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Prakash Chandran (Host): The human body can stretch, bend and flex thanks to its musculoskeletal system. But what happens when injury or disease damages this system and threatens your mobility? Here with us to discuss is Dr. Renee Smith, an Orthopedic Surgeon. This is Healthy Conversations. I'm your host, Prakash Chandran. So, Dr. Smith, thank you so much for joining us today. I really appreciate your time. I want to get started by learning a little bit more about you. Why exactly did you decide to become an Orthopedic Surgeon? 

Renee Smith, MD: You know, I thought about that a lot. I've been an Orthopedic Surgeon for a long time, so, I feel like I've just always done it. But when I think back, I always wanted to be a surgeon. I think I just knew that I wanted to be a surgeon. I, I like to do things with my hands. I know when I was in middle school, I took shop instead of home ec. I wanted to build things and I, I think I liked power tools, so orthopedics really allows me to do that. It allows me to sort of build things, fix things, use tools, and it's very satisfying to me, to fix things that are broken.

Host: Yeah, I mean is really fascinating that you had that inclination at an early age, and obviously not everyone has that propensity for surgery. You know, tell me, I guess, regarding orthopedics specifically, what are some of the most common issues that you see in your practice?

Renee Smith, MD: Well, you know, there's the obvious things, which would be broken bones. So I see broken bones, but I see a lot of sports injuries, even overuse injuries. And then I see a lot of conditions related to arthritis and aging.

Host: Okay. Awesome. And when we talk about I guess scratching that itch for your younger self of being able to fix things with these common issues that you see in most cases, outside of, for example, arthritis, do you feel like you're able to help fix people, whether it be broken bones or sports injuries?

Renee Smith, MD: Yeah, that's the appeal to me is obviously a bone that it's broken, believe it or not, it will heal actually. So I guess I can't really say that I'm healing the bone. What I'm doing often is aligning the bone and keeping it lined up so it heals in a good position or it heals in a normal position.

 And then a lot of the sports injuries I'm repairing things that have torn or broken, like a rotator cuff repair or a meniscal repair. Even in arthritis, even though I'm not repairing things, I can take people who are in pain and do something, manipulate their joint in a surgical way to get them out of pain.

Host: Yeah. Kind of that quality of life fix there. When we think about some of the issues that you mentioned, do you think that it's just like a normal part of life or aging or participating in sports, or are there things that you recommend that people think about to prevent some of the more common issues that you see?

Renee Smith, MD: That's a good question. I think a lot of people think that for instance, arthritis is just aging and actually it's not. There's a genetic component and some people can get very, will get very old and never had any arthritis in their life at all. So it's not just a matter of aging. Arthritis isn't a matter of aging, it's, there's a genetic component and sometimes there's a traumatic component. So we can get arthritis if we injure a joint in our youth. And then as we grow older, that joint degenerates. So if we want to pre, prevent some of these issues, certainly the genetic component we can't really do a lot about. But overuse injuries, I would say are the easiest ones to prevent. Just really all things in moderation. Listen to your body, don't overuse your body. I, think the take home message would be just to be wise and thoughtful about how you use your body. Be safe.

Host: Yeah, I mean, that makes a lot of sense. Now, one of the things that you mentioned is that arthritis, isn't always, I guess gotten as a part of aging. Are there any other orthopedic issues that do, I guess, exacerbate with time or that are a part of aging that are worth mentioning?

Renee Smith, MD: Not so much aging as again, just overuse or repetitive injuries. A good example would be tennis elbow. Believe it or not, I usually don't see that from people playing tennis, but I do see it when people do the same thing over and over again, like kayaking, let's say. 

Host: And tell me, do male and female patients differ in the problems that they come in for?

Renee Smith, MD: We see the same problems in both female and male patients, generally. We see a little bit different distribution. For instance, ACL injuries are actually more common in women than they are in men. So that's a ligament in your knee. But for the most parts, male and female bodies, bones, musculoskeletal systems are very similar, although we don't know everything. So as time goes on, we may, learn other things.

Host: One of the things that I had read is that sometimes women tend to need more joint replacement over time than men. Is that true?

Renee Smith, MD: That actually is true. We think there's a couple of reasons for that. One might be that, to be honest with you, women are more likely to seek treatment and go see a doctor. Women also live longer than men, but the most interesting reason is that believe it or not, women are more active over the course of their lifetime than men, and we think that also might be part of the problem.

Host: Hmm. Yeah, that's interesting. You know, I know that hand surgery is one of the areas that you specialize in. Can you tell me a little bit more about what type of conditions you're seeing with regards to the hand?

Renee Smith, MD: Sure, I see a lot of carpal tunnel syndrome, which is very common. I think most people have heard of that term. That's just a condition that's almost ubiquitous to humans. It doesn't matter what kind of work you do or if you're a stay at home parent or if you're out in the fields laboring or if you're at a computer all day long. For some reason, our nerve can get compressed at the wrist. That will cause numbness and tingling, and so I see that a lot and we can treat that and we can make people feel better. The other thing that I see a lot in hands aside from injuries, would be arthritis at the base of the thumb. I see that. That's very, very common too in humans.

Host: And another thing I wanted to ask just with regards to the hand, is that our lives have changed quite a bit. Obviously, we're at a desk, we're holding our phones. These are things that, for example, in the past, like 10 to 15 years have just become exacerbated. Do you see any changes, with regards to hand issues because of those lifestyle changes?

Renee Smith, MD: Yeah, absolutely. I remember when I first realized that people were coming in for sort of a new thing that I didn't see much. And that it must be related to their phone use because, you know, they don't tell you, they just come in and say, my thumbs hurt. But, they're not going to say, I literally do all of my work on my smartphone. But I see a lot of thumb tendonitis and I have to remind these people to, Hey, get off your smartphone and get back on a computer to do some of those things because people will write full letters on their smartphone.

Host: Wow.

Renee Smith, MD: Which was interesting. Yeah.

Host: Yeah, I guess that's true. Some people just tend to just use their phone for everything and like you said, it's like when you're overusing something and you're doing something over and over, that obviously can lead to injury, right?

Renee Smith, MD: Yeah, for sure.

Host: Yeah. I think more broadly, it does feel like people are maybe a little bit more thoughtful when it comes to mobility, flexibility, and things of that nature. Just understanding that the body is a connected system that, for example, may not just be your wrist, but the muscles and the supporting tissue that are around it. Do you agree with that kind of mental model of how the body is like one connected system, and do you see that there's more awareness in people today?

Renee Smith, MD: Yeah. I agree. I see that all the time actually. People come in with shoulder pain, it's actually their neck, or they'll come in with hip pain, it's actually their back. But pain in one place can cause pain in the other. You know, if your shoulder doesn't move, it will put strain on your neck.

So there, I definitely have to look at the body as a system of interconnected parts that affect each other. And also I have to look at the patient as a whole because one type of treatment that works for one person may not be the best treatment for another person. I have to look at what their lifestyle is, what work they do, how old they are, things like that. But I do think that people they're more aware. They are getting more aware and they're trying to be healthier and to be more active and to be less hard on their bodies I think, in general.

Host: Yeah, I think that it's so important what you mentioned there, just that you have to treat the person as a whole because everything is connected and that's why I think it's important to see a specialist like yourself who can evaluate that, right? Like you understand how the body is connected and how even things like lifestyle choices may be factoring into a pain, for example, in their shoulder. Would you agree with that? And how can someone get started to get assessed if they're feeling some pain?

Renee Smith, MD: Yeah, I think that's really important. Like if you were to ask me you have the microphone, what's the one thing you want to say? I would say that continued pain is not necessarily, a normal part of life and doesn't have to be a part of life. So I see a lot of patients who are older that have had pain for a long time, and maybe their primary care doctor or their friends would just say, oh, you're getting older, that's why you hurt. But often, in fact, most times there's an explanation for what's going on, and there's a way to feel better, and certainly in this day and age in this, with modern medicine you don't have to put up with pain even if you're older. We have a lot of ways, not all of them surgical, a lot of non-operative ways also, to make people feel much better and to increase their quality of life.

Host: Yeah, I think that is so important because so often people just live with pain, my father included, where he is just like, well, I'm just getting older now, and things hurt. That's just how it goes. And while there may be truth to maybe inflammation and things that maybe didn't affect us when we were 20, maybe it affects us now at 60 or 70. We don't have to live with that, right? There are treatments, there are strengthening exercises. There are things that we can do to feel better.

Renee Smith, MD: Yeah, absolutely. Absolutely. And I hear many, many times in my practice from patients, oh, I wish I would've come in sooner. I wish I would've known, or I'm going to tell my friends because they realize that this is modern day medicine. We have ways to help you feel better.

Host: Yeah. Well, just before we close Dr. Smith, is there anything that we've missed or anything that you think is important for people to know about orthopedics and what you do as a surgeon?

Renee Smith, MD: I would just say you don't have to live with pain, so ask your primary doctor to refer you or find your way to an orthopedic surgeon. Just because we're surgeons doesn't mean we only do surgery. Really, we are musculoskeletal physicians. So anything that has to do with your muscles, your joints, your bones with the exception of your head, we're going to be well-versed in the different options for treatment and most of the time I don't operate on my patients, but if they have a condition that will be made better by surgery or if surgery is a good option, then I have the ability to help them in that area as well. So just because you're going to a surgeon doesn't mean they'll automatically operate on you.

Host: Well, Dr. Smith, I think that is the perfect place to end. Thank you so much for sharing your wisdom today and yeah, definitely learned a lot from this conversation.

Renee Smith, MD: Thanks. It's been a pleasure.

Host: If you found this podcast to be helpful, consider sharing it on your social media channels. Thanks for listening to this episode of Healthy Conversations. My name is Prakash Chandran, and until next time, be well.

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Disclaimer: This program is a community service and is not intended to be a substitute for medical advice. Listeners having questions about their health should make an appointment to see their personal physician. Any opinions or statements made during the program are those of the individuals or physicians making the statements and are not the opinions or statements of the hospital.