A Professional Pivot During The Pandemic

We all knew that COVID-19 was coming. The real implications of a global pandemic seemed distant. Things slowly evolved until mid-March, when they suddenly became frenetic with a State-of-Emergency being called, followed by rumors of a stay-at-home order in Massachusetts. When the Governor officially passed the order on March 23, 2020, an eerie calm set in. 

Within a matter of days, I went from being a busy in-demand orthopedic surgeon and educator performing surgeries and travelling the country to totally grounded. After cancelling upcoming surgeries and plane tickets, I hunkered down at home with my wife and kids with one thought: “What happens next?”

If you’d asked me last year what I’d be doing in the spring of 2020, I wouldn’t have guessed that I’d be hosting a podcast out of my closet or running a clinical trial involving lasers and lungs.

Clinic & Hospital Work

When the shutdown first happened, we went totally dark at the office. We were not seeing any patients and we sent staff home. We were determined to keep everyone on full payroll for two weeks not knowing how long the shutdown would last. As time quickly passed we weren’t sure how we’d survive as a clinic long-term without revenue. No loans were out yet and it was just an anxious time. At the time this is published, a percentage of staff are still furloughed and we are doing our best to make plans to return to the new normal within restrictions placed by the Governor. We’re slowly starting to do more and we are back in the office seeing urgent patients as well as performing telemedicine with hopes of bringing more staff back when able.

At my OrthoLazer location, we tried to keep people on. But the reality was early on, patients weren’t comfortable coming to our office, so we asked Erin, the office manage to stay on. OrthoLazer is now back online with strict precautions, such as taking temperatures and screening all patients. We’re nine weeks into this pandemic, so many patients who were scheduled for surgery or who were experiencing chronic pain are now coming in for pain relief. Honestly, we have seen some great success stories of pain relief since reopening. It is gratifying to provide patients another option for pain relief during these trying times. We are seeing similar results in our other OrthoLazer sites across the country. We have also seen tremendous interest from potential Orthopedic Surgeon and Pain Management partners for OrthoLazer franchises. It is clear there will be prolonged delays for elective surgery for the elderly and many younger patients will delay surgery in order to return to the workforce. Patients will be seeking alternative options for pain relief. We anticipate Ortholazer Centers to provide that alternative. 

At Lowell General Hospital, where I normally operate, it feels like a bit of a ghost town. Watching what happened in NYC, we were all prepared for a tidal wave of cases but our hospital has kept up well. Because of the moratorium on elective surgeries in my state, I have taken the opportunity to operate elsewhere. I live just a few miles outside of New Hampshire, a state with a completely different approach to managing the pandemic. Fortunately, I was able to obtain privileges at Northridge Surgical Suites in Nashua. I am making the trip twice a week and am performing time-sensitive surgeries such as rotator cuff and ACL reconstructions. It is a relief to me and my patients to start healing again especially for patients that may have long term negative outcomes by waiting longer. 

Telemedicine is now at the forefront and given long-term social distancing, it should become a permanent part of medical practice.

Of course, like almost every other physician in North America, the pandemic has changed the way I see patients. Telemedicine is now at the forefront and given long-term social distancing, it should become a permanent part of medical practice. Telemedicine will prove to be more efficient for both doctors and patients. No longer will patients have to carve out three hours of their life for a doctor's appointment. Doctors will be able to clear busy waiting rooms. These improvements are long overdue. As a Vitals “Ontime Doctor” I have always said our patients' time is as valuable as the doctors. Telemedicine will make our lives better.

Into the Master Closet

Back in December 2019 (during those simpler pre-pandemic times), I was out at the OSET conference in Las Vegas. The Ortho Show podcast guys, Micah Nicholls and Benjamin Young, interviewed me for an episode and nicknamed it “The Fro Show.” The episode was well-received, so they got in touch to do an episode specifically on OrthoLazer. But the day they were going to fly out to see me, everything shut down. 

Initially, I was pretty disappointed. Then they came back to me with an offer to be a special guest host through the pandemic with a ten-part series. We figured that most people were tired of listening to the news. So we rounded up experts in their fields to provide real-time unfiltered information directly to our listeners without the lens of the media. We had a supply chain expert, a virologist, and other friends and ortho colleagues from across the country. My time as host of The Ortho Show podcast has been well received. The good news is I will continue to partner with The Ortho Show podcast team to bring you interesting Orthopedic Characters from around the world on a weekly basis.

I don’t know when I’m going to get up on a podium again, so my conundrum was: How do I evolve my speaking skills? How am I going to continue to message and influence?

So yes, I’ve been hosting the episodes of the podcast out of my master closet and I’ve been having a blast. Most importantly, it’s given me a way to continue to educate and entertain. I don’t know when I’m going to get up on a podium again, so my conundrum was: How do I evolve my speaking skills? How am I going to continue to message and influence? The answer is: it’s taken the form of communicating through the podcast, as well as social media and webinars. Pardon the Saturday Night Live reference, but the closet has been “very, very good to me” during this pandemic. 

The lineup (so far):

• Demystifying Orthopedic Telemedicine—with Dr. Mike Greiwe
• Words of Wisdom—with Joe Mullings
• Physical Therapy Going Digital
• Ortho Influencers—with Dr. Vinod Dasa
• Steadfast in Adversity—with Dr. Anthony Romeo
• Ask the Expert—with Prof. Paul Cannon
• The Matrix—with Dr. Michael Langworthy
• The New Guard—with Sean McMillan, D.O.
• The New Knee Guarantee—with Dr. Michael Suk

Listen on: Spotify | Apple Podcasts | Google Podcasts | Stitcher | iHeardRadio

A COVID-19 Clinical Trial (!!)

What does orthopedic surgery and COVID-19 have in common? Well, as the benched orthopedic surgeons across the country will tell you—not much. So how does The Fro end up running a COVID-19 FDA-guided IRB approved clinical trial? Sit down, folks and let me tell you a story. 

As I was hanging out in my master closet early on in the pandemic, I kept thinking about the virus and how the medical community was going to beat it. Then an idea came to me: what if we repurposed my Orthopedic lasers for COVID-19? Our MLS M8 lasers worked beautifully on acute inflammation. But was there any evidence that lasers could be used in the setting of acute inflammation of the lung?

The findings seemed to back up my hunch that the inflammation caused by COVID-19 might respond to lasers.

I immediately went down a research rabbit hole and found some pre-clinical studies using lasers in the lungs of rats and mice. The findings seemed to back up my hunch that the inflammation caused by COVID-19 might respond to lasers. I gathered enough evidence to convince my local hospital that it was worth trying. The local Institutional Review Board (IRB) was willing to listen to my ideas but said they would need some guidance on lasers from the FDA before moving forward. Sure, I thought, let’s just give the FDA a quick shout.

And you know what? That’s exactly what we did! We literally called the FDA and the craziest thing happened—someone called us back six hours later and they were interested in the laser idea. Over the next six days, my team presented them with the guidelines, protocols, specs of the laser, temperature readings, the power grid (how strong the laser was), safety profile, etc. We basically threw everything we had at them and they gave us the guidance to move forward with our “non-significant risk device.” 

The next hurdle was to create a protocol. I work on plantar fasciitis, tennis elbow, knees and shoulders. Lungs are just not my thing. So I called my laser peeps in Italy. Prior to starting OrthoLazer, I spent significant time with the laser manufacturer and Professor Monica Monici, a leading cellular biologist, who knows all about lasers and cells. So I went back to the Italian crew to see if lasering the lungs was reasonable. Although they gave us some guidance on the dosage, they didn’t have direct experience in treating the lungs. 

So back down the research rabbit hole I went. On Researchgate, I found Dr. Soheila Mokmeli MD PHD, an Iranian trained Anesthesiologist, Russian and Swedish trained laser expert, residing in Canada (oh yeah, she was easy to find…I mean you can’t even make this stuff up). Dr. Mokmeli is a leading authority on lasers and has peer-reviewed research in using lasers in humans for COPD and other lung conditions. I DM’d her and gave her the specs of the laser. She replied with an exact protocol and what she believed to be the correct dosage of how to treat patients. Score! 

Finally, we went back to the IRB and they gave us approval. We’ve completed the first phase of the study with profoundly favorable results. We are in the process of publishing the case report on Patient One and collating the data for the entire group. We should have an announcement on the results soon.

The next step is a larger study at an academic institution with better controls and a better evaluation of inflammatory markers to identify which patients would benefit. Oh, and perhaps finding a “real doctor” other than an orthopedic surgeon to run the pulmonary clinical trial would certainly help. 

In all seriousness, we should be looking at questions such as: Where in the disease process can we use lasers? Can we use lasers to keep people off ventilators? Can we get patients off ventilators faster with the use of lasers in the ICU? And could lasers help patients post-COVID-19 to improve laboured breathing, exhaustion, and faster healing from the disease? 

Where We Go From Here

If you’d asked me last year what I’d be doing in the spring of 2020, I wouldn’t have guessed that I’d be hosting a podcast out of my closet or running a clinical trial involving lasers and lungs. But here we are in a brave new world. I’m not entirely sure where we go from here, but I know that the future of medicine (and everyday life) will look significantly different than our pre-pandemic days. 

• As an orthopedic surgeon, I know that we have months of backlogged elective surgeries to triage and get through once we’re given the green light. 
• As an educator, I know that I will adapt to the new paradigm of tele-teaching.
• As an OrthoLazer advocate, I know that there is overwhelming interest in this non-surgical pain management option to manage the backlog and create a new revenue stream for clinics. 
• As a laser advocate, I wonder if we have found a way to treat COVID disease so we can reduce the anxiety of infection and perhaps save lives and help to get us moving. 
• As a citizen, I know that I may have to give up some of my liberties if we are going to return to any semblance of normalcy. I, for one, am willing. 

So while I wait to get fully back to the operating room with my patients, and back to dinner dates with my wife, and back to watching my kids swim, play hockey, lacrosse and football, I know that the key is to remain adaptable. In the meantime, I’m doing all I can to better myself and the world that I can control. 

Fro Respect.

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