The Chris Voss Show - The Chris Voss Show Podcast Trevor W. Turner, M.D. of Georgia Bone & Joint

Episode Date: June 11, 2019

Trevor W. Turner, M.D. of Georgia Bone & Joint

Hi folks, it's the Boss here from thechrisfossshow.com, thechrisfossshow.com. Hey, coming to you here, we're coming to you with another podcast. We certainly appreciate you guys tuning in. Be sure to give us a like, subscribe to us on YouTube, hit that bell notification button so you get all the wonderful notifications of all the stuff we're doing here and all that good stuff. So today we have a most excellent guest. I think you're going to learn some really important stuff, especially about your health.

And health is important, last time I checked, especially in your old age and with all the stuff that's going on. Today we actually have a doctor on the show, so we're going to get really smart. His name is Trevor W. Turner, MD. I've got to get used to saying MD there. So Trevor is a board-certified physical medicine and rehabilitation physician who specializes in minimally invasive image-guided orthopedic procedures to place steroids, platelet-rich plasma, and stem cell injections into damaged tissues and help patients recover faster with lower risk. You've probably been hearing about a lot of this stuff lately. And we're going to find out why he is passionate about healthcare, entrepreneurship, and serves as an advisor and strategic partner to numerous startups focused on disruptive innovation in medicine. So we're going to learn a lot as to startups and all that good stuff. Welcome to the show, Trevor. How are you doing today?

Hey, thank you so much for the introduction, Chris. I'm fantastic. I appreciate you having me here and I look forward to discussing what it is that you introduce. Awesome sauce. So give us the dot com so people can take a look you up on the website. Sure. Our practice website is Georgia bone and joint all one word dot org. And if you head to that website now, you'll probably see on our landing page, the first thing that pops up is regenerative orthopedics with a button to click through and learn more. We do have people book actually our clinic appointments directly from the website. But if you just want to go to learn more, you can click there and we'll be happy to have a consultation.

So I'm going to assume you guys are in Georgia. Is that correct? Yeah, that's correct correct we're on the south side of atlanta so we're about 25 minutes from the airport which actually is much less traffic than all of the horrible things you hear about the northern part of the city yeah and so we actually frequently do have people fly in for care and so they'll fly in and we even have a car service that'll help pick up patients at the airport, bring them to our facility. We're really fortunate to have everything under one roof. So here in a one-stop shop, we've got physical therapy, we have our own imaging and

MRI center, we have a clinic, and we have a dedicated team of six different orthopedists with PAs and then myself as a minimally evasive non-operative specialist and also have our own ambulatory surgery center. So we actually do same day procedures right there all under one roof with the goal of getting people the care that they need, but doing it in a way that's very efficient and very customer centric. So involved around giving people the highest level of satisfaction. Awesome sauce. So people anywhere in the world or anywhere in the nation can fly to your facility and get help. And so what do you guys do that helps people? Yeah, so I would say, you know, we have a lot of different subspecialties within orthopedic

surgery, including pediatrics here, which there's not a lot of pediatric orthopedics floating around. But then we have other specialists in foot and ankle, as well as sports and outpatient joint replacement, and are actively recruiting a new hand physician here. And then myself, I am, as you mentioned, I trained in physical medicine and rehabilitation. And so that is really a specialty in which we sort of kind of toe the line between somebody who practices sports medicine or pain medicine, but does so in a way that's less invasive than open surgery. And so most of the care that I deliver, if it's going to be involved with a procedure, it means it's being done either with an ultrasound probe, which is great because there's no radiation with that kind of treatment, or an x-ray machine if we need to for advanced cases. And then the patients go home the same day, and we usually couple that with a very advanced type of rehabilitation protocol that's tailored to an individual person.

Awesome, Sauce. So if I'm having, like, knee trouble trouble or bone issues i know my mom has bad knees uh in her old age uh she's had to have several different injections in her knees in fact she just had one replaced um so you guys it sounds like a lot of what you guys offer is a way to make those joints and bones work uh do you guys do the full replacement or you guys just do like the stem cell stuff and all that? Yeah, no, I tell people that basically there's five ways that we can help them. And, you know, knee arthritis is one of the most common reasons that people come to the doctor in the United States today. So that's a good example. So generally, you know, we try to start with

things that are less risky. So we go from changing your exercise program or physical therapy and low impact exercise. We also look at even what you eat and whether you're getting enough anti-inflammatory food with, you know, be that vitamin D or omega-3 fatty acids, etc. Then we look at medicine, if that is something that people need. And, you know, kind of the standard of care for the treatment of arthritis would be taking anti-inflammatories. And those medicines do help some people, but there's a lot of people who are motivated not to take medicine on a daily basis, or they're very aware of a lot of the side effects. So for example, you know, anti-inflammatories, while they can help reduce pain, oftentimes they lead to side

effects with ulcers of the stomach, or even problems with kidneys at advanced age. And so we use those, but we're always trying to be smart about risk and benefit. The next kind of standard of care would be injections. And so traditionally, if somebody hurts and has an arthritic joint, they would come in and get a steroid injection. And that's been done for decades at this point. But really, there's sort of a revolution going on in medicine. And so the idea that we're going to take something that is, you know, number one, synthetic, and number two, you know, that may not really give you that long term benefit, you know, may help you for a couple months, but it doesn't last as long as people want, people are starting to kind of get, you know, looking for a different option. And so that's kind of where the field of regenerative orthopedics, or some people call it orthobiologics, really started to come in. Because we do do joint replacement here. And when you're

joint, you know, when you have no space left in it, and it's what we call we grade knees on a scale based on x-rays. And so when you have grade four arthritis, you do need a replacement. That's the right thing to do. But we have a lot of people who are looking for another option. And so that option of regenerative orthopedics means that we use kind of a a mix of things and so the probably the ones that most people hear about um consistently are either the use of visco supplementation uh which is basically like uh the use of a kind of like a lubricant that goes in the joint uh there's platelet rich oil be up like uh like the tin man from wizard of oz yeah right exactly and that was And that was covered by a little oil. Right,

right, a little oil, yeah. And a lot of people call it rooster comb or chicken fat. They abbreviate it that way because that's how they actually create that. But I would say, you know, more sophisticatedly are two other options that a lot of patients have questions about and are starting to see better longer-term benefits for. One of those is platelet-rich plasma, and the other one would be the use of stem cells, or specifically mesenchymal stem cells is the word for it. And we get those by taking both of those, PRP and stem cell, we get those from taking them from a patient in a same-day procedure. And then based on FDA guidelines and compliance, we minimally manipulate them, which means we don't add any chemicals to them.

We don't do anything other than basically put them in a machine of centrifuge. And that's a machine that basically just takes whatever you put in it, it spins at a very, very high speed in order to concentrate the stuff that you really want to use. And so a lot of people have shown strong interest in the ability to be basically treated with their own cells because they're saying, look, you know, I'm tired of synthetic options. I'm tired of things that don't last as long as I want to. I don't want to be coming back and getting injections every three to six months.

And then I think, you know, when this field started to take off, you know, I kind of felt the same way because, you know, it was great to help somebody and see them, you know, for a few months get better. But I didn't want to see patients every three months for the rest of their lives to give them shots. I love seeing patients, but, you know, the goal is always to maximize your function and to do so in a way that gives you the best long-term outcome. And so I think as we started to focus on that more and more, we offer those options to people either, one, to, let's say, avoid joint replacement because they can get substantially longer improved function. Or two, sometimes we do these procedures actually in conjunction. So a great example of that would be like rotator cuff repair, for example. We know that if you have a rotator cuff tear, and that if we take you to the OR to fix it with a

scope or a camera, that if we actually combine that and we take stem cells from your bone marrow and we put those at the place where that tendon meets your bone, and not only do people get better faster in their recovery after the surgery, but actually their rate of re-tearing that, which is a major complication of the surgery, goes way down. And we actually have numbers that go all the way to 10 years out, which is really, really strong. Because if you look at a lot of papers or evidence-based literature in medicine, you'll find that people go out to six months or a year or a couple years, but there's not a lot of data that goes out to 10 years. So when you get data that's that strong, it means, hey, not only do we have another option, but we're really focusing on options that last for the long term.

And I think that's the standard that patients today want, and it's the standard that drives people to come in here because they're looking for a way to either avoid surgery by doing something that's lower risk, that doesn't have the same level of complications. Or they're looking to say, look, if I'm going to have a surgery, I don't want to have more than one. I want to be down one time. And when I recover, I want to do so as effectively as I can with less pain and better function so that it's one good surgery done right without additional procedures or complications. Awesome sauce. Why does stem cells work so well in this regenerative thing? I know one time, I think the Bush administration outlawed research with them, and then they overturned that. Why does stem cells work so good at regeneration? Yeah, so that's a great question. So it's interesting.

So last week I went to TOBI, which is the Orthobiologic Institute. They have an international conference every year, and there were 83 different countries represented there and over 700 people. Really fun because you just get to talk to all kinds of world leaders and talk to the people who did the initial research in the first place. I actually spoke to Dr. Arnold Kaplan there, who he was the first person to coin the term stem cell, actually. And so he developed this term, and the formal term for that is MSC or mesenchymal stem cell. Why is it MSC instead of just stem cell? Well, that's because there's different kinds, right? You could get a stem cell from an is it MSC instead of just stem cell? Well, that's because there's different

kinds, right? You could get a stem cell from an embryo, which was the kind that, you know, that was, you know, what George Bush and his administration made the big rule about. You can get them from an umbilical cord, you can get them from fat, you can get them from bone marrow. And so for us, you know, the type of cell that we're getting is not the kind that comes from an umbilical cord or an embryo. It's actually the kind of cell that comes from your own body. And so we happen to know that maybe that can't develop into as many tissues as you could as if you use the cell from an embryo. However, the kind of things we're using it for, it's perfect. So we're

looking to help people with problems with bone, problems with cartilage, problems with muscle, tendon, and ligament, and maybe sometimes even also their discs or sometimes their labrums. So those are maybe some technical terms there. But the point is that we're taking the cells from a place that they become the things that we are targeting in particular. And so for us, it's a great niche to do so. And there's a lot of regulations in the FDA about what's permitted and not permitted. And you'll find plenty of people out there who are not practicing according to what the FDA stipulates. And in fact, last week in the New York Times, there was a huge article about actually a national company that has been shut down for

doing things against basically what the FDA said was appropriate. And so everything that they stipulate, you know, we draw kind of a very hard line on here. There's no gray area for us. That means that number one, the cells are homologous and autologous. So the explanation of that jargon is they're taken out of your own body. They're not taken out of anybody else's and it's not an off the shelf product. It's all coming from you, number one, as a source. And number two, they're being placed under very advanced image guidance back into the same kind of tissue that they are somewhere else. And so for us, we happen to know that the yield or basically the number of cells that we can get, at least when it comes to bone marrow, is highest in the back of the hip. And

actually, that's one of the things that scares, you know, people in the first place when they're considering a procedure is they say, oh, my gosh, you're gonna, you're gonna take cells out of my hip, that sounds terribly painful. And what I have to tell them is, look, you know, I have trained with some of the best people in the United States, you know, specifically, I would say Dr. James Andrews, who I worked with for the last four years at the Andrews Institute of Orthopedics and Sports Medicine. I've taken care of everybody from professional to collegiate to amateur athletes to baby boomers to weekend warriors to special operators in the military, including Navy SEALs and Army Rangers, as well as force recon Marines and Delta members. So, you know, it's not

a problem of can we do this for you and it's going to hurt you we can do the procedure for you and not hurt you that's that's not a question it's the fact of if you're going to come get a cell-based treatment or an orthobiologic which those are the terms i really use for this field is one is it indicated and then two you know is the person who's going to do it really well qualified to do it for you well and the right way and so we're searching for evidence all of the time yeah so that's dr arnold kaplan and he is actually the guy who coined the term stem cell or msc so it was great to talk to him him at the Orthobiologic Institute Conference as a world leader. And the interesting thing is, is he is actually recommending that we change the term.

So he said, I would rather call these medicinal signaling cells. And so, you know, people said, why the need to change the term? And he said, you know, the concept that we take a cell and that it grows into something else, into the environment we put it in, may not even be completely accurate. But he said there's a very complex signaling cascade or basically a whole process that occurs that when you put these cells into an environment in your body, it sends an overwhelmingly strong signal for your body to do what it should do to heal. So let's say that you fall and you get a cut. And if you get a cut, immediately your body starts developing a clot so it can stop you from bleeding. And then it sends cells to those same place to basically change the tissue and then to relay a new scaffold or to lay a new membrane to build back the native tissue that you have when you get a scar and then it goes away and it comes

back to normal skin. And so the suggestion is that, you know, the cells on the one hand are important, but these progenitor cells or these cells, whatever you want to call them, not only is it just putting a cell into one place, but the fact is that it's sending a remarkably powerful signal for your body to heal or to recover in a way that profoundly affects the whole environment of the joint. And so a lot of people, I think, have come out and criticized steroids because they've said, well, look, you know, in a lot of cases, we're injecting one, something that's foreign and two, something that's synthetic into a place in your body. And some of these places, as we've come to understand these diseases, don't actually have inflammation in that. And so if you're going to use something anti-inflammatory for a process that doesn't have inflammation, you know, I mean, it's no wonder that that's not going to work well in the long term. I think the idea that we can use either platelets or PRP, as well as the signaling cell

or the progenitor cell or the stem cell, you know, from your bone marrow back into a specific place that's been injured, has been something that we've found is changing outcomes. And the collection of outcomes data has now become critically important, because we know that these type of procedures are new, they're innovative, and We have a lot of good data on safety for the people who are adhering to the FDA's kind of definition and regulation. But the question is, is how long do they last? And, you know, a lot of people ask, well, hey, you know, this is not covered by my insurance. Why would I do this? Or, you know, look, if it costs a certain amount to get this procedure and I've got to pay a copay and a deductible to go get a surgery done, why not just pay my deductible and go get my surgery? alternative, but it's an alternative in a lot of ways that can maximize your function and help you achieve your goals with less risk and oftentimes at a cost that is far competitive when you compare

it to all the costs of what it's like to have a surgery, stay in a hospital, do rehab afterwards, be braced, miss work, etc. And so that's what we're all about, you know, is helping you try to achieve your long-term goals with less risk in a way that's consistent with what your goals and expectations are. Well, I think a lot of people maybe have a misnomer about steroids and what they are. They don't realize that your body has a natural steroid system operating within it. Absolutely. Yeah. I didn't know. I didn't even know that. I just always thought steroids were foreign until I had a girlfriend who had Cushing's disease, which is cancer on the pituitary gland. And I was reading up to try and understand her cancer.

And that's when I discovered that the body runs on its own internal system of steroids. And it pretty much operates you, really, or keeps you functioning, to my understanding. It does, yeah. And it's just that when we're giving people injections with them, we're using an amount of steroid that is way in excess of what the body would naturally give itself. And in certain circumstances, that can be really, really helpful. But I think there's a huge number of circumstances that we're now going back and looking at it and saying, you know, hey, this is not what the body does when it's in trouble. Should we really be doing this for

people, especially in the long term? You know, this is the part of the show where, you know, you doctors hate this when people do this to you part of the show where, you know, you doctors hate this when people do this to you, where it's called the, does this look infected, doc? But, no, to bring up a topic that's personal to me is recently I started getting really bad tennis elbow. And a lot of it is probably coming from my over gaming because that's when I kind of notice it.

But I've talked to some different friends that have had tennis elbow, because I asked my audience on social media, I said, you know, hey, who's had tennis elbow? And what's the best way to help them? A lot of people did respond to me that they had the steroid shot into their tennis elbow. Like it's been fine ever since. Stuff does work. Yeah, so I would tell you, at least in terms of randomized control trial data for tennis elbow, number one, I'm usually seeing patients who've had tennis elbow that's failed kind of usual treatments. What we found in some head-to-head studies is that people who get steroids with tennis elbow, oftentimes they get better for a couple of weeks,

but then don't always have a good long-term outcome. And so part of the way, one is, you know, we have to diagnose you correctly and appropriately. How I do that is through diagnostic ultrasound. I love ultrasound because number one, it's so cheap. So it costs less than a hundred bucks to do an ultrasound compared to an MRI, which is oftentimes in excess of a thousand dollars. Um, number two, there's no radiation with it. Number three is dynamic. So if you come in and you say, you know, Hey Trevor, Hey Dr. Turner, you know, my elbow has been bothering me. I've been crushing it in the halo, but I'm having a tough time with my elbow. You know, what, what's going on. It's so easy for me, not only to just put the probe

right on you at the first visit, but then I say, look, Chris, why don't you do the thing that normally bothers you? And let me watch how your tendons or your ligaments change while you're doing that, right? And you don't get that from an MRI. You don't get that dynamic picture where we get to watch you and see you actually reproduce what it is that bothers you. So number one is we got to diagnose you really well. Number two would be is that we do have some long-term clinical studies now that do show that compared to steroids that people who use, this is not the stem cell, but this is PRP or platelet-rich plasma. And platelets are cells that are routinely found in your bloodstream,

but it's something that we harvest from your vein. So we do a simple blood draw, and then we use that in a centrifuge to concentrate it. So that's the machine that spins really fast so that we can get those concentration of platelets. And then we find that damaged tissue or that scar tissue under ultrasound and we put those back in and we know that at least over 82 percent of people who have that done for tennis elbow are going to have not only a good outcome in the short term but a good outcome over a year and so that's the difference to me and doing steroids for tennis elbow now does that mean that nobody should get steroids for tennis elbow. Now, does that mean that nobody should get steroids for tennis elbow? No, I don't think so. But I think what it shows us is now the patient who comes in and says, gosh,

you know, I went to physical therapy and I wore a brace on my hand and I've been popping ibuprofen like candy or goodie powders or whatever it is. And it's keeping me up at night. It's affecting me being able to use my arm at work or on the job or when I play tennis, whatever I do. You know, I had a steroid shot and it helped me for a couple days or just didn't help me at all. What am I going to do? You know, they tell me that I don't need surgery for this problem.

And now we can say, look, you know, not only do we have a great option for you, but we have an option for you that is going to give you longstanding belief and not just last for a shorter period of time. So I think, you know, my goal is not to tell people, look, you should, you know, you should forget about all the things that everybody else has told you that can make you better. And I would say to you that, you know, in the first place, when I see a patient in the clinic, you know, I don't say, you know, hey, let's do a stem cell procedure. I say, look, you know, let's talk about what you've tried to get better. Because many times exercise alone or exercise in combination with some

medicine or bracing will help people. And so, you know, it's like, and we take an oath, like a Hippocratic oath, and we say, you know, the first goal is to do no harm, right? And so as we kind of move through our paradigm of things we can offer patients, we know that as we get more invasive, you know, typically that risk goes up. And so my goal is always to help people with the lowest risk treatment that's available to them. Yeah, because a lot of times it's great that your company has that broad range where they can start with something, you know, it's pretty non-invasive. And then, of course, you can escalate up there uh my mom's

and and for people that are out there that are having tendon issues uh like like say i am uh one thing that some of the people were telling me was that if you don't get stuff like this fixed and it keeps on going that the tendon damage can move up the arm and you can start having all sorts of problems so if you're having this sort of tendonitis sort of stuff or issues with your knees, et cetera, et cetera, you really want to have it worked on because letting it go can make things worse. Is that correct? Yeah, I think that's true. And I think also if you look at the data, I mean, so we're starting to get data, you know, I'd say tennis elbow is actually a fantastic example so i appreciate

you bringing it up um and and i have a ton of people come in for tendon problems like with the achilles with their patellar tendon by their knee with problems with their these gluteus tendons in the hip that wrap around to the outside of the hip bone as well as rotator cuff is a huge one uh and then you know you have the standard joint arthritis, shoulder, hip, and knee, big joints. But what we find is that when we use these cell-based strategies, like whether it's platelets or stem cell, you know, the dramatic responders and the people who get four and five years relief, oftentimes it's because they're coming in when their pathology or when their, you know, when their injury is kind of early to middle stage, you know, so people with moderate arthritis, oh, I mean, they do fantastic, they do really, really well, as it gets more and more advanced, you know, then I start to have this

conversation with them where I say, look, you know, I think that you can do better than you're doing now, but your, you know, your expectations, your outcomes actually go down a little bit. And so instead of seeing four to five years in relief, maybe we're talking about three years or less. But it also depends on what people want to do. And the reason that I love seeing people from all different walks of life is their goals are very different. And so we'll have a grandmother who says, look, I just want to be able to pick up my grandkids. Or somebody who's going to go on a big trip and they're going to travel and walk places. And then I have guys from the military who are saying, look, I have to be

able to jump out of a chopper. I have to be able to parachute down and land on the ground, potentially at high speed. I have to cover multiple avenues of terrain, I have to be able to repel and carry an 80 pound pack while I'm doing this, you know, how can you make my ankle stable, you know, and that is fun. I mean, it's challenging, but it's really rewarding, because you get to see people who have, you know, different kinds of demands, and you have to tailor what you're doing to what their goals and their expectations are. I've never been sort of that kind of physician that said, you know, see somebody and then says, you know, okay, look, well, you need to stop running or, okay, well, you need to quit doing that.

I mean, that's just not good enough. It's not good enough for me. It's not good enough for me anymore. Yeah. Yeah. Right. I mean, it's not good enough for me. And I mean, I was an athlete who was injured growing up. I mean, it's not good enough for me. And I mean, I was an athlete who was injured growing up. I mean, I played football in Texas in high school and loved it, part of my identity.

And I remember the first time I herniated a disc and that was a tough deal. And, you know, I think part of the reason I started to believe in the cascade of minimally invasive treatment is because I'm an example of it, right? I herniated two different discs, one playing football and another kickboxing. And now, you know, I'm 35 and I've been practicing medicine for about eight years. But, you know, I still do triathlons. I still do ruck competitions and things that, you know, maybe a lot of people who had an injury that didn't get good care wouldn't be doing, you know. And, you know, we're designed, I mean, we've evolved to be a species or a group of people who move. You know, and movement is very therapeutic.

And it's something that, you know, gives us not only a better quality of life, but oftentimes helps us find meaning, I think. And so we've got to focus on restoring those things that people use to derive meaning. And I think when we do that, then we sort of bridge that gap from somebody who's just maybe a doctor to quote you statistics to somebody who says, you know, look, I really had a connection with this person because they understand the things that are part of my identity and the part of the things that I have to do to be the best version of myself. And I think, you know, that's what moves us beyond just being maybe a doc to being somebody who's really a healer. So that's awesome. And it's awesome. You guys have the service there in Georgia, the facility to be able to do this

because picking your healthcare and getting the right doctor is important. I've found that over the years in my experience with doctors. And one of my favorite shows to watch recently is Botched. And I don't know if you're familiar with

the show, but it's a it's a plastic surgery show and they basically take people who went to bad doctors who botched their plastic surgery and these I guess these Beverly Hills doctors or whatever they try and see if they could fix what happened with the thing and seeing bad doctors doctors that don't give you the best advice and and stuff can really take you down a road that is hard to recover from or hard to fix and can be a big challenge. So you definitely want to be choosy about when it comes to your health care and the investment you make and the quality of life as you get older is really important as well. Absolutely. So I haven't seen the show for the record, Chris, but I have heard about it because it's popular and people talk to me about the TV shows they watch when they come in.

But I think, you know, kind of an important takeaway from that too is that people are saying, look, procedures and getting sick, first of all, is scary. In the United States, it's expensive and in many places, but especially here, because we're facing a healthcare crisis, employers are trying to figure out how they cover rising healthcare costs for the people that they hire. And then people are looking for options that enable them to not miss work and still, you know, be able to function and be a mom or a dad or do whatever it is that they, you know, want to do. And the, you know, the result is that if you have a bad outcome, you know, that can last for a long time, and it can really

jeopardize your ability to function. And so, you know, that's why I loved kind of the whole residency in PM&R, physical medicine and rehabilitation. I mean, it's kind of like almost like combining orthopedics and neurology. Not that we do all of what both of they do, but I think, you know, we offer kind of a, like an out of the box perspective to think of things a little more holistically, but have excellent training in anatomy and physical knowledge and work very well with the rest of the healthcare team. And so, you know, I think the advantage there is that instead of saying, well, look, there's one way to do things, you know, people come in with questions. And actually, I love that. So I think people are better sort of informed than they've ever been before when it comes to picking healthcare options. I think the awareness of regenerative medicine is kind of slowly growing, but there's definitely a lot of misconceptions about, you know, one,

what's permitted by the FDA, and then number two, what it actually should be used for. And I only can speak to orthopedics in particular, but, you know, I think it's critical that we sort of get it right the first time around. Or if we see that unfortunate patient who's had a bad interaction with the health care system, you've got to work really hard a lot of times to reverse that, to say, look, you know, if you come in the store, you're going to have a different and a better experience than you've ever had anywhere else before. And some problems are challenging more than others, but that's the expectation that we set here with our staff, not just the physicians, but our extenders and people who meet you at the front desk and the people you talk to on the phone and trying to make things more convenient and desirable from a customer service perspective, I think as well. Because people, when they come into a physician, I mean, they're already, at least in my experience, I've been, you know, kind of scared or nervous because something is being taken away from me. I mean, something's being threatened that I'm having a hard time doing.

You know, and then number two, I mean, you know, when you're in that kind of vulnerable situation, I mean, you want to be treated with respect and you want to be treated in a way that makes you feel valuable. And I think that's what people expect when they come here. And that's ultimately what they get, which is why they come. Most definitely. And like you said, picking you're making a smart choice of picking who you, you know, we've all had horror stories about doing bad doctors. And I think I'm a I'm a car crash person. So I always love cops like shows like Cops or Cheaters. I can't watch all of Botch because if I see blood or surgery,

I just start going, I can never be a doctor. There's no way. I've got to hand it to you guys. Anybody who can see blood and stuff and the internals or whatever, you know. God bless you guys because you guys are brilliant

in the science of all that. I'd just be passing out all the time before. But, you know, my mom's gone through knee surgery on one knee. She had knee replacement. They told her that her bone, that she's bone on bone. And I've always been

like, what does that really mean? Yeah. How there's a generalization and you can monitor, you can get an estimate on how much tissue is still in there. And I guess it does, in fact, become bone on bone eventually. Yeah, it can. But, Chris, you wouldn't believe how many people come in my office and tell me, hey, you know, I've got bone on bone.

And I say, okay, well, let's look. You know, and even a simple x-ray will tell you about that. But we use ultra, you know, my personal pattern is to use ultrasound a lot, very heavily, because I find things that other people don't find that way. Then we say, well, look, you know, look at your pictures with me, you know, because the pictures, you know, that's the, you know, that's the saying that picture is worth a thousand words. But we look at the pictures together. And a lot of times the people who've been told that damaged or their bone on bone, or, you know, they're just riddled with arthritis. I mean, we look at it and say, look, you know, you have some disease here, but you know, this is not insurmountable. I mean, this is an amount

of disease that we can treat. And especially now, maybe more than ever, treat effectively with either a simple platelet-rich plasma procedure or sometimes compared with a bone marrow-derived cell injection. But I think, you know, it's hard. I mean, you're having so many people tell you different things. And so, you know, I think the great physicians are the people who are not just smart, because you do have to be smart. I mean, in the United States, it's very difficult to, you know, to make it through the selection process. But, you know, one thing that we're not always training people well for, and maybe we're not selecting out, is how to be a great communicator.

And it's like one of the kind of the joyful moments for me is when a patient comes in and we have a, you know, even just a first time consultation. And before they leave, they say, you know, nobody has ever talked to me about all of that. And I'm like, well, it's kind of like, you know, that's what you deserve. I mean, you're here in a vulnerable place, oftentimes spending your hard-earned money to be able to understand, number one, what's going on. And then I believe that the people who have good understanding, those are the people who do great, who have great outcomes. Because you have to be able to understand what's going on to learn how to beat it. And the people who invest in that and take ownership in it, they really just do fantastic, I think. And so and that's part of our mission, you know, is enabling oftentimes people just to learn how to protect themselves and to learn how to be their own advocates and be sort

of the best version of themselves. Most definitely. And now with an aging, I mean, we're living longer and longer. I mean, I never thought I would have some of the issues that I had in my 40s and 50s. I've led a really healthful life. I rarely get like an infection from a flu. I'm going through a little bit of one now. So I get like a nasal infection or an ear infection, something of that nature, sometimes a viral cough, you know, walking the moon or whatever. But it's really rare that I do that. And if I use antibiotics, I'm back in play. I think I've broken a toe in my whole life, but,

uh, I've had this weird life where I've been very healthy, knock on wood, but I'm noticing that it's my aging, you know, like, like I'm having this tendonitis now and different things. And, uh, certainly as we age longer and longer, you know, my mom's, uh, I think approaching 90. And, uh, so she's, you know, uh, well, hold on. I think she's approaching her eighties, 78. She probably hears what I just said. Uh, don't let her watch this part of the podcast. She is stronger than an ox. Like every morning, she does two hours at the gym. I've tried working out with her and she will kick my butt. Like she's like that, uh, uh, SCOTUS judge. What's your name? Um, uh, boy, excuse me now. She's a great judge. Uh, but anyway, she does, she does the workout too. And my mom's like, if I don't do this workout,

I've tried working out with her. Oh man, I'm just tired. I get tired of watching her workout. But she's, she's not going down and she watching her workout and uh but she's she's not going down and she's i don't think she's had a heart attack i don't think she's had any real major issues other than these knees coming apart on her i think she had some i think years ago she had some risks done with the carpal tunnel risk surgery she had that done um but yeah definitely as we age as a community as as a, as a population, you know, there's just going to be more issues that we're going to have because we're living longer and somehow we've got to get this. So give us your final sales pitch for coming down to

the Georgia clinic there. Sure. Well, I don't know about a sales pitch, but what I would say is I would do some things, you know, we offer some things here that are really unique. And I would say that, you know, number one, we're well established and we've been helping change this community for many years and doing so in a way that's very ethical. But we're very, very innovative here. So I think you'll meet a lot of people that say, well, I do stem cells or I do regenerative medicine because either they took a course over the weekend or they have a company that provides them with a centrifuge to do some studies in their office. But you're really getting something a lot more when you come

here. I think the team overall is incredibly strong and you're getting what's called a true pinch to bedside approach, which means not only, you know, if you come here for treatment, are we, you know, doing things sort of in the context of what we call in the industry is a good manufacturing practice facility. But what that means is it's being done in a sterile hood. We're analyzing all of your cells before we put them back in a hemoanalyzer. And then we're keeping registry data. So we're keeping data about how well you do for how long based on your age, based on what kind of disease you have. And that's what's going to change the world and change the industry. It's the people who are committed to the highest level of science and are going to do that to make patient outcomes better for the long run. And I think all of us here, we feel like it's just a great privilege to be able to do what we do. And I think the patients who come, they know. I mean, you can feel it when your physician is connectable to you and is passionate about what he's doing compared to someone that maybe unfortunately is a little bit burned out or who's in it just to grind through the day. That's not what great medicine is about.

And that's not what people find here. They find a beautiful product. Plus, people have found that you're a great guy. You seem to really know what you're doing. And, of course, that's a big thing in picking a great doctor and trusting them and all that sort of good stuff and and knowing what their knowledge is i mean i've met i've met some old crotchety doctors that that they kind of have a one-sided way of thinking and and um i remember one time i went to a doctor for a burnt foot and uh they just insisting on that. I, I needed to get a bone scrape and I went to another doctor and he's like,

you just need better penicillin. Oh my God. They wanted me to do a bone scrape at the hospital. Wow. Cause it had gotten infected off a burn. And another doctor's just like, you just need more. I need the silver stuff that you put on a burn.

And then he's just like, you just need more. I need the silver stuff that you put on a burn. Uh-huh. And then he's just like, you just need some more powerful antibiotics. So he did that for me. Three days. Boom. Wow. It's better. And these other gentlemen were trying to do a bone scrape. Oh, my gosh.

So, you know. I'd be nervous if I heard you say that. It's good. What they do is really important. It's been a great exposure. Thanks for having us on the show. Trevor, give us your website one more time so people can look it up. Yeah, sure.

That's georgiaboneandjoint.org, or you can always find us on Facebook or Instagram as well. Sounds good. And thanks for Trevor to be on the show. Be sure to check him out. Look at the website, all the good stuff. Refer it to your family and friends. I'm probably going to refer it to my mom who needs her second knee replacement or maybe we can figure

out a way to keep her from getting a knee replacement because she doesn't want to do the whole knee replacement uh but it's it's just so invasive and it was tough to recover with the knee replacement uh but i always tease her about how she's the bionic woman so there's that it sounds like an awesome lady, Chris. She's wonderful. Thanks for tuning into my audience. We certainly appreciate you guys. And give us a like, subscribe to us on YouTube, hit that bell notification.

Be sure to refer the show to your friends, neighbors, relatives. And we'll see you next time. Thank you.