At this time of the coronavirus (Covid-19) outbreak, we wanted to keep you informed of our continued commitment to the highest standard of infection control.
As are most people throughout the country, we are closely monitoring the current situation and following the updated guidance from the CDC (Centers for Disease Control), WHO (World Health Organization) and state health departments. As this situation evolves, we are dedicated to ensuring that our patients, staff and their families are in a safe and healthy environment.
We are maintaining our strict infection control protocols, which include cleaning and disinfection of all areas of our facilities and good hand hygiene practices.
We have implemented a pre-screening process for our patients and encourage their drivers to wait in the vehicles during the patient visit as part of the “social distancing” recommendation. Social distancing involves maintaining 3 to 6 feet (preferably 6 feet) distance from others and limiting interaction with the community.
If you have any flu-like symptoms, fever, difficulty breathing and/or cough, or have had close contact with someone who has, we ask that you refrain from coming to the office and call us. If you have recently travelled through large airports or on mass transit (bus, train) or have had close contact with someone who has, please call our office before arriving for your appointment. Some things you can do to help protect yourself and others:
• Stay home and limit your contact with others
• Wash your hands frequently with soap and water for 20 seconds or use hand gel
• Cover your cough with your elbow or tissue and sneeze with a tissue
• Clean and disinfect frequently touched objects in your home (cellphone, etc.)
• Do not travel when sick
We again want to reassure you that we are committed to ensuring a safe and healthy environment for our patients and staff, and look forward to seeing you at your appointment.
If you would like more information or have questions, the states of Wisconsin and Michigan have set up hotlines that you can call. There is also information available from the CDC at CDC.gov/coronavirus/2019ncov.
Wisconsin – through the University of Wisconsin - (608) 720-5300
Website – dhs.wisconsin.gov/covid-19
Michigan – 1-888-535-6136 8 am to 5 pm (Eastern Time), 7 days a week
Website – Michigan.gov/coronavirus Donna Collins, RN ASC Manager / Infection Control Director
Donna Collins, RN
ASC Manager / Infection Control Director
Have you every watched gymnasts bend backwards? Then run, leap, summersault in the air, and twist and stick the landings with two feet!? It’s incredible. Their arms and legs providing power. Their backs allowing for those highly controlled adjustments in the air. Those slight bends in the spine, at each vertebra*—at least amongst the 24 bones with movable joints—allow for the astonishing mechanics of a human body flipping in the air, and then landing without injury. Would you believe that the ability to do this relies on a tiny joint, smaller than a dime, connecting two stacking vertebrae on both the right side and the left side?
The facet joint is marvelous. It’s not a flat joint, like the intervertebral joint that has a top facing directly up and the bottom facing directly down. Rather, the facet joint has a slight angle, and this allows the parts of the vertebra that stick out in the back—kind of like ears—to slide a little. When this is repeated over each joint, the effect is a smooth curve of the entire back—to either the right, left, backward or forward—without having to create a severe angle at any one joint. And that’s extremely important since this protects the spine from severe injury, and the spine is what houses the spinal cord, which communicates everything between the brain and the neck down.
Unfortunately, like all joints, injuries can cause tiny tears, either along the ligaments connecting the bones or the tissue in between. If these tears don’t heal properly, leading to more inflammation, the nerves nearby may continue to communicate that there is an injury, leading to a persistent pain sensation. A specific nerve along the facet joint, called the medial branch nerve of the dorsal ramus of the spinal nerve, is a little famous amongst interventional pain specialists because it processes both proprioceptive innervation and nociceptive innervation. This means it detects where our bodies are in space, as well as pain. And so small injuries or degeneration to this area can lead to both disability and pain.
After a good physical and neurological exam, a common way for an interventional pain specialist to know whether this nerve might be a source of chronic pain is by doing an anesthetic block. This is short-term pain reducing medicine that is injected along side the nerve and facet joint, under low dose x-ray guidance. It’s a diagnostic procedure. If the patient has improvement in their pain symptoms afterwards, then physician and patient can discuss more permanent pain relief options, like using strong anti-inflammatory medication or radiofrequency ablation.
*Vertebra means a single back bone, and vertebrae means more than one back bone
Many people suffer from a condition commonly known by the name “whiplash injury”. This condition is caused by a sudden acceleration/deceleration of force; the head and neck are hyper extended when whipped backward and immediately following, the head and neck are thrown forward and hyper flexed. This motion is usually caused by car accidents, falls, horseback riding, snowboarding, skiing, and contact sports. Following such an incident, the muscles and many other structures of the neck are sometimes left damaged. The symptoms involved with this condition include pain in the neck, shoulder, back, jaw and/or arm; headaches, dizziness, and weakness are common as well.
Often, the pain from whiplash injury doesn’t start until hours or even days after. But once it arrives, it can partner with other strange symptoms, including dizziness, ringing in the ears, hearing loss, insomnia, the loss of concentration, fatigability, memory loss, jaw pain, chest pain and even fever. The combination of any of these symptoms with a known whiplash injury is called whiplash associated disorder.
The trauma caused by whiplash injury can be very elusive. Consequently, it is not uncommon for X-Rays, MRIs, and CAT scans to not show the source of the problem. In order to properly treat whiplash, it is important to understand the progression of a patient’s symptoms. The multiple factors revolving around the injury make management of the pain highly variable from patient to patient. Our physicians will listen closely to the patient and may also rely on advanced minimally invasive spinal interventions to locate the exact source of the pain. Once the source has been determined they can develop an appropriate treatment plan. Nerve blocks under imaging guidance are a specific interventional technique that aid in both the identification of the pain source and its subsequent treatment.
Evaluation and treatment of all whiplash related pain is recommended as soon as symptoms appear. If the condition is ignored, whiplash pain has the potential to become chronic.
If you or a loved one is suffering from whiplash injury, contact Spine Pain Diagnostics Associates today. We have over 45 years of combined experience in treating whiplash injuries and can help you find relief from your lingering pain. Don’t continue suffering and masking your pain with pain medications, let the physicians at Spine Pain Diagnostics Associates treat it at the source so you can get back to enjoying life.
For more information or to schedule an appointment, you can visit our website at www.paindiagnostics.net or call us 1-888-PAIN.DRS. In most cases, no referral is necessary and we accept most major insurances.
Back pain, specifically low back pain, is the leading cause of disability in the country.i More than depression. More than diabetes. Low back pain is the number one contributor to years of life with disability.
Spinal stenosis is an abnormal narrowing of a space in the vertebra. Nerves, arteries and other non-bony tissues pass through these spaces. When this narrowing interferes with these tissues you can have pain, numbness and, if sever, poor muscle control. The disease typically occurs in the low back or neck, and is more common in older patients.
One of the hallmarks of spinal stenosis of the low – a.k.a. lumbar spinal stenosis – is shooting pain from the buttocks to down the leg that gets better when bending forward or sitting. A second hallmark is pain in the leg that worsens when walking. There may be numbness, and the pain remains even when you stop walking. It’s not until you sit or bend forward that you find relief.
There are a number of good treatment options available for spinal stenosis: activity, modification, epidural steroid injections, decompressive laminectomy, microdecompression and interspinous spacer.ii Activity modification includes things like using a cane and bending forward. Epidural steroid injections are one of the more familiar interventional pain management treatments applies anti-inflammatory medicine to the suspected source of pain. Decompression laminectomy and microdecompression are spine surgeries that have been performed primarily by spine surgeons, but can also be done using minimally invasive techniques. And finally, interspinous spaces are like drywall anchors that keep two vertebrae from narrowing the suspected spinal stenosis. It is not a new concept – spacers have been around since the 1950s – but the device took a hiatus from the therapeutic tool chest for the past 40 years to receive an engineering upgrade. They have recently seen an uptick in use as more spine pain physicians become trained in them.
All these treatment options have been shown to improve symptoms in some patients, but there is no resounding conclusion on which is the best for whom. We do know, however, that in patients’ with the hallmarks of spinal stenosis conservative therapies focusing solely on exercising and occasional over the counter pain-relievers do not relieve these symptoms. And so the practice is really to secure a specific diagnosis, identify the patient’s goals and functional health, and match a suitable treatment option.iii
i The stat of US health, 1990-2016: Burden of Diseases, injuries and risk factors among US States. The US burden of disease collaborators. JAMA. 2018;319(14):1444-1472.
ii Markman JD. Lumbar spinal stenosis: current therapy and future direction. Current therapy in pain. Saunders/Elsevier; 2009:316-322
iii Lurie J, Tomkins-Lan C; Management of lumbar spinal stenosis. BMJ 2016; 352 :h6234
Most middle-aged adults in America are overweight, and 35.1% are classified as obese. That means, every third person is obese.* In 1962, every 10th person was obese.[i] What happened?!
We don’t have an answer. Most scientists think it’s a combination of genetics, lifestyle factors and changes in food access (e.g. more sedentary work, more restaurant dining, more TV, daily soda and sugary drinks, and thrifty-genes). [ii] But there are also other theories including disrupted sleep, exposure to exogenous hormones and things called endocrine disruptors, changes to your gut bacteria, oppression, and sunlight exposure. There are even theories about infectious disease causing obesity.
With so many obesogenic forces at play, you would think that we would have a battery of interventions. But we don’t. For the most part, we leave it to the patients and doctors to deal with it on an individual level.
And the treatment? Eat less! Yep. Fifty years of obesity research and the resounding conclusion is that you need to take in less calories than you burn in order to lose weight.[iii] Even with bariatric surgery and medications, the end goal is to help the patient eat fewer calories. But, anyone who has dieted knows this is very hard. If people could just “eat less,” we would not have an obesity epidemic.
What makes losing weight hard? At a biological level, it’s your fat cells. They don’t like to disappear. You get a set of fat cells when you are born, and then another set when you go through puberty. By the time you are in your early twenties, you should pretty much have all the fat cells you can generate. [iv] So weight gain mostly leads to filling up those fat cells. But something in the past 50 years has changed (re: the second paragraph from the top) where more fat cells are being generated into adulthood, leading to obesity. And it’s really hard to get rid of them. Even with liposuction—the most popular cosmetic surgery in the world[v]—fat cells return!
Fat cells aren’t all bad. They do great things like release important hormones and regulate reproduction. But in obesity**, it’s as if they can’t stop sending signals, so you are constantly fighting the urge to feed yourself.
However, there is hope. A high-intensity, in-person intervention provided by a behavioral specialist, nutritionist or other trained profession with at least 14 sessions in 6 months is effective. The components of the intervention are no surprise: reduced-calorie diet, increased physical activity and strategies to trouble-shoot dieting challenges. When this isn’t possible, food-tracking seems to be effective, too. But you have less personal support. Free online apps like Lose-it and MyFitnessPal are popular.
There may be a future when we’ve figured out all the environmental causes of obesity and coordinated a really effective population-based treatment. In the meantime, we should try our very best to pack half of our plates with fresh fruits and veggies at every meal, and to exercise everyday. And if you are obese or overweight, don’t be afraid to ask your doctor or healthcare provider for help. They want to help. It’s what they are there for. Your whole health is important to them.
*The term obesity means fatness, and the most common way we measure it is by the body mass index, a.k.a. BMI. That is equal to your weight in kilograms divided by your height in meters-squared. A BMI greater than or equal to 30 is considered obese. Sometimes the BMI can be high because of a lot of muscle, but for most people it is due to fat composition.
** Obesity has been debated as to whether or not it is a disease in itself. Regardless, it can be a cause of heart problems, blood clots, diabetes, joint problems, social problems, breathing and sleeping difficulties, and cancer.
[i] Fryar CD, Carroll MD, Ogden CL. Prevalence of overweight, obesity, and extreme obesity among adults aged 20 and over: United States, 1960–1962 through 2011–2014. National Center for Health Statistics Data, Health E-Stats, July 2016. https://www.cdc.gov/nchs/data/hestat/obesity_adult_13_14/obesity_adult_13_14.htm
[ii] Williams, E.P., Mesidor, M., Winters, K. et al. Overweight and obesity: prevalence, consequences, and causes of a growing public health problem. Curr Obes Rep. 2015). 4: 363. https://doi.org/10.1007/s13679-015-0169-4
[iii] Jensen MD, Ryan DH, Apovian CM, et al. 2013 AHA/ACC/TOS guideline for the management of overweight and obesity in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Obesity Society. Obesity. 2014;2:S5–39. doi: 10.1002/oby.20821.
[iv] Rosen ED, Spiegelman BM. What we talk about when we talk about fat. Cell. 2014 Jan 16;156(1-2):20-44. doi: 10.1016/j.cell.2013.12.012. Review. PubMed PMID: 24439368; PubMed Central PMCID: PMC3934003.
Angelie Singh, MD, MPH, MS