Fitness + Health + Wisdom + Wealth

Sports Medicine & Rheumatology Chat – Dr. Ahmed Elghawy


Guest: Dr. Ahmed Elghawy

Release Date: 3/14/2022

Welcome to Trulyfit the online fitness marketplace connecting pros and clients through unique fitness business software.

Steve Washuta:

Welcome to the Trulyfit podcast where we interview experts in fitness and health to expand our wisdom and wealth. I am your host, Steve Washuta, co-founder of Trulyfit and author of Fitness Business 101. In today’s episode, I have Dr. Ahmed Elghawy who works at the Cleveland Clinic as a rheumatologist and a sports medicine physician.

We go over what exactly a rheumatologist does, we go over what Ra is, and also what Gout is and other rheumatology issues that he deals with on a day to day basis to help us in the fitness and health industry deal with clients who have these things and understand a little bit more about what exactly they are and what they do in the body.

And then we get into the sports medicine side, we talk about everything from what’s going on today in the sports medicine field updates.

Insofar as new medicine and new procedures go over concussions, I get a doctor a metal guy always take on lifting and why there are so many injuries today, what he thinks we can do to prevent that potentially.

It’s a great conversation. I really appreciate his time. With no further ado, here’s Dr. Metal Galloway. Ahmed, thank you so much for joining the Trulyfit podcast. Why don’t you give my listeners in the audience a background on who you are and what you do in the medical field?

Dr. Ahmed Elghawy: Sure. My name is Armando gaue. I’m a rheumatologist and Sports Med doc and in Cleveland, I work for the Cleveland Clinic.

I manage patients who have autoimmune conditions. As well as those who’ve just come in with run of the mill muscle-skeletal issue. Whether it’s a hurt knee or hurt shoulder, I’m kind of do a little bit of, of everything in the muscle skeletal field,

Steve Washuta:

I have to say, I know nothing about rheumatology whatsoever. i My wife is a physician, as you know. And I’ll always ask her questions about things. And a lot of times it has to do with autoimmune and rheumatology. You know what, just get on a podcast with Matt, he’ll explain it all to you. Stop asking me all these questions. Why don’t we just begin from giving a good definition of what a rheumatologist does and what it is?

Dr. Ahmed Elghawy:

Sure, you know, that’s interesting because, when I started my fellowship in rheumatology. One of the first things my program director asked me was what do you think rheumatology is? My co founder and I were like, Oh, we’re arthritis, Doc’s we manage autoimmune conditions.

He summed that up as we are interventional immunologists. So what we do is we manage autoimmune conditions or conditions where the, the immune system is acting inappropriately. We try to quell that we try to bring that back to its normal baseline.

And so whether that is the joints kind of swelling up, or the heart becoming swollen, or inflamed. The lungs becoming like that, we try to bring that back to its normal baseline.

Steve Washuta: Now, you mentioned arthritis, can you name some of the other more common rheumatic issues and diseases?

Dr. Ahmed Elghawy: Sure, sure

. The things that I manage mostly tend to be things like rheumatoid arthritis, psoriatic arthritis. Other autoimmune conditions are things like lupus, sjogrens, scleroderma, autoimmune hepatitis, inflammatory bowel disease, like Crohn’s and Ulcerative Colitis. These are all things where the immune system kind of goes a little haywire and attacks itself inappropriately.

Steve Washuta

So walk me through your patient experience, Steve walks into your office, I’ve probably been referred by a general practitioner.ou can tell me if I’m wrong. I see you then we go through a series of labs. You’re looking at those labs or how does the process go?

Dr. Ahmed Elghawy: Sure, like you said, either come in, somebody sends you over to me, because there’s a concern for an autoimmune condition from whatever you had with your previous doctor. Or sometimes I have patients will come in on their own without anything and say, listen, I’ve been looking this up online.

A lot of the things I’m reading about this specific disease or syndrome kind of matches up with what I have. I kind of want to run it by you and see what’s going on.

So we sit down and we’ll sit and talk about what’s going on with you. Whether it is specifically joint pain or fatigue or a specific organ that’s that’s that’s been acting up. We will go through things that your primary may have already ordered. That are leaving the thing that you may have an autoimmune condition.

We go step by step on all that whether we take your full history, we go through your full background. We perform a full exam, and then from there, I kind of decide what the next step is going to be with you in mind.

Okay, so if it is something like an arthritis, we get imaging, we get X rays, we do some blood work and urine tests. But it really depends on what you’re coming in with.

So the kind of just when you’re coming in, we sit down, we try to figure out your story, you you kind of tell me what’s going on with you. We do our exam and we try to mix those two things together. We order a subset of bloodwork and labs and imaging to try to put together a diagnosis

. Now with rheumatology, unfortunately, not everything fits perfectly in boxes. That’s because, you know, a rheumatoid arthritis patient in you could be completely different from somebody else. And so there might be features that you have that someone else doesn’t have. So we had to do our best to kind of put all that together.

Steve Washuta: I was gonna ask this question later, but I got to get to it. Now, what? Is there any controversy around autoimmune diseases or alreay? Like, are there other doctors who deal with it in different ways?

Let’s say like holistic doctors or like integrative medicine physicians, are there more than one way to deal with? I guess you would say autoimmune issues that you deal with.

Dr. Ahmed Elghawy: Yeah. Yeah, absolutely. I mean, I think that there’s it there has to be a multidisciplinary approach to autoimmune conditions. Now, autoimmune conditions are not necessarily curable. Now, when you are diagnosed formally, within home, you can, this is something you carry with you.

And it doesn’t necessarily go away. What we do is we try to bring the immune system back to its normal baseline from being inappropriately overactive.

And so, you know, integrative therapies or holistic therapies have their place in treatment. They do not, prevent some of the long term effects of these of these issues if they’re not treated, okay.

So for example, if you have, let’s say, lupus, okay, and it goes untreated for years. It can start to attack your heart, lungs, kidneys. You know, holistic therapies are not going to prevent those things. Where holistic therapies kind of come in, things like acupuncture, massage, Tai Chi, yoga, pilates, and even medications. Kind of like, therapeutics, like turmeric or ginger, they have anti inflammatory components to it,

They do help, but they don’t necessarily change the course of the disease. They may give you some relief.

Steve Washuta: Now, are there nutritional interventions. So

Dr. Ahmed Elghawy: like I said, in terms of like turmeric, having an anti-inflammatory component, same with ginger, you know, we know for sure that the gut biome is intimately related with the, with the immune system.

And so we try to limit processed foods, and sugar. Make sure they eat a lot of greens, lean meats, a lot of water. And so all these things kind of together, can can definitely boost up your immune system.

There’s also some data and it kind of goes back and forth. You know, every few years, a new paper comes out, that’s debates, one or the other. But vitamin D, we think has a pretty strong, you know, role in immunity.

So those with lower vitamin D, tend to have a little bit worse immune system, they may pick up infections. And so you know, conversely, those when we supplement with vitamin D, those bases tend to get also get better.

Steve Washuta: I know autoimmune is obviously sort of an umbrella term for a lot of different things. You already named Lucas, and RA, and some of these, or any of these are all of these. Could you find out in advance? preemptively. If somebody has it? Let’s say I walked into your office and said, I think my parents had rheumatoid arthritis. Can you other tests to take that I could take even if I’m not having symptoms yet?

Dr. Ahmed Elghawy: Yeah, there are. Actually, we know for sure that a lot of times, your antibodies will be positive long before you develop any symptoms. If you came in, you say, Hey, listen, my mom and dad both have rheumatoid arthritis, I’m really concerned that I might too. I would take that very seriously.

I would make order a panel and not only just check your your antibodies, but I would probably also get X rays, baseline X rays of your hands, your feet, your neck, areas that I think would be concerning for rheumatory arthritis. So the reason I do that is twofold.

One, sometimes you may develop, the sequela of that inflammatory arthropathy even before you know it. Until even if your your your baseline markers are totally normal, now they serve as a baseline. That way we can use them if things change in the future. Now you’re you’re a young guy.

So, you know, if everything’s normal now, but your parent read, you have a strong family history. It might be worthwhile to check you again later as you get older, especially if your symptoms change.

Steve Washuta: Do you think that’s how the industry does it like are other physicians in your workplace doing that kind of preemptively. Trying to get people to say, listen, if you have a familial history, that’s worthwhile preemptively attacking this, it’s not just you.

Dr. Ahmed Elghawy: no, no, I think I think that’s appropriate too. I’d have a lot of primary care Doc’s who will send their patients or their patients children over to me. Because of a family member who was recently diagnosed with an autoimmune condition.

Someone you know, and in different autoimmune conditions attack us, or not attack us, but they they occur at different times in our in our lives. When you think of like things like rheumatoid arthritis or lupus, they tend to happen kind of towards the middle age.

But when you think of like an athlete, or a younger person, someone in their 20s with low back pain. The thing we kind of worry about most something like ankylosing spondylitis. Which is an inflammatory back and tendon disease that tends to affect younger people.

Now, if you came in and you’re 75 years old. I’m going to tell you, you probably don’t have that we’re looking for other things in that age group instead.

It depends, but I think that, you know, there is a strong hair ability to autoimmunity. If you have somebody in your family with an autoimmune condition, it does increase your risk of you yourself having one too.

If you yourself already have something, like your thyroid, which tends to be autoimmune in general, it increases your risk of developing a second issue. And the third issue. Let’s unpack

Steve Washuta: already a little bit further, especially on the spectrum of how a personal trainer could potentially deal with a client who has rheumatoid arthritis. What are the symptoms that we are going to see in them?

That is something that could or should be concerning, if we see something that is office or medication that they may be taking. We should be concerned with that could affect things in their workout, anything you could think of? 

Dr. Ahmed Elghawy: Sure. When you think of something like rheumatoid arthritis, I like to think of it as a symmetric small joint arthropathy.

What that means is it tends to affect both sides of the body at the same time. It loves to attack small joints. Like the hands, specifically the knuckles, wrists, and the knees and feet.

And so from a personal training perspective, you know, the things you worry about are functionality, you know, if the patient isn’t able to move, if they’re really stiff, really strong, morning stiffness, swollen joints, or they say they feel swollen.

They’re not able to do the things that they normally would with you. That has to be taken seriously. That could be a sign that their disease is not controlled, you know.

Now, sometimes they may need something like an over the counter or anti-inflammatory. Ibuprofen or Motrin, to kind of get them through their workouts. If you feel like hey, every time you’re working out with them, they need something to get them through the workout. Can be another indication that their disease is not totally controlled.

Steve Washuta: Yeah, that makes a lot of sense, good information. And then what about medications that they are on specifically not for sort of reactive inflammation? But for preventative for rheumatoid arthritis? Do they have any complications or side effects that one should be concerned with?

Dr. Ahmed Elghawy: I mean, from a personal training perspective, they can be a lot of times when we’re in the beginning of treating one of these diseases, we put them on steroids.

Steroids are very potent anti inflammatories, but they’re they’re kind of a double edged sword. Because as as good as they are, there’s a lot of side effects that come with them.

Things like raising their heart rate, blood pressure, blood sugar ,or if they’re on it for long enough, they actually start to wear with their bones, they can develop osteoporosis very early.

So if you have a patient who is chronically on steroids over and over my worry is if they fall into it, and they break a bone. If they’re their heart rate is going through the roof that you know you barely started the workout in their heart rates in the hundreds. That could be a sign that, they’re also getting some of that from their medication.

Because it has so many side effects. We try to put them on what we call de martes. Or disease modifying antirheumatic drugs.

And essentially, these are drugs that we put them on to manage the long term. So they don’t have to be on steroids. Okay, those medications, the biggest thing we have to worry about with those is that they are immunosuppressive. Okay, and so they are they’re increased risk of developing immune infection compared to someone who’s not on that medication. And so, in a pandemic world like we’re in right now, they have to be extra careful.

Steve Washuta: Yeah, I did not know that. That’s very interesting. Again, I don’t know much about Ra. I do. I met somebody recently, who was 20 years old. And she had already and I thought that was odd. Is that is that very elegant

Dr. Ahmed Elghawy: on the that’s a little bit on the younger side. But we do know that those who are let’s say, children with juvenile idiopathic arthritis. Specific subsets of those patients will go on to develop rheumatoid arthritis earlier. And so it’d be interesting to know if maybe she had some similar symptoms when she was younger. But that is a little bit on the earlier side, but it’s not it’s not unheard of.

Steve Washuta: And then also, I know that women develop ra more so than men, right? Is there a mechanistic factor? Why one gender would get it over another? Or we just don’t know?

Dr. Ahmed Elghawy: Yeah, I mean, so. So women, I think they get it about two between two and three times as much as men. And it’s not even just rheumatoid arthritis. If you look at the numbers from lupus, women are nine times more likely to develop lupus than a man is. And we’re not 100% sure why it happens more in women, there’s this kind of there’s there’s a couple of theories, one may think that because they carry 2x genes, that actually is more prone to developing mutations than the Y gene.

And so that that could lead to an autoimmune issue. Women are also tend to have more hormonal changes throughout their whole lifetime. They tend to go through more transitional periods between puberty between pregnancy and between menopause than men do. Men really only go through puberty and then and then for the rest of the time, for the most part, they’re most of their hormones stay relatively steady or do a very, very slow decline over time. There’s not like a drastic change in our arms. Those are two theories, but really, we were not really sure.

Steve Washuta: That seems like the billion-dollar question. Doctor, I mean, if you can figure that out, you can deduce exactly what is going on right? You’re saying okay, well, if women if this man basically is going on more with women than men. We know this is the cause. And then that would that would do a lot,

Dr. Ahmed Elghawy: a lot immediately get written on.

Steve Washuta: As if there’s not 10s of 1000s of people trying to figure this out as we speak. I’m

Dr. Ahmed Elghawy: sure I think we’ll figure it out.

Steve Washuta: I think you and I can fit this. Oh, of course. Yeah. But probably by the end of this podcast will. So, I have a lot of clients who have gout because I work with seniors. So they come in with gout. And I was always under the impression gout was autoimmune but was simply a something going on with bad diet that essentially caused it, can you just expand on what exactly Gout is

Dr. Ahmed Elghawy: more? Sure, gout, gout is an interesting one, because gout kind of falls in that in the in-between autoimmune and autoinflammatory. And so autoimmune conditions tend to be an issue with our adaptive immune system, the way we develop antibodies. autoinflammatory tends to be more with our innate immune system, where it’s through through our neutrophils and lymphocytes and things like that.

It’s a very like, you know, primitive type of immune system that that’s going on there, we tend to see with more with fevers, and so a gal kind of rides the line between those two. Now with gout, it’s a little different in the sense that it doesn’t carry maybe some of the same. It’s much more treatable limited. So it’s much more treatable than let’s say, ra, or lupus, or any of these other things where that require lifelong therapies. galleys, something that you can take care of.

And although you like you said, there can be kind of a dietary or lifestyle component to it, that only accounts for about 10% of gout patients, not 90% of the time, it’s because the patient does not have the ability to clear the excess uric acid that they’re building up through the kidney. And so it’s usually more of a kidney issue than anything else. Now, is there any specific, you know, is there anything that’s specific that with your patients that you feel that or anyone that you see that, that you have any issues with that I can maybe talk about, 

Steve Washuta: I would just say pain? So So I guess my question always with Pain is pain is described in different ways. I always make sure my clients tell me exactly what’s going on. So for personal trainers, sometimes they’ll say, Oh, my back hurts. You’re like, Okay, well, is it a short pain? Right? Is this nerve pain, soreness, or is it because we worked out too hard and figuring out exactly what sort of pain they’re feeling?

And you have to do this, I’m sure all the time. It’s very important, right? So you keep asking what else? What else? What else you got as much information as you can, and you make that the duction. And with the gout, they have a lot of pain, let’s say in their toes and their feet. But for me, I don’t know if it’s okay, is this pain we could push through? Because it’s it’s uric acid. And it’s not necessarily anything going on with like, the muscle itself? Or is this pain I should say, What’s let’s stray away from doing things?

Dr. Ahmed Elghawy: I would say the poly bladder. I remember even just reading through my rheumatology textbooks in my training, and I remember coming to the Gout chapter. And I won’t forget this because it’s such a, every every chapter was awkward, like a quote, or something profound about it. This one was, it was just a quote from a an anonymous US veteran, and it was something along the lines of I’ve been shot, I’ve been stabbed, I’ve been thrown out of a helicopter.

And the worst pain I’ve ever felt in my life is get out. Yeah. And it was it was something along those lines, it can be it’s a debilitating type of pain. These are patients when they you know, typically, like you said get it in their in their feet, they can get it in their toes, their knees, their elbows.

And so they’re, it’s to the point where a lot of them have problems, even putting on their socks, just the act of the actual the cloth itself, or the sheet on their bed, grazing the joint or grazing that area can be so profoundly painful that it can be pretty debilitating. And so a lot of these I would take that pain very seriously. It’s like the uric acid or they’re, they’re basically little crystals that are depositing in the joint. And so for them, it feels the way they’ve always been described to me by my patients, it feels like a hot knife is going into the joint.

Steve Washuta: So I was only under the impression that it happened in the toes and the feet I didn’t know another area. So let’s go ahead and say it’s happening in my elbow. How do I know it’s not like some sort of golfer’s elbow or tendinitis as opposed to Gout is it just from labs seeing the uric acid,

Dr. Ahmed Elghawy: so it’s a kind of a combination because I tend, you tend to have tennis or golfer’s elbow, like a long that bone and just a little bit south of that bone kind of goes into like where the tendon attaches to that bone, okay. Galkin can occur inside the joint itself. And so patients will have a hard time bending the elbow altogether. A lot of times I will have the image.

So I’ll usually image them with ultrasound or X rays. And if there’s an a fluid in there, I drained the actual joint itself and pull the fluid out and actually look under the microscope to see the uric acid crystals. That’s how we diagnose and that not just for the elbow, but really any joint that becomes really swollen like that we need to be able to, to make sure that we we can formally diagnose

Steve Washuta: that. Now again, you’re in sports medicine and your rheumatologist. Are there other physicians who would be doing this? So let’s go ahead and say I went to like, I don’t know an orthopedic or a general practitioner, they’re not going to be draining. and looking under the microscope for this specifically your your profession

Dr. Ahmed Elghawy: yeah and so if you go to like a sports medicine doc, they may drain it but unlikely that they’re going to send you know the the, they’re gonna look at it under a microscope or sent to a lab to look for uric acid crystals. That’s not typically what a sports medicine doc looks for or is trained to treat a primary care doc may just kind of depends on their comfort level but a rheumatologist will and in every any rheumatologist who sees a swollen joint, they’re concerned about, you know, what we call a crystal arthropathy or either through uric acid or calcium, that that joint needs to be drained. You know, or there needs to be some proof that there’s gout in there, whether that you see on erosions on the X-ray or you see, you know, evidence of it on the ultrasound.

Steve Washuta: Very interesting. Well, I will make sure to let my clients know, next time they’re filling out and like you’re, you’re lucky, I was told by a professional that we don’t actually have to do anything involving legs. Yeah,

Dr. Ahmed Elghawy: but I say, let them you know, if it’s in their foot, yeah, like you said, All revised up, it’s in their arms do all over life, but let them whatever areas affected, let it cool down. Um, a lot of times, these gout flares will subside within a week. But they really need to see a professional because you know, if you do not, you know, if you treat the Gout only, you’re not kind of solving the problem, you’re cheating the flare, excuse me, you do not fault, you’re not solving the problem, because your account is still building and building and building and building.

And so they need to come in, they need to get the uric acid levels checked. If it’s high enough, they need to be put on medications to reduce that uric acid otherwise, their flares are going to become more frequent. And their flares are going to last longer.

Steve Washuta: Is the medication a binding agent that binds the arc acid? And then you get rid of it? How does that work? 

Dr. Ahmed Elghawy: Yeah, that’s basically we have a few different agents that do that one, one that binds it, one that increases the uric acid, kind of like, you know, excretion through the urine, we have other ones that we do through an infusion where it actually it converts the uric acid into something that’s completely soluble.

Now, mammals, we are missing that enzyme that converts uric acid to another thing called allantoic. And so you look at a lot of other animals, they don’t get out like we do. We’re missing that enzyme. And so if it gets bad enough, we’ll actually get we’ll do an infusion of that of that enzyme to convert it.

But that’s those are, those are for the like the absolute worst cases, patients have had this for 1020 years, never treated. They’ve developed so much gout and uric acid buildup that it’s actually starting to build up in their joint and you can actually start to see it kind of pop through the skin,

Steve Washuta: or they literally taking enzymes from an animal. are they developing this enzyme in a lab? Like free? They’re usually doing it through a lab?

Dr. Ahmed Elghawy: Yeah. Yeah. First of all, but but it works. I mean, it works really, really well. But it’s a last resort, because I would say more often than not very, very few patients ever get that far in Canadian, that kind of tree. And most of most of our more conventional therapies work really well.

Steve Washuta: Now that we’re speaking about joints and pain, we already hit on the elbow and the toes and everything else, let’s jump right into some of the sports medicine stuff there is, you know, a long history from my lifetime, which is only since the 80s of every five years or so it’s almost like when you’re in the newspaper, eggs are good for you.

And then two days later, eggs are bad for you, they’ll kill you. Or people change their mind about how to treat sprains or the old school thought maybe this is back to the new school thought is Okay, the first let’s say 36 hours we treated with ice we get the inflammation down. And then once the inflammation is down, maybe it’s x rayed, then we can go ahead and get some heat towards it to get the blood flow going if especially if you’re in areas that are not vascular, right because it’s ligaments and tendons Is that still the thought process

Dr. Ahmed Elghawy: that is typically this this the way it like you said it kind of bounced every few years, they kind of go back and forth. I think right now the current the conventional thing is to if something is acutely painful, and swollen ice first, let it cool down for a little bit of time. Mentally, this is a good pain reliever numbs the skin and it actually reduces the swelling. In general, anything that’s less than six months old, with we call it a cube. And so with acute pain, we usually tend to ice a little bit more.

Now when we go into the kind of in the chronic phase, when this has been going on for long periods of time, the body kind of forgets about it. If you have an issue with like tendinitis, and this has been gone on and on and on you ice and everything, and he’s still painful, eventually the body stops using its resources to try to repair it. So some sometimes putting a little heat can kind of revascularize that area and kind of remind the body Hey, listen, we got it, we got to go back and try to fix this. Ice first, let it let let everything kind of cooled down a little bit and then over time, you can go towards eat.

Steve Washuta: Yeah. And that’s you know, that’s typically what most personal trainers will tell their clients and that’s more along the lines of what has been, I’d say that it’s filled the years of information but here in there, things do switch up and we see new information come through and I but sort of to counter that. I know a lot of sports medicine doctors who will tell my clients who have plantar fasciitis to like roll their foot out on a bottle. And this is again, this is not an acute injury. As plantar fasciitis hasn’t been there for four or five, six months, so it’s like, okay, well, why am I using ice in that case? But I think maybe there’s nothing else you can do.

Dr. Ahmed Elghawy: I think they’re doing that therapeutically only like I do, I think they’re doing it for their own comfort at that point, you’re doing it for pain relief, less less for anything else, you know. And so, at that point, you know, if you’re doing that, just for comfort, I don’t think you’re gonna get the same kind of relief out of ice, rolling it for plantar fasciitis, you know, six months down the line, as you would have, you know, within the first couple of weeks, for sure. I think that that is only for pain relief. At that point.

At that point, they need to start looking at things like, you know, do we need to to get you into therapy, you we need to get you new orthotics either over the counter or prescription grade custom orthotics. You need to change your shoe, where do we need to change the way you walk, your change your date, all of these things.

Steve Washuta: So I’m going to go on a quick rant here about something sports medicine and then you can just jump on in but there has been this long sort of group think that cramping is specific to dehydration. Everyone who says oh, we have cramping and dehydration. I don’t know if there’s been like formal studies done on it. But just from a, me analyzing the body standpoint. Typically, it’s just your hamstrings and your calves that are cramping, right? Nobody ever woke up in the middle of night with a bicep cramping. So to me, it’s an it’s just as much if not more of an overuse issue than it is a lack of hydration issue.

Dr. Ahmed Elghawy: I agree, especially especially in the upper body. And I’m sure like you’ve gone to the gym, you overdid it. You know doing arms one day, and for the rest of that day, in the next day, your arms feel like every time you try to hold a pen or something, it creeps up on you. I think that’s purely overuse at that point, because I’m you know, you’re drinking water all day, you know, that doesn’t make it better at that point.

There are some times when it can be a dehydration issue, for sure, for sure. Especially if you’re out in the heat, you’re working out outside. You’re working out doing it like long-distance type of races. Those are all things where you think of a little bit more of dehydration.

Especially if you’re losing electrolytes like magnesium, but otherwise, I think most of the time it is overuse. It is you know you’re doing something repetitively throughout your entire especially your workday, if you’re doing something specifically at that worksite constantly, and that’s where you cramp most likely overuse.

Steve Washuta: Yeah, yeah. I I’m just glad to hear you echo my thoughts, because I have to get like conversations with people. And they’d say that it’s only because of the loss of water. And I say, Well, if they’re a runner, how come their forearm never cramped up before and the runners only thing is a cramp up on the runners or their leg muscles. There’s a reason because there’s an overuse component, at least there’s two factors

Dr. Ahmed Elghawy: agreed. Then there’s also a third kind of section. This is where the autoimmunity part comes in with when if there’s enough damaged muscle in place, and you actually leak start leaking muscle enzyme that can also induce cramping, too. Whether, you know, you hear about patients with rhabdomyolysis, you know, they’ll go outside, they run for, you know, an extra couple of miles than they normally whether they go more aggressively, or they are they’re in a CrossFit class that’s particularly difficult that they for them, and then leaking muscle enzyme that will also induce cramping as well.

That’s kind of where the dehydration portion of it, I think people, you know, talk about, because hydration is the treatment for that. But it’s not necessarily that they’re dehydrated, it’s just that the muscle itself has become damaged. And from an autoimmune perspective, whether that is mechanical because of the sport that you did, or is it is it autoimmune driven? Is Is there an immune process driving the muscle breaking down?

Steve Washuta: No. Interesting. What else is going on in the sports medicine world? I know, recently, there’s been players who have been injured on the field, and they’re paralyzed, and they do this, like free spine treatment. Is there anything that you could add to that, or something that’s new and innovative?

Dr. Ahmed Elghawy: I think I think the next or at least when I was in my train, the thing that everyone kind of talked about was regenerative medicine, you know, and we’re things like PRP and bone marrow aspirate concentration. I think that that’s kind of where the field is going to start to go is trying to do minimum, like, you know, try to avoid surgical procedures or supplant surgery with more regenerative medicine try to grow back cartilage tried to, to revascularize areas that a bit of, you know, notoriously been difficult to revascularize.

I do think that in the future, you know, it’s still a little early now. And I think the data is pretty sparse. Because the data is sparse, these treatments are not necessarily approved for everyone. So that was my reason.

Steve Washuta: that was my next question. It feels like what’s holding it up is the fact that insurance hasn’t sort of cleared ever want to do it. So you have to pay, you know, $8,000 out of pocket to get some stem shells shot in your knee and you’re like, Okay, well, the less people who do it, the obviously the less opportunity you have to make a decision on who you want to use. So it’s risky.

Dr. Ahmed Elghawy: But but the fault is on us as as practitioners because the ones who are doing research are not standardizing the formulas for these when they’re doing when they’re creating the research. You’ll have someone who does a PRP paper that says the hay period works great on the knee. The next person’s like, No, it doesn’t and these two completely different PRP formulations.

These studies are not being replicated in the ways that is convincing the FDA to say, Hey, listen, this sounds like a very viable option. So we will approve it and then that way insurance companies can get behind it. We’re kind of shooting ourselves in the foot, we really should be putting more resources and trying to standardize these therapies across the board. So that way, they do get approved because the data is promising. But then every once in a while, you get a paper that says, hey, PRP is no better than sailing, you know? Yeah. So

Steve Washuta: I’ve heard that too, before from somebody who I know who’s in sports medicine, who might or might not live in my house, that she has read papers before that said to as long as there’s some sort of liquid in there, there have been papers to say that, that there is an effect that could be a placebo effect. That’s not to say that other things don’t work better, but that there is some sort of effect. But I guess my next question is, is there like, nefarious reasons behind this, people want to keep their sort of compounds to themselves? Because they’re the ones who do it properly, or people just being lazy?

Dr. Ahmed Elghawy: I really don’t know, to be honest with you. I think, personally, I think the reason why PRP is not, I think why we’re not getting consistent results is one, we’re not standardizing the formula, but two, we probably aren’t using enough, we’re probably not taking enough product and putting it into that spot.

And so the concentrations probably too low to get to have a positive effect. Because when you talk to those who are doing the regenerate who are really big on regenerative medicine, that’s kind of their biggest critique of a lot of these studies is, hey, this is not enough PRP that you’re injecting into these areas. And so I don’t I’m not sure it’s, you know, is it is it somebody else who doesn’t want PRP to thrive or be Mac to thrive because it takes away their own business. I don’t know that that’s, that’s a little bit beyond me.

But I mean, I’ve used it on my patients, and they love it, I I’ve found much more success doing it than not. In fact, I actually had it done on myself when I was in medical school, I had it done on my ankle, and I rolled ankle really hard wrestling, I think it was I was a second-year medical student at the time.

This thing just lingered forever, and eventually ended up you know, I got a steroid injection that help the therapy didn’t help and then getting PRP. And, and, you know, I ran a marathon few years ago, though, I went from not being able to walk to running a marathon. And so anecdotally, I think it works great, you know, in my, in my own personal life, and in my patients that I’ve done it all. But we need bigger studies to show that this is a viable option. Otherwise, you’re gonna be spending 1000s of dollars out of pocket to get this done.

Steve Washuta: Yeah, and I’m sure there are so many variables, it’s difficult to write. So if you give me some sort of PRP injection in my knee, and then let’s say 100 other people, I might be more apt as a personal trainer, or someone who takes care of myself to make sure that I’m building up the quad muscle around my knee to you know, further expedite healing where someone else might just be sitting at their desk all day. And then we both come in at the end of the study. And they’re like, Well, it worked for Steve, it didn’t work for Cindy. It’s like, well, Cindy didn’t do anything this last six weeks to help it. So I think it’s it must be difficult to get these studies

Dr. Ahmed Elghawy: and all that but it’s it requires a lot of the patient to it because you do these PRP says What what are you doing with PRP is you’re you’re trying to restart the immune system, or you’re trying to re say, Hey, listen, we’re trying to kind of get the body to start repairing this area.

So the immune system needs to be restarted. To do that. If you’re taking if you’re putting ice on it, or you’re taking Advil or ibuprofen or Motrin, these things, you’re you’re basically undoing the PRP at that point. And so we have a lot of patients who will self medicate with these over-the-counter anti-inflammatories, and essentially ruin the product themselves. And they really shouldn’t be on it for weeks and weeks at a time. But that’s a long time to ask a patient not to do

Steve Washuta: that. Also, in these studies, as you know, self-reporting studies don’t work as well. Right? So unless you’re gonna lock the patient in a room for like, for four months, if they come back and self report, and they they’re in the doctor’s office, and the doctor is like, have you taken Tylenol in the last four weeks? Cuz you know, you weren’t supposed to? They’re like, of course I didn’t. And obviously, they’re gonna,

Dr. Ahmed Elghawy: they’re gonna be like, well, then we’re gonna ask them that question. Well, the doctor just want me to take this, I remember them telling me this. I’m just gonna stay at this one. And so, you know, for them. It did work now all of a sudden, it’s a negative study. So is that the case? Maybe we’re at that point. I think we’re kind of guessing. But I do think that there are problems with the way that we’re making these research projects.

Steve Washuta: There are more sports injuries than ever. We have more orthopedists, we have more people going to orthopedic and sports medicine doctors, we have more surgeries done and we have more medicine for those things. Why is that if our science is getting better if our health is supposed to be getting better, or why do we have more of these issues?

Dr. Ahmed Elghawy: Sure. I mean, I would say it’s hard to say I think that as we get better we know we’re the level of competition is getting better and better and better all the time. You know, we’re getting better at training. We’re also getting better at nutrition. Our athletes are performing at The highest level athletes now are performing at a much higher level than highest level highest level athletes were a decade ago, or before.

And so there’s a lot more, you know, the game, a lot of times the game has changed. And so we’re still learning how that happens, new rules that come out, are kind of changing the game as well, I would say it’s hard to say why if you go to a surgeon, a surgeon is gonna say they want to do surgery, that’s probably why you see more surgeon surgeries. In that case, I will say, in the last few years, I can kind of give a better idea as to why we’re having a lot more problems.

And I think part of is the pandemic, I think that we’re seeing a lot less competition, a lot more training, a lot more fatigue, but we’re also seeing a lot more D training as well. Okay, we’re having a lot more time off. And so we’re having a lot of patients who were normally very active developing a lot of, you know, stress fractures, a lot more concussions a lot more, just, you know, injuries in general, because they’re not performing at that level that they’re normally performing that they have a lot more downtime.

And so that’s, that can kind of explain the last few years, but it’s the generally why part of it could also be that we’re recording a lot better. You know, before, there probably were a lot of injuries that were not just not being reported, or people kind of, you know, playing through them, you know, whether it’s for, you know, their own financial gain, because they’re a professional athlete, it’s their livelihood, or it’s, it’s what, for whatever reason, but I think now that we’ve normalized that hate when you’re hurt, you’re hurt, and it’s okay to take time off.

Steve Washuta: That all makes perfect sense. And I you know, from personal trainer side, I just like to add sometimes, I think it, unfortunately, has a lot to do with the lifting styles and the modalities there are, is more more emphasis on lift as much weight as you possibly can. And if you’re an athlete, that doesn’t always benefit you, right, if you’re not a bodybuilder, you don’t always need to work in one plane of motion.

So even traditional exercises for football players like your deadlift, and your and your back squat and things of that nature, where you keep going up and up and up. Now we have players squatting 750 pounds, it’s like, well, I get your wide receiver, is that really necessary? No, you need to be explosive for it. So I think there’s a there’s also a sometimes an issue with training styles, muscles get obviously, the sort of synergistic dominance there we’re building too much posterior muscle not enough in the front.

We’re not We’re not loose enough. We’re not moving again, in all planes of motion, or you don’t have thoracic mobility, everyone’s too tight. And I think I think that’s gonna change because we have like the Tom Brady style of training. Now we see the Lebron James people who are not I mean, LeBron James is built like, like a god. But if you actually watch him sort of like take your shirt off, he’s not at like 678 percent body fat. He’s at like 10% body fat, right? 

Dr. Ahmed Elghawy: He’s He’s a healthy build. Yeah. And he clearly taking himself care of himself functionally more so than aesthetically.

Steve Washuta: Yes. And I think and I think there is a problem in our society. This is another whole conversation with people masquerading that they’re trying to work on their fitness, but they’re just trying to work on their vanity. And I think when that starts to come back, we start to see the Tom Brady’s and LeBron James be able to extend their physical prowess late into their 40s. Potentially, I think people will come back around and say, You know what, maybe I need to do more things involving full body rotation, let’s say and less me squatting 450 pounds when I’m 38 years old,

Dr. Ahmed Elghawy: agreed, agree. And I also I wonder, you know, you know, and I would love to get your opinion on this. But I also wonder if it’s the social media aspect of it, and everyone kind of, you know, show it like, you know, that showing it like, you know, doing a lot more fitness pages, or just in general, more people getting into fitness is maybe why we’re seeing more injuries, people who don’t, who normally wouldn’t be working out who start off right away, because they saw something on social media, you know, maybe they’re getting injured, or they’re getting wrong information, or they’re, they’re, they’re, they’re watching a video on Instagram that shows them how to do one, it’s completely wrong. You know, that’s, that’s where they’re getting their, their training education from, I wonder if any of that also is contributing to it?

Steve Washuta: I’m sure it is. I’m sure there’s, it’s unfortunate, but I’m sure there’s a lot of people who, again, there’s sort of this vanity Keeping Up with the Joneses thing going on. And you know, I have to also be able to do this and you see these people who are in the gym more focused on recording themselves than actually doing the exercise right before you know it.

There’s there’s an injury and, and I do think there is a there’s an addictive part to lifting heavy. Anyone who’s done it understands it, right, you get your one rep max or you put on heavyweight, you’re able to do it four or five times. There is a great feeling. And there is of course growth in the muscle from doing that. It’s important to be able to do that here and there. But it can’t be the only thing especially when you get to a certain age now when you’re 22. I think maybe this is also the problem. When you’re 22 you can pretty much do whatever you want, right? You can get away with it right? You can eat whatever you want, you can drink whatever you want, you can work out however you want, everything is benefiting you.

Then we cross that line and hormones change and whatever else happens. Before you know it, we have to be much more careful. I think people sometimes don’t change their both their dietary habits and their workout lifting habits in accordance with their age process. I think as we age, we need to be even more concerned and make sure that we’re doing things preemptively.

But also make sure that again, I keep, I can’t stress this enough, that we’re not just moving in one plane of motion, things can’t just be a sagittal plane, we can’t just be doing curls, and squats, we have to be able to move rotationally and focus on the spine and make sure you are you know, your sports medicine doctor, our hips and our shoulders, right? We’re ball and socket, how many people actually move their shoulders in a circle on a day to

Dr. Ahmed Elghawy: day that was all I see. Rheumatoid pay, or rheumatology patients or Sports Med patients, every patient that I see almost always has an issue with their shoulder or their hip. And it’s always it’s not even inside the joints always extra-articular it’s always rotator cuff, it’s always biceps tendon, it’s always glutes, it’s always Piriform. It’s always the musculature around that helps you move in lateral planes or in rotational planes, where they just don’t use those muscles in their everyday life.

And that’s an issue. And I think you make a great point about us kind of changing as we as we get a little bit older and the way we change in our lip, our lift, we should be better lifters, as we get older, like we should be like when it comes to lifting weights, you should be better at it at 30 than you were at 20. Now, if you’re doing it correctly, doesn’t mean you’re gonna be lifting more weights, you should be better at it, like your Google form should be better and that, your technique needs to grow as you grow.

Steve Washuta: Completely. Yeah, and I, it’s unfortunate, I don’t think that’s necessarily the case. Because if you’re only focused on the weight, and you’re not focused just on the technique, then then then that’s how the injury start. And I don’t know what it is we can do except continue to spread good information and hope people understand because I it, it pains me to see people get injured as they get older.

And I know that road to getting back, it’s so difficult to that’s another thing, right? When you’re 22 and you have a small injury, it’s nothing but even my friends in their mid 30s who tear the rotator cuff. And it’s just you know, three years later, they’re still not back in the gym, just because of all the things going on. It’s like, ah, you know, just this is, these are problems that I see in my clients and my friends and I try to pass this information on other people is not worth you sitting out for three or four years, make sure that you’re working whole body, well, we

Dr. Ahmed Elghawy: need to we need to get rid of the culture of push, just push past the pain all the time, you know, because that’s it. That’s an old-school culture. And growing up, as you know, I wrestled in high school I didn’t I didn’t really do much beyond that. But the wrestling culture in general and football culture is push through the pain, just get through it, suck it up, deal with it. And that’s the wrong approach.

When something hurts, that’s your body saying, hey, you need to back off for a minute. Because we’re getting close to hurting ourselves. When you’re at the gym, and you’re deadlifting. You feel it really filled in your back, did you put that down. Just step away from that bar. Maybe take some of the weight off and do it correctly. There’s you know, a lot of strength, in kind of doing that. I think that the worst thing you can do is to try to push through something that’s gonna hurt you in the long run.

Steve Washuta: This is a marathon, not a sprint, as they say the life of fitness. You’re not gonna, especially if you’re not competing for something, right? If you’re actually going up on stage, and you have, six weeks, and you’re a bodybuilder, I get it. That’s a different story. But if you’re the general population, which is the vast majority of people who are doing this, you’re, it’s not worth it. It’s just not it’s not worth injuring yourself and sending yourself out weeks,

Dr. Ahmed Elghawy: not every day has to be your best day in the gym all the time. There are some days where you should step back. Say, today, we’re only going to work on technique. Pay today, we’re going to go a little bit heavier, but not too heavy and do work. Every day, we’re gonna do something different. And we’re focusing on a different thing. Progress in the gym isn’t just pounds, it just isn’t just numbers. Sometimes it’s reps, sometimes it’s sets. Sometimes it’s purely breathing technique. If anything you walk away, everybody should walk away from gym having improved in something. But not everyday has to you don’t have to break a new personal record every single

Steve Washuta: day. I also think, you know, adding to what we’ve been saying. The gym doesn’t have to be the only modality in which you’re working out. I think that’s that’s a really big problem nowadays. It’s like, I used to have so many friend groups who are like, we’re in a basketball league, and we’re on a kickball league, we’re gonna play softball. There’s all these things going on. And now it’s like everybody is going to the gym only it’s only lifting it’s only picking up weights. I think, again, that’s what leads to what we’re just talking about. You’re not moving in all directions. You’re not challenging your body in different ways, and you’re not working the small muscles.

Dr. Ahmed Elghawy: Yeah, and the thing is, like, you know, you really should try to incorporate different things that are going to challenge you and give you a good workout but the gym you can only get so much from the gym, you know, do you know those? You know, I hate running.

I really don’t think its a for me. It’s a necessary evil, but I appreciate what what I get out of it. And so I go for a run several times a week. You know, when the pools are open, I try to swim when I can. Because it’s different enough from the gym, that I don’t feel like I’m getting stuck. Like you say, and kind of in one plane all the time, I’m moving my body in a different way.

Steve Washuta: That’s, you know, swimming is obviously, low to no impact. Which is good, too, right. You need to have some low impact exercises and test some high impact. And as we get older, we need to start limiting those high impact exercises. Going towards more low and no impact

Dr. Ahmed Elghawy: was really great. And if we are gonna do the high impact, we just need to do it smarter.

Steve Washuta: Yeah, yeah. So let’s talk a little bit. Sort of the last two months or so I’ve been talking to a lot of physicians. And so I’ve asked all of them these questions, so it’s not going to just be you. So I’m going to end with some like rapid fire stuff. But first, we’ll just throw to you. What is something that you would change in your industry? If you could, that you believe what would be more helpful for that patient or for you?

Dr. Ahmed Elghawy: Sure, I would, the accessibility I think is really difficult. Whether it is you know, try, you got to go get a referral to go see this person or to see this person, hey, we want to try this therapy, your insurance denies it, you know, it’s the accessibility that turns people away from from health care. And I think that that gets people frustrated with health care, you know, think about every time you’ve ever gone to the doctor, nobody goes to the doctor, because they, they’re happy that they’re going to the doctor, usually there’s a lizard going for an annual checkup you’re going in, because there’s something that that’s concerning you, there’s a lot of pressure there. There’s a lot of anxiety there that goes into that.

And so to add issues of finance, to add issues of prior authorizations not getting approved to add that, hey, you’ve been rejected for this medication, all that compounds and like already stressed out person. And so I think the accessibility is the part that I would change, I really think that we need to figure out a way, you know, I should not be arguing my case, to get an MRI and someone that I know needs an MRI, because an insurance company or businessman or lawyer says hey, the cheaper option is to do X ray and therapy first.

No, I think that this something is torn. I think we need to know the extent of this is surgical or not, you know, that we need to move on this quickly. Because the patients suffering, things like that, you know, I think that there’s there’s a lot of excess baggage in the middle that prevents everyone in the medical community from helping the patient the best they can. And so the patient suffers, the physician gets, you know, frustrated. And I think at the end, everybody loses.

Steve Washuta: Yeah, well, well said, You’re not the only one to, you probably put it the best so far. But a lot of people have echoed your thoughts. And I think that’s, it’s, it’s, it’s getting a little bit better, I hope, I think we’re moving in the right direction. I don’t think we’re moving in the wrong direction. But But it needs a lot of work. I don’t know the answers to this, I hope they come down the road. It’s really hard.

Dr. Ahmed Elghawy: And you know, I’m a little spoiled because I work at the Cleveland Clinic. And so you know, it’s a physician-run. Organization, they they’re really helpful things can get done a lot easier at the Cleveland Clinic than they can in most other places. And so when I hear about patients coming in to us for a second or third opinion, who have had a lot of problems, getting things done, it stinks, you know, some of these patients are coming from out of state or even out of the country for this care, because this is the easiest way for them to get care than it is to get in their own their own home.

Steve Washuta: Do they incentivize? And if not, why not? Physicians going from let’s say med school to residency to enter into particular residency spots that are needed. So for example, let’s say, child psychologists are needed in Cleveland, and there’s only one in all of Cleveland, you need more child psychologist? Are there other incentives for someone to do that? Or is that not the case?

Dr. Ahmed Elghawy: Um, in terms of a need based areas, there are some incentives, not necessarily for residencies, I think that that once you’re out of your training, they do incentivize some of us or some people in general to move to areas of higher need. And so in in needed places, the biggest incentive is that they’ll give you is that you spend by I think it’s like five years there. A lot of times they’ll forgive your student loans. Yeah. That’s the biggest incentive. I haven’t heard of any other incentives, in terms of, you know, of what else to do.

But I think I think what would be a pretty cool approach to training would be, hey, what kind of were you going to wear? Do you think you’re going to practice if you’re going to practice somewhere that’s rural, you should learn how to practice rural medicine in this area, like you should learn how to practice all the ways that you’re going to practice in the real world in an area that you’re going to, you know, help help influence when you don’t maybe don’t have as many resources or you may need to do more things on your own or you may need to do more travel medicine or what have you.

So that would be a I think that would be a good incentive it. You’d have to kind of know going into residency, you know, the type of environment that you’d want to practice, but I think that that will Be that’d be a pretty interesting way to train.

Steve Washuta: Yeah, I think so. And the reason why I asked the other question was because it’s almost too late at the point when you have these people already in residency, choose their program, and then go on what I mean is, let’s say there’s a number of someone sat down and said, We really need whatever it is 600 rheumatologist in America, right? I’m sure there’s a lot more than that.

But let’s just say that was the number, right? And you’re like, Okay, well, we currently have 600, but we have 100 retirings next year. So we really need 100 in programs right now in order to fill all the current spots. And I feel like if you don’t know that already in in the leading into residency, then you don’t have these people going into those programs and being folded into the positions that are necessary.

Dr. Ahmed Elghawy: And at no point do is that ever made clear to us when we’re in training? Um, you know, and I think that that’s actually really interesting. So that about rheumatology, because we’re at a massive shortage of rheumatologists because we are seeing a whole generation of rheumatologists retiring kind of at a similar time. We’re not producing enough rheumatologists to match that.

Part of that is just there’s not enough programs, and and not not enough, you know, fellowship spots to train these people. So the ideal thing would be that more programs would be opened and more fellows would be allowed to do that. Instead, we have a growing demand, but very limited spots and so the field becomes more and more competitive, and more people apply, but don’t get don’t get it.

Steve Washuta: Yeah, it’s an interesting issue that I see. Because there seems to be more specialists. But the specialist seems to be harder to get into. But because there’s more patients, that’s more patients,

Dr. Ahmed Elghawy: there’s so few, there’s so few specialists in general. And, you know, there’s, you know, it’s difficult, because I really do wish they would teach us that may be in medical school, like, Hey, what are the biggest needs in the medical community at this time? To kind of, you know, show us like, Hey, listen, if you’re interested in this specific thing, we really need more of them, you know, but to my knowledge, we don’t really have that.

Now, I imagine at some point that, you know, the ACGME, and all that there, I’m sure they’re well aware of from specialties and specialty, what is their need, and I’m sure that they’re trying to accommodate opening up more programs to match that. But it’s a it’s a, it’s a very big system, and things move very, very slowly. And so to get a program to open up takes it could take years for for a hospital to open up their own programming, any specialty. Yeah.

Steve Washuta: Oh, that makes sense. Let’s, let’s put us on a positive note here. Let’s I’m gonna, I’m gonna ask you a sports medicine question here. What are what are some injuries that you’re seeing? Maybe less of four that you think are not happening as much in the population? Sure.

Dr. Ahmed Elghawy: Um, I mean, in general, I will say that, overall, we’re seeing less concussion in the last like, few decades, I think it’s just better to focus on it now.

Steve Washuta: Right? Where’s the focus

Dr. Ahmed Elghawy: on it, we’re recognizing it a lot more. You know, there’s, there’s a whole movement like against, you know, developing CTE, I think a lot of people are really trying to make sure that that doesn’t happen. We’re, we’re formalizing testing that a lot better year after year, every few years, we’re to develop a new, you know, kind of whole modality of testing to make sure that people are okay, and we really stress really close follow up.

We’re very strict about limiting, you know, activity during a concussion. So I think that that’s, that is one thing that you’re really seeing a huge change in. Maybe if you look at the numbers, you might not see a huge difference. But that’s probably because it was just so underreported previously.

Steve Washuta: I mean, I remember getting multiple concussions throughout my high school and never actually having a diagnose concussion. But I mean, I would get up from a play, everything would be green. I would be puking the next night. So I mean, I know that it was concussion, right? So it’s just we that just like we talked about before the old school mentality play through it. Those sorts of things that with with concussion might have been more so than almost any other injury. At least with the ankle, they see you hobbling and they go, Well, he’s not as effective. Yeah, with the concussion, they don’t know. They can’t really pinpoint your lack of ability. So they just send you back in.

Dr. Ahmed Elghawy: Yeah, they’re just like these days, suck it up, go back in or snap out of it. That’s, that’s, that’s when we hear sometimes or, or, you know, that’s something we would hear when we were younger. The problem is that we don’t see those long term effects for a whole generation until they get older. They become debilitated from it. And I think we’re at the point now, where we are seeing the previous generation kind of started. We’re starting to see the CTE from the previous generation that wasn’t managed properly at that time. And again, it just wasn’t recognizable.

Steve Washuta: Yeah, I do think that football gets a bad rap for this. You know, if you look at things like skateboarding, or BMX thing, right, they’re falling sometimes from 20 feet off these halfpipe smacking their head on the ground. Boxers are getting hit, sometimes at times in a round, right. So you can multiply that by by 10. It’s we’re always looking at foot SCT but I do think that we’re going to start seeing it in athletes all over the board. 

Dr. Ahmed Elghawy: We see it a lot in soccer. We see the LaCrosse, lacrosse a lot. And so it’s it’s I think football has become the the flagship sport for for concussion. But concussions have improved in football. I think with real changes and avoiding head on head collisions and those type of things. It’s it’s improved, for sure. But yeah, I think I think we still got a while to go. I mean, we’ll see over time. If what we’ve done in the last few years has really influenced the next, few decades.

Steve Washuta: I can’t thank you enough for your time and joining the Trulyfit podcast. Is there anywhere where people can reach out to you directly? Whether they want to get more information on Sports, medicine and rheumatology or if they’re in the Cleveland area. They want to see you any information about you feel for sure.

Dr. Ahmed Elghawy: Sure. You can you can find me on Twitter at Ahmed Ali Al gaue. You can also find me on LinkedIn as well say under the same thing, Ahmed Ali, oh, Gary. I could also maybe even give you my number for the office. If anyone’s in the Cleveland area and wants to be formally formally seen. I can do that as well.

Steve Washuta: I will put LinkedIn and Twitter below when we release this. Thank you very much for joining through the podcast. 

Dr. Ahmed Elghawy: I appreciate it. Thank you for having me. 

Steve Washuta: Thanks for joining us on the Trulyfit podcast. Please subscribe, rate, and review on your listening platform. Feel free to email us as we’d love to hear from you.

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