Dr.TO 872

Episode Transcript

(00:00):
It's tip off time for Doctor tO. Sorrel and Inside Sports Medicine on
ninety seven to one The Freak.Doctor Sorriel, one of the nation's leading
orthopedic surgeons and former head team physicianfor the Dallas Mavericks, bringing his unique
sports insights and stories from inside thegame. With special guests from the world
of professional, college and high schoolsports and sports medicine, the Doctor breaks

(00:21):
it all down. Buckle up yourchin strap and tighten your laces for the
most informative ninety minutes in sports medicine. It's kickoff time for Inside Sports Medicine
with Doctor t. O. Sorrialon ninety seven to one The Freak.

(01:06):
Good Saturday Morning. Everyone, GoodSaturday morning, and welcome to Inside Sports
Medicine. I'm your host, Doctort O. Sorry, I live in
the studio on this episode eight hundredand seventy two. Live episode eight hundred
and seventy two that spans twenty threeyears of being on the air on Saturday

(01:27):
mornings. This is your sports medicinecurrent events show where the topics are ripped
right off of the sports desk.Over the next ninety minutes, You're going
to be informed entertained and hopefully learnsomething new. You'll have an opportunity to
call in or text in any questions. Joining me live this morning, doctor

(01:48):
Brad Ballard, Good morning Brad.What's up, don Hunter. I'm actively
downloading that song. Isn't that justa classic? Yeah? So Garrett great.
By the way, it's on theother side of the glass, he's
running the board, he's answering thephone, he's doing everything. You recognize
the song, I do. It'sa classic. It was the name if
I first called me off guard,and then once you hear it, it's

(02:09):
like, oh, yeah, Iknow this classic, I know this.
Everybody knows this. Good morning Hunter, Good morning Hunter. Spears is in
the studio with us today. Spears. What a great name, good name
for a football player. Yeah,you're kidding, like Spears on the tackle.
It's crazy. So every year,like Bleacher Reporters, one of the

(02:30):
reporting organizations comes out with the topfive names, top five recruiting names list,
And somehow, for the year Iwas being recruited, I was on
it, like names of the Ilove that Storm, Duck, Maverick,
Mackivory, just these landish names,and I have somehow because when you google
my name. It's just like thesepeople out in the jungle throwing spears.
Yeah, makes sense, just hunting, And isn't wasn't there a quarterback named

(02:54):
Gunn or something I played for NotreDame. Maybe he was there for a
year anyway, Gunner throws the hunter. Yeah. So welcome to the show.
If you are new, Thank youvery much for stumbling into this episode

(03:14):
so early on a Saturday daylight savingtime? Are we in daylight saving time?
Are we out of daylight? So? I don't. I'm always computed.
I can never figured out. Ihave no idea. All I can
say is I want to go backto sleep with this darkness outside. I
do not like waking up in thedark. No, it's easier to wake
up when it's already bright outside.I feel like I'm ready to start my

(03:34):
day. I'm ready for it tobe dark around six o'clock yep, a
normal time for it to be dark. Boom. I can start settling down
for the night and just take iteasy. Isn't there some action in Congress
or somewhere governmental to do away withthis, because you know, there are
a couple of states that don't doI know Arizona doesn't Arizona doesn't. I

(03:57):
know, Hawaii doesn't do it.I think it's supposed to be this is
the last time. Okay, it'ssupposed to happen. But they've been saying
that for the past year and ahalf to two years, because I know,
like United States is the crazy warcountry in the world. Any other
country doesn't do this at all.Oh really, I didn't know that.
You go to Europe, they don'tdo this. They don't have daylight saving

(04:18):
time. They don't change their clockbackor anything. I didn't know that.
But it's like an old farm tradition, right, it is because they want
to make sure the farmers, dependingon the season, daylight more daylight for
growing plants to grow and crops togrow. But well, no, no,
that doesn't change that because the changingthe clock. I think so.

(04:40):
And I don't know anything about this. I just bits and pieces and a
couple of neurons in the back ofmy brain that are just flickering right now.
Benjamin Franklin is credited with making daylightsaving time a thing. And and
by the way, it's saving notjust make sure you don't put the s

(05:02):
on there, otherwise you sound likeyou're from Mesquite, And did I just
defend somebody. I thought I thoughtScot Blumenthal was here anyway, daylight saving
time, and I think you're right, And it did have something to do
with farming, and it did havesomething to do with more daylight for them

(05:24):
to work so that they can worklater into the evening kind of thing.
But yeah, look, I neverdid understand whether we're in it or out
of it right now, but Ihate coming to work when it's dark.
All I know is we gained anhour, and the other one is we
lose an hour, right, soyou spring forward and fall back. That's
that's how I remember it, ButI don't know what it's supposed to do.

(05:46):
I'm fine with the fallback. Thefallback you get an extra hour.
The spring forward we can do awaywith. But you can't have one with
that the other. That's true.But did you not if I had to
pick, so, if we couldjust keep falling back, yeah, get
you next shower, the next hourhealth so little side note along the same
same token. You know how wehave Eastern Eastern time zone, Central Pacific

(06:11):
and West coast right China, whichis bigger than we are, only has
one time only have one time zone. Won't you check that? Make sure
I'm right before I sound like I'mfrom somewhere else. But I think they
only have I think they only haveone time zone. So good morning,
everybody. This is the Inside Sportsman. In case you were wondering what's going

(06:34):
on? What is happening here?You turned on ninety seven point one and
we're talking about daylight saving. Yeah, okay, so we have some news.
Yes, However, the whole countryobserves the same local time and the
theory China could have five time zones, but the country has only one official
time zone. In spite of beingalmost the same size as the continental USA,

(06:58):
China has the he has only oneofficial times of So on the east
side of the country, let's justsay New York and we'll just put China
in that place. It's six inthe morning right on the west coast in
LA it's still six in the morning, and one's got the sun out ones.
How does that work? Yeah,I don't know. That's weak.

(07:20):
But when you say call me atsix, there's no confusion. There's definitely
no confusion. I don't know howmany times during COVID when we had zoom
calls, it got all messed up. Yes, call me at four and
this is your time or my time. I gotta remember is what is specific
you're six or my six? Right? Yeah, what's your six? All
right? So yeah, this isinside sports medicine. We do have a

(07:42):
bunch to get to. Uh so, if you're if you're a regular.
The way the way that I theway that all of us go through this
the week is we make notes ofinteresting cases, interesting events to talk about
on the show on Saturday. Infact, sometimes we'll we'll meet in the

(08:03):
lounge and we'll have a discussion andone of us will say, oh,
save it, save it for Saturday. So we have notes of things that
we want to talk about. Andon my notes, I had a really
interesting case that that I actually performedyesterday, but it's been brewined for a
couple of weeks and it it introducessome of the business of medicine, but

(08:33):
it also introduces a subject that iskind of sensitive between doctors. You know,
one of the one of the thingsthat we were taught in medical school
is, you know, don't speakill of another doctor because you weren't there.
You're not in his shoes or hershoes. You don't know what was

(08:54):
said, et cetera, et cetera. So with that as a background,
and you know, I was notthere. I'm only going by what mom
and Dad told me when they cameover for a second opinion. But it
was one of the most idiotic judgmentdecisions I've ever come across ever ever.

(09:16):
And okay, so I'll tell youthe whole story. Seventeen eighteen year old
baseball player. And I'm not surewhether he was sliding in the base or
took a big cut, but somehowor another, his kneecap dislocated, his

(09:41):
potilla dislocated. He falls to theground in excruciating pain. The trainer comes
out, Yep, it's dislocated.The trainer is athletic, trainer is experienced,
and he reduces it. He popsit back into place. They go
to the emergency room at a veryrespectable North Dallas hospital. They do x

(10:05):
rays. It appears on the xrays that there's a bone chip, and
they put the young man in ana mobilizer and send him to another very
well respected pediatric orthopedic center. Andyou would think that a pediatric orthopedic center

(10:28):
would would know a lot about this. So, according to the mom and
Dad's story. They see the bonechip, they get an MRI, and
I think this is part of theproblem, is that the MRI was not
actually done at the hospital. Itwas done at one of those free standing
places, and the read was wrong. The radiologist did not see the bone

(10:54):
ship, and in all fairness tothe radiologist, sometimes you can't see them
on an MRI. They're much bettervisualized on an x ray, and so
he didn't see it. So theMRI report did not mention loose body.
In fact, he went out ofhis way to say, no, loose
body is present, but it wasright there and there was not a donor

(11:16):
site, meaning that he did notsay, is there a place on the
patella, Is there a place onin the knee where that's missing some bone?
He didn't mention it. So akind of a series of events where
dislocated his kneecap knocked off a pieceof bone. They saw it on the
x ray, couldn't see it onthe MRI. And this is where the

(11:41):
this is where the story kind ofgets lost, it goes left. Apparently
they orthopedic surgeon saw the piece onthe x ray and decided to do an
ultrasound. By the way, ultrasoundsare becoming far more frequently used. It's

(12:03):
something you can do in the office. It's painless. It's the same,
essentially, the same ultrasound machine thatthey do on pregnant ladies to look at
the baby and all that sort ofthing. And the pictures are just getting
remarkably clear over the years. Andit's a relatively inexpensive test. So he
does an ultrasound and this is whatmom and dad telled me. He told
them that the bone chip is outsideof the joint, it's not in the

(12:28):
joint, and therefore we're going torehab his Pateeller dislocation episode for a month
and then reevaluate. Well, theydidn't think that was right. Mom and
Dad didn't think that was right.So they come to see me, and
I have the same information that Ijust told you. So I look at
this bone chip and it's pretty big. I mean it's it's big. It's

(12:52):
the size of a quarter and maybeas thick as an oreo. And this
did you like where I went there? As thick as an oreo. Everybody
knows what I'm talking about. Yeah, yeah, yeah, yeah, no,
that's good. That's a whole notthing, and it's sitting right there.
I mean, let me ask yousure. This is you looking at
the x ray. This is melooking at the x ray. Okay,
all right, go ahead, andwhich which which? The previous doctor looked

(13:16):
at the x ray too and sawit. I mean, I'm not telling
you that they missed it. Theysaw it, but they reached a conclusion
based on the ultrasound that it wasoutside the joint. Well, so I
looked at him, and so Itook a second look at the MRI and
I discussed it with our radiologists,and he agreed that there was not only
a bone fragment in there, butthere was a donor site yea. And

(13:39):
so I said, look, thisis one of those cases that you don't
have a choice. You absolutely surgicallydon't have a choice. There are a
handful of injuries where our hands aretied. You know, a broken tibio
that's exposed to the elements, Yep, don't have a choice. That is

(14:01):
surgical, no two ways about it. Well, a tailler dislocation with a
bone fragment surgical, no choice.They're just some of those procedures that you
just don't have a choice. Itold mom and Dad. I said,
look, there's bone chip in hisknee. You can rehabit till the cows
come home. That ain't going tofix that. So it's either we take
this chip out or we replace it, put it back on the donor site.

(14:24):
And everybody was in agreement, andwe're getting it all lined up.
And now comes the business of medicine. So Hunter, who works with me
on a daily basis, says,hey, Doc, I got bad news.
I said, what. He goes, United Healthcare denied this, denied
the procedure to put the bone chipback belongs. I said, You've got

(14:48):
to be kidding. Is there away that we can appeal this? Did
they get my notes? Did theyget a copy of my notes? He
goes, yep, yep, theygot a copy of your notes. So
I was pissed because this is verytime consuming now that I have to talk
to some peer to peer doctor andwe have to set it up. And
we set it up after I wasdone with surgery, when it was convenient

(15:09):
for her whatever whatever, And andso she calls me and I said,
did you read my notes? Shesaid, yeah, I read. Wait,
by the way, this is atime where you're pleading your case to
do what is peer to peer decitelynecessary. Understand this. It's also worth
noting that the peer doctor is notthe one who actually reviewed and denied the
case initially. Yes, probably notan orthopedic doctor. Oh, I'm thinking

(15:31):
it was probably a nurse. Andso as she said, yes, I
read your notes and we did makea mistake that my predecessor apparently did not
read the section on the bone chip. So finally they approved it. And
look, there was a lot ofdelays here, but there the knee jerk
reaction for an insurance carrier is todeny, deny, deny. Yeah,

(15:56):
so yesterday was the day of surgeryand it was exactly as built by the
way. I need to go backto the peer to peer this is.
I think this is funny, butI think the remaining the audience, whatever's
left of our audience, probably willnot think that's fun So they said,
we will approve the procedure to putthe fragment back in place. And I

(16:19):
said, what about the arthroscopy,the diagnostic karthroscopy, Because the first step
of that procedure is to be ascope in there and mind it exact and
find it. She said, well, we can't approve that. I said,
do you want me to just cutthe knee wide open? Right off
the bat? She goes, Ican't tell you what to do medical judgment

(16:40):
based on what's approved and not approved. I said, the standard of care
is to put a camera in thereand look. She said, well,
you know you can always retroactively.What a pain in the butt. So
the point of this is, soI go in, I do what's right.
I looked at it with the scope. It was a huge piece.

(17:03):
There's no way for me to eventake it out. But I did think
that it was saved. We couldsave it. And I found the donor
site and so we made the decision. Now this is none of you guys
are going to think this is funny. But it was two pieces. And
so it was a two piece puzzle. And it took me and doctor Leevy
a half hour to figure out howthe two pieces fit. It was the

(17:29):
strangest thing. It was. Youknow, it's a two piece puzzle.
Hell, even a politician can dothat between rotating and rotating and which one
is on the top and which oneis on the bottom. It was.
But finally and it came together beautifullyput it back in place, put some
screws that will eventually dissolve, andtook pictures of it. It's gorgeous.

(17:51):
Now, what I told Mom andDad is that that we have to have
it time to heal. And thenon addition to all this stuff, we
have to deal with the dislocated patellain the first place, right right,
which is a whole other issue allby itself. Anyway, there's more to
talk about, because this does openup, ye doesn't It's opened up.
That's probably about five or six pointsyeah, five, in terms of that

(18:15):
whole story that you just shared.Yeah, anyway, we got to go
on a quick little break. Thisis the kind of stuff that we talk
about because it wasn't it. I'msorry, it's early in the morning and
daylight saving time and my brain isblank. Mahomes' first name Patrick Patrick Mahomes
didn't have a teller dislocation a coupleof years ago. Absolutely he did.

(18:37):
He did, Yep, he did. He was I remember the play.
It was on the goal line.It was he was doing a quarterback sneak
and a helmet hit his kneecap anddislocated. Quick a little break coming right
back welcome back, Welcome back toInside Sports Medicine too. Sorry, I'll

(19:15):
brad the lard hunter spears. Garrett'son the other side of the glass.
The phone number it also functions asthe text number. Two one four two
one four seven eight seven nineteen seventyone. Two one four seven eight seven
nineteen seventy one. Yes, we'realways looking for the farthest away listener.

(19:37):
You can listen to us on iHeartRadioApp from wherever you are on the face
of the planet. Yeah. iHeartRadioApp. Oh, did you get the
number already? Yep. Two onefour seven eight seven nineteen seventy one.
Okay, So I was kind ofdescribing a a really interesting case in the

(20:03):
first segment, and just in summary, kneecap dislocation is a relatively common sports
injury. I mean pretty common.This is It's like, not quite as
common as a sprained ankle, butit's a relatively common This is sports medicine
freshman class. Yeah, yeah,this is I was gonna tell you that's

(20:23):
probably a good sports medicine one onone top. Yeah, it is a
sports medicine one on one. Andand in the same context, I always
tell my patients it's one of thehardest things for me to treat because there's
not a reproducible, one hundred percentfix, use that term fix. The

(20:48):
reason that your kneecap is unstable inthe first place often is structural. You
know, the the patella, whichlook at it from the top kind of
looks like a bar of soap andit slides on the femur. But if
you look at it underneath, itis V shaped. It almost looks like

(21:08):
the keel of a boat as you'regoing down the lake. But there are
some people where the underneath side ofthe kneecap is just flat. It's just
flat, so the sharp point endis just not there. Adding to structure
the end of the femur. Thethigh bone also has a trough, and

(21:30):
so the V fits in the troughand you have structural stability. Well,
some people aren't born with that,so the bottom of the kneecap is flat.
The top of the femur, insteadof having a trough, is also
flat, so the kneecap just kindof slides back and forth and is unstable.
If you get a helmet on theside of the knee and it dislocates

(21:55):
like Patrick Mahomes. Did I thinkit was a playoff game? It might
have been a playoff game it happens, or perhaps like this case that I
was just presenting to you guys thismorning. You know, you take a
big old swing on a baseball andyou and you your knee twists and it
dislocates. Yeah, it's that's astructural problem, and it's hard to fix

(22:18):
because we can't fix the anatomy.So there are procedures to tighten this and
loosen that and reconstruct this. Andalthough the results have gotten significantly better,
you know, if you do areconstruction with a new fresh ligament to hold

(22:38):
the patella in place, it's almostninety percent success rate. Notice not one
hundred it's gotten better, but nonethelessit's still really hard to treat with with
ACL injuries. For example, youknow our my my surgery rate, my
revision rates ninety eight percent, sothat's pretty damn good, but again not

(23:03):
one hundred percent. Going back tothis particular case, sometimes when the kneecap
comes out, it knocks off apiece of bone, and that's exactly what
happened in this particular case, andthe reason that I was scratching my head.
And the reason that I was thinkingthat this was an an absolutely idiotic
decision is that they they, theprevious orthopedic surgeon that saw this young man

(23:27):
before us, did not have anexplanation for why this piece of bone was
there. And more importantly, whatBrad said, where did it come from?
Yeah, So we originally got onthis topic because we were talking about,
you know, in training. Inessence, we were taught and it's

(23:48):
not even taught, it's just kindof understood, like you don't throw another
dock under the bus, right,We're always taught about that. So,
because like you said, you weren'tthere, you don't know the circumstances is
just you know, you don't youdon't want to be playing Monday morning quarterback.
But ultimately I want to defend myselfhere. Yeah. Ultimately the decision
he reached, which was erroneous,led to the patient coming to me right

(24:10):
right right, So, no matterwho was in the room, the end
result was it's not surgical, We'regoing to rehab your we'll see you later.
So that confirmed the idiocy. Whatis the word idiocracy? No,
it's not the word, and it'snot idiocracy. He made a stupid call.
Go ahead. Yeah, so we'retaught, so you know, and

(24:33):
you know, my disclaimer here isthat I'm not trying to throw anybody under
the bus. I think what we'resaying is that ultimately the diagnosis was wrong
and the treatment was not right.But to give people an idea of what
happens whenever we're trying to diagnose theproblem. The best way that I can
describe this is that everything that wedo, whether it's an X ray,

(24:57):
an MRI, talking to the patientand getting what we call their history,
and the physical exam, all ofthese things are pieces to a puzzle to
paint a picture. Absolutely. Ilove the way you put that. So
everything that we get contributes to paintinga picture for us, which we've talked
about before, Doc, the mostimportant thing is the diagnosis. Yeah,

(25:22):
I can't I can't treat, andI can't be accurate unless I know what
I'm treating. Got to have adiagnosis, right. So which, by
the way, if you're friends ofours or you have a doctor friend and
you just say, hey, myknee hurts, what do you think or
hey I kind of did this,sometimes you're like, I don't know because
I don't have enough of the piecesto paint a picture, don't have enough

(25:45):
data, don't have enough data.There's nothing worse than standing in church line
to get into Easter service and theguy says, my elbow hurts right here.
What do you think? What doyou think? Well, I don't
know what I think. I don'tdude, I mean, I don't have
extra I can tell you possibly,but I who know. I mean,
I don't know. I don't knowwhat I think. I don't have enough
information. So with that said,the there are certain pieces of the puzzle

(26:07):
that will contribute more to the tothe picture than others. And in this
case, when you have an xray and a history that says, hey,
listen, I dislocated my patella.I disocated my kneecap, and then
you have trainer put it back.To put it back, I mean like
the picture is being painted pretty clearhere, and then you have an x

(26:29):
ray that shows us a bone piecethe the picture is painted at this point.
Now think about it this way.If I'm getting an MRI, I'm
really only adding a few you know, paint strokes on on what's already pretty
being you know, being painted prettyclear here. So when the MRI I
comes comes back. Even if itwas a bad read, it was incorrectly

(26:53):
incorrectly read the radio. I'll justmiss who missed it whatever, right,
bad day, I don't know.That doesn't change the picture. It doesn't
change the picture that's already been paintedexactly. And that's what I'm saying.
I feel like once the MRI gotback, the picture that was already painted
was erased. Yeah, And it'slike that's when what they call the clinical

(27:15):
gestalt or the kind of spidy sensein the back of your head as a
physician that says, hold up,hold on, I can't unsee what I
saw with the bone ship still inthe knee, even if the read was
was wrong right, So it's ourresponsibility. It makes no sense if there's

(27:37):
a bone chip on the x rayand the MRI didn't see you a bone
chip. You have to have anexplanation. What did I just see?
What did I see it with myown two eyes on the x ray?
And so if you remember the storythat I just said, a few minutes
ago, United Healthcare went by theMRI which was erroneous, and the MRI
the United Healthcare denied the procedure becauseAMRII didn't show a bone chip. Yeah.

(28:00):
Well, well wait a second,there's more to this painting, right
right, right, So now whenyou talk about the business of medicine,
the treatment that is actually required forthe diagnosis is now not covered. Yep,
because an MRI said, you knowso. So yeah, listen,
it's a it's a it's a.I love the case. I don't think

(28:22):
it. I don't think it shouldhave been a tough case, but it
ended up, you know, becomingit. But yeah, and and there
was some you know, mom anddad were upset, and and the youngster
just wanted to get it over withand all that stuff. But but I
love what you just said, Brad, about the story and the exam and
the X ray and all paints ofpicture. I love that. And and

(28:48):
medicine can't be cookbook. It justcan't. Look maybe eighty percent of the
time, it can be cookbook.You know, you sprained your ankle.
Yep, pretty pretty straightforward. Butit but not for every case. And
and the picture has to make sense. It just has to make sense.
I keep going back to that.Oh god, now now I'm the derailer.

(29:15):
Remember that you're way too young forthis. The O. J.
Simpson trial and try to put theglove on. And he said, if
it does not fit, you mustOkay, Johnny cockran the whole deal.
Not I wasn't remember. Okay,this is kind of that same picture.
If it doesn't fit, there hasgot to be You said something during the

(29:37):
break, so they saw the boneship, where did it come from?
You said something during the break thatwas just yeah, you you as a
physician, as especially as a surgeon. And then you're gonna have to You're
responsible for fixing this young man.You've got to have an explanation. What
am I looking at? Right?Where to go? What's the explanation?
What did it come from? Right? Because because does the MRI. It

(30:00):
doesn't erase the it doesn't erase what'salready been painted. It's the best way
I can put it. So itshould contribute, not erase what. And
it was like it completely painted adifferent picture. It's like, hold up,
but we already got some we alreadygot some paint on the canvas here,
right that we got to acknowledge,you know what I mean. So
now the other part is, youguys know, I do a bunch of

(30:21):
ultrasound in the clinic, And Ithought about this Hunter because you said that.
So, for people who don't understand, Hunter is doctor. Sooreal's assistant
right now, pre mad. He'sgoing to be in medical school someday soon,
and he's going to be a damngood doctor because he's way ahead of
the absolute rocks, way ahead ofthe game. So he's so we were

(30:41):
talking on the break. He said, well, the ultrasound apparently confirmed that
there was no bone chip, right, No, no, no, no,
no, no, they said theysaid the they saw the bones use
the ultrasound to confirm that the boneship was extra articulate. It was outside
the joint, Okay, And Ithink I understand. I remember it was

(31:03):
a big It was the size ofan oreo. It's a big chip.
Right. The only way that's trueis that they saw nothing on the ultra
sound. No, they saw it. No, But that's what I'm saying
that, like, like, theonly way that's true is that they say
we saw nothing in the joint.That's the only way it's true, because
it can't be like because we confirmedseeing something outside of the joint exclusion.
Yeah, obviously that's the only wayit makes sense to me, But anyone

(31:26):
anyway, Well, I was curious, so I was looking. Patrick Mahomes
ended up not doing anything to addresshis dislocation. So it's not uncommon,
very very like common injury for adolescents, athlete young athletes. As like a
parent and someone that might be goingthrough this, experiencing this with their child,
what as a physician do you recommendthat, like parents look for when

(31:48):
their kid experiences a towar dislocation,et cetera, et cetera. Yeah,
but again I go back to whatwe've all said, We're all in agreement.
This is a very difficult diagnosis totry. It's just a very difficult
and sometimes and by the way,Pateller instability is far more common in girls
and boys. Yeah, my daughterhad it this year. Ye, so
we're not we're not really sure why, but it's far more common in girls

(32:13):
and boys boys. Usually it's traumatic, like Patrick Mahomes, you get a
helmet or you get a hockey stickor something that knocks a kneecap out.
For girls, sometimes it's not traumatic, and in fact, most of the
time it's not. There's not adirect blow to the kneecap anyway, and
sometimes it just slips in and outwithout actually coming all the way out.

(32:35):
When the kneecap comes all the wayout, that's it's gruesome. It's gruesome,
it's painful, it's just yeah.But so sometimes it just slips,
which makes it even harder to treat. Normally, for me, if it's
a first time dislocation and there isnot a bone chip, okay, doc,

(32:57):
okay, okay, not a bonechip, then we go with rehab
and embrace and Strengthen now the problemis the recurrence rates really high, really
high. You might be able toget away with it and it doesn't happen
again, but often it will happenagain, and then the whole bunch of

(33:17):
surgeries. So what I told Momand dad in this particular case we've been
talking about, if he didn't havethat OREO sized bone chip, we probably
would I would have agreed four weeksof rehab. Absolutely, I would have
agreed. So so so let meask you, because now it's clinical.
So while you were there, didyou try to repair the the media ligament?

(33:42):
He was asleep, we had anincision. We're already taking all the
surgical risk of infection and whatever,might as well repair the ligament while you're
there that makes sense. That makessense, all right, quick little break.

(34:21):
Welcome back, Welcome back to InsideSports Medicine teo story. Brad Ballard,
Hunter spears Garrett on the other sideof the glass. All right,
Moving on. Baked in a butteryflaky crust. Baked in a buttery flaky
crust. You. Yeah, SoI was supposed to do a live read

(34:46):
and I bailed. I couldn't doit. I bailed. Remember, we're
not radio people here. We're notradio people here. We're doctors that fake
being radio people. All right,So this is not on my notes of
things to talk about. But Hunterand doctor Ballard just showed me something that

(35:09):
I did not know existed. Yeah, I neither did I until this past
week. All right, share itwith the folks. Uh, pet chiropractic,
pet chiropractic. Yeah, yeah,so what yeah? So and there
are videos that go with it.Oh man, the best part of the
videos is the dog's reaction. You'renot doing that to my dog? Well

(35:32):
after you watching it, after youwatched it, oh, you were like,
yeah, I'm not doing this.But I think the dogs are probably
thinking the same thing. When youlook at the reaction, they're just like
it's given the fact that it's aradio show and you don't have access to
video and you can watch it afterwards. The apparently the chiropractor is manipulating the

(35:55):
dog's neck or hips and pops it. Yes, and it looks pretty.
It's like a violent like it's brutal. Yeah, and it's But the best
part is the dog's reaction. Dogsreact like what did you just do?
To me? Yes, the dog'sreaction is can we say w T F

(36:16):
w TF? Okay, Well youcan say the letters, right, I
mean not not not not the not, But I can say why why why
the face? That's the that's yourmodern family. Do you not why the
face? Oh? Why? No, I missed that. I didn't see
that, but we are. Thatis what the dog. That is what

(36:37):
the dogs face is clearly saying.Okay, so like what, so explain
something to me. What is thepoint of pet chiropractic? I don't know
how because the dogs not complaining?Yeah, how do you know to take
your dog to a chiropractor? Right? I mean I've watched the video this
dog chiropractor. I don't know.Is there different do you have to have

(36:58):
different license? License? Sure tobe a chiropractic versus a pet chiropractor.
I don't know. Oh, ifthere are any veterinarians listening out there,
chime in two one, four,seven, eight seven, nineteen seventy one.
We're very curious about this. Doyou have to have any special licensure
or or if you refer to apet chiropractor what what would be the reasons?

(37:19):
And how much does it cost?Oh? Man, I don't know.
And how do you know if itworked? That's the other thing that
the dog gives you that face thatwhen the dog gives you the WTF face,
I think you've you've done your job. My, oh my goodness.
This is people do that. Ohyeah, that guy, I mean,
it's the same guy. The personwho's on my phone is the same person

(37:40):
that hunter showed you. Then oneguy was one guy was adjusting a horse.
He was just showing me. Peoplelove their animals. Oh I do
too, but I wouldn't put himthrough that. I sometimes I go on
a little rabbit hole on TikTok andsocial media where I see some of the
food that people feed their dogs.They're feeding them like fish and quail eggs

(38:00):
and beef, flivver and tomahawk ribbones and what crazy? They just chew
on the bone, the bone,but the tomahawk they're feeding like ground beef
and quail eggs. I don't seea problem. That's just well from pecco.
Oh but there's a whole whole bunchof ads on TV about all these

(38:23):
pre made dog premium dog food.Yeah. No, I love my Stanley,
the best, greatest dog ever.Yeah, greatest dog ever. But
I wouldn't he's not complaining of anypains. What happens if you take your
dog to the vet and and says, you know, doctor story, I'm

(38:45):
going to refer Stanley to a petchiropractic. I'm gonna find me a new
vet. I just, I justI didn't understand that. Wow. Wow
two one four seven eight seven nineteenseventy one is the text or phone number,

(39:06):
And if you're living in Fort Worth, it's eight one seven seven eight
seven nineteen seventy one. What arewe talking about during the break that?
Yeah, yeah, I can't rememberwhat else it was on my notes of

(39:31):
certain topics to discuss something that isnot necessarily sports medicine related, but maybe
peripherally sports medicine related. Uh mygosh, I am blinking march madness.

(39:53):
That's the word, march madness.I was not aware that tomorrow is is
the day. And we do thisin our practice on a regular basis.
We use my march madness as anexample of do you think you can play
or not? Oh? Yeah,Because if you've got a sprained ankle and

(40:15):
it's a regular season game, wemight want to sit out. But if
it's a los and you go home, then all of a sudden, the
risk reward equation changes. So doesit help me here because I have to
fill out a bracket in a nottoo distant future. Does the playing games?

(40:35):
Is that part of my bracket isthere? On Tuesday games like four
games? It's like the last fourin Do you are you asking? Basically?
Do I fill out the bracket afterthose games are done or before those
games are done? To me,the bracket doesn't start until you have the
full six Thursday, right at fullsixty four. That's because it's this play
in tournament is kind of new too, and I find it odd. I

(41:00):
find it odd that the play inwinner is an eleventh seed. Why is
the play in winner not a sixteenseed? That's a good question. Because
you obviously were not good enough tomake the tournament. Yeah, yeah,
so you were not good enough tomake the top sixty four. Now you've

(41:22):
got to play in to get intothe top sixty four. Any idea why
the play in winners get eleventh seed? You got to push the bar.
I was on the wrong I pushedthe wrong one. So the are we
talking like first like first four ollike next four out? Or Look,

(41:42):
they've changed it so much. Ididn't really know what they're the sixteenth seed,
but I have noticed in the pastthey make it to where they're the
eleventh seed. Yeah, and I'mnot too sure about that because I feel
like you should put those teams outeither fifteen or sixteen. I think,
so make it fair because that eleventhseed, I forget who they play.
I think they play the Fource somethinglike that. So because the ten and

(42:07):
seven play each other normally, oreight and nine play each other one in
sixteen two and fifteen three and four? So is there a and I want
to go to the phones in justa second, so tell William that he'll
be first up. Is there aclear leader this year? I mean,
is there a team that is betterthan everybody else? I like you of

(42:28):
h Yeah, I was gonna sayHouston and you Purdue, I think are
the top two teams. You andsee look really good the other night.
Yeah, all right, let's goto the phones. Let's go to William.
Good morning. You're on inside SportsMedicine. What's up? Can you
give a birthday shout out? Sure? Hey, hey, this is this
is ninety seven one in a freakwhere we say what we want, So

(42:49):
go ahead and say what you want. What the hell does happened there?
Somebody pushed the button? I guesshe hung up. He wanted to talk
about a knee problem. I'm confused. I don't know birthday shout. I
didn't push anything. He was upand potted. All right, Well we'll
moving on. Yeah, so,yess he doesn't have any problems. I
guess maybe that was just kind oflike a joke back Houston. Yeah,

(43:15):
so, I mean, I'm I'mgoing with U of H only because my
roots are there. My I mean, my wife, my brothers graduated from
there. Do they have final rankings? I mean, are are number one?
To be? They've gotta be anoverall one. So the overall one
one, Okay, they gotta bea one seed. I don't know if

(43:35):
that who's going to be the overallone? Is it produced? So here
are the overall like top twenty fiveAP Top twenty five, it goes Houston,
Yukon, Purdue, North Carolina.That's the top four and those are
all one seeds. Yeah, allright, so Houston is technically going to
be the overall number one. Yeah. So I don't watch even though I

(43:55):
spent a good part of three decadesin the NBA, I don't watch a
lot of college basketball. Uh,it's a completely different Gamely, it's a
completely different game college basketball. Look, I also think college football is a
completely different game than the NFL.Oh, certain those are two completely different
games. But sometimes early in theyear college basketball is not watchable. Have

(44:25):
to watch They can't make the basket, No, they can't. You give
them an open six footer and theymiss it. Well, and it's Look,
if you watch college basketball, defenseis primary. Yep. It's not
like the league. The league isentertaining, Like You're not gonna see guys
sticking on people like that. Imean, it's just not like that.
Right, So college I mean,you know, people are defending and and

(44:51):
and you got guys who aren't asprolific as you know Boca and you know
all these guys who can actually shoot. So sometimes the the field goal percentage
is not as by the time youget to the pros if you have an
open six foot or you're nine timesout of ten layup. And now was
getting to the point where you knowopen threes, the layups. But you
talked about risk versus reward. AndI don't know if you remember this,

(45:15):
but Doc definitely remembers this. Therewas a Louisville player years ago. This
is when Rick Patino was coaching Louisvilleand they were in the Final four,
I believe, and a guy hadan open fracture. Oh yeah, I'll
never forget it, and the nationaltelevision. The only thing that I can
think you talk about risk versus rewardis that this kid had a stress injury

(45:38):
to his tibia, which was probablyconsidered the shin splints going into March,
and it probably hurt, but itwas like risk versus reward, and no
one's thinking you're gonna go out thereand fracture your leg open fraction, right,

(45:58):
And so I think one ended uphappen with that kid, because there's
no way you can fractually that leg. Understand this, There's no way that
that leg breaks like that without alreadyhaving some mileage on it. And something.
I think the same thing happened toPaul George. I think the same
thing happened to uh Hill. Ohyeah, Grant Hill. So yeah,

(46:20):
all right, quick, a littlebreak, coming right back. Welcome back,

(46:49):
Garrett. You picked some a cDC songs that I've never heard of,
but you can tell her that's whothey are. My assistant back here,
Nick picked the song before this one, so I give him props.
But this one, I want tochange it up. I don't want to
play the same ACDC song every week, and so I got to change it
up for the listeners. And Iknow some of the listeners who are ac

(47:10):
DC fans we create appreciate the songswe do choose. Well, you did
good. This is a good one. Okay. Yeah. On the break,
we were talking about documentaries. Yes, swamp Kings was what we were
talking about, being college football fans, just kind of understanding what happened at
the Florida Gators, you know,prime time when they had Urban Meyer.
But you talk about music. Anothergreat documentaries is called the Greatest Night in

(47:35):
Pop. It was the night thatthey recorded We Are the World. Oh
really, oh Doc, all thosepeople are in one room. You gotta
watch it. Okay, greatest Nightin Pop. Billy Joel I need to
know he was. He was oneof the singers. Did Michael Jackson?
I didn't either. By the way, the Billy Joel video is yeah,

(47:58):
absolutely amazing. I keep going backto that because it's it's Ai. Yeah.
Yeah, I keep scratching my head. If you have not seen his
new song video, you've got towatch it. Uh, she's got Stevie
Wonder anybody who was anybody? Youknow. I like documentaries. I like

(48:20):
documentaries that are reasonably accurate. Notso much Hollywood. The the knock on
this Swamp Kings is that they couldhave been Oh they could have went in
they could have went in more.Yeah, yeah, I don't. I
don't think they give a full picturein terms of the level of Look.
I think Urban Meyer has a reputation. Oh, clearly he has a reputation.

(48:43):
Yeah they only touched the surface.But he wins. Yeah, but
here's here's my thing is that hiswins come at too great of a cost.
Yeah, well that was what Igot when I was thinking at it.
For some some people would trade anythingfor national cheap. Some people that's
trying to reach I get it.I get it. So today is March

(49:08):
sixteenth, and while that may meanvery little to other people, that was
the day that the medical community,the medical students, get their match.
At least that was the day thatI got my match. And it's usually
mid March, and it's always ona Friday, and I probably ought to

(49:31):
let people know what that means.So you go to college, you get
your degree in whatever you get yourdegree in, but you have to have
your prerequisites for medical school, soa certain number of hours of chemistry,
certain number of hours of biology,et cetera, et cetera. And you
take the MCAT Medical College Admission Test, and you apply to medical schools and

(49:59):
you there's a match for No,is there a match for medical school or
no, there's not a match forTexas schools. There are outside of Texas.
It's just rolling admissions. Yeah,So let me describe what a match
is. You rank the schools thatyou prefer in order, and the schools

(50:20):
rank this prospective students in order,and some computer matches the two, which
which helps because it opens up spacesfor other people. So you know,
a very qualified candidate does not takea space at every single medical school,
so the match allows that to bemore fair for other candidates. I just

(50:45):
know one thing, sure, Solike the match algorithm that they developed actually
won the Nobel Prize for Economics inlike twenty twelve, seriously for how it
worked, for like how it worksand how it well it makes it.
It makes it a lot fairer forall candidates. But you know, so
if you get into your first choice, you have no way of knowing if

(51:06):
you've gotten into any of the otherschools, right not. But if you
got into your last choice, thenthat means the top. All your other
choices said no, thank you.Well anyway, so you go to college,
go to medical school four years,and then you pick a specialty that
you want to go into. Itcould be family practice, it could be

(51:28):
orthopedics. In my world, itcould be internal medicine, et cetera,
et cetera. Well, all ofthose specialties have residency programs all around the
country, all around the country,and your first year of residency, by
the way, is called your internyear. So often people confuse that even

(51:49):
people in my own family confuse.Well, he's a third year intern.
No, it's not. Doesn't makeit just your first year out of medical
school. It's called your internship year. And after your internship then you are
in residency. And the time variesby specialty. There are some specialties that
are five years long, some specialtiesthat are three years long, and I'm

(52:10):
guessing they're all total four years now, right, or is there still a
three year Oh yeah, you arestill three years play neurosurgery take up to
like six years. Surgery six lastsix it will be up to like seven.
Well anyway, So the match usuallycomes out in the middle of March
on a Friday, and so mymatch was March sixteenth, So every March

(52:34):
sixteenth comes around, I always rememberthat day because it also coincided with the
day that I got into med school. So March sixteenth I got in med
school. March sixteenth, I gotin a residency at Southwestern. Now tomorrow
is Saint Patti's Day? Is aparade today or tomorrow? It is today?
Today? It is today. Oh, it's going to rain. Rain's

(52:55):
not supposed to be heavy or reallyeffect anything until starting one o'clock twish.
If they can get it off byeleven and get the majority of it done
before one. I think they're good, but yeah, this afternoon it's going
to be a wet one. Sodo you wear green today or tomorrow?
Today? And tomorrow today at theparade? Have any of you been to

(53:17):
the Barada wor have not? I'mgoing to it for the first time this
year ever in my life because thepast couple of years I've been having to
work saturdays care I've been out oftown. And some good content because they're
gonna be some it's it's it's lively, it gets really Oh it's lively.
The Greenville Avenue. Yeah, neverbeen. Oh yeah, it's a party.
You know. Mark Cuban and theMavericks have always been sponsors of that

(53:42):
parade. I've just never been.And this year there if you after the
parade and all that, if youhead towards the AAC, they're unveiling another
statue. It's a Dallas Stars player. I forget his name. If Mike
Madonna, it's got to be MikeMadonna. It is. I couldn't think
of the name of the top butstatute right across from Dirk. Very very

(54:05):
cool, very well deserved. Ohvery well deserved. I think he still
lives in DAWs. So last thingwe're going to talk about today that is
medically oriented pain meds, and soit's kind of an interesting subject. It's

(54:29):
in in the in the press ona regular basis because, as you know,
we have the we we have aproblem. We have a problem in
this country with pain medications and opiatesand et cetera, et cetera. And
I lay a lot of that blameon on the on the doctors, on

(54:52):
physicians. Yeah, we got totake responsibility. We you know, we
have over prescribed for decades. I'venever bought into that personally. Even when
we were training in residency, Ido remember others writing prescriptions for a three

(55:13):
month supply of Narco and I thoughtto myself, this makes no sense,
This absolutely makes no sense. Butfast forward since my first day in practice,
and I will tell you that allof us at Texas Sports Medicine,
we are very judicious with pain medicationsnarcotics in general. My post operatives.

(55:37):
So when I do an ACL surgeryand I know exactly what that feels like
because I've had it done to me, they only get ten talent aw threes
ten and I tell every single oneof my patients. If you need more,
something's not right. Yeah, no, that's good. If you need
more than ten, something's not right. You've got an infection or something's going

(55:59):
on. And guess what, Hunter, we've been together, what a year
and a half, two years?Have you ever refilled the talent OFL three
prescription. I don't think we've everdone it. Well. I also don't
think you would, and I wouldn'twell even but if somebody calls and says,
hey, look I need more talentoff threes, I've already used up

(56:20):
my ten. I said, comeon in, I got to look at
you, I got to see something. Well, so let's talk about that,
because I think what's what's prudent asa physician is setting expectation, right,
so we know that if we dosomething procedural or surgical on a patient,
there's going to be pain. Absolutely, that's just it. That's just

(56:44):
the nature of what's going to happen. Like in the repair or in an
attempt to get you better. Youmight take a step back in terms of
how it hurts, how it feels. But if I can walk you through
that and the expectations set all andyou say, this is what it's gonna
feel like. This is kind ofestimate how long, but we have something

(57:05):
for you, and and and listen, I'm not expecting you to be pain
free. Oh I'm so glad yousaid that. I'm not expecting you to
be pain free. That's part ofmy script. Now they can go into
it saying, Okay, I'm gonnahave some pain. Right. So it's
our responsibility to set up expectation.But it's also our responsibility not just just
right off. If they do havepain, we'll just take the pain medication.

(57:28):
We're not doing the patient any favor. Here's more, here's more,
just just you know, here yougo. You know, you're you're absolutely
right, because there are there arepatients that I've experienced over the years that
their expectation is they're gonna have painmedicine, so they don't have pain.
Right. It doesn't work that way, No, no, no, no,
it does not work this conversation withthe patient. Yesterday, we were
doing a procedure in the uh,you know, in our procedure room,

(57:49):
doing some regenitive medicine. Some PRP. I said, hey, listen,
you're gonna hurt tomorrow. YEP,you're gonna hurt this weekend, expect it.
You can take TiAl and on,but if you hurt, expect that.
So okay, I think I findthat ice is one of my most
potent pain relievers. Just ice youknee down. You know you sprained your
ankle. Ice your ankle down.You don't need narcotics. Ice your ankle

(58:13):
down, right, So, sothe the job, our job is not
to make people pain free. Yep. That that is that is such an
important concept to get across. Andand so and let's shift gears. Let's
let's switch it the other way around. Pain is so subjective. Oh yeah,

(58:34):
it is so subjective. You knowwhat, what's an eight to me?
Maybe a two to you? Yea, And those two cannot be treated
the same. So so well.One of our one of our chiefs,
in fact, the the chief oforthopedics. When I was training doctor Mooney,
Uh, one of his favorite sayingsis, I can't see pain.

(58:57):
I just I can't see pain.We have no way of measuring. So
a lot of it may there's awhole specialty, by the way, and
neither Brad or Eye are experts inthis, but there's a whole pain management
specialty that we're we're just not we'renot smart enough to know how that all
that stuff works. But we doprocedures and we see patients that come in

(59:21):
with a broken leg or whatever,and so we see pain every single day.
Absolutely. Look, I explained topatients, and we talked earlier about
you know, the whole thing ofwhat happened with the other doctor in communicating,
and we talked about the some ofthe art and the constault of medicine.

(59:42):
One of the things I try tomake clear to my patients, I
say, you you you came into see me, probably because there's some
there's some function that you're either concernedabout or you're trying to You're trying to
do something functionally, whether it's playtennis, walk, but that function is
affected. So you came to seeme. So I said, let me
make something clear. My goal isto help you hit your goal of functionality

(01:00:07):
with as little pain as possible.So if we can focus on your function
and it's not that painful, that'sa win, right, Right, So
now the expectations set again, we'retalking about that, right, But if
it's like, hey, well I'mjust coming here to just be pain free,

(01:00:30):
so part of my script patient comesin, So why are you here
to see me today? My knee'sbeen bothering me? Well, and I
always interrupted and say, what doyou mean when you said bothering? Does
your need hurt? Does your kneeswell? Does your need clicked? What
is your definition of my knees botheringme? And it's not just as simple

(01:00:52):
as well, here's some narcotics botheringyou, right, you got to figure
out what the ideology is. Well, it's not just figuring out the ideology.
But like you said, and wetalked about this before, like why
are you here? You know doctorMayor who every time he talked about it,
because he said you can hear mekicking down the door and saying why
are you here? But really,I mean, that's that's what we're really

(01:01:15):
trying to understand. Because even oncethe picture is painted, we talked about
that earlier. Once the picture ispainted the real then the question is,
Okay, the picture is painted,but what's a win in in our book
in terms of why you came tosee me? For some people are like,
dude, my kniece just clicking rightdoesn't hurt? I just need an
answer, doesn't hurt. My niececlicked. Okay, oh well it's clicking

(01:01:37):
because of this. You would besurprised how often that happens. You would
be absolutely surprised. Some peace ofmind, right, and and you're going
through all this thing like I'm gonnfix this on the like, Okay,
well your NIE's clicking because you gota little bit of Arthur. I don't
know, but but if we cananswer that for him, that's different than
doude. My my my knee isswelling and I can't play tennis. I'm
looking to get back to playing tennishere and back to this the pain manage

(01:02:00):
thing. There. There are folkswho think that if my knee hurts and
something's wrong, and yeah, that'san interesting assumption. It's an absolutely interesting
assumption. But once you determine thatyour knee hurts because you have tendonitis and
it's treatable, then all of asudden, there's a peace of mind that

(01:02:22):
comes goes along with that. Yep, yep. But I had a patient
yesterday, seventy five year old gentleman. A friend of mine brought his father
in. Seventy five year old gentlemanwho had a big rotator cuff tear.
Okay, now my question was howis how are you like, how are

(01:02:46):
you functioning? Is that? Isthat a pain thing or a function?
Yeah? I said, well hewas like, well I can. I
can do kind of pretty much everythingI need to do every day. It
has a little bit of pain,and the pain is getting much better.
So the picture is painted. Wegot a big rotator cuff tear. The
book may say, oh, thisis how you repair rotator cuff tear surgically,

(01:03:09):
but the question is do we reallyneed to go Is it worth the
risk of this gentleman undergoing a bigsurgery or a big rotator cuff tear to
capture maybe a little bit more functionwhen his pain is already kind of low.
We're back to the risk rewordy questionexactly. We've been. We've been
under this risk rewarder question since thefirst day of school. So so Rick

(01:03:31):
and I talked about it yesterday.I said, doctor Levy, he's rotator
cuff specialist in our in our clinic, and I said, is there anything
stopping this gentleman from being able toget by and not get surgery because they're
not really interested and he's pretty functional. He's like yeah, no, just
because it's torn. Yeah, yeah, right, So when when you can

(01:03:53):
understand that as a clinician, andthat's the part that comes with time,
you know, is is really matchingthe picture to what are we gonna do?
That's a win in your book,there's a as a patient. So
I'm gonna leave you on a kindof a funny note when we're talking about
this opiate problem, because it's avery serious problem. I think there's an

(01:04:15):
ad on TV about chickens and noantibiotics, and in the ad, the
guy says, you just can't throwantibiotics at at your problems. And it
shows a lady on the side ofthe road with the hood of the car
up in the air and there's steamcoming out and she takes these pills out

(01:04:41):
of her pocket and throws them atthe engine. You can't you can't just
throw antibiotics at your problems. Well, you can't just throw pain pills at
your problem. No, it's yougot to be able to figure it out.
That's good, all right, Episodeeight seventy two. We will be
back next Saturday. Until then,you can listen to the podcast on iHeartRadio

(01:05:04):
app. You can come see usat Texas Sports Medicine. I do want
to thank all of our sponsors.Jaguar, Landrover of Dallas, part of
the Snell Automotive family, Backendorf Jewelersfamily owned since nineteen forty eight, the
Texas Sports Medicine, Performance and RecoveryCenter. I started to do a live

(01:05:24):
read on that, and then Ikind of bil I bailed. I bailed.
I'm just not good. It's actuallyfor the best. After I heard
it was for the best. Yes, Anyway, until next week on behalf
of all of us here on Insidesports Medicine. In ninety seven point won
the Freak Tell your friends. Tenan