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Dr. David

Hey, everyone, my name is Dr. David Middaugh. Welcome to the Stay Healthy El Paso Podcast. I've got a good friend of mine here, Tony Stafford. Tony Stafford is a client of ours. He came in for a little issue that people in their 20s and 30s tend to deal with, and it's a relatively quick problem to solve, and he's doing fantastic at this point.

He's nearly at the end of his care with us. But the reason I want to bring him in is because he's not in his 20s or 30s. He's actually in his mid-80s, 84 to be precise. He'll tell you more about himself in just a second here, but I wanted to bring him on because he's got some awesome advice on how to keep healthy into your 80s. So welcome onto the show, Tony. Tell us a bit about yourself. Tony, where are you from?

Tony Stafford

I'm from North Carolina, originally, little town outside of Charlotte called Belmont. I went to Wake Forest University and graduated in 1957. After I graduated from Wake Forest, I was drafted into the army and spent my first year in Fort Meade, Maryland. Then I was shipped to Fort Bliss, and that's how I ended up in El Paso. When I got here, I discovered that there was a little college here by the name of Texas Western college, so I checked it out and started taking some night classes at Texas Western college. And met a girl Of course, and when I got out of the army, I stayed in El Paso to finish my master's at Texas Western. After I got my master's from Texas Western, I went to LSU for my Doctorate, and I was not coming back to El Paso, but Texas Western called me and said, Hey, we'd love to have you as a doctoral candidate. So, I told my wife, I said, we'll go back there for about a year or two, till I finish my dissertation, then we'll be out of there. 55 years later, I'm still here because I love El Paso. I'm here by choice.

Dr. David

Fantastic. Yeah. So, you said there that you went through all this education. You ended up moving away from El Paso for a while to go to LSU, to do your doctorate. And would you mind sharing what your doctorate is in which are you studying?

Tony Stafford

Yeah, my specialty is English and American literature. My dissertation was on Shakespeare.  At University of Texas El Paso now I'm in the English department, and I teach a variety classes. My specialty is dramatic literature, and additionally, Shakespeare, a British playwright, American playwrights, but I can teach it all.

Dr. David

that's awesome. Sounds like you'd be a fun professor to have as a student.

Tony Stafford

I love teaching. I put a lot of energy into it, and It keeps you young.

Dr. David

Oh, yeah. And you can tell with your personality and disposition. Well, let's get into some of the health tips that I think that you've got, that our listeners need to hear. So, first off, just getting motivated is a big deal. So, for you what are two or three motivating factors for you to stay healthy?

Tony Stafford

Well, that's pretty easy. I hate being sick, and I love feeling healthy. So, to me that's a powerful motivating factor. I don't like being overweight. So, I like to watch my diet and workout and a little bit of vanity. I don't want to get fat and ugly, it I don't have to yet. But staying healthy is what's important to me, and I noticed it’s something you have to work at. It doesn't come free. The law of the universities says use it or lose it.

Dr. David

It's so true. I love that. That's fantastic that that motivates you. I know for me specifically. I don't want to have to get bigger clothes. I don't have to go up in the size of my pants or my shirts or anything like that.

Tony Stafford

It's called vanity also.

Dr. David

Yep. It's a bit of vanity for sure.

Tony Stafford

That is also about health.

Dr. David

Oh, yeah. You just feel tremendously better. A little bit of my whole story. I won't take much time at all, but I used to be very obese when I was a kid. I kind of grew up like that. But once I lost a lot of weight. I was stunned at how good I felt, and I never knew that I could feel like that, because I was so used to feeling the way that I felt when I was really overweight.

Tony Stafford

You just feel lethargic and low energy. And that's not a good feeling.

Dr. David

So, what have you tried and found that has not worked for you to keep healthy?

Tony Stafford

That's a hard question to answer because everything I've tried so far seems to be working. I tried bicycling, but then I discovered the streets of El Paso are rather dangerous. I had several friends who were killed on bicycle. Including Beto. O'Rourke's father who was killed on a bicycle. I tried swimming, swimming wasn't for me. But I played football in high school and junior college, and you have to run a lot to stay in shape. And I found out that I really enjoyed running just for the sake of it. But bicycling didn't work. Swimming didn't Work. And eating steaks and hamburgers didn't work. So, I had to eliminate those things.

Dr. David

So, does that mean that you're not eating meat right now? Are you eating chicken or fish? Or what's your diet look like, how is that contributing to your health?

Tony Stafford

Vegetarian all the way. I started off on this kick about three and a half years ago, and I was going to try to be vegan. That's very, very strict. And you can't have cheese which I love, and eggs which I have one egg a week. But so, I slipped back to the Fed classification of vegetarian but no poultry, no ham, and I love pork chops. But you know, when you get into a vegetarian diet, and you learn all kinds of delicious dishes, you discover after a while you don't really miss meat. I don't miss it at all. Not even tempted. A few bacon crumbles on my salad maybe when I go out to eat, but that's about it.

Dr. David

Wow. Yeah, that's fantastic. For me, I was a pretty heavy on meat, especially back when the Paleo Diet was a big kick, and I know a lot of people are on the keto diet. If you're listening right now and you're very carnivorous, or you're following one of these, paleo, keto, or there's a bunch of other diets out there. I think what Tony has developed, I've had other conversations with him about health and for myself too, is you kind of have to figure out what works best for you, and your genetics and your health. And maybe meat is a part of that.

Tony Stafford

I would say, if you're going to eat meat, you should have small pieces. Sparingly and of course, poultry is not as fattening, or doesn't contain as much fat as beef, or pork does. So that might be an alternative for some people. I know my son's a big Health Nut also, and they eat mostly Turkey, which is pretty close to almost no fat.

Dr. David

Yeah, it's pretty lean. Especially the breast. So just to sum it up there, you found that exercise wise, cycling was not your thing because of safety. Swimming didn't really take too,

Tony Stafford

even though I was a lifeguard when I was in college. I was a sinker. Swimming is very difficult. So, I gave up swimming. And I found my niche was running.

Dr. David

Yeah, we'll talk more about that right now on the next question. The other things that didn't work out for you too well was eating meat, especially you said pork and beef me. I'm glad that you found that out. For those of you listening I'm looking at Tony, I'm describing he's probably going to blush right now, but he said he's 84 but he does not look like a year pass 54. He looks fantastic. I mean if you look at his skin, he's got excellent color. I've worked on him, hands on wise, and he just feels sturdy and strong, not frail at all. Someone in their 80s it's not uncommon to see them as somebody that if you if you shove them or nudge them accidentally, they might fall over. Tony looks like he'll shove you and nudge you and knock you over. He's a tough, sturdy guy. He's in fantastic health so it's evident. That's why I wanted to bring him on the podcast today.

Tony Stafford

One of the essentials in life is good blood flow. Through your skin, through your muscles, for your heart, for your lunges for everything. Good blood flow. Lots of oxygen. I think that keeps you young.

Dr. David

Definitely, and mind wise, something that I think maybe you're picking up on is, Tony's a sharp guy and he's into reading, and keeping up to date with things. He's feeding his brain, exercising his brain quite a bit as well.

Tony Stafford

Crossword puzzles, I exercise my brain. The law of the universe use it or lose it.

Dr. David

Yep. Fantastic. So, let's go on to the next question here. Tony, what are three or more things, if you've got more, that you attribute to your current successful health?

Tony Stafford

Well, it may be a little repetitive, but I run every day. I'm in a phase out program right now. So, I'm not teaching this semester, so I have that luxury of being able to run every day. I may take one day off a week. But running is one of the secrets from me. I run pretty long distances anywhere from 30 to 50 minutes every time I go out, and I try to keep a pretty good pace.

I think running is absolutely in my life for me is essential. I love running and when I'm running, I'm breathing deeply and looking at the blue skies and just enjoying the exercise and feeling my body in good health, and it's that, in itself is very stimulating.

The running is one thing. The other course is the vegetarian diet. For me, that works very well, and I don't get into a medical history, but every time I have a checkup, I blow my doctor socks off because he can't believe my cholesterol and my heartbeat and all my vitals condition, they're in. Yeah, again, vigorous exercise, and then a healthy diet.

The other thing is attitude. A lot of people get 60 or so, and they go around talking about how old they are, and they make themselves old. I do not see myself as old. I see myself as young. Maybe that's kind of stupid on my part, but, but I think the brain has so much effect on the body. For me, we know the relationship between brain and body and having the right attitude, and a youthful attitude and enjoying things in life.

I am a scholar. But I'm not often the library all day long, doing research. I have a good balance in my life. I mean, I go to football games and basketball games, and dining with my lady friend, and just staying involved in life and enjoying good things, enjoying good movies, enjoying good play, enjoying good concerts. Those things. attitude is the third thing I would mention here. Running, diet, and attitude my summation for that.

Dr. David

That's super good. That's spot on. Just to highlight each point that you're saying there. With the running specifically, I love that you found that out for yourself, and for me as an expert physical therapist, and I will never forget one conversation I had with a woman. It's been two years now, who came in, she was in her 50s very petite shaped. In other words, she had a small waist, big hips and she was short. And she told me it's been on my bucket list to run a half marathon. Yet she was seeing me because her knee and her hip are killing her from running just a couple miles, and she's talking about she was having to ice her knee.

I had been working with her for a little while already, and I had been pushing her to do strength training. Now she did phenomenal. With the strength training, nothing hurt her. She was actually good at it, and she enjoyed it. So, I had this conversation with her. I said, “look, you're genetically built to lift weights like that. That's what your body is built to be good at, running a half marathon you're just not cut out for.” I think there's something to that. That's why you see, Kenyans and Ethiopians win the Boston Marathon, there's a certain body type that's built.

Tony Stafford

They're very small. UTEP has a number of Kenyans, and I see them around campus and they're tiny guys, they probably weigh 135 or 140, something like that.

Dr. David

They're lightweight and you're looking at your build, I could see why you would tolerate running as much as you do. Because I'm sure there's listeners out there saying oh my gosh, every time I run my knees kill me or my feet kill me or something hurts and, and so I would consider that you know, what have you done exercise wise that you've enjoyed that hasn't been harmful to you? And what have you done that has hurt and don't dismiss it as I'm not just I'm just not an Exercise person. It's not for me. There's got to be something out there something that you enjoy

Tony Stafford

Bicycle, a stationary bike or something like that. One of the questions I always get asked David is, well don't your joints hurt from running so much? Of course, I don't do marathons. That's beyond my scope. But I do run every day. Those distances I mentioned. Yeah, but people always ask me well don't your joints hurt. I've never had any joint problem. And the thing is, I think everybody should hear this.

First you want to buy very good shoes and make sure they're plenty cushion. And then I buy a couple of extra inserts in my soles so that my shoe has lots of padding in it because there is some pounding that takes place which I which jogging and running. But I think if you have that cushion there, I think it really eliminates the trauma to your joints that way. So, I would say make sure you have some good shoes and put extra Doctor Sholls inserts in for extra padding. That's what I do.

Dr. David

I agree hundred percent. I think investing in your footwear is a big deal. I've been running myself in the past, and I've noticed a difference when I the palest level running shoes versus the running store running shoes are the top brands. You definitely pay for what you get when it comes to running shoes.

The other point that you brought up, on the three things that that attribute to your health, was nutrition, your diet. I love how when I've heard you talk about your diet, it's very disciplined and you don't seem stressed out about it. You don't seem worried about it. I see some people that bring up how they wish they could have this food, or that food that they can't have because they're on their diet. But the resolve that I have seen you is incredible to me that this is just the way that they eat, I enjoy it.

Tony Stafford

This may be hard for a lot of people. They love food, which is very easily to understand, and some people can't do without food, and they can't get enough of it. That becomes the problems. I've tried to minimize the importance of food. I love vegetables, and I have fruits and nuts and vegetables and pastas, and all kinds of wonderful things with lots of good sauces and everything else. But I don't make food that I'm not living from meal to meal.

Some people are, and for some people is a recreation, and or pastime or a way to feed their own happiness. But you don't need to make food so important. Yes, it's vital, to be able to have the nourishment to live on, but you mustn't get it out of perspective as to just how the role it plays in your life. I have friends for whom food is extremely important. They spend all their time reading cookbooks and trimming up all these fantastic dishes. Can't quite go there. I have to be reading a good book.

Dr. David

I think that's connected to the third point, which is your attitude, your mindset towards your health and nutrition. I can tell you, my background, I grew up with food being probably the most important thing when it comes to get together,

Tony Stafford

My culture was the same way. I was a southern boy. And food is really important to Southerners. Fried chicken and all those things.

Dr. David

I've taken the angle of I just need sustenance, I need this to be good., and it needs to give me the energy that I need to make me feel good. I don't want to fall asleep because it had.

Tony Stafford

I think when you eat a little bit, you enjoy it more. When you reach the point where you're eating, you're already full and you just keep on eating, and it really gets to be painful and kind of nauseated.

Dr. David

I love that. Those are excellent health tips, and I think really foundational for everybody, it's awesome that you're doing that. Let's move on to the next question here. So what health advice do you have for listeners that are in their 30s 40s and 50s? The people that might be working right now, they might have a family to care for at home, because you were there at one point, it looks like you were just there.

Otherwise, I mean, age wise, they're busy, they're dealing with day to day constant things or they're spending the time working all day and so, finding time to exercise and cook and do all that stuff is stressful. What advice would you have for them?

Tony Stafford

Well, I know when you're young and you have a family, and lots of obligation, it is extremely difficult. I don't make light of that. My son is just turned 40 and he has three little ones. But he carves out time somehow. Even if he has to get up at 4:30 in the morning to go ride. He carves out a little bit of Time. If his wife ever complains, he says to her, would you rather be I'd be hanging out at bars.

I'm not preaching, and I sympathize with you when you have lots of obligations and a full-time job, and a family, and all those things going on. But you just have to set aside a little bit of time to take care of yourself. Otherwise you won't be around for your family very long. And I think if they know you're doing it for them, they'll appreciate it and be supportive.

I understand the challenge completely. My son has been known to jog in the middle of the night before dawn, all these times, yes, he's a marathoner. He is in a different category. He's got to be committed. He works out he lifts weights and everything. So, it can be done. It just takes a little bit of discipline.

First, make it important. Secondly, be determined that you're going to do this. And then considering your family's needs and their schedules, carve out a little time for yourself to do that. Otherwise family life will devour everything and that's important too. But you got to take care of yourself. Also, you won't be around for long for your family.

Dr. David

So true. Yeah, you're doing it for them. If I could put in my two cents, I'm currently in my 30s right now, and I've got three small children, and of course working and my wife's working and we're in the same boat. So, I'm like your son, I'm the guy waking up showing up at the gym at 4am 4:30 in the morning, trying to get 40 minutes of weightlifting in.

On Monday, I went for a run in the dark at about 4:30am as well. In certain spots where the streetlights were very good. I had my phone, so I flip on the flashlight. Yeah, I'm on a familiar path though, so I can know what to expect.

But just a concern that might come up for listeners out there that my wife deals with. Because I get home from my run and she says, Well, I'm glad you ran. I wish I could do that. I'm the lady and running at five o'clock in the morning, doesn't sound very appealing to me. Because you never know. The safety of all that stuff is questionable for a woman. And so, I completely get that.

Tony Stafford

I understand her frustration, because for my son is that his wife manages some city gyms. So, she's in the gym all day long, and she gets her workouts in while she's at work. And she’s teaching aerobics classes and all those things. They don't have much tension when it comes to that, but I can understand your wife’s frustration.

Dr. David

Oh, yeah. She manages though, we make it a point to get the kids to exercise as well. We bought a jogger. stroller and on the weekends, we'll all go run together and jog. Yeah, we'll go to the park, have the kids play in the park where we take turns running around.

Tony Stafford

There's nothing wrong with a nice good steady walk. You don't have to be running all the time, and you and your family can all walk with you. Just tell them keep up the pace a little bit. And they need the exercise also.

Dr. David

And one more piece that I think listeners will appreciate, is the idea of life ebbs and flows, but staying in your zone. So, for instance, the holidays might come around, the December holidays that everybody's on break. For me, my kids were off during that time. So, my schedules changed. I was comfortable with saying, you know what, I've worked out well enough. I can take a couple weeks off. Maybe get some workouts in, here and there with the kids. But as soon as life gets back to normal, the holidays are over, back on my schedule, and that's okay.

Tony Stafford

There's nothing wrong with taking a Break.

Dr. David

Yeah. So, taking breaks, I think is okay. The key is getting disciplined enough to come back onto the normal healthy schedule. So, we got one more question here before we're out of time. Now we talked about people in the 30s 40s and 50s. What health advice do you have for somebody in their 60s 70s 80s and beyond? Or somebody who was about to retire, maybe has already retired, and they're looking to stay healthy? What advice you have for them?

Tony Stafford

Of course, it depends on what their lifestyle has been like. Many people at that age are very sedentary. It's like, use it or lose it. If you just sit down, once you're retired or in your old age, because you're tired a lot, it gets worse. You have to force yourself to get out of the easy chair and out from in front of the TV set. And because you're following the line of least resistance just to plop down in a chair, have lots of snacks and watch TV. If you do that every day, you're not going to last long.

Staying active is really important. If someone can't start off running and that kind of thing. But you can take walks, and I would say, also have interests in addition to the physical and the dietary considerations that we talked about attitude, but also have some interest. I read every day. I of course, I'm an English professor. So, I love writing, and just finished my third novel. But go to art galleries, go to concerts, find a really interesting hobby, something that you're good at. All of us have a special talent. And many times, we follow our economic needs and go into jobs and whatever because we have to, but at some point, you have to ask yourself, what do I really enjoy doing? What am I kind of good at got a knack for?

People's hobbies often bring them a lot of satisfaction. So, having interest and getting out of the house, going to movies, plays, concerts, that kind of thing. But having interest is important for people. I mean, I've seen people have the attitude, oh, I'm this age and I'm no damn good anymore and I'm worthless and, and they just make it worse for themselves by just kind of resigning and not having a positive attitude.

I sound like Norman Vincent Peale, but as we said before, the relationship between the mind and the body is a powerful one. The mind can affect incredibly powerfully the body. Having interest and having a good attitude, and having some activity, it doesn't have to be running.

That's what I would say to people, you have to start off very slowly. It should be something you look forward to every day. When you are getting out of bed in the morning, what is it in your day that you're really looking forward to? And I've known people who just said, I'm not looking forward to anything. And I don't care if I die now or not. I'm like, Hey, man, there's a lot to be lived yet. And so just enjoy the sunshine and the rain and everything, just enjoy life. That would be my advice. Not that I'm a counselor or anything. I'm just speaking from my own experience.

Dr. David

I love it. I hear, throughout the past year even, we've had clients that are older, and we've seen them lose a spouse who's relatively devastating. Talking with him through that and being able to see how they cope with it and then realize their purpose in life beyond where they're at, and beyond losing the spouse has been amazing.

For me personally, as a youngster, relative to somebody at that age, I look at you and how I learned a lot from you, and I see it as I have so much to learn from all these people that are older than me. So, I need them in my life. And I think it's important for somebody who's getting older in their years to realize how they can contribute to the generations.

Tony Stafford

Go to senior citizens cities, centers, meet somebody new. Don’t give up!

Dr. David

Yeah.

Tony Stafford

So, I would say that … where was I going with this…. I told you the story before. My mother had a sister, my aunt Ruby, and she was married to my father's cousin, Uncle Brady, and they worked very hard all their lives. They made a decent amount of money, had real estate holdings, and so they were comfortable. But when they retired, they stayed in bed all day. They ate in bed, they read the newspaper in bed, they watch TV in bed, and I'm telling you within a year's time, they totally deteriorate. Both of them became very senile and demented. Why? Because they just weren't using their body and their mind anymore. Now, and I just watched it. I was flabbergasted to see how quickly they deteriorated from just doing nothing. So, you don't want to stay in bed all day. You want to have activities and that kind of thing.

Dr. David

Yeah, great advice. This has been a wonderful bit of advice. I think our listeners are going to benefit a lot from this. Thank you so much, Tony. Appreciate it.

Tony Stafford

My pleasure

Dr. David

Well, guys, for those of you listening, if you want to hear more podcasts, you can visit the website, www.stayhealthyelpaso.com, please subscribe to our podcast on the platform that you're listening on, whether it's Apple or Google or Android, any of you were on all the platforms, just so that you can get updates about future podcasts coming out. And I hope that you are staying healthy out there. So, have a wonderful day. Bye bye.

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Dr. David

Hey there. I'm Dr. David, welcome to the show. I've got a great guest here, friend of mine. His name is Dr. Angel Garcia. He's a physician here in El Paso, sports medicine specialist. One of the best in the southwest. Certainly, the best in El Paso and I let him tell you more about all that. But I just want to welcome you to the show. Thank you for listening, and welcome on here. Dr. Garcia. How are you?

Dr. Garcia

Good. Thanks for having me.

Dr. David

Yeah, absolutely. We sure appreciate it.

Dr. Garcia

So, my name is Angel Garcia, was born in Puerto Rico moved to El Paso when I was about five years old. Been here since then. Went to Bel Air High School, part of the health magnet there, first graduating class. After Bel Air, went to Baylor for my undergrad, got my degree in psychology. And then from there I went to San Antonio for Med School, Medical University of Texas Health Science Center, San Antonio for medical school.

Graduated there, came back home for residency at Texas Tech in Family Medicine, and then after completing the residency in family medicine, stayed at Texas Tech for a fellowship in sports medicine, to better serve the patient population that I was interested in treating.

What drew me to family medicine was more of the… being able to see the whole family, treating the whole family, but I really love the musculoskeletal system working with athletes, and dealing with those type of issues and trying to provide a different perspective then what was provided by surgeons.

Not that, you know, surgery has its place, but for the vast majority of problems can be solved without surgery. And I was wanting to be able to help my patients more. So, I decided to do the sports medicine fellowship at Texas Tech.

Dr. David

That's awesome. Were you one of the first classes there at Texas Tech because they are pretty new?

Dr. Garcia

For sports medicine. We were the first class for sports medicine at Texas Tech. They had, you know, different program throughout the state. But my wife and I really want to stay here in El Paso with family.

Dr. David

Cool, cool, awesome. I love El Paso. So, you've got your own company here and let's just where we're at right now we're recording from Dr. Garcia's office. So, tell me about your company, what's the name and where's it at?

Dr. Garcia

So, yeah, when I left residency and fellowship, I really wanted to just kind of go out on my own, you know, not working for the man. So, we opened up a clinic El Paso Center for Family Sports Medicine. Initially we were at another location on Lee Trevino. But we recently just moved, we got a new building, trying to expand our services. So now we're on George Dieter and physicians, right next to diagnostic outpatient imaging and across the street from foundations hospital. So, it's a pretty cool location. So far, people are really liking the new building.

Dr. David

I know, I just got a tour when I walked in and is swanky looking. I mean I think of just modern. The floors are just beautiful, everything is, it smells like that new car smell.

Dr. Garcia

Still breaking it in, still moving in. But slowly but surely. Yeah.

Dr. David

So, I don’t know if you mentioned, but when did you start your practice?

Dr. Garcia

So, we've been in practice, I’ve been in practice for about seven years now, outside of residency and fellowship, but if you take that into account that has been about 10 years.

Dr. David

Nice, awesome. And then you mentioned that you did the fellowship and the residency and all that. Just so that people understand the difference, because I don't think the general population understands. I think they think you go to medical school, you become a physician, and residency and fellowship kind of just loses meaning after that. Could you explain a little bit more about what that means?

Dr. Garcia

So medical school, everyone kind of receives like the same kind of groundwork knowledge for general medicine. Then you had to start picking what specialty you're wanting to go into. So, whether you want to do dermatology, ophthalmology, or you know disorders of the eye, or if you want to focus on skin, if you want to become a surgeon, if you want to become a heart specialist, then those require more training than just what's in medical school.

Once you graduate medical school, you can become a general practitioner, but you're not necessarily a specialist of in of any sort. So, OBGYN had to do a residency in OBGYN. Cardiologists have to go to fellowship to study the specifics of the heart. So, after medical school, you have this kind of groundwork that you have to build on, and then depending on what specialty you're wanting to do, that's the fellowship or residency that you go into. Residencies can vary from three to seven years. Family Medicine is a three-year residency. Most of the primary care residency are two years. So, pediatrics is also three years, psychiatrists two years the surgical subspecialties can be anywhere from four to five years.

Dr. David

So, what's the difference between a residency and a fellowship?

Dr. Garcia

So, residency is your primary specialty, so internal medicine, psychiatry, pediatrics, family medicine.  Fellowship is when you want to take an aspect of that, and sub specialize. So, you get further training in the heart. Your further training in the GI tract. You get special training and different surgical procedures.

In my case, we got more training in the muscle skeletal system, more common sports type injuries, management of those injuries. Just dealing in more specifics on a smaller area, that you can become more specialized in, as opposed to this broad topic of, Family Medicine, where you have tons of medical elements that you study. The fellowship focuses on one of those, and you go into that a lot more in depth.

Dr. David

So, you're, that's like super specialist. My understanding is, it's like the most specialized that you can get in a specific body area or subject within the medical field.

Dr. Garcia

Right. And that's where the fellowship comes in. Some people will do multiple fellowships to get specialize in very minutiae. So, like the eye doctor can become a specialist of the retina. So, there are different things like that. Orthopedic surgeons who will become specialists in just the hand. So, that's the point of fellowship. It is just to focus on one or two areas and expand your knowledge on that as supposed to just kind of generally brush.

Dr. David

So, we are going to get into our topic of the day, one of the favorite things for you to talk about is shoulder problems. And, you know, it's definitely a commonly injured body part for people in sports. So, tell us about shoulder problems, what got you interested in that?

Dr. Garcia

So, it's basically what got me interested in sports medicine in general is just trying to deal with, you know, common ailments that athletes, and I use the term athlete loosely, you know, you don't have to be a professional athlete or anything like that to have shoulder pain.

Dr. David

Be like a weekend warrior.

Dr. Garcia

Weekend warrior, you know, or even just recreational. Just dealing with aches that I myself had, you know, I had a shoulder injury a few years back when I fell and dislocated my shoulder. You never realize how important the body part is until it hurts. So, helping people deal with shoulder issues is something that I enjoy just as my general sports medicine practice and trying to provide a non-invasive or non-surgical approach to something that can be pretty debilitating. And try to approach it from a vantage point that is just not isolated to the shoulder, but like the whole body in general.

Sometimes people will have neck pain that presents in the shoulder. Or they could have the elbow that is the cause of their shoulder pain. So, it's not just the shoulder that you have to look at. You have to look at the whole individual. And sometimes when you go to, you know, other specialists and tell them you have shoulder pain, they don't necessarily evaluate the other things that could be masking as shoulder pain, and people go undiagnosed, or misdiagnosed for several years. So that's one of the things of why I was wanting to get into that so that I can help patients get to the right diagnosis. And the right treatment sooner.

Dr. David

Yeah. That's awesome. That's so cool. And so, how long have you been focusing on people with shoulder problems? I mean, was that been your whole career pretty much it was an after the fellowship more so?

Dr. Garcia

More so after the fellowship. I didn't do as much during my family medicine residency. But the little I did do was what sparked my interest to do the fellowship. So, in my fellowship, and then the time since then, so for the past seven, eight years, have been really, really focusing on shoulder issues.

Dr. David

Now you said that you help people out with avoiding surgery or alternatives to surgery more. So is what he said. What are some of the common problems with shoulders that you see like some of the more specific diagnoses?

Dr. Garcia

So, the most common would be, you know, rotator cuff injuries. That's, that's kind of a catch all phrase, sometimes, but that's, you know, definitely the most common shoulder problem that that we see. And rotator cuff issues don't necessarily have to be caused by any, you know, real significant injury or trauma. Someone could just reach for something really quickly or, awkwardly rotate their arm a certain way and they develop inflammation of the rotator cuff or a sprain.

Not all rotator cuff issues are necessarily tearing that require surgery, a lot of times it's a muscle strain or inflammation of a muscle that just needs the right type of treatment. Most of the time that treatment consists a lot of going someone like you and getting physical therapy.

Sometimes, when I tell my patients it's a simple fix, but it's not a quick fix. The exercises aren't very elaborate, you don't have to have a lot of weights or a fancy gym because people always say, “Well, I don't have time to go to the gym.” Well, you don’t have to go to the gym, you can learn about some of these exercises, you can just use your door jamb for exercising the muscles of the rotator cuff. But the key is arriving at that right diagnosis. So that the appropriate treatment can be applied.

Dr. David

And one of the other diagnoses that I commonly see, related to rotator cuff tears, and the way that I look at the body, it's more of a spectrum and on the lower end of the spectrum of rotator cuff tears like the extreme end, on the other end would be like nerve impingement. So, there's something wrong with the ball and socket joint. Do you get a lot of those people as well?

Dr. Garcia

Yeah, it's definitely a spectrum. It's the impingement, I think, is one of the more overlooked. And the reason why is because, a lot of the studies that we use, or a lot of the diagnostic studies that people use nowadays, don't involve, unfortunately, the physical exam.

So, x-ray, a lot of people will focus on X-ray when people have shoulder pain and like, “Whoa, you have nothing.” Meaning that yeah, there's not a break. You may have a little bit of arthritis, but the X-ray is normal. Until the patient's like, “Well, why do I have this pain?”

Well, one you know, muscle doesn't show up on X ray. Second, test that is commonly used is the MRI. The MRI is great for looking at tears. It's great for looking at signs of inflammation. Maybe some calcifications in the tendon that cause irritation. But it doesn't allow for you to examine the muscle in movement. And impingement is one of those things where movement is what triggers the symptoms.

So yeah, the MRI may come back negative, because impingement you're holding still in an MRI, you can't move. So, there's no way to, appropriately diagnose impingement using MRI. So, impingement is more of a clinical diagnosis in terms of certain exams that you do within the visit that trigger that symptom.

That's one of the things that, sports medicine specialists learn in fellowship are those provocative tests to elicit that symptom, that can't necessarily be visualized with the most common modalities that we have.

Dr. David

Yeah, that's exactly I wanted to ask you next is, what are you doing? You specifically as a sports medicine shoulder specialist, what are you doing that's different than, say a general doctor, like what kind of knowledge, or hands on test do you do that they wouldn't necessarily know to do?

Dr. Garcia

In family medicine, when I was doing my residency. The basic exam that I got was, do they have full range of motion of the shoulder, or are they tender to a particular spot. For impingement, and other shoulder issues, there's a slew of tests that can be done to test the rotator cuff.

There's one is called the job's maneuver where you know, you're putting pressure on the arm and external rotation pushing kind of up towards your head. The other one that's called for impingement is the nearest test so you kind of put your thumb facing down and then you kind of elevate your arm close to your ears. So near to the ear.

Hopkins test is another test that checks for impingement where it's kind of like you hold your arm out in front of you, bend your elbow and just kind of rotate your arm down towards the floor, as you move across your body.

So, there's different tests that specialists have been trained to do that that weren't part of my, my residency training. And a lot of times you got to use multiple tests to isolate the issue, because the longer an issue goes on, other muscles start to get affected, they start to ache and can give you a false positive on some test and kind of lead you to another direction when it's all coming from the impingement.

It's just that it's gone on for so long that the other muscles around it are irritated because they're having to pick up the slack. So, it's a combination of all those tests. Sometimes I'll do an ultrasound. So that's one of the few, or I think the only one, that you can actually visualize the impingement because you're actually visualizing the muscle and then you move the joint, and then you can see the impingement on ultrasound. So that's, that's another modality that we can use.

Dr. David

Wow. That's awesome. What type of symptoms should people be looking for when they have a shoulder problem? When should they decide to come and see you versus waiting and seeing if it'll pass?

Dr. Garcia

That's a great question because you know, everyone's going to have aches and pains. It's part of life. You tweak muscles here and there. When it starts affecting your activities of daily living, if you're having trouble getting dressed, or putting on your shirt, women having issues striking the bra, reaching for a cup in the cupboards, or doorknobs.

When it's affecting your activities of daily living, and the symptoms have been going on for about a week or two. Most muscle strains heal within a week or two timeframes. But if it's severe pain, if it's pain that's keeping you up at night. If there's any significant weakness or neurological issues, numbness, tingling, burning, then I would definitely come in sooner.

But if it's just a pain to the shoulder, without significant reduction in your daily living, you know that 7 to 10-day window is usually good enough for most muscle strains to kind of go away. But if it's persisting past that, that definitely seeing someone would be beneficial.

Dr. David

Yeah, one of the common ones that I hear about all the time is picking up the full pot of coffee, to pour their coffee people always say “Gosh, that kills me every morning! That’s how I know my problem still hasn't gone away!”

Dr. Garcia

It could be something as simple as that. I've had one person that couldn't get their toothpaste on because they would have to reach up into the medicine cabinet to get it. Just that motion of moving their arm up the few degrees was killer.

Dr. David

Oh, cooking is another one, like chopping up a lot of vegetables or you know, whatever it is they're chopping, that force repetitive, I hear a lot of people complain about that.

Dr. Garcia

Yeah, that too. The people who are able to enjoy their golf, they are finely attuned to when their swing goes awry because of the shoulders bothering them.

Dr. David

Yep. And in the sports world, people lifting weights, all the time run into shoulder problems. Especially with like doing overhead exercises or anything with any shoulder specific exercises. Bench-press, I hear about all the time.

Dr. Garcia

So, for people who are who are on the more athletic side, do more performance. Being akin to your body is key. If there's a gradual loss of weakness on one side to the other, that wasn't there before. In someone who trains a lot needs to be dealt with soon, because those slight weaknesses can actually be a sign of pre-significant muscle damage and someone who's very well built.

So, someone who has that, or notices that you should be seen pretty quickly. For those who are wanting to work out form is key. You can be doing the right exercise, but if your form is not right, you are going to hurt yourself.

Dr. David

I see that all the time. I agree 100%. So, do you have any other helpful information that you want to share with people in El Paso about shoulder problems, that they may not otherwise know? Like, it's not common knowledge or something that unique that you end up telling patients a lot.

Dr. Garcia

What I tell patients in particularly, because I'm a huge believer in diet and exercise. And a lot of people think that one day they have to go to the gym or have a lot of fancy equipment to do the exercises. But in terms of the shoulder, they are very basic, simple exercises that for the actual intrinsic rotator cuff muscles don't require a whole lot of heavy weights or machines. It's, it's mostly a lot of range of motion and an appropriate range of motion.

Just because you go to the, and I get this a lot for people when I try to refer them for physical therapy is like, “Why, I go to the gym three, four times a day. I'm already doing exercise.” Yeah, you're doing exercises but you're doing exercises one for more of a general kind of well-being of the body, and usually more geared towards muscle building or muscle toning.

The exercises for shoulder injury, or any musculoskeletal injury are more geared to taking away the inflammation, or muscle strain from the smaller intrinsic muscles that oftentimes get overlooked when you're going to the gym.  Curling or bench pressing, that are focused more on the larger muscle groups.

Physical Therapy is something that focuses on the intrinsic muscles, that helps stabilize the joints better, that don't necessarily make you look, it doesn't add to the curb appeal. But it just helps mitigate the pain by assuring more proper alignment of the muscles and joints.

Dr. David

Yeah. I always have people that, whenever I talk to them about working on their rotator cuff muscle, I tell them this, you'll feel somewhat of a burn but it's not going to be like if you go work out your biceps are triceps, and then you never going to have the muscle burn where you look in the mirror and flex and rise like, look at this rotator cuff back here. It's just popping out like that.

Dr. Garcia

Because people go to the gym to focus on muscle building or improving their physique. The exercises for rotator cuff, the emphasis is not on improving the physique. It's on improving your pain, which will down the line allow you to improve your physique by letting you do the exercises that you're more wanting to do. But these exercises are needed to help prevent injury when you're doing those other more strenuous, heavy lifting exercises.

Dr. David

For the rotator cuff muscles, just to talk about that a little bit because that's a super common problem area for a lot of shoulder problems. There's four of them. We don't have to go to the names you can certainly Google them, but they all pull in different directions. They help to connect the ball on to the socket in the shoulder joint. And so, as a physical therapist, finding the exact direction in motion, that is the weakness or that is the main problem area or knowing which rotator cuff tendon is injured is also part of the problem. When we talk about doing shoulder exercises, rotator cuff exercises, it's not always like the same one that's going to help every person.

Dr. Garcia

Right? Because with their being the four major muscles that make up the rotator cuff, not everyone's going to be injured in the same muscle. And like you said, each muscle has their own action. One of the muscles rotate your arm outside, and another one rotate inside, another one lifted above your head. And then depending on what degree you're in, multiple muscles are working at the same time to give you that same benefit.

So that's what we talked about, when we talked about what exams to do for shoulder pain. Evaluation is trying to isolate that muscle in a particular movement or test that elicits that symptom.

The same exercises don't work for everybody, because not everybody injures the same rotator cuff muscle. Even though we dump it in the catch all phrase of rotator cuff injury. But rotator cuff injury can be a slew of different things. Because there are the four major muscles and then you have all those other smaller intrinsic muscles or ligaments that that can be injured.

Dr. David

Biceps tendon, I always hear about that.

Dr. Garcia

I see that bicep tendon is pretty common. You got ligaments that are combined but hold the humerus, and the shoulder together, are really small ligaments that that can be a cause of posterior shoulder pain, or pain on the backside of the shoulder that aren't necessarily muscle related. It's a ligament that attaches or holds two joints together. So yeah, every rotator cuff injury is different and therefore needs a different set of exercises to work through.

Dr. Garcia

Yeah, yeah. Cool. Well, this has been great. Talk about the shoulder today. So, do you have anything else that you think you want to share with El Pasoans about shoulder problems, or your company, or just in general about anything else you help us with?

Dr. Garcia

So, I mean, we're here, like I said, on the corner of Georgia Dieter and Physicians 11851 Physicians Dr. to help you with any sports medicine or musculoskeletal injuries. We also offer a vast array of other things, to general found medicine issues. So, we see anywhere from kids to adults.

For people who do a lot of working out trying to lose weight. We offer a weight management, education and help with weight management in terms of medication and diet, nutrition counseling.  For people who have problem areas that they want to get rid of love handles or things like that. We have some aesthetic procedures that we offer SculpSure is a non-invasive way to lose the fat in those problem areas that aren't responding to diet and exercise.

It's not a substitute for diet and exercise. It's just for people who had those polar bears that they just can't get rid of that we can give you that added assistance with the with the SculpSure.

Dr. David

Amen to the problem areas. I know very well about that. Well cool. So, if someone El Paso wants to learn more about your clinic, Dr. Garcia, or even maybe make an appointment. What's the best way for them to get in touch with you?

Dr. Garcia

They can call us here at the clinic, 915-493-6646. We have a Facebook page and they can just search El Paso Center For Family Sports Medicine. They can reach out to us on our website, and they can actually book through our website at www.elpasocenterfamilyandsportsmed.com. There's a link there that you can actually book online if for whatever reason you're trying to book an appointment after hours or over the weekend. So those are the main ways to get a hold of us.

Dr. David

Awesome! Great information today. Thank you so much for taking the time to talk with us really appreciate it. I think El Pasoans are going to benefit from this, time and time again as this podcast is available.

The show is available on Anchor | Spotify | iTunes | Google Podcast | and others...

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Dr. David

Hey there El Paso! Welcome to the show. Thank you so much for joining us. I've got an awesome interview lined up for you today. My name again is Dr. David Middaugh, physical therapists. I'm the owner of El Paso Manual Physical Therapy. And I've got Julio Alcalá with me. Julio is the owner of XR imaging.

I've known him for years now. He's fantastic at what he does, probably one of the best around. He is an expert, X-ray technologists. He's got 16 years of experience. And I'll let him tell you more about all the stuff that he does and where he went to school and all that. But just before we get on the show, we're going to focus on our topic today, what Julio is really going to talking about his osteoporosis, and I'll let him go into the definition of it and in a related condition called osteopenia, and he'll tell you some interesting facts about those conditions.

But if you've got osteoporosis, or osteopenia, you definitely want to tune in to every word that Julio has to say. You might even want to give him a call, and work with him so that you can help fix that problem. Which is very fixable. A lot of people don't think that it is. Even in the medical field, they think that you're going to have it for the rest of your life, but that's just not the case. You can improve if you do the right things and get the right kind of help. So without any more pauses here. Let's talk to Julio, so Julio, welcome to the show.

Julio Alcalá

Thank you. Thank you, David. Thank you for inviting me. I'm glad to be here on your show and ready to share nice and valuable information with your listeners here.

Dr. David

Awesome. I'm glad to have you. Well, let's start by getting to know you a little bit better. I know you decently well, but let's hear about where you're from, and where you went to school. How did you get into this field?

Julio Alcalá

Well, a little bit of a story about myself. I always say they brought me here to the states, right? I was a teenager I came to El Paso when I was 14 years old, and I went to Eastwood High School. So for those listeners out there, you know that are troopers. Once a trooper always a trooper, that's what they say back then, in Eastwood?

Then after that I went to EPCC, and I enrolled in the X-ray program at a EPCC. Throwing a little commercial there. But very intense and very high level of training, that they have those guys there on the EPCC. So I became an X-ray technologist back in 2003. And I started working in our local places here, in different hospitals and clinics. Back in 2009, I decided to further my education in radiology. So, I went and got my bachelor's degree in radiology science.

I had the intention to become a radiologist assistant, but then I finished my bachelor's degree and, you know, life happens. So then now I find myself owning an imaging center and providing X-ray services for the community here in El Paso. So that's how I how evolved here in this nice community.

Dr. David

Yeah, El Paso is a nice place. Well, tell us more about your company XR Imaging. Can you tell us where it's at and give us more information about it, please?

Julio Alcalá

Yeah, XR Imaging. It's a diagnostic imaging center, it's located in the east side of El Paso. What we do there is, that we primarily offer very affordable and quality X-ray services, ultrasound services, and bone density scans as well.

So we are primarily targeting those individuals that are tired of the conventional diagnostic services, right? Where you go there and you're dealing with insurances, they give you an appointment, per se 10 in the morning, you get seen at 11 in the morning, so you're there in a large waiting area and wait. Maybe listening to other people's stories and whatnot right.

But anyway, so, we provide X-ray services, ultrasounds, bone densities, and we are trying to improve the patient care and patient satisfaction by offering all of our clients and patients a one-to-one interaction with a technologist, and no waiting time.

We're very good on the time that we tell you that you're going to be seen. That's when you get seen. It's a nice comfortable setting. And we offer pretty much every diagnostic will do, right? Data quality and fast results to your providers.

Dr. David

Very nice. Awesome. And what's something that's particularly unique about your company?

Julio Alcalá

What is unique about XR Imaging is that we do we do offer that one-to-one interaction with patients. So the moment that you get there, you are going to be greeted nicely. We value your time, we know that for most individuals, they're taking time off from work, they have family to attend to. So we welcome you nicely. We take care of you on time, and one other very important aspect of our practices is that we like to educate patients.

You're not going to be one more number, one more patient, were you go there, and we take a picture and then you're out. We are going to take the time to do a very quality study, show you, and educate you through the images.

Now, we don't diagnose there, because that's not our job. That's the doctor's job. But we are very good at showing you the images and identifying different aspects of your anatomy. If you have any questions regarding areas where it hurts the most, or you have concerns about, we will show you that we are getting a quality picture of the area, making sure that the study is going to be complete for the radiologist to do a very precise diagnosis.

We do take that time per patient, and we allocated this time, or playing with logistics, to make sure that we don't go on and make this a long, long, long visit. It's effective timing. Educational timing in a nice comfortable setting.

Dr. David

That's awesome. So you actually get to show your clients their images, or whatever it is that they're getting scanned by you?

Julio Alcalá

Yes definitely. So, we work with digital imaging. So, the moment that I take an X-ray the moment that Deseret does the ultrasound, the images are there in a digital format. So we show them to you. Also with these two processes, screenings, the moment that I finished scanning the lumbar spine, the hip, the image is there available for you to see, if you require, or you want to have records of these images.

After the radiologist has the data and completed report, we can gladly provide up either a PDF file, or just a digital format. We can burn a CD you can take your images with you. The patient has access to see their images at any given point.

Dr. David

That's really cool because I knew, as a physical therapist, we get people here in the office all the time, that they had x-rays, or an MRI, or whatever imaging done, and they've never seen them before. They just didn't. Nobody showed it to them. They saw the doctor, but the doctor just told them, hey, you have arthritis, or you have this whatever problem it is. But there's something about that individual just being able to see all the imaging and all the stuff that was done. Because if they can, then they have a visualization for what's going on with their problem, why they have their issue, that's really cool that you give them that opportunity.

Julio Alcalá

And then to elaborate a little bit more, it's a very touchy subject, because in school we are taught not to, obviously as x-ray technologist, we are not be able to, or we should not be telling them what the patient has. Like diagnosing the person. That's the doctor's job.

But most technologists are afraid to show the images to the patient because the patient's will then ask that question, what do I have? Do I have a fracture, or have these conditiones or whatever pathology it is. But what we do is that we want to educate you. So we can show you the picture. And if there's any specific area that you're concerned, we will illustrate this area to you. So that when you go to your doctor, and you have questions for your doctor. You can say I got to see the X rays, and I thought, I saw this area right here. Did you see the same tingling on the images?

Because most doctors will get a radiologist report, and then tell you essentially what he saw on the paper, without even seeing the pictures. So then by the patient, being educated, and having those questions to the doctor, you just improve patient care. I mean, we're just humans the doctor can make a mistake as well. I know that a lot of doctors out they don't accept that, but we're just humans. But it's also the patient's responsibility to ask questions that pertain challenge that diagnosis and ask why. And then seek for other alternatives of course, right?

Dr. David

So that they are in a better position to win so that when they get to the doctor's visit, they're better educated about it, and they can ask better questions. That's awesome. That's so cool, powerful stuff. Let's get into talking about osteoporosis. So what got you interested in osteoporosis?

Julio Alcalá

Well, it's one of these conditions that presents no symptoms. So truly, there is a, well, let me throw this statistic out there, one third of the female population here in the United States, that's one out of three, right? Females over the age of 50 will suffer or will develop osteoporosis. So the problem here is that we don't know when. We don't know if it's going to be at 50, 55, 60, 75 right. So then, osteoporosis, has no symptoms. I got very interested on doing osteoporosis screening, because throughout my usual experience in doing X-rays and doing bone density tests, I came across with high volume profile of individuals, female the most, were they just… I don't know if I'm using the right word, but the cane away, right?

I mean, they don't know they have osteoporosis. I get to see how bad their bones are internally, and for the most part, they pretty much ignore it most of their adulthood, through their adult life. They didn't know they had this. So I kept just asking myself this. I mean, we should have a more proactive approach to help those individuals. Because at 65, 75 it's already too late. You can definitely do something. And it's a very simple test. It's a very simple screening test that it can definitely improve your quality of life.

Dr. David

Yeah. Oh, it's so simple. It's so fast. It's very quick and you get tons of information right away. Well, for those of the listeners out there that maybe don't fully understand what osteoporosis is, could you just in simple terms, define it for us?

Julio Alcalá

Yes. So osteoporosis is a condition that affects your bones, and it affects the bones by making them very, very weak in the inside. So if you go to any place they should actually, they're going to take a picture of the outside of the bone. What we refer to as the cortex of the bone, and with this radiograph, with this picture, we can determine fractures, locations and things like that. But we cannot diagnose osteoporosis based on a simple radiograph.

Now, if osteoporosis that it's advanced, that means if the bone is drastically weak, then at that point, we can see it on a radiograph. But why would you want to wait right? Why would you want to wait just to go with a radiograph to diagnosis osteoporosis? This is why technology like the DEXA scan, DEXA is an acronym for a very fancy words, Dual Energy X-ray Photometry. So, we just call it DEXA, and it's x-rays as well, but DEXA can measure inside the bone, rather than just taking a picture of the outside of the cortex, or outside of the bone.

So then measuring the inside of the bone will let us know at any given, age how strong or weak your bones are. If your bones are weak, then we need to rely on these technologies to find out how weak they are. If you could be on the phase before osteoporosis wishes to osteopenia, or osteoporosis. Think about osteopenia as the phase before osteoporosis, when we start noticing a decrease in bone density. But it's a good time for you to take action to prevent osteoporosis.

And in just talking a little bit more into it, we run with a system of a score, and most are very healthy individual at 30 years old, he is going to have a score of zero. Okay? So then we're going to start comparing this score to these particular individuals. So if your score is anywhere, lower than 2.5 points in this score system, that we call t-score, you're going to be diagnosed with osteoporosis.

Anything between zero and negative one, you're going to be diagnosed with osteoporosis. But think about this, right? If you are diagnosed with osteopenia, you're 40-45 right? You have at least a decade, maybe two decades to do something to prevent osteoporosis and essentially improve your quality of life as you age.

Dr. David

Oh, man. So, my takeaways from that are, that osteoporosis, it doesn't hurt, it decays the bones from the inside out, and you probably won't even see much happen on the outside, you have to look at the inside. It's the density of the bones. And the lower the density, the worse your score. Once it gets to a certain point, then that's the threshold of where they call it osteoporosis.

Julio Alcalá

That's exactly what it is.

Dr. David

tends to affect women 50

Julio Alcalá

Right. Yes. So then the National Osteoporosis foundation recommends osteoporosis screening for all females over the age of 50. But that's a recommendation. Now, we do have here at XR Imaging on authorization by the Texas Department of Health to do self-refer osteoporosis screening. So you don’t have to go to your doctor and ask him “doctor I want to check my bones.” You now can do it on your own.

So then you're 40-45 you want to buy some time, you just want to make sure, if you're listening, if you're a female right before, pre-menopause or menopause, or you're through menopause. That will be a good point for you to start thinking about “What about my bones?”

Because you mentioned something very important. Osteoporosis has no symptoms and it’s not going to hurt. Most individuals say oh my bones hurt, or my joints, or my back, right? And they might confuse this pain with weak bonds. But that is not the case. There are no nerves inside the bones to trigger a pain effect, to let us know okay your bones are weak right?

So then we rely on technology like DEXA to truly measure these values these bones. But in being proactive on your health. If you scan yourself with a suprosis of screaming at early age, you're even better, right?

You don't have to wait for your doctor to request this. It is pretty much informing the public that you have the right to be practical with your own health. And this is primarily going to affect females. And definitely just because of changes in hormones and through menopause, any deviation of estrogen is going to, and we have other risk factors, but primarily the estrogen. As you decrease estrogen, you increase the risk of developing osteoporosis.

Dr. David

So that's probably especially helpful at going in before 50. If you're female, if like your mom or your grandma, or other people in your family have known osteoporosis, that they've been diagnosed with osteoporosis, then that's probably somebody who should say, hey, maybe I should go get checked out in my 40s I should probably go take advantage of this ability to go see somebody like you and get scanned now for osteoporosis so that they can be prepared for the future.

That's cool. So let's talk about just kind of a tangent here. What could happen to somebody that has progressive osteoporosis? What are the problems we'll run into? Because if it doesn't hurt, they're not going to know that they have it necessarily. They might have back pain, hip pain or other stuff, but that's more related to their joints or muscles, or something else, but the inside of the bones, what you're saying is not going to hurt. But let's say that osteoporosis keeps getting worse. What could happen?

Julio Alcalá

So worst case scenario, right? If you are having a fracture on your spine, or you fracture your hip. So we know, by statistics, that those hip fractures primarily are quite dangerous. There's a highest that this is for individuals who broken a huge danger. They're up in the hospital and they don't make it. You know, it's drastic, the numbers are drastic.

So then who might suffer from a hip fracture? We know that by accident most people can, any type of trauma, but individuals with weak bones, and we're talking about the elder here. They're taking a shower, they slip, and they fall. If they have weak bones guess what, either the back, or the hip is going to be one of the areas that fractures.

We see a lot of fractures also on the wrist, because just by tendency landing ourselves, we put our hands out. But, the one of most concern is going to be spine fractures, and hip fractures. So then, as we age, we want to age with a good quality of life. We want to be doing things, enjoying our grandsons, enjoying those, good days, be walking

Dr. David

Going on a vacation, walk around….

Julio Alcalá

So then, what we want is to prevent that from happening, right? Making sure that the public here understands that osteoporosis is truly a thing to consider. And it’s quite easy to diagnose and to prevent. It is very hard, very hard to early age, as a diagnosis to process to recover from it. So, the younger you are, the better you are, you will be proactive and then you just pretty much improving the outcome towards the, you're late years, I guess I shouldn't put it like that.

Dr. David

And just to give you, the listeners a perspective, from the physical therapy side. Because I see people that have had hip fractures, and spine fractures and that kind of thing. Rehabbing and recovering the strength and mobility and the ability to walk and do normal life things sucks. It's terrible. And you know, a lot of these people have had a hip replacement because they couldn't salvage the hip bones.

Some will get a pin surgically put in to stabilize the fracture in their hip, and their life changes dramatically. So yeah, many of them passed away. Unfortunately, because of all the changes that happened after breaking a hip or fracture in the spine. But if they lived, usually they're attached to a walker, or a cane for the rest of their life. And people hate having to carry a walk around.

You have to put it in the trunk of your car whenever you leave. It gets caught on things it it's miserable. The best is, if you can just have your own body, and not have to carry any sort of walker or cane and get around and do whatever you want. And yeah even better, like you said, quality of life. Being able to say I'm going to get on the floor and play with my grandkids and not be afraid that I'm going to injure myself for that, or that dealt with this fracture that I got, you know, years back or last year, and it can't get I can't do that anymore.

Okay. So, yeah, the dealing with the problems of osteoporosis is not fun, it's just that it happens suddenly. And it is terrible as it comes. But let's talk about the other end of that. What could be done to prevent it from getting worse or maybe even improve it?

Julio Alcalá

So, in understanding first the risk factor, so we classify them by control risk factors and uncontrolled risk factors, right. So, suddenly being controlled or uncontrolled receptors will be gender, age, and genetics. So then, I mean, right there out of the bat, females will have. So osteoporosis is going to by genetics is going to target females over the age of 50, they cannot control this, and then like you mentioned, before you know if your parents your grandparents had osteoporosis, that doesn't mean that you will have it, but the risk increases right?

So if you cannot control the age, you cannot control your hormones as to going through menopause. The only thing that you can control it's be proactive right? Go get checked, call me if you want. If you're listening to this right now, just give me a phone call 915-613-2748 we'll help you with a simple osteoporosis screening. It's a very simple test that brings a lot of value. You want to know if your bones are strong, to be conscious, be aware of this and enjoy your life, and if they're not, take it as it is, with the attitude of improving and then we will offer you a second scan.

We will refer you with the specialist that we you know can help you to improve your bone density. Then you'll come back six months, two months to do another scan and see how you're improving. But that's essentially a way of contemplating these now excluding these uncontrolled risk factors because you cannot control it, right?

We know that sedentary individuals who are more prone to develop osteoporosis. The bones, we call this process osteogenesis. So it's like, generating new bone or the beginning of building more, right? So then the cells to Genesis process gets stimulated when there's high impact on the bone. So we know that individuals who practice high impact exercises or resistance training, they do better, they minimize the risk of developing osteoporosis.

So if you're young, you are active in the gym that's going to be benefit for you, in preventing developing osteoporosis. We also know that very acidic drinks such as Coke, excessive coffee, many soft drinks obviously, that carry a lot of the, the pH is very acidic, it will start affecting on the long run. I mean, I told this one time, and then the patient told me, what do you mean if I just drink one cup of coffee? I'm like, No, no, I didn't say that. Enjoy your coffee, right? But in the excess on the long term is going to have an impact.

Dr. David

I'm putting my coffee down.

Julio Alcalá

I love coffee. So I just, you know, being aware of the, you know, be putting myself on that on that limitation. Be cautious when I'm doing

Dr. David

drink water instead.

Julio Alcalá

No, no, but yeah. So then think about these little things that you can do in early age, right? What's your soft drinks, making sure that you're not drinking too much acidic, or high acidic drink? Then be active, not necessarily cardio, okay, a lot of people think just by going and walking around. So in fact, there's this very interesting report in the society that came in 2007 in UCLA, it was a short, it was only 40 individual, with certain characteristics, but they sleeting in groups of 20. Okay.

The one group of 20 patients was pure females, over the age of 50. They had them do cardio, just pure cardio exercise, and then they were tracking how their density will progress within 24 months. And then the other 20 deep resistance. Well those that the resistance and high impact, develop or maintain better bone density compared to the ones that were just doing cardio, okay. So then the that type of exercise is also very important.

Dr. David

And just to speak to it from a physical therapist standpoint. A lot of people, as they say, if you're 50 and up, people tend to have back pain, or hip pain or things hurts, and then having this understanding of “Alright, well, I got to go do some sort of resistance training that might mean weightlifting or something else.” It depends on what the individual likes to do that. So we guide them towards just how to do it in a way that's helpful for them.

If they're running into back pain or hip pain, and the exercise they want to do, then talking to somebody like me is a huge benefit so that physical therapists can guide them on the right exercises, and it might be that they're not ready to lift weights today, they need to do some other stuff definitely leading up to it so that they then can begin to hit the weights a little bit harder and be safe about it and not get injured some other way.

But it's true. We see so many clients here that they end up going to go to weight training and the way I tell people is, just like you get calluses on your hands from working with your hands a lot, or other tissues respond, similarly, our muscles will get thicker, our tendons will get thicker, and our bones get more dense. It's just a natural response of our bodies have to extra forces you put on them. But what I see from our clients is it's uncomfortable to lift weights and push yourself too hard. It's kind of easy and very gratifying to get on the treadmill, or the bike, or whatever and say I burned 500 calories. I feel good about myself. And you don't get the same kind of response when you lift the weights. It's like Well, I don't know how many calories are burned and if you actually look it up, it's not that many calories, but the benefit that you don't feel right then in there is that your bones get stronger, and your muscles get stronger and all that.

Julio Alcalá

This is one of the things I encourage most individuals, because they go there and they express, “I am in pain” or “My back hurts” or “My joints hurt”, right? It's going to be impossible for me to do exercise, but they don't realize that a physical therapist it's science. You guys, you doctors, you go through school, you get a very, very specific training on how the body works and ways to, what to do to supplement for a specific type of movement or exercise. So, I understand. Pain is pain, and it could be relative from patient to patient, but seeking help is…. You need to decide whether you truly need the help, and then seek individuals like you.

When I improve my health, I know I'm hurting, but yet I know I need to do something, some type of movement. I want to go to the specialty school who are the specialties that will tell me what movements to do, how to do them and my body mechanics. With all due respect your primary doctor, more than likely, is not going to do it. So then seek individual help like physical therapy.

Dr. David

Yeah, doctors tend to be specialists in medicine, and everybody in the field kind of has their own specialty and so, so yeah, just find the right person for the problem that you are facing, and that's where you're going to find the best help.  So let's talk about a specific client of yours, that you can think of, that had osteoporosis and has maybe had a good outcome. Do you have anybody like this?

Julio Alcalá

Yes, so I have this patient through the self-referral program. This patient very, very proactive, very motivated to improve her health. So she goes there, she was referred by her primary doctor, we ended up doing just the osteoporosis screening. So it turns out that she had osteoporosis but very severe. Now, you will see this patient walking normal, right? I mean, she's just fine. She wasn't complaining but she should calls the office back a couple of weeks later and she says “ i was there, I followed up with my doctor, they diagnosed me with osteoporosis, they put me on these medication, but I want to do something extra to improve my health. Is there any recommendation? We talked about some things when I was there in the office? Can I do something else?”.

So then I went back on talking to her about the recommendations and I told her Okay, once you start implementing these basic things and stick to the treatment that your doctor obviously recommended. Because usually that helps to rebuild that bone, but improve due to physical activity, right. It started limiting your acidic liquids, right. I'm also starting to improve on your diet correct? And then she went on and did these changes, she does follow up six months later now i don't know if i she ended up doing something more in the natural or I think osteopathic.

So she seek some type of herbs and then some type of different teas, right? That because she didn't want to be on these medications long term. Well, I was in in, in my 16 years of experience right, doing x rays and doing bone density. I never seen a drastic increase in bone density in a short period of time of six months right.

Now, when we look at the values right or maybe right now it wouldn't make sense right? But just one point. But only in this score and the scale of what we when we utilize this score, right? It's a huge improvement. We see an increase of a T-score of one point on the T-score, maybe within a year, a year and a half but for this lady to have these improvements within six weeks. It was amazing, right?

So then, once again, I respect the treatment that your doctor is given to you, but do something else, right? Try to try to do that extra, those basic recommendations and then science in medical, the medical or medicine tells that there's no cure for surprises. There's only a treatment, and we can definitely prolong the damage or extend the data, the timing that osteoporosis is going to damage your bones right. So medication. But I truly feel that by improving your quality of life, you do have control of osteoporosis, you manipulate how strong your bones can get, but by being proactive and just simple life, regular life activities, right?

Dr. David

Oh, that's awesome. It's a great story. And I think its kind of like the idea of there's no cure for osteoporosis implies that it's like a disease, or like it's a virus, or like something that you cath. It's more like putting on weigh. It's a condition, it's the state of your health. You don't get a bug and then all of a sudden get overweight or obese, it's because of the way that you live, its because of how you eat, and what you do.

And I think it's the same thing with osteoporosis. It's your habits, the way you live that puts you in an osteoritic state or not, and that's what this lady changed. And so, when doctors give you a medicine for osteoporosis, I think it's easy for some patients to go into the thinking of, Oh, this is what's going to fix it. Just like when I went to the doctor before and I had a sinus infection, and they gave me antibiotics and it fixed it. That's not how this works. It's medicine, and diet and exercise and other factors that are that might be in your life that are just like with obesity or putting on weight, it's the same way that you got to treat it. And you have to maintain it.

Julio Alcalá

And one of the reasons that I shared the story about this patient is because we run by protocols, right? So then you go to your doctor, medical doctor, right primary physician, they order any type of test. In this particular case for us to proceed screening the protocol. It's one, one screening or one test every two years. Now, if you're being diagnosed with osteoporosis, we're going to do one exam, or one scan every year, right? But that's the protocol.

But do you have to stick to that, or if you're paying with insurances you're going to have to because insurances follow these protocols, right? They're only going to pay if you have osteoporosis, going to be one or once a year, if you don't, they're going to pay once every two years, right? But the nice thing about individuals like these is that they don't they don't settle with which is one. Yeah, one diagnosis and one simple decision that okay, you have osteoporosis, take this pill, that's it.

No, she went on and took care of her health by doing the things that she had to do, and not waiting for next year, or next two years. She realized that we do have this authorization to do self-refer. So then she went back in measure herself. And there it is, right. Like she now knew that she's on the right path to improve her health, right. She didn't have to wait another year or two years. So be proactive. Yes, doctors are great. To take care of certain conditions, but you primarily have to have control of your own health. Right?

Dr. David

Yeah, that's awesome. Well, when should somebody in El Paso reach out to you for help with osteoporosis?

Julio Alcalá

We've been primarily talking about females, but men also develop a process. The statistics are, or the ratio is a little bit less. So one out of five men over the age of 55 will develop osteoporosis, same concept, but we don't know when. So 55, 60, 75, right, we don't know when but essentially, if you are a female, over the age of 50, you're listening to this podcast. You're a female over the age of 50. You never check your bones. your bones never hurt, right? Do yourself a favor, be proactive, go get your bone check. It's a five-minute scan.

That brings a lot of value to understand how your bones are, right? And if you're a man over the age of 55, you never go, and I guess this is also a cultural thing. Okay? I get this a lot about Hispanic men over the age of 50 that Oh, I feel strong I'm these martial men I get to lift, very heavy things, I'm out there. But once again it's a condition that is not going to discriminate on gender, in that particular sense. It doesn't matter why or I should say on ethnicity. Don't matter.

Having weak bones is not a matter of whether you were a mushroom or not, so I go get chicken. It's good. So now, if you're listening to this podcast, and you're a female, you're a male that are in your mid-40s. You don't have to wait. You don't have to wait into the recommendations. You can give us a call 915-613-2748 and schedule your bone density or osteoporosis screen. We'll be gladly to take you in, explain to you what the results are, and show you how your bones are. So that way you know you can improve your quality of life.

Dr. David

That's awesome. Were there any helpful tips that you share with clients that they usually don't know before they come in and talk to you and meet you?

Julio Alcalá

Um, any tips that I want to want to share? I mean, when you will see your doctor right your doctor orders a specific, a specific test whatever it is, right. We love educating the patients and one of these, this part of the education is the fact that you have rights as a patient as consumers, matter of fact. So if a Doctor sends you to any specific place, they give you the order, or the referral form right? More than likely, they're doing it because you know they have a good relationship with this particular place right? But you might go to this place and you may experience that they are not greeting you correctly right?

You may experience that maybe that technology they didn’t give you the time that you deserve as a as a consumer, as a client. In the state of Texas, you have the right to choose the place that is best for you right? Yes, we love doctors, making this referral but ultimately, the patient has a right to choose where to go.

So what we offer here is that if you're not happy with this place that your doctor is sending you to, you have options, call around, compare prices, compare rates. Ask about reviews online. Now it's very easy to get on Google and find out about the reviews of different places right? So coming to us, if you're concerned about you're an individual that are health and fitness oriented, and you just want to step it up, get to know your body at a deeper level, you can call us and we're able to help you in in understanding how your bones in your body composition is that way you can improve your health in and in your fitness as well.

Dr. David

That goes into the next question. We can talk about this before we even started the interview is and then you offer other services besides osteoporosis screening, we mentioned a little bit about the DEXA scan, but it gives other information besides the bone density. Could you tell us a little bit more?

Julio Alcalá

Yeah, so these scans, these DEXA scanner not only measures the bone, it also measures your visceral fat. Visceral fat is the toxic metabolic active fat around your organs. A lot of people ignore this. We usually, because we can feel what is underneath our skins right, we change, we pride ourselves in around our bellies, right? So we can say oh, I have a, you know, I'm overweight or I have these six amount of pounds of fat. But most people ignore that internally underneath our abdominal muscles. On top of our organs, we have these very vicious, toxic fat that is there.

The more fat that you have, the more chances of developing cardiovascular diseases. The more visceral fat you have, the more chances of developing metabolic syndrome and diabetes, type two or type two diabetes. So then our DEXA scan can also measure these and let you know, so we know that the recommended value of visceral fat is less than one pound. Anything more than one pound is excess visceral fat.

Sadly, listen to these guys. Okay. Here in El Paso, we know that we are consider a very obese community, right? The average of visceral fat, in El Paso, is three and a half pounds to four and a half pounds of visceral fat. The recommended value is one pound or less, right? So then, you know, this is a I wish you can invite me to another podcast to talk about the certified DEXA scan, we'll make sure this is as well. We can also make sure we have the ability to measure your muscle, find out how much muscle you carry in this is an important value for muscle symmetry.

For those of you out there practicing any type of a sport, any type of physical activity, muscle symmetry, it's an amazing thing that most people ignore. So we know that the body works best when it's symmetrical. And essentially what's going to be doing the work is the muscles, right? So you minimize injuries by staying symmetrical, right how much muscle you're carrying on one side compared to the other. We're talking about your hands and your legs. So we can measure that as well. And then the last thing is, because of these BMI, the body mass index, this is a formula developed, back in the 1800s.

So you go to a doctor, they take your weight, and they tell you you're overweight, when in reality you might not be. So DEXA scan can let us know your true classification of weight per se, by accurately measuring, you're measuring your body fat percentage,

Dr. David

I've had this scan done myself, you did it on me, and I even had it back when I was in college. So I knew about it. And it's fast. I mean, you just lay down on this little bed, you put a pillow there, and you're not in the tube, it’s not like an MRI machine. So just to paint the picture from somebody who's done it. It's an open area and there's this arm that slowly goes over you, and it's maybe a foot away from you and it doesn't feel scary in any way, that is nothing loud it just it's very quiet. It's almost like it's just like it i mean it makes probably about same type of noises of like a printer might, and that's it. The whole scan itself is over within minutes, maybe like what 5-10 minutes

Julio Alcalá

Yeah depending on the Hight. Tall individuals is going to take anywhere between six to seven minutes. It all depends on that, but on the average anywhere from four up to seven minutes. You're going to have your waste coming in and you describe it. Very nice. It's not invasive whatsoever. So you're completely dressed. The only recommendation that we want to make sure is that we don't want you wearing metal, obviously within your clothing but if you go there with a nice comfortable clothing without metals, you just hop on the on the scanner and it starts scanning from head to toes.

You're not going to see or feel anything. The radiation amount that's another issue. Most were concerned about radiation we always tell patients to be concerned about radiation. But this scanner is very minimal quantities of radiation in a full scan, compared to an X ray compared to a CT scan. It's almost incomparable. The scan is very, very safe. Yes, we take precautions, nonetheless. Because once again, we're working with radiation, but that's our responsibility as technologist to make sure that that your scan is safe, that is high quality and that we're utilizing the least amount of radiation possible.

Dr. David

Yeah, so it's very easy to do. And the information you get is invaluable and I've seen people that are into the extremes. People looking at their body fat and muscle mass like the body builders, the people that are doing fitness competitions, and look a certain way and get their body fat down. But even your everyday Joe that just wants to get healthier and lose fat and put on muscle, they're not interested in competing. The DEXA scan gives you top notch information to be able to meet those goals and measure as you're going along.

Julio Alcalá

I utilize this phrase, and I'm pretty sure you have heard this before, what gets measured gets managed, right? So most individuals, as you described, they go start doing exercise or trying to improve their fitness, but if you're not assessing your body, measuring your body, how can you improve? I mean, you can go by looking at yourself in the mirror, but that's an external look, right? What's happening inside, you're going to rely on different technology.

So then the other thing is, let me tell you this. This is very, here in El Paso right? Not too long ago I was driving on I-10 and I see these billboards about Weight Loss Challenges. I'm not bashing anyone here or anything like that right no fitness centers but they're very common. That's what I'm trying to say weight loss challenges are very common. I support them because they at least get you motivated to do something. The problem with that is that individuals losing, or places that promise you that you're going to lose 20 pounds 30 pounds within a four to six-week period. You can do it, and they have the system to allow you to lose that drastic weight.

The problem with that is that as you lose weight, or you just go by your scale, you don't know what you're losing. You don't know if these 20 pounds, 30 pounds you don't know if it’s just mainly fat. You don’t know if it's a combination of fat or muscle, or even worse, you don’t know if it’s a combination of fat, muscle, and bone density. So then you might feel great. You might look great losing 20 pounds. But what are those 30 pounds? Did you maintain your bone density? Did you maintain your muscle as well?

Now when you decide to do these types of challenges, it's almost like a train, everyone is doing them. I encourage you to measure yourself. Create a baseline measurement, see how you are before your weight loss challenge, and I'm not talking about measuring tapes, okay, or even calipers. You got to find a technology that measures inside of you, gives you quantities of your tissues, then go on and practice your diet, your nutrition, your training, whatever they're offering to you. Then follow up with a scan and see what you lost.

Because if you're making an investment in time and money to these places, or anyone it can be an online thing, right? But if you're paying in these training or nutrition is not yielding the right results. Then you're being you know, they're tricking you in an essence, right? And then more than that, they're potentially affect your health. So then be wise about that.

And the other thing is that whatever weight that you lose, you want to sustain it, you want to maintain it, you don't want to lose weight in six weeks, and then just to see yourself in four months gaining it all back. So, DEXA scan will let us know realistically how much can you improve, in an X period of time, so that you leave the practice understanding, okay, this is our realistic approach. Once I meet these benchmarks, I'm going to be able to maintain my weight loss. Not only for six months, but on a long term, right.

That's what you want. But you need a tool, you need a tool to measure and to determine your values internally. The best technology that is out there is DEXA, nothing is going to be as good. There’re some other commercial devices, but they're you're dealing with a large margin of error in terms of the number, so decide where you can afford what you can and you know what, check us out, go visit www.XRImagingEP.com check out rates there. Very accessible very affordable. This is nothing all you know that it's, it's going to be out of the pocket of most individuals. It's something that, if you are spending X amount of dollars in a weekend, you know, to go have fun. Pretty sure you can afford our scans definitely.

Dr. David

Well, cool. Well, so you mentioned the website, and you mentioned the phone number as well. Can you tell us phone number one more time in case somebody wants to reach out to you?

Julio Alcalá

Yes, so you can reach XR imaging at 915-613-2748 you can also find us on our website www.XRImagingEP.com and we are on social media Facebook and Instagram you can find us the same way as us XR Imagine.

Dr. David

Awesome. Well great, awesome interview here for the podcast. If there's anything else you want to let us know.

Julio Alcalá

Yes, for those listeners of you who are interested in getting a full body composition analysis, this is the analysis that we talked about where we analyze your bones, we analyze your fat, your visceral fat, your body fat, and your lean mass. We call this a body composition analysis. So if you're interested in getting this analysis, we offer you a 10% discount. Only if you mentioned this podcast that you listened to this podcast and then make a reference of your practice.

Dr. David

Awesome. Fantastic. Thank you so much for that discount. This is huge. Well, great interview Julio, thank you so much for your time and wisdom and we look forward to possibly me on the show again sometime in the near future.

Julio Alcalá

Yeah, any other topic that you can think of that can bring value to your listeners or to your audience, please think about me.

Dr. David

Absolutely. Bye, guys. We'll catch you next time.

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