HI I'M JENNIFER BLOMQUIST.

WELCOME TO HEALTHLINE.

THIS TUESDAY EVENING.

I'M SO GLAD YOU JOINED US.

IF YOU'RE NEW TO THE PROGRAM THIS IS A LIVE SHOW.

I'M HERE IN THE STUDIO BY MYSELF.

WE ARE GOING TO BE JOINED BY A DOCTOR THOUGH VIA VIDEO CONFERENCE SO WE WILL HAVE SOMEBODY ANSWERING QUESTIONS LIVE DURING THE SHOW.

IT IS A CALL CALL.

WE WELCOME CALLS DURING THE SHOW.

THERE'S A NUMBER IN CASE YOU WANT TO CALL AND ASK THE DOCTOR A QUESTION, WE'RE GOING TO BE TALKING ABOUT PAIN MANAGEMENT MORE IN THE ORTHOPEDIC WHELM AND WE WILL HAVE A PAIN MANAGEMENT SPECIALIST HERE TO TAKE ANY QUESTIONS YOU MAY HAVE.

SO THERE'S THE NUMBER TO CALL NINE SIX NINE TWO SEVEN TWO ZERO IF YOU'RE OUTSIDE OF FORT WAYNE IT IS A TOLL FREE CALL AS LONG AS YOU PUT AN EIGHT SIX SIX IN FRONT OF THEIR AND IT WILL GET YOU RIGHT THROUGH.

NOW IF YOU WANT TO ASK A QUESTION LIVE, YOU'RE MORE WELCOME TO DO THAT ANY TIME REALLY FROM THE START OF THE SHOW UNTIL THE END AT EIGHT O'CLOCK OR YOU ALWAYS HAVE THE OPTION OF JUST CALLING AND GIVING THE PERSON ON PHONES YOUR QUESTION AND THEN THEY CAN PASS THAT ALONG TO ME.

SO JUST KEEP THAT IN MIND.

I'D HATE FOR YOU TO MISS SOME FREE ADVICE JUST IN CASE YOU'RE MAYBE MORE OF A SHY INDIVIDUAL.

SO I GET THE PHONE LINES ARE OPEN NOW WE WELCOME YOUR CALLS AT ANY TIME.

LET'S GO AHEAD AND MEET OUR GUEST WHO'S BEEN KIND ENOUGH TO GIVE US HIS TIME THIS EVENING.

THIS IS DR. JOHN KARL WHO IS A PAIN MANAGEMENT SPECIALIST.

DR. KARL, THANK YOU SO MUCH FOR COMING TONIGHT.

YES, THANK YOU FOR HAVING ME, JENNIFER.

I AM HOPING IN THE FUTURE WILL BE ABLE TO HAVE YOU GUYS IN THE STUDIO.

BUT FOR RIGHT NOW IT'S PROBABLY JUST PLAYING IT SAFE BECAUSE OF THE VIRUS.

SO WHY DON'T WE TALK, DR. KARL, ABOUT WHAT EXACTLY YOU DO?

YOU ARE A PAIN MANAGEMENT SPECIALIST.

YOU WORK IN ORTHOPEDICS.

SO CAN YOU KIND OF GIVE PEOPLE AN IDEA OF THE KINDS OF THINGS YOU WOULD TREAT?

YEAH, THAT'S RIGHT.

I'M A PAIN MANAGEMENT OVER AT WORK IN NORTHEAST AND SO I SEE A WIDE RANGE OF DIFFERENT TYPES OF PAIN PROBLEMS PROBABLY ONE OF THE MOST COMMON THINGS THAT I SEE ARE PEOPLE WITH SPINE PAIN WHETHER THE CERVICAL THORACIC LUMBAR IN SOME OF THE CONDITIONS THAT GO ALONG WITH THAT SUCH AS SOME OF THE SCIATIC PAIN.

BUT BEYOND THAT I ACTUALLY TREAT ALL TYPES OF PAIN SO I WILL ALSO TREAT DIFFERENT TYPES OF NEUROPATHIES, THINGS LIKE FIBROMYALGIA REALLY A WIDE RANGE OF CONDITIONS INCLUDING JUST YOUR EVERYDAY SHOULDER PAIN, KNEE PAIN BUT PAIN.

I PRETTY MUCH PRIDE MYSELF IN TREATING IT ALL AND I KNOW MANY OF YOUR COLLEAGUES HAVE BEEN ON OUR PROGRAM BEFORE AND I WAS WONDERING IF YOU COULD DISCUSS SOMETHING THAT THEY HAVE BROUGHT UP IN THE PAST JUST TO EASE PEOPLE'S CONCERNS BECAUSE YOU DO PRACTICE CONSERVATIVELY.

I THINK PEOPLE ARE ALWAYS AFRAID IF THEY GO TO SEE A SPECIALIST THEY'RE GOING TO, YOU KNOW, GET SIGNED UP FOR SURGERY OR SOMETHING.

SO CAN YOU DISCUSS IT FROM THERE THAT IT KIND OF SOUNDS LIKE YOU GUYS TAKE BABY STEPS TO TRY AND ADDRESS THE ISSUE?

YES, THAT'S RIGHT.

AND IN GENERAL A LOT OF PATIENTS SEE ME IN ONE OF THE FIRST THINGS THAT THEY'LL SAY IS I DON'T KNOW WHY MY DOCTOR SENT ME TO SEE A PAIN SPECIALIST.

I'M NOT REALLY HERE SEEKING DRUGS.

I DON'T KNOW WHY I'M HERE.

BUT ULTIMATELY MY MY SPECIALTY CONSISTS OF A MIX OF ORTHOPEDICS, NEUROLOGY, EVEN PSYCHIATRY TO SOME EXTENT AND REALLY AS FAR AS TREATING PAIN, THOSE THOSE CONCERNED A LOT OF PEOPLE HAVE ABOUT BEING STARBOUND OPIOID NARCOTICS THAT'S ACTUALLY AT LEAST FAVORITE WAY OF HELPING PEOPLE AND IT'S REALLY A SMALL TIME MODAL APPROACH WHICH MEANS THAT WE DO A LOT OF THE SIMPLE STUFF FIRST AND WORK TOWARDS MORE ADVANCED THERAPIES THAT THE CONSERVATIVE MEASURES AREN'T HELPING.

SO THINGS THAT I UTILIZE BEYOND MEDICATIONS ARE PHYSICAL THERAPY INJECTIONS EVEN CONSULTING WITH SOME OF OUR ORTHOPEDICS PASTILLA.

SO THERE'S A WIDE RANGE OF TREATMENT OPTIONS THAT I USE AND I KNOW THERE WERE TWO TOPICS IN PARTICULAR YOU WANTED TO FOCUS ON TONIGHT THAT YOU USE AND THE FIRST ONE WAS CALLED STIMMING SPINAL CORD STIMULATORS OR S C. S THAT WAS NEW TO ME.

CAN YOU TALK ABOUT WHAT THAT IS AND AND WHAT KINDS OF PATIENTS COULD BENEFIT FROM IT?

YEAH, SO I WOULD BE HAPPY TO.

SO SPINAL CORD STIMULATION IS SOMETHING THAT'S BEEN AROUND FOR A WHILE BUT EVEN IN THE TWELVE YEARS THAT I'VE BEEN WITH ONLY THE ADVANCES IN SPINAL CORD STIMULATION HAS JUST REALLY REALLY TAKEN OFF AND WHAT IT IS IT'S A WAY OF CONTROLLING PAIN AFTER SPINAL CORD LEVEL AND I HAVE A SPINE HERE TO ILLUSTRATE SO THE SPINAL CORD STIMULATION IS DONE IN TWO PHASES.

THE FIRST PHASE IS CALLED THE TRIAL WHERE A A LEAD WHICH I'LL SHOW YOU RIGHT HERE WHICH IS BASICALLY A WIRE THAT HAS SOME ELECTRODES AT THE END OF IT.

IT'S THE ELECTRODES THAT ARE ABLE TO EMIT AN ELECTRICAL CLOUD AROUND THE END THIS WEEK.

AND SO WHAT THAT DOES IS IT INFLUENCES THE SPINAL CORD AND CHANGES PAIN BEFORE IT GETS UP TO THE BRAIN TO BE EXPERIENCED THAT PAIN AS PAIN IT CHANGES IT INTO A MORE POTENT SENSATION.

AND SOME OF THE NEWER SPINAL CORD STIMULATOR OPTIONS TODAY YOU ACTUALLY DON'T EVEN FEEL ANYTHING.

TRADITIONALLY IT WAS MORE OF A MASSAGE YOUR TYPE FEELING.

BUT EVEN TODAY THERE'S SETTINGS WHERE IT'S NOT MOVING.

I THINK THAT'S SOMETHING THAT PEOPLE WILL EVEN NOTICE EXCEPT FOR THE PAIN IN THE BACK AND LEGS WILL DISAPPEAR.

THIS IS ALSO USED FOR PAIN IN THE NECK THAT GOES INTO THE ARM AS WELL AND PROBABLY THE MOST COMMON THING THAT YOU USE THIS FOR IS LOW BACK PAIN BUT WITH NERVE PAIN IT'S SIMPLY NOT GOING AWAY WITH ANY OTHER MEASURE.

THESE ARE PEOPLE THAT HAVE BEEN THROUGH PHYSICAL THERAPY AND ON MEDICATIONS A LOT OF TIMES HAVE TRIED INJECTIONS, HAVE EVEN HAD SPINAL SURGERY AND STILL HAVE IT ON READMITTING NERVE PAIN.

AND IT'S IMPORTANT TO NOTE THAT THIS IS REALLY MORE FOR NERVE PAIN THAN OTHER TYPES OF PAIN SUCH AS ARTHRITIS, PAIN OR MUSCLE PAIN.

SO IT'S KIND OF IMPORTANT TO DECIDE WHICH PATIENTS ARE GOING TO BENEFIT FROM HAVING SOMETHING LIKE A SPINAL CORD STIMULATOR TRIAL AND THEN ULTIMATELY IF YOU DO WELL WITH A SPINAL CORD STIMULATOR TRIAL IN OTHER WORDS GET SIGNIFICANT RELIEF, ARE ABLE TO DO MORE THINGS IF IT'S REALLY SOMETHING THEY LIKE AND THAT STAYS IN FOR ABOUT A WEEK DURING THE NEXT TRIAL, THEN WE GIVE THEM SCHEDULED FOR THE PERMANENT ONE IN WHICH CASE EVERYTHING IS IMPLANTED.

THE TRIAL ELITE SUCH AS THIS IS PLACED TEMPORARILY INTO THE EPIDURAL SPACE AND IT'S ACTUALLY THREADED UP INTO THE THORACIC LEVEL WHERE IT DOES ITS ACTION FOR THE PERMANENT THERE IS AN ADDITIONAL DEVICE THAT'S IMPLANTED AND IT'S THIS TYPE OF BATTERY WHAT WE CALL THE SPINAL CORD SIMILAR GENERATOR WHICH ACTUALLY POWERS THE WHOLE SYSTEM.

IT GIVES IT ITS POWER.

IT'S ALSO A HIGHLY PROGRAMABLE DEVICE TO BE ABLE TO TARGET EXACTLY WHERE THE PATIENTS NEED THE PAIN FROM.

SO JUST TO CLARIFY WHEN IN THE TRIAL TRIAL PERIOD YOU SAY THAT'S ABOUT A WEEK YOU WOULD JUST HAVE I MEAN DOES THAT IS A SURGICAL PROCEDURE EVEN AT THAT POINT TO PUT THE LEAD IN AND THEN YOU JUST LEAVE IT IN AND SEE WHAT HAPPENS?

RIGHT.

THAT'S A GREAT QUESTION.

BOTH OF THESE PROCEDURES ARE OUTPATIENT PROCEDURES FOR EACH TRIAL.

IT'S DONE A LOT LIKE AN EPIDURAL STEROID INJECTIONS.

SO SOMEONE WOULD COME IN RECEIVE MAYBE RECEIVE SOME I.V.

ANTIBIOTICS AND GO INTO OUR PROCEDURE ROOM.

SO ANYBODY WHO'S HAD AN EPIDURAL STEROID INJECTIONS, THAT TYPE OF A PROCEDURE IS REALLY WHAT STEM OR THE STIMULATOR TRIAL AND FOR THAT PEOPLE RECEIVING SEDATION.

I START BY INTRODUCING A NEEDLE INTO THE EPIDURAL SPACE AND THEN THROUGH THAT NEEDLE THIS LEAD IS THEN STEERED INTO PLACE USING LINE X-RAY SO I CAN GET VERY PRECISE PLACEMENT ON THAT LEAD IN ORDER TO ACHIEVE THE BEST STIMULATION.

IS IT INSTANT RELIEF OR DOES IT TAKE TIME FOR THE PATIENT TO NOTICE A DIFFERENCE?

WHAT'S REALLY COOL ABOUT IT IS GENERALLY WHEN WE TURN ON THE STIMULATION A LOT OF PEOPLE RIGHT FROM THE START WILL JUST SAY WOW, THAT FEELS REALLY GOOD.

SO A LOT OF PEOPLE START TO NOTICE IT RIGHT FROM STAFF.

IN SOME CASES IT COULD TAKE A DAY OR TWO FOR PEOPLE TO USE IT IN THEIR EVERYDAY ENVIRONMENT TO BE ABLE TO KNOW IT'S GOING TO HELP THEM.

BUT A LOT OF TIMES PEOPLE WILL START TO FEEL THAT REALLY RIGHT AWAY.

THAT'S AMAZING.

HAS A LOT OF TIMES ANY TYPE OF ORTHOPEDIC SURGERY YOU KNOW, IT CAN BE MONTHS, YOU KNOW, RECOVERY AND PHYSICAL THERAPY BEFORE YOU NOTICE A DIFFERENCE EVEN A DAY OR TWO.

THAT'S NOT BAD.

THAT'S NOT BAD AT ALL.

SO WHAT SO WHAT IF IT SEEMS TO BE THE APPROPRIATE, YOU KNOW, METHOD FOR THIS PATIENT THEN YOU WOULD SAY LIKE A WEEK LATER YOU WOULD GO BACK IN AND THE BATTERY PACK IN THAT IS PUT INTO THE PATIENT OR RIGHT.

THE PATIENT'S FOLLOW UP IN THE OFFICE IN ABOUT A WEEK AND AT THAT TIME WE EVALUATE THE SUCCESS WE WANT TO SEE AT LEAST 70 PERCENT RELATED IF NOT MORE FROM THAT AND THE TRIAL LEADS ARE REMOVED IN THE OFFICE WHETHER THE TRIAL IS A SUCCESS OR NOT AND I'LL KNOW THAT IN MY PRACTICE SOMEWHERE AROUND 75 PERCENT, 80 PERCENT OF PEOPLE WHO TRY THE STIMULATOR OUT LIKE IT SO MUCH THAT THEY DECIDE TO DO THE PERMANENT.

AND SO IN THE OFFICE A SUTURE IS ORNITHOMIMUS SKIN AND LEAD IS BASICALLY JUST BROUGHT RIGHT BACK IN THE OFFICE AND A BAND-AID IS PLACED AND THEN THE PERMANENT SPINAL CORD STIMULATOR PROCEDURE WOULD BE ORDERED AND GENERALLY WITH INSURANCE SCHEDULING WE'RE USUALLY DOING THAT ABOUT A MONTH OR TWO AFTER THE TRIAL IS OVER AND FOR THAT PROCEDURE IT'S A LITTLE MORE INVOLVED.

I USUALLY HAVE AN ANESTHESIOLOGIST PROVIDING SOME DEEPER DEGREES OF SEDATION FOR THAT AND THEY'RE STUPID DECISIONS THAT ARE MADE FOR THAT ONE THAT'S MADE IN THE PATIENT'S MIDLINE HERE IN ORDER TO ANCHOR THE LEAD DOWN RIGHT NEAR THE SPINE AND ALSO SOMEWHERE LOWER WHERE I'M GOING TO MAKE A POCKET UNDER THE SKIN TO PLACE THIS BATTERY SO THAT PROCEDURE GENERALLY TAKES ABOUT AN HOUR OR SO.

IT'S A LITTLE BIT MORE INVOLVED BUT YET IT'S OUTPATIENT SURGERY WHERE THE TRIAL IS JUST SIMPLY TO TWO LITTLE PUNCTURE EXCEPT NORMALLY I'LL PLACE TWO OF THESE LEADS IN ORDER TO GET THE BEST COVERAGE AND THEN WHATEVER LEAD CONFIGURATION WORKS OUT DURING THE TRIAL I WILL PLAY THIS THE EXACT SAME WAY FOR THE PERMANENT PROCEDURE.

THAT'S AMAZING.

I'M SURE A LOT OF PEOPLE LIKE YOU SAID, THESE ARE FOR PEOPLE WHO'VE ALREADY HAD BACK SURGERY WHICH I ALWAYS THINK IS PRETTY EXTREME AND IF THIS IS YOU KNOW, GIVES THEM MAYBE A LITTLE MORE HOPE, THAT'S GREAT NEWS .

SURE.

A LOT OF PEOPLE WHO ARE LOOKING FOR RELIEF WITH THEIR BACK SURGERY AND IN SOME CASES THOSE NERVES JUST DO NOT WANT TO SETTLE DOWN.

THEY CONTINUE SEND SHOOTING BURNING PAIN AND THEN SOMETIMES SOMETHING LIKE THIS CAN REALLY, TRULY BE A LIFE CHANGING MIRACLE FOR FOR SOME OF MY PATIENTS.

YEAH, IT SOUNDS LIKE IT.

SO WHAT WHAT WOULD A PATIENT EXPECT AFTER THEY IF THEY GET THE PERMANENT PROCEDURE DONE?

WHAT KIND OF MAINTENANCE IS NEEDED BEYOND THAT?

LIKE HOW OFTEN WOULD THEY HAVE TO SEE YOU OR DOES THE EQUIPMENT NEED TO BE REPLACED AFTER SO MANY YEARS?

WELL THE EQUIPMENT THE LEAVES ARE THE REALLY LAST A LIFETIME THERE TO REQUIRE LEADS.

EVERY SO OFTEN SOMETHING WILL OCCUR WHERE THE LEADS WILL FRACTURE AND I'LL HAVE TO REPLACE IT.

BUT THAT'S ACTUALLY EXTREMELY RARE.

IN THE OLD DAYS WE WOULD HAVE TO REPLACE THIS BATTERY ABOUT EVERY TEN YEARS.

BUT THIS NEWER TECHNOLOGY NOW ALLOWS THESE BATTERIES TO LAST MOST LIKELY SIGNIFICANTLY LONGER THAN THAT JUST BECAUSE OF SOME OF THE BATTERY TECHNOLOGY THAT WE HAVE AVAILABLE NOW.

ALL RIGHT, GREAT.

THANK YOU SO THAT WAS SO HELPFUL THAT YOU HAD THE VISUALS THERE FOR ALL OF US TO BE ABLE TO SEE THAT WE HAVE PLENTY MORE THAT WE CAN TALK ABOUT WITH DR. KARL, I DO WANT TO WELCOME YOUR CALLS.

THAT'S WHY WE'VE THE PHONE NUMBER UP AT THE BOTTOM OF THE SCREEN.

IT'S NINE SIX NINE TWO SEVEN TWO ZERO PUT AN EIGHT SIX SIX IN FRONT OF THERE IN CASE YOU'RE OUTSIDE OF THE FORT WAYNE AREA.

STILL THE TOLL FREE CALL FOR YOU AND AGAIN WE'RE ONLY HERE TILL EIGHT O'CLOCK SO I'LL CALL SOONER RATHER THAN LATER.

WE DID DR. KARL HAVE GENTLEMAN WHO CALLED AND WANTED ME TO ASK A QUESTION FOR HIM AND IT WAS IT IS REGARDING BACK PAIN.

SO A MAN NAMED WESLEY SAID HE'S HEAVY BACK PAIN.

HE'S USING PAIN MANAGEMENT BUT HE'S STILL HAVING SHARP PAINS AND HE WAS WONDERING HOW CAN I TELL IF IT'S A NEW PAIN OR IF IT'S SOMETHING FROM AN EXISTING INJURY THAT CAN BE VERY DIFFICULT TO FIGURE OUT IN SOME CASES IS THE HISTORY OF IT IS GOING TO BE VERY IMPORTANT.

IN OTHER WORDS, IF THEY HAVE PAIN BEFORE SOME SORT OF INJURY IN SOME CASES PEOPLE WILL HAVE PREEXISTING DEGENERATIVE DISEASE ARE SERIOUS AND THEN SOMETHING WILL HAPPEN SOME INJURY THAT'LL GET THE INFLAMMATION GOING AND SO SOMETIMES IT COULD BE VERY DIFFICULT TO DETERMINE WHETHER OR NOT SOMETHING IS NEW OR ALL BECAUSE SOMETIMES THERE'S THERE'S ISSUES IN THE MIND THAT KIND OF LAY DORMANT AND THEN SOME SOME INJURY CAN GET THE INFLAMMATION STARTED AND THEN IT'S WHAT WE WOULD BE AWARE OF AS PAIN AT THAT.

SO SHOULD HE CONSULT, DEAL WITH IT, CONTINUE TO DEAL WITH THE PAIN MANAGEMENT SPECIALIST OR DOES HE MAYBE NEED TO SEE SOMEBODY WHO COULD MAYBE DO SOME FURTHER TESTING?

I DON'T KNOW.

SOME KINDS OF SCANS COULD GIVE HIM SOME ANSWERS.

WELL, NORMALLY WHAT WE'LL DO IN PAIN MANAGEMENT IS WE'LL START WITH SOME OF THE MORE CONSERVATIVE TREATMENTS AND THEN WORK OUR WAY TO SOME OF THE MORE ADVANCED SO IT DOESN'T FEEL LIKE HE'S GETTING THE ANSWERS HE NEEDS.

HE COULD GET A SECOND OPINION.

HE COULD SEE SOMEONE IN A SIMILAR SPECIALTY BUT SOMETIMES JUST STICKING WITH THE SAME DOCTOR.

SOMETIMES IT JUST TAKES SOMETIMES TO WORK THROUGH SOME OF THE POSSIBILITIES AND TO MAYBE GET TO THE RIGHT TESTS OR STUDY THAT'S GOING TO GIVE US A BETTER ANSWER.

OK, THANK YOU AND THANK YOU TO WESLEY FOR THAT QUESTION.

WE DO HAVE SOMEBODY DR. CARL WHO I'D LIKE TO ASK YOU A QUESTION LIVES LET ME SEE IF SHE'S STILL ON THE PHONE LINE.

ANNA, ARE YOU STILL THERE?

YES, I AM.

HI.

THANK YOU FOR YOUR PATIENCE.

GO AHEAD AND ASK DR. CARL THE QUESTION.

HI, DR. CARL.

THIS AM I AND MY AND MY PREVIOUS HUSBAND THAT HAD THE SPINAL STIMULATOR PUT IN WHEN DR. HATCH STARTED ALL THIS.

WHAT IS THE DIFFERENCE BETWEEN THE ONE LEADER AS OPPOSED THE TWO THAT YOU'RE TALKING ABOUT?

WELL, IN SOME CASES DEPENDING ON IF PAIN IS ONE SIDED, SOMETIMES ONE MEETING WILL DO THE JOB IN GENERAL IT'S AS FAR AS SOME OF THE MODERN PROGRAMING OPTIONS THAT WE HAVE TO GIVE THE MOST OPTIONS FOR PROGRAMING SO EACH LEAD ACTUALLY HAS A ELECTRODES ON IT.

AND SO WITH TWO THAT GIVES YOU SIXTEEN ELECTRODES SO THAT GIVES US SO MANY MORE PROGRAMING OPTIONS BECAUSE SOMETIMES IF THEY HAVE ONE LEAD IS EXACTLY WHERE IT NEEDS TO BE THEN IDEAL STIMULATION COULD BE HAD.

HOWEVER SOMETIMES IF THAT'S NOT GETTING THE BEST STIMULATION IT'S NOT UNCOMMON FOR ME SOMETIMES TO EVEN HAVE PATIENTS READY TO HAVE A SPINAL CORD STIMULATOR.

A LOT OF TIMES WHAT I'LL DO IS REVISE THAT LEADS TO A LOT OF TIMES TAKING OUT SOME OF THE OLDER TECHNOLOGY AND PLACING SOME OF THE NEW TECHNOLOGY WHICH IS NOW MRI SAY AND THESE BATTERIES DO A WHOLE LOT MORE AS ARE SOME OF THE MORE ADVANCED PROGRAMING OPTIONS.

SO IT'S NOT UNUSUAL FOR ME TO TAKE SOMEONE WHO MAY NOT BE HAVING THE BEST STIMULATION WITH THEIR CURRENT STIMULATOR AND REVISING IT AND PUTTING IN NEW EQUIPMENT TO DO A WHOLE LOT BETTER JOB FOR THEM.

ANNA, DID YOU WANT TO ASK DR. CARL ANYTHING ELSE?

YES, I KNOW THIS MY EX-HUSBAND.

WHY DO YOU THINK JUST WHEN I SHOULD SAY HE HAD A BROKEN NECK FROM THREE, FIVE, SIX AND SEVEN HE WAS CLOSE TO BEING A QUADRIPLEGIC AND WITH THAT JUST ONE SINGLE THING WAS ONLY ONE ONE LATE AND HE ONLY HAD LIKE A FORTY PERCENT RELEASE AT THAT TIME.

SO I'M SO GLAD THAT YOU GUYS ARE ABSOLU WE MAKE IT BETTER FOR OTHERS.

I HAVE ACTUALLY BEEN GOING THROUGH THE SAME THING NOW WE HAVE SOME GREAT ADVANCES AND IT'S ONE OF THE THINGS THAT REALLY MAKES WHAT I DO SO SATISFYING IS SEEING SOME OF THESE PEOPLE WHO HAVE BEEN SUFFERING FOR SO LONG AND THEN WE DO SOMETHING LIKE THAT AND IT'S REALLY LIFE CHANGING.

SO THAT'S REALLY THE BEST PART OF WHAT I DO.

IT SEEMS SOME OF THESE GREAT SUCCESSES.

ALL RIGHT.

THANK YOU.

THANK YOU, ANNA.

THOSE ARE GREAT QUESTIONS AND YEAH, YOU KNOW, LIKE ANNA SAID, I MEAN I CAN'T COUNT THE NUMBER OF PEOPLE I'VE HAD OVER THE YEARS WHO HAVE BACK PAIN AND MANY OF THEM THEY DO DR. KALIGHAT, GET TO THE POINT WHERE THEY'LL SAY WELL I GUESS THIS IS JUST SOMETHING I'M GOING TO HAVE TO LIVE WITH.

YOU KNOW, THEY THEY JUST FEEL LIKE THEY'VE RUN OUT OF OPTIONS ONCE THEY'VE HAD SURGERY SO RIGHT.

THINK ABOUT HOW LONG THE PATIENT IS THERE.

THERE'S ALWAYS THINGS THAT WE CAN FIND SOMETIMES WE'LL COME UP WITH JUST THE RIGHT THING.

SO THERE'S ALWAYS MORTGAGE TIME USUALLY.

YEAH.

SO I LOVE DOING THIS SHOW BECAUSE I YOU KNOW, AT LEAST FOR PEOPLE THAT FEEL LIKE THEY'VE GOT NOWHERE ELSE TO TURN, YOU KNOW, THEY'RE ALWAYS LEARNING ABOUT NEW THINGS AND ALL THESE ADVANCES SO HOPEFULLY WE'RE GETTING THE WORD OUT TO THEM.

I DON'T DOCTOR CARL SO WE TALKED ABOUT THE STIMULUS CORD STIMULATORS.

ANOTHER PROCEDURE YOU WANTED TO TALK ABOUT IS CALLED RADIO FREQUENCY ABLATION.

CAN YOU TALK ABOUT THAT?

YES.

SO PEOPLE WHO ARE SUFFERING WITH CHRONIC BACK PAIN AND THIS IS BACK PAIN THAT IS STAYING RIGHT IN THE SPINE ITSELF WITHOUT NERVE PAIN, SCIATICA, WHAT REALLY CAUSES THAT TYPE OF PAIN ARE THESE LITTLE JOINTS BACK HERE THAT WE CALL FORSETT JOINTS AND YOU HAD THEM ON BOTH SIDES IN THE JOINTS ARE WHAT GET YOUR SPINE MOTION IN THE BACK PART.

BUT WHEN YOU GET ARTHRITIS IN THERE A CAUSES PAIN PARTICULARLY WITH STANDING FOR LONG PERIODS OF TIME WITH TWITCHING A LOT OF TIMES ONE OF THE WORST THINGS IS STANDING THERE OVER A THING TRYING TO DO DISHES OR TRYING TO PULL LAUNDRY.

YOU'VE GET A LOT OF THAT PAIN THAT'S FROM ARTHRITIS AND SO WHAT RADIO FREQUENCY AND THIS IS SOMETHING TO THAT I'M AMAZED AT HOW MANY PEOPLE I'LL TALK TO IN THE OFFICE, HOW MANY PATIENTS AND I HAD NO IDEA THAT SOMETHING LIKE THIS EXISTS BUT IT'S DONE IN TWO STEPS SAYS WELL ONE OF THE FIRST IS DOING A CALLED THE DIAGNOSTIC BLOCK AND FOR THAT I INJECT SOME LONG NUMBING AGENT AT THE NERVES THAT SENSE PAIN FROM THESE JOINTS.

AND SO IF WE WERE DOING A PROCEDURE HERE FOR A VERY LOW BACK I WOULD START BY DOING A DIAGNOSTIC BLOCK WHICH IS A SIMPLE TEN FIFTEEN MINUTE INJECTION PROCEDURE AND DEPOSITS SOME LONG ACTING AN AGENT THERE AND THEN THE PATIENT GOES HOME AND DOES THINGS THAT WOULD NORMALLY COST THEIR DOCTOR AND WE SEE WHAT KIND OF RELIEF THAT THEY CAN GET FROM THAT.

SO THAT'S DIAGNOSTIC PROCEDURE THAT LASTS FOR A DAY OR TWO.

BUT IF THEY'RE ABLE TO GET SIGNIFICANT RELIEF FROM THAT THEN THE NEXT STEP WILL BE DOING THE EVALUATION AND WHAT THAT USES IS A SPECIAL NEEDLE WHERE IT'S INSOLATED EXCEPT FOR THE VERY TIP WHERE THE MEDICINE CORRECT POSITION I CAN ALLOW THAT TO HEAT UP AND WE HEAT IT UP TO EIGHTY DEGREES CELSIUS WHICH IS ABOUT ONE HUNDRED AND SEVENTY SIX DEGREES FAHRENHEIT FOR NINETY SECONDS AND THAT COVID IN VERY PREDICTABLE SMALL BURN AT THE END AND SO FOR ME MAYBE FAMILIAR WITH THIS AS SOMEONE THE POOR PEOPLE WHO HAVE HAD THEIR NERVES BURN BUT WHAT THAT MEANS IS DOING A PROCEDURE WHERE I TURN OFF THE NERVES THAT PAIN FROM THE JOINTS TO THE SIDE.

SO EVEN THOUGH IT'S THE NERVE ABLATION PROCEDURE, IT TURNS OFF THE ARTHRITIS PAIN FROM THE BACK AND THE GREAT NEWS ABOUT THIS IS IT USUALLY IS AT LEAST A YEAR OR TWO OF GREAT RELIEF FROM THE BAD SOMETIMES LONGER.

THE REASON WHY IT'S NOT PERMANENT IS THOSE LITTLE NERVES TEND TO REGENERATE AND THEN AT THAT TIME THE PATIENTS CAN START TO EXPERIENCE PAIN AGAIN.

IT CAN ACTUALLY BE REPEATED.

THERE'S NO LIMIT TO THE AMOUNT OF TIME THAT WE CAN DO BUT THIS IS SOMETHING THAT CAN HELP SIGNIFICANTLY WITH PEOPLE STRUGGLE WITH PAIN THAT'S IN A LOW BACK OR THE MID BACK OR EVEN UP IN THE CERVICAL SPINE.

I CAN DO THAT AT ALL LEVELS.

I EVEN CAN DO THIS ON THESE PEOPLE WHO HAVE CHRONIC KNEE PAIN THAT'S NOT IMPROVING THE INJECTIONS OR EVEN SURGERY.

I HAVE PATIENTS WHO HAVE HAD TOTAL KNEE REPLACEMENTS BUT YES, TO HAVE PAIN AROUND THE KNEE I CAN DO THIS PROCEDURE AROUND THE KNEE AND GETTING THOSE NERVES AND GIVE RELIEF AS WELL.

SO THE PROCEDURE HAS A LOT OF GREAT USES AND THIS AS FAR AS FOR THE PEOPLE WHO ARE HAVING BACK ISSUES, IS THIS EVEN SOMETHING SUITABLE FOR SOMEBODY MAYBE WHO'S ALREADY GONE THROUGH A LOT OF DIFFERENT METHODS INCLUDING SURGERY IS IS STILL AN OPTION BEYOND THOSE EXTREMES.

IT IN SOME CASES WHEN PEOPLE HAVE EXTENSIVE SPINAL FUSIONS WITH HARBORER IT MAKES THIS TECHNIQUE A LITTLE MORE DIFFICULT AND SOMETIMES IT'S NOT EFFECTIVE.

BUT GENERALLY IF THE IF THE IF THE PATIENT IS HAVING PAIN THAT WE IDENTIFY AS JOINT PAIN THEN MUST BE A VERY EFFECTIVE PROCEDURE AND PREVIOUS SURGERIES DON'T NECESSARILY MAKE SOMETHING THAT WE CANNOT DO AND I FEEL BADLY BECAUSE THE LAST FEW SHOWS I'VE DONE WE'VE TALKED ABOUT NEW PROCEDURES IN ORTHOPEDICS AND THEN I RAN INTO SOME PEOPLE THE GROCERY STORE AND THEY SAID HEY, WHY DON'T YOU EVER LET US KNOW IF INSURANCE WILL COVER THAT STUFF BECAUSE IT SOUNDS PRETTY NEW AGE.

AND SO I'VE GOT TO ASK YOU THE LIST FOR THE SPINAL CORD STIMULATORS, RADIOFREQUENCY ABLATION ARE THOSE CAN YOU KNOW, CONSIDERED MAINSTREAM NOW THAT THEY WOULD BE COVERED BY INSURANCE IN GENERAL?

AND THANKFULLY, YES, INSURANCE IS PAID FOR THIS PROCEDURE.

BUT NORMALLY AS FAR AS THE PROGRESS THOUGH, IT'S IMPORTANT THAT THE CONSERVATIVE MEASURES HAVE BEEN DONE FIRST THINGS SUCH AS PHYSICAL THERAPY MATTERSON WHICH IS ANTIINFLAMMATORY, PERHAPS OTHERS TECHNIQUES REQUIRE SOME CONSERVATIVE MEASURES HAVE BEEN TRIED AND IT DIDN'T HELP THE PATIENT THEN MOST INSURANCE IS BY FAR WILL COVER BOTH RADIOFREQUENCY PROCEDURES AS WELL AS SPINAL CORD STIMULATORS .

ALL RIGHT.

GOOD NEWS TO HEAR A DOCTOR CARL.

OH, THIS IS TERRIBLE BUT WE'RE OUT OF TIME THAT JOY TO HAVE YOU TONIGHT LEARNING SO MUCH FROM YOU.

THANK YOU SO MUCH FOR YOUR TIME AND YOUR EXPERTIZE.

WELL, THANK YOU FOR INVITING ME TONIGHT.

THANK YOU.

ALL RIGHT.

TAKE CARE AND STAY HEALTHY AND THANKS TO ALL OF YOU ESPECIALLY WE HAD A COUPLE OF CALLS COME IN.

I REALLY APPRECIATE THAT AND TAKE CARE AGAIN.

THERE'LL BE ANOTHER HEALTHLINE ON ONE WEEK FROM TONIGHT.

SAME TIME.

TAKE CARE.

WE'LL SEE YOU NEXT WEEK