Spinal Cord Injury. Introducing Thomas N Bryce

Recovering from spinal cord injuries is a complex process as they can be the result of serious localized trauma or lifestyle habits. That is why it is helpful to have a professional by your side while you undergo recovery. Thomas N Bryce, our leader in Spinal Cord Medicine at the Department of Rehabilitative medicine, has been a part of our team here at Mount Sinai since 1997 and could be the answer to your problem.

Dr Thomas Bryce has an impressive academic record. Prior to joining us, he completed his undergraduate degree from Albany Medical College and received speciality training at Thomas Jefferson University Hospital. He is a leader in the field, being the principal investigator of several ongoing studies in these areas and “wrote the book” (quite literally) on spinal cord injuries having authored numerous chapters and peer-reviewed articles on the subject.

Dr Bryce’s research is focused on assessing residing pain after spine damage, use of robotic exoskeletons to facilitate walking, and stem cell implantations for neurological recovery. He has been involved in several international taskforces with the aim to reduce pain after spinal cord surgery.

He is currently Governor Cuomo to the New York State Spinal Cord Research Board. Dr Bryce’s method is intersectional. He works closely with physical therapists, occupational therapists, neuropsychologists, and other surgical specialists to provide bespoke comprehensive care.

Dr Bryce understands the intricacies that are involved in recovering from spinal cord injury.

A bespoke plan can be constructed to suit anyone’s individual needs when going through this difficult period. Spine damage can be the result of hard trauma or lifestyle or a mix of both. Dr. Bryce can accommodate plans that involve difficult lifestyle changes. This includes both long-term habitual corrections, such as posture to post-surgery rehab.

If you have suffered a sports-related injury, please contact us at Mount Sinai Department of Rehabilitative Medicine for a bespoke rehab plan. Contact our switchboard on: (212) 241-6321

Recovering from spinal cord surgery

Spinal cord injuries are the result of both accidents and lifestyle habits. We can avoid developing a weak spine by adjusting our lifestyles. Unfortunately, the same cannot be said for accidents. A car accident or slipping over can lead to tremendous long-term discomfort and pain with little we can do to prevent these damages, assuming you're wearing your seatbelt and not running on unstable surfaces. Nonetheless, there are ways we can tackle this issue using advances in medical science. Spine surgery can have incredible effects on your quality of life. Let’s investigate how you can plan your recovery after a surgery. Please note that timestamps are generalized and dependent on your health and recovery plan.

Spine surgery is one of the more common types of surgery, and most are minimally invasive.  Let’s take a look at what spine surgery can do for you.

Firstly, when you’re in the hospital, you may have one of these surgeries depending on what type of damage you have incurred.  

·       Diskectomy – surgery to remove all or part of your disk

·       Foraminotory – surgery to widen the opening in your back where nerve roots leave your spinal column

·       Laminectomy – surgery to remove the lamina, two small bones that make up a vertebra, or bone spurs in your back, to take pressure off your spinal nerves or spinal column

·       Spinal fusion – the fusing of two bones together in your back to correct problems in your spine

Your physician will give you a bespoke plan relating to your damage and recovery plan.

Depending on your surgery, recovery could take anywhere between 3 weeks to 6 months to recover. Other conditions that could affect your recovery is your lifestyle and bodily condition before the surgery.

Your bandages have a lifespan of approximately 9 days.  Check to see if the area has changed colour, swollen, or begins to open up. If this happens, contact your surgeon immediately. If there are no issues, you may begin to shower again. Wait 5 days before showering, and cover the incision with plastic wrap. Do not allow shower from the head to spray the wounded area. You should also want to avoid stairs for the first week or so.

Once a few weeks have passed, and the healing process is underway, you should be attempting to work your way into your previous routine. Before continuing your rehab, please note: do not sit still for extended periods of time, and inform yourself on proper posture by reading this. If you are supported by a brace or corset, you should be wearing it when sitting and walking, however, it would be unnecessary to wear the brace when you are sitting for short periods of time or using the bathroom at night. Finally, do not drive for the first 2 weeks.

Now is the point where, as opposed to what you should avoid, we can start looking at how you can actively help the healing process.

Around the 4 week stage, generally, you should be taking light walks to strengthen surrounding areas. Increase the speed or duration of the walk slowly. This allows the spine to heal itself within an active body and correct itself. A sedentary lifestyle will encourage previous problems to return. Continue to up your exercise slowly as your spine recovers.

Please note, you should contact your surgeon immediately if you experience any of the following:

·        Chills or a fever of 101°F (38.3°C), or higher

·        More pain where you had your surgery

·        Drainage from the wound or the drainage is green or yellow

·        Lose feeling or have a change of feeling in your arms (if you had neck surgery) or your legs and feet (if you had lower back surgery)

·        Chest pain, shortness of breath

·        Swelling

·        Calf pain

·        Your back pain worsens and does not get better with rest and/or pain medicine

·        Difficulty urinating and controlling your bowel movements

If this routine does not help, or you need medical attention, please contact us at Mount Sinai Department of Rehabilitative Medicine. A bespoke plan will be necessary if you suffer from other medical problems. Contact our switchboard on: (212) 241-6321

Age-Related Musculoskeletal Changes

As we get older our bodies become more fragile, as bone and muscle densities reduce, increasing the likelihood of broken bones and body instability. Movement may become slower, and walking gait may become shorter, more unsteady, and with less swinging of the arms. Older individuals may become tired more easily and perform tasks less energetically, but what are the internal processes that drive these changes in musculoskeletal function?

From around the age of thirty bone mass begins to decrease in both men and women, increasing in rate in women after the onset of menopause. As a result, the risk of bone fractures increases. One common feature of ageing is a gradual shrinking in size. This is due to fluid loss in the spinal disks. Between the vertebral bones in the back are the gel-like cushions which serve to absorb shocks between the vertebrae. With age these discs begin to lose fluid, meaning the spinal bones grow closer together and the spine shrinks. Furthermore, the actual bones begin to lose mineral content, becoming thinner. Being less rigid the spinal column becomes curved, adding to the appearance of height loss.

As with the spinal disks, lubricating fluid between joints may also be lost during the ageing process, reducing protection against cartilage rubbing together and wearing away. As a result, the joints may become stiffer and less flexible, increasing the risk of developing arthritis. As bone wears away the minerals may be deposited around joints and calcify, causing extra joint stiffness.

In tandem with skeletal wear, the muscular system is also affected by age. As bone density decreases around one's 30s so does muscle mass. The result of this muscle loss, known as sarcopenia, is that the muscles are less able to support the bones, and stress on certain joints, such as the knees or back, increases. Deterioration is not universal throughout all types of muscle, and the muscle fibres that contract faster are more susceptible to damage than the slower contracting fibres. This translates into overall slower contraction of the muscles in old age and affects physical mobility, muscular strength, and grip. Around 7% of people over 70 are affected by functional sarcopenia - age-related muscle loss – and this figure increases to around 20% of the elderly over 80. As muscles lose function people become less able to move autonomously and this may translate into the development of muscle contractures, where the muscles shorten and harden.

While it is a natural process of ageing to lose both muscular and skeletal mass, the process can be slowed and prevented to a certain degree by maintaining a healthy lifestyle, with regular exercise to promote strength, balance, and flexibility. Keeping fit can also help the bones to stay strong, to reduce the risk of shrinking or breaking. To further support the maintenance of sturdy bones diet control is crucial, being well-balanced and high in calcium. Particularly women need to be aware of getting enough calcium and vitamin D in their diet as they age to lessen the risk of developing arthritis or osteoporosis. 

Introducing Dr. Spinner

Last month we met Dr. Joseph Herrera. This month we introduce you to Director of Pain Medicine and Minimally Invasive Spine Surgery for the Department of Rehabilitation Medicine, Dr. David Spinner.

Dr. Spinner has always had a keen interest in sports, specifically baseball, basketball and the winter Olympics. Besides being a fan of various teams, he has also participated in many sports over the years, including volleyball, skiing, tennis, and most preferred of all, baseball. This interest in sports directly links to his current particular interest in sports injuries and the related field of musculoskeletal medicine. Musculoskeletal medicine is left largely unexplored in most medical sectors and it was his interest in this niche topic which led him to eventually specialize in Rehabilitation Medicine.

The medical education leading towards Dr. Spinner's eventual specialization began at Emory University, before being continued at the New York College of Osteopathic Medicine. Following this he completed an internship at Maimonides Medical Center, Brooklyn and subsequently embarked on a residency at the Icahn School of Medicine. In 2015 he won an award for pain medicine fellowship excellence for his work during a fellowship in Interventional Pain at the Beth Israel Deaconess Medical Center and the Harvard Spine Center. He has made contributions to furthering the field of Rehabilitation Medicine through investigating new ways to advance procedures and improve patient care. Dr. Spinner is one of the first physicians in the country to be certified in diagnostic musculoskeletal ultrasonography, and performs many musculoskeletal pathologies. His focus lies in ultrasound guided interventions, advanced spine interventions, and minimally invasive spine surgery, and he has written several publications concerning these techniques. The list of other interventions that Dr. Spinner performs also includes spinal cord and peripheral nerve stimulation, kyphoplasties, endoscopic rhizotomies, and disectomies.

As a specialist within his field, Dr. Spinner lectures on musculoskeletal ultrasonography across the country and was the lead editor for the Atlas of Ultrasound Guided Musculoskeletal Injections, the first textbook on this subject. He has developed his own unique strategies towards the treatment of both acute and chronic pain.

The interest that Dr. Spinner has in this field continues beyond his professional practice. He is a supporter of various pain and musculoskeletal charities, including the Facial Pain Association, a resource for information and guidance for those suffering from neuropathic facial pain. Dr. Spinner is also an active and involved supporter the Wounded Warriors Project, whose mission it is to honour and empower war veterans who suffer from physical and mental ailments in relation to their military service.

Supporting a Loved One through Rehabilitation

Supporting a loved one through Rehabilitation can be one of the most difficult and isolating experiences there is. Serious injuries, and the subsequent care, can affect families and caregivers as much as the individual themselves. However, there are steps any caregiver can take to do make the transition to rehabilitation as smooth as possible.

The first thing to remember to do always is take care of yourself. If, at any point, you find yourself feeling too isolated or too stressed, reach out to other people – be they friends and family, an external support group, or a doctor. Learn to relax, get enough sleep, and find out which coping strategies work best for you – and this applies to all caregivers.

Brain Injuries

Daily structure and normality are extremely helpful for those coping with a brain injury. Be sure to stick to a routine every day, factoring in plenty of rest and limiting the number of visitors and amount of noise, so as to avoid over-stimulation. Include your loved one in family activities and conversations, wherever possible, and do whatever you can to be as natural as possible with them. Remember to be respectful, treating them as an adult and being sure to consider their likes and dislikes. Point out milestones and try not to lose patience. You should also bear general safety matters in mind – make sure there is no clutter around for the sufferer to trip on, and keep sharp objects out of harm’s way.

Stroke

The road to recovery after a stroke is different for every patient, as there are a number of complex variables which can lead to someone having a stroke. The most important thing to remember, then, is that comparisons with other people’s rehabilitation can only be harmful, not helpful. Steps forward can come quickly or slowly, so have patience, measure progress, and stay positive. Depression is extremely common after a stroke, so monitor your loved one’s mood and behavior, and step in if you notice any signs of depression. Also, it is important that you are clued-up on medication and instructions given by the physician, especially those which relate to preventing future strokes. Encourage a healthy diet and exercise, and make sure all medication is being taken as prescribed.

Sports Injuries

Sports injuries vary enormously – from acute injuries incurred during a game to wear-and-tear injuries from repeated use. They can also affect vastly different parts of the body and take different lengths of time to heal, but there are some general rules which should help with all of them. Firstly, be sure that the injured person sees the doctor regularly throughout their rehabilitation, and that they take their advice and instructions seriously. Motivate them through difficult aspects such as physical therapy while being sure not to encourage them to get back into their sport of choice before they are ready.

Wheelchair

It is important to bear in mind that, life in a wheelchair can be extremely challenging – particularly for those who are new to it. To begin with, the crucial thing is simply to be there for your loved one, and to remind them of this sensitively, without constantly reminding them of the things they can no longer do. One of the trickiest things, our patients’ families find, is learning to tread the fine line between drawing constant attention to the wheelchair and conspicuously not mentioning it. This may take time and effort, but you will get there. Adapt your home to make it as wheelchair friendly as possible – this is something your hospital or medical center can help you with. Finally, be prepared to help them in any way they need – especially at the beginning. There may be a number of everyday activities they find difficult to do on their own – from bathing to dressing – and it is imperative that you lay any reluctance to one side and do what is necessary. Over time, they may well learn to do these things without you.

Spinal Injuries

Experiencing a Spinal Cord Injury can profoundly change the way in which someone interacts with the world. As a caregiver, it is crucial that you make this transition as painless as possible. Sufferers often experience high levels of guilt, frustration, and depression – as well as physical pain – so it is your role to help prevent this, whenever possible, and never to let your loved one feel like a burden. Be prepared to face these emotions, and try to communicate openly and often with your loved one about them. On the whole, it is good to interact with them as you normally would. One of the best things to do is to work out early on which tasks the patient can complete independently and which tasks could use your assistance. Keep the whole family or household involved and be sure to nurture healthy, positive relationships – providing your loved one with as much contact with the outside world as possible.

When it comes to rehabilitation for any serious condition, your role is vital. Your love, care, and support can be the difference between a patient recovering, and them not recovering. It is a role which is exceedingly challenging, but which can be hugely rewarding and, whatever the condition of your loved one, it is always important to remember: you are doing a good job.

Top Tips for a Healthy Spine

Back pain and spinal conditions can be some of the most debilitating that there are. According to NINDS (the National Institute of Neurological Disorders and Stroke) lower-back pain is the leading cause of job-related disability, and – worst of all – back pain can be particularly difficult to diagnose and treatment can take time. All this considered, it is worth doing everything you can to ensure that you keep your spine healthy – either to manage existing back pain or to prevent its occurrence altogether. To help, this week our Mount Sinai spine care experts have compiled a list of useful tips for keeping your spine healthy.

1. Stretch and Strengthen

The spine is supported by a complex system of muscles. 20-30 minutes a day spent toning and strengthening the abdominals and the muscles in your lower back can help keep them strong and flexible, taking pressure off the spine. Stretching frequently is invaluable too. A short routine of targeted stretches first thing in the morning can help keep you supple, maintaining joint function and range of motion and reducing your risk of back injury.

2. Sleep smart

Sleep is essential for helping the body heal and repair itself after a long day, so it is important that you are maximising its effectiveness when it comes to spinal health. Research pillows and mattresses before you buy them to ensure you are getting the correct level of comfort and support for your back. If you find yourself feeling stiff or in pain in the mornings, it could also be a sign that your sleeping position is putting unnecessary pressure on your spine, so perhaps try sleeping on your side.

3. Practice healthy working habits

That spending hour upon hour sitting at a desk is bad for your body is a well-researched fact. Not only can sitting for long stretches of time exacerbate a back condition – it can even create one, as the discs in the lower spine are loaded three times more while sitting than while standing. From unsupportive chairs to desks at the wrong level, office life and a healthy spine can often seem incompatible, but there are some key things you can do to minimise this. Be sure to get up and stretch every half hour, walk around whenever you can, and do what you can to find an office chair which offers support and a desk set to the right height for you.

4. Exercise

Getting and staying active is a healthy choice for more than just your spine – but it can be particularly helpful. Increasing your heart rate will encourage blood flow, bringing nutrients to the spine to fuel it and help it heal. An exercise routine which involves aerobic activity, stretching and strengthening, as we mentioned above, is particularly good. Being unfit increases your risk of lower back pain considerably, as does being overweight, or gaining a considerable amount of weight in a short period of time. Excess weight puts extra stress on ligaments, tendons and muscles in the lower back – another excellent reason to hit the gym.

5. Listen to your body

And, finally, we would urge you to remember that pain is never normal, nor is it something you should accept. Pain, or even discomfort, in your back could be an indicator of more serious issues, so do not ignore it. Get regular check-ups and make an appointment with your doctor if you notice any pain – be that after lifting something too heavy, persistent stiffness from sitting still, or an unexplained twinge for no obvious reason. 

If you are experiencing back pain of any kind, please reach out to us by telephone on 212-241-6335 to make an appointment.