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Up In Your Business is a Radio Show by FlagandBanner.com

EPISODE 158

[INTRODUCTION]

[0:00:08.8] GM: Welcome to Up in Your Business with Kerry McCoy, a production of flagandbanner.com. Through storytelling and conversational interviews, this weekly radio show and podcast offers listeners an insider’s view into starting and running a business, the ups and downs of risk-taking and the commonalities of successful people. Connect with Kerry through her candid, often funny and always informative weekly blog. There, you'll read, learn and may comment on life as a 21st century wife, mother, daughter and entrepreneur.

Now, it's time for Kerry McCoy to get all up in your business.

[INTERVIEW]

[0:00:42.2] KM: Thank you, son Gray. Just being a surgeon is quite an accomplishment, don't we all agree? My guest today is more than that. Dr. Lowry Barnes is an orthopedic surgeon, who is also a businessman and an inventor. This good doctor holds numerous patents on orthopedic devices and hip and knee implants, all developed and designed to improve surgery success and patient wellness.

Barnes of course, is an expert in his field and lectures nationally and internationally on joint replacement surgery. He established the HipKnee Arkansas Foundation; a nonprofit and research center that further studies patients with arthritis, which I think if you live long enough, everybody gets. He is a prolific writer and on the editorial board of numerous medical journals. It goes without saying, he has many awards and accolades.

Leaving no stone unturned, Dr. Barnes is known nationally not only for his efficient surgeries, but also for his business creativity. He is an expert on healthcare reform. To coincide with our recent healthcare system changes, he initiated an innovative payment system for his patients that we'll learn more about today. I'm really curious about that.

Of all his many accomplishments, Dr. Lowery Barnes, orthopedic surgeon, inventor, creative businessman says it's his participation with Operation Walk that he considers one of his most rewarding aspects of his career. It is a pleasure to welcome to the table dr. Lowry Barnes.
[0:02:19.1] LB: Thank you.

[0:02:19.9] KM: He's been up since 3:00. I'm over there about to give him some coffee in a minute. What's Operation Walk?

[0:02:26.6] LB: It's different than what we do on a daily basis. On a daily basis, we're taking care of patients for insurance companies and we're dealing with paperwork and doing what we do on a daily basis. Operation Walk is a program started by Dr. Larry Dorr, total joint surgeon in California. His first trip was to Russia and he realized that there was something that we could be doing internationally to help patients who don't have the benefit of being able to get hip and knee replacements.

Now there are about 15 chapters around the country that do that and we go to different countries. I’ve been to India, Peru, Trinidad and back to Peru doing operations for patients who otherwise couldn't get it. We get there on the morning. First morning, we see patients in the office to seeing who's candidates for surgery. There may be unfortunately 250, 300 people hoping to get surgery. We can only do about 50 in a three-day period.

We have usually five or six surgeons from around the country who are working with a team. We take everything with us. Not just the anesthesiologist and the people, but all the equipment that's necessary, because most of the countries where we work don't have what we need. It's very rewarding to have these patients who've not been able to walk very well, get joint replacements and get their life back.

The things we learn is these patients, they're tough. Here, we know about our opioid epidemic and the problems that we have with our pain medicines. These patients take Tylenol. At the time we first started, they’re taking Darvocet, something we don't have any more for their post-operative pain. No major narcotics and they just function.

There is a lady I took care of in Peru that had both her hips had essentially autofused, so she generally couldn't sit very well, she couldn't do much because her hips were so stiff. To go to the bathroom, she had to go to the shower. We did both our hips at one setting. She took nothing for pain medicine afterwards and was sitting and walking the next day and going to the bathroom like others go to the bathroom.

You don't see those too often. Our normal practice in America, you don't see those patients who are just so bad that they can't function, that you’d really can make that impact. We treat patients who have arthritis and get them out of pain, improve function. It's rare that you’d change somebody that much.

[0:04:59.2] KM: No wonder it's so rewarding. It's like missionary work.

[0:05:01.2] LB: Exactly.

[0:05:02.8] KM: When you say you take everything, does that mean you have to charter a big plane? Do you go on a commercial plane?

[0:05:07.7] LB: No. Here we go commercially and the people do and then we send cargo before we go, which is always a challenge getting it through customs.

[0:05:15.9] KM: Oh, I bet. Is it machines, or is it just devices?

[0:05:19.7] LB: Sometimes it requires anesthesia, machines that are not there. Often it’s devices, dressings, drapes, bandages.

[0:05:27.2] KM: You got five or six doctors. How many is the whole team?

[0:05:30.9] LB: Usually 35, 40 people.

[0:05:32.5] KM: You stay how long?

[0:05:33.9] LB: Five days. There'll be two people usually stay a little bit longer to make sure everybody's okay postoperatively.

[0:05:38.9] KM: How do you pick the country you're going to go to?

[0:05:41.5] LB: Each of the chapters around the United States have certain areas where they go. I've been with a group from Maryland and Paul Khanuja leads that group and he's now leading it as part of the American Association of hip and knee surgeons. We brought Operation Walk into this big organization a year ago, because Larry's reaching retirement age, etc. We want his dream and what's become so successful to live on.

[0:06:09.6] KM: Do you go every year?

[0:06:10.5] LB: No. Simon Mirrors, one of our partner's here, I met him in India. He was working at Johns Hopkins at the time and I met him in India, operated with him there when I moved from private practice. I've been in private practice most my career, moved to the university a little less than five years ago.

I knew that Simon had moved to Dallas and was doing private practice work and he's truly enacting the mission at heart. Great teacher, a great researcher, a great surgeon. I called Simon and said, “You know, if you ever get bored doing what you're doing, we've got a spot for you in Arkansas doing academics again.” He said, “I'm bored. When can I come look?” Now we alternate years, because he's been a big part of Operation Walk as well.

[0:06:53.0] KM: When you come back and you have to see Americans and we all know we're spoiled, me included, how did you make that jump back into caring for these people when you've been like, “You don't have it bad. You should see what I've just seen.”

[0:07:07.8] LB: Yeah, we feel that about ourselves too, not just our patient we’re taking care of, but we see a whole different side of the world and a civilization that don't have the benefits we have. It's not just about our patients.

[0:07:18.9] KM: It's almost like coming back from war. You're almost in these different cultures and you come and you're – it's hard to get back into thinking about the materialistic way that we live here. The ease of our life.

[0:07:32.4] LB: Yeah. We have been able to do it in the United States as well. It's we don't do it as much in United States now. In private practice, we did have a few events here once a year where we could do them. Now because of the Affordable Health Care Act and more universal coverage, it's harder to do those things, because –

[0:07:51.0] KM: Why?

[0:07:52.2] LB: Because patients are expected to have insurance and coverage. It's covered for their plans, so there's really no – this is charity work, so it's hard to do charity work that way.

[0:08:03.6] KM: You're saying that there's not that much need for charity work because they've got insurance now?

[0:08:10.4] LB: Correct. From what we do, that's correct. Here in our state with expanded Medicaid, certainly there's access.

[0:08:18.7] KM: It sounds like when I read about you that you always knew you wanted to be a doctor. You came right out of school.

[0:08:24.6] LB: Nobody in either side of my family had ever been to college even. When I was five or six, seven-years-old, I knew I wanted to be a doctor. I just got lucky that I was introduced to orthopedics in high school and loved it and I felt early on that's what I want to do. I went to med school here, did residency in Little Rock. The chairman was Carl Nelson at the time. He was a total joint surgeon and I loved what he did.

One of my grandmother's had rheumatoid arthritis and was essentially crippled by orthopedic surgeons who didn't know how to take care of patients with the disease process she had. She's 85-years-old, worked the New York Times crossword puzzle faster than anybody, but couldn't get from her bed to her chair without assistance. Not so much because of her disease, but because of her treatment.

My other grandmother had breast cancer, had her hip replaced and the orthopedic surgeon thought he was operating for a arthritic hip. It was actually a metastatic breast disease. It was missed. She went in to have her hip replaced for arthritis. She had had breast cancer 20 years earlier and it was not arthritis, it was actually cancer that had spread to her hip over that long period of time. I saw these things, this was years ago and we've come a long way. Our imaging technology is so much better now, our procedures are better.

[0:09:43.6] KM: When you say imaging technology unit, MRIs?

[0:09:46.4] LB: Certainly MRIs have changed what we do.

[0:09:49.7] KM: Let's talk about what your first operations were like compared to what they're like today.

[0:09:55.6] LB: Sure.

[0:09:56.8] KM: I can’t even imagine.

[0:09:59.1] LB: When I finished residency, so that was in 1991, the average length of stay for hip or knee replacement was 12 days, which was including a one-day preoperatively. Now 90 something percent of our patients go home the next day.

[0:10:16.5] KM: Is that because health insurance won't pay, or is that because it's such an improved operation?

[0:10:24.2] LB: It has very little do with pay. We now realized that we have – we made a bigger deal out of it than it was and we were scared about protecting patients. Patients are probably safer at home. You're used to the bacteria you have in your own home. You're not used to my bacteria, or other people's bacteria. Back in your own environment is the safest place to be. Now we've got great data to show it.

We know that patients who leave the hospital after drawing a placement go to a skilled nursing facility, go to a rehab hospital, they have a higher infection rate and a higher readmission rate and more costly care. Some people have no choice, because they don't have the family support. We're fortunate in Arkansas. Most of our patients can find help. We send very few patients to those facilities now.

[0:11:12.5] KM: We're a family-oriented state, I think. Do you happen to know when the very first knee replacements were made? In the 50s?

[0:11:20.0] LB: Yeah. Certainly, there were some done in the 50s. Got more popular in mid-60s. Hip’s a little bit earlier. The early results were not great. They were pain relieving operations, but not so much function improving. They had tremendous progression over the last six years.

[0:11:41.1] KM: Yes, because I think you used to come out of surgery with a big knee that would never bend again right.

[0:11:47.0] LB: Sure they hope they would bend, but there was a different type of replacement early on the bottom were hinges, so the two pieces were hooked together, very much like what a lot of my patients think when they come to see me that we're going to chop off into the thigh bone, chop off the top of the shin bone and put two pieces of metal that are connected together and that's going to be your new knee joint.

[0:12:07.3] KM: What are you going to do?

[0:12:08.7] LB: In reality, it’s really resurfacing now. On the femur, we make five little cuts to trim the bone and it's capped with a piece of metal. We’re using chrome cobalt metal. The shin bone, the tibial sod has a flat cut made off of it, taking off a few millimeters of bone with a metal base plate being placed on it with a plastic insert and then we trim off some of the knee cap and put a plastic button on it. It's really very little bone resection. It’s a resurfacing operation.

[0:12:36.3] KM: Do you harvest some ligaments to use, to rebuild anything?

[0:12:42.0] LB: No. The ligaments are actually substituted for. The implant itself does that. We actually take the ligaments out on the inside part, the anterior cruciate ligament that –

[0:12:54.3] KM: You don’t need an – What's it what's an ACL? Is that a ligament?

[0:12:56.7] LB: It is. That's the anterior cruciate ligament across of –

[0:12:58.7] KM: You don't need that one anymore?

[0:13:00.1] LB: Not with a knee replacement. We actually take out the poster cruciate ligament as well, which is the one behind it, because the implant can give the stability to the knee that those ligaments do.

[0:13:11.0] KM: I'm speaking today with Dr. Lowry Barnes, orthopedic surgeon in Little Rock, Arkansas, who is internationally known for his patents and innovative approach to hip and knee replacement surgery. We talked a little bit about the history of orthopedics, the evolution, I guess I should say, of orthopedic surgery.

[0:13:29.0] LB: Great name. That's one of the implants I designed was the evolution knee.

[0:13:32.9] KM: Really?

[0:13:33.7] LB: You read something, didn’t you?

[0:13:34.7] KM: No. Yes, I did. I mean, yes, I did. Yeah, I knew that. Yeah, it is absolutely evolution. Let's talk about that. How did the idea to reinvent hip and knee devices come about?

[0:13:49.9] LB: Well, we're always trying to make improvements, not just me. Orthopedic surgeons and engineers around the country saying, “How can we make the knee more like the normal knee and increase function for patients and have it last longer?” The one you just referred to, the evolutionist one. That was started by a company called Wright Medical, now has been sold to MicroPort, who bought the hip and knee line from them.

There were five or six of us on the design team who took a previous iteration. It was called a medial pivot knee. A lot of different designs of knees based upon saving this ligament, saving that ligament, how the knee functions and kinematically how it bends. This design function is more like a normal knee and that the inside part of the knee acts different than the outside part of the knee, just like ours does.

The stability of our knee comes from the inside. The outside portion has more laxity to it. That's what allows flexion of your knee, but still has the ability from the inside part. We reproduce that at a knee implant. Unfortunately, it's now become very popular in that many other companies have now mimicked that design.

[0:15:02.9] KM: Is it an actual device, or is it a procedure?

[0:15:06.9] LB: It's a device.

[0:15:08.3] KM: Did you have to get a patent? You got a patent on it. Your group of five decided, “This is great. Let's get a patent on it.”

[0:15:13.6] LB: Yeah. There are a series of patents associated with an implant as you might imagine, because there are a lot of different changes. One might be related to a special instrument that allows us to size the thigh bone a certain way. Another might be related to how the plastic locks into the metal. Each implant can have a number of different patents, if what you're developing or designing is different than enough than what's been designed before.

[0:15:37.9] KM: I never thought about it. You got to make the tools. You've got to design tools, because every time you try to do anything in construction, or in sewing, or in anything, it's about the tools.

[0:15:51.4] LB: Instruments matter.

[0:15:53.0] KM: They really do matter. How many patents did you end up making?

[0:15:56.8] LB: I don't know how many I have. 10 or 12, I guess.

[0:15:59.7] KM: Do you have them as an individual, or do you have them as this team of doctors?

[0:16:03.1] LB: They’re as a team. It depends on who's working on what part.

[0:16:07.8] KM: Do you get residuals from it, or does your team get residuals?

[0:16:10.5] LB: Both. The individual gets it as it is, like that company has no longer getting residuals from that. I bought out my contract years ago. More recently, my mentor Dick Scott from Boston, who I did my fellowship with, he and I and one other gentleman who's an engineer, who had worked with Dr. Scott in the past, the three of us started a new company. At the time it was called Responsive Orthopedics, and developed a new type of knee and hip and looking at a prosthesis that was less expensive and served the needs of our population well, because it had all the modern capabilities. Then Medtronic one of the large companies in the healthcare world bought our company a few years ago.

[0:16:54.9] KM: It seemed that knee and the hip would not be able to use the same procedures.

[0:17:02.4] LB: They don't at all.

[0:17:03.3] KM: Maybe the same instruments.

[0:17:04.7] LB: Not the same instruments, not the same implants, not the same procedure. They're totally different.

[0:17:08.5] KM: What does it take to develop a procedure like that?

[0:17:11.3] LB: Procedures still developing. We make minor changes. Each year, a years’ implants can take – the design process may take a year. Getting approval from the FDA and go through the whole process may take four or five years.

[0:17:28.4] KM: This new evolution, what did it solve?

[0:17:32.0] LB: It came from what we think is a more normal feeling knee. They have stability. One of the challenges you have with knee replacement is that if you go downstairs, or do rotatory motion, sometimes your thigh bone can slide on your shin bone. This implant gives you stability.

[0:17:48.0] KM: What do you think is of all of those surgeries, which one is your favorite one that you think you've had the best success ratio on?

[0:17:54.1] LB: Whichever one I'm doing at the time.

[0:17:55.8] KM: Good answer. What is the biggest hurdle patients have to overcome after surgery?

[0:18:02.4] LB: Oftentimes, it's before surgery, not after surgery. It's deciding it's time. Unfortunately, it's – we have certain groups of patients who don't get knee replacement at the same rate as others, because we don't know if it's – is it health literacy issue, is it a fried issue, is it an access issue and those are things – some of the things we're trying to figure out now, how we can make sure that more patients who need knee replacements can get it?

[0:18:27.7] KM: Is it better to put it off for as long as you can, or does that actually hurt the operation when you get ready to do it?

[0:18:33.1] LB: Great question. If you get too far, you get too many deformities. Your leg gets too angled, or you can't get your leg straight for a long period of time, then patients don't do quite as well. You don't want to do it too early either.

About the time I was training, we were very careful. These operations were for really – for older patients, because they didn't know how long they're going to last. When I was in Boston to my fellowship, the Chair, Dr. Clement Sledge, we're seeing a patient in their early 50s or so and he said, “What do you think?” I said, “Well, bad –” I can’t remember if it was hip or knee. It’s a bad problem, but they need to be older. He said, “Why would you do that? They're at their prime of their life now, why would you tell them they have to wait? They can't do the things they want to do now, so why don't you take care of them. If there's problems later, fix them then.” That's where we are enjoying replacement now.

[0:19:27.0] KM: How long do they last?

[0:19:28.0] LB: We don't know for sure, because everything is a little different. It’s model changes and unfortunately, when you say how long does it last, it matters now by a lot of things; how good is the surgeon, how well is it placed? If it's a knee, how well the ligaments’ balanced? How well is it cemented into place? How good is the component itself? If it's the plastic that's being used. There are a lot of things that affect it.

We often say on average, 15 to 20 years from both hips and knees. Some last much longer, some last much shorter. That's the problem. The early failures of joint placement are a problem. I think that's probably what scares people. We have a very large revision practice.

[0:20:10.0] KM: You're saying don't wait. We can always redo it again later, because you're at the prime of your life. Why be miserable during the prime of your life?

[0:20:18.9] LB: Under certain – I mean, if you meet all the other criteria, you failed on upper management, you've done physical therapy, you've tried acetaminophen medications; Tylenol, you've gotten your weight to an appropriate level, but you still have in-stage arthritis.

[0:20:31.1] KM: You just answered all my questions.

[0:20:32.9] LB: Good.

[0:20:34.2] KM: What is preventative? Weight level? What were the other ones you said?

[0:20:39.6] LB: Strength is important, so especially for the knee. The muscle in the front of your thigh, the quadriceps.

[0:20:44.2] KM: Should you be doing weight training?

[0:20:46.2] LB: Certainly, weight training is good for everyone, well cause it helps build your bones to – build the bones and helps prevent osteoporosis. Bones respond to stress. If you have a load on it, that helps the bone form new bone. The quadriceps muscle, just doing leg lifts and bicycling are enough to keep that muscle toned. Many people think just walking is enough, but it's not for that muscle.

We see that after knee replacement. Patients sometimes do their therapy early, then they may come back in six, eight months later and saying, “All of a sudden, my knee hurts.” We test them and their quadricep strength is half what the other one is.

[0:21:22.9] KM: Because they’re walking.

[0:21:24.4] LB: Well, it’s just because they hadn’t been doing exercise. They had got past their pain in the therapy early on and they got on with their normal life and quit. Now they're weak. Then the joint starts taking more of the load, having muscles that function well across the front of your knee and their dynamic stabilizers are the knee, so it takes stress off the knee. We’d get the patients get their muscles stronger. We send them test their strength, show them how much weaker they are, send them to therapy, build up their strength, retest them. Variably when they get stronger, their pain gets better.

[0:21:55.7] KM: I think this is true with every ache in your body is go out and do a little exercise. It seems as I get older though, I want to do more swimming.

[0:22:02.3] LB: It's great for you.

[0:22:03.7] KM: It doesn't seem to hurt your joints. When I ride a bike, it seems to make my joints hurt.

[0:22:08.0] LB: Yeah, it depends on the problems you have. Bikes are great for hip and knee replacements, because they encourage motion and it's good for arthritis too, because you get motion that's not weight-bearing. Swimming is the best, especially with the hip, because it's great for after hip replacement to have a patient get in the pool. Oftentimes, I'll turn to my PAs when we're seeing a patient and say, “Been in a pool or not, been in a pool.”

[0:22:34.5] KM: It’s a game.

[0:22:35.7] LB: Or they say, “You know, I've been swimming.” We look at each other knowing, they're doing so well because they've been in the pool and they've gotten their motion and they're not tight.

[0:22:43.1] KM: I would think that you have a problem with people doing their PT, physical therapy. It does seem like my son who had ACL replacement, because someone hit – he was on a bike and a car hit him and he had to have ACL replacement. They harvested his hamstring.

[0:23:00.7] LB: Sure.

[0:23:02.2] KM: Which was fascinating for everybody listening. He won't do his physical therapy.

[0:23:09.2] LB: Mom, get him going.

[0:23:10.1] KM: I know. I think about you. Are you frustrated all the time about that?

[0:23:15.3] LB: No, because most of my patients do their therapy, because they've said different type things. Your son had an injury. He was normal one day and then has a problem and not really into the whole fix.

[0:23:28.2] KM: He's young.

[0:23:29.4] LB: Yeah. If he’d had arthritis for 10 years and affecting your life every day and you get an operation, you're pretty – most patients are pretty determined to do what they're supposed to after surgery, to get the benefit from their surgery.

[0:23:40.9] KM: The vitamins work, because you see people all the time talking about take vitamins and it'll help.

[0:23:45.8] LB: Nothing I know of for arthritis.

[0:23:47.9] KM: You're the 20th person – they say joint pain, take vitamins to – well, glucosamine.

[0:23:53.1] LB: Yeah. No proven benefit for chondroitin and glucosamine. There are some animal studies that show some really – some cartilage changes. Some patients swear by it and my answer is if you take it and you think it helps you, keep taking it. If there's no side effects that you know of.

[0:24:07.2] KM: Okay, good. Any advice for sufferers who might be out there besides diet, exercise? Was there something else? Pain management?

[0:24:15.9] LB: Yeah. Over-the-counter pain meds usually. Tylenol, anti-inflammatory medications. The biggest thing I can tell you is no patients should be taking narcotics for arthritis and no doctors should be describing and just prescribing narcotics for hip or knee arthritis.

[0:24:32.9] KM: That's for sure. This is a great place to take a break. When we come back, we'll continue our conversation with the inventor, businessman, philanthropist, author, orator and renowned-orthopedic surgeon, Dr. Lowry Barnes.

[BREAK]

[0:24:43.4] ANNOUNCER: Friends of Dreamland are proud to sponsor Up In your Business with Kerry McCoy. Dreamland Ballroom located on the third floor of the flagandbanner.com building in the historic Taborian Hall, is a nonprofit dedicated to bringing back the music, the history and the party of the Dreamland Ballroom.

Our annual fundraiser, Dancing into Dreamland will be a tournament of past champions to celebrate the 10th year. Mark Friday, November 15th at 7 p.m. on your calendar. The night will include a dance competition, where audience members text their votes for their favorite acts, a silent auction, free hors d'oeuvres, cash bar and your opportunity to experience the magic and imagine the music of the legends that played on the Dreamland stage, like Ella Fitzgerald, Ray Charles, Louis Armstrong and many more.

Tickets available at dreamlandballroom.org for the 10th annual Dancing into Dreamland. Be a part of the history of Dreamland.

[INTERVIEW CONTINUED]

[0:25:38.1] KM: You're listening Up In your Business with me, Kerry McCoy. I'm speaking today with Dr. Lowry Barnes, orthopedic surgeon in Little Rock, Arkansas, who is internationally known for his patents and innovative approach to hip and knee replacement surgery. Before the break, we talked about – I love talking about the work you did in what was it called? Operation Walk?

[0:25:57.9] LB: Right.

[0:25:59.1] KM: Operation Walk is a missionary thing, where a bunch of doctors get together. It's funny when you get older how you want to help everybody. You notice that?

[0:26:07.2] LB: No doubt.

[0:26:07.8] KM: How long have you been doing Operation Walk?

[0:26:11.5] LB: 12 years, something like that.

[0:26:12.9] KM: Oh, long time. Even when you were in your hard work and career, you were doing it?

[0:26:19.5] LB: I'm still hard-working.

[0:26:20.5] KM: You are. I should tell everybody you look like you need a nap. You've been up since 3 in the morning.

[0:26:24.9] LB: Come on. Come on. You’re about giving back. I left private practice about five years ago, because I want to be back in academics. It's the next generation of orthopedic surgeon, the next generation of students, people need to know that it's fun to be a doctor, despite all the challenges that may come with being a physician, with paperwork and all the financial challenges that we face, there's nothing like having a patient appreciate what you've done for them in changing their lives. I'm glad to be back over there and working on that and building the orthopedic program. You can talk about business. We even certainly improved the business of orthopedics at UAMS as well. We've grown significantly and it's fun. We've got a great team.

[0:27:12.6] KM: We're lucky to have you at UAMS.

[0:27:14.0] LB: Yes, we are.

[0:27:15.5] KM: I think it's really nice that you're paying your wisdom forward.

[0:27:19.3] LB: Well, thanks.

[0:27:20.5] KM: Speaking of the expense of becoming a doctor, it's $200,000 in debt to become a doctor today right now, which is why people are specializing, because you've got to pay that debt back. We don't have enough general practicing doctors.

[0:27:37.1] LB: That's not why people become specialists, why most people become specialists. Some may, but most people figure out where their niche is and where they think they can do the most benefit.

[0:27:46.9] KM: Right now, we are at a crushing 1.5 trillion dollars in student debt. That's unbelievable. By 2030, we will have 50,000 doctor shortage in primary care.

[0:27:59.1] LB: Right. No doubt it is a major challenge.

[0:28:02.0] KM: Is it because it's so expensive to go to school to become a doctor that low-income families cannot do it?

[0:28:07.6] LB: Yeah. I think some of it is that and some of it is that unfortunately, doctors don't make as much as much as their peers who have put the same number of hours in for that period of med school, residency.

You take nine, 10 years of your life there where you're making a sacrifice financially to learn your profession. I think many people see their peers from college that are doing very well, etc., during that period of time. Then they see older siblings that have done medicine, others that haven't done medicine, they start looking at the challenges. Certainly, the cost of medical school education is significant.

[0:28:49.3] KM: Did you see where NYU recent announcement that all tuition was going to be free?

[0:28:52.9] LB: Yeah. They just actually gave some release debt to people as well, not just going forward, but in the past. That's huge. Wouldn’t it be nice if this state had that money to have that endowment to pay for the medical education of the students who want to be docs?

[0:29:12.3] KM: I saw the guy, Ken and his wife Elaine who are the co-founders of Home Depot, who were the people that gave the money and he said, he was doing it because he wanted more primary care doctors. He felt that might help low-income people who have a desire to be a doctor to get in the field.

[0:29:35.3] LB: Let's hope it works. I wish you want to come do the same experiment in Arkansas and then he could compare a rural state like ours to New York and who benefits the most from that investment into primary care. We totally believe primary care is so important to the health of our community. For too long, we've talked about healthcare, instead of about health. The primary care physicians are the ones who can most likely improve the health of our state. We are ranked 46 in the country for health. Not where we need to be.

[0:30:10.2] KM: The worst health?

[0:30:10.9] LB: Yeah. 49th for obesity. Only Alabama's worse. These are areas where we can make marked improvement for our community.

[0:30:19.6] KM: Those are almost educational tasks on how to eat right and how to exercise though. I don't want to treat them after they're sick, I want to treat them before they get sick.

[0:30:30.1] LB: Absolutely. Then all the other things for which you may need to be treated, your outcomes are better. We can decrease the risk of diabetes. The instance diabetes for second –secondary to obesity for type 2 diabetes, if we can see that those patients who have diabetes better manage their diabetes. Well then, when you go in for another procedure like your gallbladder, your risk of complication goes down, same with obesity. We know that these things make a significant difference. Then we have all the social determinants of healthcare, which affect our state.

[0:31:02.5] KM: What do you mean?

[0:31:04.2] LB: Appropriate housing, food. You have too many people in our state who don't have enough food to get proper nourishment, like 14%.

[0:31:11.4] KM: Healthy food. Yeah, they're eating cheap food.

[0:31:15.0] LB: Yeah. Transportation, so they can get to and from healthcare providers. We're doing what we can to try to take health and healthcare to people.

[0:31:24.6] KM: I haven’t thought of it like that. I haven't thought about not being able to get to a doctor. Arthritis, you’ve started a hip and knee Arkansas foundation. It's a non-profit, it's a research institute. It's really looking at arthritis and the causes of arthritis. What causes arthritis?

[0:31:41.4] LB: Sure. I should point out that HipKnee Arkansas is actually something I did when I was in private practice. It still exists, but most of our research is done through UAMS now. We have a very strong orthopedic research program. It has grown significantly in the last five years. It's run by Erin Manne, the PhD in biomechanics. She's absolutely an all-star team builder. We have lots of people working with her. The students work with her postdoc PhDs, and most like your son, instead of – Those projects. They're in our lab working in how do we treat these issues and how do we prevent them, so it's been a lot of fun.

I’ll answer your question about arthritis in a second. At the lab right now, the HipKnee lab, we have this incredible equipment, so that we can do great gait analysis and motion analysis studies. When I was in private practice, we had a donor give us a significant amount of money so we could establish this. We have a lab that has force plate, so you can look at weight transfer, high-speed cameras to look at how the body moves. We then do fun things with it.

Right now, we're looking at the golf swing. We're looking at how does arthritis affect the hip and knee and now the spine also in golf swing and how do patients respond after joint replacement? Next week at the Hip Society meeting, my talk is on loads on the hip in the golf swing. We've been telling people patients wrong for years how to go back to golf after joint replacement.

[0:33:10.6] KM: What do you mean?

[0:33:11.5] LB: We've always said go back, use your short irons first, then use longer irons and then get to your driver, because you put less torque on your hip doing that. In reality, the 6-iron and the driver are the same. It's really about how hard you swing, not about the club length. It would be fun to share this, because there'll be a lot of golfers in the group.

[0:33:30.8] KM: Well, people can relate to that.

[0:33:31.7] LB: Absolutely.

[0:33:32.5] KM: You get up there and start talking with all that doctor lingo, you're just going to glaze over. You go, “Hey, you want to improve your golf swing?” They're like, “What? What are you saying?”

[0:33:40.3] LB: Exactly.

[0:33:42.6] KM: Tiger Woods had back problems.

[0:33:44.6] LB: No doubt about it. We're looking at the golf swing after spine fusions as well, which is what he had.

[0:33:50.4] KM: Is there any sport that doesn't hurt a man? I mean, there's basketball, football, golf.

[0:33:59.2] LB: Certainly, they all have their benefits, but they all have the potential risk of injury. Post-injury is when we see arthritis in the knee oftentimes.

[0:34:07.0] KM: What is arthritis?

[0:34:07.6] LB: Arthritis is when the cartilage starts to wear.

[0:34:09.9] KM: Does everyone’s cartilage going to wear out?

[0:34:12.2] LB: Well, probably if you live long enough, you'll have some arthritis, but not so much you have to be treated by an orthopedic surgeon, and I mean, may not by your primary care doc for that. The prevalence is quite high. If you have trauma to it, an injury, or if you're obese, it's certainly higher for the lower extremities.

[0:34:31.5] KM: Well, I mean, I'm thin. Why do I have backaches?

[0:34:37.6] LB: Well, backache is a multifactorial thing. We all back pains and something –

[0:34:42.7] KM: Don’t you think it’s cartilage that comes in the back of your spine in that –

[0:34:47.1] LB: Well, you have disc there that have some cartilage in them, fibrocartilage. Certainly, you’re going to have deterioration there with aging. If you really want to hear with aging –

[0:34:57.3] KM: Yeah. I was about to say you leave that word out.

[0:35:01.2] LB: Out back sees lots of load, right? We do lots of things, twisting, turning, bending and –

[0:35:05.5] KM: Women carry purses everywhere. What do you think about steroid shots? Speaking of, I've heard, I mean, they will cure any inflammation you have in your body, but I have heard that they and I don't know, or that they are not particularly good for your bones. Being an orthopedic surgeon, what do you think?

[0:35:22.8] LB: Great question. Steroid shots really don't cure anything. They treat symptoms. I can tell you, I've had steroid shots and I've had steroid shots to my back by Dr. Gorrie at UAMS, who's absolutely a magician with a needle. I’d do it again in a heartbeat if I had the same problem. I had disc problems getting pain, spasm, some nerve irritation, it works great for that.

Now getting repeated injections to your knee for arthritis, over time it can do some damage to it. If you have too many steroid injections, or take steroids systemically, then you can get other side effects. The one we see is in addition to osteoporosis, or softening of the bones, more common in women is we see something called avascular necrosis, which is loss of blood supply to the ball part of the hip joint more commonly.

[0:36:13.7] KM: What did you call it?

[0:36:15.0] LB: A vascular necrosis. It's got a bunch of other names as well, but it just means that the ball portion, the ball and socket loses its blood supply and then it collapses and you need a joint replacement after that. We're careful with steroids –

[0:36:28.8] KM: You want to do aerobics? Does that keep your blood supply up? You needed to cardio all the time?

[0:36:34.3] LB: It certainly has its benefits, but it won't help your hips, as far as blood supply. They’re unrelated.

[0:36:38.7] KM: What does blood supply come from? Where does that –

[0:36:40.8] LB: We all have a small artery, arteries and arterioles that go to the bone. For some reason when you take steroids, drink alcohol and get the bends, there's actually 60 something causes of this process.

There's something pathologically that happens; it increases the pressure in the hip joint that the blood can get there, but it can't get out and it gets in a clogged situation, and so you end up with this problem. Fortunately, it doesn't happen very often, except for patients who are – who have exposure to these things on high doses.

[0:37:13.4] KM: Like alcohol and steroid shots?

[0:37:15.6] LB: Right.

[0:37:16.2] KM: Uh-oh. You're an author. You lecture. You said a little bit, you're going to go lecture about – well, I'm going to tell everybody that just tuned in that you're listening to Up In your Business with me, Kerry McCoy and I'm speaking today with Dr. Lowry Barnes, an orthopedic surgeon in Little Rock, Arkansas, who is internationally known for his patents and innovative approach to hip and knee replacement surgery. If you missed the first part of the show, you should go listen to the podcast next week, because everybody's got arthritis, everybody's got questions, everybody's – if you live long enough, you're going to have a few aches and pains. He says – you say no pain pills. Narcotic.

[0:38:00.0] LB: No narcotic, pain pills.

[0:38:02.2] KM: Over-the-counter pain pills work great.

[0:38:03.4] LB: You bet.

[0:38:04.0] KM: They really do. If you get immune to one, just switch to another one.

[0:38:08.5] LB: Absolutely.

[0:38:08.8] KM: Don't you think?

[0:38:09.6] LB: No doubt about it.

[0:38:10.3] KM: You're an author. What do you write about?

[0:38:13.3] LB: Hip and knee replacements. We’ve published articles on our research, on our patient series and how patients do with certain procedures. That's what our department does is not just me. We have certainly have a group of four hip and knee surgeons who do this together, but we have 26 orthopedic surgeons in the department who are working in different areas. Then we're all looking at what we do and how we do it and what we can do to move the field forward. That’s why –

[0:38:39.5] KM: Now that you're an academic, you said earlier that you've been out of private practice for about four years, I think you said.

[0:38:45.2] LB: Something like that.

[0:38:46.7] KM: Now that you're an academic, I guess you lecture all the time.

[0:38:51.2] LB: Well, I lecture probably the same as always did, because most of my lecturing is nationally, internationally for meetings that the medical school, there's not a whole lot of orthopedic lecturing during the medical school years. They learn from rotating with us. Go into our clinic, go into the operating room with us and learning that way. We teach residents as well over five-year period.

[0:39:14.0] KM: What do you want your legacy to be?

[0:39:16.2] LB: Great question. Hopefully right now, I'd say it's – I'm in the second career. I still may want to have a third career. We'll see.

[0:39:24.3] KM: I agree. I agree.

[0:39:25.5] LB: I think change is good.

[0:39:26.8] KM: I agree.

[0:39:27.9] LB: Right now, my legacy is to make orthopedics better in our state and improve the health of Arkansas through UAMS and what we can do to make the state better.

[0:39:35.4] KM: Don't you wish wisdom was transferable?

[0:39:37.9] LB: No doubt about it. I wish that somebody had transferred some to me.

[0:39:41.5] KM: You wouldn't listen.

[0:39:43.1] LB: Good point.

[0:39:44.4] KM: That's the problem.

[0:39:45.4] LB: That's right.

[0:39:46.8] KM: At least people are paying money to come here, you talk, so maybe they're going to listen to what you have to say. I want to thank you so much for coming on. I have a gift for you.

[0:39:55.7] LB: Well, thank you. I love it.

[0:39:57.7] KM: It's a US and Arkansas desk set. You can put it in your office. We're lucky to have UAMS. We had Hank Kelly on last week, who said that one of the things that makes a great city is a research college.

[0:40:11.8] LB: He is correct.

[0:40:13.5] KM: Because it brings in talent and it brings in patience. You find out about the city of Little Rock and often are surprised in how nice it is.

[0:40:25.7] LB: It’s a great place.

[0:40:26.9] KM: It's a great place to live. Any advice you'd give yourself from 20 years ago?

[0:40:32.7] LB: Listen more, talk less.

[0:40:35.1] KM: I just learned how to do that.

[0:40:37.1] LB: Congratulations. I'm still trying.

[0:40:39.0] KM: No, you're a great listener. Thanks again so much. I really enjoyed visiting with you and meeting you. You’re a special guy.

[0:40:44.8] LB: Thank you. You’re kind. Thank you. I’ve enjoyed it.

[0:40:46.7] KM: You’re welcome. For those of listeners who might have a great entrepreneurial story that they'd like to share, I would love to hear from you. You can send me a brief bio. You can send your contact info to Kerry@flagandbanner.com and somebody will be in touch. We are booked all the way through December with guests and we're talking about going up to Fayetteville and interviewing some people in Fayetteville in 2020, which I can't believe is right around the corner.

Thank you for spending time with us. We hope you've heard or learned something that's very inspiring or enlightening and if you haven't, then you haven't been listening. That it, whatever it is will help you up your business, your independence or your life. I'm Kerry McCoy and I'll see you next time on Up In your Business. Until then, be brave and keep it up.

[END OF INTERVIEW]

[0:41:38.9] GM: You’ve been listening to Up in Your Business with Kerry McCoy. For links to resources you heard discussed on today’s show, go to flagandbanner.com, select radio and choose today’s guest. All interviews are recorded and posted the following week. Subscribe to podcasts wherever you like to listen. Kerry’s goal is simple, to help you live the American Dream.

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