Painless With Dr Gabriele Jasper MD

A Medical Podcast About The Pain Many Of Us Suffer And What You Need To Do To Get Rid Of IT.

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Tune in for Painless with Dr.Gabriele Jasper MD! 

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www.jaspermd.com

Transcript

unknown 0:00

Okay.

SPEAKER_00 0:01

Good morning, everybody. This is Gabriel Jasper, MD, Jeremy Vickers, and we have a couple of uh guests today, which I'll introduce in a little bit. But uh I just want to let you know that I'm interventional pain, and that means that we find a pain generator and we get rid of it, take it away, therefore, no more pain generator, therefore, no more pain. Yeah, all right. So um that's what an interventional pain physician does. We get rid of the pain by finding a pain generator, and we have today we have so many different ways of doing it. I I saw from the beginning in 1996, actually, not 1996, it was 1993 when I started my um anesthesia residency, and I was interested in pain, but they didn't have much going on. But once I started getting more interested and I saw the future of pain, it's gonna be I I had had this premonition that it was gonna be better and it's gonna evolve into different stuff to get rid of pain. Yeah, you know, and it did, and every couple months something new comes along, right? And that's why uh today I've invited uh the representatives for Spinal Simplicity, which is a company, and I'll have them explain exactly what they do. But what I've been using them for for quite a few years, how many years probably?

SPEAKER_02 1:28

It's uh right before COVID.

SPEAKER_00 1:30

Yeah, just before COVID. I've been using them for uh spinal stenosis, and it's has been a game changer. It's um it and they and they're coming out with different stuff for sacroiliac joint fusions, and and I'll let them explain that. And I'm using that also, which is uh it's a game changer as far as you know, it does basically the same thing than other um fusion devices for spinal cord for uh for SI joint, sacro iliac joints, but much easier and more efficient, and they'll explain that to you. But just real quick, uh, you know what? Now that we're on the topic about spinal stenosis, and we've been through this many, many times, but today it's gonna be the major topic of it because we have the company here that actually gives me the tools to fix it. Right? So, real quick, spinal stenosis it comes from degenerative disc disease, and it's also genetic because it's amazing how you can have uh people who have spinal stenosis in their offsprings. Children have it, maybe half of them do and half of them don't. And they start people that's genetic, it could start at 40 years old. I've treated people at 40 years old with this treatment. But what it is, it's degenerative dys. This starts out like this, right? When it does start out like that, look how much room you have in the back here, right? You got a lot of room, you can see the spinal nerves in the middle, and it's it's protected by this uh thick ligament. And the reason why it's ligament and it's not bone, because if it was bone, we'd be stiff. But we were created in a way to have flexibility, lean forward, lean back, and twist. And that's what that's that's what that ligament does. But that ligament is made like kind of like a leather belt. You ever fold a leather belt and snap it, it's flat. When you push it together, it forms a loop. Well, when you sit down, this is this is a disease of somebody who has low back pain because when they sit down, well, I gotta stop this over here. When they sit down, they feel better because this opens up. When they stand up, this collapses. They walk, they stand, they can't do it too much. That's called intermittent neurogenic cloudication for the people who want to know the terminology. They walk a little bit, the back starts to hurt into the buttock, sometimes goes down the legs, and then they have to sit down or lean on a shopping cart. They got the lean on a shopper cart syndrome. So just like the leather belt, when they sit down, that ligament, like a leather belt, snaps and doesn't touch the nerves. As soon as you stand up, it collapses and forms this loop that rubs up against the nerves, which hurts. It also cuts down the blood circulation, which causes a lack of oxygen, nutrients, with and that causes pain.

SPEAKER_01 4:14

Yeah, yeah.

SPEAKER_00 4:15

How do we fix this? Well, very simple. We measure how wide this has to be when you sit down to make you feel good, which means that it flattens out that ligament. Once we figure that out, we make a little incision, it's very quick, easy, simple, and not dangerous at all. We put a uh spacer in between. So when you stand up, this can't collapse. The spacer keeps it up and you're done. Yeah, it's amazing. I had a patient the other day. The lady said, My legs feel 50 pounds lighter. I mean, that was amazing. And you know what was funny? I don't know if you were there, but I noticed uh classically when they feel better and their legs are stronger, when they start to walk, their legs, the knees go way up high. Why are they going up high? And like they're in the marching because of the fact they got to put so much energy to lift their legs normally because they get half the impulses because the nerves are not working properly when the ligament presses up against it, that they struggle to get it up. All of a sudden, now it's not put pressure on it, and they they do the same energy and the leg pops up. I mean, that's a you ever hear that phenomenon?

SPEAKER_01 5:29

Yeah, yeah, I do.

SPEAKER_00 5:30

I mean, it looks like they're marching, and then after a couple, a couple minutes or a couple seconds, they start to right away get used to it and start to walk normal.

SPEAKER_01 5:37

I felt that way. I felt that way when um, you know, afterwards, but before, like you're struggling to keep make clearance with your feet as you're walking because Well, you had spot you had spacer? No, no, but I had some of the same um symptoms is my own.

SPEAKER_00 5:52

You had endoscopic surgery, which means I take out some of the ligaments, yeah, yeah.

SPEAKER_01 5:56

Which is but when when you when I before I saw you though, uh switch out to you. I know it's on them. Before I before I saw you, I'll just go around the room. Yeah. That camera's dead. All right, turn on. Yeah.

SPEAKER_00 6:12

Anyway, go all right. So anyway, so so it's it's a great technique that I use with uh SI joint fusions. And uh I like to introduce uh the representatives of spinal simplicity. We got Ryan, and we got Tyler, and they're a great help. They bring people for me to help teach them and learn how to do these procedures, and they're experts. Uh, if anybody's out there listening that is interventional pain, please contact them, contact us, they'll give you the numbers, and uh and let them you know give talk about a little bit. We want to start start out with Ryan and and uh Tyler could talk a little bit, whatever you want. All right, yeah, switch it over to them. There they go. There they go.

SPEAKER_02 6:56

Hello, everyone. Thank you for having us, Dr. Jasper. I appreciate it. It's been uh quite a few years since we did this on the radio back in the day. I know that was a long time ago. How long ago was that? At least it's probably 2021 or 2022 when you came back on and we had a good run and we did it at the radio station.

SPEAKER_00 7:11

Yep, yes, sir.

SPEAKER_01 7:12

That's right.

SPEAKER_00 7:12

WOBM. Yeah, this will be on, by the way, WOBM tomorrow morning at seven o'clock.

SPEAKER_01 7:18

92.7.

SPEAKER_00 7:20

And and you know, if anybody has any questions about anything in pain, please call us today. Right now, we have the ability to answer questions. If you have questions for uh the representatives for spinal simplicity, Reiner, uh Tyler.

SPEAKER_01 7:35

Yeah, this is the best time to call because they're they're here, the actual people that that supply us with these uh procedures. What's the number to call? It's right up on the screen right now, Dr. Jasper. It's uh 609-389-8695.

SPEAKER_00 7:51

And by the way, we're located, my practice is located in Bricktown, 74 Brick Boulevard, Brick, New Jersey. You can call us and make an appointment at 732-2620700. 732-2620700. We'll get a pen ready. We'll we'll uh we'll tell it, say it to you again later. And we and you can get us on the um our you would our website is what?

SPEAKER_01 8:15

Is uh jaspermd.com.

SPEAKER_00 8:18

All right, good.

SPEAKER_02 8:18

All right, so take it, guys. Well, once again, I appreciate being here. Uh, the opportunity to talk about us and the things that you do. Um, you know, working with you for six years now, it doesn't seem like that. Time flies, right? Coming coming from Oklahoma, meet one of the most innovative interventional spine physicians I've ever had the pleasure of meeting early on. It's been a good ride. And one of the uh I'm to kind of piggyback on the story you just told, one of the unique things about your practice is you interview every patient after the procedure. Yeah, which doesn't typically sometimes always happen. Patients just get up, they you know, they go home and then they come for their week or two follow-up, which is fine. But we get to see some really I mean, like sometimes patients take a week or two to come back to feel relief, three, four weeks, but you have a lot of patients that stand up right away and drop foot's gone, or their legs are stronger, like you just said, or you know, they're a lot of times it's their spouses telling us how much straighter they're standing and how much taller they are.

SPEAKER_00 9:18

I had a guy one time six foot four, six foot four, normally six foot five, but he was kind of slouched and and we put a spot, we put a spacer in him. He was again six foot four. His wife says, I haven't seen you like this for years. You know, you know, it's one of the few procedures that we do that you have instantaneous, the majority of people have instantaneous results. Why? Because when they stand up, the ligament is no longer crushing the nerves. So that's why, and I have a book, we're gonna one day we'll publish this book on the comments that all the patients have immediately 20 minutes to half hour after the procedure, which are comments like we're talking about, you know.

SPEAKER_02 9:59

So but uh to get to the topic, I guess, of spinal simplicity itself, it is a like Dr. Jasper mentioned, it is a very unique company that's one of the most committed to this transformation of interventional pain and spine that exists. Yeah. Um, we don't just focus on there's a lot of companies out there that just have one little widget that's maybe like a Me Too that they try to sell for cheap or get a few guys working here and there, but we're in for the long haul. We we're an engineer, we're a heavy engineering company manufacturing in the US, making high-quality, innovative products that we focus on to make basically the procedures efficient and streamlined. What that means for patients is same-day procedures where they get to go home and immediately feel better, smaller incisions, uh, keep sparing more of their own native anatomy. I had another doctor that I like that I do a lot of work with, in upstate that I go to all the time. He mentioned it one time at a meeting. He said, it's like when you get a new car and you've got windshield wipers, and then no matter how many times you replace them after that, they always leave streaks. And he said, So as much as as much of the native anatomy of a patient you can spare and keep and make that work for them, the better off they're gonna be, which is what we really focus on and what we accomplish. And um, we have two great products right now that Dr. Jasper utilizes all the time. We have other products that are similar to other things he uses where he's able to decompress and remove some ligament when he needs to, which isn't necessarily the end game, but it's something that Dr. Jasper recognizes and does before to allow the spacers to ultimately work better at the end.

SPEAKER_00 11:35

I got you. Another thing good about the company is the fact that uh I've been doing this particular procedure in probably six, seven years. And over the over that period of time, they have um engineers, they have engineers there that actually make the product continuously better and better and better. This particular product, better, but like how many different generations do you have? But we're on the sixth generation now. So I started with the first race, right? Yes, yes, sir. Now we've gone through six generations, it just makes it better, better, safer, uh, quicker, uh and simpler to do with better results.

SPEAKER_04 12:11

And with Dr.

SPEAKER_02 12:11

Jasper's background as an anesthesiologist, too, you can speak to that. Like, you know, this allows us to do you want to say awake, but it you know, it's conscious sedation. So you're sleepy, but you get in and out, and there's less risk there, less OR time, less anesthesia time, which adds its own inherent risks. So everything about this is just about for the benefit of the patient and for the efficiency and ease of use for the doctor. And that's what we really focus on. And we're we're continuing to engineer and make modifications to already great products, which we don't necessarily need to do, but we do for the benefit of the doctors and the patients. And then we're also for looking, engineering other pathologies that we're going to treat. Yeah, so it's a very innovative company, it's a company committed to this space and uh effectively training and getting interventional pain and spine doctors up and running and able to provide this to their local community.

SPEAKER_01 13:00

Yeah, you're changing a lot of lives in the process, yeah.

SPEAKER_03 13:04

Changing lines, and you're also giving um the life back to the patient. You know, sure. Dr. Jasper likes to ask uh some of the patients like, what are some of the things that you used to do um that you can no longer do? Uh, would you would you like to achieve those again? And uh some of those things could just be walking around the uh neighborhood with their with their wife or their spouse.

SPEAKER_01 13:22

Yeah, sometimes people just look for that uh like I just want to dance at my daughter's wedding, you know, and and we can make that possible.

SPEAKER_02 13:29

Yeah, or at the story Dr. Jasper always tells about how most of these people even know how many steps they have in their house.

SPEAKER_00 13:35

Right, right, yeah, that's it's classical, it's classical. You know, what when I when I uh interview some of these patients, I uh and I look at the MRI, I say to him, I say, Well, I used to say, I used to ask him, I bet you you can't walk far. I can walk far, but I stopped saying that now. I said, All right, let me rephrase that. I bet you can't walk far without pain. Yeah, oh yeah, yeah, yeah. And I said, I bet you walk a certain distance, you sit down, and it relieves the pain after a minute or so. Yeah, it does. I said, I bet you go to a supermarket and lean on a shopping car. Hey, how do you know? I said, Another thing, I've never been to your house, but I bet you you don't have any stairs. No, I don't have any stairs. And then if they do say I have stairs, I say, Well, how many stairs do you have? 13. They know right off the top of their head how many stairs because they're pulling, and I say, Do you walk right up the stairs? I bet you you pull yourself up the banister with the banister. You say, Yeah, I do. What do you follow me around? You know, and uh because most of these people, it's so tough for them to get up the stairs that they start counting. Yeah, all right, I only got five more left, I got four more left, and they pull and pull, right? And that's that's uh it's classical. It's easy to diagnose, but the worst part about it, half of these guys don't even diagnose it, they don't know how to diagnose it, you know. Because you know why, because they they don't know, because really uh a traditional pain doctor, I'm not even gonna say interventional pain, because you're you're interventional, you got to do what I do. Yeah, yeah. You know, and uh and most of them don't. Yeah, I'm not gonna get into why, but that's another topic. But anyway, um, if you're an true interventional pain physician, you should be doing this, you should be ashamed of yourself if you don't. Right. Right. And uh, and it's common sense. The guys that don't know how to make the diagnosis because they know they don't do this, so there's no use even looking at it. They give them a series of three epidurals and they send them back to the surgeons. What do you think? Hey, you guys travel all over the place. What's the furthest you traveled this week?

SPEAKER_03 15:46

Oh, this week uh we went to uh Utica, New York.

SPEAKER_00 15:50

Utica, New These guys are all over the United States, yeah, yeah. All over the place, uh helping doctors do the best for their patients.

SPEAKER_02 15:59

I just booked all my one-way flights to go from Charleston, West Virginia to Syracuse, New York to Boston, Massachusetts next week. So I'll be I'll be out all week next week.

SPEAKER_00 16:08

So and you guys got kids, huh? How many kids you got? Three. I got two, two kids, and they're young. Two kids. Well, you know what?

SPEAKER_02 16:17

His two and my two youngest are basically right at the same age. Yeah, yeah. Yep, four and two.

SPEAKER_00 16:21

That's nice. That's great. And they still believe me, they work hard, but they spend a lot of time, the dedicated fathers. I know New York because I see it.

SPEAKER_01 16:30

Well, we have the the most beautiful Gabriela uh Hill group, you might know. I wonder why she's watching this show.

SPEAKER_00 16:37

Yeah, uh who never watches this show.

SPEAKER_01 16:40

What are the newest information uh innovations from Spino Simplicity? She has.

SPEAKER_00 16:45

Oh, well, we got we got some yeah.

SPEAKER_02 16:48

Who's gonna say that one? So, I mean, everything is approved and coming out, so I mean, I don't think there's anything uh left to hide. But so what we currently have out is the Minuteman, which Dr. Jasper uses effectively. We have a new version of it, which has been approved and it's going through manufacturing, is is waiting for mass release, probably here sometime in the summer, mid to late summer.

SPEAKER_01 17:12

What changes what changes for it?

SPEAKER_02 17:14

Um, it's just uh another engineering leap forward to allow it to basically navigate tighter spaces, um, different anatomies and patients that you run into problems with. Oh, that's amazing. And um, just to make it once again more efficient. Yeah, same same outcomes. And that's generation what, six? Yeah, yeah, that's generation six. Generation six a little bit more um you know, strength to the implant itself as far as like the the fixation and hold of it. And then we have both of our SI fusion products. And we come out, we know that certain doctors have certain approaches they're comfortable with. So we have a lateral compression approach, which I believe is the best on the market. It's unique in that fact that it's the only implant that actually crosses the joint and provides true compression, which is necessary if we're gonna be fusing a joint.

SPEAKER_00 17:59

Well, you talk about SI joint now. We probably have uh a whole list of people on this uh listening to us here now. Right. Let me see. It's uh one two things uh there with one person listening to us right now. We got a handful. Yeah, we do. Well, who hey, put your hands up if you listen. Anyway, uh up here. We got a handful. You know, people probably it's gonna be on the radio tomorrow anyway. So yeah, uh we got to tell them what an SI joint is, sacral iliac joint. I usually have models here, but it's basic basically the pelvic area of of a of a person. You know, you have the spine, right? Here's a spine which goes up from the base of the skull all the way down to the tailbone. So you have the cervical, thoracic, lumbar, and sacral area. Basically the tip of the sacral area, which is all the way in the bottom, is your tailbone. Right? And the tailbone is together with the sacrum, and it's kind of like a it's kind of like a triangle shape, and it goes to your tailbone. Now, connected to is your hip, you know, the iliac crest, and that's where the ball joints go to your femur, you know, your legs are hooked into there. Right now, what happens? That's the you ever hear somebody, I broke my pelvic in the car accident, you know, or the symphysis pubic in the front. Well, anyway, you got you got joints, you got the SI joint, sacroiliac joint, and you got the symphysis pubis, which we really should bring that model in. And um maybe you guys can supply it one of these days, and and this way we could talk better about it, but but it's all connected, and these are the joints that aren't aren't joints like ball joints, like the hip joints and and the shoulder joints, but they're they're they're they're joints that have uh different curvatures to it, so it's almost like a puzzle that fits in there. Now, you have a lot of people have what they call SI joint pain, you know, sacral iliac joint pain, which is arthritis, arthritis of the joint. And who has a higher incidence of that? You know, you could anybody could have it, any man, any female, but it seems that a woman has a higher incidence of it. Why? Because of the fact that they have babies, right? And the il and the and the and the pelvis area with with the hormones during pregnancy loosens up the SI joint, sacriliac joint, and the symphysis pubis, so it opens up to allow the baby to come out in the vagina. So that's that's a natural occurrence, and then especially if someone has multiple children multiple times throughout their life, it expands and then it contracts to the point where it might not contract real well after a while, and it's chronically loose and it moves and it causes arthritic pain. And this is somebody, this is an unstable sacral iliac joint, and this is how this company, with their technology, simple, fast, non-invasive, they call it minimally invasive, but it's almost non-invasive, little incisions, and the patients get up virtually with hardly any pain, you know, and uh and they could just start walking on their own, right? I mean, there's no so somebody's some of these companies they they do it and they have no weight bearing for a while. They can't even stand up for a while. But this the way it's designed, it just it's one screw, it goes in, once it bottoms out, it squeezes the joint together and it works.

SPEAKER_02 21:24

Yeah, in the past, these have been bigger procedures with multiple implants, more traumatic, non-weight bearing for you know four or six weeks. And with us, you go home the same day. Maybe ask you to use a use a cane or just take it easy for a week or two, but you're you're ambulatory, you're going home. You know, that's post-operative pain.

SPEAKER_00 21:42

So I had um I think it I think it was um Nicole. I had Nicole look it up. Somebody, one of the nurses looked this up. You know, reached my age, you can't remember shit anyway. But uh look up, because I had a patient that had a two-level fusion. And it was uh actually three levels at three, four, no, four, five, and s one. No, five, S1. So it was a two-level fusion. And they had five out of five sacroiliac joint maneuver positive. In other words, what we do is clinically, you see, it's sometimes it's hard to see um arthritis in a joint unless it's real bad. But you got pain in that joint uh that you can provoke the pain doing certain types of maneuvers, you know, physical examination. And if they have three, two out of five, three out of five, five out of five, you know, the more they have, the more toward, you know, you could you could suggest that they have iliac, sacro iliac joint problems. But um, this particular person had five out of five. And I said, the reason why, and I hate to say it, it's probably because you've been fused, especially at 5S1. Because what happens is when you fuse somebody, let's say this is not a sacred iliac joint, but if you fuse somebody at um let's say, do you have another one? Sorry. No, no, no. If you fuse somebody uh at, let's say, this level, then you got the level above, which is doing all the movement, right? So he's doing all the movement, then this goes, which was good before they fuse it. They call that adjacent dys disease. And it's basically the same thing with uh sacred iliac joint. Everything is fused, and now more motion is going on in a sacred reliac joint because that's not fused. I mean, it goes.

SPEAKER_02 23:34

Those are your most two common patient types that you just mentioned pregnant, post-pregnancy, and then they've had you know lower level lumbar fusions.

SPEAKER_00 23:41

Yeah, and most common type. Not to mention a lot of men have it too for who the hell knows for what reason. It's usually because they've they've worked very hard throughout their life. But uh, what I wanted to mention is that I I said, I've never seen the statistics on what is the incidence of getting um sacro iliac joint pain, and somebody has this fusion of the lumbar spine. So I had one of the one of the nurses look it up, and uh and I said, I bet you it's like 50, around 50. And they look it up, guess what it was? 40 to 60 percent. I was like, I was right, because you know, I see so many patients, I said 50% of them have sacred iliac joint problems, you know, which means I should be doing more sacred iliac joints. That's what you're thinking.

SPEAKER_02 24:28

Well, no, I was about to actually about to mention that. That's one of the things to Dr. Jasper's credit, because our other approach is a posterior approach, which for um other physicians that don't want to go lateral for whatever reasons, comfort level, um, what they're imaging, they're used to seeing, but it's the our other product is a basically an exact similar trajectory as when you do sacral iliac joint injections, which are necessary to document and reflect that the patient actually has SI joint pain.

SPEAKER_04 24:56

Yeah, yeah.

SPEAKER_02 24:57

When Dr. Jasper does those, the patients tend to do very, very well. And if he can have you come back once a year and do an injection, he's gonna have you do that. He's not gonna put you on the table for um a bigger procedure that he doesn't deem as necessary.

SPEAKER_00 25:10

See, a lot of it's technique, and it's what type of steroid you use. You know, you get what you pay for. If you use good expensive medication, it's gonna work better. You know, you you buy a Volkswagen. Well, some of the Volkswagens are pretty good today. But you you buy what's either buy a Cadillac or you buy just a cheap Chevy, the Cadillac's gonna ride better. You know, it's you get what you pay for. And a lot of these doctors use um use um medication that's cheap, you know. So that's one reason. The other reason, you need to put that right in the right spot. And you need to use enough medication. So what he's saying is I don't do a whole lot of sacral iliac joint injections because I do these injections and they seem to do well. And when he was alluded to, if I got a patient that comes back six months, a year later, and consistently is perfect during that period of time that they're not there, they have no more pain in the sacred job, why fuse it?

unknown 26:11

Yeah.

SPEAKER_00 26:11

Because you get a shot, because it's not that much medication, it's not gonna hurt them. You know, but if the patient is a diabetic, they got other problems that need steroid injections, then you got to think about let's treat this in a more permanent way so that you don't increase the risk of any side effects from the steroids. Yeah, some people really can't take steroids, so thank God we have these uh these devices here that will help it, you know.

SPEAKER_02 26:38

Um, and then future forward looking, uh, we have some products that are gonna be very minimally invasive that uh allow you to do remove some of the ligament like we talked about, do some decompressive work, um, whether that's in an open or like you know fluoroscopic uh style. Uh, we and then the the big thing we have, which is gonna have to go through heavy level one like data collection and trials, which would kind of be the holy grail, is something to treat uh disc pathologies, which is to stave most of this off. And that's where Dr. Jasper maybe could explain the degenerative cascade, because what we treat are degenerative conditions, which lends us to helping out mostly the elderly population because you know the disc goes away, everything goes back to the posterior elements. We use the spacer to secure the the segment. Um, we do the SI joint fusions, um, we debulk the ligament. And then this, what this product would eventually do is to help earlier on in that degenerative cascade is to strengthen up the disc to stay involved. What is this that you're talking about? This is a product called Intralink that we got to the FDA. So it is uh an injectable device that uh also got a breakthrough designation by the FDA, so it's going to be somewhat fast-tracked as we do our data collection. But what that is uh to do is to form covalent bonds and basically re-strengthen the annulus, the outer ring.

SPEAKER_00 28:02

The outer ring and the center.

SPEAKER_02 28:04

The outer ring. The outer ring.

SPEAKER_00 28:05

So you inject it in the center or you into the center?

SPEAKER_02 28:08

No, you inject it in the annulus with a bilateral approach.

SPEAKER_04 28:13

Really?

SPEAKER_02 28:14

Yeah, so did it have a code for it and everything? Not yet. So we're about to start enrolling in a big level one trial, probably in the next few months. That's a big deal. Yeah, yeah, absolutely.

SPEAKER_00 28:23

Yeah, you know that you think about it, that that's an ingenious way of treating disks because uh all right, you have the nucleus, the disc is made up of the nucleus, which is in the center, right? This is a good example. The nucleus is in the center, right? And the annulus is on the outside, right? And then what happens is when you start to get DGR of this disease, the disc starts to get weak. And when it gets weak, you start to lose the center, which is a nucleus, and then after that, you start to lose the annulus, starts to break down and gets weak. And this is a perfect example. You got part of the nucleus that will crack through the weak annulus and cause you to have a herniation. That's severe sciatica pain, it can incapacitates people, uh, and uh, and we need to prevent that. Uh, and this sounds like you know, if you can maintain, even if you don't have the nucleus, which by the way, there's uh there's ways we could put replace the nucleus too, uh, but the combination of replacing a nucleus with an allograph and then strengthening the the annulus, it's a home run.

SPEAKER_01 29:31

Yeah, you know, I mean this is unbelievable.

SPEAKER_02 29:34

With with this new one, um, does it build up height at all or just strengthen or oh we'll have to see what that uh shows in the studies, but the theory is yes, but mostly it just it restores basically forms covalent bonds with the annulus and restraints, gives you more gotta be up to date with this thing here.

SPEAKER_00 29:52

Change this around when you gotta do it.

SPEAKER_02 29:53

Yeah, but it just increases the tensile strength of the annulus, restores the tensile strength of the annulus. So we get, I guess the other theory is if we get too good at that early and early stages, we won't have as many of these patients that we're treating currently.

SPEAKER_00 30:06

Well, you know what the problem is, it's probably gonna be way in the future because the the we the problem, the other product that you guys use by uh it's a different company because you you also have your own company, right? Uh you want to talk a little bit about that?

SPEAKER_02 30:19

Well, sure. No, like like what Dr. Jasper mentioned, there are products out there currently that are on the market approved, um, that can be used in in certain jurisdictions, uh, Dr. Jasper's being one of them, uh, mostly on Medicare age patients, where you can inject it's basic donor tissue. So you're taking a donor nucleus, fliposis, the center disc and injecting it into the center of the patient's disc and restoring that, giving them back that nucleus.

SPEAKER_00 30:43

And that that that works tremendously also, you know, with a patient who has what they call discogenic pain. And that's usually pain you have when you sit down for a long time or bend over and lift lift stuff up. But that, but that that um that works really well. But the combination of that and and the uh the new product that you're talking about for the annulus, what what will it be made up of? So it's a plant-based product.

SPEAKER_02 31:06

So as far as I know, what I know right now.

SPEAKER_04 31:08

Oh, I see.

SPEAKER_02 31:09

Yeah, yeah. So because we we haven't had full exposure to it just because you know I I have a little bit more knowledge of it just because being like an investor and being with the company so long and working directly for the company. So we know some more that that's coming out. We've had some discussions about it, but it's it's still under what they call the IRB, where you have to just design the study in conjunction with the FDA, could have the parameters set, and then they'll start enrolling in different sites around the country to prove it works. It's been put in patients, I believe, in the Philippines and New Zealand, I think, is where they use some patient trials to get it approved.

SPEAKER_00 31:42

Oh, for from the same company or somebody else's?

SPEAKER_02 31:44

So it's a company that um spinal simplicity acquired. Oh, and now our our head, like our head PhD that does all of our scientific studies and stuff, Tom Hedman, he owned, he founded the product, owned the company, and now he works with Spinal Simplicity.

SPEAKER_00 31:58

Oh, cool, that's good. Yeah, so uh so what sounds good about it is uh the fact that it's plant-based. Plant-based is kind of like saying, yeah, it's it's made in the United States. It's a good, it's a good uh way of making people happy because you know, if you talk about, yeah, I'm taking this thing out of a person's body and we're gonna process it and put it in your body, there are some people saying, no, hell, you ain't putting anything in my body from somebody else's body, but you know, that people don't have to worry about even that extreme.

SPEAKER_02 32:33

All this is very well regulated. You're not gonna have to have any worries about that.

SPEAKER_00 32:37

Yeah, you don't ever have any worry about it because they today the technology of making something from one person's body, put it into another person's body, it becomes totally inert, which means that what you got to worry about is you gotta worry about the body rejecting it as not self. Uh, have a reaction, an allergic reaction to it. But they've found out ways of completely eliminating that. You know, it's not like somebody getting a liver transplant from another person. You can't make that inert because it's got to work. So a person who has a liver transplant, a lung transplant, a heart transplant, a kidney transplant, they have to go on chronic immune, immunosuppressive uh medication for the rest of their life. So it's uh it's nothing like that. These things, these things, bone grafts we've been using for years, uh, and and there's no con bad consequences from these things. So when a doctor tells you that it's safe, chances are it's safe.

SPEAKER_02 33:35

And that's another point to where I think we're at as a company, because there is some you know controversy with you know surgeons versus interventional pain and spine doctors.

SPEAKER_00 33:44

Well, you really want to go there today? No, we don't have to go there. I can I can talk about that. Don't get me going.

SPEAKER_02 33:49

I think it's very benign because what what what we're doing as a company for the most part, what Dr. Jasper and others like him are doing, is you know, there is a a rapidly aging, you know, baby baby boomer population in this country. And there aren't enough surgeons and physicians necessarily to even triage and see all of them in a in an efficient manner. So, what these things do that are mentally invasive that fall in line with people that have had these chronic degenerative conditions, um, that are older, maybe not even won't tolerate a bigger surgery. I mean, we have a lot of skilled surgeons in this country that do a lot of big, complex surgeries that we don't deal with. And there's a huge need, and they help a lot of people. I don't want to diminish that at all. Um, but we're serving a population that sometimes lacks um access or even the ability to undergo these bigger procedures, and we're able to do it in a minimally invasive fashion fashion and help them and get their later years back and get quality life better.

SPEAKER_00 34:48

You are so uh what's the word? Uh you're so um, I mean, you've got a way of putting things in a neutral aspect. But uh, and you're right, you know, there are surgeons out there that are doing tremendous work on patients that really need big surgeries. You can't take it away from them. They will never go away, the big surgeons that do the big cases because they're they're needed. But I'm gonna say it a little, maybe not as nice as you say it, not as political as you say, politically correct. But there's a lot of unnecessary surgeries going on out there that these procedures, that spinal simplicity and other minimally invasive uh companies that are producing these procedures are doing it for one main reason to make it as efficient, more efficient, safer for the patient, with smaller incisions, quicker, easier, and faster uh recovery. Because and because most of these procedures is there's no blood loss. If there is any blood loss, you're talking two or three cc's of blood. You do a major surgery, which you there are still surgeons out there doing major surgery for somebody with spinal stenosis. And uh and there are other procedures that are minimally evasive that you can do for spinal stenosis, but the insurance companies don't pay for it. So and the insurance companies pay for these big procedures, so they're gonna continue to do it as long as they pay for it. Uh and these these minimally evasive procedures that you don't get paid like you do for big surgeries. So it's kind of a deterrent for these guys to learn how to do the right thing. I mean, you go to any other country, you go to any other country, and and I hate to say this, you know, I'm not a socialist, I don't believe in socialized medicine, because uh a lot of times with socialized medicine, it's stunts, it it stuns the the the evolution uh the the ability or the the the the want to or the incentive to learn and develop new procedures because the money's not there here in the United States we spent a lot of money in research. Why? Because of the fact that you know there's a we we're able to because of of our financial uh ability to do that. Whereas in other countries that they don't have that, so it's kind of held back, yeah. But but when you're in another country and you have a choice to get paid the same amount of money as doing a big fusion case and doing a smaller case, minimally invasive case is gonna do basically the same thing, maybe better, you're gonna do the small case. Because you don't have that incentive. There's too much monetary incentive when it comes to spine surgery. I hate to say it. You know, this is why a lot of surgeons don't like me. They'd like to see me go away. Well, one day I will go away. When I in about 25 years, I'll uh I'll maybe consider saving money for my retirement. About 25 years from that. Who else is here? We got Rick Chappa here. Bongiorno Fratello Mio. That's right. Our buddy. How are you doing? Where's Chris? Where's Chris today? I gave him a shot yesterday. He should be feeling good. Chris Cullen's not on today.

SPEAKER_01 38:18

Well, there had to have been a fire or something.

SPEAKER_00 38:21

Did you put it on uh Facebook that we're coming up? Yes, sir. Yeah, Chris.

SPEAKER_02 38:25

Yeah, but the Dr. Jasper's point about like the incentives and insurance and things like that, that's the point I wanted to make too. That's where spinal simplicity in this segment separates itself as well, because we have you know a dedicated team that's doing the research, doing the study, collecting the data that the insurance companies want to see that will allow these minimally invasive procedures to be more broadly accepted.

SPEAKER_00 38:47

Well, that's a great point you bring up. You know why? Because I've been doing minimally invasive spine surgery probably over 20 years. And uh, and guess where all the studies are done on most of these, not including what you guys have. But like, for example, endoscopic surgery. Endoscopic surgery is a procedure, is a procedure that I've been doing and teaching for many, many years, but it's kind of gone to the wayside because uh basically the surgeons took it away from us uh because we were there were so many doctors doing so well with it that uh they were able to take our code away and devaluate it. So it's not even worth doing it. Though even though it's a tremendous procedure, it's not worth taking the risk of operating on somebody for peanuts. Yeah, they just don't do it. I hate to say it. No, I get that you know you because it you can easily get sued, you know, as soon as as soon as you say I'm operating, even if it's minimally invasive surgery to the spine, you say I'm gonna operate, you tell your insurance company your your your your uh malpractice insurance goes up 80% or more. You know, the doctor's paying over$100,000 a year because of that.

SPEAKER_02 39:57

Well, lead that into maybe some of the stories you told me about how you have replaced some of the need for even that endoscopic surgery with some of the products that we're oh yeah, that's that well that that's a good thing.

SPEAKER_00 40:07

The fact that the fact that uh you know, we do spacers and and we do uh other procedures uh where we actually in direct visualization we take out some of the ligament, which would be the mild procedure, uh has has replaced a lot of the endoscopic surgeries. I used to spend an hour, an hour and a half sometimes uh dissecting out the ligament under direct visualization endoscopically, because that's all we had to do. It was kind of like a uh a miniature version of a hemilaminectomy, which if any of the surgeons are gonna do anything for spilosenosis, that's all they should do. Not a laminectomy with fusion. That's ridiculous. You know, I'm a little um I got some passion about that because it's they destroy people's lives. But anyway, um that's uh that what I what I was leading up to is the fact that you guys are here in America and you're doing these uh studies that are valid. You're doing retrospective studies, prospective, double blind, sham uh with cohort groups is what these insurance companies uh gotta see. And they and like I said, endoscopically, most of the studies have been done, very good studies in Korea and uh all over the Orient, uh, Europe, Germany, especially, France, Italy, but for some reason, it's like the American insurance companies that pay for this stuff, and they probably just use it as an excuse. They they say that those tests, those uh studies are not valid. They have to be American studies. To me, it's just an excuse. Sure. Why is it why do we not have American studies? Because nobody gets paid for it here, so who wants to do it? I do it still because number one, it helps the patient. I get paid shit for it, but it helps the patient. Sometimes they pay so little that I have to ask some money from the patient just to throw pay for the disposable instruments. I basically don't make anything. I do it as a courtesy for my patients that need it, that need it. If we're um, you know, if spile simplicity stuff doesn't work uh in enough, which is possible, uh you have to add certain things to it, and which is endoscopic surgery. You know, if a if a person has pain shooting down their leg, uh and we put we do a mild procedure, we take out some indirect visualization, we take out the ligament, and then we put a spacer in it, they're gonna do fantastic. But there is like maybe one, two percent of the patients at the most three percent that might still have pain down the leg. And if they still have pain down the leg, then we do endoscopic, we open it up, and the pain goes away.

SPEAKER_01 42:54

Who's this? This is the beautiful Carmel. She says, Christopher will wake up around 1 p.m. Uh, resting, talk about the patient who had 30 years of MRI reports, and you are the only one that fixed her problem.

SPEAKER_00 43:11

Oh, yeah. There was a uh George uh said you gotta talk about this patient. It was a patient yesterday. Um I can't we didn't do we didn't do any uh was it no, it was Thursday. We didn't do a Miniman Thursday, right?

SPEAKER_03 43:29

She did one.

SPEAKER_00 43:30

Oh, I did one. Yeah. Well, I think this might have been the lady that then that uh we did the yeah, probably was her. She had in her walker, right? You know, those walkers, she had a little compartment, and she had 30 years of MRIs in there. She was I've been to an unbelievable amount of doctors over the 30 years, and nobody, this is what she said to George, and then she said it to me later on she was nobody knew what was wrong. With me until I came to you and you told me what's wrong with me, now I feel good. I got spinal stenosis. You know, I can this is the point that I tried to bring out before. Half of these guys don't even talk about spinal stenosis. Now, if you get a good surgeon, when you have an older lady in their 80s pushing 90, and they got spinal stenosis, uh, if you're an honest good surgeon, uh and they have a few other uh comorbidities, like maybe not a great heart, like you were talking about, but not candidates. They tell them that, you know what, you're not a candidate for this big surgery because of the fact that, you know, you're not it's not safe. Or they say, uh, you got three or four bad levels. I got to operate on every one of those levels, and it might make you worse. But then you get some surgeons that don't give a shit and they'll operate on them anyway. But that's why she said nobody really knew what was wrong with me. They probably did. You know, they're not idiots, you know. And they said, There's not much I could do about it. But we got these procedures that, you know, they're they're asleep for a short period of time. The tech, the technology, the type of medications we use today to put people to sleep, they're very stable. And we don't really use even any any narcotics most of the time with these procedures because it's it's not as painful. And they wake up like they didn't even, you got a night. I had a 92-year-old that woke up like they never even went to sleep. You know, that's how how how great the technology is, even in anesthesia.

SPEAKER_02 45:31

Well, you're bringing up reading the MRIs and all those types of things. That's another uh resource and like you know, effort that the company's putting into this segment. You know, I've had physicians over the years, because you know, we were pioneers in in bringing some of this stuff to the market, you know, in 2020. You know, that was the time when it was actually offered in an outpatient setting, the code itself. Yeah, you know, that was the first year, and then we've it's it's grown tremendously since then. I don't really want to talk about the company's overall growth, but it's been a lot. I mean, you know that. Well, because it's a great product, absolutely. But we even then we have some physicians that talk about in MRI findings and stuff like that. There's the other procedures, you know, basor vertebral nerve, you know, mile, things like that, where they say, okay, I see something on an image that I know I need to treat, and it's static, and then that's their algorithm. Yeah, with these products, it's kind of like, well, give me something to see that I know to treat it on. Without that, I can't do it. And that's where, even with your expertise, we're getting better as a company and developing those algorithms of like if you see these things, if you see facetic fusions, if you see angulation in the discs, like I guess comprehensive, you know, a list of action items you can see that say, like, if your pain patient is experiencing this type of pain and you see these types of things on the findings, that's the level and the type of patient you want to treat. And we're getting a lot better at that to expand the utilization of this because that's been something we've had to overcome as a company. We have an entire clinical team that's focused just on that and doing just that education around the country to newer physicians to expand this modality even more.

SPEAKER_00 47:11

You guys are not only coming out with with brand new uh ways of treating patients with with pain generators that they've had for years, these pain generators, but you're also mastering and perfecting existing uh technologies that are out there. You know, I guess you you must have these engineers, and I'm I'm just talking off the top of my head, I don't know exactly how it works, but you must have these engineers that that take certain procedures and certain instrumentations that are out there that don't really work that well and just make it better.

SPEAKER_01 47:46

Innovate them, yeah.

SPEAKER_00 47:47

Make them innovate them, make them better. You know, you're kind of like the uh you know, like in the wars when a plane crashed. Yeah, they said, we need to first thing you need to do, we need to destroy this airplane. Why do they destroy the airplane so the enemy doesn't get a hold of it and take that technology and make it better?

SPEAKER_02 48:05

Yeah, I mean to your point where you even mentioned a while ago, things come back to me. You know, it's like the weave. Yeah, but things come back to me. You even mentioned, like, you know, only need to do a lemenectomy for sinosis a lot of times. The company is actually actually developing a retractor-based system to allow a single incision approach where surgeons can go in and just do that hemilemanectomy and then you know, fixate and you know, structurally support that segment with a Minuteman all through one small, tiny incision. You know, so they're forward thinking, like you said, to perfect these tools to allow more people to do these things with removing as little of the anatomy as possible to create the maximum outcome that we're looking for.

SPEAKER_00 48:48

Yeah, yes. Well, I mean, I I was considering doing that myself. As far as um, you know, I could do an endoscopic uh decompression of the ligament and then uh followed up with a with a uh Minuteman. You know, that that's something that we talked about that maybe we're gonna start doing in the near future. Uh but uh the problem is, you know, the insurance company wants to pay for it. You know, it's it it you know, theoretically it's gonna work and work great, but technically it should work better. But uh, you know, the more ligament you take out with the least invasive uh with the least invasive ways of doing it, the better it is.

SPEAKER_02 49:28

And that's what this retractor system we're talking about with solves because you know it's a slightly bigger incision than endoscopic, but it's still small, it's still retractor-based, you're not dissecting through a bunch of muscle.

SPEAKER_00 49:38

It's like a micro dyskectomy, but you're taking out the ligament.

SPEAKER_02 49:40

And it allows for a direct visualization code, which is a code that exists and the insurance companies are happy to pay.

SPEAKER_00 49:45

Yeah. So but you know, but it I don't think they're paying that much for uh for hemilamonic anymore. See, that's the problem. You know, uh when they took endoscopic uh code away from us, and then we came up with a new code, and then it went to the RUC committee, which is a relative value committee, to put a new value on it. Of course, there was guess who was on that committee? The surgeons that didn't want us to do it anymore. So they devaluated it. Yeah, but the code was similar to the code for a hemilaminectomy, which is not a laminectomy, and that code was devaluated. I don't know how they kind of shot themselves in the foot. So, so I hate to say this, but I will say it that the the problem here with devaluating the best procedure that an open spine surgeon can do, which is a hemilambinectomy for somebody with spinal stenosis directly related to the ligament, the size of the ligament, is a hemilambinectomy, you take the ligament, the flavum out, they don't get paid for it. So what is I've seen this now, I'm not accusing anybody specifically, but I've seen uh they don't get paid for the hemilaminectomy, but they'll do a complete laminectomy, which is probably less tedious because they cut all these bones out, they just cut these bones right out and then they fuse them. Tell me what the what's the purpose? If there's a surgeon out there uh listening to us, please tell us what the purpose of a fusion after you do a uh laminectomy, because you still have the joints, you still have the facet joints, so that's that's keeps the spine stable. This doesn't create stability to lamina, uh, unless you have a major car accident or something, but but I I'm still trying to figure that out. So they do what I the only conclusion I get is the fact that they get paid good money to do a fusion, so that justifies doing the proper procedure. Uh I know I'm gonna get in trouble for this. My father's probably listening, he's gonna be pissed off.

SPEAKER_01 51:50

I was thinking about that the whole time.

SPEAKER_00 51:52

He says, Don't talk about the surgeons. Well, oh yeah, listen, and I'm gonna keep saying it. There are fantastic surgeons out there. I have nothing against the great surgeons that are doing what they're supposed to do. Please do what you're supposed to do.

SPEAKER_02 52:05

No, but you know, like you know, like with anything else. Hey Felix, with anything else, with like you know, even like an orthopedics, but total, I mean, total joints are moving to the surgery center, outpatient, yeah, right. Which whoever who 20 years ago, 15 years ago, whoever thought you'd see that. As more of these things move to outpatient centers, more surgeons get involved with that, us being able to provide them a way to do the tools they need to do in an efficient, streamlined way where time matters when you're in your own surgery center and efficiency matters, uh, creating these things will create more utilization for sure. And and there's a lot of surgeons that completely understand that and simplify that mode. Chris is awake, yeah.

SPEAKER_01 52:43

Chris is awake. He says, I'm here. Thank you for the treatment yesterday. Uh, and for your new pickup and delivery uh by George, who brought him home. Uh, bravo, 100 stars, first class doctor, not in pain today. Uh, and Chris also says, forever grateful.

SPEAKER_00 53:06

Well, I mean, I listen, I'm glad you're feeling better. Man, you were in bad shape yesterday. But just put it out there to the public, there is no um VIP, there's only a VIP pickup because of the fact that you're very close to George. He went, he volunteered personally to pick you up as a friend. Right. Right. Don't everybody out there thinking that hey, tomorrow I'm gonna get Dr. Jasper pick us up.

SPEAKER_01 53:29

I was wondering about that because we I've heard a mumble in the office.

SPEAKER_00 53:33

You know, but it doesn't mean it's gonna come pick you up.

SPEAKER_01 53:34

Yeah, yeah. You never know. You never know.

SPEAKER_00 53:37

That was nice of George. Thanks, George.

SPEAKER_01 53:39

George is awesome. Oh, we got Chris again. He says, uh, if anyone is listening and is in any kind of pain, back, arm, legs, hands, etc., etc., pick up the phone today and make your call to the Jasper Spine Institute and get out of a hundred percent of your pain. I have been a patient for over six years or more. Get back uh or more. Get uh yeah, get back to your good life. That's it.

SPEAKER_00 54:13

Thanks, Chris. All right, so that's cool. You know, he's feeling better.

SPEAKER_01 54:17

Yeah, I gotta say, our numbers have have maintained that, you know, or only gotten uh higher today. This is you know, people are liking it what what you're saying here, yeah.

SPEAKER_00 54:26

Well, I mean, it's all it's all new stuff, and it's gotta get out there. It's gotta get out there. We gotta we gotta tell people how it is, especially the doctors. Yeah, you know, the doctors are the uh the key, you know, if they know how to do this kind of stuff, they're gonna make their patients better, less invasive uh procedures, um, less side effects, and the recovery is is tremendous, you know. You know, you know, some people have a little bit more pain than others, but most people say I don't have any pain. Like I give the probably the majority of people I give them pain medication after these procedures, they don't even take it. Yeah, but then you get a couple of them that you know have very low pain thresholds and they call back, can I have some more pain medication? Yeah, yeah. It's all subjective. It's all subjective. So that's good. So anything else you guys want to talk about?

SPEAKER_02 55:14

I think that's it. That's what we that's what we got for the future moving forward. We covered it all.

SPEAKER_01 55:18

I think you have very exciting things coming up, and uh that's something we all have to uh think about when we find our pain doctor in the future because we've got spinal simplicity uh on our on our team.

SPEAKER_02 55:32

So yeah, there's only there's only so many of us, and there's only so much time, right? But we're developing more and more awareness day by day. Um, we've got willing and capable physicians in this area, including Dr. Jasper, that are happy to train Proctor, show you how to do things, um, which we're blessed to have. And so it's it's only getting bigger, we're only getting stronger as a company, and we're only getting more and more committed to helping as many patients as we can. So that's good.

SPEAKER_00 56:00

Excellent. Is it we done yet? Oh, yeah. Yeah, we've got we we're a little late starting, so uh we're a little late ending it too. But yeah, I'd like to uh thank you guys for coming. We'll do it again. Yeah, absolutely. Maybe one day we'll have Todd Mosley come in.

SPEAKER_02 56:14

Yeah, absolutely.

SPEAKER_00 56:15

Todd Mosley. Yeah, he's uh he's good. You guys he's got so much knowledge and and and push to to make things better.

SPEAKER_02 56:24

Yeah, maybe we take you to Kansas City and you shoot an episode of our podcast as well.

SPEAKER_00 56:27

Yeah, oh that'd be nice.

SPEAKER_02 56:28

Yeah, absolutely.

SPEAKER_00 56:29

I didn't even know. Who runs a podcast?

SPEAKER_02 56:32

Parker, the marketing head of marketing.

SPEAKER_00 56:34

Nice, absolutely. That'd be fun.

SPEAKER_02 56:37

Yeah.

SPEAKER_00 56:38

All right. So well, listen, thank you everybody for listening and uh and the usual suspects that are listening. Yeah, we got to figure out a way to get more people, but uh it's okay. Uh a lot of people listen, they don't listen to this, but they'll listen to the radio.

SPEAKER_01 56:53

Radio is big, people listen to us every weekend.

SPEAKER_02 56:56

Yeah, it's uh recorded and posted on your Facebook page.

SPEAKER_00 56:59

Yeah, Facebook and YouTube, yeah, Spotify too.

SPEAKER_01 57:04

Yeah, it'll be on Spotify, it'll be on like as a podcast, just a sound only. It'll be a podcast on like Spotify, uh, iTunes, every everywhere you can find uh podcast.

SPEAKER_00 57:15

Yeah, all right. Well, thank you very much. Uh don't forget to call us at 732-262-0700. That's it. And uh, and we'll make an you can make an appointment. Uh if you have if you happen to have a um an MRI laying around in a disc, uh you could just send it in and we'll go over and tell us, we'll let you know if we can help you.

SPEAKER_01 57:36

Yeah.

SPEAKER_00 57:36

All right, have a great weekend. Supposed to be a good one this one. And uh happy Easter. Right.

SPEAKER_01 57:42

Uh for more information about Dr. Gabriel Jasper and all the wonderful things we talk about on our show, please go to www.jaspermde.com. Take care, everybody.