Barbell Shrugged - Spine Surgery Preparation, Recovery, and Metal Allergy Testing w/ Dr. Mitch Reiter, Anders Varner, Doug Larson, and Travis Mash #804

Episode Date: June 25, 2025

Dr. Mitchell Reiter is a board-certified orthopedic surgeon with fellowship training in spinal surgery who has been in practice in New Jersey managing patients with spinal disorders for more than 20 years. Dr. Reiter is one of those rare individuals that always knew that he wanted to be a physician. Straight out of high school he entered the prestigious accelerated six-year combined B.S./M.D. Honors Program in Medical Education at the University of Miami. He then underwent five years of residency training in Orthopedic Surgery at The University of Miami – Jackson Memorial Hospital followed by a year of fellowship training in spinal surgery at Emory University in Atlanta which are two of the busiest spine centers in the country. Dr. Reiter spent his first ten years in practice at the Rutgers School of Medicine where he remains an Assistant Clinical Professor of Orthopedic Surgery. Dr. Reiter has been elected to Alpha Omega Alpha (the U.S. national medical honor society), has won numerous teaching awards, and has consistently been named as a New Jersey Top Doctor by New Jersey Monthly Magazine for more than 10 years. Dr. Reiter has published numerous journal articles and book chapters in the field of spine surgery. Enjoy. Work With Us: Arétē by RAPID Health Optimization Links: Sensiband Website Anders Varner on Instagram Doug Larson on Instagram Coach Travis Mash on Instagram

Shrug Family this week on Barbell Shrug, Dr. Mitch Ryder is coming on the podcast and he is a spine surgeon up in New Jersey and also has a very cool company that is testing for heavy metals called SenseBand. And if you have any surgeries or scheduled for any surgeries, I highly recommend listening to this show

so you can understand preparation, recovery, and if there are any irritations or potential allergies that you have to heavy metals, there's a big deep dive into that and how you can arm yourself, advocate for yourself before that surgery. As always friends, make sure you get over to rapidhealthreport.com.

That is where Dan Garner and Dr. Andy Galpin are doing a free lab lifestyle and performance analysis, and you can access that free report over at rapidhealthreport.com. Friends, let's get into the show. Welcome to Barbell Shrugged, I'm Anders Warner. Doug Larson, Dr. Mitch Ryder. Guys, this happened in real life.

We shook hands. That's incredible in 2025. Telling a story, I was asking my kids the other day what they thought I did and my son, my now four-year-old goes, you talk to the computer. I went, thanks, that's great. That's how he looks up to me. Your dad's a real hero just yelling at the screen here. So we got to shake hands in New Jersey and that is special. This is actually how we met through a couple mutual friends and then I'm excited to dig in. You're a spine surgeon up in New Jersey and first off, that seems like a

very complex thing. Anytime the spine is involved seems very, very important to one, have that working, two, surgery around that area. If I have too much coffee, I disqualify myself for that. So I'd love to dig in just on a little bit of like, how did spine surgeon come to be? That's a great question. It's stressful. I wasn't fully warned about the magnitude of that. But you know, I have one of those guys that always wanted to be a doctor since I was a little kid. I did a six year combined college med school program, so I kind of always knew where I was heading.

Did five years of orthopedic residency. And during that, I started to see spine surgery, did another fellowship after that, really getting into spine surgery. And what always impressed me is in being carefully selected patients, they just do so well. Like they'll wake up in the recovery room and say, thank you.

You know, you just cut a hole in them and they're thanking you because the shooting burning pain down their arm or leg is gone. So it really does work great in properly selected patients. That's the key. So, you know, that's what got me into it. When you first see that miracle, you're like, oh my God, I want to be part of that. Yeah. When you look at the spine though,

I would imagine you're not working on the whole spine. Are you more cervical, thoracic, lumbar? Like what is your specialty? Yeah, that's a great question. So within spine, some of the specialties are like deformity, people that are high degree, severe scoliosis. I'll do scoliosis in adults. I don't do that much pediatric scoliosis anymore, but I do the whole spine.

Most of us don't super sub-specialize. I do a lot of cervical disc replacement. Nowadays, a lot of things are about motion preservation, minimally invasive surgeries, everything. We used to set off a nuclear bomb and say, we got it. We realized that wasn't the best answer. We really now are just highly focused on minimizing collateral damage. So I do lumbar cervical. Thoracic is less common, just not that much surgery is needed in that area.

But I'm a broad-based generalist in spine. Yeah, we talked about this in New York. When you say minimally invasive, you just hit like all the bullet points because my wife is also on the product side of cervical spine things. You just hit all the touch points. It's what I've been listening to for the last 14 years of my life. There you go, now you're ready.

Minimally invasive, like, I'd love to dig in because there's some of these surgeries that I did not realize how great, like, I always think the spine being like, it's the back of your body. And if you're going to have surgery there, there would be some sort of, sometimes I learned and this is probably like, I hope it's not all the time. Sometimes you have to go through people's throat to get to the back of their spine. Yeah, a lot of the time. It's actually easier on the patient because everything up here is soft

and moves out of the way. And if you look, your spine is actually in the center of your body. That's why it works sort of a hold you up. Otherwise you'd be constantly fighting, falling forward. Going from the front, there's very good planes between the tissues, so we don't go through your throat, but we move everything over and the recovery is so easy and nice for the patients because you're not disrupting all these muscles and ligaments in the back. The same thing in the lumbar spinal. Sometimes go from the front because your abdominal contents are squishy, they move out of the way. We can really do a much better job reconstructing things biomechanically, restoring height to

discs, stabilizing, putting in artificial discs, all from the front. So at first, even my residents will say, oh my God, it's so close when they see the spine is like right there from the front. But it does work quite well going in that direction. That's so wild to me. Yeah, I would have not realized that. I'd love to kind of dig in. You mentioned kind of like the qualifications of your patients.

And when does somebody actually know that like surgery is the next step? Because we all kind of know that almost everybody is going to have some sort of back pain in their life. And when does that go from like a movement issue that a trainer could help with or like inflammation to dry needling to chiropractic to now I'm in your office saying I need surgery to actually go fix this structural problem.

Yeah, no, that's a great question. I'm clearly the last step in a long line of other things. So most back and neck problems get better. So it's just with some time or some anti-inflammatory medicines. Physical therapy is quite critical. The key is getting your biomechanics established, making sure your core is strong, you have your proper flexibility. There's a lot that goes into that.

So everyone starts with, let's get you into good therapy, have somebody qualify, take a look at you. If you have a great trainer, they can do it too. You know, we use some medications to sort of mitigate the pain while you're trying to get your body to heal and rehab. You know, step two, we start into the imaging, you know, x-rays and MRIs,

and then there's some interventional pain management procedures that's again sometimes, you know, block people's pain and get them back on the recovery course. And then on the last step, and it's always a balance. If somebody has a big mess of a problem that needs a huge surgery, we try hard to avoid that. But if somebody has a smaller problem that's a sound bite that I can fix and get them right back on track, some people choose to do that.

They don't want to wait a year. They want to get back to athletics and sport. So it's balancing risks, benefits, you're looking at your patient, what's their overall health, what are their goals. But yeah, on the last step in a long line of prior treatments. So you really want to exhaust all that. And you have to be your own advocate. I don't want to sound jaded, but there are some surgeons that are pretty aggressive. So if you go into some surgeon's offices, you're going to get told you need surgery, but really make sure you've tried hard to avoid it.

And you probably do your favor getting a second opinion, making sure people agree, you know, with what's being recommended. Yeah, it's probably like the reverse, whatever, whatever methodologies you've used to mitigate the idea of having to have surgery. Once you get to that part of the pyramid, then it's walking yourself back down from the surgeon to the physical therapist to the trainer to the chiropractor. You want to, once you are injured, step by step get to you and then step by step also coming back to being your best self, I would imagine is kind of how you work with things

on the outpatient side as well. Yeah, of course. And surgery is best at sort of undoing mechanical problems like pinch nerves, instability. Surgery for just degenerative problems, arthritis, that's really, it's not a great option. We try hard not to do it. I want to say never, but we really, we're particularly good when you have a very focused problem, there's a mechanical instability or You know what's called stenosis where nerves are being pinched those patients are so happy a lot of them Wish they've done a little sooner because they gave up years sometimes living around it But you know, you know, you don't want to have surgery just because you have an aching back

You want to really have the big problem? So an acute injury specifically for our audience like weightlifters powerllifters, crossfitters, bodybuilders, people do a lot of heavy lifting like rounding your back on a deadlift as an example is just like a very common obvious no-no in our industry because you'll slip a disc. What exactly is happening there and to what degree can physical therapy actually fix that if it's gone too far versus surgery becoming 100% necessary. Yeah, no, I do see a lot of lifters. So, you know, the disc is the cushion between the bones in your spine and it's shaped like a jelly donut. And what a slip disc really is when you tear the outer part of that jelly donut, it's called the

annulus, and then some of the jelly squeezes out and it pushes right up against the nerve, the beginning of the sciatic nerve. So you get that shooting pain down your leg. So that's called a herniated disc and your body can reabsorb that. And most people, your body will reabsorb that. So if you get a severe back pain followed by shooting pain down your leg

and numbness or weakness, that's almost always a herniated disc. And I see a lot with bad form. I used to see when kettlebell swings or the rage, if you don't know just right, I used to see that. And you still start with therapy and medications, and sometimes your body will reabsorb that piece of disc that's come out and healed the whole disc. But when they don't, that's when we do a microsurgery, where I go in there under magnification, five optic lights, and just do a small cut, go home the same day, remove that fragment that's pinching the nerve, and those patients are so happy. So it's a very good surgery,

but you know, a lot of people don't need it. So you start with, you start with a less invasive and if you don't get better, we fix it. Well, you said it can be reabsorbed. Like to what degree after it's reabsorbed, can it just come right back out? Does the tear or the hole actually heal up or is the hole kind of still there and like the pathway out is now the door is open, so to speak. Yeah, you seem like you know your stuff. So that hole heals. It's never quite as strong as a perfect disc, whether you have surgery or not. And there's something called a recurrent disc herniation. So it can re-tear, but that rate is low. It's 7% or so, depending on how

the type of tear. If you have a huge like, like if you have like a blowout Of a tire picture of it, you know It's much more likely that that doesn't heal as well as you as opposed to get a little fissure and a piece squeezes out So depending on the size of the disruption the size of the herniation There's a rate of recurrent disc herniation But what they shown is you you can't really hide from that you want to be active you want to use your your back Is like your heart, you know, you don't ever say hey lay down don't waste those heartbeats You know, you kind of want to be active. You want to use your your back is like your heart. You know, you don't ever say, Hey, lay down, don't waste those heartbeats. You know, you kind of want to use your spine. So we get people back to full everything. You know, maybe the only time the recurrent rate is higher is in like

professional football, maybe very violent contact sports, but lifting, other things like that, they don't raise the recurrent disc herniation rate. Yeah. Um, I mean, specific to weightlifters who are in hypererextension a lot, they end up getting spondylolisthesis and similar issues like that. Do you do surgery for those procedures or is that more of a PT thing? Well, so spondylolisthesis, there's two types of spondylolisthesis. One, the type you see in weightlifters, especially when they start in adolescence, is it's from

a stress fracture in the back, which is called a spondylolysis. A stress fracture means it's broken, but it's like when you take a paperclip and just wiggle it a million times and it cracks. When that happens, when the bone cracks, it can then shift out of place, and that's the spondylolysis. Most time they get better with rehab,

sometimes they do have to do a surgery for that. And those patients, they're back to, you know, deadlifting and everything once it's healed up. So they get back to everything. But most people don't need that surgery. Usually you can rehab through it. I have some like level 10 gymnasts with spinal lacesis, that are doing crazy stuff.

But there's a group that need to be fixed. And when I fix them, they're very happy. They get back to everything. Dr. Andy Galpin here. As a listener of the show, you've probably heard us talking about the RTA program, which we're all incredibly proud of. It's a culmination of everything Dan Garner and I have learned over more than two decades

of working with some of the world's most elite performers, award-winning athletes, billionaires, musicians, executives, and frankly, anyone who just wanted to be at their absolute best. Arrete is not a normal coaching program. It's not just macros and a workout plan. It's not physique transformation and pre and post pictures. Arate is something completely different. Arate is incredibly comprehensive and designed to uncover your unique molecular signature,

find your performance anchors, and solve them permanently. You'll be working with not one person, but rather a full team of elite professionals, each with their own special expertise, to maximize precision, accuracy, and effectiveness of your analysis and optimization plan. Arrete isn't about treating symptoms or quick fixes. It's about unlocking your full potential and looking, feeling, and performing at your absolute best, physically and mentally when the stakes are the highest. To learn more visit aretelab.com that's a-r-e-t-e lab.com. Now back to the show. Yeah. Yeah, go ahead Doug. Sorry. I was gonna say a specific to me I've done a lot of jiu-jitsu in my life and the guys we were hanging out with in New Jersey, buddies of yours, they also do a lot of jiu-jitsu. Neck problems are especially prominent in jujitsu.

You're being guillotined, you're being choked, you're being collar tied, and there's just a lot of wear and tear on the head and neck. I've had chronic neck pain now for 15 years, never warranting surgery in my opinion, but it's just kind of always there. So in a selfish way, when should I start start looking into surgery if ever for, you know, for like the kind of like the gapping that I have felt with someone just tearing on my head trying to choke me and I can feel my spine kind of pulling apart at times. Yeah, that's a good question.

If you're not having a shooting pain down your arms, you know, I would try hard to rehab. I would see an actual therapist because there are certain physical therapy things reposition your head. It's called chin tucks. There's certain ways to take some strain off those discs, improve your flexibility. And then if it's really bad, you may at least want to see somebody you get an MRI know what you're up against. If there's one bad disc, I'm a secondary black belt. So I've done disc replacement surgery and some jujitsu people and they've been very happy. They're back to full contact. First I was a little worried because I was like,

should I do a fusion, which is a more solid surgery but not as good for them? But I have disc replacement people doing jujitsu, getting choked out and everything's going well. So there are options, but neck pain, we try hard to avoid surgery. When you start getting nerve pain, we lean more towards surgery. Years and years, if you've already tried rehab and tried everything then I would

at least see somebody get an MRI and just know what you're dealing with. Yeah, very fortunately I've not gotten any shooting pains. It's pretty localized. I seem to be hypermobile, mid cervical and I do a lot of manual stability exercises and that's helped a lot and I just don't compete anymore which is another part of it. But yeah, it's uh, it's always kind of on my mind of am I ever gonna need to have surgery on my neck at some point? Which of course I don't want to have if I don't have to yeah, hopefully not And yeah, but you want to keep doing those exercises And I tell people just like diabetics have to watch what they eat you have a neck issue You got to set aside five or ten minutes a day to keep your neck really extra solid and bulletproof that area. Mm-hmm. Yeah

to keep your neck really extra solid and bulletproof that area. Mm-hmm. Yeah. You mentioned earlier about kind of people having that instantaneous relief. Is it common to have reoccurring issues or is this kind of... I would imagine it's your goal, but the reality of life is that a lot of people go back to the same bad habits or don't fix some of the movement issues or whatever that is When when you see that people walk out healthy are they are they typically coming back? Do you is it is it there are there many people that have like the recurring issues?

Like specific to spine Yeah, so it's a multi-layered question. So our spines are segmental, meaning there's lots of different levels. So if you have a problem at L4,5, for example, it's in your lower back, the rest of your spine is still there. And even if I fix that level, there's a chance you're going to have trouble at another level.

You're going to keep getting older, which is a good thing. And then our goal is to not have you come back for problems at the same spot. But that being said, you know, like we talked about with the disc herniation, we get the pressure off the nerve. People's job is to keep their core really strong, stay fit. And usually they never look back. We've tried with surgery to do what's called motion preservation, where we used to do what's called a fusion, where you remove motion from the spine and make things really solid.

And they felt good. But the problem is that then puts stress above and below the fusion. You transfer that stress to the next levels and you accelerate the wear and tear at those levels. We try nowadays to do less fusion, more motion preservation surgery to reduce the risk of needing additional surgeries. But your spine keeps getting older,

there are other spots and there's things that can recur, so we deal with it. The other thing is when people just injure their back in general, we say that back and neck problems are episodic. I mean, you can be fine one day, and then reach for a can of soda, and your back go out, and you're stuck on the ground. It's a Nobel Prize-winning to be won.

They have some famous MRI studies where they have somebody with a baseline MRI for some chronic back pain. They re-MRI them when they can't even get out of bed because they went to put their sock on and there's no change. Then over a few days or a week, they usually reset to their baseline. There's not something massive structural that happens, but back and neck problems can be episodic where you can have a major flare up and we just need to learn to rehab through

that, use medications. And over time, you know, if you get your back in great shape, that happens less often and they're not as severe, you know, they don't last as long. Yeah. When you said that many people have that like instantaneous feeling of relief, it's very interesting how some body parts specifically, like my dad had a hip surgery and they wanted him walking on it immediately that night like walking out of the house or out of the out of the office essentially like load it as as much as as hard as fast as you can to like really

start to like dig that new thing into your hip and your shoulder and your hip are like relatively similar but my mom had a shoulder replacement and that was like four months of do not move your arm. It's in are there different parts of the spine that take longer to heal in that like some of them are more stable areas of the spine. Some are built for more flexibility. Does it matter where when it comes to kind of the recovery side of things on how long people can expect to be dealing with any pain or issues? Yeah, so it's very variable for different parts of the body. So first, before I go to spine, for example, in a shoulder surgery, you're reattaching ligaments and tendons. Yeah.

Those reattachments are weak until they heal. So that's why motion is limited. You don't want to start firing muscles off and pulling rotator cuff off. Yeah. Hip replacement, it's really stabilized with cement. It's impacted in there. You want them up.

So every surgery has to be tailored to the exact, what was done and the patient, but in spine, the big push is to rep for rapid mobilization so we fix things strong enough so you can get up and out of bed quickly because it is very bad for you to be stuck in bed any longer than absolutely necessary. So nowadays you know with implants and you know we can make things strong that we usually don't even need to use a brace or some doctors like the braces you know belt and suspenders but we get people up and moving quickly whether it's the neck or the lower back so very it's very rare to

tell somebody to stay down. While we were in New Jersey you were talking about different types of metals with the implants can cause problems within the body. I had had some taste of this with my mom when she wears a necklace, like her skin will start to bubble up and like get all blotchy. And I never really thought too much about putting metal in your body from an implant or a joint replacement. But you talked about this extensively when we were in person. Can you dig into that a little bit? Yeah, no, definitely. As you know, I have an invention related to that. So, you know, allergies have become just more common. You know, I have kids with nut allergies. You know, we carry EpiPens.

You know, gluten allergies are common. You know, you know, there's all kinds of autoimmune diseases. For whatever reason, we are all just, our immune systems are more sensitized. And, you know, we're trying to figure out what's causing that, but it's a fact. And metal allergies are common. There's a lot of people that can't wear certain jewelry

or they'll react to a belt buckle or to a ring. And yet despite that, surgeons are putting metal in people all the time and almost nobody's getting tested. And that would be okay if all the results were great, but the problem is the results are not always great. Something like 30% of knee replacement patients have chronic issues, have a suboptimal outcome.

Same thing with hip replacements or certain dental implants, sports procedures. Any procedure where metal is put in your body, there's a subset of people that don't do great. And some of them we think might be a reaction to the metal that's in their body. And then actually in 2019, the head of the FDA even put out an alert saying,

we need to figure more out about this. People are having reactions to metals in their body. So that's, you know, I, you know, triggered my interest. And then there's a long story that goes after that as to where it led me. But, you know, definitely some people react to metals, the metal allergies are known. I mean, any, you know, a lot of women will know they can't wear certain metal. Yeah, we're putting them permanently. When you, when you were talking to us about it, it was one of those things to me where it was like, it's like, duh, this is like so obvious, like, in our lab testing that we do inside our program, like, we test for heavy metals. We want those gone from people. And then you go and have surgery, you're like, how about this metal rod we're gonna put on you, you're like,

hold on a second. How wait second. No one's testing me for does this fit for me? I guess what are the normal metals? Which ones are safer, broadly speaking? What's the standard practice and what are the options that people can have going in to have this conversation with their doctor? And also, the thing about the outcomes not being great, it turns out that the surgeons have options as to what they put in you. It's not just you get the exact same implant for everybody. And we want to figure out ahead of time, what is the right implant for each person? And there's ways to test people now for metal allergies to see, hey, maybe nickel isn't right for you, or maybe cobalt is not good to go into your body.

And medicine has changed, and people like you are helping wake people up that we can't wait for problems and then go after them. We can't say, hey, now you have diabetes. That's the last step on your insulin axis going off for 20 years before all of a sudden you meet the criteria for diabetes. So it's the same thing with surgery. We need to get the right implant for people. The most common metals that are put in people, stainless steel is an alloy of nickel and

chromium and iron. Iron is okay because it's in our blood. Nobody reacts to iron, but sometimes there's a little cobalt in there. Titanium is now like titanium, vanadium, aluminum. So joint replacements usually have nickel, cobalt, chrome, and molybdenum. So there's a lot of metals that get put in people. And most surgeons are just busy and they just aren't interested. And they don't want any barriers to getting people into surgery. They're just trying to move fast. And it's not a short conversation when you start asking people about mental allergies because a lot of them

have them or a lot of them know somebody who, hey my aunt had a knee replacement and it went south. You know a few percentage of these things get loose, of implants get loose in people and they call it aseptic loosening and we don't know what's causing that but you know we suspect allergies may be a part of that. We're not, you know, they're getting loose for unknown reason. Hmm. Wait, so what will be the mechanism there?

If you, if you have an allergy to a metal, how does it cause the, the implants or the replacement to loosen? Yeah. So an allergy to a metal is called a type four hypersensitivity reaction. It's a, it's a T cell mediated reaction and it leads to chronic inflammation. So a lot of people that have an implant will have pain at the site of the implant or inflammation or swelling, but some of them get more systemic symptoms. They just feel crappy. They're tired, they're achy, you know, fatigued or headaches. And the surgeon is a lot of times just write them off and

say, hey, you know, you have fibromyalgia, you know, that's why you are achy and everything stinks or you know, it sucks to get old or, it sucks to get old, or they say you're depressed. There's a lot of answers to why people say, I'm not doing great after I had this implant. But what's happening is they're having inflammation in their body. It's a T-cell mediated type 4 hypersensitivity response. And it causes any type of inflammation, which is all those things, swelling, bone resorption, whatever inflammation causes. Yeah, I can see the swelling especially. It's like it swells, it's getting bigger and smaller over time and then kind of just makes it looser and looser and looser.

And then as it gets kind of more wiggly, people say, it just gets achier. Yeah, and that's a smaller percentage of people. Some people don't get loose, but they just hurt. They're just like, hey, I have my knee replacement, still hurting. It's five years later and it's aching and swelling. And if you find out, hey, you have a chrome allergy, it'd be nice to know that so that you don't get another knee replacement with chrome in it.

And that's kind of the concept behind what I've invented, a way of testing people, because what we wanna do is make sure they get the right implant. The big companies make nickel-free implants. They make hypoallergenic implants. So while they don't like to talk about this problem, you know, because they sell so many regular implants, they obviously know

it's out there. And there's they come up with solutions. So it analogy I asked people, I tell people is that I'm going to buy a house under a cell tower. And I said, Well, listen, I called Verizon, I called AT&T, they said it's okay. You know, I don't know how interested they are in actually knowing, you know. Sure. Same thing with the implant companies. They're nice, but they're not looking for trouble,

if you know what I mean. Yeah, yeah. You said something similar about other doctors, like they, and you said something similar on the show just now about how they just wanna move fast and get things done. If you can't be like directly blamed for something, then, you know, not my

fault, not my problem. But you mentioned in New Jersey that you've talked to other doctors about this. And they basically said, I don't think you really think it's a problem. And then you ask them like, well, if you knew somebody was allergic to nickel, would you put a nickel implant in their body? And they said, Oh, no, no way. Absolutely not. And you go, well, so it does matter. You should test your patients for this, right? No, you're exactly right. I'm always flabbergasted because they say, I don't think it's a really big problem.

And there's some data that tries to say that it's not a big problem. Because if you just look at what's the failure rate of knee replacements, they're going to say it's equal. It's not failure. You've got to look at nuances. But then I said, well, if they come up to you and say,

I'm allergic to nickel, well, then they're going to say, oh, I won't use nickel in you said they get like you just said they do care They just don't want to scientifically gather that information prior to surgery So it's it's I don't know how they rationalize that in their mind, but it's a nobody says oh you're Nick allergic I still put nickel you I don't care. Yeah, I mean not a shoulder surgery. I slapped air years ago and You know got it fixed and it's better in many ways, but it still hurts on a regular basis. Like not all the time, but sometimes achy, sometimes I get a sharp pain here and there. Like I consider it to be a successful surgery, but it's definitely not what it used to be.

And so if you get a replacement and your knee is still achy, maybe it's just a two out of 10 for the rest of your life on the achiness scale, it's a successful surgery, but also it'd be a lot better if it didn't ache. Yeah, exactly. So the achiness might just be that's just the way it is, you know, or it could be you're having a low grade response. The thing is, if it's easy to know that, it'd be nice to, and I'm not saying ever take that thing out unless it's really just a total failure, but you know for your next one, because a lot of people get one knee replaced and five years later they need the hip replaced or they need the shoulder done. It's nice to know, hey, nickel is not good for me. There's other options. So let the surgeon know.

So if you've already had a joint replacement, or we also talked about dental implants as another way people get metal into their body, And you are experiencing some chronic achiness. You suspect maybe after hearing this show, you have a metal in you that is problematic for your body. You're having some type of immune response to it and the achiness or pain you're feeling is from an inflammatory response to the metal itself. How do you test for it? And then after you test for it and you determine,

hey, they put nickel in my body, I respond negatively to nickel. Then do you go back to your doctor and say, hey, you guys put this metal in my body that my body is allergic to or I'm having a reaction to, I want a new one or is it gonna leave it in? There's downsides. There's about two, right?

So, the way we test for mental allergies traditionally before, you know, a Sensiband that I'll talk about is, there's really two ways. One is called skin patch testing. That's the gold standard where you go to an allergist and they put patches on your body and you go back to the allergist two days later

and they look at them. And sometimes they'll have you come back at five days if it's trying to get a delayed look. So it's three visits. But it's really a metal salt in a petrolatum gel. There's adhesives. You can't exercise because you can't sweat under there. You can't swim.

So it's inconvenient. It's expensive. It requires multiple doctor's visits and it gives you the skin data. And then there's another test called lymphocyte transformation testing. It's very rarely done, but it's a blood test. It's expensive and it's really not at the approved for this, but it might be a really good test. You know, as

we're trying to learn more about that test, but it's rare and like I said, not even FDA approved for it. So there was really, we need for something better. So what I wanted to do and my partner, Mark Dersalo, was a spine surgeon as well, we wanted to make a test that was convenient, didn't require a prescription. We wanted patients to learn what they were was convenient, didn't require a prescription. We wanted patients to learn what they were allergic to, empower them, and we wanted to make it cost effective so we could look at large populations of people, not wait until somebody's having the rare failure, then they go for the lymphocyte test. We want to look at everybody. So, Sensiband is a wearable device.

You get a kit that contains multiple metals. Right now, the kit has seven metals, and you can wear them on your wrist like a watch, like a swatch, for seven days, and you see if you get a kit that contains multiple metals. Right now, the kit has seven metals. And you can wear them on your wrist, like a watch, like a swatch, for seven days. And you see if you get a delayed type hypersensitive reaction. It's called a contact dermatitis, like a poison ivy type reaction. So if you get a reaction to the metal on your skin, then it gives you some information.

So those are the three tests. Now we used to be only two tests. Now you have three tests that let you know if you're allergic. To get to the second part of your question is, what do you do if you're having a poor outcome? So mental allergies are the Wild West. Like nobody fully understands them. So I'm not saying that your doctor did malpractice or something crazy and they didn't test you. Like we're trying to get this out there. It's not really being done commonly yet. We're trying to change medicine just like you guys are trying to get

better testing ahead of time to make people healthier. So if you go to the dentist and having a poor outcome from your implants, number one, if you get another implant and you're nicologic, they can do what's called a zirconium implant. It's a hypoallergenic better implant. So more expensive, but it's better. My partner insisted on zirconium implants in his mouth,

for example. Should you take out the old ones? I would not do that unless they're really failing. Because taking an implant out is a big deal. There's downsides to that. Now, that being said, there are cases where people have a metal allergy that's so bad that the implant is revised and they have a better outcome. But that is a big decision with risks that you need to discuss with your surgeon. It's not like a gimme, like get these things out. But it will let you know the next one that needs to be done should be done with the proper metal for you.

Give me any data or any insight into kind of what percentage of the population has these kinds of issues? Is this like a 0.1% of the population or is this like a 5% of the population? Where are these numbers in your mind? No, they're pretty high. So in Europe, they actually have something called the Nickel Initiative where they're trying to use

less nickel in all products because so many people are becoming nickel allergic. So in the United States, 20% of women are nickel allergic. So it's a high percentage. Men, it's lower. It's probably below 5%. Chromium and cobalt are the next two metals

and they're in the sort of one to three percent range, so lower. And then it goes down from there. Titanium is pretty rare to be allergic to. Vanadium is very rare. But nickel, chrome, cobalt, they're up there. Not super high, but 20% for nickel is really high in women. So those are the sort of the four horsemen. So it's not 0.1%, it's higher than that, but it's not, you know, half. And then as far as implants go,

like what are the most common metals for implants? Yeah, that's great. So if you break a bone or have a sports procedure, usually they're using stainless steel, which contains nickel and chrome, two of the worst offenders. And there's a titanium option. And titanium works just as well.

Maybe it's a little more expensive, not even much. So if you're nickel allergic, you have a great alternative. So most broken bones and sports procedures are using a stainless steel implant. When you get into joint replacement, the metallurgy is more complex and they're using cobalt chrome molybdenum. That's why we test for all of those. But there are hypoallergenic joint replacements. There's one that contains none of those. It's made of zirconium. But most commonly, they make nickel-free joint replacements. Most big companies

now have a nickel-free option since nickel is so much higher than all the other allergens. So they're commonly put in people's body. In spine, we use titanium implants. And titanium is very hypoallergenic, not zero, but much lower. And we don't have a good alternative because in the spine, we use MRIs a lot. And MRIs, you can't have what's called a ferromagnetic material near where you're looking with the MRI, it creates a blur. It's not dangerous, it doesn't go out of place or anything, you don't drag across the room. But it causes a blurriness or artifact around it. So we try and use titanium implants. So spine, we don't routinely test because we don't have

a great alternative and you know the incidence is low. So in all of medicine we're always looking at that. What is the incidence? What is the alternative? But in germ placements you have great alternatives and in other surgeries you have great alternatives and the incidence is not super low. So if it's cheap and easy, why not, why not? No. Yeah. Um, you also mentioned since you just mentioned titanium, I remember you saying that Skittles have titanium.

I think they have a titanium dioxide or they have something dioxide. They have a metal coating. It's not, you know, not in Europe, in the U S um's a metal, it's on the outside. So I'm not as good at the nutrition side of metal allergies, but some people really don't love it. I'm going to look, I'm just going to look right now what metal is in Skittles, just so I don't get it wrong. Let's see. Titanium dioxide. Yep. it's titanium dioxide. So that's the coating to make them shiny and crunchy. Yeah. Kinda crazy, like.

Crazy. You know, it's not funny, but a lot of people are worried about nutrition and with the metals in your nutrition too. It's sort of out of my area of implants, so I don't wanna go there, but the allergists I've talked to are starting to think about that as well.

Sure. Yeah, we don't need to dig into it too much, but imagine if I'm a person who flags, I got one of your Sensi bands on right now, I've been going through the metals. If I flag for titanium, I probably will stop eating Skittles. But I like Skittles, but I would not eat them at all if I saw that I was having a significant immune response to them. Yeah, fortunately, titanium is a pretty low instance of immune response. Thank God. But what once got me into this, I'll give you just a divert,

what really made me go all the way with SensiBand, I've been worried about allergies for quite a while, you know, and I've been thinking about it, what do we do? We need to find a way to test people. But then I operated on a nurse, and I had done a cervical fusion on her like 10 years ago before we had disc replacement. She had a good result for 10 years, but then the next level wore out, which is what you worry about with fusion. So she had a titanium plate in there, but I took it out and I converted the next level to a disc replacement, which had cobalt and chrominate.

And she did great for about a week, arm pain gone, you know, typical happy result. And then her whole body started having her ashes. Really bad. She's losing it. I sent her to allergists, immunologists. Ultimately she was found out to have a cobalt allergy and she was on high dose steroids. We tried everything. She begged me, she said, please just take this thing out of me. So six weeks after surgery I agreed to take it out and I was worried that maybe, I thought maybe she had a new pesticide in her house, a new laundry detergent, like and I'm gonna take this thing out her neck. So I took it out of her neck and replaced it with a fusion with the same type of titanium plate that I knew she tolerated and everything went away.

So that made me really say, holy cow, there's a subset of people that are very reactive and I've been hearing that but I haven't seen it. And you know, she literally everything went away and she's great. She's just, seven or eight years ago, she's fine. So it's pretty, and there's a subset of people that are very reactive. And then there's a lot of people that are non-reactors, just like we know some people are sensitive to their environment and other people are not. When it comes to surgery though, if somebody has this reaction,

is there best remedy for this, depending upon the kind of the severity of that reaction to have another surgery and replace that because that seems like you know I think that's a great question. I've been a prize 27 years once I've had to do that. So yeah, no, most people have a much, much lower grade reaction and I'm not saying to take it out. I'm really saying ideally you identify beforehand. Test yourself beforehand because your doctor is not going to do it for you in most cases. Some doctors are getting it.

Once you know about mental allergies, it's so obvious. If you're reacting on your skin, you don't want to put in you forever. But test yourself and go to your doctor and say, hey listen, I react to chrome. Please don't use a chrome implant and then they won't. If you already have it in you and you're having some response, the answer is, you know, now you have an answer, you know why you're reacting and don't get that put in another place. If you're in a small subset of people where the reaction is so bad and you just really can't take it, then you have to weigh the risk and benefits of a revision.

But that is not the knee-jerk response. Most people ride it out. It's kind of like Doug. His shoulder isn't perfect. That's probably not an allergy. There's a small chance, but it probably might just be how surgery ended up. But if it is an allergy, I wouldn't mess with it for what you're feeling. It's too risky to go in there and mess with your shoulder unless it was just a freebie to take out one screw or something. So in general, you're kind of stuck once you've had the surgery, unless it's a very bad reaction. But just knowing what's bothering you, instead of the surgeon telling you you're depressed, you say, I know, the reason I feel crappy is I have low grade inflammation because I'm reacting to nickel that you put in me. Yeah. I can imagine the frustration that would be too. One, not knowing, but any allergic reaction,

even if it's seasonal allergies, you're like, my nose is running. When it's inside your body, what are you going to do? Itch it away? You can't scratch. That would be the most frustrating thing. You're like, no, it's in me. I can feel it. This is bothering me.

And someone's like, I don't know. And you're making a point. Plus, you're inflamed. And that's probably not good for you. I have friends in cardiology. And since we're just on the edge of learning this, we'd love to do some bigger studies looking at inflammatory factors, because they do lead to coronary artery

disease and other things. So it's probably not healthy to just sort of always have some inflammation. Yeah. It just eats at your immune system for, you know, call it three, four percent a day, but over time that compounds and it just chips away. We don't have data. Yeah. I don't have data on that yet, but it's sort of intuitive that, you know, you probably

don't want to be inflamed. Yeah. Are you guys doing any kind of a more comprehensive studies into this? Yeah, no, that's a good... So we are FDA registered, meaning we're safe. You know, FDA knows about our device and we manufacture according to strict FDA criteria. We are now doing some trials. We have a surgeon named Dr. Sa, Alexander Sa in California, does over a thousand joint

replacements a year. He's looking at our tests versus skin patch testing and lymphocyte transformation testing. He's going to look at the rate of, there already is some data showing the rate of allergies in patients that have a failed implant are much higher than the normal population. So some of them probably are from allergies, like the implant has failed and we know they're much more likely to be allergic. So we're doing some studies, but the problem is I have a day job, I'm a spine surgeon, and it's kind of tough, but once we get some traction and we have the funding needed, we could start to hire staff and look at bigger studies because we do want to push forward the science in allergies.

Because right now, with the SensiBan test, some people are claiming the skin is not as good as testing internally. The truth is, allergists use skin patch testing. Like, they're the experts. And what test do they use? Skin patch. They don't say, no, skin doesn't matter. So when surgeons say to me, I don't think skin matters, I say to them, well, do you think it's a different immune system? It's the same immune system, the same T cells, they migrate. So, but the industry is trying to say, oh, skin patch testing is not that helpful. And, you know, they're trying to denigrate. And again, we need more science.

And I don't want to say they're totally wrong to just question. But on the other hand, if you don't have data, you probably should err on the side of caution, as opposed to err on the side of just keep doing what you're doing and not care. Yeah, I think anytime most people are telling you you're wrong, you're doing a great job. That just means you're thinking outside the box and you probably have something that's like poking holes in a narrative that needs to have holes poked in it. And I feel like anytime someone's making a broad generalization of like, you should do all like, hold on a second, what about for me?

I don't want to hear like the the whole country should do this. I want to know what I should do. And if you if you send somebody your product and it has eight different things to test for, there's a there's a decent chance, especially with the overall health of people, that there's going to be some sort of inflammation, some sort of reaction to one of those things, and it at least arms the people to be advocates for themselves to go in and say, can we at least pay attention to this? Yeah, I know that. I think that's what we're trying to do. And the kits might be, you know, we have seven metals in them now. That's a little bit overwhelming, I think some people we might make some smaller kits because most people if you're going for regular surgery

you probably don't need to test for titanium and aluminum and we want to pair it down because We don't want we want to make it an easier sound bite for people to handle if you're gonna considering a joint replacement Maybe just test these four, you know If you're considering, you know trauma surgery just do these three, you know We're trying to simplify it so that people don't have to, because wearing seven different bands might just be a little overwhelming for some people. We want to make it more approachable. But yeah, we want to empower the patients so they know what the right implant is for

them. My partner, he's concerned because when you get a stent in your heart, when you have coronary arteries, those stents, most of them contain nickel. It's called nitinol. It's a metal with nickel in it. And they do make titanium versions of that, which would be less allergic. So we don't have data yet, but it makes sense to me. If you react to nickel, I don't know if you want it in your coronary arteries. It may not be as effective. So again, this is an example where we just need data and it's going to be expensive and difficult, but maybe with AI, we're going to be expensive and difficult but maybe with AI we're going to be able to drill through some of this because like you said, what you'll look at

is a giant study that says something doesn't work because the effects are canceling out amongst various subsets of patients and you really have to drill down to find which subset to get the right information out of. Well, if I was about to go have a surgery and you showed me some of the after pictures of people and their Allergies to specific metals I would be wearing all of the band Make sure that I was not about to put something in my body that was going to cause that much I mean it looked like some people were having like actual like holes like burned into their body You know not maybe not that aggressive,

but the the inflammation like it looks like it almost like bubbles up on the skin. And I couldn't imagine somebody like that going in and actually having that permanently implanted into their body like you talk about the immune system and the inflammation, that's guaranteed to happen. And it may not be one, two, 3% of an inconvenience, but those people, it could be 15, 20% of an inconvenience

on a daily basis and irritable. Some people have like, from the pictures you showed, like that's a serious thing that people need to know about. No, I agree with you. Once people see the reactions, you get it. Whenever someone says, I don't think it's a big deal, I say, well, look what nickel does to this woman's skin in three days. Do you think you should put that in her body? And it just passes the smell test. It's completely obvious that you shouldn't do that. So while I don't have data on 50,000 joint replacements and looking at drilling down into swelling and inflammation and revision and you

know we kind of it's obvious that you just don't want that put in your body. Yeah. You know especially when there's a good alternative like why not just say hey you know what use the one that doesn't have that. Yeah. So in your mind what is what is best case scenario for surgery prep for this category in the next five, 10 years here? Yeah, I mean, I think the best case would be, I think once patients start doing this and going to the surgeon and saying, hey, before I get my knee replacement, my hair replacement, know that I'm cobalt allergic, I think surgeons will then start to say, hey,

you know what, I got to get on board with this. Because right now, surgeons just don't want to spend the time. Because it's not a one minute conversation. You have to explain to people and some people who are on the cusp, you know, say your knees bother you, you may need a knee replacement and then you hear, oh, you could be allergic to the metal. You may say, I'll hold off for a few more years and surgeons don't like that. They want to get their procedure done. So ideally we'd like to get, we're marketing now to the public. We realize that some surgeons are adopting this but

a lot are just, they just got too many plates in the air, they just can't do it. So we want the public to know about this. And I think before you get a surgery, you should ask the surgeon, what are you going to be putting in me? And then just test yourself to those metals and go back to them and say, you know, I know you're planning to use a nickel containing implant, but I'm nickel allergic. Can you use something different?

And I think a good surgeon who'll say, yeah. Now some surgeons say, nope, I only know how to use this one. And that probably tells you something about them. You probably want to then find somebody who can get you the right implant. And then other people will say, well, should I also do the LTT test or do the skin patch test? We don't know which of these is superior, but I know if I react to something, I wouldn't say, well, I did the blood test and it says, okay, and put it in my body. I think if any one of those is positive, I'm going to err on the side of don't put it inside

of me. But yeah, our goal would be to empower patients, get people before they have surgery or people having a poor outcome from surgery to test themselves and not to revise the implant, but just to have an answer and know not to get it again. And then over time, we'd love it if it was just part of the surgical protocol to test people, at least for the most common metals, nickel and chrome and cobalt and tailor the implant to them so that we'll see less failures and better, just better overall outcomes.

Yeah. Yeah, absolutely. I mean, and just for, just for the audience, like we get no financial benefit from, from talking about this. We just met in New Jersey here a couple of weeks back and you were talking about it. And again, me having my mom my entire life, knowing that she had having seen her reacting to metals, just wearing a necklace or whatever it was, that really caught my eye when you were talking about this.

And also thinking I'm probably going to end up with a joint replacement at some point in my life. And I figured I should I should be on board with this from day one and I'm wearing one right now. Of course, I've gone through a handful of metals, haven't reacted to anything yet, but I figured since I very likely would have some metal in my body at some point that it would be wise for me to jump on this as convenient as it is. Just basically to wear a watch for a couple weeks to figure out if metal is going to cause a problem for many years in a row. Might as well just knock it out.

You're smart, you're smart. Cause also, if you have an accident and you break a bone, unfortunately you're not allergic. But if you were reacting to chrome or nickel, you could say, you know what, I'm nickel allergic or chrome allergic and they'll use a titanium plate. It's right there or titanium rod. So you're gonna, you're ahead of the curve,

but most people are not gonna react. And that's good information to have, too. You say, hey, listen, I'm not about... We're looking at testing the military, you know? So we've had some meetings with the military and testing soldiers ahead of time so that if they get injured in battle, they'll know what's right for them. So the military, you know, we've had to reconfigure the kit. Everything has to be made in America.

We're doing it, you know, and we're hopefully going to get that, you know, accomplished. But, you know, they're looking at hard at us because they see the value. Yeah, dr. Ryder. This has been fantastic, man it was great meeting you in New Jersey and As soon as you started talking about this. I was like I did I did that thing was like stop talking Authentic we got to get you on the podcast we can do a full hour so I appreciate you taking the time to come on today and Tell tell everybody kind everybody what you're working on here. If they are interested, where can they find you, Sensei Band, kind of all the

outlets that you have? Perfect. So right now we're available on Amazon and Shopify and we're going to be on Walmart's online store very soon. We've had meetings with Walgreens and CVS but we're not there yet. So right now, probably just Google Sensei Band, Amazon or Shopify are probably the easiest ways to get a hold of it. And listen, I really appreciate you guys having me because what you're doing is great. You guys are forward thinkers. You want to preemptively catch problems and that's what you're all about. So I'm so glad you see the value in this as well.

Absolutely. And we'll put a link down in the show notes as well. So make sure you check that out if you're interested. Doug Larson. You bet. I am on Instagram, Douglas C. Larson. Dr. Wright, appreciate you coming on the show. I think you're onto something very cool here. You also of course are a forward thinker

and not many people are talking about this. So I think you're doing good work here. So appreciate you being here. All right, thank you so much. I really enjoyed having you doing this and thanks for having me. I'm Anders Varner at Anders Varner and we are barbell shrug to barbell underscore shrug to make sure you get over to rapid health report.com. That is where Dan Garner and Dr. Andy Galpin are doing a free lab lifestyle and performance analysis. And you can access

that at rapid health report.com friends. We'll see you guys next week.