Back in Bloom

Ablation relieves lumbar arthritis, allowing return to garden sanctuary.

In early April, not long after the coronavirus began to spread wildly across the United States, the National Institutes of Health launched a study to determine how many people became infected with the virus before anyone really knew what it was.

Photo by Nerissa Johnson.

Robert Palmer

For more than 12 years, guiding the NIH through its decision to launch such studies was a task that belonged to Robert Palmer, who once owned a consulting firm that specialized in organizational development in the Washington, DC, area.

“My specialty was working with not-for-profit and large multinational organizations,” Robert says. “If they had a pain point, they’d contact me, and I’d go in, diagnose the problem, figure out how to fix it and then help them do it.

“During my career, I was fortunate to work with many of the agencies inside the United Nations, including the World Health Organization and the National Institutes of Health, which was my biggest client for about 12 years.”

While advising a smaller client, Robert visited Florida for the first time some 20 years ago. He loved the climate so much that he moved here shortly thereafter, but life in the Sunshine State has not always been sunny for this active 76-year-old retiree.

Twice in the past 12 years, he has been badly injured in accidents that occurred while riding his bicycle. The first incident resulted in Robert undergoing neck fusion surgery. The second resulted in work being done on his lower back.

Throw in that arthritis has developed throughout his spine since the accidents and he has suffered from migraine headaches since childhood, and Robert has spent most of the past decade in debilitating pain.

“I had to give up riding a bike because it actually made my back worse,’’ Robert explains. “Because of the vibration and the jarring movement that came with riding a bike, I’d finish up a ride and just be miserable afterward.

“There were times when the pain was so bad that I almost couldn’t walk and a couple of times when I wound up in the emergency room because the pain was so bad that I couldn’t sit or stand or even lie down. Thankfully, I have a high tolerance for pain, because I’ve really had to just kind of learn to function with the headaches and back pain.”

But a functional life is not the same as a rewarding life. As a result, Robert has continually sought relief for his pain. He finally found it at McGreevy NeuroHealth, the St. Augustine practice of Kai McGreevy, MD, DABPN, RPVI.

A board-certified neurologist and interventional pain management specialist, Dr. McGreevy also has an office in Palm Coast. Robert discovered Dr. McGreevy through his primary care physician shortly after McGreevy opened his practice several years ago.

“When Robert came to us, he reported localized pain in his spine, particularly in his lower back,” Dr. McGreevy recalls. “The pain was worse in the morning and was associated with stiffness and rigidity of the spine.

“Robert’s low back pain became worse with extension and rotation of the spine. It eventually became so severe that it limited his walking and, ultimately, his ability to function on a daily basis.”

Dr. McGreevy began his evaluation with a complete neurological evaluation, including an MRI of Robert’s back. Dr. McGreevy determined Robert suffered from lumbar spondylosis, a wear and tear of the joints of the lower spine due to osteoarthritis.

“Robert’s MRI confirmed that his issue was with his lumbar facet joints,” Dr. McGreevy says. “This is an extremely common problem, one of the most frequently seen in our neurology and pain management clinic.

“Low back pain is one of the most common reasons patients visit their primary care physicians and is a leading cause of disability in the United States.”

After examining Robert, reviewing his imaging and performing diagnostic testing, Dr. McGreevy decided that a procedure called radiofrequency ablation, or RFA, was the best option for relieving his low back pain.

The Best Fit

RFA has long been used to treat arthritis pain, and pain management specialists have tailored it to treat pain patterns radiating from the low back into the pelvis and hips, or into the legs and feet. RFA treatment can be customized to address various pain syndromes and symptoms.

Photo by Nerissa Johnson.

RFA treatments allowed Robert to resume his active lifestyle.

“What is unique about radio-frequency ablation is that it does not involve steroids, it is long-lasting and it can treat multiple problems at once,” Dr. McGreevy notes. “In Robert’s case, we are able to treat his low back pain simply by targeting the appropriate lumbar nerves.”

Before proceeding with RFA, Dr. McGreevy conducts a diagnostic nerve block, also called a medial branch block, which is an injection of pain-relieving lidocaine under local anesthetic. The purpose of the medial branch block is to confirm that the pain is being generated by the suspected joints and nerves. It proves the suitability of RFA as a treatment.

“Robert received dramatic pain relief, greater than 80 percent, following each diagnostic injection,” Dr. McGreevy recalls. “That allowed us to proceed with radiofrequency ablation as a definitive treatment for his lumbar arthritis.”

RFA is often used for patients who have not received sustained pain relief from other treatments, including epidural steroid injections, facet joint injections and nerve blocks. In many cases, RFA is the best fit to improve patients’ pain, range of motion and quality of life.

RFA is a minimally invasive, nonsurgical, outpatient procedure during which patients remain awake but are lightly sedated to minimize discomfort and reduce anxiety. Doctors consider it highly effective in temporarily reducing the type of severe back and neck pain that plagues nearly two-thirds of the world’s population.

During RFA, radio waves are used to produce heat that is delivered through a probe to a group of specified spinal nerves. The heat creates a lesion, or wound, on the nerve tissue that interferes with the transmission of pain signals to the brain, thereby reducing discomfort in the troubled area.

“There are many chronic pain conditions that respond well to radiofrequency ablation,” Dr. McGreevy asserts. “These include spinal arthritis and spine degeneration, as well as pain after spine surgery.”

Dr. McGreevy details the RFA procedure: “When we are doing the radiofrequency ablation, the patient lies on a table on his or her belly, and an x-ray camera is used to take pictures of the region we are working on,” he describes. “That is how we can see all the landmarks we need to safely perform the procedure.”

A local anesthetic is then administered to the skin and deeper tissues to provide comfort so that a needle can be inserted and directed toward the targeted nerves. When the needle is precisely positioned, a stylet is pulled out of the needle and replaced by a thin probe.

“The probe is directed to the targeted nerve, and a radiofrequency generator is turned on,” Dr. McGreevy continues. “That generator provides 120 seconds of radiofrequency waves, or energy, that are delivered to the targeted nerve and create the lesion that cauterizes the nerve.”

When the nerve is cauterized, it can’t send pain signals, so nothing is received and interpreted by the brain. Subsequently, no return message to feel pain is sent back to the affected area of the body.

By targeting and damaging the specific nerves responsible for carrying pain signals, RFA can effectively reduce or eliminate a patient’s pain for a few months or even years.

“Using radiofrequency ablation, Robert received substantial relief from his low back pain that lasted approximately 12 months,” Dr. McGreevy reports. “Sometimes, the facet nerves grow back slowly, and if the pain returns in the same fashion but not to the same degree, we can repeat the procedure. We’ve treated Robert several times over three years.”

Garden Sanctuary

For nearly 12 years, Robert lived with back pain from spinal arthritis that began following his bicycle accidents. But he says that he feels better now than he has in a long time.
“That’s absolutely true,” he agrees. “And my treatment is on a schedule now. About the time that the RFA wears off, it’s time to go back.”

Without the back pain, Robert can participate in his favorite hobby, which is gardening, without restriction.

“Dr. McGreevy surrounds himself with good people, which is why I’ve sent a number of people to him.” -Robert

“I have a gorgeous garden,” he boasts. “Everyone in town knows about it. Because this is a tourist town, many people walk by my garden and ask questions such as, What’s that blooming? And I let them take pictures.

“My garden is a sanctuary of sorts for butterflies, bees and hummingbirds. I provide whatever they need to thrive. Take butterflies, for example. The adults need nectar flowers to feed on but a different kind of plant to lay their eggs on. When the eggs hatch, they feed on those plants before they turn into a chrysalis and become butterflies.”

Robert is grateful to Dr. McGreevy and his staff and is quick to recommend the doctor and his practice to others needing the care of a pain management specialist.

“Dr. McGreevy is young and knows about all the new research,” Robert describes. “Today’s treatments are very advanced. There are options available now that never existed 20 or 30 years ago, and Dr. McGreevy is on top of all of it.

“And he’s a nice guy, too. He has a nice bedside manner. He also has a great staff at McGreevy NeuroHealth. They’re all very well-trained, so it’s not just him. Dr. McGreevy surrounds himself with good people, which is why I’ve sent a number of people to him.”

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