Yes that is a big dilemma. Basics....miltonias/miltoniopsis have very fine numerous roots and because of this crowded condition can, and do, get root rot easily. Orchiata is a fairly long lasting media and may still be ok tangled in the roots (you don't have to get every single piece out but get out as much as you can). But eventually it will be nearly impossible to dry it out without severly drying the roots. If this is a valuable plant (one you really enjoy) then take the time to get as much old media out of the rootball as possible. Or......you can simply turn the plant over, spread the rootmass as wide as possible put an inverted air cone pot on top of it turn it over and pot it. But I would spend the time necessary to get as much of the old media out as you can. I use tweezers and just slowly comb through the roots from one end to the other.
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