Taking Charge of Your Health

– Well I think the
future of orthobiologics is absolutely unbelievable. But we don’t quite
understand why they work, where they work, so you have a lot of charlatans there promoting stem cells for
things they may or may not do. So we have a bald knee. We have a knee that
needs a knee replacement. It has no cartilage in it, just like the head has no hair. So if somebody comes
by a rep in the office and has a bowl of cream
and calls it stem cells, how many people would pay $5000 and say, rub it on your head and
expect hair to grow tomorrow? Probably not too many, but
that’s what’s happening out there right now. I think the future is unbelievable, but there’s a lot of charlatans and people are willing to pay
$5000 out of their pocket. They complain about a $20
copay to see Dr. Luchetti and he’s worth 30. (laughter)
I don’t care what you say. He’s worth 30, he’s not 20. So but this 5000, they will pay $5000 because they want to avoid surgery. But it’s just not there. You can’t inject this stuff into the knee, expect it to grow cartilage. It’s not there. The only way it’ll help is if you have a wallet
and you take $5000 out so you weigh less, and then
there’ll be less pressure on your knees. That’s about the only value. So we’re here because this a
health and wellness seminar. Was thinking about this last night, what if it was called the
sickness and illness seminar? How many people would come? (laughter) Probably not many, you know? But that’s what we’re here for. We want to avoid sickness and illness. So I can avoid all my slides
and go right to the conclusion, I think that’s what I’m gonna do. So really if you wanna
stay healthy and well, the two take home points today, are stay out of hospitals and stay away from
doctors and prescriptions. you will stay much more healthy and the statistics show that. Okay? Hospital and medical related errors are the third leading cause
of death in this country. 400,000 people. Now if you’re sick, you need it. But most people that come to
Wayne and I, they’re not sick. They have a sore shoulder,
or sore hip, or sore knee. They’re not sick. You don’t need to be in a hospital. And how about prescriptions? Do you know how many people
come in with polypharmacy, and that means they’re on
20 different prescriptions? It’s unbelievable. Probably they don’t need a lot of those, and the rule with prescriptions is you should be on the lowest amount for the shortest amount
of time, most of the time. But you just get one because
you think it’s appropriate. Look at this. So prescriptions are the
fourth leading cause of death in this country. Side effects of prescriptions. How many people knew that? Everybody here is afraid of
a heart attack or stroke. How many people are afraid of dying of the side effects of prescription drugs? But it’s true. It’s true. So… You know a lot of the advances in knees are not that great over
the last 20 or 30 years. You know, Wayne was talking about the hinge joint we put in there. The metallic properties
aren’t a whole lot different. I could take a knee from
25 years ago and put it in and pretty much get the same result of the knees that they have today. The technical advances aren’t that much. The advances that we have
are in tissue management, pain control, how we treat the patient. That’s really what I’m
gonna concentrate on here. So, the opioid crisis,
I call it the 5 P’s. Everybody has some blame there. Physicians are perhaps
tied at the top of the list with pharmaceutical companies
to cause this problem and I’ll show you why. Payers, patients, politicians,
we could have a sixth P, probably police are in there. But these are responsible. So if that’s the case, and
we’re partly responsible, you know what? Then maybe we should
be part of the solution and I’m gonna go over that with you. So, we’re the silent
gateway to this problem because 80% of all the addiction problems start with our prescriptions. If you look at this,
these are millennials. 18% of millennial women went on to persistent
opiod use after surgery. 18% became addicted. And women are more likely than men to become persistent
users or to be addicted. If you look at it, women are prescribed
more opioids than men. And they’re prescribed 15%
more, it’s just reality for whatever reason. One in four orthopedic surgical patients were prescribed a daily,
daily dose of opioids equal to 90 milligrams of morphine. This is what they go home with. This is the history. If you look at this. 20% of surgical patients admit to refilling their opioid prescriptions even though they don’t need it. They just want it at
home just in case, okay? And 90% of them have extra opioids at home and they’re accessible to family, friends, they’ve admitted to it. So this is part of the issue. Look at this, the
average knee replacement. The average knee replacement
goes home with 130 Oxycodone, Vicodin,
Percocet prescriptions. That’s crazy. You know what we give now with our new multimodal pain approaches? 10 to 15. Let’s say 13. One tenth of that. One tenth of that. So it’s absolutely amazing, and if you look at the surgeries, zero in on the hip and knee. So between 10 and 15%
of our surgical patients become chronic narcotic users. That’s our fault. That’s our fault. It’s our fault. So anyway, but they’re the historical standard, this is all we knew when we trained. All we knew was how to use opioids. We had no other tools in our toolbox. But look at the side effects, there’s two dozen side effects. Nausea, urinary retention, constipation. Decreased breathing. And so we need an alternative game plan This can’t stop or else
we’ll go back to the old days of Samuel Gross. This was our historic
post-operative pain protocol. We operate and we gave you narcotics. That’s all we did. Look what we’re doing now. Now we have something
called preemptive analgesia. Now this didn’t start until 1993. That was the first article on preemptive multimodal analgesia. The average age of an orthopedic surgeon in this country is 56. If you do the math, half the orthopedic
surgeons in this country graduated before the first article on multimodal pain relief came out. So you wonder why they’re
prescribing 130 Percocet after surgeries, ’cause
they weren’t trained. So this is what it was,
but look what it is now. Now we start and I’ll go
over, 30 days ahead of time, we know about supplements, we know about nutraceuticals that decrease pain and inflammation. We start a month ahead of time. The day before, we load patients with
non narcotic medications. The day of surgery, before surgery, we have four or five other
non narcotic medications. Not everybody does this. Look at that list that we start before we even start the surgery. In surgery, during surgery, we have a bunch of other
medications that we go over. And post-op, we put
people on around-the-clock non-narcotic pain pills. And look what happened to the Oxycodone, it drifted all the way to the bottom. It’s all the way to the bottom. And it’s only there for breakthrough pain with those 10 or 13 pills. Not 130 pills. I was out to dinner the
other night with my neighbor who reiterated a story when
he had his wisdom teeth out when he was 20 and had 100
Percocet to go home with. And he went home and he was diligent in taking every one of them. He laid there in bed for
three weeks and just took ’em. And he got addicted to it, he had to go into withdrawal, and this is what happens. So, I look at this as preparing for a test or preparing for a race. If you do your homework
and you do your training, when you show up for your
test it’s just a formality. You know what it is. When you show up for that marathon and you’ve done four months of training, you’re gonna do great. But if you show up and you didn’t train, Or you didn’t study, you’re gonna fail the test, you’re gonna do terrible in that race. That’s the same thing
that happens in surgery. If you’re not prepared
to do all this stuff, you’re gonna wake up, you’re gonna have tremendous pain, they’re gonna give you opioids. If you do all the preparation, it’s absolutely amazing how little pain you have post-operatively. So, here’s what a
multimodal pain approach, all those medications we talked about work at different parts
of the pain pathway. And so, some work at the incision, some work at the nerve, some work at the spinal cord, some work at the brain. But if you look at the top right, this is how orthopedics think of this. The pain message is that
what gets to the brain, or the water coming out the end of a hose. So if you don’t do anything, that pain signal is
gonna inundate the brain. If you step on that hose it might dampen that
water or that pain signal, but if you have six people
stepping on that hose, which are all the different medications, there’s no pain signals
that get to the brain that need opioids. So that’s the logic behind
layering this stuff. I’ll kind of go over that
with you a little bit. So all pain comes from chemical
inflammatory mediators. When you get cut, when
we make an incision, there’s chemical mediators
that’s at the level of the cells that stimulate a pain signal to go up. So if we could decrease those
signals before the incision, you’re gonna have less pain afterwards. So here’s a list that I give to patients. And that list is in the back. You don’t have to remember this, you can pick up a handout on the way out. But when patients come in and they say, well I can’t take
anti-inflammatories, I have an ulcer, I’ve had gastric bypass
surgery, I’m on blood thinners, you know, what else can I take? And you know what they take,
is they get a prescription for Percocet or Vicodin or Oxycodone. I give them this handout and say, here’s 25 different
things that you can take that will lower that inflammation, and a lot of you have heard
about a couple of these, I’m not gonna go through the whole list, but I’ll give you an idea. There’s move evidence based science behind Omega-3s and fish oil
than any other supplements. The only supplement ever, ever recommended by the American Heart Association, because it not only
reduces cardiac mortality, mortality is death, but
all cause mortality. So why wouldn’t you take this? But yet we’re still
called the night before at some of these hospitals that say, stop your baby aspirin,
stop your fish oil, we’re stopping these things that not only decreases inflammation, but it decreases your
stroke, chance of an MI, arrhythmias, platelet
clumping, clotting, DVTs, pulmonary, why would you stop this stuff? Those are things we don’t want to happen post-operatively, right? So another thing you
probably never even heard of, L-Arginine. L-Arginine, combined with Omega-3. Anybody that trained like Wayne and I did in an intensive care unit,
spent time in a burn unit, and a trauma unit, all of the nutrition that you give these patients
has two substances in it. Omega-3, which is fish oil, or L-Arginine. Why? Because together, they
work synergistically to decrease the infection rate. This is proven in wound care,
everybody in wound care, and it allows the
incisions to heal better. Why wouldn’t we give this to our patients? How many people ever had
surgery and their doc said, take L-Arginine or fish oil because you’re gonna have
lower, but this is science. We’re not making this stuff up. And do you think Nestle and
Abbott haven’t figured this out? These are immunonutritions,
drinks that they promote to cancer patients, any
surgical patient that says, take these drinks before surgery,
the month ahead of surgery and look what’s in them. All that’s in them is
fish oil, L-Arginine, some protein, and water. So these companies aren’t silly. So you don’t have to get this, so we put all of our patients
on L-Arginine and fish oil a month ahead of time. So these are wonderful easy things that don’t have the side effects that you ought to be doing. Turmeric. How many people have heard of turmeric? Yeah. How many people that
have heard of turmeric were put on it by their physicians? Ahh. (audience laughing) You know, this has been
around for 5,000 years, right? Modern humans have been
around for 50,000 years. That’s one tenth of the time that humans have been on this earth. You know, humans are not stupid. They figured out that this works. They don’t know how it
works, but it worked. And look what it does. Modern research now, it’s like aspirin. We used aspirin for years before
we knew what how it worked but know we know how it works, same thing with turmeric. We know it works because
it’s an anti oxidant. Has anti-cancer properties, has anti-biotic properties,
has anti-viral properties. And it’s five to eight times as strong as vitamin C and vitamin E. Why wouldn’t you try this? It tastes terrible, but
now it comes in capsules. This is another thing. So why is your doctor more likely to give you a prescription? Well because 70% of us are
on that, or on one of them, 50% are on two, and I can’t tell you, I think half our patients
are on 10 of them! I think half our patients
are on 10 of them. And the most common ones,
opioids and anti-depressants. I’ll just regress because
I like regressing. I like history, I like history. So why is this, why does this happen? Because 100 years ago,
the titans of industry, Rockefeller and Carnegie
were well invested. People think that they were in the banking and the railroad industry, they were in the drug
industry, petrochemicals. Petrochemicals, right? So they commissioned the
Flexner report, 1910, over 100 years ago, to shut down half of all the
medical schools in the country. They said there’s too
many medical schools. There’s 150. 150. They shut down 75 of them. And they said we will fund
these under the auspices that we change the curriculum, and we take everything
out of the curriculum that has to do with diet,
plants, herbs, and vitamins. Because they have no role. Everything has to be pharmaceutical based. So that is why allopathic
medicine is pharmaceutical based 100 years ago. Now there’s some good things about that. They came up with the
scientific principles, we started studying them. But really, their impetus was
to preserve their industry. So that’s really why we had a year of pharmaceutical training but we had about an hour
of supplements, okay? So the other thing, why
can’t we get hemp-based CBD, the active ingredient in
marijuana, but hemp-based? Because it’s a wonderful,
wonderful chemical. I’ll talk about that a little later. It’s the same thing. So these guys in 1937, they
controlled the paper industry, the petroleum industry, and hemp. Hemp, hemp, not marijuana,
would compete with them. So, and they were part
of the opium cartel. So they got that sanctioned
as a Level 1 drug. It’s absolutely crazy. Another medication, this has been around for
5,000 years like turmeric. But we can’t use it. So it’s gonna a blip in
history between 1937 and 2018 where it’s now become illegal
because we could do some, we could do some research on it, okay? Here’s a great, there was a
vitaminologist, vitamintologist, who ever knew there
there was such a thing? So this was in the 40’s, right? This was after Rockefeller
was given all of this money to the allopathic medical schools and he was saying, you know what? The farming isn’t that great. Almost the beginning of
organic farming, okay? And he said, maybe we
should look at supplements like B vitamins, wheat germ, the soil was depleted of nutrients, and you know what the FDA did? They prosecuted him. Ten docs of the American
Medical Association testified against him and they said vitamins are not necessary
for the human body. It’s 1948. Many people were probably born 1948. And so he was found
guilty and he was fined the equivalent of $25,000. So this is crazy when
you look at the history. And so then the FDA helped and they said, we’re gonna define a
supplement as something that, it can’t treat, cure, prevent,
or diagnose a disease. So you can use it, but we
can’t call it that, okay? We can’t call it that, and why? Is because it costs, you
know, millions and millions of dollars to get the drug… approved. And most of that funding is a source of funding for the FDA, so they don’t wanna approve something. But here’s the sort of home run. Do you know how many drugs
come from plants and herbs? – [Male Audience Member] Most? – Most of them! Right? So pharmaceutical company isn’t crazy. Think of them, right? Think of aspirin, digitalis, metformin, almost every antibiotic, okay? Vincristine, cancer drugs,
all of these things. Cortisone, morphine, pain
med, all of it comes. So what did they do? So pharma can’t patent nature, and they have no interest
in natural cures. So they copy or they slightly modify them, then they patent them. They market the pill as a wonder drug. And then they called the
original plant worthless. This is what happens in the world. So guess what type of medicine
Rockefeller, his family, and the British family still use? Homeopathy. So it’s sort of interesting,
just to look at the history. It’s not all bad, but it is sort of
interesting to look at that. So this is why, I always cringe when we sort of talk about supplements, and they go oh, thanks doctor, I’m going to go talk to my
family doc, and I just go ugh. (audience laughing) I go, because it’s a crapshoot. He may know nothing about it, but everybody thinks that, you know, the family docs, their
interns, they’re omnipotent. They’re really not. They didn’t learn about it. They didn’t learn about it. And unless they have an interest in it, they’re not gonna be able
to sort of inform you. So look at now. Look what’s happening, right? Look what’s happening 100 years later. The tide is turned, okay? The biggest gift ever,
ever, to a medical school. Two hundred million dollars. You see Irving last year. What was that for? It was for the implementation and studying of alternative medicines,
supplements, and nutraceuticals. Look what traditional medicine did. Guy from Yale. “This is a massive failure of academia. “This should be the final line
that doesn’t get crossed.” “This is crazy. “Doctors should avoid medical schools “where integrative medical
courses are required. “If you want to use
your time productively, “don’t take classes where
you’re not gonna learn “anything that helps you make”, These are from the academic centers. And so look what happened 100 years later. Somebody with money, somebody with money, like
Rockefeller, is changing this. So this’ll come full circle. So now we’re gonna be able to research. We never had the money, without the money, they’re just going to poo-poo it. So it’s pretty interesting. So anyway, let’s go back to where I got carried
away there for a second. But I like getting carried away. So here is our tool box, these are all the things that
we use now to avoid narcotics. Which are good for acute
pain, don’t get me wrong, you get your foot run
over by a train today, it’s very good for a week or so. But you know what the problem is? Chronic pain. We now know. We’ve done a disservice. People, does this make sense? People on chronic opioids have more pain. It magnifies their pain. People that come in, I’ve been opioids for 10
years for my back pain. Well it was a self propagating issue where it’s called neuroplasticity, your neurologic system changes. And you have more pain. And it’s often hard to get them off it. Because now their neurons,
their synapses, have changed. So, going forward we could avoid that, a lot of patients don’t like that. But here our anesthesia colleagues were a lot smarter than we were. This, couple of years ago they
said every surgical patient, every surgical patient,
should be on nonsteroidals, acetaminophen, and a neuroleptic like Lyrica or gabapentin. Unless it’s contraindicated. And it lowers, it hits that neural pathway at several layers so you
don’t need the opioids. But how many people have a knee scope, they have ENT surgery,
they have urologic surgery. You still get the narcotics. Because they say stop
the anti inflammatory, stop this, it’s gonna
cause bleeding, et cetera. And a lot of that is not based in fact. How many people say, Advil doesn’t help me. Aleve doesn’t help me. You know what I say? You don’t know the dosages. You don’t know the dosages. So they go, I take two
Advil, doesn’t help me, I go, you know what? Before it went over the counter, the prescription was 800. So do the math, that’s
four of those little pills. Now you should still take it for the shortest amount of time, but if you take real doses, the best over the counter remedy, is you go, take four ibuprofen, four Advil, two extra strength Tylenol, they go, oh my god, that’s six pills. But they’ll go home and take an oxycodone. They’ll take an oxycodone, right? So you take this, as long as you take it for a short period of time, you could do that three
times a day, that’s 18 pills, oh, 18 pills! Well they don’t know the math! They don’t know the math! So if you get ’em over that, that’s the morphine equivalent,
of six to eight of morphine in a day, without the
euphoric effects, and they go, so we do this before surgery. You know how many people
come in for knee surgery and they go doc, do I
need my knee done today? Yesterday I took all that
medicine, it feels great. I go well, you know, of course it does. You just can’t do that long term. But that’s sort of the secret of understanding multimodal pain approach. And here’s a game changer. It’s another controversial thing. As you can see, I like
controversial things, okay? So, this is a medication that
came out a couple years ago. It’s a longer acting Novocaine. When the dentist gives you
Novocaine, it lasts two hours. They have a new Novocaine
that lasts two days. Two to three days. And we put it in the knee, but there’s a couple early
studies that were poorly done, pharmaceutical companies didn’t like it. They said it doesn’t work, but if you do it right,
and it’s been proven now in 16 large centers,
this is a game changer. Only coordinated health can use this ’cause it costs a little
more, not a whole lot more. But it allows us to get people home. But the big hospital
networks where I work at, they won’t even approve this. But they will approve 120
oxycodone to go home with, right? And we do have other
tissue sparing effects, so we are a lot better, like
Wayne showed that incision, so even though that looked
like a formidable incision, it’s a lot smaller than it was years ago. We’re efficient, you don’t
wanna spend two hours in the OR, we use a short tourniquet time, we have other really cool medications which stop the bleeding. We don’t type and cross people any more. Remember the old days,
you had to give you blood? I mean, it was like a
bloodletting, you know? Now we don’t do any of that stuff. And the driving forces have
been outpatient arthroplasty, why is that? Because it costs too much money. We can’t afford to take
all these healthy people, you’re not sick, you don’t
need to be in a sick place. So we can’t afford it. So if we’re gonna send you
home we better make sure that you’re not calling
Wayne at 2:00 in the morning asking for more Percocet and he goes, no, Dr. Mead said I can’t give that stuff. (audience laughing) Go take some vitamins. (laughing) So, anyway. Why would we do this? And so the modern knee replacement, I had the word knee replacement, okay? If we replace your hip,
we replace your hip. We replace your shoulder,
we replace your shoulder. You know if we replace your knee, we don’t replace your knee. Now why do we call it that? I don’t know, it confuses patients! Confuse ’em. We replace the cartilage,
or we resurface it. Think of us like a
dentist, now, of the knee. So we take off minimal bone,
we put these caps on there, and it confuses people, you know, is that a partial knee, no, a partial knee is a half of a knee. But even our total knee
is like a resurfacing. So that’s sort of, just a
clarification if you will. So all these cases used to be
done as an inpatient, okay? Partial knee, spine, now they’re
all done as an outpatient. So why not joint replacements? So two thirds of all the humans, two thirds of all the
humans who have ever lived in the last 50,000 years,
over 65 are alive now. So, that’s good I guess. But their parts wear out. You know, 1900, the average
life expectancy was 45. We’ve doubled the life
expectancy in 100 years. So, and we have 12,000 people
a day joining Medicare, it’s gonna go broke by 2026. And total knee replacement is the second most common
procedure in the country, what’s first? – [Female Audience Member] Hips. – [Other Female Audience Member] Heart. – Cataracts. (audience murmuring) Cataracts. So, and statins cause
cataracts by the way, that’s another lecture some day. So we can’t afford it,
traditional beds cost too much. And if you look at it, it costs $50,000 to be in the hospital and
have a hip or a knee done, it costs half of that as an outpatient. So if Medicare’s going broke, we better figure out how
to do it and make it less. And how about this? Is it safer in a hospital? We went over that already, right? But your risk of infection and stiffness is higher if you stay in a hospital. Why? I don’t know why, but just
don’t be there, you know? Is everybody a candidate? Well I have 90 year
olds that feel like 50, I got 50 year olds that feel like 90. Okay? So not everybody is a candidate, like this guy may be
not a great candidate, I don’t know.
(audience laughing) You have-
(audience laughing) You have to take some
responsibility for your health. So maybe he’s gotta stop smoking, get his diabetes under control, eat a few less french fries there. And probably joint camp, Melissa’s in the back,
she runs our joint camp. It’s all about education. Everybody had a knee or a
hip done, their neighbor did. Worst pain in the world and it’s true! 50% of these patients historically had the worst pain the world. Now, we don’t have zero
pain, but it’s amazing to see people going home four hours later. They have no pain that day. Reality, third or fourth
day it hurts a little more, but they’re home, it’s manageable, I say don’t wear your pajamas. If you wear your pajamas,
you’ll think you’re sick. No pajamas. Put your clothes on. (audience laughing) Remember? Remember that? Remember you had the flu,
you stayed home from school, you put your pajamas on, you’re sick. (audience laughing) You put your clothes on,
wow, I could go out now, ’cause it’s 3:00, your friends are home. (audience laughing) I mean it’s true! It’s true. So, and so… – [Male Audience Member] It is true! – It’s true! Right? Yeah, no pajamas! So anyway, we’ve done now over 530 out, only at coordinated health. We have no medical readmissions, we control the pain. And so now I’m going to go on to my last controversial topic, The endocannabinoid system, okay? This didn’t happen in the 60’s, okay? This isn’t Reefer Madness, okay? This is a system of cellular communication that’s been around for 500 million years. This is how our cells communicate. We’ve just found a plant,
the phytocannabinoids, that attach to those receptors, and do some of the wonderful things that our own body does okay? It’s like endorphins, okay? So, our body has its own
morphine, its own opium, okay? We just found a plant
that hits those receptors to take care of that pain. So, if you’re out in the
war zone and you get shot, you know what, you’re
worried about living, all of a sudden your leg’s blown off, and you’re really not in a lot of pain. You’re just crazy, you just can’t believe your leg is blown off, okay? But your endorphins are kicking in. These are natural endorphins,
that’s what opium is. Well the endocannabinoids
are the same thing. Look what they do. They modulate everything in our body. They modulate pain,
inflammation, anti-nausea. I don’t know if you remember years ago, anybody with chemotherapy in the old days you got sick, you lost your hair, you did all that stuff,
what did they give you? The only thing that would
help was medical marijuana. Remember that? Real marijuana,
because it’s an anti-nausea. Anti anxiety, tissue healing. There’s no respiratory depression, there’s no CB receptors in the brain stem. You don’t stop breathing
if you smoke too much. We’re not smoking it
now, we have it in pills. But it’s crazy, you know? Do you know how many
people die of opioids? We just talk how many people die of, you drink a quart of alcohol, you die. There’s never been a death
of overdose of marijuana. But yet, it’s a Schedule 1 drug the same as heroin, cocaine, crack, that has no medical use,
does this sound familiar? Sound familiar? Okay, just like the vitamins, right? So this is gonna come out there. But how about this? The government, the United
States Health and Human Services, what do they own? – [Female Audience Member] The patent. – They own a patent! A patent on cannabinoids
as an anti oxidant and a neuroprotective. So the government knows
this, but you know, they get paid by pharmaceutical
companies, it’s crazy. So hopefully the pharm
bill will go through and the hemp-based CBDs
will be another addition to our multimodal pain approach so that decreases your anxiety, all this is pre clinical studies. Why isn’t it out there? Well there’s no studies,
’cause we’re inhibited, prevented from studying it,
’cause it’s a Level 1 drug. You can’t do a study on heroin, okay? Because it’s a Schedule 1
drug that has no medical use. So they’ve kept it as a Schedule 1 drug so there’s not a lot of basic science. These are all pre clinical studies that, these are accurate things. How about going into surgery, if you could have less
anxiety, less nausea, less pain and inflammation. So it makes sense. This is not crazy. How about this? These are all the things that
it does at a cellular level because it’s been around
for 600 million years, this is what it does, it modulates homeostasis in the body. So anyway. And most of these things act
on the cannabinoid receptors, things we use every day. Advil, Toradol, Tylenol, Celebrex, they have a cannabinoid
mechanism of action. Remember the runner’s high, people talk about, oh if I go
run ten miles I feel great. Feel this runner’s high, they thought it was from
endorphins, the natural opioids. It’s not. It’s from the natural
endocannabinoids we know now. So this is a wonderful thing. And you know what? It’s derived, where are they made, okay? They’re not made out
in the marijuana plant, they’re in your body. They’re made from the cell membranes. Arachidonic acid. You know what else is made
from the cell membranes? Omega-3s. Anti-inflammatories. Why are they both great
anti-inflammatories? They come from the same
place in the cell membrane. And so when you get some
of the liberal media now, talking about, it’s time for
medical marijuana revolution. So again, a lot of the advantages
like Wayne talked about are orthobiologics, not
necessarily the equipment, but a lot of the approach to medicine to decrease side effects and your pain. And as Aran and Wayne said, we do the highest volume, hard to believe, we’re the smallest network, we do the highest volume
of joint replacement with the best results. Highest health grades. We like being here, we
love you being here. Thank you for coming out, and
I probably talked too long, but that’s it! (applause)

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