Armor Men's Health Show

EP 683: Know Your Knees! The Problem with Pickleball & Dr. Goldberg's Warning for Weekend Warriors

• Dr. Sandeep Mistry and Donna Lee

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In this episode, Dr. Mistry and Donna Lee are joined by Dr. Tyler Goldberg of Austin Orthopedic Institute. Like Dr. Mistry, Dr. Goldberg loves surgery. In fact, he has performed more than 9,700 joint replacement surgeries as an orthopedic surgeon! Today, Dr. Goldberg shares his wealth of experience with our listeners. While our knee cartilage is doomed to breakdown if we live long enough, you can actually train your body to better absorb the impact of walking/running through our daily lives. If you've ever wondered, "Is it time to have this hip or knee replaced?" tune in to hear Dr. Goldberg’s prescription for better joint replacement surgery outcomes. Visit him online or call 512-856-1000 today!

Voted top Men's Health Podcast, Sex Therapy Podcast, and Prostate Cancer Podcast by FeedSpot

Dr. Mistry is a board-certified urologist and has been treating patients in the Austin and Greater Williamson County area since he started his private practice in 2007.

We enjoy hearing from you! Email us at armormenshealth@gmail.com and we’ll answer your question in an upcoming episode.

Phone: (512) 238-0762

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Speaker 1:

<silence>

Speaker 2:

Welcome to the Armor Men's Health Show with Dr. Mystery and Donna Lee.

Speaker 3:

Hello and welcome to the Armor Men's Health Show. This is Dr. Mystery , your host, board certified urologist and expert in Men's Health. I'm joined by my co-host Donnel Lee . Hey

Speaker 4:

Everybody, welcome to the show. Thanks so much for listening and sharing this podcast with your friends.

Speaker 3:

We really pride ourselves in a holistic approach to urologic care, including the inclusion of many different types of practitioners, including advanced practice providers like PAs and nurse practitioners, as well as sex therapy. A health coach that helps you with your diet, nutrition. We deal with sleep, we deal with pelvic floor physical therapy, and then of course urology. Mm

Speaker 4:

Oh, there's that. I remember interviewing a urologist and they were like, what is holistic urology? Like, I want to do surgery.

Speaker 3:

That's right. I

Speaker 4:

Had to explain it. Yes.

Speaker 3:

Okay . Which is that we care about the whole you and how do we become patients of ours. Donna,

Speaker 4:

You can find out how to be the whole you by calling it 5 1 2 2 3 8 0 7 6 2 and visit our website, armor men's health.com where you can submit your questions that will answer anonymously. If you're

Speaker 3:

A regular listener, you'll know that one of our little taglines is from the nipples to the knees. Mm-Hmm. <affirmative>. And so we stop at the knees. So sometimes it's good to find out more about knees. We have

Speaker 4:

A knee

Speaker 3:

Expert. We have a knee expert. Alright . We're joined by one of my great friends , uh, a wonderful pal that I really enjoy being around and talking to Dr. Tyler Goldberg , uh, orthopedic surgeon here in Austin, Texas. Thank

Speaker 5:

You so much for having me. I didn't know I was a steamed knee expert today. I did sleep at a Holiday Inn Express last night. So

Speaker 3:

<laugh> ,

Speaker 5:

I feel quite confident in my knee skills today.

Speaker 3:

That's amazing. So, you know , uh, the , the last couple of months I've been starting to do some yoga and some stretching. What? And some like, and some exercises. Really. And my knees hurt

Speaker 5:

More of a holistic approach to life.

Speaker 3:

Right. And I wasn't an athlete. I mean, I sat on the couch and studied a lot.

Speaker 5:

I can't believe you weren't an athlete.

Speaker 3:

<laugh> . Very funny. <laugh> man. Oh wow. That was , that was cold . That was cold. That was good. So , um, I guess maybe I wanted to talk about just kind of the natural evolution of knee pain. What happens to us as we get older even , I mean, I understand Earl Campbell can't walk around Sure. 'cause he was a , was a truck. But what about just like those of us that, like, you know , those

Speaker 5:

Of us that are regular human beings that walk around for a living and sleep and go to work and things like that. Why do we get knee pain? What should we

Speaker 3:

Expect as we're aging?

Speaker 5:

You know, it's interesting being orthopedic surgeon because a hundred percent of the population will get knee arthritis if we live long enough. It's a wow , it's a great disease for orthopedic surgeons because we're all gonna get it. But that's just kind of one of the natural things with , uh, aging. Some of us have a higher incidence to, you know, a higher desire or higher need to get it, if you will, because they have family issues or they have post-traumatic issues like an Earl Campbell that, you know, tore cartilage in inside the knee. But most of us, if we just live our daily life, eventually our cartilage will begin to break down. That's just what happens with life. And

Speaker 3:

That's because this knee joint that we have really carries quite a bit of our weight whenever we run upstairs or walk. Yeah. It re there , there really is a big transition between our, our weight distribution and our knee

Speaker 5:

For sure. And when we, when we do certain activities, it's more than just our body weight. For example, you mentioned stairs . When we go upstairs , it's three to five times our body weight across our knee joint. And when we go down it's five to eight times. So there's a significant amount of force that's over and above just how much we weigh that gets delivered to our knees. That's why we're talking about activities such as yoga like you wanna do and like you're getting into and bicycling, things like that, that provide a good cyclical motion for the knee, but don't really sort of impact load it and overload it so that we'll sort of hasten up or speed up the degeneration process.

Speaker 3:

Now when you're seeing men that are trying to like, get into fitness, you know, and they're , I I'm not talking about the 18 year olds that are kind of doing weird things that Yeah , yeah . Don't make any sense in the CrossFit gym, but when you're, when when you , when you see like a middle aged guy, like who I am now, somebody in their forties and fifties Yeah . That's

Speaker 5:

Trying to get Yeah . I'm talking to 'em all day 'cause I'm that guy too. Mm-Hmm . <affirmative> and

Speaker 3:

You're trying to get back into fitness. What are some common mistakes you see them make?

Speaker 5:

Uh, so, you know, it's definitely the kind of the weakened warrior. They could do too much too fast and they end up, their body's not ready for it. Their body's not flexible enough for that particular activity. It's the CrossFit on the weekend. Pickle ball's been great for my particular industry, <laugh> because they think that they can go out there and perform like they're 18 years old on a pickleball court and their body's just not ready to do it. So , mm-hmm . When they're starting, you know, and I spend all day talking to guys like this , uh, and ladies, actually, when you're starting your activities, you need to sort of ramp up and build up into these activities and train your body to be able to accommodate what you want it to do. Right. And some of us just have limitations. I have no motion in my left hip. Okay, great. Guess what? I've got to accommodate everything that I do. You know, I'm a big golfer and uh, you know, I have to modify my activities on the golf course to account for my motion, my hip. And so you have to learn that.

Speaker 3:

So as a fellow physician, explain this to me in my brain, the mechanics of the knee or the hip or the joints are just bones and cartilage and hard things that don't change. Now, how do you prepare your body to be able to do things? Like why does it matter if you warm up or ease into things? Aren't these just mechanical hard things that they're going to get harmed no

Speaker 5:

Matter what? Sure . But they respond into correlation to a , an old sort of scientific entity called Wolf's law. Right. And so Wolf's law means that structures build in , in accordance to how they are loaded. So you need to sort of train your bones and your cartilage and your muscles to be able to see this activity, this exercise, and respond to it and heal from it. That's why everybody would think, well, my practice would be full of old marathon runners. Well, marathon runners actually have like super cartilage because they've spent years developing their cartilage and, you know , making their cartilage resistant to wear as they do these particular activities.

Speaker 3:

Because that's how the body is different than a machine. The body can adapt to what you're doing and make micro changes to get you into a position to tolerate that activity more.

Speaker 5:

A hundred percent. And we're just sort of watching it and sort of manipulating its natural processes, right? This is so through the whole stage of like healing, right? Everybody says, well, I'm a fast healer. Well, you're not really a fast healer from injury, you're a healer. And the body has a certain way that it heals, whether it's from surgery or an injury. And the body has a certain sort of program built into us that it's gonna go through. And we have to sort of adapt and honor that. And that's what we are as physicians sort of charged to do, is sort of lead people through that healing process in a good way.

Speaker 3:

So, you know, we talk about when do people need surgery? And almost universally the orthopedic mantra is when you can't do the things you want to do

Speaker 5:

Or they have a beating heart. Okay .

Speaker 3:

<laugh>. That's why we love each other because you're really a surgeon at heart, just like me. You know, that's that indication for surgery. Uh , patient is still alive and has a penis. Yeah . <laugh> . So there's not being able to think do the things that you want to do and then feeling tweaks or clicks or pain when you're doing something that you're already doing. Yeah. Yeah. You think it's possible that once you're having pain to be able to go back and do things so that you can do those activities and not have pain? A

Speaker 5:

Hundred percent. That's, that's the reason for my existence, right. That's what I do. I take people from having pain and dysfunction and in anybody to do the things they want to do and restore them back to their activities. And they call me every day and they're like, you're not gonna believe what I did today, <laugh> . I'm like, okay, good. <laugh> . I just bike from Nebraska from the east side to the west side. I'm like, well , why did you bike across in Nebraska? 'cause you gave me a new knee. Okay, great. Here you go.

Speaker 3:

And I think that a lot of people view getting a knee or a hip as the end, not necessarily the beginning of a new , new journey.

Speaker 5:

I , yeah. Yeah. I would say it's restoring your life back. I mean, you know, they're mechanical things, so they're certainly not perfect and there can be problems with them, but the improvement in quality of life as immeasurable for these people that get these things. So you kind of mentioned and touched on kind of the indications for surgery . For me it's very, very easy, right? When you have pain every day , you can't do the things you want to do. When you have pain at night that prevents you or wakes you from sleep. And when you've done everything in the conservative world and you're like, I'm done. I'm ready to be fixed. That's when it's time to do surgery. And

Speaker 3:

So , uh, how do you distinguish someone that needs a knee replacement or a partial knee replacement or a ligamentous repair, like knee pain for the patient may just be knee pain. Yeah. Yeah. What kind of tests , uh, diagnostic things do you rely on to advise a patient on how, how to repair them?

Speaker 5:

Number one, I listen to 'em. That's it. 90% of my diagnoses comes from sitting there just listening to the patient. They already know what they have when they come in nine, nine outta 10 of these patients. Some patients are very pleasantly surprised that they don't have as much arthritis as they thought they did or something like that. But I just listen to the patient. If they give me those three characteristics and they've done everything the conservable zone and they're just , they're desperate for a fix, then it's time to fix them almost regardless of what all these x-rays and MRIs and CT scans and all these sort of advanced diagnostic things that we use on a daily basis. It's the patient, right? Because we don't, at the end of the day, we don't treat the pa , we don't treat X-rays, we don't treat CT scans, we treat people, right? And so if somebody has a problem that I can fix for them, then I'm ready to do it.

Speaker 3:

It really, really speaks to how important the practitioner that you go to can impact the type of care you get. Because I think many patients experience is such that people aren't listening to them, people aren't kind of trying to help them with the , what their problem is. And so then they call me their urologist to order their knee MRI because they're like, well, just give me some kind of answer on what's going on.

Speaker 5:

Correct. And some people, you know, they kind of want to be their own sort of doctor initially and they wanna say, okay, I think I need this, I need this. 'cause they go to Dr . Google. And that's completely, that's completely fine. Right? That's a, to me that's a welcome sort of conversation because they're at least interested, right? I'd rather have somebody that's interested in their care than just as like, well, I don't care. Whatever you wanna do, doc. No, no, let's get you invested in your care and , and do some shared decision making , right? I'm very into this kind of, this shared decision making . There's times where I kinda have to put my doctor hat on and say, you have to have this. You're having a problem, we gotta do this. You don't have a choice. And then 90% of the time it is, Hey, let's talk about what the right thing is for you. What treatment fits you best. A holistic approach. That's a great thought .

Speaker 4:

There we go. Holistic orthopedics. There

Speaker 5:

You go.

Speaker 3:

I wouldn't go that far. <laugh> , <laugh> . This guy's about as straight in a air as it comes as it comes to orthopedic surgery. So , uh, you just started or, or you left a large group and started your own practice. Here's, here's your test. Do you know the name of your practice, your website and your phone number? Let's hear it. I

Speaker 5:

Do indeed. I can't believe I'm getting tested on this. So let's do it. My name of my practice is Austin Orthopedic Institute. I came up with that myself, so I'm glad I can still remember that. <laugh> . Uh , the website is austin oi.com and there are two ways to reach us. There's a phone number on the website as well as just a contact us click button on the website that you can reach us and schedule an appointment for either myself, Dr. Hurt , Dr. Kilbride, or Dr. Robin .

Speaker 3:

Well thank you so much, Donna. How do people get ahold of us?

Speaker 4:

You can call us at (512) 238-0762 and visit our website, armor men's health.com.

Speaker 3:

Hello and welcome back to the Armor Men's Health Show. I'm Dr. Mystery , your host joined as always with my co-host, business manager and one of my best friends, Donald Lee . Oh ,

Speaker 4:

That's so sweet. Remember back in the day you used to insult me every single episode. Now you're so nice. I don't know what to do with

Speaker 3:

This. Well, I'm getting older and you're getting meaner <laugh>. So , uh, as a board certified urologist, we really specialize in men's health issues and today we're joined by one of our favorite guests , Dr. Tyler Goldberg, with Austin Orthopedic Institute. Welcome Tyler.

Speaker 5:

Happy to be here once again. My third visit to the show. Mm ,

Speaker 3:

That's right . Lovely . It's a regular,

Speaker 5:

I'm a veteran and y'all just keep getting nicer to me on the show, so I'm quite happy to be here , <laugh> . Oh, good .

Speaker 4:

We're gonna quiz you later about your phone number. Yes , yes . <laugh> .

Speaker 3:

What really strikes me in the lounge, in our interactions and on the show is how much energy you have as a physician. How old are you and how many years have you practiced medicine? Wow .

Speaker 5:

52. And I'm very much a typical physician that I went straight through , uh, high school, college, med school straight away . Did not take any breaks to go do another career. So I've been doing this for 20 something years. Been doing it a long time, almost , uh, I'm gonna cross 11,000 joint replacements this year. Wow. So it's a small town. Been doing it a while , still love it. Interesting thing about medicine is it never gets old. I I love it more today than I did 20 years ago when I first started. That's

Speaker 3:

Awesome . It's such a fascinating thing to hear because I feel exactly the same way. I get excited about going to work. I love treating the patients when it comes to surgery. Those are my favorite days. Mm-Hmm . <affirmative> on earth. And that's the same excitement that I had many years ago. But that excitement is not shared by all doctors. Oh yeah.

Speaker 5:

No , for sure. And

Speaker 3:

So often we will see so many different types of surgeons, internal medicine, doctors getting beat down, getting worn out by , by what's going on. And I think that really affects the kind of care they give patients.

Speaker 5:

A hundred percent agree. So I've had this idea for years, like what would I do if I wasn't a physician? You know what I would do? I would write a book about what makes physicians, physicians, right. Because I think what you're alluding to is the different reasons why people come to be a physician. Some people just feel drawn to it. Some people probably have some sort of childhood disturbance or, you know, interaction where they felt like they had to be caring, compassionate and caregiver to other people. 'cause they didn't get that when they were a child. Some people do it as a business decision. And so there's all these sort of decisions and things that happen in our lives that make us come to the decision to be a physician. Right. And then once we do, what impact did those decisions and those life experiences have on the type of physician we become? And

Speaker 3:

Moreover, a lot of those decisions are made when our brains are 17, 18. We decided what field we're gonna go into. And our, our listeners may not know I was 21 years old when I decided that I was gonna spend the rest of my life playing with people's balls. Yeah.

Speaker 5:

21. So you , you wanna know for me? Yeah. Seventh grade. Wow. When I was in seventh grade, my dad and I sat down at the kitchen table and he, he wrote out every class that I was gonna take between junior high and medical school. Wow. All I had to do was execute the plan because I had it all there. And it's kind of weird because that's too , I would, I would say that's way too early to make that type of life decision, but it kind of worked out for me. 'cause I love what I do, but I can, I could see that if I didn't like that and I was just trying to execute that plan to make my dad proud of me or whatever, you'd be miserable and I would be absolutely miserable. Mm-Hmm . <affirmative> . But for just some reason, dumb luck, it worked out for me. Great. Wow . Since I love it. There's nothing I could do other than this. Sometimes

Speaker 3:

We get lucky in who we become and what pathway we go . But what I like about your approach is that you almost know what you're gonna do for the patient based upon the history, the physical, the primary complaint. It's not like every person that comes to you has to be completely, like, you have to start from scratch. You kind of know your talk track. You know what you're gonna say to them. You understand where they're coming from. And this helps you execute plans that you've done over and over again. And I think that makes you a great doctor.

Speaker 5:

Well, I appreciate that. You know, I do , uh, only, you know, I've kind of put myself in a little corner, right? I take care of hip and knee. I have a very small little function of the body, small little area of the body. And so, you know, I get very into the details. So it's a lot of redundancy. Right. So where do I find my variability in the minute details that patients bring me in , what can I do to just tweak their care just a little bit? And not every knee is the same. I was telling , telling this to a student I had with me this past week, I've been doing this for, you know, 20 plus years have almost 11,000 of these replacements in no two are the same. Yesterday I did a hip replacement with 10 ccs of blood loss. Mm . That's like a vial that you would go to the laboratory to give your routine blood work and

Speaker 3:

Put it around your neck if you're Angelique.

Speaker 5:

Correct. I did a hip replacement for that amount of blood and that amount of blood. I mean, you know, I've been doing this for, I've never, I've never done that. That is crazy. Good.

Speaker 3:

The patient was alive at the time.

Speaker 5:

Patient was alive. Okay .

Speaker 3:

Hallelujah. <laugh> . Well , there you go. All right . All right . I just wanted to make sure. I just wanna make

Speaker 5:

Sure . Patient happy, patient

Speaker 3:

Happy patient.

Speaker 5:

You know, so it's always, always improving. So

Speaker 3:

For, for our listeners out there, oftentimes they're sent to a doctor because of a primary care referral. Their insurance told 'em to go somewhere. They're really limited by, by who. They see what they see, just kind of by the environment around them. What do you think when you're going out there looking for, you know, if, if you needed a physician for one of your family members and you didn't know them or you didn't know the field, what kind of things would you look for in that person when you're talking to them or, or seeing them that make you feel like they're gonna be a good doctor for you?

Speaker 5:

Yeah, so for for sure it's communication, right? It is. Do you the physician patient , to me is really key. And I'm, I'm really kind into that is do you appreciate the way the physician communicates to you? Are you a straight shooter? Is a p is a physician compassionate or are they a straight shooter and they have no compassion, no empathy, and they just tell you what it is and they see you from the door and then they walk out? Or do they really take the time to sit down, find out a little about you, and decide kind of in a shared way what y'all are going to do together. Because you really have to have that buy-in from the patient to the physician to be able to be compliant with the treatment protocol. And the physician needs a buy-in from the patient for them to execute the plan that you have decided for them. So it's really all about sort of communication. And then when you're shopping for a surgeon, it's, to me, it's, at the end of the day, it's, it's sort of one question. If I have a problem, are you the doctor that fixes it

Speaker 3:

Exactly right After a surgery? Can you handle your own complications? That is a very important one that, that I see. And this issue of shared decision making with your patients, I think is important. A lot of patients come to me and there's , and they say things like, well, you're the doctor. I'll do whatever you say. And that may sound to some people, like, the greatest thing you can say to a doctor, it is not, not at

Speaker 5:

All.

Speaker 3:

It is not. It just means that now in all the worlds of things that could go wrong, you've taken zero responsibility for the decision that you've just made. <laugh> .

Speaker 5:

Absolutely. And it's also a little bit of a passive aggressive, to me, that's a test. 'cause they already know what they're gonna do . Mm-Hmm . That patient sometimes already knows, well, you're the doctor, I'm just gonna do what you say. But really they're thinking, but if you don't do what I want you to do, I'm behind my mind. I'm walking . Yeah . Yeah. I'm outta here. Right . You're not , you're not the guy. For me . That's , so

Speaker 3:

That's a good , the communication with the patient is really important. If, if, if your doctor's not taking an interest in who you are, why you're there, what activities are you trying to accomplish? Yeah. Yeah. Like what is your goal through this interaction? I will say 100% of the time, those conversations have yielded important, actionable data for me a

Speaker 5:

Hundred percent of the time. Right . That's why us as surgeons have such a unique opportunity to interact with patients. I love it. Because we have very short, intense patient relationships, right? Yes . We get all in their business. Right? We are all in their business super quick. And we know all about them very, very quick. It's not like a primary care where they come back every two months and we sit down and talk for 15 minutes and yada yada yada. And just goes on and on and on with no sort of ending. These are short. Let's get to know each other really quick. Tell me, I need to really invade your life really quickly to find out what you need and what you want to do. And what are your expectations?

Speaker 3:

Your Bumble profile must be spectacular <laugh> .

Speaker 5:

Oh man. Not

Speaker 3:

Anymore. I'm just , I'm just here for a short term thing in which I really intervene heavily intense and get what I need. And then I'm out of here. Intense. Very , oh, by the way, oh by the way, what's your name? <laugh> .

Speaker 5:

<laugh> . You know , we all have our talents,

Speaker 3:

<laugh> . And so throughout this process of trying to develop a relationship with a patient, I think that understanding how complications are dealt with, it's not the time to become the friend of the patient when something went wrong. No. You have to be their friend and they have to trust you from the beginning. And so when it comes to complications, which happens to all of us.

Speaker 5:

Yeah . It's regardless, it's the nature of the game. If

Speaker 3:

You don't, if you don't have complications, you're either not doing enough or you're probably not doing the right

Speaker 5:

Thing, or you're not checking your patients.

Speaker 3:

Oh, that's right. Mm-Hmm . Or maybe they're just leaving you. Yeah. Yeah . And so your model of practice is evolving and you are trying to have patients , uh, unfortunately because the insurance model that we live in, you're having to adjust kind of how you're practicing. Why don't you tell us a little bit about your programs?

Speaker 5:

I think what my practice allows me to do, since I've kind of separated myself and gone to a little smaller boutique practice, is sort of experiment with the patient experience. Right? Even after all these years, I'm still way into the patient experience. What do they see when they walk in the office? What's the vibe of the office? What do they feel? What music do they hear? Do they see a bunch of medical degrees on the wall? Or do they see art? You know what I mean? What is it sterile or is it a happy place to be? And then what is the interaction, the experience they have with their physician? Right? So, being in my smaller group, I've gotten to create sort of medical tourism programs and concierge programs that my patients have just absolutely loved , right? Because I've, you know, been a student of this for 20 years. And I listen to patients and say, what would you like, what would've made your experience better around your knee replacement or hip replacement? And they tell me. And eventually I kind of sat down, I put it all together through a program, and I was able to create these sort of entrepreneurial endeavors that help patients and give them sort of a vested interest in their outcome. And they love it. Isn't

Speaker 3:

Such an , it's such an important holistic kind of , uh, approach. So, so just for our listeners, how long does it take? I'm gonna get to a point here for you to do an average knee half an hour. So in 30 minutes, that patient who's kind of contemplated over this huge life-changing decision for 15 years about whether to get their knee done Sure. And has all , all this thing, you're a wham bam . Thank you, sir. In 30 minutes. Meaning that all of your training has allowed you to accomplish something in 30 minutes. But there's a rehab, there's a prehab , there's weight loss, there's testosterone management, there's all the things that you wanna do before and after. For

Speaker 5:

Sure. The surgery is the

Speaker 3:

Afterthought. The surgery is only 30 minutes. Right . When in the patient's mind, that was the whole thing. And I think that your understanding that the experience is more than just the 30 minutes you get to have with them. Correct. Even though that's all you really wanted in the first place. <laugh> , <laugh> ,

Speaker 4:

You know what , just like a man,

Speaker 5:

You know, it all changes in that 30 minutes. But you know, it's the experience of the patients through the whole process. How do they feel about what happens around their surgery? That is the key to everything for me. And if people

Speaker 3:

Want to get their knee and hip problems looked at by you, how do they get ahold of you?

Speaker 5:

My website, austin oi.com. And they can find lots of contact information and lots of videos and lots of blogs and patient information about how to come and see us. The

Speaker 2:

Armor Men's Health Show is brought to you by NAU Urology Specialist. For questions or to schedule an appointment, please call 5 1 2 2 3 8 0 7 6 2 or online at armor men's health.com.