StarTalk Radio - Rebuilding the Human Body

Episode Date: August 28, 2020

How do we rebuild athletes after injury? Neil deGrasse Tyson, co-hosts Gary O’Reilly and Chuck Nice, and orthopedic surgeon Dr. Kevin R. Stone, MD, investigate the world of surgeries and recovery. NOTE: StarTalk+ Patrons can watch or listen to this entire episode commercial-free here: https://www.startalkradio.net/show/rebuilding-the-human-body/ Photo Credit: The Stone Clinic. Subscribe to SiriusXM Podcasts+ on Apple Podcasts to listen to new episodes ad-free and a whole week early.

Hey, StarTalk fans, just a heads up. This episode of Sports Edition features frank, detailed conversation about physical injury, surgery, and other similar topics. We advise you to use your discretion while listening. Welcome to StarTalk, your place in the universe where science and pop culture collide. StarTalk begins right now. This is StarTalk Sports Edition. This time we're talking about rebuilding athletes.

We can rebuild them. We can make them faster. We can make them stronger. That's, of course, Chuck Nice. Chuck, there you go. Hey, what's up, Neil? All right. Looking forward to this.

I just want to know if they can actually give them the sound effects that go choo-choo-choo-choo-choo-choo-choo. You need the sound effects. Otherwise, it's not really happening. The whole show was sound effects. You're talking about a show from 40 years ago, The Six Million Dollar Man. Hey, look, it's part of my wonderful childhood. Gary O'Reilly. Gary, you're the only thing that gives us street cred in this sports edition. I want to make it's part of my wonderful childhood. And Gary O'Reilly. Gary, you're the

only thing that gives us street cred in this sports edition. So I want to make it clear to you about that. Well, my ego is suitably happy. And thank you. Good to be here again. Former soccer pro and sports commentator, actually, before joining us here on the other side of the pond. us here on the other side of the pond. And today we're talking about sort of rebuilding athletes. Can we rebuild them? And we've got somebody who's intricately tuned in to just that need, Dr. Kevin Stone. Kevin, welcome to Star Talk. Thank you. Thank you. Excellent. So you're based in San Francisco, a private practice. And you, I have on your sort of mini resume here, you've worked with the U.S. ski team and at the U.S. Olympic Training Center

and with various dance and ballet companies. So these are sports that really take a toll on joints and limbs. And so, but do you specialize in knees? Is that correct? Indeed, we see primarily knees, but also shoulders and ankles. Oh, okay.

Now, what about toes? Head, shoulders, knees, and toes. What about head and toes? You want the whole song in there. Do you sing during surgery? Only for patients who sing to me. Okay. No, that's how he remembers how the body's connected, right?

They need the mnemonics themselves. Let me tell you something. If your orthopedic surgeon is singing head, shoulders, knees, and toes to remind them of where the parts are, you need to come out of that anesthetic. Haze. Come out of that haze and get off that table.

So I think in your field, you're an orthopedic surgeon, but you're also a scientist and inventor. And you hold 41 patents. Whoa. For like including medical devices, among other things. Now, are patents like babies? Do you have a favorite, or are you not allowed to have a favorite? Oh, you definitely have favorites.

The ones that pay you money are the favorites. They make the most money. Oh, my God. It is just like fatherhood. It's just the same with the kids. So tell me something. What's the difference between what you do and what someone who might specialize in pain management do? Because in all those sports, they experience pain.

And is the pain telling you you've got to replace their bones or fix their bones? Where do you land in that landscape of surgeons and other doctors who help athletes sure so the pain management folks are wonderful in that they help treat the pain my job in life is to cure the problem that caused the pain so okay so so the book begins and ends with you okay and sometimes that means going in and messing with the bones i I guess. Yes, it's more soft tissue these days because our athletes more commonly tear their meniscus and their ACLs and their articular cartilage than they break their bones. Oh, okay. So now I once heard a long, long, long time ago that when I did try to play some sports, it was chess. When I did try to play some sports, it was chess.

I got to tell you, the cramping. Oh, the cramping. Three finger cramps. Terrible. So that a sprain, a soft tissue injury is so much worse. A bad sprain is so much worse than a break. Is that true? Well, breaks heal back to normal, bone heals back to normal bone. Sprains or tears of tissue often heal back with scar. So a big part of our job is to figure out how to tweak that system and get it to heal back normally, preferably fast. So Gary

doesn't have to sit on the bench for too long. Can you speak to the coach? But I've heard your profession, I don't know if you take it as a compliment, as a loving compliment, or as an insult, that orthopedic surgeons were like the carpenters of surgeons. Is that a fair characterization? Not anymore. I mean, I've spent my life as a scientist and as a surgeon, and pretty much because those of us who believe that you should never put something in or do something to a patient, that you either don't know the outcome or aren't trying to study the outcome. So what that means is we're always trying to make things better.

How can I tweak the system? How can I make you heal faster? How can I apply something new to your healing process? How can I push the envelope forward? Because essentially most of what we know today is probably not true, meaning we'll know more tomorrow, we'll evolve our thinking. And so the scientist's mind is always asking,

what's next, how to make it better. So you're saying you have the right brain wiring for what you're doing and to preserve your value going forward, always on the cutting edge. Yes. Okay, that's good. I mean, let's jump forward here because, I mean, the hammer and chisel stuff that we are horrified by looking at. Right, because we've seen the doctor bags of orthopedic surgeons. That's why I'm asking if you guys are carpenters or what.

What interests me now is… Don't worry, Doc. Jesus was a carpenter. You're in good company. You're in good company. How do I feel those words aren't as soothing as you intended, Jack? So, you have a wonderful term, which I must admit, I gravitated towards immediately, called biologics.

Yes. Now, it's that point which you've just discussed about we would take things out and hope that what we did was enough to enable an athlete or a patient to continue onwards. But now you've fallen into this area of biologics. Can you explain just how, why, and everything it kind of encapsulates? And can you start with what the hell is biologics? Yes, please. So biologics is when you were in high school,

you dissected the worm, where bionics, you went and rebuilt the engine. So biologics means everything from a living organism, whether it's animals, plants, or microorganisms. And in my world, what I most commonly get the phone call for is, hey doc, I've injured my knee. Can't you just put a shock absorber back in it so I can go back out and play? I can keep playing. I don't want to have a joint replacement. So a big part of my life is creating bio knees or biologic joint replacement, where we regrow the cartilage, replace the veniscus, rebuild the ACL. And today we're in what I call the anabolic era of orthopedics, meaning we want to add growth factors to all those tissues and stem cells and other such things. And so in the past, you injured your knee, you went to the doc, he took the tissues out, sent you back out on the field,

or maybe jammed some cortisone in, which shuts down healing, right? And today, you injure your knee. My job is either to repair it, regenerate it, or replace the tissues that you've injured, and then add growth factors and cells to accelerate your healing process. That's what biologics is. I was going to say, are you able to specifically target an area, and I'm speaking particularly to regeneration,

so would you be able to target an area to regrow, like if you were using stem cells, or is it just something that is a support in terms of strengthening? It's both. So you are much more like a salamander than you realize, meaning you have- Well, thank you. Thank you, doctor. Wait, let him finish. Let him finish that thought. You have- I think I know where he's going with it, but go on. You have all the regenerative capability inside your genes and inside your body. You just don't usually have the templates or the scaffolds to regrow tissue through. So my job is to either rebuild that

scaffold or give you a new collagen scaffold or a new tissue, and then tweak the systems that you do what your body knows how to do. Oh, wow. What's been the game changer, doctor? Because people must have had that thought, give me something that's a shock absorber. Wouldn't it be great if dot, dot, dot. So what's been the game changer to take you from the thought to the action? So I would identify, there've been many, of course, but I'll identify two big game changers. One is tissue donation. So now when a young person falls off their motorcycle, which we call donor cycles. Or I call Tuesday. Right? They'll donate their parts to us. So we get the meniscus and the ACLs and the tissues that we want to rebuild with. Or when a mom comes to her healthy C-section, that amniotic fluid and birth tissues are loaded with growth factors and stem cells and all the

things that we want to use. Nothing's growing faster than the fetus. And so that bathing fluid has all the potent fountain of youth that we've always wanted to have. And we want to apply that to an old guy like Gary and get him back out to play the've always wanted to have. And we want to apply that to an old guy like Gary and get him back out to play the sports he wants to play. I used to like you. So those two, those things that number one donation, number two, we've learned that we can work with growth factors in the body's own, what we now call not stem cells, but stem cell derived self-repair cells. Terrible term.

We don't have a shorter term for it yet, but we will. And that's because we don't necessarily inject stem cells anymore, as you've heard about with so many athletes. Right. We now do is we inject growth factors to recruit the body's billions of cells to the site of injury to accelerate the healing. Wow, that's cool. It's almost like a really super advanced skin graft. Well, that's not a bad analogy. It is. Yeah. What's the timeline when you say accelerate? Because it could take five years and everyone's on wow that's really

quick but i'm guessing it's not going to take anything like that sort of time oh no we're using these today of course so gary in your day a footballer will injure his acl he's out for a year right why does it take a year to come back so there's two reasons. Number one, I have a guarantee contract. That's one. Number one, it takes time for the tissue to mature. And so we can goose that tissue these days and help it mature faster. And number two, one of the really big problems when I hit you with an ax, otherwise known as surgery, is that you have this huge cortisol release, a stress hormone. And within eight hours of surgery, your muscles start to atrophy. So ask any athlete who's gone through a knee surgery or a shoulder surgery. It's not so much the surgery that is painful,

and it is a bit, it's really the pain of going to rehab for a year, trying to build back that muscle that you lost. So we're doing a study right now with a natural substitute that can block those receptors that the cortisol binds to in the muscle and maybe prevent that muscle atrophy. So two ways in which we can accelerate the athlete getting back to sports, the growth factors and preventing some of the damage that happens at first time. Can I just say this, Doc? Can I just suggest this? Okay. Maybe instead of operating with an ax, you use a scalpel.

Okay. Just help him out there. Thanks, Chuck, for helping the good doctor out. He never thought of that. That's good. Doctor, you know I'm going to use the very basic of medical terms because that's all I will understand, more or less. But the knee is a bony hinge in a sack of fluid, more or less.

And it's the fluid that is able... And you came up with the most wonderful term, lubricity. Yes. Oh, I like it. Isn't it, Chuck? It's a word I can feel... I still have to think about it, but go on. Is the fluid the same in all the joints?

What is that, synovial fluid? Is that in all the joints? Yes, it is. So do we lose some of that? And as such, we have the grinding and bone on bone. And then can I get a do-it-yourself kit for home? It's called WD-40. I'm just about there with the WD-40, by the way.

So I happen to take care of lots of skiers, and I have a huge number of skiers with arthritic knees who come in in October, November for their annual lube job before ski season. who come in in October, November for their annual lube job before ski season. And so, yes, we can augment the lubrication that's inside the joints. We can add an injection of that actual lubricant called hyaluronic acid. But even better than that today, we can add to the lubricant some growth factors that stimulate your body to produce more lubricant

so that the effect will last longer than just the length of time of the lube job. How many athletes, elite athletes, come to you, doctor, and say, I ain't got nothing wrong with me, but I could do with an upgrade because I know in the next few years I'm going to get hit hard. I'm going to need to run harder, faster. Can you upgrade my ligaments? Is that me imagining something or is this an actual real thing? I worry about something. If you do all of this to an athlete and you prolong their career and they're excellent for a longer period of time, like at the end of it all, do they just decompose into a pile of dust? Have you over-prolonged them so that, in fact,

there's a secondary effect later on, which is the consequence of all this that you're doing? So I just finished a book, which we'll start to publish, which is called Play For... Wait, you didn't just say no. Wait, why didn't you say no? They don't turn into a pile of dust. Because the title of the book is called Play Forever.

And so our goal is to have you drop dead at 100 playing the sport that you love. Wow, that's so cool. So if you drop that sport from walking to the mall down to sitting on the couch eating donuts, then I'm all for it. I was just going to say, because Gary brought something up with this almost preventative. So let's go from upgrade to preventative. I would like to know if when you have a tear or you detach a ligament, is that due to a repeated stress that starts as perhaps a micro tear or a small tear? Or just a stretching. Forget the tear.

It's just like a rubber band. A tear and then I'll, or just a stretching, forget the tear. It's just like a rubber band, a stretch and then pop. So if that's the case, what could you do to recruit building blocks to that area to reinforce it before the injury ever happens? Yes, that's a great question. So we want you to pay attention to yourself. Don't just ignore those injuries and play through them. The earlier we get to you, the more likely we can prevent you from taking a small tweak and making it into a big break. And a big part of that is that so many of the injuries that I see in athletes are actually mental errors, meaning they were going a little too fast and thinking about something else. They made a decision to reach out their leg when they knew they shouldn't. Most sports injuries are actual mental errors. And so if we can teach people to really be paying attention to themselves, to be in the game,

to put the cell phone away, to think about what they're doing. Stop texting while you're playing tennis. Exactly. We'll see a lot fewer errors. But then once they have that little tweak that you're talking about, Chuck, we can address those. We can inject those often. We can treat them with soft tissue massage. We can treat them with exercises that help them heal. If we can get you early, we can prevent that late injury. So doctor, do patients come into you and you look at them and go, or you look at the imaging, whichever way it works for this particular patient, and you go, I can't give you a biological solution. So 80% of the people in the world who are told that they need a knee replacement

actually don't. What's happened is that part of the knee has often worn out. And so our guideline is if it's worn out but there's still joint space, we can often rebuild it biologically if it's worn out but it's bone on bone in one part of the knee we can resurface just that part of the knee not a full knee replacement if it's worn out completely across the knee then we've reimagined what knee replacement is so it's not your grandfather's knee replacement. Now what we do is we use a robot and a computer system. We can make extremely precise cuts. So we can put a metal cap on the

bone that your body will grow into the metal porous surface and become part of you. So no more cement to worry about loosening. So we have so many of our patients going back to playing tennis, to running, to hiking, to doing the things they thought they could never do on these reimagined joint replacements. So you're like a brick specialist, man. That's what you are. You realign your bricks. You're like a brick specialist. It's so cool.

You want to realign it. Yeah, we've got to resurface your rotors. You know what I mean? I need a lube too. While you're there, we'll do the lube. Yeah. We've taken one of the world's leading orthopedic surgeons. Made him a brain specialist.

Basically thrown him in the trash. All right, we've got to actually wind this up. Oh, man. I know, no, time goes fast. So, Kevin, a question. We didn't spend much time on this. Is there some brief promise you could give to us about the future of this technology where you create a collagen scaffold? Is it made of collagen?

Yes. the cells that your body already knows how to make, it clads that scaffold and basically regenerates an entire organ or an entire functioning element of your physiology. Yes. So that was my first invention. It was called a collagen scaffold for the meniscus, a collagen meniscus implant. And it acted like a rose trellis. The body would grow through it and regrow a new meniscus cartilage. And now we're using that same technology to regrow other tissues, ligaments, articular cartilage, things that keep you functioning. So the idea that you're just referring to, how do we create scaffolds and cause the body to regrow it? Again, back to that salamander that

Chuck is still thinking about. I think you have the ability within you to regrow an awful lot of things. For instance, we never thought you could regrow your liver or that brain cells regrew. And we now know both of those. Both of them do. You bet. So if you stay in touch with orthopedics,

you'll find that we'll be regrowing your parts more than replacing them. Okay, so let's end on this. Sure. Last question writes here. So if you, the last rights. Are you? Not until you're age 100.

While you're playing tennis. So in 10 years, what will we look like as human beings if we continue on the arc that you have engaged? So my goal is to have you look fitter, faster, and stronger and have you be healthy until the day you die. So this would... Is that why your skin is so dewy, doctor? So you want to make nursing homes obsolete.

That's what you're trying to do here. Unless they have tennis courts. No. Good. There you go. That sounds more like country club. Yeah, I'm retiring to a country club. That's a cool thing.

We got to take a break now. But Dr. Stone, can you hang out for our third segment? Because that's when we really just chew the fat. And there's just so much fat chewable stuff that you do that we want to talk about. So can you hang out? Sure. Excellent. Excellent.

We'll come back to you. This is StarTalk Sports Edition. We can rebuild them when we return. Welcome back to StarTalk Sports Edition. We're going to title this segment Medical Lane. So we've looked at the cutting edge of knee surgery and biologics. But what I wonder is what was it like back before all of this way back 30 40 years at the first olympics way way back in the 1980s and 1990s this way back because you know gary o'reilly, he's our co-host here.

He's usually a commentator, but now he's our subject. That's right. And we want to know what players like Gary O'Reilly, as a professional soccer player, did before people like Dr. Kevin Stone came on the scene. So, Gary, how many times were you injured and had to go away and come back? Oh gosh, injuries are one thing, Neil. The number of times I had to get sewn back together again through cuts and things or through surgeries. All right, let's do this in a sort of organized manner. Let's start at the bottom.

You get kicked across the shins all the time in training, but I had, oh, this is really quite modern. I had an arthroscopic surgery on a torn meniscus, so the cartilage in my knee, but the tear was inside the cartilage itself. So it didn't breach to an outer wall. So the surgeon sutured it, which was great. And during recovery, it just ripped itself to pieces. So there I had to go back in, have that removed. In the meantime, I had reconstructive surgery on the same knee for my MCL, my medial collateral ligament,

which is the one on the inside that runs sort of north to south and it would become really and you hear i'm an astrophysicist so when you say north south i'm thinking you mean up and down bottom yeah okay okay because up is not north up is space okay just be clear who you're talking to here thank you you for reminding me. Point taken. So you heard Dr. Stone talk about how you get some laxity in the ligament and you can do certain things to tighten it up. Well, what they used for me, and this was 92, so it was one of the last surgeries I had as a player, was a technique called reefing. So if you imagine cheese string that you, as a child, you strip little pieces off of it.

And then what they did was they wrapped it around the ligament. So they took strands of the ligament itself and then wrapped it around in the sort of, in a, in a rope manner. So they were using science. Like steel, like steel cable. Like steel cable. Yeah. Yeah. So they tried to strengthen the Like steel cable. Like steel cable, yeah. Yeah, so they tried to strengthen the ligament via that technique. Moving up, you have quite a load of horrible groin strains and injuries. I had two spinal operations when I broke a facet joint,

had prolapsed discs. And as a result of that, I have about a mile of scar tissue in my spine. Oh, God, I'm in so much pain right now. I am in pain listening to this. Then you come up to the head where, and Chuck, you'll understand the phraseology I'll use here. I viciously attacked an opponent's elbow with my nose and ended up with a double fracture and had to...

Elbow, nose. Let me see which one that exchange was. Mm-mm-mm. Okay? Mm-hmm. There's only... That's like when jocks and geeks collide. Yeah, there's generally only one winner.

And that ended up with rhinoplasty, so I had to have my nose rebuilt after a double fracture. I have had my, unintentionally I might add now, my eyelid sewn to my eyebrow because I got cut across just underneath one of my eyebrows and the surgeon, when he was stitching it, put it through the eyelid and attached it to. And I just sat there, looked at him and said, do you think both my eyes should close?

Or are you happy with this? So we had to go back and revisit. There's scars all over the face because I would be involved in aerial challenges all the time and elbows would fly. Aerial challenges, that's what you call them. Oh, yes. Everyone is airborne trying to get the ball. Yep. And hit it with their head, I guess.

Yeah. And to protect yourself and to ensure that you get there first, elbows are up and they are armed, literally. So you... Thank you. So you go through... That was good. Chuck, admit that was good.

I was right there. So that's kind of standard procedure. I was lucky I didn't get the bad ankles that a lot of the players get. So, you know, in my sport, it's a very explosive sport, but it's also a sport that you need to have stamina. So it's an interesting hybrid of being able to be extremely quick and explosive over a short distance, then come back and recover to do it all over again in rapid time, but then to have to replicate this for a 90-something minute game and

do this for 10 months of a year. So how old were you over your time of professional? over your time of professional sport? As a pro, I came in at 18 and I exited at 32. Wow. That's a long time for a professional sporting career. And in that period of time, because of the catalogue of injuries that you've had, you manage certain things that you have and you know aren't quite the way that you left the factory.

You accommodate them, yes. Yeah, yeah. So, you know, when people say... That means you changed your game, knowing that you had certain limitations. Yeah, it kind of gets forced upon you. Sometimes you lose some of your explosivity in terms of acceleration,

your ability to come off the standing steel to reach top speed. Sometimes you don't reach top speed. That's just a new top speed. It's not that. Yeah, I know. Right. It's like the Ferrari that doesn't do the speed it did when it left the factory.

But then again, it's 50-something years old. Chuck, you caught that. He analogized himself to a Ferrari. As a Ferrari, yes. I got you. So what was the medical, chemical medical regimen associated with all this? Painkillers, this sort of thing, steroids? Steroids, no, because they were banned. Because the only steroids you'd use were sort of muscle-developing steroids,

and they were anabolic. So they've been banned for some time. Yeah, but sometimes, not even the steroids to help for healing and recovery. I mean, those are different types of steroids. I think once you say steroid, then you have to go and uh a medical panel to endorse the fact that it's wait wait wait if you're not playing because you're on sick leave take whatever steroid you want nope and and then cleanse it out of your system by the time you come back and then you got better naughty what's wrong with that uh naughty step for that neil because who would

ever know it um that true um but it's one of those things where you'd like to think you adhered to the rules of the game even though you're injured. I thought you just can't be on steroids while you're playing. But if you're laying up in a stretcher... I suppose it would be seen as performance enhancement because you are recovering quicker. Damn. And missing your ability to perform from the stretcher.

All right, so here's the thing with pain-killing injections. You've got cortisone injections, but you can only have so many in your lifetime. And they're degrading too, right? They create degradation, and we're at the source of injection. The other thing is, and you talk about the source of injection, you reminded me. One day I had a particularly painful adductor.

So it's right at the top of my groin. And the only thing that's going to calm this down is a pain-killing injection. In your groin? In my groin. So the local anesthetic goes in, which is great. And then the pain-killing injection itself is administered. Now, I'm not worried about the needle and looking at it and fainting and there's going to be no blood.

But what kind of made me wince more than anything was the noise of the tip of the needle scraping across the bone. And you just have these sort of experiences as a professional player. You have to undergo this sort of experiences as a professional player. You have to undergo this sort of experience and be prepared to accept it as part of what it takes for you to be a professional athlete. Because you're a biological machine that makes money and I don't care about you, your feelings.

Get the hell out there and play. I don't care how bad you feel. Let me tell you something. If the doctor told me that they had to stick a needle in my most intimate of areas. You probably moved past the groin part. You're stuck

on the groin. No, I'm still stuck on the groin. A needle in the groin. Scraping against bone. When I get home, it's going to be like what did the doctor say? He said I have to retire. That's what he said. And you see, the thing is, Chuck, as a fan, and in the end, as a professional, they are everything.

Because without the supporters, without the fans, there is no professional sport. They don't want to hear about my problems. They've spent all week with their problems. This is 90 minutes or a few hours of them abandoning their problems and getting invested in this game, this sport. And so I just have to be mindful of what it takes to give them everything that I can. Let me generalize this. Back in this prehistoric time, the 1980s and 90s, what was the most common sort of soccer injury um the the the meniscus tear would be common uh and that's because you're changing direction yeah uh abruptly the acceleration is very high yeah you have these shearing forces in play and uh

sometimes i mean that along with the anterior and posterior cruciate knee ligaments they're quite common so when you retired was it because you your injuries took you out could you have gone a few more years uh i would love to have gone a few more years no i'm talking not whether you would have left no no no no but the owner and the people paying you, would they have loved you to go on? No, because it meant they had to pay someone to walk next to me with a wheelbarrow to pick up. What's he going to play? He's going to play wheelchair soccer?

No, there's all these pieces keep falling off and you're no value to the franchise. So what happened was my my knee reconstruction surgery was successful because uh not just the medial ligament but both anterior and posterior cruciate ligaments were seriously and badly damaged um i got to a point where i could do just about everything but the turning, the stopping and going in a sort of 90 degree direction, that was causing a problem. And then when I go back to see the surgeon several months later, he said, look, here's the deal. You can continue as a professional player. You've got enough strength in there to continue as a professional player. And we've said i'm 32 years of age he said but i can assure you by the time you're 38 you will be a cripple

that and that kind of focuses your mind so that that's six more good years yeah think of the positivity. So the thing is... In fact, sumo wrestlers are dead by the time those six years are up. I mean, yeah. So, Gary,

you clearly weren't serious about your sport. No. Not at all. Where's the dedication, man? I know, and I played. I played games with my meniscus torn.

I played games with fractured bones in my back. It's just slipped discs. So let me ask you this. Were you just a clumsy player? Is that why you had all these injuries? No. I mean, here's another one.

No, no, great play. No, let me just hear this out. All right. So the greatest players we think of somehow managed to resist injury and had long careers as a result of it. So is it because of how you played that made you more susceptible? Or are you an aggressive player?

Are you more aggressive? Why do some players last long and others don't? That's my question. Maybe their game exists inside their physical capacity. Maybe some player's game is built on them playing at the envelope of their capacity. So if their game is built on speed, they will always have to use that speed. So therefore, they're always stressing their hamstrings, their quads, those muscles. If they're a player that's always involved in the melee, the scrimmage, in particular

in central areas or as I was in defense, you're always going to have that much more contact. And therefore the liability is greater for you to get contact damage. I like the way you say that. If you're within the envelope of your abilities, if you're

performing within that envelope, you're less likely to be injured. At the edge of the envelope, if you're performing within that envelope, you're less likely to be injured. Yeah, absolutely. At the edge of the envelope, then you're at risk every single time. Absolutely. I mean, it is something you're mindful of. And going back to something you just said earlier, you play with certain limitations in your mind.

And there are very few players who can produce their very very best games knowing that they're incapacitated by 20 or 30 percent invariably any spectator will say he's crap today and that that's obvious but when they look at you and they don't notice that you've got this problem because your game is so good, then, you know, even guys like me who played for 14 years will turn around and applaud. It's like seeing a guitarist bust a string and there's no difference in the music they produce. They have freestyled immediately knowing that that string's gone

and that means compensation in other areas. When you see things like that, that is special. That is genius. Compensation in other areas. When you see things like that, that is special. That is genius. Well, right now, you have made me feel like I need to go see an osteosurgeon. Because I feel like I'm injured from this conversation.

See, the other thing is, Gary, you're a handsome man. What you're saying is, your face has been all chewed up and scarred and stitched. You were more handsome in the past yeah you might you might have made one hell of a j2 model before yeah what letter of the alphabet am i now excellent excellent excellent gotta take a quick break, but when we come back, Dr. Kevin Stone will rejoin us as we just explore sort of off the cuff what's going on with Gary. Past, present, and especially the future of keeping folks like Gary at the top of their game on StarTalk Sports Edition. We're back. StarTalk Sports Edition, segment three. Shoot the shit. That's what we call it, isn't it, Chuck?

Yep. No, no, we don't. Yeah, we do. We do. And we drag Kevin Stone, MD, back on. Yay. Because he's the guy we want to just sort of chew the fat with. So, Kevin, let me ask.

Is this, where does this end? I mean, if you can start regrowing tissue and organs, then living to 100 is not even the limit i mean the sky is the limit yeah maybe it becomes like robocop just like i want full body regrowth you know yeah just regrowth and you just you just regrow it and so then you just never die you just go to the trouble spots and fix them so is that really what you're planning in your basement so i'm not so much about longevity as i am about quality of life while you're here today. But if you look at an elephant, he weighs 15,000 pounds. He can run up

to almost 50 miles an hour, lives to 60 years old, doesn't get arthritis. So there's something about their joint cartilage that we can learn from. But How do you know they don't get arthritis? How do you know? You've never gone to the zoo and seen an elephant go, oh, God, my back. I'm telling you, it's going to rain. It's going to rain. Yeah, there you go. So the whole idea, though, is that some tissues in animals, either we can use in people or we can learn from the way animals have developed to make us

better people. Wow. So let me ask you this, speaking of arthritis and elephants and, you know, longevity. Yeah. Where are you going? No, no, no. It's the understanding that inflammation being the greatest enemy to the body. Is that true in recent years, just the last couple? There's been so much talk about inflammation and not just from an osteo or orthopedic perspective, but even from your organs to your brain and plaque buildup, all of this is somehow linked to inflammation. One, if that's the case, what is the link? And two, is that really the case? Sure. So the term you're smoking hot has a new meaning now.

Well, not for me, Doc. So it could be that biologics that we talked about earlier, growth factors in stem cells, may be the cure for COVID-19. Because you hear about these huge cytokine storms. Yes. These are massive inflammations in the lungs and in other organs around the body. And so biologics, especially the ones around the amniotic fluid, are potent anti-inflammatories. And these are being harnessed to see if they can shut down

these cytokine storms. So your analogy that inflammation is the common pathway in so many diseases, arthritis, Alzheimer's, cardiovascular disease is exactly right. We have a little study going on right now where we're looking at mouth flora to see if people who carry certain bacteria in their mouth also carry them in their arthritic knee. Those kinds of bacteria, they're very difficult to grow,

but we can test with PCR that you've now learned so much about in staining techniques. So you're right. Inflammation is probably the common pathway. I'm just uncomfortable you referring to people's mouths as having flora. Flora. That's just a little creepy. I mean, I understand.

But to talk, oh, let's look at all the kingdom of animals in your mouth. Flora. So are we, I mean, we've always known the body can heal itself to a certain degree. I mean, we've always known the body can heal itself to a certain degree. Are we now realizing that it can heal itself to a much greater degree, doctor? Yes, we can. Well, both it can heal itself to a greater degree, but that healing process can become erratic and out of control, which is what we're seeing in COVID-19. Oh, so what you're saying.

So when you say your treatment is not to prevent COVID-19, but to help protect you against your own defenses. Exactly. That huge inflammation response that kills, unfortunately, a number of people from that disease. Right. You may be able to shut that down by using these biologic cells. So some percentage of the COVID people die from their own physiological reaction because your body's not good at fighting it. Or too good. Or too good. Or too good.

Yeah. It kills both you and the COVID. Right, exactly. Your body is just like, you know what? I'm sick of all this. Everybody dies. Everybody dies. Well, that's what chemotherapy was for many years.

Yes, yes, absolutely. You just basically, you kill everything and then hope the immune system will respond by coming back and coming back without the cancer. Exactly right. So the blessing becomes the curse, which is the phrase that sort of sits there, yeah. Yeah, yeah. Yeah, yeah.

Yeah, so I want to make sure I understand this correctly. So your collagen scaffold is not rejectable. I mean, you can grow a scaffold, put it in a human body, and it doesn't have biological organisms that can be rejected by the host. Isn't that correct? No, in fact, it does. If you take animal collagen and put it in people, it will stimulate a rejection response.

Oh, I didn't know that. You have to treat the collagen to strip away the antigens before you put it in. Oh, but it is treatable, though. Yes. In that way. So the collagen has antigens with it. So when you put it in the person's body, the person's body doesn't see it as a foreign threat at that point.

If it doesn't have antigens. Right. If there's no antigens. So how do you achieve that? So as long as I can kill the tissue, meaning I couldn't do it to a heart or to a liver or kidney transplant, but for a collagen scaffold, I can wipe away those antigens with enzymes and make an essentially humanized collagen scaffold.

And then you can take cells from the person's own body, attach it to the scaffold, and then they multiply. Oh, my God. You thought of this? That's what we did. Dude, you are really smart. That's why he's on. That's why he's here, Chuck. That's why, Chuck, that's why he's a guest on StarTalk.

Yeah. We only invite smart people. Let's make that clear. So, I mean, if I think about it in a cynical athlete sort of way, we know Tommy John surgery for baseball pitchers can actually give you two to three mile an hour more on your pitch. Are we looking at potentially doing things like that in the future? And are we now into this ethical mess?

Or is that, you know what? That's good. Do it. So, yes. So that's a field of what I call super biologics. So yes, so that's a field of what I call super biologics, meaning can we make an athlete better than they've ever been and better than they could be, even if they were never injured in the first place? So if you look at the foot piece that Pistoris used in South Africa, who unfortunately got in trouble later on, the blade. It caused him to run faster than normal humans can, right? So what happened?

Nike took that same design and put it in their new running shoes. And people now run a little faster than they've ever run before. So there's an example where we're taking technology and putting in the equipment. What's the difference between putting in the equipment and putting it in the person? Wow. Wow. Excellent point of reference there. Because like, for example,

if you run faster with sneakers at all, then that's giving you an advantage over someone who's running barefoot. Right. Right. And I think the ancient Greeks ran all barefoot. And if they saw you come by, whiz by in a pair of sneakers,

they might cry foul. But we accept it as, of course, you're wearing sneakers. You're protecting your feet. So what you're talking about may be the answer to steroidal recovery because steroids are damaging. And the moral argument against them is that you are harming the athlete. It's a terrible thing. And so you shouldn't do it. But if you were able to do that, strengthen and recover and regrow and get stronger without the deleterious effects

of steroids, you eliminate that argument. Sure. So we do that today. So if you take a vitamin, if you take glucosamine, which is a supplement for your joint that improves lubricity in the joint, those things are legal ways to improve your performance. If you take caffeine, you can increase your acceleration on a bicycle. But if you take a specific band substance, you're over the line, right? And so the question is, where does society want to draw the line for all these different things? Currently, we're helping athletes exceed their potential every way we can legally. Okay, so it's just a matter of where the legal line sits. Exactly. If we were able to regrow certain things in a body, in a joint that enabled faster running or pitching faster,

joint that enabled faster running or pitching faster. We've introduced an alien object to begin with, but it's been accepted within the host, if I can call it that. Is that not a natural process or are we blurring the line here rather than moving it? Sure. So you don't know where the line is. Let me correct one thing you might have said. The Tommy John surgery helps athletes, it helps pitchers, but it doesn't help them pitch better. It helps them pitch better because they were injured. You take a healthy joint and rebuild it. You're not making that joint work better than Mother Nature did. And for many athletes, when they get injured, though, as I mentioned before, it's an excuse to optimize their training program, their nutrition, their technique, and they come back better than they were before. And that's our goal with everyone who ever gets injured.

That's an excellent point because when you're injured, you think much more about everything your body and limbs do. So there's a honing of your craft caused by the fact that you got injured in the first place. So every patient who comes in, I want them to ask themselves, why don't you treat yourself like a pro athlete? A pro athlete who has an injured knee would work on his nutrition and have a nutritionist, have a physical therapist, have a trainer, maybe a sports psychologist. He'd pull together the team and his coaching team to come back better than he's ever been. He pulled together the team and his coaching team to come back better than he's ever been. You, Neil, sitting in front of me with your injured knee, pull together your team, help yourself come back better than you've ever been. And that's the way to treat yourself like an athlete.

And there would have been no motivation to have even thought that way at the beginning of that exercise. Use your injury as an excuse to come better. Could you tell me what's the most common reason why a ballet dancer would come to you? Ah, so I've cared for ballet dancers for 30 years. So in the beginning, they were very thin in the Balanchine model. They were all smoking cigarettes and their nutrition was awful. Smoking cigarettes. They were paid. In the middle of Swan Lake.

Wait a minute. I got to take a joke. Plié. Demi-plié. You got it. Nailed it. They were all paid like artists, but asked to work like athletes. And so I saw them with all these injuries, knee injuries, ankle injuries, back injuries,

and they had none of the athletic tools to come back. And so what happened post-Balanchine is that dance studios and dance masters realized that their dancers needed to be more muscular. They needed to have more, they needed to be more like athletes to reduce these injuries. And the entire dance field evolved. So now when I see a dancer, they've got phenomenal fitness programs. They've got extremely well-developed muscles. They're tuned into the entire athletic field, but they still get injured. So they leap, they go off on a leap, they land poorly sometimes and tear their ACLs, they injure their ankles, they injure their backs.

Interesting you say that because I used to dance um and at that same time i was also very much into uh varsity athletics i was a wrestler but my my point is i had a strength a muscle tone that other male dancers did not have and so that was an interesting i don't want to call it an advantage but it was a. It was clearly a difference at the time. And I noticed that there were things I would have no hesitation doing that other dancers said, well, maybe I might not do that because I could get hurt. And I said, I know I'm not going to get hurt

because I'm wrestling on a mat, you know, two hours a day. Where he took that dancing and turned and created a move called the pirouetting pile drive. Okay. No, no, I'm just, it's interesting to hear that dancers had to sort of catch up with the athlete, with, you know, pro athletes. You have, you took away the fear of not being able to execute that dance move. What I'm hearing the doctor say is, with the surgery, with the procedure, with an approach, a holistic approach, the athlete or the patient no longer has to sit there and think, is this going to work?

When's it going to break? Right. And you take that aspect away. Am I wrong there, doctor? If I am, please correct me. My strength training, I think, gave me that knowledge and that insight. It really right except for one fact what's that all athletes cheat how dare you so even if i tell them it might take a month or three months i'll find them out on the pitch at three weeks and so the common denominator amongst athletes is, you told me I could do this. I'm going to do more.

And so our job is two things. Number one, to learn from our athletes who cheat and get away with it. Why did it work for them, but not for somebody else? And then number two, to figure out how do we communicate with them? And then how do we provide them with tools and therapies that permit them to go faster than you ever thought was possible. Because mostly we held our athletes back out of ignorance for so many years. What's the most successful cheat so far for you that you've come across? Oh, I rebuilt an ACL for a world-class skier, and she was on the slopes competing at two months, which is crazy. Wow! That's insane.

That's what we said. However, to my point that I made, she did not re-injure her knee. She came back and won. In fact, she won X Games gold that year. So, you know, you learn from these athletes in ways that you never thought you would. We got to end on that note. Doctor, when does your book come out? So I'm just deciding right now on the self-published versus publishing house.

So it will take us a month or two. Possibly 2021. Oh, no, it'll be out this year. Oh, this year. Okay. We're done with it. And the title was How to Live to 1,000, if I remember correctly. Just teach me how.

How to play forever. Dr. Stone, thank you for being on StarTalk. It's great to talk to you guys. All right. Thank you. Gary, Chuck. Yeah, good stuff. Pleasure, Neil.

All right, guys. Time to go. This has been yet another installment of Star Talk Sports Edition. We can rebuild them. I'm Neil deGrasse Tyson, your personal astrophysicist, bidding you keep looking up. Bye.