Catalyst Health, Wellness and Performance Coaching

Myth-Busting: Orthopedic Surgeon Style! (with Dr. Howard Luks) - #070

February 10, 2020 Dr. Howard Luks Season 3 Episode 6
Catalyst Health, Wellness and Performance Coaching
Myth-Busting: Orthopedic Surgeon Style! (with Dr. Howard Luks) - #070
Catalyst Health, Wellness and Performance Coaching
Myth-Busting: Orthopedic Surgeon Style! (with Dr. Howard Luks) - #070
Feb 10, 2020 Season 3 Episode 6
Dr. Howard Luks

Is arthritis due to overuse? Is arthroscopic surgery the best answer for knee issues? Should I get an MRI on my shoulder when it's painful? Is running bad for my knees? Do my food choices affect my joint pain?

These are just a few of the questions we discussed with Dr. Howard Luks, a well-known surgeon who doesn't always sound like a surgeon. You will LOVE this episode - do not miss it!

Show Notes Transcript

Is arthritis due to overuse? Is arthroscopic surgery the best answer for knee issues? Should I get an MRI on my shoulder when it's painful? Is running bad for my knees? Do my food choices affect my joint pain?

These are just a few of the questions we discussed with Dr. Howard Luks, a well-known surgeon who doesn't always sound like a surgeon. You will LOVE this episode - do not miss it!

Dr. Cooper:   0:08
welcome to the latest episode of The Catalysts Health and Wellness Coaching podcast. I'm your host, Dr Bradford Cooper, and about eight months ago I came across a doctor, Howard Luks. He's an orthopedic surgeon who didn't sound like most orthopedic surgeons I'd met over the years. His intriguing blog post noted that MRI's don't always provide the answer and that surgery may not be necessary at all. The more I read, the more intrigued I became, and the more obvious it was that you'd want to hear from him, too. Dr. Luks is a board certified orthopedic surgeon specializing in sports medicine. He's done that for over 20 years. He's also an associate professor of orthopedic surgery at New York Medical College and is the chief of sports medicine at W. M. C. Health, a branch of Westchester Medical Center. He's also a trail runner, amateur cyclists and the father to three children. He also, like most of you here, believes in the pursuit of better, which you'll hear come out in the interview. If you're planning on pursuing the National board certification before the requirements and frankly, the costs increases later this year, please don't wait to get registered. We do have an April 4th and 5th fast track certification coming up in Colorado, but it's gonna fill just due to all the changes going on with the NBHWC that are coming later this year. Email us anytime. If there's any confusion about it, if you have any questions, it's [email protected] You can find all the details, get registered, including there's a six month no interest option on there at Now let's listen in with Dr Howard Luks, as he provides us with a new perspective on the world of orthopedic surgery on this episode of the Catalyst Health and Wellness Coaching podcast.  

Dr. Cooper:   2:10
Dr. Luks, it's great to have you join us today.  

Dr. Luks:   2:13
Thank you, Bradford. It's a pleasure to be here.  

Dr. Cooper:   2:16
You're such an interesting read. I came across your stuff maybe 6, 8 months ago. Your blogs, your tweets, and you seemed to swim against the current. Is that a more recent development, or is that something that's taken place over time as an orthopedic surgeon?

Dr. Luks:   2:32
Funny, I wouldn't say I'm swimming against the current. I think I'm just on the slower side. I'm not in the center of the stream. I'm out towards the edge where the current moves at a less rapid pace. If you look at my writings on my website for the last 15 years, I'm sometimes surprised at how long I've had this, I'll call it a surgical conservative or medical conservative approach to orthopedics and orthopedic surgery. I just started to notice that people were getting better, without treating many things surgically and also some of the principles of what caused shoulder pain, this whole bone spurs concept. Yeah, I just never bought into it. Luckily, you know, I've been vindicated and all the research shows that, in fact, it's not true. And the sham surgery studies show, in fact, that you know bone spur removal isn't necessary. But, you know, I can't remember one specific moment that brought me to this point. I just thought that there was a different way to approach all of this, you know, and FIFA Service aside, I just felt that doing the right thing, and helping people get past a certain injury was the right thing to do? As you've noticed, I know that you follow what I write. My blog has taken, you know, a very distinct twist. And that tutorial I put up this morning highlights that where we really can't look at these things in isolation, right? You know, a meniscus tear in someone with a BMI ofI 40, an LDL of 300, and fasting blood sugar of 210 is different than you who's presenting as an ultra runner who can't run anymore. And so we have to start to look at the totality of the person before us and figure out really what the most appropriate thing to do is.

Dr. Cooper:   5:01
I love it. It's so refreshing. You know the old saying when you're a hammer, everything looks like a nail. It's just very refreshing. I appreciate it. So as an athletic trainer, physical therapist for 30 years now, your message for me is really unique. Very fascinating. Can we just do a free form on some of the hot topics you've addressed?

Dr. Luks:   5:19
Yeah, of course. 

Dr. Cooper:   5:21
Alright, let's start off with the MRI's. Why does or doesn't an MRI accurately assess the situation?

Dr. Luks:   5:27
As we're taught in medical school and how 20 something years of doing this it turns out, that the patient will give you their diagnosis. You just have to learn how to ask the right question. So 8 times out of 10. I'm gonna know the diagnosis based on your history. The story that you give, my exam is going to confirm that and we'll then use an MRI if necessary to confirm our suspicion, our diagnosis. If you don't know the cause of pain or don't have a high suspicion, then the MRI's often not useful. And that's because no one over the age of 35 and certainly over the age of 45 is gonna have an MRI where the impression comes back normal. Still, we know that a lot of structures within our joints change as we age. So you and I are both ultra runners. We have a significant chance of having a meniscus tear in our nature despite the fact that we're running and active. I was a pitcher growing up. There's almost 100% chance that I have a labral tear. There's a good 35 to 45% chance that I have a rotator cuff tear, but you'd never know that seeing me push and pull heavy things in the gym every day. So if you push the envelope and get MRI's too soon, you're gonna start defying these normal age appropriate finding. And you're going to identify that or label that as a cause of pain and you're not actually gonna know if it is in fact, the cause of pain. So, for example, I may have lost everyone. You have a small rotator cuff tear, you just don't know it and your shoulder just starts hurting one day. You go into a doctor's office instead of saying, look, let's wait six weeks, they order an MRI and the MRI comes back and shows a small rotator cuff tear. You don't know that that tear was there, you know, long before your MRI was obtained. But now you're in trouble. So now you may be in, a doctor's office who says you have to have an operation for this. And if you're in a physician's office, who says, you know what? You don't need an operation, but you're a tennis player. Every time you go to hit a serve and you have a little twinge in your shoulder, you're gonna be afraid you're making that tear worse. So there is the real chance of causing harm by seeing your MRI reports.

Dr. Cooper:   8:10
It's like it puts a label on it, and now you're tuned into whatever was maybe there before, but now we feel like that's the answer. Wow. All right, let's talk arthritis. Is it an overuse injury that requires constant rest? I'm setting you up on this one. It's a slow pitch that's been floated to you.

Dr. Luks:   8:32
Definitely not. People were taught to think that osteoarthritis, which is the loss of cartilage or cushioning in your knee, is because of a mechanical issue. So sandpaper rubbing away wood, cheese grater shrinking down you know, your Parmesan. It's not the case. There's actually thousands of chemicals and proteins and hormones that are involved in the nutrition of our cartilage in our joints. You know, the prevalence of osteoarthritis is increasing. It's not increasing because we're more active. It's not only increasing because we're heavier. It turns out that our metabolism and our overall metabolic health and wellness has a lot to do with the health of our soft tissues and the cartilages involved there. So we know that people with metabolic disregulations, so glucose metabolic issues, diabetes, prediabetes, etc, hyper-triglyceride even, high cholesterol, etc. They all have issues with their cartilage health, tendon health, muscle health, etc. So we're setting ourselves up for the development of osteoarthritis. Now, when people are told that osteoarthritis is caused by wear and tear, as we discussed the damage incurred by an MRI finding, now these people are gonna be less happy about exercising or taking that long walk. I find that the most important thing that I get to tell people in the office is you can walk or do X, Y and Z despite the pain without fear of causing harm. Until you say that, you haven't really done them justice. You might tell them that they don't need an operation, but they're still going to be worried. So the literature, the scientific research is really clear, exercise benefits and certainly doesn't worsen a case of osteoarthritis the vast majority of times. Yeah, of course. There are instances where it follows trauma, or there's an alignment issue where you had a break previously, but those are very rare cases.

Dr. Cooper:   11:05
Great, great stuff. All right. Orthopedic surgery or a scope as people refer to it. Is that an easy answer to knee issues?  

Dr. Luks:   11:13
You're just lobbing.  

Dr. Cooper:   11:15
I'm just laying him out there for you aren't I?

Dr. Luks:   11:21
This is a fun technique. So there have been so many research studies out over the last five years or so on the sham studies. And for those who don't know what a sham surgery study means is, let's say you have a meniscus tear. We'll take you, and 99 of your best friends who have the same tear will put 100 of you to sleep. 50 of you will have the actual operation with the meniscus tear is treated. 50 of you're going to get two incisions in your knee. You're gonna lay there on the operating room table for 15 minutes, but you're not gonna have anything done on the inside. You both have the same chance of getting better. The key is you both get better, which is the reason why it triggers the brain of a surgeon. The surgeon says they're getting better, this has to work. But the placebo effect is enormous. So obviously this is not the surgery that's creating this effect. It's the placebo. And we're finding out the same is true for cartilage lesions. Same is true for tennis elbow surgery. They just came out with a sham study for again bone spurs, or impingement syndrome. They've shown that surgery is not beneficial for that over a placebo. The whole question is okay, so how do we generate this placebo response? And I haven't heard a great answer to that yet. But certainly the key here is, alright let me back up. So if I have a typical patient our age, our activity and their knee hurts, it's swollen goes on for five or six weeks. You insist on an MRII? I don't want to argue with you again, you get the MRI and you have a meniscus tear. It shows a little swelling. Shows a tear, you're thinking that you need an operation. For some reason, this magical six week number has emerged in orthopedics. It's like everything's gonna get better at six weeks. It's just not true. So most meniscus tears are gonna calm down in the 3 to 4 months range, and that swelling's gonna go away. Your meniscus tear is gonna stop hurting the majority of time. Not every time. Don't send me mean messages. If you have a frozen shoulder, or a sore shoulder, a small rotator cuff tear. Same thing. It's not gonna get better in 4 to 6 weeks. That's not a magical time frame. It might take 3-4 months. It might take a year, but if you wait long enough and stick with your therapy and rehab and exercise, you'll often do just fine without us having to put anything inside your body.

Dr. Cooper:   14:08
Interesting. It's funny we joke about these being softball pitches, but you and I both know these are the questions that we get every day. People are literally asking these things, and you and I laugh, and that's why I love having you on here, because everything you write, I'm like, oh my gosh, we've got to get that out here. So here's another softball question for you. Speaking of knee pain, running is obviously bad for your knees, right?

Dr. Luks:   14:31
Yes it's terrible. No! So the incidence of osteoarthritis is lower in runners, than in a similar non running cohort. There's probably many reasons for that. As I mentioned, your metabolic health has a lot to do with the health of your cartilage. So one would imagine that a runner usually is taking better care of themselves. So they're setting themselves up for success. Two t turns out that articular cartilage, which is the cartilage that we're talking about, that coats the end of our bones tends to go like this cyclical loading that running presents. As I mentioned, there's hundreds of chemicals and proteins and compounds inside our knee, and we could take fluid out of your knee, put it into a testing device and get a list of all the chemicals there. We're gonna find some pretty bad ones. One called comp, which is, a chemical that shows the degradation level of cartilage. We'll find IL-6, which is a pro inflammatory mediator. And then we could send you running around the block for 20 minutes and take more fluid out of your knee. That comp level is now down. Your IL-6 level is now dying down. Your IL-10 which is your own anti inflammatory interleukin, have now risen up. So somehow this stimulates the production of these protective hormones, chemicals, proteins in our knee. So the vast majority of runners can continue to run and should just shut out everything that their friends are telling them about how bad running is for their knee.

Dr. Cooper:   16:30
All right, middle aged shoulder pain. What is it? And why shouldn't it necessarily involve MRIs and surgery? You touched on this a little bit before, but can you go a little bit deeper into it?

Dr. Luks:   16:40
Yeah sure? The vast majority of you who have shoulder pain, forties and beyond have more mild, annoying, occasionally sharp pain. I'm not talking about the severe cases, I'll get to those in a second. So you wake up, you know you're a side sleeper and you realize your arm aches and you have to turn, you know, twist around at night. You try to reach to the top of a cabinet to grab something, or you extend your arm out to get milk, or you reach back for your seat belt. These are all classic stories that we get. The majority of time, you have a little bit of inflammation inside the shoulder in a structure we call the bursa. It's usually not severe if your pain is not terrible. Now, as I mentioned your rotator cuff, which are the four tendons that are deep to your deltoid, they really control your shoulder motion, and you need to have a mostly intact rotator cuff for your shoulder to function well. Those rotator cuff tendons change as we age. The process of tendon aging is something we call tendonosis. So the majority of people are going to show evidence of tendonosis from their forties and beyond. Sometimes that progresses to little bit of fraying. What do I mean? So imagine your favorite pair of blue jeans. You look down at the knee one day, the fabric is getting really soft. You look there a few months later, you see some fibers are sticking up, and then you look there a few months after that, and all of a sudden you see your knee. You didn't tear your blue jeans. It just wore out and your rotator cuff is not very different. So the majority of you are going to respond to physical therapy stretching to preserve your range of motion and prevent a frozen shoulder. And you're not gonna need to pursue cross sectional imaging or an MRI.  

Dr. Luks:   18:40
On rare occasion, you do. The people who we tend to MRI are those with weakness on our examination because those people may have a large enough rotator cuff tear that we need to worry about that. However, 90 plus percent of you are not gonna fit into the classification, and you're gonna be fine if you give your therapy a chance, do it on your own. And again, 4 to 6 weeks is simply not a realistic number. The closer number is somewhere in 3 to 6 months or more. A few of you are gonna just wake up one morning, screaming in pain, really uncomfortable. Can't sleep, can't sit still. Don't know what to do it yourself. Many of you are gonna be found to have calcific tendinitis, which is a little bit of calcium with the consistency of toothpaste, seems to form within the tendon of the rotator cuff itself. We can get these in the Achilles, we can get them in some of our hip tendons, too, but the vast majority of time it's in the shoulder. Calcific tendinitis seems to hurt like nothing else. These people are just miserable. And unfortunately, many were told that they need surgery to remove the calcium, and they're more than happy to do it because they really are beside themselves uncomfortable. But oftentimes you can find a radiologist or someone who's skilled in the use of ultrasound who can wash the calcium out with a needle. And most people are gonna be fine. Another group of people are gonna have something we call parsonage Turner Syndrome. It's much more common than we think, it often follows a viral illness or syndrome, it could follow a vaccine, and it may be due to an immune reaction. But they get this intense, horrible pain around the shoulder that's followed a few weeks later by weakness, which is the hallmark. They may have some numbness and tingling in various areas, too, but they're exceedingly uncomfortable. And unfortunately, there's just no way to treat them successfully. We need to, let the disease run its course and a dozen will go away, but it can be a number of months.

Dr. Cooper:   21:02
Just before we jumped on today, you tweeted out about the PRP in Achilles study. Can you talk us through the brief nature of that? Both what is PRP for folks that aren't familiar with it? And then your second comment was most people with, you know, Achilles tendon ruptures don't need surgery. Can you just give us the high level version of that for the people that are thinking, that's just an automatic?

Dr. Luks:   21:24
Yeah, it's really astonishing. Soapy PRP. That study addressed whether, infiltrating PRP into a healing Achilles tendon tear assisted the healing, created a stronger repair or a better outcome. And it turned out it didn't. What PRP is, is platelet rich plasma. So the platelets or one of cell types that are in your blood, they assist in clotting. They have a number of chemicals and growth factors deep within them, and those can be released by activating the platelets. So we spin your blood in a centrifuge, it separates out, those platelets can be then taken off into a syringe, and we can then use that to inject anywhere we want to. We use it in places of tendinitis or tendonosis, such as tennis elbow and it's been tried in a patella tendon or jumper's knee and Achilles tendons of runners. As I mentioned in that tweet, PRP in Achilles tendons just don't get along. It doesn't work for cases of tendinitis or tendonosis or what was called a AT or achilles tendonopathy. And it obviously doesn't work in the setting of a rupture. People are going to shoot me messages and say it worked for me. Of course it did. You know, this is again versus placebo. So, you know, no one wants to think that they had a placebo response. But you do. People can get it all the time.  

Dr. Luks:   23:08
Now Achilles tendon tears. You know, the research is really clear. The majority of Achilles tendons, ruptures or tears, I don't care if it's a complete or partials don't need to be repaired. Some do, and it's very hard to determine who that person is. I think people with really large gaps and I'm not gonna give you a number can be considered for repair. I've seen Achilles tears where the edge flips on itself, so the two torn edges aren't opposed to one another. I operate on those cause I don't imagine those are going to heal, but I've seen people get back to competitive martial arts and tennis, running and jogging with tendon, you know, a gap of two centimeters, two and 1/2 centimeters, basketball players. And they do fine. What I worry about with Achilles tendon ruptures is you have very little skin on the back of your ankle. That's very thin skin. There's no fat under there. No cushion, nothing. So if you have any issues with healing or skin compromise, those surgeries go bad really fast. And as I mentioned, you end up having to have a plastic surgeon do a flap where they're gonna move skin from your thigh or your forearm. They may have to move a muscle from your thigh or forearm and bring that down and plug it into an artery behind your ankle to get coverage of a soft tissue defect that occurs around the Achilles. And in those situations, you might lose the Achilles tendon if it got infected, too. So now you know, is that common? No, I'm not trying to scare people, but it's a reality. The only surgery without risk is a surgery on somebody else. You know, if I tear my Achilles and the two ends are in the same room, you know, with one another, you're not operating on my Achilles. You know, it's been shown that an aggressive, accelerated rehabilitation of a non operatively managed to achilles tendon rupture, is equivalent to a successful repair.

Dr. Cooper:   25:50
Very good. All right, let's take a slight side turn here. But it may affect all of these answers. How does what we eat affect our joint pain?

Dr. Luks:   26:00
Yikes, you know, you're gonna light up Twitter with this. I really hate getting into the diet discussion because of what goes on on Twitter. It's really terrible, we've lost the ability to talk to one another. So this goes back to what I was talking about with your metabolism. Your metabolism matters. You're resting blood sugar matters. You're fasting insulin level matters. Your LDL level matters. I don't care what they say online, cholesterol is not good for you. I shouldn't say that, high cholesterol is not been proven to be good for you. And statins aren't killing, you know, tens of millions of people so, I don't even know where to go but in order to make sure that we are optimized for a long health span which is an active, healthy life span, then paying attention to our metabolism and what we're shoveling into our mouth matters. We you know, there's no one food group that contributed to the obesity epidemic and to our metabolic dysfunction. Carbs are not the devil. Gluten is not the devil, right? Despite what you might read online. And you know, nor am I a believer that moderation is the key. No, you know, you can't smoke moderately. You can't eat, you know, half a cupcake a day. I'm not a fan of that approach either. But what gets us in trouble is processed foods. A calorie is not a calorie. They're not the same. If I give you a diet of whole foods, 2000 calories vs. processed food, 2000 calories. You're gonna get sicker and fatter on the 2000 count calories of process food as opposed to the whole food, despite having the same macros. So the same percentage of fat carbs and protein. So something is happening inside us with this processing of our foods. You know, fructose is evil, not fruit. I'm a big fan of fruit. Don't hate me. But high fructose corn syrup and again process derivatives, of fructose are having a profound effect on us.

Dr. Cooper:   28:55
Even at the level of the joint?

Dr. Luks:   28:58
100%, so your uric acid is almost a direct reflection of your fructose intake. As well as other things, and you start getting uric acid deposition, at a uric acid level of 7 to 8. It can be lower in some instances and higher based upon other chemistry's in your blood, and you start to deposit that stuff in your joints. You're going to trigger this low grade inflammation that's going to trigger your IL-6, your comp, and also sorts of degradation processes that's gonna lead to degeneration. It's all connected. That's the whole gist and point of everything that I'm trying to present to people.

Dr. Cooper:   29:48
Very good. Very good. All right. Strength training. You are obviously a big believer in strength training, especially as we age. Can you talk us through some of the reasons behind this?

Dr. Luks:   29:58
Yeah. So your muscle mass. The presence of active muscle mass correlates with longevity. Meaning that the bigger, more active, and healthier that your muscles are the better your metabolic processes are gonna be? You have two highly metabolic tissues in your body. Aside from the brain that's your most metabolically active tissue. And one is belly fat, that's the fat that's in our gut. That's a very dangerous tissue because it creates a lot of inflammatory proteins and compounds that have very deleterious effects on your overall health and well being. The other group of tissues that we have are very active are muscles. So muscles are our largest sink for glucose. So you like carbs? That's fine. You better have some way to store them that doesn't involve fat. And certainly the fat around your organs because that's the dangerous belly fat. So the larger your muscles, the more metabolically active they are, the better you're going to manage your blood glucose levels. Your inflammatory levels and the more fit that you're gonna be metabolically. Now there's other ways to look at this too. Sarcopneia, or age related muscle loss. You can't stop this. We're genetically pre programmed to develop this, which this is the reason why we see, you know, very thin, frail limbs on a lot of our grand parents and older folks who are walking around. That's due to age related muscle loss. I see this, you know, every time I operate and do a knee replacement, and I get to see the quadriceps. Some of these muscles are nice and robust, and these are people who are healthy and active. And some of these muscles are either not present or they're just laced with fat. So if it were a steak, you might love it. But if it's your own quadriceps, you don't want it at all. Because that weakness comes at a big toll. You know, heart disease, strokes and dementia might be listed as a cause of death. And heart disease may be the number one cause of death. However if you think about it, frailty has caused a lot more deaths than any of these. And it's just not listed as the cause of death, it's not written on a death certificate.

Dr. Luks:   32:55
And the issue with frailty is this, if you lose muscle mass and you can't get up from a chair without assistance. And you're pushing yourself up. You can't get up from a seated position on the floor. Let's say you sustained an injury. You'll recover from that injury in two or three weeks. But you're gonna not return to baseline. You're gonna be a little bit weaker than you were prior to that last fall. And then you're going to fall again at some point in time and you're going to not respond back to the baseline level of fitness that you had before your more recent fall. And this just starts to snowball. And then all of a sudden, you know, you're not moving around, you're sitting more now, you need a walker now because you're not working on your balance. You're starting to trip more often. You're started to catch your toes more often and you're gonna take a fall break a hip and 30 to 50% of people who break a hip are not gonna be alive within a year. It's a big, big problem. So when I talk to people about exercise programs. There's four pillars, right? There's aerobic training to get your heart and cardio respiratory system in shape. So that's zone 2 heart rate training, right? That's getting on a bike and just spinning the pedals to get your heart rate up 120 to 140 depending on your age. That's resistance training, preferably legs. If you're doing this to look good in a mirror, you can do some upper extremity work. But if you're doing this to live longer and live healthier, you're doing legs. Then balance training. Anyone who's over 35 or 40 knows that when they first get up from a chair and they have to step to the left or right to balance themselves or they're catching their toes on a carpet or, you know, an edge more often you can see this. Your balance and your ability to balance is decreasing. You're getting on a stand up paddleboard, you know, in the middle of the ocean. I bet a lot of you can't do that. But if you train yourself, train your balance. I bet you will be able to do that. I speak from experience in this. And then high intensity interval training. You know, I think HIT work, adds just another level. I don't really push it on people. Yes, I'll do it as part of a sprinting program, one of those resistance fan bikes, wind bikes. Whatever you call them. But if I can get people to walk, work on some balance and do some little chair squats, I'm really happy.

Dr. Cooper:   36:04
Excellent. Excellent. Alright. What questions should individuals be asking their surgeon that they're likely not currently asking?

Dr. Luks:   36:13
So you know, the majority of the time you're not seeing someone because you tripped, fell and ripped something. This isn't a quadricep tendon of which all of them need surgery. The patella tendon, all of them need surgery. The majority of you are gonna wake up one day or you're in the gym and your shoulder hurts or your knee hurts. And after 2-3 weeks, which you're gonna assume is enough time, you're going to go to your doctor. Hopefully your exam is pretty benign, and hopefully you get the talk that if you can continue working out or exercising if the pain isn't severe. Two, let's give it a little while. Sometimes again, 6-8 weeks, depending on the circumstances. And if it doesn't, you can revisit the need to get an MRI. I would caution you not to walk in and insist on getting an MRI. Those are very awkward situations. And again, your MRI results could complicate the decision making here and not necessarily improve it. Because there's a good chance they're going to find something, and that's going to impact you and your ability to exercise, and desire to exercise. And it might lead to that surgeon suggesting an operation for you. Shannon Brownlee has a great book, called Overdiagnosis and Overtreatment. And we are over diagnosing and that leads to over treatment. And if you're overtreated, you're gonna run into complications that are associated with those treatments. So you don't want to be a statistic. So you're gonna ask, you know, what happens if I don't have this operated on? Could this get worse? Could it have more of an impact on me in the future? And what are the other options for treatment? What's a realistic time frame for my recovery? If you hear 4 to 6 weeks, you're probably just in the wrong office.

Dr. Cooper:   38:44
There's some advice you can take to the bank. 

Dr. Luks:   38:46
I just haven't seen anything get better in 4 to 6 weeks. But you just have to ask a lot of questions. You know, most doctors want to do the right thing, they're good people. They're skilled professionals. I see wonderful surgical skills exhibited, you know, on Twitter with some really complex things presenting. I love the discussion. And I don't necessarily fault the surgeon. I think a lot of it goes back to our training and how we train future generations. I don't think they're spending enough time in the office. I don't think they're spending enough time learning about the natural history of these disease processes. You know, if you're an orthopedic surgery resident, you're in an operating room all day and you're fixing 10 rotator cuff tears, you know, in a month you may assume that all rotator cuff tears are fixed. Right, so the educational programs are not standardized. You see severe bone on bone arthritis and now you're doing a knee replacement. So somehow in your mind, you're drawing a conclusion that if you see someone with bone on bone arthritis in your office, they need a knee replacement. I happen to know, I have a good friend who has a bone on bone arthritis, and he just ran a sub 21 minute 5k with me. So he's faster than me, which I really hate. So don't treat an X-ray, you treat the person. So you just have to understand that this is a fee for service system. And you have to, you know, be your own best advocate. Be careful what you read online. There is some great stuff online and there's some real junk online. And oftentimes it's hard to tell what's the truth and what's not. And second and third opinions are always really good ideas.

Dr. Cooper:   41:05
Excellent. Excellent. Two more questions. First one, let's turn the mirror around for a minute. What's something you're currently working on in your own health and wellness that might surprise people who know you?

Dr. Luks:   41:16
I don't think anyone would be surprised. Yeah, I've been mostly Mediterranean diet, vegetarian for years. And it annoys many friends and family members that I just can rarely drop that and go for that cake, that doughnut or that bagel. You know, I have to practice what I preach and obviously those who live in moderation see this as being extreme and perhaps a little nuts, but it is what it is. They know me. They see me out on the road. They see me on the trails. They know I'm going running. Don't mess with my running time. 

Dr. Cooper:   42:13
Ha ha, that sounds familiar.

Dr. Luks:   42:15
Right? I'm just going to go. Please don't give me an ultimatum, because I may make the wrong decision that I'll end up paying for later. I really have came around late to learning the fine points of saving for retirement, so I'm gonna work forever. I'm joking, sort of. I came around late to realizing the fine points of what it's going to take to live longer. And not only that to live a more active and healthy life, I'm really envious of these folks that I see in the office, they are 95, they're in full possession of the mental faculties. They remember the exact date that they came to see me last. What room they were in and even what kind of socks that I was wearing.Yeah, they're incredibly impressive people. And I could see muscle definition. Now, some of them are working at this, and some of them just struck it rich on the genetic clock. And someone who wasn't as genetically predestined to be, you know, centenarian. They can get awful close to those levels by watching what they eat, watching their bio markers, exercising, and doing everything that they can so that they age well.

Dr. Cooper:   44:00
So that's what you're focused on is being consistent with, hey, I'm saying these things. I'm tweeting these things. I'm blogging these things and I'm living these things. That's your biggest emphasis. 

Dr. Luks:   44:11
Yes this is not me just sitting at a computer spouting things off. There's a reason why you see these tweets come out of my home office of 4:30 in the morning. You know, because I'm up, I'm having a cup of coffee and I'm about to throw on a pair of shoes and go running. And if it's over 20 degrees, it's shorts and a T shirt because it just works. And my breakfast, I don't break the mold. Yes, you can cheat. Sure, I'm not that crazy. But this is, you know, a lifestyle that I've chosen to pursue, it's not painful whatsoever. I enjoy it. And hopefully I can be a father longer, cause this is gonna be a different world that our kids are growing up in and I just want to be there to help them muddle through it.

Dr. Cooper:   45:16
Yeah, beautiful. Beautiful. Last one. Any final words of wisdom for coaches or other folks that are out there trying to help individuals more broadly with their health and wellness that maybe I haven't teed up with the right question yet?

Dr. Luks:   45:28
Oh, boy. So you're getting into an area that's great. Sleep is just hypercritical. Far too many of us think of sleep as this passive activity that's going to come to us when we're just utterly exhausted enough from doing everything else, you know, which includes binge watching something. We have to actively pursue that magical eight hour sleep window, which admittedly, can be awfully difficult, in this always on frantically active world. But we can prevent, you know, a whole host of things, there's no known disease whose course is not altered by poor sleep. It really is astonishing. And for the health and wellness coaches, you know there's no one answer. Please don't push him into, you know, one specific diet or one specific nutritional regimen or supplement. Not one exercise, not just walking. There is a whole package. And that's sleep and it's eating right and it's exercising, which is aerobic and balance and muscle training and resistance work. And we can get there, we're not going to convince everyone. But I've seen these lightbulb moments go off and they're really wonderful moments. You know, we can change a whole family's medical history. And I'll touch on this, just give me one second. I had a great case recently where someone came back, they're in really terrible pain, very overweight, severe knee arthritis wanted to do a knee replacement. Too heavy, A1C and blood sugar far too high. So infection risk is high, failure rate is high. We had a few talks and we set some goals, helped them through their diet and dietary management. Wife was not on board and was actually quite angry at me for ignoring her husband. But he bought in, and he lost the weight. By the time he came to surgery, he was down about 80 pounds, his diabetes was really well controlled. Probably be off his diabetes meds soon. And when he came in for a post surgical visit, his wife was there. She was smiling and she looked good. She shared that she had recently lost weight because she went on the same diet. This was a whole foods, plant based diet. And then they talked about how it's helping their kids and their kids lose weight. And think about that. You're impacting a whole family. And what you don't know is the science of this gets even more intriguing. So your diet affects your DNA, right? You have, you know, thousands of genes, but only a few 100 are turned on. Your diet and lifestyle can affect which genes are turned on. That's called your epigenetics. Let's say you go and have children, and your epigenetic changes will affect your unborn children so they can benefit from your active lifestyle or suffer from your ill lifestyle.

Dr. Cooper:   49:24
We had Dr Kenneth Pelt here on with us in August, and that's his go to. So you're doing a great callback for us there because it is so fascinating. 

Dr. Luks:   49:34
It's absolutely fascinating. So you can, you know, have an effect on downstream generations that you don't even know.

Dr. Cooper:   49:41
Yeah. Yeah. Well, Doctor Luks, really appreciate it. I know you're crazy busy, and you gave us a lot of time. So thanks for diving in and answering a lot of the questions that people just, they're not getting.

Dr. Luks:   49:53
My pleasure Brad, I really had fun doing this, thanks. 

Dr. Cooper:   50:06
Now you understand why we worked so hard to have Dr Luks join us, don't you? What great insights. Important food for thought for us, our family, our friends and our clients. This is probably one of those episodes that's gonna be shared quite a bit. Thanks again to Dr Howard Luks. You can follow him on Twitter. You're gonna love following him on Twitter. It's @HJLuks or feel free to follow me @Catalyst2Thrive, catalyst 2 thrive, and I retweet quite a few of his posts. If you're planning out your year at this point, you may want to take a look at the Rocky Mountain Coaching Retreat and Symposium, which takes place in Estes Park, Colorado, on September 18th through the 20th. It's not just a great chance to learn new coaching tools, earn CEUs, connect with health coaches from around the country. It's also an opportunity to recharge your batteries to restore that joy that we have for coaching. All the details are available at under the retreat tab, and the early registration rate is still available if you're looking into it. As always, feel free to reach out any time with questions about anything coaching related. We're here for you. [email protected] Now it's your turn. Let's go get better and let's help those around us do the same. We have an opportunity each and every day to make a positive difference, and that difference begins with one step. Thanks again for joining us. This is Dr Bradford Cooper signing off, make it a great rest of your day and I'll speak with you soon on the next episode of the Catalyst Health and Wellness Coaching Podcast.