It Had to Start Somewhere- History of Surgery

Podcast Transcript

Speaker 2: 0:09

You heel bone connected to you , anchor your ankle . Hello and welcome to the Bone and Joint Playbook with Dr. John sst . TIPS for pain-free aging. Dr . John SST is a board certified orthopedic surgeon with over 35 years experience in the Dayton, Ohio area. He is also a clinical fellowship trained surgeon in total joint replacement from Harvard. This episode is brought to you by Ted’s authentic Greek salad dressing and marinade. It’s healthy, gluten-free, and delicious. You can find ted’s in Dayton, Ohio at Dorothy Lane Markets, health Foods unlimited and dots markets. That’s Ted’s authentic Greek dressing and marinade. Thanks, Ted.

Speaker 3: 0:54

Well, all right folks. We are gathered back here together in October of 2023, and this is a perfect topic for October. Dr. S you know what topic we’re gonna talk about today?

Speaker 1: 1:06

I do, Terry ,

Speaker 3: 1:07

It’s what

Speaker 1: 1:09

It’s called. Surgery had to start somewhere. So

Speaker 3: 1:12

This can , we’re gonna go back through time and then talk about how the surgery’s evolved over time and things have gotten better and , uh, you’re gonna kinda walk us through all that. Correct?

Speaker 1: 1:22

That’s correct.

Speaker 3: 1:23

So where do you wanna start? How far back do you wanna go?

Speaker 1: 1:25

We’re going way back.

Speaker 3: 1:26

<laugh>.

Speaker 1: 1:26

Those who ignore history are destined to repeat its mistakes.

Speaker 3: 1:30

<laugh> , that

Speaker 1: 1:31

Was George Santiana . Yeah, we’re

Speaker 3: 1:32

Gonna get a lot philosophy in this one too, aren’t we? You

Speaker 1: 1:34

Might, but it’s true. We , um, if you go back long enough, the history of wound healing is much like the history of mankind. We , um, look at things like salamanders who lose a tail and they regrow a tail. Some of our less complex , um, animals, reptiles actually can regenerate lost limbs and body parts. Humans don’t have that ability. So we have to figure out a way to address a wound because a small wound can lead to a loss of a limb or even your life. In the example of a civil war soldier who gets shot in the leg without the proper care, that leg wound gets infected, they lose their leg, or perhaps they even die from, from worse complications. So mankind had to figure out a way to get rapid healing in simple fashion. So a lot of things went back to back to the days where even our ancient river civilizations, and there were four of ’em where they figured there were three main tenets of taking care of a wound or an injury to the body. And they called those the three healing gestures. And they were really interventions, much like we intervened with anything, that’s a problem. If something’s bleeding, you need a rapid intervention. You don’t need a slow recovery process. You need to stop the bleeding, right.

Speaker 3: 2:57

Address

Speaker 1: 2:57

The wound. So the three things that we would do would be to wash a wound, which cleanses it and removes bacteria or other harmful dirt. And, you know, organisms, the second thing you would do is apply an ointment or a lineament. Uh, the Egyptians were famous for using honey and types of oils and honey is almost impervious to , uh, any type of bacteria or viral growth. Uh, they said you could take honey out of King Tut’s tomb and still eat it , uh, this day ’cause nothing could penetrate through. It was , and I think I’ve had that at Cracker Barrel. Yeah, it , it’s the same honey, but it’s probably a little softer <laugh> . Um , and the last thing about a wound would be then to bandage it or , or to cover it. And the covering it protected it, but it also controlled bleeding. So compression, we all know to put compression on a bleeder , uh, that, that slows the bleeding down. So the , um, the way we pass information along is , um, something animals can’t do. We can write things down. So we look at these mesopotamian , uh, tablets, clay tablets, that show what they did with wounds. And the people who who look at the big picture medicine basically comes from a Latin word, medicina, meaning , um, to, to heal or to care for problems that need healing. Okay? Uh , doctors. And also a Latin word, meaning to teach. So the doctor was the person. It could be a, it could be a sorcerer, it could be a medicine man or woman. It could be , uh, which doctor, anybody who was told, Hey, take care of this problem, had to become the healer, right? Um, and then teach other people in their tribe or their civilization how to do it. So we have the ability as humans though, to pass knowledge down to future generations on in written form, or perhaps in podcast form now. And that allowed us to move through all these things that were done ahead of us by some, some pretty remote civilizations. They had to figure a way to continue to hunt. And how long are we talking about ? We’re going back, we’re talking about 2000 bc The , the Mesopotamian clay tablets are, are still found when people are interpreting hieroglyphics of how wounds were cared for. So, you know, let’s move forward a little bit to the Romans. Romans came along. They recognized these four stages of inflammation. You have, you have redness, you have swelling, you have heat, and it hurts and pain. So those four things, this guy named Celsus said, Hey, this is bad looking leg . It’s red. He’s probably got a thorn in there somewhere. Or , and they said, how do we address that? So then the Greeks came along with their civilization. They looked at what the, what the Egyptians did, what the Romans did. And they said, Hey, we need to, we need to start looking at things more in more detail. Galen , one of the fathers of modern day , um, anatomy would dissect animals and cadavers. And they literally said, Hey, his is, this is a liver, this is a , a vessel. This is this. They were the first . And that’s the Greeks that did that? Or was that the , the Greeks. Galen , yeah. Okay . So the first original anatomy books were all written 2000 years ago by Galen who said, Hey , um, if this blood vessel’s, you know, pumping at you, you can ligate, you can tie it off. And it was really important. And certainly as we do surgery now, we’re gonna go forward going what things or what principles in surgery are gonna be important, where surgery becomes a separate discipline. Another 1500 years later. We’re not even there. We’re talking about medicine is a way to treat things that need to heal, right? You’re treating illness, medicine, surgery, there’s no surgery at this point, right ? There’s nobody taking you into a room and doing things. We now have to move. We have to fast forward up to London to the 1760s. And , um, John Hunter is considered the , the father of modern day surgery. And he said, look, this is silly to look at 2000 year old , um, books from the Greeks and Galen . We need to like the dissect cadavers and look and perform, you know, science to find what’s, what’s wrong and what we can do to help people back in London. The worst thing you could get in the day was a, a coachman ate a lot of carriages, right? You had to take Charlotte Holmes around and do things. And the Coachman had these high black boots and the back of their knee hit the buckboard . And where the boots hit and the back of the knee hit, they started getting these , uh, injuries to the back of the knee in their popliteal artery. Well, the artery started to balloon out. They call that an aneurysm. And all of a sudden, the leg would hurt, it would cramp. This big, big artery was gonna either burst or something. So they would take people to, to surgery, which was begun back in London in the late 17 hundreds. And they would clamp this vessel above , uh, the aneurysm. But what would happen is it was bad artery to begin with. That’s why it ballooned. And then the person would lose their leg above the knee. And this is like a , a horrible problem. John Hunter said. The problem is you’re, you’re clamping an artery where it’s really diseased instead of where it’s healthy. So he had a big game reserve in the back of his London state , and he would pay people to bring cadavers, no questions asked. You could take ’em out of a grave. He didn’t care where they came from. He gave you x amount of money for ’em . He set up cadaver dissections, taught that at the medical schools in London, and then said, here’s how we should be doing surgery. We should be looking at things that we’ve studied on live, well, not now, not live, but, but real, right ? Cadavers, not books from, from Greece. And then he took game animals in the back, tranquilized them and would like tranquilize a deer and tie off an artery with a ligature to its neck. And one of the deer antlers would turn like blue and cold ’cause there was no blood flow. And then he’d watch this and after a few weeks, the, the antler would pink up and get warm again. And he said, my theory is if you clamp a normal artery, the body finds a way to get blood flow around that. So he said the problem, we can apply that to surgery on these knee problems. So he came up to a little area on the side of the thigh away from that aneurysm in a place now called Hunter’s Canal. And he tied off the femoral artery and where it was normal above the knee. And then the blood flow stopped going to that aneurysm. The aneurysm shrunk, and all of a sudden the blood flow around it restored blood flow to the rest of the leg. And his, his coachman walked outta the hospitals like, Hey, I got a little incision on my leg and my aneurysms gone, and I’m not walking around without a leg like his , his buddy who saw the other doctor. Well, that was a great solution for that problem. That was a surgical solution that had never been done. But it also caused everybody to be jealous of him. All his, one of his brothers was a doctor. He hated him <laugh> . And he got kicked out of the historical society. But that’s how innovation happens. Innovation happens through people trying things that other people won’t try. When you move forward now, you say, okay, we can do more surgeries. Well, guess what? There’s no anesthesia. So in the eight , early 18 hundreds, it was a barbaric act to consider doing surgery on somebody. There was, there was certainly, you better be quick if you’re the surgeon.

Speaker 3: 10:01

But can I, can I ask a question before we go forward? I wanna go back slightly like to the, the Middle Ages. The , the , the, the Normans, the Saxons. Zach , when they do sword fights, you see ’em in movies all the time. I watch ’em constantly, right? Guys are getting gash with swords. Are the odds really high that guy’s dying even with a gash?

Speaker 1: 10:20

Absolutely, because, ’cause there’s, you know, number one, they didn’t know. They didn’t know what their , the wound should be , um, like closed over bandaged properly. They felt that separation, which was puss, was good for a wound. So when that came out of the wound, that was egressing from the wound, and that was actually bacteria, which was not good. You know, bacteria is never good for any wounds. And so , um, the wounds got a , a small wound became a bigger wound or an infection that led to redness up the arm. We talked about inflammation. And then you get blood bacteria in the bloodstream. And these , these are serious wounds. Now, if you get ’em bandage, as we talked about, you , you clean it, you control a , seal it with a , you know, linein or oil, or they used mud, they used mud, they used grease, anything to seal the wound. And some of ’em were better, honey was, was good. Yeah.

Speaker 3: 11:11

And

Speaker 1: 11:11

Then , um, you know, you bandaged it and then if you kept everything else from re-injury to that area, or um, compressed it to stop the bleeding, then maybe they weren’t gonna die. So, you know, injuries of any kind were bad. That’s why the armor developed. And the lightest armor was always the best ’cause you had to move and travel. But that’s why the Romans taught all their guys to walk with heavy , uh, munitions and go on long walks. Those kinds of

Speaker 3: 11:37

In great shape. So when we see those, that big battle where they’re running across the field at each other and swords are flying, yeah . Odds are nobody survived that. Sure.

Speaker 1: 11:43

Yeah. Well, a lot of people survived it, but a lot of people didn’t do well after, just like, so the civil war in , in America was in the 1860s, and the, the damage from a a , a minor bullet hole in the arm or leg was almost as useful in killing somebody maybe a little a week or two later, right? Than a , than a shot to the chest. So when we get to , um, things that needed surgery, remember with no anesthesia, there’s no, there’s only gonna be life threatening or limb threatening procedures done. ’cause number one, there was no way to hold the patient down. You gave ’em a , a shot of whiskey, you gave ’em a piece of leather to chew on. And they , and the surgeons in, in London, not only were had to be fast, they had, they were big guys. They held the leg, these big long knives, 14 inch knives that they used to amputate a leg. Uh, the first amputation in history. Do you know how long it took?

Speaker 3: 12:36

No, I have no idea.

Speaker 1: 12:37

It took one minute,

Speaker 3: 12:38

One

Speaker 1: 12:38

Minute. And the patient died five minutes later, <laugh>. So their , the lesson learned was we better tie off some of these arteries. So the guy who was doing it, number one, had no gloves. They didn’t wash the instruments. It was the same knife he used on the last guy. He had blood on his smock. In fact, the most experienced surgeons had the most blood on their smock, their aprons. And they , um, just seemed to be the one who did the most child delivery or surgeries. And they were the people that took care of these gangrenous legs or bad, you know, gunshot wounds or knife wounds to the legs or arms.

Speaker 3: 13:11

Wasn’t that the barber pole ? Doesn’t that mean red or something about the red spin ? The

Speaker 1: 13:14

Barbers, the , the barber , the original people who did amputations. ’cause they had the knives and the instruments to do that. So the barbers, I actually have that in my notes, but I thought we <laugh> we have to, we have to kind skip through parts of the world here. But , um, as we got , um, more and more people getting surgery, this was a Mac , you can guess a macabre episode in an or. But it was a , it is just like, people want to hear about this, you know, grizzly type of thing. They sold tickets to surgery . So you’ve seen people sit up in these balcony seats watching surgery, right? Like remember the Simpsons episode or the

Speaker 3: 13:49

Seinfeld episode? Yeah.

Speaker 1: 13:51

Yeah . And they dropped the junior mint in the guy’s belly <laugh> . Well, this, this is the sa what they sold ringside tickets around the back of the surgeon. So like, you could stand behind the surgeon that was, those tickets cost more money. They were literally right there. They sold tickets for autopsies. They sold tickets to surgeries in London. You would walk through the streets where people were throwing their, their waist out the windows into the streets. You’d walk through the streets with your shoes, walk into the OR because you had a ticket. Right? Right.

Speaker 3: 14:19

And,

Speaker 1: 14:20

And these rooms were horribly contaminated. And the, what do you think the , the death or mortality rate was for an amputation in London in the mid 18 hundreds?

Speaker 3: 14:31

Uh , 50%,

Speaker 1: 14:32

90%. No <laugh> . So if you did the same surgery in Coventry, Coventry, England, in the, in a rural , uh, environment without all the, the theater full of people, right?

Speaker 3: 14:43

The

Speaker 1: 14:43

Death rate was 10%.

Speaker 3: 14:44

What? Really?

Speaker 1: 14:45

And it’s because of this room traffic and contamination. And what, what they found was in the back of the room was this little dweeby guy named Joseph Lister , who’s taking notes. He was a medical student. And he said, you know, there’s a lot of people in here. There’s a lot of crap going on, and I think this stuff’s not good.

Speaker 3: 15:02

Lister ring , is this where Listerine came from?

Speaker 1: 15:03

Joseph Blister. Same guy.

Speaker 3: 15:04

Holy cow. So

Speaker 1: 15:05

He decides, I’m gonna learn more about it. He goes to France, meets a chemist named Louis Paste . You may have heard of him if you’ve pasteurized your milk. The wine makers were particularly interested in finding why some wine tasted poorly. So they had these big wine vats and there was a film on top of some of them . And that wine tasted bad. So they said that this chemist, Louis Pasteur , can you tell us why? So he looks at this film under a microscope and he says, there’s a little critters in there. These little organisms are why your wine tastes bad. And he said, I don’t think those are good for wine. And I’ve seen those in wounds of people’s arms and legs. He goes, I think this is not good for people. But they didn’t listen to Louis Paster because he was a , a chemist, not a physician. Joseph Lister did. He said, what can I do for those? He goes, kill ’em with chemicals. So carbolic acid became the thing. Los Joseph Lister used to wash his instruments and his hands before surgery. Joseph Lister goes to Scotland, opens his own, or he’s a surgeon. Guess what his , uh, infection and death rate was with amputation surgery? 2%.

Speaker 3: 16:14

Wow. So

Speaker 1: 16:14

Queen Victoria gets an abscess, a big boil under her arm in London. And who do they call to come and take care of it? It wasn’t a guy in London, it was Joseph Blister. He comes down, cleanses the wound, does the surgery. She does great. Goes back to London and he says, Hey, I need to invent some moneymakers for my future so my family can get some royalties. So , and

Speaker 3: 16:34

That was probably what, 1870 something like 1880s. I

Speaker 1: 16:36

Made the Listerine part up, but really ,

Speaker 3: 16:38

No, that makes sense, wouldn’t

Speaker 1: 16:39

You , Listerine ? That’s where they made the name up from. Oh , okay . Was his name okay? It wasn’t him. But , uh, in truth, he really standardized cleaning instruments, which was a novel idea because I told you that the guy who was cutting the leg off then would put the knife in his mouth, tie off the artery like this because he had to, you know, control the bleeding. He realized if I didn’t tie off the big arteries to the leg, they were gonna die and bleed to death. So you can’t just, you know, unless you take a hot frying pan <laugh> and sear her on the end. There’s an old movie called The Ruins that has some medieval amputation by some kids in a jungle. It’s like, wow. That is a field amputation there. So

Speaker 3: 17:17

Let me ask her , uh, just in general, when did , uh, the term doctor or physician , uh, require , uh, education? Right? When did , when did that happen?

Speaker 1: 17:27

Well, I am not sure I have that. They certainly had medical schools. They had medical societies in the 17 and 18 hundreds. Okay .

Speaker 3: 17:35

’cause

Speaker 1: 17:35

These were physicians. The surgery , surgery caught up to medicine after the mid 17 hundreds. The best thing that happened , um, well the worst thing that happened actually was anesthesia. You think, well, that’s great. We could keep people asleep and they won’t feel the pain. Well, now we were doing more surgeries on with contaminated ORs and dirty instruments. No, no gloves for the surgeons and, and everything was a mess. Now you’re doing more surgeries because you could hold people under anesthesia longer. Finally, ether in the 1840s came along. They took a guy’s , uh, tumor off his neck. Then they did a dental extraction in Boston , uh, with Ether. And that was real , um, volatile. It , it would explode if people were smoking up there in the or <laugh> . They blew up rooms. They blew up operating rooms. So , um, if you fast forward a little bit from Lister , um, a guy named William Halstead is the guy who was credited with, fixed with developing the first clean operating room. He , um, lived in , uh, Baltimore and went to Europe and studied under a guy named , uh, Robert Koch. And it’s not the, not the soda, it’s the right K O C H. But Coke said that that dirt you see has spores in it. And those spores in a warm environment can, can become like, like seeds in a pod. They become bacteria. And he says, so you’re telling me dirt that has spores is bad if you wanna keep bacteria away from like a wound? He goes, absolutely. He goes back and he had gone to Europe because they were using cocaine in the eyes to numb up the eyes to work on dogs. And they could see the dog just sitting there not feeling anything. Cocaine is a , is a numbing medicine, right? It was originally used for eye and nose surgery and it numbs the area. All the words that end in a I n e , like Novocaine or Marcaine , um, cocaine , um, were useful for numbing an area before you worked on it. So he came back to , uh, what’s now Johns Hopkins developed. He said, I wanna set up an operating room, but it has to be my way. It’s gonna be clean and I’m gonna control everything. And they go, no, you can’t do it. <laugh>. And, and , and he just, you know, it’s conventional medicine. So they said, well, you can go put up a tent in the courtyard where everybody eats lunch in the hospital. They have a little courtyard there with the plants. He set a tent up just like a civil war tent. He took the wood, the smooth wood you see on a bowling alley. Yeah, that’s , that doesn’t have any grooves or anything. It’s smooth. You can clean it. That was his flooring. And he set up clean instruments. He washed everything with carbolic acid, washed their hands. Set up the first surgery in like 1888 in , in Baltimore. The Johns Hopkins First surgery was a gallbladder surgery. They bring in the head of surgery, you know, Dr. Schmo, who’s the guy, Dr. Schmo <laugh> . And he comes in with dirt under his nails and he goes, you out, you’re not doing the surgery on my patient. He goes, I’m Dr. Schmo. And he said, I don’t care. Those things are bad for the wound and you’re not doing anything in this, this tent with dirt on you out. And he didn’t let the guy do the surgery, which of course incurred some more wrath. But basically he was a stickler for, for , uh, cleanliness. His, his head nurse washed everything. They cleansed hands with this carbolic acid, but it ate away at their hands . So finally in like 1910, he said, you know, I’m calling Goodyear. I need a thin rubber glove. My wife, who was his head nurse, he married her , uh, he, he said, I need some thin gloves. I’m tired of hearing my wife complaining about her hands. So surgical gloves were developed by Goodyear, the rubber company, the tire company. Right. And that’s where surgical gloves then came, which at least was better than wiping your hands on your smock. Right? So surgeons then had gloves. So did nurses and you know, surgery started evolving into a more specialized , um, profession.

Speaker 3: 21:25

Alright , so surgeon surgery. When did , when did the term surgeon become like a thing?

Speaker 1: 21:30

Well, I mean, I guess , um, that, that you got me on. ’cause <laugh> ,

Speaker 3: 21:35

Because you are a doctor, right? You’d call the guy down the road. He Dr

Speaker 1: 21:38

Yeah. A doctor’s just a Latin word for somebody who teaches, right?

Speaker 3: 21:41

So

Speaker 1: 21:42

A surgeon would be somebody who does surgery. And um, there were, there are other applications of surgery surgeons, right? Yeah . So there are people that, that work on things that need fixed. The surgical field was a evolution of medicine that took care of a tumor on your le on your neck or fix a broken bone or, you know, like what I do in orthopedics is, you know, bones and joints. That wasn’t, the orthopedics wasn’t even a specialty in medicine till after World War ii. They had all these trauma , uh, cases. The general surgeon would take out your gallbladder and fix your femur. And that was a trauma trauma surgeon all bundled into one area. Surgeons did everything right. Then it became more specialized , uh, in Europe, traumatologists take care of broken legs, broken uh, hips, broken ankles , um, car wrecks. But the , um, general orthopedic doctor would do your bunion or your rotator cuff or uh , an knee scope . They wouldn’t, they wouldn’t do the trauma part. They separate those disciplines in parts of the world. But some places, it depends on how many doctors there are in your area. So if you’re the only guy in Seward, Alaska, you’re probably doing about everything. ’cause

Speaker 3: 22:59

<laugh> ,

Speaker 1: 22:59

You’re the only thing around.

Speaker 3: 23:00

So the , you know, back in even the 1920s, you’d have a farm doctor out there. Would he be doing surgery as well or would he just basically say, this is outta my scope and I’m gonna have to ,

Speaker 1: 23:11

Would do, they would definitely do minor procedures. I mean, you could look at gun smoke and look at doc stone , right? Oh

Speaker 3: 23:17

Yeah. And ,

Speaker 1: 23:18

Uh, taking a bullet out and doing procedures. There were, there were things that limited what we could do. If you, if you look at things in history , um, in, in 1901, our president , uh, William McKinley was, was at a rally in oh

Speaker 3: 23:34

Yeah,

Speaker 1: 23:34

In buffalo. Shaking hands in some crazy , uh, uh, assassin came up, shot him, and you know, he was taken right to a hospital in Buffalo. Uh , they called the chief surgeon who was at Niagara Falls with his family. So they had to call second guy in charge, right ? Who comes in? They rush him to surgery. He’s got a , a bullet in his abdomen and they work on him for, I don’t know , probably three hours. And and how did

Speaker 3: 24:01

They keep him under at that time? Well ,

Speaker 1: 24:03

They had anesthesia then. So remember , what was it? Well, it would’ve been ether, but they had other things like chloroform and other agents.

Speaker 3: 24:08

So is he waking up and they’re going, okay, put ’em back under.

Speaker 1: 24:10

Yeah. Or they just keep him under there . The what actually limited his surgery was sunlight. They didn’t have electricity until 1880. Edison didn’t discover electricity until 1880, so all hospitals didn’t have electricity inside. So at five o’clock they were shining. The medical student was shining a mirror from the window into the room with sunlight that, I mean, it wasn’t, there weren’t lights, right ? I mean,

Speaker 3: 24:35

This

Speaker 1: 24:35

Is candles. And uh , you know, once it got dark, it was like, guys, there’s no more light. And they closed up McKinley and they said he’s a goner . ’cause they never found he’s a car . They never found the bullet. So he spikes 104 fever that night. They call the vice president in who was hunting that would’ve been Teddy Roosevelt. Teddy comes in, goes, well, I’m here if you need me. And then they think McKinley’s gone. But you know what? He rallies and he’s better. Teddy goes back hunting seven days later, McKinley dies. Teddy’s rose . Teddy is

Speaker 3: 25:05

The president . So what’d he die of if he

Speaker 1: 25:07

Died of like infection from the surgery? From the bullet bleeding internally. I mean, I don’t really know what killed him, but they didn’t find the bullet. He probably, I’m even sure they had to get the bullet out. You know, we used to, we have people from the wars that have had shrapnel in ’em for 50 years. And the, the , if you got a piece of shrapnel in your leg, it’s not gonna kill you . You know, bullets kill people if they transect an artery or cut a cut a major portion of your , uh, intestine and it leaks bowel fluid into the belly. So you don’t

Speaker 3: 25:33

Need a pool

Speaker 1: 25:34

Bull . I never

Speaker 3: 25:35

Knew that. I thought for sure

Speaker 1: 25:36

You had to get the bullet out. It’s , it’s drama. When we take out a screw or a bullet, we always get a metal basin to drop it in. Yeah , it sounds , make it tinging . In fact, the girls don’t even have metal basins anymore. So they go on their phones and they go on a list on Google and it makes a tinging sound. And they go, here , I can’t drop this bullet in. ’cause everybody’s waiting for you to get the bullet out. Right? Right. Like anesthesia’s waiting, all the people are there. You’re there to get the screw or the bullet or metal piece out of the body. And they’re, they’re not that easy to find. I mean , see , <laugh> , they didn’t , they didn’t find it on McKinley. So , um, you know, there were things that evolved in surgery, better lighting, better everything. As we became more technology , now we have, we had a podcast on robotics. We had a podcast on computer navigation. We’d have podcasts on, you know, next thing it’ll be virtual reality. These headsets the kids are using to play games we’re using now , uh, in surgery to see how to put your knee in or how to put a screw in your back to fuse your back. So, you know, we’re wearing these virtual headsets. There’s no radiation with that. I don’t have to get a cat . I don’t have to do these other major , um, um, imaging modalities in the procedure. So as, as technology evolves, we get better ways to do everything. We have gamma knives for taking a thing in your brain out with a precise laser cut. I mean, there are things that just will continue to evolve. Well to do

Speaker 3: 26:56

Be , that’d be a good podcast. Right? We’ve now covered the history a little bit. Why could we ever do one on what the heck the next 20 years will look like? We

Speaker 1: 27:04

Can do whatever we want because we’re podcast guys,

Speaker 3: 27:07

<laugh> . Well, I think that would be fascinating to look to . ’cause we look back now, let’s look forward. That would be something fun that we could look forward to doing.

Speaker 1: 27:14

Yeah, I , um, I think this topic is, is really an interesting topic because you can see that it , it’s really been a problem through the years as we figure out how to take care of things. Now we have , uh, what are called hyperbaric oxygen chambers now where you have a , a wound that won’t heal and it, it actually hyper , um, intensifies the oxygen in the chamber. And oxygen obviously brings blood flow or oxygenation for healing. And this helps wounds that couldn’t heal otherwise. Maybe you have a , a person who’s a smoker or a diabetic with bad blood flow or vascular disease, or they’ve had a , you know, a bad, you know , um, ocean , uh, contaminated injury right

Speaker 3: 28:03

From

Speaker 1: 28:03

A piece of coral and, and hyperbaric oxygen is a , is a great modality for wound healing. There are things we talked about with platelets. P R P is probably considered, we talked about the three healing gestures. They’re now saying the fourth healing gesture may be , um, what are called natural biologics that have growth factors. So platelets called in in the P R P P

Speaker 3: 28:25

R P , right? Yeah . Comes from

Speaker 1: 28:27

Platelet poor plasma. Yep .

Speaker 3: 28:28

There’s

Speaker 1: 28:28

Over 1100 growth and anti-inflammatory factors in platelets. Those are natural things that help healing and growth and help stimulate the body’s recovery from an injury. So there are a lot of surgeries where they close your breastbone after heart surgery and they put in p r p like, like the Pope putting in holy water along the front of your sternum. And that helps healing or cuts down scarring. We do these, I talked about hip arthroscopy and shaving bumps that rub on the hip labrum. And when we trim that bump or bunion type spur away , um, it’s a raw bone edge. So we put p r P in that reduces scarring, decreases pain, decreases , uh, pain and narcotic use after surgery. Improves move motion. And, and these are, you know, level one, which is the best randomized double-blind studies out there. So there will be more what are called , um, ways we get wounds to heal and address those. I mean, there’s nothing , um, more , um, disturbing to a patient or a doctor than a wound problem after a joint replacement. So I tell people we had a , a couple podcasts on tips for bad hips or how to get a great knee replacement. Right?

Speaker 3: 29:40

Let

Speaker 1: 29:40

Me ask you this. You know, I tell my patients about a wound problem after a total joint and a wound problem with a total joint patient is a disaster. And you have to, you have to get the wound to heal. You’ve got this implant in and you have to hope that the bacteria doesn’t get down in the wound. That’s why we have people scrub their skin, get all their dental work done, get any wounds covered or cleaned, don’t have surgery. If you’re not in a healthy condition, cut down your, you know, stop your smoking before surgery. Do things that optimize your ability to heal a wound. Now surgeries that are elective like a joint replacement, you can do that ahead of time, right? If you’re getting hit by a right , by an elk driving your car and you’re in a car wreck , uh, then you know, we don’t know whether when , when you took your last showers, your mom just cares what your underwear looks like when you go to the er. Right, <laugh> . That is true. So I think you’re just, you know, you’re dealing with, you know, what are called elective and emergency situations. And you know, again, wound healing is a huge subject. We talked about it from the Mesopotamian years to now. And it’ll continue evolve to evolve as we go forward.

Speaker 3: 30:47

So this is a great place to land this podcast. And, and again, this is fascinating to me ’cause I could e listen to it all day long. This is great stuff. Uh, is there anything you wanna leave our listeners with before we sign off?

Speaker 1: 30:58

Well, no, I’d like to say , uh, thank you to Ted’s dressing sponsor Ted’s

Speaker 3: 31:03

Dressing. It’s great stuff by the way. It’s really good

Speaker 1: 31:04

Stuff. It’s, it’s , uh, it’s gluten-free, dairy-free, sugar-free. It’s all natural . Um, it is available in, in the lo fortunately only in the Dayton area now. Um, so you have to come to Ohio. This is the best Air Force museum in the world here.

Speaker 3: 31:17

It is.

Speaker 1: 31:18

Um, but , uh, it will be at some point available on the internet. Um, the , um, the podcasts are available and we thank tri-level recording for , uh, putting a great podcast together.

Speaker 3: 31:29

Absolutely.

Speaker 1: 31:29

Uh , we just hit our 75th hundred 7500, 7500

Speaker 3: 31:33

People downloads. Yeah ,

Speaker 1: 31:34

That’s pretty good. So is

Speaker 3: 31:35

It you, are you the only one downloading these things 7,500 times?

Speaker 1: 31:37

I , well, yeah. My finger is getting tired, <laugh>. Um , but , um, we appreciate people telling other people about the Bone and Joint Playbook. It’s on, you know, it’s on , uh, Spotify, apple , uh, Google, YouTube, any place you listen to podcasts and , uh, you know, tell your friends. We try to keep it , uh, not too technical. That’s right . But just enough to keep the grizzly , uh, interest of the, the listener in there.

Speaker 3: 32:00

Well, this, this was a great podcast for the Halloween days. Looking forward ahead. So , uh, we’ll sign off here. Dr. Erst, thank you again for joining us on the Bone and Joint Playbook.

Speaker 1: 32:10

Well, thanks Terry . And , and , and I hope somebody out there is gonna dress up like a , uh, like a surgeon, surgeon for , uh, with blood on their <laugh> , because otherwise it’s gonna be a bunch of Barbies going door to door

Speaker 3: 32:20

As Barbies gonna be popular this year . Alright guys, thanks very much. We’ll see you soon.

Speaker 4: 32:26

Thank you for joining us today on this episode of The Bone and Joint Playbook with Dr. John s Tips for pain-free aging. Please join us again for another episode produced by Terry O’Brien .