 Lakeland Public Television presents Currents with host Ray Gildow, sponsored by Niswa Tax Service, offering tax preparation for individuals and businesses across from the City Hall in Niswa and on the web at niswatax.com. Hello everyone and welcome to Lakeland Currents where this evening it's my opportunity and pretty unique opportunity to welcome the two newest orthopedic surgeons to the Cayuna Regional Medical Center in Crosby and they are two of now what are seven staff surgeons which really is incredible when you consider the size of the area is the size of their Crosby Ironton area so that's pretty cool. To my immediate right is Susan Mohan who is a hand specialist orthopedic surgeon and Dr. Jonathan Herseth and you are a general orthopedic surgeon, do you have a specialty? Yeah I do general orthopedics, I also had an additional year of training in sports surgery so focusing on problems with shoulder, knees, as well as hips. Well let's just talk a little bit about your backgrounds because you're both new to the area Susan I think you've been here since the 1st of September and Jonathan I don't know how long you've been here. About the same time. About the same time. Started about a week after. Very short period of time and your first impressions of the region? Love it. That's great and I know you work at Satellite maybe you both work at Satellite places so you've got a Satellite office in Baxter and another one in what is it Aiken in Aiken so you have three different sites where patients can contact you if they need your services. Susan what's your background? I grew up in Stillwater and we used to vacation up here all the time when I was younger yeah so that's how we became familiar with the area. We used to go up on Gall Lake and I was too young to really remember which resort so don't ask me. I just remember it being some of my favorite trips when I was younger. I grew up as a big water skier and then I went to college in medical school and I've been gone for ten years and so the chance to come back to Minnesota was something I was looking for and the practice that Dr. Severson built is just incredible up here. And you went to Creighton University in Omaha and you said that you had 130 or so students in your class and you were sort of amazed to find out that you're a woman in a man's field. Yeah so 11% of practicing orthopedic surgeons are women. Wow that surprises me I didn't realize that. Yeah it's you know up in this area it's nice you know I'm not the only female orthopedic surgeon in the area but so it's nice to have that in this region and see that it's kind of changing and shifting some but. And you said the first thing you look at when you meet people are their hands. I do. What are you looking for when you talk to us. Well a lot of different things I look I can't help myself. I see a lot of people have had run-ins with the chainstaws or table saws in their path. No fingers and that sort of thing. But you know you can see arthritis at times or some different hand conditions that kind of present themselves and are very subtle apparently if you're not looking for them but I've grown accustomed to kind of looking at people's hands and going oh you have this it's incredible what you see. And Jonathan what's your background. So I'm a native to Minnesota as well I grew up in Roseau Minnesota. I kind of stuck around though I did all my training here. University of Minnesota. Yeah so I did medical school starting at Duluth so I did two years up in Duluth and as the program goes you go to the cities for your last two years and I also did orthopedic residency training at the University of Minnesota and then an additional year of sports training at Tree Orthopedic Center. So did you work with specialists at that center where people that just did knees or just did shoulders or elbows or did you work with all kinds of them. Yeah so at some of those larger centers people kind of have their niche and so we had people that worked specifically with shoulder and so I would have an opportunity to work with them people that did only knee type of surgery and I had the opportunity to work with them so it was a great opportunity I got to get some exposure to high school college and professional sports teams during that year and got to kind of see you know what their what their day-to-day operations are in terms of taking care of athletes so what attracted you folks to this area it's so common to I have I was a coach for 30 years and a lot of my former players went to the big cities where they could make all the money what attracted you to rural Minnesota well I think I'm sorry I didn't mean to interject but I think for me specifically you know I wanted to try to fulfill part of the mission of our the medical school that I chose to attend University of Minnesota Duluth campus specifically is very focused on rural medicine ideally they would have wanted me to go into family practice and I did fail them in that regard but I did want to fulfill the mission of trying to stay in a rural area and provide medical care in a rural area but you knew right away you wanted to go into especially like orthopedics you didn't I did not know right away I did not know originally you were going to be a family practitioner and that yeah that was my original plan and that was my original goal and you know life circumstances happen and all of a sudden your interests kind of change I had I had a rotation in orthopedics early on in my third year of training and absolutely loved it and then later that year I had a pretty significant knee injury that had required a lot of surgery a lot of rehab and and after that occurred I was I became very interested in orthopedics and that's what I wanted to do Susan tell us what's unique about an orthopedic hand surgeon what what why is that different than just an orthopedic surgeon yeah so you know I did my five years of residency in Akron Ohio to be an orthopedic surgeon to do kind of treat all the conditions I really found a lot of interest in the hand because there's a lot of moving moving parts and it's very intricate balance and there's a lot of really small things the glasses that I wear in the OR have the little microscopes in them to see them and there's some micro surgery involved and really like Google glasses yeah but they work they were sort of they disappeared haven't they but so you know I found the anatomy and the complexity of it very fascinating and there's a lot of different things that can then go wrong but then there's a lot of different ways you can fix it so there's not just you know arthritis there's problems with tendonitis or ligament injuries or issues with your nerve compression or blood flow that all kind of fall into that category so how do people with problems with their hands know to come to you versus to go to a Jonathan did you work that out within your team or how do they know people that don't know you and they got a problem with their hand would they just go to Jonathan and he'd refer them to you or how does that work you know I think we have a system in play you know if people call in and they want to be seen for something specific like they say my thumb hurts then the nurses are able to triage it to the provider unless they have a specific request then we have them see who they would like to see and then we talk amongst ourselves and work out is appropriate it's not terribly uncommon where I I occasionally see patients that have multiple problems and you know for things that involve the upper extremity I you know aside from the shoulder you know I might see if Susan would be willing to see that patient so that you know we kind of work as a team you know I wouldn't say we're just you know individual units running around we you know we we talk communicate and try to get each patient to the appropriate provider so you're talking about micro surgery like carpal tunnel is that still pretty much of the basic same surgery that it's been for ten years or is you see that changing too so there's a couple different ways that you can do it the way that I do it is the way that Dr. Paul Severson has been doing it up here for years and really made it the standard of care for the area which is kind of advanced in some regions still and that's through a scope so it's actually using a camera to visualize the ligament it means a smaller incision in the palm it's still the same procedure in the end as far as the final outcome but patients seem to prefer it as far as the incision and recovery time so how far can you actually see along that you can see the whole ligament really with a scope wow and then that blows up on a screen I suppose like a TV screen or something and then do you do that surgery from that screen mm-hmm wow has a little blade and that kind of flips up and it it cuts the ligament you watch on the screen actually as it cuts it so it's so when when people come to you and I've seen people with extreme arthritis where they're just their hands are deformed what can you do for those people or is there anything you can do well it depends on the cause of the arthritis sometimes if it's something like a rheumatoid arthritis which is more a systemic problem than medications are really the mainstay if there's certain joints that are bothersome then we can try and treat them with injections or with therapy and then sometimes there's surgeries to try and help with those certain joints the difficult thing is it's not like your shoulder where it's one basic joint you have all of the joints in your hand every knuckle is a joint and so to try and treat all of those to try and prioritize you know okay which ones are the ones that are causing pain and how do we make those feel better and keep your function and your motion no I'm not suggesting you've done this before but we're seeing more and more reattached hands or attached hands for the first time from one person to another what a person a neurologist who does that sort of work work with an orthopedic surgeon for the rehab portion of it then or how does how would that typically work in a hospital so the people who reattach hands and that are generally our hand specialist whether they come at it through plastic surgery or orthopedic surgery they're hand surgeons who do that procedure that generally requires a pretty big facility and they have multi-surgeon teams that do those procedures and it's relatively uncommon so when it comes into that then then you're looking at really a multi- specialty team and then multiple hand surgeons working together to to reattach something that that that's that significantly injured that's amazing technology it really is Jonathan you talked about your knee injury as a coach for many many years I've just amazed at how many more ACLs and meniscus issues that we're seeing yeah are these just overuse injuries for the most part or what do you think is well no I you know I think there's very well defined mechanisms as to why some of these injuries happen there's very specific knee positions that the knee might be placed in during competitive athletics that predisposes you to you know rupturing your ACL or having other legamentous injuries one of the big focuses in kind of the sports world has been to really maximize preventative measures in terms of decreasing the incidence of ACL injuries and you know I think overall the results of these preventive measures have been good it's a little bit hard to delineate in the population just how effective we've been with it but I think the general consensus is that there has been some good effect with that so if you were talking to coaches who might be watching you would say is there a place that you can go and learn about the kinds of activities you can do to strengthen knees and arms to prevent these kinds of injuries yeah you know so physical therapists and athletic trainers have become pretty well versed in the preventative measures as well as sports medicine doctors as well and certainly there are programs that are starting to be developed that can really focus you and put you through kind of a training algorithm to focus certain muscle groups to try to prevent injuries like that from happening did you happen to catch Teddy Bridgewater the Vikings quarterback with how he just fell that was just amazing yeah that was an interesting that was an interesting mechanism what that was kind of unusual wasn't the way this happened yeah yeah that was a very significant knee injury with you know relatively low trauma I have seen it one other time really in in my training where a gentleman had a similar mechanism to that but it is a very very unusual problem I don't know the specifics of Teddy Bridgewater's injury but I know they were very concerned about arteries veins exactly yeah so a knee dislocation can be a very very serious injury and could be even limb threatening in the worst case scenario so fortunately for him it seems like his nerves and arteries and everything were were okay it's amazing talk a little bit about the microsurgery that we're hearing about I mean I know a couple guys who had a hip replacement and they have a scar about this long I don't know is that common or is that I know that was practiced for a while and maybe but why are we getting away from that again a little bit you know it's it's a constantly evolving methodology for doing any kind of total joint replacement is is kind of happening there there was a two incision technique for a total hip arthroplasty that was popular about ten years ago I never did any training with that I never actually saw any of those surgeries one of the more you know talked about methods is doing an anterior approach or a direct anterior approach for total hip arthroplasty ultimately patients have potentially a little bit less pain and a little bit faster recovery in the first six weeks but you know currently it's thought that at about one year there's really no difference whether or not they go from a posterior approach or to an anterior approach so my partner Dr. Sieverson is doing some anterior hip replacements and he also does a posterior approach I've been more well-versed in doing a posterior approach so that's kind of my my go-to technique so as we're getting older which unfortunately we I haven't figured out where to stop that we're seeing more and more of these baby boomers actually I'm I'm pre baby boomer so I'm not a baby boomer but I would guess that you're seeing a lot more knee and hip issues because of people's age I would guess the other contributing factor for America is obesity putting a lot more weight on those particular joints yeah absolutely we have just to the nice collaboration we have at Cayuna is the general surgeons have their bariatric program which they've really been at the forefront of the field in that and the procedures and their interventions that they have for patients in that respect so that's really helped us in collaborating as far as you know what component of your arthritis is from you know your weight and how much in what can we do to try and take the stress off of that and improve your overall health as well and you know improve your outcomes with surgery because we know people who are morbidly obese have a higher rate of complications with their joint replacements so we want the best outcome for the patient so that's been a nice collaboration that they've been doing now for years to try and improve outcomes for patients so maybe get them out of program where they can lose weight start watching those other factors before you would have to do surgery or if you do have to do surgery get them to a certain level so that it'll be more successful recovery I do remember Dr. Severs and talking about that when he was on the program one one year right that's amazing yeah looking at the whole person now not just at a bone or just absolutely you know obesity specifically doesn't just affect your joints you know it predisposes you to conditions like diabetes and it can be a serious you know health problem and it puts more stress on your cardiovascular system so you know your knee might hurt but there's definitely more benefits to losing weight and trying to keep your weight down you know he talked about diabetes and I know that a lot of people have lost limbs from diabetes what happens when they do because I had a month my mother-in-law had lost a leg and she had diabetes and she never took a pain pill after the surgery and the doctor said that's not uncommon because your nerves are all gone what does the diabetes do to our nerves when it gets to that kind of a situation we know it changes the makeup of the nerves themselves especially and it tends to involve the small nerves and the fingertips but we think of it more on our feet and the first what ultimately happens is you lose so we call protective sensation so you step on a Lego and it hurts that's your body's protective sensation or you're walking in an uncomfortable pair of shoes and you feel a blister that you take your shoes off or you stop walking or you look at it if you don't have that protective sensation you continue to walk on it and you can wear the skin all the way through and so then you get these ulcers and infection becomes a problem so it's that loss of that protective sensation kind of our body's gift of pain that tells us something's wrong you lose that with diabetes and that and that can be kind of the source of the problem and then you also have a decreased ability to fight the infection once you get it you know it's interesting over the years over the ten years that this is our tenth year of our program have had a number of experienced doctors on from a number of hospitals and they all sort of lament about the tremendous changes they're dealing with from an administrative side of being a doctor you know where before they could deal with the patients and the nurse or somebody else took care of all the the paperwork and I would guess that you being new and haven't had that burden of what it used to be like you're probably finding that transition easier it or do you you find it frustrating the way you have to do all your reports well so when I was in residency in Ohio the hospital I was at for the first few years was still on paper charts and we hand wrote our notes and then you had to go physically find the charter you had to call and had somebody read it to you and those kinds of things and it led to a lot of problems of you somebody writes a big long note but you can't read anything that it says or you don't remember what was in there and so it's somewhere else so the patient goes with it so it's while there's it's cumbersome to use the electronic medical records it is also nice to have access to all this information and I can look at the most recent note from a patient's family doctor without trying to having to dig through the chart and try and find it and go through that so well some of it is cumbersome and you know we work on trying to streamline that I think there's definitely some benefits to it I know as a patient I really like the fact that I can go online yeah and tie into the team of medical staff that are working with my doctor and I don't have to go to the clinic every time I have a question I think that's pretty cool but it's like change for most people the older folks sometimes have a harder time making that change than the younger folks do when you folks deal with your patient for the first time I get the sense from your hospital that surgery isn't the first thing you look at no no we start with you know is it something that needs to be fixed or is this some you know kind of a explaining the condition and then giving a patient the options and most of the time you want to exhaust all your nonoperative things such as therapy braces splints injections before you progress to surgery because any surgery no matter how small there's complications and there's risks involved and so you want to know that we tried you know all these other things and and we've looked at all your other options before we've gone to this and for the most part the nice thing about elective orthopedic surgery is it's not a life saving but it can be a life-changing surgery so it you know it's the patient the patient has some decision and some choice in it where they can decide you know when is the right time and and what what feels right for me you know I tell patients not infrequently that there's things we can do you know but the question is should we do or do we need to do that you know because there are conditions where you know we might see a little bit of pathology there might be a partial thickness rotator cuff tear or something like that but people can oftentimes you know they don't need surgery for that right away you know they can get better with therapy we could try you know different types of nonoperative things like injections to see if we can get their pain under control so that they can actually rehab their shoulder or their you know their muscles and they oftentimes can avoid surgery and you know I like Susan was saying surgery is a big deal you know as routine as it's maybe been thought to be you know in the public I think it's it's still kind of a big deal you know a lot of people get total knees as you were saying you know we're hitting the baby boom generation we're anticipating that the the number of total joints that we'll be doing in the country will possibly close to double by 2030 wow and so you know these these are seemingly routine surgeries but they are big deal surgeries that's kind of my take on it you know I think I think it's best to try to try to do everything we can before we go down that road well I have a couple minutes left but I love asking this question I did ask it a doctor Severson I remember his response and I'll tell you what he's when you get through but the first time you did your surgery really on your own I suppose it was residency what was that like for you the first time I felt very empowered really yeah it also don't realize the gentle encouragement you're hearing from the you know someone else when you're doing it where kind of get a mm-hmm as you're going and so when you're doing it on your own you're making those decisions and you know this is the okay this is where it's gonna go and this is you know we're good this is released and like that so I found it very empowering I like that I thought it was great you know I you know just kind of reinforced what you've been training for and learning about and then and then it's fun to see their reaction when you pull up the x-ray the next day and it looks good I don't remember the exact area where he was doing surgery but I think it was something new in the gastronomic area maybe and he said that he was basically on his own and it was petrifying he was it was the first experience at doing this because he's done some cutting edge things and I saw I thought that was pretty unique well we're out of time believe it or not but I would like to take the opportunity of thanking both of you for appearing on our program and you both get a new car for being here now not really but welcome to the Brainerd Crosby area and the Cayuna Regional Medical Center and I hope you have a long and great career in the communities all right well thanks for having you you've been watching Lakeland Currents we're talking about what you're talking about I'm Ray Gildow so long until next time