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You are listening to the Darren Wilson Show, I'm Darren, I spent the last 20 years devoted to improving health, protecting the environment and finding ways to live a more sustainable life. In this podcast, I have honest conversations with people that inspire me. I hope that through their knowledge and unique perspectives, they'll inspire you, too. We talk about all kinds of topics from amping up your diets and improving your well-being to the mind blowing stories behind the human experience and the people that are striving to save us and our incredible planet.


We've investigated some of life's fatal conveniences. You know, those things that we are told might be good for us, but totally aren't. So here's to making better choices and the small tweaks in your life that amount to big changes for you and the people around you and the planet. Let's do this. This is my show, The Darren Olean Show. Hello, everybody, welcome to the show, The Darren Wilson Show. I'm Darren and I will be your pilot navigating you through another installment.


And this guest is an incredible giant of a guy, incredible heart, incredible human. Dr. David Gazzaniga, who is the current head team physician for the Los Angeles Chargers. And he has a wealth of information. He is well seasoned in performance and getting people back in their game again. After growing up in Orange County, Dr. Gazzaniga played football at Dartmouth College. He went on to then complete his medical training at Dartmouth and then had his residency at Harvard University.


And then he went on and a couple other fellowships won in at the trauma fellowship and a sports medicine fellowship at the Stedman Hawkins Clinic in Vail, Colorado. He then was one of the team doctors for New York Jets football team and was the head orthopedic surgeon for the New York Islanders hockey team and also Hofstra University. He then was an orthopedic surgeon at the US Open in New York. So this guy has been all over working with some of the top athletes, trying to get them playing again.


And we had some great conversations both before the podcast and certainly within the podcast. And we talked about alternatives. And he really made a point of like this stuff shouldn't be alternative. It should be all doctors working towards the common good and not just stick these guys full of medications so this can apply to you in every way. But it's shifting that paradigm in that American Medical Association thing of drugs and germ theory and vaccinations, as opposed to health, medicinal plants, botanicals, taking care of yourself, using common sense of health, eating and sleeping and eating great food and taking botanicals.


We've been using botanicals for nearly 60000 years. And so let's shift that alternative idea into this is my primary. So I don't know about you guys, but it's very rare that I end up at a hospital unless I've cut something open or broken something, which definitely happens in the middle of nowhere when I'm playing around with my dog and I'm cutting trees down. But other than that, I'm not getting any vaccinations of any kind for the last thirty five years.


And you're definitely not going to get me started now. I'm going to take care of myself. I'm to eat the best food ever, and I'm going to let medicine be the food and the herbs, my medicine. That's my approach. And so we got a little bit into that with the doctor. And you'll find this incredibly fascinating from a guy that's lived at the top of the food chain within his field and helping people perform better at at every level.


So enjoy this great conversation with Dr. David Gazzaniga. Before we jump into some of your and kind of step back and give people, because you kind of have this really cool background and working with the teams and the athletes and yeah, just give a little background as to why you went north to surgery, what works in that kind of world and why you got into athletics and kind of now how you're getting into the alternative. Call it side of things or maybe a broader view of injury prevention, et cetera.


Yeah, thanks for having me. And it's funny, as you were saying, alternative. It it seems almost like the wrong term, like it should be mainstream, you know, bingo.


Absolutely. And I think the more we learn about things that we're told, the more we understand there's and we were talking a little bit about, you know, how hard it is to find the truth in in in media and just pretty much where where where were normal sites for getting information is more and more difficult. So for me, I grew up in Orange County and Santana and I went to high school there. But oddly, I got really tired of the California thing when I was growing up and I wanted to get out of there.


So I went to school in New Hampshire and then went to med school. My dad was a cardiothoracic surgeon, pretty well known chief of staff at St. Joseph's Hospital, and was definitely my mentor. But he was a cardiothoracic surgeon. So I get to medical school and I find out that some of those people, they don't do so well when you operate on them. And so I was I was thinking, you know, I'd like to do surgery, but I don't want to go that way.


So I was drawn towards orthopedics because it sort of fit my personality in terms of wanting to be sort of a carpenter, to build things, put things back together, you know?


And so so I ended up getting into orthopedics and then, you know, you gravitate towards the people that you connect with. I played football in college all for years. And so I I really enjoyed the sports aspect of it. And it's a real challenge to take someone who's injured or, you know, was at one level and then they dropped back down to try to get them back up to that level again. And, you know, it's not always possible.


But if you have the the skill and the patience and the and the patients are very motivated that you can get to that spot that sort of led itself to me spending time with athletes. And so I got my first job was in New York. I was a head team physician for the New York Islanders. And then I worked with the same group. We worked for the Jets and then I moved back to California to help take care of my parents was the main reason for coming back.


And I was just going through, you know, looking at different high schools, maybe taking care of. And then I was blessed to have the Chargers give me a call to ask me to be their doctor. But when you're hanging around professional athletes, you know, they'll be things where, you know, the general public will roll their eyes or even my colleagues and in medicine or in orthopedics will roll their eyes like that stuff doesn't work or that doesn't make any difference.


And you talk to a professional athlete and they say, well, if it makes half a percent of a difference and I'm fighting against somebody who's got that difference, know on board that I'm that's the way I'm going. So, you know, it it really ups your game that there's no there's no you know, there's nothing off the table in terms of discussion and to get people to their maximum potential for their health and their athletic ability. So that's really where I am now.


And, you know, we we started at our in our group in our hospital at Hoag Hospital. We did a study on what it looked like for people getting opioids or pain medicine after surgery. And so I'll get into that and then sort of where we want to go in the future as far as pain management are really helping people to be healthy and and understanding what the facts are about, I guess.


What was the shift for you to start? I mean, orthopedics, like you said, little carpentry work. So there's there's a little bit of pounding, a little bit of screwing, a little bit of, you know, so it's a little straightforward in that in that way.


But at the same time, what they used to zipper open the knee, you can do it or it's topically so of course there's advancing and all of that. So I guess for you, how did it occur to you that my even though my colleagues were a certain way, how was it? For you that you needed to open and expand to other things like what was that point like for you?


It's always been with me and through my parents to be both critical and and open minded at the same time, you know, like you can't dismiss something out of hand that you don't have all the information about. And like you're saying, you know, if you want to study something, you have to break it down to the smallest part. But you break it down too far. And there are environment, there are all sorts of influences that come about that that you've taken what actually is happening and you've made it into something that's not real or not, you know, not part of what nature is.


So, you know, I'm not you know. I'm not going to say that everything that's out there that's alternative is is the correct way to go, but when I have colleagues that say, well, why would you want to take glucosamine and chondroitin sulfate if if if it doesn't work for anybody and or what? Why does nutrition matter at all? And then I'll say, well, if you eat French fries every day, then, you know, for a couple of months, then come back and talk to me about how you feel.


Right. So, I mean, yeah, you could eat a French fry. It doesn't bother you, but but if you don't exercise and that's all you eat with nothing else to balance that you're you're going to have problems for sure. So that's sort of where my mind went. And then when I was in college, I was a biology major and I took this seminar. It was about Linus Pauling and his idea of vitamins. And, you know, if you don't know who I mean, I know you do.


But if your audience doesn't isn't aware of Linus Pauling was a Nobel laureate that really believed in vitamins and very high doses of vitamins, and he had very sound ideas about it. Maybe some of it was maybe some of it work, maybe some of it didn't work. But but to just say all vitamins make no difference at any dose, then that's that's that's just lunacy. You're not you're not contemplating the whole the whole picture, the whole person in that in that regard.


Yeah, so I mean, everything from our current environment to not talking about nutrition, vitamin D levels and vitamin C and basic nutrition, that's just insane. Of course, all those things have to have a factor. So then I'm just curious, before we dive into this other stuff, I'm curious. Like, so now you're with the Chargers, just so people can have understanding what's the day in the life of that job? What does that typically look like?


Is it is it a pain management job? Is it a function and and function first? Pain first. Like how is like what does that actually look like on a day to day?


It's really hard to describe these these athletes. You know, there's because I played football in college, as I mentioned, and defensive end or offensive or I was a tight end going into my first thought, but I ended up playing offensive line.


By the time I left, it was it was easier to get my premed stuff done if I was playing offensive line for some reason.


I don't know why. Anyway, I played center for two years, my my junior and senior year. So it was a fun position and I really enjoyed it. You're right there in the middle. And but so these athletes, I know that on any any given place, someone steps on your foot, they twist your hand, you know, you fall down and your knee hits the ground. You twist your ankle as someone runs by you. These things are happening every single play.


And, you know, you finish the game, you win or lose, you got it. Soreness. And of course, if you win it, it's not quite as sore. But these guys, when you watch them play the sport, they run into each other with such force. That is impossible, impossible for me to imagine that they would stand up afterwards and go back and do another play. Yeah, my whole body aches just watching it.


And and, you know, there aren't a lot of, you know, late thirties football players because it's just it's not possible. And I look at some of these guys and I know they have pain every day. But one thing about these guys is that they literally do not feel pain the way that we do when there's one player a couple of years ago who went down and I ran out on the field and he said I broke my ankle. And I said, well, all right, let me just check this out.


How do you know you broke your ankle? As I felt it, I felt a break in the same voice that I'm speaking right now. And I reached out. I reached down. I grabbed his ankle. And the whole thing crunches because his ankle is broken. And I was like, you know, you broke your ankle. Yeah, I felt it. So we get into the sideline. He doesn't want to take the card or anything. He wants to get off the sidelines.


He goes in, turn off the x ray, shows a fracture. And I put them in this booth and I said, all right, now just use these crutches, stay off it. It's going to hurt like heck if you walk around on a second half is going on. I look down the line and here he is standing there with no crutches, just walking around, talking to his buddies like nothing ever happened walking on a broken ankle. So at that point, I was like, oh, this is just these people just aren't normal people.


And that's just what we're dealing with here. And so, you know, you look at some of these guys in the supermarket, I could go on line. But you look at some of these guys in the supermarket, like that guy's a football player. It doesn't seem that impressive when he's when he's checking out, you know, he's getting his food. And but there is such a huge difference between what you see on on the outside and what they're capable of on the inside.


It's they're they're special people for sure.


I have a funny moment that just I've said this to my friend. So I so back in so I played college football and career ending back injury. But so in the back of my mind, it stopped early and I still want to keep playing and so cut to at a friend I was training with in Boulder who was still in the NFL seven years offensive lineman. We wrote Harlettes together, hung out, trained in the last few seasons of his career and his three three plus.


And so one day we got out, we were riding motorcycles. We got to our Mexican restaurant. We had a couple of shots, tequila, as we kind of did. And I was feeling a little sassy and I was like two hundred twenty pounds and he was still has three hundred. And so I said, I'm going to get around you. And he goes, Huh. And so, so, so we got in our stance and I took off with every ounce of.


What I thought I had, and he took one step, you know, and did that punch, and it threw me like I've never been thrown in my life, like I was airborne and in that moment. I understood no one, that's why I'm not there. No to the jump from college to pros and that that is and you look at Ariel and even though he had me by 80 pounds, he wasn't that far away from me in terms of in the gym.


Like, I was pretty strong I could hold. But when it translated to just a different.


Yeah. So it's because you could strip these guys down in normal clothes are big people, but then the ability to produce power some different. It's just something different.


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Guys, go get some. So let's talk about then, because that's a perfect segue way of this kid breaking his ankle, I always think of the Romney loss or it was snapped his finger. Right. And he actually didn't cut it off during the that was the urban legend that he had to cut it off at the game. But they all talk about he just was a whole nother level of pain. But but then you have the spectrum of people in pain and just a variety of different ways.


And they're always hurt. Every NFL player, every football is going to be hurt the entire season. So. So with that level of collision with that level of performance, with that level of pressure, I can imagine. Get my ass back in the field. I'm over. I'm done. And so as far as the doctor.


You can't just, you know, shuffle all these gnarly drugs at the guys, right? You have to figure out how to heal and then how to help these people deal with the trauma and the pain.


So talk to me about that. Like, what's the the you know, the athletes come in and obviously there's Monday morning we go over injuries and we take care of, you know, what we can we get pictures of what need needs to be looked at with MRI or x rays. And then they have Tuesday off around the league is an off day for the players and pretty much across the board they will say that one day is bad, but Tuesday is terrible, you know, and it's it's funny that that's their day off because I'm sure that's the day where they don't want to move and do anything.


And they show up on Wednesday and they go to practice. So I don't know I don't know what happens to these guys, but I do know what happens. They just they say, all right, this is this is what I got to go through and I got to get ready for the next game. And so Wednesday I'm going to be sore still. And they come in and they get their treatments at six o'clock in the morning. You know, you think of these guys is, you know, they're going to show up on Sunday.


They're going to practice maybe a couple of days a week in trouble. But they you know, if they get injured at 6:00 a.m. every single day, they're they're getting treatment. They get treatment. They go to meetings, they go to meetings. They go to practice their practice. They're going to meetings, you know, and so they're there all day. I mean, it's a full time job for them. And, you know, obviously, they're working on Sundays all day, too.


So I don't begrudge any of these guys the money that they make because, you know, they're paying a dear, dear price for for a long time. And they they got families to take care of. And so, you know, there's a lot of things that can motivate someone into doing that. But I don't know if you're if you're around a guy who really loves the game, like loves football, it's that those people are just they lift the whole team, you know, they and they're they're just going to show up day after day and just get the job done.


It's pretty amazing.


So how do you help these guys in the healthiest way possible to deal with that level of performance, recovery, injury, injury prevention, pain management.


So pain pain management is has been in the league like in the past. So using true painkillers like opioids in the NFL is not as prevalent now. I rarely will write a prescription for opioids, and it's usually for a broken ankle or something. That's a herniated disc or something that's pretty severe. But for the most part, these guys go natural. They they're very in tune with their diet. They will take supplements that they they have been prescribed or that they've been asked to take.


We will check their vitamin levels, vitamin D, you know, we are stay on top of that. They get treatments from an amazing training staff that they they do just about everything for them. You know, they there's a couple of chiropractors in the training room. There's you know, they do cupping. They do, you know, all sorts of things. And that's the range of motion acupuncture, you know. And so the athletic trainers are unbelievable amount of knowledge that they have and the ability for them to take someone who's got an injury swollen and can't walk in two days.


They're playing on the field and it's it's pretty spectacular. But, you know, all I do, I sometimes I feel like the fifth wheel because I just point out the problem and tell them what it is and then they take care of it. So it's a it's it's a pretty special environment. It's fun to be around. But, you know, in terms of injury prevention, there's there's a whole off season. There's there's lifting and running and maintenance that occurs during the season, you know, flexibility, different types of exercise modalities, lower demand, yoga type of stuff up to really high level plyometric type of stuff.


And really, the NFL has also spent some time trying to figure out how to prevent soft tissue injuries. So they really looked at how much time it takes for an athlete coming into pre-season to ramp up to be more fit or really to have less injury potential. And they broken it down to this many days, this many hours of practice. And, you know, will will decrease the risk of having like a hamstring strain or groin strain.


And so there's a there's a lot of there's a lot of thought brain power going into that.


Is that like an NFL wide? They're given that information and do people have to follow it or is it just kind of a guide like we. Seeing that if you go over this amount of hours and workload and threshold that there's a propensity to have more injury and do they just distribute that and then coaches make their own decisions and and how does that work?


It's a little bit of both. You know, the the ultimate the there's the you know, it's kind of like a federal government in the States, you know. So there's there's these are the things that we found. And so they can make a mandate, like these are the only helmets that you can choose. But there's 30 helmets that you can choose. These are shoes that we've tested with the most sophisticated ways possible. And so these are the ones that are good for this position and some other position.


These ones are riskier. These ones are safer. But then it comes down to the players and the players have their players association with their, you know, collective bargaining. They they can mandate that. So they practice hours are set by an agreement between the NFL and the collective bargaining. And the ramp up period is built into the system like how many days there are before the first game. But how the team actually manages those days is more so up to them.


So so there are certain things they put in, you know, the guardrails on either side. But then it's up to the team to try to figure out how to maneuver that.


From your experience of seeing that high performance and then like you were saying, kind of almost this conductor role of here's what's going on, you great group of people, your your staff, let them do the work and then you're watching things that work and don't work or whatever. What would you say to the general population who have aches and pains and what have you learned? And I guess what wisdom from the perch that you've that you're No one have studied in a number two, you've been in this high performance zone and observing these high performing people.


What what we're you know, a few things you could say from that perspective that people could or should implement in their lives so that they feel more free and capable.


I'd say, you know, I couldn't say that it translates perfectly well. But for these athletes, hydration is a big deal. Soft tissue injuries are definitely seemed to be more prevalent when people are dehydrated. So hydration is a big deal. Nutrition is huge. You know, your ability to recover if you're your nutrition isn't there and your your you know, your body isn't equipped, doesn't have the raw materials to heal. Those are those are big deals.


And then above all else for these guys is for me. And understanding is motion. If they ever stop moving, then things go downhill. So you look at guys and some guys will have arthritis in their elbow or the shoulder or their knee. And you have to maintain range of motion and keep it moving, because once you stop moving those joints, they get stiff and then then you've got to climb out of a deep hole there. So trainers are working with them is keep them moving, keep them moving, you know, whatever.


If you have to put them on the alter and have them run at, you know, X percentage of their body weight, that's better than just, you know, throwing ice on something and then walking away. Yeah, it's different. Then like go do hit training for an hour and, you know, hours after that when you're dealing with injury. So it's like using backing off but doing correct. Safe, effective movement. You know, hearing that you're like, well it's it's like even when we're in Sardinia with the blue zones and you're like, you look at them like, OK, they move every day, they walk every day.


They go out and pick their own food from their garden. It's fresh, it's there. And they they and they're drinking fresh water and like it's all kind of basic. Yeah. And that's the it's it's probably even more acute and necessary when you're dealing with that high level turnover. So now for you, like, what are you doing moving forward, like what's your goal for the team and for the athletes? And like what's your what's your plan to continue?


I would imagine you're living that high performance zone. So you also are a challenge.


So what are how are you looking at innovating and and and helping and supporting this ecosystem, moving from. With these athletes, yes, so, you know, I have conversations with them and, you know, it's a highly motivated, intelligent group of people that they will seek answers and, you know, they will ask me questions at times, but they they have, you know, sources that they they trust and they go to. And, you know, I get it.


There's been, you know. A feeling around the league in years past, it's changing now, though. But but, you know, if you want to find someone you can trust, you got to go outside the organization. And that's that is a mentality that was probably fostered a bit by some disgruntled players or, you know. Different examples that would come up in the news or in different situations, and I totally get that. So I don't I don't try to force anything upon them, but sometimes they will I'll have to ask about a certain sort of treatment and I will have a discussion about whether it's safe or viable or whether it would help them or set them back.


And so in the reality, you know, we and my partner there, Doctor Jim, is the internal medicine doctor. We we will create the healthiest environment possible and identify their injuries and give them sort of an idea. OK, if you go back and play, this is this is your risk and the risk we share risk. My risk and their risk is together if they and so I don't want to risk my reputation. I really don't want to have that be a major issue.


But at the same time, if I don't take any risks, that everybody who gets hurt just sits on the sideline, you know? So. So it's a very I won't say it's delicate, but it's it is it requires a lot of trust. And so that's really where I try to insert myself into their lives. As you know, I am here is a resource of helping you to navigate this this injury or this situation. And if I can be the resource to that and ultimately and not infrequently, I'll say, look, you can't go back and play with this injury because it's too risky, or I'll say I don't know the answer to how risky it is.


So maybe we hold back and and and other times they will look at me and say, is it safe to play? And I'll say it is safe to play. It might hurt, but it's it's safe to play. So those are those are things, you know, I'll have. Unfortunately, some players. We want to get back more than would be healthy for them, and I've been asked for giving them pain medication to be able to go back, and that is something that I never want to cross over that boundary.


I don't mind giving it to them for a day or two to recover, but. To give it to them in order for them to go out and play is and that's that's not not something that's something that has happened in that league. Yeah. In the past. So that's changing.


Yeah, that's a dangerous thing. You're shutting off your own. Yeah. Circulating ability to respond to injury anymore. And protection protection window is just thrown out. And the pressure I can imagine back in the day I have heard the stories, you know, it's like it's crazy. That's the problem.


There is if if the doctor covid his job more than the health of the players, then then you will make compromises. Or if you if you think that the organization and the way they view you is more important than the athlete's health, and you're going to run into a dilemma and have a problem. So I try to tell their athletes, look, I would rather quit my job and walk away from this and have you put at risk. You know, it's an unnecessary risk, I should say, because there's always risk.


I firmly and honestly believe that that there's I could I could go do my old job and be OK with that. But if if I gave someone, you know, the advice that they were going to be fine and something catastrophic happens, you know, bad things happen. That's that's part of the job. But but catastrophic things, I that's why I didn't go into cardiothoracic surgery in the first place. I didn't I didn't want to be, you know, standing over someone whose heart stopped while I was working on it.


I would say, yeah, that's so I went to I went to carpentry.


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What have you seen effective or not effective with this kind of treatments? That's a good question.


I had a lot to say about opioids and how how terrible they are. And really, just in a in a summary in a brief summary of we were fed this idea. Nineteen eighty was written a a letter to the editor was written by a couple of physicians saying, you know, we have eleven thousand people and in the hospital we've given them all opioids and maybe four of them had any kind of addiction problem. So they said. So from that standpoint, addiction is not an issue for people taking.


So that was like the first quote unquote major study that said opioids are fine.


Yeah, which which is and it's been cited over 600 times in peer reviewed literature. But that is was a letter to Ed wasn't even a study. It was just like, hey, by the way, we had we only saw four people, but they didn't study it. They didn't. And it was literally like a one paragraph letter to the editor. And that somehow became the mantra. And that that came back in the 90s when, you know, opioid prescriptions started started to go up.


And then the concept around the mid 90s that, you know, when people have pain, it's it's immoral to treat their pain. So they created this concept of the fifth vital sign, which was pain, and they would monitor pain and they track it like a vital sign. And then the American Medical Association got behind that and they said, you know, there should be this fifth vital sign. So then it became this idea. And a small tangent.


If if you look at if you go to a doctor and say, well, how do you get patients in your office and what draws them into your office, they will point to Yelp reviews. And you know how many stars I have on this thing. So if you're a doctor who says, you know what, I'm afraid you're taking too many narcotics, you you know your pain, we have to figure out to manage your pain other than give you some kind of opioid.


Well, then you're going to get the one star. And my doctor is a jackass and he won't give me any kind of pain medicine. And so it's built into the system to over treat with opioids because you don't want to be the one star doctor, you want to be the five star doctor. So then started to change around the mid 2000s where heroin now all of a sudden became less expensive and more available than prescription drugs. And so heroin started to take off again and then and then the final phase.


So there was the opioid heroin and then now fentanyl, which has been mixed with heroin to be able to boost your your product and make it more sort of more volume, essentially. But that's created a no. This is that's where the opioid crisis has really come to. Now, at this point, we did a study at the Orthopaedic Institute, which was very simple. We just had a pain journal. And in the pain journal, we asked people who were having just a simple man asked me who are opioid naïve, where they've never had any kind of, you know, opioids before.


And we had him keep this journal and then there were eight surgeons and we just we just said our I just prescribe what you normally prescribe and don't change any practices at all. We're just going to keep track of things. The people would take the pain medicines only for about two days. Then the number of pills that were prescribed on average was about thirty seven pills. So after one hundred and two surgeries, we said, well, this is getting out of control.


We actually had to change the way we prescribed the medication and talk to the doctors, you know, the group of us that and after only one hundred and two surgeries there were almost thirty two hundred pills that were just out in the community. So doing the math from that, if you take seven hundred and fifty nine thousand discectomy, which are done around the country and you times it by just three thousand. So we had three thousand pills left after one hundred surgeries.


So by that math there are twenty two point seven million opioid pills just sitting in, in neighborhoods that went unused from a simple operation. That's one operation, one operation.


And so so we said we've got to change that. So I started going to alternative ways of treating pain, you know, using more nonsteroidal and Tylenol. And then if you need a little something extra that to use a really low potency type of narcotic and I don't get phone calls in the middle of night, I don't get any more than I did before. And studies like this are coming out all over the place. There's a study in the Netherlands where they had people with ankle fractures that required surgery and they only gave them Tylenol.


And that was the only medicine they gave after their surgery. And and they gave another group pain medicine. There was no difference in the outcomes or satisfactions in terms of. So there's a there's a guy, Dr. David Ring, who's in Texas who talks a lot about pain, you know, this sort of pain problem in the opioid crisis. And he says that it's a lot of this has to do with managing expectations. So if, you know, going into an operation or some situation, that pain is part of what you're going to have, then you should be able to have the knowledge to understand that it's a natural part of having surgery and then going forward from there.


So if you have that expectation, it's a lot easier to have a conversation than with someone who says, you said I wasn't going to have any pain after this operation. I still feel a little bit of pain right here. I need my my narcotics refilled. Just one last thing. If you look at people who take pain medicine after an acute operation, six, about six percent of the people who take the pain medicine for more than one day have a risk of still taking it.


And after a year, you take it more than one day, after one day, after seven, after seven days, about 13 percent of those people will still be on narcotics at one year. So that's four. That's my little shout out to any doctors that might be listening. And the doctors that prescribe pain medicine far more than any other are the primary care doctors, partly because there are more primary care doctors than than any other group out there.


But just the idea of understanding, like, all right, I'm going to give someone pain medication, I'm going to give them enough to get through three days, and then we've got to figure something else out for acute pain. And that brings us to chronic pain. And we we at home now are trying to look at alternative pain meds. We methods. We're doing regional blocs. We actually have a study going where we're going to use a device that actually freezes the nerves to the knee, literally puts an icicle around them.


So that goes to sleep for about, you know, a couple of weeks. A couple of weeks. Yeah. Wow, that's pretty amazing. But what I would like to bring into this is the understanding of how CBD can be effective in treating acute pain. Certainly, it's understandable that it could have some effect on chronic pain. CBD, just to go over the basics of it is a cannabinoid. It's it's a type of molecule that we actually have similar molecules in our body.


We have these things called endocannabinoids and we actually make them. And actually people who exercise heavily, it's been shown that those go up.


So when you get the runner's high, it is actually your own little, you know, hit sort of speaking chemistry factory and yourself. Yeah. So so these these substances are in the cannabis plant. So there's marijuana, which has a higher level of THC to CBD, and then there's hemp, which has a higher level of THC. So the ratios are different. And for hemp for the most part. Only three percent is qualifies it or takes it out of the realm of being a controlled substance, so it's it's safe to take.


And so, you know, when you get when you get medicine, if you ever go to buy CBD, you can look at full spectrum CBD, which is going to have THC in it. And then you can look at multi spectrum, which is takes the THC out, but it has a lot of the other cannabinoids in there, which there's something like 80 of them in in just the Implanon. I didn't know that. Yeah. So there's a lot.


And so it's really just those two that we ever talk about because the ones who we study. But so then and then there's the isolator, the pure CBD, which is really just taking the CBD itself and really taking that out and using that portion of it. And then the CBD, CBD actually works in kind of a funny way, you think. All right, well, the CBD goes and attaches to my brain and my immune system, and that's what turns things on.


It actually competes for the for the enzyme that breaks down your own cannabinoids anonymise is what it's called. And so by by competing for the same metabolism, those the level of your own cannabinoids goes up because it can't break down as fast. So when you take these take the CBD, there's two places where it could attach to your own cannabinoids can attach. One is in your immune system and that would be a two. So that's in your in your tonsils, your thymus, your spleen.


You know, those those are where those become more more active. THC tends to go towards CB1, which is more in the brain. But CBD also has some effect on the brain as well. And the idea there is that it can help with sleep or anxiety and things regarding the nervous system. So the idea of using something that both will modulate your pain, like going for a run without actually going for the run or getting your immune system to be more active and and up regulated would be great for people who have chronic pain or, you know, things like fibromyalgia, which is which is a chronic pain situation or even long term arthritis.


So that's where we want to enter in. And we've been working with the FDA. The FDA doesn't want to necessarily. Make it easy to to do it, part of the problem is, as you were saying before, as you know, with with CBD, we have to prove that it's you know, you have to go through phase one trials to show that it's investigator investigational new drug and which would allow you then to start to test it on people to make sure it's safe.


Once you can do that and you can move into phase two and you could start to use it for post-operative patients, which I want to do for ACL surgery, and then that would then get into phase three, which is more widespread use to see how people respond to it and study it that way. But that's sort of where I stand with the CBD. I think it's super exciting. And, you know, the the more we can bring it into mainstream, the more people who will demand it, but the more so that we can take some of the regulations off of it so we can really study to see how it works.


There is some idea which needs to be studied. And if we could take some of the regulation down, there's something called the entourage effect, which is CBD needs a little bit of THC to be more effective. Well, how much THC, how much CBD do we deliver it through? Can we deliver it or is it absorbed properly? We know that CBD doesn't really get into your system. I take it back. It gets in your system a much better if you take eat a fatty meal before you take it because the oil helps to drive it in through the gut.


I can't prescribe it. I can offer someone to to go find it and take it. We don't I don't sell it. And so that's really where my hands are tied is as I have a belief that this could be a way of pulling us away from this opioid crisis, getting some of these pills off the street and getting people back to where, you know, they can have a pain pain treatment that doesn't involve narcotics. But I can't go forward until we have the FDA saying, all right, we're going to now regulate this.


This is what a pill looks like. This is how you package it. This is the dose that we're going to use. And that's really where I want to get this study going, moving forward. And we've got people working on it. It's just it's it's it's really difficult to get, you know, what the study protocols look like.


Well, it would be first, we have to get the R&D to make sure that we can show that it's a safe drug to take, which is pure a pure CBD is exists in a in a particular seizure drug, which is now on the market. So from that standpoint, there is there is some evidence that, you know, they had to go through that R&D process. And so they were able to prove that. But the FDA would only allow for that medicine to be used for one single purpose, which is first for a couple of very rare childhood seizure disorder.


So for us, the protocol would be if we can get the and then to start to consent patients to allow them to take take CBD at differing dosages postoperatively and see if that influences their need for opioids. So they would still have opioids available to them. We do the same sort of pain, Geral, and then we see if they said, well, you know, when I take the CBD, I only need, you know, this amount of pain medications.


And anecdotally, I have patients to do that all the time. They come in and say. You know, I was taking this medicine you gave me and actually felt worse, and so I smoked, you know, a couple of bowls and I was OK and. All right. Well, if that's what's working, you know, what am I supposed to say? Yeah, but but but that's that's sort of the the scenario, you know, it's funny.


You know, opioids have the ability to increase pain. Actually, there's there's a situation where people take opioids and they actually up regulate their pain. Well, and it's and so you have people that come in and say, you know, I have this pain, I take this pain medicine. I was OK for a minute that I was a lot worse.


And then a, what is that from?


Just a different it's called an opioid hyperalgesia, which just means it's just a heightened sensitivity to your nerves. And you're actually after nerves of pain, nerves. But it's it's a real thing that anesthesiologists know all around, you know, that this this sort of thing happens. But we don't really talk about it. And, you know, it's the problem with pain medication that you take it and you develop a tolerance and then now you're really behind because you can't now live your life without getting that medicine back into your system.


Your system will function properly without it for you. Are those studies coming together? And there's just going to funding and and also is there are other people trying to push some funding?


I would imagine CBDs is all around in terms of wanting to to make that happen. And hopefully, you know, in the in the community of caregivers that we can share information. And there are I have a friend who has been able to get the A&E done and he's moving into a study. And, you know, so if we can be one portion of that study or we can use that information to branch off into a different study, that's really where we need to go forward is just say, all right, CBD here to stay.


We need opioid crisis is not going away. We need to come together and figure out how we're going to move this forward. And if CBT is the answer, let's let's figure that out sooner rather than later. Obviously, there's some serious problems in the system, serious problems. And the prescription, just like you said, certain eliminate the numbers. That can get pretty profound pretty quick. I don't know what the stats are on, you know, hard core street drugs as opposed to these.


But I would imagine those numbers are astonishing in terms of the prescriptive side of things.


There's been a spike in this, you know, obtaining it in a different way.


So there was you know, heroin was sort of flatlined in terms of deaths per year for the longest time until around 2007. Whatever happened, there was been an influx. And if you look at Midwestern states, even like Ohio, Ohio went crazy with heroin and how that evolved or how that happened, I'm sure there are people that know that and understand that. But it just doesn't doesn't make sense in terms of, you know, just the logistics of it.


But, you know, opioid is is very high and and was still the leader in terms of overdoses in twenty seventeen, I think there were something like seventy two thousand overdose deaths. And which is just, you know, it doesn't make any sense to have, you know, to you know, we talk about different illnesses and you know, seventy two thousand deaths was more than AIDS at its height and you know, per year. So it gets swept.


It's not I don't want to be political, but it's not politically expedient to talk about opioids and heroin and how these things are causing problems because, you know, it's it shuffles back and forth. What's going on in rural America is different than what's going on in the cities, you know, in rural America or, you know, there's a lot more prescription overdoses than in the cities which love more heroin overdoses. And, you know, so from that standpoint, it's it needs to be just, you know, something where the doctors are aware they need to be be cognizant of the fact that their prescriptions could kill somebody and it might not be the person you're giving it to.


It could be someone who, you know, a 12 year old kid who sees an oxy prescription in the medicine cabinet of, you know, grandma's house. And you know that that is the last choice he makes.


What advice would you give someone who is in pain, who is a person that absolutely probably could go to the doctor and the doctor would give them a normal potential opioid oxycodone or whatever the choice is?


And I think you laid it out. Exactly. I'm in pain now. What advice would you give that person? It depends a bit on what's causing the pain. Yeah, you know, when you look at people who become addicted to prescription pain medicine, there's a certain sort of pre-existing conditions which can make it worse. One is fibromyalgia so that those people tend to modulate pain differently so they have a higher risk. And if people have back pain going into surgery for any reason, they come out with a higher risk of being addicted.


Just back pain and not even the surgery may have nothing to do with the back. Yeah, it's kind of interesting.


While the idea is that if you go into and you fell and you twisted your ankle, so you have an ankle sprain, those sort of injuries, those acute injuries, people frequently will put ice on their injuries with the idea that it decreases swelling. Well, anybody who grew up in a snowy climate who threw snowballs without gloves on knows that your your hands swell up if you throw snowballs without gloves on.


And so the reality is that ice never was never did decrease swelling it. But, you know, our moms and dads and coaches told us to do that is a great painkiller. So to use regular icing is a form of pain control is a really smart idea, even for sort of long term osis problems. So if you have patellar tendinitis or things like that, icing is great for helping to control that pain. So that's one that's one strategy. But I think nonsteroidal antiinflammatory is Tylenol for short term motion things that get overlooked, like meditation.


You know, being able to really relax in a quiet environment is is a very big deal in terms of coping with a lot of stress. And that's essentially what pain is. But you have to be really honest. That's what I talked about. I really enjoy taking care of the people who have substance abuse problems that are honest about it and have recovered, of course, because they they grab you onto their team right away, you know, like they say, I want to achieve this, but I want to avoid narcotics.


And so now you go forward with this drug rather than you say you're your team. I'm going to give you some pain medicine on my team. We're going to be over here in the office and we'll see how you do. So from that from that standpoint, I think it's really important. If you want to try to avoid narcotics, just say that up front and say, all right, give me all the strategies that you have. No matter what it is, I want to explore it without taking an opioid.


And I think that that creates that creates a team. Nahanni, your doctor, talk about this trust between, you know, what your doctor is giving you. If they're if they're a physician that wants to that has your best interests in mind, which most of them do, then they'll say, all right, well, let's let's see what we can do. Let's figure something out. Well, to your point, they all do. But then there's some.


But just with a little more openness, like yourself, someone like yourself, you're open to a little more of an exploration rather than just a, you know, the clinical side of things. Whereas you could add in some CBD, you could add in some curcumin, you could add in some other kind of dampening herbs to help with maybe the information, maybe the you know, so, you know, there's a lot and, you know, I go back to the foundational stuff.


It's like you're no one's going to be great if you're not sleeping and you're eating like crap and you know, and you're not in you're dehydrated. I mean, the root of all, I think there's like every college student in the world.


Exactly. I know. I know. It's just astonishing.


But, oh, doc, this is awesome. Like, what a great conversation. And I just I'm having conversations with people like you who are enough in in in the system. But also enough critically looking at ways that we need to shift our perspective and the way we're doing things so that we can just deal with the flaws of our humanity a little better than we have been.


I mean, I think that, you know, if we all got to live in a place like this where, you know, the mountain lions walk by and, you know, Breeze is coming through your through your home, you know, things would would certainly be a lot a lot easier to cope with. But but the reality is we live in we live in lives that don't allow us to have those sort of peaceful moments. So we have to be intentional about creating I mean, they don't have to be in, you know, a Shangri-La like this.


But they they they need to have times where you are quiet and alone and get good rest and and, you know, you could be a better husband, wife, you know, boss, employee, you know, just just understand that, you know, the craziness that's going on in the world, that that doesn't need to be that is maybe your your world, your life.


Doug, I think that was probably the best medicine that you could possibly give you right now. Just be a little more quiet and listen to yourself, you know, and that's we all need that because it's life. It's just if we're not doing it, we're being yanked around by something and some other weird point of view. So we need to just kind of give ourselves a time out and take a breath, close your eyes, go inside and just go, you know what?


It's going to be OK. Yeah. Thank you, brother. I'm sure. Tricia, thanks so much.


What a fantastic episode. So tell me, what is one thing you got out of today's conversation? If this episode struck a chord with you and you want to dive a little deeper into my other conversations with incredible guests, you can head over to my website, Derrinallum Dotcom, for more episodes and in-depth articles. Keep diving, my friends. Keep diving. This episode is produced by my team at Must Amplify, an audio marketing company that specializes in giving a voice to a brand and making sure the right people hear it.


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