The secrets of Orthobiologics with Dr. John Schultz, MD | Clinic Gym Radio

hey everybody welcome to another exciting episode of Clinic gy radio I'm your host Dr Josh sadly and it's my pleasure today to be joined by Dr John Schultz Dr Schultz how are you today I'm great Josh thanks for this opportunity absolutely now for those of you uh who don't know Dr Schultz which I I mean come on who doesn't know Dr Schultz but uh he is one of the founding members of the centenno Schultz clinic in beautiful uh Colorado and I'm sure there's a lot of buildings with uh two names sied together on the you know Smith Jones Clinic but you really specialize in the world of uh what did you call it orthobiologics correct yeah and to me what that means is you help get active people back Acer absolutely Josh the the kind of the journey started 16 years ago when we closed the door on a successful pain practice where we were doing high do steroids we were burning nerves and we we had a pain practice uh dispensing opioids uh the problem was that despite it being successful we weren't sleeping at night because intuitively knew it wasn't the right thing yeah the same time there was an article by saki that demonstrated the Regeneration of a disc and the rest is history so for the last 16 and a half years this is all we do we don't do it on Monday Wednesday and Friday followed by Botox and filler or radio frequency every single day and Saturday Sunday when we're not in clinic we are consumed by how to get athletes Weekend Warriors back in the game utilizing PRP or bone marrow derived stem cells or both that's our commitment because you Josh know that surgery all too often number one can be lifechanging lifechanging not to the good right not a positive life change and you can't take it back it's like a medial menisectomy taking out a meniscus tear well you know what there's three highlevel studies that have demonstrated it's no better than Physical Therapy but the business model for orthopedic surgery is you got to keep cutting out that meniscus yeah so we're here also to advocate for patients and their long-term performance and Longevity I love it so most of the listeners to this uh podcast right now are actively going to their chiropractic clinic right now they're they're actively treating people in their physical therapy location some strength coaches listening and some Blended clinics and so I think we're driving with this whole thing I love the fact that you came out of a quote unquote pain clinic and moved to an active approach because I think everybody listening here it drives us nuts as conservative therapy providers is like hey you this thought of like uh treat pain treat pain treat pain it's like the people in front of me the patients are telling me that's not all they want so this idea of that being the only marker or the only goal is it's ridiculous it's unbelievable and it's certainly not the life that that person in front of me is asking for like again you could numb all their pain and if it's like well in exchange for you get to sit on the couch and never do any never go on another hike or another bike ride they'd be like forget it I I I'll suffer through everything and that seems like that's the market you're really serving huh that's it I mean just recently in the last three months we have or I have personally helped three people obtain a goal like a lifechanging goal there was a 75y old who had he called it a trophy uh elk hunt that's all he's been talking about for the last three years but he had this sciatica and he was like I'm gonna do it I'm gonna do it I'm do it and he did it he absolutely did it same thing last year was someone that wanted to do hking he's going with these rocket scientists we got him so we could go and really enjoy the Deep powder in British Colombia so it's about as you speak about passion and goals not sitting on the sideline yeah yeah and you think about all the other uh what what do you call it unintended consequences of of that man being able to go on that trophy elcon so he had to prep he had to hike he's better with his kids he's better with his grandkids he's better at work he's motivated every single Health marker just jumps if you can help him achieve that goal versus hey take this prednizone and a you know and some Tylenol and your quote unquote pain will go away the like it that doesn't serve goals no one no one WS except for pharmaceutical and we've already seen that this is the same group of people that told us that no one would get addicted no one's teeth would rot because of all the chronic steroids we know the Integrity of those people we choose not to interact with them yeah we also have a large CrossFit Community here in the Denver Boulder metropolitan area and we have single-handedly helped many of our athletes go on to compete both regionally and on a national level really exciting yeah it is so uh what I'd love to do with uh today's interview I want to make sure that every listening knows where they can move this chess piece into play in their patient kind of Journey because I think traditionally I graduated chiropratic college about 15 years ago and I think traditionally as you said it was like uh you take them as far as you can if you can't have success with that person like big success that they want to achieve that goal are options are send a pain management send a surgery and it's our job to figure out which one they're going to because whoever they go to they're going to have a procedure right like we need to be the filter unfortunately like it's pretty rare and there there's a short list of surgeons and that's the only ones I sent to in my local area of like that will tell you like hey you don't you don't need surgery go back to whatever but where do these orthobiologics play a role in these patients that have ongoing pain or they've plateaued at a four out of 10 and they just can't seem to get better so in two specific areas as you mentioned if a given patient has plateaued and despite your Gifted Hands your gifted technique you're just not making progress don't forget my good looks and yeah I mean you're very handsome guy it's it's an audio podcast if you've plateaued and you don't want to have a surgery or you want to look at everything but a surgery okay so that's it and the other time is is we do a lot of patients with instability and I'm here to tell you we inject ligaments we in enjoint inject acl's but we can't treat them we keep can't maintain them with the daily so often times and we have a whole list of chiropractors that we've worked with successfully to see them after the injections I mean we see patients all over the nation coming to here because this is where it all started so um really two different things a plateau or a patient that needs Continued Care in a local community but they came to the Denver Boulder area to get treated okay and just to make this very tactical and you know obviously we want everybody listening to form a relationship with some provider of this and hopefully if they're in the Denver area it's the amazing Dr John Schultz right I mean like why go anywhere else but in all seriousness specific conditions that you think are are well served because I'll tell you chiropractors we used to be like you know hey I have back pain or neck pain now I would say that every listener of this podcast is getting people in their office every week if not every day with planner fitis knee pain foot pain hip pain and once they establish that relationship with a provider patients typically trust them and so they go back no matter where the ache or pain is but if you could give us the top three to five conditions where you're like this needs to be the top of the algorithm yeah so first and foremost before I dive into that list it's all related right I mean what shoulder not related to the neck or which elbow problem brother you're talking to a chiropractor we message for decades we've been trying to send this message yeah but we understand it we actually embrace it right yeah there's no such thing as a hip problem without looking at the at the back right so to with the cervical spine and the shoulder so I can tell you categorically that we have developed a treatment for cranial cervical instability that's provided nowhere else in the world yeah rather than putting in the hardware at the base of the skull and into the cervical spine yeah we do it here it's done the back of the mouth so but it's all yeah it's in the back of the mouth we go right next to the cord and we put patient stem cells we've done about 700 of those cases to date we have a registry and we've made some tremendous successes great not every everyone gets that success but if we can save one person from that surgery it's a home run oh yeah okay yeah number two Rotator and also posterior so AO AA joint any of the cervical facets number two the rotator cuff is an easy as long as the uh injury is not a retract a full retraction right okay so if there's a tendonosis if there's a partial thickness tear this is a great place for orthobiologics either PRP or bone marrow derve cells why the problem with the rotator cuff is the number of stem cells has gone down so it makes no sense to cut it put in some anchors with the surgeon because the Integrity of the tissue is compromised so let's Beef It Up with either some bone marrow or some PRP or both and it's very easy to see so that's really an easy one and just as an aside on that one I I have this special group of rotator cuff uh people I work with a ton of golfers and so work with Country Club golfers I would say that after the age of about you know this marker is moving all the time but let's say 70 yeah is it still effective in that what what you know 70 is the new 55 right like that like 70 is not old for golfer but they start getting kind of that difficult to build muscle difficult to you know keep comination at 70 there are lots of things but there is not a ceiling okay okay there's not a ceiling as you know you need to look at the neck and the shoulder when you're looking at rotator cuff right because I bet you there's a c56 stenosis or foraminal narrowing so you got to look at both and we treat them both which gets me into the next one actually we've started utilizing intradiscal into the discs both in the cervical and the lumbar which have just been incredibly successful who would have thought we initially we're doing bone marrow but the PRP has been really very effective all you have to do is have a blood draw in the morning we do the injection in the afternoon and it doesn't flare like a bone Mar really it's really impressive in fact two of our own dos have had it done on themselves wow life changing yeah so upper cervical instability cervical rotator cuff rotator cuff cervical spine yep okay ACL knee I mean just I'm here to tell you we developed or we pioneered the technique whereby we can regrow or or heal not regrow we can heal an injured ACL if there are not retractions okay okay so if as a general rule if I have a a major ligament or um tendon that has partially torn partially correct partially but fibers are still intact I should it sounds to me like I should start moving this up up my absolutely because you know Josh as well as I do that number one the orthopedic surgeon is not GNA say oh by the way this is just a partial thickness tear in fact I have a patient tomorrow that it was just a sprain and he was going to cut out the ACL can you believe it no it's funny like orthopedic surgeons it it like I don't want to disparage them like there are a bunch of them that are incredibly smart but some of them I swear I want like how would you hang this picture in your house and they're like well I'd first I'd remove the drywall and then uh I would probably cut out these two studs and then I put a bar across or titanium bar across and i' hang the picture on that titanium bar and you're like do like have you ever hung a picture I'm talking simp obviously not and obviously they wouldn't do the same to their to their own children right right right right yeah so ligaments I mean think about it every joint is dep the stability of every joint is dependent upon two things the ligaments and the muscles okay we can beef up the the muscles but there's nothing that an orthopedic or a physiatrist can do M for the ligaments but guess what we can look at them under ultrasound whether it be all the the capsule ligaments and the shoulder or the knee or the hip or the ankle or the toes and actually see them and directly inject them that's an easy one so any patient that you have that has mild hypermobility all the way up to those patients with EDS EDS is eer danala syndrome yeah gosh what else are you going to do you're not going to do surgery on these patients right we've had some life altering results in those patients neck shoulder low back knees home runs yeah let's di I mean you talked about ACL and the neck and shoulder dive real quick if you don't mind into low back because I would love to know where this is super high success rate because one of the issues I think and one of the reason I want to have you on this podcast but one of the issues of being um a a ancillary healthcare provider like a chiropractor is everybody that number one nobody comes in your office so that's one thing but everybody who does come to your office yeah tells you that they have the solution to everything right and like the orthopedic so you know of course we're approached by like the large orthopedic surgery groups that want to get all the referrals y but I will one of the worst days in my clinic is when I had a patient come back about a year after ID last seen him and they had had surgery and it was not successful yeah and you know they they said hey thank you for sending me to Dr so and so unfortunately didn't work out BL and they weren't blaming me sure but I'll tell you that was a rough night of sleep and and a couple heavy drinks for me because I was like I I I opened this gate you know and and they got jacked and uh my interpretation of of kind of the orthobiologics like you're talking about is let's say they're not successful but for whatever reason the the we're not removing function we're not remove increasing pain and this person did not gain any function and had increased significantly their amount of pain and I could see in front me it was clear as day their quality of life was significantly lower than when I first met them you know and that that really sucks so the the surgery is you know high risk High reward sometimes but it seems like you are in a uh a low risk High reward scenario yeah I mean if you do a a PRP or a stem cell and it doesn't work you can go always have surgery there's nothing to prevent you from having surgery but the converse is if you go have surgery if you go take part of that lamina out during a laminectomy or if you take part of that disc out with a disc ectomy the landscape as you know it has forever changed right most importantly the stability the ligaments that all hold this functional unit have now changed right yeah and you can't get it back so I think it's probably reasonable to start with what's our approach our approach is not the you know let's find the generator of your pain like most clinics we owledge like you in fact we've tied the Chiropractic bottle that it's a functional unit what does that mean that means that there's a dis there's exiting nerve Roots there's facets facet capsules with ligaments the sup spinus the intraspinous the ligamentum Flav them and then there's a thoracal lumbar fashion those all interact and they have to be addressed and treated if a given patient with low back and if you treat those there's a good chance you know unless it's a grade two spondi that you're going to get clinical benefit but it's when you look at it as a functional unit the other piece that Josh many people Miss is they miss the tendinopathies that's to say yeah you know I got the disc and I got the facettes but they miss the glute meat and Men tendonopathy both on the origin or down on the greater troll cancer or they missed the the poor performing or mal or dysfunctioning SI joint we are absolutely uh almost paranoid about looking at all the tendinopathies looking at all the other things that can go wrong so to give patients the best clinical outcome I love it uh real quick Dr Dr Schultz while people are listening can you if people are Jing with what you're saying and they're like this is where I want to send people how can listeners of the show again mostly Chiropractic physical therapist how can they get a hold of your clinic yeah so we have a website Centos schultz.com there's um also hopefully Sarah who's helping me do this you can have my email if you have any questions just email me and I'll help you I may not get in the weeds with you but I will in a timely fashion get you to the right person person because we're committed to making a difference in the community because when you make a difference in the community the families and the children Prosper love it so talking to professionals here tell us you said you mentioned recovery and so let's just say I go through I have six weeks of care with somebody and we've plateaued and I go hey I I think you know PRP or stem cells the next thing so I refer them to your clinic for that patient what's the recovery time for for them after that I mean is it almost immediate do you say hey no movement for 10 weeks what's the it just depends obviously a patient that has stem cell into the bone in their knee is going to be different than someone that has just a ligament injection along the atlas so it's just going to depend upon what procedure they did obviously that first one to two weeks we're going to ratchet down the the level of Mobility but we do want you moving we don't want you on the couch so you're not sending people home with immobilizers and and braces and that kind of stuff well with the exception of a a a knee an unloader okay so let's say they have a medial compartment a medial meniscus or lesion on the medial compartment we're gonna offload it okay okay but we do not want you sitting on the couch so same to with the all the ankle ligament stuff that we do we're going to stabilize because of the three phases the three phases of ligament healing you know there's a honeymon then there's a disorganization then a reorganization we want to give you some artificial support but you got to be out there doing the work yeah okay and and giving that like a timeline for those things is it you know four to six weeks like we typically it's four weeks for the unloader or the ankle brace with the exception if they're going to go out and try to kill it if they're going to do a prolonged hike if they're going to go snowshoeing I want them to put the brace back on okay sweet so this is not a uh this is not like a a you know the old version of of ACL six months of of rehab following absolutely not rehab's important but if you look at the animal model animals don't have the luxury of just sitting at the on the couch and watching Netflix right they gota go out and and and you know do the work so too yeah so too you know I mean my dog just had 5,000 worth of essentially acl crucia ligament surgery and we're two weeks out and she you you couldn't tell exactly she except for the scar and the deficit of uh dollars in my wallet but otherwise everything's looking fine yeah this is yeah this is fantastic now how about repeated procedures so let's you know we have these hard Chargers I mean you mentioned the CrossFit Games athletes um and and we I've seen it a thousand times in my career you treat somebody and you know you're you quote unquote have them at 100% but their goal or they're the type of person that wants to go out and beat the hell out of themselves and and I'm not here to stop them like hey it's you know it's your life so can people have multiple procedures same joint and how long do you typically separate them or is it not recommended go ahead absolutely I mean we do have those hard charging people the people that have competitions come up people that go out and just ratchet hard you know yeah got we got a three-month summer and they hit it hard and if they flare it's much easier J to catch a problem while it's small than to get profound instability then you get cartilage problems and meniscus so yeah I mean if they call me or they text me hey I'm having a problem with this because I did why let's get it in and get the small problem fixed and also do you get your teeth cleaned yeah yeah twice a year right prevention is really key and some of the you know I love the fact that you talked about not focusing on pain there's lots of signs and signals that we can pick up during the exam or during the questionnaire there there's some dysfunction you know those little muscle twitches in your legs or your feet those are just some telltale signs that something needs a little bit of work I don't want to see you when you have a Frank radiculopathy or sciatica right right I'd much rather catch you when you have a little problem so do we treat a couple times on a given Place sure okay and then is if we had one of those hard charges so I'm thinking of some I have a guy that golfs this is great this guy golfs harder and more often than anybody I've ever met in my life right I mean he will fit in a a full day of work and round and possibly a second round like he is a machine about golf like it's he's just a machine and he and his friends are uh competitive would be an understatement so for example he went out for his member guest uh and by the ninth hole he had tried to uh single-handedly put the cart girl through medical school with the amount of booze he was buying oh my oh my went to the clubhouse had hired one of these uh you've seen these like IV places yeah his chair set up he and his three playing buddies all have get IVs at the turn take an hour off and then they go back out and do it again and for nine holes and uh so he's maximizing every God forbid that he would play a a round of golf without all the assistance of technology and and you know throw money at the problem in the highest regard anyways in my mind I'm thinking that dude could right now I would send him to a consult with you for his shoulder his neck uh his hip and possibly his low back and maybe even his right knee as I think about this yep um guy comes in like that multiple sites that are all a candidate do you just start rank ordering can you do multiple procedures at the same time how great question great question absolutely I mean as we talked about it's a functional unit where is the neck stop and the shoulder start I mean yeah absolutely so we oftentimes treat the neck the shoulder the hip and the back in one setting awesome however that said with this guy we have have to have a a a mutually agreed upon plan that this is you know we're going to spend time we're going to spend money and I don't want to do this in vain so he's got to give me some Grace and he's got to cooperate with rehab if he thinks that platelets or stem cell by themselves without any rehab without any downtime is going to be the solution I probably won't treat him because it's not going to work yeah there are seasons in this guy's life where he will uh slow down change his approach in in exchange for something else you know so there you go tournament season is is not that time but y I think that's that's what's exciting so if we have somebody that need that has a a a you know let's say somebody uh I'm trying to think I'm sure you've had a lot of patients who are running local marathons to qualify for Boston right and we know the date of Boston how far before Boston Marathon for example it's going to be a competitive environment whatnot how far before that would you say hey here's our drop dead date don't get a procedure in this 10we window 8we window 20we window whatever it is before a major competition like that that's a hard one because it might a tendonopathy a mild tendonopathy like if they have a peanin insertion yeah that that' be okay but if they have a discreation that's a completely ball of walks so I'm a little hesitant to say that there's a drop down I mean if if the Boston's coming and they have a minor tendon problem a month within the G within the race okay if they have a discreation it's going to be months because obviously they're going to be pounding that disc every single stride so I I don't have a hard answer for you okay unfortunately yeah I just because I'm sure a lot of listeners here for whether it's running season or CrossFit season or whatever they have a yearly season right and baseball and everything and I'm I'm always wondering like when is the best time to do this because you're like it it is as you've dealt with athletes the conversation of hey we need to shut this down for a set amount of time yep is is not a a frivolous conversation like it's a serious like let's talk about everything that's going on here and if you have a pro that's looking to sign a contract or something like that like there's even more pressure on the situation but the best time is when you can cooperate with the rehab protocol and allow the injected area to heal so there's the answer give me your best window what's your longest window that you're going to be compliant because otherwise you're cheating the system and and you know this isn't pixie dust yeah yeah I mean it used to be easy too because it used to be that Sports had an offseason and certainly in the you know Youth Sports and college there there no longer seems to be an offseason at any point for any sport well let's talk about that youth because right now whether you know it or not there's absolutely an epidemic of young women that are hurting their acl's and medium min it's like 6.8 times as likely female the male right yeah and guess what they get shuffled to they get shuffled off the court off the field to where an orthopedic oric surgeon yeah yeah and it's just I mean we need to somehow stop this epidemic well that's yeah I mean in my mind that's funny you mentioned that I'm I'm thinking that stem cells PRP is for a more aged population I in just ARB 35 and up in my mind right but now that you say that I'm like well hell they actually have more the the possibility like you're you're uh theide potential on 16year old girl who who partially Tor her ACL is huge and her future is so compromised by cutting it out drilling the holes making it too loose too tight getting some arthritis and then by the way we're going to trim that meniscus age 16 yeah so it just the removal of a vital part of like the knee mechanics stare mechanical functional unit as you're saying I'm like whose thought was this like we would never go to a car mechanic and go all right well looks like it's rattling so I'm G to just remove this part like what part what part in your motor can be removed and it's not going to affect the car's performance you know it's a we both know Josh it's a business model yeah yeah it's a business model so so go back just real quick because that this is getting my mind moving so we have that adolescent female with a partial ACL tear I mean I've had I don't know 150 of those come through my office at some point so I'm the one I'm thinking in my mind is that 14 to 16y old uh female that's start her she's hitting her grossir right so she's getting lanky and lanky and the levers are just extending every night she partially tears yeah and the downside to me is female especially in that age group female adolescents have additional social pressures worries and a an ACL injury in volleyball I mean basically you just wiped out the next calendar year for her right I mean yeah so what's the recovery time like in in this situation so uh they get the magic juice from you and they get the stem cell I mean that's not a PRP that's a bone marrow put your hands on your waist that iliac crest that's where we get it it's a one day procedure they're going to be in a brace for a month okay specific to that knee brace yep that brace they're able to walk they're able to ulate they're going to physical therapy after that month as long as they've got some good quad strength they're going to come out at about three months if they've followed the strength they're going to do what's called return to play exercises yeah is if you see a a young woman when she um when she lands her knees collapse inward yeah guys don't okay so we need to learn she needs to to learn how to uh fall and jump appropriately and then we get an MRI in about 6 months and it's pretty impressive usually so there's a chance she could injure herself in a fall Sport and that Fall's gonna be scrubbed the spring will be scrubbed but she could probably start practicing with whatever sport start of summer probably okay I mean that's a lot better than hey you're going to miss this year and all of next year and then come back that's psychologically that's just such a blow to them that you know it can send them spiraling unfortunately it so that's fantastic and it's also the family right because the family's invested in the daughter so it's not just a a single person it's so when we treat young women we treat the family that's awesome so you know I mean again I don't want to disparage orthopedic surgeons but if you were to walk through the the waiting room of the largest orthopedic surgery outfit in your area I mean somewhere around Denver there's got to be some major player there are what percentage of the people in that waiting room do you think you would better serve I mean in general like if if if we look at all the people refer sitting that these aren't fractures that are compound fractures that are open fractures would probably they ulate it in there with help 6% 60% of the people sitting in the waiting room I know I could do a better job wow that's amazing yeah I mean I really think you you guys uh not not to give you advice but I think every chiropr in the world could undergo some training here to understand where this fits in their model because in so many ways we're just told like told or it's just what the the person that taught us said hey it's the reflex right when we do the biceps reflex it comes up like this gee I've got an ankle injury where are we gonna go oh we're gonna go to an orthopedic surgeon yeah we need to we need to really stop and look at that reflex and and think about the consequences both for that patient and the community at large because there is alternative yeah and at no point did you uh did you uh are we really talking about a significant increase in pain I mean I've seen people that have spinal surgery they're dying they're writhing in pain for hopefully a weeks but sometimes it extends longer than that you know and and that again that's not where we want to be all right last question I I know I want to respect your time and you got to go uh thank you play Superman and and help somebody uh it's a team okay I just they limp in and you're going to help him go run a marathon this afternoon because that's how powerful this stuff is it's incredible but uh you were pain surgeon I mean sorry pain uh provider for a long time and and and uh what looking back like let's say you saw 10,000 people as a as a pain management provider and now you've seen 10,000 since the moment you decided to switch uh what percent now do you think you truly have helped them versus before I mean a guy with your brains and your you had every option in the world I can tell you categorically Josh that we not just me we will give every single patient that walks in here because this is not a mill did I tell you that we spend an hour you know 40 to 40 to 60 minutes with every new patient every new patient gets a physical examination a history review of Imaging and an ultrasound every single new patient yeah so we are committed to giving you 110% of everything we know who can I serve I would say we make a a clinical difference in 70 to 75% of those patients that come through here and every new patient gets what's called a candidacy grading I will tell you upfront what the likelihood of your clinical success is and put it in writing and why so if if they're obese and they're obese if they're hyp like we just got to face the music here it's just not going to work yeah and and we'll be completely transparent love it yeah that's great fantastic it works yeah and and everybody wants it to be successful I mean you want you want to know that you're making a difference too right like that's the that's the kicker is like it seems like it's rewarding to you all right can you throw out the information again how people can get a hold of you yeah our website there's a am I a candidate and then Sarah at the end will give you my email and then please feel free any provider that has a problem or question you'll have my email there and I I get to my email with and if we have a hard charger that wants this regardless of where they live uh I'm your guy yeah we can send them to you you can consult them yeah they can stay in the night and and leave or would you do a procedure I mean is it typically a long wait between analysis and or evaluation they depends the severity I mean if it's a high charging person with a hard deadline like a elk a trophy elk or some major yeah we'll fit them in all right okay I love it all right well Dr Schultz go do the magic and uh I'll thank you so much Jos it was a pleasure thank you all listeners all right thank you sir all right sir you got cleanup crew now so for those listeners uh Sarah is uh Dr schula's right-hand man or uh helping him out so email address if we want to send so this would be for a provider that has a patient they want to send his way and has some questions or procedural questions what's that email address all right the direct email address to reach Dr John Schultz MD at the sentano Schultz clinic in Broomfield Colorado that is J Schultz and that's s c u LTZ sentos schultz.com if you need that spelled it's Cen teen o c s c h u l TZ um um and we're here for any questions you might have and please reach out for any questions about patients any conversations with Dr Shel we' love to chat fantastic all right Sarah well thanks for running cleanup crew for your man you're like the uh you're essentially the the the bronny guy right like you just go behind Dr Schultz and wiping up like cleaning up all the messes so we appreciate it yeah and hopefully we can get some people over to you because I think this is this should be a high priority for anybody listening I mean I can think of dozens of patients that at least need the consultation because they've plateaued or they want to get to that next level and um you I do everything I can every day for them but still can have some some issues that I can't solve so it's fantastic I have another option absolutely and if you ever have any questions you want to reach one of our providers directly um you want to send a referral you want information about a patient that we're mutually working on please feel free to call our clinic on our general line and ask for Sarah I would be more than happy to help you out get you whatever you need fantastic all right Sarah thank you so much and let Dr Schultz know I said thanks and uh for all my listeners out there as we end every podcast we always say go out there maximize your license and live the life you dream of thanks so much for checking out these videos I hope they're useful we'll cover things like rehab exercise business model progressions layout everything else that helps you build a clinic so if you're interested you can click here there here here or anywhere to get more videos just like like this thanks a lot for watching and we'll see you soon