32 - Dr. James Pinkston on Regenerative Medicine and the Case for Aging Strong

Dr. James Pinkston Returns: Regenerative Medicine and the Case for Aging Strong

In this episode of the Wellness in Asheville Podcast, host Travis Richardson welcomes back Dr. James Pinkston, DO, of Asheville Non-Surgical Orthopedics, for a second conversation on regenerative medicine, pain relief, and what it actually takes to stay mobile as you age.

Dr. Pinkston breaks down the science behind platelet-rich plasma (PRP) and stem cell therapy, clears up what "stem cells" really means in the U.S. (hint: it's not what most marketing implies), and introduces the concept of joint "dysfunction" — why two patients can have nearly identical X-rays and completely different pain levels. He and Travis also get into why muscle strength might be the single biggest lever for healthy aging, how lifestyle choices change the quality of a PRP treatment, and why insurance coverage for regenerative medicine tends to lag the research by decades.

Real patient stories anchor the conversation: a marathon runner who went from sidelined to winning her age group, a new grandfather who couldn't get down on the floor with his grandchild, and a patient who needed a working hip for a long-planned anniversary trip to Europe.

Key Takeaways:

• Why strength training — not just cardio — is Dr. Pinkston's top recommendation for aging well, and how contracting muscle releases proteins that help control pain and inflammation
• What "stem cells" actually means in U.S. regenerative medicine: only bone marrow and fat qualify, and they act more like directors of healing than replacement parts
• The difference between PRP and cellular (stem cell) therapy, and which conditions each one treats best
• Why joint "dysfunction" — the inflammatory environment inside a joint — often predicts pain better than what shows up on an X-ray
• How diet, alcohol, hydration, and avoiding anti-inflammatories around treatment time change PRP outcomes
• Why insurance coverage for regenerative medicine lags the research, and what that means for patients weighing their options
• Where peptides might fit into regenerative medicine's future, and why the safety data isn't there yet

Timestamps

00:00 Welcome back: Travis reintroduces Dr. Pinkston
01:00 From childhood fascination with anatomy to non-surgical orthopedics
06:00 Patient stories: a marathon runner's comeback and a grandfather back on the floor
10:15 Mobility, muscle mass, and the real definition of aging well
14:00 What stem cells actually are (and aren't) in U.S. regenerative medicine
20:15 "Dysfunction": why imaging doesn't predict pain the way we assume
25:30 Platelet-rich plasma explained, plus a hip injection that saved an anniversary trip
30:30 The lifestyle habits that make PRP work better — and worse
35:20 Peptides, AI, and where regenerative medicine is headed
38:30 Insurance, protocols, and treating the patient instead of the algorithm
44:40 How to reach Asheville Non-Surgical Orthopedics

Episode Links:

• Be Well Asheville
• Be Well Asheville Podcast Archive
• Meet Dr. James Pinkston
• Dr. Pinkston's First Episode: Regenerative Medicine & Non-Surgical Orthopedics in Asheville
• Asheville Non-Surgical Orthopedics
• Asheville Non-Surgical Orthopedics on Instagram
• Asheville Non-Surgical Orthopedics on Facebook

The Wellness in Asheville podcast is produced by Be Well Asheville, your local news source covering health + wellness news + events in Asheville. Get the latest at bewellasheville.com or follow @bewellasheville.

Transcript

Travis Richardson (00:03)
Last night I was working, I had last night was one of these things where, what's going on here? Sorry. I have some questions here, I'm trying to pull up.

Travis Richardson (00:19)
Anyways, last night, it was like nine o'clock at night and I was still working and I for some reason thought it was like seven o'clock at night and I was like, my freaking God. like, cause I had worked like 13 hours. I mean, I was like, I got up at five in the morning and just like, literally like worked.

Travis Richardson (00:38)
maybe took a break for lunch and went on a walk and then, that was about it. And you know, like in business, there's like these times where, you know, it's not linear. There's like a, there's times where it's really a ramp up and then you can settle down, but there's like, shit, everything you have an idea or you have to try something. And so you just ramp up again, you know, it's like sprints.

James Pinkston (00:59)
Yeah.

Travis Richardson (01:01)
And so yesterday as a sprint, I'm trying to test some, um,

Travis Richardson (01:07)
gather analytics in a few different ways to see how my traffic flows in the kinds of things I'm doing. So,

James Pinkston (01:17)
That must involve AI of some type.

Travis Richardson (01:19)
Yeah, part, yeah, it's always

Travis Richardson (01:21)
involved. The AI is involved in every loop typically. But you know, this one was, so one of the things I do for marketing is I use a heat map tool called Lead Snap. And it's a really cool tool because, and this is kind of shit, as an engineer, that's why I like marketing, because it's at least the...

Travis Richardson (01:44)
digital form and the analytical form of it because I can see the numbers and how they change. Anyways, it's a heat map and I was looking at the interesting thing where I did a search on a keyword search term. It was like wellness events in Asheville and I was comparing myself to some competitors in that regard.

Travis Richardson (02:08)
And I noticed on this heat map that my rankings were really amazing from the North, North Asheville up. So you can see the pockets where you're weak and you can see where you're strong. And the idea is I'm really weak in South Asheville. I'm really weak in some of those other areas. so like, so some of strategies is like, what if I produce content that actually targets and, and, and says,

Travis Richardson (02:38)
that I provide like you know services for South Asheville and some of the communities and so I'm playing with anyways we're dude I'm like sorry man this is supposed to anyways I'm gonna see see if I can move the needle

James Pinkston (02:53)
interesting.

Travis Richardson (02:53)
in in specific neighborhoods and see if I can change the because what this is telling you is that if somebody searches for you in that neighborhood you're not gonna they're not gonna find you

Travis Richardson (03:06)
So how can you market to those neighborhoods

James Pinkston (03:09)
That's a great tool.

Travis Richardson (03:10)
by like even the street name? So that's the shit I geek out on.

James Pinkston (03:17)
Well, Julie Brooke would love to hear that. I'm going to have to share that with my office manager.

Travis Richardson (03:21)
Yeah man, yeah,

Travis Richardson (03:23)
Somebody who likes to play with numbers and enjoys seeing how things, that's the kind of stuff that agencies do that for clients when they're trying to work with them is to use those kinds of tools to move the needle for them. All right, I'm gonna just start in here. Let me get to.

Travis Richardson (03:45)
Okay, all right. Well, all right. So we have Dr. Pinkston on the show. This is our second time. This is really exciting for me. There's a reason why I'm having him back on the show. That's because I loved the first episode that we did, and I couldn't wait to have him back on. So welcome to the show. Dr. Pinkston.

James Pinkston (04:05)
so much. I imagine it'll be a pleasure again.

Travis Richardson (04:07)
Yeah, so I

Travis Richardson (04:08)
continue to love what you're doing over there. Your business, Asheville Non-Surgical Orthopedics in regenerative medicine. And that is really in alignment, of course, with what we do or what I'm trying to do with this longevity series here.

Travis Richardson (04:24)
So we began where we always do, which is the story of what drew you to this practice. And so for those of the listeners out there that didn't hear the first episode, apologies to have you repeat yourself here, but what drew you to regenerative medicine and what does non-surgical orthopedics actually mean for those who haven't heard that term before?

James Pinkston (04:52)
can summarize it pretty quickly from a child, young impressionable child, looking at things like the action figures of the day, Arnold Schwarzenegger, having a fascination with anatomy, pursuing that, having the influence of my mother, who is an extreme caregiver of four children, and...

James Pinkston (05:22)
going into healthcare fields. So personal training, athletic training, leading to medical school, and in medical school, ultimately focusing on what I do now, neuromusculoskeletal medicine. And the field that I am practicing in really is orthopedics, but the non-surgical variety of that.

James Pinkston (05:49)
which means really treating any orthopedic condition with something other than surgery. And that could be the standard treatment that you might think of like steroid injections or physical therapy. Physical therapy is amazing. It's a big part of how I help patients, but also things that aren't part of your typical medical practice like regenerative medicine. And that's really

James Pinkston (06:20)
where I have expanded my services. That's the main thing that I focus on. And in a nutshell, that's just things you can do to get the body to heal itself. And there's a number of treatments in that category from various energies, sound energy like shockwave, laser, magnetic, and a lot of injections from really...

James Pinkston (06:45)
taken from the person. I call those biologic injections cellular therapy. So a little bit different perspective.

Travis Richardson (06:52)
Yeah,

Travis Richardson (06:52)
you know, it's when you think about injections, it's a breath of fresh air, honestly, to me, when I think about taking components of my own body and just using those to stimulate.

Travis Richardson (07:09)
growth factors and some of the other things that you talk about to induce healing. We'll talk about some of those here on this show. But before we do, I guess I imagine the kind of person that comes to see you, like me, when I first met you, I was really frustrated with some of the conventional.

Travis Richardson (07:33)
approaches and they all everything has their place. So I'm somebody who really believes that finding the right technique or modalities is the thing, not to dismiss all of them. who is your typical patient that you see and what are they usually, I guess, what are common frustrations that people might have when they come see you?

James Pinkston (08:00)
Frustration is a pretty good description.

Travis Richardson (08:02)
Mm.

James Pinkston (08:03)
We often see patients who've seen a lot of other providers to tried a lot of different treatments and they're really getting fed up and then they find our practice something to them seems much more alternative and They're frustrated because there's something that they

James Pinkston (08:28)
want to do or they're afraid that they won't be able to do in the future. Now, it's not always some grand competition, although sometimes it is. We've had a marathon runner very upset because they couldn't practice the way they want, they couldn't compete. And with some...

James Pinkston (08:53)
treatment to Achilles, plantar fascia, shock laser. Not only were they able to compete, they were able to win at least their age category, but not only that, the one below it. So they did really great. And there's also very simple things, like a grandpa, first time grandpa, and he had gotten to the point with his knees that he was having extreme difficulty getting up and down off

Travis Richardson (09:20)
Hmm.

James Pinkston (09:20)
of the floor. It was really mostly.

James Pinkston (09:23)
bending there was some pain but the range of motion was limited and they wanted to be able to play on the floor with their grandkid. So we did some cellular therapy with them. In this case some fat and we may talk a little bit more about that and

Travis Richardson (09:42)
Hmm.

James Pinkston (09:43)
much better. Not totally resolved but good enough. You pain under control, range of motion

James Pinkston (09:50)
nearly normal so that they could now get down on the floor, play with their grandkid and get back up. So little victories like that mean a lot to us and that's really our goal, kind of define what the patient is looking for and see what tools we have in our belt to help them out.

Travis Richardson (10:14)
Yeah, think that mobility, I was listening to a podcast, I don't remember who was talking about it, but the way they framed up longevity was that how well can you move in your older ages? Because if you can move well in your older ages, you probably are gonna have the kind of muscle that it's going to require to

Travis Richardson (10:44)
keep your blood sugar down and intact. You're gonna move your lymph system. It requires movement, so you're gonna have that be, you you're gonna be circulating lymph better. You're gonna be putting out lots of healing hormones. So I think that when it comes to longevity,

Travis Richardson (11:09)
making sure that you stay mobile so that you can have and do the kinds of exercises that are needed as you go along are important. So how do you frame sort of your philosophy behind keeping people healthy as they age? I know you and I talked about frailty and sarcopenia and those kinds of things. So guess what's your overall philosophy behind

Travis Richardson (11:38)
keeping people active. How does that show up for you in the practice?

James Pinkston (11:45)
One of my soap boxes that I'll inevitably get on is talking to people about staying strong and active. Those are the two words that I use when I say that's the secret to aging gracefully. And one of the bigger priorities for me to get across and communicate to patients is muscle mass and strength and

James Pinkston (12:11)
Maintaining or improving really at any age so I spent a great deal of time talking about strength training and That doesn't have to be necessarily with weights or at a gym There's all sorts of varieties of that but bottom line building and maintaining strength so you Maintain independence you can still do everything you want to do and You don't have to

James Pinkston (12:40)
rely on others or you don't lose the activities that you once enjoyed. And just from a pain perspective, which of course is really big in my practice, really the stronger joint, usually the more stable, usually the less pain. And even if it's not because of stability, just contracting muscles release proteins into the bloodstream that help with pain and inflammation.

Travis Richardson (13:06)
Hmm

James Pinkston (13:07)
So it's

Travis Richardson (13:09)
Say that again. You said contracting

James Pinkston (13:10)
It can't be understated the importance.

Travis Richardson (13:12)
muscle releases proteins that reduce, did you say reduce inflammation? I've never heard that. That's really interesting to me. That's super important to know. Say that again.

James Pinkston (13:23)
Yeah, that help control pain and inflammation.

Travis Richardson (13:26)
Okay.

James Pinkston (13:29)
So any form of strength training anywhere really, so if you have leg pain or just working your arms will help to a degree with

Travis Richardson (13:35)
Yeah. Sure.

James Pinkston (13:38)
that. It's not going to fix it. And it's also important to realize on the other end of things being sedentary and having more in this case, fat cells, adipocytes, they release

James Pinkston (13:53)
signals and proteins into the bloodstream that promote inflammation, which typically leads to pain in a lot of people.

Travis Richardson (13:59)
Yeah, interesting.

Travis Richardson (14:00)
One of the things I really appreciated in working with you and I was in the times I've been in to talk to you about my pain and what I'm going through. Lots of people know about my my neck issues.

Travis Richardson (14:14)
is the additional talk around all these other things. And I really appreciated that. I think that's one of the things I really loved about coming in. Now let's go move on to stem cells because I think there's a lot of confusion around these. I don't really even hear, honestly, like I don't hear a lot about stem cells. Like there was some, there was like a time where stem cells were in the news a lot. And I think it was really became pretty

Travis Richardson (14:45)
much into the mainstream's consciousness to know what a stem cell was with it. But there's a lot of confusion. So what are stem cell therapies and what are they actually doing inside the body?

James Pinkston (15:02)
The term stem cell, at least as it's used now, is really just a grab bag

Travis Richardson (15:06)
Mmm.

James Pinkston (15:07)
term. It's applied to many different things, doesn't necessarily mean something specifically. And yeah, it's even been in the news cautioning people against treatments like that because of certain bad actors. what stem cell...

James Pinkston (15:27)
could mean when people are using it. It could mean some sort of birth tissue product like amniotic fluid or umbilical fluid which don't have living cells in them but a lot of proteins and signaling molecules and that's really kind of how it all works is the signaling within the body. Some people even call blood products, platelet rich plasma stem cells.

James Pinkston (15:57)
None of those really have stem cells in them. In the United States, the two treatments that are actually stem cells would be tissues that have mesenchymal stem cells. That would be the classification, mesenchymal stem cells. And that is bone marrow and fat. Those are the two that are approved. So everyone has something that comes to mind when they hear the term.

James Pinkston (16:27)
but it's not embryonic. It's not the birth tissue products or the blood product. In the U.S. it's either fat or bone marrow.

Travis Richardson (16:40)
Yeah, so because

Travis Richardson (16:41)
like for me I always used to think it's really for some reason this idea of signaling as a signaling mechanism to help instruct and tell your body what to do better basically. I always think because I always used to think of stem cells as they're gonna grow something new. They're doing something, they themselves are growing new tissue.

Travis Richardson (17:04)
but it's not necessarily them that is doing that. They're acting as a signaling sort of like a traffic cop that is waving and telling what should happen next inside the body. So that's an interesting.

James Pinkston (17:22)
right that's a common misconception they think okay put these stem cells in they go become the new tissue

Travis Richardson (17:28)
Yes.

James Pinkston (17:29)
that I'm lacking say cartilage cells or a torn tendon or something and to a degree there seems to be some of that but the the real effect seems to be what those stem cells release into the area the environment they create

James Pinkston (17:49)
and they're just recruiting your inflammatory system, your immune system to come to the area and try to heal.

Travis Richardson (17:57)
So, okay, so this

Travis Richardson (18:00)
is a, you know, when I do these kinds of.

Travis Richardson (18:03)
these podcast recordings, I like to kind of keep a flow and talk, ask sort of sequential questions, but this one here makes me think, and this is just me wondering, all right, I'm gonna just say that it seems to be like a stem cell is a smarter form of a cell that has not lost its intelligence on what to do next. So.

Travis Richardson (18:31)
It seems to me that maybe as we age, the cells lose their ability to be smart about what they should be doing. I mean, we know that there's the senescent cells, which are zombie cells, essentially have lost the idea that they should, they're just no longer functioning like they used to when they were younger. Let's call it.

Travis Richardson (18:55)
So is a stem cell just a smarter, younger cell? Do you know where I'm coming from? I'm a layman here, but I'm like, this is how I'm thinking of them.

James Pinkston (19:12)
I would call it a more capable cell. So they are tissues that can differentiate. In this case, can really mesenchymal cells can only differentiate into musculoskeletal tissue. And normally in the body, yes, that's what they do. They do become the new tissue that you are looking for. But when harvested and injected, they're just more of like a

James Pinkston (19:42)
Director a conductor and yes, there's a bit of a innate intelligence That's pretty miraculous that it knows how to address the different pathological conditions whether it be tendonitis arthritis neuropathy all sorts of things the body just does know and is capable of How to heal itself

Travis Richardson (20:11)
What

Travis Richardson (20:12)
when we had our pre interview call we talked about and you introduced me to a new concept called.

Travis Richardson (20:19)
I don't, well, it had the word dysfunction in it. And I remember us talking about that. And the way that came up was that I was asking about somehow, and I think you made mentioned that there's times where you could have two different patients coming in with very similar presentations, structural, maybe they both have structure structural damage and one is in dire straits pain ready for surgery. And another person's not that bad off, but yet you look on a, on a X-ray or something.

Travis Richardson (20:49)
and you wouldn't be able to tell the difference. so pain doesn't always map to what you see on an x-ray. And then you talked about this idea of dysfunction. I think this may be like a dysfunctional cellular environment or something like that. What are you talking, can you talk more about that?

James Pinkston (21:12)
Yeah, I can. You're right in pointing out, for one, differences in people, their presentations, how they respond to treatment, and health status. And a lot of that boils down to the environment that we'll just talk about a joint to make it easier. So the environment that that joint is in.

James Pinkston (21:41)
the environment of the inside of the joint inside the synovial membrane. You know, there's fluid floating around and there's proteins floating around. There's cells in the area. It all has a function. It all has a goal and action that it should produce. And there's various states of that. There is what you would like a normal healthy, you know,

James Pinkston (22:10)
state of homeostasis where everything is as it should be. And then there are what I often see is inflammatory states, which is totally different. And you were hinting at imaging not being able to predict people's pain. Absolutely. There's not very much correlation at all between let's say

James Pinkston (22:39)
degree of arthritis seen on imaging and the symptoms that that produces in the person. Really, it seems to be due to the environment, how everything is functioning within the joint. And if it's in that chronic inflammatory state, tends to be a lot of pain dysfunction versus more of a healthy, relatively pain-free state.

Travis Richardson (23:02)
Okay,

Travis Richardson (23:03)
so yeah, so what that is for me is that's a bit of a message of hope because what it means is that maybe somebody is coming in, they're saying, look, I've got bone on bone, man. I don't think you could help me. Or...

Travis Richardson (23:20)
You know, I've been told by everybody that I gotta go, I gotta get surgery. And it might be that they do need surgery. It may be, I'm not saying it's not. For some percentage of those, my guess would be that if they can do all the things, let's say, improve their, you know, have improved their nutrition, maybe, yeah, try to reduce inflammation through, you know, not eating lots of bad stuff, maybe reduce alcohol consumption,

Travis Richardson (23:50)
that's a big, a problem, not a problem, something that would be beneficial, and then come get some treatment that would help reorganize and make that environment better, then you may have somebody who does have bone on bone where they can function much better than they were.

Travis Richardson (24:14)
before prior to having a disorganized system. I guess what I'm saying is that it feels like everyone could be a candidate to be helped. You'd have to see how it goes.

James Pinkston (24:30)
That's true. There's plenty of reason to be hopeful. Almost regardless of what imaging says, yes, some cases are certainly surgical, but even really severe end stage arthritis can have excellent results with the things you mentioned, which was lifestyle modification, living in a healthy manner, what you eat, drink, activity level.

James Pinkston (25:00)
and a procedure in their regenerative space, whether it be a cellular procedure, platelet-rich plasma, et cetera. Those things together, they can really just change function. And that can often lead to what they're looking for, which isn't necessarily a brand new joint. People want to feel better, and they want to be able to do the activities

Travis Richardson (25:29)
All right, tell

James Pinkston (25:29)
they love.

Travis Richardson (25:30)
me about PRP, platelet-rich plasma. I had that done. I know you do a lot of it. Tell me about that. Who gets that and what for, what are the kind of conditions that you use that for? Platelet-rich plasma.

James Pinkston (25:53)
Platelet-rich plasma is a blood product, which means you draw some of the patient's blood, you spin it to separate out the platelets, and you inject mostly the platelets just in a little bit of plasma, which makes it platelet-rich plasma. So basically, you're taking what's in your bloodstream, concentrating it, and injecting that into the person, because those platelets contain a great deal.

James Pinkston (26:21)
of the signals that we're talking about. They're proteins and when they are injected into an area they release them and they create the signal that you're looking for a much stronger signal for healing than typically happens just with injury because that does happen with injury but with something like platelet rich plasma greatly amplified and it works excellent for

James Pinkston (26:52)
We'll say up to moderate arthritis, so not typically end stage severe. And most tendinopathies, unless again, they're more severe like a large tear. And after one to two months, a lot of people are feeling a lot better, especially coupled with the lifestyle changes and importantly strengthening of the tissue in that area.

Travis Richardson (27:18)
Can you

Travis Richardson (27:20)
give me an example of somebody who came in and got either stem cells? I mean, you did give me an example of the marathon runner.

Travis Richardson (27:32)
Any other therapy that you can give us an example of somebody coming in and kind of obviously results vary. So this isn't saying that this is what everyone would experience, whatever it is you come up with, but somebody coming in and knocking it out of the park and who also then who also took care of the other components, which is lifestyle. They did everything right. And like what.

Travis Richardson (27:55)
Give us an example. It could be shockwave, could be laser, the PRP, stem cells. One more example of good results.

James Pinkston (28:08)
Well, we were talking about PRP. There's a, had a few cases like this actually of patients traveling to Europe in particular because there's a lot more walking there or the activities that they had planned involved being on their feet a lot more. a certain patient has come into mind that was beginning to develop symptoms, arthritic symptoms in the hip.

James Pinkston (28:37)
and yet they could still walk but they couldn't go very far and this was an anniversary trip with their you know spouse and they've been planning it for over a year and suddenly there's pain and they're looking at well in two months I'm going to be in another continent I don't know if I'm going to be able to experience all the things I wanted to experience so certainly not enough time for something like surgery

James Pinkston (29:06)
But a few months can change the way someone is feeling pretty dramatically with more of a biologic solution, a regenerative medicine solution like platelet-rich plasma. So we did an injection into the hip joint. It gets a little sore at first, but then pretty quickly they start to see within a couple of weeks they're doing a lot better. And in this patient,

James Pinkston (29:36)
they were able to go on the trip and not

Travis Richardson (29:39)
Mm.

James Pinkston (29:40)
even think about the hip. They just enjoy themselves, enjoy their spouse, celebrate the anniversary, and then come back with excellent memories. And I do wish that I could help everyone. It's worth noting that, yes, not everyone, but the percentages are pretty good using the concepts of the body healing itself.

James Pinkston (30:04)
and amplifying what the body is capable of with these regenerative medicine techniques. But there is always the homework. There's always the patient's participation. with their help, it's hard to treat someone in spite of themselves. But usually the people who come to me are pretty motivated. And you can have really significant results that are long lasting.

Travis Richardson (30:30)
I

Travis Richardson (30:30)
find it really interesting to see that what people do, how much it matters what you do to increase your ability to heal this movement away from taking just essentially a chemical compound.

Travis Richardson (30:53)
a pharmaceutical for instance, having that be the only thing that you're told can help you, which I have experienced firsthand in various ways in my life where it's like there's a very cultural mindset that this intervention that's being done usually to you is

Travis Richardson (31:21)
the thing and they you when we when we synthesize and we test drugs pharmaceuticals the whole goal is essentially to make it work the same across all populations or we that's the goal right we try and have the highest cure rate whatever across populations and there's not really a consideration of of what the patient does to influence their

Travis Richardson (31:51)
their outcome. And that's not really something that's done that says, hey, take this. But if you do, by the way, when you take this, if you do these other lifestyle factors, you're gonna increase the impact of this drug by 30%, whatever it might be.

Travis Richardson (32:07)
That's just not study, those are not. But the thing is that those are, that's likely real, such that whatever drug that you're taking, the state of the body at time of you're taking it, matters. And it's gonna impact how much of it you might, your tolerance level, your absorption level.

Travis Richardson (32:30)
That kind of thing. Now with PRP, you and I talked about the fact that it matters what you do. There's some research, right, on what you do to enhance that. So I guess share with us about that and any other things. Like let's say somebody's wanting to come in and they're gonna do some PRP or something with you and like what can they do lifestyle-wise to make it big a bang for their buck, I guess, for lack of better terminology for it.

James Pinkston (33:01)
Yeah, it is helpful when patients are living what I guess I would consider generally a healthy lifestyle. So that would mean avoiding processed foods, avoiding or at least limiting alcohol, smoking, consistent exercising, being well hydrated. There's a number of things that can kind of increase the quality of the platelet-rich plasma. And that's just...

James Pinkston (33:31)
talking about the blood draw after the procedure, those things become even more effective. One is not getting in the way of the processes that are being started. So avoiding things like anti-inflammatories, really all kinds of anti-inflammatories. even advise people in the supplement realm, if you think it might be anti-inflammatory, just in case even ice.

James Pinkston (34:00)
try not to use it. And that's how we know, that's the things we know we can do to create a better quality, platelet-rich plasma. I think interesting is gonna be in the future, the things we learn to predict and enhance outcomes even more. How do we make?

James Pinkston (34:28)
individualized platelet-rich plasma, not just concentrating it, what we get, taking it, sure concentrating it, but how can we adjust it in the lab? But for the patients themselves, if they're willing to take some degree of responsibility, most of them do quite well. But if they

James Pinkston (34:58)
are eating a pretty poor, highly processed diet. They're mostly sedentary. They're regularly consuming alcohol and smoking. They can still have good outcomes, but not to the same degree.

Travis Richardson (35:16)
Can

Travis Richardson (35:17)
you actually see visibly? Can you do a draw on someone and be like, wow, look at those platelets? Or man, we got to work on the lifestyle. These platelets aren't too shiny. Can you visibly see it? Is that something you can actually see?

James Pinkston (35:37)
Yeah, but not with my setup. No, that would be very nerdy laboratory setup.

Travis Richardson (35:42)
See, that's that's like That's

Travis Richardson (35:45)
my that'd be my team. I probably waste a bunch of money on like on that

James Pinkston (35:53)
Now when hit home you can show somebody very obviously look what you're doing to yourself

Travis Richardson (35:57)
Yeah, look at these platelets. They're just

Travis Richardson (35:59)
screaming for some attention. How about,

James Pinkston (36:05)
It's saving.

Travis Richardson (36:06)
what do you know about peptides? Are you interested in ever using those? Do they help? Are they?

Travis Richardson (36:14)
You don't use peptides currently, that right? Yeah, okay. Do

James Pinkston (36:20)
That's right.

Travis Richardson (36:21)
you know, are there any synergistic, have you read any research on any synergy with supplementing with peptides? Do they help stimulate any further growth or any, activate any platelets further? Or do we know that? That's probably too early to know, maybe.

James Pinkston (36:42)
I think that's the bottom line. Yes, you know, much more

Travis Richardson (36:45)
Yeah.

James Pinkston (36:46)
research is needed on one, effectiveness, two, safety. I think that's the biggest one, safety. Data is just very limited. I worked with a number of patients who use various peptides. In my space, the musculoskeletal space, they've been using them for many years.

James Pinkston (37:11)
paired with regenerative medicine does seem to have some sort of synergy with certain peptides. And I haven't seen bad outcomes. It's just really a theoretical, the what if game. And I look forward, I think now we're going to be able to do more research into those types of things. Peptides are also proteins and they work.

James Pinkston (37:39)
in the same way we've been talking about signaling as really more kind of designer signaling, you know, how can we have this specific effect and not these negative effects? I think that's likely going to be a big part of medicine in the future and pairing them together is going to be important. And some people do that on their own and they've been doing well. So I can't say a whole lot on it, but

Travis Richardson (38:09)
I think

Travis Richardson (38:09)
we're going to have AI

James Pinkston (38:09)
Those are my thoughts.

Travis Richardson (38:10)
will probably in the years to come be able to model some of these and then the experiments will be ran where they'll go off and test the suggested model, the suggested framework, the suggested protocol and we'll more quickly have resolution to do does this work.

Travis Richardson (38:32)
does it not because we aren't going to be scanning through an infinite set of possibilities. AI will help us narrow down what should we try first. That's what I think. All right, let's talk quickly about insurance and then we'll get wrapped up here. So in reality, insurance is painful for everyone. Practitioners.

Travis Richardson (39:00)
clients, patients alike, we all are in a system that isn't amazing. But that's a sticking point for a of people. I guess what in your opinion do you have to say on insurance? I know you're a cash-based business. What's your kind of like stance on insurance?

James Pinkston (39:27)
Insurance is a difficult topic and it's not a great system. It's not really a patient forward system, I suppose. I would say more of a business model rather than anything else. And in my situation, unfortunately, insurance is not covering a lot of these regenerative techniques.

James Pinkston (39:56)
I do think that in the future they will, but the tendency is to lag behind maybe 20 years and require a enormous amount of research. And even when you can use something, you can only use it for say one specific indication like knee arthritis or shoulder arthritis. It's very specific in that way.

James Pinkston (40:23)
So unfortunately, it's hard to treat people when another entity is telling you the tools that you have. You can only use these things for these situations. Okay, do the best you can. And that doesn't lead to optimal outcomes by any means. And we like to think that

James Pinkston (40:53)
if insurance would cover some of these things that even from their business model perspective, they'd probably come out ahead. They'd prevent a lot of things that they do end up having to pay for in the future. But currently it's just kind of a disappointing system.

Travis Richardson (41:09)
Yeah, it is. I'll

Travis Richardson (41:11)
quickly tell a story just because it's super like crazy relevant here. My son had a bacterial infection when he was in his teen years. maybe I've told the story, but it's worth telling again, because it's exactly this point. He got treated with metronidazole. It's a powerful antimicrobial.

Travis Richardson (41:34)
It worked. then what happens is, as we know, many of the listeners will know antibiotics will often kill off the whole, it's like a nuclear bomb going off, right? So everything gets destroyed, but then you've got lots of.

Travis Richardson (41:50)
opportunity for pathogenic bacteria to creep back in. And that's what happened. So then he actually developed a C. difficile infections, AKA C. diff. For those that don't know what C. difficile, difficile stands for difficult, difficult to treat.

Travis Richardson (42:11)
It's a bacteria that's often seen in hospitals. You don't want that one. You'd like to not have that. Well, if you have a weakened immune system and you have that, you really don't want it. So anyways, I did some research on this and I found that...

Travis Richardson (42:30)
was that fecal transplants were 95 % cure rate, like outstanding, just like remarkable cure rate for infections like this. But the insurance protocol, the standard of care protocol that insurance requires is that you must treat with vancomycin three rounds before...

Travis Richardson (42:58)
you're indicated for a fecal transplant. So we, my son had a C. difficile and we treated him literally vancomycin wiped it out. Right. But guess what? It came back. Vancomycin wiped it out again.

Travis Richardson (43:13)
Guess what? It came back again. Vancomycin wiped it out. Finally, he qualified for a fecal transplant because it came back. Maybe it was the third time. I don't remember exactly, but anyways, it came back and finally the fecal transplant was curative. Finally, which makes sense at that cure rate of 95%. Vancomycin was like 40 or 50 or 60. It was like a lot worse.

Travis Richardson (43:41)
And the point of the story is that, well, what happened was he actually then developed ulcerative colitis. And my thought was, is that his system had went through metronidazole one round, three rounds of vancomycin, and finally the curative fecal transplant. Now you either say one or two things. The fecal transplant caused his system to freak out and give him ulcerative colitis.

Travis Richardson (44:08)
or the overall trauma of all of this combined. And my thought was it was probably the over-treatment with vancomycin. And anyway, if I were a doctor and I was looking at this, I'd say I wished I would have just been able to treat him with a fecal transplant because the cure rate is double, maybe triple that of the standard protocol, which is really dismal and very powerful.

Travis Richardson (44:36)
And anyways, it's a personal story, but it highlights the way that sometimes a physician might be handcuffed to a protocol that may or may not make sense depending on the client or the patient in front of them. So we don't need to drone in on drone about that. Any reflections, I guess you'll probably just shake, nod your head and say about right maybe.

James Pinkston (45:02)
Well, it is a shame when medicine becomes more of an algorithm rather than an art.

Travis Richardson (45:05)
Yeah, perfect.

James Pinkston (45:08)
even physicians who take the oath of do no harm, they can't even uphold that oath based in the set of rules that they have to play in. Unfortunate.

Travis Richardson (45:19)
Well, that's perfectly said. And

Travis Richardson (45:20)
I would also add to that is that with AI, for better or worse, the algorithm is probably going to be, the idea of it being an algorithm is going to be perfected.

Travis Richardson (45:35)
will maybe serve some better and others will lock them into something that's even harder to get out of. Anyways, I don't mean to be negative. feel like I'm really being negative here. But I like the idea of it being an art. I like to keep it that way. I'd like people to not be so seen as something that's robotic and algorithmic. We have plenty of that already. Well, I'm happy anyways, I am happy that you're doing what

Travis Richardson (46:05)
you're doing that you're allowed the flexibility because of the model that you have and it's why I have you on the podcast because I want to see and make sure that you're as successful as you absolutely possibly can be. You helped me and I know personally people that you've helped as well so I just really love the work that you're doing. Speaking of which, for somebody curious about your work what's the next step? How do they find out about you? What do they do?

James Pinkston (46:34)
simply reach out to the office, again, Asheville Non-Searchical Orthopedics. You can find our website, ashvillenso.com. You can certainly find us through a web search. Really just give us a call. It's not an office that requires a referral. And we'd be happy to try and help anyone who's looking to get through a difficult time or condition.

Travis Richardson (46:59)
Awesome. Well,

Travis Richardson (47:00)
I continue to send people your way and thank you for your time. Really appreciate it.

Travis Richardson (47:10)
Hey, all

James Pinkston (47:10)
Thanks Travis.

Travis Richardson (47:10)
right, we did it. It's a wrap. Awesome. Sorry if I got a little long winded there on the story and maybe a little negative there. was trying to like, I'm like, hey, keep it, keep it, keep it. But you know what? It speaks to a lot of the, a lot of folks.

James Pinkston (47:27)
Yeah.

James Pinkston (47:34)
Well, here we are right at the end having connection issues,

James Pinkston (48:04)
Yeah, I was dying before I got on I had to cookie monster it in real quick

James Pinkston (48:14)
I'm

James Pinkston (48:20)
yeah?