Sports Medicine and Surgical Readiness

 with Dr. Leila Borders

About Dr. Leila Borders

Olympia Orthopaedic Associates physician Leila Borders, M.D. uses her dual background in Internal Medicine and Sports Medicine to help patients tackle everything from sports injuries to surgical readiness.

In this interview, Dr. Borders explains why obesity is more than just a lifestyle issue; what special populations should consider bone density evaluations; and why she absolutely loves working as team physician for local sports teams.

You have a unique training and background, having completed both an Internal Medicine residency and a Sports Medicine fellowship. How does this intersection of experience inform your practice?

I really appreciate how my training works together and I think it’s a boon for what I do. When I was a young, doe-eyed person in med school, I set out to keep people healthy. I went into Internal Medicine but then I discovered that while it involves keeping people healthy, there is also a lot of disease management involved. I really wanted to be on the front side of that as opposed to only the treatment side.

During my residency, I started looking into Sports Medicine and it was a good fit to get me working with the athletic aspects of people to keep them healthy and keep them moving. It worked well with my Internal Medicine background, which helps me care for my patients’ internal health – their organs and everything else.

The combination of Internal Medicine and Sports Medicine meshed really well with my philosophy. My goal is really to keep people healthy, moving, and doing what they want to do. And that is what I get to do every day now, which is pretty cool!

Tell me about your work with surgical readiness?

Basically, what I do is obesity management. These patients come to me to get help managing their comorbidities in a way that helps them lose weight. The real focus is losing weight so patients are able to get their surgery safely and then be able to really utilize a new joint well.

Some patients are referred to me because they have comorbidities like osteoarthritis, diabetes, or another metabolic problem. The first thing that happens is that they get pain in their joints so they go to a surgeon who may say they need a new joint. But we have all of these studies and all this information showing that if we replace your joint at a higher weight, then you’re not going to do as well and your surgery will be riskier. It’s riskier to operate on patients with obesity because the anesthesia, medical comorbidities (like diabetes, high blood pressure, and those kinds of things), and prescription medications all make a difference in increasing complications.

I don’t use any kind of major magic. I use some different techniques, depending on what the patient needs. Most of my patients are fairly successful. After losing weight, some patients go on to get a joint replacement and others find themselves in less pain so don’t actually require surgery in the end.

Did You Know?

Optimizing body weight before surgery is very important. A patient with a high Body Mass Index (BMI) has a higher risk of complications during surgery. If a patient can lower their BMI pre-surgery, then their outcome for a joint replacement is statistically going to be better.

What is the relationship between osteoarthritis and obesity?

Osteoarthritis is a comorbidity of obesity. People used to think that adipocytes tissue and fat cells were just this extra weight and that the whole problem was just putting too much weight on your joints. That is part of it, but we now know that these fat cells are not just sitting around. They actually secrete hormones and they secrete cytokines. All these things put our bodies into a state of inflammation. We are still studying how that relates to osteoarthritis, but we do know that there are some specific cytokines that these cells release that actually worsens osteoarthritis and can make it move faster.

So when you lose weight, not only are you physically taking the weight off the joint, but you are also decreasing the amount of inflammation in that joint from the actual things that are being released.

I think a big thing with obesity treatment is that the original thought process with excess weight was that you just need to eat less and exercise more. While your lifestyle is a big part of things, it is not necessarily everything that is going on. I think that people need to know that there are other things that we can do together to be able to lose weight. And it may not be that you lose 150 lbs – it may be that you lose 15 lbs and that makes a huge difference in your life.

How has osteoporosis management changed in recent times?

There’s been some new developments and medications. It used to be that the only things that we had were poorly absorbed pills that you would take once a week or once a month. They caused all sorts of problems with GERD and GI issues. Over the years, we’ve come up with some different injectable medications that are better tolerated, have less side effects, and are maybe even easier for patients to take.

In the past, we used to only have medications that helped to prevent bone loss but now we also have medications that help to build up bones for people who are very high risk for fractures or who already have fractures. So we do all the normal things like Fosamax, Reclast, and Prolia for patients that need that, but we also use some of the anabolic medications like EVENITY™, which is the newest one. It’s a new, well-studied injectable medication used for women with osteoporosis after menopause at high risk for fracture. We were one of the first clinics to start using it. Our patients are doing really well with very few side effects and they’re improving their bone mineral density to the point that they’re able to do a lot more with less fracture risk.

Who should consider being seen for osteoporosis management?

Everyone! There are some special populations that especially benefit from getting a bone density evaluation.

First, if you’re a female and you’re postmenopausal, it’s highly recommendable to have a DEXA scan at some point, whether it’s with your primary care physician or a specialist. It’s important to evaluate your bone mineral density and make sure that you are on the right track.

Next, it’s important to look at bone density if you had a fracture that shouldn’t have happened. If you are walking along and your femur breaks, that indicates a problem because those bones usually require a very high impact in order to break. If this happens, then you probably need to have an evaluation of your bone health to make sure that things are okay.

If you’ve lost height, that’s a big one. Some people say that they’re shrinking. A lot of times people shrink because their vertebrae are actually collapsing, and they may not know it. Also, if you have a family history of osteoporosis, consider bone density evaluation.

And then if people have had bariatric surgery (gastric bypass) that puts you at higher risk for osteoporosis. Actually, any big shifts in weight put you at a slightly higher risk for bone loss, but there is something about the gastric bypass surgery itself that puts people at higher risk which the medical community is studying to better understand.

Osteoporosis is one of those things that there is no age limit or comorbidity of treating it. So if you are 95-years-old and you have Alzheimer’s, you may not want treatment for a lot of your comorbidities but a fracture will devastate your life and will definitely shorten your life, so it’s something that we consider treating in everyone.

What is your favorite thing about working at OOA?

I really like that the whole approach here is about being healthy. Our surgeons don’t do surgery unless you need it – they will never recommend a surgery just because you showed up in their office with an orthopedic issue of some kind. And our Sports Medicine providers are genuinely trying to help you get out of pain and do the things that you want to do.

I also appreciate that we have the opportunity to get out into the community more, which is important to me. I like everybody that I work with and I love that I’m able to do the things that I want to do practice-wise.

Can you tell me about the community outreach work that you do?

I do a lot of team physician work with the Tumwater High School athletes and it is definitely one of my favorite things to do. I’m at all of their football games on the sidelines in case of injury. I also see their athletes in their training room or at our clinic to make sure that they have resources to stay healthy and stay in the game. I do the same thing with Evergreen College as well.

These kids are just great. It’s super fun to sit on the sidelines and watch them play. They are all incredibly dedicated and are super respectful, which is awesome. It’s a fun way to get out into the community and be able to provide a service.

What do you want patients to know about your practice?

No matter why a patient is coming to see me, whether it’s for a sports injury or obesity management, I’m going to listen to them and figure out what their goals are. A patient’s goals make a difference in how I determine a treatment plan for them. If your goal is to run a marathon and you have certain injuries, then we’re going to treat things differently than if your goal is to garden and you have a different injury. It’s a very personalized approach of: ‘How can I help you in your life? How can I meet you where you are to get you to where you want to be?’

Since arriving in Olympia in the summer of 2018, Dr. Borders has used her time outside of work to eagerly explore the beautiful outdoor playground of our area, camping at Mount Rainier National Park and discovering Priest Point Park.

Did You Know?

Olympia Orthopedic Associates offers team physician services to local high schools and colleges. Our team of sports medicine physicians works alongside each team’s athletic trainers to keep young athletes healthy and in the game. Our services include attending home games to provide sideline support, providing follow-up treatment for sports injuries, facilitating safe returns-to-play, and educating athletes on healthy lifestyle choices.

Currently, Olympia Orthopedic Associates is proud to work and partner with the following schools:

  • St. Martin’s University
  • South Puget Sound Community College
  • The Evergreen State College
  • Olympia High School
  • Capital High School
  • North Thurston High School
  • Timberline High School
  • River Ridge High School
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