for those of um our listeners who don't know, this is Dr. Shawn Goddard. He's the founder of the um Osteopathic Center, which has multiple locations in the US including in Miami, which is where I got to meet you. You've brought back high-level athletes, professional athletes um from injury into back into their their uh sport including the NFL, CrossFit, and other professional sports using PRP and stem cell and other wonderful things that you do. And in CrossFit, you treated Rich Froning's knee and Danny's shoulder. Um of course for me, multiple people recommended that I see you not only because of the fact that you get things done and do it well um in terms of getting people back to their sport, but also your bedside manner. And I'm sure people will see uh what I'm talking about at the end of this podcast. Um and you've given me a new shoulder. So, um that in a nutshell is Dr. Shawn Goddard. >> Thanks for the kind introduction. I appreciate it. >> Well, tell us what is PRP? Cuz I know I didn't know what it was until my chiropractor, um Dr. Kaplan here in Miami, and my uh physiotherapist, Dr. Annika, who we've had on the podcast before, told me I should get it done. So, tell me, what is PRP? >> Okay, so PRP stands for platelet-rich plasma. So, a platelet is one of the first cells when you get injured, no matter if you twist your ankle or have any type of injury, it's going to go to the area and start a healing cascade. Well, somebody had a great idea in the late '80s, '90s, and they concentrated these platelets out of your own blood. So, if you put them in high numbers and put them into an area, it'll promote healing even better. And it started actually after open-heart surgery to help the the closure of the wounds and also dentistry. They found that if they injected it, it could help the bone grow better in the in the jaw after they they did some types of removal of teeth. So, then somebody had a bright idea, well, if it's working and helping in those areas, why aren't we injecting it into tendons and joints? So, a couple of the first places it really got its claim to fame was in tennis elbow and plantar fasciitis. And it's of course progressed to what it is today. Now, the difficult thing is just cuz we hear PRP doesn't mean that if you go to 10 doctors, it's all the same thing, unfortunately. So, the variability in it is is the biggest issue in our field right now. Um the second big issue is the technique of injecting, but that can go into anything um as far as whether it be stem cell work or prolotherapy work as well. But uh going back to PRP, um we use a double spin uh system. Uh we we buy a we buy a kit. We I like to do that cuz it keeps variability down between patients. We We have the human error as involved and it allows staff to to process everything the same way each time. Um and we do double spin. The first spin, it separates your red blood cells from your plasma. And that's where we're going with platelet-rich plasma. Um some people only take that first spin and reinject that. Uh we take that plasma out, put it in another container, and spin it again to really highly concentrate the platelets. And it just gives a much more magnified effect when it's injected. And unfortunately, it's a little more painful, too. But, that's part of the process I'm sure we'll end up talking about. But, the PRP is the the um way to take your own body's blood and get the best parts out of it with platelets that release growth factors and start the healing process. >> And what I like about that, at least when I first heard about it, was that you actually use your own body to heal your body. Um and of course, we can take it we can one-up this and talk about stem cell. What are the stem cell injections all about? >> So, I'd like to clarify what we're actually talking about. Because when this cell was first found back in, you know, a long time ago actually back, you know, even that there was some early research done in the '80s on it. But, the term mesenchymal stem cell, which was believed to be an adult stem cell, was coined by Dr. Arnold Caplan, uh PhD at Case Western University, in the early '90s. Um then, let's fast forward uh to 2017. He wrote another little paper that said, "Time to change the name." Because it's not a stem cell. So, what we all think of as stem cell goes back to one called embryonic stem cells. And that can become anything in your entire body. Any organ system it self-replicates. Well, this cell we've that was called a mesenchymal stem cell is actually found around your blood cells, um, called pericytes. And when you get injured, that cell activates and becomes that mesenchymal stem cell. Well, it releases these growth factors that have been termed exosomes. And that's what actually starts tissue-specific healing. So, if you get injured in your muscle, those cells get activated, they stimulate your muscle to heal. If it's your joint, stimulates your joint to heal. And etc. etc. Well, he proposed a name change to something called medicinal signaling cells. And so, we did so we don't confuse it, we just all call them MSCs now. Um, because there's controversy as to who's correct. I really like what Dr. Dr. Caplan came up with. I think it makes sense and and it fits the definition of what a true cell is. Um, and it's not a stem cell. Um, so I like to kind of go through the the semantics first because when you look things up online, everything's about stem cell. And unfortunately, the terminology's been out there for decades and uh, we kind of have to talk about it to some degree like that because if we don't, people have no idea what we're talking about. And then we put things in different, um, frameworks. So, out of yourself, we can get these types of cells and growth factors from your adipose, which is your fat tissue, or your bone marrow, or we can get it, um, from somebody else. And that gets into different types of placental products and or people go overseas a lot and they're like, "Well, what what's allowed overseas and not here?" Well, that's culture expansion of placental cells. And that means they got it out of a placenta. That's the particular cell. They put it in a Petri dish and grew it to high high numbers. And that's one thing we can't do over here. Um but the question is, do we need it? And that's that's where I've been using a tissue-based product, which is like a tissue graft done in surgeries. And it has lots of growth factors on it, and I've seen phenomenal results with it. I was uh first exposed to that in 2014 at the World Stem Cell Summit by a doctor for the San Antonio Spurs. And he talked about how they use it on players. And I was like, "You know what? If it's good enough for him to be using it with them, it's good enough for me to use it." And the rest is history. I After I started using that product, my results were magnitudes higher than they were before with just PRP alone. Um now, I've used all types of the the stem cell products, the adipose, the bone marrow, um the tissue grafts, the cells, and I see great results with all of them. And it's just a matter of trying to think through and talk with each patient about what what do they want to do? Like like you just said, it a lot of people think it's great to have it out of yourself, and they don't want to think about having something from someone else. But there's also some hard facts as we get older. These cells in your bone marrow decrease significantly after 20 and 30 years old. And so, you don't have many of those cells left. Um in adipose tissue, it takes the right kind of technique to get get it out of your body and to isolate things the proper way. So, there are some procedural technical issues that can happen that will uh cause the the results to be less efficacious. And then the problems with the ones that we get from other people and companies, you really have to vet out the products. Uh years ago, there were some bad actors and they really created uh big issues which which which in a which made sense for the FDA to come down on the field was cuz some of them were causing infections in people. And unfortunately, doctors a lot of doctors don't fly to these companies. They don't go see what the scientist has to say, the owner. Every product we use from somebody else, I will go and talk to the companies personally and look at their labs because I I just don't want to be caught up in a in a situation where we're using something that's not um not safe for people and also not what we're being told it really is. >> Mhm. >> Um me and my other doctor that works with me, Dr. Jesse Morse, we were um at this uh conference this past weekend, Cell Surgical Conference, and we both gave lectures there and we got to we get to hear lectures from the PhDs um who are you know, the smartest people in the world talking about this subject. As well as doctors all over the country and the world utilizing this. And I believe in education and continual learning. And that's how we make sure that we're giving our patients the actual and best products available to get the best healing. >> Mhm. And what I liked about um seeing you with regards to my injuries that you gave me multiple options. Um just PRP or PRP and stem cell and different types of uh stem cell. Do you mind going into the ones um that I ended up choosing? >> Yeah. Yeah. And you know, I've done so many injections at this point with these different products like collectively I've done probably 200,000 injections with all these different things. And I've been able to see overall the probability for different injuries and and what it looks like. So, um PRP was one of the products we we chose with you. And uh also amniotic tissue and uh technically it it's a connective tissue graft and it's taking the the pieces of tissue that are are surrounding the baby and it cuts it up the companies do and it micronizes it so it's still visible. And when it's injected, it acts like a scaffold for tissue to be grown on top of just like if you had surgery with an ACL graft or or as they put different tissue in different places, your body's going to grow onto that. And I find that's what's augmenting the process of PRP. So, we get a physical actual um scaffold to build on top of with the growth factors that are already on it and the growth factors of PRP. Now, the hard thing we have to discuss with people is the recovery. And also the technique on how this is done. Um in my mind, I I separate the different Well, let me let me phrase it like this. When I look at all the doctors doing this from my experience going to conferences and different places, uh there's three different ways doctors inject. One is I'm just going to inject your joint and that's it. It's going to it's going to filter around to the labrum and to other other issues that you have. Well, that's a very, you know, rudimentary. It's easy to do so anybody can inject that. Let to get a little more complex, we get into direct tendon, muscle, ligament, or even nerve hydrodissections. And some some doctors will just inject a couple of those spots to try to get your pain down. And it can work. Both of those joint and I call them spot injections can work, but it doesn't always address the root cause of what made the injury happen. And that gets into a little more comprehensive injection. And and I've come up with my own terminology just to kind of try to help differentiate what we do. And it's called the prolotherapy procedure. And that's utilizing 10 to 15 injections around, in your case, your shoulder in order to help the injury itself as well as the stability. And it's usually the instability of a shoulder, of a hip, a knee, whatever joint it might be that creates other issues such as the tendons and muscles. And you know, I think you could speak to this. You know, you went to physical therapy and and it would just plateau. Right? And and that, you know, I'm sure we'll get into this, but after we were able to go in and stabilize, now the therapy's magnified even to the point that your that shoulder stronger than your other one. >> Yeah. >> And so it, you know, my philosophy comes from a mixture of things. Um for one, I I got injured myself a month before medical school and I went and the traditional route and I was saw surgeons, I saw therapists, I had injections, I had teeth shaved down, and nothing worked. And the people that helped me were these injections to my jaw, osteopathic manipulation, particularly craniosacral, and acupuncture. And that really changed my thought process and I decided I want to learn more about it. So, I did a fellowship in manipulation. So, I I really got to understand body mechanics. Um I even trained in acupuncture. So, I got philosophy from from how that could be so beneficial. And then training in these types of injections as well as traditional pain management. Um and so combining all those philosophies together helped me come up with a a framework on how to do these injections properly. And so in your case, you have instability. You have uh you had capsular issues. You had labrum tear, which is a big sign of instability. And so then your body and your mind want to protect your joint. So, it utilizes your muscles to actually protect the joint instead of move the joint. And that's the underlying issue that uh we don't always talk about because now the muscle fibers are not completely used to work out or move. We have to break that cycle. Well, the only way you're going to break it is if you stabilize the joint. And a lot of people think stabilization means, "Oh, I'm going to get my muscles stronger." Well, true stabilization in medicine means ligaments, capsule, labrum are holding your joints together. Then you can get the compensatory mechanism to relax that has been developing in most people for decades. >> I Thank you for going over all of that. I actually I I want to be honest with you. When I first got the breakdown of the different treatment options for my shoulder, I had to really ask myself, "Am I okay with using someone else's tissue?" Um I It was honestly it was a split second. It didn't it didn't take too long for me to say, "I'm going to do it." Um just because I weighed different factors. I'm 37. Um, you know, my my own stem cells I I figured wouldn't be as good. Um, and I also thought there's so many things that you do even just a blood blood transfusion, right? It's someone else's blood and given how advanced we've gotten in and uh medicine, I thought, "Well, yeah, this is definitely if I can do this, I will do this." And I did tell you my right shoulder which um is was the injured one is a lot more stable now. I did my first handstand push-ups yesterday. And my left shoulder's lagging. Um, was there was was there a a decrease in strength during this whole process? Yes. I mean, I had to definitely train less, um rehab a whole lot. But that strength is quickly quickly coming back, which to be honest is is very surprising to me. Even in terms of the way my arms looked as they were after the injections, my right arm became smaller and smaller. Of course, there's no pump like the left arm is cuz I was still very much training my left arm. Um, but I thought, "Oh, wow, I'm really losing muscle." But as soon as I could actually start putting weights and resistance bands in my right hand and start really rehabbing that right shoulder, my the volume came back. So, I'm seeing the physical appearances come back. The strength is coming back really quickly. And there's more stability. And I guess to me, my question is I mean, I have multiple questions, but the first one being why was this sort of stuff illegal for a while in the US? And so, athletes had to go abroad to get this done when it quite honestly, I wouldn't can it a miracle, but it's it's fairly amazing in terms of a treatment. So, why was it illegal for a while in the US? >> So, that's a misnomer. It never was illegal. We couldn't and we still can't. We can't make claims about stem cells because we need research to prove it. So, it becomes a personal discussion with your doctor. And the truth is how many doctors out of a hundred actually do these types of procedures? Now, lately more and more do, but especially 10, 20 years ago, it was extremely rare. Um so, overseas people could talk about it more because the regulation wasn't as tight. And even that still happens to today. I have lots of people that fly to Tijuana or or Colombia. They're like, "Well, why aren't you talking about this and this?" I'm like, "Well, we we can't." Um and so, that's why I really appreciate you having me on because this is the best way to get information out and talk about what we do in an effective manner. Um now, don't get me wrong. There are certain types of stem cells like embryonic stem cells are illegal. And almost every country in the world makes them illegal because of how you have to harvest those cells. Um and so, everything just to um really clarify how the placental products are are uh are gotten in the US, it comes from live birth C-sections. And the mother has to have a known medical history from her family with everything clean, with all everything tested for, a questionnaire is perfectly normal, um no disease states, pregnancy went perfect, no medicines. Um obviously no cancers. I mean, it is a very in-depth uh process to to do this properly in the United States. And that's one reason I like people to stay here because I know they're not going to some clinic overseas where we can't say 100% how the regulation really is. Um And so now as we've gone through the process and more and more people are performing this, especially in the orthopedic surgical world, um it really gives credence to the the field itself and and makes us uh more gives us more validation. You know, the issue now it comes down to the technique. And you know, like for example, when we did your procedure, we did the comprehensive technique. And you get pretty sore from that technique. And >> I love how you used the word comprehensive. Cuz I was rocked. I won't go into that, but yes, it was a comprehensive >> Well, and and it you know, I've realized over time you know, when I was younger I wasn't as wise. So I'm learning how to talk better about it. And I really want people to understand that the way we do this type of procedure it it's all it's kind of like a mini surgical procedure. And and I'm sure you'll talk about it. You get scared for a few days thinking that what did I just do? Um I've just done you know, I did my first injection uh regenerative injection in 2003. Um then on my own I opened my first practice in 2009. And so I've just I understand the process that these injections take. And some people uh do take longer than other people to recover and heal. And that that's some of the hardest thing we're trying to figure out. And we talk about it in our conferences a lot. How do we optimize our patients for the best healing possible? >> So, maybe it's time I I get into the story of of not only the injections, but the healing, too. Um so, last December, around last December, maybe November, I started feeling pain in my right shoulder at the front um in certain movements. Not in gymnastics, zero pain in gymnastics, um just on the rig, but mostly pain um in overhead movements when I was going from the shoulder to overhead. So, in that initial loading phase, it was quite a short um range of pain, but as soon as I got out of there, I was fine. There was no pain. Um of course, doing the sport of CrossFit, you feel niggles here and there once in a while. You try to sort of lay off certain movements that that hurt. Um maybe try to rehab it. Um I of course see my physio and chiropractor regularly. Um eat a lot, eat well, recover well. So, for a few months, it just I tried all all of those things. It wouldn't go away. Handstand push-ups started hurting again in the initial loading phase, but gymnastics were fine, push-ups were fine. Um so, I thought it must be a small thing, but after a while, it didn't go away. My chiropractor said, um "By now, it should have gone away. I think you have a tear." Um so, I went to my physio, as it turns out, it was the same day, and she said, "Okay, I know who you need to see. It needs to You need to see Dr. Goddard." Um and of course, talking to different people, including the owner of the gym I go to, um he went to see you as well for the same thing in his shoulder. Um so, I I to you. We did a couple tests. Uh tested the range of motion, saw instability from what I I remember, and you said we need to get a an MRI. Um and the MRI confirmed what you thought, which was a labral tear in the shoulder. Which is from what I understand, the cartilage. Um so, what happened then is you sent me a bunch of uh different treatment plans. I chose the mix between the PRP and the stem cells. And I chose the aggressive route. Uh because I thought I have a lifetime of sports ahead of me. And I want to give my body the best chance to to heal itself in order to enjoy my life and enjoy sports and not think about my shoulder being pain, cuz I don't think anyone deserves to be in pain. Um so, from what I I remember, you said it would be around 36 injections over the course of 3 days with one rest day in between. The first injections went fine. I I thought, oh, it's okay. I mean, you can feel them. It's It's definitely painful. But it's it's not as bad as what I thought it would be. But I I remember you telling me stories about how some grown men faint uh during the injections. Quite quite big. >> Yep. >> Um and then I trained the next day. Uh I figured I have one arm, two two legs, and a brain and a heart to train, so might as well keep training. But of course, kept the right arm, the injured arm, um very protected, and didn't move it. I come in for the second round of injections. Now, that is when I got rocked. It wasn't the injections themselves, it was after. And I have I'll be very honest, Dr. Goddard. I have and I told you this, I have never felt that kind of pain before. It was this throbbing inflammation and it went all the way down my arm into my thumb. And I started making noises I never thought I could make and now I understand why women in labor make those noises. It's pure pain. It just tries to exit your body. Um yeah, I I I was very rocked and during that day off in between uh waiting for my third round I remember thinking I don't think I can do it. But then I thought, okay, I'm lucky enough to access to this. I really want to have a lifetime full of sports and no pain. Let me go in. So, I remember before coming in for my last round, I went to the gym, uh went on the stationary bike cuz there there wasn't much I could do at that point. Physically, mentally, I was beat. Um it felt like I had gone through a war, to be honest. Um and I was still working, so a lot of my energy went towards that. And I remember the owner of the gym I go to, Jay, who's who's the guy you you did the shoulder of. He looked at me and I could tell in his eyes he could see I was in so much pain. And he knew what was waiting, right? You I think he just did one round with you and I was doing three. Um he he already knew. And um I remember going into your um clinic thinking, okay, this is going to be bad, but I can do it. And I I think I was crying the whole time. Dr. Morse did my last round. I remember just crying just because I was and I'm I'm just trying to be honest because I I feel like the more you know, the less surprised you are, the better it is. And for me the third time was very hard. I just didn't want to be in pain anymore and I didn't want to be pricked and prodded anymore. But I was thinking in the long run this this is good for you. And I remember Dr. Morse being very sweet and telling me, "If you want, I can back off. We don't have to do as much as and I kept telling him, "No, let's do it." He put He asked me for the kind of music I wanted. I wanted classical music. He was so kind. Cuz he knew. He knew. And I remember coming out of that and uh going home and again same pain. Um but I remember just thinking, "Okay, it's going to be the last time. I don't have to do this. Now Now we rehab." So, got through it. It was quite painful. Couldn't walk cuz my arm kept banging against my leg. Um so I had to hold on to my um my shorts or whatever so that my arm wouldn't bang against my leg and hurt. Couldn't put my socks on. Couldn't do my hair. Couldn't do anything really. Um but now that I'm 3 months in of very aggressive rehab trying to get my range of motion back and now back to barbell cycling, handstand push-ups I look back at that time as a real lesson of how much the human body can take and what it can do to heal itself. And I look at it with so much gratitude. And I'm so glad that I did it. And it was very important for me to not do surgery. So I guess my question to you is I from what I remember you said I could have done surgery. But is there a reason or multiple reasons why you would recommend that someone not do surgery and do PRP or or stem cell injections instead? >> Yeah, I'll give you a an example. At the time this patient was a D1 tennis player. And he's openly talked about this as well. Um he he tore his labrum and he had a subscapularis, a large tear in one of the rotator cuff muscles. He went to three surgeons before he came to me. The first two said, "You have to have surgery. Let's just get it scheduled next week and that way you can play the next year." He was a junior at this point in time. Um the third one goes, "Did the first two tell you you may never play tennis at a high level again?" And he's like, "They did." He goes, "Go do stem cells and if it doesn't work, you can always do surgery later." And coincidentally, um he then he told me, "Well, my brother played D1 and he had the surgery and he never played again in college." So, um I put a plan together and we we did uh actually a mixture of uh bone marrow and a the tissue graft and then 3 weeks later we did PRP to follow it up. And this was years ago before I developed the technique that I've fully developed now. Um but then I sent he stayed in Miami and he did therapy with um you know, as you're saying a a very high level therapist and that's for everybody out there that's extremely important um after the fact which we may get into later. And so he saw this person every day and he was hitting again within a month. Um unfortunately, he went back to the school and they they made him go a lot slower. So, he ended up not really progressing for about 6 months, but he ended up having the best season of his career. And he went to play uh pro for 3 years and, you know, it became a hitting partner even a partner even after that. And if anybody knows uh the stability you need for pro tennis, uh it's you need lots of uh stability around the shoulder and everything. We ended up doing a repeat MRI on him years later. And the subscapularis rotator cuff uh tear was completely healed. Um the labrum tear was still there. So, you know, people ask me all the time, "What are we really doing? Are we regrowing tissue?" You know, a lot of times we have seen muscles and and sometimes even tendons uh regrow, but most of the time we don't necessarily see the tissue completely regrow. So, I like to uh think about our injections as uh the map to healing. So, map means the M is for mobility. A is for activity, and P is for pain relief. That's what I'm trying to achieve with my patients. Cuz now, because so many people are doing these injections now, there are a lot of post MRIs and ultrasounds, and and so we we don't always see the tissue uh regrow or heal, but we do see people get active again. And if you in my field, um especially the manipulation field, we're really big into fascia. And there's a a company out there that actually put a camera in to look at living human fascia and how it like connects tissue together. And I really think that's got to be what's regrowing to create microstability, even though we don't see something like the labrum heal, we're able to see somebody go play like the labrum's perfectly normal. Um so, I've I've been able to do enough of those at this point in time that I know I can get people active again at high levels and and really not have problems and you know, if if we get injured, of course it's going to be just like if you got injured on a a super healthy shoulder. Um, repetitive activities, you know, as you know, CrossFit's rough on the body. So, there's a a lot that goes into, you know, do we need to do anything in the future? Um, but um, go ahead and you know, that's why I say why not why isn't this field the precursor to surgery? Um, because we have the potential to make people way, way better without going through the risks of surgery and I I you know, I I I won't go into the details. I've had some people that had some pretty bad complications after surgery, you know, and even though, let's say 95% of all surgeries go well, there's a percentage that don't and the risks of what doesn't go right in surgery are a lot worse than um, the risks there are with the injections. And >> Perhaps it comes down to cost as well from what I understand. Not any insurance company covers There's not one that covers um, these injections. Whereas, of course, surgery is covered by insurance. So, unfortunately, right now, we're at a point in this country where this sort of treated treatment is not accessible to everyone, which is why some people, if not most, are actually forced to go the surgery route. >> You're completely right. You know, that um, I'm in a lot of groups. So, I have heard the the certain VAs um, are covering PRP for certain body parts. Um, so that gives us hope that it will trickle into different places. Um, there was a period of time that uh Medicare had a PRP coverage, but it was so low that it wasn't worth the cost for even you know, that it wouldn't pay for the staff to even do anything. So, they they got rid of that and you know, there I know they're trying to work on that. Um, even amniotic fluid um was covered by Medicare at one point. Um, but then they took it off. Um, so you know, I I don't know. Why is there so many back and forth with this? I've no idea. But, you know, hopefully um hopefully everything progresses and it and it gets fast-tracked because this field is so good and and you know, I do cuz I have my own issue with some of the ways other practitioners inject. They don't do it properly. And okay, so if if you get 90% of people or doctors doing injections the improper way and they're just getting reimbursements off of it, that kind of sucks, too. Um, so how do we get this field to where we we do everything the right way to get the best results? And I think that'll take some time to really happen. >> It's an interesting point and then of course, like you said, rehab is so important when it comes to getting the injections, post injections. And again, that comes at a cost and not everyone's insurance covers it or covers all of them. Why is it so important to rehab the um injured area after the injections and why is it so important to fight to get that range of motion back so quickly? Because that was the second most painful part of this process for me. >> Yeah, it's actually to segue into this, can you tell everybody how your range of motion was for a week. >> Oh god. >> And and that that way people can start to get an idea and and also to preface this PRP is the most painful thing that we inject. So, the recovery is is a lot harder than than others. But >> Yeah, yeah. And perhaps my brain blocked it out. Um it there was no range of motion. I couldn't move whatsoever. Sleeping was extremely painful. I didn't think about this, but when you sleep, the gravity pulls your shoulder down towards the mattress. That in itself hurt so much cuz my joint was so inflamed that it couldn't move and didn't want to move. So, I couldn't move much at all for at least the three four first days and I would use a wooden spoon to test that how much I could actually move because there was no movement that could be initiated from my arm. I had to use the spoon in another hand to push my arm up. Um So, I just slowly but surely fought to get my range of motion back. Just little things. Uh I remember working with Dr. Annika telling me take a towel and imagine you're cleaning the wall. So, you're going up and down. Little things like that um definitely helped. Pushing a wall a ball up the wall and down. Taking a mobility stick, trying to go as far overhead as possible whilst laying down. Um that hurt so much cuz it felt like my muscles were ripping. But I had to do it. And so I remember doing it every day, morning and evening. I made it my second job. Because I thought I didn't go through all of this to get sort of to to see this obstacle and stop. >> Well, that's that's the attitude we need with these type of injections. Um and yeah, I talked to Dr. Annika a lot. And and we we get we had to give you a lot of support. It it it's tough. It it's really hard for when you feel this cuz you feel like what did I just do? Um am I ever going to move again? >> Yeah. >> And it's and it's scary. You know, luckily I've I've done it long enough that I just know the process. But one of the first things we want, we want people to move. In the the shoulder, of course, move the shoulder as much as you can. Don't don't push it through the severe pain all the time, but you know, the you know, we have to think oh, we don't want frozen shoulder. And we know if we move a joint after these injections, the blood flow gets there and the healing's going to be better. So with these types of injuries, any kind of instability injury, your your mind is going to make the muscle tighten around the joint. And so that builds up for a long long time. And by the time it gets to to an actual tear, um then it's probably built up over the at least 5 or even 10 years. And so we got to break that pattern that the mind has developed. And a lot of times there's even scar tissue within the muscle and tendons. And that's why I like very um hands-on therapists. Now, I want somebody that's going to dig in um with their hands, with the scraping, with dry needling to help to free that muscle up and get blood flow into the muscle itself. And then we go through this we have to break this pattern and usually we're doing that for anywhere from two to four weeks. And then we get into muscle balancing. And then we get into actual strengthening. And I think the hardest part for athletes is they want to get into strengthening immediately. Um but we can have setbacks if we get in too quickly and and that kind of gets into the actual mechanism of the injections. Even though we talk about the injections as PRP, stem cell, prolotherapy, all these things, the the mechanism is actually your own body's immune system and innate way of healing. When we put the needle in, it's going to create an acute inflammatory response. Well, the acute inflammatory response only lasts approximately two weeks. And what do most doctors when you get injured, what do they tell you to take? They usually say take an anti-inflammatory. Take the pain away. Well, that automatically cuts off the healing response. So, you're predisposed in yourself to an to a longer chronic injury over time. So, we're re-stimulating that acute inflammatory response. Your body brings the necessary ingredients in in order to try to heal the area. Now, what we put with that just augments it. Whether it be the stem cell products, whether it be the PRP or or the prolotherapy dextrose. So, that obviously the higher we go, the better response you'll get from the acute inflammatory response. And after the two weeks, then your body goes into a remodeling phase and where it starts to lay down new tissue. And research has shown that especially with the stem cell, this will continue to happen for 1 to 2 years. So, you know, we're only 3 months out from your procedure, but you know, you're going to see, you know, if it's possible, even more stability happen over time. And And that gets into T regulatory cells and some scientific jargon. I don't I don't want to go all the way into that, but but just know that this can keep lasting, which is what we love the most. And And also, we don't know why. There There's about 10% of people that don't feel the pain. And like you said, that first treatment, your body didn't really feel it. But why did it feel it the second, the third? And I've seen this happen not not in a lot of people, because normally people's bodies are pretty consistent, but I have seen it happen. And this gets into what we call patient biology and responders versus non-responders and and different types of terminology. And And it could be toxins in the body. It could be genetics. There's lots of different factors that can play a role. Um and and we're still figuring the details on all that out. >> I remember because you mentioned how um some people are like, "Why did I do this?" I remember thinking for a split second, "Why did I do this to myself? Why am I in so much pain? Am I really, like you said, going to get my arm back?" But I remember seeing Dr. Arnica very um quickly after the third round. And I trust her fully, and I know that she and you have worked together on each other's patients for a very long time. So, I knew she told me stories as well as you of successful outcomes. And I just remember thinking, "Okay, I need to make sure to just keep listening to these stories, keep focused, and do what I'm told to do. Because as you said, it's a very hard for people who are used to living an active lifestyle to all of a sudden be told you can't do this, you can't do that. And I remember whenever I asked Dr. Annika, "Can I do this movement? Can I do that?" And she told me no. The pain in her face telling me no, cuz she knew cuz she's she's an ultra-endurance runner. She knows how important movement is. She's also very much into weightlifting. So, she understands the pain, physical and mental. And she's actually had PRP and stem cell done, too, in her knee. So, she she understood, so I felt very much like I had a team behind me. You and Dr. Annika, Dr. Morris, who very much wanted me to succeed and understood the pain that I was going through and even the mental aspect of it, and you were very patient with me. Which I really appreciated, which in turn made me patient with myself in the whole process. >> Yeah, it's a it's scary feeling that way. And, you know, without my experience to back it up, it would have been very difficult to give that comfort. Um, one of Dr. Annika's colleagues um that works with her, he's a doctor of physical therapy now, but I saw him in high school. And he had a bad bad labrum tear and tendons and all this stuff and and um unfortunately for him, he was one of my guinea pigs to figure out how to actually fix labrums. Um, because we tried PRP like eight times and he still had weakness and instability. And finally, we did some bone marrow and tissue grafts and it got him better and he's that's, you know, help propel him and make him understand what we do in our field and because of him I met Dr. Annika and now we work very closely together. So, I'm thankful for that association. You know, and Go ahead. >> No, please go ahead. >> Uh no, I was I was I was thinking, you know, one thing I didn't really talk about even though I talk about a comprehensive treatment approach and that in my mind I think, okay, that's doing so many injections to re restabilize uh an area where whether be shoulders, knees, spines. But um doing three treatments I didn't really talk about and and I I got into that cuz I did lots and lots of different time frames between injections. All in one week, once a week, once a month, once every 6 months. And I saw some consistency start to happen over the years that most people, no matter if you did them really close together or if you separated them by 3 months, three procedures was about what people needed in order to get their body back to to health. And I'm like, well, if you're like me, I want to do it all at once. I don't want to be painful over a year time period. So, so that's why you know, I'm I'm like, look, if if you're if you're an aggressive kind of person, you can do this, but look, I have some people that like, you know what? I don't need to be aggressive. I'll do it once every 3 months. So, I don't want people to think we have to do it this way, but for the quickest recovery and usually it it's our athletes, right? They they want to get back. So, this is the definitely the way to go. >> And I remember you showing me a video. I think it's on um Instagram of you getting a crazy amount of stem cell injections. Can you tell us more about that? >> Yeah, so so once you believe in this field, you'll want you know it cuz obviously being an athlete you want to be active, but but as you get older and I'm you know, I'm starting to get older now. I think about I I want to be good the rest of my life to where I can just be healthy and and not that much pain. And so I decided to have the doctors working for me. They They did approximately 400 injections in my body. And I had MRI I had whole body MRI. I had special MRIs of my shoulder, my spine and different areas of my body and you know, we knew what was a severe injury, what wasn't and and we injected my entire spine cuz I have a lot of spinal issues. I had five herniated discs in my my cervical spine. I had a couple in my lumbar. So we injected to stabilize the spine. We did disc injections to help the disc be more healthy. Also complete shoulder injections like you did. Jaw you know, what got me in this field was a jaw injury in 2003. And so I I still have to touch that up every so often. And then knees, hips, feet, wrists, elbows. And you know, I ended up doing in a complete allograft treatment which means complete placental treatment. And so the the pain response after that is a lot lower than PRP. And so the recovery is a lot quicker. So I did it on a Friday and I was able to work again on Monday. >> Wow. >> But but for two days 400 injections is a lot. So I I was in bed for two days. >> Yes. >> But but the allografts you do come back a lot quicker. But again, getting into what we talked about price issues. This is not feasible for people to do all allografts. So we mix it with PRP, almost all the time. But, um and and then it it took Just so people know, it took 8 months and then I was feeling great. Uh Yeah. >> It's it's it still blows my mind. It I can't for one I again, I feel super grateful that I was able to to do this, but it still blows my mind that not everyone has access to this and I'm I'm hoping with this podcast that more people know about it, do research on it. And of course, as of course this happens, I do a podcast with Manning um Summer from No Days Off and we start talking. Turns out you're his doctor, too. It seems like everyone's injured and everyone's coming to see you. >> Yeah, I met Manning 15 years ago about and yeah, he was told he needed three three different surgeons said, "You need you need fusions." One surgeon said, "You need to remove the vertebra." Um it some craziness. I was like, "Okay, Manning, we got you know, I don't know you, but here, just trust me." And I was able to get him better and we became friends and I got to say, he's the one that got me stuck in Miami. Yeah, I'm I'm from Tennessee. Uh me and Miami don't always jive, but um cuz after I helped him, he started sending me all of his athletes. >> Yeah. >> And that's what really got me, you know, to develop reputation in Miami. And and now, of course, he's what, eight gyms now and owns a water company and >> Incredible. >> and I still see him and I'm going to I got to get on his podcast uh soon. We keep talking about it. Um >> that would be a really good one. And and I know that you also have an IV clinic. Um >> Yes. >> You You guys offer a bunch of different things. I know NAD is is offered. Do you guys offer peptides as well? >> Yes, we do do peptides. Um for people that don't know, a lot of people hear peptides and they think, "Oh, Ozempic." And others. Those are peptides, but that's not what we focus on. We focus on the peptides like BPC, um GHK copper, thymosin alpha 1, thymosin beta 4, the growth hormone stimulators. And they're great because a lot of them are just naturally occurring peptides in your body that as we get older, they decrease. So, rather than hormone therapy, in our field, a lot of us are moving to the peptides cuz hormone therapy isn't without risk. And peptides have a lot less risk potential. Now, unfortunately, when it comes to CrossFit and a lot of pro sports, and there's quite a few peptides you can't take. But, for the the person that just wants to be healthy, this is a great option in order to to stay healthy, heal better, heal faster. Um part of the downside is a lot of them are injectable. So, you have to inject them every day, basically, at home. And then we just cycle through. We rotate to different ones depending on what your medical history is and what you're looking to achieve. Um the IVs are are fantastic. Um NAD you brought up. A lot of athletes do NAD. It's a mitochondrial stimulator. Other mitochondrial stimulators are ozone or EBOO, ten-pass, and methylene blue. And then we do, of course, vitamin therapy, high-dose vitamin C, 50 or 100 g of vitamin C. And people don't realize vitamin C is necessary for connective tissue growth and collagen. So, getting high amounts is extremely beneficial for healing. And then we do other things like alpha lipoic acid which keeps your liver healthy or phosphatidylcholine which keeps your cell membranes healthy. And then we we go one step further and we do something called chelation which is looking for heavy metals. And we've seen lots more heavy metals in the past 5 years pop up. And if if you have high levels of mercury or lead, aluminum, these different types it's going to inhibit your healing process. And then we really need to take that out. It it gets a little overwhelming for people so I don't always bring it up to every person that comes in because for first of all, just talking about PRP and stem cells is confusing. And then we start talking about IVs and then people are like, well you know, nobody does IVs so why why should I believe in them? But as you probably know in Miami, like lots more places are doing IVs down here now. Again, the problem is the quality and and you know, what level of knowledge is going behind the IVs? Are they getting the products and the chemicals and the nutrients from good sources? We've hired nurses that have worked at multiple IV clinics around town. And they're like, they dilute them by 1/10. They buy them out of China without getting it from a compounding pharmacy. And so, you know, you really got to trust whoever the the owner and doctors are of your clinic to give you the absolute best stuff that's going inside your body. >> I'm seeing peptides pop up everywhere. Social media, people that I know are taking them. I'm quite confused by them. I'll I'll be honest. What do you think of the rise of peptides? Do you think it's a trend? Do you think it's um definitely something that's going to stay with regards to, you know, medicine? What what do you think about this whole thing? >> Yeah, I've taken lots of peptide conference courses and conferences and they primarily came out of Russia. You know, there's other people that research them, but heavy research out of Russia and the results were phenomenal and and even, you know, after Chernobyl, which was the really bad nuclear reactor disaster, you know, he was able to help a lot of people that had issues after that and then the research has just progressed over the decades. Um you know, overall, I think it it is one of the best things to be doing. I I personally do two a day and over every 3 months I'll rotate those. Um the difficulty is sourcing. Um so, I like to work with compounding pharmacies with everything we do and then on top of that, make sure we know the pharmacist who's getting high quality and testing the products that he's using cuz we've talked to a few of these pharmacists and they test products that are done on that you can get online. And you know, so far they say there was nothing dangerous in them, but the potency varied from 5% to 50% and this one particular pharmacist said he never saw it go above 50%. So, if you're getting 10 mg of something online, it may be 5 mg. It may be 0.5 mg or 0.1 mg. So, unfortunately, you don't know exactly what you're getting. And you know, when I'm working with patients, I don't want to use something that says for research purposes only either. Um I want to get stuff that we know what the the potency is, we know there's no toxins in it and we can put that in the body, but you know, the reason peptides are making such a hit all over the internet and everywhere is because they work and they're a great anti-aging tool. They're also a great medical tool. Um for medical issues I like to mix IVs with I'm I'm not a a huge supplementation fan cuz it taking lots of supplements can get old and and tough. Um but mixing IVs and peptides and and very I certain uh supplements is what I like to do. >> So correct me if I'm wrong, but there are some peptides that help people lose weight. Ozempic is one. And for um these peptides from what I understand, if you stop taking them, you'll put the weight back on. Does that sort of thinking uh and logic apply to other peptides where let's say if you take a peptide that helps you put on muscle and during that time you put on more muscle, but then you stop inject- injecting yourself with that peptide that you lose the muscle? Is that the case for nearly all peptides? >> So that's a that's a great point. So the first peptides you're talking about are called GLP-1s and you don't know where you're going to lose the weight at. So at this conference me and Dr. Morris were just at, there was a lecture on this. And it's making sure that you get the right nutrients in your body while you're losing the weight. So that's very important. And you know, a lot of people do that particular uh peptide with GLP-1s, it it helps to slow motility in your gut. So when you stop it, all of a sudden you get really hungry again and it's really easy to to um to gain the weight back. Very rudimentary talk about it, but so you have to really discipline yourself um with that. Now with the other peptides, let's say let's take the growth hormone stimulators like CJC, ipamorelin, sermorelin, tesamorelin. Those are going to help stimulate your brain to produce growth hormone. Well, then you're more likely to put muscle on and and gain weight, also feel better and look younger. And if you stop it, your energy level will decrease. And so it it it in and of itself is not going to cause the issue, but the fact that you may not feel the same energy could cause you to not do things the same way. >> So you don't necessarily lose your gains. You just don't feel as good as you did before. >> Right. And then are you keeping up working out and or are you stopping? Are you How's your diet? And I like to do there's a 21-day cleanse I like to do with patients from Standard Process where we just put lots of good nutrients in the body and do they have some cleansing pills that help clean gut, liver, kidney out. And it's a it's out of a organic farm up up in Wisconsin and they've been around since 1929. And it's not a complete like fasting diet or anything. They do fruits and vegetables for 10 days and you add meats on day 11. And I do things like that just to flood the body with nutrients. And overall they say it takes 21 days to make a habit. And so if we can pattern somebody's diet and lifestyle for at least 21 if not longer, we're going to help them be healthier overall cuz exercise really is the only thing that's proven for longevity, right? I mean we have all this great stuff that we do and I see people do great on it, but um you know, exercise is something you can pattern yourself, you can do on an everyday basis and you have control over it. You know, you don't need money for it. Um you just need your own willpower to get out there and do it. >> For sure. And I wonder if all of this again, I mean I from what I I understand none of these things like peptides are covered by insurance. And again, we're going back into the whole debate of if you have money, are you living better, living happier, living pain-free, living longer. Um I think it it you know, let's let's see where this goes, I guess. >> Yeah, it kind of sucks. I saw this years ago and you know, as we treat some pretty you know, musculoskeletal. It's one thing to be in pain and try to avoid surgery, but when it comes to disease states, we see some pretty sick people and like they can't function anymore. I've had somebody that had to carry their daughter in as a teenager cuz she couldn't even get out of bed. And and we were ultimately able to help her and we helped many people like that, but years ago it made me go, you know, I I got to find a way to try to help people. And I had patients that were wealthy and they're like, "Hey, if you open a foundation, we would donate to it in order to help." And so I did. And then my lawyer goes, "Well, you can't give from the foundation to your own practice uh because they look at that you know, some people are going to take advantage of that process." >> Yeah. >> So, I'm trying to think through things like that cuz I think that'd be a great way to go. Um have a have a clinic where people could just donate to in the state where we could go in and provide these types of services. Um you know, it's unfortunate. Like even the the injection conferences where we really learn our in-depth technique, we have to pay to go overseas in order to inject people there for free. And why can't that happen in the United States? And me and my friends talk about it is frustrating. The legality is so um difficult here. And I don't know what it what it takes to break through that to that and get that done. >> Perhaps there's some political things at play. >> Yep, you're right about that. >> Um, to finish off, I would like, if you don't mind, for you to tell our listeners one thing that you wish most people knew about their bodies. >> You know, I'm a I'm a big believer in willpower. You know, I you know, I really think the mind can heal itself. The body can heal itself. I'm in the process of writing a book and preview. It's going to It's going to kind of be termed the body's wisdom. Because everything I do in my practice, I'm not fixing anything. I'm not healing anything. I'm pointing out that the body to the body, "Hey, when we do an injection, hey, put your blood flow over here. When we do an IV, we're making the cells' mitochondria better." I want the body to work better because in our world, it's so toxic with, you know, the food, the chemicals, the pesticides, that unfortunately, we're we're a battling an uphill battle. Um, but if you can just remember, trust your intuition, your your your will and your body knows best. Um, and use that as you make decisions going forward, whether be in your health care or your personal life. >> I like that a lot. Thank you, Shawn, for today. >> Well, I really appreciate you and thanks for having me on. >> Always. >> All right.