Expert Blog

27Nov

Prevent Back Pain During Holiday Shopping

Holiday shopping is said to burn 1500 calories per trip, so it can be as harsh on your body as it is on your bank account. There are 12000 ER visits caused by activities of the season every year. 10% of them are caused by back strain, and 34% are related to falls. Keep your shopping trips safe and injury-free with these tips:

Keep a Light Purse and Slim Wallet

You probably know you need to empty out your purse before a long shopping trip, but your wallet can cause as many back problems as the weight you carry. Keeping an overloaded wallet in your back pocket can put pressure on the sciatic nerve, causing pain. Keep your cards and license in a front pocket and wear a purse diagonally over your chest.

Stay Alert

Most acute back pain is caused by overstretching and accidents, so save your Christmas shopping for times when you’re alert. Making your shopping trips when you're alert will also help you stay attentive to traffic and avoid injuries caused by road crashes and near misses.

Balance Your Load

Carry your shopping bags in such a way that weight is evenly distributed on both sides of your body. Better yet, use a shopping cart. Bring your own sturdy, comfortable bags instead of using the ones from stores.

Learn Healthy Lifting Habits  

Don’t bend at the waist, as this places weight on your spine. Instead, use your legs and arms where possible, keeping any weight focused on the top of the spine. Make use of railings and handholds where possible, and if you experience pain, respect your need for rest.

Stretch

If you’ve just woken up or are going shopping after spending hours at a desk, do some simple stretches before you go shopping. Don’t neglect your neck, hamstrings, and lower back.

Finally, don't forget to stay hydrated. The holidays are supposed to be a festive time, so make sure your shopping trip leaves you energized and ready to celebrate the season pain-free. 

Posted in Expert Blog

27Nov

Throw Yourself A Bone: Prevent Osteoporosis

Osteoporosis has found itself in the midst of more than a few debates, particularly for its responsiveness to supplementation. Vitamins D, K, and calcium are often pinpointed as the roads to perfect bone health, but the truth is not quite that simple.

The Truth About Supplementation

Osteoporosis’ catastrophic falls and fractures make even the most marginal improvements important. Vitamin D has been the subject of a few tiny studies but hasn’t performed consistently in meta studies. Calcium and vitamin D deficiencies certainly lead to bone softening, but that doesn’t make supplements after diagnosis a cure. D supplements do reduce falls slightly, so they’re an important part of care. Calcium levels need to be increased in most adults because daily intake is generally lower than the recommended levels. The Cochrane Review concluded that supplementation over recommended daily allowances has little effect as a preventative measure. In other words, it's best to get your nutrition from food whenever possible.

Building through Prevention

Osteoporosis develops over decades, so bone strength and density must be protected continuously through daily habits. Alcohol and nicotine consumption will cause more problems than those D supplements will ever prevent. Quit smoking, forego that second glass of wine, and watch your estrogen levels.

If you have a high risk of developing osteoporosis, do regular bone density scans and add regular weight bearing exercise to your routine. This way, you can encourage the resorption and formation of new bone, which should compensate for normal bone loss.

Bisphosphonate drugs are effective at reducing spine fractures and raising bone density, but such vertebral fractures are often asymptomatic and subclinical. Medications are thus only recommended when there is significant risk of fractures. Every patient needs the judgement call of their own doctors.

Osteoporosis arises from lifestyle choices made from adolescence onward, so it’s never too early to begin a preventative program. 

Posted in Expert Blog

10Nov

Dr. Chang featured in azcentral article

Michael S. Chang, MD was recently interviewed for an azcentral article. Read about Dr. Chang and his expertise on spinal conditions in children and adults.

Read "Spinal conditions in children and adults"

Posted in Expert Blog, Michael Chang MD

31Oct

Tingling In Your Spine? It Might Not Be Halloween

You might think that numbness and tingling don't deserve serious care because these symptoms seem more benign than pain, but any unusual sensation is your body’s request for change. Numbness can be surprisingly debilitating. It even takes a toll on your emotional resources. It should be looked into as soon as possible, because it may indicate stroke, seizures, or circulation loss.

Numbness

Complete or partial numbness is usually a sign of damage or nerve compression, which can be caused by carpal tunnel syndrome, a slipped disc, or secondary problems related to diabetes. The hands and feet are more prone to this form of damage. Most numbness is not associated with strokes or tumors, but these causes must be ruled out by a doctor anyway. You can assist with diagnosis by keeping a diary of your symptoms, along with their time of day, your activity levels, and exercise. An EMG and MRI might be needed, but the more careful you are with recording your symptoms, the faster and more accurate your doctors will be.

Tingling

Tingling and numbness often coexist and even have the same causes sometimes. However, tingling can also be a sign of an insect bite, nutritional deficiencies, infection, and Raynaud’s Phenomenon. You’ll need a thyroid test and your physician might look for spinal cord swelling. Seizures and migraines can also cause strange sensations, including skin crawling. A toxicology screen, angiogram, and ultrasound might also be ordered, depending on your response to basic in-practice diagnostics.

The Creepy-Crawlies In Medical Terms

In addition to these two symptoms, you might experience formication—the sensation of bugs crawling on or under the skin. This latter symptom could be the result of medication side effects, so take a list of the pharmaceuticals you use to your appointment. The absence of pain doesn’t mean the absence of suffering, and you deserve care. 

Posted in Expert Blog

31Oct

Halloween Skeleton Facts

Your spine might well be the oddest part of your body. It evolved too poorly to do its job well, undergoes changes from morning to night, and has the same number of vertebrae as a giraffe. It’s made from billions of neurons and keeps your brain in contact with the rest of your body. As spine specialists, we thought we'd share some fun facts about the spine in time for Halloween:

If You Want To become Taller, Visit the Moon

Gravity affects your height more than you might imagine. You’re taller when you wake up than when you go to sleep. Astronauts who spend time in space grow by as much as two inches. Once they return to planet earth, gravity goes to work to steal all that precious height.

Your Spine is Your Body’s Data Center

The spinal cord consists of a tangle of billions of nerves that send and receive information to and from the rest of the body. It’s the hub of all the body’s nerve signals. It doesn’t even need messages from the brain in all scenarios. Sometimes, it sends signals autonomously.

Doctors are Starting to do Robotic Back Surgeries

Robot-assisted spine surgery might sound as though it belongs in a sci-fi film, but surgeons are already using it to do surgeries in some locations. In the future, the technology will improve precision and outcomes.

Babies have "Extra" Vertebrae

Humans usually have 33 vertebrae, which are separate at birth. As you grow, the bones of the lower spine fuse, forming the sacrum and coccyx. So, if you've ever envied a baby's flexibility, don't feel bad.

The Spinal Cord Has Gray Matter

Just like the brain, the spine is made from white and gray matter. The latter is a collection of motor neurons, and the former is responsible for communicating with the rest of the body.

The spine is your brain’s personal assistant, and it does its job beautifully. If you are experiencing issues with your spine, contact us for a consultation.

Posted in Expert Blog

11Oct

Stem Cell Study Shows Promise for Paralyzed Patients

Stem cell therapy is among the most exciting developments in modern medicine. The science is still in its early stages, so it’s not quite time to make an appointment, but legitimate trials are beginning to show promising results.

Can Stem Cells Cure Paralysis?

Asterias Biotherapeutics conducted one of the largest human trials in 2016, using a sample group of six patients with varying degrees of paralysis. The trial’s results began to roll in in October 2017, a year after 10 million stem cells had been transplanted. Four of the six patients experienced improved mobility significant enough to impact their quality of life. While a study of this size and scope cannot be viewed as conclusive, researchers have high hopes based on these results.

Human Trials in Stem Cell Spine Research

As yet, most trials have had small sample groups or animal subjects. Stem cell research has ambled along at a sluggish pace, and Asterias’ trial patients may have improved for reasons unrelated to the use of embryonic cells. Spontaneous recovery is surprisingly common in patients with some forms of paralysis. 27% of traumatic six-nerve palsy patients recover on their own, and most of those with Bell’s palsy recuperate within six weeks.

Stem cells could restore communication between your body and brain, but with no clear direction in sight, researchers are still arriving at the most effective way to handle transplants. 99% of spinal cord injury patients who are paralyzed a month after a back injury never walk again, so researchers have been focusing on transplanting new cells into the cavity formed by the damaged area in the spinal cord. They also hope that stem cell therapy will reduce inflammation that causes further paralysis.

Nobel laureate Shinya Yamanaka says there are 10 diseases that may respond to embryonic stem cell therapy. Medical breakthroughs takes time, but the science is already beginning to prove its mettle. 

Posted in Expert Blog

11Oct

How Do NFL Players Recover From Spine Injuries?

NCAA football season has arrived with all its fans, thrills, and injuries. Each year, scholastic football endures almost 15 catastrophic cervical spine injuries. That’s a rate of four injuries for every 100,000 players. That said, the situation does come with a little hope. A study by Wolters Kluwer Health found that most NFL players who undergo upper cervical spine surgery for herniated discs recover and move on to enjoy another season -- three seasons, in fact, with performance comparable to athletes who have not sustained these types of injuries.

CDH Surgery and the NFL

The study surveyed 53 players who’d had the life-changing surgery between 1979 and 2017. 15 had upper spine herniation and 25 had lower level injuries. Nine months after the procedure, between 67 and 72% of the players had returned to the game. Of those who’d had spinal fusion, four required further surgery. Of the six who had less invasive ACDF surgery, half needed more treatments. Researchers believe that professional athletes should receive treatments tailored to their desire to return to high-performance athletics.

Cervical Spine Surgeries

Minimally invasive percutaneous cervical disc nucleoplasties are effective in 81% of patients. 95 to 98% of non-players who undergo the procedure enjoy excellent results, which underlines the importance of post-operative care. Football players in the Kluwer study returned to the field only nine months after their procedures, which may not be long enough for the bone to mature and solidify.

It’s recommended that patients get back to exercise once the fusion has set, and a reconditioning program is needed to gradually introduce stretching, strengthening, and aerobic exercise. While some patients can begin training six months after the procedure, every case should be treated as unique. Full recovery usually occurs at between 12 and 18 months.

Posted in Expert Blog

15Sep

Community Outreach

community outreach 2017

Thank you to all those who donated their time, resources, products, and services to help this Albanian Catholic Religious Sister get her spinal deformity surgery done.

Posted in Expert Blog, Dennis Crandall MD

05Sep

What is TLIF?

The first spinal fusion procedures were performed in 1911, using a strip of tibia to fuse the spine and provide extra stability. Medical research has focused heavily on developing more effective and less invasive ways to perform the surgery, but this hasn’t done much to make spinal fusion less contentious. Long-term improvement is hugely ranging depending on the condition the procedure is intended to treat. Spinal stenosis patients do as well with surgery as they do with physiotherapy. Those with degenerative disc disease do a little better with surgery. This is true for fractures and spondylolysis, too, but disc herniations and general lower back pain usually don’t respond well to fusion.

Understanding Spinal Fusion

Today’s fusions can be done using minimally invasive techniques that cause less damage to soft tissue. There are many different approaches, all of which have the same goal: to relieve pressure on the nerves and stop the disc from causing pain. Transforaminal lumbar interbody fusion (TLIF) uses an interbody spacer to restore height and stabilize the anterior spinal columns. Screws, rods, and a bone graft support the column. The procedure has shown remarkable results in trials. Patients’ pain was improved by between 60% and 80% depending on their diagnosis.

No surgery is free of risks, and TLIF has its potential complications. Nerve injury can happen, pain may continue, and the fusion may fail. These complications are rare, but they often happen because the cause of the patient’s pain wasn’t correctly identified. Getting an accurate diagnosis is one of the most important ways to benefit from TLIF. Patients should also exhaust other treatment options before considering the procedure.

Spinal fusion surgery is a relatively drastic approach that can have dramatic, and even life changing, results as long as it’s carefully chosen according to a well diagnosed condition. 

Posted in Expert Blog

05Sep

Is fibromyalgia real or imagined?

Chronic pain that lacks an obvious cause has confounded doctors for as long as medicine has existed as a field. Fibromyalgia (FMS) is thus one step forward in a journey that has lasted centuries. To answer the question of whether FMS is imaginary, you must understand the purpose of diagnostics: to give doctors an efficient way to treat patients.

Difference between Syndromes and Diseases

Diseases with obvious causes such as diabetes and cancer are no more legitimate than those with obscure origins. Suffering patients deserve the right care. FMS has unknown origins, so it’s known as a syndrome rather than a disease. The fact that there are no laboratory tests that can confirm its diagnosis doesn't make the symptoms any less genuine.

FMS was first defined in 1990 as a way to research a pain phenomenon with a specific symptom set, but it has evolved to become a diagnostic label. Its symptoms include:

  • Chronic and widespread pain
  • Insomnia and lack of fourth stage sleep
  • Fatigue
  • Lack of clarity

Patients respond to the same broad therapies. Doctors don’t need to know the cause to treat the symptoms any more than you need to understand how your digestive system works in order to sate your hunger. Many syndromes share this characteristic—doctors can only guess at the cause of migraines and even the reason their treatments work. This does not make migraine sufferers’ need for treatment any less urgent.

Chronic pain patients are almost four times more likely to attempt suicide, so treatment is potentially lifesaving. Doctors are stuck in the initial stages of understanding fibromyalgia’s physiological causes, so as knowledge improves, they may learn that these patients have a few different diseases. The symptoms and their causes are nonetheless authentic: You needn’t see the roots of a tree to know they are there.

Posted in Expert Blog

26Jul

Spinal Surgery Can Improve Quality of Life

Quality of life is something most doctors dream of offering their patients, but sorting through the risks and potential benefits of treatments must be done in partnership. For Jim Scheiter, however, invasive care provided the new life he hoped for. 

He came back from two tours in Iraq so utterly disabled that he couldn’t stand for longer than 15 minutes at a time. He spent years trying medication and physiotherapy to no avail. Then a spine surgeon recommended a lumbar interbody fusion, a surgery usually reserved for disc disease. This therapy has performed well in trials, with 88% of patients gaining quality of life. The operation is able to remove the cause of pain without cutting through muscle.

Within a week, Scheiter was already walking, and today, he’s completely pain-free. 

Is Spine Surgery for You?

Aside from the obvious fact that your individual condition may or may not warrant surgery, there are a number of factors to consider. Every patient has a different degree of tolerance to the risks associated with spine surgery, and every surgery has different rates of success. Surgery is a process rather than a choice you make at a single point in time. In most cases, patients exhaust non-invasive options before considering invasive ones. More importantly, they must find a skilled, board certified surgeon they can trust.

This is no easy decision to make, so make sure you feel comfortable asking your doctor questions about your options.

Quality of Life

Back surgery’s efficacy rates vary enormously from condition to condition, and your idea of what quality of life means is core to your choice because patients’ values vary as much as their personalities. Quality of life can be seen as a subjective idea of happiness, but for pain patients, it frequently means restoring a normal lifestyle. You deserve a full life and your best chance at a pain-free one. At Sonoran Spine, our doctors recommend only strong evidence-based medical treatments. We cannot promise miracles, but we can offer realistic hope.

Posted in Expert Blog

26Jul

When Did the Human Spine Evolve?

If you’ve ever had back pain, you’ve probably cursed your spine as the root of all evil, and you would be partially right. 90% of animals have no spine. The human form has a problematic backbone that is responsible for many chronic pain conditions.

Ancient History of Back Pain

The spine evolved about 500 million years ago. The Cambrian explosion responsible for upright walking began when the ocean’s creatures developed vertebrae. They didn’t have a spine yet, though, only “notochords”, which are made of a material similar to cartilage.

Nobody agrees on which creature is humanity’s earliest ancestor, but recently, researchers discovered the fossil of a young child that might answer that question more precisely. It reveals that the human spine has existed for at least 3.3 million years. Even more exciting, the fossil’s vertebrae were in the process of forming into individual parts, which gives scientists insight into how the backbone evolved. The flexibility that the backbone lost when it evolved from a notocord to a spinal cord was replaced by stronger bone, but came with parts that rubbed together to cause neuropathic and muscular pain. 

The first hominids climbed trees and walked, so they had both apelike and humanoid qualities. They became bipedal about six million years ago, but the curved spine we recognize today only formed 2.5 million years ago. Early human backbones connected to the back of the skull like a chimpanzee’s. They evolved to connect underneath the skull to allow for upright walking.

Chronic Pain Conditions Not Caused by Injury or Illness

If you can't attribute your pain to a single injury or illness, it may be due to repetitive motion or strenuous activities. Walking upright has unfortunate consequences, particularly because the muscles that support your body attach on an inward curve. Now we've added behaviors like playing sports, working at a desk, and texting to complicate matters for the spine. Since you can't wait around for your skeleton to adapt perfectly to your lifestyle, we work with what you have. Come in for a consultation to discuss your diagnosis and which non-invasive and surgical treatment options best address the issue.

Posted in Expert Blog

30Jun

Preparing for Outpatient Spine Surgery

Though we strive to build trusting relationships with our patients and to empower them with knowledge, spine surgery can be scary. Because of this, your preparations need to be practical and emotional.

Household Preparations a Week Before Surgery

Items that you use often should be placed at arm height so that you don’t need to bend down or stretch to reach them. Paper plates are useful to cut down on cleaning up, and a reacher will take care of the rest of your needs.

Stock your freezer with prepared meals and buy slip on shoes so that you don’t have to bend. Prepare canes, walkers, and crutches as needed. A toilet riser will help you to stand up during the weeks after your surgery. You may need pre-surgery evaluation and EKG.  Smoking can increase post-operative infection and can slow your healing, so consider stopping.

Try To Relax

Gather information about your surgery so that your postoperative time goes without a hitch. Consider your personality style when it comes to pain. Information seekers tend to relax more easily into their pain if they have all the data related to their surgery. Information avoiders do better with tools that distract them from their pain. If that’s you, a series marathon is doctor’s orders -- just avoid shows that make you lean off the edge of your seat!

A Day Before Surgery

Some of the most common medications to stop before surgery are warfarin, aspirin, and blood pressure pills. Many of these mustn’t be taken two weeks before your procedure, but our physicians will weigh up the risks of your unique case, so make sure you’re clear on your doctor’s advice.

Remove your jewelry the night before your operation and confirm the time you must arrive for the procedure. Don’t eat or drink from midnight on the night before your procedure, and pack comfortable, loose clothes to wear after the procedure. Arrange a ride home because you’ll be groggy and distracted. 

Always defer to your specific doctor's orders, since they vary based on individual patients and procedures. If you have any questions before your surgery, don't hesitate to call.

Posted in Expert Blog

30Jun

Why Choose an Outpatient Spine Center?

The shift from inpatient to outpatient spine surgery has surged in recent years with the rise in innovative techniques that cost a fraction of what they used to. Anyone who’s spent time in a hospital will know that the flow of nurses, doctors, visiting hours, and meals are enough to exhaust inpatients, so our outpatient clinic provides precisely the rest our doctors prefer.

On average, inpatient care in Arizona costs between $1,965 and $2,581 per day, so the less time spent in the hospital, the more money you can save. Of course, this saving is only beneficial if you’re careful with your rehabilitation. Failed back surgeries have many causes. Muscle spasms caused by inflammation and poor compliance with physical therapy are the most common of these.

Infection Control

Surgical site infections are a significant risk that can be diminished by outpatient care. It’s important to choose a healthcare institution with excellent infection control. Avoiding overnight stays entirely can shrink your infection risk dramatically.

Complications

Inpatient care generally reduces scheduling delays, but it also gives physicians more autonomy when it comes to your care. If your surgery has complex rehabilitative needs, our ambulatory centers have visiting nurses and physical therapists to support follow up care. Complications such as hematomas and reherniation of discs can be monitored better when you're prepared thoroughly by your surgeon.

Pain

Pain is an odd creature, often responding in ways that are completely counter-intuitive. Your emotional state has a significant effect on your pain levels, as does your clinical setting. Outpatients tend to suffer from less pain than inpatients and feel more satisfied than their inpatient counterparts.

Patient Empowerment and Responsibility

Patients who do not support their own care will enjoy few of these outpatient benefits. If you educate and empower yourself, though, you'll see improved outcomes. Be proactive in asking questions and voicing concerns to your spine specialist.

Posted in Expert Blog

30May

Chiropractic Risks and Alternatives

Why don’t we offer chiropractic adjustments?

As spinal specialists, we provide a range of treatment options based on each patient’s needs. We perform surgery on some patients for whom the benefits outweigh the risks. For others, we recommend alternatives to surgery such as physical therapy or massage. However, we don’t recommend chiropractic adjustments, and this is because we prefer strong evidence-based treatments that are as low risk as possible.

Risks of Chiropractic Adjustments

There’s no denying that some patients report excellent results from receiving adjustments from a chiropractor. Alternative treatments may have the advantage of long tradition, developing over centuries and resulting in a good number of positive anecdotes supporting their efficacy. However, as medical experts, we choose not to base our decisions on anecdotal evidence. We are willing to consider treatments that have undergone rigorous clinical trials. This is for your health and safety. Even if someone you know swears by chiropractic, what works for them may turn out harmful to you.

Twisting and cracking the spine typically causes short-term pain, and chiropractors might tell you this is simply a side effect. However, there is limited evidence that chiropractic is safe and effective in the long-term. Meanwhile, patients have suffered from strokes, pinched nerves and other complications due to damage caused by spinal manipulation. Unless a strong body of scientific evidence emerges in support of specific chiropractic methods, we are not willing to put our patients at risk.

Alternatives to Alternative Treatment

We understand the risks of the treatments we do offer, and are able to educate our patients about the benefits and drawbacks of each approach. Some chiropractors do offer treatments we recommend, while others make wild and unsupported claims. When you choose Sonoran Spine, you can have confidence that you’re choosing experts who have filtered out hypotheses from strong conclusions.

Spinal decompression can be performed without violently manipulating the spine. Gentle cervical traction addresses neck pain and other conditions stemming from the upper back. This method decompresses the neck while stretching muscles and joint structures. Of course, we cannot recommend any treatment without a proper examination, but we strive to take a minimally invasive course without overreliance on medication. If you have questions about treatment methods, please feel free to ask.

Posted in Expert Blog

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