Expert Advice on Managing Persistent Pain with Dr. James Sanfilippo
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00:00Hello, everybody, and welcome in to another Virtua Stay Well Health Chat.
00:05I'm Andrew Salchunas, host of Kincaid and Salchunas Mornings on 97.5 The Fanatic.
00:10And I love to do this every single month.
00:12Every single month I get to talk to another member of the Virtua Health team,
00:16just the incredible people at Virtua Health.
00:18And I learn so much about every single topic that we talk about,
00:22and I hope that you guys all learn everything that we talk about.
00:25And sometimes some of these Stay Well Health Chats directly, you know, impact you.
00:30And maybe you learn a little bit more about yourself.
00:32Our last one we talked about a good way to get heart healthy for the new year of 2025.
00:37Everybody has the same goals.
00:38I want to be healthy to start the new year.
00:40So I hope that helped you out.
00:42And today we get to talk more about your body.
00:44And I'm joined today by Dr. James Sanfilippo, MD, MBA, board-certified,
00:50fellowship-trained orthopedic spine surgeon
00:52with the Virtua Reconstructive Orthopedic team.
00:55He's been with the Virtua team for over 15 years.
00:58So you know that he is comfortable, and Virtua keeps on bringing him back.
01:01So that means he's doing a pretty damn good job with everything with you as the patient.
01:06Dr. Sanfilippo also serves as the vice president of clinical operations
01:10for musculoskeletal medicine at Virtua Health.
01:13Doc, welcome in.
01:14Thank you for joining me.
01:15Thank you for everything that you do.
01:18You know, you've impacted a lot of lives.
01:19I appreciate it, and thank you for taking the time joining us today.
01:22Now, Andrew, thank you for having me.
01:23I appreciate it.
01:24Well, so let's get right into it.
01:26What are some of the signs, the key signs,
01:28that maybe orthopedic pain requires an orthopedic evaluation
01:32rather than just home remedies, right?
01:34I feel like everybody goes, ah, my back hurts a little bit.
01:37I'll just pop a little Motrin.
01:38I'll pop a little Advil here.
01:40Ah, my knee's a little pain.
01:41I'm just going to put my foot up for a little bit,
01:43take a little bit easier from exercising.
01:44What are some of the key signs where you're going,
01:47all right, maybe I should actually get an evaluation from a doctor here?
01:51Yeah, so I think there's really two scenarios that we talk about.
01:54You know, you have the chronic ailments, right?
01:56Oh, my knee bothers me on and off for five years,
01:59but I take some Motrin or Advil to leave.
02:02I ice it.
02:02I'm good after a couple of days.
02:04You know, those types of conditions,
02:06whether it's your back, your knee, your shoulder,
02:08we all have those.
02:09When those remedies stop working, you know,
02:13when there is a material change in those symptoms,
02:16meaning, you know, usually I take Advil,
02:18it works after two or three days and I'm good to go,
02:21and now it's been two weeks and my knee's still killing me.
02:24You know, now it's time to get it checked out.
02:25There's been a change in that.
02:27The other is the injury, right?
02:29You know, we go out this weekend, we go for a run,
02:32we come back in, my back's killing me.
02:34Well, you know, after 24, 48 hours of rest, ice, heat,
02:39you know, the anti-inflammatories,
02:40if that's not getting better,
02:42if we're not seeing improvement,
02:44you know, at that point, it's a good opportunity
02:45for the acute, the new injury,
02:47to really go get it checked out.
02:49So are there any specific symptoms
02:51where it might prompt like an immediate visit
02:54to an orthopedic specialist?
02:55Because last year I was running.
02:58It got to the point where my back seized up
03:00in the middle of the run
03:01and I'm walking very slow back to my house.
03:04And my first thought is,
03:05well, let me give it a day or two
03:07and I'll see how I'm feeling after a day or two.
03:10But are there any symptoms where it's like,
03:12wow, this just happened.
03:13I'm feeling this.
03:14I should go check it out.
03:15I should get this checked out now
03:16as opposed to a couple of days from now.
03:18Yeah, so I think the scenario you presented
03:20is the exact one, you know,
03:22that we just talked about of,
03:23you know what, give it a day or two and see.
03:25But I mean, anything really worrisome.
03:27So you can't bear weight on your leg,
03:30whether it's because of your ankle,
03:31your knee, your hip, or your back.
03:33You know, if I can't lift my arm,
03:36if I can't make a fist and grip something
03:38because of weakness,
03:40you know, those are things that do not mess around with.
03:42Proceed immediately to get that checked out.
03:45Anything, any joint swelling
03:47that's also associated with severe redness or a fever,
03:52definitely have to get those types of things checked out
03:55because then you start worrying about more,
03:57not just injury,
03:58but possible infection type symptoms.
04:01So those are, you know, those red flags,
04:04the ones that really inhibit function
04:06of a limb, of your back, of your neck,
04:10or are associated with other symptoms
04:12such as fever, chills, redness,
04:15those types of things.
04:16See, this is why before we start recording,
04:19I told you,
04:19I learn something new
04:21every time I do a virtuous Stay Well Health chat.
04:24So what you're telling me is
04:25I could tweak my knee playing basketball
04:28and if it's a certain tweak,
04:30it could get infected
04:32and I could start feeling chills and feeling fevers.
04:35Like, I didn't know that.
04:36Well, yeah, I mean,
04:37there's bacteria floating around in our body.
04:39We all have little cuts on our hands
04:41or our feet that we don't realize.
04:43And sometimes like that,
04:44you tweak your knee and your knee swells,
04:46that's blood flow to the knee.
04:48Well, that blood may also bring in
04:50some bacteria that may have entered
04:52through a cut in your foot
04:53or your hand or something.
04:55And now you wind up having
04:56a additional problem
04:58on top of the musculoskeletal injury.
05:00Now you have a possible infection problem as well.
05:05All right.
05:05So I decide,
05:06maybe not the immediate,
05:07the immediacy of going to see a doctor,
05:10but I'm deciding,
05:10all right, it's been a couple of days.
05:12The pain's not going away.
05:13I should go see a specialist.
05:15What are some factors
05:16that are most important for a patient
05:18when it comes to looking
05:19for the right orthopedic specialist for them?
05:22Obviously, I trust everybody
05:23at the Virtua team.
05:25So I would,
05:25whether it's you
05:26or any of your colleagues,
05:27I trust you guys
05:28because I love the Virtua team.
05:29But you think about a patient,
05:31a patient wants maybe sometimes
05:32a specific doctor,
05:34a specific specialist.
05:35What goes into that?
05:36So, you know,
05:37I think there's a couple of things.
05:38So first off is trust, right?
05:39So if you have a family member,
05:41a friend or yourself
05:42has had an experience
05:44and you trust that provider
05:45or trust that recommendation,
05:47you know, that goes a long way.
05:49You know, your primary care doc
05:50may have a recommendation.
05:52You know, again,
05:53if there's trust there,
05:54that goes a long way.
05:55But my mind sort of starts to go to,
05:57we have all this information now
06:00available online.
06:01You know, making sure
06:02that the providers are well-trained,
06:04making sure that they have,
06:05they treat the specialty
06:06that you're looking for,
06:08making sure that they have
06:09good reviews online
06:11and good outcomes online.
06:12You know, that goes a long way
06:13into building that trust
06:14before you even meet somebody.
06:15But then in addition to that
06:17is, you know,
06:18where am I going to go
06:19that I can get the best treatment
06:21but the most treatment,
06:22you know, in one stop?
06:23I don't want to have to bounce around,
06:25you know, from a doctor's office
06:26to then go get an x-ray
06:28and then someplace else
06:28to go get a brace
06:29and then back to the doctor.
06:31You know, is there an opportunity
06:32for a one-stop shop type deal?
06:35One of the things that we've done
06:36over the last few years
06:38and really have tried to stress this
06:39is really being that
06:40for the patient.
06:42If you come in,
06:43you know, we have a couple
06:44of different points of access,
06:45whether it's through
06:46our walk-in clinics,
06:47we have two of them,
06:48OrthoExpress,
06:50where you don't even need
06:51an appointment,
06:52but you can get an x-ray,
06:53you can get a brace,
06:54you can see an orthopedic specialist
06:56in any of our specialties.
06:59And we cover, you know,
07:00pretty much every orthopedic specialty
07:02at this point.
07:03And you can get
07:04not only the physical exam,
07:07but you can get
07:07all the diagnostic work up
07:09and you can get
07:09the post-care treatment
07:10of bracing,
07:11physical therapy,
07:12all of that,
07:13in one location
07:14set up at the time
07:15of that first visit.
07:17You know, that goes a long way
07:18to being efficient
07:19and respectful of your time
07:21and your treatment.
07:23I always like asking a question
07:25to try to talk about
07:27different generations.
07:28Like, I'm 31,
07:29so if I deal with some of my knee,
07:32I'm probably going to ignore it
07:33for a while.
07:34But if it does come time
07:35where I feel like
07:36I need to see a specialist
07:37and then I do need
07:38to get some sort of operation
07:39or some sort of physical therapy,
07:41can you talk about
07:42the difference
07:43between maybe a 30-year-old,
07:44a 50-year-old,
07:45an 80-year-old
07:46that also needs
07:47this kind of care
07:48and what goes into it
07:49from the team at Virtua
07:51and trying to take care
07:52of people
07:52of all different ages?
07:53Yeah.
07:54Well, the first thing is,
07:55you know,
07:55those three patients
07:57not only have,
07:58you know,
07:59usual, typical problems
08:01for their age groups,
08:02but also different expectations
08:03for what that outcome
08:04is going to be, right?
08:06So, you know,
08:07you have yourself
08:07at 30 years old,
08:08you hurt your knee,
08:09you know,
08:10you're not looking for,
08:11you know,
08:12a surgery to get back,
08:13you know,
08:14to whatever.
08:15You're looking to get back
08:16to your activity level
08:17as quickly as possible
08:19and a 100% return
08:20to that activity level.
08:22Surgery may be an option,
08:23but what else can we do
08:24to treat you
08:24to get you back
08:25as quickly as possible?
08:26And your activity level
08:28at 31
08:29is going to be
08:29very different
08:30than the 55-year-old
08:32or the 85-year-old
08:33as we go forward.
08:34The other thing
08:36really becomes
08:37having the different
08:37specialists and specialties
08:39to deal with that.
08:41You know,
08:41it's very unlikely
08:42that you hurt your knee
08:43at 31
08:43that you're going to need
08:44a knee replacement.
08:46You know,
08:46so having our
08:47non-operative sports providers
08:48or our sports surgeons
08:50there to be able
08:51to treat you at 31
08:53is going to be key.
08:54Where somebody at 85,
08:56usually those are
08:57more arthritic-type conditions.
08:59Again,
08:59not looking to jump
09:00right to surgery,
09:01but having our
09:02physical medicine
09:03rehabilitation docs there,
09:05having something
09:06that we call
09:06the arthritis clinics
09:08where we have a pathway
09:09for treating
09:10hip and knee
09:11and shoulder arthritis,
09:13and then also having
09:14our drug replacement
09:15specialists available
09:16if that's where
09:17we head.
09:18You know,
09:18having all of those
09:20different pathways
09:20and all of those options
09:21both on the surgical
09:22and non-surgical side,
09:24and also being able
09:25to manage the expectations
09:26that come with
09:27those different age groups
09:28and different activity levels
09:31goes a long way
09:32in treating every patient
09:33in sort of
09:34what I like to call
09:35like a continuum of care
09:37where, you know,
09:38you start from,
09:39you know,
09:40we talked about the rest
09:40and the ice
09:41and the anti-inflammatory
09:42all the way
09:43to surgical treatment
09:44if that's what's needed
09:45and everything in between.
09:46See, that's great insight
09:47and I appreciate it.
09:48Now, before I let you go,
09:50I want to know
09:50a little bit more about you.
09:52Like, you know,
09:52I told you,
09:53my wife's a nurse,
09:54my mom's a nurse,
09:55so I know how much work
09:57doctors put in
09:58to get their doctor degrees,
10:00but I don't know,
10:01was your dream
10:02when you first went
10:03to medical school
10:04like, hey,
10:04I want to work
10:05with musculoskeletal medicine
10:06or, you know,
10:08I want to know
10:09what your path was
10:10to get to this.
10:11What made you choose
10:12orthopedics
10:13as your specialty?
10:15Yeah, so when I first
10:16went to medical school,
10:17no, I actually,
10:18you talk about heart health,
10:19I wanted to be
10:20a cardiologist.
10:21Okay.
10:21My grandfather
10:22is somebody
10:23who was sort of
10:25my person growing up
10:26and he was
10:26a cardiac patient
10:28for years
10:29and then,
10:30you know,
10:30when I got
10:31into medicine,
10:32I sort of started
10:33to gravitate
10:34towards musculoskeletal
10:36and orthopedics
10:37just because I
10:38sort of associated
10:39with it.
10:40It's those injuries
10:40that we were dealing
10:41with, you know,
10:42when I was in my
10:43mid-20s
10:43and early-30s,
10:45but really,
10:46it's two things
10:47really that drove
10:48me to orthopedics
10:49and that's,
10:50number one,
10:51the type of people
10:51I get to work with.
10:53You know,
10:53very team approach,
10:55team-oriented people.
10:56You know,
10:57we all have our jobs,
10:58we all do our jobs.
10:59You know,
11:00getting back
11:00to that continuum
11:01of care,
11:02you know,
11:02I love working
11:02with our therapists
11:03and our advanced
11:06practice providers
11:08such as our PAs
11:09and our nurse practitioners
11:10and my other,
11:11you know,
11:12orthopedic specialists
11:13that I get to work with.
11:14It's very much
11:14a team approach
11:15to taking care
11:16of patients.
11:17And then the other
11:18is the type of patients
11:19I get to work with.
11:20These tend to be
11:21very motivated patients.
11:22You know,
11:23you have an injury,
11:23you want to get back
11:25to your life
11:26and,
11:26you know,
11:27that motivation
11:28of going to do
11:29the physical therapy
11:30either before
11:30or after surgery
11:31or,
11:32you know,
11:33taking the medication
11:34that we give you
11:34or doing those types
11:35of things.
11:36You know,
11:36if you want to get back
11:37to playing basketball
11:38after hurting your knee
11:39at 31,
11:40you're going to do
11:41those things
11:41that I suggest
11:43and we're going
11:44to work together
11:45to get you back there.
11:46And it's sort of
11:47that mentality
11:47that I really love
11:49about orthopedics.
11:50I love that
11:51and it's really cool
11:52that you've been
11:52with the Virtua team
11:53for over 15 years
11:54and the way you speak
11:56about everybody
11:57that you work with,
11:58I hope people take
11:59that into account
12:00when they go,
12:00all right,
12:01which program
12:02should I go through?
12:02Which hospital
12:03should I use?
12:04And the Virtua team
12:05has been spectacular.
12:05I love talking
12:06to all of you guys
12:07from the Virtua health team.
12:08So I appreciate it
12:09so much,
12:10Dr. Sanfilippo.
12:11If you want to get
12:11more information,
12:12I hope you learned a lot
12:13just by watching
12:14this video today.
12:15But if you want
12:15more information
12:16from the Virtua team
12:17itself,
12:18go to Virtua.org
12:19slash dream team.
12:20That's Virtua.org
12:21slash dream team.
12:23Not Vince Young,
12:24not the Vince Young
12:24Eagles dream team.
12:25We're talking about
12:26the real dream team
12:27with the team
12:28at Virtua Health.
12:29Dr. Sanfilippo,
12:29I appreciate it so much.
12:31Thank you for taking
12:31the time today.
12:32Andrew,
12:32thank you very much.
12:33I appreciate it.