Using Nerve Blocks to Extinguish Headaches and Migraines

Dealing With Migraines So You Can Relax This Weekend

Migraines – they’re a real headache. After a long week of working we deserve to have some time off; and whether that’s having a lie in, a series binge on Netflix, or jumping into your overgrown garden and getting stuck into some horticulture – we all need to switch off a bit at the end of the week. We should have some escapism. But there’s nothing worse than your tranquillity being intruded on by a throbbing head pain that gets gradually worse. There’s a banging on one side of your head, like a nail been driven by a hammer and you feel a slight nausea. So much for your down time. Again, migraines, they can be real headaches. But not to worry, I can sort that for you.

Enter: Nerve Blocks

Medical science has transformed the usage of Nerve Blocks, which work a type of local anaesthetic, to treat migraines and headaches. The procedure is usually used for the treatment of pain, chronic pain, and complicated dental work. 

Peripheral Nerve Blocks are a reasonable option for many patients with headache disorders. The injection is administered with a syringe and needle that is utilized to inject nerves on the outside of the skull. Alternatively, a soft and minimally invasive catheter will deliver numbing medicine to a target bundle of nerves via the nasal passages.

The goal of this procedure is to temporarily numb the nerves in the periphery and consequently reduce the pain signals travelling to and from the central nervous system, and of course –allow you to watch Netflix and drift off in peace.

How Does the Procedure Work?

Your physician will usually take a few minutes to administer the entire procedure. Depending on your physician and the location of the migraine the anaesthetic may be injected directly to where the pain is manifesting itself. 

Thanks to this breakthrough procedure, no hair needs to be shaved – and all you will experience is a slight discomfort before your migraine completely breaks and you can enjoy the weekend you deserve. This procedure is especially beneficial for rescuing patients whose home medication has failed them.

If you are interested in Nerve Blocks to help you overcome a migraine, especially if your home medication is failing you, then make sure you contact your local physician. Alternatively, if you are local, you can find me at Mount Sinai’s Department of Rehabilitative Medicine’s Downtown office.

Spine Care: Strengthening the Core of Your Body

Strengthen Your Supporting Arch

If the body is a temple the spine is the supporting arch, but it should be treated like the sanctuary. That’s because the spine has more than a duty to keep the body upright. It’s more than just a bunch of bones as it homes the pathways of our central nervous system which allows our brain to communicate with everything else in our body. We should prioritize our spine’s health in our day-to-day life as lack of care can lead to physical discomfort and make us susceptible to future complications. Spine care is an everyday task that can be optimized with a few careful steps. This leads us straight into the crux and goal of this blog entry: keeping a good posture.

Keeping correct posture is the most difficult aspect of spine care, and it won’t happen overnight - although, you can get the process going immediately. Your spine wants to be in a slight S shape with your shoulders squared and your hip tucked in. Often, achieving this position is relatively easy, making it a subconscious and natural stance is where the difficulty lies.

·        For starters, imagine a string tied to the back of your head. Now imagine someone lightly tugging it back as if you were a marionette. Your head should be lifted and held high and proud.

·        Then, tighten your shoulders by pulling them back slightly (without puffing your chest out like a bird). They should be squared and back, not rounded and hunched.

·        Tuck your pelvis in using your gluts. Stand up straight and distribute weight evenly between both your feet.

At this stage, you may feel slight discomfort – if not – great, just keep practicing until it becomes your natural stance. If you are feeling discomfort, then read on.

I frequently explain to patients who visit me about posture and back pain at the Mount Sinai Center of Rehabilitative Medicine that their discomfort in standing straight usually stems from underdeveloped supporting muscles. Either this, or the pain they are experiencing is due to their body weight – and I’ll explain why.

For every kilo you lose, your spine frees 8 kilos worth of tension, which means that thinner people put less strain on their spine and heavier people put on more. But an exercise regime isn’t just about losing weight, in fact, that is just a bonus. The real benefit comes from strengthening the muscles that support the skeletal structure.

Think about it, there are plenty of athletes who would score high on the BMI scale for being overweight, consequently meaning their back should be under high levels of pressure, but do not suffer from back problems as their muscles are sufficiently developed to handle the extra stress. Once your muscles have been adequately strengthened, holding the aforementioned posture will no longer be uncomfortable.

The balancing act lies between being at a suitable weight comparative to your core strength. That’s why a focus on exercising the abdominals and lower back muscles will immediately reduce the impact the spine sustains throughout everyday life.

But of course, make sure your lifting technique is spot-on. There would be nothing worse than damaging your spine in your attempt to strengthen it. 

How Technology is Becoming More Human Than Ever

The word technology resonates with incompressible circuit boards, expensive gadgets, and the film i-Robot. Sometimes, we even consider it something to be feared (just think back to Y2K). But technology is defined as an application of knowledge for practical purposes – it doesn’t have to be complex machinery and computers. In fact, the best technologies aren’t the most complicated, but the ones that have the most impact. Touch Graphics is a perfect example of innovative technology that makes treatment accessible. These innovative revolutions are helping to reduce the impact of life-altering events, like losing sight.

 Touch Graphics focuses on technologies that enable the visually impaired to draw through low-tech, accessible, and affordable means. The project is predicated on the idea that when drawing, sight is needed to give feedback to the artist. You must visualize where your pencil has been, and where it is going to go to complete a coherent piece. If the drawer cannot see or visualize at which point they are at, it becomes difficult to locate where the next stroke will go – and even mean that they cannot experience their project upon completion.

In the past, this has meant the visually impaired were unable to draw. The Touch Graphics project has revolutionized this principle by using tactile feedback. It is somewhat similar to braille. A person can learn to draw by using styli and paper – using feel to see their drawing – opposed to sight. As their instrument passes over the paper, the styli beneath raises, allowing the artist to explore their work and decipher the next point of contact without sight. They can visualize the piece, which empowers hobbyists and born-to-be artists to engage with art, in a way which was otherwise impossible.

 Anyone with good motor skills in their fingertips can learn to use this set-up. In bringing tactile sensation to the perceptual foreground, vision becomes effortless. It has shown to become a highly refined skill with practice. The set-up is affordable due to materials being easily accessible for everyone. A perfect example of technology being intelligent innovation – and fit for purpose.

 Touch Graphics, inc focuses on products that communicate spatial information through the sense of touch for use by visually impaired. They are featured on https://www.cooperhewitt.org/ an organisation which curates a myriad of designs that enable people in the artistic field. If you have a story to share, drop me a comment or retweet – I’d love to hear what you think.

Dr Spinner's Top Tips for Hitting A Home Run

Most things are easier said than done. Hitting a home run is no different. There are two key aspects when trying to become a Yankee superstar. Firstly, you need to hit the sweet spot -  and secondly, you need to hit it hard. Hitting the right spot is achieved by the movements I’m going to outline below. The great thing is, good technique will inadvertently make you hit the ball harder as well. By following these instructions, you won’t waste energy, and your entire swing will focus your power on the bat.

Get Comfortable

Identify if you feel more comfortable with a narrow or wide stance when getting into position. Your knees should be inside your feet and you should be looking at the pitcher (who is about to get a shock when you smash his ball out the park). Your feet and body should be facing away from the pitcher at a perpendicular angle, with your head turned facing the pitcher.

Negative Mode

Next, we go into the Negative Move. As the ball approaches and you begin your swing, load your weight onto the back foot (remembering to keep the knees inside the feet). The bat should be slightly behind but parallel with the shoulder. As the ball approaches, you want to dip into negative mode before shifting your weight forward.

Spin the Back Toe

Now we shift our weight onto the toe of the foot. As the ball approaches get onto the toe of your front foot releasing the weight from your back foot. Your weight should be shifting from back to front. As your front heel goes down your back knee should start to turn – ending with the laces pointed toward the pitcher. You should be doing this alongside the bat movement. 

The batters laces are facing the pitcher.

The Journey Begins

The bat should find itself coming from that starting position (parallel to shoulder), through the body motion, and hitting the ball with the shortest distance traveled from the starting position. All of your energy should be focused on shifting power through this small point. With practice, your feet, torso, and “third arm” will all move in harmony making for a high-intensity swing that pumps all your power into that one little point between your bat and the pitcher's ball. 

Following Through

Once the ball is hit, the journey isn’t over. You need to continue to bring the bat around and end with it behind the front shoulder. Following through is key in all sports – from baseball – to soccer – to football. Any motion that requires maximum power (like a free kick in soccer) requires the player to follow through with their foot (or whichever limb). This allows the player to exert all their power through the ball.

Start Slow

All good things take time. Get the technique right before you exert all your force into a shot. Slowly build up using power in your shot so that your body has the correct mechanics and muscle memory. Hitting a home run requires patience both during a game and in training. After some practice, you will master the solid path to the baseball.  

Practice Practice Practice

Batting is difficult because it requires your whole body to synchronize and rally its effort through a foreign object – i.e. the baseball bat – which becomes an extension of the body. Ensuring the upper body and lower body works together is key to hitting a home run. 

Practice is the key to learning how to shift your weight with the upper body movement while the ball flies toward you. There are three things going on, it’s a lot to take in. As you repeat the motion again and again, your body begins to remember how it should behave without you telling it what to do and your swing becomes second nature. Your knees know to not step outside the feet without you thinking about it and you won’t overshoot your back foot's twist. When you do all these things without thinking, you’re on the money.

How Can You Cope With Male Pelvic Pain?

Dealing with Male Pelvic Pain

 Male Pelvic Pain is a generic term given to chronic pain in the groin, the prostate and surrounding areas of the pelvis. Its genesis varies and is generally considered a symptom. The pain can be a symptom of orchialgia, from a prior surgery around the testicles and penis, and patients who have recently had penile implants. Using neuromodulation and nerve blocks we can sever the ties between the pain receptors and the brain which will numb the pain. Let’s take a deeper look into the more common manifestations briefly aforementioned before delving into medical science’s response to it.

What is Male Pelvic Pain?

Prostatitis

The prostate is a walnut sized gland that sits in front of the rectum – just below the bladder. It has the responsibility of making a part of the fluid required for semen. Prostatitis is an infection or inflammation of the prostate and is the most common urologic problem in men younger than 50. It can cause painful urination and ejaculation – and is commonly conflated or confused with other urinary tract infections. Prostatitis may not be associated with bacterial infections of the prostate.

Orchialgia

Orchialgia is the name given to long-term pain of the testes considered chronic if the pain persists over three months. It could be caused by injury, surgery, cancer, or testicular torsion – and is a possible complication of a vasectomy.

Inguinal Hernia

A hernia occurs when an internal organ pushes blood through an area that has damaged or weak muscle. Muscles are usually strong enough to keep organs in place, a hernia develops when there are weak spots. An inguinal hernia is the most common type of hernia – and appears as a swelling or lump in the groin. The swelling can be incredibly painful and will often protrude when lifting something and retract when sitting or lying down.

Surgery hopes to push the bulge back into place and strengthen the weakness in the abdominal wall, however, can cause serious pain to the pelvic area.

Penile Implants

A penile prosthesis is an optional treatment for men with erectile dysfunction. There is a myriad of distinct types of prosthetic from malleable rods to a pump connected to the system, connected under the loose skin of the scrotal sac between the testicles. This surgery can sometimes lead to chronic pain in the penis area.

A Solution to Male Pelvic Pain

Advances in medical science have meant we can deal with acute and chronic localized pain in Male Pelvic Pain regardless of the cause. 

Nerve Blocks

During an episode of chronic pain, a group of nerves called a plexus or ganglion sends pain signals to the brain. This pathway can be blocked using Nerve Blocks – an injection of medication that numbs a specific region of the body from picking up pain signals. The brain will not receive signals that the area is in pain which stops pain.

Therapeutic Nerves Blocks can be used to treat more painful conditions. These blocks contain local anaesthetic than can control and relieve a localized pain.

Sympathetic Nerves Blocks can be used to determine if there is damage to the sympathetic nerve chain which serves as a diagnostic.

These can be used after, or in lieu of, surgery.

Neuromodulation

Neuromodulation is the process by which an implantable wire is placed onto the nerves carrying the electrical transmission of pain and thereby reducing the painful firing of those nerves.  This is a very common approach to alter the nerve activity.  The process normalizes or modulates nervous tissue function. Subsequently, neuromodulation minimizes symptoms of Male Chronic Pelvic Pain by lessening the number of painful neurons fired. 

If you are interested in tackling Male Pelvic Pain with one of these minimally interventional methods, contact us to discuss a plan.

Pregnancy Related Musculoskeletal Pain

How To Deal With Pregnancy Related Muscle Pain

Pregnancy is an exciting time for any woman or family, but it brings with it many anatomic and physiological changes that can hinder a woman’s quality of life. During pregnancy, many women suffer from musculoskeletal pain due to the intense changes the body endures throughout the process, this includes but is not limited to: arthralgias, back pain, separation of the pelvis, transient osteoporosis, and tendonitis. This month, we’ll explore how we can manage the pregnancy-related pain while limiting the use of oral medications.

Women usually gain in the range of 25-35 pounds during pregnancy. A shift occurs in the woman’s centre of gravity. Hormonal and biomechanical alterations strain the axial skeleton and the pelvis which are pivotal in maintaining good posture. The body’s adaptions can overload a normally well-designed system, which causes acute pain and possibly chronic pain.  Symptoms vary from person to person, but commonly patients experience pain, fatigue, and sleep disturbances.

Traditionally, treatment includes some oral medications including nonsteroidal anti-inflammatories (NSAIDs).   Patients who have trouble sleeping are often provided medications that modulate sleep and pain.   However, during pregnancy, the uses of oral medications is often limited as many medications can cross the blood-brain barrier and affect the foetus. 

Specialized physical therapy programs can focus on stretching, strengthening, bracing and the use of modalities such as heat, ice and massage to ease the pain.  We can also use the same ultrasound technology your obstetrician uses to see the baby to diagnose many of musculoskeletal disorders that arise during pregnancy.  We also utilize this same technology to provide accurate guided injections to provide relief for moderate to severe pain.   

We’ll focus treatment on limiting oral medications, working mainly with the right physical therapy and offering an ultrasound-guided (non-radiation) approach to interventions when necessary.

Reclaiming Your Life From Knee Injury

How Can Medical Science Put A Stop To Knee Arthritis?

Arthritis in the knee is caused by an inflammation of one or more joints around the femur, patella, and tibia. The joint will become painful, and gradually get worse if not attended to. This medical problem can be down to your genetics or lifestyle – long periods of not moving or heavy loads on the knees being the most common culprits. Patients tend to struggle with mundane tasks like walking up the stairs and bending the knee. Thankfully, with progressions in medical science, we have a promising treatment for knee arthritis - stem cell injections.

Stem Cell procedures consist of taking cells from your own body and using them to create more cells. Cells live in all tissue and can be poised to fix existing damages to the body. A top cure for arthritis is to renew the cartilage that separates the bones, which will (often alongside physiotherapy) bring you back to fighting fit health – alongside preventing any more troubles this lingering problem will cause.

But what exactly is knee arthritis? The knee is cushioned from impact by smooth and slippery substances called cartilage. This substance acts as a shock absorber and stops the bone from eroding. Arthritis is a condition in which the cartilage begins to wear away – a biological “wear-and-tear” – reducing the space between the bones. The result is painful, reduces the capacity of the knee, and chips away at surrounding bone, producing bone spurs.

Arthritis in the knee is a symptom of lifestyle, genetics, or a combination of both. You could be unlucky and have it hereditarily, or develop the problem from things you do. Playing sports and working jobs that have a heavy impact on the knees are often the genesis of this problem. Surprisingly, arthritis in the knee often worsens from lack of knee activity alongside an overload of activity – like heavy squats. Sitting with the knee in one position for prolonged periods of time can cause the arthritis to form, or worsen underlying issues.

As the symptoms get worse, it gets gradually more difficult to walk up the stairs, play sports; and can have a detrimental effect on your work and your quality of life. Imagine, every time you use your knee – you are causing more damage to it, as the bones continue to wear away at each other. Knee arthritis can be a slippery slope, once it begins – it can worsen to extreme situations where the cartilage completely erodes.

Thankfully, medical science can rescue us from this predicament.

Cells are harvested from the body – usually from a vein in your arm, and a sample of bone marrow will be taken (usually from the hip). The cells are then separately prepared before being re-injected into your body. Regeneration of the cartilage will mean you can resume sports, start walking normally again and give you the ability to reclaim your life.

A Game Changer – Spinal Cord Injury

How To Prevent Spine Damage

Since an early age, I have always been an avid sports enthusiast. It was this interest in sports over the years that directed me to my current interest in sports injuries and other related fields of musculoskeletal medicine. So many careers, amateur and professional, have ended with an unfortunate knock to the spine. But injuries don’t just happen on the field. Often, it’s the seemingly trivial things, like the way we sit, that can augment damage during impact. A knock to the spine can gravely affect a person’s quality of life. However, a knock to a strong spine is not going to cause as much damage as knock to a weak spine. I want to walk you through what spinal cord injury is, how it can happen, and some damage-prevention tips.

Put simply, spinal cord injury (SCI) is damage to the spinal cord. But damage to the spinal cord is an extremely serious physical trauma. This is due to the role the spine plays in the body’s function. We can think of the spinal cord as the body’s “courier system” – it is a series of nerves and other tissues that send messages to the brain. This “system” is protected by the vertebrae, the outer bones that are more commonly associated with the spine. If the spinal cord is injured, either the bones or the nerves, some of these impulses may not be able to reach the brain. This results in complete or total loss of sensation and mobility below the injury. If the injury is closer to the neck, there is a substantial risk of complete paralysis or lack of mobility.

I could (and won’t) sit here all day listing the assorted reasons people come to me with spinal cord injuries. But, I can quickly outline the more common: these include, motor vehicle accidents, bad falls, acts of violence, sports related injuries, alcohol, and diseases (such as osteoporosis and arthritis). Unfortunately, most of these are outside of our locus of control. I could recommend that you wear a seat-belt, that you don’t engage in violent behaviour, or abuse alcohol - but that wouldn’t be helpful, as you probably already know that. What I can offer here is some tips to help keep your spine strong, so, if you do encounter a grave knock to your spine – you will be in the best position to recover, and sustain as little damage as possible.

Again: a hard knock to a strong spine will cause significantly less damage than it would to a weak spine.

Top Tips On Maintaining A Healthy Spine

1)     Exercising regularly is a fantastic way to keep your spine in great shape by helping maintain a stable weight, and helps reduce stiffness and tension in the spine. I recommend a mix of aerobic and anaerobic exercises. Importantly, when weight lifting you should maintain a balance between your chest and back, an overly strong chest on a weak back can cause serious back problems, and vice-versa.

2)     Maintain a healthy weight. Being overweight puts excess strain on the spine and can weaken the spinal column which makes a heavy impact (like a car crash) even more dangerous. Fat accumulation in the abdomen is especially detrimental as it can cause bad posture. There is a strong association between the premature wear of the cartilage that protects your “courier system” and being obese. So, make sure you stay on top of your weight.

3)     Eat healthily. These seems obvious from the last two points, but eating healthily not only helps maintain a stable weight, but also gives the body the nutrition it needs to help the spine do the job it needs. Vitamin D (which you can get from the sun) and calcium (which you can get from milk) are two key nutrients that help conserve bone strength and density.

4)     Improve your posture. A good posture, both walking and when resting, is a great preventative step to lessen stress on the spine. It facilitates weight distribution and keeps the vertebrae and discs in the correct position.

5)     Stretch. I especially direct this one to those of you who are in front of a computer screen all day. When at work, take time to stretch out your body every half hour to an hour. Even if you have great posture, staying the same position for extended periods of time usually causes tension and stress on the spine.

As I explained, SCI can occur from a vast quantity factors and there is only so much we can do in preventing damage to the spinal cord. We can’t prevent things outside of our locus of control, but we can ensure that if something does happen, we are in the best situation to combat it.

Maintaining a strong spine is the best preventative step to avoid SCI. Maintaining a strong spine could be the deciding factor between a life changing accident, or manageable spine damage. Sports are a fantastic way of maintaining a healthy spine - a game of tennis or a quick gym session before work can do miles for helping your spine stay strong and healthy.

How To Cope With Spinal Cord Injury Pain

Using A Dorsal Column Stimulation For Spinal Cord Injury Associated Pain

Back pain is extremely common, it affects most people; fortunately, it usually goes away on its own accord after around six to twelve months. But for some people, chronic back pain is a lifelong struggle, and severely hinders lifestyle choices. We have a solution, one that means you will no longer wake up and realize you will not be able to attend your kids band rehearsal, make that perfect that golf swing, or make a coffee appointment with an old friend. With Dorsal Column Stimulation (DCS), we can squash these problems for you. Say hello to your new life.

DCS is a neurostimulation transmitter that works by intercepting nerve endings’ pain signals before they reach the brain. In more simple terms, pain originates in transmitted signals from nerve endings that pass up your spinal column - DCS intercepts these signals and transposes them. The brain receives a more pleasant signal in lieu of pain. Patients describe this feeling as a gentle massaging, and others as the absence of pain.  

The minimally invasive surgery works firstly by making a small incision in you back, and placing the medical wires (leads) that deliver stimulation into the epidural space of your spinal cord. The second incision creates a tiny pocket under the skin that is large enough to hold the neurostimulator. Finally, the physician will connect the leads to the neurotransmitter. The parts are designed to work together to manage pain, and come with chargeable and non-chargeable batteries, usually placed inside the buttock or abdomen. You will be handed a small handheld device to give you full control over the pain signals, and allow you to manipulate the sensation. And with this, the surgery is complete; and you can begin planning your new life.

During the first few months, it is advised to not lift heavy objects, involve yourself in physical activity – or any movements that involve twisting, climbing, bending etc. You should look at this  as a recovery time, or better still, a space to plan your new life. Most patients report that their lives have never been better.

DCS has helped thousands reclaim their lives.

Dr Spinner can perform the surgery at Mount Sinai, NYC. With all that has been said, only your doctor can tell you if it right for you. There are some conditions where this surgery will not work. If you wish to see Dr Spinner, or would like to learn more, please contact our switch board at: (212) 724-6362

Dr David Spinner, Mount Sinai