.

>> And good evening.

Thank you so much for watching HealthLine here on PBS for Wayne.

I'm your host Mark Evans.

Great to have you along.

We'll have a very interesting show tonight since a lot of sports are popping up because of the spring, summer and fall season.

>> We'll talk about sports physicals and wellness exams and talk about sports medicine and pediatrics.

A couple of great doctors on tap today to answer your questions and we do invite you to call that number on your screen 866 (969) 27 two zero and we have Dr. Joseph Mattocks who is a sports medicine physician.

Great to have you back.

Thanks for having me.

Yes, I'm actually board certified family practice of sports Medicine Fellowship about six years ago and I specialize in that since then.

Oh, I see.

And you've been on the program since.

Yes.

Thanks for having me back.

>> Absolutely.

And then Dr. Dwayne Hulk Hogan Dobler I've been trying to practice that all day and I will get it.

>> Hogan Dobler, a pediatric physician.

Great to have you first time on air our television station.

All right.

Well, it's great to having me.

I'm just now getting started and hope to have you back.

All right.

All right.

>> So let's go ahead and just break this down will kind of pave the way for the area here to build the platform as like to call it Dr. Maddox.

Can you explain?

I know you can but explain to us the sports medicine entity and how long has it been around so I think the sports medicine priest participation physical has been around as long as there's been sports during my career.

I've seen quite the evolution of this starting in residency in the late 90s and the early 2000s, most sports physicals or pre participation exams were done in gymnasiums, huge gatherings, a lot of noise and you know, parents got to send their kid, get their kids home with their form filled out and they felt like OK, my kid's good for the good for the year and they're healthy and ready to go.

And I looked at this in residency and thought this is just not the best standard of medicine that we should be providing that you're getting of quick sports physical but not that great wellness exam that we were taught to give and we were in medical school and residency and and training and Dwayne and I came together on this topic and have tried to pull these sports physicals participation exams out of the gymnasiums, get them back in with their primary care physician so they can get that good wellness exam along with the sports physical exam.

Mm hmm.

So that sounds fairly comprehensive.

In fact, if not entirely.

I mean you've got the sports angle and of course you've got the looking up for the for the child themselves so got kind of a two and one thing that sounds like to me well let's go ahead and thank you for that and by the way, it's only been like in the mid 20th century correcto in sports medicine kind of appeared as became a specialty, correct?

>> Yeah.

Good research on your part.

Oh thank you.

Yeah.

And Dr. Hogan, Doppler as a pediatric physician, of course many people know what that is but go ahead and explain that for those who may not know.

>> So our our training is from birth to 18 and all the ages in between.

So that's where we spend our internships and residencies and that studying that particular population.

And you have a particular specialty within the pediatric specialty or do you just you take care.

I'm a general pediatrician.

General pediatrician, OK?

And I remember my doctor daily in Indianapolis what a great guy was.

Did you know him?

Yes, I'll be darned.

Yeah, he was a great guy.

All right.

Let's go ahead and get started here.

So we're talking about sports physicals versus wellness exams .

What are the differences?

Let's let's break those down and I appreciate your your opening comments with that because I think that that too many people felt that the sports physical counted as their yearly exam and it really is just a small part of what that entails.

So a wellness exam for those of us in primary care pediatrics, family medicine and the internal medicine group look at the whole child.

And so in that wellness exam we're looking at their mental health status, looking at any old problems that they've had.

So injuries, heart problems, lung problems, asthma, diabetes, those kinds of things and these things wouldn't be noticed by a sports physician.

>> Not necessarily our sports, our properties patient exam that we're doing athletic training rooms mostly in universities now we're mostly screening for sudden cardiac death, somebody that has a some sort of cardiac myopathy and that happens to young people and that happens young people currently in collegiate age athletes the number one cause of death, sudden cardiac death.

It's more than trauma, more than sickle cell.

It's more than heat stroke.

So that's why we're screening for that and we screen for it by first asking questions.

Do you have symptoms?

Do you have any shortness of breath?

Do you have chest pain?

Have you ever passed out?

Do you have any issues with that?

And then we get into family history.

Is there anyone in your family that's died younger than age 50 due to heart related problems?

Do you have anybody in your family with any history of Marfan syndrome specific questions like that.

So we're really trying to limit that with the sports physical and it's very focused whereas the wellness exam is much broader like Dwane was mentioning including mental illness, vaccines, immunizations, wellbeing, family history of any sort of chronic you know, medical issues outside of the heart and sudden cardiac death.

>> OK, so again working together and making sure that everybody is on the same page for what's best for that particular pediatric.

>> Let's talk about the well, you did cover that.

In fact that was my next question.

What would a wellness exam cover or include that isn't included in sports physical?

I think we took care of that.

>> What are the benefits to regularly seeing a primary care provider or a pediatrician for a wellness exam?

So even though you get checked out to play sports it's OK but you should continue seeing your pediatrician, is that correct?

>> Yes, we we asked them to do well in the first two years.

They come often, you know, just months apart but in and then after three we'd like to see everyone every year and a lot of it is there are some things that develop over time and one of the big ones is scoliosis and we've had that unfortunate circumstance where kids have gone to the back in the day the sports things and finally show up in our office and they've got terrible scoliosis that wasn't necessarily picked up at the time and things like that.

Heart murmurs You know that that type of stuff.

So there's things that can happen even the child seems to be OK.

There are things that we look for when they come.

I'm sure doing any blood testing or anything like that.

>> There are different screening things we're doing now much more aggressively than we did in the past.

One of them is they're recommending that all kids 11 and above have mental health screens so for anxiety depression.

So that's part of it.

And then kids around nine should have lipid tests and and then there's two other things just as time goes on.

So various things based on your medical history and their age need to unarranged you need to keep an eye on.

OK, well I want to remind our viewers in case you're just checking in we were talking about sports medicine and the exams and physicals that go along with that.

Of course if you have any questions regarding sports medicine in general or pediatric medicine, give us a call.

But we're going to talk more about the the differences in the sports physicals and the wellness exams.

That phone number is on your screen two six zero (969) 27 two zero then kind of threading with what we just said intertwining the benefits of seeing a sports medicine provider.

Go ahead and tell us about that, Dr. Maddox and what situations would you want to seek care from a sports medicine provider rather than a primary care provider?

Sure.

My specific sports medicine practice is filled with essentially high school age collegiate age athletes that are hurt on their field of play and through athletic trainers are then referred on to me for their treatment.

That treatment may just be ice some sort of antiinflammatory we might need to involve some actual treatments by the athletic trainers in the universities or we may involve physical therapists with ongoing treatment in order to get them back to the level play to get them back on the field younger age somebody gets a muscular skeletal injury say not high school age not not in sports as much.

They may end up first seeing their teacher.

They might see the one work in the playground for the day and get sent to their primary care physician.

And then there's numerous primary care physicians, pediatrics family practitioners that take care of musculoskeletal issues every day.

But like we talked about earlier, there's some that are so busy with diabetes, hypertension, hyperlipidemia thyroid, you know, all those illnesses that someone comes in with a musculoskeletal problem.

>> They just don't have time in their schedule and those people will then get sent on to me.

Now do either of you when it comes to a sports injury have to refer a patient to another specialist like a surgeon of any sort?

>> I mean that's that's a big part of my daily activity.

But you're doing essentially I'm seeing people for their initial evaluation deciding if any imaging is needed, evaluating them and starting them on some conservative therapy in order to get them back to their field of play.

If they're not responding to therapy, then deciding if there's further imaging needed if imaging comes back consistent with something that needs a surgical evaluation, then we will move them on at that point would you both collaborate with a pediatrician versus or along with the sports medicine physician must be on the same page with that.

>> I mean and they keep us informed and I think one of the biggest benefits they've been for for us is when athletes need to end up you know, they've got an elbow injury because they're not throwing properly and these guys teach them how to how to do it the right way and then also the strengthening stretching and all that that goes with it.

>> But that that's huge too.

So sometimes it's not a huge injury but it's just nagging and needs help.

>> And as I said, I think what you're alluding there's definitely a meshing of our professions without a doubt.

>> I mean there's there's times where I'll be seeing someone in and you know, say they come in with some numbness and they're sent to me because they think that they've got carpal tunnel and I do an evaluation.

I'm thinking how this looks maybe more like it might be sugars and I'll call up Dwayne or one of the primary care physician.

I'm like, hey, I think this patient actually needs to be with you not in my office.

>> That is exactly what I was driving.

Yeah.

And so you're kind of looking out for each yes.

OK. And it is of course that very important to keep that child in good condition and their healing is going to be able to get back on the field and they're going to do well the I was going to ask you to because when you said we're talking about what you did and so forth, are you a sports fanatic yourself?

>> Yes, I'd be lying if I knew.

Oh yes.

So that's one of the reasons why you have this passion for this line of work.

Absolutely OK. And so knowing the realm of all of these are actually what is entailed in all these sports.

I mean, you know, all the moving parts and what muscles are being used the most.

>> I mean I find that very interesting.

Yes.

To boil all that down per sport.

Yeah.

I love my job.

Oh, I'm sure I can tell both of you as a matter of fact.

All right.

Well let's go out and talk about the as we're getting a call coming in from Suze and we'll take care of that in just a second.

But what sport or sports are bringing the most injuries to our pediatrics these days at a man one if you want to start with kids?

>> Yeah.

So it's really age dependent, I think.

And so the younger kids we see a lot of falls trampolines, roller skating.

Oh, ice skating, you know all those things we can always kind of tell what the seasons are based on the injuries that are coming and then bicycles and but basically anyway a kid can fall.

Is this how they can get hurt and then when they get it more into the sport it's probably more where you see I mean for me it's seasonal football season.

We're we're seeing more broken bones.

Obviously our last topic more concussions.

Yes.

Significantly more concussion.

Yes.

You know, then you move into basketball season a lot more twisted ankles and injuries along those lines you get into baseball season more shoulders and elbows and things with those.

>> So mine's very seasonal.

Yeah.

I would imagine if changes with each season.

Yeah that's all right.

Well we have a call coming in and Susan prefers to stay off the air which is fine.

So we'll go ahead and read her question and it says here my actually I can see this one better my kids play sports year round.

>> Should they be getting more than one physical per year?

Good question.

Yeah.

So if we do the thorough wellness exam I think that covers it and then if they have any issues I think getting them in quickly you know not not waiting until maybe it'll get better you know it's if it's hurting pain means something and talk more about that in the musculoskeletal but it means something if it if it's if it hurts they need to get it checked out.

OK, that was very good question Susan.

We're going to be on a year here for another it looks like fifteen minutes or so.

So if you have any questions give us a call at (969) 27 to zero with eight eight six six six in front of it.

>> Let's talk more about the these injuries the way they're going to be treated and this is where I'm trying to delineate who takes care of what.

So what would be the most common protocol for a patient if they got hurt in sports?

Who is going to take care of them, override their care entirely?

>> Who's going to assume that responsibility?

>> I mentioned this earlier and essentially for me if it's at high school or collegiate age, OK, they're going to have athletic trainers which I refer to as their primary care physicians in their schools.

They're not really physicians.

Very good.

I mean they touch a lot of lives and take care of a lot of people and so with say an ankle sprain, typically our athletic trainers will be involved in the high schools and you know, get the swelling down and start working on range of motion and working on strength.

And if they're not responding to the things that they're trained to do at that point, then they'll move them on the next step and give me a call and say, hey, you know, is there any way we can Timmy in to take a look at this ankle?

He's not responding to my therapy.

I think he might need to have some further imaging or whatever and then we get them in at the collegiate level again we have teams of athletic trainers taking care of all the collegiates or all the athletes and when they have an injury they'll start unless it's an obvious injury that needs to see a physician right away.

They're going to start with conservative therapy, get that swelling down, get them on medication if indicated over the counter and if they're not responding that they'll move on to the next step of getting them into a physician, get them evaluated and the question about, you know, do you need more than one physical like Dwayne said, the one physical is all that's required outside of that if your son or daughter has an injury and if after and there's no obvious deformity if after forty eight hours they're not starting to move better especially in the pediatric age that that Dwayne works with that age wants to have fun.

>> So if they're not moving there's something wrong and that's really a time don't sit on it as a parent if your child doesn't want to walk, doesn't want to use an arm to throw a ball when they used to throw a ball too much, there's something going on in there.

Let us let us take a look and make sure there's not a fracture something going on.

>> And from the psychological aspect of the child, are they afraid to tell the parent that they're hurting or are they afraid to go to the doctor?

>> I mean, you know, there's a kid there's an age group where they're just so honest and they really are just about wanting to play and have fun that they're not going to hide it.

Typically they're going to change their activity.

They're going to change the way they walk, change the way they move their arm.

They're going to continue to have fun but they're holding their arms at their side because they've dislocated something and they don't want to move it because it hurts, you know, something like that if you notice this, it's something that obviously they need to get in be seen either by their primary care physician or by someone like me and especially if they're out there holding their head and looking like they're seeing stars and I'm alluding to concussions of course, you know, we did a show with you not too long ago on the subject of concussions and it was very interesting.

I didn't realize that there was so much involved when a kid hit their head but with the education that's going on now and I'm sure it's probably not enough but how how are the rates of concussions?

>> Are we are we making a difference with this with the with the without a doubt sports specific?

>> There's been changes that have reduced how much concussions are there still there?

I mean let's not kid anybody and there's still some people that either don't want to understand them or or refuse to believe in them and there's there's coaches out there still that have that philosophy but there's less and the education is getting better and better and the care for the athlete is getting better and better.

I think maybe you recall in your last show that the one thing I say about concussions in parents is there's no one that watches your kid more than you if your kid's not acting like your kid on that field, walk out on that field and get them off.

I'm fine with that.

I mean I can't watch everybody well, from what I understood for the last show, sometimes the child doesn't even realize that he's yeah.

And hurt that bad.

You just kind of shaken up and got the wind knocked out of them.

So what are those signs kind of stinger little stinger.

>> So what are those signs those parents should be looking for along with the coaches and the managers of the teams and so forth?

>> Well, you know, you say that drunken step you know they have that moment where they're hit and they stagger and they don't have their balance.

They may be confused walk to the wrong huddle in football.

I've had individuals come off on the sidelines and have no idea where they are but they want to get back in the game.

You know, so it there's we're trained to look for these things and without a doubt we noticed them.

But again, like I said in a sport like football has twenty two players out there you can't watch all twenty two and you know if you if a parent sees something because a lot of times it's fast and then they're their buddies get them back to the field and get them back in a huddle and if you didn't see it the ref didn't see it they're going to go to the next play and then the next play could be the worst play of their life , right?

>> Yeah.

If they get hit again, you're absolutely right.

So it does make a difference.

We have to keep an eye on the kids correctly and watch for those and then and then once you know they've had a head injury, just be patient.

>> That's my biggest message to parents and coaches.

We talk so the national average from the day of concussion to the return to the playing field.

>> Forty three days no one likes to have their kid out for forty three days from sports.

>> Yeah that seems like I don't care.

I'm worried about your brain.

I'm worried about your brain when you're our age because that's what's important to me and it's just a matter of you got to see the big picture when it comes to these kids with head injuries and if those aren't taken care of of course late in later years as you just spoke about those things become prevalent.

I mean what are some of the things that can happen if you don't get those brain injuries taken care of when you're young?

>> I mean, you know, we're kind of reviewing our last show but well, that's OK. A lot of our viewers didn't see that.

Yeah, You know, you can have definite permanent injury.

You know you can develop seizures.

You can even die with too many.

The issue is when you start when you have a concussion you haven't recovered completely from that concussion and you take another hit and we as humans we do really well if we get a concussion and you let me heal completely and then you let me go back, OK, so that second concussion will not have as much danger to it.

It's when I'm not healed completely and I get hit again.

>> I think it's very important to address that that's those are so important they are probably one of the most important injuries when you see them when it has to do with the brain.

>> Sure.

Yeah.

>> Well let's go back to our original subject and I do apologize for getting off of course there a little bit and I did want to bring that up.

You have a passion for concussion.

Yes.

Lasting passion for yeah.

So what were you talking about ?

>> OK, but if a child is injured playing sports and you did remember kind of recapturing recapping here from some of the information that you both provided earlier but if a child is injured playing sports, the best course of action to seek medical help is what where should they start and can you give me a couple of scenarios when you go yeah.

>> To say get them in your primary care if you can.

Primary care if now obviously if it's a bone that's in a W shaped and that needs to go to the emergency room, then the primary care physician gets involved right.

So I mean I'm not sure if you've been around Fort Wayne but musculoskeletal clinics that they don't take care of general med stuff.

>> They're just orthopedic.

That's what they walk in clinics.

Yes.

They're popping up every street corner it seems like now.

>> So it sounds like they're needed.

Yes.

Yes.

OK, so just start out if you can if you don't go to the E.R., start out with your primary care physician and they'll go from there.

Yeah, a lot of times we can help direct better.

>> Yes.

And in our all the health systems in the area now have the ability of a call clinic call no like care navigation type number that you call into and they're going to direct you they're going to call your primary care physician and say hey, can you get in on this girl or boy for this injury and that that nurse is going to respond for Dwayne.

Right and say I don't have a face but we can get them here.

>> All right.

Which leads to my next question do you need a referral from a primary care physician to go and seek help from a sports medicine physician?

>> No, no.

I don't see anybody on the street OK, anybody on the street?

>> All right.

Let's talk about covid-19 and its effects on our athletes and hurt our kids when playing sports and having this time off and if they got covid, are there any repercussions of covid you're seeing and some of these people sure of you don't mind I mean no but I mean for me personally I mean, you know, five university training rooms over twenty six high schools that I'm involved with and the biggest thing I see is these athletes that have had covid they've sat out the get done with their covid and we have an evaluation to make sure that they're ready to go.

Then we put them through a return to play program to get them back to their competitive level after being with Kovik I may see them two weeks it might be two months after and they come in Doc I just I can't get to where I was before if that's happening don't try and push through that.

Come in and see me see your primary care primary care physician.

There are things that can happen after covid infection that we need to rule out to make sure it's OK for you to push through it, make sure you don't have a cardiac myositis any sort of inflammation around your heart.

They'll come in complaining of shortness of breath, chest pain with exertion, these type of things if that's happening, don't push through it after you've had covid get cleared by a physician.

There was a period of time during covid that we did an echo on every collegiate age the age athlete after covid to make sure they didn't have cardiac myositis.

>> That was overkill.

But but I don't blame you.

Yeah, there was a time where it was just unknown.

>> We needed more information.

We gathered more information.

We learned from that information and now we're more focused.

But we need I and I hope every physician that sees post-Soviet athletes I discuss with them here's the symptoms you're looking for when you go back to training if you experienced chest pain, shortness of breath, Despommier things on exertion that are out of proportion there don't seem like anything you've ever experienced before.

>> Let me see you get in and see a doctor.

Don't push through them.

Good advice.

Well, I just got the wrap sign .

Very good conversation.

I'm so glad we did this especially this time of the year.

Dr. Joseph Mattocks, sports medicine physician.

Dr. Dwayne Hogan Doubler.

Very good.

Thank you.

I got a plus on that one pediatric physician.

Great to see you both and hope to see you again.

Thank you.

We hope to see you next time as well.

We'll be here on HealthLine Tuesday nights and only on PBS for it.

Wait until next time.

Good night and good