Transcription:
Let's DISH about Spine & Neck Surgery

Gina: Welcome to the Iowa Specialty Hospitals and Clinics' ISH Dish Podcast, practical health advice from Iowa Specialty Experts. We want to connect the members of our communities with the latest healthcare information that's understandable, relatable and useful to your daily life. Today, on the show, we have Dr. Lynn Nelson, who by trade is a spine surgeon and his nurse practitioner, Monique Bailey, a.k.a., Mo. Thank you both for being on today.

Dr. Lynn Nelson: Thank you for having us.

Gina: Absolutely. So, we've done a video. So if anybody is listening and curious as to what these two lovely people look like, you can go to our website and search for orthopedics spine surgery. It's out there. It's on our Facebook page. There's a nice video out there of both of you. So, I'll give you a little break today and we don't have to record your faces.

Dr. Lynn Nelson: All right.

Gina: All right. So, let's just jump right in. Dr. Nelson, tell us a little bit about who you are, what you do, how you got to be with us.

Dr. Lynn Nelson: Right. I'm an orthopedic spine surgeon. I completed an MD degree back at the University of Iowa, then an orthopedic residency at Indiana University and a spine fellowship at Kansas University in Kansas City. I have practiced spine since 1994. For the past over 20 years, my practice has been limited to spine that includes evaluation and treatment of cervical spine, which is one's neck and the lumbar spine, which is one's low back.

Gina: Wonderful. I would imagine that you probably never run out of patients for those two areas.

Dr. Lynn Nelson: There's a lot of changes in healthcare, certainly in regards to payers and where persons are able to seek care and the insurance coverage and so forth. But it's very clear that the patients themselves are not going away.

Gina: Right. Yeah. And I think as as a whole Americans, for sure, we've just made that worse with our poor posture and work ergonomics and whatnot.

Dr. Lynn Nelson: Absolutely true. And certainly, spine problems do tend to correlate with smoking and diabetes and other things that unfortunately tend to be in the rise.

Gina: That's interesting. Thank you. Mo, tell us a little bit about yourself and how you became to be where you are today.

Monique Bailey: Today, well, got my ADN from Iowa Central, worked at an ICU for ten years and came to Iowa Surgery Department, obtained my bachelor's and master's degree from Briarcliffe University. I wanted to stay in the surgery area and the opportunity arose to work with Dr. Nelson. I was able to go down in preceptor a little bit with my schooling and stuff. And then when he came full-time, I joined with him as his nurse practitioner.

Gina: Nice. Okay. So, I think people are often curious as to how you came into the field that you are in today. I know that when we did an interview with Dr. Adams, you know, how does somebody become interested in gastroenterology of all things? So, how did you become interested in the profession that you're in today?

Dr. Lynn Nelson: When I entered medical school, I thought I most likely would become a family practice physician because that was the specialty with which I was most familiar. However, in medical school, I absolutely loved orthopedics. Orthopedic surgery is by far the coolest specialty. Orthopedic surgeons can affect really remarkable improvement in patient's lives in a really short period of time. The results are generally very good and we tend to have satisfied and happy patients.

In regards to spine, I believe the largest influence was my father's spine problems. He was, by any definition of the word, a failed back patient. In fact, he had a total of five lumbar spine surgical procedures and one neck procedure. I learned firsthand that, in some cases, the surgeries are effective and, unfortunately, in some cases, they're not. That experience prompted me to develop an interest in spine and really do what I could to impact patient's lives in a positive way.

Gina: Wonderful. Thank you so much. I don't think it's any secret that you worked several years down in Des Moines and now you obviously are working here at Iowa Specialty Hospitals and Clinics. What attracted you the most to come back in this area or work for Iowa Specialty in general?

Dr. Lynn Nelson: Iowa Specialty Hospitals is a remarkable story of the success rural healthcare can be. Prior to my coming here, Iowa Specialty Hospitals had really first rate total joint replacement and orthopedic services. Iowa Specialty Hospitals offered me the opportunity to continue to practice spine only to provide high quality care in an environment where the system administrators wanted to provide what I needed to have a successful practice. Also, I grew up on a farm only 20 miles straight west of Belmont and having the opportunity to come back to my home community and take care of those descendants of who I grew up with was just an opportunity too good to pass.

Gina: That's such a cool story, that you're a rural Iowa farm boy who went big city and now you're back and taking care of all the people that probably really need it the most.

Dr. Lynn Nelson: Well, thank you. I never really left the farm in many senses, and very happy to be back here practicing full-time.

Gina: Very good. If somebody wants to be referred to you, what would be the process for them to do that?

Dr. Lynn Nelson: The vast majority of patients are referred by their primary care provider. Most patients have had plain films of the involved spine part and most patients have also had either a CT scan or a MRI scan, most commonly an MRI scan. Ideally, patients have tried non-surgical means before seeing myself.

Gina: Okay. And what type of diagnoses do you actually treat?

Dr. Lynn Nelson: The most common diagnoses are herniated discs of either the neck or low back or spinal stenosis, which is a condition where degenerative changes cause soft tissue and bony structures to hypertrophy or overgrow, and that overgrowth of tissue causes nerve impingement. In some cases, persons can have additionally an instability that is a condition where the vertebrae move too much or don't line up properly or have really marked wear and tear degenerative changes affecting the discs or, less commonly, the facet joints.

Gina: All right. That's a lot.

Dr. Lynn Nelson: It is indeed.

Gina: How would I know if I had a herniated disc?

Dr. Lynn Nelson: The most common symptom associated with herniated discs is pain down one's arm if the cervical spine is the culprit. Or down one's leg if the lumbar spine or low back is the culprit. The radicular pain means that it matches the distribution of the nerve root, which is being impinged upon.

Gina: And that is different from sciatica?

Dr. Lynn Nelson: No, they really, in most senses, are used interchangeably.

Gina: Interesting. I have a husband at home who thinks he has some sciatica and nobody wants to do an MRI for him, it seems. And I told him, "Well, you just might have to become a little more insistent to get that taken care of."

Dr. Lynn Nelson: Certainly, the insurers have algorithms that patients have to check the boxes, if you will, in many cases to qualify for an MRI scan. But one who's had symptoms for a reasonable period of time who is limited with those symptoms should be insistent and seek the care that they need.

Gina: Yeah, absolutely. Good point. I'll make sure to mention that. So, I want to go back to you for a second, Mo. If I make an appointment to see Dr. Nelson, am I just going to see him or are you going to be involved in every step as well?

Monique Bailey: I'm usually involved in every step along the way. I get to see the patients preoperatively prior to Dr. Nelson going in. We just kind of go over their presenting illness, go over an assessment. And then, Dr. Nelson goes in to see them. I get to help during surgery. And then, I get to see them in their postoperative visits with Dr. Nelson.

Gina: So, you really are just a team floating around together then. That's really cool. Okay. is spine surgery considered high risk? Or do the benefits really outweigh any possible risks that there might be? I feel like this is a question that I hear frequently. Because if you're coming at me with a surgical instrument to my spine, people get a little edgy.

Dr. Lynn Nelson: Yes, rightly so. The risk-benefit analysis or RBA is the most important preoperative discussion that I have with patients. Certainly, in some cases, patients have pain that they may believe warrant surgical treatment, but unfortunately, conditions related to their diagnosis or the procedure itself simply may not be likely enough to help those symptoms that I'd offer them the procedure. I think that certainly the complications that can occur with spine are indeed scary. Those complications can be life-changing and certainly have to be considered in that risk-benefit analysis

Gina: Sure. What kind of recovery time are you generally looking at if you have a spine or neck surgery?

Dr. Lynn Nelson: Recovery time varies greatly depending upon the surgical procedure performed, depending on the patient's condition preoperatively and the general health of the patient. Low back surgeries to take pressure off nerves have really quite rapid recoveries in regards to return to light activities of daily living. But returning to more demanding physical activities in sports is, in most cases, at least 12 weeks.

Fusions are much slower in regards to returning to activities because we have to wait for the biologic fusion to occur, which is a rather slow biologic process. For lumbar fusions, getting back to full activities is at least four months, quite commonly six months. For the neck or cervical spine after a fusion, patients typically are able to get back to reasonable activities after three to four months.

Gina: Okay. So, it's not a cookie cutter thing obviously.

Dr. Lynn Nelson: It's absolutely not. The patient care is individualized based on the many factors involved.

Gina: You are now seeing patients back in the Des Moines area at our Iowa Weight Loss Clinic, correct?

Dr. Lynn Nelson: It is true. I see patients currently every Monday at the newly remodeled, very nice Iowa Specialty Hospitals building at 5901 Thornton, which is just southeast of the intersection of Park and 63rd Street in West Des Moines.

Gina: That is a really nice facility.

Dr. Lynn Nelson: It really is. Beautiful facility, and the people there want to do a good job, want to take good care of folks.

Gina: Yeah, it's very easy to get to. Yeah. I like it down there. All right. Is there anything else that you would want to add about your practice? What you can offer?

Dr. Lynn Nelson: I'd like to emphasize the team approach of Iowa Specialty Hospital's spine care. Patients seen in the office are of course registered. The registration people universally here are very nice. Once roomed, patients typically see an RN, registered nurse and also see nurse practitioner, Mo, prior to seeing myself. Those patients who are scheduled to undergo surgical treatment, at least for the fusion patients, complete a spine class by, again, a very caring, competent group of people. Once patients come to the Belmont Hospital for surgical treatment, again, the registration people universally are well respected by my patients and found to be very kind. The pre-operative staff likewise very well appreciated, nice folks. The operating room staff do excellent work. And the ward care at Belmont Hospital, I believe, is a really top-notch caring group of experienced nurses who provide excellent care.

Gina: Wonderful. I think people absolutely love the Belmont facility. We get a lot of compliments both obviously, but there's something about that Belmont Hospital that's just quiet and quaint.

Dr. Lynn Nelson: I think the Belmont Healthcare providers very much have an attitude of neighbors taking care of neighbors. it just results in very good care that patients appreciate.

Gina: If someone wants to see you, do they need to have a referral from their family practice provider?

Dr. Lynn Nelson: Patients ideally would have a referral from their primary care provider. Ideally, they would have plain films and imaging studies such as CT scans or MRI scans available as well so that their visit with myself can be more productive.

Gina: Thank you both very much for being on the podcast today.

Dr. Lynn Nelson: Thank you very much for the opportunity.

Gina: Absolutely. Thank you for listening to Iowa Specialty Hospitals and Clinics' ISH Dish Podcast. For more information on the topics we discussed today, visit us on the web at iowaspecialtyhospital.com. There, you can read a transcript of today's episode or previously aired episodes, as well as get the latest news from Iowa Specialty Hospitals and Clinics and explore all of the services that we offer. For the ISH Dish Podcast, I'm Gina. Thanks for tuning in.