Introduction

Dr. Bob: And welcome to The Dr. Bob Show. I hope you have been watching The Dr. Bob Show and learning a little bit more about how to make your life happier and healthier. Are you one of those backyard sports persons? If you are, you are going to want to watch this show. If you are outside at all, you are going to watch this show and get a lot of information. If you have ever sprained an ankle or hurt your fingers or hurt your shoulder or fallen down and sprained your ankle and don't know if it's broken or not. We've all done those things. We've got our children that have done those things. That's what we are going to be talking about on this show.

Hello, I'm Dr. Robert Overholt and I will be your host for the next 30 minutes on The Dr. Bob Show. We've got an outstanding guest. My guest is Dr. Sam Marcy. Dr. Marcy is a board-certified orthopedic surgeon. He's been on The Dr. Bob Show before and he's one of my favorites. He's always got on a cute bow tie and you're going to love Dr. Sam Marcy. Later on we will be talking about those…a little bit more about high blood pressure, a little bit more about cholesterol. What causes anemia? We may get into a little bit of radiation problems. What happens if we were to get a nuclear attack or a dirty bomb? We may be talking about that, anemia, chronic lymphocytic leukemia. We've got more than we can possibly talk about. But, first we want to be sure that you've been exercising 20 minutes and be sure you do that seven times a week. Walk, ride a bike, swim, do whatever you want but have a good time exercising. Start that day off with eight hours of wonderful sleep. You'll do a whole lot better that day and then a breakfast of fruit and fiber. Make it a good breakfast. One that will get you going during the day and you'll have a lot of energy and most of all, what is it we like on The Dr. Bob Show? It's laughter in your life. Find that person you like to laugh with because it's going to make your life a whole lot better. Stay tuned. We will be talking about those ohhhh, those injuries that you had and I've had a million of them.

Dr. Bob: We're talking about those backyard injuries. The kind that you and I have always had and I've got an outstanding guest, Dr. Sam Marcy, board-certified orthopedic surgeon. Sam, always nice to have you on The Dr. Bob Show.

Dr. Marcy: Thank you for having me Bob.

Dr. Bob: Lots of backyard injuries or most of them now in organized sports?

Dr. Marcy: Lots of backyard injuries happen still every day practically there is some one who has a minor injury at first that may progress to be a little worse than they thought it was and ended up in the doctor's office.

Dr. Bob: Now, what's a common one that you see?

Dr. Marcy: Well, we're going to talk a little about sprained ankles because they're so common and it's, it's always a little bit of a question of how bad is it and do I need to go do something about it?

Dr. Bob: You know, a sprained ankle is so common, you can step off a stair, you can step on a pebble, you can step on somebody else's foot when you are playing or, I can remember your saying always running around in the backyard and stepping in that hole.

Dr. Marcy: Stepping in a hole is very common.

Dr. Bob: Tell me what happens to the ankle when you've got a sprain or a break.

Dr. Marcy: The usual cause of a sprain is when the ankle turns in. That is when the big toe comes up and the little toe goes down. That's what we call a supination injury of the ankle and that puts a lot of torque on the outside of the ankle obviously and the ankle is able to tolerate, the bones are able to tolerate that but the ligaments aren't.

Dr. Bob: Now, what are ligaments?

Dr. Marcy: Ligaments hold the bones together. They, they're tissues that go from bone to bone.

Dr. Bob: Are they pretty strong?

Dr. Marcy: They are very strong.

Dr. Bob: Do they, hold when you sprain, do they stretch or do they tear?

Dr. Marcy: Both.

Dr. Bob: Both of them.

Dr. Marcy: Both.

Dr. Bob: Which is worse?

Dr. Marcy: Stretch tear……

Dr. Bob: tear

Dr. Marcy: tear is worse. Stretch is the grade I sprain. That's the kind that it hurts for a few minutes and you get a little better, may have a tiny bit of swelling and then it goes away.

Dr. Bob: Is it better to walk off a sprain? You always hear, walk it off, get up and walk it off, or do you have to listen to your body. If it hurts so much you can't walk it off, you better stop.

Dr. Marcy: Absolutely.

Dr. Bob: Is that sort of the key on that?

Dr. Marcy: That's, that's the whole thing. It's just a little common sense and to not be bullied by someone else to say, oh yeah, you can walk it off and, in fact, you may have a more serious injury and you are damaging yourself. So, if it's too painful, just don't do it. If it hurts for a few minutes and then it gets a lot better, then you may use a little common sense and go about activities that are reasonable, probably not quiet as high performance as you might want to do.

Dr. Bob: So, keep on going - are you going to stretch it a little bit more and have a grade II or are you going to tear it?

Dr. Marcy: Well, probably just stretch it a little more and have a grade II. You are unlikely to tear it unless you have another injury.

Dr. Bob: Now, what's a grade II?

Dr. Marcy: Now, that's when you get some tearing with a sprain and what happens there is you get the bleeding and the big kind of goose egg that shows up on the outside of the ankle……

Dr. Bob: What is that goose egg? Because a lot of times, boy, somebody comes in they've got a huge swelling on their ankle. What is that?

Dr. Marcy: It really is just blood.

Dr. Bob: So, it's blood in there.

Dr. Marcy: Yes, exactly.

Dr. Bob: And frequently you see that end up a couple days later having a bruise all the way down their toes and up their leg……

Dr. Marcy: And down the outside of their foot. Yes, indeed.

Dr. Bob: So, how do you treat that or you tell me what's going on here.

Dr. Marcy: The treatment for that injury and for actually the minor sprain too is the same and that is, you need to get off of your foot, put some ice on it, keep it propped up. If you have a little elastic bandage around it, that cuts down on the amount of swelling you have and if we stop the bleeding with ice, elevation, and a little elastic support, then you don't have the extravasation, the extra swelling, the prolongation of your symptoms. You can, you can really cut down on the morbidity and the trouble that you have with a sprained ankle with proper care but you have to stop what you are doing to do that.

Dr. Bob: Now, if one of my children had a goose egg on their ankle and they were just really limping and they were crying and their ankle was hurt, I would want to take them to the emergency room to get an x-ray. What should I do?

Dr. Marcy: If, in fact, you can get them quiet, you can get control of the pain with the ice, a little support, elevation and maybe some Tylenol, then, that's exactly the thing to do. Because it may not be a sprain, it may be a fracture.

Dr. Bob: And if you get a fracture, let's talk about that, we've got a couple of minutes here. What happens if it's a fracture? Where do you break the ankle and how do you fix it?

Dr. Marcy: Well, there, of course, the ankle generally breaks on the inside or the outside but if it, it usually starts in the whole mechanism of how the ankle breaks with the outside bone or the distal fibula….

Dr. Bob: Well, that's the little bone that goes down…….

Dr. Marcy: That's the smaller bone on the outside, on the little toe side of the ankle and then if that cracks and breaks and the force continues, that is you're still falling, you're twisting on it, then you get enormous forces that go to the inside and that little medial bone along the big toe side, that's called the media malleolus and that's really the lower end of the tibia. And, that can break off and then when you've got them both broken, then you are in, that's a bigger deal, and you end up with surgery.

Dr. Bob: Which one breaks easier, the outside or the inside?

Dr. Marcy: Outside.

Dr. Bob: Now, do you ever get a compound, what is compound fracture?

Dr. Marcy: That means that the skin has been torn and the bone sticks out. It is pretty gross and it does happen and that's just another degree of injury. You've broken the outside bone, you break the inside bone and the force continues and then you've got a sharp edge of bone that can stick out through the skin.

Dr. Bob: So, depending on the severity means you put a cast on or you have to go in and operate and put some pins and straighten it out.

Dr. Marcy: Exactly.

Dr. Bob: Good results in repairing ankles?

Dr. Marcy: Very good results in the vast majority of people.

Dr. Bob: We're going to talk about a patient now, Sam, who was out playing a little bit too aggressively and sprained his ankle. Let's see what happens to Jeff.

A Patient's Experience with a Sprained Ankle:

Jane Nowiski: Most people don't consider a sprained ankle a long term injury. However, a severe sprain can take longer to heal than a broken leg or a broken foot as when Jeff Sullivan found out when he became injured during a church league basketball game.

Jeff Sullivan: I was having a great game but early on I ended up going up for a lay-up and came down on top of another guy's foot. I was moving to the right and my ankle went to the left and ended up making an awful popping sound and everyone assumed it was broken.

Jane Nowiski: But Jeff didn't break his foot. He has sustained what his physician determined was a high ankle sprain which was painful and would take months for a complete recovery.

Jeff Sullivan: It was black and blue up through the middle part of the calf and most of the swelling was at the top half of the ankle. So, it was painful for quite sometime and I think from what Dr. Marcy told me, it was longer to heal on a high ankle sprain and I was in considerable amount of pain. I was on crutches for several days and then went to a boot for about three or four weeks and then after that just walked with a limp for a couple of weeks and now I am back to, being slightly gimpy.

Jane Nowiski: Four months later Jeff says he is able to once again play basketball. However, he does take precautions to prevent further injury.

Jeff Sullivan: So, it still gets stiff at some point so if I hit a step wrong, I'll get a shot of pain but for the most part, it is fine. I still go and play tennis or play basketball but I just have to wrap it up now and have a ankle brace on it.

Jane Nowiski: For The Dr. Bob Show, I'm Jane Nowiski:.

Dr. Bob: We're talking with Dr. Sam Marcy, board-certified orthopedic surgeon and we've talked about sprained ankles. Remember, what we said. Elevate, ace wrap and ice initially. The ice keeps the blood from swelling everything and if we can keep that swelling down, you'll be better. If you just can't step on the ankle or if it's really that painful, probably time to get that x-ray and make sure that it is not broken. Excellent results by an orthopedic surgeon when you get that taken care of.

Dr. Bob: And Sam, the injuries that we were talking about, mainly outside in the warm months of the year, I want to talk about some winter injuries and I am thinking about slipping and sliding on some ice or………. What are some common injuries in the winter?

Dr. Marcy: Just exactly as you would expect. In the winter, you know when you fall, your body's reaction is to put your hand out to keep you from hurting your face and your head and your brain and this is the most common injury to do when you fall down and we do see a tremendous number in icy weather and especially the black ice times whenever you don't know it's there and you step outside, you're down, your hand's out and we one time had a hundred broken wrists in one day from the black ice back in the 70's.

Dr. Bob: Wow! Boy, that must have really been something. Now, black ice would mean there's really not a snow, the rain just came down and you've just got a thin layer of ice and nobody knows it's there.

Dr. Marcy: Don't know it's there.

Dr. Bob: A hundred broken wrists. So, it's very very common. Where is the wrist bone? You know, I hear a lot of bones in the wrist, what's broken usually?

Dr. Marcy: Actually, it's really the lower end of the forearm that's broken and that bone's name is, of course, the radius. And, the radius is the most commonly broken and it's broad and it has most of the articulation with it. The little bones in the wrist sit against the radius more than they do the smaller bone which is ulnar.

Dr. Bob: And, I'm going to show off my knowledge. I think we used to call that a Colles' fracture.

Dr. Marcy: Abraham Colles. That's exactly who described that.

Dr. Bob: Now, exactly what is a Colles' fracture and how are we going to treat it?

Dr. Marcy: Well, now, a Colles' fracture is when you put your wrist out in extension and you land on it and the force is too great for the bone to tolerate it and then it breaks. It usually breaks in the last inch of the radius and then there is a little fleck of the ulnar that often is pulled off with that as well.

Dr. Bob: Just cast it?

Dr. Marcy: Actually there has been some advances in the treatment in that in that in people who don't have good bone mass, who have osteoporosis problems, we have a lot of trouble in keeping the bone in the right place. We would often have to set those bones where you numb them up or even have an anesthetic, push the bone back in place, set it if you will.

Dr. Bob: This maybe hurt?

Dr. Marcy: Oh, it does hurt and then you put a cast on or a splint but the bone then, if it's soft, will tend to impact on itself and shorten so that instead of having the little normal angle of the wrist coming down and out like that, it gets to be a little bit over this way and some prominence of this little bony prominence right here called the ulnar but we are doing better with that now and we but we can't do better than setting it. We have to use some external fixtures on the commuted ones, that's the ones that are broken in a lot of pieces and just don't have enough bone to hold themselves together and they compact. So, there's a good bit more recommendation for some surgery not necessarily making incisions at the fracture site but putting some pins in the hand and in the arm above and keeping it distracted out to the length that it needs to be and then lets heal in that way.

Dr. Bob: When I was in the emergency room as an intern, we used to see people that felll and broke their hip and it was very classic. You could look at somebody on the stretcher and what do you see that you know it is a broken hip?

Dr. Marcy: Lying there and the involved leg is turned way out to the side. The external rotation if you look at it carefully it's a little shortened and it hurts like mischief if you just rotate their knee just a least little bit, they just…….

Dr. Bob: Why does the hip break when you fall?

Dr. Marcy: Well, you land on it and again, it is very much associated with…..it's more of a senior injury than a young person's injury and it's a loss of bone mass. Again, this is the osteoporosis and a major sequelae of osteoporosis. And we find that the hip is at an angle. You know, the hip comes up and then it turns in at 135 degree angle. And when that happens, there's just a lot of force that gets across there and it can be at the bend and it can be under the ball. I can't make the ball right there. But, anyway, the femeral neck breaks or the intertrochanteric region breaks. That makes different treatment but similar morbidity.

Dr. Bob: When you evaluate where the hip is broken, do you ever just let a hip heal on its own or you better go in there and put a pin in or you better go replace the joint, how do you decide?

Dr. Marcy: Well, there are a few cases where we do let nature take its course but that is fairly very very sick people who the anesthesia for fixing the hip would probably be fatal.

Dr. Bob: So, usually what are we going to do?

Dr. Marcy: But 98% of people need to have their hip fixed.

Dr. Bob: And when you get it fixed, do you pin it because we have about 30 seconds. How do you fix them?

Dr. Marcy: But if you break it in the bend, we pin it. If you break it right under the ball, we take out the ball and put a prosthesis in its place. We cement them in now. It has an extra joint motion and they're a lot better than they used to be.

Dr. Bob: You know, it is amazing to me that when people break their hip, they are up and walking and the orthopedic surgeon does such a great job. I am just absolutely amazed at the results that I see in patients that have broken a hip, broken their wrist or broken their arm. You all are amazing. Sam Marcy, you are a great teacher. I always love having you. Thank you for taking your time to come here again.

Dr. Marcy: Well, thank you very much for having me. I enjoy it too.

Supplemental Commentary

Announcer: Up next on The Dr. Bob Show - Fitness expert, Missy Kane, has some tips to help you achieve your personal best and later Dr. Bob answers his mail.

Missy Kane: I often tell people that walk and jog to try and go on a soft surface like a trail or a track because it is a lot easier on your joints. The problem with a soft surface like grass is it is easy to twist an ankle. I am going to show you some easy exercises that can really make a difference and help prevent ankle injuries. All you need to do is sit in a nice comfortable chair and here are three exercises. One of the first ones is just to point and flex your foot. Do this about 20 times on each ankle. The other one is ankle circles. Big circles with your toes both directions. Ten times in one direction and then switch directions. The last one - this really works great. ABC's with your ankles. You are going to literally draw the alphabet with your toe. And I guarantee by the time you get to the letter M, you will feel a great work-out in the lower part of your leg. Now, this is also great when you think about osteoporosis. So many people have this bone britlling disease and if you do trip or fall, if you have a weak ankle, it is easier to break a leg or a wrist. So, try those ankle exercises at least three times a week.

For The Dr. Bob Show, I am Missy Kane

Conclusion of Interviews

Dr. Bob: I want to thank Dr. Sam Marcy for a wonderful discussion on backyard injuries - sprained ankles, broken ankles, broken hips in the winter and also broken wrists. You know, Dr. Marcy actually really saved my life one time because my wife was having trouble with her knee in running and she loves to run, had a problem with the patella and Dr. Marcy fixed it up and she's still running like a little rabbit.

Articles & Letters

Dr. Bob: Now we are going to be talking about some questions from you, the viewer, and some articles that I think will be important to you. There is an article in the New England Journal of Medicine that talks about radiation exposure. You know and I think it is something that we all need to be thinking about because there can always be some nuclear accidents that we have or, who knows, could be some terrorism that causes problems. Now, nuclear radiation - there are three or four types of rays. There can be x-ray and gamma ray, they are the important ones because they penetrate into the body. There is some beta and alpha that really don't cause all this much problems. When we have radiation exposure, they get to the part of the body where the cells are really regenerating at their greatest. One would be red blood cells so we can get problems with massive red blood cell destruction, suppression of the bone marrow or the gastrointestinal - the cells in the stomach. So, if somebody gets radiation exposure that's mild, frequently they get nausea and vomiting for a period of 24-48 hours and then sometimes depending on how much we can go on and get further damage. Now, there's two types of radiation damage that I really want to talk about. One that would be sort of like a dirty bomb. What can you do for something like that? Well, if you know there is radiation exposure, there's three things that you need to think about. Time of exposure - get away quickly. Sounds simple. Well, sometimes there is a desire to help people and sometimes you have to help people and sometimes you need to get away. It would depend on the amount of radiation that's in that area. The other one would be shielding. If you are in an area where you can shield yourself from exposure, it will also be very important and then there's distance. If you are a long way away, you can bet if it's a mild radiation exposure, it's not going to cause problems. Nuclear blast. The air blast is what really initially knocks people down close proximity, enough force to kill. The thermal burn that comes there and the fireball that comes out can cause extensive burn injuries and if you are two to three miles from a ball, the thermal ball of fire, then don't look at that because it can cause damage to the eye. There is treatment. It will be and I don't want to scare people. We just need to have some information on that but if there is a nuclear accident of some kind, there will be lots of information over the airways and immediately turn on radio and television and find out what you should be doing. And I am going to get away from that right now before it scares too many people. I don't want you to be scared but I want you to be educated.

Letter #1: Dr. Bob, what happens if borderline blood pressure elevation is left untreated?

Response #1: Well, there's some good studies on that. Well, my blood pressure is not all that high, I'll just watch it and not pay attention to it. Bad thing. Because it's the normal blood pressure which is 120/80 and if the blood pressure goes up above 140, we know you must treat it. Between 120 and 140 - studies have shown that needs to be treated also because everytime the heart beats, it beats against that blood pressure and the heart is a muscle that initially gets big and eventually gets weak and increases the incidence of heart failure. That high blood pressure if left untreated is easier to develop into greater blood pressure problems later on. Pay attention to your blood pressure and know what your number is.

Talking about numbers. Another common question is, Dr. Bob, cholesterol numbers. What's most important, the low cholesterol or the high cholesterol? The LDL, low density lipoprotein. That's the one that causes all the problem that gets into the blood vessels that causes the hardening of the arteries and we like it below 130 but if you've had heart disease or if you really want to take care of yourself, get it down below 100. Let me tell you about myself. My father had hardening of the arteries. He actually ended up dying of a heart attack. He had hardening of the arteries to the brain. He was 86 when he died and was a wonderful person. But his cholesterol was elevated and back then, we couldn't lower it as easy as we can now. So, my cholesterol was running around 200, not bad. My LDL was just a little elevated, not bad. My HDL was fine. What did I do? I started treating it and now my LDL is in the 70's and my HDL is in the 70's and from a cholesterol standpoint, I plan to live a long time. I heard somebody say the other day 85% of cardiologists take a form of cholesterol lowering medicines because they know that even in normal people if you lower their cholesterol, you will do better.

Letter #2:What are common causes of anemia?

Response #2: Let's talk about anemia. Anemia is where the blood count is too low and people get tired and fatigued and the color in their face is drained and the conjunctivae is drained of its color. You can get anemia from many causes. The blood cells are not formed rapidly enough or we are losing too much. Now, normal red blood cell that circulates in the body circulates for about 100 days so there is a turn over every 100 days. If you've got an ulcer and you are losing blood. If you've got a chronic illness and those red blood cells die too easy. If you've got a leukemia and your spleen gets rid of those blood cells or there's something wrong in your bone marrow, you will become anemic. Your doctor needs to give you a thorough history and a thorough exam and take care of that.

Closing

Dr. Bob: And that's all the time we've got for those questions and as every week, we want to be sure that you are exercising. Be sure that you exercise as it will cut down on stress, blood pressure, lose those pounds that you want. Eat a good diet. Get 8 hours of sleep and see how refreshed you feel and how fun and most of all, what is it we like, it's laughter in your life. I hope you've liked this show as well as I have.

If you have a question for Dr. Bob, write to The Dr. Bob Show - 6700 Baum Drive, Suite 1, Knoxville, TN 37919 or send your e-mail to letters at letters@drbobshow.com