Caitlin Whyte (Host): This is the ISH Dish Podcast. I'm Caitlin Whyte, and with me is Alex Conley, a certified physician assistant from Iowa Specialty Hospitals and Clinics. Today, we're diving into the world of Orthopedics and Sports Medicine. Well, Alex, to start our show today, can you share how your experience in the operating room has influenced your approach to diagnosing and treating patients in your own practice now?

Alex Conley: My experience in the operating room, I feel like, has kind of changed the way that I work with patients kind of pre and post-op, because I'm able to see really what's going on. Coming into my role here in Orthopedic Surgery, I had worked in surgery some throughout school. But other than that, I hadn't worked in orthopedic surgery much. So, seeing how things work in the OR and how patients are treated, how, you know, in Orthopedics, how implants are placed in and just seeing the before and after the patients, it's really made me focus on how the patient's doing and feeling preoperatively, making sure that they're fully confident going into that surgery so that we can get the best outcome for them.

And then, coming out of surgery and post-op meetings with the patients, just knowing what they've gone through with a knee replacement, a hip replacement, those joints are moving more than they've moved probably in years. So, knowing that the patient's going to be sore and understanding that for them and just making it known to them that I understand that they are sore, and I'm going to do the best that I can to treat their pain, but also making sure that they can get back to moving and doing what they want to do.

Host: Absolutely. And what are some common myths about orthopedic surgeries that you often encounter, and how do you address these with your patients?

Alex Conley: I'd say that the biggest myth that I see is patients coming in and, you know, needing a joint replacement, whether it be shoulder, hip, or knee, and them thinking that they're going to be out for the count, not able to move at all for weeks on end. That may have been something that happened, you know, 30, 40 years ago. But now, with how far medicine has come and especially Anesthesiology, we're able to get patients moving that day, the day of surgery. So, that's been a really big myth, is seeing patients come in and just not necessarily being confident on soon they're going to get back to doing what they want to do. Whereas before, maybe it was a couple months out, now we're looking at six weeks for a lot of our patients, and they're happy in doing what they want to do.

Host: Now based on your experience, what are the key benefits of rehabilitation following that orthopedic surgery? And how do you ensure that patients actually stick to the rehabilitation programs?

Alex Conley: The key benefits for rehab following orthopedic surgery, a lot of it is pain management and mobility for the patient. Patients don't necessarily understand that the more that they move, the less that they're going to have pain. Their body's getting back to its state of motion. It's not allowed to get stiff and have complications that come with immobility of joints. So, that's really important. Getting them to rehab, getting them moving and grooving. And we have a lot of patients that are really happy once they're able to move.

And when it comes to staying up on them with rehab, we do followups, usually post-surgery, either one-week or two-week followups to ensure that they've started physical therapy. And if they haven't, we get on that. I usually give a call over to the rehab facility if I need to, to make sure that things get moving for our patients, because I know that it's so important, getting and regaining full range of motion of the joint that's been replaced.

Host: I'd love to also hear more about how working directly with surgeons has shaped your understanding of patient care from both that pre-op and postoperative perspective.

Alex Conley: I think, for me, working with the surgeons has just been so beneficial in the education that they're able to provide me. The surgeons that I work with have been practicing for 10 years plus, some others 20, 20 plus years. So, they've really been able to see kind of the ups and downs of surgery and how it's progressed in a positive way over that time. Having those doctors and physicians teach me what's best pre-op for patients and kind of the process that we go leading up to surgery and then, even in surgery, having them show me, "This is how we used to do the procedure." But we learned that a different method provided better relief for our patients or provided better patient outcomes. So, I think that's been really important. And then, post-op, it's been really nice to see and be taught by those providers what the best process was for the best patient outcomes and making sure that they're able to get back to what they want to do as soon as possible.

Host: And what preventative strategies do you recommend to athletes to avoid common sports-related injuries?

Alex Conley: I think the biggest preventative strategy to avoid those negative outcomes with sports is stretching. I know that it's repeated so often and coaches and trainers and parents and providers, everybody says that the stretching is important, but it really is. If the body is able to move fluidly, without any hiccups, it really helps avoid a lot of the injuries that are common. Now, there is going to be injuries that just happened due to contact sports that you can't necessarily prevent, but stretching and kind of easing into whatever sport the athlete is participating in it is key.

And then, also, post activity, staying hydrated, stretching, eating the right foods to make sure that the body can recover from whatever strenuous activity the athlete has been doing is key to continue to stay healthy and make it through a long season.

Host: And as we begin to wrap up here, Alex, can you discuss a recent breakthrough in Orthopedic Surgery that you believe will significantly improve patient outcomes in the future?

Alex Conley: I've been practicing in Orthopedic Surgery for a year and a half. So, I'm relatively new when it comes to our practice. But the biggest breakthrough that I'm seeing and what I'm reading in journals and at conferences is just treatment of pain management. There's been a lot of great breakthroughs with medications that are able to be applied and oral medications that necessarily weren't being used before that have been able to significantly decrease pain, specifically over the first 48 to 72 hours post-op. And then, oral pain medications that are able to use the first couple weeks post-op that have really increased patient outcomes. A lot for our patients to be a lot happier post-surgery and get back to moving in ways that they want to a lot sooner than before.

Host: And when treating patients with chronic orthopedic conditions, what are the most effective non-surgical options that you recommend?

Alex Conley: There's a couple options for chronic orthopedic conditions. When we're talking about those chronic conditions, a lot of it is arthritis of the shoulders, knees, hips, things of that I usually go down a treatment regimen of starting off least invasive with ice. Ice is great for treatment of inflammation that is caused by that chronic arthritis, oral anti-inflammatory medications, ibuprofen, Aleve, Advil help pretty well. We also have once daily oral anti-inflammatories like meloxicam or Celebrex, they work great for patients. They're really happy because they only have to take it once in the morning. It lasts 24 hours and they just take one every day. There are corticosteroid injections that work very well. A lot of our patients are very happy with that, and they get those quite often. We can do those once every three months or anytime after that three months to assist with decrease of inflammation.

Physical therapy is always great with, you know, regaining range of motion of those joints. Bracing can help sometimes. But if I had to choose kind of my top three would be, it would be physical therapy, corticosteroid injections, and then oral anti-inflammatory medications, then ice.

Host: Well, thank you so much for your time today, Alex. That was Alex Conley. For more information, go to ishorthopedics.com. That's ISH orthopedics.com. If you enjoyed this podcast, please share it on your social channels and check out the entire podcast library for topics of interest to you. I'm Caitlin Whyte. And this is the ISH Dish Podcast. Thanks for listening.