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

Why SAD affects us in the winter

Seasonal Affective Disorder (SAD) is a state of depression that stems from the changing of the season, specifically – the summer to winter. In the winter, the days get shorter, it is cloudy and cold – but SAD isn’t a prophetic fallacy – it’s a physical reaction to a lack of vitamin D. Although there is a myriad of reasons as to how this depressive state can be triggered, none is more widely accepted than the vitamin D deficiency the body undergoes during the winter. A lack of vitamin D will create a chain reaction with other symptoms of SAD, which then feed into other depressive behaviours, in turn worsening the state of affairs. Let’s look at what vitamin D deficiency does to the human body.

Vitamin D, like all vitamins, it is a nutrient we make in our body; and most it comes from the sun. But vitamin D is unique as it is a hormone and not a nutrient like other vitamins. It works with calcium and phosphorus to create and maintain healthy bones, muscles, and teeth. Without enough vitamin D, your body will not be able to absorb calcium and other important nutrients that allow our body to function. In turn, many people with low levels of vitamin D will experience rickets, osteomalacia alongside other muscle and bone deficiencies. This leads us to be being tired, frustrated that our bodies are not functioning as it should be, and possibly lowering our immune system.

Vitamin D also has a role in maintaining stable brain hormones. Serotonin, the hormone associated with happiness, rises with the exposure to bright light – and drops in correlation with decreased sun exposure. As understood by research in medical science, people with lower vitamin D are 11 times more prone to be depressed than those with healthy does. A low level of vitamin D will cause a deficiency in serotonin, causing depressive-like behaviours to occur.

If we amalgamate these two factors, we see instantly that low vitamin D, caused by reduced sun exposure, is responsible for making us tired and unhappy. These physical deprivations feed into mental manifestations of psychological dispositions – such as bipolar – or other types of depression. It also suppresses the immune system, which can have a knock-on effect on making us ill, and then beginning the “cycle of depression”.

If you would like to learn more about how the cycle of depression works, click here.

SAD can have an extremely negative impact on your quality of life. If you need a consultation or are suffering from any of the symptoms outlined at the end of the article, please contact us on (212) 241-6321 to book an appointment.

The Light at The End of The Tunnel

Seasonal affective disorder (SAD) is a type of depression stimulated by the changing of the season. In previous articles, we have reviewed what SAD is, how it manifests itself, and the physiological and psychological approaches to understanding the disorder. The best ways to deal with SAD are to ensure you are aware of it, sleep well, and eat well. However, your physician may recommend you use a light box. This week, we will investigate light therapy and explain its uses when fighting SAD.

Light box therapy is an effective and non-invasive treatment for SAD – it stimulates your brain as much as sunlight does. It probably will not cure SAD, “nonseasonal” depression, or other conditions – but it may ease symptoms, increase energy levels, and make the condition more bearable as it has a positive effect on mood and helps with vitamin D deficiency.

Here are some tips on ensuring you get the most out of your lightbox:

·        Get the right light box. Brands like Lumie make fantastic products, but you need to know what specifications to look for.

·        Be consistent by sticking to daily routines of light therapy sessions. It’s better to do more frequent but shorter sessions than fewer but longer sessions.

·        Never look directly into the light as it can severely damage the retina. Ensure that you only look at something the light reflects off, such as a book or magazine.

·        Do not interrupt your schedule as the symptoms could return stronger. Ensure you follow a plan set out by your physician.

Your physician will advise you on how to best purchase and use a lightbox. They will explain to you: which brands are most suited for your personal condition, how long you should sit under it, at what point in the day, and how far from the box you should be positioned. Like any other prescriptive medicine, light box therapy should be taken in “doses,” and there is not a “one size fits all” approach. Each dose should be appropriately prescribed as per your personal situation.

If your symptoms do not improve you may need to consider additional therapy. Your physician will advise you about other treatment options, such as antidepressants or psychotherapy.

To see whether a lightbox could improve your quality of life, contact your physician or book into Mount Sinai for expert advice.

SAD can have an extremely negative impact on your quality of life. If you need a consultation, or are suffering from any of the symptoms outlined at the end of the article, please contact us on (212) 241-6321 to book an appointment.

SAD – Nature’s Effect on Nurture

Historically, Seasonal Affective Disorder (SAD) has been understood as being the result of one of two binary positions: biological (your genetic composition) or environmental (learned behaviours and other external influences). In more recent years, it has become widely accepted that the two elements feed into each other. That means that while people have predispositions toward depression, that depression is simultaneously affected by an external influence (in this case winter). SAD is made distinct from other types of depression due to its temporal pattern. Major episodes begin in the winter, and there is always a full emission in the spring.

Let’s take a quick look at the two factors before seeing how they link into each other.

Is It in The Genes?

The bracket of “Biological Vulnerability” covers a vast field of potential reasons one experiences SAD – but is generally understood as a rhythmic abnormality in the winter. This simply means, a biological composition or a natural disposition to biological changes in winter causes SAD. Some of the most well understood reasons are as follows: there could be a delay or advance in the release of melatonin (the hormone that tells us it’s time to sleep), a retinal sensitivity to light, a dysfunction between neurotransmitters (the chemical substance which sends messages between nerves), a genetic variation in brain composition, and a reduced release of serotonin. 

SAD can be a result of one or more of these biological aspects, but more often than not, they are emphasized by psychological factors.

How Our Environment Can Make Us SAD

Depression is understood as an interaction between a cognitive vulnerability to depression (as we looked at above) and a stressor. There are different cognitive models that propose different vulnerabilities, let’s take a look at the main ones.

Alongside the genetical predisposition, it is common for the sufferer to also be affected by one of the following: a dysfunctional attitude (learned negative attitudes and outlook on the world), rumination (focusing attention on dysphoric moods and/or potential negative consequences), and a negative attributional style (catastrophizing negative events to a global scale). These aspects are usually interwoven.

Once a predisposition is influenced by one of these negative cognitive aspects, this combinatorial (see below for a visual representation of this process). All of these cognitive aspects are stressors.

Combining the Two. 

Source: Biological and Psychological Mechanisms of Seasonal Affective Disorder: A Review and Integration. Kelly J. Rohan, Kathryn A. Roecklein, and David A.F. Haaga. Current Psychiatry Reviews, 2009, 5., 37-47

As we can see following the graph, the environmental aspect (on the left) can run its own path to SAD, as can the biological (on the right). It is widely accepted that the psychological vulnerability and the physiological vulnerability feed into each other (as seen with the double-arrow that links the two sides together).

If you would like to learn more about the symptoms of SAD click here.

If you would like an introduction to one of our physicians that specializes in SAD click here.

SAD can have an extremely negative impact on your quality of life. If you need a consultation, or are suffering from any of the symptoms outlined at the end of the article, please contact us on (212) 241-6321 to book an appointment.

A Physician That Can Stop You Feeling SAD – Dr Wayne A Gordon (PhD)

In a previous article, we explored Seasonal Affective Disorder (SAD), its manifestations, and some ways in which you can cope with this type of depression. As we said, symptoms tend to get better on their own, but sometimes they don’t. That is why this week we introduce Dr Wayne A Gordon, Mount Sinai’s response to SAD in the Department of Rehabilitation Medicine.

Dr. Gordon is the Jack Nash Professor and Vice Chair of the Department of Rehabilitation Medicine at the Icahn School of Medicine. He holds a PhD in Psychology from Yeshiva University alongside an internship in Neuropsychology from Rusk Institute. His specialization in Rehabilitative Psychology has finessed his clinical expertise toward dealing with SAD.

His clinical focus is centred around brain rehabilitation. That extends to fields of Anxiety, Concussion, Dementia, Insomnia, Parkinson’s, and all manifestations of Depression. His work in academia prove his profound understanding of how to help deal with SAD, and other types of Depression. He has published more than 100 articles and book chapters, and has received several awards during his career including recognition for “visionary work” in TBI (Traumatic Brain Injury).

When is the best time to see a physician about SAD?

One of the primary concerns with SAD is that it is difficult to diagnose, and equally sensitive to manage. The first step to dealing with SAD is diagnosis. This job is best done by a physician such as Dr Gordon, who can remove possibilities of other disorders that have similar symptoms. At this stage, it is possible to manage SAD using the step-by-step we supplied here. 

It is also important to see a physician if you feel the disorder is unmanageable. The step-by-step is helpful to some patients, but not to all. The symptoms of SAD don’t need to be managed alone. Dr Gordon has dedicated his life to helping people deal with SAD and equipping them with effective bespoke methods to deal with their personal battles. This can range from learning to deal with your symptoms to understanding what your symptoms are. SAD can manifest itself in “cycles” and become self-feeding. Dr Gordon can give you a metaphorical manual to your disorder which will help you understand what you are going through. This makes SAD manageable.

SAD can have an extremely negative impact on your quality of life. If you need a consultation, or are suffering from any of the symptoms outlined at the end of the article, please contact us on (212) 241-6321 to book an appointment.