When traditional medicine meets cutting-edge surgery, the results can be life-changing. That's exactly what my wife discovered under the care of Dr. Jimmy Chow, an expert in hip and knee surgery, and the centerpiece of our latest episode. We traverse the collaborative landscape of chiropractic care and orthopedic surgery, where Dr. Chow's skilled hands and sharp insights brought to light my wife's hip condition through the revealing lens of MRI technology. The chapter unfolds a story of diagnosis and the revelation of hidden ailments, such as labral tears and arthritis, showcasing the power of cross-specialty cooperation in healthcare.
Recovery from surgery is a marathon, not a sprint, an adage Dr. Chow and I explore thoroughly as we focus on the underestimated but pivotal gluteus medius muscle. It's this deep dive into the post-operative journey that illuminates the common pitfalls for patients who rush back into activity, risking further injury. We also engage in a conversation about the evolving landscape of medical treatments, turning away from quick fixes like cortisone shots and embracing the painstaking but fruitful path of regenerative medicine.
And what does the horizon hold for orthopedic innovation? Our episode peers into the future of 3D printed collagen scaffolds and the potential for groundbreaking stem cell therapies. We celebrate the quantum leaps from lengthy hospital stays to patients bouncing back into action, with the caveat that such progress must be balanced with patient safety. As Dr. Chow and I close the conversation, we do so with a nod of appreciation for the healthcare professionals whose dedication underpins every success story. This episode is a tribute to the advancements and collaborative spirit that are reshaping the orthopedic realm.
When traditional medicine meets cutting-edge surgery, the results can be life-changing. That's exactly what my wife discovered under the care of Dr. Jimmy Chow, an expert in hip and knee surgery, and the centerpiece of our latest episode. We traverse the collaborative landscape of chiropractic care and orthopedic surgery, where Dr. Chow's skilled hands and sharp insights brought to light my wife's hip condition through the revealing lens of MRI technology. The chapter unfolds a story of diagnosis and the revelation of hidden ailments, such as labral tears and arthritis, showcasing the power of cross-specialty cooperation in healthcare.
Recovery from surgery is a marathon, not a sprint, an adage Dr. Chow and I explore thoroughly as we focus on the underestimated but pivotal gluteus medius muscle. It's this deep dive into the post-operative journey that illuminates the common pitfalls for patients who rush back into activity, risking further injury. We also engage in a conversation about the evolving landscape of medical treatments, turning away from quick fixes like cortisone shots and embracing the painstaking but fruitful path of regenerative medicine.
And what does the horizon hold for orthopedic innovation? Our episode peers into the future of 3D printed collagen scaffolds and the potential for groundbreaking stem cell therapies. We celebrate the quantum leaps from lengthy hospital stays to patients bouncing back into action, with the caveat that such progress must be balanced with patient safety. As Dr. Chow and I close the conversation, we do so with a nod of appreciation for the healthcare professionals whose dedication underpins every success story. This episode is a tribute to the advancements and collaborative spirit that are reshaping the orthopedic realm.
Hello, I'm Arlen Foer. I'm the chairman and the founder of Activator Methods International. Welcome to Activate your Practice podcast. Today I am honored to have a highly respected orthopedic surgeon from the Phoenix area and, as you know, phoenix is known as the hip replacement capital of the world. And so today we have Dr Jimmy Chow MD, who is an orthopedic surgeon and one of the best in the city, if not the best. He's very humble, so he will say that he's one of the best. So but good afternoon Dr Chow, good afternoon Arlen. Thanks for having me. You're welcome.
Speaker 1:
I really got to know him because, I'm going to tell you right up front, I had a patient that was very dear to me it's my wife and she started out last summer with some point hip pain and so I did all the activator analysis on her and everything and just wasn't finding anything and it wasn't getting well. So when we got back to the Valley and from the summer, she said I need to go see somebody to find out what's going on. I said I totally agree. So we ended up in Dr Chow's office and we walked in and were met by his PA, and that's Shelly Kuhn, and she did an examination and she got everything looked at and she said you need an MRI.
Speaker 1:
And it was really funny because I had just looked in the Dynamic Chiropractic Journal and Dr Mark Studen from the University of Bridgeport had just written an article on why chiropractors don't look at MRIs and they should, and so when the MRI came back and we can put that MRI up, it was very obvious that she had a problem. And I'm going to let Dr Chow just tell you what the problem was when the MRI came back.
Speaker 2:
Sure. So I mean, I think I might want to comment on something before we start talking about the MRI, and that's simply that you know all of these healthcare professions. You know all of them, whether you're chiropractic, all the way to dermatology, all the way to what I do in hip and knee surgery. You know, if whatever you're doing is not working or is not improving the patient, it's silly to keep thinking that doing more is going to work. You know, and every single one of us is going to have to change what we do, and I see this a lot in our clinic. I mean, if I can't make the patient better and I don't understand what it is, I start calling out to other people I say like hey, is there something else that I'm doing or something else that can be looked at?
Speaker 2:
Mri is a perfect example because it is not, as you know, not classically a study that you would get for routine arthritis or routine. You know muscle sprain around the hip. You know it's something that's just minor or even something major, but it would be operative. Most people would resort to x-ray. Ok, in Judy's case specifically, as she's walking, there was a deficit in a certain muscle group in her hip and that deficit led us to think immediately or especially in my PA, a very astute practitioner to recognize that hey, I think there might be a muscle incongruity here, something that's not actually working. So the MRI is up here and if you look at the MRI, this is an MRI not so much of the joint space but of the outside part of the hip For those other practitioners listening to this podcast, you can see the trochanter there and this is what's known as a T2-weighted MRI.
Speaker 2:
T2 means that fluid shows up as white space or light space, and solid structures and more dense structures, less watery structures, show up as dark, and so right on the side of this area this would be the left side of the screen you can see a lot of white coming out of the muscle that's going to the greater trochanter, and that white in the greater trochanter area is fluid buildup and actually retracted tendon. So the muscle was torn off of the greater trochanter. So the muscle was, not was torn off of the greater trochanter. We call that a deltoid injury or it's been erroneously but affectionately called the rotator cuff tear of the hip, and so that's essentially the main significant complaint that she had, along with underlying arthritis that you could see a little bit on x-ray and more on the MRI as well.
Speaker 1:
I think you said at that time that it looked like she had a labrum that was involved, correct?
Speaker 2:
Yeah, so the labrum is the soft tissue gasket around the acetabulum, around the cup of the joint, and the labrum becomes degenerative as the joint wears out. It can also be acutely degenerative or acutely injured by extreme forced motion. But you know, I'm going to guess that she was not in a recent football injury. So you know, usually over time, as many decades go by, labral tears are pretty common. But it is a sign of underlying degeneration and it becomes very symptomatic as well, very, very painful very symptomatic as well, Very, very painful.
Speaker 1:
That's probably why you said let's just put a whole new hip in. So you don't have to go through that again while we're having you in surgery. And that made sense to me. Yeah, I mean.
Speaker 2:
So we know very clearly that after so many decades and most people after the age of 50 or 60, if you start having a labral tear and you start seeing signs of arthritis the true term is chondromalacia or cartilage wear you start seeing signs of that in the same form as, or the same studies as, degenerative labrum, then you know it's part of the same process.
Speaker 2:
You know it's not an acute injury, it's not a quick tear, that happened because of extreme motion and so because of that, you also know that your body is going to compensate for those problems. And so if the body is going to compensate for those problems, one of the main compensation methods is to deactivate if you want to use a good term for this podcast, to deactivate the gluteus medius muscle, which is attached directly to the greater trochanter. So if that's getting deactivated naturally because of an arthritic process that's going on, if we repair it or fix it by itself, it's going to hinder that reactivation process over time. So not only will it, you know, may not heal so well, but it might not become very coordinated with the rest of your hip and we may be back several years later having to do hip replacement after going through the repair process.
Speaker 1:
And tell us a little bit about the ligament repair process, because you had some history in artificial material. I guess what would you call it? Polymorphous tissue?
Speaker 2:
Yeah, it's really cool stuff. So, yeah, I wish that I did. I wish I was actually involved in the creation of this. So that goes back to an innovator in our field, dr Lars Pedersen. He's somewhere in Europe, I believe he's outside of either Switzerland or Germany, but I could have that wrong.
Speaker 2:
But Lars Pedersen spent his entire life looking at artificial ligaments and he had gone through some failures, just like the rest of us, or maybe learned ways how to not do it, with what's known as a Lars ligament, which is a polyethylene braided ligament. And the problem with those is they would fail over time, usually after seven years or more, and the failure would create frayed substance, kind of like frayed rope, and that would cause a lot of tissue irritation and destruction. So his second go at this, after many tries, was a polylactone urea, which is kind of a modified polymer that absorbs or dissolves in an aqueous solution without an inflammatory process, so basically your body doesn't have to actively react to it to make it go away. It's a biodegradable, if you will. Okay, rather than you know, rather than you know absorbable.
Speaker 2:
And the nice thing about it is that it biodegrades over the course of seven years. It doesn't biodegrade over the course of like three or four weeks. So seven years is more than enough time for your body to use it as a scaffold for scar tissue to come in, more than enough time for your body to create new collagen. More than enough time for your body to create new collagen in an appropriate place, in an appropriate position. And so we're utilizing that innovation in large joints where they weren't used before. So the surgical technique that we used for your wife, that was innovated by us we actually call it the lazy paper airplane because of the way that we fashion the artisan tissue and the way that we put it on. But essentially we reattach the structure to the bone and then we augment it with this material so that it's protected while it's healing, and we've seen amazing results with this. And we do have a small series that we put together, but it'll be a while before I publish that, if I do.
Speaker 1:
But I think I remember you saying there were three tears gluteus minimus medius, and those were the two big tears was it.
Speaker 2:
Those are the big tears. The biggest one was of the medius. The medius is the main driver of the hip. The minimus is a harder one, because a minimus has a very small short structure and it's attached to the capsule and we're not sure what those actually do with respect to the hip other than tense and act as proprioceptors of the hip. So we see a lot of dysfunction in gluteus minimus that may or may not need actual reconstruction. When a hip replacement is placed when a native hip is there, we're not sure if it actually has more function. Okay.
Speaker 1:
But you have how many patents in this kind of work?
Speaker 2:
Oh, I wish I had more in this kind of work. I actually have not patented this. There's some kit patents pending right now, but we have not patented them To date. I have just under 20 patents in various different things. Some are relevant, some are less relevant. You know how this business goes, but you know, we, we like to, we like to call ourselves creatives in the in the process, because we, you know, we, we, we're excited about this stuff. This is what we've dedicated our lives to.
Speaker 1:
Well, tell them, wasn't it the ACL joint? Isn't that where they first started putting?
Speaker 2:
Yes, so they actually the the the art the art salon is the name of the material at one point, a-r-t-e-l-o-n. Initially it was marketed by Biomet as what's known as Sport Mesh and they were using it to augment ACLs and we've got about 17 years worth of data behind that, so we know it's not exactly a new product and it has been very well shown to work. It's established. It was used in rotator cuff augmentation and then it was very poorly used in hand. They are actually using it to act as an arthritic replacement for one of the joints and those did very poorly because it was a wrong application of the material and then they pivoted and went right into foot and ankle and they're using it in foot and ankle really, really well on the small joints around it and a lot of ligament repairs and augmentations there. So we're just taking the material and we're using it around larger joints, because I only do hips and knees and that's where we're using quite a bit of it.
Speaker 1:
Now tell the audience how the process works, because Judy has been on a walker now for she's on her sixth month. Explain that because you know I will never look at a caretaker again the same, because I have been a caretaker for six months and you know when you are a caretaker to an A-type personality, you know they like to run over you with their walker. But explain a little bit about how you were very careful about that.
Speaker 2:
That's the hardest part of my job. I mean, that really is so. You know it's easy and fun to fix something, but then to do the post-operative recovery process you really have to pay attention to the biology very closely and this is one of the longest to heal things, because your gluteus medius is a major driver of your hip and you really can't walk around, you really can't do anything in life without utilizing it. It really it is the main muscle that gets pulled. And so if you think about it in a way that you're trying to get to heal something that was not just torn but that does not want to heal and you've got to protect the work that you've done, yet you're basically protecting it from the patient's lifestyle. That's the hardest thing Now, on the very base. You also have to know the basic science behind it and how the physiology works.
Speaker 2:
Bones are more simple, because bones you can immobilize and they'll heal, usually over the course of about three to four months, is usually a bone. Unfortunately, ligaments and tendons take twice that long. So you're looking at a six to eight month recovery process for ligaments and tendons and one of the hardest parts of it is that when you feel the best, it's not necessarily the strongest. And so we see that time and time again with professional athletes, especially back in the 80s and early 90s, Professional athletes would get an ACL reconstruction and then they'd go back to play and you'd see they'd immediately re-rupture, They'd be out for the season again and they'd have to have a revision surgery.
Speaker 2:
I mean, how many players have you seen with that? And the reason is is that they're feeling great, they're doing all this other stuff, but that ligament or that tendon that they had reconstructed just is not stout and firm and strong enough yet, even if it's feeling fine and grown it, so that therein lies the biggest headache that I've got in my practice is convincing patients who are motivated and have problems that they want to get better to say, hey, wait a minute, I know you're feeling fine, but you're not fine yet, Okay, and I need to protect this for just a little bit more. And once you get them past that that spot and especially if you have a little experience with this and you can post this ahead of time, because when I saw you for the first time, when I saw her for the first time, I was very clear about what this would take I said, look, I want to make sure that you understand what you're getting into this is not an easy thing for you.
Speaker 2:
It's not horrible, but it takes a long time. It is absolutely a test of patience, but when you get past it and when you get to the end now you've got a solution and a fix for something that historically didn't actually have a good solution. You've got something that actually will work.
Speaker 1:
Well, even the medical profession, you know, for years and years and years didn't they use cortisone? Wasn't that the preferred treatment on that lateral, you know, trochanter.
Speaker 2:
Yes. So historically speaking we misunderstood the pathophysiology. So we would call it bursitis, and bursitis is you know, was essentially under the skin blister or under the muscle blister. And they would say, oh, the bursa is inflamed and that's why this is occurring, not realizing that usually there's degeneration of the tendon that's causing the other muscles to be utilized too heavily, namely the IT band and the glute max, which applies pressure to that bursa, which is why the bursa gets inflamed.
Speaker 2:
So treating the bursa itself is like treating a blister around a rock in your shoe. You know the rock's still there and it's still going to cause problems. So we also know that cortisone itself is collagen destructive. It will weaken tendons. As a matter of fact, there are certain areas of the body that you never inject cortisone because you're worried about tendon rupture, like namely the Achilles tendon, namely the patellar tendon, where it's really dire if they end up rupturing. So you don't want that in a major structure around your hip and classically that was the only tool in our bag. So surgeons would or physicians would inject greater stroke cancer with bursa, bursa with cortisone, sometimes 20 or 30 times, causing a worsening of the problem and rupture, even if they felt better immediately. And so we now know in 2024 that the answer is more regenerative medicine. And you know, I advise my patients, if they're going to get cortisone, never do more than three in their lifetime, which is a very big transition from where we were 20 years ago.
Speaker 1:
Yeah, and you said something that really interested me. You said that Medicare came out with a new diagnosis or a new class now, and it was called lateral trochanter pain syndrome.
Speaker 2:
Yeah, lateral trochanteric pain syndrome. I don't know if it was Medicare, but they do have a new classification for it, like the term is no longer bursitis. I mean, people do call it bursitis, but that's now become a misnomer. So they call it lateral trochanteric pain syndrome, and those of us in the industry like to be much more specific. We like to say a proximal IT band inflammatory process or a proximal IT band contracture or medius insertional tendinopathy, depending on the etiology for that lateral trachea and tachypain syndrome. So there's several different things that can cause it and it's really this, this, uh, discoordination of muscle groups and motors around the hip that really caused the problem.
Speaker 1:
Uh, also, I've noticed just uh in, I've taken care of her that her iliotibial band is involved. I mean I can you know that's got areas in that are tender little nodules and so forth and so on. Is that quite common?
Speaker 2:
Actually it's. It's not just common, it's almost 100% of the patients. Oh, okay, yeah, almost everyone has an IT band irritation with this, which is why they call it lateral trigonometric pain syndrome. The IT band is your body's first step in accommodating this problem, so your body always uses the bigger muscle to try to overcome it. And unfortunately the mechanics of the IT band are horrible for upright walking because it pulls on the side of your knee to keep you elevated rather than directly on the greater trochanter. So even if the muscle's big, it's got a very bad mechanical disadvantage.
Speaker 1:
Interesting. So she's about six months now, and how soon can she go off her walker then?
Speaker 2:
Well, we're going to be, we're going to be very gentle with it. You know, the most, the most critical time period is between four to six months. That's the most critical time. That's when people will re injure themselves. Typically After that it's a I'm very conservative. It's a slow, slow return to function, mostly because I also know that not only do we reattach a muscle and tendon to their bone, but even if it's healed, that muscle and tendon isn't being activated well yet. So it's still uncoordinated and we're waiting for some of that muscle to grow back and to re-engage, and that usually takes several months for that to occur too. So, just walking around normally, I think it's going to be probably nine months or so before she's going to be there minimally and I know she doesn't want to hear that. But when she gets there, once she turns that corner, it's a big corner, it's pretty impressive.
Speaker 1:
I remember you telling about a patient you had and it was 10 months and he was still having pain for 10 months and then one day he walked in and said it's gone.
Speaker 2:
Yeah, Almost like he woke up and he was healed. It was almost like miraculous when it happened, and I hope that's her experience too. I mean we do see that quite frequently, I mean in medicine. You've seen this in your practice. I'm sure Patients turn the proverbial corner. We don't improve at a gradual rate, we improve in the stepwise fashion. Sometimes those steps are pretty tall.
Speaker 1:
And you can look if you look closer. The pin that was put in by the lateral trochanter up there, that's where you tied the new material to correct. That's correct.
Speaker 2:
Yeah. So what we did was we repaired her medius back to her, to her bone, and whatever stump was left of the material so that we actually had her native tissue is reattached. And then we know that that's gonna pull off. It's not strong enough. So then we wove this polylactone urea graft over that using Kevlar suture and then we pinned that to her bone using this titanium staple. So it's very, very strong. As a matter of fact, I have one failure that I'm aware of in my case series. That failure was a forcible dislocation after trauma and she did not pull through the Kevlar suture. She did not pull through the titanium staple. It actually required that she rip through the material itself in order for it to occur.
Speaker 1:
Was she in an accident?
Speaker 2:
Yeah, she had an accident.
Speaker 1:
Yes.
Speaker 2:
And we went back and fixed her and she's doing well now.
Speaker 1:
Yes, what do you see in the future? I mean, this is pretty well. First of all, let me say something else that I was impressed with. You've done over 5,000 hip replacements and 28 ligament, reattachments or 29 or whatever.
Speaker 2:
29 now, yeah, yeah, 29.
Speaker 1:
So it's not an everyday thing, oh, not at all. That happens, not at all, and so that's why I wanted to get you on the podcast, because there's people around the country here that may be suffering from that very thing, that could fly in for an evaluation and see what they would find out.
Speaker 2:
I will comment on this a little bit. So you know, just like everything else, if you don't have the tool to fix something, most of them get unrecognized or unfixed. Okay, so up until now the adage in our field has always been if there's metal or plastic in the area meaning if there's an implant there it has to be fixed with more metal and plastic. It doesn't get fixed otherwise, and I think that's a disservice. I would like to modify that adage and that's what I'm trying to do with a portion of my career right now, and I have colleagues that know this about me. The modification is not that it doesn't work. The modification is that our historical ways of doing it weren't strong enough to keep up with metal and plastic. So this is why you see that x-ray and there's a titanium staple there. Why would you attach something with a titanium staple?
Speaker 2:
When we fix ACL reconstructions, we use a plastic screw. Why would you need a titanium staple? Well, there's metal and plastic in there. There's an actual total hip replacement there. So you need something much stronger to hold it together, because you know your body uses it a little bit differently.
Speaker 2:
It relies on the structures more and, historically, any attempt that we had to fix soft tissue around a total knee replacement or total hip replacement usually ended in failure. It really did. So we resorted to, you know, for the past 30, 40 years we resorted to techniques that were really salvage techniques. I mean the number one way to fix this around a total hip replacement, that the problem that Judy has would be a muscle transfer of the glute max to the trochanter. That would be to take your, your, your butt muscle and sticking it right to the trochanter and hoping that she learns how to use her muscle more appropriately, assuming that it heals. You know that's a pretty morbid procedure and you talk about recovery. That's more than a year recovery and that was the next closest thing we had to just fixing it directly.
Speaker 1:
So how do you see the future? Do you see change? What changes do you see that will make it easier, better.
Speaker 2:
There's a lot of things, okay. So it depends on how far into the future you want to look. So the immediate future stuff that I'm going to be involved in, or at least I hope to be involved in, is we want to kit this stuff for the lay surgeon out there. So there are such things known as kit patents, where useful to the companies. Really, what's useful to the provider, namely surgeons out there that need it or patients who would be the recipient of this, would be kits that have just the tools needed for this particular application. So if you have that kit, then you know this is made for this purpose. And so, all of a sudden, surgeons out there who have to think about this, figure it out, learn from a guy like me, have enough chutzpah to actually do it on their own without it being an established technique and then following the patient properly, now have the security of having this is what this is for. Here you go, okay. So that would be the maybe less exciting but the immediate future stuff. If you want far more distant future stuff, um, you know I'm in the hip and knee implant business.
Speaker 2:
I do sports medicine around hip and knee Well. I was trained in multiple aspects of orthopedics, but I don't practice there anymore. We have things so far as um, as 3d printing on a collagen scaffold with stem cells and tissue engineering. Uh, we do believe that at some point in time in the future. It may take 50 to 100 years to get there, but we believe that with an artificial hip like this you should be able to reverse it to the patient's natural anatomy just by removing the hip and putting in an engineered hip made of their own bone and soft tissue. So it is very likely that at some point in time in the future, instead of artificial ligament, we'd be able to grow and replace that stuff in vitro into a lab and implant that.
Speaker 1:
Well, you know, I remember when she had a knee replaced here six, seven years ago, they measured the implant. And so because I, as a practitioner, when I was examining people, I used to see some imbalances in leg length, inequality. That was sickening.
Speaker 2:
Oh yeah.
Speaker 1:
Nobody paid any attention to, and now they were getting it down to millimeters and I thought, wow, they're paying attention to this, which is a very good thing.
Speaker 2:
Well, they need to. I mean, we've been doing this now. I mean hip implants. Hip replacement implants are one of the oldest part of replacement technology in orthopedics and even as such, it's still in its infancy, Even as such, you know, we've only been doing it for, you know, just under a hundred years, and even 20, even 10 years ago, we weren't paying attention to some of the stuff.
Speaker 1:
What I found interesting is that used to be coming from the posterior. Then the big find was come from the anterior. When you did it, you came from the top, and I must say that if it would have been just the hip replacement, that would have been over in a week. I mean, it would have been nothing. And even the closing person your closer you can't even see a scar on her today and within a month it was gone.
Speaker 2:
That's pretty cool stuff.
Speaker 2:
Yeah, very cool. But I, you know, I often think what would happen if we could kind of go back in time and show the pioneers of our field back in the eighties and seventies what we're doing today. I think the jaws would be on the floor because you know what used to be a three week hospital stay, riddled with all kinds of complications, where the most successful surgery was getting up of a chair and going to the mailbox and back. You know, now people are playing professional basketball on. You know it's just amazing what, what can be done now compared to where we started. You know, even even three to four decades ago.
Speaker 1:
Yes, well, and I think the the professions are opening more to you know, getting into new things. The young kids coming out of school are definitely open. I think, yeah, yeah, what's?
Speaker 2:
new.
Speaker 1:
Yeah.
Speaker 2:
I mean it's, you know it's. The profession itself is open because everybody is learning. There are how do I say this properly? Academic resistances to certain newer, to certain newer technologies, but that just that's good, you know. That's good to protect patients as well, cause you don't want some cowboy out there doing random stuff just because he thinks it might be cool. Yes, like you do need to have a deliberate improvement. As you go, um and as as those things start becoming adopted by patients and practitioners alike, it moves from experimental to established, to standard of care, and that's really where we see a lot of this stuff, even coming from the superior aspect of the hip. I mean it works too well for it not to eventually become standard of care.
Speaker 1:
It's just too early for that to be the case, and you have to have somebody that knows what's going on. By the way, dr Chow has a waiting list of about a year now, and so you can't just walk in. We got lucky we were in the office and I pleaded Very persistent.
Speaker 2:
Yes.
Speaker 1:
I think he had a cancellation, but anyway, we were lucky to get in at a reasonable time. But just so you know that that's where he's at is because he is innovative. And the first of all, and I got to say one thing, and I know your office will watch this, but your staff is outstanding, from Ruby opening the door to say hello to on to you know, kim and all the rest of them. They care and they're very caring people and they look after you and so it's no fun to go through this, but we had the most enjoyable time you can have going through something like this.
Speaker 2:
Yeah, we. I am very proud of our staff. They are easily industry best across the board and you know mad props to them. I'm very proud of our staff. They are easily industry best across the board and you know mad props to them. I'm very proud of the work that they do. And you're right, nobody wants surgery, but everyone wants the results of surgery. And nobody wants to have problems, but everyone wants their problems fixed.
Speaker 1:
So and on that note, I just want to thank you for coming in. By the way, Dr Chow is a chiropractic patient and he goes a couple of times a week, he said. But you know, surgeons get in very bad positions and they are required to be in that position for a period of time, and so he has a full exercise regime and everything. So and we just seem to be friends and I'm really happy to have you as a friend, and so thank you for coming on.
