“Detroit Wellness:” David Walks Episode 15 with Physical Therapist John Putnam

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David:             Hello, and welcome to David Walks. We are broadcasting live from … 94? Is this 94?

John:               We’re almost at 94.

David:             Almost 94. I’m here with John Putnam. Is that how you say it?

John:               Close enough.

David:             He is a physical therapist. Today’s going to give us some insights into the healthcare industry in Detroit and chiropractor, maybe chiropracti, is that even the plural of it? Why are you a physical therapist?

John:               Why am I a physical therapist? I find a new reason everyday to be a PT. What initially got me started on … I guess intrigued. I’ve always wanted to be some sort of doctor since I was a kid. I’ve had some personal experiences, first-hand experiences, with PT, more so in my college years. Right before that as well.

My mom suffered a couple strokes. When they sent her to the hospital, she was basically lifeless, just a blob of mush of atrophied muscles and dysfunction. I saw her slowly progress to the ability to come home, eventually, where she works hand in hand with physical therapists, occupational therapists, speech pathologists, nurses, the whole getup.

To see her transformation to being ambulatory again and somewhat functional in her own home definitely inspired me. That’s when the seed was planted.

David:             How old were you when she came back home?

John:               I was probably 17. It was right before college, about a month before I left for the University of Michigan to start my undergraduate studies. Knowing that I wanted to do more PT work kind of came on more in the midpoint of my undergraduate career when I started working with an organization called Dance Marathon where individuals would stand for 30 hours to raise money for special needs children and their rehabilitation. I started getting involved with that.

I did martial arts therapy and aquatic therapy with children with special needs. That’s when I kind of really catapulted my interest in physical therapy as a whole.

David:             That’s quite a field, bring people back to health. It’s also complicated. You can say, I don’t think enough people get it. Actually get the time doing therapy, you know? That need it? There’s always this battle for hours. I don’t know. I kind of just want to talk a little bit about the healthcare. I am a little distracted in the snow.

John:               Me too. Legit. [crosstalk 00:03:04] but healthcare, in general, is a very evolving concept. More so now than ever, is we start shifting our sights to more preventative healthcare. More than ever, I feel we’re pushing to avoid surgical intervention, and basic intervention, even medicinal sort of intervention. Just first-hand witnessing people hooked on opioids and their addictions …

People are always wanting a quick fix is the issue. They’re quick to go under the knife. The outcomes are not necessarily the greatest.

David:             When you get back from the knife, depending on the surgery, but that’s a small portion of the success. The recovery from surgery really has to be prioritized.

John:               Exactly. The recovery and it seems their bodies are never the same after they have the surgery. There’s a good portion that have great success with it. The medical director of our company says that only two to five percent of individuals with chronic back pain, for example, actually need invasive neurological surgery. He’s a neurosurgeon saying that. You think about how many people go to get surgery so quickly –

David:             Yeah.

John:               Before other interventions are even tried. It’s baffling. I’ll ask a patient. Have you tried PT? Did you try a chiropractor? Did you try injections, multiple consultations? No, no, no, no. Their answer is always no.

David:             They’re like, “I want to solve this as soon as possible.”

John:               Exactly.

David:             Yeah.

John:               And my doctor said I need surgery. Okay, did you get a second opinion, a third opinion? Did you try anything else that’s more holistic, like exercising or weight loss? Simple things that go a drastically long way. I’ve been able to witness that first hand as well.

David:             Do you get a lot of healthcare.gov, people through the government health care? Are you dealing with the new payment policies at all with the new healthcare bill?

John:               We are. We’re trying to see – our sort of approach is more going for bundled as opposed to fee for service. What you’re referring to is fee for service, so they only pay for certain things. They’re not going to pay for a lot of modalities, only pay for drug contact time, which is kind of a medicare.

Medicare’s paying for less and less. They’re covering less and less durable medical equipment. They’re really taking away. Our mindset is we need to shift away from that because they’re not reimbursing well. We need to go for unions and different companies. Ah, shit, sorry.

David:             Oh crap. Were we supposed to get off that exit?

John:               No.

David:             I forget.

John:               No, the next one.

David:             Cool.

John:               But yeah, we’re shifting our focus on getting more unions and insurance companies –

David:             It’s funny that you have to leave Detroit. Get on a road that says headed to Chicago to get to the Detroit airport.

John:               The Detroit airport is actually in [Crosstalk 00:06:18], so it’s not even close to Detroit. Go figure.

David:             Yeah, but if you were typing Romulus on the computer, no one would find the Detroit airport. It’s like you have to call it like DT, you know?

John:               DTW?

David:             DTW. Yeah, so our vision is go to this company. Say, “Give us this amount of money, and we’ll fix your patient for you. We’re going to avoid surgery. We’re going to avoid injections. We’re get them off medications.” That’s sort of where we need to start heading. The sad truth of it, because insurance companies are just not reimbursing it as well anymore for little things.

John:               Yeah, I just got the picture of the Chicago side. Yeah, it’s a serious thing, not reimbursing. I’m a little exhausted. I’m ready for this travel, I guess. The airplane exhausts me either way.

David:             Traveling in general is exhausting.

John:               Yeah.

David:             I did physical therapy – I should have done it more aggressively when I tore my ACL in 10th grade. Physical therapy was pretty awful actually. I just sleep in a straight leg brace for like six weeks or something like that. Then it was all like my muscles like half the size. It was like you can’t do anything on the ground. It’s like all these stupid exercises. Not stupid.

John:               [Crosstalk 00:07:53].

David:             That’s what it feels like. Yeah.

John:               Yeah, I know, because basically compared to where you were at, really frustrating.

David:             Yeah, and it’s like just the wear and tear of moving around. Just to get to places is a pain. Then it’s like – I don’t know. Then you’re like, “I don’t want to do it.” I would aggressively – I probably could have been back to close to normal sooner. It’s something you really have to dedicate – like if it’s a major injury, this is what I do now, the recovery phase. Not like I’m continuing in life, and going to recover. You know?

John:               Yeah, exactly. It’s not going to be a natural process. The weird things is there are a lot of doctors out there that believe that PT is not even necessary for a lot of different things, even back surgeries. They’ll tell their patient, just go back to normal life. Just give them certain restrictions. Your rehab process might have been slower than others.

It’s a tough thing, because you don’t want to really put too much stress on that ACL graft, just put it on your knee, and piss off the surgeon by ruining his surgery. That’s your biggest fear. Sometimes you got to err in the side of caution.

David:             Yeah.

John:               With more professional athletes, it’s under the pressure to get them back as soon as possible.

David:             Have you been closely been following Derek Rose just for the base story of injury and injury recovery?

John:               No, I just know the longevity of it.

David:             Yeah.

John:               Been out for a season or something like that. It’s wild.

David:             Yeah, he did. It was ACL, [inaudible 00:09:23] meniscus, and now it’s like lingering. He basically has arthritis at this point.

John:               Oh yeah.

David:             But then at the same time, it’s one of the most explosive players of the league. I saw a stat a few days ago and it was like how he’s changed the way he plays. He averages like I think they said six drives to the basket a quarter. They’re measuring how many drives to the basket he has. Then at the fourth quarter, he goes up to ten.

John:               Wow.

David:             It’s kind of like he’s pacing himself.

John:               Yeah.

David:             Not that he’s not going to have a good play, but it’s kind of like he’s trying to get everyone involved. Then at the end, he plays at this super aggressive rate that he used to play at kind of all the time.

John:               That’s smart.

David:             Yeah, it’s a cool little thing. In terms of case study of managing your body after major injuries, he’s an interesting one that like … If he recovers, it’s really missing two, two and a half years of your career.

The only time that really happens is back in war day or something. When people would go to war, you know? You miss a couple of years. Players don’t miss two and a half years and come back playing as well.

John:               No.

David:             It’s Michael Jordan playing baseball. You don’t have it just for an injury gap. I guess what I’m saying is if you were to come back, like keep getting better and reach where he was or better, it’s a great testament to physical therapy.

John:               Yeah.

David:             And all the doctors too.

John:               Also, the strategy that he’s using too.

David:             Yeah.

John:               The coaching as well. If they’re involved in that, because that’s going to prolong the longevity of his career. If he went hard all four quarters, he’s going to burn out –

David:             Yeah.

John:               In five years. At least now, he can play, potentially, a full career still.

David:             Do you think the doctors and the physical therapists understand that it’s one patient? A lot of times, its different practice, or different department, and there’s a level of the whole medical system has to be working together. Is it pretty hard to communicate with the doctors, like their recommendations?

John:               It’s relatively easy to reach out to them and try to communicate. What they do with that communication is up to them. That’s the issue. A lot of them are so overworked. They have so many patients that they don’t have the time to care about that stuff. They’ll just sign off on things without actually reading my reports.

What I’ve gotten when I tried contacting doctors – I actually called a surgeon once and told him that his patient no longer had any pain. She was scheduled for a surgery. Her pain was like a zero to a 0 out of 10. She was at 9 out of 10. We calmed her down with just lifestyle modification, exercise, taking her from a sedentary lifestyle, making her more active, and just different psychosocial strategies. We got down her pain to a threshold of negligible levels.

I called the surgeon and said I don’t really think it’s warranted. He actually sounded upset because that’s money lost. There are doctors that take it that way. He ended up doing the surgery anyway. Her function was never restored. Her pain levels was never restored to what we got them at, even after the surgery. There are surgeons that will do it anyway and just ignore my advice.

David:             Yeah.

John:               There are ones that will actually heed my advice and are actually listening to me and actually follow through and adapt accordingly. Sometimes they’re easy to get a hold of. Usually, they’re pretty individual people which makes communication difficult.

David:             Do you remember what it was like to treat your first patient?

John:               Out of school? Yeah. They kind of get you to the point where you are independent in the schooling anyway. By the last internship –

David:             You’re like shadowing a lot?

John:               Yeah. You shadow probably the first internship. By the fourth one that we had, we were supposed to be entry level for all our categories. There’s about 20 things that we’re [trained on 00:13:27]. They expect us to be able to walk out of that clinic and be able to treat anyone on our own. When you first start, you kind of look over your shoulder looking for that person to say, “You’re doing it right. Keep it up.” You’re kind of like, “Am I doing this okay?” You want sort of a mentor, but they’re not there anymore necessarily. It’s you. This is what you’ve been training for for so many years.

David:             It’s powerful and scary.

John:               Oh yeah.

David:             It’s self-sufficiency but it’s also like a liability.

John:               A liability and responsibility for sure. You have all the skills within you, and I kind of recognize that. I realized that I can do this. This is what I’ve been training for for so long. It’s what I’m meant to do.

David:             Yeah.

John:               Once you get over that, once you get that realization, it’s just smooth. It’s been good ever since.

David:             What’s your clinic called?

John:               It’s called Pure Healthy Back.

David:             Pure Healthy Back.

John:               There’s only four in the United States right now. We’re the second. My clinic was the second in the United States, in Canton, Michigan. The first one was in New Orleans, Louisiana. Michigan has two [inaudible 00:14:35]. The fourth one is in Delaware.

We specialize in chronic back and neck pain only. At least three months after initiation of the back pain into decades with back pain, people with failed surgical intervention, failed physical therapy, failed chiropractic care, failed injections, medications don’t work. There are people looking to us as last resorts.

We treat the patient from all realms, pairing them with a health coach. They’ll talk to them on lifestyle modification, diet, nutrition, adherence to the home exercises. We keep patient compliant by offering free massages throughout their clinical care. Every ten visits or so, they get a free massage. Also, the health coaches, they’re there to ensure compliance with our program as well.

Nutritional therapy is three times a week. Ours is only two times a week. It’s all clinically evidence based. We find through all of our research, about thirty years of research, that over two time exercising, going through these machines that we use, may actually be over exercising. You can get overuse injuries. The strength gain is almost negligible two times a week compared to three times a week.

After a ten week return to function physical therapy, we release them into our wellness program where they continue the therapy for nine months. Basically, it’s a wellness program. They have their own wellness coach, who’s an exercise physiologist. They’re also still in my clinic, so they have access to a PT, an MD, whatever they need continuously while they do the wellness program to maintain the functional ability that we’ve restored in our physical therapy program.

David:             Pretty all-encompassing.

John:               That’s the goal. That’s the future of healthcare.

David:             I mean, should I be talking to someone everyday about my – It’s almost like you can get like – If you just could, if budget wasn’t a thing, would you hire a life coach across all these issues?

John:               Yeah.

David:             You know like, “Oh yeah, you have your personal trainer, your physical therapist -” You just have this team to optimize your efficiency, your output.

John:               In an ideal world, yeah. I even use my health coach that we’ve hired personally to talk about diet and nutrition. I think everyone should have it. It’s amazing what you can learn about what food you intake, and the terrible things on our food today, and what to look for in a grocery store.

David:             What do you mean?

John:               Slows was a bad idea. The nutritionist that we have would be disappointed in me that I went to Slows today, and stuff my face with barbecue.

David:             Oh, it’s delicious.

John:               It was so delicious. You can treat yourself once in a while, but yeah. A whole, all-encompassing sort of healthcare team would be ideal if finances really into question –

David:             Maybe I’ll just start interviewing a whole team, put them on my podcast, just for like –

John:               That would be interesting.

David:             I guess it would get a little too detailed into specific things.

John:               Yeah, get the personalities coming out. People may butt heads and start disagreeing because the healthcare world is so full of egos. That’s the biggest blockage to a lot of drastic changes or progression in healthcare is not really seeing eye to eye. They’ve been trained a certain way. They seem to think a certain way. They’re going to stick to that. It also makes things a little bit interesting.

David:             Yeah, then we can chop up the episodes by key moments to get their different opinions.

John:               Yup.

David:             All right, well, I think my voice is getting tired. We have about 13 minutes here. Do you have a last thought about what someone should do in Detroit?

John:               What should someone do in Detroit?

David:             Yeah. You know nothing about them. They just happen to be in the airport. All right, we’ll give them something. They’re going through, stuck in a layover, heading out back to see their family. They have a whole night in Detroit now, so its the layover, the snow, a lot like today.

John:               Okay.

David:             What should they do in Detroit?

John:               See Detroit’s such a cultural melting pot that it depends on the person that’s asking. Everyone has different interests. There’s such a variety of things to do. You could go historical and see where the [inaudible 00:19:18] was built. If you want to gamble, you can go gambling. You can go across the [Masser 00:19:25] bridge into Windsor, Canada and gamble there and hit the town. It really depends on what you’re interested in.

Sports, there’s always a sports game on. We’re a sports town. Well, it’s winter time right now. We’re in a snow storm, so tonight, I’m going to see a Piston’s game.

David:             Oh, cool.

John:               They’re on a hot streak, so –

David:             Are you seeing the Cavs? No. Is that yesterday?

John:               I didn’t even know they were playing Detroit. That’s a great question. I’m going to the game. It’s just –

David:             The team is really good.

John:               That’s definitely Colorado or a Red Wings game or [inaudible 00:19:59] is downtown. Hockey town café, [inaudible 00:20:12], Greek Town Casino, Greek Town is still the best Greek food you’ll have. Mexican town, some of the best Mexican food you’ll have. The options are really endless.

David:             Yeah, I went to that bookstore yesterday too.

John:               Yeah, apparently, it’s one of the world’s largest bookstores.

David:             Yeah, a million books. [inaudible 00:20:29]. It was awesome, dude. It was like something between a library and a mansion of a crazy old person that just kept filling it with books. Sometimes it feels like a library, but other times, you feel like you’re in just a hoarder – I don’t know. A literary hoarder’s house. I guess that’s a library.

John:               Hoarder of books.

David:             Hoarder of books.

John:               For sure. There was a show that showed the historical relevance of this city. Some still remain, some of those buildings still remain. Some have been left to ruins. You just saw Grand Central Station was one of the most beautiful, state of the art train stations. Now, it’s just sitting there with windows busted out. For some reason, there’s security guards in front of it. I don’t know what they’re trying to protect. Pretty much everything’s been torn apart and stolen, but they’re just, “Don’t you steal those pillars.” What’s left?

David:             Could the security be doing something else?

John:               Yeah, exactly. [inaudible 00:21:33] Priorities. Oh, shoot.

David:             It’s tough being stuck behind the snow blowers or snow plows.

John:               Yeah. [inaudible 00:21:47] like this guy.

David:             Yeah. He’s like a liability to us.

John:               Yeah, he really is.

David:             We got to get him out of here. Driving his little Ford Focus. It’s funny when the city goes down a little bit, then it starts growing again. It’s like an interesting – I don’t know if this comparison is quite right. Whenever eastern block companies or countries, once they got out of the Soviet Union, there was a lot of buildings that were very, they’re not the same, but they’re very industrial and getting abandoned. You know, changing architecture?

I don’t think it’s quite the same. It’s an interesting thing to see architecturally where it’s very nice downtown. Surrounded, there’s areas that are really bad. Then there’s all these driving areas too around it. It’s a pretty cool city.

John:               Even though they’re largely bankrupt, I’ve seen more growth in Detroit than I have pretty much my entire life. People are loving the rag on Detroit right now and saying how bankrupt they are, and what a mess they are. If you actually came to visit, you’d see all these beautiful new buildings, and the light rail that I mentioned to you before connecting the town to the suburbs. The new Red Wing stadium that’s being built. There’s different shopping districts that [inaudible 00:23:13] are buying out.

David:             It seems like a lot of the broken down buildings are getting bought out at a better rate anyway.

John:               Oh yeah.

David:             I don’t know what some of them are doing, but a lot are being purchased.

John:               I actually treated a building inspector for Detroit. They were saying that now is the time to own realty in Detroit and to hold on to it, especially around the Woodward region. Just hold on out, he tells families, just wait a couple of more years. When all these stuff is finally built up, you’re going to be very thankful, because you’ll be able to sell your house or rent it out for a ridiculous amount of money. That goes to say, this is definitely a changing time. It’s nice, because it’s been pretty stagnant my whole life. Finally, the abandoned buildings are being torn down. The major projects are being torn down.

David:             Whenever like the whole 2008 happened. I mean like, say it was kind of stagnant your whole life, how traumatic was it when the auto companies going down, the government buying them out, you know? That area. That time period. Did it feel much worse, or did it feel stagnant?

John:               It was worse, because I know a lot of auto families. My dad, personally, was a engineer for Ford. Even in the 90s, before he passed away, I saw a glimpse of what was to come. He was [inaudible 00:24:40] for his job even with all the seniority, because they were kind of hiring these young guys and right out of college or cheaper and more innovative to get in there. The auto companies were starting to realize, “We need to step up our game a little bit.” Ford’s also the only one that wasn’t bought out by the government. The only one that’s not owned by the government. Chrysler and GM kind of fell to that.

David:             Oh, did I say Ford before? GM and Chrysler were both the government’s and Ford’s –

John:               Ford is still fine. They have totally pulled themselves out. There was a huge [inaudible 00:25:11]. It was scary for our whole area. We were kind of thinking of which direction should we go, because this is what we were built on is auto. It’s definitely making a comeback. You’ve see it in cars, how much they’ve changed in the last ten, fifteen years. They’re getting smarter. They’re getting more efficient, fuel wise. They last longer. It’s just amazing. They’ve really kind of stepped up the game and really turned it around. I guess the city of Detroit has reaped the benefits of that, for sure.

David:             Right as I’m about to take an airplane.

John:               All right.

David:             I couldn’t get here without the car. All right, thanks, John.

John:               You’re welcome. Thanks for having me.

David:             Later.