Tulsa pain management : Ep-7 Part 2
OK. And it tells the Tulsa pain management that says you treat the C-spine that he’s fine in the spine. Can you tell me the different locations of the parts of the spine.
So the cervical spine is in the neck. So it’s certainly base of the skull and it ends around the level of the shoulders thoracic spine as the name suggests is a thorax which is the chest and starts from the level of the shoulders and extend all the way down to 12 which is the last thoracic vertebra in the lumbar which is the low back Lombards they started from L-1 and he goes all the way down to the two sacrement which is the fuse tailbone of the lumbar spine basically.
OK so say I have neck pain and I call it Tulsa pain management. What are some injections you might offer. I come in and see you what might you suggest.
So what I would do is examine the patient ask about the symptoms like does it hurt to look up as the hurt Christian neck because it hurt when you drive and you you have to look in it when you reverse your car you turn your back. Does it hurt to do that. If that’s the case and the pain does not go down the arm. So you don’t have like a sidekick sort sort of into your arms then it’s likely to be a pain coming from the set joints. So for these patients then I would schedule them for a facility injection typically depending on which side heard one side left or right or both then I would inject. And those that side that hurts. And and if the patient has neck as well as shooting arm so like a sidecar sort of down the arm and I would then review the MRI of the neck and see it as a pinched nerve from a protruding disk or a disc bulge or a swollen soft tissue in the neck that if that is the case then I would offer them an epidural injection. What we do is instead of injecting into the joints we inject disturbance and medication into the space around the spinal cord. The idea is that you know when you have a disc bulge and nerve is pinched it triggers an inflammatory response. And that in fact response causes pain. So steroids are very strong very potent anti-inflammatory.
So we’re putting it around the disk and a nerve root. We sort of come down and shrink all that swelling so that we should be able to give the patient relief especially with any pain down the arm.
OK. And it was a Tulsa pain management we don’t just treat back spines hips and knees we also do some treatment for migraines that are taking and tell us a little bit about Botox injections.
So we offer migraine injections so patients who has have failed you know the usual migraine medications. Typically it has to be a fairly frequent and debilitating migraine headaches. I think more in 14 days or the patient has migraine. So when we when we do the migraine injection there patients come in. You know it’s a very easy procedure. It’s not terribly painful encounter because we use is really really small and short. What we do is we inject in a circular motion around the skull starting from the front of the forehead and then we go around to the side and the back and then we also put some. In the neck as well. So you know we really do both sides because migraines generally is you know it’s a headache that involves a whole scalp in the neck. And we’ve got I’ve gotten really good results that patients who are suffering from migraines for years and feel all the medications and then they get almost almost instantaneous pain relief. Maybe take a couple of days for the Botox to kick in. And we usually repeat these injections every three months as needed and typically how that’s how long it lasts two to three months.
OK. I do for Tulsa pain management. I do the authorizations for Botox and I can tell you that they are not very easy to get approved. It can take me anywhere from 30 to 60 days. They must generally are denied. And I have to go through an appeal process. They’re not. They’re not cheap so they’re really hard to get approved. But again along with Dr. Chan we have seen amazing results with the botox and we had patients that come in they do Botox and that was an impact that wasn’t effective for them. So they came in and we offer a stimulator for that as well. Can you tell us a little bit about that.
Yes. We also put those things that do not respond to Botox or medication.
We offer a spinal Asare was not a spinal it’s a peripheral roast him later. But what we do is implant these so-called insulated wires around the back of the front of the scalp just under the skin. So what it does is is connected to the battery and then it runs. We run current through that a very small current. It creates a feel of stimulation. So what is typically what a patient feel is that someone’s given a nice scalp massage and that somehow blocks off the pain from the migraine or any headaches. The theory is that is that by in some ways creating white noise you block of the painful stimulation you kind of block off by creating an extra stimulation that is pleasant so you kind of substitute an unpleasant sensation with something that is pleasant. Typically we do a trial first before we implant and that last between three days to a week. We put in temporary wires. There’s no surgery involved in the trial. And if the patient you know has a three to five well three to seven days then it comes back and again you know that’s when we remove the tape release and we asked them you know how is this working for you. I’ve had really good results of patients who’ve had migraine or any headaches as refractory to all kinds of what is considered a treatment in. And if they agree to have an implant then we haven’t come back another day and we will do the implant where we implant the generated battery so-called right under the skin. And that way you know everything’s internalizes nothing that protrudes Tulsa pain management.