Dr. Shivajee Nallamothu and the Business of Orthopedic Medicine
Toree: Hi, I’m Toree McGee, and this is The Rapid Recovery Report, sponsored by ROMTech, the modern technology of rehabilitation. We’ll be doing this series every once in a while. If you’re following us on our social media, you’ll get alerts when we have brand new streams.
If you’re new here, basically, we talk to different guests, surgeons, patients, insiders here at ROMTech to talk everything from wellness to health and our PortableConnect device. If you’ve never seen it before, this little beauty here is our PortableConnect. It’s a high-tech recovery device, and it’s geared to get patients moving and on the road to recovery faster from injuries and surgeries.
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Today, we’ve got a really fun guest and let’s get right into it.
Michigan Orthopedic Surgeon, Dr. Shivajee Nallamothu
Intro: All of the red tape and paperwork in the business of medicine can cause a divide between doctors and patients. Dr. Shivajee Nallamothu is able to maintain a solid connection between himself and his patients in spite of the red tape problems by always looking for better ways to do things. Dr. Nallamothu always believes that you must ask the right questions and listen to the patient. Being a coach, Dr. Nallamothu uses the same methods to motivate and inspire his patients as he does his athletes, and that is a winning strategy every time. Dr. Nallamothu, we salute you.
Toree: Hey, Dr. Nallamothu, it’s so great to have you here.
Dr. Nallamothu: Oh, great to be here. Thank you for inviting.
Toree: Yeah. I understand you got your medical degree from Michigan State. You did your residency at Michigan State. Now, you’re the founder of Michigan Center for Ortho, so Michigan through and through.
Dr. Nallamothu: Yeah. I’ve only taken about three months off and went to Vegas to do our trauma rotation during residency. Otherwise, I’ve been here since 1979. Came here from Tennessee, and I’ve been here since. Loving it up here and it’s nice to visit the warm weather, but hey, we’re in Michigan.
Toree: Yeah. Well, I mean the Vegas desert’s a real hard sell.
Dr. Nallamothu: Yeah, gets pretty hot. Even in the swimming pools, you come out sweating.
Toree: Yeah, you never really get to cool down there in the summer, so I don’t blame you for sticking around in Michigan. I understand that your father was a psychiatrist, and he thought you’d be a great orthopedic surgeon.
Dr. Nallamothu: Yeah. I’m actually supposed to be a villager and a farmer in India but my dad decided to come here and go to medical school, and he became a psychiatrist, and then we came up to Michigan. Growing up, in our family, there’s a lot of physicians. It was almost like it’s a given you’re going to go to med school. When we were talking about what kind of medicine to do, he kind of understood right away. You should go into medicine where you can use your hands, like in surgery, some type of surgery. This is how I ended up in orthopedics.
Toree: Okay. You must have liked to fix things and build things as a young kid, right?
Dr. Nallamothu: Yeah, whenever something broke in the house, I was always called, and I would look at it. Either I threw it away or I try to take it apart, and if I could fix it, I could fix it. If I didn’t, it just went in the garbage, but I love doing that kind of stuff. Even now, I kind of look at things, and trinkets, and try to fix things.
Toree: The Doctor Mister Fix-It, I like it.
Dr. Nallamothu: Yeah.
Hospitals vs. Surgery Centers
Toree: There has been a shift, it seems, to using surgery centers for ortho procedures versus a hospital stay, and that’s been over the past few years, I would say. What is your preference and why is that?
Dr. Nallamothu: Different patients do better in different places. If it’s a sick patient, an elderly, they need help, they need to stay for a day or two to get up and move around and rehab, then the hospital is probably the best place to go. Otherwise, younger people, when you’re doing a 50-year-old that needs a knee replacement, they want to go home right away, the same day. They want to start therapy right away. They want to get aggressive and start moving and get back to their life and get back to work. The outpatient center is perfect for them. You do the surgery, you’re home two, three hours later.
They love it. It’s efficient. It’s clean. The efficiency is really good. The staff there actually is really well trained on how to get people up. The way they talk to them, little subtle things like, hey, it’s time to get up, not do you want to get up and let’s start moving. The family’s there to watch. We got the walker right there. They walk right to their car, get in, and go home.
Preparing for Surgery
Toree: Awesome. Yeah, I think that’s what I prefer most definitely. How important is prepping before surgery for patients? How do you prepare patients for surgery weeks before versus days before or immediately before?
Dr. Nallamothu: It’s actually months before because when we first see the patient they complain of knee pain but you can’t board them and start talking about surgery because that’s not what the right thing to do is. The right thing is physical therapy, anti-inflammatories, injections. That talk actually starts way back when we first meet them.
We can look at the X-ray and assume you’re going to end up with a knee replacement but that’s not the first step. We go through these steps and each time we see them, we talk about the knee replacement, and the procedure, then they start asking more questions, understanding what their disease process is, and then they got better questions more, in-depth questions.
Once we board them for surgery, we talk to them for 20, 30 minutes in the office, and that’s just the beginning. I actually require the patients to come to my office a week earlier, and we have like a 50 or 60 slide presentation for all of them. They come in a group and they get to a little camaraderie. They talk about how they’re going to do better than the other patient next to them. When they meet in OR or in the pre-op, they actually know each other and talk to each other. Some of them become friends afterwards.
That process of having them come to the office and doing that presentation is huge. I mean 50, 60 slides of just from one step to the next, until you get home, and even afterwards, what they can expect. It’s a big process to make sure that the patient knows what’s happening. Even then, they still have questions.
Toree: Yeah, I’m sure. Well, I mean the good thing is if they’re making friends in class, one of them forgets something, hopefully they can call the other one and ask, right?
Dr. Nallamothu: We know these patients for six months sometimes before we do the knee replacement, so we’ll see him in the neighborhood, at the grocery stores, and they’ll show me their knee and how they’re doing, and they’ll brag about how well they are.
Toree: Good. Is there anything that you think is the most important thing to tell patients ahead of surgery?
Dr. Nallamothu: Their biggest thing is high expectations. They have a friend that said, “Hey, I had my knee, and I was walking right away.” That’s not really what they meant. What they meant was they were allowed to walk right away, so you have to actually tailor the expectations. If they have really high expectations, you have to bring them down a little bit, and say, “Listen, this is a major surgery, we’re cutting bone, and getting into the joint, doing a replacement, cementing something, then you got to start the rehab, it’s a huge process.”
That’s the biggest thing is to know you’re going through a major surgery and you have to take baby steps, and gradually, you will be that person that brags about how great they did after the surgery, but it’s not an overnight thing, and people exaggerate when they get done how well they did, and so we got to make sure the patient knows what to expect.
Younger and Younger Knee Patients
Toree: Yeah, that makes sense. We’ve heard from other ortho surgeons that they’re seeing a trend of younger and younger patients who need knee procedures and I assume that you’ve been seeing that as well. I also would assume that those who have really high expectations for a quick recovery are coming from younger patients. Is that right?
Dr. Nallamothu: Yeah, and they want to get back to work. They have kids. They got younger kids, and they’re not 70-year-olds where their kids are 50-year-olds. They really want to get back to doing their regular activities, working out. They want to show off, you know, when they get back to work, and really work hard at it. They take pride in how hard they work, and that’s why the PortableConnect is actually really excellent for this.
Toree: Awesome. I do want to get into the PortableConnect a little bit more but before we move on, I just want to ask why do you think that it’s happening that more and more younger people are having to have knee procedures done?
Dr. Nallamothu: I think sports participation has increased a lot and the injuries before that we couldn’t do much with, now we’re having new procedures that come out that we can help them with. We’re doing more minor procedures, leading to more major procedures, and as the arthritis gets worse, they don’t want to put up with pain anymore. Now, when they know there’s options with marketing and things like that that the companies do, now that they know there’s options, they want to do something.
When we fail, you know, anti-inflammatories, physical therapy, injections, the next step is knee replacement. Used to be, when I was a resident, they would tell patients, don’t do anything until you can’t walk anymore. Well, that’s not the rule anymore, and a lot of physicians would say, “You’re too young, don’t do it right now, wait until you’re 60 or 70,” but people don’t want to wait anymore because they got things to do. They don’t want to suffer. There’s no reason to suffer. If you can get something fixed, get it fixed.
The implants are so good right now and the other physicians that came up with these implants, the scientists, the bioengineers. The implants are so good that they’ll last 20, 30 years now. The technique is getting better. We’re just benefiting from being able to do surgery on patients and helping them. Those other guys here before, they gave us these tools, so we get to pass it onto the patients.
Dr. Nallamothu’s Patients on the PortableConnect
Toree: We’re really excited to find out about how the PortableConnect has been working for your patients. I know you just mentioned it, so can you share with us a little bit about what you’re seeing so far?
Dr. Nallamothu: Yeah, actually, patients want to participate in their rehab. They don’t want to sit there. The old CPMs, you would buy this machine, or rent the machine, the patient would put it up in their bedroom upstairs, away from everybody, and they’d sit there for three hours. It’s boring. Nobody wants to use it. They would fall off the bed. It doesn’t fit right, that kind of thing.
The PortableConnect is a whole new generation of just advancements. The PortableConnect can be put in the living room, in front of the TV, where the dinner parties are, the cocktail parties are, it’s right there where all the action is in the home, so they feel like they’re still part of the house. We encourage them to go out and do things.
This machine, the way it works is it puts pressure on the knee to work faster. With the range of motion increasing over time, they kind of compete against themselves to do better. With the iPad type of screen, the interaction is just great. I’ve been on it before, I’ve tried it. The interaction is really cool. Patients love that technology. I get to look at it in the office, and see how the patient is doing every day. If they’re not using it, I know. When they come into the office, they brag about how much they used it. They love it.
Again, they like participating in rehab. When they do better and they’re starting to walk by themselves, they know it was them that did it. I tell people all the time, I got the easy part in surgery, takes me an hour to do this, they got the hard part for the next two to three months. I think the therapy afterwards, they need less than if they didn’t have the PortableConnect. Now, instead of going to three months of therapy, they’re dropping down to two months, even six weeks sometimes.
Toree: Wow, that’s a big drop.
Dr. Nallamothu: I actually have one of the original prototypes in my in my office right here.
Toree: What we lovingly referred to as the clunker.
Dr. Nallamothu: It’s the clunker but it’s beautiful.
Toree: Everybody wants to start somewhere.
Dr. Nallamothu: A little tower on it like this big. It tells you how many revolutions.
Toree: They’ve come a long way.
Dr. Nallamothu: Yes. It’s a beautiful machine right now.
Toree: Well, I mean the initial technology of the pedal radius and everything is still there. We’ve just shooshed it up a little bit.
Dr. Nallamothu: Oh, yeah. It’s smooth. It works really good. Oh yeah, I love it.
Advancements in Medicine
Toree: Great. After talking about things changing for the better, how do you think the business of medicine can get better in the future?
Dr. Nallamothu: Well, there’s a few things. I think the biggest thing is the scientists that right now, the research that’s coming out is giving us better protocols on how to treat patients with certain disease processes. For example, I remember the MARCQI program here in Michigan. It’s Michigan Arthroplasty Registry Collaborative Quality Initiative. That’s a letter soup.
We pick a project. For example trying to give antibiotics within an hour of the surgery. We shoot for that for the next few months while we’re coming up with the next process, blood transfusions. We’re trying to tackle that problem. The more transfusions you have, higher problems you can get afterwards. We realize that we can let the hemoglobin drop a little lower before we have to transfuse. We’re picking more specific patients to do that, and so things like that. We’re advancing that kind of process.
Once the protocols are out there, then we get to test them. Once we test them, we know what works, what doesn’t work, what works better. I mean for example, we’re all giving aspirin to patients now instead of Lovenox and ARIXTRA, and all these other medicines. Those advancements are happening and I think that’s the best part, is we get to test ourselves against our own protocols, and we get to compare ourselves to the other physicians in our state at least for this, and then throughout the country with research papers that come out. That’s the advancements.
The implants, the metals, the plastics, all that is always advancing. I have less to do with that because that’s a different field but we get the benefit of using this new advanced technology.
Toree: Yeah, absolutely. We’ve heard from other surgeons but I wanted to ask you, are you seeing a drop in Narcotics for your patients who are using the PortableConnect or using movement instead of just relying on narcotics?
Dr. Nallamothu: Yeah, that’s actually very interesting you said that. I think when the patients are more alert, they don’t feel sick they use the PortableConnect more often. Once they get off of it, they feel better, and they don’t want to take it anymore, so for sure. We also have a lot of restrictions on how much narcotics we can give. There’s actually a regimen of what you give, what you don’t give, and how much for how many days, so that’s throughout the federal government.
Even using that PortableConnect, I see a difference between them and the patients that don’t use it or can’t get up for insurance purposes or whatever.
The Future of Orthopedics
Toree: Okay. Now, this might be a loaded question but where do you see Orthopedics in the future? I know it’s very broad.
Dr. Nallamothu: I think we are one of the leaders in medicine, in general, to get better technology. We pressure ourselves and each other to do better because with this MARCQI thing I was talking about, I compare myself to the surgeon across the street in a different hospital but I know them socially, so we can talk in a friendly way to say, “Hey listen, I’ve got let’s say two infections, what do you do about this, what do you do about that?” That brings that conversation forward without insulting each other and without being punished for it through the departments or through the hospital.
The hospitals are actually participating in this. They understand that we’re trying to get better, and so the data is out there. I think we have like a few hundred thousand people in this database right now. You can do research off of this database. We’re trying to teach each other and work together to do this advancement.
Toree: Wow. Surgeons have a reputation for being highly competitive, and I feel like that’s the case among a lot of folks in medicine. Just it’s always rankings and everything from the minute that you apply into med school in the first place, so it’s really great to hear that there’s this collaborative nature going on with the MARCQI program and hopefully other places across the country will follow suit if this isn’t a common occurrence by now.
Dr. Nallamothu: Yeah. It’s really important to actually put pressure on ourselves to do better. It’s easy to say, “Hey, you know what, I did 10 knee replacements this month or whatever,” they’ll do fine, but to say I got this evidence and the PortableConnect, how often they used it that they’re getting better, they’re getting better quicker, they’re up and moving around a lot faster.
I actually have a 6’6, 270-pound guy on one right now. He’s an athlete. He played basketball in college and he loves it. He calls me and texts me because I was friends with him in college, and brags about how good he’s doing. Patients put pressure on themselves, so do we, to try to do better.
Toree: I love to hear it. It’s great too that these people who maybe otherwise would have difficulty with traditional devices can use our device. We’ve tried really hard to make it inclusive for people of all sizes, short and tall, and heavier, smaller, so that everybody can sort of use it, so it’s great to hear these stories of people who are loving it. Maybe we fall outside of the normal outliers.
Dr. Nallamothu: Yeah, and they advance at their own schedule. The better they do, the more they are allowed to do, and so we get to keep a record of that and talk about it when they come to the office.
Advice for Patients
Toree: Awesome. I love it. I love to hear those stories. I just got a couple more questions for you. What advice could you give to someone who’s in need of a procedure and is looking for answers to their questions?
Dr. Nallamothu: Well, look on the internet, talk to your friends, the stories that you hear are the bad stories. There’s a certain percentage that are going to have some issues, but you never hear about the person that did so good that they’re walking by you. They don’t talk about it.
You got to write down your questions. That’s why I put them through our presentation so they know what to expect. I think part of it is you got to ask the right questions to the right people. For us, we have to explain something to them, and we got to explain it again, and then we got to explain it one more time.
Kind of compare it to me going to get my car fixed. He tells me four things that I got to do, I come home my wife says, “So, what do you say you got to fix?” I go, “I don’t know, I don’t even know what he said.” It’s the same thing. We can explain it to somebody. I always encourage them to bring their spouse or a family member with them so they’re going to ask more aggressive questions because patients want to make us happy. They don’t want to make us upset because they’re keeping us too long.
The family member doesn’t care. They’re there to ask questions. They’ll write down these notes, and I encourage them to write all this stuff down. Even then, if they got questions, they should call us, call the office. Our medical assistants can answer questions, or we can answer questions. We can get on the phone and talk to them. A lot of problems we can deal with on the phone without having to have them come into the office or go to the ER. Nobody wants to go to the ER at 2:00 in the morning when they can just call my office and see me in the next day.
Toree: Yeah, absolutely.
Dr. Nallamothu: Communicate with the physician as much as possible and as much as you need, and don’t feel like you’re harassing us.
Toree: Maybe you don’t want to open that door.
Dr. Nallamothu: I don’t give all of them my phone number.
Advice for Medical Students
Toree: That’s true. All right, I just have one, maybe two more questions for you. What advice would you give to a young student just starting medical school, aside from obviously you should be going to Michigan State?
Dr. Nallamothu: And go into orthopedics.
Toree: That’s right.
Dr. Nallamothu: The advice would be to have nothing to do with orthopedics actually. I think one of them is, when you get to med school, everybody’s under stress and pressure. Find the most positive people in your class and hang out with them. Find the negative ones, and stay away from them. There’s always negative and positive people, and then you have to be one of those positive people.
Hold a smile on your face whenever you can, whenever you think about you got to frown, smile, because it’s like in sports. You missed 10 three-pointers in a row, the shooter knows he’s going to make his 11th shot. If you act positive, you treat everybody positive, they’re going to want to hang out with you too. You get that group of positive people together, and you’re going to have a much better life in general forever than hanging out with the negatives.
The other one would be probably, I think, you got to compliment the people in your office and people around you, even if it’s occasionally, the staff that works in the OR. To us, it doesn’t mean much saying, “Hey, great job today, thanks for getting me going so fast, and everything went really good.” To us, it’s not a big deal. To the people around you, even when you go home, compliment your kids, compliment the spouse. It means a lot to them.
Can you imagine someone comes up to you, and says, “Hey, your hair looks great today”? That makes your day. Do that once in a while, and that’s that positive thing. You got to stay positive.
Toree: What a wonderful note.
Dr. Nallamothu: Have fun doing this. Otherwise, why are you doing it? There’s a lot of people out there, those miserable people, even if they’re flipping burgers or working on a factory, they’d be miserable doing that too. You got to find you the positive people and stay with them.
Toree: Yeah, I love that, find the Joy. Find the joy in what it is that you’re doing.
Dr. Nallamothu: That’s right.
Toree: Well, thank you so much. What a great ending to this interview. I appreciate that so much. Thank you so much again, Dr. Nallamothu for hanging out with us and answering all of my questions here today. We really appreciate it. We really appreciate your parents having you go into orthopedics here in the US, so that we have the opportunity to have wonderful doctors like you.
Dr. Nallamothu: Oh, thank you very much. We got a great team at ROMTech too, so I love meeting all these guys and you. I appreciate your time too.
Toree: Yeah, of course. All right, folks, wherever you’re watching, you can see Dr. Nallamothu’s information below, so if you want to check him out, go ahead and visit his website or visit him on Facebook. If you want to learn a little bit more about us, you can always check us out at Romtech.com. All of our details are below in the description box, as is Dr. Nallamothu’s.
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All right, thanks so much. We appreciate it. Again, have a wonderful day.
Dr. Nallamothu: Thank you, bye-bye.
Disclaimer: Content discussed on this program is often medical in nature and is used for informational purposes only. No content discussed should be taken as medical advice. Please consult your healthcare professional for any medical questions.
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