Title: From Crash to Recovery: The Truth About Back Pain, PRP & Getting Your Life Back
Downloaded: 2026-04-10 14:50:29

[music] Welcome back to another episode of the Auto Accident Attorneys podcast brought to you by the AutoAcctorneys Group where our motto is simple, we take care of you. I'm your host, attorney Ali. You can find me on almost any platform, attorney Ali. Some of them are attorney ali, others are attorney. Alali. I couldn't get them all except for X. There you can find me under Aliwood. If you're uh new to this podcast, it's not just about auto accidents. Um we try to provide consumers with information that they typically would not think about otherwise.

trying to give you as much information as possible and tie it into auto accidents in general. And today I have a friend of the show, a personal friend of mine, a very great healer, Dr. Omar Hajad. Dr. O, thank you so much for coming. >> Thanks for having me. >> I'm so happy that I get a chance to actually talk to you on a podcast as opposed to just on uh text threads. Yeah. Today, [laughter] >> Dr. O, why don't you uh tell us a little bit about yourself, how you became Dr. O, and then lead us into Olympus MD as a nice little intro, please.

>> Yeah, so I was actually born in Atlanta and we've known each other for probably close to 20 years now. And um I went to medical school at Mercer University and then graduated um from there went to Miami for my anesthesia residency and then came back to Atlanta for a pain fellowship. And during that time, I collaborated with one of my co-residents down in Miami about opening up a business in Atlanta for pain management. But um we actually joined a group before because we kind of were like, we have no idea what we're doing.

And so we joined a group for about a year and a half, figured out what we wanted to do and we ended up creating Olympus MD pain and wellness specialist. And we've been going four years strong now. >> That's amazing. and I've seen your success. I've seen your patients. We've had uh some of our clients come through your clinics and and they come back uh healed. The insurance companies love it because it stops the bleeding for them. They know that they're not going to have to continue paying future medical bills.

So, to much to my chagrin, you're you're healing everybody. No, I'm just kidding. I'm happy that you're doing it. Dr. O, what tell us um give us your your like your credentials, your your title. What kind of doctor are you for our listeners? So, board certified anesthesiologist and board certified pain management specialist. And so, uh, I got my board certification from the University of Miami in anesthesia. And [snorts] then I, like I said, I came to Atlanta, went to Emory for a year and did a one-year fellowship in interventional pain and then became board certified in that as well.

Uh, my partner, Dr. Oso Gamian, is also board certified as well in both anesthesia and pain management. >> [clears throat] >> So tell me um about the most common types of symptoms that you're treating after an auto accident. What do you or actually let me take auto accident out of it on a day-to-day basis? What is it that comes through your clinic most? >> Uh the majority of patients who come to our clinic are suffering from neck and back pain. It's almost 90% of our our patient population. We [clears throat] do non-surgical ortho evaluations and treatments, but at the end of the day, if someone needs surgery, I'm referring them to an orthopedic surgeon because that's their wheelhouse, not mine.

But anything non-surgical, I can take care of as well. But the majority of patients are coming with neck and back pain. And that can be from just something that happens spontaneously. One day they just bent over to pick up a book and all of a sudden they came back and now they have pain shooting down their leg from their back or unfortunately from a car accident. So obviously we're we're getting the auto accident cases that are are coming your way. Uh mostly either cervical spine injury, it's usually a disc bulge or something or a lumbar spine.

We rarely see anything in the thoracic. Do you do you ever >> find So thoracic is not necessarily rare, but it's not as common as cervical and lumbar. So the thoracic spine is a lot it's protected by a lot more parispinal muscles. The the covering of the spinal cord and it is is different in terms of how the shape [snorts] of the bones are right and so it's there that also is has a protective mechanism but for the most part the impact of a car accident or a fall or whatever is more um uh absorbed by the cervical and lumbar spine.

And so when you get those cervical injuries, usually it's a it's like a disc bulge that's that's pressing on a nerve, right? >> Well, it could be anything from that has discreated pathology, right? So you can have anything as minor as a disc bulge to a complete extrusion of the disc into the spinal canal space. And so there's like bulges, protrusion, herniations, ex extrusions. So there's varying degrees of of disc issues [snorts] >> and is it the when we talk about pain right now can you describe the the type of pain the symptoms is it is it a radiating pain what are what are the patients coming in complaining of >> it could be anything so patients can say I have a constant dull ache in my neck or my back and it doesn't go away or I they say I have pain that shoots into my arms or my legs and it's constant or it's not constant, but it happens with certain movements.

Um, so it could be sharp, dull, aching, throbbing, electric, right? And so the based off of those symptoms, we have a better idea about what is going on. So if if a patient says I just have a dull ache but the pain does not radiate down my arm or leg then we can say it could be traumatic arthopathy which basically means arthritis from trauma or you can have uh discogenic pain so pain solely from the disc. So certain movements can cause discomfort but it doesn't necessarily have to have a ridicular or radiating quality.

uh what what does the the the disc injury what does that present like? In other word, if if you want to get to the pathology of it, if I'm in pain, I'm feeling something in my in my neck, I'm trying to figure out without seeing Dr. O, obviously I'm going to come see you, but without seeing Dr. O, how can I determine if it's if it's disc trauma? What? So, the easiest way to have the suspicion that you have a disc issue is that if you're flexing [snorts] your neck or back forward, right, and you have an increase in pain, you're causing an increased pressure on the disc.

And if the disc is compromised, then it might elicit symptoms of sharp pain, dull, increased pain, um a throbbing sensation, right? Because people have to understand discs are like shock absorbers for the body. So when you're running, walking, these discs absorb the pressure of walking or any type of activity. The second you get in a car accident or a fall or whatever the case and the disc is compromised, it's no longer providing that function. So for example, when the shock absorbers of your car are are worn out and you hit a bump, you feel it hard, right?

Whereas normally, if they're not, you take that bump and you're like, that was nothing. Mhm. [clears throat] >> And that's exactly what happens when you have uh a herniation or a um or even an an annular fissure. You know, the inside of the disc is, for lack of a better word, fractured, right? And uh you'll feel it and you don't have to have those radiating symptoms. >> Can you describe uh for me what an annular fissure is like? >> Yeah. So, just imagine It's kind of hard. Imagine a a donut and in the middle of the donut, it's like the jelly part, right?

And just imagine like you take like a like a straw and you just like run a line through the straw and now it's like kind of separated or something like that. And so you just have a little fracture there or just like it's not a complete, you know, um >> you're pushing the the straw is the mechanism that's pushing the jelly through the little center that it was remaining. Is that what you Well, I'm just saying if you wanted to separate and cause like a like a division in the center of the of the jelly donut like with anything your finger like >> I see.

>> Yeah. But for example, when you have an annular fissure, the inside of the disc, the annular fibers, right, are are uh are disrupted. And so those fibers are used to um uh contain the disc inside for for lack of a better word. And um when when that's fractured, you can potentially get a herniation out, you know, and the contents of the disc can extrude out or just the fact that you have a uh annular fissure yourself without any extrusion can cause discreated pain. Like I I personally have an L5S1 annular fissure and I found out randomly that I had one because I I got a MRI in South Korea just for you know they they offer those like uh full body scan stuff like that.

>> You did that? >> Oh yeah. Me and my wife did it when we went to South Korea on a whim and uh we did full body scans, blood work, the whole nine yards in under three hours. And they were just like, "Oh, by the way, you have a L5S1 annular fissure." And I was like, "Oh, okay." And luckily it I would say I barely ever feel it. >> How good was their magnet? >> It took 15 minutes to do an MRI for brain uh uh cervical spine and lumbar spine. The whole process took 35 minutes whereas in in in America for whatever reason takes 45 minutes per body part.

And I don't know how many patients do it because that tube is tight. >> Yeah. >> And so I hate it. the o the open MRI thing concept is is obviously a lot better and and more and more MRI companies or or companies that are doing imaging are are providing that which is obviously a real good benefit for people who are claustrophobic. >> Yeah. >> Like I'm not personally claustrophobic but I was not comfortable >> in there but the fact that they're like it's going to take 15 minutes like per body part I was like oh okay this is easy >> you you can deal with it.

Absolutely. I u now I didn't expect that we talk about uh MRIs but since we're talking about it that's something very common almost 90% of our clients have to go through it and that is a major concern for them. One thing I want to share, uh, if it is like an upper extremity, your head's going in, if the head's not going in, it it's not really stressful, right? >> Uh, for me personally, a little tip or dad vice for the listeners. Uh, if you're going in, I went in for a brain scan. Uh, all I did is I I before going in, I made up my mind I was going to close my eyes and I wasn't going to open it open them until I got out and that made all the difference in the world.

Uh, >> that's what I did. >> Just just keep your eyes closed. The second they start pulling me through, I just closed my eyes and I just started thinking of something. >> Yeah. >> And just like whatever, just just think of a movie or whatever. Just something to keep you off your mind. But as long as you close your eyes, it helps for sure. >> Yeah. >> And you know, unfortunately, some patients just can't do it. And we'll prescribe them like a Valium >> to help them get through it. And that usually does pretty well for most patients.

But >> I didn't know you could get prescription meds to take an MRI. >> Yeah. >> I'm going to get more scans more often. [laughter] And usually this is a small dose because obviously you don't want to take too much and you're just completely asleep because you still want to remain still and if you're if you're snoozing and you just move like it [clears throat] messes up the MRI. Yeah. >> So >> no I I think the um the keeping the eyes closed if if you open your eyes it's it goes downhill real fast cuz then your brain brain starts telling you that you got to get out >> and you're looking at this like wall which is like two inches above your head and you're just like what the hell?

[laughter] They just should play music in the MRIs. If they played music, I think it would really help because that like, you know, the noise that an MRI does is so annoying. >> That dinging. >> Yeah. >> So, I actually um I had an MRI at a facility here in in Georgia and they it was enclosed, not open, and they were playing music. >> No. >> Um it took a little bit longer because it was a brain scan. >> Yeah. I don't remember exactly how long, but uh long enough where I was concerned that I would be uncomfortable.

>> Yeah, >> that's that's why I just made sure not to open my eyes. But we got we got off track. That's maybe off camera. I want to ask you other questions about South Korea. >> Oh, [laughter] absolutely. >> All right. So, uh you were we got on to South Korea because you said that you have you've randomly discovered that you had an annular fissure, but you're asymptomatic. >> Correct. Every once in a while when I make a weird movement, I'll feel it, but I have pretty much no symptoms. And that's and that can happen with patients.

Like we have a lot of patients who walk around with really bad pathology on MRIs and they're not in any pain. And then you have one [clears throat] patient who comes in with a minor disc bulge and it's like the end of the world for them. And rightfully so. Like people everyone has >> everyone deals with pain differently. The body addresses pain differently. And so if you have just like a one one page script on how you're going to treat every patient who walks in with pain, then you're missing the point, right?

And pe you're going to you're going to undertreat you're and and patients are going to walk out of your clinic thinking that like am I just another number here or did they really even listen to me, right? And so it's really important that you have your algorithms, you have your your your your checklist on, okay, this patient has told me that they're having this type of pain. So I need to make sure that I cover my basis on why are you having this type of pain? Where is it coming from? How often are you getting it?

What degree of pain are you having? Is it a four in the morning, a six at night? Is it only um painful when you're working? Is it painful when you're laying down, sitting up? You know those are because different mechanisms different movements can elicit that pain and that gives us more information. >> And what does a a course of let me focus on ridiculopathy. >> Yeah. >> Uh so ridiculopathy typically if I'm not mistaken is caused by a disc bulge compressing on a nerve. >> It can be a disc bulge. It also can be bone spurs.

So as you get older or you have a trauma, bone starts rubbing on itself and it creates more bone and you don't know where that which what direction that bone is going to um move, right? And so sometimes it can encroach on the framen or the exits of the nerves where they come out of the spine. >> Um and so sometimes that can that can cause pain too. So many patients will get an MRI and they're like there's no disc bulge but then you have the framen are smaller >> because the bone has grown through arthritic processes and then you can have ridicular symptoms which like you said means pain that shoots down the arm or the leg.

>> So does does how does pain medication work for is it the same mechanism whether it's a disc bulge or the bone spur? It's still essentially in my uh civilian brain we're we're deadening the nerve. >> So it depends on what type of pain medicine you're using. So normally we'll use the gabapentenoid type medications which are the for I like to tell my patients like the anti- nerve pain medications. They're non-narcotic medications but they they um basically tell the nerve to calm down and tell the nerve to stop you know sending that constant signal.

You know, that's how easily I can exp explain it. But they're pretty good medications. And most patients, I would say a healthy percentage can get relief with these with these medications. And they're non the only big side effect with them is the major side effect is sedation. So we usually start them out at night so that if they're sleepy, it's not affecting their daily routine. Sometimes their body will get used to it and then they can start taking it during the day and they're they're they're doing pretty good, but it it depends on the degree of herniation that they're having and and whether those medications will help.

They could help to a certain degree where patients like, well, my pain was an eight out of 10 after I took this medication. It sits around a four or five, which is to some patients is manageable, you know. And as a pain doctor, I tell patients all the time based off of their age, the degree of herniation. I'm like, I'm my my job is not to get you to necessarily a zero out of 10 pain, which is always going to be my goal. >> However, we need to have a realistic expectation of what we're getting ourselves into.

My job is to improve your quality of life. And so >> if you tell me this medication is bringing me down to a two or three and I don't have to do procedures which is completely reasonable or I don't have to I don't have to think about the pain consistently that's a win. Now if I don't have to give anybody any medications that that's also a win to me. Medications are tough. You have to take it regimented and and patients you know sometimes forget or it becomes a you know a part of their life and it it's it's it sucks and it costs money.

medications cost and insurance companies are not doing us any favors on that. >> So >> um that's why we t sometimes will recommend procedures in lie of medications because we can kind of get to the source of the problem >> and that and that's why and that's what we kind of do at our clinic >> and the as far as what I want to have is a conversation on on injections. >> Yeah. As far as injections go, what what's the most [snorts] [sighs] if I get into a rear-end collision and I'm suffering from a cervical spine disc uh bulge or herniation that's causing radiating ridiculopathy, radiating pain down my arms?

What's I walk into your clinic, what's the go-to? >> So, or is there a go-to? >> There is a go-to. And the conventional treatment that we provide for patients who have, you know, cervical pain after accident or in general some radiating pain or a known disc herniation that was not there prior to the accident, we'll offer them an epidural. And an epidural is just a simple procedure where we place an uh we inject um medications in the epidural space which is the space prior to the spine the CSF or the spinal space.

I try to like make it as simple as possible and that space holds can hold a lot of volume and can and and can take those medications and and safely diffuse out and cause relief by reducing the inflammation around those nerves. And then what I tell patients all the time is I can inject you a thousand times with medications. If you're not doing your physical therapy, if you're not being active or staying active, it's a waste of your money and it's a waste of your time. Now, the goal of injections is is is reduce the inflammation, helping you feel better so that you can do your physical therapy and then and then potentially providing a regenerative outlook on that.

So that's why PRP or platelet rich plasma has become more popular amongst our younger generations. >> Mhm. >> And people who get in carox like I don't want steroid which steroids is it's safe but you just don't want to do do too much of it right. You want to spread it out over three four month period so that it's not overwhelming the body but it's it's safe. But PRP has become very popular because it's pretty much natural, right? You're taking your own blood, spinning it down, and those healing factors in your blood are injected into the areas where you're having discomfort.

And it provides a relatively safe natural approach. And some of the literature says by 6 weeks, the difference between a epidural steroid injection and an epidural PRP injection are pretty close to the same. >> Wow. >> Yeah. But then you have the regenerative properties of PRP. >> Yeah. for more long term and you know um the literature just keeps coming out more and more in favor of that right but as you know in Europe 20 years ago you had athletes like Kobe Bryant and Dirk Nitzky and >> they're just flying to Europe in the offseason getting all these PRP injections and physical therapy in order to like get ready for the offseason and so now it's becoming a lot more popular here.

>> Yeah. uh patients that patients clients of ours that have been patients that have gotten PRP injections resoundingly the ones that at least have have called us um have had really positive uh outcomes with PRP. So much so that I've been waiting to get some PRP injections. My shoulder's killing me. >> I got [laughter] you. Just let me know when. So along those lines, um when I'm thinking about like your average person that's sitting out there, they're they're driving right now and they've got this nagging shoulder pain.

Do they have to go to their PCP to tell their PCP that their shoulder hurts? Their PCP has to to write an order. Uh in other words, is Olympus MD a direct portal? Can can patients come directly to you? Can they choose to see you and walk right through your doors? >> Yeah, patients can walk right off the street into our office and we will uh we'll we'll see them. I mean, obviously sometimes we're restricted by what insurance they have. >> Mhm. >> Uh but for the most part, we will see pretty much anybody walks through the door and uh and you it does not an HMO if I'm not mistaken requires a direct referral from your PCP if I'm not mistaken.

people with PPOs's, Medicare, Oscar, and better accident uh uh cases, they can walk in on the street and we will see them. They don't require referral per se. Um and yes, if you had a a shoulder issue, um you know, we would see you, evaluate you, and then we would determine based off of your symptoms and the degree of pain whether an MRI is appropriate or not. Sometimes we'll just directly refer you to a physical therapist and be like, I want you to try this for a few weeks and see if it gets better.

And if it gets better, then we're all good. You don't have to do injections. You don't have to do medications. Maybe we'll just put you on an anti-inflammatory medication like ibuprofen or something or or Tylenol if you can't handle ibuprofen because you have stomach issues. >> Um, and most patients are really cool with that. Muscle relaxers are very cool, are very popular, too, because it really helps relax those spasms that patients have in their necks and backs and even shoulder pain as well. Um but yeah, you can walk all and most and most clinics I think could provide that but some people are very particular about you know what you know their patients and they want to have a a a direct referral before they see them.

>> Yeah. Okay. That's good to know. >> Yeah. >> Um and then how about talk to me about you mentioned muscle spasms. >> Yeah. >> When when do muscle spasms or why do muscle spasms occur after an auto accident? So, the easiest way to explain how muscle spasms work um is and what I tell my patients is that when you have an accident, you tense up, right? Or you don't tense up. It's such a surprise that that you'll herniate a disc or whatnot. But most of the time is I tell them you have to look at it from a deep level.

If you have a a herniation or you have uh like your facetses, which are kind of like your joints of your back, they get inflamed because of an accident or a fall or whatnot. Your body is now trying to compensate for the pain that you're suffering from that. So if you're having pain, your body naturally you'll shift here and there. You'll overcompensate to the left, overcompensate to the right, you'll favor one leg, we'll favor another leg, right? And so those muscles are working overtime to to deal with that compensation.

So the muscles start to fatigue and when the muscles start to fatigue they start to spasm and then you get pain. That's the easiest way I can explain it. And so the role of muscle relaxers is to help mitigate that that spasm that spasming that's occurring and help relax the muscle. It's not to the point where you're going to relax and you're just going to kind of fall on the ground. Right. Right. But it it helps relieve some of those spasms and so patients really really like that and it helps. >> Is is there any um you're really is there a therapeutic reason that muscle spasm is it protecting an injury or is it just is the muscle spasm the injury itself?

So if the muscle so you can get direct muscle injury, right? So the you know if the airbag hits you, right? Or you're um you so you you can have a like you said a potential protective mechanism where the muscle is spasming and trying to tell you something's wrong or you can actually have gotten like just a true muscle injury, direct impact injury, and the muscles are like, "Yo, I'm swelling. I'm having pro I'm having a problem here. This is me spasming out for you to kind of address it. And so muscle injuries, muscle strains, you know, most of the time, like for example, if you're in the yard or you're picking up something and you you're like, "Oh, I threw my back out." You know, everyone there's that, you know, yeah, that common saying, "I threw my back out the other night, right?" It's not because you had a herniation.

It's not because, you know, um the facetses are just like, "Hey, you know, I'm having a bad time right now." It's just the muscle. the muscle strained and muscle strains can take four to six weeks to heal, >> especially especially if it's a bad one, right? And so that alone can, you know, obviously result in a lot of discomfort to the point where you can't even breathe. >> You'll you'll you'll try to move and patients are like, "Oh, I like I can't even breathe." And you're just like, "Oh, is it something serious?" And I'm like, "No, it's a really bad muscle strain." And so we can do things for patients like this.

We can offer them like trigger point injections which we inject directly into the muscle. Some uh local anesthetic to relieve that um that pain in the at that time. Some um uh like anti-inflammatory medication as well and sometimes some steroid if it's really that bad. But the most important thing is you have to remain active. You do not want that muscle to get cold, for lack of a better word, or um or just remain stagnant because it'll just get worse, right? That's why they say sitting on the couch when you when you're having a muscle uh a lumbar strain or something like that is is a bad idea.

You want to remain active, continually getting that blood flow to the muscle and so it starts healing itself. And that's where PRP really comes into play too with with muscle injuries as well. >> That's an interesting take because I was always uh obviously a misconception. And I was always under the belief that you're the the pain is a signal to you to stop using that thing. So if you took the medication in my brain, the way I was processing it was that the medication took the pain away. But but remember it was trying to tell you to not use it.

>> Yeah. And that was something I I I thought was the case too until I went uh to my fellowship and you know I was learning more about you know muscle strains, sprains, etc. And uh yeah, you do not want to remain inactive after having a muscle strain. Now for if you are struggling and you you can't breathe like I said like sometimes muscle pain can knock the breath out of you right >> if it's too hard right then obviously you know take it easy I don't want you to go like run a marathon on a muscle strain right I don't want you to lift anything heavy >> but if if it's too much where like ibuprofen and a muscle relaxer is not cutting it then you it's best to come to like a pain specialist and just kind of like evaluate and make sure it's not anything like deeper than that.

But usually by 4 to 6 weeks it starts to ease up. >> If it is something deeper than that, if if it is a severe muscle strain, you come in and you get it's it's important to not let it stay stagnant, right? So it actually becomes more important to come in to get some sort of medication to alleviate the pain so that you can have movement in the muscle. Am I understanding that correctly? >> For sure. >> Okay. >> Or even do physical therapy with the muscle strain. And the physical therapists are really good about increasing your range of motion and your your strength, your core in order to help alleviate that stiffness that you're getting during that during that time.

And so massage therapy is al also really good. And and in the acute phase, sometimes chiropractic care is also appropriate. >> [snorts] >> Uh but if if there's pain, they they're not going to be able to manipulate the >> Once again, it just depends on the the source of the injury. Now, like >> um [clears throat] with massage therapy, you know, kind of massaging those those muscles out a little bit, helping them relax. You never whenever you feel like like I have a knot in my back, you know, helping uh open that up, you know, that's that's that's important.

And then obviously you can do like dry needling which is very popular where you you you break up the muscle fibers. So whenever you have a muscle strain uh a trigger point uh a tal band whatever you have to realize that muscles contract like this right? And so when you get when you have a muscle strain or like a trigger point, the muscle goes like this and becomes like a ball of yarn that gets like tangled up and you literally have to like massage it out or you can do like dry needling or trigger points to break up those fibers and help help break them up and patients usually feel really really good after that.

>> Dr. O, what's the difference between trigger point injections and dry needling? Trigger point injections normally have some sort of solution in them like like a local anesthetic or or a steroid or PRP where dry needling is strictly with needling. >> And so dry needling it's the it's the act of actually like manipulating muscle. Is that what's going on? >> Yeah. You insert the needle into the area of of discomfort and you break up those fibers. Right. And then that way uh you relieve that tension that's in the back.

Uh, is is it that the muscle is reacting to this foreign object so it loosens up or is it >> it's just a mechanical relief, right? You're just really breaking up fibers and the muscle's like, "Oh, okay, cool." Like, I'm not tangled as much anymore. >> It's incredible. So, I had dry needling um about a month ago at at the PT clinic right across the street, >> and I I actually called in a favor. This is going to sound silly, but uh in the morning I was I was shampooing. I was just shampooing my hair. I was going to play golf that day, so I was shampooing my hair and I I just sort of like moved my head back to to get the water on my face.

I don't know what happened, but all of a sudden on my left side of my neck, it was just it became super super stiff. I was like, I can't move this. So, I called the PT clinic. I was like, look, I got a tea time in two hours. I know [laughter] he I don't have an appointment or anything. Is there any way that you can squeeze me in? They did. I still had some pain, but I went out and played 18 holes. Yeah. >> And it was just from I think it took about maybe 45 minutes for them to go in there with the needles.

It's really incredible. >> Yeah. And if you do trigger points, you pretty much walk out with zero pain because you've numbed it up. >> It would have the medication in it. [clears throat] >> Okay. I'm a I'm a big proponent of trigger point injections. [laughter] >> They No, they're they're really good for, you know, myofascial pain. So pain from like muscles and and whatnot. So, it they're a really good option, especially with PRP, too. Now, people are really liking that as well. >> I wish that we had brought somebody from the uh Olympus MD front desk on so I could get into questions about okay, what's the practical uh way of getting these like if somebody's I woke up that that morning and I was like, I need to go do this.

I don't have health insurance. What how do I get an appointment? What's it going to cost me? All of those >> Yeah. I mean, you can you can most of our our our staff members are trained to answer these questions when a patient calls and be like, "Hey, I I'm I'm not feeling good. Something happened. Is there any way you can squeeze me in?" And I mean, we usually have a few like spots open up uh for walk-ins. Uh and we're always having people who have to reschedule. You know, life gets in the way, work, child care, whatever the case may be.

>> Car accident, can't make my appointment. And so we we usually can if if somebody's really need needs it, you know, we'll we'll we'll get them in that day and we provide them a pricing and stuff like that. And obviously if someone has a financial constraint but needs it, we always work with them on it. >> That was that's not what I was getting after, but that's really that's incredible to know for like a resource for the community. Anybody that's listening here, that's >> that was worth the price of admission to listen to this podcast.

>> [laughter] >> Well, no, but like in terms of like they can call and they can get, you know, if they have my understanding is that what's what's the process in order to like >> if someone wanted to do something like the same day and knowing that what what their expectation is and and prior to coming in, >> right? >> Yeah. We we provide that over the phone. You know, we we give them a general idea of what the what the expectation, how long they're going to wait, what the uh you know, who they're going to see.

>> Um what potential options can they can get, but they give them a a very basic option because they don't want to diagnose someone over the phone because, you know, they can't, >> right? >> They don't want to do that. But they can give patients kind of indication of what they're ex what to expect if they do come in. Um, earlier you mentioned something that I actually made a note of because I'd never heard of it, but traumatic arthritis. >> Traumatic arthropathy. >> Traumatic for for trauma related arthritis.

>> So, how I I when I hear arthritis, I think of a chronic degenerative disease. >> Yeah. >> So, tell me how that's how acute trauma you're saying acute trauma can cause that. Absolutely. >> Yeah. So whenever you're >> the easiest example is look at a 35-year-old NFL exNFL player. >> They are peak athlete, right? By the time they retire at 35, they can barely walk. Some of them, not all of them. >> Mhm. >> Uh and that's because they're they undergo sustained traumatic, you know, hits throughout their career.

Now, a hit can doesn't have to be traumatic, but it's still trauma to be tackled. Right. >> Right. >> Right. And so, they get tackled, they get they get right back up. No big deal. But their body still sustained a high impact like hit. And so, the body will react to that and the arthritic process without a doubt is going to be accelerated in that. So, that's why when you get an MRI of a 35-year-old NFL player, don't put the the age on the the screen. a radiologist, pain doctor, regular doc will look at him and be like, "Oh man, how old is this patient?

85." >> Like now he's 35, you know, and the and so traumatic arthropathy whether it's knee, back, um shoulder, whatever, is is is definitely possible uh and uh in a car accident case, a fall or or um in like sports injuries. So it [snorts] I for a moment I I thought that it's arthritis that shows up later that was caused by trauma. But what you're saying is it looks like arthritis immediately after the trauma. >> Not immediately. It's a process for sure. But remember the arthritic process is going to be accelerated, right?

And so it might not show up on the X-ray or the MRI immediately, right? But patients will come in with symptoms of arthritis, right? And so you have to kind of deduce from there, okay, you're in a car accident, you're in a soccer game, and and you know, you can have acute, you know, uh, injuries, right? That can become chronic. And most of the patients that we see that come from a car accident, um, if they're young, we'll see them after three or four months, right? >> [clears throat] >> So after that you can kind of you you can tell that they're like that arthritic process is kind of coming into fruition right it's like it's making it's rearing its ugly head right >> will that actually show up on diagnostic imaging in a matter of months >> I haven't actually done like a a study myself where I see patients like from the pre right that's something that but it's it's definitely possible you know and and and when a patient doesn't have >> herniations and the MRI doesn't show anything but they're having you know, problems bending forward or bending back and they're just like, I'm always stiff and my muscles are stiff and then like you, you know, you'll do a facet injection and they they're like, oh my god, that just opened up my entire world, right?

That [clears throat] loosened me up. Then you can deduce from that >> that it's more likely to be, you know, some sort of arthritic process. Now, for example, facet joint injections or uh facet mediated pain does not require an MRI to confirm that that you know that's what's going on. It's more of a clinical diagnosis. Right. And so >> because it reacts to the injection itself. >> Correct. Right. And so when you do a diagnostic injection for someone who has clinical features of arthropathy, right, arthritic related injury and they get better, that pushes us in the right direction or some direction to be like, okay, maybe this is an arthritic component or it could be severe ligament strain, right?

So for example, a patient will have no MRI findings of a herniation. The facetses look okay. There might be a little swelling or edema, but then they'll say there's straightening of the cervical spine or straightening of the lumbar spine might be indicated as a ligament or uh ligament uh injury or sprain. >> Mhm. >> And that's that comes with the word the the whiplash injury, right? >> And so um we we'll do like deep injections sometimes on the facetses because those ligaments connect to the facetses and connect to the spine, right?

And so when we do PRP around that, patients start to feel real much better after that. >> So in in the ligament situation, is that also a diagnostic uh injection if they respond? >> Yeah, absolutely. >> What uh what's the next step on a facet injection that that's a it's a diagnostic injection to see if the injury is there, the patient is responding well. >> What's the next step? If if typically does does pain come back? >> So it can so if you're if you're young and um your injuries are relatively mild mild to moderate if you do a facet injections.

So sometimes you can do diagnostic facetses where you just only put local and see what happens and then you can follow that up with an ablation >> if you want where we kind of heat up those nerves and tell them to stop sending that those pain signals. And then as you're doing your physical therapy, when those nerves grow back, the pain does not come with it because your body has already healed itself, right? That's like one option. Or another option is just to go ahead and just do a facet injection with some steroid, right?

And just relieve that inflammation around that area. Hopefully, it'll last about, you know, two or three months, but usually your body will be healing itself before that and you're doing fine. And my favorite now is PRP injections into the facet along the ligament and muscle line, right? To help promote, you know, that regenerative process. And then PE patients do really well with that one. But PRP is a great modality, a great option now, but it there are some restrictions to it, right? You know, if you have moderate to severe arthritis, PRP might not help, right?

And a lot of people will sell that point like oh PRP for everybody and you got and it's like no you have to meet certain criteria because don't PRP is not covered by insurance unfortunately and it comes out of pocket and you have to be mindful of that for the patients because they don't want to be paying whatever people charge. It could be hundreds or it could be thousands. It depends on the clinic. >> Yeah. >> For something that may or may not help. And so you have to be very very careful on who you're selecting for PRP.

Now, if a, you know, if a 35-year-old came in and said, "I want PRP," and their body, you know, they're doing relative, they would be more of a candidate. If an a 75-year-old came in, I'm not trying to be like discriminated against, you know, our older population, but if they have more advanced arthritis, PRP might not be the most appropriate for them. Happy to try it if they're really adamant about it, you know, I'll never turn down what a patient wants, right? But I always I want to be fiscally cons, you know, conscientious of their of of of the possibility that it will cost them money and not help, >> right?

>> Yeah. So, which is, you know, PRP is great, but it it's becoming more popular and there's probably going to be newer versions or types of of PRP that can, you know, really help for the moderate to severe cases, but not right now. >> So, you just teed it up. So, what's the solution for arthritic pain? So the best solution at this point is a multimodal approach, right? A little bit of anti-inflammatory option like with the like ibuprofen, Tylenol if they can't handle that, physical therapy, remaining active.

Um, possibly PRP injections to help not reverse as much but slow down the arthritic process. >> Um, but by the way, I'm just I'm making as simple as possible. There's a lot more It's a lot more intricate than that, but that's >> we'll do that on another episode. >> Yeah, [laughter] >> that's the basis behind it. But then if you have arthritic neck pain, arthritic back pain, knee, hip, we we do do injections and like I [snorts] mentioned earlier, the ablation to help numb the arthritic pain process. So how it works is that you have these nerves that supply the joints of your neck and your back.

>> And so what we'll do is we will target those nerves. We'll numb them up with a little local and then we we tell them take the day, do the activities that normally would cause you discomfort and pain and let me know how you're feeling during that time. The local is going to wear off. I tell them every time it's going to wear off and you're going to hate me after a couple hours because you're going to be feeling good hopefully. But that's on purpose because we want to objectively make sure that what we're doing is appropriate so that if we move on to the next step, you're going to get potentially some good relief.

And so what happens is if they if they do well with the diagnostic blocks, injections, then we'll we'll move on to something called the ablation and we call like radio frequency ablation. There's cryobablation. Um but most common is the radio frequ frequency ablations where we also take a small needle. It has a little probe in there and then um in a simplified terms it kind of heats up the area around the nerve hopefully catches that nerve and the nerve stops operating or stops sending pain signals.

And the beauty of it is we're only tackling sensory nerves. So we're not tackling motor nerves. So you're not going to have, you know, decreased ability to move your uh your neck or your back. You're it's not like you're going to be down for the count. your people all majority of my patients just walk out of the clinic after the ablations are done, right? And the goal is to dene those nerves or tell those nerves to stop saying those signals and hopefully get between three and 18 months of relief. Now, the I've had a handful of patients who've gotten over the year mark of relief with the ablations.

Unfortunately, the majority of them get between three and six months >> and then they'll just do uh they'll just do like a tuneup in ablation after six months. And the whole goal is if we can reduce your pain by 60 70 80%. Most patients if you ask them if I could take your pain down from an eight to a three or an 8 to a four or an eight to a two but you're still going to have a little bit of discomfort would you take that? And they and majority of them are like absolutely. If I ever if you ever walk into a pain doctor's office like I can get you 100% free, you just walk right back out because they're not being honest with you.

>> Yeah. Just because you have to under every patient is is unique. Every patient has a certain threshold of pain and arthritic process or or degree of herniation. And if someone is like, "Oh, 100% painfree. Just let me work on you." It's it's not it's not true. You just have you have to present your patients with realistic expectations. And the expectation is like I want you to feel better and I want your quality of life to improve. But if you think you're going to go down from uh from 10 out of 10 pain to zero, it's it's not that it's not realistic, it's that the the overwhelming majority will get better, but it's not going to be 100%.

But to my to, you know, to my surprise and and and satisfaction, I have patients who come back like, I have zero pain after this. It's an injection. And I'm like, great. >> Yeah. >> You're not it's not a rare thing, right? And >> you've done that for our clients. >> Yeah. So, most patients like some patients will come in and they'll get an injection. They'll be like, I feel great. I have no pain that all the discomfort has happened. And it and it happens more than uh you know more often than not but it's important to set expectations for your patient like this is why I think you're going to your pain is going to come down to a certain level.

This is why I don't think it's going to become zero, right? Because sometimes you have you have a true mechanical compression, a a true mechanical pro problem when someone has something called severe spinal stenosis, right? Where the spine is being squeezed by a herniation or arthritis or ligament hypertrophy, right? The ligaments are are are swelling or getting bigger and it's closing the hole where the spinal cord hangs out. I can do an injection. You probably feel good for a couple months or a couple weeks, but your pain's going to come back, right?

Because [clears throat] >> that process is a mechanical compression, and the only way to really relieve that potentially is surgery. >> Mhm. >> And then obviously surgery is a whole another podcast. >> Yeah. >> Yeah. >> Doc, uh, I wanted to to ask like where how you started, why you wanted to get into this profession, but we're running out of time, so it it is going to have to be a second podcast. But in closing, I don't know if you've listened to the podcast before, but >> I listen to all of them. >> At the end, [laughter] then you already know at the end of the podcast, what I like to do is turn it over to the guest.

And if there's a question that you feel like I I should have asked that I didn't or if there was a topic that was left unsaid or if there's a piece of information that you want to bestow upon our listeners as like uh parting wisdom. [snorts] I I think that you're in a unique position where you deal with people that are in pain. I don't care if you're like you said a super athlete, an NFL player or a 75year-old lady. when pain hits you're it oftentimes it's debilitating. If it's not debilitating it's it's ruining your your day-to-day experience of your life.

So coming from that perspective and and what you do uh I'd love to hear something brilliant. [laughter] >> Um >> no pressure. No, I mean I think the most important thing that patients need to understand is that we are in a new age of medicine and the patriarchal authoritative physicianled you know medical care is is no longer a part is it's no longer feasible. Right? Patients need to be a part of the treatment plan and their input is really important because at the end of the day patients are going to let me know whether they feel comfortable with the uh treatment plan or not.

And yeah, it's great if a patient's like, "Oh yeah, just tell me whatever you want me to do and I'll do it." That's cool, but I want you patients need to be more um involved in the decision- making for their their their treatments and whe that's whether it's pain or something else, right? But >> because if you're more involved in your treatment plan, you're more likely to get better. That's just it happens. And it's there. I think there's been studies on that that the more involved in your treatment plan you are, the more likely you're going to get better because you're more willing to partake in, you know, everything about that treatment plan.

I'm doing my exercises. I'm taking my medications. I'm getting my injections. I'm I'm doing all this. I'm going to physical therapy. I'm remaining active. I'm eating right, etc. And that all together will come like provide better outcomes. >> So my biggest thing is, you know, if you go to a pain doctor or any doctor, you know, ask for multiple treatment options, right? Be like, what are all my options? And we'll lay it out. You can do nerve blocks, you can do epidurals, you can do physical therapy, you can do pain meds, right?

And don't be afraid to take certain medications, right? But at the same time, you want to have a physician who is responsible with whatever medications they they prescribe you, right? But there's no magic pill, you know, for for for every disease, right? It's got to be a collaboration with not only you, but you're a physician. And so that I think that bodess well for the future in medicine if you know you are you're taking an active step in your treatment as well. >> I that makes a lot of sense. be be an active participant not just in the treatment but also in in the diagnosis.

Right? You would I I feel like a lot of I have a unique perspective of uh being on phone calls with clients that have been injured after an auto accident and they're telling me about all of these things that are going wrong and then I will months later be reading doctor's notes on intake and the patients haven't said 30% of what they've shared with me. And it's almost like they're they're being a passive participant in the the health care process and the diagnosis for some reason. And I don't know why that is.

>> And I don't know, it could be the white coat syndrome thing where they're very nervous around the doctors and they're just hoping that we kind of get it out of them, you know, and just pry it out of them. And so, you know, I'll talk to patients. I'll be like, you know, >> if they're just like, "Yeah, my neck hurts." I'm like, "All right, well, you know, what part of your neck hurts?" You know, the top part. And you know, you just have to have Yeah. Exactly. But I mean, and some pe you know, some people are very active in their treatment and some people are just like, like I said, doc, just do whatever you think is necessary to get me feel better.

And I'm just like, okay. But, you know, you know, sometimes those patients don't do as well long term because, you know, they're just expecting, you know, you know, one shot, one pill that will help with everything. And unfortunately, just with the complexities of the human body, it's just not possible anymore. >> Yeah. Dr. O, uh, always a pleasure seeing you. I appreciate your time. I definitely want to get you back. What I'd love to do one day, we're not going to be able to record that episode in this room, but I want to have like a panel of bring in pain management, bring in ortho, bring in a PT, bring in uh a Cairo even and go through like the whole gamut of okay, let let's take this practice scenario and this happens.

How does it get from here to here? What does this person do? because that's really what what a real real world patient would have to go through when they're they're looking for uh relief of pain which is sometimes diagnosing the pain I think is is very really fleeting. >> The the the injury or the the pathology is fleeting. You can't tell. There's some people that have lower back pain that just they can't nobody can figure out why it hurts them so much. So >> yeah, absolutely. I think that'd be a fantastic idea.

I appreciate it. So good to see you. Uh listeners, hopefully you got something out of today's episode. As always, we try and give you information that you may not be having a conversation about. So for that, if you would reward me with a follow, like, share, comment, any of it, I'll take it. Mom, as always, thank you for listening. I love you very much. And I'll see you guys next week. Take care, everybody.