The Prosthetics and Orthotics Podcast
The Prosthetics and Orthotics Podcast is a deep dive into what 3D printing and Additive Manufacturing mean for prosthetics and orthotics. We’re Brent and Joris both passionate about 3D printing and Additive Manufacturing. We’re on a journey together to explore the digitization of prostheses and orthoses together. Join us! Have a question, suggestion or guest for us? Reach out. Or have a listen to the podcast here. The Prosthetic and Orthotic field is experiencing a revolution where manufacturing is being digitized. 3D scanning, CAD software, machine learning, automation software, apps, the internet, new materials and Additive Manufacturing are all impactful in and of themselves. These developments are now, in concert, collectively reshaping orthotics and prosthetics right now. We want to be on the cutting edge of these developments and understand them as they happen. We’ve decided to do a podcast to learn, understand and explore the revolution in prosthetics and orthotics.
The Prosthetics and Orthotics Podcast
Prosthetic Innovation and Entrepreneurship with Mike Astilla
This episode is brought to you by Advanced 3D.
Welcome to season seven of the prosthetics and orthotics podcast. This is where we chat with experts in the field, patients who use these devices, physical therapists and the vendors who make it all happen. Our goal to share stories, tips and insights that ultimately help our patients get the best possible outcomes. Tune in and join the conversation. We are thrilled you are here and hope it is the highlight of your day. Hi everyone.
Speaker 2:My name is Joris Piels and this is another episode of the prosthetics and orthotics podcast, and with me, as always, is Brent Wright. How you doing, brent? Hey, joris, I do it well, ben.
Speaker 1:I'm a little jealous of everybody kind of packing up for the academy meeting that's happening Okay, and I actually think our guest is going to be there as well. So I'll be kind of curious to hear in on some of that stuff. But yeah, I mean, there's a lot of really cool things and you know, friends of the podcast that have been on the show before are going to have some new things that they're showing. So I'm really excited to kind of see, at least from the social media perspective, what happens, because I will not be attending, unfortunately. Oh wow, you're still doing that.
Speaker 2:You can do the baseball thing, yeah, yeah. So yeah, I can't miss, miss the show.
Speaker 1:So, yeah, I can't miss, miss that. Connor is a he's. He's one of the three starting pitchers and he pitches typically at the end of the week, but then he's also a hitter too, so I would miss a few games. And at this point in life there's there's always another show. I think you know there's plenty of those to go to Okay.
Speaker 2:Go, go, go. So, um well, first off, do we have a sponsor for today, Brent.
Speaker 1:Yes, and in fact you may. You may know them, okay, advanced advanced 3D is going to be sponsoring this season, and yeah, I'm really excited about that.
Speaker 1:What's advanced 3D, brent? So advanced 3D. I'm a part of that, along with Paul and Tyler. We are a 3D print, 3d printing contract manufacturing company that specializes in orthotics and prosthetics, but we do a lot more than that and I'm really looking forward to actually seeing where, where this goes. We have some automation coming into play, some web app stuff that's coming down the pike, even some training that you'll find potentially nice is. We're going to have some training about mesh mixer and prosthetics. So just trying to get people into 3D printing, I don't, you know, I would love for advanced 3D to be, you know, the contract and manufacturing partner and all that stuff, but really the overall goal is to help provide information for people to take that step into the digital realm.
Speaker 2:I think it's a cool thing. I was like, if it's right for them, right Because then they've become a good customer or they've become a happy customer. They've become like a customer for many years, right right, yeah, 100%.
Speaker 1:So that's that's the main thing is, and we want to have a relationship with our customers. So obviously at some point in time you've got to talk about price, but that relationship of price and value, I think we provide a good benefit to that.
Speaker 2:Okay, cool. Man, you guys like you know, why is it important that you guys are only OMP or your own P kind of focused?
Speaker 1:So the main thing is is that we're able to take a look and make sure that the solution is not only clinically relevant but then safe for the patient. We've been doing this for a long time now almost six years for definitive prosthetic sockets and you know, as you're learning, you definitely want somebody to kind of check behind you and make sure that everything's good to go, and we will definitely help give you feedback and we also don't compromise, say, orientation, or build densities or that sort of thing to get your part in the machine.
Speaker 1:So, those are the reasons why you want to look for somebody that can specifically make you know your or contract manufacturer 3d print your devices. Is somebody that knows, knows the space.
Speaker 2:Cool Sounds good. So I had a get up Brent and a trans advance. You read and we won't see you. I see who's our guest today, mom.
Speaker 1:Well, I'm really excited to have Mike Astilla on the show today. He co-founded a company that I think you might find very interesting called Lim Guard. Now, one thing that people don't think about when they think about amputations and such is that these, the people that have had an amputation, usually have some sort of, you know, fresh suture. They've just had their amputation, they're in a bed and all those nerves that you have still are telling your brain that you have a foot. So sometimes in the middle of the night people can get up out of their bed and they think they still have a foot and they fall and they could really hurt their leg if they fall straight on their amputation.
Speaker 1:Well, Michael and his co-founder created Lim Guard and it's essentially a helmet for your leg while you're healing, and there's a couple and I'm sure he'll cite some studies and all that stuff that go along with it but it's just a great way to get started on a person's journey. A patient's journey is to go ahead and have that protection, get some of the sensation of having a prosthesis on your leg, and so anyway, yeah, I'd love to hear you know what he's been up to, and he's also a certified clinician. He had a practice, founded a practice, ended up selling his practice and now he's doing this full time. So I'm really excited to kind of hear that perspective and to hear his journey into the field as well.
Speaker 2:All right, sounds really exciting. Welcome to the show.
Speaker 3:Mike Hi Hi, Thanks for having me. It's great to be here. That's a great, great intro rent to the world of limb protection. Can't wait to dive into that.
Speaker 2:So how'd you first get involved in our Thalysion prosthetics?
Speaker 3:I was. I'm originally from New Orleans and my dad had a physical therapy practice down there sort of a one man shop and I thought I wanted to do that. So I went back to New Orleans after college and thought I'd dip into that. And at the time a lot of physician-owned practices were opening up. And I remember one day going to his clinic and he came up to me and he said you know, there's a lot of physician-owned practices popping up here and there. You may want to find something else to dip into. And so that sort of left me thinking, okay, what am I going to do? I sort of like rehab-y type stuff. I've always been a tinker rebuilt cars as a teenager and that sort of thing and I thought, all right, well, I want to stay in this realm.
Speaker 3:And I randomly found a graduate program in Springfield, massachusetts. It's a masters in biomechanics, went up there and was. I was actually a TA in one of the PT programs and there was a few PTs were doing a study on AFOs. And I didn't actually know what an AFO was. I didn't even, I'd never heard of the OMP field. And I said you know, what is that thing? You guys are studying, what are these things. And I remember a couple of PTs said, man, this is awesome, if I was in PT school I'd be doing this, and you know. So I dug in a little bit, learned about the program and, just sort of a knee-jerk type thing, I was like, wow, that sounds cool, let me try to get in. And lo and behold, brian Malis, the director at Northwestern, was kind enough to see some potential enemy and let me into the program and rest his history.
Speaker 2:Okay, that's cool. That's cool. And did you specialize quite early, or did you want to be really broad first, or how did your journey continue?
Speaker 3:Yeah, Well, I really was very partial to orthotics initially but as I was in the field more and more during my residency although it wasn't officially a residency back then I sort of gained an appreciation for prosthetics. And then it wasn't until, frankly, until we started our own practice down in Durham, North Carolina. Kind of fast forwarded there, my wife and I decided to jump down to North Carolina from Chicago and, working in the area, I sort of became more and more interested, working with my partner Laura Riedel, more and more in the prosthetics realm and so, yeah, just sort of grew organically for me and just developed an interest in obviously building that part of the business and the practice for us. But yeah, it's just sort of a progression there, natural evolution for me.
Speaker 2:And if you look at this like did you always want to have your own practice? Like you ended up partnering with someone. How did that? Was it organic? Did it happen randomly oh, this guy, I could work with this guy or was there a big plan?
Speaker 3:No, that's a good question. So Laura and I actually work together randomly. We're both from Louisiana, we both randomly work for the same national company in the Durham area and we're just very like-minded. She had a very strong prosthetics background working down in New Orleans, mine not so much, and we just really compliment each other. And to answer your question, yes, I did. I always knew in the back of my head I would have my own company.
Speaker 3:I didn't know what that looked like, but my dad was an entrepreneur. I knew what that looked like and that lifestyle and that's sort of what I wanted. I knew I'd have a company. I didn't know I'd want to be in a product-based company. So a clinical just made a lot more sense to me. So one day Laura and I were working with this company and realized, boy, we could probably do this on our own Shoot. These referral sources really seem to like us. We seem to be doing a pretty good job. And so, just like that, we partnered up with Mike Neal and Tony Seya, who actually had some clinics in the North Carolina area, and with some support from them, we opened up our Durham practice and, yeah, started very scrappy and just doing the work that sort of crossed our plate for a few years. And then, yeah, just sort of an organic growth between us.
Speaker 2:And having had now like a practice first and now more of a product business, is it very different? Is it? If there's people like you know, it just to me seems like a product business is a lot more. Like you know, it's easier to have a life on the side, I'll tell you Whereas maybe it has its own challenges, right?
Speaker 3:Yeah, very much. So we did not know. We didn't know we were getting into. I mean, we decided to open the clinical practice and it really wasn't until 10 years into running the clinical practice that we realized there was this need we, you know, back up a second and say we were, we weren't the cool kids in town when it came to OMP. We were not part of the prosthetics clinic across the street in our hospital. We couldn't get into the VA hospital because someone lost their application to become a VA contractor. We couldn't get into Duke hospital. So we had to get very creative and sort of scrappy to sort of try to grow our practice.
Speaker 3:And it wasn't until I had gone to I think it was either it might have been a state meeting and was in the exhibit hall and saw a couple of limb protectors and I remember coming back from having this conversation with Laura saying you know, if we're ever going to be able to provide prosthetic care and get referrals that are, you know, folks who are new amputees versus what we were currently getting, are folks who just sort of maybe had grown tired of their current care providers or moved to the area. You know, if we were actually going to grow and have a developing practice, like some of these other folks. Because you go to these meetings, of course everyone talks about how big their prosthetic practice is and all the patients they're taking care of. But if we're ever going to be that, we have to have a different, you know, source for getting these patients. And so I did some research and realized there was one main protector out there currently, and then Laura had worked a lot with the national company that had their own protector and she had quite a bit of experience back in New Orleans with it and we thought, well, all right, so let's do this. We're going to go talk to some of the new physicians who come to town because we weren't getting referrals from the other folks, and let's present this pathway of we can provide this care to protect your patient right after surgery.
Speaker 3:After a couple of in services, we actually got a referral or two from some of the new physicians and then we thought, oh boy, we need to actually have these protectors in stock. And, mind you, we were very scrappy. I mean, we were buying our cast cells on eBay and we were buying our furniture in the clinics at Duke Surplus, and our furniture a lot of our furniture was from IKEA. So keeping an inventory or a big inventory was really not an option for us, and some of the products that were available at the time required a bit of inventory and they were kind of expensive, and Brent can attest to this.
Speaker 3:So then we thought, ok, we can't keep these in stock. We can't afford to keep these in stock, so why don't we come up with our own? After we had taken care of a few patients and made some molds and done a handful of fittings, fast forward we had about 10 to 20 molds in the background and we looked at each other and thought, boy, a lot of these look really similar as a matter of fact, I can't even tell left from right, and they all seem to fall within these size ranges. Why don't we just pre-make some that sort of encompass what we're seeing here? And, ps, why don't we also figure out a way to put our practice logo and branding on it? That way the patients with their discharge we won't lose them.
Speaker 1:So with that, what do you I mean? So that is a pretty innovative way to kind of get into a new practice and I've heard a couple clinicians do it that way. But as far as incidences and that sort of thing and the benefits to not only the patient but then also the caregivers and the surgeons, can you take us down a little bit of that road with some of just the practical, objective numbers? Objectively, we know, okay, hey, we're protecting the limb, but objectively, what are we doing?
Speaker 3:Right, so you're talking about fast forwarding from us making our own to. It was probably about 2018, where we were at a meeting, and I want to say that last time the national meeting was in Atlanta and we'd go to the trade show. We'd go to the national meeting and set up a table and I met a gentleman named Jim Reitman and Jim I call Jim the sensei of limb protectors. He worked for a national company and he was tasked with business development and he realized quite early that the most successful practices within the company were using limb protectors hands down and so he's a very curious guy and decided I'm going to do a deep dive into the research. What's the evidence behind this stuff? And so Jim actually went on to pursue a master's in public health, where he actually did his thesis on limb protectors and amputee support, but it's really his baby. But Jim introduced me to we all heard the expression evidence-based practice how much we're able to successfully use it in a small practice in our decision making. We do our best, obviously. This was one of those areas that, as Jim pointed out and Jim would argue and I believe there's a lot to support this it is probably Lime protectors removal, rigid dressings is probably one of the most thoroughly researched parts of the OMP industry, but it's actually only used about 20% of the time at best, so it's not that well adopted. So that's our first piece of data Patients in removal rigid dressings or limb protectors and this is A lot of this research is level one studies, and I like to say level one studies are equivalent to having the best Amazon review. You've got 100,000 five-star reviews of all verified buyers. That means this is legit. So removal rigid dressing patients began aesthetic use faster by two weeks as compared to patients using elastic wrap and a neomobilizer which, george, I don't know if you're familiar with that, but that's sort of in some areas they consider that care for an amputee at the surgery. Thank you.
Speaker 3:Secondly, amputees of all of the entire population inpatient in the hospital have the highest fall rate. So they have a fall rate of about 20%. Second highest is stroke. So a lot of people don't realize. You know these amputees, as Brent mentioned earlier, because of their sensation, compromise and they feel like they have a limb. They're very prone to falling.
Speaker 3:47% of baloney amputees that suffer a fall and they require a revision surgery. 47% of those that require a revision surgery end up with an above knee amputation. That one and I actually spoke to Jim recently and every time he tells me I'm just floored. And then one of the other bullet points that Jim always hits upon and he used this quite a bit when he was trying to increase the use of limb protectors in the business is return on investment. So when he would talk to surgeons, when you talk to hospitals to get them to adopt these protocols, revision surgeries of a patient who has had a fall from after an amputation so after they're sutured up they're in the hospital, they fall Revision surgeries cost between $25,000 to $30,000.
Speaker 3:In the hospital the physician, they are not reimbursed for that, so that is on them. It's a big no-no. The use it's been shown that the use of a rigid dressing or limb protector revision surgeries and falls are eliminated. So it's a simple step, very small investment. It just makes. It makes sense ethically from a healing standpoint, from a protection standpoint, but it also makes financial sense for the payers in the hospital.
Speaker 2:Okay, this sounds really good. I mean, it sounds really cost effective. And what are these things cost just about? Like what would it be the cost for a patient or what would the protector itself cost? Because the whole thing, I know it's different depending on how you buy and stuff, but just gives it kind of an idea.
Speaker 3:Yeah, I'd say, depending on the region you're in, you're talking about a few hundred bucks for a limb protector.
Speaker 2:Okay, okay, that sounds super cost effective. And then I was wondering another thing it's like, because these guys are so used to falling, protecting the limb sounds a good idea, but are they also used to getting like head wounds and stuff like other stuff, just because you just tumble around much more, because you don't know how to balance yourself and all that kind of stuff?
Speaker 3:Yeah, that's a really good question. I don't know any. I don't have any data on the incense and other injuries associated with falling, but I've got to think that those are up there. I mean, it's funny when I go to meetings and I talk about fall rate because, frankly, inpatient and I don't know if you've experienced this, brent, but I actually haven't seen an amputee fall inpatient when I was in there and I have a lot of clinicians will tell me I've never seen fall. And the thing is we're talking about the 30 or 45 minutes that we're able to encounter somebody in the hospital. It's not a great data point, but the data shows these folks are falling.
Speaker 2:It's a very precarious situation and I'm also interested in knowing a little bit, because I think one thing we're going to rewind a little bit. I don't want to be too annoying, but I'm just wondering you met this one guy who told you who's just evangelizing this kind of like clinician-based database approach? You met these other people that showed you this product? There seems to be a lot of happenstance there, but also there's a lot of networking there. Are you like a natural networker? Are you always all over people talking to people, or do you?
Speaker 2:have to make yourself doing this, or did you get super lucky?
Speaker 3:Yes, both. I am a very I think most people in OMP are just innately curious. I always describe us as sort of tinkerers. You have to like problem-solving things and so, yeah, I've always been the sort of curious person and if someone's got an interesting spin on things and I've bugged Brent in the past about different ideas you want to just sort of tinker. So, yeah, I've always been a very curious person and it's one of the reasons I love going to the meeting.
Speaker 3:I just love engaging with fellow clinicians and talking about their practice and talking about what they're doing, what they're doing differently and brainstorming that sort of thing. So lucky in a sense that, yeah, I do happen across people that I find just been shared my curiosity and want to talk about what they're doing. But then again, also, I just sort of share that just wanting to improve things. A day doesn't go by that I'm not thinking of a different design for an improved limb protector, and when Laura hears this she's going to roll her eyes because I'm texting her images. I'm always in mesh mixer trying to retool things and figure out different ways to protect things and so, yeah, it's sort of a it's luck with running into the right people and two just being innately curious Okay that's good.
Speaker 2:Do you have any advice for people who are maybe not naturally extrovert, because it seems like you're just like if you network, some people say it was a burden, but if you do this with curiosity in mind and just meeting new people, you're really creating chances for yourself, not only business chances, but friendships and stuff. Do you have any kind of advice for somebody who is maybe not a natural network or not as extroverted? How to get them to make these connections?
Speaker 3:Gosh. Well, I'll use this as an example. My son introduced me to LinkedIn a year ago. I'd been on LinkedIn but I really used it. But he introduced me to. He said you know, dad, lengard's really a B2B product.
Speaker 2:You need to be on six or seven.
Speaker 3:I haven't had a dedicated, quite a bit of Lengard to LinkedIn Lengard or Extremity or Ethotics. One of the things I realized is I used to think, okay, well, and then he introduced me to Canva at the same time and I thought, boy, I really need to curate things and I really need to make the message really hit home and just be awesome. And one of the things I learned over time is that showing, you know, being trying to make your posts relatable, you know we as a practice owner we were flawed. I didn't always run reports to make sure we were capturing all the patients we fit. But then after a while and you know I was lucky enough to get, and speaking of luck, meeting Jennifer Robinson, who joined us from the Mean Streets of Florida OMP, which is a, you know, really competitive OMP market came up to Durham and joined us and just really introduced me to a very disciplined approach to care.
Speaker 3:But, talking about that, when I go to meetings I talk to folks and I say, look, I know you don't want to do this, or I know you're nervous about talking to a new referral source. I was there, I didn't, I didn't love that. You know it can be uncomfortable. You're invading their space Half the time. They're not thrilled that you're in their clinic, but so, talking and relating to folks and you know, even you know when I'm face to face with folks, you talk about your insecurities in terms of building your business and it makes it, you know, makes it. It makes it more relaxed for me and I think maybe it comes across as more authentic because it really is.
Speaker 2:And and and also about like because, like the, the OMP market isn't huge, right. So you know the, the, a lot of traditional funding things, like things that you see, or maybe even banks, like they presuppose like a huge market and and was it difficult for you guys to get funding? Or you just had no other option? You were just like self-funded because, like you know, sweat equity, because you had to direct money.
Speaker 3:Yes, sweat equity, and I'll probably to a fault. You know, we, we, you know, to backtrack a little bit in terms of the evolution of Limgard, we, we were making our own for a while and you know we didn't. I remember one day I had this business advisory guy come in and say, you know, just because you can make all these doesn't mean you should. And the light bulb went off with you know, laura and I, we looked at each other and thought, okay, we're here on Saturday making all these things. If we're really going to try to to grow this I think this was before the people use the expression, scaling it but we're going to scale this we need to figure out another way to to have these made.
Speaker 3:And we always had a great relationship with the folks at Friarles or the peak and we took a trip down and met with Becca, rachel and Frank and we said you know, here's our idea. We want to make these. We fit a bunch of these things. They're kind of easy to make and this is what it does and we think it should cost this much. And I remember at one point we were sort of we were sort of mid sentence in our pitch and Rachel looks at us as like yes, we'll do it. Oh wow, someone else likes our idea. Idea, we've got something here. We're not completely crazy, and so that was. That was pivotal, really kind of growing things.
Speaker 2:And that's wonderful, I mean. But what I see, especially in like a hardware business, is that it's very difficult to find a supplier that's perfect for your stage of growth, right. So there's people that are perfect. Making five of these a day are great, right, but if you need 100, then all of a sudden they're going to be like well, flee and equipped to do this, and then the next bigger option, right, they'll you'll be too small for them. So the you know what is loyalty like in that relationship? I mean because you know, at one point these guys aren't going to be the cheapest. At one point you could, you could say you know what? We could go to China, we could do this really differently. Do you really believe in loyalty and long run? Or you're just like look, this makes sense to us. We're all grownups. This is like a business relationship because you know we have a mutual dependence, it's financially attractive for both of us.
Speaker 3:We have zero loyalty. I'm just kidding. We, you know, the relationship we've had with Friddles is it's really just been a handshake. It's been, it's been. We've had great communication. We're we're we're business partners, but we're friends and we have open lines of communication. We text all the time. We're always trying to forecast you know what things are going to look like down the road and anticipate, and that's not to say we haven't had bumps in the road.
Speaker 3:We have a great relationship with the folks at Pace Line that make our limb sock. And you know, I guess the answer to your question is yeah, we, we really, we really value the relationships we have. We value how we do business. We like what we're doing, we like the product. It checks a lot of boxes.
Speaker 3:You know, after I sold my clinical practice I thought, okay, well, I'm semi retired but I'm doing the limb guard thing is sort of a side thing. And about six months ago my wife looked at me and said you realize you've made limb guard a whole ton job. Like you think you work two hours a day, but you work eight hours a day. And it's true. You know, we like the way we do things, we like that our products are made in the states and that we know the folks and we, like the folks we're working with. That's not to say we don't have bumps, as I said. But I think it also makes us better as business people, you know. It makes us more aware of potential problems down the road. We know the limitations of smaller fabrication, so it forces us to be a little bit more aware, maybe do a little bit, be a little bit more diligent with forecasting. I'm still hoping for a chat GPT plugin where I can just upload our spreadsheets and it just tells us what to do and what to expect down the road.
Speaker 1:So I'm really surprised that yours didn't jump all over your use of mesh mixer. Yours loves mesh mixer. This is the one tool.
Speaker 2:Mesh mix is the one tool that's keeping at least the additive manufacturing three and period part of this. This, the LMP industry going is amazing and in one hand I want to shout it from the rooftops to thank everybody the Autodesk and the other hand I don't want them to know about it because maybe I'll forget about this morphine tool, and they're like it doesn't fit into our current like platform strategy and I'll kill it.
Speaker 2:So I love mesh mixer and it's my yeah, my doodle everything for 3D tool. I love it to death, but that does imply that you're doing some 3D printing stuff as well, right?
Speaker 3:Yes, I do quite a bit of prototyping. We are working on a new concept and I'm printing some, some mini versions that I sort of play with and sort of experiment with. I think, brent, I think you introduced me to CME CNC. I had one of their Delta printers at home, so it looked like print taller stuff and you know I can get everything I need to on there and it's it's. It's certainly not what you're working with, brent, but it's. It gets me the the. You know the working versions of it.
Speaker 3:But to your point about mesh mixer I love mesh mixer so much it is. I told my kids when I saw that what I liked about. When my son is a software engineer and I said you know it's antiquated and no CAD folks look down upon the mesh mixer folks, or at least I think they do. But I love the interface. It looks like the. You know the layout and the big buttons. It looks like Fisher Price designed it for me, which is exactly my sophistication level. I actually met a guy at a meeting in San Francisco and there was a guy, a representative from Autodesk, and we got in a conversation. I took him aside. I need you to promise me you guys will never get rid of the mesh mixer. Look me in the eyes because I need this. I've almost gone so far as to have just a dedicated laptop that's not connected to the web, with mesh mixer sitting on it.
Speaker 2:I totally agree. I hope that I love mesh mix. I hope Autodesk never finds out about it and I love that you mentioned you gave a shout out to CBCNC oh, my goodness, I'd almost forgotten the existence. I like they make pretty like really good Delta printers, but that to me was like a lifetime in 3D print land. God, I'm so happy you're using it and you're happy with it.
Speaker 3:Oh yeah, I love you know, it's just a great, you know American company.
Speaker 2:If you need some support, steve, you reply and we actually in our practice we had and then how about, like, if you're, if you're trying to like as I could imagine, though, though a bunch of people here are looking at like inventing stuff with 3D printing If you're going to be doing this in a mesh mixture of desktop 3D printer, like kind of way, and, like you know, you're not well grounded in CAD, maybe, although you did have that biomechanics like study, so I guess you did pick up some here and there, right, but maybe. But what advice would you have for me, like, if I wanted? Like you know, imagine I'm sitting and I'm listening to this show. I'm an orthodist or whatever. I have my dream, you know my dream product in my head. What are some of the tips of making a product come out and making a product work?
Speaker 3:Yeah, Well, the first part of your question. When I was in biomechanics school, we didn't just the internet, we didn't have email. This was the dark ages. I'm old but in terms of you know, I always tell it's funny.
Speaker 3:I was just texting my son this morning because he finished an app and he loves he loves working in apps and developing apps and he's sort of a tinker in the software space and he made this app that had some really cool features and it'll use a little AI and incorporate Spotify property. And Spotify came back after their application, like three months ago. Spotify came back and said you can't do that. And we were texting this morning. I said you know, he said bad news. I said no, it's not bad news. You put in the reps, you know. You put in hours that pushed you down the road and got you close to the 10,000 hours that you need to put in to reach the mastery level of anything. So it wasn't a waste and you made a cool, minimally viable product and it looks cool and you should be proud as heck. So what I'm getting at is do it, you know. Put in the reps, you know we've. I've actually shown Brent a couple of things we've come up with over the years and it's about tinkering and if you don't have a 3D printer, then use plaster or cardboard or plastic and just actually go through the action of making things.
Speaker 3:I always consider that a big test is like how, yeah, I have folks and our friends, you know, I went to school with him coming to me like, ah, I got this idea. And they kind of explain it and I was like, well, show me what you got. Oh, I'm not making anything, we need to get a prototype. And I was like, no, I feel like you really need to to roll up your sleeves and get dirty and figure out the limitations of things. And so what I'm saying is, go through the action of making the product and you learn so much with just making different iterations of things. And then I'm, your head would spin if you saw the little samples and product that I have here in my shop of different things, if it's not not limited to, to OMP. I mean, I made a thing for our coffee grinders the other day and I was like, oh, that's a good idea, let's, let's use this. And then my wife over there I was and said, not another money's printed thing in my kitchen.
Speaker 1:Well, and that's interesting that you say that you know there there is a difference between ideas and execution, for sure. And then I mean, I think really it comes down to and and I'd love for you to speak to this is you know, as people get deeper and deeper into the additive manufacturing side, it really to me becomes a communication tool of what you're wanting. So, as a clinician, if you cannot express what you are trying to do and what the result you want is, it's not that other people can't do it, it's that the clinician actually is not a very good communicator. Would you agree or disagree with that statement?
Speaker 3:Yeah, I completely agree. I think that and I've never heard I've actually not heard that idea of printing and being as being an expression, but I think so often it's thought of as printing is is the thing. You know, it is the idea it is. It's really just sort of the end result of working through all the shortcomings of your idea. You know not not to beat the mesh mixture thing up too much, but I mean, you know, when you have an idea and you actually start modeling something in mesh mixture, you learn a lot. When you see it in three dimension, you know you go, oh wow, I can't do this, this doesn't look like this can physically happen. Or you think, oh, this is amazing. So I think I'm losing track here. But yeah, I agree with you completely. I think it's. It's. It is sort of an indication of how well or how how well thought out something is.
Speaker 2:Yeah, and it's a good idea. And also I want to point out to people who are maybe not software minded or something I know a bunch of people that prototype in Lego, right yeah, or use clay or something like that. But I know a bunch of people have made like full, full devices with electronic stuff, with Lego being the body of it, right. So you know there are other options there if you're not very software minded at all. But and looking back at this, this practice, do you miss the practice at all? You know now you're doing the thing that's a product business. Do you miss the patients? Do you miss the long term relationship?
Speaker 3:I do I miss. I do miss the patient care. You know, towards the tail end of things I was fairly removed from patient care and I had this paradigm shift. I was more, instead of working in the clinic, I was working on the clinic and I actually really did enjoy that. You know, I had we've had the practice for 20 years and at the tail end I did, I just I wanted a different challenge and so I sort of put myself removed myself from clinical care and I do, I do miss that aspect of working on the business.
Speaker 3:I did this. Are you guys familiar with lean manufacturing? So I did this deep dive and I say deep dive it means I watched 20 YouTube videos on these different ways that folks have incorporated lean and so I thought, wow, this is really cool, this is, we can really create some efficiencies if we make strong visual cues about how things are to be done and even just the physicality, where things are supposed to be placed in a practice, because you know it's so much of OMP is just the physical devices. And so I really got kind of geeked out about organizing the clinic space in terms of where things were staged and different aspects of production. Even, even I actually went a little overboard. I'm sure my employees roll their eyes Listen to this, but I got into. Are you guys familiar with Kaizen phone?
Speaker 1:Oh yeah, you cut those things out, didn't you?
Speaker 3:Yes, sir.
Speaker 3:And in every clinic. I, you know, I go in on a Saturday and I trace every tool. And I did the Kaizen phone laid out and it was especially, you know, the tool rack laid out perfectly. And it was, it was beautiful. And initially there was tons of eye rolling and I looked at folks and I said, look, I know, I know I'm a dork, I know I'm always rearranging things, but guess what? You don't have to ask where the Phillips head screwdriver is, you don't have to ask where the hammer is, because it's right here and it goes right back in this little spot and there's little efficiencies. And it's funny because it took, you know, after a while folks I noticed, wow, tools are always back in the same spot. You know, it's easy.
Speaker 3:So just one little example of just trying to create efficiencies and things, and I really do miss that, although I do try to incorporate that into the way Laura and I run LEM Guard. You know we run into challenges all the time and when we meet I think, okay, what do we need to do to never have this problem again? What sort of safeguards do we need to put in place? And so we think about things. In that respect, we try to think about things you know in the LEM perspective. You're always thinking about things from the customer experience and so our customers being other OMP clinics, and so how do we make this experience of using a LEM Guard or purchasing them from us, how do we make it easy, how do we make it make complete sense to have an inventory of LEM Guard and be ready to take care of the patients when we get that call, because the calls always come at 435 o'clock on a Friday afternoon?
Speaker 2:Super cool and also, by the way, the one thing. Maybe you do this already, maybe I haven't realized, but a ton of people are now turning to 3D printing to make pokeyoka type of improvised guides and ways for people to make less errors as well. So in manufacturing companies and they're making trays, for example, like simply the kaizen from they're making labels for things, ways to lock certain things, ways to make certain tools a little less accessible, others more accessible. So 3D printing pokeyoka might be something you would love to get involved with as well.
Speaker 3:Oh, absolutely, I think OMP is, I think someone. If someone was a, I know they have different levels like black belts and things like that if somebody was one of those, I think you could really help the OMP community. In going to practices I mean we've, Brent, you and I have walked into clinics and you know the level of organization varies. And boy, if you could sort of standardize the way things are done, I think someone can just have a field day with our industry.
Speaker 1:It is universally funny just to walk into an O&P place and you see like the rack of you know Allen keys, and every rack has missing the three, four and five millimeter key. They're somewhere. And then they have stacks and stacks of, like you know, eight millimeter keys, six millimeter keys, because they keep on going and buying these kits. That stuff drives me nuts.
Speaker 3:Makes my skin crawl. It makes my skin crawl. Yeah, I was, yeah, I, yeah, it just it's, it's. I think it's a healthy obsession when it comes to to working on a business. If you're a decision maker in a clinic, I think it is, you know, creating efficiencies. I think some of the mindset of lean is it sort of creates a sense of calm, and it's not only just efficiency, it's just like all right, this just got to the place of the better vibe. When it's more organized, I can say, undoubtedly you put out better work, you know things just look cleaner and they just, I don't know, it just creates a more chill vibe.
Speaker 2:So I just want to like one complete unrelated question. I love where we're going here, but I wanted to ask is one thing how do you sell your practice? I mean, I think this is something that a lot of people have occurred to or thought about, this, and maybe but you know, I don't know if there's a workshop or something, but maybe people don't know how it is how do you sell your practice? Do you sell it by not selling it? You know how do you go?
Speaker 3:about that. Yeah, that's a good question and it's the way we decided to go is to engage a broker. We actually, at one point, gave a put in call to folks at Lloyd's Capital and just wanted to just have a Q&A what does this look like? How do you sell a practice? A ton of questions answered that way. The benefit of using a broker they've got they understand what the entities that are buying practices, they understand what they're looking at, and so it can be educational for you. It was.
Speaker 3:It did shape the way we ran our business at one point after we realized, okay, these are the things that they really care about. So, yeah, that was the way we went. They obviously had executed a lot of deals in O&P and so they knew what was appealing to buyers and who are the buyers at the time, and so it was one of the situations where we just sort of put the feelers out and it actually happens very quickly. You know, they always tell folks you know, before you go down this road, make sure you're ready to sell. I mean, I've talked to folks who sold their practice and they miss it dearly. Gosh, this is void now. You know, I've been at it for 20 years and I was ready and so I also cautioned people like before you go down that road and make sure you're ready, because it can happen and then you're not sort of the decision maker in the practice anymore and you have to be okay with that. But broker brokers seem like a great way for us to go.
Speaker 2:And we're the things that they were looking for. The sellers are really interested that maybe you hadn't realized. Like, is it just revenue? Is it how well you manage your finances? What are the stuff that they're really interested? To kind of surprise you.
Speaker 3:You know, what surprised me was how you know, I've always been an IP guy, you know intellectual property I just thought that was like that brought a lot of value and so we had a good bit of that. But no, that really wasn't. It was very black and white. You know, when you're dealing with the MNA team, you know emergency acquisitions, they know numbers, they want to know how much money is going out, how much money is coming in, and it really is sort of that basic.
Speaker 3:There is some nuance in terms of what, how secure the distribution of your revenue is in terms of is it all coming from one referral source? Do you have a, you know, a nice varied pipeline of referral sources from various different referral sources? That's a nice healthy mix and you're not tuned, you don't have all your eggs in one basket that can go away. They really like a healthy amount of prosthetic referrals and you know, it's no secret and obviously I'm a big believer in limb protectors. That was one thing we had heard a couple of times and think, okay, you've got this relationship with all these referral sources and they're calling you to fit the limb protector and so you have this. You know, we've, obviously we retain those patients if you're doing it right, so that creates a very healthy pipeline of referrals for prosthetics.
Speaker 2:Okay, that's cool. And how about patients? I mean some of these people you presumably had for 20 years or 10 years like, how do you do with that transition? Like saying like hey Bob, so yeah, it's going to be somebody else, there's Ron Gief, he's going to take care of you from Tuesday. How do you do that in kind of an organized way for a patient?
Speaker 3:You know, when we, when we, when we decided to sell, we did have a very, a good game plan and, fortunately, a lot of the face. A lot of my team stayed behind, and so I had, as I'd mentioned, removed myself from clinical practice and so me not being part of the equation wasn't so bad. However, I do see one of my old patients at Costco. She works at Costco and I see her every week when I'm back and see what's the talk. But it's so for us it was very methodical and a lot of my teams stayed behind, and so that was a nice organic transition, and I like to think you know I wasn't involved in the clinical practice after the sale, but even after touching base with my phone employees, it seems like it it things transitioned pretty nicely.
Speaker 2:Right. Well, thank you so much, Mike, for being so open-hearted and clear about you know the product, businesses, but also the practice or experience there and limb protection, so thank you so much for being on our podcast today. Oh it's my pleasure. This is fun, cool, and yeah, thanks Brent for being as well, of course.
Speaker 1:Yeah Well, I thought this was great and I think it'll give our listeners really a lot of insight into this idea of not only the limb protection hopefully people will look that up and look you up but then also you know some of the product development and being creative and kind of the product life, right From the idea of iterations to final production and everything in between. So hopefully our listeners will get some encouragement for that as well.
Speaker 3:Hopefully our listeners too. Oh, my goodness, no, no.
Speaker 2:We're going to hide it from them.
Speaker 1:We're going to like, you know, like geo-block it from like San.
Speaker 2:Francisco, so they never find out about it.
Speaker 3:I keep it on the down low. Anyway, yeah.
Speaker 2:Thank you so much to Brent for participating in the episode today.
Speaker 1:Yeah, this has been great. Really looking forward to seeing where this goes with Mike as well.
Speaker 2:Yeah, me too, man. Thank you so much for advancing and for sponsoring us. So if you need some engineering services or some 3D print services, or just curious what that would mean for you, hit them up. All right, look at me.
