A (3:35)

Cameron, you're a top surgeon and you do plastic surgery, correct? That means that people have to heal well or they look weird.

B (3:43)

Absolutely.

A (3:44)

How much plastic surgery have you had?

B (3:46)

I've had no plastic surgery today.

A (3:48)

Yeah, today or today?

B (3:49)

Oh yeah. Today or to date I've had procedures, lasers and things like that.

A (3:53)

Okay. Yeah, good deal. One of the things that's frustrated me, I've gone in for a fair share of surgeries. I had three knee surgeries when I was very young for arthritis and dislocated knees. And few years ago I had the bone in my foot cut in half and did a little what did I do before surgery and after surgery to heal much faster than I'm supposed to and put that online. But I'm not a professional surgeon. In fact, I'm not even an amateur surgeon. So I want to know from you, because you're practicing these pre and post op things in a very progressive way, what should people do before they go in for surgery that their doctor doesn't tell them?

B (4:34)

Yeah, well, you know, as we were just kind of talking about offline, is there's very little said before surgery about what to do. And there are so many ways to optimize that process before we even happen. And I like to think of it, I think of my patients and myself. As an athlete, we know that there's going to be an event, an injury, whatever we want to call it on this particular date, we get to choose it in my world, you know, it's one of the beauties of elective surgery. And in that process, going into it, we know that if Lebron James were going to have an injury on this date, he would be very optimized. Going into what that looks like, and that means having all of the right metabolic setup, inflammatory setup, nutritionally being set to go, there's lots of ways that we can get ready. And so I like to break this down with my patients based off of all the information I have about them, some of that I know what procedure we're going to do. I'm doing facial plastic surgery very specifically, and I'm doing it in a setting that is elective, where my patients are traveling to me generally from other places far away. So we have quite a bit of time beforehand to get ready. Nothing's happening on short notice, which gives us opportunities to optimize nutritionally, which I find that a lot of my patients are already pretty good at. From what you've been doing for years, what's been out, people have some awareness. And so I'm not finding people that would be so metabolically off from a nutritional standpoint. They're usually pretty good about it. They're familiar with fasting regimens and inflammatory foods and things like that that can lead in depending on what particular diet they may be on. And then there's a whole supplemental regimen, which has also been an interesting change that I've seen over the years where something like creatine that I've suggested my patients take for a long time, I would say interestingly, over like the last two years maybe or year, I find a lot more people preemptively on creatine before I see them coming in. And even my patients that are traveling from afar, you know, talking about sleep, which I know is something that you've talked about, like the simplest, cheapest way to recover from anything, let alone surgery. Well, we can optimize those types of things before they come too. If I have somebody traveling internationally, we can start getting them acclimated to maybe a nine hour time change. If they're coming to me from Europe, we can do things like melatonin that have benefits to not just their sleep architecture afterwards, but also some anti inflammatory properties to them. Then even the anesthetics that I'm choosing in surgery are really geared towards sleep. So there's a lot of different levers we can pull if we want to go that way. With things that I like to do to get people optimized before they come for surgery.

A (6:52)

All right. I love how information dense that was. Circadian timing is such a big thing. You want to enter surgery in a rested state. Just like you wouldn't run a marathon the day before you run a marathon for your performance. And I have a few times Maybe flown internationally and landed and gone in.

B (7:12)

For procedures the next day because it.

A (7:13)

Was the only time I had. But I know how to do that so I can get away with it. It's still not optimal. But if I flew the way I did in my mid-20s, when I didn't know any of this, it would have been really dangerous for me to do it.

B (7:27)

Right.

A (7:27)

Right. What do you do if someone comes to you and they're just really not that rested? They're not metabolically optimized? I mean, do you tell them it's going to take a couple weeks? And what do you do two weeks out from surgery if you just haven't done anything?

B (7:40)

Yeah. So in my world, we're trying to jump on this beforehand because the worst case scenario is that you travel international, then we can't do your procedure. So we're jumping on those things very early, even with the types of laboratory values that we're getting. So my ideal world and what happens most often is I have a very robust lab profile, almost like a functional medicine type of profile on my patients. And if. Usually we'll have their genetic information as well, so we'll know everything from. How do you methylate, you know, everything that. All the information we can get. And that helps us get into this optimization before they come so that we don't have that exact situation happen where they show up dysregulated two weeks before, you know, from their surgery, and they're just not quite ready for a procedure like. Like that. I do also have my patients come in before, like, you know, at least a day before, and we'll start to, like, get them ready. Even from an oxygenation standpoint, like time in the hyperbaric chamber, which has a double benefit in addition to just the hyperbaric physiology. They're also getting some sensory deprivation in some time and falling asleep. And so we have these sort of like switching. Switching states to a parasympathetic state, being ready for these types of procedures and all the physiologic benefits of something like hyperbarics before as well.

A (8:45)

Oh, so that's kind of fascinating. You do hyperbaric before surgery?

B (8:50)

Yeah.

A (8:50)

How many sessions?

B (8:51)

Usually just one session preoperatively. I would love to do more, but logistics dictate usually that one session.

A (8:56)

Yeah, yeah. When I did my big procedure on my foot, I did it several times before. And then oxy health was kind enough to bring a van with a hyperbaric.

B (9:07)

Oh, it's incredible.

A (9:08)

So I could just hobble down there and do it. Twice a day actually.

B (9:11)

Yeah.

A (9:11)

And it's fed healing. And when I go down to do stem cell procedures at RMI in Costa Rica, there's always hyperbaric as part of the recovery. Absolutely. Stem cells take root better. Do you use stem cells with surgery?

B (9:25)

I do. I use stem cells in a very autologous fashion. A lot of the procedures that I'm doing, facially based are very focused on fat pads in our face. And fat pads in our face serve multiple purposes. Even if we get into just like the neuroanatomy of what our faces function are, which is a lot of non verbal communication via muscular action on soft tissues, fat pads are int to that and how they support the muscle structure, their glide planes, they even change the vectors of how these muscles contract. So I'm thinking about optimizing those fat pads from a positional standpoint, which is like with something like a lift would do gravitationally repositioning the fat pads. But there's more to it than that, you know, as you know, it's getting the fat pads to the right place, but then it's also making sure that they're appropriately structurally sound and they're appropriately volumized. So something like breast tissue I think we can all think about. We know how a breast ages. It's not just shrinking in volume, but it's changing position and orientation. Right. Which is a perfect slash terrible analogy for how our facial fat pads age as well. And getting to the root of the question there is that I'm going after those fat pads to revolumize them with our. Your own fat. Our own fat in a way that is focused not just on volumizing them, but also on regenerating the structural components of them, which we call septa. It's like almost like a honeycomb, if you will, where the honeycomb portion is collagen based and then where the honey would go in between, that's where the fat's actually living and those very unique fat pads of our face. And that's one of the beauties of fat transfer to the face versus other parts of the body, is that the regenerative component goes further because it's restructuring the fat pads in addition to just adding volume, which is highly stem cell dependent, which is a beautiful option when we're using our own fat. Okay. And I know you've been through this and there's lots of fun nuances to talk about.

A (11:08)

There's tons of nuances around stem cells. Like I want to talk more about surgery procedures and I just want to talk about stem cells, but one of the things that I've noticed, having had enough surgeries to a B test some things I've had spinals, I've had epidurals, I've had general anesthesia with various compounds. And it feels like the general anesthesia most of the time is a shit show from a health perspective.

B (11:35)

Soft way to say it. Yeah.

A (11:37)

What do people do for anesthesia wrong in settings today or things that are just causing harm for no good reason?

B (11:43)

Yeah, I think it's a lack of sort of questioning what and why we're doing what the purpose of anesthesia is. And it's to keep our patients safe, really, during these procedures that they have a general anesthetic. Just to, you know, kind of define what that would mean is, is the idea of pushing somebody so deep into an unconscious, then paralyzed, physically paralyzed state that they need support to live, which is usually in breathing. So you'll be intubated with a tube in your throat, a breathing tube that, you know, breathes for you, and you're completely unconscious. And in that process, you could have painful things done to you like surgery, and never sort of register directly that that's happening. But that's where we get into the nuances of that, is that if you're under general anesthesia and you get a cut on your hand or something like that, the signals are still being sent from your periphery to your central nervous system. They are just not being registered and acted upon at that time, but those pathways are open. And then there's questions of what types of lingering effects that would have post general anesthesia with pain coming from that peripheral injury that has now traveling through open pathways, or pain that was not realized initially centrally, but then kind of has some effects afterwards. We know without question, strongly evidence backed that even with general anesthetic procedures, that doing local anesthesia at, say, the incision site of your appendectomy significantly reduces post operative pain even after the local anesthetic is gone, which is blocking those pathways from ever sort of being primed before they happen. In my world, I am not doing general anesthetic for the types of procedures that I do, because I don't have to. From a safety standpoint for my patients, we can do them very well with the patients asleep, so we're not awake, but we're using a type of IV sedation that is putting you, instead of pushing you to the bottom of the ocean completely unconscious, we're getting you just subconscious to where we're not registering anything. But that if you had a peripheral stimuli like pain, it would, it would wake you, it would activate you. So then the next step becomes being really good with local anesthesia so that there's never a peripheral signal sent to our central nervous system, which is beautiful in a lot of ways because it allows us to keep our brain inhibition low and still very safely and comfortably perform our procedure that we need to do. And it sets us up really well for after anesthesia. The things that tend to happen after anesthesia are something called post operative cognitive dysfunction, pocd, which is really under talked about in my opinion.

A (14:09)

It's a huge thing.

B (14:10)

It blows my mind. Yeah, it's talked about mostly in elderly populations, like a 60 plus type of population. But it's not isolated there. It happens to everybody. Almost everybody has an anecdotal story about postoperative brain fog. And it's the anesthesia that's causing that via multiple mechanisms, from microemboli to neuroinflammation postoperatively. Right. And I know that you've talked about some of these things, but they're really important to understand why they're happening. With different types of anesthesia, you can mitigate some of those risks, you can eliminate some of those risks in different ways. And that can come at the expense of other things as well. So again, post general anesthesia, people tend to have really disrupted sleep or sleep architecture. So when we go towards this more minimalistic, for me that means no opioids, no benzodiazepines at any point, preoperatively, intraoperatively or postoperatively. I do not want those things. Which leads to a discussion of pain management as well. But from an anesthesia standpoint, purely for the procedure, I'm focused on agents that are protecting sleep archetyp, that are anti inflammatory to our central nervous system, that are getting us safely through our procedure, comfortably through, asleep, no idea what's happening. But then we wake up quickly. We don't have any postoperative cognitive dysfunction. We're going to the bathroom normally, which is an important detoxification pathway for us. There's a lot of importance with how that works.

A (15:27)

So what are the agents that you work with that are less harmful for.

B (15:32)

This brain fog outside of general anesthesia, when we get into IV sedation, types of procedures, I think people really familiar with this idea of twilight sedation. A lot of people have heard of that you might get for a colonoscopy or something. Those are generally a benzodiazepine and an opioid mixed together that's like the most common com.

A (15:47)

You don't want to do those, right?

B (15:49)

Absolutely not. Because it has all of those things that we talked about from a neuro inflammatory standpoint and then a complete central nervous system cognition change afterwards. Right.

A (15:59)

Okay.

B (15:59)

So agents that we can use instead. I use something called Dex metatomidine and that is a Central Acting Alpha 2 Agonist. This gets really interesting into the science, but it's a. We're nerds. Yeah. It's a sympathetic specifically for alpha 2. Very specific central nervous system stimulant of this alpha 2 adrenergic receptor, which then makes us send less signal from our central to our periphery that we're in a sympathetic state. Sort of puts us very, very parasympathetic, which is wonderfully beneficial for our sleep architecture. It's mimicking a deep sleep state essentially, which helps us get primed for our sleep afterwards. It does not cause neuroinflammation, tends to slow our heart rate down, does not affect our breathing. These are all really important things that we're thinking about in anesthesia and it does a great job from a consciousness control level. I will supplement that with some other agents. Ketamine, something that everybody's heard of. Ketamine has a sort of bimo. It's a completely different mechanism of action now than a central alpha agonist and has a bimodal action on how it affects our brain at very low doses. Ketamine has its nice dissociative effect, has some analgesia to it, but it also is really, really neuroprotective at low dose. Once you get to higher doses, things change a little bit via its mechanism in our brain. But if we can use that as a secondary supplemental agent, we now have really great anesthesia, restored sleep architecture and we have some ability to have some neuro anti inflammation postoperatively with the ketamine that we're using as well.

A (17:21)

Your risk of even Alzheimer's later in life, the more you go under for general, the worse it is. It's actually not good for you. Right. So I'm protecting myself. I also take some things that I don't really talk about. Like aniracetam.

B (17:33)

Yeah, Theracetams. Yes. Yeah.

A (17:35)

These are things that don't affect sedation at all. But if they're present along with just the normal things that are antioxidants and things, if you pre prep with that, you're much less likely to get this and you're less likely to get brain fog. And then I tell the anesthesiologist I don't want propofol. Right. I want ketamine and I don't want you to give me anything that gives me amnesia and talk to me about the drugs that make you forget what you just did and the good and bad of those.

B (18:03)

So the most common are the benzodiazepines. Those are hands down the most common. There's oral and IV versions of those that you can take. They're anxiolytics. They make you less anxious leading into your procedure as well, which is why they're so commonly used before you even go in the room for something like anesthesia. My patients, you know, if you're working with me, we're going to be doing breathwork and mindfulness types of things going in, because you're familiar with that and that's going to be a powerful tool for you to use, more so than an anxiolytic like a benzodiaz. Propofol, which you mentioned, which is a. Has pros and cons as an anesthetic, but does have some issues with pocd. So a super strong amnestic definitely makes you forget what's happening during a procedure, but has a very short half life. It's very lipid soluble. So there's some benefits to that if needed for something for a shorter procedure, somebody who is really anxious going in. But intention is a very important part of, not just for me, intention of what we're doing, but for you going into it as well. And I find that my patients that go in in sort of a more mindful what we're doing, are comfortable with what they're doing, are familiar with the whole process, don't tend to need those types of things. I supplement that too, even just with like what my patient is hearing during their procedure. I tend to use some blockade, some noise canceling blockade with alpha, or, excuse me, with delta and theta waves, as opposed to what we might be in like an alpha wave, just binaural beats type of thing.

A (19:24)

And you're doing this with headphones?

B (19:25)

We're doing this with headphones, correct? Yeah.

A (19:27)

That is so cool.

B (19:28)

Yeah, it's very simple. And I need less anesthetic to do what I'm doing, which is great. We reduce our total load of anesthetic. It's a very calming state, almost by definition for the patient. And then it kind of eliminates some of the quite literally chatter that's happening in the background. And I find that. And chatter is all positive talk generally, but it's communicating amongst the team that it's not important for the person to be tuned into. It's interesting. What I hear from my patients though, is that they can hear the binary beats, they get the relaxation, but they can also sometimes hear their heart rate. And they get this like little biofeedback and it's kind of very comforting that they can hear all those things going on. So I just getting into like even. I think what we hear in the operating room is very important to what our needs are for some of these medications, pre and post.

A (20:11)

So I've noticed that if I'm doing procedures where I'm, I'm going to be awake but calm, my blood pressure can drop too much. So I usually just say, play rage against the machine. Is that a good strategy?

B (20:22)

I guess it just goes to show that how powerful that can be. I do love rage against the machine.

A (20:27)

Probably not the best surgery.

B (20:28)

Hey, you know, whatever. Whatever works for what our needs are. If you can raise a heart rate that needs to be raised with rage, let's do it.

A (20:34)

I think the reason that it raises my blood pressure was the way they behave towards masks. Okay, just kidding. Maybe not. All right. Propofol.

B (20:44)

Propofol.

A (20:45)

So this is one of those things. It's what most general anesthetic is like you go to most places is what they use, but it has evidence of mitochondrial harm behind it. What would work better than that? Like if you weren't doing surgery, what would you choose?

B (21:02)

Yeah, Propofol is very dose dependent as well. Same story. So it can be mixed in instead of as a primary agent for some folks, like a tertiary agent. Right. As a general anesthetic. Propofol is that amnestic part of things. Right. And that would be compared in a general anesthetic to like an inhaled gas. Right. There's a whole different animal and how those work. But propofol has those benefits of being used oftentimes in tertiary settings as like a short dose. Right. When it's used as the only agent or as the primary or the main agent, like a total IV anesthesia type of situation. That's where you can get into the POCD issues with propofol. And you know, you talked about, which I'd be happy to go into some of the ways to get around specifically what type of POCD propofol can cause. And, and for some people it can be a safe alternative, but it's like it's a total dose at that. How, how long did you have propofol? How much did you have? Was that, you know, the third thing on Your list behind like dexmedetomidine and ketamine. And it was mixed in, or was it the main thing you had for eight hours?

C (22:06)

Guess what? Your longevity plan isn't going to work unless your gut barrier is working too.

A (22:12)

Because that's where inflammation and aging actually start.

C (22:14)

And everything in modern life, like EMFs and seed oils and stress and whole.

A (22:18)

Grains, all that stuff breaks down your gut barrier.

C (22:21)

And that barrier is the foundation of your immune system, your metabolism, even your brain health. And once your gut barrier weakens, everything from recovery to energy to skin health.

A (22:30)

All start to fall apart.

C (22:31)

Amrod Colostrum is a unique compound that can rebuild that defense system from the inside out.

A (22:37)

That's because because it has over 400 bioactive nutrients, things like growth factors, peptides and prebiotics.

C (22:43)

And those things restore gut integrity, they help you to regulate hormones, and they bring your body back into balance. Clinical studies on bovine colostrum show it improves muscle recovery and strengthens immunity. And it enhances your body's ability to absorb nutrients.

A (22:57)

It's incredibly potent and it is ethically sourced. So if you're serious about longevity or just feel feeling good all the time.

C (23:04)

Start where resilience begins.

B (23:06)

It's in your gut.

C (23:07)

And because you're a listener, you get a special deal.

A (23:09)

30% off your first subscription order. That's a huge discount.

C (23:13)

Go to armrad.comdave and get 30% off.

A (23:16)

Your first subscription order.

C (23:17)

That's a r m r a.comdave.

A (23:23)

Your face is the first thing people see. And you can work out clean. But if you still look older than you feel, especially if you're a guy, you're not maximizing your potential. Your skin is a signal of how well you're really taking care of yourself. And if it looks inflamed or tired or just old, that's what people are going to notice. Even if you're doing your best to eat well. The good news is there's a company called Caldera Lab that's here to fix that for you. This isn't your girlfriend's 20 step routine. It's skincare designed specifically for men, which means it has to be simple and effective and. And backed by science. But not too much work. After using caldera lab products, 100% of men said their skin looks smoother and healthier. And 97% said they had improved hydration and texture. And 93% reported a more youthful appearance. Caldera Lab has spent years developing and testing each of their formulas with leading cosmetic chemists. So you can tell it actually works. And if they don't love it, they don't release it. Which is the same way I am with my own products. Some of the products you might want to try are the good, which is a face serum that has 3.4 million antioxidant units per drop. There's the eye serum. These are peptides that make you look fully rested even when you stayed up all night doing something you wanted to do. And the base layer, which is a stem cell powered moisturizer that isn't going to give you pimples by clogging your pores. And all their products are cruelty free and plastic neutral. And for every product they sell, they pull the same amount of plastic from the environment, which is good because having little bits of plastic in your mitochondria actually sucks. So upgrade your routine with Caldera lab and see the difference for yourself. Go to caldera lab.com Dave use code Dave and they'll give you 20% off your first order. So if you're not taking care of your skin because it's just been too much work, now you have a solution. Caldera lab.com Dave if someone's going into surgery and they talk to the anesthesiologist, what do they say in order to get a better mix of agents that are less likely to cause cancer?

B (25:24)

Well, I would say, and I know you've talked about this a little bit and I really resonate this is just sort of questioning everything. Letting your anesthesiologist and or surgeon. It depends on the setting, right? In my world, I have my own private surgery center. I get to control everything.

A (25:36)

You know, I bring in an anesthesiologist.

B (25:38)

I bring in an anesthesiologist, the same one or ones every single time. People I'm very familiar to work with and I, they're sharing the same mindset that I do and they wouldn't be with me if they weren't. And they're driving it too, which is really fun. And those settings are important because if I want to change something, it immediately happens. I decide one day that I don't want any plastics or plasticizers in my or everything is shed if I'm in a hospital. Good luck. Number one, it's expensive. These changes are hard to make but in this setting it's really great because we can work together and sort of go down this route of here's the changes we want to make. So under any setting because I would love for your listeners to have this, this ability to. Under any surgical setting they're going into for any purpose whatsoever, be able to pull some levers, make some changes, have some benefit. In a hospital setting, it is often very little communication between the surgeon and the anesthesiologist. Sometimes, like, they don't even know who they're working with until they walk in the room type of a setting. So in that situation, the anesthesiologist is very important to work with. And their main objective is to keep you safe. Right? It truly is to keep you safe. How progressively thinking they are luck of the draw a little bit.

A (26:41)

And they don't care about your brain fog?

B (26:43)

Well, not as much, no. Because it's. Again, that goes back to. It's under talked about, in my opinion. It's under talked about. It's. They're trying to keep you alive.

A (26:50)

I think you have to like, castrate yourself that way. Yeah. You could just say it's under talked about.

B (26:54)

Yeah. Yes, it is. It is under talked about. It is under talked about. And. And you're right, it is. It's a long. Not that your anesthesiologist doesn't care about you long term. I don't think there's any malice here. No, no, I think it's their. Their objective is immediately is to keep you, get you out of the surgery alive and safe.

A (27:10)

And if that's the only goal, rather than alive, safe and thriving, you can see.

B (27:14)

Exactly Right.

A (27:15)

And then hospitals institutionalize these rules so that when someone who's a progressive anesthesiologist comes in, they actually aren't allowed to do some of the things that they would do, which is crazy.

B (27:26)

Right. And it gets into the interaction with the surgeon because the surgeon's main objective is to have as smooth of a surgery as they can. Right. They want do to. To be easy. And a surgery under general anesthesia, it quite literally is easier. It doesn't matter how good your local anesthesia is. It doesn't matter how good your technique is. It doesn't matter your pace. It is like you do whatever you want. So these battle each other a little bit. And then I think that, you know, this is probably getting in the weeds a little bit, but there's probably some bureaucratic reimbursement issues with anesthesia into this, which again, in a private setting like I have, that's a beautiful world. I don't have to worry about those things. I can use the agents I want and the frequency I want and have to worry about the. This sort of like being reimbursed for it. So there's a lot of factors. So back to your question, though, I think is letting your anesthesiologist or surgeon know that you're really interested in these things and asking questions about, you know, can I do this under light sedation or can I do this under local anesthesia with a block, a nerve block, for something like a hand surgery, there's lots of options that can exist in there. And if you can get a collaboration between the surgeon and the anesthesiologist, you can certainly find ways out of having general anesthesia. Not every time, but often.

A (28:29)

I typically say, no benzos, no opiates, no propofol. If possible, use as little as you can.

B (28:37)

Right.

A (28:37)

And I say, I like ketamine. It's generally good for my brain. Yep.

B (28:41)

And that's a super safe. And every anesthesiologist will resonate with that. They will hear it.

A (28:46)

Cool. Yeah. So then here's the other thing that I always say. I say, don't give me anything that gives me amnesia.

B (28:51)

Okay.

A (28:51)

And one time somebody didn't mention they were slipping it in and I could not remember what I had for dinner the night before. I was completely wiped from my memory. And they're saying, well, if you forget the surgery, then it won't have hurt your cells. Don't forget. So I think it creates a schism where the body's like, I know something bad happened, but the mind doesn't know something bad happened, so it's just unnecessary. And if you do some deep breaths or some tapping or emdr, whatever, if you're traumatized by the idea of surgery, do that. So it's okay to remember the surgery.

B (29:23)

Yeah.

A (29:24)

So I. I think that's a bit paternalistic, but from a memory perspective, if you don't want brain fog, maybe giving yourself amnesia is a bad idea.

B (29:31)

Yeah. There's a whole bunch of deeper levels with the different types of trauma with that too.

A (29:35)

Yeah.

B (29:35)

And we know that some of that, like, evidence backed exists whether we can externalize or put it into our consciousness or not like that. There are sort of a cellular trauma definitely happens. Yeah. The tough part of the no opioids is the postoperative pain management. Right. And some of that is set up with what happens going into the surgery, Some of it, what happens during the surgery, how smooth and, you know, kind of slick that procedure is and how much trauma it causes. But there's a lot afterwards, too, that is difficult to control just from an anxiety standpoint about a fear of pain, basically. And so there's a few ways that I really like to Manage that as well. And one of them starts sort of right at the end of the procedure. And it's another local anesthetic based thing, but it's using a bupivacaine, which is a very long acting local anesthetic carriage and a liposome. And so that liposomal bupivacaine lasts 48 to 72 hours. So if you put that around a local nerve root, you have a reduction, I'm not going to say full elimination, but a reduction of sensation in that area of surgery for two days, three days postoperatively, which is incredible because that's when most of our post operative pain happens anyway. So you can get around it in this beautiful way. And there's a new drug, FDA approved in the United States, first in class, Approved this year, 2025. And it works via a peripheral sodium channel. And I only say that to say that that is also how local anesthetics work on sodium channels. They stop the transmission of a pain signal via a sodium channel. And there's now an oral medication that we can take with an incredibly safe side effect profile that's aimed at peripheral sodium channels. It stops them at the transmission site so you don't get the peripheral, the central communication. It's not blocking it at our brain like an opioid would. And they're highly effective and they're going to be really, really opioid sparing for us in the long term, moving forward. It's very new, not highly adopted yet. I'm loving it. My patients are loving it. And it's before, even before this medication, I had like under a 5% rate of my patients needing an opioid mostly again for that fear of pain. And it's reduced it even further from there.

A (31:36)

That's incredible.

B (31:37)

Yeah.

A (31:37)

What are the name of those drugs?

B (31:38)

Suzetragine.

A (31:39)

Suzetragine, yeah. So if you're listening to this episode going, my eyes are crossing because there's a lot of. Susan, you can play it back, we'll put it in the notes and all that. But the reality is you talk to your anesthesiologist and tell them that you're calm, you're peaceful. And if the anesthesiologist and the surgeon say, look, you need opiates, there's a specific reason for it and they're reasonable about it.

B (32:01)

Cool.

A (32:02)

If they instead shame you and tell you that you're an asshole for asking. There's really two powerful words that always work. You're fired. Those work really well. Unless it's an ER and you're about to die, in which case, you know, you can fix it afterwards.

B (32:16)

Yeah. And these, these conversations are best had preemptively. But the challenge though, like you said, even, is that you're, let's say, let's talk about an orthopedic surgery, something that a lot of your listeners commonly have. You might talk to your surgeon about this. This at the pre operative visit.

A (32:29)

Yeah.

B (32:29)

Or if you're seeing the surgeon, if you're lucky enough, maybe you're seeing, you know, somebody who's not even your actual surgeon, who's prepping you and you mention it, but he doesn't know who he's working with that day in the hospital or the surgery center. And so it is definitely best to preemptively have these conversations and be prepared. And when you tell them that you're chill and you're mindful, you got to be act that way too. Right. Because again, everybody wants you to be safe.

A (32:48)

And your anesthesiologist and your doctor are not your enemy. No, they're actually on your care team. And some people in the health field have been traumatized by doctors who just didn't listen. Like if you have chronic fatigue syndrome, you've probably been to 25 doctors. Some of them gaslight you because they just didn't believe you.

B (33:03)

Right.

A (33:03)

I've been to people like that. So you get angry, it's not going to go well because anger doesn't really create great surgical outcomes for anybody. So build a relationship and all that. Just, just general advice.

B (33:13)

Yeah. Choose your surgeon carefully, you know. Yeah, I, I always am thinking when you're going to the person who's local to you, that's great. Is it the best person who's local to you? Is this something you can find maybe the expert on somewhere else? Which again, is certainly biased by my practice, which is travel based. But, you know, you got to choose for me. It's whoever you work with, you are forever enmeshed with that person in a very positive way. And those relationships are valuable. So choose carefully.

A (33:37)

Very well said. And I remember when I was going in for that relatively major foot surgery, you know, cutting all the way through the bone on your foot, taking 3 millimeters out. I said, no, I'm going to be awake for this. I'm missing out on that because I'm kind of curious about this and I'm just not afraid of pain or surgery. So they're like, well, that's kind of weird, but okay. So I literally laid there and talked to the surgeon While he did it. And, you know, I heard the bone saw.

B (34:00)

Yeah.

A (34:00)

And it was a little bit scary when it goes and it wouldn't cut through the bone. And he looks at the nurse and goes, I'm having a hard time getting through the bone. Is this guy even human? And then I'm like, I'm starting to feel heat from down there.

B (34:13)

Interesting.

A (34:14)

Right past the nerve block. So this is why some of that biohacking stuff can give you really, really strong bones.

B (34:20)

Yeah.

A (34:21)

So he let it cool off and finished the cut.

B (34:23)

There you go.

A (34:23)

But it was just like, this is so cool.

B (34:25)

That was a cool part of the documentary. And when you got to see the intraoperative. I think it's fun to see in there.

A (34:30)

It's really cool, like, what's going on inside. But I also recognize those people are, like, turning green from talking about this. Right. So in this, for listeners, if you're scared of your surgery, you can do something about it, like listen to the Dr. Amen episode we just did. Listen to any episode on tapping or EMDR or neurofeedback or positive visualization. There's probably a hundred episodes that apply. Pick one and teach your body that it's safe. And then tell your body you're safe. You can tap on yourself at the points and be like, I'm safe, even though I'm scared. I deeply and profoundly love and accept myself. I hate it that that works. But it does. Do you do tapping or anything like that with patients?

B (35:08)

Yeah, it's funny. We do some tapping. Emdr, then we'll do, like, Havening as well, which is sort of like, yeah, yeah, and yeah, and. And they're effective. And it's a little bit different for everybody. And you can. I mean, you get a feel pretty quickly who's who. It's effective with, who's adopting it, whose mindset is there and who isn't.

A (35:24)

Okay, I want you to demonstrate Havening really quick because I just interviewed Dr. Amen, and I don't know which episode's going to come out first. And we talked about Havening.

B (35:33)

Oh, really?

A (35:34)

New book about pain.

B (35:35)

Okay.

A (35:35)

So it's change your brain, change your pain. And we just did a thing on it with I don't know who's going to hear this and not hear the other one. So define Havening and do a quick demo of it. So anyone, if you're afraid whether it's surgical or not, you could do this.

B (35:48)

Yeah. So this is going to be probably a very rudimentary understanding based off pain and Anxiety mitigation or anxiolysis. And I love this for me because I get to haven before I go in the operating room. So haven is generally like crossing midline and almost like a hugging or embracing type of fashion or what you will see people do is sort of almost like rubbing or writing their hands together is another version of Havening, which is what I'm doing when I'm scrubbing. So that's my last little mindful. This literally the last thing I do before I go in the operating room. So I'm using that as my havening time as I'm, you know, kind of embracing my own hands basically. But havening is a way of almost like a self hug and it's. I love this because what really resonated with me when I first heard about this is, you know, you have this image of like driving by the car accident on the side of the road and imagining what the people are doing. And many of them are sort of natural actually in this position.

A (36:36)

Right.

B (36:37)

Like kind of relieving their own trauma or anxiety. And so that would be my very rudimentary way of doing it. And we quite literally place my patients in this like physical position of sort of like Havening. When we put the. As we place them and we're putting in their noise canceling headphones and we're putting their, you know, red light LED compression on, it's all part. And we do it within a mindful. We don't just do it, not tell them, we do tell them why we're doing it. And you know, it's all these little things. So the, you know, everything's in the details basically.

A (37:03)

It feels like some practices probably especially er, it's like this is a piece of meat. We got to keep it alive. We just kind of slap it around, say whatever you want to say. And this very mindful approach where you pay attention to details and you create peace and safety and then you go in, you're getting really different recovery outcomes.

B (37:21)

Absolutely.

A (37:22)

What do you see that's different when you stack everything right versus if you just go in and sort of knock them out and cut them open?

B (37:29)

Right. Well, this is the confounding challenge because like you just mentioned, there's a bunch of pre during and we're from physiologic and metabolic modalities all the way through some of these psychological types of things. Then in the post operative period it gets even more involved with hyperbarics and red light and PEMF and things, you know, like kind of what you Did. So what's working? Right, Right. And this is where you. We can get into like separating out the items with the strongest evidence behind them, how they all mix together, which, which isn't that well defined, interestingly. But I find that, you know, the ability to do all these things leading in different people resonate with different parts of it. Like the havening may be really beneficial for some people and not as much for others. If I have a, I don't know, I'm gonna make up some narrative of a macho guy and we try to tell him about havening as we go and it may not resonate with him as much and he's just gonna like, kind of live with a little bit more anxiety before or after. But other people may have. Have more. Maybe we did more of a stem cell based procedure on them and the hyperbarics is more important for them or whatever how all those things sort of mix together. But I do notice essentially in the end having a lot of data about normal recovery times. And I know that you've been into like how we recover faster. What I tell my patients, based off my protocol is if we were to get as objective as we can with inflammatory markers, swelling and inflammation, how a surgical recovery looks with things that are measurable and quantifiable, a really robust and active post operative recovery regimen is worth, I say worth about three days for every one day of that that you do, it's worth about three days of normal recovery time in the first week. And then as time goes on, we know that there's some diminishing returns. So in the second week, it tends to be worth about two days for every one day. So you're getting twice as much out of it now. All that to be said, it's. It's active. Like when. If we were to take what you did after your procedures and boil it down, there's some commitment to that, you know.

A (39:17)

Yeah, it was basically full time, exactly four or five days. I was doing something. I was either sleeping, eating three pounds of steak a day.

B (39:25)

Right.

A (39:25)

With enzymes and amino acids and all that, or I was doing something to recover.

B (39:30)

And this is what my patients do when they come. We have homes for them to stay in that are like very curated as well, from EMF protection and views of water and mountains and like very set to be a healing space. But then also they're pretty active and it's low intensity. It's not like you're active running around, but you know, for four to six hours a day you're committed Full time to, you know, healing. And I think there's power in just that in addition to the modalities themselves.

A (39:55)

The mindset part of it.

B (39:56)

100.

A (39:57)

Okay. Have you ever used xenon gas?

B (40:00)

I have not used xenon gas.

A (40:01)

Do you know about it?

B (40:02)

I don't know much about it other than other than the periodic table parts of it.

A (40:06)

Okay. This is one of those of those weird things where I've been wanting to do a surgical procedure with xenon gas and no one offers it in the US because it's three times more expensive than anything else.

B (40:17)

Interesting.

A (40:17)

And I have a tank of it downstairs.

B (40:19)

Okay.

A (40:19)

Unfortunately, it was like $14,000 for a relatively small amount of xenon, but it's cheaper at big volumes. So xenon knocks you out full on general anesthesia. It has no neuroinflammation side effects, it raises epo, it raises bdnf, and it acclimates you to altitude if you use it for a few days.

B (40:41)

Interesting.

A (40:42)

So it's one of these zero toxin things.

B (40:45)

Yeah.

A (40:46)

If you've ever used nitrous oxide.

B (40:48)

Yep.

A (40:49)

Which of course you would never use recreationally, given that in med school. You just had it right there.

B (40:52)

Yeah. Never. Not my world, but.

A (40:55)

I'm just kidding.

B (40:56)

People love it. People come in and ask for it. Yeah, yeah.

A (40:58)

But it's. It's actually not good for the brain. Right. But. And that's because of peroxy nitrite free radical formation. Guys, if you're wondering if you're using whippets at Burning man, that's probably the wrong way to do it. Not that I never have tried it just once. But xenon gas feels like that you're inhaling something, but then it feels like you're on ketamine.

B (41:17)

Oh, interest. It's dissociative. Yeah. Oh, okay.

A (41:20)

And so it might be more than dissociative, but the sensation is the same. And then you want to have it on a rebreather because it's really expensive and I don't have a. At home, you know, Mr. Rebreather next to my Mr. Coffee, which I also don't have. But so I just do it through a surgical anesthesia balloon until I kind of pass out. But it is really good for the brain, and it's the lowest harm of all the anesthesia agents I found. But they only know about it in Russia where they've done all the research.

B (41:48)

Interesting.

A (41:49)

So I want that to come into the U.S. okay. Since you're super cutting edge on all this talk with your anesthesiologist, see if we can get some anesthesia. I'll just come down to I'll be your guinea pig.

B (41:57)

There you go. And that's the beautiful part, is those are the types of changes we can look into and make. Or the. That's really interesting.

D (42:05)

The wait is over.

A (42:08)

Dive into Audible's most anticipated collection, the Best of 2025.

D (42:13)

Featuring top audiobooks, podcasts, and originals across all genres, our editors have carefully curated.

A (42:20)

This year's must listens. From brilliant hidden gems to buzziest new releases, every title in this collection has earned its spot.

D (42:29)

This is your go to for the.

A (42:31)

Absolute best in 2025 audio entertainment. Whether you love thrillers, romance, or nonfiction, your next favorite listen awaits. Discover why there's more to imagine when you listen@audible.com BestOfTheYear.

B (42:47)

You mentioned the racetams too, a little bit, which I think is a really interesting conversation of the POCD part of things. Things. And that was spurred by, you know, only available in Russia with xenon. And that's how the racetams have been in the United States as sort of frowned on a little bit. Or not legal or not. A supplement, not a drug.

A (43:04)

Like, yeah, they're not legal, but not illegal.

C (43:06)

Right.

B (43:07)

Like, for me as a physician, I can talk about them, but can't prescribe them type of thing. Right. So if you're using. If you're my patient and you're using them, it's like, oh, that's a. We can have that healthy conversation. But I also can't, like, give them to you or have you take them. And. But they're interesting because I think that they get into how any nootropic can. Can benefit POCD mechanistically. Right? Right. Racetams are very unique in that they don't really block or excite glutamate. They just kind of like normalize it. And that's how a lot of anesthetic agents work. And so it's this beautiful insight to like, okay, well, this is helping people after anesthesia or strokes or people with dementia. And we know that all those things are tied in at least mechanistically together with how this POCD works. So I think it just. It should excite us, just like xenon gas should. It should excite us into what types of things we could or should be looking at to help this issue that's under talked about.

A (44:00)

What intrigues me is that Piracetam is manufactured by Sandoz Pharmaceuticals, and it has been since about 1960. So this is a real pharmaceutical, and for some reason, it's not in the physician's desk reference. Even though, like, who made that decision? Like, what was his name and what was his motivation? I imagine that he worked for some big pharma company, and he probably has horns coming up his head. There's no excuse for that. If it's a drug, we should have access to it because some doctor somewhere might want to use it for something. And it's just not a regulator's job to say that. But when they first were doing the research on piracetam, they found that they could administer piracetam to dogs and then cut off blood flow to their brain for up to 45 minutes and then provide blood. And they were not seeing cell death or brain damage.

B (44:50)

Yeah, it creates a bunch of neuroinflammation without something to stop that.

A (44:54)

That ischemic damage, which is what's gonna happen with these micro blood clots that are very common with surgical procedures and anesthesia.

B (45:02)

Correct.

A (45:03)

So if I was gonna get a micro blood clot, I'd rather have no neuroinflammation from it because then the damage would be exceptionally small. But if I didn't have that present and I got a micro blood clot, the area around that tissue is likely to get damaged. Right, Right.

B (45:16)

Yep.

A (45:17)

So I take aniracetam because it's fat soluble and anti anxiety and similar to aniracetam before I do any procedure, because just in case.

B (45:25)

Yep, there you go.

A (45:26)

All right. Any issues? I should think about that. I mean, I'm not a doctor.

B (45:29)

For me, if. If we were having this conversation before, I would say, okay, should we be taking it before the procedure or should we be taking it right after the procedure because of the interaction with some of the anesthetics? That's the only thing that really comes to mind for me.

A (45:40)

I tell the anesthesiologist and they usually say, anna, what? And then I tell them what it is. I say, it's not a big deal.

B (45:45)

Right, Exactly.

A (45:46)

Okay. And what about intravenous things? Like, I am a huge fan of intravenous glutathione. I was getting IVs, amino acids, glutathione, some other stuff. The second I was out of the procedure and it was safe to not, you know, cause blood thinning or something?

B (46:00)

Yep.

A (46:01)

Do you use IV therapies after surgery?

B (46:03)

I do. I start them immediately. Intra or post op, if you will. Even simple things like magnesium.

A (46:09)

Okay.

B (46:09)

With some caffeine sometimes, depending on somebody's Baseline state. Caffeine has some excitatory parts of it, of course, with this effect on adenosine, but also has some reductions in pain.

A (46:18)

Yeah.

B (46:19)

So nice little benefit there. But then as far as IV glutathione, wildly beneficial when somebody is post anesthesia. Right. Same thing with nad, which is, you know, now we're talking about affecting it. Everything meets in the mitochondria to some degree. Right. So now we're talking about all these mitochondrial functions and benefits happening in different ways. But NAD I'll use afterwards. And then I think the most fun is, let's say we're postoperative day one. You had surgery yesterday, we're back in, we're starting this whole recovery protocol the next day. If we have your, if I have your genetic information and I know all of your laboratory values beforehand, I know what mineral deficiencies you might have. I know how you, like I was saying, you know how you methylate things. I know a lot of baseline nutrition status. Your IV with me is going to be very customized to what you're doing, but definitely involving glutathione post op, especially early in the postoperative period.

A (47:11)

What do you think about taking ketones before they go into the procedure?

B (47:16)

Yes. So this is one of my favorites because, you know, if we look at ketones, we know that they're neurostabilizing. And I personally love doing my surgeries in ketosis, organically in ketosis, fasting before or getting on a ketogenic type of diet before. For me, it's usually fasting and then refeeding. And if anybody's ever done anything in ketosis, like I say, a cognitively demanding task, you almost feel like this is how we're supposed to be a little so. And you don't have to do it the hard way. You can do it the easy way with exogenous ketones as well. So I'm not necessarily asking my patients to be in ketosis going to surgery. Cause that can be challenging and demanding and maybe now that they're used to.

A (47:56)

You can raise cortisol too.

B (47:57)

Yeah, absolutely. Which for me is a good thing thing because I want to be activated energetically in their surgery. So exogenous ketones preoperatively, this is one thing I will start preoperatively, then carry into the post operative period, are wildly beneficial for neurostabilization. So now we're going back to everything we're doing with anesthesia. And now you're working on more resilient neurons that are stronger and we Know this from like seizure thresholds with, you know, Dr. Dominic D' Agostino's work looking at hyperbaric oxygen toxicity.

A (48:25)

Here's one of the first 10 guests on. On the show. Was he 100 episodes ago?

B (48:28)

Yeah. Oh, my goodness. He's incredible. Yeah. Great guy. And you know, what he showed there was like mind blowingly remarkable. Right. And widely applicable, but also not something that is talked about. What a simple solution to not. We're not talking about seizure threshold here. We're just talking about neuronal protection. And so I love ketones for that reason. That would be one of the things that my patients, I think is more novel to them sometimes. Again, I've noticed over the past couple years, people have played with ketones more, but it's really fun to do that with them because it feels good preoperatively. And then they have this wonderful benefit interoperatively and after anesthesia.

A (49:06)

And we want to go in for a procedure as a patient, as resilient as possible. Ketones increase resilience for sure.

B (49:12)

Yeah.

A (49:13)

We use exogenous ketones during 40 years of zen because people are doing really intense neurofeedback for hours every day. You just can't do it without ketones. You just hit the wall at a certain point. And my goal if I'm going in for a procedure is I don't want to be anywhere near the wall when I go in, and I don't want to be near when I come out. And ketones are a part of what I do there.

B (49:32)

That's, you know, it's a metabolic flexibility or resilience. And it. Yeah, it's really interesting.

A (49:38)

Guys, go to daveasprey.com ketones and I'll tell you about the ones that I use because there's a whole bunch of strategies there.

B (49:44)

Yeah, love that.

A (49:46)

So, all right, ketones are good. And there's two compounds that speed healing really dramatically. One of them is testosterone. The other one is growth hormone.

B (49:57)

Yes.

A (49:58)

So maybe I should just be taking a lot of testosterone for that first week and I should be maybe squirting a little growth hormone in there. What do you think about that?

B (50:07)

Yeah, well, so this goes back to, I think the. So unquestionably, yes. My patients that are on done. Those things heal wonderfully. This is not something that I use. I'm not going to put my patients on those for my purposes. Right. Because in my opinion, there should be a lot more thought that goes into those around what they're doing from an overall health standpoint. Yeah. And this would get into a conversation of peptides, the growth hormone analogs. Right, okay. Ghrelin mimickers, things like that. And so like cjc, ephemeralin sort of things. Yeah, exactly. And so those are peptides. I'd say a lot of my patients are on just jumping to that part, but I didn't necessarily start them on it, but they know going into it with their functional health provider, what stress they're about to be under. And they heal really well. But the real answer to this question is going back to the almost the first question you asked me. How do you get somebody ready for surgery beforehand? Right. Are you metabolically optimized coming in? Are you hormonally, what we're asking here, Optimized coming in? Have you been training? What's your muscle mass, all these wonderful things that go into that. How have you been sleeping? Probably the biggest lever we can pull easily for these growth hormone and testosterone types of benefits. And unquestionably people heal faster. And I find that when they're on their growth hormone analogs, the other peptides that I like to use work better with those as well. So they tend. I see some little almost additive effect, which kind of makes sense when we think about the mechanisms of something like bpc or thymosin beta 4 or GHK copper, like how they're interacting with our wound healing environment. It makes a little bit of sense that growth hormone tends to kind of pour fuel on those fires a little bit.

A (51:41)

It's funny that I took all three of those.

B (51:43)

You did.

A (51:44)

When I was healing, of course, especially bpc. That seems like anyone who goes in for surgery should just have that by default. Except that would require some big pharma companies to pound sand because they were trying to block it. Right, right, absolutely. And that's. That's just a systemic ill in the US at least. Now. Many years ago, my dad went in for hernia repair and I said, hey, dad, you know, somebody actually left some growth hormone in your fridge for you. Can't imagine who that would be. So maybe you might want to just use this at a moderate dose during your healing phase. And he was already getting along in years and he was okay. So he did it. And he went in for his first recovery visit with a surgeon. Surgeon. It's a miracle. You heal faster than I've ever seen heal. And he said, well, do you want to know what I did? And his surgeon looked at him and said, you couldn't have done anything for this. It's just a miracle. Okay, so why are you different as a doctor that you're willing to think about all this stuff? But there are a lot of doctors who are very. I learned this in med school. This is how I do it. And they're just not curious about it the way you are.

B (52:52)

Yeah, I mean, you just nailed it. It is a curiosity. I mean, you have to. I think you have to carry that in life. It's the antidote to most things in life, including ignorance and boredom and lots of things. It's just. Yeah, just staying curious. Probably actually came from my mom who was a nutritionist, who was very much like a, I think, looking back, retroact, like if I look retro at her when I was a kid, she was very sort of counterculture in the nutrition world. And I didn't know it at the time. She was just my weird mom nutritionist who didn't let me eat margarine and, you know, like all these things that I now know. But I think that's where a lot of this intellectual curiosity came from, specifically related to how those ice. That really clicked with me when I became a higher level athlete and I felt differences, I saw differences that were no questionably linked or non questionably linked to what my mom had taught me. And so I'm like, oh, so I can perform better, recover better with these types of simple tools. That's where it really came from.

A (53:47)

So you had a nutritionist mom. If you'd had a dietitian mom, you'd have been eating Twinkies and McDonald's every day like they give you in the hospital.

B (53:54)

Yeah, well, that's what she was, a dietitian. She was a registered dietitian. But that's why I say she was very counterculture even. You know, it's crazy.

A (54:00)

She was an RD and she wasn't doing what they teach RDs.

B (54:02)

No, she. And she was again, she was a critical thinker and, you know, curious critical thinker. And I remember her, you know, talking about what would be, we'd call seed oils now, you know, she called like industrial oils or margarine. Because I had this period of time when I was a kid where margarine became the choice of the American Dietetic association from a fat, which is my mom's word that I learned as a kid was asinine. And I'm like, that's how I learned that word. She's like, that is asinine and. Yeah, and trouble and there's a bunch of things like that. But she was definitely counter. And she kind of taught me about deceptive marketing for cereals for kids, even as a kid. And she talked about. And I truly believe that this is capitalism, not malice. A lot of times there are people trying to make money, right. And, you know, delicious engineered foods make people want to eat more of them, and bottom lines go up. And so she was just more into teaching me those types of things. But she. She realized, I think, that the American Dietetic association, in her opinion, was. Was overly influenced by the food industry. Wow. If I were to put a nutshell on it. Yeah.

A (55:05)

Well, I sound like I'm totally ripping on registered dietitians, and I want to say, for the most part, you guys earned it. That's because, truly, a good number of the troll comments I get are from angry RDs who literally recommend McDonald's and canola oil still to this day. And they get really angry when someone suggests it might not be good. Good. So generally, the American Dietetic association is a bunch of highly corrupt people. Whether they know it or not isn't relevant. But there are also functional dietitians out there. In fact, I have one on my team who works for me who's very well educated. So there's tons of good dietitians. But when people are a nutritionist, they're generally more on the natural food side. But even then, natural foods, a lot of natural foods aren't that good for you, like flaxseed and whole wheat. And there's all kinds of crap that mother Nature makes, too. Right. So just look at the bias or lack of bias and the curiosity of whoever you work for. But if they recommend McDonald's or school lunches, they're probably not working for the good guys right now.

B (56:07)

Yeah. Which is sad and interesting. Yeah.

A (56:10)

Okay. Would you say no to doing surgery on someone who just eats a crappy diet and has three glasses of wine at night every night?

B (56:16)

It happens often. Okay. Yeah. And the way that my process works is if somebody wants to engage, engage with me. I go through this photo screening that's free, so it's very low friction to see me for the first time. You send photos in. Send a little form, what you're interested in. I look through at them myself, and I go through this process you and I sort of talked about earlier that is like, is this somebody that I want to work with forever because I can only do so many surgeries. Is this somebody that I would want to work with forever? What do I think their outcome is going to be? Are they a good candidate, et cetera, et cetera. And that would, for Me be a situation where this might make you not a great candidate for this.

C (56:49)

This.

B (56:50)

I know I've seen this too many times. Even when I go to use your stem cells and get the stem cell density out of your fat, I see changes in those stem cells based off of, let's just say how metabolically healthy you are. And that could be related to BMI or blood glucose or inflammation, whatever it may be. Someone can have a low BMI and still be inflamed or have a high blood glucose. We all know those things. But I noticed changes in their fat composition, which for me weighs up into the results that I can deliver. Because. And this we keep talking about, like, getting ready and healing and we can make things faster. And that's all very true and wonderful for my patients, but where are, where we really align is that I'm. I carry a healthy obsession with the results that I deliver. That is my calling card. That's what made me who I am. And I will take half percentage points of improvement anywhere that I can get them. A lot of those things tend to also benefit our healing time. Right. And so that gets into, can I give you the best result that I can give you if you are drinking, you know, drinking wine every night and eating, you know, processed foods? And the answer is, no, I cannot. So then it would be into like, well, are we willing to get on the same page and jive here with, you know, giving the best results that we can, and then we get. That's where the relationship starts a little bit. But I do also, you know, everybody loves to rescue. I love that process of, like, look at, look at where you started and where you came out. I've had patients who came in with crazy, you know, hemoglobin A1 or blood sugar dysreg regulation, and by the end, they look incredible and they're metabolically so much healthier than they were prior. So. I love those stories too. Yeah.

A (58:21)

If you had to choose without knowing anything else, whether to operate on a vegan or a carnivore person, which would.

B (58:28)

You choose for best outcomes without inflaming or inciting things too much? I would choose a carnivore.

A (58:33)

I just inflamed things on purpose.

B (58:35)

I know you did. Thank you for setting me up for that. I would choose a carnivore based off of. And if I could even just get down into what the main macro and micronutrients are for healing. Yeah, right. Because, you know, we have these phases of wound healing or this wound healing curve that we cannot decouple. Right. No matter how many biohacks we do, we can make it happen more efficiently, we can make it happen better. It's kind of like a what you'd say in a business meeting, let's make this. Let's be brief, be bright and be gone. Like do our thing really well, then get out of it. That's what we want to do with our whole wound healing curve from, you know, proliferation and maturation, all these things. So, okay, where are the building blocks for that? This is where the peptides even come in to like hit these different parts of that curve. But we need protein. Like we, we need protein.

A (59:20)

Beans and rice. Come on, man.

B (59:21)

Yeah. Well, you completed there a little bit, but not quite in the right way from an amino acid profile, but because even all, not all proteins are created equal. Right. So that's where the carnivore part comes in. We need vitamin C, we need zinc, we need copper and selenium. We need all those things. Right. But, but protein is king. That's. My kids say that to me. You know, we know in our family that's sort of where it goes.

A (59:41)

I am not on the carnivore diet. I have been grass fed and saturated fat centric for 15 years. I do eat some plants, I just eat less inflammatory ones. But when I'm recovering from a surgery, I literally eat three pounds of ribeye every day for the first week. I cannot get enough of it. I have oysters, I have some liver because the body just sucks it up. You cannot believe how it sucks it up as long as you can digest it. So I take stomach acid, betaine, HCl and enzymes, and it really does speed healing and resilience. But I also have carbs because you don't necessarily need to be on a zero carb diet. And carbs reduce adrenaline and cortisol and you probably have too much of those post surgery. So this maybe isn't a time to be on an extreme keto obsession in recovery. Right, Right.

B (60:25)

Okay. We want to use that method, metabolic flexibility that you came in with and, you know, leverage all those things because it's funny that you said, because if you were to get me really pinned against the wall, I would want a carnivore was eating organs. You know, even if we get into the peptide conversations like they're coming from the thymus and the stomach, like we should be eating those organs. That's where, that's, I think, where what people think of as a, you know, a vegan diet versus a carnivore diet. That's where the overlap can come to kind of like bridge that gap a little bit.

A (60:52)

How many testicles per day should I eat post surgical?

B (60:55)

Four. Let's get into four.

A (60:57)

We're calling Liver King. He's gonna be very angry.

B (60:59)

We have to keep it an even number.

A (61:03)

An even number. Okay, that's funny.

C (61:07)

No, I'm.

A (61:08)

I'm only sort of joking, but, yeah, whole organs are a good thing.

B (61:11)

Absolutely.

A (61:12)

And do we have to worry about getting purines from too many organs post surgical or post surgery?

B (61:18)

Yeah. I mean, so you can. You can overload in that way. You sort of mentioned this idea with, like, low inflammatory plants. You can do the same thing on the other end, too, if you're heavily eating oxalates or something on the other. And so the answer is yes. So this is where I believe in life. This will kind of bring everything back home. That politics, food, all these things. Like, there's two extremes that always exist. They tend to not like each other. And the truth often lives somewhere in the middle. And our job is to use science and critical thinking and experience to find out where in the middle, how close to either end of the spectrum we live to get the best.

A (61:54)

Tell me about nicotine and surgery.

B (61:57)

So nicotine has been a very hot topic lately, and I think that public opinion around it is changing a little bit.

A (62:03)

I've been doing my best on that for the last 10 years.

B (62:05)

Yeah. Right. So I should say lately, but. Yeah. Much longer with you?

A (62:08)

Well, it didn't move the needle much.

B (62:10)

Right.

A (62:10)

Recently. So, yeah.

B (62:11)

And, you know, I would just say that the source of the nicotine is the key element of this. Right. We know the nootropic effects of it. We know what it's doing from essential nervous system standpoint, which we could get into, is probably beneficial. Where the rubber meets the road, though, is are you getting your nicotine from tobacco or vaping, which are wildly vasoactive and an absolute deal breaker for a procedure like mine that is super elective. And again, back to that tight relationship. I wouldn't compromise your results with something like that. So I would be very neutral on it overall, but I would just. We'd be looking at the source of where you're getting it from.

A (62:43)

I kind of like oral nicotine because it does increase angiogenesis, which is growth of new blood vessels. And if I have a surgical procedure, do I need new blood vessels?

B (62:53)

Yeah. The most important thing, everything we've talked about, like, from hyperbarics to red light to. They're all Driving that, you know, even the stem cells are driving angio neogenesis. And yeah, so that's where I say that we. The overall benefit of the nicotine is probably there. That being said, I am not at this point in time, who knows where things go as I get more into it and research it more. But I'm not starting my patients on nicotine who are naive to nicotine going into it.

A (63:18)

That would be probably a good move because who knows how they're going to feel. You don't want them throwing up or something.

B (63:23)

Exactly.

A (63:24)

Post procedure. That's a little bit of blood pressure change, right guys? Davealesbree.com Nicotine has the two master class episodes on safe uses of non smoking nicotine that I put together for you. And there's just so much good science behind it for neuroprotection even. But I guess you should tell your anesthesiologist. Most of the anesthesiologists I've spoken with are saying, well, don't use nicotine before or during or after surgery. But they're conflating it with smoking.

B (63:53)

Right, Exactly.

A (63:54)

And if you look at low dose nicotine like under 10 milligrams a day ideally, and that if you do that, it appears to be beneficial on almost everything except cancer, in which case angiogenesis might be good or might be bad, depending on your treatment plan.

B (64:07)

Exactly.

A (64:08)

So this is one of those things where I wish surgeons would say, you know, we're going to put a patch on for, you know, 7 milligrams, which is a very low dose, over 24 hours because it'll speed growth of blood vessels and then we just won't give you more patches and then you're done. I don't think anyone's doing that yet, but maybe you'll start.

B (64:25)

Yeah, that's definitely worth looking at. I mean anything that, anything that increases angiogenesis, you know, is wildly beneficial.

A (64:32)

Do you do anything with surgical room or recovery room lighting? Like when I go into the normal hospital, they put the worst, cheapest, like it's the equivalent of McDonald's french fries in a light right above the bed, shining into my eyes and there's beeping and bogging and you know, Dr. Davis, telephone please. And anything you can do to just disrupt quality. I imagine you don't do this in your theater because you get to control it. But do you like soften the lights? Do you recommend people do things afterwards? Tell me about light and surgery or.

B (65:01)

Light in all medical settings. Right. It tends to, to be very like you Know, calling it the fast food of lights and garbage light and things like that. It definitely exists. This goes even to the circadian talks we had at the very beginning of my patients traveling internationally or just getting sleep cycles optimized or getting cortisol levels regulated properly. I, because I get to own my own operating rooms. They all have windows, big windows. Right. And so we're not just soft lighting, we're natural lighting when we get into like bringing patients into the room. And so this experience looks like kind of coming into a room with like natural lighting, you know, kind of getting set, you know, havening, getting your headphones in, getting your compression red light boots and which is also like thermal regulation, which is wildly important. Proper oxygen, proper thermal regulation to set up our healing and this whole experience and even good light. So this all goes into before, you know, kind of turning out the lights, if you will, for the patient. Then for me, I need high quality light to do what I'm doing. But the patient at that point is sort of out of it. Right, okay. And then by the time the procedure is finishing, it's the same thing. We're waking up. Like waking up is very quick with my anesthesia protocol. It's not a multi hour ordeal, it's a multi minute ordeal. So which is beautiful for us because we can very precisely control that emergence, like coming out and what that experience is like from lighting and interaction with staff and all those things. And so I think a lot about that, again, partially selfishly, for the sleep regulation that I want to be happening that night.

A (66:32)

Okay.

B (66:32)

Yeah, but windows, natural light is my key to that.

A (66:36)

You ever think about putting patients on 15 or 30 milligrams of desiccated thyroid for recovery?

B (66:42)

I have not played with that specifically as far as like an organ goes. Come on, doc. Okay, I know, right? But you know, it's same mechanism. So we know that that is going to be really helpful for this from a wound healing standpoint. Right. When we get into some angiogenic factors. Yeah. So I have not done that specifically.

A (67:01)

But, but I'm curious maybe it's.

B (67:04)

I'm always curious.

A (67:05)

Yeah. Look at the studies. It comes down to bioenergetics. The cells have more energy. Turn up the energy thermostat a little bit, turn up testosterone a little bit with analogs or just a short course dose, turn up growth hormone with peptides or I just use the, the good stuff. And I do see faster healing. And you're not going to suppress anything with a low dose for a week.

B (67:24)

Right.

A (67:24)

It's it's just like turning it on. Are there risks to healing too fast?

B (67:30)

Oh, well, that's defining what too fast is because this brings up a really interesting point. The answer is yes, there are. What most people think is healing, though, is getting decoupled from what needs to happen. And the thing that I see most commonly with this all the time, daily, frustratingly, is postoperatively somebody's getting steroids. And this is corticosteroids. I'm talking about things like prednisone or methylprednisolone or something. Those are really important because those are completely turning off our inflammatory cascades. So when we go back to those phases of wound healing that we need, you have shut them down. This gets misinterpreted as healing quickly because your inflammation goes right away. But that's inflammation that we need. Right. It can be more comfortable because you don't have as much distention from swelling. Things appear to be healing faster. Your redness after your laser that I'm doing might go away faster. It's also because you're building no new blood vessels in this process. Right. So I would say that that is really commonly interpreted as faster healing with something like steroids. But you are compromising your outcome, your long term results. It's the comfort crisis. It is. Comfort's a slow death. You're killing the results by making things more comfortable, which is really tempting from a surgeon's standpoint because I want you to have the best experience you can have. And I can take everything away. But we have to have that mindfulness going in, that there's a little bit of a cocoon. We have to go into our chrysalis a little bit to kind of come out the other end. And we don't want to take that away. And so that's probably my biggest answer to yes, you can heal too fast. On the flip side of that is if we're bright, brief and we get, get our phases over with, we go through them, but we go through them efficiently. We get the jobs done that we need to get done. We're building the blood vessels, we're creating the new kind of like functional adhesions that we need to create. Great, let's move through that as fast as we can. As long as the job gets done right. And we want to do that because we don't want things switching from acute to chronic inflammation. That's not a good thing. And that's what all the things we talk about. If, you know, if a patient's going to upgrade Labs afterwards or something. That's all that. What's. What we're trying to do afterwards is make those inflammatory phases efficient and done and move on.

A (69:31)

So you're not a fan of like a low dose dexamethasone just to support the adrenals during healing.

B (69:36)

Well, so now we're talking about low dose. Right. Like supporting adrenals because we need adrenal function and we do release corticosteroids. Like we have to do that. That's one of our stress hormones run.

A (69:44)

Out of them, they get sick.

B (69:45)

Right. Well. And so what was our state going in in general? That's not what people are doing when they're getting steroids. So that's a whole different mindset. Exactly. It's a whole different mindset around it. A dream. Adrenal support? Yes, absolutely. We need, it goes beyond adrenals to livers and kidneys and things like that. We need all those functioning appropriately. But if we need adrenal support, this is something where we know generally from a very functional medicine deep dive first. If we're going to need that situation, that's a different story.

A (70:10)

So, yeah, I typically take adrenal glandulars pre and post surgery because it supports my adrenals. I know that I don't make enough cortisol genetically, so I take a little extra cortef, which is basically lasts for about six hours. It's bioidentical cortisol and also works for jet lag. So yeah, your body makes 20 milligrams a day. So I take an extra 20 milligrams a day for a little while after the procedure, which just lets my body have plenty of what it's trying to make but doesn't do a good job of making.

B (70:39)

And you're that prime example of that knowledge being power to be able to do. If you don't know that, you don't know that. And then your surgical recovery is suboptimal and you're not even sure of all the multiple things that could be happening. But like, that's important to know. So you can replace that.

A (70:52)

That's why getting to know thyself with some genetic testing and epigenetic testing and viome and all this stuff, it provides a lot of value. And also for me, just in terms of resilience, I know what it feels like. My body wants more adrenaline and cortisol and it can't make it. So I can support that. And it turns out everyone hits burnout sometimes. And if you know what that is, you can treat Burnout and recover faster, just like you recover faster from surgery, which is why this is so fascinating. And I want to ask you about something that's plastic surgery specific. Sure. Talk to me about fillers. Are they good for you? Are they bad for you?

B (71:25)

Oh, well, I think that they're in general fillers as a product. We have to divide into the two different main types of fillers. There are fillers that we would call bio stimulants. These get injected and their goal is to stimulate collagen in air quotes. Stimulate collagen. They do so via a foreign body response. They go in, they stimulate, you know, foreign body response. Collagen, which is some version of fibrosis scar tissue type of things, gets laid down and then the product goes away. That's one category. Biostimulants very hot and popular right now because there's become this filler fatigue or filler fear around. The other main class of fillers that are from hyaluronic acid, this is the one that most people know. These are the names like Juvederm and Restylane and Rha and all these things that are readily available on every corner you go to. And the pervasive thought behind these gels, they're a cross linked gel. And you'll hear things like, well, hyaluronic acid is a natural part of our skin, which is true, but in a different form that's not cross linked. And you put it in your face and it lasts six to 12 months and then it goes away. Also not true. If you don't like it, you can put an enzyme on it and it just magically goes away. Magic wand type of ideal. Partially true, but much more difficult to do than that. And that when it's put in, wherever it goes, it stays there, it doesn't go anywhere else, which is wildly not true. It moves very significantly. We're putting a gel in a. And a very dynamic tissue that moves a lot.

A (72:49)

So it doesn't behave like the COVID vaccine either, does it just stay in one spot?

B (72:52)

Doesn't stay in one spot. The hot topic hot button. And so this is my COVID vaccine is fillers. Right. And so, and I don't think that a lot of people injecting it know those things. I think they truly believe what they've been taught by generally it's the companies. These aren't really. And this has changed in the last 10 years. Like it's, it's been commoditized and so everybody's an expert who injects Them, but. But most people don't believe that. And I'm starting to see changes in there. But if this is the dangerous paradigm here, if you believe those things and use it, you're going to get yourself and your patients into trouble because you're going to be doing it every year. We got to you come back, Dave. Let's do it again next year. Well, the filler, we're just adding to the problem at that point. The filler I gave you is probably moved somewhere else. Where does it go throughout other parts of your face? Like, let's say I want to put it in your lips, right. Or in your cheeks, or I was.

A (73:38)

On this kissy lips.

B (73:39)

Yeah, it's gone under your eyes, or it's migrated up towards. Towards your nose, or it's moved somewhere else. And so then I just backfill behind it. And guess what? That filler does the same thing. And then it starts to break down over time, which it does do, but not over six or 12 months, over decades. And as it breaks down, it's hydrophilic. It loves water. It attracts water. So you get puffy, and so you get puffy. And we've all seen this. Right now it's clicking with people like, oh, the puffy faces. It gets distorting, quite distorting. And our. Our brain, the way that our neuroanatomy works, we pick up changes in the face very acutely. Like, it happens quickly. We know what's off, but it has to go to our frontal cortex. Whole different neuroanatomy to analyze what's actually off. I can look at somebody and know that's not right, but I don't know what happened. And this is what I try to do with my results in a positive way. Like, that person looks better, but I can't put my finger on why that's a good thing. Right. On the flip side, we don't want that to happen. And this is what fillers can do very readily, very slowly, over time. And then you get in trouble where you look different, you're puffy. Things have moved from where they were put originally, and it's not so easy to just get rid of it. I see this in surgery every week. I am removing massive amounts of hyaluronic acid filler almost every procedure I do. It's rare that I'm not managing it as part of the procedures that I'm doing. And it makes sense. It seems like such a low barrier to entry when you're experiencing your first sign of aging. Let's Go get this simple gel. It's relatively inexpensive. It's. It's going to do it, you know, promise to do all these wonderful things. You don't need surgery if you get it. And none of those things end up panning out to be true. So it's, it's complicated and unfortunate. It's not the product that's bad, it's the use of it that's bad.

A (75:14)

So what's better than filler? I mean, do we put, you know.

B (75:17)

Well, so we talk about butter. Yeah. Using filler with the idea that it's a semi permanent implant. Okay. And it's going to move. Okay, great. If you're doing those things, what are the right applications for it? Something like a bio stimulant that we talked about. Not much better and can cause significant tissue changes as well. Then we get into like, I love regenerative medicine. I love. If I'm going to. If I'm talking about losing volume in our face from lost fat. Let's put fat back in the face in the places it's supposed to go, inside the fat pad. When we use autologous fat transfer, it cannot move. Once I put it in the fat pad, it has to build new blood vessels back to that angiogenesis. And once it's done that, it can't go anywhere. It's physically attached.

A (75:55)

Fat transfer. Suckle it out of the butt and put it in.

B (75:57)

Yeah, butt, flanks, abdomen, thighs. Like, that's a whole fun conversation about stem cell density and all these different fat locations and then metabolic profile the patient and how the stem cells work and, you know, taking fat and turning it into the stem cell density we want. But it, it's like, for like fat for fat. And it has a massive regenerative capacity, which is. So if you were to look at your skin, skin after a fat transfer procedure, not touching the skin, no lasers, no radio frequency, no anything like that. You're also going to get improvements in your skin from this, like, paracrine cell signaling communication to the adjacent tissues. Just from your fat pad being full of young stem cell rich fat. Wow, this is really cool.

A (76:34)

This is something I did not know about. Filler. That's, that's actually remarkable.

B (76:38)

Yeah.

A (76:38)

So thanks for the warning on that. I, I guess I won't get any filler. It's like, that's probably.

B (76:42)

There's better options. Options.

A (76:43)

All right, good deal.

B (76:44)

Yeah.

A (76:45)

And I've been pretty public. I've, I've had some work done, a couple different procedures, and I have no regrets about that. Yeah, because you know, I cut my toenails when they get too long and if you lose £100, you're probably gonna lose extra skin. As you age you're gonna have extra skin and yeah, we're looking at living for hundreds of years. You know, you cut your toenails every couple weeks. You probably are going to need a skin trim every now and then. At least with what we know now. Do you think we're far away from, from magic laser pharmaceutical peptides or something? Just shrink the skin?

B (77:15)

Yeah, that's the holy grail I think of where we're not quite to, from the level of efficacy that we'd want yet, but it's over promised. And that's a lot of the dangers around devices and things like that is even just the thought paradigm of we need to understand what's the changes in the skin that have happened. Because we talk about collagen a lot, which is important, but we talk less about elastin, which is another fibril in the skin that's probably more important to the overall elasticity of what we're after. This is where regenerative medicine comes in. Because we can skew the creation of collagen to elastin to be in favor of something like elastin postoperatively. Just by taking your own fat based stem cells and putting them in your skin, we can upregulate your elastin production. So we're not there yet. We're making steps in that direction and I think that we're going to continue to do that Right now where people need to be careful though is the promise of a non surgical facelift or something like that. Where the they go, you're gonna get this device, it's gonna lift and tighten everything. The very best case scenario is that it does little to nothing. And that's what all the evidence and results show. If you get really objective about good photos and good results you can show you can see all kinds of different lighting and different positioning, but when you really get into it, it's little to no results. And the only downside of that is in addition to your spend. But you take a risk because on the flip side of that is you can damage those soft tissues by over being overly aggressive with their ability to heal or regenerate from those things. And that's just what I would encourage people to be sort of, you know, kind of aware of. If it sounds too good to be true, it probably is. You know, we, it takes a lot of little things, a lot of Little things to accumulate to get the results that we're after. With you having had your procedure, one of the things that I love about, you know, what you've said is your mindset about it. Right. You said your clip your toenails when they get too long. Yeah, that's perfect because I see a lot of my patients wrestling with the cognitive dissonance around doing these types of procedures. And my patients are high achieving, high performing, vital people who start to get a mismatch of what they're seeing in the mirror, physically seeing where their body's at and what they feel inside, how vibrant they are. And I've always viewed myself in this middle of. And that's a challenging space to be in. How do you make those things like, realign? And we know that even like your looks are going to follow your health to some degree, it's just not perfectly linear. There's going to be a decoupling of that at some point. So I've always viewed my job as trying to put those back together. Like, let's get things realized. I don't do anything transformative in the sense of. That's just my personal vision is that I don't change you into something you never were. I'm just trying to like, match up. So no bbls, no bbls, no breast augmentations. I don't even do rhinoplasty. Right. I don't do any of those jobs. I do things that are rejuvenative or regenerative types of things. And so I've appreciated your like, mindset on it, but that is that this is okay, it's part of biohacking or just part of a longevity process because that's what a lot of people feel but have a hard time articulating.

A (80:06)

It's funny, some people get really triggered by that, but they're always the people who seem like they need to have facial surgery because they have deep frowns and they're angry all the time and it just leaves marks. And we could fix those surgically, guys. So if you'd like to troll me, I'm just going to make fun of how you look.

B (80:20)

Well, for us to argue with what we put into the world not being wildly impactful is crazy. Like how we carry ourselves is important. You know, what you put out and, and so there's a dissonance around that. There's. And you get into like RBF and RDF and all these things that people like. I feel like I look sad, feel like I'm looking mean all the time. And I'm. They're not that person. Right. So that. That's something.

A (80:40)

Dude, my dimples went away. I lost so much weight. I had, like, a fistful of skin on each side. I have no problem with saying I did something about it. Yeah, some people, they really do have problems, but, you know, people are gonna have problems with people, but the people have the problem are the problem.

B (80:54)

Yeah.

A (80:54)

So I just. I just don't sweat it anymore.

B (80:56)

Well, I just appreciate that from, like, patients, like, kind of being able to resonate with that and, you know, just. And kind of falling into, I think, a lot of my patients by a selection bias or, you know, people who would, you know, resonate with your overall messaging and sort of like, the mindsets around all the things we've talked about. And so it can be quite relieving to. To know, like, yeah, this is okay to do.

A (81:15)

Well, Cameron, thanks for coming in and talking about all the stuff no one talks about around surgery and for doing things in a much more functional and natural way. You're@clinic5c.com right?

B (81:26)

Correct. Yep. I'm most active on Instagram. That's where I talk a lot about lots of things with this in anesthesia. And there's lots of before and after results. Again, that's what my practice is built off of. So lots of fun journeys on there to follow. You can see a lot of people who. What's your instinct? Instagram account chestnutmd all right.

A (81:42)

With no T, right?

B (81:43)

No t in the middle. Chestnut MD Good memory.

A (81:45)

Thanks for tuning in. I know we got technical on this, but now if you're going in for surgery, you know what to say, what to not say. And if you look up all those words around the specific pharmaceuticals for anesthesia and you're going in for a procedure, well, you can actually have an intelligent conversation with the anesthesiologist. That means you're going to feel better when you get out and you know something about fillers that I didn't know. See you next time on the Human Upgrade Podcast.

D (82:17)

The Human Upgrade, formerly Bulletproof Radio, was created and is hosted by Dave Asprey. The information contained in this podcast is provided for informational purposes only and is not intended for the purposes of diagnosing, treating, curing, or preventing any disease. Before using any products referenced on the podcast, consult with your healthcare provider carefully, read all labels, and heed all directions and cautions that accompany the products. Information found or received through the podcast should not be used in place of a consultation or advice from a healthcare provider. If you suspect you have a medical problem or should you have any healthcare questions, please promptly call or see your healthcare provider. This podcast, including Dave Asprey and the producers, disclaim responsibility for any possible adverse effects from the use of information contained herein. Opinions of guests are their own and this podcast does not endorse or accept responsibility for statements made by guests. This podcast does not make any representations or warranties about guest qualifications or credibility. This podcast may contain paid endorsements and advertisements for products or services. Individuals on this podcast may have a direct or indirect financial interest in products or services referred to herein. This podcast is owned by Bulletproof Media.