Pain Free at Last

Minimally invasive procedure provides long-sought relief.

Included in the 18 years Michael Herman spent serving his country in the US Army were several harrowing days during which the former buck sergeant had a front row seat for some of the largest tank battles of the First Gulf War in Iraq.

“We were connected to a tank unit because we hauled ammunition,” Michael says of the 15-man squad he led. “We were no more than twenty yards from some of those tanks at times, and let me tell you, it was like the Fourth of July out there.

Former Army sergeant Michael Herman finally found a solution for his neck pain at Advanced Orthopedic Center.

Michael Herman

“We were right there where everything was going on all the time because we had to move the ammunition, which made us a big target. If we had ever been hit, you can’t imagine the hole it would have created in that desert.”

Michael didn’t make it out of the war unscathed. He is permanently disabled now with post-traumatic stress disorder (PTSD), and he continues to fight a number of other health issues. For years, one of those was chronic neck pain and weakness in his left arm.

“I carried that one around for a long time,” Michael confirms. “I used to just fight through it, but I’m fifty-nine now, and I recently reached a point where the pain and weakness was too much to ignore, so I decided, I’ve got to get this fixed.”

The fix Michael eventually settled on was surgery to relieve a pinched nerve. That surgery was performed in March 2015 and was considered successful because it alleviated the weakness and pain Michael was experiencing in his left arm, It did not permanently relieve Michael of the pain he was experiencing in his neck, which soon grew worse.

When it did, Michael’s case was handed over to Lee M. James, DO. A board-certified rehabilitation and pain medicine specialist at Advanced Orthopedic Center, Dr. James first tried relieving Michael’s pain through epidural steroid injections.

The injections provided only temporary relief, and as a result, Dr. James next performed a radiofrequency ablation in which radio waves produce an electrical current that heats the nerves and decreases the pain signals sent to the joints in the neck.

Like the steroid injections, the radio-frequency ablation provided relief for only a month or two. When Michael’s persistent neck pain returned yet again, Dr. James decided to see if a spinal cord stimulator would alleviate his symptoms.

New Wave Treatment

Spinal cord stimulation produces electrical impulses that keep pain messages from traveling from affected nerves to the brain. By interrupting these messages, the stimulus for pain is not detected, so less pain is felt by the patient.

At Advanced Orthopedic Center, the first phase of spinal cord stimulation treatment is a three- to seven-day trial period during which Dr. James determines whether the patient would indeed benefit from the therapy.

Michael’s trial period began with Dr. James threading two small catheters the width of a strand of spaghetti into the epidural space in his neck. Those catheters contain electrodes that are connected at the bottom end to an external battery.

“The electrodes sit in the epidural space, and the battery creates the electrical impulse that blocks the body’s painful pathway and replaces the pain with a very smooth and gentle tingling sensation that we call a paresthesia,” Dr. James informs.

“The technology is such now that we can create programs, where the patient doesn’t feel much of anything. Our goal, of course, is to reduce our patients’ pain and increase their activity.

“For example, if you can walk a block, we want you to be able to walk two blocks. But a lot of our patients are older and just want to be able to go to the grocery store, travel, go fishing or play golf again.

“Our objective is to help them meet those goals, so during the trial period, we encourage them to go out and do something they normally don’t do because of their pain. That will give us an idea of what they can achieve with a permanent implant.”

Michael’s trial began on a Monday. He returned to see Dr. James four days later, on Friday, and like most patients, he reported experiencing a significant reduction in pain. It was then that Michael and Dr. James decided to insert a permanent spinal cord stimulator.

High Rate of Success

“About ninety-two percent of  my patients who do the trial go on to the permanent implantation, and of that ninety-two
percent, most report a long term reduction in pain of anywhere from fifty to seventy-five percent on average, which we consider a success,” Dr. James explains.

“We usually wait three to four weeks after the trial before doing the permanent implant, which is done through two small incisions about an inch long. Through one incision, the electrodes are implanted and anchored into some tissue under the skin.

“They are then tunneled into an area in the body that has a little bit of fat, which is where the battery is placed. The battery is about the size of a pacemaker. All of that gets implanted underneath the skin, and the incisions are closed with dissolvable sutures.”

Patients control the impulses with a remote control and are asked to avoid excessive bending, lifting and twisting for about six weeks while scar tissue builds up around the electrodes and battery.

After six weeks, patients are free to resume normal activities, which for Michael are still limited because of his other health issues. He’s happy to say, though, that neck pain is no longer one of the things holding him back.

“My neck feels great,” he says. “I don’t have any of that pain anymore, and what a relief it is after thirty years. Dr. James did a wonderful job, a beautiful job. And what a staff he has. They’re all just great.

“A lot of people probably say this about Dr. James, but I’m the kind of guy that will tell you what is and what isn’t, and Dr. James and his staff are some of the best medical people I’ve ever dealt with. And I’ve dealt with a lot of them. But these guys are fabulous.”

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