On this latest episode of Head to Total we talk with Dr. Stephen Mendelson about Nerve Stimulation as an alternative to surgery and other forms of treatment. Our host, Colleen Young, sits with Dr. Mendelson to discuss how he started in the field of orthopedics, what kind of patients he treats, what treatments he recommends for different types of injuries, as well as his passion for being in medicine. Pull back the curtain with us as we continue our discussion on everything, from head to toe, on this latest podcast episode of Head to Total!
#podcast #podcasting #podcaster #healthcast #synergy #Doctor #Synergyhealth #Orthopedics #Medicine #Medical #Surgery #Treatment #Nervestimulator
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On this latest episode of Head to Total we talk with Dr. Stephen Mendelson about Nerve Stimulation as an alternative to surgery and other forms of treatment. Our host, Colleen Young, sits with Dr. Mendelson to discuss how he started in the field of orthopedics, what kind of patients he treats, what treatments he recommends for different types of injuries, as well as his passion for being in medicine. Pull back the curtain with us as we continue our discussion on everything, from head to toe, on this latest podcast episode of Head to Total!
#podcast #podcasting #podcaster #healthcast #synergy #Doctor #Synergyhealth #Orthopedics #Medicine #Medical #Surgery #Treatment #Nervestimulator
Refresh by Roa Music | https://soundcloud.com/roa_music1031
Music promoted by https://www.free-stock-music.com
Creative Commons Attribution 3.0 Unported License
https://creativecommons.org/licenses/by/3.0/deed.en_US
Colleen Young: Hi everyone, welcome to the next edition of Head to Total, a podcast that pulls back the curtain on all things medical from the administrative side to working with your physician side. I'm Colleen Young, and today my guest is Dr. Stephen Mendelson of Mendelson Kornblum Orthopedics Synergy Health Partners. Hey, Dr. Steve.
Dr. Stephen Mendelson: Hello Colleen, thank you very much for having me on this.
Colleen Young: Yeah, I'm looking forward to it because we've had some guests, we have talked about orthopedics, and we've tried to spell orthopedics. We asked about the European spelling versus the other spelling. Give us a real deal, what is the right spelling of orthopedics?
Dr. Stephen Mendelson: Wow, what a great question. They do spell it differently over in England. They spell it o-r-t-h-o-p-a-e-d-i-c, we don't have that e. And I think there’s something about their spelling in England. They just have to be different. You know, the Beatles, the Rolling Stones, they've all gotta be just different. And even the garbage collectors over there sound so intelligent compared to us lowly Americans.
Colleen Young: It's the accent and the knickers, yeah.
Dr. Stephen Mendelson: I think it's, yes.
Colleen Young: Yeah. Well, I was looking forward to talking with you today for a multitude of reasons. But what I really wanted to focus on is the audience, those who don't know you, those who don't know what your day-to-day is like, could you tell us a little bit about who Dr. Steve Mendelson is?
Dr. Stephen Mendelson: Well, Dr. Steve Mendelson's a lucky guy. I'm an orthopedic surgeon. My father was just a great man; a lot of fun. He was a guy who fixed everything and was a very generous man. I got to grow up in his household and I wanted to be just like my father. So for me, I get to get up in the morning and go to work, I have patients who have problems that we can fix, people who have discomfort in their joints. Maybe they've hurt something playing sports, or maybe years of work, physical labor has taken a toll on the body. And in this year, 2022, we have just a lot of great options to help them. So it's a joy, whether we use medicine or therapy or injections or surgery, we have a lot of tools in that toolbox to help people. And every day is fun because you come home fulfilled, and you feel like you've made a difference. And every day we have that pleasure. Plus, to be honest, I'm grateful for the people that work with me. I have a wonderful, wonderful group of helpers, assistants and physician associates, and even administrators that really are pushing and rowing in my direction. So I'm very fortunate.
Colleen Young: We talked to that one cat, Mitch Misiak a few podcasts ago and one of the questions I asked him was, when it comes to orthopedics, a lot of people don't even understand what that means. It's more than just bone. Correct me if I'm wrong, Dr. Steve, but it's also the tendons, the muscles, it runs deeper than just bones.
Dr. Stephen Mendelson: Well, they say beauty is skin deep, but ugly is to the bone, but we do take care of everything between the skin and the bones. We get help occasionally from our micro-surgeons when we have to fix blood vessels or nerves. But if you tear a tendon, that's orthopedics. If you sprain something and injure a ligament, that's orthopedics. If you need a joint replaced, if you need a bone bent, if you need any of those kinds of soft tissue things, that's really us.
Colleen Young: You know, one of the things that I think is very intimidating is from the patient side, right? I always bring the patient perspective to the table because I really don't know anything. So I ask the question of, I see Dr. Steve Mendelson that says orthopedic surgeon, I gotta tell you, that's an intimidating title. I mean, if I come to see you, do I expect surgery? Can you pull back the curtain there?
Dr. Stephen Mendelson: No, most people who come to see me want answers to their problems. They wanna know why is my shoulder hurting. They want a diagnosis and we help get to that point. Sometimes that's half the battle. Once you have a diagnosis, there are lots of treatment options. So many, if not, most of the treatments that I provide are things like doing an injection. Things like using medications like anti-inflammatories or muscle relaxers. We use things like braces to help people who have problematic joints. We use things like different kinds of modalities: stimulators, electrical treatments, and ultrasound treatments. So many people can get better without having to have surgery. That's wonderful because don't get me wrong, I'm a surgeon and I love the operating room, but you don't want to go there if you don't need to.
Colleen Young: See, I heard from your brother that they just come from the entertainment value and the entertainment value of the Mendelson is why they really show up. And in all honesty, that's one of the reasons why I wanted to talk to you today, I want you to talk to us a little bit about the connection between the doctor and the patient and how important that is. And the connections that you have made and how you go about doing that. Because I think that's the first part of care.
Dr. Stephen Mendelson: When you meet someone, anyone, you want to connect with them, and part of that is finding common interests. I have a particular fondness for history and languages. It's finding out about shared experiences, maybe we both happen to have interests in restoring cars, and that's something I enjoy. Maybe you're a welder. I've done plumbing, a lot of plumbing. So you find something that you can talk to someone about and you get good on your feet. It's a little bit like when you meet someone at a party, are you gonna be the person who's just quiet in the corner or you're gonna be someone who reaches out, shakes a person's hand, introduces yourself and makes a perfect stranger feel welcome and make a connection. I happen to use a lot of humor, I love telling jokes. I got it from my father.
Culturally, the way we were brought up, humor was a part of everything that we did, and I think it puts people at ease. I think it makes things more fun. And through all of that, you have to be able to let someone know that you care. You have to let them know that their problem is front and center and important. And some of the beginning conversations of meeting a patient is telling them who you are personality wise, intellect wise and how you are just a concerned human. And that can take many forms. There are some people who are straighter than I am, and patients feel that they are caring and concerning doctors, and that's important. I happen to utilize a lot of humor, a lot of history, a lot of trying to make additional connections beyond just the sole problem that they come into the office for. Many times we discover new things we learn about each other, it makes it the fun part of life. I mean, for God's sake, all of us spend so much time either in our own workplace or interacting with other workplaces. We might as well get along and have a good time together.
Colleen Young: Agreed. You know, I think too, as from a patient perspective, when you walk into a room with a physician and that physician is at ease and can talk to you and have a conversation, really learn about you, that's when I know that you're invested in me. And then you're not just doing medicine for the sake of my insurance, right? You're getting to know me and you're getting to know what could be good for me. When you walk in and you see a patient with a knee issue and you learn that that patient might be slightly overweight, might have a heart condition, what options are you offering patients like that?
Dr. Stephen Mendelson: Well, I think there has to be a totally whole approach to a patient. Some people have real social issues that can prevent them from doing things. They may not be able to afford all the kind of care that's out there. You have to be cognizant of that. They may not have the time. You might have children, you might have work that interferes. I have a lot of patients who are taking care of their parents that have become infirmed. So as you get to know someone, you have to know what are the distances they're willing to travel? And then you start talking about other options. For people who have excessive weight, we talk about weight loss. Weight loss is a great way to relieve pressure on the knees. That sometimes takes the form of things like weight watchers or medical weight loss. I've referred people along the way for bariatric surgery because that's a wonderful modality that can help relieve the weight and that makes a difference for the knees, in addition to the rest of the body; the heart and the lungs. We talk about different kinds of options that may fit a person who might not be a great surgical candidate, perhaps certain kinds of medicine they're not able to take.
For instance, someone may have had an ulcer in the past, they can't take Motrin or Advil. We might talk about other things like Toradol or even Tylenol. There are some people for whom they need therapy because they become very deconditioned. And if we take a person who is deconditioned and put them through a course of therapy, many times their knees feel much better. There are other options of course, we do have certain people who come in who maybe are heavy or have other medical problems, and we think about also sometimes doing surgery for them, even though it may be riskier, but we have a shared discussion about that. I like to bring in family members in the modern era. I like to use not only telephones, but FaceTime and Zoom. It's a great way to bring that old fashion village, which now is so spread out together again so you can have the input. I mean, you'd be amazed how many times you go in to review or you talk with a guy who's a patient and then you bring their wife in on the phone and you learn a world of new information.
I've had instances where family members from other states, other countries come on the phone and suddenly you learn more about that patient, what their concerns are, what their problems are. We have people who come into the office, they act tough, nothing bothers them, but then you talk to their wife and you realize they're really suffering. They just need some way to be able to express that. So I think it's important to talk about all those options and bring in more people, not less. Geez, COVID kept us so separate, and if we're smart, we're gonna use that technology to bring that whole broad non-nuclear family in.
Colleen Young: I think you hit on something with the options. First of all, like I said before, the title said surgeon, so you automatically go there and I’m feeling a little anxious, you've put me at ease with your personality and your knowledge. But one of the other things that we as patients do is we Google. So knee pain, I'm Google that, what do I got going on there. And I come in to see you and I'm like, you know, Dr. Stephen, my knee is hurting, I think it's this, and you're like let's talk about that. But what are some of the new options that are out there for patients with pain? What's really going on in the industry today? What's new and exciting?
Dr. Stephen Mendelson: Well I'm very excited about something called neuromodulation. So we have people who have painful knees, either from arthritis or perhaps a failed surgery. And maybe they're not a great surgical candidate, maybe they have a medical problem, maybe they have comorbidity. And it could be many things, it could be diabetes that's not well controlled, it could be weight issues, could be dialysis, could be heart disease. And in the past we had had a certain complement of options: Tylenol, lubricant injections, and brace therapy. When people have exhausted that, they're frustrated and we didn't have great options. With neuromodulation, we're able to implant wires around the knee joint that touch on the nerves that supply the sensation to the knee. And what we can do is with special kinds of electrical pulses, we can turn off those nerves.
So yes, you may have arthritis, but you will feel substantially less pain. And the advantage there is, unlike a medicine that affects your whole body, this affects only the involved area, or unlike a surgery which involves incisions and has risks. And they're not small, when you have someone that has, God forbid, an infection of a knee, that's a major thing. You can have someone who has a blood clot, that's a major thing. With these procedures that we're doing with neuromodulation or what we call stimulators, we don't have that kind of a risk profile. It's a small procedure, it's done through tiny poke holes about the same as putting in an iv. People go home the same day and there's minimal to no rehab after that. So for those patients who are not great candidates, peripheral nerve stimulators, which is a part of neuromodulation, it's an incredibly exciting new area.
Colleen Young: Do you usually do that just on the knee or are there other areas of the body, Dr. Steve, that you do neuromodulations on?
Dr. Stephen Mendelson: Well neuromodulation is in a variety of areas of the body now. So for instance, our neurosurgeons, persons who have seizures that are not well controlled, they're using electrical stimulation to stop those seizures. Persons who have Parkinson's disease, we're using neuromodulation or those electrodes to correct that problem with Parkinson's or at least make it better, so they are being used in a variety of areas of the body. In orthopedics and podiatry, we're using them for people who have peripheral neuropathy. So if you have bad neuropathy in your feet and you're burning and it's uncomfortable, we do a procedure similar to a carpal tunnel of the foot where we release the nerve and we place these stimulators and people get tremendous relief. I focus a lot on knees, hips and shoulders. I have patients who are not great candidates for the joint replacements that I love to do. I didn't have another option for them. Now I can offer them these implantable stimulators for their hips or their shoulders in addition to the knees and give them something to help with that pain and discomfort.
Colleen Young: Is it implanted, like what's implanted under the skin? And is this something I adjust? You know, what happens when I leave Dr. Steve?
Dr. Stephen Mendelson: Well, typically someone will come in and we'll talk about neurostimulation. We'll see if you're the right candidate. So for instance, if you have a pacemaker, you can't have neurostimulation because that electrical impulse could affect your pacemaker. If you have a special kind of CPAP type machine, CPAPs are fine, but they now do a surgery, the ear, nose, and throat people, where they will implant a special breathing stimulator. Well, you can't have a knee stimulator if you have one of those for your breathing. But if you're a good candidate, we set you up for a trial and a trial typically involves coming to a surgical center. We then place these electrodes, they come out of the skin like a porcupine and in the recovery room we will connect up our little electrical stimulators and test those for about 20 minutes, see how you do. We wrap you up with those wires, send you home, bring you back two days later to the office and connect the stimulator again. Because on that second day, you're not gonna have any kind of confusion variable. You won't have, oh, maybe some pain from the procedure or maybe some carryover effect from anesthesia. Two days later you don't have any of that. So we trial that in the office and then we take the wires out in the office. People do not feel that at all. They don't feel the wires coming out and then we see if you got good relief.
About 80 to 85% of people will have good relief, 15% will not. And if you are not one of those persons, we don't proceed with anything further. If you are, we proceed to a permanent implant, which involves going to the operating room. And instead of having a wire come out of the skin, we have a small, very special what's called a lead, which is a special kind of wire that's spun around plastic about the thickness of a spaghetti. In fact, it moves like a wet piece of spaghetti. We implant that to the nerve and bury it under the skin. We put a couple of those in and that takes us about 20 minutes to do that. Go home the same day. Those leads that are now under the skin, you don't see them, they are completely buried. And when you need to stimulate and help with the pain, you have a little stimulator box that looks sort of like an AirPod case. And you put it on top of the area where those leads are buried under the skin, stimulate the nerves, prevents the pain, or I should say helps significantly with the pain.
People may still feel a little bit, but we do have some people who've gone from maybe what they rated as 8 or 9 out of 10 pain down to 1 out of a 10 pain, and that's huge. And what's fascinating is that the effect of this neuromodulation is fascinating. It blocks the nerve from transmitting, which is a good thing, but it also sends an electrical signal back to where, let's call it the cell body or the cell warehouse lives. And it helps to deplete some of these neurotransmitters that are used for pain. So people can have a carryover effect, which means that if you stimulate for six hours, you may get 24 hours of pain relief before those neurotransmitters are built back up. So people are not having to wear that little iPod case on their knees all the time because they get that carryover effect. And anecdotally, we see that the amount of time people have to use the stimulator seems to go down the longer they have the stimulator.
Colleen Young: Okay, so you've implanted this under my skin, my next question to you is what have you experienced with this cartilage or anything growing around it? Is there a hardening in that area?
Dr. Stephen Mendelson: No. So let me answer that. What we have is, you may know people who've had an IV in for an extended period of time. Does the body react to it? It's an inert material, so there is a little bit of fibrous tissue around it, but it doesn't cause an inflammatory reaction. It's not in the joint, so it is not mechanically obstructing or blocking a joint. And there are instances when we've had to take them out. Let's say a person's had one in for an extended period of time, perhaps it was in the knee and they've had bariatric surgery, several years have gone by, they're now ready for their knee replacement, there are instances when we can take those wires out when we do the knee replacement. Although I have to tell you, it's interesting, I just did one where the patient wanted the wires left in so they could use the stimulator for their pain after their joint replacement. And I told them you'd probably need it for about four to six weeks and then you won't need it anymore.
Colleen Young: That's pretty cool because then you're not taking medicine. Some people have that and they just don't wanna take anything and there's a solution.
Dr. Stephen Mendelson: People used to take a tremendous amount of narcotics. I mean, we had an opioid epidemic, real epidemic. And especially for these nonsurgical patients, especially for the ones who are not great candidates because you put them under anesthesia and God forbid they can have a heart attack or they're at high risk for infection. And so what option did you have? They'd be snowed on narcotics, and as much as it can help with the pain early on, those narcotics have a lot of harmful effects. You have to take more and more of them to get the same amount of pain relief. They do bad things to your brain and they do bad things to your intestines. And so, yeah, being able to use these kinds of stimulators is a real benefit to people that don’t require narcotics or opioids.
Colleen Young: And you simply sit on the couch and you just put this little device on for a couple hours and then you could be good for 24.
Dr. Stephen Mendelson: Well, actually people wear them while they do stuff. You're not restricted to sitting.
Colleen Young: Oh, you're not. Okay.
Dr. Stephen Mendelson: No, you can sit, I mean if you're watching a rerun of Seinfeld or something like that or sports, but it's applied with an adhesive so you can wear it anywhere you'd like to go. You don't swim with it, you just would take it off when you go swimming, but you could put it right back on afterwards.
Colleen Young: And from what I've heard, it's a small device so you can, it doesn't limit you. You can wear it under clothes and nobody will even know.
Dr. Stephen Mendelson: That's right. You wear it under clothing, people don't see it at all.
Colleen Young: Yeah, okay. Dr. Steve Mendelson, thank you so much for being here today and being a part of Head to Total. We learned a lot from you today about peripheral nerve stimulators, what the procedure is like. And it's amazing that it's one of the few medical procedures, not the only medical procedure, that you can try before you buy. You know, you have so much information to give us and our audience would truly appreciate, as would I, you coming back to talk about robotic hip replacement and where you're going with that. So if you would, we've got all that ground to cover, we hope you'll be back and see you again soon on Head to Total.