When A Pioneering Spine Surgeon Becomes A Patient

This insightful and inspiring podcast features Dr. Stephen Hochschuler, a distinguished and pioneering spine specialist with a 40-year history as a world-renowned spine surgeon. In a conversation with Dr. Rita Roy, the CEO of the National Spine Health Foundation, immerse in their dialogue as they explore Dr. Hochschuler's personal journey from a prolific spine surgeon to becoming a spine patient himself.

Despite his high pain tolerance, Dr. Hochschuler shares his experience with enduring hip and thigh discomfort over several months. Increasingly, the pain and numbness began to disable him. He shares his decision-making process, from seeking treatment and initially exploring conservative methods utilizing anti-inflammatories and rest. After trying a conservative approach with no relief, he realized that he would need further exploration to discover the cause of his condition and what to do about it, particularly given his age of 81 years.

The podcast conversation explores the emotional dimensions of being a patient, where Dr. Hochschuler emphasizes the empathy he gained while understanding patient fears. The significance of a comprehensive approach to spine care is discussed, as Dr. Hochschuler underscores the integration of diverse professionals like psychologists, chiropractors, and physical therapists within patient treatment at Texas Back Institute, one of the world's first comprehensive spine practices, which he co-founded.

This conversation sheds light on Dr. Hochschuler's distinctive perspective as both a spine surgeon and a spine patient, unraveling essential aspects of spine care, patient education, and informed decision-making for spinal conditions. The discussion extends to postoperative care, the importance of physical therapy and balance training, the role of yoga and fine motor control in sustaining health, and the broader implications of aging on spine health.

Throughout the exchange, Dr. Hochschuler's pride in facilitating patients' recovery and his awareness of the privilege and duty associated with trusted healthcare provision are palpable. The conversation culminates with Dr. Hochschuler praising Dr. Roy's adept interviewing skills and expressing gratitude for the chance to share his insights. As a finale, the speakers encourage listeners to find inspiration and recovery through shared narratives of triumph and expertise within the realm of spine health.

Transcript

Get Back to It with Dr. Stephen Hochschuler
When a Pioneering Surgeon Becomes A Patient

[00:00:00] Stephen: Hi everyone. My name is Dr. Rita Roy, CEO at the National Spine Health Foundation, and I'm your host for the Get Back To It podcast, where we tell real stories of healing and recovery. What does it mean to get back to it? It means overcoming spinal conditions through treatments that work in order to return to the people and activities you love, whatever that looks like for you.

[00:00:24] Rita: It means getting back to your life. We're here to share the success stories of those who did just that. And some of these stories, you are not going to believe. At the Get Back to It podcast, our goal is to tell stories of spinal champions who've been able to achieve a better quality of life through spinal health care.

Today's episode is really special and unique because I'll be speaking with Dr. Stephen Hochschuler, who is a world renowned spine specialist and spine surgeon pioneer. Dr. Hochschuler's spine challenges began recently. But Dr. Hochschuler has a world of information to share with us, not only on the history of spinal technology, but all the events that led him to ultimately becoming a patient. So with that, and now that you know what to expect, let's get back to it and dive right into Dr. Hochschuler's story. Dr. Hochschuler, talk to us about your symptoms and when they first began.

[00:01:34] Stephen: My symptoms first started about four months ago, and what I noticed was, as I was walking, I was getting more and more pain into my right hip and anterior, or the front of the thigh. And this would kind of get better when I sat down, but the minute I stood up, I felt the same pain.

[00:02:00] Rita: how did those symptoms affect your life? How was it impacting your life?

[00:02:06] Stephen: Well, initially it was not. I have a very high pain tolerance because I have suffered for about 40, 50 years with a gout, and anybody who's had gout knows it's an extremely painful situation, almost like having a kidney stone. And I'd get attacks, and I still was able to operate, and I still was able to participate in conferences.

Uh, but. That's a really painful thing. And I had the gout attacks almost every place, from my big toe, which is usual, to my knee, to my hands. And, uh, I could not take the simplest medicine, which was allopurinol.

[00:02:52] Rita: Mm

[00:02:52] Stephen: I'm allergic to nothing but that.

[00:02:54] Rita: Oh my gosh.

[00:02:56] Stephen: they came up with a medicine, which terribly expensive, but I've taken that for the last ten years.

So, long story short, I knew how to tolerate pain. Uh, but this pain that I was getting pretty much in my hip and my thigh every time I stood or walked was, uh, very annoying.

[00:03:20] Rita: And, and Dr. Hochschuler, how long did you experience this hip and thigh pain? you know, it sort of started and that went on for weeks or months or how, what did that look like?

[00:03:34] Stephen: Well, pretty much months and having been a spine surgeon for 45 years, I had a pretty good idea of what was going on and I figured I'd just give it a tincture of time. And hopefully it would get better.

[00:03:49] Rita: And so you are in a very unique situation because you are a spine surgeon and not just any spine surgeon. You have been a pioneering spine surgeon. You've looked at all kinds of pathologies and, and injuries and, and conditions that patients have had over many years. And so when you had this pain. You knew it wasn't gout pain.

You knew this was something different based on how you felt, right? and so as you become a patient, what goes through your mind? I mean, you know a lot about the spine and the kinds of ways that that pain presents How does that feel then to be a patient now? Experiencing that.

[00:04:33] Stephen: Well, I think being a patient gives you a whole new view of what the art of spine is all about. But also, what patients experience. Now, as bad as this is going to sound, I could recommend nothing more or better for a spine surgeon or a spine physician to go through what a patient's going through. And the only way to go through that is to experience it oneself.

[00:05:04] Rita: Yeah, so you decided you had these symptoms and it had gone on for a couple of months and you were giving it a Some time to settle down. And at what point did you decide you needed to seek treatment?

[00:05:20] Stephen: Well, I really treated myself initially, so I started out with an anti inflammatory. Then I went to a little stronger anti inflammatory. I tried, seeing if a little bed rest would help, but I'm a very impatient person and I can't stay in bed. Uh, and I limited my activities because I do think, uh, physical fitness is very important. And so I've exercised my entire life, but I changed the exercises and I did a less kind of weight bearing,

[00:05:57] Rita: Mm-hmm.

[00:05:58] Stephen: but I worked with my upper extremities and, uh, I just try to bear with it. However, when it wasn't getting any better, I had one of my partners, my ex partners, who says I'm retired now for about two years, but, uh, order a Medrol dose pack, which is basically a steroid.

[00:06:19] Rita: Okay.

[00:06:19] Stephen: Uh, which, uh, is out of five, six days supply and starts with a high dose and goes to a low dose. And that often will help patients, but it certainly did not help me. I was at a spine meeting in San Francisco. I guess about two and a half months ago, and a lot of people there I usually talk with and visit this for exhibits and attend conferences.

And as long as I was sitting, I was fine. But when standing up and looking at exhibits, I couldn't stand for more than really 30 seconds without searing pain. So I dragged around a folding chair. And it

[00:07:04] Rita: Oh my gosh.

[00:07:06] Stephen: people, people were standing around me talking with me and I'm sitting down looking up.

So even that, I understood the experience of somebody in a wheelchair.

[00:07:16] Rita: Yeah.

[00:07:16] Stephen: you usually like to be eye to eye with people you're speaking with. And here I'm looking up. Uh, not that I couldn't handle that, but it was an interesting kind of uh, interlude. Long story short, I always got tired of dragging around the chair. And, uh, finally decided maybe it's time to get a study. So, uh, a friend of mine, a neuroradiologist, ordered a, initially, a CT scan. And, basically, I got that. And it did confirm I had pressure on. Few nerve roots.

[00:07:57] Rita: So that was a lot of information, Dr. Hochschuler. I'm going to ask a few questions here because there were, there was so much that you covered in that. And essentially what you've just gone through is that sort of. trial of what we call conservative treatment, right? Starting with anti inflammatory medications, now moving to, you know, steroid treatment as as a more intense anti inflammatory treatment.

And now you're at a place where you're beginning to feel disabled. by this condition. So let's get some imaging studies done and see what's going on. That's causing this. Do you think that's a sort of good general description of that journey there?

[00:08:45] Stephen: Perfect. You should be a physician.

[00:08:48] Rita: Oh, you, so in that, in those couple of weeks, you know, six or eight weeks of that conservative treatment journey, one of the things you talked about was physical activity.

And something we talk about a lot here at the foundation is the importance of physical activity to maintaining your spine health. But the problem is when you're in pain, it's hard to move. And so one of the things you just said is that You know, you gave yourself some bed rest, which is, which is a good idea to rest when something is inflamed, but you didn't want to stay completely sessile during that time.

So you worked on upper body movement. You worked on some mobility. can you share with us from your perspective as a spine surgeon, why you thought that was important and if that was hard for you to do when you, When you were also in pain.

[00:09:49] Stephen: Yes, because, uh, physical therapy, you want to keep your body in good condition. And so, for instance, when I practice prior to operating on a patient, we do what is called prehab or pre surgical rehabilitation or exercise to keep the patient in the best condition. So you keep their muscles toned, so post surgery, they would have an easier time of regaining strength.

Flexibility, balance, and consequently get back to life sooner.

[00:10:28] Rita: So pre habbing, which is doing some physical therapy, exercise, conditioning, before you go into surgery, helps make a better outcome after surgery. Is that, is that what you're, you're saying? And, and there's evidence, there's, there's evidence to show that, but you also saw as a clinician the impact of that.

Is that right?

[00:10:53] Stephen: Absolutely.

what I would add to that, the other thing having practiced as a spine surgeon for 45 years, I wasn't worried about what was going on. Once I knew what was wrong, and I related almost to like a woman who has a lump in her breast. That lump hurts, but once you find out the lump is not cancer, it's amazing how much longer you can tolerate the lump.

[00:11:24] Rita: Interesting.

[00:11:27] Stephen: So when you're having problems in your spine, you worry, Am I going to be paralyzed? What's wrong? Is it a, what is it?

[00:11:34] Rita: Yeah, the fear

[00:11:36] Stephen: the fear. And so we here at Texas Back always had psychologists as part of our treatment regimen. So we had two psychologists and every patient would meet with the psychologist pre op to just be sure that their fears were limited and they were best shaped physically and mentally prior to the surgery.

[00:12:03] Rita: that that is so fascinating. One of the things that we are looking at in the foundation is the connection between pain and fear and pain management and fear and this is particularly true for spine patients as as you mentioned and You know, it's no wonder that the practice that you helped create and and grow Texas back institute is such a landmark organization.

because that kind of treatment is, I think, unique, to have patients see a psychologist to talk about their fears and how that plays into their pain and managing their pain. That is just, that is awesome. Um, at what point, I'm just curious, at what point did you bring that into your practice?

[00:12:48] Stephen: Very, very early on. What we recognized, uh, one of my partners who founded the organization with me, Dr. Ralph Rashbaum. I met him in the military in 1971 and actually he worked for me. Well then, long story short, I swore I'd never practice with this guy, but he was brilliant. And he trained with two of the best spine people in the world.

one, uh, was Henry Bowman, cervical spine specialist. And the other was Richard Rothman. Down in Philadelphia, and he was their first fellow, both cases, he, he's really a brilliant guy, and I wound up bringing him to Texas, and we started the Texas Back Institute, but our goal was to have a multidisciplinary approach.

to the spine. So we wound up bringing chiropractors in. We brought physical therapists, occupational therapists, nurse clinicians, trainers. And when we did all this, trust me when I tell you, there's turf battles. And that basically is Everybody's protecting their own turf. And our goal was really to put this patient in the center of the universe.

Not any special doctor, not any special specialty, but the patient, and whoever could give the patient the necessary treatment. They were to try and always start with conservative therapy. Surgery was the last thing we did.

[00:14:35] Rita: what I was just going to ask. Yeah. How many, how much of the time would patients Would patients come to Texas back and see you and your partners and not need surgery? you could offer them other treatments. Would you say that was 50% of the time, 60% of the time, 20% of the time? What did that look like, do you think?

[00:14:56] Stephen: It was really 80% of the time. And, you know, most patients don't need surgery. So you don't want to hop into surgery. But it's a very difficult thing when you're having pain, and you want it resolved ASAP.

to convince the patients to just wait, give it a few weeks. But most people who will do that basically are benefited by it.

[00:15:22] Rita: Mm hmm,

[00:15:23] Stephen: it's truly amazing how many people get better with non surgical treatment.

[00:15:29] Rita: right. So, let's pick up on that point. So we talked about your pain. It went on for a Six, eight weeks, couple months, you were, you were doing the conservative treatment and now you've called a friend who's a radiologist to get some imaging because the pain in your hip and your thigh are not resolving and there's, it's starting to disable you.

and you had a CAT scan done. I'm curious about the CAT scan. Um, oftentimes people get x rays and MRIs. How did you end up in a, with a CT scan?

[00:16:06] Stephen: Well, it gets a little more complicated, but what I would say is first, physically, I was getting what's called dysesthesias in my thigh. So if I were to touch my thigh, my right thigh, which is the painful thigh, as compared to the left thigh, there was a very big difference. Plus, I was starting to get a minimal amount, but some weakness in the quadriceps muscle. So in essence, It was a change of sensation and some weakness starting, but minimal,

[00:16:43] Rita: Mm hmm.

[00:16:44] Stephen: knew, I knew what was going on.

[00:16:46] Rita: You knew.

[00:16:47] Stephen: The other thing is, years before I had had some spine surgery, and so I knew that there was some changes in the vertebra from the surgery. And you can see the vertebra or the bones better on a CT scan than an MRI scan.

[00:17:07] Rita: Got it.

[00:17:09] Stephen: in practice, I would not go to a CT scan first. I would go to an MRI scan if the scan were indicative.

[00:17:18] Rita: Got it. so, Dr. Hochschuler, talk to us about that earlier procedure that you had on your back.

[00:17:25] Stephen: Well, in 2015, uh, similarly, I'm a very active guy. I've exercised since I'm three years old. So, and I, I've always known the importance of keeping physically fit for both, uh, your profession as well as your general health and, uh, for longevity. So even though I probably look older than I am, I'll be 81,

[00:17:53] Rita: 81? You don't look 81! You do not look 81.

[00:17:57] Stephen: thank you as my wife, but nevertheless,

[00:18:00] Rita: My goodness, no. You, very handsome, very vital, very youthful looking. So if that's what physical activity does, I gotta keep doing it.

[00:18:09] Stephen: well, I'd like this recording if you'd get me a copy anyway, uh, no, but I think I'm 30 inside. And so I think keeping active mentally, physically, uh, exercise, positive thinking, all these things are very important to your enjoyment of life, your happiness in life, et cetera, et cetera. And so the surgery the first time around, again, one of my partners operated on me the first time.

And when you have 25 spine surgeons in your group because Texas Back has 14 offices all over North Texas, uh, you don't want to insult anybody, but you still want to choose the one you want to operate on you. And I'm,

[00:18:56] Rita: point is how you choose your surgeon. We'll come back to that, but go ahead.

[00:19:00] Stephen: well, I'm, uh, you don't know me really well, but I'm very direct. And so, uh, bottom line. I just didn't worry about that. I figured they'd have to handle it themselves. So at that time, I chose who I felt was best, who was really an expert at minimally invasive surgery. And, uh, he did at that time. I had a ruptured disc at L2 3, and I had spinal stenosis at 3 4 and 4 5. And he did it all, what we call percutaneously, or through a small skin incision.

[00:19:40] Rita: Wow.

[00:19:41] Stephen: And he operate, 2015, yeah,

[00:19:44] Rita: was that sort of new technology at that time?

[00:19:47] Stephen: no, but evolving and today it's becoming more and more and more important. And, uh, there are all sorts of new technologies. Making it simpler, so like an operating on a knee, use an arthroscope, and, uh, those scopes are now used frequently on the spine. And, in essence, like anything else, you want somebody who's been well, well trained in it, who's done numerous cases, not one or two, and, uh, has had good results.

And so I chose one of my partners who did all of that, plus I liked him. And that's another important thing.

[00:20:32] Rita: important. Yes.

[00:20:34] Stephen: in essence, uh, he operated on me on a Thursday, I went home on a Friday. And, uh, we, we have residents, uh, in Arizona, as well as in Texas, and he operated on me in Texas, and Sunday, two days later, I was on a plane back to Texas.

[00:20:51] Rita: Oh my gosh.

[00:20:52] Stephen: mean back to Arizona, sorry.

[00:20:54] Rita: And, and what, what minimally invasive procedure did you have done at that time in 2015?

[00:21:01] Stephen: Well, what he did was at L2 3, he removed the herniated disc, which is kind of like, let's say, a balloon going into your canal, and he removed that piece of balloon, and then that was at lumbar 2 3, and then at 3 4 4 5, he opened up the canal, because in spinal stenosis, the canal Or the exiting nerve roots get tight.

And he was able to kind of decompress that area or open it up. And, uh, did a great job.

[00:21:36] Rita: That's awesome. And that's stenosis. Was that likely from just regular arthritis or what do you think now,

[00:21:44] Stephen: I think it's an aging process. Uh, I don't have arthritis. I think people use the term, you know, you have osteoarthritis

[00:21:52] Rita: Yeah.

[00:21:53] Stephen: we all have changes in our bones as we age and we all get shorter. That's why when you're 80, you're an inch shorter than when you were 20 because you lose disc height, things change, bones change.

And I was a pretty active athlete my whole life and consequently I expected changes.

[00:22:13] Rita: Yeah. Well, after I had my lumbar fusion and a cage inserted, I actually gained an inch from my spine surgery. So that was a great outcome.

[00:22:24] Stephen: Well, it is a great outcome. But I go so far back, we helped develop all those cages and actually it, the whole concept came out of the horse world, believe it or not. So horses do have problems in their neck. They started out operating on them and they put in a cage to keep the space between the vertebrae open.

Well, years later, we adopted that. So, so much is learned by cross pollinization.

[00:22:55] Rita: Yes,

[00:22:56] Stephen: So we've learned a lot from veterinary medicine. We've learned a lot from dental medicine, and the key is cross pollinization. You always get ideas from elsewhere. In fact, I've invented a lot of instruments and procedures. And guess what?

From going to Home Depot,

[00:23:17] Rita: Oh my gosh. Wow, using the carpentry, uh, analogy there, right? That's, that's incredible. So back to your story. You had this minimally invasive surgery with the decompression and And it was a laminectomy, no, discectomy and decompression,

[00:23:36] Stephen: partial laminectomy.

[00:23:37] Rita: partial laminectomy. So you knew that you had some changes that had been done in your back.

So fast forward, you know, eight or nine years and now you've got low back pain and you're thinking to yourself, I need to take a look at what's going on back there. Is that right?

[00:23:55] Stephen: Correct.

[00:23:56] Rita: So the CAT scan showed what, my goodness,

[00:23:59] Stephen: Well, the Cascadian showed why I'm shorter than I was. Fortunately, uh, I've always believed in good posture, which is very important for men and women. And, uh, so I walk in good position, uh, but I knew that, uh, because of the prior surgery and my activity and et that there probably were bony changes.

Uh, one of the things I can say, years ago, back in 1964, when I was in medical school, I had one of the first pair of running shoes. And, uh, at that time, nobody was running. And I was in Boston, and I was running every day, and people looked at you as if you were crazy. mean, what are you doing out running?

I mean, now that's hard to believe, but that's what it was. Right,

[00:24:55] Rita: that's incredible.

[00:24:57] Stephen: but I attributed some of my problems because I did a lot of running and that's weight bearing and

[00:25:03] Rita: concrete. Running on concrete.

[00:25:05] Stephen: correct. And the shoes Initially didn't have the same kind of balance or the name of the shoe was new balance But didn't have the same kind of balance And, uh, you know, they've improved, like

[00:25:20] Rita: and cushioning and all this. Yes. Yes. That's right. Yeah. So, uh, the CAT scan now reveals,

[00:25:29] Stephen: Well, it revealed that I had, uh, several changes in the bony structure, which had narrowed the exit of some of the nerves. So, in essence, there were changes at L2 3, which I'd had the disc on before, and especially where the nerves were leaving the spinal canal, what's called the foramen. And I had changes both left side and right side at L2 3, lumbar 2 3, as well as L3 4.

So I had four nerves markedly compromised, but the only one that was really causing symptoms was the one going to my right anterior thigh.

[00:26:17] Rita: Wow. So with that information, what do you do? What's the decision making process and how you're a spine surgeon, but most people who have these conditions don't have the kind of knowledge that you have. Take us through the decision making process there and what to do next.

[00:26:38] Stephen: Well, I think the key thing is, again, you've got to work with a surgeon who you feel is the right surgeon for you, recognizing at that point you needed surgery because nothing short of surgery was working. And so, in essence, uh, one of the fellows we trained 25 years ago, who was practicing in a big group in Arizona, where I was at the time, I went to see him and he evaluated me and looked at everything and in essence, uh, checked whether my spine was stable and he did that by getting what we call a flexion extinction x ray, which means you're standing sideways and you bend forward and stand up straight and lean backwards to see if my vertebra remained in good position and they did.

So he knew I did not need a fusion. Because there was no real instability,

[00:27:39] Rita: Got it.

[00:27:41] Stephen: I didn't want anything more than I needed. On the other hand, even though he knew where the pain was coming from, because of the symptoms, and you put that together with the CAT scan, he felt, because of my active lifestyle, that he thought he should deal with all four of the foramen.

And we discussed that. Uh, and that's what I wanted because I'm not going to slow down I don't want to be back in six months or nine months or a year. And I was willing to take the risk of doing more surgery rather than less, which usually we advise just the opposite. So you don't want to do any more than you have to do and you've got to.

kind of change your lifestyle. Many people have to stop playing golf because, you know, that twisting and torque leads to more degeneration or change the golf they play go to what's called natural golf. So long story short, we decided, you know, myself in consultation with him, which is always important.

And I think you always bring a family member in. So my wife went through it as well.

[00:28:59] Rita: That's such an important point to have support with you as you're making these decisions. And I, I'm surprised to hear you say that, pleasantly surprised to hear you say, even in your case with the incredible knowledge you have about spine, when you're in the patient chair to have your support with you as you're making these decisions,

[00:29:22] Stephen: I think it's very important because your spouse worries too. And you never know, you know, you think that they don't worry, but knowledge is important

[00:29:33] Rita: knowledge, knowledge. Can you say that again? Knowledge is important.

[00:29:37] Stephen: Knowledge is key in anything.

[00:29:39] Rita: That's what we're doing here. That's what we're doing here.

[00:29:42] Stephen: Well, absolutely. And I commend you because I think a spine foundation, you gotta impart knowledge to the patient. I believe in patient participation in their care. Participation, I should say. And it's key. And the more a patient knows, the better. I always told patients to write down questions because when they're in the doctor's office, they get nervous and they forget.

I also tell them, feel free to record what I'm telling you. Some doctors don't like that. I always tell them, why not? So the patient can bring home, talk if the spouse isn't with them, or in pre op, just before the surgery, I think it's always important to have one of the, the spouse come as well, so they can ask questions.

How long are you going to be in bed? How long are you going to be able to, you know, sit, or walk, or run? or whatever. So the more knowledge a patient and the family has, number one, the better for them, and number two, it's easier to treat them.

[00:30:51] Rita: Yep. That's amazing. You know, Dr. Hochschuler, so much of the time patients are nervous or intimidated when they meet their spine surgeon. It's, it seems overwhelming. There's a lot happening. I'm, I'm imagining you being in the patient room with your wife sitting next to you and now the surgeon comes in to see you and he was once trained by you.

 Do you think he was nervous? having you as a patient. Was that a little role reversal there? What was that like?

[00:31:23] Stephen: I think so, but he certainly didn't show it, and I teased him about that. Uh, you know, but the truth is he didn't. And the other thing, when you're the patient, everything you consider routine, checking in, You're sitting there wondering, why is this taking so long? Number two, they repeat the questions over and over.

Why, why don't they just have this recorded? Why am I repeating it? Then they explain things to you. And you know, you want to say, well, I've only done it 45 years, but they go through the routine. And you recognize, or after the surgery, when you call for assistance from the nurse, you're wondering how long it's going to take for them to get to your room.

And

[00:32:10] Rita: our world.

[00:32:11] Stephen: well that's what I'm saying, when's the medicine going to come? And you, you really understand many more things about what's happening, what's going on, and how important patient education is.

[00:32:26] Rita: that's right. That's right. So you're, you're in the, in the room, your surgeon comes in, you're talking about the x ray findings, the CAT scan findings. It's clear that surgery is the right option. for relieving your pain. It's very clear from the imaging. This is a surgical problem or this is a problem that can be fixed.

with surgery. And the question is, how much surgery, right? And so then you've got to take into consideration your age, your activity level, what's the likelihood that you might need to come back if you don't do maybe more now. And those are all the considerations that factor into deciding what surgery to have and as you say, how much surgery to have.

and so the decision you made was What?

[00:33:20] Stephen: The decision was that do all four areas, do it as minimally invasively as possible, so don't destroy any more muscle than you have to, because you got to rehab those muscles, and to Get into a position that you can rehab the soonest, be more active sooner, and in essence, it all was well done, except one thing, and I knew this, but there's nothing I could do about it.

As you get older, anesthesia is a much more difficult thing.

[00:33:58] Rita: Ah.

[00:33:59] Stephen: when you're 20 years old, Anesthesia, you pop right out of it, usually.

[00:34:05] Rita: Yeah.

[00:34:07] Stephen: If you're 80 years old, the hardest thing for me was post op, getting all my thinking straight.

[00:34:16] Rita: Interesting.

[00:34:18] Stephen: really caused more difficulty than anything. Not really pain, there was spasm, there was pain, but as I said, I can handle pain.

[00:34:27] Rita: Yeah.

[00:34:28] Stephen: But I was kind of, for lack of a better word, goofy and people who know me, you know, I wasn't making a lot of sense

[00:34:36] Rita: And how long did that last? How long did

[00:34:39] Stephen: for me about two weeks.

[00:34:41] Rita: Wow.

[00:34:42] Stephen: Yeah, no, I thought it would be a day or two, but it was two weeks.

[00:34:46] Rita: My goodness.

[00:34:47] Stephen: to be at an international conference down in Mexico that I planned on going and I like, cause it's more of a think tank.

And I waited to the last minute to cancel, so I was supposed to be there on a Wednesday, I cancelled Tuesday. Because I still wasn't, just wasn't thinking straight.

[00:35:06] Rita: Thinking straight. My goodness. That's, that's fascinating. So factors to consider when you're having surgery outside of just the surgical procedure itself. Right? And anesthesia is a big component of that for sure.

[00:35:21] Stephen: Correct.

[00:35:22] Rita: Wow. so, how long were you in the hospital after your surgery?

[00:35:28] Stephen: Uh, I could have gone home that day, but they wanted me to stay overnight, so I did stay overnight. I went home the next morning, 8am. and uh, no problem whatsoever.

[00:35:40] Rita: Were you up and walking around?

[00:35:43] Stephen: Yes.

[00:35:46] Rita: No pain.

[00:35:48] Stephen: Minimal. No, I won't say no pain,

[00:35:50] Rita: sore.

[00:35:51] Stephen: it was sore and a little muscle spasm, but nothing, nothing that I didn't expect. And that's the other thing. If you know what to expect, then you need less pain medicine. And I don't like pain medicine. I think, unfortunately, we've addicted too many people to pain medicine.

Uh, and it's time to just, uh, just not use as much.

[00:36:15] Rita: Yes, such, such an interesting point and, so much there. We talk about in spine surgery, patient expectation, right? And you, you and I both know about the studies, uh, that are done. Many studies have been done over the past 10 years on patient expectation, and, and understanding. If, if the surgeon is satisfied with the outcome, is the patient also satisfied with that outcome?

Or what did they expect in their outcome? And so much of that can be done or should be done preoperatively, right? In talking about what to expect when you come out of the surgery. And again, I think that's a critical place where the National Spine Health Foundation can play a role in listening to stories like the one we're talking about now, in understanding the journey and what that can be like and what that should be like.

in the immediate post operative time, but then in the longer, you know, more, more longer term, post op time, your, your life after surgery. and so that expectation, so important. The other thing that you're talking about there in opioids, the National Spine Health Foundation published a one site study, last year looking at, it was a pill count study looking at the amount of opioids that the modern spine patient takes.

after spine surgery. And our hypothesis is that we're over prescribing. And we were absolutely right about that. because the techniques that you're describing with minimally invasive surgery, less disruption of the body as the surgeon is cutting into your skin and going past the muscle. So less disruption, shorter time period in and out of the operating room faster, that the pain that is felt.

ought to be less. And in fact, it is less. And yet, our prescribing patterns for post operative opioids are still, have not changed much. And so that's something that we've been looking at, at the National Spine Health Foundation to say, you know, let's, let's, let's talk about maybe setting a different standard for the amount of pain control patients will need.

Because there is something in there where we say, we're going to give you 60 pills. You might be in pain and we don't want you to be. As opposed to. We don't think you're going to have that much pain. We're going to give you a little bit. If you need more, call us, right? That also sets an expectation, uh, for patients and sort of the.

the mind body, connection on, on pain and our perception of pain, which is a whole field of study into itself. 

[00:38:41] Stephen: correct.

[00:38:43] Rita: so that, that's amazing, Dr. Hochschuler, you, you went from having pain, getting it figured out, you know, you had this awareness, you had a spine problem, you figured out what the problem was, you found the right treatment, you found the right surgeon that you felt comfortable with.

You had your operation, you went home, and you're, you're up and running. With the exception of some of that anesthesia, you know, wackiness that, that can linger for, for a period of time. Physically, you're back to doing the things that you want to do. Is that, is that a summary of the

[00:39:20] Stephen: Yes, again, you've got to be cautious post op in terms of lifting, bending, twisting, all these things, but I'm At this point and it's, uh, I guess two months post, I'm, uh, walking quickly three miles, each day. I'm lifting light weights because I think, uh, weights are important. But light weights, uh, you know, it's not like when I was 20 where I wanted big muscles.

Now I want just fit muscles, but not big, not big muscles. Uh, I don't want to carry any more weight than I need to carry. And, uh, I just, I'm back into everything I used to do. You need to change certain activities. So, you know, it's like when you treat young patients, and, uh, let's say they have a problem, but, and you caution them not to do certain activities, but they do them anyway.

Well, at least they've got to know the consequences and not complain thereafter or try not to. And it's the same with any patient. So you've got to get back and get back in a smart way, normally with physical therapy, occupational therapy, different things to get back to work. We used to have what was called work We would copy what the patient had to do on their job. and teach him how to do it with proper body mechanics to prevent future insult.

[00:40:54] Rita: Oh my goodness. That's brilliant.

[00:40:56] Stephen: Well, it works. The other thing is, there's a big argument that back supports work. Well, in my way of thinking, back work because they remind you when you have it on to be careful.

[00:41:09] Rita: Yeah.

[00:41:10] Stephen: You don't want to get dependent. You've got to keep your core strong,

[00:41:14] Rita: Mm

[00:41:15] Stephen: and I'm fortunate, my core has always been strong, and there are ways to do it without injuring your back.

[00:41:22] Rita: hmm. And so learning those techniques is really important and finding a skilled trainer or physical therapist to help you learn how to do that, is worth the time spent to do that because it could save you, uh, in the long run for sure.

[00:41:40] Stephen: I fully agree, and I used to always comment, physical therapy is not physical therapy is not physical therapy. So as a physician, I'd say what I wanted done. So for instance, I wanted core strengthening, balance. And we haven't

[00:41:58] Rita: I was going to, we was going to, I was going to talk about balance. That was my next question to you. And we've had a little back and forth on balance postoperatively I was thinking as you came out of the surgery and, and you physically felt fine, but you felt the anesthesia was making you a little foggy.

I think there is a risk of imbalance or, you know, that sort of. Risk of falling. Was that something that you thought about? And was that a factor for you immediately? Uh,

[00:42:27] Stephen: you always think about it. And as we get older, balance, we lose balance. This is universal. However, if you work on balance, you can get it back. But the sooner you start working on balance, like if you worked on balance your whole life, You won't lose it as quickly as you get older, but even as you get older, when you notice, you know, like I used to be able, without thinking, you put on your pants one leg at a time.

You get, you get older, you got to think and maybe lean against something as you put your pants on, so you don't fall. Now that sounds absurd to somebody who's, uh, you know, 50 or 40 or 30 years old. But slowly but surely you lose balance, so you gotta work on it.

[00:43:15] Rita: Yeah, that's so interesting. Um, Dr. Hochschuler, September is, um, Aging Awareness Month, in the United States. And I think that the National Spine Health Foundation has a role to play in that aging awareness. And some of the things you've just described, the natural aging process, you talked about changes in your, your back anatomy that happened just as the natural course of aging, whether or not it's osteoarthritis or arthritis, it's just the aging process.

And that can. cause conditions like you've had, and, and other, other anatomical changes, um, and balance being a really big issue that we should talk about more in our society. Um, because it's like an annuity. If you're doing. yoga training or balance, activity, you know, in your younger years, whether it's you're in your thirties, forties, fifties, sixties, the sooner you begin doing those kinds of activities, it's like putting money in the piggy bank, right?

you will have that longer. And I think that's, that's something that we feel we have a role to, to play in educating, people about that. So I, I thank you for bringing that up.

[00:44:24] Stephen: I think it's all very important, and just listening to you just a second ago, what I have noticed, yoga. Now, yoga, women are better to yoga than men. Now, isn't that interesting? Why? Men tend to have more big motor control, big muscles. Women have more fine motor control. Now, as good a shape as I always thought I was in, if I went to a yoga class, I'd be shaking. I'd be sweating and shaking. I'm serious. And why is it? Because fine motor control, just, I didn't keep it up. And I think yoga is so important, and not that I do a lot of it, because I'm more into, you know, exercises you see in a gym that men do.

[00:45:22] Rita: yeah,

[00:45:22] Stephen: I think it is key to do fine motor control, and yoga is about as good as you can get.

[00:45:31] Rita: that is great advice. such great information. We do a lot of information on, on yoga, uh, flexibility, myofascial release, those kinds of activities that keep your muscles trained and that fine motor control, which helps ultimately with balance. you know, as, as we age, it's so important. gosh, if we could all be doing what you're doing at your age.

Uh, you, you've, you've written a playbook on this, um, just by living the life that you've, you've lived. It's, it's actually very remarkable and how awesome to be at your age, to be able to undergo pretty major back surgery. And um, Back to doing most of the things you want to do and, and looking at, um, you know, traveling and attending conferences and, and just getting back to your life.

 that's such, such great news for people. And we're here to give that knowledge because the knowledge gives hope. to others. and that hope helps you overcome fear. and, and that's so wonderful. So thank you for your time today. Dr. Hochschuler, you're a very humble man. Um, we haven't gone through the list of accolades, that are applied to you.

You've, you've mentioned, you know, inventing devices and things, but you really have been at the forefront. of the revolution in spinal health care that has benefited millions of people, not only in the United States, but in the world. and of, of all the things that you've done, can you share with our audience some of the achievements that you're most proud of to have been part of?

[00:47:12] Stephen: I really think what I'm most proud of is getting people better. I mean, that sounds a little trite, but it's true. you know, a lot of times I'd go to the surgeon's lounge where you had lunch and hearing several doctors complaining of how the economics of healthcare have changed, how, uh, insurance companies are driving them crazy and this and that and the other because you have so many influences working on you nowadays.

The only two that should be important is number one, the patient, number two, the doctor, and then you get the insurance companies, you get attorneys, you get work comp, you get all sorts of crazy things. And I always felt that despite what happens with economics and this, that, and the other, look what a privileged position you're in, that a patient trusts you with their life.

[00:48:06] Rita: Yeah.

[00:48:07] Stephen: that is an amazing. Thing and when you can give them what they consider their life back just makes you feel good And so for me, everything else is kind of ancillary. I mean, it's been a fun trip. I've enjoyed what I've done, and if you like what you're doing, you really never feel you're working. And the only thing I felt different from when I was practicing to now is that despite the fact when you cut back and you're no longer operating but you're still seeing patients, you still, there's a subconscious worry.

And when you no longer have that burden,

you're much more relaxed. So I find, as I got older, and I didn't worry about, you know, did the patient do alright, am I going to have a complication, is there a post operative bleed, or any of these things, you don't know, but you carry that with you, and if you don't, As far as I'm concerned, you're not a good doctor.

[00:49:10] Rita: Yeah. That's amazing. Dr. Hochschuler very, very beautifully said. And, I think that is what has propelled you to achieve so much in your life to have been at the forefront of inventions that have made people's lives better. and throughout that time, contributing to advancing knowledge and advancing evidence.

Um, you've been with us A leader, a founder of professional spine societies and, um, been very committed to patient education, uh, throughout your career. And we need your input. We need your, uh, your wisdom and your insight, uh, here as we, as we roll along in the foundation. So with that, are there any final comments or thoughts or words of wisdom you've given so much today?

Um, Words of wisdom to, to people listening. Any, any closing comments or closing thoughts?

[00:50:05] Stephen: Yeah, I'd say one thing in closing, uh, throughout my life, I've gone through a lot of interviews, uh, a lot of, uh, speeches, et cetera, and I really have to say, Rita, and I'm not a paid performer. You're the best interviewer I've seen. Your knowledge is incredible. You place it, you position things in a very logical manner.

And I appreciate the interview.

[00:50:32] Rita: Thank you, uh, to our audience. I promise I didn't ask him to say that. That means a lot to me. That means the world to me. I'm so I'm so humbled. I'm so honored, um, for you to share that. So thank you for that. At the National Spine Health Foundation, something we believe in most is providing hope for recovery through sharing stories of success and expertise. It isn't always easy to find someone to relate to, even though 100 million adults suffer from neck or low back pain every year. To hear more stories of spinal champion recovery and to access educational materials about spine health, visit us at SpineHealth.

org. If you're interested in supporting our show financially, you can contribute at the link provided. Thank you for listening.