Kerry 0:00

All right. Hi, everybody. Welcome back to the Get Healthy Tampa Bay podcast. I'm your host, Dr. Kerry Reller, and today we have Dr. Ron Torrence joining us from Sarasota today. Why don't you tell us a little bit about who you are and what you do?

Ron 0:14

Yeah. So I'm Dr. Ron Torrance. I'm a double board-certified sports medicine physician that specializes in image-guided procedures for orthopedic injuries that we try to help you get back to doing what you love through non-surgical alternatives. So you've been told you need a meniscectomy. There's a recent study that shows that 10-year data for meniscectomy, if you have a degenerative meniscus tear, actually predisposes you to an earlier knee replacement. So I think that's that was New England Journal of Medicine, the first, the sham surgery came out in about 2013 talking about sham surgery versus PT and really there's no difference between PT and sham surgery a year out with meniscectomy. At the end of the day it's just showing that, do we need surgery? Can we do things that are better and from your own body and help your body get better through your own means? That's what we specialize in, and we do it every day, and that's that's our space. We're in Sarasota, Tampa, St. Pete, and Orlando. I'm out of the St. Pete and Sarasota office. I split my time, and love what I do. I it's a passion for sure and educating is part of the process

Kerry 1:12

Absolutely, and this is obviously why I'm bringing you on today, 'cause this is not a topic I know a lot about. However, so it's interesting. I would like to know how you got into this role from family medicine, 'cause even for me, I would tell you I initially was gonna go into sports medicine myself and then took a totally different direction. So I'm assuming that's how it happened. But how did you get into this in the first place?

01:32 From Family Medicine to Regenerative Orthopedics

Ron 1:32

Yeah. So I thought I was gonna be an orthopedic surgeon, right? It-- everything, I was gunning for orthopedic surgery and it's a tough, it's a tough field to get into, right? Thirty percent of med students get into that space, and unfortunately I didn't match there. So I went into a surgical internship a traditional rotating year, tried to gun again for orthopedics, and that didn't happen either. So I rolled into a family medicine spot in, in the hopes of doing sports medicine. And along the way and along the path, I got really involved in functional medicine. I did Chris Kresser's training course. I was one of the founding members for the functional medicine training course, and did that concurrently with my s- family medicine residency. And then I rolled into a sports medicine fellowship where I got really good with ultrasound and fluoroscopic-guided procedures. And then I came back to Florida. I was actually in Philadelphia doing my training and the Greater Philadelphia area, South Jersey, all that kind of stuff. And I found this space, and I wouldn't do it any other way. Everybody tells you when you're in medicine that you find your path and find where you're supposed to be, and I definitely feel like I'm in that space

Kerry 2:32

Yeah, it's s- landed in your lap what you're doing. I think that's, an amazing journey that you had, and I think that what you're doing is great. And y- I like how you led with the menisc- mis- I can't even say it. Meniscectomy?

Ron 2:48

Yes. Yes

Kerry 2:49

me. Meniscectomy. Anyway, I can't even say it. But because that is something I've noticed as well, right? So patients will come in and they'll h- need to have a procedure on their meniscus, and they don't do really any better. So obviously I didn't know this led to also a knee replacement down the line, so that's even, worse of an outcome. But I think it's really interesting that you led with that because I would like to hear more about what you guys can do to, avoid those ne- unnecessary surgeries maybe and to have better outcomes down the road. Clearly you've had some, unique training and, bringing different things into from a family medicine approach as well, and then obviously with sports medicine. So tell me about, how would you approach the patient that's having these issues?

Why Meniscus Surgery Isn't Always the Answer

Ron 3:30

So I got into functional medicine, that's how I got in, and then I got to treating the root cause of orthopedic issues, right? So the root cause for meniscus tear in somebody who has a degenerative meniscus tear. If somebody's over 30, 35 that's a degenerative meniscus tear because there's usually some chondromalacia or thinning of the cartilage present. So that was the study. It really looked at PT versus meniscectomy, and at one year out, what happened? And what they saw was there was no better outcomes for the person who had the surgical intervention, and then they carried that study along for another 10 years. So that was published in 2013, and they just published the 10-year data. Not only did the person who got the meniscectomy, the surgical intervention, not do better, they actually at 10 years had more predisposition to a knee replacement, right? So not good. Now, there's been multiple studies now, platelet-rich plasma, bone marrow concentrate, that show that PRP is... I inject precisely with ultrasound guidance or fluoroscopic, depending on what type of meniscus issue you're having. I'll inject right into the root cause of the issue. That's why I wanna talk about root cause medicine. And so we'll inject into the parameniscal ligaments. We'll inject into the meniscus itself. We'll inject the MCL, and we'll inject to those structures to try to help that tissue repair itself. And so not only it-- we don't have to necessarily see resolution of the repair. It doesn't necessarily have to repair itself, but it just has to res-resolve the inflammation that's causing the root cause of the problem, right? Inflammation brings pain makes people uncomfortable. That makes the a bad outcome. So that's where we-- that, that's up my space, right? That's what I do every day. And there's multiple good studies now that show that PRP for meniscus tears does great. Not only does it help... and make sure that you're finding somebody that's does high concentration PRP. I think the biggest problem is that there's a lot of people who dabble in this space and think that they're experts, and I teach people to do ultrasound. I teach people to do fluoroscopic images, image-guided injections. I'm the teacher, I'm the instructor. I've been doing this for nine-plus years. There are people who, "Hey, I'll do PRP." How many tubes of blood are you drawing? That's probably one of the best things that a patient can look for if they're looking for it, right? Or if you're, as a clinician, if you're asking somebody, "Hey, so how many tubes of blood did you get drawn?" If they draw two tubes of blood, we know that there's not enough platelets in two tubes of blood to get a significant difference, right? When you're giving somebody a medication, like if you're giving somebody amoxicillin for strep, you need five hundred milligrams twice a day for ten days. I think it's still the still the recommended dose, right? And so when you're doing, when you're doing platelet-rich plasma, you need to have a s- absolute platelet count, and what we're finding is over eight billion platelets need to be delivered to the knee joint if there's some arthritis present to get a significant difference. So how do you get eight billion platelets? In you have to draw a large number of tubes of blood. Twenty-four tubes is what I usually draw. Those are about the nine cc tubes. So nine times twenty, you're about two hundred ccs of blood. That's gonna get you with a standard platelet count about two hundred and fifty thousand. That's gonna get you to that number, right? So anyways, it's a lot of kind of like nuance, but I think the easiest way as a patient or a clinician, how many tubes of blood did they draw, right? They drew two tubes of blood, not significant enough to get a difference. If they drew twenty-four tubes, if they have a good capture rate and a lot of other little things you'll see good outcomes. So that's like the meniscus. I inject backs and cervical spines all the time too, and those are some of the biggest issues in the world is back pain, right? And so how do we help people with back issues? Instead of dr- injecting corticosteroids, which are toxic and break things down and make things worse, we inject your body's platelets a lot of times to get better outcomes.

What Is Platelet-Rich Plasma (PRP)?

Kerry 7:05

Yeah, so for our listeners, maybe explain like what PRP is. You're drawing, withdrawing their own blood, right? Spinning it down and getting the platelets, and obviously you're saying there's more concentration of platelets if they draw more blood. So do you draw 24 tubes at one sitting?

Ron 7:21

Yeah. So so a traditional blood draw is if you're gonna donate blood, is much, much more than that, right? And like I'm drawing a half a pint of blood, so it's one-twentieth of what your total blood volume is. It's not something that's gonna really make depleted and make you feel awful. It's just more than what, it's more than what people who are doing this poorly do. So that's my quick hard and fast how are you getting a good... H-how do you know if you're getting a good PRP procedure versus a bad one, right? And in anything in life, there's good physicians, there's bad physicians. There's, good physical therapists, there's bad physical therapists. That's why we're here today, because of a good physical therapist that we both know, and I'm super grateful for that

Kerry 7:58

Absolutely. I think that, there, I don't know where I was gonna go with that thought, but so the PRP, basically you can treat all these different things and you're recommending, why, what sets you apart? What makes you different, right? And that's because you are, doing it in an appropriate way with getting enough blood to spin it down. So what does that do for, the joints or what condition that you're trying to do? You mentioned, decrease inflammation, but is there anything else in particular that I guess helps treat the root cause of the problem?

Treating the Root Cause of Joint Pain

Ron 8:27

Yeah, you really need to make sure the patient's dialed in from a a metabolic perspective, right? Metabolic issues. I regularly will have people take curcumin the active form of turmeric, and we find that decreases systemic inflammation in somebody who might be a metabolic nightmare, as I would say, right? If somebody comes in, they're fluffy. There's... I think you, you see this in your practice. I see this in my practice. They're eating, ultra-processed foods. They're eating things that aren't really good for their body, right? I tell people you need to eat to thrive. You don't wanna eat to, survive. Eating to survive is what we have now. It... I think the food-- I think a lot of the things that we're doing right now, leave politics aside, with with food I think that getting the red-- the dyes out of foods, I think making sure that we're staying away from sugars and processed foods. As much as we wanna criticize the new food pyramid by inverting it, I think that by getting more protein forward is definitely where we need to be. And again, leaving politics aside protein forward is where we need to be. If you eat more protein, it satiates you, and then you don't need to sit there and eat all the ultra-processed foods or the carbohydrates, which then really lead to fat deposition. Insulin is a fat storage hormone. And by triggering insulin you're going to de- de-deposit fat. And, men typically do a pendulous abdomen. Women typically do it in their hips and their, in their butt, and that's where food-- that's where your ultra-processed foods and your carbohydrates get deposited. So metabolically, making sure you dial them metabolically working with good clinicians such as yourself and then also making sure that you're working with somebody with good movement, right? I think that's one of the biggest things that working with a good physio, somebody... if you're ex- you need to exercise you need to work with a good physio to make sure that exercise is dialed in, make sure that you're doing things the right way. I just got done doing a big workout this morning. I got a great crew that I'm rolling with. I'm super, super grateful for that. And then, making sure that you're dialing in your sleep, right? Sleep is the free thing that you get in life. If you're sitting there sleeping five to six hours a night- that's a problem. We need to make sure your sleep's good, and make sure make sure you're getting your sleep, getting, a full seven to eight hours, depending on which one is ideal for you. There's a lot of wearable devices that talk about those things. And then stress management. Stress management is huge. Really make sure that you're not super stressed. There's good stress, eustress, which is like exercise and all those types of things, and then there's distress, which is the stuff that everybody knows about, right? The stress that causes problems, anxieties, all that type of stuff. And you need to try to make sure you get yourself out of those. But obviously there's some stress in life that's gonna happen. And then I just talked about it and I didn't really mention it, but those are the five pillars. One of the last pillars is community, making sure that you have a good group of people that really... if you're the fourth person who's doing a triathlon those-- if you're with four people who are doing a triathlon you're gonna be the fifth, right? If you're with four people who just like to go out and get hammered and get drunk, you're gonna be the fifth, right? It's like you, you have to choose your crew wisely, 'cause I think that those things are all important. So those are my five pillars. I, I did author a book way back when called Exercise 2.0, and th-those are the five pillars. But those are the things that you really want to look for to get somebody to have an ideal outcome.

Kerry 11:24

Absolutely. So do you have time to work with patients on this in your practice?

Ron 11:29

Yeah. So again, teamwork and community, right? So I see patients, all of our consults are an hour long. We see patients. I do a diagnostic ultrasound on most extremities, whether it's knee, shoulder, elbow, hip ankle hand, and we'll do a diagnostic ultrasound on those patients. So I do a diagnostic ultrasound in the office, obviously with a history and physical, and get to know the patient. And when it's a spine, I usually-- I'm gonna, usually get an MRI to look at the spine, see if there's any disc issues, that kind of stuff. But I do... we do a very good workup. We work with our patients and take our time to get to know them. Part of my little shtick when I talk to patients about doing things is, "Yeah, I wanna make sure that you're eating well." I'll talk to patients about, "Hey, listen, if you're a couple pounds overweight, I'm gonna tell you that, taking one pound off the body is gonna take four pounds off the knees," right? So we really need to make sure that we try to do everything we can. If somebody's, if I see them vi-visibly, having issues, I'll have them do a squat sometimes, see if-- see how their squat form looks. If they're bending their knees too much, they have knee issues, I'll make sure that they think about really hip hinging first. I have a kinda CrossFit background, so that's kinda where my, In sports

Kerry 12:36

I did read that. Yeah. I did read that, that you're a CrossFit guy. Yeah.

Ron 12:40

Yeah. So yeah, I do have my level two in CrossFit, so it's something where I'll try to use, bring that in there. And then, talk about pe- talk about a lot of things that people, don't get time to talk about. We have the luxury of having an hour-long consult with a patient and really get to dial in and identify the root cause of their issues.

Kerry 12:55

That's awesome. I think you're definitely going above and beyond than a, another typical orthopedic-type practice that would do things like that. And, the name, what is the name of the practice? Ridge- like, how do you guys

Ron 13:05

so re- yeah, so Regenexx at Neurogeneration Orthopedics of Florida. Our so we license Regenexx technology because what the Regenexx brand brings high concentration of platelets and the best processes possible. So our practice we own it independently. That's Neurogeneration Orthopedics of Florida, and I own that with my managing partner, Dr. James Lieber, and Dr. Nadios Pappas. And we have two associates, Dr. Lisa Valastro and Dr. Greg Zigas. He's out of Orlando office, and Dr. Valastro's out of St. Pete in Tampa, and Dr. Pappas is in Tampa. But yeah, so yeah we utilize that system because it allows us to do manual processing of the cells. There's a lot of kits out there that people get for PRP, platelet-rich plasma, that may or may not be good a lot of times, and that's really a, again, I gave you the hard and fast, just how many tubes of blood are drawn. That's really easy, but there's a lot of nuance in the space that really if you don't dive in you're not

Who Is a Candidate for Regenerative Medicine?

Ron 13:59

gonna really understand,

Kerry 13:59

tell us more about, regenerative medicine and what what might be an ideal candidate for, considering some of these procedures that you do

Ron 14:07

Yeah, I think that, anybody who's 35 and over and who's been told they need a knee meniscectomy is a perfect candidate, right? It's somebody who's really shouldn't probably be getting cut on and getting a knee meniscectomy. I think that's always, I love working with knees. The-- we do have a study that shows that partial ACL tears, we can actually regenerate the ACL for grade one, grade two, and grade three non-retracted ACL tears. We use your bone marrow concentrate and we've been able to see the MRI follow-up that the ACL integrity's gotten much, much more strong and solid. That's a great indication. I would say some of the-- some of our best rotator cuff too. We do have some follow-up data on partial tears of the rotator cuff. I think that a lot of people think that tear-- all tears are tears. And do you allow sharing? I like to if you don't mind if I

Kerry 14:49

Sure.

Ron 14:50

And then, yeah, let me just kinda show you. So I think that one of the things that I like to educate here is that there's a lot of different flavors of rotator cuff tears. This is a paper by Physical Medicine and Rehab, but everybody thinks they have a complete tear, and I think that's one of the biggest fallacies is that not everybody has a complete tear. Most of them are partial thickness or full thickness, and I think that this is a really good r- way to understand that you don't need to necessarily have to sew everything back together if it's like this, right? Because if we can inject precisely into these spaces, we can get the cells to proliferate, divide and fill in that space. There's a good study that looks at partial thickness tears that we've been able to see MRI follow-up where we've actually been able to fix tears. Just like to sh- show that, and I think that this is a good, that's a good image to see. So partial thickness rotator cuff tears are a really good one. Lumbar spine degenerative disc disease or herniations and I'm actually have a patient that I'm being deposed for because they had an annular tear that the, a disc, yeah, a disc issue, that they're having sitting intolerance and sitting issues. And she's 67% better right now. She's only about three months out, which is, I think, fantastic for where she's at, but she had an injury, and I'm being deposed to just discu- discuss why we went with this versus steroid injection or radiofrequency ablation or surgical intervention, right? That's it. I was just kinda doing some studying this morning on sh- you know, doing my due diligence to make sure that I'm up, up to speed on all the literature, and there are good studies that show that PRP or platelet lysate does really well for those things. Whether you stay outside the disc or go into the disc with an intradiscal injection there's a lot of good evidence for platelet-rich plasma or platelet lysate. I think we'll-

Kerry 16:25

You mentioned, bone marrow concentrate. Can you explain a little bit more about that?

PRP vs. Bone Marrow Concentrate (Stem Cells)

Ron 16:30

Yeah, so bone marrow concentrate is most people know bone marrow from like leukemias and bone ma- bone marrow transplants. I'll tell you that the procedure isn't as Crazy as, those, I have a pediatric oncologist patient, and I was like, "So you guys use ultrasound for your bone marrow aspirations?" And he goes, "No." I'm like, "Man that's rough." Because s- there's some people who need a little more guidance and if you have to use palpation it's just not good. It's not... I think s- I think if somebody's not using ultrasound guidance for injections at this point, I think it's subpar medicine. Don't-- hopefully I don't hurt anybody's feelings, but we have ultrasounds, use them. I do all my injections guided, but when I do a bone marrow aspiration, so I aspirate bone marrow. Again I do a higher volume bone marrow aspiration. I'm usually doing about 108 to 120 ccs of bone marrow aspirate, and that will concentrate down to about five to 10 ccs. And then we calculate the total nucleated cell count to identify, it's a rough analog to colony-forming units, so CFUs. So that, the colony-forming units are the one we want to get. But the one we can do in office is the TNCC is what it's called. And then we also look at viability, the number of live cells. So a lot of people are being sold and marketed to that umbilical and placental and all these types of cells are younger and they're better for you. I'll tell you right now that they're not. They're mostly dead cells, number one. Number two those dead cells aren't usually-- there's no stem cells present. So you want the stem cells, and that's what you're looking for. And I'll tell you that the bone marrow concentrate actually has 85 to 95% viable and live cells when I do those bone marrow aspirations. So you're being told, "Oh, you don't have any live cells. You don't..." It's like that's what you're being marketed to. And unfortunately, in, in the state of Florida right now, we had that bill that got passed as of July one last year that looked at that allowed some of these companies to contradict what the Fed look, how that Fed looks at call at the umbilical and placental cells, right? And so yeah. So one of the biggest issues there is that we're contradicting, the state of Florida is contradicting with the Fed, how the federal government looks at stem cells, right? And so you can still be brought up on charges by the federal government even if the state allows it, right? Because federal government trumps the state at those types of levels. At the end of the day, just because the state of Florida says, "Hey, we can... Everybody can do stem cells as long as it's not aborted fetuses," like they're, that's they're fine with it. But there's been no... Th- those are real, those are actually drugs is the problem with it. They're actually making a drug, and that's how the federal government looks at it. Because when you get these cells, where are you getting them from? You're, you're getting cells from something else. If it's not from your own body that's the practice of medicine right? You can draw blood, you can do all these types of things in your practice in the scope of medicine. That's how PRP and bone marrow concentrate. Bone marrow concentrate is from your own body. We concentrate that down. We reinject it into the place that needs it, and that's what helps. So I sorry how I got there, but I, I think, yeah, like the umbilical placental myth and fallacy is one of the biggest things that we have to educate people on

Kerry 19:29

So we're talking about stem cells, right? And you're saying other people get them from those other sources, umbilical and placental, and you guys mo- focus on, using the own, per- patient's own bone marrow aspirate to do that. And then how is that different than the PRP to help regenerate everything? Or what are your, what you're targeting?

Ron 19:49

Yeah, when I see patients in practice, what I tell them, here's the hard and fast, right? When you have PRP, you have two things, growth factors and cytokines, okay? Those are what you're dealing with. When you have bone marrow, you have stem cells plus growth factors plus cytokines. That's the easiest way to think about it, and I think it gets the point across to patients. Now, if you wanna dive in, we can dive in as physicians and clinicians talk about the TG-- the tumor growth factor beta, and the, like all the platelet-derived growth factors and all these types of things that really come with it. But hard and fast, that's the easiest way to look at it. MSC is the mesenchymal stem cells or medicinal signaling cells is what Arne Kaplan, before he passed rest in peace he's the one who coined the term mesenchymal stem cell 30 years ago, and then he kinda came back and said they're probably more medicinal signaling cells because they signal all the things." They're more like the general contractors in the body. And so those general contractors go in and create everything, so

Kerry 20:43

So say a person... You mentioned the back pain and things like that. Would you be using PRP or bone marrow aspirate for someone that would come in with chronic back pain, degenerative disc disease, and things like that?

Chronic Back Pain and Degenerative Disc Disease

Ron 20:57

Yeah, chronic back pain, degenerative disc disease, most of the time I'm doing platelet-rich plasma. We see that works so well. Now, in some patients, there are non-responders. I'd say nine out of ten patients do really well. We tell patients for back issues, especially degenerative disc disease, we can get about fifty to sixty percent improvement with one procedure. That's our outcomes data, so we track all those outcomes. And those tracked outcomes have allowed us to get Crown Auto, Morgan Auto, those-- they have us as a benefit option Regenexx. So that's one of the reasons also we work with Regenexx is because they have a large corporate benefit option. So Diocese of St. Pete, Morgan Auto, Crown Auto, seven eleven, they all have us as a benefit option to, to... If they came in, they've had steroid injections, they've had conservative care, and they're being recommended a fusion, right? We can do our injections, and it'll be covered by their insurance

Kerry 21:45

So tell us some more about the insurance thing, 'cause I was under the impression that nothing, not that what you're doing is covered by insurance.

Ron 21:53

Don't get me wrong, 75% of our patients are mostly cash pay, but we do have a, we do have 25% of our patients do come from our corporate side. And so that's something that nobody else has in the country besides Regenexx. And that's what makes us different, right? So we've tracked all of our outcomes. All the patients that come through become part of our registry, and that's been going on since 2005. Dr. Centeno founded Regenexx in 2005, and he's tracked all the outcomes since the beginning. And so that's a great foresight, and he's the kind of y- the guy who created, this kind of space. And that's allowed us to leverage these companies and so companies like that. Manatee County School is one of our patient or one of our clients as well. Sarasota County Sheriffs Venice, the City of Venice is one of our clients. So a lot of, a lot of municipalities. Pasco County. Pasco County is actually one of our one of... Pasco County Sheriffs they're actually on board with us too. So i-if you have us as a benefit option, it's always good to have come in for a second opinion if you've been told you need a surgery, and that's something that we're here to help people with. And what it does is you come in, we do a consult. We have to put you through... obviously, if you've had all these-- if you had phy-- physical therapy for six weeks, if you had, a steroid injection, and then you're being recommended a surgery, we fill that gap. Hopefully, we can help you avoid that surgery, and that's how that works for our corporate side.

Kerry 23:06

And how often do you think anyone still needs to have surgery? Is that something that still has, that happens or what do you see? Yeah

Ron 23:15

absolutely. I had a surgeon comment on one of my posts and I was like, "Oh, what, you gotta do 50 to 60 injections? When do you send them to surgery?" He's "Listen, most of the times, and our outcomes show this, that we can give people a meaningful difference in a s- one set of injections." And I don't just inject one spot, right? And so that's a m- a main difference between us two is I'm not just injecting the joint and saying, "Hey, wham bam, get out of here." I'm usually injecting the ligaments, the structures, and everything else that we need to inject to make things stronger and better. But yes so most of the time so I would say how often do we help people avoid it? I'd say probably about 90% success rate.

Real Patient Success Stories

Kerry 23:50

That's awesome. Are there any good patient stories that you can share with everybody so we can

Ron 23:55

Yeah. I, we have some on our b- on our blog if you go to our website newregentortho.com there's a blog site. One of my patients elbow arthritis came in pretty bad elbow arthritis. And he was being recommended elbow replacement which, not really great surgery. So we did bone marrow concentrate. He had a little what we call bone marrow lesion, a little bit of inflammation in the olecranon. So not only did I inject the joint, the structures and the ligaments around the elbow but I also injected that bone a little bit with bone marrow. And we have some pretty good strong indications for that. But he's been 95% better. Since his elbow's so good, he c- he actually went and played golf. He couldn't do consecutive days in golf, and he wanted to get back to doing consecutive days in golf 'cause he's retired and that's what he wants to do. So he, I think, golfed 17 days in a row when he was in Scotland on a vacation after the procedure. He got back to doing what he loves, our mission and goal is to get them back to doing what they love through non-surgical orthopedics, so.

Kerry 24:51

is there imaging evidence of the improvements that you guys see? What do you see on imaging?

Ron 24:57

Yeah. Do you mind if I sh- I'm gonna sh- You okay if I share a screen?

Kerry 25:01

Yeah.

Ron 25:01

So Dr. Felipe Hernigou is one of the kind of pioneers in this space. And and so we do webinars pretty much like once a month to just educate people. And knee arthritis is probably one of the biggest best outcomes that we see. And so this is knee arthritis. So this is this is what on an MRI. If somebody has knee arthritis, usually symptomatic, you'll see a bone marrow lesion. Okay? And so by doing image-guided injections like this is the infographic that kind of shows how we do it. Okay? So this is H- Dr. Hernigou's work, and so this was a bone marrow that he did a direct comparison of injecting the joint by itself, injecting the bone by itself, and he did a fifteen-year follow-up study. And what he found was the people who had bone mar-- bone marrow injected into the bone only twelve went on to knee replacement at fifteen years. So eighty percent of patients who have been recommended a knee replacement avoided a knee replacement at fifteen years later. And so

Kerry 25:58

awesome.

Ron 26:00

yeah, right? So yeah, so if somebody's-- the person I think this is great for is the forty to fifty-year-old who's, if they do a knee replacement now, they're gonna need another knee replacement at sixty or seventy because there is a wear-out rate, right? And if we can help those patients avoid that, right? So what we see here, this is what we see after treatment with MSCs, mesenchymal stem cells injection into the subchondral bone, right? We see that this progresses to the bone marrow lesion goes away and their symptoms go away

Kerry 26:24

Amazing. Yeah. Is there anybody that is not a candidate?

Ron 26:30

Yeah. There are patients who have me- you know, if their flexion, they can't get their knee fully extended. They can't get their knee full, their flexion and extensions is awful, right? There's patients who obviously patients who have cancer, patients who have active infections, all that kind of stuff. There's contraindications and, candidacy is part of the, part of the workup, and that's why we do an hour-long consult, right? We wanna make sure that they're not on any blood thinners that they can't come off of. There's, obviously if you're on blood thinners, that's a, you don't wanna be drawing a lot of bone marrow and that kind of stuff from the bodies.

Kerry 26:57

Absolutely. Is there anything else you'd like to share about your expertise in this field or about your

Ron 27:04

no. No this is what I do every day. I can talk about it for days on end. Anybody knows that they're like, "Oh, I gotta talk to him about this." I'm sure they're probably like... But it's you can tell I'm passionate about it. This is what I love to do, and I don't work a day in my life because

How to Know If You Need Surgery

Ron 27:17

I help patients get better,

Kerry 27:17

I love that, yeah. And I love the, root cause approach too, and I've And applying it in an orthopedic setting is also really, interesting to me, and I think that's great that you guys are able to, even counsel on some of these things with lifestyle improvements. And we do a lot of that in our practice as well. But I think that's a very unique setting. But yeah, so you mentioned your website. You guys have a lot of webinars you said, so what else Where can people find you or follow you if they want to hear more about your practice? And I know you're in St. Pete, so you're pretty close to, my, my offices.

Ron 27:49

So Regenexx NROFL, R-E-G-E-N-E-X-X NROFL for Instagram if you wanna follow our practice page. Love Health Doc is my my Instagram handle. It's just been since I joined CrossFit Love when I was up in Philly. And Love Health was gonna be my moniker, but like I said, I found something that I'm even more passionate about than just functional medicine. I'm functional medicine orthopedics, essentially.

Kerry 28:12

Yeah, that's

Ron 28:12

think that's a pretty cool space. And so yeah give us a follow. Trying to put up a lot of good stuff lately, especially do you need, right? You said that you need orthopedic surgery. Most orthopedic surgeries are elective, right? And unless it's a surgical emergency, right? So knee meniscus surgery, elective, right? Back, back fusion surgery, elective. It's based on pain. Unless you're having, again, progressive leg weakness and, there's reasons for surgical intervention. But most of them are elective. And so I would say we're always a great second opinion if you've been told you need surgery. Come see us for a consult. We take most insurances and, only thing, one we don't take is like United 'cause it won't let us in-network forever. But because, we're board-certified physicians, so we do our consults through your traditional insurance, so you can come see us. And and if we don't take it, we- we do a fair cash rate to make sure that you get a for an hour-long consult with a physician, I think that it's worth it. But yeah, no grateful to be on here and if you have any, if you have any questions, you can feel free to, to email me rontea@regentampabay.com, R-E-G-E-N-tampabay.com.

Kerry 29:14

Awesome. Thank you so much. And everybody, we'll put all that information in the show notes stay tuned next week for next week's episode and Get Healthy Tampa Bay. Thank you so much, Dr. Torrance