Episode Transcript
[00:01:07] Thanks so much for having me.
[00:01:20] So actually, what got me into medicine is when I was about 13 years old, I was on a school trip coming home from Montreal, Canada, and I was in eighth grade. And we were driving home, it was April, but upstate there was still some ice and snow. And actually the coach bus hit a patch of black ice and it rolled over a 75 foot embankment.
[00:01:40] And then I was actually. I had a laceration about this big across my thigh, just missed the major artery, you know, It's a huge accident, you know, and what I found, though, is I'm in the emergency room, all this crazy stuff is going on. And I wanted to see what was going on. I wanted to see my leg, I wanted to see them. So it, you know, and I kept. They kept having to hold me down because I really wanted to do that. And it just kind of sparked an interest in medicine. And ever since that day, I knew I wanted to be a doctor.
[00:02:28] Yeah. So originally, when I was in third and fourth year of medical school, I really thought I wanted to do orthopedic surgery.
[00:02:34] So then my fourth year, where we have a lot of electives, I lined up a bunch of orthopedic surgical rotations.
[00:02:41] And I liked it, but I was like, do I want to do this for the rest of my life? You know, So I started looking at other paths and I found sports medicine, you know, which is similar patient population. I love sports. I love athletes. Like, I played sports my whole life. I did 20 years of martial arts, baseball, football, all sorts of stuff, you know, but, you know, so I got to still work with those athletes. But then right about that time is when regenerative medicine was coming into play too. So like PRP and also musculoskeletal ultrasound was becoming very big. I'm looking at all this stuff and I'm like, wow. I think that that's really what I want to do, you know, because like, the surgeries, some people need surgeries, but if we can prevent them, that's even better, you know, as far as I'm concerned.
[00:03:36] Yeah. Because I mean, listen, anytime you go for surgery, there's always a chance there's going to be an issue you can come out worse for. We. And honestly, there are a lot of surgeries that used to be done all the time that really have very little to no benefit or just aren't needed anymore, you know, so. So not only do we have regenerative treatments, like using your own blood platelets or your bone marrow or other parts of your blood to help Bring healing to places that they can't normally get to. But now with ultrasound, I can do procedures like tendon debridements through little 3-5 millimeter incisions, no stitches required. It's the same procedure and the same effectiveness as making a big open incision, but obviously with a whole lot less risk of infection, less recovery time. So. Yeah. So, you know, it's just, you know, I always say you want to do the least amount that works. So if we can get you there without having to do a big surgery, I think that's the way to go.
[00:04:47] Yeah, sure. So, you know, the easiest way to describe regenerative medicine is I always say our body has all the capability to heal itself. The problem is sometimes our delivery system isn't very good. Okay. So places like our tendons, our ligaments, our joints, they don't have very good or sometimes no blood supply whatsoever, whatsoever. Cartilage, things like that. So what we do is we take a heavy dose of them, we concentrate them, and we put them in places that they can't normally get to, and we promote healing in places that otherwise wouldn't heal.
[00:05:18] As far as the regenerative treatments that I use now, it all started, you know, prolotherapy was probably the original, and a lot of people still do that. I just kind of phased it out of my practice. But PRP is kind of really where I started, you know, which is platelet rich plasma. So basically taking your blood, concentrating the platelets and using those platelets, which are the healers of your blood into those areas of injury. Beyond that, now we have ways where we can mix other cells, cells called extracellular vesicles, which are much smaller cells that don't come out of the PRP process. But now we have a process where we can mix that with the PRP to give you an even better result.
[00:05:55] You know, bone marrow is just full of stem cells and. And other healers in there as well, so just even more healing potential than the platelets have. You know, I would typically use those for, you know, if the partial tear is a little bit worse than it, you know, then just mild. I. I like to use it on joints and cartilage because I think while PRP works for some people, sometimes it's just not enough.
[00:06:20] Another really cool regenerative treatment I've been doing now for a while is something called A2M or alpha 2 macroglobulin. It's a protein that we get in our liver. It comes out of our blood, but instead of spinning it like prp, what you do is you put it through this filtration process, you switch it back and forth, and what it does is it concentrates the plasma and concentrates the A2M at the same time. What A2M is, is it's a protease inhibitor. So it basically just eats up inflammation. Where I think it works really well is for people with post traumatic joints, like an ACL tear or a fracture through the joint, because those people are at a very high risk of what we call post traumatic arthritis. This actually helps prevent that. So again, just another tool. So sometimes even after surgery, the regeneratives are a very good option.
[00:07:15] Yeah, so I would say probably the most common things we see are chronic tendon issues. You know, tendinopathies, so golfer's elbow, tennis elbow, your Achilles tendon, you know, plantar fascia, that type of stuff. We also do a whole lot of joints, so arthritis, you know, labral tears, you know, which are all cartilage. You know, we treat some muscle, too much muscle tends to heal pretty well on its own, though, because it has a very good blood supply as compared to the others. But some people, it doesn't heal, and we can kind of fix those areas if we need to.
[00:08:03] I mean, so many. So I'll tell you, I got into hormones because a lot of people ask, why is a sports medicine doctor doing hormone replacement? And honestly, it's because it's really a regenerative treatment. Like, it helps with recovery, it helps heal things. You know, I was having these patients where, you know, even post surgically or post treatment, you, the tissue looked way better, but they were still having problems, you know, and then you start doing this deep dive. And hormones are a big issue for a lot of people, you know, so besides that, not only helping with joint pains, you know, things like that, it's. It's super heart protective. They're now finally admitting that there's probably some decreased dementia risk along with it. It's good for energy, libido, sleep. It's a great mood stabilizer. It works for anxiety and depression.
[00:08:46] You know, just again, better sleep energy. There's just so many things, you know, that, that, that it helps with.
[00:09:03] Well, honestly, pretty much Anyone over like 35 to 40 could probably benefit from some hormone optimization. But the common signs, I would say, are different from person to person. So some people, it's like they never had anxiety before and there was no, no traumatic event. But all of a sudden they're just noticing they're a little bit more jumpy, they're a little bit more anxious. Some people, it's an exercise capacity thing. You know, I can no longer work out the way I used to. And I'm putting on this weight even though my diet's good.
[00:09:30] Low libido is certainly a big one, you know, so, yeah, you know, a lot of those just kind of common, like, I'm not feeling great, there's nothing wrong. You know, a lot of times that's hormones.
[00:10:06] Sure. So you know, it. That all goes back to a study that was done in the late 90s and early 2000s. It was called the Women's Health Initiative. They stopped the study early. It made the COVID of Time magazine that hormones cause heart attacks, hormones cause cancer, all this other stuff.
[00:10:21] A, they weren't using the best hormones at the time. They were using an estrogen that was made from pregnant horse urine and they were also using progestins, not progesterone.
[00:10:31] Now the, the good thing is, is that about two years later they went back on that data and basically redacted everything except that the progestins do cause an increased risk of breast cancer.
[00:10:44] But that doesn't make the COVID of Time magazine, right? It's only the everything's bad makes the COVID of Time magazine, right? So if hormones are done properly, there's really no increased risk. It actually reduces the risk for most things, like testosterone, for instance, significantly reduces breast cancer risk. Although estrogen is a little bit of a hotbed as far as like breast cancer and stuff like that. There's good studies that show that the people that take hormone replacement are less likely to have a recurrence if they had breast cancer. Less likely, and it's going to be at a lesser stage and just less likely to die, you know, so overall that's even good. It's a little medical legal. So sometimes with a history of breast cancer, we just treat women with testosterone. But yeah, you know, so, yeah, I mean, if it's done properly, proper blood work, making sure you're doing the right amount, there's really only long term benefit.
[00:11:59] So longer term health. I mean, I would say probably the number one thing, especially in this country is diet, right? Like, so you can be active, you can exercise, you could do all that stuff. If you can't, you can't exercise your way out of a poor diet, you know, so, so, you know, making sure that you're limiting the processed foods and the added sugars and all that stu stuff and then also just making sure you're moving, you know, like I tell my patients, all the time movement is life. You know, if you're moving, you're less likely to have health issues than if you're sitting on the couch most of the time, you know. Now ideally, that movement will also incorporate a little bit of resistance exercise, a little bit of mild to moderate cardio. So I think another mistake a lot of people make is they think more is great, you know, and intense cardio, unless you're training for like a race or something like that, is honestly not the best. You know, they find that what we call zone two cardio, which is kind of a mild to moderate. So, like, if you're jogging, you could still hold a conversation, is really kind of where the magic happens, you know, that's where you're not losing muscle, you're not spiking cortisol, and you're getting that cardiovascular health, you know, and then again, obviously, making sure your hormones are optimized. And when you are getting into a program where I think a lot of people make the biggest mistake is they go too hard too soon, you know, and then that's where that is the recipe for injury, you know, like, so that, you know, that's when you come see me. And I see it all the time, you know, but yeah, I mean, it's really diet and exercises where, where you're going to get the most beneficial.
[00:13:47] Yeah. So, you know, what I always tell them is you, you want to start real low and go slow. Okay. So as far as resistance goes, start with very light weights, make sure your form is good, and then slowly build over time. Same thing with cardio, you know, like, if you, if you're not a runner, don't go out and try and run three miles the first time because, you know, you're. You'll have difficulty walking for the next week if you do that. And you can, you know, pull a hamstring or tear something or, you know, also just making sure you're doing good. Warm up, good stretch, and again, good diet. You know, that diet and good diet and hydration also do help prevent injury, you know, so if your diet is solid and you're. And you're well hydrated, that does help prevent injury.
[00:14:44] Yeah, I mean, I would say unless you're like musculoskeletally trained, you probably don't want to really do regenerative medicine, you know, like, you know, send them to me. I'll be happy to see, you know, or another sports medicine doctor or something like that, you know, because unfortunately, even so, prp, for instance, I say it's A little bit like the Wild West. There's a lot of people doing it that don't really understand it, you know, not.
[00:15:07] You don't inject the same PRP into every place.
[00:15:11] Ideally you want to change concentrations depending on the tissue. You want to change whether you're putting white blood cells in there or not, depending on the tissue.
[00:15:19] Also, there's probably about 50 kits out there right now and maybe three of them are actually good. So you can do it and not get enough platelets in there to actually have results.
[00:15:31] If you are doing regenerative medicine, I think it is imperative that you are doing it ultrasound guided or fluoroscopic guided, but some kind of guidance. I get a lot of patients that come to me that had PRP somewhere else and they did it completely blind and it didn't work, you know, and then when we do it the right way, it's fantastic. You know, I always tell people if you do PRP without guidance, you might as well just pour it down the drain because it's, you're going to pretty much get the same results unless someone gets really lucky and puts it in the right spot, you know, so.
[00:16:22] Sure. So, you know, I mean, I like to say I, if I'm the one that's, you know, showing you the treatment and I'm the one that knows about it, I feel like I should be the one doing the procedure too, you know. So unfortunately there's a lot of these fly by clinics where you have someone that basically sells you the product and then somebody else is doing the injection, usually a PA or an np. I tell people to stay away from those places, you know, that's just me.
[00:16:47] Yeah. So you want to make sure that you're going to someone that has a lot of experience with this. Ideally, you know, I would say most regenerative doctors are either non operative, sports trained. There are some orthopedic surgeons that are very good at regenerative medicine as well.
[00:17:00] Yeah, just making, make sure you go into a good reputable place, you know, and, and if you have any doubts, go get a second opinion. I tell my patients all the time I'm happy if you go get a second opinion, you know, and then if you have any questions after that, you let me know, you know, I, I don't have any problem with that.
[00:17:26] Yeah. So, I mean, I think regenerative medicine is going to be growing by leaps and bounds, you know, already now they have this new really cool laser that just came out where not only is a topical laser, but it has an 18 gauge needle that you can put into the joint and create little micro channels within the cartilage. And then you mix that with regeneratives and the data showing that it's actually regrowing some cartilage. You know, as far as just the injections themselves, I would say the biggest problem we have in this country is just we're very limited. The government, government is a little bit strict on us, you know, so basically we can get the cells, we can concentrate the cells, but we're not supposed to culture the cells. So we can't take the best, pick out the best platelets or best stem cells and then throw them in a petri dish and grow them out so that we can inject them. That being said, I mean, what we do still works very well, but, but I think that you would see a big difference. You know, we also know in a lab we can, we can kind of tell stem cells what they should be doing, you know, but we can't do that in practice, you know. So as these things up, I think what has to happen first is unfortunately there's a lot of bad actors in regenerative medicine that are selling products that they really shouldn't be injecting into people.
[00:18:38] I think you have to clean out those places first and then for the people that are really left that are true regenerative doctors, then you have to open up what we're allowed to do, you know, and I, I think you'll just see much different results.
[00:19:09] Sure. So, you know, I started Apex center for Regenerative Medicine, but I've actually combined with a group called One Oak Medical. So now we're pretty good multi specialty groups. So I do the non surgical stuff. We have specialist orthopedic surgeons, podiatrists, all that stuff. So if you ever need the surgery, it's all in house, which is great.
[00:19:27] You know, you can reach us on our, our phone if you're in the New Jersey area or I do have people that come from Pennsylvania, Delaware, you know, New England, all sorts of places.
[00:19:37] Our number is 732-385-2739. You can always also email, you can email me directly. Honestly, it's daniel.savarino1oakmedical.com and yeah, you know, if you have any questions, I'll be happy to answer. And then if you want to come in, I can relay it to the people that make the appointments.
[00:20:08] Thank you so much for having me. My pleasure.
