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Against the Grain with Dr. Chad Edwards | Back Pain Healing Tulsa| Podcast 10 – Part 2
Brian: Man, you are just rolling out the big words today.
Dr. Edwards: You like that?
Dr. Edwards: Well, I slept at a Holiday Inn Express last night.
Brian: Right. This guy is going to doctor it up, the whole show. I like it. Bringing your A game. I told you. Bring it. Let’s do it.
Dr. Edwards: Challenge accepted. I did some extra orthopedics rotations and my thought process was, I want to spend more time with the orthopedic surgeon because I saw them as the pinnacle of understanding musculoskeletal conditions. Not to disrespect any of them, because I’ve got some fantastic friends that are orthopedic surgeons, but what I found is their emphasis was on identifying if there was a surgical issue or not. They did not do the clinical stuff, the outpatient stuff, the non-surgical stuff. They would look at it, see if it was surgery related … This may have to do with the fact that it was military. I don’t know that, but we had what we called ortho PAs, orthopedic physician assistants, and they were the ones that ran the clinics.
What I discovered is that I wanted to spend all my time with those guys because I’m not an orthopedic surgeon, I wasn’t going to go do orthopedic surgery and knee replacements and hip replacements and all these things, so it didn’t make sense that I learned how to do those things. If somebody needs that, I need to appropriately funnel them to those guys so that they can get them fixed in the most appropriate way. What I wanted was the clinical stuff.
Then, as I spent time with them, there were some … You do valgus stress testing, you angle the knee and are these ligaments intact … We did that as athletic trainers in college and we can pick some things up with that, but patients will come in, they’ve got an injury, they’ve got pain, whatever it is, and they’ll say, “Something’s wrong with me. I need to get this fixed.” I, as a primary care doc, depending on my training, on what level of athletic mentality or athletic training that I’ve had, or evaluating in the sports medicine realm, will kind of dictate the path that that patient goes on.
If I don’t spend that much time with the patient, don’t do a thorough physical exam … I could even do a thorough physical exam and I could say, “I don’t really know, but this sounds like runner’s knee. Sounds like a torn ACL. Sounds like blah blah blah blah blah, let’s get an MRI to be sure.” We’ll get an MRI and depending on the findings, “Oh, yep, there’s something torn in there, we’ve got to send you to an orthopedic surgeon and let’s get surgery and get that fixed.” You’re right. That’s exactly the pipeline that we’re talking about.
If the patient … I remember having this issue … A patient came to me and said, “I’ve got X condition …” I can’t remember what his particular condition was, I think it was low back, and I said, “Do you want an MRI?” He said, “Yeah, I do.” I said, “Okay. If we find something abnormal, when in your schedule can we fit surgery in?” He’s like, “I don’t want surgery.” I was like, “So, there’s no way you would consider surgery?” He said, “No way.” I was like, “Then why are we getting an MRI?” From a non-surgical perspective, it’s not going to change my management. He didn’t have a clinical symptom that made me think he needed surgery immediately, like this was a surgical emergency, so even with a torn ACL, you don’t have to do surgery on that emergently. In fact, most of the time they’ll let the swelling calm down anyway. So, why?
If you just want to know, okay, that’s one thing, but insurance doesn’t often cover because I just want to know.
Brian: It’s not a line.
Dr. Edwards: That’s right.
Brian: It is, but it’s rejected 100% of the time.
Dr. Edwards: Exactly. In the military we often got those because if that’s a torn ACL, torn whatever, then we need to know that because he may not be able to deploy, he may not be able to do his job, those kinds of things.
It led me off on this quest to better understand MRI and when should I best utilize them and who should I get them on. Of course, we’ve talked about prolotherapy before and prolotherapy changed the whole game for me. It literally changed my entire approach to musculoskeletal medicine because ligaments and tendons are a common source for a lot of musculoskeletal pain. MRI isn’t going to detect the cause of their pain.
The other thing that prolotherapy has changed for me is there is lidocaine in the solution, so if you come in and say “I hurt in point A,” and then on my exam I find that it’s actually point B and I go to inject there, a lot of times patient are like, “But I don’t hurt over there, I hurt over here,” then we do that and sometimes … A common one would be pain going down my arm, like into my bicep and down this way. That’s often biceps tendinitis and I can inject that and the pain, because that lidocaine goes away pretty much immediately. Then I can directly correlate their symptoms with the location of the problem because of that lidocaine. It numbs up that spot. If I do one injection and numb it up and their symptoms go away, it pretty much has to be that spot. If they’re hurting from somewhere else and I inject that spot, then it doesn’t affect that pain.
Prolotherapy really changed my whole thought process on this whole thing. I was getting patients that were coming in with a variety of conditions. They would say, “I’ve got an MRI and it shows I’ve got a torn meniscus,” or “It shows I have a torn ACL or a torn MCL or a torn fill in the blanks and they recommended surgery.” I was like, “Yeah, but I just don’t see that much of this. Let’s do prolotherapy, I want to see what we get. We did prolotherapy and they get better.