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Hello and welcome to HealthLine on this Tuesday evening.

I'm Jennifer Blomquist.

I'll be hosting the program tonight as if you're new to this show.

It is a live show.

We're here in the studio right now and that's where we have a phone number up at the bottom of the screen because you can call in and ask questions.

We have an orthopedic doctor with us tonight.

He's on the show before.

He has a wealth of knowledge that he's more than willing to share with you.

He'd be happy to take any questions that you have orthopedic related.

So please call sooner rather than later.

You don't want to miss your opportunity to get some free advice because as we all know, nothing's really free today.

>> So but this I guarantee is even if you're outside Fort Wayne it's still a toll free call.

So it's (969) 27 to zero.

And again, if you're outside Fort Wayne it's still free.

If you put an 866- in front of that, we'll keep that number up for you throughout the show .

So as I've said, people tend to call them later in the show and sometimes the phone lines get a little backed up.

So call sooner and let me introduce you to the guest tonight we have Dr. Sean Carr.

He has been with us before.

>> You're an orthopedic surgeon.

We appreciate you coming on.

So happy to be on.

It's always always fun to be here and answer questions when I can and talk about orthopedics.

That's what I love to do so it's not hard to talk about.

>> Well, and I think a lot of people there they're nervous to you know, they maybe have some issue with their foot or their back or and they are afraid that they're going to be told oh you just need to have surgery or something something huge and then that requires recovery time off of work.

So I think some people shy away from getting an issue addressed.

>> Yeah.

Because they're worried about what what could be said.

So I don't know if you want to start with the fact that you and your colleagues in the field of orthopedics they start they take baby steps.

>> Oh of course you know, they'll be completely honest.

I think that's an anxiety that a lot of us have with a lot of things.

You know, we avoid I've been the the culprit of that before where I'm not going to go get my car.

>> Look, Dex's making a funny noise because I know there's going to tell me something but in the long run that doesn't do you very well and in medicine too, you know, we spend a lot of time and training to be able to find out when surgery is the right time and when surgery isn't the right time and the same time we are always working to treat people without surgery first if I can find a way to treat you and get you better or get you to a point where you are happy with where you are without surgery, that's a much lower risk and it's a much more favorable outcome and honestly one that most of us try to get with every patient that we can.

Sometimes that doesn't work out in surgery then becomes the next option but it's rarely the first option that's you.

>> The other thing is I think people sometimes they just get used to it and they live with it which I know some sometimes you guys have said somebody will say well when do I have to have surgery?

And sometimes I've heard the doc say well you tell me when when is it become just unbearable?

>> Yeah, there is a lot of surgeries, especially orthopedics that we would classify as elective surgery.

So it's something that doesn't necessarily need to be done.

It's not life threatening at the time but it's an option and I have that conversation a lot with my patients.

They say well should I have surgery yet?

>> Should I not in my line always is.

You know, when it starts to impact you enough that keeps you from doing the things that you really like to do or the things that you love to do or even the things you need to do, that's the right time to start doing it.

>> I've always been a big advocate of quality of life and sometimes you know, I would say for myself it would be quality over quantity.

Yeah.

And so if I had an injury or an ailment that kept me from doing the things that really bring value to my life and that I love doing, then that's when I would say that's the right time to step in and and I guess it would be take the risk of doing something a little more invasive to try to get that outcome to bring you back to the things you love to do well and you had mentioned invasiveness and some of the surgeries orthopedic wise obviously are.

But the trend one thing we wanted to really focus on tonight was there are a lot of minimally invasive procedures that can be I'm always shocked when I hear you guys talk about hip replacements and that the patient is you would expect somebody to be standing that night, you know, whereas you know, I'm thinking of my my grandma broke her hip years and years ago.

She was in the hospital for a long time and she certainly was not out of bed.

>> Right.

You know, that night after surgery.

So yeah, in orthopedics I think some of our our main advancements that have allowed us to push the envelope of , you know, recovery times and then also with what we can do with a smaller incision.

>> A lot of that comes from not only our surgical techniques better understanding and better maybe preoperative planning with imaging and things like that but also our material side.

>> So the actual materials that we work with have really advanced over the past I would say 50 years we wouldn't be able to get people up who had hip fractures up and walking the next day if we didn't have the ability to make titanium rods that you could insert through a small incision that can take so much force but are light and allow people to get up and walk walking on them right away and the understanding of those then surgical techniques that go into that that allow us to harness the body's own ability to heal but then augmented as well with our different instrumentation and our different implants that kind of allow people to push that envelope of hey, I'm going to get up on this broken hip.

It's still broken but we can start helping the body heal and recover by getting up and moving on it quickly and safely has really it's been a great thing in orthopedics and we continue to push that envelope with what we call more minimally invasive surgery which we nicknamed Miss just to make it a little less of a mouthful and mystic's classically have always been described as when we start making smaller and smaller incisions to accomplish the same surgery and techniques are constantly evolving with that and they've been introduced in the past in orthopedics and sometimes they work out and sometimes historically they haven't.

>> But we're constantly trying to figure out when that is an appropriate and with our new technology and all that kind of stuff, people have gone back to techniques now back techniques but back to ideas of minimally invasive surgery that haven't worked in the past because we now we have new techniques and materials that make it possible and luckily a lot of them are working out and doing really well.

>> Yeah, we've had I know some of the docs have brought things on the show.

You know, on the set and it's amazing how small some of these things are but yet they make a big difference.

So I just want to remind everybody that we only have Dr. Carr here till eight o'clock and it does go by the show does go by quickly call sooner rather than later.

We're talking about minimally invasive surgery or is as a doctor to say they they phrase it as miss.

We're going to be talking about that.

But if you have something else orthopedic related, he is more than happy to take on that question and know give you some free advice, maybe point you in the right direction to to get an issue taking care of .

I did want to turn over to somebody who just called in and wanted to ask you a question.

>> This is Paul.

Hello Paul.

Yes.

Go ahead with your question.

>> Oh go ahead Paul.

OK, I would like to know if the doctor thinks if all of his patients cut out total sugar in their life would they be totally keep doing exercises but get rid of sugar if I got it out of my life and all my pains went away.

>> Wow, that's interesting.

I've heard of this.

>> That was kind of a fad and now I haven't heard too much about it lately about, you know, just cutting out sugar.

Well, you know, there's there's a lot of different kinds of sugar when we talk about it and you know, refined sugar definitely we know has a lot of calories and has a lot of impacts on your body that when taken in excess can definitely cause you know, deleterious side effects or bad things to happen to the body.

But then again, that's every anything in excess really starts to starts to push that way.

>> The problem is is that a lot of the foods are body was meant o respond to refined sus not out of any problem with our bodies but just how our bodies were initially designed and those refined sugars light up your brain saying that's really good and tasty because that's what we tried to find when we weren't making things in factories and had an agricultural society.

And so a lot of those refined sugars we just are easy to come by and so easy to get and so we take them in in excess.

>> So cutting them out completely I think is is really hard to do but reducing your intake definitely and just knowing what you're eating and what's in what you're eating I think is very important because that's when you really start to understand that men maybe you know this can of soup that has you know, all of this sodium in it but it also has added sugar in it.

Why do I need that and maybe you don't and so making the better choices where you're not getting that refined sugar is probably good but there's sugar and fruit and you know we all know yeah.

>> And carbs are technically a sugar.

They're just sugar molecules linked together and we need carbs for energy.

>> You can't cut out carbs completely.

A lot of people do that with diets and that's a good way to just limit your portions but you still need carbohydrates in your body to function and we still need sugar.

That's the base energy molecule that our body uses to produce energy.

>> Now you get it from breaking down food.

So I would say yeah, cutting out refined sugar processed sugar is a great goal.

>> It's difficult but definitely reducing or intake.

>> So you're not taking excess I think can have a lot of benefits for the money.

Well and this is a great time of year to talk about sugar because I know my kids one of them got something from school the other day is one of those candies where it's a packet and there's like a salad stick that you lick and then you stick it in this basically packet of sugar that's colored or flavored.

>> Yeah, yeah.

I watch the kids and the kids love turns their tongues funky colors and it's sugar and they love it.

>> Yeah yeah yeah you know it's one of those things that they're all that's that's why kids love candy because they're designed our bodies are designed to seek out that high dense energy food and sugar is one of those and it makes you feel good and you love it and it gives you all this energy but in that way of getting that in excess can start to cause problems.

>> Well, kudos to Paul.

You must be like Superman.

That takes a lot of discipline.

I could not do that.

So I give you a lot of credit for that was that was a great question.

So thank you so much.

We also had somebody else who called in and wanted me to ask the question for them which I want to let you know that's an option.

So if you're a little shy or maybe don't want to ask your question love when you call they don't put you on the air right away you can give them they're quite the question if you want and then I'll ask it.

So I'll do that now for Rita who called it and she undoctored know what would you recommend or what would you recommend for someone with osteoporosis that has minimal side effects?

>> Yeah so that's that's a great great question.

Osteoporosis obviously is a diagnosis that we label people when they have bone density that is you know one and a half to two standard deviations below their people of their same age or people and there's a couple different ways we measure it or at your maximum bone density for a female or male if you're way below that you get classed classified as osteoporotic.

>> If you're kind of in the low range you might be called osteopenia which is not quite osteoporosis but still lower bone density.

>> And so the things that we I always recommend to all of my patients is that especially in our great state of Indiana or more likely for weight we're all a little bit vitamin D deficient.

>> Oh, and it's because of the we just don't see the sun now for about a week going on seven or eight days exactly right.

>> So you know taking vitamin D we know is very important for bone just like an over the counter is an over-the-counter supplement and and then a lot of us get enough calcium through our diet if you're eating a well balanced but making sure that you are eating plenty of vegetables especially the green vegetables which have a lot of good calcium in it and then the vitamin D and then the other thing is some you weight kind of weight bearing exercise so walking or even some light weight lifting even two , three, four pounds of just carrying those while you walk or doing some light can really increase your bone densities.

Your bone responds to pressure if you're not putting pressure or stress on your bones then they tend your body says well we don't need this bone and it tends to take the resources away from it.

>> So if you're up and active and you know on your bones they tend to build themselves stronger because they know they're being used.

>> So the minimal invasive stuff would be taking the vitamin, making sure you eat a well balanced diet, maybe taking some that extra vitamin D on top of that and then and then some, you know, light exercise and things like that.

>> But when you start getting into the osteoporosis, if it's a true diagnosis, if you've had the scans and talk to your primary care doctor about it, sometimes the risk of fractures get high enough.

We have some really good medications out there now that can lower that risk because we know that when you start getting fractures based on your bone density meaning that your bones are breaking without a traumatic event, then that really puts you at risk for a lot of problems, you know, and can put you at risk for even a small fall leading to a big problem like a broken hip or a compression fracture in your spine and all these things that can really lead to just a decline in your overall health .

You know, you mentioned the bone density test.

Is that at a certain age do you recommend people have that and maybe how often?

>> Yeah, so it's we call it a DEXA scan and you usually go through your primary care provider.

>> They're the ones that are doing it and the age recommendation kind of varies for everyone because sometimes we'll recommend a Dex's Garnett at a younger age and even your 50s if you've had a fracture that we consider an at risk fracture.

>> So if at 50 years old you fall and you break your wrist, it can be a sign that hey, maybe you know, you might have lower bone density.

>> And the unfortunate part too if you look at our physiology between even men and women, women pretty much after the age of twenty five unfortunately start to see a decline in bone health when in men it happens a little bit later and that just has to do just with the physiology and the hormones within our body.

And so women we tend to recommend DEXA scans earlier than men and it's usually in that age range of fifty five to sixty five.

Will we start saying hey you know if you start having signs where we're worried about your bone density then we start getting that checked out OK yeah yeah.

>> Now I just yeah I didn't if there was any recommendations that is good good good conversation to have I guess.

Yeah in that age range absolutely zero and again he was as Dr. Carr was saying you can do that with your primary care doctor.

So we had another individual called in and wanted to ask I wanted me to ask a question for him.

>> So Jack wants to know what can you do for a broken tailbone?

Yeah, I always heard nothing but maybe that's not true.

>> Well, so it really depends on exactly where the break is in the tailbone because if we're talking you know, tailbone is part of the sacrum which is kind of the bottom part of your spine right off the pelvis if it's the really small bones in what we call the coccyx which is the really tiny ones at the bottom, there's not a lot you can do for that in some rare cases if they get really out of place they could be excised but it's a surgery to do that.

Oftentimes we just let it heal and they usually gets better with time if it's a little higher up in the sacrum which is still kind of technically part of the tailbone that you know, depends a lot on what the fracture looks like.

>> How long has it been hurting you and there are surgical techniques to fix those and sometimes put reinforcement through those bones to help heal the bones or at least make them a lot less painful.

>> But it depends just a lot where the break is and what it looks like and usually requires a CT scan or really find out and look at that morphology.

>> So if you fall or have an incident like that, is that I mean is there any danger in kind of waiting I mean maybe I don't know if if that sets you back if you don't address it right away not necessarily.

>> You know, if anyone that you know, if you have a fall and it hurts bad enough to where you're not walking in the next day or the day after, that would probably be a time to start seeking some medical care if you fall down in it it hurts for a while but you're able to ambulate in your walk and you're able to get up and do the things you need to do then it's probably OK waiting a time period before immediately rushing and seeing someone and sometimes that's kind of nice.

Now our health care system has moved to some more of these orthopedic urgent care.

Yeah, they're walking the walk in clinics and things like that which you know, you don't have to go to that E.R.

You're not sick.

>> It's not an emergency necessarily.

But if you've been hurting for a few days it might be worth it to at least go and then there's someone there usually you know, a mid-level provider who is trained in orthopedics who can get an X-ray look at it critically and they think you this needs someone higher up or there's nothing there.

I think we're going to be OK then that's kind of a nice middle way between, you know, taking yourself to the emergency department every time you fall especially down cold and flu season because they're all the I think all the years are pretty well packed.

>> Yeah, that's that it's a nice option to have so yeah.

>> All right.

Yes.

We've used that many times usually after a baseball game we've we've made many trips to the walk in clinic.

Let's see we're just getting tons of calls.

It just great.

I encourage anyone to call and again you have the option of me asking the question for you or you can ask it live Eve wanted me to ask you what can you do that doesn't require surgery for bone and bone pain that even the option so well, I think I'm guessing what you're talking about is likely either arthritis either in the knees or the hips or the ankles really any joints that has two bones that move can eventually where the cartilage away and you can have what we call bone on bone with our arthritis which is usually what we call end stage arthritis where there's not much more to generate because it's bone on bone it's OK but that doesn't always necessarily mean that it's bone on bone everywhere with it and there are lots of things that we can try to reduce the pain in bone on bone arthritis.

>> Some of them are very successful but there's definitely no harm in trying those in a lot of those can be you know, again increasing the strength and musculature around the joint to help support it.

So it's not you know, it's not just the bones holding you up but your muscles are doing some of that weight loss is always a great thing.

>> A lot of us don't realize, you know, all of our weight it's not just your body weight that your joints see but as you get further and further down in your legs, you start to see multiplications of your body weight because the force of that is concentrated in a small area.

>> So even a small amount of weight loss ten pounds can be feel like twenty pounds off your knee or forty pounds off your ankle and so that could make a big effect too.

>> And then there's lots of injections that people are doing now and there are there some newer injections that are coming out.

Platelet rich plasma is kind of one that's just been endorsed by our orthopedic society on a national scale is something that's been helpful.

But once the cartilage is gone there's no really bringing it back.

So a lot of these techniques are often temporary and they're great to try and they're great to keep doing as long as they work.

>> But you know, in our business too we kind of get a good understanding after seeing thousands of x rays and when you see one and you go you know, we were happy to try all these things but the likelihood we kind of deal in probabilities, the likelihood of it working you can sometimes tell is like it's just not very likely this is going to work.

But it's always OK to try a lot of it because they rarely burn bridges.

>> So surgery I always tell my patients surgery can always be an option.

You know, that's kind of our last resort.

It's always an option.

There's lots of other things we can try, you know, but but sometimes we just kind of know that we've reached the end and the next step sometimes is surgery.

>> So well, I think people I think people like having like you said, options that they kind of feel like they have a little control over the situation and you know, maybe they they want to just absolutely try something just to convince themselves that yeah, they have to you have to take the next step.

>> I think what a lot of us sort of like yeah.

I completely understand that exhaust all other options.

>> All right.

Well we only have a couple of minutes left but I want to try and squeeze one more question if we could.

So she recalled it and she wanted to know what are the side effects of steroid shots and does it raise potassium levels?

>> Yeah.

So well, you know, it depends a lot on where you're getting the steroid shots because steroid shots in joints and we've studied this by, you know, labeling the steroids and things like that with Radio Marker's and inject them in joints and then seeing do they go anywhere else in the body after you inject them into a joint and very little of it actually gets into the circulatory system when we put them inside joints now OK, if you're putting it into soft tissues meaning No one that I do quite a bit as an orthopedic for an ankle surgeon, you know there's lots of tendons around there that you can inject.

>> There's the plantar fascia every once in a while that you inject and that's not in a fluid tight spot and so that can get into the circulatory system.

>> As for raising potassium levels, I haven't seen it raise just a potassium level or anything like that.

It is cleared by the kidneys.

So people with you kidney disease or chronic kidney disease should always talk to their either primary care doctor or their nephrologist which the kidney doctor before going to get a cortisone injection or something like that.

>> If they're going to get it in the soft tissues, it's relatively safe to get it in joints.

We see Cortazar injections or steroid injections sometimes raise the blood sugar too, especially in diabetics.

>> Yeah, it's usually transient meaning it comes and it goes and we always tell our diabetics to watch out for that when they get joint injections but they're still safe to do.

>> And so you know, the side effects of them are are are there but if you get them in the right spot and at the right levels and with enough time in between, there aren't really many long term side effects from doing those injections at the proper times.

>> All right.

Well and sadly we are out of time.

I know we've we always say this showed us why people come here.

They go there no commercials but it goes by very quickly.

So I thank you to everybody who called in.

You had great questions tonight and Dr. Carr, thank you so much .

>> I know you're very busy and we certainly appreciate you coming in and helping us out.

Happy to be here.

Yeah, well we'll have to you have to have you back in the new year.

>> Yes, absolutely.

We're almost at that point.

Well, thanks so much for everybody.

I appreciate the questions tonight.

Take care and have a merry Christmas.

I won't be back until after Christmas so Merry Christmas to all of you and happy New Year.

>> We'll see you later.

Bye bye.