• By: Linda Hurtado

Linda Consalvo is a yoga instructor who helps her students learn how to listen to their own bodies. “People have an idea of what they think yoga is, and they don’t think they can do whatever their image is, like standing on their head.”

Linda says a non-aggressive form of exercise is not difficult and is excellent for many who suffer from back pain.

But today, Linda is the one taking instruction in Stacy Rinz’s yoga therapy class, because Linda came to yoga as a way to stop her own excruciating pain.  “I began having back problems 25 years ago when I herniated a disk in my back and I received chiropractic care for many years and did relatively well, then I ruptured a disk and I was in excruciating pain.”

Linda says yoga saved her. “I’ve gotten back my active lifestyle. I work out. I do cardio. I work out with weights.”

Doctor Sara Rizk explains how yoga and other forms of non-aggressive exercise like Tai Chi work on the back. “It’s actually strengthening the core muscles. When you straighten them, those muscles take pressure off your spine.  Research has shown that’s actually one of the best treatments for back pain — taking pressure off the spine. It also helps with posture, balance, alignment, and with relaxation because stress is a big problem.”

Doctor Rizk actually writes prescriptions to her patients for yoga and Tai Chi, and even has some classes at her work place. “We can monitor them and see who is benefiting from it and who needs to hold off until they heal a little more and we follow them to make sure they aren’t getting worse, but actually getting better.”

You can take Tai Chi or yoga classes anywhere in our viewing area, but ask and make sure the instructor is properly trained and let your physician know first.

Start to Finish Spine Care
431 Southwest Blvd. North
St. Petersburg, FL 33703

(St. Petersburg, Fla.) January 13, 2010 – You’re only 47 years-old. You’re fairly healthy, with no severe medical issues. You’ve never been in an accident or experienced serious injury. Yet, you lay in bed having your meals fed to you because it’s too excruciating to move your body beyond the distance of your bedroom to your restroom. This was Christine Barone’s life. An average 47-year-old, East Lake resident who would have done anything to have the quality of her life back.

It all started nearly six years ago when Barone, a front-office supervisor to a medical practice, experienced relentless back aches. “I would lay flat in bed, icing myself 24-7,” said Barone. No car accident, work injury or fall caused this pain. For Barone, it was purely and unfortunately – bad luck of the draw. “Christine was diagnosed with degenerative disc disease (DDD) of the spine, which can be extremely painful,” said her treating physician, David McKalip, M.D. neurosurgeon of the brain and spine of Start to Finish Spine Care in St. Petersburg. DDD can be a normal part of aging and for most it does not cause a problem. However, for other individuals, the outcome can be chronic, immensely affecting one’s quality of life. In some cases DDD can be treated with physical therapy, osteopathic manipulation or anti-inflammatory medications.

“I was desperate,” she said. Barone even tried spinal injections, which helped for a little while. “Spinal injections are best described as pain-reducing medicines that go to the source of the pain,” said McKalip. From epidural steroid injections and cortisone shots to nerve root blocks – depending on the situation, any of these can help. Barone had two injections, which alleviated her pain for a while but she spent most of her time “ignoring the pain,” and ignoring her quality of life.

It wasn’t long until Barone was bedridden. The pain had spread to her ankle and she was not able to put any weight on her leg without experiencing unbearable pain. “Christine’s MRI scans truly revealed the extent of her pain,” said McKalip. Without hesitation the team at Start to Finish Spine Care ordered Barone back in immediately to undergo surgery. “I am a very conservative doctor,” McKalip said to Barone, “I look at all possible alternatives to treatment before surgery. But in this case surgery is a must.”

Like most people, Barone was nervous with the haste in which surgery was required. “Dr. McKalip said if it were his family, he would tell them to get surgery. I knew I was in good hands. He told me exactly what I was going to experience,” she said, “when surgery was over, like clockwork – everything I was told happened.” Knowing surgery was always her physician’s last approach, Barone went into the OR 24 hours later. Barone was hesitant to anesthesia, having bad reactions in the past, yet this time, she went to sleep easily and woke-up a new woman.

“The first thing I did after I woke-up from surgery was move my legs… just to make sure,” she says with a laugh. “I couldn’t believe it. The pain was completely gone.” Barone was asked countless times from the medical team if she had any pain and her answer was the same. None. “The team treated me like family. They wondered if I was just in euphoria but I am telling you, I was up and ready to go the next day. Two hours after surgery, I got-up and walked myself to the restroom,” Barone said proudly.

“It’s like a miracle,” she said, “I have a new lease on life. That kind of pain was brutal and it left me wondering what my life would be like. It was awful before. I don’t cry easy but when I saw Dr. McKalip, I just started to cry. I had to give him a hug. It was amazing what he did for me.”

Like she was told by the medical team, every day Barone was able to regain the quality of her life back more and more. Before her procedure, she wasn’t able to turn her neck; by week three, she was brushing her hair – just as the doctor told her – on schedule.

With her new lease on life, Barone has pledged to embrace the quality of her life by exercising more and building her core strength as she was advised by her medical team. “I couldn’t be happier for Christine and her amazing improvement. She was a trooper in and out of the procedure. Her positive attitude and spunk for life was also her saving grace,” said McKalip.

About Start to Finish Spine Care: Start to Finish Spine Care is a revolutionary concept in spine care – a comprehensive, multidisciplinary facility where recovery is sought quickly and all under one roof. With medical spine management, manipulation, physical therapy, spinal injections and a spine surgeon all in one location, whatever a patients’ spine care needs may be, Start to Finish Spine Care maps the road to recovery from start… to finish. Start to Finish Spine Care specialists consist of founder and neurosurgeon, Dr. David M. McKalip, physical medicine and rehabilitation specialist, Dr. Sara Rizk, Hartley Physical Therapy and Fitness and Dr. Michael Solomon for advanced medical spine management. Start to Finish Spine Care is located at 731 Southwest Blvd. N. in St. Petersburg, FL 33703. For more information, visit www.StartToFinish.com or call 727-822-3500.

Most commonly a “pinched nerve” refers to pressure on a nerve in the spine of the neck or the lower back.  The nerves start as microscopic cells in the brain or at the ends of the tissues like the skin, tendons or joints.  They travel in and out of the brain through the spinal cord and enter the spinal cord as nerve roots.

A nerve is typically pinched if it exits the spine. Pinching can occur from a disc that is bulging or herniated, an overgrown joint or thickened ligament.  This typically causes pain and symptoms that travel in very discrete patterns. For instance, a nerve pinched by a disc herniated at C5/6 on the right will nearly always cause pain, numbness and tingling into the thumb and index finger and sometimes weakness in the biceps of the arm or a particular forearm muscle.

The good news first – most pain from a pinched nerve goes away by itself, WITHOUT SURGERY! The goals then are to:

1. Make sure you get an accurate diagnosis from a doctor to ensure this is a not a dangerous problem.
2. Treat the pain and help you remain as functional as possible while you heal on your own.
3. Help you develop a spine fitness program to prevent further occurrences in the future.

In rare cases, surgery will be needed but it should only be as a last resort or for special circumstances that permanently endanger your nerve function.

Getting an Accurate diagnosis – are you seeing a doctor, or a nurse?

The first step is to get an accurate diagnosis – what is the cause of your pain? Is it really a pinched nerve? Is it coming from the spine, the brain or the nerves in the arms or legs? Could there be something growing outside your spine, or an infection? A visit with an experienced doctor is designed to answer these questions. At Start To Finish Spine Care, you will see a doctor first. On your first visit, you will see a spine specialist who will spend 45 minutes with you to understand your medical history and make sure you are safe. At most other spine clinics, you will often see a nurse for 95% of your visit and a doctor will spend perhaps 5 minutes with you. That is the difference between other spine clinics and Start to Finish Spine Care.

Nurses and physician’s assistants are not trained, experienced or able to make an accurate diagnosis and come-up with a treatment plan for you. Nor is this position able to ensure ruling out the more rare causes of pain that may be more serious. Make sure you see a doctor who spends their time with you. You are paying the same – why not get the best? Even better, you can usually get an appointment to see an experienced spine specialist within a few days or the same day at Start to Finish Spine Care. Such a quick visit with a specialist is a rarity these days (except at Start to Finish Spine Care).

The doctor will work with you to determine if you need specific tests to help diagnose your problems, such as an MRI, and will then order them and have you come back into the office to explain the results. Many times, extensive and expensive testing will not be needed and can be avoided. This is helpful in times when more and more health costs have to be paid for out of your own pocket. No nurse is going to be able to give you sound advice when it comes to picking the right test and no doctor who spends 5 minutes with you will do it as well as one that spends the entire visit with you.

Treating your pain – without surgery in 95% of cases.

Once you get your diagnosis  – what can be done to help ease your pain – without surgery?

After your spine specialist ensures that there is no danger requiring urgent surgery, there are many options that can help.  First are basic medications like prescription strength versions of drugs like Motrin (called “NSAIDS” – non-steroidal anti-inflammatory drugs).  Muscle relaxants can help, as can mild narcotic pain medications.  Narcotic pain medication must be used with extreme caution and should be used only temporarily when other methods do not work.

Physical therapy is a critical part of recovery to ensure that muscles and joints remain functional and moving.  Pain may cause us to internally splint certain joints so they don’t move. That is a phenomenon that must be guarded against.  Physical therapy can help get the spine moving again and can also help with local pain treatments like deep heat, massage, ultrasound and electrical stimulation.

The spinal muscles of the low back and neck may also spasm or become inactive. This is where “osteopathic manipulation” can come in. The spine can be mobilized by a trained physician with experience in treating patients with pain.  The lining of the muscles may need to be released (“myofascial release”) and certain joints mobilized so they don’t “lock up” and cause further problems.  Our start to Finish Spine Care Osteopathic physician, Dr. Rizk, can help with spinal manipulation to relieve neck, back, arm and leg pain while the body works to heal itself.

When pain is very severe or not decreasing quickly enough, spinal injections may be the next best step.  Small doses of steroids (“cortisone shots” ) can be delivered with great precision right onto the lining of an effected nerve or into a joint lining or ligament that has swollen and is pinching a nerve.  These procedures can be done in minutes in our spinal injection suite right at Start To Finish Spine Care.

In rare cases, surgery will be needed early, or if symptoms are not gone in 6-8 weeks.  At Start to Finish Spine Care, experienced Spine Surgeon, Dr. David McKalip is rapidly available to Dr. Rizk who can consult with him if there is a concern that a surgical visit is needed quickly. During surgery, microscopic-size incisions are made to make a small tunnel to the spine and allow the pressure on the nerve to be relieved. Simple cases can be done in 45 minutes and require a brief stay in the hospital with discharge the same day. More complex cases may require more time and a longer stay.

Keeping your Spine in Shape

So you have gotten through your episode of having a pinched nerve and you never want to go through that again. What now?  It is time to make sure your spine is well supported and our team at Start to Finish Spine Care will help you devise a plan to keep your spine in shape. That means working with the Physical Therapy Department to develop a Home Exercize Program. Perhaps you need multiple physical therapy visits to focus on particular problem areas.  It is vital to develop a program that meets multiple goals:

1. Strengthen the muscles that support the spine in the abdomen, back and in the fronts and backs of the legs.
2. Improves posture by focusing on exercise, balance training and perhaps through osteopathic manipulation to mobilize joints and muscles.
3. Promotes weight loss to allow a lower stress on the spine.
4. Restore as much lost function as possible from weakness or numbness from any past pinched nerves.

Sometimes it is hard to keep up with a home exercise program, which is why Start to Finish Spine Care is working with partners who offer onsite exercise programs right on the lot next to our building.  Classes now include Tai Chi and basic and advanced Chinese martial arts instruction such as Chi Gong, Ba Gua Zhaung  and Shao Lin Kung Fu.  We are working on bringing partners for Yoga and traditional calesthenics as well.

A pinched nerve can be a painfully memorable experience that can limit function for at least a few weeks.  At Start to Finish Spine Care, we will be there to help you get a diagnosis from a doctor, develop a treatment plan and develop a spine fitness plan to keep you from having repeat episodes in the future.

Call today for an appointment and we will get you in, usually within a few days.

Spine surgeons must take all possible measures to decrease infection rates among their patients and produce the best outcomes. Infections can occur for various reasons and when an infection does occur, it takes more time and effort from the patient and the surgeon to resolve, which may or may not be reimbursed. “If you’re not meticulous with sterile technique, you can get in trouble,” says Donald Corenman, MD, of The Steadman Clinic in Vail, Colo. “Prevention is absolutely key because dealing with infections is a tremendous amount of work and it really sets the patient back.”

Here are seven ways spine surgeons can decrease the risk of infection in their practice.

1. Strict patient selection. Infection rates are usually higher when procedures are performed at university and teaching hospitals because patients are generally sicker when undergoing surgery there, says Dr. Corenman. Be aware of the patient’s chronic conditions, such as autoimmune deficiencies ore diabetes, and take the appropriate precautions against infections. “If a patient is chronically ill, work extra hard with the primary care physician to make sure the patient is ready for the procedure,” says David McKalip, MD, a neurosurgeon practicing in St. Petersburg, Fla. The surgeon can also consider different types of operations for chronically ill patients, such as choosing an anterior instead of posterior procedure for a diabetic patient.

2. Screen for infections. Whenever possible, spine surgeons should only allow patients to undergo surgery if they are free of infection. “Insist that all cultures are negative 2-4 weeks preceding the surgery,” says Dr. McKalip. This includes screening all infections, such as bladder or kidney infections, and taking blood cell counts. Naturally, if the patient needs emergency surgery, these measures cannot be taken and surgeons must rely on other precautions. “If the patient isn’t the best candidate for surgery, you have to do everything you can to prevent their risk for infection,” says Dr. Corenman.

3. Limit the number of people in the OR. Don’t allow extra people, such as students or device company representatives, in the operating room unless it is absolutely necessary, says Dr. Corenmen. Even though students and representatives understand that certain areas of the operating room are sterile, they are undereducated and might not completely understand sterile technique. “There are areas around the patient that should be bacteria-free,” says Dr. Corenman. “But if someone brushes against a bacteria area and then handles the instruments, they can spread infections that way.”

4. Administer pre-op and post-op antiseptics. While some studies recommend against using antiseptics, other studies and physicians strongly promote their use to decrease the risk of infection during surgery. Antiseptics should be administered one hour before surgery and continued for three days after surgery, says Dr. McKalip. Surgeons can also advise that the patient take antibiotics in certain situations after the operation, such as before receiving dental work, says Dr. Corenman.

5. Take precautions during post-op period. Making sure to employ good wound care after the surgery is essential for further decreasing the rate of infections in spine surgery patients. Inflammation in the wound indicates there might be a problem which should be addressed immediately. The patients should be monitored closely when surgeons use dissolvable sutures to make sure there is no inflammation.

6. Follow the Halstead’s principles. Spine surgeons should be familiar with the Hallstead principles for preventing infection and they should be careful to implement the principles during every surgery, says Dr. McKalip. These principles include good haemostasis, eliminate deadspace, anatomic dissection of tissues, use non-irritating suture material, avoidance of tension and strict asepsis during procedure preparation.

7. Trust the sterilization department. Whether the physician is working through a hospital or ambulatory surgery center, the spine surgeons must ensure the facility has a good sterile processing department, says Dr. Corenman. Surgeons need to make sure everyone around them is taking steps to prevent infection. “There is a whole laundry list of stuff you have to get after. You have to make sure your staff is on the same page,” says Dr. Corenman. Surgeons should communicate with their staff and sterilization department for the best results. “It helps if the OR staff does a pre-cleaning process by spraying down the instrumentation with an enzyme spray,” says Jerzy Kaczor, BSBA, MBA, a sterile processing consultant with Soyring Consulting. The spray will begin breaking down the enzymes and make the sterilization process easier.

The sterilization staff should also be familiar with the assembly trays and know which pieces of equipment might need special treatment, says Mr. Kaczor. Some spine instrumentation is delicate and can break if another instrument is on put top of it during sterilization. All the equipment for a tray should be kept together in facilities dealing with sterilization for multiple spine trays at once. “The department should have a set list of each item and a description of the instrumentation to tell you what goes in each specific tray,” says Mr. Kaczor. “Keeping the trays together is more efficient because after sterilization you don’t have to go through looking for specific items.”