Kerry Reller 0:28

Hi, everybody. Welcome back to the Get Healthy Tampa Bay podcast. I'm your host, Dr. Kerry Reller, and today we have Dr. M- Mierdalus, right? Diaz Ramirez. I hope I did it right. Th- for coming on the podcast today.

Myrdalis 0:43

Yes, it, thanks a lot. Thanks for having me here. It's an honor

Kerry Reller 0:46

And you said it's okay if patients and I call you Dr. Diaz,

Myrdalis 0:50

That's plenty, yes.

Kerry Reller 0:52

Okay. Why don't you tell us a little bit about who you are and what you do?

Meet Dr. Myrdalis Diaz-Ramirez

Myrdalis 0:56

I'm really excited to share this story. I'm a physician, and patients come to me when they have had t- have tried everything, and they don't know what else to do. So these patients, they come to me not to read an MRI. They come because they want a change in their lives. They want to either go ahead and spend some time with their family, go on that trip that they haven't been able to do, maybe go to graduation or even just walk to the post to get something from the mail box in their homes. So I do pain management, focusing on their backs, on their spine, and I've been doing interventional pain management for 25 years. I trained as an anesthesiologist and went through my fellowship for pain medicine, and I've done interventional pain management for over 25 years, so I've seen a lot in my patients, and I've learned a lot from them. Then I did regenerative medicine 10 years ago, and that was, like, mind-blowing. Actually, I went into this because I wanted to do surgeries and then with intervention, with a regenerative medicine, which is, u- the use of that PRP, platelet-rich plasma, bone marrow aspiration. We can use our own body. We repurpose that, and then we help the patients in other areas, in this case, mainly the spine. So that's what I've been doing.

Kerry Reller 2:18

Wow, and you've been doing that from a different perspective. So I mentioned we, did have a recent episode, but this is a different perspective. So having an anesthesiologist background, right? And obviously pain medicine and the regenerative medicine, you have a different approach to everything. So that's really interesting. And what kind of led you even into this? What led you into the anesthesiologist pain medicine route? It was just the patients that you were seeing, or what would you say?

Myrdalis 2:42

I have to tell you what's very interesting. During my residency, I always wanted to do something that was surgical, to tell you the truth. Growing up, whenever I chose, I saw myself as a physician, I saw myself as a surgeon. And in Puerto Rico where I trained initially medical school, eventually I saw the different areas and I was more geared towards anesthesiology. Within my residency, I developed pain myself. So I'm right-handed, and I had

How Personal Pain Led Her to Pain Medicine

Myrdalis 3:10

problems with my wrist, and I was dumped in the pain clinic because I could not be in the operating room taking care of emergencies. So I say dumped because many an- many residents did not have the at length experience, and they didn't like it because they did not see the befores and after. Because I s- was able to spend more time in the pain clinic, I saw the results and I said, "Oh my goodness, I get to be in the operating room. I'm a surgeon. I see the results for these patients." And improving the quality of life, not only for the patients but for their family, to me, was the most fantastic thing in the world that I could combine all my interests. So that's what took me to pain management. Then once I was doing that for a while, I started learning more about other natural ways of healing oneself, looking for options for me, within functional medicine. I found solutions for hormone replacement and things which at the time I needed. And then within that, then I learned about regenerative medicine and I was like, "Oh my goodness, I cannot believe I can apply this to all my patients," because I had tons of patients who had been on medications for a very long time. And it's once you start with that... and there's different reasons why people get into medications and people who need them,

Kerry Reller 4:28

Uhum

Myrdalis 4:28

people don't, didn't have access to these other alternatives, and I learned them. I was like, "This is wonderful to bring to my patients." So I've been able, through the last 25 years, to be able to do everything from surgeries for the spine all the way to very simple injections, and then finding here a way to help those patients who really don't want surgery and don't want medications to help them be more active

Kerry Reller 4:54

Wow, I love that. And I love that you have that really unique personal experience while in even residency that kind of led you to the right exact path that you're supposed to be in. So that's super cool. So you mentioned several times about this kind of specific patient, this person who's tried everything and, came to you. Tell us more about that patient.

Myrdalis 5:14

So I have a lot of patients who have, who are young, but we also have the patients who are like maybe, you know, ready in that empty nest stage, that they're ready to do a lot of things. But they've used their bodies through their life, right? They've been either in sports or they've been in taking care of business owning their own businesses, and now they're hurting their back. So I have many patients who have been through five, six, seven, eight physical therapies, chiropractors,

Why Chronic Back Pain Requires a Whole-Spine Approach

Myrdalis 5:42

and I have patients who have been told, "Just all you need is medications." And they come to me, we discuss everything, like we do a thorough physical exam. We know, we establish what their goals are in life, as part of what we're doing. We see the actual films with them, so I have a huge, a monitor where I, we're able to explain to them their own MRIs. Maybe they haven't had these before. And I really touch and look for the areas of pain. One of the important things that people, when my patients come with your question, is that they have been focusing either on a herniated disc, right? Or sciatica or just like one term, and they haven't seen the spine as a functional unit that it is. If you have something that affects, for example, a disc, you've probably had a lot of forces, sheer forces and forces that come physically to your spine that affect other parts. And I go like this because, the spine is a column, and the spine has not only discs, it has joints. It has the bones themselves, muscles, tendons, ligaments. And we cannot just treat one thing. And that patient that comes many times, that's what they've been doing, either doing this part or this other part and not integrating the different things that we have available to make them feel better. They, many times they're not optimized for their procedures. They're lacking nutritional preparation for their procedures. Maybe they were given things like steroids, which are super common. And then steroids, they will be fantastic in helping the pain temporarily, but we know even from one injection you can have worsening of ligaments. They can cause more tears. They can com- cause more degenerative changes. So my patients have received many of them those injections. I have given those injections through time because the system that we have, whatever is insurance wise, whatever, whenever you have insurance involved, there's gonna be algorithms. There's gonna be things that are covered and things that are not covered for the patients. So they have gone through the injections. They have gone through the medications. They have gone through many of these therapies unsuccessfully, and they're ready to invest in their health. That's the main patient. We also have some others that they don't care about any of that. They already have the knowledge. They know how powerful regenerative medicine is, and they're ready just to come and invest in their health the same way like athletes do, right? Professional athletes will not waste time with steroids. They will go straight to regenerative therapies because they want to get good results and long-term results for their bodies

Kerry Reller 8:28

Yeah, I think I was looking around, one of your expertise in the comments was, is about, is that the pro athletes and things like that, like you... Basically what you just said, they don't waste time with the steroid injections and things like that. They're going to come right to these new procedures, even if they're not, as studied as much. But it is sad. It's almost like you described the siloed part of medicine, but of the spine, right? They're treating the, just the sciatica, just the, herniated disc instead of the whole spine support and everything like that. So it's even within, this very particular part of medicine, it can even be siloed. So you're doing this comprehensive spine approach as well, which is really needed, right? And interesting. And you mentioned even nutritional health and things like that. So that's super, super important as well. So you've got these, patients who've, been through a lot like you said, they had to go through those steps with the insurance things, right? 'Cause if you want something covered or, they have to, try this, fail this, try that, fail that, and it's really frustrating. So how do you, if for those patients that don't already know they wanna do it, how do you tell them and convince them what is, how is this gonna be different,

Myrdalis 9:36

so we go through their goals and their story, what they're looking for, and if they want me to help them. They obviously have to trust what we're doing. We're putting a lot of educational information out there for the patients to understand what we do, have a better under- understanding. To me, the important part is that they're connecting and that I understand as a guide to them what they're looking for. And depending on their stage, whatever we do is gonna be very personalized

Creating a Personalized Pain Treatment Plan

Myrdalis 10:04

to them. Yes, we have some guides of what our treatments, our protocols are gonna be, but I want to make sure that whatever I'm giving is specific to that patient. And I will meet with them. I will spend the whole time that we need to figure out what it is that, we know that they have, we think that's causing the problem. And then after having gone through that thorough evaluation, we plan together. So we plan... One of the things that I learned in my fellowship was this thing that's called the biopsychosocial model of pain, right? And then you help them within that, that for them, what's gonna be effective for them in where they live, in the situation of their body, the state of their body, their social status, their mental status, and all those things. If what I have, if what I have I don't think is gonna help them, I let them know, and I do a plan for them regardless. Because if I have experience going from minimally invasive surgery all the way to doing different injections, I am capable of telling the patients, what I have is not good for you," or, "What I have I think would be the ideal thing for you." And I think that discussing all this into context of what's important to them gives them the trust that they can decide on what we're gonna be doing for them.

Kerry Reller 11:22

Yeah, what I was gonna say is to summarize what you said is that there's things that I'm hearing that you're saying is part of this visit or the approach is one was trust, right? So trusting, your

Myrdalis 11:33

Mhm

Kerry Reller 11:33

you trust the patient, and then the other thing was personalized medicine, right? Every individual approach based upon what the patient needs. And then the other thing was, planning together, that shared decision-making. I think that's really important, too. It's just like an excellent approach. And can you tell us more about that biopsychosocial model of pain so patients can maybe, or listeners can understand more of what you mean by that?

Myrdalis 11:57

So this was like one of the very basic concepts that I have from I don't know, a long time ago when I graduated. It's 25 years ago. It's older than that. So bio means like your body, right? Your biology. Bio, psycho. Psycho is the part, the mental part where we are. And bio-psycho-social, the social is what you're able to do in your life. For example, something extreme would be a patient who

The Biopsychosocial Model of Pain

Myrdalis 12:25

has significant mental health issues and they have a they belong to a particular way of thinking that doesn't allow them to get a blood transfusion when they need them, right? So as a physician, if I was in that situation, I would have to take care of all those things. In this situation for the spine, we look at all the biology in terms of what they are, what they live, the way that they move, and their MRIs and their X-rays, whatever is available, and that's the biological part of it. The psychological part of it, I've had patients who have back pain. We have to recognize that pain can be a manifestation of things like trauma, for example. So I've had patient even recently, just, in the last year, who I didn't think I could inject their spine with anything. I could do any surgery. But from a psychological point of view, they would not benefit to their best. So that part needs to be optimized before they come to see me. Even in the biological, like it might be that they have uncontrolled diabetes, uncontrolled hypertension, things that need to be taken care of before they can benefit from my treatments. And then the other part is the social part. So are they gonna have the support at home? Do they have the elements to be able to comply with the therapy? My patients are ready. They know that they have to invest in their therapy because doing other things are already too expensive to them, so they already know that part. And then socially, they have the support that they a- are able to finally commit to something that's gonna make a difference in their lives. So we take all those things into consideration. When I'm putting a plan together for a patient, if they have to drive three hours to see me so often, I know that's not g- gonna work for them. So we do a plan for them that's gonna take all these elements into account.

Kerry Reller 14:17

I'm so glad you brought up that approach and the definition because we actually use that biopsychosocial comment and approach in obesity medicine as well. And honestly, it should be used throughout all areas of medicine. But that's just something that we do discuss a lot on the obesity medicine side of things. So I'm doing similar things every day, though I don't spell it out like that or anything. But it's I'm glad you brought that up. So you're obviously working with the body's biology rather than around it and making this plan for the patient. So what kind of things might that include specifically,

Myrdalis 14:50

so when the patients come to us, sometimes, for example, if you get somebody who's very young, they just had an injury, a sports injury, we'll focus on what's happening more on the biological point right there. Maybe get, Because they heal very fast, they might not need some other therapies. So we might just say, "Okay, you need just a platelet-rich plasma injection." If we need more volume, we might need plasma concentrate, which is another way. Let me explain it a little bit because you're asking me about

How PRP and Regenerative Medicine Work

Myrdalis 15:18

the specifics. So platelet-rich plasma comes from our blood. We just do a blood draw, and I point to my arm because that's normally most of the time where it comes from. We do a blood draw. From there, we take that specimen, that, that amount of blood. We put it in a machine that's called a centrifuge that allows us to separate the different parts. If you have somebody who cuts themselves, how when you cut yourself, you have, first you have the open wound, then the bleeding stops, then we have some little coverage that happens inside, then we have a crust, and then eventually we have, like nothing happened, right? All that process, most of it is dealt through the action of platelets So the platelets call these factors into your area of where you've been hurt, and then they they help you with the healing. So part of the things that we use are those platelets. So we get blood, we get the platelets, and then from there, there's part of that plasma we call that has a lot of other factors, and we need more volume, then we get more from that. So that's plasma concentrate. So that's the basis of what we're using. If there's somebody who just came and has a little bit of an injury, something very quick that we know that's gonna be with that and maybe some rehab, that's what we'll recommend. Many patients will have to prepare them so that we have better chances. As I said, like many of our patients are in chronic pain. They have had this for at least three years, many of them. And we have to optimize them from a nutritional point of view. We know that essential amino acids are important, so we will probably recommend some essential amino acids for them. We'll probably do a detox. We will probably work with the quitting smoking optimizing the blood sugar, optimizing the blood pressure and all these things so when they come to see me, they're in a better chance at getting better. We might want to increase their amount of platelets. We know that, for example, hyperbaric oxygen, given a certain time, can improve your amount of platelets. That is like increasing your dose that you're gonna be receiving for your treatment. So we might include that. We do laser therapy. Laser therapy can help. The laser that we have is a class IV laser, and this class IV laser works with two different main types of way. One is in the 800s and the other one is the 900 centimeter. And one of them will work with inflammation, the other one will work with pain. This class IV laser is the only one that doesn't get hot, so the patients can tolerate. So if you have somebody who's a younger patient who doesn't want to be poked, we might use the laser and not platelet-rich plasma, for example, depending on what the injury is. Or we might add this. So all these things come into play. Then, depending on the place of injury, we might decide to use our platelet-rich plasma as a base and then add other things like bone marrow aspirate. And when people talk about the, these cells in our body that help us, the cells are really produced in our bone marrow. Bone marrow, instead of doing a blood draw from the arm, we do a blood draw but from your marrow, usually on your pelvis, which is done at the office. So depending on what the patients need, we're gonna be adding different things to their care. And those are gonna be the main things that we're gonna use, but we can use them in combination mainly as part of a protocol for most of our patients that come to our clinic.

Kerry Reller 18:46

Wow, that's definitely a lot, and a lot of new modalities that I hadn't heard before, especially with the hyperbaric oxygen. That's interesting. Do you have a hyperbaric chamber there that you go-

Myrdalis 18:57

oxygen here. I believe that people should get the best it's very easy to get an inflatable unit, but that doesn't really supply what the patients need. We have a collaboration with a local physician who's been doing this for 30 years with their hyperbaric oxygen chambers. They have solid good chambers that they've had, and then we collaborate with them and we do that as part of our concierge service. We will coordinate that with for our patients with their office

Kerry Reller 19:25

Oh, cool. Okay. So after you do some of the procedures that maybe you said you combine some things, maybe they do something by itself, how- what does success look like? How does this differentiate from someone who was told they need surgery?

Myrdalis 19:41

So it's gonna be dependent on all those things, right? The state of the patient, if they're compliant with the instructions that we're giving them, if they have a, what the anatomy

What Success Looks Like Without Surgery

Myrdalis 19:53

is. Because, for example, if you have somebody who has a huge disc herniation, they will need surgery if that's pinching a nerve and they're having neurological symptoms. I'm not gonna treat that patient, and we have to understand the limitations of our therapies. So when we're talking about this in terms, like the functional unit versus that, you don't have a study that will compare apples to apples and organs to organs. We can say within these patients, they have, we look for a significant improvement in their function. We look for a significant improvement in their ability to return to their family life. And for that, with the combinations that we're doing, we're getting great results with most of our patients to be able to do that. So patient satisfaction is very high

Kerry Reller 20:41

I'm assuming reduction of pain too, right?

Myrdalis 20:45

Well, the reduction of pain will allow them to achieve that, yes.

Kerry Reller 20:49

Yeah. Yeah, of course. Yeah. So a lot of people, are maybe told that, surgery is the only option. You mentioned a couple examples where maybe it is, but

Myrdalis 20:59

உம்

Kerry Reller 21:02

when, maybe it wasn't the best choice or not the appropriate choice to do surgery?

Myrdalis 21:07

Well, we know that this displacement and herniation, for example, bec- I mention this because many patients focus on that herniation, right?

Kerry Reller 21:16

உம்

Myrdalis 21:16

you have different, de- depending on the radiologist who reads the MRI, they're gonna call a herniation something like 1.5 millimeters this displacement Or more. Some people will call it after two millimeters. So you can have patients who have a disc displacement that's

When Back Pain May Not Require Surgery

Myrdalis 21:35

really minimal, that doesn't require surgery, but they're gonna be recommended to surgery because somebody said that's a herniation and they might have some radicular symptoms. So if you have something that's on the smaller side where you're not really being pinched that much, you can have significant pain relief without having any surgery. You can have sprains, strains, tears of your ligaments. There, there's no surgery for those. We include that in our treatments, which is normally not treated by conventional medicine. And if you put steroid there, what the steroid's gonna do is destroy that. You can have arthritis, and arthritis can be treated with the decreasing inflammation and pain with the regenerative medicine. So we have ablative therapies, radiofrequency ablation that many people go through. We can try to cause more regeneration through our therapies with regenerative therapy rather than destroying. When we're destroying, we're not only Normally what we do, there is something that's called the medial branch nerve. That's the nerve that gives sensation to these joints, little joints in the spine. When we're killing sensation to those joints, we're also killing sensation to the multifidus muscle, which is that huge muscle that goes along our spine. And those muscles atrophy. So if we can cause regeneration and rebuilding and having that patient restore through physical therapy afterwards, then they're gonna be doing better if we do the opposite. And don't take me wrong, there's many patients that's what they need. I have patients who cannot have regenerative medicine because maybe they're on some blood thinner or some medication that doesn't allow them to have regenerative medicine, and we give that. We tell them, that's might be the choice for you." But when patients have all these problems with the spine and we see it as what it is, we are able to inject into these different areas. For example, you can have tears of a disc. And the treatments that we have right now covered or not by insurance may not be the best. We could possibly help regenerate that disc, giving them a better chance with, for example, bone marrow aspiration, right? And then we can inject a patient who comes with a complex problem, and we can do an epidural placement of platelet-rich plasma for that disc displacement. We could do some bone marrow aspiration for that disc tear. We can do some of the PRP and plasma concentrate for the, For the tears, for the sprains in the ligaments and the facet joints. So we can do different injections depending on what the patients have. So for me to say, "Okay, one pa- everybody will benefit from this," it's not that. That's why it's personalized medicine, right? It's concierge medicine. We're going through that patient and we see what they have. We can take into account the sacroiliac joint, which many times is involved, and we don't necessarily diagnose that as frequently as we should. So it depends on the patient, what we're gonna be doing, and on the amount of material that we need to work for them. But everything is easy enough that it can be done at the office. They're comfortable. They go home the same day, and they're usually happy with the results

Kerry Reller 24:54

And to clarify a little bit, you mentioned the, was it the RF ablation, right? Is that what you

Myrdalis 24:59

Yes,

Kerry Reller 24:59

destroy

Myrdalis 25:00

ablation. Yeah

Kerry Reller 25:01

So the nerve innervates, the muscle, so the muscle atrophies as a result of that, and then you rebuild it back with physical therapy. Is that right?

Myrdalis 25:08

You try, yeah, you try to do that. Not rebuilding, but we make it stronger, yeah, with physical therapy. So usually when patients, my patients go through ablation, through the 25 years of doing this, we'll want them to go on through rehab. But if we're able to treat them with regenerative medicine without having to do the ablation, they don't have to have the atrophy that the radiofrequency ablation causes

Kerry Reller 25:35

Yeah. So obviously it's come a long way now to have the regenerative medicine

Myrdalis 25:39

Yes

Kerry Reller 25:39

addition to it, right? Interesting. Do you have any favorite case stories or anything that you wanna share?

Myrdalis 25:46

I'm gonna tell you about Ruth because Ruth was my first patient and I always remember Ruth. And Ruth, I loved her. And this was in the beginnings of me doing this. She was my very first patient when I started doing PRP. And Ruth came to me when she was like in her late 70s, and they had told her that surgery would have been the thing for her. They didn't diagnose her sacroiliac joint problem and still they told, "Yeah, you need surgery, but we

Patient Success Stories with PRP

Myrdalis 26:14

cannot do surgery because of all your problems with your health. So let's have you go to the pain doctor so that they can give you hydrocodone." That was the thing. So they come to me for hydrocodone. I talk to the family and the daughter. Her main issue is that she did not want to be a charge, like a, a burden in her family, and she still wanted to be part of her family. She did not want to be drugged. She just wanted to be independent. The daughters, they were very close. And she was very active, very happy. She would come and make jokes and all these things. And that's how she wanted to be, right? So she did not want to be drugged. She was not a candidate for surgery. And see, the surgery would not have helped her for the problem that she had at the time. So she had sacroiliac joint pain, which is the lower spine. And we did PRP for her with plasma concentrate. I had her... She would come every two, three years to me for that. No medications in the middle, nothing else. But she would be active until she unfortunately passed away in her late 80. Actually, she got to 90. Yeah, in her late 80s. And that was fantastic. I loved taking care of her. She had done, the physical therapy. And many people at this stage, when they come to me at that, that stage, they don't really want to do physical therapy, but they want to be active, and it was perfect for her. So I love that, that story there. I've had some other patients. I had one patient who had an injury that was older than me. That was a pretty exciting one. So at the time, they had the pain longer than what I had been living for, and I was able to help them with just PRP. For the first time in so many years, they got relief and they were able to walk again to the extent that they wanted to walk. So those two cases, like I really loved them

Kerry Reller 28:02

Those are amazing. That's awesome. So like you alluded to, sometimes patients are sent to pain medicine for pain drugs, which is, hopefully falling out of favor, right? What have you seen in the community or anything like that? Do we think that we're veering away from that and using more alternative approaches like this?

Myrdalis 28:25

In interventional pain management, that's been the trend. We have more tools and things that are being recognized, especially, for patients who are in the in the insurance world. There is still regenerative medicine is not really covered by insurance,

Kerry Reller 28:37

उहं

Myrdalis 28:39

other things that are more invasive are. And in getting those, people are really trying to stay away from medications. I come from a, an era, I was training in the 2000 was when I graduated from my residency. 2000, 2001 was my fellowship.

Moving Beyond Opioids and the Future of Pain Medicine

Myrdalis 28:54

In that stage, we believed that there was no ceiling to opioids, right? We would give opioids... I had a patient who was on almost 2,000 milligrams of oxycodone that I saw coming to the clinic when I was training. One of the attendings was giving them that, and you would see it was great coming. I was like, "Oh my goodness, how can somebody be under that much medication?" Eventually it was weaned out. We've learned through time that now opioids can produce pain, right? You can have hyperalgesia from opioids. So the medication itself, we would talk about tolerance, but it's not really tolerance. It's that the medication is giving you pain, and they start with a diffused body pain. So we've learned a lot through, over the last, over 20, 25 years in pain management, and the trend has been to give patients less opioids. But still it's a very important part of our algorithms in the clinics that depend on insurance, because they will not necessarily cover for all these therapies that are available now to the patients. So we still have many patients, and patients call our clinic all day every day to also ask about that, that alternative

Kerry Reller 30:10

Where do you think kind of pain medicine is heading in like the next five to 10 years? Do you think some of these things may be covered by insurance, or where do you think it's heading?

Myrdalis 30:20

So that's hard to tell because of the priorities of the healthcare that's been changing, and I wish I, I knew exactly where we were. I can tell you in terms of what we learn in pain management. In pain management, in our meetings we're learning more and more ways, for example, in orthobiologics, which is what we're operating with here, in ways of optimizing those therapies for our patients. That's why I'm telling you now about protocols which we didn't have and many f- offices still don't have. We still don't have the way of optimizing the patients. That's why I created this method that I call the Doctor to Spine Motion Method where we first prime that patient, we prepare them, then we map. I've had patients that come to me and they, the, the person who did their procedures never saw an MRI with them. Why sit down with them and we take a look at their MRIs? Or they're treating just like an X-ray and MRI without treating that patient, so we, they don't know exactly where the problem's coming from. We've had patients that they come and they do blind injections on them rather than using some type of imaging. They say, "Oh, I have stem cells here, but And they touch my back, but they really didn't see exactly where they were doing. So we target, that's the third part of our system. Then using these med- these I call them medications, your own PRP or your own, that those are medications, that the body's giving us to repair. That's the next part. And then we restore them. So we not only take them to the point of the injection, we're able to restore them and we add more of these therapies that we mentioned at the beginning to make sure that we have a complete eh, improvement of that patient. So if you ask me where is pain management headache in orthobiologics is to look for that evidence that all these things are working, how we can optimize dose of platelets, for example. That's why I tell you, okay, we can time even, a essential amino acids. Some preliminary data of some studies have shown that giving amino acids just one hour right before your treatments can increase your platelet amount. And we know that increasing platelet amount increases doses. It's like dosing medication, right? So we use those type of things to improve regenerative therapy. So I see that coming more as we study these combinations more, moving into that direction where we have better therapies, better combinations to offer to our patients

Kerry Reller 32:49

So you have in your practice created this systematic approach of what you just described essentially, right? And you I think it's fun you call it Dr. Chu Spine, right? But that's also the, your website and things like that, correct?

Myrdalis 33:02

Yeah, that came out, that's a variation of my name actually, I have to tell you. So I'm Myrdalis Diaz Ramirez, so I was gonna be either my initials MD or DR. So I'm Dr. DR, so that's... I would have people in my residency call me doctor or they would call me DR squared, so that's where it came from. So DR squared and then that became Doctor 2 Spine and that whole thing. But that's where it came from. Yeah

Kerry Reller 33:30

That's so cute. I love that. That makes a

Myrdalis 33:33

I was meant to be a doctor no matter what, MD or DR. Those are my initials, so

Kerry Reller 33:38

Absolutely, you were meant to be a doctor. anything else you'd like to share with our listeners today about, you, your practice, or anything specific with what you do?

Myrdalis 33:47

I would love for anybody who has any questions, we are putting, we have a YouTube channel which is Doctor 2 Spine, Dr2Spine. And we have our website which is the same thing, doctor2spine.com. Our phone number, I always have to read it because I don't want to forget it, which is 813-597-3405. That's our phone number. You can call us. You can have a free consultation on the phone to see if you would be probably a candidate or not for our therapies. And then after that they would meet with me and we go over this whole system and we explain. One of the things that I've done with the practice that you asked at the beginning about differentiating from other practices is that because I have a method, I have a way of when we document for our patients, that patients will have accessible to them a timeline of exactly everything that they have to do and which part of our system that falls into. So they will have a, basically like a calendar of what they have to do of their optimization for those, those therapies. And I think that is important that you're part of that decision and that you understand. So we try to give as much information as we can to our patients. And we have also... We're bilingual, English and Español. So I say that our educational channel on YouTube is becoming like the regenerative spine Duolingo.

Kerry Reller 35:13

oh

Myrdalis 35:13

Because we're publishing in both English and Spanish the same information. So you can learn Spanish with our YouTube channel, too

Kerry Reller 35:21

That's awesome. Yeah. And you guys you're on Habana Street. That makes me think of, Cuba and the Spanish language as well. But you are in Tampa, right?

Myrdalis 35:29

Yeah. We're in Tampa right next dead center here, very close to the Raymond James Stadium, right next to St. Joseph's Hospital. Our address is 4700 North Habana Avenue, Suite 507 in Tampa. And you can come and visit us. Just call our phone number and we'll have an appointment for you

Kerry Reller 35:48

Awesome. Thank you so much for being on the podcast today and sharing your wisdom and your approach, and I think everybody needs to hear this. And know that there are alternatives to being sent to pain medicine. Granted, you did mention it's not covered by insurance, but sometimes it's worth going outside of that, insurance network to get the actual care you need that's personalized and specialized and customized for yourself

Myrdalis 36:11

What I say is that we either pay with time or with money, right? You pay somehow, and you have to see if it's an investment for your body. So many of our patients have been spending years looking for a solution that will keep them active in their families, keep them active at work, and they have not seen those. And if you're ready to take that step, I say, "Are you ready? Let's go. Let's just do it."

Kerry Reller 36:34

Awesome. Everybody stay tuned next week for next week's episode, and thank you so much, Dr. Diaz.

Myrdalis 36:38

Thank you for having me