Chet Zelasko: Welcome to Straight Talk on Health, I’m your host Dr. Chet Zelasko. Together with WGVU in Grand Rapids, Michigan. I examine the latest and greatest in the world of health. Whether it's research that makes headlines, another miracle diet, a new supplement or an exercise trend. I look at the science behind things and let you know whether it's real or not. You can check out the other things that I do on my website, drchet.com. And sign up for my free e-mails.
Today I have the distinct pleasure of bringing into the studio Dr. Scott Russo and we're going to talk about prehabilitation. Dr.Russo, how are you doing?
Scott Russo: I'm doing great. Thank you very much, Chet, for having me today. For the invitation to share something I'm very passionate about. Something we can use to optimize patients before surgery and give them the best outcome their best life. I’m a graduate of Michigan State undergrad, Wayne State’s Med school, I did the Spectrum Michigan State residency program. It has a different name when I was going through it. And now I’m an orthopedic surgeon and this is my 32nd year of being in practice, I’m on staff at all the hospitals in town, past chief of orthopedics at Saint Mary's and Spectrum. And it's been an honor to take care of the patients in our community and to a lecture at different conferences nationwide and worldwide.
CZ: And on top of that, he's a great guy, he has no god complex, let's put it that way. I've talked about that on the show long, long time ago. Good podcast, Tim Harford, The God Complex. If you guys want to enjoy something, go see that. Scott, we're going to talk about prehabilitation, but what are the events, if there were any, or what were the factors that led you to developing something that can be done before surgeries attempted? How did you get here?
SR: Yes, so I think any one of us can look back in their life, their family's life and understand patients whose lives have been hijacked by an illness. And in 2008, I came down with a staph infection that ended up in my spine. So spine surgeon with a staph infection. And in my heart. And, you know, I was admitted to the hospital and fortunately the antibiotics took care of it but what I really felt was the emotional distress of worry about being a patient and having my chest cracked open and my heart valve removed or my spine operated on, as a spine surgeon who knew what it was like. I was discharged home after 8 days of being at a hospital. And I remember the air never smelled so great to get out of the hospital. But the reality was - over the next 6 weeks, I was depressed. I was malnourished, I lost 20 pounds of weight. And I was physically deconditioned and I left the hospital with no path forward. And that was the impetus to start thinking about what we can do better as health care providers.
CZ: So what you're saying is that after that time in the hospital, there was no exit plan, there was nothing for you to do.
SR: I was discharged home with a bag of antibiotics, a pic line in my arm and a follow-up visit with the infectious disease specialist and a cardiologist - and everybody was great. It was just a gap in the care.
CZ: Interesting. So anything else that led you to examining this path more fully.
SR: So a good physician, a good surgeon, will look back on these cases and recognize things that he could have done different. And of course, over the course of my practice or have been patients who I expected to have a great clinical outcome who went on to have a less than perfect clinical outcome. So that reflection led me to pursue a deeper knowledge in the care of patients before surgery. And I've always use nutrition and physical therapy and promoted that. But not to the extent that I recommend now and in creating a program that patients can follow beforehand, even to a point where they can be referred to a practice that will address that.
CZ: So that is where we're headed now towards prehabilitation. Define what you mean by that for listeners who may not have heard that word before.
SR: So there are 2 key areas for pre surgical optimization. The first areas medical optimization and that's in the hands of the primary care physicians or some surgically some specialized surgical units that do up research cull units. What I've done is taken that I look at the concept up rehabilitation or 3 key pillars. The first pillars behavior well-being and what I call medical risk assessment and I can go into that a little bit greater depth in a second. The second pillar is physical optimization preparing the patient. Again. There's layers upon layers of what we do for that. And then the 3rd pillar is working with a dietician for nutritional optimization. All these things done 6 to 8 weeks before service. When the patient comes to the operating room. When they walk in the hospital, they are mentally ready to do battle in the operating room. They're physically ready to accept that challenge and nutritionally they are at the best health.
CZ: Now’s the time to define that first pillar. Let's go in little more detail with that.
SR: So behavioral well-being, I went a little deeper in my education outside of medicine. I took a life coaching course. I started to realize that there are ways that I can communicate with my patients a little bit better. And there are ways mentally so mental resiliency training, in other words, optimizing the patient mentally before surgery through the concept of mindfulness positivity, teaching them how to visualize walking the into the hospital and having an excellent surgical outcome and really practicing that over the 6-8 weeks before surgery, everyday mindfulness in their secondary benefits of that, it's probably the real long-term benefit is that we prepare patients, Pre-operatively. So that after surgery, the continued the same behaviors which will improve high blood pressure, improve their dietary habits, will continue them on the conditioning program so that they'll be healthier and less likely to experience at least severe chronic illness down the line. That's the goal.
CZ: Let me ask you this. In the age of Google and YouTube, some of your patients, at least since that's become the rage in the last few years, had they gone to the extent where, they're going to try and find the kind of surgery that they're going to have on a video. And I can I will tell you that from a knee replacement, I did that, but not in a live one been done in the cadaver, which is why we took like 5 minutes. But the spine surgeries difficult because it can last a long, long time. Has anybody done that and does that impact when they see what could be involved in this? Have you seen anything like that where people doubt starts creating in their mind?
SR: It's a good question. Yeah many patients come in having looked at videos on YouTube and things of that nature, which I respect and I want them to come in because they come in with very good questions, but also does create some degree of anxiety and those peak individuals predisposed to depression might create a depressive episode. So Pre-operatively, if we look at that measure that and talk to them about it and then we go through the behavioral being process. We talk about mindfulness and we replace those negative thoughts the depressive thoughts with positive thoughts is a perfect not at all, but it gives the patient control. I really encourage sure I encourage shared decision-making between the patient and the surgeon between the patient's family and the surgeon. We want the patients to be empowered to have less fear. So this is it's a real important thing from the patient's standpoint.
CZ: It's interesting. Use that term a shared decision-making because that's the 3rd time I've seen it in just the last week. It was in a couple papers I was I was reading and then you just used it again. I think that's really tremendous. Second pillar:
SR: second pillars, physical optimization. There are 5 key components in my mind. One is again, the patient's work with a physical therapist before serving starting 6 to 8 weeks before hand and the first pillar of strength training. We want to build up their muscles. Let them load up on their body protein. Before we break them down surgically the second pillars aerobic conditioning. We want to strengthen their heart and lungs. The third part of it. The sub pillar we can call. It is a balance treating patients fall after surgery. We want to protect them. The 4th one is flexibility. Flexibility is important just to feel good. And then the 5th Pillar is activities with daily living. So, I have my physical therapist train patients in how to do their activities before they get injured with surgery. A positive injury. That is yeah, that's it. So we track it. We strengthen them. And if they do it one time with the therapist. Every week we transition to home therapy or gyms like Planet Fitness. No plug, MVP, no plug. YMCA. These programs, smaller companies are really cost effective for patients and encourages them to adopt this healthy lifestyle. At the same time, the therapists are working on the mental well-being standpoint. They're encouraging to go further to visualize to be stronger. So it's putting the care of the patient in the hands of the patient, empowering them that for their best life.
CZ: Phenomenal. When I was preparing for my knee replacement, you know, I did as much as I could do. And it still left me shocked at how much loss I had. OK, let's get to the 3rd part because we don't want to run out of time.
SR: So the third pillar is nutrition optimization. Unfortunately many people, most people live the standard American diet. And this is unfortunately 70% of our society is overweight, obese or super obese. We can impact that, leveraging the surgical experience. Implanting in patients the positive nature of weight optimization. And this is no criticism. Weight is challenging. There's no doubt about it, but we have to support our patients. Those that want to go to the next level to work again on their weight. And most patients who have lived with obesity have worked very hard on their lives. And we as surgeons, we as physicians, have to continue to support them in the path to the best health. So we work with a dietician. I have a dietician that works with me as part of my separate practice, different from my orthopedic spine practice, and they counsel the patients. My go-to diet is a Mediterranean diet. But we also have created a surgical supplement kit that addresses, fills in those nutritional gaps. So seven key supplements for health and wellness that's available to patients before surgery. We start three weeks before surgery, we go for two weeks, we hold it for a week and then we start up for another 2 weeks after surgery. And we've had great experience with this whole nutritional process.
CZ: Anything that comes out clear in your mind, that's a real success in your opinion?
SR: When patients have a great clinical outcome when they walk in and they say, you know what? Doc, I’ve lost weight, I've got a new way of looking at my health. I'm exercising regularly and we're studying it now. We're still in the pilot phase, but we're working on that to have the best outcome in to try to do it in the most cost effective manner for the patients, their families and the insurance companies. We really want to keep costs down to support health care in General.
CZ: Scott, I think your program is phenomenal. I'm a big believer in pre-hab. I did some of the things that you recommended, not all of them, but folks, let me tell you something: This is the future of medicine and especially surgical care. And especially when you know it's coming. I think this is something that's going to change your life. If you get the opportunity to participate in a prehabilitation program before you have any type of surgery, whether it's your shoulder, whether it's your knee, whether it is your spine. Scott, thanks for being in the show today.
SR: Appreciate that, Chet. Is there a way to share where people can go to learn more about this?
CZ: Very Quickly.
SR: Yes. So, Neutrifuel nutrition N-U-T-R-I-F-U-E-L nutrition dot com or recover health dot net. Thank you very much, Chet, for this time to share this and I look forward to visiting with patients and helping them be their best self.
CZ: Well, it's phenomenal and I think you're way ahead of the field. Dr. Russo. Unfortunately, that's all the time we have for to show until next time this is Dr. Chet Zelasko saying health is choice, people, choose wisely today and every day.
Narr: Straight Talk on Health with Dr. Chet Zelasko was recorded in the studios of WGVU Public Radio in Grand Rapids, Michigan. The views and opinions expressed on Straight Talk on Health are not necessarily those of WGVU, its underwriters, or Grand Valley State University. Episodes are found at wgvunews.org and wherever you get your podcasts.
