Episode 69 - The Root of Pain & Prolotherapy

Root of pain and prolotherapy


Speaker 1: 00:00 This is Dr Chad Edwards and you’re listening to podcast number 69 of against the grain.

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Speaker 1: 01:02 and today I am joined with Dr Chad Edwards, who believes that 80 percent of medical recommendations are crap. Pure crap, technically speaking. Um, he is a board certified family physician. He served in the U s army. He’s the author of revolutionize your health with customized supplements. He is the founder of revolution of health.org and the against the grain podcast, Dr Edwards. Welcome. It’s good to be here. It feels like forever, but it hasn’t been it, you know, I don’t know. It’s good to be here. Yeah, absolutely. And we’ve, we’ve covered some really awesome topics recently. You know, the last podcast we did the HCG diet. Yep. Okay. And uh, a little while back we were breaching the topic of cholesterol, which we have some more episodes coming up soon. Yes. And so, uh, so what are we getting into today as the hot topic? Yeah. So today I wanted to, and I was actually thinking, you know, as you were saying that I was like, maybe some of these topics were against the grain.

Speaker 1: 02:01 Yeah, sorry, got a little cheese on your day. So today I wanted to talk about something that I’m actually pretty passionate about, I mean as if I’m not passionate about many of these topics, but this one in particular is really kind of how, and I’ve talked about this many times on some of the podcast before, but we’re going to talk about some of the mechanisms by which your body gets pain, how you perceive pain and then what we should do about it. Uh, and there’s two reasons that I wanted to do this topic and it’s not necessarily a whole new topic, but we’re going to take a little bit different spin on it because so many patients have pain that you, they don’t quite understand. So often, you know, it’s low back pain and it’s going down my leg and they think it’s a herniated disc. And the reality is, is most of the time, in my experience, I can’t say across the board.

Speaker 1: 02:52 I’m talking about in my clinical experience. And literally over the last eight years of doing prolotherapy, I’ve had one patient, one that came in that had back pain that had pain going down their leg. That was due to a herniated disc, one patients that I see in the emergency room, same thing, you know, I’ll do an exam on them and I don’t ever want to cross that ethical boundary of I’m seeing you in the emergency room and hey come see me in clinic and I’ll get you, you know, of course it’s another city anyway. But um, it’s, I don’t want to like cross that ethical battery in and say, Hey, I’m gonna come to my clinic and I’ll treat you. Although, you know, if you know the solution, then why wouldn’t you, you know, I just like to keep it real clean, you know, I don’t want to steer them or ever be perceived of having some kind of conflict of interest or something like that.

Speaker 1: 03:40 So, uh, but I see them so commonly they’ll come in, they’ve got back pain, they’ve got some kind of thing going on, they’ve got leg weakness, they’ve got this tingling a kind of thing. They are any of these kinds of symptoms and I will do an exam and I’m like, the only thing that’s going to fix this is a ligament or a tendon regeneration technique like prolotherapy prp and stem cell, and many of them don’t. They don’t have the funds to be able to afford something like that insurance, unfortunately. Does it cover most of these procedures? Uh, and I, I mean, I feel bad for them, but maybe maybe one of the listeners can come up with some way that we can set up a go fund me for everyone that wants or needs prolotherapy stem cell prp kind of thing. But it’s not free.

Speaker 1: 04:26 There’s a cost with it, you know, I have to, I have to charge patients to do that. So, uh, but so many of them, it’s like, gosh, I mean, I wish that there was a way that patients could get it in the same way that they would get surgery. It would save insurance companies so much money if they would just listen to this. And it goes back to that, you know, 80 percent of medical recommendations are crap. I was reading a study that was published in, um, I’m trying to remember what journal it was, study published in, I think it was the Lancet and it was done in the mid 19 eighties on prolotherapy and had very significant results, I mean statistically significant improvement in pain and it was a randomized placebo controlled double blinded study and the good gold standard kind of studies and it showed it worked.

Speaker 1: 05:19 That’s a study proving prolotherapy and I’ll be honest with you, I don’t need a study to prove that prolotherapy works. If you come to see me, you have pain. I inject prolotherapy or perform this procedure, prolotherapy prp, stem cell, and you walk away, not necessarily tomorrow, but you have no pain and you have full function. Do I need to study to tell me that that procedure works? So why? I mean this goes back to that, you know, so many of my colleagues, they just get caught up in this, well what’s the evidence? It works and I’m like, I don’t know because your patient got better. I mean it’s, it’s Asinine to me and it’s absolutely maddening. So I want to talk about a little more about some of the ways that your body can perceive pain. And so I had a couple of patients that I wanted to kind of throw out there because I thought it was just really interesting about this first one.

Speaker 1: 06:07 Uh, so this is a, um, I don’t remember her exact age. I’ll say 40 year old. Um, we’ll call her Sheila Sheila. So 40 year old, a lady, she was a, she actually saw me when I worked at one of the big clinics here in Tulsa in 2011. It may have been early 2012, but somewhere in that realm. So we’re talking five to six, four to five years ago. And she was hit by a semi truck. So in her car and there was a lawsuit associated with that and you know, there’s all kinds of stuff, but she had a specific kind of pain and, or a specific kind of symptom. And the only thing that really worked for her was prolotherapy, but she couldn’t get it because of all the nuances associated with the, um, with the litigation. And the fact that the semi truck and you know, all those kinds of things, well everything got settled recently and so she was finally able to come see us.

Speaker 1: 07:09 She waited five years to come see us and followup in the pain’s still there, pain’s still there, actually had surgeries on different things and we’re going to be addressing all of those things. But you know, it was just striking to me that she got a procedure five years ago, felt better, didn’t fix it, but felt better. She was able to perform and do her job and do everything she needed to do, but they wouldn’t let her get more of it because we had the check boxes for, you know, different litigation things. And I’ve had other patients that had similar issues. Well, Workman’s comp won’t let me do this. Are you kidding you? The goal is that you get better. The goal is that you return to full function. Why in the world where we intervene on that and it’s because they’ll say, well, where’s, where’s the proof?

Speaker 1: 07:56 There’s no proof that this works. Yes, there is almost all of our patients. I mean, greater than 90 percent success rate. So the interesting thing about this patient is, you know, when we do this procedure, there’s a little bit of light to in the solution and the way you do the procedure matters and there is an art to it and I’ve done thousands and thousands of these procedures and obviously very comfortable with it. But the feedback the patient gives me at the time that we do the procedure is critical that many times, you know, and I’ve, I’ve developed the, uh, the patterns for how patients hurt and their referral patterns and you know, I’ve got a pretty good idea, you know, and they come in and they say I’ve got shoulder pain but it goes down the side of my arm and when I do this it goes down to my elbow and I’ve got a pretty good idea of, okay, this is where the problem is.

Speaker 1: 08:48 And you know, nine times out of 10 I’ll inject that. And they’re like, oh yeah, that’s it. And they get up and the Lidacain we’ll numb that area up. And so that gives us the feedback that, yep, that was it. Now, the interesting thing for this particular patient, it wasn’t that she necessarily had this horrific pain. It was that she had a lot of instability. She felt I’m over exaggerating and these are not her words, but she almost felt like her, her vertebrae were going to fall apart, you know, that there was just no stability whatsoever. Uh, felt kinda like Gumby, uh, just Jello. I feel like that all the time. Do you six foot seven? I just. Yeah, that’s amazing. Yeah. Because I can’t, I’m not even, I’m not even, you know, five foot seven. So it’s just, you’re like in another world,

Speaker 3: 09:35 they’re just, I feel like I’m going to topple over at any moment and many times I do. Dan. Dan Remembers that I was playing basketball last night. I was on the floor more than one cell upright, so it was good that, that I can’t even, I apologize. No, it’s good. So she, she feels like her vertebrae is going to fall apart and so she feels like gumby. And so the instability is a significant part in addition to the pain you’re fixing the pain that she’s experiencing. Okay. Yeah. But, but why? Why instability as well?

Speaker 1: 10:06 Yeah. And so that gets into the heart of the issue and that one of the main things that I wanted to talk about is when you, you hurt. Actually, let me go ahead and address the second patient. Let me go and introduce this. Okay.

Speaker 3: 10:18 And so we’re coming back. She’s experienced that Sheila, Sheila, she’s experiencing instability in her spine and her spine. Is that right? Vertebrae? That’s right. Okay. And now we’re moving onto patient number two. Yeah. We’ll call him

Speaker 1: 10:31 biff biff. Okay. Why not? Yeah. So He. So this guy comes in and he’s got hip pain. Now we’d done a couple of rounds of prolotherapy on his hip. We did some intra articular. Then we had treated some areas around his hip after his second prolotherapy procedure, the same day he went and got an MRI. The Mri interestingly showed inflammation and all these different places and said he had tendinopathy in the rectus femoris tendon and the Gluteus Medius, gluteus Medius, and minimus. Anyway, one of the Google complex muscles and like all these different things and it was like there’s, you know, a significant amount of tendinosis and the Dema and I was like, yeah, because we just did it.

Speaker 3: 11:18 What does all that mean for, for my third grader mind, is it swelling, inflammation? What is all that?

Speaker 1: 11:23 Yeah. So the, the, the suffix Itis, so tendonitis, appendicitis or appendix apprentice, Ids, you know, those. It’s inflammation of that particular structure. So we’re talking about attendance. It’s inflammation of that tendon. And remember the body heals through inflammation. Inflammation is the, is the mechanism by which we heal. Chronic inflammation is a different story, but we heal through inflammation. So it’s a good thing. And so in this case he had gotten prolotherapy went and got an Mri and it showed there were five, you know, they, they often will do finding number one, number two, number three, four or five. So three through five. We’re all about a tendinosis tendinopathy and the osis is just conditioned off. So there’s just some kind of problem with the tendon. And all of them were in the places where we did the prolotherapy and I was like, spot on rock and roll because it tells me, yeah, yeah sir.

Speaker 1: 12:19 You had a procedure done, didn’t you? Yeah, that’s my, that’s my thought. But of course, you know, most, most physicians aren’t doing prolotherapy and certainly we’re not getting prolotherapy and then immediately going into an MRI. So this isn’t a finding that we see frequently, but it’s in the exact areas where he did the injection. So it’s just interesting to me that, you know, we saw this, but the real, the real issue is that on his Mri he had this big labral tear. So in the, there’s this, it’s almost like the meniscus in your knee, but for your hip. So you had this big labral tear almost completely all the way around. And I, of course he didn’t see an orthopedic surgeon immediately after that. Hasn’t seen one in follow up yet. Um, he, he came to me for followup. So I look at that and I, and, and this patient says they have hip pain.

Speaker 1: 13:09 I can almost guarantee that when he sees an orthopedic surgeon, they’re going to say, oh, we need to go in and repair that, that Labor from, you know, that’s, that’s the problem with your hip. And so that, you know, you got one patient that feels instability and then you have another patient that has pain in the quote hip and two different mechanisms to different things going on. And you know, one of them, of course she had had surgery and has not had an MRI on her thoracic spine to determine is there any issues that need to be addressed with surgery. But so, but, but it feels unstable. So it’s just different. And then I’ve had some patients that came in and they felt like tingling, you know, it’s like this tingling sensation. Uh, I get patients will come in and their, their knees will feel weak, their elbows will feel weak.

Speaker 1: 14:00 In fact, my former commander, when I was on active duty, the guy that got me triggered into prolotherapy couldn’t grab a suitcase or briefcase, so his weapon anything and grab it and pick it up because of that pain in his elbow. That is what we, you know, a lateral epicondylitis. And so just like the signal gets shut off, like the muscles won’t work. I can’t lift it up. It hurts sometimes. Sometimes it’s just weakness. I just can’t do it. It won’t do it. The body’s trying to protect itself and so we can, if you want, we can take a little break and then we can come back and talk about the what’s actually going on and what we do about that and how we know that that’s the real problem and not something else. I want to hear the kind of the wrap up of these two patients. So we’ll take a quick break. We’ll come back and wrap it up. Cool.

Speaker 2: 14:52 Are you tired and fatigued? Are you frustrated with doctors because they just don’t seem to listen. Do you want to fix your pain without surgery? If you answered yes to any of these questions and we are the clinic for you, we offer prolotherapy, PRP or platelet rich plasma therapy and stem cell injections, ivy nutritional therapies, bioidentical hormone replacement therapy, and functional medicine to get you back on track to optimal health, call our clinic at nine one eight, nine three, five, three, six, three, six. Or visit our website@wwwdotrevolutionhealth.org to schedule your appointment today.

Speaker 3: 15:23 Okay. We are back with Dr Chad Edwards and we’re talking about a couple cases here and how it relates to prolo therapy. These two cases are a little bit unique in that, uh, they have two separate symptoms, I guess you would say are pain. They’re experiencing pain in different places. You Got Sheila? Okay. Sheila, who’s experiencing instability in her spine and then you have biff. Okay. We got biff who’s experiencing a lot of pain in his hip and uh, biff had just brought back a Mri to Dr Edwards here. And we’re talking about these two different cases and how maybe prolotherapy played a role in the pain and the instability of Sheila there. But, uh, Dr Edwards, talk to me, what really was causing a, maybe these two issues or what was the underlying root, because we talked about what they were coming, uh, the, the two patients were coming from the hospital and telling you what the doctor said there. Okay. Uh, tell me what is Kinda like the issue that’s going on for both of them?

Speaker 1: 16:33 Yeah. So pain is multifactorial. There’s multiple components of that. Some people, you know, they’ve got a very high threshold, uh, they’ve got a very high pain tolerance. Uh, it takes a lot before they say, oh, that really hurts. Some patients like the wind changes and they’re like, oh, it hurts. There’s a lot of psychological component with that and that doesn’t mean they’re crazy. That doesn’t mean, you know, there can be a large anxiety component with it. Um, so there’s just a lot that goes into the perception of pain. But in the case of a. So we’ll start with, we’ll start with Sheila. So in her case, you have the structure, you have the spine, and then we’ll holds the spine together, our ligaments holding the bones together and forming these, the set joints and all those kinds of things. And you have these inter or inter spinus intervertebral discs, you know, the, the, uh, the lumbar, thoracic and cervical discs, and then you have muscles that kind of hold all that stuff together as well.

Speaker 1: 17:41 So you’ve got some tendons that are holding the muscles to the bones and those kinds of things. What most people don’t think about, what most physicians, I would argue don’t think about, is that ligaments are very, very densely innervated with nerve fibers. In other words, there’s a lot of nerves and ligaments and tendons. Pain comes from somewhere. It requires a receptor except for like a, a, a phantom pain, Phantom limb pain. You get your leg cut off, but it’s still a nerve that’s interpreting something weird even though that nerves not down there at the ankle. If you get your knee, you know, cut off at the knee, but you feel like your ankle hurts because of the stimulation on that nerve. So in this case, ligaments and tendons, very densely innervated with nerves and those nerves are sensitive to pressure and stretching, and if you think about a micro damage, micro tear, micro, however you want to call it, but it’s on a very, very small scale that allows the ligament to stretch ever so slightly, but it irritates the nerves because those nerves don’t like stretching and they don’t like the pressure on them either.

Speaker 1: 18:47 It’s why some swelling can cause pain because it’s putting pressure on those nerves. And that’s one of the mechanisms by which that can cause pain. So the, uh, the ligaments and tendons, when they’re kind of doing this micro stretching thing, causes a signal to be sent to the brain. Now sometimes that signal is interpreted as pain. So that can be one of the manifestations. You got something wrong, it hurts. You need to face it. In her case, this instability was caused by ligament and tendon damage and she had a significant mechanism multiple years ago, didn’t heal. And that’s what she’s dealing with. So the interesting thing is when we go in with prolotherapy and do these injections, remember there’s a little bit of lie to in the solute in the solution. So what we’re doing is we’re taking that receptor, that nerve receptor that lives in the ligaments and tendons were taking that out of the equation.

Speaker 1: 19:40 The interesting thing for me is that she sat up and she said, oh my gosh, I feel like my back just completely tightened up and it doesn’t feel loose and floppy anymore. She and she put her hands together, one on top of the other and kind of squeezed, made that squeezing motion and was just like, it just feels like, you know, and it’s just tightened up. I didn’t. Nothing happened that actually tightened anything up. It’s not. Her back is not fixed. It’s not healed. It’s not any of those things. That’s gonna take time through the healing process, through inflammation. The interesting thing is that the lidacain removed this sensation. So the signal is no longer going to the brain. The brain is no longer interpreting this as an instability. My point is that there. I would argue that there really isn’t any true instability that her spine isn’t necessarily any floppier, although maybe but our spine isn’t necessarily any floppy or that it was before.

Speaker 1: 20:36 You just removed this sensation of that and that is one of the really cool things about the way we do prolotherapy with that lidacain because we can identify with very high success rate exactly where the problem is coming from and we’ve talked about MRI before in a previous podcast. I can’t, I can’t remember which, what number it was. If you go back for our listeners to go back and just scroll down the page, you’ll, you’ll find it. But MRI is a very, very sensitive evaluation. It’s a very sensitive test. Sensitive means that you’re going to pick up everything. You’re going to identify every single possible, um, issue. Now it, it’s not going to detect some of these minor ligament tendon damage issues. There’s really nothing to detect on MRI. But in [inaudible] case, patient to, in his case, he’s the one with the hip, the hip, that hip pain.

Speaker 1: 21:34 That’s right. So it saw where we had injected. It’s got this fluid in this inflammation, but it also saw this label issue, so I looked at that and I said, Oh man, you know, I, you’ve probably got some issues going on outside of your hip, but if your problem is inside the hip joint, just like if it’s inside the knee joint, my approach may be a little bit different. We may need to be a little bit more aggressive about how we treat that and what I mean is, you know, we’ve talked about prolotherapy, we talked a little bit about prp or platelet rich plasma therapy and we talked a little bit about stem cell. If his problem is inside that joint, prp or stem cell may be a better option. Prolotherapy has been around for a long time. It does very well. It may be a really good option too, but inside the joint, especially hip and knee, we may want to be more aggressive and go with PRP or stem cell.

Speaker 1: 22:32 You keep saying a better option, a better option than what, than the than the standard dextrose prolotherapy then, you know, so all of them are those tissue regeneration techniques. Sure. All of them, if we can fix these issues with any of them, I would argue that’s a better option than surgery. Surgery has its place. I’m not anti surgery, but I don’t go into a patient evaluation and the patient says my knee hurts. I can’t find anything wrong. Well, let’s go take a look. That’s a load of crap in. And based on the MRI that he brought you, you believe that the next recommendation from the orthopedists, um, he, he would, he would be recommending surgery for that type of terror. I suspect that that’s the case. I mean, in fairness, that didn’t happen. I’m not an orthopedic surgeon. I can’t say exactly just my experience.

Speaker 1: 23:29 That’s what they’re going to recommend that that’s my experience. Sure. So, I mean, I don’t want to be clear about that. Yeah. So, but when I looked at his MRI, I was like, oh, okay, we’re, we may be dealing with something more intra articular than inside the joint than what I was originally thinking. So I actually talked with him, did the full discussion about prp and stem cell and I said, you know, we’ll, we’ll have to bring you back to do the stem cell portion because it takes time to harvest the stem cells if we use umbilical to or a amniotic than, you know, gotTa, order them in and all those things. So it’s gonna take time. So we’ll bring you back. But I said, you know, it may not be a bad idea just to go ahead and address everything else on your hip.

Speaker 1: 24:13 So we were injecting, you know, near the sacred Iliac and the back, uh, the pubic tubercle and the front, some tendon insertion, those kinds of things. And, but we also injected inside the hip joint. We did all of that same time on his second round. So for this one I said, you know, let’s, let’s go ahead and treat everything else. We’ll have to bring you back. We’re pretty booked up so we’re gonna have to squeeze it in and it’ll be easier if we just go and get everything else knocked out. Then we can just do the one intraarticular that won’t take me too long. We can get you squeezed in pretty quick. So he was like, man, that sounds like a great idea. Let’s rock and roll. Let’s do that. So he was teed up, ready to come back for stem cell and PRP, which is substantially more expensive than, than prolotherapy.

Speaker 1: 24:57 But the interesting thing was I did his injections at the, the, uh, the pubic tubercle and uh, the, uh, the FBI joint in the back and I had him stand up and of course there’s a lot of changes like we talked about with, with Sheila and he stood up and he was like, Oh man, hey, that’s, I’m good. So my thought is if you had a problem inside your hip joint and we didn’t inject inside your hip joint, but we injected these other things and you feel like those symptoms are now gone, is your problem actually coming from inside the hip joint? And I would argue probably not. It’s not to say that there’s nothing there, there’s clearly something there, but that’s not what’s causing his symptoms. I didn’t inject that. We didn’t remove that from the equation. We injected these other areas. So after that, and this is where prolotherapy gets really cool because we’ve got MRI findings, there’s something wrong on Mri.

Speaker 1: 25:57 The issue is, is that, is that what’s causing his pain? So when we injected these other two areas, it removed those two pieces from the equation and he got better. So at the end of the thing I said, you know, I really hate to do this because I’m taking money out of my own pocket and I’ve already quote convinced you you need this procedure but you don’t need that procedure. I really don’t think he does. And, and so we discussed that and of course he was fine with that and I said, you know, if you just want to come donate to the clinic sometime, well I’m happy to do it. A not a big deal. It’s not a, not difficult, but um, but I don’t, I don’t think you need that at this point. And if we need to add it at any point, we can do that at any point.

Speaker 1: 26:40 So we want to be as cost effective as we can provide interventions that are the lowest risk with the least side effect. And prolotherapy does really well at that. And because of the way we do the procedure, we can evaluate is that really the problem or is there something else going on? It’s really cool. And along the way, I’m sure now if not before a, you’ve won a patient in a good way for life in that he’s going to trust you, that you’re not going to recommend treatments that he doesn’t need, you know, to feel better. Right? But should the problem or a different problem arise? That’s a similar. It’s a pain related symptom. Hey, maybe I’ll check out prolotherapy, you know, before I go get, you know, uh, you know, my elbow looked at for tennis elbow, right? You know. Well, you know, when it comes to surgery you can, you can do that at any point.

Speaker 1: 27:38 We can do prolotherapy or stem cell or prp and intervene in this area. And if it doesn’t work, the only thing you’ve lost is time and money. Not that that’s in that. Not that that’s nothing, but there’s next to no risk. There’s very, very low risk potential for those procedures and there’s really no recovery time. You don’t have to take time off. One of my good friends had a hip issue, um, and I mean it was clear in the discussion with him that he had kind of made up his mind he wanted to go down the surgery route and I mean, I’m not going to try and talk him out of that. Um, but my thought, I didn’t know with what he had surgery may have without question been the best issue or the best intervention. I don’t know that, but what if prolotherapy would’ve fixed it?

Speaker 1: 28:27 He got surgery. You didn’t really have any complication from surgery other than the fact that, you know, we’re two, three, four months out and he’s still having pain. Like we’re, I don’t want to say worse than it was before. It’s different though. Sure. And so he’s got this, this pain that he. I mean, he had to take significant amount of time down, couldn’t work, couldn’t do that. And you know, those are your, those are not risks, those are complications from surgery. There’s a recovery time with prolotherapy, there’s not. You can get it and go back to work that day. You can still play sports, you can still do all of your activities. There’s no real downtime. So cost effective from a medical intervention perspective, cost effective from a recovery and what it costs the US economy. We like to say back pain cost. The American people $8,000,000,000 a year.

Speaker 1: 29:23 I made that number up. But there’s none. There’s none of that because they can go right back to work. There’s a, it’s just, to me it’s a no brainer to at least try it upfront. If it doesn’t work then you know, go, go get surgery or whatever else is recommended by one of the other. But you know what comes to shoulders, we get great results with that low back pain. We get great results from head to toe just about without exception. I’m almost always going to recommend prolotherapy prp or stem cell as my initial intervention. And if we need to, we can always do surgery. That’s their orthopedic surgeons that would be happy to do surgery for those issues, but let’s do everything we can to try to prevent that and you know, if, if in, in, in, in my, and biff in his case, if I’m saying that as, as, as if it’s his real name would, you know, uh, anyway, so in his case he could have surgery on his, on the labor him for his hip.

Speaker 1: 30:24 It may fix that and he walks away still having pain. Let’s fix those things first. If we’re still having a problem, now we’ll go pursue that, get that, get the overall as healthy as we can see what’s left. The efficiency and consistency of success with prolotherapy. It strikes again to more patients. Happy patients. Absolutely. And the list goes on and on. Sure. Well, I’ll tell you what, I uh, you know, I still am going to feel like Gumby, but I feel like that’s a problem. Prolotherapy is not going to be able to help me with, you know, in terms of my six foot seven this didn’t gumby have a donkey mascot. Pokey, pokey pokey. Okay. Pokey, if anybody has a pokey figuring, we would love to see it. What’s a good email address that you send a picture to? A I would send it to either info at or reception at Revolution Health Dot Org. Boom. Thank you guys so much for listening, Dr Edwards, thanks for joining us today on prolotherapy. Always good to be here. You know, this is one of my passions. I love a great procedure. We’ll talk to you guys next time. Thanks. Thanks for listening to this week’s podcast with Dr Chad Edwards. Tune in next week where we’ll be going against the grain.