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Radio Interview: On “The Home Show”, Talking About Orthopedic Surgery (Part II)

March 8th, 2011

I was recently asked to discuss orthopedic surgery on The Home Show Radio Show near my office in Torrance, Southern California. To listen to the second part of the recording, simply press the play button below.

Host: And welcome back to the Home Show here on News Talk 870 KRLA. My name is Jessie Lovelady, as if you don’t know it already, and I’m with Dr. Stuart Gold. He’s an orthopedic surgeon. I’m very proud to have him on the show and for you listeners out there that are always asking questions about are we going to do medical issues and things like that, hey, I have a doctor that even put out a book for you to help you and you can get that book.

All you have to do is go to orthopedicsurgerybook.com. Even I can find it that way so you listeners out there and it’s got a lot of things on there for you to kind of look at and all this information. I’m sure that a lot of you have questions that you’ve wanted to ask, didn’t know what to ask. We’re trying to help you here. Now, as far as asking, you know, how should you assess surgical skill, how would you do that?

Dr. Gold: Well, patient referrals are usually the best so if a friend has been happy…

Host: Um, hum.

Dr. Gold: with whom they’ve been dealing with, and have had a good result, that’s usually the best referral. However, if you don’t have answer to that or you’re not sure, then if you know any nurses, particularly nurses who work in operating rooms, or anesthesiologists, these are the people that know the physicians and surgeons who are technically gifted and the best. These people would be the best referral for the technical part. As far as personality, again this is something that would come either from direct referrals, doing a little research with your friends, checking the doctor out online to see what he’s accomplished and what he’s done. But just again, because someone is very accomplished doesn’t mean that they’re going to have the personality that you’re going to click with.

Host: Humm.

Dr. Gold: So, again, you still may need to shop around a little bit just like when you’re going to purchase something, you don’t necessarily purchase the first item you see. You look around and see if you can find the ideal item for you.

Host: Now, Doctor, what role does research like invention and education have in developing a great surgeon? Why is that so important?

Dr. Gold: You want somebody who is very adept and knows what they’re doing and although they may not have invented something, that person may technically be the best to put it in if it is a procedure where something is being implanted. The researcher in many cases doesn’t always have a great personality and may not have the best hands, but in many instances they are the premier researcher. We need these people as well.

Host: Um, hum.

Dr. Gold: And again, you know, personalities overlap. Someone could be a great researcher and a great educator. Someone could be a great educator and a great surgeon. Someone could be a great communicator and a great surgeon. You just need to figure out what you’re looking for. But the researchers and inventors are not always necessarily the best surgeon.

Host: Humm. Now, this is another topic that I think a lot of people kind of, you know, feel this, what’s wrong with me, and sometimes we don’t understand what the doctor is saying to us. We’re kind of puzzled and saying, you know, it really is — how — like how is the patient diagnosis similar to a puzzle would you say?

Dr. Gold: Well, the puzzle that we need to put together is to figure out what the diagnosis is and what that refers to is the differential diagnosis meaning what are the possibilities that could be causing the symptoms that you have.

Host: Um, hum.

Dr. Gold: And the biggest problem we have with orthopedics is the difference between mechanical and neurogenic pain. Mechanical problems would be something like tendonitis, an inflamed tendon, arthritis of a knee or a hip, degenerative disc disease of the neck or the back. However, overlapping with a lot of these pains is something called neurogenic pain? That is pain elicited from inflamed nerve roots. And in many cases, these diagnoses, okay, overlap with respect to their symptoms and so it’s our job to figure out is this truly a mechanical issue or is it a nerve issue. And the word that most people will relate to is sciatica…

Host: Humm.

Dr. Gold: Sciatica is pain down the leg from an inflamed nerve root. But that radiating pain can also give you knee pain and foot pain. Someone may show up in my office and say, “Doctor, I’ve got terrible knee pain. I’ve got terrible foot pain.” Now it’s my job to figure out is it truly a foot or a knee problem or is it potentially sciatica or an inflamed nerve that’s starting up in the back or somewhere else in the leg that’s causing this discomfort.

Host: Okay, you listeners out there, we are talking with Dr. Stuart Gold and, of course, he is an orthopedic surgeon and I want to tell you we are talking about his book and the book is going to take you on your guide to orthopedic surgery and I’ll tell you, you can get a lot of questions that are answered on this. Want to give you a website where you can actually to. That is orthopedicsurgerybook.com. Orthopedicsurgerybook.com. If you’d like to call him directly, his number is 310-542-3472. That’s 310-542-3472. Now, Dr. Gold, we’re talking about pain and what is referred pain?

Dr. Gold: A referred pain is what I was just discussing and just getting into, Jessie.

Host: Okay.

Dr. Gold: It’s that radiating pain that if you have shoulder pain and you go to the doctor…

Host: Okay.

Dr. Gold: All right. The patient most of the times will say I’ve got something wrong with my shoulder, Doc.

Host: Um, hum.

Dr. Gold: And if I look a little further, in many cases it’s because of a pinched nerve in the neck and that would be a specific nerve root that provides the sensation to the shoulder. So, even though the patient may say, “Gee, my shoulder hurts a lot,” we’ll examine the shoulder, try to assure that it’s not a mechanical problem in the shoulder, then look elsewhere to see if possibly it’s the inflamed nerve root that supplies the sensation to the shoulder and that referred pain, even though the patient thinks it’s the shoulder, is truly coming from a pinched nerve in the neck. It can also come from a pinched nerve in the elbow which can give you what we’ll call retrograde or backwards referred pain from that irritated nerve at the elbow up to the shoulder.

Host: Ouch. Humm. Now, a neurogenic problem, what exactly is that? Can you define that for us?

Dr. Gold: Basically the nerve can either be pinched and give you a neurogenic problem or…

Host: That hurts.

Dr. Gold: Or it can just be inflamed and so in the neck or the back from a disc or from a bone pinching on the nerve, the nerve can then become inflamed and then elicit pain. The other way a nerve can get irritated would be from a stretching injury.

Host: Oh.

Dr. Gold: Example, around the shoulder and if the shoulder’s pushed back, the whole nerve complex that goes down the arm can be irritated. If somebody falls with a significant blow on the buttock…

Host: Humm.

Dr. Gold: They can irritate their sciatic nerve just directly from that blow. That sciatic…

Host: Oh.

Dr. Gold: Nerve is then composed of five different nerve roots that go down the leg so any one of those could then be inflamed.

Host: Ouch.

Dr. Gold: And, therefore, it would be a neuritis or an inflamed nerve root can provide that neurogenic or that pain that goes down a leg or an arm.

Host. Now, Doctor, what are the diagnostic considerations for shoulders, necks, elbows, wrists, knees, and ankles?

Dr. Gold: If someone decides to purchase the book you’ll see that I go through many of the different general diagnoses that occur throughout the body from head to toe. The book by no means can provide you with every single detail…

Host: Sure.

Dr. Gold: Because I wanted it short in order that anybody could read this in less than an hour.

Host: I loved it. I just — but I have to tell the listeners out there because I do my homework and I read it and I went through it again because I wanted to go back because there were certain parts of it that really, you know, kind of laid into my life, too, and I thought this was well done because sometimes you can get a book that’s so thick, you don’t get anything from it but definitely if they get this book, they can see that they can pick up so much information. They’re going to want to back to it again, so I want to thank you for putting this book out. Now they can get it on the website and they can go to orthopedicsurgerybook.com, so we want to let the listeners know that right now so you don’t say, “Jessie, you didn’t tell us where we can go buy it.” Well, you can. You go to the website, orthopedicsurgerybook.com, and you can. Now, again, what tests may be required to diagnosis with our ailment?

Dr. Gold: We have lots of different tests to help us determine if we have a mechanical or a neurogenic problem and these tests would include MRI scans which are magnetic resonance imaging.

Host: Um, hum.

Dr. Gold: There’s no radiation with those tests just so everybody knows. We do X-rays when we’re looking specifically at joints…

Host: Um, hum.

Dr. Gold: In order to see if they’re degenerative or if there’s any fractures or any loose fragments in the joint. We also have tests for nerves which are called electromyographic, EMG, and nerve conduction velocity tests which go by NCV and these are tests which can let us know where a nerve is being irritated or if it’s being pinched. We also have other kinds of scans which will also give us specific information for infection or where a bone may be inflamed or overreacting. What I’d like to say, though, about tests and what’s happened in the past probably 10 to 20 years is that we really need to make sure that your physician or your surgeon is examining you and asking you questions and going back to what I call classic medicine, the history and the physical, because these tests that we have, and they’re fantastic these days, should be used to really confirm a diagnosis……

Host: Humm.

Dr. Gold: And shouldn’t be ordered to determine what a diagnosis is and most of the time we can get a pretty good idea what’s going on just from the history and physical.

Host: Very interesting. We are going to take another quick break, Doctor, and I want our listeners to stay tuned more for the continuation of the Home Show and I want to give you the direct number for Dr. Stuart Gold at 310-542-3472. That’s 310-542-3472 and if you’d like to get his book, here it is. The website is orthopedicsurgerybook.com. Thank you very much for listening to the Home Show here on News Talk 870 KRLA.

About the Author: Dr. Stuart Gold, M.D. is a board certified orthopedic surgeon who has 23 years experience specializing in sport injuries, joint replacement, arthritis and limb salvage. As the Director of the Orthopedic Institute, Dr. Gold recently published The Patient's Guide To Orthopedic Surgery to help patients better understand the challenges, risks and opportunities of orthopedic care.

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