Evo Terra (Host): This is Checkup Chat with EvergreenHealth. I'm Evo Terra. And with me is orthopedic surgeon Dr. Avi Goodman from EvergreenHealth as we continue our series on the dangers of delaying care. Thanks for joining me today, Dr. Goodman.

Avi Goodman, MD: Thank you very much for having me.

Host: So beyond the obvious conditions like a broken hand, why should people avoid delaying care for orthopedic issues?

Avi Goodman, MD: Well, that's a good question, and there's a few reasons for that. One of them is that there are some conditions which, if left unchecked, can get to be quite a bit worse, and then people could have irreparable harm. Those are things like nerve compression. So as a hand surgeon, I see a lot of folks with carpal tunnel, for example. And the longer that you leave nerves compressed, potentially the worse the nerve damage is and the harder it is to either reverse that or to fix it later. So, that's definitely one of the things that we worry about.

Host: I hadn't even thought about the nerve damage aspect. So, that makes sense. You see a lot of conditions obviously in your office from a variety of things. Which of those things or give me some examples perhaps of some conditions that you see that really could have been avoided or lessened with earlier intervention?

Avi Goodman, MD: Absolutely. So, some are the more traumatic kind of injuries, and sometimes that's obvious things. Folks who fall and break their wrists, but think, "Oh, I'm just going to shake it off. I don't know what this is. I think it's just a sprain." Or especially people who cut tendons or cut nerves. Those are things that are definitely fixable, but are so much easier and better and have a much better outcome, more importantly, if done really quickly, like in the first week or so. And they're much, much harder to do if people delay care and if they wait a month or two to come in then. So, tendon problems, nerve problems, and broken bones. That's one sort of area.

And then, another area is the area of chronic problems that just progress over time. There are some problems like arthritis, which isn't as time sensitive, but the nerve problems are certainly much more time sensitive. They're easier to deal with if done sooner, and they also have better outcomes.

Host: I'm going to return back to my first question that was about—and rephrase it in such a way as this one—what kinds of orthopedic conditions should people never delay care for?

Avi Goodman, MD: That's a very a specific and important point. Things where there's a concern for a cut tendon, a cut nerve, a broken bone, an infection, injuries like a cat bite or a dog bite are really, really important, and those can cause some serious and profound problems if left unchecked. those are the most important ones, the injuries, and then also more chronic nerve problems are the ones that I would think of as the most important.

Host: So if I've just got a shoulder that's been aching or a knee that's been popping, should I still go quickly and see someone like yourself or can I wait for a while?

Avi Goodman, MD: It depends on what it is. If it's something that is an acute injury, then it's much better to see someone sooner because it might be something that can be fixed or really addressed better. And that's not necessarily with a surgery, but that might be with physical therapy. It might be sometimes with a steroid injection or other things like that, but it's best to have it to start the treatment pathway right away as opposed to waiting months and months and months when there might be irreparable damage.

There are some certain things that are more like, oh, little aches and pains, aren't necessarily things you need to run in and see. So, not everything needs to be seen right away. But anything where there's a traumatic injury, absolutely, because again, much easier and better outcome to deal with sooner.

And then, chronic injuries that have been nagging, oftentimes those will benefit from coming in and getting treated. And some of it is also just a quality of life. Like you don't necessarily have to live with this thing, and we can help put you on the right treatment pathway, not necessarily in a surgical way, but just through braces, therapy, injections, or so many other different ways of treating it

Host: I think that's an important part. You know, many people probably assume that if they're going to have a consultation with an orthopedic surgeon, that that guy's going to cut them open. But I know that's not necessarily the truth. Do you have any idea about what percentage of conditions you see that have to be treated with surgery versus those other modalities you mentioned?

Avi Goodman, MD: it's only a small fraction of the patients who come to my office who actually end up needing a surgery. The people, however, who come in with broken wrists, there's a reasonably high chance that we could make it better with a surgery, or things like cat bites, or if they have a cut tendon or a cut nerve, almost always the recommendation is for surgery, especially if it's acute, because it's something we can make better, especially if they come in quickly.

If they come in after a month, two months, or a year, then it's something that's much, much harder to get better. And at that point, the risks may be worse than the actual benefits that they might get. So, coming in to see a surgeon certainly does not necessarily mean that you walk out having a, uh, having a surgery

Host: So what does that consultation look like? What happens when someone goes to see you?

Avi Goodman, MD: when people come to our office, we take stock of what's going on. We take a history. We see if it is something that happened acutely or if it's something that's been more nagging. Oftentimes, we'll get X-rays of the affected body part. And sometimes, we'll get several sets of X-rays.

We'll do a thorough examination. We'll take a look at the body part. We'll run you through a series of maneuvers. We'll see what seems to make the problem worse, what seems to make it better. And based on that focused examination and the history, then sometimes we'll need to get more information. We'll need to get other tests like an MRI or a CT scan. Sometimes injections will be the next course of treatment, sometimes physical therapy or hand therapy. But there are some where I say, "No, you actually really should have a surgery for this." And sometimes it's urgent and sometimes it's not urgent, but almost always we'll go through the list of here—you know, "Here's option one, here's option two, here's option three." And of course, it's always up to the patient to decide what they want to do because we want to meet the patients where they are. We're not telling them, "Here's what you have to do." We say, "Here's our recommendation, and you can either be more aggressive about this, you can be less aggressive about this, but here's a slate of options."

And sometimes I'll say, "I have a very strong recommendation. I really think that you should do either A or B." And sometimes that's, "I really think you should do no surgery." And sometimes I'd say, "I really think you should do surgery for this." If you come in and you were bitten by a cat three days ago and you've been taking antibiotics and it seems to be getting worse, then, you know, sometimes surgery is what we need to do. Or if you have a broken wrist and they put it back in place, but it's fallen back off, then surgery is sometimes what we need to do.

And so, really meeting the patients where they are and trying to give them an honest assessment of their options is a very, very important thing. And part of that too is understanding who the patient is and what their goals are and what their other medical problems are. And then, we can give them a really, I think, thorough and personalized assessment to figure out what's right for them.

Host: That's really great to hear. I know a lot of people are terrified of surgery whatsoever. And that's great that there are these less invasive treatments that are still going to offer and provide them some relief. We've covered a lot of ground here today, Doctor. Is there anything else you'd like to add?

Avi Goodman, MD: You know, It's interesting you should mention that last point because sometimes folks will come in with a fracture, and the first thing I'll say is, "Look, I don't think you need surgery for this." So then, they'll actually hear what I have to say after that becasue in their mind, they're thinking, "Oh, is he going to say I really need a surgery?" then, they just won't hear anything. So if I say, "You know, I don't think you need a surgery for this, but here's the really important treatment steps that I believe you should take," then that's a way that we can enhance our partnership and really get the patient better.

Another way that we often treat people is with different kinds of injections. Sometimes steroid injections can be really good ways of treating people, and that can reduce inflammation, and sometimes it's enough. That can be a curative treatment and that can get people all the way better. Whereas other times it's really a temporary measure, but it might work for six months or a year, and that might be what they need. And it can be a bridge to surgery, get people to retirement, get people through the beautiful time of summer, and get them into a season where they might be able to take several months off if they need to for surgery. So, we really, again, try to meet people where they are and figure out what the best time of treatment or best time and kind of treatment is for them.

And we also work with our colleagues. The nice thing about Evergreen is we have a nice integrated system where we have physical therapy, hand therapy, occupational therapy. We have our physiatry colleagues who are non-operative doctors who do lots of image-guided injections and nerve testing and other modalities like that. So, it's really nice to work in a very integrated center like ours.

Host: All of that sounds amazing, and I think will put plenty of people's minds at ease. Dr. Goodman, thanks for joining me today.

Avi Goodman, MD: Absolutely. Thank you very much for having me.

Host: And that wraps up this episode of Checkup Chat with EvergreenHealth. Please visit our website at evergreenhealth.com for more information and to get connected with one of our providers. Please remember to subscribe, rate, and review this episode as well as the other EvergreenHealth podcast episodes. For more health tips and updates, follow us on your social channels. Thanks for watching this episode of Checkup Chat with EvergreenHealth.