00:00:00 Dr. John Santa Ana is introduced as a board-certified physician specializing in interventional sports joints and spine treatments. He received his medical degree from the New York College of Osteopathic Medicine and completed his specialty training at the Walter Reed Army Medical Center. Dr. Santa Ana shares that his practice, Michigan Center for Regenerative Medicine, is a hybrid insurance and cash-based one, allowing for more time with patients to explain options and make informed decisions. He discusses his uncommon background, growing up in the Philippines and eventually settling in Michigan, where he went to undergrad at Wayne State University. Initially unsure of his career path, he took premed courses and eventually decided to pursue a degree in nutrition, but the experience led him to medicine.

00:05:00 Dr. John Santa Ana shares his journey into medicine, starting from his college days where he was influenced by friends to pursue medical education. He attended New York College of Osteopathic Medicine and gravitated towards Emergency Medicine due to his interest in saving lives and his athletic background. However, he also considered Orthopedics as an option because of his hand skills and love for sports. During medical school rotations, he found his niche in Physical Medicine and Rehabilitation (PMR), which deals with musculoskeletal issues and is non-surgical but procedural. The field appealed to him due to its focus on function, anatomy, and the ability to make all body parts work. PMR's definition emphasizes its specialty in function, encompassing various medical aspects.

00:10:00 Dr. John Santa Ana, a physiatrist specializing in Physical Medicine and Rehabilitation (PMR), discusses his role in helping patients navigate various disabilities and chronic pain issues. He explains that PMR doctors focus on functional movement, enabling patients with conditions like strokes, spinal cord injuries, or chronic pain to improve their abilities and return to their normal activities. Dr. Santa Ana shares his personal background, including his family's military history and how joining the military helped him pay for medical school through scholarships.

00:15:00 In this section of the podcast, Dr. John Santa Ana shares his experience of joining the military through the Health Professions Scholarship Program (HPSP) while already in medical school. Feeling disheartened about the prospect of enlisting before medical school, he was introduced to the HPSP by a friend attending the University of Michigan. The program covered his medical school expenses and commissioned him as an officer upon graduation. However, the first year of medical school was not covered, and after graduation, he was required to complete his residency in military-based programs. These residencies offered equal curriculum as prestigious universities, and Dr. Santa Ana ranked for a Physical Medicine and Rehabilitation (PMR) residency at Walter Reed, the only PMR program in the military. The experience provided unique training opportunities with high-level athletes from various military branches. When asked about the impact on his family, Dr. Santa Ana shared that they all moved to support him during medical school, and the financial assistance from the military eased their financial burden.

00:20:00 Dr. John Santa Ana outlines his personal journey of joining the Army and pursuing medical school. He explains how his parents initially had reservations about his decision to join the military but were eventually reassured when they understood that he would be going in as a physician. Dr. Santa Ana also discusses how his family's expectations of him to pursue a professional career, such as science, technology, engineering, or math, played a role in his decision to become a doctor. He reflects on how the military experience added an extra layer of pride for his family, given their military lineage. When asked if the military route created more passion and resolve in his career, Dr. Santa Ana affirms that it was a significant factor.

00:25:00 Dr. John Santa Ana shares how his military background shaped his perspective on people and medicine. He explains that the military taught him to be responsible and mature, and exposed him to diverse backgrounds and cultures, broadening his horizons. This new perspective helps him connect with patients and understand their unique experiences. Additionally, Dr. Santa Ana discusses how the military covered a significant portion of his medical school costs, allowing him to start his life and career without the burden of student loan debt.

00:30:00 Dr. John Santa Ana shares his experiences during his military service and its impact on his financial situation. He explains how the military scholarship program helped him financially during his residency, allowing him to make more money than his peers who were not in the military. This extra income, however, came with the trade-off of a lower salary after residency compared to his attending colleagues. Dr. Santa Ana also discusses the benefits of having no student debt and the importance of finding one's way in life, using education and making a positive impact as guiding principles. He concludes by mentioning his interest in sports and the challenges of maintaining an active lifestyle as he and the podcast host get older.

00:35:00 In this section of the podcast, Dr. John Santa Ana discusses Tiger Woods' experience with spinal injuries and the treatments he underwent, including four spinal fusion surgeries. Woods' anomalous condition as a golfer subjected him to immense forces and torque, leading to degeneration or herniation of his L5 S1 disc. Initially, he underwent discectomy procedures to relieve pressure on nerves, but the loss of disc material as a shock absorber resulted in a decreased ability to absorb forces, necessitating a fusion surgery. An anterior fusion involves replacing the disc with hardware to create space, but this significantly reduces the normal movement between vertebrae, potentially leading to adjacent segment disease and the need for additional fusions. Dr. Santa Ana also mentions that he performs discectomy procedures through a needle with image guidance.

00:40:00 Dr. John Santa Ana discusses cervical microdisectomy, a common procedure to relieve pressure on nerves in the spine, using Peyton Manning's experience as an example. The procedure involves removing a piece of the disc to alleviate pressure on the nerve. The spine's structure, with its hard bony surface and gooey disc, makes it susceptible to degeneration, leading to the need for microdisectomies. Loss of range of motion and accelerated arthritis are potential consequences of the procedure. Dr. Santa Ana notes that regenerative medicine, while a young field, is gaining popularity as an alternative to surgery for treating degenerated discs. However, not all physicians are familiar with its capabilities, and patients often seek out this treatment on their own after exhausting other options.

00:45:00 Dr. John Santa Ana explains the role of orthobiologics, specifically regenerative medicine, in treating patients with degenerated or herniated discs. He explains that while surgeons may offer options such as pain management or fusion surgery, some patients seek out regenerative medicine when they have exhausted conservative treatments but are not yet ready for surgery. The goal of regenerative medicine is to optimize the body's natural healing ability using growth factors, stem cells, or other methods, allowing the disc to repair and regain stability. Dr. Santa Ana shares that the lack of information and education about regenerative medicine in medical schools and residencies, as well as the lack of insurance coverage, may contribute to orthopedic surgeons not recommending it as a first option. However, he and his team are working to change this perception and increase awareness of the effectiveness of regenerative medicine.

00:50:00 Dr. John Santa Ana discusses the challenges orthopedic surgeons face in embracing regenerative medicine due to insurance coverage and lack of incentives. Regenerative medicine, which involves optimizing the body's natural healing process, is not typically covered by insurance, making it less attractive for surgeons to invest time and resources in learning about it. However, the guest on the podcast expresses his belief in the potential of regenerative medicine as a precursor to surgery and a more relevant therapy in today's world. He emphasizes the importance of tracking data and standardizing processes to provide proof of its effectiveness and overcome skepticism.

00:55:00 Dr. John Santa Ana discusses the importance of having a sufficient number of platelets in Orthobiologic treatments, such as PRP, for effective results. He uses the analogy of taking different doses of Tylenol for a headache to illustrate the concept. Dr. Santa Ana also emphasizes the significance of recording and tracking outcomes to help patients make informed decisions. He mentions that the field of regenerative medicine is currently in the data gathering stage, which is crucial for legitimizing the field and potentially gaining insurance coverage. Additionally, Dr. Santa Ana suggests that the cost-effectiveness of regenerative medicine treatments, such as PRP and stem cell therapies, may contribute to their growing popularity and acceptance.

01:00:00 Dr. John Santa Ana goes over his work in rehab medicine and pain management, focusing on functional improvement and escape from the "hamster wheel" of repeated treatments. He emphasizes the diversity of patients, from athletes to construction workers, all dealing with sports-related injuries. Regenerative medicine offers significant benefits, depending on the patient's goals and health status, with older patients aiming for maintenance and younger patients seeking full recovery. The success of regenerative medicine treatments depends on the patient's health and injury severity.

01:05:00 Dr. John Santa Ana discusses the evolution of orthobiologics, which aims to give time back to patients by providing less invasive and cost-effective alternatives to traditional surgeries. He believes the next big innovation in this field will be the ability to replicate and replace damaged tissues in a lab using the patient's own proteins. This would eliminate the need for synthetic materials and reduce the risk of rejection. Dr. Santa Ana also mentions the importance of having a second opinion, not just in medical treatments but also in financial planning.

01:10:00 Dr. John Santa Ana discusses the advancements in the field of orthobiologics. He explains how these treatments, which include platelet-rich plasma (PRP), bone marrow aspirate concentrate (BMAC), and stem cell therapy, have revolutionized the way orthopedic injuries are treated. Dr. Santa Ana shares his personal experience with using orthobiologics in his practice and the positive outcomes his patients have experienced. He also touches on the future potential of these treatments and the ongoing research to further improve their efficacy.