From Pain To Possibility, Diane's Brain & Spine Story

A stiff back and aching leg can look like a simple lower spine problem until the real culprit hides higher up. We share Diane’s journey from conservative care to targeted injections and, finally, two precisely timed surgeries that unlocked lasting relief. Along the way, our interventional pain specialist and neurosurgeon walk through how they think, starting with imaging and exam, testing hypotheses with blocks and epidurals and only then decide whether surgery is the safest, most effective move.

You’ll hear how short-lived relief from medial branch blocks, rhizotomy, and epidural injections became a diagnostic signal, not a failure. The turning point came with a second MRI that revealed severe cervical stenosis compressing the spinal cord, an insight that explained leg symptoms and shifted priority to neck surgery first. We break down why the cervical spine often takes precedence, how operating where the danger is highest can also calm symptoms elsewhere and why “smallest effective surgery” often beats a bigger, hardware-heavy approach.

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Transcript

Meet The Care Team

Cami Smith 0:00

Hi, and welcome to And So Much More. I'm your host, Cami Smith, and I am here with a bigger team than I'm usually here with. Usually it's just me and one other person. But we get to hear such a great story. A friend of mine and co-worker, Diane. And Diane, you were having some back and neck pain, which kind of started your journey toward the care that you received. And we're going to hear a little bit about that. But I'm also here with Dr. Jeong and Dr. Estrada . We are in the new Langhorne Medical Center, which is absolutely beautiful. And we're excited to kind of see the doors open and patients coming in. So why don't we first just to get to know you guys a little bit, Dr. Dr. Jeong, tell us a little bit about yourself and then what your role is here at Centra?

Speaker 2 0:51

Well, nice to meet you all. My name is William Jeong. I'm a neurosurgeon here, and I'm also now the executive medical director of Centra Brain and Spine.

Cami Smith 1:01

Okay. And then Dr. Estrada?

Speaker 3 1:03

Yes, I'm the interventional pain management doctor here, medical director of the office as well.

Speaker 1 1:09

Okay.

Speaker 3 1:10

I deal with uh patients with chronic pain and uh do injections for any type of neck and low back pain.

Cami Smith 1:17

Okay. Which everybody who is watching has probably had some type of pain at some point in their life. Um, some probably worse than others. And I know when your pain is more chronic, um, there's this urgency to just figure out what's going on and find the best care possible and find out how to get this fixed as soon as possible. And Diane, that's kind of where your story began. So why don't you tell us a little bit about your journey?

Speaker 1:44

Yeah, so back in at the end of 2023, I started, I had been having what I thought was arthritic pain. My mom had some pretty severe arthritis, and so um I was having a lot of stiffness in the evening and in the morning. Um, and so I thought that was pretty manageable. I was doing a lot of conservative treatments, I try to stay fit. I'm a big walker, I love to walk. Um, and it was becoming increasingly difficult to walk. I was starting to have pain down my leg, which was new. I had never experienced that. So I did a lot of conservative treatments. Um, I went to physical therapy, I joined a stretch clinic, um, I was seeing a chiropractor regularly, and I was just getting worse. And so, with my family history, uh, my dad, over the course of his life, had over nine back surgeries.

Speaker 1 2:36

Oh my.

Speaker 2:36

My mom also had some spine issues. So I had done a lot of research and had walked that journey with them in their life. And so I knew that for me the next step was going to be epidurals or trying to look for injections to see if that was an option. And that's how I got to know Dr. Estrada and the pain management center here at Centra. And he um I'll let him talk, but he off he did the first MRI. I had never I had never had even an x-ray on my back. Yeah. Um, and so we really didn't, I had no idea what my issues were.

Cami Smith 3:08

Yeah, or probably where to even begin. Yes, yeah. Um, so Diane is the marketing director of um center marketing and and one of my bosses. And so, you know, getting to just work with you every day and see this progress, um, knowing that you guys would go on your walks every single day. Um, and then even in meetings, like I remember you just really having to stand a lot and still engage and be a part of what was going on, but it was just uncomfortable to sit for long periods of time or be able to go and walk. And um, and I know we were all kind of you know in there with you, just hearing how things were going and hoping. And so your first step was with Dr. Estrada. And so, why don't you tell us a little bit from a clinical perspective what that looked like?

Speaker 3 3:59

Um, so I began by getting imaging to see um what was exactly going on with the spine, yeah. Um, and I did find several issues with it, and uh uh the the best targeted therapy would be injections at that point. So we started doing a set of injections. Um, we did uh these uh medial branch nerve blocks followed by lumbar rhizotomies, which helped some. Um and then we started addressing the leg pain that she was having with the epidural injections. Um there was always some degree of partial relief, okay, um, but the relief was uh short-lived, and so that's when the decision was made to maybe have a consultation with my colleague, Dr. Jeong.

Interventional Plan And Limits

Cami Smith 4:43

Yeah, and so that collaboration between the two of you, which you know was incredibly helpful. Yes. And does that happen often? Like, is there a lot of intercommunication amongst like a care team like that when things like this happen with patients?

Speaker 3 4:58

Uh yes, it is, and um, we rely primarily on the medical record system to follow up and see what the notes are saying from your colleagues. Yeah, but now that we are together at the this new Langhorne Medical Office building, we're right next to each other. So it does add an additional step, a nice little step uh where we can just talk to each other face to face whenever we can.

Cami Smith 5:24

So, what all do you explore with your patients before you are stepping in or looking for that type of feedback outside of your work? Um, yes, with Diane, but also, you know, in other instances for those who maybe aren't experiencing that specific type of pain, um, what areas do you explore and what treatments do you provide?

Speaker 3 5:47

Um so uh primarily um the most common pain locations are neck and lower back. So we really do focus on those areas. Um we use a multimodal approach, a comprehensive approach. So that involves physical therapy, um, over-the-counter analgesics, um, creams, uh even prescribed medications of all different classes. And then we also address neck and low back pain with more interventional techniques like injections and risotomies. Um, we do all these things and um and we kind of gauge the relief achieved. We're looking for improved functionality, um, return of quality of life, and uh you know I've seen a lot of patients not be able to hang out with family members on vacation, not be able to walk on the beach because the pain inhibits that. So if I can provide relief, um it's all go. Yeah, and if I'm not, then you know if the imaging supports maybe a neurosurgical consult and possible intervention, then I get my colleagues to come in.

Cami Smith 6:57

Okay, so enter Dr. Jeong.

unknown 7:00

Yes.

Teamwork In A Unified Center

Cami Smith 7:01

Um, so when you specifically for Diane's situation, when you were brought in, what was your initial perspective?

Speaker 2 7:11

Um the initial feeling is a surprise because we work together all the time. She's a close colleague of ours. So when I walk into the clinic and see her, of course, there's an element of surprise and concern.

Speaker 1 7:25

Yeah.

Speaker 2 7:26

But it's also a reminder that what is the condition that we treat affects so many of us.

Speaker 1 7:32

Yeah.

Speaker 2 7:33

It can be affecting us, and nobody's immune to that. So again, it's a reminder for those of us, like Dr. Estrada and I, that we're making an important decision that affects everyone. Uh but then you have to get the physician and the patient relationship going. So the first visit is always about identifying the problem. Uh, in this case, things are easier because I have a good patient and a good colleague, and I'm able to share the records and I'm able to understand everything, but have to do our due diligence. So the first visit is just making sure that my understanding of the problem is accurate. Because oftentimes patients are worried about coming and seeing us because they think it's all going to be about treatment, right? Injections for you and surgery for me. But this is not a technical exercise for us. In order to give good outcome and improvement, we have to identify the problem. So we spend a lot of time talking, going back about what's been bothering, more in a chronic level, subacute level, but then what is something that's been getting more worse in recent times? After that, we evaluate the imaging. And but another important thing, even before that, is examination. When patients start responding well to treatment or there are certain acute changes, then what I start thinking is do I have the right problem list? Because not everyone, not this is not always the case, but it is not uncommon for patients who're having a problem in one part of the spine to have similar, similar things going on in different parts of the spine. And that ended up being the case here as well.

Speaker 1 9:10

Yeah.

Surgeon’s Approach To Diagnosis

Speaker 2 9:11

So I think the most important thing is as a surgeon, treatment is still the last resort, even for surgical subspecialty. Um we know very well that the goal of care is to get the patient better.

Speaker 1 9:22

Yes.

Speaker 2 9:22

And if we can do that without surgery by identifying the problem and working close with colleagues like that, then that is the goal.

Cami Smith 9:30

Yeah. So, Diane, at this point, you're facing surgery. What was your what was your mindset at this point?

Speaker 9:39

So, again, my dad had had multiple surgeries, some had great outcomes, and some not so great. So, like a lot of people out there, I was fearful of surgery. Um, but I was also also optimistic and I knew that I had to get back to my life. I'm extremely active. And um, so after meeting with Dr. Jeong and my husband came with me, the second appointment, um we went through the second MRI because out of an abundance of caution, because I had been having some numbness in my arms, um, Dr. Jeong said, Well, I think maybe we need to do an MRI of your neck too. So again, I'm gonna let you know.

Cami Smith 10:20

Well, also, real quick, now that MRI step is also in this building. Yes. Yes, and so just one more. I really think that it is incredibly special to have so much together in one space, that collaboration and then that consolidation of um services and care, it just makes things so much easier. Yes, it's gonna be so easy for patients, yes, and convenient. So we were at two MRIs now.

Speaker 10:46

Yes, okay, yes, and actually my surgery for my back was scheduled on July 15th. Okay, and when I went in for my appointment, which I think was just like not even two weeks prior to July 15th, Dr. Jeong had some interesting news to share with me. Oh gosh, okay. So what happened next time?

Speaker 2 11:04

Yeah, so interesting news is generally not a good news. Well, but I was concerned, I was concerned after hearing the story. I realized that maybe there's something else going on and didn't want to just pigeonhole ourselves and focus in the lower back and miss something else that is happening. So we ended up getting an MRI of the neck, and the MRI of the neck ended up showing a severe narrowing and compression of the spinal cord. So the thing about neck that is tricky is that because it connects the brain or our head to the rest of our body, any compression or impingement on the neck can also affect the other parts, such as the lower back and the legs, the arms. So then we had to have some tough conversations after reviewing the films at all options, and you know, make an important decision.

The Crucial Neck MRI

Speaker 11:57

Yeah, yeah. So I did end up having surgery on July 15th, but it was for my neck. Wow. Which was heartbreaking because I was so excited about finally getting the pain out of the legs so I could walk again. But a necessary step. But a necessary step.

Cami Smith 12:13

So were these things related?

Speaker 2 12:16

Uh yeah, so the nerves are because any impingement on the neck can also affect the outer body parts, and plus you're dealing with the spinal cord in the neck, which is generally more delicate than the nerve in the lower back. If we have two options, we generally like to operate on the neck first and see how much of that symptom was responsible for the patient's symptoms, including the lower back and the leg.

Cami Smith 12:40

I see. Okay.

Speaker 2 12:41

And then sometimes we get lucky, sometimes patients get robust improvement and are surprised, but also realize that a lot of their symptoms were related to the neck. And then we can push back surgery, and they end up getting the relief that they were getting initially without Dr. Estrada, and we can keep pushing back. But there are patients where it was important and then they get some improvement, and it was also to prevent further decline and compression, which can be dangerous, and then them needing to have another surgery in a short stage manner.

Speaker 13:12

Yeah.

Cami Smith 13:12

Okay. So then surgery number two.

Choosing Cervical Surgery First

Speaker 13:15

Yeah, so Dr. Jeong had suggested that I wait three months, and I wasn't happy with that. Um, I said, I don't think I can wait three months. Um, and luckily I re responded and recovered really well from the next surgery. I mean, I was very surprised. Um, and so when I went for one of my follow-up visits, I sort of begged Dr. Jeong and said, Can we please do it sooner? And he agreed. And so on August 19th, I had my back surgery. Yes, and um, I've been doing physical therapy, and that's finished now, and strengthening my core and getting my neck muscles back. Yeah, and um, I'm doing great, and I'm back to walking two, three miles every day, yeah, and working out with some light weights again, and uh, so I've I've got my life back. Yeah, yeah.

Cami Smith 14:10

That's huge. So is there ever a reason for a patient after surgery to go back to Dr. Estrada's side of things, or is that more of like a road in? Is it also like a step down?

Accelerating Lumbar Surgery

Speaker 2 14:22

Oh no, that's a great question. Um so surgeries can be performed for different reasons, uh, pain being one of them, but sometimes we have to do surgery to preserve neurological functions and allow the quality of life. So there are often times when I do surgery to preserve those neurological functions and may create more space for the nerve. But I offer smaller surgery that doesn't involve either instrumentation or hardware. So I know before that that the surgery might be beneficial for the nerves and the neurological function, but the patient might have continuous joint pain or aggravation of other things, then I let the patient know that clearly before the surgery, that there's going to be a lot of collaboration between Dr. Estrada and I. And if the surgery ended up making the low back pain worse related to the joint, then still it's a better option for them to get radio branch block and radio frequency relation without Dr. Estrada than just having a bigger surgery up front. Because one thing that I realized over the years is that you can't do bigger surgery thinking that it's gonna prevent patients from having more surgery down the road. Often a bigger surgery will lead to bigger surgery, but unless it's if necessary or impossible. So we often collaborate in that manner as well.

Cami Smith 15:41

Okay. Wow. So how are you feeling now? You said you have your life back, you can do some of these things that you love to do. I know you love to travel, and that's probably gonna be a lot more um enjoyable and easier now as well.

Recovery, Results, And Return

Speaker 15:55

Yes, I'm really looking forward to my new chapter. And uh what I really want to say for everyone is there's hope. So, you know, living with debilitating pain isn't much fun, um, but we have great care here at Centra. And I'm here not as a Centra employee, quite honestly. I mean, I've been here with Centra almost 18 years and I've loved every minute of it. Yeah, I just want people to know that we've got great care right here in Lynchburg. Yeah um from injections to physical therapy, we have a great physical therapy team to neurosurgery, and there's help available. Um, and so physical therapy also in this building?

Cami Smith 16:37

Yes, also in this building. This is not a commercial for Billing for a medical center, however. No, I love that you brought that up because as someone who just cares about you, to see you um have this weight lifted off of your shoulders um is huge. And and I know that you have become really an advocate for those who think that you have to travel elsewhere to get this type of help. And um to just I think it's so important for communities to know that this level of care is available, whether that is surgery or if that is pain management or if that is physical therapy, like there's so much that is available to you here at Sintra. Um, and just you know, advocating for yourself and getting that ball rolling is so important. Like don't just suffer in silence.

Speaker 17:27

Absolutely. Yeah, do it. There's a light, there's a little bit of, but you just you have to do it and you have to be committed to it. And uh yeah, so wonderful.

Cami Smith 17:36

Well, thank you all for sharing your perspective and your experience and um and just kind of showing a little inside perspective of you know what happens in a patient journey when you start and you don't know what's next or even know how to proceed, and things can fall into place with the right care team. And um, so yeah, I really appreciate your time and thank you all for watching on and so much more.