Controlling Pain and Interventional Pain Management

Posted on May 16, 2012 by osc

Exercise Properly and Throw No Pain, No Gain Out the Window

by Orthopaedic & Spine Center Staff – Call (797) 596-1900 for consultation

We have all heard the phrase “No pain, no gain.” Often these words are grunted by gym rats in a workout facility (insert clip “I pick things up and put things down”). In fact, Jane Fonda is credited as popularizing the motto in the early 1980s, during her “aerobic video” phase. She encouraged us to keep pushing ourselves to feel the burn as we worked our muscles to exhaustion in our living rooms. The motto encourages us to keep trying, keep pushing, keep going, even if it hurts.

Apply these words to everyday life: Is this a healthy way to live? Is it in our best interest to keep tolerating the pain? Does it do any good to ignore our own suffering?

The answers to these questions are a resounding no, no and no!

Doctors generally class pain into 2 types, nociceptive and neuropathic. Nociceptive is a result of an injury to a part of the body, such as a muscle or bone. The pain is in one place and constant, and when the damage heals, the pain usually goes away. Examples are bumps, bruises, broken bones, and burns.

Neuropathic pain is more complicated. It is the result of an injury or problem with the nerves, and is often triggered by an injury or surgery. The injured nerve stops working properly and sends the wrong signals to the brain. Nerve pain is often difficult to diagnose because the pain results from an issue inside your body, not on the outside. It can be related to a number of medical conditions such as diabetes, shingles, cancer, carpal tunnel syndrome, a failed surgery or it can be from a totally unknown cause. Symptoms can include tingling, numbness, burning, or a “pins and needles” feeling.

When not properly managed, any type of pain can affect your quality of life. Simple acts can be agonizing. You may have difficulty sleeping at night or trouble concentrating, be unable to work or feel hopeless that no relief is in sight. There are options for you to effectively manage your pain and continue to live an enriched and productive life. Make an appointment with an Interventional Pain Management Specialist to hear about medicines and procedures that may help you feel better.

OSC's Interventional Pain Management Specialists

Dr Jenny Andrus and Dr Raj Sureja

Visit www.osc-ortho.com to learn more about Dr. Raj Sureja and Dr. Jenny Andrus, the OSC Interventional Pain Management Specialists, and the procedures they do to help patients improve their quality of life. Throw the motto “no pain, no gain” out the window and start living your life to its fullest again!

Contact Orthopaedic & Spine Center for a consultation on (797) 596-1900

Symptoms and Causes of Carpal Tunnel Syndrome

Posted on May 15, 2012 by osc

A Recap of a Lecture by OSC’s Dr Boyd Haynes on Carpal Tunnel Syndrome

Call (797) 596-1900 for a consultation with Dr Haynes at Orthopaedic & Spine Center

I recently attended a lecture on Carpal Tunnel Syndrome (CTS) presented by Dr. Boyd Haynes of the Orthopaedic and Spine Center and thought it so interesting that I decided to blog about it. Please remember that I am not a doctor and if you think that this information pertains to you or someone you know, the best thing to do is to get in to be evaluated by a fellowship-trained orthopedic specialist.

Don’t self-diagnose or you could potentially wind up much worse, or with a condition completely unrelated to this topic. In fact, tendonitis or bursitis can easily be misdiagnosed as CTS, so it pays to go to a specialist who is experienced in diagnosing and treating this condition.

Some of the more common symptoms of carpal tunnel syndrome are:

Usually is seen in adults
May appear in only one or both hands (dominant hand usually first)
Numbness, pain, burning or tingling in your thumb, index and middle fingers and palm
Discomfort awakens you at night
Shaking your hand provides relief
Loss of grip strength (advanced)
Atrophy of palm muscle near the thumb (advanced)

Why do some people seem to be more susceptible to this problem and why do others have no issues? Many physicians seem to think that a combination of factors most often causes problems, such as genetic predisposition, stress, overuse, rheumatic arthritis, previous injury to the wrist and a variety of other issues. Carpal Tunnel Syndrome is seen three times more in women than men. Pregnancy can cause problems and those problems can go away as soon as the baby is delivered. Diabetes may also confuse this condition.

It is a widely held belief that repetitive motion can cause CTS; however, there is no conclusive scientific evidence that supports this for the general office worker performing computer work. However, other jobs, such as working on an assembly line, do seem to be associated with Carpal Tunnel Syndrome.

Call (797) 596-1900 for a consultation with Dr Haynes

The Orthopaedic & Spine Center of Virginia

Plantar Fasciitis Facts

Posted on May 14, 2012 by osc

Guide to Plantar Fasciitis by Orthopaedic & Spine Center

Call (757) 596-1900 for AN Interventional PaIn Management consultation

If you wake up in the morning and experience a sharp, burning pain in the heel of your foot, you may be suffering from Plantar Fasciitis, a very common disorder of the fibrous tissue that runs along the bottom of the foot. This tissue is what connects the toes to the heel bone and it also is the architecture for the foot arch.

Preventing Plantar Fasciitis is relatively easy, but healing this disorder can be painful, tough, take a year and may require surgery. Prevention consists of stretching the foot, Achilles Tendon and ankles and calf muscles regularly to maintain flexibility.

One of the easiest stretches to these muscles is to stand with your toes on the edge of a curb or step, with your heels hanging off the edge. Then, slowly lower your heels until you feel a good, gentle stretch. If you perform this exercise regularly, you will notice that you will eventually be able to stretch with a much greater degree of flexibility AND help to prevent Plantar Fasciitis from occurring.

What Causes Plantar Fasciitis

For anyone suffering from Plantar Fasciitis, they know the sharp, disabling pain that occurs when they first walk upon awakening or after sitting for a long time. Ouch! Most people immediately think that a bone spur must have formed on their heel to cause such intense stabbing pain. However, the connective tissue that runs from the heel to the toe can make us yelp in pain without having any other issue other than being inflamed.

Why do we get this disorder? There are many reasons, but the most common are:
• Lack of flexibility in the Achilles tendon, foot, ankle and calf
• Quick weight gain or chronic obesity
• Having high arches or flat feet
• Running on irregular surfaces, downhill or for great distances
• Wearing ill-fitting, non-supportive shoes

Plantar Fasciitis Facts

• Can occur in men and women, but more commonly in men who are active and between the ages of 40-70.
• Does not necessarily involve a bone spur of the heel, but both can occur simultaneously
• One of the most common reasons for a person to seek medical care from an Orthopaedic specialist
• Lack of flexibility, Weight gain or obesity, having flat feet or high arches or running competitively can put you at greater risk of developing this disorder
• Most Plantar Fasciitis is treated non-surgically, with stretching, NSAIDS, Physical Therapy and steroid injections.

Plantar Fasciitis Symptoms

You may suspect that you have Plantar Fasciitis if you experience heel pain, but what are the most common indications that you may have this disorder? You might experience the following symptoms:
• Pain, from mild to severe, which may be burning, sharp, stabbing or dull in the heel
• Pain is usually worse in the morning when you get out of bed, after intense periods of activity, if you sit or stand for a period of time, or when climbing ladders or stairs
• Your foot may swell or become red
• You may feel like your foot is tight or stiff, especially in the bottom of your arch
• The bottom of your foot may also feel tender to the touch

How Is Plantar Fasciitis Treated?

Most people will PF can easily be treated without surgery or any injections. Rest, icing the area, taking Ibuprofen or Naproxen Sodium to reduce inflammation and ease pain and beginning a comprehensive stretching program which addresses flexibility issues of the Achilles tendon, calf muscles and foot and ankle muscles will usually help most people recover. Your doctor may also recommend that you buy a good pair of supportive shoes.

Recovery may be slow. For those persons who do not respond to the aforementioned treatments, orthopaedic physicians may also recommend wearing a heel cup or using shoe inserts. Splints that hold the Plantar Fascia in a flexed position may also be recommended for use at night. Using a plastic removable boot cast for several weeks may also help. Tougher cases may require the injections of steroids into the heel or having custom orthotics made to be worn everyday in the shoe.

Rarely, a person may not recover and surgery will need to be considered to release the tight connective Plantar Fascia. Although this surgery is simple and performed as an outpatient procedure, all surgery has risks that need to be discussed with your doctor. In some persons, pain will continue even after surgery. That person will then need to be referred to a Pain Management Specialist or consultation.

For a consultation with OSC – Orthopaedic & Spine Center – Call (757) 596-1900

Email: info@osc-ortho.com

What is Kyphoplasty by OSC’s Dr Mark McFarland D.O.

Posted on May 4, 2012 by osc

Dr Mark McFarland, DO of Orthopaedic & Spine Center

Call (757) 596-1900 for a consultation with Dr McFarland

Kyphoplasty is a unique, minimally-invasive way to treat compression fractures of the thoracic and lumbar spine. Most fractures of the aged spine are related to osteoporosis and can lead to a “bent forward” posture called kyphosis. The kyphoplasty procedure can help restore the height of the collapsed vertebrae and relieve a patient of pain by repairing the bone with a strong internal scaffold of bone cement.

Dr McFarland performs a spinal examination

The procedure can be done under conscious sedation or general anesthesic and usually takes around 15-25 minutes to complete. A small needle is passed through the skin and into both sides of the broken vertebrae. Next, small tubes are placed over the needles and small balloons are placed into the bone. The balloons are elevated under pressure to help restore the bone, correct the patient’s posture and reduce the kyphosis. Next, bone cement is placed into the bone to stabilize the fracture, just like an internal cast.

After the kyphoplasty procedure, the bone is very strong and usually the pain will be significantly reduced immediately. Mild residual pain may last up to another 2 weeks after the procedure.

Orthopaedic & Spine Center

Call (757) 596-1900 for a consultation with Dr McFarland

A Day In the Life of an Orthopaedic Physician Assistant

Posted on May 2, 2012 by osc

by Orthopaedic & Spine Center’s Tonia Yocum, PA-C

(Physicians Assistant – Certified)

On a typical surgical day, I am up and out of bed at 5:15 AM. I leave the house at 6:00 AM and normally arrive at the hospital around 6:30 AM. I usually change into surgical scrubs when I arrive, although I wear a lab coat when rounding on our post-operative patients.

Tonia Yocum

My days in the hospital are divided into two distinct parts: (1) rounding (visiting and evaluating) patients who have already had surgery and; (2) assisting Dr. Jeffrey Carlson with his orthopaedic surgical cases in the operating room.

Upon arrival at the hospital, I usually complete rounds (evaluations) on post-operative patients. When I am in a patient room, my activities include:
• Asking the patient how they are feeling while checking the surgical area for any abnormalities (if I find anything of concern, I report it to Dr. Carlson immediately)
• Answering any questions they may have about their surgery and recovery
• Outlining expectations of what will happen during the day at the hospital & helping them feel comfortable with the planned therapies (mainly ambulating with physical therapy),
• Reviewing their lab results, vitals and writing SOAP (Subjective, Objective, Assessment Plan – medical format) notes in their chart.

OSC's State of the Art Orthopaedic Facility

Around 7:30 AM, I report to operating room for first surgical case of the day. Part of the surgical P.A.’s job involves pre-operative preparation. I spend time with each of our surgical patients before surgery and these are some of the responsibilities I have:
• Speaking with the patient before surgery to answer any last minute questions and to reassure the patient if they are anxious about their surgery
• Discussing post-operative instructions
• Listening to patient’s heart and lungs
• Assessing vital signs
• Asking the patient pre-operative questions (Example: Did you have anything to eat or drink after Midnight?)

If everything checks out okay with the patient, I then pull together all of the information necessary for Dr. Carlson to proceed with the surgery. This includes patient demographical information, their history & physical and MRI images. Dr. Carlson will review this information before the surgery and may refer to it during the surgery.

At this point, the patient has been prepared for surgery and has been seen by the anesthesiologist, who has started an IV and sedated the patient to help them become less anxious. The patient is wheeled into the OR and I then begin to assist with the surgery. Some of the duties I perform are:
• Helping the surgical team transfer patient to O.R bed
• Standing-by during patient intubation
• Positioning the patient properly on O.R table
• Scrubbing- in for the surgical case
• Opening surgical instruments
• Making sure all necessary equipment is available and ready
• Draping the surgical patient
• Performing suction, retraction, tying, suturing during the operation
• Applying dressing to surgical area

At 10:10 AM, we finish our first surgical case. The patient is extubated and transferred back to a hospital bed. I write post-operative notes & orders specific to our patient that will be used by the nursing staff while the patient remains in the hospital. I then assist with transferring the patient to recovery room.

At 10:25 AM, I start the process over again with our second surgical patient of the day. My evaluation lasts until 10:40 AM. I then start writing some orders and grab a quick snack before returning to the OR.

Dr. Carlson and I have successfully completed 5 surgical cases today. I did get to grab a bite of lunch after our second surgical case and another quick snack around 5:00 PM. Today, my day at the hospital ends at 7:15 PM. I now leave for my second job, being a wife and mother!

Bad to the Bone – Medical Humor

Posted on April 25, 2012 by osc

Who Says Orthopaedic Surgeons Have No Humerus!

OSC's Bad to the Bone Cartoon Humor Dr Jeffrey Carlson M.D. may be the first spinal surgeon to have performed a cervical fusion in Virginia on an outpatient basis. Dr Carlson may be the first spine specialist to have performed a cervical disc arthroplasty on the Virginia Peninsula. He may be a consummate professional, highly skilled and one of the best spinal surgeons in the country.

But Dr Carlson definitely has a sense of humor

Dr. Jeffrey Carlson Named Chief-of Surgery

Posted on April 16, 2012 by osc

Leading Spinal Surgeon Dr. Jeffrey Carlson M.D.

Appointment at Bon Secours Mary Immaculate Hospital

Orthopaedic & Spine Center is delighted to announce that Jeffrey R. Carlson, MD, was recently named Chief-of-Surgery at Mary Immaculate Hospital in Newport News, VA. Dr. Carlson is the President and Managing Partner at Orthopaedic and Spine Center in Newport News, VA and is a Fellowship-trained and board-certified Orthopaedic Spine Surgeon. Dr. Carlson has practiced at OSC since July of 1999, after completing an extensive medical education and further fellowship training.

Chief of Surgery at Bon Secours Dr Jeffrey Carlson MD

Dr Carlson preps for surgery

Dr. Carlson received his undergraduate degree from The University of Maryland and attended Medical School at George Washington University in Washington, DC. He then completed a General Surgery Internship at Dartmouth-Hitchcock Medical Center and moved on to residency at Harvard University’s Combined Orthopaedic Program. After completing residency, Dr. Carlson went on to complete two separate fellowships: one in Orthopaedic Trauma at Massachusetts General and another in Orthopaedic Spine Surgery at Brigham and Women’s Hospital, both in Boston, MA.

An innovator in the field of spinal surgery, Dr. Carlson is known as the first surgeon on the Virginia Peninsula to perform Cervical Disc Arthroplasty (CDA), and also as the first in Virginia to perform a cervical fusion in an Ambulatory Surgery Center.

Dr. Carlson is an active member of the American Medical Association, the North American Spine Society, a member of the AO North America Spine Faculty, and an active member of the International Association for Minimally Invasive Spine Surgery. A published researcher and scholar, Dr. Carlson teaches advanced spinal surgery techniques to physicians here in the United States and around the world. He was recently named as one of the “Top 200 Spine Surgeons to Know” by the internationally-recognized journal Becker’s Orthopaedic and Spine Review. as was one of only 5 Virginia spine/neurosurgeons chosen for this recognition.

Dr. Carlson is also heavily involved in the community, is a benefactor and active contributor to such organizations as the Arthritis Foundation, as a patron of the arts and is active in his church. He lives in Newport News, VA with his wife, Sandra, and their 3 children.

Contact Orthopaedic & Spine Center for a consultation with Dr Carlson

Tel: (757) 596-1900

Email: info@osc-ortho.com

Knee Pain Relief and the Confessions of a Big Baby

Posted on April 8, 2012 by osc

Written by an Orthopaedic & Spine Center Staffer (who shall remain anonymous)

My knees ache! Carrying around this extra weight for all these years is not helping. “Lose weight”, says my doctor. How can I exercise to get the weight off when my knees are so painful? It is a vicious cycle: Lose weight with more exercise to stop aching; can’t exercise to lose weight because my knees ache from all the extra weight! My friend had a cortisone shot in her knee (done by her orthopedic specialist) and said it helped her pain for at least two months. Forget it! Just pass the potato chips and the foot stool! Steroid shot? No way, I hate needles!

If I can just talk myself into the shot, I could get relief from my pain and start exercising to lose the weight, I could then stop the pain for the long haul. That seems like a much better cycle to be in.

Perhaps there is some comfort in knowing that the stuff inside the needle is actually a synthetic version of a substance that is produced by our own bodies. When our bodies are under stress, the adrenal gland produces cortisone that is released into the blood stream. However, the cortisone produced by the body does not last long and it is definitely not going directly to my bad knees. When a patient is given an injection to the knee, the cortisone goes right to the area of the problem. Now, cortisone is not going to relieve the pain, but it relieves inflammation, which can cause pain. It may also take a few days to work, but lasts much longer than the steroids our bodies produce.

On the outside of the skin, an anesthetic will be used so the injection site shouldn’t hurt. Since the cortisone may take a few days to make a difference in my discomfort, an anesthetic like Lidocaine or Marcaine may be included in the injection to numb my pain, fortunately with the same needle!

OSC pain spoecialists Dr Jenny Andrus and Dr Raj Sureja

Dr Jenny Andrus & Dr Raj Sureja - Interventional Pain Management Specialists

There might also be some comfort in knowing that the orthopedic physician has very specially trained hands that will use ultrasound to guide the injection. The ultrasound wand is placed near the site of the injection and the computer screen shows the physician exactly where the needle should go for the synthetic cortisone to provide the most benefit. It would be amazing to see the inside of my knee on the computer! It is reassuring to know that it is not just a random, blind jab, but a carefully guided placement of medicine. Having this information really helps calm my nerves about this procedure.

So, now that I have gained power through knowledge, I will take a deep breath, cover my eyes and invest in my future health!

Different Types of Epidurals

Posted on March 20, 2012 by osc

An Overview of the Different Types of Epidural Injection Used for Interventional Pain Management

Did you know that there are different types of epidural steroid injections? Everyone thinks of an epidural as the procedure you have to relieve pain and make you go numb before having a baby. But, this kind of epidural is different from the steroid epidural that is done, either within the cervical or the lumbar spine, and which provides long term pain relief.

First of all, you should only seek care from a skilled physician who has experience in providing epidural injections. At OSC, Dr. Mark McFarland, a fellowship-trained spine specialist does them in the lumbar spine, as do the two Interventional Pain Management Specialists (Dr Jenny Andrus & Dr Raj Sureja), who do cervical and lumbar. The facility where your epidural is being performed should use fluoroscopy (a special X-ray using dye) to make sure your epidural is being done in the right place and that it is not being done “blindly”. At OSC, we have two state-of-the-art “C ARM” fluoroscopy machines. They are called “C Arms” because they look like a great big letter “C”.

It should be noted that an epidural does not penetrate into the spinal cord, the vertebral bone or into the spinal nerves. The physician will look for the epidural space, near the nerve that is inflamed and will place the medication near the nerve itself. At no time should the needle ever enter the spinal cord. Sometimes patients believe this to be true and it frightens them away from having an epidural.

You can get an epidural in your cervical spine (neck) or in your lumbar spine (lower back). The cervical epidural is used for pain that is caused by some kind of problem in the cervical spine, like a disc herniation or spinal stenosis. However, the pain can be felt in the neck, head, shoulder, or arm. The lumbar epidural is for problems with the lumbar spine, characterized by pain in the lower back, buttock or leg. Cervical Epidurals usually provide pain relief for patients anywhere from a few months to several years. Lumbar epidurals typically do not last quite as long and can provide pain relief for up to a year in most cases.

Intralaminar Epidurals are most commonly performed and involve the injection happening in the middle or mid-line area of the spine. Sometimes this approach works well and provides pain relief. In cases where the nerves along the side of the spine are inflamed or where there are discs that are herniated to either side, a Transforaminal Epidural may be best. These Epidurals are done with a more diagonal or side approach so that the affected nerve(s) and or disc can be better treated.

Contact Orthopaedic & Spine Center today for a consultation.

Tel: (757) 596-1900

Email: info@osc-ortho.com

Once, Twice, Three Times an Epidural!

Posted on February 16, 2012 by osc

A Real -Life OSC Patient Talks About Her Pain Management Experience and Use of Epidurals

Hello, it’s me! (that was also the title of a great Todd Rungren song in the 70s)

Yes, I am back again and this time, it is to talk about having epidurals, not once, not twice, but three or more times.

Back in 2011, during the early summer, I had an epidural injection (which didn’t work) quickly followed by another epidural injection (that did work). The second epidural injection was one or two discs lower that the first one, but it really did the trick! I lived almost totally pain-free for about 7 months. Yes, I might get a minor twinge here and there, if I slept wrong, but the relief from the epidural injection was palpable and wonderful! I had forgotten what it was like to have pain free nights, able to sleep restfully and days at work that were not marred with searing pain in my neck, trapezoids and shoulder region. It was sheer bliss, and for someone who hates needles and passes out very easily, I have become the world’s biggest advocate of epidurals,because they work!

Dr Jenny Andrus - Interventional Pain Management Specialist

So, now that I am starting to feel pain again, I ran, not walked, to schedule my next epidural, because I want the pain relief that it afforded me. I began to wonder, just how many epidurals can you have safely over a year or over a lifetime? To answer my question, I consulted Dr. Jenny Andrus, a Pain Management Specialist here at OSC. Dr. Andrus told me that you can safely have multiple epidurals in a year, but usually not more than 3 or 4. Too much steroid can be a bad thing, so a good physician makes sure to monitor how much steroid is administered to an individual over a certain period of time. A person who has a herniated disc or other spinal issue can safely have epidurals through-out their lifetime for pain management. This is wonderful news for persons who cannot have surgery for medical reasons or for those who just choose not to have spinal surgery. Sometimes, as in my case, better pain relief is afforded by having two injections, at different vertebral levels, done closely, within a few weeks. This gets a good amount of steroid near the inflamed nerve root, allowing it to heal, the inflammation to lessen and providing pain relief. It is amazing how much misinformation there is about epidurals, but if I can help to set the record straight, I am happy to do so!

by Orthopaedic & Spine Center Staff – Call (797) 596-1900 for consultation

Contact Orthopaedic & Spine Center for a consultation on (797) 596-1900

Call (797) 596-1900 for a consultation with Dr Haynes at Orthopaedic & Spine Center

Call (797) 596-1900 for a consultation with Dr Haynes

The Orthopaedic & Spine Center of Virginia

Guide to Plantar Fasciitis by Orthopaedic & Spine Center

Call (757) 596-1900 for AN Interventional PaIn Management consultation

What Causes Plantar Fasciitis

Plantar Fasciitis Facts

Plantar Fasciitis Symptoms

How Is Plantar Fasciitis Treated?

For a consultation with OSC – Orthopaedic & Spine Center – Call (757) 596-1900

Email: info@osc-ortho.com

Call (757) 596-1900 for a consultation with Dr McFarland

Call (757) 596-1900 for a consultation with Dr McFarland

by Orthopaedic & Spine Center’s Tonia Yocum, PA-C

(Physicians Assistant – Certified)

Leading Spinal Surgeon Dr. Jeffrey Carlson M.D.

Appointment at Bon Secours Mary Immaculate Hospital

Contact Orthopaedic & Spine Center for a consultation with Dr Carlson

Tel: (757) 596-1900

Email: info@osc-ortho.com

Written by an Orthopaedic & Spine Center Staffer (who shall remain anonymous)

Tel: (757) 596-1900

Email: info@osc-ortho.com

Contact Dr Jenny Andrus for a consultation through Orthopaedic & Spine Center

Tel: (757) 596-1900

Email: info@osc-ortho.com