ADJUSTED

Keys to Orthopedic Surgeries with Dr. James Dettling

March 21, 2022 Berkley Industrial Comp Season 3 Episode 32
ADJUSTED
Keys to Orthopedic Surgeries with Dr. James Dettling
Show Notes Transcript

In this episode, ADJUSTED welcomes Dr. James Dettling, Medical Director for the Vegas Golden Knights. Dr. Dettling shares his thoughts on achieving successful orthopedic surgeries.

Season 3 is brought to you by Berkley Industrial Comp. This episode is hosted by Greg Hamlin and guest co-host Natalie Dangles, RESOLUTION Manager for Berkley Industrial Comp.

Visit the Berkley Industrial Comp blog for more!
Got questions? Send them to marketing@berkindcomp.com
For music inquiries, contact Cameron Runyan at camrunyan9@gmail.com

Greg Hamlin:

Hello everybody and welcome to Adjusted. I'm your host Greg Hamlin coming at you from beautiful Birmingham, Alabama where the skies are so blue and with me as my guest co host Natalie dangles. Natalie, do you want to introduce yourself to everybody?

Natalie Dangles:

Hello, everyone, this is Natalie Dangles. I'm in Las Vegas, Nevada, and I'm a regional resolution manager with Berkeley Industrial Comp.

Greg Hamlin:

And I'm lucky because I get to work with Natalie every day. So thank you. She's amazing. We've got a special guest today Dr. James Detling, with sports ortho in Las Vegas, Nevada. And I thought I would let Dr. Detling introduce himself. So Dr. Detling, tell us a little bit about yourself.

Dr. Detling:

Hi, everybody. My name is Jim Detling. Coming from Las Vegas, Nevada. I'm a practicing orthopedic surgeon specializing in sports orthopedics. I've been in Las Vegas for now about 21 years, and I'm feeling really old after our pre recording conversation right now. So

Greg Hamlin:

I was told Dr. Detling, like we just had our sixth baby. And he was telling me about a surgery, somebody who had performed surgery on when they were 14, and now they have kids.

Natalie Dangles:

So and I was telling them that, you know, he was one of the first surgeons that I got to speak to when I started off in worker's comp 14 years ago. And he's like, Oh, no, I feel so old.

Greg Hamlin:

So the big question, Dr. Detling, is, how did you when did you know that you wanted to be an orthopedic surgeon or that you wanted to be a doctor? Was that something that was a dream of yours as a kid? Or when did you decide that path for yourself?

Dr. Detling:

I really decided that I wanted to be a doctor when I was in high school. My senior year in high school, I was playing football, I broke my leg. I was involved, obviously with doctors at that time, and they got me back to being able to play toward the end of my season. And then later on that year, I played baseball, and I threw my shoulder out. And that ended my baseball career at that time, and I had aspirations look a play at a different level. And that kind of ended it and when it my shoulder got injured, they just said is injured, not much you can do about it. Too bad. So sad. And I thought, Damn, that's that's kind of bad. And so anyway, long story short, those were really what got me interested in the in the field of medicine, and particularly actually in orthopedics. And I went through medical school, I went to Georgetown Medical School and then afterwards that want continued. And I was fortunate enough to get into an orthopedic residency and that's

Greg Hamlin:

So were you from Las Vegas originally when you kind of how it started. went to Georgetown? Or did you come out here to practice?

Dr. Detling:

No, I originally grew up in a small farming community in Northern California woodlands and went to university Southern California for college, then back east to Georgetown.

Greg Hamlin:

Okay, so you did you did the east to the west and

Dr. Detling:

Yeah, west east west. I've bounced from coast to back to the west. coast.

Natalie Dangles:

What brought you to Las Vegas?

Dr. Detling:

I was actually recruited out here. I did my fellowship at the Kerlin job Orthopedic Clinic in Los Angeles after my residency, and a large group that actually came looking and they recruited me here. And that's how I came to Las Vegas.

Natalie Dangles:

You must like it, because you've been here awhile.

Dr. Detling:

Yeah, you know, it's really interesting when I moved here, and when I came, I wasn't really sure I was going to stay. And all of a sudden you blink your eyes, and it's 21 years later, so I guess I stayed. Like, how did that happen?

Greg Hamlin:

So when you were we're moving on into orthopedic surgery, how did you decide what areas you want to specialize in?

Dr. Detling:

During your residency, you do everything you know, you're okay, you can you do spine res rotations and sports rotations, and foot and ankle rotations. And I've always gravitated toward the sports stuff. And I think it probably falls back on like what we talked about earlier about my original injuries. And what really prompted me to get into medicine itself. I spent a lot of time around sports people even in college and during my residency, and it just it was kind of a natural resonance towards that field.

Greg Hamlin:

So is there a big difference between a sports injury versus a work injury,

Dr. Detling:

They often look a lot the same. When you engineer your tissue, whether it's your shoulder, your knee, it's physics, you know, and it's a physic physics, it's your physics, whether you are playing football, or baseball or hockey, a contact sport, or whether you're working on the job and you fall off a scaffold or you fall off a ladder. It's pure physics when you injure a body part. So they're very similar, but oftentimes in a different population.

Natalie Gaines:

Which one is hardest to recover from the shoulder or the knee,

Dr. Detling:

I would say the shoulder, okay. And my reasoning for that is there's multiple ranges of motion, or there are degrees of motion in the shoulder that the knee doesn't have. The knee has a unique planar joint, it moves in one direction, to shoulder has to move and six or a combination thereof directions to function and it's Is the shoulders more challenging to recover from?

Greg Hamlin:

Interesting? So I know you do a lot of work with the hockey team in Las Vegas. I'm not from Las Vegas. So it's, you have to remind me of the professional hockey team there. I'm a huge basketball fan. So it's what's the team in Las Vegas?

Natalie Dangles:

Vegas, Golden Knights, the Golden Knights.

Greg Hamlin:

Nice. So one of the things you know, I don't know if you've seen this, I've seen it on the work side. And I'm curious if you've seen it in your profession, where sometimes the mindset of the person who's going through the treatment has impacts the recovery, I can think of injured workers who didn't want to go back to work versus ones who really did imagine, with the Golden Knights, when you're seeing athletes that have multimillion dollar contracts that are tied up, there's probably a different level of motivation, maybe. So just curious on your thoughts on that, if you've seen if you've seen that have any impact in the recovery process?

Dr. Detling:

Absolutely. Mindset is critical. And you've touched on it in a very broad way, when you have professional athletes, and I have the privilege of working with a nice and I also have the privilege of taking care of Cirque du Soleil shows here in town. And when you have motivated individuals, it's a lot, certainly not easier to treat them in a manner of some form or manner. And so motivation is key, the ability to want to get back to doing what they did or liked to, you know, had to do like to do want to do etc. plays a critical role in the recovery

Natalie Dangles:

With the hockey team. Are they more apt to get a shoulder injury or a knee injury?

Dr. Detling:

Yes. Yes, both are very common. Okay. Both are very common.

Natalie Dangles:

And I imagine that's challenging because unlike outside of sports, it's not like they have light duty available with athletes. So it's either your full duty or you're not working. It's all or nothing and complex work. So the Vegas Golden Knights to see, you know, Greg, it is such a big thing out here. There's not there's nowhere that you can drive without seeing the Vegas personalized plates, because those are offered in the state of Nevada, bumper stickers. It's a huge thing. So you're very love.

Greg Hamlin:

Let's gonna say until you all got an NFL team for a while there. That was your that was your one professional team, right?

Natalie Dangles:

Since 2017. Yeah.

Greg Hamlin:

I remember I had some friends in Columbus and was there and they have a hockey team there. And that was a big deal. Because it's the same for them. That was their that was their pro team. So people were all in. So I know that that can definitely make an impact. It's always good to have a good fan support system for any, any sport. So when you're working with these injured players or injured workers, do you see that their support system has any impact on that as far as family members, you know, positive negative?

Dr. Detling:

Support system is, again, a critical component of somebody's recovery, and professional athletes. And as whether it's the Vegas Golden Knights or a number of other teams, I've had the privilege of being around you know, they have a huge support system, Viet, their trainers, their nutritionists, their strength and conditioning coaches, they're very well supported. And they have every opportunity to get back to their level, it's in everybody's best interest to get them back right as fast as you can and safely as you can and work setting, it's the same. Having a support system, where you may not be an athletic trainer that hovers over you every minute of the day, you know, your family members, your friends, your co workers, makes a big difference in whether it's either better financial support or motivational support or moral support, or simply being able to have someone drive you to your clinic appointment or your physical therapy appointment when you can't, right after a potential surgery makes a big difference. And you see that patients who have family members in town or a solid support system. Anecdotally, they do they bet they do better they do well, people who don't have that support system, it's not uncommon, they struggle a bit. So I think that's an incredibly important for the patient's mind, and the patient's fiscal recovery.

Natalie Dangles:

And it's interesting that you say that too, because over the years, what I've always been appreciative is you get them back to light duty as soon as you can, because they are motivated to go back to light duty. The employers want to bring them back to light duty. And you always specify exactly what the restrictions are. And it makes it a lot easier when you're asking the employer can you provide it because it's really detailed what you put exactly what they can do. And, you know, it makes it better when they're getting back to work and they're back in a routine of some sort. So I've always been appreciate it that that

Dr. Detling:

I think it's important that they're able to get back in into some form of society. I don't like it if someone's sister, you know, has a knee surgery or shoulder surgery and then they sit at home for weeks and they're isolated. And all they have to do is watch Oprah or play Halo or something and never leave their house. I don't think that's a positive factor force in one's recovery. So I think it's good that they get out you know, Whether it's going to physical therapy or going to work, or going to a friend's house, you know somebody that can support them.

Greg Hamlin:

I agree completely. In your profession, you've probably seen a zillion shoulders and zillion different knees. Can you think of a situation where you've had two maybe very similar injuries that had very different outcomes? And what was in your mind, like looking back and thinking about that injury, whether it was two different two knees with similar injuries or two shoulders? What stood out to you now thinking back on it that could have caused different outcomes when you think about how maybe one went one way and one went a different way?

Dr. Detling:

Are you're asking it the same injury in two different patient populations,

Greg Hamlin:

Right. Or even just, maybe you have two meniscus tears from two different patients, and one went really well, they recovered, they were back to work, all those things. Maybe the other should have gone well, but got complicated. And what were some of the things that maybe caused that that we could look at to do different?

Dr. Detling:

I think we've touched on a number of those important factors that would be involved in that couple things, one mindset for the patient two motivation, three access to ancillary staff, or the appropriate physician. And for us the timeliness of care. Okay, I'll use the example if I may.

Greg Hamlin:

Go for it.

Dr. Detling:

Elbow injury, a distal biceps tear, okay, just the biceps tear, you have a finite amount of time to fix, if you don't fix it at that time, it becomes extremely difficult, if not impossible to repair. So getting that patient from the original primary doctor being seen, having them recognize that getting the appropriate MRI, getting them to the appropriate orthopedic surgeon and get him to the operating room, you really have six to eight weeks to do that. After that becomes it's not impossible, nothing's impossible, but it's it's a challenge. So if you don't have everything that line up just right, you have a primary doctor that maybe doesn't recognize the injury right away, or it takes utilization review for weeks to authorize a really simply simple MRI. And then it takes a week to get seen by an orthopedic surgeon, and it takes another week or two to get authorized by the utilization reviews, all of a sudden, you're at eight weeks or nine weeks for some people versus others. Well, where there is recognized immediately, a phone call is made and MRIs done, doctors see the orthopod sees them and boom, they're in the operating room. Within three weeks, there's a perfect example, the person who's had had the treatment in a timely manner is going to do theoretically better than someone who had to wait 10-12 weeks before they were able to get the operating room for an elbow reconstruction.

Greg Hamlin:

So you hit on something that I would love if you're comfortable to talk a little bit more about and that's utilization review. I know like insurance companies, like having a process, a lot of states have put these into practice. And the idea is to avoid having unnecessary treatment. But at the same time, I got the sense from some of the things you're mentioning, it can be frustrating on the other side when you want to get person take care of and that's held up. Talk to us a little bit about your experience with utilization review, good, bad, indifferent.

Dr. Detling:

I understand the reasoning for and I understand the process. So I you know that I'm not I'm not here to criticize. But I think that utilization review is being overused. I think that if somebody has a distal biceps repair is pretty just biceps tear, excuse me, it's pretty obvious that it's an appropriate thing to surgically repair, I need to wait two and a half weeks for a nurse case manager or somebody to tell me that I need to do that, or it's okay to do that. So I think utilization review, though I understand why. And I certainly respect to why I think it's inappropriate in a lot of situations, and it creates more problems than it helps in certain situations. And I'll go on and emphasize on that where I've had to speak. And I'm happy to speak to doctors, I have no problem talking. It's very, I'm very conservative. And if I ask for something, it's, I always have plenty of data to back up what I'm asking for. But it's really challenging when I have to talk to a nephrologist in Massachusetts and try to teach them orthopedic surgery and why I want to fix an ACL PCL surgery that the person can't stand on their knee. And I have to spend time in my busy clinic, educating them first on orthopedics and then why I want to do the operation. So that's a bit frustrating.

Greg Hamlin:

Let's it's good. No, I think it's good to hear the other side of that, because we don't often get to and I think you know, you guys also are trying to do your job. So finding that middle ground and I don't know what that looks like. Because of course you have a few bad actors that cause problems for everybody or you've got probably the majority of the population that are actually doing really care about their patients and want to see them recover. So

Dr. Detling:

Yeah, absolutely. And you know, there's always times there's always times when you have a patient who's been treated and certainly and there's injuries that you try not to operate on them. You try not to fix them and those there's there's clearly times when talking to another orthopedic surgeon or somebody say Hey, this is what I'm thinking. This is what I've done. This is what is and is not working This hasn't worked. This is what I want to do. And, you know, there's times I've talked to I mean, they're good conversations. And I saw I'm not I'm not poo-pooing the process, I just think that using it as a, as a brush to paint the entire picture, utilizing utilization review for, again, back with just a parrot, it's not necessary.

Greg Hamlin:

Freat points.

Natalie Dangles:

And just to touch on that, too. I've seen some of your reports, because your reports are so detailed, and they explain exactly, you know, the mechanism of injury causation, which really helps adjusters when they're looking at the report. Sure, but I've also seen, like, when you've had a retort on something, it's always with facts. And I've always it was like, Oh, he's fiery with facts, because he's really passionate about what he does. And, you know, I've also been on the other end early in my career of those, you know, reports from you. So it's like, oh, now I bet I learned something. You know, I used to think, you know, when you're new adjuster and somebody falls on their hand, you're thinking, Oh, they have a hand injury, Why'd it turn into a shoulder? Well, you explained when you put out your arm to break your fall, that's why, you know, the shoulder got injured. But it's always with facts. It's never snarky, it's just fiery with facts. And it's like, oh, I learned a lot.

Dr. Detling:

Well, I think you know, what, you know, in this thing is especially you have to be very thorough. And yes, if I, if I requesting an MRI or from requesting of physical therapy, or whatever it might be, I think, I mean, it's reasonable to be able to say, Okay, this is what I'm thinking, this is why I'm asking for what I'm asking for. And if people have questions, listen, I'm I'm not beyond reproach. I'm happy to talk to people. And I've had conversations with utilization review, where I'm talking to another orthopedic surgeon, someone and they go, well have you tried this? Oh, man, I haven't tried that. But that's a really good idea. So I don't have a problem with the with the process utilization review, I just think that, like I said, There's certain times when it's probably not necessary. And that creates a time again, goes back to timeliness creates a cost to the employer and everything else. May not be necessary.

Greg Hamlin:

Absolutely. So, so talking about the recovery process, so you perform surgery, let's say in this example, and the person's doing well, what role does physical therapy play in that? Or home therapy? And, you know, what are your thoughts on that?

Dr. Detling:

I'm a, I'm a really big believer in physical therapy, for a number of reasons, good physical therapy, okay, for a number of reasons. Again, motivation, getting somebody out of the house, getting them to communicate with other people. I can't see a patient every day after I do surgery on them, but the therapist can see him three, four times a week, so they can be my eyes, for lack of a better word. And in good physical therapy for what I do is critical, because range of motion of an elbow or a shoulder or knee strength of those joints are critical from not only getting in the back to work, but getting them back to their normal activities of daily living. So I, I believe, anecdotally, that the therapy makes a big difference in a lot of patients. You know, of course, there's always outliers. So some people are so self motivated, they do great on their own, or other people that aren't motivated at all. And they do therapy, and they don't do as good as you'd expect, you know? Sure. But, but for the most part, I think it is a positive factor and has a positive effect on people's recovery after surgery. In my field,

Greg Hamlin:

You stress good physical therapy. So can you talk to us about what that is? First what it's not I'm gonna I'm gonna, I'd love to hear it from your perspective, haven't seen gold, I'm sure.

Dr. Detling:

Well, you know, is like anything else doesn't matter if you're an attorney, or a physician, or businessman or an adjuster, you work in your field. And you you know, there's maybe other some people who are a little better at it than others and what I might be talking about, right, I've been around long enough that I know who's who has who the really good physical therapists are, I know who the ones that aren't maybe not quite so good. And so I always make a big point to push people to the good physical therapists, even if they have to drive a little bit farther from their home. I don't have any financial involvement with any physical therapy people here in Las Vegas. So I, I have no dog in the hunt. I have no dog in the hunt. Exactly. But I can do the same procedure on three different people on the same day. And I can send them to a physical therapist, a, b, and c. And I can tell you who's going to do great good and fair by winter. So I'm on a really big believer in the therapy, good physical therapy.

Greg Hamlin:

I remember I had energy injured might well have got something wrong with my shoulder anyway, and they'd sent me to some physical therapy and, and I went to a few visits, but I felt like I had I think I had somebody it was a summertime and I think I had somebody from high school that was just kind of like following me around on some things and like, the last five minutes, like whoever the physical therapist was spent, like five minutes with me each time and I was like, I could do this at home. I'm not really getting one shot of this, you know, like this person could be one of my kids. So I but on the flip side, I've toured some places or seen with injured workers the opposite, like physical therapists who are very engaged and are hands on and are really involved in their recovery. So that was why I wanted to ask that because I think there is there is a difference, it's not a one size fits all,

Dr. Detling:

Not at all it makes a makes a really big difference.

Natalie Dangles:

Especially with soldiers too, because you will get a lot of where they have to have another surgery, you know, with the capsulitis. Because if you're not working it properly, then they get that, you know, where they're still don't have that range of motion. And then they end up having another surgery.

Dr. Detling:

Yeah, I think that, you know, physical therapy is just one of the cogs in the wheel, if you will, and I often tell my patients I go, you know, your surgical outcome 50% is me, technically, the other 50% is you and your therapist, you know, you have to work and it's sometimes it's not fun, a lot of time, it's not fun, because they are their nicknames or physical tortures, you know PT. So, they'll push you to work, they'll push your range of motion, and it's been it's it is not physically pleasurable, you know, to do that, but it's really important.

Greg Hamlin:

So switching gears what's what's the greatest challenge in helping an injured worker in their recovery? From your experience? I know you do a lot with sports, ortho, but looking at the employer injured worker side, what's the biggest hurdle in their recovery?

Dr. Detling:

I think we touched on a bit timeliness, timeliness, getting to see a patient and getting them treated in the appropriate manner in an appropriate period of time. You know, just like your weather, it doesn't doesn't matter if you're playing a professional sport, or you're, you're working for a company, that organization wants you back, right. And so, you know, going through the process, oftentimes can be a bit challenging. The guidelines that are used here in Las Vegas are the AECOM guidelines. I can tell you historically, and it doesn't matter if you're using odg, like guidelines or a con for workers comp, the guidelines don't necessarily line up with standards of care. So you have, again, go back to somebody, you know, you have an ACL tear, that the person can't walk across, you get him into physical therapy, that's part of an ACL injury, and you get them going, and you get the range of motion back and everything, their strength is back where they can walk, but they still walk across the parking lot. And they fall because there any buckles on it, there's no reason to wait three months do three months of physical therapy or go through a you know, a protocol, and then do the surgery, you're gonna that somebody who's likely going to need to have that ACL reconstructed. So you know, you're putting an undue burden on the patient, financially, emotionally, their families stressed, the employer is out a person, the costs associated with that person not being at work, that all can be shortened. It doesn't have to go through a three month rehab process and then get the authorization do the surgery. So I think I think that's a that's a challenge that we face every day. That these and like I said, there's orthopedic surgeons during utilization review, we can talk to and they get it, and they understand we if we say something, we say, alright, this is this is ridiculous. He needs to have this fix he or she. But then there's other people, we talk to you that aren't orthopedic surgeons and background, they don't have that they go well, the guide, say you have to do this. I'm just using this as a general example, this a very generalized conversation. But and then you'll get you'll have a nice conversation, they'll come back and they'll say, well, the odg guidelines, say, when we say well, first ODG isn't a AECOM is what we use in Las Vegas, not ODG. And we get into a big conversation about that, and it creates a timeliness issue. So I think that's the biggest challenge.

Greg Hamlin:

Do you see that on the personal health side as well? Or is that more work comp thing? Just out of curiosity,

Dr. Detling:

Think its more of a work comp thing.

Greg Hamlin:

Interesting. Interesting.

Dr. Detling:

I mean, there's certain protocols like you know, you have to do XY and Z in for in private insurance as well. Right? For a lot of what I do, right? Because it's pretty straightforward stuff. That's not It's not nearly I don't I don't think it's nearly as complicated. The other thing that's becoming a challenge is the the a lot of the companies make use of these third party organizations can either try to schedule physical therapy or MRIs or something like that. And that's a, that's problematic as

Natalie Dangles:

Well. So and back on that to about timeliness. I'm not you, but I mean, because I handle a bunch of states. But I have seen, you know, in reports, it'll say an MRI is needed. And then the next thing I'm doing is calling and saying, Okay, can I get the MRI order so I can get it moving? And that can cause a lot of problems too, when you don't get those orders? Because I can't authorize something. I don't have the order for it and get it scheduled.

Dr. Detling:

100%. And there's a lot of you know, there's a lot of moving parts, you know, I'm not trying to pin anything on one on one individual, but I just but that's the, in my practice, you know, we're really well, we're fine. And you know, there's Gabby and Diana and Patrick. They, they're, they're exceptional, right? So I understand if you say, well, we're gonna order this and you have to wait three weeks to put the order in, that's part of the problem. That's not helping the problem.

Greg Hamlin:

And I think what makes work comp so challenging is there's 50 Different versions for for every state, and a lot of them have stuff that's old and archaic and not kept up to date and then trying to get anything changed. Of course, it's got to go through state legislature, which is a whole nother, you know, frustration. There was a time I spent almost five years working for the state funding Kentucky where I was one state one line, and I got to see maybe a window into some how that all works. And I can't say that it's like that for all the states, but it's crazy. So it's, it's always nice, you know, when things could be more streamlined. And I think we've all probably have some work to do on that for sure. So Dr. detling, if you could wave a wand and change one thing in the healthcare world work comp or not, what would you change?

Dr. Detling:

Oh, my gosh, that is a really loaded question. I think there's two things I would change, okay, access access to good physicians, and doesn't matter if it's workers comp, or if it's in the private sector, access to the right physicians, I think it would be a very important change, if you will. The other thing that I would I would probably say is, again, the utilization review. So we're talking specifically about workers comp, I think the utilization review needs to really be looked at, for a number of reasons we've talked about already. So that's those are the those are two things that if I, if I could stand up in front of somebody who would listen, and truly think about making changes, that's those are the two things I would ask for

Greg Hamlin:

I think those are great points. And I think you know, what's challenging, and I've said this to my family and friends before is, if you do have an injury, it's really hard to know if you're going where you should be going, and that where you're going is a good doctor, because we don't really have it. I mean, if you if you do tear your ACL, or you need a meniscal repair, this is probably the first time it's happened. So how are you supposed to know and the system's not really set up in a way that helps anybody figure that out? Right, a lot of it's so opaque, even from the billing to the referral process to everything that trying to figure out that stuff. Even if you're relatively educated and trying to it's not easy.

Dr. Detling:

It's exactly true. And it doesn't matter if you're if you're going to your primary care physician, or if you're going to a first contact physician and workers comp, you know, there's they don't have those physicians, oftentimes, and again, this is a general statement, not there's, there's exceptions to every rule. They didn't do an orthopedic residency, right? Oh, they spent a few weeks in an orthopedic rotation, or maybe a month or two or three and over their, their training. But the subtleties of things. You see, I go back to my biceps tendon, you know, if you look at an elbow injury, and I, I can look across the room at somebody, and I can tell they have a biceps tear. But somebody who may we've never seen one before, that may not be so obvious.

Natalie Dangles:

And it's so true to about access to good doctors, because I mean, God forbid I ever get a knee or shoulder. There's only two doctors, I would go to out here. You're one of them. And there's another one. Yeah. But it's like, God forbid, but it is true. If you don't know, you know, if you've never had one before. It's like, Well, who do you go to?

Dr. Detling:

Sure.

Greg Hamlin:

You got your mom's grandma's sister said was really great. That's, or whoever your doctor referred you to, because you hope that they know what it is. So for sure, I've seen that. Well, Dr. Detling, one thing I've been I wanted to do this year, and I'm gonna catch a little off guard. But hopefully it won't be too hard, is this world that we're living in now? It's just kind of crazy. Since COVID, there's a lot of angst and anger, I think you turn on the radio or the TV. And I think there's this mindset of if two people with differing points of view, yell, whoever he was allowed us is going to go in to be right. And somewhere in all of that we're like forgotten that, like what happiness actually is. And so one of the things I'm asking our guests this season, unrelated to, to the main topic of the discussion is just, if you can think about a time that you were really happy, who we were You were with, and what were you doing, and if you wouldn't mind sharing that with us. That would be huge. Sure. Let's put some good vibes out there.

Dr. Detling:

Absolutely. The first thought that comes to my mind is fishing in Alaska with my wife and daughter.

Greg Hamlin:

That is awesome, so salmon fishing or fly fishing salmon,

Dr. Detling:

Halibut lingcod everything out there. Yeah, that's, that's, that's my happy thought.

Greg Hamlin:

That is awesome. That is awesome. I never fished much until I was in between jobs. And that became the thing I did every afternoon just to de stress and unwind and find my find my center. And I love that there's nothing nothing quite like it. Yeah.

Dr. Detling:

Are you a fly fisherman?

Greg Hamlin:

No, I was just using that. I was just We had creeks in Kentucky. So I was fishing the creeks in Kentucky this fall, and I go out there in the afternoon, you know, do some work on looking for the next opportunity for my job. And in the meantime, when I had downtime, it's like, well, I'm not going to sit in my basement and feel bad for myself. I'm gonna go out there and be outside, get some sun, right and catch some fish. And I really enjoyed it. So it was great.

Dr. Detling:

That's awesome.

Greg Hamlin:

So well we really appreciate having you. I know you're an expert in your field. I encourage anybody that's in that area, in the Las Vegas area to check you out if they have a sports or an orthopedic injury. And I would just remind people in general our theme of do write think differently, and don't forget to care. And we look forward to our guests next week and appreciate your time with us.