23 | Inside the Mind of an Orthopedic Surgeon w/ Dr. Scott Whitlow

As I am sure most of you are aware this podcast’s creation stemmed from Max and I’s traumatic climbing injuries that occurred just over a year ago. Within a week of each other and in different countries Max and I both took trad falls and sustained ankle injuries that required surgery.  If you haven’t heard those stories cruise back to episodes 2&3. As a patient of surgery, I was curious as to what the procedure was like. What was going through the surgeon's head? What was actually happening while I was under with a tourniquet wrapped around my leg?  In today’s episode, we get answers to those questions as we have the rare privilege of sitting down with Dr. Scott Whitlow THE orthopedic surgeon that performed my bilateral ankle surgery. Scott received his medical degree from the Boston University School of Medicine and completed his residency at UC Davis. He then went on to receive specialty training in foot and ankle surgery in Vail, CO. Over the years he has performed countless surgeries and is considered an expert in his field. In our conversation, we dive into the surgeon's perspective of handling a patient with lower extremity injuries, the future of joint replacements, post-procedure options like scoping and hardware removal, and we get to hear Scott's story about how HE became the patient for a serious of unfortunate orthopedic surgeries… that nearly claimed his life.

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Contact us:
IG: @the.climbing.majority
Email: theclimbingmajoritypodcast@gmail.com

References

The Best Forearm Crutches
https://www.sidestix.com/

Pick Line Covers
https://mighty-well.com/

Transcript

00:00:00:14 - 00:00:23:22
Speaker 1
Hey, everyone. Kyle here. Welcome back to the Climbing Majority podcast where Max and I sit down with living legends, professional athletes, certified guides and recreational climbers alike to discuss the topics, lessons, stories and experiences found in the life of a climber. If you haven't already, please subscribe, rate and review us wherever you get your podcasts.

00:00:27:06 - 00:00:43:22
Speaker 1
Hey, everyone. Kyle here. Just a quick message before we get started. So I'm not sure if you've noticed, but we've had a couple sound issues with the last couple of episodes and I just wanted to come out and apologize for that. We strive to have super pristine sound quality for ourselves and our guests, and we kind of dropped the ball.

00:00:44:05 - 00:01:05:12
Speaker 1
So moving forward, we will be sending mikes to our guests that need them in order to eliminate this problem. That being said, this is going to be one of those episodes that have a bit of background noise and some extra clicks and pops that were on removable and added in. So I do apologize for that. That being said, this is the last episode where things like this are going to happen.

00:01:05:13 - 00:01:11:17
Speaker 1
So thanks for understanding. We are a work in progress and this episode is still rockin. So enjoy.

00:01:12:15 - 00:01:14:18
Speaker 2
The.

00:01:15:15 - 00:01:40:16
Speaker 1
All right, let's dove in to today's episode. As I'm sure most of you are aware, this Podcast's creation stemmed from Max Knight's traumatic climbing injuries that occurred just over a year ago, within a week of each other and in different countries. Max and I both took Triad Falls and sustained ankle injuries that required surgery. If you haven't heard these stories, cruise back to episodes two and three where you can get a deep dove into our experiences as a patient of surgery.

00:01:40:16 - 00:02:01:12
Speaker 1
I was curious as to what the procedure was like, what was going on in the surgeon's head, what was actually happening while I was under the knife with a tourniquet wrapped around my leg. In today's episode, we get answers to those questions as we have the rare privilege of sitting down with Dr. Scott Whitlow, the orthopedic surgeon that performed my bilateral ankle surgery.

00:02:02:22 - 00:02:32:18
Speaker 1
Scott received his medical degree from the Boston University School of Medicine and completed his residency at UC Davis. He then went on to receive specialty training in foot and ankle surgery in Vail, Colorado. Over the years, he has performed countless surgeries and is considered an expert in his field. In our conversation, we dove into the surgeon's perspective of handling a patient with lower extremity injuries, the future of joint replacements, post procedure options like scoping and hardware removal.

00:02:33:07 - 00:03:00:18
Speaker 1
And we get to hear Scott's story about how he became the patient for a series of unfortunate orthopedic surgeries that nearly claimed his life and. All right, we are live and recording. Scott Mr.. Dr.. WHITLOW Yeah. Doctor, welcome to the show.

00:03:01:09 - 00:03:02:14
Speaker 2
Those are you guys.

00:03:02:14 - 00:03:04:04
Speaker 1
Good, man. Really good.

00:03:04:04 - 00:03:05:20
Speaker 2
Great to be back with you guys.

00:03:06:07 - 00:03:24:10
Speaker 1
Yeah. Tell you he had recommended me to a P.T. and I was. I was about to tell him. It's funny, because, you know, my ankle is pretty jacked up to begin with. Right. And so he recommends this. P.T., I make a schedule, an appointment, and then I go stand up paddleboarding down the Truckee River like a day before this session.

00:03:24:18 - 00:03:41:18
Speaker 1
And we we decided to go down this area that had rapids that we didn't know about. So I spent like 5 hours going down rapids and just massacring my feet in these rocks and stuff. And so I show up to my session the next day and he's like, What the fuck did you do to yourself? Like, Is this all from the accident?

00:03:41:18 - 00:03:57:05
Speaker 1
And I'm like, No, man, the accident was like a year ago, this is yesterday. And I was like, Please take, take my mobility and take my swelling with a grain of salt because I'm like pretty messed up right now. So he probably thought I was way, way worse off than I actually am. But he gave me some great insight and some stuff that I'm doing every day.

00:03:57:05 - 00:03:58:00
Speaker 1
So thanks for that.

00:03:58:18 - 00:04:19:21
Speaker 2
Yeah, yeah, absolutely. I've been going there, too. I haven't been there about two weeks. I've been out of town, but that's what I've been going to the awesome dudes, guys and girls over there. Good group. So I'm glad we got you over there. I like seeing the people, the good these people put their hands on you. You just see what we can get out of you, right?

00:04:19:22 - 00:04:28:07
Speaker 2
You can get out of the service. You can get out of an injury. See if maybe we can treat you without surgery. Not you. But you know.

00:04:28:07 - 00:04:33:22
Speaker 1
Yeah. Kyle, you really just shouldn't have gotten surgery, man.

00:04:33:22 - 00:04:41:23
Speaker 2
It's my friend. I'm sorry about that, but my usual, my usual, like, didn't clinic, did spend a lot of time trying to treat people without it.

00:04:41:23 - 00:04:48:18
Speaker 1
That's awesome. Yeah. Yeah. I remember you had said there is some sort of like residency week or something going on it rock is is that is that happening now?

00:04:50:06 - 00:05:25:06
Speaker 2
Well, we have fellowship program where we teach orthopedic surgeons at the end of their residency to be foot and ankle surgeons. It's been an extra year doing a fellowship and it starts on first day of August and ends on the last day of July. And every last weekend in July we have a big, uh, just a get together symposia here is what we call it when we get old fellows together, the two that are coming in for next year, the two they're graduating from last year, there are five faculty between between the guys at Marine Orthopedic and then two guys over at UC Davis.

00:05:25:06 - 00:05:46:21
Speaker 2
We all we all teach these these guys and girls for a year. And so they graduate in the end of July. And we all get together and we hang out, we get talks, talk about cases, all sorts of stuff. So those are those are weekend, last weekend. And then after that, my family and I went up to Lake Elsinore.

00:05:46:21 - 00:05:53:11
Speaker 2
It's my my wife and my favorite, favorite week of the year. We go hanging out with some of my family up in Lake Elsinore. So we just got back from that.

00:05:54:01 - 00:05:55:00
Speaker 1
Cool. Make it clear.

00:05:55:07 - 00:05:58:02
Speaker 2
Sounds like this stuff going on. I got to get away every once in a while.

00:05:58:18 - 00:06:02:23
Speaker 1
Yeah, sure. It's easy to do out here. You know, we're pretty close to a lot of stuff.

00:06:03:09 - 00:06:26:17
Speaker 2
We man, we actually had a symposium in Monterey this year, which was really far. We usually have it in in Lake Tahoe somewhere, usually, usually at Palisades or sometimes Napa Valley. But this is a little further this time. But, you know, Sunday drive in six and a half hours back was the last one and drive back from from Tahoe.

00:06:27:06 - 00:06:28:22
Speaker 2
Yeah, 45 minutes. You know.

00:06:29:04 - 00:06:31:16
Speaker 1
Monterey is in Nevada. Excuse my Canadian ness.

00:06:32:21 - 00:06:53:18
Speaker 2
No, Morris. Monterey is out on the California. Okay. South south of the bay. Okay. It's beautiful. Yeah, there's nothing is amazing. Gosh, it's just far. Yeah. Whereas we have, we have so many cool things right around the corner from us here in Reno in kind of between Reno and Sacramento, too. So we'll go back to late next year.

00:06:53:18 - 00:06:55:17
Speaker 2
It'll be a real good nice.

00:06:57:00 - 00:07:19:04
Speaker 1
Yeah. Wicked man. Well, nice. Yeah. I think just to start us off here, just kind of give the, you know, I'll give you a little bit of an introduction before the episode starts, but just kind of tell everybody, you know, who you are, what you do for work. We're a little bit of a background on kind of where you're where you grew up and how you got into med school.

00:07:19:04 - 00:07:41:07
Speaker 2
Yeah, I. My name's Scott Whitlow. I'm an orthopedic surgeon in Reno, Nevada. I did a fellowship year to an ankle surgery, so that's where I specialize in just getting seven, four years in practice after ten years of training before that, all the culture to the north of guys, ten years and four years in school, five residency and then one of fellowship.

00:07:42:09 - 00:08:08:02
Speaker 2
So yeah, seven years out, crazy time. Time really does fly. No, people say that. But it's true. So I grew up in Seattle. I was a Seattle kid through and through, went away to school with the intention of coming back and wanted to live somewhere else. Before I moved away and ended up in Maine for college and I went to medical school in Boston, residency at UC Davis for five years.

00:08:08:02 - 00:08:29:02
Speaker 2
And then I did my fellowship year in Vail, Colorado, before coming back to Reno or coming to Reno. It was my first time here, so no, I interviewed a couple of times that was like, No, I just want to go back to Seattle Seahawks fan, Mariners and Sonics fan old thing. And I still am, but but Reno has actually been a fan of this.

00:08:29:04 - 00:08:47:20
Speaker 2
It's a it's a great outdoors place. And I've been really happy. I'm part of the great, great speaker and supportive and lets me kind of take care of people and take care of and which is pretty much anybody who comes to my door, you know that. So here we are, Reno.

00:08:47:22 - 00:08:53:07
Speaker 1
Seven years crazy man. I kind of missed like, did you choose Reno or is it kind of like something that was almost.

00:08:53:07 - 00:09:12:19
Speaker 2
Never forced upon me? I wasn't. You can't decide on you decide on a job and sort of the year or two beforehand. And I, I interviewed at some places I knew I was going to live for my residency. I was living in Sacramento. Sacramento wasn't bad. My family in the East Bay and I kind of wanted to go back to Seattle.

00:09:13:05 - 00:09:35:08
Speaker 2
I knew I was going to the Colorado Rockies for my fellowship year, so I looked at all those places for four jobs. And Reno really is just a it was a great job, great people. I think it's important to be around around good people in your work in a lot of orthopedic groups and I know a few surgeons take offense to it, but there's a lot of arrogance.

00:09:35:08 - 00:10:00:06
Speaker 2
And in orthopedic surgery there can be anyway. And I found that really on the East Coast, I found a little bit in Colorado. It's kind of these fancy places, you know, where I was. And and Reno was just a lot of relaxed people as far as orthopedic surgeons go in a relatively supportive environment. And I have some family nearby, and it's just been a it's been a it's been a win for sure.

00:10:00:21 - 00:10:10:04
Speaker 1
Do you have like any major thing that like what was your prime motivator for wanting to get into med school and become a surgeon? Because obviously such a large commitment. I'm just I'm curious.

00:10:10:12 - 00:10:32:00
Speaker 2
Right. I think when you're doing it, you know, before you get in, you're like, oh, ten years was ten years. I was like 24, you know? And then it's like after life. But I actually started in graduate school. I thought I was going to be a I wanted to do science and I got into an immunology program and gosh, was a couple of years into it.

00:10:32:00 - 00:10:51:13
Speaker 2
And I'm like, Gosh, I don't know if this is what I want to do. You know, I'm like making my super cool. I do and doing research on on sort of gene switching and gene from. But I really wanted to be like more kind of hands on like move around more. And so I switched over to med school and when I started med school, I kept a super open mind.

00:10:51:13 - 00:11:08:20
Speaker 2
I was like, How many years in school you know, those guys all seem to climb in ski and shift. Work is cool, you know, you work, you know, 12 hours a day for three or four days a week. You know, whatever they whatever they do. And I went into everything with a super open mind and just got a little bit frustrated.

00:11:08:20 - 00:11:29:17
Speaker 2
I was in Boston. Everybody's pretty intense in the medical field and everything I was doing, I was like, Man, I don't love it like I wanted to do. You know, medicine was a little shorter residency or er was a little shorter residency, but I just didn't like it that much. And then surgery was kind of a little bit longer residency generally, but I liked it a lot more.

00:11:29:17 - 00:11:57:09
Speaker 2
Some like, right, it's worth it. I mean, I've come this far, let's do something we like and initially wanted to do trauma, surgery, general surgery, trauma. And those guys are amazing. They they save people's lives. They take care of them in the ICU, too. And and that's what I was kind of hanging my hat on then realized I didn't really like kind of the everyday surgeries, like the just for me, like the abdominal surgeries I didn't love, you know, kind of surgery, stuff like that.

00:11:57:09 - 00:12:22:15
Speaker 2
So I sort of gravitated towards Ortho a little bit late in my medical school career for for someone to choose a relatively competitive specialty. And I got really fortunate. I marched into Mass in North Phenix. I found it really fun. I thought the non-drama, the Non-Drama cases were great, you know, you still I didn't know what I was going to do at the time, you know, nice girls, knee replacements, hip replacements, shoulder surgery, whatever.

00:12:22:15 - 00:12:42:10
Speaker 2
I thought it was a lot more. Just something I enjoyed doing more so. So I went for it and that's North Ortho and I'm really happy with the decision. It was it's been great for me. I really enjoy it. Not without it. Stress, of course. You know, nothing in medicine I don't think is or, you know, anybody's anybody's day to day job.

00:12:42:10 - 00:12:46:02
Speaker 2
But it's been a good it's been it's been good for me. I really like it.

00:12:47:07 - 00:12:51:20
Speaker 1
Yeah, that's really cool. I can attest to your.

00:12:51:20 - 00:12:54:06
Speaker 2
Well yeah.

00:12:54:06 - 00:12:55:08
Speaker 1
Kathy qualify as.

00:12:57:22 - 00:12:59:11
Speaker 2
Yeah I'll I'll wear a shirt.

00:13:00:05 - 00:13:04:09
Speaker 1
Hunt want it turned out to.

00:13:04:09 - 00:13:23:15
Speaker 2
Well I'm glad I met you for sure. Now I get to meet Mexico City and I get to meet a lot of local people. A lot of people super happy with what you do. You know, you get you can plug yourself up on on people who do well and you let yourself get down on people who don't do well because that happens to everybody.

00:13:23:15 - 00:13:45:14
Speaker 2
The surgeon tells you they got perfect results and that's not true. So, you know, you just you got to take care of everybody. And the winds are great. The the the people who aren't doing well are tougher. But Sawyer for four, right. Like those guys, I mean, they're not doing well. We got to figure that out, too. And if we can't figure it out, I got I got five faculty in my fellowship program who can help me out.

00:13:45:14 - 00:13:55:05
Speaker 2
I got other people that I know around the country, in the world who can help me out. And you just got to ask for help. You going to be, you know, you try to help people and it's a lot of fun.

00:13:56:04 - 00:14:09:20
Speaker 1
Oh, yeah. You had mentioned before when you were kind of thinking about Reno that you were pumped, that people were climbers and outdoor enthusiasts, like, do you have an athletic background? When did you get into mountain sports and kind of where where do you lie in that realm?

00:14:10:14 - 00:14:30:20
Speaker 2
Yeah, I well, I grew up playing kind of everything sort of in the city, in Seattle. I even played basketball, you know, but I was in sixth grade, like some little white guy getting dumped on in guys in technicals in like seventh grade for Duncan. Honestly, you know that. That was fun. Baseball, a lot of baseball, a lot of soccer rookie.

00:14:30:20 - 00:14:58:20
Speaker 2
And we had a little ski house. My folks, a lot of ski house when I was in fourth or fifth grade at an area called Stevens Pass in Washington. And I have a super soft spot in my heart from the Cascades in Washington and both Stevens Bass and the Crystal Mountains of Russo. So my dad, before we had the house, you'd wake up at like 530 and drive us up to the mountain and in it all, VW bus like a micro bus in the mountain is like sketchy.

00:14:58:20 - 00:15:21:00
Speaker 2
Like it's not, it's like a longer version of Mount Rose Highway or like to see the Guy Highway and like no barrier between, you know, I mean, it snows a ton like you put chains on almost every day. I don't know how he did it. I mean, I drive 20 minutes to take the little guy skiing and I, like, relish in how easy it is to take him.

00:15:21:00 - 00:15:40:14
Speaker 2
I could take him for 3 hours. That's all he wants. My dad would take me and my little sister for, you know, eight or whatever and kind of beat it into us. And we loved it. Like, not every day when you get soaked, you know, we didn't even have Gore-Tex or whatever. Yeah, but man, did we learn how to ski and we learned to appreciate it.

00:15:41:01 - 00:16:01:16
Speaker 2
And then when they got the house kind of late elementary school, we'd usually stay up there for the weekend. Since skiing was a big thing. I didn't I didn't start climbing, actually, until college. So college I learned how to climb and I started doing just like indoor competitions. I helped, like, build a climbing wall at my little college, Colby College, in Maine.

00:16:02:05 - 00:16:22:03
Speaker 2
We built it like inside we had a big field house. And then when I went to graduate school, we built a like a bouldering, I would say I was at the Harvard Harvard Med School. There's like a separate gym there. There's like with a bunch of squash courts, a few more use in squash courts all the time. So we built like an indoor bouldering cave out of one of the squash courts.

00:16:22:17 - 00:16:50:06
Speaker 2
When I was there. And I was like, Well, yeah, I'm super comfortable with track climbing. Like I did it. I could get to like 5/8 or something, but I just never I never got super comfortable with it, you know? I was just kind of a gym rat, I guess, and I never, like, pumped my chest about it. I looked weird, like, I'm really skinny, and I had these, like, giant forearms, like one these giant forearms, because inside I could climb, like 14, you know, for jeans and stuff, but not outside.

00:16:50:06 - 00:17:07:17
Speaker 2
So I never really made the transition. And then when I moved to Boston, I moved away from a lot of my climbing friends and I kind of fell away from it. I haven't done much since all my clients, so some big box in the garage. Well, I'm sad to say. I'm sorry. How could that? Yeah. Yeah, no.

00:17:08:06 - 00:17:08:23
Speaker 1
Offense taken.

00:17:08:23 - 00:17:11:20
Speaker 2
But. Yeah. Oh.

00:17:14:00 - 00:17:29:10
Speaker 1
Yeah. So you you kind of alluded to the fact that you were definitely more of a skier. And, I mean, this kind of like, leads us into this this next little chapter here, the the injury that you've been dealing with for, gosh, what, seven years now?

00:17:29:23 - 00:17:31:23
Speaker 2
No, no, three, three and a half.

00:17:31:23 - 00:17:32:21
Speaker 1
Three years more.

00:17:33:16 - 00:17:37:13
Speaker 2
Than sometimes. I have just I have just had my seventh surgery.

00:17:37:19 - 00:17:38:22
Speaker 1
That's what it was. Seven.

00:17:38:22 - 00:17:56:02
Speaker 2
Yeah, yeah. Three and a half years I've been I used to do stupid stuff, you know, I used to, like, flips in the cause and be a little bit more intense about skiing, but like, as I've gotten older, I realized that I've gotten older in the last 15 years or so. I just keep my skis on the ground.

00:17:56:11 - 00:18:33:07
Speaker 2
But I've really tried to learn how to ski. Like I grew up. I didn't really race growing up. I think all my friends in New England real racing so they learn this really sounds set these really this really sound technique that that that I wasn't that I didn't totally have at least going into college. And then in college I started learning that we ski of bit Sugarloaf Mountain in Maine which is this ice icy you break and I started learning about about technique and turning and then the last ten or 15 years like I will see you fast no ski Steve but I really like I really worked on my turn and just technique and

00:18:33:18 - 00:18:55:14
Speaker 2
and I listen to you know, kind of race coaches and skiers. I think I like to I travel every year with the ski team, travel those guys and take care of them. I don't see all of them, obviously, but I see you of them kind of not not on the races. We we do a little warmup runs together and I'll take up little things, but I really just try to try to be sort of deliberate about turns and things like that.

00:18:55:17 - 00:19:13:04
Speaker 2
So were we were up at South Lake Tahoe in March of 19 for a group retreat every spring or my whole orthopedic group would go and talk about business and talk about, you know, the practice and you get to the wives, get new new families, get to know the guys have been there for a while and things like that.

00:19:13:04 - 00:19:41:12
Speaker 2
And we were up in South Lake Tahoe and we had scheduled a ski day on Saturday morning, followed by meetings in the afternoon. So bunch of us were skiing all morning and in kind of the back to back areas heavily that I don't really know Heavenly Mountain that well, but we're having a good day, super called good snow and it's getting to be kind of 11:00, something like that, time to go maybe ski down and have some lunch and and go out to meetings for the afternoon.

00:19:41:23 - 00:19:57:09
Speaker 2
So all my friends go through the trees. The trees are a little bit tight and we'd been doing that all morning and I saw this. Why do open groomer ice just ice cream that didn't have a crowd on it and I'm like all right I'm going to my wife is skiing behind me. I was just doing like a tree line.

00:19:57:09 - 00:20:16:18
Speaker 2
The tree line is just like turns and I hit some of my right ski and made into a right, right footed turn and hit some thought. My ski hit like, oh, I'm just ice cookie or something committed weight back to it and just fell through my leg and I was like, Come on, smooth, sit down. Actually, like, I didn't tumble.

00:20:16:18 - 00:20:46:03
Speaker 2
I didn't like fortunately my skis came off at that point, my butt was pretty close to the ground because my knees were bad and I just slid to a stop and I'm like, What the fuck was that? Right? Like, I've never really been hurt before. And I was on a new square groomer, you know, in Lake Tahoe. I'm like, Wow, maybe I was looking up at the lake and I see something or whatever and looked down and my boot is like flopped over on its buckles and like, oh shit.

00:20:46:03 - 00:21:05:15
Speaker 2
And I like tried to try to bend my knee and like that bent my knee, but my foot, my foot, like my tibia kind of just flex like my boot stayed on the ground, you know, I couldn't straighten it out like dang. And as I'm taking care of a lot of a lot of racers, you know, that kind of injury, usually it's not through the joint.

00:21:05:15 - 00:21:34:20
Speaker 2
Usually it's the tibia and fibula. Then I was like, Oh man, I'm kind of skinny, right? Maybe I wonder if the bone is sticking through the skin. So pulled up my pants and there was no blood. Fortunately, you got a little higher risk of an infection with an open injuries. So those clothes I thought it was extra articular that got packaged up by ski patrol and I was driven down to Reno by a couple of my partners, one who's a trauma guy and one who is my foot and ankle partner and got fixed.

00:21:34:20 - 00:22:03:22
Speaker 2
We got we got x rays in the in the derby. They're like they called down and they're like, is Whitlow like, so Whitlow is the patient. And they're like, No, is Whitlow who's Whitlow operating on? And they're like, No, no, he's small. Yeah. And got actually is in trauma bay and unfortunately it was just a comminuted so a ton of pieces not unlike Kyle's cocaine use the just a ton of pieces from my boots up into my joints.

00:22:04:04 - 00:22:23:11
Speaker 2
So my fibula was fracture then my tibia was fractured up into the inside and the outside part of the knee. It's followed by Candler Plateau Fracture. And that's what I felt was not stable anymore in the lateral part of the joint. The outside part of the joint was pretty messed up. A lot of pieces, the inside part, not so many.

00:22:24:20 - 00:22:40:20
Speaker 2
So I was disappointed. I thought I was going to be an extra articular injury where generally you get a you get a rod in the center of the bone and and you kind of move on. Sometimes you get some into your knee pain. I'm like, All right, I'm going to learn about surgery. I'm going to learn about a nerve block.

00:22:40:20 - 00:23:06:04
Speaker 2
I'm going to learn about an E-Scooter Miller Bell's crap that I put people through, you know, so often. And it ended up being unfortunately, just being a little bit more significant of an injury than I had anticipated. But I had surgery that day, spent the night in the hospital, went home the next day. And unfortunately, I got and my partner did just an amazing job on my joint, a great job on my joint.

00:23:06:04 - 00:23:33:15
Speaker 2
But my foot was a bit like the outside of where it normally should be. It's called velvet. So so I ended up a bit knocked me it was just unfortunate, a little bit crooked. And then eight weeks out, I was like, All right, I'm going to rehab the shit out of this. So I was doing therapy like at our place, and then I started developing just like I had like this persistent swelling that seemed more than is typical for this know I've seen it a lot and my foot was on.

00:23:33:15 - 00:23:57:15
Speaker 2
I couldn't get an issue. I was working on screws around, on crutches and stuff like that, but manages any fevers, anything. But it just seemed a little swollen. I got myself tested for a blood clot a couple times and then I stepped on it. Kind of funny at like eight weeks, eight weeks out from my surgery, I was non-Labor in for 12 and eight weeks and I'm doing my therapy and staying off it, whatever.

00:23:57:15 - 00:24:17:01
Speaker 2
And I stepped on funny and got septic after that. So I had had a like a dirty bilateral. I had to play some activity on the inside one outside, the outside one was dirty, we think. And I had walled off a little abscess around it. They got released into my blood system, so I had an infection in my bone and my body.

00:24:17:01 - 00:24:37:16
Speaker 2
So I got a I got I had the next day I was like in general at 104, it was in clinic all day, came out of the clinic and measured by tapping it was on her for and had one of my one of my partners sort of look at it with an ultrasound and and drains fluid out of it and clinic the next day.

00:24:37:16 - 00:24:55:03
Speaker 2
And it was just like frank pause, just like exactly what you don't want to see in a surgical patient, you know. And so I had to get washed out the next day. I actually had a couple of cases scheduled, so I went to the hospital not having even I did a couple of cases. I checked it and got to I.V. line for I.V. antibiotics, like a permanent one.

00:24:55:06 - 00:25:17:18
Speaker 2
Well, not permanent of the long term. It's called a pick line and then got washed out. And yeah, it kind of started started like a the crookedness was was sort of the least of my worries at that point. I got septic and I.V. antibiotics for six weeks now, got washed out a couple times. I had a new school the following week.

00:25:17:18 - 00:25:41:10
Speaker 2
Also and then got my pick line out on Father's Day 2019. Pulled it out, got to pull it out myself. I usually let people do that, but I knew how to do it so that when it was okay, when I was given permission right by my infectious disease doc and I was on oral antibiotics had to be on all antibiotics until the actually until you can get the hardware.

00:25:41:10 - 00:25:58:12
Speaker 2
All his hardware is non biologic. You can't you can never get rid of an infection on hardware unfortunately. So. Wow, the antibiotics are driving me crazy. So I'm like in July, I'm like, that's, you know, a month later, I'm like, these antibiotics are driving me crazy. I would rather like go back on crutches. So you got a CT scan to look for healing.

00:25:58:19 - 00:26:22:06
Speaker 2
So hopefully I get my plates out of antibiotics and it showed no healing. Fibula was like my tibia. And so that when you have that happen, you have to assume it's because of the infection. So you do what's called a stage revision where I had I had my plate sticking out surgically or had a hunk of antibiotics that put into my tibia and the whole of my tibia.

00:26:22:10 - 00:26:42:08
Speaker 2
And I got another PICC line and had Ivy in box for another month or so. And then I scheduled a revision surgery. I went to to Colorado. I was kind of kind of wanted like someone besides my own or staff to operate on me and this kind of a well known guy. And in Colorado, I didn't know he was in there when I was there.

00:26:42:08 - 00:26:58:22
Speaker 2
He came after, but kind of a well known guy. He called me here about my case today. It was really cool. I was like, and I could help you like and just called me at home, talked about it sitting right here for a while and I'm like, All right, it sounds awesome. I'd like to come out and just be a patient like, I can see you.

00:26:59:06 - 00:27:15:19
Speaker 2
Like, Tell me what we can do. Tell me you can fix it. And I just want to be a regular, regular guy. And so I went out. So he's like, Yep, we can do this and this and this and this. And so in late September, I had my stage revision. I took a bunch of bone out of my head.

00:27:16:03 - 00:27:40:22
Speaker 2
They like cut down my, my crooked bones. It they cut through my schedule of my people. I had a little bit of healing. So they cut back through it, cut through the tibia and were supposed to straighten it out. And that was like a four and a half hour surgery. And I woke up and my legs still crooked and I'm like to like as soon as I woke up and I was out of it, like, I didn't wake up that I was getting more and more sick.

00:27:40:22 - 00:27:59:09
Speaker 2
This is like six months after I got hurt and it was my fifth surgery to balance that I.V. antibiotics. Like, I was just, like, debilitated. I lost a bunch of weight and I thought it was it, right? Like this is my last surgery. Number five, let's say, like, thank you for taking care of me, doctor, and still working.

00:27:59:14 - 00:28:17:20
Speaker 2
And I'm like, wow, fuck, you know, it's not over, right? It's not over. Yeah. There's no way that I like. And then I was like, All right, maybe. Maybe it's as good as I think. I'm going to heal it. I'm going to rehab the shit out of it and see what I can get out of it. Maybe I'll have to do anything else.

00:28:19:19 - 00:28:35:20
Speaker 2
So, you know, we got out later. I mean, I don't know if you guys need to do the spa, but but I got I actually got blood clots. I got arterial blood clots. A week and a half later when I was back in Reno, woke up with this just searing abdominal pain and oh, my God, what what is that one to the hospital?

00:28:36:04 - 00:28:56:16
Speaker 2
And they're like, I think you're just constipated, maybe too much pain meds. And why would I even take it on which being this this is my this is my surgery. And I'm having to I've used up the meds from my first one, you know, and turned out to be like clots in my aorta, which is the big holy shit and a couple of clubs there and a couple plots of my way.

00:28:57:06 - 00:29:20:06
Speaker 2
So I had surgery to try to sneak those out, which was which they put like incisions and my growing kind of both sides that they, they use one side and right side was my affected side. So they put a catheter in there to try to get the clots out. But they make one on your other side to put a balloon up in your left leg to prevent clots from going down there like this to protect your good side.

00:29:20:06 - 00:29:51:08
Speaker 2
Yeah. So that incisions on both sides and the surgeon couldn't even get them out. You like you really wanted to get a sample, but it was like stuck to the wall of my. So they didn't want to pull too hard and get them out. So probably didn't need that one either. And they after that I had like a kind of an adrenal crisis where like my, my vitals were all kind of weird for me, the ICU, because with the anticoagulant I was on, I was kind of breaking down clots or my body and I blood around my adrenal glands.

00:29:51:08 - 00:30:12:16
Speaker 2
And so there's this thick capsule around your brain. Also, when it bleeds, it kind of crushes the gland rather than bleeds outside. So my adrenal is kind of stopped working, signing up in ICU for a couple of days for monitoring and stuff like that. But ultimately, fine after that, six surgeries and my leg is still crooked. I'm like, I got three.

00:30:12:17 - 00:30:33:22
Speaker 2
Have it now, yeah, now, yeah. I have, you know. And so I did a rehab and unfortunately just couldn't get rid of it like the crookedness was really wearing out the outside part of my, my knee joint. So that's going to wear out. I'm relatively young. I'm not young, but I'm relatively young. And and it was hard for me to get my clot working because it was pulling in about 11 degree angle.

00:30:34:20 - 00:30:49:04
Speaker 2
And so I saw like five different people this time. Like, I don't need to rush into anything. And they all disagreed on what to do, but they all agreed that I should have something done, including my wife, who thought I was going to die. That one of those nights. Nice, nice use in the light that I was going to die.

00:30:49:04 - 00:31:10:18
Speaker 2
She's a medical. Yeah. Knows one more than I do. Yeah. And she's like, pass, go get that fixed. You know what? Knowing that it's like, all right, you know, this could, you know, we've got potential for a problem with a history of clots, history of infection. And if anybody's listening who's had things like this, I mean, it's it's a big deal, right?

00:31:10:18 - 00:31:38:05
Speaker 2
You got to decide, like, is it important enough to to risk do you trust the people who are taking care of you? Right. So after after my last surgery at two cuts, they cut my femur and opened it and they cut my tibia and closed it to get my foot back under my leg. Then now st is awesome but I take antibiotics for six weeks as any coagulant drug called xarelto that prevents blood clots for ten weeks.

00:31:38:05 - 00:31:57:02
Speaker 2
I think. And so I'm off all that stuff. I'm 12 weeks out and I'm hopeful. That's great. Wow. As you just was using to be done. You know what? I'm done. Like most people. Yeah, most people don't need seven surgeries for it to be applied to a fracture. But it's been educational for you that.

00:31:57:15 - 00:32:04:01
Speaker 1
Yeah, yeah. Wow, it's so heavy. So heavy, man. It's just like it's a lot to take in total.

00:32:04:22 - 00:32:08:13
Speaker 2
Yeah, it's like a run on, man. I'm sorry I didn't let you guys.

00:32:08:13 - 00:32:17:18
Speaker 1
No, no, I thought it was awesome. Yeah, yeah, yeah.

00:32:17:18 - 00:32:31:16
Speaker 2
I rode the bike today, and I was doing some. I was doing some step up. So my right leg it's great. And area hell yeah is today my 12 week x rays. I got to tell you, I see you. And so you know how positive that can feel. Yeah. Yeah.

00:32:31:19 - 00:33:00:10
Speaker 1
I mean, at this point, you got to take as many wins as you can get, though. As I was telling Max, like I you know, until just now, I had her just bits and pieces of your story and the the emotion that kept coming up in my own experience was just frustration and anger I kept like that's how I would be so pissed at like seven surgeries in especially that time where you woke up and it was crooked the second time, like, I would just be beside myself.

00:33:00:10 - 00:33:23:21
Speaker 1
And so far, you know, you've been just like so positive and so empathetic towards the surgeon. And and I'm just impressed. I'm impressed by that because I would be I would be besides my beside myself. So it's been it's been cool to see your your perspective on that. Like outside of I'm sure there there are some frustrations, especially in the moment.

00:33:23:21 - 00:33:36:12
Speaker 1
It seems like you've moved past them, I guess like what, what kind of effect mentally has this experience had on you personally and on your work as a as someone who's doing this to to people as well?

00:33:37:00 - 00:34:00:17
Speaker 2
Well, those are those are two two totally different things. And and it's been important in a couple of ways. Like I as far as orthopedic surgeons go. And I don't mean my partners disagree with me, but I'm more on the empathetic end of the spectrum than the surgeon of an orthopedic surgeon anyway. Not like compared to a lot of doctors, but I'm more empathetic than your average orthopedic surgeon.

00:34:00:17 - 00:34:19:00
Speaker 2
So there's some guys that needed this experience more than me to learn empathy and like, understand what people are going through or give a shit about it. But it is certainly real, right? Like when I first broke it. Oh, my God, I'm going to learn about surgery. You learn about surgery or about pain meds. I never had a narcotic before.

00:34:19:18 - 00:34:42:07
Speaker 2
And anyway, I didn't even have wisdom teeth, so I never even had that then and learned about this device and all this stuff. So I was like, All right, I was looking at all these different crutch companies. I found an awesome one. Both sticks, by the way. And he was a graduate and and learned about therapy and what's important and found some really good people from that.

00:34:42:07 - 00:35:03:13
Speaker 2
And and it was it helped me it it didn't help me as much as you'd think, at least the initial experience. But then with all the complications in my heart, I got infected. I'm like, All right, I'm going to learn about PICC lines like the peripherally inserted central catheter, like it goes from your arm all the way to your heart.

00:35:04:07 - 00:35:21:18
Speaker 2
And so of that. And I learned about kind of like a really cool like armband for PICC lines that, that when I looked on their website like because they give you this like mesh thing that starts really itching after like a day and to put around it in your arm permanently, like you got to, you got to keep it there, you got to keep it dry and stuff like that.

00:35:21:18 - 00:35:44:04
Speaker 2
Just like you do the splint and this company called Mighty Well, that makes these really cool like armbands that was really comfortable, like all those people that are on that website there, they have pick lines for like, you know, chronic infections and diabetes and like chemotherapy for cancer. And I'm like, all right, I got nothing worked out. I'm like, you know, I'm I'm going to put it tomorrow working.

00:35:44:04 - 00:36:03:22
Speaker 2
Yeah. Yeah, I'm doing pretty good, right? Yeah. So, like learning about all this stuff was cool and like, I'll have patience to see you guys. I do a lot of these big reconstructive procedures on people with flat B that you guys don't notice walking around, but like they might be diabetic where they got like a little hole in their foot, right?

00:36:03:22 - 00:36:20:20
Speaker 2
Like a little, little ulcer. And they'll get mad at me if I'm like, look, we got we got to wait till an ulcer reveals. It's really hard to get these ill, by the way. Like, it takes a while to get that heal before we do any major reconstruction with with hardware. Right. Because if your hardware gets infected, that's a big deal.

00:36:20:20 - 00:36:39:14
Speaker 2
It might be we might be cutting it off to get to your question. But like the you know, they and they would get pissed and you're like, why my leg? I'm not trying to hurt you. I'm trying to help you. And believe me, like when I got hurt, the fracture was nothing like I was. I got hurt Saturday or Sunday.

00:36:39:14 - 00:36:55:04
Speaker 2
Monday, I was like, Well, I'm not having any pain. I'm going to figure out how it can work. You know, like found out where I can put angels in my car on Monday because I was going to have my mom come down from Seattle. I'm driving around for three months, you know, like I was having like I wasn't having much of an issue.

00:36:55:04 - 00:37:15:13
Speaker 2
But when I got sick, when I got septic, I lost like £20, £25 all the way, 155 or whatever we did. And that was way harder for me to deal with and it's hard for me to deal with is relatively healthy. 40 year like this can be really hard for you as a diabetic, you know, 75 year old person who has a hard time using crutches.

00:37:16:02 - 00:37:33:20
Speaker 2
So help me help me talk to people. Everyone's like, man, hope I don't talk about my own case too much. I don't want to be that that guy who does that. But it was really helpful as far as patients goes, I think the thing that frustrated me the most was I'm like, I'm thinking I couldn't figure out exactly.

00:37:33:20 - 00:37:47:14
Speaker 2
It's not like the script when I first got out of the OR, I wasn't totally sure. We didn't have long wait films and it's hard for you to remember. It's like, did my leg like didn't look like that before or my feet like this far apart when I put my knees together before, maybe it was, I don't know, I don't remember.

00:37:49:06 - 00:38:10:11
Speaker 2
But then you get X-rays and it's like, well, it just doesn't really look like the other side. You know, my partners like, well, straighten left your room like what are you sure is definitely not that's fine we all we all need we all leave the O.R. with less than perfect alignment. And you have to that the important thing is to be honest with people about it, right?

00:38:10:23 - 00:38:36:14
Speaker 2
So that was that was the only frustrating thing with me. I think they tried hard like they, you know, they meant well all that, but it wasn't like, well, you left your lack of accountability. Yeah. And that's what's frustrating. And then yeah, with the reviews, I think the most pressing was, yeah, that revision surgery where you wake up period where it's controlled, it's elective, basically, we had planned it out.

00:38:36:14 - 00:38:57:23
Speaker 2
I saw four weeks before I had my surgery. That was a little bit that was a little bit harder, just fine. I have I have a little bit of a hard time with that one. So yeah, that's if I get I get a little upset about that on that that of course I had like, you know, the blood clots and ICU stains, all the stuff that maybe doesn't need to happen that happens again to everybody.

00:38:57:23 - 00:39:22:16
Speaker 2
It's not like you did that to me intentionally, but if I had, if I had a most frustrating moment. Yeah, it's with that. It's with that revision surgery. So I'll tell you what, I woke up from this last one real quick and we we took our dressings off on day one possibly, y'know, go to therapy, possibly one after I get discharges in hospital again and I could actually touch my feet together.

00:39:22:16 - 00:39:33:07
Speaker 2
And they looked relatively similar. Aside from the giant incisions, you know, I was stoked like hell yeah, my, my folks were with me there because we have to look almost.

00:39:33:07 - 00:39:33:07
Speaker 3
All my wife.

00:39:33:07 - 00:39:57:03
Speaker 2
Said, you know, but and I was involved in that surgery as well. And it was just like, okay, we might finally. Yeah, yeah. Seventh time might be the charm. It was a little like there was a second revision. Third, real surgery on the leg is three foot in Washington, vascular surgery in there. But like, yeah, it's like, okay, we might actually be able to be done with this patient for a while.

00:39:57:15 - 00:40:03:07
Speaker 1
I'm I'm curious, what is actually causing the blood clotting like? I know that's really common with surgery.

00:40:03:07 - 00:40:34:06
Speaker 2
Oh, good question. So you want to talk about attitude and so so they weren't totally sure when I first got to the hospital. So every once in a while you can have when I first got to the hospital with clots and they they one of my wife's partners had a hypothesis that I had reacted to heparin for heparin induced thrombocytopenia so that supposedly in your blood and and and they gave me a heparin a type of heparin after surgery to try to prevent me from getting blood clots.

00:40:34:06 - 00:40:56:01
Speaker 2
And I had had heparin flushes in my IV line for six and a half weeks and then for four weeks. And so he thought maybe I was having essentially a heparin allergy and switch me to a different I.V. Anyway, I gulet, which is great because if they continue giving me heparin, I would have continued making clots if that was it.

00:40:56:14 - 00:41:21:08
Speaker 2
The hematologist thought it was a different like a genetic disorder and he continued testing me for that and I just keep asking me for it. And yeah, I, I got out of the hospital in like mid October or early October and I went to see a clot hematologist at Stanford and she just sees like people in clots all day, right.

00:41:21:08 - 00:41:38:20
Speaker 2
She probably is 22 through this week, but she's a super isolated European lady and I had to wait. I saw her in January. I think I waited for three or four months for the appointment and she's talking to me cetera and see me first. And then. And then she's talking to me. And she came over and gave me a hug.

00:41:39:08 - 00:42:00:06
Speaker 2
I'm like, she's like I never seen she's like, I see this twice a year, maybe like what you have. And I never seen anybody with this kind of an attitude about it. I'm like, Well, what do I got to do? You know, what are you going to tell me? I can get off of anticoagulation. Like, one of the things that you might have to do if you're if you're hyper coagulant is be on anticoagulation for your whole life.

00:42:00:20 - 00:42:16:20
Speaker 2
And if you like to mountain bike or ski, you got to be really careful of your legs, your head, you can believe more easily, things like that. And she said, I think as long as you stay away from heparin, you can get off. I was I think I just transition to a maybe aspirin twice a day at the time.

00:42:17:12 - 00:42:39:02
Speaker 2
And she's like, I think you can get off everything. And she's like, when you have surgery, go on 0 to 4 till you walk it again. And I think that's it. Like, okay, that's as good of a solution as I could up for. So yeah, what we think is that I had a reaction to heparin first my that were negative too but I had to watch clots so something's up.

00:42:39:17 - 00:42:45:19
Speaker 1
So that's that's something that you test for before surgery is the the heparin reaction.

00:42:46:05 - 00:42:46:18
Speaker 2
What was that.

00:42:47:06 - 00:42:49:18
Speaker 1
You test for that before surgery to avoid that.

00:42:50:00 - 00:43:08:22
Speaker 2
Yes. When you're in the hospital with blood clots, there are some just the use to try to test for it. I was I was negative for everything that they were testing for. And she thinks I had kind of a unique version of it were sort of delayed and possibly brought on by the flushes. I was getting the blood from my heparin in my take lives.

00:43:09:15 - 00:43:18:05
Speaker 2
Wow. So yeah, kind of unique model. Unique things. If I add up all my, all my uniqueness, they shoot on the water instead or something.

00:43:19:20 - 00:43:24:11
Speaker 1
Yeah. It seems like you've gone through basically everything like all your patients could go through and just.

00:43:24:16 - 00:43:24:21
Speaker 2
All.

00:43:25:04 - 00:43:27:19
Speaker 1
Myself, all the things, just in one experience.

00:43:27:19 - 00:43:44:10
Speaker 2
Always more hang out. And I thought maybe if yeah. Anyway, but yeah, unique situation. But I think I mean really beyond kind of the kind of the, the home home road here I got a lot of therapy to do, but I'm, I'm psyched, man.

00:43:45:00 - 00:43:58:23
Speaker 1
It's awesome. And I'm super happy that that road is kind of closing and that chapter's done and you're able to kind of look look forward and not have to stuck kind of wondering what's going to happen. So super pumped for you. Yeah, we got to we've got a soft spot for people with traumatic injuries on the show.

00:43:59:11 - 00:44:01:08
Speaker 2
So even if it's.

00:44:01:09 - 00:44:03:07
Speaker 1
Often by the surgeons fixing them.

00:44:04:11 - 00:44:13:14
Speaker 2
Yeah, I know how fell off his rock. He's not like I'm going to find the guy similar. Oh, yeah.

00:44:13:15 - 00:44:35:01
Speaker 1
Well, yeah, I mean, this kind of this is just the perfect little kind of transition here. You know, our audience is pretty familiar with maximize accidents. We've we've covered them at length in multiple episodes. And I think the one of the coolest things about getting you on the show here is that you you are the one that reconstructed my my dusted calcaneus.

00:44:35:08 - 00:45:08:12
Speaker 1
And I really think that I personally am not familiar with any sort of situation where you get to hear it from the surgeon's perspective. And I think offering that that to our audience would be really, really unique and a super cool thing. So if you just want to kind of recap a little bit on your perspective of of my injury from the time I kind of like came in with my situation to the actual like reconstruction of my bone and what that was like on the floor.

00:45:09:06 - 00:45:34:05
Speaker 2
All right Yeah, I mean, I remember you came in with your girlfriend in a wheelchair, just a regular old clinic visit. Usually we don't see a new calcaneus fracture or anti loss function. By the way you forget you you focus on kokanee is rightfully but you're talus was not an insignificant injury. Yeah with bilateral splints on and you guys had just moved to the area.

00:45:36:02 - 00:46:06:13
Speaker 2
I, I, I thought, you know, I think you were maybe uninsured. And it's a stressful situation. Young, healthy guy fell hiking or climbing and, you know, girlfriend in the industry too. I think she was applying for jobs at the time, if I remember correctly, in a bilateral surgical. Right. So, yeah, you know, surgical injuries are expensive and people without insurance are fucked, right.

00:46:06:13 - 00:46:27:03
Speaker 2
So, you know, you really want to be like in a good you need to be in as good of a situation as possible. And so from my standpoint, you needed surgery, right? You're a young, healthy guy. Like even your talus was is relatively non displaced needed to be fixed because the talus loves to not heal itself, is surrounded by joint fluid on all sides in it.

00:46:27:03 - 00:46:48:19
Speaker 2
And joint fluid is actually like tossing oil onto it or something like that. And so that needs to be fixed too. And you know, I had to give you that, that news. And the most important thing that any of us can be with any of our patients is honest and if we're going to take you to the operating room, we got to do a good job.

00:46:48:19 - 00:47:10:16
Speaker 2
Right. So you needed to be splinted for a little while to get your slowing down. So you calcaneus. I got one. I got one tomorrow. Lady saw last week I think right before we went to the like I saw on Monday she had a ton of swelling and she's like I want to get this is the season or 50 she's like, oh you tomorrow we can't get three small right.

00:47:10:16 - 00:47:29:08
Speaker 2
It's dangerous. We need to we need display need to keep it elevated. You need to be patient. She's clearly not a virtue and we will fix when it's the right time. So I've got around scale for mom. So yeah. Then for you needed the same thing, particularly on your calcaneus side, which I think is your right. That's correct.

00:47:29:22 - 00:47:52:14
Speaker 2
Okay. Also, you drive on foot, right? So it's like, well, you got to be off of both of these for a while. And good thing that your girlfriend is a nurse and seems to love you and please continue to be in stressful situation because you need that like I need. Yeah and she emptied my little but that's okay.

00:47:52:17 - 00:48:17:22
Speaker 2
Well every time I had surgery, you know like how many times. Yeah. And it's, it was great that you had it was great that you had her in that she understood your situation next is, is like, all right and here are all your images. Like this is this is what I see and this is what I think you need to have surgery and we will make it as palatable for you as possible and the American medical system.

00:48:19:02 - 00:48:45:23
Speaker 2
So we set you up for an outpatient surgery. We did it at our surgery center, which is which is if you can control the cost anywhere at all, it's there. You know, there's still an cost of doing business and the cost of hardware and things like that. But for someone who's going to get to be paying the bill and not going to have an insurance company that's driving the drive and bill down for you, you think, well, it's heavy.

00:48:46:00 - 00:49:04:06
Speaker 2
I think about surgical time and you got to think about number of screws and you got to think about, you know, all of those things because the because the cost adds up. And and that that is one thing that stresses me out as a surgeon is is guys like you, then I want to see do well so badly.

00:49:05:05 - 00:49:24:15
Speaker 2
I know we're paying for it. And if you go back to go back to my case real quick, like if I didn't have insurance and I had to stay the night in the hospital and then I got an infection and I had to have a couple of things washed out, like doctors not paying for that. Right. Like we can't afford we can't afford that because we do have complications.

00:49:24:15 - 00:49:51:03
Speaker 2
Like even with the best intentions, you have complications. If I wanted to to Bill, I couldn't afford it. You know, like if you had vaccine or nonunion or or anything like that. So and so, yeah. The surgery day, we, we do do our best job. We take our time, we make sure we do it right. And then we, you know, make sure that every little every little shot looks as good as it possibly can.

00:49:51:03 - 00:50:03:02
Speaker 1
How are you manipulating the actual pieces of of the bone? And and is there a visual that you can have in terms of reconstructing the bone itself? Like, how does that process actually go down?

00:50:03:21 - 00:50:05:14
Speaker 2
Like in in surgery?

00:50:05:17 - 00:50:07:07
Speaker 1
So in surgery, it's.

00:50:07:21 - 00:50:25:06
Speaker 2
Usually on the CT scan. Like, I'll go through it on your clinic day and I'll go through it the night before and kind of make a plan and then I'll go through it right before you get on the assignment, you know, check in and be like, Hey, guys, how you doing? You know, any questions? Mark both your feet and your case.

00:50:25:17 - 00:50:55:11
Speaker 2
Make sure we're we're on the same page as far as the plan and then your talus was relatively straightforward, it was relatively non display. So we got to do a little percutaneous procedure on that. That's a fun procedure. As long as you get the screws in the proper alignment, right? Like crazy. They compress like you general heal and kokkinis is a whole different ballgame because because of all the common use, not little pieces, you're most of your percent of your calcaneus.

00:50:55:12 - 00:51:22:15
Speaker 2
That's one of the main weight bearing joint of your Satara joint. Looked a lot like my lateral plateau did. And so what we do is we we make an incision to where we can see it as well as possible. We use combination of direct visualization, which is the advantage. Cocaine is an X-ray. Ton of X-rays. I wish I could looked down how many issues I think it's probably and we use little instruments that there's a little one too that I love called a dental pick.

00:51:23:09 - 00:51:49:22
Speaker 2
It looks like a dental. We can move these little pieces, the pieces of pieces of bone around, a pieces of cartilage. We there's a little one called a prayer, which is sort of like a little, little spoon that we can use. And the cheerleader I love the cheerleader. That one spreads things up and, you know, it's actually going to let me know.

00:51:49:23 - 00:52:13:03
Speaker 2
I was a junior. So like that the that typically the joint services push down like the larger pieces of the joint surface or push down. So we use that to kind of push it back up and get it get it relatively well aligned with the talus. You can use the this as a guide and then there's typically a solid piece of bone on the medial side and that remains intact.

00:52:13:03 - 00:52:47:16
Speaker 2
And so so you have a, you have a plan where you basically build things back to that piece of bone, and it's a hard piece about it. You can get you can get screws across, you can get screws underneath the joint and get it into that piece of bone. You get screws. Once I get things relatively well aligned, we put a plate on there and we will put if you've got a tiny combination or a ton of little pieces, there are screws that will just push against the plate, like the screws that go, that will push the faceplate of your like light switch against a wall that's just screws into the wall and it pushes

00:52:48:06 - 00:53:06:13
Speaker 2
the plate against the wall. And there are locking screws that operate into the plates and the screws will not push it against the bottom. Those screws will go straight where you want them and it will it into the plate. So if you push something down on it, say a joint surface, this you will not will not rotate down like it will.

00:53:06:14 - 00:53:27:13
Speaker 2
It's not a smooth number of locking screws induces like your try to try to support the joint surface and get it to heal, Nigro suggested not to walk on it. You do your own little pieces, you know. It's like it's like, you know, you would just push right through that thing. So you did your part and in in staying off it.

00:53:27:13 - 00:53:31:06
Speaker 2
And that is just as important as the initial surgery. Wow.

00:53:31:20 - 00:53:36:02
Speaker 1
How many pieces, if you could guess that I have inside that little sac of my heel?

00:53:36:19 - 00:53:47:01
Speaker 2
Oh, man. You know, people ask this, and I need to find a good way to estimate. Like, they ask how many stitches and, like, I don't know, not really what I needed. Yeah. Yeah. Uh, would you.

00:53:47:01 - 00:53:48:01
Speaker 1
Like 50, one.

00:53:48:02 - 00:54:08:15
Speaker 2
Hundred if you had if you. If you liked it, like little tiny pieces, you had hundreds. But they're, you know, they're probably just like tens, right? Like like pieces that we could identify and, like, and put back together, you know, maybe 25 or 30. Then you got you got a million like inside the and an instantaneous is like an egg where it's kind of a thick shell around it.

00:54:08:15 - 00:54:32:15
Speaker 2
It's an oddly shaped egg, of course. But the center part is just is just can sell a soft bone with good blood supply and that all gets a smash down. And that that can be hundreds of pieces. But I but I think, you know, identifiable and like pieces that we put little pins in. That's everything. We get them like close to where we need it.

00:54:32:15 - 00:54:50:05
Speaker 2
We put all these smooth pins focusing on wires and you can have like you look like the porcupine probably put all these all these personal wires and we'll put them in permutations, like not through your incision, through your skin and areas where, you know, there's a lot of nerve. And we hope there's not in urban areas and numbness on the outside of your foot.

00:54:50:06 - 00:55:06:17
Speaker 2
We'll talk about that later. But the but those are all things in place while we can all we can put some bone graft in there if we want to it or put the plate on. So wow. So no, not a wonderful answer, but I guess 25 to 45, something like that.

00:55:06:17 - 00:55:17:20
Speaker 1
I guess from my perspective, what I'm having trouble conceptualizing is so there's some of these larger pieces. Do they fit almost like a puzzle piece, like you can find the they can only.

00:55:17:22 - 00:55:54:13
Speaker 2
Fit when they fit like a puzzle piece or orthopedic surgeons get excited really when you get these you get these moments in the cases, not one of those. The calcaneus is not super satisfying because that's a great question, right? Because a lot of times you don't get that. You don't get that claim. So one that does typically is is the post you to rusty the part of your companions that your Achilles attaches to typically will will go in and into Beerus or you'll go closer to the midline and you can see that on a special type of X, and you can mobilize that piece and get it out.

00:55:54:21 - 00:56:13:18
Speaker 2
And on x ray, see kind of a recreation of the curve of the inside part of the calcaneus. That's pretty awesome. And then you'll generally run a screw. I'll generally run the screw up. We all have our ways of fixing it, but I'll generally run a screw up there to hold that posture, to grasp the alignment, and then rebuild, rebuild the joint service to that.

00:56:14:05 - 00:56:16:12
Speaker 2
So yes and.

00:56:16:12 - 00:56:35:13
Speaker 1
No. And so with all the smaller pieces that you can't actually have that kind of puzzle component to it, what I'm just imagining like a whole bunch of sand, you know, I've seen x ray, like, floating around. And so what I'm wondering is, do you remove some of the bone? Does that kind of just try and stay in place on the more inside spaces area?

00:56:35:18 - 00:56:36:09
Speaker 1
How is that?

00:56:36:17 - 00:56:53:14
Speaker 2
Yeah, that's a great question. So a lot of the pieces of bone from the center part of the calcaneus that can this bone or that the critical bone is the hard bone gets all those wounds kind of in the middle. I'll pull it out and I'll put it on the back table and then once to get them off as instructed the.

00:56:53:21 - 00:57:18:01
Speaker 2
Yeah. Well do we want to preserve that. Right. Like stuff that I'm not going to preserve. I take home to my dog. We talked about that stuff that I'm going to use like we will even if it's not the right place, we can't sell this bone. It doesn't necessarily matter. So once I recreate the space like the height of this calcaneus, we will fill those pieces back in underneath.

00:57:18:17 - 00:57:37:13
Speaker 2
And for him, I don't want to I don't want him to pay for like some some, like, allograft bone chips. Like I got a bunch of cadaver bone in my tibia, like all in there to pay for that off the shelf. So I use like as much of his own stuff as possible and that and then it heals in, heals in and blood supply.

00:57:37:22 - 00:57:52:23
Speaker 2
In his case, like he healed it, he held it great. Unfortunately, there are some little pieces of cartilage that will not be reincorporated. And just like my knee and he's going to develop stiffness and some arthritis from that. Yeah. And that's what you have to deal with down the road.

00:57:54:05 - 00:58:02:09
Speaker 1
Both the the inner serial killer in me is wondering how lucrative cadaver bone industry, the cadaver bone.

00:58:02:09 - 00:58:28:01
Speaker 2
You're making it sound quite impressive. You know, all these little pieces, the skull stacking is of what, an investment. But I get a lot of stuff from I mean, we use a ton of biologic stuff, right? We use for care. I use a lot of biologic tissue, for example, like placental tissue will use that to churn out wound healing and it's all stuff that will be thrown away.

00:58:28:01 - 00:58:53:15
Speaker 2
So we had our last baby. We actually sign something so that they could take our placental tissue and use it for this. And then of course, they sell it back to me for a thousand severe. But it's the elements. Yeah. The allograft chips that we use to basically create space or a hold space we use in the company is quite bit ah it's like freeze dried, but there's nothing living in it.

00:58:53:23 - 00:59:12:05
Speaker 2
And so I don't love, I don't love using it if I don't have to, but it's good. Like how would you would have yielded in his body. Would have remodeled it most likely. But I got a big chunk in my tibia with, with gensler's bone and they, they made it I'm sorry. With allograft chips in the allograft somebody else autographed meats from you.

00:59:13:12 - 00:59:29:13
Speaker 2
The they took a wedge out in and closed it together that like where I had my allograft chips before and it doesn't look normal you need to look normal in that in that osteotomy that bump that is heal a much more piercing or much more slowly. Mm hmm. Yeah.

00:59:29:19 - 00:59:32:05
Speaker 1
Which just makes sense. Yeah. Makes sense for it.

00:59:32:05 - 00:59:37:19
Speaker 2
Does non biologic. And it's, it's, it's a huge difference whether they're living cells or not. Wow.

00:59:38:12 - 00:59:46:00
Speaker 1
What a what complications were you worried about specifically? In my case, either during the surgery or in post-op during you.

00:59:46:00 - 00:59:58:02
Speaker 2
Don't worry about since there are still a lot of times it's nerves. Nerves. It goes down the outside of your outside of your foot. You know that your says, I think still got to sleep and still have some numbness out on the outside of your foot.

00:59:58:11 - 01:00:04:17
Speaker 1
Yeah. I mean, you can tell me what it is. My guess is that there's some plates or screws going through the nerve. But yeah, now.

01:00:04:19 - 01:00:23:03
Speaker 2
It's just going through it. Probably it got it got a traction injury to it because you we made a an incision that was as short as could be, but then needed to make it longer to visualize your joint a little bit better. And sometimes the joint is just a little nervous, a little bit more anterior than than is typical.

01:00:23:13 - 01:00:39:19
Speaker 2
You can go to sleep so there's nothing through it to take your plate out. It might improve, but it might not. Fortunately, it's just it's just a like a skin or something. It doesn't, it doesn't take care of any any muscles.

01:00:40:14 - 01:00:48:23
Speaker 1
Yeah. I've not noticed any, any sort of problems from it at all. I was going to touch it with my hand. I'm like, Oh, it's kind of numb, but it's very easy.

01:00:49:04 - 01:01:08:22
Speaker 2
That's it, that's it. I had the same thing in front of my TV, like I can't feel anything between my incisions except if, like the radiology tech moves the C arm and I'm not like the actual thing and it hits me in the leg, then I'll feel that. But I don't, I don't, you know, when I'm touching it, I'll feel anything in there and it just unfortunately it will happen.

01:01:08:23 - 01:01:34:13
Speaker 2
So you worry about so I worry about that the biggest thing with you and calcaneus fractures is you worry about wound healing. So there's a lot of stress on that one. We retract on it. It turns out the way it's had trauma to it, any way, it's got it's got iron and blood cells in it. And so the one of the more common complications of continuous fracture surgery is, is a like a wound problem.

01:01:35:04 - 01:01:55:08
Speaker 2
So I was worried about that. If you get a wound problem, you can get an infection in the bone. If you get that, you got to take you back to surgery and wash it out. And you would take lines and all this stuff that cost too much money. Yeah. And we worry about all those things. Another common one, of course, is stiffness and genetic arthritis, which I'm sure I told you about when I met you.

01:01:55:22 - 01:02:05:00
Speaker 2
Yeah, of course. That's why we. That's why I spent two and a half hours. And you said that on your podcast, and listen, two and a half hours are usually I'll spend an hour and a half.

01:02:05:20 - 01:02:07:03
Speaker 1
An hour specifically.

01:02:07:17 - 01:02:24:15
Speaker 2
But it's typical. We'll take as long as we need. Right? Like who cares if the next phase, it's the lady who cares for dinner. Like that doesn't matter, right? What matters is the person on the table. And so you're right. I thought I thought maybe that was two and a half hours between the two. But you're telling me 5 minutes or something?

01:02:25:04 - 01:02:34:04
Speaker 2
Yeah. And you can do it a half hours. And that is, I think because I had a little extra stress level one to get it right. Yeah.

01:02:35:15 - 01:02:43:15
Speaker 1
Well, I like again, I appreciate it. And like you said, I've definitely healed super fast. You know, I was back to climbing you with this.

01:02:43:23 - 01:03:07:15
Speaker 2
It's almost like in there and I know I know you some an expert is here for a couple follow ups and and she's like he's done an awesome these want to do more or maybe a little like you know some oh no yeah yeah. I mean every time I'm like, oh thank God. Cause, you know, that was that is just great, you know?

01:03:07:15 - 01:03:23:18
Speaker 2
And, and then usually in clinic, you know, a lot of people who are doing well, my nurse practitioner, I'll see him and then I guess some people who aren't or the kind of, you know, people who are, I see a lot of it kind of kind of second opinions and do a lot of revision surgery and stuff like that.

01:03:23:18 - 01:03:26:06
Speaker 2
Everybody's on my own, too. Yeah.

01:03:26:12 - 01:03:29:08
Speaker 1
And those people are just inherently grumpy.

01:03:29:08 - 01:03:54:01
Speaker 2
They can. I would. Yeah. Yeah. Problems, right? Yeah. Yeah. Okay. So, so yeah. Like, like it manages to see a lot of that, a lot of happy, you know, happy, awesome people. Yeah. This good, you know. So it's a lot we sign up for but that's the reason she's I you're doing you're doing great and it wasn't because I didn't want to see I see that like it's you.

01:03:54:01 - 01:03:54:15
Speaker 1
Know it's all.

01:03:54:15 - 01:03:59:07
Speaker 2
Good like people who are doing great. Gosh, that'd be. That'd be awesome. At least on that feeling great.

01:04:00:01 - 01:04:00:10
Speaker 1
Yeah.

01:04:01:16 - 01:04:20:07
Speaker 2
So, yeah. Wow, you killed that man. And there's it was definitely a team effort. And I think people, you know like that it was injury was no joke like you had to be non weight bearing on that as well and that has a high nonunion rate. Like if you don't get that, you don't get the talus compressed appropriately, it can not you.

01:04:20:07 - 01:04:29:06
Speaker 2
And that can cause a lot of a lot of problems. So I love to I love it when you're talking about your injuries and never mention it. That's like yeah.

01:04:30:01 - 01:04:40:06
Speaker 1
Doing honestly. Yeah. Because that talus bone healed so fast. I was like walking on it super fast. Like, it was like I never even had a broken bone down there. So, yeah.

01:04:40:08 - 01:04:40:16
Speaker 2
That you.

01:04:40:16 - 01:05:00:15
Speaker 1
Killed it. But I did. There's a gentleman who reached out to me on my Instagram, you know, because we get people with broken ankles reaching out to us pretty, pretty often now. And this guy fell in Turkey, he hit a tree and his talus cracked in half and rotated up out of place like it showed me the X-rays.

01:05:00:15 - 01:05:09:21
Speaker 1
And it was just it was horrific. And I just keep remembering what you said. Like talus injuries are really severe. You know, it's pretty rough. And I felt really bad for him because it looked and it looked awful.

01:05:10:07 - 01:05:31:16
Speaker 2
Totally. Is that is a tough injury because you can the talus and also lose its blood supply and then the part of the talus articulates with the tibia at the ankle that can if it loses its blood supply, it can die and you can get what's called the avascular necrosis. And that becomes becomes a difficult issue for patients and for surgeons.

01:05:31:16 - 01:05:34:21
Speaker 1
So, Scott, you are an ankle specialist, is that. That's correct.

01:05:36:01 - 01:06:01:04
Speaker 2
Yep. I did a foot and ankle fellowship. I took a ton of until last year. I did a on a trauma like general comma, general trauma also, you know, risk fractures and stuff. Like if it didn't need to go that night generally and I wasn't I didn't feel like I could do the best job. I would generally kind of keep it in the hospital and give it to one of my trauma specific partners with hip fractures, plateaus, things like that, femur nails.

01:06:01:05 - 01:06:12:06
Speaker 1
That's, I guess what I was wondering with like if your specialization is foot and ankles, but you still operate in a lot of other areas, correct? Like. Yeah, okay. Yeah, yeah. No, I was just curious about that.

01:06:13:08 - 01:06:31:11
Speaker 2
For the most part in my elective practice. Like even if all my patients ask me if I want, if I could do a knee scope on them, they go on meniscus thing, I generally will give it to one of my specific partners, right? Like I've done hundreds of knee scopes in my residency, but I'll do them that much anymore and those guys do them all the time.

01:06:31:11 - 01:06:42:02
Speaker 2
So I will. If it's anything that I feel like one of my partners can do better than me, I'll refer it out to make sense. Well, I pretty much stick stick below the knee for the most part now. Yeah.

01:06:43:08 - 01:07:00:05
Speaker 1
Yeah. We, we one of the things we talked about in the podcast is if you can, obviously this is circumstantial, but finding someone who's done, done the surgery before and and hopefully not not being with somebody who's, you know, it's the first couple of times just as a reference point like how many calc reconstructions have you done before you did mine?

01:07:01:05 - 01:07:21:20
Speaker 2
I don't know. I, I, I she looked it up. It's hard to do because in residency, so all of us, every orthopedic surgeon did a residency, right? They did these fractures in residency that they may not have been the primary surgeon on, but they were part of it went to trauma a trauma heavy residency program at UC Davis and probably saw 40 or 50 of them.

01:07:22:08 - 01:07:45:16
Speaker 2
And then out in practice, probably another like, you know, 100, maybe something like that, seven years. So I don't do a ton. I mean, I'll do, you know, some years I'll do like five, some years I'll do 20 and things like that. I don't out and then my my child partners take in more primary trauma call and they they can fix some do so they, they will generally hang on to them.

01:07:46:17 - 01:08:00:13
Speaker 2
So I get the ones now mostly that they go to an outside hospital, they get referred to me from there, sort decline as many as I used to be and we'll do we'll do a number of them. So I guess to answer your question, maybe around 150 to 200.

01:08:01:22 - 01:08:03:17
Speaker 1
Yeah, that's a lot. Yeah, that's awesome.

01:08:03:18 - 01:08:30:20
Speaker 2
That's right. And you like to see the fellowship and then you're, you know, practice for seven years. I probably do between like even on on a year where I was hurt, you know, you'll do like 600 surgeries in years, 6 to 8. Wow. And that's being a conservative guy. You know, I'll talk I'll talk to people about non upper management all day long and yeah we're just you know, we see we see a lot of people and our surgical days run relatively efficiently.

01:08:31:06 - 01:08:52:21
Speaker 2
And so you definitely, definitely get to see definitely get to see a lot of a lot of stuff in there. And then I also get to see my fellows, my all of my graduated fellows and our faculty. We'll talk about we'll show injuries and we'll show injury films, show what we did and things like that. So you get to see, you know, other people's other people's trauma injuries to.

01:08:53:13 - 01:09:10:18
Speaker 1
Do you feel like you're generally pretty good at dissociating like do you take some of the patients you could say trauma more so emotional trauma home with you at all ever like are there days you get home or that something really affects you or you view yourself like you can you can just cut that off pretty easily.

01:09:11:05 - 01:09:35:00
Speaker 2
But I mean, if people have bad results like I will take that on with me sometimes. You know, if I feel like, oh gosh, I can't figure out like why person isn't doing well, but like I will take that home with me and then my wife will tell you. And in some of my patients, like A.K.A, a lot of doctors and nurses around town, a lot of kind of the professional athletes that I that I take care of, they have my phone number and they'll just like, Hey, man, what's going on with this?

01:09:35:00 - 01:10:06:04
Speaker 2
You know, and and I'm happy to tonight I was talking to one of them, you know, just on text and you to I will take that stuff home with me. I don't sleep great. And I don't think that I stay up thinking about patients but I might, you know, maybe more than that, but yet the really genetic stuff and not very often, honestly, I think it's more like I think a lot about my patients and why someone might not doing well, why not, might not be doing well.

01:10:06:13 - 01:10:33:15
Speaker 2
And I think about those people any time more. I think about people like Kyle who are doing great play and then you just you are going to clearly be like, Man, I had a rough day. It was like two or three people were having problems or something. I couldn't figure out, you know, I forget about like, you know, the 15 or so that we're doing great and we set our calls and and that's just kind of yeah, you know.

01:10:33:15 - 01:10:33:22
Speaker 2
Yeah.

01:10:35:04 - 01:10:51:06
Speaker 1
Well, I think that some it seems like you alluded to the fact that some surgeons aren't as empathetic as you and kind of put up a wall to these kind of experiences. So I guess it's kind of case by case with but who you're dealing with. And I think in the long run, it it seems like it's a bit of strife on your end.

01:10:51:06 - 01:10:56:21
Speaker 1
But I think it you know, at least with mine, it definitely seems like it translates positively to the to the patient.

01:10:57:11 - 01:11:01:09
Speaker 2
Oh, yeah. I mean, how can it not unless you unless you're up all night, you know.

01:11:02:05 - 01:11:03:04
Speaker 1
Yeah, exactly.

01:11:03:04 - 01:11:27:00
Speaker 2
But I think that's part of the benefit of having a fellowship program to like continuing to be in teaching. You talk about these things the time and I have I can't remember if I had a photo of me on the day that I did your shooting. But, you know, we talk about cases and I ask them if you want to look at all my cases the name for before we do it and do if they've got a different plan or like if they think we should be doing something different, let's talk about it.

01:11:27:00 - 01:11:48:20
Speaker 2
You know, I'm not just like this. You know, I'm not Iron Fist. You're like, we got to talk about these things and we continue to do that. And it really, I think makes you a makes me a better surgeon or better caregiver because we're always talking about this stuff. Some fellows are like, right, we'll talk, you know, give me their more than others.

01:11:48:20 - 01:12:05:10
Speaker 2
Some I'm like, No, no, whatever you want and all of you. It's kind of annoying. I hate it when they do. They all of them are like, I want to talk on Monday. What's wrong with that? They don't watch again and yeah, I think it I think it ultimately helps you get better, but you're never going to be perfect.

01:12:06:10 - 01:12:29:23
Speaker 1
Yeah, you had said that, you know, along this topic of kind of having empathy and have taken stuff home with you and also kind of being worried about these surgeries that you might be going into. You know, the uninsured was a group of people like myself that kind of brings that anxiety along where it's like I think you had mentioned high school college athletes being another group that kind of fit that bill, right.

01:12:30:21 - 01:12:58:09
Speaker 2
High school athletes like we don't you know, the majority of people see or aren't super wealthy. Right. Like they they can't just like afford to go buy like shoes that are that are going to help them offload their feet. And when you have a high school athlete who's potentially a scholarship athlete, they get nervous about that. Right. I see a lot of those, like whether it's volleyball or footballers or cheerleading or whatever it is.

01:12:59:02 - 01:13:24:03
Speaker 2
And, you know, you want to do a good job. You want them to have a good result. You want everybody to, of course. But what those guys have the result because it could be their college education, right? Their future, whether they can play or not. And that that does cause a little bit of anxiety. I think it causes more than it does for some professional athletes who have like their, you know, their training stats and and things like that.

01:13:24:03 - 01:13:37:13
Speaker 2
And they've got they've got some dollars on the line, too, there's no doubt. You really need to you need to take care of everybody the same. But, yeah, that that high school athlete who's working on it start working on a college scholarship now against me for some reason.

01:13:38:20 - 01:13:40:16
Speaker 1
Yeah, there's a lot of pressure.

01:13:40:23 - 01:14:00:09
Speaker 2
Yes. Like you can't just like go to go to Stanford, like, and get in without sports necessarily or like you in ours or local school, university in Nevada, Reno. Good are you in are and just you know, the parents can just be like, all right, I'll pay for it instead of instead of a scholarship. Like it's a financially and personally and educational.

01:14:00:09 - 01:14:01:00
Speaker 2
It's a big deal.

01:14:01:00 - 01:14:08:19
Speaker 1
Yeah, well, that too. I mean, they might not be able they might get back to the sport that they love doing on top of everything else, right?

01:14:09:04 - 01:14:25:07
Speaker 2
Yeah. Yeah, right. That's their, that's their outlet. And now they drive a lot of confidence. So yeah, I mean, some people you just can't like some injuries. You can't, you can't totally get them back. But yeah, it's in your hands and you just, you just want to do as well as good of a job for him as yeah.

01:14:26:06 - 01:14:47:13
Speaker 1
Yeah, yeah. So you know me being that the Canadian in the room, the digital room, I got to ask, you know, so I'm wondering if maybe a like what are your thoughts on a privatized health care system versus socialized like health care system? And then also maybe, you know, any surgeons in in Canada who have more like an on the ground look that you discussed that with.

01:14:47:17 - 01:14:51:06
Speaker 1
Just I'm just curious and your perspective on those things.

01:14:51:06 - 01:15:13:11
Speaker 2
Oh, man. I mean, you know, logistically, it's in the United States. I think it would be impossible. It would be difficult to implement right. I would love it. I mean, I would love it if if everybody could get health care, you just go in and it would be paid for. The fantastic surgeons I mean, I think, you know, if that's the case, surgeons, surgeons would like that.

01:15:13:16 - 01:15:30:09
Speaker 2
But I wouldn't make make as much money doing that. Mm. I don't know how it would, you know I haven't, I haven't read a ton about it to give you a great answer on how we would implement it or if we ever could. But it sounds great. Like I spent some time in Canada. I spent some time in Spain.

01:15:30:09 - 01:15:50:16
Speaker 2
You know, it's, it's cool to think about and in Australia too, right? I think they have it too. And I mean, it'd be great if everybody could just like you break your ankle, you go in, you get taken care of. And I think I think in practice it's a lot it's a lot more difficult to do it. A lot of people who are paying for it, you know, I'll pay for it.

01:15:52:04 - 01:16:13:10
Speaker 2
I have a really good friend who's a trauma surgeon in Canada, but I haven't talked to her about that. So I was asking and maybe she's sorry that she's you did a residency in Vancouver and then her first trauma fellowship in the United States in North Carolina, and now she's back somewhere, Greece, Colombia, that's a little bit more rural.

01:16:13:10 - 01:16:19:06
Speaker 2
And I know I was in there exactly where I was. I talked to her about things like this.

01:16:19:07 - 01:16:35:03
Speaker 1
Do you think the this like the so-called meritocracy and the incentive structure of a privatized system where you can make more money produces a more competitive medical field and produces maybe I mean, I don't want to get controversial here, but like better surgeons.

01:16:35:20 - 01:17:02:00
Speaker 2
And that's a good question. So it might. Yeah, but it may also it may also produce intelligent people who are doing it for the wrong reason. In Canada, it's really competitive to get a job like it's you have to do. I think it was the surgeons are still the same and I'm sure I'll get corrected. But my lane had to do.

01:17:02:00 - 01:17:23:15
Speaker 2
My friend Lane had to do two fellowships, I think, even to get a job. And if I thought about going to Canada, it would be impossible. I think I'd have to do, you know, all of their boards and plus probably another fellowship. And part is part of the problem that creates is that there's not as much access is my understanding, there just aren't as many surgeons for the number of people who need it.

01:17:24:03 - 01:17:46:13
Speaker 2
So in the United States, the Internet, people can come see me for like chronic pain, you know, things to things that are tough to do in the clinic and or nonsurgical and and just take a lot. They take a lot of time. You know, anybody can come in and see us. They just have to pay their copay. Whereas in Canada, I think I think it's pretty hard to get in to see an orthopedic foot and ankle specialist, right?

01:17:46:13 - 01:18:07:20
Speaker 2
Like if I've got and it hurts in my forefoot when I run, it's been like this for a couple of years, I think. I think it's really hard to see somebody because there isn't there just aren't enough surgeons. So I think there's maybe a balance in between. We've got we've got quite a few surgeons who are all you know, they think everybody is going into medicine.

01:18:07:20 - 01:18:25:22
Speaker 2
These days because they think they're going to make money and they're kind of barking up the wrong tree after like ten years of training and lost lost income. And they're not making millions of dollars anyway. You got to get into it because busy like it like I don't think that many people are getting into into medicine because of the money anymore.

01:18:26:11 - 01:18:31:03
Speaker 2
It's a lot more lucrative to do business and be in school for less time and stuff like that.

01:18:31:03 - 01:18:55:16
Speaker 1
Yeah. And your point about seeing a surgeon up here, I didn't even actually get to see my surgeon. I a different surgeon who didn't perform the surgery for my follow up because I wasn't even able to get time. And he was a great guy. Really, really nice not not saying anything bad about him, but I think there's definitely an issue with, you know, getting getting people serviced as well.

01:18:55:17 - 01:19:21:19
Speaker 2
It's like, like here we've got like Kaiser is a local system that is like an HMO and, you know, Kaiser Health and and you pay for there and there's great surgeons there. I did a lot of training there when I was in residency. But if you basically pay, I think, a just a fee for your health care. So like if you have a potentially surgical issue, they don't necessarily want to pay for you to have surgery because they they sort of lose money on that.

01:19:22:09 - 01:19:41:08
Speaker 2
So they'll send you to like therapy and then make your way and do all this stuff before you before you can get get your surgery to the point where a relative of mine actually paid cash to have surgery in our surgery center. And so could have it done more quickly. And it turned out that the Casper's in surgery and it was cheaper than his co-pay at Kaiser anyway.

01:19:42:06 - 01:20:03:23
Speaker 2
Wow. For something like no hardware or anything, it was like a bridge for me related sort of nerve release thing, but that kind of crazy, right? Like when they're not incentivized to necessarily take care of you the way you need to be taking care of their incentivize, kind of rack up the bill, spend less money with socialized with, with HMO.

01:20:04:05 - 01:20:08:23
Speaker 2
And again not I'm not super around it, so I'm just kind of my impressions.

01:20:09:05 - 01:20:41:08
Speaker 1
Yeah. Interesting, man. Thanks. I appreciate the insights and your responses. Yeah, I guess moving along here, I want to talk a little bit about kind of like some more operation or stuff and then we can move on to more recovery. Is there like a particular injury or a joint or some sort of surgery that is just like something you don't want to work on or the most complicated or kind of scary to to operate on?

01:20:42:08 - 01:20:58:14
Speaker 2
Well, they're different questions because don't want to work on for a foot and ankle guy is like toes like him to like bunions and stuff like that because everybody gets stiff and everybody's at their toes, like sitting up a little bit. You're like, How much is it? A little bit, you know, like, well, we told you this can happen.

01:20:59:11 - 01:21:17:09
Speaker 2
And so nobody in for an ankle surgery really likes for foot and toes. You're like, all right, I wish that somebody else deal with this funny, you see, but I've actually learned how to do it. Do a newer technique that I like, and generally people are doing quite a bit better and they're able to move a little bit more quickly.

01:21:18:02 - 01:21:42:15
Speaker 2
And things that make you nervous are are like big hind foot, big high foot reconstructions in diabetics. So they will get this sort of joint collapse through their ankle or their midfoot or bones that can create ulcers, they can create pain, they can decrease their mobility. And they can't do they can't walk and be normal and their sugars go up and their weight goes up and things like that.

01:21:42:15 - 01:22:07:05
Speaker 2
And it's bad for their health. So those are those are fun things to treat, but they are difficult surgically to get them in the right place. And then they're difficult postoperatively because they're at a high risk of nonunion because the bones are very good and the blood supply is not very good. You see high, high risk of falling because they're, you know, it's hard to walk on crutches and stay off of the limb that they need to stay off of.

01:22:08:02 - 01:22:29:13
Speaker 2
And if they get infected, it's it's hard to take care of then hard to hard to get rid of those infections. So I think there's this big there called Sherpa changes. Big, big Chako reconstructions and diabetics are really difficult to take care of. They're fun. We get a lot of them. We get them referred to us. And we have a lot of great successes.

01:22:29:13 - 01:22:35:16
Speaker 2
But people, you will get a lot of complications of those as well. And it's hard for people deal with. So would you.

01:22:35:16 - 01:22:54:05
Speaker 1
Say that that's a that's a pretty common thread among all orthopedic surgeons regardless of your specialty is dealing with either overweight diabetic patients or do you feel that your your field in specific working with the lower extremities has a more has more trouble with these patients because of where these injuries lie on the body.

01:22:54:17 - 01:23:18:12
Speaker 2
Yeah I think I think we all struggle with it and joint replacement surgeons to hips and knees. There's some pressure on we operate on people a certain weight. You know if you operate in someone above a certain age, sometimes we'll be held financially responsible for their complications. So you ask people to you make people lose weight, spine surgery, same thing.

01:23:18:12 - 01:23:40:05
Speaker 2
They people lose weight before surgery, which is hard because your joints hurt and they're not that mobile and you got to have that conversation. So I think it's I think it's throughout throughout the day. So I think the diabetic problem is, you know, they just a hard, hard time healing your surgery. There are many wounds and they have a high risk of complications.

01:23:40:19 - 01:24:01:14
Speaker 2
But I mean, I like to go do because they need to be taken care of. You know, it's it's which is something that we got to do and and you got to stick with them. And, you know, there's going to be more visits and you know, to be potentially, you know, some hospital stays and things like that. But they need to be taken care of.

01:24:01:20 - 01:24:14:12
Speaker 2
And if it's not worth doing surgery, you tell them that to try everything not operating again, the it's the obesity and diabetes. Difficult issue, I think across the board in orthopedic surgery and medicine in general.

01:24:14:12 - 01:24:25:14
Speaker 1
Yeah, yeah, for sure. And obviously, like a rising problem. Like I'm assuming there's a lot of people you're operating on who are obese and diabetic, right?

01:24:25:14 - 01:24:49:07
Speaker 2
Yeah. Yeah. You temper that, like for if you're doing something totally elective, like a knee replacement or in my case, an angle replacement, you can you need to make sure that they're fairly well optimized because if those things don't, if they get an infection or something, it's it's a really big deal, even bigger deal than than like is it going to take out all the implants and possibly do a fusion and things like that, make it to stay off for a long time?

01:24:50:04 - 01:24:54:17
Speaker 2
And so you try to do things. You try to make sure they're they're totally optimized for surgery.

01:24:54:17 - 01:25:17:18
Speaker 1
I think that's that's a good segway here for actually something I'm really curious about. So obviously for you, it's it's knee and ankle replacements. Are is there any are there any like joint replacements where the tech is just objectively better? Like you have a way better outcome in in in knee replacements as opposed to ankle replacements. Yeah, I'm wondering about that.

01:25:19:02 - 01:25:40:17
Speaker 2
The hip hip was the operation of the century last century. My joint colleague likes to tell me that all the time. So the hip is generally very successful. People get up and walk on it right away and they feel great because they had so much pain in their life afterwards. And surgery is relatively less painful. The knees is is a second place, ankle is not as common.

01:25:40:17 - 01:26:01:09
Speaker 2
You don't actually develop and you actually get a ton of people of ankle arthritis. Generally it's post traumatic as opposed to like the hip and the knee can just be osteoarthritis. It's a bit more common. And so replacements are a little less common. They also you get the entire way to the body coming down to this, you know, little kind of a little tiny area.

01:26:01:16 - 01:26:25:20
Speaker 2
So there's a lot more pressure going across. And if you're doing it for the right reasons, people that have being just pain directly in the ankle joint people are not neuropathic. They're relatively quality. They do great. They do great. So my ankle replacement patients are some of my happiest, but hips and knees are way more common. I think I did like or 400 total knees in residency, right?

01:26:25:20 - 01:26:49:08
Speaker 2
Because they're just happening all the time and our joint surgeons do hips and knees all day long and they're and they're great at it. They can do moves. The ankle is a little bit a little bit less common. And we do, I'd say as a group, we probably do maybe 40 or 40 of them a year, 40 or 50 of them a year between the three of us, as opposed to the Joint Colleagues.

01:26:49:08 - 01:27:02:18
Speaker 2
And you're just doing it doing them all day. Every day, right? My joints Colleagues and colleagues was in the hour with sedated tens, I think, and they were either hips your knees like all yeah. So a lot more common.

01:27:02:18 - 01:27:08:23
Speaker 1
What does an ankle replacement actually look like? Like what are you replacing the joint with?

01:27:09:14 - 01:27:30:03
Speaker 2
Well, you are cutting. So you'll make a cut in the tibia to cut away sort of arthritic bone in the tibia and replacing you with a little metal plate. There are a number of different models and kinds. Anybody who's interested in them to just do whatever the surgeon is most comfortable putting in rather than requesting a certain implant.

01:27:30:03 - 01:27:51:00
Speaker 2
And that goes for knees and arms too. And then we resurface the top of the with the round part of the talus. And then there's a little plastic baseball that goes in between the two of them. And the most important thing is that we line in a minor up correctly. If, if you're if it's mal aligned, then it'll wear out quickly, sort of like having, having melon in your car or something like that.

01:27:51:00 - 01:27:51:18
Speaker 2
It just gets worse.

01:27:52:12 - 01:28:10:14
Speaker 1
What's the what's the outcome like for someone dealing with that? How how long does that does that do those components last in maybe a good outcome? And what is the kind of functionality that someone can get out of that? Can they return to sports? Can they do things? Are they pain free generally? How does that work?

01:28:10:14 - 01:28:32:17
Speaker 2
Yeah, requested. So generally we can't guarantee they get more motion than they have before surgery because they're they're soft tissues so stiff. But it does seem like people will get a little bit more motion in the ankle and the pain goes away. So if you're doing it for for if the arthritis is causing the pain that goes away and people are stoked on that and the implants they will last.

01:28:32:18 - 01:28:51:10
Speaker 2
Like if you do it in a young guy like of you guys, you guys are going to wear out. It's like, well, I'll wear out. Absolutely. So usually I try to do I'm a little bit older patient in their fifties and beyond, younger patients with horrible ankle arthritis generally need to get a fusion which is very durable. You can run on a fusion.

01:28:51:10 - 01:29:15:05
Speaker 2
You shouldn't run on a replacement because that little plastic spacer can break, you can climb, you can ski on sort of roof stuff without doing bumps your big chance. You can hike. But generally we like you to hike without a big, heavy backpack. It's all about trying to try not to break that plastic spacer in between the two pieces of the metal and protecting that.

01:29:15:09 - 01:29:19:00
Speaker 2
And if you do, sometimes we can we can take it in and replace that space.

01:29:19:00 - 01:29:32:18
Speaker 1
So what does a fusion look like then? If you could just quickly go through the process of what a fusion is and then if you have a whole bunch of arthritic pain, let's say through the talus or other areas, does that does the fusion remove that pain? How does that work?

01:29:33:09 - 01:29:52:22
Speaker 2
It does. The pain goes totally way. We can't move the ankle joint anymore. Typically you get a lot of motion through your sub Taylor joint step on you're Kyle and that's about all the joints in the foot like the joint in the book have a ton of motion so if you if you use the ankle people generally will walk relatively normally and their pain will go away.

01:29:53:21 - 01:30:14:12
Speaker 2
And what that looks like is we can do it if the alignment loads, it'll be good. We can do with an after school up to little vocals and we look into the joint to still point out any cartilage that's remaining. And then we'll put a couple of percutaneous screws into to stick the two bones together and then we keep people off of it for about eight weeks or 6 to 10, whatever, whatever it takes to heal.

01:30:15:04 - 01:30:40:17
Speaker 2
Once it's healed, then they can start walking on it and you can run on it. You can see bones, you can do whatever the heck you want on fusion and they can put a little pressure on the other joints around. So you're spectacular joint the joints of your foot it can there's some evidence that it can increase wear on those joints, whereas the replacement sort of maintains that ankle motion and it will protect those joints around it.

01:30:41:00 - 01:30:45:03
Speaker 1
And so once you fuze something I'm guessing you you can never go back, right?

01:30:45:18 - 01:31:12:01
Speaker 2
Right. There's been there have been a lot of people who've taken down ankle fusions and put in replacements. And if I was giving we were talking to a group of foot and ankle surgeons, there'd be a bunch of them say, Yep, my patients do great. In my experience, they don't seem to do that well because depending on how long they've been fuzed, because the Achilles hasn't been working, peroneal tendons haven't been working all the all the soft tissues around your ankle haven't moved for a long time.

01:31:12:01 - 01:31:23:06
Speaker 2
So, you know, you that infuse and put in a replacement, it doesn't really move that well. And so I have been doing haven't been doing too many of those for that reason.

01:31:23:06 - 01:31:33:12
Speaker 1
Yeah, yeah, yeah. You can, you can use the talus and the tip five together and you can also fuze the calcaneus and the tallis together. Is that correct.

01:31:33:17 - 01:31:34:05
Speaker 2
That's right.

01:31:35:05 - 01:31:37:20
Speaker 1
Yeah. And they're two separate things or do.

01:31:37:20 - 01:31:53:11
Speaker 2
Separate things a lot of times in kind of the diabetics that we're talking about where they've got a lot of alignment in their hands, used way out to the side, we'll put a rod up through the couplings and into the tibia where use both of those joints to get back in alignment.

01:31:54:18 - 01:32:00:10
Speaker 1
And your because you were talking about a fusion for me. Where you talking about a calcaneus talus fusion?

01:32:00:11 - 01:32:24:14
Speaker 2
That's right yeah. For you. Okay. You develop stiffness and pain in that joint and you can't get it moving again with taking your hardware out. Maybe and maybe arthroscopic lead to breathing your joint. Then fusion is a good option because you don't lose much that you haven't already lost the you if you if you to the point where you're talking about a fusion you've probably already lost your central motion because surgery and subsequent surgery.

01:32:25:07 - 01:32:35:04
Speaker 2
So the fusion really will just take away your pain. Mm hmm. But it won't decrease your your motion any more than you. Any more than you've already lost it.

01:32:36:04 - 01:32:41:03
Speaker 1
Yeah, that's the point. That you're looking for a fusion. I actually don't have pain in that joint at all, which is pretty nice.

01:32:41:03 - 01:32:43:18
Speaker 2
It's just good. Yeah.

01:32:44:04 - 01:33:03:09
Speaker 1
I. The only thing I've been dealing with now is ever since he's been giving me that, I've been like, cranking my, my calcaneus kind of forcing it through its range of motion. And I feel the tendons around the right side of my malleable is kind of like stretching and wrapping over the bone. Is that just because they're tight or are they are they fixated to the to the hardware?

01:33:04:03 - 01:33:04:20
Speaker 1
Do you have any idea?

01:33:05:00 - 01:33:22:10
Speaker 2
It's like they're slightly a they're like me just stuck in scar. They're probably stuck to the plate. Like, we go in there and take your plate out, like carefully dissect those tendons out and get them moving again. And I'll let you tell you that right away to try to keep them from getting stuck again.

01:33:22:10 - 01:33:38:09
Speaker 1
Yeah. So I guess this is a great little conjuncture to hardware removal. Do you recommend it? And yeah, the only time postoperatively is just letting the wound heal. Right. Otherwise it's quite good to go structurally for the bone.

01:33:38:21 - 01:33:56:18
Speaker 2
Well, so I would only out your hardware. It's bothering you. So some of your tendons, you start down to it if you feel it's bothering you on the outside of your outside part, right under the skin of your shirt, right under the skin. Then it's worth. It's worth taking out. If it doesn't bug you, take it out. It can stay in there forever.

01:33:57:13 - 01:34:22:17
Speaker 2
The post-operative. Yes. You worry about the incision, so I will let you walk on it. But I'll generally have you walking through for a week or two till you get your stitches out and I will get you back into therapy in about a week. And this you there will be holes, one of the screws or so. I like people to avoid impacts like going for runs and for 6 to 10 weeks, something like that.

01:34:23:05 - 01:34:37:02
Speaker 2
They'll feel and I'll feel really comfortable with you run in between ten and 12 you just of let you ramp up your activities tolerate. But the bone is a little bit weaker when you take out when you take out the screws until you can't your body feels more prone.

01:34:38:05 - 01:34:45:14
Speaker 1
Yeah, I would imagine so. And I guess the more screws you have, the more fragile it is. Right? I got 14 in there, so that's going to be like Swiss cheese in there. Yeah, it's going to be.

01:34:45:19 - 01:35:07:20
Speaker 2
Yeah. And how it sounds largely from those. Yeah. Yes. You'll have 14 holes in there that need that need to heal in before you're really ready to impact it. And I would just recommend you, you know, you let it heal. You can you can walk on it. You can you know, you can start and, you know, start doing more activity and get on your bike, things like that.

01:35:07:20 - 01:35:15:04
Speaker 2
But you want to avoid impact. You're like jumping off a bouldering wall or onto a pad or something like that for for a couple of months.

01:35:16:03 - 01:35:19:05
Speaker 1
Yeah, it'll be horrible and horrific. Just a crushed all over again.

01:35:19:09 - 01:35:38:07
Speaker 2
You don't even think about it, but think about re break into these things that I was like this weekend. I'm like I really wanted to go wake surfing and I'm like, I'd love to, but I'm just not ready. Like, can you imagine? Like, yeah, like wake surfing and then broke my osteotomy like, no, yeah.

01:35:39:22 - 01:35:41:05
Speaker 1
Yeah. It's not going anywhere.

01:35:42:11 - 01:35:45:06
Speaker 2
Though this year. Yeah.

01:35:46:08 - 01:36:04:10
Speaker 1
I'm wondering about like scoping if someone has a lot of pain and they're arthritic. Like in these cases we were talking about four fusions or anything like that. If you're scoping and, you know, pain and dorsiflexion when you're scoping it out, what about that? Is creating a better outcome for the person and how is it alleviating pain if it does so?

01:36:06:03 - 01:36:27:08
Speaker 2
Well, a lot of times what we'll do is we'll inject the joint first because if you get relief. So in your case, probably your ankle, right. Like, well, it will inject your ankle even if it's just some light. Again for a day. Did you get some relief for that day that if it did, then it's possible that it's likely that your pain is coming from your joint.

01:36:27:18 - 01:36:46:23
Speaker 2
Right. So, okay, we could focus we could focus on the joint. And so if you got joint space, meaning if you got no joint space meaning then but you need to have something done besides the scope because you don't have any cartilage left. You no need to talk about effusion or replacement or something like that. In Kylie's case, you know, his Taylor joint.

01:36:46:23 - 01:37:13:18
Speaker 2
It would need to be it would need to be a fusion. If you got space left and the injection alleviates pain, you probably dealing with some scar tissue or impingement or you've got scar tissue that is catching between the two bones as they move in, causing your discomfort. So that's the case. You can take that away with a scope, and that's the only way for a guy who had an ankle fracture 29 and he was having been in the front of his ankle joint, his plate was bothering him.

01:37:13:18 - 01:37:29:22
Speaker 2
So he took his plate out and we still disjointed, spent some time just looking around the joint. We evaluated the joint service and took a bunch of pictures. We took a bunch of scar tissue on the front of the joint, which is typically scar tissue will collect in an ankle and hopefully and they'll get him walking right away.

01:37:30:05 - 01:37:36:02
Speaker 2
I'll get him into therapy in a week or so and try to prevent that from coming back and take away some of that impingement type pain.

01:37:37:02 - 01:37:40:04
Speaker 1
And so what's the what's the healing process? Time for something like that.

01:37:41:19 - 01:38:02:20
Speaker 2
Something like that. Like I'm having him in his in his boot, mostly because I made a big incision over his skin, letting it play out like I really want I don't want people to go to go crazy too quickly and break down Susan for example, we didn't do anything structural with him. Right? Like he's got like he could theoretically his bones could tolerate running the holes in his tubular.

01:38:02:20 - 01:38:24:03
Speaker 2
They don't take a lot of weight like your calcaneus does so he could be a little bit more active but we really need is incision to heal otherwise you're going to break down an infection and you got to do a deal with that whole thing. So if I just scoped your ankle, I would generally let you walk. Now, between the knee strap, I'm getting the therapy within a week and.

01:38:24:03 - 01:38:46:15
Speaker 2
I wouldn't want you running or playing sports until your incisions healed. And then. And then you can tell me when your swelling was going down and when you could tolerate it, and then you could go back to that stuff. So it can be as quick as two weeks, it can take as long as eight. If you got actually took out a lot of scar tissue and you bled into your joint a little bit, it may take you a little bit longer to rehab from that.

01:38:47:02 - 01:39:10:07
Speaker 2
There's not a ton of downside to it other than going under anesthesia, the expensive surgery, trying to get a surgeon to do it in Canada. And, you know, there's potential for some some nerve issues. Like you get a little bit of irritation from your incision, particularly if you're really active really quickly, even if they're tiny little mole skills, it's not totally benign.

01:39:10:08 - 01:39:12:11
Speaker 2
You can you can definitely get a little irritation from that.

01:39:12:19 - 01:39:18:07
Speaker 1
And if you had a sub control defect, is that something that scoping could have a good outcome for it as well?

01:39:18:13 - 01:39:36:15
Speaker 2
Not really. Yeah. I mean, you talk to everybody who's got a little bit of a different opinion, but there hasn't been a ton of new work done on defects, but typically it will kind of stimulate the area or clean it up. You can take a little hole in the cartilage and try to try to draw some stem cells into the joint.

01:39:37:03 - 01:40:11:13
Speaker 2
There's some cartilage, substrates that we will use. Like when I do revisions, like the first time that I see a defect or some form of defect, I'll usually just kind of degrade it and sort of stimulate some bone marrow cells come into the into this on an injury the second time. And I'll usually use there are a couple of options there and there's a little cartilage, substrate discs you can use and kind of so in there a little there's this mechanized cartilage that's non-living that you can mix with with spun down blood cells or any input into the defect.

01:40:12:03 - 01:40:32:08
Speaker 2
There is actual live cartilage cells that they get from kids who've died from other, other of course. And they all you can that's called the noble cartilage where you can put that in and I'll use that occasionally. Nothing's perfect, but those those are some pretty good options for painful lesions.

01:40:32:08 - 01:40:52:20
Speaker 1
And so is that kind of like almost like like art. So one of the questions I had here because you just mentioned about like breeding it or getting stem cells into it itself, what do you think? Like the effects like like I've read a study about them looking into like stem cell grafting in to like put kind of tissue like that on.

01:40:53:01 - 01:40:57:09
Speaker 1
Is that something that you see in your field? Is that maybe gimmick? Yeah.

01:40:57:23 - 01:41:20:12
Speaker 2
We do that. We will. That's where you'll mix. You'll make stem cells. I don't do it as much here. I will use more platelet rich plasma. Yeah. Or because the patient generally has to pay for that, either whether it's stem cell that you take out of patients and send it down or platelet rich plasma, which is from peripheral blood, all mix that with with the cartilage that I put in there to do it.

01:41:20:12 - 01:41:47:19
Speaker 2
Some biology patients generally pay for that, which is where I did my fellowship. Everybody got stem cells. We would we had they had their own in-house stem cell company. And people are planning to come out, fly out there and have surgery anyway. So they didn't care. And it's it's great that adds biology and the data on like how much it really helps is not not totally there and it certainly doesn't certainly doesn't hurt.

01:41:47:20 - 01:42:01:23
Speaker 2
Right. Like that's what I would want. I would want, you know, cartilage mixed with bone marrow aspirate or or just PRP. You would be fine. But just something to give it. A little bit of biology can give you a better chance you lives.

01:42:02:07 - 01:42:24:12
Speaker 1
Yeah so I've I've actually been using PRP for scalp. I've been balding a little bit. Yeah. Hannah works at a plastic surgery place, and it's turning more into, like, a, like a batik, almost, because the surgery, the surgeon's going to retire sooner or later. And there have been testing the PRP on my scalp and it's been working. It's actually pretty cool.

01:42:24:22 - 01:42:35:17
Speaker 1
Yeah It's funny that you you you mentioned it for for these kind of injuries. Like, is there a use case for PRP for my my sort of Taylor joint or the surrounding area?

01:42:36:04 - 01:42:53:20
Speaker 2
Yeah. One of my partners does a lot of PRP and she thinks it works better in like tendonitis, things like that than it does in arthritic joints. But there's not a ton of downside other than the expense. Okay. I think if I remember where.

01:42:53:21 - 01:42:56:19
Speaker 1
Where would I instruct the surgeon to inject it.

01:42:57:03 - 01:42:58:03
Speaker 2
In your said joint.

01:42:58:13 - 01:42:59:10
Speaker 1
So you need okay.

01:42:59:23 - 01:43:06:14
Speaker 2
You can inject it around your peroneal tendons do it. Typically we would we would visualize that with an ultrasound.

01:43:07:14 - 01:43:08:00
Speaker 1
Okay.

01:43:08:21 - 01:43:16:00
Speaker 2
So we can give them a little diagram or or just bring it into the office. We'll do it.

01:43:16:17 - 01:43:21:22
Speaker 1
There we go. Actually, Hannah's the one who's been drawing up my my plasma, so maybe I'll do that and bring it to.

01:43:21:22 - 01:43:37:10
Speaker 2
Bring some in and, and and we use ultrasound to localize your use of the other joint in your peroneal tendons and injected in there. That's great. I mean, I love these things. I love when you hear that these things are working for people for sure. Yeah.

01:43:38:07 - 01:43:45:07
Speaker 1
Yeah. I guess I definitely think I'm going to get these these plates and stuff removed. So I just do it all in one swoop, bring it, bring the plasma and.

01:43:45:18 - 01:43:48:15
Speaker 2
We're going to do them.

01:43:48:15 - 01:43:50:03
Speaker 1
Like, what am I going to do with the hardware?

01:43:50:09 - 01:43:50:18
Speaker 2
Yeah.

01:43:51:13 - 01:44:05:06
Speaker 1
Yeah. I'll probably hang it up somewhere shallow box or something, because like I told you before, I have the nut that I broke. I pulled it out of the wall and I have the same gloves I was climbing on that day too. So I'll probably just make, like, a little memorial, including. Yeah. Screws and all that.

01:44:05:18 - 01:44:25:09
Speaker 2
That sounds great. I think it goes in my personal plates are in our Christmas ornament box below the instruments that I committed the screws into the plate. The plate was like a gunmetal color. And then my last were like stainless steel and with the medial plate was particularly bothersome because it would bang on the crossbar of my bike.

01:44:25:09 - 01:44:38:06
Speaker 2
So I made that one into a tap handle for size. I always wanted to do that. One's actually a little bigger than the ones I got. I got to think something good to do with that one. And I'm hoping these things I got now stay in there forever.

01:44:39:08 - 01:44:42:04
Speaker 1
Yeah. Don't have to go under the knife again.

01:44:42:17 - 01:44:44:14
Speaker 2
Now, man. Not if you can help it.

01:44:45:22 - 01:45:03:17
Speaker 1
I'm. I'm wondering here, like, where do you see the future of orthopedics going? Are there any big breakthroughs that are going to happen in our lifetime? That's with stem cells or joint replacements? I'm just wondering what your thoughts are on something like that.

01:45:04:09 - 01:45:22:10
Speaker 2
Well, I hope so. So the joint replacement and the stem cell question are related, because if we can find a way to regenerate cartilage, that would be amazing, right? Like fix the cartilage, defect in your jaw and fix it in mine. Fixes in tiles without having to do either a fusion or a replacement. Because right now you can, right?

01:45:22:10 - 01:45:39:09
Speaker 2
Like your joint wears out your knee joint and you solve the ends and put in metal and plastic and that same thing with your ankle and with toes, take the whole joint out and put a giant screw across it. You know, if we can figure out how to how to regenerate cartilage and you can talk about this for years, that would be amazing.

01:45:39:17 - 01:46:03:22
Speaker 2
You put our joints guys out of business, right? But your patients didn't think it would be cool. Is the intraoperative imaging is relatively archaic. So I was thinking about this question the see arms we got these old X-ray machines that like that just don't take great pictures like my X-rays in clinic are much the machines stronger, the issues are better.

01:46:03:22 - 01:46:25:10
Speaker 2
And every once in a while I'm like, what doesn't look as good as I thought it did in the O.R.? You know, we have see arms in the O.R., but you generally, it's called an arm. I'm sorry. We have questions in our in no arms that everybody will take a shot and everybody has to leave the room. It's like a ton of radiation, and it just it's it takes a ton of time, right?

01:46:25:10 - 01:46:45:08
Speaker 2
Like baller to the arm, in Kylie's case, to take me 4 hours because in he's got to take it off and all this stuff that you don't want to have it for forever. So if we can improve interoperate intraoperative imaging I think would be great, like in some 3D use. Like a couple of things to make 3D 3-D pictures and get a better picture.

01:46:45:08 - 01:46:49:15
Speaker 2
Of course. So Taylor joint things like that, I think that'd be great. And to be great to figure that out.

01:46:50:19 - 01:47:02:19
Speaker 1
Yeah, it makes a lot of sense. Yeah, for sure. Why? Why is the castle why is the cartilage so such a difficult area to heal like biologically? Why are we such problems fixing them?

01:47:03:09 - 01:47:28:17
Speaker 2
It doesn't have nerve endings. Like you don't have nerve endings and it doesn't have blood supply to bones. Great, because it has it has blood supply. Right. Leads your well cartilage. Cartilage doesn't have that. And so when you have a defect, it has a very hard time, very hard to regenerate. So no nerves, no blood. It's just tough for now.

01:47:28:18 - 01:47:29:01
Speaker 1
Okay.

01:47:29:13 - 01:47:36:13
Speaker 2
For now. Yeah, we got to figure it out. It's tough and it's a tough nut to crack.

01:47:36:13 - 01:47:52:20
Speaker 1
Is there any potential that, like, prescribing steroids, like testosterone, could help in the healing process, even just like getting out, like poster, just helping people recover faster? Like, what's the reason? That's not a male.

01:47:52:20 - 01:48:24:05
Speaker 2
I think the reason that it's not is that most of us have adequate levels anyway. There's there's some data that that it could cause wound healing issues. And then another that said there was an increased DVT risk, like blood clot risk. I think that's mostly been debunked. Honestly, I don't I don't think because there's there's more research, I think with with patients that need to be on test therapy for whatever reason.

01:48:24:09 - 01:48:47:22
Speaker 2
And and I think there's there's been a little bit more more research on it now, you know, like changing genders or whatever, whatever other health reason, people need to be on it and we get that. And so there's been a little bit more research in my understanding lately. And I think I think that it doesn't necessarily cause any of those problems like increased DVT or or wound problems.

01:48:47:22 - 01:48:53:06
Speaker 2
So they may not be a huge downside to it, but We haven't we certainly haven't talked about it very much.

01:48:53:07 - 01:49:01:11
Speaker 1
Interesting. And I'm wondering, what's your opinion about like hyaluronic acid or like corticosteroid injections.

01:49:04:18 - 01:49:27:00
Speaker 2
Like in the gel or corticosteroids can slow healing. So like if you have like a like you want to inject a corticosteroid into a tendon, for example, you do a joint is fine because it can it can decrease inflammation. But if you have an infection, for example, it can actually make the infection worse. Hyaluronic acid could definitely help.

01:49:27:00 - 01:49:46:17
Speaker 2
It's it's in the States. Again, it's kind of a coverage issue, right? Like The it's approved in the knee. But if anybody wants it in the ankle, then they got to pay for it themselves. And it's one of those things where some people it helps. Some people it doesn't. So the only downside of doing it is really the expense.

01:49:46:17 - 01:49:57:10
Speaker 2
Like if my ankles or my for me and my knees bugging me now, maybe I'll give it a try. This not a ton of downside do the as long as I have an allergy to eggs but.

01:49:57:16 - 01:49:58:04
Speaker 1
I'm safe.

01:49:58:04 - 01:50:14:03
Speaker 2
There. But for like if Kyle wants it in as Taylor joint like we would have to, you know, find one that fell off the truck through, like steal one, you know, to get it. Let's see what it is. It doesn't need smaller joints like that, does that? It might have.

01:50:14:07 - 01:50:20:05
Speaker 1
Does this cortisone like degrade tissue or anything over time? I feel like I've heard that does.

01:50:20:18 - 01:50:45:12
Speaker 2
Yeah, it does. So like in someone like what do you guys see? We're going to we're going to hang on to your joint forever. I would only do one, maybe two steroid injections because over time, it can degraded cartilage. But if you've got any stage arthritis where we know we're not saving that joint, in the end, like steroid injections is going to help you, you can go climb into three, four or five months on.

01:50:45:13 - 01:50:54:10
Speaker 2
Yeah. Keep doing injections, you know, push up the surgery. It's not not a ton of downside. Gotcha. But it will be, right? Yeah. Okay.

01:50:55:05 - 01:50:55:19
Speaker 1
Wicked man.

01:50:56:08 - 01:51:01:03
Speaker 2
Cartilage is fragile. Yeah. And we've all amped up some cartilage.

01:51:01:03 - 01:51:16:18
Speaker 1
Unfortunately, man. Yeah, yeah, I think. I think that's. I think that's everything on my end here. Kyle, do you have anything else? No, man. I was honestly, we got through it all. It was a lot to talk about, and I think we delve super deep and us super happy with the conversation.

01:51:17:13 - 01:51:20:23
Speaker 2
All is awesome. See you guys.

01:51:20:23 - 01:51:44:08
Speaker 1
Yeah. I just want to say thanks so much, man, for taking, like, your valuable time and, you know, sitting here talking with us. I know you got a family there and stuff and your kids and everything. So I really appreciate it. It's been a totally rad conversation. And and I also think it's going to be really good for a lot of people to listen to because there's a lot of people out there, you know, like Colin, I grew up, unfortunately, and you, you know, you have, you know, had some unfortunate accidents and we get to listen to, you.

01:51:44:19 - 01:52:00:06
Speaker 2
Know, yeah, U.S. business do unfortunately but why you guys you guys are both you guys both just doing awesome with your injuries and getting it out there. And the conversations that you're creating are just great. And I really appreciate you, including me.

01:52:00:06 - 01:52:11:22
Speaker 1
Yeah. Good, sir. Thanks for taking your time. And it's definitely been a cool full circle thing to come around all this way after all this time. It's been up in an awesome, unique experience.

01:52:11:22 - 01:52:16:05
Speaker 2
So thank you, no doubt. Appreciate you guys.

01:52:16:05 - 01:52:20:13
Speaker 1
Yeah sorry about the to oh it's you know, I just wanted to catch it.

01:52:21:18 - 01:52:27:18
Speaker 2
Yeah, you did. And I had this. It's like a little like this is for fishing, but like.

01:52:27:18 - 01:52:28:17
Speaker 1
Is that the cheerleader.

01:52:28:18 - 01:52:45:19
Speaker 2
Means. Yeah, yeah, yeah. This is more like when it when we're six and this one's for fishing and it just happened to be here because I was trying to fix my wife's necklace. So, anyway, we like to fidget, and I'm glad you caught me, man. I wish it was.

01:52:45:19 - 01:53:00:06
Speaker 3
It's all good.