Back Talk Doc

Just like the spine — the clinicians, doctors, and practitioners who practice spinal care comprise a complex system.

In this episode of Back Doc Talk, we are talking about the team it takes to manage your spinal health, and especially the role of Physician Assistants (PAs). 

PAs like Mike Nido of Carolina Neurosurgery and Spine Associates are responsible for a range of treatments and assistance when it comes to fixing back and spine problems.

But is patient care compromised when you see a PA instead of a physician?

PAs are a backbone of the spine issue treatment. Pun fully intended!

Whether it is always seeking that second opinion, having multiple safety nets in place when it comes to films and imaging, or just having a friendly face,

“We make it very clear to [patients] that even though I'm here providing your care, the doctor that's standing behind me is very aware of what's going on and very involved in all of the decisions that are made,” Mike explains.

Listen to this episode of Back Talk Doc to understand the role of a PA and the type of care you can expect from one, how they work with physicians to address spine issues, and much more.

Name: Michael Nido

What he does: Mike pulls double duty not only as a Physician Assistant, but also as the Director of Clinical Services at Carolina Neurosurgery and Spine Associates. He’s been with the clinic for 24 years. 

Company: Carolina Neurosurgery and Spine Associates

Words of wisdom: “The important thing for our patient to understand is that you're not getting second class care. You're not going to the B team. This is your way of getting your foot in the door, getting your care initiated in such a way that by the time you see the physician, all the important stuff has been completed and ready for his review.” 

Connect: LinkedIn

Top takeaways from this Back Talk Doc episode 

★    The team needed to keep a clinic running is larger than you think.  Between doctors and receptionists, nurses, and PAs, there are more types of medical professionals at your local spinal clinic than you may realize. It truly takes a team to provide care and aid your back and spinal recovery.

★    PAs and physicians are in constant communication. One of the main concerns from patients when they go into a clinic and are assigned a Physician's Assistant rather than a doctor is that they may not believe the PA is up to the task. But the fact is that PAs work very closely with physicians and are making sure you are getting the highest quality care. PAs and physicians communicate a ton behind the scenes.

★    Seeing a PA is practical. When patients see a Physician’s Assistant rather than a physician, they’re not getting sub-quality care. In fact, it makes practical sense because a PA can help a doctor get all the tools needed to make a diagnosis. PAs help get tests done and identify the problem so that by the time the patient does see the doctor, everything will be in place for diagnosis and treatment. 

[00:00] Mobile-based solutions for clinical practice: Check out our sponsor, QxMD, which builds mobile solutions that drive evidence-based medicine in clinical practice.

[02:47] Introducing Physician Assistants: The lead Physician Assistant at Carolina Neurosurgery & Spine Associates, Mike Nido, describes his role.

[05:13] The role of Physician Assistants in clinics: Mike gets into the details of his day-to-day experience as a PA, including the education needed and what types of patients he cares for.

[07:33] PA vs. Certified Nurse Practitioner: Knowing all the different types of practitioners can be overwhelming. Dr. Lakhia asks Mike to explain the difference between these roles, especially in a clinic and hospital setting.

[9:55] But I don’t want to see the PA: Communication is important. Mike and Dr. Lakhia discuss why patients are often skeptical of Physician Assistants. They also talk about why this skepticism usually isn’t founded. 

[12:09] Teamwork: Not all clinics have a collaborative model, but it is something Dr. Lakhia believes is beneficial for overall care.

[13:20] Getting an appointment is the hardest part: Everyone understands the pain of waiting to be seen. By choosing a PA instead of a physician, Dr. Lakhia explains that patients can get into the clinic a lot faster.

[14:13] Show and tell: Wrapping up. Mike Lido shares a bit more about himself and his family.

👉 If you enjoyed this episode of Back Talk Doc, check out our recent episode How Back Pain Can Affect Your Relationship (and What to Do About It).

🔎 For more information on Dr. Sanjiv Lakhia and the podcast visit BackTalkDoc.com.

🎧 Subscribe in your favorite podcast app.

Back Talk Doc is brought to you by Carolina Neurosurgery & Spine Associates, with offices in North and South Carolina. To learn more about Dr. Lakhia and treatment options for back and spine issues, go to backtalkdoc.com. To schedule an appointment with Carolina Neurosurgery & Spine Associates, you can call us at 1-800-344-6716 or visit our website at carolinaneurosurgery.com.

We’re talking about healthy relationships on this episode of Back Doc Talk.

What does that have to do with back and spine health? A lot. 

With power couple and relationship coaches Jocelyn and Aaron Freeman at the helm, this episode examines how back and spine issues can affect your relationship and vice versa. 

Physical pain influences how we feel and how we interact with others, and developing a conscious awareness about how that affects our loved ones is critical.

Aaron dissects the difference between pain and suffering, while Jocelyn explains the importance of setting expectations. 

A sudden injury can change your life considerably, and dealing with the pain can feel like a burden to a partner. One way to address this is by more clearly defining roles and responsibilities when a family member is dealing with pain. This helps ensure there’s a discussion around expectations and to avoid leaving family members disappointed. 

Helping a partner who is managing pain is a balancing act — one that can be strengthened by better understanding how your partner communicates. No one is a mind reader! 

Tune in to this episode to discover how you can improve communication about back pain and prevent spine issues and injuries from wreaking havoc on your relationship.

Name: Aaron and Jocelyn Freeman 

What they do: Aaron and Jocelyn are a power couple in the relationship world, helping couples navigate the highs and lows of married life. Through their sold-out events all over Arizona, their book, and coaching classes, Aaron and Jocelyn are in the business of healthy relationships. They are the founders of the Empowered Couples University, which helps couples harness important communication skills and invest in their relationship. 

Company: Meet the Freemans 

Words of wisdom: “[T]he place to really start to make a differentiation here, between the impact on the person that has the ailment, and is actually in physical pain versus the spouse. It is the difference...between pain being of the body and suffering being of the mind.” 

Connect: LinkedIn | Facebook | Podcast

Top takeaways from this Back Talk Doc episode 

★    Open communication is your greatest tool. To prevent pain from creating havoc on your relationship, open and honest communication is essential for couples. This applies directly to how spouses and partners deal with their loved ones being in pain. How to navigate that is critically important, not only for suffering but for support.

★    Understanding you and your partner’s personality type is crucial. Whether you are a reserved or assertive communicator will affect how you handle a challenge — like pain in your relationship. Knowing whether you need to ask more questions (or fewer!) can be critical in navigating pain management and care of a loved one. Jocelyn and Aaron developed a quiz to determine your personality type. Take it at mycouplesquiz.com. 

★    ‘Depositing’ thanks and ‘withdrawing’ energy. Using a bank account as a metaphor to describe the transfer of energy and emotions between couples is a useful way to think about pain and stress. When you’re the one in pain, “depositing” gratitude into your partner’s bank account can greatly help your recovery process. On the other hand. “withdrawing” too much of their energy can cause resentment. Balancing this and understanding you’re not a burden is a hard lesson to learn, but an important one.

[00:00] Mobile-based solutions for clinical practice: Check out our sponsor, QxMD, mobile solutions for driving evidence-based medicine in clinical practice.

[01:34] Introducing the Freemans: Dr. Lakhia introduces relationship coaches Aaron and Jocelyn Freeman, authors of “The New Power Couple” and “The Argument Hangover: Empowering Couples to Fight Smarter and Overcome Communication Pitfalls.”

[04:51] Breaking L1 to L4 and her relationship: Jocelyn speaks to how hurting her back had an emotional impact on her previous relationship because she pushed herself too far.

[07:29] Navigating back pain and interpersonal issues: Aaron and Jocelyn detail how to mitigate and develop a conscious awareness of how pain can affect relationships.

[9:58] Pain in the face of powerlessness: Being in pain can give people a sense of powerlessness that can leak over into relationships. Jocelyn talks about her personal experience.

[13:21] Checking on expectations in a relationship: Introducing the theme of their newest book, “The Argument Hangover,” the Freemans talk about managing expectations in a relationship, especially when there is a sudden and dramatic change like a back injury.

[17:23] Do the work: Dr. Lakhia challenges listeners to write down everything they need to do to help with their pain, from exercises to knowing who in your family is doing what. Make it concise and clear.

[18:00] Pain journaling can help expectations: While pain journaling is nothing new, Dr. Lakhia and his guests discuss how it can be used to help set and meet expectations when it comes to pain.

[22:08] Knowing your communication type: Jocelyn breaks down the communication personality types outlined in their book and the importance of not only knowing your own communication type but understanding your partner’s.

[27:17] A love bank account: The Freemans break down the concept of a “love bank account” and how the metaphorical idea of depositing and withdrawing energy from one another is applicable to relationships in crisis.

[30:32] On feeling like a burden: Dr. Lakhia reveals his own struggles with feeling like a burden to his family when he suffered a disc injury.

[35:15] Authentic conversations on Clubhouse: Aaron mentions he got on Clubhouse recently and was surprised at the vulnerable conversations people were having about their relationships.

[37:45] Healthy habits: Dr. Lakhia asks Aaron and Jocelyn about their personal workout and health routines.

[40:15] Words have meaning: Dr. Lakhia explains why the most important book in his life is “Autobiography of a Yogi,” by Paramahansa Yogananda.

👉 If you enjoyed this episode of Back Talk Doc, check out our recent episode Ins and Outs of Spinal Fusions with Dr. Hunter Dyer.

🔎 For more information on Dr. Sanjiv Lakhia and the podcast visit BackTalkDoc.com.

🎧 Subscribe in your favorite podcast app.

Back Talk Doc is brought to you by Carolina Neurosurgery & Spine Associates, with offices in North and South Carolina. To learn more about Dr. Lakhia and treatment options for back and spine issues, go to backtalkdoc.com. To schedule an appointment with Carolina Neurosurgery & Spine Associates, you can call us at 1-800-344-6716 or visit our website at carolinaneurosurgery.com.

The general public’s understanding of spinal fusion often starts with a misconception.

When Dr. Hunter Dyer talks to people about lumbar fusion, many think that it’s the screws doctors place that are the fusion. But that’s not true — the hardware just holds the spine in alignment until the vertebrae or spinal elements grow back together.

As an expert in spinal fusions, Dr. Dyer is familiar with what people get wrong or just don’t understand about caring for their spine and fixing spinal issues. It’s a complicated field of medicine and, as such, patients considering surgery like a fusion should consult with an expert first.

For example, Dr. Dyer says that most patients with back pain don’t actually need surgery. Rather, alternative care like physical therapy is often a better starting point before committing to the sometimes-extensive recovery from a fusion procedure.

In addition, there are myriad risk factors to consider: Does the patient smoke? What’s their surgical history? How old are they? What’s their body type? All these things and more, Dr. Dyer says, can influence whether a patient is a good candidate for a spinal fusion.

On this episode of Back Talk Doc, Dr. Dyer explains all things spinal fusion with host Dr. Sanjiv Lakhia.

Name: Dr. Hunter Dyer

What he does: Dr. Dyer is an expert in degenerative spine disease, endoscopic spine surgery, minimally invasive spine surgery, skull base surgery, spinal fusion, transsphenoidal surgery and vascular neurosurgery. He is the President at Carolina Neurosurgery & Spine Associates. 

Company: Carolina Neurosurgery & Spine Associates 

Words of wisdom: “The key to any great job, or being good at what you do, is I absolutely love what I do. I wake up every single day excited to see what I've got for the day and see if I can help people surgically, to see if I can help people in the clinic. And that's why we love being physicians and we love being in health care, because it's just so rewarding.” 

Connect: LinkedIn

Top takeaways from this Back Talk Doc episode 

★    Most spinal issues probably don’t need surgery. Even as a surgeon, most patients Dr. Dyer sees can address their issues with conservative care — physical therapy, spinal traction, or injections. “The only people that we need to consider for spinal fusion are typically those that have problems where they require so much bone removal that they require stabilization of the spine,” he says.

★    Smoking is a major risk factor for spinal issues. It can affect people with problems in either the neck or back. “We typically do not like to even consider spinal fusion if somebody is using tobacco,” Dr. Dyer says. “If they've used it in the past, it's likely that they get degeneration of the disk and that can lead to accelerated adjacent-level problems.” 

★    The direction of spinal surgery can influence the healing process. Dr. Dyer explains that when a surgeon uses a lateral approach, patients don’t often experience a lot of pain. When the best course of action involves the posterior or anterior approach, patients can experience more pain after surgery. “In general, there's more pain with the posterior approach, but it's still the most common way because it does provide that direct view of the nerves,” he notes. 

★    Spinal fusion techniques are advancing rapidly — which is good for patients. In the past five years, technology has advanced so that surgeons can be more precise with placing screws, thanks to MRI and CT images. In addition, robotic tools have made surgery much safer and much easier to heal from. “For many people, it’s just a better thing all around,” Dr. Dyer says.

[00:00] Mobile-based solutions for clinical practice: Check out our sponsor, QxMD, mobile solutions for driving evidence-based medicine in clinical practice.

[01:45] Introducing the physician: Dr. E. Hunter Dyer is a specialist in degenerative spine disease and endoscopic spine surgery, among other things.

[03:50] Neurosurgery isn’t just for the brain: The reality, Dr. Dyer says, is that spinal issues make up the majority of neurosurgeons’ caseloads.

[05:50] Conservative care can help most spinal issues: Care options like physical therapy or injections are often the first steps in recovery before exploring spinal fusion.

[8:20] What is lumbar fusion?: It’s not actually referring to the hardware. “Fusion is actually the growth between or around the spinal elements, whether it's the vertebrae growing together, or whether it's the spinal elements in the back part of the spine that grow together,” Dr. Dyer explains.

[10:40] Two types of spinal instability: One is in patients who haven’t had any procedures and have their vertebrae moving due to degeneration of spinal joints; the other is found in someone who has had excess bone removed, creating an unstable spine where doctors must secure spinal segments.

[13:00] Changes for lower back care: Dr. Dyer says spinal fusions for lower back pain are much less common than they were a decade ago. 

[15:30] Differences in lumbar fusion acronyms: Dr. Dyer explains what ALIF, XLIF and other types of fusions actually mean.

[18:40] Recovery times vary: Dr. Dyer explains how and why the healing will differ depending on whether a surgeon uses an anterior, lateral, or posterior approach.

[20:40] Complexities of evaluating spinal surgery: A myriad factors within a patient can influence what types of treatment are best.

[23:44] Breaking down recovery restrictions: Post-surgery recovery varies from person to person but often can last several weeks at minimum.

[27:15] Benefits of physical therapy: Most spinal fusion patients find that physical therapy helps at a certain point in their recovery.

[28:26] On adjacent-level disk disease: Dr. Dyer explains the importance of identifying the exact problem in the patient, common post-spinal fusion issues and risk factors.

[32:27] Outlook for future surgery: There is a possibility that patients who have lumbar fusion could require an extension or further surgery down the road. Dr. Dyer says while it’s not common and it is a “complete game changer” for some, doctors should educate patients about possibilities down the road.

[34:45] Are spinal fusion surgeries overdone?: Dr. Dyer discusses why some in the medical community have the perception that not all spinal fusions are necessary and shares current insights on when it makes sense to skip the procedure.

[37:06] Looking ahead: Robotic tools, minimally invasive procedures, and new imaging technology are making for quicker-healing and less-painful procedures. “There also are incredible advances in what we call navigation,” he says, noting that navigation enables doctors to attach instruments to the imaging study.

[40:43] Final thoughts: “I'm not the best example of somebody who is an extremely regular exercise person, but I stay on the go and I think my metabolism stays at a high rate, which helps,” he says reflecting on what has helped his success. “I lean on having great family support. I've got a great wife and kids. And also the key to any great job [is] I absolutely love what I do.”

👉 If you enjoyed this episode of Back Talk Doc, check out our recent episode Reduce Back Pain and Improve Posture with Active Sitting.

🔎 For more information on Dr. Sanjiv Lakhia and the podcast visit BackTalkDoc.com.

🎧 Subscribe in your favorite podcast app.

Back Talk Doc is brought to you by Carolina Neurosurgery & Spine Associates, with offices in North and South Carolina. To learn more about Dr. Lakhia and treatment options for back and spine issues, go to backtalkdoc.com. To schedule an appointment with Carolina Neurosurgery & Spine Associates, you can call us at 1

With fifteen years of experience as a spine physician, Dr. Sanjiv Lakhia is always on the lookout for ways to help his patients improve their back health, particularly with natural, less invasive methods that can be easily integrated into their day-to-day lives. Today, we’re going to be discussing a common cause of back and neck pain, prolonged periods of sitting.

Joining us on this episode of Back Talk Doc is Dr. Turner Osler, a retired trauma surgeon, epidemiologist, entrepreneur, and founder of QOR360, a company designing chairs to improve posture and prevent back pain caused by conventional sitting.

Dr. Osler explains “Sitting Disease” and explores the negative affects sitting prolonged periods of sitting have on the body. “We think all the chairs that we have are normal, and they are not. Humans are not designed to sit all day… We're simply not set up to sit slumped in front of a PC all day.” (6:37) Many issues like headaches, neck and back pain, weight gain, and even mood disorders can be traced back to incorrect posture while sitting. Dr. Osler discusses the natural human posture (10:05) and how we have been letting our chairs shape our bodies, instead of shaping our chairs to fit our bodies. (11:34) 

Dr. Osler then discusses the benefits of “active sitting” (a sitting experience that allows and/or encourages movement while seated), including reducing back pain and improving posture. (21:23)

Other topics discussed include negative effects of sitting in a slumped posture (14:03), contraindications for using an active sitting chair, (35:11) and a word of caution for those with lumbar disk herniations or acute back pain. (38:51)

To learn more about Dr. Osler’s mission of educating the community about the benefits of active sitting, visit QOR360.com and ButtOnChairs.org, which promotes active sitting for children.

View Dr. Osler’s TED Talk.

The Gokhale Method: a system of healthy posture and movement to help restore your structural integrity, so you can live an active and pain-free life.

For more information on Dr. Sanjiv Lakhia and Back Talk Doc visit BackTalkDoc.com.

Back Talk Doc is brought to you by Carolina Neurosurgery & Spine Associates, with offices in North and South Carolina. To learn more about Dr. Lakhia and treatment options for back and spine issues, go to backtalkdoc.com. To schedule an appointment with Carolina Neurosurgery & Spine Associates, you can call us at 1-800-344-6716 or visit our website at carolinaneurosurgery.com.

On Episode 13 of Back Talk Doc we spoke with Dr. Matt McGirt about Adult Spinal Deformity (Ep. 13 - Adult Spinal Deformity with Dr. Matt McGirt.) It proved to be a popular and valuable episode for our community, so today we’re following up that episode with a discussion of scoliosis and spinal deformity in pediatric patients.

Joining us is Carolina Neurosurgery and Spine Associates’ new partner, Dr. Michael Bohl. Dr. Bohl attended medical school at the University of Michigan and completed his residency at Barrow Neurological Institute. A U.S. Marine Corps Veteran, Dr. Bohl was involved in humanitarian aid missions in East Africa. While he was not considering medical school at the time, the impact of that experience led him to return to East Africa after leaving the Marine Corp to work as a nurses aid.

Dr. Bohl and Dr. Lakhia first differentiate between the terms ‘scoliosis’ and ‘spinal deformity’, which are frequently used interchangeably. (10:17) The latter is the umbrella term which describes a condition wherein the shape of the spine is leading to a problem. Scoliosis, on the other hand, is a type of deformity where the spine shows an S or C-shaped curve.

They examine the causes of pediatric spinal deformities and urge parents to be mindful of their child’s posture as they grow. (13:20) Indicators of pediatric scoliosis include a visible curve in the spine, a curve that worsens over time, and whether or not the spinal deformity is causing symptoms like pain or neurological symptoms. The goal of treatment is to keep the curve from getting worse, usually through minimally invasive methods like bracing and physical therapy. (16:32) And, as with many medical conditions, early intervention is the key to more successful outcomes. (21:21)

Scoliotic curves get worse during periods of active growth, so a brace can help stabilize and control the growth of the curve. (21:55) Early intervention is important here because once the curve reaches a certain severity the problem is likely to continue getting worse into adulthood. If bracing is ineffective and the curvature is becoming more sever, spinal surgery may be an option. However, in a pediatric patient, smaller, less invasive surgeries are performed to manage the curve and not impede the child’s growth. (25:10) 

Candidates for surgery include curves greater than fifty degrees and curves that are rapidly progressing and not adequately responding to a brace. Dr. Bohl stresses that while surgical outcomes are overwhelmingly positive, non-surgical treatment options remain a priority for treating pediatric spinal deformities.

For more information on Dr. Sanjiv Lakhia and Back Talk Doc visit BackTalkDoc.com.

Back Talk Doc is brought to you by Carolina Neurosurgery & Spine Associates, with offices in North and South Carolina. To learn more about Dr. Lakhia and treatment options for back and spine issues, go to backtalkdoc.com. To schedule an appointment with Carolina Neurosurgery & Spine Associates, you can call us at 1-800-344-6716 or visit our website at carolinaneurosurgery.com.

We have addressed numerous aspects of low back pain from surgical angles to medications, nutrition, and injections on the podcast, but an increasing number of patients are also suffering from mid-back pain or “thoracic pain.”

On this episode of Back Talk Doc, Dr. Sanjiv Lakhia is joined by Dr. Scott Otis, a physiatrist at the Carolina Neurosurgery and Spine Associates, to discuss thoracic back pain. Dr. Otis attended medical school at The Ohio State University College of Medicine and completed his internship at Riverside Hospital in Columbus. Dr. Otis is currently affiliated with the American Academy of Physical Medicine and Rehab. An expert in electro-diagnostic medicine and interventional spine care, Dr. Otis works out of the main office in Charlotte.

Dr. Otis reveals why thoracic back pain is so challenging to diagnose, any pain experienced in that area of the body are often compensatory issues from neck or low back issues or referral pain from neck and low back issues that present as thoracic spine pain. (4:45) He also discusses non-spinal issues that cause pain and abnormalities, including GI issues, pulmonary and heart ailments, and liver disease. (07:34) The Doctors also cover other ailments including “White Collar Disease” (09:35), poor body posture, and how poor ergonomics in furniture lead to upper back pain. (09:18)

Dr. Otis also examines the methods physiatrists employ to evaluate back pain and stress the importance of ruling out non-spinal causes before arriving at a proper diagnosis. (10:30) Thoracic back pain treatment includes self-care, physical therapy, and in a few extreme cases, surgical intervention. (13:05)

 More topics discussed on this episode include:

• The effects of Scoliosis and osteoporosis (15:03)
• How to prevent osteoporotic fractures (16:33)
• The role of physical therapy in treating upper back pain (18:33)

If you enjoyed this episode of Back Talk Doc, check out our recent episode A Pain in the Neck (and Back!): How Technology, Stress, and Genetics are Leading to Aches and Pains With Dr. Sameer Vemuri

For more information on Dr. Sanjiv Lakhia and the podcast visit BackTalkDoc.com.

 Subscribe in your favorite podcast app.

 Back Talk Doc is brought to you by Carolina Neurosurgery & Spine Associates, with offices in North and South Carolina. To learn more about Dr. Lakhia and treatment options for back and spine issues, go to backtalkdoc.com. To schedule an appointment with Carolina Neurosurgery & Spine Associates, you can call us at 1-800-344-6716 or visit our website at carolinaneurosurgery.com.

By the numbers, a solid percentage of you are listening to this 29th episode of Back Talk Doc on your mobile device or in front of your computer. You may be hunched over peeping at the show notes on the screen, a noticeable strain rippling down your back. Whether you’re experiencing back or neck pain as you’re reading these words, this episode is here to help.

On today's episode of Back Talk Doc, our host Dr. Sanjiv Lakhia is accompanied by Dr. Sameer Vemuri, a partner at Carolina Neurosurgery and Spine Associates. Dr. Vemuri works at the Ballantyne and Mathews offices. Board-certified in physical medicine and rehabilitation, Dr. Vermuri received his medical training at the American University of the Caribbean School of Medicine, then went on to intern at Providence Hospital and Medical Center in Michigan. (2:27)

Dr. Lakhia and Dr. Vemuri discuss the burden of spine care in the United States. Both men care for a tremendous number of patients suffering from neck and back pain, with many patients suffering from both. Dr. Vemuri reveals four common factors leading to back pain: (1) genetics, (2) day-to-day stresses, (3) acute injuries, and (4) a big factor both doctors see: the use and overuse of technology devices. (8:59)

"Technology and our phones and our devices has really taken over our life and forced all of us to be looking down constantly and promoting somewhat of a rounded posture." (9:31) Dr. Vemuri explains that these postures place strain on the structural cervical spine in the neck region. "Eventually, you're going to have some changes in the structural anatomy of that spine, and afterwards, you're going to have more chances of irritation of some of these nerves that come through that spinal area." (10:27)

More topics discussed on this episode include:

• Providing patients with realistic expectations during the healing process (23:43)
• The importance of mind-body connections when discussing back and neck pains. (26:36)
• When a headache is more than just a headache: how to know when back and neck problems are leading to headaches. (31:36)

For more information on Dr. Sanjiv Lakhia and the podcast visit BackTalkDoc.com.

Back Talk Doc is brought to you by Carolina Neurosurgery & Spine Associates, with offices in North and South Carolina. To learn more about Dr. Lakhia and treatment options for back and spine issues, go to backtalkdoc.com. To schedule an appointment with Carolina Neurosurgery & Spine Associates, you can call us at 1-800-344-6716 or visit our website at carolinaneurosurgery.com.

While COVID-19 has the headlines, for many, 2020 has also become synonymous with back pain. Working from home has cast many people from their ergonomic office chairs to couches, spare bedrooms, and dining room chairs. 

On this episode, our Back Talk Doc, Dr. Sanjiv Lakhia, explores the benefits of utilizing electrical stimulation to combat those work-from-home back pains. Electrical stimulation, a form of neuromodulation, is essentially applying different types of electrical or electricity-based products and magnetic-based products to influence the physiology of your nervous system, that is, the brain, spinal cord, or peripheral nervous system. (3:46)

Dr. Lakhia identifies and briefly reviews three of the most common electrical stimulation devices.

1. TENS unit (4:50): TENS stands for transcutaneous electrical nerve stimulation and is available at any local pharmacy. The cost ranges from $50 to a couple of hundred dollars. The TENS unit stimulates the sensory nerves to block pain signals and generate endorphins. It is often used for the treatment of acute post-operative pain and chronic intractable pain. The downside to TENS is that it provides very short-term relief, sometimes providing relief only while being used, with a maximum relief window of 3-4 hours.
2. Alpha-Stim (8:45): Alpha-Stim waveform electrotherapy is FDA approved for the treatment of chronic pain, anxiety, and depression and is one of the more well-researched neuromodulation devices for pain. The Alpha-Stim works with small electrodes that clip to your earlobe and send a low microcurrent 0.5-hertz frequency wave through cranial nerve connections from the ear into the deep pain centers of the brain. This can stimulate the brainstem as well as the cortex and affect serotonin, norepinephrine, other neurotransmitter levels. The Alpha-Stim can also be used with wand-like electrode probes that can be applied to each side of an affected area. The probes send quick electrical pulses to the area. The Alpha-Stim may also provide relief to patients suffering from insomnia and other back pain-related sleep problems.
3. H-Wave (15:42): H-Wave is a multi-functional electrical stimulation device intended to speed recovery, restore function, and manage chronic, acute, or post-operative pain. The H-Wave delivers a low voltage current that promotes injury recovery and rehabilitation by stimulating muscles and can help prevent disuse atrophy. The H-Wave can provide significant relief, and, like the Alpha-Stim, it appears that the benefits of H-Wave are cumulative and lasting. So, over time, you get better and better results the more you use it. And it's an alternative to the use of prescription pain medication. The typical session lasts around 30 to 60 minutes. H-Wave is available both by prescription and offered as an OTC model.

For more information on Dr. Sanjiv Lakhia's practice, visit BackTalkDoc.com

Back Talk Doc is brought to you by Carolina Neurosurgery & Spine Associates, with offices in North and South Carolina. To learn more about Dr. Lakhia and treatment options for back and spine issues, go to backtalkdoc.com. To schedule an appointment with Carolina Neurosurgery & Spine Associates, you can call us at 1-800-344-6716 or visit our website at carolinaneurosurgery.com.

While the holiday season is known for evoking feelings of joy and merriment, we know that back pain can dampen even the most festive of spirits. That’s why we’re devoting this episode to our Top 10 Gift Ideas to promote a healthy spine. If you have a friend or family member struggling with back issues this holiday season, consider a gift that will help them stay active and pain-free in 2021.

1.    Traditional Medicinal Tea. Medicinal teas are available at most grocery stores, and many contain ingredients like ginger, turmeric, and meadowsweet that can reduce inflammation in the body and control or modulate your immune system. Dr. Lakhia’s favorite Tumeric with Meadowsweet & Ginger $5.79/box.

2.    Lumbar Support. Whether you suffer from back pain or not, we can all benefit from lumbar support. A lumbar support is a cushion intended to help create proper lordosis, or proper curvature, in your low back. You can use a lumbar in any of your chairs. Dr. Lakhia recommends the Core Products Small Inflatable Lumbar Cushion $30.

3.    Foam Roller. A foam roller is a cylindrical tool that you can use almost as a portable massage therapist. Placing it on the ground, you use the roller to target problem areas. A quick search on YouTube will return numerous exercise options. Dr. Lakhia recommends getting two sizes, a smaller one and a longer one, to target specific areas. Foam rollers are a cheap and critical tool to have in the toolbox as you battle any sort of back issue. Try the Gimmer 10 Foam Roller $23.

4.    Thera Cane. A Thera Cane is a handheld tool for self-treating myofascial trigger points and tender points in your back, hip, and pelvis. The Thera Cane’s design allows you to get leverage to address your pain points if no one is around to assist you. Dr. Lakhia recommends the Body Back Buddy Elite $30.

5.    Trigger Point Manual. If you’re purchasing a Thera Cane, you will also want to pick up the Trigger Point Manual. It’s a patient education manual and it shows you where you can find all the trigger points. (Learn more about trigger points in our episode on Acupuncture vs. Dry Needling) Trigger Point Therapy Workbook $20.

6.    HeartMath. HeartMath is a biofeedback tool that provides you with guided breathing exercises to help you develop what’s called heart and brain coherence, where the energy of your heart center can become in tune with the energy of your brain. The HeartMath tool takes you through daily breathing exercises. Over time, it can improve your heart rate variability, which means you’re lowering your stress and boosting your immune system and overall health. HeartMath $120

7.    Venom Back Brace. The Venom brace is like a portable physical therapy gym, allowing you to treat yourself on the go with built-in deep heat and vibration. Venom Brace from Hyperice $199.

8.    Oura Ring. The Oura Ring is a premium sleep tracker that tracks your sleep time, sleep cycles, and helps you understand how your daily habits help or hinder your sleep. OuraRing.com $299.

9.    HigherDOSE Infrared Sauna Blanket. With amethyst, tourmaline, and charcoal in the cover, the sauna blanket is going to heat you up, promote detoxification, and relax your muscles. It’s also incredibly portable and comes at a fraction of the price tag of a traditional sauna. (Listen to this episode where Dr. Lakhia discusses the far-infrared sauna) Dr. Lakhia cautions you to stay hydrated and replenish your electrolytes with coconut water or another natural, low-sugar beverage. HigherDOSE Infrared Sauna Blanket $499.

10. Original Mattress Company Orthopedic Ultra Plush Mattress. One of the top questions doctors receive about back pain is, “what mattress should I use?” This can be a hard question to answer because, like finding a good pair of shoes, mattresses are a highly personalized experience. What works wonders for one person may be awful for another. With that said, Dr. Lakhia recommends the Original Mattress Factory Orthopedic Ultra Plush Mattress. The mattresses are composed of high-quality materials, the prices are reasonable, and the company stands by its products. Original Mattress Factory Orthopedic Ultra Plush Mattress Set $600-$1300.

With something on here for everyone’s price point, we hope these products can provide some value and relief to you or a loved one this holiday season. If you have a limited budget and really can only go for one of these things, Dr. Lakhia recommends the foam roller. It’s an incredibly useful tool that any physical therapist would likely recommend.

For more information about our sponsor, QxMD, visit qxmd.com, or email [email protected]. To try QxMD’s apps, download them on your device’s app store or follow these links: Calculate by QxMD, Read by QxMD, Learn by QxMD.

For more information on Dr. Sanjiv Lakhia’s practice, visit BackTalkDoc.com

Back Talk Doc is brought to you by Carolina Neurosurgery & Spine Associates, with offices in North and South Carolina. To learn more about Dr. Lakhia and treatment options for back and spine issues, go to backtalkdoc.com. To schedule an appointment with Carolina Neurosurgery & Spine Associates, you can call us at 1-800-344-6716 or visit our website at carolinaneurosurgery.com.

Because medicine is in a perpetual state of evolution, it is incumbent upon medical practitioners to be lifelong learners, always sharpening their intellect and skillset. In recent years, much of this continuing education has become reliant on technology. While clinicians have access to scientific journals, magazines, blogs, podcasts, and other digital sources at their fingertips, quickly accessing full research articles continues to be a hindrance. Enter QxMD, a company designing apps to help clinicians keep up with the latest research and integrate decision support tools into their practices.

On today’s episode of Back Talk Doc, Dr. Lakhia welcomes the co-founder of Back Talk doc’s new sponsor, QxMD, Dr. Daniel Schwartz. Dr. Schwartz is a practicing kidney doctor, nephrologist, clinical educator, and vice president of WebMD. Additionally, he’s the medical director of a regional home dialysis program and a clinical assistant professor of medicine at the University of British Columbia.

Dr. Schwartz shares his experience building QxMD. From starting with a product with no commercial strategy to an eventual partnership with WebMD, Dr. Schwartz reveals how solving his own problem led him to designing a service focused on making it easier for doctors and other healthcare providers to access relevant medical literature. Dr. Schwartz also walks us through three of QxMD’s innovative products: Calculate, Read, and Learn.

• Dr. Schwartz’s path from clinician to entrepreneur (03:37)
• On building a useful product and then finding a pathway to profit (06:52)
• What is QxMD? (09:39)
• Overcoming access to information obstacles (13:45)
• The birth of QxMD (17:13)
• The relationship between QxMD and WebMD. (22:43)
•  What’s on the horizon for QxMD (28:01)
• Health hacks from Dr. Daniel Schwartz (30:13)

For more information about QxMD visit qxmd.com, or email [email protected]. To try QxMD’s apps, download them on your device’s app store or follow these links:

Calculate by QxMD, Read by QxMD, Learn by QxMD.

For more information on Dr. Sanjiv Lakhia’s practice, visit BackTalkDoc.com

Back Talk Doc is brought to you by Carolina Neurosurgery & Spine Associates, with offices in North and South Carolina. To learn more about Dr. Lakhia and treatment options for back and spine issues, go to backtalkdoc.com. To schedule an appointment with Carolina Neurosurgery & Spine Associates, you can call us at 1-800-344-6716 or visit our website at carolinaneurosurgery.com.