Joey Wahler (Host): It is aimed at enhancing patient care before and after hip and knee replacements, and also supports non-operative patients. So, we're discussing the PrescribeFit service And it's proposed partnership with Orthopedic Associates of Central Maryland Division. Our guests, Brock Leonti, he's Chief Executive Officer and founder of PrescribeFit, as well as Dr. Joseph Serino, an orthopedic surgeon specializing in hip and knee replacement.

This is A Bone to Fix from Orthopedic Associates of Central Maryland Division. Thanks for joining us. I'm Joey Wahler. Hi, gentlemen. Welcome.

Dr. Joe Serino: Thank you.

Brock Leonti: Thank you for having me.

Host: Yeah, great to have you both aboard. So, first, Brock, give us an idea in a nutshell of what your company does and the mission of PrescribeFit.

Brock Leonti: Sure thing. Thank you for having me on the podcast. I appreciate it. Anytime that we can talk about our message to the greater community is just great opportunity for more patients to take advantage of this. And more surgeons to have the support they need to help their patients in a greater way.

So, PrescribeFit was built as a virtual care platform for orthopedics. We're there to help patients drive down weight, improve pain and mobility, all in a virtual care sense. So, we're built with an app that we have built with our team in house. We designed specifically, and it all started in 2017, where I was sitting in a coffee shop and also working out in a gym, kind of planning out what was next in my life. And while I was at the gym, a provider came over and said, "Exercise is medicine. I like my patients to get healthy." And the gym owner and I knew each other and that's where we stepped off with it. So, it was that little spark of an idea that became the national program that we offer for orthopedic practices across the nation.

And we're here to bring a mobile app and a mobile experience with a hardware component, which is a body weight scale and a remote care team of care coordinators, all to the provider's practice underneath their umbrella to drive care at home. We're there to really bring a new perspective to that practice.

So instead of just looking at the joint and the back or whichever body part, the providers get to focus on that. And now, they get to follow through with their recommendation to get healthier, to lose weight, to do better, you know, activities at home with an actual program that supports the patient throughout that.

So, our mission is really to improve orthopedic outcomes by supporting the patient there with consistency and accountability. We're there to really drive that forward. It's a moment where outcomes really are impacted by activity. And by activity, I mean engagements, the things that the patients do between visits. I mean, and we'll fill in those gaps there. So, we extend care and provide that patient with the support they need to bring their doctor's plan to life.

Host: And speaking of which, Dr. Serino, the term pre-rehabilitation, we know about rehab after a procedure or after a certain type of treatment, but what's meant by pre-rehab before joint replacement surgery because it's an important part of the picture, right?

Dr. Joe Serino: Sure. And thanks for having me. It's great to be back. The term prehabilitation typically refers to a formal structured physical therapy program before joint replacement surgery. But obviously, it can include a lot more than that in practice. But in terms of the medical studies that have been done on formal prehabilitation programs, the data on it is actually fairly limited, but it does seem to have some modest benefits in terms of helping patients recover function and strength more quickly after surgery and can potentially reduce pain after surgery, especially after hip replacement. I think these studies are really limited because they only look at, you know, these structured in-person PT programs that patients do maybe a couple times a week in the weeks leading up to surgery.

And I think the important question for patients isn't "How can I get my joints stronger or moving better before surgery" but more, you know, "How I improve my overall health to get the most out of my new joint and reduce the risk of complications?" And I think that's where PrescribeFit could potentially really fill an important void, is not just focusing on the movement aspects, which are certainly important, but the bigger picture like Brock was alluding to.

Host: Yeah, I'm going to ask more about that in just a moment. But first, Dr. Serino, you talked there about pre-procedure, but on the flip side, how does weight management specifically affect the joints, particularly after a replacement surgery? And along those lines, are there any dietary recommendations you suggest when prepping for or recovering from lower extremity joint replacement surgery in particular?

Dr. Joe Serino: It's a bit of a loaded question, a lot to unpack. But in terms of weight management, it's a really important aspect of joint health, in general. I think the most important time to be thinking about that is well before even considering surgery. There's lots of different forms of weight loss. And I think an important part of it is it does need to be healthy and gradual. And there's lots of data that shows patients of any weight can still benefit from a joint replacement, but gradual safe weight loss is important to keep the muscles strong, maintain good range of motion and, in many cases, can relieve significant amounts of pain from hip or knee arthritis so that the patient may not even end up needing surgery in the first place.

But then, being at a healthy weight or losing some weight before surgery is important to reduce the risk of certain complications that can be really problematic, like infection, wound healing complications, loosening of the implants, needing another surgery. So again, the most important time to be thinking about that is fairly proactively. But then after surgery, in addition to helping patients avoid those risks, it can help them move better, get the most out of their new joint, recover faster, have less pain. So, it really is a big focus in joint health from beginning to end.

In terms of nutrition, you asked about that, nutrition is a really important area to focus on before surgery again, but that kind of continues through the perioperative period, including after surgery. Nutrition does play a big role in weight loss. But then, it's also focusing on key micro and macronutrients as well, like getting sufficient protein intake. Vitamin D, other micronutrients like zinc are important for wound healing as well. So, that's an important variable that I talk to all my patients about before surgery.

Host: Absolutely. And along those lines, Brock, how would you say PrescribeFit, in fact, helps patients manage those exercise and nutritional needs, both before and after joint surgery?

Brock Leonti: Yeah. To help support Dr. Serino being the physician, he's got a lot to be concerned about with the patients, right? The surgery is the procedure, recovery is a process and they all need support. And I think when we look at patients and they come into our solution, managing them well before surgery is the key, but that's not always the possibility.

 So when we look at the plan, it's dependent upon the time that we have. It is addressed over a longer period of time or talking about behavior change, right? And it's hard for us to even remember to sometimes pick up our keys in our wallet before we leave the house to go to the car, let alone change our behaviors that have defined us, you know, every day, sometimes culturally, spiritually, financially, or otherwise.

So, we're breaking this down looking at that-- and I know that's a big high level-- but to bring it down into a more just centered level, I think patients are motivated to do this, but they don't know how to turn that into action. And the providers certainly are providing this information to the patients and saying, "Hey, let's get you ready for surgery." But unless there's a plan and someone to help them stay adherent to it, it's hard for the patient to do that. I mean, they have to already prepare their house and get their lives ready for one of the hardest things that they're going to go through.

So, we give them a clear roadmap. We help them with giving them a scale, letting them know what they're getting into upfront. It's definitely a conversation with the patient, and it's a shared decision-making model rather than a directive model. That helps them reframe it in their mind to be a little more accepting. We use motivational interviewing to take them through this. So when we're talking about exercise and nutrition, we're asking them questions that lead them to the right answer rather than saying, "This is the answer." And instead of giving them just a strict plan to follow, we help them to find what works for them. This is not an all-or-nothing. It's not a diet, it's not a quick fix. So, there is an opportunity before surgery to say, "Okay, well, what do we need to do to really help you prepare for this from a strength standpoint and being more intentional about the intensity of our movements?" And we'll provide exercises to them that are generally directionally correct for them, and then edit those over time as they go through that and we get the feedback from them.

And then, post-surgically, we don't interfere with any other treatment pathway. So, we take into account where they are, what they're willing to do. And what steps they can take. So when you look at a patient that's thickened into therapy after surgery, great. We're not giving them those exercises yet. We're focused on better recovery, nutrition, doing consistent things that help engage a better, healthier outlook for the future. I always like to say that it's like medication, right? You take daily doses of medication. This is daily doses of good decision-making. And what that means is not going through the drive-throughs as much, cutting your portions in half or in a portion of just what you'd normally have, looking at the healthier foods rather than the unhealthier foods and balancing it in that direction, but never eliminating the things that make you happy, because it just doesn't work. Diets don't work And we need something that's consistent.

So as we prepare them for surgery and recovery from after our app helps track the progress, but it's the person on person communication and interaction week after week that helps them stay adherent to it. That's really, I think, the not-so-secret but secret sauce of our solution, is that we provide that team to the practice. So when Dr. Serino says, "Okay, you're going to go through recovery and here's what we want you to do," you know, they're not gaining weight. Like, some studies now have recently shown where patients go into surgery and they say, "Okay, when I have surgery, I'm going to come out and I'm going to lose the weight that I gained since I haven't been moving." And actually, Mayo Clinic has showed in a recent study that they've gained weight after surgery. That's why patients need this. We need to be able to say, "All right, let's take the right steps now, literally and figuratively, to get to nine months post-surgery where you're better and now you're making those happy, healthy decisions."

Host: Gotcha. And, Brock, one of the things you mentioned there was the importance of strength, getting stronger, staying stronger. And with that in mind, Dr. Serino, there's this common misconception that the hip is solely held in place by its socket, but can you clarify how strong muscles also play a vital role here?

Dr. Joe Serino: Sure. So, the hip joint is indeed a bone and socket joint, but for both replaced hips and native hips. There's actually not a whole lot about the bone or the typical implants that we use that physically holds them together. There are some important soft tissue structures like the ligaments and the joint capsule and the native hip, the labrum, that do help hold the hip together.

But the most important soft tissue structure that helps with this are the abductors, which would be the gluteus medius and minimus. And essentially, they directly pull the hip bone and the ball of the joint up into the socket, so it can glide smoothly and function properly. And so, having strong abductors, regardless of why you're having hip pain, if you've had your joint replaced, having strong hip abductors are really critical to allow the hip to function as optimally as possible. And they'll help keep your body upright and stable as you walk and stand. And by contrast, having weak abductors can lead to pain, limping and, in some cases, even dislocation of the joint. So, kind of like you alluded to, having strong muscles is really critical for hip function.

Host: And then, switching gears a little bit, I asked Brock how his product helps in this area. But for joint replacement patients, Doctor, how does OACM's strong support system impact recovery by you and yours collaborating as a team?

Dr. Joe Serino: I think the two points that Brock kind of emphasized that I think are really important I want to emphasize again are consistency and accountability, and that's really where the support system is most helpful. Like we've been talking about, surgery is a big team approach. You know, the patient is the captain of the team, I have my job to do. But the whole support system, including physical therapists, medical doctors, anesthesiologists, family members are all really critical parts of the team.

And I think the consistency aspect is important. Having a support system that checks in on you frequently-- that includes all of us, you know, me, the physical therapist, et cetera-- but having a system that checks in on you frequently to make sure that you're progressing as we would expect, identifies potential areas of weakness or issues before they become a bigger problem is important. And accountability similarly helps the patient understand their progress, make sure they're on track, and gives them motivation to push through that early recovery period.

Host: And, Doc, can you explain for us what the En Route Meal Program.

Dr. Joe Serino: Sure. So, that is another service that our group has partnered with. It's a protein supplementation service that provides protein packet powder that can be mixed to make a protein shake for the two weeks before surgery and the two weeks afterwards. I think protein is a really key nutrient for patients preparing for surgery.

It's very, very common, up to 50% of patients undergoing hip or knee replacement have some degree of protein malnutrition. And the body requires a lot of protein to heal the incision, heal their muscles and their bone. Having adequate protein can reduce the risk of infection and wound healing complications. It helps them rebuild a muscle that's probably been lagging behind over the years as they've been dealing with joint pain. And so, I always talk to patients about protein supplementation, whether that's through En Route or just through dietary modification. But the benefit of En Route is it is designed specifically for surgery and has some additional micronutrients like vitamin D that I think are helpful for the recovery process.

Host: Couple of other things before we let you both go. Brock, how can people best leverage their overall support systems here, including use of your platform, of course, during either their recovery journey after joint surgery, or as we alluded to at the top here, even if they're being treated without surgery?

Brock Leonti: I think Dr. Serino said this right in the response before, the patient is the captain. They have to be the one that says they're ready to take these steps that lead the way and ultimately self-direct at a certain point, or at least are accepting and open to it. So, it starts off by being ready to change and being ready to take the next steps, and also being open to ask, and maybe there's even a little bit of vulnerability in there too, to be able to say, "I need this support." So, when we're doing this, we're providing support as an extension of the practice to the patient through our app, through our team. But there's also the support that they need through learning. And knowledge acquisition is definitely a way to provide that support to themselves. Also, through their family and friends, I mean, checking in daily, having someone there ready to help them. My personal friend, very best friend just had knee surgery. And I spent three weeks in Tampa helping him recover from surgery down there. So, it's the little things like letting the dog out or that kind of stuff. So, those kind of things are meaningful. And then, holding you accountable too. I think there's an accountability support part of this that is certainly meaningful. The app becomes an anchor between appointments and between therapy and between the calls that we have each week with the patient. But it's the patient who really makes the decision.

And I think the final thing that I want to say about this too, and in support, is surgery is very physical, right? Especially orthopedics. I mean, you think you got to knock on a knee, you got to see it, you got to drill in there. And as crazy as that sounds, I mean, it's a very physical component to our bodies, but there's a mental aspect of this that you can't ignore. And it's not only the physical recovery, but there's the huge mental side of as well that's meaningful. So if patients feel stuck or they don't know, or they're uncertain, PrescribeFit plus the other members of the team, including the practice is there to help them. And I think those tools are definitely the way to really make someone's recovery a class A event.

Dr. Joe Serino: I think it's a really important topic and something I see with patients all the time. In terms of leveraging the support system, like Brock has been saying, I really think the most important thing is communication. Understandably, there is often a lot of anxiety surrounding surgery.

And, like Brock said, information acquisition, educating yourself and the rest of your support system, what the process is going to look like is really important. But just asking for what you need as a patient, communicating what you're worried about, what your goals are, it's really common for patients to not want to ask for help. But oftentimes, there are lots of family and friends who are more than willing to help. You just got to ask for it and communicate about it, and I think that goes a really long way in helping patients.

Host: Yeah. It comes down to patients being their own best advocate. And then, before we let you go in summary here, gentlemen, I wonder what you both think about whether this is just the start in apps, platforms like the one we're discussing here in technology in general, connecting with orthopedic practices. Brock, what say you?

Brock Leonti: During our test here, when you said you were going to ask this question, I said, "Yes, it is." We have a lot of things planned internally at PrescribeFit to expand our technology and our services alone. The other entrepreneurs out there that are thinking of different ways-- or providers, even provider entrepreneurs, whoever-- that are thinking of the different ways to solve for the issues.

I mean, patient navigation is a huge issue that we have, you know, what to do next, what seems right, what is right along that journey pathway that's not necessarily related to direct care or an outcome. But the steps that you take for insurance approvals and all those things, I mean, there's a lot there to navigate, and it's not easy.

And so, technology is definitely the key to that And the key to helping providers like Dr. Serino do the best work he can without being worried about all the other things that surround it, right? Because we want our providers to be focused on our surgery and the best in that area, and that's what they're trained for. But we have other parts of care that are part of that, and technology can be the source of truth for all of it.

Dr. Joe Serino: Yeah, I really couldn't agree more. I think we're in a really exciting time in healthcare and there's a lot of advancements being made in technology. I don't think anybody would say that we have a smooth perfectly functioning healthcare system. I think there's lots of areas that are unnecessarily complex and time-consuming and challenging for patients and providers to navigate. And the more help we can have from technology, I think absolutely the better. I'm excited for changes coming down the line.

Host: Well, folks, we trust you are now more familiar with joint replacement surgery and the PrescribeFit platform. Brock, Dr. Serino, we wish you great success with your upcoming partnership. Thanks for being with us, and we really appreciate it.

Dr. Joe Serino: Thanks so much. Appreciate everything.

Brock Leonti: Yeah. Thank you very much, Joey, Dr. Serino.

Dr. Joe Serino: It's a pleasure.

Host: Absolutely. And a reminder, folks, that Dr. Serino's Nutrition Podcast can be found on YouTube. To learn more about the PrescribeFit platform and what it can do for you, please visit prescribefit.com. The platform is covered by insurance, but patients will need a prescription from your orthopedic physician to get started there.

Now, if you're dealing with joint pain or discomfort, please visit mdbonedocs.com to schedule a consultation. I'm Joey Wahler, and thanks again for being part of A Bone to Fix from Orthopedic Associates of Central Maryland Division.