Doc Discussions with Dr. Jason Edwards
THIS is the podcast you have been looking for! "Doc Discussions" are just what the title says they are: physicians from a wide range of specialties, talking about relevant, up-to-date medical topics, not to mention tips on habits to help you live your best life. Your host, Jason Edwards, MD, is a board-certified radiation oncologist with a PhD in cellular and integrative physiology at St. Luke's Hospital in St. Louis, Missouri. Dr. Edwards explores not only diseases but also suggests techniques to optimize mental and physical health for a long and good life. Real people. Real advice. Real good. This is Doc Discussions, with Dr. Jason Edwards!
Doc Discussions with Dr. Jason Edwards
Innovation in Orthopedic Surgery: Insights on Joint Treatments and Injury Prevention with Dr. Richard Rames, Jr
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Dr. Richard Rames, Jr. sheds light on the importance of joint health in maintaining both physical and mental well-being, discussing preventative measures and advances in orthopedic treatment. He provides insights into effective strategies to reduce injury risks, emphasizing the role of exercise, weight management, and nutrition.
• Understanding common orthopedic injuries and their treatments
• Importance of joint health for overall quality of life
• Advances in hip and knee replacement technology
• Role of exercise and weight management in injury prevention
• Nutrition's impact on bone health and inflammation
• Addressing gender differences in joint issues
• Risks associated with popular exercise trends
• Strategies for self-care and injury avoidance
If you’re keen on enhancing your orthopedic health, we encourage you to follow Dr. Rames's advice and discuss with your primary care physician.
Orthopedic Surgeon Discusses Joint Injuries
Speaker 1Hello , this is Jason Edwards . Welcome to .
Speaker 2Doc .
Speaker 1Discussions . Today I'm going to talk to Dr Richard Ramis , an orthopedic surgeon , and we're going to talk about specific injuries that people deal with , why they have these injuries and what we can do to reverse or reduce the probability of having these injuries . Rich , how are you doing today ?
Speaker 2Doing great Jason . Thanks for having me . Good to see you .
Speaker 1I've known your father for a while and actually knew him before I knew you , and he's a fellow orthopedic surgeon as well . How's it working with your father ? He is , it's great .
Speaker 2Yeah , he has been here . I was talking to Todd here about that . He's been out here for a long time . I think he joined staff here in I want to say 92 or 93 and has obviously been here the entire time and has a great reputation here at St Luke's and uh and I have personally been coming out here pretty much my whole life .
Speaker 2I saw my pediatrician here when I was a kid and and uh , I've obviously been fond of St Luke's for a long , long time and so you know , when it came time for me to decide , you know where I was going to practice it was . You know it's kind of a no brainer for me . It's been fun practicing with my dad . It's been fun being in the office with him and kind of bouncing ideas off each other and it's made , you know , obviously the transition that can sometimes be hard into practice a little bit easier because of that kind of comfort level .
Speaker 1And obviously , you know , having him has been around St Luke's for a long time and having that great relationship with the staff and , you know , the other physicians around the hospital has made it easy to , as far as you know , being introduced to people and so that's been great , yeah , and you know how it works is patients or other doctors send you patients , and if they have good outcomes , they keep sending your patients , and so I think when you first got here a few years back , a couple of my patients actually saw you and had great outcomes , and so that's always good to know that we got . You know , typically you have very high quality doctors , but it's always good to confirm it . Now , your grandfather was a physician as well in Vandalia , is that right ? He was . Yeah , I had a patient who I think was a patient of your grandfathers a few years back , and so was he a family medicine doctor .
Speaker 2Yeah , he did family practice , so he was one of these kind of small town do it all general practitioners so he delivered babies , he was in the OR , he you know he did everything for his patients and so yeah he's . We still have a lot of patients that come over from Vandalia who still know the practice and know and then obviously my dad kind of had that little niche market for a long time and now they come over and and see me too and so it's been fun because it's always . I always enjoy that interaction in the office of patients that knew , knew my grandpa and , and it's fun to take a few minutes to talk about him .
Speaker 1Yeah , yeah for sure . And so you know you're an orthopedic surgeon . What do you spend most of your day doing in the OR ?
Speaker 2Yeah , so most of my clinical practice , especially my elective practice , is on hip and knee arthritis , hip and knee replacements , revisions of hip and knee replacements that , for whatever reason , need to be redone . That's what I did my fellowship in . I did an extra year of training doing hip and knee and so that is most of what my referrals are . I do take a lot of trauma call at the hospital and so we treat a lot of hip fractures and wrist fractures and ankle fractures , things like that , and so the majority of my practice is more of on the degenerative side of the hip and knee arthritis side . But yeah , I do to get a lot of referrals of patients who have had painful total joints that have been done previously that for one reason or the next , need to be redone .
Speaker 1And so I've always heard that if you have a hip replacement or a knee replacement , you have something like 15 years or so and then it needs to be redone . Is that accurate or what's the deal with that ?
Speaker 2Yeah , that's a good question .
Speaker 2Patients , we talk about that a lot and that is a little bit not of a not a misconception now , because that is how it used to be , but we are still , I mean , not in its infancy , but hip and knee replacement didn't become , you know , very widespread utilized until , I don't know , the 70s or 80s .
Speaker 2And then the question was always what's the youngest person you would do this in , because the plastic liners usually was the limiting factor , and so they would wear out , and so most people would say you don't want to do a joint replacement if you're expected to live more than 10 or 15 years , because you have to have it revised . Now , about the year 2000 , 2001 , 2002 , they developed what's called highly cross-linked polyethylene . So it's just a better way to engineer the plastic that we rely on for the replacements , and we are seeing , you know , kind of awesome results from this new polyethylene , and so it's just not wearing like it used to , and so that kind of gives us the ability to treat a younger and younger patient population who , for one reason or the next , get arthritis at a younger age , and whereas in the past we would kind of say you know , you're probably too young , you kind of just have to live with it and try different pain . You know treatments and medications and injections .
Speaker 1But now we're seeing younger and younger patients who are doing very well with joint replacements and younger patients who are doing very well with joint replacements , the when I , you know , think about health overall , a lot of times I'm thinking about length of life and you know , as far as how do I reduce a risk of heart attack or a stroke or things like that . But you know , and I think there's probably a link between your joint health and your length of life too , because if you can't move you're like less mobile and but to me , you know , this kind of stuff is really a huge quality of life issue , and I've had patients who them or their spouse have had , you know , significant knee issues or hip issues which have really just limited their ability to kind of live their full life , and it's kind of stolen their freedom from them , and so to me it seems like just a real detriment to your quality of life .
Speaker 2Yeah , absolutely , I mean it's . It is quality of life , no question . And it's also and there have been studies that looked into this as far as being , you know , a productive member of the workforce and of society , because a lot of these things will affect , you know , laborers where it's they literally cannot do their jobs because of their either hip or knee or their arthritis or the pain that they're in , and so being able to restore that function and allow these people to function pain-free kind of gets them back into , you know , the workforce and back into contributing . And I think that , yeah , it's a quality of life thing . And then it also affects people's mental health . I mean , it's just such a big thing to be able to exercise and be able to , you know , be without pain , and it affects all aspects of your life , not only kind of your physical ability to exercise and maintain a healthy lifestyle , but also kind of your mental health of being able to do the things that you want to do that are kind of these stress relievers for patients .
Speaker 1For sure , and , like you said , having a job gives you purpose in life , you feel like you matter , and all that is really going to have a huge impact on your mental health . Now , I'm sure there's data out there , too that shows that you know , at a certain age , if you have a fracture , that it can limit the length of your life as well .
Speaker 2Yeah , and I have that discussion with families of patients who come in with either hip fractures , and that's most of the data that we have is on the hip fracture population . And you know , we know that , based on the Medicare data , that those which is obviously patients over the age of 65 , that about 30% of those patients , you know there's a one-year mortality of about 30% and it's a really important number . And you know , we know that it's not a lot of times it's not because of the hip fracture itself , it's the stuff that comes along with it , it's the medical , you know , comorbidities and issues that come along with the hip fracture . And a lot of times it kind of signals kind of a loss of independence . And you know , a lot of times these patients end up .
Speaker 2You know they either , you know , need help after the hip fracture , they need to go into kind of more of an assisted living or memory care type facility . And so you know I'm very honest with families when this happens is that , you know , because it can be a signal of okay , things need to change as far as you know , lifestyle and home situation and that sort of thing . And unfortunately I feel like , at least in our society , it becomes , a people aren't as proactive about it as far as kind of getting out in front of these things , and it's usually to the point where something like a hip fracture or some sort of fracture happens and then it necessitates kind of a different level of care . And so it is an important discussion for those patients , no question .
Preventing Hip Fractures Through Exercise
Speaker 1And when you say hip fracture , is that like the top of the femur , like a femoral neck fracture ? Is that typically where the lesion's at ?
Speaker 2Yeah , exactly , so usually we'll see them and that's kind of one of the most common things we treat here at St Luke's .
Speaker 2As far as our fracture population is either , when I talk to patients about it I kind of categorize them into two different types of hip fractures either intracapsular , which is like your femoral neck fracture , or extracapsular , where it's outside of the hip joint and that kind of determines whether or not you have to just replace it or you can fix it .
Speaker 2And by fixing it we usually use what's called an intramedullary nail and align the fracture fragments and they will reliably heal . But when they're inside the capsule , that's when we talk about just replacing them , because they generally do better . That way You're not relying on the fracture healing and it allows the patients to kind of get up and moving , which is honestly the biggest thing as far as treating especially geriatric population is . You want to be able to get them out of bed , get them moving , get them back walking , to prevent the medical complications that can come with it , Like you know , pneumonia and blood clots and bed sores and these sorts of things that we worry about within that population blood clots and bed sores and these sorts of things that we worry about within that population , and over the years to me that seems like that's been one thing .
Speaker 1That's really changed a lot is after the surgery . The impetus to actually have them moving , like walking either day of surgery or day after surgery , and the dependence on physical therapy seems to only have kind of become more important over the years .
Speaker 2Yeah , and I think that's one of the things that you know people ask , okay , what's changed with what you guys are doing in the last 10 or 15 years ?
Speaker 2And most of the time it's not necessarily the surgeries themselves , the technical aspects of things , sometimes it's the implants a little bit . But I think the biggest thing is just our you know focus on rapid recovery protocols thing is just our uh , you know focus on rapid recovery protocols and we've kind of learned the importance of , okay , same day therapy , get you up and out of bed and start to get moving . Because we recognize how there's a little bit of a you know time crunch as far as , uh , people do better when they're out of bed as quickly as you can . And so you know , when these fractures come in , there they are , we do treat them kind of as an urgent , urgent thing . We try to get to them as quickly as we can . You know , and there's been studies that have shown if you do these fractures within 24 , 48 hours , they do a whole lot better , less medical complications than waiting . And so we stress the importance of getting kind of early surgery to be able to get these patients out of bed , and generally they do better that way .
Speaker 1Um , the um . So if somebody is trying to stay out of this situation where they're having a hip fracture and they're trying to not be one of your patients , what are , what are some general things that people can do to reduce their likelihood of a hip fracture or a rotator cuff tear or something like that ?
Speaker 2Yeah . So hip fracture avoidance and kind of you know , preventative measures of what we call fragility fractures , so not just at the hip but at shoulder , wrist , lumbar spine , compression fractures , those sorts of things . We kind of stress the importance of number one making sure you're following up with your primary care physician about your bone health . So regular screenings as far as DEXA scans , your bone mineral density , that sort of thing , getting those done and because there are medications you can be on to help with that and it's , you know it's something that unfortunately there is . You know we have a shortage of endocrinologists that treat these and so a lot of times it does , the impetus does fall on the primary care physicians and sometimes us as orthopedists .
Speaker 2We try to do what we can as far as getting people started with things like calcium , vitamin D , other dietary supplements that may help with bone health . So that's one of the main things . And secondarily it's simple things like at home , getting rid of things that might be loose on the floor , getting people either assistive devices , either walkers or canes , or something that may help with their balance . Therapy can be a big thing as far as maintaining your strength in your lower extremities and certain exercises that you can work on for balance . All those things are important and there's been kind of a new found stress in the orthopedic world as far as bone health and there's a program called Own the Bone which is kind of driven by our overarching board as far as doing what we can to get these people who have either you're seeing them for a hip fracture , to get them in with somebody to prevent future injuries with , you know , smaller , lower energy mechanisms to prevent future injuries with , you know , smaller , lower energy mechanisms .
Speaker 1So the you know . One thing I'm a big fan of is doing squats . If you , you know , if you can do it with weight better . Just it's kind of the king of all exercises , they say . And , but plenty of patients I encourage to do squats just up and out of their chair and but with the weight and the gravity that can cause the bones to be a lot stronger and a lot more dense . Before I was a physician , I was a researcher and the lab across the hall from me had grants from NASA because the astronauts without gravity develop osteoporosis and osteopenia , which makes the bones weaker , and so I kind of had . Then you eat lunch with these people and you hear about it a lot . But weight training is that a ? Is that ?
Speaker 2a big deal , yeah , very important .
Speaker 2And you know , and that's and I kind of have similar conversations with my arthritis population too as far as the importance of low impact exercising in some level of strength training too , because you know , like you said , as soon as you stop walking , you stop , you know , going to the gym , you stop exercising .
Speaker 2Then all of a sudden , not only do your you know you lose some of that bone health , your bones , you know , lose some of their strength to it , but also your , you know , you get muscle weakness , you start to get deconditioned and all these things kind of tend to spiral . And then you get medical issues with being more sedentary . And so I try to talk to everybody about the importance of low impact exercising for both your cardiovascular health as well as the health of your joints , and so we try to . I talk to patients about walking , stationary bike , elliptical swimming , rowing machine , and then , like you said , some form of exercise , strength training with squats and , and you know , quad sets and different things you can do with your legs as far as keeping and maintaining your strength as you get older and so if you build up the muscle , it's protective to some degree .
Speaker 1Is that how it works ?
Speaker 2Yeah , exactly , we think that it can strengthen the joint . It also helps keep you flexible , keep the mobility in the joints . We know that as patients get arthritis , things tend to stiffen up .
Speaker 1Yeah .
Speaker 2And then once things stiffen up , it's just hard to get that back , and so it's kind of important to maintain your joint flexibility maintain , you know , your joint flexibility .
Speaker 1Yeah , you know that's . I mean , one of the things I really like about doing squats is if you know the weights on your back and it it pushes you down , so you actually gain flexibility if you go deep . Now some people will argue you know how , should you go past parallel or not ? But if you go past parallel you get a great stretch on the hamstrings and usually I think that's the issue with most people because they sit in chairs all day and their hamstrings begin to shorten over the years . And so and I've talked before in the podcast about doing it like a 10 or 15 minute stretching routine before I go to bed , and I think it's just one of those things that keeps you young yeah , and the , the age at which you know they do the average knee replacement has gone down over the years , and that's kind of not surprising because I think just the , the weight of the average , you know , human in our society has gone up , and so it's , if you know , you know the weight times , the's , it's going to cause the deterioration of the joint faster , yeah , and so have you noticed , you know , younger people getting these surgeries .
Speaker 2Yeah , no question , I think it's a . It's a younger , it's a younger patient population . I think that's kind of multifactorial . I mean , not only are we seeing and there's a lot of orthopedic , you know , literature out there as far as projections of joint replacements by the year 2030 and beyond , and it's kind of it's almost like a logarithmic graph . I mean it's going like straight up because it's a combination of things .
Speaker 2I think obviously we have an aging population , the patients are generally getting older , and then it's also , like we talked about earlier , that we've , you know , the . The implants are better and so we are more apt and more ready to help a patient earlier on in their life because we're not as worried about having to revise them again down the road because the implants are a little better . And so I think with that we are not . I don't think it's necessarily . It's probably a combination of things . I think in the past , if you were young and had arthritis , a lot of times they would say you know , you're , you're just a little too young , we can't do this yet , Whereas now we're a little more ready to do that operation .
Speaker 2And secondarily , obviously , you know our society as a whole , unfortunately , is getting bigger .
Speaker 2I mean obesity thing is a is a real um problem , and so with that you're putting a lot more force and pressure on your joints and we know that that can lead to progressive arthritis and it can get worse quicker because of the obesity factor .
Speaker 2And so that's another thing that I talk to patients about as far as preventative measures is keeping your weight at a manageable level . You know there's six pounds of force for every one pound of body weight that you have off across your hip and your knee , and so you know , when I have this conversation with patients that are either you know there are some patients that just are not good candidates for hip or knee replacement because of their BMI , their body mass index , and you know we talked to them about it and the importance of weight loss to get him back into a lower risk profile around surgery . Then I have some patients that lose 10 or 15 pounds that come back and see me and they say well , you know what I actually feel . Okay , now my pain's better . I think I'm just going to put this off . That's great . Those are honestly some of the best conversations you can have is because you kind of help these patients get to a healthier situation , then they get in a routine and then that carries forward to the other parts of their life .
Speaker 1You know I talked earlier about seeing patients who actually it's one patient in particular whose spouse had significant joint disease and it really limited his life as far as what he could do , and so it scared me and so I started this is a few years back but I started reading about , like well , what causes the damage , and it was . It was mainly like trauma , you know , due to , you know you know , pressure on the joint and then blood flow was the other issue and and that's kind of the issue with with obesity is you have not only the weight but there's probably some thickening of the arterioles that feed the joint and so you kind of get damage on both sides and that . But then you know , losing weight and eating better , you can reverse , you know , narrowing of the arteries and certainly reverse your , you know , your weight , you know decrease your weight .
Speaker 2Yeah , no question . I mean , I think it's yeah , there's probably so many factors of it that we're still kind of learning about too , and there's a big push now as far as and a lot of patients ask about this as far as what can you eat or how can you change and modify your diet or what you're doing to help prevent , kind of , some of the inflammatory conditions that we have . And certainly , you know , there is definitely something to that and I usually will kind of refer patients to dieticians because I , you know , I tell them honestly , like I'm not the best person to talk to about that it's obviously , you know , trying to limit what you're doing as far as processed foods and , you know , sugars and high fructose corn syrup all that stuff certainly can decrease inflammation throughout the body , but that is a part of it that is becoming more and more kind of commonplace and looked at more . So there is certainly something to that with joint inflammation and what you're eating .
Speaker 1Yeah , there's a book called Body on Fire that kind of just talks about overall inflammation and certainly you know that can play into the joints too . And then the last thing I wanted to talk to you about is it looks like there's more female patients than male patients . Does that have to do with the angle of the hip or at the knee , or do you notice that in your patient population there's more females than male ? I have 58% of orthopedic patients are female .
Speaker 2Yeah , that's interesting . I think that's there's probably something to that . I mean , in my practice I guess I don't . I could look back and see what my percentages are , but some of it may be that just the you know , their lower extremity alignment . A lot of times women are in more of what's called valgus with their lower extremities , so their hips are generally out a little wider and then it kind of comes into almost a knock knee type alignment at their knees and we know that that can lead to some abnormal mechanics in the . We know that that can lead to some abnormal mechanics in the lower extremities and that can lead to some earlier arthritis . We certainly know in our in our young population .
Speaker 2As far as you know , sports related injuries , acl injuries , are more common in female athletes and uh ,
Injury Prevention in Sports Activities
Speaker 2and we think there is something to that as far as lower extremity alignment may put them at a higher risk of having something like an ACL rupture . And now , yeah , there's even more training that's going on as far as you know , how to properly land Like if a lot of time we'll see in volleyball players . Acl injuries generally are kind of non-contact injuries and so there's more and more training that goes into injury prevention . And some of that is , you know , knowing what to strengthen as far as the lower extremities , how to land properly so you're not stressing the ligaments of your knees . But yeah , I think there's some to that .
Speaker 1Yeah , I think it's . You know , a really important thing to do in sports in general is to kind of follow what they call a linear progression , and that is like you slowly increase the volume of you know stress that you're putting your body under , whether you're lifting weights or running or whatever . It is people you know it's , it's the , it's the , it's the old athlete who you know thinks they still got it , who kind of jumped back into it and their body's just not ready to handle the load . And I'm sure you've seen , you know , plenty of that .
Speaker 2Yeah , it's the at the old , the weekend warriors that , uh , either you know , haven't done it for a while and try to go zero to 60 , and or the , you know the middle-aged person that thinks they can get into CrossFit at a , uh , at a very you know age . That maybe won't , you know not , uh , your body's just not accustomed to moving like that anymore and , and yeah , we'll see plenty of injuries related to CrossFit . Or , you know , pickleball is becoming a huge thing .
Speaker 2And you know people joke that pickleball was invented by an orthopedist because of some of the injuries that we see from it now .
Speaker 1I shouldn't laugh . It's just comical to think of pickleball cause it , but it makes sense .
Speaker 2I mean you know it's a lot of lateral movements and , like you said , I mean it's a lot of times people will get into it because their friends play and they want to play and they haven't done anything like that those kind of quick lateral movements in a very long time and then they try to get into it and either have an injury or they'll come in and have , you know , either arthritis or some condition that they want to get taken care of so they can get back to playing pickleball and and and so , yeah , that is there's now . There's articles about it in our , you know , our journal of our Academy of orthopedic surgeons about pickleball injuries and , just because they are becoming so common , about what's common , how can you counsel patients about how to avoid them and treatment options , and so ?
Speaker 1yeah it's .
Speaker 2It's definitely becoming more and more common .
Speaker 1Yeah , and , and you know , I think I'm definitely pro pickleball . It's a good social thing , but you just got to ease into it and and , and you know , maybe don't trust yourself fully until you , you know , have spent some time doing it . Yeah , okay , now I'm going to . I'm going to round out with this one , maybe a little controversial , but what are your thoughts on CrossFit ? Do you have any thoughts on it ?
Speaker 1My personal thought is it's pretty herky-jerky . I mean , I do powerlifting , which is just squat , bench and deadlift , and power is a misnomer because scientifically , power is like moving a force over time . Everything's slow in powerlifting . You don't speed squat , you don't doing cleans and clean and jerk and snatches . That's like you know . Olympic weightlifting is power , where you do it quickly , but powerlifting is slow . So there's no herky jerky and so to me , I think it's a lot safer flipping around on these bars and stuff like this . I think there's a lot of good benefits from it , but it seems risky to me when you're older benefits from it , but it seems risky to me when you're older .
Speaker 2Yeah , no question , I mean I , you know , I don't , I personally I've never , I've never gotten into CrossFit , um , but I agree with you watching , um , some of these people do it . There are certain things that , as an orthopedist , you and it's whatever you know I'm sure there are things like this for you too , where you , as an orthopedist , you look at it and you cringe a little bit because you're just , the body wasn't necessarily made to do things like that , especially at an older age . I mean , there are certain things , not CrossFit , but other things that make orthopedists a little bit cringeworthy , and that's pediatric stuff like trampolines , monkey bars , older motorcycles , older motorcycles , like these kind of things we look at and are just kind of worried because we're almost traumatized by what we see coming through training .
Speaker 1Yeah .
Speaker 2Either you know , injuries in the pediatric population or in adults , big motorcycle wrecks , things like this that we all kind of look at and we get a little worried about , but CrossFit's one of those .
Speaker 1in an older population , where it's just the body is not necessarily meant to do those things . Yeah , certainly there are some people who've done this for years , over years and their body is well-tuned for it . But to run and jump out and start , I mean to me like as an adult , like swinging from bars , I just personally I worry about my rotator cuff , Like I just I don't think it's strong enough for my weight . It's a risky proposition For me personally , not worth it .
Speaker 2But yeah , I'm with you on that . I kind of I gave up , uh I stopped playing basketball too , cause I was just worried about uh you know I don't love it enough to uh risk , uh you know , an Achilles or an ACL injury or something .
Speaker 1That's a career . I ran track in college and if you had an Achilles injury , that was it . I mean you could recover . You could do the whole thing for a year and seeing patients in the office .
Speaker 2And it's just , you know it is a risk
Balancing Risk With Mental Health
Speaker 2benefit thing . It's like are you going to put your body at risk ? You know to do this , that you know whether or not . But there are people that you know I see patients that say , look , this is what , this is my thing , I love it and if it's and , I need to keep doing it for my mental health . And then we kind of have a discussion and say that you know , that's fine , I'll try to get you to a place where you can do that . But I can't , you know , promise that at this age that this is , you know you're going to be able to keep doing this forever .
Speaker 1Yeah , 100% . If people understand the risks and they do their own analysis , I mean , they know how to solve that equation better than I do and I'm with you . You know some people will say , like run and I'll tell them it's going to make your skin reaction worse . But for most people running is really good for your mental health and when you're going through something difficult it's probably worth a little bit more redness of skin for the mental health benefits . So , yeah , people understand the risks . You know there are certainly a lot of secondary benefits to exercising .
Speaker 2Oh yeah , no question .
Speaker 1Well , rich , thanks for everything man I appreciate you .