In this week's episode of the Spine & Nerve podcast, Dr. Julie Hastings connects with Dr. Krystyna Holland, PT, DPT to learn about trauma informed care. Trauma informed care has many definitions, including some fantastic work done by the Substance Abuse and Mental Health Services Administration. One definition is a consistent and intentional effort to reduce our propensity for harm. Another describes it as an approach in the human service field that assumes that an individual is more likely than not to have a history of trauma. Listen in as Drs. Hastings and Holland discuss this very important topic and share some tips on how to better show up for our patients. Krystyna Holland, DPT (she/her) is a physical therapist in Denver, Colorado specializing in the provision of trauma informed pelvic floor care to individuals across the gender identity spectrum. In addition to helping folks feel confident in their ability to live without leaking and have pleasurable sex, Krystyna aims to change the fundamental patient provider relationship from one that centers the provider as a problem solver to one that focuses on collaboration between the patient and the provider.She is a well-known Instagram educator (@krystyna.holland) and an instructor of trauma-informed care webinars. She owns a small private practice called Inclusive Care and lives in Denver, CO. https://instagram.com/krystyna.holland https://www.inclusivecarellc.com/
In this week's episode of the Spine & Nerve podcast, Drs. Nicolas Karvelas and Brian Joves discuss infectious spondylodiscitis, a relatively rare inflammatory process involving an intervertebral disc and the adjacent vertebral bodies. Spondylodiscitis has a prevalence of about 4-24 per million, and has been increasing as patients have more risk factors (advanced age, immunocompromised states such as HIV infection, intravenous drug users, healthcare-associated infections, expansion of spinal surgery indications) and improved diagnostic modalities. Patients generally present with pain and tenderness in the region, about 50% present with high fever, and about 1/4 with neurologic compromise. The symptoms can be fairly non-specific, so patients with risk factors must be evaluated with a high degree of suspicion. Infection is the most common cause of spondylodiscitis, which is often spontaneous and hematogenous in origin and most commonly affects the lumbar spine, followed by thoracic, cervical, and sacral. The infectious pathogens can be pyogenic (bacterial), granulomatous (tuberculosis, fungal), or parasitic, though many noninfectious processes affecting the spine such as pseudarthrosis in ankylosing spondylitis, amyloidosis, destructive spondyloarthropathy of hemodialysis, Modic changes type 1, neuropathic arthropathy, calcium pyrophosphate dehydrate (CPPD) spondyloarthropathy and gout can mimic infectious discitis/ osteomyelitis. To determine whether a particular patient’s spinal process is due to an infectious versus non-infectious cause and to determine the pathogencan be challenging. Clinical findings and laboratory studies including erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP) can be helpful in the diagnosis due to their high sensitivity; however, their specificity is low. Magnetic resonance imaging and biopsy have become the standard when working up this process, particularly in cases where the origin of the pathogen is unknown. Listen as the doctors give a high-level overview of this disease process, and walk us through the challenging diagnostic process of a disease that may have an insidious onset, with subtle and misleading clinical features and briefly discuss management requiring a multidisciplinary approach involving radiologists, infectious diseases specialists, spine surgeons and rehabilitation personnel. This podcast is for information and educational purposes only, it is not meant to be medical or career advice. If anything discussed may pertain to you, please seek council with your healthcare provider. The views expressed are those of the individuals expressing them, they may not represent the views of Spine & Nerve. 1.Salaffi, F., Ceccarelli, L., Carotti, M.et al.Differentiation between infectious spondylodiscitis versus inflammatory or degenerative spinal changes: How can magnetic resonance imaging help the clinician?.Radiol med126,843–859 (2021). 2. Mavrogenis AF, Megaloikonomos PD, Igoumenou VG, et al. Spondylodiscitis revisited.EFORT Open Rev. 2017;2(11):447-461. Published 2017 Nov 15. doi:10.1302/2058-5241.2.160062
In this week's episode of the Spine & Nerve podcast, Drs. Julie Hastings, Nicolas Karvelas, and Brian Joves present a journal club on interventional management of patients with persistent pelvic pain syndrome. Three different interventions are covered in the articles presented, showing a range on invasiveness and diversity of targets to help moderate the pain symptoms. Listen as the doctors dive in and discuss these articles and discuss ways these articles might help patients living with persistent pelvic pain syndrome and the physicians caring for them. This podcast is for information and educational purposes only, it is not meant to be medical or career advice. If anything discussed may pertain to you, please seek council with your healthcare provider. The views expressed are those of the individuals expressing them, they may not represent the views of Spine & Nerve. References: 1.Hong DG, Hwang SM, Park JM. Efficacy of ganglion impar block on vulvodynia: Case series and results of mid- and long-term follow-up. Medicine (Baltimore). 2021;100(30):e26799. 2. Agarwal-Kozlowski K, Lorke DE, Habermann CR, Am Esch JS, Beck H. CT-guided blocks and neuroablation of the ganglion impar (Walther) in perineal pain: anatomy, technique, safety, and efficacy. Clin J Pain. 2009 Sep;25(7):570-6. 3. Istek A, Gungor Ugurlucan F, Yasa C, Gokyildiz S, Yalcin O. Randomized trial of long-term effects of percutaneous tibial nerve stimulation on chronic pelvic pain. Arch Gynecol Obstet 2014;290(2):291–8 4. Hunter CW, Yang A. Dorsal Root Ganglion Stimulation for Chronic Pelvic Pain: A Case Series and Technical Report on a Novel Lead Configuration. Neuromodulation. 2019 Jan;22(1):87-95. doi: 10.1111/ner.12801. Epub 2018 Aug 1. PMID: 30067887.
In this week's episode of the Spine & Nerve podcast, Dr. Joves welcomes Dr. Raman Gurai back to the show. Dr. Gurai walks us through his journey in medicine and how he took the road less traveled to achieve his goals and dreams! Dr. Gurai's Bio: Dr. Raman Gurai is a board certified Physical Medicine and Rehabilitation physician with a special interest in Interventional Spine. He was born and raised in northern California and his interest in medicine started in college where he majored in Molecular and Cell Biology with an emphasis in Neuroscience at the University of California at Berkeley in Berkeley, California. From there he headed to Grenada (West Indies) for his medical degree, and thereafter he completed his residency at the UCLA/VA Physical Medicine and Rehabilitation training program. He stayed on for an extra year to complete his current specialty, Interventional Spine. His medical interests include diagnosing and healing ailments of the spine with a multitude of modalities including EMG/NCS nerve testing and spine procedures including facet injections, epidurals, medial branch blocks, radiofrequency ablations, sacroiliac joint injections, and spinal cord stimulation among other cutting edge techniques. Dr. Gurai’s personal approach to medicine is to treat each individual as if they were a family member. It is with this approach that he hopes to restore the quality of life and function each person deserves. This podcast is for information and educational purposes only, it is not meant to be medical or career advice. If anything discussed may pertain to you, please seek council with your healthcare provider. The views expressed are those of the individuals expressing them, they may not represent the views of Spine & Nerve.
In this week's episode of the Spine & Nerve podcast,Dr. Julie Hastings sits down with Shereen Sairafi, PT, DPT, WCS to discuss all things pelvic physical therapy related. Pelvic floor physical therapists play an integral role in helping patients who have urinary, bowel, or sexual dysfunction, as well as pelvic pain. Dr. Shereen Sairafi graduated from Boston University in 2013 with a doctorate of physical therapy. Since that time she has been working in the pelvic health field and advocating for broader access for patients with pelvic floor dysfunction. Most recently she founded the pelvic health physical therapy program at Denver’s public health, safety-net hospital. Her clinical interests include rehabbing and preventing obstetric anal sphincter injuries, assisting patients in returning to all functional activities (including sex) pain free, and caring for gender diverse patients. In her free time she enjoys running, playing tennis, reading, crafting, and perfecting her tahdig recipe. Some of the big questions that they address in this episode: Who is an appropriate patient for pelvic PT? How to pitch the idea or prepare a patient for pelvic PT? How does pelvic floor dysfunction overlap with other musculoskeletal pathologies? To find a PT: https://aptapelvichealth.org/ptlocator/ https://pelvicguru.com/directory/ Return to run guidelines: https://www.researchgate.net/publication/335928424_Returning_to_running_postnatal_-_guidelines_for_medical_health_and_fitness_professionals_managing_this_population This podcast is for information and educational purposes only, it is not meant to be medical or career advice. If anything discussed may pertain to you, please seek council with your healthcare provider. The views expressed are those of the individuals expressing them, they may not represent the views of Spine & Nerve.
In this week's episode of the Spine & Nerve podcast, Dr. Julie Hastings and Dr. Brian Joves go back to basics and give us an overview of persistent pelvic pain. Persistent pelvic pain is defined as non malignant pain that is present for more than six months. It may or may not be associated with a woman's cycle or related to intercourse. Studies have shown that approximately 24% of female bodied individuals will experience significant pelvic pain. Persistent pelvic pain tends to have a multifactorial presentation and it can be hard to differentiate the primary source of pain. Pelvic pain is associated with other chronic overlapping pain conditions which contributes to the challenges of diagnosis, treatment and management. The differential diagnosis is vast and etiologies of persistent pelvic pain include sources from many body systems including but not limited to: Gynecologic Urologic Gastrointestinal Musculoskeletal Psychologic The severity and consistency of pain increases with multisystem presentation requiring a multi-specialty combined effort to evaluate and treat these patients effectively. This podcast is for information and educational purposes only, it is not meant to be medical or career advice. If anything discussed may pertain to you, please seek council with your healthcare provider. The views expressed are those of the individuals expressing them, they may not represent the views of Spine & Nerve.
In this week's episode of the Spine & Nerve podcast, Dr. Nicolas Karvelas and Dr. Brian Joves celebrate the 100th episode and welcome Dr. Julie Hastings to the show! We are so appreciative of the support, and love to hear the feedback from all of you. We never imagined that we would make 100 episodes of the podcast, let alone reach as many listeners as we have. Thank you for subscribing, sharing the podcast and contributing to our continued success in our desire to educate others. Listen in as Dr. Joves and Dr. Hastings discuss her unconventional path to medicine, her passion for women’s health, and why she went back to fellowship for further education and training after years of practicing medicine. They will also preview the upcoming series that Dr. Hastings will host which will take the podcast into pathologies, diagnoses and discussions we have never had before! Please see Dr. Hasting’s bio below for more specific background information. You can reach her at JHastings@spinenerve.com to thank her for contributing and sharing her story. And don’t forget to submit your questions and comments, either to one of our social media accounts or on the Spotify app! Dr. Julie Hastings Bio: Dr. Julie Hastings is a board-certified Physical Medicine and Rehabilitation physician with a special interest in Interventional Spine. Dr. Hastings completed a North American Spine Society (NASS) recognized fellowship in Interventional Spine and Musculoskeletal Medicine at Desert Spine and Sports Physicians in Phoenix, Arizona. Prior to this Dr. Hastings was faculty at University of Arizona and Creighton Medical School where she focused on pelvic pain and pelvic floor dysfunction. She completed residency training in Physical Medicine and Rehabilitation at the University of Colorado and earned her medical degree from Mount Sinai in New York City, and her Bachelor of Arts degree in Community Studies from UC Santa Cruz. Dr. Hastings strives to provide patients with the care she would want for her own family including an accurate diagnosis and treatment plan customized to each patient’s specific goals. Whether your pain is keeping you from athletic endeavors, work, or simply enjoying time with your family, Dr. Hastings aims to get you back to those activities empowered with knowledge about your own body and skills to manage your pain. Dr. Hastings has presented research nationally on interdisciplinary chronic pain care, opioids and suicide, pelvic pain and joint hypermobility, and healthcare quality improvement, as well as co-authored a textbook chapter on nonsurgical pain management. She believes strongly in education and mentorship and works with medical students and residents around the country as a mentor. Outside of medicine Dr. Hastings enjoys spending time outdoors, fitness, cooking, and spending time with friends and family.
In this week's episode of the Spine & Nerve podcast Dr. Brian Joves is joined by a very special guest, Dr. Monica Verduzco-Gutierrez, to discuss Long COVID, otherwise known as Post Acute Sequalae of SARS CoV2 (PASC). Long COVID is defined as a condition in which a patient continues with symptoms of COVID-19 more than 2 months after being infected by the virus. Longitudinal studies quote anywhere from a 15-80% prevalence of long COVID. Although every patient presents with a different compilation of symptoms, the most common symptoms of Long COVID are fatigue, impaired respiratory function, “brain fog”, headache, attention disorder, hair loss and pain. Though the risk factors for developing Long COVID are not fully known, studies suggest anosmia and ageusia, GI symptoms, and more severe acute infection may contribute to long term symptoms. There are many proposed mechanisms for these symptoms including inflammation, peripheral organ dysfunction, and virus shedding from the gut empha...
In this week's episode of the Spine & Nerve podcast Dr. Nicolas Karvelas and Dr. Brian Joves discuss Post Herpetic Neuralgia (PHN), the most common complication of Herpes Zoster (also known as Shingles, which is caused by reactivation of the Varicella Zoster Virus). PHN is defined by pain that is typically burning or electrical, and may be associated with allodynia or hyperesthesia in a dermatomal distribution. Pain from PHN is typically sustained for at least 90 days after the rash. PHN is caused by nerve injury due to the inflammatory response induced by viral replication within the nerve. Epidemiologic studies have found that PHN occurs in about 20% of patients who have Herpes Zoster. With the relatively recent development of the preventative vaccine Shingrix (which has been found to be 97% effective in preventing Herpes Zoster) it is anticipated that the total prevalence of Herpes Zoster and PHN will decrease. However, research has repeatedly demonstrated that immunocompromised patients are at a significantly increased risk for Herpes Zoster and PHN (20-100 times increased risk of development of PHN). As of today, the Advisory Committee on Immunization Practices has not cleared immunocompromised patients to receive the Shingrex (or Zostavax) vaccine; therefore for multiple reasons PHN will most likely continue to be a prevalent diagnosis. Treatment options for PHN include physical modalities (TENS, desensitization), topical medications (including Lidocaine 5% patch, and Capsaicin), oral medications (including Gabapentin, Pregabalin, Tricyclic Antidepressants), and procedures. Listen as the doctors review Herpes Zoster, PHN, and a recent research article evaluating the effect of the Erector Spinae Plane Block in regards to prevention of PHN once Herpes Zoster has already developed. This podcast is for information and educational purposes only, it is not meant to be medical or career advice. If anything discussed may pertain to you, please seek counsel with your healthcare provider. The views expressed are those of the individuals expressing them, they may not represent the views of Spine & Nerve. References: 1. Zeng-Mao Lin, MD, Hai-Feng Wang, MD, Feng Zhang, MD, Jia-Hui Ma, MD, PhD, Ni Yan, RN, and Xiu-Fen Liu, MD. The Effect of Erector Spinae Plane Blockade on Prevention of Postherpetic Neuralgia in Elderly Patients: A Randomized Double-blind Placebo-controlled Trial. 2021;24;E1109-E1118. 2. Dooling KL, Guo A, Patel M, et al. Recommendations of the Advisory Committee on Immunization Practices for Use of Herpes Zoster Vaccines. MMWR Morb Mortal Wkly Rep 2018;67:103–108.
In this week's episode of the Spine & Nerve podcast Drs. Nicolas Karvelas and Brian Joves take a look back at basic physiology to try to look into the future. An area of research that has really piqued the interest of Dr. Karvelas in recent years has been the discussion/possibility of selective voltage gated sodium channel (NaV) modulators. NaV are transmembrane proteins that are an integral part of the initiation and propagation of action potentials in neurons and other electrically excitable cells. We have seen that small changes in NaV function are biologically relevant because there are several human diseases that are the result of mutations in these channels. This has led to research into selective NaV modulators as a potential target as we continue to search for treatment options with significant analgesic potential and decreased risk of side effects / adverse effects. The medical / research community continues to work to optimize medication options to treat painful disease processes. From an analgesic medication perspective, although there are a variety of different medications available including: topical medications, acetaminophen, non-steroidal anti-inflammatory drugs, gabapentin, pregabalin, serotonin norepinephrine reuptake inhibitors, tricyclic anti-depressant medications, non-selective sodium channel blockers, NMDA receptor modulations (Memantine, Ketamine), alpha-2 agonists, glial cell modulators (Low Dose Naltrexone), Buprenorphine, full mu opioids. These Medications are not without their limitations for multiple reasons including but not limited to side effects, risks, and contraindications depending on patient’s age and/or comorbidities. To the best of our knowledge there are 10 different NaV subtypes; and specifically NaV 1.3, 1.7, 1.8, 1.9 have been demonstrated to play a critical role in pain signaling. NaV 1.8 is a sensory neuron specific channel with preferential expression in the dorsal root ganglion and trigeminal ganglion neurons, and it is highly expressed on nociceptors. Similar to the other NaV subtypes that have been identified to play essential roles in pain, mutations in NaV 1.8 have been demonstrated to lead to significant alterations in the nervous system / pain pathways; specifically gain of function NaV 1.8 mutations clinically manifest as painful small fiber peripheral polyneuropathy. NaV 1.8 modulation is being aggressively researched with the goal of positive impact on painful diseases. VX-150 is a oral pro-drug that is a highly selective inhibitor of NaV1.8, and a recent study by Dr. Hijma and colleagues was published evaluating the analgesic potential and safety of VX-150. Listen as the doctors discuss this exciting and important area of research. The discussion includes a detailed review of the fore-mentioned recent research article. This podcast is for information and educational purposes only, it is not meant to be medical or career advice. If anything discussed may pertain to you, please seek council with your healthcare provider. The views expressed are those of the individuals expressing them, they may not represent the views of Spine & Nerve. References: 1. Hijma HJ, Siebenga PS, de Kam ML, Groeneveld GJ. A Phase 1, Randomized, Double-Blind, Placebo-Controlled, Crossover Study to Evaluate the Pharmacodynamic Effects of VX-150, a Highly Selective NaV1.8 Inhibitor, in Healthy Male Adults. Pain Med. 2021 Aug 6;22(8):1814-1826.