Welcome And Why Regeneration Matters

Dr Andrew Greenland 0:00

Welcome to another episode of Voices in Health and Wellness, where we speak with clinicians, innovators, and healthcare leaders who are challenging conventional thinking and helping shape the future of patient care. Today's guest is Dr. Thomas Buchheit, founder of Triangle Regen Medicine and Biologic Centre in North Carolina. Dr. Buchheit has spent years studying regenerative medicine, platelet-rich plasma, stem cell therapies and immune-based healing. He's also the author of Healing Joints and Nerves, a book helping patients understand why regenerative medicine replaces a genuine shift in how we have healing. So today we're going to discuss ortho biologics and why it remains misunderstood, the science behind regenerative medicine, patient education, and where this exciting, exciting field is heading. So with that, I was like to welcome you to the show and thank you very much for joining me on this podcast today.

Dr Thomas Buchheit 0:48

Dr. Greenland, thank you. It's a pleasure to be here and thank you for inviting me. You're very welcome.

Dr Andrew Greenland 0:53

So perhaps

From Spine Practice To Immune Science

Dr Andrew Greenland 0:54

we could start a little bit about you and your journey. So just tell us a little bit about your journey so far and how you've found your way into regenerative medicine.

Dr Thomas Buchheit 1:01

Well, when I write it, it's a great question. When I finished residency and fellowship, this field didn't exist, right? So I finished an interventional pain and spine fellowship in 1999 and I became fairly steeped in the spine world for about a decade or so. And there are some things about that I wasn't that found a little bit distasteful over the years, um, you know, medication use and heavy surgery use uh for spine conditions. And in 2010, I had a really nice opportunity to uh to join a research group and a clinical group at Duke. And so I ended up uh leaving the practice I was in and joining up with Duke and really started a really interesting journey of not at just understanding nerve injury and mechanisms of that, but also learning about how those mechanism, those the same mechanisms that exist in, for instance, osteoarthritis. Uh, we started, I started looking at and focusing on not just uh risks of chronic pain, but resiliency. So if you have 100 people who have the same condition, um, what makes those who recover and recover from pain and are resilient? What's different about them? And the answer was really the immune system. Those who have a strong immune response to injury, interestingly, are more likely to recover. And that has implications for all of us, right? It has implications for exercise, it has implications for our use of anti-inflammatory medications or steroids. And it really forms the foundation of regenerative medicine. We studied kind of all these therapies, and it was really a uh really wonderful exploration.

Dr Andrew Greenland 2:41

So amazing, thank you. Always really helps have some background and context as to the work that you currently do. So I think you've kind of already alluded to this, but what was that particular moment that convinced you there had to be a better approach than traditional pain management? I think you've given us a couple of clues, but what was that trigger for you?

Dr Thomas Buchheit 2:57

The trigger was probably a paper in 2017 that came out in American in JAMA, Journal of American Medical Association, and it showed an association with repeated steroid injections and accelerated osteoarthritis of the knee. And that was the moment when I read that paper that I realized that we really have to change how we're practicing. Because I came from a world and we all did, where we thought that you have inflammation in a joint that's arthritic, if you quiet down that inflammation, the joint's going to get better, you're gonna improve the pain. You might actually improve the joint longer term as well. And it turns out we weren't. It turns out we were actually making things worse, not better. So that was the that was my threat kind of threshold moment and realized we really need a new pathway and a new way of looking at this.

Dr Andrew Greenland 3:46

Thank

Defining Regenerative Medicine For Patients

Dr Andrew Greenland 3:47

you. So I think you mentioned that regenerative medicine is often misunderstood. So, what's how do you define regenerative medicine or how do you explain that concept to your patients? And what is this misunderstanding that exists out there?

Dr Thomas Buchheit 3:59

I I like to think broadly about regenerative medicine being the restoration of tissues and restoration of function. You know, some people think of it as a growing new tissues, growing a new heart, a new ear, uh something else. Uh that's a very, I think, a narrow definition. But to me, anything that restores function and restores um tissue health is regenerative. And in that respect, exercise is probably one of the most regenerative therapies that we all do, right? And if you think about it, it makes a lot of sense. So, you know, when we when we exercise or work out, you actually create an inflammatory process, right? And you can even biopsy a muscle afterwards and see increases in interleukin 6 and all these inflammatory cytokines, but you start a cascade of healing that ultimately will strengthen those tissues and grow those tissues. And and you know, that's why all the literature on, for instance, exercise and osteoarthritis is very clear that breast walking is a good thing, good exercise for somebody with arthritis. So, so that's to me that that's the fundamental step is that um that immune cascade. And that really formed the basis of the book. You know, I started working on the book about six or seven years ago, and with the really the goal of helping people to understand how these therapies work, how do stem cells really work? How does PRP, platelet-rich plasma really work? What is this thing called Regenikine that people are flying to Germany for? And how does it work? And we can dive into some of the research we did with that. And it was really a wonderful exercise to go through systematically. I probably reviewed over a thousand papers in the process of writing this book to try to distill down the science to a broad audience. It turns out that all of these therapies just work in different parts of the immune system, which is really interesting. You may have PRP that works early on, where you know, if you think of an injury, you have an injury and you have platelet release. Yes, you have clotting factors, but you also have growth factors that release. They recruit in neutrophils in these early white blood cells. They were then recruiting monocytes that come into the tissue, become macrophages. And if all goes well, the macrophage polarizes, right, and it starts to rebuild tissues. And you can slide in all the therapies, including stem cells, into this immune cascade, which I thought was just a it was a nice framework to hopefully help uh people understand how they're how these treatments are working.

Dr Andrew Greenland 6:27

So,

Regenokine Explained And Why It Works

Dr Andrew Greenland 6:28

in terms of your repertoire of tools in your box, as it were, what are your most treasured tools that you can offer people or techniques, treatments that perhaps they've not heard of before, that you can really get some leverage over that condition with?

Dr Thomas Buchheit 6:43

You know, probably the the main tool that people have heard less about is the Regenekine program. Um, and that's people think of it as a as a PRP-like process, but it's really not. Um it's a it comes from blood, so you take blood out and then you let it coagulate and clot overnight. And really what you're doing is letting those blood cells and those white cells work very hard for you. And then we filter, we have a full uh full lab, full sterile lab, full hood and everything else for processing, and you filter that and process that and then start injecting that. And that's really been a very nice therapy for people where other things have failed. Most of the people that we treat with Regenokine have had other treatments, they've had PRP, they've had stem cells, they've had roller therapy, those haven't worked, and so now they're coming for uh something else. And uh it's been nice, you know. It it it started with Dr. Peter Whaling and in Germany, and uh, at least in the United States, you we always hear about uh athletes, pro athletes who are flying to Germany for their treatment. A lot of times they're going to see going to see Peter, who uh was my mentor for and still is my mentor. I've worked with him for seven or eight years, and we've been, you know, we've actually I've been using a program here in my Chapel Hill office since we since we opened up, and I used it for years at Duke when I was at Duke. But it really is a nice, a nice treatment when other things have not worked, and we know how it works now, too. So we looked at, we actually teased this apart in the lab. People always used to think of the Regenekine program as a product of what people call IRAP, right? So interleukin 1 receptor antagonist protein. So IL-1 antagonist is a protein our bodies make to fight and shut down IL uh IL1 to shut down IL1. And it is powerfully analgesic, but if you study IL-1 IRAP, that protein, it only works for a short period of time in an arthritic joint. And there was some part of this therapy that we were missing that we weren't understanding. So we took it to the lab and we dissected out the different mechanisms of it, um, biochemically and also in animal models. And it turns out that it's actually exosome. Most of the effect is exosome-based. That is a nice story for for me and for for patients as well, because there's people talk a lot about exosomes, and we can dive into that a little bit. But the most important part about that is making sure they're safe. And if you can get exosomes and exosome therapy from your own blood, not from donor blood, uh, you've also increased the safety of that product as well. So that that was a nice uh that was a nice research journey over several years as well.

The Shift From Suppression To Ignition

Dr Andrew Greenland 9:30

Amazing. So I think in our last conversation, you described um this paradigm shift as to what was been happening before in pain management as opposed to the kind of work you're doing now. But what do you mean by paradigm shift? Um, and how do you and how has your philosophy of medicine changed as you've been doing more of this work?

Dr Thomas Buchheit 9:50

Right. To me, the paradigm shift is is shifting from this concept of suppressing the immune system with corticosteroid injections, with with NSADs, um, to igniting it. Really, what my interest, and I think your interest as well, right, is how do you turn on these healing mechanisms? And first you feed the body, right? You feed the body with with the polyphenols and the bioflavonoids and all these all these good products your bodies need to heal, and then you turn it on. And you know, the foundation of that obviously is exercise and motion and movement. Um, but sometimes it's not enough, right? If somebody's had a prior injury, a meniscal old meniscus tear, they've got some arthritis, they've got an old ACL injury, uh, labral tear. Those mechanisms may be enough, but they may not be. And that's where I go to employ some of the regenerative therapies as a way to reignite that healing mechanism, kind of push them along that that journey. Um, so to me, the paradigm shift is from suppression of inflammation to actually uh using it, harnessing it, and turning it on. And so the first thing I do using when people come in the clinic is I take them off anti-inflammatories. Uh, we don't do any therapies until they've had corticosteroid injections, until the steroids are washed out of their body. Um, because we we're trying to turn on all these mechanisms. And it's a very right, it's a very different approach. It also takes longer. And the other paradigm shift is people have to be patient. So if they're used to going in and getting an injection, feeling better the next day or two days later after steroid, they have to realize that uh these treatments take time. And if you look at the immune cascade of how our bodies respond to injury, it makes sense, right? If you take if it takes several days alone just to run through that cascade of platelet degranulation, neutrophil activation, and and macrophage polarization, um, that's not it, that's not a 24 to 48-hour process, right? That's a that's a longer process. So part of that paradigm shift is is turning on and igniting these healing cascades, and part of it also patience uh from the patients uh to uh understand that this process takes a little bit longer than, for instance, a steroid injection.

Dr Andrew Greenland 12:05

Thank

Knee And Shoulder Plans With PRP Dosing

Dr Andrew Greenland 12:06

you. And so thinking about the patient journey itself, how has that evolved over time, Karino, from where you've come from before in pain medicine to what does it look like now? For give me a typical condition that you might treat and just kind of show us what the journey looks like for them.

Dr Thomas Buchheit 12:20

Probably typical treatment would be somebody coming in for uh knee arthritis or rotator covet with some you know glenohumeral osteoarthritis as well. So a degenerative condition. They've had a couple of steroid injections in the past, they've probably seen a physical therapist, they're on anti-inflammatories, maybe they're on some supplements, maybe they're on some other stronger pain medicines. And the journey is you know, we meet, we act, I actually go through diet with people. I go through some of the supplements, I believe in some of them, especially uh omega-3s and some of the fatty acids that help resolve inflammation that our macrophages use for that process. And then we talk about how to regain that that function. Um, everybody's different, right? Some people are trying to get back to uh get back to the NBA, and some people are just trying to be able to walk their dog again. Um, and so we have to figure out where that person is starting, what their goals are, and uh uh and you know, and we can usually get there. We can usually get there with uh different things. The other thing we've done is with PRP is that we've started to increasingly use a lot of boosters, and those boosters may be protein concentrates with A2M, uh, some of them may be other things of autologous uh like super shot that we've started to use that has autologous exosomes. It's not the Regenikine program, but it's a single injection. So all these therapies um I think can be tailored. The other part of this process is that you know, we talked about the importance of immune stimulation with this, and that's been really a fantastic under learning opportunity in the world of plateforge plasma, right? So, you know, we a lot of patients come in, they say, Well, I saw this this study in JAM or I saw this study in another journal of PRP, doesn't work for nearthritis. But if you tease out those studies looking at the platelet doses, you can predict what studies are negative and what studies are positive. If there's a PRP and they use less than 3 billion platelets, it's going to be a negative study. And patients, I think no patient should receive uh a PRP with a platelet dose of less than six or seven billion for a large joint. We actually increasingly been obvious that we really need to get closer to 10 billion. So what we start doing in the clinic is using that information, say if we want 10 billion platelets for a knee, six billion for a tendon, let's measure it and calculate it, make sure we get there. So we measure the person's platelet count at the beginning of the procedure, not from two weeks ago because it may be different from two weeks ago. We have them exercise before they come in to activate these mechanisms, we measure their counts, and then we ask the question how much blood do we need to get to get them to 10 billion or 16 billion or 24 billion, whatever we need. And and then we draw that blood because we know we're gonna get a 79 to 82 percent yield in our process, and then we can we can reliably deliver the doses we need, and it really has made a big difference in outcomes. It's a longer process to do, um, but it's uh it's been very satisfying to do because uh we can deliver what we think is some of the best you know treatments in the country. And there are a couple clinics in in the US doing this now, uh, but it does take a little extra work, so it's it's uh it's a little more labor-intensive to do.

Dr Andrew Greenland 15:44

So thank you. Um so with everything you've said about the healing processes that you can list it using you know your techniques, why have we become so fixated on suppressing inflammation? And why are we not thinking why is it not you know this more broadly accepted as an approach for achieving this sort of level of healing?

Dr Thomas Buchheit 16:04

I think it's history, right? And we can go back to 1899 and the synthesis of aspirin. We can go back to 1951 when the first critical steroid injection was done for neoarthritis. That's what we grew up, that's what we all grew up with, which is that if you have pain, you put steroid on it, and it usually makes it feel better. And it's true, right? If somebody has a painful joint attendant, whatever it is, if you put steroid on it, it usually helps it feel better pretty quickly. And so to me, I think it's just I think it's inertia and it's habit. Uh, and it's and it's it's hard to change people's minds about this, too, because we're also talking again from uh injection where somebody can offer in their office very easily, that would is going to produce pain relief very quickly to one that's a much longer process, but that longer process is gonna help longer term. And so to me, it it it's just it's just history, and and you know, medicine is slow to change. It is. And the other thing is insurance companies don't cover treatments that stimulate the immune system, they cover suppression, they'll cover NSAIDs, they'll cover steroid injections, they'll cover ways to burn nerves off of joints, which I used to do and don't do anymore. And I would make an argument that burning nerves off of joints is not a good idea unless they really don't have any other options. They'll cover things that just that destroy nerves and suppress inflammation, but they will not cover things that stimulate. Now, I think that's gonna change, uh, right? And and actually the oncologists, I think, have helped us out a little bit here because they have opened up this world of checkpoint inhibitors and immune stimulants that can potentially cure cancer. So I think this mindset has begun to change a little bit, but that is is just starting to creep into the world of orthobiologics and care of joints and nerves. It's it's gonna come, but I think it's gonna be a few years.

Dr Andrew Greenland 18:00

Well,

Why Steroids And NSAIDs Still Dominate

Dr Andrew Greenland 18:01

I guess this is a relatively new field. I mean, I know it's been around for a while, but with every new field, there comes a marketing challenge in terms of how do you get the message out there, how do you get patients to understand what it's about. What's your kind of approach to this? How do you, for want of a better expression, sell this?

Dr Thomas Buchheit 18:17

Yes. Um, that that was a challenge, that was a challenge for me and remains a challenge because I can speak at all kinds of academic conferences and write papers and everything else, but patients don't see and hear any of that stuff, right? So I actually have somebody who helps out with uh social media just because that that's just not that's not an area that I know, it's not an area that I uh have any expertise in. Um so I have I have help with that. But my goal is very clear is that I want people to understand this field. And I think more broadly than you know, trying to market services, I want people to understand the field so that they can do better longer term. And it may be with us, it may be with somebody else. But if I want somebody, it doesn't matter if they're in North Carolina or California, Michigan, or Washington State, if they go have a treatment for their knee arthritis or their torn rotator cuff tendon, I want to make sure that they get the best treatment that they can no matter where they are. We now know what makes better treatments, which is great. And actually, we've learned a ton over the past even year. Um and so my hope is to educate, that's why one of the reasons I wrote the book too, is that if people read the book, if if consumers and patients read the book, when they go in to look for treatment, then they'll be able to ask very, you know, intelligent questions of what are you using, why are you using it? Uh, you know, if you're doing PRP, are you looking at platelet counts on platelet dosing? If you're looking at stem cells, what kind of cells are you looking at? Um, the stem cell uh story is another one we can dive into if you want, but it's a really fascinating story of really good science that's been kind of misinterpreted uh in the lay public as well.

Dr Andrew Greenland 20:06

So

Education Imaging And The Book Mission

Dr Andrew Greenland 20:08

thank you. Um so tell us a bit about Triangle, the setup that you have there. Um what's what's the operation look like? What's your kind of day-to-day involvement? Uh, what are you offering? Who are you seeing? Just give us a bit of background practice.

Dr Thomas Buchheit 20:20

Well, we see folks from teenagers all the way up to non-edinarians and everywhere in between. Um, I don't do any uh really traditional medication management. We really focus on people come in, people find us because they're looking for alternatives to steroids, alternatives to surgery. And that's that's the typical patient we see. Someone who's been through the traditional system. Maybe they have grade two, grade three Neo A. Uh, they're not a candidate for surgery or they don't want it, and they're looking for other alternatives because they've been through, they they've had a couple hyaluronic acid injections, maybe with a little bit of improvement, a couple steroid injections in the month or two, but nothing longer term. I I like to think of myself as focusing on or the patients in orthopedic limbo. Um, they have a problem, it limits what they do, but they're not a candidate or not a candidate for don't want joint replacement surgery, or it's a joint that's not easily replaced, right? We see a lot of uh a lot of thumbs and big toes as well. So um those are the typical folks we see, and seeing everyone from you know young individuals with with uh injuries and sports injuries to to professional athletes to octogenarians and non-ogenarians who really just went out and get out and walk with their their spouse, their friends, or their dog, and they're having a hard time getting moving again. And they're all really very satisfying to work with. I love working with that whole that whole spectrum of of folks, it's very satisfying.

Dr Andrew Greenland 21:53

And are there any patients that are not suitable off the top of your head for your kind of approach?

Dr Thomas Buchheit 21:59

Great question. You know, folks are coming in on chronic steroids or her having you know repeated steroinjections are hard to work with. Um those are probably the ones who are kind of in that model and really don't and don't have the time. Also, we need the time. So when folks come in, I like to work with them for a few weeks. We see folks and they may have travel coming up or plans. And a lot of the things we do take time. So if they see us on a Monday and they're leaving on a flight on Friday, usually we'll say, We're probably what we have to offer you is probably not going to kick in by Friday, so you might want to go more traditional route with that. Uh, but the the treatments that we do tend to tend to uh roll on over a couple of weeks, and it's a gradual improvement. So we like to work with people uh over those usually days to weeks, not uh hours to days.

Dr Andrew Greenland 22:52

So in terms of a like a typical patient consultation itself, what does that look like and you know how much of the time is spent on education and expectation management and the kind of the rehab they have to do themselves at home?

Dr Thomas Buchheit 23:06

I I love the initial consultation to me, is I I really enjoy those. Um I tend to use imaging to teach a lot. You know, I when people come in, if they have an MRI, we put it up on the screen and we'll go through it. You know, people get everybody gets their MRI reports and their x-ray reports. Nobody can understand and sift through the language of those, right? So I just put up the images and we go through the images themselves because most people can understand an image if you show them what we're looking at. And the other thing I do is I do ultrasound exams on probably 75% of the initial consults I see, because there's a lot of things we can see on ultrasound that you can't see on X-ray or even MRI. Um, and it's really nice to see in real time if somebody has a supraspinatus tear or infraspinatus tear or you know, uh medial meniscus issue, you can show them those issues and you can show them, and it makes it very concrete for them. So, I to me, that education of uh mechanically what's going on is very helpful. And then we talk a lot about how do you kind of ignite those healing, that healing process. Uh, talk about nutrition, we talk about some supplements as well, kind of go through all of that. But that initial consult to me is a really important step to kind of let them uh help them understand what's going on. Most people just a lot of people come in, they don't, they've been told, well, I have this and I have some arthritis, and but the details of it they really don't know. And for instance, the shoulder is a great example. Uh shoulders are complex, so they're wonderfully complex, right? Uh people rarely, it seems like have an isolated glenoid issue or or superspinators or AC joint. It's an entire unit, and and looking at the entire unit, I think, is really helpful and important. We also we also coordinate with uh a lot of the physical therapists in the area, and there are some really good physical therapists who do very hands-on work. They'll do video filming of mechanics, they'll teach the patients, they'll do this very uh patient process, which is which is really wonderful as well.

Dr Andrew Greenland 25:12

Now tell about the book. So the book Healing Joints and Nerves. I know it's been a bit of a labor of love, it's taken a number of years to put together. So I suppose the question is what inspired you to write it and who did you write it for? Was it primarily for patients or for fellow clinicians? Uh yeah, tell us a bit more about the book.

Dr Thomas Buchheit 25:28

Well, I I found myself having a lot of conversations that were cut short in the clinic. People would come in and they'd ask about stem cells, they'd ask about PRP, they'd ask about Regenicine. And the questions they had were fantastic. And I realized that I couldn't answer them in the space of a 10, 20 minute form. I needed a longer format. So I started, I just started writing stuff down. I started writing chapters, and I realized it really needed to be a long format book. And it I wanted a book that a patient could read and then they could really understand the entire field of what drives osteoarthritis, what drives neuropathy, and how do I get this better. So it was really written for the patient, although I actually have a lot of clinician colleagues who read it as well and have told me they really like it. It's been a guide for them and teaching their patients as well. So I wonder if there's as many, I think there may be as many clinicians who are reading it as patients at this point, which is which is great.

Dr Andrew Greenland 26:24

And if readers were to take one message from the book, what would you hope that that would be?

Dr Thomas Buchheit 26:29

Um, our bodies have the capacity to heal, we just need to figure out how to turn on those mechanisms. And then I think that's it. The mechanisms are there, we just need to figure, and and we now know how to turn them on. We just need to turn them on.

Dr Andrew Greenland 26:45

And I guess when you write a book, when you invest you know so much time and energy and effort into something, did that change your own thinking about your own practice? Did you kind of learn anything really um key from the research that you did or anything that was any assumptions that you had that shifted just from the mere act of writing the book?

Dr Thomas Buchheit 27:03

Absolutely. You know, I mean I think all of the protocols that we do now have have really followed on the heels of what the research we did. Now, some of this, it's hard, I can't separate the research we did from the writing because these are all in kind of lockstep. So we have you know research we did in the lab, the clinical work, the reading of all the papers I did to put the book together, and then the writing of it. But you know, it's amazing how writing can crystallize and also how an editor can uh force you to crystallize your thoughts. I had an editor who was very good, and uh she forced me many times to take out um a lot of the uh unnecessary, uh excessively technical language in it. What I also realized is that um if you can explain something without using lots of acronyms, you probably understand it a whole lot better, right? And it that was a really an important exercise because I realized, like a lot of us, we learn to speak in acronyms and we learn to speak in abbreviations and technical talk. And when I went through the exercise of trying to explain these mechanisms and explain these therapies without excessive technical knowledge, I actually understood them better. So it really helped me to kind of develop that narrative to explain it to patients as well. So it was a great exercise. It wasn't easy. I thought it was gonna take me two years, it took me uh uh almost seven. Um, but uh you know I'm I'm I'm pleased with the outcome. It just took a whole lot longer than I thought it was gonna take.

Dr Andrew Greenland 28:37

So

Building Triangle Regen And Spreading The Word

Dr Andrew Greenland 28:38

cool. Well, we'll put the details of the book on the bio page so anybody wants to um source themselves a copy, then they should be able to get the information for that. Very happy to help promote that for you. Okay, so thinking now about triangle as a regenerative medicine practice, it is a business. Um, what are you most proud of from a business perspective in terms of what you've built?

Dr Thomas Buchheit 28:57

I am most proud that we have followed our vision. We want I wanted to build a clinic that that focused on ways to get people healthier. And also I'm living outside the insurance world as well. I really did not, I I felt like my hand was forced so many times when I was living within the insurance world of doing things. I the first question when patients came in the door was not what is what is the best way to get your shoulder-knee hip better, which is the question was, what does your insurance uh coverage, what does your insurance policy cover? And I did not like asking that question, but that ended up being the first question I would ask. Well, they cover this hyaluronic acid, they'll cover this steroid injection, maybe it'll cover this nerve burn. I didn't want to do those, and I didn't think that they were helping longer term. So I really love developing protocols and treatments that I think are in the patient's best interest. I love the team that we've assembled. It's uh, you know, to me, it's that this is medicine is a team sport, right? Clinic is a team sport, and you're only as good as your crew, and I have a delightful team I work with. And I love the fact that we are continually learning. You know, we measure everything, we measure all of our products, we measure all of our PRPs and our growth factor and our counts and our weight counts and everything, and we're constantly improving that process. And we've actually monitored and improved it even a tremendous amount based on what compared to what I was doing even last year and the year before. Um, so and my hope is that I will continue that learning journey, uh, even maybe with some publications of things. But uh that that's the I'm I'm proud of the team and I'm proud of the philosophy of what we're doing.

Dr Andrew Greenland 30:41

So amazing. And on that point of learning, what have been the biggest business lessons that you've kind of learned along the way um from doing the work that you do?

Dr Thomas Buchheit 30:51

Biggest business lesson for me was uh academic success does not translate to clinical success. You know, it uh it really does take uh direct outreach to to patients and those kinds of uh social media outlets that uh that again I I needed I needed somebody to help with because I didn't understand that field. I really still don't understand it, but I have someone who who works with it, does a nice job for me. So but that was that was my biggest uh you know you can have the again lots of publications and speaking and in a book and everything else, but if patients don't hear about you, you're you can run what what someone described as a top secret clinic. You don't want to run a top secret clinic where nobody knows about it, you know. Um and the other thing is word of mouth, you know, our our most powerful uh a lot of the patients, actually, probably most of the patients we see are here because we treated a friend or a family member. And that's really nice to hear because those, you know, those endorsements are are are nice. That means that uh we're affecting people in a positive way and they're telling their friends, which is great.

Dr Andrew Greenland 32:03

And is there anything that keeps you up at night as a business owner? Is there anything sort of ongoing challenges or bottlenecks that you have to navigate on a day-to-day basis?

Dr Thomas Buchheit 32:13

You know, I am I would say very globally the all the business aspects, right? Because I don't have an MBA, I'm not a business person. This is my kind of first foray into running my own small business. So I have to make sure that the rent is paid and the employees are paid, and and so I'm kind of in that scenario where I am uh running, you know, in terms of the team, the clinical protocols, all the business aspects, and I think it's the business aspects that I are the are the biggest challenge for me personally because that's a new world. The rest of it, the team, um approach to things, the clinical protocols, the science behind it, that's um that's a very comfortable space for me. The business part is less comfortable, and that's the part that probably keeps me up more than anything else. I'm learning.

Dr Andrew Greenland 33:00

For sure. And um, I guess as a business owner, you're wearing all the hats and you do a bit of everything. Which is the biggest time drain for you? I mean, there are obviously things that you love doing and you're passionate about in your work, but there must be things that take you away from that. What are those things?

Dr Thomas Buchheit 33:14

Oh, um, you know, I could use phrases like you know, doing payroll or or that, but uh you know, it's kind of all the business aspects. I I don't know if it's a time drain, it's just part of the the build of the practice. You know, the the parts I love are the the clinical side and the clinical protocols and how do you tweak a clinical protocol to make it better. Um to get the word out and how to make that match with a a viable business plan is probably the the biggest challenge. And I wouldn't say it's a time drain, it's just uh it's probably an aspect that I underestimated the importance of and I underestimated how much time it would take. Um but I would probably say you know the business part of it is the biggest challenge. And that's where I feel like having a good team. I have a very I have a great accountant, I have a good social media person. And also I have now uh staff. I have a physician assistant, Max Mueller, who's just a fantastic PA, and and he's doing some outreach as well, which is which is great. So to me, it's again, it's getting about getting that the message out about what we do and more broadly what patients can do to get themselves better again, even if they don't come to see us at the key and come see somebody around the country that they get uh they get what they need.

Dr Andrew Greenland 34:33

Thank you. And if you were starting over tomorrow, would you do anything different with everything that you've learned along the way?

Dr Thomas Buchheit 34:41

Um going back for the business I started last year or going back 30 years to the career, I guess is the question, right?

Dr Andrew Greenland 34:48

I guess I mean you you've made a switch in your the field that you're working in. I just wondered if you were going to start a regenerative practice tomorrow with everything that you've learned along the way, is there anything you would fundamentally change and do from the outset? Or maybe there's nothing. I mean, sometimes you we just we we the learning is as as important as part of the journey. I just wonder if there's anything that you would do differently.

Dr Thomas Buchheit 35:07

Yeah, I'd probably pay more attention to the importance of social media earlier on and have uh someone uh join or early to really look at that strategy. Um because I think and that's that's the part I believe that I underestimated a little bit, the importance of.

Dr Andrew Greenland 35:25

Got it. So what does the future hold? Where would you like um to be or the clinic to be in the next, say, 12 months or so? What are your plans for um the clinic?

Dr Thomas Buchheit 35:35

I I you know I think our plans are to continue getting the word out and continue growing. I'd love to partner with uh, you know, all the local physical therapists, they're doing uh great work. Um I love, you know, we're gonna we're continuing to partner with some of the sports teams as well, and um just kind of get the word out. That that's my very simple goal. And you know, I'd love to see patients coming in the door who like they are doing now, or they're coming in looking for a new way of treating their joint, their tendon, their ligament, their or their nerve. And and uh to me, it's just a matter of getting getting that message out and having them understand, and and that our growth has been very organic with that. Um, and that's been that's been a nice process, and I'd love to continue seeing that very kind of progressive organic growth too.

Dr Andrew Greenland 36:24

And would that be more clinics or a bigger clinic than you're in, just more staff, being able to treat more patients? What does it kind of look like for you?

Dr Thomas Buchheit 36:31

Right now, I think it's more of just growing the the clinic and the staffing. We have a space that can accommodate a little bit uh uh more than what we're doing right now. Um we are actually just finished hiring up uh another uh another two staff members actually the past couple weeks, which is which is wonderful. So we are we are growing within our space, which is great. I don't have any immediate plans of additional. I I really like to control the quality and the experience of a patient coming through. And to me, it's a very big step to open up a second site where you're not physically present as much. So I I really enjoy very much that hands-on approach because I can monitor and make sure the quality of the experience is great. To me, it's it's like running a nice restaurant, right? I want people to have a really great experience from the from the moment they walk into the moment they leave. And I feel like, you know, maybe this is because in college and medical school, I waited tables at restaurants and um and I, but I feel like their model is a really good model of of the patient experience, more so than a traditional medical model where patients come in and they're gonna get they're gonna get what they're offered, and they're only gonna be offered a few things. Um, and that might or not might not be what's best for them. And I really love that that service-oriented model of of a restaurant, really as much as anything.

The One Change He Wants

Dr Andrew Greenland 37:52

And final question on closing. Um, if you could change one thing about modern health care, what would it be? Slightly philosophical um question, but I'd probably a good one to end on.

Dr Thomas Buchheit 38:01

I would love to have uh this paradigm shift that we're talking about shift more quickly. And um, I think it's needed, I think it's in all of our best interests. Uh these these shifts happen very, very slowly, obviously, and all paradigms die very slowly. But I would love to see this this uh kind of way of keeping joints and nerves healthy. I'd love to see those mechanisms and those techniques be employed faster than they are.

Dr Andrew Greenland 38:39

With that, Thomas, I'd love to thank you so much for joining me today. I've really enjoyed the conversation. Thank you for telling us about your practice, the different things that you can offer the patients, giving us a real understanding of regenerative medicine, what it is, what it isn't, some of the misconceptions, and just sharing a little bit about behind the scenes of the practice and what you're aiming to achieve. It's been a real delight. So thank you so much.

Dr Thomas Buchheit 38:58

Andrew, thank you so much. Really appreciate you having me on. Delight to talk.