Well hello.

Welcome to HealthLine on this Tuesday evening.

I'm Jennifer Blomquist.

I'm so glad you're joining us.

No matter if you watch a show a million times because it's different every time we're on our live program or if you're new to the show, I guarantee you will learn something tonight I get some free advice.

We actually have a physician's assistant who is with us tonight.

She's been with us many times before.

She specializes in orthopedics and we're going to be talking about something I think a lot of us maybe needs to be educated about orthopedic walk in clinics like when to go to them or maybe when to go to a regular walking clinic or the emergency room so you can learn all about that tonight and please feel free to give us a call at any time once we get our conversation started and that's why we keep the phone number up at the bottom of the screen is up there throughout the show so that you can call in any time and ask our guest a question.

So it's (969) 27 two zero if outside of Fort Wayne put an 866- in front of there and that'll get you through toll free and so we'll go ahead and introduce you to our guests.

But again, I always tell people to call sooner rather later because sometimes the phone lines get pretty busy toward the end of the show.

So feel free to interrupt us at any time.

Our guest tonight I hope it's a familiar face if you're a long time viewer, this is Jodi Chambers, also a friend of mine.

>> She's the physician assistant specializing in orthopedic care.

>> So thanks for having me back.

Oh, thank you so much.

Well, I think I was excited about this topic because I've going to orthopedic Walk-In clinics a lot with my children the last couple of years a lot-e injuries and I like it.

Is it because they have it seems like to me you can get everything done there quickly and it's what they specialize in.

So I personally thought we've had a positive experience with it as opposed to going to just a traditional walking facility.

>> They may not have X-ray MRI, you know some of the things you need.

>> So in general if you have an injury, how do you decide what makes more sense?

>> I think the biggest distinguishing factor between regular walk in clinics and orthopedics when you know we're not going to deal with the cold and the flu.

>> So you know, if it's something that you don't feel like you should be exposed to other people because you're not sick, then maybe you know so neck pain, back pain, our two most common fractures and then with kids most clinics can do some small suturing but not like big things.

A general rule of thumb is if it's crooked probably not for a walk in clinic situation because we probably don't have the appropriate medication to make you comfortable to to set that fracture if that's indicated.

But for the most part fractures back pain I would say is a big one neck pain, shoulder injuries, tendonitis is this summer we saw a lot of people with hamstring pulls, Achilles tendon ruptures.

>> So I would say if you're like I don't know if it's my you know, if it's an extremity then I would say a walk in clinic is is the appropriate place to go.

>> So if you decide to go in I'm just wondering sometimes it can take forever to get an appointment to get in to see an orthopedic specialist because that's such a busy specialty.

>> So say it's not an acute thing.

You know you don't you didn't like injure something maybe over the last few months you like you said your back has been hurting.

Is that OK to go to an orthopedic walking clinic if it's not like urgent it's just something that's creeped up but you can't get into so I would say for the most part yes.

>> So there's some you know, most orthopedic walk in clinics here in Fort Wayne are all ran by probably physician assistants and nurse practitioners.

I would venture to guess you probably would not see a physician situations but in rightly so I don't think that it's appropriate or needed if we have any issues we can get a hold of any of those people.

So chronic things.

Yes, the things that aren't appropriate for walking clinics are second and third opinions.

You know, we've had people that have come in and say, you know, I've had three back surgeries and I'm here to discuss my MRI from a year ago that's that warrants and an appointment.

But you know, if you said hey, I have back surgery a year ago but I lifted awkwardly and now I'm having an acute back pain.

Absolutely OK, some people come in because they think that they can get a stat MRI very infrequently.

Are we going to order a stat MRI if we're to that point we're going to send you to the E.R.

because we're that concerned but it's not a loophole or get around to get an MRI that day we can order MRI if it's it's clinically appropriate but they wouldn't normally just do it right now and they're OK.

I would say in the since twenty seventeen I've not ordered an MRI in the clinic unless I sent you to the emergency room.

>> So x rays though are that seems to be pretty common.

They would all pretty much have x I have not worked at every orthopedic walk in clinic but I worked several and I would say that all of them have x ray on site.

Some walk in clinics don't have non orthopedic ones don't have x ray or maybe they only have three to four or four thirty but they don't have x rays passed till eight when they're opened.

>> Yeah.

So you know we get a lot of people who unfortunately went to another walking clinic and they were sat for two or three hours because they're there with all the sick people and then they come in to see us because they found out they didn't have x ray.

>> Yeah.

So you know, I guess the deciding factor for me would be, you know, am I ill or am I hurt?

>> Yeah, If you're ill not we're not your your your go to spot.

>> It is nice that most tomorrow up until seven or eight at night.

>> Yeah I would say most are seven to seven or eight to eight and I think that is appropriate for both ends because the seven to seven catches the kids like Fort Wayne Community Schools who don't have to come to school till later so they can get in and out in the morning.

We see a lot of kids at the back end of the day because they were at practice and they got hurt.

>> So you know, ideally the people who, you know, got home from school right now it's going to be the kids get home from school.

They're playing out in the yard and they fell off their swing set.

You know, those are the things we need to see because that doesn't need to go to the emergency room unless it's crooked.

If it's obviously deformed, I mean we could see it in splinted.

>> We're probably not going to be able to do definitive care.

So that would warrant an emergency.

But yeah, if it's if it's obviously deformed.

>> OK, all right.

Good information.

We're going to talk more about walking clinics but we only get a call from somebody who wanted me to ask for him.

So this is from Marshall and he wanted to know can walk in orthopedics treat something like arthritis.

>> Oh, absolutely.

So let's say you have established here with a surgeon and you just need an injection so we get a lot of people who are like I'm getting ready to go on vacation or my grandkids getting married and I need to be able to be available at the reception so we can do those.

You know, there are there are different types of injections that may not be done.

So some some people use the lubricant injections called viscose supplementation that has to be pre authorized with insurance.

So that would not be one you could get by walking.

We could order it and it could get set up.

>> But for cortisone injections we can diagnose your arthritis if you didn't know you had it.

We can talk about a treatment plan.

We can start you on a medication regiment so physical therapy orders all of that stuff.

>> So absolutely that's probably 50 percent of what I do a day.

And you know, you kind of mentioned some things that needed to be approved by insurance is I mean do you find that most people don't have is there any insurance barrier that will run into in terms of going to an emergency room versus a walk in clinic?

>> Yes, there could be.

It depends on the individual clinic.

>> So some people some clinics would require a cash up front fee if it's an emergency room because they're all federally funded.

>> They can't turn people away.

So if if finances are an issue then there may be times it's not very frequent.

>> It's I would say one to two times a week.

Do we turn people away?

I mean it's not very often or if they've gotten referred they've been to the emergency room.

They were diagnosed a fracture and then they're told to follow up.

They're not going to incur because they've been referred from the hospital.

>> So yeah, I was and no, that's this is all outpatient walking clinics.

>> You're not going to be admitted or anything like that.

No.

I mean if you would be admitted it would be through an emergency room.

>> We don't have any direct admit situations as of yet.

It may happen but not right >> And I wondered is there anypd it be would your insurance like t because maybe it's oh for sure cheaper than go into so and a lot of that's depended upon insurances.

It's definitely going to be smaller out of pocket expense because most of them are treated like a just a regular office visit.

Oh so in that a lot of times depends on how the clinic would billett it but I would say for a majority of it it's just an office appointment that is always much cheaper.

>> Yes.

What you get in an emergency room in time you know we I would say you know Mondays no matter where I've worked Mondays are always awful so I always tell people if it's been going on for like three months, don't come on Monday because you're going to end up waiting.

>> But most of the clinics I worked at were staffed with two people on Mondays because to accept the influx of patients over the weekend.

But I would say most of the time it's not more than a couple hour wait and we try and get people seen as efficiently as possible without compromising quality of care obviously no.

>> The emergency room can be a long way, especially if you have a child.

Yeah, it's really difficult.

We do get someone else who wanted to call wanted me to ask a question for you so they wanted to know if if you treat arthritis for knees this actually this is going back to Marshall.

>> I didn't see the whole question.

So Marshall thanks for calling in Marshall that so he was asking about if you could treat arthritis but what he wanted to also know what you would prescribe for that something like that.

>> So typical or arthritis workup would be ordering x rays talking about what other medications are because obviously there's interaction so that not every person is going to have the same prescription.

We'll probably talk about weight reduction because for every extra pound it's an extra four pounds that are being distributed through your knees.

So does it does weight cause arthritis know does it exacerbate it?

Yes.

So we may have that discussion if it's a if it's an issue where you're not strong then we may talk about some physical therapy exercises.

>> Yeah, the x rays are going to be done to discuss what what the status or structural status of your your joint is, whether it's a knee or a shoulder or whatever.

But so we would do that and then we would come up with the lan so commonly it would be medication whether that's over the counter, whether that's prescription maybe it's an injection, maybe it's physical therapy, maybe it's a combination thereof.

Maybe I'm suspicious that it's it's it's something that I need to get an MRI and I can I can start that that process emotion we can get things started and then get you into a surgeon.

So the other the other nice part about the walking clinic is it saves the appointments for the people who need to see a surgeon.

So once you get there you're talking about a surgical problem, you know or maybe it's a hip problem and you know you see a hip doctor well it wasn't your hip.

It was your back.

So the other nice thing about walking clinics is we do general orthopeic so we can step back from a bigger, broader perspective and say OK, yeah, you say it's your hip but I really think it's coming from your back so we can streamline you to where you need to be.

All right.

And I guess another question somebody had was about you know, are you going to know necessarily if you're going to an orthopedic walk in clinic?

Are they identified as Ed?

>> Some of them are just you know, might be associated with with a health care system in your community?

>> Do you have I mean I don't know what if it would identify it?

Yes, I would say that almost every clinic probably has the some version of ortho and it would say or if it doesn't say ortho like in their title then it's probably just regular walking and you know, everyone has access to everything on their phones.

>> You can type in ortho clinic near me.

Yeah.

And you're going to get the you know, the closest ones to you and then then then by that point it's like which which is more cost effective for you through insurance.

>> Yeah.

And you know and I've I've had that personally that experience before where I went to a place I don't know the person I talked to was new or didn't know but I had a bulging disc in my back.

I didn't know it.

I just couldn't walk.

So I literally crawled into this clinic and of course everyone staring at me wondering why she's not walking and anyway yeah, then after like waiting for like an hour like just laying on the floor they're like we don't have an x ray machine here so you'd be amazed you can happen.

>> They get busy and they're like oh yeah we should tell that lady that she has to go somewhere else.

So you would think you would think that you wouldn't have to ask but I guess it probably makes sense.& Yeah they're busy.

Yeah yeah.

And that would be probably not be something that the front desk would probably volunteer to you.

>> Yeah.

Because you know it could be that it's coming from your appendix so yeah that would be probably a proactive question for the patient to ask is I'm here for what I think is an orthopedic problem.

Do you guys have x ray in house and that made me decision for you.

>> Yeah, no it is and that is a life saver to sometimes be able to do one stop shopping.

Yeah, So we have somebody named Buck on the line and he is going to ask the question himself.

>> So Buck, are you still there?

Yes I am.

Thanks for your patience.

You want to ask Jody your question?

Hi ladies.

I was wondering I had an injury play on a sport today and if I said oh how like down the road effect was that meaning like three months from now the amount of ice I do with it today does that have a significant difference on and I'm older fifty or above what I have a significant difference on like the last of the injury and then it's a night and night where I rather than focus on sleep there's a certain amount of ice I should be doing every other hour and and I'll just hang up and just kind of leave it at that.

OK, give me some pointers on the ice cream type stuff would you think?

Yeah, that is an excellent question but so a couple of things ice we typically use for the first 24, 48, 72 hours because think of it as you've got injured and you have this flame in your body and you're trying to calm down the flame.

Yeah.

If you put heat on that acute injury it's like putting gas to fire.

>> You're making the flame bigger so ice is never the wrong answer but heat usually is the first 72 hours of an injury.

>> So I always tell patients, you know, ice is never wrong, heat is going to be wrong at& the front end.

But let's say like he mentioned, it's six months down the road.

Well, why is it sore?

>> Is it sore because you exercise it it's inflamed or is it sore because it's stiff because you haven't been doing anything.

>> So sometimes I tell patients, you know, it may be different every day.

may make it feel better or tomorrow ice might make it feel better.

But general rule of thumb is about twenty minutes two to three times a day if you can get it in but one to two is fine and don't don't wake up three a.m. because it's time for ICE that's you know, sleep is much more important for the healing process than ice at that point.

>> Basically icing is just another way that we treat symptoms and treat inflammation .

>> So I love I hate ice because it's so cold.

I know I've heard that about the heat.

>> What about for your back though?

I mean I always feel like depends like so if you feel yeah he does feel better if it's something that you like well I know I'm going to play softball tonight someone put some heat on or put on my car seat heaters to on my way to the game but then if at the end of the game and saw then I would say follow up with ice.

>> Yeah.

What about people?

VANNATTER Arthritis we're talking about the back like I do see creams topical that are supposed to be pain reducing or some it I guess I think there is a lot of good options.

I think there's so many and so there's there's prescription kinds and then there's supplemental.

>> So the difference is prescriptions have to go through FDA standardization supplements don't so when you get into the supplements I think it can give people a bad taste in the mouth because they're not you're not comparing apples to apples and oranges to oranges.

>> So prescriptions are are more consist but there are supplements that are non prescription medications that would be helpful as well.

>> But you just don't know because everything's different .

So they you know, they could say oh it can turn my hair blue but you would quickly figure out that that's not going to happen.

So but yeah, I think tropicals are extremely beneficial especially for like tendonitis is like if your wrist if your elbow because these are very superficial tendons to the skin.

So it's going to absorb OK if it's a hip problem probably not just because you know that's a pretty deep, deep tissue area but sometimes like Arnica which is an antiinflammatory cream that helps with bruising some sometimes will prescribe that postoperatively because it can help with inflammation but not cause any bleeding side effects.

>> So I mean there's there's a lot of things that go into the decision making of what we decided to use.

>> Yeah.

For every good benefit there's always a sign that side effects you have to get up.

You have to balance the pros and cons for sure.

Let's see.

We have somebody who wanted me to ask the question for so Leslie wants to know if a walking clinic can treat more than one broken bone injury.

>> So it would depend let's say you tripped on the stairs and you broke your toe and you broke your wrist.

Absolutely.

Now if you broke your femur and you broke your humerus two big bones, I don't know that that would be something that would be appropriate in a walk in clinic.

Yeah, sometimes there is time constraints that may say that we can only see two body parts .

You know, there's sometimes people coming like oh I have head to toe pain and I want to get all of it evaluated.

That's just not a feasible request nor can we do justice to treat all of those different injuries.

>> So so yeah I would say probably two body parts but it's going to depend on what body parts are.

>> Maybe it's your finger in your wrist or you know your ankle and your thumb or something like that.

>> So OK. Yeah that's a good question.

That's a really yeah.

>> Because that you I just wanted to emphasize you guys don't do surgical procedures.

No I do not do any surgical procedures no OK nor can we get you like scheduled same day if that's the situation then you're we're probably sending you to the E.R.

and getting things done that way that would be very, very infrequently.

Some people think that it's it's a back door approach to getting to what you need to get done.

>> But we still have to go through the same hoops.

We're just more of more instant access.

>> Sure.

And so but I think the the best part of what we do is that we approach it from a general orthopedic standpoint and then triage you down to where you need to be.

>> So once you're with the physician you're with the appropriate surgeon or the physician or the team that you need to be with.

>> Yeah.

All right.

This is a good question to you kind of mentioned this you know that you're probably going to see a physician assistant or a nurse practitioner MP and somebody was calling to say what is the difference between a nurse practitioner and an actual physician?

>> Really good question you can prescribe.

Correct.

OK, so physicians obviously you can have you know, M.D.

but they're not surgeons.

So obviously once you get to the surgeon level which almost everybody that I work with our surgeons have had fellowships and residencies.

Physician assistants are trained in the physician model so they have to get accepted into physician assistants.

School were trained in like a four year medical degree condensed into a two year degree but you have to have a lot of experience to even get accepted into the school.

So it's not like you're taking somebody at high school.

They're getting straight into his four years of undergrad and then the and then nurse practitioner is the master's degree level for nurses.

So they're in the nursing model.

So it's just a functionally when you when you meet us we're going to what a nurse practitioner doesn't my my job is the same thing I do.

>> Nurse practitioners tend to do more like family medicine, OBGYN things like that but they can be surgeons, they can be you work in any specialty just as it can.

>> So it just kind of depends on what the individual clinician is comfortable with.

>> Yeah, that is a good question because you don't see a lot of gosh I don't remember the last time we saw a physician at any kind of a walk in clinic but we still had really great care.

Yeah, I think it's I call us like the octopus arm so when I first started twenty five years ago the physician can only have one that they supervise now you can have up to five in some states up to eight so one physician can give themselves eight arms so that they can be able to you know, capture all those patients and then and then dissect down what they feel like you need you know so once you get to the surgeon you're going to have more time with them because they're not seeing things aren't appropriate for them to see.

Right.

Well, I wouldn't say probably as a patient saves you time because you know, if they're five percent can help, it's just one doctor you've been waiting a lot longer.

Yeah.

So, um, let's see we are getting another call coming in.

We've a lot of folks tonight they're asking me to ask a question for them so somebody one woman Pam wants to know what is sciatica and what what would be the treatment for that so sciatica is the nerve that runs down from your back.

>> Usually the L5 S1 level and it runs down your back down the posterior buttock into the back of your leg.

So some people called my back pain my sciatic Pinciotti pain is a very specific nerve that gets irritated but we tend to casually throw it out as oh my sciatic nerve is is inflamed and so SADIC typically causes pain down the back of the leg because Bernie, it can cause weakness.

It can cause spasms because once the nerve gets irritated then then it causes muscle spasms.

So if a nerve is annoyed it does this like hey what are you doing, what are you doing?

And then the muscle gets mad and then you get the muscle spasms and then it becomes this cascade.

So just like anything else it's an inflammatory problem treating the symptoms, getting your inflammation calm down whether that's with the prescription steroids nonsteroidal giving a muscle relaxer if that's appropriate there's nerve pain medicine we can use and then every person has back pain, thinks that they need MRI and I would say 80 percent of adults are going to get back pain in their lifetime 80 percent or so of that 80 percent I would say maybe 20 percent of those people would be surgical candidates.

So what we do is we start everybody the same and then if after four weeks of therapy or medication we're starting to notice that they're not responding, then we'll start doing you know, the MRI's in the CT scans and whatever test is next next in line to be appropriate.

But most of the time it's medication, physical therapy, work restrictions, modifications of activities and then, you know, keeping an eye on symptoms.

The things that make us nervous is if you're starting to get weakness then we have to pay attention.

>> I always describe a nerve as like a hose and the longer the hose is kinked the the less stream is going down.

>> So the stream going down is going to be either function or or pain.

>> So if you have but you know, weakness not that I'm not concerned about that but I know that that's not a permanent issue.

>> But when you have maybe have weakness but not that much pain, that's much more clinically significant.

So that's what we're looking at and if that's the situation then I'll be like, you know what, we need to get this now instead of later.

>> So I think that people think we have these algorithms of treatment plans and absolutely isn't the case when we're dealing with because it's every patient is different.

>> So I was going to say yeah, especially with orthopedics it seems I see some people of all different ages do I mean I see the very young the usually those are injuries that I can tell, you know, but then you see other people that could be just wear and tear.

>> Yeah.

I mean some days I'll have six people that are over 90 yeah.

>> Some of them are arthritic, some of them have a fracture you know I mean it's it's crazy how how functional some people can be and so my take away every day is you know, just being kind to your body and not taking for granted your ability to function and to move and our bodies are made to move and sitting is the new smoking.

And so people are getting we're seeing so many people that are having Deacon auditioning problems because we're not active.

>> Right.

So but those people that are in their nineties, they're going after they're playing pickleball and walk in ash and all this fire.

>> Yeah.

Yes.

Well this is of course Jodi Chambers.

Thank you so much for coming.

It does go so fast and thank you to everybody who called great questions and you have to come back again.

So I know we need to catch up gossip things.

Yeah.

So thanks again for joining us.

And there's another HealthLine next week the same time same channel.

I'm Jennifer Bloomquist.

Take care.

Have a great rest your week.

>> Bye bye