- Welcome back to the Becker's Healthcare Podcast,
devote to the people who power US healthcare.
I'm Molly Gamble at Becker's
and delight to have you join us for another episode filled
with insights from healthcare leaders.
Today I'm spending some time with Dr. Jason Co. Dr.
Co serves as the director of the Orthopedic
and Spine Institute and Endeavor,
formerly North Shore University Health System, chairman
of its Department of Orthopedic Surgery,
and also Chief Medical Officer
with Chicago Fire Major League Soccer team.
Dr. Co, welcome to the podcast.
Thanks for being my guest today. How are you?
And where does the podcast find you?
- Well, Molly, uh, thanks a lot.
Uh, I'm excited to be here today. I'm doing great.
Um, I'm particularly looking forward to this season
because the Chicago fire have their home opener coming up,
and the team is looking great.
Oh. So we've had a good team last year
and made some key additions,
so we're looking forward to a great season.
- Terrific. That's wonderful to hear.
I, I think Chicago sports fans, we, we,
that's welcome news, Dr.
Co. So thanks for, for listeners in the area, um, some,
something to look forward to.
But speaking of the Chicago Fire, I think
as my introduction just highlighted, you wear many hats
as an orthopedic surgeon team, physician leader.
Can you walk us through your role
so our listeners can just better appreciate your
perspective today?
- Sure. Um, well, I mean, you started
with orthopedic surgeon and I think that's part of, uh,
my definition.
Um, for me, uh, I went into orthopedic surgery
to help people get better.
Uh, I keep people active and pain free,
and that really informs a lot of my goals.
The, uh, I'm a practice reading orthopedic surgeon.
I typically do, uh, over 300 to 400 surgeries a year,
uh, see lots of patients,
and it's a true source of, uh, enduring joy
and satisfaction in my life to be able
to help people get better.
Uh, with regards to that, um, it's allowed me
to become very effective as a team physician.
Uh, being an orthopedic surgeon, assessing patients, uh,
helps me assess injured athletes,
whether they're professional or recreational.
Um, it does make me think about things in a,
a different way in terms of where the individual is in terms
of their team, the timing of sport.
Uh, we're always focused on the athletes first. Mm-Hmm.
. And then finally, as a leader, uh,
I've been running the Department of Orthopedic Surgery at,
uh, endeavor, which was formerly North Shore
and now for a dozen years.
And we've become the busiest orthopedic department in
Chicago, uh, the market leader in terms of the number
of cases that we do at our dedicated
orthopedic and spine hospital.
Uh, this requires obviously a coordination of a number
of different moving parts,
but again, having worked with teams, having been on teams,
I think that, uh, that's informed me in terms
of my management style
and bringing people together to work towards a common goal.
And in this case, a common goal is, uh,
outstanding orthopedic and spine care. Mm-Hmm.
- . Mm-Hmm, . Well,
let's dive into some field notes.
If you'll share this with us in our listeners about
interesting trends you're detecting right now in the fields
of orthopedic surgery and sports medicine.
Is there anything up and coming
that listeners should be keeping an eye on
or things that maybe you're seeing intensify compared
to the past couple of years?
- Absolutely. So one of the things that's happening is that
orthopedics and spine surgery has gone
through amazing advancements in technology.
And the technology is,
includes both improvement in surgical techniques,
but also other aspects such
as rehabilitation, pain management.
And this is some of what we focused our
work and research on.
So at this point in time, we're seeing the majority
of our patients have, for example,
joint replacements on an outpatient basis.
Uh, patients are able to, uh, have procedures that are
so minimally invasive and recover so quickly
and have, uh, great pain control so that they're able
to go home the same day, um,
and, uh, they're able to return back to their normal life,
uh, a lot quicker than they were before.
So, uh, that's a trend that we continue to see develop.
Um, this is supported in many ways by the use
of increasing technology, uh, around, uh, computer assisted
or robotic surgery.
Um, and, uh, for example, the, uh, probably 90 plus percent
of the joint replacements done at our Orthopedic
and Spine Institute are, uh, done with the assistance
of either robotic or computer assisted, uh, tools
that allow us to sort of, uh,
really truly measure much more precisely than we are
with manual tools.
Some of the other things that are happening in sports
medicine is, uh,
continuing interest in regenerative techniques
and regenerative medicine.
Uh, we're doing research
and using, uh, harnessing the body's, uh,
own regenerative capabilities in implicit in the blood
or, uh, bone marrow to help patients, uh, heal
and restore back to normal function.
And then also in, uh, sports medicine in general,
we really try to approach our athletes from a
multidisciplinary approach.
And so that means, you know, keeping track
of things like sleep timing and nutrition,
and how we taste the intensity of training
and workload, uh, on our athletes.
So these are some of the exciting things
that I see happening right now.
- I mean, these are big shifts that you just touched on,
and I'm curious for either more
and more joint replacements moving to the outpatient setting
or the regenerative medicine up uptick in the growth of
that option for athletes especially.
Is there anything around patient expectations
and the management of those expectations
that you found yourself needing to rely on more
as these things take off
and grow in their frequency or popularity?
- Absolutely. I think one of the things is, uh, it is, uh,
since the field is changing
and continuing to develop, uh, is about, uh, providing,
uh, patients with the knowledge that there are lots of ways
that we can help them, uh, in a less invasive way that, uh,
allows them to be pain-free
and restored to full function much quicker than they
might've thought before.
As you know, I mean, our population, uh, there's a,
a large number of, uh, older, uh, athletes
and older people who are part of that baby boomer,
uh, generation.
And the expectations that they have, uh, for themselves is
to stay active longer.
Uh, they've had active lifestyles.
They want to continue
to maintain their health and independence.
And so I, it's part of our role to help make sure
that they're able to maintain that.
- Well, let's dive into that more
because my, my next question was about patient populations
and orthopedic surgical needs among varying demographics.
Are there any shifts worth, worth mentioning?
You already talked about in the large number of older adults
and older athletes who wanna stay active for much longer.
I think you can even see that in some sports
like golf, for instance.
Um, you see some of the, the ages of these players are,
what about younger patients?
Are you seeing more need for orthopedic surgery
among any younger patients?
That's worth pointing out.
- Absolutely. I, one of the things
that we're seeing nowadays, uh,
and has been an area of some concern for orthopedic surgeons
who do sports medicine, is the increasing sub-specialization
of kids at a younger and younger age.
Uh, this idea that, you know, you could be a kid
and you could play, you know, baseball during one season
or football during another,
or, you know, soccer and basketball.
Uh, now there's some increased number
of folks who are just doing one sport, uh, 365 days a year.
And what that can lead to is over training,
overuse injuries.
Uh, and sometimes, you know, frankly, burnout on, uh,
on the psychological side, um, we encourage, uh, kids to,
uh, pursue a variety of different sports
and to have a variety of different interests.
And one of the things that actually,
if you take a look at the professional level, is that
in such areas like, uh, major League Baseball
or the NFL mm-Hmm, , um, many of these people,
uh, have had, uh,
played multiple sports throughout their high school careers.
The, uh, super Bowl winning, uh, quarterback,
Patrick Mahomes was a outstanding baseball player
before, uh, he decided to pursue his career in football.
So I think the idea that there's, uh,
people should explore different sports and, uh, practice
and try doing cross training in different areas,
it will help avoid some
of these overuse injuries that we're seeing. Mm-Hmm,
- , that's really interesting.
And is that typically like high school age, you start
to really notice that increasing sub-specialization
where they're really leaning into one specific sport?
Or is it even younger than that?
- Well, we used to see it in high school age students,
but now we're starting to see, uh, kids
who are even younger than that, um,
getting specialized in one sport right away.
And so, uh, one of the things that our, uh,
professional organizations like the American Academy
of Orthopedic Surgeons
and the American Orthopedic Society
for Sports Medicine are focused on is, uh, injury prevention
and trying to allow kids to have time to,
for their bodies to grow and recover.
Um, these are growing developing bodies.
Uh, they respond to different stresses differently.
And if people are overtrained, then uh, injuries can occur.
So for example, uh, you know, I've taken care of, uh,
major league baseball teams,
and, uh, what we're seeing is actually that, uh,
elbow injuries to the ulnar collateral ligament are
happening in younger and younger kids at this point in time.
What used to be the Tommy John operation
for Major League baseball players is now happening, uh, uh,
in college
and high school athletes as a result
of some of this overuse.
- Wow. Wow. I've heard, I mean, I've heard of Tommy, Jenn
and I always equated that with pretty
like long standing athletes, those
who had been playing for quite a while.
So for now, an athlete in high school in their teens
to be undergoing that, that's a pretty big shift.
- It is, and I think it's
because of the fact that we're seeing, uh, more
and more, uh,
athletes really focusing on just one sport all the time.
And, uh, so what we're trying to do as, uh,
orthopedic exploits medicine community is sort
of provide the idea that, um, people can fatigue.
You might be very strong,
but if your body fatigues,
then it puts more stress on the other
tissues around the joint.
- Mm-Hmm. . Mm-Hmm. .
You know, one other thing I wanted to ask you about Dr.
Co is any thoughts on the growth
of GLP ones and weight loss?
And I know there's a lot of caveating around that in terms
of making sure we're speaking realistically about the
potential for those drugs.
Obesity is gonna be a big problem public health wise
and a priority for years to come.
But are you seeing or hearing anything from patients about
just having that tool being available
to them in terms of weight loss goals?
Is it affecting anyone's needs
for orthopedic surgery or the recovery?
- Well, I think like many things, there's, uh,
pluses and minuses.
Obviously, these new medications are able
to really help people improve their overall
cardiovascular health.
Um, uh, I've seen patients who, uh, have
gone off, uh, needing, uh, insulin
or different kinds of cardiac meds.
And so their overall health improves.
This allows them in many ways to sort of be more comfortable
and physically, uh, active
because they're not carrying around an extra, uh,
20, 30, 40,
or a hundred pounds of weight, um, which can be,
uh, very painful.
What ends up happening for, uh, many obese patients is that
that extra load causes extra forces on the joints
and clearly contributes to joint pain and discomfort.
On the other hand, one of the things
that we are concerned about is the fact
that when this rapid weight loss occurs, significant portion
of that actually comes from muscle mass.
Hmm. And so the, uh,
body stores the glycogen primarily in the muscles.
That's the first place the body goes to get energy.
And so with these medications, um, it starts, uh,
burning some of the muscle before it gets to the fat.
Uh, so I think one of the critical things is,
although people may be losing weight,
that doesn't necessarily mean that they're going to be
more fit Mm-Hmm.
, uh, in terms of strength and endurance.
And so, uh, I think it's very important
that the message is not only, you know,
there is some advantage in losing weight in terms
of overall fitness and, you know, perhaps endurance, uh,
since you're not carrying around as much,
but without a thoughtful program where you're going to
actually have to do some work to maintain muscle mass,
will mean that you need to continue to
maintain your activity level.
Hmm. Um, I do think that's one thing that's, uh,
very interesting nowadays.
And, uh, you know, Peter Atia
and others are, uh, discussing this,
but the idea that you wanna maintain a certain amount
of strength and muscle activity
and endurance, uh,
over your lifespan is critically important for people
who are getting older to maintain an active and functional
and independent lifestyle.
- Right, right. No, I mean, that's so true.
Even, even just my question, you know, when we talk about
or see headlines
and the high level discussion about weight loss, I think
so often we fail to make those distinctions between,
like you said, fat and then muscle mass.
So a really important thing for us to keep in mind, um,
you know, in your opening remarks,
and you were kind of talking us about,
talking to us about your role as Dr.
Co, you had made mention of your role as a team physician.
You're the top physician for Chicago Fire in that role,
you are the coordinator of an entire multidisciplinary team.
Um, I, I wanted to ask you, you know,
I think your contributions to the team are very clear,
but I'm also curious how serving
as a team physician has changed
or shaped you, you know, what, what lessons
or major lessons have you walked away
with from these experiences being close
to athletes and teams?
- Absolutely. Um, first of all, uh, I would say, uh,
it's a real privilege to take care of
athletes performing at this level.
Uh, professional athletes have, they're special people.
They have a unique combination of talent, um, ability,
dedication, art, and actually a lot of resilience.
Um, if you take a look at, uh, what they're like,
I mean, these are people who are in
performing at the highest levels,
but many of them over the years, particularly the veterans,
uh, have accumulated some, uh, injuries
and other, uh, areas of damage, uh,
but continue to stay active.
And to me, that's actually very inspiring that, uh,
we all can stay active.
That, um, even older patients who may have some arthritis
or some other injuries
or, uh, damage, uh, still will be able to remain active,
remain pain-free and very functional.
So some of the other things are, uh, again, being
a team physician, you actually are part of the team.
And you realize as a team member, you can serve,
you may be really outstanding in one role.
You can help in others, in others, uh, areas.
Uh, you need the help of your other teammates.
And the way I approach this in the team physician role
and the chief medical officer role is I have outstanding
colleagues who, um, like Julian Bales,
who's a world class expert in concussion.
Uh, we have world class experts in sports cardiology
and expert exercise induce asthma.
Uh, I'm able to identify some of these things
and then help direct, uh, our athletes to those areas.
And so, uh, to me, it's always, uh, a great
experience to be working as part of a, a team
of really outstanding providers.
Uh, it's also, um, I'm humbled
by the people I get to work with.
Mm-Hmm.
- In that role, in that overseeing this multidisciplinary
fantastic team.
As you just touched on, you know, I think about one
of your earlier remarks about high school students when they
have this subspecialization like you were describing,
it can be increased risk of burnout.
Is there anything that, and I know you're an orthopedic
surgeon, I don't wanna go into another specialty in any way
that would make you feel like you're speaking out of, out
of turn here, but the link between an injury and depression
or the, the emotional side effects of being out of a game
or out of the sport for a, a period of time.
Is there anything you can share
with our listeners about that link?
And as the leader of the multidisciplinary team like you
are, how you make sure that when we're talking about health,
it's not just the muscle or the tendon,
but also, you know, the, the whole athlete
and any sort of emotional
or mental effects that might come with that injury?
- Absolutely. So, obviously, um,
and, uh, I think many of us have had some sort
of musculoskeletal injury, uh, during their life
or some, uh, limitation, whether it was like a, a
bad sprained ankle or severe back pain
that impacted our ability for daily living.
Uh, it for an athlete, uh, these can be very, uh,
not only physically, but also emotionally devastating,
and it can take a long time for people to recover from that.
Mm-Hmm. , and one of my, uh, good friends, uh,
actually, uh, from Sydney, Australia, uh, did a look.
I did a study looking at essentially the psychological
profile of people with ACL tears
and, uh, a significant number of them.
Um, even at a year, about close to 30%, even at a year,
I still had some essentially, uh, inhibition
and concern related to their knee
and their return to ability, their ability
to return to sports activity.
Uh, these kind of injuries are significant.
Um, and it does take time for people to go through that.
Um, uh, one of the advantages, again, of being part
of a a team is that, you know, if we have athletes
who have, um, are having anxiety
or, uh, concern dealing with these kind of issues, um,
that goes beyond the kind of, uh, empathetic care
that we can provide, um, is to also have them meet
with frankly, uh, health professionals that are, uh,
certified and specialized in these
kind of mental health issues. Mm-Hmm. .
- Mm-Hmm. . - Well, thanks for speaking.
I, I was curious about that.
Uh, and that's great to, I mean,
I'm sure there's great resources available
to the Chicago fire athletes and then some, um,
but when we talk about injuries, I know even just
as non-serious athletes like you were saying, Dr.
Co, that can be really
devastating to people and set them back.
Um, so it's, it's great to hear
that there's resources available,
and I appreciate you mentioning
to your colleagues research. That's fascinating.
- I, I mean, and,
and certainly what I want to say is like,
we have a great team assembled to care for the Chicago fire,
but, um, I grew up in this community.
I live in this community. I have kids who played sports.
Uh, I understand that all
of our active patients have these kind of needs.
And so what we've been really trying to do
with our comprehensive sports medicine program is bring
that kind of professional level care
and comprehensive ability to address all the needs
of our athletes, uh, to recreational athletes,
whether they're in, um, high school or college
or senior level,
or even just older people who are playing pickleball.
And, uh, so our, our thought is
we approach our, uh, athletes, whether they're
of any level as we would approach.
And so, uh, bringing that kind of comprehensive approach
that's not just around purely orthopedic surgery
or, um, uh, other types of rehabilitation,
I think really helps best address the needs of, uh,
our people who wanna stay active.
- Mm-Hmm. . Mm-Hmm. .
- Well, this has been just such a dynamic conversation.
I've learned a lot from you in a
relatively short amount of time.
Dr. Co, is there anything you'd like
to leave our listeners with?
Any closing thoughts?
- Sure. I think, first of all, on, uh, we're thrilled
to help people stay active.
Our goal is to keep people moving active and pain-free.
Uh, the more we learn about, uh, aging
and life is that staying active is important
to staying active
and independent, independent for many years.
Um, uh, one of the key things is
that we see this aging demographic.
Um, but I think the expectations of people now in their,
uh, you know, sixties
and seventies is in many cases,
they're gonna keep playing tennis.
They're gonna keep playing golf.
They're still gonna, uh, uh, you know, wanna run or jog
or play pickleball and be physically active.
And I think, uh, part of our goal is to try to, uh,
help people maintain their level of activity, their quality
of life, their independence, um, at every step of the way.
So keep moving, uh,
and, uh, we're here to help you stay that way.
- Great. Well, listeners, this has been Dr.
Jason Coe, director of the Orthopedic and Spine Institute
and Endeavor, chairman of its Department
of Orthopedic Surgery, and Chief Medical Officer
with Chicago Fire.
Dr. Co, thank you so much for being my guest,
- Molly.
Thank you very much.