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Bill Klaproth: Welcome to Right Beside You, a Reid Health podcast. I'm Bill Klaproth. And today, I invite you to listen as we explore primary care sports medicine. And joining me is Dr. Brayton Kiedrowski, a sports and family medicine provider with Reid Health. Dr. Kiedrowski, thank you so much for your time today. We really appreciate it. So, let me ask you about primary care sports medicine. How does this new role fit into Reid Orthopedics?

Brayton Kiedrowski: Absolutely. That's a great question. Thank you for having me, first of all. But how primary care sports medicine kind of fits into Reid Orthopedics is in the recent history, they're hasn't been a primary care sports medicine physician working in the ortho group at Reid Orthopedics. And so there's some differences in mindsets, how I approach patients versus how my colleagues that are trained as orthopedic surgeons would approach the same patient or athlete.

Bill Klaproth: Okay. So let me ask you this then, so you come at this more from a sports medicine angle. If I'm not an athlete, can I still come and see you? I'm sure people have that question.

Brayton Kiedrowski: Absolutely. So I treat everywhere from three years old to 103 years old. Whether you were on Friday night football and you're the star quarterback of some high school or college team or you're out running a 5k or you're training for a 5k or 10K on the weekend or, frankly, if you're getting up in age and so the tissues breaking down, but you still want to be active. I want you to be active as well. And so I treat everybody that I can, and if you are motivated, and wanting to get back to doing, putting quotations, "sports", because sports is different for every person based on their activity level, well, then that makes perfect sense to see a sports medicine doctor.

Really the sports medicine as a phrase, I mean, it's not a bad phrase, but musculoskeletal active lifestyle medicine makes a little more sense for some patients. Sports medicine makes sense for the high school and the college athlete, but the active lifestyle musculoskeletal medicine, but that's kind of a long phrase.

Bill Klaproth: Yeah. So you're very well suited for someone who has an active lifestyle, the weekend warrior, the runner, the cyclist, the racket ball player, someone who might say, "You know, Dr. Kiedrowski is the guy for me because I play tennis and my knee hurts or my hip hurts" or "I'm a runner" or whatever. "I play softball on the weekends." You would be the right person for someone who is very active to see. Is that the right way to look at it?

Brayton Kiedrowski: That's a good way to look at it. So my residency training was in family medicine, and then I did a year-long fellowship in sports medicine for the extra kind of skills and extra musculoskeletal training. So I would say that I don't plan or intend to see patients as their primary care provider.

Number one, I don't want to step on a primary care provider's toes if they already have a relationship built with a patient. And number two, you know, I did the fellowship for a reason to become an expert or to gain more expertise in the sports medicine and the modalities that we can use to help treat those sporty injuries or musculoskeletal injuries.

Bill Klaproth: Right. Well, this is really interesting. And you just mentioned modalities. Can you talk about new treatment modalities?

Brayton Kiedrowski: Sure. First off probably is the integration of ultrasound into my practice. You know, we all know about the ultrasound that you get when either you or your wife are pregnant or -- I'm sorry. I mean, if you're a guy, you wouldn't be pregnant, but if your wife or your significant other is pregnant, the ER uses ultrasound to assess for kind of bedside assessment of dangerous kind of traumatic things. And we use ultrasound for other things.

But ultrasound in musculoskeletal medicine has been coming along and kind of pushed more by sports medicine providers, being that sports medicine is a young specialty or sub-specialty, only been around since the 1990s or so. As ultrasound has developed and been used in musculoskeletal assessment and therapeutic uses, sports medicine has kind of taken it on as a specialty that utilizes it a lot.

Yes, the ER doc and the family med doc, they may have ultrasound machine that they use, but I don't think they would use it near as much for kind of doing the type of therapeutic things that we would use for it primarily of, which is ultrasound-guided injections. We would use ultrasound for diagnostic reasons as well. There's certain tissues, especially more soft tissue, tendons, especially where they insert into their attachments onto bones, where you can use an ultrasound in more of a dynamic fashion to see the health of that tendon, bone or tendon muscle interface. But that's not as common as the ultrasound-guided injection either for places that are hard to reach.

So a very common reason I would use ultrasound in the clinic would be an ultrasound-guided hip injection. So if we want to put steroid or an anesthetic into someone's hip joint itself, it's a deeper joint within the body. And so we want to see where we're putting the medicine to make sure we got it in the right place, so we would use the ultrasound for that.

Bill Klaproth: This is really fascinating, using ultrasound to help guide a treatment. What are some of the other reasons you might decide to use ultrasound technology?

Brayton Kiedrowski: Sure. Number two reason why we would use ultrasound is when we're injecting something that we want to make sure we're in the right location and, usually, that's something that's going to be a little bit more expensive. When we look at the continuum of things we can inject into a space, the cheapest end is probably your anesthetic. So like your lidocaine that you get at the dentist, you know, pretty cheap. We can kind of spread that everywhere. And so long as the patient isn't feeling any pain, great, we're in a good place. Moving up the continuum, obviously steroids, when we inject them into a joint can be a little bit more expensive than lidocaine, but it's not too bad. When we really want to make something into a joint, we would use the ultrasound and the things I'm talking about are things like viscosupplementation, which is a type of medication, an injectable that you would inject for someone who's got knee arthritis. And because hyaluronic acid is a type of viscosupplementation and because that is so expensive, we want to make sure that we got it in the knee joint instead of putting it into a bursa or something like that.

Kind of moving up the continuum and to kind of closing question out, something even more expensive and usually currently is not really covered by insurances and that's why it is so expensive to pay out of pocket would be something like orthobiologics, which underneath that umbrella are things like platelet-rich plasma, which is something where we take a patient's blood, we spin it down really fast with a centrifuge in order to get the platelets and the plasma out of the blood. So blood cells, red blood cells are toxic to joint surfaces and we don't want to put those in a joint. Eventually, we get to this platelet-rich plasma injectable or PRP. It is kind of in this early stage of research where there haven't been very large trials looking at how it can help patients, but there have been some smaller trials where it has given relief. And there's a giant debate in musculoskeletal medicine right now and probably will continue for the next decade or two as to is steroid better? Is PRP better? There are other orthobiologics that I won't get into now, because they've got even less research than PRP. But PRP, going back to that question, PRP is going to be this expensive injectable, and you want to make sure you get it where you want it to go, so you use the ultrasound.

Bill Klaproth: Yeah, that's really cool. So it not only helps you guide the medication in the right area, but it's also useful for delivering more expensive treatment options would be a good way to put it, I guess.

Brayton Kiedrowski: That's absolutely correct. Yeah.

Bill Klaproth: So Dr. Kiedrowski, I understand you are a cyclist. So you would be the preferred go-to person for cyclists as they have injuries from time to time.

Brayton Kiedrowski: Well, I don't know if the cyclists in the area know that I am a cyclist yet, but hopefully they realize that. But I would hope to build that practice. You're absolutely correct.

Bill Klaproth: Well, now they know. Inquiring minds want to know. Well, this has been a lot of fun. Dr. Kiedrowski. Anything else you'd like to add?

Brayton Kiedrowski: The thing that I usually say to every single patient I interact with, regardless of how long I treat them is the number one objective I have for you as a patient is that you continue to exercise, because a combination of exercise and good nutrition -- and nutrition is a whole other topic we could get into that -- but a combination of exercise and good nutrition is going to keep you the most healthy. And so I just want to continue to enable patients to be able to exercise and to stay healthy because of that.

Bill Klaproth: Well, that is a great message. Continue to exercise and make sure you pay attention to nutrition and your diet, and those are two things that really will help you stay healthy. Really cool stuff. And thank you for talking to us about primary care sports medicine. This is really kind of a new thing and we're happy to have you there at Reid Health. Dr. Kiedrowski, thank you for your time. We appreciate it.

Brayton Kiedrowski: Oh, thank you very much. You have a good day.

Bill Klaproth: And that's Dr. Brayton Kiedrowski. And call (765) 962-4444 to get connected with one of our primary care providers. And for more information, please visit ReidHealth.org. And that concludes this episode of Right Beside You, a Reid Health podcast. And please remember to subscribe, rate and review this podcast and all the other Reid Health podcasts. And for updates on the latest medical advancements and breakthroughs, follow us on your social media channels. And if you found this podcast informative, please share it on your social media and be sure to check out all of the other interesting podcasts in our library. I'm Bill Klaproth. Thanks for listening.