Ever felt overwhelmed when faced with a patient's orthopedic concerns? Have you wondered when to refer and how to best collaborate with specialists? In this episode of the LTC University Podcast, we sit down with Krystyna Nau, Regional Vice President at YourHealth Primary Care, to demystify the world of orthopedics for primary care providers. Krystyna, with her extensive experience in healthcare leadership and clinical practice, shares valuable insights on: Common orthopedic challenges primary care providers encounter When and how to refer patients to specialists effectively Essential knowledge gaps to bridge and best practices to adopt The future of orthopedic care and how primary care can stay ahead of the curve Whether you're a seasoned clinician or just starting your career, this episode will equip you with the tools and confidence to provide comprehensive care for your patients with musculoskeletal issues. Tune in to the LTC University Podcast for expert advice and practical strategies that will elevate your orthopedic knowledge and enhance patient outcomes.
www.experiencinghealthcare.com
Welcome to the LTC University podcast. My name is Jamie, and we're excited to have you here this week listening those of you that are listening in, if you're your health employee or maybe you're one of our assisted living partners, but it's great to have you. Thanks for listening in today. Now today we're joined by Christina. Now she's the regional vice president at your health primary care in Columbia, and Christina has a wealth of experience in healthcare leadership, and she's here to share her insights on how primary care providers can better navigate the world of orthopedics. But first, Christina, welcome to the podcast. How are you today?
Thank you. I'm doing wonderful. How are you awesome? I'm
doing well. I'm doing well. It's Friday, where we made it through the week and ready for the weekend. But now I'm always curious about people's paths. How did you get started in healthcare.
So, you know, I was an athlete growing up, and had many injuries myself. So I actually first started out in the athletic training and sports medicine field where I got my bachelor's degree. I did a lot of emergency care. I, you know, on field athletic training. So I was on, you know, the football fields and lacrosse fields and all that good stuff. Then I was also in the physical therapy realm for quite some time. And then I decided I wanted to do something a little more, something a little different. So actually got my Master's in orthopedic physician assisting, and then I combined that with my certified surgical first assist certification. So with that, I was able to work in private practice and orthopedics. I've worked in trauma centers, in hospitals, teaching hospitals, so I've had my share of trauma. I've worked in joint replacement surgeries, sports medicine, dabbled in some management, which I'm also doing healthcare leadership and management here as well. And I really loved being bedside, and surgery was definitely my niche. But however, working in the hospital setting, I really saw that there were a lot of gaps in healthcare for patients. And so that's when I actually found out about your health. And I, you know, set up an interview, I talked to some various people that worked here, and I really, really wanted to be a part of a company that was so innovative in healthcare and was really able to work on meeting patient needs. So that's how I ended up here.
Yeah, that's amazing. Yeah, yeah, you know, I really have no experience with orthopedics, except one. I had to get a cortisone shot in my shoulder one time, and that was, that was an experience. That was a long needle, so, and, yes, yeah, it was a really long, thick needle. And, yeah, I remember the actually had two doctors there, and they were, one pulled my shoulder apart, and then the other one put the needle in. It was but it was instant relief. It was amazing at what they did. So, yeah, it was actually instant relief. So, so yeah, you know, I, you know my, my dad, I remember him having knee surgery. So yeah, it is just as you age, you're gonna, your body's gonna break down, you know, you're not, not able to do the things you used to do, and hip replace. I mean, there's just so many things, especially senior healthcare. So it's so needed and and today, you know, we want our providers to be able to kind of get that knowledge of how this really plays a part of primary care and what you need to know. So, yeah, Christina, you have a fantastic vantage point as an RVP for your health. From your perspective, what are some of the biggest hurdles primary care providers face when dealing with, you know, muscular, muscular, skeletal issues and orthopedics.
So, you know, I would say orthopedics. And, you know, MSK is a short way we call musculoskeletal issues. It's not something that primary care providers truly have a huge training on or coursework as they're becoming nurse practitioners, physician assistant, you know, MDS, you know, it's a very small portion of their training. So sometimes they just, I would say, their biggest hurdle, they just don't know when they need to send out to an orthopedic sooner than later, oftentimes, and I think that's, you know, going through some points for that would be super helpful to the primary care provider. You know, one question that I get oftentimes from a lot of the providers that I work with on a daily basis are, you know, how do I know when to send this? Send this off? And one of my biggest things are fractures and dislocation. Patients, you know, oftentimes we can have a fracture, you know, that might be a non displaced fracture. It's something we can treat conservatively. But anytime a primary care provider comes across a displaced fracture or fracture that goes into the articular surface of a joint, these are really times where you absolutely need to send it off, because oftentimes these may require surgery. They may require specific splinting or DME or casting. You know, for example, we have wrist fracture sometimes that are displaced coming into an orthopedic but we may actually be able to reduce that fracture and splint it in a specific way that we can hopefully avoid surgery. And you know, those are things that a primary care just isn't trained on. And so I think those are super important points where, you know, the sooner you send it, you can help decrease their risk of early onset arthritis, decrease the risk of deformity forming if it doesn't heal correctly. And oftentimes, you know, you might be able to prevent an extensive surgery that maybe won't be so extensive, if we get to it quickly and soon, and we're able to hopefully prevent some long term issues with these types of
things. Yeah, and that's the point, is to prevent. Now, I think a lot of people, when they think orthopedics, they think, oh, there's these surgeons. They just want to make money. Operate, operate, operate. Now that hasn't been my experience. You know, the surgeons I worked with, you know, a long time ago, you know, for my shoulder, that was not their first thing. Hey, let's, let's go here. Let's, you know, I'm sure there are those money grabs out there, and there are those doctors, unfortunately, but you know, you know, your health is all about prevention. You know all about let's, let's, let's, let's take the finding the better path. And sometimes that is surgery, sometimes that is a knee replacement, or or both knees, or whatever the the patient needs, you know. So I think that's, you know, such a such a big point. Prevent, prevent, prevent. What can you do? Because nobody, nobody wants to go through surgery.
No, absolutely. And I think that's, you know, a really important point is that, you know, we, if we can treat it conservatively, we'd, we'd love for the primary to do it, and oftentimes, for clavicle fractures, for example, for your collarbone, you know, it may be displaced, the orthopedic may be able to put them in a specific type of, you know, brace or sling them, and then they may say, okay, you know, we can treat this conservatively. We'll get an x ray in another two weeks, make sure there's been no change. We'll get an x ray in four weeks, and then we'll let your primary care continue, your, you know, following you, as long as they see that there's been, you know, healing around that bone and that fracture, yeah. So, you know, getting it to us sooner as an orthopedic and a specialist, you know, a lot of times, we'll be able to then send it back to the provider, the primary care, to continue following them from a conservative treatment standpoint, and that does help in the long run, where we are preventing those things that may be more costly for the patient down the line, it may cause more surgery and may cause long term issues. So I think having them work together is just super important, and having that open communication from provider to provider,
yeah, absolutely. Now, in your experience, what? What are some of the most common misunderstandings from primary care providers perspectives. You know that they may, they might have about, you know, what are those misunderstandings that they have about orthopedic surgeons and orthopedics in general?
I think one of the, you know, something that they misunderstand is maybe the importance of an x ray. I think a lot of some primary cares that I have talked to, they're like, Yeah, we don't need those x rays, though. They're just trying to get money and build the insurance. But there's a lot of important reasons that many orthopedic surgeons without an x ray will not see the patient. We have to have them come in. The first thing they're going to do is get an x ray, or make sure that they brought X rays with them, even if you may think it's a sprain, you know, a simple sprain. But the importance of this is to ensure you are not missing something as a provider, oftentimes, you can miss a pathological fracture, you can miss bone lesions, you can miss other abnormalities. If you didn't take an x ray, you would know we're there. You know, for example, when I was in training as an orthopedic PA, I will never forget, it was one of my first rotations, and we had a patient come into the ER, he did go to see his primary care prior. And there was no X ray taken. He had been having hip pain. They thought it was just because he mowed the lawn uphill. Nothing much came into the ER, because his pain was getting worse, we took an x ray, and unfortunately, we found that he had a pathological fracture, because the patient had multiple myeloma, which is a type of bone cancer. And so these are the Yeah, and it was a very sad you know thing, and we realized that he had pathological fractures in his in his upper arms and his other leg. And it's so important that just, I think people in general, not just primary care, understand that the X rays are not a money grab, but it's really to protect the patient, but also to protect the provider, to make sure that we're not missing something that you might not otherwise see. Yeah,
yeah. I remember when I was 19, I was working for a construction company, and I slipped coming down a ladder and twisted my foot. Long story short, I ended up working on this bum foot for a month. And finally that my boss was like, go to the doctor. He's like, it's covered on a workman's comp. So I went and saw the doctor, you know, reluctantly, and because I was a knucklehead and, you know, they they did the X rays, they said, Yeah, it's probably just spraying, you probably just twist. It's probably simple. And the matter of fact, the doctor gave me these exercises to do with my feet, you know, they were like, here just, we want you to, you know, write the ABCs in the air with your foot. Just do this as an exercise to build your foot back up. And so she had me doing those. And she left the room for a few minutes. Came back with the X rays, and she was like, Stop doing that. I was like, what? She's like, your foot's broken. So, yeah, so exactly,
you know, sometimes you just, you don't realize exactly, you know, and and it is important. And so it's not just, not just a money grab.
They didn't know if my foot was broken, and they matter of fact, they didn't think it was because they also saw that I continued to work construction, and I was in really bad pain that whole time. And again, I was a knucklehead, you know. We roofed houses. We did everything, you know, you know, work wise. And I, yeah, and my, my boss was tired of me limping around. That's why I ended up going to the doctor. But had they not done the X rays, you know, who knows what would happen? So that's, yeah, absolutely, yeah. It's really go ahead. I would know.
I was just going to say in earlier, you know, you talked about cortisone injections, for example. And I think, you know, that's something that's super important to mention as well is that you really don't want to inject into a joint where you don't have an x ray pre existing, because same thing, you don't know what you're injecting into if there's bone lesions or abnormalities in the area, and I think it's super important to make sure that you know. You also take that into consideration, because let's say you did inject into an area that you've then got later imaging and realize that this patient may need surgery. And something to take into consideration from an orthopedic standpoint, is that if a patient is going to be having surgery in the near future, you don't want to inject because it increases your risk of infection significantly. So, for example, for arthroscopy, you know, for arthropy like your knee or your shoulder, you know it's recommended about four to six weeks. You want to make sure you do not have any injections within that time frame, because it will increase your risk of infection. And same thing, for patients that might end up having a fracture, or they have significant arthritis that really does need to turn into a joint replacement. You don't want to inject within three months. And some surgeons even push it to sticks, yeah, because of the risk of infection. So you know, that's why I always say, when in doubt, go ahead and get that X ray, and then we can move forward from there. Yeah,
absolutely, yeah. Now, looking in the future, you know, your crystal, your crystal ball, you know, how do you see the role of primary care changing when it comes to managing orthopedics? And what kind of trends do you see or innovations coming up on the horizon?
Yeah, so there's so many advances now that allow ease of access for obtaining images within the home or facility or clinics, which our company your health uses, we utilize a company that will go into patients home and take X rays. So I think that's a huge plus. And there's way easier access for providers to consult with each other now. So between that and then the use of ultrasound for diagnostics, there's something called platelet rich plasma that's been a lot around for a while now. It's still something being researched about the true statistics of you know. And its outcomes, but it is something that moving forward, you know, primary care providers could potentially do in the office. I know a lot of orthopedics do. We also do it in the operating room. Basically, you draw some blood, you spin it down to get all the good stuff, get all the plasma, and then you inject it into the joint or to the tendon to help promote healing. So there's things like that, there's there's peptides discussions now, there's just so many things coming out that I think if the primary cares really are interested in being able to treat their patients from an orthopedic standpoint, that they're able to also encourage their patients to exercise, seeing them more often, which is what our you know, our model at your health is see them as often as we can to make sure that they are healthy, and we're catching things sooner prevent issues. And the healthier the patients are, they're more that they're moving. Being able to identify issues sooner than later is really, I think, wonderful advancements within, you know, healthcare moving forward. Yeah.
And what it brings my mind to automatically is preventing falls, like, when you're really staying on top of this, you know, especially when you're talking knees and hips and, you know, you know, all kinds of stuff. You know. You know, my mom here, back this last year, had to have a wrist surgery because she fell, you know, she caught herself, you know, with her hand. You know, like they often do. You know, it's, it's just it. You know, that kind of prevention is just massive when it comes to that and preventing that, and we know, you know, especially in senior health care, what a fall can do. I mean, a fall literally, can set forth, you know, a series of events that unfortunately Can, can lead to your demise. And that's so important to stay on top of these things and make them a priority. I 100% agree. What advice would you give to primary care providers who want to become more confident and skilled in handling these orthopedic issues with their patients?
I would say education is key. Join, you know, conferences that provide CMEs and help learn a little bit more about orthopedics. Go to classes that give you deeper insight. There are some classes that you can take. So in the orthopedic world, we have special testing that we do for every joint, and that helps us to without imaging and without X ray. You know, it helps us to guide what we think might be the issue, and then we utilize, oftentimes, the imaging to confirm so learning those special tests that allow you, when you're seeing your patient, to do more in depth evaluation from an orthopedic standpoint, reaching out to colleagues, look at the images. That's another huge thing for me. Is oftentimes, you know, we have one of our our Chief, Chief nervous practitioner, she reaches out to me sometimes, and she's like, Hey, can you look at this for me? And she's like, Oh, I didn't sometimes realize you know what the report was talking about, because you get these reports from the radiologist, and a lot of times it says everything, but being able to look at the image, look at the report, and be able to correlate to your exam of the patient is huge in being able to really be able to confidently handle your patient and some of their orthopedic issues. Yeah,
that's fascinating. Yeah, it's it really is. Now I the thing that I know for myself, and I know about myself, I could have never done the surgery thing. So that would be, I love it, you guys, the people you know. I know lots of people like you who love that stuff, I would have passed out like, I yeah, there's no way. Just yeah.
They joke that orthopedics are the carpentry of the body. And it's true. Yeah, we use malice, and we use saws and we use drills, but, you know, but really, it's wonderful seeing, you know, being able to take a fracture, for example, or replace a joint and, you know, put it back where it belongs, put a brand new knee in there, and then be able to see the patient be successful after. It's really wonderful. And, you know, being in primary care and orthopedics, you get to see the outcome of that, because, you know, orthopedics will follow it for a period of time, and then you're still going to continue seeing your primary care regularly. And so, you know, you get to be that one to still see how well they're doing, that they're have a more active life, potentially, and things like that. But I think it's a wonderful, wonderful thing. Yeah, that's great. Yeah.
Christina, thanks so much for being on the podcast. This is, this is great. What would your final word to providers be? What? What would you if you could say one thing to them? What would it be?
I would say, educate yourselves. And when in doubt, ask or send to the specialist that those would be my biggest pointers. I would say,
yeah, yeah. And how can providers from your health reach out to you?
They can reach out directly to me. You know my email address is the K, N, A, U, at your health.org they can call me on teams. I'm happy to, you know, chat with anyone. I will be up at the doctor circle office essentially every day starting next week. So they're welcome to come find me, and I'm happy to chat at any time. Yeah,
now for those providers looking her up in teams, you know, her name is not spelled like the typical Christina. So, I So, it is the best way I've ever seen it spelled. So, K, R, y, s, t, y, n, a, so, yeah, that is correct. Yes, yeah. So, so, yeah. So, what a cool, what a cool name. So, yeah, I'm just a thing, yeah, I'm just a regular, just j, A, M, I, E, so, yeah, pretty boring. So Christina, thanks again for being on the podcast. We're grateful to have you great, grateful for this information and sharing your experience. Sounds like you have a ton with this, and it's great to have you on the your health team, leading and and kind of running that region and helping so providers reach out to her if you have questions, comments and yeah, continue to help those patients with their orthopedic needs and don't shy away from it. So thanks for being on the podcast.
Thank you for having me. I appreciate it!