Ask Algos Anything!

[Spine Specialist]

Algos,

Firstly, my apologies for starting this thread on your name without your consent. I hope you dont mind.
People like me who are new in practice have hundreds of dumb questions in their mind when they practice alone. During fellowship we have people to ask around like director or any other senior attending etc. No one becomes an expert after a fellowship right away. Learning is a continous process. Can you help people like me in this forum who is looking for answers? You are alreading helping us here. There is no doubt. This is official algos thread. Expect silly questions sometimes. I hope this thread benefit all.

I saw a patient yesterday who had laproscopic BAK surgery done by anterior approach for disc problem. What is it?
( I dont care even if this thread is gonna expose my ignorance )

---

Members don't see this ad.

 

[sleepydoc]

Here is a nice description.... otherwise known as part of the 'cage rage'

http://www.spine-inc.com/glossary/b/bak-cage.htm

 

[Spine Specialist]

Thanks sleepydoc This is the reason....i SDN.
Cool procedure.

 

[Aether2000]

Thanks sleepydoc...was too busy to get on the forum today...

 

[Spine Specialist]

I have not done any thoracic discography yet. How different is T11/T12 discography from Lumbar discography? How safe is performing thoracic discogaphy with fluoro?. I have read Waldman and Fenton. I guess CT guided is safe.

 

[PainDr]

Although we all appreciate Algos' input, it's really not fair to put him on the spot like this. Also, reading from a textbook is not enough. At the very least, one should review the literature and stay abreast of current developments and evidence based guidlines. You can also talk with equipment representatives who can guide you to other resources. Although Algos is a valuable source of info, requesting assistance on an online forum is not the best way of educating yourself.

 

[Aether2000]

I personally believe CT guided discography of the thoracic spine is very dangerous and should be abandoned. It is taking significant chance of injury. Effectively with CT, one advances a needle blindly, then obtains a CT to see where one advanced the needle. When the spinal cord itself is at risk, one should never employ blind advancement of needles. I feel the same about CT guided transforaminal injections in which real time neurography is not available.

 

[Spine Specialist]

Although we all appreciate Algos' input, it's really not fair to put him on the spot like this. Also, reading from a textbook is not enough. At the very least, one should review the literature and stay abreast of current developments and evidence based guidlines. You can also talk with equipment representatives who can guide you to other resources. Although Algos is a valuable source of info, requesting assistance on an online forum is not the best way of educating yourself.

I would love to see this pain rounds forum to develop into an educational tool for residents, fellows and other pain practitioners. I dont see anything wrong in putting algos into spot light...because he is the only one who is readily sharing his professional experience with beginners. What is wrong in asking for education on an online forum? I dont think online is only for dating and sex. I do take all efforts like reading literature, books and attending conferences. I have no shame in asking, begging and borrowing knowledge.(sometimes stealing...
also...i dont want to see painrounds to become dead forums like some other forums withot any discussions. Keep posting something.

 

[Aether2000]

OMG...online is also for dating or for sex? Geez...consider all the time I have spent on the internet wasted on education when it could have been for sex. Perhaps my favorites list should have been updated years ago.
(just kidding_____)

 

[analgesic]

I would love to see this pain rounds forum to develop into an educational tool for residents, fellows and other pain practitioners. I dont see anything wrong in putting algos into spot light...because he is the only one who is readily sharing his professional experience with beginners. What is wrong in asking for education on an online forum? I dont think online is only for dating and sex. I do take all efforts like reading literature, books and attending conferences. I have no shame in asking, begging and borrowing knowledge.(sometimes stealing...
also...i dont want to see painrounds to become dead forums like some other forums withot any discussions. Keep posting something.

PS,

I couldn't agree with you more. Algos is extremely knowledgable and very approachable when it comes to clinical applications and billing practices. You can only obtain so much from books or journal articles. I am sure if algos was offended he would openly state it. If anything this post should be taken as a complement. We should all strive to donate our knowledge and experience when opportunity presents itself. To quote Afzal Amir "obtain knowledge from whoever gives it and offer knowledge to whomever seeks it for learning is the most noble form of begging". Thanks Algos for always being a guiding light to those of us who seek to better ourselves as pain practitioners.

 

[Spine Specialist]

PS,

I couldn't agree with you more. Algos is extremely knowledgable and very approachable when it comes to clinical applications and billing practices. You can only obtain so much from books or journal articles. I am sure if algos was offended he would openly state it. If anything this post should be taken as a complement. We should all strive to donate our knowledge and experience when opportunity presents itself. To quote Afzal Amir "obtain knowledge from whoever gives it and offer knowledge to whomever seeks it for learning is the most noble form of begging". Thanks Algos for always being a guiding light to those of us who seek to better ourselves as pain practitioners.

^^^^

My boss also agrees with your post. I like that Afzal Amir quote....i am gonna be a beggar forever man!

 

[stim4u]

Hello:

A question to Algos and the Board. I have taken care of many Medicaid patients during my training and have enjoyed my interactions with this population. I am not sure whether continuing to see these patients would be financially possible. Clearly, the Medicaid fee schedule does not compare with Medicare (and commercial insurance), but is it reasonable to still offer services to medical assistance patients in a private office-based setting? Furthermore, is it true that a medicaid payment for a transforaminal lumbar inj is $230 vs. $375 w/ Medicare. Any thoughts...

 

[Aether2000]

In my state, Medicaid pays the physician $147 for a transforaminal steroid injection. Medicare in my state pays around $370 for the same procedure. Because the Medicaid population is irresponsible (forgets about injection appointments even when called the day before), inconsistent (patient cannot always get a ride to the clinic or to an ASC for appointments/injections), is demanding (drug city, man), hostile, may divert the medications prescribed, and is responsible for 80% of the telephone calls to your clinic even though they are only 15% of the total clinic population, my suggestion would be to just say no. It will cost you a few referrals, but will save you immense headaches in the long run. Of course if you are the only doc in the area not accepting medicaid, you may be risking more than a few referrals. However, many family practice groups have discovered what we did: it is not possible to make enough money from the medicaid population to justify continued treatment.

 

[Spine Specialist]

algos-

Imagine you are the program director of pain medicine residency @ algos school of pain medicine.....how would YOU structure a residency training program?

 

[spinepain]

Wouldn't it be great if the entire didactic curriculum for a Pain Medicine fellowship was presented online here? Just submit each lecture transcript as a new thread. We could read it at our convenience from anywhere in the world, ask questions, discuss controversial points, get perspective from the "heavy hitters", etc.

As a Physiatrist about to begin an Interventional Spine fellowship, I would love to be able to study in this way.

 

[Spine Specialist]

Wouldn't it be great if the entire didactic curriculum for a Pain Medicine fellowship was presented online here? Just submit each lecture transcript as a new thread. We could read it at our convenience from anywhere in the world, ask questions, discuss controversial points, get perspective from the "heavy hitters", etc.

As a Physiatrist about to begin an Interventional Spine fellowship, I would love to be able to study in this way.

Good idea. That will help me to keep in touch with the subject which i have already forgotten after passing pain boards. I visit painrounds.com almost regularly than visiting my hospital library. It will make my life easier. Algos will turn into online professor. .

 

[Aether2000]

I think we all could contribute some bits of arcane knowledge that may benefit us all...
I will work on a unit on intradiscal pathologies and sources of pain

 

[Spine Specialist]

We could read it at our convenience from anywhere in the world, ask questions, discuss controversial points, get perspective from the "heavy hitters", etc.

You are absolutely right. Internet has changed our world into smaller, flatter and cooler. You never know who is reading our pain forums. Bogduk could be reading our threads or some enthusiastic pain specialist from rural korea or india could be reading from a public library with poor internet connection. It is all good. Knowledge makes world a better place to live and practice good medicine.

 

[spinepain]

I think we all could contribute some bits of arcane knowledge that may benefit us all...
I will work on a unit on intradiscal pathologies and sources of pain

Obviously, your posts have been more than "bits of arcane knowledge".

A unit on intradiscal pathologies and sources of pain would be great. There are probably others around the world who have already prepared lectures or lecture series that could be persuaded to post them here too. A "Journal Club" of some sort could be done with more experienced members choosing the most important current articles to present and discuss.

I have no idea how to best do this, but it seems that if someone were to make the effort to structure and organize these discussions, it could easily turn into a very competent "core" pain curriculum. Certainly better than what we had in my PM+R residency.

 

[paz5559]

While I recognize it is near-suicide to take on the great and powerful algos on this board, isnt the ISIS board already a repository for exactly that sort of discussion?

 

[Aether2000]

lol...great and powerful wizards are from Oz, and I have never been there, but have met the wizard.
The ISIS discussion board is quite advanced and does not frequently venture into pathophysiology as much as it does into advanced clinical pearls/academic jousting.

 

[paz5559]

lol...great and powerful wizards are from Oz, and I have never been there, but have met the wizard.
The ISIS discussion board is quite advanced and does not frequently venture into pathophysiology as much as it does into advanced clinical pearls/academic jousting.

Well, yes, if you just read the most recent posts, that would be true, oh omnipotent, omniscient, and omnipresent man behind the curtain. If, on the other hand, you were insane enough (read like me!) to go back and read the entire board from its inception, there is a wealth of clinical information to be gleened, both advanced AND basic.

 

[Aether2000]

I not only read the entire ISIS board, but have partially cataloged the topics on the ISIS board and the responses. FYI, this is not the first ISIS board...and I participated on the old board long before the transition to the new board that is presently accessable. I do wish we had access to the old days topics. They would seem quite primitive compared to the lofty topics now being discussed.

 

[apellous]

Algos,

I know you practice in Indiana and I was wondering if you could comment on IU's pain program. I Will be starting my CA-1 there in July and I am very interested in Pain. Thanks.

 

[Aether2000]

Like many pain programs around the country, it has not had stable leadership over the past several years, and many faculty come and go. The director of the pain fellowship at this time is well received by faculty and fellows alike, and even though young, brings a wealth of knowledge to the program. But you have many years before entering a pain fellowship, so you should watch the program and contact the fellows in the program to ask them about their experiences as time goes on.

 

[Spine Specialist]

Algos-

http://www.algosresearch.org website should partner with SDN/Painrounds. Many students and residents are not aware of this excellent educational website.

 

[Aether2000]

The website was designed to be a practical information repository freely accessable to pain docs, and without commercial sponsorship to muddy the waters or create product bias. The information, pics, and powerpoint presentations there can be downloaded for use in teaching or for personal use. While some of the information is freely linked at SDN (such as conference listings), it is not my goal to compete with any other organization or pain forum. SDN does a great job as does painphysicians.org forum and website, and ISIS forums (spinalinjection.com).

 

[Spine Specialist]

I think Painrounds should also give pass word entry only for medical professionals like painphysicains and ISIS forums.

 

[Aether2000]

May not be a bad idea...
Painrounds and other physician forums are visited by lawyers, CRNAs, NPs, etc.

 

[Spine Specialist]

Algos-

Let us not talk about dirty politics of pain medicine. It hurts everyones feelings.. ......what is your prediction of pain medicine in the next 10 years in the US? I know pain medicine is changing every six months.....it is a very difficult question. Please summarize your thoughts if you dont mind. I am sure you have plans in your mind.

( lemme know when you become sick of my questions in this Mythread.com equivalent of Myspace.com..... )