[Music] shall be responsible for the views opinions or facts expressed by the panelists on this television program please consult your doctor [Music] in order to prevent the spread of the virus we all need to do our part one of the easiest ways to prevent that is by wearing a mask in order for masks to do its job it needs to cover your nose your mouth and your chin first you should wash your hands with either sanitizer or soap and water before putting on a mask then pick up your mask by one of the ear loops to make sure that there's no tears or stains on the mask if it is dirty throw it away immediately if it's intact take both loops and put it over your ears like this and then press down on the bridge of the nose to make sure that it fits and there are no gaps once you are done with the mask please take it off the same way both ear loops pull it away and put it either in a ziploc bag or throw it away if it's a surgical mask if it's a cloth mask make sure to wash it with soap and water and keep it dry for the next use do not put your mask down at your chin or above on your forehead when you're starting to remove it as that just contaminates the mask thank you so much for doing your part to prevent the spray throughout the muscle and joint pain it's an issue that many of us struggle with every single day sometimes it's from old sports injuries sometimes it's the weekend warriors and we all know who we are there are also the student athletes that we're going to talk about tonight and then there are those of us who are sitting at our office chairs all day long zoom meeting after zoom meeting after zoo meeting these are all issues that orthopedic doctors deal with during this next hour we have two orthopedic surgeons one specializing in adults and one specializing in pediatrics and student athletes this is a live program as you know so think of some questions of your own that you want to call and ask us that number is 881-013 this evening's program is underwritten by the hospitals of providence a special thank you to the palio foster school of medicine for providing students for us this evening today we have serous farsi and we also have courtney holbrook soroosh is a first year it's always fun to say that and courtney came back and she's a second year so thanks for both of you being here they've already texted some questions my way and this is going to be a great evening for them we also want to say thank you to the el paso county medical society who has been bringing the show to you and we were joking 23 almost 24 years now good evening i'm katherine berg and you're watching the el paso physician [Music] we are at march 18th today and we are still in the middle of covid there is help on the way vaccines are arriving daily i do want to just let you all know if you have not registered yet here's some information for you ep covid vaccine.com that's a website that makes it super easy when you go to that website you will see in the corner register for the vaccine and you click there and just follow the prompts so again that is ep covid vaccine.com ep as an el paso i know it's hard to understand that through the mass also if you're a telephone person uh you'll be on hold for a while so be patient but the telephone number is 915-212-1032 el paso is actually a pretty good vaccination rate compared to much of the country and we want to say thank you to everybody who has patients and continues to have patience that's good for all of us to reduce the risk so we appreciate that with me this evening we have uh we were talking about an adult pediatric or excuse me an adult orthopedic surgeon and a pediatric orthopedic surgeon we have dr eric torres here and then we have dr ike own it right ike so dr ongni dekka own he's our pediatric orthopedic surgeon but he's also going to talk about sports medicine he's going to talk about growth plates and we're going to talk about with mr dr taurus all the replacements the knees the hips and arthritis and all that good stuff so this is going to be a great show and i want to go to first when people say orthopedics and we talked a little bit about this prior to the show by the way these two have great rapport it's going to be a lot of fun to watch um when people say orthopedics it's not just the bones and a couple of muscles and tendons what exactly is the discipline and the specialty of orthopedics sure that's that's a good question and you're absolutely right it's not just the bones and although we are orthopedic surgeons by trade it is not just surgery some people think well i don't want to go to the orthopedic surgeon because i don't want surgery that's not necessarily true as orthopedic surgeons we're training the musculoskeletal system so anything that involves a joint a bone a muscle a ligament tendons and i can go on and on but really your musculoskeletal system what keeps you going keeps you moving is what we specialize in from the neck down so any of those elements that involves that is what we work with and there's a lot of treatment modalities not just surgery even as an orthopedic surgeon and i like that we say that it's it's the achy breakies right it's everything that you feel a little bit like oh this hurts a little bit that hurts a little bit and you guys become the rock stars because you're the heroes then right oh you fix this and you fix that so as a pediatric and i feel like pediatric it's not just kids because you're treating people all the way through high school sometimes in their first college years when it comes to sports um what do you specialize in when it looks at orthopedics with pediatrics it's funny because orthopedics actually being straight child so i basically treat deformity sports trauma and everything that kids could do to injure themselves or anything any issues that bournemouth is what i basically deal with congenital anomalies i said like i said fractures trauma sports right so when we're looking at that and i'm going to start with pediatrics first and i i wanted to say it out of the gate because something that i learned about several years ago when we were doing an orthopedic show is that i didn't realize that there were what people call growth what are called growth plates so there are plates in certain bones not all the bones and i'd love for you to explain to the audience which bones are in so when you set a fifth grader for example if they break their wrist and it's a it's not a clean break it's kind of broken but there's a growth plate in there you have to make sure cast is on only so long or maybe you have to switch the cast if you can kind of explain what that is that would be nice actually all bones either have a growth plate or hypothesis okay so all long bones have an hypothesis so like your humerus your radius on a femur tibia fibula or have a physicist we call it physis okay that's where the growth occurs for your bone okay so like you said like for the five like a five year old compared to a 25 or a 50 year old there's different things i have to think about when you're setting a bone or treating a bone like i said kids are not small adults exactly so we treat kids differently than we treat adults exactly and kids tolerate more deformity and to tolerate more injury than adults do so on that note too and i'm going to get to dr taurus in a minute if there is a let's say brand newborn a brand newborn child you can't tell that there is some kind of an orthopedic deformity until later on um when is that usually found out is that when they start moving start crawling start trying to walk is it something that you can see early on or is it usually when the child starts moving and you're finding that there's some difficulty in the way they're able to move it depends on the pathology and the disease process some pathology you could be seen in your row for example like club fee i do a lot of club foot in my clinic and explain what that is if you don't mind when you say club foot explain what a club foot is so i go to the technical definition so cavus adduct this varus and quiets the formula foot okay and the foot larry appears to be like a club okay it's like basically it's a fixed deformity where you you can't passively stretch the child we do treat that now with basically serial casting before which would more of a surgical process so now we basically have to like correct that each deformity in the child to correct that deformity and club flip and when that occurs are you as the child is growing are you changing the casting or is it a way so the basically how they treat it is serial casting for a week oh [ -_-_ ] okay maybe five to six weeks depending on how severe or even longer depending on how severe the crop foot is so actually i had i did my first i have a eight day old today that did the first cast today eight days old and actually the earlier you start the better the outcome because they're more pliable as they are younger right exactly so he'll go through five to six casts then to correct that he called aquinas or basically the foot is planar flex or flex down right i have to do a little percutaneous cut of the achilles tendon to get that foot to come back up and then cast it again and they basically got put into what we call boots and bars for the next few years to maintain a deformity correction and that that's fascinating to me and you were you were talking about pliability and now we're going to go to exactly the opposite us old people we're not that pliable anymore right so dr taurus um i wanted to kind of start off with pediatrics so and i like this so the audience can start figuring out which questions to ask of which doctor um so let's talk about people of the age of 54 plus because i always feel like okay this is me and we were joking about me i've got scoliosis and it would have been great to see you before you know i grew up and that was still a thing so yeah i've got all kinds of little joint things and muscle things we were talking about coveted earlier are there a lot of people that you've seen this past year and it's kind of crazy that we say this past year at this point that have been putting off coming to see you about some aches and pains that they've had some people that maybe were considering a knee replacement or hip replacement prior to kovid now they're like uh and the reason i want to talk about that is that covet is a thing but the hospitals and the doctor's offices everyone is very very cautious about how to go ahead and do certain elective surgeries and i wanted to bring that up and make that a point this evening sure absolutely my practice hip and knee replacements is purely elective having said that people should not be putting off taking care of themselves and also taking care of their health we're living in a different world people are working from home they're being more sanitary normally when they go to the office they're walking around they go through parking lots so people are not being as active and and so they're putting off a lot of the elements and not just in their musculoskeletal system their heart their lungs their routine medical health care so yeah it's important that although we are living in different times and very few of us are vaccinated you have to take care of yourself and a lot of medical practices have adapted they've adapted to people's needs and also the risk especially in my patient population so we have taken different precautions to make it a very safe environment we also offer telemedicine so there's different ways to get the care that you need without thinking you're going to be really exposing yourself or being at high risk exactly um so that's so that's something that we've done in our practice we offer telemedicine now we're very careful we don't book a lot of people at the same time so there's not too many people in the lobby we've actually gotten rid of ninety percent of the chairs in our lobby because they're not used anymore no i'm glad because i was going to ask you describe to the audience at home what they what they encounter when they do so you've had the television television visit and now it's time for you to physically see them so now they're coming into the office describe to them what that process is like so that they in their head go okay i know that there's not tons of people around sure let them know what the proquest is the biggest point i'm trying to make is there's not a large wait time and this is something where medicine is changing before you'd have to wait for hours in somebody's lobby next to a lot of people now we're making sure we get people in and out of there we don't want people crossing with other people we are screening every patient that comes into the office right we're being extra cautious we're being very careful the staff is vaccinated but yeah i think it's uh making things more efficient and i think this is going to be a new wave of medicine for us i think that's going to set a new precedent going forward which is good it's going to be better medicine i agree and it's interesting because doing these shows over the last several months there are so many things that have been put in place that there are certain doctors and certain programs that don't want to take that away you know it's the efficiency rate is really great and telemedicine efficiency timeliness all that great stuff is going to be wonderful here um i want to ask a little bit about sports medicine and we are kind of at the point where slowly some actually several schools have been in action with sports for several months now um and you were you were joking earlier i asked if if you're like one of the docs on the sidelines he's i serve all of el paso so i'd love you to think about one of the most common sports injuries in teenagers in the high school realm and just walk us through we were talking earlier about different stories that you might have you know without names without identifying anybody what are some of the most common injuries that you see in teenagers and sports i think it's a that's a good question because that's a theme of my office is called a general spectrum of overuse injuries and sports overuse effects shoulders knees hips everything so a lot of actually the growing trend now in youth sports of specialization especially down here like it's always sunny and warm kids play the same sport all year round since like they were like five years old i have like five-year-old pictures with like overuse injuries because they throw every day for a year and it's it's almost like trying to break down like stigmas of just because you play a sport a lot doesn't mean you actually get better at it you actually get worse and not be able to play sport anymore so like like i have to briefly preach to like parents saying hey like your son or daughter needs like to rest and recover the rest of recovery is what helps you prevent injury and also if you don't specialize you play different sports you have to become a better athlete and better athletes are better at sports it's hard to basically tell parents hey your kid can we play baseball in the fall he could run track in the in the in the winter or spring or swim or play soccer and kind of break these habits of oh you have to play tennis all year round to be to make the pros or play football you want to make a pros right and it's it's a lot it's it's it's weird because it's already preached in the general population but we've done so much research on it now especially in orthopedics that we're trying to get that out to the community that you have to stop these trends right what would you say is the most common pediatric sport again pediatrics is that word but i feel like soccer has been introduced over the last decade and a half two decades i grew up on soccer but when i came to america there was soccer wasn't a thing but i feel like almost every kid that's the rite of passage just like in my day it was like softball or baseball or whatever um is that kind of what you're seeing is because soccer can be played year round oh yeah here now on el paso soccer is a huge sport right i have a ton of soccer players especially female soccer players it's actually interesting a lot of my most of my pediatric i do pediatric acls and like i don't know acls most of my pediatric acl injuries are female soccer players okay so when you talk about overuse um in acl i feel like something had to snap so let's talk about an acl snapping something going wrong and how and you know what let's maybe talking about the growth let's say this is someone who's in first grade and then go to someone who might be a junior senior in high school and how differently do you deal with a an injured acl in those age groups so acl is more of a adolescent teenage injury okay is that it's very very rare for someone younger than maybe 11 or 10 have an acl injury so it's it's a good question because there's a spectrum of how you treat acls and age groups so for example if you're um previews that pre-progressing girl or boy and you have an open fyces we'll be very careful about bridging your physicists with our graft tell me what a fice is so fast as a grow plate gotcha so basically when we do an ace when we perform an acl surgery we have to drill from the do it's all about the graft to make a new make a new ligament we use a tendon to make a new ligament and adolescence it's better to get up the tendon from the actual individual it could be a quad a hamstring an it band and make a make and turn that tendon into a ligament okay i'm going to stop here this is just a curiosity question now so now you take a ligament from attendant sorry attendant from in you take part of a tendon you take a like how do you know for example like like um i used to i do a lot of hamstring harvesting for my acls i'm trying to hamstring harvesting wow i do hamstring harvesting so we'll take your distal hamstrings two tendons your graceless mit and then turn that into a graph that we will make to replace your injured acl okay all right next time you come on you bring a video i really would like to see that that's that's very interesting to me um i like to switch over because this is fun because we're going to talk about kids and we're going to talk about unkids not old people just uh let's talk a little bit about acl you know let's talk about that because those are injuries that jumping off the curb accident you know in a wrong way or putting your cart back at the grocery store the wrong way i mean acl that's that thing that just always gets messed up now we're not looking at young ones anymore what do you see in uh adults and how you treat the acl injuries i mean you also do some harvesting do you do harvesting as well i glass because so so this is the thing i see a lot of patients in my practice who have had an acl that was never treated okay yeah you know that's an excellent point yeah that's really an excellent i'm the guy you go see five ten years down the road and you're like you know i'm questioning people did you hurt your knee at some point in your life ah there was that one time yeah so say you tear your acl you don't think much of it for whatever reason or you're not bad enough to hurt as bad no it hurts it hurts but we live in a community where people are tough yeah that's true we are very tough we don't like to go to the doctor they're gonna find something right so say you get hurt you tear your acl and some acl tears are very subtle right so yeah you're playing softball or something as simple as i stepped wrong leaving the grocery store um if somebody lives without an acl the kinematics of your knee change that's why the acl is such an important ligament so what i mean by kinematics the way our joint moves our knee has so many different motions in different planes right let's take a look at this model since we brought it let's use it yeah all right normal knee normal knee i love that can you can we zoom in there is there a zoom in function she's working on it yeah all right there we go acl right there i'm pointing right at it so let me get my pen maybe there you go all right acl anterior cruciate ligament cruciate because it crosses and it's in the front say that gets torn right for whatever reason the function of that acl is prevent the tibia from sliding forward forward okay well i have felt that feeling so you tear your acl you keep living with life because you can you can still walk you can get back to life but 5 10 15 years down the road you're going to end up with severe arthritis in your knee which is kind of what this model shows okay red angry torn meniscus potholes a lot of pain and stiffness you know arthritis isn't always pain sometimes people are just stiff i can't bend it really good i can't put my socks on it's hard to get in and out of the truck so these are all signs that it could be something going on but if you don't have that ligament your knee is not working fun properly and you will end up with arthritis it's not a matter of if it's a matter of when that's why it's important to get the appropriate health care at an early time frame so here's a question can your ligament be completely torn and you not know absolutely see that that that doesn't compute right you know in everyday life you don't really stress your acl to its maximum potential okay so walking through the grocery store getting in and out of the car you know you're still you've been so you're still getting that subtle instability right but you can live with it if you're a skier you play soccer you will know for sure that your acl is gone but if you don't push your knee to the limit you're just gonna have that subtle instability that's constantly happening and eventually end up hurting your knee really bad yeah so that's a good question and there's still a lot of research going into this right uh because we reconstruct acls we don't repair them they don't repair because they don't have good blood supply so like dr ornerica said we have to take some tendon from somewhere your hamstring your tendon your patellar tendon and we give you a new acl in order to save your knee from sliding forward which is what an acl does you know i have had that feeling before and i just uh you might have an acl team no i was gonna say when i really do a deep squat gardening what have you there is one knee that's a little yeah so on my next question is how does one let's just say it's me there's there's you know 54 year old lady she's doing her thing she comes to you just because there's something nagging her but it's not really hurt what how do you diagnose like what what type of uh images do you take do you do a lot of clinical i mean how do you figure out what's wrong sure well you know step number one listen to your patient the history will give me 90 of what i need to know then comes the exam there's different exam techniques to evaluate your acl pcl mcl i'm throwing out a lot of names but there's a lot of ligaments to it yeah oh yeah and there's a reason why medical school is four years in orthopedic surgery residency is five so we can learn a lot of that stuff right but yeah there's ways to test the different ligaments the meniscus and to kind of get an idea of what's going on um it's not a bad idea to get some baseline x-rays you get a lot of information right and then we can go on about other advanced studies they're not always needed but yeah we have a lot of tools in our toolbox to get to the bottom of it and really diagnose patients so here's a question i get a lot with an x-ray obviously you see bone can you see ligaments can you see tendons i mean on an x-ray what all is accessible to the eye from an x-ray prior to going to an mri cat scan etc sure but if it has calcium or metal you'll see it on x-ray gotcha so no you cannot see the acl you cannot see meniscus but you can tell a lot of things based on an x-ray the resting station of your tibia is it sliding forward is it sliding back are people getting a specific type of arthritis like anteromedial arthritis is there calcification in a prior ligament sometimes we damage ligaments and they calcify we can see that on x-ray so x-rays yes you're right they only tell us what the bone is doing but it gives us a lot of information like you said too if it's been 10 or 15 years is a different way that your mechanics are are then working exactly there is a specific type of acl tear that will show up on x-ray it's a type of evolution fracture so it's a little flick of bone and you see that hanging around the corner of somebody's knee you know it's an acl tear wow and then your job is to go in and clean up what could have happened 20 years ago 10 years ago but also what could have happened last weekend right that's kind of yes i don't deal too much in acl reconstruction okay i think by the time you reach my office you have a pretty bad knee right and you're discussing options of treatment when arthritis kicks in okay and it's not just surgery like i said there's a lot of different modalities in treating your knee and also preserving whatever's left of it exactly i won't rush somebody into a knee replacement it's actually not my job to say when somebody's ready the patient will tell me when they're ready for a new knee but when it comes down to a knee replacement our new implants are so good we don't need an acl anymore nice yeah so when i come back to you we're going to talk what i'd like to do i know we're getting some questions from the audience what i like to do is really talk about replacements i know that's your specialty and i want to talk um i want to ask a little bit about dr ike if you were talking about congenital issues and we talked a little bit about clubfoot and you described what that is what are some relatively common congenital issues that you deal with in children and how does it affect you you were talking about beautifully how you've got the you know you've got the you were talking about how you cut certain ligaments or certain tendons and you correct things in every several weeks you change out but other defects or other congenital issues what might some of those be like just like throw the gamut out there oscars are most the most common things like hip issues like hip dysplasia okay when a newborn infant uh basically has some it could be frankly it's dislocated it has some uncovered issues in their hip and a lot of times you could get that in a screening test where basically the pediatrician will stress the hip and see if they have her hip click maybe a click a little pop right and then they might get an ultrasound if they're concerned if it has a certain measurement on the sound that's sent to me for further treatment okay i think it's like it's an issue you want to catch early because the squelly for later on could be more invasive procedures to fix it mm-hmm someone in an infant put them into a little harness for a few months right if it's missing a little older they might have to get a cold spiker cast but basically mold the cast to keep and reduce their hip if i can't mold the cast release the hip i actually have to go in and open reduce the hip go in this dissect take out all the impediments to the reduction okay and put it back in and then if they're a lot older i'll do osteotomies to basically put the hip back in and correct the deformity okay so it's a large spectrum and the part that that fascinates me is there's growing going on this entire time so every time there's a cast on a little one on something that's congenital just how often you have to go through and change it and i know that i'd love to talk about growth spurts because there seems to be in every teenager's life and you were talking about about you know 12 years old for a female about 13 14 years old for a male but talk about the growth spurts and what issues can happen from like really fast experts you guys great question back to overuse and injuries like a lot of growing pains we taught alpha and are those real i mean they actually are really telling people they're real we have names we have names for them for example in the knee then when you have knee pain at like the anterior aspect of your tibia it's called ash good schlatter's disease or table tubercle apophysitis dear lord say that slowly tibial tubercle apophysitis or what we call osgood slaughter disease by the people who actually discovered diseases okay so essentially it's like jumper's knee when people have pain in that bump they feel a bump on the front of the tibia so a lot of my volleyball players basketball players get that injury and they come in saying oh i've been having painia for a long time i play this sport and then not going away and snagging me i feel a little bump here i get an x-ray and you'll see that a little deformity at their teeth as i go yep and is that from overuse or is that something that their body kind of originally had and overused overuse messed it up overuse facilitates the methodology okay so they'll feel a lot if you're not running around and jumping won't bother you but when you start playing sports hardcore okay it really bothers them they could shut they could shut a kid down i don't i had it when i played football in high school that's why i know exactly right it's it it hurts yeah okay it's serious yeah so i want to talk before i switch over to doing a lot of replacements i want to talk about scoliosis because i feel like that's the silent thing that you know kids don't know when they have it and again i'm looking at kind of the age of when if you're gonna have scoliosis and i feel like it's far more common in females i could be wrong maybe just because and and why is that and what age does that begin and what could be the complications going forward so the most common form of scoliosis we see is adult uh as a adolescent and inhibits the ais okay so that's when the 11 year old girl 11 and 12 people a boy they have you guys scoliosis is a good general you have infantile juvenile and so on so but the most common one is the adolescent oh adolescent so a lot of times like i said like like the be in the school it was the school nurse to do a forward bending test you go oh you have a little bump a hump on your back and i go oh you need to go see your doctor go see an ortho and to get an x-ray to see if you have scoliosis so a lot of times um my parents would be kind of scared because eating soils soilosis means surgery you know how high like what what's going on my child can i prevent this did i cause this i have to explain to them that it's a it happens you can't do anything about it there's some genetic factors to it depending on the severity levels to it they could be that's a different degree a specific degree so okay so you model the b from like anything above 10 we have basically uh we do an angle called the cob angle anything above 10 is considered scoliosis okay you go about to 10 to mid 20s it would be like moderate to mid-20s when you get to the mid-20s we still think about bracing you say you're pre-compute pre-pubescent the brace will actually help to almost control the curve so we could catch it before your growth spurt probably help control to get as bad later on i'm looking behind me keep talking because i have a spinal cord behind me [Laughter] but here you go look here's a toy for you um and we can talk and uh here's brenda again i don't know if we can oh she's all perfect that's really hot if i could bend this because i can so basically it's a coronal abnormality don't break it i know i'm probably gonna break it my bad all right you can break it it's fine you see there's a curve there could be a curve and they call like the front looking at the spine and there's a curve in it like that so depending on how bad the curve is it depends on the treatment like i said so if it's in the like a moderate curve if you'd be braced and you're young enough to be braced if it gets severe enough where it's in the 40s and above you think about fusing it back and and uh and basically fusing them back to to prevent any more thoracic or visceral is your issues because if you curvy it gets uh some kids have severe courage like it could be 90 degrees or 100 against the effect of breathing right exactly and it actually becomes a life issue okay like a net issue not just a appearance issue or function issue right so just depending on the severities how we go about treating it so let's say somebody's now in their 20s all all the growing's done they are and i don't know this is a hard question to ask but it's in between being like this is really affecting my life and i like you were talking about people just live with it like i've always had i've always kind of walked a little bit this way boys how does one treat after all the growing's done can this be treated and i'd imagine it's through surgery um are there rods that i don't know you tell me so the pegasus depends on the severity and it's like medicine is an art okay to say oh you have a 40 degree curve you get surgery ah so no thank you thank you yeah i'm sure yes we discussed we had a discussion they go this is what we recommend this is it was how you're feeling what do you want to proceed with so we only give you suggestions i can't make you do anything even like eric could tell you that you can't make it get a hip replacement right and usually even hip replacements you he like you he he'll he'll go to him saying please replace my hip so thing with sort of with certain issues like scully a lot of will tell you hey it's in the best interest that you have this procedure for x and y reasons or if you don't want to it's okay right so we just have a discussion yeah and i'm just thinking me in my 20s if i had again i don't have bad scoliosis but it does affect me i mean like we were talking about before the show my left neck and shoulder always bug me if i'm walking for more than an hour so the left hip is like starting to burn because then with bad scolio could progress when you're older to really bad arthritis in your back then you will actually need to have bad pain and have radiculopathy or like pain go into your legs or nerve issues then that's different then you you lean more towards surgery to preserve your function okay since you're the old person person dr taurus i guess i need to come in and see you and get some x-rays see how crooked i really am um actually i i have a question here from the audience that is for you dr torres we were talking about knees i said that we were going to go to um to joint replacements but this is a great one six-year-old female and thank you for getting down the sex and the age that's super helpful thanks students um six-year-old female wants to know what kind of exercise she needs to do to help heal a partial ripped meniscus so we haven't talked a lot about meniscus yet sure so let's kind of start with there okay and then we'll try to answer her question sure because there are exercises but you all have to be careful too and you're to your point rest is a good thing right yeah but miss do we have a meniscus there we go we've got plenty of minutes so what is a meniscus what is a meniscus think of it as a cushioned disc inside of your knee and we have two okay think of it as a shock absorber to your truck but these are to our knees they commonly tear it's a common injury not all meniscus that tear needs surgery okay there are ways to rehab through it get you better and get you into a functional state where you don't have to undergo any more intervention some of them do require surgery so first line of treatment is if it happened recently cryotherapy so ice to lower inflammation when we hurt something inside of the knee we have some internal bleeding so that's where swelling comes in automatically of internal bleeding yeah is that yeah that's the bruising okay that's the that's the well my knee pawned up i'm swollen and why is it so swollen i can't bend it so when our knees swell we can't bend it very well and our muscles shut up so in order to rehab somebody from an acute injury you want to give them some ice rest like dr oneticus said some compression does help and then start getting the knee moving again right by rest i don't mean lay on your couch or be in bed for the next four weeks exactly but i mean don't go for a jog maybe go for a walk low impact activity so that's what's important there is a role for formal physical therapy uh they can help guide you through the right exercise and activities and they can help you recover from such an injury not all meniscus need surgery right having said that there are some that can be quite uh problematic and they're not amenable to to conservative treatment and if that's the case then there is a minimally invasive intervention such as arthroscopy which is camera surgery to try to fix or repair that meniscus so if you don't mind talk because everybody talks about the surgery now what what has happened so you've got the the two little tubes going in do you have the little claws describe what is happening when you do orthoscopic surgery so arthroscopic by definition is a camera surgery right you do small incisions to get instruments into the knee it's a minimally invasive way to a take a really good look inside of the knee okay and b access the meniscus or the ligaments or cartilage whatever it be that you're after and we've got all sorts of tools so is the camera itself a robot as well so it's a camera that also has the little claws on there and i know i'm trying to really dumb this down because i want to be specific or two different things camera is not a robot okay uh a camera you're holding it with your hand right and then you're doing this and then you've got your other arm controlling the tools to do whatever work you need to do gotcha yeah there is no such thing as robotic arthroscopic surgery in orthopedics you've got the camera but then you also have the clippers that take off it's coming yeah you know the the polyp so in my head i'm trying to figure out you know our anyway we answered that question right so that's good so let's go back to what kind of exercise sheet if she knows that she has a an injured meniscus what kind of exercise should be she be doing to help heal it at this point sure 360. okay yeah low impact activities such as walking instead of running cycling swimming these are great for your knee and help you recover from any injury okay um i am i'm doing a cold call read right here a question from celia she's 60 years old and she i had my right arm shattered and rotator cuff torn many years ago now doctors tell me that it's too late to have the rotator cuff surgery and i'm in pain every day what options do i have to stop the pain and be able to function daily uh that's a cold read from the audience taurus i'm throwing that your way unless you want to throw it away no well i'm sure you know we both take trauma call we both deal with patients who end up with shattered arms torn meniscus so i'll give doctor onyetica i'll get you something that's past the age of 18. after this one um there are treatment options so this is a patient who's describing an irreparable cuff tear that's what it sounds like to me right so when somebody tears tendons you do have a time frame to fix them sometimes it is damaged so bad that they are irreparable and so in somebody who has no rotator cuff which means they don't have the tendons to lift the arm there are salvage options in order to fix that in somebody who has significant loss of function and pain without this is what i'm thinking harvesting i mean you take from one part of the body um i will tell you yeah there are some options that do that i am not a shoulder specialist by any means i'm a hip and knee specialist but i but i did go through an orthopedic residency there are ways to put a capsular barrier to prevent your humerus from riding high getting into a lot of detail but yes there are minimally invasive ways and there are what we call maximally invasive such as uh reverse shoulder replacements and total shoulder replacements and options such as those gotcha yeah okay nicely explained okay i have a couple of questions here we were talking about when growing stops growth place stopped you so i think you said 14 for girls girls 16 for boys except for collarbones um and these are fun right these these are fun questions so broken collarbones i feel like with contact sports you know controversial yeah we can skip it literally i mean we've got something so let's talk about how do you because you can't really set or cast a collarbone how do you how do you treat a collarbone so let's start from infants or even neonates to adults okay sometimes it'd be a difficult birth and a child is actually born with a broken collarbone and actually calling to the from the nicu saying oh the child is cow bone what do we do so neonates are like wolverine and the x-men they heal they heal almost everything yeah so they'll literally make a new bone quickly so all you have to do they do is pin their arm they basically get a long sleeve onesie and pin it to their chest and they'll because they're growing so fast it will start making bone they're throwing this throwing out bone nice then it gets older so in my younger kids you know is it almost totally unindicated to ever operate on a young child's collarbone i've never seen it i don't think you should ever do it but they'll heal it like you said there's pliable yeah and then once they get almost like they're a little bit less old like older wolverine they can still heal healing then it gets more complicated because they're adolescents then it gets consequent more my realm when to fix what not to fix so for example i i do a lot of four players so say i get a 14-15 player who's still growing has a bad comedy broken up pieces totally displays pointing to the skin and i dare to go bigger kid like a lineman and after like push i am more inclined to actually fix operatively fix that bone because i know if i don't if that bone is a little too short right or not totally healed right they might lose strength in that arm and then we'll do their job for their sport and then if it's some other kid who's not an athlete who's just hanging out doing this thing i go you know what you're going to heal this don't worry about it right so it gets controversial as it gets kind of respected eric are laughing because it's controversial in our literature when you should ever fix a collarbone right some people are super aggressive right you'll never fix any collar bones right so yeah it's a fun topic so i was like me i'm i'm i'm like you know a tweener mode i'm like i i look at the patient and give them the options right and tell them what i think will happen or if i think this will help them or not and then we go from there yeah and that's interesting because even i'm a layperson so i just think they wear a sling so you're not moving around and just hope it heals i mean that's kind of what right right my thought process i was on call we all know somebody who back in high school broke it they treated now they've got it they've got a nice little bug but they're living i know a guy with a bomb yeah i get it i get it um i want to go because dr torres we keep saying that we're going to get back but all these questions to keep coming what do you specialize in you were talking about knee and hips talk about which one you you like more that's the wrong question what do you feel most versed in i know both but just take it away because i know there's a lot of people watching that are knee replacements are a big thing and such a blessing when people finally get them when they finally make the decision maybe that's the first question when do people finally say okay it's time for a knee replacement and then do the same thing with the hips sure so i don't have a favorite okay you don't want the favorite chocolate basements i think uh i love both which is why i do it for a living um when do patients say they're ready that's different every patient's different every pathology is different and it's important that i tell patients we don't treat their x-rays i get a lot of patients come in we get some x-rays sure looks bad and they tell me doc is this bad enough for a replacement i tell them listen we're not here to treat your x-ray we're here to treat you and everybody tolerates pain a little bit different and really if you simplify a hip knee or even any joint replacement into two things pain or function right okay so this is what i tell my patients if you're to the point that you have a hard time walking through the grocery store going for walks getting in and out of a car putting on your shoes or your socks that maybe you ought to consider what i don't want is my patient to become sedentary start gaining weight then they've got heart disease their diabetes gets worse or they get diabetic so these are all connected things so you never have to have a hip or knee replacement it's important to know that it's purely a quality of life thing and i tell my patients listen you'll know when it's time not your x-ray not your significant other you'll know when it's time and and it's important to that people know there are conservative treatment options even for severe arthritis not every patient that comes through my door with bad knee ends up with the new knee right i just give them their options i tell them these are all the options we have some might work better than others and you tell me which way you want to go and i would say there's a leap of faith in there too which is a good thing because every now and again you just got to take that chance and get it done everyone that i have spoken to truly not one who has had a knee replacement or hip replacement regrets doing it it's in most of the time it's like i should have done this earlier and so i'm saying that because i'm not the doctor i'm allowed to say a leap of faith and sometimes you just got to throw that into the mix as well so when you're replacing a like i've heard of partial knee replacements uh-huh what does that mean versus a full knee replacement are you able to go through that really quick sure yeah that's a good question so a knee is made up of three compartments as simple as that medial which is the inside lateral which is the outside and patellofemoral so under your kneecap there's another compartment and a good candidate for a partial knee replacement is somebody who only has partial disease as simple as that if you have partial disease and your goal is in earlier recovery getting back to life and the rest of your knee looks awesome then sure you might be a good candidate for a partial knee you know i see a lot of patients come in and see me because the media pushes partials a lot because it's a much less invasive surgery and faster recovery it's important that patients understand if they do have disease in other parts of the knee they might be better off with other options but yeah a partial knee is a great surgery that some people qualify for because it's less invasive and it gets them back to life sooner right yeah now i'm curious about the hip um again i think eventually in my lifetime i hope to live to be 99 years old but i'm thinking the left hip might need some help right around 86. so let's talk about hip replacements and and you know what speaking of ages because i feel like now the the 50 yeah is the new 30 et cetera et cetera because you know and talk a little bit about that people like oh i'm too old to do that but that's not really the case well you know you keep bringing up the age thing i don't i don't run a geriatrics practice i j i run a total joint practice and i have 17 year olds that come and see me that are in need of help it's important to know that arthritis is not a disease of the elderly right it can happen to anybody and it can happen for many reasons it's multifactorial injuries age genetics that's a big part of it right that's something we can't change right prior to forming so the list can go on and on having said that um it's not something that you absolutely need to get as you age not every 85 or 90 year old ends up with a hip replacement right okay right some people do i uh end up never needing a joint replacement in their lives it's important to know that yeah and it is really you will know when it's time yeah we are running a little bit out of time here we've got about 12 ish minutes massimenos and so um dr oniereka i would like to ask you i have a bunch of just concussions i know you're not a concussion guy i get it we talked about acls um i do want to talk about tailbone injuries because i feel like nobody talks about that i i was a gymnast in high school i had a doozy of it i mean i couldn't walk right for about four or five months you can do no at least at the time you can't do anything about it i i could have been a hairline crack i'm not sure is that even something that is treatable yeah it's a weird it's a weird one i'm throwing the weirdest one out there that i can look at right here that's an interesting question because operatively most ortho we actually don't operatively treat tailbone injuries right you just it's kind of like a collarbone thing it does that it's where the location is it's in your basically your um by your intestines right right your rectum so we don't like operating down there it's kind of dangerous so a lot of times you want if you ever need a tailbone excision which is super rare we'll probably refer you to a general surgeon or maybe if a sponsor wants to dabble down there but we don't really do it i i see no no i see a lot of tailbone injuries yeah i was they first but we treat it non-operatively like what the the the the tushy cushions and right okay so that also something that made it on its own for the most part you watch you know you do what you need to do commonly fractured rarely needs any kind of surgery right exactly very very rare and if if there's a bone in your body you can fracture it no kidding um you talked about overuse injuries and so i've got a couple here that i think about the golf risk i think about i think with tennis tennis elbow that's just a common one um with golfing i guess it's shoulders just in general people that are the weeknd warriors you talked about it before but i would like you to talk about it again that if they feel like something's not right when do they know to go to you or you and when do they know just to kind of lay off for a while good question too it's you gotta like like understand your body if you have pain your pain is refractory to like motrin tylenol rest you are thinking about seeing a doctor because then like something might be really wrong usually like recovery is like the mainstay of healing the body heals by rest as you go back to my like recovery and overuse in sports with kids and athletes it's a lot of athletes don't rest well right they don't they don't listen to their bodies and um like like i'm loving sports now like with like lebron and even tom brady that they're showing how important it is to to listen to and treat your body well that's why they're still playing at a high level because they take care of their bodies they know when they're in pain or injured and they they spend millions on recovery because it's so important so a lot of people when you say recovery resting resting therapies exercising exercise eating well okay they'll all it all matters so like a lot like until like they see now in this new age we're learning more and more about that so we can warriors a lot of times they get injured because they're not in great shape and i don't know why they're not they're not in great shape well because they're sitting all day all day i'm gonna go play whole rounds of gold for tennis and they start aching because their body isn't used to that kind of abrupt like quick activity they go what are we doing right now like we don't do this we don't do this like what we're doing so that they have to basically it's good to like stretch stretching warming up when your school starts sprinting right i couldn't do it right now i'll probably tear your knees achilles yeah i tried to just sprint right now so you have to basically warm your body up okay we're going to do activity now let's get stretched let's warm up and it's get the blood flowing literally except get the blood flowing right then start doing stuff right yeah and i think that's such an important thing because i'm a weekend warrior i mean i'm that person that sits at my desk all day and then i do i do golfing or you know i had a black eye a couple of months ago but i won't talk about that that was me just not not paying attention i fell down it was great i had lots of makeup on i did the show brenda remember let's talk about that um but i do have another question here from the audience actually this is kind of cool because they know everything there's no secrets with me 67 year old male he walks two miles every morning number one good for you walks two miles every morning we were talking about moving around a few hours later when he rests his lower leg twitches um he says it doesn't really have pain but it twitches and this is not a neurological show i get it but i like to honor the questions from the audience i'm throwing that your way dr torres if there's something that you might be able to answer with that i don't know you know the first thing i would ask is are you staying hydrated he's obviously being active he's getting out there especially now that uh spring and summer's around the corner here in el paso twitching muscle cramps this is something we commonly see especially in athletes but not just athletes anybody who remains active outdoors staying well hydrated making sure your electrolytes everything is in check so right that would be one thing i would want to ask and then also too just keep moving that's a really really big thing um i've got all kinds i have a whole da vinci system here but i'm not going to talk about that right now what i do want to do since we're running a little bit out of time is give once again that if you have not received your cobit vaccine and if you're interested in receiving it i know there's some hesitation there and that's something too uh there's epcovidvacine.com there's also el paso strong dot org that is a website that you can go to that just gives you information about the vaccines it's a big decision to make but if you are interested you can register at just think of el paso ep covid vaccine.com if you like to do it via telephone there is going to be a waiting time so be forewarned but 9152121032 um dr onierica i would like to know if there's anything that you thought about coming over here tonight that we haven't touched base on yet that you'd like to get across the audience before we start closing down because sometimes it's like oh i forgot to get this out or i just didn't have time to get that out is there anything you'd like to say yeah like we basically touched on that overuse and sports injuries and kids like like my may see my practice it's kids aren't little adults your five-year-olds should not be throwing a hundred pages every single day they will throw their elbows out unfortunately i see that and i have to give lectures of that every single day so always remember the younger the kid is the less strenuous activity they could do until they get older and older and mature and become scaly and mature so don't treat your five or six year old like a pro baseball player he's not a pro baseball player yeah may not go on scholarship yeah yeah right yeah they might not okay exactly that's okay kids are let the kids have fun you know i'm saying and everything i always say work smarter not harder a lot of times people like holding my practice seven days a week eight hours a day i'm like dude chill that's real right you got like you need to recover like i said recall it gets you gotta you gotta rest your body you know like a lot of times the kids can't they just eat mentally and physically they just can't deal with that kind of straining what they want they might not tell you they can't do it right and they'll hold it in because they're in tears exactly that's a big deal oh i'm on the team the team's relying on me and coach i don't get i don't get in trouble they won't tell you anything they won't tell you when they're hurt right so the mom in their home like limping around i was like what's wrong with you oh my foot hurts it's been hurting for a month and you're gonna be going to practice for a month so you gotta like gotta watch these kids i gotta like train smarter train harder education is key mm-hmm like coaches trainers i love math like trainers and like coaches and trainers is to be on like work together right and it's for a team so if a trainer tells until the coach has kids hurt they're hurt right yes speaking from you as a pediatric doc who's listening and watching the show or not the kids it's mom and dad and grandma and grandpa and the people who are pushing them so i think that was a beautiful way to just chill out yes do the best that you can but chill out how about you anything that you want to get across before yeah the one thing i would want to say is don't delay health care just because of the pandemic this might or might not go away this is just the new world we're living in you've got to take care of yourself you've got to take care of your your health you know a lot of patients have the misconception that a hip replacement will put you out for months you know i specialize in a very minimally invasive muscle sparing a lot of my patients go home either same day next day and get back to work in a couple of weeks so there are ways to treat uh your ailments uh appropriately even in uh the different days we're living in these days so uh that's all that's all i want to say to to the audience just keep your health in check right and it's it's nice when you say that too because we are at a point where we're too sanitary so if you can go out and walk a little bit and if you do jump off the curve a little bit weird they need to come see you and i think that's something that we want to get across to the audience that if they're hurt yes it's a time of covet help is coming vaccines are coming but you all are prepared to receive patients even in this day and age and i and i love how you said earlier that telemedicine it's not going away it's here to stay you know it's going to be modified here and there but if there is a way that somebody's just really too scared to go in right now have a telephone medicine communication with you and again this program is underwritten by hospitals of providence so call hospitals of providence there you can talk to both of these docs here we have eric torres here and we have ike onyetica um and i do do better there i like that so those are the two that we have here and again the el paso county medical society is the the sponsors of the show you can always ask them to see who it was is on the show you can also watch a show back on pbselpaso.org and also on epcms.com so one is oregon.com and i say that because sometimes we go through these things so fast that it's like what did he say what did she say and that way you know you can show your mom that you're on tv too that's important you know when you go over there that's what i was doing i want to say very very much a huge thank you to sarosh farsi and also to courtney holbrook who have done a great job and i really love the way you guys give the questions to me so i appreciate that again covidvacine.com get registered i'm catherine berg and you've been watching the el paso physician do [Music] [Music] you