Before ultrasound became a revolutionizing staple in the field of pain medicine, some brilliant, forward-thinking doctors used X-Ray (fluoroscopy) to add vision to their pain injections. But with these tools came drawbacks. Firstly, while fluoroscopy is excellent for viewing bones and spread of contrast, they do not let us see the intricate detail of muscles, tendons and ligaments. Secondly, they emit radiation, which means that they should only be used on an ‘as necessary’ basis. In our effort to provided safe, accurate and effective injections, about 10-15 years ago our field began using ultrasound to make major improvements. Not only is it 100% safe, ultrasound immediately transformed pain medicine patient outcomes.
Way before I became I pain physician I was acutely aware of a particular maxim: an ounce of prevention is worth a pound of cure. Despite its triteness, in this expression I found unbounded wisdom: wearing knee pads while rollerblading averted nasty knee cuts and ripped jeans, while a napkin in my lap discouraged tomato sauce stains. Back in my own days as an athlete – a batting helmet defended my skull from menacing fastballs. These days, this aphorism’s weighs heavily on my shoulders when I am confronted by yet another patient who is an athlete with an injury resulting from poor to complete reckless abandonment of sports nutrition. Many such patients have suffered muscle injuries and/or severe cramping that has resulted from dehydration, electrolyte abnormalities and/or potassium and magnesium deficiencies. This is not just frustrating because these kinds of injuries are extremely avoidable through a proper sports nutrition-inspired diet, but also failure to acquire the full range of protein, carbohydrates, micronutrients and vitamins an athlete requires will severely limit the ability to reach maximum performance. To put it in laypersons terms, without sports nutrition athletes will increase the likelihood of debilitating injury and will also be actively hampering their ability to perform to their full potential.
If you are considering back surgery because of a pain issue, it might not even be the most expedient treatment for you as it will not always alleviate or mitigate pain. Unless your back issue is neurological or an instance of instability of the spine, surgery simply is not your best course of treatment. If you suffer from muscular or myofascial pain, lumbar facet arthropathy or lumbar disc herniation, amongst other back pain issues, your best bet is to treat your back pain without surgery. Read my blog for the full details of the non-surgical treatments I recommend.
Musculoskeletal Ultrasounds (MSUs) are my go-to when attempting to pin down an issue that we don’t believe to be bone related. That means they are perfect for diagnosing muscle, tendon, and ligament injury – as this dynamic investigative and explorable procedure tells us in seconds the make-up of your musculoskeletal system. We have found that MSU has been pivotal in helping diagnose sports injuries and others who find they are in pain when they move a joint. Traditional analysis like x-rays and MRIs take static images where MSUs create dynamic images in motion. Let’s explore that some more.
We’re living in unprecedented times. The spread of COVID-19 across the world means that healthcare facilities are under pressure like never before. Governments are doing everything they can to reduce this burden, including urging people to stay home unless it’s absolutely necessary to go out. But what does this mean for those of us who need access to a doctor?
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.
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
