I’ve had a lot of doctors on this podcast. Dr. Fawad Mian is the first one who spent most of our conversation talking about being a patient.

He’s board-certified in neurology and regenerative medicine. He treats pain and complex neurological cases for a living. And for over a decade, he was also on the other side of the table — torn ligaments, wrecked joints, and doctor after doctor telling him the same thing before they’d even finished looking at his chart: we can probably get a surgery out of you.

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“Maybe We Can Get a Surgery Out of You”

It started in medical school with a torn ACL on the basketball court. Surgery. Recovery that never felt complete.

Then, years into practice, a weight slipped in the gym and tore up his shoulder. He went to an orthopedic doctor, and before any real workup was done, the doctor told him: “Maybe we can get a surgery out of you.” Not “let’s find out what’s wrong.” Not even “let’s rule some things out first.” Surgery was the starting point, not the last resort.

Then it was his foot. Plantar fasciitis, from years of walking in dress shoes during his training in New York City. Steroid injections. Then his Achilles, irritated as a direct result of those same injections. Then his knee — the same one from his ACL tear, now over a decade later — where an MRI revealed the original repair had never actually held. It had been torn the whole time.

By the time we got to this part of the story, I had to sit with it for a second. Doctor after doctor, and the answer was always some version of cut it, chop it, or scrape it out. Dr. Mian said it plainly: “That is the mantra of how medicine is now.”

The Steroids Caused Real Injury

Here’s the part of this conversation that I think more people need to hear.

Dr. Mian told me flatly: “What people don’t know is that steroids are actually toxic. They’re toxic. So if you put it around ligaments, tendon, and joints, they eat them up. They destroy it.”

He wasn’t speaking in the abstract. He had ultrasound images of his own shoulder, taken before and after a round of steroid injections. His description of what he saw has stuck with me since we recorded: “It looked like a dog chewed on it.”

Steroids can bring real, fast relief — which is exactly why they’re used so often, and why almost nobody questions them. But relief isn’t the same thing as healing. In Dr. Mian’s case, and in the many patients he now treats who’ve been through the same cycle, the steroids that were supposed to buy him time ended up costing him tissue he later had to spend years trying to rebuild with his own regenerative treatments.

Battlefield Medicine

Tenay and I are both veterans, and partway through this conversation I found myself describing conventional medicine the way we’d describe a combat medic on the field. When the bullets are flying, you don’t have time to ask someone about their diet or their sleep. You stop the bleeding. You get them stable. You get them out.

That’s necessary. It’s also supposed to be only one part of the larger healing process, not the whole thing. Dr. Mian’s experience — and the experience of so many patients who come to him after the surgeons have already thrown their hands up — is a system that’s stuck in battlefield mode long after the emergency has passed. Stop the bleeding, and then just… stop. No one’s asking what got the person onto the battlefield in the first place, or what it will actually take to get them all the way home.

The Tipping Point

Something Dr. Mian said reminded me of language I hadn’t used since my undergrad days studying urban planning and sustainability: the idea of an ecological tipping point. Push a system hard enough, in one direction, for long enough, and there’s a threshold you cross where you can’t just remove the pressure and expect things to snap back. A new, worse equilibrium takes hold, and getting back to the old one takes real, sustained work.

That’s what chronic pain, bad sleep, and inflammation do to a body. Dr. Mian described it as a spiral — pain disrupts sleep, poor sleep prevents the body from repairing itself and clearing inflammation, and that unrepaired inflammation makes the pain worse, which disrupts sleep further. Left alone long enough, you’re not dealing with the original injury anymore. You’re dealing with a new, more complicated version of your body that has to be very deliberately walked back.

His advice for people already in that spiral wasn’t a quick fix — because there isn’t one. It was closer to a mindset: you have to actually believe you can get better, and you have to be willing to do the slower work of undoing years of compensation and damage. As he put it, it’s less like taking a pill and more like solving a Rubik’s cube.

What Regenerative Medicine Actually Is

For those unfamiliar with the term, regenerative medicine is built around a simple idea: instead of masking pain or removing damaged tissue, you use the body’s own healing mechanisms to repair it. PRP (platelet-rich plasma) concentrates your own blood’s healing factors and reinjects them into damaged tissue. Prolotherapy and stem cell treatments work on similar principles — preserve the structure you have, and give your body what it needs to actually heal it.

It’s the opposite instinct from “let’s chop this out.” And it’s why Dr. Mian describes his own approach as preservation-first — treating the joint, tendon, or ligament you already have as something worth saving, rather than something to be removed and replaced.

What This Means for You

If you’re reading this because you’re somewhere in that spiral yourself — pain that won’t resolve, sleep that won’t come easy, a specialist who’s already told you surgery is the only option left — Dr. Mian’s story isn’t a guarantee that regenerative medicine is right for you. But it is permission to ask more questions before you agree to anything irreversible.

Ask what the alternatives are. Ask what a steroid injection is actually doing to the tissue around it. Ask if surgery is genuinely necessary, or if it’s just the option your insurance makes easiest to reach. You are allowed to want to understand your own body before someone cuts it open.

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If this conversation resonated with you, please subscribe to The Care We Need, leave a like, and share this episode with someone you know who’s stuck in their own pain spiral. The more people who know these alternatives exist, the faster we build the care we actually need.

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Resources mentioned in this episode:

• Getting to Pain Free: How to Stop Hurting So You Can Start Living Without Drugs or Surgery, by Dr. Fawad Mian — available on Amazon
• Reclaim Your Mind course quiz — course.prolohealing.com/quiz

Watch the full episode here: