Ankeet Choxi, MD - Anesthesiologist and Interventional Pain Management in Miami, Florida

Eva Sheie (00:03):
The purpose of this podcast is simple. We want you to get to know your doctor before meeting them in person because you're making a life-changing decision and time is scarce. The more you can learn about who your doctor is before you meet them, the better that first meeting will be. I'm your host Eva Sheie, and you're listening to Meet the Doctor. Welcome back to Meet the Doctor. My guest today is Dr. Ankeet Choxi and he's a double board certified anesthesiologist and interventional pain management physician. And where are you located, Dr. Choxi?

Dr. Choxi (00:36):
Well, thank you for the introduction. I'm in South Florida in Miami.

Eva Sheie (00:39):
That is an amazing place to be. How did you end up there?

Dr. Choxi (00:43):
I came down here for my training in residency in anesthesiology. I trained at Jackson and I had never really spent much time in Miami and after four years in training here, fell in love with it and decided to make it home.

Eva Sheie (00:55):
Did you sort of always know that you were going to head towards pain management or anesthesia or is that something that you fell into?

Dr. Choxi (01:03):
In my anesthesia training, I certainly, I loved being in the operating room. I loved the interaction with surgeons. It's just the sort of schedule and call schedule really dissuaded me and I realized I did like doing more with my hands, being more proceduralist, and so that led me to discover more about pain management. And I had a really great mentor during my residency who really mentored and guided me and taught me a lot about pain management and kind of fell in love with that field and since, and then decided to do a pain management fellowship, which no regrets about that looking back.

Eva Sheie (01:34):
And where was that?

Dr. Choxi (01:35):
I did my pain management fellowship in New York at NYU Langone Health.

Eva Sheie (01:39):
That's a pretty busy place to be.

Dr. Choxi (01:42):
It is both New York City and NYU. Yeah, it's busy as good though in fellowship you want to try and see and do as much as you can and obviously got to enjoy New York City and living there was great and learned a lot from a lot of great mentors and faculty at NYU.

Eva Sheie (01:58):
What kind of patients are you seeing during that pain management fellowship?

Dr. Choxi (02:02):
Everything. We see a lot of acute pain people just with herniated discs, arthritis, joint pain, acute and chronic, excuse me, we see a lot of cancer patients as well, cancer related pain symptoms. And then another big component of at least the NYU fellowship was also inpatient hospital pain care. So a lot of post-surgical patients, patients with, there's been various ailments that've been in the hospital for a very long time trying to manage their pain symptoms. So it was pretty robust fellowship, saw pretty much everything you could on the pain management spectrum from outpatient acute and chronic pain to inpatient pain to cancer related pain.

Eva Sheie (02:39):
What's happening in terms of the treatment of pain? You'd have to be kind of under a rock to not have known how controversial pain management has gotten in the last 10 or 15 years. Are there people working on making changes in pain management that are less controversial

Dr. Choxi (03:02):
With opioid management? Yeah, I mean obviously I think opioids certainly play an important role in pain management and they are obviously a powerful drug, but obviously come with a host of negative side effects as well. And the risk of obviously addiction with opioids, I think there's a lot more regulation in place and trying to control who is getting opioids, make sure there's appropriate patients that should be getting it, and just more testing and office visits to make sure it's not being abused, to make sure it's being used properly and the doses are appropriate. My practice itself, I don't do much medical management. I've shifted away from medical management. I do a lot more interventional management, so a lot of injections for spine and joint and with that really doing a lot more regenerative medicine now. So on the lines of things like PRP, stem cells, exosomes not only to reduce pain and inflammation, but to help these patients promote the growth of new healthy tissue and really addressing root causes of pain rather than just trying to mask pain symptoms.

Eva Sheie (04:03):
Is that something you're studying formally?

Dr. Choxi (04:06):
I mean every day I'm learning more and more. I wouldn't say formally in terms of doing a fellowship or anything like that in that, but every day there's just new technologies, new drugs being available and new systems. And yes, I mean just learning as much as I can and really just trying to educate myself so I'm able to educate patients and treat them with what I consider to be really cutting edge next level technology in medicine.

Eva Sheie (04:28):
We've had PRP in aesthetics for a while, which is my background, but when did PRP start being used for things like pain management?

Dr. Choxi (04:38):
Honestly, it's been in practice for decades. I think it's gotten a lot more recognition and use recently, probably in the past five years. And a lot of that's just, I guess awareness of both physicians and patients that this is a great modality to treat acute and chronic pain symptoms with PRP also comes the higher level products of stem cells, exosomes, but PRP is pretty widely accepted now, like you mentioned in aesthetics and now also in orthopedic injury.

Eva Sheie (05:02):
What other kinds of things have you found helping maybe in conjunction with PRP or

Dr. Choxi (05:08):
Yeah, I mean I love multimodality approach to pain management. So all my patients, certainly we use PRP or any other orthobiologics to help really get in there and start the healing cascade and healing process. But I always love to combine that with good physical therapy for my patients. Shockwave is a great adjunct therapy as well, just to improve blood flow, to improve some vascularity to the area to help loosen up tight tissues. We live in an age of now biohacking, longevity, anti-aging where everyone's using different things and I always tell patients, any other modality you use is always a plus. You're more than likely not going to harm the PRP we did. So things like hyperbaric chamber, red light therapy, augmenting with potential peptides, different pharmaceuticals, it's always a positive.

Eva Sheie (05:59):
Are these all things that you have right there in your practice available to you?

Dr. Choxi (06:04):
We don't have hyperbaric and necessarily red light therapy, but we have strong relationships here in South Florida with partner clinics that offer these services and happy to refer our patients to there to ensure they're getting the right people to do the right thing.

Eva Sheie (06:20):
Let's do a few little definitions here. I realize we've been saying PRP without actually defining it. So let's start there. What is PRP?

Dr. Choxi (06:28):
Yeah, that's very smart. PRP, platelet rich plasma. The blood has three components to it, red blood, white blood, red blood cells, white blood cells, and plasma. And what we do is we draw a patient's blood, we spin it down in a centrifuge to separate really the red and white blood cell layers from the plasma. And in that centrifugation process, the plasma ends up containing a lot of the platelets, hence platelet rich plasma. And it's really these platelets that are thought to be the growth factors, the healing properties of the body, which contain a lot of growth factors, nutrients, anti-inflammatory mediators, which help expedite and sort of boost the healing cascade. So you think when you scrape your knee or you have a paper cut, the bleeding stops pretty rapidly and it's platelets that come get called to action comes to that area to help with the repair and healing. Our thought process is to be able to concentrate those platelets that naturally in the body and give them back to areas of injury can really help to heal injury, change, pathology, and help possibly regenerate damaged tissue.

Eva Sheie (07:30):
Both of my kids who whenever they get injured, it seems like they're fine in a day, they heal so fast. Why do kids heal so much faster than the rest of us?

Dr. Choxi (07:39):
Yeah, kids are constantly growing and there's such a high cell turnover in children and younger people. And as we get older, our body undergoes specifically to stem cells, what's called stem cell fatigue, that our stem cells are not necessarily as robust or powerful as they used to be. And obviously stem cells, the building blocks of the body, when we look at in bone marrow where a lot of our blood cells come from, they all generate from hematopoietic stem cell line. So as we get older, those stem cells also get older and our platelets, our healing factors, everything just kind of tuned down and they're not as powerful as they should be. And so the kids definitely have a much more powerful one immune system, regenerative system, and they heal much quickly. Yeah, kids absolutely bounce back much faster.

Eva Sheie (08:23):
So when we're doing things like stem cell therapy in adults, are we trying to make that healing process go faster the same way that it happens when we're kids?

Dr. Choxi (08:32):
I guess with the stem cells in adults is really about where we are getting stem cells from and what we're using. We can certainly use a patient's own stem cells from their own body, but as patients gets older, sometimes we sort of shy away from using those products just because as I mentioned, there is stem cell fatigue. There is sort of a decline in how efficacious those stem cells are, but can certainly be used and certainly get good benefit. But a lot of times when you look at these international stem cell clinics that are offering stem cell therapy places in Columbia, Mexico, Bahamas, and those facilities are really using stem cells that are coming from umbilical cord tissue or placental tissue from newborn babies. And so those are extremely powerful, extremely potent stem cells. And when we think about age, those are probably the youngest patients that we can procure stem cells from, which in turn tend to be the strongest, most potent stem cells.

Eva Sheie (09:28):
Is anybody creating them any other way?

Dr. Choxi (09:30):
I mean, no. I mean most stem cells that we use from donor stem cells are coming from, so there's donor and so I guess autologous and allogeneic stem cells, so autologous meaning from your own body, so if we take stem cells from your own body, we're taking 'em from fat tissue or bone marrow, so we do a bone marrow harvest or adipose harvest and then process that tissue sort of same day and inject that back to trouble areas. But then the allogeneic stem cells which are donor, we are able to procure those from lab or travel internationally to these clinics that have stem cells available and those are taken from placental or umbilical cord tissues at birth. Those tissues are then taken to lab where stem cells are isolated, extracted, grown in lab. They go through a certain number of passages to ensure viability of the cells, and then obviously through rigorous testing, those are able to be used for clinical use in patients.

Eva Sheie (10:23):
What is shockwave?

Dr. Choxi (10:24):
The shockwave is it's used, it's like an ultrasound or uses sound waves to penetrate skin tissue and in turn thought processes that helps to break up tight tissue in the body and improve blood flow in the area.

Eva Sheie (10:37):
The third one that you threw my way was the hyperbaric oxygen or chamber.

Dr. Choxi (10:42):
Yeah, hyperbaric oxygen. It's been used for decades as well. We use it mainly for scuba diving, de-pressureation, sort of sickness, high altitude sickness, and it's pretty much just forcing oxygen at high pressures into the body and in turn the thought process is we're able to push oxygen into the body, we can increase the metabolism in the body, increase healing and push out free radicals and other sort of inflammatory products, which just helps to augment the healing process.

Eva Sheie (11:14):
This is often what elite athletes use during recovery, like marathon runners and

Dr. Choxi (11:19):
Yeah, they, they've started to use a lot more hyperbaric oxygen in the recovery processes, especially those that train at high altitude and they're not getting enough oxygen delivered to their muscles. I think athletes commonly, especially Olympic athletes, when they're in training phases, they choose to train in places like Colorado or other high altitude places just to maximize their body's training capabilities, but in conjunction with that, they do use a lot of hyperbaric oxygen in the recovery process.

Eva Sheie (11:46):
And it has applications for ordinary people too, beyond the elite athletes.

Dr. Choxi (11:52):
No, of course, of course. I, it's just an adjunct to recovery, so as much as a patient can and is willing to do in the recovery process, it's all beneficial.

Eva Sheie (12:01):
Can you give us some scenarios around what kinds of patients are coming to see you and how are you treating them that incorporate these things so that I can visualize what's happening in real life?

Dr. Choxi (12:13):
Yeah, that's a great question. I mean, I see patients from all different demographics, whether that's young, 20-year-old people who just had an injury in the gym or were out skiing and sprained a knee to older patients 50 sixties with chronic arthritis or degenerative back disease, back pain. They're all sort of coming for different modalities of treatment and I think a big thing I'm starting to hear more and more of is a lot of people are trying to shy away from obviously steroids for injection and pain. I think for a long time you mentioned athletes, even athletes, they, cortisone injections is just a buzzword that we hear all the time. You're in pain, just get a quick cortisone injection, you'll feel better. But of course, that's not good for long-term. Steroids, repeated use can definitely damage cartilage damage tissues, and there's obviously systemic side effects of steroids, and so I think people are just getting more educated now that there's more literature, more education through social media and different platforms, that there is other options out there that are a little bit more natural. And so we see a wide breadth of patients from all different demographics, all sorts of injuries that are coming in for treatments like PRP or stem cells that reduce their pain inflammation, but really we're targeting root cause issues. A lot of the injections I do are all very much image guided, so I'm using ultrasound or fluoroscopy to directly visualize body parts, anatomy and putting our needle exactly where we know there's injury based on ultrasound or MRI.

Eva Sheie (13:41):
What kind of results are you seeing?

Dr. Choxi (13:42):
Some of the results I've seen, I just haven't been able to believe myself, to be honest with you. There's been some great, great results. I mean, every patient's different and we want a hundred percent pain relief, but I would say vast majority of our patients are seeing significant improvements, at least getting back to normal form and function, improving quality of life. We've seen injuries heal completely on repeat MRIs six months a year later where I'm calling the radiologist myself and what do you mean you don't see that labral tear on the shoulder and radiologists saying that they really can't see a tear? It's scarred over, it's calcified. There's no tear there anymore, and thought process, a lot of that is from these injection therapies that we're doing. In terms of research, it's starting to pick up a little bit in terms of bigger academic institutions and even private companies doing bigger research studies to validate some of these treatments and get more data. We don't really have a lot of longitudinal or long-term data on these therapies. It's more so anecdotal, so it's hard for me to quantify or give you numbers.

Eva Sheie (14:39):
I feel like, tell me if I'm wrong, a practice like yours maybe wouldn't have been possible even 10 years ago, and I wonder if this is driven largely by patient demand and just people just being unwilling to just say, give me medicine for whatever's wrong with me.

Dr. Choxi (14:56):
I agree. I think in the past five years that there's just been much more health and wellness focused education out there and patients kind of wanting to take, I don't want to say take back control of their own lives, but taking more ownership in their own medical care. I think in the past, especially say 15, 20 years ago, you went to the doctor, the doctor gave you medicine, you took it, you didn't really push back. I think now more patients are getting a little bit more educated, understand there are alternative therapies that maybe it's some of the traditional medicines still works, it's still an option, but want to explore other routes before they go to things like surgery or steroids or more invasive procedures.

Eva Sheie (15:37):
The root cause thing comes up over and over and over now and people just don't want to not understand why something is happening before they go ahead and just blindly, blindly move forward with whatever. I just think we're in a much better place.

Dr. Choxi (15:51):
Yeah, patients are getting smarter, smarter, and smarter as they should be, and wanting to be more educated and not just taking everything at face value, which I think is great. I think the patient comes first in all these treatments and they should be as educated and make as many informed decisions as they can.

Eva Sheie (16:09):
We certainly couldn't do that without doctors who are also doing that. Are you like that yourself?

Dr. Choxi (16:15):
Yeah, absolutely. I mean, in terms of my own healthcare, yeah, of course. I mean, obviously I come from, my background is in medicine, so it's easy for me to make decisions, but I love being able to educate a patient. I love hearing the questions a patient has because it forces me to think of things I've never thought of before in terms of speaking with a patient and doing things and really just sparks ideas of what could be next out there that these patients have questions about.

Eva Sheie (16:40):
Is there anything you're excited about right now?

Dr. Choxi (16:42):
Well, I mentioned these international stem cell clinics that are doing the more high level stem cell treatment. Florida, the state of Florida just passed a bill with the Senate and the house to legalize the use of stem cells in the state of Florida. So a lot of those stem cells that we see internationally in Columbia, Mexico, Bahamas will now hopefully be readily available for use in Florida. Of course, these are still not FDA approved treatments. The state of Florida is saying they're going to sidestep the FDA and authorize the use under certain conditions for these stem cells, which is exciting, but also terrifying. Yeah, well, interestingly, it's already approved in Utah. Similar bill passed in Utah about a year and a half ago, and then recently, more recently in Nevada, so a couple of states are starting to understand that this is real treatment that's being used internationally, that the red tape and bureaucracy of maybe FDA big pharma is getting in the way of patients getting treatment they want, but at the same time, I think we have to be cautious in how these cells are used and who's able to use them because anytime new stuff comes in, unfortunately, there's just a lot of bad players that come into the market as well and try to take advantage of patients.

Eva Sheie (17:55):
All the time. How do people find you?

Dr. Choxi (17:57):
Hopefully through this podcast?

Eva Sheie (18:00):
I hope so too.

Dr. Choxi (18:01):
We have a strong network here in South Florida, Miami. We have a lot of strong referral sources, word of mouth referrals. We do some advertising online as well, and I think that's a good question. I think more and more people are searching on Google, on chat, GPT, other AI platforms for stem cells, for PRP, for these sort of buzzwords in keywords that we notice increased searches for this in just our analytics and traffic searches, and so it's exciting. It's becoming more of a mainstream therapy or more commonly accepted therapy. Surprisingly though, we have people flying in from all over the world, honestly, to treat with us. We have patients coming from a patient flying in from Dubai soon, patients from Canada, El Salvador, and then within the US as well. We've had patients flying from California, New York for treatment with us.

Eva Sheie (18:52):
Who's on your team?

Dr. Choxi (18:53):
We have a full back office with administrative staff, obviously, office manager, medical assistants. We have sort of a patient liaison that really helps us, the intermediary between me and the patients in certain cases, especially as we're working them up to help with coordinating diagnostic tests, appointment scheduling, booking follow-ups, and then I also have a medical partner, Dr. Jared Mait. He handles a lot more of the medical management as well, integrative medicine, functional medicine, hormone replacement, peptide therapy, and so he's an integral part of the practice obviously as well.

Eva Sheie (19:25):
What do you like to do when you're not at work?

Dr. Choxi (19:27):
Oh, man. I feel like I'm always working, but no, just

Eva Sheie (19:30):
Think about work when you're not at work.

Dr. Choxi (19:31):
No, I mean, I recently got married. I got married a few months ago, and so just enjoy spending time with my wife. We're actually going on vacation tomorrow to Mexico, so looking forward to some time away. Love to work out and train. I've started boxing in the past couple of years and find that to be just great exercise. I'm not sparring or anything, but so the coach just hitting mitts and heavy bags, and then I've really taken up golf and sailing have been two hobbies I'd say in the past two years that I'm trying to get better at. Golf, very difficult sport, very frustrating sport, but focuses me to kind of slow down in life and put everything aside and just pay attention to what I'm doing, and then sailing is just in South Florida, just an incredible recreational activity. I just love being on the water. It's peaceful and just the sort of technicality and engineering of sailing really I find beautiful.

Eva Sheie (20:20):
Where can we find out more about you online or potentially reach out and schedule an appointment with you?

Dr. Choxi (20:25):
Yeah, I mean, our regenerative medicine practice is called Stems Health, S-T-E-M-S Health. I mean, hopefully with a quick Google search or SEO team is working. We come up pretty quickly. The websites stems-health.com and similarly, our Instagram page. We have free virtual telemedicine consultations with our patient liaison, so just jump on board, get free consultation about what we do, how we can help, whether you're the right candidate to see us or not. The last thing we want to do is waste a patient's time or money, so at least they get those initial conversations and make sure it's the right fit for them. Big component is unfortunately, this is a self-pay practice. Insurance doesn't reimburse for these things, and so like I said, we like to make sure that we prescreen patients and make sure they are appropriate before we kind of start them down the journey of potential treatments and injections.

Eva Sheie (21:14):
Makes sense. It's a great way to do things. Thank you so much for letting us get to know you today. I've really enjoyed talking to you.

Dr. Choxi (21:21):
Absolutely. Yeah, this was a great time. I appreciate your time as well.

Eva Sheie (21:24):
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