Dr Jay Joshi Pain Management Anesthesiologist Ketamine, Stem Cells, Stimulators

[titaniumed]

Valuable Pain Doctor talks about pain....

http://www.nationalpain.com/dr-jay-joshi

Ketamine infusion
https://www.youtube.com/watch?v=QshZ_unVDQQ

IV Ketamine and Cutting edge treatments
https://www.youtube.com/watch?v=2bvzG4GknRU

Marijuana for Chronic Pain, Pharmacology, Neuropathic Pain
https://www.youtube.com/watch?v=pPacWyzClz4

Ed

[titaniumed]

Notes on 1st video:

What is a pain expert? (Does anyone know?)

The reality of pain management 20:07

1) 90% Have no formal training. 90% Have no formal training. 90% Have no formal training.90% Have no formal training. 90% Have no formal training.
2) Board certification can be bought
3) Variable quality of training....trained by the un-trained
4) Unaccredited programs...."work for me for free and get your fellowship"
5) Outdated training programs...

(Smug face)

Central Sensitization (Hyper-reactive brain, highly excitable) 24:00

Hyperactive feedback loop (neurons continually fire) sending pain signal after injury (tissue damage) is over.
Every injury results in brain re-organization resulting in memories....major changes in both the spinal cord and the brain.

Types of Central Sensitization
1) Anxiety
2) Chronic pain
3) CRPS/RSD (Central regional pain syndrome)
4) Depression
5) Fibromylagia
6) Headaches
7) Opioid Induced Hyperalgesia (Causes increased Central Sensitization, Horrible feedback loop)
8) Phantom limb pain
9) PTSD

Disinhibition...Basically what happens, is a complete short circuit...(29:50) Cord and Brain
================================================== ========================================
Ketamine Infusion 34:20

FDA Approval 1970
World Health Core Medication
Brand name Ketamine vs non brand name (Cheap stuff) makes a big difference
Resets the NMDA receptors (Spinal cord and the brain) (Magnesium used for CRPS)
Ketamine reduces sensitivity to new opiate receptors 39:33
Use of Ketamine to reduce opioid use (resets receptors) 39:50

Effects of Ketamine 41:40
Does not inhibit breathing
Increases blood pressure and heart rate and cerebral blood flow (headaches)
Reduces chronic pain and need for opiate medications Lots of evidence 42:35 Prevents hyper sensitization
Why isn't it used more often? Lazyiness and ignorance 43:00
Ketamine reduces and reverses PTSD 43:28
Dr Joshi does Ketamine infusion in a surgery center, (North of Chicago) not a closet. 44:45
Central sensitization sometimes reduced to zero...

================================================== =======================================

Once again, some members here have had Ketamine, including myself. I think it explains why I terminated Percoset as quickly as I did. I had it in ICU post surgery, and didn't feel a thing. I did not have infusions after my surgeries. I would not do this unless I had a cutting edge anesthesiologist in a hospital setting. Your reprogramming your Central Nervous System.

Its pain month around here, that why I am posting this valuable material.

Ed

[RitaR]

Well, seeing as the past 16+ hours I have spent in bed these past couple days I did a lot of thinking about this pain issue and scoliosis. It seems if u have surgery and a good surgeon, have no problems postoperative, you will do just fine. No surgeon wants to get in on fixing someone else’s screw up. That’s bad for me, too, unfortunately.

[titaniumed]

Rita, it is scary for the surgeon....They will try, but its always a major undertaking especially if its a full procedure. Sometimes the answers are not always surgery.

I don't know if you watched the video, it can be a lot to absorb, (That's why I did the notes) but when neuropathic pain gets out of control, and no-one is seeing anything standing out saying "operate here", the next step is seeing a pain specialist just like what Jackie did. A Central Nervous System expert, one with high caliber credentials. For neuropathic pain, heavy nerve pain, this is all we have.

Initial scoliosis surgeries like what we had years ago are easier decisions when we have huge curves and there are 50 things wrong that anyone can see. Revision surgeries on scoliosis patients for pain are much more difficult since the surgeons have to find that pain source. I don't know if its in this video or another video, but there are many many injection points for blocks, and these injections have to be located within a very tight area 1/2mm or .02. (2 matchbook covers) The proposed location can be correct, but the injection can fail to prove out the cause due to location inaccuracies. If there are multiple pain sources, this really makes things difficult in the diagnosis process.

You can have major pain and have the best spine surgeons in the world say they don't see anything wrong. This was Jackie's story....and Pam's story. I don't know if this is due to a radiological miscall, (running wrong diagnostics parameters) or lack of diagnostic technology, or if its not an orthopedic bone or hardware related problem. It "could" be a CNS problem. That's why I posted this video.

If I had a pain problem, I would want to know the cause. If there is a good clue, I would prefer to keep the revision on a small scale, possibly minimally invasive if at all possible. If there are no clues, this makes surgical intervention an extremely difficult decision.

If one has the inability to pay for any "desperately" needed medical procedures, there is always crowdfunding.

Ed

[Pooka1]

Hi Rita,

I am sorry you are going through this. I don't have scoliosis but have had herniated discs starting when I was about 30. I am on this forum because both my daughters were fused for scoliosis.

Anyway a few years ago I read or heard on Doctor Radio about a spine surgeon who stopped doing one and two level fusions for pain because they weren't working. He did thousands of them and just had to stop. He changed specialties and now does pain research to try to help his patients. He is working at the level of the brain and trying to disrupt the circuitry that gives the sensation of pain. Like Ed said, it seems like surgery is not going to be the answer for some pain associated with spine.

I can see why a surgeon would not want to operate if they didn't see anything on imaging that could be causing the pain. That might even be malpractice if they did.

I will try to find that guy's name.

Good luck.

[jackieg412]

Ed is spot on. Sometimes the orthopaedic doctors are looking at the structure situation not the big picture. Sure everything looks good on X-Ray but you know something is not good.
I was fortunate to trust a neurosurgeon and a second opinion. While the scan showed some questions of another surgery the neurosurgeon was it is too dangerous so he sent me to a pain specialist.
It is through a teaching hospital in Chicago. And there the correct doctor for me worked hard and listened to every thing I said. Never was my littlest concern dismissed. It was addressed and then helped in some way. Ed has posted a link to a presentation by my doctor. A young man who truely cares for his patients.
On my last surgery ketamine was used. It is a wonder. It brought instant peace. I guess it is used in other ways but for that surgery and those few days it was great. The feeling continued for awhile afterwards just like the research said. I do understand it is an expensive drug. It is worth looking into.

[titaniumed]

Thoughts about Osteoporosis.....Adult scoliosis decisions.

In following around here for all these years, one of the things I see that is of major concern with scoliosis is osteoporosis. Osteoporosis and scoliosis DO NOT go together well. I have to post this someplace even if this isn't the best thread. What is the common denominator of painful scoliosis revision patients? Is osteoporosis the main cause of the most painful (revision) testimonials around here?

Although there are ways of improving DEXA (Bone density) scoring, using cortical screws, and things like injection of bone cements through screws, and any other osteoporotic tricks of the trade that scoliosis surgeons can use, one can get through a scoliosis surgery ok, and then end up with a fracture or micro fracture later which is a painful situation that sometimes doesn't warrant any surgical intervention. Fractures and hardware movement would seem to happen easier with osteoporosis. Falls and car accidents are inevitable.....they really need to be avoided at all costs. I don't have osteoporosis, but I quit skiing. I am not going to take that chance anymore as I am not too keen about doing future spine surgeries. At almost 11-1/2 years I can safely say that I am fused, that's just one less thing to worry about.

Years ago, I mentioned that there should be an adult system of decision. I probably posted Age 50, Cobb 50, and don't wait too long. 50:50 cutoff point.

With females (and some males) with big curves, it would probably be best to go with Age 40, Cobb 40. Entering menopause with osteoporosis having scoliosis hardware installed "earlier" is probably going to be a better scenario. It also skips all the degeneration (and pain) that happens during our 40's. I heard the words "Why did you wait so long" multiple times, and I don't have osteoporosis. Maybe it would be best to DEXA at age 40, and monitor these results often for those in this category. ??? I am not sure. Best to ask a scoliosis surgeon about this. Scoliosis intervention is all about timing.....Keeping osteoporosis in check is also very important after fusion....

Its been years since I have looked at holding strength studies, but most (90%) of the screw holding strength happens in the cortical (outside) bone. Its only 1-1/2 turns on the thread. The cancellous (inside) bone is the spongy bone which has much less holding strength. Is pain caused by microfractures under each screw head that surgeons cant see? Impossible or extremely difficult aspects of radiology? Once again, finding pain sources is not easy.

Ed

[LindaRacine]

Hi Rita,

I am sorry you are going through this. I don't have scoliosis but have had herniated discs starting when I was about 30. I am on this forum because both my daughters were fused for scoliosis.

Anyway a few years ago I read or heard on Doctor Radio about a spine surgeon who stopped doing one and two level fusions for pain because they weren't working. He didn't thousands of them and just had to stop. He changed specialties and now does pain research to try to help his patients. He is working at the level of the brain and trying to disrupt the circuitry that gives the sensation of pain. Like Ed said, it seems like surgery is not going to be the answer for some pain associated with spine.

I can see why a surgeon would not want to operate if they didn't see anything on imaging that could be causing the pain. That might even be malpractice if they did.

I will try to find that guy's name.

Good luck.

There are actually two such doctors:
David Hanscom (https://backincontrol.com/)
John Sarno (http://johnesarnomd.com/

[Pooka1]

There are actually two such doctors:
David Hanscom (https://backincontrol.com/)
John Sarno (http://johnesarnomd.com/

Yes it was Hanscom. Good that you posted about these guys.

[jackieg412]

Interesting thoughts on osteoporosis, so far that isn't one of my problems. I am actually amazed that in that car accident I had in September of last year all of the fusion held. All the rods, pins screws held. Now everything inbetween broke. I still don't have words to use to describe what it felt like to be driven into a brick wall at 30 miles per hour. The strength of the seat belt alone was crushing. Yet all fusion held in place. It amazes me yet.

[titaniumed]

I am actually amazed that in that car accident I had in September of last year all of the fusion held. All the rods, pins screws held. Now everything inbetween broke. I still don't have words to use to describe what it felt like to be driven into a brick wall at 30 miles per hour. The strength of the seat belt alone was crushing. Yet all fusion held in place. It amazes me yet.

Jackie, That's what they told you....because they didn't see anything,(not their fault) or didn't want to add on to an already tough situation. Hitting a solid wall with a car can produce incredible amounts of force. You did damage to your whole body when that happened. It damaged my body when I read your post! (smiley face)

On anxiety, my absolute worst anxiety had nothing to do with my surgeries, it was while ski jumping as a teen. The jumps got bigger and bigger, and that produces extreme anxiety. Your in total control with nobody to blame, and can die in the next few seconds. I thought, why doubt myself? Many of the skiers that do incredibly scary terrain have learned to control anxiety mentally. Heart rate needs to be normal, not racing. Many times skiing, I would dip off into the woods for solitude, to be in the trees in deep powder is serene, its complete calm. Its a good place to gather thoughts.....I also skied alone most of my life as an expert skier. I got really good at doing this with my life, my mind, and battling scoliosis. I skied in pain but accepted it to a point of extreme and probably waited too long for my scoliosis surgeries. I destroyed my spine skiing all those years. The crashes and the forces were insane. I didn't crash much, but when I did, they were whoppers and I broke stuff. I have broken several pairs of skis, ripped bindings off skis, broke my arm and shoulder, got 27 stitches in my head once, (Age 16) (Most blood I have ever seen in any skiing accident in over 50 years)

This going into the woods for a reset, was key. I have skied over 100 areas in the US and Canada, and have been in 5 lodges....not my bag, that's for sure, I went up for the trees....Everyone needs to find their own woods....and turn things off mentally. Prep for a life with scoliosis.

I have glanced at Dr Hanscom's material. In fact, there is a blog, here it is.
https://backincontrol.com/insights-index/

Many of the things he writes about are so familiar to me, I guess because I lived it. Its good material...perhaps a good foundation that we should all know. I want to assume that most of us around here know this material, and think so because extreme scoliosis and its effects shape us or mold our minds into a sort of survival mode.

The thing is that we have a few stragglers around here that need help with things. The mental aspects of scoliosis pain are good to apply, but extreme neuropathic pain, on a level that some of the hardcore patients feel needs attention or a re-direction by someone like Dr Joshi, or Young. I don't know what the true answer is, I do know and strongly feel that long term opioid use is not the answer, and it makes things worse. (#7 on the Central Sensitization list) It could be Ketamine, its great at re-programming and after you do this, it really mellows out the memories of pain....It could be stem cells, and only someone leading into this research will really know what works and what doesn't.

It works incredibly well for depression, produced by anxiety, and also PTSD.

I know a few war vets that could use Ketamine infusion. (smug face) They can't turn it off. You have to learn to turn it off.

Sailors who circumnavigate the globe have scary rough seas to deal with, they also hit the doldrums where everything is calm and the ocean becomes glass.....Everyone has opportunities to find their own moments of solitude for mental health, for me it is the trees, for sailors its the glassy sea of doldrums....

Ed

[titaniumed]

I went down to the plant yesterday and was talking with one of the programmers about re-building fixtures from steel for holding parts in a particular machining operation. The hardened steel we are machining has a much higher tensile than the steel used for the fixtures that are in an annealed state (16 Rockwell C scale) Yup, its soft. I can almost bite it with my teeth and leave marks in it....

The thing is that most people think if its made of steel, its solid as a rock and that is FAR from the truth. Steel moves, and we see it. Its a constant battle trying to hold tolerances of .0002 total tolerance. Stuff moves and we can measure it. We have to figure out what is moving. We can measure to .00005 depending on temp fluctuations, optics problems, and dirt. Dirt is our worst enemy.

We have hardware of various tensile strengths, Titanium, Ti-6Al-7Nb, 316LVM, some Colbalt alloys and we have bone of different hardness levels. Hard materials usually crack easier than softer materials....especially with a good force.

You get into a crash and I am sure there are micro cracks, hardware and bone....cancellous bone where all the holding strength is right under the screw heads. I doubt they can see this many of the times due to the faults in optics, clarity, focusing, angle of view, radiology difficulties etc. Nerves are in bone, I cant see this not being affected somehow, and producing some level of pain through the repair or healing process. Who knows how many micro cracks there are? 1 or a million? You don't know if you cant see, and pain is usually the result. Healing happens, its truly an amazing thing.

Just wanted to clarify some things about movement and forces.

Crashes are no good. Falls are no good.

Ed

[jackieg412]

Yes Ed we do have to be careful of falls and accidents.I
There is a lot to be said about the force created. I know the seat belt caught the pain pump and was moved further into me. It is also on an angle. It needs to be replaced but not right now. I really thought the pump was crushed but I'm told it is not. It is harder to feel.
We all need to work on our internal peace. For me it is being outside everyday. In Chicago that isn't always easy. I need to find my sunshine and bunnies to bring me peace. Soft and gentle. That is what Dr Young brings. He has been so good to me.