# Dr. Cesar Ceballos — episode transcript Transcript aligned to the published episode. Three passages are marked [unclear] rather than guessed. Timestamps include the opening; spoken wording is retained without inferred speaker labels. This educational conversation is not individual medical advice. ### 00:00:00,100–00:00:03,880 Surgery should always be the last tool in the toolbox that you use, especially ### 00:00:03,940–00:00:08,260 nowadays. There are so many other options before you get to surgery, ### 00:00:08,760–00:00:11,420 even though, although surgery sometimes is the right option. ### 00:00:11,622–00:00:16,082 Once you've had that excruciating nerve pain coming down your leg and ### 00:00:16,182–00:00:20,622 incapacitating you and you have to have major surgery, you feel differently ### 00:00:20,662–00:00:21,862 when you take care of patients. ### 00:00:22,330–00:00:25,130 So, since we're talking about technology, I want to show something that we developed ### 00:00:25,190–00:00:27,910 over the last couple of days that is pretty exciting. ### 00:00:28,163–00:00:31,063 So I said, let me try to see if I could actually use the ### 00:00:33,603–00:00:37,443 GPS capabilities of the watch to track ### 00:00:38,383–00:00:41,882 a padel, you know, a padel activity. ### 00:00:42,043–00:00:43,503 I think I haven't verified all this. ### 00:00:43,543–00:00:45,083 This is first version of this. ### 00:00:45,703–00:00:49,703 And I got to actually, you know, see how ### 00:00:50,963–00:00:52,563 I moved through the court. ### 00:00:53,460–00:00:55,160 Welcome to Augmented Wellness. ### 00:00:55,580–00:00:57,980 Where we meet the people in pursuit of Better. ### 00:00:58,540–00:01:02,940 Today, we speak with Doctor Cesar Ceballos orthopedic surgeon and sports ### 00:01:03,020–00:01:04,160 medicine specialist. ### 00:01:08,009–00:01:11,529 Hello. Welcome to another episode of Augmented Wellness. ### 00:01:11,909–00:01:15,209 I'm here joined today by Dr. Ceballos. ### 00:01:15,549–00:01:22,349 He is an orthopedic surgeon and sport medicine specialist who has spent 25 ### 00:01:22,349–00:01:24,429 years treating injuries right here in South Florida. ### 00:01:25,549–00:01:28,329 And yeah, we're going to have a talk today, a little bit about your life, ### 00:01:28,529–00:01:33,909 about your upbringing in Miami, what brought you into this world, ### 00:01:33,909–00:01:39,549 and learn what are the latest innovations in this space. ### 00:01:39,569–00:01:42,969 I'm excited because I know you treat a lot of athletes, ### 00:01:42,969–00:01:48,509 and I'm excited to see what you're seeing in the cutting edge of this field. ### 00:01:48,709–00:01:50,189 So welcome, Dr. Ceballos. ### 00:01:50,189–00:01:53,029 Thank you, Demian. Thank you very much for having me here, ### 00:01:53,129–00:01:56,549 and it's always a pleasure to see you and collaborate. ### 00:01:58,129–00:02:01,529 Awesome. So yeah, so let's start at the beginning. ### 00:02:01,649–00:02:06,109 I'd like to go way back. I mean, you're a native of South Florida. ### 00:02:08,329–00:02:14,269 I know that, you know, like many people here, you're passionate about baseball, ### 00:02:14,269–00:02:20,929 and you started your journey as an athlete there, but then you had an injury. ### 00:02:21,429–00:02:25,369 So take me back, sort of back in those initial years, ### 00:02:25,389–00:02:30,409 and how was it to grow up in Miami, and what was life back then? ### 00:02:30,409–00:02:34,029 Yeah, Miami was a small town. I mean, I'm a little, ### 00:02:34,209–00:02:39,789 I got a few years on me, so Miami was a small town, nothing like it is now. ### 00:02:40,309–00:02:44,549 I went, I've been here since I was two years old. My family immigrated from Cuba. ### 00:02:46,229–00:02:53,769 I was gifted with athletic talents. I actually got hurt playing football. ### 00:02:54,029–00:02:54,809 Oh, football, okay. ### 00:02:55,109–00:02:59,489 But, which, I had scholarships to most of the big schools in the ### 00:02:59,489–00:03:04,489 country for football, but where I can take it to the professional level was baseball. ### 00:03:04,689–00:03:05,749 I was better at baseball. ### 00:03:05,949–00:03:06,309 Okay. ### 00:03:07,949–00:03:10,049 And from, at the age of 17, ### 00:03:10,089–00:03:14,489 I had a really bad football injury, and then switched to baseball in college. ### 00:03:14,669–00:03:18,769 And then that injury kept flaring up throughout my career in baseball. ### 00:03:20,989–00:03:22,409 And after that, ### 00:03:22,429–00:03:27,489 I had a child fairly young, and had to work to support my family, ### 00:03:28,809–00:03:35,889 and never thought medicine was going to be part of my livelihood in the future. ### 00:03:37,569–00:03:40,589 As I was getting up in age a little bit in my mid, ### 00:03:40,669–00:03:46,069 late 20s, I met my wife, who is a fourth-generation Miamian. ### 00:03:47,009–00:03:47,429 Her ### 00:03:47,429–00:03:50,969 great-grandfather is actually one of the guys that incorporated the city of Miami. ### 00:03:51,189–00:03:51,469 Wow. ### 00:03:51,469–00:03:53,029 So they have deep roots here. ### 00:03:53,209–00:03:57,729 Actually, my grandkids are sixth-generation Miamians through my wife. ### 00:03:58,189–00:04:00,649 So with her help and support, ### 00:04:01,109–00:04:06,329 went back to medical school, went to the University of Miami. ### 00:04:06,569–00:04:11,249 Then I did a five-year orthopedic residency there, ### 00:04:11,269–00:04:16,629 and then I did an extra year in California at Stanford University of Sports Medicine. ### 00:04:16,629–00:04:20,609 And came back, I got offered the job to be the 49ers physician. ### 00:04:21,369–00:04:21,969 Declined it. ### 00:04:22,589–00:04:24,529 There's no way I was getting my wife out of Miami. ### 00:04:24,729–00:04:25,129 Yeah. ### 00:04:25,409–00:04:31,249 So I had to come back here, which it's nice to take care of a professional team, ### 00:04:31,249–00:04:35,089 but you lose a lot of interaction with your family and your kids. ### 00:04:35,249–00:04:36,229 And I have five daughters, ### 00:04:36,229–00:04:42,429 and I value that a lot more than just work, even though I'm a workaholic. ### 00:04:42,429–00:04:44,969 But I always put family first. ### 00:04:45,549–00:04:50,689 And eventually, with her help, we noticed Miami. ### 00:04:50,849–00:04:53,609 As Miami grew into the metropolis that is now, ### 00:04:53,849–00:04:58,809 we noticed it doesn't have a multi-specialty orthopedic group ### 00:04:58,809–00:05:02,449 that can provide care for different body injuries, ### 00:05:02,789–00:05:08,869 different subspecialties within the realm of orthopedics. ### 00:05:08,869–00:05:11,409 So we founded OrthoMiami, ### 00:05:11,729–00:05:18,169 and not too long afterwards, I joined forces with Dr. Hommen, Pieter Hommen, ### 00:05:18,589–00:05:23,329 who's been instrumental in building the group we have now, soon. ### 00:05:23,689–00:05:24,269 And my doctor. ### 00:05:24,989–00:05:26,489 Your doctor also, yes. ### 00:05:26,629–00:05:29,149 I actually broke my clavicle. ### 00:05:29,829–00:05:32,529 He took care of it, cycling. ### 00:05:32,769–00:05:35,549 So Pieter, Dr. Hommen, actually, he's not from here. ### 00:05:35,549–00:05:36,729 He's Dutch. ### 00:05:37,109–00:05:40,089 I think he came down to the States when he was 11, Pittsburgh. ### 00:05:40,909–00:05:44,869 But eventually, when he finished orthopedics, came down to Miami, ### 00:05:45,529–00:05:52,149 although his wife is a large Miami family, and they also care about – ### 00:05:52,149–00:05:55,289 we had the same philosophy. ### 00:05:55,289–00:05:56,869 Let's build this group together. ### 00:05:57,009–00:05:58,289 There's nothing like this in Miami. ### 00:05:58,769–00:06:02,029 You either have to go to a big hospital system or the university ### 00:06:02,029–00:06:06,909 systems where you lose that personal care that we can provide in the private sector. ### 00:06:07,269–00:06:09,249 So we joined forces, and ### 00:06:09,249–00:06:13,909 I think in September we'll get the last – one of the last pieces of the puzzle. ### 00:06:14,029–00:06:15,689 We're having a spine surgeon join us, ### 00:06:15,709–00:06:20,229 and we'll have most of the major subspecialties in orthopedics. ### 00:06:20,229–00:06:21,889 So which are they? ### 00:06:22,369–00:06:24,749 We have sports medicine, ### 00:06:25,269–00:06:32,449 orthopedic hand, foot and ankle, joint reconstruction, spine surgery. ### 00:06:33,409–00:06:34,369 What else? ### 00:06:34,549–00:06:36,589 We have interventional pain management. ### 00:06:36,909–00:06:37,509 The only ### 00:06:37,509–00:06:41,729 ones we basically don't have is pediatric orthopedics and oncology orthopedics, ### 00:06:41,829–00:06:44,989 which those – especially oncology orthopedics, ### 00:06:45,149–00:06:49,149 that usually is best served by a big university program. ### 00:06:49,149–00:06:49,529 Yeah. ### 00:06:50,449–00:06:51,289 Very interesting. ### 00:06:51,649–00:06:57,249 So obviously your injury as a young athlete also ### 00:06:57,249–00:07:06,969 gave you a passion for how life-changing these orthopedic challenges could be, ### 00:07:07,149–00:07:09,069 especially for an aspiring athlete. ### 00:07:09,769–00:07:14,649 And you've been on the other side of the table a couple of times yourself, right? ### 00:07:15,189–00:07:16,069 More than a couple. ### 00:07:16,289–00:07:17,049 More than a couple. ### 00:07:17,049–00:07:19,449 So, yeah, walk us a little bit. ### 00:07:19,529–00:07:23,369 What did you learn, you know, as a patient that you applied, ### 00:07:23,369–00:07:29,449 you know, in your practice or in your way of, you know, ### 00:07:29,569–00:07:33,209 helping your patients go through this journey? ### 00:07:33,289–00:07:34,789 Because sometimes it's pretty difficult. ### 00:07:35,069–00:07:40,849 I mean, that's a huge part of how I practice medicine. ### 00:07:40,849–00:07:44,689 And my original injury, I wasn't treated properly. ### 00:07:45,089–00:07:48,809 In retrospect, going back and knowing medicine now, I wasn't treated properly. ### 00:07:48,809–00:07:53,309 So that's always been ingrained in me, like you have to do the right thing. ### 00:07:53,309–00:07:55,269 And I am a surgeon. ### 00:07:57,429–00:08:02,189 And many surgeons see a patient while you came to the office because I'm a surgeon. ### 00:08:02,389–00:08:05,349 So, you know, most surgery is one of the first tools you use. ### 00:08:05,349–00:08:06,909 I look at it the other way. ### 00:08:07,029–00:08:10,209 Surgery should always be the last tool in the toolbox that you use, ### 00:08:10,249–00:08:11,109 especially nowadays. ### 00:08:11,589–00:08:15,129 There are so many other options before you get to surgery, ### 00:08:15,629–00:08:18,249 even though, although surgery sometimes is the right option. ### 00:08:19,089–00:08:21,549 But losing, being a patient, ### 00:08:21,749–00:08:29,769 losing mobility and losing the capacity to do what you like to do is, if you haven't ### 00:08:29,769–00:08:34,009 experienced it and you just read it in the books as a physician, it's not the same. ### 00:08:34,229–00:08:36,889 Once you've had that excruciating nerve pain ### 00:08:36,889–00:08:41,369 coming down your leg and incapacitating you and you have to have major surgery, ### 00:08:41,709–00:08:44,369 you feel differently when you take care of patients. ### 00:08:44,369–00:08:51,049 So I always use that and be very compassionate and thoughtful. ### 00:08:51,349–00:08:54,389 And that's really instrumental in how I practice. ### 00:08:55,149–00:08:58,849 Yeah, look, you know, my father, obviously, you know, ### 00:08:58,909–00:09:02,329 he's been in the office taking empanadas to you guys quite a year of time. ### 00:09:02,449–00:09:06,789 But, I mean, I'm right now struggling personally with him. ### 00:09:07,889–00:09:12,029 You know, he's had a couple back surgeries and, ### 00:09:12,189–00:09:18,309 you know, he's a fragment of what he was even a year ago. ### 00:09:18,489–00:09:18,789 Right. ### 00:09:19,629–00:09:20,989 And it's hard. ### 00:09:21,329–00:09:22,629 And, you know, he goes to therapy. ### 00:09:22,909–00:09:26,169 I think, yeah, I think he goes with you guys a couple of times a week. ### 00:09:26,369–00:09:28,549 He's trying everything, but it's so hard. ### 00:09:29,709–00:09:31,229 And he sees different surgeons. ### 00:09:33,129–00:09:37,269 And, yeah, most of the time I can't go with him to the appointments. ### 00:09:37,989–00:09:39,349 But, you know, I hope ### 00:09:39,349–00:09:43,469 that the doctors have the compassion to see how he's suffering because I see him. ### 00:09:44,229–00:09:45,309 My parents live with me. ### 00:09:45,709–00:09:48,869 I see him 24-7, this struggle from the moment he wakes up in the morning. ### 00:09:49,229–00:09:51,929 You know, he didn't have a good night because of the pain. ### 00:09:52,409–00:09:55,729 Then, you know, now he's falling asleep regularly because of that pain. ### 00:09:55,969–00:09:56,729 Sleep is huge. ### 00:09:56,729–00:09:58,769 Yeah, and, you know, ### 00:09:58,829–00:10:04,149 you see a deterioration that happens, and you feel a little bit hopeless or helpless ### 00:10:04,149–00:10:07,909 on what I could do myself because he's seeing the best doctors. ### 00:10:09,269–00:10:10,529 So, yeah, ### 00:10:10,609–00:10:17,929 it's definitely good to obviously see someone that sees it from the other side. ### 00:10:18,149–00:10:20,809 Yeah, and, you know, a lot of the younger ### 00:10:20,809–00:10:25,389 doctors in my office haven't had the surgeries I've had, but I always try to. ### 00:10:25,949–00:10:27,569 So, yeah, tell us a little bit because, ### 00:10:27,669–00:10:32,449 you know, in your research I saw, you know, spine, knee, hip, you know. ### 00:10:32,809–00:10:36,629 Yeah, I've had multiple knee surgeries. ### 00:10:36,889–00:10:40,749 That was the original injury that threw off. ### 00:10:41,689–00:10:42,129 Actually, ### 00:10:42,129–00:10:47,769 good and bad because I ended up becoming a physician instead of a baseball player. ### 00:10:48,349–00:10:49,749 Now I can help others. ### 00:10:49,969–00:10:53,089 As a baseball player, I can just entertain them and not really help them. ### 00:10:54,289–00:10:56,089 But I have a knee replacement. ### 00:10:56,109–00:10:57,289 I have both hips replaced. ### 00:10:57,489–00:10:58,829 I've had five back surgeries. ### 00:10:59,709–00:11:01,989 And this is because you continue doing sports or? ### 00:11:02,389–00:11:04,449 Yeah, you know, some of the things are genetics. ### 00:11:04,689–00:11:06,589 You have some genetic issues with your spine, ### 00:11:06,589–00:11:09,369 and then you do sports or dumb stuff when you're young. ### 00:11:09,989–00:11:12,129 And then you pay the price when you get a little bit older. ### 00:11:12,129–00:11:12,489 Yeah. ### 00:11:13,289–00:11:16,949 And, but, yeah, that losing mobility and the capacity ### 00:11:16,949–00:11:21,769 to do what you like to do is it affects you not only physically but mentally. ### 00:11:21,769–00:11:22,569 So I always ### 00:11:22,569–00:11:25,889 keep that in the back of my mind when I practice medicine and see a patient. ### 00:11:26,329–00:11:26,509 Yeah. ### 00:11:27,109–00:11:27,469 Yeah. ### 00:11:27,969–00:11:30,989 Again, going back to my father, I mean, mentally is really, ### 00:11:31,409–00:11:36,169 you know, where I see him not being who he was, as I said, like a year ago. ### 00:11:36,169–00:11:42,969 So, and in that sense, I mean, is there any, I mean, there's so many things going ### 00:11:42,969–00:11:50,149 on in health care now, and especially, you know, practices that before didn't, ### 00:11:50,609–00:11:54,569 you know, weren't collaborative in a way, but mental health. ### 00:11:54,749–00:11:58,989 Is mental health now a factor or still ### 00:11:58,989–00:12:02,429 very separated from the way that you treat patients? ### 00:12:02,949–00:12:06,149 I mean, we tried to pick it up, but it's still fragmented. ### 00:12:06,369–00:12:07,989 It's still separated, to be honest. ### 00:12:08,549–00:12:10,129 Like medicine is separated. ### 00:12:10,409–00:12:13,069 Everybody's so specialized and especially. ### 00:12:13,069–00:12:14,069 Especially pain, right? ### 00:12:14,189–00:12:15,269 Pain, pain management. ### 00:12:15,669–00:12:16,549 I mean, and mental health. ### 00:12:16,689–00:12:19,009 I mean, I was in the mental health space on that, ### 00:12:19,169–00:12:25,349 and, you know, just, you know, chronic pain is one of. ### 00:12:25,509–00:12:26,049 It's horrible. ### 00:12:26,209–00:12:26,709 I've been there. ### 00:12:26,829–00:12:26,969 Yeah. ### 00:12:27,249–00:12:27,449 Yeah. ### 00:12:27,629–00:12:28,149 It's horrible. ### 00:12:28,149–00:12:28,189 It's horrible. ### 00:12:31,389–00:12:35,449 So, you know, to move on a little bit here on, you know, ### 00:12:35,469–00:12:40,489 actually the next slide, it says, when someone comes to you in pain, how ### 00:12:40,489–00:12:44,189 do you decide whether the answer is time, rehabilitation, a procedure, or surgery? ### 00:12:45,369–00:12:48,529 So it ties a little bit into how. ### 00:12:48,909–00:12:49,869 The whole package. ### 00:12:49,889–00:12:52,309 There's not one just thing. ### 00:12:52,449–00:12:55,849 You've got to look at the, first of all, you've got to get the diagnosis right. ### 00:12:55,849–00:12:55,869 Right. ### 00:12:56,609–00:12:57,689 Now, why is that? ### 00:12:57,769–00:12:58,829 Why are they having pain? ### 00:12:58,989–00:12:59,849 That's number one. ### 00:13:00,029–00:13:04,429 And then it can be from just adjusting the way they carry things at work, ### 00:13:04,549–00:13:05,809 working on their mechanics, ### 00:13:05,949–00:13:10,249 how they lift things, physical therapy, getting more flexibility back. ### 00:13:11,229–00:13:13,589 And then it's like biologics now, especially now in Florida, ### 00:13:13,749–00:13:19,289 that we can treat patients with stem cells. ### 00:13:19,929–00:13:20,409 PRP ### 00:13:20,409–00:13:25,729 is huge that we use a lot to try to avoid taking the patient to the next level, ### 00:13:25,849–00:13:30,129 which the last level in our, the last tool in our toolbox is always surgery. ### 00:13:30,869–00:13:33,269 And even surgery sometimes is the correct answer. ### 00:13:33,449–00:13:35,569 But we look at the whole picture from, ### 00:13:35,569–00:13:40,829 you know, from doing as least as possible to do the most invasive thing if needed. ### 00:13:43,009–00:13:46,289 So, you know, now obviously a lot of people today have access to AI. ### 00:13:46,489–00:13:48,649 We've been talking about AI for a while. ### 00:13:49,549–00:13:50,849 How has that changed? ### 00:13:51,049–00:13:51,929 What have you observed? ### 00:13:51,929–00:13:53,209 I mean, you know, people come, ### 00:13:53,349–00:14:00,789 you know, ready now with some, you know, self-assessment that they've done. ### 00:14:03,329–00:14:04,129 Dr. Google. ### 00:14:04,309–00:14:06,549 Dr. Google or Dr. GPT. ### 00:14:07,809–00:14:08,909 You know, what are you seeing? ### 00:14:09,009–00:14:09,909 What are the trends you're seeing? ### 00:14:09,989–00:14:11,029 I mean, obviously the models ### 00:14:11,029–00:14:14,289 are getting better and better and people now could upload a photo or a video. ### 00:14:16,289–00:14:18,129 Dr. I personally think it's phenomenal. ### 00:14:18,369–00:14:19,549 Education is huge. ### 00:14:19,969–00:14:22,269 Now, it does have its downside. ### 00:14:23,869–00:14:29,069 It's not a, you got to get the whole evaluation right. ### 00:14:29,649–00:14:31,489 AI is good for data collection. ### 00:14:31,889–00:14:34,429 You got to put the data together, you know, ### 00:14:34,529–00:14:38,809 and humanize it and get the diagnosis right and then provide the treatment. ### 00:14:38,809–00:14:45,449 I think where AI will really be huge in our practice is not, ### 00:14:45,689–00:14:50,789 is the diagnosis they can get, AI can get it, can get it down to the T. ### 00:14:51,029–00:14:55,849 But it's the minutes between getting the diagnosis, ### 00:14:56,169–00:14:58,769 evaluating the MRI, and then tell the patient, ### 00:14:58,909–00:15:02,149 okay, go to physical therapy, do this, see me back in six weeks. ### 00:15:02,149–00:15:06,529 During that six weeks, the data collection with AI and then what we do with that, ### 00:15:06,749–00:15:10,669 I think that's where it's going to really take medicine to the next level. ### 00:15:10,829–00:15:11,449 Yeah, yeah, yeah. ### 00:15:11,549–00:15:17,669 Because even last episode we talked about, you know, ### 00:15:17,809–00:15:21,249 one of our partners that we're doing a lot of personalized training. ### 00:15:22,429–00:15:27,069 You know, when they go to the gym, it's less than 2% of the time. ### 00:15:27,069–00:15:30,109 I mean, what happens the rest of the time, and, you know, in therapy, ### 00:15:30,589–00:15:34,729 when physical rehabilitation is, yeah, the person doesn't do the homework, ### 00:15:35,049–00:15:37,609 doesn't, you know, do the stretch and all that. ### 00:15:38,609–00:15:40,009 You know, it's great that they come and, ### 00:15:40,149–00:15:44,449 you know, they do it for an hour with your therapist, but if they don't continue it, ### 00:15:44,589–00:15:48,469 you know, it's not going to have the same effect, right? ### 00:15:48,829–00:15:49,309 Yeah, correct. ### 00:15:49,309–00:15:53,089 And we, you know, we'll spend 20, 30, 40 minutes with a patient in the room, ### 00:15:53,209–00:15:57,629 but what do they do the next hours between visits? ### 00:15:57,749–00:15:58,249 Yeah, yeah. ### 00:15:58,249–00:15:58,549 It's huge. ### 00:16:01,889–00:16:07,409 And so let me see here, you know, I have a couple of things that we already covered. ### 00:16:08,289–00:16:12,169 So let's go into, obviously, a very exciting part, right? ### 00:16:12,629–00:16:16,069 You know, you sort of hinted at it, regenerative medicine. ### 00:16:17,089–00:16:18,869 There's a lot of hype, right? ### 00:16:18,949–00:16:20,169 There's a lot of promise. ### 00:16:23,689–00:16:29,089 How, you know, explain to us a little bit about PRP, stem cells, exosomes. ### 00:16:29,769–00:16:31,709 You know, what is the difference? ### 00:16:31,789–00:16:32,549 I mean, what do they mean? ### 00:16:32,649–00:16:33,309 What is the difference? ### 00:16:34,109–00:16:36,209 What are you guys excited about? ### 00:16:37,049–00:16:37,889 Well, we're ### 00:16:37,889–00:16:41,689 excited now that some of those weren't legal before in the state of Florida. ### 00:16:42,549–00:16:42,869 Patients, ### 00:16:43,029–00:16:50,129 famous people, athletes will have to leave the country to get stem cell treatment. ### 00:16:50,469–00:16:52,609 Now they can do it in Florida. ### 00:16:54,489–00:17:00,209 Not, you know, not everybody, but it was July 1st, 2025. ### 00:17:01,049–00:17:04,249 There was a law passed in Florida where we can ### 00:17:04,249–00:17:09,529 use stem cell treatments for orthopedics, pain management, and wound care. ### 00:17:09,809–00:17:11,169 So, and these are, ### 00:17:11,329–00:17:18,149 so just to go into the technical aspects of it, is stem cells from someone's own? ### 00:17:19,129–00:17:21,949 Someone's own, you could use it before as long as you didn't modify it. ### 00:17:22,049–00:17:23,649 Like, you can do bone marrow aspirate. ### 00:17:23,749–00:17:25,989 You can take some blood from the patient's bones, ### 00:17:26,169–00:17:28,749 concentrate it a little bit, spin it in the centrifuge, ### 00:17:28,749–00:17:30,309 and reintroduce it to the patients, ### 00:17:30,329–00:17:33,209 but you don't know how many stem cells you're actually getting from there. ### 00:17:33,569–00:17:36,009 That's called autologous. ### 00:17:36,189–00:17:36,569 Okay. ### 00:17:36,789–00:17:39,989 Allogenic stem cells you can get from a donor. ### 00:17:40,189–00:17:40,509 Okay. ### 00:17:40,709–00:17:43,389 Those are the ones that have become legal now, ### 00:17:43,829–00:17:46,669 although they're not FDA approved, of course. ### 00:17:46,789–00:17:46,909 Right. ### 00:17:47,569–00:17:51,249 So you have to be careful how you use them, how you explain it to the patient, ### 00:17:51,369–00:17:56,329 get appropriate consent, educate the patient, give them alternative treatments. ### 00:17:57,769–00:18:01,209 That's stem cells, and it's not a cure. ### 00:18:01,509–00:18:02,189 It's not magic. ### 00:18:02,569–00:18:04,069 It's part of a... ### 00:18:04,069–00:18:04,989 Of a treatment plan. ### 00:18:05,129–00:18:06,209 Part of a treatment plan. ### 00:18:06,449–00:18:06,969 It's just like PRP. ### 00:18:06,969–00:18:09,169 I know this happens in the office. ### 00:18:09,429–00:18:09,809 Yes. ### 00:18:10,009–00:18:11,789 And what is the... ### 00:18:12,869–00:18:14,189 It happens in one visit? ### 00:18:14,509–00:18:16,409 I mean, what is the period of that treatment? ### 00:18:16,649–00:18:20,329 It can, like for PRP, you mentioned platelet-rich plasma. ### 00:18:20,529–00:18:21,889 That's been around for a while. ### 00:18:21,889–00:18:24,849 That's longer than stem cells down here in Florida. ### 00:18:25,209–00:18:27,489 We use it for many things in orthopedics. ### 00:18:27,609–00:18:30,189 We use it sometimes to delay or avoid surgical intervention. ### 00:18:31,129–00:18:33,709 We use it to enhance healing after surgery. ### 00:18:34,569–00:18:36,409 That's taking the patient's own blood. ### 00:18:36,549–00:18:40,209 We centrifuge it, and we separate the red cells from the growth factors. ### 00:18:40,209–00:18:45,749 And nowadays, the good PRP is high-concentrated platelet PRP. ### 00:18:46,009–00:18:46,929 That's done, ### 00:18:47,429–00:18:52,209 takes about usually 10, 15 minutes to spin it in the centrifuge after the blood draw, ### 00:18:52,429–00:18:55,829 and that can be reintroduced right then and there to the patient. ### 00:18:57,469–00:18:58,649 Autologous stem cells, ### 00:18:58,809–00:19:02,429 you can get it from the patient's pelvic bone towards the back. ### 00:19:02,589–00:19:06,549 You can do that in the office, spin it in the centrifuge and reintroduce it. ### 00:19:07,329–00:19:07,849 Allogenic. ### 00:19:07,849–00:19:10,489 And that takes also 15, 20 minutes? ### 00:19:10,729–00:19:13,029 Yeah, that takes – the spinning does. ### 00:19:13,229–00:19:16,009 The spinning in the centrifuge takes 10, 15 minutes. ### 00:19:16,229–00:19:20,269 The procedure takes probably 20 minutes to do it and then reintroduce it. ### 00:19:20,329–00:19:22,349 You're there for about an hour in the office. ### 00:19:22,549–00:19:23,329 And then the other one, ### 00:19:23,369–00:19:30,169 the allogenic, it comes – you have to have it at a certain temperature, very low, ### 00:19:30,729–00:19:33,949 and it comes usually overnight FedEx in a little vial. ### 00:19:33,949–00:19:38,909 And all these are out-of-pocket or insurance covers some of them? ### 00:19:39,129–00:19:39,749 What is the – ### 00:19:39,749–00:19:43,069 Insurance basically, they don't cover these. ### 00:19:43,129–00:19:43,569 Okay. ### 00:19:43,809–00:19:44,609 These are – ### 00:19:44,609–00:19:50,249 Some workers' compensation insurance will cover platelet-rich plasma, PRP, ### 00:19:50,249–00:19:54,309 and maybe one or two of these insurance programs may cover it, ### 00:19:54,329–00:19:56,509 but it's usually out-of-pocket, yeah, unfortunately. ### 00:19:58,669–00:20:02,609 And what makes a good candidate for these type of treatments? ### 00:20:05,329–00:20:07,069 It depends on the diagnosis. ### 00:20:08,149–00:20:10,329 And maybe we can get into this later. ### 00:20:10,589–00:20:15,009 A good candidate, I believe, is somebody who wants to do preventive stuff. ### 00:20:15,249–00:20:16,949 You know, and orthopedics, ### 00:20:17,069–00:20:21,229 to me, is the most reactive – medicine is reactive in the United States. ### 00:20:21,229–00:20:21,469 Yeah. ### 00:20:21,469–00:20:22,849 You wait until you get sick, you see the doctor. ### 00:20:22,849–00:20:25,269 You don't come see me if you're feeling well. ### 00:20:25,489–00:20:26,229 You break a bone, ### 00:20:26,369–00:20:31,209 you have an ACL injury, you take your rotator cuff, then you come in. ### 00:20:32,169–00:20:34,649 With all these new biologics available, ### 00:20:35,449–00:20:38,889 eating healthy, you mentioned earlier, you mentioned proper sleep. ### 00:20:39,329–00:20:40,129 There's so much ### 00:20:40,129–00:20:45,369 we can do to prevent injuries and prevent disease that we're not taking advantage. ### 00:20:45,369–00:20:48,489 And I'm actually in the middle of developing ### 00:20:48,489–00:20:53,589 a preventive orthopedic branch of our office to try to prevent these injuries ### 00:20:53,589–00:20:57,489 and provide patients with a healthier and longer health span. ### 00:20:57,549–00:20:58,749 So how would that look like? ### 00:20:59,409–00:21:02,909 What would be a typical preventive – ### 00:21:02,909–00:21:03,929 For example, ### 00:21:04,009–00:21:09,229 something really cool that I've developed, we can get into later, needle arthroscopy. ### 00:21:09,709–00:21:12,149 When you have an arthroscopic surgery in the joint, ### 00:21:12,369–00:21:15,329 you typically use a big camera, it goes in your knee. ### 00:21:15,429–00:21:17,949 I use something that's called needle arthroscopy. ### 00:21:18,249–00:21:21,689 It's the size of a needle, basically with a camera chip on the tip. ### 00:21:23,029–00:21:29,409 Let's say you're a marathon runner or you like to run a lot of miles a week. ### 00:21:29,569–00:21:32,209 Why don't you come in once or twice a year? ### 00:21:32,469–00:21:34,329 I can stick a needle in your knee, ### 00:21:34,609–00:21:37,769 evaluate the cartilage in the office, take a look. ### 00:21:37,769–00:21:39,489 Listen, your cartilage looks super healthy. ### 00:21:40,089–00:21:40,829 Right then and there, ### 00:21:40,889–00:21:45,769 I can put some PRP in your knee, which can protect the cartilage. ### 00:21:46,449–00:21:50,029 And you can – you know, okay, listen, I can continue to increase my mileage. ### 00:21:51,349–00:21:54,229 Different example, your cartilage is taking a beating. ### 00:21:54,449–00:21:55,609 How many miles are you running? ### 00:21:55,709–00:21:58,409 Why don't you cut back on a certain amount of miles, ### 00:21:58,629–00:22:03,209 cycle a little bit more, swim a little bit more, inject PRP preventively? ### 00:22:03,549–00:22:06,749 There's things like that that you can do that we couldn't do five years ago. ### 00:22:06,749–00:22:07,149 Yeah. ### 00:22:07,369–00:22:10,089 And many more preventive things we can do. ### 00:22:10,109–00:22:12,289 Well, actually, so this ties a little bit to what we were talking about, you know, ### 00:22:12,369–00:22:14,329 the collaboration opportunities that we have. ### 00:22:14,389–00:22:18,029 And when I show a little bit of the demo I'm going to show today, ### 00:22:18,189–00:22:19,049 it's exactly that. ### 00:22:19,209–00:22:24,009 How, you know, how can we partner so you can monitor people's, ### 00:22:24,229–00:22:26,269 you know, are you doing too many miles, right? ### 00:22:26,689–00:22:29,149 Should you cut back a little bit, you know, ### 00:22:29,269–00:22:34,109 given X, Y, Z, and then, you know, alternate it with other type of sports? ### 00:22:35,029–00:22:35,389 Right. ### 00:22:36,529–00:22:36,889 Yeah. ### 00:22:37,029–00:22:37,449 Yeah, so it's... ### 00:22:37,449–00:22:39,849 Yeah, I'm excited to hopefully get that done. ### 00:22:40,069–00:22:40,689 That's going to be phenomenal. ### 00:22:40,689–00:22:47,229 Yeah, yeah, because, I mean, I mean, as not an expert in running, ### 00:22:47,349–00:22:50,389 but running is, for me, it's a really hard sport. ### 00:22:50,829–00:22:54,949 I'm, how do you say, my biomechanics are not for running. ### 00:22:54,989–00:22:55,449 You weren't built for running. ### 00:22:55,609–00:22:56,429 You weren't built for running. ### 00:22:56,429–00:22:58,009 I mean, I just ran one time, ### 00:22:58,089–00:23:00,049 I did a half marathon, and I thought I was going to die. ### 00:23:00,249–00:23:03,929 Well, in cycling, I never thought I was a cyclist, ### 00:23:03,929–00:23:06,889 and a couple years ago I picked it up, and it feels amazing. ### 00:23:07,009–00:23:07,269 Right. ### 00:23:07,689–00:23:10,229 For me, and I react very well to it, ### 00:23:11,109–00:23:17,209 obviously it doesn't have the same, you know, what do you say? ### 00:23:17,729–00:23:18,729 Load on your body. ### 00:23:18,729–00:23:19,209 Impact, impact. ### 00:23:19,389–00:23:26,469 I actually went with Dr. Nimer, who was here from Sylvester a couple episodes ago. ### 00:23:26,709–00:23:29,349 He invited me to a longevity talk, and ### 00:23:29,349–00:23:36,869 there was this lady that she's the medical director, I think, for Boston Marathon. ### 00:23:37,529–00:23:45,389 And she was actually sharing some data of the amount of inflammation that, ### 00:23:45,389–00:23:48,809 you know, like marathon runners have. ### 00:23:49,029–00:23:49,969 It's just incredible. ### 00:23:49,969–00:23:50,209 Yeah. ### 00:23:50,209–00:23:52,769 I mean, the impact, and then, ### 00:23:52,849–00:23:56,609 you know, how that leads to sort of generalized inflammation of the body. ### 00:23:57,389–00:24:00,329 And you don't have to wait for that to become an issue nowadays. ### 00:24:00,329–00:24:01,989 There's things you can do preventively. ### 00:24:02,069–00:24:02,349 Exactly. ### 00:24:02,509–00:24:03,649 Now that we know that. ### 00:24:03,649–00:24:04,889 From, you know, obviously. ### 00:24:05,249–00:24:05,289 That's data. ### 00:24:05,549–00:24:05,929 That's data. ### 00:24:05,929–00:24:05,949 That's data. ### 00:24:06,209–00:24:06,749 We have the data, ### 00:24:06,809–00:24:10,529 and now we can do preventive medicine to prevent the final problem. ### 00:24:10,809–00:24:10,949 Yeah. ### 00:24:14,229–00:24:16,989 So, yeah, let's talk a little bit about Florida. ### 00:24:17,229–00:24:22,609 So, how unique is it that Florida allows this? ### 00:24:22,789–00:24:23,909 How many other states? ### 00:24:24,089–00:24:29,149 I mean, because obviously, talking to professionals down here, ### 00:24:29,249–00:24:30,849 they're pretty excited that Florida allows this. ### 00:24:30,849–00:24:34,309 But is it something so innovative versus other states? ### 00:24:34,629–00:24:35,749 What is the situation? ### 00:24:35,989–00:24:37,069 It's very innovative. ### 00:24:37,489–00:24:39,049 Again, it's not FDA approved. ### 00:24:39,169–00:24:40,749 The feds don't recognize it. ### 00:24:42,029–00:24:44,189 It's kind of like medical marijuana in Florida. ### 00:24:44,489–00:24:45,209 It's done. ### 00:24:45,209–00:24:48,269 It's done, and it helps a lot of people, but it's not FDA approved. ### 00:24:48,329–00:24:49,389 The feds don't recognize it. ### 00:24:51,409–00:24:54,089 It's, I think we have about six or seven states. ### 00:24:54,189–00:24:55,409 I think Tennessee's on board now. ### 00:24:55,509–00:24:57,149 I think it's about six or seven other states. ### 00:24:57,349–00:24:58,249 Six or seven. ### 00:24:58,689–00:25:00,489 Don't hold me to it, but I think there's six or seven ### 00:25:00,489–00:25:04,329 other states that have similar laws that have been passed over the last few years. ### 00:25:04,329–00:25:06,749 A couple just were implemented not too long ago. ### 00:25:07,489–00:25:08,229 But it's huge. ### 00:25:08,289–00:25:10,089 You don't have to travel out of the country. ### 00:25:11,089–00:25:14,449 You go to some of these places out of the country, ### 00:25:14,549–00:25:15,489 you don't know what you're getting. ### 00:25:16,589–00:25:19,129 If you get it from a reputable company down here, ### 00:25:19,309–00:25:20,629 you know exactly what you're getting. ### 00:25:20,789–00:25:25,249 And I have labs that have tested the products where we receive it, ### 00:25:25,309–00:25:26,169 and it's right on point. ### 00:25:26,309–00:25:27,689 You're getting what they tell you you're getting. ### 00:25:28,389–00:25:30,169 This is exciting, ### 00:25:30,169–00:25:34,709 and obviously it's great that we have this available in our backyards. ### 00:25:37,269–00:25:42,869 To that point, I mean, what are, you know, some of the things to watch for? ### 00:25:43,069–00:25:45,209 You said, you know, reputable. ### 00:25:46,189–00:25:48,369 Is it that they do third-party testing? ### 00:25:48,629–00:25:50,629 I mean, what are some of the general suggestions? ### 00:25:50,629–00:25:51,789 Yeah, third-party testing. ### 00:25:51,929–00:25:52,669 You have to be careful. ### 00:25:52,789–00:25:54,469 A lot of companies want to move into Florida. ### 00:25:54,469–00:25:56,069 Hey, let's make a quick buck and leave. ### 00:25:56,489–00:25:59,629 One of the companies that I use, they've been around here for 13 years. ### 00:26:00,009–00:26:02,109 They're not just here because of that law has passed. ### 00:26:02,109–00:26:04,709 They want to advance medicine. ### 00:26:04,889–00:26:07,789 They want to make medicine better, and they care about it. ### 00:26:07,849–00:26:08,509 They do research. ### 00:26:08,689–00:26:08,729 They're ### 00:26:08,729–00:26:12,869 doing some research with the NFL and with high school players about certain things ### 00:26:12,869–00:26:16,869 to reduce inflammation with some other products right after an acute injury, ### 00:26:17,129–00:26:19,509 even TBI injuries. ### 00:26:20,249–00:26:22,109 But you have, like anything, ### 00:26:22,249–00:26:25,269 you have to be careful where you're getting it from and do your research. ### 00:26:25,709–00:26:26,949 A question on inflammation. ### 00:26:27,109–00:26:30,209 What markers do you use to measure inflammation? ### 00:26:30,209–00:26:33,809 Do you use, like, also blood panels, like hs-CRP and those type of? ### 00:26:33,809–00:26:35,469 I leave that more for the medical guys. ### 00:26:35,589–00:26:35,789 Okay. ### 00:26:35,889–00:26:36,929 I'm an orthopedic guy. ### 00:26:36,929–00:26:38,629 I'm more like a mechanic. ### 00:26:38,629–00:26:39,009 Mechanic. ### 00:26:39,169–00:26:39,329 Okay. ### 00:26:39,349–00:26:42,989 But I leave it for the guys that are smarter than I am, such as yourself, ### 00:26:43,129–00:26:44,009 building all this. ### 00:26:44,049–00:26:48,709 Well, I, you know, I self, I'm a, I guess, a biohacker. ### 00:26:50,829–00:26:52,889 But I leave it to the smarter physicians. ### 00:26:53,289–00:26:57,549 You know, and then I take their advice and I implement that advice into our program. ### 00:26:58,549–00:26:59,109 Great. ### 00:27:03,469–00:27:05,129 So, interesting question here. ### 00:27:05,389–00:27:09,649 I coordinate with some other primary physicians that will do that. ### 00:27:09,769–00:27:10,509 They'll give me the data. ### 00:27:10,689–00:27:13,189 Then our physical therapy guys take that into consideration. ### 00:27:13,189–00:27:17,209 Yeah, I know the full coordination between all the experts. ### 00:27:17,609–00:27:19,529 So, you talked about the little camera needle. ### 00:27:23,629–00:27:26,389 So, it says here that, you know, ### 00:27:26,449–00:27:28,469 you could look inside the joints now, right, with a needle. ### 00:27:28,769–00:27:30,529 You know, arthroscopy. ### 00:27:30,709–00:27:32,369 That's, you know, I haven't said that word in a while. ### 00:27:34,389–00:27:40,529 So, what, I mean, is this like a new technology that, you know. ### 00:27:40,569–00:27:41,709 It's fairly new. ### 00:27:42,169–00:27:45,089 It's revolutionizing the way we practice orthopedics. ### 00:27:45,229–00:27:48,169 In the future, whoever doesn't use that ### 00:27:48,169–00:27:52,749 camera to perform an arthroscopic surgery is doing a disservice to the patient. ### 00:27:52,909–00:27:55,609 And once you use the camera, there's no impact. ### 00:27:55,809–00:27:57,349 I mean, you could go about your day. ### 00:27:57,349–00:27:58,789 It's just like injecting a knee. ### 00:27:59,029–00:28:01,149 But I do my surgeries with that camera. ### 00:28:01,449–00:28:01,589 Wow. ### 00:28:01,709–00:28:03,969 Anytime I need an arthroscopic, I use that camera. ### 00:28:04,109–00:28:07,569 For example, the data that I've been collecting, ### 00:28:07,889–00:28:11,989 most people know what a meniscectomy is, meniscus. ### 00:28:12,049–00:28:12,889 A little cushion between ### 00:28:12,889–00:28:15,569 the thigh bone and the leg bone and the knee that tears very frequently. ### 00:28:16,269–00:28:17,049 Typically, a ### 00:28:17,049–00:28:22,309 20-year-old college football player has a meniscus tear that doesn't require fixing. ### 00:28:22,309–00:28:25,849 It just requires a little cleaning up so it doesn't rub between both bones. ### 00:28:25,849–00:28:27,809 Sometimes you go in there with a regular camera. ### 00:28:28,009–00:28:31,849 They're playing in a game at the college level maybe six weeks, ### 00:28:32,229–00:28:35,329 five weeks, maybe four weeks, depending on their pain tolerance. ### 00:28:35,809–00:28:39,489 With the needle scope, you can get it back in 10, 12 days. ### 00:28:39,769–00:28:40,049 Wow. ### 00:28:40,209–00:28:40,609 For example, ### 00:28:40,789–00:28:45,749 our Olympic hockey team, the U.S. hockey team that won the gold medal, that goalie ### 00:28:45,749–00:28:52,129 had his knee scoped with a needle scope three weeks before the gold match game. ### 00:28:52,249–00:28:54,289 If it would have been done with the other scope. ### 00:28:54,289–00:28:55,789 Why exactly is it? ### 00:28:55,929–00:28:57,529 Because it's more precise? ### 00:28:58,449–00:28:59,329 It's precise. ### 00:28:59,749–00:29:01,349 Just as precise is the size. ### 00:29:01,509–00:29:04,469 It's smaller, less trauma in the joint. ### 00:29:04,609–00:29:06,309 You're not sticking a big instrument in there. ### 00:29:06,309–00:29:15,169 And I think the [unclear], what really separates it is with the big ### 00:29:15,169–00:29:18,429 camera, you have to inflate the knee with a lot of pressure with fluid. ### 00:29:18,909–00:29:20,949 With the needle scope, minimal fluid. ### 00:29:21,149–00:29:22,989 And I think that's what causes it. ### 00:29:22,989–00:29:27,129 So there's minimal trauma inside the joint, less swelling, quicker recovery. ### 00:29:27,129–00:29:29,509 And I haven't ### 00:29:29,509–00:29:33,429 prescribed a narcotic in I don't know how many years after a regular knee scope. ### 00:29:34,269–00:29:36,289 With a regular camera, ### 00:29:36,769–00:29:39,769 typically most doctors prescribe a narcotic after surgery. ### 00:29:39,869–00:29:41,369 I haven't done that, I think, over three years. ### 00:29:41,369–00:29:43,649 I haven't prescribed a narcotic for a regular knee scope. ### 00:29:44,889–00:29:49,789 No, obviously that has all its benefits on their own, right? ### 00:29:51,289–00:29:56,089 So just to compare, is this like a replacement for an MRI? ### 00:29:57,409–00:29:59,489 It can be used as a diagnostic tool. ### 00:29:59,649–00:30:03,689 I've used it in the office when patients can't get an MRI because ### 00:30:03,689–00:30:07,969 they may have some type of metal near their heart, a pacemaker, defibrillator. ### 00:30:08,509–00:30:10,049 Some patients are claustrophobic. ### 00:30:10,229–00:30:11,209 They can't get an MRI. ### 00:30:11,409–00:30:12,809 I've used it for that particular reason. ### 00:30:13,349–00:30:15,769 When MRIs are inconclusive, you're not sure. ### 00:30:16,629–00:30:18,449 It can be used for diagnosis also. ### 00:30:18,609–00:30:20,409 And at the same time, you can identify the problem. ### 00:30:20,749–00:30:22,629 In many cases, you can treat it right then and there. ### 00:30:23,269–00:30:24,769 And it's actually better than an MRI. ### 00:30:24,889–00:30:25,929 You're actually looking at the structure. ### 00:30:26,049–00:30:28,169 Yeah, you're actually looking at the real thing, right? ### 00:30:28,369–00:30:30,569 And I'm sure it's like 4D, you know. ### 00:30:30,749–00:30:32,449 Yeah, and it's just getting better. ### 00:30:32,789–00:30:35,089 The new one's coming out now, I think, in October. ### 00:30:35,089–00:30:38,349 The next generation, which will be easier to use. ### 00:30:38,569–00:30:41,969 So hopefully more doctors will start using it and better serve patients. ### 00:30:42,669–00:30:44,769 Just ballpark, what is the cost of something like that? ### 00:30:46,229–00:30:47,029 It depends. ### 00:30:47,649–00:30:51,149 It depends what you're doing, what type of surgery you're doing with it. ### 00:30:51,229–00:30:53,169 Just taking a look can be a few thousand dollars. ### 00:30:53,629–00:30:56,629 But the camera itself, is it like a $20,000, $30,000, $50,000? ### 00:30:56,949–00:30:58,689 No, no, no, no, no, no, no. ### 00:30:58,809–00:30:59,329 No, it's not. ### 00:31:00,409–00:31:03,529 It's actually disposable, and it connects to an iPad. ### 00:31:04,169–00:31:04,509 Oh, yeah? ### 00:31:04,509–00:31:05,529 Yeah, it's really cool. ### 00:31:06,989–00:31:08,029 It's disposable, yeah. ### 00:31:08,269–00:31:09,509 You use it one time, you throw it away. ### 00:31:09,749–00:31:11,689 So it's like a fiber. ### 00:31:11,689–00:31:11,869 That's it. ### 00:31:11,869–00:31:13,249 I wish I should have brought it. ### 00:31:13,349–00:31:15,909 I have it behind my desk, a little sample one. ### 00:31:16,069–00:31:16,729 I should have brought it. ### 00:31:16,849–00:31:19,649 So basically, it's a cable that connects to an iPad that has a camera. ### 00:31:19,689–00:31:21,109 You use it and dispose it. ### 00:31:21,129–00:31:22,549 You take pictures with it, and then you. ### 00:31:23,049–00:31:23,389 Wow. ### 00:31:23,589–00:31:23,709 Yeah. ### 00:31:23,909–00:31:24,369 It's amazing. ### 00:31:24,629–00:31:25,989 You learn something every day. ### 00:31:34,289–00:31:35,049 So, yeah. ### 00:31:35,169–00:31:41,129 So let's talk a little bit about OrthoMiami and your plans. ### 00:31:41,329–00:31:43,009 I mean, I know you have big plans for it. ### 00:31:45,489–00:31:48,469 And so right now you have how many offices? ### 00:31:48,649–00:31:49,209 You have Doral? ### 00:31:49,989–00:31:51,649 Right now we have two offices. ### 00:31:52,049–00:31:58,049 South Miami Kendall on 87th Avenue between Sunset and Kendall, the original office. ### 00:31:58,049–00:31:58,809 By the way, ### 00:31:59,009–00:32:04,509 I just walked into the lobby of the original, and I love how you guys did it. ### 00:32:04,569–00:32:05,109 Yeah, expanded. ### 00:32:05,349–00:32:05,769 It's huge now. ### 00:32:05,909–00:32:06,049 Yeah. ### 00:32:06,129–00:32:07,929 We have physical therapy there also. ### 00:32:08,509–00:32:10,909 The guys who run our physical therapy are phenomenal. ### 00:32:11,789–00:32:12,769 One in Doral. ### 00:32:13,529–00:32:13,649 Yep. ### 00:32:13,809–00:32:15,669 And we'll be expanding pretty soon. ### 00:32:15,869–00:32:17,749 We're looking for a centralized location, ### 00:32:17,749–00:32:20,949 a little bit closer to the Brickell area, possibly, ### 00:32:22,709–00:32:23,069 and ### 00:32:23,069–00:32:29,149 tying that together with a new surgical center to better serve our population. ### 00:32:29,669–00:32:32,829 And what, you know, talking about the population, ### 00:32:32,989–00:32:35,429 what are the shifts that you've seen in Miami? ### 00:32:35,989–00:32:37,249 Obviously, Miami has changed a lot. ### 00:32:37,369–00:32:39,389 I mean, you said, obviously, from when you were young. ### 00:32:39,669–00:32:41,589 So what are the shifts that you see? ### 00:32:41,889–00:32:43,089 I mean, because everybody used to say all sorts. ### 00:32:43,089–00:32:43,709 Besides traffic. ### 00:32:43,929–00:32:44,369 Oh, yeah. ### 00:32:45,369–00:32:45,729 Yeah. ### 00:32:45,849–00:32:48,829 But, you know, everybody in Florida, you know, all their population, all that. ### 00:32:48,989–00:32:50,049 I mean, that has changed dramatically. ### 00:32:50,049–00:32:50,169 Dramatically. ### 00:32:50,589–00:32:50,789 Yeah. ### 00:32:51,229–00:32:53,909 The sports scene has changed dramatically, Miami. ### 00:32:54,389–00:32:55,409 When I was younger, ### 00:32:55,409–00:32:59,249 you go to California and you see everybody outdoors walking or jogging ### 00:32:59,249–00:33:00,989 that wasn't like that down here. ### 00:33:01,169–00:33:04,169 Now this is the place to do the outdoor stuff. ### 00:33:04,449–00:33:06,109 And obviously now we have, ### 00:33:06,269–00:33:09,909 I mean, there's also all these cultural shifts on people now, ### 00:33:11,089–00:33:15,849 you know, changing nightlife for actually healthier stuff. ### 00:33:16,069–00:33:16,629 They're running more. ### 00:33:16,629–00:33:18,829 But I'm sure by running more and doing all that, ### 00:33:19,249–00:33:22,029 you know, there's also an increase on injuries and things like that. ### 00:33:22,249–00:33:25,729 It's no longer the 80s where nightlife was what you did for recreation. ### 00:33:26,129–00:33:28,429 Now you take care of your body. ### 00:33:28,629–00:33:29,169 You run. ### 00:33:29,369–00:33:31,809 And unfortunately, with that comes injuries. ### 00:33:32,269–00:33:32,569 Orthopedic. ### 00:33:32,569–00:33:35,009 Well, that's where exactly also the preventive stuff, right? ### 00:33:35,169–00:33:35,269 Correct. ### 00:33:35,269–00:33:37,009 So if people, I mean, you know, because, ### 00:33:37,069–00:33:42,789 I mean, running, you know, running, going back, I mean, if you run regularly, yeah. ### 00:33:42,989–00:33:45,269 And if you're not watching your body. ### 00:33:46,869–00:33:49,309 Not only just working out also, lifting weights, ### 00:33:49,469–00:33:51,249 everything, everything takes a toll on your body. ### 00:33:51,389–00:33:54,689 And you can do things for it not to get to where it's a disease. ### 00:33:54,929–00:33:55,089 Yeah. ### 00:33:55,349–00:33:57,329 You got a little ache, soreness, all that is good. ### 00:33:57,609–00:33:58,309 And I expect it. ### 00:33:58,409–00:34:01,009 But you can, there's so much you can do now to ### 00:34:01,009–00:34:05,369 prevent all that getting to a disease and a problem that will limit your mobility. ### 00:34:06,309–00:34:07,329 And we got it. ### 00:34:07,429–00:34:08,809 We have to get, we have to be better ### 00:34:08,809–00:34:12,469 as physicians to get the word out there and let the, or people know about it. ### 00:34:12,469–00:34:14,649 Well, actually, when we did the event here, ### 00:34:14,769–00:34:18,309 you guys, you know, share how much has changed as a physician, right? ### 00:34:18,409–00:34:24,829 I mean, I think we were talking and you said, like, you know, five, ten years ago, ### 00:34:24,989–00:34:28,309 you know, the role that we had as a physician was so different than today. ### 00:34:28,649–00:34:30,889 Especially now with social media, you know, ### 00:34:31,169–00:34:33,769 having to, you know, educate and be out there. ### 00:34:34,369–00:34:36,629 What do you see, you know, how do you ### 00:34:36,629–00:34:40,409 see the role of a physician now with AI changing in the next couple of years? ### 00:34:40,589–00:34:42,189 I mean, especially in your particular area. ### 00:34:42,989–00:34:45,949 I mean, I'm older than these young doctors that are getting out there now. ### 00:34:46,069–00:34:47,389 But if you don't use it, ### 00:34:47,509–00:34:50,789 you stay behind and you stay behind for your patients, which is important. ### 00:34:50,989–00:34:57,109 You need to, but you have to integrate it in a way that it serves the right purpose. ### 00:34:57,109–00:35:00,489 Like we were talking earlier about collecting the right data and, ### 00:35:00,609–00:35:02,669 most importantly, making the right diagnosis. ### 00:35:02,949–00:35:06,149 And then using AI to take that to a different level, ### 00:35:06,409–00:35:08,289 expedite the patient's recovery. ### 00:35:09,389–00:35:14,189 You can, before we, like, getting somebody back after an ACL injury, before ### 00:35:14,189–00:35:18,249 we do a functional ACL analysis testing, that's making them jump on one leg. ### 00:35:19,229–00:35:20,929 So, you know, measuring their strength now with AI, ### 00:35:21,129–00:35:23,969 we can probably take that to the next level and do something that's... ### 00:35:23,969–00:35:26,229 And do it on their own time, right? ### 00:35:26,289–00:35:28,149 So, that way it also relieves it. ### 00:35:28,593–00:35:30,773 So, since we're talking about technology, I want to show ### 00:35:30,773–00:35:34,393 something that we developed over the last couple of days that is pretty exciting. ### 00:35:34,593–00:35:38,753 And surprisingly, I developed it because I have a ### 00:35:38,753–00:35:41,813 lot of friends that are playing padel and racquetball and other sports. ### 00:35:42,993–00:35:46,753 And as we now develop the new version of the platform where we want to ### 00:35:46,753–00:35:53,973 track as many sports as possible and track it with as much accuracy as possible. ### 00:35:54,913–00:35:57,513 I don't know if you knew this, but, you know, Apple has, ### 00:35:57,673–00:36:01,593 obviously, the Apple Watch has, you know, a bunch of activities you could track. ### 00:36:01,793–00:36:02,773 But if you put something like tennis, ### 00:36:02,873–00:36:04,693 well, first of all, it doesn't even have padel, right? ### 00:36:04,693–00:36:04,773 Right. ### 00:36:04,893–00:36:07,293 Which is a pretty big sport globally. ### 00:36:07,533–00:36:09,433 And in Miami, it's a big thing. ### 00:36:10,113–00:36:13,053 But if you track tennis, it only tracks your heart rate. ### 00:36:13,253–00:36:13,553 Right. ### 00:36:13,693–00:36:13,893 Right? ### 00:36:14,053–00:36:16,293 And obviously, you're moving a lot in tennis, right? ### 00:36:16,593–00:36:21,733 The only ones that you could track by the use of GPS that I've seen is walking, ### 00:36:21,893–00:36:23,473 outdoor sports, running, cycling. ### 00:36:23,473–00:36:26,913 So I said, let me try to see if I could actually ### 00:36:26,913–00:36:38,113 use the GPS capabilities of the watch to track a padel, you know, a padel activity. ### 00:36:38,613–00:36:40,613 And actually, this is pretty exciting. ### 00:36:42,033–00:36:46,453 You know, this is, I'm here in our friend's Wynwood Padel here in Miami. ### 00:36:46,453–00:36:52,253 I played, this is a half an hour play, and it, ### 00:36:52,253–00:36:55,813 you know, it quantifies a little bit of some of the specific things for padel. ### 00:36:55,993–00:36:58,253 Like, I ran, like, 0.2 miles. ### 00:36:58,393–00:36:59,653 I think I haven't verified all this. ### 00:36:59,773–00:37:01,273 This is first version of this. ### 00:37:01,593–00:37:07,473 My top speed was 20 miles per hour, and 29% I was in play. ### 00:37:07,773–00:37:09,433 And I added some zones. ### 00:37:09,693–00:37:10,393 I actually ### 00:37:10,393–00:37:15,213 had my AI help me figure out what are some of the things that are specific to padel. ### 00:37:15,213–00:37:18,333 So these are my zone play times. ### 00:37:18,513–00:37:23,753 What I wanted to do, I wanted to actually see it, you know, in a [unclear] overlay. ### 00:37:23,933–00:37:27,453 So this is actually Wynwood Padel right here in Miami, right here in Wynwood. ### 00:37:27,833–00:37:29,313 And I was playing in this court. ### 00:37:30,313–00:37:37,473 And I got to actually, you know, see how I moved through the court. ### 00:37:38,193–00:37:40,013 I did a perimeter first. ### 00:37:40,513–00:37:45,413 That's my own invention to really make sure that I could lock it into the court. ### 00:37:45,613–00:37:49,073 But this is how I moved, you know, in the 30 minutes throughout the court. ### 00:37:49,873–00:37:51,713 And this is exciting because this is, ### 00:37:51,853–00:37:57,133 you know, being able to, you know, put some data down to how I played. ### 00:37:58,853–00:38:04,433 And, you know, obviously with the Apple Watch, I could also measure my heart rate. ### 00:38:04,613–00:38:09,373 So this is my heart rate evolution during the play time that I had there. ### 00:38:10,093–00:38:12,973 My elevation, obviously the court didn't have a lot of elevation. ### 00:38:13,253–00:38:14,153 My pace. ### 00:38:14,453–00:38:17,913 So here's some of the little bit of running that I did. ### 00:38:18,693–00:38:19,993 I didn't run that much. ### 00:38:20,913–00:38:22,313 And then my heart rate zones. ### 00:38:22,913–00:38:25,053 So, you know, this is exciting because ### 00:38:25,053–00:38:31,633 it could be applied to any sport where you could track via GPS. ### 00:38:31,953–00:38:32,733 So tennis. ### 00:38:32,733–00:38:33,473 That's phenomenal. ### 00:38:34,893–00:38:37,453 And, you know, going back to some of the things that we discussed. ### 00:38:37,453–00:38:44,033 I mean, if someone is tracking, you know, themselves through their daily life ### 00:38:44,033–00:38:47,993 and you start adding up, okay, well, you know, your knee is hurting. ### 00:38:47,993–00:38:49,753 But let's see what you've been doing. ### 00:38:49,873–00:38:50,773 Oh, you've been playing padel, ### 00:38:50,913–00:38:56,633 which obviously is probably pretty abrupt in your knees or other type of sports. ### 00:38:56,893–00:38:58,233 Plus, you've been running a lot. ### 00:38:58,353–00:38:59,673 And we start adding those miles. ### 00:39:00,073–00:39:05,073 You know, now we see that, yeah, you either need to take some ### 00:39:05,073–00:39:11,713 preventive care or preventive treatments or slow down or change the mix of sports. ### 00:39:12,133–00:39:14,913 So, again, this is a little bit exciting. ### 00:39:15,173–00:39:16,073 That's super exciting. ### 00:39:16,213–00:39:17,253 You can use it for any sport. ### 00:39:18,293–00:39:19,053 Yeah, yeah. ### 00:39:19,133–00:39:20,813 I mean, my daughter plays beach volleyball. ### 00:39:20,953–00:39:22,073 We talked to her the other day. ### 00:39:22,293–00:39:24,793 I said, hey, I'll build one of this for you. ### 00:39:24,973–00:39:27,953 So, you know, how much are you moving around the court? ### 00:39:28,693–00:39:30,773 And probably with these devices, ### 00:39:30,773–00:39:33,293 you could even measure, like, you know, if they're jumping. ### 00:39:34,053–00:39:34,793 It's exciting. ### 00:39:35,553–00:39:39,913 But, you know, but when I told my friend that he's an expert in padel, ### 00:39:39,993–00:39:42,713 he owns this, he's like, I only thought you could do this with, ### 00:39:42,713–00:39:45,133 like, cameras that you put in the actual court. ### 00:39:45,513–00:39:47,993 This is actually done with a device that anybody could get. ### 00:39:48,033–00:39:48,593 That's what I thought. ### 00:39:48,653–00:39:50,093 You can only do it with cameras on the court. ### 00:39:50,093–00:39:52,513 So, yeah. ### 00:39:52,793–00:39:53,093 So, yeah. ### 00:39:55,113–00:39:56,173 That's going to be beneficial, ### 00:39:56,173–00:39:59,333 even from all the way up to the professional level for many sports. ### 00:39:59,453–00:40:01,433 And you could even see what your opponents are doing. ### 00:40:02,573–00:40:04,033 The data is shared. ### 00:40:04,093–00:40:06,013 I could actually make the two. ### 00:40:06,133–00:40:07,853 And, you know, obviously, I make it fun and competitive. ### 00:40:07,853–00:40:10,173 Like, oh, I ran, like, 20% more than you did. ### 00:40:11,373–00:40:12,633 But this is just for me. ### 00:40:12,733–00:40:13,933 I mean, obviously, I'm not a padel player. ### 00:40:14,013–00:40:15,393 But just the fact that I stayed. ### 00:40:15,493–00:40:16,793 I mean, you picked it up immediately. ### 00:40:17,093–00:40:17,493 You're right-handed. ### 00:40:17,573–00:40:18,633 You said you're right-handed. ### 00:40:18,633–00:40:21,193 You picked it up immediately that I played on this side. ### 00:40:23,053–00:40:25,373 But, yeah, it's interesting. ### 00:40:26,173–00:40:27,513 I could use it for my pickleball. ### 00:40:27,773–00:40:30,073 I've been relegated to pickleball because of my knee. ### 00:40:30,073–00:40:32,633 Yeah, actually, let me see here. ### 00:40:34,153–00:40:38,173 If you change the workout type to pickleball, ### 00:40:38,453–00:40:47,593 look, it put it over a pickleball court and it changed the layout. ### 00:40:47,713–00:40:48,373 You would have been on that. ### 00:40:48,493–00:40:48,673 Yeah. ### 00:40:48,973–00:40:49,553 That's amazing. ### 00:40:49,813–00:40:49,913 Yeah. ### 00:40:50,213–00:40:50,393 Yeah. ### 00:40:50,573–00:40:51,973 And, obviously, maybe, yeah. ### 00:40:52,313–00:40:53,033 So, again, ### 00:40:53,113–00:40:58,973 this is all, you know, bleeding-edge development that we've been doing here. ### 00:41:00,033–00:41:01,333 So, yeah, it's exciting. ### 00:41:01,513–00:41:02,593 That's very innovative. ### 00:41:02,833–00:41:03,813 All from the watch. ### 00:41:04,033–00:41:05,793 All from the watch, yeah. ### 00:41:05,973–00:41:08,153 So, I'm actually going to be – this is Apple Watch. ### 00:41:08,253–00:41:10,753 I'm going to be trying it with Garmin watches. ### 00:41:10,753–00:41:11,753 I haven't tried it yet. ### 00:41:12,013–00:41:13,993 I think they have a little bit more precision. ### 00:41:13,993–00:41:16,213 So, let's see how that looks. ### 00:41:16,393–00:41:22,233 So, you know, to wrap things up, you know, so we look at the next 10 years. ### 00:41:22,313–00:41:27,753 We talked a little bit about, you know, what do you see as exciting? ### 00:41:27,753–00:41:28,453 I mean, obviously, ### 00:41:28,713–00:41:33,153 all these innovations in new cameras are probably going to get even smaller. ### 00:41:34,653–00:41:36,733 You know, what else? ### 00:41:37,573–00:41:43,113 I see all that innovation tying the needle arthroscopies with the biologics, ### 00:41:43,233–00:41:44,173 integrating them, ### 00:41:44,333–00:41:50,013 not just using each one or the other separately, with the assistance of AI. ### 00:41:50,013–00:41:56,433 I think AI, we're not even doing the tip of what we can do, ### 00:41:56,673–00:41:59,933 not even a percent of what we can do in medicine with AI. ### 00:42:00,093–00:42:03,113 I think AI, we have to figure out how to use it properly for medicine, ### 00:42:03,113–00:42:05,833 you know, and for recovery. ### 00:42:05,833–00:42:06,633 I think it's ### 00:42:06,633–00:42:11,693 going to take it to the next level that we have no idea where we're going to be. ### 00:42:11,753–00:42:14,753 It's going to – and it's going to blow up in the next three to five years. ### 00:42:15,433–00:42:15,813 Yeah. ### 00:42:15,913–00:42:16,193 You know. ### 00:42:16,333–00:42:21,653 No, and it's – and it democratizes – well, ### 00:42:21,933–00:42:26,333 it democratizes the access so you guys could help more people, right? ### 00:42:26,333–00:42:32,753 Because, I mean, even just showing up to the office or visiting the office, ### 00:42:32,953–00:42:35,713 you know, take time, people have to take time from work, all that. ### 00:42:35,933–00:42:39,793 So people could, you know, do this at home and you could monitor and you could – ### 00:42:39,793–00:42:42,513 you know, the data from home, they don't have to come in through the office. ### 00:42:42,953–00:42:44,813 Patients are going to be better educated. ### 00:42:45,273–00:42:46,853 Doctors will be better educated. ### 00:42:47,853–00:42:50,373 That's what I noticed when I did my fellowship at Stanford, ### 00:42:50,373–00:42:51,673 that the population there, ### 00:42:51,773–00:42:55,453 that was during the Silicon Valley era, very educated patients. ### 00:42:55,593–00:42:58,373 They used to ask me, well, what's that screw made out of? ### 00:42:58,593–00:42:59,153 Yeah, exactly. ### 00:42:59,353–00:43:00,973 I had to be on top of my game. ### 00:43:00,993–00:43:04,073 Well, you add Elon Musk, he probably develops his own, you know. ### 00:43:04,613–00:43:08,793 But, yeah, it's going to change the way medicine is practiced for sure. ### 00:43:08,793–00:43:10,693 And it is changing it now for the better. ### 00:43:11,453–00:43:13,913 Well, Dr. [unclear], it was an honor having you. ### 00:43:15,453–00:43:22,073 It's obviously an area that we haven't covered, orthopedics and the innovation. ### 00:43:22,273–00:43:24,973 And obviously, as a long-time patient of your practice, ### 00:43:24,993–00:43:28,113 I'm excited to have been able to share this time with you. ### 00:43:28,333–00:43:29,793 Hopefully, you won't need our services. ### 00:43:29,993–00:43:33,153 But I appreciate you having me here, and it's been a pleasure, Demian. ### 00:43:33,533–00:43:34,153 Thank you. ### 00:43:34,333–00:43:35,053 Thank you so much. ### 00:43:35,153–00:43:35,473 Thank you. ### 00:43:36,373–00:43:38,433 Well, another episode of Augmented Wellness. ### 00:43:38,913–00:43:40,493 Thank you so much for watching. ### 00:43:40,873–00:43:44,953 And hopefully, some of this technology that I shared here, ### 00:43:44,973–00:43:46,353 you're going to see it in the app soon. ### 00:43:47,053–00:43:50,053 So I would love to hear your feedback in what you think about it. ### 00:43:50,353–00:43:51,153 Thank you so much. ### 00:43:51,993–00:43:52,373 Thank you.