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

Introducing Parag Sheth

Introducing Parag Sheth – Mount Sinai’s Carpal Syndrome Tunnel Expert

This month, with our continued aim of ensuring our patients know and trust our physicians, Mount Sinai presents to you our long-standing Assistant Professor of rehabilitation medicine, Dr Parag Sheth. Dr Sheth holds a certification in Physical Medicine and Rehabilitation; his specialisation lies in Carpal Tunnel Syndrome (CTS).

Dr Sheth’s expertise is grounded in his rich and varied academic career. Beginning his studies receiving honors at Johns Hopkins University, Dr Sheth moved on to study at Stony Brook School of Medicine, and subsequently held the position of Chief Resident at St. Vincent’s Medical Center’s Rehabilitation Residency Program. Dr Sheth is now a fellow of The Mayo Clinic, where he specialised in Musculoskeletal Rehabilitation; and he has been with us at Mount Sinai for over 20 years. During his time practicing with us, Dr Sheth has always gone beyond the call-of-duty to ensure patient satisfaction.

CTS, Dr Sheth’s specialization, manifest itself as a tingling, numbness and sometimes pain in the hand and fingers. This is caused by a compression of the median nerve, which controls sensation and movement in the hand. It can sometimes be hard to identify as the symptoms are common and often go unchecked. Dr Sheth is renowned for his ability to exercise expert judgement on patient’s symptoms, but always communicates in way understandable to the patient; we believe this to be paramount to a patient’s happiness. Dr Sheth has often been praised for his ability to listen carefully, and explain the process of treatment and aftercare in a concise and easy to follow way; this has made him a patient favorite. 

His clinical focus also extends to: back pain, electrodiagnostic testing, epidural steroid injections, herniated disk, knee pain, low back pain, shoulder pain, neck pain, and spine stimulation.

Outside of his professional career with us, Dr Sheth also teaches a yearly cadaveric dissection and weekly musculoskeletal lectures where he has been awarded the Avital Fast Award and the Department Teacher of the Year award. His research has been published in Nature, Lancet, and The American Journal of Sports Medicine. 

Dr Sheth is “Board Certified” and accepts insurance plans. For more details on appointment availabilities and plan coverages, please contact our call center at: (212) 241-6321.

What Causes Carpal Tunnel Syndrome?

Carpal Tunnel Syndrome (CTS) is the compression – and sometimes squashing – of the median nerve that passes through the wrist. Its symptoms can include numbness, tingling and pain in the thumbs, fingers and wrists, which can travel as far as to the arms and even to the shoulder. Modern medicine has a firm grip on what CTS is; what causes it is quite a different story.

Diagnosing CTS can be done through a relatively simple physical examination. One test is called the ‘flick signal’, for which the patient is asked, ‘what do you do when your symptoms are worse?’ If the patient responds with a hand movement that resembles the shaking of a thermometer, there is good reason to suspect CTS. There are plenty of other tests such as Phalen’s Test and Tinel’s Sign – yet, despite the relative wealth of ways to diagnose CTS, there actually isn’t any kind of test to identify the precise cause CTS, and – except for patients suffering from underlying diseases – the biological mechanisms that create this inflammatory disorder remain unknown. 

It is a common story that CTS is caused through repetitive and often high-stress tasks that involve the wrists and hands – typing, using a computer mouse, manual labour to even playing the piano. While the correlation between CTS and tasks of this nature is undoubted, there is minimal evidence to suggest any clear causality.

In fact, most studies today indicate that CTS’ causes go above and beyond mere so-called ‘workplace factors’ and that they are rather linked to ailments that cause swelling in the wrist (osteoarthritis and rheumatoid arthritis) and others that obstruct blood flow (hypothyroidism and diabetes). We also see CTS pop up in clusters within a family, which suggests that something genetic is at play. Lifestyle also appears to play a significant factor, as those who smoke, drink alcohol excessively, consume excessive salt and who are obese all show increased risk of developing CTS. Women are also three times more likely to develop CTS than men, particularly after childbirth and during menopause.

Despite the range of medical, physical, genetic and life-style related items that are linked to an increased risk in developing CTS, their relationship is that of a correlation and not one of cause and effect. A modicum of clarity might be achieved, however, by overlapping both ends of the spectrum – the ‘workplace effect’ with medical/genetic/lifestyle factors. When somebody is susceptible to CTS – whether it be through genetics, a medical condition or an unhealthy or stressful lifestyle – and they also subject their hands and wrist to frequent, repetitive task, the likelihood of suffering from CTS will be at its greatest.

If you believe you are at risk of developing CTS, we would like to encourage you to seek medical advice on how to prevent it; if you believe you might already be suffering from it, we suggest you speak to one of our specialists for a suitable treatment. The earlier CTS is treated, the more likely – and easier – a full recovery will become.

Exoskeleton Technology – Helping Paraplegics Walk Again

As technologies become more and more advanced new techniques for treating injury are constantly being developed. In 2011 the Mount Sinai Rehabilitation Center became one of only 30 hospitals in the world to test, and offer to a select few patients, a new tool that could changes the lives of paraplegic patients.

The robotics company Ekso Bionic has developed a battery-powered, robotic exoskeleton which enables patients who have lost function in their lower body to walk again. The suit, called Ekso, is a 50 pound framework made of aluminium and titanium that is controlled by a handheld remote. The patient's lower body is strapped into the suit which then uses 15 sensors to ascertain when the user is in a stable position. Pushing a button triggers the Ekso to then take a step forward. Initially only a therapeutic tool for use in rehabilitation centres, select patients are now being chosen to use the device at home.

One such patient is architect Robert Woo who became paralysed in 2007 due to an injury in the workplace. An accident, in which several tons of metal studs fell onto the trailer in which Woo was working, left him paralysed from the chest down and having to use a wheelchair to get around. The new technology has allowed him to travel around on his own two feet with the aid of forearm crutches. Following trials of the Ekso technology, Woo became on of the first people in the United States to be certified to purchase a similar technology, the ReWalk Personal 6.0 System, to use at home.

Alongside the new-found independence that the system has given him, it has also had unexpected effects on his body. Whereas prior to testing the walking technology Woo was incapable of any movement below the chest, he has found that with frequent use of the ReWalk system his upper leg muscles have begun to regain functionality. Although he still relies on the robotic support to walk the process has given him back enough muscle strength that he can now independently lift his legs while sitting.

The technology is still relatively and new each unit costs around $100,000 however, as developments continue the hope is that demand for the walking aid will increase. This in turn will increase production and thus bring the price down, making it easier for more patients to afford this life-changing device. 

Bringing Science to the Community – Introducing Dr. David Putrino

This month we introduce to you Dr. David Putrino, Director of Rehabilitation Innovation for the Mount Sinai Health System. Dr. Putrino's medical career began in Australia, where he completed an undergraduate degree in physiotherapy before carrying out a PhD in neuroscience at the University of Western Australia. On completion of his PhD, Dr. Putrino held teaching positions, both at Curtin University of Technology and Edith Cowan University in Perth in Western Australia, teaching neuroanatomy and neuropathology.

After working as a clinician in Australia Dr. Putrino moved to New York to study computational neuroscience at Harvard Medical School, MIT, and NYU. During his time at NYU he worked as a assistant in the School of Medicine, teaching neuroanatomy and clinical neuroscience. Currently he holds a position, not only as the Director of Rehabilitation Innovation, but also as an Assistant Professor of Rehabilitation Medicine at the Icahn School of Medicine at Mount Sinai. His work includes developing innovative technology solutions for patients who are in need of better healthcare accessibility. He also lends his technological expertise to the Red Bull High Performance athletics division, consulting with them and using state-of-the-art technologies to monitor, and improve, the performance of athletes.

As well as using his medical training within rehabilitation medicine, and the athletics field, Dr. Putrino believes that it is the responsibility of scientists and medical professionals to add to the education of the community. He believes scientists need to engage the public in science, technological advances, and current research, and to explain why these are such important fields. With this in mind, Dr. Putrino dedicated a portion of his time to co-founding the not-for-profit organization StreetSmart Science. This venture connects scientific mentors with local high schools to get students excited about working in the science sector. The organization currently works with three inner-city high schools in the Bronx and Harlem areas. This passion for community enrichment has also led to Dr. Putrino holding the position of “Chief Mad Scientist” at Not Impossible Labs, an organization that crowd-sources accessible technological solutions for high-impact humanitarian issues.

This interest in community education has brought Dr. Putrino's work into the public eye. He has appeared as a scientific expert on the American Heroes Network as well as having his research featured in a whole range of media, from the ABC, to the LA Times, to the Wall Street Journal, BuzzFeed to name but a few. It is his strong passion for using science to help his community, alongside his extensive background in neuroscience and technology, that have led to Dr Putrino becoming an integral part of the Mount Sinai Rehabilitation Innovation team.

World-Class Care – Introducing Dr. Donald Kastenbaum

This week we introduce one of our senior faculty members in orthopaedic surgery, Physician-In-Chief Dr. Donald Kastenbaum. Having performed over 5,000 primary and revision total hip and total knee replacements Dr. Kastenbaum has certainly earned the position of authority he holds in the field of orthopaedics. An expert in hip and knee surgeries, he has helped to develop several prosthetics for hips and knees that are being used worldwide in replacement surgeries.

Dr. Kastenbaum's journey to his current position of prestige began with studying for a medical degree at the University of Health Sciences – the Chicago Medical School. On completion of this he began an internship in general surgery at the Lenox Hill Hospital, followed by a residency in orthopaedic surgery at the Hospital for Joint Diseases Orthopaedic Institute. His specialisation into the field of hip and knee surgeries was further honed with a fellowship in Sports Medicine at New York University Hospital Medical Center before crossing the pond to complete another in Total Hip and Knee Replacement Surgery/ Arthritis at the London Hospital Medical Center.

His medical work on an international scale continued after his British fellowship, and over the past decade he has both lectured and worked worldwide. Having trained over 30 Chinese orthopaedic fellows, Dr. Kastenbaum returns to China every quarter in order to carry out, and teach, advanced surgical techniques, including minimally invasive and revision hip and knee surgery. Closer to home, he created Mount Sinai's first Comprehensive Arthritis Center, a facility designed to provide complete orthopaedic and rheumatological care, and physical therapy services. Dr. Kastenbaum holds positions within this institution as both Co-Director and Surgeon-In-Chief.

That, however, does not complete his list of medical contributions. In 2002 he was invited to be a part of the Insall Scott Kelly Institute for Orthopaedic and Sports Medicine, and was given the position of Associate Chairman of the Department of Orthopaedic Surgery, before becoming the Vice President in 2005. To add to his already-full career Dr. Kastenbaum also holds the position of President of the Mount Sinai Beth Israel Medical Board and Chairman of the Surgical Chairs. He is renowned as an expert in Hospital Perioperative Management, Safety/ Efficiency/ Outcome Analysis and aids hospitals across the world in developing their models of “best practice”.

All of Dr. Kastenbaum's involvements in different institutions are predicated on his great knowledge and expertise in the field of orthopaedic surgery. For more information on the medical procedures this world-class doctor can provide call 212-241-6335 to book a consultation.

Our Tips for Reducing Back Pain

 Back pain can be debilitating and leave one feeling like they cannot do everyday activities. Before seeking surgical solutions, there are a range of activities that may help alleviate the pain, and get you back to moving as normal.

Pain Relief – As a first port of call, and as a short-term solution pain killers can reduce suffering. To counteract swelling and inflammation cold packs can be beneficial while hot packs work to lessen tension, cramping and muscle spasms.

Manual Therapy – This method involves a therapist using their hands to massage, gently move, and apply careful force to the muscles, bones and joints of the spine. This removes tension in the muscles and encourages them to relax though it will only be effective if used alongside other measures, such as those listed here.

Exercise and Stretches – Traditional thinking is that in order to fix back pain bed rest is the best option. It has since been found that it is better to remain active, to retain muscle strength and flexibility. At first avoid any heavy-duty weight bearing exercises and opt more for gentle stretches and yoga. Exercises that lengthen out back muscles, such as back-bends and the cat-and-camel move, are the best for reducing pain.

Aquatic Therapy – If exercise exacerbates back pain at first, this can be countered in aquatic therapy. This involves gentle movement in a pool. The buoyancy of the water helps to remove strain from the joints, putting less pressure on the back, while the warmth of the water can help increase blood circulation, relax the back muscles, and remove tension.

Electric Stimulation – It has been seen that mild electrical currents can reduce perception of back pain. Electric stimulation involves using a Transcutaneous Electric Nerve Stimulator (TENS) machine to send low-voltage electrical currents to the body, through electrodes placed on the back. The exact mechanisms of this therapy are unknown, but one hypothesis is that the currents work to scramble pain messages to the brain, so the brain does not process them. An alternate idea is that the electrical impulses stimulate the body to release endorphins which override the sensation of pain.

For the most effective recovery it is recommended that a combination of these techniques is used. Some, such as pain relief and manual therapy, only alleviate pain in the short term, and so it is necessary to combine them with other techniques, such as stretches, for long term improvements.  

Introducing Our Director of Brain Injury Research - Dr. Dams-O'Connor

 This week we are introducing Dr. Kristen Dams-O'Connor, the new director of the Brain Injury Research Center of Mount Sinai who specialises in traumatic brain injuries (TBI), and more specifically, the recovery process of TBI patients.

When beginning college at Colgate University, Dr. Dams-O'Connor intended to major in international relations; however, after taking an introductory course in neuroscience she was hooked, and chose instead to major in this field. Her research began in controlled laboratory experiments and she fell in love with the accuracy and certainty with which she could observe cause-and-effect relationships in her studies.

Following her undergraduate degree in neuroscience, Dr. Dams-O'Connor decided to do further studies in psychology so she could work more closely with patients who were living with neurological diseases. During her doctoral studies she worked at a clinical site for three years at the University at Albany , participating in programs that helped people with devastating brain diseases live more productive and meaningful lives.

Moving to New York, she carried out an internship in neurorehabilitation at the Rusk Institute of Rehabilitation Medicine at New York University Medical Center. On completion of the internship she progressed to a fellowship in Clinical Neuropsychology at Mount Sinai. During this Dr. Dams-O'Connor began to focus her research more on TBI, taking an interest in the heterogeneous nature of these injuries, with no two cases being alike. This variability allowed her to apply her knowledge of empirically supported neurobehavioral interventions to unique individual cases.

Today, as well as being a director, Dr. Dams-O'Connor is also an Associate Professor in the Department of Rehabilitation Medicine at the Icahn School of Medicine, and the Director of Research. She is PI of two grants from the National Institutes of Health and Co-Project Director of the New York Traumatic Brain Injury Model System which, as well as carrying out research on brain trauma, also provides emergency medical services, acute care, rehabilitation services, and long-term outpatient care. In her career to date she has published over 60 peer-reviewed manuscripts and chapters on traumatic brain injuries, their treatments, and outcomes and her work is internationally recognised. In her current research Dr. Dams-O'Connor works primarily on studying the long-term outcomes of brain injuries including clinicopathological signatures of TBI. A key interest of hers is understanding why some patients display a full recovery after their injuries while others partially recover before regressing later in life.

You can read more about the Brain Injury Research Center here - www.tbicentral.org

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.

Tips to keep your brain young and healthy

Changes in our brain functions are a very common consequence of ageing and mental decline may be one of the most feared results of getting old. According to research more than 16 million people in the United States suffer from cognitive impairment, which means they have trouble remembering, focusing or even learning new things.

If you are noticing some of the early symptoms of cognitive impairment such as forgetting appointments and recent events or having trouble making sound decisions here are a few tips to keep your brain healthy and young.

Exercise

Physical exercise can help the brain become more efficient and adaptive to change.  According to Harvard Medical School “research shows that using your muscles may also help your mind. (…) Exercise lowers blood pressure, improves cholesterol levels, fights diabetes, and reduces mental stress, all of which can help your brain as well as your heart.” Exercising 3 times per week is a great way to start.

Eat healthy

A healthy diet can help both your body and mind. Eating foods that are low in saturated fat and keeping your calorie intake balanced will keep your brain younger. Also, vitamins B6, B12 and folic acid, which can be found in cereals and grains have proved to reduce homocysteine levels that are linked to cognitive impairment.

Mental Exercise

Engage in activities that challenge and stimulate your brain. Try solving math problems or crosswords, painting, or learning a new craft or language.

Socialize 

By having friends and going out, you are open to new experiences and challenges. They are also a great motivation when it comes to getting involved in several activities.

Avoid tobacco, alcohol and other drugs

Excessive abuse of tobacco, alcohol and other drugs can reduce your ability to remember, focus or execute tasks.

Keep your emotions balanced

Even though extreme anxiety and depression are not linked to cognitive impairment, it is always beneficial for your metal health to keep your emotions balanced.

Maintain social connections

 Constant communication and interaction with others is very important in maintaining social connections. The ability to bond with others over a period of time is associated with lower blood pressure and better mental health.  

Avoid injuries

Head injuries such as concussions can affect your brain’s activity while getting older. Reduce the risk by protecting your head.

These are just some simple tips and tricks to help your brain stay young and healthy. They are easy to incorporate in your everyday life, and will also improve your physical and mental health.