April 19, 2021

Interview with Scott Sigman, MD

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Scott Sigman, MD 0:02 
My name is Dr. Scott Sigman, I like to describe myself as the original opioid sparing orthopedic surgeon, healer of knees and shoulders left and right, host of the ortho show podcast and Chief Medical Officer of the ortho laser, where the big laser centers so my my entire clinical professional career over the last decade has really been trying to influence and change the behavior of physicians, health care providers, as well as trying to empower patients to let them know they have choices. And so opioid sparing has been a passion. And that's where laser came into play, I was able to identify the laser as an alternative treatment option potentially for patients and I did my research, I went to Italy met with a laser manufacturer, and did a lot of real behind the scenes research, evaluation and the basic science of lasers actually quite strong. So I decided to bring a laser into my private clinical practice where I'm a partner at orthopedic surgical associates. In just north of Boston, as we said, I practice at a local General Hospital as well as drum Hill surgery center. But those are not I do not have ownership in those facilities. So I'm a private practitioner. So we tried the laser in the office, and we had some very early success. And then I decided, you know why I do this in a very busy with the pedic office with lots of overhead and all kinds of people running around doing insurance and stuff. Why don't we open up a center that just does laser? And so that's what I did. And then the laser manufacturer and distributor came to me and said, Wow, we really like this model. And we'd like to potentially franchise this across the country with you as our founder. I said, Yes, I think that sounds like a great idea that we can offer this, you know, alternative to opioids. Remember, I always like to say, you know, the opioid epidemic is the Forgotten epidemic in the setting of a world wide pandemic. And unfortunately, it's actually getting worse. And so our patients, you know, have been home, they've been depressed, they haven't been working. And we've seen a neural uptake, uptick in the opioid epidemic. So, conceptually, we got together, and we developed ortho laser with a big laser franchise, we have nine facilities now open across the country with another 16 that have been committed. So we're really excited about this as an opportunity for alternative treatment options for our patients with acute and chronic orthopedic conditions, such as the shoulder problems we've talked about. Now, again, you know, with shoulder range of motion, we've all been taught, especially with surgery, more often than not that we're going to keep them in the abduction pillar for six weeks, they're going to do pendulum range of motion only, they can move their elbow and fingers, but we're not going to go for early motion. However, there's more and more literature support coming out at this point that perhaps early range of motion, will benefit the patient to create the force vectors that are needed for the fibroblasts to come in and lay down the collagen for the healing of the rotator cuff in an organized fashion. And so we've my surgeon, friends and colleagues from around the country, they joke with me and they say, Hey, you know, siggy, you know, your let your patients do burpees in the recovery room. And I said, Well, maybe not that exactly. But you know, we do put them in a sling, but we get them out of the sling in four to five days, once the block is worn off, we start early range of motion. So the idea of having the ability to have early functional range of motion, at home with home exercises is actually very attractive for me in the setting of the surgical world. So we've really, we've really created a much better patient experience for our patients in the first six weeks after the surgical intervention, which has always been the worst. And so that, you know, nowadays, I get patients every day coming to me from afar, you know, learning about this, the techniques that we use, asking us to care for them because they know other individuals that have had successful outcomes. And so I think that rotator cuff surgery, even total shoulder replacement surgery now at this point, can be done near opioid free. It's really quite remarkable.

RangeMaster Rob 3:56 
Well, that's a couple of things there. One, let's talk about the total shoulder. You know, you the people that are recovering from the total shoulder or the reverse shoulder have a lower anecdotal reporting of pain in that early period. And is that because in your mind's eye, that we're dealing more with the bone than we are with the soft tissue or what do you think the reason that they are reporting out that their recoveries moving along more quickly?

Scott Sigman, MD 4:34 
Great question, Rob. And I think probably there's a few things first and foremost of people that have shoulder arthritis have been used to living with pretty severe pain for quite some time. Very few will undergo, you know, if you have a rotator cuff tear, you fall off the ladder, you get surgery, you know, three weeks later and you get your rotator cuff fixed, you didn't have any pain prior to your rotator cuff tearing. Now for the total shoulder patients they've had chronic, you know, pain and discomfort for quite some time. Now, remember been about three years now. And many, many of the orthopedic surgeons that are shoulder specialists around the country now are incorporating the blocks that we're talking about, which is then, you know, they may the patients may not understand that, but they're probably receiving these nerve blocks now that are prolonged as far as our action is concerned. And to be, you know, if we think about the pandemic and how the world's going to change, well, one thing's for sure, more and more surgery is going to be done in outpatient surgery centers and away from the big white building with sick people, right. So, you know, people don't want to go to a hospital where there's still COVID, we have 30 patients that are hospitals still right now that are admitted with COVID. They're always looking for, for options. And if you look at, if you listen to the pundits, as many as 80% of surgery will be done as an outpatient procedure by 2024. So that's the direction that we're heading. So I think that there's definitely things that we're doing, again, even within the total shoulder space to make the patient experience, you know, so much better for the patient. And, you know, also, you know, I'm a big believer in trying non operative approach for as long as you can, right surgery is a last resort, always, unless they're, you know, is it an acute injury, or a tear or fracture, or something that we know, you know, surgery is the best first option, but the overwhelming majority of shoulder conditions can be treated non operatively, before recommending surgery. So I talked early on about, you know, our laser, I'm the chief medical officer and founder where the laser with big laser centers. And that's where we got the idea of using the laser for COVID. But we're big believers in the combination of using laser with associated occupational therapy, physical therapy, whether it be in the setting of the office or the home. For patients to do these exercises, it's quite symbiotic. So here you are doing this laser, what we try to do is every other day, if you can go get a laser treatment takes 20 minutes, you can hear it field or see it is completely painless. It's a pulsed laser. So patients really, you know, enjoy the fact that they can go and have a quick and easy treatment. And then the next day, we say either do your home exercises, you know, with the equipment that you have, or you do your physical therapy with your therapist, if that's where you are. And the same thing for Occupational Therapy. So the combination of those two events has really helped us to try and you know, unload a lot of the patients that were cancelled for surgery or other patients that are looking to avoid surgery in the setting of the pandemic. So that's been quite helpful. 

RangeMaster Rob 7:26 
So when you talk about the laser, and what's happening in their, in your, in on your website, and places you talk about it, forgive me if I'm saying this wrong, that you're activating, inter intra cellular communication, um, and in a much more pedestrian way I say to people about using a home exercise and pain free range is that you're you're you're getting things moving again.

Scott Sigman, MD 8:01 
Absolutely. at the molecular level, the laser actually increases the temperature by about three degrees Celsius, well below any concern for neck skin necrosis, I mean, our laser technologies been around for over a decade without a single incidence of complication or skin burn. So we don't have to worry about that, because it's a robotic pulsed laser. Many of the lasers that most physical therapists and occupational therapists are familiar with are handheld, and they have to move around because they generate heat. And otherwise you can cause issue, but ours does not because it's pulsed, but it's so generates three degrees of increase Celsius, and then all the little molecules get moving a little bit. And then the other thing that it does is that it increases, we got to go back to your high school science here. Now Rob, and were to go to the to the mitochondria, the powerhouse of the cell, which makes ATP, which is the energy of the cell. And it stimulates increased production of ATP. So the cells around the area that are being laser wake up. And then they start producing these things called proteins, which are the communications that you're talking about. That's how they communicate between cells. And the reason it works so well for inflammation, even if you think about COVID. COVID is the cytokine storm we know about that, right? The cytokine storm gets crazy, it creates this very powerful inflammation that the body can recover from. And what that's mediated by is these proteins. And these cytokines are the proteins, and they're pro inflammatory. But you know, God is good for whatever reason, when you focus wavelengths of light, that are the right wavelength into these cells, the cells now make proteins that are anti inflammatory, and they block the formation of the bad proteins that create the cytokine storm. And that's what's happening. And that's what happens happening for acute and chronic inflammation of the elbow, knee, shoulder, as well as in the lungs in the setting of COVID, which is why it works so well for COVID. And so it's a real cellular mediated thing. And it's exciting, you know, the idea that you can take a laser, plug it into the wall, you know, use the amount of energy that it takes for a hairdryer to be able to then you know, use it on these patients to create reduction in pain and inflammation. 

RangeMaster Rob 10:15 
Are we're going to see this kind of technology. In physical therapy clinics, does it require an orthopedist to be the director of one of your clinics or kind of build that framework for me a little bit? 

Scott Sigman, MD 10:28 
Yeah, so the physical therapists are many of them are used to the idea of laser many of them will have a class 3d laser, which is a lower energy laser, but it can still generate the heat RS is a is the only class for pulsed energy laser. So that does not generate heat, it can be left alone with the patient as well. So it doesn't, it has a robot scanner, so you just set to x y grid, and you can leave the room while the treatments going on. But we have many physical therapists in our areas around the area, which our centers are that we have that symbiotic relationship where we're using laser plus the therapy together. And that has really worked out well. As a general rule, in order to get the laser that we have, which is the MLS m eight laser, it is uniquely tied to ortho laser, where the pedic laser centers, but you know, there's no reason that in depending on the location that physical therapy cannot be a part owner in a center such as ortho laser as well. Interesting, interesting. And so we're really going back to treating that out of control inflammation, and calming that down. Your website says you're having like an 80% success rate. That's correct. We right now are really, you know, with vast scores visual analog scores, we ask every patient pre and post treatment, and 80% of our patients are seeing significant pain relief that's within the chronic space. But I would tell you, we use it to other ways, we use the laser for acute injury. So we'd have near 100% efficacy for that athlete, for example, that rolls their ankle, or has an elbow strain, or has a minor fracture, or a muscle strain, we put them under the laser 100% of those patients will see improvement in a matter of three to four treatments, it's really quite remarkable. And then the other way that we use it as well, Rob is because what is surgery, I mean, I described surgery is I androgenic acute inflammation, right? We take a knife to your skin and we edit hurts, because we create inflammation, right? So we use the laser perioperatively to reduce the pain and swelling of the surgical intervention. So the patients also get better, faster as well. So it's that I'm an all hands on deck approach to minimizing exposure of opioids to our patients, and really improving the patient experience so that the patients when they do go to church and work, they say, yeah, go get your rotator cuff fix, because, you know, it really wasn't that bad. And I'm doing really well. 

RangeMaster Rob 12:56 
Yeah, well, there. You're you're describing a continuum there, where are we any place along the way the patient could drop out and say, Hey, I'm feeling better. I mean, it's fun to work on those athletes, and especially if they're famous, you know, you get a little of that fame rubs off on you. But most of our patients are someplace between 50 and 85 years old. And and things are just wearing out, you know? 

Scott Sigman, MD 13:20 
Yeah, you know, I did my training at the curling job. Orthopedic Clinic in Los Angeles, where we took care of all the major athletes from all over the world. And that was a tremendous year of my life. But, you know, at the end of the day, it's really the weekend warriors, it's the regular people that are out there, as you describe that 50 to 80 year old population, those are the ones that are getting the wear and tear and where everything starts to hurt. 

RangeMaster Rob 13:42 
Well, that's, that's really fascinating. Well, these are the topics I wanted to talk with you about today. And if anybody is interested in following up with you, what's what's the website you'd like them to go to if they're in this medical space? 

Scott Sigman, MD 14:01 
So you know, there's a lot of a lot of ways you can find the fro You know, my I've sort of been known for my hair now guys. So it's like, hashtag follow the fro is my end line for everything that I do. But we're all over. I'm on LinkedIn for my professional account where it's where I really talk about my opioid sparing strategies and all the things that we're doing to help patients for the old people you can find me on Facebook, Scott A Sigman MD there too, for family and friends. And then for the young people, we obviously like to be on Instagram too, because they're, they're getting a lot of fun about what we're doing these days. So that's @scottasigmanmd and then my personal website as well scottasigmanmd.com so lots of places you can find me, you can't turn on a computer and not find the fro too far down the ride. 

RangeMaster Rob 14:44 
Well, that that'll beg a final step. Tell us how you got to the fro. Was that after your first trip to Italy? Or was that? 

Scott Sigman, MD 14:51 
Yeah, you know, it's what was once the pandemic really hit, you know, it was like, you could really get to the Get your haircut and I was like, you know, we're just gonna let that thing go well, and then it just became it just became you know, it's funny. I'll go to a meeting when you ever when we used to go to meetings, right? But you know, people tapped me on the shoulder and say, Hey, I love what you're doing. I follow the flow. So it's lots of fun. It's becoming now sort of a part of who I am. It's part of my brand and we love to talk about it. 

RangeMaster Rob 15:17 
Well, I appreciate it. Thank you for the time you spent with us today...

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