Orthobiologics: Laser, PRP, or Both? How to Choose the Right Protocol | Conversations in Regen Ep.17

Confused about whether to use MLS laser therapy, PRP, or both in your orthobiologics practice? Discover how to choose the best protocol for your patients today.
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In this episode, Dr. Ariana DeMers, the Queen of Business Orthobiologic, is joined by Dr. Marc Pietropaoli to dive deep into the evolving landscape of regenerative medicine. They explore how MLS laser therapy and platelet rich plasma therapy (PRP) can work together or stand alone to treat orthopedic conditions, and how doctors can determine the best approach for their patients. With a focus on orthopedic innovation, Dr. DeMers and Dr. Pietropaoli discuss the science behind both therapies, the advantages of combining them, and why some conditions may respond better to one treatment over the other.

Dr. Pietropaoli shares his expert insights on how laser therapy can enhance PRP outcomes and why it’s becoming an essential part of regenerative protocols. This video offers valuable clinical insights for doctors looking to integrate MLS laser or PRP into their practices, optimize patient outcomes, and stay ahead in the rapidly advancing field of orthobiologics. 

Building a successful cash-based orthobiologic practice is not a single decision. It is a series of the right decisions made in the right order. The Business of Orthobiologics offers three distinct programs designed to meet physicians at different stages of readiness — whether you are just beginning to explore PRP, ready to build a full practice system, or committed to going all-in on a comprehensive transformation.

Learn More here: https://thebusinessoforthobiologics.com/programs-explanation 

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Transcript

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SPEAKER_01 0:00

Laser absolutely can help, I think, acute injuries heal faster. It can help nerve injuries heal. It's not going to grow back new cartilage when your mitochondria work better, right? Everything else works better. It makes old fibroblasts behave like young fibroblasts. If you want to get to the 90-95% good results, learn how to use that handpiece is really important.

SPEAKER_00 0:21

If laser truly enhances PRP or other biologics, why are they not built in to all standardized regenerative protocols yet? Welcome, welcome, welcome. All right. So I want to welcome you all to conversations in regenerative medicine where we explore frontiers in PRP, BMC, and MFOT. And this is a series that is with the pioneers of regenerative medicine, where we maybe tackle some more controversial topics and undercover cutting-edge insights that are shaping the future of interventional orthobiologics. So this is where we're gonna start today. For those of you who don't know me, I am Dr. Ariana Demers. I'm a board certified fellowship training, sports medicine orthopedic surgeon and a regenerative medicine enthusiast. I do a lot of ortho training and education both in orthobiologics and ultrasound. I have successfully moved my practice in rural Northern California away from insurance. And I am passionate about helping doctors incorporate orthobiologics seamlessly in their practices. Tonight it's my distinct pleasure to bring to you Dr. Mark Petra Pauli. He is my friend and uh colleague. He is also a founder and CEO of Victory in Motion, which is home of knee repair, not knee replacement program, as well as Victory Sports of Medicine and Orthopedics. He is a fellowship training sports of medicine orthopedic surgeon with 27 years of experience in boards of medicine orthopedic surgery. He's boards certified. He did uh complete his fellowship at the illustrious American Supports of Medicine Institute in Birmingham, Alabama, under Jane, Dr. James Andrews. And he is also passionate about orthobiologics and regenerative therapies. So, Mark, thank you so much for joining us today. It's such a pleasure to have you. I'm so glad you're here and you know, talking about maybe a couple of things that are a little bit more controversial.

SPEAKER_01 2:51

Great to be here. And I I will say you were totally incorrect about one thing. You know what that is?

SPEAKER_00 2:57

What?

SPEAKER_01 2:58

You said you're an orthobiologics enthusiast. I think you're an expert, so we'll we'll give you that.

SPEAKER_00 3:05

Okay, okay. Thank you, thank you.

SPEAKER_01 3:07

You're not an enthusiast, you're an expert.

SPEAKER_00 3:09

I I'm I'm obsessed. How about that? Uh so I want to thank everyone for joining. Uh we like to hear from internation renowned experts in regenerative medicine, explore controversial topics, and gain some really actionable insights that you can implement in your practice immediately. And then there's gonna be a QA session. So here's the deal Orthobiologics, in my opinion, will be a first-line treatment for musculoskeletal care in the next five years. And the train is leaving the station. And if you are not actively offering these treatments for your patients, you gotta get on the train. So, however you figure out how to get on the train, you gotta get on the train because the train is leaving the station. Here's the deal successful integration of orthobiologics is hard, right? I know many of you are looking for a successful orthobiologics in practice, but it's hard. You know, we know ortho biologics and treatments are the best treatments for our patients. But how to be successful in this cash-based world? You know, maybe you've tried some things, maybe you're saying to yourself, I don't know the science, I don't know the techniques, I don't know cash business, I don't know marketing. And, you know, if you tell me that I have to do more sales, I'm gonna poke my eyeballs out. So maybe you've thought, or maybe someone has told you that you're not good at business, and it's not our thoughts. We didn't learn this in school. You know, maybe some of you are struggling with how to be successful and capitalize on the four billion dollar worth of biological market out there. Yes, I said four billion, which is quite something. And I'm sure all of you who are in standard insurance-driven practice, you're thinking we deserve more. And why is this so hard? So, how do we win, right? While we are talking about the science today, we also need to consider how we can talk about this with our patients. So we all win. And just like everything that we've learned in medicine, you need a system. Now, we are not gonna go all of the over this today, but we are gonna get a little further down this journey to be wildly successful in your orthobiological practice with the knowledge piece. So Mark, let's get down to business. We have questions for you. And our first question is we're talking about the science and also how to consider this with our patients. So is laser therapy actually regenerative, or are we redefining regeneration as to just justify better pain control?

SPEAKER_01 6:09

All right, so that's the question. I think my answer is that laser therapy as we currently know it, because I think we've only scratched the tip of the iceberg, as I'm sure you agree with, especially having visited Italy and all the amazing things that just ASA Laser is doing themselves. Right now, it's not necessarily regenerative. And I don't think any laser company is saying that they truly regenerate tissue. It's definitely part of a regenerative medicine program, and it's regenerative supportive. I don't necessarily think that anybody's proven that it grows back new cartilage or muscle or tendon or anything like that. There is evidence that it stimulates fibroblasts, as you know, and so fibroblasts obviously lay down collagen, and so it there probably is increased collagen production, etc. But I don't think structurally it's actually regenerating anything definitively. So I would say it's not regenerative in and of itself, and I wouldn't say that the laser is going to regenerate anything, but I would say it's part of a regenerative medicine supportive protocol, for instance. And again, I don't think we've I don't think we've fully tapped into I think laser could become regenerative, and I think with the right dose, the right presentation, the right wavelengths, the right hertz. I mean, there's so many variables, right? It that it it could become regenerative. And in my mind, I do feel the Star Trek tricorder is going to happen someday. Ultrasound is going to be the how we look inside or some other imaging and laser or the ultrasonic waves or things like that are going to be utilized to help heal, but also maybe even if focused properly, perform surgery, partial meniscatomies, things like that. So I don't think we've really reached the full potential. But right now, long answer, it's not regenerative, no.

SPEAKER_00 8:03

And and maybe going one step farther, and I'm just you know, thinking out loud, picking your brain, because there are so many people out there that are are jumping on this. Oh, I do regenerative medicine, bandwagon, and then the question is is is it what is that definition of regenerative medicine? Is it you know improving regeneration of tissue, just improving your ability to be healthier, have better mitochondrial activity, modulate inflammation, neuromodulation? Like, where do you draw that line or where what would you lump into this regenerative medicine, you know, catch-all phrase? And does laser, you know, can you put that in there?

SPEAKER_01 8:52

Right. The so from an FTA and FTC standpoint, I don't think we can we can really can't say that we're regenerating anything pretty much with any treatment that we're doing currently from a regulatory standpoint. So you should start regulatory first. But if you look at the all the government websites on an FTA website, FTC, etc., they do talk about regenerative medicine. So that is actually a term that the government uses, even though some, as you know, some attorneys, some healthcare regulators still feel we shouldn't even use that term technically. But I just think to me, there's no definitive definition of it, but really regenerative medicine is using the body's ability to heal itself and us helping the body do its job. So I just look at it that way. And I do think maybe I shouldn't say this, but I do think there are ways to regenerate tissue, but technically we can't say that yet. But I don't think laser necessarily at this exact stage is doing any significant structural regeneration of tissue.

SPEAKER_00 9:55

Great. Yeah, I I tend to agree with you that that that term regenerative medicine is how we help the body heal itself. And I do think that lumping laser into that does laser does help the body in that supportive role. So my next question is advocates for the MLS laser say that it reduces inflammation, improves circulation, and accelerates tissue repair. So why do outcomes plateau without PRP or you know, if if lasers work so well, can it be a standalone replacement for injections? Or what else is uh going on here?

SPEAKER_01 10:38

I think that's a great question. And I think I'm a good example of that in that I was exposed to actually laser therapy back in the late 90s, early 2000s during my fellowship in Birmingham. Kevin Wilkes, huge laser proponent, physical therapist, doctor of physical therapy, really ahead of his time using laser, you know, forever. And I was also exposed to very early PRP. It was probably mostly blood, frankly. But so I was when I went into practice, I started utilizing laser was too expensive. I as time went on, I started using PRP, but I didn't know, like you're teaching the business of earth biologics, and you say a business on the slide. I didn't know anything about anything about the business, which we're not taught, right? We have no idea. So I had no idea how to present PRP or biologics, or even laser if I had it at that time, to my patients. And obviously, this is great that you're teaching this type of stuff because you need to be able to do that as well, so you can deliver the best care to your patients. So eventually what happened was yes, I was dabbling in PRP. I did have an ultrasound, I had been using PRP for probably nine years before I bought my first laser. But once I bought the laser, that's a significant investment, as you know. And it's a lower entry point cash outlay for a patient. So instead of saying, oh, we're gonna charge you $800 or $1,000 for a PRP injection, which is very very low, by the way. That was like back in the past. But we would say, well, we can we can do lasers, you know, we can do laser treatments, $60 or $70 a treatment, six, twelve, twenty-four treatments, and it wasn't as much of a cash outlay out of pocket for the patient. So in my experience, I started my practice, really started doing a lot of laser, just standalone laser, as you say here, back in 2017, 2017, 2018, 2019. 2020 is when I really started, even before that, I started listening to Dr. Herntigo and the bone marrow and all that, maybe 2017, and this study came out in 2020. So I started doing that more then. But I did a lot of laser by itself. So you're absolutely right. It does decrease inflammation, increases blood flow, stimulates the mitochondria, so it energizes the cells, it decreases, you know, it inhibits the painful nerve fibers and gnosisceptors, so it can it can relieve pain. So it's relieving pain, it's decreasing swelling and inflammation, it's increasing blood flow. So it is helping healing. If you do an ultrasound or an MRI of an area that's injured and you do laser on it, you're gonna see it changes, it improves, it goes from white to normal tissue on an MRI or reverse on an ultrasound. So, but if it's a chronic condition like arthritis, it absolutely can help the pain, it can help the inflammation go down, it can help the swelling, but it's not going to give the longevity of relief that a PRP or a bone marrow or together, etc. would. And also it's not going to make someone's mechanical problems get better, it's not going to help someone's muscular imbalances get better, it's not going to help their gait abnormalities. So I started thinking more in a global way. So laser absolutely can help. I think acute injuries heal faster. I think there's some there's proof of that. It can help nerve injuries heal, there's proof of that. It can help symptoms from arthritis, it's not going to grow back new cartilage. So those types of chronic conditions usually would need a maintenance. You might you might treat them once, you know, once they get their 12 treatments or 24 treatments or whatever you decide, and they're 85, 90, 95% better, then maybe once a month just to re-energize those mitochondria or twice a month, or whatever you choose works best for you. So it it can be a standalone, but it it doesn't it usually, if it's an acute injury, it can help it heal, but if it's more chronic, you're gonna need some type of maintenance. Whereas with PRP and bone marrow, you're gonna have a lot longer um outlay before you may have to ever repeat it. I mean, frankly, I've I can't recall anybody I've ever repeated bone marrow on, frankly, but that's just and PRP gives you longer relief as well. So I hope I answered the question. So can it be standalone? It can be standalone, but you're gonna need to do some maintenance for a chronic condition. And it still works, it works great, but it's not structurally changing anything. And so, as you know, I treat things and you treat things more globally. We do programs. I started out doing just a shot or just laser or just, but when you do a whole program, you're gonna account for all those, and including diet, right? Diet, hormones, right? Everything. So it can get very, very the more you know, the more you realize we don't know, right?

SPEAKER_00 15:16

Right. The more you know, the the the the slower you're like, oh my gosh, what else don't I know? Yeah, absolutely. So I I agree. I do offer standalone for certain conditions, especially those acute conditions, strain sprains, those work quite well. And then in combination with my PRP BMC fat interventions, I'm using MLS, and we do have that evidence that it does actually improve the outcomes when in given in combination. So we still have more questions for you, my friend. So our next question is are we confusing this biological plausibility with clinical proof when we're talking about laser outcomes? You know, we know from a biologic plausibility that mitochondrial activation happens, AATP upregulates nitric oxide cycling. This all sounds really compelling. But where do we cross cross from plausible to proven clinical effect? And should regenerative medicine demand maybe a higher bar than you know the uh traditional pain management medicine historically has.

SPEAKER_01 16:32

There's a lot of questions there, but I know, I know. Yeah, I mean, well, there is biologic proof that laser, there is scientific proof that laser laser does, as you just said, improve the biologic milieu and the physiology, and it's kind of like preparing the fields before you plant the seeds type thing. I'm a gardener, so I like to use that. It's also like sunlight, it get and energizes your mitochondria. When your mitochondria work better, right? Everything else works better. It makes old fiber blasts behave like young fibroblasts. It probably makes old platelets behave like young platelets. No one's done that study yet, but the fiberblast one's been done. So, I mean, I think there is biologic proof. The clinical proof is more patient-reported, just like data biologics is all patient-reported outcomes. And there is proof that just a PRP shot alone is going to help, you know, people's pain goes down and their function goes up if you look at those two graphs. If you use laser, their pain goes down further and faster if you combine it with the PRP. And if you combine it with the PRP, the function goes up faster and goes up higher. So I think that's some of our clinical proof, but should there be better, maybe actual, you know, that's patient recorded outcomes in data biologic showing this, but are there definitive studies showing that laser improves uh orthobiologics? And I don't know as though we have randomized double-blind studies that show that yet, correct? Would you agree?

SPEAKER_00 18:06

I would agree. We don't have those studies yet. Don't uh give me uh something else to do right in my spare time. But yeah, I I I do know that that does exist in our real world data from data biologics, and that is covered underneath an IRB. So I suspect in the next little bit there will be some publications coming out for that real world data. What we do know is that the FDA is taking a very interested look at real world data as a corollary to those randomized controlled trials. And they are putting quite a bit more weight on that real world data. So that's good news for all of us who you know are in private practice and are collecting data and you know, frankly, don't have the wherewith or the resources to run a randomized control trial. I also think that, you know, as we collect these massive data sets, the translatability between patients in the real world starts to become much more compelling. So if we can find that in the real world, that it does decrease pain quicker and more and increase function faster and better. Well, I think that that may be pretty darn compelling to be able to add laser therapy. So I do think we are further along than just the biologic plausibility. Um and I think we do have some early clinical proof about laser outcomes when we talk about uh regenerative medicine or PRP or or the biologic in combination with laser. So I would 100% agree with you.

SPEAKER_01 19:46

Right. I mean, it would be very interesting to see if we had a right, a sham laser that was, you know, you did PRP and one group got the sham laser with the PRP and one group got the laser. I I'm I would be blown away if there wasn't an improvement with the real laser, but you know, you never know until someone actually does that study. As Don Buford always says, the same thing, you know, also like really what matters most is what you know the patient, you know, what comes out of the patient's mouth. That's the best outcome study of all. And if they're doing better, they're doing better. That's that out ultimately that is what you know this is all about. But it would be very interesting to see those studies done. Someone's just gonna have to do them.

SPEAKER_00 20:26

Right? All right, everybody on the call. Let's get going.

SPEAKER_01 20:29

I have laser, I'll help.

SPEAKER_00 20:30

I don't yeah, no, have laser will travel. So we still have more questions. So, does laser therapy in your practice improve outcomes or just across the board improve patient satisfaction scores? You know, patients feel better with laser, right? But does this feeling better correlate with longer durability, longer-term joint health? You know, are we measuring the right endpoints? Is patient satisfaction the appropriate endpoint to measure?

SPEAKER_01 21:04

It's a nice one, it's one of many to measure, sure, for sure. I mean, because oh, someone has great range of motion and they can they can do all these activities, but if if they're if they're not happy, then they're not happy. That's not you know, so you do you do want to know what their satisfaction level is. Function is just as important as pain relief in my mind. So laser therapy is very good for decreasing pain, and I do think it does help improve function, but I think there's more, you know, I I strongly believe in the physical medicine and the total body fitness and the you know, physical therapy rehab aspect of things. I think that significantly improves function. So measuring pain relief is important, measuring function is really important. So those are the two main things we look at when we look at our data biologics, and we do look at but we do look at patient satisfaction. I think ours is 94% right now, and you know, it was not. 93 at one point, and we're always trying to get better. So it it helps, it does help you try to get better. And you do want to see people in the you know 90s. No one's ever 100%, you know, accept death or taxes when you look at a whole group.

SPEAKER_00 22:13

So yeah, absolutely. Yeah, I would agree. And and and I do think one of the things we haven't talked about from a patient satisfaction standpoint is they get more touches from your team. They get to come back and get loved on 12 extra times. They get that attention, they get their questions answered, they get all of that other piece that that intangible that really helps, I think, drive satisfaction as well. Is you have 12 extra times to prove that you are you know better, different, worth the weight, whatever, because you're giving them this extra time, this extra modality.

SPEAKER_01 22:59

I love it. It's great insight.

SPEAKER_00 23:02

So, our final question for you if laser truly enhances PRP or other biologics, why are not they not built in to all standardized regenerative protocols yet?

SPEAKER_01 23:14

Well, I think they are starting to be built into for sure. I mean, I I have seen an absolute explosion in the amount of laser being used. And really, it's been over the last three or four years. I mean, you and I remember back maybe when 2022, 2023, and the group that we were in, the mastermind that we were in, you know, hardly anybody had laser, but little by little, more and more people got it. And now you go to these conferences, and it's amazing how many people are using laser. So I do think it's getting, it's gonna be and also show showing the data biologics results that it does improve outcomes. I I think you're seeing a lot more people do it. I mean, I think cost is, you know, there is it is there is a cost to acquiring equipment. So that leaves that that you know, some people don't know how to handle that part of things, but it's it's a you can get a pretty pretty good return on your investment if if you handle it correctly, and you listen to someone who's been there done that, like you, or you know, I'm not in the exact business you're in doing, you know, but I I obviously I'm more than happy to help people with advice on how to do this stuff as well.

SPEAKER_00 24:29

Of course, yeah. So, you know, you did touch on an issue that why isn't it standardized? And I think Juana is uh, you know, the the capital outlay. You know, if that capital outlay was mitigated by a monthly payment and you can just pay over time, I think that makes it a no-brainer, honestly. And then, you know, when I look back, and I'm gonna ask you this question first. If you look back at a properly priced PRP with a laser package, when do you see yourself getting that uh a return on investment? Is it at three months, six months, 12 months, you know, and then is it within the year? Because if it's within the year, then it still makes financial I mean there's there's no reason.

SPEAKER_01 25:19

There's no I mean there's no reason, even with just straight laser, a straight laser program, laser only, I did, I mean, we did it. I did I from 2017 to 2020, I did a lot of straight laser before I really started incorporating any into more holistic programs. And absolutely, you can you should be able to pay your laser off within a year for sure. And and most of the time less less than that, but you absolutely should be able to pay your laser off in a year or less. I'd be very if if you're if you're not, you're not doing things right. And and and frankly, the company that we deal with cutting edge laser, which has MLS laser, but there's a lot of other laser companies out there. I like MLS because it's the safest one, right? We're not gonna burn somebody, it's a very safe system, but there's a lot more resources from these laser companies out there now to help you with that as well. And then obviously you have someone like Dr. Demers, who is actually like literally teaching it to other doctors, and so it's so much easier to do it now because there's so many people helping, like you. And I think that's that's I mean, it's huge. We didn't have that.

SPEAKER_00 26:30

Yeah, you know, when I look back at my financials, I probably broke even at about the five to six month mark. Sure. But when when you look at that, that's a game changer because then in months seven, eight, nine, ten, eleven, twelve, you're actually making money on this purchase. So honestly, uh, like this is not a pitch for this, but I just think that it's uh such a beneficial adjunct. It helps with pain, swelling, inflammation, it helps your patients, it increases patient satisfaction. Uh, it's it's just really for me a no-brainer.

SPEAKER_01 27:05

I mean, here's it here's another thing we didn't really talk about either is that not everybody can have like if you have a sports medicine practice, uh my practice was heavily sports medicine, it's be gotten older as time's gone on. My avatar, my ideal client, but there's a lot of people who can't stop playing sports, or even they did they just started their golf league, they have decrevanes, Tina Cinovitis, they're not gonna want an injection, even you know, they're not gonna want to slow down for anything. And so that's where things, modalities such as laser and shockwave are awesome for people who you have a runner training for a marathon, i.e., myself. I used laser many, many, many a time to keep training so that I didn't have to stop. And I wouldn't have I would have had to stop it or at least slow down or alter if I had a PRP or a bone marrow shot or something like that. So it's tremendous for people who can't afford to stop doing what they're doing. It's just tremendous for that. So that's that's that's a huge niche.

SPEAKER_00 28:04

Yeah, you're exactly right. You know, I sort of, you know, I treat my daughter who's a soccer player, and she won't stop. And it's like you're either gonna play her or you're gonna play unhurt. So let's pop you under the laser and keep you going.

SPEAKER_01 28:21

So it was for fat pad inflammation, anterior knee pain, and we still use it to this day. So the Bella protocol. So, yes, absolutely, it's great for those types of situations, and it's very safe. No needles, no shots, no side effects. It's very, very safe. Really, the growth plate contraindication isn't really a contraindication. It's no one really proven. I mean, if you just fired it over the growth plate 24-7, it might cause that growth plate to, you know, because increased blood flow, maybe it theoretically causes the growth plate to grow faster and that limb to actually get longer and then maybe close sooner. But no one's ever proven that, and no one's is using it in that type of situation. And if you use the hand piece, you can aim away from the growth plate anyway.

SPEAKER_00 29:04

So unless you're my daughter and she's she's got Siever's disease and she has a growth plate, you know, a pop-up.

SPEAKER_01 29:10

Well, yeah, that's a fine one. Yeah, but that one's fine to use it on, right? Yeah, absolutely.

SPEAKER_00 29:14

Yes. Awesome, awesome, awesome. So, you know, this has been such a great conversation. So the question is is like, what's the next step? We've talked about the science, we've talked about laser and how compelling that is. So the next step is attracting the right patients. You need our system, right? Our practice launch system. And we now have all this knowledge under our belt and we know how to use it, but now we need to know who the right patients are, the ones who need our help, how to create that cash-based business, how to convert those consults. Maybe they aren't a uh candidate for PRP, but they'd be an amazing candidate for a laser therapy because they're terrified of needles. And then clearly you need this system, a systemized approach to be able to put it all together for success. So I want to just give you an opportunity. If you want the fast track, come join us in Clearwater. We do our hands-on lab and join us in Clearwater, Florida. Saturday is our business of orthobiologics express course. And Sunday is an actual cadaver lab with advanced technology training in adipose harvest and bone marrow, concentrate aspiration, as well as get your hands on the XLPRP and PC and really figure out how to do that. But on Saturday, we talk about patient-focused branding. So, how do you how do you brand your practice to attract and keep your ortho biological patients? We talk about effective pricing strategies, and I think Mark went into that a little bit. We talk about using AI to expand your practice and and tools and tactics for growth. And then clearly we talk about how to overcome challenges and avoid common pitfalls in your practice. So scan a QR code that should be good for continuing through this spring. And then I do have a little bit of a quiz for you all. If you're not sure where you fall in this continuum, scan that QR code and that'll help you assess, you know, are you ready for capital investments like a laser therapy? What's your clinical confidence? Do you have a non-compete that you're having to deal with? So these scores will help you kind of tell you whether you're ready for a full practice launch, maybe a lean PRP start, or just maybe an early stage interest. If you want more of this conversation, we are having a virtual training experience in February. And this is designed for licensed clinicians who want real clinical and business clarity before making their next move. So this is a virtual event. It's February 14th. You're going to learn how to use MSK Ultrasound to inform patient selection and regenerative planning, as well as a cash pay structure and patient acquisition frameworks and marketing. And I would love to see you all there. So please scan the QR code, check it out, come on down during the day so you can still have your Valentine's date at night, and you can spend all of Valentine's Day with us getting your business and your micropractice launched in one day. I do want to give you a congratulations. This is Mark's new book, Repair, Not Replace, Natural Joint Relief Without Surgery or Pills. He is now on an Amazon number one bestseller. Yes, I've got my copy too. Yes, yes, yes. And if you're interested, this is a phenomenal book, kind of giving us the how and to and how you you came from this surgical mindset and really moved forward and through the thought that you needed, you knew there was a better way to treat patients in a comprehensive approach. That victory in motion programming that you've created is phenomenal. And so if anyone is interested in purchasing the book, I I definitely picked up my copy. It's it's an awesome read. So I just wanted you to be aware you are talking with and listening to a Amazon number one bestseller author, Dr. Mark Petra Pauly, with the foreword by Dr. James Andrews, which is you know what an honor and a privilege. So I just wanted to put it through to everybody for questions. This is our live QA session. This is the time when you can ask any and all questions related to how the heck do you publish a book? How the heck do you go 27 years in orthopedic surgery before you start doing PRP? And is it working?

SPEAKER_01 34:08

I didn't wait that long. I started doing that.

SPEAKER_00 34:12

Yes, I did.

SPEAKER_01 34:14

Before that, I think I got a PRP injection in my knee in 1998, but like I said, I think it was mostly blood and it hurt like hell. I didn't know much about it at the time, but it was pretty funny. But it worked, it actually did work because I had tellertendinosis from running the Boston Marathon, and Dr. Bradley was talking about PRP and using it on Pittsburgh Steeler athletes, and that most of the surgeons were like, that's stupid, and we're gonna do that, etc.

SPEAKER_00 34:41

And then you know, if you do medicine, you're like, I'll do it.

SPEAKER_01 34:44

Totally. I was like, yeah, they're like, if you want to go to a workshop later on, you know, go. So I'm the only I'm the only surgeon who showed up. So yes, I don't, I think a PT injected my knee, and which is fine. I we were just experimenting on each other, but don't say anything. But uh yeah, it w it actually worked out, but it was it was definitely not I didn't know anything about PRP at the time, but I knew that there had, you know, that the that there was a way to the body to help heal itself. And Kevin Wilk, Dr. Andrews, Dr. Bradley, Pittsburgh Steelers doctor, taught me a lot regarding that. And you know, a few years later, when Heinz Ward, two weeks after spraining his MCL, he got a PRP injection as a huge thing all over the the news, all over the and he he got back and played in the Super Bowl that year, and Steelers won, boom. It was like all of a sudden every sports medicine doctor thought it was cool. So that that's just a little taste of my origin story. But I was very fortunate to have great mentors for sure.

SPEAKER_00 35:40

Yeah, yeah. So there's some questions here in the chat. Number one, what's the anti-ernine profile of Hertz and intensity? She he wants to know what the Bella protocol is.

SPEAKER_01 35:50

Hey Jonathan, I saw you on here somewhere. I don't I don't have to I'd have to look up the exact thing, but I I can almost guarantee it's mostly it's mostly hand piece with an MLS laser and it's most it's seven, it would be 700 Hertz because it's anti-inflammatory. And probably started out at 50% for the first two or three and then cranked that up to 100. But 700 is more anti-inflammatory, and it was to aim it more through your almost like your portal site windows, and a little even more anterior at that fat pad. And then there was lymphatic drainage that was utilized as well. But I don't believe with her growth plates were wide open at the time that we used the ultra head for that for that protocol. And nowadays, you probably could use the ultra head because they're not people aren't as scared about quote unquote using it over growth plates. But it was it was learning how to use that hand piece to get into the nooks and crannies is a really big advantage that a lot of people they they just go, oh, this is a robotic laser and you can just set it and forget it, which you can. You're probably gonna get 70 or 80% good results. But if you want to get to the 90, 95% good results, learn how to use that hand piece is really important. And now all my PTs and my my total body fitness staff, ATCs, PTAs, they're the ones who do all the treatments because they know the anatomy best, and they're doing all kinds of advanced things with you know, the patient might be literally like stepping up and down off of uh you know a block or doing calf raises, and they have the laser on there while you know while they're doing all these dynamic things. So they've gotten pretty advanced with it. So I'm sure they could tell you what that exact protocol is, but I I I know that's pretty much what it was at the time.

SPEAKER_00 37:34

Yeah. So there was a great question about you know, how long do you wait after giving PRP injection to initiate the MLS laser therapy? And and what John said, you can do it right after. And I would agree, we can do it, we do it the same day. We sometimes, you know, it's not built on our protocol, but it is scientifically sound to actually give them one treatment uh directly ahead of the PRP injection. It decreases that nosyoceptive response and stimulates that increase in blood flow.

SPEAKER_01 38:01

So also pre-condition your your actual PRP if you want as well, and we do that as well, just as an FYI. So it's so far off 500 hertz, 50 for five minutes. Just think of all fives, just trying to stick because obviously platelets have mitochondria. We're not activating the platelets, you're preconditioning them. So that goes it. We don't know if this is a definitive, but there's a lot of people who precondition their platelets. I think Dr. Buford is actually doing a study. The real question is like, what wavelength is he using for how long? It's so different, the protocols. That's another one of your questions. I think that's part of the problem. We don't really have great, great, great standardized laser protocols. The laser is so versatile that you can use it in different ways, but that's the that's a pro it's good, but it's also bad because now everybody's doing their own different protocols, and there's even more advanced protocols you can use within more advanced machines. I mean, you can get really crazy with 30%, 20%. I mean, it's it's amazing.

SPEAKER_00 39:04

Yeah, absolutely. So there's another question in here. So if the if if the MLS is something like, you know, like 65k, how much do you charge per package? And you know, that helps you kind of you know break down that that break-even, how many patients, you know. So you're are you doing traditionally 12 sessions or 24 sessions?

SPEAKER_01 39:27

You're asking me. So it we usually do 12 or 24, or sometimes even more, depending on the program that we have the person in. But as far as how much, I mean, I would just I would start with $100 of treatment. So if you're doing 12 treatments, that's $1,200. There are again with some of these more advanced M MI and MIS lasers, which are higher wattage, you probably can get people better. You can get people better faster. But with your traditional M6 and N7, which is the robotic head and the handpiece, with those, I st I, you know, 10 or 12 treatments is is very good for getting good results if you're gonna go standalone program. And if you know they're really bad arthritis and they don't want anything else done, you might book them for 24, right? You know, and just spread them out once you get past once you get up about 85%, you can start spreading those out a little further.

SPEAKER_00 40:23

Sure. I did do the math on that. So if you charge $100 a session, you need 54 patients.

SPEAKER_01 40:31

Yeah.

SPEAKER_00 40:32

With if there are if each each if p each patient is getting 12 sessions and you charge $100 a session, you need 54 patients. Some people see 54 patients in a day.

unknown 40:43

Sure.

SPEAKER_00 40:44

So you know, I don't think there's a uh a problem with the the number of patients, but yeah, 54 patients is all you need to.

SPEAKER_01 40:52

Well, you didn't and and you didn't even really get to like who's indicated for it. So they're seeing 54 patients. I mean, technically, almost every single one of those patients is a candidate. Now, are they all gonna want to do it or do they all need to do it? No, but they should all be that's it's a nice alternative compared to cortisone or pills. There's no pills, no needles, no shots. It's very, very safe. And no narcotics, no side effects from taking anti-inflammatory medications. So I think every who's a candidate, just about everybody's a candidate, unless they have a tumor, or if you're you know, if they're pregnant and you're you're not gonna, you know, you don't want to be treating the spine, you know, or directly over the baby or over the pacemaker, but there's not too many people who technically are not candidates to at least offer it to. It's their choice. They can say yes or no. That's the beauty of it. You don't you don't demand somebody use it, you just educate them and then they can decide if they want to or not. So maybe not all 54 are gonna do it, but it's not in your mind, it's in their mind. What if they if you know it can help them and don't take it personally if they say no, but offer start offering it to everybody. Don't be afraid. You're not gonna, you know, you're just being honest with them, and they can say yes or no. And if they say no, boom, you move on. Yes or no is good, maybe's terrible, maybe is horrendous. Don't you don't want a maybe, you want a yes or a no, and you're fine. That's that's one huge piece of advice with anything that you're doing that's cash pay or out of pocket. The best answers are yes or no. Maybe is the worst answer and a complete waste of time. So do your best to not get a maybe.

SPEAKER_00 42:32

Yeah, that that is solid advice. You know, I will share with you the the one thing that really changed from a financial viability, but also changed my mind on why you know who do I offer this to, is I honestly included it in my package as part of the package, and then just raised my price a thousand dollars. And everybody had an option to have it, and they didn't really have a choice not to have it. It's more like a gym membership where the recommended, you can choose not to, but you're still paying for the sauna. So you should probably take advantage of the sauna because it's better outcomes. So for me, that has been the fastest, easiest way to get that business on the books and completed. And it's word of mouth. I have lots of pieces. We do not advertise standalone laser packages at all, but we have a number of patients who come in and ask about them because their neighbor had laser or their friend had laser or their mom had laser and they're like, I just want the laser, like they said this was amazing. Can I please do it? And so of course the answer is yes. You can, but we just don't advertise that. So great. So, any other questions about laser therapy, the science behind it. If there isn't any, I I am going to leave everybody with a little FYI. There is and and And Dr. Petra Pauli alluded to this that there is a new style of laser coming out in 2026 that has a significantly higher dose while still maintaining safety and tissue safety with not being able to get a burn. And so just like we talk about dose is really important in orthobiologics, whether it's PRP, BMC, dose appears to be quite important in laser therapy as well. And so I think the more that we can be precise, the more that we can know what our treatments are, whether it's PRP, BMC, how what the watts are, what the what the power is, and understand that dosing appears to be significantly more important than we've paid attention to. It is not a quantitative thing, it is a qualitative thing. And then I would leave you with an observation that dose is not just for uh treatments, but if you may take a look around at medicine in general, it appears that we are overdosing on work. And that when polled, doctors don't choose to leave medicine in their perfect world, they just choose to reduce the dose. And so that that desire to practice two or three days a week and not work 60, 70, 80 hours a week also is a dosing issue. So people who are burnt out, people who are overwhelmed with the the job of doctor, it does appear to be a dosing problem. So that's what I'm gonna leave you with tonight. If there are no further questions, Mark, congratulations on your book. Congratulations on the Victory in Motion and the VFIT program, V Slim program. These are awesome programs, such a good job. Your patients are super lucky. And for those of you who are wondering, how do we become successful in our orthobiologic practices? How do I purchase a laser and get a return on investment in the first six months of having this laser? Come to the virtual training, come hang out with us for a day and get you way further along on that journey towards autonomy, towards success in your cash-based orthobiologic practice. So thank you so much for joining us. I really appreciate you joining us. And if there is no further questions, we will wrap this up tonight.

SPEAKER_01 46:53

And thank you, Ariana, for having me on, and thank you all for watching. You have an amazing teacher here. Listen to her, and I've known her for a long time. She'll she'll teach you well and correctly, and you'll you'll bypass years of trial and error, which is huge. So I highly recommend her in many ways. She's tremendous and is being very humble. But great job. Thank you. I appreciate being on.

SPEAKER_00 47:20

Thanks so much, Mark. Thanks for joining us. Everybody, thanks so much for joining us. Be kind to yourself, and we'll see you in two weeks for a very exciting guest in two weeks. So keep tuned, keep posted on LinkedIn.

SPEAKER_01 47:33

Much more exciting than me.

SPEAKER_00 47:35

Oh no, no, no. You you're you, I mean, you're an Amazon uh best number one bestseller list, man. That's pretty darn good. We'll take it. So thanks everybody for joining, and we'll see you next time. Stay tuned for our next conversations in regenerative medicine, and I will get see you next time.