Dr. TO 864

Full house in studio today with 4 doctors and of course they want to start out with what type of music they listen to in the O.R. Doctors discuss there start time for surgeries or meeting with patients and go into depth about injuries and doctor life. The doctors take calls from listeners.

Episode Transcript

(00:00):
It's tip off time for Doctor t. O. Sorriel and Inside Sports Medicine
on ninety seven to one The Freak. Doctor Sorriel, one of the nation's
leading orthopedic surgeons and former head teamphysician for the Dallas Mavericks, bringing his
unique sports insights and stories from insidethe game. With special guests from the
world of professional, college and highschool sports and sports medicine, the Doctor

(00:20):
breaks it all down. Buckle upyour chin strap and tighten your laces for
the most informative ninety minutes in sportsmedicine. It's kickoff time for Inside Sports
Medicine with Doctor t. O.Sorrial on ninety seven to one The Freak.

(01:19):
Good Saturday morning, everyone, andwelcome to Inside Sports Medicine. I'm
your host, Doctor t O.Sorryall on this first Saturday of the year.
Happy New Year everyone. This isyour sports Medicine current Events show,
where the topics are ripped right offof the sports desk. Over the next

(01:40):
ninety minutes, you're going to beinformed, entertained, and hopefully learn something
new. You'll have the opportunity tocall in or text in questions and comments
and kind of listening as we chatthroughout this morning. Today, we have
a full house in the studio.We have our regulars, doctor Scott Blumenthal's

(02:04):
good morning, Scott, Hey,good morning. How you doing, Doctor
Brad Ballard, what's up do?And doctor Ryan Blaylock, good morning.
We have doctor doctor doctor, doctor, doctor, doctor, doctor, doctor,
doctor, doctor, doctor, doctor, doctor, doctor, doctor,

(02:27):
doctor, doctor, doctor, doctor, doctor, doctor, doctor, doctor,
and doctor. Well we miss anyone. You have to be of a
certain age to know this reference.There's an old movie back in I don't
know, seventies or eighties called SpiesLike Us with Dan Aykroyd and Chevy Chase.
Chevy Chase, right. Chevy Chaseis one of those comedians that either

(02:52):
you think is really funny or youjust like don't get it. Which one
are you? I think he's reallyfunny. I'm an old, I'm an
original. Well we're the same vintagethe original Saturday Night lives back in the
seventies. So you think he's funny, I think yeah, I think so.
You know, we were just talkingabout the what's the vacation movie Christmas
Christmas vacation movies you're playing? Thatwas playing you know this whole holiday season.

(03:15):
Oh yeah, and those so Icame out back during the heyday of
Saturday Night Live, right. Soyeah, So there was a reference that
movie spies like us, and therewas a scene where the doctors were all
meeting each other and it was doctor, doctor, doctor, doctor. I
guess I don't have to do thatanymore. No, you don't have to

(03:37):
explain it. I think I thinkthey got it. So to us,
it was very funny. The openingwas to our show was very funny.
Just now, just now. Tous, it was funny. Oh my
god. Okay, so we're stillwaking up. Yeah, everybody's got coffee,
so it's we're good. So ifyou're new to the show, well

(04:00):
thank you. If you're a regular, and I know that many of you
Destination show, thank you for yourloyalty. I have a regular story.
Regulars, can you do air quoteson a radio show? That just didn't
work either? It didn't didn't anyway. So one of our regulars was in

(04:23):
to see me as a patient Thursday, and I've not seen her nor met
her before, but we do thevisit, we come up with our treatment
plan, and she said, Ilove your show and I wanted to share
a story with you. I said, please feel free she's a nurse and

(04:46):
when she finished her shift, onher way home from the overnight shift,
she would tune in and listen tothe show. And this is where I've
found it tremendously flattering. She wouldget home and stay in the car to
finish the show, and she said, I thought you'd want to know that,

(05:11):
And I'm terribly flattered by that.I didn't think we were that interesting.
But it's not really a matter.It's not really a matter of us
being interesting or entertaining. It's thatwe teach, and people want to learn
about tennis elbow and that's one ofthe things we're going to talk about today.
People want to learn about what Scottdoes with disc replacement. And you

(05:31):
know, even though it is Saturdaymorning, and even though it's you know,
you guys are all on your wayto soccer practice or making rounds.
If you're medical, people want tolearn about this stuff. I call our
listeners medical nerds, but I don'twant that to sound offensive. Yeah,
but one of the things that hasalways surprised me over the years is the
amount of medical professionals that listen tothe show and appreciate the show. Oh

(05:55):
absolutely, yeah, all the wayfrom athletic trainers, nurses, doctor,
I know salespeople who are in medicalwho are like, yo, yeah,
I listen for sure. So wewe kind of pulled the curtain back and
we talk about things that regular peoplewonder but they don't really have answers.

(06:17):
For example, do you guys listento music in the O R? Yes?
Yeah, And then what do youlisten to? And I, you
know, we tell them, youknow, at least in my in my
station in my O R. Youknow, I listened to classic rock,
and they're just I think they findthat strange, But I don't find it

(06:38):
strange at all. I'm always entertainedby people's playlists. Uh, doctor Bloomenthal
Scott, what do you listen toin the O R? Man, It's
the same thing, classic rocker.And it was funny was speaking talking to
this with my daughter, who's,you know, finishing a residency in neurology,
and you know what they listen to. And I said to Zoe,

(06:58):
I said, Zoe, I havethis weird thing. Tell me if it's
the same with you that we open, we close. I teach the fellows.
The fellows you know, do somelike beginning and ending stuff. But
the meat of the surgery. Ido. And I said, if you
asked me what song was on whenI'm dialed in, I have no idea
hundred percent. But you know,at the beginning of the end, when

(07:18):
we're just kind of prepping and gettingstuff ready, we talk about you know,
you know, we play name thattune and in the first couple bars
or beats. But yeah, Ieye zone out. I don't. You
could be playing anything when I'm zonedin, and I just I don't hear
it. Do you have a preference? I don't. Usually I let the

(07:39):
circulating or scrub nurse choose, youknow. So I'm gonna, I'm gonna.
I'm gonna. I'm gonna tattle onhim. So I was helping.
I was helping Ryan yesterday do acase. And you can you still know
how to do handcases. I washolding retractors, oh those little those little
ones with the little prongs. Yes, yeah, I was holding baby retractor.
So helping is maybe too much ofit was a stretch. I was

(08:03):
there, You were there, andso you know, everything is is prep
draped and and I walk in andI'm putting all my gloves and all that,
and it's just silent, And Isaid, Ryan, why don't we
have music? He goes, Idon't care. I said, how can
How can you work in complete silence? Because I can't work in complete silence.

(08:24):
So here's the analogy. And thismay not be a good analogy.
Have you ever tried working out andyour music's broken? Like you know,
say you put your headphones on andnothing's working. Can you work out without
music? That's how we did itback in the seventies and eighties, dude,
what's wrong with you? Yea workout like the same thing. So
I would go on run with nomusic? What what? What? I

(08:50):
would go on a five mile run? And how the world do you survive
running? Oh? My goodness?But okay, So now say you're in
the gym and you're using the stationarybike? Did you do that without music?
I can't? Now, not now, I can't. That's my that's
my point I'm talking about. Now, I'm not talking about you know,
before Sony Walkman's or whatever it wasit was. I swear to god it

(09:11):
was a Sony Walkman. And thenthey had it Sony Discman, which you
put your CD in and it skippedevery time you took a step. Do
you remember how bad the original mP three players were talking about skipping and
the meeting. I still have those, Yeah, the little iPod. I
have a drawer full of blackberries.I never threw away blackberries. Blackberries.

(09:33):
Tarik and I were we we wewere the last holdouts with blackberries. And
everybody else was getting iPhones because Ilike the keyboard. I thought the keyboard
was cool. Blackberries were the best. But this music thing, I mean
really, it really breaks up theIt breaks up the silence and it gives
you something to talk about. Particularlymusic comes on. I'll say this real
quick, Doctor Levy has the mosteclectic, vast variety of music. Am

(10:01):
I wrong? Ryan? It is? I mean it is everywhere. You'll
hear Taylor Swift and you hear country, and then Richard Pryor comes on.
Does not surprise me. I mean, and I'll be in the room helping.
I'm like, Wow, I'm justentertained by the whole list, the
whole playlist, and it's always different, well it's always, but it's always,

(10:22):
you know, very you know alot of variety. I found out
a few years back that Rick oneof his favorite artists. He was the
ficionado of Gordon Lightfoot. I loveGordon Lightfoot. He went to see him
just last year. I think newGordon Lightfoot died last year. It was
about three four years ago, andI ran into him at the concert because
I went to Alstar. I hadto admit I was a Gordon lightfooty.

(10:43):
I was not the recor of theEdmund Fitzgerald. Have we talked about anything
substantial this morning? It depends onwhat me. I mean music I think
is substantial. So we have acouple of things that we're going to get
to today on sports medicine. Oneon one, we're going to talk about
tennis elbow. On if we havetime, we're going to talk about ACLS.
But right after the show is over, we're going back to the office

(11:07):
to do something kind of fun.Yeah, it'd be real cool tell people.
So we talked about this a coupleof weeks ago. But every year
we do a we really host agroup of pre combined athletes. So these
athletes who are done with the collegefootball season and then looking to enter the
draft to become professional football players.We really almost kind of do like a

(11:30):
mock medical screen for these guys.It's very beneficial for them. The agents,
and really what we're looking for isis there anything that's going to hinder
their performance on the field or thatwhen they go to the combine and go
through the medical screen, there isthere anything that we can find that will
help improve their performance or at leasttreat whatever thing that you know, might

(11:54):
come up whenever they go to themedical screen at the combine. And it's
it's actually pretty fun. It isfun. You get to see these guys
that you just saw on TVs yesterday. Yeah. Yeah, So there's not
a weekend that goes by that ifI'm just kind of scanning through NFL Sunday
guys that have come through our clinicwho play on Sundays. Now, Yeah,
these screenings are extraordinarily valuable. Sofor the rest of us who really

(12:18):
did not know what a combine was. There's two parts. There's a and
this was NFL and I did theNBA combine for guys twenty five twenty five
different years. And there's two components. One is a performance component, how
fast do you run the forty?How high can you jump? And they

(12:41):
have some scrimmages in the NBA.I don't know what they do in the
NFL. In terms of actually onthe field stuff. But anyway, there's
a performance component, but then there'salso a medical component, and that medical
component is thorough. It you arebeing evaluate, examined, prodded by physicians

(13:03):
from every team in the NFL andobviously for the NBA same thing. So
you have to go through thirty differentstations, and in those stations you are
examined and questioned, et cetera,et cetera, and they get MRIs of
pretty much every body part. Ifyou say, hey, when I was

(13:24):
in high school, I rolled mybig toe, they get an MRI's right,
they get an MRI. And soit ends up being obviously two parts
performance and medical. On the performanceside, I don't know that that's really
going to hurt you if you're atenth of a second off on your forty

(13:45):
run. But if they find thatyou have a torn meniscus or something,
yeah, you might drop. No, no, you will drop. So
it's fascinating me because year after year, everybody is so focused on how fast
the forty is going to be ran, how big the broad jump is going
to be. You know, allof these measurable numbers based on performance,

(14:09):
But what we know behind the scenesis what is probably a bigger influencer in
terms of what's gonna help or hurtsomeone's draft stock is actually going to be
medical. And we've got some stories. Yeah, I think we shoure talking
about before before we got on air. What about the subjective part? What
if they I could imagine an NFLplayer and saying, so, do you

(14:33):
do you ever you forget a concussion? Nope, and they're just they're just
not going to tell you. Sothat happens, right, right, that
happens. So here's what here's what'sbeautiful about today. And I do this
every year. We talk to theguys when they show up to our clinic.
We say, listen, we arehere for you. Yeah, We're
not like like we we are partneredwith you and your agent to actually help

(14:54):
you. It's not gonna benefit youto not disclose something today, right because
if if we can find something thatmight come up later, that's of benefits
you. You don't want to tryto keep things close to the best of
I'm saying, but not not yourdeal. But in the actually go to
the combine the NFL doctors happens allthe time and what so, so there's

(15:16):
a there's a fail safe mechanism,at least in the NBA, because we
get a medical form from their trainers. So their college trainers fill out a
medical form what did you see playerx four during his four year career,
and then you get this list ofwhat the player was seen for. So

(15:37):
if they say they didn't have aconcussion, but the trainer says they had
a concussion, you pick it up. You pick it up. Yeah.
Look, uh, what if theyou know, the player and the trainer
kind of worked together and you know, yeah, I really can't my medical
history. What if he didn't disclosewhile he was at you know, at
college. So yeah, I meanthat's something to the trainer wasn't meticulous in

(15:58):
doctor every time he saw the athlete. Look, it's it's funny you picked
concussion because that's a hot topic andthere's not really a test for that kind
of but and often that goes undiagnosedor unrecognized. But the other stuff,
for example, the case that Bradand Scott were talking about this morning,

(16:19):
the player with the back pain thatyeah, played for a major university and
I think they won a national championship, may have that year. I think
they did win the National championship thatyear. Anyway, he was, he
complained of back pain, pain,shooting down his leg, couldn't even sit
down. It was pretty textbook,but for whatever reason, it wasn't picked
up by his university, but itwas picked up by the screenings sent to

(16:42):
Scott Blimenthal had surgery and then tellthe story at the combine. Buddy of
mine at the time was one ofthe NFL doctor spine guy and said he
was in charge of screening all theback patients players and he said, of
four or five five players that hadsurgery in the offseason, the only one

(17:03):
he cleared was the one that Idid the surgery on. Yeah, they
all still had problems. So soI mean you got to consider this.
If that doesn't get picked up andhe shows up to the combine, it
would have been picked up with acomprehenated disc. Oh yeah, I mean
he goes from what he was maybemid first rounder, to he was he
was supposed to be. Interestingly enough, this is the exact opposite. What

(17:26):
do you expect? He was supposedto be a mid rounder like fourth,
fifth, sixth round. He endedup being a second rounder. I mean
he I mean, it is iswhat the I read about it? What
he was supposed to be? Butall right, quick little break Inside Sports
Medicine. The gang is in thehouse live. The number is seven eights.

(17:47):
No, what is the number?The number is two one four seven
eight seven one one, nineteen seventyone. And by the way, that
number you can call or you caneat been text And so if you're listening
to us on the iHeartRadio app,text us that. I'm very curious how

(18:07):
many people listen on the app versushow many people listen on the air,
And if you're listening on the appfrom a long ways away, mention that
two one four seven eight seven nineteenthirty one. Too sorryl Inside Sports Medicine
Coming back, Welcome back, Welcomeback to Inside Sports Medicine. Except Bruce

(18:55):
hornsby Bruce hornsby the way, itis, I think that song's been remade
by well several several times. Yeah, there's so many covers that when I
actually played this in my car withmy kids said, oh who made that?

(19:15):
Yeah? They thought this was theremake. No, this was the
original. Welcome back to Inside SportsMedicine, too, sorry. I Scott
Blumenthal, Brad Ballard, Ryan Blaylock. The other side of the glass,
Garrett is running the board and answeringthe phones. Yes, yes, I
gave out the wrong number. Iam so sorry. Two one four seven,

(19:38):
eight seven, nineteen seventy one,nineteen thirty one is my phone number,
nineteen seventy one. In case youwere interested in Too's phone number.
Well, it's not that you're interested. Is that you know how I made
the mistake because it was my Okay, we have to talk about some in

(20:00):
medical Okay, okay, I promiseyou guys were waking up. I'm just
telling you, like I got acoffee. Do you be waking up?
Well? You get up early?You always get up early. Yeah.
Hitting the stride here, Yeah,I'm not an early riser, So pulling
the curtain back so we all doprocedures and surgery and that sort of thing.

(20:26):
It always boggled my mind how mostof the surgical colleagues want that seven
o'clock slot. Oh, we canstart at six thirty. Can we start
at six thirty? What are youthinking? No? I know I don't
start at six thirty. What areyou one of those people? I'm just
an early riser, no matter whatI mean. Scott are you. I'm

(20:48):
up at five thirty six o'clock onthe pretty much with Brad, I have
to have the seven o'clock slot.You've got to be kidding. I'll give
away my afternoon time, but themorning times, that's fine. Seven seven
seven's too early for me. I'mmore like my sweet spot would be like
a seven thirty eight o'clock start.But I just I don't know. I'm

(21:11):
not hitting on all cylinders by seventhat I'm an eight thirty start. I
always started at eight thirty. I'vedone it. So this goes way back
to when my kids were young.Because of my commitment with the Mavericks and
all the evenings that I spent awayfrom the kids. I always made it
a point that we're going to havebreakfast together before they go to school,

(21:34):
and often I would take them toschool and then I would go do the
surgery or see patients or whatever.And that's stuck. So now, even
though we're empty nesters, it's aneight thirty start anyway. Okay, Grandpa,
but that was but I was doingthat when I was thirty. Little
sidebar thing again. Gosh, there'sa lot of a lot of derailing today,

(21:57):
and most of it is me.When the MAVs were in the playoffs
in two thousand and six, bythe time we made it to the finals,
the schedule changed so that they werenot evening games anymore. There were
some noon games, and so wehad a noon game in Miami scheduled,

(22:18):
and with the time change that waslike eleven o'clock Dallas time. Well,
a lot of the players would stillbe asleep at eleven o'clock had this not
been a game. So I recruiteda sleep expert. I went to Uto
Southwestern. I met with this guywho literally wrote the textbook on sleep,
and he was the one that kindof informed me that there are two types

(22:45):
of people, just what you described, the early risers and the late risers.
And they called them spring and fall. So there are spring people and
there are fall people, kind oflike people that either love oysters or hate
oysters. Two types of people.Yeah, yeah, yeah like that,
Sure, yeah, yeah, Ilove Oh my god, Now we're going

(23:07):
to talk about oyster. No Ican't. I'm just saying, go ahead,
go ahead. I don't like oysterseither, all right, So back
to this most recent derailment, thesleep thing, and and so most of
the sleep studies have been done onairline pilots, which surprised me, but

(23:32):
it makes sense now that you knowabout it, because they go through different
time zones and they have to beable to perform, and they have to
be able to spend the night inTokyo and then still wake up and be
at their top to fly back home. It was really interesting. So the
one question I asked him, Isaid, well, so eleven am start
Dallas time. Most of our guysare sleepy. What do we do?

(23:55):
He said, turn on every lightyou can possibly turn on. Let their
eyes think that it's daylight. Sowhen we had breakfast, we actually literally
brought spotlights into the breakfast hall.Lots of sound, so we had loud,
loud music, and and just tryto make it as routine morning as

(24:15):
you possibly can. But the loudmusic and the bright lights was something that
I would have never thought of.We ended up losing that game. I
was going to say that it didn'twork. It did not work, But
the point is I learned about thisspring and fall people, and and that
I'm just wired not to do sixthirty starts, all right? So what

(24:37):
were we talking about before that?Oysters? No, that was after that.
Oh yeah, sports medicine stuff.I think sleep is very pertinent sports
medicine topic. I think that's I'mglad you brought that up. The listeners
would find that interesting. You're you're, you're absolutely right. One of the

(24:57):
things that we've talked about on theshow before is our Performance and Recovery Center,
the TSM Performance and Recovery Center,And what you're talking about is sleep
and that is such an important partof recovering from the activity. Well,
they talk about it the NFL allthe time. Oh well, you know
West Coast team traveling east. That'sworth you know, a couple points on
the betting line or whatever. Thatis true, but that goes along with

(25:21):
exactly what you're saying. This isexactly what we learned when we went to
Miami and play at eleven o'clock amDallas time. And again, your body
is not set up for that.It's not wired for that. You need
a few days to accommodate. It'sall recovery. It is, it is.
Let's go to the phones. Iwasn't planning to do it till the
next segment, but this seems interestingand it's kind of be right in line

(25:44):
with what we're scheduled to talk about. Good morning, earl. How are
you, Good morning, gentlemen,how are you on? Very well?
Thank you? What you got well? I called you guys. A couple
of years ago. I was involvedin a real bad horse accident. I
broke my m some five places,the head off the humprance wow brook,
the elbow, and broke all ofmy ribs on the right side. I

(26:06):
had a really good surgeon to doa lot of work on the elbow and
shoulder and got everything, probably asgood as it'll ever get. He's now
moved to Houston, and I'm havingan issue where if I'm doing something like
holding a plate or holding a waterbottle a certain way, my bicep will
cramp or spat them to the pointwhere it's excruciating as and then needs to

(26:32):
put down whatever I'm doing. AndI've seen a couple of doctors about this
and nobody has any real ideas.So was a hang on. So I
have a question. Did you haveany So did you have any neurologic injury,
like any nerve damage with this terriblefracture. Yeah, if they went
in and know what nerve it is. But I've got a pretty wicked scar

(26:55):
on the inside of my elbow wherethey had to go in and really pressure
on it. Nerves that runs Iguess down the inside of your owner.
Oh you know what, I'm goingto throw out a term and you tell
me if it's a radial nerve orall your nerve. If you had a
five part humorous fracture, I wouldbe worried that it might have been the

(27:15):
radial nerve. Anyway, I don'twant to get too two technical. So
how long ago was all this?About two and a half three years ago
actually, and the bones are fullyrecovered. Yes, well, Brian,
and you described the pain as acramping in your biceps with like prolonged lifting

(27:37):
or anlifting is actually this is actuallydoing just you know, small things.
It's not lifting weights at all.It's if I hold it holding it up
a bottle of water the wrong wayor something light, it just that bicet
just goes into an extreme cramp orI don't know if I'm using a return
spizing. Yeah, and it's extremeeither painful and if I don't stop what

(28:02):
I'm doing, whatever I'm doing willcome out of my hand. So after
after you stop what you're doing,how long does it take for to recover
a couple of seconds or the restof yea, yeah, just with him
talking. A couple of things thatcome to mind are going to be your
right die, Is this something neurologic, because when we when someone starts mentioning

(28:25):
spasm, you start thinking about thatbecause you need the nerve to actually innovate
the muscle appropriately for the for themuscles to work. And the other thing
I could you know, is thissoft tissue something related to the to the
bicet muscle attending itself? You knowA said why, but you know you
would certainly need an evaluation imaging,you know, to be able to tell

(28:48):
the difference because those are two differentdiagnoses that will require two different you know,
two different ways to treat it.Another thing to think about would be,
you know, with that much energybeing delivered to your arm and your
shoulder during the accident, there's aweb of nerves in your shoulder called the
brachial plexus that you know is sometimesa difficult diagnosis to make and definitely could

(29:12):
contribute to a you know, thetype of symptoms you're discussing your bicep and
even farther up than that, like, did you also did you also potentially
sustain some type of injury to thenerves coming out of your neck, which
is doctor Blumenthal's specialty. Look,we're all on the same page, Earl.
I think you probably ought to bechecked out. And I'm going to
say this, and it's it's gonnasound kind of selfish, but you might

(29:34):
want to come see Ryan. He'san upper extremity guy, doctor Blaylock,
who was just answering you a question. And this type of injury, this
type of diagnosis needs a lot ofthought. You know, this is not
Hey, I rolled my ankle.This is this needs a lot of thought.
And at this stage, I thinkthat if if you're open to it,

(29:57):
uh, come see doctor Blaylock.I think that's a good place to
start. Happy to help, Okay, all right, good luck. So
that's a good call because when youthink about it, you know, there
are some things that someone will calland we all know this, Scott,
you can, you can, youcan vouch for this. Someone will call

(30:17):
and as they're describing what's going on, we're all looking at one another kind
of shaking our hands like yep,we know what this is. And those
are typical presentations and then you havesomething that's atypicals, and this is going
to require some thought, well,some thoughts, some some diagnostic testing,
definitely somebody you know, you know, examining you. And and this is
one of those atypical presentations exactly,I would agree because nothing was really I

(30:44):
mean, obviously, with the historyof major up extremity trauma, you know,
scar tissue entrapment, you think thingslike that. Yep, I think
we all thought the same thing.But you can't put your finger on it,
which is why you know it needsit needs to be evaluated. And
I think I think that was areally good call. We have a disclaimer
on this radio show. At theend of the day, this is radio
radio radio. That's not a doctorpatient relationship. I didn't examine you,

(31:07):
I didn't look at your X rayor MRI. But we can guide you.
And this is what we've done forthis is our twenty third season.
Now we can guide you as towhere to go and what questions to ask
this this this shoulder nerve thing isrelatively common. You know, Scott and

(31:27):
I were talking about a patient onthe elevator coming up here. He came
to see me for shoulder problems.And while I was examining him, I
thought that there was some overlap herewith something neurologic, and it turns out
that he did have some next surgeryin the past. So this shoulder nerve
thing, what is it that Iused to say dogs can have ticks and

(31:51):
fleas. I use that all thetime. You can have two things that
overlap that that kind of masket.It's different than hey, I rolled my
ankle. That one is easy.Yeah, you know, I rolled my
ankle. Yep, I've seen thevideo. I know exactly what you got.
But this ticks and flees thing.So it's interesting. During the pandemic

(32:14):
we all utilize to take care ofour patients, a lot of telemedicine became
very common. Now in Texas.Telemedicine is legal in Texas. You can
see a patient things like that.Orthopedics is one of those specialties that does
not lend itself to TELEMEDICINEW spine,I actually participated in an analysis what they

(32:36):
call them a Delphi analysis, andit got published in one of the major
spine journals on which particular diagnoses andspine was amenable to evaluation and making good
recommendations on telemedicine visits nice and whichones? No, you need to come
in. I need to examine inOrtho obviously it's almost one hundred percent.

(32:57):
You got to be examined. Andspine's about fifty percent most of the time,
not most, but a good percentageof the time. And in fact,
we still do tell the medicine andand I've gotten a couple of telemedicine
licenses in other states to see patients. Wait you have wait wait, wait,
wait wait, you have to havea license to do telemedicine. What
during the pandemics? Yeah, theythis emergency tell the medicine thing you could

(33:23):
it's this is very complicated. It'sa whole other segment. It's where it's
the practice of medicine. It canbe defined as where the patient is or
where the doctor is. Many timesit's where the patient is. And if
you're not, if you're doing telemedicinein the state of Montana, you could
theoretically be breaking the medical license lawsof Montana. If wow, it's telemedicine

(33:49):
is very complicated. So I neverknow the medicine in states that I have
licenses in. You know, I'llstill screen patients and tell them to come.
They need to come in. Butit's so happy, so we have
to go on break here. Butit's an interesting subject and I'll stop.
So I see a lot of patientsfrom out of town, primarily just recently
college students who are now back attheir various colleges, and I FaceTime with

(34:14):
them. Am I breaking the law? Coming back? Quick break Inside Sports
Medicine two one, four, seven, eight seven, nineteen seventy one,
seen seventy one, nineteen seventy one. That's the number to call or text
year shaking to see it. Welcomeback to Inside sports Medicine too. Story
I'll here doctor Scott Blumenthal, doctorBrad Ballard, and doctor Ryan Blaylock,

(34:39):
doctor doctor. So before the break, I was made aware that when I
FaceTime, my patient's going to theUniversity of Georgia and hey, how's your
knee going? Show me the scar? I want to see how much swell.
I was made aware that that isnot the most appropriate way to do

(35:04):
it. Let's just put it thatway. I don't understand. You guys
need to educate me. So wewere talking about telemedicine before we were right
and s orthopedics or muscular skeletal sportsmedicine, you got to examine the need
to find out if the ACL isthere or not. So there's no way
I can do that unless they comein. However, so I do the

(35:28):
ACL surgery the guy's doing great orthe girls doing great. Now they're back
at all their different colleges, andso it is part of my routine at
the end of clinic to do theseFaceTime calls just to check on them.
Sure, how's your knee coming,Let me see you walk, and because
I want to see their limping ornot, show me a range of motion.
So it works great for that.But Scott was telling me, and

(35:51):
how even Ryan was telling me that'snot hipo compliant. I didn't know about
the FaceTime not being hippopot know thatour telemedicine platform, the software that we
use, we purchased the software froma company that went through all the hoops
to be tell themedicine hippo compliant.And if there's a listener out there who's

(36:12):
more versed in this than me,please correct me. But my understanding,
FaceTime is not hippo compliant, andit has to do with the level of
encryption and things of that nature.And so the bottom line of medicine,
you have to put a patient's privacyas your utmost concern, and that is
where the where the spirit of hippoderives from. Okay, I get it,

(36:35):
all right, so look at itfrom my standpoint. I really want
to know how they're doing. Yeah, So do I bring them in or
do I tell them go to this? I don't. I don't know.
I didn't realize I used to dotheir platforms and software where it's designed to
be hippo complaint, you still seethem. I don't see. I don't

(36:58):
get that because telephone call follow upsare very frequently done. Is FaceTime different
than a telephone call? Good questionis, yeah, it is o versus
just a telephone call. And Ithink can actually even be billed differently,
But in fact I think it's Italso plays into like if you're billing the
FaceTime call versus not I think.And again so I don't, So I

(37:21):
don't. I don't build for these. I mean, particularly in the early
post off there, you know,ninety days, where you're taking care of
patients that are your fee telephone.I mean, before our telemedicine platform,
we would talk to our patients,call in and ask questions. You know,
doctor, So the telephone is verycommonly used in medicine, but this
FaceTime thing, I just don't know. This is the first time I've heard

(37:43):
it. And the rules got lackvery lax during COVID, just out of
the spirit of like taking care asmany people as possible. And then that
so a lot of people got usedto doing it, and then it gets
ratcheted back as we've come back intomore normal times. And I what are
the current set of hipp A compliantlegally allowed things you can do with FaceTime?

(38:05):
I would have to go back tothe research and double check that.
And even the formal telemedicine regulations arestill there's a more gray zone than black
and white. Like you said,they've rolled back some of the lessening of
restrictions, but I just read somethingabout a month ago saying that certain of

(38:30):
them are extended till twenty twenty five. I mean, it's so telemedicine is
very much into flux. It's certainlyhere to stay. Patients love it.
I mean, if you've got apatient from the Rio Grande Valley who just
needs to send me an X rayof their artificial disc and tell me they're
doing great. That's an easy thingto do because there are Hippo compliant ways

(38:51):
to transmit X rays. Now thatwe have a portal, well, I'm
sure you do your website also,so I'm often asked by agents to look
at a certain player's MRI. Iget that that needs to be on a
private platform, et cetera, etcetera. But I've always thought that FaceTime
is one of the greatest inventions thatwe've ever come up with, or and

(39:15):
I keep using face time. Itdoesn't have to be an iPhone product or
whatever, but the fact that youcan converse with your son or daughter who
is, you know, three thousandmiles away and actually see them and hold
up there, you know, lookat look at this dress that I just
bought. That is fascinating at acompletely revolution. That was, by the

(39:37):
way, his daughter talking to him, not him talking to his daughter.
Yeah yeah, yeah, Okay,So thank you for the clarification on that.
The point is, as long asyou have Wi Fi, you can
talk to anybody on the planet andsee them. And if they say,
hey, look at my incision,does this look good or does this look
batter? Share, I go getthis checked out there was no other mechanism

(40:00):
for that prior to face. Yeah, and we have patients who will say
I have a question about my decision, and they'll they'll take a picture from
someone and they'll email it to us. But I think Ryan brings up a
good point about you know what,in terms of face to face interaction,
screen to screen to screen or whatever, what what is now appropriate for medicine.

(40:25):
And I'm fascinated by that. I'mI'm well versed on the formal telemedicine
platforms, the FaceTime video chat stuff. I'm not you know, it's funny
because I don't. I don't considerand I guess I'm the one that's wrong
here. I don't consider checking onmy a cl at the University of Georgia

(40:46):
in the locker room, kid,I don't consider that telemedicine. I consider
that I'm talking to him on thephone. But wow, now I have
a picture, and that may bethe case. And I think by the
spirit of what you're doing, Idon't think you do anything wrong, particularly
if you're not building. I'm notbuilding, so I don't have a code
for this. I don't think thereis a code for that. But any

(41:07):
but but I didn't realize that therewas an issue there. I thought this
was I thought I was doing agood thing by saving them the trip or
having to save them from having togo see it. Well, I think
you are doing a good thing.It is just I think there's the way
you go about you do you nothave a telemedicine platform in your in your
e HR system at Texas Sports Medicine. Most times when I'm following up with

(41:30):
someone long distance, it's usually justa normal telephone call. Every now and
then I feel like I need totake a look and see something. But
usually it's just a normal telephone call, and there is a billable telephone call.
Yeah, you have to look intoit. I mean, because you
guys have such a large reach andsay you're just doing Texas yea, even
Texas is a huge state telemedicine.It may be worth the investment in the

(41:52):
in the software for your because it'llit'll interface with your you know, with
with the hardware that you have.I think we have it. I think
we have it. I've just haven'tnever needed, never explored it. That
was an interesting It's a little finicky. I mean, believe it's not just
push a button and you're there.There's there's a few steps and I'm sure

(42:13):
disclaimer at the front too. Ohis there really? Oh? Yeah,
and there is on my note whenI when I do a telemedicine console,
there's a the top of the noteit said this was done using a kip
A compliant Tell the Medicine platform.Blah blah blah blah blah. What well,
it prepopulates itself. You don't haveto do anything interesting and it's all
part of the software. We havepeople listening on iHeartRadio. We have a

(42:36):
question about low back pain that radiates. I'm going to be very brief on
that one three nine six three.Uh, low back pain that radiates into
the buttocks really hurts. Blah blahblah. That sounds like a pinch nerve
to me. Yep. Uh probablyought to get that looked at, even
either your primary care physician or goto uh doctor Bloomenthal woom. Yeah.

(43:02):
Yeah, yeah, that's that's whatthat sounds like. My guess is,
even though we have a text andwe can't go back and forth, my
guess is that's always one sided anddoesn't radiate from right to left. So
there normally pinch nerve is either onright hand side or left hand side.
Right hurts when they stand too long. They said, so makes sense.
I'm sure. I bet that's whatit is. See, this is the

(43:22):
kind of stuff that you can youcan do on radio because the stories kind
of make sense what he just described. And two or she, I don't
know, yeah, three nine sixthree. I can't see the screen.
It's pretty far from here, itis. It's hard to see, by
the way, But that's all right. What they described most of the time

(43:42):
is relatively classic. But the phonecall we had is absolutely not classical.
It's not classic. It it's there'sso many diagnoses that you know within a
minute of talking to the patient,it's clear what they have, and the
rest of the visit is confirming whatyou already know. Like if somebody comes
to me and says, doc,every morning at about four am, I
wake up, my hands are numb. I have to shake him out and

(44:05):
walk around before I can go backto sleep. That is carpal tunnel until
proven otherwise. Now there are otherthings, but I mean, that's a
pretty dead to rights diagnosis. Ihave crushing chest pain that radiates down my
left arm. That's all of thesethings. So doctor Houston. I did
my fellowship at the Houston Clinic inColumbus, Georgia, and doctor Jack Houston

(44:27):
spelled hug h not like the cityHouston. It's very very strong Georgia accent.
Doctor Houston would always tell us thefellows, the patient's gonna tell you
what's wrong with them. So thehistory was so important because when the patient
starts telling you what their symptoms are, he said, the patient will tell

(44:52):
you what they've got. Yeah,yeah, if you're willing to listen,
and yeah, you really if youwill listen, yeah, you gotta.
And that's why, at least forspine, when you don't have to check
whether the ACL is there or not, that we can do a lot on
tile of medicine because exactly that youlisten to the patient, you look at

(45:13):
their scans that they've sent in onHippo compliant platforms, and you can make
a diagnosis more than fifty percent ofthe time. But even with the ACLS
and I want to go there,we watch, the patient will tell you
I was running up the field,I planned to change direction, something popped,
I fell to the ground. That'stextbook. That's learning from you and

(45:35):
from you know, a million yearsago in orthopedics, like even my kids.
Now, we'll be watching a footballgame and we'll see an injury on
the field. ACL. I meanthat linebacker for Miami with a non contact
injury last week. They're good,but Chubb U. We were watching it
and we all look at each otherto ACL. But but but you do

(45:55):
have other thing, which is Ididn't have an appreciation for this. Once
they get them to the sideline andthey take their helmet off, the expression
on their face tells you, oh, dude, the injury too, you
know, because the player, Imean, they know when that's ooh yeah,
that's a biggie, Yeah yeah,Or the reaction on the field,
how long it takes them to getup. Yeah. All of that stuff

(46:17):
kind of plays a part into what'sreally going on. All right, quick
little break. That was a shortsegment. Uh two four seven eight seven,
nineteen seventy one text or call.This is inside Sports Medicine. The
Gang's coming right back. Welcome backthe music today, Bruce Hornsby next week.

(47:00):
I'm gonna let you pick when I'mready. Have you ever heard of
Have you ever heard of? BruceHornsby? Yes, it's been a long
time since I've heard his music.But when you showed me the song,
the first song this morning, Iwas like, oh, okay, I
was confused this morning by who itwas. We're gonna have to bring back
for some of our regulars hip hopword of the Day. I'm gonna we

(47:22):
haven't done that, and we hadn'tdone that in a while. Yeah,
but Scott was contributing to that fora while. Hip Hop Word of the
Day. I was watching You've probablycollected more since the last time we've been
on the radio. I was watching, you know, one of the shows,
you know, around football games,and like a pregame show, and
they were making fun of each otherand they use the word swollen, and

(47:45):
before I would have not known whatthey meant. I know you're looking swollen.
But my kids are are teaching mesome new ones so that I can
stay in the know and you know, stay kind of young. I guess,
Yeah, I don't like his MICis on who's Bryan's all? Right?

(48:06):
Uh say something? Right? Seeif I can hear you? Test
test? Did that go in here? Okay? Maybe the Red Lives might
work? Ah call, I thinkwe should go to the call. Let's
go to Izzy Is that correct?How you say it? Is? He?
Hey? Good morning? Is he? What's up? Morning? Nah?
Man, it's been a couple ofyears. About three years ago,

(48:27):
we're playing basketball. I don't knowhow it happened, and my brother ended
up on my back and I heldhim up for a little bit and he's
like, man, I crushed you. I have to feel it, you
know, I crushed you. Wow. I got up and I'm like,
man, I couldn't walk. It'slike, man, I cried. I
was like, I could not walkfor some reason. So a couple of
days later, my thing's so swollen. I never went to the doctor.
It's been about three years. SoI was like, you know what,

(48:49):
I'm just gonna focus on just usingit, using it. I never stopped.
I kept going, kept going.Fun that wake up middle of the
night just screaming in pain. Youmove it a certain way, and oh
man, you know, but it'sbeen three years. I feel like I'm
like ninety five percent. I feellike it doesn't hurt as bad. But
I get an aching. I geta like almost like a throbbing every once
in a while. Is it toolate to go see if I need like

(49:10):
an MRI or what the answer isno, No, that's a great question.
That's a really good question. Yeah, I think everybody's chimed in.
It's not too late. But thefact that you're better is is really good.
I mean that's really what ninety percentbetter are pretty good. Yet obviously
you had some type of direct blowinjury. Sounds like it's well, ay

(49:31):
a load. No, no,no, it's actually a load because his
brothers jumped on him, well,jumped on his back, right, is
that what? Yeah? I was. I stopped and before I knew because
there was a little kid that ranon the court, so I stopped,
and my brother he was up inthe air and somehow he was landed on
my back. And I didn't evenknow that's what happened. He was like,
man, I felt you crush underme. I thought I could sell.

(49:52):
I had no idea what happened.So the short answer is, it's
not too late. Yeah, butif it bothers you, if that five
percent bothers you enough, because kindof that's the natural history of most back
injuries, is they get better ontheir own. If not one hundred percent,
close to one hundred percent, Yeah, and and and if there wasn't
an abnormality. It'll probably still bevisible on the MRI. So yeah,

(50:12):
it's no, it's not too late. Good question, perfect, Thank you
so much. Thanks Izzie, Ilove that name. We never did talk
about the sports medicine one on one, so maybe this is a good time
to bring it. So Ryan Blaylockthe newest physician at Texas Sports Medicine.
It did a orthopedic residency training,of course, and his fellowship training was

(50:38):
in hand surgery, which is avery focused area. It's at some point
in my career, early in mycareer, I thought I might want to
do hands. I thought it wasvery delicate surgery. It is. The
anatomy is fascinating. But I endedup doing sports medicine, which is almost
the exact opposite. But so Ryanjoined us about six months ago, and

(51:02):
one of the things that I askedhim to maybe talk about briefly in our
segment that we normally called sports medicineone oh one, because hand and elbow
and shoulder are kind of all related. So it's upper extremity tennis elbow and
golfer's elbow often confused by the public, but extraordinarily common problems. Can you

(51:29):
briefly just kind of tell the folksin their cars what is tennis elbow and
what is golfer's elbow? Absolutely so, tennis elbow is the colloquial term for
lateral epicondlightis, and golfer's elbow isthe colloquial term for media epicond lightis,
and these are both things that causepain in the elbow. So the most

(51:51):
common presentation of tennis elbow is somebodywalks in and says, I have this
really bad pain on the outside ofmy elbow, basically if you're palms facing
up to be the side not nextto your body. And they say,
Doc, it hurts when I pickup my Stanley Mug, or it hurts
when I pick up my purse.Did you just say Stanley Mugg? The
Stanley? You realize that's the hottestgame thing in the world. Now apparently

(52:15):
there's another one that's even hotter thanthat, like's coming on to the same
My wife teaches me all this,I don't what people wait in for hours?
What's that Stanley? Stanley Mugg?But it looks like a YETI,
except it's a different Brandy. It'sa it's a about the market blogger.
Well, some some bloggers started usingit and then it took off. Oh,

(52:37):
it's an influencer. But Stanley's likean iconic American brand that I didn't
know that. I've never heard ofit. But Stanley's been around, I
mean probably close to one hundred years, like making Yeah, Stanley's instruction instruction
those old gray or tan thermoses yousaw, like, yeah, those are
made by a lot of them byStanley. But then this blogger used it.

(53:00):
An influencer used and then they said, you know, you should kind
of tap into some of the youknow it email market hoddest thing on the
planet right now, and they comein all colors pink. There was like
a there's a guy who got arrestedat the Starbucks for trying to run off
with like Starbucks was releasing like alimited edition one. He tried to run
off with the whole box and there'sa video online of him getting tackled as

(53:21):
he tries to run out with thisgigant box. Target did the same thing.
What happened. Target did the samething the other day. They had
to actually have cops at Target tocontrol the line because the Target was dropping
their own type of Stanleys or something. This is. Yeah, it was
phenomenal, and I just can't believeyou just mentioned it on the show.
Anyway, we're talking about tennis elbow. But yeah, so these things hold
like forty ounces, you know,it's five pounds of water, and everybody's

(53:45):
like, my arm hurts on theoutside. Well, tennis elbow ladder.
Lepicondolitis is a tendonitis. So themajority of the muscles that extend your wrist
and your fingers attached on the outsideof your elbow, on your upper arm
bone called the humorous at a specificpart of the bone, the little knob
on the outside, if you will, called the lateral epicondyle, and this
tendon that attaches the bone to themuscle frequently becomes irritated. Now nobody knows

(54:09):
for sure what is the pathology orwhat is the cause of this pathology,
Like, is it it's picking upa Stanley. It's well, it's part
but it's it's part that church thewater. Yeah, it's part that,
but it's also probably part your underlyinggenetics. You know, you just got
your you have a propensity to havetendonitis. You bought a Stanley mug.
Now you have tennis elbow. Sothere's there's some great things about tennis elbow,

(54:32):
and there's some really annoying things abouttennis elbow, and it it unfortunately
is one of the one of theharder things to treat. But the best
thing about it is with nonoperative management, about ninety to ninety five percent of
people will get better. Now,what they don't tell you when they tell
you that number is it's going totake six to nine months for it to

(54:52):
completely go away. And if you'repatient and you can add some things like
stretching protocols. I'll give a shoutout to the American Academy at Orthopedic Surgery.
If you google AAOS tennis elbow.They have a beautiful website and a
beautiful rehab protocol that's from the AmericanAcademy at Orthopedic Surgery, which is our
overseeing body, that you can goon learn about it and do the same

(55:15):
exercises you would do with a therapist. And if you're diligent about those exercises,
you do the stretchings described like,this problem will go away. But
the thing is, we live ina society where everybody wants to feel better
five minutes later, and unfortunately therejust really isn't a treatment that allows for

(55:37):
that for tennis elbow. A lotof times to try to achieve that,
people and certain physicians will do cortizoneinjections to the common extens or ten and
the ten and I was speaking about, and you will feel better after a
quarterzone injection, and usually it lastsfor about three or four months, and
then one of two things is goingto happen. One, it's going to

(55:59):
go away forever. You're going tosing the praises whoever injected you, and
that's that. The other thing thatwill happen. And if unfortunately it does
happen, your pain comes back,and it comes back with worse n engines.
And if that happens, it isreally really really hard to get tennis
elbow to go away subsequently, soI try everything in my power to not

(56:20):
put cortizone into tennis elbow or golfer'selbow because on the off, on the
the slever of patients that don't getbetter are going to be miserable for a
long time, and they're your treatmentoptions at that point are become much more
narrow. I you know, doctordoctor Billard can chime in about you know,
he does a lot of our tendonitismanagement and some of the other things

(56:43):
we can try. But Brad So, by the way, that was an
excellent description of tennis elbow, eveneven though I knew that the problem,
the way you described it was betterthan I would have done it. But
so tennis elbow used the word annoying. It's kind of a nuisance injury and
it's not dangerous. It's not dangerous, and it is hard to treat because

(57:06):
we're always using our arm. Youknow, you're shaking hands, you're grabbing
the Stanley cup, you're lifting weights, and you're gripping. So I see
tennis elbow, Uh, not somuch from tennis. I see tennis elbow
from weightlifters. Oh yeah, Sowhen you're gripping that barbell and you're doing
that last repetition on your third set, that's when you're doing doing damage to

(57:27):
your elbow. You did PRP onme for that. I was about to
say, well, let's just talkto Scott about because I aggrevated mind doing
surgery and it was bothering me duringsurgery. So we did all the non
ops and all the conservative stuff,and it was just kind of nagging.
Didn't go away. So he didPRP and the ways platelet riche plasma.
So one of one of the problemsthat makes tennis elbow difficult to treat is

(57:50):
it's not really a good blood supply. There's not a good place. You
can't stop using your and you can'tstop using I mean, I wasn't I
wasn't going to take off six weeksoff of surgery. So part of my
script is when I tell my talkto my patients about this, I said,
look, if I put you ina cast for six weeks, this
will go away. But that's justnot practical. I can't put you in
a cast for six weeks for tennishelp. So again it's hard to treat

(58:10):
because you're using it and there's nota good blood supply. And then now
comes platelet rich plasma, which isrelatively new. Brad, you do that,
you see more of that than anybodyelse. Yeah, So Scott,
real quick, how from the timethat you got the platelet rich plasma injection
to your symptoms being you know,virtually gone. What was what was the
time for how many how many weekswas it? I'm jogging my memory,

(58:34):
but if I remember correctly, itstarted getting better in a couple of weeks,
and by six weeks I didn't noticeit any ore about six to eight
weeks. So so one of theone of the benefits of having an ultrasound
machine in the practice is the abilityto be able to actually see the tissue
and see the amount of damage thatis within the tendon. So oftentimes,

(58:55):
you know, doctor blaylaugh, youtalked about a cortison injection. If I
if I look at that tenant andit looks beat up, I'm almost certain
that's they're going to come back andwithin a certain amount of time after a
quarter zone injection is just saying thisthing is worse because the underlying tissue is
already damaged. So I agree withyou. We try to avoid putting quarter

(59:15):
zone near soft tissue, particularly likea tennis or golfer's elbow. But yeah,
I mean, you know, platelit rich plasma for a lot of
patients can work to try to limitsome of that timeframe that you talked about
that what is the typical timeframe oflike months and months. There's also a
procedure that we do call percutaneous tanotomy, which is not surgery, but
it's a little more invasive than PRP. And you know, I followed up

(59:37):
with a patient the other day whohad golfer zelp our tennis elbow for months,
tried physical therapy. You know,is a flight attendant and he's seven
and a half weeks out from thepercutaneous anonymy. He's like, I feel
fantastic, ready to go back towork and do that. So there are

(59:58):
some options out there that probably aren'toffered everywhere, but they work to try
to limit the amount of time andincrease the function of you know, somebody
who might have this or have hadit for a while. So Ryan nailed
it when he said that ninety percentwill get better by themselves without even going
to the doctor. We're talking aboutthose five percent that don't that do come

(01:00:22):
to us well because it is frustrating, and it does linger, and it
is it does affect your lifestyle.Well, we know the numbers. It's
actually about twenty percent of every tenniselbow case will probably turn chronic. So
two out of every ten will actuallybecome that one that lasts longer than it
normally does. And prior to tenyears ago, we had cortisone shot which

(01:00:45):
was temporary or surgery which was allright, Well, let's go in there
and debrid it and repair it orhoping it just gets better. And now
we have this PRP which works well. Not on everybody, but it works
well, especially if you've got theultrasound eye that Ballard has because he can
put the stuff exactly where it needsto go. And this tunontomy thing.

(01:01:06):
I mean, so now we haveI'm trying to remember the last time I
did a tennis elbow surgery, sowe did a golfer z elbow. We
did a golfer's elbow, but shehad symptoms for ten years, and she'd
also had twenty five Yeah, cortisoneCortizon injection, Scott, I wanted to
ask after you had your PRP injection. I've heard patients describe that it actually
is pretty painful for a few daysafterwards. I mean, PRP is a

(01:01:29):
pro inflammatory substance. The whole ideais we're trying to get it to be
more inflame to increase that blood flow, so ultimately the disease tissue will heal.
I mean pathologic studies I taking apiece sending it to the lab show
that there's defined changes in the tissueif you take it out and send it
to the lab. So it's tryingto get that tissue to heal. And
I've heard that it can be painfulin the few days after PRP. What

(01:01:51):
was your experience. Fortunately, Ididn't have a flow up, so no,
it didn't escalate the pain for acouple of days. Yeah, out
uncommon, And I tell my patientslisten, it'll probably feel worse for several
days before it feels better, allof which is normal, which is what
we're looking for. You're trying toget the body to engage in a in
a new healing cascade. And soyou're right, we want that flamma inflammatory

(01:02:15):
reaction and we don't want them onanti inflammatory medicines while that's happening. That's
right, we don't because we don'twant to suppress that inflammatory cascade that we're
looking for to try to help healthe tissue. So if are going to
go get PRP, don't take youradvil or leave nay or after around when
you're getting the procedure because you're youknow, I know this is off topic,

(01:02:37):
but somewhat related. Do you guysare okay with titlenol first for for
after PRP? Oh? Yeah,yeah, yeah, yeah, yeah,
no anti inflammatory effect in talent oil, so it should be fine. Sorry,
And if someone if you see aphysician that does plately rich plasma injections,

(01:02:57):
you know they'll they should walk youthrough what this. You know what
you need to do, like youtalk about anti inflammatories, yes or no?
So yeah, yeah. The mechanismat which talan all relieves pain is
actually fairly interesting. And the lasttime I read was like not completely understood
why it exactly works. But yeah, it's a much different pain the typical

(01:03:20):
for medicine. Yeah, it's it'smuch different pain relief mechanism than your non
steroidal anti inflammatory drugs. You're advil, you're a leave things of that name.
You know, it's funny that Scottjust brought up isn't that typical for
medicine because we were going to talkabout this in the opening segment. We
were going to talk about the uncertaintyof medicine. And now here we are,
two minutes left to go in inthe show and it's popping up.

(01:03:45):
Ye want to get that moldy pieceof fruit from from Peoria, Illinois and
which turns out to be penicillin?Was I thought it was a piece of
bread. I think it's a pieceof bread. I thought it was piece
of fruit, but it was.It was mold well and and aspirin as
a tree bark of a willow tree. I mean, and that's how it
was discovered and so but there's there'sa lot of uncertainty in medicine, and

(01:04:06):
I've always found it troubling because Ido lose sleep on the patients that aren't
doing well. You know, youknow, aspirin was never FDA approved,
even to now it predates the FDA. Oh, you're right, I know,
it's over one hundred years old.Yeah, it's so came from Germany,
Bear, the pharmaceutical company Bear,that's Bear aspirin. Yeah. I

(01:04:29):
think I'm pretty sure it was neverFD approved. But it's just because it
predates the FDA. I have totell you, aspirin works great for me.
It's just a decide effects. Yeah, I mean, if if that
never takes your stomach and you're notworried about a little blood, then er
or you want a little blood thinglike it works well. I mean at
one point it was kind of gospeltext you and call me in the morning.

(01:04:50):
No, but for heart attack andstroke prevention in people our age is
incent is. Recent studies are callingthat in a question. No, no,
no, you're thinking about daily aspirinas a preventative. No, that's
what I mean. Daily askpena isa preventative, right, I mean the
one baby asper in a day thingis now controversiable. No, that's not
what I understand. I guess wehave to talk about that next week.

(01:05:12):
But I think I think at somepoint you cross the line where the risk
of the daily aspirin outweighs the benefit. Correct, But that's what the study.
The more recent studies are calling thequestion just blanket. Everybody should take
a baby asper in a day.So I took a baby aspirin a day
from my forties all the way toI think, well, I stopped out

(01:05:33):
at mid sixties. I said,you know what, why'd you shaw?
Because of that study you just quoted. I take it before I get on
a flight that's over. Oh yeah, yeah, that's that's brilliant. That
music means that we're about to wrapup episode number What did I say?
Six eight hundred and sixty four AndI finally got the phone number right.

(01:05:57):
I want to thank all of oursponsor center for Dick's this replacement at TPI
Buckan doorf Jewelers, family owned sincenineteen forty eight, Jaguar Landrover of Dallas,
Texas Sports Medicine, Performance and RecoveryCenter. That everybody's made that mistake.
I've done it in a lecture infront of a thousand people, and

(01:06:17):
it's a It's just one of thosethings. Hey, uh the freak.
This is a place where we saywhat we want. We say what we
want. Oh yeah, okay,So listen to us on iHeartRadio. Hopefully
the podcasts are going to be downloadedhere, hopefully next week. I keep

(01:06:38):
saying that every week, Garrett,are we closer? I have every episode
up till this one, So Ikeep asking and keep pressuring them. Is
like, hey, doctor to isready to buffalo us. I need the
website so I can upload it.People are begging, and as soon as
they tell me it's it's live.All the episodes will be uploaded from the
first day you started here, allright on, behalf of all of us

(01:06:58):
here on Inside Sports Medicine. Thankyou, Doctor Ballard, Thank you,
Doctor Bluemhal, thank you Doctor Black. Until next week, Tell your friends