278. Dr. Jason Snibbe: On Why Meniscus Surgery Backfires, Prehab, Peptides, & Robotic Joint Surgery

Most people are told a torn meniscus needs surgery to "clean it out". But in this episode, orthopedic surgeon Dr. Jason Snibbe tells me that roughly 30% of those patients end up needing a full knee replacement within three to six months, because the cleanout itself is trauma that speeds up the joint's breakdown. Instead, he uses a simple platelet-rich plasma injection that gets many patients 70 to 80% better from a single shot, sending them back to tennis and golf without ever going under the knife. As he put it to me, "I don't operate on your MRI, I operate on how you feel." We also get into "prehab," why your knee pain often starts in your hip, how robotic surgery spares the muscle older methods destroy, and why his patients are walking within an hour of a joint replacement. CLICK HERE TO BECOME GARY’S VIP!: https://bit.ly/4ai0Xwg Shop Snibbs (Dr. Snibbe's shoe brand): https://bit.ly/3SnPpmk Connect with Dr. Jason Snibbe Website: https://bit.ly/3S0qFAD YouTube: https://bit.ly/4vPOUju Instagram: https://bit.ly/4vNGUzp Facebook: ​​https://bit.ly/43Am2zG TikTok: https://bit.ly/4eJzl76 Thank you to our partners A-GAME: “ULTIMATE15” FOR 15% OFF: http://bit.ly/4kek1ij AION: “ULTIMATE10” FOR 10% OFF: https://bit.ly/4h6KHAD AIRES: "ULTIMATE20 " FOR 20% OFF: https://bit.ly/4a3Duze BAJA GOLD: "ULTIMATE10" FOR 10% OFF: https://bit.ly/3WSBqUa BODYHEALTH: “ULTIMATE20” FOR 20% OFF: http://bit.ly/4e5IjsV COLD LIFE: THE ULTIMATE HUMAN PLUNGE: https://bit.ly/4eULUKp CYMBIOTIKA: "ULTIMATE10" FOR 10% OFF: https://bit.ly/4tjyluP GENETIC METHYLATION TEST (UK ONLY): https://bit.ly/48QJJrk GENETIC TEST (USA ONLY): ⁠https://bit.ly/3Yg1Uk9 GOPUFF: GET YOUR FAVORITE SNACK!: https://bit.ly/4obIFDC H2TAB: “ULTIMATE10” FOR 10% OFF: https://bit.ly/4hMNdgg HEALF: 10% OFF YOUR ORDER: https://bit.ly/41HJg6S PEPTUAL: “TUH10” FOR 10% OFF: https://bit.ly/4mKxgcn SNOOZE: LET’S GET TO SLEEP!: https://bit.ly/4pt1T6V WHOOP: JOIN & GET 1 FREE MONTH!: https://bit.ly/3VQ0nzW Watch the “Ultimate Human Podcast” every Tuesday & Thursday at 9AM EST: YouTube: https://bit.ly/3RPQYX8 Podcasts: https://bit.ly/3RQftU0 Connect with Gary Brecka Instagram: https://bit.ly/3RPpnFs TikTok: https://bit.ly/4coJ8foX: https://bit.ly/3Opc8tf Facebook: https://bit.ly/464VA1H LinkedIn: https://bit.ly/4hH7Ri2 Website: https://bit.ly/4eLDbdU Merch: https://bit.ly/4aBpOM1 Newsletter: https://bit.ly/47ejrws Ask Gary: https://bit.ly/3PEAJuG Timestamps 00:00 - Intro of Show 02:07 - Prehab: the missing Biohack 03:30 - The tourniquet that crushes your quad 05:52 - What a prehab cycle looks like 10:14 - Why movement protects cartilage 10:47 - Walking and the kinetic chain 14:57 - What robotic surgery really does 17:12 - Haptic tech: the saw never leaves bone 19:54 - A rehab that went wrong 22:40 - Walking within an hour of surgery 25:18 - Best peptides for recovery 27:15 - "I don't operate on your MRI." 33:27 - Gary's ACL and the 70% rule 37:17 - Why knee pain hides in the hip 38:35 - The shoe built for standing 44:16 - The future of orthopedic surgery 47:57 - The meniscus surgery trap 50:51 - Why a total shoulder feels brutal Disclaimer: This podcast is for informational purposes only and does not provide medical advice. It is not intended for diagnosing or treating any health condition. Always consult a licensed healthcare professional before making health or wellness decisions. Gary Brecka is the owner of Ultimate Human, LLC which operates The Ultimate Human podcast and promotes certain third-party products used by Gary Brecka in his personal health and wellness protocols and daily life and for which Ultimate Human LLC and / or Gary Brecka directly or indirectly holds an economic interest or receives compensation. Accordingly, statements made by Gary Brecka and others (including on The Ultimate Human podcast) may be considered promotional in nature. Learn more about your ad choices. Visit megaphone.fm/adchoices

Speaker names marked ? are inferred from speaking time and the show’s known hosts — they are not voice-verified.

• 0:00Speaker 00

  Our goal is to walk within an hour of the surgery. There's enormous amount of data showing that if you get up and walk on your joint replacement, immediately, your confidence goes through the roof of trusting the joint.

• 0:12Gary Brecka?

  I love thought leaders like yourself that are really patient centric and thinking about, what is the best possible outcome for this patient to get back to full life?

• 0:21Speaker 00

  It's like you're an artist. You want that canvas to be good quality canvas. So if the canvas or the patient is not quality, they don't have good tissue or good metabolism and good health, no matter how great of a painting you draw, no matter how great of a surgery you do, you're going to have a bad outcome.

• 0:36Gary Brecka?

  The focus on prehabilitation, posthabilitation, minimally invasive surgery, and the use of all of the biohacking modalities tells me that you're really focused on the whole patient journey.

• 0:46Speaker 00

  My big passion is controlling the episode of care for these patients.

• 0:51Gary Brecka?

  Where do you see the future of orthopedic surgery going?

• 0:55Speaker 00

  I think the future of orthopedic surgery will be...

• 1:13Gary Brecka?

  Hey, guys. Welcome back to the Ultimate Human Podcast. I'm your host, human biologist Gary Brecka, where we go down the road of everything, anti-aging, biohacking, longevity, and everything in between. And today is going to be one of those really fascinating, what I would call the in-between podcasts, because we're going to look at a classically trained surgeon who is doing some phenomenal things, not just with joint replacements, but with surgical interventions, minimally invasive, sparing as much muscle as possible, and getting patients back to to activity faster than traditional methods. And what I love about this surgeon is that he is also a biohacker.

• 1:52Gary Brecka?

  He's he's as curious as I am about ways that we can improve outcomes using things like nutrition and biohacking modalities to improve these surgical outcomes. So, welcome to the podcast, Dr. Jason Snaby.

• 2:05Speaker 00

  Thank you for having me, Gary.

• 2:07Gary Brecka?

  Certified orthopedic surgeon. And slash biohacker.

• 2:11Speaker 00

  That's right.

• 2:12Gary Brecka?

  Yeah, I, I, I love it. In fact, I, I wrote something down here that I thought was a really cool way to start the podcast. Prehab is the missing biohack.

• 2:21Speaker 00

  Yes.

• 2:22Gary Brecka?

  Certainly heard of rehab, but I've never heard of prehab.

• 2:25Speaker 00

  Absolutely.

• 2:25Gary Brecka?

  And, um, you know, before the podcast started, like a lot of my guests, we sort of ran a mini podcast in our hyperbaric chamber.

• 2:31Speaker 00

  Yeah, it was so nice.

• 2:33Gary Brecka?

  Um, but I, I find it really fascinating that you take this whole patient approach um, to something like a surgical intervention um, on, on, on a joint. And I, and I wonder if you might just talk about that for a minute. What was your journey from classically trained surgeon to now being one of the pioneers and arguably one of the leading authorities um, in, in the world on these minimally invasive robotic surgeries? And, and your attitude towards this rehabilitation?

• 3:04Speaker 00

  I think, you know, my approach to surgery has always been, how can we make it better? What are the little things that we can do to make it better? And I, when I started my career, I realized that if I'm super gentle on the tissue, I'm easy on the muscles, I don't put, you know, traditionally there would be these heavy retractors that would tear through muscle and tear through tissue. It's kind of brutal.

• 3:25Gary Brecka?

  Mm hmm.

• 3:26Speaker 00

  And I realized.

• 3:26Gary Brecka?

  Like open heart surgery, like, you know, the old rib spreader.

• 3:29Speaker 00

  Yeah, just, just so brutal. And I realized if I just am gentle, then when I would go see the patient the next day in the hospital, I'd be like, wow, this guy's getting up out of bed. He's able to engage his muscles. He's able to move so easily and move so quickly without having all this trauma to the joint. So everything that we traditionally do, so for example, like in a knee replacement, traditionally people put a tourniquet on your leg. A tourniquet for, you know, the case would take an hour and a half, two hours. It would crush your quad muscle.

• 4:01Gary Brecka?

  Right.

• 4:01Speaker 00

  For, for, for two hours.

• 4:03Gary Brecka?

  Right.

• 4:03Speaker 00

  And so then they would say, okay, get up and move. You're like, I can't. Someone, it's like, it's like a car was sitting on my leg for two hours.

• 4:09Gary Brecka?

  Right.

• 4:10Speaker 00

  And so these things, by eliminating all these little things that were involved with the classical aspects of surgery, I refined my technique to be. Less and less and less and less invasive. And I realized on the back end, the patients were incredibly happy and satisfied, but they could, they could, they were like, I got rid of my cane so quickly.

• 4:30Gary Brecka?

  Yeah.

• 4:31Speaker 00

  And I, my patients, sometimes it's, it's a, it's a joke, sometimes that what they joke about it, they say, the physical therapist comes to their house typically the first couple of weeks and they open the door. And they, the patient walks up to the door with nothing and they're like, they're like, it's, let's say it's a man, they say, okay, is your wife, where's your wife? And she, he goes, no, no, I'm the one that had the surgery. They're like, but you're walking around.

• 4:52Gary Brecka?

  Yeah.

• 4:52Speaker 00

  Because they, the, the, the results are just incredible.

• 4:55Gary Brecka?

  Wow.

• 4:56Speaker 00

  But I also think that like the neuro connectivity to your muscles and activating your muscles. For example, like you go to the gym and you're like, I want to work on my glutes and my quads. If you do really focused exercises on those muscles, you start activating those muscle fibers. You start getting neuro transmission to those muscles to activate those muscles. So by the prehab we talk about is getting you into that surgery, whether it's a shoulder surgery or knee surgery or hip surgery. Activating the muscles around that joint, also trying to mobilize the joint, try to stretch.

• 5:31Gary Brecka?

  Prior to surgery.

• 5:32Speaker 00

  Prior.

• 5:32Gary Brecka?

  Yeah.

• 5:33Speaker 00

  Sometimes you can't because it's arthritic and it's damaged, but as much as you can to, to stretch and mobilize the fibers. And then increase blood flow and connectivity to your muscles. And so then when you come in, your muscles are activated and you have a much better, easier time to activate those muscles again.

• 5:51Gary Brecka?

  I don't think that a lot of people think about getting in shape for surgery, right?

• 5:55Speaker 00

  Right.

• 5:56Gary Brecka?

  And, and we talked about this a little bit too. I had some experience with the NFL Alumni Association where.

• 6:01Speaker 00

  Yeah.

• 6:02Gary Brecka?

  They were, you know, uh, these athletes, after they had retired from the league were having, you know, uh, uh, surgical interventions. I mean, the ones that had trauma went right away, but, but the repetitive use injuries that, you know, built up over time. And now they need rotator cuff surgery or, or knee hip or, um, shoulder surgery. And the difference in outcomes just by, um, rehabbing them, I guess, you know, and getting their hemoglobin A1C under control. Getting their, some of their inflammatory markers like C-reactive protein under control, getting them. On a good, clean diet to lower their inflammatory cascade.

• 6:37Speaker 00

  Absolutely.

• 6:38Gary Brecka?

  So what would be, in a perfect world, I'm coming in for a knee procedure, let's say a joint replacement.

• 6:47Speaker 00

  Yes.

• 6:48Gary Brecka?

  And what does a prehab cycle look like for you? How far out and what does that map look like?

• 6:53Speaker 00

  I mean, we like to get to people as early as possible, obviously, for many different reasons. And I think that way I look at it is that we try to be the best we can be. We try to create the best surgery, minimally invasive. I use robotic technology. We're doing so much to make that operation great. But if the base, the foundation is poor, no matter how good you are, you can't get a great result sometimes.

• 7:17Gary Brecka?

  Yeah.

• 7:18Speaker 00

  And so we love to get to people many months before. Let's say three months, even maybe six months if possible. To get them organized, especially with their inflammation in their body, to lower the inflammation, to work on their diet. And then also whatever supplements they need, whether it's like, I'm a huge fan of your amino acids. I go, I go all over the world.

• 7:41Gary Brecka?

  The Perfect Aminos.

• 7:42Speaker 00

  The Perfect Aminos, which is, which I think is an incredible supplement. It's so easy. And we're, right now with the patients, we're getting them on Perfect. If they, let's say they're not taking it and let's say they want surgery quickly. We will put them on Perfect Amino every day, all the way up to the surgery. And then, and then, and then at least for six weeks after. Most of the patients love it so much, they stay on it for the rest of, for the rest of the time.

• 8:07Gary Brecka?

  I take it every single day. I take that.

• 8:09Speaker 00

  Yeah.

• 8:10Gary Brecka?

  H2 tabs and a mineral salt.

• 8:11Speaker 00

  Yeah.

• 8:12Gary Brecka?

  Every single.

• 8:12Speaker 00

  And I do the same myself. Absolutely.

• 8:14Gary Brecka?

  Are you taking the H2 tab too?

• 8:16Speaker 00

  And I take the mineral salt. Yeah, I take it all. I'm a believer. I'm a believer. If you look, if your pantry looks exactly like my pantry.

• 8:26Speaker 00

  So I do it. I'm a firm believer. And I just think that putting people on those programs, you're creating an environment for them to gain, prevent as much muscle loss as possible so they can gain the muscle quicker. You're getting rid of the antioxidants in their body to just rid themselves of all this stuff. But also remember, we're giving them a lot of poison.

• 8:51Gary Brecka?

  Yeah.

• 8:51Speaker 00

  We're giving them anesthesia. We're giving them narcotics. We're giving all these horrible medications.

• 8:56Gary Brecka?

  Right.

• 8:56Speaker 00

  That patients don't like taking them, but they have to in the beginning because it hurts. But to rid themselves of all this stuff is this, these supplements are very key to do that.

• 9:07Gary Brecka?

  I love that you're talking about, you know, diet, lifestyle factors even prior to surgery. And I know that you and I have very similar viewpoints on sedentary lifestyle. And you know, when I was really drilling into your background, you've spoken openly a lot about how very often the problem is not in the joint. It's from the lack of mobility causing the joint to now be dysfunctional. And I think that conventionally you would think the opposite, right? The more I use it, the more I wear it out. But your discussions around snowy fluid, snowy fluid and things like that. And that mobility is critical for the, for life extension of our joints.

• 9:51Speaker 00

  Absolutely. And I think it's not only weight training, resistance training. It's also stretching, working on your flexibility, like keeping the tendons and the ligaments around the joint flexible. So there's natural movement because we know if I put your leg in a cast for six weeks and your knee doesn't move, your cartilage breaks down.

• 10:12Gary Brecka?

  Your cartilage breaks down from?

• 10:14Speaker 00

  From lack of movement.

• 10:16Gary Brecka?

  Lack of movement and load.

• 10:17Speaker 00

  Correct.

• 10:18Gary Brecka?

  Right?

• 10:18Speaker 00

  Yeah. And because, because naturally when you move, the cartilage is on the surface of your bones. They have water, the synovial fluid goes in and out of those cartilage cells by movement. So the more movement you have in a joint, the more natural environment of the cartilage will exist and it will be better for your joints to move. But also, it's the muscles around it. And you know, like we see their spine patients who they get spinal cord injuries and they lose thirty, forty percent of their quad, they get knee pain.

• 10:47Gary Brecka?

  Yeah.

• 10:47Speaker 00

  They have a normal knee on an MRI, but their knee hurts because they don't have the strength.

• 10:50Gary Brecka?

  Right.

• 10:51Speaker 00

  So it's built, it's making sure that they build up that power and that strength in their legs. But the, I tell every patient, you need to walk every day. You need to get out and walk and move because it's so important, especially as we age, for balance, for mobility, for your whole system. And I talk all about this all the time with patients is the kinetic chain.

• 11:12Gary Brecka?

  Yeah.

• 11:13Speaker 00

  So the minute your foot touches the ground, there's forces going through your leg, through your back, through your whole body. And so by walking, you're activating that whole kinetic chain in your body as opposed to just doing like a bicep workout or just doing like a quad workout. You're working on all the little muscles all throughout your body.

• 11:30Gary Brecka?

  Yeah. I mean, I think, you know, walking is so uniquely designed to do everything that we need to live a long, healthy life. I mean, it's, it's, it circulates lymphatic fluid, you know, it's, it's actually a part of our detoxification pathway. You know, that's why sedentary lifestyle is the leading cause of all-cause mortality. When I was in the mortality space, I was fascinated that sitting had become the new smoking.

• 11:54Speaker 00

  Oh, yeah.

• 11:54Gary Brecka?

  You know, and, and as an orthopedic surgeon, you're saying it's just as detrimental to the joints.

• 12:00Speaker 00

  Absolutely, yeah. It, it makes your joints break down. It, it makes, it creates a lot more trouble and degradation of your, of your cartilage and all your joints.

• 12:10Gary Brecka?

  Yeah.

• 12:10Speaker 00

  But specifically the weight-bearing joints.

• 12:12Gary Brecka?

  So somebody that's in a position where they are considering a joint replacement, you know, probably out of necessity. I mean, most people don't get them done because they don't absolutely have the time.

• 12:21Speaker 00

  Exactly.

• 12:22Gary Brecka?

  You, what's, I, I, I want to talk about what's unique about this minimally invasive, muscle-sparing robotic surgery because there are not a lot of orthopedic surgeons that are highly skilled. In that area and you are the not just the thought leader, but you're also you train other physicians on these procedures. You're also affiliated with a number of professional sports teams, heavily weighted towards basketball for some reason.

• 12:48Speaker 00

  Yeah, yeah, I just I've been I work a lot in NBA and NHL too.

• 12:52Gary Brecka?

  Okay, okay. Listen, there's what I share on this podcast and then there's what I share with my inner circle. If you've been following me for a while, you know how I hold nothing back here. But my VIP community, that's where the real magic happens. Picture this, you're struggling with energy crashes, brain fog, or just feeling like you're not operating at your peak and you don't know where to get real answers. But here's what really sets this apart. You're not just getting my insights. When I have incredible guests on the podcast, VIP members get to submit questions for our private podcast segment. So that world renowned expert we just interviewed, you get exclusive access to their knowledge tailored to your specific situation. This section is under the private podcast section in the ultimate human community. And speaking of exclusive, you're getting my personal

• 13:37Gary Brecka?

  protocols, the exact tools I use for water fasting, gut optimization, and morning routines that have taken me decades to perfect. This isn't theory. This is what works in the real world. The community launches challenges throughout the year where you get direct access to me and my network of experts. It's like having a personal health advisory board for less than $100 a month. Your health is your wealth and this investment pays dividends for life. Join the VIP community at theultimatehuman.com/vip and step into your ultimate potential. Now, let's get back to the ultimate human podcast. I think trauma is one thing, right? We understand trauma and sports and you know, anytime you apply severe trauma to the joint, you're going to actually need to have surgery. But repetitive use injuries, repetitive use

• 14:22Gary Brecka?

  injuries is is something I think is, you know, a broad category where people have just worn the joints out or they've had poor biomechanics to the point now where they're considering a replacement.

• 14:34Speaker 00

  Yeah.

• 14:34Gary Brecka?

  What makes what you do with minimally invasive robotic surgery? First of all, I don't think a lot of people really understand what robotic surgery is. Like you don't leave the room and a robot does it.

• 14:44Speaker 00

  Okay, good.

• 14:47Gary Brecka?

  Cause I feel like Tesla is gonna try to do that soon with their.

• 14:50Speaker 00

  Go into a sauna or cold plunge while the surgery is happening.

• 14:53Gary Brecka?

  They can already wash your dishes, dude. I mean, they can drive your car.

• 14:56Speaker 00

  Exactly, exactly. No, I think that, so what, what we used to do before robotics became the mainstream, or, or not, sorry, not mainstream, but before we had the opportunity to use robotics. We were doing the same operation essentially for everybody. We were kind of aligning joints. They said, this is the best way for this joint to be stable and this, and for it to be aligned properly. What we do with robotics is we get a CT scan of the joint. Let's say we talk about the knee. We get a CT scan of your knee. Now we know literally your alignment from your hip down to your ankle. Rotationally in all three planes of, of the body, we know exactly where your knee lies.

• 15:39Gary Brecka?

  Right.

• 15:40Speaker 00

  And then from that, we understand the size, the size of the bone, the, the approximate sizing of the implant. And then during the surgery, I stress your ligaments, your ligaments, not somebody else's, not, not based on some like research number. It's basically how your ligaments respond. And then based on those responses, the ligaments, we get a set of numbers and I adjust on a computer screen, the implant to accept your ligaments. So it aligns your body to exactly the way your body is aligned. So you get the proper center of rotation. So that allows your leg to be in the perfect alignment.

• 16:21Speaker 00

  Not somebody else's, Gary Brecka's alignment, you know, the way your knee is aligned and your knee is, is balanced. But also the sizing is perfect and the alignment is perfect. So we're literally putting it in because if you look at the data on total knees, let's say, 80% say, I like it. 20% say it feels weird. It doesn't feel like it's right because we're putting it in this weird way.

• 16:42Gary Brecka?

  Yeah, you can't put like a perfect hinge into somebody that has genuvalgus or genuvaris or, you know, wide, wide hips and narrow, uh, you know, angle versus narrow hips and in more of a straight angle.

• 16:55Speaker 00

  Absolutely.

• 16:56Gary Brecka?

  So you're accounting for that in anatomical physiology on a per person, uh, per patient basis.

• 17:01Speaker 00

  Absolutely. But it also, imagine someone has a weird shape to their femur, a weird shape to their ankle. They had a broken ankle years ago. You're getting, you're, you're gonna count for all of that.

• 17:11Gary Brecka?

  Yeah.

• 17:12Speaker 00

  And then, what also makes it incredible is this idea called haptic technology. So when you're cutting the bone, the robot knows exactly where the bone is in space. So the saw will never leave the bone.

• 17:27Gary Brecka?

  Really?

• 17:27Speaker 00

  Absolutely. So I'm a big guy. I'm six four.

• 17:29Gary Brecka?

  I thought you held the thing in your hand like.

• 17:32Speaker 00

  It's on the robotic arm. So I tell people like I'm six four, I weigh about 215 pounds. If I lean all my body against that robotic arm, it will not move. Because when, when we used to do knee replacements and people still do them without the robot, the saw would exit the bone and that would cut all your tissue and create more scar tissue, more trauma, more damage. So the haptic technology keeps the saw or the cutting device within the parameters of the bone and it will never exit. And that makes it so, so perfect. And that's, that's really where robotics is a game changer. And now we have it for the hip, we have it for the knee and we have it for the shoulder now.

• 18:12Speaker 00

  And so the accuracy of putting those implants in and getting the actual center of rotation where your muscles work the most efficiently, where you have the best result with range of motion and stability, you get all that without having to like use like, you know, kind of primitive X-ray or something that you don't understand. Now you know three dimensionally exactly the way it's going to be.

• 18:35Gary Brecka?

  So when you have a, a selection of, I'm just curious, I mean, when you have a selection of like different prosthetics, knees for example, I always thought everybody got the same knee.

• 18:46Speaker 00

  No.

• 18:46Gary Brecka?

  Right. So, you know, like, uh, Stryker just made

• 18:49Speaker 00

  Yeah.

• 18:50Gary Brecka?

  200,000 knees and, and, and you just bought it and stuck it in there.

• 18:54Speaker 00

  Well, no, it's, it's, well, I use Stryker. That's who the robot robotic company.

• 18:59Gary Brecka?

  Yeah, I know, I'm just trying to shout them out.

• 19:00Speaker 00

  Yeah, but, but I, but, but yes, so they come in different sizes and different kind of alignments and stuff like that. And that's what you pick. So like, for example, like a woman may be a size two or like I may be a size five, but we have different sizes, but it's the positioning of that implant to get the best range of motion and the best movement. But also we're not damaging any tissue. While we're doing it.

• 19:22Gary Brecka?

  That's the big thing, right?

• 19:23Speaker 00

  Huge, huge.

• 19:24Gary Brecka?

  And patients are so, so my mom Judy Barco is in the audience with us today. Hi mom. She had bilateral knee replacement. I wish we had known him when you had your knee replacement.

• 19:38Gary Brecka?

  Cause she actually had to have one redone. She had an infection in one. So they put a temporary in.

• 19:45Speaker 00

  Oh yeah, that's a two stager.

• 19:46Gary Brecka?

  Yeah, that I think had like antibiotics in it to kind of clean up the infection.

• 19:51Speaker 00

  I know.

• 19:52Gary Brecka?

  It wasn't.

• 19:53Speaker 00

  That's a tough recovery, yeah.

• 19:54Gary Brecka?

  Yeah, and truthfully, what happened was, and I've talked about this a number of times and I can say it while my mom is here is, you know, she went to this rehab facility, post surgical rehab facility and they didn't get her out of bed. For almost 45 days, except for like restroom and things like.

• 20:13Speaker 00

  Oh my God.

• 20:14Gary Brecka?

  And this was an issue because there was this little loophole where one of the rehabilitation specialists could come in. And if my mom denied therapy, they would get paid for the therapy and they would just leave. So yeah, I found out that this, you know, young therapist was coming in on, on the day she was supposed to see my mom. And if she said, okay, you know, you ready to go, Mrs. Brecker? And she goes, oh, I think I need to, you know, go to the bathroom. She go, oh, patient denied therapy. And by noting the denial of therapy, they didn't have to do the, do the rehab. So it set her back tremendously. And then she had the knee replacement and she was starting so far beyond, behind the eight ball.

• 20:57Speaker 00

  The muscle loss just from that.

• 20:58Gary Brecka?

  The muscle loss was incredible.

• 20:59Speaker 00

  Yeah.

• 21:00Gary Brecka?

  Incredible and, and, and she's working her way out of it now, you know, I have a rehabilitative specialist comes to the house. What, three, four days, four days a week. Dr. Evan, big shout out to you and, and, and does the post surgical rehab and gait analysis and things like that. And it's, and it's helping a lot.

• 21:16Speaker 00

  Great.

• 21:17Gary Brecka?

  Helped my father with his gait. But I wish we had known about the prehab.

• 21:22Speaker 00

  Yes.

• 21:24Gary Brecka?

  So for someone like my mother, what would, you know, where we've decided, yeah, it needs to be a bilateral knees and you do them both at the same time, right?

• 21:32Speaker 00

  Sometimes, yeah, in the right patient.

• 21:34Gary Brecka?

  Yeah. And with this robotic surgery, what would that prehab timeline look like? And what kind of biomarkers, if any, are you looking at before?

• 21:43Speaker 00

  I mean, we like, I mean, we obviously work with professionals that do the labs and we like to look at, you know, A1C. We like, you know, we like to look at all the inflammatory markers.

• 21:55Gary Brecka?

  C-reactive protein.

• 21:55Speaker 00

  C-reactive protein. All these inflammatory markers, sedimentation rate, different things to make, see, look what people's inflammation is. And also to look at all other aspects of their health, you know? And whatever they need, as many biomarkers as they can check, you know? To just make sure that like even heavy metals and all those kinds of things to just get them detoxed from all these things. Because I just think the more optimized you are, but like I said, I like to get to people as early as possible. Most of the time, we have about three months, you know, to get them going. And so getting them in prehab and getting them through that process where they're getting stronger. But we also empower the patients. We say, you're getting up day one and you're getting up immediately and that's your job.

• 22:39Gary Brecka?

  Walking the day of surgery.

• 22:40Speaker 00

  Day of surgery. And we, our goal is to walk within an hour of the surgery.

• 22:45Gary Brecka?

  Oh, my God.

• 22:46Speaker 02

  The nurse is always gonna say, if you have snippy do your surgery, you're up and walking day one.

• 22:52Speaker 00

  So, so there's, there's an enormous amount of data showing that if you get up and walk on your joint replacement immediately, your confidence goes through the roof of trusting the joint. And I tell this to patients all the time, I'm like, your joint replacement is like a delicate egg. It's not gonna break. It's so strong. This is metal and plastic. It's really strong.

• 23:12Gary Brecka?

  Right.

• 23:13Speaker 00

  So we get them immediately up and then when they have that confidence, they realize, oh, wait, I'm okay. I can put my weight on my leg. It's, I'm not gonna collapse. I'm not gonna fall and, and, and, and break something. I can actually put pressure on it immediately.

• 23:27Gary Brecka?

  Yeah.

• 23:28Speaker 00

  And that's one of the reasons, it's a good segue, is one of the reasons for us, for me. We wanna, I'm a big passion, my big passion is controlling the episode of care for these patients is how do we get the right people to touch our patients and have access to our patients through that process because in the medical system now it's hard.

• 23:51Gary Brecka?

  Yeah.

• 23:51Speaker 00

  Because in a hospital, some therapists buy into the system, they don't. Some internists buy into the system, some don't. And so I have spent my whole life, my whole career, trying to control that episode of care, to get the best physical therapist, the best person to check all those markers, the best person to give them the right medication, the right treatment to get them through that process. And we're starting to evolve into that.

• 24:16Gary Brecka?

  Yeah.

• 24:16Speaker 00

  Where it's all about, like, all the things that you do.

• 24:19Gary Brecka?

  Yeah.

• 24:20Speaker 00

  That I love.

• 24:20Gary Brecka?

  I was very flattered that you invited me in to be a part of your rehabilitation facility.

• 24:25Speaker 00

  Absolutely.

• 24:25Gary Brecka?

  And bring some of my biohacking tools there and.

• 24:28Speaker 00

  We would love, we would love that.

• 24:29Gary Brecka?

  Maybe even take advice on how we could do, you know, better recovery through different biohacking modalities.

• 24:35Speaker 00

  Yeah, and that's what we want. We want a whole system. Because I think, like, it's almost like, yeah, you have to have a surgery and it's a process, but you can save that person's life.

• 24:46Gary Brecka?

  Hmm.

• 24:46Speaker 00

  You know, if you do this whole analysis on them and you realize, hey, you need to lose some weight, you need to get your inflammation markers better, you can make their entire life better.

• 24:55Gary Brecka?

  Yeah.

• 24:55Speaker 00

  You know, the level of activity, their level of resilience and strength, you can change their life completely.

• 25:01Gary Brecka?

  Yeah, I love that. I also like that you're outside the box and you have a very progressive attitude towards things like PRP, exosomes, stem cells, and fascinatingly and very exciting peptide.

• 25:18Speaker 00

  Yes.

• 25:19Gary Brecka?

  You said that you're not only on peptides yourself, but.

• 25:22Speaker 00

  Yes, I love them.

• 25:24Gary Brecka?

  Which is a good, which is a good sign. But, you know, talking about peptides specifically for a moment, what peptides have you found in your surgical practice and your rehabilitation of patients post-surgery have been the most effective? Like, what are your go-tos?

• 25:39Speaker 00

  So my go-tos are BPC157. TB 500 and ipamorulin, which is a stimulation of your own growth hormone.

• 25:46Gary Brecka?

  Yes.

• 25:46Speaker 00

  Those are the main ones that we use and, and those are the ones that we tend to see great results with.

• 25:51Gary Brecka?

  Yeah.

• 25:52Speaker 00

  And the peptides have been a game changer because we're putting people on these peptides. And a lot of them are getting better without anything. Like I had a guy in the office the other day who had little rotator cuff tendonitis. We put him on BPC 157 TB 500. He, he texted me a month later, he goes, I'm 80% better. So it's incredible. And then I, I have my own story about peptides. So I had all these patients on peptides. I had this horrendous Achilles tendonitis. It was so bad, my patients are like, hey doc, why are you limping around?

• 26:24Gary Brecka?

  Yeah, it's not good to be limping as an orthopedic surgeon, dude. It's not a good look.

• 26:27Speaker 00

  It's not a good look.

• 26:28Gary Brecka?

  It's like being a skinny chef.

• 26:29Speaker 00

  Exactly.

• 26:30Gary Brecka?

  It's not a good look.

• 26:31Speaker 00

  Exactly. So I had this, and so I had a few patients, actually a couple of patients in Vegas. And they were all on peptides. And I'm like, you know what? I just gotta put myself, I put myself on it. Six weeks cured. I had, I had it for two years.

• 26:45Gary Brecka?

  Yeah.

• 26:46Speaker 00

  It was gone. Like if someone hit my Achilles, I'd like go through the roof. It was so painful. And so it literally just healed it. And so I'm a huge believer in it. I also think for me, I'm a surgeon, but my single, the principle that I've lived my life by is, how do we avoid surgery? When people come to me, and a lot of people come to me in LA and from all over the country, because they say, go to Snibby because if you don't need the surgery, he will tell you.

• 27:15Gary Brecka?

  Really?

• 27:15Speaker 00

  Because I always say, I'm more, I'm more popular from the people I didn't operate on than the ones I did. Because I like to, I like to look at things and look at the, and I, and I ask the questions. I was, I always tell patients, I don't operate on your MRI. I operate on how you feel.

• 27:29Gary Brecka?

  I love that. Yeah, I saw that in your record.

• 27:32Speaker 00

  You could have, you could have a meniscus tear, a little arthritis. And you say, well, I can play golf five days a week and I'm exercising, working out. So I'm like, well, why, what's the problem? Just go keep doing it.

• 27:42Gary Brecka?

  Yeah.

• 27:42Speaker 00

  And then the other thing is all these injections. These injections help continue the process of healing and promote healing into the joints, increase blood flow. Lower inflammation and all of these, these injections that we do, whether it's PRP, whether it's exosomes are going to keep evolving. I mean, you're, you're on top of this data so, so much.

• 28:04Gary Brecka?

  No question.

• 28:04Speaker 00

  We're, we're just, we're just at the tip of the iceberg of this thing where we're going to be able to modulate these things based on what you have. So they say, okay, you have arthritis, this is what we use.

• 28:14Gary Brecka?

  Yeah.

• 28:14Speaker 00

  You have meniscus, this is what we use. Rotator comptenitis, this is what we use. And I think that that's the key for me is that I'm always asking the question, how does this affect your life? How is it, how is it, what's the impact? I'm like, and I always tell them, you can always have surgery.

• 28:30Gary Brecka?

  Right.

• 28:30Speaker 00

  You can have surgery tomorrow, you can have surgery three years from now, you could, I can always operate on you and if I do it, I'll do a good job.

• 28:36Gary Brecka?

  Right.

• 28:37Speaker 00

  But right now, you don't need it. Go get your biomarkers better, go get your, your, your nutrition better, lose a little bit of weight, get your diet organized and let's see what happens.

• 28:48Gary Brecka?

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• 29:28Gary Brecka?

  That's A-I-O-N gear.com and you can use code ULTIMATE for 10% off and start training smarter today. Now let's get back to the Ultimate Human Podcast. You know, you and I have a friend in common, Ram Dandaliya.

• 29:42Speaker 00

  Yes.

• 29:43Gary Brecka?

  Is it Ram or Ram?

• 29:44Speaker 00

  Ram.

• 29:44Gary Brecka?

  Ram, okay. Ram Dandaliya. Every, every other Indian doctor I know is named Patel. So he's like.

• 29:52Speaker 00

  Exactly.

• 29:53Gary Brecka?

  I think you almost have to be a Patel if you're Indian and you're a doctor. It's like.

• 29:57Speaker 00

  I think so, yeah. There's a lot of them. It's like Smith in India.

• 30:01Gary Brecka?

  So.

• 30:03Gary Brecka?

  But he and I connected over Dana White's journey. He was his cardiac doctor. And he's out at Senors where you are.

• 30:13Speaker 00

  Yes.

• 30:13Gary Brecka?

  What I really find fascinating is what you guys are doing with this more than $100 million center that you're building for not just surgery, but pre and post surgical rehab.

• 30:26Speaker 00

  Yes.

• 30:26Gary Brecka?

  Bringing biohacking modalities like red light and hyperbaric, you know, chambers and, and things like that to the table to really help patients accelerate their healing process, but at the same time just improve their, their cellular biology.

• 30:42Speaker 00

  Absolutely.

• 30:43Gary Brecka?

  How, how is it that you're, you know, such a classically trained allopathic physician and surgeon, but you're willing to consider and you're open to some of these biohacking modalities and, and therapies that I would call non mainstream like red light and, hyperbarics.

• 31:02Speaker 00

  I think that, I think that when, like we said earlier, I think that, you know, it's like, it's like you're an artist, right? And you have a canvas. You want that canvas to be good quality canvas and that you can paint on. You make that beautiful picture. So if the canvas or the patient is not quality, they're not, they don't have good tissue or good metabolism and good health, no matter how great of a painting you draw, no matter how great of a surgery you do, you're going to have a bad outcome.

• 31:27Gary Brecka?

  Yeah.

• 31:27Speaker 00

  You're going to increase your infection rate. You're going to have wound healing problems. You're going to have muscle wasting and muscle loss. And sometimes they can never gain it back.

• 31:35Gary Brecka?

  Yeah.

• 31:36Speaker 00

  And so, like I said earlier, how do we control the episode of care? Because it's not a transactional thing. We're like, okay, you come in here, you have a knee replacement, goodbye, I'll see you later. It's now a process where we can take them through and try to control some of these things and also mitigate risk and try to, try to make sure that they don't have, they have a lower chance of, given the best chance for the wound to heal, put them in a hyperbaric oxygen chamber.

• 32:05Gary Brecka?

  Yeah.

• 32:05Speaker 00

  Put them in red light to increase blood flow so their wound healing is better. So they get better blood flow to their muscles and their, the microvasculature.

• 32:12Gary Brecka?

  Yeah, yeah.

• 32:13Speaker 00

  All of that stuff is just, is just such a huge part of it. And I think that for me, I've always thought, that's why I embrace robotic technology. Cause I said, this is where we're going. This is where the technology needs to be. And I don't want to be in the backseat. I want to be driving this. But then by building this beautiful hospital that will be done at the end of this year, you'll come see it.

• 32:35Gary Brecka?

  Yeah.

• 32:36Speaker 00

  We'll have.

• 32:36Gary Brecka?

  You're literally building a hospital.

• 32:38Speaker 00

  Building a hospital, 70,000 square foot hospital.

• 32:40Gary Brecka?

  When you say building, ground up?

• 32:41Speaker 00

  Ground up, from ground up. Just a beautiful, gorgeous hospital that we can control all these aspects. So we can put hyperbaric red light inside of it. Because when you work in a hospital system, there's so much regulatory issues that restrict you from doing the things that you want, really want to do. And so I said to myself, I said, how do I, how can I make the experience on all levels amazing? But it's also, like we said earlier, the non-surgical patient. You know, you have a meniscus tear and you're going to get an exosome in your knee.

• 33:12Gary Brecka?

  I love that.

• 33:12Speaker 00

  I want you, I want you doing all this stuff too.

• 33:15Gary Brecka?

  Yeah.

• 33:15Speaker 00

  You know, I want you doing the red light and the, and the hyperbaric and the, and the peptides and the, and the, and the aminos. I want you on all this stuff to optimize your recovery, even surgical or non-surgical.

• 33:27Gary Brecka?

  Yeah, I, I love that. I mean, and I think the, I think the, the future of medicine in general is this whole patient approach.

• 33:34Speaker 00

  Absolutely.

• 33:35Gary Brecka?

  I, I, I think, you know, for, for so many decades, we've, we've only treated the one little narrow symptom that's presented, like, you know, uh, you know, the joint has degraded. Let's replace the joint.

• 33:48Speaker 00

  Right.

• 33:49Gary Brecka?

  And, and we just focus on that event, not this pre-abilitation and post-abilitation. You know, I, um, I had a orthopedic surgeon named Dr. Alex D. Simone. And I'm grateful to that man to this day because in 2009, um, I had an ACL, an MCL. And I, and I actually clacked the lateral half of my tibial plateau.

• 34:11Speaker 00

  Oh, wow.

• 34:11Gary Brecka?

  And, and a bad knee injury. I wish I had a great story. The story's terrible.

• 34:17Gary Brecka?

  I'm going to make something up so it sounds like heroic. But the truth is I'd had a few cocktails and, and decided that, uh, the one jujitsu class that I took, uh, at the YMCA qualified me to wrestle, uh, uh, a D1 wrestler that was my business development director.

• 34:34Speaker 00

  Oh, my God.

• 34:34Gary Brecka?

  It was like this short little spark plug and, and we got to chatting at, at a. At the bar at an insurance conference and I was like, hey, let's just go up to the room and figure it out.

• 34:45Speaker 00

  Oh, yeah.

• 34:45Gary Brecka?

  I'll hip toss you all over this place. And I was like, you know, it's like one of those like,

• 34:49Speaker 00

  hilarious.

• 34:50Gary Brecka?

  You know, like the guy that's taking two boxing classes and I'm like, no, don't grab me like this. Grab, grab me like this. Don't, don't stand there. Stand over here. Put this like here and then I'm going to like throw you across the room. He's like, we're going to wrestle, we're going to wrestle. And he handedly whipped my ass and in the process, you know, broke my, dislocated my knee and, and, um, but, but I remember what he said to me after surgery was, um, and, and he said, I need you to hear these words because it's the most important thing you're going to hear for the rest of your life. And this will determine, um, the use, your pain level, your functionality, um, for the rest of your life. He said, surgery is 30% of your journey and your surgery went exceptionally well.

• 35:35Gary Brecka?

  I did a great job. You got great tissue in there. Joint's very healthy. He said, 70% is going to be how dedicated you are to your post-operative rehab. And, and at some point you're going to feel like you're tearing pages out of a phone book, meaning like your progress is going to be so minimal. You know, for the first few weeks, it's like big progress.

• 35:56Speaker 00

  Yeah.

• 35:56Gary Brecka?

  You know?

• 35:57Speaker 00

  Absolutely.

• 35:58Gary Brecka?

  And, and I never forgot that and I just, I hardcore dedicated six months of my life to just rehabbing that joint. And, you know, a few years later, I was age group champion for the state of Florida and medium distance triathlons. I was, you know, and, and to this day, God bless him, I have zero pain, no loss of range of motion.

• 36:17Speaker 00

  That's great.

• 36:18Gary Brecka?

  Um, you know, knock on wood.

• 36:19Speaker 00

  Yeah.

• 36:20Gary Brecka?

  But he was, you know, I, I think a lot of patients think, okay, surgery's over. I'm going back to normal life and they don't think about how much care do I need to give to this so that it doesn't, I'm just not, not buying myself a problem in 10 years.

• 36:34Speaker 00

  Absolutely. Yeah. And I tell patients all the time, like I, I take care of professional athletes and

• 36:38Gary Brecka?

  Yeah. I mean, you're, you're, your roster, not, not to interrupt you though, the LA Clippers, the Lakers, the Sparks, the Kings and the Angels and assistant team physician ties to the Dodgers, uh, Galaxy. And others, I mean, you're a monolithic mega giant. He's being very humble, guys.

• 36:53Speaker 00

  Thank you.

• 36:55Gary Brecka?

  You know, with his career in professional sports.

• 36:57Speaker 00

  And I was gonna say, like, when you take care of a professional athlete, they're back playing sometimes at six months. But then you have a conversation with them and you say, when did you feel, if you ask the question, when do you feel like you were back? Like, when did you feel like you were explosive as you were before you got injured? And a lot of them say a year.

• 37:16Gary Brecka?

  Yeah.

• 37:17Speaker 00

  Many of them say a year because it takes that long for those fast twitch fibers in your muscles and the explosiveness of your body to be able to do that. It's also really important for us as orthopedic surgeons to look at the whole body. Like, someone comes in with knee pain, you gotta do a good back exam, you gotta do a good hip exam. You really have to check other parts of the body. For example, I had a patient the other day who I did a knee replacement on, he goes, my knee replacement's hurting. I'm having trouble. And I examined him and his medial claddyligament was on fire. Like, I just touched it, he went through the roof. And I examined him and I examined his hip, his hip was arthritic. He'd worn out his hip. And I'm like, because your hip's arthritic, you're cranking on your knee too much. So guess what? We replaced his hip and now he's great.

• 38:02Gary Brecka?

  Really?

• 38:03Speaker 00

  No problem. So it's by looking, not being so, you know, hyper-focused on that one joint, is really looking at the whole person. You know, like, what other surgeries have you had recently? Have you had abdominal surgery? Have you had a back surgery? You know, how is your life right now? Are you under a lot of stress? What's your work-life balance like? You know, thinking about the whole person is very important to understand what makes them tick, but also how to organize and customize their recovery or planning for their surgery.

• 38:35Gary Brecka?

  Yeah. So you're building a hospital. You also launched your own shoe brand.

• 38:40Speaker 00

  I did.

• 38:40Gary Brecka?

  Which I think is so awesome and so fascinating.

• 38:43Speaker 00

  It's great, actually. It's really, it's a fun project.

• 38:45Gary Brecka?

  Yeah, I mean, specifically designed around, it sounds like you did it out of need because, you know, designed around people that are on their feet for longer, long periods of time, which anyone that's in a hospital, and those are concrete or hard tile floors.

• 38:58Speaker 00

  Absolutely.

• 38:59Gary Brecka?

  I'm standing on all that. I mean, I just noticed it walking around my own, my own place because we've got tile in here.

• 39:04Speaker 00

  Yeah.

• 39:04Gary Brecka?

  If I walk around barefoot for too many hours, just being in here, I.

• 39:07Speaker 00

  It's a lot of stress.

• 39:08Gary Brecka?

  Yeah, it's a lot, a lot of stress.

• 39:09Speaker 00

  Yeah, so I, I spent about four years. My, my partner is a chef and I'm a surgeon. And so the two of us look.

• 39:17Gary Brecka?

  Chef and surgeon got together and made a shoe.

• 39:19Speaker 00

  Made a shoe.

• 39:19Gary Brecka?

  Okay, good.

• 39:20Speaker 00

  And so we, we said, we said, our shoes are so bad. You know, we have these clogs that you can barely walk in, or people just wear like a pair of Nikes or, or Asics to the, to the hospital. And the, the fluid gets through it and this padding in it wears out after like, let's say, two, three months. And so we said, we spent four years designing a shoe, working with materials and testing them. And going in, I would go in the OR with them and spend days working with them. He would work with them on, in, as a chef.

• 39:51Gary Brecka?

  Yeah.

• 39:52Speaker 00

  And we saw, and we put them on our friends and family and said, okay, how does this feel to you? And finally, we developed a company called Snibs. It's a, it's a parody.

• 40:00Gary Brecka?

  It's got Snibs, that's cool.

• 40:01Speaker 00

  S N I B B S. And we created this amazing shoe and then we also now have multiple levels of shoes. We have shoes that are waterproof and slip proof. Most of them are slip proof. We have a, a work boot. We have a clog. We have all different kinds of shoes for different environments and it's really not just a doctor chef thing. It's for anybody, anyone that works on their feet, anyone that's out working and walking, people, people wear them to work out. People wear them for long walks and people like we have people wear them on movie sets when they're working those 12 hour days. All kinds of environments, but it's to basically take the stress of your body away.

• 40:42Speaker 00

  And we always say, I would say about the shoes is like, I want you not to think about your feet at the end of your day.

• 40:48Gary Brecka?

  Yeah.

• 40:48Speaker 00

  I want you to come home and think about, okay, how am I going to enjoy my night? I'm going to have dinner with my wife. I'm going to go do something relaxing. I don't want you to say, oh my gosh, my feet are killing me.

• 40:56Gary Brecka?

  Yeah.

• 40:57Speaker 00

  And so, and we realize by making great shoe wear, you take stress off your knees, off your hips, off your back. And that makes you perform better as a person. Makes you feel better as a person. And it also, we're also realizing that we're minimizing injury. And so we've done, we've done a couple of projects. Actually, one of them was at Caesar's Palace in Vegas. We gave two, 300 people shoes and none of them had a slip and fall over the course of about a six month period. And so we're realizing that we can actually have the potential to minimize injury.

• 41:35Gary Brecka?

  Is this because of the floor grip, the anti-slip?

• 41:38Speaker 00

  Exactly, the anti-slip and also the fact that the shoe really captures your foot. And we also designed the shoe to allow for swelling. As your foot swells over the course of the day, it accepts that. And so those, we're realizing that we can actually even benefit the patients, and, sorry, excuse me, the patients and also the employees by not having injury. Which can take them out of their life and cause horrible problems for themselves.

• 42:01Gary Brecka?

  And what's unique about the padding? Is there something?

• 42:06Speaker 00

  The padding is a special kind of padding. It's a special rubber material that we proprietary designed that basically has resilience and cushioning, but it doesn't wear out in three months. It's not the same stuff that, like if you have a running shoe, like a Hoka running shoe. The Hoka running shoe is very cushy and bouncy, bouncy. It's great for about three months.

• 42:29Gary Brecka?

  Right, 50 miles, I think is what my son says he replaces them after.

• 42:33Speaker 00

  Exactly, so after that it goes. But our shoe, we're not obviously running in them, but they have much more resilience. So they last a year, year and a half of that cushioning. It's much more resilient.

• 42:44Gary Brecka?

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• 43:07Gary Brecka?

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• 43:47Gary Brecka?

  Where do you see the future of orthopedic surgery going? Like, what's like really exciting for you on the high, on the horizon? Is it faster healing through things like stem cells and peptides and exosomes? And, and different biohacking modalities? Or, or is there new technology on the horizon that you've got your eye on? That, that you think is going to revolutionize orthopedic surgery? Or do you consider what you're doing right now to be the absolute most cutting edge thing available?

• 44:16Speaker 00

  I think that, I think, I don't think, I don't think that, I think we're always changing and moving and learning and things of just being, and they're going faster than they ever have been. I think the future of orthopedic surgery will be even less, less invasive than what we do now. I think that we have the ability with the robot at some point to have what they call automation, where you basically, you know, you open up, you make small, even smaller incisions that we make now, where the, the robot can go in and prepare the joint or prepare things for us with cutting even less tissue and even less materials. You have to still make an incision to get the implant in there. But even less trauma to the soft tissues than we do right now.

• 45:01Speaker 00

  And so I think that's, that's really important. I think that we already are using AI. And when we get the CT scan, AI kind of prepares a 3D model of the joint for us. So we use AI already, but there's going to be even more AI on data. So what there's going to be happen is that in the future is going to be like, okay, I think this, this person should have a hip that looks like this. And they're going to say, well,

• 45:28Speaker 00

  Of the last 5,000 hips that were done in the United States that have hip just like this, this is the decisions that they made. They use this implant, they use this sizing, this positioning, and those patients had 98% satisfaction. Wow. So we'll be able to use outcome data to correlate live during surgery to make sure that like, we want to make sure that this person has the best result. Wow. So that's a big part of it. There's also some, you may, you know more probably about this than me I do, but there's, there are also some data about muscle mass. He's special MRIs now, looking at muscle mass. Oh yeah, I have for Novo. Yeah, and all, and all these, and looking at the quality of your muscle. So,

• 46:08Speaker 00

  part of that prehab is that, how do we quantify muscle mass? Like, how do we know? We don't know. Like, if someone comes to me and they have a bad hip, they've lost a lot of muscle mass in their glute. Did they lose 50%? Did they lose 20%? We don't know. So, understanding the, the, the value, a quantitative value of like how much muscle mass you've lost, and this is how much you need to gain, and we can check them post-surgically to say, you've gained back 80, 90% of your muscle mass now. Wow. And so that, those are some things, but I also think the biggest part of this i- in my life will be all of these, these biological things that we can do to patients without having surgery. Yeah. And how do we treat joints? Like, for example, when you tore your ACL, right?

• 46:53Speaker 00

  Mm-hmm. Like, is it important, should you have gotten like 10 injections of exosomes over the course of a year? Right. Into your knee to protect you from post-traumatic arthritis? Like, what are the things that we can do to prevent these things from happening? And also, we're seeing people get arthritis and damage in their joints just from wear and tear, but also from metabolically, right? Yeah. They're like, women, they're post-menopausal, they lose their estrogen, they all of a sudden, they wear out their joints. Wow. From, from lack of estrogen. And so how do we, how do we understand that better? How do we understand why you have so much inflammation in your body because your diet is horrible? Mm-hmm. That you, your knee wears out? Right. And so it's just, it's understanding these things on a higher level.

• 47:37Speaker 00

  I think is going to be the most incredible thing where people will, all the things that you do that are so incredible that everyone will have access to that.

• 47:45Gary Brecka?

  I love that. I mean, what's an example of somebody that had, let's say, arthritic knees? And you use some other intervention besides surgery?

• 47:55Speaker 00

  Absolutely.

• 47:56Gary Brecka?

  What ways have you intervened in?

• 47:57Speaker 00

  So one of the, one of the simple things is meniscus tear. So classically, if you tore, you tear your meniscus in your knee, an orthopedic surgeon like me would say, oh, we're going to go in there and nibble away that meniscus. Well, guess what? Thirty percent of those patients, which is a big number, end up within three to six months with a knee replacement.

• 48:14Gary Brecka?

  Really?

• 48:15Speaker 00

  Because by just mucking around in the knee.

• 48:17Gary Brecka?

  Cleaning it up.

• 48:18Speaker 00

  Going in, cleaning out, just that little clean out. It, it's trauma, you know, surgery's trauma. So you're creating trauma inside the joint, which makes the knee deteriorate. So those patients, the simple injection would be platelet-rich plasma. You draw some platelet-rich plasma, you spin it down, you inject it into the knee. Sometimes if they have a little bit of arthritis, I'll put hyaluronic acid with it. But that's simple injection, many patients get seventy to eighty percent better from one injection.

• 48:46Gary Brecka?

  Really?

• 48:47Speaker 00

  Absolutely.

• 48:48Gary Brecka?

  PRP or hyaluronic acid or exosomes?

• 48:51Speaker 00

  A combo of that. Or sometimes we'll do exosomes. But the thing is, we get, we get patients better with that simple meniscus injury. And I tell patients all the time, and I'm fifty-three years old. If I tore my meniscus, I wouldn't let anybody touch it. Because I see so many problems with this meniscus surgery.

• 49:07Gary Brecka?

  Yeah.

• 49:07Speaker 00

  And so I, I treat them with, with exosomes, with PRP, a good physical therapy, supplements. And then they get through it and they're, they're back, they're back on the tennis court, they're back playing golf, they're back exercising, and they're fine. Sometimes it takes a couple injections to get them across the finish line.

• 49:24Gary Brecka?

  Yeah, but I mean, a couple of injections versus a full, you know, joint replacement is, or, or surgery and then a joint replacement.

• 49:30Speaker 00

  Absolutely.

• 49:30Gary Brecka?

  You know, is, is, is a much easier road.

• 49:33Speaker 00

  Much easier. And that's something that is, is in my, in my, unfortunately, it's not the mainstay in all practices, but in my practice, that's what we do every time.

• 49:41Gary Brecka?

  Yeah.

• 49:42Speaker 00

  And that's why a lot of people come to me, people think like, oh, they come to Dr. Sim because he's just going to operate on you. They come to me all the time. They say, I heard you do this PRP in the hip and to get me better.

• 49:52Gary Brecka?

  Yeah.

• 49:52Speaker 00

  And they're like, that's why I'm here. Like, I saw three surgeons. They all want to operate on me.

• 49:56Gary Brecka?

  Right.

• 49:56Speaker 00

  And we do PRP and they're like, I got better and I can't believe I was gonna have a surgery and you just fixed me with a simple little shot.

• 50:02Gary Brecka?

  Yeah. And even in arthritic patients, these exosomes, the platelet-rich plasma, hyaluronic acid, you see improvements in those arthritic knees. They may not have, yeah, dramatic anatomical issues, but pain.

• 50:17Speaker 00

  Absolutely. And obviously, every patient is different. I mean, we analyze the MRIs carefully. We look at the deformity of the knee, how much disease they have, how much they don't have. And, you know, it's, I always say, when you come to me, it's like a picture. I'm taking a picture of your knee in this one moment in 2026. And things can change and move, and sometimes it doesn't change. But we try to optimize that joint and get that joint happy as it can be.

• 50:44Gary Brecka?

  Yeah.

• 50:44Speaker 00

  Right now.

• 50:45Gary Brecka?

  You know, I, it seems like I have a lot of friends for some reason right now that are having total shoulders.

• 50:51Speaker 00

  Yes.

• 50:52Gary Brecka?

  And not a single one of them has not told me that it was the most brutal thing they've ever been through. Like, even though they prepared for it before surgery, like, coming out of it, the length of time getting back to full mobility, for them, TJ Dillashaw is one of my buddies, a UFC fighter, is getting ready to have one. But I have a number of friends that have had them for some reason. And I wonder if there's, you know, in your case, do you do?

• 51:22Speaker 00

  Yes, I do.

• 51:22Gary Brecka?

  Okay. And are there minimally invasive, you know, robotic procedures that lessen that kind of recovery time?

• 51:29Speaker 00

  Absolutely. So, in a shoulder, a shoulder's a unique joint because it's like, I call it like a golf ball and a golf tee. The socket is a tiny little bone. It's called the glenoid. It's tiny. It's like, it's like, some of them are like a quarter, maybe a little bit big. It's like, it's a tiny little bone. The ball is big. But to put an implant on that little bone, that little golf tee, the socket is very difficult because you have to fire a pin down the bone that's in the perfect alignment. And so the robot, which is incredible, I was on the development team for the robotic shoulder. The ability to get that pin in the perfect position every single time with the robot is like as accurate as it can be. It's incredible.

• 52:14Speaker 00

  And so that makes a big difference because now you're putting the implant in the right spot, but also you're minimizing bone loss. So remember, we talked about haptic technology. The robot prevents you from taking too much bone or causing too much trauma around the joint. And so the robotic technology will make a big difference. It is making a big difference in the way people recover from those surgeries and the way they respond from those surgeries. Because sometimes the preparation of the bone and all the tissue causes a lot of trauma around the joint.

• 52:45Gary Brecka?

  Yeah, just getting in there. You're going to do a lot of damage getting in.

• 52:48Speaker 00

  But also the issue with the shoulder too is like we talked about muscle mass. A lot of these people have these very arthritic shoulders that don't move. And so they have a lot of muscle wasting. So it takes them a very long time, sometimes a year, to gain all that muscle back. But again, by doing things like perfect amino, by taking certain things in your body to help maintain your muscle mass and build your muscle mass. Because sometimes just you on your own, eating, you know, fish and vegetables is not enough.

• 53:22Gary Brecka?

  Right, right.

• 53:23Speaker 00

  You know what I mean?

• 53:23Gary Brecka?

  Yeah, to fix your shoulder.

• 53:25Speaker 00

  Exactly. So you need supplements that will help build those things.

• 53:28Gary Brecka?

  Yeah. Dr. Snively, this has been amazing. I know my audience is going to be so excited to listen to this podcast and tear through this information. I love thought leaders like yourself that are really patient centric and thinking about what is the best possible outcome for this patient to get back to full life? And forget that this surgery ever even happened. And the focus on prehabilitation, posthabilitation, minimally invasive.

• 53:57Gary Brecka?

  of surgery and the use of things like peptides and stem cells and exosomes and platelet-rich plasma and all of the biohacking modalities. You know, tells me that you're you're really focused on on the whole patient journey and I really, I really applaud you for that. I wish.

• 54:12Speaker 00

  Thank you.

• 54:13Gary Brecka?

  You know, more of allopathic medicine would take this this whole patient approach. It's it's really exciting. But so for my audience that wants to find out more about you, where can they find you?

• 54:23Speaker 00

  So they can, I'm on social media at Dr. Snibby, Dr. Jason Snibby on my Instagram, on Facebook. I have a website, Dr. Jason Snibby.

• 54:33Gary Brecka?

  Okay.

• 54:34Speaker 00

  So they can find me all over.

• 54:35Gary Brecka?

  Okay, I'll put links to to to both of those in in the show notes so people can find it. And I'll put links to your new, when is your new, this new hospital?

• 54:42Speaker 00

  Those will be done being built in December.

• 54:45Gary Brecka?

  Oh, dude, you guys are.

• 54:45Speaker 00

  Yeah, we're we're cranking.

• 54:46Gary Brecka?

  Well underway.

• 54:47Speaker 00

  And then we'll probably do our first cases like January, February.

• 54:50Gary Brecka?

  Okay, and is this all outpatient?

• 54:52Speaker 00

  No, inpatient, you can stay overnight.

• 54:54Gary Brecka?

  Wow.

• 54:54Speaker 00

  So we'll have physical therapy in the place. They'll stay a few nights, you know, and then they'll go home, but we'll have all of that there. And then we're gonna, and then we're building out this whole thing. So we want to do this whole longevity kind of thing.

• 55:05Gary Brecka?

  Well, I'm gonna do it with you.

• 55:06Speaker 00

  Yeah, I love it.

• 55:08Speaker 00

  I would love that. It'd be a dream.

• 55:09Gary Brecka?

  Yeah, yeah. So I'll come out and see you next month and we'll talk about how we build the the most impactful rehabilitation center for these post-surgical patients that the world's ever seen.

• 55:18Speaker 00

  I would love it.

• 55:19Gary Brecka?

  So I wind down all of my podcasts by asking all my guests the same question. There's no right or wrong answer to this question.

• 55:25Speaker 00

  Sure.

• 55:26Gary Brecka?

  But what does it mean to you to be an ultimate human?

• 55:29Speaker 00

  To be an ultimate human is to be a person that for me, to be to help people, to really, really help people in what they their their struggles in their life and obviously for me orthopedically. And to be an ultimate human, I want to do whatever I can on every level of their life to make them. Move and perform and, and, and go through life comfortable and happy and strong. And to me, that is the ultimate, for me, being the, that is what I would say is the ultimate human for me.

• 56:06Gary Brecka?

  That's awesome, man. Well, I think you're an ultimate human, so.

• 56:09Speaker 00

  Thank you so much. From you, that means a lot.

• 56:12Gary Brecka?

  Yeah. Dr. Dibby, thank you for coming on the Ultimate Human Podcast.

• 56:15Speaker 00

  Thank you, buddy.

• 56:15Gary Brecka?

  We're gonna head over to my VIP room now. I've got some VIPs waiting for you to ask questions. They, they knew you were coming on the show and they, they, they asked a lot of questions. So we'll go in and, and speak to those guys. And until next time, guys, that's just science.