Very interesting seminar. First 1/2 was by Dr. Vernon Williams talking about COMPREHENSIVE pain management and diagnosis provided by his full service facility at Kerlan-Jobe Orthopaedics. I was very impressed and believe that he really has a great approach.
There were some great discussions... definition of pain includes both sensory and emotional component and something I'm understanding more and more, that chronic pain can become a disease unto itself. He had many very informative slides discussing nociceptive vx. neuropathic pain.
I asked how trigger-point injections can work for referred pain and he really nailed the answer and made me understand how even though the source of the referred pain may be elsewhere, our response to the referred pain sets up local problems that contribute to a complex pain syndrome. During his explanation he pulled his elbow into his waist as an example guarding mechanism to explain how the guarding itself can cause pain. His motion was so much like mine... everyone laughed when I said, "are you making fun of me?" My shoulder hurts like hell as I write this and I wish K-J was on my insurance... I'd be camped out in his office right now.
Best line of the night was when he talked about "evidence based medicine" being used by insurance companies to deny reasonable coverage. He said, "Evidence Based Medicine say that we must use the best available evidence. It does not say that we only can use double-blind, randomized, placebo controlled..... studies."
Dr. Williams also had a great section on how Thoracic Outlet Syndrome mimics cervical spine problems. His was the first presentaion I've seen on full-agonist vs. partial-agonist opoids and his use of Buprenorphine instead of traditional opioids. I will not preted to understand this or to be able to explain it. I look forward to learning more .
Nicely done Dr. Williams.
It was great to see Bill Dillin... I had only seen him once as a patient > 8 years ago. He looks younger now? His presentation was about making surgical decision. He presented an overview of treatment options and a much more 'real world' outcomes than what I'm used to seeing surgeons present. His bad review of fusions for back pain kept me from doing a 2-level 360 fusion in 2000. There is NO QUESTION about it... this man does not do surgery because it's lucrative. He will only do surgery if he has a very high expectation of success.
While I appreciate his candor and his caring demeanor and think that EVERYONE considering spine surgery should hear what he has to say, I do not agree with so much of what he has to say. He seems to believe that lumbar ADR via anterior procedures is an absolute non-starter because of potential revision issues. If his recommendation is no fusion, adr or other surgery (for back pain) beyond the low invasive high success surgeries, I think that he paint the entire patient community with too broad a brush and does not understand what people that are in the condition I was in before my ADR surgery face. Even if he's right that it's only 60% successful, the patient should be able to take that risk. Actually... his position is completely reasonable in selecting the surgeries that he wants to do based on what he believes is an acceptable success rate. You have the choice to go elsewhere. There... so I change opinions in mid-sentence.
I was pleased to be able thank him personally for the great help he was to me in 2000. I also thanked him for Maria, as she told me about him calling her before she had even seen him. He's a great guy and it's a pleasure to deal with a doctor who's motivations are so clear.
Thanks Dr. Dillin!
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