Maggie McKay (Host): When your knees are out of order, so is your mobility. So if you ever had one or both knees out of commission, you know how restrictive and painful it can be. So today we'll talk about tears and repairs and the basics of knee stability with my guest, Dr. Bo Naysmith Loy, Orthopedic surgeon at Northern Inyo Healthcare District. I'm Maggie McKay. Welcome to Mountain Medicine, the official podcast of Northern Inyo Healthcare District. Thank you for being here today, Dr. Loy. Let's get right to it. When it comes to knee pain, what are some symptoms?

Dr Bo Nasmyth Loy: Hey Megan. Thanks for having me. So, yeah, people generally know what's going on with their knees and it's one of those things if you have this like pivoting, twisting motion where you plant your knee and you hear a pop, your knee gets swollen, doesn't feel like your knee is working right. that's one of the most common things that I see and that's kind of my specialty, is where you are younger. And younger is less than 60, basically is when you're not in the arthroplasty knee replacement range and you twist pop your knee and it's not working right.

The symptoms are relatively intuitive. My knee felt better yesterday, I was skiing, I heard a pop. It doesn't work well today. It's swollen, it doesn't feel right, all that kind of stuff. And it can always be vague, especially in the acute phase. People can't always tell you like, oh, I, tore the femoral attachment of my ACL yesterday. No, they're not gonna come in and say that. But in time when their symptoms start to calm down, you get a good exam and you get the proper imaging and you start to piece things together. But I always tell people, trust your gut. If your knee doesn't feel right, that's time to get checked out.

Maggie McKay (Host): And what are the main causes and risks of knee pain that you see?

Dr Bo Nasmyth Loy: So where I practice in sports medicine and it's not always a sports injury, people go, oh, well I just injured my knee hiking yesterday. that's not a sporting event. I wasn't playing soccer. But, you know, we don't have an NFL team out here, so I'm not covering an NFL team. But if you're being active and you twist and plant your knee and it doesn't feel right afterwards and you hear a pop and a click and your knee becomes swollen and it looks like the size of a grapefruit. Those are all kind of things and reasons to be checked out. So the most common stuff is just what's most common around me and around us.

So for us, it's hiking, it's skiing, it's backpacking, it's ranching, it's working the cattle, and it's people just planting their knee, twisting it, tearing. Meniscus, hurting their acl, damaging their cartilage. It's all kind of one and the same. So it's whatever sport and activities that people do the most, or athletic endeavors is what I see the most. And out here it's all those aforementioned activities.

Maggie McKay (Host): So let's say you need to go see a doctor, but you can't get an appointment right away and there's no ER close to you. Maybe. How do you relieve the pain in between? Heat, ice, pain relievers?

Dr Bo Nasmyth Loy: So generally speaking in the acute phase, the whole rice thing, so r i c e, rest, ice, compression elevation, so, rest the knee, right? If you injured it hiking, try to get back to the car safely and I wouldn't go back out the next day if your knee hurts a ton. So ice it, help with the swelling. Use a compressive wrap and ace bandage or whatever you've got at home to put a little bit of pressure on it so there's less volume in the knee for less of an effusion, less swelling.

And then if you can elevate it, you've gotta get things that you want to decrease the swelling above your heart so they can all drain back to your heart. So you wanna rest, ice, compress and elevate. And then if you've got ibuprofen and Tylenol out home and you know they're safe for you, start using those and alternate intermittently. And then, usually you can get an appointment pretty quickly.

Maggie McKay (Host): Dr. Loy, when it comes to sports medicine, when you're talking about knee injuries, does it always have to result in surgery?

Dr Bo Nasmyth Loy: Oh, no, I would say a small portion of my patients need surgery and this is my thought process, is even if you did need surgery and it's an injury that can wait a few weeks, you really aren't burning bridges for injuries that can wait to wait. Because if you start getting better and you recover to your level of satisfaction, then who am I to tell you that? Just because I see something torn on MRI that you need surgery. No, that's counter to my philosophy. I don't treat MRIs and x-rays. I treat patients. so I would always say if someone wants to try to avoid surgery, that is right in line with my tactics is let's try to avoid it.

But if I think I can make you a lot better, I'll tell you. And if you want to move forward with it, let's do it. And there's some injuries that almost always need surgery, but that's okay too. We just go down the process. I just tell them everything I know, as best I can and let my patients decide.

Maggie McKay (Host): Not that patients are gonna give up on the sports they love, but is there a sport or two that, you see most often come in like, you know, skiing injuries, I don't know, ice skating, running?

Dr Bo Nasmyth Loy: Yeah, so skiing and knee injuries. Go hand in hand. And then I know we're talking about arthroscopy and knee injuries, but then rock climbing and bouldering and ankle injuries and the bouldering in particular with no protection, people always say, oh, I never fall, but they only fall once every few years and it's just these falls from five to 10 feet that are not. Significant trauma to the human body, but enough to break an ankle type thing. So, skiing number one, probably just normal hiking because the total volume of hikers and the amount of miles people put on. Hiking's not dangerous. I would never warn anybody against any of these activities. I do them all, they're fantastic. But because so many people are hiking so many miles that I see some knee injuries.

Maggie McKay (Host): Well, I guess I'm in denial. I never thought of rock climbing, because that's what my son does.

Dr Bo Nasmyth Loy: Ah, it's fantastic.

Maggie McKay (Host): It is, he's heavy into it, but you're right about the injuries. Like the other day, I saw him and his arms all messed up and I'm like, what happened? He's like, rock climbing. I'm like, of course.

Dr Bo Nasmyth Loy: He'll go right back out the next day, right?

Maggie McKay (Host): Absolutely. So for people who don't know, where are you located?

Dr Bo Nasmyth Loy: So we're in Bishop California and Bishop is up to 395. Between the Sierras and the White Mountains, near Big Pine and Mammoth.

Maggie McKay (Host): Beautiful. What does it mean when a knee just gives out? Once I had that happen to me, I was walking across a busy intersection and I just fell to the ground. My knee just gave out. What's up with that?

Dr Bo Nasmyth Loy: Well, I'm sorry to hear that, so it can be two things. So yours might be, the other, so if your knee gives out and you're, adding. Your weight to it or it's a trauma like you are running and it twists and you fall and it gives out. That can be an injury often to one of the four main ligaments of the knee that ACL, PCL, MCL, and LCL. You can kind of think of two ligaments inside the knee that crossed at the cruciates, and then two ligaments on the outside of the knee kind of struts. And if one of those breaks, then you've lost one of your four main ligaments in the knee. And it can be unstable and your knee will give out. And that's where I would say, don't go back to your sporting activities.

You need to get checked out. You need to protect that knee yours. If you're just walking and it gives out and you didn't feel like you had a trauma, you didn't slip on ice or like that, that's probably a quad inhibition type thing where your knee felt something, funny click and your body thinks, I don't want to injure my knee anymore. I'm gonna just stop walking on it. And you don't have time to think about this as more of a reflex. So your quad just stops firing for a second and just goes limp, and then your knee feels like it gives out and you kind of buckle and take that like stutter step.

But then your next step is normal and your quad's working and you kind of think, what the heck was that? So that actually happens a lot of. After people injure themselves where they have an effusion on their knee or after surgery, their quads aren't quite ready to wake up fully, and they get these little, inhibitions where the quad gives out for just a moment. And it's part of a recovery process, but if it happens while you're just crossing the street, it's probably something like that, like a quad inhibition.

Maggie McKay (Host): How do you treat knee injury in surgery?

Dr Bo Nasmyth Loy: So it just depends. So if we're talking about a knee injury and someone tore the meniscus, then the meniscus are these two cushions medial and lateral meniscus that are between your femur and your tibia. And they kind of take a round femur and they made it to a flat tibia. So they make it a deeper socket. And I tell people that if you think about a golf tea, and if you put that tea in the ground slightly uneven, the golf ball will roll off. But if you can imagine putting a little silicone soft bumper to it, then that golf ball would sit deeper in it. It'd be a little more congruent and a little more, structurally sound.

That's what the meniscus does. It kind of creates this cushion and this buffer between the femur and the tibia. And if you tear it, there's all sorts of ways to go about it. Sometimes if it's torn in a direction and in a location that you can fix it, then you can use su. A lot of times I'll use sutures just, it's called all inside. So you still use the same two poke holes for knee arthroscopy, just poke holes the size of a BIC pen, and then you can put sutures in through that and fix it. You can open up the knee with a smaller incision and do sutures from the inside out or outside in. And sometimes if it's a really small tear, and it's not where tissue's repairable.

You do what's called a partial mastectomy. That's just a fancy way of saying you cut out part of the disease meniscus. So there's lots of ways to take care of the knee and I just highlighted the meniscus there. But a lot of which can all be done arthroscopically, which is my specialty.

Maggie McKay (Host): Again, when you're younger, you don't really think about taking care of your knees for the future probably. But Are there any exercises or ways we can be kinder to our knees for the long run?

Dr Bo Nasmyth Loy: Yeah. You know, avoiding direct trauma. So if jumping off of roofs onto cement is like your, for. I would say careful. That's probably gonna wear out your knees but any iteration of that, you can just imagine the more trauma the cartilage sees, the cartilage is a real mechanical structure and how much insult can cartilage take? And it's not quite the right analogy, but if you think of cartilage as being the tread on your tire, Well, hopefully you bought good name brand tires that have like 50,000 mile guarantee. But if your treads wear out, then you just replace your tires in your car.

Well, if your tread wears out in your knee, oh, you really wanna go through surgery and have to replace it. It's very common. We do it all the time. But trying to preserve that, it's tricky. I would never tell someone don't do any activities. Cause that's probably worse for the cartilage. It needs to see some stress, but too much stress, too much trauma is probably a bad thing. So you can think about it yourself, which sports put a lot of stress on the knees, and some of them happen to be my favorite sports, and I'm probably still gonna do them, but, Swimming, cycling, fantastic for the knees. Hiking's good. Running's not bad for the knees.

Running's good for the knees if you do it right and you're not overexerting yourself. But it's the traumas that I think matter more. It's the injuries, it's the falling, it's the hurting yourself that adds the trauma. So, When your cartilage sees a major insult, it probably carries that with it, the rest of its life.

Maggie McKay (Host): And not with just knees, but in general before you work out, after you work out, some people believe stretching is pretty crucial. What do you think about that? And would you do it before or after, or both?

Dr Bo Nasmyth Loy: Yeah. So yes, yes and yes. More stretching is good. So, If you think about the things you can control in your body, you can really control your muscles and your tendons. And if your muscles and tendons are tight and you didn't stretch, then you can tear and rupture things. And then if you finish your exercising, and if you're an athlete and you take it seriously and you wanna go out again the next day, stretching afterwards to kind of loosen yourself up and help mobilize those fluids is a really good thing.

And I have this like straw man argument. NFL players 60 years ago used to be really strong and not very limber, but nowadays, NFL athletes are doing yoga and all sorts of other kind of stretching based exercises, and the best muscle is a big, strong and flexible muscle. That's the best thing for the body and the joints is having both increase your strength and increase the flexibility. So yeah, stretching is crucial.

Maggie McKay (Host): And Dr. Loy, why did you pick sports medicine and what's the most rewarding part of it?

Dr Bo Nasmyth Loy: So I wanted to be a surgeon and I wanted to be an orthopedic surgeon. And then within orthopedic surgery, you've kind of gotta pick, and for me it was the diversity of patients. So I see patients that are trying to get back to They're sports, trying to get back to what they wanna do. Or a lot of people are just, hey, this is what I do on the ranch or the farm and I need to get back out and get back to work. And there's something really rewarding about having someone come in with an injury and then guiding them through the process, educating them, ordering the labs and the images that they need and showing them that, hey, this is this kind of injury. I see this frequently.

It usually takes this long to recover on its own, and that's probably the most rewarding, is having someone come in scared and thinking they're gonna have to go under the knife and getting the proper imaging and the proper diagnosis and then walking them through that and not needing surgery. And they just feel that weight lifted. Like, ah, they come in to review their MRI, they're like, oh, thank you so much. I don't have to have something invasive. I can just recover up from this on my own. I think that's the best experience.

It's the easiest for me becaus e I just show them MRI and coach them through it. And I do like surgery, but there's something really rewarding about that relief for someone that thinks they need surgery when they actually don't. That's a good feeling.

Maggie McKay (Host): I bet in closing, is there anything you would like, our listeners to take away from this conversation?

Dr Bo Nasmyth Loy: Well, if you live in Bishop, it's a beautiful place. I'm looking outside right now. There's been a ton of snow this year. Enjoy the outside, get outdoors. Get your vitamin D, get your heart rate, get your breathing going, and have fun.

Maggie McKay (Host): Dr. Loy, thank you so much for sharing your knowledge and your expertise. This has been so informative and helpful. I appreciate it.

Dr Bo Nasmyth Loy: Thank you Maggie.

Maggie McKay (Host): That's Dr. Bo Naysmith. Loy orthopedist at Northern Ino Healthcare District. For a consultation with Dr. Loy, please call Northern Ino Associates Orthopedic Clinic at 760-873-2605. If you found this podcast helpful, please share it on your social channels and check out our entire podcast library for topics of interest to you. Thank you for listening to Mountain Medicine, the official podcast of Northern Inyo Healthcare District. I'm Maggie McKay. Be well.