[Music] Lakeland Currents, your public affairs program for north central Minnesota.

Closed captioning is made possible by Bemidji Regional Airport, serving the region with daily flights to Minneapolis-St. Paul International Airport.

More information available at bemidjiairport.org.

Hello, again, everybody, and welcome to Lakeland Currents where tonight we are talking with two orthopedic specialists who are involved in a process of building a new clinic in Staples with Essentia Health, and we're going to talk about a lot of exciting things happening at the clinic, but before we do that we're going to talk a little bit about orthopedics in general.

Welcome to the show.

Glad to have you guys taking time on your busy schedule to spend some time with with us.

Yeah, happy to.

Paul, do you guys specialize in certain things, shoulders, hips, or do you do the same things the two of you?

For the most part we do the same things.

There are some things that are a little different.

I do a little more foot and ankle work and I do ankle replacements which nobody else at the practice does.

However, both of us do shoulders, hips, knees.

Dr. Metz is probably a little bit busier on the joint replacement side of things but for the most part both of us take care of trauma, sports medicine, joint replacements that kind of thing.

I've been watching Viking games and I can't get over how many of these guys are getting hurt.

I coached for 28 years and I've always felt that a lot of those injuries were overuse.

What's causing all of these achilles tendon tears and ACL?

Do you think it's overuse or do you just think it's the physical impact of the game?

I think the amount of training that people do and how much time they practice and such that may predispose them to some of these injuries, but I think if you look at specifically Kurt Cousins, who tore his achilles tendon, and you know, as we get a little bit older, our tissues aren't quite as, they don't bounce back quite as well, so sometimes as we get older our tissues degenerate and can lead to injuries a little bit easier.

So tell us a little bit about what you folks do and what you'll be doing at that new clinic in Staples.

What are some of your other things that you do, specialties.

Well like Dr. Thompson said we're general orthopedists, so we see a lot of those those things that he talked about.

We do have a hand specialist, Dr. Nord, who specializes in hand.

She'll see upper extremity things and some other things but she specializes in upper extremity.

We'll be adding a sports and shoulder trained, fellowship trained individual, Dr. Theismann, next year in August.

All of us will be going to Staples when it opens and the tentative open date would be June or July of 2024.

That's pretty exciting that Staples has just built a new Ortho Clinic at the other end of town, so we'll have a clinic at each end of town which I think is wonderful for a small community.

That's really, really exciting to have that happen.

When you work now, you used to be kind of an independent organization didn't you at one time?

Correct.

Before you hooked up with Essentia Health.

Correct.

In 2018 is when we merged with Essentia Health and we were an independent group leading up until that time.

That has allowed us to continue to recruit more orthopedic surgeons as the practice grows.

You know we're doing more outreach.

We have our main, you know, clinic in Brainerd here but we also have outreach up in Hackensack, Cross Lake, Pine River, we're, you know, working our way to the east over at Piers and Onamia.

We currently have outreach in Pillager now we're expanding that to Staples.

So, you know, it takes manpower to kind of grow the practice and it was a little bit difficult for us for a while to recruit additional surgeons, but our merger with Essentia Health has allowed us to kind of continue to grow and expand that practice which we're happy about.

What is the, what are the injuries that you see the most in central Minnesota.

Are you seeing mostly hips, knees, shoulders?

I would say that our population is aging.

We've both seen the transition over time, too.

We've been here for 25 years.

We've seen the population change and Covid, if it did nothing else, it really, a lot of people can work virtual, so we've got people moving to the area and that's a younger population, younger people.

We see a lot of older people for wear and tear, arthritis and such, rotator cuffs and things, but our hand surgeon is busy.

You know we as a group are very busy.

We've been busy and just getting busier over time.

Are there any new changes in carpal tunnel surgery, is that still pretty much the same that it's been the last 10-15 years.

Pretty straightforward when it comes time to carpal tunnel surgery.

There's an open and an endoscopic procedure that, you know, you have a conversation, just like anything, you want to have a conversation with your surgeon in terms of what the options are and which one in their hands works better.

Have that conversation, but not a lot of new things when it comes time to carpal tunnel surgery.

So when you have a hand specialist do they deal with disease mostly or do they deal with injuries?

I really feel like it's both.

I mean they deal with a fair amount of tendon injuries, but at the same time, you know, rheumatoid arthritis and lots of wear and tear arthritis takes place in the wrist and the digits.

This, in addition to carpal tunnel or trigger fingers, you don't need to see a hand specialist to be, you know, to get a lot of that treated, but the fact that we have a hand specialist really has opened up our ability to treat several things that once upon a time we did refer to St.

Cloud or down to the Cities so having Dr. Nord, you know, her presence has really been a beneficial thing for the area and the group.

I'm amazed at the care, really quality care, we have all the way from Aiken to Perham.

I mean if you look at Wadena just built a new hospital.

I've had the Crosby folks on a number of times, Essentia folks a number of times, and the care in this central Minnesota area it's really phenomenal, isn't it?

We don't think people need to go south to get their care.

We think we provide a wide range of care, specialized care.

We don't think that you need to leave here to have that care and that's the key for us has always been, you know, we live here, we live in your community, we're your neighbors, we're here for you 24/7.

That's what we're hoping when we get into Staples.

We've got a large population of patients that we've taken care of for 40 plus years over there, and we're here, we're always here, we always have people available to see.

One of the things that's changed in terms of how we deliver care, care teams.

So both Dr. Thompson and I have a physician's assistant that works with us, and that person is on our care team.

If you can't get a hold of me right away or Dr. Thompson, you can get a hold of our PA or our assistant and we can get your care coordinated.

So that's really our goal is to be here for you 24/7 and we've worked together for 25 years like I said.

Dr. Rud's been here for 30 years.

We've got a history together and we think we work really well.

I would guess you're moving into the robotic surgery more and more all the time.

Is that true or not so?

That is true.

You know not everything at the present time can be done robotically but we at this point in time are doing robotic knees.

There are several robots that assist with robotic implants and each robot tends to be implant specific.

So there are several different manufacturers of joint implants, each one has their own particular robot.

Both Dr. Metz and myself implant Biomet joints, Biomet hips, knees, shoulders, and the robot that we use is called Rosa and it basically is a tool that's used to kind of fine-tune joint implant, make it a little more patient specific and I've been very excited about its use in the past calendar year.

What are the advantages of using a robot versus us, just a practical approach from a person.

Well, you know, we've been doing total joints for decades and I think that we do them well, always have.

You know everybody's anatomy is just a little bit different than everybody else's, and what for me the robot does is it allows me to kind of fine-tune, make some decisions about how I want to implant that joint before I, you know, get down to the surgical procedure itself.

So I think it's a little more patient specific in each case.

I just find that so fascinating that there's so many surgeries, prostate surgeries, for example, now they're being done robotically.

Yes.

And it takes away a lot of that human error I would guess that I'm sure you can still make an error with a robot but it seems like it's may be more.

The key is the, and I think some people when they come in and ask about the robot they think the robot's doing the surgery, the robot really isn't doing it.

When we do the robot we put in numbers, we put in landmarks, we do things that generate data and that helps us to make cuts that we really want to make, fine-tuning like Dr. Thompson said, but the robot's really not doing the operation, we're doing the operation and I can't speak to the prostate and general surgeons will do robot things as well, I can't speak to that.

Hopefully, over time, when it comes time for shoulder replacements and hip replacements we can use that robot.

The Zimmer Biomet company is working on software to help us with the hip replacements as well as shoulder replacements and doing that same thing.

I've had a number of surgeons on this program over the years and I always ask this question: what was it like the first time you did that surgery on your own?

How did you feel, whether it was shoulder or hip, was that a little scary?

No doubt about it.

You know, I mean, orthopedics is something I'm truly passionate about.

I am in love with this job, I'm in love with the, you know, the people I call my patients.

You know they become more than just patients, they're friends, and you know, there's always stress each and every day, stressful moments in each and every surgery, but it's a thrill to be a part of orthopedics, orthopedics in Brainerd.

I'm also thrilled about, you know, expanding out to the west in the Staples area and I think we have a lot to offer the patients in the Staples area.

And I'm not suggesting that you went from no training to do surgery because I know you have a lot of long-term training before you start doing those things, but I have a friend who was a nurse for an orthopedic surgeon and she said if people could hear the sounds coming out of those rooms when, you know, the pounding and the hacking and stuff, but it's amazing we were talking before the show started that when I was a kid if you had a bad knee or a bad hip you were probably permanently paralyzed, you were going to be maybe in a wheelchair or with a cane, you know the surgeries just weren't as common as they are.

Now it's just nothing to hear of people with two knee replacements or two hip replacements, it's just amazing, and if they follow your directions in the recovery process usually they are coming out really well aren't they?

Absolutely.

Yeah.

We, you know, we've seen a lot change over our 25 years.

When I got here people were staying in the hospital for, you know, 5 days and we've got people that are going home the same day.

Doesn't necessarily, the procedure hasn't necessarily changed a whole bunch, but how we manage pain and how we prepare patients for the process has allowed us to get people home the same day.

And you ask about, you know, the first time we did certain procedures.

You know we look back at our training and both of us were in Michigan for training and they trained us very, very well.

One of the benefits of being in this group, I think, and the reason I joined, is because I've got partners like Dr. Thompson, Dr. Rud, Dr. Schmidts, Brown, Bardolph and now the new partners that we have, Dr. Lesmeister, Dr. Nord, Dr Lelwica.

We've got a team and as much as I go into a case thinking that it's going to be straightforward, if there's something that surprises me and such I know I've got backup, I've got partners that are going to, are willing to be there to help me out at any point.

So, you know, that's another benefit to the orthopedics and coverage that you have here.

And how many clinics do you service right now?

As Dr. Thompson said we're to the west, we'll be in Staples, we're in Pillager temporarily, to the north Hackensack, and Pine River and Cross Lake.

Yeah thank you.

Piers to the east and south.

Dr. Lelwica goes to Onamia and I'm forgetting one right next to state to Crosby too.

Deer River Deerwood.

Oh, Deerwood.

So do you have your own staff at each of those sites then that help schedule appointments and that sort of thing?

I think they have the staff there in terms of scheduling but our PA may come with us and we use scribes when it comes time to that and we may actually have a nurse that comes up as well.

We see a large volume of patients and are very efficient over time.

Again, as a group, we've developed efficiencies that, you know, it makes it a lot easier when we're in those particular places to deliver care.

So what's going to happen in the new clinic in Staples, what's going on there?

Well, so there are several specialties that are going to be available there, there's podiatry, there's urology, there's oncology, there's some obstetrics that's going to take place there, but there's also pharmacy and urgent care that are going to be present there, but from an orthopedic standpoint we're going to have an orthopedic surgeon there 5 days a week.

Will that be the same doctor or is that rotation?

Well, everyone will basically have their day in the Staples clinic.

So every Wednesday it'll be Dr. Metz, every Thursday it'll be Dr. me, you know, myself.

I don't necessarily know that those are the days we're going to be there but we'll each have our day a week so patients will have, will know who when they come in on Wednesday or you know if they're going to follow up with me they know what day of the week to come see me and we're not going to be doing any surgeries in Staples.

Any surgical procedures, you know, we'll come back to Brainerd for that.

But, you know, one of the things that we want to be able to provide those patients, you know, is physical therapy locally.

A followup for any orthopedic care they get can be done locally.

So, you know, the only thing they're really going to need to leave the Staples area for is the surgical intervention in and of itself.

And that's understandable when you look at the cost of surgery equipment you just can't do that in all those different sites.

Right.

And you plan to open this spring of 2024?

Tentative timeline is for June or July of 2024.

Okay, yeah.

And that's if you, right now is Brainerd the only place that you would do the surgeries for all of your sites and the sites are then treatment sites for rehabbing and stuff?

Basically that's correct at the present time.

You know most of our outpatient surgeries we do at the Brainerd Lakes Surgery Center which is in Baxter.

Any inpatient surgeries really are done at St. Joseph's Hospital, Essentia Hospital, and that will continue.

And are you going to have, I think you're going to have a pharmacy if I'm not mistaken?

In Staples that's correct.

And then will you have any general MD's will they be there at all?

Primary Care will be there as well yes.

Okay.

Am I missing anything that would be offered at that clinic?

There's one thing we haven't talked about.

Dr Andrew Zhao is an orthopedist, a medical orthopedist, who does a lot of intervention with ultrasound and injections and such and our goal eventually would be to have him in Staples as well providing injection therapy.

He's also a trainer, works with the teams.

Not a trainer, he works with the teams and works with trainers and our goal would be to get him involved out there when it makes sense as well.

Okay interesting.

I think I always ask people this but if, I know we're getting older, I'm getting older and a lot of these issues you deal with are from just our age, like you said, arthritis and that sort of thing, but are there some common things that people can do as they're getting into their 50s and 60s to prevent some of these issues that you deal with healthwise, I mean diet, exercise, what would you recommend for people to try to take better care of themselves than some of them do.

I think that consistent exercise, you know, weight management, I think those things are important.

When I say exercise I'm not talking about running marathons or you know being involved in triathlons or anything but I think a person needs to stay active whether you know you're busy in the garden, whether you're walking your dog, or walking with a partner or you know swimming in the summer consistently.

I think it's important to just kind of maintain a moderately active lifestyle.

I think that helps with joint pain, it helps you know psychologically you feel better about yourself if you're active.

In my opinion that's probably the most important thing as we age.

In your clinic do you have people who sit down with patients and try to educate them on things they can do to take better care of themselves or is that something you stay away from.

In our orthopedic clinic we don't, but Dr. Eisenschenk has, if it's specifically weight reduction, he's got a clinic that he would see for that, but attached to that is the nutritionist who can sit down and come together with a good diet for you.

We have physical therapists that we would send you to in terms of outlining a therapy plan.

So that therapy plan when you're 20 years old is going to be different when you're 50 and we're going to focus on the load and on impact things, maintaining your heart rate instead of maintaining a certain weight in terms of exercise, lots of things.

Diet is going to be important, as well as smoking and smoking cessation.

So there are places we can send you, specific groups that will take care of a plan for you.

Diabetics is a huge issue isn't it and overweight is a huge issue.

I know lots of knee and hip issues are from people who are overweight.

I like to watch some of the old western shows because there's hardly anybody that's fat on those old western tv shows and now I shouldn't be saying fat but I mean it's becoming, obesity is becoming a very, very big issue in our culture and it certainly is in a lot of other cultures, but what percentage of people do you think you see because of obesity that's creating problems in their joints, can you target that or not?

I would say about a half.

50%.

And so there's a spectrum of weight in terms of being, and you've seen terms obese, morbidly obese and such, and it really has to do with your weight and your height, so we use that ratio to help us understand where you are and it's one of the hardest conversations we have with people.

Their back hurts, their knees hurt, their hips hurt, and they've got terrible arthritis on their x-rays, but when you're really overweight that really puts you at risk for complications if we're ever going to do surgery.

And it also makes it challenging for people to exercise and rehab.

That's why this program with Dr. Eisenschenk and Essentia is really important.

Getting people plugged into the right people, helping to manage their diet, their exercise, their habits, helping to manage their diabetes at the same time, which is a huge challenge for people and managing psychologically how are you going to approach this, you know, you got to lose weight.

They can help you figure out that plan, not just from a diet standpoint, but from all of those aspects.

You spend a lot of time with athletes, high school athletes, we were talking a little bit about this before you came.

You wonder how many of these ACL injuries are from overuse, especially in young people.

Do you think overuse is an issue or do you think it's just genetics or what do you think is causing that?

I think you can understand that Cousins our quarterback for the Vikings is no kid anymore, so he snapped his achilles but.

I think, you know, one of the things that's kind of changing from a young athlete standpoint is many more of these athletes are becoming kind of single sport athletes and you know if tennis is your thing, you know, you play tennis, you know, four seasons a year.

I think there's value in, you know, the old-fashioned multiple sport athlete.

It's kind of a cross training phenomena.

You're not using the same, you know, muscles in baseball that you are in basketball, that you are in football and so, you know, I think it's easy to kind of over specialize, particularly, you know, in these young people these days and I think that poses more of a problem than, you know, overall general fitness which I think does result in less of these injuries.

Do you think diet is a big issue for younger people or not so much?

I don't think so if you look at fit and trim and such they surely work out a lot and they surely exercise a lot whether they stop at McDonald's or Burger King or wherever on the way home, they sure look healthy and I think when they focus on their sports they're not just hearing the part about you got to hit the weight room, they also hear that you need to have a balanced diet and you need to, nutrition wise lots of them are using supplements, lots of them are using other things to help them train, so I think they're in tune with what they need to do from a nutrition standpoint.

We don't have to have as many conversations with the young athletes as we do with us old athletes who like to play pickleball and some of these other things.

Yeah that's an easier conversation to have with the kids.

How about in the recovery?

There's been a lot of controversy about opioids over the years, and I think you've as an industry have made a big change in that.

Do you use many opioids for a short period of time anyway until people are able to get through the pain, how do you handle that today?

Well, I mean, I think that any orthopedic surgery is inherently painful.

You know there are things, carpal tunnel release, you know, some things that don't produce tremendous discomfort, but if you know you're talking hip replacement, knee replacement, shoulder replacements, hip fracture, you know we treat lots of fractures, those things are intensely uncomfortable for a week or so.

So most of our patients if, you know, if we are going to replace a joint we enter in kind of a pain contract so to speak with them.

You know we're going to provide you with pain medication for a couple of weeks if you need it.

Anticipate that, you know, I'm the only surgeon you're going to get your medication from, you're going to be decreasing the amount of narcotics that you use consistently.

And, you know, most patients are not having issues with, you know, narcotic abuse or overuse.

Most people are as anxious to get off the narcotics as we as surgeons are anxious for them to get off narcotics and we try to utilize, you know, multiple things to treat discomfort, anti-inflammatories, Tylenol, ice, heat, you know, persistent motion, physical therapy in addition to narcotics.

So it's a multifaceted pain control approach.

We're out of time, it goes fast.

Goes fast.

But if they want to get in touch with you folks in the spring in Staples they would probably go to the Essentia website I would guess.

For sure.

That's how you would do that.

And I want to congratulate you on this new endeavor.

Being from Staples myself, we welcome you.

I think it's very exciting you're coming and thanks for jumping on the show today with us it's really appreciated.

I'm happy to be here.

Happy to be here.

We'll be excited to be back.

You've been watching Lakeland Currents.

I'm Ray Gildow, so long until next time.