Cataracts Cataracts are the leading cause of visual loss in adults age 55 and over. A cataract is the clouding of your eye's natural lens and can be the reason sharp objects become blurred, bright colors become dull or seeing at night is more difficult. The majority of cataracts are simply a result of the natural aging process but can also be caused by diabetes, medications or trauma to the eye.

Fortunately, correcting cataracts is relatively simple. The patient's cloudy lens is removed and replaced with an artificial lens using a small incision and a "no stitch" technique. The result may be extraordinary and some patients experience the best vision of their lives.

NOTE: It is important to understand that cataracts can only be removed surgically and medications or special diets will not cure them.

Is cataract surgery safe?
Yes, cataract removal is one of the safest and most effective surgical procedures. More than 3 million cataract surgeries are performed each year in the United States and the success rate of cataract surgery restoring sight is 95%.

Does cataract surgery hurt?
No, most people are surprised to find out how easy and pain-free cataract surgery is. Anesthetic drops numb the nerves in and around your eye so you should feel little to no discomfort. The procedure itself takes about 20 minutes and most patients are back to their normal activities the next day.

How soon will my vision improve?
When your cataract is removed all the things you could not see clearly are bright, clear and vivid again. Most patients experience improved vision immediately, but your sight may continue to improve for several days or weeks.

What is an IOL?
An intraocular lens (IOL) is the artificial lens implanted during cataract surgery. Technological advancements in IOLs now allow you to choose between three different lens types: monofocal, multifocal and astigmatism-correcting. This advancement allows you to see well at all distances without the help of glasses, bifocals or reading glasses. The correct lens for you will depend on your eyes and your ophthalmologist will help you determine the most appropriate option for you.

Monofocal lens: This type of lens has only one point of focus and can usually give you clear distance vision.

Multifocal lens: This type of lens is designed to replace cataracts and correct presbyopia at the same time. The goal is to give you a full range of clear vision, near, far, and everywhere in between.

Astigmatism-correcting lens: This type of lens is for patients with existing corneal astigmatism and can usually give you quality distance vision with less dependence on glasses.

What happens if cataracts go untreated?
Over time, the clouded area of your lens will become larger and denser. Eventually, your entire lens can be cloudy and cause blindness.

Glaucoma Glaucoma is the leading cause of blindness in the United States. It refers to a group of eye diseases, many of which are caused by increased pressure in the eye. This increased pressure damages the optic nerve, which can cause blindness.

Think of your eye as a sink and the faucet is always running and the drain is always open. When the drain becomes clogged, fluid cannot leave the eye as fast as it is produced, causing the fluid to back up and intraocular pressure (IOP) to build within the eye. When the IOP builds to a high level the optic nerve gets compressed and the nerve cells become damaged and eventually die. If the optic nerve is damaged it cannot send images to the brain; and if left untreated it can result in permanent visual loss. Early diagnosis and treatment of glaucoma can prevent this from happening.

NOTE: There are several types of glaucoma; the most common is open-angle glaucoma (described above). A rarer form is acute closed-angle glaucoma--it is a medical emergency and needs to be treated immediately or blindness can result in one to two days. If you are experiencing pain, nausea, vomiting, blurred vision or seeing halos around lights, call your ophthalmologist right away.

Who is at risk for developing glaucoma?
While anyone can develop glaucoma, there are a few conditions that put you at a greater risk:
  • 45 years and older
  • Family history
  • African descent
  • Hispanics
  • People with a thin central cornea
  • Very nearsighted (myopic)
  • Systemic health problems (diabetes, migraine headaches, poor circulation)
  • Prolonged cortisone or steroid use
  • IOP above the normal range
  • Severe eye injury
  • Low blood pressure

What are the symptoms of glaucoma?
Glaucoma is referred to as "the sneak thief of sight" because usually there are no symptoms until there is irreversible vision loss. You may see perfectly, read or drive without problems. It is crucial to have your eyes checked regularly by your ophthalmologist. Early detection and treatment is important in the prevention of unnecessary vision loss. Sixy-seven million people worldwide have glaucoma, but only half of those affected may realize they have it.

How is glaucoma detected?
Regular eye examinations by your ophthalmologist are the best way to detect glaucoma. During your glaucoma evaluation, your ophthalmologist will measure your intraocular pressure, inspect the drainage angle of your eye, evaluate if there is any optic nerve damage and test the peripheral (side) vision of each eye. Photography of the optic nerve or other computerized imaging may be recommended. Some of these tests may not be necessary for everyone.

How is glaucoma treated?
Damage caused by glaucoma cannot be reversed. Eye drops, laser and/or eye surgery are used to help prevent further damage by lowering the existing IOP level. When non-surgical methods fail to decrease pressure, surgery may be required to create a new drainage channel. Filtration surgeries are designed to relieve eye pressure by removing tissue, inserting implants in the eye or a combination of both. Laser and eye surgery is typically performed as an outpatient procedure and the patient feels little to no discomfort.

Retina The retina is the nerve layer that lines the back of the eye. It senses light energy and converts this into electrical signals that travel through the optic nerve to the brain. The retina is very delicate and therefore a number of things can affect its function.

Retinal detachment

Occurs when a hole appears in the retina and it peels away from the eye like wallpaper. The retina cannot work when it is detached.

Who is at risk for retinal detachment?
Retinal detachment often occurs on its own without an underlying cause. However, it can be caused by trauma, diabetes, or an inflammatory disorder. It may also be caused by a related condition called posterior vitreous detachment.

What are the symptoms of retinal detachment?
  • Bright flashes of light, especially in peripheral (side) vision
  • Blurred vision
  • Floaters in the eye
  • Shadow or blindness in a part of the visual field of one eye

How is retinal detachment detected?
A variety of tests will be done to check the retina and pupil response and your ability to see colors properly. Retinal detachment is an urgent problem that requires medical attention within 24 hours of the first symptoms. Early detection is crucial.

How is retinal detachment treated?
The only way to repair the retina is to have surgery that finds the hole(s) in the retina and seals them. Consult with an ophthalmologist at Southgate Surgery Center for more information.



Diabetic retinopathy
This is damage to retinal vessels due to high blood-sugar levels. There are two types of diabetic retinopathy: nonproliferative diabetic retinopathy (NPDR) and proliferative diabetic retinopathy (PDR):

NPDR
In this early stage of diabetic retinopathy, tiny blood vessels within the retina leak blood or fluid. The leaking fluid causes the retina to swell or to form deposits. Many people with diabetes have mild NPDR and vision usually is not affected unless it is the result of macular edema and/or macular ischemia.

Macular edema: Swelling or thickening of the macula, due to fluid leaking from retinal blood vessels. It is the most common cause of visual loss in diabetes.

Macular ischemia: A result of small blood vessels closing. Vision blurs because the macula no longer receives sufficient blood supply to work properly.

PDR
This form of diabetic retinopathy is present when abnormal new vessels begin growing on the surface of the retina, in an attempt to supply blood to areas where original vessels closed. The new abnormal blood vessels do not re-supply the retina with normal blood flow and visual loss can occur in the following ways:

Vitreous hemorrhage: When new vessels bleed into the vitreous. If the vitreous hemorrhage is small, a person might see only a few new, dark floaters. A very large hemorrhage might block out all vision. Surgery may be recommended by your ophthalmologist if the eye does not clear the blood adequately within a reasonable amount of time.

Traction retinal detachment: When PDR is present, scar tissue associated with the abnormal new vessels can shrink, wrinkling and pulling the retina from its normal position. This causes visual distortion, but severe vision loss can occur if the macula or large areas of the retina are detached.

Neovascular glaucoma: Occasionally, extensive retinal vessel closure will cause new, abnormal blood vessels to grow on the iris and in the drainage channels in the front of the eye. This blocks the normal flow of fluid, causing pressure to build up in the eye, resulting in neovasuclar glaucoma, a severe eye disease that causes damage to the optic nerve.

How is diabetic retinopathy treated?
Laser surgery is often recommended for people with diabetic retinopathy. The main goal of treatment is to prevent further loss of vision; you should consult your ophthalmologist to determine what is right for you.



Age-related macular degeneration
This is a common eye disease associated with aging that gradually destroys sharp, central vision and may lead to a loss of vision in one or both eyes. Age-related macular degeneration (AMD) occurs in two forms:

Dry AMD: Studies suggest that an area of the retina becomes diseased, leading to the slow breakdown of the light-sensing cells in the macula and a gradual loss of central vision. Ninety percent of all people with AMD have this type.

Wet AMD: As dry AMD becomes worse, new blood vessels may begin to grow and cause wet AMD. These new blood vessels tend to be very fragile and will often leak blood and fluid under the macula. This causes rapid damage and loss of central vision in a short period of time. Although only 10% of all people with AMD have this type, it accounts for 90% of all blindness from the disease.

Who is at risk for developing AMD?
  • People over the age of 60
  • Women
  • Caucasians
  • Smokers
  • Those with a family history of AMD

What are the symptoms of AMD?
There is no pain associated with AMD, but most people experience blurred central vision, a blind spot in the middle of their field of vision, and straight lines that appear crooked.

How is AMD detected?
It is important to have your eyes examined through dilated pupils at least once a year by your ophthalmologist to help determine if you have AMD.

How is AMD treated?
Research continues to find causes and cures, but currently no proven cure exists. Good nutrition and a healthy lifestyle is a good start in protecting yourself from AMD. Research suggests that taking certain extra vitamins and minerals may slow the progression of dry AMD, but more research is needed before scientists can know for sure if it helps.

Some cases of wet AMD may be treated with laser surgery. This treatment involves aiming a strong light beam onto the new blood vessels to destroy them. Legal blindness is a common result of wet AMD and laser surgery saves what is left of the macula, but will not necessarily restore normal vision. The procedure is quick and patients experience little to no discomfort.

Retina Vitamins Macular Defense® is a natural dietary supplement developed by a team of retina specialists in the U.S. to slow the progression of age-related macular degeneration (AMD). A Michigan-based product, the formula incorporates the results of cutting-edge research and premium ingredients for the well-informed consumer.

  • Significant improvement over the original AREDS formula
  • Premium quality Lutein (FloraGLO®) and Zeaxanthin (OPTISHARP™)
  • Natural ingredients with no fillers
  • Vegetarian, Kosher, gluten- and dairy-free
  • Easy to swallow capsules
  • Made in a GMP certified lab
  • $25 for a one-month supply (60 capsules)

Where can I purchase Macular Defense®?
Right here at Southgate Surgery Center. Just ask our receptionist for a bottle. You can also purchase it online here.

Eyelid Surgery As well as having healthy eyes, complete eye health includes having healthy eyelids. Some people have eyelids that are droopy, turn inward or outward, have excess skin or prolapsed fat pads which fall over the eyelashes. These conditions make lids appear puffy or heavy and can cause eye discomfort, limit vision and affect overall appearance. Fortunately, eyelid surgery can help.

What is eyelid surgery?
Eyelid surgery is the surgical intervention that restores the lid to its natural position.

Is it covered by my insurance?
When there is visual impairment involved, most insurance companies will pay for the procedure. Ask your ophthalmologist for more information.



Ptosis (upper eyelid drooping)
Ptosis can either be present at birth (congenital) or develop with age (involutional). For those with congenital ptosis, surgery is recommended in the preschool years to make it easier for your child to see. Ptosis that develops with age may limit your side or even your central vision. If it occurs in only one eye, it may create an uneven appearance. Eyelid surgery will often time lead to better vision and improved appearance.

Excess eyelid skin
Eyelid skin is the thinnest skin of the body and as a result, it tends to stretch with age. If the skin in the upper eyelid stretches, it may limit your side vision. If this occurs in your lower eyelid, "bags" tend to form. This excess skin can be removed surgically by a procedure called blepharoplasty. It will improve your side vision and other symptoms, as well as improve the overall appearance.

Ectropion (outward turning of the lower eyelid)
Ectropion is when the lower eyelid stretches with age and causes the skin to droop downward and turn outward. Eyelid burns or skin disease can also cause this problem. Ectropion can cause dryness of the eye, excessive tearing, redness, and sensitivity to light and wind. Surgery will help to improve these symptoms.

Entropion (inward turning of the lower eyelid)
Like ectropion, entropion occurs with age. Infection and scarring inside the eyelid are other common causes of entropion. When the skin turns inward, the eyelashes and skin rub against the eye, making it red, irritated, watery, sensitive to light and wind. If entropion is not treated, an infection may develop on the cornea. Surgery will help to protect the eye and improve these symptoms.

Colonoscopy Colorectal cancer is the second leading cause of death due to cancer in the United States and someone dies from it every 9.3 minutes. If everyone aged 50 years or older had regular screening tests, at least 60% of deaths from colorectal cancer could be avoided.

What is colorectal cancer?
Colorectal cancer is cancer of the colon or rectum. The colon is the large intestine and the rectum is the passageway connecting the colon and the anus, which are both part of the digestive system. In most cases, colon and rectal cancers grow slowly over a period of several years. Most cases begin with a polyp (growth) and over time it can become cancerous. Removing the polyp early is important and may keep it from maturing into cancer.

What are the symptoms of colorectal cancer?
In the beginning stages, most people experience no symptoms, but may still have polyps or colorectal cancer and not know it. Symptoms you may experience are:

  • Blood in the stool
  • Stomach aches, pains, or cramps that do not go away
  • Losing weight and you do not know why
  • Iron-deficiency anemia
  • Change in bowel habits

Who is at risk for colorectal cancer?
  • Adults 50 years of age and older
  • People with family history of bowel disease, polyps, colorectal cancer
  • African Americans
  • People with a poor diet and/or low physical activity
  • People who smoke and/or drink alcohol excessively

How is colorectal cancer detected?
A colonoscopy is an excellent way to find polyps or colorectal cancer. The doctor uses a short, thin, flexible, lighted tube to search the entire colon and rectum for polyps or cancer. If the doctor sees any polyps or growths, he/she can remove the polyps or take a piece of the growth and test it for cancer. A colonoscopy is an outpatient procedure and the patient is given a mild sedation so there is no discomfort during the procedure.

The American College of Gastroenterology recommends a colonoscopy screening beginning at age 50. African Americans and those with family history of colon cancer should begin screening at age 45 or earlier.

Is a colonoscopy covered by insurance?
Yes, the Affordable Care Act requires new private insurers to cover preventive services with no co-payments and with preventive services being exempt from deductibles. In January 2011, Medicare will have no co-payments as well. Check with your plan to learn more.

Southgate Surgery Center accepts most insurances and is dedicated to early detection and prevention.

Why is bowel prep important before a colonoscopy?
It is extremely important that your colon be thoroughly cleaned before your colonoscopy so your doctor can see any abnormalities during the procedure. Cleansing the colon before a colonoscopy is called bowel preparation, or "prep."
It involves taking medication that causes diarrhea for the purpose of emptying the colon. The medication is taken orally and comes in liquid or tablet form. You will also need to change your diet for a day or two before the colonoscopy. Many patients feel that the bowel prep is the most difficult part of a colonoscopy.

What are the types of bowel prep and how is my prep determined?
Several types of bowel prep medications are available. Your doctor will prescribe the type that is best for you. Your medical condition is the most important factor in deciding which type of bowel prep is prescribed. Tell your doctor if you:

  • Are pregnant or breast feeding
  • Have a history of bowel obstruction
  • Have high blood pressure
  • Have any heart, kidney or liver disease now or in the past
  • Have allergies to medicines
  • Have had difficulty with a bowel prep in the past

Other factors in determining the type of prep are: the time of the colonoscopy appointment; whether the prep is covered by your medical insurance; individual preferences such taste and amount of medication. If taste is important, our patients tell us that the Miralax/Gatorade prep is flavorless and most tolerable. Be sure to discuss the options available to you with your doctor.

What bowel preparation steps are involved before the colonoscopy?
You will need to carefully follow your doctor's instructions about the exact dose and timing of your prep. In general, here is what you can expect:

  • Changing your diet at least one day before your colonoscopy
  • Limiting your diet to clear broths, beverages and gelatin desserts
  • Not consuming dairy products or non-dairy creamers
  • Not consuming red or purple beverages, gelatins and popsicles
  • Drinking more fluids than you usually do to avoid dehydration
  • To follow carefully all the steps your doctor prescribes
  • To tell your doctor what medications you are taking

What medications interfere with bowel prep and/or colonoscopy?
Be sure to talk with your doctor about what you can and cannot take. Most medications can be continued, but these medications may interfere:

  • Aspirin products
  • Arthritis medications
  • Anticoagulants (blood thinners such as warfarin or heparin)
  • Clopidogrel
  • Insulin
  • Iron products

What are the common side effects of bowel prep?
The type and severity of side effects differ among patients. They also vary with the product used. Some patients have nausea, vomiting, bloating (swelling in the abdomen) or abdominal pain. A prep can cause kidney failure, heart failure or seizures, but this is rare. Your doctor will explain the possible side effects of the prep selected for you.

What if I forget to take the medication when I should or remember too late to finish the prep?
Call us and ask what to do if you are not able to complete the bowel prep as advised.

IMPORTANT REMINDER: This information is intended only to provide general guidance. It does not provide definitive medical advice. It is very important that you consult your doctor about your specific condition.

Source: American Society for Gastrointestinal Endoscopy

EGD & ERCP Esophagogastroduodenoscopy (EGD) is a procedure that allows a physician to view the esophagus, stomach and first part of the small bowel (duodenum) through a scope. The patient's throat is numbed and they are given mild sedation so there is no discomfort during the procedure.

Why would I need an EGD?
An EGD is an excellent way to view specific areas and better evaluate or detect problems. It may be helpful in diagnosing ulcers, gastritis, growths, GERD, Barrett's Esophagus, causes of bleeding or pain and cancer. It may detect the presence of pylori, a type of bacteria that causes ulcers. During an EGD a sample of tissue (biopsy) may be taken, foreign objects or growths can be removed, bleeding can be stopped and narrow areas (strictures) can be opened.

When should I get an EGD?
If you are experiencing any of the following symptoms your doctor may recommend an EGD:
  • Nausea
  • Vomiting
  • Heartburn
  • Chronic acid reflux
  • Difficulty or pain swallowing
  • Unexplained anemia
  • Upper gastrointestinal bleeding

NOTE: Symptoms such as a little heartburn may not seem like a big deal, but it is crucial to seek a doctor's advice. Something more severe could be going on, like damage to your stomach or esophagus.

Is an EGD covered by insurance?
Many insurance plans and Medicare cover EGD screenings. Check with your plan to find out if it is covered for you.

Southgate Surgery Center accepts most insurances and is dedicated to early detection and prevention.

What is gastresophageal reflux disease (GERD)?
GERD is a more serious form of gastroesophageal reflux (GER), also commonly referred to as acid reflux. GER occurs when stomach contents rise into the esophagus, causing a burning sensation in the chest or throat called heartburn. Occasional GER is common, but when reflux is persistent and occurs more than twice a week, it is considered GERD and can eventually lead to more serious health problems.

GERD can occur in people of all ages and those experiencing symptoms should consult a physician. If left untreated, it can lead to complications such as a bleeding ulcer. Scars from the tissue damage can lead to strictures (narrowed areas of the esophagus) and this makes swallowing difficult. GERD may also cause hoarseness, chronic cough and conditions such as asthma.

What is Barrett's Esophagus?
Barrett's Esophagus is a condition in which there is an abnormal change in the cells of the tissue lining of the esophagus.

No signs or symptoms are associated with Barrett's Esophagus, but it is commonly found in people with gastroesophageal reflux disease (GERD). A small number of people with Barrett's Esophagus develop a rare but often deadly type of cancer of the esophagus.

While the average age of diagnosis is 50, determining when the problem started is usually difficult. Men are twice as likely to develop Barrett's Esophagus and Caucasian men are at a higher risk than men of other races. Since Barrett's Esophagus is more commonly seen in people with GERD, it is crucial to manage and improve symptoms of GERD if you are affected by it, which may lower the risk of developing Barrett's Esophagus.

Barrett's Esophagus can only be diagnosed by having an EGD performed. Since it does not have any symptoms, it is recommended that adults 40 years and older that have had GERD for a number of years have an EGD regularly to check for the condition.



Endoscopic retrograde cholangiopancreatography (ERCP) is a technique in which the gallbladder, bile ducts and pancreatic ducts are injected with x-ray dye and radiographic pictures are taken. When these x-rays reveal stones or obstructions, they can often be treated during the same ERCP examination. Thus, ERCP is a useful method for both diagnosis and treatment.

Why would I need an ERCP?
The gallbladder, bile ducts and pancreas can develop a number of disorders, due to factors related to diet, environment and heredity. These disorders can develop into a variety of diseases and/or symptoms and an ERCP can help diagnose and often treat the condition. An ERCP is used for:
  • Gallstones
  • Blockage of the bile duct
  • Jaundice, which turns the skin yellow and the urine dark
  • Upper abdominal pain
  • Inflammatory strictures (scars)
  • Leaks (from trauma and surgery)
  • Cancer of the bile ducts or pancreas
  • Pancreatitis (inflammation of the pancreas)

Varicose Veins Varicose veins affect 1 out of 2 people age 50 and older. Varicose veins are enlarged veins that are swollen and usually have a ropey appearance. They develop when valves in the veins that allow blood to flow toward the heart stop working properly causing blood to "leak" backward. As a result, blood pools in the veins and causes them to get large. This condition is called reflux disease.

If left untreated, varicose veins usually enlarge and worsen over time. Severe varicose veins can cause health problems including life-threatening blood clots.

Symptoms of varicose veins:
  • Pain, aching, cramping
  • Heavy feeling
  • Swelling
  • Burning and itching of the skin
  • Restless legs
  • Skin discolorations
  • Open sores

NOTE: Vein disorders are not always visible but the symptoms may be there. That is why it's important to see your doctor if you suffer from any of the symptoms.

The Closure® procedure
Using ultrasound as a guide, a tiny catheter is guided into the vein. The catheter delivers radio frequency energy to the vein wall. As the energy is delivered and the catheter is withdrawn, the vein wall is heated, causing the collagen in the wall to shrink and the vein to close. Once the diseased vein is closed, blood is re-routed to other healthy veins.

Benefits of the Closure® procedure
  • Covered by most insurance including Medicare (certain criteria may be required)
  • Many patients notice an immediate relief of symptoms
  • Resume normal activity within a day
  • Performed as an outpatient procedure
  • Treatment is less than one hour
  • Good cosmetic outcome with minimal to no scarring, bruising, or swelling
  • 97% reflux free after 1 year

Hemorrhoids Having hemorrhoids can be an embarrassing and painful experience and discussing it with your physician may be uncomfortable, but it's important to know it is a medical condition that affects 80% of Americans at some point in their life. Immediate relief from the discomfort associated with hemorrhoids is available using infrared coagulation.

What are Hemorrhoids?
Hemorrhoids are enlarged, bulging blood vessels in and around the anus and lower rectum. External hemorrhoids develop near the anus and are covered by very sensitive skin. If a blood clot develops in one of them, a painful swelling may occur.

External hemorrhoids feel like a hard, sensitive lump and can bleed if it ruptures.

Internal hemorrhoids develop within the anus beneath the lining.

Common symptoms include painless bleeding and protrusion during bowel movements. Internal hemorrhoids can cause severe pain if they protrude from the anal opening and cannot be pushed back inside.

What causes a hemorrhoid?
The exact cause is unknown, but contributing factors include:
  • Aging
  • Chronic constipation or diarrhea
  • Pregnancy
  • Heredity
  • Faulty bowel function from the overuse of laxatives or enemas
  • Spending long periods of time on the toilet (ex: reading)

What are the symptoms?
  • Bleeding during bowel movements
  • Protrusion during bowel movements
  • Itching in the anal area
  • Sensitive lump(s)

NOTE: Symptoms of hemorrhoids are similar to those of colorectal cancer and other diseases of the digestive system. It is important to investigate all symptoms and seek your doctor's advice. Do not rely on over-the-counter medications or other self-treatments. It is crucial to properly evaluate your condition and seek a doctor's advice for treatment.

What is infrared coagulation (IRC)?
IRC is a non-surgical hemorrhoid treatment that has been performed since 1984 and is safe, effective and virtually painless. A small probe contacts the area above the hemorrhoid and the area is quickly exposed to a burst of infrared light. This cuts off the blood supply to the veins supporting the internal hemorrhoid causing it to shrink and recede. This procedure is performed in an area that is lacking pain sensing nerves; as a result there is no pain.

Benefits of IRC:
  • 10 minute procedure
  • No anesthesia needed
  • No special preparation required
  • No medications or creams
  • Done in an outpatient setting
  • Return to your normal routine the same day
  • Hemorrhoids treated with IRC generally do not recur

Is this covered by my insurance?
Yes, most insurances including Medicare will cover IRC procedures.

Pain ManagementAccording to the American Pain Foundation, chronic pain affects more people than diabetes, heart disease and cancer combined and is a leading cause of disability in the United States. Over 76 million Americans are suffering from chronic pain and 70%-85% of adults have it at some point in their lifetime.

What is chronic pain?
Chronic pain is defined as pain lasting longer than three months or pain persisting beyond the reasonable amount of time to heal. Various factors may cause chronic pain including accidents, post-op/surgery, childbirth, chronic diseases such as arthritis, cancer, musculoskeletal or neurological disorders. Chronic pain affects all aspects of a person's life including daily activities, family life, work, leisure-time, sleep patterns and mood.

What is pain management?
Pain management is a type of specialized medical care designed to reduce the burden of chronic pain and helps patients enjoy greater quality of life. The doctor strives to find the best balance of medicine and minimally invasive procedures for the most significant relief for your unique needs. Patient feedback is integral to effective pain management, and when needed, your doctor will "fine-tune" your medicine and/or treatments to obtain the best results possible.

Where does pain management begin?
Pain management begins with a consultation. During your initial consultation the doctor will examine you and talk to you about the chronic pain you are experiencing and the history of your symptoms and previous treatment, if any. Also, the doctor may perform diagnostic testing to pinpoint the source of your pain. If you have recent testing reports (MRI, x-ray, CT scan, bone scans, etc.), you may not be required to have new testing done. If testing is necessary, we will help you locate a testing facility if needed. After consultation, the doctor will use this analysis to create your individualized treatment plan.

Medication:
Medication is an important aspect of pain management. Everybody experiences different pain tolerance, sensitivities and ideologies about medicinal treatments. The doctor will assess the best approach for the full-spectrum of your needs. It is important to take medications as prescribed and if you find that your medication is not adequately alleviating your pain or you are experiencing unusual side effects, contact your doctor immediately to reassess your treatment plan. Also, because pain management medications can be habit-forming, we are cautious in our prescribing practices.

Procedures:
Minimally invasive procedures while you are under anesthesia, could include:

Epidural or transforaminal injections of the neck (cervical), upper back (thoracic) or lower back (lumbar ) spine and facet joint regions. A steroid medication is injected which can anesthetize these areas and block the pain.

Radiofrequency ablation. A small needle is inserted into the area where you are experiencing pain. Using x-ray guidance (fluoroscopy), your doctor will guide the needle to find the target area of pain. A microelectrode is then inserted through the needle to begin the stimulation process which creates a mild tingling sensation. Once the needle and electrode placement are verified, a radiofrequency current is sent through the electrode into the surrounding tissue, interrupting the pain signals from the brain.

Medial branch block. Using x-ray guidance (fluoroscopy), your doctor will guide a very small needle over the medial branch nerves to target the area of pain. Several drops of contrast dye are then injected to confirm that the medicine only goes over these medial branch nerves. Following this confirmation, a small mixture of numbing medicine will then be slowly injected onto each targeted nerve.

Peripheral nerve blocks are injections of a local anesthetic or steroid medication into or near a peripheral nerve (located outside of the brain and spinal cord) to prevent pain signals from reaching the brain. Peripheral nerve blocks can be performed as a single injection or series. This pain management procedure may relieve pain from several hours to several months. In many cases, peripheral nerve blocks are performed together with a broader rehabilitation program.

Spinal cord stimulator trials. Using local anesthetics with the help of a needle through a small incision near the spinal cord, your doctor places one or more electrodes that prevent pain signals from reaching the brain. By feeling where the stimulation blocks pain, you help your doctor determine where the electrodes are placed.

Botox® injection therapy. Botox® is the brand name for botulinum toxin type A, a purified protein produced from a toxin that causes food poisoning. This injectable medication is safe when properly administered by your doctor. Botox® works by reducing the amount of neurotransmitters in your body to relax your muscles. Similarly, these injections dull the nervous system, producing a pain-killing effect. It is used for managing migraine and neck pain.