[00:00:00] Luke Storey: I'm Luke Storey. For the past 22 years, I've been relentlessly committed to my deepest passion, designing the ultimate lifestyle based on the most powerful principles of spirituality, health, psychology. The Life Stylist podcast is a show dedicated to sharing my discoveries and the experts behind them with you. Well, hot, damn, we made it to the mics finally, guys.

[00:00:28] Dr. John Lieurance: Yes, we did.

[00:00:29] Luke Storey: Really, what a journey over the past day. I feel like we've been here a week.

[00:00:35] Dr. Matthew Cook: Yeah, me too.

[00:00:36] Luke Storey: It's been really, actually, quite wild to have Dr. John Lieurance here in Matt's clinic, and Matt doing all kinds of work with kind of John being our wingman, and observing, and helping out.

[00:00:52] Dr. John Lieurance: Watching Matt do his magic.

[00:00:53] Luke Storey: Yeah, it's been pretty cool. So, I guess we'll start out, perhaps, Matt, you could give your definition of regenerative medicine, or actually, both of you can just kind of give what you do, because you both have these incredible clinics that are very cutting-edge, and I'd like to just kind of familiarize people with your perspective on that.

[00:01:16] Dr. Matthew Cook: That was a good one. So, regenerative medicine, I think, is an approach towards healing the body at every level with techniques that involve both IVs, procedures like plasmapheresis that sort of reset the immune system, and then primarily focused around different injections that we use to reboot and reset the musculoskeletal system. And so, we do nerve hybridization.

[00:01:52] We do ultrasound-guided injections into joints, into fascia. We actually inject into the bone marrow sometimes. And so, there's a wide variety of different injections and different materials that we use that have a healing effect on tissues of the body. And then, what we do is try to use those approaches and those techniques to basically heal the body and reset it.

[00:02:17] Luke Storey: Cool. How would you define that in what you do at your clinic in Sarasota?

[00:02:22] Dr. John Lieurance: Yeah. I mean, I would agree with Matt into his point that there's a variety of different ways to apply regenerative medicine. But ultimately, you're fixing the cause and there's a lot of different expressions of disease that are just a symptom. And it's just that, it's an expression, like you've got a runny nose, you got an upset stomach, you have pain in your body somewhere. Like if we just look at pain, and we were to say, okay, is the problem pain, which is probably inflammation is underlying?

[00:02:54] But is the inflammation even the problem? Right? So, I'm going to take an anti-inflammatory or a pain reliever, but is that really fixing anything? So, in my opinion, you're painting over rust in that situation. So, if you were to look at arthritis, what I tell my patients in the clinic is let's get rid of that word, because people get confused, they think it's like a cold, something they catch or genetic and they get very baffled.

[00:03:22] And when we come in, and we also do a lot of ultrasound, which I think, clinically, is one of the biggest game changers ever, because you can see and diagnose, and then you can actually guide your procedures to the soft tissues and some of the hydrodissection that I watched Dr. Cook do yesterday. And he is an absolute black belt with it, which I think we should dive a little bit into.

[00:03:45] But being able to go in there and see what arthritis looks like, which is rough cartilage and loose ligaments. So, if you have an injury, or there's postural, or bad habits that you have, they're stressing the connective tissue, that connective tissue breaks down and allows the joint to start moving into a position that starts stressing the cartilage, where it's normally supposed to be setting in a certain juxtaposition.

[00:04:10] And so, you start to get chips and roughness of that cartilage and the connective tissues loose. So, let's call arthritis loose ligaments and rough cartilage, because that's actually what's happening. So, anybody that has any type of arthritic pain, they need to be using their thought processes, what can I do to strengthen ligaments, and get cartilage to be smooth and friction-free? I mean, cartilage is really an amazing structure. It's 10 times slipperier than ice on ice.

[00:04:43] I mean, man has made something so incredible, and I'm sorry, our body has made it, right? But we have these joint replacements, it's not anything close to what our body actually does. And so, it's this friction-free surface that allows inflammation not to occur. And when you start getting roughness, it's like sandpaper, and you get friction, and that stirs up the inflammation, and then you see all the fluid on the joint, and the pain. So, fixing those problems is, in my opinion, that's regenerative medicine.

[00:05:12] Luke Storey: Awesome. So, same kind of root cause thing rather than just looking at symptoms, which are ultimately, I think in biomechanical situations, going to end up in surgery or prescription drugs that you might even become dependent on to stay symptom-free, which doesn't sound like much fun to me. So, let's see where I want to go with this.

[00:05:37] Dr. Matthew Cook: I remember so clearly when I was a second year anesthesia resident in the year 2000. And I don't know where it came from, but from a governmental level, they said, we need to pay more attention to pain. And I think doctors had always been somewhat like accepting of pain. And so, they said pain is the fifth vital sign. And so, at that time, it was kind of interesting. Nobody was really taking narcotics that much.

[00:06:12] And at that time, in San Francisco, there was a heroin epidemic, but the most heroin anybody would take was like one, or two, or three grams, and I had never even heard of heroin until I got to residency. And so then, we would take care of a lot of heroin addicts in the emergency room, but then all of a sudden, pain is the fifth vital sign, everybody started paying attention to it. 

[00:06:32] And then, they thought, well, we're going to get rid of this, and how are we going to get rid of it? With opioids. And so then, what happened, and I remember this anesthesiologist, and she said, well, don't worry, because you'll just go in, and you'll give these people fentanyl, and then nobody, she goes, everybody falls asleep with 10 ccs of fentanyl, which was 500 micrograms.

[00:06:56] And so then, that was like this thing that we always did for the heroin users, because it got them enough narcotic to keep them comfortable and we would get them through that. And then, over the next five or six years, what happened is, all of a sudden, there was this explosion of opioids that came onto the market. And then, next thing you know, everybody's taking the opioids and we had an opioid epidemic. And it's super hard for people to get off of those. 

[00:07:22] And so then, that created this wave, just from one kind of governmental idea that seemed like a good idea at the time, and I remember going to that lecture and I was super pumped up, because I was like, oh, we're going to start paying attention to pain, my career is going to be amazing, we're going to give people pain medicine. And then, now, it's like we go so far out of our way to never write a pain, an opioid prescription, and I almost never do, but still, everybody is afraid, because it created such a catastrophe for the last 20 years.

[00:07:55] Luke Storey: Yeah, certainly. It seems to be getting worse in many ways. So, either one of you could answer this, maybe in your own way, what are some of the most common symptoms of pain? It seems to me that, often, it has to do with joints, like it's centered around a joint, whether someone has lower back pain, knee problems, ankle problems, big toe problems, elbow, tendinitis, all this kind of stuff. What are some of the root causes then of the pain that we experience?

[00:08:27] Dr. John Lieurance: Well, there's a number of different tissues that can produce pain, nerves can produce pain, ligaments can produce pain, tendons, muscles, fascia. One of the things that Matt does in his clinic, where it's just fascinating, I want to learn more about this, we do a little bit of this in our clinic, but this nerve hydrodissection, which you're actually addressing the fascia and you're addressing the nerves.

[00:08:54] So, imagine in your body, you have muscles that need to move past each other, right? And over joints, and over bones, and tendons, and so forth. So, there's this motion that happens within the body between all these different planes and that needs to be friction-free. I also do cranial work and there's connective tissue in and around the cranium that gets adhesions to it and can cause disruption to the flow of circulation, right?

[00:09:24] So, I'm always telling my patients, you're either a swamp or a river, right? And so, when tissues become more swampy, they become more toxic. This favors more pain. So, some of the procedures that Matt does in his practices under ultrasound, he can go in there and literally inject within these planes, which I watched him do with your back, right? And you saw some of those pictures, right?

[00:09:47] Luke Storey: Yeah, I watched it too.

[00:09:49] Dr. John Lieurance: And it just opens it up. And so then, that opens up and it frees those adhesions. And now, you have all this movement that's normal. And so, you can literally see people that can't even touch their toes, and after getting worked on with this hydrodissection, just the flexibility is just incredible. I'm sure you could kind of speak to that as well.

[00:10:10] Dr. Matthew Cook: Yeah. So then, if you go back to kind of like what—I like what you said, if these different causes of pain will cause different genres and types of pain, and a whole bunch of different types of nerves, and they will carry different genres of pain, too. So, it's like pain is not just like one word, it's a whole bunch of sort of different categories. And so, sometimes, there's a pain that is like a tendon is torn.

[00:10:47] And so then, there's nerve that goes to that tendon and the nerve is telling you that that tendon is partially torn. Sometimes, a nerve goes underneath a tunnel like carpal tunnel, and if that nerve is pinched, then that can create pain. Sometimes, a person, in maybe one part of the body or in one area, they don't get enough blood flow, and so then there's a chronic lack of blood flow, and that lack of oxygen and lack of flow to the tissue can cause pain.

[00:11:19] And so, that's a different type of pain. And then, what I generally see is that most people have a little bit of two or three different categories of pain. So, sometimes, there are some nerve impingement. Sometimes, there are some inflammatory thing going on that may be inflammation in the joint. And the cause of that inflammation in the joint may be just what John said, that those loose ligaments causing hypermobility.

[00:11:47] And certain people, like you hear about people that are called hypermobility or Ehlers-Danlos Syndrome, that is called EDS in some communities, a lot of those people will have much more pain. And then, interestingly, those people, I find to be more susceptible to kind of chronic infections, and then the pain, this infection type of pain. So, for example, people with Lyme disease can have pain and joints.

[00:12:12] So, you have all of these different categories, and so our job as clinicians is to try to suss out of these different types of pain, which one do we think it is, and then depending on that, then that says, oh, okay, then I've got a handful of different modalities here, and then trying to pick and choose the right modality based on the type of pain that that person has.

[00:12:39] Luke Storey: So, yeah, go ahead, John.

[00:12:40] Dr. John Lieurance: Well, we were going to get into disk, right? And I'm going to just kind of jump in right now. So, disk pain is fairly rare in older age, right? And there's such a huge, myopic view of back pain, meaning that it's all disk, right? In fact, in my practice, I'm sure your practice is the same thing, everybody shows up, I've got my MRI, I've got a disk problem, what can you do for my disk? There is no concept that maybe it's not even your disk causing the pain.

[00:13:10] So, there's something called referred pain. And referred pain can often come from connective tissue. So, if you look at the textbooks and you look at leg pain, for instance, there are five different common causes of leg pain, there's a disk, which would be a nerve root, right? Then, there's SI joint, there's the SI ligaments, then there's the hip, and there's the hip capsule. So, out of all those five causes of leg pain, only one is the disk.

[00:13:39] So, why is there such a huge focus on disk when it's like sciatic? Right? So, in our practice, we do a procedure called prolotherapy very commonly, especially for patients with different, more complex pain. And so, prolotherapy is a regenerative treatment. We've been doing it in our practice for about 25 years, and it's using dextrose, which is a sugar, and it's hypertonic, and it stimulates an inflammatory response that leads to collagen synthesis and basically regeneration. So, what's nice about it is that there's lidocaine with it as well.

[00:14:15] So, if we take it step by step, like somebody comes to our office and they have leg pain, we can go in and inject their Si joint if they palpate. So, I know Dr. Cook was doing a lot of palpation. I thought it was genius, the way he was going in with his thumb and very meticulously like feeling, okay, is this right where you feel your pain? And then, he'd take his ultrasound, he'd look, and he's poking on the side, you can kind of see the tissues moving, and he's looking to see, are those fascial planes working or not. 

[00:14:43] And it's just such a great way to look in and find out where is that pain-producing tissue coming from? Where's the origin of that pain? And then, once you figure that out and you can look at it with an ultrasound, which is, in my opinion, better than an MRI or X-ray, you can look at it and see, what's going on there? What's that tissue, what type of tissue it is?

[00:15:04] And then, Dr. Cook and I, we both have this kind of palette of things that we use, and most of them are injected, but there's also like electrical devices like you had used one today in the practice. We use a soundwave device, ultrasound laser. So, in our practices, we kind of fuse a few different things together to kind of target these specific areas.

[00:15:31] Luke Storey: Yeah, it's interesting. You mentioned the prolotherapy and that you put lidocaine. I was doing that for back pain years ago, and I don't think they put the lidocaine. It was so painful. It was brutal and it was right on my back. But to your point, maybe there's something in kind of the easy road of blaming pain like back pain on a disk rather than referred pain and this nerve pain that could be located in any number of places. I remember years ago, I went to a very traditional, I don't know if he was an osteopath or what, in Beverly Hills, and I said, I have lower back pain, got me an MRI, and one of my disks was a little dehydrated, a little smaller than the others.

[00:16:10] And his recommendation without even thinking about, oh, we'll just fuse that, come on back in. And I thought, that sounds a little weird, like I don't feel like I want to stop the mobility in one of my vertebrae, right? Thankfully, I didn't do it, but come to find out, I come in yesterday and get treated by Matt, and it's like, we're not even looking anywhere around the disks. It's this whole other thing. So, perhaps, do you think that that's often kind of the place certain doctors go just because it's like an easy fix with surgery?

[00:16:44] Dr. John Lieurance: Well, they're indoctrinated into that. They've got the MRI and the insurance companies pay for it. The surgeons who do a lot of back surgeries, it's just low-lying fruit for them. It's sad. I feel sad. I feel that there should be some more education. And I wish that, because I've got a lot of patients that come in after they've had surgery, multiple surgeries, and we do this prolotherapy, and it's their SI joint, or they're really a lumbar ligament, or their hip joint. I'm sure you've seen it a million times as well.

[00:17:22] Dr. Matthew Cook: My sort of analogy, and I kind of have some good thoughts on prolotherapy, and interestingly, for years, I've been going to Mexico, and then we'll go down and we'll do like kind of mission type of trips and do prolotherapy for people. So, even though I don't do dextrose prolotherapy in my practice now, I've done a lot of it over the years and it's kind of like Hallelujah when you go, and somebody's had pain for a long time, and then you fix it.

[00:17:50] It's pretty awesome to go do stuff like that. When I think of the spine, if you see the spine, it looks like a tower. And so, in the front, you've got a vertebra and a disk, and a vertebra and a disk, it's kind of like a pile of pancakes going up on the front. And then, the back, at every level, there are two facet joints. And they have almost like two hands touching each other. And so then, they can rotate a little bit, which is why we can turn.

[00:18:26] And then, the spinal cord's in the middle, and then all the nerves come out the side. And so, I like to say that half the force is going through the front of the spine, through the vertebra and the disks, and then half the force is going through the back of the spine, through the facet joints, and then they call it, the posterior ligament as complex, all the ligaments, and tendons, and fascia, and the nerves are going out the side.

[00:18:51] Now, as long as everything is going great with what I just said, then you're basically going to be totally fine. However, what happens a lot of times is people will get a little arthritis in those facet joints, and then those joints aren't quite as good at handling their half of the force. And so then, that causes dysfunction. And the other thing that happens when that happens is it puts the nerves that are going by the facet joints and do a little bit of spasm.

[00:19:20] When that happens, that puts the erector spine and a lot of your muscles into spasm, which further compromises efficient flow of force going through your back. And so, as a result of that and that dysfunction, I think that that sets you up for a susceptibility for a little bit of a disk herniation. But when somebody presents just like they present to you and just like they presented me with back pain, with a little bit of a disk, 99% of the time, when I put the ultrasound down, I find two or three other things.

[00:19:52] And then, generally, what I do is I treat those things, and generally, we're able to start to stabilize, get improved function, force flowing through the spine, and then by treating facet joints, and the posterior ligament is complex, and there's a hundred ways that are all kind of useful and good that we could kind of discuss. And then, generally, those usually get better. 

[00:20:17] Now, we will go into a disk, but there's more complications with going into a disc and it's a bigger thing, and so then I do like to start with the other stuff, and I think it's a better way to go. And even if you talk to sophisticated regenerative people that I know, generally, we talk to a lot of people, and say, you know what, I used to do disks, but lately, I'm not doing so many, because I just fixed so many people without it.

[00:20:44] Dr. John Lieurance: Yeah, that's true.

[00:20:46] Luke Storey: Can you break down what we did in my procedure yesterday, which was to me, as John's indicated, I mean, just watching your whole operation at BioReset, which is, for those listeners here in Los Gatos, California, we'll put it in the show notes, I mean, the whole operation was just so seamless? There's this orchestration of people that was really fascinating to watch, just your techs and assistants are just showing up with plates of syringes, and everyone's just on time, they know where to be.

[00:21:18] It's actually really quite a workflow there that was very impressive. But beyond that, having the ability with the ultrasound for me to lay on the table and watch these needles going in with the hydrodissection, I mean, it's just really just a fascinating experience, actually. I felt like I fast-forwarded in medicine by 25 years. I mean, it felt so futuristic versus kind of the old model you spoke to. If you go get an MRI, then they want to fuse your disks and just like real surgery. This was more of a procedure involving a bunch of needles.

[00:21:53] So, maybe you could kind of break down how you got to what you felt the root of the problem was, which we kind of arrived at today and some of the things that you did. And then, John, it might be interesting for you, let's say we weren't even out at Matt's clinic at all, and I came to see you at Advanced Rejuvenation in Sarasota, what would have you done differently? Would you have employed any other tools that we didn't or how would you have seen it? So, maybe start with Matt and just kind of break down what we did. It was really incredible.

[00:22:24] Dr. Matthew Cook: Okay. So, that's a good one. So, we talked for a little bit, and basically, what I heard is that you had a traumatic experience probably 25 years ago, and after that, you got better, but then you've had 15 years of fairly substantial pain in the front of the hip. And then, also almost that long of a pain that was in the low back SI joint area that's been moderately intense in the ballpark of a four or five out of 10. And sometimes, worse, and sometimes, better. And sometimes, it bothers you standing, and sometimes, the standing is more in the front with the hip, and then sitting in a hard chair is in the low back.

[00:23:16] Luke Storey: Yes, hence the pillows underneath me right now.

[00:23:20] Dr. Matthew Cook: So then, we talked a fair bit and I generally try to do that to try to get a sense of the trajectory, what's happened? And you had had stem cells and it hadn't helped, which was a good one. And so then, immediately, that started to make me think, oh, okay, that was probably a good stem cell treatment, and so then it may not be his joint, because they treated your joints. So then, that was kind of cluing me in, oh, okay, I wonder if this is something else. And so then, I did what I almost always do, which is kind of check in, otherwise, totally healthy. And so, I gave you some IVs. I gave you vitamin C, and glutathione, and a little bit of NAD, and some other things like that—we skipped the NAD. 

[00:24:13] Luke Storey: Because I had one of John's suppositories.

[00:24:14] Dr. Matthew Cook: Yeah, the NAD suppository, which I have on right now. And so then, we did the ultrasound exam and sort of looked around. And it was interesting, you had a lot of pain at your S1 foramen, which is the foramen that the first foramen of your sacrum, where some nerves come out, and yet some pain in your lumbar facet joints and you had some pain where your SI joint is. And then, we rolled you over, and then you have hardly any pain in your transverse processes. 

[00:24:55] And I looked at a bunch of other things that you didn't have. And then, we rolled you over, you had some pain in your greater trochanter, and then you had a lot of pain in the front of your hip. Not really in the ball and socket of your hip joint, but when I palpated the psoas tendon and the psoas tendon is your primary hip flexor, and then you also had a moderate amount of pain in the top of a muscle called the sartorius, which is another hip flexor.

[00:25:27] So, basically, you had two hip flexors that had quite a bit of pain. Your hip joint looked pretty good and some pain in your greater trochanter. So then, we put that all together and sort of made a plan. And so then, what I did is we did a placental matrix and we use placental matrix to treat your facet joints. And I treated all the facet joints, the bottom facet joints on your right, L34, L45, and L51. 

[00:26:02] That's one I did, and I went actually through that foramen, and then I did an epidural at S1. I actually went into the SI joint and treated your SI joint with placental matrix also. And then, I did a hydrodissection with placental matrix of your thoracolumbar fascia. And basically, what happens is I told you that you've got two facet joints at every level, and then superficial to those joints, you've got all of these muscles, and then superficial to all of the muscles.

[00:26:43] So, basically, like just a centimeter under your skin, there's a fascia that it's almost like a sail, and all of the muscles attach to it. And a lot of times, that can be a pain generator, because the nerves that go to your skin have to pierce that and go through that so that they can get all the way out to your skin and provide sensation. And a lot of times, people that have been in pain for a long time will have pain there.

[00:27:10] So then, what I did is I did this hydrodissection of the thoracolumbar fascia, which for anybody that wants to know, on a scale from one to 10 of being difficult, it's about a two, super easy to do once you know how. And so then, I'm kind of into the idea of like Grateful Dead style, disseminating as much information as possible, and we listen to the Grateful Dead while we did that treatment.

[00:27:35] Luke Storey: I got to say, like the whole experience, A, from just how long you chatted with me and how much detail you went into, I mean, I'm thinking of just a traditional allopathic visit., it's like, okay, where does it hurt or whatever? Here's a pill, or let's sign you up for surgery, or whatever. It's like you really went into great detail, but maybe my favorite part was listening to the Dead while this whole procedure was going on, and you're singing, I'm singing. I mean, I'm like, this is very untraditional, to say the least. But anyway, that added to it.

[00:28:03] Dr. Matthew Cook: That's kind of interesting. And then, it's interesting. And then, we're talking, and so it's like a very serious experience, and yet the music has a lot of insight and wisdom. And so, I always quote lyrics as they're coming up, because interestingly, sometimes, emotional things come up. And so then, we went to the side and I treated the greater trochanter a little bit and I did a hydrodissection of the proximal sartorius, where basically, I come underneath that muscle and I put fluid in the fascial plane where that is.

[00:28:40] And a lot of times, that releases a bunch of the proximal hip flexor muscles and they'll function better. And then, I did this cool hydrodissection where I do a hydrodissection between that and the tensor fasciae latae, and that's the muscle that attaches to your IT band. And you've had kind of this tight IT band thing forever, and I had that, too, and I did this and sort of fix it. And so, it's been an interesting experience. 

[00:29:09] And I'm going to have you do some peptides and some other things that are going to continue the treatment ongoing. But then, the other thing that I did is like, I actually went, and I come above the hip, and then I do a hydrodissection of the psoas tendon, and interestingly, that was the thing that you were like, oh, this is the pain that I have all the time. So then, we treated that, and then I treated your hip joint as well. 

[00:29:37] And so then, that's most of what we did. And so then, we did that. It was interesting, because then, you were like, oh, the psoas tendon is the thing that hurts me. And then, I had been watching you walk, and then I was talking to John about it. And so, we were like, it's my favorite thing when anyone like other than me comes to my clinic, because then I'm trying to absorb everything that you have. 

[00:30:06] And especially since you come from the chiropractic background, like chiropractors are always better than me at like movement assessment and like seeing things, and you're always like two steps ahead of me, but then I'm trying to like, oh, okay, that's what that is. And so then, it was kind of cool, because as I watched, I began to realize and it really sunk into me today, you walk with a little bit of a trendelenburg gait, where you're avoiding putting force through your psoas tendon, because I think that's been so irritated for so long. 

[00:30:40] And then, I think that what happened is because of that, that caused you to put a little extra torque and exaggerated lift, basically, on your lower facet joints and your SI ligaments. And so, that creates that torque in the back. And interestingly, when I was pushing on your psoas, we were doing things, you were like, oh, this is causing pain in my SI joint.

[00:31:09] And so, part of that is that those are reciprocals of each other that are doing the same thing. And so, there's, what you said, reciprocal inhibition is super awesome thing to talk about, maybe later. But then, the other part of that is that with reciprocal pairs, if there's a problem with one, then you always end up with a problem in the other one. And part of that is that baseline, but part of that is with dynamic movement.

[00:31:34] Luke Storey: Got it. And could you explain to people what placental matrix is?

[00:31:39] Dr. Matthew Cook: Oh, yeah. So, placental matrix is a product where they take, if a woman can donate her placenta when she has an elective C-section. So, it's great, because it's just donated tissue. And so then, I used to participate in this when I was an anesthesiologist, because I used to do C-sections all the time and I used to play music during C-sections. That was kind of how I got into it, because I found like things would go like infinitely better if I would just play music for people that they liked, and kind of cheer them up that way, and kind of puts them—and there's a bunch of evidence, actually, in our literature, in the Anesthesia Literature, that people will have less pain and do better when music is playing if it's kind of managed appropriately and stuff like that. 

[00:32:30] But then, what happens to this is the placenta has some growth factors. It's got connective tissue. It has a lot of anti-infection properties. And then, what they do is they sterilize it. So, there are no living cells, which is nice. It's just connective tissue, there's a lot of collagen in there, and then there's some growth factors. And that acts as a scaffold and it tends to stay there. So, I always say, if I spilled water on my jeans, and I told you this yesterday, by the time dinner comes, you're never even going to notice that I did that.

[00:33:01] But if I spill the green smoothie on there, that green smoothies could be on my pants until they go to the dry cleaner, at least for a couple of months. And sure enough, when you put a placental tissue around a tendon, like I did around your psoas tendon, that's going to be around there, and it's going to be causing your own cells to migrate in there and start to heal that. And that's going to stay there, probably, for a couple of months.

[00:33:29] Luke Storey: Interesting.

[00:33:29] Dr. Matthew Cook: So, I'll tell people, this is going to work for three months, the reality is it's going to take longer. The studies where they look at PRP, they evaluate the effectiveness of the treatment at nine months. We think the placental matrix works a lot quicker, but if you have that timeframe, you can imagine that every once in a while, somebody will call me, and they'll be like, oh, I'm still not better. And I always say, remember, our real final end date is going to be in 90 days, and every maybe 5% of the time, I'll have somebody call at like 85 days, and they're like, oh, I'm so much better. It's kind of like it finally kicked in, so it's important to remember that time course. 

[00:34:18] Luke Storey: And so, with the placental matrix sticking like a smoothie rather than water, if one were to use stem cells or exosomes, and these kind of things, they wouldn't hang around as long, right?

[00:34:32] Dr. Matthew Cook: They probably don't hang around as long. But then, each product in regenerative medicine has a profile. So, stem cells work in a certain way. Exosomes work in a certain way. Placental matrix works a certain way. There's a lot of, now more than ever, regulatory issues, and it's uncertain what we're going to be left with and what could be taken away. And so, my philosophy is I'm just sort of waiting for guidance and I'm going to follow whatever they say. 

[00:35:04] But our feeling is that there are several regulatory categories and the easiest regulatory category to meet is something that's called less than minimally manipulated. And so, that's a product that the regulatory number for that is 361. And so, the companies that we use, which is called Skye Biologics strongly believes that their product is a 361 product and that it's less than minimally manipulated, which means not a whole lot of engineering and laboratory process was done on that, that it's a safe product. It doesn't have somebody else's cells in it. And so, we can use that and that would be helpful.

[00:35:53] Luke Storey: So, with the FDA, in terms of regulation, it's sort of like whether or not something is categorized as a drug based on how much it's been manipulated, hence the stem cell tourism, you go to Panama or another country, and they can culture stem cells and give you way more of them, et cetera. But if you did that here, that would be illegal, because that's technically a drug, because there's so much kind of manipulation in the lab that happens?

[00:36:18] Dr. John Lieurance: Exactly.

[00:36:18] Dr. Matthew Cook: Right. So, we take people out of the country for those type of processes. But that's exactly right. And so, it's unclear what's going to happen with exosomes, but I think that 99% exosomes are could be considered to be a drug. And so then, we'll see how that evolves over time. And so, we're sort of preparing to really have a big emphasis of using placental matrix, and PRP, and some of the other regenerative products that are not too controversial.

[00:36:53] Luke Storey: Right. And so, PRP being platelet-rich plasma, which I did a number of years ago on like a tennis elbow thing, and just problem solved, just fixed, never came back. It's incredible and it was ultrasound-guided also. I forget the woman's name that did it in LA. It was quite a while ago. I think it was fairly new at that time, maybe 15 years ago or something.

[00:37:13] Dr. Matthew Cook: Oh, that's good.

[00:37:15] Luke Storey: I want to ask you, John, let's say we didn't even know Matt and I flew out to Advanced Rejuvenation to see you and you assessed me, what, if anything, would have been different about your protocol? Would you have employed any different tools or do you do much of the same work? What would that look like for you?

[00:37:34] Dr. John Lieurance: Well, listen, the skill set that it took Matt to do your treatment was enormous. I mean, this is not something that a lot of doctors have available to them. I mean, he's creative. He's put a lot of time in clinically. He's got some amazing tools that he's using. And it was humbling to watch the treatment. I mean, he did a beautiful job, and I think that's going to be really, really helpful for you.

[00:38:03] I see that being an answer to a problem you've had for a long time. So, yeah, there might be some differences, but the overall gist is that Matt figured out where the pain was coming from, and I might have used our TRT machines or we have the stem wave. This sends these sound waves into the body, and when it interacts with damaged tissues, you can feel it. So, whether it was me or Dr. Dan Kirschner in my clinic, giving him a shoutout again.

[00:38:41] Luke Storey: What's up, Dan?

[00:38:43] Dr. John Lieurance: He gives me a report back, and says, hey, it looks like the sartorius, or the iliolumbar, or the SI, or the psoas, or wherever seems to be active. And so, I take that into account. We also do palpation, obviously, my naturopathic and chiropractic background, has a lot of training with hands-on, and there would be some structural things that we would probably look at. And I do kinesiology as well.

[00:39:13] And we had kind of talked about your glute being not activated, and then that reciprocal inhibition bringing that psoas to be so tight. I probably would have used bone marrow in your case. And for me, it's just when I see a lot of different areas that need to be treated, we're able to pull bone marrow, we use anesthesia for these procedures. It's fairly comfortable for most patients. A lot of people, when we start talking about like, oh, some people are a little bit nervous about it, but it's-

[00:39:51] Luke Storey: With the ice pick getting hammered into your hip bone, no big deal.

[00:39:54] Dr. John Lieurance: Yeah. Well, most people, our goal is most people, once they're done getting their bone marrow aspirated, they're like, oh, that wasn't bad at all. And it gives us a lot of material to work with.

[00:40:07] Luke Storey: So, you're getting marrow-derived stem cells, endogenous stem cells from a person's body, and then reinserting them to areas, where there's damaged tissue, et cetera.

[00:40:19] Dr. John Lieurance: Looking at the regulation, so we used to use fat, so we used to do a liposuction, and then we would dissolve the fat and take the stem cells from the fat, because fat is a huge reservoir of stem cells. But the FDA came along, and said, you can't do that anymore. It's more than manipulating, which is what Matt was talking about. So, we were looking around for a way, because we had been doing bone marrow as well.

[00:40:44] And so, we found a device that we're able to pull bone marrow in a way that it pulls about 60 times more stem cells than what a traditional procedure would. So, since we started using that method, our results have been infinitely better, infinitely faster, quicker, as far as the response level. But I know Matt used a lot of product on you, which is awesome, right? So, sometimes, that's a factor. I know with some of the placental products, you have a certain amount that you can use, right?

[00:41:18] So, when I'm looking at a case, I'm looking at like what all I need to treat, and sometimes, that's a thought process that I have and would lead me into bone marrow just from a cost point with a patient. But your case could have probably even been addressed with prolotherapy and ozone, but you might have been looking at multiple visits, or even with platelets and PRP. So, sometimes, the conversation is, can I do a one and done for you, which is what Matt did for you? I mean, he did a one and done like I'm anticipating like this problem solved, or is it something where we may need to do like one to three treatments or a series of 12 treatments?

[00:42:06] Dr. Matthew Cook: That's a good one. And also, then I just made a judgment. I made a judgment, A, of what I was kind of going to do, and then you like the Grateful Dead, so I just said, we're going to get along great. I just went for it. But then, interestingly, let's say you came back and asked me the same question, so you can't do that, what would you do? So then, like to hydrodissect that was tendon, PRP or PRP plus some platelet-poor plasma is a fantastic treatment for that. Now, it tends to be sore ,and you are a little sore today, so it would have been more sore significantly.

[00:42:47] Luke Storey: Oh, wow, because I was super sore last night, much more than I expected.

[00:42:50] Dr. Matthew Cook: Which was more than I expected, too, because I almost never see that. But then, this has been going on so long. But if you said just like what you said, John, I bet you that if I did PRP two or three times, you would totally love that, and I think a lot of the back stuff is just compensatory and would kind of go away. And so, any of the four or five things that we do for the low back plus that would have been a great treatment. And then, interestingly, if we just started doing subcutaneous peptides and had you starting to work myofascially that psoas tendon, I bet you we could get an amazing result with that.

[00:43:33] And so then, it's kind of cool to begin to say, oh, okay, so then if we could diagnostically come to clarity around what we think is going on, and then we have so many different ways of working with this that—and interestingly, like a lot of emotional stuff also came up all of a sudden, which was like my favorite part. And so then, we started doing qigong and stuff like that. And so then, all of a sudden, you have a lot of diversity of ways to sort of approach something. And even though you would love to think that it's one and done, a lot of times, I'll do something, but then a lot of times, the second time is like real minimal.

[00:44:14] Luke Storey: Got it. So, when it comes to kind of what tool either of you want to choose, from what I'm hearing, some of that's going to be dependent on what someone can afford and how much time they have, right? So, in the spectrum of what you just described, in the spectrum of least to most expensive, would like prolotherapy be kind of at the lower end price-wise? And what's that cascade of costs, because the insurance isn't covering this stuff, because it works?

[00:44:48] Dr. John Lieurance: I would say prolo with dextrose and ozone would be kind of like ground floor, at least in our clinic. And then, you start to work into platelet-rich plasma, which is the next step. And then, you start to look at things like amniotic material, and placental material, and bone marrow, the exosomes. These tend to be more in the thousands when you get into more stem cell procedures.

[00:45:17] Luke Storey: Got it. Would that be in alignment with your practice, too, Matt?

[00:45:20] Dr. Matthew Cook: Yeah.

[00:45:21] Luke Storey: Do you guys see any possibility of this type of medicine to become as mainstream, where insurance would potentially cover these types of procedures, or is it because it's not pharmaceutically driven, it's just going to live in its own cash basis?

[00:45:38] Dr. Matthew Cook: A friend of mine, Dr. Nazarian, actually got a whole bunch of data and presented it to the insurance companies in his state for carpal tunnel. Because we, all the time, will do a hydrodissection, where we'll put fluid around the median nerve to treat carpal tunnel. And so then, he presented it to the top three insurance companies, and it worked. And then, they said, we have done a whole bunch of research and we found that people are afraid of surgery, but this doesn't look very scary. This looks super easy to do, and we think utilization will go up, and it will cost us more, so we're not going to go pay for it.

[00:46:20] Luke Storey: Oh, interesting.

[00:46:20] Dr. John Lieurance: Yeah, because imagine if all of a sudden they made stem cells available on the insurance. So, if I were to need a knee—I had bone on bone knee, and I had a choice to go get an injection or to have to go get a knee replacement. I mean, people are terrified to get a knee replacement, but there would be cattle, a cattle call with people wanting to go get that injection, because the recovery, the downtime is almost nothing. 

[00:46:49] Dr. Matthew Cook: But that being said, like I've been telling people this lately, I remember as clear as it was yesterday, I was hanging out with these cardiac surgeons in Missoula, Montana, and there was a big cardiac institute in Missoula, Montana, and they did just like—and this is in 1993. Every hospital in America was doing three rooms, two or three open heart surgeries a day. And so, the cardiac surgeons were like, hey, kid, definitely go, and we are the kings of this hospital, everybody does what we say, and they did. 

[00:47:29] And so, definitely go into cardiac surgery and you'll be the coolest. So, that was like, okay, I'm definitely going to do this, because they were like the guys. And then, they said, just so you know what's happening, you need to go spend one day with a cardiologist, but don't listen to him and come back down here, because we're the kings. So, it's like, oh, okay. So then, we went up there and the cardiologist, I still remember, it was like it was yesterday, and he goes, they told you just to come up here, and then not listen to me, because they said, they're the kings, right?

[00:48:04] And I looked at him, I was like, yeah. He goes, do you know what I'm doing right now? And then, I go, what? He goes, I'm doing a stent. And I go, oh, what's that? He goes, I'm opening up the coronary artery. He goes, I'm going to stop referring to those guys, and they're going to all go out of business, because nobody's going to do heart surgery anymore unless they have a valve, which is fundamentally what happened.

[00:48:27] And so, in my career, at the beginning, cardiac surgery ruled everything, and now, they're walking around the hospital having coffee. And so then, what I predict is this is the same thing, in 20 years, we're going to be doing percutaneous procedures, all of the stuff is going to be more effective than what's done now, medicine evolves, and I think that medicine is going to fundamentally begin to adopt this stuff.

[00:48:57] And then, we're starting to do clinical trials, other people are going to do clinical trials, and we're going to have data. And then, that data is going to get better, and better, and better. And then, we're going to be able to say, oh, okay, I'll compete with you on price, and people are just beginning to do this now. And so then, for certain things like total knee replacement, then I'll compete with somebody on price. Like all gamble, because I think we'd probably beat them. 

[00:49:24] And not 100% of the time, and so then we're going to have to classify, and we're going to have different groups, and we're going to say, okay, this group of patients, for sure, responds super well to, pick a product, PRP, stem cells, placenta matrix. And so then, the practice is going to evolve, but it always evolves to being less operation and more injection that is percutaneous, like a stent or with a needle. And so, I'm actually super optimistic, but it's just going to take a lot of time.

[00:50:02] Luke Storey: I'm glad to hear that, because people need access. That's the thing. I mean, this game now is for the wealthy, you know what I mean? If somebody really wants to go whole hog and insurance isn't going to cover the kind of procedure they want, I mean, I imagine so many people end up getting a hip, or knee replacement, or fused their spine just because they can't afford or else are just completely unaware that there's this whole other way to do things, right?

[00:50:30] Dr. John Lieurance: Well, to your point, Matt, I've been in this area of health for so long, I've seen so much change. And back in the beginning years, you'd go to the conferences and there'd just be a handful of people. Now. they're massive. I mean, it has really hit somewhat of a critical mass all over the world. I mean, I remember when I would have a patient come in, and we would talk them about stem cells, or PRP, or whatnot, and they would say, well, let me go talk to my orthopedic, and I would be worried, because I'm thinking, they're going to go to their orthopedic and their orthopedic is going to say, well, there's no research on that.

[00:51:12] It doesn't work. I wouldn't recommend you try that. Now, it's a different worry. I'm worried that I'm going to lose the patient, because they're going to go to the orthopedic, and say, oh, let us do it, because now, they're all doing it. And then, I have to have the conversation with them, which we had kind of touched on it earlier about the art of prolotherapy. 

[00:51:31] Both Matt and I, we studied these arts using these injections, where there's an understanding of the ligaments and being able to target these different areas of the body and treat all of the involved areas, not thinking, oh, it's this, because it's hardly ever one spot, right? It's hardly ever one problem. It's usually what all is contributing to this pain. And so, this is what's missing with the orthopedic training, is that they're trained to use steroids. And you could virtually just give an intramuscular steroid and you'll get a systemic effect.

[00:52:11] So, they don't have to be accurate with these shots particularly, where with things like placental matrix, and bone marrow, and stuff, you're treating a rotator cuff injury or a labral tear, you've got to be right on that. So, I think one thing that people should really consider is not necessarily looking at the orthopedics as being the experts in this model, because this is a completely different skill set. It's just a different model. Although these surgeons are good diagnosticians and they understand orthopedics, they may not be the right practitioner to go to for regenerative medicine.

[00:52:51] Luke Storey: If regenerative practices such as you guys are describing fail, at what point would a knee, or hip, or shoulder replacement, like one of those big joints, when do you kind of hit the wall, and go, alright, you know what, the thing's trash, you just got to get a new one? Like how far will you go until you're like, ah, can't help you?

[00:53:16] Dr. Matthew Cook: So, I actually spent most of my career, almost my entire anesthesia career, I spent doing ultrasound-guided blocks to put the nerves to those joints asleep, and then I did sedation for total joint replacement or orthopedic surgeries. So, I have a lot of experience with like—they're kind of my brothers. And hip surgery, total hip replacement has been a long-term successful treatment. And hip replacement is the hardest—or really bad, degenerative hips are the hardest thing for regenerative medicine to help.

[00:53:58] Dr. John Lieurance: True.

[00:53:59] Dr. Matthew Cook: I would say the last 10 people that came that were scheduled to have a shoulder replacement didn't need to have one. Like if I hear somebody needs a shoulder replacement, almost all the time, I think, oh, I can prevent that. And even like I ran into a guy, and I was like, oh, didn't I see your dad? He was like, oh, yeah, he needed a shoulder replacement, but then he came to see you, and you treated him, his shoulder was fine now.

[00:54:28] So, knees is somewhere in between. And so then, we will try hard, but then it also, and this goes into the diagnostically trying to figure it out, so, for example, sometimes, people will have profound inflammation in the bone marrow of their femur. And so then, that can cause pain and it may be that you put something into the joint that's amazing, but they still have bone marrow pain. Sometimes, people can have profound buttressing and spurring of the bones on either side of that joint that pinched nerves. 

[00:55:06] And so, there are going to certainly be cases that are going to come to both of us, I'm going to say, that we do our best and we can't prevent that. And so then, I think the thing is going to be to get better and better clarity in terms of how we stage and grade severity, and then how we figure out from a data perspective what works. And then, just kind of echoing John, my favorite treatment of all time was the adipose stem cells.

[00:55:43] But then, I'm not doing that either from a regulatory perspective, although, I think it's just a totally fantastic treatment. And so, sort of evolving into it, but I think it's going to be important for practitioners to lean further and further into diagnostically understanding what's going on to help have a clarity in terms of decision making and processing of how to process through that.

[00:56:14] Dr. John Lieurance: One thing that you had brought up is the intraosseous approach, and I don't think people are really talking about it, because there's giant leaps forward with regenerative medicine. So, you get to the point, where you're like, oh, man, this bone on bone knee is—and really, you have to look at each patient, you have to say, okay, so this person has this very injured joint or tissues. And as you get older, there's less demand on that.

[00:56:43] So, you might have like an 85-year-old grandmother who comes in, she just wants to walk out, get her mail, versus an athlete. So, you're looking at those aspects, because you can regenerate things to some extent, right? So, younger people, they have a better ability to heal and grow new tissues, older people, less so, but they're less active, right? So, there had been this limitation to the amount of cartilage we could really produce and create.

[00:57:12] And over the last, I guess it's about three years now, there's been a big leap forward, where we figured out that the bone underneath the cartilage was basically dead, and because of that, it's not supplying nutrients to the cartilage. And so, there's an approach, and we use this in our practice, so does Dr. Cook here, where it's actually an injection of PRP, or sometimes, you'll use stem cells into the bone just underneath the cartilage, and it basically wakes that bone up. And the bone can actually be painful as well. Some people may have deep joint pain that could be literally coming from the bone. So, that seems to be a better approach when it comes to more moderate to severe type of arthritic.

[00:58:03] Luke Storey: And what are the limitations of manual therapy body work? I know so many people in my life have had various issues like mine, and we'll go see some very talented practitioners, and there's a temporary relief, but I don't often see a permanent fix. And a couple of things that come up a lot with that are people have or think they have scar tissue, and that if you get the right body worker, they can get in there and break up scar tissue. That's kind of a common thing. And if we can only get to that, then it's going to free this joint or whatever it is.

[00:58:40] And then, also, kind of the myofascial release, body workers that want to get in and work on the fascia, which I've had incredible experiences with, but nothing ever seems to produce, for me, in my experience, and most people I know, a fix, where it's like, wow, worked with this body worker a bit, things gone. What do you think the limitation is there? And is the scar tissue around old injury sites and stuff, is that really a problem or is it just kind of a cultural meme that we've all bought into that's not really the thing?

[00:59:12] Dr. John Lieurance: Oh, no, it's very real. And if you really want to have a holistic approach, I feel like you have to have a strengthening program. There has to be muscular balance, there has to be flexibility. People have to have proper gait or walking. There's getting in and out of their car, the way that they're operating and activities of daily living. All of these things matter, right? Because these things are what are leading to the stress on the joint.

[00:59:41] So, what these treatments that we're talking about, they're not a compensation for that type of physical medicine. In fact, they're complementary. And so, if you're someone that wants to live to 100 years old or beyond, you're going to look at some of these limitations that are going to happen to your body due to the breakdown of the joints and the cartilage.

[01:00:03] Well, you can exercise until the cows come home, but you're not going to actually build and get that friction-free surface of that joint back. It's just not going to happen, or the loose ligaments, or the torn rotator cuff. I mean, something like 80% of people, by the time they're 65, they have a torn supraspinatus tendon. And this is something that is easily fixed. You stick a needle right into that tear, you put some platelets or some placental products, and you've got almost a brand new tendon.

[01:00:35] Dr. Matthew Cook: Now, I like that. So then, that's a big thing to kind of recognize, because when orthopedic surgeons found out that the way to make money if you're an orthopedic surgeon is buy it into a surgery center, where you get part of the facility fee when you take somebody to get an outpatient orthopedic rotator cuff repair. So then, every joint replacement surgery, that surgeon that I knew that was 50 was trying to figure out how to do shoulder arthroscopy so that they could make money.

[01:01:04] That was like that era. Okay. But that's one of the best things that responds to regenerative medicine. And the other thing for supraspinatus is if you treat the AC joint, a lot of times, the AC joint causes, if it gets swollen, and stretched, and inflamed, it can impinge the supraspinatus. But when you think about myofascial stuff, if you go back to this diagnostic algorithm that we're talking about with ultrasound, some people have no nerve pain, but they've got myofascial stuff.

[01:01:42] Some people have really profound nerve pain, and I found a few people have profound nerve pain, they don't do that well with myofascial treatments. Another thing that is a big cause of pain is vascular arterial issues. And sometimes, there's a nerve component that relates to the autonomic nervous system with it. And so, sometimes, when we do hydrodissection, I'll hydrodissect arteries, sometimes, I'll hydrodissect nerves, often, I'm hydradissecting both, because they're right by each other. 

[01:02:16] And so then, a person that's just a normal person like me, like my entire life, I was totally focused on yoga, and exercise, and myofascial treatments. And I basically dedicated my life to that stuff, because I thought that was going to be the source of healing myself, and I fundamentally couldn't do it. And so then, I ended up going to regenerative medicine. Now, I still love myofascial stuff as much as I ever did, and interestingly, a lot of times, if you start to fix that nerve pain, if you start to fix the myofascial stuff, a lot of times, then you'll start to respond really well to manual therapies.

[01:02:59] Luke Storey: Yeah. And I want to go back and hit the rewind button there. I was in no way also insinuating that body work is not valid, and there are incredibly talented people out there. I'm more speaking to like, huh, I guess maybe that we're talking about root causes here, but back to where you went, John, it's like the root, root cause deep under the surface, perhaps, is that we're sitting like this most of our life. We're sitting at a desk, sitting in a car, we don't move as a natural human, if you think about the ancestral and functional movement seen, right?

[01:03:31] We all should be able to move like a leopard or a baby, and have all of those ranges of motion, and strength, and flexibility, but because of our domesticated lifestyle, we don't. So, I think that's kind of the piece, where perhaps body work and functional movement comes in so that a guy like me doesn't fix this inflamed tissue or whatever we worked on, and then just go back to sitting all day long, I'm going to end up eventually, probably in the same place or have another similar issue just from the dysfunction of the biomechanics being misused or underused.

[01:04:06] Dr. John Lieurance: One of the things that Matt had brought up that it's like, you have the function of the muscle and the range of motion flexibility, and then you have the quality of the joint itself in the tissues, and you have to pay attention to both. If you don't, you're really missing out on 50%. So, imagine if you were like a runner, right? You ran a marathon. Anybody that's done that, they wake up the next morning, you're going to be stiff and sore.

[01:04:35] So, you can imagine if that underlying joint tissue is chronically like that, because it's damaged, you're trying to stretch, you're trying to exercise, and you're going to have a lot of limitations to be able to get the most out of whatever rehab you're trying to do. So, if you can only imagine if you address both at the same time, you're really getting the most complete treatment.

[01:04:58] Luke Storey: I love that. Explain to me, Matt, what you did with this woman, young girl, we promised to give her a shoutout, Ayala, I think, was her name, and you said, hey, guys, come in, one of my patients is cool if you guys want to come in the room and observe this procedure. It was a steely ganglion. Am I pronouncing that right?

[01:05:19] Dr. Matthew Cook: Yeah, stellate.

[01:05:19] Luke Storey: Stellate ganglion. Could you describe that and how that ties into the systemic relief of pain?

[01:05:29] Dr. Matthew Cook: Okay. Oh, that's a good one. So, we were talking about these different genres or categories of pain. And so then, one thing would be like if you have a tendon and there are always nerves around that tendon. And so then, if you pulled the tendon, that nerve would tell you, ah, you just pull the tendon and it super hurts. So, that's called nociceptive pain. Okay. 

[01:05:59] Now, then there's another type of thing that can happen, which is, let's say that for some reason you went into a fight or flight state, and then stayed in that state for a super long time. And that might be in an artery or that might be in like, for example, an arm or a leg. And then, that part of the body is stuck in fight or flight, fight or flight causes all of your blood vessels to squeeze so that your blood pressure is high. 

[01:06:33] But then, if you stay in a squeezed, tight position, then over time, it causes you to not get enough blood flow to tissues. And then, normally, we cycle between relaxed and fight or flight. And so, normally, there's just kind of a balanced homeostasis between those. But sometimes, if you get stuck in fight or flight, one example of that would be PTSD. Another example of it is this condition that I treat a lot called complex regional pain syndrome, where a part of the body is stuck in fight or flight.

[01:07:07] And another one is, sometimes, people with migraine headaches, well, there's a component of people, and also, for head pain and face pain, what will happen is the blood vessels are stuck in a chronic fight or flight state and they never release. And so then, what we do is I do an injection, and I go in the front of the neck, right to where the fight or flight nerves are, and then I put them to sleep for like eight hours. And so then, when I put them to sleep, and I also treat the vagus nerve, which is the rest and relax nerves.

[01:07:46] So, I basically take rest and relax and fight or flight, and basically put them to sleep. And then, what that does is it causes them to shut down. And then, when they wake back up, they tend to wake back up kind of at the factory default settings. And so, that can be helpful for people in terms of resetting, because now, that's going to reset, basically, the balance between rest and relax and fight or flight to the arteries or wherever we're trying to do that for them.

[01:08:17] Luke Storey: It was really interesting watching her go through that experience. She was a trooper, but the patient's lying there watching the ultrasound monitor. I'm watching that, and then you have, I mean, not a thick gauge needle, but a pretty long needle deep in her neck and she's just hanging out. And I thought that was so interesting. And you later explained that you don't really have pain receptors much inside there. It's more on the surface of the skin, because I was like, how is this girl not jumping off the table?

[01:08:46] Dr. Matthew Cook: Yeah, it's kind of crazy, from a big picture, to think about how that works. Basically, we're hanging out basically in my kitchen. And what happens is all of our senses, so our taste, smell, hearing, vision are mapping into this part of the brain called the amygdala. And so, at every second, our amygdala is constantly screening to make sure that this is not fight or flight. So then, if everything is cool, now, we're just in this kind of great conversation, everything's rest and relaxed, and it's cool.

[01:09:24] Now, if you smelled something that was burning, that might be a signal that was fight or flight, but your consciousness could suppress that because your consciousness could say, oh, Barb's just making toast for us, so everything's fine. She just burned the toast. That's kind of funny. And so then, we'd still be in rest and relax, as super cool. But the same thing could trigger fight or flight.

[01:09:50] Now, if fight or flight is triggered, then what happens is the amygdala, I call it Crazy Amy, projects out, and it goes through these nerves, and there's three big ganglion, that the nerves kind of—it's like basically kind of the Grand Central Station for the fight or flight nervous system is in the neck. And then, they send branches that go to the arteries, and they can either cause you to squeeze or relax.

[01:10:17] Now, what happens is a lot of times, somebody goes to Afghanistan, or they get trauma, or they get assaulted, something happens. And then, let's say it happens again, and then it happens again, all of a sudden, you begin to have an idea, I don't know when this fight or flight is ever going to stop. And so then, what will happen is the brain will get stuck in a loop, where it stays in fight or flight all the time. 

[01:10:43] And that's our definition of PTSD. And that could happen for a PTSD reason. It can happen with anxiety. And then, the other thing that can happen is if you're in pain all the time, sometimes, you get stuck in that state. So then, the super interesting thing is that we look with the ultrasound, and then I put a needle into the sternocleidomastoid, which doesn't hurt at all, because having a needle on muscle, I go over the nerves that I used to block when I was treating shoulders, I go over the brachial plexus, and then I go right next to the carotid artery into a plane in between two muscles.

[01:11:25] And it's the two deepest muscles in the front of your neck, so it's pretty interesting, right by your spine called longus colli and longus capitis. And then, I just use numbing medicine, and I open that plane up, and so you just see a beautiful sort of opening. Interestingly, a lot of times, that helps reset those muscles and people will feel better. But then, that is right where those nerves that came from the amygdala, from Crazy Amy, are. And so, when you turn them off, it's kind of a reboot or a reset, and it was actually—I fell in love with this procedure so much that I actually named my company after it, BioReset, and more after the concept of a reset.

[01:12:09] Dr. John Lieurance: Yeah.

[01:12:09] Luke Storey: And why did one of her eyes pupils dilate so much and the other one not? It's like kind of a Bell's Palsy sort of situation she had going on.

[01:12:21] Dr. Matthew Cook: Yeah. My friend, Sean Tierney, says that it's a one out of 10 for pain, and a nine out of 10 for weird.

[01:12:30] Luke Storey: I'm reminded there's this one photo of David Bowie where his—I mean, he had kind of different colored eyes, but there's a very famous photo, where one pupil's huge and the other one's not. It's really strange. You don't see that often in people.

[01:12:41] Dr. Matthew Cook: Yeah. So then, we put them to sleep. And so, you can imagine, if this was a fight or flight situation, I would open my eyes wide awake. So, therefore, if I turn to fight or flight off, that eye gets droopy. And so then, if this was a fight or flight situation, I would open up my pupils real wide to see everything, but if this is rest and relax, I go down. So, what happens is the pupil gets small, the eye gets droopy, if this was a fight or flight situation, I would need to breathe through this nose.

[01:13:13] I would have to open it all the way up, so I could run. But if it's rest and relax, it gets congested. So then, when I do it, like within about 30 seconds or a minute, you saw it only took about 30 seconds, all of a sudden, the eye gets droopy, your eye gets real red, the pupil gets small, you can't breathe through this nose, and then the nerve that goes to your voice box is running with the vagus nerve, which is the main rest and relax nerve. And so then, that goes up. It's called the recurrent laryngeal nerve. That, we block, especially if I do a vagus nerve hydrodissection.

[01:13:54] So, the voice gets hoarse. And then, the other thing that happens is that relaxes the tight squeeze on the blood vessels that go to your brain, so you get more blood flow. So, sometimes, you get a little bit of a headache afterwards, and I always do. But then, what happens afterwards is all of that gets reset. And interestingly, like my voice, after I did it on both sides, my voice gets better, and then sometimes, we'll use other products other than a numbing medicine, and interestingly, I'm finding that there's a lot that can happen in terms of improving people's voice, their ability to sing and stuff like that.

[01:14:35] Luke Storey: Interesting.

[01:14:35] Dr. John Lieurance: I think this is such an important topic. And Matt and I share a friend, Sean Mulvaney, that did some just incredible research with PTSD in the military.

[01:14:47] Dr. Matthew Cook: The greatest.

[01:14:48] Dr. John Lieurance: Yeah, and he's an amazing guy. Hi, Sean. And I've heard him lecture on this and this procedure is absolutely amazing. And to be able to go in and reset, and so it's a treatment that lasts, right? So, you go in, you do, and then you have this reset to the sympathetics. So, the sympathetics is this fight or flight. You've got the parasympathetic that's opposite, just like your glute and your psoas, right? You have that reciprocal inhibition, just like that weak glute is causing that psoas to be hyper contracted.

[01:15:22] The same thing happens when you have a weak parasympathetic nervous system you get this hyper responsive sympathetic. And that's basically, I think, one of the biggest problems we face right now. There's too much stress. Like how many people do you know that has too much rest and relaxation? It just doesn't happen. One of the things that we're using clinically that we're seeing some really good effects with balancing the sympathetics is high-dose melatonin, because it's one of the primary activators and supporters of the parasympathetic nervous system. 

[01:15:54] And if you think about it, it makes sense, you've got this circadian rhythm, you go into sleep, right? And this is where you rest and regenerate, and this is where you're completely parasympathetic, then you wake up, cortisol, which is the primary activator of the sympathetics. This is the problem, when you have this stress response, you think your life is in jeopardy, you've got cortisol that kicks in. And cortisol is destructive to a lot of hormones. It's bad for your gut.

[01:16:22] Doing a treatment like this, stellate ganglion block, is just incredible, because people can have improvements to their gut, people can have better brain function, because when you're sympathetic, you don't have as good as circulation to your brain. So, there's a lot of problems with degenerative neurologic disease long-term. I mean, even just the consequence of poor sleep from having overactive sympathetics, and what that leads to with just almost all diseases. You could look at almost every single disease and say that if the sleep is bad, the disease is going to be made worse. If you get the sleep better, that person's disease process is going to improve.

[01:17:06] Luke Storey: When you do this procedure, is it typically done on both sides on different days?

[01:17:12] Dr. Matthew Cook: So, a lot of times, I will do both sides, and sometimes, I'll do one side and let people integrate that experience, and then I'll do the other side. The right side tends to be a little bit more resetting fight or flight and trauma. The left side, often, people will have more improvements cognitively in terms of thinking. I'm going to your high-dose melatonin along with this, because that first night's a rocky night. 

[01:17:43] And so, it may be the best idea I've ever heard to take a high-dose melatonin suppository that night. And it might even be a really great thing, because the nervous system is more susceptible to other good influences that you give it. And then, like we were talking at dinner last night about consciousness, and it's interesting, fight or flight is a great state to be in, especially when you're young. 

[01:18:17] And you don't have any anxiety, so fight or flight is fun and it's exciting. And if you have any ADHD, you don't even have to worry about it, because you're going to be fully concentrating. I remember that was part of the appeal of anesthesia to me. Like if somebody is dying down the hall, there's no consideration of whether or not you want to do it, you just run into the room and do what you have to do. 

[01:18:41] But then, that sort of genre of living your life eventually becomes fairly overwhelming, and interestingly, it's not super effective. And so then, finding a way to kind of start to run a rest and relax algorithm, and have a better ability to kind of go back and forth between fight or flight and rest and relax, I think, is what we're all looking for. And sometimes, I think that doing the block teaches your brain, oh, okay, I can go into that state. Like I was telling John, I do five or six every day, and it's my favorite thing to do, because then I just go at super low stress, because I do it so much. 

[01:19:31] And so then, I walk in, and it's like, oh, okay, everything's going to be amazing, I just kind of connect and get in heart space. And then, it's like my favorite thing to do. And what I feel like is that we're learning through these medical procedures how to be in a clear, conscious state. But then, the medical procedure is just like a gimmick that is encouraging us and kind of helping us, but the reality is, and this has been my belief from the beginning, is that we don't need that, and I always say, once I get really good, I'm not going to need to do that anymore, even though I totally love doing it.

[01:20:14] Luke Storey: And when do you decide whether or not to incorporate the hydrodissection of the vagus nerve?

[01:20:28] Dr. Matthew Cook: It's interesting, what happens is you'll do something like in your practice, and then you'll fall in love with doing that, and then you'll make a change. Somebody else, I'll call Sean Mulvaney, or Sean Tierney is another friend of mine who knows a lot about ultrasound, and then we'll argue back and forth, and talk about it. So, like we're having a conversation now of doing a double stellate, so one at C6 and one at C4 on the same day, where what I am currently doing that I like the most is I go at C5. 

[01:21:06] And there's a fascial plane that opens perfectly for me there, and I do the stellate and the vagus at the same time, and I just do it in one fell swoop, and then I'll have them come back for the other side. So, it's a continually evolving thing. And so, what you'll do is you'll do two, or three, or four, or 500, and then talk, and evolve, and listen to conversations like this, and have an idea like, oh, I wonder what would happen if I gave my high-dose melatonin? That's like a lightning bolt for me, so it's interesting.

[01:21:45] Dr. John Lieurance: Yeah. Well, we both went to Joe Dispenza right?

[01:21:49] Luke Storey: Yeah.

[01:21:50] Dr. John Lieurance: And he talks about the high beta, right? You're in a sympathetic state, you're focused on a single point, right? And that's how most people are operating all day long. And Matt was talking about consciousness, and we all want to be more present in the moment. And that's really where we're moving more towards that parasympathetic. The more we can be in that parasympathetic state, the more we're going to really completely be appreciating the moment, which is all we're ever going to have. The more we're in the sympathetic state, it's taking us away from that present moment. One of the things that Dispenza has us do in our meditations is look and consider the space around your body, where you're broadening out your focus. And that actually changes the brain waves to more alpha and you're lowering them.

[01:22:40] Luke Storey: Right. It's kind of taking you out of that survival, myopic awareness of the body and your immediate surroundings, where it's scanning for danger or benefit. Now, that's really interesting. How does the skull and jaw play into all this? I know you do work on people's cranium. You ballooned me out in Austin, which is really incredible, and a couple, unsuspecting friends of mine who really actually enjoyed the benefits of it. And we were chatting a little bit yesterday about TMJ. How does the neck up kind of relate since we're in that area already from either of you, I guess starting with you, John?

[01:23:18] Dr. John Lieurance: Yeah, that's a good question. I do very unique forms of cranial treatment, where we use endonasal balloons. So, the cranium is a bunch of bones, and they move, and where they come together are similar to what the joint that your tooth fits into your jaw, right? And so, they actually can move. And if you look 100 years ago, people didn't have to have their wisdom teeth removed. And so, what's happening is the cranium is getting more narrow and we have more crowding of the teeth.

[01:23:50] And so, things get jammed, the maxillary bones kind of sink in. And so, it alters the position of the jaw, because your jawbone, your mandible is one bone, it's not going to move, but the temporal bones that fit the TMJ, they can change and move. So, what we do in my clinic is, and this is a good example of how we talked about function and the integrity of the tissues, so when people start developing TMJ, often, you have a malalignment of that joint that then stresses the tissues, which often, there's this disk that then gets migrated forward, and stretched, and damaged.

[01:24:31] And then, there's the capsule of the joint itself. And so, there's damage to that joint and it hurts, right? And so, what we do is we realign the cranium. And oftentimes, just using the functional cranial release, people will notice that their jaw stops clicking and it feels better. And so then, we'll go in with something like, I find typically that platelets work really well for fibrocartilage, which is mostly the structural damage of the TMJ. So, oftentimes, we would start with something like that with a platelet-rich plasma injections in the jaw, and it's very rare that we see patients that don't respond really well to that.

[01:25:10] Luke Storey: Wow. I think it's so interesting, when I interviewed Dr. Dean Howell that I know you're aware of, it never quite landed with me that the skull is a bunch of bones. I think many of us think of the skull as just one solid bone that holds your brain. It's a interesting concept that it is designed to move, right? And there are ligaments and tendons all around the head that are supposed to naturally work in unison, and work with one another.

[01:25:37] And that flexibility, I think that's so interesting. One thing I noticed from the endonasal balloons that you put up my nose, and I experienced this with Dr. Howell, too, is just this maybe it's blood flow. I don't know, you could explain, but it's just this mental clarity. It's like the best nootropic. For a couple of days after, it's just like, whoa, everything's very clear, just very centered, kind of able to hold more than one thing in mind. And I don't know, just like a real flow state, I guess that's the word I'm looking for.

[01:26:08] Dr. John Lieurance: Well, going back to that concept of you're either a swamp or a river, right? So, cranial rhythm is a movement pattern that moves cerebrospinal fluid. And so, cerebrospinal fluid carries oxygen, and neurotransmitters, and nutrients that the brain and spinal cord need. So, every 12 hours, actually, your cerebrospinal fluid is supposed to flow the entire length of the spinal cord around the brain, but it does get stuck in areas.

[01:26:36] And so, it's not just the cranial bones, but there's something called the dura mater that's inside of the cranium, and it extends down the spinal cord, wraps around all the different areas, the brain, it actually becomes the whites of the eye. And it's very, very dense, and dura mater means tough mother in Latin. Mother because it's kind of protecting something so important, your central nervous system.

[01:27:02] And you get adhesions to these structures, and it could happen from the birthing process, or it could happen from head injuries, or it could happen from postural distortions. And so, what happens when we go in there, and do these different manipulations and these adjustments is we're releasing these adhesions, and we're restoring the cranium to a more wide position, people breathe better.

[01:27:25] It has a very powerful influence on the vestibular system. So, one of the things I do, I'm a functional neurologist, and so we see a lot of patients with neurological conditions, and we use the balloons, and we adjust their cranium. It allows their brain to work better. And then, we go in with very specific functional exercises to balance using something called neuroplasticity. And this conversation is almost as, in my mind, monumental as the conversation we had about orthopedics.

[01:28:01] You're talking about actually fixing the problem. If you have someone that has a neurological problem and you give them a drug, that's why nobody can—they can't find any drugs for like Parkinson's and Alzheimer's, really, I mean, as far as fixing it. So, when you give a drug, it's global. It's going to be a global activator or a global inhibitor. But if I were to say I'm going to give you a pill so that you know what a strawberry tastes like, like that's impossible, right?

[01:28:29] But if you take one taste of a strawberry, you know for the rest of your life what it tastes like. So, the nerves are fired, right? And certain nerves, and it's a complex kind of symphony. And so, this is the same thing that happens with neurological situations, is you have to activate those specific pathways. There's never going to be a drug that's going to fix a lot of these problems, ever.

[01:28:51] Luke Storey: Wow.

[01:28:52] Dr. Matthew Cook: I'll give a shoutout, I love functional neurology. And so, that was like one of my first forays into kind of understanding chiropractic medicine. And then, I studied pretty extensively with a guy named, do you know Andy Barlow?

[01:29:09] Dr. John Lieurance: Yes. Oh, yeah.

[01:29:10] Dr. Matthew Cook: He's the greatest. 

[01:29:11] Dr. John Lieurance: Yeah, he's in New Orleans or Louisiana.

[01:29:15] Dr. Matthew Cook: He's in Tupelo, Mississippi, so I kept flying down to Tupelo. It's the birthplace of Elvis, so I was like, no problem, I'll go to Tupelo. So awesome. And it's a slightly different world view, but then if you took 100% of what is taught in functional neurology, I think it would be in integrity with basically the neurology that I learned in medical school. And there are a lot of exercises and things that people are given to sort of reset the stuff. And so, I'm a big fan.

[01:29:51] Luke Storey: What about the topic of peptides? I know this is something that's been kind of emerging. And Matt, you were telling me that from a regulatory standpoint, they're kind of in limbo a bit. Have either of you had great success with them? And if so, which ones? And where do you see that going? Are we going to have to leave the country at some point to work with these?

[01:30:15] Dr. John Lieurance: Well, I know Matt has a lot more experience in this, but I can tell you personally, I've had phenomenal results with it. We've used them in the practice as well. My eyes have been opened a bit, too, in conversations with Matt as far as some of the potential of some of the other varieties of peptides. But I've always thought it was the medicine of the future.

[01:30:40] I mean, looking at how these peptides are starting to come on board, and then now, how they're beginning to be discriminated against and the target of the FDA to shut them down when it's such a pure medicine. It was first developed in Russia. From what I understand, in Russia, they were basically like United States, screw you, you got all the pharmaceutical, we're going to have our own deal.

[01:31:07] And so, they started to really research these peptides, and I think ultimately, they work more complementary with the body. Like for instance, the growth hormone-releasing peptides, instead of taking growth hormone, these growth hormone-releasing peptides get you to produce your own growth hormone, or BCP157, which is naturally produced in the stomach, where if you get an ulcer, this peptide would be there to help heal that ulcer up really quick. 

[01:31:34] But it happens to also heal up a lot of the other parts of your body, which kind of aligns with, when you talk to people in Chinese medicine, they'll say, stomach is everything. You have a strong stomach, you're completely strong overall, right? They call it stomach fire, right? And so, when you start looking at BCP, it starts to become really fascinating on how powerful that one peptide can be just for general health and vitality.

[01:32:05] Dr. Matthew Cook: Yeah, where if I only had one modality, and you said I'm going to take everything away and you can only have one thing, then I would keep peptides.

[01:32:17] Luke Storey: Wow. Damn.

[01:32:19] Dr. Matthew Cook: And I co-founded something called International Peptide Academy. And so, we're doing a lot of teaching around this. The most famous peptide in the world just to kind of give you a little insight is insulin. So, 30 million people a day inject peptides into their body or have pumps that inject peptides into their body to help manage diabetes. And so, we have little small signaling molecules that communicate something.

[01:32:54] And so, a cell might secrete a peptide or it might secrete another molecule, and that molecule is kind of like a little thought bubble that says, hey, how are you doing? Could you do me a favor and go fix that tendon? And so then, that's the little thought bubble that I could send over to you, and then you could do that. And that thought bubble might be an exosome. It might be a peptide. 

[01:33:17] It might be another molecule. And so then, within peptides, there's a real big diversity of different types of peptides that do different things. But generally, these are all just molecules that we make in our own body that are a sequence of amino acids. And so then, I could take and have a reactor, where I just put amino acids together in the right order, and then you can synthesize and make these. 

[01:33:51] And they tend to be extremely stable. And so then, what happens is the peptides are mailed to someone, and they're either in a lyophilized form or a liquid form, and then someone uses an insulin syringe, which is a tiny, tiny needle, and then they inject it. So, there are some peptides that help with immune function, and I think part of the controversy on peptides now is a lot of people were using peptides in and around COVID.

[01:34:20] And so, that's just a topic. There are some peptides that tend to be very anti-inflammatory. One of the best ones is the BPC 157 that John was mentioning, and then Thymosin Beta 4, which is also an immune peptide. And it's an evolving process. And I'm not going to say too much, because we're not going to know how all of this is going to fall out until probably when this podcast comes out in a couple of months.

[01:34:51] There are some peptides that are quite helpful at stimulating and improving the way that mitochondria function. And then, there's these peptides that will help your body release growth hormone. And so then, they're very helpful for body composition change. And at this point, I think you'd basically just about have to be crazy to take growth hormone. Like anybody in the world taking growth hormone, I would think about getting off of that and switching to these peptides. And so then-

[01:35:25] Dr. John Lieurance: By the way, what's your favorite stack as a growth hormone-releasing?

[01:35:32] Dr. Matthew Cook: And so then, this one's kind of controversial, too, because there's some patent issues with this, but if you just said all takers, tesamorelin is fantastic and you can have a combination of tesamorelin and ipamorelin. So, I like that and I like that before working out in the morning. There's the classic one that almost everybody does is CJC and ipamorelin. And so, there's a stack where you could do a tesamorelin, maybe with ipa in the morning, CJC and ipamorelin in the afternoon.

[01:36:16] And then, in the evening, you can do, and there's a formulation where you can take IGF, LR3, tesa—I mean, CJC and ipamorelin, so you do that combination. And so, that's actually a pretty nice stack. But then, what I do with all of the growth hormone-secretagogues is I'm cycling through. And so, I never have people on the same thing permanently. And so then, I'll do one sequence, and then I'll switch that up, and we'll try something else. And so then, kind of seeing how they respond, and then just like working out a diversity of approaches tends to be better.

[01:37:05] Dr. John Lieurance: Are there protocols that you're finding better results with, say, like Lyme and mold or people with just biotoxin illness?

[01:37:13] Dr. Matthew Cook: Okay. So then, one thing is that the growth hormone secretagogues can trigger problems for people with Lyme and mold. And so then, what I would say is that for the Lyme and mold people, the best thing to do is to start with just the immune peptides. And interestingly, within Lyme and mold, then the two big kind of avant garde things that are happening is people can get mass cell activation, which is almost like an allergic type of reaction to a variety of substances, or they can get postural orthostatic hypotension, where they can get either low blood pressure, or high heart rate, or both.

[01:38:00] So, these are things that a lot of patients with complex illness will present with. And so then, what happens is on the Lyme, mold conversation, then I try to get an assessment of, okay, are those things going on? And then, are they sensitive? Now, then if that's the case, traditionally, by far, the best thing to start with has been Thymosin alpha 1. And it seems that from a regulatory perspective in the United States, that's probably going to go away.

[01:38:32] Dr. John Lieurance: That's a shame.

[01:38:33] Dr. Matthew Cook: Which is I think that that's probably a shame. Then, the next one is Thymosin beta 4. All indication is that's probably going to go away, too, in the United States. 

[01:38:46] Dr. John Lieurance: And of course, the BCP 157.

[01:38:50] Dr. Matthew Cook: So, BPC 157 tends to be great. It's not really an immune, it promotes angiogenesis. So, it does a lot of good things, very good for anti-inflammatory. BPC TB4 is one of the most amazing approaches for myofascial pain. And I think that's because there's an immune component to a lot of pain, so there's a great question that I didn't get into, when you said, oh, what are these categories of pain, back from the beginning of the conversation? And so then, think about Lyme disease and chronic mold, a lot of those patients have peripheral neuropathy.

[01:39:32] And so then, interestingly, probably one of the greatest treatments in the world for peripheral neuropathy is to hydrodissect all of those nerves with Thymosin beta 4 and BPC 157. But I mean, that's just going to go by the wayside in the States for now. So then, to approach those people, I try to go very cautiously. And for those people, I don't put them on the growth hormone secretagogues. There are going to be some new things that are going to come out, Thymulin and some other immune peptides are going to come, so it's going to be an evolution to see what happens with that. The Lyme and complex illness patients respond really well to mitochondrial peptides.

[01:40:16] Dr. John Lieurance: Yeah, I was going to ask you that.

[01:40:17] Dr. Matthew Cook: And so then, I think that that's probably a homerun, because then you start to give them more energy, and they feel better, and that's stimulating immune function.

[01:40:29] Dr. John Lieurance: Well, it makes sense because biotoxin illness, you've got this toxis—just toxins are being bombarded, fat-soluble toxins, into the cell membrane, and you've got all these cytokines. And so, what's really going to get choked off is the mitochondria, because it's going to go into that aerobic glycolysis, which was like 10% of the energy that it would normally create.

[01:40:52] And that's one of the things that I'm so excited to be in the middle of this whole melatonin, super physiological melatonin, because it actually works at that level. And I really see a huge benefit of combining things, things like peptides in some of the work that we're doing with the melatonin, because you're able to get at the mitochondria and actually fix it. And then, of course, various detoxification protocols are super important.

[01:41:22] Dr. Matthew Cook: So then, it's a good one, because I was thinking about you. So, there's a peptide that can help for sleep, delta sleep-inducing peptide. It's not like a super great long-term peptide. The epitalon is one of the Russian bioregulator peptides that you talked about, and then that-and so there's a lot of people that will use that as an approach for short-term, high-dose cycles, maybe a couple of times a year. But then, you can use that in low dose, and interestingly, in low dose, in low dose or high dose is quite helpful for sleep, but interestingly, low dose of that for sleep can be very beneficial. 

[01:42:08] And so then, you were coming, and I was kind of thinking about this, and meditating on it, and I think that there's going to be a super interesting combination, where you're starting to use some of the stuff that you have suppository-wise, and tell people about that, and the role of the suppository in terms of how melatonin goes into the bloodstream, and that time course, because, A, I think that that's super interesting. And then, B, then to think about layering on something at a peptide level that helps induce sleep. And then, now, your suppository's maintaining that.

[01:42:47] Well, what we were talking about the other day is that I was looking at all the research, and these researchers are like, well, melatonin supplementation helps sleep latency so you can go to sleep, but it's not helping with all these other issues, right? And it's because when you take it orally, there's something called peak plasma. So, any pill that you take orally, you take it, and for about an hour, and this happens with IVs, unfortunately, as well, unless it's a really slow drip, is you've got like, it's in the bloodstream for a certain period of time, and then it's gone.

[01:43:19] So, the cells have this moment where they can pull it into the cell, which is where you want the nutrient, and then it's gone and they don't have that available to them anymore. So, what a suppository does is it slow releases a substance over the course of three, four, or five, or even seven hours. And so, this is a really good advantage for really any nutrient. I mean, CoQ10, NAD, this is one of the suppositories that we're making. is NAD Max. 

[01:43:51] Luke Storey: By the way, your NAD suppository changed my life, especially flying, which I've told you, but to tell the audience. And not to interrupt, but I want to let the audience know, by the time this comes out, I don't know the episode number, but there already will have been a long form conversation with you, John, about all of that, but carry on. We did a deep dive on the suppositories, no pun intended.

[01:44:16] Dr. John Lieurance: We also dove deep into how melatonin works with the mitochondria, so we don't need to like repeat all that.

[01:44:23] Luke Storey: But carry on with the blood plasma levels. I think that's really interesting to get a prolonged kind of slow release of whatever nutrient you happen to be using. That's really fascinating.

[01:44:32] Dr. John Lieurance: Yeah. So, a slow release is really beneficial. So, if you wanted to go get an NAD IV, you might have to sit there for five or eight hours and it costs $500, where we have a suppository that has virtually the same dosage, and you put it in, and you're just off with your day, you don't even know it's there. With melatonin, oral melatonin is two-and-a-half percent absorbable. This is in the research. 

[01:45:01] So, not much is even getting in, because you have first pass through the liver, you have your digestive enzymes, and so not much makes it into the bloodstream to begin with. And then, what's left is they're in a peak plasma for a short period of time, where when you do a suppository, you're skipping the digestive juices and you're skipping the first pass to the liver, it's going directly into the bloodstream, and slowly over a period of time.

[01:45:28] So, the cells have the time to get and draw those—like if you were to have like a bowl of beans, and you pour water into them, and you come back an hour later, and you look at the beans, they're probably going to look about the same, they're still going to be hard, right? But you come the next day after a full 24 hours, and they're starting to really absorb all that water, and that's how your cells are. Your cells don't suck things in very quick. They need time to absorb it.

[01:45:55] Dr. Matthew Cook: If I could give like—I always loved that song when I was a kid, I'd Like to Buy the World a Coke. I would like to not buy the world a coke. But like we were talking about addiction yesterday, and one takeaway that I'll give people is everybody with addiction is super depleted in NAD.

[01:46:20] Dr. John Lieurance: Absolutely.

[01:46:21] Dr. Matthew Cook: And I was one of the relatively early people doing a lot of NAD IVs for addiction, but then it's like flying across the country and spend $10,000 getting, and so I'm trying to evolve into new ways to do that. I think the NAD suppository is a home run for addiction, because all of a sudden, if people have a little bit of energy and they're feeling better, they're less susceptible to fall off the wagon in search of something that's going to help them self-medicate.

[01:46:51] None of those people can sleep. And so then, I think the idea of melatonin in that population is super great idea. And then, I'll just throw it out there, even though we think from a regulatory perspective that this may go away, in my experience, Thymosin Beta 4 is for addiction and Thymosin peptides in general, and I think it has an effect of detoxing something in the central nervous system, can be profoundly helpful. If you said what dose would I be thinking about, I'd be thinking about kind of a traditional dose like 1.5 milligrams a day.

[01:47:29] Some people will do a bolus once a week, get a little bit higher dose, maybe three or six milligrams. And then, there are 100 other things in those genres, but if you did those three things, I bet you might be surprised at how helpful it is. And I was telling Luke, like I just started calling my friends during COVID who were drinking too much and saying, hey, why don't you try this? And everybody stopped drinking. And so, I think it's super interesting. It's almost like a social justice topic that we need to do more to help people in a functional way sort of get through some of those struggles.

[01:48:15] Dr. John Lieurance: Well, I think the addiction is a huge topic, and I think we should talk a little bit more about it. And what happens when you're drinking, you're not sleeping well, they've shown that you're not getting REM sleep. So, when you go into REM, this is when all the things that happen throughout that day, your brain is basically defragging. You're making sense of things, right? So, I have a friend that I knew in high school, right?

[01:48:44] And this person is literally the same as they were in high school. They just haven't matured. And that's what you'll see with people that are drinkers in particular, is because they're not getting sleep. It's particularly the REM, but they're also not getting deep sleep. Now, deep sleep in particular, it's one of the primary activators of something called the glymphatic system, which is where your brain actually detoxes itself.

[01:49:06] So, using things like the Thymosin beta to curb the cravings, and also, things like NAD, where you're going to feel more socially, you're going to feel better about yourself. You can use these tools that you're learning listening to this podcast, and if you really pay attention to your sleep, because you know who you are if you're watching this, obviously, if you haven't been sleeping for a long time and you actually start to get the sleep dialed in, you will not believe how much better you feel. Like literally, it will be transformational, you start getting some NAD on board, if you can find some Thymosin beta, that just sounds like the trifecta to me

[01:49:53] That's a good one.

[01:49:56] Luke Storey: Before we wrap up here, because we're just about out of time, because we have a lot of festivities planned today, too. I'm like, man, I'm looking at the clock, oh, time is wearing on, and I could talk to you guys forever or even just listen. I think this is the quietest I've ever been in one of my podcasts, because I'm just like absorbing so much.

[01:50:13] But I did want to circle back to physical pain, and overcoming these structural injuries and whatnot, and to what degree does the role of unhealed emotional trauma play in that? Do you find that, at times, you throw everything but the kitchen sink at someone's physical problem and that you suspect that there are some deep underlying PTSD or emotional trauma that's preventing the final threshold from being crossed when it comes to healing the physical body?

[01:50:46] Dr. John Lieurance: Well, there are so many different stressors that can cause an adaptation response in the body, right? And so, physical adaptation responses are common. I mean, we had a patient in the clinic the other day that had a locked occiput, and Matt came in and said, hey, I'm a chiropractor and I'm licensed here, so we did an adjustment on her occiput, and it was great for her, right? And then, he did the stellate ganglion block to just down-regulate, because the sympathetics being fired up, there's actually a joint in the foot, in both foot, I forget the name of this doctor's name, but he discovered the occiput, the very first joint between the skull, and the spine, and the ankles, we store emotions in those. 

[01:51:40] And there's actually something called injury recall technique. I was actually going to show this to you at the clinic, and I was considering doing it with you, where you can literally pinch over an area that's basically sympathetic, because you have that vascular compromise, and you've got pain, you pinch over it, and you're attracting attention by the body, and then you go in, and actually, you'll change these joints to bring them the opposite direction that they want to go. And I've seen some just amazing things shift with just that, yeah.

[01:52:16] Luke Storey: Awesome. How about you, Matt?

[01:52:18] Dr. Matthew Cook: Well, that, and interestingly, if you think about it, the nerve input to the superficial skin over a joint ultimately meets up with the same nerve that goes to the joint. And we need the nerve to the skin and the nerve to the joint to meet up with each other so that you have good coordination between the skin and the joint. So then, there are tons of therapies aimed at kind of resetting superficial things on the skin that actually can be moderately helpful for resetting things at a deeper level. And that goes from everything-

[01:52:58] Dr. John Lieurance: Neuralprolo, it's like a whole another subject we could dive into for another hour, yeah.

[01:53:04] Dr. Matthew Cook: But then, interestingly, for me, it all comes back, we did like this three-year doctorate of medical qigong with Jerry Alan Johnson, who was super inspirational for me to sort of dive into the emotional and spiritual aspect of life, but then also pain. And so then, we use stellate ganglia bloch, we used ketamine, we used just talking and kind of being in a connected space to try to help reset that. 

[01:53:38] And if if you can do it, I think it's profoundly healing. And I think it's the most important healing, really, that you can do. And so then, we're looking at all times for any tool or any technique that can help people feel safe, and connected, and grounded so that—Jerry Alan Johnson, he always used to say, all of my patients are healed and some of them are even healed physically.

[01:54:10] Luke Storey: Yeah, well said.

[01:54:12] Dr. John Lieurance: I was fortunate enough to spend a couple of days with Rhonda Byrne, and she's the one that wrote the book, The Secret. This was just literally a couple of days ago. And I was sitting with her for breakfast and she made a comment that I found so profound, she says, there are only two emotions, there's love and there's fear. That's it. Nothing else. And so, what happens is when we move away from who our true nature is, which is pure love, and we have the illusion that there are things that bring up fear for us, this brings up a disease. 

[01:54:53] It's a lack of ease in the body, right? So, I think when you look at it like that, it's not a surprise that a lot of emotions get stored in our tissues, because there are times when I've done endonasal balloons or different types of body work on people and they'll just start crying profusely, because that memory was stored in their tissues. I almost think about it like a thumb drive or fiber optics, I mean, there's information there. And when you release that information, then it comes up for people, that actually can be quite healing for a lot of people.

[01:55:33] Luke Storey: Yeah, I've had that experience on multiple occasions, where there'll be this cascade of memories and traumas coming to my awareness, coming into my consciousness, and I had no intention of bringing that about. I wasn't like, I'm getting some deep body work, I'm going to think about some trauma. It's just like, oh, that feels good, yeah, rub right there, and they start hitting the spot, and all of a sudden, there's this sort of almost transcendent experience that takes place in terms of—I had a little bit, actually, one of those yesterday.

[01:56:05] There was an emotional release and tears in my eyes, and then I was kind of brought back to one of the, if not the root causes of that issue that I was having. And it had nothing to do with the physical body. It was just kind of an emotional trauma. And I think that's something that a lot of us perhaps miss, especially those that become so focused on the physical body, that we kind of lose touch of our consciousness itself and that it actually has the ability to guide us into healing some of these things that are downstream, and connecting to that.

[01:56:42] I know both of you guys are very much into that, and I'm glad we got to touch on it, because in my journey, that's how I've arrived at kind of the self-love that's facilitated so much of the healing are just the inspiration to track someone down like each of you and do some work with you. It's kind of like that underlying sense of being worthy of healing and actually feel like you're deserving of being whole and complete, which can't come from reading a book or an intellectual process. It's got to be really that felt.

[01:57:12] Dr. John Lieurance: You mean there's not a pill for that? I can't just take a pill and-

[01:57:15] Luke Storey: There are some-

[01:57:16] Dr. Matthew Cook: There's a peptide for that.

[01:57:17] Luke Storey: Yeah, there might be-

[01:57:19] Dr. John Lieurance: Well, we might be talking about some psychedelic medicines as well.

[01:57:22] Luke Storey: Yeah, right. Yeah, exactly. And those have been a big part of my journey in coming to that. So, I definitely wanted to touch on that and close on that as we're talking about the physicality of our experience that let's not forget about consciousness and the emotional healing as it gets trapped in, and then manifest in these physical symptoms. I want to ask you guys one last question. I think I've asked you this in our prior interview, so I'll start with Matt. Who have been three teachers or teachings that have influenced your life and your work that you might share with us?

[01:57:55] Dr. Matthew Cook: Okay. So, Arkady, is my yoga teacher who's just totally larger than life, amazing, generous, amazing human being. And I walk around my clinic, and I always like—and me and Barb studied with Arkady for 10 years, and we basically spent 24 hours a day trying to deconstruct everything that Arkady said to us. And he's not like the kinder, gentler yoga teacher. Like he's definitely like a Russian yoga teacher, but he's just totally the greatest. And I still walk around all day, and like am still kind of deconstructing him in my mind and even in my practice.

[01:58:41] Jerry Alan Johnston was just the most incredible, Kung Fu, Tai Chi, qigong, Ba Gua teacher for me. And then, my parents. My parents are just totally the greatest. I love them. It's interesting, like I tell everybody, like there was this joke in my family that psychology didn't work, my Uncle Dan, would always talk about the crazies who my dad took care of because my dad's a psychologist. And so then, the idea is that I was going to do the farthest thing from psychology and be an anesthesiologist, and yet I think both of my parents are my greatest teachers, and the reality is that I'm a psychologist with a needle and an ultrasound.

[01:59:41] Luke Storey: Yeah, that's wild.

[01:59:42] Dr. John Lieurance: That's funny.

[01:59:43] Luke Storey: Very true. How about you, John?

[01:59:44] Dr. John Lieurance: Well, you can reference the last one as far as the-but I'd like to add Rhonda Byrne. I don't think I mentioned her in the last one. And she just blew my mind when I was with her last last time. And one of the two things, you may or may not be ready to hear this, but for me, I was sitting there talking about this idea, and this is kind of deep consciousness, is I had this idea that there was like this master consciousness, which was God, right? And then, I was this consciousness here, and I'm kind of talking to her about my idea, and she looks over, and she says, John, there's only one consciousness, and she says, and it's you. So, with that said, meditate on that.

[02:00:29] Luke Storey: Awesome. Thank you, guys. And give us the stats on where we can find your practices and things like that, which of course, we'll put in the show notes.

[02:00:36] Dr. John Lieurance: Yeah. So, I have a supplement company. We make both suppositories and liposomes, which in the high-dose melatonin in the NAD, we also have an oral version.

[02:00:45] Luke Storey: And nasal sprays. A lot of the listeners by now will have seen me or practiced themselves with the Zen spray. Incredible.

[02:00:53] Dr. John Lieurance: Which I'm going to do a Zen as soon as we're done, because-

[02:00:56] Luke Storey: I did one right before.

[02:00:57] Dr. John Lieurance: Oh, did you?

[02:00:58] Luke Storey: Yeah.

[02:00:59] Dr. John Lieurance: Yeah. So, MitoZen, M-I-T-O-Z-E-N. And then, our clinic is advancedrejuvenation.us.

[02:01:06] Luke Storey: Cool. Awesome. And that's in Sarasota, Florida. And you get a lot of people, I'm sure both of you, traveling in, because they can't find what they need in their town or city.

[02:01:15] Dr. John Lieurance: Yeah.

[02:01:16] Dr. Matthew Cook: And then, we are at bioreset.com. And so then, we've got a practice here in Silicon Valley and another one coming in South Florida.

[02:01:26] Dr. John Lieurance: Right down the road from me, right?

[02:01:29] Dr. Matthew Cook: Right down the road. We're going to be hanging out all the time.

[02:01:31] Dr. John Lieurance: Why don't you just join my practice? We'll just make one collective.

[02:01:33] Dr. Matthew Cook: It's going to be a collective for sure.

[02:01:36] Dr. John Lieurance: Yeah. 

[02:01:36] Dr. Matthew Cook: Yeah. And so then, we'll give you the website for the peptide academy as well.

[02:01:41] Luke Storey: Oh, cool. Great. Yeah. And thank you for doing that work, too. God, I'd love to see these become more widely available and hopefully not regulated into oblivion, such a useful and safe method of medicine. I love it. I ran out as I was telling you, but peptides have been huge for me. I want to say one thing about the DSIP, the deep sleep one, I was cautious with that, I didn't use it all the time, but I would track my sleep, and I would get great deep sleep scores, but it tanked my REM sleep. It's what I noticed about that.

[02:02:16] Dr. Matthew Cook: Yeah, I'm not a super DSIP person. I think it's a useful little adjunct intermittently, but I agree. And so then, it's like you talk about like the problems of our day and I think sleep is like one of the defining things that a lot of people have a lot of trouble with. People in their 60s and 70s, aa lot of times, you give them some cannabis, plus or minus like our little trifecta we talked about, can be profoundly helpful for them also.

[02:02:49] Luke Storey: Awesome. Alright. Let's give the elders some weed. Thanks for joining me today, guys. Incredible conversation. And thank you so much, Matt, and also, you, John, for being there with your input, too, man.

[02:02:59] Dr. Matthew Cook: Yeah, it was awesome, John. Thanks.

[02:03:03] Dr. John Lieurance: A pleasure.

[02:03:03] Luke Storey: You guys are just magicians and wizards of the highest order, and I really appreciate the work you're doing in the world and for coming on the show.

[02:03:21] Dr. Matthew Cook: Thank you, Luke.

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