Spine & Nerve

In this episode of the Spine & Nerve podcast, join Brian Joves, MD for an enlightening conversation with Mike Ochoa, DPT, a passionate advocate for fitness in aging populations. Dr. Mike brings valuable insights into the importance of exercise, particularly weightlifting, in promoting longevity and overall well-being as we age. Discover the truth behind common misconceptions about aging and exercise, and learn how to tailor fitness routines to individual needs and goals. Key Takeaways: Learn why weightlifting is a powerful tool for enhancing muscle health and longevity in older adults. Understand the importance of challenging, albeit sometimes uncomfortable, exercise for optimal improvement. Explore the benefits of resistance training in preventing age-related conditions like sarcopenia and osteoporosis. Gain insights into debunking myths surrounding aging and exercise, fostering a mindset of empowerment and possibility. Discover practical strategies for creating personalized exercise programs that cater to individual abilities and aspirations. Tune in to gain valuable wisdom and actionable advice from Dr. Mike Ochoa, and embark on a journey toward maximizing fitness and vitality in your golden years. find Dr. Mike on YouTube, IG, TikTok @MovewithDrMike (https://www.youtube.com/@MovewithDrMike  ) Connect with Dr. Joves on Linkedin or X Follow @spinenerve on Youtube, IG 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.

Episode Summary:Join Dr. Jason Kung and Dr. Brian Joves for an in-depth discussion on the latest in neuromodulation. This episode covers a range of topics from the North American Neuromodulation Society 2024 Annual Meeting highlights to a journal club traversing the topics of spinal cord stimulation, closed-loop technology, and the impact of paraspinal muscle atrophy on vertebral endplates. With a blend of expert insights and a review of recent studies, this episode offers a comprehensive look into the advancements and challenges within the field of neuromodulation. Key Points Discussed: North American Neuromodulation Society Meeting Recap: Dr. Kung shares his experiences and key takeaways from the event, highlighting the growing interest in SI joint fusion and the lack of major announcements in neuromodulation waveforms. MRI Compatibility in Neuromodulation Devices: The hosts delve into the importance of MRI compatibility, discussing the implications for patient care and device selection. The Evoke Study and Closed-Loop Stimulation: An in-depth review of the 36-month data from the Evoke trial, which compares closed-loop spinal cord stimulation to traditional open-loop systems. The study's findings on pain relief and the potential for closed-loop technology to revolutionize patient outcomes are explored. Paraspinal Muscle Atrophy and Spinal Health: A discussion on a recent study examining the association between paraspinal muscle atrophy and vertebral endplate degeneration, underscoring the importance of physical therapy and core strength in pain management. Notable Quotes:" The development of the space is not just about this waveform versus that waveform, but understanding that there are many factors that play into patient success." - Dr. Brian Joves "With ECAPs, we're moving towards a two-way feedback system in spinal cord stimulation, akin to how a pacemaker works." - Dr. Jason Kung Closing Thoughts:The episode wraps up with reflections on the potential of neuromodulation technologies and the importance of continued innovation to improve patient care. The hosts also express interest in seeing how closed-loop stimulation and other advancements will perform in real-world settings. Connect with Us: Find Dr. Jason Kung or Dr. Brian Joves on LinkedIn Connect with the podcast on YouTube, IG and Facebook @ SpineNerve Be sure to share, like and subscribe! Upcoming Episodes:Stay tuned for future discussions on groundbreaking studies in pain management and neuromodulation, along with guest appearances from leaders in the field. References: Mullins CF, Harris S, Pang D. A retrospective review of elevated lead impedances in impedance-dependent magnetic resonance-conditional spinal cord stimulation devices. Pain Pract. 2024; 24: 270–277. https://doi.org/10.1111/papr.13301. Mekhail NA, Levy RM, Deer TR, et al ECAP-controlled closed-loop versus open-loop SCS for the treatment of chronic pain: 36-month results of the EVOKE blinded randomized clinical trial Regional Anesthesia & Pain Medicine Published Online First: 27 August 2023. doi: 10.1136/rapm-2023-104751 Schönnagel, Lukas et al. Understanding the Interplay Between Paraspinal Muscle Atrophy and Lumbar Endplate Degeneration: A 3-Year Longitudinal Study. Spine 48(23):p 1627-1634, December 1, 2023. | DOI: 10.1097/BRS.0000000000004826 Pritzlaff et al. A Review of the Factors and Outcomes of Institutional Interdisciplinary Neuromodulation Committees: A Multicenter Experience. Neuromodulation. February 06, 2024 Disclaimer: Reminder that the information provided is for educational purposes and is not intended as medical advice. Always consult with a healthcare professional.

In this episode of The Spine & Nerve Podcast, Dr. Dr. Jason Kung and Dr. Brian Joves have a reflective and forward-looking discussion as we transition from 2023 into 2024, sharing our podcast's journey, personal insights, biggest happenings in pain medicine, and anticipations for the new year. 1. Podcast Journey and Global Reach: Transitioning through 2023: The evolution of our podcast through the year. Spotify Wrapped Insights: A deep dive into our audience demographics, celebrating a significant international listenership with a special shoutout to our friends in New Zealand, India, Spain, Brazil, and Hungary. 2. Engaging Medical Discussions: Spotlight Episode - Spinal Stenosis: Discussion on why our spinal stenosis episode resonated with so many listeners and the importance of addressing prevalent health issues. Medical Innovations and Literature: A look back at the year's significant advancements in radiofrequency ablation and the evolving landscape of pain management. 3. Personal Reflections and Resolutions: Embracing Challenges: The team's participation in a Spartan Race, symbolizing our dedication to personal growth and community engagement. 4. Community Impact and Listener Engagement: Top 10 Recognition: Celebrating being in the top 10 of listeners' favorite podcasts and what it means to us. Listener Interaction: Encouraging feedback, stories, and engagement from our global audience. 5. Looking Forward to 2024: Medical Community and Conferences: Anticipation for upcoming medical conferences, new technologies, and the continuing battle against the opioid crisis. Optimism for the Future: Our commitment to staying informed, optimistic, and ready to tackle the challenges and opportunities the new year brings. Closing Thoughts: A heartfelt thank you to all our listeners for their continued support and engagement. We look forward to another year of learning, growth, and community. Contact Information: We Encourage listeners to stay connected through our social media channels (LinkedIn, YouTube, Twitter (X), and Facebook are the easiest), website, and Spotify Podcast page for feedback, questions, and community stories. Disclaimer: Reminder that the information provided is for educational purposes and is not intended as medical advice. Always consult with a healthcare professional.

In this episode of the Spine & Nerve Podcast, Dr. Brian Joves has the distinct pleasure to welcome Dr. Andrea Furlan to the show. Dr. Furlan is a pain specialist in Toronto Canada. She is a physiatrist (specialist in Physical Medicine & Rehabilitation). She holds a medical degree from the University of Sao Paulo and a Ph.D. degree from the University of Toronto. She has 30 years of experience helping people with chronic pain to get better quality of life. In this insightful conversation, Dr. Furlan shares her vast experience in managing chronic pain, addressing key aspects of pain management that are crucial for medical providers to understand. Key Takeaways: 1. The Complexity of Chronic Pain: Chronic pain is a multifaceted condition with complex neurobiological and psychosocial components. Understanding the diverse factors contributing to chronic pain is essential for medical providers to provide effective care. 2. The Role of Empathy and Communication: Dr. Furlan emphasizes the importance of empathy and active listening when interacting with patients in pain. Effective communication skills are crucial for building trust and facilitating patient-doctor relationships. 3. Educating Patients: Educating patients about their condition and treatment options is a fundamental aspect of pain management. Medical providers should learn how to explain complex medical concepts in simple terms to ensure patient comprehension. 4. The Value of Multidisciplinary Approaches: Chronic pain often requires a multidisciplinary approach, involving various healthcare professionals such as physiatrists, psychologists, and physical therapists. 5. The Impact of Lifestyle Modifications: Lifestyle modifications, including diet, exercise, sleep, and stress management, play a significant role in pain management. 6. Emotions and Pain Perception: Emotions can influence pain perception, making it essential for medical students to consider the emotional well-being of patients. 7. Patient Support and Online Communities: Dr. Furlan discusses the value of patient support groups and online communities, where individuals with chronic pain can share their experiences and learn from one another. Medical providers can explore these resources to better understand patient perspectives. 8. Dr. Furlan's Book - A Resource for providers: Dr. Furlan's book, which outlines eight steps for managing chronic pain, is recommended for medical providers looking to deepen their knowledge of pain management. The book provides practical insights and strategies for patient care. Medical providers should embrace the holistic approach to chronic pain management, considering both the physical and emotional aspects of the condition. Dr. Furlan's expertise and insights shared in this episode offer valuable lessons for aspiring healthcare professionals in the field of pain medicine. 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. You can find Dr. Furlan at: https://www.youtube.com/ @DrAndreaFurlan  https://www.doctorandreafurlan.com/ X  @adfurlan  IG @dr.andrea.furlan

In this episode of the Spine & Nerve Show, Dr. Robert Bowers joins Dr. Brian Joves to discuss the progression of young athletes in throwing sports, such as baseball. He emphasizes the importance of allowing children to play multiple sports and avoid specializing too early. Dr. Bowers also highlights the risks associated with overuse injuries and the need for rest periods. He discusses the role of mechanics and training programs in preventing injuries and increasing velocity. Dr. Bowers also touches on the use of biologics, such as PRP, in the treatment of injuries in young athletes.​ About The Guest: Dr. Robert Bowers is a sports medicine physician at Emory in Atlanta, Georgia. He specializes in the treatment of throwing athletes and has a particular interest in baseball injuries. Dr. Bowers has extensive experience working with athletes at all levels, including professional baseball players and college athletes. He is passionate about helping athletes optimize their performance and prevent injuries.​ Key Takeaways: - Young athletes should play multiple sports to develop athleticism and motor skills. - Rest periods are crucial for preventing overuse injuries in young athletes.- Proper mechanics and training programs can help prevent injuries and increase velocity. - Weighted ball programs can increase velocity but also carry an increased risk of injury. - Biologics, such as PRP, can be used to treat certain injuries in young athletes.​ Quotes: "If these kids can take three months of throwing off, four months, even better, that should be good to allow their arm to rest."- "The harder you throw, the more at risk your arm is." "Velocity gets kids noticed, but it also increases injury risk." "Weighted ball programs increase velocity but also increase injury risk." "The way to deal with increased intensity is to decrease volume."

In this episode of the Spine & Nerve podcast, Dr. Jason Kung and Dr. Brian Joves delve into a comprehensive discussion surrounding anticoagulation guidelines and their implications in interventional pain procedures. With over a hundred thousand downloads and over 1,000 YouTube subscribers, we would like to express our sincere gratitude to all the listeners for your engagement and support. Please continue to share and subscribe to help more people discover the podcast. Today's episode focuses on the safety of epidural steroid injections and the critical role of anticoagulation management.Understanding the rationale behind a patient's anticoagulation therapy is vital for interventional pain physicians. This approach empowers clinicians to make informed decisions about whether to continue or withhold anticoagulation medications prior to procedures. There is a delicate balance between patient-specific risks and the benefits of these interventions. One of the things that must be known and emphasized is the remarkable safety profile of epidural steroid injections. Approximately nine million epidural steroid injections are administered annually, resulting in an adverse event rate of about one in 780,000. This reassuring statistic is attributed to the collaborative efforts of medical societies and the implementation of strict anticoagulation guidelines. The hosts emphasize the role of fluoroscopic guidance, non-particulate steroids, and avoidance of deep sedation in enhancing the safety of these procedures. The episode further delves into the nuances of assessing bleeding risks in patients undergoing interventional pain procedures. As always, we must underscore the importance of a comprehensive physical examination, with a specific focus on identifying signs of easy bruising and mucosal bleeding. The hosts discuss the relevance of specific medications, including aspirin and NSAIDs, and their implications for procedural safety. The hosts engage in an insightful exploration of the guidelines for managing anticoagulation medications pre- and post-procedure. They stress the need for pain physicians to consider the anatomical location of the intervention and evaluate the potential risks versus benefits. The doctors conclude the episode by highlighting the crucial role of shared decision-making and patient education. By fostering collaboration between patients and physicians, the hosts emphasize the creation of a safe and informed healthcare environment.In this thought-provoking episode, the doctors try to help you navigate the complexities of anticoagulation management in interventional pain procedures, and offer some insights for practitioners seeking to provide the highest level of care to their patients. References: Anesthesia Quality Institute Closed Claims Database Review 2011 through 2021 for Epidural Steroid Complications. Naeem Haider. Pain Physician 26 (3), E251, 2023 Stephen Endres, MD and others, The Risks of Continuing or Discontinuing Anticoagulants for Patients Undergoing Common Interventional Pain Procedures, Pain Medicine, Volume 18, Issue 3, March 2017, Pages 403–409, https://doi.org/10.1093/pm/pnw108 Narouze S, Benzon HT, Provenzano D, et alInterventional Spine and Pain Procedures in Patients on Antiplatelet and Anticoagulant Medications (Second Edition): Guidelines From the American Society of Regional Anesthesia and Pain Medicine, the European Society of Regional Anaesthesia and Pain Therapy, the American Academy of Pain Medicine, the International Neuromodulation Society, the North American Neuromodulation Society, and the World Institute of PainRegional Anesthesia & Pain Medicine 2018; 43:225-262. The ASRA App: https://www.asra.com/the-asra-family/asra-app

In this episode, we have a special guest, Dr. Nikhil Verma, who shares his inspiring journey from undergrad to establishing his own medical practice. Dr. Verma opens up about the challenges he faced, the pivotal moments that shaped his career, and the lessons he learned along the way. Join us as we delve into his story of perseverance, passion, and the pursuit of personalized medicine. Episode Highlights: Dr. Verma recounts his early struggles and the uncertainties he faced during his pursuit of medical school. Despite not getting accepted initially, he used the time to reflect and explore different options, eventually finding his way to St. George's University. The importance of resilience and perseverance shines through as he shares how he overcame setbacks and stayed motivated. Dr. Verma's interest in rehabilitation medicine and sports medicine grew during his residency. He shares how his personal experience with a sports-related injury shaped his perspective and ignited his passion for helping others through physical therapy and non-surgical interventions. Dr. Verma discusses the decision to open his own medical practice, highlighting the challenges and rewards of being an independent practitioner. From finding the ideal location to setting up the practice and acquiring necessary equipment, he shares the steps involved in laying the groundwork for his venture. Dr. Verma emphasizes the importance of tailoring treatments to individual patients, providing temporary relief while considering long-term solutions. He highlights advanced procedures and technologies that enable more targeted and effective interventions, showcasing the potential impact of personalized medicine. Dr. Verma encourages med students and early residents to stay open-minded and embrace change. He shares the significance of finding passion and purpose in one's work, reminding listeners that it's okay to evolve and pursue new interests within the medical field. Dr. Nikhil Verma's story is a testament to the power of determination, adaptability, and following one's true calling. His journey from facing initial rejections to establishing a successful practice showcases the importance of resilience and finding personal fulfillment in the medical profession. Join us in thanking Dr. Verma for sharing his insights and experiences. Tune in to the full episode to hear his story in his own words. You can find Dr. Verma on all your favorite social platforms, as well as our hosts. 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, we have a return guest! Dr. Hunter Vincent returns to the show to chat with Dr. Brian Joves about health coaches and how they can help your patients to be more successful in their journey with and through chronic pain. In this episode we'll discuss: What is a health coach? Where does this fit into the treatment and provider paradigm? How can ancillary team members like health coaches help your patients and your team to be more successful? Dr. Vincent is the CEO of Pogo Health. He is a double board certified physician who received his residency training from UC Davis in Physical Medicine & Rehabilitation (PM&R) with a subspecialty certification in Pain Medicine from UCLA. Prior to starting his medical training, he received a Bachelor's of Science in Exercise Biology. He has spent the last decade actively involved in healthcare initiatives focused on maximizing patient engagement in their own health journey. He has worked with various healthcare teams in the fields of clinical obesity, chronic pain, and neurological disorders.  Pogo Health is a virtual platform Virtual that utilizes a team approach to treating chronic pain. Their interdisciplinary opioid-free approach integrates the pain physician, pain therapist and specialized health coach to create a completely virtual and customized treatment program. The Pogo Health multi-modal approach utilizes evidence based techniques to provide long term physical and mental health benefits to combat chronic pain. Learn more at https://pogo-health.com/ 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. Jason Kung and Dr. Brian Joves try to digest all the recent happenings in the world of neuromodulation. They address: Internal Pulse Generators Artificial Intelligence The Cochran Study Listen as the doctors get excited, frustrated, and try to bring a silver lining to the whirlwind of headlines that have been discussing neuromodulation so far this year! There were many references in this episode, but most importantly here is the Cochran review on SCS for low back pain: Traeger AC, Gilbert SE, Harris IA, Maher CG. Spinal cord stimulation for low back pain. Cochrane Database Syst Rev. 2023 Mar 7;3(3):CD014789. doi: 10.1002/14651858.CD014789.pub2. PMID: 36878313; PMCID: PMC9990744. Here is the Hara study: Hara S, Andresen H, Solheim O, Carlsen SM, Sundstrøm T, Lønne G, Lønne VV, Taraldsen K, Tronvik EA, Øie LR, Gulati AM, Sagberg LM, Jakola AS, Solberg TK, Nygaard ØP, Salvesen ØO, Gulati S. Effect of Spinal Cord Burst Stimulation vs Placebo Stimulation on Disability in Patients With Chronic Radicular Pain After Lumbar Spine Surgery: A Randomized Clinical Trial. JAMA. 2022 Oct 18;328(15):1506-1514. doi: 10.1001/jama.2022.18231. PMID: 36255427; PMCID: PMC9579901. 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 we would like to introduce you all to the newest member of the Spine & Nerve family... Dr. Jason Kung.  Jason Kung, MD, is a board-eligible anesthesiologist and interventional pain physician who joined Spine & Nerve last year. Listen in as Brian Joves, MD gets to know Dr. Kung better and explore his journey into medicine and to discovering his passion for pain medicine. He  graduated from the University of San Francisco in California with a  bachelor's degree in biology. He then went to Boston University School  of Medicine in Massachusetts for his medical degree. Dr. Kung  completed his residency in Anesthesiology and fellowship in  Interventional Pain at Harvard Medical School, Massachusetts General  Hospital in 2020. Dr. Kung specializes in several interventional  procedures, including spinal cord stimulation, epidural injections,  radiofrequency ablations, implantable devices, and ultrasound-guided  nerve/joint injections. He strives to provide  compassionate evidence-based care to all his patients. He is certified as an instructor in  medical simulation. Dr. Kung has completed research and published in the  areas of bone healing and the effects of natural sources of vitamin D. During  his free time, he enjoys playing guitar, surfing/snowboarding, and  exploring California with his wife and dog.  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 we take a deep dive into lumbar spinal stenosis, discussing the underlying disease process as well as treatment options in the medical literature. The studies referenced in this podcast are given at the end of the podcast. This is meant for education and entertainment only, this is not to be interpreted as medical advice. If you feel that something discussed may be relevant to you, please discuss with your medical provider. The views and opinions discussed in this podcast are those of the individuals who express them, and are not the views and opinions of Spine & Nerve Diagnostic Center.

In this week's episode of The Spine & Nerve Podcast, Evan Hauger, DPT joins Brian Joves, MD to discuss movement as medicine. Dr. Evan Hauger Evan specializes in  sports physical therapy, strength, and conditioning. He knows the ins  & outs of injury from years of personal experience. Growing up, he  was a multi-sport athlete and went on to play baseball at Shasta College. Through multiple personal injuries related to his athletic career, Evan realized that he had a passion for improving the way people  move and enhancing their performance in sport and life. Also a  StrongFirst Certified Level 1 instructor, Evan earned his Doctorate in  Physical Therapy from Sacramento State University and has worked with  athletes of all calibers, including MLB, NFL, NBA, UFC, and Olympians.  He has also spent time with some of the best minds in sports physical  therapy in Boston, MA, been a medical team leader for the USA Track and  Field National Championships, assisted with NFL combine training at Exos  in Phoenix, AZ, and been the performance coach for a group of Olympic athletes. 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 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 med 126, 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 emphasizing the gut-brain connection that still needs to be researched further. Listen as Dr. Gutierrez educates on her experience in helping these patients and provides us with practical considerations when patient's present to the clinic. Most importantly, Dr. Gutierrez recommends one simple way to optimize outcomes for patient's suffering from Long COVID, and all patients for that matter. 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: Herrera, JE, Niehaus, WN, Whiteson, J, et al. Multidisciplinary collaborative consensus guidance statement on the assessment and treatment of fatigue in postacute sequelae of SARS-CoV-2 infection (PASC) patients. PM&R. 2021; 13( 9): 1027- 1043. https://doi.org/10.1002/pmrj.12684 You can find Dr. Monica Verduzco-Gutierrez: twitter.com/MVGutierrezM instagram.com/monicavgutierrez https://www.linkedin.com/in/monica-verduzco-gutierrez-m-d-74aab370/