When is Back Surgery Right for You?
Olivia Macleod was sitting on the floor three years ago playing with her three-year-old niece and went to get up.
“Come on auntie, let’s go,” Olivia’s niece implored.
“I couldn’t get up,” Olivia remembers.
This was the first time Olivia, at 36 years of age, had experienced any back pain in her life. Little did she know this was the beginning of a painful three years ahead.
Olivia’s experience is common. Experts’ estimate 80% of the population will experience back pain at some point in their lives. Low back pain is the leading cause of disability worldwide and the second leading cause for doctor visits.
Olivia says she laid around for a few days and took Ibuprofen. She was able to recuperate enough to return to her everyday activities. Three weeks later it happened again.
“I crawled to the chiropractor. I went in crying,” Olivia said.
She was diagnosed with a degenerative disc. She began regular chiropractic treatments, functioning well enough to work but remaining in constant discomfort. The treatments ended when she could no longer afford paying for regular visits.
Over the next eight months her condition deteriorated to the point that she needed to visit a general practitioner to get pain medication and start physical therapy.
She got an epidural, which is supposed to relieve pain for six months. Her relief lasted three weeks.
“I had a total emotional breakdown on my physical therapist,” Olivia recalls. “I couldn’t even put my shoes on.”
“I called my doctor and said ‘I’m done,’” Olivia remembers.
Olivia’s friend Amy Walsh is a physical therapist at Palomar Medical Center Escondido. She recommended Olivia see a spine surgeon affiliated with Palomar Health.
“When she came to me she had a lot of disc degeneration and a herniated disc,” Dr. Barba said, adding she had pinched nerves exiting the spine.
When consulting with clients, Dr. Barba says he looks at a variety of factors before recommending any treatment.
“I give them all the options, the risks, the benefits,” Dr. Barba says.
Many options are available like; simple rest, drugs, physical therapy, FACET injections, to the most invasive surgeries. However, Dr. Barba says he recommends back surgery for fewer than 5% of his patients.
After reviewing Olivia’s x-rays and discussing her options Olivia says Dr. Barba told her, “I know I can fix you but you have to make the decision.”
Friends, family, and doctors had discouraged her from pursuing back surgery because of her young age (38), but she had already unsuccessfully tried all the non-surgical methods.
“Dr. Barba did not have one ounce of hesitation. He was so confident he could make this work,” Olivia said.
Together Dr. Barba and Olivia decided to have an anterior spinal fusion. Dr. Barba performed the surgery on December 29, 2016.
“This was my first surgery ever,” Olivia said. “I never broke any bones, nothing.”
The anterior spinal fusion was performed at Palomar Medical Center Escondido on a Thursday. She was released from the hospital the next day.
“Everyone was really amazed,” Olivia said. Typical hospital stays are 3-4 days. “The only thing that hurt was my incision.”
She was walking stairs within 24 hours and went shopping on Saturday, two days after surgery.
“I felt great. I hadn’t felt back pain relief in years,” Olivia said.
Five months after surgery Olivia is now walking 3-5 miles a day. She goes to the gym, rides a stationary bike, and is in the beginning stages of doing circuit training, including lifting weights. She is considering playing tennis and riding her standup paddle board again.
“It’s like night and day. I don’t feel restricted. I feel like it’s endless to what I can do.”
Olivia’s decision to have a spinal fusion has turned out exceptional for her as it has for thousands of others. Spinal fusions are dramatically superior today than they were even a decade ago. However, the decision to have any type of back surgery should not be taken lightly. Surgery should only be pursued after careful consideration between the patient and provider and only when the patient is certain they have run out of other options.
Palomar Health is a great option for patients with back and neck pain.
They deliver complete care, ranging from non-surgical treatments that pinpoint pain at the source, to minimally invasive surgery that resolves complex conditions with lasting results. The multidisciplinary team works together in utilizing state-of-the-art methods and fostering a caring environment, helping patients get back to everyday activity as quickly, comfortably, and safely as possible.
Huey Lewis - Still Rockin' After Knee Surgery
By Carol LeBeau, Palomar Health Champion
In 1985, “Huey Lewis and the News” hit the Top 10 with “The Heart of Rock and Roll,” the first track on “Sports,” an album that sold more than 10 million copies. More popular than ever, the baby-boomer rock star is marking the 30th anniversary of “Sports” with a concert tour and release of a re-mastered CD.
In a recent interview, Huey Lewis shared with me how he’s still kicking it … and without knee pain thanks to Dr. James Bried, an orthopedic surgeon affiliated with Palomar Health.
Carol: When did you first notice your knee pain?
Huey: On the golf course … but it was a good shot!
Carol: How would you describe the pain?
Huey: It was a constant, dull pain that was sharp now and again.
Carol: How did the pain affect your live performances? Not to mention the rest of your life?
Huey: The pain bothered me on-stage, but I could get the gig done. Mostly it was interfering with my golf game.
Carol: Is that what got you to the doctor?
Huey: Yeah. I was playing at Pauma Valley one day with my pal, Chuck. Chuck suggested that I see (Dr.) Jim Bried, the surgeon who repaired his knee and shoulder.
Carol: What kind of treatment or therapy did you try before choosing surgery?
Huey: Just some ibuprofen … and a few Negronis! (laughs)
Carol: Ultimately, you had an arthroscopic procedure to repair a torn meniscus. How’d it go?
Huey: It was simple! I went in. They started an IV. Next thing I knew I woke up.
Carol: Was there much “down” time?
Huey: No. Recovery was a piece of cake. I elevated my leg for one day and then went Christmas shopping!
Carol: Sounds like a positive experience.
Huey: Dr. Bried and his staff were great! Quick and efficient. Got ‘er done!
Carol: And your golf game’s back? I hear you’re pretty good. Scratch?
Huey: I wish! I’m a 9 handicap.
Carol: I hear you love to fly-fish on your Montana ranch. Must be a lot more fun now without knee pain.
Huey: Definitely. In the water, your feet tend to get stuck down in the mud and it’s hard on the knees to pull them out.
Carol: So, we know you love golf and fly-fishing. What else do you do to stay in shape?
Huey: I tour the gym as often as I can at home and on the road.
Carol: Any advice for other folks out there dealing with joint pain?
Huey: Negronis! (laughs)
Carol: You’re on tour through November … venues all selling out. What is it about your music that resonates with fans of all ages?
Huey: I think it’s my gorgeous voice! No, I like to think our songs are real and truthful.
Carol: My favorite HLN song is “Jacob’s Ladder.” What yours?
Huey: I’m not allowed to have a favorite. I’m selling them all!
Carol: What kind of music do you listen to?
Huey: I listen to a lot of big band stuff and a lot of jazz. My Dad was a jazz musician.
Carol: He must have been proud of your success.
Huey: Yeah, but he kept it real. Once I called him to say my record went number one. He teased and said, “Oh, that’s too bad. The best stuff is never the most popular.”
Carol: What keeps you and “The News” band members together after all these years?
Huey: We pay well! Actually, four of us have been together for 35 years … the newest member for 12 years. We’re like brothers.
Carol: And, you’re still a major rock star. Is it true you don’t even have a tattoo?
Huey: Not that I’m aware of, but I haven’t checked my backside lately!
Carol: So, it really IS hip to be square?!
Huey: No! (laughs)
Carol: Any plans after the anniversary tour? Maybe kick back a little?
Huey: We’ll work on some new material in the studio … be a little more relaxed, but we’ll still do some shows.
Carol: You’re one of few musicians to enjoy a successful multi-decade career. How does that feel?
Huey: I just wanna be able to play music for a living. Fortunately, we’ve been able to do that. I’m thankful.
Carol: So are we, Huey. So are we!
Living Pain-Free after Minimally Invasive Spine Surgery
Ronald Kunkel’s job as a contractor demanded grueling physical labor which eventually took its toll on his back.
“I was in construction my whole life and worked hard and probably lifted stuff I shouldn’t have,” he says. “I never thought about my back at the time, but I’m sure that’s how I ruined it.”
Ronald, 71, went to several different doctors and chiropractors and got injections, epidurals and therapy but “nothing relieved the pain until I came to Dr. Kim,” he says.
Although Ronald was hesitant to have spinal surgery, he’s very happy he chose the minimally invasive transforaminal lumbar interbody fusion (TLIF) – a type of spinal fusion used to stabilize the spine by restoring disc height and fusing vertebrae together, which enhances spinal stability and alleviates nerve compression.
“Soon after I woke up from surgery I was able to walk to the end of the hall without a walker – and without any pain,” Ronald says. “I came to the hospital on Friday morning and went home Saturday afternoon. It was a miracle.”
“Minimally invasive TLIF surgery is the same as traditional surgery but the incision is made in a way that decreases damage to the surrounding soft tissue and muscle,” says Choll Kim, M.D., one of several orthopedic and spine surgeons affiliated with Palomar Health. “We make two small incisions instead of one big incision. All of this means less pain and faster recovery for the patient.”
Today, Ronald is pain-free and partially retired. He traded in his hard-core construction work for handyman jobs for neighbors and friends. His goal is to “always take care of my back.”
Giving Pain the Cold Shoulder
Paul Ross says he knows exactly what damaged his shoulders, eventually causing so much pain that he underwent two shoulder replacement surgeries last year at Palomar Medical Center Poway.
“I have always been a very active person,” Paul says. “In school I participated in wrestling, baseball, football, weightlifting and power lifting – and I really beat up my joints.”
A devoted weightlifter, Paul pursued the sport into his 40s, even as his shoulders protested and he had arthroscopic surgery on both knees. “My shoulder was popping in and out of the socket,” he recalls. “It got to the point where the pain was unbearable, especially at night.”
Paul had turned to board-certified orthopedic surgeon Brad Cohen, M.D., in 2005 for his knees and continued to confer with him about his shoulders. In April 2012, Dr. Cohen replaced Paul’s left shoulder and then performed a right shoulder replacement seven months later.
Paul is among 53,000 people a year who have shoulder replacement surgery each year in the United States. That compares to more than 900,000 knee and hip replacements done annually.
“Shoulder replacement surgeries probably are less common because knees and hips are weight-bearing joints that are more likely to be damaged,” says Dr. Cohen, who is affiliated with Palomar Health’s Orthopedic and Spine Center. “Patients also may try to live with shoulder pain because it doesn’t affect their mobility. We don’t walk on our shoulders.”
Paul said he opted for shoulder replacement surgery to stop hurting and to regain his active lifestyle. “These were very successful procedures from start to finish,” Paul says. “I am so glad I’m back to doing what I love to do. I still go to the gym and do cardio and yoga. On the weekend I bike, play tennis and even golf – with a full range of motion. Probably the best part is that I can sleep again without tossing and turning from pain.”
Paul’s story is typical of many patients who choose shoulder replacement surgery, according to Dr. Cohen. “They definitely tend to be active,” he says. “And they come in with pain, pain, pain.”
Paul’s weightlifting had repeatedly stressed his shoulders and led to substantial osteoarthritis so that he could no longer lift his arms above his shoulders, Dr. Cohen says.
Osteoarthritis is often a culprit in painful shoulder damage that restricts joint mobility.
Osteoarthritis is more common as we age, but also can be brought on by joint injury, repetitive stress on the joint, bone deformity or some diseases. Rheumatoid arthritis and chronic steroid use also can be significant causes of joint damage, according to the American Academy of Orthopaedic Surgeons.
Surgery should be the last option after first trying more conservative treatments, Dr. Cohen says. “I usually have all my patients try treatments such as cortisone injections, physical therapy and anti-inflammatory medications first. If that doesn’t work, then we may consider surgery,” he says. “If x-rays show a high level of arthritis, the patient’s level of pain is most important and guides what we do for treatment.”
Shoulder replacement surgery takes about 90 minutes. The patient usually is hospitalized for at least a day, although a patient occasionally may leave the same day as the procedure. That was the case with Paul Ross.
“I did both of his surgeries and he left the hospital the same day both times,” Dr. Cohen says.
Physical therapy is important for strengthening the muscles around the new shoulder joint and typically starts about four days after surgery, continuing for one to two months.
“The goal is for the patient to regain a full range of motion and at least the same activity level as before,” Dr. Cohen says. “Paul had lost at least 50 percent of his range of motion and now it’s fully restored. It’s amazing, really.”
Total Knee Replacement
Michelle Condon had two total knee replacements at Palomar Medical Center Poway in 2014, one in April and the other in June. Although the surgeries were less than three months apart, the difference in her experience and comfort was monumental.
“With the first surgery I was in the hospital for two days and was nauseated and constipated,” says the 60-year-old Ramona resident. “It was difficult to control the pain since the pain medicines made me so nauseated.”
With the second surgery, Michelle was able to go home the next day, had no nausea or constipation and needed less pain medicine when she got home. What a difference a new pain management protocol can make.
“With less pain and no nausea or constipation, it helped me get started on my recovery on a positive note,” Michelle says. “The new pain protocol meant I was healing and feeling better soon after the surgery.”
In May, the Palomar Health Total Joint Committee developed a standard pain management protocol to be used during hip and knee surgeries to improve patients’ reported levels of pain. Palomar Health surgeons, anesthesiologists, pharmacists, physical therapists and nurses joined forces to explore available literature, strategies and national guidelines on pain management. They also consulted with Mayo Clinic.
“It is Palomar Health’s goal to be the number one total joint replacement center in the southwest United States,” says Anesthesiologist Gary Gonsalves, M.D. “If we want to be the best it means we constantly have to challenge what we think to be true and use evidence-based medicine to optimize patient outcomes.”
Up until that time, surgeons often had their own individualized style of pain management, explains Pharmacist Jeremy Lee, manager of Clinical Pharmacy Services. There was no standardization and it was difficult for nurses to try to follow different directions from each doctor.
“Some of the successes we saw in the post-operative period were so variable that we had to take another look at things and ask if there was a starting point in pain management that could potentially help everybody,” Dr. Gonsalves says.
It was found that Mayo Clinic’s guidelines aligned with what Palomar Health wanted to do.
“Mayo’s (pain management) protocol had bits and pieces of what everyone here was following,” Dr. Gonsalves says. “So we took their protocol and used it as a base to build our own.”
Palomar Health’s new pain management protocol says that instead of having the patients wait until they have pain to take medications, pain meds should be scheduled before the pain begins and taken regularly. Pain medication begins before the surgery, under the new protocol.
“Before (the new pain management protocol), we would be chasing our tails trying to control the pain,” says Dawn Lopez, orthopedic clinical coordinator at Palomar Health. “Now, because we start pain medication about a half hour before surgery, we are ahead of the curve a lot of the time.”
The new pain management protocol includes acetaminophen around-the-clock, non-steroidal anti-inflammatory drugs, and steroids to decrease inflammation and pain. In addition, every patient gets a local anesthetic cocktail injected directly into the bone around the joint during surgery. Every patient also gets a scheduled long-acting morphine-like drug.
“The goal has been to avoid medication that gives people side effects like nausea and vomiting and at the same time, control their pain,” says Orthopedic Surgeon James Bried, M.D. “Recent injectable medicines, such as nerve blocks, can control pain and scientific evidence shows that if you control different pain pathways with anti-inflammatories and acetaminophen, you can eliminate the amount of narcotics you need for pain control.”
For patients on this pain management protocol, the amount of breakthrough pain is low and very manageable, Lee says.
“When we ask patients about their pain in previous experiences and how it compares to now, they say they find it is less painful now,” Lopez says. “Patients tell us their pain (since the new protocol) is a 3 or 4 (on a scale of 1 to 10, 10 being the worst). In previous surgeries, their pain was a 7 or 8. This is a significant improvement.
“With less pain, come other benefits, including a shorter hospital stay and a lowered risk of infection since patients aren’t in the hospital as long, Dr. Bried says. “On behalf of Palomar Health, we are looking at other patient populations who might benefit from a similar approach,”
Dr. Bried says. “To have some uniformity (in pain management) would be beneficial for both nursing care and pain control of patients.”
Everyone seems to agree that consulting with Mayo Clinic on the new pain protocol was beneficial to the cause.
“It added a lot to the conversation and made everyone here more confident in what we were doing,” Lee says. Using Mayo Clinic as a guide for the new pain management protocol made it “easier for us to communicate with physicians that we had found a better pain management template to use,” Dr. Bried says. “It gave credence to the position that we were trying to practice a scientific-based manner of caring for patients. It was helpful to have such a strong and learned institution, such as Mayo, behind us. It’s a lot more viable to say, ‘that’s what they’re doing at Mayo.’”
However, Dr. Gonsalves is quick to point out that even though a new protocol has been established, each patient is unique and requires different considerations.
“Medicine is not a cookbook. A protocol is where you start, not where you necessarily end up,” Dr. Gonsalves says. “We created this protocol and use it as a baseline. As physicians we evaluate how individual patients respond to the protocol and make any changes, if needed, to best fit each patient.”