Surf Cat

 Added on December 12, 2019  Kevin Cody  Manhattan Beach , newsletter

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Dr. Brad Thomas in his surgery center at Beach Cities Orthopedics and Sports Medicine.
Photo by Brad Jacobson (CivicCouch.com)

by Kevin Cody

Brad Thomas moved to New York City in 1995 to begin his residency in orthopedic surgery at Montefiore Medical Center/Albert Einstein College of Medicine.

He arrived with a backpack, a skateboard and a surfboard. After finding a room in the Bronx he went looking for surf.

At 27, he was still uncertain about his direction. The ocean exerted a strong pull on him.

“I was surrounded by cement, dirt and heat and going stir crazy. So, on the fifth day, I walked down the street, found a car for $800 and drove off in the direction I thought was the beach,” he recalled.

He ended up taking a ferry to Fire Island.

“There was a freak two- to -three foot swell. I paddled out and for the first time since arriving in New York, I felt free. I caught a wave to the beach and was paddling back out when a lifeguard yells over a bullhorn that the beach is closed due to the large surf.

“I yelled, ‘I’m from California. I can swim. Come join me.’”

The start of his residency coincided with the start of the Atlantic hurricane season. 

“It was freezing and wetsuits weren’t good then. Also, surfing hurricane waves is tricky because the intervals are really short. So I surfed mostly by myself, at Monmouth Beach in New Jersey before it became known, and all over Long Island, which can get really fun.”

That winter Thomas discovered he didn’t need to choose between the operating room and the ocean.

Today, Thomas is known internationally among surfers, paddlers, and volleyball players as the “shoulder and knee doc.”

He’s also a respected big wave surfer and paddler. In 2011, at age 41, he won the Catalina Classic, a 32-mile prone paddleboard race from Two Harbors on Catalina Island to the Manhattan Beach pier. Other names on the Catalina Classic perpetual trophy include legendary watermen Tom Zaun, Rick Grigg, Kip Jerger and Jamie Mitchell.

Thomas has performed an estimated 12,000 shoulder and knee surgeries, putting him well over the 10,000 hour threshold identified by writer Malcolm Gladwell as the hours needed to become a world class practitioner.

He has put a similar number of hours into surfing, but dismissed the idea that the two are complementary skills.

“I’m not sure why I became a surgeon. Surgery is not like something I was good at as a kid,” he said.

But then he added, “The one constant in my life has been surfing and the ocean. I grew up wanting to be Mike Doyle even though most of the time he didn’t have a dime. My family had a place near his in Cabo and I spent a lot of time talking to him about surf spots, paddling, training, and what it’s like to be alone, five miles out to sea.” 

Doyle finished second in stock and fifth overall in the 1960 Catalina Classic. His autobiography Morning Glass, published in 1993, is to surfers what Jack Kerouac’s “On the Road” is to other alienated youth. Doyle was inducted in the Hermosa Surfer Walk of Fame in April 2013 and passed away this past April.

Thomas met Doyle through his dad Don, the founding editor of Surfer magazine. Twice a year, and some years more often, he took his family on surf trips to Baja and mainland Mexico. Thomas’ dad quit as Surfer’s editor in the mid 1980s to work in the sailing industry, in preparation for what became a 14-year retirement aboard his Peterson 44 sailboat “Tamure” (a Polynesian dance). Thomas crewed for his dad on the initial leg of his retirement cruise, from Newport to Ensenada, and frequently joined him when “Tamure” made port in Central America and the Caribbean. The surf trips, supplemented by high school and college Spanish classes, gave Thomas fluency in Spanish.

Among the tight knit family friends who lined up their rainbow chairs every weekend on Monarch Beach, in Dana Point, was an orthopedic surgeon named Dr. Waters.

“I called him Dr. Pepper because he always had a Dr. Pepper. He surfed, dived, skied, and sailed a Hobie Cat off the beach. Whenever a kid got hurt, our parents would march us over to Dr. Pepper’s,” Thomas said. 

Dr. Pepper’s home was on the bluff overlooking Monarch Bay. 

Brad Thomas at the surfboard shed down the hill from his home overlooking the Santa Monica Bay. Photo by Kevin Cody

“In high school I thought, I wouldn’t mind being like him. I loved science and didn’t find it hard. So there was a natural progression to my studying biology at UC San Diego.”

Thomas swam and played water polo in high school and at UCSD, where he became an NCAA All American swimmer. Then he went to the University of Southern California for a medical degree.

Today, at 52, he maintains the overdeveloped lats and deltoids that give swimmers their broad backs and speaks the high-pitched, nasal voice common to surfers. 

Five years in New York City, instilled in him an appreciation for city nightlife. So instead of returning to Orange County after his residency, he moved to Manhattan Beach to be close to both the ocean and the clubs in downtown Los Angeles.

“I lived on Alma and then Vista and surfed 28th Street because it wasn’t crowded. The friends I met there are still my friends today,” he said.

His fellowship, in 2001, was at the Southern California Center of Sports Medicine in Long Beach.

“I was lucky to train under Dr. David Morrison, who had trained under Dr. Charlie Neer, the ‘grandfather of shoulder surgery’,” he said.

“I did 900 surgeries that year. Every day we did surgery with two training docs and two experienced surgeons.”

“I believe in surgical specialities. Mine are shoulders and knees, both still very much an art. 

Following his fellowship, Thomas joined South Bay Orthopedics in Torrance.

“I put my head down and worked there for seven years. In the end, we had differing visions. I was always pushing innovation. Let’s get an MRI, let’s get athletic trainers in the office.”

In 2008, he joined fellow waterman and orthopedic surgeon Bill Mealer in opening Beach Cities Orthopedics in Manhattan Beach.

They began with five employees and 10 years later have 170 employees, among them 11 surgeons, whose specialties include hand, spine, hip and diabetic care.

In 2010, Beach Cities Orthopedics opened a second office in Torrance. Next year it will open a third office in San Pedro. Thomas describes himself as a hands on owner, down to the designing of the center’s offices. He devotes his lunch hour to management meetings.

For both practical and philosophical reasons, Thomas and Mealer have resisted the trend to join  hospital-owned medical practices.

“Physicians who join hospital-owned practices have high satisfaction rates for the first six months. The pay’s better and the workload is less. There’s no billing or personnel to deal with. But then an administrator starts telling them what to do. Who they can see and when they can take vacations. Physicians are typically altruistic. We do free stuff all day long. Can’t afford a brace? Take it. Your grandmother needs to see a doctor. Bring her in. Do you think they’ll let you do that at a hospital-owned group? They’ll take a patient’s house as soon as let them be seen for $50.”

“I’m a massive believer in physician-managed health care, versus health care managed by executives. Where decisions are made in the best interest of the patient, not the bottom line.

“We’re cheaper, faster and quicker to adopt new technologies. 

BCO was the first specialty orthopedic practice in LA county to use in office ultrasound for diagnostics and guided injections, and the first two-man orthopedic group in the country to buy a 1.5 Tesla MRI. It was also the first in Southern California to use 4K [ultra high definition] video for arthroscopic surgery, Thomas said.

“Hospitals typically charge three times or more what we charge. We charge $500 for an MRI. Hospitals charge $5,000. So, instead of a $125 copay, your hospital copay might be $1,500.

“I had a woman call Friday with acute back pain. Her hospital physician told her it would be three weeks before she could be seen and three months before she could get an injection. We scheduled her for Monday.

“We see people on the Canadian health plan who can’t wait six months to get arthroscopic surgery.”

But resisting hospital overtures comes at a price, he said.

“We are unfortunately excluded from hospital referrals, which has been a bit painful for our business. So we drive our own referrals through excellent outcomes and word of mouth.”

Last year, to ensure access to operating rooms, and to be able to offer outpatient surgery for joint replaceent patients, Thomas and Mealer opened their own surgery center at their Manhattan Beach office. 

“Because we have our own surgery center we can schedule efficiently. And because we don’t do ‘dirty’ surgery [involving patients with infections], our operating rooms are always clean.”

Thomas acknowledged hospitals are necessary for patients whose needs exceed the services of a specialty clinic, such as cancer patients who require a care plan involving multiple physicians and therapists.

But he believes the trend will swing back to physician-managed practices.

Thomas typically performs surgery on Tuesday, Thursday and Friday mornings. Patients who undergo shoulder or knee replacements go home the same day.

Outpatient surgery reduces a patient’s exposure to infections, blood clots and swelling that can result from time spent in a hospital bed, Thomas noted.

“People who walk on the day of their hip or knee replacement have 50 percent fewer complications.” 

Outpatient shoulder and knee surgery, he said, has been made possible in part by advancements in anesthesiology. Lidocaine [a pain killer], which used to last 12 hours, now lasts three days, he said.

Both shoulder and knee surgery last approximately 1.5 hours and require “substantial cuts.” 

“A shoulder replacement is indicated when cartilage between the arm and shoulder socket deteriorates. Cartilage is a protective surface. The shiny white stuff you see on the end of a chicken bone is cartilage. When it’s damaged, you get bone on bone, which is painful and limits motion. We replace the cartilage with metal surfaces bolted to the glenoid (shoulder socket) and the humerus (arm) bone. Then we bolt a plastic spacer to the socket because metal on metal would shred.”

Knee replacements involve a similar procedure, but are complicated by the need to push the kneecap out of the way. 

Both operations, he said, reconstruct the ball and socket joints, so the ball is round and the socket smooth.

Like tooth enamel and unlike muscles and tendons, cartilage does not regenerate. Age compounds cartilage problems because with age comes loss of  elasticity and fewer cells to renew tissue, Thomas said.

“If you are hard on your joints in your teens and early 20s, you’ll have cartilage damage that will worsen over time,” he said.

He numbers himself among this group. His left shoulder is subject to soreness from water polo and years of surfing. He manages it with ice and exercise. But surgery may become necessary, he acknowledged.

Damage to joints “comes down to mechanics,” he said. “The arm is three feet long. A tennis racquet is two feet. That’s a five foot lever bearing down on the rotator cuff’s two inch tendon.” 

“I cringe when I see high school volleyball players hit balls with their elbows at full extension. Give up an inch or two in reach and they can engage the deltoids and biceps to protect the rotator cuff from absorbing the full shock of hitting the ball. Rotate the torso and they can use their whole body to increase power.

“I see a lot of youg baseball players with Little Leaguer pitcher’s elbow and Little Leaguer’s  shoulder. They’re whipping their arms to throw. I put their throwing hand in the shot put position and tell them to throw the ball from the mound to the plate. The only way to do that is to engage the legs and torso. Using the power of the torso and legs translates to almost all sports.”

Thomas advises paddlers to utilize a swimmer’s long, high elbow, early vertical forearm (EVF) stroke to maintain the board’s momentum.

“Oh yeah, and enjoy the pain,” he added, (referring not to the pain of an injury, but to the pain of sustained exertion).

Thomas is one of 10 master instructors in the Arthroscopy Association of North America (AANA). Each year, they teach classes at AANA’s cadaver laboratory in Chicago.

“Bailing out novice surgeons puts you in places you’d never want to find yourself in. Plus, the other instructors push you to attempt difficult techniques, which I enjoy. I enjoy competition,” he said. Because of his proficiency in Spanish, he often finds himself assigned to work with surgeons from Mexico and Central America.

Thomas describes Beach Cities Orthopedics not as a surgery practice, but as a muscular and skeletal practice. 

“People think because I’m a surgeon, I just want to operate. But I just want to get you better.

Our goal is to restore our patients’ ability to walk, reach and lift, to be able to surf, ski and play volleyball again.

“Over the years, we’ve added non surgical services. We have pain management specialists, chiropractors, acupuncturists, massage therapists, and a primary care physician.” 

In 2014, Thomas and Mealer opened Health & Wellness Center @ BCO to offer less conventional, holistic medical services. These include Cold Laser therapy for pain relief, sports taping to speed muscle recovery,  EMSculpt, which uses electromagnetic current to strengthen muscles, and LED light therapy to heal wounds.

“Instead of a traditional patient physician relationship, I want a client physician relationship. Instead of the front desk handing you a clipboard, our receptionist welcomes you with, ‘Hello, how are you.’ We didn’t look for a receptionist with a medical background. We hired a person from LuluLemon, where my wife was a manager.”

Thomas, his wife Jennifer and four children live in an old home on the bluff above Torrance Beach. South is a whitewater view of Haggerty’s, a popular left surf break on the southern end of the Santa Monica Bay. At the northern end of the Bay, (through a telescope), swells can be seen rounding Point Dume. Behind the house, a switchback hacked through sagebrush and manzanita winds down the steep bluff to the beach. Midway down the trail is an old tool shed with a tree growing through it and a dozen, locally shaped surfboards inside. ER