MOST POST-OP PATIENTS GET THIS WRONG ABOUT PAIN PILLS

Meet The Nurses Behind It

SPEAKER_00 0:19

All right. Well, start off like we always do. Tell us a little bit about who you are and what you do.

SPEAKER_05 0:25

Yeah, so I'm Katie. This is Kendall. We're two nurses here in the Valley, and we just decided to start a post-op concierge nursing business. We've known each other for about six years. We actually met, my dad had cancer back in 2020, and Kendall was his nurse. So we met then. I was actually in nursing school still at the time. And then later I got hired on at Mayo, and Kendall was my preceptor. So that's kind of our background. Then we transitioned from the hospital inpatient to outpatient concierge medicine. And then we decided let's take a leap and try something on our own.

SPEAKER_04 1:07

Yeah. So essentially we're just our and only private pay concierge for post op nursing. And it can be anything from plastic, aesthetics, to orthopedic surgery for patients. So we meet them from the moment they wake up from surgery, help them get back home, and then just help them through their recovery.

SPEAKER_00 1:25

Oh, very nice. How do you like it in comparison to the inpatient?

SPEAKER_04 1:29

Oh, love it. And this was always something that we enjoyed doing. So in concierge, we had a lot of patients that were in undergoing plastic surgery, orthopedic surgery, all of that. Um, but that was really our favorite part is that these patients are really looking forward to these types of surgeries, are really motivated either to feel better, move better, or look better. Uh, so I feel like this is definitely where we thrive. And you know, we've just fallen in love with what we do.

SPEAKER_00 2:02

What were you doing at Mayo is that kind of like transitioned your path from inpatient to uh doing concierge?

Inside Mayo Concierge Medicine

SPEAKER_04 2:12

Yeah. So what we were doing at Mayo, the last part was concierge. So essentially there's one nurse paired with one physician that have a panel of just about 300 patients. And they're really, you know, high profile CEO type patients. So they demand a high level of care and you know experience from their nurse. Uh, so that's that's really what we've been doing the last five years. But before that, it was inpatient oncology and um so postmisectomy or reconstruction patients we were taking care of while they were in the hospital in chemotherapy, of course.

SPEAKER_00 2:48

And how about the concierge stuff you were doing at Mayo? I'm just curious to find out like what their setup is.

SPEAKER_04 2:55

Like what they do for their patients?

SPEAKER_00 2:57

Yeah.

SPEAKER_04 2:57

So they're the physicians are on call 24-7 for the patients. Um, and they have one dedicated nurse. So I worked for one physician, Katie worked for another.

SPEAKER_00 3:07

And so it's an oncologist or nope, just primary care.

SPEAKER_04 3:11

Okay. Yeah. So separate from oncology, this is just concierge at Mayo. Um, and so they had 24-7 access to their physician, and then we worked Monday through Friday. We were always the first point of contact for those patients. So we got to know them pretty well. Um, and we took care of the same patients for five years. So you really get to know these patients, you know, whatever they want to share with you. And so that we bonded with quite a bit.

SPEAKER_05 3:38

Yeah, I think the way that Mayo concierge differs from other concierge, in my opinion, is or from what I know, is they don't do home visits. So none of the doctors will go to a patient's home or visit them in the ER. So there might be, I think a few other concierge offices do that, but Mayo doesn't. So they have access to the doctor 24-7 as far as phone call or text, but the doctors don't go to their homes.

SPEAKER_00 4:05

Okay. Or the hospital. Or the hospital, yeah. Yeah, that's kind of where they probably could easily get credentialed at their facilities, but right.

SPEAKER_05 4:15

Yeah, no, that was one thing. A lot of the patients would have loved that. We often heard that. You know, I wish that the doctor would come to the hospital, but that was not part of what any of the doctors there did.

SPEAKER_00 4:26

Yeah, if we get any complaints, it's like, I can't believe my doctor didn't come to that hospital. Like, well, you went to a hospital, I'm not credentialed at. I tried.

SPEAKER_04 4:34

They would call us from the ER or their inpatient room and be like, why isn't why aren't you here?

SPEAKER_05 4:41

Yeah, yeah. It's a very interesting patient population. We've I've had a call from a patient that it was in the ER saying, Katie, they won't bring me a warm blanket. I asked for about an hour ago. I'm like, well, I'm sorry. Not much I can do. You're in the ER. So yeah, that that would be a huge patient satisfier if they would go to the hospital.

SPEAKER_00 5:03

Yeah. And uh is it just you two or do you have a staff that you appoint to like patient for patient?

Picking The Right Concierge Nurse

SPEAKER_04 5:11

So we have a couple PRN nurses right now, but we're it's Katie and I primarily, and then we're working on onboarding a few other nurses. But again, from our concierge background and experience, we're very particular um on the type of nurse and you know, the type of clientele or patient population that we treat as well.

SPEAKER_00 5:33

Not necessarily level of care, but level of um, I don't know how to describe it.

SPEAKER_04 5:38

Emotional intelligence.

SPEAKER_00 5:39

Yeah, emotional intelligence and patient expectations. So, like with any of our bigger cases, anything over three hours, we have concierge nursing. Oh, nice, yeah, and and they they'll even like be willing to pick patients up so they don't have to arrange for a ride home and stuff, and and even spend like the night at their house taking care of stuff, and nursing staff can take care of IVs if they need, but like it really improves overall like patient satisfaction and like how comfortable they are. Just had a patient today, did not expect them to need anything, and and she went home and our director nursing called us. Like, I talked to her, she sounds like she's in trouble. Oh no, yeah.

Preventing Pain And Home Chaos

SPEAKER_00 6:26

So we we set her up with somebody right away, and they went over like just like, okay, you're you're kind of off schedule with your medication. This is the best way to take it. Like, we do multimodal pain regimens, so there is like four to six meds they have to take, especially being like post-operatively, like just going home alone. She didn't tell me that that she was going home to take care of her seven-year-old.

SPEAKER_02 6:53

Oh, yeah.

SPEAKER_00 6:54

Yeah, so then uh I guess something sounded off from our nurse, so we got her set up and like somebody went out.

SPEAKER_02 7:01

Yeah.

SPEAKER_00 7:01

And then he just contacted me. He was like, Yeah, I got in touch with her again, she's doing a lot better. Yeah. It's like, it's it's quite a bit like dealing with like a young kid and then trying to recover from surgery.

SPEAKER_04 7:13

Yeah, it's definitely part of our process. Like when we try to consult with them before by video, just kind of get to know what their day-to-day is right now before surgery, and what that looks like after surgery, and try to kind of have their recovery as least disruptive as possible. But child care comes in the mix, like, yeah, that's something I realized early on in our practice.

SPEAKER_00 7:36

Like try to ask about how things are. That's part of planning the appropriate procedure. Because like this procedure is better for you, but at this point in your life, you're probably better off going with this, and then when you're ready for it, we can do the bigger surgery. But um being confined to like just a certain amount of time you spend with patients, especially like insurance cases, it's hard to pick that up to get all the little things because it sometimes they they're you can see they're stressed out, but like what happened yesterday, she's like, Oh, yeah, like all gun-ho for the surgery and stuff, and then like wasn't that long of a surgery, and she went home and was not equipped for that.

SPEAKER_05 8:22

Yeah, yeah. I think that's the hardest part is they maybe don't anticipate the little things. Kendall just had a patient that went home and she said, I can't find my glasses, and she's like, I don't want to put my contacts in.

SPEAKER_04 8:36

I mean, it's just the littlest things or walk home there don't you have breast surgery and she can't like lift her arm? She was like, and I don't know where my glasses are and I can't put my contacts in.

SPEAKER_00 8:45

You know, it's those little punch from her stepping on her glasses.

SPEAKER_04 8:48

Yeah, it's just that small thing.

SPEAKER_05 8:50

Yeah. So do you uh work with outside nursing services or do you have a nursing staff of concierge nurses that work with you?

SPEAKER_00 8:58

It's a it's a company.

SPEAKER_05 9:00

A company that you work with. Okay.

SPEAKER_00 9:03

So somebody's daughter that does anesthesia for us at uh one of the facilities. So he's an anesthesiologist, and that's what we we have going. We have a couple other backup services too, just in case they can't cover. So yeah, any anything over three hours, we're like, okay, we we uh price it in. Like this is the you you need to do this. Like, I'm not gonna do it without that. And like anything over five or six hours, it's it's a must. Like it's all priced in, it's still uh all reasonable, it doesn't cost that much uh more compared to what they're paying. But you we do try to keep overall pricing like uh pretty marketable. Um because we could keep jacking up prices, and I think we have room to do that, but it's like making sure you're taking care of most of the people who want that care. Right. They might not have that surgery because it it's just not having uh essentials for recovery.

SPEAKER_04 10:07

Right. Yeah, we always say it's like your surgery is an investment, and then your recovery should be an equal investment too, and kind of planning that accordingly, you know, and yeah, and it helps not to say like just about patient satisfaction, but the better the recovery, the easier the recovery is, the satisfaction score goes way up.

SPEAKER_00 10:26

And then you're like, oh, I was more comfortable post-operatively, my pain was controlled. I had a nurse for one night, I decided to keep them two nights just because they helped out so much. Right. Um and no matter what surgery, but when you enhance recovery, it it it just enhances everything. Right. So even if they're gonna get to the same result, but like you achieve that result in like one month compared to three months is a world of difference as far as someone's gonna be like, Yeah, I was thinking about having this done, and like, okay, I had it done, it's definitely worthwhile compared to the oh yeah, just go for it.

SPEAKER_04 11:04

Yeah, like we had a patient that you know, one of their kids were getting married in a year, and she had three procedures planned. We got her on the first procedure and liposuction. The next one was gonna be breast dog, and then the third one was gonna be a facelift. So we felt a lot of pressure. We're like, if this doesn't go well, then she probably won't return for her breast dog, you know. But that's kind of how it is. You know, we're kind of like an extension of the surgeons as well, making sure that that recovery goes as smoothly as possible. So they do come back for that.

SPEAKER_00 11:35

Yeah, exactly. And that that's actually a good buildup because liposuction should be a little less invasive than breast dog, and then facelifts. Recovery is generally fast, but you've seen facelift patients on day one where the face is all blown up, and you're just like, Oh my god, like first one I did years ago, I was just like, What did I do to this person?

SPEAKER_05 11:59

You bring them back in.

SPEAKER_00 12:01

Yeah, and like, okay, they said this would happen. Yeah. Chill out, calm down, and you just watch the swelling go down the first couple weeks.

SPEAKER_04 12:10

Yeah, appearance-wise, I think that one's the most frightening for patients too. You know, they expect it's not gonna look that much different, you know, right after surgery, and then they can barely open their eyes, their face is blown up, they have bandages wrapped around their head, you know. So liposuction is painful, but I do feel like, like you said, it's kind of like a good starting point for that.

SPEAKER_00 12:32

Yeah, yeah, definitely. Breast sogs, most people do like really well. There's an occasional patient like um that's like, oh, I didn't expect this, or my you you never know with people and like the the spectrum of people's like pain tolerance, also, right? But um breast sog done very well with again the multimodal pain regimen, and then just injecting a ton of local anesthetics around there and just making sure they're they know what to do. So, like having somebody overnight, like having somebody on that first day, like being like, Okay, maybe like just shy away from that. Because if if they don't have that, they'll attempt to do that and hurt themselves more. And we don't find out until their first follow-up at like week one.

SPEAKER_04 13:19

Yeah, and we commonly find that patients feel pretty good the first day home from surgery. You know, they have the local anesthetic or expirel, whatever it may be, and then they kind of get behind on their pain because of that. So that's kind of part of our job is educating them and prepping them. I know you guys do a great job with that too, but when you're tired and you don't want to get out of bed, you know, that's something that we try to stay on top of for them.

SPEAKER_00 13:43

And making sure they increase activity. Like sometimes like overall trajectory, you get to do more every day, but like you will have some down days and you can't like feed into the down day because then that can like cycle back.

SPEAKER_04 13:57

Yeah.

Orthopedic Recovery And Home PT

SPEAKER_00 13:58

So what kind of orthopaedic uh patients have you guys had?

SPEAKER_04 14:03

Uh a lot of joint replacements, yeah. Knee replacement. We've had like a couple uh like repairs, ACL, uh, but mostly hip and knee is where it's the most support. We've had a couple shoulders here and there, but they're usually a little bit younger than the hip replacement. So the hip replacements really need like a lot more RN attention.

SPEAKER_05 14:26

Yeah, I or the knees. I feel like yeah, the knees are usually the ones that kind of struggle, but we also partnered with Anatomy Optimized.

SPEAKER_02 14:34

What is it?

SPEAKER_05 14:35

And they are a physical therapy concierge. Um, and so they we it's really nice to have their support on the joints because they're really good with post-op care. Um, so we'll usually put them into our package, yeah, and then have them come and consult. Obviously, still following the surgeon's orders if they have any restrictions, but it's been nice to have them on our back because PT is not our forte.

SPEAKER_04 15:02

Yeah, and they bring everything like to the patient's home, which is really helpful. So if a patient really wants like our end concierge care, then that kind of pairs nicely. It's like a one-stop shop.

SPEAKER_02 15:12

Yep.

SPEAKER_04 15:13

So they bring like the recumbent bike, you know, table, whatever they might need. And so as soon as they need to start physical therapy, they're already scheduled, ready to go. So when they book with us, it's like you know, they already know what when and who's gonna be showing up.

SPEAKER_00 15:28

And yeah, the the um post op for orthopedics, physical therapy is so important. And they've been speeding it up higher, like sooner and sooner. And a lot of people think, okay, I'll just uh stay at home, get like home health. Not to say, oh, home health care. Uh home health when you go through insurance, like you have to be homebound. You're not technically homebound after a knee replacement or even a hip replacement. So so it's hard to get that approved, and they don't like specialize. It's good to have like uh team members that are tied in, like so like the they know the protocol for each surgeon. Because even though, like, okay, this has worked out better, the surgeon just doesn't want to do that. Yeah, so you don't want to do something and end up with a complication and then have to answer to a surgeon. But um my my wife's a physical therapist, she does outpatient. Um, so she tells me about the variable things, but she did home health when we first moved to New Orleans, and the stuff she was going through is like, oh, I don't know if that's even physical therapy.

SPEAKER_05 16:45

Yeah, yeah, yeah. Home health is kind of a different beast. Yeah. I think the most difficult thing, even with home health, though, is just trying to get, like you said, the right orders from the right surgeon and make sure you're following the right protocol.

SPEAKER_04 16:58

Yeah.

SPEAKER_05 16:58

Even in with the recovery practice, sometimes that can be the biggest challenge. Do you give your phone number to the concierge nurses that they hire? Yeah, so they can reach you directly.

SPEAKER_00 17:09

Yeah. A lot of our patients we'd give our phone numbers to also. So if they have like real concerns, so they don't have to wait like for a call back or if there's an issue with our call service. Sometimes they'll text us. This person's calling, it's like 3 a.m. I'm not gonna wake up to a text.

SPEAKER_04 17:28

Yeah, that's great.

SPEAKER_00 17:29

We've been better about it, but still we most of the time, especially all the cosmetic patients, like they have direct contact.

SPEAKER_05 17:36

Oh, that's nice. We've worked with a couple surgeons that don't do that, and it can be really challenging. Yeah. Just because if it's 2 a.m., 3 a.m. and something really is concerning, it's it can sometimes be hard to get a call back from the answering surgical.

SPEAKER_04 17:51

We kind of have to make that judgment call, you know, which is it's worked out, you know, but we always want that.

SPEAKER_00 17:57

You gotta put your profession ahead and think through it as far as like what's best for the patient.

SPEAKER_04 18:03

Yeah, we definitely don't want to interrupt somebody at 2 a.m. But you know, we want to make sure that we have that layer of support if needed, yeah.

SPEAKER_00 18:11

I was in uh vascular surgery rotation. Vascular surgery gets like the most complex patients because it's not just one artery, it's they're all their blood vessels are screwed up, so all their systems are running on like fumes. But um one of the fellows, I was a resident, one of the fellows I was under that I have to wake up, be like this and that. Like one time I had to admit a patient to the ICU and he got up in the middle of the night. We're close friends now, just talked to him recently, but he he just like he's like grumpy, like yelling at me. So another time, similar issue came up, and I just I was just pretty much bedside going like with this medication, okay, that medication, just to keep this patient out of the ICU. Yeah. The next morning he came around and and I told him everything I did to make sure his blood pressure was high enough that he didn't need pressors and go to the ICU. And then she's like, dude, why don't you just call me and transfer the patient to the ICU six years ago? And I'm like, you asshole.

SPEAKER_04 19:20

He would have texted back, okay. I feel like that's the physical thing.

SPEAKER_00 19:24

He probably still would have yelled at him and said, Did you try this? Did you try that? Actually talked to him yesterday, which is a funny thing.

SPEAKER_05 19:31

But yeah, we try to avoid that if possible, but I feel like it doesn't come up a ton that we have to call overnight. I mean, it has to be something pretty much.

SPEAKER_00 19:40

It's also the clientele to exactly.

SPEAKER_04 19:43

Yeah. We came from concierge. We had one physician, so we got to know that physician super well. We knew when they wanted to be bothered. You know, my physician was great. She's like, whatever you need. She was an educator. You know, she wanted me to understand everything that you know that I could. Um, but uh, I don't know. And I guess it just kind of depends. Yeah. Yeah.

SPEAKER_00 20:04

But that's that's like either family medicine or internal medicine doctor.

SPEAKER_04 20:08

Yeah, but those patients are.

SPEAKER_00 20:14

That's true. Yeah. Um, but yeah, it's I mean, it is what it is. The nice part in Phoenix is there's a ton of private practice. So I think overall attitude, people are generally nicer than when like when I was training in Boston, it's all academics, university hospitals, employed physicians, they surgeons, they tend to be a little more short-fused.

SPEAKER_05 20:40

Yeah, oh, I'm sure. Yeah, I don't miss the hospital days having to page the attending, and you're like, I don't know, but we had to.

SPEAKER_04 20:47

We like, you know, we're like, we're calling from whatever concierge department, and sometimes they knew. They were like, okay, I get it, you know, or the nurse would contact the surgeon or interrupt them or whatever and be like, because of this type of patient, they already knew, you know, so it's a little bit lucky. Now that we're kind of out of it, we're just trying to get to know the surgeons, like we did our physician. Like, what do you want? Yeah, you know, how can we help you?

SPEAKER_00 21:14

Yeah, they the um it's also part to do with the male brand. We've had patients come in and like, I'm a male patient. Like, okay.

SPEAKER_02 21:23

Probably awesome.

SPEAKER_00 21:25

Congratulations. Yeah. Like, what'd you get there? Um, so so it's like almost like a sense of entitlement, which you know the the level you gotta bring to that. It's it's not like I'm gonna treat you any better than any other patient, but I don't know. I I I might think twice about something, which not necessarily in a good way, but um but yeah, it's it's uh when you have the brand you have the entitlement. Same thing with clothes and stuff, designer clothes. So um yeah, it's kind of like level of service. You're you're gonna most people are gonna do just fine. Or hopefully your surgeon told you you're not a good candidate for that surgery. But it's again the experience of it all. So that's why we like just start incorporating with like most of our surgeries. The ones we haven't is again the insurance base, because it's like okay, some people don't want to pay that outside of their like deductibles, premiums, stuff like that.

SPEAKER_04 22:30

So

Travel Surgery And Safety Timelines

SPEAKER_04 22:31

is insurance cover like is it mostly like reconstruction or breast cancer? Or are you finding that insurance will kind of jump in for home health with even cosmetic patients? I do even know that that was a good idea.

SPEAKER_00 22:42

They won't cover any of that. Yeah. Um, so it would be for insurance cases, but for insurance cases, they won't cover nursing care at home. So we keep them overnight at like one of the facilities, a couple of facilities uh that we work out of, we're just like, okay, you live like three hours away. I don't want you driving home after this. It's not a big surgery, but uh you shouldn't be in a car for three hours after this procedure. Right. Um, so for those certain cases, we'll use a facility that has overnight beds.

SPEAKER_05 23:18

Nice. Do you have a lot of patients that fly in from out of state or do you not see that very well?

SPEAKER_00 23:23

I wouldn't say a lot, like percentage-wise compared to our the rest of our practice, but it's still a good amount. Yeah. And like because New Mexico doesn't have a lot of providers. Right. Oh, that's so um, and we have a lot of snowbirds that'll adjust their schedule of travel to whether they live in North Dakota, South Dakota, because again, they have like a couple plastic surgeons, and not all do like microsurgery and flaps and stuff. So they will fly in for that.

SPEAKER_05 23:53

Yeah. And how long do you like them to stay in town after surgery or just to find out?

SPEAKER_00 23:57

I generally say one to two weeks, as long as they're like healthy, like if they have issues and like expecting something, I say two weeks. Yeah. Just because most of the big post-op problems will show up in the first two weeks. And again, you don't want somebody flying on a plane if they've had like a six-hour procedure.

SPEAKER_02 24:15

Right.

SPEAKER_00 24:16

So and again, then those procedures, like even if it's cosmetics, like t uh Tommy Tox and stuff, it does increase your risk of developing blood clots, PEs. So those patients, we want to make sure they're out of the two-week window before they go anywhere. And if if something's gonna happen with wounds and stuff like that, usually it's just dealt with unless it's an implant implant infections really suck. But like if they use their own tissue to reconstruct their breasts, most of that can be like dealt with like medically, uh like with uh oral antibiotics, stuff like that.

SPEAKER_04 24:59

And I saw you guys have like the hyperbaric chamber.

Hyperbaric And Red Light Add-Ons

SPEAKER_04 25:02

Do you use that for like a lot of flaps or just like if they're not?

SPEAKER_00 25:05

Not really the flaps, actually. Uh that's another thing we include with the cosmetic procedures. Because it a lot of people say the data is inconclusive, but it reduces swelling, bruising, decreases uh wounds. So we include like two visits in that first week post-operatively. We include like the vibrow wave. Um people can buy it at home, also. It just pretty much shakes you. But that the studies on that are pretty strong about increasing blood flow to like um, especially your subcutaneous tissue and your skin, which is our wheelhouse. Like, that's like I don't want to be in the abdomen or in a chest cavity. I want to be superficial to all that. It's like this is where you're getting the main advantage. That and red light. So red light, we include a couple sessions, facial procedures. I just tell people like just invest in a little red light mask. If you're paying this many thousand dollars for surgery, even like a 200, 300 mask you can find on Amazon is good. At first, I was just like, I think this will be good for patients, but I it really hit me when like I had uh just the nose job, they get a lot of bruising around the eyes, a lot of swelling. It takes them a good 12 months to clear up from all that swelling. Um, they came back and in like week one. I'm like, very minimum bruising. Swelling, you're gonna definitely have some, especially at the tip. That does take your 12 months to resolve. But I was just like, you look like you're six weeks post-op. Like, no, no lie. And I was like, What have you been doing? I was like, I don't think I've changed my technique much.

SPEAKER_05 26:49

Um but then you should have just taken the credit.

SPEAKER_00 26:53

No, no, but I want to know what's drastically change. I do think these little tweaks with not being as aggressive with the dissection and stuff like that definitely helps. But with her, and it it's also variable patient to patient. Some patients that might do exactly what she did will still get a lot more bruising and swelling. But hers looks so good. And then the next one I did, she I was just like, What are you doing? She's like, Oh, I've been wearing a red light mask like like throughout the day, like for 15 minutes at a time, and just put it on. I was like, Okay. And then my next patient, similar recovery. So then I'm like, Oh, it's probably my technique. I just ask them, they're like, Oh, I've been doing the red light mask. I I read on Reddit that it's good.

SPEAKER_03 27:40

Start building that into your package, yeah.

SPEAKER_00 27:42

No, seriously, yeah. Yeah, so so it was just like, okay, this is real. So yeah, so we we are starting to include that with our like facelifts, nose jobs, but even the breast body uh contouring stuff, we do have the big board of red lights that we do include in the post op package. It helps with all of that stuff, even if it people argue statistically, I don't know if this is valid.

SPEAKER_05 28:12

Do people keep doing the hyperbaric chamber after those two sessions, or do you do they kind of stop?

SPEAKER_00 28:18

So some people do.

SPEAKER_05 28:19

Yeah.

SPEAKER_00 28:20

I I would say majority don't. Um but because it's included. You know. Um so another added advantage that I've seen anecdotally, like the residual effects of like brain fog and stuff from all the anesthesia seems to resolve a lot faster.

SPEAKER_05 28:41

Oh, that's interesting.

SPEAKER_00 28:42

We do certain supplements, peptides postoperatively too, to help the overall thing. But we're like, okay, let's get you back to normal as soon as possible, because then it'll like really ramp things up.

SPEAKER_04 28:55

Yeah. Yeah. I'd love to hear about that stuff because coming from a huge hospital that's academic and only evidence-based, you know, sometimes we're behind in the times.

SPEAKER_03 29:05

Yep.

SPEAKER_04 29:05

And patients are not, you know, they're the ones that are kind of diving on the internet or seeing, you know, what's out there in current research. So we've heard a lot of like red light, hyperbaric, and you know, compression, all of those things that were or peptides, you know. Um, and we're just kind of starting, we are going to a conference for plastic surgery in October, late October in Toronto for plastic surgery nurses. And one of the sessions is about all of that stuff, and I'm super excited because I feel like we they Mayo Clinic doesn't endorse anything that's not like you know proven and evidence, but you know, there are you can see.

SPEAKER_00 29:47

It's also reimbursement too. So they don't have they've built the brand. Yeah. So you don't have to sell as much where we're private, so we want to add to the benefit, like how how much better can we make your recovery for you to for us to build our brand, pretty much. And we're like, okay, most of this stuff is brought up by my brother. He's like health and longevity nut, and he's just been like diving deep into it for like the last five, six years. But all the stuff he's brought up, he's like, I want to get a hyperbaric chamber. I'm like, let me look at the research. I'm like, yeah, checks out. Yeah, it's not like conclusive, yeah, but it checks out. And same thing with red light, same thing with the just the vibration plate. It's just like this certain studies, I was like, This, this is all I need to see. It doesn't like definitively say in like a clinical trial where you stand on a vibrow wave, it'll decrease wounds. And on top of that, it'll it'll uh maintain muscle mass, bone density, which like post-operatively, people move less, eat less. So you lose a lot of that. So I'm like, oh, in uh these different settings, it's been shown to do this. Improves lymphatic flow, improves blood flow to the skin and subcutaneous tissue, um, it maintains bone density, muscle mass, where people lose, like after a tummy tuck, just go stand on a shake plate for like 10 minutes a day. That's that's good enough to maintain your core muscle and bone density, where like rather than taking a four-week, eight uh four week or six-week hit and then building back up. Yeah.

SPEAKER_05 31:36

So well, I think even just going back to the patient population, I think that these patients in particular are really into all of the new technology and the longevity. And you know, I we have been big. It's huge. Yeah, I think it's especially with anti-aging and a lot of our patients just can't fathom that, you know, they're 60 or 70 and they have wrinkles now. And they're like, what can I do? Anything, like anything to don't want to take a statin. They don't want to take the smaller. Yeah, yeah. Yeah. I got this. So we ran into that a lot. I actually had a patient on my panel that statins kind of suck.

SPEAKER_04 32:20

That's what I could tell you our patients, they have five alternatives that I could probably recite because.

SPEAKER_00 32:27

There are, there are.

SPEAKER_05 32:30

I started my crest door and my my leg is cramping. I stopped it. It's better.

SPEAKER_04 32:35

They get their coronary skin or ultras carotid ultrasound, they'd be like, look, Kendall, it went down two percent.

SPEAKER_00 32:41

And that's because I didn't take a statin and I was taking the and statins uh reduce some some types of cholesterol that are actually good for you.

SPEAKER_04 32:51

Yeah, yeah, for brain health, right? Like that's kind of where the research is saying, yeah.

SPEAKER_00 32:55

Yep.

SPEAKER_04 32:55

Yep, they'll come up with anything that they can find.

SPEAKER_00 32:59

That's the fun of concierge, though.

SPEAKER_05 33:01

Considering it's private practice, like, okay, I can we had a patient buy their own hyperbaric chamber.

SPEAKER_00 33:07

Oh, yeah.

SPEAKER_05 33:08

Oh, in their basement, yeah. Yeah, in their basement. And then they were, you know, asking for orders. Like, I don't our physicians didn't know how to write the orders for like how often to use it or anything.

SPEAKER_00 33:18

Yeah, it's just pretty much willy-nilly, just go until like you're seeing double or have symptoms secondary to the hyperbarics.

unknown 33:27

Yeah.

SPEAKER_00 33:28

So we had the lie down that chamber that you just go in, one person looks like a capsule. And then when we opened up our new clinic, we were just like, all right, let's we just bought a walk-in one. So then patients aren't uncomfortable, especially after a tummy tuck, trying to lay in a chamber is uh brutal. Yeah, so this has recliners can fit up to four people. Wow, and it's just walk-in. So um, we had to move it around because of oxygen issues and having a new like surgery center. There's laws about like how much oxygen can be taken away. You need to keep that for the surgical patients. So we had to move it to the clinic side and build a special room for it.

SPEAKER_03 34:11

That's interesting. I didn't know that. I know.

SPEAKER_00 34:14

Yeah, it it's out of all the devices, like you know, those like minimally invasive like skin tightening, lasers, all that stuff that like you kind of have to have so you don't turn your patients to another practice. This has been the best investment for the price, has been this hyperbarics machine.

SPEAKER_04 34:35

Really? Yeah, you're you guys are probably one of the few, I would say the only that I know of uh that has it in their practice. And I know in particular, I'm kind of like a research nerd. Yeah, but uh for like reconstruction or you know, flap procedures, then you know, that's that's actually the research is saying that that is beneficial, you know, for incision health.

SPEAKER_00 34:56

The nice part, like you guys took care of mastectomy patients. Sometimes the mastectomy flaps are thin and they start dying off, and you're just like, well, let's see what happens.

SPEAKER_04 35:05

Yeah.

SPEAKER_00 35:06

So for some patients, the nice part is like if we need to get them into hyperbarics, there's a few wound care clinics and stuff that have hyperbarracks in town that we know their physicians closely, and they're like, just send them, we'll start up. But a lot of places they wait for a prior auth from insurance. So that takes around two weeks. So you lost your window of having any benefit of having hyperbarics.

SPEAKER_05 35:34

So when that approved even, I would it does.

SPEAKER_00 35:38

It does when like a mastectomy flap is like necrotic or you have a wound, they they will approve. Right, but um but this way it's just like okay, worst comes to worst, this person is not gonna have a good outcome. We'll eat the costs. We have free time. This isn't scheduled, just go sit in the hyperbarracks like for 60 minutes or 90 minutes, and that way we can like just prevent uh further like just decay, even though technically we're paying for staff, the machine, blah, blah, blah.

SPEAKER_04 36:10

Yeah, early intervention.

SPEAKER_00 36:12

Yeah, and hyperbaric's most important in the first week. So that's why our postal protocol that includes the two visits, like you can technically use it anytime. We don't say that, but we're like we have that scheduled. Like, okay, you have your surgery on Monday, come in on Tuesday or Wednesday, and then again on Thursday or Friday, get those two treatments right away. Because if it's gonna help you, that's the optimal time.

SPEAKER_05 36:37

So when you use um concierge nurses, are do you base it on the surgery specifically that they're having, or more the time that it took in the OR? Or what what do you feel would be like a really good patient to have a concierge?

SPEAKER_00 36:51

Mostly by time.

SPEAKER_05 36:52

By time.

SPEAKER_00 36:53

Honestly, because if if it goes over three hours, the complexity of the case increases. But there's some patients, you know, you get medical clearance, cardiac clearance, whatever, neurology, urology. Um, if if you have a couple comorbidities or a couple issues, then it's like you're getting put under anesthesia for even an hour and a half, two hours. You're you're gonna need a nurse postoperatively. That just again prevents like needless ER visits, stuff like that. Or if they need an IV and just like could use some fluids to uh feel better. Um, it it's just helpful. So patient health, length of surgery, and probably support system at home.

SPEAKER_04 37:38

That's it. That's it. That's the see.

SPEAKER_00 37:39

It's like we do this for a living.

SPEAKER_04 37:41

So yeah, that's a good podcaster. Yeah, that's a lot of I guess a lot of our patients is is really their support system at home. We have one patient that like her husband couldn't stand the sight of blood. He would he was gonna pass out, you know. So it was like he set us up at a resort and said, You're gonna be there for a week with her and then send her back when she's no longer putting blood in that little tube.

SPEAKER_02 38:09

Yeah.

SPEAKER_04 38:10

Okay, we'll do it.

SPEAKER_00 38:12

Nice.

Recovery Packages With Resort Stays

SPEAKER_00 38:13

So we're we're starting to talk about developing packages because our practice is like right next to the princess resort. It's a fantastic place for people to stay. I stayed there from first time this year, and I was like, oh, this is really nice. Yeah. Um, and then like do like a package with like a stay there. Let's say uh lady has a mommy makeover, we book some like 18 holes for the husband while she's still undergoing. Like it's it's the clientele, yeah, like especially traveling clientele. Yeah, so we're we're we have a lot in the works, and we keep talking about things, and then we just get backed up with everything. So we're like, we have to do this, we have to do this. Yeah, even like compared to like Beverly Hills or Southern California plastic surgeons, like fitting that in with like a resort trip with uh with 18 holes on one of the greatest golf courses in the US, like that'll still come out cheaper than staying around town and having it done there.

SPEAKER_05 39:21

Right. No, I think that's a great idea. And I've been shocked by some of the surgeons that have surgery recovery centers, and not very impressed by them. And I can only imagine if like a concierge patient is in these recovery centers and they look kind of like a nursing home.

SPEAKER_00 39:40

Oh, really?

SPEAKER_05 39:40

And I'm thinking, hmm, that's interesting.

SPEAKER_04 39:43

Yeah, they serve the purpose, but it's like we we know some of our patients, former patients, they would be like, absolutely not. Yeah, but you you get me at the Phoenician. Yeah.

SPEAKER_02 39:53

Yep.

SPEAKER_05 39:54

But if you could package that with a hotel and a nurse and the golf, I think that'd be perfect.

SPEAKER_00 40:01

So I uh we just went through the accreditation process for a surgery center in Arizona. To have overnight, you technically need to keep an anesthesiologist there in-house while the patient's there. Oh a lot of places don't do that. I don't know how they get around it, but um they do fine, you know, or else they wouldn't be able to do it repeatedly. But you have a nurse there that's with the patient the whole night. But the rules from the accreditation board that told us you can't have an overnight stay with the patient.

SPEAKER_05 40:37

If you have like a CRNA though, I don't know about that.

SPEAKER_00 40:40

That's that would still be pricey. Probably keep a CRNA in in-house just for that. So we do have a we do have a overnight stay room that we don't use. Um, but it but like you say, it's it's not the same as being at the Phoenician or just being in their home in their bed.

SPEAKER_04 40:58

You know, sometimes that's where their recovery is best, is when they're in their own environment and they unless and pet their dog or you know, being that's that's the absolute best place for recovery is someone's home.

SPEAKER_00 41:10

Like you can't beat that. Okay.

SPEAKER_05 41:13

Or the Phoenician where there's kids running around. That wasn't so bad. Yeah.

Rapid Fire Recovery Must-Haves

SPEAKER_00 41:20

All right, let's go through these rapid fire question most underrated recovery tool.

SPEAKER_04 41:26

Okay, we're gonna differ on this. I say water bottle. So I say something that you can sip and then it has a stroma. So I'm um like the Hawala water bottle, you can sip it. It has like a built-in stroma. So it depends on how much do they pay you? Nothing, but if they want to pay me, they can find me at. Um, but I feel like that's the best one. It keeps your water cold, you know. Um, we want patients to be hydrating orally, obviously, that's better, you know.

SPEAKER_05 41:57

I think it is kind of nice because you can you can sip it or turn it either way, yeah.

SPEAKER_04 42:02

Or sweatpants, zip-ups. People always get cute stuff and then they regret it because they can't, or their drainage stuff gets all over it. I know what you're gonna say, but go ahead.

SPEAKER_05 42:13

My aquaphor.

SPEAKER_04 42:14

Aquaphore.

SPEAKER_02 42:15

Aquaphore.

SPEAKER_05 42:16

Yes, I feel like every patient, I don't care what surgery they have, then my lips are dry.

SPEAKER_04 42:20

Yeah.

SPEAKER_05 42:21

Well, let me go get my aquapore for you. Yeah.

SPEAKER_00 42:25

Well, I that kind of makes sense. Like, just it's one one's hydration internally and the other one's topical. Um, so like my wife going through pregnancy, she got was it uh cocoa butter or something else. But like I think that prevented stretch marks, yeah. So, like, especially with like post-operative swelling, you obviously don't want to put it on the incision line, but around it to like just because when you get swelling, your body, you it's eventually gonna slough off. So, like to prevent that too, I think that's really important. Um, let's go favorite healthy snack after a long shift.

SPEAKER_05 43:07

I wouldn't say I'm a very healthy eater, so I probably stop and get a Coke at McDonald's after a shift. Oh wow.

SPEAKER_00 43:14

The fountain coke, you prefer that over bottled coke? Okay.

SPEAKER_05 43:18

I need all the fizz.

SPEAKER_04 43:20

Yeah. Um, I like banana and peanut butter, I would say that one, but I'm more of like a charcuterie snacker. I always have like little charcuterie home packed snacks that beets and cheese. Yes. Yeah. What's your soda? I know we should ask you. What should we eat?

SPEAKER_00 43:40

I'm trying to think because I'd like recently started on terzepatide, just like a low dose, and it's just crushed my like appetite.

SPEAKER_04 43:51

Do you tell your patients to stop it so they can eat protein and actually heal after?

SPEAKER_00 43:57

Two, I generally say two weeks prior. Yeah. And two weeks post, but it matters how their recovery is. If they have anything that looks fishy at all, I'm like, hold off on starting that. You need to get your protein. I generally tell my patients, we I really like Juven. There's some thorn supplements with like amino acids that we really like. Um and what did I say? And I say like just get used pre-op, get used to eating twice the amount of protein you eat. So protein intake, protein intake. Yeah. And pre-op that way they're used to it rather than trying to get used to it after they're going through this major stressor in their life.

SPEAKER_02 44:38

Yeah. That's great.

SPEAKER_00 44:40

I I'd like, I personally like a lot of sunflower seeds as a healthy snack. Yeah. Like pistachios.

SPEAKER_05 44:49

The pre-cracked ones? Yeah. Yeah, yeah.

SPEAKER_00 44:51

Yeah. Unless I feel like taking a spit bottle in front of my patients just with like a packed lip. But yeah, I would say that's probably it.

SPEAKER_05 45:01

Did you uh start tears appetite for weight loss, or did you are you thinking for any of the honesty is stubborn?

SPEAKER_00 45:08

I want to lose like 10 pounds. Not that I felt like I needed to. I would love to like jiggle less when I walk fast. But um, but it's for all the health benefits. I think the risk uh reward ratio is like really good. Yeah. So I was like, let me just go light dose on this. So I took a break because we had a vacation in Italy for two weeks. I'm like, I do not want. So I stopped two weeks before that. Yeah, and it worked out just fine.

SPEAKER_05 45:41

You gotta have all the wine and carbs when you're there.

SPEAKER_00 45:44

Yeah, exactly. But it was it, but with the amount you walk, it's like I I ate a ton of carbs. They say it affects you differently there because it's not the same processing, which is absolutely true. But people are like, Oh, so you did you eat a lot? I'm like, Yeah, it's like, did you lose weight? I'm like, no, I maintained, I didn't gain anything. But I was drinking a lot of crappy Italian bear too. And it was just like with the amount I consumed, looking back, I'm like, yeah, I can't believe I came back at the same weight.

SPEAKER_04 46:14

Yeah, yeah, yeah.

SPEAKER_00 46:15

And a lot of gelatos.

SPEAKER_04 46:16

Yeah, we are heard that a lot when people go to Europe or actually lose weight, they eat their way through it, and then yeah, and you're just walking, you're walking the same stuff because not like a beach vacation.

SPEAKER_00 46:26

You know, like, oh, look at this site, look at that site, and like 20,000 steps.

SPEAKER_04 46:30

And you're not stuffing your face. Everybody says, like, you actually spend your time at like a restaurant.

SPEAKER_00 46:34

No, I was stuffing my face. Who told you that line?

SPEAKER_04 46:38

They're not eating up, like here in America, it's like they're bringing you your your check, like as soon as they set your dinner down, and then over there, it's like more of like an experience.

SPEAKER_00 46:47

And I also think it's like the lack of whole grains that uh kind of fill you up a little more over there. And uh the problem I had with carbs, and I did keto a couple of years ago, and the reason I thought it really helped out is I eat carbs, it sets me up to eat more carbs. Like, if I eat like three slices of pizza for dinner, I'm ready to go for five slices that for lunch. Yeah, like it's just like I noticed this first when I was a kid because I'm like, I ate cereal and I'm like, this is making me hungrier. Yeah, like this isn't doing anything for me. Yeah, so I've always skipped breakfast since then, but um, those carbs just manage to expand your stomach. I think it's uh like they teach you in med school, like the fibers crossing for like even skeletal muscle, like once they get too expanded out, like it's hard for that muscle to contract with the same force. So your stomach is all smooth muscles. Not only the like when it's expanded, the hormones it gives off to tell your body to like uh slow down and stuff. I think that downregulates over time, and it's part of the GLP1 pathway too, but it also doesn't contract as like forcefully or as effectively. Same thing with congestive heart failure, those are muscles getting spread too far that when they're contracting, they're not given the force they need. So random thoughts.

SPEAKER_05 48:19

So, were you a healthy eater before?

SPEAKER_00 48:22

Um, I was pretty healthy. I've gone through sprees, and even when I'm unhealthy, I'm not that unhealthy because I I I like more savory and sour stuff. So, like the worst things are like sour gummy bears and stuff like that. We just had some before we started. So, like I'm I'm never like I really never crave chocolate and stuff like that. So I very light dessert eater. So in that regard, yes, but like actually watching what I eat, I go through waves. And then also wrestling growing up, like I I wrestled for 12 years, that kind of set me up to be like pretty, like, even if it's not healthy, it's efficient, like efficient calories. So I I think in general, I'm a healthy eater.

SPEAKER_05 49:09

Yeah, but is your wife being a PT is she pretty healthy eating? Oh, yeah, yeah.

SPEAKER_00 49:14

She always has been, yeah.

SPEAKER_05 49:15

But they're usually pretty good. I know, yeah, good combo.

SPEAKER_00 49:18

Yeah, it's just like, why are you eating that? I thought you said you're gonna stop drinking all the time.

SPEAKER_05 49:24

Well, now with your tears appetite, a lot of people stop drinking. Yeah, yeah, like it just cuts that right out.

SPEAKER_00 49:30

It's got great data for addiction. And even with just food, some studies have shown that like people on GLPs, even when they go to consume the limited calories they do take in, they crave like vegetables rather than potato chips. So that's a weird one. The other ones, you're 50% more likely to quit cigarettes if you're trying to quit and are on a GLP one. Alcohol, uh, it's very effective in in mitigating alcohol uh addiction. Strongest data is for cocaine. So their best data is for people with issues with cocaine.

SPEAKER_05 50:14

That's interesting. I feel like it's kind of a good with everything. Maybe I need it. I don't know.

SPEAKER_00 50:20

It's it it's again risk to reward, and then like trying it out with low dose, just knowing doing low dose. I I dropped a few pounds right away, but like don't expect to lose a ton right away. Right. And and see how you feel. I think it does a better job at regulating your glucose levels, so you're not dipping and spiking, dipping and spiking. And that's where I think you feel crappy throughout the day, and that's where it helps me out. And another thing with those DIP flaps, that's or like big mommy makeovers, those are like six to eight hour procedures. I'm not like craving to run out to eat at like 12 or 1. Oh yeah, I can I can focus on what I'm there to do and just get done with it. But like if I don't take a break or something, even in the long cases, by like noon, one o'clock, I'm just like, uh, I feel it. So that's why for a lot of surgeons doing big cases, I would recommend just try it out. It actually helps with those long days. Yeah, it's it's a weird added benefit. I wasn't expecting, but I'm like, okay, it makes sense.

SPEAKER_05 51:29

So you can promote it to all the surgeons. I know.

SPEAKER_00 51:33

Hey, have you tried this? I'm not calling you fat, even though we'll be focused, I know, and it'll help with your cocaine problem.

SPEAKER_02 51:46

Oh gosh.

SPEAKER_00 51:47

So, yeah, that that's that's been a nice, nice little uh thing that's come about since I started, but then started working out to the biggest downside, most common downside is you lose muscle mass again and bone density. A lot of people just walk with a weighted vest for like 30 minutes a day, and that'll probably be enough. So I I started testosterone replacement and working out more. Yeah, so this isn't so rapid fire. We fire, but it's not in a rapid. Oh, this is a good one. What's one thing every surgery patient should buy before their procedure?

SPEAKER_05 52:27

I almost think a wedge pillow. Is that what you were doing?

SPEAKER_04 52:30

Yeah, a wedge pillow system. We always have like an extra one for for patients, and we can work with whatever they got couch pillows, all the pillows in the house. We can do it. But there's you know, wedge pillow systems you can get on Amazon or whatever. And there's so many different ways you can make them work. And for facelift, tummy tuck, breast dog, you know, pretty much anything from the hips up. Yeah, I'm a side sleeper, and when I had surgery myself, it was that was the hardest part for me.

SPEAKER_00 52:59

And use it sleeping on your back.

SPEAKER_04 53:01

Yeah. And so I feel like if we can get them comfortable, you know, where they just feel weightless and those wedge pills, do it. Yeah, then they'll go right to sleep.

SPEAKER_00 53:10

Okay, nice.

SPEAKER_04 53:12

And they're in the big position that you want them in.

SPEAKER_00 53:14

That's right. Decreased swelling. Biggest recovery myth.

SPEAKER_05 53:20

I think the myth is that they can do it alone. Yeah. I think a lot of women go in and just think, oh, I'll be fine, my husband will help me, but then I think they underestimate what they really have up in front of them after surgery.

SPEAKER_04 53:33

Or they're more the caregiver in their household, you know, before surgery, and then it flips, and then suddenly, you know, they're the ones that are having to be cared for and they're not used to asking for help. So we always say, you know, that if you have friends, they're like, How how can I help you? or what can I do? You know, give them one task, you know, can you bring me dinner or can you make me soup? Or and then hopefully what we can do is just let let the spouse be the spouse, the support, because really that's what you need after surgery, and and then we can do all the mechanical stuff.

SPEAKER_00 54:06

Yeah. That's that's funny because now that I think of it, like if my wife were to have any surgery, like asking about the support system is like, well, when you've left the house for two or more days and came back, how is the house looked? Yeah, so you're gonna need some support.

SPEAKER_05 54:22

Yeah, that should be your intake question. Yeah, yeah.

SPEAKER_00 54:28

Um, most common patient question.

SPEAKER_04 54:31

Oh well, they ask us a lot of questions we can't answer. They'll say, How long am I gonna be swollen for? Like, uh, six weeks.

SPEAKER_00 54:39

Just say six weeks.

SPEAKER_05 54:40

Yeah, it's the golden answer. Two weeks at the start to look like you're using your red light. Yeah, exactly. I feel like a long time.

SPEAKER_00 54:49

Oh, you're in for like 12 months.

SPEAKER_05 54:52

Oh, but I know a guy. So no, I don't know. I I would say the the more common one. Yeah, the most interesting thing I think when we get home is I would think going into surgery, the my biggest fear would be pain. And you'd be shocked by patients that go home and they have no idea what their pain meds are.

SPEAKER_01 55:14

Yeah.

SPEAKER_05 55:14

Yeah. Like it's almost like it feels like it would be common sense, but I feel like that's probably the biggest question is like, what makes a lot of sense?

SPEAKER_00 55:23

That patient yesterday, like, that's exactly the issue. She was just like taking the pile of meds and taking them all at once every two hours. And that's why my nurse was like, This is out of control. I was like, okay, we got to do something about this right away. Right. Because she doesn't sound good. And she says she's just taking a handful of pills every two hours.

SPEAKER_04 55:43

And they have no idea. No. And we've been in some of the pre-op appointments with them right before surgery. We know that you guys, the nurse, is going over everything. We were there. But they get home and it's like, what is this? What is on Dancetron?

SPEAKER_00 55:56

What is, you know, or yeah, and we have a printout. Yeah, we have a printout, like, this is how you should do things. And it it's a lot. I mean, for non-medical people, I could see how it's like overwhelming.

SPEAKER_03 56:07

Yeah.

SPEAKER_00 56:08

Or if it's not reviewed at all, and being like, I'll figure this out after surgery.

SPEAKER_05 56:12

Well, we ran into going to a patient's house, and you know, you send three scripts to the pharmacy, but they only fill two and they're out of stock of one. Well, the patient just goes to the pharmacy, picks it up. Easy enough. There's only two in there, and we're like, oh no, we have to figure out how we're gonna get this other med here, ASAP. You know, they don't even open it when they get home to make sure everything's in there.

SPEAKER_04 56:34

And we always try to get like a copy of like your orders before we see that. So ideally, you know, if a patient has surgery two weeks from now, they call us, you know, we'll call your office and we'll get all those orders. So we we know, you know, because again, they're under like a lot of stress. They just went through everything and everything's kind of out the window once they go home. And it's anesthesia, the relearning period. Yeah.

Multimodal Pain Plans Without Panic

SPEAKER_05 56:56

Are you using? We've been seeing um, I don't know if I say it right, the journalx. Yeah, do you guys use?

SPEAKER_00 57:02

Yeah, we've been having a problem with pronunciation.

unknown 57:05

Yeah.

SPEAKER_05 57:05

How do you say? Yeah, I think we've been seeing that more and more frequently.

SPEAKER_00 57:11

We just started, yeah. It's like a loading dose for one day, and then you take it with a non-narcotic. Yeah, so if the patients can get it, we'd we prefer that. And we've been switching over to that. I I would say with like, I mean, it's a ton of medications we give them, but again, it's to reduce like the need for narcotics, speed up recovery, get up and walk around as soon as possible. Um, but this this is a good little way to experiment. Like, even with our multimodal regimen, I would say about 20 to 30 percent of our patients don't even take narcotics. Really? So um, but they are prescribed it in case they need it. We don't want them to have to run out to get it. So we give a uh Ketorolac or NSAID. It's either Katorelac or Celicocci. Um so we cover the NSAID route, acetaminophen, um, like gabapentin or lyrica. So have that nerve agent. And then on top of that, if they that's still not cutting the pain, the next thing we tell them to go is for for cyclobenzoprene or a muscle relaxer. And if that's not cutting it, go to the oxycodone. But right now we're transitioning from like if they can get the gernovex, transitioning to just use that rather than using oxycodone at all.

SPEAKER_05 58:32

So do your patients ever fight you on the gabapentin?

SPEAKER_00 58:36

In what way?

SPEAKER_05 58:37

Well, we had a did you have a lot of patients that didn't want it or wants it? Don't want it. I feel like they're coming out with more research on dementia with it, and our patients were really starting to get hesitant. Some that have been on for years are like, I don't want it anymore.

SPEAKER_00 58:52

I don't recommend it for people over 65. Oh, okay. Um apprehensive over 60, they have way more of the mental side effects from taking it that like the younger patients can like just deal with it and all. Um yeah, I don't feel strongly one way or another, so it's like, oh, if I I'm not taking this, like you don't need to. Any of those medications I just gave you, unless you're just gonna be popping oxies and saying I don't I'm allergic to NSAID. So that's a little bit of a red flag.

SPEAKER_05 59:25

But in your experience, do you feel like the journal X has made a big difference for them then?

SPEAKER_00 59:31

We recently, it's been like two, three weeks. Oh, yeah. I like to see because we do breast bot again, breast, body, face, nose. So I'd like to see a little longer runway before I judge it one way or another. If it works, we'll keep doing it. If it doesn't, we won't.

SPEAKER_05 59:50

Because it's expensive too, it's not usually covered. And you do that in addition to the tordol and the cerebrex.

SPEAKER_00 59:56

So it's tordol or celebrex. Oh, you don't mix those two. And the tordol is only up to like five days. So after that, you switch from tordol to ibuprofen. So a little bit milder NSAID, but those are tordol is my favorite medication for pain post-operatively. And if you use it at like 15 milligram dose, that that's IV. The oral doses are lower and you absorb less. So I don't think they're dangerous at all. But even IV post-operatively immediately, if you give 15 milligrams, the data is pretty good that it doesn't increase like hematomas or bleeding like that.

SPEAKER_04 1:00:36

Okay, a lower dose. We gave it I am a bunch. Yeah, you do. Especially everybody loved that tortol.

SPEAKER_00 1:00:43

But it's so good.

SPEAKER_04 1:00:44

Yeah, it was like within 15 minutes. If they had like back pain or anything, within I was like, by the time you walk out of this office, feeling good.

SPEAKER_00 1:00:51

I did I did it once because my back was flaring up, middle of surgery. I'm like, I got six hours to go. Yeah. Oh yeah. Like, what? Oh yeah.

SPEAKER_03 1:00:59

Gosh, I can't even imagine. Yeah.

SPEAKER_00 1:01:02

And it it helped out a lot. It didn't like completely resolve it. Yeah. It's from another underlying issue, but like for that day, it was just like, okay, I so needed it.

SPEAKER_03 1:01:13

Right. Yeah.

SPEAKER_00 1:01:14

All

How To Reach The Team

SPEAKER_00 1:01:15

right. You guys will um before Jose jumps down my throat again. Uh do you guys want to uh tell everybody where they can find more about your services or if they're interested where to find you?

SPEAKER_04 1:01:27

Um, so our website is therecoverypractice.com. We're on Instagram at the recovery practice. We're new to TikTok. The recovery practice. Everywhere on social is the recovery practice. Nice. You can call us, go to our website, submit an inquiry, whatever you need.

SPEAKER_00 1:01:43

Awesome. Thank you guys for joining.

SPEAKER_05 1:01:45

Okay, thank you.