Scott Webb (Host): I'm sure we've all seen ads and infomercials promising quick fixes for our orthopedic and musculoskeletal pain and problems. But proper diagnosis and treatment, even if that means surgery by experts like my guest today is paramount to healing and getting our lives back. And I'm joined today by orthopedic surgeon, Dr. Sam Sydney, and physical therapist Dr. Sami Ahmed, and they're both with Orthopedic Associates of Central Maryland.

Hi, I'm Scott Webb and I've got a bone to fix with you. So, I want to thank you both for joining me today. We're essentially going to talk about these quick-fix orthopedics, if you will. I'm kind of putting that in air quotes, right, Sami? So, I just want to give you a chance as we get rolling here, when we think about and frame this as quick-fix orthopedics. What are your thoughts on that? All these devices, supplement, services that we're seeing in these ads and all these different places on the internet? What are your thoughts about this stuff?

Sami Ahmed: I'll say that here at the Orthopedic Associates of Central Maryland, we have noticed that there has been this uptick and this increase in the number of ads and products that are out. Some are over-the-counter some require you to go to a doc to get it, but a lot of times you just see things that are click bait, right? People go in, they want to click an item because they've got knee pain and it's supposed to make everything better. It's supposed to make your back better. These braces, electrical simulation units, et cetera. And, you know, in some cases they work. In some cases, our group, we will absolutely provide them to our patients. And we tell them like, these are the parameters that research has shown that this is going to help you get better. But usually, that's part of a smaller thing that leads to something else, right? Usually, when someone comes to us, , to our practice, whether they're coming to see us in PT or seeing our physician counterparts, what's the straw that broke the camel's back, right? There are small things that have led up to this point where someone is willing to come in to get care. And so, a lot of times, yes, there are devices out there that help, braces, ice packs, different machines that will do all these great things, but ultimately getting seen by a provider, seeing our physician staff and coming and seeing in someone in physical therapy is really the ultimate way to, one, get a real and right diagnosis rather than diagnosing yourself and, two, making sure that in the long run you're going to find long-term solutions that'll keep you better and keep you healthy for longer periods of time.

Host: Yeah. And Sami, one of the things that I noticed, because I've spoken to you before and we've done these things before, is I see these things and a lot of times they promise or they say no surgery, no physical therapy, none of these things are needed. And I always think of you, I always think, "I wonder what Sami thinks about that when they say that, you know, that some of these things will never be needed." I'm assuming your thoughts on that are that, well, they might be, and that's why you should speak to a provider, right?

Sami Ahmed: Well, absolutely. I mean, you think about it, right? If you've got a headache, you know there's a chance that, yeah, like it could just be a headache and taking something over-the-counter might help you get better from your headache, but it could be a sign of something a lot worse. And in many of those cases, you want to make sure that you're getting checked out from a provider to make sure that there's not something larger happening underneath the surface. And so, yeah, sometimes, you can get a quick fix, absolutely. But a quick fix isn't always the right fix. I mean, I wouldn't want someone to just patch a plumbing line in my house and have the whole thing flooded next time, would I?

Host: No. Yeah, you wouldn't. And, Dr. Sidney, I want to bring you in here and talk about, you know, I think there's a sense for many of us that just because we see an orthopedist, that automatically means surgery. That you're going to wheel us right into, you know, the OR, so to speak. And it doesn't necessarily mean that, right? That just because we see an orthopedist, I sort of think of it a little bit like a mechanic, right? They don't just like replace your whole engine just because the engine light is on, right? You start small and you work your way up and some folks end up needing surgery. But from your perspective here, you know, and that thought that, "Uh-oh, we're seeing an orthopedist. That's going to mean surgery," what do you think about that?

Dr. Sam Sydney: You know, I think at Orthopedic Associates, we are a group of expert surgeons. We do do a lot of surgery, but what gets lost is that we see a lot of patients that do not need surgery. And I think what Sami alluded to earlier is that you need to make a correct diagnosis. And unlike some of my colleagues who are offended when a person goes and sees some alternative care person, I don't get at all offended by that. I feel they should go with a correct diagnosis.

You know, what happens is the media is getting flooded, and trying to portray orthopedic surgeons who are experts in taking care of musculoskeletal problems as rushing to surgery. And I do want to point out that that is really not the case. Our job is to make a correct diagnosis and help that patient along that journey.

And if I could back up for just a moment, why does a patient usually seek attention or seek some sort of medical opinion? It's usually pain. That's probably by far and away the most driving and common problem, it's pain. And the second would be some compromise in their function. So of those two things, you can sometimes have a compromise in function, but not a lot of pain, but more often than not, it's associated with pain and nobody likes to live with pain, nobody certainly wants to get cut on if they can avoid it. But I think the paramount thing we'd be trying to stress is make a correct diagnosis. Once you have a correct diagnosis, then you owe it to yourself to be as informed as possible to then decide what's the best treatment choice for you.

In terms of informed decision-making, and this is an area that's fairly near and dear to my heart, when you make a decision, whether it's medical or otherwise, there really are five components you want to bear in mind. Number one, what is the diagnosis? What are the alternatives to treatment? What are the benefits? What are the risks? And what are the potential outcome? No matter what you do, I think those are the things you have to keep in mind before you go down a path of whatever treatment it is, whether it's surgical, non-surgical, whether it's bracing, whether it's nutritional supplements, whatever it is. I think you need to bear those in mind with whatever treatment you embark upon.

Host: Yeah, I think you're so right. Most of us end up with our providers, with our doctors, perhaps in your office because we're experiencing generally some sort of pain. It's affecting our quality of life. And I think what it really comes down to, doctor, is that you all are focused there really on identifying like the specific needs of patients, right? And for some of them, it may be physical therapy, it may be some sort of device, or it may be surgery, right? But it really comes down to the patient, right?

Dr. Sam Sydney: Absolutely. You know, the idea that surgeons have a one-size-fits-all mentality is very wrong. It's unfair to portray that because, you know, we deal with the whole spectrum from very young elite athletes to the has-been athletes to the weekend warriors to those retired. What do all these people have in common? They want to have good quality of life, be able to do the things they want to do when they want to do it. It's our job to figure out for that particular situation, what is the right course of treatment to allow that. And this is where, you know, Sami as a physical therapist is very, very important because a lot of times these problems can arise from deconditioning or these muscles not working in concert to allow whatever joint or body part to function correctly.

Host: Yeah. And I was mentioning all these ads and things that were sort of inundated by. And one of the things I've noticed, doctor, is about injections. A lot of these ads, you know, they call out the pain and they often say that injections don't work, don't even bother getting injections. And I was hoping, as you were saying earlier, like, you know, what we're trying to do here is educate a little bit, maybe you could educate me and the rest of the listeners about the injections, the effectiveness, what should our expectations be and so on.

Dr. Sam Sydney: So what you want to do as a consumer, you want to start with the least invasive and go down the line of what does it ultimately going to take to get to the level of function you want? So, the least invasive, and Sami alluded to this earlier, is you oftentimes start with some over-the-counter recommended medications. If you're talking about pain, it would be things like Tylenol. If there's no contraindication, using an anti-inflammatory would be something that we'd recommend. If it's something more than that, you need to think about some sort of a prescription medication. And then, you want to look at what are some of the alternatives in terms of nutritional supplements, what they call nutraceuticals, that we would recommend you get them from some sort of a reputable company. A lot of times I've noticed if I was in pain, I'm up at all hours of the night. And on late night television, you get the most unusual infomercials or ads that would lead you down a rabbit hole that, before you know it, you're trying something that during daytime hours you think, "Boy, that is pretty nuts to go down that hole." So the reason for that, folks are in pain, they're looking for a way to get out of pain. So, I'm a firm believer in starting from making a correct diagnosis with the least invasive and going down the pathway of more and more invasive, intrusive types of treatments as the case warrants.

Host: Yeah. And I was mentioning injections and just wondering just specifically your thoughts about injections and whether or not, as you're saying, there's sort of this buffet of options, right? Start with Tylenol. We work our way down through the buffet. Where do you land on injections specifically?

Dr. Sam Sydney: Well, I think injections can be very beneficial in the right circumstance. So for years, a corticosteroid or a steroid shot was a go-to treatment. We now know that with very frequent cortisone injections, actually that they can have a negative effect where it weakens tissue and can cause further joint or muscle breakdown. That's if it's done frequently. If it's infrequent, and I think of that being two to three times a year into a particular joint, it can be very beneficial. Then, we have these other joint injections that are approved, which are these so-called hyaluronic acid injections. These are things that most insurance companies would cover. It acts like a joint lubricant. If I could just digress for a moment, hyaluronic acid is a naturally-occurring substance in all of our joints. As a joint starts to deteriorate, it does not produce the right quality of hyaluronic acid. We now are able to produce in labs and many different companies come up with this product which are then injected. Does it cause arthritis to go away? No, it does not. there is no product that I'm aware of that can actually reverse the process of arthritis once it's begun. And I will stand by that because no matter what these infomercials might allude, I once again want to state there's no product that we know of that can reverse a process of arthritis once it starts.

Host: Yeah. And as somebody who suffers from osteoarthritis in most of my joints, and I've tried just about everything except surgery. But Sami, I wanted to bring you back here and talk about the sort of multidisciplinary approach that you guys have there. How you combine PT services with the other specialists, make sure that everybody's on the same page, so open lines of communication and that, you know, the care solutions for patients is really, it's a plan. It's really well thought out, well-rounded, and so on.

Sami Ahmed: I mean, you just hit the nail on the head with your question. I mean, that is exactly the product that we give at the Orthopedic Associates of Central Maryland, right? I have been working here for just about eight years with Dr. Sydney. And since day one, as a newer grad PT who's coming out fully enthusiastic, very, very ready to jump at, you know, the return to athletes and sports medicine guys, it was very, very easy to reach out to. Dr. Sidney and say, "Hey, I've got this patient. I'm in a little bit of a rut in terms of what direction I should be taking them. Can we have, you know, a conversation or two?" And over the years, we've developed this rapport where, if there is a concern about a patient that is being seen on one side of our group or the other, meaning the PT or orthopedic side, we are very quick to, within our group, message each other and have conversations to ensure that the patient has the best bout of care possible.

Actually, ironically enough that speaking of Dr. Sidney and his particular team, he works very closely with the PA, Aaron Shakespeare, who is in fact a physical therapist who went back and became a PA years later and works regularly with Dr. Sidney. And so, their team has a very, very specific PT approach to things where, you know, if there ever is an issue that's orthopedic-based and we feel that strength training or activity related with physical therapy, neuromuscular reeducation could help improve a patient's outcome, we will absolutely do that. We've come to understand that about 40% of your body is made up of muscle, right? Another 14% give or take of body weight is that of skeletal tissue, right? And so, that's more than 50% of your body has some type of musculoskeletal component to it. And you add in the neuro component, and we've got so many practitioners that we can now rely on to attack all these different sides, right? And even in-house, there have been times where I've started off with a patient who has had, you know, knee OA and we're treating it and they're progressing and getting better and they are a patient of Dr. Sydney's. And after a few sessions of treatment, we realize that there's another component. Maybe there's a low back referral component that wasn't initially established and discussed with the patient and we've got low back and pain specialist on staff where we can refer out to some of our other physicians and our other cohorts to look at and say, "Hey, could you also get an eye on this MRI or can we get further imaging done?"

And so ultimately, coming back to your question, I think that, you know, compared to other places that I've personally worked at and other places that I've seen, what makes us so unique here at the Orthopedic Associates of Central Maryland is our willingness to do everything we can to help our patients. We collaborate at a level that I've never seen before in medicine and I hope that other groups are actually starting to look at us and attempt to try to do this as well.

Host: Yeah, I love that. I love that approach. It feels like a bit like a one-stop shopping, right? That you have all the bases covered there and there's just open lines of communication and everybody's working. Together and collaborating and making sure that the plans are unique and specific to patients. You say if you have to refer out, you will, but you've got a lot covered in-house. And it's been really educational as it always is when I have you guys on. And Dr. Sidney, I just want to finish up with you today. Final thoughts and takeaways when we think about these ads and infomercials and all of that and how we don't want folks sort of diagnosing themselves, right? We want them to come and see their providers and be referred and speak to experts when they think about or try to deal with their pain, their quality of life, suffering and so on.

Dr. Sam Sydney: I think that is key, a black mark on our medical professions that we're probably not sometimes the best at managing pain without a huge hammer. We since sometimes go with very strong prescription medications. There are other ways to do it. And this is one of the unique attributes of our practice where we have a strong collegial relationship with the physical therapy members of the team, where that plays such an important part of the patients getting better. And I think that really, as Sami had mentioned, is growing, whether there's this collaborative approach to the patient between physical therapy and orthopedic surgeons and musculoskeletal specialists, and I think that will grow. And with the right diagnosis, with the right information, most patients are going to want to get better and do the right thing. It's just that there's so much noise out there that can be very confusing and very appealing that sometimes patients can get distracted.

And I would advise initially if there's a problem, have a good relationship with your primary care physician or your internal medicine doctor. Run that by him or her. Make that it is what you think it is, because a lot of times low back pain could even be a kidney stone or, in rare instance, we've even had appendicitis, which presents as low back pain. Get the correct diagnosis. Get pointed in the right direction. Once you get pointed in the right direction, understand what the diagnosis and understand what that buffet of options you have. And then hopefully, you can have a much improved quality of life and recover from these ailments that you're having.

Host: Yeah, that's well said. You know, and I've spoken with Sami before. It's great to speak with you today. So, I just want to thank you both for your time and you both stay well.

Sami Ahmed: Thank you.

Dr. Sam Sydney: Thank you very much.

Host: Meeting with an orthopedist doesn't always mean surgery. Schedule an appointment easily online today for a consultation about your pain at mdbonedocs.com. Find out more about us online at mdbonedocs.com. And please remember to share and subscribe to this podcast. And that's all for today. I'm Scott Webb. And that was a bone that's fixed.