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Orthopedic surgeons start practicing in Buffalo during Covid-19

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Dr. Scott R. Nodzo knew about half the staff when he started work last month as the newest joint replacement surgeon at UBMD Orthopaedics & Sports Medicine, which includes 40 doctors and a staff of 340 spread across 11 offices in the region.

He got to know many of his co-workers years ago while a University at Buffalo medical school student and resident, before leaving for a fellowship in New York City and four-year-stint as a U.S. Air Force major, operating on wounded soldiers in Afghanistan and mostly retired veterans at Nellis Air Force Base in Las Vegas.

Reacquaintances have proven a challenge, what with Nodzo and his colleagues wearing masks on the job.

“People have seen my picture, but nobody knew who I was for the first week and a half,” said the doctor, 36, an Auburn native happy to settle down in Buffalo this summer with his girlfriend, Dr. K. Keely Boyle, who he met six years ago while the two were medical residents.

Boyle will finish her orthopedic fellowship next month at the Hospital for Special Surgery – the same place Nodzo completed his – then join him and start a complex adult joint reconstruction center of excellence as part of UBMD Ortho.

They expect it will take a year to develop the project with Kaleida Health at Buffalo General Medical Center. They hope a second site will become part of a new UBMD Orthopaedics medical headquarters and ambulatory surgery center planned for the Northtown Center property in Amherst.

The complex joint center will allow patients to get office visits, lab tests, imaging and procedures in the same location instead of managing appointments in several places while hobbled.

“We're trying to eliminate all those extra steps for patients,” Nodzo said.

Meanwhile, he continues to adjust to his new practice in the midst of a pandemic.

Q: Why did you and Dr. Boyle choose to return to practice in Buffalo?

We absolutely love the university medical group, the orthopedic group. The talent in the city is incredible. There is also an opportunity here to expand the department and create a center of excellence in joint replacement.

Q: What have the first few weeks been like since you started in mid-May?

It's been interesting. I dealt with the peak of the Covid crisis in Vegas, but here things are starting to ease up a little bit. The biggest change is interviewing patients and meeting people for the first time … and having masks on. They can't really see my face, and I can't really see their face, and trying to create a personal connection in a short period of time and figure out the best care pathway is a little challenging.

The staff has already done an incredible job rearranging things, setting up barriers, pre-screening everybody when they come in, using different office patterns in terms of how we see patients. We don’t see as many patients in a day, so the waiting room isn’t packed.

Q: Have you been doing some of your appointments virtually through telemedicine?

One or two, but most of the patients have wanted to come in. Especially being new, most people want to meet me. It’s been good. Everybody has been taking the appropriate precautions: wearing masks, hand hygiene and staying away from each other in the exam rooms until you absolutely have to examine patients.

Q: What do you say to new patients who come in with knee and hip challenges and fear they need surgery?

Everybody is a unique individual. Treatments are based on your symptoms, how bad your pain is, if you're able to tolerate your pain and if the pain is interfering with your quality of life. If you're able to manage the pain with non-steroidal medication – Advil, Motrin, Tylenol, Aleve – and you're able to do your daily activities, we continue to watch you and to treat nonoperatively. That includes icing, bracing, oral medication, then knee and hip injections. Eventually, when all those things fail, then we start talking about joint replacement.

Q: Have you had anybody who could be helped by outpatient surgery say, ‘Look until we know a little bit more about what's going on, I'm going to suffer through all this?’ ”

I had a lady come in and give a similar story. It's interesting because we don't know what's going to happen again this winter. I've been guiding people in a ton of pain right now who think they're close to the edge of wanting a joint replacement to really evaluate things over the next month or two and have surgery at the end of August or September, because if we get a second wave in November, December and we have to shut down again, you could have to wait another six, seven months before you have surgery. Some people can suffer with that and some people can't.

Q: How has knee and hip replacement changed since you were in medical school?

When I was in my first year or two of residency, people would stay in the hospital for two, three days. We’d change their dressings in the hospital. A lot of people used to go to a rehab facility after surgery. Now we're doing outpatient total joints. We don't change the dressing at all. We keep it on for five days to help prevent infection …

What's also changed is the increased use of regional anesthesia – spinal anesthesia – and preoperative, non-narcotic pain control … which helps with pain control post-operatively. We've also had the addition of improved intra-articular injections. At the time of surgery, we inject pain medication in and around the knee joint and the hip joint that dramatically helps with pain control post-operatively and allows patients to get up and move right away with their pain controlled. We also use medications that really cut down on blood loss, which is helpful for joint swelling and tissue swelling and helps with pain control and early mobilization.

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