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Train Your Body (438)
The show for fitness buffs or beginners. Expert guest from the American College of Sports Medicine (ACSM) discuss all areas of fitness, nutrition, athletics and sports medicine.
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Staying Well (382)
RadioMD’s “talking” Health A-Z hosted by senior health correspondent, Melanie Cole, MS. Melanie interviews experts in the world of health, wellness, fitness and medicine.
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Healthy Talk w/ Dr. Michael Smith (698)
Integrative physician, Michael A. Smith, MD is committed to providing listeners with the most current health information available.
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Naturally Savvy (899)
Registered Holistic Nutritionist, Andrea Donsky and health expert Lisa Davis discuss their passion for living a natural, healthy lifestyle.
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Eat Right Radio (48)
EatRight Radio, with experts from the Academy of Nutrition and Dietetics, discusses food and nutrition topics, healthy weight, allergies and health conditions, healthy aging, food safety and so much more. Give us 10-minutes and we'll give you the important information and expert advice from registered dietitian nutritionists to help you eat right, feel better, and live a healthier life. Hosted by Melanie Cole, MS.
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Sharecare Radio (235)
Sharecare Radio, hosted by Sharecare’s own Dr. Darria Long Gillespie, SVP of Clinical Strategy at Sharecare, will appear live every Tuesday from 12 to 1 p.m. EST on RadioMD. Dr. Darria will break down the top health news of the week, pull in experts from around the country on a wide array of health topics and answer listeners’ live questions on all things health.
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Wellness for Life (455)
On Wellness For Life Radio you will learn practical, easy-to implement tips to improve your life and start feeling better — the natural way.
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The Wizard of Eyes (163)
Dr. Robert Abel Jr. talks about many of the important and unrecognized parts of our visual system which we so often take for granted. The show covers the usual common ocular disorders with an East/West approach to both prevention and therapy. The eye-brain connection is presented with information about memory retention, Alzheimer's, the myopia epidemic, and many more subjects. Dr. Abel discusses how the eye and vision are connected with remote parts of the body including your gut flora, musculoskeletal system, blood pressure, drugs and lifestyle. practical and simple health tips.
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Code Delicious with Dr. Mike (135)
Code Delicious with Dr. Mike breaks all the rules. Unabashedly confronting the questions, concerns and conundrums that continually confuse both public and experts alike; Dr. Mike takes us on a tasty trip of inquiry.
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CLEAN Food Network (98)
This show is a call to action for all the clean eating revolutionaries that care about their health and how and what they eat. Non-GMO, natural, organic . . . food the way nature intended. The clean food movement is huge and is growing exponentially. This companion program talks to experts in food preparation, healthcare, celebrities, and even those companies that care enough to provide the best, wholesome, organic foods and groceries.
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Talk Healthy Today (213)
Looking to create your best self? Whether it’s good-for-you lifestyle hacks, smarter ways to supplement, or tasty tips to fuel optimal health, Talk Healthy Today brings you the latest research, tools, and common sense tips you need to get and stay healthy... starting today!
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Be a Doer (17)
Be A Doer features master coach and TV personality John Abdo as he shares health and fitness tips aimed at getting you in shape – and keeping you there!
View items...The Power of Probiotics (3)
Probiotics is a major global industry. But like any industry, it had to have a beginning. Natasha Trenev is the daughter of an Eastern European family where the manufacturing of yogurt was a generational business. When Natasha emigrated to the US in the 1960’s, she brought with her 750 years of family experience with probiotics – and introduced the science (and the term itself) to her new country. Today, Natasha’s California-based Natren, Inc. is the recognized pioneer in probiotics and company founder Natasha Trenev has earned recognition as the Mother of Probiotics. Her more than 50 years of work in natural health is at the core of the unparalleled success of her company – and you will benefit from her depth of expertise in each and every episode of THE POWER OF PROBIOTICS.
Probiotics are live microrganisms that are commonly referred to as ‘friendly,’ ‘good’ or ‘healthy’ bacteria that function to help maintain the natural balance of organisms in the intestine. Throughout Natasha’s extensive work in the field of probiotics, she has always been amazed by how nature provides the very ‘good’ bacteria that can help overpower ‘bad’ bacteria to keep our digestive tracts functioning at peak performance. Properly cultivating friendly bacteria and ensuring their potency is at the core of the Natren Process. Natren is cited – by retailers, by the medical community and by consumers – as the best probiotic supplement available. Only Natren carefully chooses its probiotic cultures, formulates and manufactures its industry standard probiotics in its own plant and utilizes a specially-formulated oil matrix to protect probiotics bacteria to survive until they reach their destination in the upper small intestine. This is why only Natren is the most trusted probiotic supplement on the market. Truly, where other probiotic supplements promise – Natren Delivers.
To learn more about how probiotics can benefit your health, we are proud to introduce you to THE POWER OF PROBIOTICS with The Mother of Probiotics, Natasha Trenev.
Your Brain Health (24)
Noted Los Angeles-based neuroscientist and media personality Dr. Kristen Willeumier launches Your Brain Health with Dr. Kristen Willeumier, a podcast series that explores the latest news and information in the burgeoning science of brain health.
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Support brain health as you age.
Additional Info
- Segment Number 1
- Audio File wellness_for_life/wl391.mp3
- Featured Speaker John E. Lewis, PhD
- Guest Website Nurish.Me
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Guest Bio
Dr. John E. Lewis has been the principal investigator of multiple nutrition, dietary supplement, exercise training, and medical device studies in the last two decades. Much of his research has included investigating the effects of interventions on a wide variety of outcomes, including immune and cognitive functioning, inflammation, physical fitness, nutrient status, quality of life, and mental health, in healthy adults and in those with Alzheimer’s, HIV, MS, non-alcoholic fatty liver disease, diabetes, chronic pain, and GI disorders, among others.
He has co-authored more than 170 peer-reviewed scientific articles, has mentored many undergraduate, graduate, and medical students in exercise, nutrition, and health promotion, and has been an invited speaker at multiple international and national conferences. - Length (mins) 26:05
- Waiver Received No
- Host Susanne Bennett, DC
Healing from past trauma can support physical wellness.
Additional Info
- Segment Number 1
- Audio File wellness_for_life/wl390.mp3
- Featured Speaker Meg Haworth, PhD
- Guest Website Meg Haworth, PhD
- Guest Facebook Account www.facebook.com/coachdrmeghaworth
- Guest Twitter Account @drmeghaworth
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Guest Bio
As a survivor of sexual abuse, drowning, being struck by lightning, and healing over a dozen illnesses including fibromyalgia, Dr. Meg Haworth knows what it takes to overcome life's biggest challenges and has helped thousands of others do the same over more than two decades.
She is the founder of Lightning Women; Overcoming The Wounds of Sexual, Physical & Emotional Abuse, a movement for women who suffered abuse as children and now have a chronic illness. This link has been confirmed by science through the ACE Study quiz available on her website.
She is a bestselling author of Get Well Now, speaker, and nutritional celebrity chef. She has been featured on NBC Nightly News, The Los Angeles Times, and The Huffington Post and offers total wellness solutions from food plans to her Whole Person Integration Technique, multiple books in cooking & personal development, a podcast series on iTunes, online programs, private sessions and wellness coaching. - Length (mins) 24:55
- Waiver Received No
- Host Susanne Bennett, DC
Jennifer Noel Taylor, CEO of Quantum-Touch, Inc., found herself in a tough spot when she'd racked up $135,000 in debt. Learn how she turned it around -- and how you can too.
Additional Info
- Segment Number 1
- Audio File naturally_savvy/ns838.mp3
- Featured Speaker Jennifer Noel Taylor, CEO of Quantum-Touch, Inc.
- Book Title Spiritual and Broke: How to Stop Struggling With Money and Live Your Purpose
- Guest Website Love Incorporated: The Business of Doing What You Love
- Guest Twitter Account @jennoeltaylor
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Guest Bio
Jennifer Noel Taylor is an energy healing practitioner, self-help motivator, and the CEO of Quantum-Touch, Inc. She has dedicated her life work to helping people discover the healing power of their love.
Jennifer graduated from Cal Poly (San Luis Obispo, CA) with a Bachelor of Science Degree in Computer Science and a Minor in Philosophy. After graduation, she started her first job as a Software Engineer at a big company in San Diego. Like so many people, she felt incredibly trapped and depressed at a job that paid the bills but didn’t align with her true passion in life. She innately knew that she had a purpose and felt keenly aware that she was not following her true calling in life.
To cope with the social isolation and depression she felt at work, she studied bodywork and alternative healing. She attended the International Professional School of Bodywork, Esalen Institute in Big Sur, and the Maui Academy of Healing Arts. While working on people, she started to feel the “energy fields” emanating from people. She became fascinated by energy healing and studied various energy healing modalities, including Reiki.
She met Richard Gordon, the founder of Quantum-Touch as his lecture on Maui. She fell in love with the vision of Quantum-Touch and received a very clear message from the Universe that energy healing was her true calling. Shortly after training in Quantum-Touch, she quit her job, took a leap of faith, and finally followed her Heart. She took over as CEO of Quantum-Touch in June 2002.
As CEO of Quantum-Touch, she continues to promote optimal wellness by helping people connect more deeply to their love. Not only is Love the basis of all healing but it also is the guiding force behind the business itself. Her business practices include spiritually rewarding jobs, loving service to the world, environmental responsibility, and financial abundance. Quantum-Touch has grown from a regional U.S company to a Multinational corporation.
Imagine... If more people did what they love, how much more joyful the world would be. - Length (mins) 20:54
- Waiver Received Yes
- Host Andrea Donsky, RHN and Lisa Davis, MPH
When you lose someone dear, that hurt and pain can stay with you for a lifetime in varying degrees.
Additional Info
- Segment Number 1
- Audio File naturally_savvy/ns837.mp3
- Featured Speaker Christina Rasmussen, Founder of Second Firsts
- Organization Life Reentry Institute
- Book Title Where Did You Go? A Life-Changing Journey to Connect with Those We’ve Lost
- Guest Website Second Firsts
- Guest Facebook Account https://www.facebook.com/Secondfirsts
- Guest Twitter Account @SecondFirsts
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Guest Bio
Christina Rasmussen is on a crusade to change the way we live after loss. As the founder of Second Firsts, an organization to help people create a pathway back to life after loss, Christina spends her time speaking, coaching, and helping thousands of people rebuild, reclaim, and relaunch their lives using the most powerful tool for personal reinvention: the human mind. Her personal story and fresh approach to life after loss has garnered international attention.
She writes for the Huffington Post, she's been featured as a Woman Working to Do Good in the White House Blog, and she was named the Leading Mom in Business by StartupNation. Her first book, Second Firsts: Live, Laugh and Love Again, has achieved bestseller status on both Amazon and Barnes and Noble. You can also sign up to receive her weekly newsletter, the "Message in a Bottle," by visiting www.secondfirsts.com. - Length (mins) 23:59
- Waiver Received Yes
- Host Andrea Donsky, RHN and Lisa Davis, MPH
Make the most of your dates to find your mate.
Additional Info
- Segment Number 1
- Audio File lifes_too_short/ts93.mp3
- Featured Speaker John Gottman, PhD
- Guest Website The Gottman Institute
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Guest Bio
World-renowned for his work on marital stability and divorce prediction, John Gottman has conducted more than 40 years of breakthrough research with thousands of couples. His work on marriage and parenting has earned him numerous major awards and he is the author or coauthor of over 200 published academic articles and more than 40 books, including the bestselling The Seven Principles for Making Marriage Work. Dr.Gottman’s media appearances include Good Morning America, Today, CBS This Morning, and The Oprah Winfrey Show, as well articles in The New York Times,Redbook, Glamour, Woman’s Day, People, Self, Reader’s Digest, and Psychology Today. Cofounder of the GottmanInstitute with his wife, Dr. Julie Schwartz Gottman, John is also Professor Emeritus of Psychology at the University of Washington, where he founded The Love Lab and conducted much of his research on couples.
- Length (mins) 11:54
- Waiver Received Yes
- Internal Notes no social media
- Host Melanie Cole, MS
Chocolate -- specifically dark chocolate -- has some significant health benefits.
Additional Info
- Segment Number 1
- Audio File naturally_savvy/ns835.mp3
- Length (mins) 19:08
- Waiver Received Yes
- Host Andrea Donsky, RHN and Lisa Davis, MPH
Men can navigate the modern landscape of relationships.
Additional Info
- Segment Number 1
- Audio File lifes_too_short/ts92.mp3
- Featured Speaker John Kim, LMFT
- Book Title I Used to Be a Miserable F***: An Everyman’s Guide to a Meaningful Life
- Guest Website John Kim, LMFT
- Guest Facebook Account www.facebook.com/theangrytherapist
- Guest Twitter Account @angrytherapist
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Guest Bio
John Kim, LMFT (The Angry Therapist), pioneered the online life coaching movement seven years ago, after going through a divorce which led to his total re-birth. He quickly built a devoted following of fans who loved the frank and authentic insights that he freely shared on social media. He pulled the curtain back and showed himself by practicing transparency and sharing his story something therapists are taught not to do. Kim became known as an unconventional therapist who worked out of the box by seeing clients at coffee shops, on hikes, in a CrossFit box. He built a coaching team of his own and launched a sister company called JRNI, creating a new way to help people help people and change the way we change. He lives in Los Angeles.
- Length (mins) 28:30
- Waiver Received Yes
- Internal Notes no social media
- Host Melanie Cole, MS
For too long, commerce has ignored the health of our planet and our bodies.
Additional Info
- Segment Number 1
- Audio File naturally_savvy/ns836.mp3
- Featured Speaker Marci Zaroff
- Book Title ecoRenaissance A Lifestyle Guide for Cocreating a Stylish, Sexy + Sustainable World
- Guest Website Marci Zaroff
- Guest Facebook Account https://www.facebook.com/marcizaroff/
- Guest Twitter Account @marcizaroff
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Guest Bio
Marci Zaroff is an internationally recognized ECOlifestyle visionary, authority, innovator and educator and has been instrumental in driving authenticity, environmental leadership & social justice worldwide for nearly three decades.
With a degree from the Haas Business School, University of California, Berkeley, Marci co-founded a thriving health and environmental educational center in 1990 with an organic café, AVEDA concept salon and national magazine — now known as “The Institute for Integrative Nutrition,” the largest professional “health coach” certification program in the world.
After nearly a decade in natural/organic food and beauty, Marci recognized the “missing link” in the wellness equation, and in 1995, seized the opportunity to launch leading lifestyle brand Under the Canopy, to coin and trademark the term “ECOfashion®” and to pioneer the market for organic & sustainable apparel and home textiles. As Founder and former CEO of “UTC”, Marci created a unique and unparalleled development, distribution and monitoring business model to ensure that processes and products remain pure, transparent and authentic.
Today, Marci is the Founder and CEO of MetaWear — the first “sustainable style” GOTS and Cradle to Cradle Certified cut and sew manufacturer in the world for turnkey, full package organic/eco-friendly apparel. Offering garment dyeing & cutting-edge seaweed-based screen printing free of harmful toxins, Metawear’s 40,000 square foot factory is powered by renewable energy and is producing printed T-shirts and garments for countless corporations, brands, retailers, universities, films, festivals and leading NGOs. MetaWear’s a la carte ECOfashion platform also produces from a vertically integrated GOTS certified supply chain in India. - Length (mins) 20:44
- Waiver Received Yes
- Host Andrea Donsky, RHN and Lisa Davis, MPH
Modern scientists are discovering some fascinating healing properties of mushrooms.
Additional Info
- Segment Number 1
- Audio File naturally_savvy/ns844.mp3
- Featured Speaker Jery Cochern, Founder of Pure Essence Labs
- Guest Website Pure Essence Labs
- Guest Facebook Account https://www.facebook.com/PureEssenceLabs
- Guest Twitter Account @PureEssenceLabs
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Guest Bio
Jery Cochern, Pure Essence’s Founder and President of Research and Development, is an industry icon who has established two highly unique brands – Rainbow Light & Pure Essence – each of which provides innovative and effective formulations. He is a Certified Nutritionist, Certified Nutritional Consultant, and one of a handful of American Superior Herbalists. He is widely known as one of the natural industry’s most holistic thinkers, innovative formulators, and exceptional speakers.
Jery’s dedication to the natural health movement has spanned 40 years. In 1978, he was a key member of a team of nutritionists who introduced spirulina to the US Market. A year later, he became the National Sales Manager for a major spirulina importer. Through his continuing education seminars, he made “green foods” a household term.
In 1984, Jery founded Rainbow Light Nutritional Systems and made it, virtually overnight, one of the industry’s largest, most successful brands. There, Jery introduced the world’s first food-based vitamin and mineral formulations.
In 1990, Jery sold Rainbow Light to pursue natural research. It was during this time that he developed a love and appreciation for Traditional Chinese and Ayurvedic Medical disciplines. He also discovered Superior Herbalism, which is the world’s oldest and most profound system of health building dietary supplementation.
After seeing what Superior Herbs can do, Jery founded Pure Essence in 1998. Incorporating these remarkable plants into supplements and nutraceuticals, he took the whole food experience to a whole new level. As a result, Pure Essence became an industry leader, with formulations that address underlying causes in ways that competing products do not. - Length (mins) 24:54
- Waiver Received Yes
- Host Andrea Donsky, RHN and Lisa Davis, MPH
Additional Info
- Audio File christiana_care/crc002.mp3
- Doctors Bohman, Leif-Erik
- Featured Speaker Leif-Erik Bohman, MD
- Guest Bio Leif-Erik Bohman, MD specializes in minimally invasive and complex spine, brain and peripheral nerve surgery. He received his medical degree from Columbia University Vagelos College of Physicians and Surgeons in New York City and underwent neurosurgery fellowship training at Christchurch Public Hospital in New Zealand.
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Transcription
Melanie Cole (Host): It's important to recognize and understand the potential symptoms of spinal stenosis because having this knowledge can help you obtain an early diagnosis and treatment. My guest is Dr. Leif-Erik Bohman. He's a specialist in neurologic surgery and spine surgery with the Christiana Care Health System. Dr. Bowman, welcome to the show. Tell us about the current state of back pain today. What are you seeing as far as prevalence and the economic impact of back issues in this country?
Dr. Leif-Erik Bohman, MD (Guest): Thank you so much for having me. Back pain is the second most common cause of disability in adults in America, and is a cause of an estimated almost 150 million lost work days a year, and it's very, very common. About 80% of people have an episode in their life, and of these, most of them will have another episode. That's one of the most common reasons people go to their primary care doctors and it also has been linked to and probably played a very significant role in the current opioid crisis.
Host: So today we're focusing a little bit on spinal stenosis. Tell us what that is, what it means, and where on the spine does it affect someone?
Dr. Bohman: So stenosis is just the medical word for narrowing of usually a tubular structure. So you know, people with heart disease will have narrowing of their blood vessels in their heart, and that's coronary stenosis. This is- the tube we're talking about here is the spinal canal which transmits the spinal cord in the cervical spine in your neck, the thoracic spine past your ribs, and then in the lumbar spine transitions into something called the cauda equina which is just a series of nerve roots. And so the spinal canal transmits all of those things, and so stenosis is narrowing of the spinal canal, which can then apply pressure either to the spinal cord or to nerve roots depending on where it is. That can be caused by a variety of things. I mean, the most common things are disc herniations or bone spurs or overgrowth of ligaments or joints from arthritis, although people can also have mal-alignment of the spine where the bones don't line up right, kind of closing the tube, or more rarely it could be from a tumor or fat or some other substance narrowing the tube.
Host: Why does it happen, Dr. Bohman? Why does that tube narrow? Why does this stenosis happen?
Dr. Bohman: So there are a variety of ways it can happen depending on what is actually doing the narrowing. But by far the most common is just wear and tear over time from arthritic changes in the spine. The most common way it would happen suddenly is through a disc herniation, and the disc being the padding between two vertebrae, but one of the weakest points in the disc is at the back of the disc, and so some of that soft padding material can squeeze back into the spinal canal, and then take away some of the room that would otherwise be occupied by nerve roots.
Host: Can someone have spinal stenosis without back and neck pain? Can they not even realize that they have it?
Dr. Bohman: Yes, I think in fact that's very, very common, and it's one of the things that makes figuring out what the right treatment is challenging sometimes, is that we know that people can have stenosis that doesn't cause people pain, and we know that people's symptoms from it can come and go.
Host: Then let's talk about the symptoms, and do these symptoms happen quickly, or do they develop slowly over time? Give us some of the specific symptoms that we might notice for lumbar, thoracic, cervical spine stenosis.
Dr. Bohman: Sure. So yeah, the symptoms as you point out would be very different based on where the level of the stenosis is. For cervical stenosis, we worry about clumsiness with the hands, numbness in the hands, and trouble walking. And these are symptoms that are often overlooked because they frequently do come on slowly and they don't necessarily seem attributable to the spine. You know, people just have- they notice that they're walking like they're drunk they'll tell you, or they feel like they're on a ship, or they're dropping things all the time and they don't know why. And while some people have neck pain with that, not everybody does, and so sometimes these symptoms can become quite advanced before anyone puts it together that it's coming from the neck. In the thoracic spine, the symptoms are generally pretty similar to the cervical spine, although without the hand symptom. So it's more focused on balance. Occasionally people can have incontinence, but usually balance trouble is predominant, sometimes real weakness in the legs. In the lumbar spine it's a little bit different. It tends to be more pain. People have pain, heaviness, the pain can be in their low back, it can be down both legs, it can be down one leg more than the other, and frequently heaviness when they walk. And in the lumbar spine, we have something called neurogenic claudication, which is a symptom where people really feel okay when they're sitting down, and then when they get up, they start to have the back pain, potentially leg pain or heaviness of the legs, and it just gets worse the longer they're standing or walking. The classic thing those people will say is that if they lean over a shopping cart they feel much better, or they'll go for a walk but they find they then have to sit down several times along the walk and take a break, and then once they get up, they feel okay again for a few minutes, and then sit down again.
Host: We've heard about sciatica. Does radiating pain especially down the legs always mean that you have stenosis?
Dr. Bohman: It doesn't always mean that, and the term sciatica is confusing because the sciatic nerve is actually not in your back, it's in your leg, and that's not generally where the problem is. You know, most people who have what we describe as sciatica have a herniated disc or a narrowed neural foramen, which is the little windows that the nerves exit the spine through. And so you know, the colloquial we call the pinched nerve and that generally is in the spine, not in the leg where the sciatic nerve is. But because it goes down the same distribution as the sciatic nerve, we all call it sciatica, which is a little bit confusing. It doesn't have to have to be from lumbar stenosis, but certainly lumbar stenosis is one of the most common causes of that kind of sharp radiating pain down the leg.
Host: Then how is it diagnosed when someone comes to you? What questions, what history do you take, and then what imaging do you use to confirm your diagnosis?
Dr. Bohman: Sure. So I think it depends a little bit on how rapidly the symptoms have come on and what brought them on. So we always ask about how long people have been having the symptoms, how are they progressing, are they getting better or worse or staying the same? We always ask about what makes things better or worse. Imaging is usually a first line move if somebody is having symptoms that are concerning for the sort of cervical or thoracic stenosis with dysfunction of walking or some sort of neurological problem. Whereas in the lumbar spine, somebody with leg pain or just some difficulty with back pain, particularly if it's relatively acute, frequently the first things to do are physical therapy, some stretching, some back exercises, some non-steroidal anti-inflammatory medications, because many times these symptoms are relatively brief flares that will get worse and then will get better without surgical intervention or without injections. And so we don't necessarily jump right to MRI for people with those sorts of problems unless we're worried about a neurological dysfunction like a foot drop or real weakness.
Host: Then before we talk about some patient stories or first line of defense treatments, can anything be done to prevent spinal stenosis from happening?
Dr. Bohman: Unfortunately I think that what any person can do is somewhat limited. I think that there are a lot of common sense things like worrying about our posture, trying to sit and stand straight, avoiding excess weight gain, but a lot of these things do build up as sort of a response to wear and tear over time, and so it's not necessarily one thing that somebody could avoid, and they're not always avoidable. And I think there is also probably a genetic component. Certainly you hear a lot of stories about people who say, "Oh, everybody in my family has a terrible back," although that's not well-described in the literature.
Host: Give us some patients stories on people for whom this really started to affect the quality of their lives or trouble walking that occurred from spinal stenosis.
Dr. Bohman: Sure. I just saw a patient back today who had had progressive back pain, bilateral leg pain that had really gotten worse over a period of six or eight months from being a mild nagging issue to just worse and worse. And this is a very active 75-year-old man. He's lifting weights, he's hiking, going out dancing with his wife until this really starts to slow him down and he found it got to the point where he could barely walk to the mailbox without having really debilitating pain, although he was pretty comfortable once he sat down. He had an MRI and he had both quite severe lumbar stenosis at multiple levels, and he also had a slippage of the spine or a malalignment of the spine at the bottom level at L4 L5. And so we started with physical therapy and he felt like he got only a little bit of relief with that. We tried injections, which again provided him some temporary relief, but not a durable benefit. And so ultimately for him, we ended up proceeding to surgery, and he's now a month out of surgery and feeling great.
Host: If somebody comes do you and you've determined they have spinal stenosis, what can be done? Speak about the most conservative management treatments that you might try right off the bat, and when we get into medications. You mentioned opioids, so speak about NSAIDs, and opioids, and stewardship now. So what's different about first line treatments?
Dr. Bohman: Sure. So certainly the first line treatments are to be as conservative as possible. I think stretching exercises for low back. There are a number of books you can get at the library or on Amazon, or you can Google exercises on YouTube for some McKenzie back exercises. Physical therapy is really an important first line or very close to the first line for any pain flare that lasts longer than a couple of weeks. And frequently some combination of physical therapy and medications is all that is required. In terms of medications, it's a combination of things. It's anti-inflammatory medications, so the most commonly used would be a non-steroidal anti-inflammatory like Ibuprofen or Aleve. But then we sometimes will also do, for people with shooting pain down the legs, real nerve root irritation, sometimes steroids can be very helpful. Generally a short tapering dose over a few days. Tylenol can be helpful and muscle relaxants can be helpful if people are having really seizing back pain that when they first stand up their back seems to lock up, or sometimes people will be woken from sleep at night, or can't get comfortable at night due to spasms in their muscles, and muscle relaxants can be helpful. And while those of everything we've mentioned are probably the most dangerous because they can be a little bit habit forming and sedating, they are non-opioid and not nearly as dangerous as opioid. Opioids on the other hand really do not have much of a role in the management of acute back pain. You know, the evidence generally suggests that they're not that effective for it, and moreover with all of the concern about overuse and over-prescription of opioids, I think particularly for a problem that though frequently self-limited, doesn't always have a clear end in sight. Most providers these days are being very, very careful with how they hand out opioids for things like that because it's really the indefinite use of opioids for chronic pain is a big contributor to the opioid crisis, and moreover has been shown by large studies to not be very effective in actually doing what it's supposed to do, which is relieve people's pain.
Host: So you mentioned some non-surgical, non-interventional approaches such as exercise, physical therapy, McKenzie back programs; where do things like acupuncture or chiropractic care to manipulate the spine, where do they fit into that stenosis picture, and how might anti-depressants even be used sometimes to treat back pain?
Dr. Bohman: Sure. So in terms of chiropractic care and acupuncture, I think that they absolutely can have a role. They're not for every patient. I think generally for low back pain, chiropractic care can be very helpful either as an adjunct to physical therapy or instead of physical therapy, just providing different manipulations and stretches, and is generally safe done by an experienced chiropractor. Acupuncture is a treatment that there is not great evidence for in the medical literature, but certainly has been around for several thousand years, and anecdotally I've had patients have wonderful response to it. I don't necessarily understand exactly how it works, but I think it is very low risk, and so as an intervention it's reasonable to try. I generally am of the opinion to try everything you can prior to considering certainly surgery, and that's on the list of things that are worth trying for patients who are open-minded about it. In terms of anti-depressants, certainly there is some evidence for that, more for chronic pain, I think. We do use Gabapentin, which is actually an anti-epileptic by design. It is not a very effective anti-epileptic but it has some role in neuropathic pain or nerve-generated pain and has some evidence for it in lumbar stenosis and reticular pain or pinched nerve leg pain. But there are some side effects of those medications that do have to be watched a little bit, but certainly not as habit-forming and not dangerous in the same way as opioids.
Host: So now onto the subject of injection therapy. What would you like people to know about the different types of injections that are available, and what that discussion looks like?
Dr. Bohman: Sure. So I don't perform injections, so I generally defer to interventional pain specialists such as anesthesiologists or physical medicine and rehab doctors who've done fellowship training in that to talk about really the nitty gritty of the injections. But certainly I send people to get injections all the time. And my feeling about injection therapies, and there are a number of different kinds of injections that can be done in the spine, is that they can have both diagnostic value and therapeutic value. I would say the most common question I get about injections is somebody comes in with a herniated disc, and it's pushing on a nerve and causing leg pain, and they're miserable and they say, "Well isn't an injection just a Band-Aid? It doesn't make the disc herniation go away." And to some extent that is true, but ultimately we also see patients who have asymptomatic disc herniation. And my point is generally that people with asymptomatic disc herniations are not talking about having surgery for them. And so the problem is really the pain. You know? Lots of people have disc herniation. If you do an MRI on everybody walking down the street, you're going to find stenosis or disc herniation in many of them, and yet if it's asymptomatic, to some extent, who cares? And so injections have a big role in breaking what I think is a cycle of inflammation causing pain and can be really effective. A good number of patients get one or two or three injections and avoid surgery by doing that. And I think that's tremendously helpful for an intervention that really has very, very low risk, and certainly much lower risk than surgery.
Host: So you're a spine surgeon, Dr. Bohman, so now we're going to talk a little bit about surgery, and we understand it is basically the last line after you've tried all of the other conservative managements for pain and stenosis. So what does the discussion look like when you say, "I think we should really consider surgery," and what would you like listeners to know about finding a spine surgeon? What should they be looking for?
Dr. Bohman: So I think the important thing about- in any surgeon I think you certainly want to make sure that they are doing a reasonable volume of the sort of procedure you're talking about having. I think that there are a lot of studies that suggest that surgeons who are busy tend to have better outcomes, and similarly probably better to be done at a busier hospital. I think you want to make sure they have a good local reputation. You can certainly ask about board certification. One thing patients sometimes don't understand for spine surgeons in particular is that for orthopedic spine surgery, orthopedists have to do a special fellowship in spine surgery because their residency training does not include a full complement of spinal training. Neurosurgeons do not do additional fellowship necessarily in spine surgery because their residency includes that training upfront, and both are considered equally qualified for the vast majority of spinal indications. So it is totally reasonable to go to a neurosurgeon or an orthopedist for a spinal problem. If you have a problem that they don't feel comfortable with, I think they will send you to someone who is, but generally they're considered equally qualified. But I think in terms of finding a spine surgeon, it's important to recognize that spine surgery is sort of as much an art as a science. The spine is really incredibly complicated, and figuring out what is causing people's pain, and how to relieve it is often not completely straightforward. And so it's not just about understanding the imaging findings such as MRI or X-ray or CT, but it's really understanding the imaging findings in the context of symptoms, and then putting all that together with a patient's overall medical condition, their age, and really their values. You want to find a surgeon who's going to listen to you about all of that and can really talk to all of the particulars of your case, and be able to discuss their rationale for recommending one treatment or another, and even offering choices.
Host: Is spinal surgery these days- how has it changed in the last say twenty years, Dr. Bohman? Is it being done minimally invasively? Are you able to use robots? Speak about what kinds of surgeries you might be able to offer, and what the benefits for the patient and for the surgeon of these types of surgeries today.
Dr. Bohman: Sure. So there have certainly been some dramatic technological advances in spine surgery over the last twenty years or so. I think the overall trend is to make things less invasive. I think that it is important, however, to recognize that it's not always a binary choice between some sort of maximally invasive surgery and a minimally invasive surgery. You know, there are a lot of decisions in between, and that's particularly true in spine surgery, because so much of what causes pain, so much of what is truly 'invasive' is not about the size of the incision, but about the work that is done on the inside. That's in contrast to something like abdominal surgery where a minimally invasive laparoscopic surgery really cuts pain just tremendously mostly by limiting the size of incisions. In this case, it's less about limiting the size of incisions, although that can help, but about changing how we dissect the muscle, because so much of the pain in spine surgery comes from the muscle. I think the most exciting innovations in spine surgery in the last twenty years from my perspective are number one, disc replacement technologies. These are certainly not for everybody, but in certain cases to be able to do a procedure where we actually can replace a disc that is causing a problem with a new joint, that can be really exciting. But at the same time, it's not for everybody. At this point, there are three joints at every level in the spine. There's the disc in front, but then there are these two facet joints in the back of the spine, and so you really need to select patients who have isolated disc based disease and not disease of sort of every joint in the spine that might be better served by another therapy. I think that we use, at Christiana, neuronavigation with interoperative CT scans in order to place the vast majority of the hardware we put in, and that has really dramatically increased efficiency in the operating room, which is good for patients and for surgeons, and has really reduced the rate of pedicle screws particularly being placed in the wrong spot, and has let us do things that are safer, faster, and we get an interoperative CAT scan before patients leave the operating room so that we know all of the instrumentation is perfectly placed before the patient leaves or wakes up, whereas in previous days that would happen post-operatively only if they had a problem and would require returning to the operating room to fix the thing. Another exciting advance is the use of lateral surgery, lateral approaches to the lumbar spine, which uses special nerve monitoring to navigate safely and with a minimally invasive approach to do certain types of fusion procedures particularly, and allow really limiting muscle dissection on the posterior aspect, and really allow people to get up faster after surgery and feel better. In terms of robotics, robotics in the spine is still relatively young. It is essentially just an adjunct to neuronavigation or guidance to put screws in. At this point, my personal opinion is that the marginal utility of it is relatively low, but I think it's an exciting field and it's an exciting question of how that will develop in the future.
Host: So then speak about what that's like for a patient. Everybody gets scared. They hear 'back surgery,' and oh my gosh. So what do you want them to know that if they have to undergo a surgical procedure for spinal stenosis? You told us a patient's story; what is that recovery like, and what's their life like afterwards?
Dr. Bohman: I think it certainly varies by the particulars of the surgery. Even with less invasive approaches, some surgeries are still quite unpleasant to recover from. But I would say the vast majority of patients these days are in the hospital for a night or two, maybe three with a bigger procedure, and most people are getting home, getting to their lives, and not expecting to be completely immobilized by pain for weeks and weeks. Most people are up and about moving around. When I see most of my patients back at about a month after surgery, the vast majority are off of their pain medications.
Host: Wow. Isn't that amazing? Your field is advancing so rapidly. So before we wrap up, we'd like your best advice, Dr. Bohman, for keeping a healthy back, and what you would like people to know about just general back health.
Dr. Bohman: I really think the most important things for back health have to do with just ergonomics and safe lifting practices. I think that we put a lot of stress on our back in lifting things particularly, and lifting, bending, and twisting activities. There are things that you get away with doing the wrong way 99 times, and then the hundredth time, you get a disc herniation that puts you in the hospital. And so I think to be very cognizant of posture and particularly lifting practices is really important, and I think this is particularly true these days where we see a lot of younger patients who injure their backs doing things like lifting heavy weights, doing dead lifting and things like that. We have a culture that is very interested in fitness, which I think overall is incredibly positive for people's health, but I also think that people do things that perhaps would be fine if they were working with a physical therapist or a personal trainer or having somebody really work with them on their form, but it's the sort of thing that when you go to the gym by yourself, it's easy to hurt yourself. And so I think being very careful about how you lift things and good practices in that way, and just maintaining a healthy weight are probably the best things you can do for your spine.
Host: Tell us what you love about working at Christiana Care, and tell us about your team there and your multidisciplinary approach.
Dr. Bohman: Sure. So Christiana is a wonderful place to work caring for patients because there's really a very strong spirit of teamwork and shared commitment to providing care which is both technically excellent but also really compassionate. When I came to Christiana, I was really struck by how it combines very, very high quality sub-specialized care, cutting edge technology, and yet really the friendly warm feel of a community place. This is does not feel like a big anonymous hospital. People know each other. The specialists and nurses and various team members tend to work there for a long time and forge real relationships, and I think that those close bonds really do result in having better patient care. I think all of the parts of the team - the physicians, the nurses, the radiation technologists, and the surgical technologists in the operating room, the office staff outside of the operating room - everybody values and respects each other, and I think that really translates into providing the sort of care for patients that we would want for ourselves or our family members.
Host: It's great information. Thank you so much. What a great educator you are, and thank you for really sharing your expertise so very well, and explaining spinal stenosis to us, the treatment options available, and why people should come to Christiana Care for their care. Thank you again, Dr. Bohman, for joining us today. To learn more about spine services at Christiana Care, please visit www.ChristianaCare.org/imback. That's www.ChristianaCare.org/imback. This is Melanie Cole, thanks so much for tuning in. - Hosts Melanie Cole, MS
