in South Florida, but it is a very
1:29
specialty. Back pain is probably second
1:32
most common medical issue. And so it's a very common issue,
1:37
hard to treat, but yeah, that's what I do.
1:39
So why? Why do you say it has a negative
1:41
connotation in South Florida? Especially in South Florida,
1:44
there's a lot of Medicare, Medicaid fraud, a lot of opioids
1:49
that are used not responsibly. That really all started in Ohio.
1:55
But South Florida's kind of just exacerbated the issue.
1:58
There's a lot of, they're called pill mills.
2:00
Patients come in with pain and they just give them scripts of
2:04
Percocets or Dilaudid and doctors go to jail for life for
2:09
this stuff. And but it's very common.
2:11
It's easy money and but ultimately it doesn't help the
2:14
patient. I had a friend of mine that was
2:18
on the podcast the other week and the way I met him was he
2:22
was, he was a big advocate for ibogaine and he said, and he
2:26
told me that he, he told me that he played a lot of golf.
2:30
I think he tore, he tore his ACL or meniscus or something.
2:34
And, and he went to the doctor and the doctor was busy for the
2:38
next month or so. So until then he just prescribed
2:40
him painkillers and then, you know, so he was, he took him for
2:44
a month and then he went, you know, then he went in for the,
2:47
you know, got got the surgery, whatever he did.
2:49
And then he got another couple of weeks of painkillers and then
2:51
he started coming back. He's like, I have these
2:52
withdrawal symptoms. And he's like, yeah, you're a
2:55
drug addict. And he's like, I'm a what?
2:57
He's like, yeah, you're an opioid addict.
2:59
I'm sorry you got to go to rehab.
3:00
And he's like, what the heck is that about?
3:03
Well, I even remember this in medical school.
3:05
They which is true. They told us that one out of
3:08
every six patients that takes opioids for more than I believe
3:13
it was two weeks, just two weeks, one out of six will
3:16
become addicted. They're very powerful.
3:19
I, I do not prescribe long term opioids, strong opioids, like
3:25
Perkins said. I will do them for a short
3:27
course, like 10 days to get over a hump.
3:30
But in terms of chronic pain management, they've been shown
3:33
over and over again that they do not help pain, make pain worse.
3:36
They wind up the nerves. So you just get more and more
3:39
pain. They weaken your immune system.
3:41
They can actually cause some osteopenia, weakening of the
3:44
bones. So they're really good long
3:46
term, yeah. Wow, wow.
3:48
So so let's dive into a little bit.
3:50
So so how so you So anesthesia is a very prestigious, you know,
3:56
fields of medicine. I say, yeah, we kind of like the
4:00
referees. We had to be quiet.
4:02
If if we do our job well, we just nothing happens and you
4:06
don't hear us. Yeah, that's right.
4:09
And then and why'd you just, and I'm sure I mean to specialize,
4:13
how long did it take to how much, how much of Med school did
4:15
it take to? So I kind of had, I was
4:18
interested in research during Med school, so I took an extra
4:21
year. And what actually brought me to
4:23
pain is orthobiologic regenerative medicine.
4:26
But the whole training itself I was in school with in training
4:30
for a total of 15 years. Holy cow.
4:33
I did, yeah. I did 5.
4:34
I did my MBA before Med school. I did five years in Med school
4:38
and interneer residency fellowship patrol total were 5 S
4:43
15 total. Why I chose anesthesia,
4:46
Honestly, I didn't know what I wanted to do in Med school and I
4:49
did not match because I wanted to do ERI did ER last minute.
4:53
I changed cuz I just wow, didn't do ERI was in Atlanta and and
4:58
they're a huge ER that prison cells in the ER just is too
5:02
much. So I changed last minute.
5:04
I didn't match. I I just called up a program in
5:09
Las Vegas and they had just opened up and they said, yeah,
5:14
we're still looking for people. This the day after it was
5:16
probably the most stress I've ever felt.
5:18
I didn't match. Imagine five years in Med
5:20
school. We didn't get a job.
5:21
So but I called him up cold, called him interviewed next day.
5:25
He sent me the contract. I ended up in Las Vegas for
5:28
residency and they just so happened to open up an
5:31
anesthesia residency. In Med school.
5:33
You don't get much experience doing anesthesia.
5:36
It's not a sexy profession like plastics or dermatology or
5:39
ortho. So it's not a required rotation.
5:42
I did it and I really like to the pharmacology, the Physiology
5:46
and it's very procedural. So I liked it and it was an easy
5:49
transition and I just, I stayed in Vegas and Vegas is why I'm in
5:54
Miami now. So I guess it all kind of worked
5:58
out. Where are you from originally?
6:02
I was, I did my school in Kansas, but I've kind of lived
6:07
all over. My parents were in medicine.
6:10
So I was born in Michigan. I lived in New Orleans for a
6:12
little bit. Wow.
6:14
And yeah, I ended up in Kansas for a good amount of.
6:18
Years. And how'd you like Kansas?
6:21
Kansas is quiet. Is it quiet now?
6:24
I was ready to get out. It's if you want to raise a
6:25
family. It's a good place.
6:27
Now my family's in Charleston, SC Cool.
6:30
Which is more a little closer? Yeah.
6:32
Yeah, Yeah. Definitely more vibrant for
6:34
sure, but OK. And so you started with an MBA.
6:38
Why was that So? What was it the concentration
6:43
in? I actually just did general.
6:45
I didn't do any finance or healthcare.
6:48
I typed in general. I chose it because in undergrad
6:53
I was a biochemistry major and I had finished biochem, I had
7:00
finished my whole college and I felt so sheltered and one sided.
7:04
I didn't know anything about business, my interpersonal, my
7:07
presentation skills, communication.
7:09
I didn't know how the world worked, worked in terms of
7:11
assets, liabilities and so I knew I needed a year off One, I
7:16
was very burnt out and I wanted to learn more about business and
7:19
just working on the software communication skills.
7:22
So I did that for a year and that was what my was my driving
7:26
impetus. Did you would you find that it
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was valuable? Did you find that the MBA was
7:31
worthwhile? 100% you can't quantify it on
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paper, but in terms of my development, I think was very
7:37
helpful. I really pushed myself.
7:38
I joined a Toastmasters presentation group.
7:41
I started taking salsa classes. I started doing a lot of
7:45
different stuff just to like volunteering opportunities.
7:49
So I just work on my really people skills because I just
7:53
felt so I was around science people for four years and I felt
7:57
so not developed in that regard. Wow, wow.
8:02
It's cool of you to notice that, by the way.
8:03
And it's cool of you to try to, to take that risk and try that
8:06
out, you know, because it's, it's something that's really
8:09
daunting to a lot of people, you know, that like, oh, I guess,
8:12
you know, that's a whole part of my life that I'm not good at.
8:14
Well, I guess I'll just avoid it, you know, it stinks for me,
8:16
you know? Yeah, it's good to do something
8:17
about it. Yeah, I, I appreciate it.
8:20
So yeah, it was useful 100%. I would.
8:24
I think it's getting out your comfort zone is good in general.
8:27
Yeah, I, it's funny that you say that about on paper, how it
8:30
wasn't, as you know, that it's more valuable than experience
8:32
than paper, because I felt the same thing.
8:34
I got a creative writing and literature degree, which, yeah,
8:37
you know, obviously on paper is not going to do very much for
8:40
you. But I think that a lot of the
8:43
skills that I just developed as a as a human being, you know,
8:46
came from, came from that. Because, you know, one of my
8:50
teachers, the first teacher that I loved that like really got me
8:54
into English, told me a great writer, a great create
8:58
storyteller, loves at least 50 things more than writing.
9:03
Because you need something to write about.
9:04
You need to have like passions in life.
9:05
You need to have things that like light a fire under you,
9:07
that like make you want to capture that.
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And he's like, if you guys don't do anything with your life
9:12
except for just right then like, you know, what kind of writer
9:15
are you going to be? So you have to love it.
9:16
You have to prioritize so many things.
9:18
And writing just has to be consistent.
9:19
Exactly. That makes me think of the
9:21
author of Old Man in the Sea. I can't believe I can't remember
9:23
his name, but he lived. He must have lived the most
9:28
adventures exciting life and you just wrote about it.
9:30
I wish I. Yeah, the Old Man of the Sea.
9:33
I'll look it up after. I could even post it in the show
9:35
notes, captions. I like to, whenever we talk
9:37
about particular books or topics or ideas that I could like share
9:40
that people could reference, I like to post that.
9:42
So we'll find that after. That's awesome.
9:44
So, So what was Med school like? Would you?
9:46
Would you? Would you, would you?
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What was it? What was your experience?
9:49
Where were you? Med school, I was in the at the
9:52
University of Kansas. Yeah, it was.
9:57
It was difficult. I I, I did have difficulty with
10:03
medical school. Just my mind.
10:07
Schedule with the material, with the tests, with what?
10:10
My mind works. I was, it was really the
10:14
schedule's fine, the long hours are fine.
10:16
It was just, it's all, it's pretty much root memorization.
10:20
As a biochemistry major, I'm more mathematical and I like to
10:23
synthesize and analyze problems. So biochemistry, I was doing
10:28
physical chemistry, physics and, and undergraduate and that was
10:32
much as you synthesize information Med school, you just
10:35
regurgitate environment information.
10:36
You must hold a lot of information at once and then put
10:39
it out. And so just a different style of
10:42
learning, which is less critical, but it's, it's how
10:47
magical it is. So I just found it difficult.
10:50
I, I got through obviously, but it was tough and the clinicals
10:54
were very difficult. You are working 12 hours a day,
10:58
you come home and you study for your shelf exams every month.
11:02
And so you're pretty much effectively working 16 hours a
11:06
day. I just, I worked out.
11:07
I would still have some time. I do one hour a day.
11:11
I would do salsa dancing or something for that one hour and
11:15
I'd work out. Besides that it was, it's
11:20
physically, physically exhausting, but emotionally and
11:23
mentally exhausting. Always being criticized, always
11:27
being the bottom of the totem pole is is tough.
11:31
Do you do you think that that's there's a reason for that and do
11:36
you think it's the most effective way to kind of train
11:39
and also how much of information that you that you were forces
11:42
off to memorize do you retain? I do find that learning useful.
11:51
I do find that the information we used, that we were taught in
11:54
Med school is useful. But I can't say that it needs to
12:00
necessarily be 4 years. The intensity of it, there's so
12:05
much information that you need. You could only touch a surface
12:10
on some of it. I do think it is necessary, but
12:18
I think the IT could be changed. It could be changed how you
12:24
approach it. Having said that, the issue if
12:29
you make it easier, I think it's just going to attract more
12:32
people who aren't necessarily ready for the commitment.
12:36
So I think the good thing about it being rigorous and difficult
12:41
to get in is it we doubt people who are not committed to the
12:44
path. It's a long path and I get it.
12:47
If you're not in Med school, you'd be working somewhere else.
12:49
But it's still, it's different when everyday you're constantly
12:54
you're made to perform and you must perform above a certain
12:57
level or you're, you're kicked out.
12:59
So you must perform at a high level for pretty much all of
13:02
residency and Med school or else you are let go.
13:06
So I I think it's, it's a good and bad.
13:12
Yeah, yeah, yeah. That's the that's the most
13:14
compelling argument that I've heard is that it really weeds
13:17
out a lot of people. I think that the biggest
13:21
challenge that we're going to have going forward is that is,
13:25
is figuring out how to create a new Med school system with AI,
13:30
you know, and, and, and to figure like, you know, part of
13:34
the value, I was talking to a friend about this the other day.
13:36
Part of the value that people used to place in education is
13:39
how much information you can retain that you have disposable
13:42
at your fingertips, you know, and that's part of what the
13:44
value is that you have over everyone else.
13:46
So that you have all this information that you spent next
13:48
amount of time and next amount of hours accumulating and no one
13:51
else really has. And that like, even if you read
13:54
it somewhere, is it peer reviewed?
13:55
How's that, you know, how, how, how, how, how, how legit is it?
13:58
There's a lot of garbage out there, you know, how do you
14:00
figure out how to, you know, sort it through?
14:01
And like, you really do need a professional to be able to, you
14:05
know, to do that. And AI kind of just like mixes
14:08
the whole thing up in the sense that like the amount of time it
14:13
takes to get the meta information, you know, that
14:17
would ordinarily take years, could take, you know, seconds.
14:22
Yeah. No, I think you're right.
14:24
I mean, they now have the Watson IBM as a computer that can pass
14:28
the medical school entrance exam and I believe it's a board exam
14:32
now for. No way.
14:36
But there, there is a hospital in China now that has robotic
14:41
physicians that's almost, I think fully AI robotic.
14:45
I don't know exactly how it works, but I think that AI has
14:52
definitely has a place more than some people would like.
14:57
I still think you need a physician, someone who overseas
15:01
sure who sees it. I think it it'll like bowling,
15:04
will keep you in the right direction, but you still need
15:07
someone to supervise it and make sure it's adequate.
15:11
Right. So the, but so the skill set of
15:13
what you'd be learning as a doctor when you're going to Med
15:16
school would not necessarily be to be the AI to have all the
15:19
information, but it's how to how to direct it, you know, how to
15:23
manage it. Like, you almost become like an
15:24
AI manager that's a medical professional, you know, as
15:27
opposed to just spending your time just studying, you know,
15:30
you know, studying facts. That's true.
15:33
At a certain point that you say, do you need to be a doctor to do
15:36
that? Yeah, that.
15:38
Too. I don't know if I mean no one
15:41
can predict what will happen. I'd be interested to see.
15:46
I've been saying for a couple. I've been saying a little bit
15:48
now. The the thought struck me when I
15:50
was doing a podcast with, Oh my God, I'm going to be so upset if
15:54
I forgot her name because I liked her so much.
15:58
Allison Levitt. And we were talking about how
16:03
there should be doctors of medicine and doctors of health.
16:06
And like, you know, like there's doctors that like prescribe that
16:08
you come to once you're sick and once you need like some kind of
16:11
medication. And then there's doctors of
16:12
health that kind of every, every step before that step.
16:17
You know, how do you stop someone from getting to that
16:19
point? You know, I mean myself, for
16:21
example, I have a, you know, you started to talk about lower back
16:24
pain or back pain in general, kind of a little bit of lower
16:28
back pain. I have a good buddy of mine
16:29
that's a chiropractor and he gave me a couple exercises to do
16:33
at home. And he's like, everyone just
16:34
needs to strengthen their back. Like you just, and also the way
16:37
that I'm standing and the way that, you know, that, you know,
16:39
the way that I held myself, my posture all had a difference.
16:43
And I just need someone like that.
16:44
Just tell me like, hey, man, you're being, you know, this is
16:46
to be healthy and you need this to be healthy.
16:47
You need these vitamins and this and this, you know, diet and,
16:50
and hopefully you won't need a doctor, but if you do, then
16:53
here's another doctor you can go.
16:54
Do you know? Yeah.
16:56
I think it's what's happening to the airline industry with
16:59
pilots. Most pilots the take off the
17:03
flight is all it's autopilot. No way actual human human
17:10
involvement is I very little on a commercial flight, but you
17:15
still at this point need a pilot to make sure everything goes
17:19
right and to account for any mistake or the system fails.
17:26
So I think medicine is going the same way.
17:30
I know for anesthesia they do have robots now who who can
17:33
intubate. They can intubate patients and
17:36
some they've even tried to administer some kind of minister
17:39
medicines. But we're still at the point of
17:43
full autonomy. But procedure based healthcare,
17:48
I think it's difficult to be full autonomy.
17:50
Surgeons are using the Da Vinci robot every day to do most
17:54
procedures. It makes it cleaner, but I just,
17:58
I don't see a point yet where you're fully automated.
18:02
That's a scary day when you are. You just have to pay everyone a
18:06
basic income I guess. Yeah.
18:08
So the so the automated date, I don't think is that I listen,
18:12
it's, it's in the future, but I don't think it's a very distant
18:15
future because all you got to do is take those robots that Elon's
18:18
working on, those Tesla robots. And all you got to do is put AI
18:21
chip in them. And then all of a sudden they're
18:24
they're a walking version of, you know, of, of an AI that can,
18:28
you know, that has the physical capabilities.
18:30
Yeah, that's not too far that that can't was it, let's say
18:33
crazy 50 years. I mean, you know, 100 years, you
18:35
know, but that's not even that the pace of things are moving.
18:38
Yeah, I don't mean the idea of similarities.
18:41
As technology advances, it advances at a faster and faster
18:45
rate. I think what, 100 years ago
18:47
we're still with a horse and buggy and now in five years
18:50
we've got a couple, Well, who knows, 10 years from the
18:53
computer to AI, is the jump even quicker?
18:57
Yeah, yeah, I, I So we'll see what happens.
18:59
It, it, it, it, it, it does freak me out a little bit,
19:03
especially when like, I feel like the blurs between like,
19:06
what could potentially be reality, like what AI creates
19:09
and what's not, you know, starts getting harder and harder to
19:12
differentiate, you know, but you can't think too much about it.
19:17
You can't sleep, you know? I mean, it really freaks the
19:18
hell out of me. There's that mean that is going
19:20
around that I tell Chad GBT thank you every time.
19:24
So I think for the world it will spare my life.
19:28
Dude, I am. So polite to my chat bots.
19:31
It's so funny. I'm like, please, can you break
19:33
that down so far? I don't understand.
19:34
I appreciate your time. Thanks.
19:36
You know, like, yeah, just don't kill me later.
19:40
I mean, I think I don't know there is my reason truth to
19:43
that. I I, I don't think it's out of
19:46
the picture. I mean, I don't know.
19:48
And, you know, I mean, Can you imagine?
19:51
I mean, do you ever remember the book?
19:52
I don't know if you ever read it, but not even a brave new
19:56
world, That's who it was a brave new world, Yeah.
19:58
Where, like, humans are just grown in gestation and, like,
20:00
they're just creative. They're just, you know, like
20:03
these. These embryos are just placed
20:05
into different social and physical hierarchies based on
20:11
like. Whoever the creator decides that
20:13
they're going to be, you know, and like, OK, so your embryo is
20:17
going to be stronger and taller and more athletic and, and
20:20
smarter. And then you're going to be the
20:22
plebeian that's going to be shorter and, you know, Dumber
20:25
and, you know, not even capable of thinking of, you know, even
20:28
wanting a better life, you know, and like, that's just what the
20:30
that's and like. And Aldous Huxley, if you like,
20:34
if, if you Google the, the year that he came out with that book,
20:37
I forgot it was, it was early. It was I think maybe the 40s
20:39
forties or the 50s, if you, if you googled what technology was
20:43
at the time, like it was nothing and like he could already see
20:47
where things are heading. So like, I don't know, man.
20:50
It really, it really skis me out.
20:52
Yeah, it's it can be scary, but exciting.
20:56
There are so many things now in the world that it can go in so
21:00
many different directions. Yeah, yeah.
21:03
What gives me, what gives me hope in the end of the day is
21:05
that like we live in a pretty benevolent, like we live in a
21:09
world that like, things are generally like we aspire for
21:12
good and good always kind of feels like it's trying, like
21:15
it's like pushing out and emerging.
21:17
And like, I think that that like is so common for so long in so
21:22
many different aspects of life. It's so it's so interconnected.
21:25
Just do everything that like, I think the universe is built to
21:29
support life and like life is good.
21:31
Like that's what goodness is. So.
21:33
Yeah. I, I, I liked it.
21:35
I heard this quote that said we, we have fundamentally our issues
21:41
are the same as they were 2000 years ago.
21:42
We have just right now we have God like technology, we have
21:47
medieval laws, but we still have reptilian brains.
21:50
A lot of our issues are made from our differences.
21:53
The differences we have in our communities are our religions.
21:57
That's what really is pushing all this.
22:00
The fear is that we use a technology to justify these
22:06
reasons that are from the Cavemen era, that we have to
22:10
almost work on ourselves and then we can improve our society.
22:14
Yeah, totally. I believe that.
22:16
I believe that religion is the consciousness, the evolution of
22:20
consciousness. I believe that like the general
22:22
concept of trying to strive beyond our, you know, primal
22:27
animalistic nature and like invest in a future world for
22:31
better times and better community or better, you know,
22:33
family or whatever it is. I feel like that is the like
22:37
that's that like there was a certain stage of evolution that
22:39
was physical and then at a certain point, the bet the next
22:42
way for evolution to kind of like manifest is through our
22:46
consciousness and like we have to force out.
22:48
You have to shed that kind of primal animal, you know,
22:51
reptilian aspect of us and like truly just be conscious, which
22:58
is kind of Rick, it's recurring throughout a lot of different
23:01
religions and ancient tribal stories and like ideas of like
23:04
collectivism and like 1 consciousness.
23:06
And like, you know, people take psychedelics and they see all
23:09
these experiences where everything is 1 and you're like,
23:13
well, it's everywhere. You know, like, maybe it's not
23:16
the complete truth, but there's got to be, you know, aspects of
23:18
of truth that are definitely sprinkled in there.
23:20
Well, I, I think you and scientifically we are all
23:24
connected. We are really are all Stardust.
23:27
We are compressed atoms from the sun where we are part of Suns
23:33
that have collapsed and have created heavier elements.
23:36
Most of our bodies are carbon, hydrogen, oxygen, they're
23:38
organic elements. And so we really are just all
23:42
the same. We're connected, but yeah,
23:46
scientific basis, but on a spiritual basis, I I get that
23:49
too. It's hard for people to come
23:54
together, accept a lot of facts that they see a differences and.
23:59
Well, that's the point of the podcast, I hope, you know, And I
24:01
think that I think that we, I think that in it's funny because
24:05
there's definitely a cycle between like, I guess you could
24:11
call authority or establishments and then abuse of power.
24:16
And then it collapses and then builds back up again based on
24:19
like a new level of trust. And then somewhere along the
24:21
line of claps like it's, it's, it's constantly cyclical, but I
24:24
think that the ripples that happen become bigger and bigger
24:27
ripples in the, and the, you know, and the, and the
24:29
breakdowns are bigger and bigger.
24:31
I think the COVID breakdown was like a global breakdown.
24:34
And now there's a global, it feels like at least there's like
24:38
at least in the country. But, you know, I don't know
24:39
about the I really don't know much about the rest of the
24:42
world, but that there's like a there's a reassessment as to
24:47
like, hey, man, like what's really the story about anything?
24:49
Because like we don't know what to believe anymore, you know,
24:52
and like that's and that's good that that keeps us incur, you
24:55
know, looking for truth then and then we could rebuild our trust
24:58
as we see truth kind of pop out and did all the pile of crap
25:03
that's there. Yeah, I think I just think as as
25:07
humans individually, we're not very impressed if it is only
25:10
when we work together that we can make phenomenal, fantastic
25:14
advances in science, medicine, math, religion, whether whether
25:17
it be the airplane, the computer.
25:19
But the issue is once you get so large, humans are very
25:21
distressful. This distrustful of large
25:25
organizations and governments that seem to have authoritarian
25:29
power, They're very distressful of that.
25:31
So it's just a yin and Yang to yeah.
25:35
Yeah, there's something. Yeah.
25:36
That that it's so funny you say that because I don't know.
25:39
I haven't figured out how to get past this, really.
25:41
And I don't know if we can. I feel like humans operate best,
25:45
or at least my experience is that I've operated best in
25:47
smaller communities and smaller sects as opposed to bigger, you
25:50
know, like I've lived in, you know, in Manhattan and I've
25:54
lived in upstate Binghamton, upstate New York, you know.
25:58
And like, what I've found generally speaking, just, you
26:01
know, all the different places I've gone, even for my own life,
26:05
is that I feel like with in a world I thrive in a smaller set
26:11
of familiar people as opposed to a big rush of crowds who I don't
26:16
know who was going to be where at any moment.
26:17
And if I don't, if I'm going to recognize anyone at any point?
26:21
Yeah, and I think I've heard that you can really only have
26:24
your circle, your community. What, 50 people?
26:28
That's really what the humans. Yes, that's right.
26:30
A lot of what? You keep track of.
26:31
Organizations in New York City I have a lot of friends in New
26:34
York. I had a lot of friends in New
26:35
York City. In New York, City is a lonely
26:37
place. Everyone is in their own life.
26:40
They don't interact much with each other.
26:42
They like their own. They have their headphones in
26:44
the subway. They don't really interact.
26:47
So it's a lot of people, but all my friends would say it's
26:50
lonely. Here.
26:51
People are alone. They have their dogs, they keep
26:53
them company, but they live solitary lives.
26:56
I don't. Remember, if this is still
26:59
accurate, but as of a couple of years ago, I think the, the
27:02
average household in Manhattan had two dogs and 1.5 children.
27:08
And you know, and people are just more inclined to like, you
27:11
know, I think that, I mean, I'm sure it speaks a lot to the
27:13
demographic too. You know, that typically cities
27:15
are filled with young people that are, you know, you know,
27:18
commuting and OK with departments and, you know,
27:20
they're, you know, they're looking to just be close to
27:22
work. And then, you know, so like, I
27:24
do hear that there's obviously going to be biases in that
27:26
staff, but like, it's still pretty crazy to me that, you
27:29
know, the dog rate, the rate of dogs that we own is more than
27:32
that of children that we're willing to have.
27:35
Let's go. Let's talk a little bit about
27:36
medicine. And so you finished
27:38
anesthesiology in Vegas. First of all, how do you like
27:40
Vegas? I love Vegas, obviously, I like
27:43
I like big cities with a lot of energy.
27:45
I like the energy and it's a no judgement place.
27:49
Obviously in Vegas, you need to have discipline.
27:51
I knew residents who got lost and they had they, they dropped
27:55
out, got kicked out of residency.
27:58
Vegas has a lot to offer. I could.
28:00
I really liked my classmates, my the people at the hospital.
28:06
What? Kind of stuff were you doing in
28:07
the hospital? So I was doing my first year, I
28:10
did internal, I did a transitional year.
28:12
So I did internal medicine, journal surgery, some
28:15
dermatology, and then I did anesthesia the last three years
28:19
and I was at 5 different hospitals in Las Vegas.
28:22
Wow. Yeah, I was there doing a
28:24
shooting when I had that large shooting there.
28:26
No way, really. Yeah, that was 20/14/2013.
28:31
That was, you know, I can't, I think it was 13 or 14, but I'm
28:38
not, I don't remember the the actual year.
28:41
Yeah, I remember it happened towards the end of the night and
28:44
they are removing patients from one hospital to our hospital
28:50
because they had to make room in the ER.
28:52
So yeah, it was a large, large event.
28:55
That's crazy. Is an anesthesiologist.
28:59
They know this because my wife just went through this a couple
29:03
weeks ago. They do the what's the pain code
29:05
that they give women that are about to give birth.
29:09
It's not, it's not There's that big needle that they send all
29:12
the dads out because they're afraid they're.
29:13
Going to pass out. Yeah, they need the epidural.
29:15
Epidural, yes. Yes, yes, that's what I do in my
29:18
paint thing. I do the cervical, the neck
29:20
epidurals, the lumbar epidurals. I used to do the OB epidurals.
29:24
I work at a hospital here in my Baptist and so I work in Manoir.
29:29
But the labor epidurals, the OB is very satisfying to do.
29:34
But those labor epidurals as opposed to what we do here in
29:37
the clinic, we have older patients with hardware.
29:39
So we use X-rays to find the needle in the spine.
29:42
They do a blind so and they but younger females.
29:45
Why would they do? Why would you?
29:46
Why would someone do a blind as opposed to using needles?
29:51
What one for habit? Just tradition Pain medicine.
29:55
It's outpatient clinic. The patients are older, they
29:58
have spinal hardware. They're, the spaces you have to
30:00
enter are much smaller, so you have a less room for error.
30:06
And so that's why they do it in pain medicine just because also,
30:11
if you're doing an epidural in the neck, you want to be very
30:14
precise. There's much less room for
30:16
error. So you want to use an X-ray when
30:19
you're doing it for labour and women, it's always at the L45 or
30:22
in that lumbar area. They're, they're sitting up.
30:25
This space is very wide open. They're young.
30:28
So you can feel the, the ligament, you can feel like
30:31
where you're at exactly as you age, as the ligaments can become
30:34
more relaxed. You can't feel where you're
30:36
entering, so that's why. I see.
30:39
And when you when you do a lumbar epidural or something
30:42
like that on an older patient. That's that's.
30:45
Is that the same thing as? Is that the same medicine as
30:49
epidural that my wife was getting?
30:52
What's the difference? How does?
30:53
That work usually in the epidural laboring epidural
30:56
they'll use bupiricane, some fentanyl.
30:59
This to give you some one for bupiricane.
31:03
You won't feel anything and the fentanyl will relieve any pain
31:07
you do feel. Provide some just some general.
31:10
Quite a cocktail. Yeah, exactly.
31:12
I in our in our clinic or any pain clinic for an epidural,
31:17
they'll use steroid which is anti-inflammatory and then a
31:21
small dose of Marcaine bupivacaine that just it's for
31:25
short term like that day. But the real a medicine is a
31:30
steroid which works. That's so interesting.
31:32
Yeah, it's anti-inflammatory because the nerves are very
31:35
inflamed. We want to calm them down.
31:37
Or, as in laboring women, the nerves are fine, you just want
31:40
to numb them up. Yeah.
31:41
You just want to make sure that she's not feeling anything going
31:43
on. Yeah, because my grandfather had
31:46
back pain and he'd go and get injections all the time.
31:48
And I'd always ask him like, what are they injecting you?
31:51
And he's a, he's AGI, you know, You know, and, and it's like, I
31:55
don't, you know, I don't even know.
31:56
I think he maybe even told me steroids, but I don't even know
31:59
what it meant. And he never explained it to me.
32:00
But like he'd go and then you get this relief and I'd be like,
32:03
what, what are they even doing to you?
32:04
You know, So I, it's, it's good to know.
32:08
It's good to know that's what people buy ultrasounds, right?
32:09
To do that, to do that needle guided, inject those needle
32:12
guided. Injections and so for those for
32:14
ultrasound guided that's more for peripheral joints and you
32:19
can visualize with ultrasound even better than fluoroscopy
32:22
X-ray, you can really, you can see tendons, you can see muscle.
32:26
And so it's very good for not only steroids, but now as we're
32:30
approaching this regenerative age, you can do plasma
32:34
biologics. So it's easy to get into those
32:37
tendons. So let's talk about that.
32:40
I wrote a bunch of words down that I don't know what what they
32:43
meant on your website of treatment that you offer.
32:45
So I'm very excited to learn about them.
32:49
Plasma therapy. Yeah.
32:51
So we mentioned South Florida. South Florida is a hotbed also
32:56
for this. I call it false advertisement
32:59
for regenerative medicine, which was my research interest
33:04
starting back from undergraduate.
33:05
The regeneration of tissues of the body, which animals in
33:11
nature, the salamander, axatol, they can do it.
33:14
The body's capable of doing it, but the promise that we offer
33:18
patients that we're it's called regenerative tissue.
33:22
We're not regenerating tissue on a clinical scale, not in clinic
33:26
yet It's anti-inflammatory in in academics, the studies, yes,
33:30
we're regenerating. And so the idea with plasma, you
33:34
mentioned platelet rich plasma, they have found that platelets
33:40
when you centrifuge it off, there's growth factors in those
33:43
platelets that if you reinject it into the body, it provides
33:47
some anti inflammation and hopefully some healing
33:52
potential. Whether that healing that well,
33:56
that healing now is our bodies is fibrosis.
34:00
When you cut yourself, you develop a scar.
34:02
When you get surgery you have scars and abdomen adhesions.
34:06
So our bodies form scars, but young kids, neonates, when they
34:11
are cut, they don't form scars, They regenerate tissue.
34:14
So the, the whole aim of this whole field is to, for instance,
34:18
if you have arthritis in the shoulder, right now, we put
34:21
steroids, they want to regenerate that cartilage.
34:24
The reason you have pain is because there's no cartilage.
34:27
It's bone on bone. Exactly.
34:29
So you want to replace, you want to regenerate that cartilage.
34:32
That's the Holy Grail. That's the, that's the goal of
34:34
this regenerative therapy. Why can't?
34:37
We just insert more cartilage in there.
34:39
Because the cartilage is once a vascular, it's very hard to grow
34:43
in a lab or to even to grow and then to keep it in the body is
34:47
even harder to keep it there. So there's.
34:51
Re nourish it if you re find a way to re nourish it or quote UN
34:54
quote regenerate it. You could probably grow some
34:57
cartilage in the lab, but if you keep it, the joint space is a
35:01
very harsh environment. It has to stay there.
35:03
You have to find a way for the interface between the bone and
35:06
the cartilage, and that has to be like glue.
35:11
You can't, because you can just take a plate of cartilage in the
35:13
shoulder, but it won't stay there.
35:15
You have to keep on a way to keep it stuck to the the bone.
35:19
And the technology is not there yet for that.
35:21
We're not there so a lot we're promising, people are promising
35:25
regeneration. It's not regeneration yet, it's
35:28
restoration or anti inflammation.
35:30
And when would I personally do this?
35:32
Biologic, Yes, but I'm just not going to believe it's
35:35
regenerating tissue. Right, right, right.
35:38
So, So what so, so I mean, I, so typically speaking, your
35:41
patients are a little older in your in your practice.
35:44
Yeah, as we age, yeah, we get more thrice or bones, more wear
35:49
and tear. So yeah.
35:50
But a lot of patients who want their regenerative therapy are
35:54
younger athletes. Kobe Bryant was one who's
35:57
getting PRP, Right, Right, right.
36:01
So athletes want it. And for younger patients, I
36:05
would recommend PRP because the steroids, yeah, steroids they
36:09
can cause if you're injecting the in the fascia or tendon, it
36:12
weakens it actually. So you can have it makes it more
36:15
likely for a rupture. A lot of the ablations we're
36:18
doing for the, for the neck of the back, they, they ablate not
36:23
only the nerve for pain, but a nerve for the muscle.
36:26
So you weaken the neck, you weaken the lower back.
36:28
And so it's not something you want when a young active person.
36:32
Wow, interesting. But so why?
36:33
So why would you give it to an older person if they have a
36:35
harder time recovering? So you give it to an older
36:39
person, one, because the goal for an older person is to just
36:43
maintain mobility. You want to make sure just get
36:47
them over the really painful hump.
36:49
You don't want to be doing these procedures all the time,
36:51
ablations, steroids, but most of the time these this pain is
36:54
acute. Maybe there's six weeks.
36:56
You want to get them over that hump and the goal is to continue
36:59
mobility. The the model of our clinic is
37:02
restore and maintain an active life.
37:04
If you don't, if you stop moving, your joints fuse.
37:07
And when joints fuse, you get more pain, you can't move and
37:10
you just create more problems. So even if you have pain, you
37:13
want to move a little bit, you just keep the joints need
37:16
movement for lubrication. You just need to keep moving.
37:20
Yeah. Yeah, I know.
37:21
And we do very, very little of that these days.
37:24
Unfortunately, yeah, exactly. So are you seeing a younger
37:27
demographic come in for typically what would have been
37:31
considered older deterioration or deterioration that's more
37:34
common when you're older? No, young people are most people
37:42
in general, most these procedures for PRP exosomes,
37:47
they're cash. They're cash pay.
37:48
So people don't want to spend disposable cash on a pain
37:52
procedure. They want to spend on a cosmetic
37:54
procedure or something that they can see that pain is not sexy,
37:59
it's not fun. So they don't.
38:00
Yeah. So the PCP is our blood have
38:04
platelets in it. You're you, you cycle it, you
38:07
take it from the from the particular area where it's
38:10
already in pain. No, you, you, you put an IV in
38:14
and you want to, you get all 50 CCS, usually a blood, you put it
38:18
in a centrifuge and you spin it for a few minutes and it'll
38:21
separate the blood with the plasma and the serum.
38:25
And you take the A layer and that layer has the platelets
38:30
with the growth factors and that you you get that and then you
38:35
get that back in the body. So you're putting their blood
38:37
back? It's almost like enhanced blood
38:39
with extra. And so the PCP stands for what?
38:43
PRP, Lander Ridge plasma. Gotcha.
38:46
PCP is primary care provider. That's your your name, Doctor.
38:50
OK, gotcha, Gotcha. Gotcha.
38:51
Right. It's a lot.
38:53
It's a lot of what do you call it?
38:56
Shoot. What do you call it?
38:57
The acronyms. A lot of acronyms.
38:59
And so now we have, we have the PRP now and now we have the next
39:04
generation of PRP, which is called exosomes, which now they
39:07
have found exosomes are simply the PRP with a transport vehicle
39:14
that allows it to enter the cell.
39:16
And so now they've found that these exosomes, they can
39:19
concentrate them and it's even might be more beneficial than
39:23
PRP. So in that, so let's say with
39:26
the original PRP case, you're kind of flooding that blood back
39:29
in your system and you're hoping that the cells take it because
39:31
it's new blood in with exosomes, it's more inclined to latch on
39:34
or hang. In, yeah, well, PRP, you're not
39:37
getting back in the IV you're giving.
39:39
You're injecting it into the area of pain in the back or the
39:43
shoulder and the knee. Same with the exosomes.
39:46
You're taking the blood out, centrifuge it, and then you get
39:49
the exosomes, which are just the growth factors in the transport
39:53
vehicle. Yeah, it's the lipid bilayer,
39:57
which is and it just enters a cell more easily.
39:59
Isn't that how hair transplants work?
40:01
You take like the hair that's like growing from 1 area and
40:05
then you pop it into the root and you pop it into the area
40:07
where the hair is not grown, continuing to grow.
40:09
That they they use PRP and exosomes for they they use it
40:14
for hair loss. I don't, I don't know.
40:16
No, no, no, I'm not talking about using PRP for that, but
40:18
I'm saying the similar concept in the sense that like you're
40:20
taking the, you know, starting good, good, good growing hair
40:24
from 1 area and you're popping it to another part of your head
40:26
and hoping that it that it grows there.
40:28
But my dad did that. It didn't work for that all so.
40:30
I don't think I could know. I've seen people, but no, I
40:34
don't think that's more like a transplant because you're taking
40:36
hair from a good area and putting it into a bad area.
40:40
The exosome, the idea is it doesn't enter the shoulder
40:44
because blood doesn't get there and so they get good growth
40:48
factors there. You have to inject it because it
40:50
is a vascular and you can't get the blood there.
40:53
Right, right, right, right. Cool.
40:55
And is that so when people walk in, are they asking for that or
41:00
are they coming in in pain and you're making recommendations
41:02
based on like what their what their pain is?
41:05
I will make recommendations. There are some clinics that
41:08
specialize in that. The issue is I didn't want to
41:11
specialize in that because it's not the level of being able to,
41:19
in my opinion, be on its own. It should be combined with I
41:23
don't be charging patients cash. I mean, some of these procedures
41:26
are $3000 and we have a limited evidence that they even work.
41:31
My, my belief is that we can do the standard procedures that
41:35
have been shown to be effective. Even them, even those aren't
41:42
evidence based, but at least they're covered by insurance.
41:44
They're not super expensive and if you don't work, we could
41:47
consider PRP exercise, but I don't want to have to push
41:50
patients to a procedure that might not work and so I like to
41:54
offer everything. Right, right, right, right.
41:57
How did you become so open minded about?
41:59
This I don't think. It's pretty niche I think, no.
42:03
It is very niche. It was just the idea of the body
42:08
regenerating itself was fascinating for me in medical
42:12
school or an undergraduate. So it's never about creating a
42:15
business model or promising something false.
42:17
It really was about getting to the.
42:20
Point for sure, I believe that. So I guess I, I just, I don't, I
42:27
can't say that medical school developed it.
42:29
I think you just have to be open minded and just know it sounds
42:32
basic, but I think that that's it.
42:35
You just realize that if you don't really want to help,
42:39
you're not helping my falsely promising stuff.
42:41
You have to really make sure it works works and make sure it's
42:45
evidence based. Yeah, yeah, I, I guess the fact
42:49
and I mean, and does evidence grow?
42:52
Based on your like, if you're, if you're successful with X
42:54
amount of patients, right, are you like, you know, I noticed
42:57
that, you know, are there a lot of, are there a lot of trials
43:00
going on regarding this kind of Medicare medicine?
43:04
Yeah, so there are, there is. And I actually reached out to
43:07
the University of Miami Medical School of Medicine.
43:10
They're doing a lot of clinical trials with this.
43:12
They have a stem cell institute that I'm, I am cool with.
43:17
And so I, I've spoken with them to, I mean, obviously the idea
43:22
would be to have clinical trials.
43:23
So the issue is a lot of these clinics that do PRP, they're not
43:28
regulated. They're doing the PRP in house.
43:30
You don't know how they're centrifuging it, if it's even
43:33
PRP ever even works. With these clinical trials.
43:36
The goal is to regulate it how the FDA makes sure what you're
43:39
doing is correct and what we're doing is actually working.
43:42
Are there that you you know of many many.
43:45
Cases of doctors that are just making this kind of thing up,
43:48
they're like. Oh yeah, I mean, I know doctors
43:51
who are promised saying it cures erectile dysfunction, that it'll
43:54
cure hair loss. We're putting it into the
43:56
cosmetic, the procedures when you do fillers, a lot of is PRP,
44:00
it's safe, but it doesn't stay there very long.
44:03
So anything that's cash pay, people will pay cash.
44:07
There are there will be people who will accept the cash for it.
44:10
So if you want PRP for erectile dysfunction or hair loss,
44:14
someone will do it for you. What else?
44:17
What are the methods I noticed? That I wrote down that I didn't
44:19
know what it meant, but peripheral nerve stimulator.
44:22
Yeah, that's a newer technology using an older known theory.
44:28
So a lot of what we do in pain management is temporary and
44:32
you're just hiding masking pain of nerve ablations.
44:35
You're just using heat and burn the nerve and it will regrow in
44:40
a few months. Steroids you just calming down
44:42
the inflammation. You're not really caught helping
44:45
the root cause. Neither is the peripheral nerve
44:49
stimulator. The nerve stimulator is only is
44:52
sending a small electrical signal to the nerve temporarily
44:56
for six months maximum and it resets the nerve to the point
45:01
where it doesn't hopefully has been shown this by evidence that
45:07
it forgets about the pain. It resets it to its standard to
45:10
the normal nerve. A lot of chronic pain is where
45:14
the body's tricked into thinking that you have a problem in your
45:17
shoulder and your knee because you're missing, missing
45:20
cartilage and the nerves are firing continuously because
45:23
they're confused. They think you have a problem
45:25
there when in fact it's just it's an issue, but they're just
45:28
constantly firing. And the idea with the peripheral
45:31
nerve stimulator is you're resetting the nerve, you're
45:34
tricking it and making it go back to its original state and
45:37
not recognizing this thing. Yes, stimulus as pain.
45:42
So it's almost like a like a guard dog that's that becomes
45:46
familiar with you and it stops and it stops barking and jumping
45:50
on you and you walk. Exactly.
45:51
And the peripheral nerve stimulator is not burning, it's
45:53
not trinsecting, it's just providing a small signal to the
45:57
nerve to reset it. Gotcha.
45:59
Does does electroshock therapy work in a similar way?
46:02
Yeah, the spinal cord stimulator, is that what you're
46:05
referring to, like? No, I know that you should use
46:10
sound waves shock. Waves, yeah.
46:11
Shock waves, yeah. Well, the shockwave is also
46:15
around restorative. The idea is it provides these
46:19
shock waves that causes some tissue trauma.
46:23
And a little bit of tissue trauma is good because in the
46:25
areas like the fascia or the tendon, that trauma will bring
46:28
some 'cause some bruising, some bleeding.
46:32
And with that bleeding, you get platelets and those growth
46:34
factors to come to the area, which are otherwise very hard to
46:38
get to. You can't get those those those
46:42
growth factors to the area without a little bit of trauma.
46:44
And so the idea is it's called in an older terms prolotherapy
46:50
where you cause some, it's it's counterintuitive you cause some
46:56
damage the area to cause some bleeding and bruising, which
47:02
brings growth factors to the area.
47:06
I think that the whole premise of vaccines is, is pretty
47:09
similar, no, you're introducing that substance to your body for
47:12
the for the body to respond to, to become familiar and respond
47:14
to it. Yeah, exactly.
47:16
That's cool. That's really cool.
47:18
So that, so that, so that notion of introducing something to kind
47:22
of introducing something on a smaller scale, you know, that
47:25
it's so funny because unlike a social level, we have that too.
47:28
There's a, there's a book that I just mentioned even today, a
47:32
different, different podcast called the the Ancient
47:35
generation. And one of the things that he
47:38
talks about is that when you're growing up for kids, that's
47:40
important that they get into, he calls them scrapes, not breaks.
47:43
You know, that like they learn how, like they learn that
47:46
falling is not a huge deal, but they also learn how to like,
47:49
there's no consequences and that like they could just bounce back
47:52
up and they'll be OK. And then they become more adept
47:54
and more nimble and more, you know, kids become a little bit
47:57
more confident when they able to get up and kind of brush
47:59
themselves off. But, you know, you if you get a
48:02
break, obviously it's a lot more significant.
48:05
Exactly. And and like, the shockwave
48:07
itself doesn't cause any breaks. There's nothing that goes in the
48:11
body. It just provides some gentle
48:14
vibrations above the skin and that breaks up the tissue enough
48:17
to cause some. Yeah.
48:19
Yeah, yeah, I've, I think, well, I don't know.
48:24
So I went to one of those IV bars one time in Austin and I
48:28
sat there and actually, so it's funny, I sold the guy an
48:31
ultrasound machine and then I happened to be visiting Austin.
48:34
So I decided to stop by and check out what the place looked
48:36
like. And he had me sit down one of
48:39
these chairs and the chair would vibrate more intensely based on
48:45
how tense my, my back or arms or, you know, whatever part of
48:50
my body was sitting on the chair was.
48:52
And then as my body got looser, the vibrations it would, or as I
48:56
guess it opened up a little bit, the vibrations would slow down
48:58
until it would come to a stop completely.
49:00
But you didn't even realize how tense you were until that.
49:04
Until that started. Exactly.
49:07
Yeah, that's part of the whole treatment.
49:09
When how long? When did you open a Gables
49:11
paint? So Gabus Pain has actually been
49:14
open. The LLC has been open since
49:17
2022, but my doors have only been open for six months because
49:23
I've been fighting, not fighting.
49:25
I've been trying to get on insurance contracts.
49:28
Insurances are notoriously hard to have you get on their panels,
49:33
especially in large cities. They don't want to pay more
49:36
doctors obviously, despite there is always a need, especially in
49:40
pain, but it's just hard to get on the insurance panels.
49:43
So I finally got on most of them, not all of them, about 6-7
49:48
months ago. So patients have been trickling
49:50
in. Wow, interesting.
49:52
What, what, what, what, what, what steps go?
49:54
So when did you want to open this up and what steps go into
49:58
opening your own clinic? Honestly, the pain I just had to
50:03
be on my own in pain medicine when I ended up talking to so
50:07
many private equity firms who had bought up these small
50:10
private pain clinics and wanted to hire me and work me who knows
50:17
for how many hours since patients doing procedures that I
50:21
don't know if I even believed in and the way I was treated, I I
50:24
didn't appreciate it at all and. What?
50:27
What they want you to do that you weren't sure you believed
50:28
in. I mean, the the issue is you've
50:31
got, you don't have much to say. You either accept what they want
50:37
to do, or you just don't do it. Yeah.
50:41
Yeah. So the reason a lot of it's
50:47
really performance based. So the more patients you see,
50:49
the more procedures you do, the more you get paid.
50:53
And I mean, obviously that's true for me too, but I'm not
50:57
expected and held to a certain number of patients that I don't
51:01
have to. I can practice medicine as I
51:05
want to. And I evidence based.
51:09
There's multiple examples. I think just the other day there
51:12
was ACEO of a pain clinic in Tennessee or Kentucky that they
51:16
had I think 20 pain clinics. They went to prison for 30 years
51:20
for their use of injections. They were almost in a million
51:24
injections in in their patient in a year which is wow crazy
51:28
amount. And so they're.
51:30
They're pretty much care and stick model.
51:33
They were doing injections, which is how you get the most
51:35
money and the and to incentivize patients for that, you give them
51:39
opioids, you pretty much keep them addicted.
51:43
And so you give them opioids and it's it's like a handshake
51:46
agreement. I'll give you opioids if you let
51:48
me do injections on you. And so they're doing injections
51:51
once every other week, which. Is that is crazy?
51:56
What what what? This was in Tennessee.
51:58
Just in Kentucky or tenancy I just saw oh man and.
52:03
I feel like the I feel like the opioid conversation has really
52:05
blown up so much that I'm shocked that it's still
52:08
happening on the scale that it is.
52:10
Yeah, it's just it has a place. For instance, today I had a
52:14
patient who had severe back pain.
52:16
He cannot almost perform any activity.
52:19
And so I will do it for a short course to relieve maybe 10 days.
52:26
I have a Percocet just to take just to get him past the hump,
52:30
but I don't do more than that. And if.
52:33
I need to be like, real. Of course everything has a place
52:36
and time, you know? Yeah, but the but the obvious,
52:38
but the obvious conflicts of interest and the obvious
52:42
advantage that that people could be, you know, that that people
52:45
could get take people could be taken advantage of pretty
52:47
seriously, you know? Yeah.
52:49
Especially because we trust our like, we trusted doctors,
52:52
everything. You know, I was talking to
52:53
someone this past weekend and and, you know, they were his
52:58
bit. He just went, he just had a kid
53:00
and his he was telling me how the dot, how they wanted to put
53:03
this cream in the baby's eyes. And Kate, I forgot what it was
53:06
for exactly after the baby was born.
53:09
And he was asking the doctor about it.
53:10
And like, her response to him was like, he just wanted to know
53:13
what it was. He didn't know what it was.
53:14
And she's like, don't be one of those people.
53:15
Just do what you want your kid to be blind.
53:16
And like, he's like, no, sorry. And like he like looked into it
53:19
after. He was like, I totally didn't
53:20
need to do that, you know, But yeah, you know, I think people,
53:22
you know, you put on a coat, you put on scrubs, you put on, you
53:25
know, the, the mask and you walk in and you're the, you're the
53:28
figure of authority that knows. And, and everyone kind of just.
53:32
And for by the way, in an ideal case, that should be the best
53:35
thing in the entire world because ideally there is no
53:38
taking advantage of people. And ideally, you know, you don't
53:40
want to do that, you know, and like, like what you do, you go,
53:42
OK, you know, I'll do 10 days to hold you over.
53:44
But you can't go more than that because, you know, literally
53:47
thirty, 2530% chance you get addicted to these, you know, I
53:50
mean, is it worth it? You know, it's an interesting
53:55
dynamic. It's so interesting that the
53:58
abuse is still. Going on SO.
54:00
Strongly though. It's hard to fight it though.
54:02
It's very, I mean, opioids are the most is the most addictive
54:08
substance on earth. Methamphetamine and opioids, I
54:14
don't think, I think I think methamphetamine might be a
54:18
little bit more addictive, but. Yeah, yeah, yeah, yeah.
54:22
I hope we turn to, I think like with the Netflix documentaries
54:27
and the books, like I, I just read a book called The American
54:29
Cartel about the DEA trying to, you know, trying to sue,
54:35
basically. I think one of the harder things
54:37
about the opioids is it's hard to figure out who to point the
54:41
blame to. Do you point the blame to the
54:43
doctors? Do you point the blame to the
54:44
manufacturers? Do you point, do you point the
54:46
blame to the people that are providing it to the corporations
54:48
that that provide incentives and kickbacks and like say you're
54:52
the problem? Or do you say to the middle men,
54:55
you know, like the Walgreens or the, the CVS is, hey, did you
54:58
notice that one person is getting X amount of
55:00
prescriptions picked up? And like, that's not normal.
55:03
He's like, well, it's doctor. It's like it's everyone has
55:06
plausible deniability along the way, which makes it so much
55:09
harder. To crack down.
55:10
No, exactly. And I mean, I talked about
55:12
private equity, but I know a lot of private pain doctors who went
55:16
to jail for life because they just want to give its opioids
55:20
indiscriminately because they're making a lot of money.
55:23
And so the blame is on every, I mean on everybody.
55:26
You can't, I mean, common sense. If I'm given Dew Point
55:30
Industries, the ones who made Oxycontin said it was not
55:33
addictive, fine, that's fine. They're going to come to you and
55:36
tell you give me, give me put all your patients on this.
55:40
And if they start dying, I mean, guests stop using the medicine
55:44
and we see them patients are dying all the time from this
55:46
opioid. Just stop.
55:48
It's greed all it's greed everywhere.
55:51
That's what. Yeah.
55:52
What, what, what new developments are you are you
55:56
keeping your eye on or that you're keeping track of that
55:58
you're excited about in terms of in terms of chronic medicine and
56:01
well? It's not chronic yet, but a new
56:04
drug called Dronavix just got FDA approved in January.
56:09
OK. And it.
56:10
Uses sodium channels and it's non opioid based.
56:14
It's right now it's used for post surgical pain and patients
56:19
take it after surgery and it helps significantly reduces the
56:23
amount of pain they feel. And.
56:26
I think it's only a matter of time until it goes into the
56:30
chronic pain world, but it's a fantastic drug.
56:32
It was just approved this year and it uses a a novel receptor,
56:36
a sodium receptor that really targets nerves specifically.
56:42
What is, what is what you say? Sodium?
56:46
Is it sodium? Yes, sodium channel.
56:49
So our our nerves work by they use sodium potassium to move the
56:54
signal, move the polarization, the charge.
56:57
And if you can just mess with the some way they've altered the
57:02
way that the nerve responds to a lidocaine, for instance, it's a
57:05
sodium channel receptor blocker. It affects the sodium channel.
57:10
So genetics works in a similar way, but obviously longer term
57:15
and slightly different. Right, right.
57:18
Wow. And I guess you don't have any
57:19
of the side effects or addictive nature to that.
57:22
No, yeah, not have. You been prescribing it?
57:25
No, because that's prescribed by surgeons.
57:28
It's acute pain, so I don't deal with acute pain.
57:32
For me, chronic pain is anything over three months.
57:35
Oh, interesting. Gotcha.
57:38
Gotcha. But you OK, would you would you
57:41
use that as one of the holdover acute pain like prescriptions
57:44
that you'd write instead of an opioid?
57:47
Like for. That 10 days or week or
57:49
whatever. No, because it hasn't been FDA
57:52
approved for that. It's approved for really
57:55
specifically right now for surgical pain.
57:58
I see. It doesn't mean it can be, but
58:00
it just doesn't have enough studies to to kind of the way
58:08
I'm looking for is. Confidence.
58:10
Warrant, warrant, warrant use in chronic pain yet?
58:14
There's not. I got you yet?
58:16
I got you, but you're excited about it.
58:17
You think that'll be good? Yeah.
58:19
That's awesome, that's awesome. How do you keep up to date with
58:24
how much time do you spend researching?
58:28
I actually tried to do recently. I tried to do an hour a day of
58:33
either learning, whether it's new ultrasound guided methods.
58:39
I ask chat DBT a lot just because there's so much
58:41
information. There's a chat DBT for science
58:44
where you can ask new developments and to summarize
58:47
the new developments. I do that a lot.
58:49
And depending on what it tells me, I'll go read about it more.
58:52
There's a pain journal, there's anesthesia journals, but I
58:56
really like the, the meta analysis that provide this
58:58
provided by AI. It's, it's succinct and you can
59:02
tell me the evidence based based off all the studies out there.
59:05
So. Right, right, right.
59:07
So you opened, you opened your doors about six months ago.
59:09
Yeah, when so, So you had to, so you had to get a lease, I
59:13
figure, right. So the, the, the reason I chose
59:17
Vegas or Miami's because my, my friend from Las Vegas who's an,
59:22
an internist has a clinic here in Miami and he asked me to set
59:26
it up and I pay a sublease to him.
59:31
So I don't want to pay a word about the least.
59:32
It's much more economical and it gives me just a way to get
59:36
started slowly. And so I, I, I use some of his
59:40
staff. I mean, I'm a separate entity,
59:44
but I can just, I'm Gables pain, he's Gables medical.
59:47
So we just kind of piggyback of each other.
59:50
Awesome, awesome, awesome. I'm assuming you get a lot of
59:52
foot trafficking crossover patients from one another,
59:55
right? That's really, really cool.
59:57
Tell me about salsa dancing. So I'm a very active person.
1:00:01
I just, I have a hard time watching television and playing
1:00:04
video games. So I picked up also dancing
1:00:06
maybe eight years ago. I play soccer.
1:00:09
I do a lot of stuff just to stay active.
1:00:12
Got you. Just stay active.
1:00:14
And what about? Yeah, but dancing in particular
1:00:17
is like a phenomenal workout, right?
1:00:20
I think if you're much better at it, yeah, I'm not at the level
1:00:24
worst. It's exerting me physically, but
1:00:27
it's exerting me mentally to to count steps and to figure out to
1:00:31
keep my arm. So I can't say it's a good
1:00:33
workout yet. No, not yet.
1:00:35
But it's more it's fun. I I will be a little bit like
1:00:38
maybe a bit sweaty. Not, not nothing like a workout
1:00:41
though. Gotcha, gotcha, gotcha.
1:00:43
And what about diet? What about what about what about
1:00:45
your, your diet? How much?
1:00:47
How much did you pay to that? Diet I try to eat a balanced
1:00:50
diet. I do have I have fast
1:00:53
metabolism. I don't have to worry about I I
1:00:57
still worry about eating right. But in terms of diet I eat most
1:01:03
my meals. My breakfast is usually yogurt
1:01:05
and granola with fruit and and boiled eggs.
1:01:09
My lunch is my biggest meal of the day and I stop eating after
1:01:13
5-5 or six doesn't sit well with me.
1:01:17
I don't like waking up with this feeling of just so I eat real 22
1:01:26
full meals a day and a small dinner and yeah.
1:01:30
That's awesome. That's awesome.
1:01:31
Have you ever looked in? Have you ever, have you done
1:01:32
homework into the association between the between diet and
1:01:36
inflammation and especially chronic inflammation?
1:01:38
Yeah, and I believe it. I think the more if we can just
1:01:42
eat a more organic diet with less preservatives.
1:01:45
A lot of these preservatives aren't good for our bodies.
1:01:48
And I think we've seen that other countries have much
1:01:51
healthier diets. My family's Italian and they
1:01:55
have a much cleaner diet, the Mediterranean diet, very health.
1:02:00
My my grandmother is 100 years old, living by herself.
1:02:03
No way I'm out here. I'm going to go here next month
1:02:08
to celebrate her birthday, but my point is, where does she
1:02:10
live? In Genoa in Liguoria, northwest
1:02:15
Italy. So my point the the diets that
1:02:18
are cleaner Okinawa in Japan, they've shown that those diets
1:02:23
that are fish based, plant based, they're less
1:02:26
inflammatory, we create less reactive oxygen species.
1:02:31
So it's. I've been noticing and I think
1:02:34
that's what part of what's been exciting to me.
1:02:38
There's certain things I feel like you can see and tell that
1:02:41
like culture and society is changing despite what the news
1:02:43
or whatever tells you. And I think that there's certain
1:02:47
like markers or indications. So I've noticed recently that
1:02:49
when I go to Costco that a lot of the snacks are being
1:02:54
advertised or actually being, you know, healthier with five or
1:02:59
six ingredients, you know, they opt out of using, you know, a
1:03:02
lot of times they'll opt out of using seed oils or, or, or, or,
1:03:04
or, you know, emphasize that they're using olive oil or, or,
1:03:07
you know, avocado or something like that.
1:03:10
And what what makes me excited about it that is that no one's
1:03:15
Costco is not, you know, in the business of just doing what's
1:03:19
politically correct. They're in the business of
1:03:20
making money and, you know, giving people what they what
1:03:23
they want to buy, you know, and like, if if that's what's moving
1:03:26
off the shelves and if the other stuff is just kind of like, you
1:03:28
know, laying around and they're incentivized to swap it over.
1:03:32
You see with everything, you see it with cheese, you see it with
1:03:34
meat, you see it with snacks, you see it with eggs, you see it
1:03:37
with milk. Everyone just, it just feels
1:03:40
like there's just a mass awareness that the food that
1:03:43
we're eating has been, it has to be a little better and then.
1:03:49
It's trickling down not just to the Whole Foods and not just to
1:03:52
the Trader Joe's that I guess Trader Joe's is so expensive,
1:03:54
but you know, it's going to places where everyone goes.
1:03:57
Costco is where you go with a family.
1:03:58
That's where you go, you know, to shop for 10 people.
1:04:00
So I think that it's a really exciting time that that shows
1:04:05
that that we're we care about what we're putting into our
1:04:09
bodies and that's, that's really exciting.
1:04:11
Yeah, I know. That's true.
1:04:13
That's true. But I also think the flip side
1:04:16
is I think that a major issue in our society right now is mental
1:04:20
health and physical health. Obesity, obesity.
1:04:23
Oh yeah, 70% of our population now is obese or overweight.
1:04:28
Yeah, I, yeah, I went to the, I went to the doctor a year and a
1:04:31
half ago and they told I'm six, I'm six.
1:04:35
I'm closer to 6-4 than six, three and I was 220 4, right.
1:04:41
And actually like you're right on the line of overweight.
1:04:44
I would is what they told me. And like I went home and I was
1:04:49
like, I never thought I was going to be that guy that was on
1:04:51
the line of overweight. And I was like, I got to pull
1:04:53
my, I got, we got myself together, you know, and I'm not
1:04:58
that anymore, thankfully. But it started it just like, I
1:05:02
just need a little bit of a wake up call where I just went to the
1:05:04
doctor and they're like, listen, man, like that craft beer that
1:05:07
you have there is going to kill you.
1:05:08
And I was like, yeah, I, I if it's not going to get kill me,
1:05:11
it's going to give me diabetes. Dude, there's a brewery I go to
1:05:14
that they, they, they used to put, they changed it since, but
1:05:17
they used to put the amount of calories in the pour that you're
1:05:20
going to get and a stout, you know, you know, a dark beer
1:05:26
that's 1012%, I would have 4 or 500 calories in a four ounce
1:05:30
pour. Yeah, it's just it's a lot and
1:05:33
it's great. It's multiple beers, not just
1:05:35
one. Oh, sure, yeah.
1:05:37
I mean, I can I tell you from my own experience, you know,
1:05:39
definitely. But yeah, I'm really excited.
1:05:42
So, so what's what's what's what's what do you hope is next?
1:05:45
So you're, so you're, you're in this place ideally in a year or
1:05:49
five or 10 from now, Where, where do you think you'll be?
1:05:53
So I always tell people, I don't know where the clinic is going,
1:05:57
clinic is going. I can't tell.
1:06:00
I want to be, I want to do cool things with cool people.
1:06:03
Meaning I want to be able to offer these new therapies.
1:06:07
I want to offer the bread and butter therapies safely and I
1:06:10
want to have a, a comfortable and exceptional patient
1:06:13
experience which I can offer now.
1:06:16
But I want to work more like I mentioned with the, I'm working
1:06:19
with the University of Miami middle school medicine.
1:06:21
I want to be able to have clinical trials where we're
1:06:24
advancing this field of regenerative medicine where we
1:06:27
can safely offer these therapies that right now are promised in
1:06:31
the community at large falsely. I want to be able to offer them
1:06:35
safely and with evidence. And I want to say, I want to
1:06:39
guarantee and I can say with confidence that they will or
1:06:44
generate this or they will help your pain and we can offer that.
1:06:47
And I think that if I can do that and be part of that, I'd
1:06:50
feel honored. I'm really excited to see where
1:06:53
you're going to be in, you know, like I'm really excited to see
1:06:55
where you're going to be in a year or two or three.
1:06:59
Just following just like sniffing around and following
1:07:01
what's interesting and you know, kind of pursuing it because
1:07:04
that's where all the groundbreaking and interesting
1:07:06
stuff is, you know, and I hope that I hope that when that
1:07:10
happens, you either call me for equipment or for another podcast
1:07:13
because we could talk about what the what the updates going to
1:07:16
be. But this sounds, this sounds
1:07:18
really, really cool. Dude.
1:07:19
This has been so much fun and so informative.
1:07:20
I really appreciate you taking the time.
1:07:22
Yeah, 100%. I definitely would appreciate
1:07:25
talking again and I appreciate you inviting me on here.
1:07:28
Yeah, I don't do many podcasts. I don't give many invites but
1:07:32
I've done a few and this has been the best one.
1:07:35
Oh man, I, I, you know what? We'll see when you do a couple
1:07:37
more whether you still say that again.
1:07:39
Yeah. Doctor, I really appreciate it.
1:07:42
Thanks so much. And we'll be in touch.
1:07:44
I'll talk to you soon. Have a good night.